关键词: 双向转诊, 家庭医生, 中青年, 楼宇白领, 认知, 服务利用

Abstract: Background　Bi-directional referral services are an important part of tiered healthcare services in China. There are few studies on such services under the conditions that it is difficult and expensive for the masses to see a doctor. Analyzing their perception，utilization and satisfaction regarding bi-directional referral services is of great significance to the promotion of such services. Objective　To explore the perceptions，utilization and satisfaction regarding bi-directional referral services as well as associated factors in young and middle-aged white-collar workers working in office buildings. Methods　From August to September 2019，we used multi-stage sampling to select employees working in eight business office buildings in Shanghai's Hongkou District to participate in a questionnaire survey for obtaining data about their general demographics，socio-economic status，perceptions，utilization and satisfaction regarding bi-directional referral services. The survey gained a response rate of 95.48%（993/1 040）. Results　The rate of knowing bi-directional referral services was 17.27%（167/967）. Among 958 respondents who had self-reported use of referral services，165（17.22%） used bi-directional referral services. Among 182 who had self-reported use of referral mode，101（55.49%） asked for referral themselves，43（23.63%） were referred following the advice of their physician-in-charge，and 38（20.88%） asked for referral themselves and also were suggested for referral by their physician-in-charge. Of the 181 respondents who had self-reported referral process，108（59.67%） thought that their referral did not run smoothly. In terms of satisfaction with the services，the rates of being "very dissatisfied" "partly satisfied" "fairly satisfied" "relatively satisfied" "very satisfied" with the services were 8.51%（16/188），16.49%（31/188），54.26%（102/188），18.09%（34/188），and 2.66%（5/188），respectively. Both rates of knowing and utilizing bi-directional referral services varied significantly in the respondents by sex，usual address，marital status，education level，occupation，annual income，level of knowing family doctors and utilization of family doctor services（P<0.05）. The level of satisfaction with bi-directional referral services varied significantly in the respondents by education level and occupation（P<0.05）. Conclusion　Our survey suggests that this group have relatively low rates of knowing and utilizing bi-directional referral services，and the understanding of family doctors and use of family doctor services may partly improve the rates of knowing and utilizing referral services，eventually promoting seeking healthcare in primacy care，relieving the pressure of higher level hospitals，and stabilizing the implementation of tiered healthcare system.

Key words: Bi-directional referral, Family doctor, Young and middle-aged people, White-collar workers in buildings, Cognition, Services utilization