The document discusses primary health care and major frameworks. It defines primary health care as essential health care that is universally accessible, scientifically sound, and socially acceptable. The WHO defined primary health care in the Alma-Ata Declaration. Primary health care focuses on health promotion, illness prevention, care of the sick, advocacy, and community development. It discusses frameworks for primary health care including the chronic care model and people-centered primary care. It also identifies challenges in access, coordination of care, and prevention in Australian primary health care.
HISTORY OF 3-STEP LADDER WHO
1980 – WHO establishes Cancer Control Programme
Cancer prevention
Early diagnosis with curative treatment
Pain relief and palliative care
1986 – ” Cancer Pain Relief “ published by WHO
Step Ladder WHO
Updated on 1996
Worldwide acceptance protocol
Today, worldwide consensus favouring its used for management of all pain associated with serious illness
HISTORY OF 3-STEP LADDER WHO
1980 – WHO establishes Cancer Control Programme
Cancer prevention
Early diagnosis with curative treatment
Pain relief and palliative care
1986 – ” Cancer Pain Relief “ published by WHO
Step Ladder WHO
Updated on 1996
Worldwide acceptance protocol
Today, worldwide consensus favouring its used for management of all pain associated with serious illness
Measuring Health and Disease I: Introduction to Epidemiology Module GuideSaide OER Africa
This module was developed at the School of Public Health, University for the Western Cape for the Postgraduate Certificate in Public Health which was offered as a distance learning module between 2001 and 2008. It was designed to meet the growing need for an applied course in the measurement of a variety of health indicators and outcomes. Whether you manage a health programme, a health facility, or simply have to interpret health data in the course of your work, this module sets out to increase your capacity to deal with health and disease information. It aims to assist you in applying epidemiological knowledge and skills to a variety of Public Health problems such as:
Is your DOTS programme succeeding?
What does it mean if a TB prevalence is 850/100 000?
Is this a Public Health problem or not?
What is the “burden of disease” in different communities?
Geriatric Population. Geriatric Palliative and End-of-Life Care.Michelle Peck
During your journey through this slide deck Geriatric Population. Geriatric Palliative and End-of-Life Care you will experience what it means to die badly.
After practicing as a Geriatric Clinician for over a decade what I know for sure is: Life is a tremendous gift. 100% of us are going to die. If you don't communicate your end-of-life plan, then you should plan on dying badly.
In The Cost of Dying: End-of-Life Care on CBS 60 minutes Steve Kroft interviews Doctor Ira R. Byock. “Families cannot imagine that there could be anything worse than their loved one dying, but in fact there are things worse, generally it’s having someone you love die badly.” ~Doctor Ira Byock
“Dr. Byock what do you mean dying badly?” ~Mr. Kroft
“Dying suffering, dying connected to machines, denial of death at some point becomes a delusion and we start acting in ways that make no sense whatsoever.” ~Doctor Ira Byock
A majority of Americans say they want to die at home. Why is this not happening?
Place of death should be regarded as an essential goal in end-of-life care.
Let’s explore how the end-of-life decision occurs?
For Doctors
Bernacki & Block (2014) found in their review and synthesis of best practices that physician attitudes, training, and perceptions of feeling inadequate in managing the emotional and behavioral reactions of patients all play a role. A majority of trainees were not taught how to communicate and they express strong desires to learn more. Physician barriers also include not addressing psychosocial concerns, placing focus on diagnoses, treatments, and procedures during discussions about the medical care at the end-of-life.
For Patients
Bernacki & Block (2014) found that patients who do bring up dying concerns with their physicians often meet barriers and often are not aware that they are at the end-of-life. Patients that have not set goals based on meaningful conversations about their desires may overuse life-prolonging treatment and underuse services that support quality of life.
Conclusion
Bernacki & Block (2014) found that there is a large body of evidence demonstrating that early discussions of serious illness care goals are associated with:
♛ beneficial outcomes for patients,
♛ no harmful adverse effects, and
♛ potential cost savings.
Apply & Do
To prevent dying badly start early conversations, enhance your knowledge and establish goals. Dreams are only dreams until you write them down. When you write dreams down then they become goals.
Do ♛ The Conversation Project a collaboration with the Institute for Healthcare Improvement. http://theconversationproject.org/starter-kit/intro/
Do your conversation kit now and make your loved ones aware of your wishes.
