全科医疗核心特征功能研究——基础保健的综合性

综合性是基础保健的重要特征功能,与首诊、可及性、连续性和协调性之间相互关联,共同形成基础保健高绩效的作用机制。面临人口老龄化、慢性病流行、医疗费用快速上涨的挑战,综合性服务的重要性日益凸显。明确基础保健综合性的概念内涵,是研究者、政策制定者和实践管理者亟待解决的一个根本性问题,是管理综合性服务的基础。针对我国基础保健综合性服务的概念及其内涵要素尚未清晰的现状,本文将系统梳理目前关于综合性定义与概念内涵的研究,把握综合性内涵、要素及其内涵;在此基础上,遵循可控性、穷尽性和互斥性原则,理清基础保健综合性与其他特征功能的内涵边界,给出全科医疗/基础保健综合性这一特征功能的定义与内涵,为后续建立全科医疗特征功能的可操作性定义奠定基础。

Defining and conceptualizing general practice: The comprehensiveness of primary care

Comprehensiveness of care is one of the core attributes of primary health care, and it has a great impact on the first diagnosis, accessibility, coordination and continuity to form the primary health care high performance mechanism. Comprehensiveness of care has been playing an increasingly significant role in case when faced with the challenges of the aging of Chinese population, the high prevalence of chronic diseases, and the rapidly rising cost of health care. It is a fundamental problem for researchers, policy makers, and practitioners to clarify the definition of comprehensiveness of primary health care, which is the basis for managing comprehensive services. This article has systematically reviewed the current researches on definitions of comprehensiveness of basic health care, ascertained the key elements of comprehensiveness, and pinpointed the relationship between the dominant and recessive elements. Then, it defined the conception and the boundary of comprehensiveness of care in the context of primary health care, according to three principles-controllability, exhaustion, and exclusiveness, and finally conceptualized the primary health care comprehensiveness for further study on the operational definition of primary health care attributes.