73-year-old Wang Chengliang was unwell, and the first person to contact was not his children, but his contracted family doctor Chen Yao. "Dr. Chen is a doctor at the community health service center, with high medical skills and patience, I asked a lot of questions, and she always smiled and answered them. ”
I can go out to see a doctor, and I can ask a doctor at home. Xinhua Daily Telegraph reporters recently interviewed a number of community health service centers in Heping District, Shenyang City, and found that in the face of the surge in demand for medical treatment for the elderly and the uneven distribution of medical resources, Shenyang continues to strengthen the construction of community hospitals, and more and more "applauded and popular" community health service centers have sprung up. At the same time, due to the lack of posts, staff, and money, many community hospitals are still facing the dilemma of brain drain. How to retain people is becoming a common challenge for community health service centers in China.
A community doctor sees a resident. Photo by Xinhua Daily Telegraph reporter Liu Yichun.
Seeing a doctor at the door of the house allows the people to have a "doctor" in their hearts
In the community health service center, a traditional Chinese medicine characteristic outpatient clinic was opened, the family contracted doctors** answered questions, and the palliative care ward guarded the patient's last journey, spanning thousands of miles of remote consultation ......Recently, the reporter walked into a number of community health service centers in Heping District and found that "small" community hospitals have played a big role at the grassroots level. Minor and common diseases can be diagnosed and treated at home, and more and more residents' medical experience has been continuously improved, and the health management effect has been greatly improved.
The reporter visited and found that many residents have well-known and well-remembered community health service centers. At 5 o'clock in the morning, most people were still asleep, and Chen Yao, a general practitioner at the Beishi Community Health Service Center in Heping District, Shenyang City, had already begun to prepare. She tapped her mobile phone, and with the words "Today's Visit" simultaneously sent to the four residents' WeChat groups, one after another inquiries kept popping up in the groups: "Dr. Chen, my heart is not very good", "Can I take these medicines together", "My head has been hurting recently", "Is there a free lung CT in the near future", ......In the four WeChat groups, all of them are her contracted residents.
41-year-old Chen Yao is a person who is "closer than a daughter" in the hearts of contracted residents. She is available 24 hours a day** and is available for online consultation at any time. "Uncle, it's not better, I usually pant heavily at night. This is a message sent by Chen Yao at 23 o'clock. The 93-year-old Li Linbin couldn't stop panting, Chen Yao finished the consultation during the day, but he was still not at ease at night, "No matter how late it is, I have to reply to the messages in the group." ”
Chen Yao, a community doctor, is giving a health lecture. Photo by Xinhua Daily Telegraph reporter Liu Yichun.
In the health promotion class of the Daqing Road community, Chen Yao is introducing the risk of hypertension to the residents. Among the more than 50 listeners, Jiao Yuguang, a 64-year-old resident of the Beishi community, and his wife had long heard that Chen Yao was a good doctor with a sense of responsibility.
Dr. Chen can explain to us the prevention and treatment of hypertension and diabetes in the most popular language, and we have benefited a lot, she is a good doctor who can understand people, and we trust her very much. After listening to the lecture, the old couple decided to sign a contract with Chen Yao.
I went to many hospitals, but I didn't want to take my father in, and finally came to the North City Community Health Service Center, where I have been hospitalized for more than 20 days. Chen Jie's 93-year-old father suffers from colon tumors, suffering from stomach pain and vomiting every day.
The principle of palliative care is to treat natural death as a normal part of the world, to alleviate painful symptoms and to provide physical, psychological and spiritual support to patients at the end of life. Chen Ying, director of the Beishi Community Health Service Center, recalled that 61-year-old Ban Sulan had been tormented by malignant glioma for a long time, and the community health service center treated the symptoms and relieved the headache of the elderly. Later, accompanied by medical staff, Ban Sulan walked safely through the last journey of her life.
Since 2018, the Beishi Community Health Service Center has carried out the pilot work of palliative care, providing care and humanistic care for terminally ill or elderly patients through medicine, nursing and other means, so that patients can die as comfortably and dignified as possible. Since the establishment of the ward, a total of 521 patients have been admitted to the palliative care unit, of which 169 patients have passed away peacefully in the palliative care unit.
