Study On The Carrying Out And Demand Willingness To The Hospital At Home Among The Elderly With Chronic Diseases In Guangzhou

BackgroundDue to the rising population aging and the change of the disease, showing a trend of diversification of the demand for health services, then the increasingly prominent contradiction between supply and demand of health resources, only with the center of the hospital medical service mode cannot meet the demand for health services in the diversification. As a new medical forces, the Hospital at Home service is the supplement and extension of hospital beds. Hospital at Home is the family as a nursing, choosing suitable environment for health or disease rehabilitation, let the victim in the familiar environment for medical treatment and nursing, including disease census, health education and consultation, to prevent and control the occurrence of diseases development, providing "prevention, medical treatment, health care, rehabilitation, health education and family planning" six comprehensive services. Hospital at Home, according to the requirements of patients, going out the hospital, door-to-door service, can make full use of health resources, improve the hospital beds turnover, relieve expensive, the length of difficult problem, also provide continuous support for disease treatment and rehabilitation in later stage. having convenient, fast and aspects of advantages. At the same time, hospital at home as a best form of chronic disease management, through the way such as disease education, rehabilitation guidance, patients further understand the knowledge about the disease then learn to self-protection, as much as possible to avoid the occurrence of complications and improve efficiency in the use of health resources, reduce the cost of medical treatment cost, meet the increasing health needs, so the development of Hospital at Home to adapt to the situation of the development of the aging population. Therefore, we must vigorously develop Hospital at Home service, and organically combine the hospital treatment, outpatient treatment with Hospital at Home to solve the demand of basic medical and public health. With the change of the current social medical model and health system reform deepening, Hospital at Home service becomes the future medical newcomer. How about its current situation? How about the needs of the elderly patients with chronic diseases? These problems become the focus of the society. This thesis mainly divided into two parts for research:the first part is the carrying out of status quo about hospital at home in Yuexiu district of Guangzhou in 2008-2012. The second part is the demand for Hospital at Home service in elderly patients with chronic diseases and its influencing factors. By retrospective survey research methods to describe the carrying out of Hospital at Home in Yuexiu district of Guangzhou for five years, by the method of cross-sectional study to describe the demand situation of Hospital at Home on elderly patients with chronic diseases and its influence factors.ObjectiveRetrospective investigation the carrying out of Hospital at Home in Yuexiu district of Guangzhou community health service institutions in 2008-2012,and cross-sectional survey 250 chronic diseases patients demand for Hospital at Home. Demanding as guide, finding out the various factors affecting Hospital at Home. According to the existing problems, Putting forward the corresponding suggestions for community health service agencies to establish and improve the Hospital at Home, and providing reasonable scientific basis for optimizing the allocation of health resources.MethodsThe first part:a retrospective survey. Under the support and help from the district health bureau to collect the specific data of Hospital at Home in Yuexiu district in Guangzhou in 2008-2012, analyzing the basic situation of the Hospital at Home patients, disease composition, domestic sickbed expenses, etc.The second part:a two-stage random sampling method. First stage:random cluster sampling, randomly selecting four community health service agencies from 22 community health service institutions in Yuexiu district of Guangzhou. Second stage:Simple random sampling. Under the district health bureau guidance and support, each community health service institutions extract 80 patients to access the records of community health service institutions with a chronic illness records, according to the unified into and exclusion criteria, choosing eligible 320 cases of elderly patients with chronic diseases and above the age of 50. According to the time the patients need follow-up investigation to determine, a total of 280 cases of questionnaires were asked in 2014, and no appointment of 40 patients, which we take the door face to face questionnaire survey. Because of the impact of patient compliance, we take back 297 questionnaires, according to the requirement to eliminate invalid questionnaire to get effective questionnaire 250, effective rate 84.2%. The investigation of the content mainly includes:basic data; Suffering from chronic diseases; the cognitive; use of hospital at home and desire; patients daily life ability scale; the family function scale, etc. Epidata3.02 software is adopted to establish the database and SPSS 13.0 statistical software for data