中国全科医学 ›› 2023, Vol. 26 ›› Issue (26): 3269-3275.DOI: 10.12114/j.issn.1007-9572.2023.0061

• 论著·人群健康研究·儿童健康 • 上一篇    下一篇

分级诊疗背景下上呼吸道感染儿童的就医行为及影响因素分析

张利峰1,*(), 张凝凝1, 秦秀群2, 杨翊3, 钟冬梅4, 刘劭菲1, 戴雨珅1, 王晓丹1, 王明飞5   

  1. 1.510080 广东省广州市,中山大学护理学院
    2.510630 广东省广州市,中山大学附属第三医院儿科
    3.510630 广东省广州市天河区石牌街社区卫生服务中心
    4.510515 广东省广州市,南方医科大学公共卫生学院
    5.510080 广东省广州市,中山大学医院管理处
  • 收稿日期:2023-02-05 修回日期:2023-03-06 出版日期:2023-09-15 发布日期:2023-03-16
  • 通讯作者: 张利峰

  • 作者贡献:张利峰、张凝凝提出研究思路;张利峰、张凝凝、秦秀群、杨翊、王晓丹、王明飞负责项目数据管理、数据收集、形式分析、调查开展;张利峰、张凝凝、钟冬梅、刘劭菲、戴雨珅负责数据管理、形式分析、原稿写作;张利峰负责资金提供、监督管理,并对文章整体负责;所有作者确认了论文的最终稿。
  • 基金资助:
    教育部人文社会科学研究项目(21YJAZH117)

Healthcare-seeking Behavior and Influencing Factors of Children with Upper Respiratory Tract Infection in the Context of Hierarchical Medical System

ZHANG Lifeng1,*(), ZHANG Ningning1, QIN Xiuqun2, YANG Yi3, ZHONG Dongmei4, LIU Shaofei1, DAI Yushen1, WANG Xiaodan1, WANG Mingfei5   

  1. 1. School of Nursing, Sun Yat-sen University, Guangzhou 510080, China
    2. Department of Pediatrics, the Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510630, China
    3. Community Health Service Center, Shipai Street, Tianhe District, Guangzhou 510630, China
    4. School of Public Health, Southern Medical University, Guangzhou 510515, China
    5. Department of Hospital Administration, Sun Yat-sen University, Guangzhou 510080, China
  • Received:2023-02-05 Revised:2023-03-06 Published:2023-09-15 Online:2023-03-16
  • Contact: ZHANG Lifeng

摘要: 背景 推进分级诊疗是解决儿科医疗资源不合理利用的关键,但目前尚缺乏儿童分级诊疗执行现状的相关研究。 目的 总结上呼吸道感染儿童的就医行为,包括就诊次数和就诊机构,并探讨基层(社区卫生服务中心)首诊的主要影响因素。 方法 采用便利抽样法,于2019年3—7月、2022年2—7月分别在广州市中山大学附属第三医院儿科门诊及同一行政区的天河区石牌街社区卫生服务中心就诊的儿童家长进行2次问卷调查。按照调查时间将研究对象分为2019年组(n=419)和2022年组(n=307)。本研究以安德森模型为理论指导,自行设计上呼吸道感染儿童的就医行为及影响因素的调查问卷。采用单因素及多因素Logistic回归分析探讨上呼吸道感染儿童基层首诊的影响因素。 结果 2019年组的419例儿童,第1次(首诊)、第2次、第3/4次就诊者分别为301例(71.84%)、87例(20.76%)、31例(7.40%),首诊、第2次、第3/4次选择社区卫生服务中心就诊比例分别为47.49%、27.12%、16.13%;2022年组的307例儿童,第1次、第2次、第3次就诊者分别为219例(71.34%)、72例(23.45%)、16例(5.21%),首诊、第2次、第3/4次选择社区卫生服务中心就诊比例分别为41.04%、39.77%、43.75%。多因素Logistic回归分析结果显示,最近的医疗机构不是社区卫生服务中心〔OR=0.220,95%CI(0.147,1.056),P<0.001〕、父母文化程度为高中及以下〔OR=0.584,95%CI(0.365,0.936),P=0.025〕、家长评估疾病严重程度较轻、一般〔OR(95%CI)=0.399(0.207,0.768)、0.388(0.226,0.665),P=0.006、0.001〕、儿童年龄3岁以下相比7~13岁〔OR=0.537,95%CI(0.309,0.930),P=0.027〕时选择社区卫生服务中心首诊的可能性较低;家长对分级诊疗认知比较了解〔OR=2.139,95%CI(1.284,3.564),P=0.003〕及家长对分级诊疗态度比较赞同〔OR=2.841,95%CI(1.937,5.779),P=0.004〕时选择社区卫生服务中心首诊的可能性更高。 结论 儿童上呼吸道感染的多次就诊现象较普遍,基层就诊比例较低。家长的文化程度、分级诊疗的认知及态度、评估疾病严重程度,儿童年龄及最近的医疗机构是上呼吸道感染儿童基层首诊的影响因素。加强儿童常见病和分级诊疗制度的宣传教育、提高社区卫生服务中心的可及性并完善其儿科诊疗条件是促进儿童常见病基层诊治的可能途径。

