Download - COMMUNITY ORIENTED PRIMARY HEALTH CARE
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Dept. Gen.Practice, CPH, Medical University of Vienna
COMMUNITY ORIENTED PRIMARY HEALTH CARE
Manfred Maier
Chairman,
Department for General Practice
Head,
Center for Public Health
Medical University of Vienna
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Dept. Gen.Practice, CPH, Medical University of Vienna
CONTENT
• Roots of COPC• Determinants of Health- public health approach• Duties and opportunities for Primary Care
- clinical duties
- education – training – teaching
- mutual interaction with „Public Health – programs“
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Dept. Gen.Practice, CPH, Medical University of Vienna
COPC - YESTERDAY
Pieter Brueghel, 1563, KHM Vienna
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Dept. Gen.Practice, CPH, Medical University of Vienna
COMMUNITY ORIENTED PRIMARY CARE
HISTORY• South Afrika 1940• „Homelands“, rural areas • Nutritional deficits, Syphilis, Malaria, Bilharziosis,
Tuberkulosis, ...• Health Centres
- Prevention und treatment- health education- inclusion / activation of the „community“
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Dept. Gen.Practice, CPH, Medical University of Vienna
HEALTH CENTERS
• methods- demography- influence on health- assessing morbidity- „community health status“- monitoring
• implementation - physicians - nurses- social workers Pieter Brueghel, 1568, Musée du Louvre
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Dept. Gen.Practice, CPH, Medical University of Vienna
Incidence of new cases of syphilis in the Pholela defined area
Year No. of new cases Mid-year
population
Incidence per
1000 population
1943 12 887 13,52
1945 347 5184 6,69
1947 287 6524 4,40
1949 228 6622 3,44
1951 128 8549 1,50
1957 83 10496 0,79
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Dept. Gen.Practice, CPH, Medical University of Vienna
COPC - TODAY
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Dept. Gen.Practice, CPH, Medical University of Vienna
COMMUNITY ORIENTATION
• Community– A group of people, which live in a certain region and
under the same circumstances (politics, environment, occupation, social system,…).
• Characteristics– socioeconomic status– religious groups– ethnic – cultural groups– occupational groups– age groups
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Dept. Gen.Practice, CPH, Medical University of Vienna
CONTENT
• Roots of COPC• Determinants of Health- public health approach• Duties and opportunities for Primary Care
- clinical duties
- education – training – teaching
- mutual interaction with „Public Health – programs“
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Dept. Gen.Practice, CPH, Medical University of Vienna
POPULATION HEALTH MODEL
• societies that enjoy a higher level and relatively equitable distribution of wealth enjoy a higher level of health status
• at the individual level, health status is determined by the social and economic environment and the way in which this environment interacts with individual psychological resources and coping skills.
