Current Situation of Service Ability in Primary Health Care Institutions and Corresponding Improvement Measures in Wuhan

doi:10.12114/j.issn.1007-9572.2020.00.028

Abstract

Abstract: Due to the emphasis on primary health care and policy guidance at the national level，the infrastructure construction，medical equipment and medical technology in primary health care institutions in Wuhan have been greatly improved in recent years.But primary health care institutions still can not get the trust of urban and rural residents.In view of this，this study summarized the current situation of the service ability in the primary health care institutions in Wuhan and gave a review of the corresponding countermeasures and improvement measures.It was found that the primary health care institutions in Wuhan were lack of standardized business management and rational resource allocation；medical service capacity needed to be further improved，and the grassroots characteristic service needed further construction；the combination of medical and preventive work still needed to be strengthened.It was expected that through continuously improving the service capacity of primary health care institutions，residents' satisfaction and gain of sense in primary health care institutions could be enhanced in order to better promote the formation of hierarchical medical system.

Key words: Primary health care, Community health services, Health services research, Clinical competence, Status analysis, Improvement measure, Wuhan

摘要： 近年来，由于国家对基层医疗卫生服务的重视和政策指导，武汉市基层医疗卫生机构在基础设施建设、医疗设备和医疗技术水平等方面有了很大改善。但目前，基层医疗卫生机构依然得不到城乡居民的信任。鉴于此，本研究从武汉市基层医疗卫生机构服务能力现状分析、基层医疗卫生机构服务能力提升对策及改进措施两个方面进行综述，发现武汉市基层医疗卫生机构存在业务管理规范化不足、资源配置合理性不足、医疗服务能力需要进一步提升、基层特色服务需要进一步建设、医防结合工作仍待加强等现状，期望通过不断提升基层医疗卫生机构的服务能力，来提升居民对基层医疗卫生服务的获得感和满意度，进而更好地促进分级诊疗制度的落实。

关键词: 初级卫生保健, 社区卫生服务, 卫生服务研究, 临床工作能力, 现状分析, 改进措施, 武汉

LI Li. Current Situation of Service Ability in Primary Health Care Institutions and Corresponding Improvement Measures in Wuhan　[J]. Chinese General Practice, 2020, 23(4): 403-408. DOI: 10.12114/j.issn.1007-9572.2020.00.028.
黎黎. 武汉市基层医疗卫生机构服务能力现状及改进措施[J]. 中国全科医学, 2020, 23(4): 403-408. DOI: 10.12114/j.issn.1007-9572.2020.00.028.

