Future impact of continuity on quality of care - PowerPoint Presentation

Slide1

Future impact of continuity on quality of care within Primary CareSlide2

Disposition 16.30 Introduction - Continuity in primary care - background and evidence   (

C.Björkelund)

16.45 Enhancing continuity in future primary care in Europe – impact on multi-morbidity, goal- oriented care and equity (Jan de Maeseneer) 

17. 10  Continuity of care through the patient's eyes - focusing on patient   experience.    (Anna Maria Murante) 

17.30  Continuity of care – national examples          (Kathryn Hoffman A. Maun

Zsuzanna

Farkas-Pall

)

17.40 Workshop discussion on continuity:

17.55  Summary and conclusions

 Slide3

Continuity in primary care - background and evidence

Cecilia Björkelund

Department of Primary Health CareUniversity of Gothenburgand Region VästraGötalandSlide4

Continuity of care –One of the cornerstones of

primary careSlide5

Evidence from community and provider perspective

Lower

health care

costsLower hospitalization and emergency room useGreater efficiency of services Associated with substantial reductions in long-term mortalityMore effective prevention of diabetes

Increased quality of care in primary care depression treatmentSlide6

Patients’ perspective

Patients identified both factors that promote as well as factors that divide continuity of care across boundaries

Chronic ill patients valued being attended regularly and over time by one physician while Young patients valued convenient access.

“variations in perceived importance seem to depend on both individual and contextual factors which should be taken into account during healthcare provision “ Waibel S,

Henao D, Aller M-B, Vargas I, Vazquez M-L. What do we know about patients' perceptions of continuity of care? A meta-synthesis of qualitative studies. International Journal for Quality in Health Care 2011Slide7

Chronic conditions

100 000 primary care patients 182 general practices in England.

58 % of the patients had chronic conditions accounting for 78% of the consultationsreceived lower continuity. “patients with multi-morbidity are, are

less likely to receive continuity although they should be more likely to gain from itSlide8

Evidence seems to recognize continuity as one of the cornerstones of high quality primary care

Synthesis of quality of care for patients with complex care needs in eleven European countries showed that all countries needed improvements by development of care teams in primary care, managing among other things transitions and medication

BUT - there is no sign of decreasing lack of continuity in primary care in Europe. Slide9

The complexity of operationalizing

continuity in the context of multi-disciplinary team-based primary care of today and tomorrow, with the desirable effects on care both from patients’ perspectives

, from medical and health economic perspectives as well as political perspectives is a great challenge.

The challenge will also be how to measure and how to compare between primary care centers, organizations and between countries, as this will be the best way to stimulate the desired development. Slide10

There is great need of further developing methods to assess and promote continuity in primary care

There is great need of research to better understand and

operationalize continuity and how development of continuity should be stimulated and incentivized There is great need of studying the effects – including costs and benefits – of today’s general practice as well as the costs of diminishing

continuity.Slide11

EFPC Position paper

Impact of continuity on quality of care within Primary Care – with

focus on the perspective of preferences of citizens

Does interpersonal continuity lead to improved medical outcomes? Does interpersonal continuity of practitioner/nurse/team aid in the management of problems? Which organizational structures improve interpersonal continuity in primary care of today?Slide12

Enhancing continuity in future primary care in Europe – impact on multimorbidity

, goal-oriented care and

equity

Prof. Dr. J. De Maeseneer, MD, PhD

Family Physician

, Community Health Centre ,

Ledeberg-Ghent

(Belgium)

Head of

department

of

Family

Medicine

and PHC-

Ghent

University

(

Belgium

)

Chair

European Forum

for

Primary

Care

Gothenburg

, 03.09.2012Slide13

http://www.primafamed.ugent.be

http://www.euprimarycare.org

http://www.the-networktufh.org

http://www.wgcbotermarkt.beSlide14

Continuity in future primary care

Continuity of care: a catch-

all termTypology

Multimorbidity, goal-oriented care and equityThe

future of continuity: threats and

opportunities

in

patients

with

multimorbidity

Conclusion

:

from

the

patient

, the provider, the

practice

towards

the community, the team, the systemSlide15

1. Continuity of care: a catch-all term“A

sustained partnership between

patients and clinicians” (IOM)

