Prevention and Control of Major Infectious Diseases in Primary Health Care Organizations：Experiences，Problems and Countermeasures from Case-based Studies

doi:10.12114/j.issn.1007-9572.2021.00.035

Abstract

Abstract: As the providers of public health and essential medical and health services，primary health care organizations play an increasingly important role in the prevention and treatment of major infectious diseases. However，as revealed by actions in containing the 2003 SARS epidemic，2009 H1N1 pandemic and COVID-19 pandemic，their capacities in the containment of such diseases are unsatisfactory，with specific manifestations of imperfection of primary containment mechanisms for infectious diseases，insufficient primary health resources，oversights in preventive health education and low level of informatization. Hence，we proposed the following recommended solutions：further reforming the infectious diseases emergency preparedness and response mechanism，optimizing the allocation of health resources including medical professional and equipments by forms such as combining multiple bodies to co-deliver public health services and attracting social capitals to input in public health programs，further implementing the hierarchical medical system and family doctor system，enhancing informatization level，bearing in mind the idea of delivering routine medical services with sound emergency preparedness in non-epidemic period and making emergency responses to public health emergencies when needed and promoting health education.

Key words: Community health services, Community health service institutions, Novel coronavirus pheumonia, COVID-19, Case combing

摘要： 基层医疗卫生机构作为基本公共卫生与基本医疗卫生服务的提供者，在防治重大传染性疾病中的作用日益显现，基于2003年重症急性呼吸综合征（SARS）、2009年甲型H1N1流感和2019年的新型冠状病毒肺炎基层参与防控的多案例梳理发现，基层医疗卫生机构重大传染病防控能力尚存不足。主要表现为传染病防控机制不完善、卫生资源欠缺、预防性健康教育疏漏和信息化水平不高等问题，建议通过进一步改革传染病应急防控机制，联合多元主体，吸引社会资本，优化卫生资源、人才和设备配置，落实分级诊疗和家庭医生制度，加强信息化建设和树立“平战结合”思想、促进健康教育等方式，逐步提升基层医疗卫生机构传染病防控能力。

关键词: 社区卫生服务, 社区卫生服务机构, 新型冠状病毒感染, 新型冠状病毒肺炎, 案例梳理

QIN Yi, HUANG Yuanying, HE Zhongchen, ZHANG Jian, LUO Lan, TANG Guizhong. Prevention and Control of Major Infectious Diseases in Primary Health Care Organizations：Experiences，Problems and Countermeasures from Case-based Studies　[J]. Chinese General Practice, 2021, 24(1): 11-16.

秦怡, 黄元英, 何中臣, 张检, 罗蓝, 唐贵忠. 基于案例梳理的基层医疗卫生机构重大传染性疾病防控：经验、问题与对策[J]. 中国全科医学, 2021, 24(1): 11-16.

