中国老龄化社会阶段家庭医生制度的实施现状
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摘要
随着全科医学的兴起和人口老龄化程度的不断加重,以社区服务为中心的家庭医生服务模式迅速兴起。家庭医生制度在美国已经有几十年的历史,虽然中国起步较晚,但是其在中国也在迅猛发展,其实施和探索的过程也反映出中国普通群众对于社区医疗服务需求的不断增加。家庭医生制度的发展并不是一帆风顺,其在中国面临着很多的瓶颈,不仅严重制约着家庭医生制度的发展,而且严重影响了社区居民的生活质量和就医的便捷程度。本文旨在探讨,家庭医生制度在中国的实施进展过程以及其发展所面临的问题和瓶颈,为以后家庭医生制度的完善和医疗改革出谋划策。
With the rise of general practice medicine and the increasing aging of the population,the family doctor service model centered on community service has risen rapidly. The system has already had the history for decades in the United States. Although it turns up late in China,it is developed rapidly. The process of its implementation and exploration reflects the increasing demand for community medical services from the general public in China. The development of family doctor system has not been going smoothly. It faces various bottlenecks in China,which not only seriously restricts the development of the system,but also seriously affects the life quality of community residents and the convenience of medical treatment. This article aims to explore the progress of the family doctor system in China as well as the problems and bottlenecks in its development so as to provide suggestions for the improvement of the family doctor system and health care reform in the future.
With the rise of general practice medicine and the increasing aging of the population,the family doctor service model centered on community service has risen rapidly. The system has already had the history for decades in the United States. Although it turns up late in China,it is developed rapidly. The process of its implementation and exploration reflects the increasing demand for community medical services from the general public in China. The development of family doctor system has not been going smoothly. It faces various bottlenecks in China,which not only seriously restricts the development of the system,but also seriously affects the life quality of community residents and the convenience of medical treatment. This article aims to explore the progress of the family doctor system in China as well as the problems and bottlenecks in its development so as to provide suggestions for the improvement of the family doctor system and health care reform in the future.
引文
1张玮.开展家庭医生制服务的可行性分析与对策研究.中国全科医学,2011,14:2136-2138.
2 Yakubu K,Hoedebecke K,Nashat N. Young Doctor Movements:motives for membership among aspiring and young family physicians. J Family Med Prim Care,2015,4:177-181.
3 袁立,周昌明,江萍,等.上海市“长宁模式”下的家庭医生工作现状和职业满意度调查研究.中国全科医学,2014,17:3391-3394.
4 Lam R,Lee L,Tazkarji B,et al. Five-weekend care of the elderly certificate course:continuing professional development activity for family physicians. Can Fam Physician,2015,61:e135-141.
5 范翠萍,孙树学,龚勋,等.三试点城市社区卫生服务机构医务人员的满意度及稳定性分析.中国全科医学,2010,13:3479-3499.
6 Klee D,Covey C,Zhong L. Social media beliefs and usage among family medicine residents and practicing family physicians. Fam Med,2015,47:222-226.
7 王增武,王馨,张林峰,等.社区高血压控制:血压管理效果的评价.中华流行病学杂志,2010,31:1-4.
8 陈伟伟,朱曼路,何新叶,等.发挥健康体检在功能社区高血压防治中的作用.中华健康管理学杂志,2010,4:1-3.
9 Zarif Sanaiey N,Karamnejad S,Rezaee R. Educational needs of family physicians in the domains of health and conformity with continuing education in Fasa University of Medical Sciences. J Adv Med Educ Prof,2015,3:84-89.
10 陈忠伟,陈昭斌,严璐,等.社区高血压管理效果评估研究.现代预防医学,2008,35:3316-3317.
11 Crooks VA,Li N,Snyder J,et al.“You don't want to lose that trust that you've built with this patient…”:(Dis)trust,medical tourism,and the Canadian family physician-patient relationship. BMC Fam Pract,2015,16:25.
12 李永新,薛晓斌,罗小青,等.广州市某社区高血压患者自我管理效果评价.当代医学,2011,17:19-22.
13 Klee D,Covey C,Zhong L. Social media beliefs and usage among family medicine residents and practicing family physicians. Fam Med,2015,47:222-226.
14 张丽,霍敏俐,谢延,等.家庭医生在社区老年人慢性病防治中的效果分析.中国慢性病预防与控制杂志,2015,23:159-161.
15 Badran H,Pluye P,Grad R. Advantages and disadvantages of educational email alerts for family physicians:viewpoint. J Med Internet Res,2015,17:e49.
16 高喜莲,田军,曹丽莎,等.社区高血压病例规范化管理的效果分析.实用心脑肺血管病杂志,2010,18:44.
17 王甦平,周鑫,龚睿婕,等.家庭医生医护团队模式对社区高血压控制效果分析.中华全科医学,2015,13:244-246.
