Abstract: Background　The three-tiered healthcare system is implemented to meet the residents' healthcare needs and establish an orderly environment for medical treatment. Understanding the preferred healthcare institutions for treatment in residents may partially contribute to establishing a tiered mechanism for effectively diverting patients. However，few studies have discussed community residents' preferred healthcare institutions for treatment. Objective　To investigate community residents' needs of general medical services and selection of healthcare institutions for treatment，providing suggestions for developing a sound bi-directional referral system. Methods　During July to October 2019，healthcare seekers were randomly invited from Shanghai TCM-Integrated Hospital Affiliated to Shanghai University of TCM and all community health centers（n=8） in Hongkou District of Shanghai to attend a questionnaire survey for acquiring the information regarding demographics，needs of 28 kinds of general medical services and the preferred healthcare institution for seeking each kind of services. Results　The survey obtained a response rate of 98.05%（1 961/2 000）. The rates of respondents having needs of these services ranged from 67.82% to 86.18%. The top three needed services were personal medical file establishment〔1 690（86.18%）〕，the priority of patients with advanced appointment for treatment〔1 688（86.08%）〕，and first contact services for common diseases and frequently-occurring diseases〔1 664（84.85%）〕. The three needed least were hospice care for patients with cancer，advanced chronic disease or ineffective treatment〔1 330（67.82%）〕，inpatient services for patients with an unclear specialty disease needing hospitalization〔1 464（74.66%）〕，further diagnostic，therapeutic and rehabilitation services for patients with discontinuation of secondary or tertiary care due to economic，family or other personal reasons〔1 519（77.46%）〕. The first three services that residents tend to accept in general hospitals are diagnosis and treatment when other hospitals or departments are unable to make clear diagnosis；when other hospitals/departments are unable to treat；and when complicated and difficult diseases occur，the first step of diagnosis and treatment is provided. The first three services that residents tend to accept in community health service centers are signing contracts and providing comprehensive and continuous contract services, establishing personal health records and formulating targeted health management programs. Residents of different ages have different demand rates for 26 general practice services，and the choice of healthcare institutions for 14 general practice services is different（P<0.05）. Residents with different knowledge of general practice have different demand rates for 26 general practice services，and the choice of healthcare institutions for all general practice services is different（P<0.05）. Conclusion　The selection of healthcare institutions for initial treatment among residents differed by age and level of familiarity with general medical services. To promote orderly healthcare-seeking，the general practice department in general hospitals should work at its full capacity，the general medical services for residents should be improved in according to their needs and the capacities of community health centers，and residents' understanding of general practice should be enhanced.

Key words: Hospitals, general；General practice；Demand；Intention

摘要： 背景　分级诊疗是满足居民医疗服务需求、建立有序就诊环境的具体措施，目前对于社区居民全科医疗服务需求就诊机构选择的研究较少，了解居民接受对应服务的优先选择机构，对于建立有效的分级导流机制具有一定作用。目的　了解社区居民对全科医学科提供的服务内容的需求情况和就诊机构选择情况，为建立良好的分级诊疗策略提供建议。方法　于2019年7—10月，采取随机拦截的方式选取在上海中医药大学附属岳阳中西医结合医院和上海市虹口区全部8家社区卫生服务中心就诊的居民进行问卷调查。问卷包含居民一般情况、居民对一般全科医疗服务需求及就诊意向调查两部分，包括对28项全科服务内容的需求程度及对应全科服务内容的就诊机构选择倾向。结果　本次调查共发放问卷2 000份，回收有效问卷1 961份，问卷有效回收率为98.05%。被调查居民对28项全科服务内容的需求率为67.82%~86.18%。居民需求率较高的前3项全科服务内容分别是建立个人健康档案〔1 690例（86.18%）〕，优先预约就诊〔1 688例（86.08%）〕，发生常见病、多发病时提供第一步诊疗〔1 664例（84.85%）〕；居民需求率最低的3项全科服务内容分别是为恶性肿瘤患者、其他慢性病晚期患者、治疗无效患者提供临终关怀服务〔1 330例（67.82%）〕，需要住院但疾病所属专科不明确时、提供过渡期间的病房服务〔1 464例（74.66%）〕，由于经济、家庭或个人特殊情况无法继续在大医院治疗时提供后续诊疗、康复服务〔1 519例（77.46%）〕。居民倾向于前往综合性医院全科接受的前3项服务分别是在其他医院或科室无法明确诊断时进行诊疗、在其他医院/科室无法治疗时进行诊疗、发生复杂疑难病症时提供第一步诊疗；居民倾向于前往社区卫生服务中心全科接受的前3项服务分别是签约并提供综合、连续的签约服务，建立个人健康档案，制定针对性的健康管理方案。不同年龄居民对26项全科服务的需求率不同，对14项全科服务的就诊机构选择情况不同（P<0.05）。对全科了解程度不同的居民对26项全科服务的需求率不同，对所有全科服务的就诊机构选择情况不同（P<0.05）。结论　不同年龄段、对全科诊疗熟悉程度不同的居民对服务内容、愿意进行首诊的诊疗机构的选择有差异。应充分发挥综合性医院全科医学科的作用，根据居民需求与社区卫生服务中心进一步差异化服务内容，提升居民对全科服务理念的认知，促进有序分诊。

关键词: 医院, 综合, 全科医学, 需求, 就诊意向