Objective To investigate the reasons for patients with chronic diseases selecting third - level grade A hospitals to buy medicine,to compare the patients' satisfaction with buying medicine between in third - level grade A hospitals and in community health service centers( stations),and to put forward suggestions on the reformation of community health service agencies. Methods By using convenience sampling method,500 patients with chronic diseases who merely bought medicine from outpatient and emergency department in Peking University People's Hospital(third - level grade A hospital)from January 2014 to March 2014,were selected as study subjects,they were asked to complete a questionnaire. The content of the questionnaire included the internal and external influencing factors for patients with chronic diseases selecting third - level grade A hospitals to buy medicine,the patients' satisfaction with buying medicine( satisfaction was classified into five grades:highly satisfactory,quite satisfactory,general satisfactory,quite dissatisfactory,highly dissatisfactory) in third - level grade A hospitals and in community health service agencies,the reasons for satisfaction and dissatisfaction,and suggestions on the reformation of community health service agencies. Results Among 469 patients with chronic diseases,226 cases were male,243 were female;most cases were aged 60 or older;most cases were retirees;the highest education level of most cases was senior high school graduation or technical secondary school graduation;annual household income of most cases was 50 000 - < 100 000 Yuan;most cases had medical insurance for urban workers. The reasons for patients with chronic diseases selecting third - level grade A hospitals to buy medicine:the medicine of third - level grade A hospitals was complete(356 person - times,75. 9% ), the medicine had high quality(345 person - times,73. 6% ),convenient transportation(269 person - times,57. 4% ),and 160 person - times(34. 1% )were used to buy medicine in third - level grade A hospitals. The patients' satisfaction with buying medicine in third - level grade A hospitals:highly satisfactory in 53 cases,quite satisfactory in 236 cases,general satisfactory in 141 cases,quite dissatisfactory in 33 cases,highly dissatisfactory in 6 cases;the patients' satisfaction with buying medicine in community health service agencies:highly satisfactory in 21 cases,quite satisfactory in 199 cases,general satisfactory in 203 cases,quite dissatisfactory in 41 cases,highly dissatisfactory in 5 cases. The reasons for patients' dissatisfaction with buying medicine in third - level grade A hospitals:〝 long waiting time〝 in 378 person - times(80. 6% ),〝 quantity of drugs in every purchase was restricted〝 in 132 person - times(28. 1% ),〝 the types of drugs was restricted〝 in 102 person - times(21. 7% ). The reasons for patients' dissatisfaction with buying medicine in community health service agencies:〝 the medicine of community health service agencies was incomplete〝 in 398 person - times(84. 9% ),〝 question drug quality of community health service agencies〝 in 316 person - times(67. 4% ),〝 quantity of drugs in every purchase was restricted〝 in 261 person - times (55. 7% ). Mean rank of patients' satisfaction with buying medicine in community health service agencies(430. 65)was significantly less than that(508. 35)in third - level grade A hospitals(u = 91 760. 500,P < 0. 001). Patients' suggestions on the reformation of community health service:to improve the quality of the medical staff,to increase the types of drugs,to improve medical environment,to improve medical equipment,to increase quantity of drugs for every purchase,and to improve reimbursement ratio of drugs. Conclusion The patients' satisfaction with buying medicine in third - level grade A hospitals is relatively high,while patients' satisfaction with buying medicine in community health service agencies. In order to promote the patients with chronic diseases to buy medicine in community health service agencies,the types of drugs should be increased according to patients' medical needs;the medicine quality supervision system should be perfected,thus the quality of medicine can be guaranteed;the advocation should be strengthened,thus the patients' trust in drugs quality of community health service agencies can be improved;the overall strength of community health service should be enhanced.%目的：调查慢性病患者选择三级甲等医院单纯购药的原因，对比三级甲等医院及社区卫生服务中心（站）（社区）购药情况的满意度，对社区医疗改革提出建议。方法采用方便抽样的方法，2014年1—3月在北京大学人民医院（三级甲等医院）门（急）诊选择500例单纯购药的慢性病患者进行现场问卷调查。调查问卷的内容包括影响患者选择三级甲等医院单纯购药的内部和外部因素、患者对三级甲等医院及社区购药的满意度（分为非常满意、较满意、一般满意、较不满意、很不满意）、满意及不满意的原因以及对社区改进的意见等。结果回收有效问卷469份，男226例，女243例；年龄以≥60岁为主；职业以离退休人员居多；文化程度以高中/中专为主；家庭年收入以5~＜10万居多；医疗保险类型主要为享有城镇职工医疗保险。356人次（75.9%）认为三级甲等医院药品种类齐全，345人次（73.6%）认为三级甲等医院药品质量有保障，269人次（57.4%）认为医院离家或单位近、方便，160人次（34.1%）长期习惯在该院购药。患者对三级甲等医院购药非常满意53例、较满意236例、一般满意141例、较不满意33例、很不满意 6例；患者对社区购药非常满意21例、较满意199例、一般满意203例、较不满意41例、很不满意5 例。慢性病患者对三级甲等医院购药不满意的原因：378人次（80.6%） 认为排队等待时间过长，132人次（28.1%）认为可购药品时间受限，102人次（21.7%）认为在购药过程中可购药品种类受限。慢性病患者对社区购药不满意的原因：398人次（84.9%） 认为社区药品种类不全，316人次（67.4%） 质疑社区药品质量，261人次（55.7%）认为单次可购药品时间短。患者对社区满意度的平均秩次（430.65）小于对三级甲等医院满意度的平均秩次（508.35）（u ＝91760.500，P ＜0.001）。患者对社区改进的意见是提高医疗工作人员的素质、扩大药品种类、改善医疗环境、改进医疗设备、延长单次可购药品的时间、提高药品报销比例。讨论慢性病患者三级甲等医院购药满意度较高，但社区购药满意度一般，为促进慢性病患者选择社区购药，应结合患者医疗需求，适度扩大社区药品种类，健全和完善药品质量监管体系以确保社区药品质量，加大宣传力度以提高患者对社区药品的质量信赖度，提高社区卫生服务整体实力。
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