The picture shows a variety of Chinese herbal medicines placed in the pediatrician's office. Photo by Xinhua Daily Telegraph reporter Yu Yetong.
Walking into the consultation room of Shen Ling, a pediatrician at the South Railway Station Community Health Service Center in Heping District, there are more than 100 kinds of Chinese medicinal materials on the small shelf. Every time she sees a patient, Shen Ling prepares a special Chinese medicine acupuncture point patch according to the specific situation.
For a long time, the pediatric specialty of the South Railway Station Community Health Service Center's characteristic Chinese medicine concentrated decoction and traditional Chinese medicine acupoint stickers have been widely used in clinical practice, and have been called "children's kings" by patients. Shen Ling said that in the past, the medicine of "Children's King" was powder noodle medicine, and in order to make it more suitable for children, the hospital has carried out all-round improvement of the medicine, specially introduced equipment from Beijing, turned the medicine noodle into a decoction, and then squeezed and concentrated. "The finished product is just a small bag, and it is easier for children to eat. After 5 days of medicine, it was only more than 100 yuan, and the medicine was decoctioned for free. Citizen Zhao Yuan said.
Ren Zanyang, 40, has three children at home, "Traditional Chinese medicine preparations are particularly effective for my children's abdominal pain, and they can get a lot better after eating two or three packets." "Even if he has to drive 20 kilometers, he has to come here for medical treatment.
Li Dongmei, a pediatrician at the South Railway Station Community Health Service Center of Heping District, believes that the advantages of traditional Chinese medicine of "simplicity, testing, inexpensiveness and effectiveness" are often twice the result with half the effort in the primary diagnosis and treatment, and the massage technique and acupuncture can alleviate the symptoms of various diseases such as the respiratory system, digestive system, and common diseases in the department, and the scope of application is widerSome children have digestive problems, but are afraid of needles, so we use pediatric massage. ”
High-quality resources are sinking, characteristic departments are cultivated, and family doctors are contracted
The reporter interviewed and found that there are three reasons behind the popularity of many community health service centers in Heping District.
The first is the medical alliance model to guide the orderly sinking of high-quality medical resources. Since the beginning of this year, Heping District has carried out the construction of general practice and specialist joint outpatient clinics in the two community health service centers of Beishi and Changbai, and the general practice specialty of the First Affiliated Hospital of China Medical University, and integrated medical experts into the family doctor team, so that the diagnosis and treatment level of the grassroots community health service centers has been significantly improved, and the whole process of closed-loop management such as chronic disease screening, diagnosis and treatment, risk factor intervention, follow-up and follow-up has been realized.
With the construction of medical alliances as the carrier, we have formed a 'two up and two down' mechanism for medical staff and community patients, and promoted the construction of a hierarchical diagnosis and treatment system. Fu Wenli, deputy director of the Health Bureau of Heping District, Shenyang City, said that the first is the two-way flow of medical personnel. That is, to establish and improve the training and guidance system for general practitioners to go to ** hospitals and ** hospitals to community health service centers;The second is to achieve two-way referral of patients. As needed, transfer difficult and severe patients to ** hospitals, and transfer patients with clear diagnosis and stable conditions back to the community to continue**.
The second is the characteristic department of point cultivation. Fu Wenli believes that the construction of special and characteristic departments in the community such as "children's kings" and palliative care wards can effectively improve the medical service capacity of community health service centers and promote residents to choose the first diagnosis at the grassroots level.
The picture shows a variety of Chinese herbal medicines placed in the pediatrician's office. Photo by Xinhua Daily Telegraph reporter Yu Yetong.
Li Dongmei, a pediatrician at the South Station Community Health Service Center, receives an average of 20 small patients a day, and she admits that the shortage of pediatricians is a common problem in the community health service center.
Li Dongmei often goes to Nanhu, Changbai and other areas to carry out weekly inspection activities, and also has a more comprehensive understanding of primary diagnosis and treatment. "Many parents do not know the treatment of TCM pediatrics, nor do they understand its concept and scope of application, and now the first task is to strengthen the dissemination efforts, so that the masses can first understand, then recognize, and finally choose TCM pediatrics. ”
Taking characteristic pediatrics as an example, at present, Heping District has established "Children's King" studios in community health service centers such as Changbai, Shenshuiwan and Nanhu, which has promoted the improvement of the capacity of traditional Chinese medicine pediatrics and children's health care services in community health service centers.
