Reporter | Huang Wei
In order to promote the "early detection, early intervention and early triage" of severely infected people in COVID-19 at the community level, Shanghai started the expansion and empowerment of community medical services around February 10, 2022, effectively alleviating the pressure of fever clinics in large hospitals in COVID-19 during the peak period of fever treatment.
Since the second expansion on February 29th, 2022, as of October 2nd, 2023, the community health service institutions in Shanghai have added 17 1 1, 2,562 infusion places, 238 fever clinics, 665 beds and 243 ECG monitors. At the same time, antiviral drugs, oxygen indicators, oxygen bottles and other materials are given priority in the community, and the ability of critical care and prevention in community COVID-19 has been continuously improved.
On the last day of New Year's Day holiday, Xinmin Weekly visited a community health service center in Minhang District to learn about the current situation of primary medical institutions in diverting patients, timely finding and referring seriously infected people.
Fever outpatient visits decreased, while general outpatient visits increased.
"Yesterday was the fourth day of fever. I took ibuprofen to reduce my fever, but I felt dizzy and nauseous when I got up yesterday morning, and later I vomited. Yesterday, I went to the second-class hospital for various examinations, and all of them were good. I got up a little feverish today, but not high. " On the morning of June 5438+1October 2, Aunt Chen described the symptoms to the doctor at the fever clinic of Longbai Sub-center of Hongqiao Community Health Service Center in Minhang District, Shanghai.
The doctor asked about Aunt Chen's basic condition and learned about her examination results in the secondary hospital. After comprehensive judgment, she comforted Aunt Chen while diagnosing: "COVID-19's recovery after infection needs a process, which may be a little repetitive. Your immunity is fighting the virus. Don't be impatient. Your white blood cells are fine and you don't need antibiotics. If the fever is above 38.5 degrees, you can take antipyretics, but be careful not to overdo it. "
Aunt Chen and the old couple are both infected. "There's another one lying at home." She went to the community hospital this time mainly in the hope of prescribing some cough medicine.
When the doctor prescribed medicine, Aunt Chen lamented: "I knew the community was so convenient, so I didn't have to go to a big hospital yesterday. It is difficult for people to wait from morning till night. "
By this morning 10: 30, Dr. Lei Jin had treated nearly 40 patients, almost all of whom were infected with fever in COVID-19, and 80% of them were elderly people over 60 years old. The patient's condition is similar to that of Aunt Chen. They are common symptoms such as fever, cough, nausea, vomiting and pain after COVID-19's infection. Although the number of patients has decreased by about half compared with a week ago, doctors can hardly stop seeing patients.
The reporter saw in the fever clinic that more than 20 waiting chairs were not full, and the waiting chairs were basically elderly people. Cough often rings, but there is no conversation or other sounds, and the environment is relatively quiet. Two consultation rooms were opened in the fever clinic, and two doctors were consulted.
According to Zhong Hua, director of Hongqiao Community Health Service Center, the peak of fever clinic in Hongqiao Community Hospital has passed in the past week. From June 5438 to February 65438, 2022, the number of fever clinics reached 400-500, which recently dropped to around 200. However, the demand for prescriptions from general clinics for patients with post-infection cough and chronic diseases in COVID-19 has increased to 65,438+0,500 person-times per day. 80% of the medical staff infected with COVID-19 in the hospital have returned to their posts, and the shortage of staff has been alleviated, with adequate medicines.
"Last week, many people paid attention to Pfizer's small molecule drug Nemavir/Ritonavir tablets, which were also distributed to our community hospitals. After the patient comes to see a doctor, the community doctor can prescribe this medicine as long as it meets the indications. Today, we prescribed Pfizer drugs for six patients. "
Most doctors and nurses have returned to their posts and are open at night and weekends.
The orderly fever clinic has actually operated for less than one month. On June 5438+February 10, 2022, the fever whistle of the community hospital was deployed in Minhang District and expanded into a fever clinic. On the same day, Hongqiao Community Health Service Center began to rebuild. The original 30-40 square meters of fever whistle has been expanded into a fever clinic of more than 200 square meters. In addition to the clinic, there are laboratories, pharmacies and toll booths. Two days later, the fever clinic began to open, and at least three doctors were arranged to make house calls every day.
