New connotation of primary health care for the future: a brief description
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摘要: 初级卫生保健的传统概念和内涵已不能很好地适应人类社会经济和健康领域的发展。本文基于对初级卫生保健传统概念的发展回顾和内涵分析，指出其与社会发展脱节的特征内容，在传统概念的基础上进行更深入地概述，构建面向未来的初级卫生保健新内涵为：以社区为基础，依靠科技、社会创新和多部门协作，提供以人为本的整合型服务，同时具备应对突发卫生事件及气候和环境变化的能力。此新内涵共包括以社区为基础、整合和连续性、技术与社会创新、应急管理、应对气候和环境变化、政策环境支持6个特征。Abstract: Conventional concept and connotation of primary health care are no longer being well adapted to the development of human society, economy and health. After reviewing the development of conventional concept of primary health care, we analyze the concept′s characteristics that do not adapt to social development. Based on the conventional concept, the future - oriented connotation of primary health care is to provide community - based, integrated and people - oriented services which rely on technology, social innovation and multi - sectoral collaboration, and with the capacity to respond to health emergencies and climate and environmental change. The new connotation of primary health care would possess following six features: providing community - based service, with integrative and continuous framework, incorporating technological and social innovation, participating in emergency management, being capable of participating in response to climate and environmental change, and with policy environmental support.
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Key words:
- primary health care /
- new connotation /
- construction /
- farsightedness
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表 1 初级卫生保健的整合和连续性分析[31]
特征 维度 概念 初级卫生保健内容 整合 临床整合 为个人提供协调、连续服务 以患者为中心
构建和谐的医患关系
居家照护和随访服务
教育培训、同伴支持
病例管理专业整合 跨学科专业人员为特定人群提供全面协调服务 跨学科协作团队
过渡护理服务组织整合 在不同机构间协调，为特定人群提供的服务整合 跨机构协作服务
配套服务
社区互动
教育和培训系统整合 系统内规则和政策的统一，为人群提供全方位服务 卫生和社会服务网络
健康融入所有政策功能整合 围绕服务提供过程的支持性功能和活动整合 财务、管理和信息系统
技术支持规范整合 共同的使命、愿景、价值观和文化 健康文明建设 连续性 管理连续性 提供协调一致的服务以满足患者整个生命周期的健康需求 个人及家庭的积极参与
个人、家庭和服务提供者共同制定决策方案
以患者为中心，根据健康需求和选择偏好提供个性化服务
社区综合护理
跨学科团队护理
跨部门协作管理
教育和培训关系连续性 建立患者与服务提供者之间积极、持续、稳定的信任关系 个人及家庭的积极参与
维持患者和提供者之间和谐人际关系
固定的服务提供者或团队
居家照护和随访服务，提供自我管理支持
患者和服务提供者之间相互了解和信任
以患者需求为驱动，提供个性化服务
适应患者和家庭行为、文化信仰等的服务
同伴支持、社区社交网络信息连续性 患者与服务提供者以及提供者之间及时、完整、准确的信息传递和共享 和谐的医患沟通
患者对病情、护理决策的知情了解
居家照护者、社区卫生工作人员的作用
电子健康档案
共享、同步医疗记录
构建统一的标准化信息平台
创新技术支持
教育和培训纵向连续性 保证患者在跨机构的卫生服务系统中能够获得有序、无缝的多机构服务 出院计划
跨机构专业人员联系
转诊协调策略
机构间交流学习
病例管理或指导护理
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表 2 初级卫生保健的技术创新分析
内容 技术创新 领域 临床医疗、公共卫生、生物科技、卫生管理、医药 分类 产品创新、服务创新、流程创新、组织创新、系统创新 要素 政策制度（专利、保密协议等）；供应网络和产业结构（软硬件生产商和供应商）；基础设施（互联网、共享数据平台等）；人才基础；市场和用户（社会目标群体，服务接受者、医疗服务人员、医疗卫生机构等）；社会和文化因素（特定社会情境和健康需求）；健康资源（信息、资金等）；态度基础（增强对技术的认同和预期，消除偏见）。 目标 需求满足、健康改善、质量和安全、成本效益、公平性、可及性 实例 远程监控、可穿戴健康设备、数字化平台、人工智能
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表 3 初级卫生保健的应急准备和应急行动比较
项目 应急准备 应急行动 目的 促进健康和发展，
做好应急保障在紧急情况下保障生存 背景 稳定发展的社会条件 遭遇突发公共卫生事件等
紧急情况资源利用 使用合理的整体资源 利用一切可以调动的资源 原则 优化（有效性） 最大化（效率） 特点 关怀、沟通、注重人际关系 相对强制 患者层面 自主性和参与性 服从性 时间维度 长期 短期 服务性质 综合和整合服务 专业化服务（效率优先）
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