Process or outcome?RelationshipContextualCost-effective?Slide16
Slide17

Table 3. Provider Continuity (0/1) in a Multivariate

Approach With Total Health Care Cost (Logarithmic

Transformation) as the Dependent Variable:Standardized Regression Coefficients β

Explaining

Variables

Standardized

Regression

Coefficient

β

P Value

Older

age

.086

< .001

Sex

(male)

-.036

.008

Health locus of control: internal

-.030

.029

Physical functioning

-.1568

< .001

Mental functioning

-.056

< .001

Multiple morbidity

.116

< .001

Number of regular encounters

.296

< .001

Provider

continuity

-.105

< .001

R²

27.6%

De Maeseneer, J. , De Prins, L.,

Gosset

, C.

and

Heyerick

, J. (2003

).

Annals

of Family

Medicine

, 1(3):

148

.Slide18
Slide19

Continuity in future primary care

Continuity of care: a catch-

all termTypology

Multimorbidity, goal-oriented care and equity

The future of continuity: threats

and

opportunities

in

patients

with

multimorbidity

Conclusion

:

from

the

patient

, the provider, the

practice

towards

the community, the team, the systemSlide20

Informational An organized collection of medical and social information about each patient is readily available to any health care professional caring for the patient. A systemic process also allows accessing and communicating about this information among

those involved in the careSlide21

Longitudinal In addition to informational continuity, each patient has a "medical home" where the patient receives most health care, which allows the care to occur in an accessible and familiar environment from an organized team of providers. This team assumes responsibility for coordinating the quality of care, including preventive servicesSlide22

Interpersonal In addition to longitudinal continuity, an ongoing relationship exists between each patient and a personal physician

. The patient knows the physician by name and has come to trust the physician on a personal basis. The patient uses this physician for basic health services and depends on the physician to assume personal responsibility for the patient's overall health care. When the personal physician is not available, a coverage arrangement assures that longitudinal continuity occurs.Slide23

Continuity in future primary care

Continuity

of care: a catch-all term

TypologyMultimorbidity, goal-oriented care and

equity

The

future

of

continuity

:

threats

and

opportunities

in

patients

with

multimorbidity

Conclusion

:

from

the

patient

, the provider, the

practice

towards

the community, the team, the systemSlide24

The ageing societySlide25
Slide26

Multimorbidity becomes the rule, not the exceptionMore than half of the patients with COPD have either cardiovascular problems, or diabetes

Patients with COPD have a 3- to 6-fold risk to have all these problems

50 % of 65+ have at least 3 chronic conditions20 % of 65+ have at least 5 chronic conditions

(

Eur

Respir

J 2008;32:962-69)

(Anderson 2003)Slide27
Slide28

Age-standardised prevalence and prevalence ratio of diabetes by educational level in men and women, 30-64 years of age in selected countries (source:

Eurothine, 2007)

Country

Tertiary education

Lower

secundary

education

Spain

Men

Women

2.7

1.1

4.9

5.1

Belgium

Men

Women

1.5

1.2

4.4

4.6

Estonia

Men

Women

2.0

4.1

5.3

8.2Slide29
Slide30
Slide31

Wagner EH. Effective Clinical Practice 1998;1:2-4

Slide32

EMPOWERMENTSlide33
Slide34

But

…Slide35

Jennifer

is 75

years old

. Fifteen years

ago she

lost her

husband

.

She

is a

patient

in the

practice

for

15

years

now

.

During

these last 15

years

she

has been

through

a

laborious

medical

history

:

operation

for

coxarthrosis

with

a hip prothesis,

hypertension

, diabetes type 2, COPD and

osteoartritis

.

Moreover

there

is

osteoporosis

.

She

lives

independently

at her home,

with

some

help

from

her

youngest

daughter

Elisabeth. I

visit

her

regularly

and

each

time she starts saying: “Doctor, you must help me”. Then follows a succession of complaints and unwell feeling: sometimes it has to do with the heart, another time with the lungs, then the hip, …Slide36

Each

time I suggest

– according

to the guidelines - all sorts of

examinations

that

did

not

improve

her

condition

. Her

requests

become

more and more

explicit

,

my

feelings

of

powerlessness

,

insufficiency

and

spite

,

increase

.

