Analysis On Utilization Of Out-patient Health Service And Influenced Factors Among Residents Over 15 Years Old In Henan Province

ObjectiveThis study aimed to understand the current situation of outpatient utilization, and analyze the existing problems and its influencing factors. The results would provide references for improving utilization of outpatient utilization and allocating outpatient service resources rationally. MethodsPermanent residents in Henan Province in 2013 were taken as the study object, the samples were collected by multi-stage stratified cluster sampling. Household survey was conducted using the family health questionnaire. A descriptive analysis was conducted on the rate of two weeks treatment and two weeks treatment of disease.Chi square test was used to compare the treatment of two weeks’ disease in urban residents and rural residents, and the first consultation institutions and the reasons not to receive the treatment. To analysis the influencing factors of outpatient health service utilization, Firstly, the possible influencing factors are selected according to the Andersen model, Then the variables were selected by varSelRF method, Finally through the SAS GLIMMIX process and NLMIXED process to fit the two-level logistic regression model, Determine the factors that affect the utilization of outpatient health services. Results1. The proportion of patients who were treated in two weeks was 32.74%, 51.59% of two-week sick residents were treated two weeks ago and in continuous treatment, 6.85% of two-week sick residents chose the absolutely self-treatment, and 8.81% of two-week sick residents were treated with nothing. The proportion of that sick residents in urban accepted treatment within two weeks or absolutely self-treatment was less than that in rural, while the proportion of that patients who visited doctors two weeks ago were still under continuous treatment or not treated in urban prescribed continuous treatment is higher than that in rural(2c =479.772,P<0.001).2. The proportion of two-week patients who chose infirmary, clinic, and community health service stations and other primary health agencies as their first visiting medical institutions was 64.65%, in which the proportion of treatment in primary health agency in rural was higher than in urban(2c =88.711,P<0.001).3. The two-week consultation rate calculated according to the number of person is 7.74%, and the rate calculated by person-time is 12.33%, two-week sick attendance rate is 32.74%. The first five two-week sick attendance rate of different system diseases are respectively circulatory system diseases, respiratory system diseases, digestive system diseases, movement system diseases, endocrine system, nutritional and metabolic diseases, which accounted 85.47% for the total attendance person-time. Two-week attendance rate of the top five resident disease categories is respectively hypertension, acute nasopharyngitis, upper respiratory tract infection, diabetes and cerebrovascular diseases, and the total attendance person-time of the 5 kinds of disease accounts for 54.55%.4. The main reason of two-week sick residents who took no measures was that their feelings were not bad(12.90%), and economic difficulties accounted for 2.25%. In urban, the proportion of two-week sick residents who didn’t visit hospital because of having no bad feelings was higher than the proportion in rural, while the proportion in rural because of economic difficulties leading no visiting hospital was higher than that in urban(2c =95.292,P<0.001).5. Fourteen factors were screened out from 17 outpatient health service ultilization factors using varSeIRF method when OBBerror rate was the lowest(0.1952). Two-level logostic regression analysis showed that the treatment of disease on the injury of two weeks has an aggregation in the country(distic) level(ICC=0.2550),category of urban and rural, age, employment status, whether cause chronic disease or not, type of the medical insurance, the distance of the nearest medical institution, whether going on healthy examination in recent 12 months or not, the occurrence time of discomfort, sick duration and whether bed rest or not are influence factors of the residents outpatient health service utilization. Meanwhile, the distance of the nearest medical institution and bed rest or not are in different effects in various counties or areas when considering whether the treatment of two-week illness. The-2LL of the two levels of logistic regression model decreases 342.1 when compared with the one-level logistic regression model. Conclusion1. The level of utilization of health services in urban and rural residents is higher, the flow of residents is reasonable, the ratio of not treated because of economic difficulties was declined.2. The utilization of health services were affected by category of urban and rural, age, employment status, whether cause chronic disease or not, type of the medical insurance, the distance of the nearest medical institution, whether going on healthy examination in recent 12 months or not, the occurrence time of discomfort, sick duration and whether bed rest or not, these factors are considered in the formulation of health policy to improve the utilization of outpatient health services.