家庭医生责任制下城市社区公共卫生服务模式的探索与实践  

Management Mode of Urban Community Public Health Services Within the Family Doctor System

作　　者：吴燕[1] 赵燕萍[1] 黄晓霞[1] 王君燕[1] 许慧琳[1] 苏华林[1] 

机构地区：[1]上海市闵行区疾病预防控制中心,201105

出　　处：《中国全科医学》2015年第13期1504-1509,共6页Chinese General Practice

基　　金：上海市卫生和计划生育委员会2014年面上项目;上海市医院管理研究基金委(局)级课题(2014032)--家庭医生责任制公共卫生服务项目包设计及服务协同机制研究

摘　　要：目的探索总结出一套适合城市社区家庭医生责任制公共卫生的运行模式,以期为家庭医生责任制公共卫生的进一步优化提供参考。方法本研究以上海市闵行区为例,对其家庭医生责任制下的公共卫生服务模式及初步成效进行总结分析。闵行区自2011年开展社区卫生服务家庭医生责任制试点工作,社区公共卫生服务模式逐步向家庭医生责任制模式转型。具体措施包括:完善家庭医生责任制社区公共卫生服务组织架构和部门协同机制;有机整合与临床密切相关的基本公共卫生服务;搭建家庭医生责任制服务信息化网络服务平台;推行公共卫生服务项目全面预算管理;实施医务人员绩效考核管理。结果截至2014年底,闵行区家庭医生签约居民143.67万人,签约居民的家庭健康档案建档率达到100.00%;孕产妇系统管理率和儿童系统管理率均维持在较高水平(≥96%);高血压管理率〔40.73%(211 518/519 331)比28.70%(149 075/519 425)〕、高血压患者血压有效控制率〔82.13%(173 720/211 518)比77.51%(115 548/149 075)〕、糖尿病管理率〔37.85%(64 367/170 058)比21.93%(37 301/170 091)〕、糖尿病患者血糖有效控制率〔82.43%(53 058/64 367)比62.77%(23 413/37 301)〕、学生健康管理率〔99.79%(134 448/134 733)比91.54%(110 505/120 718)〕均较2010年有所上升,差异有统计学意义(P<0.001)。结论家庭医生责任制转型是社区公共卫生服务发展的必然趋势,其能更好地维护居民健康,提高社区公共卫生服务能力;但还存在全科医生人才紧缺、服务技能较弱、观念转变不够、家庭医生公共卫生服务项目界定不够清晰、部门协同机制不够完善等问题亟待解决。Objective To explore a fit management mode of urban community public health services within the family doctor system and to provide references for further improvement. Methods We took Minhang District of Shanghai as the subject and investigate its management model of public health services within the family doctor system. Minhang District became a pilot place for family doctor-based community healthcare system in 2011. Since then,the management model of public health services in the district has merged with family doctor system gradually by taking a series of measures：the adjustment of organization and coordination mechanism in community public health services,the organic integration of basic public health services closely related with clinic practice,the establishment of an informationized Internet service platform of family doctor system,the comprehensive budget management of public health service programs and the performance evaluation management of health workers. Results By the end of 2014,the number of residents contracted with family doctor system in Minhang District reached 1. 4367 million and all of them established family health records. The rates of maternal management and children management stayed at high level （≥96%）;the coverage rate of hypertension management〔40. 73%（211 518/519 331）vs. 28. 70%（149 075/519 425）〕,the rate of effective control on hypertension〔82. 13%（173 720/211 518） vs. 77. 51%（115 548/149 075）〕,the coverage rate of diabetes〔37. 85%（64 367/170 058）vs. 21. 93%（37 301/170 091）〕,the rate of effective control on the blood sugar of diabetic patients〔82. 43%（53 058/64 367）vs. 62. 77%（23 413/37 301）〕and the coverage of students＇health management〔99. 79%（134 448/134 733）vs. 91. 54%（110 505/120 718）〕all increased（P﹤0. 001）compared with 2010. Conclusion Family doctor system may be a trend of the development of community public health services,which can better maintain the residents＇ health and enhance the public he

关 键 词：家庭医生制度 公共卫生服务 城市社区 

分 类 号：R197[医药卫生—卫生事业管理]