Study on the Current Situation and Influencing Factors of Primary Diagnosis At The Grassroots Level between Community Health Service Institution and Hospital

The high-quality gatekeeper is the first step of effective allocation of healthcare resources from the perspective of the international research and practices. According to the non-vertical integration of medical and health resources, whether the primary consultation is required to be compulsory or not, the interaction mode between community health institutions and hospitals is divided into two types. One is Community first diagnosis model, which requires mandatory first consultation at the grassroots level. The other is a "guidance and protocol referral" model, which can select the community or general hospital as the first consultation institution. In the two interactive pattern, 711 residents from the cities of Dongguan and Foshan, which have the same economic and social background were surveyed. 468 residents chose the first consultation at the grassroots level when they fell ill in the past year. Research shows that "community first diagnosis" model precedes guidance and protocol referral model in the aspect of relative policy awareness of graded diagnosis and treatment. Age, distance from residence to the community medical institutions, policy awareness of graded diagnosis and treatment are statistically significant for the first consultation at the grassroots level. Whether there are familiar and trusted doctors at the grassroots level is the factor that affects the first consultation under the community first diagnosis model, while the influencing factor under the "guidance and protocol referral" model is the self-evaluated health status. On the one hand, we should divert experienced and excellent doctors to the grassroots level, which can improve the capacity of primary health services. On the other hand, we should strengthen propaganda of relevant supporting policies on primary diagnosis at the grassroots level and promote preliminary understanding of frequently and encountered disease. Finally, the interactive pattern between different levels of medical institutions can be determined according to the public opinions, which can not only cultivate correct medical habits and form a benign medical order, but also improve policy satisfaction.