Strengthening Health Systems: Lessons Learned from 2nd Decade of Thailand’s U...Borwornsom Leerapan
Special Symposium "Celebrating The Legacy of HRH Prince Mahidol of Songkla: A Century of Progress in Public Health and Medicine in Thailand", presented at Harvard University 2016.8.25
Governance issues of health screening and the practice of periodic physical examination in Thailand. Presented in Joint Conference of Medical Sciences Chula-Rama-Siriraj (JCMS2015) 2015.6.4
Primary Care: Policies and Systems,
Panel Discussion,
The 15th ACMET: The Holistic Medical Education in 21st Century Phayao University, Phayao, Thailand,
December 17, 2014
Harmonizing Healthcare Financing for Health Equity: Case Studies of Cross-sub...Borwornsom Leerapan
Harmonizing Healthcare Financing for Health Equity: Case Studies of Cross-subsidization in Thai Public Hospitals. Presented in Joint Conference of Medical Sciences Chula-Rama-Siriraj (JCMS2015) 2015.6.6
150217 mapping of health financing schemes rwanda_2014Alex Hakuzimana
A dissertation in partial fulfillment of requirements for my degree of Master of Science in Public Health at the Institute of Tropical Medicine (ITM) of Antwerp during the 2013/2014 academic year
Strengthening Health Systems: Lessons Learned from 2nd Decade of Thailand’s U...Borwornsom Leerapan
Special Symposium "Celebrating The Legacy of HRH Prince Mahidol of Songkla: A Century of Progress in Public Health and Medicine in Thailand", presented at Harvard University 2016.8.25
Governance issues of health screening and the practice of periodic physical examination in Thailand. Presented in Joint Conference of Medical Sciences Chula-Rama-Siriraj (JCMS2015) 2015.6.4
Primary Care: Policies and Systems,
Panel Discussion,
The 15th ACMET: The Holistic Medical Education in 21st Century Phayao University, Phayao, Thailand,
December 17, 2014
Harmonizing Healthcare Financing for Health Equity: Case Studies of Cross-sub...Borwornsom Leerapan
Harmonizing Healthcare Financing for Health Equity: Case Studies of Cross-subsidization in Thai Public Hospitals. Presented in Joint Conference of Medical Sciences Chula-Rama-Siriraj (JCMS2015) 2015.6.6
150217 mapping of health financing schemes rwanda_2014Alex Hakuzimana
A dissertation in partial fulfillment of requirements for my degree of Master of Science in Public Health at the Institute of Tropical Medicine (ITM) of Antwerp during the 2013/2014 academic year
Data Science for Healthcare Graduate Programs, Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on October 2, 2019
Presented at the Master of Science and Doctor of Philosophy Programs in Data Science for Healthcare and Clinical Informatics, Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on October 4, 2021
Theera-Ampornpunt N. Health informatics: the next “stethoscope” in healthcare. Presented at: Intelligent logistics for innovation hospitals; 2010 Dec 23; Faculty of Engineering, Mahidol University, Thailand. Invited speaker, in Thai.
Presented at the Data Science for Healthcare Graduate Programs, Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on October 7, 2019
Introduction to Health Informatics and Health Information Technology (Part 1)...Nawanan Theera-Ampornpunt
Presented at the Health Informatics and Health Information Technology Course, Doctor of Philosophy and Master of Science Programs in Data Science for Health Care (International Program), Faculty of Medicine Ramathibodi Hospital, Mahidol University on October 3, 2017
Public Health informatics, Consumer health informatics, mHealth & PHRs (Novem...Nawanan Theera-Ampornpunt
Presented at the M.S. and Ph.D. Programs in Data Science for Health Care, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on November 11, 2019
A presentation in February 2011 presented at the Ramathibodi Hospital Administration School, Faculty of Medicine Ramathibodi Hospital, Mahidol University in Bangkok, Thailand. Presentation partly in English and partly in Thai.
