Page 82 - 2022-22-中国全科医学

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guardians，children's opinions on hospital selection for treatment and associated factors，and intention to seek healthcare in primary
care. One survey was offline，with children aged 0-14 years as participants accidental sampled from people in two grade A tertiary
general hospitals，three community health centers，and other public places（such as public parks and squares） in Guangzhou's urban
areas，and the other one was online，with a purposive sample of age-matched children included in a WeChat group as participants.
For collecting information more appropriately，the questionnaire was completed by the children's guardians. Univariate and multivariate
ordinal regression were used to identify factors associated with children's intention to seek healthcare in primary care. Results
Altogether，the results of questionnaires effectively answered by the guardians of 501 children were used for analysis. The prevalence of
intending to seek healthcare in primary care in the children was 36.53%（183/501）. The prevalence of primarily choosing a primary
healthcare setting for initial treatment of common diseases was 26.3%（132/501），which were mainly owing to shorter distance between
home and the hospital（83.3%，110/132），shorter waiting time for treatment（40.9%，54/132） and having a pediatric or general
practice clinic（36.4%，48/132）. Multivariate Logistic regression analysis indicated that the level of intention to seek healthcare
in primary care in children was increased if the nearest hospital was a primary hospital instead of a secondary or tertiary hospital
〔OR（95%CI）=1.514（1.060，2.166）〕. Visiting a primary hospital at least four times in the last year was associated with a higher
level of intention to seek healthcare in primary care in children compared with visiting a primary hospital zero times〔OR（95%CI）=0.248
（0.111，0.557）〕. A higher level of intention to seek healthcare in primary care in children was associated with parents' high level
of satisfaction with primary care services instead of parents' fair level of satisfaction with primary care services〔OR（95%CI）=0.348
（0.236，0.515）] or parents' dissatisfaction with primary care services〔OR（95%CI）=0.086（0.043，0.173）〕. Conclusion
In general，the children in Guangzhou mainly seek healthcare in nearby hospitals，and the their level of intention to seek healthcare in
a primary hospital could be improved greatly. To improve their satisfaction with primary care services and intention to seek healthcare in
primary care settings，it is suggested to further deepen the theoretical research and practical exploration regarding hierarchical diagnosis
and treatment，strengthen the cooperation between primary and higher level hospitals for balancing the distribution of pediatric medical
resources among hospitals，and to improve the pediatric service capabilities of primary hospitals via improving the software and hardware
configuration of these hospitals.
【Key words】 Child health services；Hierarchical diagnosis and treatment system；Primary health care institution；
Andersen's behavioral model；Root cause analysis

生育政策调整背景下，我国儿科医疗资源总量不足 作者有言：
与儿童医疗服务需求增长之间的矛盾日益突出 ［1-2］ ，儿
儿童就医机构选择呈现较明显的就近特征，但儿
童医院和大医院儿科接诊患者负担过重，基层医疗卫生 童群体基层就医意愿偏低，低基层就医意愿的出现说
机构未能很好地起到分流患儿的作用 ［3-4］ 。以广东省为
明目前我国基层医疗卫生机构未能很好地发挥其距离
例，2019 年全省开设儿科的医疗机构数量比 2013 年减
近的独特优势之一。
少了 54 家，较多社区卫生服务机构（89.3%）和乡镇卫 研究发现，地理可及性、基层卫生服务满意度、
生院（40.4%）尚未设立儿科 ［5］ ，提示基层儿童医疗资
就医次数是影响儿童基层就医意愿的主要因素。为此，
源紧缺可能是患儿“趋高就诊”的原因之一。根据《中
要推动构建科学、有序的儿童就医格局，需要进一步
华人民共和国国民经济和社会发展第十四个五年规划和
巩固基层医疗卫生机构与社区居民近距离接触的地理
2035 年远景目标纲要》的内容，“十四五”期间我国 优势，并从人员配置、硬件设施、候诊环境等多个方
［6］
将全面推进“健康中国”建设，加快建设分级诊疗体系 。
面改善患儿的基层就医体验。与此同时，还需要加强
基层首诊制作为分级诊疗制度的主要突破点，对于形成 相关理论研究与实践探索，为政府有关部门采取措施
科学、有序的儿童就医秩序具有重要意义 ［7］ ，但一项
加强儿童医疗服务改革提供参考依据。
关于我国居民基层首诊意愿的荟萃分析结果显示，我国
居民的基层首诊意愿仅为 61.4% ［8］ ，儿童患病后首选 旨在了解儿童基层就医意愿并分析其影响因素，探究影
基层医疗卫生机构就医的比例则更低 ［9］ 。在国家积极 响儿童基层就医行为的主要障碍，为提升基层医疗卫生
推进分级诊疗制度的政策背景下，针对儿童的有序就医 机构儿童服务能力及改善儿童就医行为提供参考依据。
格局尚未形成，主要症结之一在于基层医疗卫生机构儿 1 对象与方法
童医疗服务能力弱化，导致儿童基层首诊未能很好落实。 1.1 研究对象 本研究开展时间为 2021 年 3—7 月，
因此，分析儿童基层就医意愿的影响因素具有一定的现 以 0~14 岁儿童为研究对象，以 0~14 岁儿童的监护人为
实意义与应用价值。本研究以安德森模型为理论依据， 调查对象。调查对象的抽取分线上、线下两部分：在广