家庭医生签约服务的短板,该补补了!

2018-04-15 甄不易 基层医师公社

近日,笔者与基层多名公卫服务人员进行了交流,了解他们的日常工作情况和工作中存在的问题,其中有县级的管理人员,也有乡镇项目专干。

近日,笔者与基层多名公卫服务人员进行了交流,了解他们的日常工作情况和工作中存在的问题,其中有县级的管理人员,也有乡镇项目专干。

大家都有好多的话要说,能感觉到大家有很多的无奈,而有些问题并不是基层可以解决的,下面我们就来说道说道。

老张是乡镇卫生院公卫科科长,一提起公共卫生服务,他说,现在普遍存在公卫人员少、工作量大的现象。

公卫人员就七八个,又干公卫又参与签约还管扶贫,一身兼数职,杂七杂八的事多的很,还要迎接各级的检查、督导、考核,今天这个项目来一拨人,隔天那个项目来几个人,干活都没有完整的时间。

他所在乡镇20个村3万多人,全科医生只有1名,和5名执业医生加起来组建了6个家庭医生签约服务团队,现在每个团队已签了约2000人,签约完成后,履约却较少,群众没有感受到签约带来的好处,自然也没有什么获得感。

老张的疑问是现阶段都服务不过来,以后还敢签不敢签?

小刘是卫生院档案管理员,他无奈地说:“现在的报表实在太多了,档案块有1个报表,签约方面每月要报三个表,扶贫块有八九个,而且设计繁琐,重复统计,能把这些表格无差错上报就很不错了!”

老赵是卫生院签约服务信息员,他认为现在的绩效考核机制不健全,医生和护士对公卫、签约工作不配合,有排斥现象。

主要原因是医生、护士的绩效工资与公卫服务不挂钩,应该制订与之相关的奖惩激励制度,促使医护人员积极参与进来,这样有利于公卫与临床融合,也能提高服务的质量。

老郭是一名签约服务队队长,他反映签约服务后勤保障跟不上,卫生院的服务车就那么一台,好几个团队共用一辆车,公卫人员时不时要去开会、交表,车辆严重不足,只好开私家车去下乡,但开私家车又存在隐患;

上级医院也没有准备充足,由卫生院转诊的签约患者优先安排大型设备检查政策得不到落实,与卫生院、卫生所宣传的优惠政策不一致,患者颇有怨言。

王主任是县公卫管理中心的负责人,他发现基层人员更换频繁,导致数据统计不准,更换频繁的主要原因是公卫人员多为临时人员,他们认为付出和报酬不成正比,活多钱少压力大,所以辞职了。这样下去,工作很难上新台阶;

再就是签约信息平台建设要求以县为单位去搞,有一定难度,他说:“为什么不在全国,至少全省开发一个信息平台呢?这样更有利于工作的开展,如后期统计、考核等工作。”

综上所述,国家基本公共卫生服务、家庭医生签约存在以下短板:活多人少、报表繁多、激励奖惩机制不健全、后勤保障跟不上、上级医院准备不足、政策保障最后一公里未打通等。

这些短板制约了服务质量的提升,足以引起我们的重视和思考,故笔者建议:

一是国家应该出台规范性文件,想方设法补足家庭医生,只有人员有了保障,才能谈服务的质量。人不足,怎么办?由谁办?多长时间予以落实,这些都是应该考虑并抓紧落实的问题。

二是明确签约服务团队中医生、护士、公卫人员、村医的职责,加强年度考核,根据医务人员签约数量、服务质量、签约居民满意度、感受度作为主要考核指标,考核结果与团队成员绩效工资挂钩。

促使医疗与公卫有机融合,改变医生、护士现有的以临床医疗和病人为中心的工作模式,向以辖区居民全方位、全生命周期的健康管理这个方向发展。

并制定与之相关的激励奖惩机制,体现多劳多得、优绩优酬,让医护人员有劳有获,干着有劲。

三是建议将基本公卫、签约服务、健康扶贫等工作深度融合,减少工作量,为基层人员减负,让下面工作人员有充足的服务时间。

家庭医生签约服务包含基本公卫、基本医疗、健康管理等,基本公卫工作已经开展好几个年头了,临床医疗、转诊工作也有临床医生、护士一直在承担着,家医签约与公卫服务是包含关系还是平行关系,这些都需要明确一下。

四是科学设计各种报表,减少表格数量,剔除重复项,不要让报表大量占用了宝贵的服务时间,让基层人员多一点精力做实做好工作。

五是加大宣传力度,从国家层面要求各级宣传媒体播放宣传片,大力宣传家庭医生签约服务的好处,鼓励居民积极主动签约,享受签约带来的便利。

六是相关部门间应沟通好,打通政策瓶颈,家庭医生签约服务不应该由卫计部门一家来干,人社医保、残联、扶贫办都应发挥各自的作用。

如医保部门要落实由乡镇卫生院转诊到二级以上医院的签约患者起付线累计、有偿服务包签约费用从医保资金支付等政策,扶贫办、残联要落实建档立卡贫困人口、残疾人个性化有偿服务包的费用。

