At the 2016 CCIH Annual Conference, Evan Novalis of IMA World Health discusses the organization's efforts to integrate its HIV/AIDS programs with cervical cancer screening and care.
Roles and responsibilities of MIDDLE LEVEL HEALTHCARE PROVIDERSharon Treesa Antony
Mid-level health worker can be defined as ‘Front-line health workers in the community who are not doctors but who have been trained to diagnose and treat common health problems, to manage emergencies, to refer appropriately and to transfer the seriously ill or injured for further care.
Because everyone matters.
IBM Health and Social Programs Summit, October 2014
Chronic and Integrated Care in Catalonia
Catalonian Department of Health-TICSalut
Mr. Juan Carlos Contel
Dr. Jordi Martínez
At the 2016 CCIH Annual Conference, Evan Novalis of IMA World Health discusses the organization's efforts to integrate its HIV/AIDS programs with cervical cancer screening and care.
Roles and responsibilities of MIDDLE LEVEL HEALTHCARE PROVIDERSharon Treesa Antony
Mid-level health worker can be defined as ‘Front-line health workers in the community who are not doctors but who have been trained to diagnose and treat common health problems, to manage emergencies, to refer appropriately and to transfer the seriously ill or injured for further care.
Similar to Chronic Disease Management: tools for balancing an increasing expenditure and a limited budget…with well-cared patients - José Augusto García Navarro
Because everyone matters.
IBM Health and Social Programs Summit, October 2014
Chronic and Integrated Care in Catalonia
Catalonian Department of Health-TICSalut
Mr. Juan Carlos Contel
Dr. Jordi Martínez
A journey from the Chronic Condition Care Program to a new health and social integrated care model.
Deck available in link:
http://www-01.ibm.com/software/city-operations/curam-research-institute/curam-roundtable/index.html
The Journey from a Chronic Care Program toward an Integrated Health and Social Care Model
Speaker: Juan Carlos Contel Segura, Department of Health, Chronic Care Program, Generalitat de Catalunya (Catalonia)
Presentation delivered by Dr Zsuzsanna Jakab, WHO Regional Director for Europe, at the 7th Meeting of the European Advisory Committee on Health Research (Copenhagen, Denmark, 6 April 2016)
The purpose of this briefing is to help you to identify the immediate priority actions to commission effective end of life care.
Publication by the National End of Life Programme which became part of NHS Improving Quality in May 2013
National programme for prevention and control of cancer npcdcsanjalatchi
A non-communicable disease (NCD) is a disease that is not transmissible directly from one person to another. NCDs include Parkinson's disease, autoimmune diseases, strokes, most heart diseases, most cancers, diabetes, chronic kidney disease, osteoarthritis, osteoporosis, Alzheimer's disease, cataracts, and others.
The Portuguese Health Care System: Interesting Ideas in the Public Health fieldmiguelcabral
Presentation used at a Research Seminar in the Institute of Public Health at the Università Cattolica del Sacro Cuore (Rome, Italy), on the 16th may 2018. This version was altered to be understood on its own. It focus on the general structure of the Portuguese National Health Service. It further addresses some of its interesting characteristics and ideas within the field of public health.
