社区导向的医防融合:理论基础和当代实施路径探析  

Community-oriented Integration of Medicine and Prevention:an Analysis of Theoretical Basis and Contemporary Implementation Pathways

作　　者：汪洋 金花 袁蓓蓓 宦红梅 杨辉[7] 于德华 方海[1,2] WANG Yang;JIN Hua;YUAN Beibei;HUAN Hongmei;YANG Hui;YU Dehua;FANG Hai(School of Public Health,Peking University,Beijing 100191,China;China Center for Health Development Studies,Peking University,Beijing 100191,China;Department of General Practice,Yangpu Hospital Affiliated to Tongji University,Shanghai 200090,China;Research Center for General Practice,School of Medicine,Tongji University,Shanghai 200090,China;Research Center for General Practice and Community Health Development,Shanghai 200090,China;Gumei Community Health Center,Minhang District,Shanghai 200237,China;School of Public Health and Preventive Medicine,Monash University,Melbourne 3168,Australia)

机构地区：[1]北京大学公共卫生学院,北京市100191 [2]北京大学中国卫生发展研究中心,北京市100191 [3]同济大学附属杨浦医院全科医学科,上海市200090 [4]同济大学医学院全科医学研究中心,上海市200090 [5]上海市全科医学与社区卫生发展研究中心,200090 [6]上海市闵行区古美社区卫生服务中心,200237 [7]蒙纳士大学公共卫生与预防医学学院,澳大利亚墨尔本市3168

出　　处：《中国全科医学》2024年第22期2689-2699,共11页Chinese General Practice

基　　金：北京市自然科学基金面上项目(9222013);上海市领军人才(YDH-20170627);上海市卫健委卫生政策课题(2023HP28,2023HP71)。

摘　　要：本篇评论阐明了我国基层医疗卫生体系相对于国际初级卫生保健体系的两个独特特点:更狭窄的患者人群和业务范围,以及更薄弱的基本医疗能力。以此为基础,文章总结和对比了20世纪的两种最具代表性的,且在全球产生了广泛影响的两种与医防融合关系极为密切的整合基本医疗服务中的临床和公共卫生部分的理论-实践模式:“社区导向的基本医疗”模式和“赤脚医生”模式。在此基础上,本文进一步结合于2023年第四季度在上海市基层医疗卫生体系中观察到的多项实际案例,阐述了未来在我国的基层医疗卫生机构中,转化和实施这两种医防融合模式的可行路径和对外部条件的需求,并提出了在不同地区实施上述模式的原则性建议。In this commentary,we elucidate two distinctive characteristics of China's primary health care system relative to the global primary health care framework:a more narrowly defined patient population and scope of services,along with a diminished clinical capacity in primary care.Building upon this foundation,we critically examine and juxtapose the two quintessential theoretical-practical models of the 20th century that are intimately linked with the integration of medication and prevention.They are the"Community-Oriented Primary Care"Model and the"Barefoot Doctor"Model.Additionally,leveraging a series of practical cases observed within Shanghai's primary care settings in the fourth quarter of 2023,we deliberate on viable approaches for adapting and applying these models in China's primary care infrastructure.We further delineate the requisite external conditions for such a transformation and offer targeted recommendations for the deployment of these models across diverse locales.

关 键 词：初级卫生保健 基本医疗 医防融合 赤脚医生 社区导向 

分 类 号：R161[医药卫生—公共卫生与预防医学]