Who will manage it?, Social Health Center's Capability Enhancement Series Focus ② White Collar Health Community in the "Billion Building" | Family Doctors | Ability
[Editor's note]
249 community health service centers in Shanghai have built a grassroots health network. How can doorstep hospitals better care for the health of residents and enhance their medical treatment capabilities in response to an aging society? At the beginning of this year, the Shanghai Municipal Health Commission set a new round of community health service center construction goals: to protect the health of the people, positioning three centers, namely nursing center, rehabilitation center, and health management center. How to better serve community residents in the face of new service attributes? How do residents feel after experiencing it? Recently, reporters from Liberation Daily have continuously visited the Community Health Service Center in Changzheng Town, Putuo District, Dapuqiao Community Health Service Center in Huangpu District, and Tianshan Community Health Service Center in Changning District, recording the process, achievements, and even confusion of community construction as the "three centers".
At 10 o'clock in the morning, a wave of people flooded into the Jinhongqiao International Center in Changning District. In 2022, this place has become the third "tax revenue building worth billions" in Shanghai. On this ordinary workday morning, nearly 20000 white-collar workers have revitalized this gathering commercial district building amidst tension and busyness.
In the new round of construction of Shanghai Community Health Service Center, which focuses on nursing centers, rehabilitation centers, and health management centers, the long-standing concept that "going to community hospitals is just dispensing medicine for the elderly" is gradually being broken. As the backbone of urban construction, who manages the health of middle-aged and young white-collar workers? Do working people need family doctors? What can the community provide for them? Recently, a reporter from Liberation Daily and Shangguan News visited the Community Health Service Center on Tianshan Road in Changning District to gain insight into the "new groups, demands, and models" of health services.
The white-collar worker bluntly stated that "there is a direction"
Ms. Zheng, who is 35 years old, is a wave in the daily tide. Last year's dog days, she stepped into the "white-collar doctor hour" health new station for the first time. "She has been coughing repeatedly for more than three months, afraid of the cold, and has recurrent eczema in her limbs and joints.". She confided her condition to family doctor Xie Zhijin. Based on Ms. Zheng's physical condition, Xie Zhijin provided Du meridian moxibustion combined with the application of "winter disease summer treatment" to regulate her for nearly a month. This year's dog days have arrived again, and Ms. Zheng was pleasantly surprised. "I didn't cough much during the season change, and my symptoms quickly improved after Yang Kang. Although eczema still occasionally occurs, it quickly subsides."
As early as 2013, Changning District proposed the requirement of "family doctors entering buildings and serving professional groups" in conjunction with the "Six Conveniences" cohesion project; In 2016, Tianshan Social Health took the lead in utilizing the community party building platform to innovate the "white-collar doctor hour" project, exploring a new model of functional community family doctors serving professional groups. With the policy support of family doctors and assistants practicing in multiple locations within the district, we adhere to regularly conducting health consultations, health lectures, and appropriate traditional Chinese medicine diagnosis and treatment at the "Tianshan Business District White Collar Service Center" public service venues.
This is the new business district of the old city, gathering a large number of young white-collar workers. However, due to factors such as overtime, poor diet, mental stress, and lack of exercise, many young white-collar workers suffer from long-term health overdrafts. At the same time, there are many objective reasons why it is difficult for the working population to seek medical treatment. "The working hours completely overlap with the medical treatment time, even longer," Mr. Tang, 43, said with a bitter smile. The 2021 physical examination showed abnormal blood sugar, blood lipids, and uric acid. "I work in the catering industry in a hotel, and I eat irregularly and don't have time to exercise. I don't even know who to check with after the examination."
On the recommendation of his colleagues, he used his lunch break to go to "white-collar doctor hours" to interpret the report. Xie Zhijin carefully answered Mr. Tang's questions and suggested: "Reduce the intake of high-purity foods, such as animal organs, seafood, soy products, meat soup, beer, etc.; replace some rice with coarse grains for staple foods, and eat more high fiber foods such as corn, wheat, oats, green vegetables, etc.; use fragmented time to participate in aerobic exercise and reduce weight." In addition to lifestyle interventions, Xie Zhijin also prescribed chronic disease medicine and tea drinks for Mr. Tang, requiring him to drink them daily instead of drinks and milk tea. Now, as a contracted patient, Mr. Tang has his own family doctor and chronic disease management records, and conducts quarterly follow-up, which allows him to say "he has direction".
Personalization, privacy, timeliness, and precision - In recent years, family doctors who have dealt with white-collar workers in buildings have found that the health management of the working population is significantly different from that of elderly residents in the jurisdiction: firstly, there is a sense of shame towards illness, even if it is a common chronic disease, they do not want to be known by colleagues; The second is that time is tight and there is inertia, and services need to be delivered to the building during short periods of lunch break and off work; The third is targeted and clear, with shoulder, neck, and back pain relief, insomnia diagnosis and treatment, weight loss, and psychological counseling being the most popular.
