以家庭医生为核心“1+1+1”医疗机构组合签约服务的实践与思考

Practice and Consideration of"1+1+1"Medical Institutions Cmtraot Service with Family Doctor as the Core

目的了解上海市实行以家庭医生为核心的"1+1+1"医疗机构组合签约服务工作进展情况,即"家庭医生制度2.0版",找出实施过程中存在的问题并提出意见和建议。方法针对"家庭医生制度1.0版"存在签约居民对家庭医生接受度不高、签约履约率低、居民无序诊疗和医疗费用逐年上涨等突出问题,上海市启动了以家庭医生为核心的"1+1+1"医疗机构组合签约工作,通过3家医疗机构组合签约、市级平台优先转诊;提供长处方和延伸处方的便捷用药服务等举措,努力尝试解决1.0版存在的问题。结果上海市243家社区卫生服务中心均开展"1+1+1"医疗机构组合签约工作。截止2018年底,医疗机构组合签约人数已超过666万人,已签约居民中77.09%在签约的3家医疗机构内就诊,在签约社区卫生服务中心就诊率达到了57.77%左右,"家庭医生制度2.0版"对分级诊疗的落实和医疗服务下沉社区起到积极的推动作用。结论上海市"家庭医生制度2.0版"实施3年多来,重点人群签约覆盖率得到了有效的提升,有序诊疗正在不断改善,分级诊疗制度逐步在实施中;延伸处方优惠政策凸显,医疗服务逐渐下沉社区。但是医疗费用仍然持续增长,后续需要家庭医生加大对签约居民医疗费用的管理。

OBJECTIVE To understand the progress of the implementation of“1+1+1”combined contracting service in Shanghai,i.e.the"Family Doctor System Version 2.0",with family doctors as the core,find out the problems existing in the implementation process and put forward suggestions and suggestions.METHODS In view of the prominent problems existing in the 1.0 edition of the family doctor system,such as the low acceptance of family doctor by contracted residents,the low rate of contract implementation,the disor⁃dered diagnosis and treatment of residents and the rising medical costs,Shanghai has launched the“1+1+1”combination of medical institutions with family doctor as the core,which provides long prescriptions and extended prescriptions through the combination of three medical institutions and preferred referral on the municipal platform.Some measures,such as convenient drug use service,are managed to solve the problems of version 1.0.RESULTS All 243 community health service centers in Shanghai carry out“1+1+1”medical institution combination contract signing.By the end of 2018,the number of contracted medical institutions has exceeded 6.66 million.77.09%of the contracted residents are in 3 contracted medical institutions.The rate of visiting the contracted community health service centers has reached to 57.77%.The 2.0 edition of the family doctor system has played a positive role in promoting the implementation of graded diagnosis and treatment and the sinking of medical services in the community.CONCLUSION With the im⁃plementation of Shanghai Family Doctor System Version 2.0 for more than three years,the contract coverage of key groups has been ef⁃fectively improved,orderly diagnosis and treatment is constantly improving,the graded diagnosis and treatment system is gradually be⁃ing implemented,the extended prescription preferential policy is highlighted,and the medical service is gradually sinking in the com⁃munity.However,medical costs continue to grow,and family doctors need to increase the cost management of contracted residents in the follow-up.