The diabetes specialist department of the town health center has developed a distinctive treatment plan with low costs and good effects, sparing diabetic foot patients the trouble of traveling back and forth to large urban hospitals for dressing changes and preventing amputations. The TCM dermatology department at the community health service center has attracted patients from all over the country for its expertise in treating herpes zoster. Other “doorstep” specialty departments include a Western dermatology department skilled in treating acne, a psychiatry department specializing in insomnia, and an integrated TCM and Western medicine rehabilitation department that leverages the complementary advantages of both medical systems.
On December 26, the Guangzhou Municipal Health Commission organized an On-site Experience Exchange Meeting on Characteristic Departments of Grassroots Medical and Health Institutions at Beixing Health Center in Huadong Town, Huadu District. The meeting honored the first batch of 40 municipal-level grassroots characteristic departments with certificates (see the list at the end of the article) and conducted an on-site inspection of the diabetes characteristic department at Beixing Health Center. Reporters learned from the event that the selected characteristic departments cover various fields such as TCM rehabilitation, chronic disease management, and maternal and child health care, closely aligning with the needs of grassroots residents. According to the plan of the Municipal Health Commission, Guangzhou will establish no fewer than 200 grassroots characteristic departments by 2030, bringing more high-quality, efficient, and convenient clinical “specialized services” to residents’ doorsteps.
Establishing a Diabetes Specialist Department at the Town Health Center
Saving Patients from Traveling to Urban Areas
Mr. Lu, a diabetic foot patient currently hospitalized at Beixing Health Center in Huadong Town, Huadu District, is from Qingyuan City. He told reporters that when he sought treatment at a hospital in Baiyun District, Guangzhou in September, he was informed by a doctor that the diabetes specialist department at this health center in Huadu “has excellent medical standards, and the director is a student of Professor Yang from Sun Yat-sen Memorial Hospital of Sun Yat-sen University”, prompting him to seek treatment here. After more than two months of treatment, the ulceration on his foot has basically healed.
“Generally, the course of treatment for diabetic foot takes at least 35 to 40 days to heal; some severe cases may require 3 to 6 months. If we cannot treat these patients here, they would have to travel over 30 kilometers to large urban hospitals every day for dressing changes,” said Chief Physician Lai Fufeng, Director of the Internal Medicine Department and Head of the Diabetes Characteristic Department at Beixing Health Center. He added that in the past, some patients delayed treatment due to this inconvenience, leading to amputations, and in extreme cases, even sepsis shock, organ failure, and death. “When Beixing Health Center set up the diabetes specialist department in 2010, we had little experience in treating diabetic foot. But seeing these patients’ suffering, we were determined to improve our medical services in this area.”
In March 2011, Beixing Health Center began long-term cooperation with Professor Yang Chuan from the Endocrinology Department of Sun Yat-sen Memorial Hospital of Sun Yat-sen University through flexible talent introduction. In September 2015, it established the Grassroots Diabetic Foot Treatment Center. Today, the small Beixing Health Center in Huadong Town treated 20,000 diabetic patients last year, including over 600 hospitalized cases. More than 95% of local diabetic patients do not need to be transferred to higher-level hospitals. In addition to patients from local areas and neighboring towns in Baiyun, Conghua, and Huadu Districts, the center also attracts patients from Guizhou, Yunnan, and other provinces who come specifically for treatment.
“I have a clear understanding of my role here. If I only came to see patients, I would not be able to leave the medical technology behind. Therefore, I focus more on guiding the doctors here,” said Yang Chuan. It is reported that over the past 15 years, Yang Chuan has visited Beixing Health Center at least once a month. The diabetes department has evolved from a team of “one attending physician leading a group of resident physicians” to its current strength, which includes 1 chief physician, 3 associate chief physicians, and 4 attending physicians—all trained locally, a remarkable achievement for a department in a town health center.
Building on the experience of large hospitals, the team has innovated treatment methods more suitable for grassroots residents. “The dressings such as silver ion products used in large hospitals are relatively expensive, and daily dressing changes for months may be unaffordable for ordinary people. Through literature research, I found that iodophor can disinfect wounds without causing irritation. We tried soaking gauze in iodophor and cutting it into dressings according to the shape of the wounds for disinfection and external application, which achieved good therapeutic effects. Moreover, each dressing change only costs a few yuan,” introduced Lai Fufeng.
