Understanding residents' psychology can reduce "hitting a wall"
Liang Zhenyu
Chronic disease management is a common but inseparable work in the community. People who haven't done it feel a little "naive", but if they do it thoroughly from beginning to end, they will find that the work is extremely complicated and often encounter the incomprehension of residents. "Some residents asked me directly, what are the benefits of participating in the management of chronic diseases? I'll go if you send me eggs. " "I once heard that there is a new diabetic in the community. I finally found him to explain my purpose, but the patient flew into a rage and told me to expose his ugliness and mind my own business. " Many community doctors have hit a wall.
In my opinion, if we want to make the management of chronic diseases distinctive and charming, we can't blindly catch up with quantity, let alone ignore quality for fear of affecting performance. Instead, we should establish every chronic disease file step by step and manage every patient well. In the years of chronic disease management, I summed up several tips to improve management efficiency.
Issue "physical examination tickets" to improve the patient's timely review rate. It is the key to improve the quality of chronic disease management to review on time and grasp the changes of illness in time. We issue an "electrocardiogram ticket" or "blood sugar ticket" to every patient who re-examines on time, and residents can go to the community health service station to do electrocardiogram or check blood sugar free of charge with the ticket. The physical examination ticket is valid all year round, and you can check it when you come. You can give it to your family if you don't need it. This move has reversed people's view that "reexamination" is a simple consultation, improved the appeal to patients with hypertension and diabetes, and improved the reexamination rate.
Speak out and improve the regular medication rate. What medicine to prescribe is the right of medical students, but whether to eat or not is entirely in the hands of patients. For example, Lao Liu, a self-employed person in our community, has high blood pressure 180. Not only does he not take medicine himself, but he often "educates" patients around him: "How old a person lives is determined by God. You should eat and drink as you please. Drinking can cure high blood pressure. The higher the alcohol content, the better the antihypertensive effect ... "Results At the age of 47, he got cerebral thrombosis, which not only failed his business. When giving a lecture on health education, Lao Liu took the initiative to stand on the podium and said earnestly, "Don't learn from me, you must obey the management of the doctor." Take whatever medicine the doctor tells you to take. " It can be seen that sometimes "what patients say" is more convincing than "what doctors say".
Establish a "patient club" to make patients more compliant with doctor's advice. With the increase of patients, in order to better organize patients, we set up a "community patient club", which regularly organizes activities in the form of expert lectures, playing CDs and communicating with patients every month. Through activities, not only the patients' health knowledge is increased, but also the doctor-patient relationship is strengthened, so that doctors can know patients better and patients can trust doctors more. In the past, the simple doctor-patient relationship has become a friend relationship. Aunt Xing, a community diabetic, said: "I am very familiar with community doctors, and we are all' one of our own'. I don't have to worry about doctors prescribing big prescriptions when I see a doctor. " The establishment of community patient club has greatly strengthened the relationship between doctors and patients, made patients obey the doctor's advice more, and effectively improved the treatment effect.
Encourage patients to participate and improve the effective control rate. Chronic diseases are mostly lifelong diseases. In the long management process, patients' understanding and cooperation is a necessary condition to improve management quality. By teaching patients to take their blood pressure and use a salt spoon, patients are brought in to discuss the treatment plan and rehabilitation plan together, so that patients can directly participate in the management, treatment and curative effect evaluation of diseases. Control diet, strengthen exercise, quit smoking and eat less salt, and blood pressure will drop, so that patients can truly feel that science is around them, and they are no longer powerless in the face of diseases and full of confidence in overcoming diseases. At the same time, it also makes patients deeply understand the hardships and fun of chronic disease management, thus making the whole management process full of vitality and fun.
The integral system evokes participation.
Hu Zhangliangfeng
As the saying goes: "A hero has three gangs, and a fence has three piles." In the management of chronic diseases, the professional management of general practitioners, the participation of volunteer teams and the self-management of patients are also indispensable. In our center, there is a team composed of general practitioners, public health doctors and general nurses to implement comprehensive management of chronic patients in Nanming and Qixing streets. All six members of this team are "full-time". Their duties are to carry out home visits, organize health knowledge lectures, and implement standardized, systematic and information-based management for patients with chronic diseases.
