中文摘要：

目的了解城镇职工医保患者对社区首诊制的接受度,并探讨其影响因素。方法于2015年7—9月,采用随机抽样法,在南京市随机抽取2个区,每个区随机抽取2个街道,每个街道随机抽取1家社区卫生服务中心（CHCs）,选取研究期间至该4家CHCs门诊就诊的城镇职工医保患者1 100例。采用自行设计的《社区居民问卷调查表》对纳入患者进行调查,主要内容包括居民的基本情况、健康状况、就诊行为、对CHCs的评价、对社区首诊制的意愿和认知。采用多因素Logistic回归分析探讨城镇职工医保患者对社区首诊制接受度的影响因素。结果共回收有效问卷1 058份,问卷有效回收率为96.2%。其中501例（47.4%）城镇职工医保患者愿意接受社区首诊制,669例（63.2%）对CHCs的报销比例感到满意,429例（40.5%）了解社区首诊制相关政策,666例（62.9%）认为转诊可能延误病情。不同性别、婚姻状况、家庭人均月收入、自评健康状况得分,以及家中是否有医疗工作者、是否因强制规定至CHCs就诊、是否在意医疗费用、是否有转诊经历患者的社区首诊制接受率比较,差异无统计学意义（P〉0.05）;不同年龄、文化程度、职业类型、年就诊次数,以及是否患慢性病、是否认为CHCs就诊费用较低、是否认为CHCs诊疗水平能够满足居民常见病诊治、是否认为CHCs医疗设备能够满足居民常见病诊治、是否认为CHCs药品配备能够满足居民常见病诊治、是否对CHCs的报销比例感到满意、是否了解社区首诊制相关政策、是否认为转诊可能延误病情患者的社区首诊制接受率比较,差异有统计学意义（P〈0.05）。多因素Logistic回归分析结果显示,年就诊次数≤3次、是否认为CHCs就诊费用较低、是否认为CHCs药品配备能够满足居民常见病诊治、是否对CHCs的报销比例感到满意、是否了解社区首诊制相关政策、是否认为转诊可能?

英文摘要：

Objective To analyze acceptance of gatekeeper system of patients with basic medical insurance for urban employees and discuss its influencing factors.Methods From July to September in 2015,the random sampling method was used to select two districts in Nanjing,from which two streets were selected,and then one community health service center（ CHCs）was selected respectively from these two streets.A total of 1 100 patients with basic medical insurance for urban employees,who came to the four CHCs for medical treatment during research period,were selected.The self-designed Questionnaire Survey of Community Residents was used to investigate the enrolled patients,and its main contents included residents＇ basic data,health condition,seeking health care behaviors,evaluation of CHCs and intention and cognition of gatekeeper system.Multivariate Logistic regression analysis was used to explore the influencing factors of the acceptance of gatekeeper system among patients with basic medical insurance for urban employees.Results A total of 1 058 valid questionnaires were collected,and the effective response rate was 96.2%.Of these results,501（ 47.4%） patients were willing to accept the gatekeeper system,669（ 63.2%） were satisfied with the reimbursement proportion of CHCs,429（ 40.5%） patients were familiar with the related policies of gatekeeper system,and 666（ 62.9%） believed that referral will delay the disease condition.There was no significant difference in the acceptance rate of gatekeeper system among patients with different gender,marital status,family monthly income per capita,self-rated health status scores,and whether there are medical workers at home,whether they are compelled to seek treatment in CHCs,and whether they care about the medical expenses,and whether they have referral experience（ P〉0.05）; there was significant difference in the acceptance rate of gatekeeper system among patients with different age,different educational level,occupational types,annual visiting times,and whether