The tiered healthcare delivery system is a crucial component in deepening healthcare reform. Analyzing the healthcare-seeking choices of outpatients and their influencing factors from the demand-side perspective, based on real-world data, holds significant practical importance for advancing the tiered healthcare system and promoting the high-quality development of healthcare services.

To identify outpatient healthcare-seeking behavior and influencing factors among residents of Guangdong Province in the context of tiered healthcare system. The report is for supporting policies on rational healthcare utilization.

Data were obtained from the Seventh National Health Service Survey, which was completed in september-october 2023, covering eight sampled counties (districts/cities) of Guangdong Province. The study population consisted of residents who reported experiencing an illness within two weeks and sought medical care at a healthcare institution (n=2 213). Taking "whether patients choose first contact at primary care facilities for sickness within two-weeks" as the dependent variable, a multivariate Logistic regression analysis was conducted to identify the influencing factors.

Of the residents who reported an illness within the two-week period, 1 597 individuals [accounting for 72.16%] sought their initial medical consultation at a primary healthcare institution. Patients in rural areas (OR=1.561, 95%CI=1.170-2.082), proximity to a primary care facility (OR=3.870, 95%CI=2.915-5.136), enrollment in urban-rural resident basic medical insurance (OR=2.209, 95%CI=1.695-2.879), and perceived mild illness (OR=3.458, 95%CI=2.449-4.883) were more likely to choose primary care facility, while those with education levels above high school (OR=0.498, 95%CI=0.293-0.847) and didn't contract with a family doctor (OR=0.671, 95%CI=0.504-0.894) were more likely to seek care at non-primary healthcare institutions.

The majority of Guangdong residents preferred primary care facility for first contact, but there is still a space of improvement. Both environmental and individual factors significantly influence healthcare-seeking choices. Efforts should focus on optimizing the distribution and accessibility of primary care facilities, strengthening service capacity and management efficiency, to promote rational healthcare utilization of residences.