Access to healthcare and its determinants among Chinese diabetic patients_Chinese Journal of Evidence-Based Medicine

Authors：

YU Xuexin ¹ ,  ZHANG Wei ²

1. Hospital Management Institute, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;
2. West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;

Corresponding author：

ZHANG Wei, Email: weizhanghx@163.com

Keywords：

Diabetes; Health access; Determinants; Urban-rural disparities

DOI：

10.7507/1672-2531.201901014

Video：

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Objective To provide policy suggestions concerning the distribution of health resources between urban and rural areas and management and education of diabetes, this study depicted the current status of access to healthcare and analyzed its determinants among Chinese diabetic patients.Methods Multivariate ordinal logistic regression and multivariate binary logistic regression were employed to analyze the effects of socioeconomic status and urban-rural disparities on health access.Results Multivariate results suggested that urban patients were more likely to conduct more blood glucose tests (P<0.000 1) and receive more self-care suggestions from physicians (P=0.02). After controlling all other covariates, patients graduated from secondary schools and those with vocational school degrees or above were 1.61 and 2.44 times more possible to take more blood glucose tests.Conclusions There exists significant urban-rural disparities of access to healthcare among Chinese diabetic patients. Education may be a key factor of access to healthcare among Chinese diabetic patients. It’s highly recommended to implement education programs on diabetes management in rural areas, where the education status and demographic factors should be considered. The distribution of health resource in rural areas requires more policy and governmental support.

Citation： YU Xuexin, ZHANG Wei. Access to healthcare and its determinants among Chinese diabetic patients. Chinese Journal of Evidence-Based Medicine, 2019, 19(6): 645-650. doi: 10.7507/1672-2531.201901014 Copy

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17.	顾一飞, 林枫. 新医改背景下乡镇卫生院的资源配置与利用分析. 行政事业资产与财务, 2018, 3: 4-6.
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19.	Penchansky R, Thomas JW. The concept of access: definition and relationship to consumer satisfaction. Med Care, 1981, 19(2): 127-140.
20.	Liobikienė G, Bernatonienė J. The determinants of access to information on the Internet and knowledge of health related topics in European countries. Health Policy, 2018, 122(12): 1348-1355.
21.	Zhao Y, Strauss J, Yang GH, et al. China Health and Retirement Longitudinal Study, 2011-2012. Peking: Peking University.
22.	中国自然医学杂志编辑部. 划分中老年人年龄的标准. 中国自然医学杂志, 2001, 3(4): 211.
23.	周启良. 城市化对城市居民卫生服务需求的影响: 基于我国283个地级及以上城市的经验证据. 中国卫生经济, 2014, 33(12): 8-10.
24.	中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2017年版). 中国实用内科杂志, 2018, 38(4): 292-344.
25.	Braveman P, Egerter S, Williams DR. The social determinants of health: coming of age. Annu Rev Public Health, 2011, 32: 381-398.
26.	Williams DR, Costa MV, Odunlami AO, et al. Moving upstream: how interventions that address the social determinants of health can improve health and reduce disparities. J Public Health Manag Pract, 2008, 14(Suppl): S8-S17.

