Policy interpretation: In January 2023, the Health Commission of the Autonomous Region, the Department of Finance, the Department of Human Resources and Social Security, the Department of Civil Affairs, and the Medical Security Bureau jointly issued the "Implementation Opinions on Strengthening the "Five Expansions" to Solidly Promote the High-quality Development of Family Doctor Contracted Services (hereinafter referred to as the "Implementation Opinions"). From public medical and health institutions to private medical institutions, from general practice to specialty, from a fixed one-year contract cycle to a flexible contract cycle, from the management of chronic diseases to the co-management of chronic diseases and infectious diseases. On the premise of ensuring the quality of service and the sense of gain, satisfaction and quality of contracted residents, it is required to actively and steadily promote contracted services, and gradually establish a family doctor system with family doctors as the gatekeeper of health.
Tianshan Net/Xinjiang Daily reporter Su Luping
As an important part of primary medical and health services, the family doctor system plays an important role in establishing a hierarchical diagnosis and treatment system, rationalizing the order of medical treatment, and improving medical services. The "Implementation Opinions" have improved the design of the contracted service system for family doctors in our district from the aspects of training mechanism, practice mode, service model, and incentive mechanism. How's the landing going? The result? A few days ago, the reporter conducted an interview.
At the site of the 2024 "Family Doctor Day Activity" in the autonomous region, medical staff will provide free consultation and health education for the masses. Photo courtesy of the Health Commission of the Autonomous Region
Let your GP "sign and make an appointment"
The key is to let family doctors "sign and make appointments" and give full play to their own strengths, which requires family doctors to be able to provide high-quality professional and standardized services.
The "Implementation Opinions" proposes to guide doctors from secondary and tertiary hospitals to join the team of family doctors, and jointly provide contracted services through counterpart support and joint construction of departments, so as to actively increase the supply of family doctor services.
Since 2023, the Luyuan Street Community Hospital of Shayibak District, Urumqi City has signed specialty construction agreements with Urumqi Traditional Chinese Medicine Hospital, Urumqi Fourth People's Hospital, Beijing Children's Hospital, Xinjiang Hospital, and the Third People's Hospital of the Autonomous Region.
"The hospital of the medical alliance sent a team of experts to help us build characteristic specialties, regularly sit for consultations, carry out medical management and clinical diagnosis and treatment guidance; Specialists are selected to join the community hospital family doctor team to carry out contracted services and provide free learning opportunities for our medical staff. At the same time, a certain number of experts and hospital beds will be reserved for residents in the jurisdiction for timely referral. Feng Chunli, director of Luyuan Street Community Hospital, introduced.
At present, the community hospital has set up 11 contracted service teams of family doctors. Considering that there are many elderly people in the community of Luyuan East Street, and there is a greater demand for traditional Chinese medicine to treat internal medicine and orthopedic diseases, the family doctors are mainly traditional Chinese medicine physicians from Urumqi Traditional Chinese Medicine Hospital and Luyuan Street Community Hospital.
The family doctor of Luyuan Street Community Hospital, Shayibak District, Urumqi City, gave medication guidance to residents. Photo by Li Jinyan
"As long as you contact one of the doctors, you can go from seeing a doctor to being hospitalized, and you can do it all at once." Liu Caixia, a resident of Luyuan East Street Community, said that at the end of May this year, she and her wife Wang Xiaobang were unwell and contacted their family doctors, who diagnosed them with degenerative changes in bones and joints and complications caused by diabetes and hypertension respectively. Considering the limited conditions of the community hospital, the family doctor transferred them to the soft injury department and endocrinology department of the Urumqi Hospital of Traditional Chinese Medicine for inpatient treatment, and the symptoms were alleviated.
"These are all things that I can't enjoy when I go to a big hospital to register and see a doctor. Not only is it convenient, but it also provides continuity of medical care. Liu Caixia commented.
Innovate the incentive mechanism to promote improvement
In order to promote the contracted service of family doctors, the leading hospitals of the medical community in various parts of our district (state and city) organized specialist doctors to contract with the family doctor contract team in the form of "1+N". Family doctor services are no longer limited to general medical services, but are gradually expanding to specialist medical services, which puts forward higher requirements for family doctor teams.
