全科医疗模式下血管性认知障碍社区干预的难点及对策

Difficult Point and Countermeasure of Community Intervention on Vascular Cognitive Impairment under General Practice Service Model

脑血管病患病率居于高位,血管性认知障碍(VCI)的患病人数也逐年增高,干预成本巨大,但效果不尽如人意,本文基于全科医学模式下社区服务的实际状况,探讨了血管性认知障碍(VCI)在全科医学模式下社区防治中存在的就诊少、诊断少和早期治疗少的内在因素。社区卫生服务实质是全科医疗服务模式的一种主要表现形式,结合社区医疗服务干预的难点,如存在人员(医务人员和患者及家属)因素、结构(知识结构等)差异、资金投入少和治疗手段落后等诸多困难,提出了建立三级医院-社区服务中心-患者及家庭的干预体系,把慢病管理(防治脑卒中)与血管性认知障碍筛查、药物治疗和康复训练以及临床干预与科研工作"三结合"的对策,做好血管性认知障碍的社区干预工作。

The rate of cerebrovascular diseases occupies the high position, and the patients with vascular cognitive impairment （VCI） increase year by year,the cost for the intervention of those is very high, but the results are not entirely satisfactory. Ac- cording to the actual situation of community service under the general practice service model, this paper will discuss the influence factors for the early diagnosis and treatment of VCI in community hospitals under general practice service model. The essence of community health services is a major manifestation of general practice service model. Combined with the difficulty of community health services, such personnel factors, structure difference, little fund inputting and behindhand therapy means, we propose the three level hospitals-community service center-patients and family intervention system, which band together the chronic disease management（ prevention and treatment of stroke） and VCI screening, together drug treatment and rehabilitation training, and to- gether prevention and treatment and scientific research work, so as to the prevention and control work can be well performed in community.