Wishing you the very best, Michelle
Bernacki RE, Block SD, for the American College of Physicians High Value Care Task Force. Communication About Serious Illness Care Goals: A Review and Synthesis of Best Practices. JAMA Intern Med. 2014;174(12):1994-2003.
The course offers an opportunity to develop a holistic understanding of Primary Health Care, its functions, and scope. The course attendants will learn the principles of Primary Health Care, the course is expected to help the students to understand and internalize international health and public health transition facilitating the integration of health sector with other sectors.
Effective pain management in terminally ill requires
Understanding of pain control strategies
Ongoing assessment
Diagnosis of pain
Breakthrough pain relief
Fine adjustment of medications
Opioid rotation
Unresolved psychosocial or spiritual issue can be great impact to pain management
Community wellbeing is the combination of social, economic, environmental, cultural, and political conditions identified by individuals and their communities as essential for them to flourish and fulfill their potential.”
When we look at community as a whole, we find three attributes that play a large role in wellbeing: connectedness, livability, and equity. We can explore each of these attributes for factors that contribute to community wellbeing.
Emotional Intelligence (EI or EQ) is the ability of an individual to identify, control and manage emotions of oneself and others in order to maintain healthy relationships. Emotional intelligence in healthcare professionals helps in enhancing patient satisfaction and clinical outcomes
Ρητορική και πολιτική στην Πρωτοβάθμια Φροντίδα. Η αναγκαιότητα μιας τεκμηριω...Evangelos Fragkoulis
Παρούσιαση μου στα πλαίσια του 13ου Health Policy Forum, με θέμα:
"Πρωτοβάθμια Φροντίδα Υγείας: Προϋποθέσεις Ανασυγκρότησης και Ανάπτυξης"
Αρχαία Ολυμπία, 15-17 Απριλίου 2016
http://www.healthpolicy.gr/13%CE%B7-%CF%83%CF%85%CE%BD%CE%AC%CE%BD%CF%84%CE%B7%CF%83%CE%B7-%CE%B1%CF%81%CF%87%CE%B1%CE%AF%CE%B1-%CE%BF%CE%BB%CF%85%CE%BC%CF%80%CE%AF%CE%B1-2016/
Measuring Health and Disease I: Introduction to Epidemiology Module GuideSaide OER Africa
This module was developed at the School of Public Health, University for the Western Cape for the Postgraduate Certificate in Public Health which was offered as a distance learning module between 2001 and 2008. It was designed to meet the growing need for an applied course in the measurement of a variety of health indicators and outcomes. Whether you manage a health programme, a health facility, or simply have to interpret health data in the course of your work, this module sets out to increase your capacity to deal with health and disease information. It aims to assist you in applying epidemiological knowledge and skills to a variety of Public Health problems such as:
Is your DOTS programme succeeding?
What does it mean if a TB prevalence is 850/100 000?
Is this a Public Health problem or not?
What is the “burden of disease” in different communities?
Geriatric Population. Geriatric Palliative and End-of-Life Care.Michelle Peck
During your journey through this slide deck Geriatric Population. Geriatric Palliative and End-of-Life Care you will experience what it means to die badly.
After practicing as a Geriatric Clinician for over a decade what I know for sure is: Life is a tremendous gift. 100% of us are going to die. If you don't communicate your end-of-life plan, then you should plan on dying badly.
In The Cost of Dying: End-of-Life Care on CBS 60 minutes Steve Kroft interviews Doctor Ira R. Byock. “Families cannot imagine that there could be anything worse than their loved one dying, but in fact there are things worse, generally it’s having someone you love die badly.” ~Doctor Ira Byock
“Dr. Byock what do you mean dying badly?” ~Mr. Kroft
“Dying suffering, dying connected to machines, denial of death at some point becomes a delusion and we start acting in ways that make no sense whatsoever.” ~Doctor Ira Byock
A majority of Americans say they want to die at home. Why is this not happening?
Place of death should be regarded as an essential goal in end-of-life care.
Let’s explore how the end-of-life decision occurs?
