Zeng Yanbing, Xu Weiqian, Chen Lele, Chen Fan, Fang Ya
State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, Key Laboratory of Health Technology Assessment of Fujian Province University, School of Public Health, Xiamen University, Xiamen, Fujian, People's Republic of China.
School of Social and Behavioral Sciences, Nanjing University, Nanjing, Jiangsu, People's Republic of China.
Patient Prefer Adherence. 2020 Mar 30;14:653-662. doi: 10.2147/PPA.S242141. eCollection 2020.
Patients often seek healthcare at general hospitals rather than at community healthcare centres (CHCs) which leads to inefficiency of health services. The primary healthcare reform developed by Xiamen has proven to break through the barriers of hierarchical diagnosis and treatment. The influencing factors of health-seeking behaviours of patients in the Xiamen reform, however, are unclear.
This study aimed to assess patients' healthcare-seeking preferences and CHCs utilization, and identify influencing factors among patients affected by the Xiamen reform.
A cross-sectional study composed of 2200 individuals with hypertension or diabetes was conducted in association with Xiamen's reform. The choice of health institutions was used to measure health-seeking preference. The probability and frequency of outpatient service use were used to measure CHC utilization. The social ecological model and two-part model were employed to examine influencing factors.
As high as 72.5% of the subjects, including those who were under 60 years old, had low education level, with long disease duration, good self-report health and low household income expressed a preference for CHC (P<0.05). Also, participants who had good-condition CHCs (χ=6.736, P=0.010), joined in three-in-one chronic disease management (χ=81.615, P<0.01) and were insured by medical insurance (χ=21.142, P<0.01) significantly preferred to visit CHCs for treatment. In addition, patients who had a preference for CHC utilized many more CHCs (P<0.01). Analysis of influencing factors found that education, self-reported health, smoking, household income, condition of the CHC, whether the patient had joined the healthcare reform and whether the patient had medical insurance were important factors affecting health-seeking preference and CHC utilization (P<0.05).
The Xiamen healthcare reform made some achievements in improving CHC utilization. However, certain challenges remain. The government should further strengthen CHCs, deepen and expand healthcare reform, and make efforts to guide reasonable healthcare-seeking behaviour and improve the efficiency of primary health systems.
患者常常前往综合医院而非社区医疗中心（CHC）寻求医疗服务，这导致了卫生服务效率低下。厦门推行的基层医疗改革已证明突破了分级诊疗的障碍。然而，厦门改革中患者就医行为的影响因素尚不清楚。
本研究旨在评估患者的就医偏好和社区医疗中心的利用情况，并确定受厦门改革影响的患者中的影响因素。
与厦门改革相关联，对2200名高血压或糖尿病患者进行了横断面研究。选择医疗机构来衡量就医偏好。门诊服务使用的概率和频率用于衡量社区医疗中心的利用情况。采用社会生态模型和两部分模型来研究影响因素。
高达72.5%的受试者，包括60岁以下、教育水平低、病程长、自我报告健康状况良好且家庭收入低的人，表现出对社区医疗中心的偏好（P<0.05）。此外，社区医疗中心条件良好（χ=6.736，P=0.010）、参加了慢性病“三位一体”管理（χ=81.615，P<0.01）且参加了医疗保险（χ=21.142，P<0.01）的参与者明显更倾向于前往社区医疗中心就诊。此外，对社区医疗中心有偏好的患者更多地利用了社区医疗中心（P<0.01）。影响因素分析发现，教育程度、自我报告的健康状况、吸烟、家庭收入、社区医疗中心的条件、患者是否参加了医疗改革以及患者是否有医疗保险是影响就医偏好和社区医疗中心利用的重要因素（P<0.05）。
厦门医疗改革在提高社区医疗中心利用率方面取得了一些成效。然而，仍存在某些挑战。政府应进一步加强社区医疗中心，深化和扩大医疗改革，并努力引导合理的就医行为，提高基层卫生系统的效率。
