分级分段医疗不能成为“空中楼阁”

卫生部副部长马晓伟强调,当前,我国医疗服务体系只看急性病,不看慢性病,只管手术,不管恢复,服务体系是一个“平面体系”不是“立体体系”。因此,应通过改革,县医院与基层医疗卫生机构必须形成“基层首诊、分级医疗、双向转诊”的医疗服务模式。     

基层医疗卫生服务整合的国际经验及对我国的启示

目的:总结典型国家基层卫生服务提供中实现医防整合的经验,为我国基层医疗卫生服务整合提供借鉴。方法:本研究方法为文献研究。结果:在个人层面,英国、泰国、古巴培养全科医生作为"守门人"并将其作为提供医防整合服务的主体;在机构层面,各国基层机构组成服务网络,内部强调跨学科合作;在体系层面,通过横向合作和有序的首诊与转诊协调服务;国家立法保障和健康保险筹资等引导支持基层医疗卫生服务整合。结论:培养和配置高质量的医防一体的全科医生、促进机构跨学科融合、通过立法和筹资体系予以保障是各国提供基层整合型服务的核心,值得我国基层医防服务整合借鉴。     

健康中国视域下辽宁省基层医疗卫生健康服务提升策略研究

目的:基层医疗卫生服务是“健康中国2030”国家战略下辽宁省基层医疗卫生服务改革的重要发力点。深入探讨辽宁省基层医疗卫生健康服务的发展现状与挑战,为“十四五”期间应对辽宁省人口的深度老龄化,构建高质量发展的辽宁省医疗卫生健康服务体系,实现辽宁全面振兴、全方位振兴贡献方案。方法:采用文献分析法和调研访谈法,探求健康中国视域下辽宁省基层医疗卫生健康服务提升策略。结论:积极推行慢性病患者“长处方”医疗服务政策;建立健全“互联网+医疗健康”的基层医疗卫生“数字化”服务体系;加强基层医疗卫生机构突发公共卫生事件的应急管理处置能力;健全基层医疗卫生机构服务人才的激励机制;建立多元筹资机制,鼓励社会资本参与基层办医;基层中医药特色诊疗服务能力等策略。     

我国基层首诊制现状及其效果的系统评价

[目的]分析我国基层首诊制度实施现状及效果,总结影响基层首诊制度的因素和各地发展基层首诊制度的举措,为探索符合我国国情的分级诊疗制度提供理论依据和政策参考。[方法]采用文献分析法,共纳入36篇调查研究文献。[结果]基层首诊制度知晓率普遍不高,大多为40.00%~60.00%。基层首诊率各地区存在较大差异,江苏省(71.13%~82.10%)明显高于其他地区。基层首诊意愿普遍较高,北京(56.80%~83.40%)、上海(62.33%~79.80%)、广东(54.40%~89.65%)高于其他地区。影响居民基层首诊的因素包括:文化程度,年龄,机构可及性,对机构人员、设备、药品的信任度等。[结论]居民对基层首诊知晓率普遍不高,居民有较高的基层首诊意愿但受机构可及性,机构人员、设备、药品的信任度等因素影响,应加强政策宣传力度,创造良好的舆论环境;保障基本药物充分供给,合理整合区域医疗资源;大力发展基层卫生机构的医疗水平,提升其医疗服务能力。     

我国县域医疗共同体研究的可视化分析

目的 通过对县域医疗共同体（以下简称“医共体”）已有研究的可视化分析，为后续县域医共体相关理论研究和建设实践提供科学支撑。方法 用CiteSpace软件对我国县域医共体研究进行可视化分析，利用知识图谱了解县域医共体研究发展状况、热点问题和趋势走向。结果 对符合检索条件的505篇研究文献进行文本分析后发现，文献数量呈稳步增长趋势，学者之间以及机构之间的相互联系不够紧密，“医共体”“分级诊疗”“紧密型”“县域”“县级医院”等是县域医共体研究的高频关键词，“医防融合”可能成为今后的研究热点，文献研究随县域医共体建设的不断深入呈现出不同的阶段性特征。结论 我国县域医共体研究呈现快速发展态势，县域医共体研究应加强区域化多元合作，注重与医防融合政策的衔接。     

