基于系统论视角的中医药融入家庭医生服务模式研究

背景　中医药作为独特的卫生资源，在基本医疗和卫生保健中发挥着不可替代的作用。因此，在为居民健康保驾护航的家庭医生服务中，中医药的融入是不可或缺的。但是，在现有的家庭医生服务模式中几乎未提及或很少涉及中医药服务，中医药的融入程度还不够。因此，推动中医药融入家庭医生服务迫在眉睫。目的　了解我国家庭医生服务的现状，找出中医药服务与家庭医生服务的契合点，为中医药融入家庭医生服务提供对策与建议。方法　2018年10月，在中国知网高级检索中，以“家庭医生服务”和“全科医生服务”为主题词，检索时间为“2010-01-01至2018-09-15”，来源为“SCI来源期刊、EI来源期刊、核心期刊、CSSCI、CSCD”，检索家庭医生服务相关期刊论文，最后纳入分析的文献83篇。以系统论为理论基础，分别从家庭医生服务系统的内外部出发，构建中医药融入家庭医生服务模式研究的分析框架。系统内部主要包括人力资源、经济负担、服务内容、服务方式四个维度，系统外部主要包括政治、经济、技术、社会四个维度。结果　纳入分析的83篇文献中：提及系统内部人力资源、经济负担、服务内容、服务方式四个维度存在问题的占比分别为62.7%、12.0%、18.1%、6.0%；提及系统外部政治、经济、技术、社会四个维度存在问题的占比分别为43.4%、12.0%、33.7%、41.0%。结论　中医药融入家庭医生服务，需要从系统内外部八个方面展开：系统内部，需鼓励中医药人才加入家庭医生队伍；加入中医医疗服务项目；中西医签约合作提供服务；适宜合理运用中医药；系统外部，需加大资金支持力度；完善相关配套政策；信息技术支撑；加强宣传引导。

Systematic Perspective of Integrating TCM Services into Family Doctor Services

Background As a unique kind of health resource,traditional Chinese medicine(TCM)plays an irreplaceable role in essential medical care and health care.Therefore,to protect the health of residents,it is indispensable to integrate TCM services into family doctor services.However,TCM services are hardly mentioned and rarely involved in current family doctor services,far from enough to satisfy the healthcare needs of the residents.So,it is urgent to promote the integration of TCM services into family doctor services.Objective To identify the aspects in family doctor services where TCM services can be integrated on the basis of analyzing the implementation status of China's family doctor services,and to provide corresponding recommendations.Methods In October 2018,we searched CNKI database for articles about family doctor services published between January 1,2010 and September 15,2018 using advanced search technique with“family doctor services”and“general practitioner services”as the keywords,and“SCI Source Journals,EI Source Journals,Core Journals,CSSCI and CSCD”as source categories.We finally included 83 articles.On the basis of the framework of system theory,we developed the analytical framework for integrating TCM services into family doctor services from the internal aspects(human resources,economic burden,service content and delivery mode)and external aspects(politics,economy,technology and society)of the family doctor services delivery system.Results Problems in the four dimensions of human resources,economic burden,service content and delivery mode,were reported in 62.7%,12.0%,18.1%,and 6.0% of the 83 articles,respectively.And problems in thefour dimensions of politics,economy,technology and society were reported in 43.4%,12.0%,33.7% and 41.0% of the 83articles,respectively.Conclusion The integration of TCM services into family doctor services needs to be carried out from thefollowing eight aspects:encouraging TCM doctors to join in the family doctor team,adding TCM service projects to family doctorservices,providing contracted integrated TCM and western services,and using TCM techniques appropriately,strengtheningfinancial support,perfecting relevant supporting policies,supplying information technology support and strengtheningpropaganda and guidance.