关键词: 分级诊疗, 初级卫生保健, 病人意愿, 首诊, 常见病, 影响因素分析

Abstract: Background　The implementation of hierarchical medical system in a scientific and orderly way is a key approach to enhancing the efficiency of healthcare delivery，reasonably using healthcare resources，and reducing medical costs.In China，it is very obvious that rural residents prefer to seek healthcare in higher level hospitals instead of the primary healthcare institutions，which leads to the waste of health resources，and hinders the effective implementation of hierarchical medical system.Objective　To investigate Xuzhou rural residents' intention and associated factors of seeking healthcare in primary healthcare institutions for common diseases during the implementation of hierarchical medical system，providing a reference for the improvement of first consultations in primary care system.Methods　From July to August 2016，a survey was conducted among 800 rural residents selected from 4 counties of Xuzhou by stratified multistage random sampling.A structured questionnaire developed by our research team was used in the survey，which consists of demographic characteristics，views on the implementation of hierarchical medical system，and intention of having first consultations in primary care.Multivariate Logistic regression was used to analyze the influencing factors associated with the residents' intention of having first consultations in primary care.Results　The questionnaire survey achieved a response rate of 95.4%（763/800）．Of the respondents，82.1%（626/763）preferred to seek healthcare in primary healthcare institutions when having a common disease，mainly because of short distance and low medical cost.But 95.1%（726/763）preferred to seek healthcare in a general hospital when having severe conditions，mainly because of high-quality medical services，and good diagnostic and therapeutic equipments.Multivariate Logistic regression analysis showed that low medical costs in the past year，long distance between home and the nearest secondary or tertiary hospital，good treatment experience in the primary healthcare institution，supporting for the implementation of hierarchical medical system，and perception of the implementation of medical insurance programs being a facilitator for the development of hierarchical medical system were factors associated with higher probability of intending to have first consultations in primary care（P<0.05）．Conclusion　The rate of intention of having first consultations in primary care among Xuzhou rural residents is reasonable at large.Medical costs in the past year，distance between home and the nearest secondary or tertiary hospital，treatment experience in the primary healthcare institution，attitude toward the implementation of hierarchical medical system，and perception of whether the implementation of medical insurance programs could facilitate the development of hierarchical medical system are associated factors for intention of having first consultations in primary care.

Key words: Hierarchical medical system, Primary health care, Patient preference, First visit, Commom disease, Root cause analysis