天津市整合型服务体系的构建、成效及问题分析

通过访谈调研,总结天津市实施镇村一体化机制、构建区级牵头医院与基层医疗机构紧密型医共体开展基层数字健共体,打造云管理、云服务、云药房和云检验平台的经验。通过构建整合型服务体系,牵头医院出院患者三四级手术占比由2018年的31.49%增加至2020年的33.44%,县域内基层机构门急诊人次数占比由2018年的50.2%上升至2020年57.4%。在医共体内统一药品目录,确保基层单位配备常用慢性病药品45个品种、196个品规。门诊收费中药占比快速上升,由2018年的76.6%增加至2020年的85.7%。天津市在构建整合型服务体系的实践中成效明显,但在紧密型医共体的组织框架和运行机制、牵头医院医防融合、城市城区紧密型医共体专科特色和数字健共体嵌入式发展运行机制等方面还需要进一步明确和加强。     

基于文献计量学及科学知识图谱的我国30年传染病防控研究热点、前沿及趋势分析

【目的】利用文献计量学及科学知识图谱技术对我国30年传染病防控研究热点、前沿及趋势进行系统的梳理和可视化分析，总结此领域研究方向、梳理知识结构，为后续研究提供指导与参考。【方法】在中国知网、万方数据库中以[（“传染病”or“传染性疾病”）and（“防控”or“防制”or“预防与控制”）]not（“慢性非传染性疾病”）进行检索，检索起止时间为1992年1月1日—2022年8月11日，检索范围限定为核心期刊（北大中文核心期刊、中文社会科学引文索引CSSCI期刊、中国科学引文数据库CSCD期刊、中国科技论文与索引数据库CSTPCD期刊），运用文献计量学软件VOSviewer 1.68及CiteSpace 5.8.3从关键词、突现词、研究作者、机构等多个方面进行科学知识图谱共现网络分析，总结我国传染病防控领域的研究热点、前沿及趋势。【结果】共检索得到文献10 777篇，经过筛选纳入7 676篇文献。从研究趋势上看我国传染病防控领域文献发表量总体均呈波动上升趋势，研究数量与传染病的暴发流行密切相关。中国疾病预防控制中心（CDC）在研究中发挥了主导作用。在研究者合作方面，复旦大学郝模、李程跃、王颖...     

云南:探索医防融合管理新机制

正云南省通过推进基层高血压医防融合工作,以单病种为突破口,实现了高血压等慢性病基层首诊、双向转诊、急慢分治、上下联动的分级诊疗制度的优化。通过完善激励机制,提升基层诊疗服务水平,基层医疗卫生机构活力得到激发,让更多的患者获得了诊治和随访服务,进一步发挥了基层医疗卫生机构健康网底作用,展现了基本公共卫生服务项目实施效果。     

分级诊疗的治理逻辑与农村居民认知偏差效应分析

自分级诊疗政策实施以来,部分地区农村基层首诊率不增反降,在自由择医的政策环境下,农村居民在无法确定疾病严重程度时倾向于选择高级别医疗机构就诊。本文从政策视角梳理了我国农村分级医疗服务体系的发展历程、剖析了分级诊疗的适配逻辑以及当前分级诊疗治理的政策困境。并在此基础上剖析了疾病不确定感对居民首诊选择的影响,界定了农村居民认知偏差效应。最后提出了推进互联网首诊服务的发展、加强基层医疗卫生机构宣传,以提升基层首诊意愿的建议。     

