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印度一个城市地区公立初级和二级医疗保健机构就诊患者的就医行为:一项横断面定量分析。

Healthcare seeking behavior among patients visiting public primary and secondary healthcare facilities in an urban Indian district: A cross-sectional quantitative analysis.

作者信息

Fatma Najiya, Ramamohan Varun

机构信息

Department of Mechanical Engineering, Indian Institute of Technology Delhi, New Delhi, India.

出版信息

PLOS Glob Public Health. 2023 Sep 5;3(9):e0001101. doi: 10.1371/journal.pgph.0001101. eCollection 2023.

Abstract

In this work, we examined healthcare seeking behavior (HSB) of patients visiting public healthcare facilities in an urban context. We conducted a cross-sectional survey across twenty-two primary and secondary public healthcare facilities in the South-west Delhi district in India. The quantitative survey was designed to ascertain from patients at these facilities their HSB-i.e., on what basis patients decide the type of healthcare facility to visit, or which type of medical practitioner to consult. Based on responses from four hundred and forty-nine participants, we observed that factors such as wait time, prior experience with care providers, distance from the facility, and also socioeconomic and demographic factors such as annual income, educational qualification, and gender significantly influenced preferences of patients in choosing healthcare facilities. We used binomial and multinomial logistic regression to determine associations between HSB and socioeconomic and demographic attributes of patients at a 0.05 level of significance. Our statistical analyses revealed that patients in the lower income group preferred to seek treatment from public healthcare facilities (OR = 3.51, 95% CI = (1.65, 7.46)) irrespective of the perceived severity of their illness, while patients in the higher income group favored directly consulting specialized doctors (OR = 2.71, 95% CI = (1.34, 5.51)). Other factors such as having more than two children increased the probability of seeking care from public facilities. This work contributes to the literature by: (a) providing quantitative evidence regarding overall patient HSB, especially at primary and secondary public healthcare facilities, regardless of their presenting illness, (b) eliciting information regarding the pathways followed by patients visiting these facilities while seeking care, and (c) providing operational information regarding the surveyed facilities to facilitate characterizing their utilization. This work can inform policy designed to improve the utilization and quality of care at public primary and secondary healthcare facilities in India.

摘要

在这项研究中,我们调查了城市环境下前往公共医疗机构就诊患者的就医行为。我们对印度德里西南部地区的22家公立基层和二级医疗机构进行了横断面调查。这项定量调查旨在从这些机构的患者中确定他们的就医行为,即患者根据什么来决定前往何种类型的医疗机构就诊,或者咨询哪种类型的医生。基于449名参与者的回答,我们观察到诸如等待时间、与医疗服务提供者的既往经历、与医疗机构的距离等因素,以及诸如年收入、教育程度和性别等社会经济和人口统计学因素,都对患者选择医疗机构的偏好产生了显著影响。我们使用二项式和多项逻辑回归来确定就医行为与患者社会经济和人口统计学特征之间在0.05显著性水平上的关联。我们的统计分析表明,低收入组的患者无论所感知的疾病严重程度如何,都更倾向于在公共医疗机构寻求治疗(OR = 3.51,95% CI = (1.65, 7.46)),而高收入组的患者则更倾向于直接咨询专科医生(OR = 2.71,95% CI = (1.34, 5.51))。其他因素,如有两个以上孩子,会增加在公共机构寻求治疗的可能性。这项研究通过以下方式为文献做出了贡献:(a) 提供关于总体患者就医行为的定量证据,特别是在公立基层和二级医疗机构,无论其当前疾病如何;(b) 收集关于这些机构的患者在寻求治疗时所遵循途径的信息;(c) 提供关于被调查机构的运营信息,以便于描述其利用情况。这项研究可为旨在提高印度公立基层和二级医疗机构医疗服务利用和质量的政策提供参考。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0d2b/10479939/7debdf7bc00d/pgph.0001101.g001.jpg

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