AU - JOUR AU - Ma, AU - qian AU - Sun, AU - xu崔东旭，AU - fang翟芳芳，AU -赵云凯，AU - He, AU - Jie, AU - Shi, AU - Jinming, AU - high, AU - Jinghong, AU - Li, Mingyuan AU - Zhang, Wenjie PY - 2020 DA - 2020/9/3 TI -互联网对中国成年人医疗决策的影响:纵向数据分析JO - J Med Internet Res SP - e18481 VL - 22 IS - 9 KW -互联网KW -医疗决策KW -医疗服务提供者选择KW -成人KW -纵向数据分析KW -分层医疗政策AB -背景:互联网导致了医疗信息的爆炸式增长，极大地提高了医学知识的可获得性。这使得互联网成为居民就医前获取医疗信息和知识的主要途径之一。然而，关于互联网如何影响医疗决策的研究很少。目的:本研究的目的是探讨中国18岁及以上成年人的网络行为与医疗决策的关系，包括是否去医院和选择哪个级别的医疗机构。方法:以城乡12个地区的成年居民(≥18岁)为研究对象，分析不同特征成年人在医疗选择上的差异，采用广义线性混合模型对2006 - 2015年中国健康营养调查的纵向数据进行分析。结果:不同年龄、性别、受教育程度、地区、居住地、伤病严重程度、高血压发病年限、慢性病史的成年人在医疗决策上存在差异，差异有统计学意义(P< 0.05)。在控制了这些潜在的混杂因素并以自我护理为参照后，参与网络浏览活动的中国成年人选择医院护理的概率为0.82 (95% CI 0.69-0.98;P=.03)，是不参加网上浏览活动的居民的两倍。在医疗机构选择方面，参与在线浏览活动的成年人为1.86 (95% CI 1.35-2.58; P<.001) times more likely to opt for municipal medical treatment than primary care. However, the effect of online browsing on the selection probability of county-level hospitals was not significant compared with primary hospitals (P=.59). Robust analysis verified that accessing the internet had a similar effect on Chinese adults’ medical decisions. Conclusions: Chinese adults who use the internet are a little less likely to go to the hospital than self-care. The internet has broken down the barriers to obtain knowledge of common diseases and thus has a slight substitution effect of self-care on hospital care. Internet use may increase the probability of adults going to municipal hospitals. The rising tendency of visiting high-level medical institutions may be consequently exacerbated due to knowledge monopoly of severe and complicated diseases that is difficult to eliminate, and the increase in inconsistent and incomplete medical information online will blur the residents’ cognitive boundary of common diseases and severe diseases. Exploring the substantive impact of the internet on medical decision making is of great significance for further rational planning and utilization of the internet, in order to guide patients to appropriate medical institution. SN - 1438-8871 UR - //www.mybigtv.com/2020/9/e18481 UR - https://doi.org/10.2196/18481 UR - http://www.ncbi.nlm.nih.gov/pubmed/32880581 DO - 10.2196/18481 ID - info:doi/10.2196/18481 ER -