Older People with Chronic Diseases: A Vision of the Futurekomalicarol
The Spanish Constitution in article 43 establishes the Right to
Health and its development, through the General Law on Health,
urges the National Health System (SNS) and the Health Services
of the Autonomous Communities (CCAA), to develop Comprehensive Plans or Regional Health Plans
7 march 12.20 exploring global issues howard cattonNHS England
CNO Summit 2018
Similar to Chronic Disease Management: tools for balancing an increasing expenditure and a limited budget…with well-cared patients - José Augusto García Navarro (20)
Respostes a les preguntes enviades pels assistents a la jornada del CSC 'Protecció de dades: novetats i aplicació de la nova LOPD-GDD al sector salut i social' - 13 de febrer de 2019
Cicle de debats CSC: "Gestió pública dels medicaments innovadors: hematologia" - 30 de Maig
Presentació a càrrec d'Álvaro Urbano, director de l’Institut Clínic de Malalties Hematològiques i Oncològiques de l’Hospital Clínic de Barcelona
Open Communication Talks: Social Media, casos d'èxit a Catalunya - 31 de maig
Presentació a càrrec de Manel Gastó, responsable de Comunicació del Banc de Sang i Teixits
Cicle de debats Gestió Pública dels Medicaments Innovadors: Hematologia - 30 de maig de 2018
Presentació a càrrec de Álvaro Urbano, director de l'Institut Clínic de Malalties Hematològiques i Oncològiques de l'Hospital Clínic de Barcelona
Cicle de debats Gestió Pública dels Medicaments Innovadors: Avaluació resultats en salut - 19 de desembre de 2017
Presentació a càrrec de Guillem López Casanovas, catedràtic d'Economia de la Universitat Pompeu Fabra
Cicle de debats Gestió Pública dels Medicaments Innovadors: Compra innovadora - 30 de novembre de 2017
Presentació a càrrec de Jaume Puig Junoy, professor del Departament d'Economia i Empresa de la Universitat Pompeu Fabra i investigador principal del Centre d'Investigació en Economia i Salut
Trobada de Salut Pública: Medi ambient i salut - 23 de novembre de 2017
Presentació a càrrec de Laia Font, Servei de Qualitat i Intervenció Ambiental de l'ASPB
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Presentació a càrrec de David Casabona, cap de l'Oficina Tècnica d'Avaluació i Gestió Ambiental de la Diputació de Barcelona
Trobada de Salut Pública: Medi ambient i salut - 23 de novembre de 2017
Presentació a càrrec de Cristina Castells, directora de la Direcció d'Energia i Qualitat Ambiental de l'Ajuntament de Barcelona
Jornada SACAC: La nova Llei de contractes del sector públic - 21 de novembre de 2017
Presentació a càrrec de Josep Esquerrà, membre fundador d'Ecoinstitut SCCL
Jornada SACAC: La nova Llei de contractes del sector públic - 21 de novembre de 2017
Presentació a càrrec de César Sánchez, tècnic de la Direcció de Coordinació de Contractació Administrativa de l'Ajuntament de Barcelona
Jornada SACAC: La nova Llei de contractes del sector públic - 21 de novembre de 2017
Presentació a càrrec de Neus Colet i Arean, presidenta del Tribunal Català de Contractes del Sector Públic de la Generalitat de Catalunya
Sessió Tècnica: "Gestió de crisi i el paper dels portaveus en la comunicació" - 16 de novembre de 2017
Presentació a càrrec de Joan Francesc Cànovas, consultor en Comunicació de crisi i Formació de portaveus
Cicle de debats Gestió Pública dels Medicaments Innovadors: Gestió de l'accés - 14 de novembre de 2017
Presentació a càrrec de Joaquín Delgadillo, gerent de Prestacions Farmacèutiques i Accés al Medicament del Servei Català de la Salut
II Jornada d'atenció social CSC: “Jo decideixo: seguim avançant en ACP” - 9 de novembre de 2017
Presentació a càrrec de Josep Carné, president de la FATEC (Federació d'Associacions de Gent Gran de Catalunya)
II Jornada d'atenció social CSC: “Jo decideixo: seguim avançant en ACP” - 9 de novembre de 2017
Presentació a càrrec de Mariona Rustullet, directora tècnica de SUMAR, serveis públics d'acció social
II Jornada d'atenció social CSC: “Jo decideixo: seguim avançant en ACP” - 9 de novembre de 2017
Presentació a càrrec de Montse Solé, directora d'infermeria d'Atenció Intermèdia del CIS Cotxeres
II Jornada d'atenció social CSC: “Jo decideixo: seguim avançant en ACP” - 9 de novembre de 2017
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Cicle de debats Gestió Pública dels Medicaments Innovadors: "Anticipar la innovació: saber el que ens espera" - 26 d'octubre de 2017
Presentació a càrrec de Josep Maria Guiu, coordinador de l'Àrea de Farmàcia i del Medicament del CSC
More from Consorci de Salut i Social de Catalunya (20)
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Antimicrobial stewardship to prevent antimicrobial resistanceGovindRankawat1
India is among the nations with the highest burden of bacterial infections.
India is one of the largest consumers of antibiotics worldwide.
India carries one of the largest burdens of drug‑resistant pathogens worldwide.
