On December 5, the National Health Commission held a conference to discuss deepening the implementation of primary healthcare services for the benefit of residents. The key initiatives for promoting chronic disease management are as follows: To begin, promote long-term prescription services for hypertension and diabetic patients in community and township health facilities, while progressively including other chronic diseases. Second, organize the compilation of the “National Guidelines for Prevention and Management of Hypertension” and “National Guidelines for Prevention and Management of Diabetes,” which guide primary healthcare institutions across the country in providing good health management services to patients with chronic diseases. Third, encourage contractual family doctors to treat patients, to assist them in preventing chronic diseases, and to provide multi-disease co-management services to patients with multiple chronic diseases. Fourth, boosting work-sharing and bidirectional referrals between primary healthcare institutions and higher-level medical institutions through the establishment of county medical communities.
国家卫健委：四方面举措推进慢性病管理
来源：医药网 2023.12.06
12月5日，国家卫健委召开新闻发布会，介绍深化实化基层卫生健康便民惠民服务举措有关情况。在推进慢性病管理方面，主要有以下几方面举措：一是推进在社区卫生服务中心、乡镇卫生院全面实施高血压和糖尿病长期处方服务，并逐步扩大慢性疾病病种覆盖范围；二是组织编制《国家基层高血压防治管理指南》和《国家基层糖尿病防治管理指南》，指导各地基层医疗卫生机构做好慢性病患者健康管理服务；三是依托家庭医生签约服务，推动预防和医疗相结合的服务，对同时患有多种慢性疾病的患者开展多病共管服务；四是依托县城医共体建设，推动基层医疗卫生机构与上级医疗机构间建立分工协作、双向转诊机制。
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