Reporter Yang Yanfan and You Yi Chang Biluo.
In Gongqiao Village, Peixing Town, Dianjiang County, Chongqing Municipality, a contracted doctor from the town health center visited the villagers to check their health. Photo by Gong Changhao.
In the Central Health Center of Qunke Town, a member unit of the Medical Community of Hualong Hui Autonomous County, Haidong City, Qinghai Province, doctors take the pulse of patients. Photo by Xinhua News Agency reporter Zhang Long.
The National Health Commission and other departments recently released the "Three-year Action Plan for the "Quality Service at the Grassroots Level" Activity and the Construction of Community Hospitals, which proposes that by 2025, township health centers and community health service centers serving a population of more than 10,000 people will generally meet the capacity standards.
Improving the capacity of primary medical services and allowing the public to obtain more equitable, accessible, systematic and continuous medical and health services is an important part of building a high-quality and efficient medical and health service system. In the county-level medical and health service system, township health centers are the hub connecting the upper and lower levels, and assume the important function of maintaining the health of the grassroots people. Recently, the reporter walked into the township health centers in Hunan, Chongqing, Sichuan and other places to explore how to improve the capacity of primary medical services.
Efforts have been concentrated on cultivating and building a number of grassroots clinical departments in township health centers, and the capacity of medical services has been significantly improved.
Stretched out his hand, raised it upward, above his head, and as he leaned forward, Liu Peide exhaled deeply. Early in the morning, he practiced breathing exercises in the corridor of the town health center. This year, 76-year-old Liu Peide, who lives in Guangping Village, Huangxu Town, Jingyang District, Deyang City, Sichuan Province, suddenly had a high fever and was sent to the Huangxu Town Health Center.
My COPD is the best disease, and it is easy to recur in winter. Liu Peide said while practicing, "Fortunately, the town health center has set up a respiratory department, and there are specialist doctors to diagnose and treat me, and the doctors also taught me breathing exercises." If you are sick, you can see it at your doorstep, and you don't have to run more than ten kilometers to go to the big hospital in the city. ”
In 2020, through the specialty alliance, the Jingyang District Hospital of Traditional Chinese Medicine in Deyang City helped Huangxu Town Health Center to build a respiratory department. As the director of the Department of Respiratory Medicine at Jingyang District Hospital of Traditional Chinese Medicine, Shi Chongyou visits Huangxu Town Health Center for one day a week to diagnose and treat respiratory diseases for the local people.
In order to improve its professional capabilities, Huangxuzhen Health Center has increased investment, improved department equipment and technical projects, and equipped ventilators, pulmonary function meters, and ECG monitors. Combined with the needs of the local people, the health center has also carried out new projects such as pulmonary function testing, non-invasive ventilator-assisted ventilation, electronic bronchoscopy and microscopic**. Since the establishment of the Department of Respiratory Medicine, a total of about 90,000 people have been treated.
Township health centers are mainly responsible for the diagnosis and treatment of common and frequently occurring diseases, and improving the capacity of medical services is the focus. Wang Jun, director of the Health Policy Research and Evaluation Center of Chinese University, believes.
In recent years, through the cooperation of specialty alliances, clinical teaching, project cooperation, etc., all localities have concentrated their efforts on cultivating and building a number of grassroots clinical characteristic departments in township health centers, and the medical service capacity has been significantly improved. In Yichang City, Hubei Province, some township health centers have hemodialysis rooms; In Mianzhu City, Sichuan Province, some town health centers have set up specialty ...... for dentistry
According to the relevant person in charge of Wengjiang Town Health Center, Pingjiang County, Hunan Province, the township health center has medical equipment such as color ultrasound and automatic biochemical analyzer, and is also equipped with pre-hospital and in-hospital first-aid equipment, including defibrillators, ECG monitors, cardiopulmonary resuscitation instruments, etc. The improvement of hardware equipment has greatly improved the basic diagnosis and treatment capacity and emergency first aid capacity of the health center.
Continue to improve the level of refined management within the medical community and attract outstanding talents to stay at the grassroots level.
69-year-old Granny Cheng fell at home, her right wrist was swollen and painful, and she came to the Shiyan Town Health Center in Changshou District, Chongqing. Liao Xiaoyong, an orthopedic surgeon from Changshou District Hospital of Traditional Chinese Medicine, sat in Shiyan Town Health Center, and after his diagnosis, he found that Granny Cheng's right distal radius was fractured, and she was quickly reduced and fixed accordingly.
Liao Xiaoyong, a doctor who is "hired by the county and used by the township", was stationed in the Shiyan Town Health Center in August last year to carry out work, and has been serving in the health center for more than half a year. "Thanks to Dr. Liao, fractures can now be solved in the township, and there is no need to wait in line at the hospital in the city. Granny Cheng said.
In view of the difficulty in recruiting and retaining people faced by grassroots medical and health institutions, Chongqing Municipality has dispatched doctors to work in township health centers through the reform of the mechanism of "county employment for township use" and "township employment for village use", and guaranteed the economic treatment and working expenses of dispatched doctors, so as to encourage and guide the flow of medical and health talents to the grassroots level.