Moreover

, I have to

cope

with

guidelines

that

are

contradictory

:

for

COPD

she

sometimes

needs

corticosteroids

,

which

worsens

her

glycemic

control

.

The

adaptation

of the

medication

for

the

blood

pressure (at one time too high, at another time too low), cannot meet with her approval, as does my interest in her HbA1C and lung function test-results.Slide37

After

so

many

contacts Jennifer says

: “Doctor, I want to tell

you

what

really

matters

for

me.

On

Tuesday

and

Thursday

, I want to

visit

my

friends

in the

neighbourhood

and

play

cards

with

them

.

On

Saturday

, I want to go to the

Supermarket

with

my

daughter

. And

for

the rest, I want to

be

left

in

peace

, I

don’t

want to

change

continually

the

therapy

anymore

, …

especially

not

having to do this and to do that”.In the conversation that followed it became clear to me how Jennifer had formulated the goals for her life. And at the same time I felt challenged how the guidelines could contribute to the achievement of Jennifer’s goals. I visit Jennifer again with pleasure ever since: I know what she wants, and

how

much

I

can

(

merely

)

contribute

to her

life

.Slide38

Sum of the guidelines

Patient

tasks

Joint protection

Energy

conservation

Self monitoring of

blood

glucose

Exercise

Non

weight

-

bearing

if

severe

foot

disease

is

present

and

weight

bearing

for

osteoporosis

Aerobic

exercise

for 30 min on

most

days

Muscle

strenghtening

Range of motion

Avoid

environmental

exposures

that

might

exacerbate

COPD

Wear

appropriate

footwear

Limit

intake

of

alcohol

Maintain

normal body

weight

Clinical

tasks

Administer

vaccine

Pneumonia

Influenza annually Check blood pressure at all clinical visits and sometimes at homeEvaluate self monitoring of blood glucoseFoot examinationLaboratory testsMicroalbuminuria annually if not present Creatinine and electrolytes at least 1-2 times a year Cholesterol levels annually Liver function biannually HbA1C biannually to quarterly ReferralsPhysical

therapy

Ophtalmologic

examination

Pulmonary

rehabilitati

Patient

education

Foot care

Oeseoartritis

COPD

medication

and

delivery

system training

Diabetes

Time

Medications

7:00 AM

Ipratropium

dose inhaler

Alendronate

70 mg/

wk

8:00 AM

Calcium 500 mg

Vit

D 200 IU

Lisinopril

40mg

Glyburide

10mg

Aspirin

81mg

Metformin

850 mg

Naproxen

250 mg

Omeprazol

20mg

1:00 PM

Ipratropium

dose inhaler

Calcium 500 mg

Vit D 200

IU

7:00 PM

Ipratropium

dose inhaler

Metformin 850 mgCalcium 500 mgVit D 200 IULovastatin 40 mgNaproxen 250 mg 11:00 PM Ipratropium dose inhalerAs neededAlbuterol dose inhalerParacetamol 1g

Boyd et al. JAMA, 2005Slide39
Slide40

“Problem-oriented versus goal-oriented care”

Problem-oriented

Goal-oriented

Definition of Health

Absence of disease as defined by the health care system

Maximum desirable and achievable quality and/or quantity of life as defined by each individualSlide41

“Problem-oriented versus goal-oriented care”

Problem-oriented

Goal-oriented

Purposes of Health Care

Eradication of disease,

prevention of death

Assistance in achieving a maximum individual health potentialSlide42

“Problem-oriented versus goal-oriented care”

Problem-oriented

Goal-oriented

Measures of success

Accuracy of diagnosis, appropriateness of treatment, eradication of disease, prevention of death

Achievement of individual goalsSlide43

“Problem-oriented versus goal-oriented care”

Problem-oriented

Goal-oriented

Evaluator of success

Physician

PatientSlide44

What really matters for patients is Functional statusSocial participation Slide45

Evolution from‘Chronic Disease Management’ towards‘Participatory Patient Management’

Puts the patient centrally in the process.

