| Objective: Medical and health behavior of patients with chronic noncommunicable diseases is essential in any society.Providing universal health services utilization of opportunities and reducing access to health services utilization of obstacle is the goal of medical and health care system reform in our country.The Andersen Model is currently recognized as the mainstream model for the study of applicable health services in the neighborhood of international health services research.Therefore,based on Anderson health service model,this study explores the utilization of health services and related influencing factors in patients with chronic diseases,and provides practical guidance for the utilization of health services in patients with chronic diseases.Methods: In this study,a cross-sectional study was conducted to collect data from patients with chronic diseases in the Second Affiliated Hospital of Dalian Medical University,the Seventh People's Hospital of Dalian and the Garden Community of Dalian from September to December 2018.Based on Anderson's health service utilization model,this paper explores the relationship between predisposing factors,enabling factors and need factors and different medical service utilization.Firstly,the study variables are analyzed by chi-square test,rank sum test and other statistical methods,and then Logistic regression is used for multivariate analysis.Finally,the influencing factors of the utilization of medical services for patients with chronic diseases are obtained.Results: 1.We tested the reliability and validity of general self-efficacy(CSES)social support(OSS-3),family function(APGAR),and health questionnaire SF-36.The results showed that the Cronbach alpha of each scale was between 0.82-0.90,and AVE(average extracted variance value)was between 0.55-0.74,indicating that the reliability and validity of each scale were good,and the internal consistency was good.2.A total of 523 questionnaires were collected in this study,among which 269(51.4%)patients,154(29.1%)patients and 100(19.1%)patients were from three groups(occasional users,moderate users and multiple users)using general medical services.The utilization rate of inpatient medical services was 160(30.6%).3.The results of univariate analysis showed that age,place of residence(city),employment status,commercial insurance,average monthly income,social support,family function,self-assessed health status and Charlson comorbidity index were the influencing factors of inpatient medical service utilization.Age,residence,employment status,general self-efficacy,commercial insurance,medical institutions,social support,family function,self-assessed health status,Charlson comorbidity index were the influencing factors of general medical service utilization.4.Multivariate Logistic regression analysis was conducted with Charlson comorbidity index as the need factor,and the results showed that residence,social support,family function and Charlson comorbidity were the influencing factors for the utilization of inpatient medical services,while residence,commercial insurance,social support,family function and Charlson comorbidity were the influencing factors for the utilization of general medical services.Multivariate Logistic regression analysis was conducted with self-health assessment as the need factor,and the results showed that age,residence,commercial insurance and general health status were the influencing factors for the utilization of inpatient medical services.Self-efficacy,social support,family function,place of residence,age,general health status and commercial insurance were the influencing factors of general medical services.Conclusion:First,Andersen model can be used as a theoretical framework and research hyPothesis for the utilization of medical services for patients with chronic diseases.Second,demand factors of self-assessment and chronic health conditions are the influencing factors to medical and health services utilization,which is consistent with the theory of Andersen.Residence(rural)of predisposing factors reduces medical service utilization possibility.In enabling factors,the enhancement of family function or social support promotes the utilization of medical services,and commercial insurance also promotes the utilization of medical services.Finally,although we have qualitatively studied the influencing factors of medical services utilization,we still need to further study the accessibility and quality of medical services. |
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