基于基层医疗卫生需求的高职临床医学专业人才培养途径的研究

现阶段,在缺医少药的农村地区开展社区卫生服务,以乡村医生为主体的农村社区无法满足农村社区卫生服务的需要。随着人们经济条件的改善,对健康的要求已不仅仅满足于身体无病,而要求有较高的生活质量,对卫生保健的需求日益提高。对山东部分地区基层百姓进行走访及问卷调查结果,目前尤其以青少年为代表性小病大病都是以去省市级医院诊治为主。达不到首诊(指的是除了危急患者、急诊患者、手术病人复诊患者和其他特殊情况外,居民在首次就医时,原则上应在当地医疗机构首诊)、常见病、多发病和慢性病人以在基层医疗机构诊疗为主,疑难重症、急危重病在大医院治疗,康复期的病人回基层医疗机构诊疗的基本要求。原因分析有三:(一)对基层医疗工作者的不信任和不认可;(二)基层医院、社区门诊医疗设备有限,对疾病的诊疗有一定受限性;(三)不清楚新的医保政策规定。本课题通过对高职高专临床医学生人才培养方案的修订,课程体系改革等,以能够"下得去、用得上、留得住"为准则面向基层医疗人才方面进行突破。对解决实行社区首诊的同时,各级医院之间也建立相应的转诊制度,这样能减轻二、三级医院的负担,也避免了高级医院专科医生治疗"小病"的尴尬。

At the present stage, it is necessary to carry out community health service in underserved rural areas and rural community, dominated by rural doctors, can not meet the needs of health service in rural community. With the improvement of people＇s economic conditions, people＇s requirement of health is not only limited to free from illness, but also a higher quality of life with increasingly higher requirements to health care. Visit and questionnaire to some grassroots citizens in Shandong Province show that most people, especially adolescents, will go to provincial and municipal hospitals if they get sick. They fail to meet the requirement that people in first diagnosis （it refers to that citizens should go to local medical institutions when they go to see the doctor for the first time, except emergent patients, re-visiting patients and other special situation） and with common disease, frequently-oc- curring disease and chronic disease should be treated in grassroots medical institutions, people with difficult and complicated disease and in emergency situation go to big hospitals and patients in recovery go back to grassroots medical institutions. There are three reasons：（ I ）patients do not trust or recognize health workers in grassroots levels; （II）there are not many medical devices in grassroots hospitals nosing and treating patients;（III）patients do not know the new tivation plan revision of clinical medicine students in higher and community clinics, resulting in limitations in diaghealth insurance policies and regulations. Through culvocational colleges and curriculum system reform, this paper makes breakthrough in grassroots medical workers who are willing to go and stay in grassroots levets and can give play to their skills. When implementing first diagnosis in community hospitals, hospitals in various levels should also build corresponding transfer system, which can release heavy burden on secondary and tertiary hospitals. It is also an effective way to avoid awkward situation in which specialist doctors in senior hospitals treat minor illness.