Changes the perspective from ‘problem-oriented care’. towards ‘goal-oriented’ care.Slide46
Slide47

F R A G M E N T A T I O NSlide48

The challenge: vertical disease- oriented programs and multimorbidity

Create duplication

Lead to inefficient facility utilization

May lead to gaps in patients with multiple co-morbiditiesLead to inequity between patientsSlide49
Slide50
Slide51

Problems with guidelines in multimorbidity“Evidence” is produced in patients with 1 disease

Guidelines may lead to contradictions (e.g. in therapy)Slide52

“Treat the patient”

“Treat-to-target”Slide53
Slide54

Resolution WHA62.12 “Primary Health Care, including health systems strengthening”

The World Health Assembly, urges member states: … (6) to encourage that vertical

programmes

, including disease-specific

programmes

, are developed, integrated and implemented in the context of integrated primary health care.Slide55
Slide56

Multi-morbidity, goal-oriented care and equity:

The

way goals are formulated by

patients is determined by social class“

contextual evidence” : how to deal

with

an

“

unhealthy

” and “

inequitable

” context?Slide57

Community

Health Centre:

Family

Physicians; nurses; dieticians; health promotors;

dentists; social

workers

; …

6000

patients

;

60

nationalities

Capitation

;

no

co-payment

COPC-strategySlide58

Dia

betes clinic: horizontal approach to chronic conditions

Objectives:Improving the care for diabetes type 2 patients through a structured multidisciplinary follow-up and health education

Improve self-efficacy of patientsTo tackle social inequalities in relation to chronic diseasesSlide59

Diabetes clinic: horizontal approach to chronic conditionsProgramme:

biomedical and behavioural follow-up by nurse, diabetes educator,dietician and family physician, implementing guidelines in the context of the patient

exchange of experiences by the patients (groups)“diabetes-cooking” (3 x / year)Slide60

Integration of personal and community health care

The Lancet 2008;372:871-2Slide61

Intersectoral action for health: the community

Ledeberg

(8.700

inh

.)

Platform of stakeholders

Implementing COPC-strategy, taking different sectors on board

Accessible

,

comprehensive

,

quality

local

health

care

facility

: a

multidisciplinary

Primary

Health Care CentreSlide62

Platform of stakeholders:

40 to 50 people

3 monthly

Exchange of information

“Community diagnosis

”

Intra-family violenceSlide63

Continuity in future primary care

Continuity

of care: a catch-all term

TypologyMultimorbidity, goal-oriented care and equity

The future of continuity

:

threats

and

opportunities

in

patients

with

multimorbidity

Conclusion

:

from

the

patient

, the provider, the

practice

towards

the community, the team, the systemSlide64

4. The future of continuity: threats and opportunities in

patients with

multimorbidityThreats:

Anonimous care – dilution of informationDilution of responsebilityOutsourcingFragmentationSlide65

4. The future of continuity: threats and opportunities in

patients with

multimorbidityOpportunities

The patient in the driver’s seatIncreased comprehensiveness –

complementary frames of referenceIncluding context

Task-sharing

Interprofessional

feedback

SustainabilitySlide66

4. The future of continuity: threats and opportunities in

patients with

multimorbidityRequirements

Culture of cooperationPatient’s choice: limits?E-health system: interprofessional

electronic patient recordInterprofessional education

Case-load

Comprehensive

financing

mechanisms

:

integrated

needs

based

capitationSlide67

Continuity in future primary care

Continuity

of care: a catch-all term

TypologyMultimorbidity, goal-oriented care and equity

The future of continuity: threats and

opportunities

in

patients

with

multimorbidity

Conclusion

:

from

the

patient

, the provider, the

practice

towards

the community, the team, the systemSlide68

Assessment over time Informational: improvement

Longitudinal: PHC team Interpersonal

: the challengeSlide69

Thank you…

jan.demaeseneer@ugent.be

WHO

Collaborating

Centre

on

PHC

We thank Lynn

Ryssaert, MA,

PhD-student for her valuable inputSlide70

Continuity of care through the patient's eyes - focusing on patient experience

Anna Maria

Murante

,

Laboratorio

Management e

Sanità

Istituto

di

Management

Scuola

Superiore

Sant’Anna

- Pisa (Italy)Slide71

Before we start...Slide72

Before we start...