For Doctors
Bernacki & Block (2014) found in their review and synthesis of best practices that physician attitudes, training, and perceptions of feeling inadequate in managing the emotional and behavioral reactions of patients all play a role. A majority of trainees were not taught how to communicate and they express strong desires to learn more. Physician barriers also include not addressing psychosocial concerns, placing focus on diagnoses, treatments, and procedures during discussions about the medical care at the end-of-life.
For Patients
Bernacki & Block (2014) found that patients who do bring up dying concerns with their physicians often meet barriers and often are not aware that they are at the end-of-life. Patients that have not set goals based on meaningful conversations about their desires may overuse life-prolonging treatment and underuse services that support quality of life.
Conclusion
Bernacki & Block (2014) found that there is a large body of evidence demonstrating that early discussions of serious illness care goals are associated with:
♛ beneficial outcomes for patients,
♛ no harmful adverse effects, and
♛ potential cost savings.
Apply & Do
To prevent dying badly start early conversations, enhance your knowledge and establish goals. Dreams are only dreams until you write them down. When you write dreams down then they become goals.
Do ♛ The Conversation Project a collaboration with the Institute for Healthcare Improvement. http://theconversationproject.org/starter-kit/intro/
Do your conversation kit now and make your loved ones aware of your wishes.
Wishing you the very best, Michelle
Bernacki RE, Block SD, for the American College of Physicians High Value Care Task Force. Communication About Serious Illness Care Goals: A Review and Synthesis of Best Practices. JAMA Intern Med. 2014;174(12):1994-2003.
The course offers an opportunity to develop a holistic understanding of Primary Health Care, its functions, and scope. The course attendants will learn the principles of Primary Health Care, the course is expected to help the students to understand and internalize international health and public health transition facilitating the integration of health sector with other sectors.
Effective pain management in terminally ill requires
Understanding of pain control strategies
Ongoing assessment
Diagnosis of pain
Breakthrough pain relief
Fine adjustment of medications
Opioid rotation
Unresolved psychosocial or spiritual issue can be great impact to pain management
Community wellbeing is the combination of social, economic, environmental, cultural, and political conditions identified by individuals and their communities as essential for them to flourish and fulfill their potential.”
When we look at community as a whole, we find three attributes that play a large role in wellbeing: connectedness, livability, and equity. We can explore each of these attributes for factors that contribute to community wellbeing.
Emotional Intelligence (EI or EQ) is the ability of an individual to identify, control and manage emotions of oneself and others in order to maintain healthy relationships. Emotional intelligence in healthcare professionals helps in enhancing patient satisfaction and clinical outcomes
Ρητορική και πολιτική στην Πρωτοβάθμια Φροντίδα. Η αναγκαιότητα μιας τεκμηριω...Evangelos Fragkoulis
Παρούσιαση μου στα πλαίσια του 13ου Health Policy Forum, με θέμα:
"Πρωτοβάθμια Φροντίδα Υγείας: Προϋποθέσεις Ανασυγκρότησης και Ανάπτυξης"
Αρχαία Ολυμπία, 15-17 Απριλίου 2016
http://www.healthpolicy.gr/13%CE%B7-%CF%83%CF%85%CE%BD%CE%AC%CE%BD%CF%84%CE%B7%CF%83%CE%B7-%CE%B1%CF%81%CF%87%CE%B1%CE%AF%CE%B1-%CE%BF%CE%BB%CF%85%CE%BC%CF%80%CE%AF%CE%B1-2016/
March 2001I N S T I T U T E O F M E D I C I N E Shap.docxwkyra78
March 2001
I N S T I T U T E O F M E D I C I N E
Shaping the Future for Health
CROSSING THE QUALITY CHASM:
A NEW HEALTH SYSTEM FOR THE 21ST CENTURY
The U.S. health care delivery system does not provide consistent, high-quality medical care to all people. Americans should be able to count on receiving care that meets their needs and is based on the best scien
tific knowledge--yet there is strong evidence that this frequently is not the
case. Health care harms patients too frequently and routinely fails to deliver
its potential benefits. Indeed, between the health care that we now have and
the health care that we could have lies not just a gap, but a chasm.
A number of factors have combined to create this chasm. Medical sci
ence and technology have advanced at an unprecedented rate during the past
half-century. In tandem has come growing complexity of health care, which
today is characterized by more to know, more to do, more to manage, more to
watch, and more people involved than ever before. Faced with such rapid
changes, the nation’s health care delivery system has fallen far short in its
ability to translate knowledge into practice and to apply new technology
safely and appropriately. And if the system cannot consistently deliver to-
day’s science and technology, it is even less prepared to respond to the ex
traordinary advances that surely will emerge during the coming decades.
