Related information on family doctor contract services (circulated internally, please do not post on Moments)

1. What are long-term prescriptions and extended prescriptions for chronic diseases?

For details, please refer to the second paragraph on page 9 of Wanwei Medical Reform Office No. 20172. The best answer has been given: For patients with chronic diseases who have stable conditions and good compliance, their family doctors can Therapeutic medications are prescribed for 4-8 weeks at a time. For contracted residents who have been referred to a specialist or general hospital by a family doctor, when they return to a primary medical and health institution for treatment, the family doctor can continue to use the hospital's prescription drugs, or prescribe necessary non-essential drugs based on their condition and the doctor's orders from the hospital to which they were transferred. In principle, drugs prescribed for common diseases contracted by contracted residents in secondary and above medical and health institutions can be provided in primary medical and health institutions.

2. Contents and assessment indicators of the “Six Ones” activities for family doctor contract services

(1) Organize a publicity event. To give full play to the role of the contracted service team as a "work team, service team, and publicity team", we can use forms that are popular with the masses, using publicity layouts, electronic scrolling screens, banners, slogans on street walls in towns (villages), taxi electronic screens, newspapers Carry out extensive publicity through TV, WeChat and other methods to achieve synchronized promotion of publicity and services, and increase the public's awareness of family doctor contract services.

(2) Provide one-time door-to-door service. The family doctor contracting team should improve the service model, adopt staggered services, appointment services, and make use of holidays, leisure time, etc. to provide one-time door-to-door services for contracted residents with chronic disease patients and domestic and foreign inpatients in the jurisdiction, promote health knowledge, carry out rehabilitation care, and provide Follow-up intervention activities focusing on traditional Chinese medicine services, publicity of health knowledge, medication guidance, dietary guidance, health assessment, institutionalized personalized treatment plans, and updating of health records.

(3) Prescribe a health prescription. Based on electronic health records, family doctors conduct a health assessment on contracted residents, carry out health education, analyze health problems, and propose personalized health prescriptions. For the sick people and key groups, the causative factors, pathogenesis, and diagnostic criteria of the disease are concisely explained; targeted guidance, intervention, treatment principles of traditional Chinese and Western medicine, health care measures, and suggestions for further treatment are proposed.

(4) Conduct a follow-up visit. According to the characteristics of different contracting groups, various modes such as night follow-up, holiday follow-up, telephone follow-up, and WeChat follow-up are adopted to issue extended prescriptions and long prescriptions, and provide basic public health services, disease referral, rehabilitation guidance and other services.

(5) Establish a referral channel. Each unit must establish a hierarchical diagnosis and treatment office, with the family doctor contracting team leader as a member. The team leader will issue an outpatient medical record for patients who need to be referred and instruct the referral office to issue a referral form, register and collect outpatient medical records.

(6) Conduct a free physical examination. Free health examinations are provided to registered poor people aged 50-59, which are specifically undertaken by grassroots medical and health institutions and family doctor contracting teams. Please see the attachment for physical examination standards and items. We should also make an organic connection with the special treatment of serious diseases for rural poor people in the health poverty alleviation work, and provide medical treatment to newly discovered poor people in designated hospitals.

Supervision and inspection content

1. Wanrong County Family Doctor Contracting Service “Six Ones” Promotional Activity Registration Form

2. Wanrong County Family Doctor Contracting Service” "Six Ones" Chronic Disease Follow-up Door-to-Door Service Registration Form

3. Wanrong County Family Doctor Contracting Service "Six Ones" Health Prescription Registration Form

4. Wanrong County Family Doctor Contracting Service Service "Six Ones" follow-up registration form

5. Organization structure of hierarchical diagnosis and treatment office, referral slip stub, registration form

5. Survey of poor residents aged 50-59 in Wanrong County Roster of basic survey

6. Physical examination roster of poor contracted residents aged 50-59 in Wanrong County

3. Publicity slogan for family doctor contract service

(optional)

Article 4 of Wanwei Jifa No. 2017195 "Closing the Last Mile" stipulates that family doctor promotion slogans should be written in communities and villages. You can refer to the following content:

1. Family doctor Enter Wanjia and sign a contract to serve you, me and others

2. Family doctor-style services to protect your health

3. Doctors and people are connected, and health and health are closely linked.

4. Sign up for family doctor-style services, allowing you to have your own health care doctor

5. Responsible doctors enter rural areas and provide health services to families

6. Family Doctors - the health gatekeepers of urban and rural residents

7. Develop good living habits and advocate healthy and civilized life.

8. Seeking a family doctor first can save you trouble, effort and money.

9. Let families have doctors and let doctors enter families.

10. Carry out family doctor contract services - let every household have a family doctor and everyone enjoys health care.

11. Family doctors - the health gatekeepers of urban and rural residents.

12. Attentive service, contracted family doctor-style service

13. Family doctor - let healthy people live healthier and sick people live better , making medical treatment more convenient and dignified for the elderly with limited mobility.

14. Have your own responsible doctor and actively sign up for family doctor-style services

15. Public health services are available everywhere, ensuring health and benefiting every household.

16. Hygiene protects health, and services help communities take off.

17. Family doctors are in every household, providing health services to you, me and others.

18. Establish public health care, enthusiasm, carefulness and patience in service concepts, and create a warm, comfortable, assured and happy medical atmosphere for residents to seek medical treatment.

