Abstract: Objective　 To investigate the chronic disease consultation status in community healthcare settings in urban and inner suburban areas of Beijing's Chaoyang District，and put forward solutions for the existing problems，promoting the development of seeking healthcare in a hierarchical manner.Methods　In June 2016，we conducted a survey among chronic disease patients from 4 community health centers（CHCs） from 2 medical consortiums in Beijing's Chaoyang District（2 were selected from a medical consortium mainly consisting of CHCs in urban areas，and other 2 from a medical consortium mainly consisting of CHCs in inner suburban areas） with a self-developed questionnaire for obtaining the data concerning consultation in CHCs.320 of the 341 returned responsive questionnaires，achieving a response rate of 93.8%.Results　The educational attainment，annual household income per capita，type of medical insurance，occupation differed significantly between chronic disease patients from urban CHCs and those from inner suburban CHCs（P<0.05）．Moreover，these two groups had significant differences in seeking medical care in CHCs first and supporting initial consultation in CHCs（P<0.05）．However，the level of satisfaction with medical care in CHCs was similar in both groups（P>0.05）．The priority of the top 5 reasons for seeking medical care in CHCs ordered by the two groups was similar，which are short distance between home and the community health center，followed by not too many visits，short waiting time for consultation，good service attitude，and easy access to the prescribed medicines.Both groups demonstrated similar percentage of patients seeking medical care in CHCs for short distance between home and the community health center，not too many visits，short waiting time for consultation，or good service attitude（P>0.05）．Higher percentage of inner suburban patients sought medical care in CHCs for easy access to the prescribed medicines or inexpensive medical expense compared with urban patients（P<0.05）．Conclusion　The consultation status in CHCs differed significantly between these two groups due to medical cost，habit and convenience of medical care seeking.Urban chronic disease patients were less likely to seek medical care in CHCs.

Key words: Chronic disease, Community first contact care, Consultation status

摘要： 目的　比较北京市朝阳区城区和近郊区慢性病患者的社区就诊情况，分析存在的问题，提出对策建议，促进患者有序就医。方法　2016年6月在北京市朝阳区城区和近郊区医联体中抽取4所社区卫生服务中心，使用自编问卷对4所社区卫生服务中心某天就诊的慢性病患者进行调查。比较城区和近郊区慢性病患者社区就诊情况的差异。共发放问卷341份，回收有效问卷320份，有效回收率为93.8%。结果　城区和近郊区的慢性病患者文化程度、家庭人均年收入、医保类型、职业比较，差异有统计学意义（P<0.05）。城区和近郊区的慢性病患者首选社区就诊、支持社区首诊情况比较，差异有统计学意义（P<0.05）；对社区满意度的比较，差异无统计学意义（P>0.05）。城区和近郊区的慢性病患者选择社区就诊的前五位原因排序相同，分别是离家近，患者少、等待时间短，医务人员态度好，取药方便，医疗费用经济。城区和近郊区慢性病患者选择社区就诊原因为离家近，患者少、等待时间短，医务人员态度好者所占比例比较，差异无统计学意义（P>0.05）；近郊区慢性病患者选择社区就诊原因为取药方便、医疗费用经济者所占比例高于城区慢性病患者，差异有统计学意义（P<0.05）。结论　由于费用负担水平、就医习惯及就医便利性的差异，城区和近郊区慢性病患者的社区就诊情况还存在一定的差异，城区慢性病患者社区首诊意愿低于近郊区的慢性病患者。

关键词: 慢性病, 社区首诊, 就诊情况