1. 侯清涛, 李芸, 李舍予, 等. 全球糖尿病疾病负担现状. 中国糖尿病杂志, 2016, 24(1): 92-96.
2. O'Connor A, Wellenius G. Rural-urban disparities in the prevalence of diabetes and coronary heart disease. Public Health, 2012, 126(10): 813-820.
3. Nwasuruba C, Osuagwu C, Bae S, et al. Racial differences in diabetes self-management and quality of care in Texas. J Diabetes Complications, 2009, 23(2): 112-118.
4. Karter AJ, Ferrara A, Darbinian JA, et al. Self-monitoring of blood glucose: language and financial barriers in a managed care population with diabetes. Diabetes Care, 2000, 23(4): 477-483.
5. Walker RJ, Gebregziabher M, Martin-Harris B, et al. Independent effects of socioeconomic and psychological social determinants of health on self-care and outcomes in type 2 diabetes. Gen Hosp Psychiatry, 2014, 36(6): 662-668.
6. Adams AS, Mah C, Soumerai SB, et al. Barriers to self-monitoring of blood glucose among adults with diabetes in an HMO: a cross-sectional study. BMC Health Serv Res, 2003, 3(1): 6.
7. Karter AJ, Ackerson LM, Darbinian JA, et al. Self-monitoring of blood glucose levels and glycemic control: the Northern California Kaiser Permanente Diabetes registry. Am J Med, 2001, 111(1): 1-9.
8. 薛君, 石丹华, 敖梅, 等. 社区2型糖尿病患者自我血糖监测的干预研究. 临床医药文献电子杂志, 2017, 4(19): 3675.
9. 李建新, 夏翠翠. 我国城乡老年人口医疗服务可及性差异研究-基于2011年中国老年健康影响因素跟踪调查数据. 中国卫生政策研究, 2014, 7(9): 42-47.
10. 李敏, 刘华富. 北京城乡中老年人健康体检当前行为与潜在需求研究. 人口与发展, 2018, 24(2): 79-89.
11. 李明, 张霞, 杨坤. 农村卫生服务可及性与政策改进—基于四川省调研数据的分析. 农村经济, 2017, (6): 127-130.
12. 李玉娇. 城乡差异、就医惯性与老年人卫生服务利用. 西北人口, 2016, 37(2): 5-10.
13. 王宁宁, 徐淑一. 我国中老年人门诊医疗服务利用的影响因素及城乡差异分析. 医学与社会, 2017, 30(5): 48-51, 70.
14. 夏敬. 加强农村基层医疗卫生人才队伍建设措施探讨—基于大连市的实证分析. 人才资源开发, 2017, (22): 61-63.
15. 杜英, 侯宝君, 张建新, 等. 阜平县乡镇卫生院医疗资源配置现状分析及对策. 河北医药, 2018, 40(10): 1565-1568.
16. 程兰花, 杨德刚. 乌昌地区医疗卫生资源失配度时空演化特征. 中国科学院大学学报, 2018, 35(3): 382-390.
17. 顾一飞, 林枫. 新医改背景下乡镇卫生院的资源配置与利用分析. 行政事业资产与财务, 2018, 3: 4-6.
18. Evans DB, Hsu J, Boerma T. Universal health coverage and universal access. Bulletin of the World Health Organization, 2013. Available at: http://dx.doi.org/10.2471/BLT.13.125450.
19. Penchansky R, Thomas JW. The concept of access: definition and relationship to consumer satisfaction. Med Care, 1981, 19(2): 127-140.
20. Liobikienė G, Bernatonienė J. The determinants of access to information on the Internet and knowledge of health related topics in European countries. Health Policy, 2018, 122(12): 1348-1355.
21. Zhao Y, Strauss J, Yang GH, et al. China Health and Retirement Longitudinal Study, 2011-2012. Peking: Peking University.
22. 中国自然医学杂志编辑部. 划分中老年人年龄的标准. 中国自然医学杂志, 2001, 3(4): 211.
23. 周启良. 城市化对城市居民卫生服务需求的影响: 基于我国283个地级及以上城市的经验证据. 中国卫生经济, 2014, 33(12): 8-10.
24. 中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2017年版). 中国实用内科杂志, 2018, 38(4): 292-344.
25. Braveman P, Egerter S, Williams DR. The social determinants of health: coming of age. Annu Rev Public Health, 2011, 32: 381-398.
26. Williams DR, Costa MV, Odunlami AO, et al. Moving upstream: how interventions that address the social determinants of health can improve health and reduce disparities. J Public Health Manag Pract, 2008, 14(Suppl): S8-S17.

Chinese Journal of Evidence-Based Medicine

Access to healthcare and its determinants among Chinese diabetic patients

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