社区全科医生首诊制是实现双向转诊制的有效途径

分析了双向转诊制度发展过程中的障碍以及原因,以社区首诊制为切入点,提出了实现双向转诊的有效途径以及相关配套措施的完善。     

无锡市完善社区首诊制度的探讨

社区首诊制是构建“小病在社区、大病进医院、康复回社区”的多层次医疗保障体系的基石。为进一步完善社区首诊制,作者针对社区首诊制的定义和发展做出阐述,通过政策研究、数据分析、人物访谈等方式对无锡市社区首诊制实施情况进行了认真的调查,在此基础上,对如何完善社区首诊制进行探讨。     

基层首诊与分级医疗制度建设的思考

文章分析了基层首诊、分级医疗目前的运行状况,列出其实施过程中的障碍和困境,并从医疗保障制度、提升基层服务、完善双向转诊、转变就医观念等方面提出对策,从而探索基层首诊、分级医疗发展的措施.     

信息技术在社区“双向转诊”制度应用的探析

社区卫生服务是我国实现人人享有初级卫生保健目标的基础。伴随着医疗改革的深化,"双向转诊"制度将是社区卫生服务工作中的一项非常重要的内容。"双向转诊"制度的实施必须借助信息网络平台才能实现。因此,建立和完善网络信息平台,统一规范的电子病历格式,提高社区医生信息技术水平,是确保"双向转诊"医疗服务渠道畅通的关键。     

社区卫生机构必须实行首诊负责制和双向转诊制

日前，卫生部发布了《社区卫生工作管理制度（试行稿）》，该制度规定，社区卫生机构实行首诊负责制和双向转诊制度。     

美国管理化医疗对我国社区双向转诊制度的启示

介绍了美国的管理化医疗保健制度，分析了目前我国社区卫生服务双向转诊运行中的障碍与困难。并对美国的管理化医疗在我国社区医疗服务中的应用作了探讨。     

社区首诊网络工程对推动社区首诊的影响研究

社区首诊网络工程对推动社区首诊、深化医药卫生体制改革有着极其重要的作用。但由于各种因素的影响,社区首诊的实施还存在一定的不足,必须通过提高认识、完善政策等途径,加快社区首诊网络工程的实施,促进社区首诊的开展。     

我国社区首诊制建立与发展的SWOT分析

本文通过阐述社区首诊制所具有的优势和劣势,分析外部环境中存在的机会和威胁,明确建立和发展社区首诊制存在的主要问题,结合SWOT进行策略分析,提出对策建议,促进社区卫生服务机构高效地开展社区首诊服务,促进社区首诊制的完善和发展,有效缓解"看病难、看病贵"的问题,使社区居民真正享受到优质、价廉、便捷、高效的社区卫生服务,使社区医生真正成为"健康守门人"。     

社区医疗机构与医院双向转诊的实现

发展社区医疗是国家调整医疗政策,解决群众看病难、看病贵问题的一个重要举措。要
真正发挥社区医疗的作用,必须解决好社区医疗机构与医院双向转诊的问题。由于多方面原因,目
前社区医疗机构与医院之间双向转诊通道并不通畅。本文分析了目前社区医疗机构与医院开展双
向转诊过程中存在的问题,并对如何解决这些问题,促进双向转诊制度的顺利开展提出意见和建议。     

上海市松江区居民首诊选择和转诊现况的调查与分析

目的调查社区居民在就医过程中的首诊选择和转诊现况,为分级诊疗体系的建立与完善提供依据。方法随机抽取社区常住居民,通过问卷调查,收集社区居民首诊选择、转诊现况及对转诊评价的相关数据,并通过描述性研究方法对调查结果进行分析。结果就医便捷度和医疗水平是选择首诊医院的主要依据,有转诊经历的社区居民比例不高,较多从下级医院转到上级医院;社区居民转诊的满意度及顺利程度一般。结论 "首诊在社区"尚未成为居民普遍的就诊习惯,强制政策的缺位及价格政策的弱效直接导致转诊秩序混乱,目前转诊问题主要集中在时间、流程和费用3个方面。     

全科医疗特征功能视角下分级诊疗的定义及制度层次

明确分级诊疗定义和内涵是建立和完善分级诊疗制度的逻辑起点,是制度的基础性研究。本文在剖析国际上分级诊疗的相关概念、探求分级诊疗本质的基础上,辨析了国内分级诊疗的定义。认为国内分级诊疗制度存在以下不足:以疾病诊治的单一维度作为三级医疗服务分工依据,忽略了人们对医疗服务体系间接性医疗服务功能的需求;导致服务体系规划忽略了非直接性医疗服务功能,缺失了具有特征功能的全科医疗与专科医疗之间的分化和互补;全科医疗和专科医疗之间功能清晰、界限分明的医疗卫生服务体系结构尚未形成;用组织治理取代了原本属于全科医疗和专科医疗之间的专业治理。最后,本文从全科医疗特征功能视角,完善了分级诊疗的定义;尝试回答了分级诊疗的三个基础性问题,并归纳提出分级诊疗制度应该包括微观、中观、宏观三个层次。     

