中国初级卫生保健偏好的趋势：一项对 2012 年至 2018 年的 12508 名居民的队列研究。
The trend in primary health care preference in China: a cohort study of 12,508 residents from 2012 to 2018.
机构信息
School of Nursing and Health Management, Shanghai University of Medicine & Health Sciences, Shanghai, 201318, China.
Dalla Lana School of Public Health, University of Toronto, Toronto, ON, M5T3M6, Canada.
出版信息
BMC Health Serv Res. 2021 Aug 3;21(1):768. doi: 10.1186/s12913-021-06790-w.
BACKGROUND
Residents' preference for primary health care (PHC) determined their utilization of PHC. This study aimed to assess the determinants of PHC service preference among the residents and the trend in PHC service preference over time in China.
METHODS
We employed the nationally representative longitudinal data from 2012 to 2018 based on the China Family Panel Studies. The analysis framework was guided by the Andersen model of health service utilization. We included a total of 12,508 individuals who have been successfully followed up in the surveys of 2012, 2014, 2016, and 2018 without any missing data. Logistic regressions were performed to analyze potential predictors of PHC preference behavior.
RESULTS
The results indicated that individuals' socio-economic circumstances and their health status factors were statistically significant determinants of PHC preference. Notably, over time, the residents' likelihood of choosing PHC service represented a decreasing trend. Compare to 2012, the likelihood of PHC service preference decreased by 18.6% (OR, 0.814; 95% CI, 0.764-0.867) in 2014, 30.0% (OR, 0.700; 95% CI, 0.657-0.745) in 2016, and 34.9% (OR, 0.651; 95% CI, 0.611-0.694) in 2018. The decrease was significantly associated with the changes in residents' health status.
CONCLUSIONS
The residents' likelihood of choosing PHC service represented a decreasing trend, which was contrary to the objective of China's National Health Reform in 2009. We recommend that policymakers adjust the primary service items in PHC facilities and strengthen the coordination of service between PHC institutions and higher-level hospitals.
背景
居民对基层医疗保健（PHC）的偏好决定了他们对 PHC 的利用。本研究旨在评估居民对 PHC 服务偏好的决定因素以及中国 PHC 服务偏好随时间的变化趋势。
方法
我们使用基于中国家庭追踪调查的 2012 年至 2018 年的全国代表性纵向数据。分析框架以卫生服务利用的安德森模型为指导。我们共纳入了 2012 年、2014 年、2016 年和 2018 年调查中成功随访的 12508 人，且这些人没有任何缺失数据。使用逻辑回归分析 PHC 偏好行为的潜在预测因素。
结果
结果表明，个人的社会经济状况和健康状况因素是 PHC 偏好的重要决定因素。值得注意的是，随着时间的推移，居民选择 PHC 服务的可能性呈下降趋势。与 2012 年相比，2014 年 PHC 服务偏好的可能性下降了 18.6%（OR，0.814；95%CI，0.764-0.867），2016 年下降了 30.0%（OR，0.700；95%CI，0.657-0.745），2018 年下降了 34.9%（OR，0.651；95%CI，0.611-0.694）。这种下降与居民健康状况的变化显著相关。
结论
居民选择 PHC 服务的可能性呈下降趋势，这与 2009 年中国国家卫生改革的目标相悖。我们建议政策制定者调整 PHC 设施中的基本服务项目，并加强 PHC 机构与上级医院之间的服务协调。
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