Health services extend to families

The report of the 20th National Congress of the Communist Party of China put forward: "Promote the expansion of high-quality medical resources and balanced regional distribution, adhere to prevention, strengthen the health management of major chronic diseases, and improve the ability of grassroots disease prevention and treatment and health management." To improve the ability of disease prevention and treatment and health management at the grassroots level is to solve the difficulties and pain points of the masses to see a doctor and actively respond to the needs of the aging population. In recent years, China has actively developed medical care for the elderly, family beds, home care and other services to promote the extension of medical and health services to communities and families.

At present, home bed services have been launched in many places to provide medical services for elderly or disabled elderly people with home medical needs and mobility difficulties, so that patients can receive medical treatment, nursing or rehabilitation in a familiar home environment.

Take the family as the daily nursing place, meet the medical needs of patients with mobility difficulties, and reduce the burden of medical expenses of patients

In Fuzhou, Fujian province, Shanghai Street Community Health Service Center doctor Lin Fenghua and nurse Jiang Huiling on the back of the tour bag ready to set out, this day is the day they build a bed for the family bed object Liu Yimei tour. In the tour package, there are stethoscope, percussion hammer, blood pressure meter, blood glucose meter, catheter and other equipment prepared a day in advance. Tap the doorbell, into the room, Jiang Huiling and Liu Yimei greeted: "Grandma, how do you feel this time?"

"I've been eating and sleeping well lately, and I'm finally expecting you again." Ms. Chen, Ms. Liu's daughter, replied.

Question and answer, Lin Fenghua for the elderly auscultation, blood pressure, after the basic inspection project, Jiang Huiling will Liu Yimei turned over, carefully check her skin. Seeing an eczema on the shoulder of the old man, Jiang Huiling took out the ointment from the touring bag, gently applied it, and turned her head to tell her family: "Long-term bed is easy to grow eczema and bedsores, and you should remember to apply the medicine on weekdays."

Last Spring Festival, 93-year-old Liu Yimei fell and broke a bone. Go to the hospital, because of old age, the doctor recommended conservative treatment. After returning home, the old man is in bed, the family can take turns to take care of life, can encounter medical operations such as replacing urine tubes, but also have to go to the hospital. "Every time I go to the hospital, I have to go up and down. When I get to the hospital, I have to take the number, queue up, and change the medicine. Watching her mother suffer, Ms. Chen was also anxious to wipe tears.

In February 2021, Fuzhou, Fujian Province, launched a pilot home bed service to provide home bed services to eligible patients. In the pilot program, it is clear that the family bed should be built for patients with clear diagnosis, stable condition, need to stay in bed due to illness or are weak, unable to take care of themselves, and need medical staff to regularly come to the home for treatment, nursing and rehabilitation.

"Hospital stays are available at home, and there are regular visits by medical staff." Ms. Chen's eyes lit up. On the "Rong Medical Pass", Ms. Chen filled in the basic situation of her mother, selected the nearest pilot medical institution, uploaded medical records, hospitalization summary, related auxiliary examination and image report, drug list and other medical records before submitting the application. On the same day, Ms. Chen received a phone call from the Shanghai Street Community Health Service Center, and then made an appointment with a doctor to assess and arrange the construction of a bed. Since then, the doctors and nurses of the community health service center will come to the house once a week to diagnose Liu Yimei's condition, change drugs, and guide her family to do daily care.

Ms. Chen told reporters that a bed-building cycle is 3 months, the total cost is only more than 4,000 yuan, after the medical insurance pooling, the cost of the individual to pay as long as 1,000 yuan, "for us to reduce a lot of burden!"

By the end of 2021, there will be 267 million people aged 60 and above, and more than 200 million people aged 65 and above, according to the National Health Commission. More than 190 million elderly people suffer from chronic diseases, and about 40 million disabled or semi-disabled elderly people have an urgent need for home medical services. The family hospital bed service takes the family as the daily nursing place, and the medical staff checks the physical condition every week to provide nursing services, which can not only meet the medical needs of patients with mobility difficulties, reduce the burden of medical expenses of patients, but also alleviate the problem of hospitalization to a certain extent.

In recent years, various places have actively explored the service model of family bed. Shanghai Municipality has issued the Measures of Shanghai Municipality on Family Hospital Bed Service to ensure the medical quality and safety of family hospital bed service from the aspects of unifying service process, standardizing service behavior and strengthening quality control. The service mode of family beds in Daxing District of Beijing focuses on the urban and rural areas and the rural areas, so that the high-quality medical resources are tilted to the elderly and disabled groups; Qufu City of Shandong Province does not charge bed fees for the elderly who meet the service conditions of family beds, other medical expenses are settled according to the hospitalization standard, and home medical care services are included in the scope of long-term care insurance.

Strengthen the construction of grassroots medical staff, effectively allocate medical resources, and improve the quality and level of service

At present, most of the family bed services are carried out by community health service centers, township hospitals or secondary and lower hospitals with general medicine. The service capacity of primary health care institutions is limited, and the care targets of family beds are older people. What should we do in case of serious illness?

"Family beds will be evaluated in detail before the construction of beds, and the center is currently providing basic medical services." Patients with other treatment needs can be transferred to higher level hospitals at any time." Fuzhou City Shanghai street community health service center director Zhou Weimin introduced.

Huang Yanguang, director of Huqian Community Health Service Center, Wufeng Street, Fuzhou City, said that the center has established a compact medical alliance with the Second hospital of Fujian Province, and the second hospital of Fujian Province has specially arranged two doctors and nurses as the consultant team of Huqian Community health Service Center's family beds. "When there is a problem beyond our ability to solve, the consultant team plays a role and quickly connects with the appropriate department to save time for patients to be transferred to a superior hospital." Huang Yanguang said.

