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Types of Community Health Services Selected by Urban and Suburban Residents in Nanjing and Influencing Factors

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Types of Community Health Services Selected by Urban and Suburban Residents in Nanjing and Influencing Factors Fam Med Com Health: first published as 10.15212/FMCH.2014.0105 on 1 March 2014. Downloaded from Family Medicine and Community Health ORIGINAL ORIGINAL RESEARCH ORIGINAL RESEARCH Types of community health services selected by urban and suburban residents in Nanjing and influencing factors Hong Fan, Qianyuan Wang, Yinyan Wu Abstract Social and Health Education Objective: The purpose of the current study was to determine the types of community health Department, School of Public services selected by urban and suburban residents in Nanjing and the influencing factors in an ef- Health, Nanjing Medical Uni- fort to improve the community health services to better meet the residents’ demands. versity, Nanjing City, Jiangsu Methods: Between 15 May 2013 and 15 June 2013, eight community health service centers Province 210029 from four districts in Nanjing (Gulou District and Baixia District in urban areas and Jiangning CORRESPONDING AUTHOR: District and Pukou District in suburban areas; two centers from each district) were selected using Hong Fan a stratified random sampling method of investigation sites. After an intercept interview with 487 Social and Health Education community residents, univariate and multivariate analyses were performed by means of logistic Department, School of Public regression. Health, Nanjing Medical Results: Among the 487 users of community health services, there were 241 residents from University, Nanjing City, Jiangsu urban areas (49.5%) and 246 residents from suburban areas (50.5%). Among the respondents, Province 210029 there were 191 (39.2%) who usually received medical treatment from community health service E-mail: [email protected] institutions, including 74 (38.7%) from urban areas and 117 (61.3%) from suburban areas. The Funding: Philosophy and So- analysis showed that the factors which influenced urban residents in Nanjing to choose community http://fmch.bmj.com/ cial Science Fund Project in health services for medical treatment included income, payment terms of medical fees, reasonable Jiangsu Province: “Research prices, medical fees, and expenses for medications, while factors influencing suburban residents on Evaluation Index System to choose community health services for medical treatment included income, level of education, of Excessive Medical Behav- carrier, medical institutions selected when feeling severely ill, availability of preventive health ior in Jiangsu Provincial Public services, availability of health counseling services, medical fees, and expenses for medications. Hospitals” [2011SJB630042]; Philosophy and Social Science Based on an analysis of the results by means of unconditioned binary logistic stepwise regression, on September 25, 2021 by guest. Protected copyright. the factors influencing whether or not the urban residents chose community health services for Special Fund Project in Nanjing Medical University: “Establish- medical treatment included gender, age, level of education, payment terms of medical fees, treat- ment of Rating Scale for Doc- ment environment, and expenses for medications, while the factors influencing suburban residents tor’s Professional Behavior in included availability of preventive health services and expenses for medications. Chinese Public Hospital under Conclusion: There was a difference between the types of community health services selected the New Health Care Reform” by residents in urban and suburban areas of Nanjing and factors influencing the selection of ser- [2013NJZS02]; Project Support- vices were different. Community health service institutions in different areas should strengthen ing for Training Talents in “Ji- their own service capability according to the local residents’ health demands. angsu Provincial Advantageous Discipline” [JX10331801]. Keywords: Nanjing, Community health service, Service type, Influencing factors, Urban and suburban residents, Diagnosis and treatment of diseases and injuries Received 20 December 2013; Accepted 18 February 2014 8 Family Medicine and Community Health 2014;2(1):8–14 www.fmch-journal.org DOI 10.15212/FMCH.2014.0105 © 2014 Family Medicine and Community Health RESEARCH ORIGINAL ORIGINAL Fam Med Com Health: first published as 10.15212/FMCH.2014.0105 on 1 March 2014. Downloaded from Types of community health services selected by urban and suburban residents Introduction sociodemographic characteristics of the users of CHSs, and Community health services (CHSs) have gained wide accept- the type of CHSs and factors influencing use of CHSs. The ance since the 1990s when first made available in China. With sociodemographic data included gender, age, income, level