Objective: To explore the characteristics of health seeking behaviors and relevant factors among the outpatients with psoriasis in a general hospital, and to provide scientific evidence to modify the inappropriate health seeking behaviors for psoriasis patients and improve the therapeutic effect.
Methods: Using cross-sectional study design, a dermatological clinic in a general hospital was selected for this study. Two hundred psoriasis outpatients from 1st April to 30th September in 2014 were enrolled. A series of questionnaires were used to collect information regarding the social-demographic characteristics, health seeking behaviors, knowledge on psoriasis, and depressive and anxious symptoms.
Results: Among 200 psoriasis outpatients, 141 patients (70.5%) experienced transfer treatment. One hundred and eighty-two patients (91.0%) went to formal hospitals in county for treatment when symptoms were firstly displayed; the other 18 patients (9.0%) went to village or community clinics, or the private clinics. Over 50% patients chose municipal hospital and 35.0% patients went to provincial hospital for medical treatment among the 182 patients. Ninety-one percent of the patients made decision for the first treatment after consulting with their spouses or relatives. According to the definition of the appropriate health seeking behavior in this study, 50 patients (25%) had inappropriate health seeking behaviors. Logistic regression analysis showed inappropriate health seeking behaviors correlated with the family whose income was less than 3 000 yuan per person per month (OR=2.232, 95%CI 1.086 to 4.585), patients who made the decision for the treatment with no discussion with other people when the symptoms appeared (OR=3.016, 95%CI 1.023 to 8.893), and the high score of the International Psoriasis Severity Index (OR=1.043, 95%CI 1.001 to 1.088).
Conclusion: The dermatological practitioner should pay more attention to the factors, such as social-demographical characteristics, especially the low level of family income and their treatment experience. It is necessary for the general hospital to conduct health education for psoriasis outpatients to promote their appropriate health seeking behaviors.
目的：了解某综合医院银屑病患者的求医行为特征及其影响因素，为促进银屑病患者形成规范的求医行为、提高其临床治疗效果及生活质量提供参考资料。方法：在横断面研究设计下，以中南地区某大型三级甲等综合医院皮肤性病科门诊作为研究现场，连续收集于2014年4月1日至9月30日期间，前来该门诊就诊且被有资质的皮肤性病专科医生诊断患有银屑病的门诊患者作为研究对象。对愿意参与研究的200名患者样本以面对面问卷调查方式，采用自编一般情况问卷、求医行为调查表和相关知识问卷了解患者社会人口学特征、求医行为情况以及相关知识知晓程度；采用国际通用的银屑病皮损面积和严重程度指数(Psoriasis Area and Severity Index，PASI)、病人健康问卷抑郁量表(Patient Health Questionnaire Depression Module，PHQ-9)和广泛性焦虑量表(Generalized Anxiety Disorder Scale，GAD-7)分别评定患者的疾病严重程度和情绪状态。结果：70.5%(141/200)的患者有转诊经历。在首诊过程中，91.0%(182/200)出现症状后选择县级及县级以上医疗机构接受治疗，其余9.0%(18/200)选择去乡镇卫生院或街道/社区门诊、私人门诊看病；在去县级及以上级别医疗机构就诊的患者中，51.0%的患者首诊医疗机构为地市级医院，其次为省级医院(35.0%)。91.0%的患者是与配偶或亲友商量后做出的首诊决定。有50名(25%)患者存在不规范求医行为。logistic回归分析结果显示：家庭人均月收入低于3 000元(OR=2.232，95% CI: 1.086~4.585)、初觉症状后由自己决定就医(OR=3.016， 95% CI: 1.023~8.893)、银屑病严重程度评分高(OR=1.043，95% CI: 1.001~1.088)与患者的不规范求医行为有统计学意义的关联。结论：在银屑病的临床诊疗中，医护人员应特别关注收入状况、求治过程等个人背景特征对其规范就医行为的影响，对症状严重的患者更应考虑在治疗的同时开展有针对性的健康教育工作。.