Compared with the traditional sitting mode, home bed service requires medical staff to go out of the institution and carry out door-to-door service, which has certain requirements on the communication ability, diagnosis and treatment level and experience of medical staff. Some primary medical staff said that the pain point of family beds is the lack of capacity of primary medical institutions.

"Different from the ready-made inpatient medical teams in public hospitals, the service quality of primary medical institutions is uneven and the number of medical personnel is insufficient. To promote family bed services, the construction of medical personnel, service level and participation enthusiasm need to be improved." A person in charge of a grass-roots community service center suggested that the team of grass-roots doctors should be further built, and the enthusiasm of medical staff engaged in family bed work should be stimulated by means of performance incentive and title evaluation.

Zhong Zhihua, director of the basic Health Department of Fuzhou Health Commission, introduced that in order to improve the service ability of medical staff to build beds for patients, on the one hand, Fuzhou opens up the city's medical resources, invites experts to record courses online, and grassroots medical staff can learn at any time; On the other hand, grassroots health service centers are encouraged to carry out further training for medical staff relying on medical associations and nursing technical assistance bases.

In the Shanghai Community Health Service Center, Zhou Weimin arranged four doctors and four nurses to specialize in family hospital bed service, and gave priority to recommending medical staff engaged in family hospital bed work in the selection of training personnel. A few months ago, Jiang Huiling finished a three-month off-job training at the provincial Cancer Hospital. "In the past, there were fewer specialized nursing practices commonly used in family beds such as intravenous catheters and stomostomy, and after training, I became more skilled in my own operation and more confident in the technology." Jiang Huiling said.

In order to improve the quality and level of family bed service, Fuzhou has also launched an online monitoring module for family bed service to dynamically monitor the development of family bed service in real time, further improve the efficiency of doctors' consultation and effectively allocate medical resources. In the background of Fujian primary medical health information system, the reporter saw that the number of beds built in all family bed medical institutions in the city, and the number of visits and medication records of each family bed patient were presented one by one. After the bed is removed, the system also invites patients and their families to conduct satisfaction surveys.

We will strengthen the connection with long-term care, old-age care and other forms of service, and improve the ability of community-level disease prevention and treatment and health management

A few years ago, Uncle Liu, who lives in Lijiatuo Street, Banan District, Chongqing, was found to have chronic obstructive pulmonary disease, and was paralyzed in bed after an accident. Mr. Wang, the family member, applied for a family pension bed for the elderly, and after a door-to-door assessment, the staff moved smart devices such as bracelets and visual intercom into Uncle Liu's home.

"Considering that the elderly man has chronic obstructive pulmonary disease and is bedridden for a long time, we also applied for home bed service for him." Kong Yifei, the person in charge of Lijiatuo Community elderly care Service Center, told reporters that the central care workers provide basic personal care such as turning, scrubbing, feeding and massage, and the medical staff of the community health service center regularly come to the house, responsible for the operation of chronic obstructive pulmonary disease care and household portable oxygen machine and other medical equipment, multi-linkage to provide better care for the elderly.

Move the "bed" into the home, not just the family bed. Family beds are connected with long-term care, old-age care and other service forms, which can provide continuous medical and nursing services for residents. The relevant person in charge of the Banan District Civil Affairs Bureau introduced that the future will strengthen the integration of medical care, further strengthen the exploration of the organic integration of elderly care beds and family beds, and realize the interoperability of mechanisms, mutual recognition of standards, and resource sharing.

The reporter's interview found that Zhejiang, Guangdong and other places are also actively exploring, encouraging the combination of family elderly care beds and family beds to promote the formation of complementary medical care and rehabilitation services in the home environment, in order to solve the problem of elderly people's home care and medical treatment. For example, the Xihu District of Hangzhou, Zhejiang Province, civil affairs and health departments jointly issued the "Xihu District on the establishment of" One bed for the elderly "service mechanism of the implementation plan (trial)" to explore the establishment of "one bed for the elderly" service mechanism, the family hospital bed and home care bed "two beds" integration. At present, pilot projects have been carried out in some streets to provide convenient medical services and personalized life care services for the elderly.

"Family beds are suitable for patients with chronic diseases who cannot be treated intermittently all year round, patients who need to stay in bed for a long time due to disease, etc., they are clearly diagnosed and meet the hospitalization conditions, and are suitable for regular systematic treatment, nursing and rehabilitation by medical staff under home conditions after assessment." These patients often have both medical and in-home care needs." Lu Yang, deputy director of the geriatrics Department of the First Affiliated Hospital of Chongqing Medical University, said that the connection between family beds and family nursing beds and other service forms is complementary, allowing the elderly to enjoy home care and professional medical services at the same time.

To expand the use of family beds and strengthen home medical and elderly care services, the key is to improve the community-level capacity for disease prevention and treatment and health management. A person in charge of a grass-roots community service center said that it is necessary to strengthen the construction of the team, equip the remote care system, improve the family bed medical liability insurance, etc., so as to protect the personal safety of medical personnel and the legitimate rights and interests of both doctors and patients, and enrich the service supply and service mode for the elderly.

Lu Yang believes that to better play the role of family beds, we should further make efforts in institutionalization and standardization, and improve the norms of family beds and home nursing services. For example, further clarify the object, service content, service form, service agreement and operation norms of family doctors' home medical services; Establish a family bed quality control and evaluation mechanism, and regularly evaluate the service quality of family beds and the satisfaction of service objects. At the same time, it is necessary to guide social forces to actively participate, coordinate regional medical resources, and increase the supply of home medical services.