Analysis Of The Evaluation Of Community Primary Health Care Services By Elderly Patients With Chronic Diseases In Urban Areas And The Factors Affecting Them

Objective(1)Through a questionnaire survey of elderly chronic disease patients in urban areas,the objective experience of the patients in actually receiving the services was used to understand the evaluation of primary health care services by this population and its influencing factors.(2)To quantitatively assess the current status of community health management based on the context of family doctor contracted services,and to provide improvement strategies for community health management.Methods In this study,a simple random sample of 510 elderly patients with chronic diseases who were within the jurisdiction of three community health service centres in Hefei City,Sanlian Street,Hongguang Street and Silihe Street,who were not out of contact and had established electronic records,was taken as the study population from January 2021 to December 2021.Patients are divided into contracted and non-contracted groups based on the presence or absence of a contracted family doctor.The Primary Care Assessment Tool-Adult Edition(PCAT-AE),the Treatment Burden Questionnaire(TBQ)and the General Information Questionnaire were administered to patients.Medical examination information on these patients is also collected from an electronic database.Statistical analysis of the above data was carried out using IBM SPSS 26.0 software.Frequency and percentages were used to describe the demographic characteristics of elderly chronic disease patients in urban areas.Theχ~2 test was used to compare the differences in clinical indicators between the two groups of elderly chronic disease patients in urban areas,and the t-test was used to compare the differences in PCAT-AE scores between the two groups of elderly chronic disease patients in urban areas.The total PCAT-AE score was used as the dependent variable for one-way analysis using t-test or ANOVA,and factors with statistically significant differences were subjected to multiple linear regression to explore the factors influencing the differences in the evaluation of community primary health care services by elderly patients with chronic diseases in urban areas.Results 1.Basic information about the study subjects:the study covered 462 instances,202 cases(43.72%)were male and 260 cases(56.28%)were female,with a male to female ratio of 1:1.29,with a female predominance.The age range of the survey respondents was between 65 and 94 years.146 cases(31.60%)were aged 65 to 69,118cases(25.54%)were aged 70 to 74,82 cases(17.75%)were aged 75 to 79,62 cases(13.42%)were aged 80 to 84 and 54 cases(11.69%)were aged 85 and above.Education level:there were 304 cases(65.80%)with junior high school education or below.Marital status:322 cases(69.70%)were married,48 cases(10.39%)were divorced or unmarried,and 92 cases(19.91%)were widowed.Medical payment method:medical insurance in455 cases(98.48%),self-payment in 7 cases(1.52%).Monthly per capita household income:mainly<3,000 yuan and 3,000-5,999 yuan,156 cases(33.77%)and 241 cases(52.16%)respectively.2.Clinical index of elderly patients with chronic diseases in urban areas:the compliance rates of BP,FPG,UA,TC and TG in elderly patients with chronic diseases in the contracted family doctor group were 63.9%,59.7%,85.0%,74.5%and 68.7%,respectively;The BP,FPG,UA,TC and TG of elderly patients with chronic diseases in the group of uncontracted family doctors were 67.1%,43.9%,73.2%,58.5%and 50.0%,respectively.There were statistically significant differences in the standards of FPG,UA,TC and TG between the two groups(P<0.05),indicating that the group of contracted family doctors reached the above indicators better than the group of uncontracted family doctors,and the BP attainment and BMI value between the two groups were not statistically significant(P>0.05).3.PCAT-AE score of elderly patients with chronic diseases in urban areas:the scores of PCAT-AE dimensions and total scores of the scale in the group of contracted family doctors were higher than those in the group of non-contracted family doctors,and the difference was statistically significant(P<0.001).4.The results of multiple linear regression showed that the number of chronic diseases,the presence or absence of a contracted family doctor and the presence or absence of hospitalization in the last 3 years were the influencing factors of PCAT-AE scores(P<0.05).Among them,those who had 2 or more chronic diseases,those who had contracted a family doctor,and those who had hospitalization in the last 3 years had higher PCAT-AE scores.Conclusion 1.Signing up with a family doctor helps improve disease control among elderly chronic disease patients in urban areas;it helps improve the evaluation of primary health care services by elderly chronic disease patients in urban areas and enhances their health care experience.2.Elderly patients with chronic diseases in urban areas have a low opinion of the primary health care services provided by primary care institutions in terms of community orientation,primary care utilization and co-ordination,and the level of services in these areas still needs to be improved.3.Elderly chronic disease patients in urban areas who were contracted to a family doctor,had 2 or more chronic diseases and a history of hospitalisation in the last 3 years had higher PCAT-AE scores.