Abstract: Background　In recent years，the three-tier healthcare delivery system in Beijing has been taking shape. Of the system，primary healthcare institutions，which are responsible for delivering first-contact care，making important contributions to improving the operational efficiency of the system. Studying the intention and influencing factors of visiting primary healthcare institutions among patients，the demander of medical services，is of great significance to the achievement of first-contact care in primary care. Objective　To investigate the choice of healthcare institutions for treating minor illness and influencing factors among patients in Beijing，to put forward targeting suggestions for guiding patients to seek healthcare in primary care appropriately. Methods　In May 2019，by convenient sampling，inpatients and outpatients were sampled from 48 secondary and tertiary hospitals in 16 districts of Beijing and received a survey regarding their intention of seeking healthcare in primary care，health status and awareness of the policies about hierarchical medical system and family doctor system. Stepwise，multivariate regression analysis was performed to identify factors associated with patients' choice of primary healthcare institutions for treating minor illness. Results　Of the 3 732 cases included，1 541（41.29%） had chronic diseases，1 509 cases（40.43%） knew the family doctor system，and 1 641 cases（43.97%） knew the hierarchical medical system，but only 12.43%（464/3 732） had a contracted family doctor. 1 349 cases（36.15%） of them indicated that they would visit a primary healthcare institution for treating minor illness. Multivariate analysis found that hukou，household registration，age，education level，social and medical insurances，monthly family income，self-assessed health，number of chronic diseases，awareness of family doctor system，contracting for family doctor services，and awareness of hierarchical medical system were associated with the selection of medical institutions（P<0.05）. Conclusion　Older age，Beijing hukou，social and medical insurances，lower education level，lower income level，awareness of the policies of hierarchical medical system and family doctor system and having a contracted family doctor are associated with higher possibility of choosing a primary healthcare institution for treating minor illness.Therefore，for those without Beijing hukou and social and medical insurances，medical security and health education should be strengthened.Furthermore，to guide more patients to seek healthcare in primary care，efforts should be made to improve professional levels of primary care physicians and the environment of primary care，to strengthen the publicity of policies of the healthcare reform launched in 2009 and to expand the coverage of contracted family doctor services.

Key words: Primary health care, Community health services, Choice of medical institution, Root cause analysis, Beijing

摘要： 背景　近年来北京市分级诊疗服务体系已初现雏形，其中基层首诊作为分级诊疗的基础，对提高医疗服务体系运行效率十分重要。患者作为医疗服务的需方，研究其就医选择意愿及影响因素对落实基层首诊具有重要意义。目的　了解北京市患者在“生小病”时的就医选择及影响因素，从而为将患者引流至基层提出针对性建议。方法　于2019年5月在北京市16个区的48家区属二、三级医院中采用方便抽样的方式对门诊和住院患者的基层就诊选择意愿及其个人基本信息、健康状况和政策知晓情况进行调查。采用多因素Logistic逐步回归分析患者“生小病”时选择基层医疗卫生机构的影响因素。结果　共有3 732例调查对象纳入本研究，其中1 541例（41.29%）患有慢性病；知晓北京开展家庭医生制度和分级诊疗制度的患者分别为1 509例（40.43%）、1 641例（43.97%），但签约了家庭医生的患者仅占12.43%（464/3 732）。1 349例（36.15%）调查对象“生小病”时会选择前往基层医疗卫生机构就医。多因素Logistic逐步回归分析结果显示，户籍、年龄、文化程度、社会医疗保险情况、家庭月收入、健康自评情况、慢性病数量、家庭医生制度知晓情况、家庭医生签约情况及分级诊疗制度知晓情况是调查对象就诊机构选择的影响因素（P<0.05）。结论　老年人、北京市户籍人口、有社会医疗保险、文化程度和收入较低、知晓分级诊疗和家庭医生相关政策、签约了家庭医生的患者在“生小病”时更倾向选择基层医疗卫生机构，因此对于非北京户籍、无社会医疗保险患者人群，应努力提高医疗保障，加强健康宣教；同时提高基层医疗技术水平和就诊环境，加大医改政策的宣传力度，并继续扩大家庭医生签约覆盖率，吸引更多患者下沉基层。

关键词: 初级卫生保健, 社区卫生服务, 就医选择：影响因素分析, 北京