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随着农村公共卫生服务工作的深入,基层社区(村级)卫生人员数量、业务素质、年龄结构、分布等不合理现象越来越凸显出来,严重制约着农村公共卫生服务工作的深入发展[1]。原有的以乡村医生为主的社区(村)责任医生难以满足广大人民群众的卫生需求,针对以上情况,笔者认为在农村社区也应组建以社区卫生服务中心(卫生院)各科室业务骨干为主要成员成立社区责任医生团队,在社区(村)开展公共卫生服务工作,进行农村社区健康教育、慢性病随访管理等工作。现笔者对与开展慢性病管理团队工作有关的团队构建、工作形式、内容等方面在此作一探讨。1完善制度,建立资金保障机制
With the deepening of rural public health services, the unreasonable phenomena such as the number of health personnel at the grass-roots level (village level), professional quality, age structure, and distribution have become increasingly prominent, which seriously restricts the in-depth development of rural public health services.[1] ]. It is difficult for the original village doctors in the village (village) to meet the health needs of the general public. In view of the above situation, the author believes that in the rural communities, the backbone of the departments of the community health service centers (health centers) should be established as The main members set up a team of community-responsible doctors to carry out public health service work in the communities (villages) and conduct rural community health education and follow-up management of chronic diseases. The author hereby discusses the aspects of team building, work forms, and content related to the development of chronic disease management teams. 1 Improve the system and establish a fund guarantee mechanism