Transcript Diapositiva 1

MINISTERIO
DE SANIDAD, POLÍTICA
SOCIAL
E IGUALDAD
”Better Health- A Shared
Challenge for Hospitals and
Primary Health Care”
Dra Mª Teresa García Ortiz
Instituto Nacional de Gestión Sanitaria
Ministerio de Sanidad, Política Social e Igualdad.
España 2011
1
Primary Health Care
 Background
 Model of primary care in Spain
 Strategic framework for the
improvement of primary care in
the 21st century
Background
 Alma Ata 1978
 Creation of the Speciality Family and
Communitary medical practitioner .
1979
 RD Basic Structures of Health
137/1984
 1986 General Health Act
 Cohesion & Quality Act (2003)
PRIMARY HEALTH
CARE MODEL IN
SPAIN
Structure of the Health Care Area
Basic Health
Zones
Health
Care Area
+
+
+
+
+
Main Hospital
+
+
+
+
+
+
+ : primary care
Specialized ambulatory care
PRIMARY CARE AS GATEKEEPER
Primary Care is the axis of the health system and it is the
nearest health resource for most people.
80% health’s problems are solved in PH Care, and the general
practitioner is the one who decides when another health
professional or specialized service has to give further assistance
to the patient.
This is the level where most activities of health promotion,
health education and preventive medicine are assumed. Physical
rehabilitation and social support are also offered.
Specific activities, focusing on specific groups are also carried
out (women, children, elderly people, oral and dental health,
terminal patients and mental health)
RD 137/1984, January 11
Basic Structures of Health
 - Health Zone delimitation
 - Health Care Centre
 - Primary Care Team:


Composition
functions
 - Working time
Health Care Zone
 Health Zone, is a Geographical demarcation
 The demarcation is done with demographic,
geographic and social criteria
 The population covered in each area is
between 5,000 and 25,000 inhabitants.
Primary Health Care
Team of one Centre
Composition:
 General practitioners
 Paediatric specialists
 Nurses, nurse assistants and midwifes.
 Pharmaceuticals
 Social worker
 Administrative staff
Primary Health Care
Functions :





Medical assistance in the centre and at
home and urgent assistance
Promotion of health, Prevention of
diseases, and social rehabilitation
Health Education to the population
Evaluation of the activities and results
Participation in health programmes
Primary Health Care:
other units
 Prevention of diseases (e.g. education, vaccinations )
 Physiotherapy
 social health care
 Special attention to women, children and risk groups
 Palliative care of terminal ill patients
 Mental health
 limited dental health care
Improvements of the New Model of
Health Care:
1.
The incorporation of family physicians,
pediatricians and nurses to primary care
teams, resulting in professional renewal and
upgrading of training
2.
Full-time work a day. It moves away from 2
hours to 7 hours working time (more dedication
per patient )
Improvements of the New Model
of Health Care:
3.
Teamwork: from an individual job to a coordinated
actions doctor-nurse and the incorporation of clinical
sessions, discussion of cases, etc
4.
Promotion and prevention programs
5.
Use of the clinical record and new technologies
Strategic framework for the
Improvement of the Primary
Health Care in Spain: 2007-2012
Strategy PHC 21
 Political Objectives (Summit of Presidents, September 2005):
increase resources and capacity of primary health care
 The Ministry of Health, Social Policy and Equality Project has
led the Strategic Framework for improving primary care in the
twenty-first century
 Collaboration of more than 90 experts nominated by scientific
societies, autonomous regions and associations of patients
Objectives
Define a strategic framework to consolidate the
public health system, with the central axis
primary health care, continuity of care in
hospital and social services.
revisar
Methodology
 Assess the current situation of primary care, analyzing
the achievements of the reform, but also the difficulties
 Propose improvements and changes necessary to
improve the quality scientific and technical, to provide an
efficient service to citizens.
Analysis based on 5 thematic
areas
 Activity in primary health care
 Organization and management
 Resolution
 Evaluation and improvement of
primary care processes
 Health outcomes
Outline document for each group:
1.
Justification
2.
Evolution and current situation
Main Characteristics I:
1. The consolidation of the working model for primary care teams
within the public health system with universal coverage and a
high degree of acceptance by the population
2. The existence of a portfolio of explicit, specific primary carebased health programs
3. The high level of technical training for professionals working in
this field
4. Implementation of an organizational culture that includes work
by objectives and processes
THREATS AND OPPORTUNITIES(I):
 Epidemiological changes produced by :
 Aging of the population
 Increase of chronical diseases and disabilities
 Emerging infectious diseases and those related to




