关键词: 初级卫生保健, 社区卫生服务, 卫生服务研究, 基层医疗卫生机构, 医防融合, 慢性病管理, 健康管理服务模式, 重庆

Abstract: Promoting the delivery of intensive integrated essential medical services and national essential public health services，as well as contracted family doctor services by primary care settings，are important tasks to deepen the reform of the pharmaceutical and healthcare system. To explore an appropriate health management mode for delivering both essential medical services and national essential public health services in primary care，we have tried to provide such services for hypertensive and diabetes patients by a contracted general practitioner team via five integrated measures（integration of management，workforce，scope items，performance assessment，and information of the two types of services）. In this way，the patient could access to both medical services and national essential public health services in an outpatient consultation. This kind of comprehensive health management（consisting of preventive，treatment and management services） is conducive to improving the service quality and residents' sense of gain，as well as promoting the intra-hospital horizontal integration of such services and inter-hospital vertical integration of medical resources.

Key words: Primary health care, Community health services, Health services research, Primary health care institutions, Integration of treatment and prevention, Chronic disease management, Health management service mode, Chongqing