Selecting the First Batch of 40 Grassroots Characteristic Departments from 94 Applicants
Focusing on “the Elderly, Children, and Chronic Disease Patients”
Less than 10 days before the on-site exchange meeting, on December 17, six national departments including the National Health Commission and the National Development and Reform Commission jointly issued the Guiding Opinions on Strengthening the Construction of Characteristic Departments in Grassroots Medical and Health Institutions. The document clarifies that on the basis of strengthening the construction of general practice, TCM, preventive health care, and medical technology departments in grassroots medical and health institutions, efforts should be focused on building several clinical departments, considering factors such as residents’ health needs, population aging, and regional medical resource distribution. The goal is to form departments with grassroots advantages and characteristics within a certain region, facilitating convenient medical services for the public and better meeting their multi-level, diversified, and high-quality health service needs.
Guangzhou took action earlier. In July this year, the Guangzhou Municipal Health Commission launched the construction of municipal-level characteristic departments in grassroots medical and health institutions. The diabetes specialist department of Beixing Health Center in Huadong Town stood out among 94 applicants and became one of the first batch of 40 characteristic departments of grassroots medical and health institutions in Guangzhou.
Zhao Changlin, head of the evaluation team for characteristic departments and Vice Dean of the School of Traditional Chinese Medicine at Guangdong Pharmaceutical University, introduced that the 40 characteristic departments in this batch mainly focus on the health needs of key groups such as “the elderly, children, and chronic disease patients”. They promote the development of grassroots specialist departments in areas including common chronic diseases among the elderly (such as hypertension, diabetes, heart disease, and osteoarthritis), pediatrics, rehabilitation medicine, and psychiatry. This enables the public to address common and frequently-occurring diseases “at their doorsteps”, improving service accessibility and meeting the multi-level, diversified health service needs of residents. The selected characteristic departments of grassroots medical and health institutions in Guangzhou are characterized by distinct features, good therapeutic effects, strong service capabilities, simple and convenient treatment methods, and low costs.
He gave examples: besides the diabetes specialist department of Beixing Health Center in Huadong Town, Huadu District—the venue of the on-site meeting—the TCM dermatology department of Renmin Street Community Health Service Center in Yuexiu District excels in treating herpes zoster, attracting patients nationwide; the Western dermatology department of Lingshan Community Health Service Center in Nansha District has developed its own treatment plan for acne, also drawing patients from various regions; the acupuncture department of Zhengguo Health Center in Zengcheng District, the northeasternmost area of Guangzhou, treats children with autism through acupuncture; the acupuncture department of Liangkou Town Central Health Center in Conghua District uses bee venom therapy by raising bees itself to treat various diseases, all achieving good therapeutic effects and gaining patients’ recognition.
Building Grassroots Characteristic Departments
Consolidating the Foundation of Hierarchical Medical System
In recent years, Guangzhou has continuously strengthened the foundation of grassroots medical and health services. Currently, nearly 80% (150) of the city’s community health service centers and town health centers have reached the recommended standards of the “National High-Quality Grassroots Medical Services Initiative”, and 73 community hospitals have been established, ranking first in Guangdong Province in both aspects. The Municipal Health Commission hopes that grassroots medical and health institutions will enhance their awareness of “integrating general practice and specialized care” through the construction of characteristic departments, promote the high-quality development of grassroots health undertakings, and consolidate the foundation of the hierarchical medical system.
“If grassroots medical institutions only measure blood pressure and blood sugar and cannot truly solve patients’ problems, they will not attract the public,” a relevant person in charge of the Municipal Health Commission stated at the on-site meeting. As the bottom line of the health service system, grassroots medical and health institutions need to strengthen the construction of characteristic departments and continuously improve service capabilities to effectively address common and frequently-occurring diseases of the public, thereby truly implementing the policy of strengthening grassroots health and the hierarchical medical system. “The ultimate goal is to enable people to first go to community hospitals when they or their family members are ill, where the hierarchical medical system is implemented, and to return to community hospitals with confidence for rehabilitation after receiving treatment in large hospitals.”
Reporters learned that Guangzhou will establish no fewer than 200 municipal-level grassroots characteristic departments by 2030. “We hope that among these 200 departments, at least 100 will become provincial-level grassroots characteristic departments,” the above-mentioned person in charge said.
In addition to benefiting community residents, the initiative of building characteristic departments at the grassroots level has also boosted the morale of grassroots medical workers. “Doctors’ clinical thinking abilities have improved, their confidence in diagnosis and treatment has been strengthened, and they now believe that they can be promoted to senior professional titles and apply for scientific research projects while working in grassroots hospitals. This has given more young doctors full confidence in rooting themselves at the grassroots level and becoming renowned local physicians,” said many medical workers and managers from grassroots medical and health institutions at the on-site meeting. They mentioned that building grassroots characteristic departments has effectively enhanced the professional honor and sense of achievement of grassroots doctors, helping to retain talents at the grassroots level, thus forming a “positive cycle” with the improvement of grassroots medical service capabilities. It is reported that Guangzhou will strengthen policy coordination and planning to provide support for the construction of grassroots characteristic departments.