Highest burden of multidrug‑resistant tuberculosis,
Alarmingly high resistance among Gram‑negative and Gram‑positive bacteria even to newer antimicrobials such as carbapenems.
NDM‑1 ( New Delhi Metallo Beta lactamase 1, an enzyme which inactivates majority of Beta lactam antibiotics including carbapenems) was reported in 2008
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
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These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
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APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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Light House Retreats: Plant Medicine Retreat Europe
Chronic Disease Management: tools for balancing an increasing expenditure and a limited budget…with well-cared patients - José Augusto García Navarro
1. WB Seminar
Washington DC, 11th September 2017
Chronic Disease Management: tools for balancing an
increasing expenditure and a limited budget…with well-
cared patients
José Augusto García Navarro
http://www.consorci.org
3. TheCSC
(CatalanHealthand
SocialCareConsortium)
1. Health and Social Care Centers
2. Facilities:
1. 42 General Hospitals
2. 57 Primary care centers
3. 171 nursing homes
4. 54 Postacute and intermediate care hospitals
5. 15 Mental Healthcare Centers
6. 25 Others (Laboratory, X-ray diagnosis, etc.)
3. 80% Hospital Discharges in Catalonia
4. 74% primary healthcare Centers
5. 45.000 Employees
4. Population over 65s doubles in 2039
Population over 85s quadruples in 2039
Average pension is reduced by a third
Population is aging and facing poverty
6. Unstoppable Expansion of New Treatments
Biologic therapies start to be prescribed by Primary Care Physicians
The Economist, Jan 3rd 2015. Going Large.
7. Where to Begin?Where to Begin?Where to Begin?Where to Begin?
Primary care and Community ProgramsPrimary care and Community ProgramsPrimary care and Community ProgramsPrimary care and Community Programs
TheThe ““DeconstructionDeconstruction”” of Hospitalsof HospitalsTheThe ““DeconstructionDeconstruction”” of Hospitalsof Hospitals
ConclusionsConclusionsConclusionsConclusions
8. Population Health Plan 2016-2020Population Health Plan 2016-2020Population Health Plan 2016-2020Population Health Plan 2016-2020
Plans to manage chronic diseases in Catalonia
http://salutweb.gencat.cat/ca/el_departament/Pla_salut/pla-de-salut-2016-2020/
9. Evolution of life expectancy for people born in Catalonia 1983-2013
Population Health Plan 2016-2020
10. Main chronic disorders among the 15+ age group in Catalonia,
2014
Population Health Plan 2016-2020
11. Population health and lifestyle habits, by gender, 2011 to 2014
Population Health Plan 2016-2020
12. Population Health Plan 2016-2020
Prevalence of tobacco consumption among the 16-64 people, by
employment status and gender, 2006 and 2013-2014
16. Programme for Prevention and TreatmentProgramme for Prevention and Treatment
of Chronicity in Catalonia (PPAC)of Chronicity in Catalonia (PPAC)
Programme for Prevention and TreatmentProgramme for Prevention and Treatment
of Chronicity in Catalonia (PPAC)of Chronicity in Catalonia (PPAC)
Plans to manage chronic diseases in Catalonia
17. Level 2
People with Chronic Diseases at
Risk
Case
Management
Disease
Management
Self-Management
Support
Level 1
People with Stable Chronic
Diseases
Level 3
Complex
Patients
Comorbidity, Hospitalizations and
Frequent Emergency Visits,
Moderate and Severe Functional
Dependence,…
Health Promotion Healthy People
Stratification + Clinical View(!)
18. Interdepartamental Plan for Health andInterdepartamental Plan for Health and
Social Care (PIAISS)Social Care (PIAISS)
Interdepartamental Plan for Health andInterdepartamental Plan for Health and
Social Care (PIAISS)Social Care (PIAISS)
Plans to manage chronic diseases in Catalonia
19. PIAISS
Integrated health and social care model.
Started in 2014 with the participation of the Governmental Ministries:
Presidency, Health and Social Welfare.
The aim is to guarantee a comprehensive health and social care service
for the 8-10% of the population who have social and healthcare needs.