References

［1］张艳国，朱士涛．社区治理：理论、模式与研究方法的发展及反思［J］．社会科学动态，2020，25（3）：5-21.
［2］习近平．在统筹推进新冠肺炎疫情防控和经济社会发展工作部署会议上的讲话［EB/OL］.（2020-01-26）［2020-04-26］.http://www.nhc.gov.cn/wjw/xwdt/202002/c1a37ab8aa15424d8545a8b59d300792.shtml.
［3］国家卫生健康委员会．关于印发突发急性传染病防治“十三五”规划（2016—2020年）的通知［EB/OL］.（2016-08-29）［2020-10-09］．http://www.nhc.gov.cn/yjb/s3577/201608/0efc0c2e658740de8c3cdcfbb75b7f2f.shtml.
［4］国家卫生健康委员会．2009年卫生统计公报数据解读［EB/OL］.（2010-04-09）［2020-10-09］．http://www.nhc.gov.cn/wjw/zcjd/201304/9757091ed0f244658607bfc24f6689dd.shtml.
［5］卫生应急办公室.截至9月6日24时新型冠状病毒肺炎疫情最新情况［EB/OL］.（2020-09-07）［2020-10-09］．http://www.nhc.gov.cn/yjb/s7860/202009/0686a84eb8ca45158929486f68d2de93.shtml.
［6］中华人民共和国中央人民政府.疫情影响中国经济一季度同比下降6.8%，3月份主要经济指标降幅明显收窄［EB/OL］.（2020-04-17）［2020-10-09］．http://www.gov.cn/xinwen/2020-04/17/content_5503447.htm.
［7］单广良，付锐，张梅淮，等．传染性非典型肺炎“三个屏障”防制策略评价［J］．中国公共卫生，2003，19（9）：1033．
［8］黄建始，杨明．甲型H1N1流感：社区医生应该知道的几个问题［J］.中华全科医学，2009，7（8）：787-788，829．DOI：10.16766/j.cnki.issn.1674-4152.2009.08.021.
HUANG J S，YANG M．Influenza A（H1N1）：what community doctors should know［J］．Chinese Journal of General Practice，2009，7（8）：787-788，829．DOI：10.16766/j.cnki.issn.1674-4152.2009.08.021.
［9］陈丽芬．甲型H1N1流感社区防控措施的决策与效果评价［J］.中国卫生产业，2012，9（3）：96-98．
［10］刘贵真，杨俊华，夏增献，等．社区卫生服务中心在社区传染病爆发时的应急工作探讨——附1宗甲型H1N1流感疫情防控分析［J］.中国全科医学，2010，13（22）：2529-2530．DOI：10.3969/j.issn.1007-9572.2010.22.041.
LIU G Z，YANG J H，XIA Z X，et al．Health emergency performance of community health service center while infectious disease outbreaks：an analysis of prevention and control management for one case with influenza A（H1N1）［J］．Chinese General Practice，2010，13（22）：2529-2530．DOI：10.3969/j.issn.1007-9572.2010.22.041.
［11］国家卫生健康委员会．关于加强基层医疗卫生机构新型冠状病毒感染的肺炎疫情防控工作的通知［EB/OL］.（2020-01-26）
［2020-06-14］．http://www.nhc.gov.cn/jws/s7874/202001/0165523421f840af816a580f260d4406.shtml.
［12］国家卫生健康委员会．抗疫在基层　地方在行动12［EB/OL］.（2020-02-28）［2020-06-14］．http://www.nhc.gov.cn/xcs/xwbd/202002/54d552b956b7488d81478a38c6dffef6.shtml.
［13］林文都，吴璐璐．基层社区突发性传染病疫情防控的标准化探析［J］.中国标准化，2020，63（4）：62-65，69．
［14］张检，何艳玲，唐贵忠．重大传染病疫情社区综合干预：问题与改进［J］.辽宁行政学院学报，2020，22（2）：61-67．
［15］国家卫生健康委员会．2019年我国卫生健康事业发展统计公报［EB/OL］.（2020-06-06）［2020-06-14］．http://www.nhc.gov.cn/guihuaxxs/s10748/202006/ebfe31f24cc145b198dd730603ec4442.shtml.
［16］祝嫦娥，陈昭蓉，周丹丹，等．基层卫生人才队伍建设路径探索［J］.医学与社会，2019，32（9）：24-27，51．
［17］史军有．个体化健康教育在对社区居民进行传染病防控工作中的应用效果分析［J］.当代医药论丛，2018，16（4）：227-228．DOI：10.3969/j.issn.2095-7629.2018.04.167.
［18］彭宗超，钟开斌．非典危机中的民众脆弱性分析［J］.清华大学学报（哲学社会科学版），2003，18（4）：25-31．DOI：10.13613/j.cnki.qhdz.000995.
PENG Z C，ZHONG K B．An analysis of the vulnerabilities of the public with the sars crisis in China［J］．Journal of Tsinghua University（Philosophy and Social Sciences），2003，18（4）：25-31．DOI：10.13613/j.cnki.qhdz.000995.
［19］沈剑峰，黄磊．信息化建设资讯：《全国基层医疗卫生机构信息化建设标准与规范（试行）》解读［J］.中国全科医学，2019，22（25）：3081.
［20］赵家义，沈菲，黄俏雯，等．上海市社区医院对新型冠状病毒肺炎认知调查和防控［J］.解放军医院管理杂志，2020，27（3）：208-212．
ZHAO J Y，SHEN F，HUANG Q W，et al．Awareness investigation and prevention experience of novel coronavirus pneumonia in community hospitals in Shanghai［J］．Hospital Administration Journal of Chinese People's Liberation Army，2020，27（3）：208-212．
［21］俞文雅，王慧．传染性重大疫情下对基层医疗卫生机构职能的思考［J］．上海预防医学，2020.［Epub ahead of print］.DOI：10.19428/j.cnki.sjpm.2020.20125.
YU W Y，WANG H．Thoughts on the function of primary health care institutions in pandemics［J］．Shanghai Journal of Preventive Medicine，2020.［Epub ahead of print］．DOI：10.19428/j.cnki.sjpm.2020.20125.
［22］傅卫，秦江梅，黄二丹，等．新型冠状病毒肺炎疫情下的基层医疗卫生发展策略［J］．中国全科医学，2020，23（10）：1199-1201．DOI：10.12114/j.issn.1007-9572.2020.00.324.
FU W，QIN J M，HUANG E D，et al．Developing strategies for primary healthcare in times of epidemic of COVID-19［J］.Chinese General Practice，2020，23（10）：1199-1201．DOI：10.12114/j.issn.1007-9572.2020.00.324.
［23］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.
LI L．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.
［24］马翠，严兴科．新型冠状病毒肺炎疫情的心理应激反应和防控策略研究进展［J］.吉林大学学报（医学版），2020，46（3）：649-654．DOI：10.13481/j.1671-587x.20200336.

[1]	YU Na, BAI Xiaoling, PANG Jin, NIU Yutian, HU Qing, WANG Yuanfang, YANG Rongze. The Experience of Inhaled COVID-19 Vaccination among First-line Medical Staff in Epidemic Prevention Aged≥18 Years in Guiyang City: a Qualitative Study [J]. Chinese General Practice, 2023, 26(36): 4575-4580.
[2]	WANG Shiyue, DONG Chen, CHANG Chudi, NAN Yuemin. Opportunities and Challenges of Surveillance for Liver Cancer in Primary Care Institutions in China [J]. Chinese General Practice, 2023, 26(36): 4498-4504,4520.
[3]	LU Lixia, WANG Rongqi. Advances in Liver Cancer Screening and Health Surveillance Management in Primary Care Institutions [J]. Chinese General Practice, 2023, 26(36): 4505-4509.
[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]	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.
[6]	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.
[7]	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.
[8]	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.
[9]	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.
[10]	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.
[11]	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.
[12]	YU Dehua. Scientific Research Conception Guided by General Practice Thinking [J]. Chinese General Practice, 2023, 26(31): 3872-3876.
[13]	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.
[14]	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.
[15]	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.