农村居民常见病首诊购买决策模型及干预策略研究

It is the development direction of health policy to provide basic services for common diseases treatment. There is still a gap between the primary medical treatment of common diseases of rural residents. There is a lack of special research on the behavior and influencing factors of the first diagnosis of common diseases in rural residents. In view of this, this study introduces the theory of consumer purchase decision, and applies structural equation modeling to the rural residents' needs for the first diagnosis of common diseases as a starting point, focusing on the real process of the first purchase decision making, and comprehensively capturing the factors that affect the first visit purchase decision. Scientifically define the influencing factors and process of decision making, build the purchase decision model of common diseases in the rural residents, and quantitatively reveal the size of the influencing factors and its action mechanism. Based on the model, evidence based design can effectively influence the decision making intervention strategy set. First of all, the first diagnosis of common diseases of rural residents purchase decision factors of induction potential promotion, obstacles and traction factors, explore the influence factors on the effect path of purchase decision; secondly, the construction of rural residents first diagnosed common disease purchase decision model: first hypothesis theory model, and then verify the mathematical model; finally, study the intervention strategies of rural residents first diagnosed primary common disease purchase decision. The implementation of this project provides new ideas for the theoretical research on medical behavior and the application of consumer purchase decision theory to new fields.

常见病治疗以基层服务提供为主是卫生政策的发展方向，农村居民常见病基层首诊离目标仍有差距。已有研究缺乏对农村居民常见病首诊行为和影响因素进行专门的研究。鉴于此，本研究引入消费者购买决策理论，运用结构方程模型，以农村居民常见病首诊需求为出发点，围绕其首诊购买决策的真实过程，全面捕捉影响其首诊购买决策的因素。科学的界定决策的影响因素和过程，构建农村居民常见病首诊购买决策模型，定量揭示影响因素的大小和其作用机制，以模型为基础，循证设计有效影响决策的干预策略集。首先，对农村居民常见病首诊购买决策影响因素进行研究：归纳潜在促进、阻碍与牵引力因素集，探索影响因素对购买决策的作用路径；其次，构建农村居民常见病首诊购买决策模型：先假设理论模型，再数理验证模型；最后，进行农村居民常见病基层首诊购买决策的干预策略研究。本项目的实现为就医行为的理论研究提供新的思路，亦将消费者购买决策理论应用拓展新的领域。

常见病治疗以基层服务提供为主是卫生政策的发展方向，农村居民常见病基层首诊离目标仍有差距。本研究引入消费者购买决策理论对农村居民常见病首诊行为和影响因素进行专门的研究。为了使消费者购买决策理论更好融入到农村居民常见病首诊购买决策过程，本研究以农村居民常见病首诊需求为出发点，围绕其首诊购买决策真实过程，构建农村居民常见病首诊购买决策的四个阶段即：需要识别和确定，购买动机形成，信息选择和方案抉择，首诊后评价。然后通过全面捕捉各阶段潜在影响因素，构建农村居民常见病首诊购买决策理论模型，运用结构方程进行数理验证模型，定量揭示影响因素的大小和其作用机制，以模型为基础，循证设计有效影响决策的干预策略集。研究结果表明，本次调研的3136名农村常见病患者整体的基层首诊率为77.8%（包括32.7%药店买药）；不同社会人口学特征的患者，其疾病需求、对基层机构诊疗能力和服务的评价、相关政策的知晓和认知状况具有显著的统计学差异；而亲友、医务人员等对其就医选择和转院等决策行为的社会支持与其基层首诊决策行为呈负相关。根据理论和实证研究结果，提出并筛选优化了农村居民常见病基层首诊决策模型的干预策略，主要包括加强常见病、多发病和慢性病的健康教育，提高农村居民健康素养；加强宣传，提高分级诊疗、基层首诊等政策知晓度；加强基层医疗机构内涵建设，提高诊疗保障能力等三方面内容，以促使农村居民常见病基层首诊决策行为的形成，引导其建立良好的就医行为和习惯，使其理性选择医疗机构，实现其常见病基层首诊的政策目标。