Patient satisfaction

vs

patient experience

(

Avedis

Donabedian

, 1988)

Patient satisfaction as

a quality-outcome indicator

The complexities of modern health care and the different expectations and experiences of patients cannot be measured by asking ‘

How satisfied are you with your care/service?

’ Slide73

Before we start...

Patient satisfaction

vs

patient experience

Patient experience measures coming from questions like ‘

What was your experience with…

’ report

(through the patient perspective/perception)

whether a certain events occurred.

However, patient tend to be more positive in evaluating care than in reporting their experience with specific events.

(Fitzpatrick et al, 2009)Slide74

Adler R,

Vasiliadis

A,

Bickell N. The relationship between continuity and patient satisfaction: a systematic review.

Fam

Pract

2010;27(2):171-8.

Continuity of care & patient satisfactionSlide75

Let's move on!Slide76

Continuity of care is a dimension of patient satisfaction

(Ware and Snyder, 1975)

Interpersonal continuity

Longitudinal continuity

Informational continuity

(Saultz,2003)Slide77

Interpersonal Continuity

& patient satisfaction

(1992)Slide78

«[…] ‘

overfamiliarity

’ or seeing the same physician too frequently could

lead to missed diagnosis

or

fed beliefs that the

physician could

become complacent with the patient’s

problems, so

that

his or her concerns were

no

longer

taken seriously

.

»

Interpersonal

Continuity

& patient satisfactionSlide79

Interpersonal and Longitudinal Continuity

& patient satisfaction

2001Slide80

«[…] patients expected from their GPs to exchange information with specialists regarding their health situation, treatment options and care facilities

»

Informational

Continuity

& patient satisfactionSlide81

Other

Continuity

& patient satisfaction

(2006)Slide82

(Naithani

et al, 2006)

Adjusting services to the needs of the individual over time.

«

The nurse … always makes time for me. If I phone […] she will always call me back on the same day. I have been able to see her when I’ve needed to

.

»

«

They’re very good here you know, whenever I need to see the doctor I can just phone up and get a appointment when you want, you don’t have to wait long and they ask you, you know, what’s it about so if you need more time then they will book you a double appointment .

»

Flexible

Continuity

& patient satisfactionSlide83

(Naithani

et al, 2006)

«

Just recently I have had to change doctors because the doctor that I have been seeing has retired. When I went to the new practice and registered and went to see the nurse, they told me they didn’t have any information on me and

my medical records hadn’t turned up

. »

Team and cross-boundary

Continuity

& patient satisfactionSlide84

(Naithani

et al, 2006)

«[…]

Patients responses to their perception of a serious lack of experienced continuity of care were sometimes to seek alternative care and advice, non-compliance with advice or treatment, or withdrawal from formal services and attempting to monitor and

manage their condition themselves.

»

Team and cross-boundary

Continuity

& patient satisfactionSlide85

What happens when patients have a chronic disease?Slide86

Patients with chronic conditions

prefer to s

ee

their GPs regularly to check the progress

even when they were

not feeling

sick

(

Infante

et al, 2004)

.

Patients

with

multiple long-term

conditions

report

that several professionals know them equally

well

(

Cowie

et al, 2009)

.

Chronicity

&

continuity & patient satisfactionSlide87

According to the experience of some patients with

diabetes

:

GPs might lose interest,

when they were referred to

secondary

care

(

Infante

et al, 2004)

GPs and specialist have to exchange information on health situation, treatment options and care facilities

(

Michielson

et al, 2007)

Chronicity

&

continuity & patient satisfaction

Patients with co-morbidities

perceived that specialists did not interact with their colleagues.

(Williams, 2004)

Patients with chronic conditions report to be frustrated when they had to repeat their antecedents to doctors, who had not informed themselves in

advance.