如果医保、扶贫办、残联不配合,签约服务团队宣传的优惠政策就是一句空话,将失信于民,更不利于签约服务工作的开展。

我们应该开展大调研,了解居民的健康需求,了解基层医务人员的服务能力,及时修订各类服务指标,及时发现公共卫生服务、签约服务在运行中的短板,并积极采取相应措施,打通瓶颈、补齐短板,以提高公卫服务、签约服务的质量,让辖区群众更有获得感。

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    2018-04-17 yuanming8
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  4. [GetPortalCommentsPageByObjectIdResponse(id=1746165, encodeId=44121e4616521, content=<a href='/topic/show?id=8ca5e59642d' target=_blank style='color:#2F92EE;'>#签约服务#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=75964, encryptionId=8ca5e59642d, topicName=签约服务)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b6ff35658964, createdName=zhang92572, createdTime=Mon Oct 29 11:18:00 CST 2018, time=2018-10-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1422250, encodeId=a1aa14222506c, content=<a href='/topic/show?id=cb40e59604f' target=_blank style='color:#2F92EE;'>#签约#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=75960, encryptionId=cb40e59604f, topicName=签约)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=24b63689109, createdName=yuanming8, createdTime=Tue Apr 17 10:18:00 CST 2018, time=2018-04-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1449112, encodeId=68141449112b3, content=<a href='/topic/show?id=4f2c463698e' target=_blank style='color:#2F92EE;'>#家庭医生#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46369, encryptionId=4f2c463698e, topicName=家庭医生)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cc475462058, createdName=yilong5287544, createdTime=Tue Apr 17 10:18:00 CST 2018, time=2018-04-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=306535, encodeId=57fd306535a4, content=千万千万不能造假, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKibA62IFMeUJEmSyIe8DvYFeERuOsfrRd8iano7nENqQU1dRR3tqeQOUL3eqgYgEZRT2t2iaEsib0JEw/132, createdBy=66771693911, createdName=易水河, createdTime=Tue Apr 17 06:25:50 CST 2018, time=2018-04-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=306137, encodeId=965f30613efb, content=很好的学习材料.对临床和科研都有很大帮助作用.水滴石穿.不断积累., beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzUn81b5CF5ibVPib8jWI92iciaxmqGHlwruOnK4SVZykd4iahqo1hicklIibyZoxm55X7EM8BW9eX1h1hQ2/0, createdBy=8aa81937526, createdName=李东泽, createdTime=Sun Apr 15 22:53:29 CST 2018, time=2018-04-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=306132, encodeId=9467306132a6, content=^_^^_^^_^^_^, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Swp2ehfHpiciczeTntUyQOlIGMzQ705ic67sdMTVMbwTv7KbmlUvxrGvRSvQZjPkz7ib5tEDfIaORgczPtmHDpwojg/0, createdBy=c54b2163125, createdName=wqkm, createdTime=Sun Apr 15 22:36:10 CST 2018, time=2018-04-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=306103, encodeId=a3793061037f, content=关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/09/11/eb1f237032e0bf07b10833fc3722e645.jpg, createdBy=2fed2145219, createdName=紫迎馨, createdTime=Sun Apr 15 20:10:01 CST 2018, time=2018-04-15, status=1, ipAttribution=)]
    2018-04-17 易水河