How can we further supervise and motivate the work of family doctors to make the vision a reality?
Luopu County has established a performance appraisal and distribution system for contracted services with more work and more rewards, and separates the contracted service fees of family doctors from the business income of primary medical and health institutions and accounts them separately. The distribution of performance-based wages is also moderately inclined to the doctors of county-level hospitals who have contracted to serve. For the contracted service fee of family doctors, 70% of the service fee will be liquidated once a month; The remaining 30% is reserved for the re-award of the year-end assessment of the contracted service of family doctors.
A family doctor in Luopu County made a follow-up visit to the home. Courtesy of Luopu County People's Hospital
In 2023, the Health Center of Charbagh Town, Luopu County, achieved the best results in the year-end assessment. "It's 800 yuan more per quarter, and 3,200 yuan more a year." This made the village doctor Reyimai · Rouzimaimaiti, who had just joined the company for one year, feel full of energy.
After graduating from junior college, Reyimai became a village doctor in Ayimak Village, Charbagh Township, and a family doctor for nearly 1,800 people in the village. "There are three village doctors with college degrees in our village, and they don't have much practical experience after graduation, and we can see very few diseases." Reyimai said that the town health center will conduct specialist training for them every month; The attending physician of the Department of Internal Medicine of Luopu County People's Hospital, Abdujilili · Obuli Kasim, joined the family doctor team and took them to the village every month for follow-up visits, taught them to judge common diseases and some emergencies, and trained them in their weak links.
In this way, the three of them grew up rapidly, from being able to see more than 40 common diseases at the beginning, to now being able to judge more than 80 common diseases, prescribing drugs independently, and providing health education to the villagers. "The more you do and the more you serve, the more you will naturally get and the more rewards you will get. I will continue to learn, improve my ability, and strive to realize the value of life. Reimai said.
Informatization empowers chronic disease management
With the number of patients with chronic diseases such as hypertension and diabetes and the incidence of related complications increasing year by year. How to strengthen the full-cycle comprehensive management of chronic diseases through one-stop service?
Drawing on the experience and practices of Zhejiang Province, Hami City has built integrated outpatient clinics for chronic diseases in 9 primary medical and health institutions, including Donghe Street Community Health Service Center and Huayuan Township Central Health Center in Yizhou District, formulated an integrated path of clinical diagnosis and treatment and follow-up management, and built an intelligent chronic disease management platform by collecting information and data such as residents' electronic health records, health examinations, and disease diagnosis and treatment, so as to provide one-stop services of "screening, assessment, intervention, treatment and rehabilitation" for patients with chronic diseases.
"The newly built integrated outpatient clinic for chronic diseases has its own outpatient area and examination area, which is more like an assembly line operation." Wang Cailan, who has suffered from high blood pressure for many years, said that now, she went to the Donghe Street Community Health Service Center to prescribe medicine and swiped her medical insurance card in the outpatient area, and began the "assembly line operation". "Not long after I went home, I received a call from my family doctor, telling me how to take the medicine, diet and exercise, and make an appointment with me for the next prescription." Feel this disease, someone is always on the mind. ”
Through the integrated management of chronic diseases, the blood pressure and blood glucose control rates of patients included in the health management of chronic diseases in Hami City increased from 72.45% and 71.18% in 2022 to 87.21% and 86.79% in 2023, respectively.
Reporter's Notes
Efforts are needed to optimize the allocation of resources
With the increasing demand for convenience, efficiency and personalized medical care, the advantages of family doctor services that are closer to the needs of patients are highlighted. The gradual implementation of the "six expansions" has gradually brought the contracted services of family doctors in Xinjiang into a professional, standardized and high-quality development track.
In order for family doctors to move forward steadily, government functional departments need to continue to increase the investment of human, material and financial resources, continuously optimize the allocation of primary medical service resources, provide sufficient guarantee for effective initial diagnosis and triage of family doctors, and effectively improve the utilization efficiency; Promote the standardization of contracted services for family doctors, make them formalized, professional, and normalized, so that family doctors can truly play the role of health "gatekeepers", provide residents with safe, convenient, effective, continuous, and economical basic medical services and basic public health services, and continuously improve the health level of residents.