Role Orientation and Pathway of Primary Care during Containing COVID-19：a Case Study of Shanghai W Community Health Center

doi:10.12114/j.issn.1007-9572.2021.00.187

Abstract

Abstract: Background　Primary care has played an significant role in containing COVID-19. But there is a lack of studies on the mechanism and pathway of its action. Objective　To explore the role of primary care during the containment of COVID-19，and to map the systematic pathway. Methods　This study was conducted between February and March 2020 in W Community Health Center（CHC），Shanghai. Data about major measures taken by center for containing COVID-19 were collected via interviews by telephone，email，WeChat voice，or key informant，and were analyzed to examine the role orientation of this CHC and to map its systematic pathway in containing the pandemic using system dynamics diagram. Results　The major actions taken by this CHC to contain COVID-19 included：establishing a COVID-19 containment management team，implementing COVID-19 screening and triage，undertaking emergency responses to COVID-19，strengthening ward management，and providing online health services. This CHC's role during COVID-19 containment was mainly summarized as: providing essential healthcare services for residents，undertaking the anti-COVID-19 tasks assigned by higher level institutions，delivering community-based anti-COVID-19 services，and parallelly cooperating with other relevant institutions. The system dynamics flow diagram showed that the CVID-19 containment system in primary care based on the practice of this CHC is composed of four subsystems: execution path，emergency path，cooperation path，and essential healthcare service path. Conclusion　Our study indicates that primary care plays an important role in COVID-19 containment，which may be summarized as "implementing duties in collaboration with other relevant institutions using parallel or vertical mode"，and recommendations for the implementation may be summarized as "providing essential healthcare services for residents，strengthening the organization and management of anti-COVID-19 services delivery，enhancing team building and improving the cooperation with other institutions".

Key words: Primary healthcare institution, Epidemic prevention and control, COVID-19, Community health center

摘要： 背景　基层医疗卫生机构在此次新型冠状病毒肺炎疫情防控中发挥着重要作用，但其在疫情防控中的作用路径与机制研究还比较缺乏。目的　本文旨在探讨基层医疗卫生机构在新型冠状病毒肺炎疫情防控中的功能定位，并刻画其发挥作用的系统路径。方法　2020年2—3月以上海市W社区卫生服务中心为例，采用邮件访谈、微信语音访谈与关键人物访谈搜集基层医疗卫生机构在疫情期间的主要措施，探索基层医疗卫生机构在疫情防控中的功能定位，并通过绘制系统动力学流图刻画基层医疗卫生机构的系统路径。结果　W社区卫生服务中心在疫情期间采取的主要措施包括组建疫情管理团队、实施分诊筛查、落实应急响应、强化病房管理、开展线上医疗，其主要功能定位包括“守住基本”“承接上线”“对接社区”“左右协同”4个方面。系统动力学流图显示，基层医疗卫生机构疫情防控系统主要由“执行路径”“应急路径”“协同路径”“基本医疗服务路径”4个子系统构成。结论　基层医疗卫生机构在重大疫情防控中发挥着重要作用，可概括为“上下左右”的功能定位。守住基本、加强组织管理、强化团队建设与提升外部协同是相应的政策建议。

关键词: 基层医疗卫生机构, 疫情防控, 新型冠状病毒肺炎, 社区卫生服务中心

HUANG Jiaoling,FU Xuanqin,WANG Liqiang, et al. Role Orientation and Pathway of Primary Care during Containing COVID-19：a Case Study of Shanghai W Community Health Center　[J]. Chinese General Practice, 2021, 24(13): 1596-1601. DOI: 10.12114/j.issn.1007-9572.2021.00.187.
黄蛟灵,傅玄琴,王黎强等. 基层医疗卫生机构在疫情防控中的功能定位与作用路径研究：以上海市W社区卫生服务中心为例[J]. 中国全科医学, 2021, 24(13): 1596-1601. DOI: 10.12114/j.issn.1007-9572.2021.00.187.

