Abstract:How can Shanghai do a good job in improving the capacity of community health services, so that people are willing to see a doctor at their "doorstep"?
Since April last year, Shanghai has launched a new round of community health service capacity improvement. Recently, the author learned from the Shanghai Municipal Health Commission that all community health service centers in Shanghai have given priority to the appointment of outpatient number sources in higher-level hospitals, so that the outpatient number sources of doctors visiting every day and at all times are preferentially open to the "municipal hierarchical diagnosis and treatment platform", and the proportion is not less than 50%. At the same time, we will continue to expand the capacity of medicines, consolidate the contracted services of family doctors, allocate more than 60% of the communities to carry out outpatient minor surgeries, and add community rehabilitation and nursing functions, so that people are willing to see a doctor at their "doorstep".
As of the end of June, the number of outpatient visits in community health service institutions in the city was 38.851 million, an increase of 5.9 million or 17.9% year-on-year, accounting for 38.9% of the total outpatient clinics for permanent residents in the city, an increase of 0.8 percentage points from the end of 2023.
Priority appointments are given to the outpatient number source of higher-level hospitals
77.4% of contracted residents aged 60 and over
"Since the start of the sinking of outpatient numbers in higher-level hospitals in April, 248 community health service centers in the city have launched the 'municipal hierarchical diagnosis and treatment platform', which can make appointments for contracted residents to 36 municipal hospitals and 116 district hospitals." According to Yang Chao, director of the grassroots department of the Municipal Health Commission, the city continues to promote the work of giving priority to contracted residents to make appointments for outpatient clinics in higher-level hospitals, so that the outpatient number sources of doctors visiting every day are preferentially open to the "municipal hierarchical diagnosis and treatment platform", with a proportion of not less than 50%. At the same time, contracted residents can make an appointment for a number source 5 days earlier than other platforms through the "Municipal Hierarchical Diagnosis and Treatment Platform", and can also make an appointment for a number source in the next 2-3 days.
Community hospitals can give priority to making appointments for outpatient numbers from higher-level hospitals. Photo courtesy of Minhang District Health Commission
It is a key point to attract residents to go to the community for medical treatment by giving priority to the appointment of outpatient numbers from higher-level hospitals. The data shows that since the sinking of the number source, 62.5% of the contracted residents with hypertension and diabetes have made appointments, and 77.4% have people aged 60 and above. This means that by sinking the source of the real number, family doctors will have channels and platforms to refer patients beyond the functional positioning and ability of the community to higher-level hospitals for further treatment, so as to attract the people, especially the elderly over 60 years old, to come to the community for the first diagnosis, so as to realize the hierarchical diagnosis and treatment pattern of "minor diseases at the grassroots level, major diseases in higher-level hospitals, and rehabilitation back to the community".
Since the beginning of this year, medical institutions at the municipal and district levels have sent a total of 21,000 experts to the sinking communities to open suitable specialist outpatient clinics, and the number of expert community outpatient clinics has reached 403,000. "In the next step, we will continue to refine the services of contracted residents in higher-level hospitals, including whether the window is set up eye-catching, carry out secondary triage, and whether the service process of providing 'priority treatment, priority examination, and priority hospitalization' is smooth, etc., so as to improve the medical experience of contracted residents after being referred by the community. At the same time, do a good job in the monitoring, evaluation and assessment of the number source appointment, and do a good job. Yang Chao said.
Expand the number of diseases, and introduce appropriate technologies into the community
More than 60% of community hospitals can carry out outpatient minor surgery
This year, Shanghai plans to use the "List of Basic Diseases in Shanghai Community Medical Services" as a starting point to promote the application of appropriate technologies in the community. The author understands that the list includes 161 diseases of Western medicine and 114 diseases of traditional Chinese medicine into the community, which is clearly based on general practice, adheres to the equal emphasis on traditional Chinese and Western medicine, and gradually strengthens the service capacity of gynecology, eye, ear, nose and throat, dermatology, pediatrics and other suitable specialties. As of June, an average of 121 types of Western medicine diagnosis and treatment diseases have been carried out in communities in the city, an increase of 13 compared with the same period in 2023, and all community health service centers can provide 6 types of traditional Chinese medicine medical technology and traditional Chinese medicine decoction piece services.