References

［1］陈王涛，刘毅俊，李俊，等．2008—2016年医疗纠纷第三方调解相关研究的回顾性分析［J］．中国卫生事业管理，2017，34（1）：39-41.
CHEN W T，LIU Y J，LI J，et al．Retrospective analysis of medical dispute third-party mediation based on the related literatures from 2008 to 2016［J］．Chinese Health Service Management，2017，34（1）：39-41.
［2］原武汉市卫生和计划生育委员会．2017年武汉市卫生和计划生育事业发展情况［EB/OL］．［2019-08-18］．https://www.docin.com/p-2197967701.html.
［3］张婷，王峥，薛镭，等．基层卫生行政管理人员能力提升培训及其体系开发研究［J］．中国初级卫生保健，2018，32（3）：21-23．DOI：10.3969/j.issn.1001-568X.2018.03.0007．
ZHANG T，WANG Z，XUE L，et al．Research on capability improvement training and its system development of basic health planning management staff ［J］．China Primary Health Care，2018，32（3）：21-23．DOI：10.3969/j.issn.1001-568X.2018.03.0007.
［4］柯菊芽．基层医院加强医疗质量防范医疗风险的探索［J］．中医药管理杂志，2019，27（12）：193-194.
KE J Y．Exploration on strengthening medical quality and preventing medical risks in primary hospitals［J］．Journal of Traditional Chinese Medicine Management，2019，27（12）：193-194.
［5］张敏芬，汪静．基层医院慢性病管理对老年患者的重要性探讨［J］．中医药管理杂志，2019，27（2）：216-217.
ZHANG M F，WANG J．Discussion on the importance of chronic disease management in primary hospitals for elderly patients［J］．Journal of Traditional Chinese Medicine Management，2019，27（2）：216-217.
［6］吕欣航，陈荃，雷行云，等．基层卫生信息化建设现状分析及思考［J］．中国数字医学，2019，14（4）：2-4，11．DOI：10.3969/j.issn.1673-7571.2019.04.001.
LYU X H，CHEN Q，LEI X Y，et al．Analysis and reflection on the current situation of health informatization at the grassroots level ［J］．China Digital Medicine，2019，14（4）：2-4，11．DOI：10.3969/j.issn.1673-7571.2019.04.001．
［7］陈园，曹易．武汉市社区卫生服务中心人力资源现状分析［J］．中国初级卫生保健，2017，31（12）：26-27，44．DOI：10.3969/j.issn.1001-568X.2017.12.0010.
CHEN Y，CAO Y．Analysis of the current situation of human resources in Wuhan community health service center［J］．China Primary Health Care，2017，31（12）：26-27，44．DOI：10.3969/j.issn.1001-568X.2017.12.0010.
［8］乔家骏，曾旖旎．新医改前后武汉市社区卫生服务中心经济运行状况分析［J］．中国全科医学，2018，21（25）：3051-3055．DOI：10.12114/j.issn.1007-9572.2018.25.005.
QIAO J J，ZENG Y N．Analysis on the economic operation of Wuhan community health service center before and after the new medical reform［J］．Chinese General Practice，2018，21（25）：3051-3055．DOI：10.12114/j.issn.1007-9572.2018.25.005.
［9］张银丽，吴小艳．武汉市社区医疗发展现状及居民满意度调查研究［J］．科技创业月刊，2016，29（10）：109-111．DOI：10.3969/j.issn.1665-2272.2016.10.043.
ZHANG Y L，WU X Y．Research on the status quo of community medical development and residents' satisfaction in Wuhan［J］．Journal of Technology Entrepreneurship，2016，29（10）：109-111．DOI：10.3969/j.issn.1665-2272.2016.10.043.
［10］张丽芳，刘中元，林春梅，等．我国社区卫生服务中心专科服务开展现状及发展策略［J］．中国全科医学，2019，22（16）：1900-1903．DOI：10.12114/j.issn.1007-9572.2019.00.284.
ZHANG L F，LIU Z Y，LIN C M，et al．Current situation and development strategies of specialized services in community health service centers in China［J］．Chinese General Practice，2019，22（16）：1900-1903．DOI：10.12114/j.issn.1007-9572.2019.00.284.
［11］叶静雪，曾庆秋，钱宁，等．基层医疗机构2型糖尿病患者家庭医生团队中医药健康管理服务现状调查分析［J］．中国全科医学，2019，22（11）：1265-1269．DOI：10.12114/j.issn.1007-9572.2018.00.433.
YE J X，ZENG Q Q，QIAN N，et al．Investigation and analysis of TCM health management service status of family doctor team of type 2 diabetes patients in primary medical institutions［J］．Chinese General Practice，2019，22（11）：1265-1269．DOI：10.12114/j.issn.1007-9572.2018.00.433.
［12］李小燕，吕鹏飞，祝秀英，等．社区卫生服务中心对家庭医生式医养结合的相关认知与需求调查［J］．中国初级卫生保健，2018，32（11）：19-22．DOI：10.3969/j.issn.1001-568X.2018.11.0007.
LI X Y，LYU P F，ZHU X Y，et al．Investigation on cognition and demand of family doctor combined with medical care in community health service center［J］．China Primary Health Care，2018，32（11）：19-22．DOI：10.3969/j.issn.1001-568X.2018.11.0007.
