Source: People's Daily
Li Zhanbin (first from left), deputy chief physician of the Department of Traditional Chinese Medicine Treatment of the Second Hospital of Sanming City, provides diagnosis and treatment services for township residents. Photo by Fan Shuhua
In the remote ultrasound real-time consultation center of Suixi County Hospital, doctors are conducting remote consultations. Photo courtesy of the interviewee
Since 2019, the National Health Commission has launched a pilot project for the construction of a close-knit county-level medical and health community. In December 2023, the National Health Commission and 10 other departments jointly issued the "Guiding Opinions on Comprehensively Promoting the Construction of a Close-knit County-level Medical and Health Community". As of the end of August this year, the number of close-knit county-level medical communities has grown to 2,171, and 90.9% of the counties have achieved full coverage of county-level hospitals dispatching personnel to township health centers.
To comprehensively promote the construction of a close-knit county-level medical community, it is necessary to optimize the benefit distribution mechanism, promote the integration of medical treatment and prevention, and the construction of informatization, so that the medical community can become a real community of responsibility, so that the people can obtain a higher level of medical and health services at their doorstep. A few days ago, the reporter of this newspaper went to Gongyi in Henan, Suixi in Anhui, Sanming in Fujian and other places to interview and investigate the relevant experience and results of the construction of a close-knit county-level medical community.
-- The editor
Gongyi, Henan Province - Building a smart shared Chinese medicine pharmacy
Reporter Zhang Wenhao
Early in the morning, Ms. Sun, who lives in Makou Village, Huiguo Town, Gongyi City, Henan Province, came to the nearby Luzhuang Town Health Center for treatment.
"How's it going to be in the morning? Is there any spitting acid? Traditional Chinese medicine doctor Li Huiya asked about the condition while taking the pulse. After looking and hearing about it, Li Huiya gave a preliminary diagnosis - menopausal syndrome, depression and phlegm stasis. "It's not a big problem, I will prescribe you a few doses of Chinese medicine and recuperate first."
Ms. Sun was very happy to learn that Gongyi General Hospital could provide traditional Chinese medicine decoction and delivery services at the town health center, "Now I can go home directly and wait for the Chinese medicine to be delivered to my home." In the afternoon of the same day, she received the decoction of Chinese medicine.
In May 2019, Gongyi was identified as a pilot county (city) for the construction of a national compact county-level medical community, and Gongyi People's Hospital, Gongyi Public Hospital of Traditional Chinese Medicine, Gongyi Maternal and Child Health Hospital, as well as 5 community health service centers, 15 township health centers and 310 village clinics formed the current Gongyi General Hospital, with Gongyi People's Hospital as the leading hospital. Relying on the construction of county-level medical community, the wisdom sharing of traditional Chinese medicine pharmacy has opened up the "last mile" of traditional Chinese medicine services in Gongyi City. At present, all members of the medical community can enjoy the decoction and distribution services of traditional Chinese medicine.
In the shared Chinese medicine pharmacy of Gongyi Public Hospital of Traditional Chinese Medicine, the decoction center of about 200 square meters is divided into functional areas such as storage, preparation, decoction, packaging, and cleaning. In the prescription circulation room of the shared Chinese medicine pharmacy, pharmacist Wang Lu reviews electronic prescriptions. These prescriptions are issued by physicians in the member units of the medical community and transmitted here through the wisdom sharing pharmacy system. "The platform has its own intelligent prescription review system, which will review prescriptions according to compatibility contraindications, overdoses, and contraindications for special populations. We will also conduct a manual re-examination, and if we find that it is not qualified, we will notify the prescriber to make corrections. ”
Depending on the nature of the drug, the pharmacist sets the soaking and decoction times and prints out a prescription with a barcode. According to reports, there are 52 automatic decoction machines and 14 packaging machines in the shared Chinese medicine pharmacy, and the efficiency and accuracy of decoction have been greatly improved. Regardless of soaking, decoction, decoction, decoction machine, and decoction personnel, the whole process can be traced, which further standardizes the decoction process and ensures the clinical efficacy.
Ms. Sun's decoction order shows that: at 10:57, the shared Chinese medicine pharmacy received the prescription and reviewed the prescription; At 11:02, the dispensing began; At 11:42, the soak begins; At 12:21, the decoction began; At 13:06, a frying is completed; At 13:36, the second decoction was completed and the medicine was packed...... Through the mobile phone, you can check the decoction process and logistics distribution in real time.
"In the future, you don't have to go to the county seat to see a doctor and decoct medicine, it's so convenient!" Ms. Sun said that the sharing of Chinese medicine pharmacies has improved the medical experience and made it easier for villagers to see a doctor and get medicine.
