从体医融合理念到服务模式具体化:国际运动转诊经验及其启示

From the Concept of Physical-Medical Integration to the Concretization of a Service Model:The International Exercise Referral Experience and Its Implications

在医疗卫生系统中设计和实施运动转诊服务正成为公共卫生优先事项。已有国家在不断试错和互鉴中开发了18种运动转诊模式,43个国家实施了运动转诊服务。系统分析运动转诊计划、身体活动处方、绿色处方、运动是良医、国家运动转诊计划等成熟案例,发现国外将运动转诊作为一项全民享有的医疗卫生服务,由健康事权部门领导多部门协作,共同制定国家标准和技术规范,建立了全教育周期的人才培养和职业资格认证体系,开展了长周期监督和多维度评价。我国现有33种体医融合服务模式是地方政府为落实健康中国战略的重要举措,国家层面构建运动转诊服务需要:1)依托现有医疗卫生系统的基础设施和服务体系设置运动转诊,并将其纳入医疗卫生服务体系;2)建立、健全相关政策保障、国家标准、人才培养、监督与评价体系;3)识别政策障碍,进行全人群、全护理环境、全区域、全疾病谱试点;4)推广并更新迭代运动转诊服务,实现循证运动干预措施向人口健康成果转化。

The design and implementation of exercise referral services in health systems is becoming a public health priority.18 exercise referral models have been established in selected countries,and in 43 countries have implemented the service.By analyzing the successful cases such as the Exercise Referral Scheme,Physical Activity Prescription,Green Prescription,Exercise is Medicine and the National Exercise Referral Scheme,we found that various countries have designated exercise referral as a healthcare service for all people.The health authority has led a cross-sectoral collaboration to formulate the national standards and technical specifications,established a system for training talents in the whole education cycle and professional qualifications,and carried out long-term monitoring and multidimensional evaluations.In China,the existing 33 models of integrating sports and medicine are concrete actions taken by local governments to implement the Healthy China strategy,the establishment of exercise referral services at the national level requires:1)Setting up exercise referrals by leveraging the infrastructure and service system of existing healthcare institutions and integrating them into the healthcare service system;2)establishing and improving the relevant policies,national standards,talent training,supervision and evaluation systems;3)identifying policy barriers and conduct whole-population,whole-care setting,wholeregion and whole-spectrum-of-disease pilot works;4)promoting and updating iterative exercise referral services to achieve the translation of evidence-based exercise interventions into population health outcomes.