    千万千万不能造假

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1746165, encodeId=44121e4616521, content=<a href='/topic/show?id=8ca5e59642d' target=_blank style='color:#2F92EE;'>#签约服务#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=75964, encryptionId=8ca5e59642d, topicName=签约服务)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b6ff35658964, createdName=zhang92572, createdTime=Mon Oct 29 11:18:00 CST 2018, time=2018-10-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1422250, encodeId=a1aa14222506c, content=<a href='/topic/show?id=cb40e59604f' target=_blank style='color:#2F92EE;'>#签约#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=75960, encryptionId=cb40e59604f, topicName=签约)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=24b63689109, createdName=yuanming8, createdTime=Tue Apr 17 10:18:00 CST 2018, time=2018-04-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1449112, encodeId=68141449112b3, content=<a href='/topic/show?id=4f2c463698e' target=_blank style='color:#2F92EE;'>#家庭医生#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46369, encryptionId=4f2c463698e, topicName=家庭医生)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cc475462058, createdName=yilong5287544, createdTime=Tue Apr 17 10:18:00 CST 2018, time=2018-04-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=306535, encodeId=57fd306535a4, content=千万千万不能造假, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKibA62IFMeUJEmSyIe8DvYFeERuOsfrRd8iano7nENqQU1dRR3tqeQOUL3eqgYgEZRT2t2iaEsib0JEw/132, createdBy=66771693911, createdName=易水河, createdTime=Tue Apr 17 06:25:50 CST 2018, time=2018-04-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=306137, encodeId=965f30613efb, content=很好的学习材料.对临床和科研都有很大帮助作用.水滴石穿.不断积累., beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzUn81b5CF5ibVPib8jWI92iciaxmqGHlwruOnK4SVZykd4iahqo1hicklIibyZoxm55X7EM8BW9eX1h1hQ2/0, createdBy=8aa81937526, createdName=李东泽, createdTime=Sun Apr 15 22:53:29 CST 2018, time=2018-04-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=306132, encodeId=9467306132a6, content=^_^^_^^_^^_^, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Swp2ehfHpiciczeTntUyQOlIGMzQ705ic67sdMTVMbwTv7KbmlUvxrGvRSvQZjPkz7ib5tEDfIaORgczPtmHDpwojg/0, createdBy=c54b2163125, createdName=wqkm, createdTime=Sun Apr 15 22:36:10 CST 2018, time=2018-04-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=306103, encodeId=a3793061037f, content=关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/09/11/eb1f237032e0bf07b10833fc3722e645.jpg, createdBy=2fed2145219, createdName=紫迎馨, createdTime=Sun Apr 15 20:10:01 CST 2018, time=2018-04-15, status=1, ipAttribution=)]
    2018-04-15 李东泽

    很好的学习材料.对临床和科研都有很大帮助作用.水滴石穿.不断积累.

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1746165, encodeId=44121e4616521, content=<a href='/topic/show?id=8ca5e59642d' target=_blank style='color:#2F92EE;'>#签约服务#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=75964, encryptionId=8ca5e59642d, topicName=签约服务)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b6ff35658964, createdName=zhang92572, createdTime=Mon Oct 29 11:18:00 CST 2018, time=2018-10-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1422250, encodeId=a1aa14222506c, content=<a href='/topic/show?id=cb40e59604f' target=_blank style='color:#2F92EE;'>#签约#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=75960, encryptionId=cb40e59604f, topicName=签约)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=24b63689109, createdName=yuanming8, createdTime=Tue Apr 17 10:18:00 CST 2018, time=2018-04-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1449112, encodeId=68141449112b3, content=<a href='/topic/show?id=4f2c463698e' target=_blank style='color:#2F92EE;'>#家庭医生#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46369, encryptionId=4f2c463698e, topicName=家庭医生)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cc475462058, createdName=yilong5287544, createdTime=Tue Apr 17 10:18:00 CST 2018, time=2018-04-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=306535, encodeId=57fd306535a4, content=千万千万不能造假, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTKibA62IFMeUJEmSyIe8DvYFeERuOsfrRd8iano7nENqQU1dRR3tqeQOUL3eqgYgEZRT2t2iaEsib0JEw/132, createdBy=66771693911, createdName=易水河, createdTime=Tue Apr 17 06:25:50 CST 2018, time=2018-04-17, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=306137, encodeId=965f30613efb, content=很好的学习材料.对临床和科研都有很大帮助作用.水滴石穿.不断积累., beContent=null, objectType=article, channel=null, level=null, likeNumber=65, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzUn81b5CF5ibVPib8jWI92iciaxmqGHlwruOnK4SVZykd4iahqo1hicklIibyZoxm55X7EM8BW9eX1h1hQ2/0, createdBy=8aa81937526, createdName=李东泽, createdTime=Sun Apr 15 22:53:29 CST 2018, time=2018-04-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=306132, encodeId=9467306132a6, content=^_^^_^^_^^_^, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/vi_32/Swp2ehfHpiciczeTntUyQOlIGMzQ705ic67sdMTVMbwTv7KbmlUvxrGvRSvQZjPkz7ib5tEDfIaORgczPtmHDpwojg/0, createdBy=c54b2163125, createdName=wqkm, createdTime=Sun Apr 15 22:36:10 CST 2018, time=2018-04-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=306103, encodeId=a3793061037f, content=关注, beContent=null, objectType=article, channel=null, level=null, likeNumber=55, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/09/11/eb1f237032e0bf07b10833fc3722e645.jpg, createdBy=2fed2145219, createdName=紫迎馨, createdTime=Sun Apr 15 20:10:01 CST 2018, time=2018-04-15, status=1, ipAttribution=)]
    2018-04-15 wqkm

    ^_^^_^^_^^_^

    0

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    2018-04-15 紫迎馨

    关注

    0

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