Since August 2022, Changshou District has dispatched two batches of 63 doctors from district-level hospitals to primary medical and health institutions, including professionals in obstetrics and gynecology, pediatrics, and stomatology. Lin Lu, head of the Organization and Personnel Section of the Health Commission of Changshou District, said. Up to now, the dispatched talents have served the grassroots people for a total of 2More than 160,000 person-times have driven the total number of diagnosis and treatment in primary medical and health institutions to increase by 24% year-on-year, and the masses can enjoy expert services without leaving the street or community.
"County employment and township use" not only brings talent support to grassroots medical and health institutions, but also helps grassroots promote new technologies and new projects. "We have carried out more than 120 academic lectures and technical training in primary medical and health institutions, taught more than 90 grassroots talents, sent more than 60 people for further study, improved more than 90 system operation processes, and promoted more than 40 new technologies and projects, which greatly improved the technical level of primary medical and health institutions. Lin Lu said.
To enhance the capacity of primary medical services, it is necessary to unleash the vitality of primary medical and health institutions. Wang Jun said that we should innovate the talent management model, promote the reform of personnel and salary, continue to improve the level of fine management within the medical community, attract outstanding talents to stay at the grassroots level, and make them truly become the local health gatekeepers.
In Pingjiang County, Hunan Province, the medical community of the local General Hospital of Integrated Traditional Chinese and Western Medicine has provided all-round precise assistance to township health centers in the form of department assistance in the form of hospital management, medical business, and basic public health, injecting "living water" into the development of grassroots health.
The experts of the General Hospital helped us establish a sound management and operation system, standardize the responsibilities of the department, clarify the quality objectives of the department, standardize the medical behavior, and improve the management of the township health center. The relevant person in charge of Wengjiang Town Health Center said that in recent years, the people's sense of access to medical treatment has been continuously enhanced.
Establish a scientific and reasonable referral mechanism to form a medical treatment pattern of "minor illnesses at the grassroots level, major illnesses go to the hospital, and return to the community".
Not long ago, Mr. Deng, a villager from Anding Town, Pingjiang County, Hunan Province, suddenly felt chest pain and came to the town health center for an electrocardiogram examination. After the examination, the doctor immediately uploaded the data to the county ECG platform, and the doctor on duty confirmed the acute anterior myocardial infarction, quickly called the emergency department**, and informed the emergency department and chest pain center to be prepared, and at the same time instructed the doctor of the health center to rescue before the ambulance arrived. Within 20 minutes, the first-aid station referred the patient to the First People's Hospital of Pingjiang County for surgery.
In recent years, all localities have used information technology to realize information sharing among medical institutions, further improve the efficiency of referrals, and allow more high-quality resources to sink to the grassroots level. For example, Pingjiang County has established a medical imaging center, an electrocardiogram center and an ultrasound diagnosis center to form mutual recognition and sharing of medical diagnosis information within the county.
In the past, there was a general shortage of professionals in ECG, imaging, and testing in the county's 24 township health centers. Most health centers have DR (digital X-ray) equipment and electrocardiogram machines, but they often do not have specialized technicians and diagnosticians. Wu Shiqi, director of the Medical Reform Office of the Pingjiang County Health Bureau, told reporters that the inspection and testing projects that the township health center could not do in the past are now visited by staff every day to take samples, and doctors in county-level hospitals issue reports free of charge through the platform, realizing the medical and technical services of township inspection, county-level diagnosis, and regional sharing.
Through the information sharing platform, some patients stayed in the township health center for diagnosis and treatment, and some patients were transferred to county-level hospitals for treatment, avoiding repeated examinations, saving labor costs, reducing missed diagnoses, and also gaining time for rescuing critically ill patients. The relevant person in charge of the Health Bureau of Pingjiang County, Hunan Province said that in 2023, the county's grassroots medical treatment rate will reach 7626%, and the proportion of hospitalizations in the county reached 8678%, and positive progress has been made in hierarchical diagnosis and treatment.
At present, all localities have continuously improved the efficiency of referral and accelerated the implementation of the hierarchical diagnosis and treatment system through innovative service models. It is understood that Qujiang District, Shaoguan City, Guangdong Province, through the promotion of joint outpatient clinics and joint wards, will sink some surgeries and first-class services to the grassroots level, open up the green channel for patients to be referred up and down, and implement the sharing and distribution of medical business income generated by patients referred up and down, and implement it on a monthly basis to promote the orderly development of two-way referral work.
Establish a scientific and reasonable referral mechanism to ensure that patients can be smoothly transferred from primary medical institutions to hospitals above the second level, forming a medical treatment pattern of 'minor diseases at the grassroots level, major illnesses going to hospitals, and returning to the community'. Wang Jun said that all localities should further improve the medical service system, clarify the process and standards of two-way referral, improve the efficiency of referral, and let patients get timely and effective services in medical institutions at all levels.
People** 2024-02-23 19th edition).