The professional capacity and infrastructure of general practitioners in grass-roots medical and health institutions in China are relatively weak, and the energy of specialists in general hospitals is limited and resources are abundant. Strengthening the cooperation between general practitioners and specialists can effectively improve the quality of community medical care and promote the health of patients. This paper systematically sorts out the typical practices and experiences of the construction of outpatient clinics of integration of general practice and specialty, and takes the source, connotation, construction path and construction path of the concept of full-specialty combination of outpatient clinics development effectiveness, existing problems and strategic recommendations are elaborated. Point out the challenges that may be faced in the construction of outpatient clinics of integration of general practice and specialty management model. In addition, this paper summarizes the possible challenges of the construction of integrated outpatient clinics, and puts forward five suggestions for the different practice methods of integrated outpatient clinics in different regions: improve the rules and regulations for the construction of outpatient clinics of integration of general practice and specialty, coordinate and unify the outpatient path of outpatient clinics of integration of general practice and specialty, pay attention to the protection of outpatient clinics of integration of general practice and specialty teams, clarify the population of outpatient clinics of integration of general practice and specialty services, and improve the health evaluation system for the outcomes of outpatient clinics of integration of general practice and specialty. In order to provide reference for the country to carry out the construction of outpatient clinics of integration of general practice and specialty in depth. Further expanding the community service function and deepening the cooperation with specialist physicians is an important direction for the future exploration of the construction of outpatient clinics of integration of general practice and specialized health care service. The joint participation and promotion of the government, medical institutions and general and specialist physicians can better promote the construction and development of community general and specialized outpatient clinics.
Primary healthcare institution undertakes a significant responsibility in medical and health provision. As the medical industry has undergone continuous development, which is evident in the obvious improvement of facilities and medical treatment environment of community health service institutions, and the effectively upgraded health information systems, the public's demand for specialized medical treatment in community health service institutions is becoming increasingly prominent. This article discusses the significance of developing specialized medical technology in community, the connotation of general-specialized combination, as well as the implementation strategies and methods. The article points out that the construction and development of specialized diagnosis and treatment technology in community health service centers can enhance the ability of community general practitioners to practice, improve the level of primary medical care technology, upgrade the level of community health services and meet the public's demand for specialized diagnosis and treatment. The goal of general-specialty integration can be achieved either by developing specialized diagnostic and treatment techniques on the basis of general practice, or by collaborating with higher-level hospitals to introduce a series of specialized techniques. In terms of specific implementation strategies, it is necessary to find appropriate specialized technologies according to the local needs, develop advanced technologies, carry out scientific research around specialized diseases, and build technical resources by opening specialized outpatient clinics, allocating medical conditions, etc., and cultivate community talents along with the four construction work, so as to implement the development strategy of the all-specialized combination of community diagnosis and treatment technologies in the four-plus-one way.
At present, the collaboration of general practice and speciality has been applied to the diagnosis, treatment and management of various chronic diseases in the community based on the technical support of disease diagnosis and treatment and the implementation of hierarchical diagnosis and treatment. Based on the patient-centered, systematic and holistic thinking characteristics of general practice, the general practice team of Yangpu Hospital Affiliated to Tongji University explored and practiced a more comprehensive, in-depth and effective collaboration model of general practice and speciality around the multi-dimensional construction of 'six ones'. The construction of 'six ones' was based on the collaboration of general practice and speciality between general hospitals and community health service centers. Taking osteoarthritis (OA), a common chronic disease in the community, as an example, its contents and characteristics were as follows. (1) Establishment of a multidisciplinary team: the established team could rely on the basis of the three-dimensional integrated health care system of the general hospitals, to give play to the liaison and coordination role of general practice department in general hospitals, refine and coordinate the multidisciplinary division of labor; (2) Improvement of a set of diagnosis and treatment processes: improve a set of hierarchical diagnosis and treatment process for diseases based on scientific evidence, and evaluate the effectiveness of the diagnosis and treatment process, so that it could help to improve patients' symptoms and quality of life; (3) Development of an APP: the developed APP could cover multiple functions such as hierarchical diagnosis and management of OA patients, doctor-patient communication, popularization of science, appointment registration, and could record the complete diagnosis and treatment data in the exclusive information platform; (4) Designing a set of publicity and promotion programs: Publicize the program in multiple scenarios such as disease diagnosis and treatment, health examination and consultation in general hospitals and communities through a variety of forms of text, pictures and videos; (5) Establishment of a case database: establish a specific disease database for OA patients, continuously follow up patients and implement hierarchical management of the collected data, so as to provide more cases with general characteristics; (6) Construction of a set of curricula: the curriculum is built around OA specialties, including "bone pain as an undifferentiated disease in general practice" and "chronic disease management of OA", the course is conducted in the form of problem-oriented learning, outpatient consultation and teaching round demonstration, which was for multi-level training of undergraduate, graduate and continuing education. Taking the 'six ones' construction of OA management in the community as an example, the practice of the collaboration of general practice and speciality for the management of chronic disease based on the thinking of general practice suggests the potential of comprehensive, in-depth cooperation and mutual promotion between the two sides in multiple dimensions of medicine, teaching and research, as well as the effectiveness of optimizing and integrating the team, technology and information support related to hierarchical disease management for promoting the physical and mental health of patients.