According to the plan, the fever clinics in the two sub-centers of Hongqiao Community Health Service Center can carry up to 1 10,000 person-times per day. According to Zhong Hua, the peak reached about 500 person-times a day, and the number of patients was slightly less than expected. "There may still be some residents who are not at ease with community hospitals and prefer to go to big hospitals."
The fever clinics in community hospitals mainly provide basic examination and symptomatic treatment, and most patients only need to prescribe some oral drugs. If you encounter a seriously ill patient, the community doctor will immediately help you refer it to a higher-level medical institution.
From 12 to 19 in 2022, 2594 fever clinics of various community health service institutions in Shanghai were all opened, which played an important role in relieving the pressure of fever clinics in 3A hospitals.
Fever clinics in community hospitals in Minhang District opened around June 5438+February 65438+May, 2022, which was the peak of infection in the whole city, but it was also the most serious period of community hospital infection and staff attrition. "During that time, our scheduling doctors were overwhelmed every day. When scheduling, you need to call to confirm: Who, who, do you have a fever? Can't go to work tomorrow? " Shen Aiyue said.
Dr. leijin told reporters that in the middle and late February of 12, more than half of his colleagues were positive. When the employee is most nervous, he goes to work until zero the day before and then goes to work at eight the next morning.
Extending the service time of community hospitals to zero is also a new arrangement made by Shanghai to divert patients from community hospitals during the peak period of COVID-19 infection. From June 5438+1 October1day, all community health service centers and sub-centers in Shanghai will provide fever diagnosis and treatment services seven days a week. As early as February 20, 2022, 65438, Minhang District launched the night fever clinic service. The headquarters of community health service centers in Minhang District 14 town and industrial zone set up a "micro-emergency" for fever at night, and the service hours of fever clinics were extended to 22 o'clock on weekends and 0 o'clock on working days.
Grass-roots doctors focus on training COVID-19's diagnosis and treatment skills.
In fact, what is more difficult than expanding space is the technical preparation of community doctors in COVID-19.
Shen Aiyue, deputy director of Longbai Sub-center of Hongqiao Community Health Service Center, said that the original fever sentinel of Shanghai community medical institutions mainly played the role of closed-loop referral of fever patients to designated hospitals in COVID-19. Due to the implementation of dynamic clearing measures in the first three years, there are very few COVID-19 patients who actually go to the community fever sentinel to see a doctor, "maybe two or three patients a week". So fever whistle and fever clinic are completely different in function and doctor's responsibility.
"In the past three years, our community doctors have some theoretical knowledge about the diagnosis and treatment of COVID-19, but they really have no experience in treating COVID-19 patients, so they have to be trained repeatedly. "Director Zhong Hua told Xinmin Weekly that since June, 5438+February, 8, 2022, community medical staff have received at least five trainings on diagnosis and treatment in COVID-19, one of which was specifically aimed at how to use the new drug Pfizer paciclovir.
When should I use hormonal drugs? Under what circumstances are antibiotics used? How to evaluate the severity tendency of using small molecular antiviral drugs? These contents are the most common in the diagnosis and treatment of infected people in COVID-19, and all belong to the scope of community doctor training.
Shen Aiyue, deputy director, said that after 65438+February 26th, 2022, the number of outpatients in Hongqiao Health Service Center increased, mostly because COVID-19 came to see a doctor with symptoms such as cough and chest tightness after infection. Some patients were infected with COVID-19 virus and complicated with other infections.
In the infusion area of the hospital, the reporter saw that transfusion chair was basically full, and the children's infusion area decorated with cartoon patterns on the wall was now open to adults. Shen Aiyue said that the hospital has also prepared a large number of oxygen cylinders, because some patients need oxygen therapy recently, and the demand for oxygen inhalation may increase in the future.
