我国基层慢性病医防融合的多种实践形式与推进障碍

Integration modes of treatment and prevention about chronic diseaseand its implement obstacle in China

破除“医”“防”之间的隔阂,实现医防融合成为慢性病综合防控的关键举措。各典型地区以高血压、糖尿病等慢性病为突破口,推进基层医防融合的实践工作。文章总结了各典型地区的疾控指导+“市—县区—社区”联合体、行政统筹—科室负责—家医履约、整合型慢性病防控小组的三种实践形式,并且认为缺乏全环节整套医防融合政策供给、“医”“防”各方机构职能分散重叠、现行医保支付方式、医防融合运行的绩效评价尚未建立、卫生信息资源联结不足等阻碍了基层慢性病医防融合,在上述基础上进一步提出促进基层慢性病医防融合的相应策略。

Breaking the gap between“medicine”and“prevention”and realizing the integration of medicine and prevention in an all⁃round and full cycle are the key measures for comprehensive prevention and control of chronic diseases(NCDs).Many areas put forward the integration of medicine and prevention in hypertension and diabetes.The study concluded three typical modes which include the alliance of CDC+“city⁃county⁃community”,the mode of administration planning⁃department in charge of⁃family doctor serving,and the integrated groups of NCDs prevention and control.We analyzed obstacles such as lack of whole⁃process policies,overlapping and dispersed institution functions,unreasonable medical insurance payment methods,inadequate performance evaluation system and poor linkages between different information resources.We provided corresponding strategies to improve the integration of medicine and prevention of NCDs in primary health care.