In primary medical institutions such as township health centers and village clinics, there were widespread problems in the past, such as the shortage of TCM professionals, the small area of decoction rooms, the small variety of TCM decoction pieces, and the high management cost. After the completion of the shared Chinese medicine pharmacy, it has opened up many blocking points such as the difficulty of decoction of traditional Chinese medicine, the difficulty of waiting for medicine, and the difficulty of quality assurance.
Qiao Laijun, Secretary of the Party Committee of Gongyi General Hospital, introduced that the General Hospital implemented unified bidding and procurement for traditional Chinese medicine decoction pieces, and inquired about the bidding suppliers of traditional Chinese medicine decoction pieces, and there were 348 varieties with a price decline, and the unit price decreased by 12.6% year-on-year. In accordance with the requirements of "the same medicine, the same city, the same quality, and the same price", the shared Chinese medicine pharmacy implements unified storage, prescription review, decoction and distribution, and makes full use of the information platform of the medical community, so as to achieve "let the information run more and let the masses run less errands". Since the operation of the shared Chinese medicine pharmacy, the proportion of grassroots Chinese medicine diagnosis and treatment and the proportion of prescriptions for traditional Chinese medicine decoction pieces in Gongyi City have continued to increase.
Suixi, Anhui Province - Implement the lump sum use of medical insurance funds
Reporter Luo Yangqi
At 9 o'clock in the morning, Guo Xiuling, a villager in Baishan Town, Suixi County, Anhui Province, came to the town health center because of leg soreness and weakness. This time, it was not the doctor from the town health center who treated her, but Lei Xiang, the chief physician of the general surgery department of Suixi County Hospital, who was "sitting" on the screen.
It turned out that Baishan Town Health Center had opened a remote consultation service, and the township health center could submit an application online, and the doctors of Suixi County Hospital could see the doctor through video. The patient can be taken in the town health center, or it can be directly transmitted to the laboratory department of Suixi County Hospital, and the doctor of the county hospital will give a diagnosis.
"Suixi is long and narrow from north to south, the county seat is in the northernmost part, from the southernmost township, it takes more than an hour to take the expressway, and it is much more convenient to pass the remote consultation and examination. This is the convenience brought by the county-level medical community to the people. Sun Donghai, Secretary of the Party Group of the Suixi County Medical Insurance Bureau, said.
At the end of 2015, Suixi County was listed as the second batch of county-level medical community reform pilot counties in Anhui Province. At present, there are two medical communities in Suixi County, led by Suixi County Hospital and Suixi County Hospital of Traditional Chinese Medicine, which are established with 12 and 6 township health centers (branches) respectively.
How to form closer cooperation between medical institutions at all levels? The crux of the matter is the "money bag". At present, Suixi County has realized the prepayment of the basic medical insurance fund for urban and rural residents according to the total capitation of the medical community. That is to say, according to the number of contributors in all townships and towns within the medical community, after deducting the risk fund of the incremental fund and the critical illness insurance fund, no less than 95% of the part will be handed over to the medical community for use. If there is a surplus in the medical insurance fund of the current year, the balance will be distributed to each medical institution according to the distribution ratio of 6:3:1 in counties, towns and villages.
"This has promoted all units in the medical community to optimize services and improve their standards, so that patients can receive high-quality medical services at the grassroots level." Sun Donghai said.
On the third floor of the inpatient department of Baishan Town Health Center, there is a rehabilitation center with an area of 800 square meters, with traction rooms, acupuncture rooms, and physiotherapy rooms. "Every morning, the rehabilitation center is full of people, and everyone thinks the effect is good." Huang Zhenhai, secretary of the Party branch of Baishan Town Health Center, said.
Last year, as a member of the medical community, Baishan Town Health Center applied to Suixi County Hospital to send experts to jointly build a rehabilitation department. Li Hao, a therapist from the rehabilitation department of Suixi County Hospital, served as the vice president of business in Baishan Town Hospital, responsible for the construction of the rehabilitation center for a term of 3 years. From January to September this year, the two leading hospitals of the medical community in Suixi County have sent 79 doctors to help them, carried out discipline co-construction with 21 departments of 13 branches, and selected 6 vice presidents to participate in the management of health centers.
How to mobilize the enthusiasm of the county hospital doctors to help the township health centers? "Township health centers take out part of the balance of the medical insurance fund as a bonus for the experts to be dispatched." Sun Donghai said.
Guo Guilin, deputy chief physician of the laboratory department of Suixi County Hospital, once went to the township health center, and he calculated an account for the reporter: the monthly salary in the county hospital is about 5,000 yuan, and working in the town health center not only has transportation and food subsidies, but also a bonus of 2,000 yuan per month. "If the income of the township health center increases, we will also have incentives." Guo Guilin said.