Evans, 1994
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Dept. Gen.Practice, CPH, Medical University of Vienna
NEJM 2007; 357:1221-1228
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Dept. Gen.Practice, CPH, Medical University of Vienna
PUBLIC HEALTH - STRUCTURES AND STRATEGIES
• addressing all determinants of health• vaccinations, disease management programs,
health checks, … • working with different professionals and
organisations to improve health• influencing policy and plans for improving public
health • gaining visibility/awareness for public health
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Dept. Gen.Practice, CPH, Medical University of Vienna
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Dept. Gen.Practice, CPH, Medical University of Vienna
EXAMPLE FOR COPC: SUBSTITUTION PROGRAMM VIENNA
• appr. 10 000 drug addicts• withdrawal - substitution • goal: decent life in society• legal basis: SMG• agreement city – ÄK – WGGK• approx. 70 % cared for by GP´s
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Dept. Gen.Practice, CPH, Medical University of Vienna
EVALUATION
• increase in patients and attendance• advantages of treatment by GP
– low threshold- easy access– existing relationship– „difficult“ patients– GP is „flexible“– decentralized care
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Dept. Gen.Practice, CPH, Medical University of Vienna
GLOBAL HEALTH 2005
• One child dies of malaria in Africa every 29 seconds
• One person is infected with HIV every 6.4 seconds
• Someone in the world dies of TB every 18 seconds
• One pregnant woman dies of complications every 60 seconds
nature 2007
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Dept. Gen.Practice, CPH, Medical University of Vienna
FACTS ARE NOT APPRECIATED:
• 95% of health care economy spent for direct medical care
• 5% invested in population - wide approaches to health improvement
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Dept. Gen.Practice, CPH, Medical University of Vienna
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Dept. Gen.Practice, CPH, Medical University of Vienna
CITIZENS PER PHYSICIAN:
Austria 212Belgium 299Denmark 372France 328Germany 333Netherlands 420USA 472
Malawi 158000
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Dept. Gen.Practice, CPH, Medical University of Vienna
POOR COUNTRIES WITH SUPERIOR OUTCOME
• Emphasis on educational attainment• Empowerment of women• Well organized Primary Health Care System
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Dept. Gen.Practice, CPH, Medical University of Vienna
CONTENT
• Roots of COPC• Determinants of Health - public health approach • Duties and opportunities for Primary Care
- clinical duties
- education – training – teaching
- mutual interaction with „Public Health – programs“
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Dept. Gen.Practice, CPH, Medical University of Vienna
THE PRIMARY CARE PHYSICIAN IN THE COMMUNITY
• Clinical responsibility• Role model – educator, teacher ?• Research opportunities ?• Initiator of change ?
• goal: improving the health status in the community
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Dept. Gen.Practice, CPH, Medical University of Vienna
CLINICAL RESPONSIBILITIES
• Epidemiology in the community– documentation of health problems / diseases– identification of risks and needs
• Vulnerable groups / people in the community – psychiatric diseases, drug dependency, homeless
people, minorities, violence, …
• Allocation of resources / possibilities– rationalisation - rationing – overuse – misuse – underuse
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Dept. Gen.Practice, CPH, Medical University of Vienna
BARRIERS FOR RECEIVING ADEQUATE HEALTH CARE
• financial reasons ?• distances, transportation ?• competing needs, priorities ?• educational level ?• psychiatric diseases ?• social context ?• fear, sense of shame ?• access to health care services ?• attitude of health care personnel ?
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Dept. Gen.Practice, CPH, Medical University of Vienna
ACCESS TO HEALTH CARE
• Dependant on
- Availability in a community
- Personal care seeking behavior• Having an usual source of care improves
– Continuity of care– Preventive care– Prenatal care– Management of chronic diseases
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Dept. Gen.Practice, CPH, Medical University of Vienna
THE PRIMARY CARE PHYSICIAN AS ROLE MODEL – EDUCATOR - TEACHER
• medical students, trainees, colleagues• patients
– disease specific information / education– general patient information
• industry, schools, institutions, associations, ...
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Dept. Gen.Practice, CPH, Medical University of Vienna
RESEARCH OPPORTUNITIES
• participation in „community based projects“– population based studies– evaluation of research results / recommendations /
guidelines for daily practice– monitoring – documentation - registry for morbidity
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Dept. Gen.Practice, CPH, Medical University of Vienna
INITIATIVES FOR CHANGE
• implementation of public health strategies– environment – drugs – alcohol – obesity – vaccinations – health checks
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Dept. Gen.Practice, CPH, Medical University of Vienna
INITIATIVES FOR CHANGE - 2
• Feedback to health politics on health care aims or health care reforms– social disadvantages– social isolation– drug policy– violence– interface problems– injustice / inequity
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Dept. Gen.Practice, CPH, Medical University of Vienna
Politics, Public Health
Programms
Patient centeredGP
implementation ?
disease centered
PHC
Family, Community, Population
Patient
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Dept. Gen.Practice, CPH, Medical University of Vienna
THANK YOU FOR YOUR ATTENTION !