The public’s health care needs have changed as well. Americans are
living longer, due at least in part to advances in medical science and techno l
ogy, and with this aging population comes an increase in the incidence and
prevalence of chronic conditions. Such conditions, including heart disease,
diabetes, and asthma, are now the leading cause of illness, disability, and
death. But today’s health system remains overly devoted to dealing with
acute, episodic care needs. There is a dearth of clinical programs with the
multidisciplinary infrastructure required to provide the full complement of
services needed by people with common chronic conditions.
The health care delivery system also is poorly organized to meet the
challenges at hand. The delivery of care often is overly complex and uncoor
dinated, requiring steps and patient “handoffs” that slow down care and de-
crease rather than improve safety. These cumbersome processes waste re-
sources; leave unaccountable voids in coverage; lead to loss of information;
Faced with such
rapid changes, the
nation’s health care
delivery system has
fallen far short in its
ability to translate
knowledge into
practice and to ap
ply new technology
safely and appro
priately.
CARE SYSTEM
Supportive
payment and
regulatory en
vironment
Organizations
that facilitate
the work of
patient-
centered teams
High perform
ing patient-
centered teams
Outcomes:
• Safe
• Effective
• Efficient
• Personalized
• Timely
• Equitable
REDESIGN IMPERATIVES: SIX CHALLENGES
• Reeng.
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
Acetabularia Information For Class 9 .docxvaibhavrinwa19
Acetabularia acetabulum is a single-celled green alga that in its vegetative state is morphologically differentiated into a basal rhizoid and an axially elongated stalk, which bears whorls of branching hairs. The single diploid nucleus resides in the rhizoid.
Instructions for Submissions thorugh G- Classroom.pptxJheel Barad
This presentation provides a briefing on how to upload submissions and documents in Google Classroom. It was prepared as part of an orientation for new Sainik School in-service teacher trainees. As a training officer, my goal is to ensure that you are comfortable and proficient with this essential tool for managing assignments and fostering student engagement.
Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
Unit 8 - Information and Communication Technology (Paper I).pdfThiyagu K
This slides describes the basic concepts of ICT, basics of Email, Emerging Technology and Digital Initiatives in Education. This presentations aligns with the UGC Paper I syllabus.
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
Biological screening of herbal drugs: Introduction and Need for
Phyto-Pharmacological Screening, New Strategies for evaluating
Natural Products, In vitro evaluation techniques for Antioxidants, Antimicrobial and Anticancer drugs. In vivo evaluation techniques
for Anti-inflammatory, Antiulcer, Anticancer, Wound healing, Antidiabetic, Hepatoprotective, Cardio protective, Diuretics and
Antifertility, Toxicity studies as per OECD guidelines
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
Introduction to AI for Nonprofits with Tapp NetworkTechSoup
Dive into the world of AI! Experts Jon Hill and Tareq Monaur will guide you through AI's role in enhancing nonprofit websites and basic marketing strategies, making it easy to understand and apply.
Welcome to TechSoup New Member Orientation and Q&A (May 2024).pdfTechSoup
In this webinar you will learn how your organization can access TechSoup's wide variety of product discount and donation programs. From hardware to software, we'll give you a tour of the tools available to help your nonprofit with productivity, collaboration, financial management, donor tracking, security, and more.
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
2. „Essential health care based on practical,
scientifically sound and socially acceptable
methods and technology made universally
accessible to individuals and families in the
community through their full participation
and at a cost that the community and the
country can afford to maintain at every stage
of their development in the spirit of self-
reliance and self-determination‟
3. The WHO Alma-Ata Declaration defined
Primary Health Care (PHC) as incorporating
curative treatment given by the first contact
provider along with promotional, preventive
and rehabilitative services provided by multi-
disciplinary teams of health-care
professionals working collaboratively
(Anderson, Bridges-Webb and Chancellor, 1986)
4. PHC is socially appropriate, universally accessible,
scientifically sound first level care provided by a
suitable trained workforce supported by integrated
referral systems and in a way that gives priority to
those most in need, maximises community and
individual self-reliance and participation and
involves collaboration with other sectors. It
includes the following:
- Health promotion
- Illness prevention
- Care of the sick
- Advocacy
- Community Development
(Australian Primary Health Care Research Institute, Australian University. Cited in Primary
Health Care-2006. Available http://www.ama.com.au/node/2502
5. Within Australia, the primary health care
services are a complex combination of State
and Commonwealth funded initiatives with
both public and private providers
Services include General Practitioners,
community health care centres, private allied
health professionals such as dietitians,
pharmacies and complimentary therapists
GPs provide majority of primary health care
services
◦ 85% of the population see a GP at least once a year
◦ average Australian person would visit a GP 6.5 times
per year.
