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                                當前位置: 首頁 > 政民互動 > 政務訪談 > 內容

                                我市百姓將有自己的家庭醫生

                                ——訪唐山市衛健委基層衛生健康處處長任永軍

                                發布時間:2019-06-12 16:07:20

                                我市家庭醫生簽約服務活動將于近日啟動,就相關政策及群眾關心的重點問題,唐山市人民政府網站“政務訪談”欄目組專門走訪了衛健委基層衛生健康處處長任永軍同志,以下為訪談內容。

                                主持人:何謂家庭醫生簽約服務?國家基本公共衛生服務項目包括哪些內容?

                                任永軍:家庭醫生簽約服務是轉變基層醫療衛生服務模式的制度性創新,由家庭醫生代表服務團隊與簽約居民簽訂服務協議,明確雙方權利、義務和責任,建立長期、穩定、信任的契約服務關系,向簽約居民提供綜合、連續、協同的基本醫療衛生服務和健康管理服務。家庭醫生簽約服務涵蓋了國家基本公共衛生服務項目。

                                目前,國家基本公共衛生服務項目包括14類內容,即:城鄉居民健康檔案管理服務、健康教育服務、預防接種服務、0至6歲兒童健康管理服務、孕產婦健康管理服務、老年人健康管理服務、高血壓患者健康管理服務、2型糖尿病患者健康管理服務、重性精神疾病患者管理服務、傳染病及突發公共衛生事件報告和處理服務、衛生監督協管服務、中醫藥健康管理服務、免費提供避孕藥具、健康素養促進行動。

                                主持人:什么是居民健康檔案?建立健康檔案有什么好處?家庭醫生可以給簽約居民帶來哪些優惠便利?

                                任永軍:居民健康檔案是居民健康狀況的資料庫,記錄著居民的疾病家庭史、藥物過敏史、遺傳史和生活方式等狀況。從居民出生開始,記錄著新生兒、嬰幼兒、學齡前期的生長發育、健康狀況與預防保健管理信息;婦女人生各期,特別是妊娠期的健康管理信息;老年人健康管理與各時期患病時的醫療保健信息等。總之,健康檔案應是陪伴居民終生、全面、綜合、連續性的健康資料,它詳實、完整地記錄了居民一生各個階段的健康狀況及預防、醫療、保健、康復信息。一份完整而系統的健康檔案,可以讓居民掌握本人健康狀況;有助于醫務人員快速、準確地確診、制定治療方案、減少重復檢查,降低費用;有助于基層醫療機構準確、全面地了解轄區內個人、家庭、社區的健康問題、危險因素等,有針對性地做好健康指導、預防群體性疾病發生。

                                家庭醫生可以給簽約居民帶來就醫、轉診、用藥及醫保方面的優惠便利。就醫:家庭醫生團隊將主動完善服務模式,按照協議為簽約居民提供全程服務、上門服務、錯時服務、預約服務等多種形式的服務。轉診:家庭醫生團隊將擁有一定比例的醫院專家號、預約掛號、預留床位等資源,方便簽約居民優先就診和住院。二級以上醫院的全科醫學科或指定科室會對接家庭醫生轉診服務,為轉診患者建立綠色轉診通道。用藥:對于簽約的慢性病患者,家庭醫生可以酌情延長單次配藥量,減少病人往返開藥的頻次。對于下轉病人,可根據病情和上級醫療機構醫囑按規定開具藥物。醫保:對簽約居民實行差異化的醫保支付政策,符合規定的轉診住院患者可以連續計算起付線等,簽約居民在基層就診會得到更高比例的醫保報銷,從而增強居民利用簽約服務的意愿。

                                主持人:家庭醫生簽約服務的主要內容有哪些?其職責如何定位?

                                任永軍:家庭醫生團隊為居民提供基本醫療、公共衛生和約定的健康管理服務。基本醫療服務涵蓋常見病和多發病的中西醫診治、合理用藥、就醫路徑指導和轉診預約等。公共衛生服務涵蓋國家基本公共衛生服務項目和規定的其他公共衛生服務。各地應當根據服務能力和需求,設定包含基本醫療和公共衛生服務在內的基礎性簽約服務內容,向所有簽約居民提供。健康管理服務主要是針對居民健康狀況和需求,制定不同類型的個性化簽約服務內容,可包括健康評估、康復指導、家庭病床服務、家庭護理、中醫藥“治未病”服務、遠程健康監測等。

                                家庭醫生是簽約服務的第一責任人。家庭醫生團隊負責向簽約居民提供簽約服務。基層醫療衛生機構是簽約服務的責任主體,負責團隊組建、任務分配和績效考核。區域內二級以上醫院和專業公共衛生機構負責為家庭醫生團隊提供技術和資源支持。縣級衛生健康行政部門負責組織協調、搭建平臺和監督管理。

                                主持人:現階段家庭醫生簽約服務的重點是什么?

