应用以人为本整合型医疗服务理念开展老年共病管理的SWOT分析和发展策略建议  

Strategies of geriatric management for elderly patients with multimorbidity based on concept of people centered integrated care

作　　者：陈昕 李扬[1] 葛剑力[1] 耿莎莎[1] 李青青[1] 朱英倩 江华[1] Chen Xin;Li Yang;Ge Jianli;Geng Shasha;Li Qingqing;Zhu Yingqian;Jiang Hua(Department of General Practice,Shanghai East Hospital,Tongji University School of Medicine,Shanghai200120,China)

机构地区：[1]同济大学附属东方医院全科医学科,上海200120

出　　处：《中华全科医师杂志》2024年第11期1210-1215,共6页Chinese Journal of General Practitioners

基　　金：上海市卫生健康委员会项目(202140248);国家重点研发计划(2022YFC3601504)。

摘　　要：老年共病管理仍是我国医疗卫生系统的巨大挑战, 以人为本整合型照护(PCIC)是我国医疗卫生服务理念改革的方向, 应用PCIC理念开展老年共病管理可更好地提升老年共病患者健康水平。本文应用SWOT(strength-优势、weakness-劣势、opportunity-机遇、threat-威胁)分析法探讨了应用PCIC理念开展老年共病管理的内部优势和劣势以及外部机遇和威胁, 并提出了借助数字化技术以推进个性化评估及多学科协作、依托紧密医疗体建设以推进共病管理、深入实践以构建中国特色老年共病管理模式、强化基层医疗机构作用以完善共病长期管理机制的应对策略。Multimorbidity management for the elderly is a big challenge for China′s healthcare system and the people centered integrated care(PCIC)is a new concept in health care reform,and the application of the PCIC in multimorbidity management can better improve the health servece for elderly patients.This article applies SWOT analysis to assess the internal strengths and weaknesses as well as external opportunities and threats of applying the PCIC to the geriatric management of multimorbidity;also proposes strategies of geriatric management for elderly patients with Chinese characteristics based on concept of PCIC.The proposed stretegies optimize the personalized assessment with the digital technology,promotes the management with close-knit healthcare system,and strengthen the role of primary medical institutions to improve the long-term management mechanism of multimorbidity.

关 键 词：老年 共病 以人为本整合型服务 SWOT分析 策略 

分 类 号：R592[医药卫生—老年医学]