作者：栗佳1，2 ，高星 1，2 ，雷行云 1，2 ，胡红濮 1，2

单位：

1.100730 北京市，北京协和医学院　2.100020 北京市，中国医学科学院医学信息研究所；通信作者：胡红濮，E-mail：hu.hongpu@imicams.ac.cn

Units：

1.Peking Union Medical College，Beijing 100730，China；2.Institute of Medical Information，Chinese Academy of Medical Sciences，Beijing 100020，China；Corresponding author：HU Hongpu，E-mail：hu.hongpu@imicams.ac.cn

关键词：

高血压；中老年人；基层医疗卫生机构；就医选择；影响因素分析

Keywords：

Hypertension；Middle-aged and aged；Primary health care institutions；Health-seeking behaviors；Root cause analysis

CLC：

R 544.1

DOI：

DOI：10.3969/j.issn.1008-5971.2020.02.015

Funds：

国家社会科学基金项目（17BGL184）

摘要：

目的　基于 2015 年中国健康与养老追踪调查（CHARLS2015）数据探讨中老年高血压患者选择基层医疗卫生机构就诊的影响因素。方法　2019 年 12 月，分析 CHARLS2015 数据并从其调查问卷中筛选“过去 1 个月里去医疗机构看过门诊或接受过上门医疗服务的高血压患者”共 1 549 例作为研究对象，参考 Andersen 卫生服务利用行为模型并综合考虑研究目的、观察指标可及性后采集患者就诊的医疗机构、一般资料、卫生服务可及性因素及医疗服务需求因素。中老年高血压患者选择基层医疗卫生机构就诊的影响因素分析采用多因素 Logistic 回归分析。结果　1 549例中老年高血压患者中 862 例（占 55.6%）选择在基层医疗卫生机构就诊。不同性别、年龄、饮酒情况、健康状况自评结果及近 4 周内是否患病、血压是否控制住患者选择基层医疗卫生机构就诊率比较，差异无统计学意义（P>0.05）；不同文化程度、户口类型、吸烟情况、医疗保险及是否服用高血压药物、社区 / 村内是否有基层医疗卫生机构、常去的医院是否在本市内患者选择基层医疗卫生机构就诊率比较，差异有统计学意义（P<0.05）。选择不同医疗机构就诊患者每周运动天数比较，差异无统计学意义（P>0.05）；选择不同医疗卫生机构就诊患者年收入、就诊费用总额、就诊费用自付比例、就诊单程交通费用及就诊单程交通时间比较，差异有统计学意义（P<0.05）。多因素 Logistic 回归分析结果显示，就诊费用总额〔OR=0.948，95%CI（0.906，0.992）〕、就诊单程交通费用〔OR=0.000，95%CI（0.000，0.007）〕是中老年高血压患者选择基层医疗卫生机构就诊的独立影响因素（P<0.05）。结论　基于 CHARLS2015 数据，中老年高血压患者选择基层医疗卫生机构就诊率为 55.6%，就诊费用总额高、就诊单程交通费用高是影响中老年高血压患者选择基层医疗卫生机构就诊的重要因素。

Abstract：

Objective　To explore the influencing factors of health-seeking behaviors in primary health careinstitutions among middle-aged and aged patients with hypertension based on the data of 2015 China Health and RetirementLongitudinal Study（CHARLS2015）. Methods　In December 2019，a total of 1，549 hypertension patients with experiencedmedical treatment（including visiting to clinic and receiving medical service at home）in the past month were screened from thequestionnaires of CHARLS2015，information about selected medical institutions，personal predisposing factors，availability ofhealth services and demand for medical services was collected based on Andersen Health Service Utilization Behavior Model andcomprehensive consideration of research objectives and the availability of observed indicators. Multivariate Logistic regressionanalysis was used to analyze the influencing factors of health-seeking behaviors in primary health care institutions among middle-aged and aged patients with hypertension. Results　Of the 1，549 patients with hypertension，862 cases chose the primaryhealth care institutions（accounting for 55.6%）. There was no statistically significant difference in visiting rate of primary healthcare institutions in patients with different gender，age，drinking status，self-assessment of health status，with falling ill orcontrol of blood pressure or not in the last 4 weeks（P>0.05）；there was statistically significant difference in visiting rate ofprimary health care institutions in patients with different educational levels，types of household registration，smoking status，medical insurance，using antihypertensive drugs or not，with establishment of primary health care institutions in a village ornot，with frequently visited hospital located in the city or not，respectively（P<0.05）. There was no statistically significantdifference in exercised days per week in patients with different selections of medical institutions，respectively（P>0.05）；there was statistically significant difference in annual income，total visiting cost，self payment ratio of visiting，one-waytransportation cost or elapsed time of one-way transportation in patients with different selections of medical institutions （P<0.05）.Multivariate Logistic regression analysis results showed that，total visiting cost〔OR=0.948，95%CI（0.906，0.992）〕and one-way transportation cost〔OR=0.000，95%CI（0.000，0.007）〕were independent influencing factors of health-seeking behaviors in primary health care institutions among middle-aged and aged patients with hypertension. Conclusion　Thevisiting rate of primary health care institutions is 55.6% in middle-aged and aged patients with hypertension based on the dataof CHARLS2015，high total visiting cost and high one-way transportation cost are independent influencing factors of health-seeking behaviors in primary health care institutions among middle-aged and aged patients with hypertension.

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