lifestyles
Influence of migration
Increased incidence of mental pathology
New challenges in reproductive health
etc.
New Challenges for Primary
Health Care C. XXI (I)
1.
Growth and progressive aging of the population
2.
Increased prevalence of chronical and degenerative
diseases
3.
Immigration
4.
Trend towards medicalization of health problems
5.
Increased workload in consultations
6.
Better-informed users , generating new needs and more
expectations in health.
New Challenges for Primary
Health Care C. XXI (II)
7.
Lost of importance of health promotion and
disease prevention in the daily chores of
professionals
8.
Emergence of different organizational models
9.
Technological development
10. Problems in coordination between primary
and specialized health care, etc..
Strategic framework improving Primary
Health Care: 2007-2012
The axes of the Strategic
Framework
 1.
Citizen
 2. Professionals
Key objectives
 1.
Quality
 2. Solving skills
 3.Continuity of care
Axes (I):
1. Citizen:
 It is necessary that the citizens feel part of the
public health system

Participation in decision-making about their health
problems
Axes (II):
2. Professionals:
 Professionals have to be involved in the management of the health
services and to participate in decision-making processes
 AP-21 Project is committed to motivating factors and incentives for
professionals, both from the economic point of view and with the
autonomy of management, the promotion of training and research,
etc..
Key Objetives (I)
Quality:

The
commitment
to
quality
must
be
comprehensive, including not only scientific and
technical
components,
but
accessibility,
resources, organization and participation.
Key Objetives (II)
2. Solving skills
 85% health’s problems must be solved in PH Care
(effectiveness)
 increasing diagnostic and therapeutical capacity
, thereby
improving the training of professionals
 Development and implementation of clinical guidelines
Key Objetives (III)
3. Continuity of care
 Coordination between primary and specialized health care is
an essential objective.
 Coordination between primary health care and public health

Coordination between primary health care and social care
Elements that reinforce
Coordination (I)
 Shared Health Clinical e-Record
 Computerization of all health centres
 Electronic prescriptions
 Electronic connection between all Primary Care Centres
and Hospital
 e-access to Lab data and Digital Imaging
 Common and Shared Training Activities
 Unification of the Organization (Same Manager Team)
Elements that reinforce
Coordination (II)
 Common Objectives in the “Management Contract”
 Electronic administrative procedures from the Health
Centre
 Definition of common guides and protocols
 Introduction of Incentive Professionals (Career / Objectives)
 Same Patient Identification Code (CIP)
 Discharge Report sent to Family/Nurse Primary Centre from
hospital
Some figures. Spain 2009
Source: Ministerio Sanidad, Política Social e Igualdad
Structure:Centres and Teams
Zonas
Centros de
salud
Consultorios
locales
ANDALUCÍA
216
390
1.116
ARAGÓN
125
117
915
ASTURIAS (PRINCIPADO DE)
84
68
151
BALEARES (ISLAS)
57
57
103
111
111
170
41
42
121
CASTILLA Y LEÓN
248
243
3.647
CASTILLA-LA MANCHA
201
200
1.113
CATALUÑA
362
415
831
COMUNIDAD VALENCIANA
240
259
583
EXTREMADURA
113
110
414
GALICIA
315
390
93
MADRID (COMUNIDAD DE)
310
258
158
MURCIA (REGIÓN DE)
89
79
189
NAVARRA (COMUNIDAD FORAL DE)
54
54
244
122
135
185
19
19
174
7
7
0
CANARIAS
CANTABRIA
PAÍS VASCO
LA RIOJA
CEUTA y MELILLA (INGESA)
2.714
2.954
10.207
Professionals Ratios
Medicina de familia
Pediatría
Enfermería
2004
1.484
1.030
1.709
2005
1.487
1.036
1.698
2006
1.441
1.080
1.627
3.042
2007
1.426
1.041
1.658
2.973
2008
1.410
1.029
1.663
3.102
2009
1.411
1.063
1.626
2.940
Total
Año 2009
Auxiliar
administrativo
Médicos Pediatras Enfermeras Aux. Adm.
28.405
6.237
28.660
22.195
Activity
Año
2007
2008
2009
Consultas
335.958.299
352.136.156
393.187.229
Individuos
11.723.697
25.753.060
28.438.666
Frecuentación Medicina de
Pediatría
familia Enfermería
2007
7,1
5,9
4,9
2008
6,8
6,2
5,3
2009
6,7
6,0
5,1
Frecuentación
general
8,73
9,13
8,42
Conclusion
The changes and improvements made
by the new model of primary health
care have been an unprecedented
leap in health care for the Spanish
population, with beneficial results in
the development of numerous health
indicators. This is a stimulus for
further work on the weaknesses
identified in this project .