6. Broader population health focus than hospital
and specialist care
◦ population health activities better delivered through
primary care eg immunisation, health promotion and
screening
More continuity of care- people receiving
ongoing care from a trusted doctor or other
health professional achieve better health
outcomes than those receiving care from a
number of doctors
Greater accessibility (financially,
geographically, culturally)
(Doggett, 2007)
7. International evidence suggests strength of a
country‟s primary care system is associated with
improved population health outcomes for all-cause
mortality from respiratory and cardiovascular
disease
Health systems that include strong primary medical
care are more efficient and have lower rates of
hospitalisation.
Continuity of care with the same primary care
provider or service has been associated with lower
use of hospitals and greater patient satisfaction
with all care
(Harris, Kidd and Snowdon, 208; WHO Regional Office for Europe‟s Health Evidence
Network (HEN), 2004)
8. Conventional Disease control People-centred
ambulatory medical programs` primary care
care in clinics or
outpatient
departments
Focus on illness and cure Focus on priority diseases Focus on health needs
Relationship limited to the Relationship limited to Enduring personal
moment of consultation program implementation relationship
Episodic curative care Program-defined disease Comprehensive,
control interventions continuous and person-
centred
Responsibility limited to Responsibility for disease- Responsibility for the health
effective and safe advice to control interventions of all in the community
the patient at the moment along the life cycle;
of consultation responsibility for tackling
determinants of ill health
Users are consumers of the Population groups are People are partners in
care they purchase targets of disease-control managing their own health
interventions and that or their community
(WHO, 2008, p.43)
9. Primary Health Care‟s focus is on providing “health
for all” through health systems that put “people at
the centre of their own care”
WHO Primary Health Care- Now More than Ever
(2008)
◦ evaluates events that have been undertaken to address health
over the last 30 years
◦ provides recommendations to decrease global health
inequalities
Available at: http://www.who.int/whr/2008/whr08_en.pdf
10. Disproportionate focus on narrow offer of
specialized curative care
Command and control approach to disease
control focused on short-term results
Hands-off approach to governance allowing
unregulated commercialization of health to
flourish
11. Inverse care – people with the most means
and often less needs consume the most care
Impoverishing care – where lack of social
protection and payment for care is largely
out-of-pocket and can result in poverty
Fragmented and fragmenting care – excessive
specialization of health care providers and
narrow focus discourage a holistic approach
12. Unsafe care – poor system design cannot
ensure safety and hygiene standards leading
to hospitalized infections and other errors
Misdirected care – resources allocation
clusters around curative services at great
cost, neglecting potential of primary health
care and health promotion to prevent up to
0% of disease burden.
13. Main Reforms Recommended include:
Universal coverage reforms
Public policy reforms
Leadership reforms
Service delivery reforms
14. Main Areas of Concern
Provides many of the required services,
however there are still many people with
multiple and complex health conditions
receiving inadequate care
There is a general lack of GPs in some areas
Poor access to GP services for some groups
in the community eg rural/remote,
indigenous communities
15. High out of pocket expenses for many allied
health services and some pharmaceuticals
Many people require a variety and number
of health professional services and the lack
of coordination of health care can ultimately
contribute to poor health outcomes and an
in emergency and hospital admissions,
placing a great burden on the health system
16. An insufficient focus on prevention and
population health
Inflexible funding system that does not
always allow consumers to gain access to the
most suitable form of care for their condition
Primary Health Care has been regarded in
Australia as being fragmented, difficult to
navigate and prone to gaps and inequities in
access to services- A REFORM of the system
including a coordinated and universal
approach to Primary Health Care is required.
