基于价值链理论的家庭医生团队在突发公共卫生事件应急防控中的现实困境及其破解路径

背景　目前家庭医生团队在发挥突发公共卫生事件应急防控“守门人”的功效上仍然面临着重重阻碍，但目前较缺乏针对家庭医生团队在突发公共卫生事件应急防控中现实困境的研究。目的　分析家庭医生团队在突发公共卫生事件应急防控中的现实困境，为保障其高效参与突发公共卫生事件应急防控工作提供理论依据和对策建议。方法　2020年6月，采用方便抽样法抽取广州市25家基层医疗卫生机构，将其一线医务人员（每家机构抽取2名）作为问卷调查对象，对2月至调查时基本公共卫生服务专线开展情况、基本医疗服务开展情况、应急防控工作开展情况进行统计调查。同时选取部分愿意配合的基层工作人员进行访谈，结合价值链理论进行分析。结果　25家机构中，19家机构停止（过）部分或全部公共卫生专线，6家机构没有确诊/疑似病例的转运通道和能力，24家机构启动应急预案，10家机构开设健康教育专线，9家机构未开放传染病及突发公共卫生事件报告和处理专线，10家机构未开设发热门诊，11家机构的所有门诊一直正常开放。访谈结合价值链理论分析显示，家庭医生团队在突发公共卫生事件应急防控中面临着内部后勤保障不到位、外部沟通协作不顺畅、监测预警功能发挥不完全、健康教育工作不深入、基本医疗服务需求得不到满足、应急基础设施不健全、应急专业人才缺口大、信息化建设步调不一致、应急物资采购机制不完善等现实困境。结论　建议优先破除阻碍开展基本工作的困境，再深入优化解决辅助工作中出现的问题，让社区成为突发公共卫生事件应急防控的坚实堡垒，保障居民的生命健康安全。

Difficulties and Solutions for the Family Doctor Team in Preventing and Managing Public Health Emergencies：a Study Using the Value Chain Approach

Background　Currently，the family doctor team still faces many obstacles in managing public health emergencies as the gatekeeper. However，there is little research on the difficulties of family doctor teams in the prevention and management of public health emergencies. Objective　To explore the difficulties of family doctor teams in the prevention and management of public health emergencies，providing a theoretical basis and recommendations on ensuring the highly efficient performance of family doctor teams in preventing and managing the emergencies. Methods　Convenience sampling was used to select frontline healthcare workers from 25 primary healthcare institutions of Guangzhou to complete an online survey using a self-administered questionnaire conducted in June 2020 for investigating the implementation of essential public health services，essential medical services and prevention and management of public health emergencies in their hospitals between February and June 2020. Interviews were conducted with some of the healthcare workers who volunteered to be interviewed. Results　According to the questionnaire survey，during February to June 2020，of the 25 institutions，19 had halted the delivery of some or all essential public health services，6 had no capacities and channels to transfer suspected or confirmed COVID-19 cases to designated COVID-19 hospitals，24 had implemented the emergency response plan for the COVID-19 pandemic，10 had offered COVID-19-related health education，9 had not set up the infectious diseases and public health emergencies reporting and managing system，10 had not established the fever clinic，and 11 had operated all the clinics as usual. Value chain analysis of the interviews indicated that difficulties faced by the family doctor team in preventing and managing public health emergencies were：insufficient in-hospital support，unsuccessful communication and collaboration between hospitals or between the hospital and other institutions，poor monitoring and early warning effect of the COVID-19 pandemic，insufficient COVID-19-related health education，residents' unmet needs of essential medical services，inadequate emergency response infrastructure，lack of public health professionals，discrepancy between the construction of various information systems，inappropriate emergency procurement system. Conclusion　To make the community a solid fortress for the prevention and management of public health emergencies to ensure residents' health and safety，the authors suggest that efforts shall be made to address the barriers to the implementation of essential medical services first，then to solve issues existing in the implementation of auxiliary services.