References

［1］World Health Organization．Coronavirus disease（COVID-19） pandemic［EB/OL］．［2020-03-01］．https://www.who.int/emergencies/diseases/novel-coronavirus-2019．
［2］王佳，路宁，崔曼莉，等．新型冠状病毒肺炎疫情防控给全科医学发展带来的思考［J］．中国全科医学，2020，23（9）：1090-1094．DOI：10.12114/j.issn.1007-9572.2020.00.298.
WANG J，LU N，CUI M L，et al．Epidemic prevention and control of COVID-19 brings thinking for the general medicine［J］．Chinese General Practice，2020，23（9）：1090-1094．DOI：10.12114/j.issn.1007-9572.2020.00.298.
［3］朱敏，唐岚，童晓维，等．关于做实做细家庭医生签约服务的实践与思考［J］．中国全科医学，2018，21（33）：4047-4052．DOI：10.12114/j.issn.1007-9572.2018.00.180.
ZHU M，TANG L，TONG X W，et al．Reflection on the delivery of contracted family doctor services with careful and down-to-earth efforts［J］．Chinese General Practice，2018，21（33）：4047-4052．DOI：10.12114/j.issn.1007-9572.2018.00.180.
［4］祝墡珠．全科医疗服务模式认识与发展［J］．中国实用内科杂志，2012，32（4）：245-246.
［5］原上海市卫生和计划生育委员会．关于进一步深化上海市社区卫生服务综合改革与发展的指导意见［EB/OL］．（2015-01-29）［2020-03-20］．http://www.hs.sh.cn/website/b/103321.shtml.
［6］吴燕，赵燕萍，黄晓霞，等．家庭医生责任制下城市社区公共卫生服务模式的探索与实践［J］．中国全科医学，2015，18（13）：1504-1509．DOI：10.3969/j.issn.1007-9572.2015.13.007.
WU Y，ZHAO Y P，HUANG X X，et al．Management mode of urban community public health services within the family doctor system［J］．Chinese General Practice，2015，18（13）：1504-1509．DOI：10.3969/j.issn.1007-9572.2015.13.007.
［7］尹文强，傅华，安妮，等．社区卫生服务机构的SWOT分析［J］．中华医院管理杂志，2004，20（3）：138-141．
YIN W Q，FU H，AN N，et al．SWOT analysis of community health service center［J］．Chinese Journal of Hospital Administration，2004，20（3）：138-141．
［8］窦伟洁，赵芳，谷景亮，等．山东省农村居民就医意愿及其影响因素分析［J］．中华全科医学，2015，13（9）：1484-1485.
DOU W J，ZHAO F，GU J L，et al．Survey of rural residents' wills to medical treatment and its influencing factors in Shandong Province［J］．Chinese Journal of General Practice，2015，13（9）：1484-1485.
［9］李家学，吴德林，李大罕．基层公共卫生体系在突发公共卫生事件应急处置中的应用［J］．健康天地，2010，4（10）：12-13.
［10］任光为，何秋萍，刘克强，等．社区健康教育在全科医疗实践工作中的探索［J］．健康教育与健康促进，2018，13（2）：108-109．DOI：10.16117/j.cnki.31-1974/r.201802005.
［11］梁万年．全科医生的素质和任务及其在社区卫生服务中的作用［J］．中国全科医学，2007，10（3）：173．DOI：10.3969/j.issn.1007-9572.2007.03.001.
