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【治国理政新实践·江苏篇】“一户一策” 健康守护:制定个性化服务包,家庭医生上门服务
“以前总认为在基层工作很辛苦,但走进贫困家庭后发现,我们的工作环境、生活条件同贫困家庭相比真的很不错了,我们要切实担当起最贫困家庭健康守护的责任。”日前,在江苏省高邮市甘垛镇北韩村五组贫困家庭王道珍老人家里上的一堂“特别党课”,让在场的甘垛镇卫生院12名党员和2名入党积极分子涤荡心灵、深受震撼。 王道珍老人今年85岁,两个儿子早年去世,两个儿媳妇也改嫁了,老人孤身一人居住在又破又矮又湿的小屋内,生活非常贫困。在江苏省高邮市委开展的“聚焦富民村村到户户访、有重点常联系”大走访大排查活动中,该市排查出了411户最贫困家庭,由江苏省高邮市委牵头负责帮扶,各相关部门制定了切实可行的“一户一策”精准扶贫方案,帮助这些最贫困家庭早日脱贫,共享小康。王道珍老人就是其中之一。 针对绝大多数贫困家庭因病因残因孤致贫的实际,江苏省高邮市卫计委出台了《“一户一策”健康守护方案》,根据每户最贫困家庭健康状况,分别制定不同的个性化服务包,签订家庭医生服务协议,落实“三师(乡村医师、全科医师、专科医师)”服务。 《“一户一策”健康守护方案》的具体内容为:一户一档,由乡村医生或基层全科医师入户,为最贫困家庭所有成员建立健康档案,如已建立的,则进行更新、完善,以便详细了解家庭成员健康状况、健康需求;一户N包,根据各家庭成员健康状况,分别制定个性化服务包,包括县、乡、村三级医师的服务内容,并签订服务协议;根据家庭成员健康需求和个性化服务包内容,分别为每户安排业务能力强、责任意识高的三级医师进行服务,一般疾病、健康服务由乡村医师、基层的全科医师服务,疑难杂症、严重疾病、严重精神障碍或乡镇不能解决的健康需求,由市直医疗机构专科医师进行服务。同时,江苏省高邮市卫计委为最贫困家庭专门印制家庭医生健康服务联系卡和服务记录本,最贫困家庭户凭家庭医生健康服务联系卡,可直接与对应的医疗专家联系,进行健康咨询、疾病诊疗等。
为将“一户一策”落实到位,高邮市卫计委还实行一院一案,要求各单位认真做好上门入户服务工作,对最贫困家庭中健康状况良好的成员,按规定提供规范服务;对患重大疾病的家庭成员,做到乡村医师每周到、乡镇全科医师每月到、市级专科医师户户到,市级专科医师同时要做好健康咨询、技术指导,开展预约诊疗、提供转诊绿色通道,切实做到贴心、精准健康服务。
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