Chronic disease archiving

For ordinary patients with chronic diseases such as hypertension and diabetes, actively cooperating to complete chronic disease filing in the community is the most cost-effective free health management method currently available.； For the grassroots public health system, true and effective chronic disease records are the smallest fulcrum to leverage the efficiency of chronic disease prevention and control in the entire region.

I was on duty at the community health service center last week, and I met Uncle Zhang, who had just been discharged from the neurology department last month. He came over with a bagful of sugar oranges to thank us. He has suffered from high blood pressure for 12 years. In the past, he would avoid our public health commissioner every time he came to the place where he was prescribed nitrobenzene. He would just curl his lips and say, "It's useless to fill out those crappy forms. I know my own body well." Last month, he suddenly became numb on one side of his body at home. When his son sent him to the emergency room, he couldn't speak clearly. He couldn't even remember the dosage of medicine he usually takes. Unfortunately, half a month ago, we came to do a health check for the elderly. We worked hard to set up a file for him. He found out that he had excessive homocysteine during the physical examination last year, and he usually stole medicine. The fact that he secretly mixed apocynum to reduce blood pressure was recorded in the system. The emergency doctor checked the public health database connected to the city and found out his past medical history in less than 5 minutes. He happened to be treated during the 4.5-hour thrombolytic window period. Now, except for the occasional numbness in his left hand, he can walk and talk like a normal person.

Of course, I also understand how many people feel annoyed when they hear the word "archive". I have been working in grassroots public health for 6 years, and I have encountered too many "dead files" that are made up to meet the assessment indicators-sitting in the office, compiling blood pressure values, filling in a random medication history, and then locking the file in the cabinet and never being touched again. Patients fill out the form for a long time, but they do not get half a cent of benefit. Everyone thinks it is a waste of time. This situation is not an isolated case. Until now, the establishment of chronic disease records in many places still relies on the assessment logic of "emphasis on quantity over quality". This is also the core reason why many people resist the establishment of records.

Now the industry is actually divided into two groups trying to solve this problem. One group is the "non-intrusive file creation" route taken by the Yangtze River Delta, which does not allow patients to fill out forms at all. You go to the community to prescribe medicine, measure blood pressure, and draw blood for free physical examinations. All data are automatically synchronized to the public health system, and doctors in the background slowly help you complete the file. You may not even know that a chronic disease file has been created. You can just adjust it directly when you need to use it. There is no burden at all. The other group is the "service binding" route taken by many counties in the northwest and northeast, and they will clearly settle the accounts with you: after setting up a profile, you can receive free blood sugar/blood lipid tests four times a year, a full set of free senior physical examinations once a year, and an increase of 5 percentage points in the medical insurance reimbursement rate for antihypertensive and hypoglycemic drugs. There is also the contact information of the family doctor, who can call you anytime if you feel uncomfortable. It is equivalent to using real benefits in exchange for your cooperation and complete information.

I have gained so many years of experience, and there is really no need to stick to any one method. For example, in our area, half are retired employees from old communities and half are floating tenants in urban villages. For the retired elderly, we use the service binding method. We explain to them clearly that after setting up a file, they can book a free fundus examination next month. It is much more cost-effective than going to the hospital to spend more than 200 yuan for the examination themselves. Everyone is willing to cooperate. For tenants in urban villages, we create a file without any concern. If someone comes to prescribe antihypertensive medication in a hurry to get to work, you drag them to fill out the form for half an hour. Next time, they will definitely go to another place to get the medicine. We will scan his medical insurance code, enter his medication information, and next time we will measure his blood pressure and fill in the blood pressure value. The file will be complete after three or four times, and no one will find it troublesome.

There are also many people who say, "I go to big hospitals for treatment of chronic diseases, and setting up a community file is useless." This is not true. Nowadays, the public health systems of most prefecture-level cities across the country are connected to the outpatient systems of tertiary-level hospitals. If you have accumulated blood pressure and blood sugar monitoring data for three or four years in the community, doctors at large hospitals can see it with just one click when you visit them. It is much better than what you memorized in that crumpled little notebook. Last month, an aunt who had been suffering from diabetes for 10 years went to the Provincial People's Hospital to get a medication plan. The doctor originally asked her to come to the hospital to test her blood sugar four times a day for a week. However, after adjusting her follow-up blood sugar data stored in our community for the past two years, the medication plan was adjusted on the spot. The aunt said that it saved her the trouble of running back and forth to the hospital for a week, and saved hundreds of dollars in taxi fares.

Of course, I don’t advise everyone to just create a profile. If you go to the community and ask what services you can enjoy by setting up a profile, the staff will be hesitant and unable to tell you. They just tell you to fill in the form first, then you can refuse. After all, a dead profile created just to make up for the quota is really useless. But as long as the other party can explain the actual services such as specific follow-up and free testing, it is really recommended that you build one. To put it bluntly, it is equivalent to opening a permanent free cloud disk for your health. You may not feel it at ordinary times, but when you really need to use it, it is more reliable than anything else.

Yesterday, an old aunt joked with me when she was setting up a profile, saying that this smart watch is much more practical than the smart watch her son bought for her, which is several thousand dollars more. At least it won't run out of power, and there will be someone to help record the data. Don't tell me, that's really what happened.