Between iatrotropic stimulus and interiatric referral: the domain of primary care research

The “iatrotropic stimulus” is a typical example of Alvan Feinstein's terminology and his clinical way of thinking about medical research. Feinstein specified “interiatric referral” as an additional important factor affecting “the likelihood that patients will appear at the particular setting in which research is being conducted.” He emphasized these phenomena as highly relevant for clinical judgment, clinical research, and clinical epidemiology. This has stimulated the realization of original clinical research in international primary medical care. It has helped to recognize the characteristics of the spectrum of health problem and morbidity patterns presented to primary care physicians and to acknowledge the position of generalistic primary care research between open population research and clinical research in referred (specialist) care. Accordingly, primary care-specific challenges in investigating (early) diagnosis, prognosis, treatment, and referral decisions have emerged. This research supports adequate decision-making by the primary care physician, which is important for effective health care. Although Feinstein was a clinical specialist and has always lived in a country without a very strong primary care tradition, he not only recognized the value of primary care research but also substantially contributed to its development.     

国际全科医生制度发展历程:影响因素分析及政策启示

全科医生制度建设的国际经验可以为中国全科医生制度的建立和发展提供借鉴。本文首先梳理了国民健康服务体制、社会医疗保险体制、商业医疗保险体制等部分典型国家的全科医生制度发展历程,重点分析了全科医生制度建设的影响因素。结果发现,建立和发展全科医生制度的主要影响因素有:经济社会因素、卫生保健体制对卫生体系的控制力、医师对卫生体系的控制力、全科医学服务的激励机制、全科医学的发展程度等。最后,结合近年我国全科医生制度建设的实际提出几点政策启示,一要以满足我国公众健康需求为目标,构建中国特色全科医生制度;二要普及全科医学服务核心价值,为建立全科医生制度提供公众民意基础;三要建立健全促进全科医生制度发展的激励机制,提高全科医生地位;四要积极推动全科与专科医学的专业分工,促进全科医学发展。     

Managing the performance of general practitioners and specialists referral networks: A system for evaluating the heart failure pathway

High quality chronic disease management requires coordinated care across different healthcare settings, involving multidisciplinary teams of professionals, and performance evaluation systems able to measure this care. Inter-organizational performance should be measured considering the professional relationships between general practitioners (GPs) and specialists, who are usually linked through informal referral networks.The aim of this paper is to identify and evaluate the performance of naturally occurring networks of GPs and hospital-based specialists providing care for congestive heart failure (CHF) patients in Tuscany, Italy. The analysis focuses on the identification and classification of networks, following CHF patients (n = 15,841) through primary care and inpatient care using administrative data, and on the assessment of process and outcome indicators for CHF patients in these referral networks.We demonstrate the existence of informal links between GPs and hospitals based on patterns of patient flow. These networks which are not geographically based vary in the intensity of relationships and quality of care. Such referral networks may represent the most effective accountability level for chronic disease management, since they encompass the multiple care settings experienced by patients. Overall, an integrated approach to evaluation and performance management that considers the naturally occurring links between professionals working in different settings may enable more efficient, integrated care and quality improvements.     

A framework for clinical general practice and for research and teaching in the discipline

This paper uses three typical case stories from general practice to demonstrate that a GP simultaneously considers four dimensions when making a diagnosis and planning subsequent treatment of a patient in the consultation: (i). a biomedical dimension; (ii). a culture and context dimension; (iii). a medico-psychological dimension; and (iv). a network and social dimension. By taking this diagnostic and therapeutic approach, the GP adds value to the total performance of the health care system. It is demonstrated that a GP needs theoretical, research-based knowledge and skills within all four dimensions, and that it is necessary for a GP to work together with both medical and non-medical disciplines when defining the research and teaching agenda. It is stressed that consultation and communication skills are important tools for any doctor, and the value of continuity of care is discussed. Finally, the implications of the diagnostic approach with respect to planning research and teaching programmes are discussed, and the need for a better balance is stressed.     