There are nearly 10,000 patients with chronic diseases in Nanming and Qixing streets. It is obviously unrealistic to manage 65438+100000 people by only six people. When we set up a professional management team for chronic diseases, we mobilized other medical staff in the center to participate in chronic disease management as volunteers, distributed heroic posts, and recruited volunteers for chronic disease management from the society. At present, medical staff 149 and 27 social workers have been recruited. Li Ming, director of the center, was the first volunteer to sign up. He opened his "Handbook of Volunteers for Comprehensive Treatment of Chronic Diseases", which recorded his volunteer activities: On June 25th, Nanming Sub-district Office held a health knowledge lecture; On June 27th, the Bureau of Organ Affairs took blood pressure; On July 1 day, the county finance bureau held a health knowledge lecture ... After joining the volunteer team, Li Ming paid more attention to collecting medical information about various chronic diseases and has compiled a large number of brochures on the prevention and treatment of hypertension and diabetes.
Volunteers participate in the management of chronic diseases and implement a star rating system. For example, if a newly discovered patient with chronic diseases is followed up and the follow-up information is input into the computer, volunteers can participate in public health activities in the community and participate in health knowledge lectures. If the accumulated points exceed a certain score, they will be awarded the title of one-star to six-star volunteers respectively. According to the star rating and performance of volunteers, the center will provide incentives such as redemption of points for physical examination items and redemption of points for studying abroad.
Patients manage themselves or assist in managing other patients, and implement the points system like volunteers. For example, diabetic patients can get corresponding points by participating in the center's health home activities, completing the self-care manual, recording the "diabetes diary", telling their own experiences to patients, controlling their blood sugar satisfactorily, and cooperating with the follow-up management. The points can be exchanged for various physical examination or auxiliary examination items, and those with a score of more than 200 can receive souvenirs such as blood glucose meters, thus continuously improving patients' self-management awareness. (Author: Nanming Street Community Health Service Center, Xinchang County, Zhejiang Province, organized by our reporter Yu Xin)
Spend more time and guide skillfully.
king
Confidant health management is a complete lifestyle management and intervention system, which mainly adopts non-drug intervention to realize comprehensive prevention and treatment of chronic diseases. This management mode requires managers to record daily meals and wear energy monitors to record exercise, so patients need to participate more actively. Compared with other forms of chronic disease management, community doctors need to pay more attention.
First, try to choose people with good compliance to participate in confidant health management. According to the age, we can divide the patients with chronic diseases into three types. In the 30-50 age group, most of these patients are still working. Although they have the desire to improve their unhealthy lifestyle, due to various reasons, their diet and exercise are not well controlled and the follow-up is not timely. In the 50-70 age group, these patients have basically retired. By watching TV lectures and participating in various health education, they know the importance of maintaining a good lifestyle to their health. Plus, they have enough time to follow up on time, and the management effect is better. In the group over 70 years old, such patients are relatively older. Unless the heart and lung function is good, exercise should not reach the standard, and increase exercise to worry about cardiovascular accidents. It is generally not recommended to join the group.
Second, confidant health management is a test of the patience of community doctors. Because a management cycle is 3 months, it takes 9 times from filing a case to the end of follow-up, and each follow-up time is very long, at least half an hour. Moreover, some patients often postpone the follow-up visit because of business trip or travel. Although it brings trouble to the follow-up management, we should be patient and call to remind and urge. After all, everything is for the health of patients. In order to enrich the content of guidance, besides medical knowledge, we should also master common sense of nutrition, psychology, exercise, health care, Chinese medicine diet therapy and so on. In order to avoid patients getting bored after repeated follow-up.
Third, don't let go of any tiny details of life. Sometimes residents take their blood pressure, and the results are unstable after repeated times, but this is not necessarily because they have not taken the medicine according to the doctor's advice or taken it improperly. There may be other reasons, such as mood swings, family disharmony, improper diet, unscientific exercise, psychological imbalance and so on. For some diehards with poor blood pressure control and poor blood sugar control, we must ask them if they have lifestyle problems, and analyze the data of the monitor with the patients, so that they can realize the changes brought about by strengthening management and make them easy to accept and cooperate.
Fourth, give patients enough understanding. Although we have arranged a unified return visit time, there are still patients who change the return visit time for various reasons. For example, office workers will come back on Saturday and Sunday. At this time, we should fully understand the patient's difficulties. For some patients who don't cooperate well, don't be too demanding and explain patiently. For example, the item of "management object records diet" is somewhat complicated, participants are not easy to insist, and the accuracy of the record is poor, which directly affects the management effect, which requires us to fully explain.