柳叶刀 | 基层医疗卫生机构在2019冠状病毒病防控中应发挥重要作用

《柳叶刀》（The Lancet）6月6日发表综述文章，由国家心血管病中心中国医学科学院阜外医院等国内外机构研究团队联合完成。文章提出，2019冠状病毒病的暴发使得基层医疗卫生体系在筛查和管理COVID-19患者，并同时维持其他常规诊疗等方面的作用备受关注。柳叶刀微信公众号邀请作者团队为读者带来相关内容的解读。

识别二维码阅读《柳叶刀》2020年6月6日刊

中国基层医疗卫生机构在抗击2019冠状病毒病中发挥的作用

过去十年中，中国出台了一系列政策，力图基于基层医疗卫生体系打造慢病和传染病防控管理的整合型的服务体系。其中，基层医疗卫生机构承担着覆盖全民的国家基本公共卫生服务项目，包括了高血压糖尿病患者健康管理、老年人健康管理等针对慢性病的内容，和预防接种、传染病报告等针对传染病的内容。(详见原文附件)近来的2019冠状病毒病（COVID-19）疫情的暴发也使得基层医疗卫生体系在筛查和管理COVID-19患者，并同时维持其他常规诊疗等方面的作用备受关注。
国家卫生健康委基层卫生健康司强调基层医疗卫生机构在疫情防控中应发挥重要作用，包括发热患者筛查、密切接触人员和康复患者管理，以及社区动员宣传等。[1]2020年2月，中国医学科学院针对全国基层医疗卫生机构的运营与服务情况开展调查，覆盖了全国31个省，335个地市的576家社区卫生服务中心和2986家乡镇卫生院。调查结果显示：92%的基层医疗卫生机构中医疗卫生服务正常开展，超过半数基层医疗卫生机构开设了发热门诊，超过八成基层医疗卫生机构开展了预检分诊服务。[2]
从基层医疗卫生机构在抗击新冠疫情中开展的实际工作来看，其作用体现了两方面特点。
一是多重任务。在抗击COVID-19的过程中，基层医疗卫生机构发挥疫情防控和患者救治的双重功能。以湖北省为例，据官方统计，全省基层医疗卫生机构每天出动医务人员8万余人次进行发热患者排查。[3]在部分疫情较重的地方，乡镇卫生院和社区卫生服务中心全员上阵投身到疫情防控与救治中。[3]在武汉市203家基层医疗卫生机构中，199家承担了疑似症状人群的预检分诊和分类筛查工作，201家承担了确诊病例密切接触者管理工作，173家承担隔离点医疗保障工作，147家承担对辖区内点位消杀工作，101家承担了居家死亡遗体处理工作。[3]此外，3家社区卫生服务中心和乡镇卫生院整体作为新冠肺炎的定点收治医院，10家可收治疑似或确诊病人，70家被抽调人员到定点医院支援。[3]二是区块化管理。政府坚持把农村和社区作为疫情防控重点，采取了一系列措施，确保防控抓早期、抓源头。以浙江省为例，开化县三管齐下：1、“家庭医生+网格化”管理，根据风险级别将全县常驻人员36.15万人、外出人员进行分类。[4] 家庭医生摸排出843名湖北返乡人员，联系到位率达到99%以上；2、“线上+线下”巡诊，组织发动了406名村医和卫生院巡诊医生参加392个乡村道路卡点的工作，开展体温排查和健康宣教，并在各村组建了微信群，普及疫情防控知识，每天还对医学观察对象早晚各进行一次电话随访；[4] 3、“总院+分院”分诊，村卫生室所有就诊患者询问接触史、外出史，并测量体温，一旦发现有发热病人立即以最快的速度转到定点县医院。定点县医院对这些患者提前安排留观病房进行住院隔离，确保把接触控制在最小范围。[4] END

We declare no competing interests.