基于CiteSpace分析我国卫生服务整合研究进展

目的 分析我国卫生服务整合领域的研究热点及发展趋势。方法 本研究选取截至2021年11月，中国学术期刊网络出版总库（CNKI）和Web of Science (WOS)核心合集数据库中关于我国卫生服务整合的文献。采用SPSS 26.0统计软件对发文数量进行频数统计。利用CiteSpace软件绘制核心作者、研究机构合作网络，并进行关键词的共现、聚类及突现情况分析，挖掘研究的热点及发展趋势。结果 我国卫生服务整合领域的发文整体呈现伴有高峰的逐步上升趋势，并已形成一批具有较高学术影响力的研究学者和机构。研究热点经历了三次转变，从乡村卫生服务一体化到区域协同医疗，再到整合型卫生服务体系。结论 我国卫生服务整合领域的研究多为典型案例研究，应切实加强理论创新、机制分析与实证效果评价研究，并强化跨区域、跨机构的中文研究合作和高质量英文研究。预测该领域下一阶段的研究将集中于县域医共体、家庭医生、医保支付方式、智慧医疗和医防融合等方面。     

医联体互联网医院支付结算系统研究

目的:医联体互联网医院支付结算系统的建设旨在落实“互联网+医疗健康”示范区建设,落实分级诊疗和资源下沉,降低医疗费用,提升居民幸福感。方法:根据该地区及医院的实际情况,某省级人民医院构建以区域医院为主体的医联体收费管理和统一支付结算服务平台,深度整合各级医疗服务机构资源,打通各级医疗机构支付结算体系,统一线上线下全流程的就医服务模式。结果:通过对医联体“互联网+医疗服务”模式的探索,逐步实现线上远程医疗、慢病管理、支付结算等全流程就医服务。结论:将患者、医疗机构、金融机构三方联通,打造医疗全流程闭环服务,对在实践中落实“互联网+医疗健康”示范区建设,落实分级诊疗和资源下沉等具有重要意义。     

Implementation of oral health initiatives by Australian rural communities: Factors for success

In this paper, we consider factors significant in the success of community participation in the implementation of new oral health services. Our analysis draws on data from the Rural Engaging Communities in Oral Health (Rural ECOH) study (2014–2016). We aimed to assess the Australian relevance of a Scottish community participation framework for health service development; Remote Service Futures. Internationally, community participation in planning of health initiatives is common, but less common in new service implementation. Health managers query the legitimacy of “lay” community members, whether they will persist, and whether they can act as change agents. Our data provide evidence that helps answer these queries. Six communities, located within regions covered by two large rural primary healthcare organisations (Medicare Locals), were selected in two Australian states. Two university‐based facilitators worked with a group of local residents (for each community) to monitor implementation of new oral health initiatives designed through participatory processes. Data about implementation were collected through interviews with 28 key stakeholders at the beginning of implementation and 12 months later. Data were coded, themed and analysed abductively. Five themes emerged; the inter‐relationship between community motivation to participate with the fortunes of the oral health initiatives, having the “right” people involved, continuing involvement of sponsors and/or significant people, trusting working relationships between participants and perceiving benefits from participation. Findings provide evidence of a role for community participation in implementing new community services if solid partnerships with relevant providers can be negotiated and services are seen to be relevant and useful to the community.     

基于CiteSpace的我国基层医疗卫生机构研究前沿与热点的可视化分析

目的 整理分析我国近20年来基层医疗卫生机构研究的发文趋势、发文机构及热点和前沿情况,为国内基层医疗卫生机构未来的研究提供参考建议。方法 以CNKI和Web Of Science上刊载的基层医疗卫生机构主题相关核心期刊文献作为数据来源,并运用CiteSpace可视化软件进行文献计量分析。 结果 国内和国际期刊上的发文量趋势不同,近20年来中文发文量显示第二阶段（2010—2016年）处于活跃阶段,第三阶段（2017年至今）发文量逐年下降;研究机构主要集中于高校,各核心研究机构群体间的合作较少;国内期刊研究热点以基层医疗卫生机构的制度、基本公共卫生服务、基层卫生人力三方面为主,国际期刊关注相关疾病的防治研究;研究前沿主要是政策性研究,缺乏预见性,存在时间滞后性。 结论 当前我国基层医疗卫生机构尚存短板,但近年来对该领域的研究发文量却逐年下降,应该加强研究机构间的协同合作,增强国际影响力,突破政策性研究,进行创新性研究,解决基层医疗卫生机构现存问题。     

