张新华 高华 杨郗 李松 陈利云 孙金海

摘 要 目的：对上海市浦东新区东明社区居家高龄老人对家庭医生服务利用的情况进行调查分析，探讨影响其利用家庭医生服务的相关因素。方法：于2019年9—11月采用整群抽样方法抽取上海市浦东新区东明社区卫生服务中心所辖4个居委的居家高龄老人作为调查对象。以Andersen-Newman行为模型为理论基础编制调查问卷，共发放问卷650份，回收645份，其中有效问卷620份，问卷有效回收率95.4%。結果：620名居家高龄老人对家庭医生服务的利用情况为“健康管理与评估”服务419名（67.6%），“定期体检”服务443名（71.5%），“健康教育与咨询”服务404名（65.2%），“门诊治疗”服务518名（83.5%），“转诊”服务302名（48.7%）。多因素Logistic回归分析结果显示，居家高龄老人对不同家庭医生服务项目的利用主要受需求因素影响。结论：需求因素是东明社区居家高龄老人利用家庭医生服务的主要影响因素，社区卫生服务中心应从居家高龄老人的实际健康需求出发，为其提供更有针对性和可及性的家庭医生服务。

关键词 居家高龄老人；家庭医生服务利用需求；Andersen-Newman行为模型；影响因素分析

中图分类号：R197.1 文献标志码：A 文章编号：1006-1533（2021）06-0010-05

Study of influencing factors of family doctor service utilization of the elderly at home based on Andersen-Newman mode

ZHANG Xinhua1， GAO Hua2， YANG Xi1， LI Song1， CHEN Liyun1， SUN Jinhai3（ 1.Dongming Community Health Service Center of Pudong New District， Shanghai 200123， China； 2.Department of Neurology of Sixth Peoples Hospital， Shanghai 201306， China； 3.Department of Health Management， Naval Medical University， Shanghai 200433， China）

ABSTRACT Objective： To investigate and analyze the utilization of family doctor services by the elderly at home in Dongming Community， Pudong New District， Shanghai to explore the related factors affecting the utilization of family doctor services. Methods： From September to November 2019， the cluster sampling method was adopted to select the elderly at home from 4 neighborhood committees under the jurisdiction of Dongming Community Health Service Center in Pudong New District of Shanghai as the investigation objects. Based on the Andersen-Newman behavioral mode， a total of 650 questionnaires were issued and 645 were recovered， of which 620 were valid and the effective recovery rate was 95.4%. Results： The utilization of family doctor services by 620 elderly people at home was as the following： 419（67.6%） of the “health management and assessment” service， 443（71.5%） of the “regular physical examination” service， 404（65.2%） of the “health education and consultation” service， 518（83.5%） of the “out-patient treatment” service， and 302（48.7%） of the “referral” service. The results of multivariate logistic regression analysis showed that the utilization of different family doctor service items by the elderly at home was mainly affected by demand factors. Conclusion： The demand factor is the main influencing factor for the elderly in Dongming Community to use family doctor service， and the community health service centers should provide more targeted and accessible family doctor services for the elderly from the actual health needs of the elderly at home.

KEY WORDS elderly people at home； family doctor service utilization demand； Andersen-Newman behavioral mode； analysis of influencing factor

*基金项目：上海市浦东新区卫生和计划生育委员会卫生计生科研项目（PW-2017C-4）

随着老年人口的增长和人均寿命的延长，高龄老人的健康状况和生活质量已成为重要的社会公共问题。目前，高龄老人存在患病率高、家庭医生服务利用率低的问题，国内学者针对此类问题开展了诸多研究[1-3]，认为主要原因为家庭医生提供的服务不能完全满足老年人的健康需要[4-5]。……