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