Reporter Zhang Tongjian Correspondent Liang Zhaokun
With the development of my country's economy and the changes in living environment, the incidence of chronic diseases has increased rapidly. Currently, Liaocheng has been clearly diagnosed with chronic diseases, and there are nearly 200,000 elderly people with weak people. During the two sessions this year, Fu Hongying, a member of the Municipal CPPCC, submitted a proposal for "Suggestions on Solving the Difficulty of Taking Medicine for Chronic Diseases". She took Yanggu County as an example and pointed out that there are now more than 20,000 chronic diseases in Yanggu County. Among them, more than 69% of the elderly over 60 years old account for more than 4.8%, and 17% of the people who continue to assist. Among the elderly patients over 60 years old, 50% of patients with diabetes, hypertension, , and coronary heart disease, 20% of patients with stroke, and 20% of patients with malignant tumors.
does not allow the purchase of medicines for chronic diseases to become a roadblock on the road to treatment
member Fu Hongying said that with the implementation of centralized volume-based procurement of drugs organized by the state, more and more types of drugs included in the centralized procurement, the dosage form and specifications are becoming more and more abundant, and the price of drugs has dropped significantly. For example, the original online price of atorvastatin 10mg*14 tablets for hypertension is 39.17 yuan/box, now 1.68 yuan/box, the original price of risperidone tablets for mental illness is 25.64 yuan/box, the current price of 1.47 yuan/box, the current price of 1.47 yuan/box, the original price of 50㎎*30 tablets for diabetes is 61.92 yuan/box, now 5.42 yuan/box, etc., bringing real benefits to the people and enhancing the sense of gain of medical treatment for the people. Especially after chronic patients are reimbursed for outpatient clinics, they have very little expenses to bear, so the prices of many drugs are no longer a problem that hinders the difficulty of taking medicine for ordinary people.
Most patients with chronic diseases live in rural areas all year round, mostly left-behind elderly people. Their children work outside all year round and cannot take care of the elderly’s daily life. Some elderly people are influenced by traditional ideas and are unwilling to bother their children, so purchasing chronic disease medicine has become a roadblock on their way to take medicine to cure their illness.
She also said that due to the unbalanced development of township (community) health centers and the incomplete variety of drugs, many chronic diseases must be purchased at county-level hospitals . Rural patients with chronic diseases, especially those far from urban areas, often need to go to the township and township location first and then take the bus to county-level hospitals to buy medicine. Some transportation costs are higher than the price of drugs. In addition, patients in county-level hospitals are relatively concentrated and waiting for a long time. This method of receiving medicine is extremely inconvenient for patients with chronic diseases and special diseases with poor physical condition, and often leads to the phenomenon of "tolerance, dragging, and anti-defense" outage of drugs.
tiered diagnosis and treatment , so that chronic diseases can be left in townships or community hospitals
Fu Hongying suggested that municipal and county health departments and medical insurance departments should work closely together to conscientiously implement the spirit of the National Health Commission and the National Health Insurance Administration's "Long-term Prescription Management Standards (Trial)" to promote integrated medical and health management in counties and townships, improve the business level of township (community) health centers, enhance the management ability of chronic diseases, allow the people to enjoy high-quality medical and health services nearby, truly achieve the goal of tiered diagnosis and treatment, and let chronic diseases really stay in townships and community hospitals .
The township health center has established a chronic disease management center to establish files for each chronic disease patient, classify management, and combine it with village-level health centers in each township to provide procurement, delivery of medicine, medication, follow-up visits and other services to patients with chronic disease patients to solve the problem of difficulty for left-behind elderly people taking medicine. Taking Yanggu County as an example, there are more than 670 village-level health clinics that undertake basic public health services, basically achieving full coverage of basic public health services in villages. These village doctors purchase chronic disease drugs for some chronic disease patients in the jurisdiction with stable medication plans, good compliance and stable disease control. This truly solves the problem of difficulty in taking medicine for the people, gives full play to the advantages of smart village doctors in health poverty alleviation, and opens up the "last mile" in taking medicine to cure diseases.
