One key to the development of the tiered diagnosis and treatment system lies in the establishment of a gatekeeping system in primary care supporting the implementation of first contact in primary care and the achievement of orderly healthcare-seeking. And the serving capacities of primary care professionals are essential in implementing first contact in primary care.

To understand the overall level of Henan primary care physicians' capabilities of diagnosing and treating common diseases, and to put recommendations for solving the problems.

In August 2020, by use of typical sampling method, physicians were selected from all primary care hospitals in four areas of Henan Province (Kaifeng's Xiangfu District and Lankao County, and Jiaozuo's Weidu District and Yanling County) . An online self-administered questionnaire survey was conducted with them for collecting information about their demographics, and capabilities of diagnosing and treating common diseases (involving the identification and diagnosis of common diseases, interpretation of relevant auxiliary examinations, and prescription of common medications) .

In all, 1 844 cases attended the survey, and 1 669 of them (90.51%) who effectively responded to the survey were included for final analysis. Among the 1 669 respondents, 917 (54.94%) had secondary health school education level or below, 663 (39.72%) had no professional title, 524 (31.40%) had a rural doctor certificate, and 509 (30.50%) had a practicing certificate. Among the 1 117 village doctors, 722 (64.64%) were 45 years old and above, 83 (7.43%) were 60 years old and above, and 848 (75.92%) had secondary health school education level or below. Among 1 631 respondents, 1 564 (95.89%) were basically able to diagnose and identify common diseases, 1 402 (86.00%) could interpret the results of common auxiliary examinations, 1 542 (94.54%) could prescribe common medications, and 1 336 (81.91%) had capabilities to diagnose and treat common diseases. Compared with urban primary care physicians, rural primary care physicians had higher level of capabilities in identifying and diagnosing common diseases as well as prescribing common medications, but lower level of capabilities in interpreting biochemical tests and electrocardiogram results (P<0.05) .

In general, the overall level of professional qualities was unsatisfactory in Henan primary care physicians, especially in those working in rural areas. Their level of capabilities for diagnosing and treating common diseases was generally satisfactory, although there is still much room for improvement. A sound cooperative mechanism between primary care hospitals and higher level hospitals should be established to ensure the safety in primary care.

建立基层卫生"守门人"制度，实现基层首诊、有序分流，是分级诊疗制度建设的关键，而要实施基层首诊，重点在于基层卫生队伍的医疗服务能力建设。

了解河南省基层医生常见病诊疗服务能力现状，分析存在问题并探讨对策。

2020年8月，采用典型抽样方法，选取河南省开封市的祥符区、兰考县和焦作市的魏都区、鄢陵县所有基层医疗卫生机构医生作为调查对象。利用自评的方式开展关于医疗服务能力的线上问卷调查，问卷内容包括基层医生的个人基本情况，常见病诊疗能力（包含常见病识别诊断能力、常见实验室检查结果解读能力和常用药使用能力）。

共回收问卷1 844份，其中有效问卷1 669份，问卷有效回收率为90.51%。1 669例基层医生中，917例（54.94%）学历为中专及以下，663例（39.72%）无职称，524例（31.40%）拥有乡村医生证，509例（30.50%）拥有执业医师资格证。1 117例村卫生室医生中，722例（64.64%）年龄≥45岁，83例（7.43%）年龄≥60岁，848例（75.92%）学历为中专及以下。在纳入分析的1 631例基层医生中（剔除医疗机构类型为其他的38例基层医生），分别有1 564例（95.89%）、1 402例（86.00%）、1 542例（94.54%）基本具备常见病的诊断识别能力、常见实验室检查结果解读能力、常用药使用能力，1 336例（81.91%）具备常见病诊疗服务能力。农村基层医生常见病的识别诊断能力、常用药使用能力具备情况优于城市基层医生，城市基层医生生化检验、心电图报告解读能力优于农村地区，差异均有统计学意义（P<0.05）。

河南省基层医生素质总体不高，村级卫生队伍尤为突出；基层医生常见病诊疗服务能力总体较好，常见病综合处置能力有待提升，应建立完善的医院与基层的协同机制，保障基层医疗服务安全、有效。