基于医-护-助责任制的德胜家庭医生签约服务模式
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摘要
家庭医生签约服务是落实医改政策的体现,是基层服务模式的转变。德胜社区卫生服务中心以老年人和慢性病患者等重点人群的健康需求为导向,立足社区现有的卫生人力资源,充分挖掘内部潜力,组建新型家庭医生签约服务医-护-助团队,建立团队内部不同专业人员明确责任划分与分工合作机制[医生依托医联体和院校专家资源建立纵向专家技术团队,不断加强家庭医生综合诊疗能力,提升签约管理水平;护士实施公共卫生管理能力提升,培养社区专科护士,建立护士健康管理室,保障签约患者综合性及个性化的健康管理权益;纳非专业人员(护士助理)入家庭医生签约服务团队,协助团队承担更多事务性工作,分担团队工作压力,扩大服务覆盖];借助计算机智能协助定向分诊,强化、巩固医患之间的契约服务关系,落实连续性管理,提供差异性签约服务;与时俱进不断完善绩效考核的监督管理与激励机制,推动家庭医生签约服务向纵深发展。德胜社区卫生服务中心经过8年的实践探索,建立了一套自下而上的基层操作版家庭医生签约服务实践运行模式,效果肯定,社区居民签约率、规范管理率、慢性病控制率,社区就诊率、健康行为改善率、签约居民满意率、辖区居民健康素养提升率均不断提高,真实有效地推动了国家医改进程,有助于基层首诊、双向转诊、急慢分治、上下联动的分级诊疗秩序形成,值得借鉴推广。
Contracted family doctor services is an embodiment of medical reform policy implementation and change of community service model.Based on the health needs of key groups such as the elderly and patients with chronic diseases,and the existing health human resources in the community,Desheng Community Health Service Center fully taps its internal potential,establishes a new doctor-nurse-assistant nurse team of contracted family doctor services,and builds a clear responsibility division and cooperation mechanism for different professionals within the team[relying on Medical Treatment Partnership System and experts resources,professional team was built to continuously strengthen the comprehensive diagnosis and treatment ability of family doctors and improve the contract management level;enhance the ability of nurses to implement public health management,train specialty nurses in communities,establish nurses' health management room,guarantee the comprehensive and personalized health management rights and interests of contracted patients;incorporate non-professional staff(nurse assistants) into the contracted service team of family doctors to undertake more routine work,share team work pressure and expand service coverage]. The computer assisted triage system was established to ensure that residents can enjoy differentiated services,so as to strengthen and consolidate the contractual service relationship between doctors and patients,implement the continuous management,and provide differentiated contract services.By keeping pace with the times,we would improve the supervision,management and incentive mechanism of performance appraisal,and promote the in-depth development of contracted family doctors services.After 8 years of practice and exploration,Desheng Community Health Service Center established a set of effective bottom-up practice operation model of contracted family doctors services.We have achieved much progress:the contracting rate,standardized management rate,control rate of chronic disease,community visiting rate,health behavior improvement rate,satisfaction rate of contracted residents and health literacy improvement rate of residents in the jurisdiction area have constantly increased.It effectively promotes the national medical improvement process,and contributes to primary treatment at the community level,two-way referral,different treatments in acute and chronic diseases,and hierarchical diagnosis and treatment.This model is worth learning and popularizing.
Contracted family doctor services is an embodiment of medical reform policy implementation and change of community service model.Based on the health needs of key groups such as the elderly and patients with chronic diseases,and the existing health human resources in the community,Desheng Community Health Service Center fully taps its internal potential,establishes a new doctor-nurse-assistant nurse team of contracted family doctor services,and builds a clear responsibility division and cooperation mechanism for different professionals within the team[relying on Medical Treatment Partnership System and experts resources,professional team was built to continuously strengthen the comprehensive diagnosis and treatment ability of family doctors and improve the contract management level;enhance the ability of nurses to implement public health management,train specialty nurses in communities,establish nurses' health management room,guarantee the comprehensive and personalized health management rights and interests of contracted patients;incorporate non-professional staff(nurse assistants) into the contracted service team of family doctors to undertake more routine work,share team work pressure and expand service coverage]. The computer assisted triage system was established to ensure that residents can enjoy differentiated services,so as to strengthen and consolidate the contractual service relationship between doctors and patients,implement the continuous management,and provide differentiated contract services.By keeping pace with the times,we would improve the supervision,management and incentive mechanism of performance appraisal,and promote the in-depth development of contracted family doctors services.After 8 years of practice and exploration,Desheng Community Health Service Center established a set of effective bottom-up practice operation model of contracted family doctors services.We have achieved much progress:the contracting rate,standardized management rate,control rate of chronic disease,community visiting rate,health behavior improvement rate,satisfaction rate of contracted residents and health literacy improvement rate of residents in the jurisdiction area have constantly increased.It effectively promotes the national medical improvement process,and contributes to primary treatment at the community level,two-way referral,different treatments in acute and chronic diseases,and hierarchical diagnosis and treatment.This model is worth learning and popularizing.
引文
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[4]高风娟,韩琤琤,刘菊红,等.不同国家和地区的家庭医生签约服务模式及激励机制介绍[J].中国乡村医药,2016,23(19):59-60.DOI:10.3969/j.issn.1006-5180.2016.19.035.GAO F J,HAN C C,LIU J H,et al.Introduction of family doctor contract service model and incentive mechanism in different countries and regions[J].Journal of Cinical Medical Literature,2016,23(19):59-60.DOI:10.3969/j.issn.1006-5180.2016.19.035.
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[7]王彤,赵岩,金光辉,等.北京市城区家庭医生式服务开展现状研究[J].中国全科医学,2015,18(28):3413-3416.DOI:10.3969/j.issn.1007-9572.2015.28.008.WANG T,ZHAO Y,JIN G H,et al.Research on the current situation of family doctor service in Beijing urban area[J].Chinese General Practice,2015,18(28):3413-3416.DOI:10.3969/j.issn.1007-9572.2015.28.008.
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[11]王凌云,刘菊红,赵洁,等.北京市德胜社区签约慢性病患者慢性病防治知信行现状调查[J].中国健康教育杂志,2013,12(29):1071-1074.WANG L Y,LIU J H,ZHAO J,et al.Investigation on knowledge,belief and practice of chronic disease prevention and treatment in Desheng Community of Beijing[J].Chinese Journal of Health Education,2013,12(29):1071-1074.
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