整体性治理视角下紧密型医共体的构建逻辑与实施路径

县域医共体的构建与运行超越了单一行政部门和服务组织边界,需要运用更加系统化与整体性的视角进行治理.本文基于整体性治理理论,从治理理念、治理结构、治理机制三方面结合安徽省紧密型医共体建设的实践,对紧密型医共体建设过程与关键要素进行分析,归纳总结紧密型医共体整体性治理模式的构建逻辑与实现路径.并进一步对整体性治理模式的适用...     

基于CiteSpace的我国“互联网+护理”研究可视化分析

目的分析“互联网+护理”领域研究整体状况、热点及前沿，以期为“互联网+护理”后续研究提供参考。方法以“互联网+护理”为主题词检索中国知网、万方、维普数据库建库至2021年1月25日收录的中文文献，使用CiteSpace 5.7.R1软件进行可视化分析。结果最终纳入722篇文献。发文量总体呈上升趋势，发文机构间合作不紧密，研究热点有“互联网+”、护理、延续护理、养老服务、社区、生活质量、健康教育、上门服务等。结论“互联网+护理”领域研究正处于快速发展阶段，未来仍需重点关注患者服务；但需加强“互联网+护理服务”区域性合作，探索护士上门服务的执业风险防控与质量安全保障，进一步完善“互联网+护理服务”体系。     

Solidarity or dissonance? A systematic review of pharmacist and GP views on community pharmacy services in the UK

There has been a strong policy emphasis over the past decade on optimising patient‐centred care and reducing general practitioners’ (GPs’) workload by extending community pharmacy services and collaboration between pharmacists and GPs. Our aim was to review current evidence of pharmacists’ and GPs’ views of extended community pharmacy services and pharmacists’ roles in the United Kingdom (UK). A systematic review was undertaken looking at UK studies investigating pharmacists’ and/or GPs’ views of community pharmacy services or roles from 2005 to 2017. A range of databases were searched including EMBASE, PubMed, Scopus, Web of Science, International Pharmaceutical Abstracts (IPA), PsycINFO, Science Direct and The Cumulative Index to Nursing and Allied Health Literature (CINAHL). In addition, reference lists of included studies were screened and grey literature was searched. Following the application of inclusion/exclusion criteria, the quality of papers was critically analysed, findings were extracted into a grid and subjected to narrative synthesis following thematic analysis. The search strategy yielded a total of 4,066 unique papers from which 60 were included. Forty‐seven papers covered pharmacists’ views, nine combined both pharmacists’ and GPs’ views and four covered GPs’ views. Study designs included interviews (n = 31, 52%), questionnaire surveys (n = 17, 28%) and focus groups (n = 7, 12%). Three main themes emerged from the data: “attitudes towards services/roles”, “community pharmacy organisations” and “external influences”. Pharmacists and GPs perceived a number of barriers to successful implementation and integration of pharmacy services. Moreover, collaboration between pharmacists and GPs remains poor despite the introduction of extended services. Overall, extending community pharmacy services require quality‐driven incentives and joint working between community pharmacists and GPs to achieve better integration within the patient's primary care pathway.     

