China's National Health Commission Releases Guidelines: Primary-Level Chronic Disease Management Enters Era of Full-Cycle ServicesChina's National Health Commission Releases Guidelines: Primary-Level Chronic Disease Management Enters Era of Full-Cycle Services
Chronic disease management is one of the core tasks of primary healthcare services, impacting the health and well-being of hundreds of millions of people. On November 20, the General Office of China's National Health Commission officially released the Guidelines for Building Primary-Level Chronic Disease Health Management Service Capabilities (hereinafter referred to as the "Guidelines"). The document explicitly calls for guiding localities to enhance primary-level chronic disease health management service capabilities based on actual needs, promoting the provision of integrated "one-stop" health management services. This initiative will usher in transformative changes in primary-level chronic disease management, enabling the public to access comprehensive, integrated health protection throughout their entire life cycle right in their own communities.
For a long time, patients with chronic diseases at the primary care level have faced fragmented services in health management-such as scattered access to health consultations, examinations, treatments, and follow-ups. They must visit community health centers for tests, then specialist clinics for follow-up appointments, and later coordinate separately with family doctors for ongoing care. This not only increases the burden of travel but also risks gaps in health information transmission between stages, undermining management effectiveness. The release of these Guidelines precisely targets this pain point, striving to break down service barriers within primary care institutions. By integrating functionalities, they aim to achieve a "one-stop" upgrade for chronic disease health management.
Notably, the functional medicine holistic health management model aligns closely with the guiding principles of the Guidelines, with its "one-stop service" comprehensively covering the entire process of chronic disease prevention and treatment.
The HRA Health Risk Assessment System can undertake multiple preliminary tasks, including health screening, early disease diagnosis, intervention effectiveness tracking and evaluation, as well as health guidance, laying the data foundation for developing personalized management plans. Meanwhile, PMR Pulsed Magnetic Microcirculation Therapy (Physical Medicine and Rehabilitation) technology provides scientific support for the prevention and rehabilitation intervention of various chronic diseases, such as cardiovascular and cerebrovascular conditions. This functional medicine "assessment + intervention" closed-loop model integrates key components, including resident health data collection, tiered health interventions, periodic health follow-ups, personalized health guidance, and dynamic health data analysis. It establishes a comprehensive chain-based management system spanning prevention, intervention, and rehabilitation.
Additionally, specialized services such as psychological stress assessment and intervention, red blood cell aggregation testing and intervention, and cognitive impairment screening and intervention can be integrated into the comprehensive management system. By combining multi-dimensional technological approaches, this creates a truly "one-stop" full-cycle chronic disease health management service, enabling primary healthcare institutions to achieve a qualitative leap in their service capabilities.
Industry experts note that the implementation of functional medicine's "one-stop management services" not only significantly enhances service efficiency and reduces patients' healthcare costs but also enables primary care physicians to gain a more comprehensive understanding of patient conditions through centralized management and sharing of health information. This allows for the provision of more targeted treatment plans and health guidance. This initiative represents both a concrete practice of the development philosophy centered on people's health and a key manifestation of high-quality development in the primary healthcare service system. As the Guidelines are progressively implemented across regions, primary care patients with chronic conditions will gain access to more convenient, high-quality, and continuous health management services, thereby strengthening the foundational layer for building a comprehensive national health security network.