【摘要】 目的 探讨慢性病患者使用互联网媒介对其卫生服务利用的影响及机制，为优化互联网+慢病管理提供依据。方法 基于知沟理论和安德森卫生服务利用行为模型，构建认知与行为的系统解释框架，使用中国健康与营养调查（CHNS）数据，建立认知的多元线性回归模型、卫生服务利用的无序多分类logistics模型及调节效应模型，探索互联网媒介使用对慢性病患者卫生服务利用的影响及机制。结果 互联网媒介使用时间增加1%，不同受教育程度的慢性病患者的健康信息知识差距扩大0.919个单位（P<0.001），可见确实存在健康信息知沟现象。调整其他变量的影响后，慢性病患者中选择门诊与预防保健服务相对于仅选择门诊服务，互联网媒介使用时间每增加1%将使这一相对风险值降低48.4%(P<0.05)，且受教育程度增加起正向调节作用。结论 互联网媒介使用造成不同受教育程度的慢性病患者健康信息知沟现象，并降低其门诊和预防保健服务利用偏好，受教育程度在其中起正向调节效应。因此，建议监测健康信息知沟变化，加强监管互联网健康信息发布主体，优化互联网+慢病管理的布局。更多还原

【Abstract】 Objective To explore the impact and mechanism of chronic disease patients’ use of Internet media on their health service utilization, and to provide a basis for optimizing the management of Internet+consumption of chronic diseases. Methods Based on the knowledge gap theory and Anderson’s behavioral model of health service utilization, we constructed a systematic explanatory framework of cognition and behavior, and used the data from the China Health and Nutrition Survey(CHNS) to establish a multiple linear regression model of cognition, an unordered multiclassified logistic model of health service utilization and a model of moderating effect, to explore the influence and mechanism of Internet media use on the utilization of health services by patients with chronic diseases. Results A 1% increase in Internet media use time widened the gap in health information knowledge among chronic disease patients with different levels of education by 0.919 units(P < 0.001). After adjusting for the effects of other variables, each 1% increase in Internet media use reduced this relative risk value by 48.4%(P < 0.05) for choosing outpatient and preventive health care services versus choosing outpatient services only among patients with chronic diseases, and increased education positively moderated this effect. Conclusion The use of Internet media causes the phenomenon of health information gap among chronic disease patients with different education levels, and reduces their preference for the utilization of outpatient and preventive health care services. Educational level has a positive moderating effect in this process. Therefore, it is recommended to monitor the changes of health information knowledge gap, strengthen supervision of Internet health information publishers, and optimize the layout of Internet + chronic disease management.更多还原