(Doggett, 2007)
17. The National Primary
Health Care Strategy
confronts the
challenges relating to
health care in the
present and the
future. The priorities
of the Primary Health
Strategy:
18. Better rewarding prevention
Promoting evidence-based management of chronic
disease
Supporting patients with chronic disease to
manage their condition
Supporting the role GPs play in the health care
team
Addressing the growing need for access to other
health professionals, including practice nurses and
allied health professionals eg dietitians and
physiotherapists
Encouraging a greater focus on multidisciplinary
team based care
(Department of Health and
Ageing, 2008)
19. Regional integration
Information and technology,
including eHealth
Skilled workforce
Infrastructure
Financing and system performance
20. Key Priority Area 1: Improving access and
reducing inequity
Key Priority Area 2: Better management of
chronic conditions
Key Priority Area 3: Increasing the focus on
prevention
Key Priority Area 4: Improving quality,
safety, performance and accountability
22. Research from the USA and New Zealand
suggest that primary health care is
contributing to a in the life expectancy gap
for indigenous peoples
Indigenous Australians continue to
experience poor access to primary health
care, despite the higher levels of morbidity
and the large gap in life expectancy.
23.
24. Developed in the USA by Edward Wagner
Describes the essential elements for
improvements in the care of people with
chronic conditions with a focus on primary
care
Aim of the CCM is to develop well informed
patients and a healthcare system that is
prepared for them
26. Delivery System Design
◦ Create teams with a clear division of labour
◦ Separated acute care from the planned care
◦ Planned visits and follow up are important features
Self-management support
◦ Collaboratively helping patients and families to
acquire the skills and confidence to manage their
condition
◦ Provide self management tools, referrals to
community resources and routinely assessing
progress
27. Decision Support
◦ Integration of evidence based clinical guidelines
into practice and reminder systems
Clinical Information Systems
◦ Reminder system to improve compliance with
guidelines, feedback on performance measures and
registries for planning the care for chronic diseases
28. Community Resources
◦ Linkages with hospitals providing patient
education classes or home care agencies to
provide case managers
◦ Linkages with community based resources-
exercise programs, self help groups and senior
centres
Health Care Organisation
◦ The structure, goals and values of the provider
organisation. Its relationship with purchaser,
insurers and other providers underpins the model
29.
30. Harris, Kidd and Snowdon (2009) have
adapted Wagner‟s CCM to address issues
relating the PHC in Australia
Provides a framework for an effective and
accessible national primary health care
system
Evidence that this model will provide a more
effective way of ensuring access, quality
and equity of care for all people in Australia
31. Model for Primary and Community Care to meet the challenges of chronic
disease prevention and management
• Reengineering the
organisation of health care
• Modification of primary care
organisations
• Engaging the community
• Monitoring performance and
accountability
• Self management and health literacy support
• Redesign of the primary health care team
• Shared information systems
• Decision support
Informed patients Proactive Team
Better Prevention and management
of chronic disease
Harris, Kidd and Snowdon, 2008, p. 7
32. Developed by the WHO in response to the
increasing prevalence of chronic diseases in both
developed and developing countries.
Adapted from CCM
◦ Shift from acute care for chronic disease to a more
preventative and long-term health care management
model.
Composed of fundamental components at the
patient (micro), organisation/ community (meso)
and policy (macro) levels
33. Macro Level - governments developing and
implementing policies to prevent and manage chronic
disease.
Meso Level - systems to manage care over time. This
will include education of health professionals,
evidence based guidelines, prevention strategies,
information systems and linking with community
resources.
Micro Level – The micro level of the model elevates
the role of patients and their families, and partners
them with communities and healthcare organisations.
34.
35. National strategic policy approach to chronic disease prevention and care
in the Australian population.
Overarching framework which encourages coordinated action nationally.
Five supporting National Service Improvement Frameworks (asthma;
cancer; diabetes; heart, stroke and vascular disease; osteoarthritis,
rheumatoid arthritis and osteoporosis).
