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对当前社区卫生改革 现状的若干思考 赴英全科培训所得

对当前社区卫生改革 现状的若干思考 赴英全科培训所得. 徐绮 沪东社区卫生服务中心. Framework of NHS （英国国民健康体系）. National Health Service started in 1948 Free at point of delivery Finance rooted in taxation Current budget more than 850 billion pound per year Hugely important in UK culture & politics. Framework of NHS.

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对当前社区卫生改革 现状的若干思考 赴英全科培训所得

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  1. 对当前社区卫生改革现状的若干思考赴英全科培训所得对当前社区卫生改革现状的若干思考赴英全科培训所得 徐绮 沪东社区卫生服务中心

  2. Framework of NHS（英国国民健康体系） National Health Service started in 1948 Free at point of delivery Finance rooted in taxation Current budget more than 850 billion pound per year Hugely important in UK culture & politics

  3. Framework of NHS NHS Structure National Government Department of Health Strategic Health Authority(10) PCT’s(150)(初级卫生保健机构）

  4. PCT’s

  5. 思索 • 加大政府投入 英国 上海 人口 6千万 2千3百万 医疗投入 850万英镑 112万人民币（61.8万） 比例 34.4%（18.7%）

  6. 思索 • 多部门参与 避免社区卫生服务中心的“百搭”现状，重点投放于基础医疗和卫生保健。 着重社区管理。

  7. QOF(Quality and Outcome Framework) Started in 2004 17 different quality targets, 2 unhealthy lifestyle & learning disabilities GPs given very specific tasks for these patients

  8. QOF for example- Diabetes • the practice can produce a register of patients with type1 or 2 diabetes (6 pts) • with BMI in last 15M (40-90%, 3 pts) • with HbA1c in last 15M (40-90%, 3 pts) • with last HbA1c <=7% (40-50%, 17 pts) • with last HbA1c <=8% (40-70%, 8 pts) • with last HbA1c <=9% (40-90%, 10 pts)

  9. QOF for example- Diabetes • with retinal screening in last 15M (40-90%, 5 pts) • with peripheral pulses in last 15M (40-90%, 3 pts) • with neuropathy testing in last 15M (40-90%, 3 pts) • with BP in last 15M (40-90%, 3 pts) • with eGFR in last 15M (40-90%, 3 pts)

  10. QOF for example- Diabetes • with Proteinuria or microalbuminuria in last 15M (40-80%, 3 pts) • with cholesterol in last 15M (40-90%, 3 pts) • with cholesterol in last 15M <=5mmol/L (40-70%, 6 pts) • with influenza vaccination in last 7M (40-85%, 3 pts)

  11. Teams relationship Primary Care Trust employed（初级卫生保健机构雇用） • District nurse（地区护士） • Health Visitors （健康防视者）

  12. Teams relationship GP practices employed • Doctors/GP （全科医生） • Nurses(Health care assistant, Practice nurse)（卫生保健护士、执行护士） • Staff(Receptionists, admin staff)（接待员、行政人员） • Manager（经理）

  13. Function of different member in GP clinic Duty of GP-clinic target CHD/Health failure/Atrial fibrillation/ Stroke/Hypertension/Diabetes/ Asthma/COPD/ Hypothyroidism/Chronic renal failure/

  14. Function of different member in GP clinic Duty of GP-clinic target Mental health/Palliative care/ Dementia（痴呆）/Learning difficulty/ Cancer/Depression/Epilepsy（癫痫）/Obesity

  15. Consulting room

  16. Canvas in consulting room

  17. Function of different member in GP clinic Duty of GP-clinic target In addition… Family planning/Antenatal care /Minor surgery/joint injections/ Anti-coagulation monitoring

  18. With GPs

  19. “A surgeon’s tool is the scalpel, a GP’s tool is the consultation” Dr Grant Blair ICSM 2010

  20. Adrenaline

  21. Dictaphone

  22. Computer system

  23. test tube

  24. Repeat prescription

  25. 思索 • 工欲善其事，必先利其器 完善的电脑系统 知识更新的实用性和可操作性 变要我学为我要学

  26. OOH(Out of Hours ) Origin Fifteen years ago a group of local family doctors set up the first doctor’s out of hours (OOH) co-operative in London. This evolved into the current member ship- based organization which operates as a ‘no for profit’ Community Benefit Society.

  27. OOH(Out of Hours ) Now LCW(London center & west) has 430 GP members drawn from the 170 local GP Surgeries. LCW provides out of hours primary care services to 80,000 patients across 4PCTs (Brent, Hammersmith & Fulham, Kensington & Chelsea and Westminster)

  28. 思索 • 正确的舆论导向 健康宣教的针对性 受众层面知识层次的提高 • 期待更完善的医疗改革 加大医疗投入 不患寡而患不均

  29. 谢 谢！ • 医学是一门有缺憾的学科 • 医生的作用是治愈少数人、帮助多数人和安慰所有人 The function of a physician is to cure a few, help many, and comfort all. • 期盼回归医疗本源

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