我国东中西部三省农村居民基层首诊意愿调查

目的 对我国东、中、西部三省农村居民就医时是否选择基层首诊的意愿及相关影响因素进行分析,为进一步推进基层首诊提供依据。 方法 采取多阶抽样方法,选取2016年7—9月山东省、河南省、四川省3省6 500例农村居民作为调查样本,采用自行设计问卷进行实地调查,主要采用单因素分析和多因素logistic回归分析。 结果 97.05%农村居民患小病时选择基层医疗机构首诊,41.96%农村居民患慢性病时选择基层医疗机构首诊,4.73%农村居民患大病时选择基层医疗机构首诊;性别、文化程度、职业类型、社会保险类型、家庭经济状况、患病未就医经历及自行购药经历(均P<0.05)均能够对居民患小病时选择基层首诊产生影响;年龄、文化程度、职业类型、社会保险类型、看病报销比例影响、过去1年的费用低于500元及患者的健康状况(均P<0.05)等因素影响居民患常见病时基层首诊意愿;社会保险类型、一年能承受的看病费用、患者的健康状况及看病报销比例(均P<0.05)这四个因素影响居民患大病时的基层首诊意愿。 结论 社会保险类型与疾病费用负担是影响居民自愿基层首诊的重要因素,家庭经济状况对居民自愿选择基层首诊的影响作用有限,看病报销比例是患常见病、大病居民自愿基层首诊行为的首要影响因素,居民自身因素及经历是影响居民自愿首诊的重要方面。 

Surveying the rural residents' willingness of primary diagnosis in eastern,central and western provinces of China

Objective To analyze the willingness of rural residents' primary diagnosis in eastern, central and western provinces of China and relevant influencing factors to further promote primary diagnosis. Methods A total of 6 500 rural residents from Shandong, Henan and Sichuan provinces were selected as survey samples by multi-order sampling method, and questionnaires from July to September were designed by ourselves for field investigation. Univariate analysis and multivariate logistic regression analysis were mainly used. Results There were 97.05% rural residents with minor diseases choosing primary diagnosis, 41.96% rural residents with chronic diseases choosing primary diagnosis, and 4.73% rural residents with serious diseases choosing primary diagnosis. Gender, education level, occupation type, social insurance type, family economic status, experience of not seeking medical treatment for illness and experience of buying drugs by oneself(all P<0.05) were influencing factors of residents' willingness of primary diagnosis. Factors such as age, education level, occupation type, social insurance type, the influence of reimbursement ratio for medical treatment, the cost less than 500 yuan in the past year, and the health status of patients(all P<0.05), etc., affected residents with common diseases on residents' willingness of primary diagnosis. When residents were seriously ill, social insurance type, annual affordable medical expenses, patients' health status and reimbursement ratio(all P<0.05) affected residents' willingness of primary diagnosis. Conclusion Social insurance type and disease burden are important factors affecting residents' willingness of primary diagnosis, family economic status on residents' willingness of primary diagnosis is limited, the reimbursement ratio is the primary influencing factor of residents with common and serious diseases on residents' willingness of primary diagnosis.