城市老年人基本公共卫生服务利用影响因素多水平模型分析
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摘要
目的探索城市老年人基本公共卫生服务的利用现状及影响因素,为进一步完善服务、提高其利用率提供参考。方法通过两阶段随机抽样,选取北京市东城区1 530名≥65岁老年人进行问卷调查,了解该群体对以社区免费健康体检为代表的基本公共卫生服务的利用情况,并应用多水平模型分析其影响因素。结果研究对象免费健康体检利用率为46.7%。多水平模型显示,所在社区卫生服务机构等级高(OR=1.92)是免费体检利用的促进因素;个体年龄在70～75岁(OR=1.39)、患有慢性病(OR=1.47)、退休前职业为专业技术人员(OR=1.43)、听说过基本公共卫生服务(OR=1.48)、了解公共卫生服务信息的主要途径为医生与居委会(OR=2.24、1.56)是体检利用的促进因素,而个人月收入在4 000～4 999元与≥5 000元(OR=0.51、0.23)与在其他机构体检过(OR=0.66)为阻碍因素。结论城市≥65岁老年人免费健康体检利用率较低;社区层面与个人层面两水平因素共同影响该群体对基本公共卫生服务的利用。建议除加强对基本公共卫生服务的宣传力度、改进宣传模式外,还需加大对社区卫生服务机构的投入、提高体检服务质量与吸引力,以进一步提高老年人对基本公共卫生服务的利用率,促进老年人口健康。
Objective To explore current situation and influencing factors of utilization of essential public health service(UEPHS) among urban elderly people and to provide references for improving UEPHS. Methods A total of 1 530 residents aged 65 years and over were selected in 51 communities in Dongcheng district of Beijing municipality with two-stage random sampling. A face-to-face questionnaire survey was conducted to collect information on participation of physical examination free of charge provided by community health service centers/stations as a indicator of UEPHS among the participants between December 2016 and January 2017. Multilevel model was used to analyze influencing factors of UEPHS.Results Of the participants, 46.7% reported participating in the free physical examination. The multilevel model analysis indicated that with the community health service provided by medical institutions at higher administration level was a promoting factor for the elderly’s participation in the examination(odds ratio [OR] = 1.92). For the participants, those aged 70 to 75 years(OR = 1.39), suffering from non-communicable chronic diseases(NCD)(OR = 1.47), being a technical personnel before retire(OR = 1.43), being aware of UEPHS(OR = 1.38), and receiving UEPHS-related information mainly through doctors and community facilities(OR = 2.24 and OR = 1.56) were more likely to take part in the physical examination free of charge; while those with the personal monthly income of 4 000 – 4 999 and > 5 000 RMB yuan(OR =0.51 and OR = 0.23) and those ever having taken a physical examination provided by other medical institutions were less likely to receive the examination. Conclusion The utilization rate of physical examination free of charge was relatively low and both community and individual factors affected the UEPHS among the urban community elderly 65 years old or more.The results suggest effective measures are needed to improve the UEPHS for health promotion among urban elderly community population.
Objective To explore current situation and influencing factors of utilization of essential public health service(UEPHS) among urban elderly people and to provide references for improving UEPHS. Methods A total of 1 530 residents aged 65 years and over were selected in 51 communities in Dongcheng district of Beijing municipality with two-stage random sampling. A face-to-face questionnaire survey was conducted to collect information on participation of physical examination free of charge provided by community health service centers/stations as a indicator of UEPHS among the participants between December 2016 and January 2017. Multilevel model was used to analyze influencing factors of UEPHS.Results Of the participants, 46.7% reported participating in the free physical examination. The multilevel model analysis indicated that with the community health service provided by medical institutions at higher administration level was a promoting factor for the elderly’s participation in the examination(odds ratio [OR] = 1.92). For the participants, those aged 70 to 75 years(OR = 1.39), suffering from non-communicable chronic diseases(NCD)(OR = 1.47), being a technical personnel before retire(OR = 1.43), being aware of UEPHS(OR = 1.38), and receiving UEPHS-related information mainly through doctors and community facilities(OR = 2.24 and OR = 1.56) were more likely to take part in the physical examination free of charge; while those with the personal monthly income of 4 000 – 4 999 and > 5 000 RMB yuan(OR =0.51 and OR = 0.23) and those ever having taken a physical examination provided by other medical institutions were less likely to receive the examination. Conclusion The utilization rate of physical examination free of charge was relatively low and both community and individual factors affected the UEPHS among the urban community elderly 65 years old or more.The results suggest effective measures are needed to improve the UEPHS for health promotion among urban elderly community population.
