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目的通过调查老年慢性多脏器疾病患者的医疗服务现状,对医疗服务模式进行研究探讨。方法采用入户或电话问卷调查的方法,调查对象为宣武医院周边地区老年人,年龄≥60岁。合并两个或两个以上慢性疾病患者为研究组,共206名;小红庙社区居民为对照组,共110名。比较两组一般情况、健康状况、主要就诊医院、就诊原因及年医疗费用等。结果两组比较性别无显著性差异;从年龄上看,研究组明显高于对照组(P<0.01);研究组患三种及以上慢性疾病者(59.2%)明显高于对照组(22.7%)(P<0.01);从残障及生活自理情况看,研究组亦明显差于对照组(P<0.01)。对照组56.9%的患者患病后选择社区卫生站、乡医院或社区卫生中心就诊,而研究组仅15.6%选择社区医院就诊,84.5%优先选择区县级、省部级医院就诊,两组比较具有显著性差异(P<0.01)。而患者选择社区医院就诊目的大部分为单纯开药,两组分别为67.1%和64.4%,两组比较无显著性差异(P>0.05)。研究组门诊费用及住院费用亦明显高于对照组(P<0.05)。结论对于老年慢性多脏器疾病的患者,目前的社区医疗服务暂不适合他们的需求。故而,探索更有利于不同程度老年患者病情康复的医疗服务模式势在必行。
Objective To investigate the medical service mode by investigating the status quo of medical services in elderly patients with chronic multiple organ disease. Methods The method of home or telephone survey was used to investigate the elderly in the area around Xuanwu Hospital, age≥60 years. A total of 206 patients with two or more chronic diseases were included in the study group. Xiao Hongmiao community residents were control group with a total of 110 patients. The two groups were compared in terms of general conditions, health status, major hospitals, reasons for medical treatment and annual medical expenses. Results There was no significant difference between the two groups in sex; the age of the study group was significantly higher than that of the control group (P <0.01); the study group was significantly higher than the control group (59.2%) with three or more chronic diseases (22.7% ) (P <0.01). From the perspective of disability and self-care, the study group was significantly worse than the control group (P <0.01). 56.9% of the patients in the control group were selected to attend the community health station, township hospital or community health center after the illness, while only 15.6% of the study group chose to visit the community hospital, 84.5% of the prefectures and provincial or ministerial hospitals preferred, and the two groups were compared There was significant difference (P <0.01). However, most of the patients who chose to visit the community hospital for medical treatment were drug-eluting. The two groups were 67.1% and 64.4% respectively, with no significant difference between the two groups (P> 0.05). Study group outpatient costs and hospitalization costs were also significantly higher than the control group (P <0.05). Conclusion For the elderly patients with chronic multiple organ disease, the current community medical services are not suitable for their needs. Therefore, it is imperative to explore a medical service model that is more conducive to the rehabilitation of elderly patients at different levels.