LIANG W N．The quality and task of general physicians and the role in the CHS［J］．Chinese General Practice，2007，10（3）：173．DOI：10.3969/j.issn.1007-9572.2007.03.001.
［12］江萍．上海市长宁区家庭医生签约服务实践［J］．中国卫生人才，2019，21（7）：18-21.
［13］MACINKO J，STARFIELD B，SHI L．The contribution of primary care systems to health outcomes within organization for economic cooperation and development（OECD） countries，1970—1998［J］．Health Services Research，2003，38（3）：831-865.
［14］章朝霞，袁家麟，许振慧，等．社区卫生服务站公共卫生服务管理模式实践与研究［J］．中国全科医学，2013，16（3）：341-343．DOI：10.3969/j.issn.1007-9572.2013.01.113.
ZHANG Z X，YUAN J L，XU Z H，et al．Practice and research of management mode for public health service in community health station［J］．Chinese General Practice，2013，16（3）：341-343．DOI：10.3969/j.issn.1007-9572.2013.01.113.
［15］HUANG J L，LIU S S，HE R R，et al．Factors associated with residents' contract behavior with family doctors in community health service centers：a longitudinal survey from China［J］．PLoS One，2018，13（11）：1-16．DOI：10.1371/journal.pone.0208200.
［16］沈琦，刘帅，崔恒清，等．上海市闵行区家庭医生工作压力与职业倦怠状况研究［J］．中国全科医学，2019，22（31）：3815-3818，3829．DOI：10.12114/j.issn.1007-9572.2019.00.439.
SHEN Q，LIU S，CUI H Q，et al．Occupational stress and burnout in family doctors in Minhang District，Shanghai［J］．Chinese General Practice，2019，22（31）：3815-3818，3829．DOI：10.12114/j.issn.1007-9572.2019.00.439.
［17］黄蛟灵，梁鸿，张宜民，等．家庭医生制度本土化困境与策略：以上海市虹口区为例［J］．中国卫生政策研究，2016，9（8）：37-43．DOI：10.3969/j.issn.1674-2982.2016.08.007.
［18］张智，王磊，周丽娟．家医签约服务费:机构内部如何分配［J］．中国卫生，2019，35（6）：56.
［19］黄蛟灵，梁鸿，张宜民，等．上海市虹口区家庭医生签约模式的创新：要素、路径与机制研究［J］．中国卫生政策研究，2019，12（8）：43-48．DOI：10.3969/j.issn.1674-2982.2019.08.007.
［20］孟庆跃，袁璟，侯志远，等．我国基层卫生机构服务功能分析［J］．中国卫生政策研究，2009，2（11）：1-6．DOI：10.3969/j.issn.1674-2982.2009.11.001.
［21］梁万年．全科医学、全科医疗和全科医生［J］．中国学校卫生，2004，25（2）：252-256．
［22］杨屹，施建芳，谢彦昕，等．上海市浦东新区社区卫生服务中心公共卫生应急能力现况［J］．上海预防医学，2018，30（11）：16．DOI：10.19428/j.cnki.sjpm.2018.18530.
［23］王明亮，孙静，王亚东，等．以情景构建为基础的美国应急预案体系建设对我国应急管理的启示［J］．医学教育管理，2016，2（2）：458-463．
［24］陈淑琴，王忠壮，黄蛟灵，等．家庭医生团队服务对社区高血压患者的管理方式分析［J］．中国初级卫生保健，2019，33（8）：12．DOI：10.3969/j.issn.1001-568X.2019.08.0012.
［25］胡志霞，元永虎．基层公共卫生体系在突发公共卫生事件应急处置中的应用［J］．中国卫生产业，2015，12（24）：174-176．DOI：10.16659/j.cnki.1672-5654.2015.24.174.