Presented at the 9th Healthcare CIO Certificate Program, School of Hospital Management, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on March 4, 2019
The Last Mile of UHC in Thailand: Do We Reach the Vulnerable?Borwornsom Leerapan
PMAC 2017 Side meeting. The panel discussion on "The Last Mile of UHC in Thailand: Do We Reach the Vulnerable?" at Centara Grand & Bangkok Convention Centre, 2017.1.30
Data Science for Healthcare Graduate Programs, Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on October 2, 2019
Presented at the Master of Science and Doctor of Philosophy Programs in Data Science for Healthcare and Clinical Informatics, Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on October 4, 2021
Theera-Ampornpunt N. Health informatics: the next “stethoscope” in healthcare. Presented at: Intelligent logistics for innovation hospitals; 2010 Dec 23; Faculty of Engineering, Mahidol University, Thailand. Invited speaker, in Thai.
Presented at the Data Science for Healthcare Graduate Programs, Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on October 7, 2019
Introduction to Health Informatics and Health Information Technology (Part 1)...Nawanan Theera-Ampornpunt
Presented at the Health Informatics and Health Information Technology Course, Doctor of Philosophy and Master of Science Programs in Data Science for Health Care (International Program), Faculty of Medicine Ramathibodi Hospital, Mahidol University on October 3, 2017
Public Health informatics, Consumer health informatics, mHealth & PHRs (Novem...Nawanan Theera-Ampornpunt
Presented at the M.S. and Ph.D. Programs in Data Science for Health Care, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on November 11, 2019
A presentation in February 2011 presented at the Ramathibodi Hospital Administration School, Faculty of Medicine Ramathibodi Hospital, Mahidol University in Bangkok, Thailand. Presentation partly in English and partly in Thai.
Presented at the 9th Healthcare CIO Certificate Program, School of Hospital Management, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on March 4, 2019
The Last Mile of UHC in Thailand: Do We Reach the Vulnerable?Borwornsom Leerapan
PMAC 2017 Side meeting. The panel discussion on "The Last Mile of UHC in Thailand: Do We Reach the Vulnerable?" at Centara Grand & Bangkok Convention Centre, 2017.1.30
The presentation by Professor David Peters was given at the First Complex Adaptive Systems Training Workshop for CNHDRC, which was held in Beijing, China, from 18-19 July. It explains the basic elements of health systems and how they relate to a complex adaptive systems approach.
This is a presentation on the Health care and hospital management.The topic cover on this presentation is Introduction of health, Health Care provider, Components of healthcare delivery system, Levels of health care, Rural Health care system in India, Hospital management system, Type, Introduction of automation management, Problem definition, Advantages of computerized hospital management system, Requirement specification, User interface, Screen shorts of software etc.
An introductory lecture for 3rd year medical students, (RACM302: Community Medicine), Faculty of Medicine Ramathibodi Hospital, Mahidol Univeristy, 2017.11.29
An introductory lecture for 3rd year medical students, (RACM302: Community Medicine), Faculty of Medicine Ramathibodi Hospital, Mahidol Univeristy, 2017.11.28
Complimentary Roles of Quantitative & Qualitative Research Methods 2015.2.25Borwornsom Leerapan
Discussion of how we learn and create new knowledge. The difference between the implementation gap and the knowledge gap. Philosophy of science that leads to different approaches of quantitative and qualitative research methods. Skill for qualitative study, including deep listening.
Complimentary Roles of Quantitative & Qualitative Research Methods 2015.2.25
Small group discussions on teamwork & leadership for the 3rd-year medical students, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 2015.2.24
The Future of Thai Health Systems: Healthcare Quality Management and Control ...Borwornsom Leerapan
Panel discussion on the future of Thai health systems: healthcare quality management and control according to the Statute on the National Health System B.E. 2552
สถานการณ์ระบบบริการสุขภาพและการควบคุมคุณภาพตามธรรมนูญว่าด้วยระบบสุขภาพแห่งชาติ พ.ศ. 2552", การอภิปราย “อนาคตระบบสุขภาพไทย สุขภาพคนไทยดีขึ้นหรือแย่ลง”, ประชุมวิชาการ การวิจัยระบบสาธารณสุข ครั้งที่ 3
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
Explore our infographic on 'Essential Metrics for Palliative Care Management' which highlights key performance indicators crucial for enhancing the quality and efficiency of palliative care services.
This visual guide breaks down important metrics across four categories: Patient-Centered Metrics, Care Efficiency Metrics, Quality of Life Metrics, and Staff Metrics. Each section is designed to help healthcare professionals monitor and improve care delivery for patients facing serious illnesses. Understand how to implement these metrics in your palliative care practices for better outcomes and higher satisfaction levels.
