Abstract: Background　The comprehensive reform of separating drug sales from medical treatment was launched in an all-round way in Beijing in 2017.It would inevitably have a significant impact on community-dwelling residents' healthcare-seeking behaviors，but few studies have evaluated the impact from patients' perspective.This study provides empirical basis for deepening the comprehensive reform by evaluating changes of residents' utilization of health services after the reform.Objective　To assess the changes in medication attitudes and behaviors of community-dwelling residents of Beijing since the comprehensive medical reform of separating drug sales from medical treatment has been launched in 2017 to evaluate the effect of the policy reform，and to provide solutions and advice based on key findings.Methods　This questionnaire survey was conducted in 1 005 participants with an experience of seeking healthcare or purchasing medicines in medical institutions in the past 6 months，recruited from 8 community health centers in Xicheng District（at least 125 from each center） by convenience and voluntary sampling in January 2018.The survey collected residents' knowledge level of zero-profit drug policy，and medication attitudes and behaviors，and preferred institutions and flow in seeking healthcare/purchasing medicines（the latter two are evaluation indicators for the effect of the policy reform）.Results　A total of 969（96.42%） valid questionnaires were collected.After the reform，80.2%（777/969） of the residents were more likely to seek healthcare or purchase medicines in community health centers.Multivariate Logistic regression analysis found that those covered by free medical care were less likely to seek healthcare or purchase medicines in a community health center compared with those with basic medical insurance for urban residents〔OR（95%CI）=0.420（0.210，0.839），P<0.05〕.For the population flow of healthcare-seeking or purchasing medicines，55.7%（540/969） of the residents continued to see a doctor or purchase medicines in the community health center after the reform，and 27.2%（264/969） switched to the community health center from secondary and tertiary hospitals.Multivariate Logistic regression analysis showed that，higher possibility of changing health institutions，from a community health center to a higher level hospital，for seeking healthcare or purchasing medicines was found in residents with high education level rather than those with low education level〔OR（95%CI）=0.721（0.529，0.983），P<0.05〕，and in residents with free medical care rather than those with basic medical insurance for urban residents〔OR（95%CI）=0.383（0.194，0.757），P<0.05〕，and in residents with perceptions of drug cost reduction after the reform rather than those without such perceptions〔OR（95%CI）=0.475（0.227，0.993），P<0.05〕.Conclusion　Since the comprehensive medical reform of separating drug sales from medical treatment has been launched in Beijing，a series of community-oriented measures，such as canceling drug markups and expanding the variety of drugs in the community，have effectively promoted the flow of residents to community health institutions to see a doctor or purchase drugs.It is necessary to further inform residents of drug policies，advocate zero-profit drugs and reduce medication costs，so as to encourage residents to change medication behaviors.

Key words: Health care reform, Separating drug sales from medical treatment, Community residents, Medication behavior, Zero-profit drugs, Community health services

摘要： 背景　2017年《北京市医药分开综合改革实施方案》全面实施，改革必然对社区居民的就医行为产生重大影响，而目前从需方角度评估改革影响的研究较少。本研究可以通过分析改革后居民卫生服务利用的变化，为综合改革向纵深发展提供实证依据。目的　了解2017年北京市医药分开综合改革对社区居民用药态度、行为的影响，进一步评价政策改革的效果，并根据其中的关键因素提出对策和建议。方法　按照方便和自愿的原则，于2018年1月选取北京市西城区8家社区卫生服务中心展开问卷调查，以近半年有至医疗机构就医/取药经历的居民为研究对象，每个社区至少抽取居民125例，共抽取1 005例。问卷调查内容主要为居民对药品“零差率”政策的知晓情况、用药观念和行为，以居民的就医/取药地点偏好、就医/取药人群流向2个指标体现政策的实施效果。结果　共回收有效问卷969份（96.42%）。从就医/取药地点偏好来看，政策实施后80.2%（777/969）的社区居民更愿意去社区卫生服务机构就医/取药；多因素Logistic回归分析显示，参加公费医疗者到社区卫生服务机构就医/取药的可能性低于参加城镇居民基本医疗保险者〔OR（95%CI）=0.420（0.210，0.839），P<0.05〕。从就医/取药人群流向来看，政策实施后55.7%（540/969）的社区居民选择继续在社区卫生服务机构就医/取药，27.2%（264/969）的社区居民将就医/取药机构从大医院转向社区卫生服务机构；多因素Logistic回归分析显示，受教育程度高者从社区卫生服务机构转向大医院就医/取药的可能性高于受教育程度低者〔OR（95%CI）=0.721（0.529，0.983），P<0.05〕，公费医疗者从社区卫生服务机构转向大医院就医/取药的可能性高于参加城镇居民基本医疗保险者〔OR（95%CI）=0.383（0.194，0.757），P<0.05〕，感觉药品费用降低者从社区卫生服务机构转向大医院就医/取药的可能性高于感觉药品费用未降低者〔OR（95%CI）=0.475（0.227，0.993），P<0.05〕。结论　北京市实施医药分开综合改革后，取消药品加成、扩大社区药品品种等一系列措施有力地促进了社区居民流向社区卫生服务机构就医/取药。今后需进一步加强药品政策宣传，促进居民改变用药行为，使用“零差率”药品，降低用药费用。

关键词: 卫生保健改革, 医药分开, 社区居民, 用药行为, 零差率药品, 社区卫生服务