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between July and August，2020 with chronic disease patients（n=630） selected from primary care settings in Guangdong's
Chaozhou by use of multistage stratified random sampling. The Primary Care Assessment Tool-Adult Simplified Version
（PCAT-AS）（consists of 10 domains，including first contact accessibility，coordination，ongoing，comprehensiveness，
community orientation and other 5 domains） was used in the survey for understanding chronic disease patients' assessment of the
quality of primary care services. Multiple linear regression was adopted to identify factors potentially associated with the PCAT-AS
score. Results Altogether，553 cases（87.8%） who returned responsive questionnaires were enrolled for analysis. The average
total PCAT-AS score for all respondents was（95.88±13.44）. The top three domains ranked in terms of average standardized
score were comprehensiveness（services needed）（7.89），first contact accessibility（7.72），and first contact utilization（7.58），
and the bottom three-ranked domains were coordination（referrals）（5.61），community orientation（6.11） and patient and
family centeredness（6.40）. Multiple linear regression analysis indicated that higher total PCAT-AS score was associated with
living in urban areas in contrast to rural areas〔b（95%CI）=-6.983（-10.598，-3.368）〕，senior high school and higher
education level instead of junior high school and lower education level〔b（95%CI）=4.046（0.966，7.125）〕，permanent
residents without the local hukou in contrast to those with local hukou〔b（95%CI）=-5.360（-9.517，-1.202）〕，good self-
rated health instead of relatively poor self-rated health〔b（95%CI）=-4.962（-8.438，-1.486）〕 or poor self-rated health
〔b（95%CI）=-7.787（-12.789，-2.786）〕，having a contracted family doctor instead of having no contracted family doctor
〔b（95%CI）=4.686（2.508，6.865）〕，first choosing a community health center for treating common diseases instead of a
village clinic〔b（95%CI）=-5.865（-9.951，-1.779）〕 or a district/county-level hospital or tertiary hospital〔b（95%CI）
=-6.061（-11.330，-0.792）〕，4-6 primary care visits instead of 1-3 primary care visits〔b（95%CI）=5.876（3.367，
8.384）or 7 or more primary care visits instead of 1-3 primary care visits〔b（95%CI）=9.045（6.512，11.579）〕，and high
satisfaction with primary care services instead of fair satisfaction〔b（95%CI）=-2.844（-4.817，-0.870）〕 or dissatisfaction
〔b（95%CI）=-10.418（-17.050，-3.786）〕. Conclusion Overall，Chaozhou chronic disease patients reported a sound
level of treatment experience in primary care. Specifically，they reported good primary care experience in three domains，
including comprehensiveness，first contact accessibility and first contact utilization，but poor experience in community
orientation，and coordination（including information systems and referrals）. However，urban patients reported better primary
care experience than rural patients. So continued efforts are needed to strengthen primary care performance in rural areas.
【Key words】 Health care quality，access，and evaluation；Primary health care；Community health services；
Chronic disease management；Evaluation study；Primary Care Assessment Tools

《中国防治慢性病中长期规划（2017—2025 年）》
本研究主要结论：
明确提出：要通过提高诊疗服务质量、推进慢性病患
（1）广东省潮州市慢性病患者对基层卫生服务
者分级诊疗和家庭医生签约服务来提高慢性病治疗效 质量的评价整体良好，城市地区总体水平高于农村地
果 ［1］ 。该规划指出要立足基层医疗卫生机构，推进家
区；（2）基层医疗卫生机构开展较好的维度为综合
庭医生签约服务，向慢性病患者提供协调、连续、综 性（服务需求）、首诊可及性和首诊利用，有待改善
合的整合型卫生服务 ［1］ 。国外经验也表明，立足于社
的维度为连续性（转诊）、面向社区、以患者和家庭
区，提供高质量的整合型基层卫生服务，对改善慢性病 为中心；（3）城乡类型、文化程度、户籍、自评健
患者健康状况和提高卫生资源利用率意义重大 ［2］ 。当
康状况、是否签约家庭医生、患常见病时首选医疗机
前，国际上采用的基层卫生服务质量评估方法多样，其
构、近一年至基层医疗卫生机构就诊次数、对基层医
中初级保健评估工具（Primary Care Assessment Tools，
疗卫生服务满意度是基层卫生服务质量评价的影响因
PCAT）是应用较为广泛的工具之一，其以服务的可及性、 素；（4）建议加强农村基层卫生服务能力；推进一
连续性、综合性等维度为测量内容 ［3-4］ 。国内有关基层
体化建设，提高慢性病管理服务的连续性；监督落实
卫生服务质量评价的研究可分为两种：一种是质量评估 家庭医生签约服务。
指标或工具的述评与构建 ［5-7］ ，另一种是运用评估工具
开展质量评估的实证研究 ［8-9］ 。基层卫生服务质量评价 研究对象，以 PCAT 量表为研究工具，调查广东省潮州
的实证研究多从需方角度出发 ［10］ ，集中探讨基层患者 市基层医疗卫生服务质量及其影响因素，从而为基层医
感知的卫生服务质量及影响因素，也有研究对不同人群 疗卫生机构开展慢性病管理服务提供实证依据。
进行横向比较 ［11］ ，但鲜有使用 PCAT 量表对基层慢性 1 对象与方法
病患者进行调查的研究。因此，本研究以慢性病患者为 1.1 调查对象 于 2020 年 7—8 月，采用多阶段分层