［13］李周洋．如何破解家庭医生服务“签而不约”问题［J］．中国农村卫生，2019，11（13）：8-10．DOI：10.3969/j.issn.1674-361X.2019.13.003．http://www.cqvip.com/QK/89405X/201913/7002435926.html.
［14］秦江梅，林春梅，张艳春，等．基层卫生综合改革重点联系区县基层卫生人力资源配置现状研究［J］．中国全科医学，2018，21（1）：28-31．DOI：10.3969/j.issn.1007-9572.2018.01.007.
QIN J M，LIN C M，ZHANG Y C，et al．Allocation status of human resources for primary care in highly focused districts/counties during the comprehensive reform of primary care system in China［J］．Chinese General Practice，2018，21（1）：28-31．DOI：10.3969/j.issn.1007-9572.2018.01.007.
［15］马祥．武汉市花桥社区公共卫生服务研究［D］．武汉：华中师范大学，2017.
［16］巩方旭，项莉，张颖，等．不同类型社区卫生服务中心公共卫生服务功能分析［J］．中国卫生经济，2017，36（7）：67-70．DOI：10.7664/CHE20170718.
GONG F X，XIANG L，ZHANG Y，et al．Analysis of public health service functions of different types of community health service centers［J］．China Health Economics，2017，36（7）：67-70．DOI：10.7664/CHE20170718.
［17］林淑周．提高基层医疗机构卫生服务能力研究综述［J］．福州党校学报，2012，30（1）：26-31．DOI：10.3969/j.issn.1674-1072.2012.01.006．http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=fuzdxxb201201006.
［18］向菲，吴显聪．武汉市医疗卫生机构服务效率分析［J］．医学与社会，2019，32（5）：10-13．DOI：10.13723/j.yxysh.2019.05.003.
XIANG F，WU X C．Analysis of service efficiency of medical and health institutions in Wuhan City［J］．Medicine and Society，2019，32（5）：10-13．DOI：10.13723/j.yxysh.2019.05.003.
［19］罗金．浅谈城市社区卫生服务中心医疗质量管理存在的问题及对策［J］．当代临床医刊，2016，29（4）：2443．DOI：10.3969/j.issn.2095-9559.2016.04.116．http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=ddlcyk201604116.
［20］许雪娇．医联体内医疗质量同质化管理方法探析［J］．中医药管理杂志，2018，26（17）：118-119.
XU X J．Exploration of the methods of homogeneity management of medical quality in medical alliance［J］．Journal of Chinese Medicine Management，2018，26（17）：118-119.
［21］颜伟伟．基于随访系统“医-护-患”三人行管理模式在基层医院慢性病患者中的应用［J］．当代护士，2019，26（3）：187-188．http://xueshu.baidu.com/usercenter/paper/show?paperid=151p0850fa7300v0ue5v0a00kk396100&site=xueshu_se.
［22］关旭静，金必辉，吴先萍，等．应用多水平模型研究基层慢性病患者健康管理服务效果的影响因素［J］．预防医学情报杂志，2019，35（1）：99-103，108.
GUAN X J，JIN B H，WU X P，et al．Study on the influencing factors of primary health services effects on chronic disease patients by hierar-chical linear model［J］．Journal of Preventive Medicine Information，2019，35（1）：99-103，108.
［23］国家卫生健康委，国家中医药管理局．全国基层医疗卫生机构信息化建设标准与规范（试行）［EB/OL］．（2019-04-28）［2019-09-12］．http://www.nhc.gov.cn/cms-search/xxgk/getManuscriptXxgk.htm?id=9d346a5ef0134e6a82c79c5c9ab96b77.
［24］吕欣航，雷行云，皮宇奇，等．我国基层卫生信息化建设与发展的SWOT分析［J］．实用心脑肺血管病杂志，2019，27（3）：10-13．DOI：10.3969/j.issn.1008-5971.2019.03.002.
LYU X H，LEI X Y，PI Y Q，et al．SWOT analysis on the construction and development of grass-roots health informatization in China［J］．Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease，2019，27（3）：10-13．DOI：10.3969/j.issn.1008-5971.2019.03.002.
［25］侯停停，何婷婷，刘彩茵，等．2012—2017年武汉市卫生资源配置现状及公平性研究［J］．医学信息，2019，32（12）：17-20．DOI：10.3969/j.issn.1006-1959.2019.12.006.
HOU T T，HE T T，LIU C Y，et al．Research on the status quo and fairness of health resources allocation in Wuhan from 2012 to 2017［J］．Medical Information，2019，32（12）：17-20．DOI：10.3969/j.issn.1006-1959.2019.12.006.
［26］陈小丽，端木琰．大型城市远郊社区基本医疗服务能力提升对策研究——以上海市金山区为例［J］．卫生软科学，2018，32（9）：59-63．DOI：10.3969/j.issn.1003-2800.2018.09.016.
CHEN X L，DUANMU Y．Study on promoting and countermeasures of basic medical care ability in exurbia community——take Jinshan District in Shanghai as an example［J］．Soft Science of Health，2018，32（9）：59-63．DOI：10.3969/j.issn.1003-2800.2018.09.016.
