Influencing Factors Of Utilization And Satisfaction Of Health Management Services For Patients With Chronic Diseases

Objective: The national basic public health service project has been carried out for ten years and has achieved remarkable results.The health management of patients with chronic diseases is an important service project.As the patients with chronic diseases are the users of basic public health services,their utilization and satisfaction of health management services directly affect the equalization of the services.This study uses the health belief model,health services utilization behavior model,and satisfaction theory as the guide to develop a questionnaire,investigates the utilization and satisfaction of health management services of patients with chronic diseases,and explores the influencing factors,to provide reference basis and policy suggestions for promoting the utilization of health management services of patients with chronic diseases and improving their satisfaction,which is of great significance to realize the equalization of basic public health services.Methods: Using multistage sampling,in the eastern,central,and western regions of China respectively,one province or municipality was randomly selected,a total of three provinces(cities)were chosen.The study randomly selected 2 non-provincial capital cities in each of the chosen provinces,1 district and 1 county in each of these cities;2districts and 2 counties in municipalities,a total of 12 counties(districts),and in each county or district randomly select 3 townships or streets;in each township or street randomly select a village or community,and in each village or community randomly select 35 patients with hypertension and type 2 diabetes respectively.Patients withhypertension and type 2 diabetes were given a questionnaire survey.The contents of the survey mainly include: general demographic characteristics,lifestyle and behavioral factors,family related factors,economic and health conditions,accessibility of medical service,social security,perceived susceptibility of chronic disease,perceived severity,perceived benefits of utilizing chronic disease health management service,perceived barriers,perceived effectiveness,utilization of chronic disease health management follow-up service,satisfaction of service utilization and etc.Epi Data3.1 software is used for data input.SPSS17.0 software was used to describe and analyze the processed data.Univariate analysis was used to understand the differences of service utilization times,service satisfaction level,health belief level and index scores of chronic patients in health management follow-up,and multiple Logistic Regression Analysis and Multiple Linear Regression Analysis were used to explore the influencing factors of service utilization,satisfaction,and health belief.Results:1.Validity and reliability of health belief scale for patients with chronic diseases.The main results were as follows:(1)using principal component analysis for factor analysis,14 common factors were extracted from the health belief scale for patients with hypertension,with a cumulative variance contribution rate of 62.652%,and 17 common factors were extracted from the health belief scale for patients with type 2 diabetes.The contribution rate of cumulative variance was 61.484%.(2)the overall Cronbach'?coefficient of hypertension patients' health belief scale was 0.924,and the Cronbach'?coefficients of perceived susceptibility,perceived severity,perceived benefits,perceived barriers,perceived effectiveness were 0.866,0.879,0.901,0.605 and 0.888 respectively.The overall Cronbach'? coefficient of the health belief scale for type 2 diabetic patients was 0.895,and the Cronbach'? coefficients of the five dimensions were 0.859,0.837,0.906,0.604 and 0.873,respectively.2.The subjects of the study..A total of 2360 patients with chronic diseases were investigated.Of the 2360 people,patients with hypertension were 1220(51.7%);patients with type 2 diabetes were 1140(48.3%);930(39.4%)were male;471(20.0%)were under60 years;old;1841(78.0%)were married;783(33.2%)were uneducated;1410(59.7%)were agricultural;2239(94.9%)were local,1378(58.4%)participated in NCMS,387(16.4%)drank alcohol,307(13.0%)smoked,and 1344(56.9%)persisted in physical exercise.Self-weight 471(20.0%),self-test blood pressure 606(25.7%),self-test blood glucose 392(16.6%),eastern 725(30.7%),central 828(35.1%),western 807(34.2%).3.The status quo ofutilization and satisfaction of health management service for patients with chronic diseases,and the related beliefs of service utilization.The main results are as follows:(1)the utilization of health management services for patients with chronic diseases.In the past year,2013(85.3%)patients with chronic diseases used the health management follow-up service,including 1026 patients with hypertension(84.1%)and 987 patients with type 2 diabetes(86.6%).1438(60.9%)patients were followed up 4 times,including 711(58.3%)with hypertension and 727(63.8%)with type 2 diabetes.(2)the present situation of satisfaction with the utilization of health management services for patients with chronic diseases.The total score of satisfaction with health management follow-up service for patients with chronic diseases was 0.87± 0.15(full score was 1).The scores of satisfaction with environment,equipment,follow-up service process,follow-up service attitude and follow-up technical level of primary health institutions were 0.86±0.16,0.85±0.17,0.87±0.16,0.90±0.15,0.86±0.17 respectively.There was a significant difference in the score of satisfaction with the environment of primary health institution between patients with hypertension and patients with type 2 diabetes(t =2.072,P =0.038).