Recent Advances
in
Primary Health Care
Dr Marilyn Baldacchino MD
Dr Glorianne Bezzina MD
Dr Anne-Marie Scerri MD
Dr Mario R Sammut MD DipHSc MScH MScPC&GP(Ulster) MMCFD
http://definitionofwellness.com
Plan
Introduction
Importance of Primary Health Care
Method
Recent advances
Information Technology
Services and Access
Dealing with Multimorbidity
Academic Family Medicine
Equity
Measuring Outcomes
Conclusion
Primary Health Care is becoming
more important in view of:
Changing demography
Ageing population
Increased demands
Increased expectations
Rising health care costs
Primary Health Care is on the
policy radar.
Why?
Primary Health Care:
◦ Improves health outcomes
◦ Reduces costs and complications
◦ Aims to achieve greater equity in health care
(Starfield, 2008)
Method
A search for articles focusing on the
specific aspects of recent advances in
primary health care was done using
internet search engines.
Articles were selected from primary and
secondary literature sources, which
included original research articles, review
articles and other epidemiological studies.
Information Technology
Integral part of health care system
iSoft Clinical Manager (iCM - computer
program used at Mater Dei Hospital as an Electronic
Medical Record, to send Orders for Lab Tests and
Medical Imaging and to receive results of Lab Tests and
reports on Medical Images)
PACS (Picture archiving and communications system)
Electronic Case Summary
myHealth: the Government of Malta's
portal for online access to health records
Advances in IT improve quality & safety by:
◦ Improving access to reference information (eg
mobile apps)
◦ Increasing adherence to guidelines
◦ Enhancing disease surveillance
◦ Reducing medication errors (legible, complete;
calculation aids)
◦ Programs that alert abnormal results (eg mobile
alerts)
◦ Improving primary & secondary preventive care
(Chaudry et al, 2006; Bates, 2003)
Systems aimed at professionals are being adopted to be used at home by patients
Software designed to help patients clarify values and computer-based decision aids
Internet as source of education
‘Cyberlicensed professionals’
(Eysenbach, 2000)
Electronic referrals
General Practitioner (GP) teleconsulting
‘Teleradiology’
(Wootton, 2001)
Focus of traditional medical informatics shifting
from health care professionals to consumers
(Eysenbach, 2000)
Services
Minor Surgery
Radiography
Orthopaedic services, including application of plaster
Chronic disease follow-up clinics by a multi-disciplinary team e.g. diabetes clinic
Mental Health Clinics
Physiotherapy, Podology
Ultrasound including echocardiograms
Health Promotion and Prevention
Home visits
‘Patient Access’ system
(Longman, 2013)
Developed for GP Practices in UK
Aim: ‘To transform access to medical care’
Technology used: telephone
Patients: time-saving, >80% seen on the
day, encouraged to choose GP to speak to
Doctors: reduced stress, flexible
appointments, fewer DNAs (Did Not
Attends), control over working day
A&E attendance is reduced by about 20%
(Longman, 2012,2013)
Dealing with multimorbidity
Older patients with multiple chronic conditions: higher risk of receiving poorer overall quality of care compared with those with single or no chronic conditions.
Disease-management programs may have difficulty to achieve comprehensive, personalized care.
Reasons:
◦ competing guidelines
◦ burden of numerous recommendations
◦ difficulty in implementing treatments for multiple conditions.
(Min et al, 2007)
Innovation: Paradigm shift
◦ from "problem-oriented" toward
"goal-oriented" care
◦ By doing so, we will avoid care that
may lead to "inequity by disease”.
(De Maeseneer, 2011)
Family Medicine in the Academic Arena
Recently joined
Medical schools suffer from challenges – do not relate to the problems of the modern world
The introduction of family medicine can solve some of these challenges
One of the main contributions of family medicine is in the innovative methods of education that family medicine can offer.
(Svab, 2012)
The hallmark is the one-to-one teaching in practice.
Other methods include role playing and small group teaching
(Svab, 2012)
Local barriers to undertake training – similar to those in UK
Include shortage of staff, lack of time and other commitments.