［27］谢彩娟，顾铭娟，俞栋．18家社区医院急诊抢救单元的建设现状与改进建议［J］．中国护理管理，2018，18（6）：849-853．DOI：10.3969/j.issn.1672-1756.2018.06.028.
XIE C J，GU M J，YU D．Construction of emergency rescue units in 18 community hospitals and corresponding recommendations for improvement［J］．Chinese Nursing Management，2018，18（6）：849-853．DOI：10.3969/j.issn.1672-1756.2018.06.028.
［28］耿文进，徐正海，陈玲，等．“社区卫生服务中心能力提升”专家主题研讨［J］．中国全科医学，2017，20（5）：512-516．DOI：10.3969/j.issn.1007-9572.2017.05.002.
GENG W J，XU Z H，CHEN L，et al．Thematic discussions on "Improvement of Service Capabilities of Community Health Service Centers"［J］．Chinese General Practice，2017，20（5）：512-516．DOI：10.3969/j.issn.1007-9572.2017.05.002.
［29］陈贞全，李筱沐，王梦玉，等．医养结合背景下武汉市社区医疗卫生服务改进研究［J］．中外企业家，2019，36（14）：232-233．http://www.cnki.com.cn/Article/CJFDTotal-ZWQY201914176.htm.
［30］张莉，李晶华，马天娇，等．患者参与社区卫生服务就诊过程的重要性及途径［J］．医学与社会，2019，32（6）：43-45．DOI：10.13723/j.yxysh.2019.06.012．
ZHANG L，LI J H，MA T J，et al．The importance of patients involved in community health services clinic process and approach［J］．Medicine and Society，2019，32（6）：43-45．DOI：10.13723/j.yxysh.2019.06.012.
［31］同昭燕，杨帆，李勇，等．面向基层的临床医学人才应具备的综合素质调查与分析［J］．成都中医药大学学报（教育科学版），2015，17（3）：19-23.
TONG Z Y，YANG F，LI Y，et al．Investigation and analysis of the grass-roots clinicians' comprehensive quality［J］．Journal of Chengdu University of TCM（Educational Science Edition），2015，17（3）：19-23.
［32］张海荣．探讨人文护理管理在社区卫生服务中心的效果［J］．临床医学研究与实践，2016，1（13）：186-187．http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=lcyxyjysj201613134．
［33］杨芬，郑桃云，李琳．武汉市不同人群对社区卫生服务需求分析［C］ //2015现代护理论坛论文集．北京：中华现代护理杂志社，2015：91-96.
［34］李一豪，李彦杰，翟优，等．我国大康复理念运行模式的研究——以河南综合医院康复医学科和社区康复机构联动建设为例［J］．中医药管理杂志，2016，24（9）：142-144．http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=zyyglzz201609069．
［35］郑宏，鞠康．严重精神障碍残疾者“医院-社区一体化”职业康复规范化建设研究［J］．中国全科医学，2018，21（35）：4328-4333．DOI：10.12114/j.issn.1007-9572.2018.00.293.
ZHENG H，JU K．Standardization building of occupational rehabilitation based on "hospital-community integration" service model for patients with mental disability due to severe mental disorder［J］．Chinese General Practice，2018，21（35）：4328-4333．DOI：10.12114 / j.issn.1007-9572.2018.00.293.
［36］秦江梅，林春梅，张丽芳，等．我国基层医疗卫生机构儿科资源及医疗服务能力现状研究［J］．中国全科医学，2019，22（13）：1511-1515．DOI：10.12114/j.issn.1007-9572.2019.00.214.
QIN J M，LIN C M，ZHANG L F，et al．Pediatric resources and medical service delivery capability in primary healthcare institutions in China［J］．Chinese General Practice，2019，22（13）：1511-1515．DOI：10.12114/j.issn.1007-9572.2019.00.214.
［37］郭会．社区医院开设中医专科的可行路径探究［J］．中国保健营养，2018，28（12）：298．DOI：10.3969/j.issn.1004-7484.2018.12.277．http://www.doc88.com/p-5718408630973.html.
［38］全晓明，张勇，董宏伟，等．我国社区卫生服务机构协同发展战略路径选择［J］．中国医院管理，2018，38（12）：31-33.
QUAN X M，ZHANG Y，DONG H W，et al．Strategic path choices of coordinated development of China's community health service institutions［J］．Chinese Hospital Management，2018，38（12）：31-33.
［39］张秀杰．社区公共卫生管理中存在的问题及解决措施分析［J］．中国卫生产业，2017，14（29）：24-25．DOI：10.16659/j.cnki.1672-5654.2017.29.024.
ZHANG X J．Analysis of the problems and solutions in community public health management［J］．China Health Industry，2017，14（29）：24-25．DOI：10.16659/j.cnki.1672-5654.2017.29.024.
［40］孔晓明，张丽，雷艳，等．社区公共卫生应急能力SWOT分析与对策——以杭州市余杭区社区为例［J］．中国农村卫生事业管理，2019，39（5）：356-360.
KONG X M，ZHANG L，LEI Y，et al．An SWOT analysis of emergency response capacity of community public health and strategies——taking communities in Yuhang District of Hangzhou City as an example［J］．Chinese Rural Health Service Administration，2019，39 （5）：356-360.

