Embed Size (px)
Citation preview
Slatina-Timiș Case StudyHow can some communities be
healthier than others
Iași6 Noiembrie 2015
Adrian PanăBogdan IleanuCristina VladuIoan Suru
I. Slatina-Timiș - Background
Creation of ADAM structure Refurbishment of health center Staffing of the health center (one family
doctor, 3 nurses for the population of 3000 persons, one stomatologist, etc)
Creation of a home care service MEDIATEQUE service Social pharmacy Ensuring sustainable funding through contracts
with the Insurance House, membership contribution, etc
Organizational set up
Home care services 82 % of diabetes patients have received a
glucometers and 150 strips, direct relationship with the specialist doctor, diabetes passport (information about the disease, types of insulin, etc.)
24% of patients with HTA have received blood pressure meters, 65%have benefitted from
Patients that need revalidation materials whatever their illness receive materials form the MEDIATEQUE (special beds, toilet chairs, mattresses anti pressure sore, etc.)
ADAM specific activities for different groups of patients
II. Slatina-Timiș- demographic indicators
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
2.5
4.5
6.5
8.5
10.5
12.5
14.5
9.0
11.4
9.7
10.3 10.410.1
7.2
5.44.9
10.7
5.6
3.7
6.3
4.7
5.7
8.0
7.17.4
8.8
12.211.9
12.3 12.4 12.3 12.312.0
11.0 11.010.7
10.510.3 10.1 10.3 10.3
9.79.2
9.5
8.8
Slatina Timis Linear (Slatina Timis) Caras Rural Linear (Caras Rural)
Romania Rural
Bir
th r
ate
s(n
ew
bo
rn/1
00
0.i
nh
)Slatina-Timiș : evolution of Birth rate
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
15.0%
16.0%
17.0%
18.0%
19.0%
20.0%
21.0%
22.0%
23.0%
24.0%
16.2%15.9%
16.7%
17.3%
17.9%
18.5%
18.9%
19.6%
20.2%
20.8% 20.8%
20.4%
20.8% 20.8%
20.2%19.8%
19.6%
20.2%
20.7%
21.4%
20.6
%
21.0
% 21.4
%
21.5
%
21.8
%
21.9
%
22.1
%
22.3
%
22.3
%
22.3
%
22.3
%
22.2
%
22.2
%
22.0
%
21.9
%
22.0
%
21.9
%
22.2
%
22.5
%
22.7
%
Romania rural Slatina Timis Caras rural
The s
hare
of
eld
erl
y (
65+
) w
om
en in t
ota
l popula
tion
Slatina-Timiș: evolution of % of women over 65
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
11.0%
12.0%
13.0%
14.0%
15.0%
16.0%
17.0%
13.5%13.7%
14.0%14.2%
14.4%14.5%
14.9% 14.9%15.0%
15.1% 15.2%15.0% 15.0%
14.8%14.7%
14.4%14.3%
14.1%14.0% 14.0%
11.6%
11.9%
12.4% 12.5%
13.2%
13.8%
14.3%
14.7%
15.1%15.2%
15.6%
15.3% 15.4%
15.0% 15.0%
15.6%
15.9%15.7%
15.5%
15.9%
Romania rural Slatina Timis Caras rural
The s
hare
of
eld
erl
y (
65+
) m
en in t
ota
l popula
tion
Slatina-Timiș: evolution of % of men over 65
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
13.2
25.4
19.6
16.5
21.5 21.6 21.1
11.1 11.3
22.8
19.5
15.5
18.6
27.5
10.7
17.4
11.1
13.8
11.7
23.9
25.625.0
23.3
21.520.8 20.9
19.8 19.4 19.9
17.917.1
14.1 14.0
12.6 12.311.8 11.8 11.5
Slatina Timis Caras Rural Romania Rural
Infa
nt
mort
ality
rate
(0-1
death
s/1000 liv
e b
irth
s)
Slatina-Timiș: evolution of infant mortality
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
8.0
10.0
12.0
14.0
16.0
18.0
20.0
22.0
24.0
18.9
22.7
14.6
13.3
14.8
17.2
12.8
14.2
11.3
16.8
13.0 13.1
17.3
19.2
13.4
15.3
16.1
14.5
12.7
17.3
13.213.5 13.4
13.8 13.713.2
12.8 12.712.3 12.4 12.5
12.913.3
13.012.4 12.2 12.4
12.712.4 12.2
15.4
16.415.9
15.2 15.0
14.4
15.3 15.3 15.214.8 14.8
14.514.1 14.2 14.5 14.6
14.1 14.213.7 13.9
Slatina Timis Linear (Slatina Timis) Caras Romania rural
Mort
ality
rate
(num
ber
of
death
s/1000 inh.)
.Slatina-Timiș: evolution of general mortality
III. Slatina-Timiș- health risks profile
Tobacco daily consumption – Slatina Timiș vs rural county and rural national
Slatina Timis Caras Rural Romania Rural
0
2
4
6
8
10
12
14
16
18
20
17.4
18.7
17.6
% o
f ad
ult
s d
ail
y s
mo
kers
Alcohol consumption – Slatina Timiș vs rural county and rural national
Slatina Timis Caras Rural Romania Rural
0
5
10
15
20
25
22.7
17.8
21.6
% o
f ad
ult
s w
ith
excess a
lco
ho
l co
nsu
mp
tio
n
Slatina Timis Caras Rural Romania Rural
0
10
20
30
40
50
60
70
80
68.1
61.258.9
% o
f ad
ult
s w
ith
ad
dit
ion
al
salt
co
nsu
mp
tio
nSalt consumption – Slatina Timiș vs rural county and rural national
Slatina Timis Caras Rural Romania Rural
0
10
20
30
40
50
60
70
58.9
41.3
33.9
% r
ed
meat
co
nsu
mp
tio
n f
rom
to
tal
ad
ult
in
h.