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
ICH Guidelines for Pharmacovigilance.pdfNEHA GUPTA
The "ICH Guidelines for Pharmacovigilance" PDF provides a comprehensive overview of the International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use (ICH) guidelines related to pharmacovigilance. These guidelines aim to ensure that drugs are safe and effective for patients by monitoring and assessing adverse effects, ensuring proper reporting systems, and improving risk management practices. The document is essential for professionals in the pharmaceutical industry, regulatory authorities, and healthcare providers, offering detailed procedures and standards for pharmacovigilance activities to enhance drug safety and protect public health.
Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondHealth Catalyst
Join us as we delve into the crucial realm of quality reporting for MSSP (Medicare Shared Savings Program) Accountable Care Organizations (ACOs).
In this session, we will explore how a robust quality management solution can empower your organization to meet regulatory requirements and improve processes for MIPS reporting and internal quality programs. Learn how our MeasureAble application enables compliance and fosters continuous improvement.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
Health Education on prevention of hypertensionRadhika kulvi
Hypertension is a chronic condition of concern due to its role in the causation of coronary heart diseases. Hypertension is a worldwide epidemic and important risk factor for coronary artery disease, stroke and renal diseases. Blood pressure is the force exerted by the blood against the walls of the blood vessels and is sufficient to maintain tissue perfusion during activity and rest. Hypertension is sustained elevation of BP. In adults, HTN exists when systolic blood pressure is equal to or greater than 140mmHg or diastolic BP is equal to or greater than 90mmHg. The
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
Integrated healthcare systems for family physicians
1. Integrated Healthcare Systems for Family Physicians
ผศ.นพ.บวรศม ลีระพันธ์
FM Academic Activities For Medical Residents
28 October 2016
Pix source: Rattanaphibunkun C., Chantaragomol C, Wongsin A., PMAC 2016 Art Contest
2. Seminar Outline
Pix source: online.wsj.com
Q1: What do we
know about
“PHC”
in Thailand?
Q2: What do we
know about
“Healthcare
Systems”
in Thailand?
Q3: What policies
are needed for the
future of PHC and
“Integrated
Healthcare
Management”?
3. Q1: What do we know about
PHC in Thailand?
(“Myths and Facts About PHC in Thailand”)
Pix source: online.wsj.com
4. What Do You Mean by “Primary Care”?
1. Basic medical services
2. Self-care, and health for all
3. First-contact, continuous, coordinated, and
comprehensive care
4. Health promotion practices, and actions on social
determinants of health
(=What a layman usually thinks of primary care)
(The Declaration of Alma-Ata 1978)
(Starfield 1992, 1998)
(Ottawa Charter 1986, The 66th World Health Assembly 2013)
7. Source: Stange KC. Barbara Starfield: Passage of the Pathfinder of Primary Care. The Annals of Family
Medicine. 2011 July 1, 2011;9(4):292-6; Pix source: practiceimprovement.com.au;
8. Action on Social
Determinants of Health
(การสร้างเสริมสุขภาพ)
Community-based
Primary Healthcare
(การสาธารณสุขมูลฐาน)
Primary Care Medicine,
Family Medicine
(เวชศาสตร์ปฐมภูมิ, เวชศาสตร์ครอบครัว)
Basic Medical Care
(บริการการแพทย์ระดับพืDนฐาน)
• Health promotion practice at
the population health level
• “Health in All Policies”
• Self-care
• Community health worker
• Community health volunteer
• “Health for All”
• First-contact care
• Continuous care
• Coordinated care
• Comprehensive Care
•Health center (สอ./รพ.สต.)
•OPD, physician office
•Mobile medical units
What Do You Mean by “Primary Care”?
9. Community-based
Primary Healthcare
Clinical Practices
at Primary Care
Level
“The Doughnut Hole” of Primary Care
• Primary care services in developed
countries
• Medical facilities in urban settings
• Medical facilities in private-sector
(without public health functions)
• Primary care services in
developing countries
• Medical facilities in rural settings
• Medical facilities in public-sector
(with public health functions)
Ø What exactly policies & systems are we talking about?
