Abstract: Background　Bi-directional referral services are an important part of tiered healthcare services in China. There are few studies on such services under the conditions that it is difficult and expensive for the masses to see a doctor. Analyzing their perception，utilization and satisfaction regarding bi-directional referral services is of great significance to the promotion of such services. Objective　To explore the perceptions，utilization and satisfaction regarding bi-directional referral services as well as associated factors in young and middle-aged white-collar workers working in office buildings. Methods　From August to September 2019，we used multi-stage sampling to select employees working in eight business office buildings in Shanghai's Hongkou District to participate in a questionnaire survey for obtaining data about their general demographics，socio-economic status，perceptions，utilization and satisfaction regarding bi-directional referral services. The survey gained a response rate of 95.48%（993/1 040）. Results　The rate of knowing bi-directional referral services was 17.27%（167/967）. Among 958 respondents who had self-reported use of referral services，165（17.22%） used bi-directional referral services. Among 182 who had self-reported use of referral mode，101（55.49%） asked for referral themselves，43（23.63%） were referred following the advice of their physician-in-charge，and 38（20.88%） asked for referral themselves and also were suggested for referral by their physician-in-charge. Of the 181 respondents who had self-reported referral process，108（59.67%） thought that their referral did not run smoothly. In terms of satisfaction with the services，the rates of being "very dissatisfied" "partly satisfied" "fairly satisfied" "relatively satisfied" "very satisfied" with the services were 8.51%（16/188），16.49%（31/188），54.26%（102/188），18.09%（34/188），and 2.66%（5/188），respectively. Both rates of knowing and utilizing bi-directional referral services varied significantly in the respondents by sex，usual address，marital status，education level，occupation，annual income，level of knowing family doctors and utilization of family doctor services（P<0.05）. The level of satisfaction with bi-directional referral services varied significantly in the respondents by education level and occupation（P<0.05）. Conclusion　Our survey suggests that this group have relatively low rates of knowing and utilizing bi-directional referral services，and the understanding of family doctors and use of family doctor services may partly improve the rates of knowing and utilizing referral services，eventually promoting seeking healthcare in primacy care，relieving the pressure of higher level hospitals，and stabilizing the implementation of tiered healthcare system.

Key words: Bi-directional referral, Family doctor, Young and middle-aged people, White-collar workers in buildings, Cognition, Services utilization

摘要： 背景　双向转诊是我国分级诊疗模式的重要组成部分，但在目前“看病难，看病贵”的情况下针对双向转诊的研究较少。分析双向转诊的认知、利用、满意度及影响因素对充分发挥转诊作用具有重要意义。目的　探讨中青年楼宇白领人群双向转诊服务认知、利用及满意度现状，并分析影响双向转诊的主要因素。方法　于2019年8—9月采用多阶段抽样法选取上海市虹口区8个商务楼的员工进行问卷调查。问卷内容包括楼宇白领人群基本人口特征、社会经济地位、对于双向转诊服务的认知、利用情况及满意度。共发放问卷1 040份，回收有效问卷993份，问卷有效回收率为95.48%。结果　共967例填写了认知情况，上海市楼宇白领人群双向转诊服务知晓率为17.27%（167/967）；共有958例填写了转诊服务使用情况，其中165例（17.22%）使用过双向转诊服务；共有182例有效填写了转诊方式，其中101例（55.49%）自己要求转诊，43例（23.63%）经主治医生建议转诊，38例（20.88%）两者兼备；共有181例有效填写了转诊顺利情况，其中108例（59.67%）转诊不顺利；共有188例有效填写了满意度情况，其中16例（8.51%）非常不满意，31例（16.49%）不太满意，102例（54.26%）一般满意，34例（18.09%）比较满意，5例（2.66%）非常满意。不同性别、常住地址、婚姻状况、受教育水平、职业、收入、家庭医生认知和利用情况的楼宇白领人群双向转诊知晓率比较、利用情况比较，差异有统计学意义（P<0.05）。不同受教育水平、职业楼宇白领人群双向转诊服务满意度比较，差异有统计学意义（P<0.05）。结论　中青年楼宇白领人群对双向转诊总体知晓率和利用程度较低，了解和签约家庭医生在一定程度上起到了提高双向转诊知晓率和促进居民利用转诊服务的作用，有利于促进基层首诊、进而缓解大医院就诊压力，稳固分级诊疗模式。

关键词: 双向转诊, 家庭医生, 中青年, 楼宇白领, 认知, 服务利用