Problem solving, employed population "signed up"
According to the introduction of Tianshan Social Health and Medical Science King Hospital Star, "white-collar medical hours" have moved from version 1.0 to version 4.0, and as of the end of last year, they have served more than 50000 people, filling the "gap" in health management for occupational groups in commercial buildings within the jurisdiction. However, they also admitted that the family doctor team is still exploring more suitable service models - while responding to every call, they are gradually getting closer to the full score answer sheet.
"The CEO fell down, and doctors from a top tier hospital told him that he needed rehabilitation, but there was a conflict between business and treatment time." "Orthopedics, orthopedics, and sports medicine, I can't distinguish them clearly." "Spending one or two hours attending a health science lecture, will the leaders feel that my business volume is not sufficient?" These genuine voices from the working population sometimes become a wall between them and health management. ". Fortunately, there is a Renji Jinhong Clinic serving as a "glue" between the Jinhongqiao International Center and Tianshan Social Health, joining the closed loop of enhancing occupational health management awareness with third-party forces.
The Renji Clinic, located on the 8th floor of the North Building of Jinhongqiao International Center, is a health service point approved by the Shanghai Federation of Trade Unions and the Shanghai Municipal Health Commission in the Shanghai industrial park. In addition to its own diagnosis and treatment services, it is also responsible for connecting various levels of medical institution resources for enterprises in its jurisdiction. After entering Jinhongqiao in 2021, it will become a powerful complement to social health care in Tianshan in the COVID-19 Test.
"After the epidemic, the public's demand for health has become even greater. In addition, health management services have quietly become an important means of attracting, attracting, stabilizing, and retaining businesses." According to Ji Min, founder and chairman of Renji Medical, "Changning District provides two models to more than 400 enterprises through government procurement services: 'finding the right doctor to see the right disease' and 'enterprise door-to-door', fully tapping into the value of a single visit, and exploring the dual employment system for family doctors in communities and tertiary hospitals, forming a long-term multi-point practice service."
Tianshan Social Health Director Bi Fangfang told reporters that with the cooperation of the street, park, and Renji Clinic, the "Family Doctor Face to Face" project will also be officially launched in the near future. The nucleic acid sampling booth next to the parking lot has been carefully renovated and will become a scheduled service point in the future. In addition to providing health consultation and rehabilitation therapy, family doctors can also sign contracts on-site.
Transforming "being signed" into "actively signing" is an important step that family doctors need to take in the health management of the working population. Li Gui, the Executive Director of Brother Business Limited, was very emotional: a health lecture that started at 3pm and continued until 7pm, leaving colleagues reluctant to leave; The first thing that post-90s employees of the company do on duty every day is to brew and raise raw tea; After learning that the community health service center could also extract teeth, a colleague born in 1995 decisively gave up the three-month queue at a tertiary hospital. "Enterprises can only pay for universal needs, and the one-on-one attention of family doctors is the real solution to the problem of 'capillaries' in health. A single glance and tone can become a bridge to build trust."
Explore multiple practice points and excellent performance rewards
A new scientific and sustainable, multi-party win-win operation mechanism has been launched in Tianshan Social Health: through a baseline survey of health status, a health service list has been developed, and service functions and contents have been expanded. Since August 2021, more than 20 general and rehabilitation therapy services have been carried out at Renji Jinhong Clinic, as well as more than 500 offline specialized services; Breast cancer screening and classification management were carried out to meet the health needs of female white-collar workers.
In Shanghai, the path of family doctor functional community service is steadily progressing. This year, the construction of 20 health service points in Jiayuan District has been included in the 2023 Municipal Government's practical project for the people. The person in charge of the Municipal Health Commission introduced that on the basis of "signing one person, fulfilling one person, and implementing one person", the city will be demand oriented, and promote the signing of functional communities such as enterprises and institutions, industrial parks, commercial buildings, and campuses in each district, steadily expanding the coverage of employment and school students. At the same time, we will strengthen our service capabilities and support social medical institutions and functional community medical institutions to provide family doctor signing services. Relevant institutions that meet the conditions and are willing will be included in the designated medical insurance system.
The health management of the whole population and the whole life cycle is aimed at the health management of the elderly, children, pregnant women and other key groups in the residential community, as well as the health management of hypertension, diabetes, tuberculosis and other key diseases. It is also the basic level network that provides a comprehensive, continuous and full process for young and middle-aged professional groups. Xie Zhijin said that as the center of the core family, health management small molecules can be formed around the working population, including the elderly, children, women, and children, based on the family unit, so as to truly play the role of family doctors.
Bi Fangfang revealed that in years of pilot experience, resident enterprises such as Ctrip provide payment for family doctor health management service fees through employee commercial insurance, while also being included in the scope of enterprise benefits. "We hope that family doctor services can enter a virtuous cycle of market value. In addition, it is necessary to work together from multiple parties to improve the evaluation system for the qualifications and abilities of multi-point practicing family doctors, strengthen the management of multi-point practicing agreements, and ensure the effective implementation of health management services. It is also necessary to enable family doctors to play to their strengths and truly achieve" more work, more benefits, and better pay "."
