Objective: To analyze the current problems and causes of the hierarchical diagnosis and dual referral of chronic diseases in selected regions of Guangdong Province. Methods: Based on macro, meso and micro perspectives, 41 primary healthcare staff in Guangzhou and Qingyuan were interviewed on the implementation of medical workers in hierarchical diagnosis and dual referral. Re- sults: The primary health care institutions surveyed had problems in lacking regular referral process, low downward transfer of pa- tients, and missed visits from primary care patients. Macro included the lack of regulation of the system, Meso included the issue of in- terests between healthcare institutions, and Micro included the influence of medical workers’attitudes. Conclusion: The long-term management of chronic diseases requires a high level of collaboration in the healthcare system, and the current barriers at the system and implementation levels affect the continuity of chronic disease management. The operational mechanism of hierarchical?diagnosis and dual referral of chronic diseases should be optimized by strengthening the regulation of dual referral and improving the rules of medical insurance, so as to enhance the continuity of chronic disease management and better meet the needs of the grassroots for chronic disease treatment and management.