Abstract: Background　One of the core contents of the national medical reform is to implement hierarchical diagnosis and treatment，encourage primary treatment at the community level，and guide the residents to seek medical treatment orderly.It has also regarded the establishment of regional medical treatment partnership system （referred to as medical consortium） and the strengthening of hierarchical diagnosis and treatment as one of the new health care reform policies.However，there is still lack of relevant information about the awareness of community residents about hierarchical diagnosis and treatment，the willingness to seek primary treatment at the community level and their reasons.Objective　To investigate the awareness of primary treatment at the community level in Shijingshan district of Beijing and analyze the relevant reasons，so as to find out the problems existing in the implementation of hierarchical diagnosis and treatment，and guide residents to seek medical treatment in an orderly manner，so as to achieve the purpose of primary treatment in the community.Methods　Using convenience sampling method，residents who visited three core hospitals and 10 community health centers in Beijing from December 2015 to October 2016 were selected as the subjects of the survey.A self-designed structured questionnaire was used to conduct a questionnaire survey among medical staff engaged in the management of the medical consortium.The content of questionnaire included gender，age，monthly income，type of medical insurance，health status （whether there are chronic diseases），residents' awareness of primary treatment in the community，selection of primary treatment at the community level，residents' reasons for choosing primary treatment in the community，residents' expectations of community health service institutions.Results　A total of 680 questionnaires were sent out，674 questionnaires were recovered and 646 valid questionnaires were recovered，with an effective recovery rate of 95.00%.Among 646 residents，336 were males （52.01%） and 310 were females （47.99%）．Eighty-eight cases （13.62%） were aged <40 years，264 cases （40.87%） aged 40-65 years，294 cases （45.51%） aged > 65 years； health status：470 cases （72.76%） had a history of chronic diseases （hypertension，coronary heart disease，diabetes mellitus，and stroke） and 176 cases （27.24%） had no history of chronic diseases.52.94% （342/646） of the residents knew about the primary treatment in the community，and 45.51% （294/646） of the residents chose the primary treatment at the community level.The awareness rate and selection rate of community first-visit among residents with a history of chronic disease were higher than those without a history of chronic disease （P<0.05）．The main reasons for residents to choose community first-visit were more consistent treatment of chronic diseases （56.12%，165/294），close proximity to home，convenient transportation （39.46%，116/294），difficulty in registration and long waiting time （34.69%，102/294） in large hospitals.The main reasons why residents did not choose community first-visit were low medical level of community doctors，risk of delay （68.47%，241/352），inconvenience of two-way referral （64.77%，228/352），incomplete equipment of community examination and laboratory examination （48.01%，169/352）．The proportion of residents with a history of chronic disease not choosing the primary diagnosis in community due to the inconvenience of two-way referral and incomplete community inspection and testing equipment was lower than that of residents without a history of chronic disease （P<0.05）．The main expectations of residents for community health service institutions were：to improve the level of community health care，common diseases and frequently-occurring diseases can be cured in the community health centers（86.68%，560/646）； to increase the publicity of primary treatment at the community level （69.66%，450/646）； to facilitate and expedite referral between community health centers and hospitals in the medical consortium （65.94%，426/646）．Conclusion　The awareness and acceptance rate of hierarchical diagnosis and treatment mode was low.We should promote its publicity to residents，improve the capability of community health institutions to diagnose and treat diseases and referral services，and speed up the construction of two-way referral information system and remote consultation system.

Key words: Community health services, Hierarchical diagnosis and treatment mode, Primary treatment at the community level, Beijing

摘要： 背景　实施分级诊疗、鼓励居民社区首诊，引导居民有序就医，是国家医疗改革（简称医改）的核心内容之一，北京市卫生健康委员会也把建立区域医疗联合体（简称医联体）、强化分级诊疗作为新医改政策之一。但社区居民对政府有关分级诊疗政策内容的知晓程度、是否愿意社区首诊及其原因，目前尚缺乏相关信息。目的　调研北京市石景山区居民社区首诊的知晓情况，并分析相关原因，以便发现分级诊疗实施中存在的问题，引导居民进行有序就医，达到首诊在社区的目的。方法　采用便利抽样法，抽取2015年12月—2016年10月于北京市3家核心医院和10家社区卫生中心（简称社区）就诊的居民作为调查对象。采用自行设计的结构式调查问卷，由从事医联体管理工作的医务人员进行问卷调查。问卷内容包括性别、年龄、月收入情况、医保类型、健康状况（是否有慢性病史），居民对社区首诊的知晓情况，社区首诊的选择情况，居民选择社区首诊与否的原因，居民对社区卫生服务机构的期望。结果　共发放调查问卷680份，回收调查问卷674份，回收有效问卷646份，有效回收率95.00%。646例居民中男336例（52.01%），女310例（47.99%）；年龄：<40岁88例（13.62%），40~65岁264例（40.87%），>65岁294例（45.51%）；健康状况：470例（72.76%）有慢性病史（分别为高血压、冠心病、糖尿病、脑卒中等），176例（27.24%）无慢性病史。52.94%（342/646）居民知晓社区首诊，45.51%（294/646）居民选择社区首诊。有慢性病史居民对社区首诊的知晓率及社区首诊选择率均高于无慢性病史居民（P<0.05）。居民选择社区首诊的主要原因为慢性病在社区治疗更连贯（56.12%，165/294），社区卫生服务机构离家近、交通方便（39.46%，116/294），大医院挂号难、等待时间长（34.69%，102/294）。有慢性病史居民因大医院挂号难、等待时间长，社区就诊转至大医院方便，慢性病在社区治疗更连贯，认为自己是小病不用去大医院而选择社区首诊的比例高于无慢性病史居民（P<0.05）。居民不选择社区首诊的主要原因依次为社区医生医疗水平不高、有耽误病情的危险（68.47%，241/352），双向转诊不便捷（64.77%，228/352），社区检查、检验设备不全（48.01%，169/352）。有慢性病史居民因双向转诊不便捷，社区检查、检验设备不全而不选择社区首诊的比例低于无慢性病史居民，因社区药品不如大医院全而不选择社区首诊的比例高于无慢性病史居民（P<0.05）。居民对社区卫生服务机构的主要期望为：提高社区医疗水平，常见病、多发病在社区能治好（86.68%，560/646）；加大社区首诊的宣传力度（69.66%，450/646）；医联体内上、下级医院之间转诊方便、快捷（65.94%，426/646）。结论　目前北京市石景山区居民对社区首诊的知晓率和接受率较低，应加大社区对居民的宣传力度，提升社区卫生机构对疾病的诊疗能力和转诊服务能力，加快双向转诊信息系统和远程会诊系统建设。

关键词: 社区卫生服务, 分级诊疗, 社区首诊 , 北京