It is worth mentioning that at present, more than 60% of the communities have the technology to carry out suitable minor surgery projects, and can provide residents with appropriate debridement and suture, burn irrigation and debridement, superficial mass excision, abscess incision and drainage, etc. Yang Chao introduced that the public does not have to worry about the quality of outpatient minor surgery, and each community has set up a standardized outpatient operating room, and the medical staff who carry out outpatient minor surgery are also physicians with rich surgical experience and experts in higher-level hospitals. At the same time, the city and all districts will carry out general practice quality control and quality control of various specialties every year to ensure medical safety and improve the homogeneity of diagnosis and treatment levels.
To expand the number of diseases, it is necessary to expand the allocation of drugs. It is reported that the city's community health service center regularly adjusts, optimizes and expands the drug supply catalog according to the needs of residents. Up to now, the city's community health service centers are equipped with an average of 669 kinds of drugs, an increase of 53 from the end of 2023. The consistency between common diseases and chronic diseases and generic drugs in the regional medical alliances in all districts of the city is 78.4%, an increase of 7.8 percentage points from the end of 2023.
Community hospital pharmacies are fully equipped and medicines continue to expand. Photo courtesy of Minhang District Health Commission
Hang Wenquan, director of the Minhang District Health Commission, said with a set of intuitive data that the hierarchical diagnosis and treatment system has achieved remarkable results in community hospitals in Minhang District, and the types of drugs have been further improved. As of June this year, 14 communities in Minhang District have carried out an average of 136 basic diseases of Western medicine and 72 basic diseases of traditional Chinese medicine, ranking first and second respectively in the city. "At the same time, the proportion of community visits has steadily increased, with 3.887 million community outpatient visits in the first half of 2024, accounting for 65.43% of the district's public medical institutions, and more medical needs can be solved in the community."
New community rehabilitation and nursing functions
On average, nearly 40 rehabilitation services are provided
A survey involving more than 17,000 residents in all communities in the city shows that "rehabilitation medical services" and "nursing services" have become the top two community diagnosis and treatment service needs. Strengthening community rehabilitation and nursing capacity building is in response to the ardent expectations of the general public. Since last year, Shanghai has added rehabilitation and nursing functions in the community, building a community rehabilitation center, a nursing center, a health management center and a standardized community dental clinic. At present, Shanghai has built 119 community rehabilitation centers, 36 nursing centers and 32 standardized dental clinics.
At present, 119 community rehabilitation centers have been built in Shanghai. Photo courtesy of Minhang District Health Commission
"The main reason is that most of the sick elderly are multi-sick coexistence, and general treatment may not meet the needs, and many need rehabilitation and nursing services, such as limb rehabilitation after fracture of the elderly, nerve and limb rehabilitation after cerebral hemorrhage, bedsore care, wound and stoma care for the elderly who have been bedridden for a long time, and so on." Yang Chao said that at present, the average treatment area of each community rehabilitation center is nearly 600 square meters, equipped with a number of rehabilitation robots, mobile antennas and other modern intelligent rehabilitation equipment, which can provide nearly 40 rehabilitation service projects. "In addition to providing 26 basic nursing services in 8 categories, such as skin care, excretory care, and nutritional care, each nursing center can also provide specialized and specialty nursing services such as peritoneal dialysis and wound care."
In addition, in terms of oral medical services, the average area of the dental department of each community health service center with standardized dental clinics is 223 square meters, with 4.5 comprehensive dental treatment chairs, which can provide 17 services including caries filling, root canal treatment, various tooth extractions, oral implant restoration, etc. "Next, we will also carry out the construction of community health management centers, using the application of residents' electronic health records as the carrier to provide residents with whole-process and continuous health management services such as archiving, screening, diagnosis and treatment, and popular science intervention, so as to further improve the health literacy level of residents."
The header picture shows the Minhang District Community Health Service Center building. Photo courtesy of Minhang District Health Commission