                                任永軍:一是優先向農村建檔立卡貧困人口,尤其是優先向建檔立卡貧困人口中的慢病患者提供服務,全面落實健康扶貧“三個一批”中的“慢病簽約管理一批”目標任務,做到建檔立卡貧困人口簽約服務全覆蓋,貧困人口慢病患者“應簽盡簽”。二是優先向老年人、孕產婦、兒童、高血壓、糖尿病、結核病等慢病疾病和嚴重精神障礙患者等重點人群提供服務。三是優先向殘疾人、計劃生育特殊家庭等特殊群體提供服務。

                                主持人:什么是貧困人口家庭醫生簽約分級負責制度?

                                任永軍:明確各級衛生健康行政部門和醫療機構家庭醫生簽約服務工作職責,實現全省貧困人口家庭醫生簽約履約服務全覆蓋,確保簽約一人,履約一人,做實一人。縣級衛生健康局領導干部包聯鄉鎮(街道),主要負責分包鄉鎮(街道)家庭醫生簽約履約服務職責、任務落實情況的督導檢查工作;鄉鎮衛生院(社區衛生服務中心)干部職工包聯村(居),主要負責分包村(居)的家庭醫生簽約履約服務職責、任務落實情況的督導檢查工作,及時發現并報告未按規定簽約履約情況;村醫(社區衛生服務站醫生)或村衛生計生專干包聯到戶,要及時掌握簽約居民的實際情況和服務需求,幫助貧困人口完成簽約工作,協助簽約團隊做好履約服務。

                                縣、鄉、村三級按年逐級簽訂家庭醫生簽約工作承諾書,村衛生室(社區服務站)與鄉鎮衛生院(社區衛生服務中心)簽訂承諾書、鄉鎮衛生院(社區衛生服務中心)與縣級衛生健康局簽訂承諾書。對各級履職盡責情況實行臺賬式管理,市、縣、鄉三級應對照年度工作任務建立年度目標任務臺賬,詳細記錄工作目標、主要任務、完成時限、責任人等信息;建立年度工作職責臺賬,記錄各級工作職責、負責人和履職情況等信息。

                                主持人:家庭醫生簽約方式有哪些?家庭醫生服務團隊如何組建?如何規范簽約服務?

                                任永軍:家庭醫生簽約方式主要包括集中簽約、診間簽約、上門簽約、手機客戶端簽約、互聯網信息化簽約。

                                家庭醫生服務團隊主要由家庭醫生、護士、公共衛生醫師(含助理公共衛生醫師)等組成。農村地區可暫采取“3+X”簽約服務模式,即由鄉鎮衛生院執業醫師、公衛人員、護理人員和若干村醫組成。我市鼓勵藥師、健康管理師、心理咨詢師、社(義)工等加入簽約服務團隊,發揮鄉鎮(街道)衛生計生專干、殘疾人專職委員等在簽約服務中的作用。要在鄉鎮衛生院、社區衛生服務中心、村衛生室、社區服務站顯著位置公示簽約服務團隊成員的姓名、分工、服務時間、聯系方式等內容,方便群眾了解簽約服務信息,主動接受監督。

                                規范簽約服務方面,簽約服務以個人為簽約對象,一個居民簽約一個家庭醫生團隊。雙方簽定服務協議,明確簽約服務內容、方式、期限和留存方式。

                                簽約服務手冊一式三份(或三聯單式),分別由鄉鎮衛生院(社區服務中心)、村衛生室(社區服務站)、簽約居民保管。協議書必須三方留存,不得將協議書集中留存在任意一方。鄉鎮衛生院(社區服務中心)、村衛生室(社區服務站)的簽約服務手冊按編號順序分類在檔案盒中存放,以便整理和查詢。簽約服務手冊上要有居民簽約編號,簽約協議書填寫內容必須完整,不能留有空項,填寫要保證字跡清晰。

                                簽約居民因不識字或肢體殘疾、視力殘疾不能簽字的,應當面向其宣讀或講解協議內容;0至6歲兒童、精神殘疾、智力殘疾的,應向監護人講解協議內容,乙方簽字可由監護人代簽(注明代簽及代簽原因),聯系電話填寫監護人電話。

                                對老年人或疾病等原因,不能到醫療機構簽約的,簽約團隊要主動上門簽約;對于常年外出打工的,要主動電話聯系,按照個人意愿簽約,可由留守家屬代為簽字,聯系方式可填寫留守家屬電話。

                                主持人:如何規范做好轉診服務?

                                任永軍:加強家庭醫生與二級以上醫院專科醫生的緊密聯系,對確需轉診的患者及時予以轉診或提供就醫路徑指導。二級以上醫院要指定專人負責對接,為轉診患者建立綠色通道。要通過信息化手段豐富家庭醫生上轉患者可選擇渠道,賦予家庭醫生一定比例的醫院專家號、預留床位等資源。

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