目的 了解长沙市社区老年人的慢性病患病情况、就医意向及影响因素,为推广社区首诊制提供依据。方法 采用多阶段分层抽样法从长沙市所辖的五个行政区抽取65岁以上老年人6 000名作为调查对象,对其就医意向及相关因素进行调查。结果 长沙市社区老年人慢性病患病率为86.34%。其中,高血压、冠心病、骨关节病、糖尿病是本地区老年人较为常见的慢性病。调查对象中有4 322人(75.3%)患病时首选二级及以上医院就诊,1 021人(17.79%)选择到社区卫生服务中心就诊,397人(6.91%)选择私人诊所或自我医疗。不同行政区域、年龄、文化程度、收入水平、同住人员的老年人,首诊医疗机构选择间差异有统计学意义(P＜0.05)。结论 长沙市老年人社区首诊的就医观念尚未普及。提高社区卫生服务机构水平、转变就医观念、为老年人提供个体化的卫生服务是推行社区首诊、双向转诊的有效途径。

Objective To investigate the incidence of chronic diseases, medical care-seeking intention and its influencing factors among the community-dwelling elderly in Changsha city, and to provide a basis for promoting community first diagnosis. Methods Multi-stage cluster random sampling method was used to select 6, 000 senior citizens aged 65 years and above in 5 administrative districts of Changsha city, and their medical care-seeking intentions and the related factors were investigated. Results The incidence rate of chronic diseases among the community-dwelling elderly in Changsha city was 86.34%, of which hypertension, coronary heart disease, osteoarthropathy and diabetes prevailed among them. Among the elderly surveyed, 4, 322 (75.3%) firstly chose secondary and above hospitals when they had a chronic illness, 1, 021 (17.79%) chose the community health service center, and 397 (6.91%) chose private clinics or self-treatment. There were statistically significant differences in the selection of medical institution for first diagnosis among the elderly with different administrative districts, ages, educational backgrounds, monthly incomes and companions (all P<0.05). Conclusions Medical care-seeking intention regarding community first diagnosis is not prevalent among the elderly in Changsha city. Improving the level of community health services, changing the concept of visiting doctors and providing individualized medical services for the senior citizens are the effective ways to practice community first diagnosis and dual referral.