| [Purpose]Based on the characteristics of residents' health service utilization,this study try to figure out the characteristics of residents' health service utilization behavior from the perspective of continuity,diversity and economy,design the concept framework of health service utilization behavior using Anderson Healthcare Utilization Model and Health Belief Model,explore the factors that affect the utilization of health services and the mechanism of influencing residents' health service utilization by monitoring analysis,summarize the laws of residents' healthcare utilization behavior considering the main results of the relative research,and to provide evidence to form residents' reasonable behavior.[Methods]Literature research method:the major characteristics of continuity,diversity,and economy of health service utilization behavior were induced based on literature review.The conceptual framework of the residents' health service utilization was built using bibliometric method.Tracking monitoring method:the monitoring tools were developed,and 5 communities in Qingshan District of Wuhan and 5 towns in Macheng City of Huangshi were selected as monitoring points in the unified coordination of national and provincial statistical information center of Health and Family Planning Commission.In the first stage(3 months),all members of 432 families with chronic diseases were monitoring objects,and 415 of them were kept to the second stage.In the second stage(3 months),155 families were added in the two places.Based on the unified monitoring tools,we carried out a 2 week follow-up monitoring using investigators,telephone surveys,questionnaires,etc.,Qualitative research method:The questionnaire was revised by literature review,expert consultation and field interview.For monitoring the occurrence of multiple levels of(discontinuous)service utilization of the population,as well as higher' education,medication compliance of poor people to conduct interviews,to explore the reasons behind the behavior.Statistical and regression analysis:the influence factors of continuity were analyzed by zero inflated negative two regression analysis,the Logistic regression method of the two category,the unordered multi classification Logistic regression analysis method,and the generalized linear model.The influence factors of diversity were analyzed by single factor analysis,two classification Logistic regression analysis and generalized linear mixed model analysis.The economy of health service utilization behavior were analyzed by the Wilcoxon rank sum test and chi square test in K-W and Pearson chi square test,and through the Gene coefficient reflected the aggregation of different medical expenditure groups,concentration index reflected the concentration of catastrophic health expenditure in the crowd.[Results]1.Continuity:the treatment interval of patients ranged from 0-28 days,and the 54.49%of residents' treatment interval was 0.The individuals without fixed usual provider are more prone to delay,which was 1.547 times of the individuals whose the usual provider was grassroots medical institutions;there were correlation between the types of chronic disease and the treatment interval,the more type of chronic diseases,the more probability of treatment interval occurred;the individuals participated in the medical insurance for urban workers were less prone to treatment delay occurred;compared with patients under 45 years old,patients over 45 years old were less prone to treatment delay occurred;the proportion of rural residents in the grassroots medical institutions was 78.01%,and the proportion of urban residents in the non grassroots medical institutions was 70.18%.In addition,patients who took first diagnosis at the grassroots level tended to choose grassroots medical institutions as their usual provider.Chronic patient groups for path dependence was higher than that of non-chronic patients,and the path dependence of patients without discomfort was better than that of patients with discomfort.The continuity of non grassroots medical institutions in urban areas was higher(0.94),and the continuity of grassroots medical institutions in rural areas was higher(0.90).Doctors in grassroots medical institutions were more familiar for urban and rural residents,but the score of physicians interpersonal continuity in urban non grassroots medical institutions was higher(0.68),and the score in rural grassroots medical institutions was higher(0.66).In a word,most service providers for the grassroots helped to improve interpersonal continuity.2.Diversity:patients within a disease period were received with a maximum of four treatment methods.When there was only one treatment received by patients,the probability of taking medication increased.And as the type of treatment increasing,the probability of seeking treatment increased,too.The amounts of different services tended to be even when four treatments were used.As for the variation of visiting time,patients from rural areas were more likely to go for a doctor at weekends,mainly in the morning.The visit rate of patients decreased and the frequency of purchasing medication increased in agricultural season.The most commonly used treatment method was purchasing medicines,and the generalized linear mixed model analysis showed that the service utilization of patients had significant monthly and seasonal effects.For patients with acute diseases,with the increase of family economic burden in the last month,the probability of non treatment up to 1.153 times,no influence on the taking medication and purchasing medication.For patients with chronic diseases,especially hypertension and diabetes,the higher the strength of the last month of household consumption,the probability of purchasing medication increased 1.074 times,the probability of non treatment increased 1.082 times.3.Economy:in the high medical expenditure crowd,hospitalization expenses accounted for 82.83%in Qingshan District and 84.38%in Macheng City;the proportion of outside medical institutions cost of low expenditure groups(such as self consumption etc.)in urban areas was the highest accounting for 46.01%,while outpatient medical expenses of low population in rural areas accounted for the highest(63.33%).From the individual point of view,the people with high medical expenses distributed in population whose self-rated health score was below 60,and more kinds of chronic diseases.From the family perspective,the high medical expenditure was associated with the numbers of patients with chronic diseases in the family.The results showed that the distribution of high medical expenditure group in Qingshan was even,and the CI was 0.001.while high-income families were concentrated in rural areas,the concentration index was 0.034.The study found that the burden of disease was more concentrated in low-income families,and the economic burden of disease had more negative effect on low-income families.[Conclusion]1.The establishment of the first primary diagnosis system is helpful to improve the utilization of health services,reduce the residents delay,enhance the continuity and interpersonal mechanism;in patients with hypertension and heart disease are more likely to delay,we should strengthen the education of timely treatment;the compliance of the patients with chronic diseases is better than that of the patients without chronic diseases,but the utilization rate of the non basic medical institutions is high.This is not conducive to the standardized management of patients with chronic diseases.2.Another characteristic of residents' health service utilization is diversity.Among the types of taking medication,purchasing medicines,tradition Chinese medicine,self-medication,outpatient and inpatient health services,the highest rate of service for patients is taking medication,attention should be paid to medication safety education.The use of residential services has a monthly,seasonal effect,and the impact on the chronic patient group,including hypertension,diabetes mellitus is higher than the acute disease,should pay attention to improve services to meet the diverse needs of different groups of people.3.The residents' medical expenditure has a characteristic of aggregation,and high medical expenses is mainly due to hospitalization expenditure.It is worth noting that high medical expenditure concentrated in high income families in rural population more than the city.However,the economic burden of disease mainly occur in the low income families which is more significant in the city.[Innovations and Limitations]Innovations:1.Based on the literature research and theoretical analysis,this study has constructed a monitoring framework of the residents' health service utilization behavior,used the longitudinal monitoring data from three aspects of continuity,diversity,economy to analyze the residents' health service utilization behavior,and obtained valuable results and conclusions some traditional cross-sectional study hard to find.2.This study has screened all the service information of patients in a disease period according to the behavior sequence using the database encoding technique.On the basis of a disease period,according to the different characteristics of the data distribution,the characteristics of healthcare utilization behavior have been figured out by logistic regression,generalized linear regression,generalized linear mixed model and so on.3.The comparative analysis was used to analyze the classification of the residents' health service utilization behavior from the perspective of population,family and disease classification,and found more explanatory results to promote the rational utilization of health service for reference.Limitations:1.The research object is the family of chronic disease,the study found that it can be extended to the family without chronic patients,further study is needed.2.Because of the overall arrangement of the project constraints,only 6 months of monitoring data,but also need to continue to track research. |
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