Investigation On Medical Coping Style And Utilization Of Community Health Service In Elderly Patients With Chronic Diseases

Objective:To investigate the current situation of the medical coping style of elderly patients with chronic diseases and the utilization of community health services,to explore the problems of community health services and to analyze the causes,and to make recommendations for promoting the development of community health services and improving the quality of life of the elderly.Methods:The study was a cross-sectional study.According to the inclusion and exclusion criteria,a face-to-face questionnaire survey was conducted from July to December2020 among patients aged 65 and above with chronic diseases who came to the First Affiliated Hospital of Xi’an Medical College,the Fourth Hospital of Shaanxi Province,Qingnian Road,Hansenzhai and Tumen Community Health Service Centre.441 valid questionnaires were collected,including a total of 171 from the hospital and 270 from the community health service centre.The survey covered general demographic and sociological characteristics,chronic disease patients’ illnesses,medical coping styles and the current status of community health service utilization.Epidata 3.1 software was used to build the database and SPSS 18.0 statistical software was used for statistical analysis.Results:1.Elderly patients with chronic diseases scored in the face dimension:(19.32±4.63),the avoidance dimension:(15.03±4.22),and the submission dimension:(10.29±3.46),the scores of avoidance and submission dimensions were significantly higher than the domestic norm,and the differences between them were statistically significant(P<0.05),while the differences in the face dimension were not statistically significant.2.Age,education,monthly income,number of illnesses and duration of illness of elderly patients with chronic diseases were the main influencing factors for the face dimension;monthly income,number of illnesses and duration of illness were the main influencing factors for the avoidance dimension;number of illnesses and duration of illness were the main influencing factors for the submission dimension.3.The top five chronic diseases are hypertension(43.3%),diabetes(33.9%),hyperlipidaemia(30.4%),cerebrovascular disease(28.4%)and ischaemic heart disease(23.3%);36.7% of people have two chronic diseases at the same time and 29.5% of people have a disease duration of 10-19 years.4.78.9% of patients with chronic diseases were willing to visit the community health service centre,with an actual utilisation rate of 83.9% and an overall satisfaction score of(3.57±0.834)on average.5.There were statistical differences in willingness to visit community health services by monthly income,mode of residence,number of illnesses and duration of illness(P<0.05);there were statistical differences in utilization of community health services by age,education,monthly income,number of illnesses and duration of illness(P<0.05);there were statistical differences in satisfaction with community health services by age,education,marriage,monthly income,mode of residence,number of illnesses and duration of illness(P<0.05).6.Confrontation dimension was positively associated with willingness to attend,utilisation and satisfaction with community health services(r=0.343,r=0.303,r=0.352,P<0.05),avoidance was negatively associated with willingness to attend,utilisation and satisfaction with community health services(r=-0.336,r=-0.308,r=-0.457,P<0.05),and submission was negatively associated with willingness to attend,utilisation and satisfaction with community health services(r=-0.336,r=-0.308,r=-0.457,P<0.05).Conclusions.1.Older patients with chronic diseases are more inclined to adopt a negative coping style of avoidance and submission,especially those who are older,have lower education,lower income,are farmers,have a longer duration of illness and have multiple co-morbidities.2.A high proportion of elderly patients with chronic diseases have hypertension,diabetes,hyperlipidaemia,cerebrovascular disease and ischaemic heart disease,and there is a prevalence of long duration and co-morbidity in the elderly.3.Elderly patients with chronic diseases have a greater demand for health services,and community health service centres have the problem of incomplete medicines.Patients generally do not trust and understand community health service centres.The overall willingness to visit,utilisation rate and overall satisfaction with community basic medical services and public health services are fair,but the willingness to visit,actual utilisation rate and satisfaction with specific services vary significantly.4.Patients’ general demographic characteristics,chronic disease prevalence and coping styles have an impact on willingness to attend,utilisation and satisfaction with community health services.Suggestions:1.Pay more attention to the health and health services of the vulnerable elderly patients with chronic diseases.2.Improve the education level and service quality of medical and health workers,enhance the soft power of community health service center,and improve patients’ trust in community health service center.3.Increase the economic investment in primary health care,increase the reserve of medical equipment and essential drugs,enhance the hard power of community health service center,and improve the patient’s experience in community health service.4.Strengthen the publicity of community health service center,and establish the referral system between different levels of medical institutions to guide patients with common diseases to primary medical institutions.