What can we learn from the history? Yugoslav tradition of - - PDF document

11.5.2014 1

Interprofessional collaboration in family practice in Slovenia

Professor Janko Kersnik, MD, MSc, PhD

President of EURACT Honorary Secretary WONCA Europe Head of Family Medicine Department, Medical School Maribor, Slovenia Head of Research Department, Department of Family Medicine, Medical School Ljubljana Quality manager Primary health Care Centre Gorenjska (OZG)

What can we learn from the history?

 Yugoslav tradition of comprehensive

approach since 1922

 Andrija Štampar (September 1,

1888 – June 26, 1958)

 From 1931 to 1933, Štampar was

permanently employed as the expert of the Health Organization

 1948 Štampar was elected as the

first President of the WHO Assembly.

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Policies and outcomes

 Prime focus (community approach) – the

most burning issues of the time.

 Well mother, well baby, tuberculosis,

trachoma clinics

 Health education and promotion  Universal access to clinics  Clinics split primary care in primary paediatric

care, gynaecology, GP, etc.

 GP / FM got leftovers of other clinics

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Socialist tradition – investment in premises, doctor centred

 Traditional linear

and hierarchical distribution of tasks between doctors, nurses and other health care workers

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Do we need „clinics“ in modern primary care?

 Clinics are a practice application of

comprehensive approach where several health care workers work for the same goals

 Health education  Screening for CVD and other non-communicable

diseases

 Management of chronic patients  Quality improvement

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Modern primary care

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11.5.2014 2 Competences of a GP / FM

• 1. To manage complaints in primary care
• 2. To be person centred in delivering care
• 3. To apply specific problem solving skills
• 4. To use comprehensive approach
• 5. To be orientated towards community
• 6. To use holistic modelling

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How to use competences effectively

To use comprehensive approach

 To manage ... both acute

and chronic health problems…

 To promote … by

applying health promotion and disease prevention…

 To manage and co-

• rdinate health

promotion, prevention, cure, care… To be orientated towards community

 to reconcile the health

needs of individual patients and the health needs of the community in which they live in balance with available resources

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Translated into every day practice

Needs of the community

 Unhealthy lifestyle  Undetected risk

factors for non- communicable diseases

 Rising numbers of

patients with chronic diseases Actions needed

 Health promotion  Screening for risk

factors for chronic non-communicable diseases

 Chronic disease

management

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NEW MODELS OF PRIMARY CARE WANTED

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Clinics in primary care in Western countries

 UK tradition  To cope with growing

numbers of patients in chronic care

 Introducing nurse

practitioners as independent practitioner

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Comprehensive approach – „clinic“ in family practice

 In 2011 a project on so called model family

medicine practices has been introduced by Ministry of health by support of all stakeholders in health care field and chaired by Ass. Prof Tonka Poplas Susic, this year awarded WONCA Europe 5* doctor.

 Each family medicine model practice’s team

consists of 1.0 FTE family physician, 1.0 FTE practice nurse and 0.5 FTE nurse practitioner with baccalaureate degree.

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11.5.2014 3 NPs’ activities

 screening for and counselling on

 Cardiovascular risk factors,  Diabetes  Depression  COPD  Hypertension  …  Smoking and  Management of smoking and risky alcohol drinking

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NPs’ activities

 routine management

• f patients with stable

chronic diseases:

 COPD  Asthma  Hypertension  Diabetes  Osteoporosis  Depression  BHP

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FIRST RESULTS

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Practices enrolled

 By the end of the year

2012 there were 217 practices enrolled, each year 84 new ones enrolled

 covering 506.053

patients, almost a quarter of the whole population.

 Political support  Media coverage

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Screening results

 31,800 „new“ patients

with cardiovascular risk factors were detected

 only 11,954 patients

ended on the list of patients without any detectable risk factor and due to be screened again in five years.

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Disease registers

 By the end of 2012

there were

 11,018 asthma

patients,

 5,863 COPD patients

and

 23,409 diabetes

patients registered

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11.5.2014 4 Challenge – shift in „thinking“

 Teamwork  Collaboration on a national level  Interprofessional collaborative practice  Quality assessment  Additional training modules (organisation of the

practice, prevention and management of asthma, COPD, diabetes and hypertension…) for FDs and NPs were launched.

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Why do we need interprofessional clinical practice?

 To assure and improve mutual respect  To share knowledge, skills and attitudes  To enable shared decision-making  To guarantee accountability  That makes better work environment

and

 Assures delivery of good (improved) patient care

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Conclusions

 We do not and should not re-invent the wheel  It is never to late to (re)start good practices  There is plenty of work to be done out there  The problems of the community are what

matters

 We have to work together for common goals  Strong professional will, interprofessional

collaboration and political support are needed

 Public is important alliance

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Thank you for your attention!