Study On The Outpatient Services Utilization Of The Sick Elderly Within Two Weeks In Shandong Province

Background:With the growth of life expectancy,the population aging has become a challenge faced by the whole world.The elderly has poorer physical health,larger demand for health services,and higher medical costs.How to meet the needs of the elderly population for health services and improve the quality of life of the elderly is an important measure for healthy aging.Outpatient service is the beginning of elderly people enjoying medical care and an important way to use health services.Therefore,it has become an inevitable research topic to study the influencing factors of the outpatient health service utilization of the elderly group and to ensure the medical needs of the elderly.Objective:Understand the current status of the outpatient health service utilization of the two-week sick elderly in Shandong Province.Analyze the influencing factors of the two-week morbidity rate,outpatient consultation rate,no consultation rate and outpatient expenditure.Provide corresponding policy to increase the utilization of health services for the sick elderly,improve the health and quality of life of the elderly residents,and promote healthy aging.Method:The research data comes from the cross-sectional survey data of the general projects of the National Natural Science Foundation of China(71673169).In this study,a multi-stage random sampling method was adopted.A total of 7070 eldly were selected in six districts in the east,middle,and west of Shandong Province.4509 elderly who sick within two weeks were selected as the research participants.Complete structured questionnaires,face-to-face interviews were used to complete the survey.Epidata was used to input the data and Stata14.0 was used for data analysis.Descriptive statistics were used to analyze the two-week prevalence and health service utilization;chi-square testand non-parametric test were used for single factor analysis.Binary logistic regression is used for multi-factor analysis,using this to assess the relative influencing factors of the two-week visit rate and no consultation rate among sick eldly.The two-stage Heckman model was used to analyze the influencing factors of outpatient visit cost.Result:The two-week prevalence rate of the elderly in Shandong Province was 63.78%;the two-week utilization rate of outpatient service for sick elderly was 16.70%,the two-week no consultation rate was 10.60%,and the average cost of outpatient visits was 322 yuan.According to the non-parametric test.the influencing factors of the two-week prevalence were gender,age,marital status,education,work,whether there is medical examination in the past year,personal annual income,self-rated economic status,arrears,savings,poor or low-income household,self-health evaluation,status,chronic diseases,activity of daily living.loneliness.mental health score.The results of single factor analysis showed that the influencing factors of outpatient health service utilization were age,urban or rural,living alone,whether there was a medical examination in the past year,self-health evaluation status,chronic diseases,activity of daily living,arrears,loneliness.mental health score,time from home to nearest clinic.distance from home to nearest clinic.Binary logistic regression results show that the factors that affect the utilization of medical services for the elderly are as follows:Compared with rural areas,the urban elderly have a lower outpatient rate(OR=0.585);compared with the seniors living alone,the seniors living with their families have a higher outpatient rate(OR=1.917).Compared with the low-income group,the middle-high income group(OR=1.647)and the high-income group(OR=1.969)have a higher outpatient rate.Compared with the elderly people with good self-health evaluation status,the elderly with poor self-health evaluation status have a higher rate(OR=1.257).Compared with the elderly suffering chronic diseases,the consultation rate of the elderly without chronic disease was higher(OR=3.131).Compared with the eldlt with no impairment of activity of daily living,the consultation rate of the elderly with severe impairment of activity of daily living was low(OR=0.616).Compared with lonely elderly people,non-lonely elderly people have a low medical consultation rate(OR=0.737).Taking the elderly with low mental health score as a control,the population with higher mental score(OR=1.559)and high(OR=1.741)has higher consultation rate.People who have a distance of 500 meters or more from home to the clinic have a less visit rate than those who the distance lesss than 500 meters(OR?0.796).The main reason why the patient not go to a doctor is that they have seen a doctor two weeks ago and they continue treatment as directed by the doctor.This proportion accounts for 87.27%.The results of single factor analysis showed that the influencing factors of two-week no consultation rate were urban or rural,whether there was a medical examination in the past year,education level,insurance,savings,chronic diseases,activity of daily living,distance from home to nearest clinic.Binary logistic regression results show that the factors that affect the two-week no consultation rateare as follows:urban or rural,whether there was a medical examination in the past year,savings,chronic diseases,activity of daily living,distance from home to nearest clinic.The Heckman model shows that the eldly living in cities,living with their families,having a high level of education,high annual personal income,poor self-health evaluation,not suffering from chronic diseases,and poor mental health status have higher outpatient costs.Conclusion and Suggestion:Conclusion:In recent years,the two weeks prevalence rate of the elderly in Shandong has increased.The elderly have more demand for health services,but the utilization rate of health services is not high.This study found that there are many factors that affect whether the sick elderly visit a doctor.Among them,urban,solitary,poor economic status,good self-health evaluation status,chronic disease,impaired activity of daily living,good mental health status,not lonely and have a long distance from their home to the medical institutions havea lower rate of medical consultation.From the point of view of outpatient expenses,elderly people living in cities,living with their families,with high annual income,high education level,not suffering from chronic diseases,poor self-health evaluation status and poor mental health status will have higher medical expenses.Suggestion:Improve the health literacy of the elderly and pay attention to their own health service needs;take multiple measures to promote the use of health services for vulnerable people;co-manage doctors and patients to improve the management of chronic diseases at the grassroots level;improve the mental health of the elderly and reduce the medical burden.