20. Inductors of model changes
Home as the hub for delivery care
Co-responsibility of patients and families
Reduce insitutionalization
21. Without
33%
CD simple or
multiple
62%
CCP
3,5%
ACD
1,5% EoL
PREVENTIVE CARE
CURATIVE CARE PALLIATIVE CARE
PATIENT AUTONOMY
TEAM COORDINATION
Source: Blay C. PPAC, 2012
PPAC: CCP (Chronic Complex Patients) and ACD
(Advanced Chronic Disease) Concepts
22. New Model for Patient Empowerment: e-mail/ enter data/ access to educational
materials / outpatient and domiciliary request, etc...
New Ways of Interacting with the Patient
23. Indicators Primary
Healthcare
Hospital
Care
Avoidable Hospitalizations ++ ++
Homecare Programme Coverage ++ -
Health Outcomes: Good Control, Procedure
and Treatment
++ ++
Re-admission Rates in Chronic
Processes:COPD and Heart Failure
++ +++
“Urgent” or “Unscheduled” Hospitalization
Rate in COPD and Heart Failure Patients
++ ++
Discharge Planning in PRE-DISCHARGE
(PREALT) Programme
++ -
Ensuring Care Continuity in POST-
DISCHARGE Programme
- ++
“Quality of Life” Rating ++ ++
Transversal First - Second Level Indicators
24. • Re-inforce nursing care services portfolio in primary healthcare: support for
COPD and Heart Failure procedures, streamline others (Diabetes, Hypertension,
etc.).
• Develop specialized and varied nursing care programmes for chronic patients at
high risk: CCP/ACD
• Develop and lead case management programmes
• Design and formulation of Individual Care Plans
• Re-inforce Discharge Planning Strategies to ensure the “continuum of care” for
patients with an objective risk of re-admission.
• Re-inforce Homecare within the Social Services (chronicity and dependence)
• Organize facilities with capacity to respond to complex chronic patients in
situations of crisis and exacerbation, during night shifts and weekend shifts
(24h/7 service)
Reinforcement and Role Changes for nurses
25. • Reinforce proactive tele-care services
• Promote self-care in order to facilitate co-responsibility between patients and
carers throughout the care process.
• Improved treatment adherence
• Special interest in children with obesity and childhood asthma.
• Prevention activities and promotion of healthcare.
Reinforcement and Role Changes for nurses
27. 27
1. Population Identification Status
2. Individual Intervention Plan Implementation Status
3. Mental Health Identification
4. Geriatric and Palliative Care (PC) Identification
5. Care Model for Children and Adolescents at End-of-life
6. Complex Care Pathways
28. 28
The PIIC (Individual Intervention
Plan) is a common and updated
document, accessible on-line for
every health provider,
containing...
29. 29
WHAT IS THE PROBLEM?
WHAT TO TAKE?
WHAT TO DO IF…?
5 LEVELS OF ACTIVATION:
Telephone, Immediate attention in home or health
center, Differed & Scheduled attention,
Intermediate Care, Acute Hospitals
30. Prevalence of patients with a well-filled PIIC
Source: Catsalut, 30th September 2016
Objective 2017
Barcelona Health Region: Good PIICs (Individual Intervention
Plan)
31. Prevalence among people with good PIIC
Source: Catsalut, 31st December 2015
PIICs (Individual Intervention Plans) with good, bad o without
completion in Catalonia
32. Where to Begin?Where to Begin?Where to Begin?Where to Begin?
Primary care and Community ProgrammesPrimary care and Community ProgrammesPrimary care and Community ProgrammesPrimary care and Community Programmes
TheThe ““DeconstructionDeconstruction”” of Hospitalsof HospitalsTheThe ““DeconstructionDeconstruction”” of Hospitalsof Hospitals
ConclusionsConclusionsConclusionsConclusions
33. Level 2
People with Chronic Diseases at
Risk
Case
Management
Disease
Management
Self-Management
Support
Level 1
People with Stable Chronic
Diseases
Level 3
Complex
Patients
Comorbidity, Hospitalizations and
Frequent Emergency Visits,
Moderate and Severe Functional
Dependence,…
Health Promotion Healthy People
Stratification + Clinical View(!)