She also suggested that the government should provide certain policy or financial support to the number of chronic patients in township health centers and village-level clinics to ensure that township health centers and village-level clinics have a good development and functional positioning.
strives to integrate medical and prevention chronic disease management in general in the city
In July this year, the Liaocheng Health Commission replied that in order to further improve the effect of basic public health services and establish a medical and prevention chronic disease management service mechanism, in 2021, Liaocheng City determined to launch the "three highs and six diseases together" in 55 counties (districts) including Dongchangfu District, Shen County, Yanggu , Dong'a , Gaotang Gaotang , complications such as Dongchangfu District, Yanggu , Dong'a , Gaotang complications) and launched the "three highs and six diseases together" (hypertension, hyperglycemia , hyperlipidemia, coronary heart disease, stroke, nephrotic syndrome , fundus lesions, peripheral neuropathy, peripheral vascular lesions and other complications). In combination with the three-year action plan to improve primary medical and health capacity, each pilot area will build a "three high home" based on the family doctor team and studio, and undertake routine drug treatment, follow-up management and high-risk population intervention for patients in stable periods. Relying on township health centers and community health service centers, we will build the "three high bases" and provide personalized plan (review) and offline and online collaborative services for patients with unstable conditions. Relying on county-level hospitals, we will build the "three high centers" and be responsible for the diagnosis and treatment of patients with refractory and complex "three highs" and "six diseases" and integrated medical and prevention services for patients who are in-hospital. The city has built 5 high centers, 28 high bases, 243 high homes, 216,478 of the high homes, 216,478 of the family doctors signed contracts for hypertension, 74,385 of the family doctors signed contracts for diabetes, and 34,145 of the family doctors signed contracts for hyperlipids, and 34,145 of the family doctors signed contracts for hyperlipids, and the pilot work has achieved initial results. In 2022, we must accelerate the pilot program of "three highs and six diseases to prevent together" for medical and prevention in combination with chronic disease management, and strive to carry out the "three highs and six diseases to prevent together" for medical and prevention in combination with chronic disease management in the city by 2023.
actively promotes and improves the layout of family doctor studios, chronic disease clinics, and health stations in primary medical and health institutions on the outpatient floors, and establishes a service process of "Appointment-Health Station Construction (Updated) File Follow-up-Targeted Triage-Inter-Clinic Health Evaluation and Medical Retrieval-Post-Clinic Health Guidance-Re-College (Next Follow-up)" with patient-centered approach, clarifying the division of responsibilities of doctors, nurses, and public health personnel in the outpatient clinic, effectively implementing the family doctor team service model, and achieving the integration of outpatient services for patients with hypertension and diabetes in the same outpatient area. Corresponding equipment should be equipped according to standards, and the role of health stations and smart follow-up equipment should be effectively played. Patients' blood pressure and blood sugar data should be automatically uploaded. For patients who need to cooperate with online consultation, try to complete the consultation immediately through remote consultations between clinics to improve the efficiency of consultation. Patients who need offline consultation should be connected with the coordinator of the Third High Center to clarify and inform the patients of the specific visit time and the attendance personnel.
promotes outpatient chronic disease diagnosis and treatment, medication collection and reimbursement services to villages (communities). Grassroots medical and health institutions should establish a drug demand ledger for patients with "three highs" based on the types and sources of drugs taken by patients with "three highs", and promptly purchase relevant drugs based on the expected drug use cycle and distribution cycle, and then transfer to villages (communities) in a graded manner. For primary medical and health institutions with large settlement volume of drugs and high proportion of funds due to extended services, we will actively coordinate with the medical insurance departments to review and settle quickly to improve settlement efficiency. Strengthen chronic disease management services for grassroots medical institutions and family contracted doctor teams, and on the premise of safety, reasonableness and effectiveness, provide long-term prescription services for qualified contracted chronic diseases patients. In principle, long-term prescriptions can be issued for 4 to 12 weeks to reduce the number of times they go to and from medical institutions. Actively promote door-to-door services and provide door-to-door medical and health services to disabled and semi-disabled elderly people, disabled people, terminal patients and other groups in real need.
further strengthens the informatization construction of primary medical institutions, establish communication and contact channels between family doctors and contracted residents outside of medical treatment, and family doctors regularly contact contracted residents to understand their health status and push targeted health information. We will gradually expand the coverage of contract services and gradually build a family doctor system with family doctors as health gatekeepers.Combined contract signing is encouraged, and in accordance with the grid layout of construction of county medical community, county-level hospitals are guided to adopt the "tire and fragmented" method, through counterpart support , department co-construction, talent sinking and other channels, and strengthen the signing service force with grassroots medical and health institutions in the jurisdiction, and jointly provide family doctor contract signing services.