The third is to improve the contract system for community doctors. Heping District continues to optimize the contracted services of family doctors, not only formulating personalized contracted service packages according to the different diagnosis and treatment needs of the elderly, but also carrying out door-to-door work such as the establishment of resident files, contracted services of family doctors, health examinations for the elderly and postpartum visits for pregnant women, etc., with the family doctor team as a unit, to ensure that the contracted services are fully covered.
Up to now, Chen Yao's team has signed more than 8,600 personalized patients, and 73 family doctor teams formed by 13 community health service centers in Heping District have entered 1,579 residents' WeChat groups to provide health services for residents in the jurisdiction 24 hours a day.
Community hospitals, which are "applauded and acclaimed", are still struggling to retain people
As soon as we heard that the higher-level medical institutions were recruiting, we were like '****, and the talents that had been cultivated with great difficulty were gone, and the community hospital became the training base of the higher-level hospitals. Chen Ying, director of the Beishi Community Health Service Center, was helpless. The reporter interviewed and found that the "three shortages" of lack of posts, lack of staff, and lack of money are the common problems faced by community health service centers in China.
First, the proportion of posts is too low, and the employment period of post level is long. On the one hand, the proportion of high- and mid-level positions is too low, and career development prospects are limitedOn the other hand, the employment of the post level is limited by the number of years of service in the staff. During the investigation, the reporter learned that there are currently 136 medical personnel with senior professional titles in the community health service center under the jurisdiction of Heping District, and they cannot be hired for the corresponding positions due to the restrictions on the proportion of posts.
It takes a minimum of 1 year and a maximum of 8 years to be hired. So many colleagues couldn't afford to wait and left. Chen Ying said that now many domestic primary medical and health institutions personnel recruitment, professional title evaluation methods so that many business backbones flow to large hospitals, the "siphon effect" of large hospitals is becoming more and more obvious.
Second, the establishment is small and the work tasks are heavy. In recent years, there has been an increase in the number of national basic public health services, and the workload of community health service centers has increased, but the staffing has rarely been adjusted. In order to alleviate the pressure of the task, community health service centers generally recruit non-staff personnel through public welfare posts, personnel services, labor dispatch and other ways to supplement them, and even most of the staff of some institutions are non-staff personnel. Low wages, large psychological gaps, lack of incentive mechanisms, and complicated and trivial tasks such as filling in ** and home follow-up have led to a low retention rate of grassroots medical workers.
Third, the medical income is small, and the treatment of grassroots workers is poor. At the grassroots level, basic public health services are mainly supported by public finance, but in terms of income distribution, the performance appraisal mechanism is not particularly skewed. There are the following problems in the development of primary medical institutions: professional positions such as public health, ultrasound imaging, ** and mental health cannot be recruitedThere is an imbalance in the distribution of human resources in different regions and between urban and rural areas, and there is a lack of good doctors in some remote areas and rural primary medical and health institutionsSome community health service centers have outdated and aging equipment, and the level of primary medical care is uneven.
In this regard, industry experts suggest: on the one hand, it is necessary to reasonably approve the establishment of positions and select and hire professionals in radiation medicine and other directions;Weaken the proportion of scores such as ** and topics, and take the number of years of grassroots service and actual performance as an important criterion for assessment, and those with excellent performance can be given priority to promotion;**The financial talent support program is tilted towards the grassroots to make up for the existing performance funding gap.
Community residents participate in a health lecture. Photo by Xinhua Daily Telegraph reporter Liu Yichun.
On the other hand, the construction of the service model of the medical alliance can be further strengthened. Some front-line medical staff believe that at present, the construction of medical alliances mainly relies on administrative orders, and mechanisms such as performance distribution and financial support within medical alliances have not yet been established, and the development of medical alliances lacks sustainable momentum. To give full play to the advantages of the medical alliance system in the long term, it is also necessary for multiple departments such as medical insurance and finance to form a joint force to promote "financial communication, medical communication and human communication" from top to bottom. (Xinhua Daily Telegraph).