Primary objectives of the NCDS are to:
Prevent/delay the onset of chronic conditions
Reduce the progression and complications of chronic conditions
Maximize the wellbeing and quality of life of individuals living with
chronic disease and their families and carers
Reduce avoidable hospital admissions and health care procedures
Implement best practice in the prevention, detection and management of
chronic disease
Enhance the capacity of the health workforce to meet population
demand for chronic disease prevention and care into the future
36. Key principles
◦ Adopt a population health approach
◦ Prioritise health promotion and illness prevention
◦ Achieve person-centred care and optimise self-
management
◦ Provide the most effective care
◦ Facilitate coordinated and integrated
multidisciplinary care across services setting and
sectors
◦ Achieve significant and sustainable change
◦ Monitor progress
37. Action areas
1)Prevention across the continuum
2)Early detection and early treatment
3)Integration and continuity of prevention and care
4)Self-management
Action implementation areas
1) Building workforce capacity
2) Developing strategic partnerships
3) Enhancing investment and funding opportunities
4) Developing infrastructure and information technology
support
38. National agreement between the Commonwealth
and the States and Territories.
Clarifies the roles and responsibility of
Commonwealth and State governments to guide
the delivery of health services
Defines objectives for chronic condition
prevention, primary and community care,
hospital and related care and aged care
Provides a description of the outputs and
performance indicators to measure success.
39. National preventative task force
National partnership on closing the gap in
Indigenous health outcomes
Australian Better Health initiative
National Health Priority Area initiative
40. GPs play a major role in the prevention and
management of chronic diseases
◦ First point of contact
◦ First to diagnose conditions
◦ Can provide counseling services, prescription & referral
◦ Strategies to support and facilitate role of GP in PHC
essential
Enhanced Primary Care Plan
Lifescripts (discussed later in semester)
SNAP methodology (discussed later in semester)
41. MBS items were introduced for health
assessments and care planning
◦ GPs could receive a MBS rebate for initiating and
participating in health assessments and care planning
Other EPC initiatives
◦ Healthy Kids Check
◦ 45 year old Health Check
◦ Type 2 Diabetes Risk Evaluation
◦ Incentive Programs
◦ Practice Nurses
42. In the 2005-2006 Budget, the Australian
Government announced funding for the Healthy for
Life program
The objectives are to :
◦ improve the availability of child and maternal health
care;
◦ improve the prevention, early detection and
management of chronic disease;
◦ improve men‟s health;
◦ improve long term health outcomes for Aboriginal
and Torres Strait Islander Australians;
◦ increase the capacity of the Aboriginal and Torres
Strait Islander health workforce through the Puggy
Hunter Memorial Scholarship Scheme.
◦ http://www.health.gov.au/internet/h4l/publishing.n
sf/Content/home-1
43. Anderson, N., Bridges-Webb, C. and Chancellor, A. (1986). General practice in Australia. Sydney University Press, Sydney
cited in Primary Health Care-2006. AMA. Available at http://www.ama.com.au/node/2502
- Australian Primary Health Care Research Institute, Australian University. Cited in Primary Health Care-2006. Available
http://www.ama.com.au/node/2502
- Department of Health and Ageing (2008). Primary Health Strategy. Available at:
http://www.health.gov.au/internet/main/publishing.nsf/Content/D66FEE14F736A789CA2574E3001783C0/$File/Discussio
nPaper.pdf
- Doggett, J. (2007). A New Approach to Primary Care for Australia. Centre for Policy Development, Sydney.
- Harris, M., Kidd, M. and Snowdon, T. (2008). New models of Primary and Community Care to meet the challenges of chronic
disease prevention and management: a discussion paper for the NHHRC.
- Harris, M., Laws, R. and Amoroso, C. (2008). Moving towards a More Integrated Approach to Chronic Disease Prevention in
Australian General Practice. Australian Journal of Primary Health. 14(3), 112-118.
- National Heart Foundation and Kinect Australia for Lifescripts Consortium. (2005). Lifescript in your Division: supporting
lifestyle risk factor management in general practice. A guide for Division of General Practice. Canberra, Commonwealth of
Australia.
- World Health Organisation. (2008). Primary Health Care: Now More than Ever. Available
at:http://www.who.int/whr/2008/whr08_en.pdf
- WHO Regional Office for Europe‟s Health Evidence Network (HEN). (2004). What are the advantages and disadvantages of
restructuring a health care system to be more focused on primary care services. Cited in Primary Health Care- 2006. AMA.
Available at http://www.ama.com.au/node/2502.