Red meat consumption- Slatina -Timiș vs rural county and rural national
IV. Slatina-Timiș- hospitalized morbidity
2008 2009 2010 2011 2012 2013
50
100
150
200
250
300
350
130.5
116.5 117.2 120.5128.4
109.9
295.4 297.6
279.9
251.6
239.9 237.9
239.9 241.6
227.8
209.4203.8 205.1
Slatina Timis Caras rural Romania rural
Inpati
ent
care
case
s/1000 inh.
General hospitalized morbidity; Slatina-Timiș vs rural county and rural country
0-10 min 11-20 min 21-30 min 31-40 min 41-50 min 51-60 min 61-70 min 70 si peste
0
10
20
30
40
50
60
70
80
67.1
51.3
43.841.5
40.0
50.5
40.8
56.2
R² = 0.79085945630486
Distance to the closest hospital
Num
ber
of
avoid
able
hosp
italiza
tion/1
000 inhab.
Avoidable hospitalizations according to distance to the closest hospital - all communities in Caraș-Severin County
V. Slatina –Timiș - Health outcomes
Average number of years/person lost due to premature death: Slatina-Timiș vs rural county and national rural
2005 2006 2007 2008 2009 2010 2011 2012
0
1
2
3
4
5
6
7
8
9
10
6.4
9
4.4
3
5.5
6.6
9
5.7
2
5.5
1
6.0
5
3.3
7
6.3
5
6.1
5
6.2
3
6.7
6
5.7
9
5.5
7
5.5
2 5.8
2
7.1
8
6.4
6 6.8
6 7.1
3
6.9
4
6.2
4
5.9
1
5.9
5
Slatina Timis Caras Rural Romania Rural
Averg
ae n
um
ber
of
years
/pers
lost
VI. Conclusions and reccommendations
The risk profile of the community highlights risk factors as eating red meat, consuming salt, drinking alcohol as factors that are above of the national average;
Slatina-Timiș faces high challenges such as increased risk profiles doubled with an accelerated growth of the population over 65 years old;
Even if Slatina-Timiș is confronted with an increased burden of diseases appearing on a rapidly growing older population (rate of increase higher that the national and county one), the results in terms of health status are good: general mortality is on a decreasing trend although such tendencies are not found at national or county level
Conclusions
The ratio of community nurses versus the number of the population existent in Slatina-Timiș seems to be one of the determinant of the better health outcomes and lower resources utilization;
The MEDIATEQUE within ADAM is a good example for fulfilling the need of the community persons; it allows community members to understand in concrete terms what are thier rights/ entitlements, it enables them to trust the health team and be confident in the services received
Health data at present is collected and aggregated at county and national level; this leaves poor health data availability at the community level, with no proper information about its results in terms of population health.
Conclusions (2)
Slatina-Timiș consumes considerable less resources from the health budget as the most expensive level of care, the hospital, is the less utilized by Slatina-Timiș patients.
The ratio of one community nurse per one thousand population has proven useful and successful in activities such as the proper monitoring of newborns and pregnant women, for monitoring chronic diseases, arranging patients’s appointments to specialist care/ hospital;
The recipe of success is comprised of several factors: fully staff Health Center, proactive personnel, community organization into Belgian mutualistic principles and values
Monitoring systems of health data at local level is of tremendous importance for health systems that should be designed at county and national level in order to enable comparisons between results of different communities
Conclusions (3)
Prevention campaigns in Slatina-Timiș should focus on healthy lifestyle education for lowering the consumption of red meat/ salt intake, alcohol and tobacco reduction.
The local level should have better access to information with regard to its population health, the trends of main health indicators, etc.;
Templates for collecting data and software to analyze data in real time and present decision makers with main findings may be developed at national level;
Reccommendations
As a model of cost effective intervention, Slatina-Timiș model should be further documented and disseminated nationwide.
The example of the ratio of community nurses per number of population as well as their role in the provision of preventive activities, home care services that are associated with the good results in health outcomes and health resources consumption could represent the basis of a public policy / be disseminated countrywide;
The health system should recognize trends of increasing needs and provide adequate funding and resources for solving the issues as close as possible to the beneficiary (at community level); this would prevent much of the unnecessary spending that otherwise appear in overutilization of the upper levels of care.
Reccomendations (2)
As a general conclusion, Slatina –Timiș is a valuable example of organizational set up, good performance of a health care team at community level resulting in more trust of the community towards its health care team, better health of the population and lower consumption of resources. Defining policies to complement this model – i.e. support with additional monitoring and evaluation efforts-, ensuring adequate sustainable funding, defining policies to enable the dissemination of this model of health care organization would be beneficial to the health of other communities as well as to the nation’s health.
![Garabet IBR{ILEANU - Provincialul · 6 Garabet Ibr[ileanu 1933 Dup[ 27 de ani, cum ]=i intituleaz[ cuv`ntul de r[mas bun, G. Ibr[ileanu trece conducerea „Vie\ii rom`ne=ti“ lui](https://img.dokumen.tips/doc/110x75/5e032dcfd9e2ea2f20422019/garabet-ibrileanu-provincialul-6-garabet-ibrileanu-1933-dup-27-de-ani-cum.jpg)
![[MEDIJI] Kolumna zastupnice Ivane Maletić: Prekomjerni deficit iznenadio Vladu](https://img.dokumen.tips/doc/110x75/568c344d1a28ab02358ff24c/mediji-kolumna-zastupnice-ivane-maletic-prekomjerni-deficit-iznenadio-vladu.jpg)