Xi Li*, Harlan M Krumholz*, Winnie Yip*, Kar Keung Cheng, Jan De Maeseneer, Qingyue Meng, Elias Mossialos, Chuang Li, Jiapeng Lu, Meng Su, Qiuli Zhang, Dong Roman Xu, Liming Li, Sharon-Lise T Normand, Richard Peto, Jing Li, Zengwu Wang, Hongbing Yan, Runlin Gao, Somsak Chunharas, Xin Gao, Raniero Guerra, Huijie Ji, Yang Ke, Zhigang Pan, Xianping Wu, Shuiyuan Xiao, Xinying Xie, Yujuan Zhang, Jun Zhu, Shanzhu Zhu, Shengshou Hu

*Contributed equally

National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (X Li PhD, J Lu PhD, M Su PhD, Q Zhang PhD, Prof J Li MD, Prof Z Wang MD, Prof H Yan MD, Prof R Gao MD, Prof S Hu MD); Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, China (X Li PhD, J Lu PhD, Prof J Li MD, Prof H Yan MD, Prof S Hu MD); Section of Cardiovascular Medicine, Department of Internal Medicine, Yale  school of Medicine and the Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA (Prof H M Krumholz MD); Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT, USA (Prof H M Krumholz MD); Department of Global Health and Population (Prof W Yip PhD) and Department of Biostatistics (Prof S-L T Normand PhD), Harvard T H Chan School of Public Health, Boston, MA, USA; Department of Health Care Policy, Harvard Medical School, Boston, MA, USA (Prof S-L T Normand PhD); Institute of Applied Health Research, University of Birmingham, Birmingham, UK (Prof K K Cheng FMedSci); General Practice Development and Research Center (Prof K K Cheng), School of Oncology (Prof Y Ke MSc), and School of Public Health (Prof Q Meng PhD, Prof L Li MD), Peking University ealth Science Center, Beijing, China; Department of Public Health and Primary Care, center of Family Medicine, Ghent University, Ghent, Belgium (Prof J De Maeseneer PhD); Department of Health Policy, London School of Economics and Political Science; Institute of Global Health Innovation, Imperial College London, London, UK (Prof E A Mossialos PhD); Health Commission of Shenzhen Municipality, Shenzhen, China (C Li MPH); Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK (Q Zhang PhD); Sun Yat-sen Global Health Institute, Sun Yat-sen University School of Public Health, and Institute of State Governance, Guangzhou, China (Prof D R Xu PhD); Nuffield Department of Population Health, University of Oxford, Oxford, UK (Prof R Peto FRS); National Health Foundation, Bangkok, Thailand (S Chunharas); Xizhuangzi Village Clinic, Jinchang, China (X Gao); Director General Office, WHO Headquarters, Geneva, Switzerland (Prof R Guerra MD); Yaojia Township Primary Care Clinic, Zhengzhou, China (H Ji); Department of General Practice, Zhongshan Hospital of Shanghai Medical College Fudan University, Shanghai, China (Prof Z Pan MD, Prof S Zhu MD); Sichuan Center for Disease Control and Prevention, Chengdu, China (Prof X Wu MD); Xiangya School of Public Health, Central South University, Changsha, China (Prof S Xiao MD); Health Commission of Yunnan Province, Kumming, China (X Xie MB); Jijie Township Primary Care Clinic, Gejiu, China (Y Zhang); and National Office for Maternal and Child Health Surveillance of China, Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China (Prof J Zhu MSc) 

Correspondence to: Prof Shengshou Hu, National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China

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参考文献（上下滑动查看）

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2. Department of Primary Health of National Health Commission. Fighting against the epidemic: the actions of local PHC providers - 13. 2020. http://www.nhc.gov.cn/jws/s3582k/202003/c13303ef5da1475d8c92afb7499d230b.shtml (accessed Apr 15 2020).

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4. Department of Primary Health of National Health Commission. Fighting against the epidemic: the actions of local PHC providers -2. 2020 http://www.nhc.gov.cn/jws/s7873/202002/41a0250ddc5d4d1bb6fe721ad6a00201.shtml (accessed Feb 22 2020).

题图：Coyright©Shutterstock/ junrong

*中文翻译仅供参考，所有内容以英文原文为准。

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