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为进一步推进慢性病防治工作的深入开展,兰陵县卫计局建立了“慢性病一体化防治管理”“二三四五”管理模式。一、“两个网络”打造框架式筛诊平台,形成无缝化诊治网络加大对慢性病高危人群筛查力度,各乡镇卫生院在门诊设立便民服务健康小屋,为患者提供一般健康检查、健康指导、用药咨询、签约服务和患者随访。乡镇卫生院、村卫生室将辖区内明确诊断的高血压、糖尿病患者纳入慢性病患者健康管理,通过预约门诊就诊、电话追踪和家庭访
To further promote the prevention and treatment of chronic diseases in-depth development, Lanling County Department of Health established a “integrated management of chronic disease” “2345 ” management. First, “two networks ” to create a framework-based screening platform to form a seamless network of diagnosis and treatment to increase the screening of people at high risk of chronic diseases, the township hospitals in the clinic set up convenient services health cabanas, to provide patients with general health check , Health advice, medication counseling, contract services and patient follow-up. Township hospitals, village clinics will be within the jurisdiction of the diagnosis of hypertension, diabetes patients with chronic diseases, health management, appointment clinic visits, telephone tracking and family visits