(Von

Bültzingslöwen

et al, 2006)Slide88

«Young and employed patients with a minor, acute health problem preferred convenient access, although achieved at the cost of seeing different healthcare professionals. In urgent cases, an immediate intervention became a priority for patients with diabetes or other long-term conditions.

»

Chronicity

&

continuity & patient satisfactionSlide89

Continuity of care & patient satisfaction

The point of...

Several

and

different

measures

are

used

to

extimate

the

relationship

between

PS and

CoC

Many

evidences

exist

about

a positive

relationship

But

also

anyothers

report a

weak

or

not

significant

relationship

.

Among

patients

with

chronic

condition

different

results

could

be

observed

(e.g.

depending on severity), however sharing information among professionals is a common need.

Timely access to services may be preferred to continuity of careSlide90

Thanks for your attention!

Anna Maria

Murante

a.murante@sssup.it

Laboratorio

Management e

Sanità

Istituto

di

Management

Scuola

Superiore

Sant’Anna

di

Pisa (Italy)Slide91

A country report Austria

Kathryn Hoffmann, MD, MPH

EFPC Conference Gothenburg 2012

Impact of continuity on quality of care within PCSlide92

The three sisters of continuityFist

Contact: Free, region-wide and full covered access for everybody

Coordination: Structural preconditions for continuity:

1) System level: E.g. single vs. group practices, financial incentives 2) Process level: E.g. gate-keeping-system, list-system, appointment-system, ...Comprehensiveness: Knowledge about the predominant diseases in the related region/county (adequate staff with adequate education and equipment):

E.g. morbidity registers, sentinel offices for surveillance, ...Continuity

Barbara

Starfields

´ 4 cardinal “C”s of PC

92Slide93

Austrian situation (excerpt)First

Contact: Free access, overall good availability, for more than 98% of population fully covered BUT free and covered access with some exceptions (e.g. radiologist) also to the secondary level of care

Coordination: No gate-keeping system, no list system, ~95% single-handed practices, fee-for-service mainly, GPs are self-employed

Comprehensiveness: Very high standard of equipment, nearly no knowledge about the morbidity situation in the primary care sector: mainly hospital based data, no incentives for community-orientation, 3-year hospital based postgraduate education to become a GP

93Slide94

Some preliminary results from Austria>70% of patients said they have a certain GP but >60% of them visited a specialist without referral at least once in the last year– QUALICOPC data

Rate of patients who visited a specialist within the last 4 weeks with referral from GP is low (~26%). Chronic disease is not a predictor for a higher referral rate in women - part of the Ecohcare-study; will be submitted soon

94Slide95

Continuity in Austria: Attempt of a summery

Single handed practices: Good for continuity, bad for GPs satisfaction?

Choice of physician as patients decision High satisfaction with system in 2004 (Euro health consumer index) vs. publication “cost of satisfaction”(Fenton, 2012)

High health care expenditures, high hospital admission rates, high utilisation of specialists (e.g. Austria 71.1% vs. the Netherlands 37.8% - own research project), low referral rates, low healthy life years for 65+

How to measure the impact of continuity on quality of care alone to highlight its

importance?

95Slide96

Continuity of care – national examples

Sweden

Andy Maun

member of quality council SFAM Q

GP Trainee, Primary Healthcare

Gothenborg

, PhD studentSlide97

Healthcare systems in SwedenIn health care and certainly primary healthcare:21 counties and regions

differing in:

payment systems IT – systems follow–up of qualitySlide98

Reform on Choice of Care 2008Aim: Increase the number of healthcare centresPatients can choose a centre but not personal GP - centres compete!

