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Primary care in Andalusia region

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This a brief summary of the Primary Care level development at the Andalusia region, Spain, in the last 25 years, and a description of the current main features and outcomes in terms of accessibility, …

This a brief summary of the Primary Care level development at the Andalusia region, Spain, in the last 25 years, and a description of the current main features and outcomes in terms of accessibility, resources, patient's satisfaction, life expectancy, mortality and health expenditure.


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  • 1. PRIMARY CARE: Regional strategies to improve efficacy and equity while guarateeing economic sustainability W O R K S H O P José L. ROCHA General Secretary for Quality and Modernisation Regional Ministry of Health Government of Andalusia, Spain. [email_address] Strategies and results in Primary Healthcare in Andalusia
  • 2.
    • Andalusia and the APHS: Quick facts
    • Primary Care in Andalusia:
      • Historical overview
      • Main Features
      • Outcomes
      • Troubles and Challenges
    Overview
  • 3. Andalusia and the Andalusian Public Healthcare System: Quick Facts
  • 4.
    • Andalusia:
    • Geographical situation
    • and population
    • 87,597 Km 2 .
    • 8.302.923 inhabitants
      • 526.942 foreigners
        • 50% Europeans
        • 24% Americans
        • 21% Africans
        • 3% Asian
    • + 1.531.668 andalusian people living in other Spanish regions
    • + 140.000 andalusian people living outside Spain
  • 5. Regional Parliament Regional Court of Justice
    • Andalusia:
    • Political context
    • Political Autonomy since 1981
    • Regional Institutions
      • Parliament
      • Government (“Junta de Andalucía”)
      • Court of Justice (TSJA)
    Jose A Griñán. President of Government Fuensanta Coves. Speaker of the Parliament Lorenzo del Río. Chief Justice Regional Government
  • 6. Andalusia: Social and Economic trends Source: Eurostat Source: Centro de Estudios Andaluces
  • 7. Andalusian Public Healthcare System: Main features 1,146 Primary care centers 360 Auxiliary offices for primary care 47 Public Hospitals (16,821 beds) 102,000 Healthcare professionals 9,390 M € Health Budget 2011, 6.67% GDP
  • 8. Primary Care in Andalusia Historic overview
  • 9.
    • Legislation Timeline
    • 1978: Spanish Constitution
      • Establishment of the Autonomous Communities
      • Settlement of the Health protection as a fundamental right
    • 1978: Creation of the Family Medicine specialty
    • 1981: Statute of Autonomy of Andalusia
      • 1981: Transfer to the Andalusia Region’s Administration the responsibility on Public Health
      • 1984: Transfer to the Andalusia Region’s Administration the public network of hospitals, ambulatory clinics and rural offices
    • 1984: National Decree on basic structures for primary care (1st step of primary care reform)
    • 1986: Healthcare National Act
      • Change from a social security model to a NHS model
      • Healthcare as a right for all the population
      • Consolidation and extension of primary care level
  • 10. Situation Before the reform: Individual work of general practitioners No specific training No health prevention/promotion/education Isolated rural medicine Hospital-centric model Lower salaries than specialists Low prestige and self-esteem
  • 11. Primary Care in Andalusia Main Features
  • 12. Primary Care in Andalusia: Main features Organisation and planning Accessibility Teamwork Extended care Intensive use of ICT
  • 13. GP as a Gatekeeper Capitation: 1 GP/1,400 inhabitants Team of professionals working in a PC Centre Homogeneous territorial distribution Aggregation of PC Centres in “ Districts ” Supportive teams at Districts for Public Health purposes: Epidemiologists, Vets, Pharmacists… Professionals are civil servants Focus on health promotion and prevention
  • 14. Primary Care in Andalusia: Main features Organisation and planning Accessibility Teamwork Extended care Intensive use of ICT
