分级诊疗视角下糖尿病患者就诊机构选择及影响因素分析OA

Objective To analyze the choice of healthcare institution and influencing factors among pa-tients with diabetes,and to provide reference for improving diabetes management and policies for hierarchical med-ical system.Methods Using stratified random sampling method,900 diabetic patients enrolled in basic public health service management in eastern,central and western Shandong province were selected for a questionnaire survey,with a total of 876 valid questionnaires.Descriptive analysis,Chi-square test and multivariate Logistic re-gression analysis were performed on the data.Results In the past six months,65.2％of diabetic patients went to primary care institutions for treatment,6.5％went to non-primary care institutions after visiting primary care insti-tutions,and 7.9％went to non-primary care institutions without visiting primary care institutions.Region(OR=1.53,P=0.03),(OR=2.80,P＜0.01),city(OR=0.68,P=0.03)were the main factors influencing pa-tients'visiting primary care institutions.The main factors that affect patients'decision to still visit primary care institutions were marital status(OR=0.40,P=0.02),region(OR=0.27,P＜0.01),(OR=0.46,P=0.02),city(OR=2.39,P=0.02).The main factors that affect patients'decision not to visit primary care insti-tutions were gender(OR=0.49,P=0.02),medical insurance(OR=0.44,P=0.02),complications(OR=4.06,P＜0.01)and other chronic diseases(OR=2.15,P=0.04).Conclusions There is still room to im-prove in the choice of healthcare institutions for patients with diabetes,and it is urgent to take measures such as improving basic health service capacity and medical insurance payment to guide patients to choose healthcare insti-tutions rationally.