12. “Primary” & “General”
Primary General
Primary School
Primary Data
Primary Election
Primary Tumor
Primary Stage [of projects, etc]
Director-General
Attorney-General
Surgeon-General
General Hospital
General [Prayuth Chan-ocha]
Ø How do you feel about the “Primaries” and “Generals” listed above”?
Ø How’s about “Primary Healthcare” and “General Practitioner”?
13. Structure of Urban Health Services
(City of Chanthaburi)
Pix source: สํานักงานวิจัยและพัฒนาระบบสุขภาพชุมชน (2555)
14. Structure of Urban Health Services
(City of Chanthaburi)
Pix source: Office of Community Based Health Care Research and Development (2012)
16. Q2: What do we know about
Healthcare Systems in Thailand?
Pix source: online.wsj.com
17. Source: W. Simpson del.; E. Walker lith.; Day & Son, Lithrs. to the Queen.
Pix source: http://en.wikipedia.org/wiki/History_of_hospitals#mediaviewer/File:Hospital_at_Scutari_2a.jpg
“Hospital at Scutari” - A ward of the hospital at Scutari where
Florence Nightingale worked and helped to restructure the modern hospital
26. Primary Care vs. Long-term Care
Source: Tishihiko Hasegawa (2013)
“Care Cycle”
27. Managing Long-Term Care
Source: Adapted from Feldman, Nadash & Gursen (2008)
1) Chronic Care
2) Palliative Care
3) Rehabilitative Services
• Activities of Daily Living (ADL)
• Instrumental Activities of Daily Living (IADL)
4) Supportive services
• Care plans, appointment arrangement
• Coordination between providers & patients-caregivers
• Logistics and supply of necessities
5) Care Management
28. Hospital Care vs. Primary Care:
Control Knobs Framework for Health Reform
Source: Adapted from Roberts et al. (2003).
29. Financing of Thai Healthcare System
CSMBS SSS UCS Motor Vehicle
Victim
Protection
Law
Private Health
Insurance
Feature State/Employer
welfare
Compulsory
heath insurance
with state
subsidies
State welfare Compulsory
heath insurance
for vehicle
owners
Voluntary health
insurance
Targeted groups
of beneficiaries
Civil servants,
state enterprise
employees and
dependents
Employees in
private sector and
temporary
employees in
public sector
Thai citizens
without the
coverage of
CSMBS & SSS
Victims of
vehicle accidents
General public
Source of
financing
Govt. budget Tri-party
(Employee,
employer and
govt. budget)
Govt. budget Vehicle owners Household
Method of
payment to
health facilities
Fee-for-service Capitation and
Fee-for-service
Capitation and
Fee-for-service
Fee-for-service Fee-for-service
Major problems Rapidly and
constantly rising
costs
Covering while
being employed
only
Inadequate
budget
Redundant
eligibility and
slow
disbursement
Redundant
eligibility and
slow
disbursement
Source: Adapted from Wibulpolprasert et al. (2011). Thailand Health Profile 2008-2010.
30. Major Mechanisms of
Healthcare Financing
Healthcare
Regulator(s)
2) Taxes
Payers
4)
Employer-
based private
health
insurance
3) Individual
private
health
insurance
Hospitals
Medical
Specialists
Generalists
& PCPs
1) Out-
of-pocket
Payments
Ambulatory
Facilities
Payment Mechanisms:
Salary, Fee-for-Service,
Global Budget,
Capitation, etc.
31. CGD
(CSMBS),
NHSO
(UCS)
Taxes Payers
Employer-based
private health
insurance
Individual &
Employer’s
private health
insurance
(Voluntary)
Hospitals
Medical
Specialists
Generalists
& PCPs
Patients paying out-of-pocket
Ambulatory
Facilities
Payment Mechanisms:
Salary, Fee-for-Service,
Global Budget,
Capitation, DRGs, etc.
Thai Healthcare Systems
Providers in
Public & Private Sector
Commercial
Insurance
Companies
Social
Security
Office (SSS)
Motor vehicle’s owners
(Mandatory by the Motor
Vehicle Victim Protection Law)
42. Q3: What policies are needed
for the future of PHC and
“Integrated Healthcare Management”?
Pix source: online.wsj.com
43. Major Issues in Thai Healthcare Systems
Frenk J, Chen L, Bhutta ZA, Cohen J, Crisp N, Evans T, et al.