  • 15. Accessibility 1146 Primary Care Centers (and 360 auxiliary offices) vs. 33 at 1986 Less than 15 min away for anybody 1 Family Physician every 1.400 people on average Primary care doctors represent 41% of APHS doctors (29% at 1986)
  • 16. Primary Care in Andalusia: Main features Organisation and planning Accessibility Teamwork Extended care Intensive use of ICT
  • 17. Primary Care in Andalusia: Main features: Organisation and planning Accessibility Teamwork Extended care Intensive use of ICT
  • 18. Primary Care professionals Family Physicians Community Nurses Pediatricians Midwives Dentists Physiotherapists Social Workers Psychiatrists/psychologists Epidemiologists Community Pharmacists Veterinaries Administration workers Auxiliary workers
  • 19. Primary Care in Andalusia: Main features: Organisation and planning Accessibility Teamwork Extended care Intensive use of ICT
  • 20. Health Care Information and Management Integrated System Appointment Prescription Radiology Waiting lists Functional tests Pathology Lab tests Inpatient care Referrals Outpatient care Primary care Hospital admission Data warehouse Emergency care 105 Million of e-prescriptions/year 95 Million of appointments/year 7.9 Million of individual EHR 3 Million of e-referrals/year 3.5 Million of x-Ray images/year
  • 21. Primary Care in Andalusia Outcomes
  • 22. Outcomes: Life expectancy and amenable mortality
  • 23. Mortality index in Andalusian municipalities vs. Spanish average Trend to convergence to Spanish average 96% of municipalities have an index equal or lower than the Spanish average for people 65 years old or less The south-west area of Andalusia shows a mortality index higher than the Spanish average for the group of 65-74 years old people The majority of municipalities have a mortality index higher than the Spanish’ one for people with more than 75 2005 - Women 15-44 years old 2005 - Women 45-64 2005 - Women 65-74 2005 - Women 75-84 Higher than Spanish average Non significative differences Lower than Spanish average Source : Atlas Interactivo de Mortalidad en Andalucía (AIMA). Revista Española de Salud Pública 2008; 82(4)
  • 24. Outcomes: Health Expenditure OECD Health Data 2010.
  • 25. Social and Economic Council of Spain, 2010. Outcomes: Health Expenditure Regional health expenditure (€ per capita). Spain 2007
  • 26. Ministry of Health and Social Policy. Spain, 2010. Outcomes: Health Expenditure on Primary Care Andalusia Spain Catalonia Valencia Madrid
  • 27.
    • Conclusions: Between 1995 and 2008, Andalusia makes a firm decision assign a greater increase in its budget for primary care than for hospital care, contrary to what occurred in the other autonomous regions.
    Simó J. The public expenditure on health in Andalusia between 1995 and 2008: a comparison with other autonomous regions. Med Fam Andal 2011; 1:12-19
  • 28. Outcomes: Efficiency The Swedish Healthcare System: How does it compare with other EU countries, the United States and Norway? Swedish Association of Local Authorities and Regions,2008 Desired direction
  • 29. Health spending in OECD countries: Obtaining value per dollars. GF Anderson, BK Frogner. Health Affairs 2008; 27:1718-1727
  • 30. Outcomes: Patient satisfaction General satisfaction on Primary care. Satisfied + Very satisfied (2/5). Institute for Social Studies of Andalusia. Spanish Scientific Research Council (CSIC)
  • 31. Primary Care in Andalusia: Key factors: Universality Lack of economic barriers for people Decentralisation Equitable planning of public resources Coordination and integration of care Community focus Extended basket of services Teamwork Clinical Management Professional commitment Long-term policies
  • 32.
    • Troubles and Challenges
    • High Frequentation
    • Work overload
    • Chronic Patients
    • Excess of bureaucracy
    • Lack of Coordination with Hospitals
    • Continuous Medical Training
    • Feminisation
    • Desertification of Rural areas
    • Physician Shortage
    • Professional Migration
  • 33. http://www.opimec.org/