基于安德森模型的老年人社区居家医养结合服务需求及影响因素分析

谭梅; 张雨婷; 张艳; 白思敏; 张敏; 陈煜

doi:10.16766/j.cnki.issn.1674-4152.003079

基于安德森模型的老年人社区居家医养结合服务需求及影响因素分析

doi: 10.16766/j.cnki.issn.1674-4152.003079

谭梅¹,
张雨婷¹,
张艳²,
白思敏³,
张敏²,
陈煜^2, ,

1.
成都医学院公共卫生学院，四川成都 610500
2.
成都医学院大健康与智能工程学院，四川成都 610500
3.
陕西中医药大学人文管理学院，陕西西安 712046

基金项目:

国家社科基金一般项目 17BGL189

四川养老与老年健康协同创新中心联合基金科研项目 YLKYYB2202

详细信息

通讯作者:
陈煜, E-mail：xydcy183@126.com

中图分类号: R197.61 R195
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- 文章访问数: 294
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- PDF下载量: 19
- 被引次数: 0
出版历程
- 收稿日期: 2022-12-13
- 网络出版日期: 2023-08-28

Analysis of the demand and influencing factors of community home combined medical and health care services in the elderly based on the Anderson model

1.
College of Public Health, Chengdu Medical College, Chengdu, Sichuan 610500, China

摘要

摘要: 目的了解陕西省老年人社区居家医养结合服务需求现状并分析其影响因素，以期为构建多层次居家医养结合养老服务体系提供理论依据。方法通过分层随机抽样法对陕西省36个县(区)共1 531位老年人进行问卷调查。基于安德森模型，采用χ²检验进行倾向因素、使能因素及需求因素对老年人社区居家医养结合服务需求的差异性分析；采用二元logistic回归分析研究其需求的影响因素。结果影响因素分析结果显示，倾向因素中，居住地类型(OR=1.328, 95% CI：1.059~1.667)和有无兴趣爱好(OR=1.360, 95% CI：1.083~1.708)；使能因素中，是否有医疗保险(OR=1.436, 95% CI：1.014~2.034)、是否有养老保险(OR=1.442, 95% CI：1.012~2.055)和社会支持度类型(一般支持度OR=1.320, 95% CI：1.036~1.681；高社会支持度OR=2.086，95% CI：1.406~3.096)；需求因素中，医养结合认知情况(OR=1.485, 95% CI：1.093~2.018)和慢性病种数(2种慢性病OR=1.398, 95% CI：1.021~1.914；4种及以上慢性病OR=4.173，95% CI：1.526~11.415)对老年人社区居家医养结合服务需求产生影响。结论农村老年人、拥有社会保障和高社会支持度、患多种慢性病和医养结合认知度高的老年人对社区居家医养结合服务有较高需求。社区居家医养结合服务应满足提供恰当的服务场所、内容和形式的原则，并在此基础上建立多元化、可持续的多层次健康养老服务体系。
- 社区居家 /
- 医养结合 /
- 安德森模型 /
- 需求
Abstract: Objective To understand the current situation of the demand for community home combined medical and health care services for the elderly in Shaanxi Province and analyze its influencing factors, in order to provide a theoretical basis for the construction of a multi-level combined medical and health care service system for the elderly at home. Methods A total of 1 531 elderly people were surveyed by stratified random sampling in 36 counties (districts) of Shaanxi Province. Based on the Anderson model, Chi-square test was used to analyze the differences among propensity factors, enabling factors and demand factors in the demand for community home combined medical and health care for the elderly. The factors influencing of their demand was studied using binary logistic regression. Results The results of the analysis of influencing factors showed that among the propensity factors, the type of residence (OR=1.328, 95% CI: 1.059 to 1.667) and the presence of hobbies (OR=1.360, 95% CI: 1.083 to 1.708); among the enabling factors, the presence of health insurance (OR=1.436, 95% CI: 1.014 to 2.034), the presence of having pension insurance (OR=1.442, 95% CI: 1.012 to 2.055) and type of social support (general support OR=1.320, 95% CI: 1.036 to 1.681); high social support OR=2.086, 95% CI: 1.406 to 3.096); among the need factors, the perception of health care integration (OR=1.485, 95% CI: 1.093 to 2.018) and the number of chronic diseases (2 chronic diseases OR=1.398, 95% CI: 1.021 to 1.914; 4 or more chronic diseases OR=4.173, 95% CI: 1.526 to 11.415) influenced the demand for community home combined medical and health care for the elderly. Conclusion The elderly in rural areas, those who have social security and high social support, suffer from multiple chronic diseases and have high awareness of the combination of medical care and care have high demand for community home combined medical care and health services. Community home medical care and health services should meet the principle of providing appropriate service place, content and form, and on this basis, establish a diversified and sustainable multi-level health and elderly care service system.
- Community home /
- Combined medical care and health services /
- Anderson model /
- Demand

