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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15.	杜英, 侯寶君, 張建新, 等. 阜平縣鄉鎮衛生院醫療資源配置現狀分析及對策. 河北醫藥, 2018, 40(10): 1565-1568.
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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.	Liobikien? G, Bernatonien? 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.	中國自然醫學雜志編輯部. 劃分中老年人年齡的標準. 中國自然醫學雜志, 2001, 3(4): 211.
23.	周啟良. 城市化對城市居民衛生服務需求的影響: 基于我國283個地級及以上城市的經驗證據. 中國衛生經濟, 2014, 33(12): 8-10.
24.	中華醫學會糖尿病學分會. 中國2型糖尿病防治指南(2017年版). 中國實用內科雜志, 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. 侯清濤, 李蕓, 李舍予, 等. 全球糖尿病疾病負擔現狀. 中國糖尿病雜志, 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, 石丹華, 敖梅, 等. 社區2型糖尿病患者自我血糖監測的干預研究. 臨床醫藥文獻電子雜志, 2017, 4(19): 3675.
9. 李建新, 夏翠翠. 我國城鄉老年人口醫療服務可及性差異研究-基于2011年中國老年健康影響因素跟蹤調查數據. 中國衛生政策研究, 2014, 7(9): 42-47.
10. 李敏, 劉華富. 北京城鄉中老年人健康體檢當前行為與潛在需求研究. 人口與發展, 2018, 24(2): 79-89.
11. 李明, 張霞, 楊坤. 農村衛生服務可及性與政策改進—基于四川省調研數據的分析. 農村經濟, 2017, (6): 127-130.
12. 李玉嬌. 城鄉差異、就醫慣性與老年人衛生服務利用. 西北人口, 2016, 37(2): 5-10.
13. 王寧寧, 徐淑一. 我國中老年人門診醫療服務利用的影響因素及城鄉差異分析. 醫學與社會, 2017, 30(5): 48-51, 70.
14. 夏敬. 加強農村基層醫療衛生人才隊伍建設措施探討—基于大連市的實證分析. 人才資源開發, 2017, (22): 61-63.
15. 杜英, 侯寶君, 張建新, 等. 阜平縣鄉鎮衛生院醫療資源配置現狀分析及對策. 河北醫藥, 2018, 40(10): 1565-1568.
16. 程蘭花, 楊德剛. 烏昌地區醫療衛生資源失配度時空演化特征. 中國科學院大學學報, 2018, 35(3): 382-390.
17. 顧一飛, 林楓. 新醫改背景下鄉鎮衛生院的資源配置與利用分析. 行政事業資產與財務, 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. Liobikien? G, Bernatonien? 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. 中國自然醫學雜志編輯部. 劃分中老年人年齡的標準. 中國自然醫學雜志, 2001, 3(4): 211.
23. 周啟良. 城市化對城市居民衛生服務需求的影響: 基于我國283個地級及以上城市的經驗證據. 中國衛生經濟, 2014, 33(12): 8-10.
24. 中華醫學會糖尿病學分會. 中國2型糖尿病防治指南(2017年版). 中國實用內科雜志, 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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