analysis, P< 0.05 for the difference was statistically significant.ResultsThe first part:the number of health service agencies to carry out Hospital at Home increase year by year, opening rate at about 50% each year. Also is the Hospital at Home number, but growth rate is not a straight line. Patient age bias ageing and priority to the chronic diseases. The total fees and drug fees of hospital at home are also rising, and drug expenses accounted for over 50% of the total expense ratio in each year.The second part:the survey of demanding for hospital at home service in elderly patients with chronic intention and its influencing factors. This survey gave out 320 questionnaires,297 took back,250 valid questionnaires, effective recovery rate was 84.2%.during 250 chronic diseases patients, male 36%, female 64%; Mostly concentrated in the 70-79, accounted for 30.8%, the average age of 70.66±10.669; education most of junior high school level, accounting for 37.6%; household income is mainly concentrated in 2000-5000 Yuan and more than 50000; 13.6% of the patients suffering from chronic diseases,86.4% of the patients suffered from two or more chronic diseases, the average man suffers from 2.82 kinds of chronic diseases: medical expense way take 52.8% as basic medical insurance for urban workers, and self-paid part of medical expenses, mainly from children and retirement; the most frequently clinic medical institutions is community health service agencies, and the reason is close to home, low prices and familiar with the doctor; during 250 patients, 197 people expressed a willingness to accept hospital at home, intend to rate of 78.95%; 42.4% of the patients had heard of "Hospital at Home, and really know the exact meaning of Hospital at Home "only 30.8%. In addition,32% of the respondents said once received Hospital at Home service, only 24% of respondents are receiving Hospital at Home services, while 64% of respondents said need Hospital at Home service. A total of 19 factors influence the demand intention for Hospital at Home for single factor analysis, age, culture level, respectively, engaged in the occupation, way of living, family income, medical expenses bear way, main source self-paid part of medical expenses, walk to the time needed for recent medical institutions, the last two weeks treatment, nearly a year of medical expenses, daily life ability, can independence to go to a doctor, caregivers, family daily life function, whether heard family, whether know home bed literally, whether received home to bed, whether to need to build a home bed, whether is undergoing home bed. Multiple logistic regression analysis, the exclusion of all other interference factors, mainly 9 factors:the influence of age, educational level, family income, respectively, the responsibility for medical expense way, the last two weeks treatment, daily life ability, family functioning, whether know the exact meaning of family bed, bed ever received home. Willingness to older counterparts in bed rate is higher; High degree of culture than low more willing to accept the home on the bed; Willingness to high family income rate is high; At public expense, new farmers, willingness to form town worker medical insurance rate is high; The last two weeks have willingness to take measures for treatment rate is high; Willingness to daily life power dependence rate is high; Family functioning good intention rate is high, heard of, and once received home bed service willingness rate is high.Conclusion1. Hospital at Home got a promotion in the community services, but as a result of the policy lag and the shortages of medical service conditions hindered the development of the hospital at home, leading to a slow growth rate.2. Hospital at Home service is beneficial to reduce health care costs and provide economic, convenient and effective medical service.3. To establish Hospital at Home not only meet the needs of patients with chronic medical service, also is the important measures to alleviate "see a doctor expensive, see a doctor difficult" problem.4. The influence factors of demand for Hospital at Home in elderly patients with chronic are various, including age, cultural level, family income, medical expenses bear way, the last two weeks treatment, daily life ability, family functioning, whether know the exact meaning of family beds, ever received hospital at home. Relevant departments should take effective measures to improve the residents’ living conditions, host activities and improve the intention of Hospital at Home.5. Hospital at Home not only improve the community health service institutions, still can alleviate the pressure of the big hospital outpatient service, promoting the allocation of health resources, and is the effective way to realize "two-way referral".6. To strengthen the management of community health service institutions for chronic diseases, setting up electronic patient records filing to meet the demand for health services in various in elderly patients with chronic diseases.7. The community health service institutions should actively develop Hospital at Home services, increasing publicity, organization health services in the community, let patients really understand Hospital at Home service connotation, improving the Hospital at Home service awareness and participation.