引文
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[13]秦江梅.国家基本公共卫生服务项目进展[J].中国公共卫生,2017,33(9):1289-1297.
[14]申动.基本公共卫生服务公众参与现状及影响因素分析[D].南方医科大学,2016.
[15]吴三通.基本公共服务均等化:简要评估及制度建议——基于财政支出的视角[J].湖南社会主义学院学报,2009,10(2):78-81.
[16]刘亚囡.中国基本公共卫生服务政策及实证研究[D].济南:山东大学,2013.
[17]赵雪岩,韩勇,白朝晖,等.上海市某社区65岁以上老人参与健康体检影响因素的调查分析[J].上海医药,2017,38(4):48-50.
[18]张雷,乔程,娄培安,等.徐州市农村地区65岁及以上老年人健康管理服务开展情况调查[J].中国初级卫生保健,2015,29(3):1-3.
[19]卫生部,财政部,国家人口和计划生育委员会.关于促进基本公共卫生服务逐步均等化的意见[EB/OL].[2017-09-04].http://www.gov.cn/ztzl/ygzt/content_1661065.htm.
[2]中华人民共和国国家统计局.2015年全国1%人口抽样调查主要数据公报[EB/OL].[2017-09-02].http://www.stats.gov.cn/tjsj/zxfb/201604/t20160420_1346151.html.
[3]赵晓芳.健康老龄化背景下“医养结合”养老服务模式研究[J].兰州学刊,2014(9):129-136.
[4]国家卫生计生委统计信息中心.第五次国家卫生服务调查分析报告[EB/OL].[2017-09-04].http://www.nhfpc.gov.cn/mohwsbws tjxxzx/s8211/201610/9f109ff40e9346fca76dd82cecf419ce.shtml.
[5]李莉.重庆主城基本公共卫生服务中老年人健康管理的现状、需求及对策研究[D].重庆:第三军医大学,2016.
[6]曾庆奇,常春,蒋莹,等.健康素养与老年居民基本公共卫生服务利用的关系研究[J].中国健康教育,2014,30(9):771-776.
[7]钱莎莎,邢健男,王璐.多水平统计模型分析方法及其应用[J].中国公共卫生,2017,33(09):1414-1416.
[8]Ene M,Leighton EA,Blue GL,et al.Multilevel models for categorical data using SAS?PROC GLIMMIX:The basics[EB/OL].[2017-09-03].http://support.sas.com/resources/papers/proceedings15/3430-2015.pdf.
[9]石长敏,郑建,张拓红,等.北京市不同经济水平农村居民基本公共卫生服务利用现状调查[J].中国卫生政策研究,2012,5(8):67-72.
[10]何莎莎,危莉,冯占春.均等化目标下我国农村老年人利用基本公共卫生服务的影响因素分析[J].中国卫生经济,2012,31(8):42-44.
[11]温秀芹,赵洁,曾庆奇,等.德胜社区老年人基本公共卫生服务利用及影响因素研究[J].中华疾病控制杂志,2015,19(4):334-337.
[12]中华人民共和国国家卫生和计划生育委员会.国家卫生计生委关于印发《国家基本公共卫生服务规范(第三版)》的通知[EB/OL].[2017-09-03].http://www.nhfpc.gov.cn/jws/s3578/201703/d20c37e23e1f4c7db7b8e25f34473e1b.shtml.
[13]秦江梅.国家基本公共卫生服务项目进展[J].中国公共卫生,2017,33(9):1289-1297.
[14]申动.基本公共卫生服务公众参与现状及影响因素分析[D].南方医科大学,2016.
[15]吴三通.基本公共服务均等化:简要评估及制度建议——基于财政支出的视角[J].湖南社会主义学院学报,2009,10(2):78-81.
[16]刘亚囡.中国基本公共卫生服务政策及实证研究[D].济南:山东大学,2013.
[17]赵雪岩,韩勇,白朝晖,等.上海市某社区65岁以上老人参与健康体检影响因素的调查分析[J].上海医药,2017,38(4):48-50.
[18]张雷,乔程,娄培安,等.徐州市农村地区65岁及以上老年人健康管理服务开展情况调查[J].中国初级卫生保健,2015,29(3):1-3.
[19]卫生部,财政部,国家人口和计划生育委员会.关于促进基本公共卫生服务逐步均等化的意见[EB/OL].[2017-09-04].http://www.gov.cn/ztzl/ygzt/content_1661065.htm.