| 马克娜,国 庆,尚余旺,等.分级诊疗背景下癌症患者首治医疗机构选择分析[J].中国肿瘤,2025,34(3):227-234. |
| 分级诊疗背景下癌症患者首治医疗机构选择分析 |
| Selection of the First-Treatment Medical Institution for Cancer Patients in the Context of Hierarchical Medical System |
| 投稿时间：2024-04-26 |
| DOI：10.11735/j.issn.1004-0242.2025.03.A010 |
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| 中文关键词: 分级诊疗 癌症患者 首治机构 |
| 英文关键词:hierarchical medical system cancer patient first-treatment institution |
| 基金项目:2023年山东省卫生健康政策研究课题（WZY202375）；齐鲁卫生与健康领军人才培育工程 |
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| 中文摘要: |
| 摘 要：［目的］ 了解癌症患者确诊后对首治医疗机构的选择情况及其影响因素，为合理配置卫生资源，推进癌症分级诊疗提供参考依据。［方法］ 将山东省内1所省级医疗机构、3所市级医疗机构和6所县级医疗机构的1 140例常见癌症患者纳入研究，对其个人基本信息与就医机构选择进行问卷调查。通过卡方检验和Fisher精确检验进行组间比较，采用无序多分类Logistic回归进行分析，探究影响癌症患者首治医疗机构选择的影响因素。［结果］ 研究共收回有效问卷 1 077份。癌症患者首治机构选择占比分别为县级医疗机构29.90%、市级医疗机构35.28%、省级医疗机构34.82%，医疗水平高是癌症患者首治机构选择的主要原因。无序多分类Logistic回归结果表明，当选择市级和县级医疗机构作为首治机构，并以首次治疗选择县级医疗机构作为参照时，与肿瘤Ⅰ期患者相比，肿瘤分期处于Ⅲ期（OR=1.789，95%CI：1.014~3.158）、Ⅳ期（OR=2.005，95%CI：1.179~3.409）的患者更倾向选择市级医疗机构；与家庭年收入＜10 000元的患者相比，家庭年收入在10 000～＜50 000元（OR=0.625，95%CI：0.414~0.943）的患者较少选择市级医疗机构。当选择省级和县级医疗机构作为首治机构，并以首次治疗选择县级医疗机构作为参照时，与肿瘤Ⅰ期患者相比，处于Ⅲ期（OR=2.885，95%CI：1.549~5.372）、Ⅳ期（OR=3.104，95%CI：1.724~5.586）的患者更倾向选择省级医疗机构；与未婚/离异/丧偶的患者相比，已婚（OR=2.248，95%CI：1.127~4.484）患者更倾向选择省级医疗机构；与没有癌症家族史的患者相比，有癌症家族史（OR=1.650，95%CI：1.115~2.441）的患者更倾向选择省级医疗机构；与＜45岁的患者相比，≥60岁（OR=0.483，95%CI：0.242~0.962）患者较少选择省级医院；与不知晓癌症相关知识的患者相比，知晓癌症相关知识（OR=0.613，95%CI：0.441~0.852）的患者较少选择省级医院。［结论］ 大力开展癌症防治知识的宣传，提高癌症患者的癌症防治素养，同时加强各级医疗机构间的纵向合作，完善省-市-县三级癌症防治网络，促进优质医疗资源下沉，是提高县域癌症防治能力，推进分级诊疗工作的重要途径。 |
| 英文摘要: |
| Abstract：［Purpose］ To investigate the choice of medical institutions for the first-treatment of cancer patients after diagnosis and the factors influencing it， so as to provide a reference basis for the rational allocation of health resources and the promotion of hierarchical diagnosis and treatment of cancer. ［Methods］ A total of 1 140 common cancer patients from 1 provincial， 3 municipal and 6 county-level medical institutions in Shandong Province were included in the study， and a questionnaire survey was conducted on their basic personal information and the selection of medical institutions. Chi-square test and Fisher exact test were used to compare different groups， and multi-classification unordered Logistic regression were used to explore the factors influencing the selection of cancer patients. ［Results］ 1 077 valid questionnaires were collected. The selection rates of first-treatment institutions for cancer patients were county hospitals (29.90%)， city hospitals (35.28%)， and provincial hospitals (34.82%)， and the high level of medical care was the main reason for the selection of first-treatment institutions for cancer patients. The results of multi-classification unordered Logistic regression showed that when choosing municipal and county medical institutions as the first treatment institution compared to choosing a county medical institution for the first treatment as a reference， compared to patients with stage Ⅰ tumors， patients with tumor stages at stage Ⅲ (OR=1.789， 95%CI：1.014~3.158) and stage Ⅳ(OR=2.005， 95%CI：1.179~3.409) were more likely to choose municipal medical institutions； and patients with annual household income of 10 000~<50 000 CNY(OR=0.625， 95%CI：0.414~0.943) were less likely to choose municipal medical institutions compared to those with an annual household income of <10 000 CNY. When choosing provincial and county medical institutions as the first treatment institution compared to patients in stage Ⅲ (OR=2.885， 95%CI：1.549~5.372) and stage Ⅳ(OR=3.104， 95%CI：1.724~5.586) compared to patients with stage Ⅰ tumors when choosing a county medical institution for the first treatment was used as a reference； married (OR=2.248， 95%CI： 1.127~4.484) patients were more likely to choose provincial healthcare organizations than unmarried/divorced/widowed patients； patients with a family history of cancer compared to patients without a family history of cancer (OR=1.650， 95%CI： 1.115~2.441) were more inclined to choose provincial healthcare institutions； compared with patients <45 years old， patients over 60 years old (OR=0.483， 95%CI：0.242~0.962) were less inclined to choose provincial hospitals； and compared with patients who were not aware of knowledge related to cancer， those who were aware of knowledge related to cancer (OR=0.613， 95%CI： 0.441~0.852) patients were less inclined to choose provincial hospitals. ［Conclusion］ Vigorously carrying out publicity on cancer prevention and treatment knowledge， improving the cancer prevention and treatment literacy of cancer patients. strengthening vertical cooperation among medical institutions at all levels， improving the provincial-municipal-county cancer prevention and treatment network， and promoting the sinking of high-quality medical resources are important ways to improve the cancer prevention and treatment capacity of counties and promote the work of hierarchical medical system. |
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