Resulted in a lot of new centres mostly run by great companies owned by risk capitalists.Slide99

Trends in most CountiesPayment by individual capitation based onage socio-economy

morbidity burden (ACG - adjusted clinical groups)The centre pays all costs for laboratory services, x-ray and drugs Slide100

Development of a register for Quality Improvement of the Western Region

Aim: regional primary healthcare register with the potential for a national register

Target group:Healthcare centres - internal improvements

Academy - scientific researchPolitical management - results, paymentPatient – choice of healthcare centreSlide101

Get a new…

…

perspectiveSlide102

IndicatorsFive chronic diseases: (< age 75)

Diabetes (National Diabetes Register)

Ischemic heart diseaseHypertension

Asthma COPDSlide103

Medical variabels

Diagnosis

SmokingWeight

LengthWaistlinesAge / Gender

Spirometry

HbA1c

Blood lipids

Blood pressure

Results can be linked to

o

ther registers e.g. stroke register

p

rescription register

s

ocioeconomic data

Slide104

Effects?

Diabetes diagnosis

Primary Healthcare, Western Region

Before/after ACG

(Payment for

morbidity

burden)

0

10 000

20 000

30 000

40 000

50 000

60 000

70 000

2005

2006

2007

2008

2009

2010

Number of

individuals

Staffan Björck, Analysis Unit Western Region Slide105

Pilot study - continuityAim: to examine the feasibility of a larger study, where the correlation between provider continuity and health outcomes is to be

exploredMethod

: retrospective study (Oct 2009-Febr 2012)

four primary care centres (33485 individuals)health outcomes (blood pressure, HbA1c) usual provider continuity (UPC) and continuity of care index (COC) for physician/nurse

continuity®Slide106

Results – No distinct correlationsNo distinct correlations could be found between interpersonal continuity with physician/nurse and blood pressure and HbA1c values

A timeline-study on the whole population of the region (1,5 million inhabitants) is feasible and necessary to gain more knowledgeSlide107

ChallengesTransformation? From interpersonal continuity towards team continuity in primary care?The big challenge: collaboration cross organizational borders?What actions are required to improve medical outcomes?Slide108

Thank you for your attention!Slide109

Dr. Zsuzsanna Farkas-Pall

Continuity of care,

a way to reduce healthinequalitiesSlide110

BackgroundIn Romania, no or little efforts were made at policy making levels to address socio-economic determinants of health and tackle health inequalities emerging from reduced access to health care, lack of local health services, povertyNo feasible solutions are offered to bridge the gap between sporadic and continuous access to health care servicesLocal primary care team can play a key role in maintaining continuity and offering tailored health services in the communitySlide111

AimsTo give an example of good practice in reliable, continuous health service delivery and gather evidence about the importance of it To act locally, use local resources and emphasize the importance of team approachTo offer integrated health services locally and monitor the impact on health indicators in the communitySlide112

The national contextApprox. 11000 GPs working in mostly solo practices

Nr. of patients/GP 1545,practice nurse/GP rate1.2

Nr. of settlements without any health care provider 88,

with a total of 153904 inhabitantsNr. of settlements without access to out of hours service 2330

Percentage of people without health insurance 16.10%

Amongst EU states Romania has the most reduced percentage of GDP spent on health care- 5.5% Slide113

Our experience Our health centre is located in the north-western region of RomaniaWe provide the community with the possibility of having ultrasound, ECG examinations, lab tests, physiotherapy, family planning services and access to

prevention programs performed locally During the years we developed educational programs targeting different groups in the community, have done research activities to gather evidences in order to prove the importance of our activities

The activites are ongoing and continuity helped developing partnership with the community Slide114

ResultsContinuity in access to high standard sustainable and reliable health services, health promotion will result in improved health indicators, healthier and more satisfied population, decreased needs of secondary care services, efficient utilization of the existent resourcesPrimary care team equipped with appropriate tools and empowered with knowledge is well positioned to reduce health inequalities

Continuity in patient education, establishing partnership will induce a more responsible and self conscious population

a ativităţii, invitaţii personalizate, intervenţii consecvente accesibile pentru populaţie.Slide115

ConclusionsIntegrated health services like ultrasounds, ECG, lab tests and ongoing population based health education and screening programs has to be delivered locally and the service must be reliable to build trust and engagementgaps in health care provision will negatively influence patient behavior and will lead to setbacksOur approach towards continuity in primary care service delivery in the community has helped to improve the relationship between our staff and the population in our area: trust has lowered the threshold for contact

The model is sustainable as it uses local resources and is based on a partnership with the community Slide116

Thank you for your attention!