19 th Wonca World Conference - 2012 - Apresentação Dra. Catherine Moura
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Coordination of healthcare and health services integration: learning from an international experience 19 th WONCAWORLD CONFERENCE 19 – 23 May, 2010, Cancun - Mexico Authors: Catherine M. F. Pinto Joan Castillejo Camila Padula Ana Kelly Malaquias Cláudia M. Desgualdo Speaker: Catherine M. F. Pinto [email protected]
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19 th Wonca World Conference - 2012 - Apresentação Dra. Catherine Moura - Coordination of healthcare and health services integration: learning from an international experience
Transcript of 19 th Wonca World Conference - 2012 - Apresentação Dra. Catherine Moura
Coordination of healthcare and health services integration: learning from an international experience
19 th WONCAWORLD CONFERENCE19 – 23 May, 2010, Cancun - Mexico
Authors: Catherine M. F. PintoJoan CastillejoCamila PadulaAna Kelly MalaquiasCláudia M. Desgualdo
Speaker: Catherine M. F. [email protected]
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International Public Health Scene
Shared Shared ConcernsConcerns
Comparing international health systems we observe common concerns and global tendencies.
Financial sustainability;Adequade planification of the available resources;High complexity of the population needs (health and life quality);Integration of health services and coordinating healthcare process;Quality of medical care;Improve multiprofessional health assistance.
Potential risks of health systems
NO QUALITY OF ASSISTANCEINEQUALITY
INSATISFATIONINEFICIENCY
INCREASING OF EMERGENCY ASSISTANCE
HEALTH SERVICES FUNCTIONING OVER CAPACITY
INCREASING NEED OF FINANCIAL
AND HUMAN RESOURCESACESS DIFFICULTIESUNSUSTAINABILITY
Health System: PHC centered and focused on the pacient needs
CONTINUITY OF HEALTH CARE EQUiTY
SATISFATIONEFICCIENCY
QUALITY
FLEXIBLE ORGANIZATION OF HEALTH SERVICES
INTEGRATED SERVICES AND CLINICAL INFORMATION
MANAGMENT OF RESOURCES ACOORDING TO HEALTH
CARE NEEDS
MULTIPROFESSIONAL WORK SUSTAINABILITY
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Catalunha (Spain)
• Extention: 32.106 km²
• Population: 7.134.697 ihab.
• Density (Inhab./km2): 222,2 hab.
• PIB/Per capita: 27.823 €
Institut Estadistica Catalunya. Dados 2005. Anuari 2007
HS of Catalunha (Spain)
Health System Health System CatalunhaCatalunha
From 1985 to 1990: global reform of the health system, reorganization of PHC, creation of social and health services, partnerships in managing health centers and development of procedures of coordenation of the health care.
Free UniversalEficiencyQualityComunity participationPHC centered Local planificationIntegration and Coordination of health assistance
Strengthening PHC as the first level of acess of the
health system
Advancing into New Model and Quality
Management in Hospitals
Advancing the coordination of resources
of public health: "Partners"
Investing in infrasstructure and technology, and in human resources
Health System
Health system in Catalunha
PHC in Catalunha: coordination and integration
The issue of coordination of care has been the focus of discussions of health systems in many countries, especially in the context of chronic diseases.
It is currently considered as a potential strategy to promote improvements in the processes of continuous health care with a view to quality of care, ordering of services offered and management resources to meet the health needs of the population.
It is considered as a conceptual reference some of the structural principles of networking, which requires sharing information between health services, sort of demand, matching the health needs and continuous care with a focus on equity, patient satisfaction, efficiency and quality of services provided .
The issue of coordination of care has been the focus of discussions of health systems in many countries, especially in the context of chronic diseases.
It is currently considered as a potential strategy to promote improvements in the processes of continuous health care with a view to quality of care, ordering of services offered and management resources to meet the health needs of the population.
It is considered as a conceptual reference some of the structural principles of networking, which requires sharing information between health services, sort of demand, matching the health needs and continuous care with a focus on equity, patient satisfaction, efficiency and quality of services provided .
PHC in Catalunha: how are they doing it?
Necessary elements for the implementation of procedures for the coordination of care and integration of health services:
Set the reference population clearly, agreeing the portfolio of services provided by different agents.
Clearly define the common package of services for the specific needs of each type of patient.
Setting protocol responsibilities shared and not shared among service partners and between types of professionals (ex: role of nursing).
Create a principle of mutual trust between partners.