(Sammut et al, 2012)
Both family medicine and the medical school have a lot to benefit from mutual cooperation
(Svab, 2012)
Equity
Provision of fair means of access to
healthcare services, irrespective of a
person’s geographic location, financial
means or cultural provenance
Attention to those who are most
vulnerable
Equal access to those with equal needs
Decentralisation to catchment areas
Provision of MDTs (Multidisciplinary
Teams)
Provision of home services to the house-
bound patient
Provision of Salaried Professionals shifts
focus of care from the purse to the person
Reaching out to vulnerable populations e.g.
Immigrants and other stigmatised groups
European Study: QUALICOPC 2010-2013
Core provisions plus population-centred
services depending on catchment area
Involvement of all stakeholders – especially
the patient
Outcomes & Outcome Measures
Standardised
Measure and compare results of
interventions
Evaluate and Reflect on Current Practices
Work towards improved services and
improved service-delivery
Evidence-based practice
Standard Validated Tools
Performance Scores/Indices
Demographic Data
Quality of Life Measures
Quantitative/Qualitative analysis
Questionnaires
Audits
Informed Healthcare Policies
Improved patient health outcomes
Reduced Hospital Burden
Lessons Learned from Telemonitoring
Provision of Incentives
Conclusion
‘Primary Health Care is essential to
provide effective and efficient health care’ (Beasley et al, 2007)
‘The better the primary care, the greater
the cost savings, the better the health
outcomes, and the greater the reduction
in health and health care disparities’ (Epstein, 2001)
Thank you!
www.wondercostumes.com
References Bates, DW. And Gawande AA., 2003, Improving Safety with Information Technology, N
Engl J Med 2003; 348: 2526-34
Carey T.A. et al, 2013. What primary health care services should residents of rural and remote Australia be able to access? A systematic review of “core” primary health care services, BMC Health Services Research 2013, 13:178
Chaudry, B. et al, 2006, Systematic Review: Impact of Health Information Technology on Quality, Efficiency and Costs of Medical Care, Annals of Internal Medicine 2006; 144
Dahrouge S., et al, 2011. Age equity in different models of primary care practice in Ontario, Can Fam Physician 2011;57:1300-9
Dahouge S. et al, 2012. Impact of remuneration and organizational factors on completing preventive manoeuvres in primary care practices, CMAJ, February 7, 2012, 184(2)
DeMaeseneer, J., & Boeckxstans, P. (n.d.). Care for noncommunicable diseases (NC... [World Hosp Health Serv. 2011] - PubMed - NCBI. World Hosp Health Serv.
Eysenbach, G., 2000, Consumer Health Informatics, BMJ 2000; 320:1713-6
Furler J. et al, 2008. Leaders, leadership and future primary care clinical research, BMC Family Practice 2008, 9:52
Green M.E. et al, 2012. Assessing methods for measurement of clinical outcomes and quality of care in primary care practices, BMC Health Services Research 2012, 12:214
http://www.patient-access.org.uk. Accessed on 21/7/2013.
http://www.isofthealth.com/en-gb/Solutions/UK%20Clinical%20Management/iCM.aspx
Martín-Lesende I. et al, 2011. Assessment of a primary care-based telemonitoring intervention for home care patients with heart failure and chronic lung disease, BMC Health Services Research 2011, 11:56
Min, L. C., Wenger, N. S., Fung, C., Chang, J. T., Ganz, D. A., Higashi, T., et al. (n.d.). Multimorbidity is associated with better quality of... [Med Care. 2007] - PubMed - NCBI. Med Care.
Muggah E. et al, 2012. Access to primary health care for immigrants: results of a patient survey conducted in 137 primary care practices in Ontario, Canada, BMC Family Practice 13:128
Reed R.L. et al, 2011. What research impacts do Australian primary health care researchers expect and achieve?,Health Research Policy and Systems 2011, 9:40
Sammut, M., Bombagi, M. & Cachia Fearne, R., 2012. A training needs analysis of health care providers within Malta's Primary Health Department - a boon or a bane? Journal of the Malta College of Family Doctors; 1(1): 12-17.
Schäfer W.LA et al, 2011. QUALICOPC, a multi-country study evaluating quality, costs and equity in primary care, BMC Family Practice 2011, 12:115
Starfield, B., 2008, Access, Primary Care and the Medical Home, Medical Care 2008; 46: 1015-1016
Svab, I., 2012. Possibilities of family medicine in medical education. Acta Medica Academica, 41(1), pp.59–63.
Wootton, R., 2001, Telemedicine, BMJ 2001; 323:557-60