关键词: 上呼吸道感染, 就医行为, 分级诊疗, 基层首诊, 儿童, 社区卫生中心, 安德森模型, 影响因素分析

Abstract:

Background

Promoting hierarchical treatment is the key to solve the irrational utilization of pediatric medical resources, but there is a lack of relevant studies on the current status of implementation of hierarchical diagnosis and treatment for children.

Objective

To describe the healthcare-seeking behavior of children with upper respiratory tract infection, including number of visits and health-seeking institutions and explore the main influencing factors of first visit of priamry care (community health services) .

Methods

Two questionnaires were administered to the parents of children attending the pediatric outpatient department of the Third Affiliated Hospital of Sun Yat-sen University and the Community Health Service Center in Shipai Street, Tianhe District in the same administrative district from March to July in 2019 and from February to July in 2022 using convenience sampling method, respectively. The included subjects were divided into the 2019 group (n=419) and 2022 group (n=307) according to the survey time. The questionnaire on the healthcare-seeking behavior and its influencing factors of children with upper respiratory tract infection using Anderson model as a theoretical guide was involved, univariate and multivariate Logistic regression analyses were used to explore the influencing factors of the first visit of children with upper respiratory tract infection in primary care.

Results

Among the 419 participated children in 2019, 301 (71.84%) visited for the first time, 87 (20.76%) for the second time and 31 (7.40%) for the third time and fourth time, with 47.49%, 27.12% and 16.13% visited the conmmunity health services centers, respectively. Among the 307 participated children in 2022, 219 (71.34%) visited for the first time, 72 (23.45%) for the second time and 16 (5.21%) for the third time or fourth time, with 41.04%, 39.77% and 43.75% visited the conmmunity health services centers, respectively. The results of multivariate Logistic regression analysis showed that the nearest medical institution was not a community health service center〔OR=0.220, 95%CI (0.147, 1.056), P<0.001〕, the education level of parents was high school or below〔OR=0.584, 95%CI (0.365, 0.936), P=0.025〕, parental assessment of disease severity was less severe and general〔OR (95%CI) =0.399 (0.207, 0.768), 0.388 (0.226, 0.665); P=0.006, 0.001〕, children aged under 3 years old〔OR=0.537, 95%CI (0.309, 0.930), P=0.027〕were correlated with less likely to choose community health service center for their first visit compared with the nearest medical institution was a community health service center, the education level of parents was bachelor's degree and above, parental assessment of disease severity was severe and very severe, children aged 7-13 years old. Parents were more awareness〔OR=2.139, 95%CI (1.284, 3.564), P=0.003〕 and in favor of hierarchical medical system〔OR=2.841, 95%CI (1.937, 5.779), P=0.004〕 were more likely to choose a community health service center for their first visit.

Conclusion

Multiple visits are more common in children with upper respiratory tract infection, the proportion of primary care visits is low. The education level of parents, awareness and and attitudes of hierarchical medical system, assessment of disease severity, the age of children and the nearest medical institution are influencing factors for children with upper respiratory tact infection to choose primary care for their first visit. Strengthening the publicity and education of common disease in children and hierarchical medical system, improving the accessibility of community health service centers and pediatric care conditions would be possible approaches to promote primary care for common children diseases.

Key words: Upper respiratory tract infection, Healthcare-seeking behavior, Hierarchical medical system, First visit to primary care institution, Child, Community health centers, Anderson model, Root cause analysis