[1]	CHEN Yiping, ZHANG Jianmei, LI Yanhu, LI Rui, ZHANG Ruiping, YANG Ping. Advances in the Diagnosis and Treatment of Post-COVID-19 Condition of Myocardial Injury [J]. Chinese General Practice, 2026, 29(18): 2585-2592.
[2]	XIANG Tong, YU Haiyan, LI Mingyue, GAO Wenjuan, ZHU Xiayuan, WU Hao. Analysis of Factors Influencing of Prediabetes Management Behaviors among Primary Care Physicians and Nurses: a Qualitative Study [J]. Chinese General Practice, 2026, 29(16): 2259-2263.
[3]	YANG Rong, JIN Hua, SHI Ling, YI Chuntao, HOU Jin, CHEN Chen, HUAN Hongmei, NI Hengru, YU Dehua. A Survey on the Quality of Diabetes Normative Management at Grassroots Level [J]. Chinese General Practice, 2026, 29(12): 1541-1547.
[4]	ZHANG Hanzhi, JIN Hua, MA Le, SHI Ling, CHEN Chen, HUAN Hongmei, YU Dehua. Analysis of the Quality of Diagnosis and Treatment of Osteoporosis in Shanghai Community Health Service Institutions [J]. Chinese General Practice, 2026, 29(12): 1548-1557.
[5]	HUANG Yanli. Implementation Elements of Primary Care Digital Transformation: Based on CFIR [J]. Chinese General Practice, 2026, 29(11): 1385-1392.
[6]	WANG Jiaxin, WU Hao, ZHAO Yali. Construction of Emergency Response Capacity Evaluation Indicators System for Major Infectious Diseases in Primary Medical Institutions in Beijing: Based on Emergency Management Theory and the Resilience Concept [J]. Chinese General Practice, 2026, 29(02): 162-169.
[7]	LI Yan, HUANG Hao, SHI Jianwei, SONG Wei, ZHU Shanzhu, TANG Lan. The Key Mechanism and Optimization Countermeasures to Realize the Business Model of Chronic Disease Medical Prevention Integration in Primary Care Institutions [J]. Chinese General Practice, 2026, 29(01): 108-114.
[8]	SU Ning, LIU Pingping, GUO Yumeng, LU Mingyue, ZHU Rui, YU Jianping. Investigation on the Prevention and Control Capacity of Infectious Diseases and Influencing Factors in Primary Medical and Health Service Institutions in Beijing in 2019-2022 [J]. Chinese General Practice, 2025, 28(35): 4473-4478.
[9]	LIN Qiyi, YANG Yunfeng, GU Wenqin, XU Liping, DING Hongjuan, SU Jin, ZHOU Peng, YI Chuntao. Practice and Prospects for the Construction of "Combination of General and Specialized disciplines" Characteristics in Communities Based on the Medical Alliance: Taking Fenglin Street Community Health Service Center in Xuhui District, Shanghai as an Example [J]. Chinese General Practice, 2025, 28(28): 3554-3557.
[10]	The General Practice Branch of the Chinese Medical Doctor Association. Implementation Recommendations for Quality Management and Control in General Practice at Primary Healthcare Institutions (2025 Edition) [J]. Chinese General Practice, 2025, 28(28): 3473-3482.
[11]	DENG Jie, TAO Liyuan, LIU Nan, LI Jun, YAN Wenxin, QIN Chenyuan, LIU Qiao, DU Min, WANG Yaping, LIU Jue. Reliability and Validity of the Chinese Version of the Modified COVID-19 Yorkshire Rehabilitation Scale [J]. Chinese General Practice, 2025, 28(13): 1642-1648.
[12]	ZHANG Xiaojuan, LIU Yang, PENG Bo, CAO Xiaolin, YE Yuan, ZHU Kun. Research on Pediatric Construction and Service Provision in Primary Health Institutions [J]. Chinese General Practice, 2025, 28(10): 1228-1235.
[13]	FU Qiang, REN Zuolei, LIN Zhiqiang, GONG Jianfeng, WANG Changzheng, WANG Ting, HU Yalan, TAN Jufang. Imaging and Clinical Characteristics of 8 Cases of COVID-19 Complicated with Pneumomediastinum in Children [J]. Chinese General Practice, 2025, 28(04): 510-515.
[14]	HUANG Lihui, SHU Juan, TAO Huihui, BAO Hairong. Progress in Treatment of Post Inflammatory Pulmonary Fibrosis Induced by SARS-CoV-2 Infection [J]. Chinese General Practice, 2024, 27(32): 4085-4092.
[15]	MA Xiaoxia, SHI Jishun, NIU Lihua, CHEN Ningqing, DING Yan. A Qualitative Study on the Status of Maternal and Infant Health Services in Shanghai Communities under the New Situation [J]. Chinese General Practice, 2024, 27(28): 3529-3534.