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表 1 倾向因素对老年人社区居家医养结合需求差异影响分析[人(%)]

Table 1. Analysis of the influence of propensity factors on the difference of elderly people's combined needs of community home medical care[person (%)]

倾向因素	类别	需要	不需要	χ²值	P值
性别	男性	439(55.7)	349(44.3)	0.232	0.630
	女性	423(56.9)	320(43.1)
年龄(岁)	55~	202(56.0)	159(44.0)	2.139	0.830
	60~	184(57.7)	135(42.3)
	65~	135(57.7)	99(42.3)
	70~	184(57.5)	136(42.5)
	75~	76(52.1)	70(47.9)
	80~	81(53.6)	70(46.4)
文化程度	文盲	120(46.3)	139(53.7)	12.955	0.024
	小学	265(57.4)	197(42.6)
	初中	288(58.7)	203(41.3)
	高中/中专/职高	136(58.9)	95(41.1)
	大专	23(60.5)	15(39.5)
	本科及以上	30(60.0)	20(40.0)
婚姻状况	在婚	663(55.9)	522(44.1)	8.787	0.067
	离异	21(51.2)	20(48.8)
	丧偶	163(61.3)	103(38.7)
	同居	10(43.5)	13(56.5)
	未婚	5(31.3)	11(68.8)
居住地类型	城市	494(60.4)	324(39.6)	11.932	0.001
	农村	368(51.6)	345(48.4)
职业	党机关单位	85(61.2)	54(38.8)	11.990	0.101
	专业技术人员	59(62.1)	36(37.9)
	办事人员	22(52.4)	20(47.6)
	社会服务人员	73(58.4)	52(41.6)
	农、林、牧生产	412(53.0)	365(47.0)
	生产制造人员	61(65.6)	32(34.4)
	军人	7(41.2)	10(58.8)
	其他从业人员	143(58.8)	100(41.2)
兴趣爱好	有	421(63.2)	245(36.8)	22.878	< 0.001
	无	441(51.0)	424(49.0)

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表 2 使能因素对老年人社区居家医养结合需求差异影响分析[人(%)]

Table 2. Analysis on the impact of enabling factors on the demand difference of elderly people's combination of community home medical care[person (%)]

使能因素	类别	需要	不需要	χ²值	P值
月收入(元)	< 500	234(51.4)	221(48.6)	9.920	0.128
	500~	192(62.5)	115(37.5)
	1 500~	139(57.4)	103(42.6)
	2 500~	124(55.4)	100(44.6)
	3 500~	91(55.8)	72(44.2)
	4 500~	48(60.0)	32(40.0)
	5 500~	34(56.7)	26(43.3)
经济状况	非常宽裕	32(65.3)	17(34.7)	3.890	0.421
	比较宽裕	138(59.2)	95(40.8)
	基本够用	508(55.0)	415(45.0)
	比较困难	170(57.2)	127(42.8)
	非常困难	14(48.3)	15(51.7)
子女数量	1个	133(56.6)	102(43.4)	4.444	0.349
	2个	394(57.9)	286(42.1)
	3个	204(55.0)	167(45.0)
	4个及以上	126(54.8)	104(45.2)
	没有	5(33.3)	10(66.7)
医疗保险	无	78(43.3)	102(56.7)	13.947	< 0.001
	有	784(58.0)	567(42.0)
养老保险	无	76(44.2)	96(55.8)	11.564	0.001
	有	786(57.8)	573(42.2)
社会支持度	低	205(48.2)	220(51.8)	26.826	< 0.001
	一般	529(57.2)	396(42.8)
	高	128(70.7)	53(29.3)

