Study On Medical Assistance And Social Resources Utilization In The Poor With Chronic Diseases

Background and Purpose:Medical assistance is the last line of defense to protect the health rights and interests of people who are unable to afford treatment due to illness,and the social resources owned by poor patients are also an important indicator to ensure health and poverty alleviation.Therefore,from the perspective of nursing professional development and resource utilization of chronic disease management,the medical assistance policies available to poor patients were screened out,their resource utilization status was investigated,and their obstacles and influencing factors were analyzed,which can provide reference for difficult patients to make full use of resources,promote health poverty alleviation in the new era,and solve the problem of relative poverty.Methods:1.Literature research method was used to sort out relevant policies of medical assistance available to poor people with chronic diseases in Chengdu.The policy documents related to medical assistance published on the official website of the state and the government document database of China National Knowledge Infrastructure(CNKI)were retrieved,and the policy documents were analyzed.The predictive version of the survey list related to medical assistance policy resources utilization for the poor with chronic diseases in Chengdu was formed,and the formal survey list was formed through field visits and pre-surveys.2.A questionnaire survey was conducted,and 2 streets were randomly selected from 4 urban village streets in W District of Chengdu by random cluster sampling method,and the people with difficulties who met the inclusion criteria were selected as the research objects.Data were collected through the general characteristics,medical assistance policy Resource Utilization questionnaire,Chronic Illness Resource Survey(CIRS)and quality of life short form 12(SF-12v2).3.Based on the results of the questionnaire survey,purposive sampling was used to select the needy people who met the prerequisites for the utilization of the medical assistance policy but did not take advantage of the policy as the research objects for a telephone return survey.Statistical description was used to analyze the resource utilization status of the subjects.Univariate analysis was used to compare the differences in general characteristics of resource utilization.Multivariate analysis was used to analyze the influencing factors of resource utilization.Correlation analysis was used to analyze the correlation between resource utilization and quality of life.Result:1.A total of 103 poor people with chronic diseases were included in this study,including 72 males(69.9%)and 31 females(30.1%),80(77.7%)were under 60 years old,54(52.4%)with primary school or below education,and 14(13.6%)with high school or above education.71 cases(68.9%)in 10 years,96 cases(93.2%)in outpatient treatment,61 cases(59.2%)in subsistence allowance with disability,and the number of years of assistance.51(49.5%)in 10 years.2.Results of the medical assistance policy survey checklist.The final list consists of 2 themes and 7 policies.The list structure was composed of three parts: policy type,policy items and utilization.The utilization situation included two options of "yes" and "no".3.Analysis of the current situation and influencing factors of medical assistance policy resources utilization.Analysis of the current situation and influencing factors of medical assistance policy resources utilization.(1)The ratio of the number of people who actually used the policy to the number of people who met the requirements of utilization ranked from high to low as follows: 100% of them were subsidized with basic medical insurance,100% with mutual critical illness insurance,100% with urban and rural critical illness insurance,45.5% with outpatient special disease management policy,13.6% with inpatient medical assistance policy,6.3% with outpatient medical assistance policy,and 0% with supplementary medical assistance policy.(2)Multivariate Logistic regression analysis showed that,Education level of high school OR above(OR=3.5),average monthly medical expenditure of 301-500 yuan(OR=4.148),living on subsistence allowances with disability(OR=2.625),and the number of comorbidities more than 3(OR=0.134)were the main influencing factors for the utilization of resources related to medical assistance policies for people in need of chronic diseases.4.Current status and influencing factors of social resources utilization.(1)The social resources utilization of the poor people with chronic diseases was poor,with an average score of(2.71±0.42)points,and 71.84% of them were less than 3 points.The dimension of medical staff had the highest score(3.87±0.72),and the dimension of organization had the lowest score(1.60 ± 0.46).(2)The results of multiple linear stepwise regression analysis showed that age,education level,type of treatment and access to assistance information entered the regression model of social resource utilization,with an explanatory degree of 40.8%.5.Results of correlation analysis between social resource utilization and quality of life.Mental health was positively correlated with social resource utilization(r=0.241-0.306).Physical health was positively correlated with medical staff dimension(r=0.263)and neighborhood dimension(r= 0.351)of social resource utilization.6.Analysis results of reasons for poor people not making full use of medical assistance resources.The content of telephone follow-up of 34 research objects was sorted out,and the frequency of the research objects not knowing the outpatient medical assistance policy was 27 times,and the frequency of the research objects not knowing the inpatient medical assistance policy was 25 times.The frequency of the subjects saying that they did not know the management policy for special diseases in the outpatient department was 5 times,the frequency of having information error was 11 times,the frequency of not visiting the designated hospital was 9 times,the frequency of drugs not covered by the reimbursement was 8 times,and the frequency of high reimbursement threshold was 6 times.The frequency of being less helpful to oneself was 1.Conclusion:1.Poor people with chronic diseases have a very good utilization of government subsidized purchase policies,but the utilization of assistance related policies that do not directly help to purchase or need to apply for is very poor,indicating that they are not able to take the initiative to obtain policies.Therefore,it is necessary to develop case management nurses to be familiar with insurance reimbursement and policy application,and help patients integrate various resources.2.The main reasons for poor utilization of assistance policies include low awareness of relevant assistance policies,errors in assistance information,failure to seek medical treatment in designated hospitals,drugs not covered by reimbursement,high reimbursement threshold and low awareness of demand,etc.It is necessary for relevant departments to solve these problems to improve the utilization of assistance policies.3.The poor people with chronic diseases mainly rely on the path of medical staff to provide support.However,its accessibility is affected by the hospitalization of people in need.The better the people in need make use of social resources,the higher their quality of life.It is necessary for medical staff to go to the community to interpret disease policies and health knowledge for patients,promote the utilization of resources and improve their quality of life.