Hospitals above the second level must add a new department! The era of medical and preventive integration has come

Medical institutions above the second level should set up public health departments independently!

Author| Rao Shuxin (Intern Editor)

Source| Medical Community (ID: vistamed)

Recently, the Hubei Provincial Health Commission issued the "Guiding Opinions on Strengthening the Public Health Responsibility of Medical Institutions (Trial)", which requires that secondary and above comprehensive medical institutions, traditional Chinese medicine hospitals, specialized hospitals, township health centers, and community health service centers need to set up independent public health departments.

At the same time, the opinions make it clear that all types of medical institutions at all levels should establish a hospital public health work leading group headed by the main responsible person, and include public health work in the important business work of the hospital and take it as an important part of the internal performance appraisal of medical institutions.

The opinions point out that medical institutions should regularly organize clinical medical staff to carry out full training in public health knowledge and skills such as epidemiology, infectious diseases, hospital infection control, biosecurity, and health emergency management every year. Physicians specializing in internal medicine in medical institutions at or above the second level are required to complete public health ability training at the CDC at the county level or above for not less than 3 months before being promoted to deputy senior title, so as to improve the clinicians' ability to timely discover, quickly warn, report and effectively respond to major infectious diseases. Implement special training for public health physicians. Public health physicians in primary medical and health institutions should participate in no less than 15 days of training on infectious disease monitoring, early warning and reporting capabilities every year, and participate in a foodborne disease monitoring and reporting professional skills training. Public health physicians at all levels of medical institutions are encouraged to participate in the standardized training of public health physicians organized by the state and provinces.

The opinions make it clear that medical institutions are an important part of the public health system and the forefront of early detection, early reporting and early disposal of public health emergencies such as infectious diseases. It is necessary to establish an information push and automatic capture mechanism between medical institutions and public health professional institutions such as the CDC, build a closed loop of population health information data throughout the life cycle, realize the effective connection of public health services and medical services, and promote the transformation of medical institutions from disease diagnosis and treatment to full health management.

It is also necessary to strengthen coordinated monitoring of medical care and prevention, strengthen the coordinated monitoring of medical institutions and the CDC, improve the sensitivity and accuracy of monitoring and evaluation of unexplained diseases and abnormal health events, and establish an intelligent multi-point early warning trigger mechanism. Carry out joint handling of the epidemic situation, for cases of unexplained diseases, medical institutions should report to the local CDC at the first time and provide samples in a timely manner, give full play to their professional advantages, and jointly carry out pathogenic microbial detection, epidemiological investigation, on-site disposal, medical treatment, and scientific research, so as to achieve complementary advantages and resource sharing.

It is understood that Hubei Province is not the first province to make such a request. In the past two years, a number of provinces, municipalities and autonomous regions across the country have issued documents and taken similar measures to clearly require the strengthening of the public health prevention and control system, and the establishment of independent public health departments in medical institutions in the province to perform corresponding duties.

In March 2021, the Hainan Provincial Health Commission issued the Notice on Doing a Good Job in the Establishment of Public Health Departments and Physician Allocation in Township Health Centers (Community Health Service Centers), which clearly requires that all township health centers (community health service centers) in the province should set up public health departments, and public health physicians should be equipped with at least 1 per 10,000 service population.

In July of the same year, the Jiangsu Provincial Health Commission issued the Notice on Promoting the Establishment of Public Health Departments in Hospitals Above the Second Level, requiring hospitals above the second level in the province to establish a public health department by the end of September to coordinate and be responsible for public health work in the hospital.

At the end of 2020, the General Office of the People's Government of Sichuan Province issued the Guiding Opinions on Building a Long-term Mechanism for Respecting Medical Institutions and Emphasizing Health, requiring that the public health responsibilities of medical institutions be strengthened, and that medical institutions at or above the second level should set up or clarify public health departments, allocate public health personnel in accordance with regulations, and incorporate the allocation, training, and use of public health talents into the medical institution level review and performance appraisal index system.

Earlier, in 2012, the Shandong Provincial Department of Health required all public hospitals above the second level in the province to set up standardized public health departments, implement "prevention first", promote the combination of medical and prevention, let the masses get sick less, get sick later, and not get sick, and ensure the return of public welfare and the play of functions of public hospitals; Shijiazhuang City, Hebei Province, issued opinions in 2015, requiring all public hospitals above the second level in the city to set up public health departments to ensure the smooth progress of public health work in hospitals.

Regarding the importance of the public health system, people in the medical and health circles are also paying attention. At this year's two sessions, Yao Shukun, member of the National Committee of the Chinese People's Political Consultative Conference and chief physician of the Gastroenterology Department of the China-Japan Friendship Hospital, submitted a proposal on the integration of medical and defense and the improvement of grass-roots public health capabilities.

Yao Shukun said that primary medical services include "medicine" and "prevention" two lines, "medicine" and "prevention" are weak, the integration of the two is not both physical, clinical and public health coordination is not smooth, seriously affecting the capacity building of grass-roots public health services. The over-specialization of tertiary hospitals in cities has also caused medical service difficulties. On the one hand, it is not conducive to the training of young doctors; on the other hand, multi-specialty diagnosis and treatment leads to excessive medication and examination. More importantly, doctors neglect the whole course of management of prevention, health care, diagnosis, treatment, rehabilitation, and health education.

Due to the lack of close integration of medical and prevention, the public health capacity of medical institutions is limited, and in the more than two years of fighting the new crown epidemic, many places in the country have repeatedly experienced hospital incidents in medical institutions, not only the heads of medical institutions have been punished, but some have caused adverse consequences of the spread of the epidemic.

As all provinces, municipalities and autonomous regions across the country have begun to attach importance to the public health function of medical institutions, it is foreseeable that in the future, medical institutions will be more comfortable in the face of public health emergencies, to ensure that diseases can be effectively and timely controlled, and to ensure that other departments of hospitals can operate normally as much as possible, reducing unnecessary inconvenience to the people. (This article is published by "Seeing the Medical Community", reprinted with permission, and the author and source are indicated at the beginning of the article.) ）

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