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.

分级诊疗制度是新一轮深化医药卫生体制改革的重要内容，从需方角度出发，基于真实世界数据分析门诊患者就医选择及其影响因素，对于推动分级诊疗、促进卫生健康事业高质量发展具有重要现实意义。

探讨广东省居民门诊就医选择及其影响因素，为完善分级诊疗制度、制定引导居民合理就医的相关政策提供数据支撑。

本研究使用2023年9—10月完成的全国第七次卫生服务调查中广东省8个样本县（区、市）的入户调查数据，选取2周患病且前往医疗卫生机构就诊的2 213名居民为研究对象。以2周患病是否选择到基层医疗卫生机构首诊为因变量，采用多因素Logistic回归进行影响因素分析。

2周患病的居民首诊医疗机构为基层医疗卫生机构者1 597名（72.16%）。农村[OR（95%CI）=1.561（1.170~2.082）]，离家最近医疗机构类型为基层医疗卫生机构[OR（95%CI）=3.870（2.915~5.136）]，参保城乡居民基本医疗保险[OR（95%CI）=2.209（1.695~2.879）]，自感病伤严重程度为一般/不严重[OR（95%CI）分别为1.923（1.455~2.541）、3.458（2.449~4.883）]的居民更倾向于到基层医疗卫生机构首诊（P<0.05）；文化程度为高中及以上[OR（95%CI）=0.498（0.293~0.847）]，未签约/不知道是否签约家庭医生服务[OR（95%CI）分别为0.671（0.504~0.894）、0.599（0.444~0.809）]的居民更愿意到非基层医疗卫生机构就诊（P<0.05）。

广东省2周患病居民首诊选择基层医疗卫生机构的比例较高，但仍然存在进一步提升空间，居民所处环境及个体特征等因素会影响其2周患病首诊医疗机构选择。需进一步优化基层医疗卫生机构分布和服务可及性，提升基层卫生服务能力和管理水平，引导居民更合理地就医。