河南省居民首诊医疗机构选择及影响因素分析

目的 探讨河南省居民首诊医疗机构选择的现状及影响因素。 方法 采用多阶段分层整群随机抽样的方法抽取河南省15岁及以上居民分析其就诊意愿，单因素分析运用〖XC小五号.EPS;P〗检验、多因素分析采用二分类logistic回归分析。 结果 2013年和2018年河南省居民到基层（83.4%、76.6%）和非基层（16.6%、23.3%）医疗机构就诊的比例差异有统计学意义（P＜0.001）。两次回归分析结果相比，2013年，文化程度小学及以下（OR=0.412，95%CI:0.205~0.829）、到医疗机构的距离为2~4公里（OR=0.066，95%CI:0.004~0.985）的居民更倾向于前往基层医疗机构就诊；急性病两周前开始发病（OR=2.185，95%CI:1.325~3.603）、健康状况较差（OR=2.620，95%CI:1.607~4.274）的居民更愿意选择基层以上医疗机构就诊。2018年，有健康档案（OR=0.612，95%CI:0.441~0.848）的居民更倾向于前往基层医疗机构就诊；患病严重及一般（OR=2.395，95%CI:1.720~3.336；OR=1.384，95%CI:1.010~1.898）、没有家庭医生签约（OR=1.555，95%CI:1.005~2.408）的居民更倾向于前往基层以上医疗机构就诊。 结论 河南省居民更倾向于前往基层医疗机构就诊，但就诊比例呈下降趋势。建议基层医疗卫生机构提升医疗卫生服务能力，为居民提供家庭医生签约服务，引导居民就近就医。

The selection of the first medical institution and its influencing factors,Henan

Abstract: Objective To investigate the current situation and influencing factors of residents’ choice of first medical institution in Henan Province. Methods A multi － stage stratified cluster random sampling method was used to select residents aged 15years and above in Henan Province to analyze their willingness to seek medical treatment. χ2 test was used for univariate analysis， and binary logistic regression analysis was used for multivariate analysis. Results In 2013 and 2018，there was a statistically significant difference ( P ＜ 0. 001 ) in the proportion of residents seeking medical treatment in grass － roots( 83. 4% ，76. 6% ) and non － grass － roots ( 16. 6% ，23. 3% ) medical institutions in Henan Province. Compared with the results of the two regression analyses， in 2013，the residents with primary school education or below ( OR = 0. 412，95% CI:0. 205 ～ 0. 829) ，and 2 ～ 4km distance from medical institutions ( OR = 0. 066，95% CI: 0. 004 ～ 0. 985) were more likely to go to primary medical institutions. Residents with acute disease that started two weeks ago ( OR = 2. 185，95% CI: 1. 325 ～3. 603) and poor health status ( OR = 2. 620，95% CI: 1. 607 ～ 4. 274) were more willing to choose medical institutions above the primary level. In 2018，residents with health records ( OR = 0. 612，95% CI: 0. 441 ～ 0. 848) were more likely to visit primary medical institutions. Severe or moderate illness ( OR = 2. 395，95% CI: 1. 720 ～ 3. 336; OR = 1. 384，95% CI: 1. 010～ 1. 898) and residents without family doctor contract ( OR = 1. 555，95% CI: 1. 005 ～ 2. 408) were more likely to go to medical institutions above the primary level. Conclusion Residents of Henan Province are more inclined to go to primary medical institutions for medical treatment， whereas the proportion of medical treatment shows a downward trend. It is suggested that primary health institutions improved their service capacity， and provided residents with contracted family doctor services to guide residents for seeking medical treatment nearby.