34. Primary Health Care and Community Programmes
Inter-ministerial Public HealthInter-ministerial Public Health
Programme (PINSAP)Programme (PINSAP)
Inter-ministerial Public HealthInter-ministerial Public Health
Programme (PINSAP)Programme (PINSAP)
Community Health ProgrammeCommunity Health Programme
(COM Salut)(COM Salut)
Community Health ProgrammeCommunity Health Programme
(COM Salut)(COM Salut)
National Primary and CommunityNational Primary and Community
Healthcare Strategy (ENAPISC)Healthcare Strategy (ENAPISC)
National Primary and CommunityNational Primary and Community
Healthcare Strategy (ENAPISC)Healthcare Strategy (ENAPISC)
https://www.youtube.com/watch?v=D2iHpdj0DcI
35. COM Salut
Started 2002
BAH (Basic Area of Health) of 10,121
inhabitants
1 Primary Health Care Team
1 City Council Health Technician
A space for
women health
Physical activity and sport
37. Primary Care
The primary healthcare network is the first level of care and serves
as the main point of access.
The area is organized on the basis of Basic Areas of Health (BAH),
each one being the operation area for the Primary HealthCare Team
(PHCT) assigned to a reference population. Catalonia is currently
divided into 369 BAH.
99.94% of the total population registered as residents in Catalonia
had an assigned PHCT in 2017.
Children under two years of age are 2.81% of the total population
and the 75+ age group represents 8.97% of the total population
(these are the two groups with more outpatient visits in primary
care).
38. Primary Care – continuous monitoring of outputs & outcomes
Adequacy
44. An Example in a district of Barcelona City:
Nou Barris
CSC - Consorci de Salut i Social de Catalunya
(Catalan Health and Social Care Consortium)
April 2017
46. 1. Integrated Homecare of complex chronic patients
Tracking Indicators: Information Shared with Social Services:
47. Social Care: Health Care:
-- Strengthen the family and community support network
-Support and training of patients and families
- Bank of technical assistance utilities
-Occupational therapy
-Mental Health support
- Support group, cs for carers
- Household cleaning and maintenance
- Functional adaptation of homes
- Direct assistance in activities of daily
living
- Home delivery of meals
- Activation/deactivation of telecare
- Social support and education
- Healthcare: diagnosis, care plan
- Physiotherapy
- Prevention guidelines
- Psychological support
- Chiropody (supplementary)
- Odontology (supplementary)
47
48. Where to Begin?Where to Begin?Where to Begin?Where to Begin?
Primary care and Community ProgrammesPrimary care and Community ProgrammesPrimary care and Community ProgrammesPrimary care and Community Programmes
TheThe ““DeconstructionDeconstruction”” of Hospitalsof HospitalsTheThe ““DeconstructionDeconstruction”” of Hospitalsof Hospitals
ConclusionsConclusionsConclusionsConclusions
50. Costs of subacute and long-term care Health services in Catalonia,
2002-12
% Total Healthcare
Cost
Social Healthcare
Service Costs
Source: Central de resultats, Catsalut, 2013
51. Cost of Patients in their Last Year of Life (Hospital Death)
January 2005 – March 2012:
- 5,125 patients
- Consumption in 2 Previous Years
Asssitencial Health Evalutation Area. SAGESSA Group, 2012. With permission
52. Reduce the Use of Hospitals
Need to Share Costs with community
Carers to be more involved
Inductors of model changes
54. Hospital Services for Complex Patients
Acute Medical and Surgical Care Units
In-hospital programmes to reduce risk (falls, delirium,…)
Rehabilitation and Recovery Units
Home Hospitalization
Re-design Accident & Emergency departments
Nursing Home Care
55. Acute Medical and Surgical Care Units
In-hospital programmes to reduce risk (falls, delirium,…)
Rehabilitation and Recovery Units
Home Hospitalization
Re-design Accident & Emergency departments
Nursing Home Care
Hospital Services for Complex Patients
58. First Data Showing the Functioning
Conditions of Subacute Units in Catalonia as
an Alternative to Conventional Hospitalization
Case study analysis and results from the implementation of subacute
programmes in 10 centers in Catalonia
Observatory of alternatives to hospitalization
May 2016
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59. Subacute Units in Catalonia (I)
1.Centre accreditation requirements
• Skilled nursing facilities linked to acute hospitals (Permeable circuits for patients
and professionals)
• Regional acute hospitals
2.Specific standards for subacute healthcare
Interdisciplinary team with 24h medical care.