Comorbidity was associated with neurologic and psychiatric diseases: a general practice-based controlled study

BACKGROUND AND OBJECTIVE: To comprehensively examine comorbidity in unselected cohorts of patients with depression, stroke, multiple sclerosis (MS), Parkinson's disease/parkinsonism (PD/PKM), dementia, migraine, and epilepsy. METHODS: This cross-sectional study used morbidity data recorded by Dutch general practitioners. Index disease cohort sizes ranged from 241 patients with MS to 6,641 patients with lifetime depression. Thirty somatic and seven psychiatric disease categories were examined to determine whether they were comorbid with the index diseases by performing comparisons with age- and gender-matched control cohorts. Identified comorbidities were classified as either "possible" or "highly probable" comorbidity. RESULTS: An extensive range of 26 disease categories was found to be comorbid with lifetime depression. The comorbidity profile of stroke was also wide, including 21 disease categories. The comorbidity patterns of migraine and epilepsy comprised each 11 disease categories. Those concerning MS, PD/PKM, and dementia included a small number of disease categories. CONCLUSION: This study provides comprehensive knowledge of the occurrence of somatic and psychiatric comorbidity in general populations of patients with depression, stroke, MS, PD/PKM, dementia, migraine, and epilepsy. The implications of the findings for clinical practice and research are discussed.     

运用ISO31000：2009建立卫生检疫风险评估总体框架初探

目的探索建立口岸卫生检疫风险评估的总体框架。方法研读ISO 31000：2009及IEC/ISO 31010：2009、Guide 73：2009及相关技术文件,结合卫生检疫工作实际和已有的风险评估应用实践,研究卫生检疫风险评估的总体步骤和技术方法。结果建立了以＂定量风险矩阵风险分析方法＂为核心的卫生检疫风险评估总体框架。结论运用ISO 31000的指导理念建立的卫生检疫风险评估总体框架,可指导建立卫生检疫各类风险的风险评估程序,并推广应用于卫生检疫风险评估工作实践。     

山西省网络直报疑似肺结核病人转诊追踪情况分析

目的了解2年来山西省综合医疗机构对疑似肺结核病人的转诊和结核病防治机构对转诊未到位的疑似结核病人的追踪情况。方法对2年来《中国疾病预防控制信息系统》和《结核病管理信息系统》的相关数据进行综合分析、评价。结果项目执行期间，全省119个县区综合医疗机构报告可疑肺结核患者22408例，转诊到结核病防治机构8139例，转诊到位率36．3％，结核病防治机构追踪到位8248例，追踪到位率69．1％，转诊追踪共到位16387例，其中4448例（27．1％）在结核病防治机构重新定诊为涂阳肺结核，转诊未到位的病人中传染性病人比例参照到位病人的比例，加强转诊和追踪工作，还可发现1632例涂阳病人，可提高5．5％的病人发现率。结论加强综合医疗机构对病人的转诊工作，提高结核病防治机构对综合医疗机构网络报告病人的追踪工作，可以有效地提高肺结核病人的发现水平。     

General practitioners' views on and referral to NHS smoking cessation services

OBJECTIVES: Increasing the rate of smoking cessation remains a major public health goal. To help achieve this in the UK, National Health Service (NHS) smoking cessation services have been established to provide treatment for smokers wanting help with stopping. Referrals from general practitioners (GPs) are crucial to the success of these clinics. This study aimed to assess English GPs' self-reported interactions with, and attitudes towards, their local smoking cessation services. STUDY DESIGN: Postal survey assessing the attitudes of GPs in England towards, and formal interactions with, NHS smoking cessation services. METHODS: A questionnaire was posted to a random sample of 544 GPs in England (response rate 63%). GPs' self-reported interactions with smoking cessation services and their attitudes towards these clinics were assessed. GPs were also asked what factors determined whether they prescribed nicotine-replacement therapy (NRT) and Buproprion (Zyban), and what was the extent and nature of their smoking cessation interventions with their patients. RESULTS: Most GPs (94%) reported that they were aware of the specialist smoking cessation service in their area. Seventy percent of GPs supported the continuation of current funding for specialist smoking cessation services. Seventy percent reported that they referred patients to these services, and 55% had staff within their practices trained as community smoking cessation advisors. Most GPs (79%) reported 'clinical need' as a determinant of whether they prescribed NRT/Zyban, and a few GPs cited 'budgetary constraints' as a factor (15%). Ninety-eight percent of GPs reported that they record smoking status when new patients join their practice, and they advise smokers to stop 'at least every now and then'. CONCLUSIONS: GPs support the existence and continuation of specialist smoking cessation services, and most reported that they refer patients to them. Virtually every GP reported that they record smoking status when new patients join their practice, and they advise smokers to stop 'at least every now and then'.