"In the past, some medical institutions rushed for patients and projects. Now, through the benefit mechanism under the medical insurance fund, medical institutions should not only improve the ability of primary medical services, but also change from disease treatment to health management, so that patients can get less sick, be hospitalized less and be healthier. Sun Donghai said. At present, Suixi County has achieved the balance of medical insurance fund for many years. From 2022 to 2023, the proportion of hospitalizations in Suixi County increased from 82.9% to 86.03%, the proportion of primary hospitalizations increased from 16.9% to 22.8%, and the proportion of medical insurance funds of primary medical and health institutions in the county increased by 1.5 percentage points.
Fujian Sanming - Promote the integrated management of chronic diseases
Reporter Shi Yu
"The high pressure is less than 150 mm Hg, the control is relatively stable, continue to reduce oil and salt, and exercise appropriately." At the Shanghukou Village Health Center in Xiaotao Town, Yongan City, Sanming City, Fujian Province, village doctor Liu Chunmian instructed Feng Abel while registering blood pressure data on the integrated health management information platform.
The 70-year-old was diagnosed with high blood pressure a few years ago and signed up with a team of family doctors for the integrated management of chronic diseases. "For contracted patients, I regularly measure their blood pressure and upload the measurement records to the platform." Liu Chunmian said that if the results of two consecutive measurements are not satisfactory, the patient will be marked with a "yellow label" on the platform, and the family doctor of the township health center will carry out corresponding diagnosis and treatment.
Since 2017, on the basis of consolidating and deepening the practice of medical system reform, Sanming has taken the establishment of a general hospital as the carrier to comprehensively build a close-knit medical community and promote the sinking of high-quality medical resources to the grassroots level. Liao Dongping, President of Yongan General Hospital of Sanming City, Fujian Province, introduced that Sanming Yongan General Hospital will form a close medical community of Sanming Second Hospital, Yongan Municipal Hospital, 15 township street health centers and 155 village health centers in the county, realizing the comprehensive improvement of the utilization level of medical resources and the ability of primary medical services.
On the integrated health management information platform, the General Hospital implements "classification, grading, slicing, and standard" management for patients with chronic diseases. Classification refers to the classification and management of diseases such as hypertension, diabetes, and tuberculosis; Grading refers to the three-level management of patients by doctors in general hospitals, primary branches, and village health centers according to counties, townships, and villages; Sharding refers to the chronic disease management team of the general hospital and the primary branch hospital to manage the chronic disease patients in the jurisdiction by sharding; The sub-standard refers to the three types of identification according to the patient's disease level: red, yellow and green, with the green label patients being managed by the village doctor on a quarterly follow-up basis, the yellow label patients being managed by the branch hospital, and the red label patients being intervened and managed by the doctors of the general hospital.
Not long ago, Feng Abo's blood pressure control was not satisfactory and he became a "yellow label" patient. Liu Chunmian quickly contacted the doctors of the Xiaotao Branch of the Yongan General Hospital of Sanming City, sent Feng Abel to the branch hospital for examination, and transferred him to the general hospital for joint consultation with cardiology experts who went to the branch hospital for consultation.
In addition to regular visits to the grassroots level, doctors from Sanming Yongan General Hospital also see patients in real time through an online platform. "After the technology and equipment are sunk, the electrocardiogram results done by the township branch hospital for patients can now be uploaded to the system and diagnosed by me." Lin Tao, deputy chief physician of the Department of Cardiovascular Medicine of Sanming General Hospital, said that on the one hand, doctors of the General Hospital can learn more about the patient's disease course information on the integrated health management information platform, and formulate personalized treatment plans for patients in remote towns and villages through the remote platform; On the other hand, the doctors of the General Hospital will also regularly go to the grassroots level for consultation, ward rounds and training to improve the level of primary diagnosis and treatment services and management capabilities.
"After the integrated management of chronic diseases carried out by the medical community, the blood pressure control rate of Yongan residents has been significantly improved." Lin Tao said.
Resources sink and the grassroots become stronger. Since the establishment of the medical community, Liu Chunmian has also participated in the training organized by the General Hospital every year to continuously improve the level of diagnosis and treatment. After hard work, Liu Chunmian has obtained the qualification certificate of licensed physician, licensed pharmacist, general practitioner qualification certificate and other qualifications. "The villagers are also trusting me more and more, and I have an average of 20 outpatient visits per day and an annual income of more than 100,000 yuan." Liu Chunmian said.
In 2023, the compliance rate of the national basic standards and recommended standards of primary medical and health institutions in Sanming City will reach 96.52%, the number of primary diagnosis and treatment will account for 57.61%, 43,000 cases will be referred in both directions, and 38,300 inpatients will be transferred from county-level hospitals, and the service accessibility will be significantly enhanced.