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  1. 1. Organizational Model of the Primary Medical Care Center Partnership between Odessa (Ukraine) – Boulder (U.S.A.) Presented by V.V. Bespoyasnaya V.V.
  2. 2. Partnership Objective: <ul><li>The objective of the Odessa-Boulder partnership for 2001 is to develop the major components of the integrated Primary Medical Care System (PMCS) based on the principals of family medicine, including introduction of prevention programs and new technologies in psychosomatic medicine </li></ul>
  3. 3. Principal Characteristics of the Populations Served by the Primary Medical Care Center Children Total 218 800 240 Total 22 105 30 Families of port workers 61 175 50 Families of personnel of the Family Health Scientific Research Center 85 350 100 Families residing in the vicinity of the Center - 20 10 Disadvantaged families 50 150 50 Student families (Family and Youth Board) Number of people in the population Number of families Population
  4. 4. <ul><li>Date the Center opened and began to operate: May 31, 2000 </li></ul><ul><li>Organizational Structure </li></ul>1 1 1 2 Registration Break room Laundry Rest rooms Auxiliary rooms 2 1 X-ray room Laboratory Clinical-diagnostic unit 6 1 Examination room, Nurse’s room Offices of physicians and nurses Number of rooms Designation Type of facility
  5. 5. Principal members of the Primary Medical Care Center Staff <ul><li>Manning table (planned –12.5 positions, currently occupied – 6.0) </li></ul>1 1 Nurse’s aid - 1 X-ray and lab technician 2 5 Family nurse 1 1 Nurse manager - 0,5 Radiologists 1 2 Assistant to the department of family medicine 1 2 Family physician Actual number on 01/01/2001 Planned number Position Title
  6. 6. <ul><ul><ul><ul><li>primary disease prevention services to the public (screening) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>clinical work </li></ul></ul></ul></ul><ul><ul><ul><ul><li>preventive measures </li></ul></ul></ul></ul><ul><ul><ul><ul><li>funding </li></ul></ul></ul></ul><ul><ul><ul><ul><li>integration with other subdivisions of primary medical care </li></ul></ul></ul></ul>Work Priorities
  7. 7. Work Priorities (Continue) Primary prevention (screening) <ul><li>Risk assessment </li></ul><ul><ul><ul><ul><li>Patient history </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Objective assessment </li></ul></ul></ul></ul><ul><li>Reservometry (examination protocol) </li></ul><ul><li>Rating and possibility of follow up monitoring of preventive and therapeutic measures </li></ul>
  8. 8. Work Priorities (Continue) Clinical Work <ul><li>Development of standards for evaluation the quality of medical care </li></ul><ul><li>Enhancement of the role of nurses </li></ul><ul><li>Adoption of new medical technologies </li></ul>
  9. 9. Work Priorities (Continue) Preventative Measures <ul><li>Clinic’s first priority – issues of reproductive health </li></ul><ul><li>Prevention of early pregnancy and STD and HIV-infections </li></ul><ul><li>Decrease of smoking rate </li></ul><ul><li>Development of a tuberculosis prevention model </li></ul>
  10. 10. <ul><ul><li>Prevention programs to be implemented for high-priority issues and supported by the Information Processing and Analysis Center for Work with the Public </li></ul></ul><ul><ul><li>Main principle of funding for prophylactic programs: whatever resources remain after treatment programs shall be used to improve public health </li></ul></ul><ul><ul><li>In the future, we plan to establish an Information and Health Maintenance Center to implement this principle </li></ul></ul>Work Priorities (Continue) Preventative Measures
  11. 11. ФИНАНСИРОВАНИЕ ++ ++ ++ + + + + ++ ++ <ul><li>Cash </li></ul><ul><li>Agreements with employers </li></ul><ul><li>Medical insurance and loans </li></ul><ul><li>Charitable funds </li></ul><ul><li>Funded scientific-research projects </li></ul><ul><li>Instructional activity </li></ul><ul><li>Investments </li></ul><ul><li>Government funding </li></ul>Most promising methods under the new PMCS model Financing methods used by our Research Institute in the Past :
  12. 12. Funding of Family Medical Center Disadvantaged Students Voluntary medical insurance Credit union Cash Subscription fees At time of service (not involving cash) Charitable medical services Medical insurance Payment at time of service Companies
  13. 13. INTEGRATION OF PRIMARY MEDICAL CARE CENTER Consulting polyclinic Research Institute of the Public Health Center Laboratory-diagnostic division Family medicine clinic Multi specialty daytime inpatient clinic Family dentistry clinic Poison control center Hospice Information processing and analysis center
  14. 14. FAMILY DENTISTRY CLINIC <ul><li>Serves all members of the family </li></ul><ul><li>Interacts closely with the family medicine clinic </li></ul><ul><li>Emphasis on preventive care </li></ul><ul><li>Treats patients at home </li></ul>