19. The steward of residents’ health, sincerely serving everyone.

20. Protect your health, enjoy discounts, and provide family doctor-style services to thousands of homes

21. Public health is people-oriented, and caring for health is based on caring for people.

22. Protect your health and enjoy discounts, family doctor contract services are available to thousands of families.

23. Go into the countryside, go deep into the family, serve the people, and live a healthy life.

24. Family doctors—housekeepers of residents’ health, serving everyone sincerely.

25. Family doctors have entered thousands of households, and healthy lives have warmed thousands of families.

26. Purchasing a contract service package for the elderly is the best gift to honor the elders.

27. Healthy life has an appointment, sincere service is unlimited.

28. Serve with heart, help each other with love, and public health creates a healthy road.

29. What better way to honor your elders is to purchase a contract service package.

30. Care is everywhere and health is real.

31. Sign up for services to enter the family and be a good health gatekeeper.

32. Make an agreement with the doctor that a dedicated person will take care of your health.

33. I am a family doctor and health consultant who helps you take care of your health and see a doctor.

34. Healthy life has an appointment, sincere service is unlimited.

4. Interpretation of family doctor contract service policy

1. What is the content of family doctor contract service?

Answer: The contracted services are composed of free services and paid services, mainly including basic public health services, basic medical services and appointment referrals, personalized health management services, home bed services, and correspondence Service package settings, etc.

2. What phenomena should we pay attention to now?

Answer: It is strictly prohibited to "emphasis on contract signing and neglect of contract performance", "emphasis on form and neglect of service", "emphasis on progress and neglect of quality", etc. to ensure the smooth implementation of contracted services.

3. What are the key contents and work goals of the current contracted services?

The contracted service targets all residents. The key targets of the contract service in the initial stage are registered poor households, poor families with family planning, elderly people over 65 years old, patients with chronic diseases, preschool children, pregnant women, people with severe mental disorders recovering at home, patients with advanced cancer maintenance treatment, and living Disabled persons, bedridden persons and other residents with contracted service needs are inconvenienced. First, ensure that all poor people are included in the scope of family doctor contract services and provide corresponding free contract services. By the end of 2017, the coverage rate of family doctor contract service will reach more than 35%, the coverage rate of contract service for registered poor households and family planning poor families will reach more than 95%, and the coverage rate of contract service for key groups will reach more than 65%.

4. How are the members of the family doctor contract service team divided?

Answer: The contract service adopts the form of team service, and the doctor (general practitioner) of the township health center is the first person responsible for the contract service. The team is composed of general practitioners, specialists, registered nurses, village doctors, health managers (or psychological counselors), social volunteers, etc. The specialists are served by doctors from secondary hospitals, providing timely and comprehensive technologies for family doctor contract services. Support, responsible for the clear diagnosis of patients' conditions and the formulation of individualized treatment plans, and teaching general practitioners and health management personnel; general practitioners are responsible for implementing the treatment plans of specialists, grasping and handling the condition in a timely manner, and communicating with specialists in a timely manner , make appointments for expert clinics, and guide the work of health management personnel; nurses, health managers, psychological counselors, village doctors, etc. assist specialists and general practitioners in communicating with patients, and are responsible for daily follow-up and screening of patients, and individualized health Education, and lifestyle interventions such as diet and exercise.

5. Family Doctor Contracting Service Questionnaire

Name: Gender: Age: Population Attribute: Contact Number:

Hello, I am from xx Township (Township) ) of the health center. Are you xxx (patient’s name)?

1. Have the health center or the doctors at the health center signed a service agreement with you?

2. What disease do you suffer from? Do you take medication every day? Do you know the name of the medicine and how to take it?

3. What is the name of your family contracted doctor?

4. Do you have his contact number?

5. Do you know the responsibilities of a family doctor?

6. What services has your family doctor provided you?

7. How often does a family doctor provide health services?

OQuarterlyOMonthlyOWeeklyOBy phone

8. Have doctors from health centers or clinics come to your home to check your health? How many times have you been inspected this year? ONot checkedOOnceOTwiceOMultiple times

9. Are you satisfied with the family doctor service?

10. What are your opinions and suggestions on the contracted services:

6. Healthy Poverty Alleviation Questionnaire

Name: Gender: Age: Population Attribute: Contact Phone:

Hello, I am from the xx Township (Town) Health Center.

Are you xxx (patient’s name)?

1. Has your family doctor signed a service agreement with you?

2. What kind of disease do you suffer from?

3. What is the name of your family contracted doctor? Can you contact him?

4. What services has your family doctor provided you?

5. How often does a family doctor provide health services?

OQuarterlyOMonthlyOWeeklyOBy phone

6. Have personnel from medical institutions come to your door to check your health? How many times have you been inspected this year? O Not checked O Once O Twice O Many times

7. Have you seen a doctor or been hospitalized this year?

O Have not seen it O Have seen outpatient services O Have been hospitalized

8. Has the doctor publicized basic medical insurance, critical illness insurance and other compensation policies to you? Clear

9. Do you know the policies of “diagnosis first, payment later” and “centralized treatment of serious illnesses”?

O know one thing O know two things O don’t know

10. Are you satisfied with health poverty alleviation? What are your opinions and suggestions on health poverty alleviation work:

7. Brief description of family doctor contract service

Unit name: Name: Service scope (village name):

1. What are the specific service contents of the family doctor contract service?

2. What is the process for signing up a family doctor service?

3. How many households and people does your team serve? How many households and people have signed contracts so far? Can it reach 35 of the total number of people in the village you are in charge of?

4. Do you know the specific responsibilities of the family doctor who signed the agreement? Do you know the specific responsibilities of rural cadres who have signed the agreement?

5. Your opinions and suggestions on family doctor contract services:

8. Brief questions on health poverty alleviation

1. What is "double contracting"?

2. Who are the target groups of family doctor contract service, health poverty alleviation and dual contract service? How many people are there in each of your towns?

3. Do you know the policies of “diagnosis first, payment later” and “centralized treatment of serious illnesses”? Briefly describe them.

4. What health poverty alleviation policies do you know now?

5. Do you have any opinions or suggestions on health poverty alleviation work?