Dr. Shen Jie, who is sitting in the general outpatient clinic, told Xinmin Weekly that he has been seeing more than 0/00 patients every day recently, most of whom are patients with various basic diseases who have just been infected with COVID-19. Common symptoms include cough, hoarseness, loss of appetite and mild fever.
Dr. Shen Jie also found that patients who came to see a doctor were not only unwell, but many people were anxious because they were worried about their illness or their family's illness, and some people were bored because they stayed at home for a long time. "The treatment we provide generally recommends oral drugs, and only those that must be rehydrated will be rehydrated. Besides prescribing medicine, I have to act as a psychologist to comfort patients. Some people have serious insomnia, and we can prescribe some drugs to help them sleep. "
Real-time tracking the health status of "red, yellow and green" people.
In COVID-19, the elderly are a serious high-risk group. In order to realize "early detection, early intervention and early guidance" at the community level, Shanghai conducted a thorough investigation on the health status of the elderly through the linkage of primary medical network and community village committees.
Through evaluation, according to the health risk level, the elderly use red, yellow and green to identify health records. Red and yellow are elderly people, and the risk is relatively high. The implementation of personnel and project management, community daily health monitoring, and provide corresponding guidance and services.
Director Zhong Hua told Xinmin Weekly that family doctors in community hospitals are the health "gatekeepers" of "red, yellow and green people". Through a thorough investigation, the health status files of the elderly in the community were established. "If an elderly person is at the onset of a chronic disease, we will classify it as a high-risk situation. If it is not in the onset period, it is in a stable period, which is a medium risk situation. If there is no particularly serious underlying disease, it is a low-risk situation. Once the old man with the red logo has COVID-19 infection, our family doctor will give him another assessment to see if he is seriously ill and prepare a treatment and referral plan. "
This special WeChat group in Director Zhong Hua's mobile phone consists of cadres in charge of the town, cadres of village neighborhood committees, staff of the Committee on Aging and community doctors. The function of WeChat group is mainly to inform the evaluation results of COVID-19's illness in the community, and the group will also coordinate and help the elderly who need referral to call 120 to call an ambulance in time.
In addition to the elderly living in the community, there are three nursing homes in the area under the jurisdiction of Hongqiao Town Community Health Service Center. At present, there are more than 300 elderly people living in nursing homes, and community doctors have also conducted consultations.
"In the past few days when drugs are tight, we have distributed drugs and blood oxygen detectors to nursing homes, and community doctors visit nursing homes every day." Zhong Hua said that these measures can timely find out whether the elderly have a serious tendency and provide them with timely treatment.
Doctors can prescribe Pfizer COVID-19 after evaluation.
In order to give full play to the diversion function of community medical and health institutions, drugs are also tilting to the grassroots. At present, Pfizer COVID-19's oral drug paciclovir has been put into use in some community health service centers and has been included in medical insurance.
Director Zhong Hua introduced that Hongqiao Community Health Service Center opened the first box of paroxetine on February 65438+3 1 2022. She introduced that the first box and the second box of paroxetine were opened by family members in community hospitals with the diagnosis report from higher hospitals. The patient's family said that drugs were in short supply in big hospitals, and doctors suggested prescribing drugs in the community. At present, some patients have gone to Paciclovir in Pfizer after being evaluated by community doctors. She believes that as residents know more about this drug, more patients will use it.
On the morning of June 5438+10/October 2, 2023, Dr. Lei Jin prescribed paciclovir for an elderly patient. "This patient happens to have basic diseases-hypertension and coronary heart disease at the beginning of the disease. I think she may develop into serious symptoms after evaluation. After examination, her liver and kidney function is good, which meets the conditions of using paciclovir. Finally, after consultation in the hospital, we agreed that this patient can use paciclovir. " According to Dr. Lei Jin, due to medical insurance reimbursement, patients pay very little, and most patients say they can afford it.
Director Zhong Hua said that after several rounds of training, community doctors have mastered COVID-19's medication methods. For example, Pfizer's paciclovir requires patients to have a serious tendency and complete liver and kidney functions within 5 days of onset. As long as the indications are met, community hospitals can meet the current drug demand.