| ObjectivesTo know the main health problems, health services demand and utilization, and intention of visiting doctors of residents in Xuhui District in Shanghai, and to analyze possible influencing factors by household survey, in order to provide reference and suggestions for the government to make related policy and regional health planning, and to allocate health resources more reasonably.MethodsThe households for survey were selected with systematic cluster sampling by the proportion of population, and were carried out household health interview survey and simple physical exam. Community Health Monitoring Questionnaire was the survey tool, which was based on the National Health Services Survey and designed by research team. The questionnaire included demographic and social characteristics, health insurance, self-rated health, health behavior, demand and utilization of outpatient and inpatient services and so on. The simple physical exam included measurement of height, weight, blood pressure and blood sugar. SPSS16.0was used to analyze the data, which included descriptive analysis, chi-square test and multiple factors regression analysis.Results1.5006households and12061people were totally investigated.48.08%was male, while51.92%was female. The proportion of people aged over65years old was the highest, which reached24.58%. Residents having Shanghai census register exceeded90%.68.21%people were married. The proportion of college degree and above was more than34%, and the proportion of junior high school, high school/technical secondary school was close to50%, while the proportion of primary school and below was only11%. What’s more, on-the-job personnel accounted for39.40%, retired personnel accounted for46.79%, and6.02%was unemployment. Residents’medical insurance coverage rate was95.15%.2. The overall overweight rate of residents was28.38%, and the obesity rate was6.39%, both of which were higher in men than in women, and showed a trend of getting younger.8.58%residents in the investigation were found that their blood pressure were on the high side (not patients with hypertension), among them9.93%in men,7.34%in women; and2.02%residents were found that their blood sugar were on the high side (not patients with diabetes), among them2.09%in men,1.96%in women.3. The overall two weeks prevalence was44.75%. After adjusted by standard population, this prevalence rate was31.21%. Among them, the prevalence of male was29.78%, while female was32.58%. Among all diseases,6.58%was new cases of the diseases in two weeks,2.40%was acute diseases last to two weeks, and another91.02%was chronic diseases last to two weeks. The overall chronic diseases prevalence was51.17%, and its adjusted prevalence was34.84%. The prevalence of male was33.32%, while female was36.34%. The composition of the diseases in two weeks and chronic diseases was very similar, and hypertension, diabetes, cardiovascular and cerebrovascular diseases were the main diseases among them, and with their prevalence was high.4. The rate of persons with physician contact within two weeks was10.58%, which was7.27%after adjusting. Among all the patients in two weeks,23.93%people saw a doctor in two weeks, and63.18%people were before two weeks. The overall rate of seeing a doctor was87.11%. The result of multiple factors analysis showed that residents’outpatient services utilization was influenced by gender, age, registered residence, employment status, self-rated health, disease type of two weeks and sick days within two weeks.5. The rate of persons with hospital admission within twelve months was6.20%, which was4.78%after adjusting. The rate of persons without hospital admission was16.42%. The factors of influencing resident’s utilization of inpatient services were age, marital status, employment status, family income, self-rated health, and whether there was a chronic disease or not.6. Residents often chose level3hospitals when they need see a doctor, and its rate was highest of41.83%. The rate of choosing community health service centers was38.91%, which ranked the second. But among actual patients in two weeks who visited doctors, the rate of going to community health service centers was higher than to level3hospitals, their rate were50.98%and31.07%respectively. What’s more, among inpatients, there were69.19%choosing level3hospitals,26.13%choosing level2hospitals, and only4.68%choosing other medical institutions. Residents’intention to see a doctor was mainly affected by age, registered residence, marital status, education, employment status, family income and self-rated health.7. The proportion of residents who thought it was difficult to access medical services was17.40%, while expensive to access outpatient services and inpatient services was35.22%and62.40%. The extent of "expensive to access medical services" is higher than "difficult to access medical services". Moreover, the feeling of people seeing doctor varied in different medical institutions, especially in level3hospitals, their feeling of "difficult and expensive to access medical services" was stronger.Conclusions and RecommendationsThe need and demand of residents in Xuhui District in Shanghai are big, but their level of utilization needs to be improved further. The chronic diseases prevalence of people was high, and hypertension and diabetes were the main diseases among them. What’s more, there are a portion of people who were screened with high blood pressure and blood sugar. The rate of overweight and obesity of men were higher than women, and showed a trend of getting younger. The health services utilization of residents was influenced by demography factors, economic factors, health status and so on. Residents’intension to see a doctor was not reasonable, which was in some extent related to "difficult and expensive to access medical services". Therefore, according to the characteristics of this region, some suggestions are concluded:1. Strengthening the management of chronic diseases, and paying attention to the health problems of key groups;2. Improving residents’unhealthy living habit, and avoiding the generation of health risk factors;3. Enhancing health services utilization of the vulnerable groups in order to meet their basic medical needs;4. Improving medical network construction of different level, and promoting people’s intension to see a doctor more reasonably;5. Establishing the dynamic monitoring system to know the change of people’s health demand and utilization timely. |
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