(3)Related beliefs on the utilization of health management services for patients with chronic diseases.The total score of beliefs related to health management service utilization in patients with chronic diseases was 0.71 ± 0.08(full score was 1).The five-dimensional index scores ofperceived susceptibility,perceived severity,perceived benefits,perceived barriers,perceived effectiveness were 0.70±0.17,0.79±0.16,0.84±0.15,0.42±0.09 and 0.81±0.14,respectively.Among them,the five-dimensional index scores of patients with hypertension and type 2 diabetes were between 0.42±0.10(perceived barriers)and 0.84± 0.15(perceived benefits).The difference of perceived susceptibility between hypertension patients and type 2 diabetes patients was statistically significant(t =6.075,P <0.001).4.Factors affecting the utilization of health management follow-up service for patients with chronic diseases.Multiple logistic regression analysis showed that:(1)Family size,low-salt diet,self-monitoring of blood pressure,distance to the nearest primary health institution,urban or rural area,perceived susceptibility,perceived barriers,and regional location affected the utilization of health management follow-up services for patients with hypertension.The first three variables with significant influence were perceived barriers(?=-3.228,95%CI of OR: 0.008?0.191,P<0.001),perceived susceptibility(?= 1.609,95%CI of OR: 2.130 ?11.719,P<0.001),urban and rural areas(?=-0.993,95%CI of OR: 0.256?0.537,P<0.001).(2)Registered place of household,self-monitoring of blood glucose,perceived susceptibility,perceived benefits,and regional location affect the utilization of health management follow-up services of type2 diabetic patients.The top three variables that have a greater impact are perceived benefits(?= 1.875,95%CI of OR:2.172?19.579,P= 0.001),eastern region(?= 1.378,95%CI of OR:2.729?5.761,P<0.001),and household registration(?=-1.117,95%CI of OR:0.167?0.643,P= 0.001).5.Influencing factors of health management follow-up service satisfaction of patients with chronic diseases.Multiple linear regression analysis showed that:(1)Age,marital status,education level,drinking,low-salt diet,physical exercise,perceived severity,perceived benefits,perceived barriers,perceived effectiveness,distance from the nearest primary health care institution,regional location and other factors affected thesatisfaction of health management follow-up service for patients with hypertension.The top three influential variables were eastern region(? =0.203,t =5.961,P<0.001),perceived benefits(?=0.151,t =4.243,P<0.001)and perceived effectiveness(?= 0.133,t =3.879,P<0.001).(2)gender,eating related behavior,physical exercise,perceived susceptibility,perceived benefits,perceived effectiveness,distance from the nearest primary health care institution,regional location and other factors affect the satisfaction of health management follow-up service for patients with type 2 diabetes.The first three variables with greater influence are perceived benefits(? =0.233,t=6.595,P<0.001),eastern region(?=0.201,t=5.567,P<0.001),and perceived susceptibility(?=-0.090,t=-2.878,P=0.004).6.Factors affecting the score of health belief index in patients with chronic diseases.The main results are as follows:(1)for patients with hypertension,age is the common influencing factor of the five dimensions of health belief,andregional location is the common influencing factors of the other four dimensions except perceived susceptibility.The type of medical insurance is the common influencing factor of perceived severity,perceived benefits,and perceived effectiveness,while urban and rural areas are the common influencing factors of perceived susceptibility,perceived benefits,and perceived effectiveness.(2)for patients with type 2 diabetes,regional location is the common influencing factor of 5-dimensional score of health belief,eating related behavior is the common influencing factor of perceived susceptibility,perceived severity and perceived barriers,self-perceived health status is the common influencing factor of perceived severity,perceived barriers and perceived effectiveness,and physical exercise is the common influencing factor of perceived benefits,perceived barriers,and perceived effectiveness.Conclusions:1.The self-designed health belief scale for patients with chronic diseases has goodreliability and validity.2.The health management follow-up service for patients with chronic diseases is underutilized,and nearly 40% of the frequency of face-to-face health management follow-up service did not meet the national minimum requirements.3.The satisfaction of health management service for patients with chronic diseases is generally high.4.The overall level of health management services for patients with chronic diseases is good,and the perceived barriers is at the moderate level.5.Perceived barriers,perceived susceptibility,perceived benefits,eastern region,registered place of household,and urban or rural area have great influence on the utilization of health management follow-up service for patients with chronic diseases;perceived benefits,eastern region,perceived susceptibility and perceived effectiveness have great influence on the satisfaction of health management follow-up service for patients with chronic diseases;age and region are the common influencing factors of related beliefs in the utilization of health management follow-up service for patients with chronic diseases.6.It is suggested to further boost the publicity for the knowledge of chronic disease and to optimize the follow-up services,strengthen patients' health beliefs,improve the condition of grass-roots health institutions,improve the technical level of follow-up personnel,to promote the use of health management follow-up services for patients with chronic diseases and improve their satisfaction.