of the continuous improvement in service functions and service education, marital status, career, and payment terms of medi- quality, CHSs have an irreplaceable role in relieving the eco- cal fees, while the latter included medical treatment, purchase nomic burden and difficulty for people in need of medical treat- of medications, physical examination, disease prevention, ment [1]. With the development of new medical reform, the health guidance, and rehabilitation. The factors influencing community health service institution is playing an important CHS use included type of treatment institutions selected for role in providing medical treatment services in urban areas. minor illnesses, type of treatment institutions selected for New health care reform has now passed and the post-medi- severe illnesses, reasons to select CHSCs, diagnosis and treat- cal reform era has come. The health care policymakers still ment fees, and expenses for medication. focus on the sustainable development of community health ser- vice centers (CHSCs), which are the backbone of the primary Statistical methods health care system [2–4]. The purpose of the current study Data processing and analysis was performed with Office 2003, was to provide scientific and real references for each region to Epi-data, SPSS 18.0, and SAS 9.0 statistical analysis software. conduct specific CHSs by analyzing the types of CHSs chosen Enumeration data comparisons were performed using a χ2 test. by residents from urban and suburban CHSCs in Nanjing and Univariate logistic regression analysis was used for factors the factors which influence patient choices, thus promoting the influencing CHS type; unconditioned binary logistic stepwise “Six in One” CHS function in Nanjing and meeting the basic regression analysis was used for factors influencing residents’ health service demand of the public. choice of CHSs for medical treatment. The inspection stand- ard was set at an α=0.05. Subjects and methods Results http://fmch.bmj.com/ Investigation subjects Between 15 May 2013 and 15 June 2013, in consideration of Sociodemographic characteristics the economic development state of different areas, humani- The differences between urban and suburban users of CHSs ties, and geographic features, as well as the current status with respect to age, level of education, marital status, career, of CHSCs in Nanjing, eight CHSCs from four districts in and payment terms of medical fees were statistically signifi- Nanjing (Gulou District and Baixia District in urban areas and cant (P<0.05), while the differences between the two groups on September 25, 2021 by guest. Protected copyright. Jiangning District and Pukou District in suburban areas; two with respect to gender and income were not statistically sig- centers from each district) were selected using a stratified ran- nificant P( >0.05, Table 1). dom sampling method at investigation sites to conduct inter- Key points: The purpose of the current study was to com- cept interviews with 487 community residents (n=241 [49.5%] pare the main services provided by the urban and suburban from urban areas and 246 [50.5%] from suburban areas. CHSCs in Nanjing, focusing on opportunities for improve- ment by analyzing the types of CHSs selected by residents in Methods the two areas and the factors which influenced the selections. A questionnaire was self-designed by referring to related The current study is novel; specifically, content was presented materials and amended according to pre-research results. which has seldom been addressed in similar studies conducted Then, the questionnaires were completed by the respondents in China. The sample size and independent variables involved anonymously at each investigation site and were collected in the study were small and should be increased in future stud- and checked after informed consent was provided by the ies. A comparative study involving CHSCs and stations and a respondents. The content of the questionnaire mainly included longitudinal study is warranted. Family Medicine and Community Health 2014;2(1):8–14 9 Fam Med Com Health: first published as 10.15212/FMCH.2014.0105 on 1 March 2014. Downloaded from ORIGINAL ORIGINAL RESEARCH Fan et al. Table 1. Comparison of sociodemographic characteristics of the two groups [n (%)] Item Urban Suburban χ2 value P value Gender 0.370 0.543 Male 108 (44.81) 117 (47.56) Female 133 (55.19) 129 (52.44) Age (years) 18.168 0.003 0~29 35 (14.52) 32 (13.01) 30~39 22 (9.13) 39 (15.85) 40~49 25 (10.37) 39 (15.85) 50~59 37 (15.35) 53 (21.55) 60~69 62 (25.73) 43 (17.48) ≥70 60 (24.90) 40 (16.26) Income (yuan/month) 9.028 0.108 0~999 13 (5.39) 27 (10.98) 1000~1999 53 (21.99) 64 (26.02) 2000~2999 86 (35.69) 79 (32.11) 3000~3999 44 (18.26) 42 (17.07) 4000~4999 22 (9.13) 21 (8.54) ≥5000 23 (9.54) 13 (5.28) Level of education 66.543 <0.001 Illiterate/semi-literate 21 (8.71) 42 (17.07) Primary school
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