Translating Life Course Theory to Clinical Practice to Address Health Disparities

Life Course Theory (LCT) is a framework that explains health and disease across populations and over time and in a powerful way, conceptualizes health and health disparities to guide improvements. It suggests a need to change priorities and paradigms in our healthcare delivery system. In “Rethinking Maternal and Child Health: The Life Course Model as an Organizing Framework,” Fine and Kotelchuck identify three areas of rethinking that have relevance to clinical care: (1) recognition of context and the “whole-person, whole-family, whole-community systems approach;” (2) longitudinal approach with “greater emphasis on early (“upstream”) determinants of health”; and (3) need for integration and “developing integrated, multi-sector service systems that become lifelong “pipelines” for healthy development”. This paper discusses promising clinical practice innovations in these three areas: addressing social influences on health in clinical practice, longitudinal and vertical integration of clinical services and horizontal integration with community services and resources. In addition, barriers and facilitators to implementation are reviewed.     

对深圳市劳务工社区首诊制的思考及其启示

社区首诊制作为分级诊疗的核心要素,对我国卫生服务体制改革的成功起着至关重要的作用。深圳市劳务工社区首诊制的实施,在分流患者方面起到了明显作用,各利益方能够接受该强制性制度。与深圳市相比,我国社区卫生服务发展较好的城市已基本具备社区首诊的能力,在实施社区首诊制的过程中应重视其强制性,以保证制度设计的效果。     

Organizing mental health services: an evidence-based approach

BACKGROUND AND AIMS: Health policy makers and program developers seek evidence-based guidance on how to organize and finance mental health services. The Swedish Council on Technology Assessment in Health Care (SBU) commissioned a conceptual framework for thinking about health care services as a medical technology. The following framework was developed, citing empirical research from mental health services research as the case example. FRAMEWORK: Historically, mental health services have focused on the organization and locus of care. Health care settings have been conceptualized as medical technologies, treatments in themselves. For example, the field speaks of an era of "asylum treatment" and "community care". Hospitals and community mental health centers are viewed as treatments with indications and "dosages", such as length of stay criteria. Assessment of mental health services often has focused on organizations and on administrative science. There are two principal perspectives for assessing the contribution of the organization of services on health. One perspective is derived from clinical services research, in which the focus is on the impact of organized treatments (and their most common settings) on health status of individuals. The other perspective is based in service systems research, in which the focus is on the impact of organizational strategies on intermediate service patterns, such as continuity of care or integration, as well as health status. METHODS: Examples of empirical investigations from clinical services research and service systems research are presented to demonstrate potential sources of evidence to support specific decisions for organizing mental health services. RESULTS: Evidence on organizing mental health services may be found in both types of services research. In clinical services research studies, service settings are viewed as treatments (e.g. "partial hospitalization"), some treatments are always embedded in a service matrix (e.g. assertive community treatment), and, where some treatments are organizationally combined (e.g. "integrated treatment" for co-occurring mental disorder and substance abuse), sometimes into a continuum of care. In service system research, integration of services and of the service system are the main focus of investigation. Studies focus on horizontal and vertical integration, primary care or specialty care and local mental health authorities - each of which may be conceptualized as a health care technology with a body of evidence assessing its effectiveness. IMPLICATIONS: A conceptual framework for assessing the organization of services as a health care technology focuses attention on evidence to guide program design and policy development. Mental health services research holds promise for such decision-making guidance.     

中国家庭医生制度探索与改革的长宁模式

探索中国的家庭医生制度模式是深化医疗卫生体制改革过程中的重要政策议题。上海市长宁区是国家首批社区卫生服务综合改革试点区,也是最早开展家庭医生服务制度探索和改革的示范区。自2008年起开始逐步探索家庭医生制度至今已有10年时间,为完善家庭医生签约服务,全面建立成熟完善的分级诊疗制度,形成基层首诊、双向转诊、上下联动、急慢分治的合理就医秩序积累了许多可复制、可推广的经验。本专题3篇文章是来自长宁区家庭医生制度综合改革十周年的调查,分别从服务模式、政府协同、绩效考核方面,展示了长宁区家庭医生制度综合改革的具体做法与政策成效。伴随着全国家庭医生签约服务现场推进会的贯彻落实,中国家庭医生制度的长宁模式将为全国各地的家庭医生制度探索与深化改革提供宝贵经验。