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表 3 需求因素对老年人社区居家医养结合需求差异影响分析[人(%)]

Table 3. Analysis on the impact of demand factors on the difference of demand for elderly people's combination of community home medical care [person (%)]

需求因素	类别	需要	不需要	χ²值	P值
自觉幸福感	不幸福	184(52.4)	167(47.6)	2.789	0.095
	幸福	678(57.5)	502(42.5)
自觉健康状况	非常好	117(60.3)	77(39.7)	4.824	0.306
	比较好	301(56.1)	236(43.9)
	一般	355(57.2)	266(42.8)
	比较差	80(50.3)	79(49.7)
	非常差	9(45.0)	11(55.0)
患慢性病种数	0	343(53.0)	304(47.0)	12.178	0.016
	1种	302(56.4)	233(43.6)
	2种	143(60.6)	93(39.4)
	3种	52(60.5)	34(39.5)
	≥4种	22(81.5)	5(18.5)
孤独感	不孤独	576(57.3)	430(42.7)	1.114	0.573
	偶感孤独	248(54.6)	206(45.4)
	常感孤独	38(53.5)	33(46.5)
医养结合认知状况	不了解	689(53.9)	590(46.1)	18.694	< 0.001
	了解	173(68.7)	79(31.3)
日常生活能力	完全正常	629(55.7)	501(44.3)	1.899	0.387
	不同程度功能下降	153(56.3)	119(43.8)
	明显功能障碍	80(62.0)	49(38.0)
抑郁状况	正常	715(56.4)	553(43.6)	0.288	0.866
	轻度	114(55.1)	93(44.9)
	中重度	33(58.9)	23(41.1)

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表 4 自变量赋值情况

Table 4. Assignment of argument variables

变量	赋值方法
倾向因素
居住地类型	城市=1，农村=2
文化程度	文盲=1，小学=2，初中=3，高中/中专/职高=4，大专=5，本科及以上=6
兴趣爱好	无=1，有=2
使能因素
医疗保险	无=1，有=2
养老保险	无=1，有=2
社会支持度	低社会支持度=1，一般社会支持度=2，高社会支持度=3
需求因素
患慢性病种数	无=1, 1种=2, 2种=3, 3种=4, 4种及以上=5
对医养结合服务的认知情况	不了解=1，了解=2

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表 5 老年人社区居家医养结合服务需求二元logistic回归分析

Table 5. Binary logistic regression analysis of elderly community home medical care combined service demand

因素	B	SE	Waldχ²	P值	OR值	95% CI
倾向因素
居住地类型(农村)	0.284	0.116	6.007	0.014	1.328	1.059~1.667
文化程度
小学	0.297	0.162	3.356	0.067	1.345	0.979~1.847
初中	0.246	0.167	2.164	0.141	1.279	0.921~1.775
高中/中专/职高	0.085	0.202	0.179	0.673	1.089	0.733~1.618
大专	-0.080	0.382	0.044	0.834	0.923	0.436~1.953
本科及以上	-0.101	0.340	0.088	0.766	0.904	0.464~1.761
兴趣爱好(有)	0.308	0.116	7.009	0.008	1.360	1.083~1.708
使能因素
医疗保险(有)	0.362	0.178	4.153	0.042	1.436	1.014~2.034
养老保险(有)	0.366	0.181	4.098	0.043	1.442	1.012~2.055
社会支持度
一般	0.277	0.124	5.028	0.025	1.320	1.036~1.681
高	0.735	0.201	13.334	＜0.001	2.086	1.406~3.096
需求因素
医养结合认知情况(了解)	0.395	0.156	6.383	0.012	1.485	1.093~2.018
患有慢性病种数
1种	0.204	0.122	2.811	0.094	1.227	0.966~1.558
2种	0.335	0.160	4.360	0.037	1.398	1.021~1.914
3种	0.469	0.244	3.693	0.055	1.598	0.991~2.579
≥4种	1.429	0.513	7.745	0.005	4.173	1.526~11.415
注：自变量均以赋值为1的类别作为参照。

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