摘要
随着城镇化加快、生活方式变化及全球人口老龄化,慢性病带来的危害日益严重。慢性病的服务提供是卫生服务系统的难题之一,而慢性病管理模式为其创设了一个新的框架。本文主要介绍慢性病照护模式、慢性病自我管理计划和创新型慢性病照护框架3种国外经典慢性病管理模式,从特点、应用效果、局限性等方面进行比较,发现其核心要素包括多方协同、连续性服务、患者自我管理、循证决策、信息技术支持等。以上经验为我国的慢性病管理工作提供了新思路:建立政府主导、多元协同的管理制度,以家庭医生签约服务为“抓手”提高服务连续性,借力智慧医疗并强化患者赋能等,以期取得更好的慢性病管理效果。
In China,chronic disease prevalence is increasingly serious with the acceleration of urbanization,changes in lifestyle and the aging of the global population.Service provision for chronic diseases is one of the dilemmas for health service systems,and the chronic disease management model has created a new framework for it.In this paper,we mainly introduced the chronic care model,chronic disease self-management program and innovative care for chronic conditions framework,and compared them in terms of characteristics,application effects,limitations,and found that the core elements included multipronged synergy,continuous services,patient self-management,evidence-based decision making,and information technology support.The above experiences provide new ideas for the management of chronic diseases in our country:to establish a government-led and multi synergistic management system,to improve service continuity by contracting services from family doctors,to borrow wisdom medical treatment and strengthen patient endowment,etc.,in the hope of achieving better chronic disease management outcomes.
作者
朱璇
陈爱云
ZHU Xuan;CHEN Aiyun(School of Health Management,Guangzhou Medical University,Guangzhou 511436,China)
出处
《中国全科医学》
CAS
北大核心
2023年第1期21-26,共6页
Chinese General Practice
基金
国家自然科学基金青年项目(72004040)——家庭医生签约背景下慢性病服务质量及影响机制研究
广东省医学科研基金项目(A2020285)——基于慢性病管理模型的基层整合型卫生服务现状及优化策略研究。
关键词
慢性病
疾病管理
管理模式
慢性病照护模式
慢性病自我管理计划
创新型慢性病照护框架
Chronic diseases
Disease management
Management model
Chronic care model
Chronic disease self-management program
Innovative care for chronic conditions framework
作者简介
通信作者:陈爱云,副教授,研究生导师,E-mail:aiyunch1221@163.com。