  15. 15. POISON CONTROL CENTER <ul><li>Information and consulting aid </li></ul><ul><ul><li>To the public </li></ul></ul><ul><ul><li>To companies </li></ul></ul><ul><ul><li>To medical institutions </li></ul></ul><ul><li>Coordination of the activities of medical facilities providing emergency aid </li></ul><ul><li>Study of the causes of poisoning in the region </li></ul><ul><li>Information support to the analytic center for developing preventive programs </li></ul>
  16. 16. HOSPICE <ul><li>Coordination of the activities of social, medical, and municipal services, public service organizations and volunteers </li></ul><ul><li>Care of incurably ill at home </li></ul><ul><li>Provision of necessary equipment and supplies </li></ul><ul><li>Inpatient care </li></ul>
  17. 17. I NFORMATION PROCESSING AND ANALYTIC CENTER <ul><li>Analysis of indicators of health status and morbidity in the region </li></ul><ul><li>Identification of the highest priority medical problems </li></ul><ul><li>Development of therapeutic and preventive programs </li></ul>
  18. 18. ISSUES IN SETTING UP A PRIMARY MEDICAL CARE CENTER: <ul><li>no government funding </li></ul><ul><li>lack of mechanism for attracting other sources of funding </li></ul><ul><li>no mechanisms for including insured medical care </li></ul><ul><li>lack of indicators and parameters for evaluating the health of family members </li></ul><ul><li>primary prevention technologies </li></ul><ul><li>inadequate level of knowledge on primary prevention technologies </li></ul><ul><li>inadequate knowledge of related specialties </li></ul><ul><li>no criteria for assessing quality of performance </li></ul><ul><li>need to change the traditional territorial principle of health care to which the directors of medical care facilities and the public are used to </li></ul><ul><li>limited possibilities in expert assessment of fitness to work </li></ul><ul><li>inadequate level of personnel training </li></ul><ul><li>lack of standardized accounting and reporting documentation </li></ul><ul><li>lack of an algorithm for interacting with other health care and maintenance facilities </li></ul>ECONOMIC TECHNOLOGICAL ADMINISTRATIVE
  19. 19. PERIODIC ASSESSMENT OF CENTER’S PRIORITIES <ul><li>Evaluation of the needs of the population served (Based on results of a sociological survey conducted in January, 2000) </li></ul><ul><ul><li>30% of the population of Odessa experience difficulties obtaining adequate medical care </li></ul></ul><ul><ul><li>20% of the population evaluates the existing health care system positively </li></ul></ul><ul><ul><li>48% of the members population evaluate their own health as satisfactory </li></ul></ul><ul><ul><li>17% as poor </li></ul></ul><ul><ul><li>5% as very poor </li></ul></ul>
  20. 20. PERIODIC ASSESSMENT OF CENTER WORK PRIORITIES (continued) <ul><li>Current priorities (revision of the model) and prediction of the way the Center’s activities will develop </li></ul><ul><li>Intensified work to prevent poisoning and accidents </li></ul><ul><li>Help of public service organizations to recruit the public into the healthy lifestyle movement </li></ul><ul><li>Development of an infrastructure for working with the public </li></ul><ul><li>Improvement of methods for observation of patients according to the principles of risk assessment and reservometry </li></ul><ul><li>Improvement of interactions with Health Care and Maintenance Organizations </li></ul><ul><li>Improvement of mechanisms for funding and economic support of the Center </li></ul>
  21. 21. USE OF EVALUATION METHODOLOGIES <ul><li>Social marketing to study public opinion in the area of health care </li></ul><ul><li>Conducting patients’ surveys on the quality of the medical services they received </li></ul><ul><li>Incorporation of quality standards for provision of medical care </li></ul><ul><li>Medical cost effectiveness of the work of various primary medical care subdivisions </li></ul>
  22. 22. <ul><li>Continued development of the concepts for primary medical care based on specific strengths of our partnership program </li></ul><ul><li>Plan for implementing this model in other regions </li></ul><ul><li>Improve the multi-specialty approach to primary care </li></ul><ul><li>Strengthen the role of nurses </li></ul>PLANS TO DEVELOP THE PRIMARY MEDICAL CARE MODEL
  23. 23. PLANS TO DEVELOP THE PRIMARY MEDICAL CARE MODEL (continued) <ul><li>Continuation of work on clinical standards for primary medical care </li></ul><ul><li>Development of programs to train medical personnel in primary care </li></ul><ul><li>Development of strategies to ensure stable functioning of the program </li></ul>
  24. 24. PRINCIPAL COMPONENTS OF THE PROGRAM STABILITY STRATEGY <ul><li>Financial stability </li></ul><ul><li>Social stability </li></ul><ul><li>Administrative stability </li></ul><ul><li>Technical stability </li></ul>