以社区为基础的医养结合策略分析

The strategy of community based integration between elderly care and medical services

目的:对社区卫生服务机构参与医养结合服务的方式、所需资源及保障条件等可行策略进行归纳分析。方法:选取东、中、西部地区已开展医养结合服务且具有代表性的上海、武汉和重庆三地6家社区卫生服务机构进行现场调查和焦点组访谈,定性资料采取主题框架分析法。结果:社区卫生服务机构参与医养结合应以家庭医生签约服务为依托,借助信息化手段,以服务协作等方式不同程度参与;所需资源以人力资源、资金投入、设备和信息化建设为主;需要政策支持、多部门协作、支付制度、第三方参与等多重保障条件。结论:社区卫生服务机构是医养结合服务的重要平台,应充分依托家庭医生签约服务的开展,在不同形式下与养老资源进行协作融合;国家层面需做好顶层设计和相应标准,提高统筹层次。

Objective:This paper summarizes and analyzes the feasible strategies, required resources and guarantee mechanisms of the participation of community health service centers in providing the elderly care services. Methods:This paper selects Shanghai in the eastern area, Wuhan in the central area, and Chongqing in the western area which have already carried out the integration of elderly care and medical services as the sample. Focus group discussion and the matic framework analysis are used during the data collection and analysis.Results: Community health institutions rely on family doctor contracting services to participate in the integration of elderly care and medical services, and use information system, service coordination and other forms of different participation degree. The requiredresources mainly include qualified human resources, capital investment, equipment, and information infrastructure. At the same time, multiple support mechanisms such as policy support, multi-department cooperation, payment mechanism and third-party participationarealso important and necessary for the further integrationof elderly care and medical services.Conclusions: Relying on the family doctor contracting services, community health institutions are regarded as the important platform for providing an integrated healthcare of both elderly care and medical services. However, top-level design, corresponding standards and different kinds of support arealso needed to promote the integration.