[1]	YAO Yuzhong, MA Xiaojun, SONG Huan, ZHONG Yu. The Management Effect of Diabetes "1358 model" on Community Diabetes Patients Based on "Precision Management Combining General Care and Specialty Care" [J]. Chinese General Practice, 2023, 26(34): 4308-4314.
[2]	QIN Fengyin, ZHANG Qishan, LAI Jinjia, HUANG Yimin, HAN Guoyin, SUN Xinglan, WANG Fen, TAN Yibing. Current Status and Influencing Factors of the Intention to Screen for High-risk Stroke among Community Residents in Guangdong [J]. Chinese General Practice, 2023, 26(34): 4283-4289.
[3]	LI Dianjiang, PAN Enchun, SUN Zhongming, WEN Jinbo, WANG Miaomiao, WU Ming, SHEN Chong. The Current Status and Influencing Factors of Clinical Inertia in Type 2 Diabetes Patients in Community [J]. Chinese General Practice, 2023, 26(34): 4296-4301.
[4]	HUANG Jinling, ZENG Zhirong. The Logic and Trend of Urban Community Health Service Policies in China [J]. Chinese General Practice, 2023, 26(34): 4239-4245.
[5]	LIAN Lu, CHEN Jiaying, WANG Xuanxuan, LI Yahui, ZHU Ya. Current Situation and Countermeasure of Medical Service Capacity of Primary Care Physicians in China [J]. Chinese General Practice, 2023, 26(34): 4246-4253.
[6]	YANG Hui, HU Ruwei, LIU Ruqing, LU Junfeng, WU Jinglan. Relationship between Community Health Service Experience and Glycemic Control Outcomes in Patients with Diabetes Mellitus [J]. Chinese General Practice, 2023, 26(34): 4290-4295.
[7]	XU Jian, DAI Fangfang, PAN Wenlei, HUANG Qian, LU Ping, WANG Jianfeng, JIA Huan, YANG Yuqi, HUANG Jiaoling. Visual Analysis of Hotspots and Cutting-edge Trends of Community TCM Service Research in China in the Context of Healthy China [J]. Chinese General Practice, 2023, 26(34): 4343-4350.
[8]	LI Qianqian, CHEN Xunrui, ZHANG Wenying, YUAN Haihua, ZHANG Yanjie, JIANG Bin, LIU Feng. Demand and Influencing Factors for Community Health Services during Chemotherapy of Patients with Advanced Cancer [J]. Chinese General Practice, 2023, 26(33): 4173-4180.
[9]	YIN Zhaoxia, MAO Lidong, ZHANG Baoshuang, HUANG Yin, FENG Yang, WANG Yunfei. Spectrum of Outpatient Illnesses in Children Contracting Family Doctor Services in Shenzhen's Community Settings and Related Implications for Standardized Residency Training of General Practitioners [J]. Chinese General Practice, 2023, 26(33): 4218-4224.
[10]	YU Dehua. Scientific Research Conception Guided by General Practice Thinking [J]. Chinese General Practice, 2023, 26(31): 3872-3876.
[11]	LI Dongxu, SU Min, LIU Bin, ZHANG Tianjiao, ZHANG Weile. "Patients-centered" in the Reform of Public Primary Health Care Institutions: Does Doctor-patient Communication Improve the Quality of Primary Care Services? [J]. Chinese General Practice, 2023, 26(31): 3847-3855.
[12]	ZHOU Yingda, ZHUO Shuxiong, YANG Xi, JIN Hua, YU Dehua. Implementation Status and Strategy Research on the Construction of Clinical Pathways for Diagnosis and Treatment of Medically Unexplained Disease in Community General Practice [J]. Chinese General Practice, 2023, 26(31): 3939-3944.
[13]	WANG Siyuan, HANG Ranfeng, WEI Yingjue, LIU Jianying, SHI Wuxiang, HUANG Zhaoquan. Development Dilemma of Primary Health Care Institutions: a Grounded Theory Study Based on Guilin City [J]. Chinese General Practice, 2023, 26(31): 3856-3862.
[14]	HONG Yuchun, WU Hua, DU Yishan, LI Shuran, SUN Wenmin, YE Mingyu, ZHANG Yongjian, LI Yang. Development of General Practice Diagnostic Terminology and Coding and Empirical Study on Its Application [J]. Chinese General Practice, 2023, 26(31): 3896-3901.
[15]	ZHOU Dongdong, GE Xuhua. The Evaluation Index of Post Competence of General Practitioners in Less-developed Areas [J]. Chinese General Practice, 2023, 26(31): 3908-3914.