18 张冠荣,林爱华,骆福添.广州市社区中老年居民高血压相关知识及防治状况调查.广东医学,2011,32:233-236.
19 Young SM,Bansal P,Vella ET,et al. Guideline for referral of patients with suspected prostate cancer by family physicians and other primary care providers. Can Fam Physician,2015,61:33-39.
20 Reyniers T,Houttekier D,Pasman HR,et al. The family physician's perceived role in preventing and guiding hospital admissions at the end of life:a focus group study. Ann Fam Med,2014,12:441-446.
21 徐崇凯,季建隆,曹静.以社区健康服务中心为主体的高血压病管理模式的探索.中华全科医学,2010,13:86-88.
22 Peterson LE,Cochrane A,Bazemore A,et al. Only one third of family physicians can estimate their patient panel size. J Am Board Fam Med,2015,28:173-174.
23 Khayatzadeh-Mahani A,Takian A. Family physician program in Iran:considerations for adapting the policy in urban settings. Arch Iran Med,2014,17:776-778.
24 常永智,王少彬.家庭医生签约服务在实施老年高血压患者社区护理管理中的应用.中国医药导报,2014,11:98-100.
25 Klemenc-Keti Z,Peterlin B. Family physicians'management of genetic aspects of a cardiac disease:a scenario-based study from slovenia.Balkan J Med Genet,2014,17:15-22.
26 王永幸,朱燕文,何佳.高血压患者社区综合防治路径研究.中华全科医学,2011,14:2290-2293.
27 Brali8 Lang V,Bergman Markovi8 B,Kranj8evi8 K. Family physician clinical inertia in glycemic control among patients with type 2 diabetes.Med Sci Monit,2015,21:403-411.
28 董玉明,杜雪平,董建琴.北京月坛社区试行家庭医生“首诊制”可行性调查.中国全科医学,2009,12:763.
29 Thomas RE,Kreptul D. Systematic review of evidence-based medicine tests for family physician residents. Fam Med,2015,47:101-117.
30 董建琴,杜雪平,钱宁.北京市月坛社区家庭医生服务的居民基本情况评价.中国全科医学,2006,9:253-255.
31 Peytremann-Bridevaux I,Ebert ST,Senn N. Involvement of family physicians in structured programs for chronic diseases or multi-morbidity in Switzerland. Eur J Intern Med,2015,26:150-151.
32 罗红艳,陈硕,王伟,等.青羊区家庭医生服务效果的探索与实践.中国卫生事业管理,2011,9:653-655.
33 史超,陈良,袁艳,等.社区家庭医生糖尿病链式分层管理的血糖控制情况及其影响因素分析.山东医药,2015,55:60-63.
34 张学标,莫希兰,高福群,等.家庭医生服务团队对社区糖尿病41例健康教育效果分析.社区医学杂志,2010,8:66-67.
35 Friemoth J. The health consequences of adverse childhood experiences:role of the family physician. Am Fam Physician,2014,90:822-824.
36 鲍勇,杜学礼,张安,等.基于健康管理的中国家庭医生制度研究.中华全科医学,2011,9:997-999.
37 Dahrouge S,Muldoon L,Ward N,et al. Roles of nurse practitioners and family physicians in community health centres. Can Fam Physician,2014,60:1020-1027.
38 杨德华,汪文新,柴云,等.成都市综合社区卫生发展模式推广可行性探讨.中国卫生事业管理,2010,3:157-159.
2 Yakubu K,Hoedebecke K,Nashat N. Young Doctor Movements:motives for membership among aspiring and young family physicians. J Family Med Prim Care,2015,4:177-181.
3 袁立,周昌明,江萍,等.上海市“长宁模式”下的家庭医生工作现状和职业满意度调查研究.中国全科医学,2014,17:3391-3394.
4 Lam R,Lee L,Tazkarji B,et al. Five-weekend care of the elderly certificate course:continuing professional development activity for family physicians. Can Fam Physician,2015,61:e135-141.
5 范翠萍,孙树学,龚勋,等.三试点城市社区卫生服务机构医务人员的满意度及稳定性分析.中国全科医学,2010,13:3479-3499.
6 Klee D,Covey C,Zhong L. Social media beliefs and usage among family medicine residents and practicing family physicians. Fam Med,2015,47:222-226.
7 王增武,王馨,张林峰,等.社区高血压控制:血压管理效果的评价.中华流行病学杂志,2010,31:1-4.
8 陈伟伟,朱曼路,何新叶,等.发挥健康体检在功能社区高血压防治中的作用.中华健康管理学杂志,2010,4:1-3.
9 Zarif Sanaiey N,Karamnejad S,Rezaee R. Educational needs of family physicians in the domains of health and conformity with continuing education in Fasa University of Medical Sciences. J Adv Med Educ Prof,2015,3:84-89.