Clarify the financial flows between the service partners.
Implement new Information and communication technologies (ex: integrated electronic medical records)
Introduce concepts of integrated care in the training programs of the professionals.
PHC in Catalunha: why are they doing it?
Equity of access
The integration of promotion, prevention and comprehensive health care
Continuity of care the health of the individual and the community.
Better clinical practice: protocols, guidelines, coordination different levels of
complexity
The development of stable mechanisms for coordination with other system resources.
The overall efficiency and effectiveness of health system
The primary care services-oriented produces better health outcomes, with more user satisfaction and lower cost
(Starfield, B. Lancet 1994)
The filter function of "gatekeeper" of primary care is essential for the proper functioning of specialized care (Mathers, MJ. BMJ 1989)
Enable the vertical and horizontal integration of health
services;
To promote the continuum of care;
Arrange the provision of services in the logic of the
priority lines of care and territorial (district) needs.
Enable the vertical and horizontal integration of health
services;
To promote the continuum of care;
Arrange the provision of services in the logic of the
priority lines of care and territorial (district) needs.
PHC in Catalunha: what to do?
Catalunha x Brasil: overview
The experience of integration and coordination of family medicine
services and community in Catalonia (Spain) was adapted to the
brazilian context and it constitutes an opportunity to strengthen the
family health strategy and, specifically, the role of the practitioner of
the primary care, such as an integration element of health team
practices.
The experience of integration and coordination of family medicine
services and community in Catalonia (Spain) was adapted to the
brazilian context and it constitutes an opportunity to strengthen the
family health strategy and, specifically, the role of the practitioner of
the primary care, such as an integration element of health team
practices.
Catalunha x Brasil: experience
Aims:
Enabling the backward-forward integration of the health centers inside the different levels of the public health system,
promoting the continuity of the assistance and the organization of the health services offers, according to the priorities healthcare programmes, and also,
to develop clinical and organizational instruments, and information systems for the extent of the integrated area (district).
Aims:
Enabling the backward-forward integration of the health centers inside the different levels of the public health system,
promoting the continuity of the assistance and the organization of the health services offers, according to the priorities healthcare programmes, and also,
to develop clinical and organizational instruments, and information systems for the extent of the integrated area (district).
Catalunha x Brasil: experience
The development of this experience of coordination is based on tree
focus:
technical advice of the implantation process through job training,
considering the clinical guidelines and local health centers
organization;
Permanent education strategies in integration elements and health
services coordination, information systems, indicators of monitoring, for
the health team workers of the primary care centers;
practical advice for implantation of the priority programmes through
international cooperation for training activities in public health
centers..
The development of this experience of coordination is based on tree
focus:
technical advice of the implantation process through job training,
considering the clinical guidelines and local health centers
organization;
Permanent education strategies in integration elements and health
services coordination, information systems, indicators of monitoring, for
the health team workers of the primary care centers;
practical advice for implantation of the priority programmes through
international cooperation for training activities in public health
centers..
Catalunha x Brasil: experience
Stage of development:
Tree districts of the city of São Paulo
1 year of job training and international cooperation
5 Clinical Guidelines (clinical aproach, organizational elements,
portifolio services, responsabilities of diferent practitioners PHC and
specialized/emergency care) – , Hypertension and DM, CVD,
Respiratory, Elderly Health
Local planning for implementartion and monitoring outcomes
Focused on the family doctor (PSF) as the coordinator of the health
care process
Stage of development:
Tree districts of the city of São Paulo
1 year of job training and international cooperation
5 Clinical Guidelines (clinical aproach, organizational elements,
portifolio services, responsabilities of diferent practitioners PHC and
specialized/emergency care) – , Hypertension and DM, CVD,
Respiratory, Elderly Health
Local planning for implementartion and monitoring outcomes
Focused on the family doctor (PSF) as the coordinator of the health
care process
Catalunha x Brasil: goals
Development and implementation of the common instruments
elaborated by the PHC professionals based on clinical guidelines and
the operational flows according to services offered by the territorial
health network, ensuring:
the access to services,
continuos and person-centered health care and
improving the quality of the information of the health care process
on a district-by-district basis.
Development and implementation of the common instruments
elaborated by the PHC professionals based on clinical guidelines and
the operational flows according to services offered by the territorial
health network, ensuring:
the access to services,
continuos and person-centered health care and
improving the quality of the information of the health care process
on a district-by-district basis.
17
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