目的: 调查东莞市居民对基层首诊制度的认知,分析居民基层首诊就医意愿的影响因素,探求优化居民支持强制基层首诊的途径和方式。方法: 采用简单随机抽样对东莞市部分地区共计350名居民进行问卷调查,用 SPSS 26.0 软件对数据进行描述性分析、卡方检验以及决策树模型分析。结果: 大部分东莞市居民支持基层首诊（83.8%）、分级诊疗制度（70.0%）,超半数居民满意转诊过程（62.7%）,65.4%的居民不赞成强制基层首诊制度。居民对基层医疗机构相关条件感到信任的比率小于30%。在基层就诊意愿的决策树分析中,基础设施信任度、转诊过程满意度是影响居民基层医疗机构就诊意愿的重要预测因素。结论: 政府应大力加强对基层首诊相关制度的宣传力度,继续提高基层医疗机构的服务能力,优化转诊流程和丰富转诊工作内容。

Objective: This study investigated Dongguan residents' cognition on policies related to first visit at the grassroots level, analyzed the influencing factors of Dongguan residents' willingness to have primary care at the grassroots level, and explored means to optimize residents' support for compulsory primary diagnosis. Methods: The questionnaire survey was conducted among 350 residents in Dongguan by simple random sampling. Descriptive analysis, chi-square test and decision tree model analysis were carried out with SPSS 26.0 software. Results: The majority of Dongguan residents support first visit at the grassroots level (83.8%) and graded diagnosis and treatment system (70.0%), and over half of them are satisfied with the referral process (62.7%) and disapprove of the compulsory first visit at the grassroots level (65.4%). Less than 30% of residents trust in primary medical institutions. In the decision tree analysis of the willingness to see a doctor at the grassroots level, the trust of infrastructure and the satisfaction of referral process are important predictors of the willingness to see a doctor at the grassroots medical institutions. Conclusion: It is necessary for the government to vigorously strengthen the publicity of policies and systems related to primary care at the grassroots level, continue to improve the service capacity of primary medical institutions, optimize the referral process and enrich the content of referral work.