24 h access, 365 days a year.
Capacity for intensive rehabilitation.
Laboratory (blood, urine and blood gas analysis), pulsioximetry, ECG,
emergency and scheduled X-rays.
Oxygen therapy, intravenous therapy, scheduled transfusions.
Accessibility to inter-consultation for other specializations in the same center
Access to programmed testing (ultrasound, CT, MRI).
Quick access to acute reference hospital.
60. Subacute Units in Catalonia (II)
¿Which patients are candidates for subacute care?
Chronic complex patients with exacerbation that requires short term hospital admission,
hemodynamically stable, and don't require high technology or need to be attended at
home.
Catalonian Department of Health outcome indicators and standards
- Mean Length of Stay (LOS) ≤ 12 days
- Return to home ≥ 70%
- Mortality ≤ 10%
- Referral to acute hospitals < 10%
- Referral to other intermediate care resources < 15%
- Admission from: A & E Department 80%
62. Results (I)
Patients characteristics
2014 2015
Age, Years (DE) 84.2 (7.2) 85.9 (7.2)
Men % 44.11 36
CCP/ACD Condition
CCP%
ACD%
No CCP/ACD%
37.20
10.77
52.03
35
11
53.8
Functional Status (Barthel Index) (DE) 56.4 (29.17) 49.43 (32.8)
Prevalence of Dementia % 43 40.4
Main Condition
Respiratory Diseases %
Cardiovascular Disorders %
37.6
23.4
55.8
20.1
63. Results (II)
Outputs & outcomes
2014 2015
Mean Length of Stay (LOS) (DE) 10.93 (7.27) 9.65 (5.73)
Admission from A & E Department(%) 73.16 84
Destination(%) Standards
Home >70%
(Residence)
Death ≤ 10%
Acute Hospital Referral< 10%
Intermediate Care Referral< 15%
71.34
(11.99)
13.82
6.10
8.74
64.3
(14.4)
16
3.5
16.2
64. Results (III)
Functional status at discharge, re-admission and 30 days
maortality after discharge
2014 2015
Barthel Discharge Operational Status (DE)
Barthel Difference
56.5 (27.65)
+0.1 (15.9)
40.94 (33.58)
-8.49 (20.52)
30 Day Analysis
Barthel
Re-admission %
Death %
n= 230
58.07
19.1
11.3
n= 508
45.5
20.5
18.9
65. Conclusions
1.Very frail patient profiles (multiple conditions, disability and dementia).
2.Partially meet pre-established standards:
• Deviations: Mortality (in accordance with the profile of patients)
• Good functioning of ALOS (Average Length of Stay) and destination at discharge
3.Moderate functional loss at discharge, with high re-admission and 30 day mortality rates.
4.This type of unit acts as a real alternative to acute hospitalization, always with an
adequate selection of patients.
66. Hospital Services for Complex Patients
Acute Medical and Surgical Care Units
In-hospital programmes to reduce risk (falls, delirium,…)
Rehabilitation and Recovery Units
Home Hospitalization
Re-design Accident & Emergency departments
Nursing Home Care
67. Intervention in Nursing Homes
Díaz-Gegúndez M. Evaluación de un programa de intervención en residencias geriátricas para reducir la frecuentación
hospitalaria. Rev Esp de geriatr y gerontol, 2011
68. Where to Begin?Where to Begin?Where to Begin?Where to Begin?
Primary care and Community ProgrammesPrimary care and Community ProgrammesPrimary care and Community ProgrammesPrimary care and Community Programmes
TheThe ““DeconstructionDeconstruction”” of Hospitalsof HospitalsTheThe ““DeconstructionDeconstruction”” of Hospitalsof Hospitals
ConclusionsConclusionsConclusionsConclusions
69. Reflections for Action
Re-inforce primary care as the main actor of healthcare
system:
From “gatekeeper” to service provision
Strengthening of team work and role changes in nurses
Orientation and stimulation towards the integration of social
and community services
Re-think hospitals in order to attend these patients:
Organization by complexity and not by medical specialty
Transfer some parts of care to alternative units to
hospitalization (day hospitals, home hospitalization, skilled
nursing facilities, etc.)
Reinforce post-acute and subacute units
Integration