远程心电筛查助力分级诊疗的管理难点及瓶颈

doi:10.12114/j.issn.1007-9572.2022.L0002

中国全科医学 ›› 2023, Vol. 26 ›› Issue (05): 525-531.DOI: 10.12114/j.issn.1007-9572.2022.L0002

• 问道全科——基层医疗卫生服务能力提升 • 上一篇下一篇

远程心电筛查助力分级诊疗的管理难点及瓶颈

张海澄¹, 余新艳², 王红宇³, 薛涛⁴, 廖晓阳⁵, 范咏梅⁶, 张青宏⁷

1．100044　北京市，北京大学人民医院心内科，北京大学医学继续教育学院
2．750001　宁夏回族自治区银川市第一人民医院健康管理（体检）中心
3．030001　山西省太原市，山西医科大学第二医院心电图诊断科
4．252600　山东省临清市人民医院心内科
5．610041　四川省成都市，四川大学华西医院全科医学中心
6．410002　湖南省长沙市，湖南省人民医院功能科
7．750001　宁夏回族自治区银川市第一人民医院基层医疗服务部

收稿日期:2022-10-17 修回日期:2022-10-25 出版日期:2023-02-15 发布日期:2022-12-19
基金资助:
国家社科基金重大项目(18ZDA086-4); 银川市科技创新重点重大专项(2021-SF-009)

Discussion on the Difficulties and Bottlenecks in the Management of Remote ECG-based Screening for Cardiovascular Disease Risk in Hierarchical Diagnosis and Treatment

ZHANG Haicheng¹, YU Xinyan², WANG Hongyu³, XUE Tao⁴, LIAO Xiaoyang⁵, FAN Yongmei⁶, ZHANG Qinghong⁷

1. Department of Cardiology, Peking University People's Hospital, Peking University School of Continuing Medical Education, Beijing100044, China
2. Health Management (Physical Examination) Center of the First People's Hospital of Yinchuan, Yinchuan 750001, China
3. Department of Electrocardiogram Diagnosis, Second Hospital of Shanxi Medical University, Taiyuan 030001, China
4. Department of Cardiology, Linqing People's Hospital, Linqing 252600, China
5. Center of General Practice, West China Hospital of Sichuan University, Chengdu 610041, China
6. Function Department of Hunan Provincial People's Hospital, Changsha 410002, China
7. Primary Medical Service Department of the First People's Hospital of Yinchuan, Yinchuan 750001, China

Received:2022-10-17 Revised:2022-10-25 Published:2023-02-15 Online:2022-12-19

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摘要/Abstract

摘要： 我国心血管疾病（CVD）患病率和发病率仍在持续增高，且近几年农村地区CVD死亡率持续超过城市地区。远程心电筛查有益于基层医疗卫生机构CVD筛查，但其也存在一定的难点。本文就如何提高远程心电筛查的知晓度、可信度以及居民的获得感？如何调动基层医生积极性，主动地参与到筛查的工作中？如何解决基层医生管理能力与管理经验不足，只能提供单一的筛查、沟通的服务？如何解决基层医疗卫生机构与上级医院的双向转诊中各级医院之间缺乏协同机制，没有持续运行的筛查团队+诊断团队+评估团队+治疗团队+随访管理团队的问题进行讨论，并提出了：合理高效利用各方资源；落实分级诊疗、加强团队分工协作；充分发挥护理和公共卫生团队的能力，制订不同筛查方案；加强上级医疗机构专家对基层医生的技术支持，增加基层医疗卫生机构社会效益；在工作中进行人才培养，提升基层人员的专业水平；"互联网+基层医疗"赋能双向转诊；构建病例的大数据库；构建医疗健康集团，分工协作等建议。

关键词: 心血管疾病, 远程医学, 心电描记术, 全科医生, 心电筛查, 分级诊疗, 基层医疗卫生服务, 初级卫生保健

Abstract:

In China, the overall prevalence and incidence of cardiovascular disease (CVD) continues to increase, and the mortality rate from CVD in rural areas has exceeded that in urban areas recently. Remote ECG-based screening for CVD risk is a beneficial supplement for CVD risk screening in primary hospitals, but there are many difficulties during its implementation, which mainly include the following aspects: how to improve the awareness and credibility of remote ECG-based screening for CVD risk and sense of gain in residents? How to incentivize primary physicians to actively participate in the screening? How to improve insufficient management ability and experience of primary physicians who can only provide single screening and communication services? How to build a collaborative mechanism between primary and higher level hospitals involved in delivering referral services, and to provide continuous services by establishing multiple teams consisting of screening team, diagnosis team, evaluation team, treatment team and follow-up management team? To address these issues, we invited a group of experts to attend discussions, in which the following recommended solutions were put forward: using various resources rationally and efficiently; strengthening the division of labor and cooperation between team members to improve hierarchical diagnosis and treatment; giving full play to the capacities of nursing and public health teams to develop different screening programmes; strengthening the technical support of experts from higher level medical institutions for primary doctors, and increasing the social benefits of primary hospitals; carrying out workplace training to improve the professional level of primary care workers; integrating Internet technologies into primary care to enable referrals; building a big data database of cases; constructing medical and health groups with clear defined division of labor and cooperation.

Key words: Cardiovascular diseases, Telemedicine, Electrocardiography, General Practitioners

张海澄,余新艳,王红宇,等. 远程心电筛查助力分级诊疗的管理难点及瓶颈[J]. 中国全科医学, 2023, 26(05): 525-531. DOI: 10.12114/j.issn.1007-9572.2022.L0002.
ZHANG Haicheng,YU Xinyan,WANG Hongyu, et al. Discussion on the Difficulties and Bottlenecks in the Management of Remote ECG-based Screening for Cardiovascular Disease Risk in Hierarchical Diagnosis and Treatment[J]. Chinese General Practice, 2023, 26(05): 525-531. DOI: 10.12114/j.issn.1007-9572.2022.L0002.

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远程心电筛查助力分级诊疗的管理难点及瓶颈

Discussion on the Difficulties and Bottlenecks in the Management of Remote ECG-based Screening for Cardiovascular Disease Risk in Hierarchical Diagnosis and Treatment

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