Center for Health Policy Studies, Department of Social Medicine, School of Public Health, Zhejiang University School of Medicine, 866 Yuhangtang Rd, Hangzhou, 310058, People's Republic of China.
Sir Run Runshaw Hospital, Zhejiang University, Hangzhou, 310016, People's Republic of China.
BMC Public Health. 2019 Jul 19;19(1):967. doi: 10.1186/s12889-019-7305-0.
The eastern and western regions of China are different in many ways such as socioeconomic characteristics and health resource distribution. This study aimed to explore the outpatient health-seeking behavior and compare the influencing factors of residents in Zhejiang and Qinghai Province, which represent the situation in eastern and western China. Thus, this research will provide evidence for health resource allocation and health reform.
A cross-sectional study was conducted on a sample selected from 1600 households in Zhejiang and Qinghai province between 2016 to 2017 by the multi-stage stratified cluster random sampling method. Among the 4231 residents aged 15 years or older in the sample, 566 who reported ill-health were selected for data analysis. Two-week outpatient visits and choice of health institutions were used to measure residents' outpatient health-seeking behavior and assessed using Chi-square tests. The binary logistic regression was adopted to demonstrate the association between explanatory variables and outpatient visits.
The study revealed that out of the people who reported ill-health, 58 individuals (50.97%) in Zhejiang and 106 (41.41%) in Qinghai went to health institutions to seek medical help (p < 0.05). The difference of residents' choice of health institution between Zhejiang and Qinghai was not statistically significant (p > 0.05). Among these respondents, Self-report severity was the common and significant factor related to their outpatient visits and it had a greater impact on outpatient visits in Zhejiang (4.18, CI 2.23-7.83, p < 0.05). Other factors such as chronic disease, knowledge of medicine and doctors and distance to the nearest health institution were significant influencing factors in Zhejiang, while in Qinghai it was occupation.
The outpatient health-seeking behavior and its influencing factors among residents in Zhejiang and Qinghai province were different. The findings suggest the importance of having discrepant health policies in the two provinces. It's necessary to improve health literacy of residents in both provinces, strengthen the accessibility of health services in remote areas of Zhejiang and pay more attention to people with low socioeconomic status in Qinghai.
中国东西部在社会经济特征和卫生资源分布等方面存在差异。本研究旨在探讨代表中国东西部情况的浙江省和青海省居民的门诊就医行为，并比较其影响因素。因此，本研究将为卫生资源配置和卫生改革提供依据。
采用多阶段分层整群随机抽样方法，于 2016 年至 2017 年在浙江省和青海省抽取 1600 户家庭，对其中 4231 名 15 岁及以上居民进行横断面研究，共选取了 566 名自述身体不适的居民进行数据分析。采用两周门诊就诊和就诊机构选择来衡量居民的门诊就医行为，并采用卡方检验进行评估。采用二项逻辑回归分析解释变量与门诊就诊之间的关系。
研究结果显示，在自述身体不适的人群中，浙江省有 58 人（50.97%）、青海省有 106 人（41.41%）去医疗机构寻求医疗帮助（p<0.05）。浙江省和青海省居民选择就诊机构的差异无统计学意义（p>0.05）。在这些受访者中，自我报告的严重程度是与门诊就诊相关的共同且重要的因素，对浙江省的门诊就诊影响更大（4.18，CI 2.23-7.83，p<0.05）。其他因素如慢性病、对药物和医生的了解程度以及到最近医疗机构的距离在浙江省是显著的影响因素，而在青海省则是职业。
浙江省和青海省居民的门诊就医行为及其影响因素存在差异。研究结果提示两省应制定不同的卫生政策。有必要提高两省居民的健康素养，加强浙江省偏远地区卫生服务的可及性，并更加关注青海省社会经济地位较低的人群。
