Shanghai Today
Neighborhood clinics take the load away from hospitals in dealing with age-related illness - October 10, 2024
社区诊所减轻了医院处理与年龄有关疾病的负担
Dr Yuan Yan examines 102-year-old Chen Yuexiang who was hospitalized with pneumonia at Dapuqiao Neighborhood Health Center.
Chen Yuexiang, who is 102 years old, regularly visits the Dapuqiao Neighborhood Health Center for outpatient or hospitalization services to manage her health and treat her diseases.
This time, pneumonia landed her in the hospital. For people her age, pneumonia can be fatal.
"I am good now. I am not coughing or short of breath anymore. Doctors and nurses here are very considerate and kind," said Chen.
Despite being over 100 years old, Chen maintains her daily routine of drinking a cup of coffee and taking a bath, even at the center where the nurses and ayis help her.
A nurse and an ayi assist Chen Yuexiang in blow-drying her hair after a bath.
"I am comfortable here. The medical staff is very kind to me," she said.
The elderly make up 80 to 90 percent of the health center's hospitalized patients and the vast majority of its outpatients.
Shanghai has a three-tiered healthcare system. While city and district hospitals treat complicated and serious diseases, local health clinics primarily provide care for common and chronic ailments, rehabilitation, and health education.
In Shanghai, each subdistrict or town, or every 50,000 to 100,000 residents, has one neighborhood health center, and every 10,000 to 20,000 people will have a healthcare station to give locals quick assistance. Approximately 87 percent of the amenities are within 15-minute walking distance of the population.
Elderly people are the primary patients and focus of grassroots health facilities, which offer convenient, long-term, and affordable care. Many older patients have developed confidence in their general practitioners.
Dr Cheng Tianyi examines 78-year-old Zhu, who has managed her chronic condition with the help of her GP and avoided cardiac stent surgery.
Shanghai is an aging society. More than 37.4 percent of the registered population is 60 or older, with 5.4 percent being 80 or older. Providing adequate health services to the elderly to improve their quality of life while also managing illness prevention and control is an important part of local government and the health field.
Take the case of a 78-year-old woman with the surname Zhu. An earlier examination at a major public hospital revealed that she required cardiac stent surgery due to a 70 percent blockage in her heart arteries. She has suffered from cardiovascular disease, diabetes, and hypertension for many years.
"I next went to the neighborhood health facility to see my general practitioner for regular and long-term chronic disease treatment. During a recent check at the same leading hospital, doctors said my blockage has gone and there is no need for surgery," she claimed.
"I am very happy."
Dr Yuan Yan chats with an 84-year-old hospitalized stroke victim.
Dr Cheng Tianyi, a general practitioner at the center, said Zhu's was a typical case.
"The major purpose of GP is to provide regular and strict monitoring, management, and instruction to patients, who can have their conditions under control to prevent deterioration and serious consequences like stroke and heart attack. This patient demonstrated a high level of awareness, complied well with the doctor's instructions, and implemented lifestyle changes, resulting in significant positive outcomes," the doctor said.
"About 30 percent of patients under our management can achieve such results. This is already a very positive outcome, given that patients' awareness and compliance, individual differences in treatment effects, and doctors' different practices all play a significant role.
"Patients with multiple chronic diseases, like diabetes, hypertension, and coronary disease, are very common at our neighborhood health center. With proper health management and cooperation between doctors and patients, they can enjoy a longer and better life," Cheng said.
A 62-year-old stroke survivor works on her rehabilitation.
Rehabilitation is another major reason the elderly visit neighborhood health centers.
Shanghai has been promoting a rehabilitation network that allows patients with acute conditions to receive surgery or treatment at a city-level hospital, followed by a transfer to a district-level hospital for follow-up treatment and rehabilitation. They can then receive long-term rehabilitation training at community health centers and service spots in the neighborhood.
The city government is currently building or upgrading community-based rehabilitation facilities. These facilities offer intelligent equipment-based modern technology and skills, combining both Western and traditional Chinese medicine.
The Shanghai Health Commission expects the integration of rehabilitation services into the grassroots health system to cover all communities by 2025.
"If a person stays in bed without any form of physical exercise, their muscles begin to shrink after about one week. Many patients have asked me about the best time to start rehabilitation. My answer is the earlier the better. Usually, rehabilitation should start soon after the acute outburst or surgery," said Dr Yuan Yan from the center.
"Many of my hospitalized patients are elderly and coming here for rehabilitation and treatment after stroke, heart attack, and fracture after a fall. Timely and professional rehabilitation can greatly improve their condition, relieve disability, and improve life quality. Some patients arrive here lying in bed or sitting in a wheelchair, but they leave by walking."
A stroke victim rehabs with a low-limb training robot at the center.
Local neighborhood health centers are innovating to maintain their usual service.
The commercial insurance system has incorporated the Dapuqiao Neighborhood Health Center as the nation's first community-level clinic. Previously, such insurance only covered medical expenses in public hospitals at the district and city levels, as well as high-end private clinics.
"Community-based medical institutions provide distinct advantages in health education, chronic disease management, and disease screening. Patients with chronic conditions require long-term monitoring and medication, so they can save time and money by attending community clinics rather than overcrowded major hospitals. Cooperation with commercial medical insurance will greatly benefit such people," said Jin Ying, director of the center.
"It is also an opportunity to boost our development, as we can learn modern management and perfect our system through cooperation with leading insurance companies."
Source: Shanghai Daily
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