Health professionals for a new century: transforming
education to strengthen health systems in an interdependent
world. The Lancet. 2010;376(9756):1923-58.
47. Poor vs. Middle-class
Source: สำมะโนประชากรและเคหะ สำนักงานสถิติแห่งชาติ, accessed from http://service.nso.go.th/nso/nsopublish/service/servstat.html
51. Source: Macagba, R. L. (1985). Hospitals and Primary Health Care: An International Study from the International
Hospital Federation. In M. Hardie (Ed.), World-wide survey on the Role of Hospitals in Primary Health Care. London:
International Hospital Federation.
52. Features of Primary Care Providers
Focus Public Health Medicine &Public Health
Setting Rural Urban
Professional
Perception
Generalist Specialist
Public
Perception
Second-tier Doctors
(“basic”)
Top-tier Doctors
(“personal & exclusive”)
System
Design
Moving
Assembly Lines
Customized
Services Systems
53. Delivery of PHC Services
Pix source: www.free-ed.net/free-ed/HealthCare/Physiology/default.asp
Structure & Organizations
of primary care services
• Patient Care Teams
• PCUs/Clinics
• Systems/Networks
• Governance policies
Four Cardinal Functions
of primary care services
• First Contact/Access
• Continuity
• Coordination
• Comprehensiveness
“Anatomy of Primary Care” “Physiology of Primary Care”
54. First
Contact/Access
Continuity Coordination Comprehensivenes
s
• Cost sharing
• Distance to PC
practice
• Distribution of
PC physicians
• List size
• Home visits in
PC
• Electronic access
• Computerization
of the practice
• Patient habits
with first contact
visits/referrals
• Endurance of
patient–provider
relationship
• PC practice
management
• Collaboration
among
practitioners
• Referral system
• Shared care
arrangements
• Premises,
equipment
• Medical
procedures
• Preventive,
rehabilitative,
educational
activities
• Disease
management
• Community links
• Technical skills
Desirable PHC Functions
Source: WHO/Europe (2010)
Ø Selected proxy measures from WHO/Europe’s Primary Care Evaluation Tool (PCET)
56. How “integrated care” could advance
primary care delivery?
Source: Vasan et al. BMC Medicine 2014, 12:6
57. Dealing with Complexity in Healthcare
Systems (UnitedHealth Group, USA)
Pix source: Lewis G. Sandy (2010). AcademyHealth 2010 Annual Research Meeting June 29, 2010
59. Traditional Work Flow in Clinics
(Cambridge Health Alliance, US)
Pix source: Southcentral Foundation & Institute of Healthcare Improvement (2010)
60. Redesign: Parallel Work Flow in Clinics
(Cambridge Health Alliance, US)
Pix source: Southcentral Foundation & Institute of Healthcare Improvement (2010)
61. Pre-visit Work in Geriatric Care
Pix source: Harvard Vanguard Medical Associates & Institute of Healthcare Improvement (2010)
62. Care Coordination: EMR
Pix source: Bates et al. (2003). A Proposal for Electronic Medical Records in U.S. Primary Care
63. Building Blocks of PHC Systems:
Research Needed
Pix source: WHO’s framework for action. (2007)
New financing?
• OOP?
• Co-payment?
• Membership fee?
New informatics?
• Mobile app?
• Personal health
data portal?
• Disadvantaged
population’s data
New organizational model?
• Team based providers?
• Linkage with hospital care?
New kinds of providers?
• MDs vs. non-MDs
• Professional Manager?
• Career path?
• Linkage with academia?
New kinds of products?
• Life-style modifications?
• Preventive medicine?
• Outlets of hospital ‘s
labs & pharmacy?
New governance?
• Focus on personal services
vs. on public health services
• Market vs. Central-planning
64. • Clinical outcomes of population-health-integrated PCUs vs.
individual-health-oriented PCUs
• Satisfaction of patients receiving care from PCUs located in urban
community vs. from PCUs attached to hospitals
• Satisfaction of primary care providers working in differently
organized PCUs
• Comparison of comprehensiveness of care delivered in differently
organized PCUs
• Financial risks of differently organized PCUs
• Appropriateness of office hours of urban PCUs
• Effectiveness of P&P programs in urban communities
Considerations for Further Study
Source: Leerapan (2012). Primary Care Services in Urban Settings: Lessons from International Experiences.