In China, a rational healthcare seeking pattern in children has not yet taken shape amid the active promotion of the implementation of hierarchical medical system, one major cause of which may be inadequate implementation of first contact in primary care settings in children due to poor service capability for children of these institutions. Therefore, it is of great practical significance and application value to analyze the influencing factors of children's intention to seek healthcare in primary healthcare institutions.

To investigate children's intention to seek healthcare in primary healthcare settings and associated determinants, offering insights into the development of a sound and rational healthcare-seeking pattern in children.

Two surveys were conducted during March to July, 2021 using a questionnaire developed based on the Anderson's Behavioral Model of Health Services Use (containing three aspects: demographics of children and their guardians, children's opinions on hospital selection for treatment and associated factors, and intention to seek healthcare in primary care. One survey was offline, with children aged 0-14 years as participants accidental sampled from people in two grade A tertiary general hospitals, three community health centers, and other public places (such as public parks and squares) in Guangzhou's urban areas, and the other one was online, with a purposive sample of age-matched children included in a WeChat group as participants. For collecting information more appropriately, the questionnaire was completed by the children's guardians. Univariate and multivariate ordinal regression were used to identify factors associated with children's intention to seek healthcare in primary care.

Altogether, the results of questionnaires effectively answered by the guardians of 501 children were used for analysis. The prevalence of intending to seek healthcare in primary care in the children was 36.53% (183/501). The prevalence of primarily choosing a primary healthcare setting for initial treatment of common diseases was 26.3% (132/501), which were mainly owing to shorter distance between home and the hospital (83.3%, 110/132), shorter waiting time for treatment (40.9%, 54/132) and having a pediatric or general practice clinic (36.4%, 48/132). Multivariate Logistic regression analysis indicated that the level of intention to seek healthcare in primary care in children was increased if the nearest hospital was a primary hospital instead of a secondary or tertiary hospital〔OR (95%CI) =1.514 (1.060, 2.166) 〕. Visiting a primary hospital at least four times in the last year was associated with a higher level of intention to seek healthcare in primary care in children compared with visiting a primary hospital zero times〔OR (95%CI) =0.248 (0.111, 0.557) 〕. A higher level of intention to seek healthcare in primary care in children was associated with parents' high level of satisfaction with primary care services instead of parents' fair level of satisfaction with primary care services〔OR (95%CI) =0.348 (0.236, 0.515) ] or parents' dissatisfaction with primary care services〔OR (95%CI) =0.086 (0.043, 0.173) 〕.

In general, the children in Guangzhou mainly seek healthcare in nearby hospitals, and the their level of intention to seek healthcare in a primary hospital could be improved greatly. To improve their satisfaction with primary care services and intention to seek healthcare in primary care settings, it is suggested to further deepen the theoretical research and practical exploration regarding hierarchical diagnosis and treatment, strengthen the cooperation between primary and higher level hospitals for balancing the distribution of pediatric medical resources among hospitals, and to improve the pediatric service capabilities of primary hospitals via improving the software and hardware configuration of these hospitals.

在国家积极推进分级诊疗制度的政策背景下，针对儿童的有序就医格局尚未形成，主要症结之一在于基层医疗卫生机构的儿童医疗服务能力弱化，导致儿童基层首诊未能很好落实。因此，分析儿童基层就医意愿的影响因素具有一定的现实意义与应用价值。

调查儿童的基层就医意愿，并分析影响儿童基层就医意愿的因素，为构建健康、有序的儿童就医格局提供参考依据。

本研究以0~14岁儿童为研究对象，以0~14岁儿童的监护人为调查对象。于2021年3—7月，在广州市城区2家三级甲等综合医院、3家社区卫生服务中心及公园、广场等公共场所开展线下偶遇抽样调查，同时通过微信群向儿童的监护人发放电子问卷，最终回收有效问卷501份。问卷基于安德森模型设计，主要内容包括：儿童及其监护人基本情况、就医医疗机构选择及原因、基层医疗卫生机构就医意愿等。采用单因素有序Logistic回归和多因素有序Logistic回归分析儿童基层就医意愿的影响因素。

501例儿童家长中，愿意到基层医疗卫生机构就医者183例（36.5%）；患常见病时，首选到基层医疗卫生机构就医者132例（26.3%），主要原因为距离近（83.3%，110/132）、候诊时间短（40.9%，54/132）、有儿科/全科门诊（36.4%，48/132）。多因素有序Logistic回归分析结果显示，离家最近的医疗机构是基层医疗卫生机构者的基层就医意愿高于离家最近的医疗机构是二级或以上医疗机构者〔OR（95%CI）=1.514（1.060，2.166）〕，最近一年到基层医疗卫生机构就医≥4次者的基层就医意愿高于最近一年未到过基层就医者〔OR（95%CI）=0.248（0.111，0.557）〕，家长对基层医疗服务总体感到满意者的基层就医意愿高于对基层医疗服务总体感到一般、不满意者〔OR（95%CI）分别为0.348（0.236，0.515）、0.086（0.043，0.173）〕。

广州市儿童就医行为基本遵循就近原则，但儿童基层就医意愿仍有较大的提升空间。建议继续深化分级诊疗理论研究与实践探索；加强卫生系统内部的上下联动，以加快儿童医疗资源均衡布局；通过改善基层医疗卫生机构的软件与硬件配置，提升基层医疗卫生机构儿童服务能力，以实现患者满意度和基层就医意愿的提升。