10 陈忠伟,陈昭斌,严璐,等.社区高血压管理效果评估研究.现代预防医学,2008,35:3316-3317.
11 Crooks VA,Li N,Snyder J,et al.“You don't want to lose that trust that you've built with this patient…”:(Dis)trust,medical tourism,and the Canadian family physician-patient relationship. BMC Fam Pract,2015,16:25.
12 李永新,薛晓斌,罗小青,等.广州市某社区高血压患者自我管理效果评价.当代医学,2011,17:19-22.
13 Klee D,Covey C,Zhong L. Social media beliefs and usage among family medicine residents and practicing family physicians. Fam Med,2015,47:222-226.
14 张丽,霍敏俐,谢延,等.家庭医生在社区老年人慢性病防治中的效果分析.中国慢性病预防与控制杂志,2015,23:159-161.
15 Badran H,Pluye P,Grad R. Advantages and disadvantages of educational email alerts for family physicians:viewpoint. J Med Internet Res,2015,17:e49.
16 高喜莲,田军,曹丽莎,等.社区高血压病例规范化管理的效果分析.实用心脑肺血管病杂志,2010,18:44.
17 王甦平,周鑫,龚睿婕,等.家庭医生医护团队模式对社区高血压控制效果分析.中华全科医学,2015,13:244-246.
18 张冠荣,林爱华,骆福添.广州市社区中老年居民高血压相关知识及防治状况调查.广东医学,2011,32:233-236.
19 Young SM,Bansal P,Vella ET,et al. Guideline for referral of patients with suspected prostate cancer by family physicians and other primary care providers. Can Fam Physician,2015,61:33-39.
20 Reyniers T,Houttekier D,Pasman HR,et al. The family physician's perceived role in preventing and guiding hospital admissions at the end of life:a focus group study. Ann Fam Med,2014,12:441-446.
21 徐崇凯,季建隆,曹静.以社区健康服务中心为主体的高血压病管理模式的探索.中华全科医学,2010,13:86-88.
22 Peterson LE,Cochrane A,Bazemore A,et al. Only one third of family physicians can estimate their patient panel size. J Am Board Fam Med,2015,28:173-174.
23 Khayatzadeh-Mahani A,Takian A. Family physician program in Iran:considerations for adapting the policy in urban settings. Arch Iran Med,2014,17:776-778.
24 常永智,王少彬.家庭医生签约服务在实施老年高血压患者社区护理管理中的应用.中国医药导报,2014,11:98-100.
25 Klemenc-Keti Z,Peterlin B. Family physicians'management of genetic aspects of a cardiac disease:a scenario-based study from slovenia.Balkan J Med Genet,2014,17:15-22.
26 王永幸,朱燕文,何佳.高血压患者社区综合防治路径研究.中华全科医学,2011,14:2290-2293.
27 Brali8 Lang V,Bergman Markovi8 B,Kranj8evi8 K. Family physician clinical inertia in glycemic control among patients with type 2 diabetes.Med Sci Monit,2015,21:403-411.
28 董玉明,杜雪平,董建琴.北京月坛社区试行家庭医生“首诊制”可行性调查.中国全科医学,2009,12:763.
29 Thomas RE,Kreptul D. Systematic review of evidence-based medicine tests for family physician residents. Fam Med,2015,47:101-117.
30 董建琴,杜雪平,钱宁.北京市月坛社区家庭医生服务的居民基本情况评价.中国全科医学,2006,9:253-255.
31 Peytremann-Bridevaux I,Ebert ST,Senn N. Involvement of family physicians in structured programs for chronic diseases or multi-morbidity in Switzerland. Eur J Intern Med,2015,26:150-151.
32 罗红艳,陈硕,王伟,等.青羊区家庭医生服务效果的探索与实践.中国卫生事业管理,2011,9:653-655.
33 史超,陈良,袁艳,等.社区家庭医生糖尿病链式分层管理的血糖控制情况及其影响因素分析.山东医药,2015,55:60-63.
34 张学标,莫希兰,高福群,等.家庭医生服务团队对社区糖尿病41例健康教育效果分析.社区医学杂志,2010,8:66-67.
35 Friemoth J. The health consequences of adverse childhood experiences:role of the family physician. Am Fam Physician,2014,90:822-824.
36 鲍勇,杜学礼,张安,等.基于健康管理的中国家庭医生制度研究.中华全科医学,2011,9:997-999.
37 Dahrouge S,Muldoon L,Ward N,et al. Roles of nurse practitioners and family physicians in community health centres. Can Fam Physician,2014,60:1020-1027.
38 杨德华,汪文新,柴云,等.成都市综合社区卫生发展模式推广可行性探讨.中国卫生事业管理,2010,3:157-159.