目的:基于典型调查,分析在分级诊疗制度下慢性病患者门诊服务的利用情况。方法:选取合肥市某三甲医院心血管内科、风湿免疫科、内分泌科和呼吸内科的门诊就诊患者为对象,利用自行设计的调查问卷进行面对面访谈或自行填写调查问卷收集资料,回收有效问卷806份,结果:(1)就该次就诊的健康问题,43.5%的患者来该三甲医院就诊是首诊,其中居住于本市患者首诊比例为49.3%,高于来自于省内其他城市和省内农村地区居民,差异有统计学意义(P<0.05);(2)就该次就诊的健康问题曾就诊过患者中,60.4%曾在省级医院就诊过,39.4%曾在市级医院就诊过,在县(区)级医院和基层医疗机构就诊过的比例分别为31.6%、18.9%。结论:慢病患者基层首诊比例不高,在分级诊疗制度下基层医疗机构的作用并没有得到发挥;改革公立医院人事制度,引导优质人力资源下沉,切实提高基层服务能力是推进分级诊疗制度得以落到实处的关键。 OBJECTIVE: To analyze the utilization of outpatient services for patients with chronic diseases in a hierarchical system based on typical surveys. Methods: Outpatients from outpatient department of cardiology, rheumatology department, endocrinology and respiratory medicine in a top three hospital in Hefei were selected as subjects. Face-to-face interviews were conducted with self-designed questionnaires or self-completed questionnaires were collected to collect 806 valid questionnaires Results: (1) 43.5% of the patients visited the top three hospitals for the health problems of this visit. The first visit among them was 49.3%, higher than those from other cities and provinces in the province (P <0.05); (2) 60.4% of the patients who had been treated for the health problems of this visit had been treated in the provincial hospitals and 39.4% had attended the municipal hospitals However, the proportion of patients visited the county (district) level hospitals and primary medical institutions was 31.6% and 18.9% respectively. Conclusions: The proportion of primary care in patients with chronic diseases is not high enough, and the role of grassroots medical institutions under the system of grading medical treatment has not been fully realized. Reforming personnel system of public hospitals, leading quality human resources to sink, and improving grassroots service ability is the key to promoting the grading system To be the key to success.