医联体背景下的基层慢性病医防融合模式构建及应用探讨

Discussion on the Construction and Application of the Integrated Mode of Medical Treatment and Prevention of Chronic Diseases at the Grassroots Level under the Background of Medical Alliance

医联体改革是引导优质医疗资源有效下沉的重要举措,是推动建立合理有序分级诊疗模式的重要内容。本文以三甲医院与社区卫生服务中心合作成立医联体为背景,积极探索高血压、糖尿病等慢性病的“防、治、管”一体化管理路径,以提高家庭服务签约率、提升基层卫生服务能力、增强居民健康管理依从性为目标,通过组建医防融合基本单元、整合大数据库资源、理顺组织架构、提升基层服务能力、建立联动机制等综合举措,构建医联体背景下的基层慢性病医防融合模式并应用到社区居民的健康管理中,有效推动了社区卫生服务中心的发展,提高了基层服务能力,增强了社区居民的健康意识及健康管理依从性,使医联体的优势得以体现,基层健康守门员的作用充分发挥,居民的就医体验感明显增强。

The reform of medical alliance is an important measure to guide the effective sinking of high-quality medical resources,and an important part of promoting the establishment of a reasonable and orderly hierarchical diagnosis and treatment model.Based on the background of the establishment of a medical consortium in cooperation between a tertiary hospital and a community health service center,this paper actively explores the integrated management path of"prevention,treatment and management"of chronic diseases such as hypertension and diabetes.The goal is to increase the rate of family service contracts,improve the capacity of grass-roots health services,and enhance residents'compliance with health management.Through the establishment of the basic unit of medical and prevention integration,the integration of large database resources,the rationalization of the organizational structure,and the improvement of grass-roots service capabilities.Establish comprehensive measures such as linkage mechanism,build a grassroots chronic disease medical prevention integration model under the background of medical alliance,and apply it to the health management of community residents.It has effectively promoted the development of community health service centers and improved grass-roots service capabilities.It enhances the health awareness and health management compliance of community residents,so that the advantages of the medical alliance can be reflected.The role of grassroots health gatekeepers has been brought into full play,and residents'medical experience has been significantly enhanced.