中文摘要：

目的探讨厦门市社区居民关于慢性病分级诊疗“三师共管”知信行的影响因素，为完善分级诊疗制度提供参考依据。方法采用分层随机抽样方法，抽取厦门市5个社区的400名居民进行问卷调查，分别以社区居民对“三师共管”的“知晓”和“加入”情况为因变量，以内部因素（社会人口经济学特征等）和外部因素（医疗费用、保险、就诊情况等）为自变量，依次建立4个logistic回归模型，分析和探讨“三师共管”知信行的影响因素。结果41．10％的被调查居民知晓“三师共管”，其中39．71％的高血压／糖尿病患者加入“高友网”或“糖友网”。年龄、教育水平、医疗费用和转诊经验对“三师共管”知信行的影响有统计学意义（P〈0．05），年龄越大、教育水平越高、有转诊经历的居民，知信行水平较高；人均月收入低、患高血压或糖尿病、有医保和对社区咨询满意的居民，对“三师共管”的知晓水平较高。结论厦门市社区居民“三师共管”的知信行水平尚可，但仍需进一步提高。应进一步加强“三师”协同管理，不断发挥财政和医保的激励作用，完善基层医疗机构的服务功能，提高社区诊疗水平，继续推进分级诊疗制度建设。

英文摘要：

Objective To investigate the influencing factors for knowledge, attitude and practice （KAP） of the ＂ Three-manager mode＂ about hierarchical medical system of Chronic diseases of the community residents in Xiamen, and provide references for the implementation of hierarchical medical system. Methods Multi-stage random sampling method was adopted, and 400 residents were randomly sampled from 5 communities of Xiamen for questionnaire survey. The survey features the dependent variable of the community residents＇ ＂ knowing＂ and ＂joining-in＂ the ＂ Three-manager mode＂ , the internal factors （social demographic characteristics ）, and the external factors （medical expenditure and healthcare insurance）. On such basis,four logistic regression models were built for analysis of such influencing factors. Results 41.10% of the surveyed were aware of the ＂ Three-manager mode＂ , and 39.71% of the hypertension/diabetes patients among them joined in the ＂ hypertension network＂ or ＂ diabetes network＂ . Age, education, medical expenditure and referral experiences were significant influencing factors for KAP level of the ＂ Three-manager mode＂ , while the residents of older age, higher education and referral experiences were high in their KAP ; those of lower per capita monthly income, hypertension or diabetes, with coverage of medical insurance and satisfied with medical consultation in community were high in their awareness of ＂ Three-manager mode＂ . Conclusions The KAP level of ＂ Three-manager mode＂ of the community residents in Xiamen is acceptable, yet expected of further improvement. Room of further improvement includes enhancement of synergy of the ＂ Three-manager mode＂ , enhanced motivation of government financial support and medical insurance, better service functions of community institutions, and especially the construction of hierarchical medical system.