Analysis of the treatment institution selection and its influencing factors in elderly patients with chronic diseases in a community in Changsha / 中华老年医学杂志

ABSTRACT

Objective To investigate the status of treatment institution selection and its influencing factors in elderly patients with chronic diseases in a community in Changsha.Methods By using systematic sampling,400 elderly patients with chronic diseases from June to August 2012 were included in the investigation by questionnaires.The influencing factors were analyzed by binary logistic regression model or multinomial logistic regression model on the basis of the numbers of response variables.Results In mild conditions in self-consciousness,more than half of the elderly patients with chronic diseases (206 cases,51.5％) preferred community health service centers including private clinics (67 cases,16.8％),municipal hospitals (92 cases,23.0％),third-grade class-A hospitals (35 cases,8.8％).In serious conditions in self-consciousness,patients preferred third-grade class-A hospital (238 cases,59.5％) and municipal hospitals (162 cases,40.5％),no one selected the private clinics or community health service center (x2=443.240,P＜0.001).The analysis of impact factors for the first treatment institution selection in patients with serious conditions in self-consciousness showed that,compared with patients selecting the municipal hospital,the following personnel preferred to choose third-grade class-A hospitalpatients in the staff remaining in positions (OR=32.38) and retirees (OR=15.17),patients with monthly income more than 5,000 yuan (OR=134.28),rural cooperative medical patients (OR=661.42),patients with highly trusting in community health service centers (OR=4.23),patients with BP and serum glucose determination at a frequency of once a month to every three months (OR=83.93),patients unknowing the telephone numbers of community health service centers(OR=3.02)and patients living far away from community health service centers (OR=15.70),patients with little information about community health service centers (OR=1.62).The analysis of impact factors for the first treatment institution selection in patients with mild conditions in self-consciousness showed that,compared with patients selecting the private hospitals,the following personnel preferred to choose community health service centerspatients with primary education level (OR=0.15),retired persons (OR=0.14),patients with higher health attention (OR=0.26),while persons with less health attention (OR-10.65) and patients living far away from community health service center (OR =5.22) were more willing to choose the private hospitals.Conclusions Patient selection for treatment agencies is affected mainly by the perceived severity,in addition,age,education level,employment status,income,health insurance type,trust and understanding on community health services centers,and the emphasis on health and the distance from community health services centers.