This document outlines Saskatchewan's Action Plan for Primary Health Care, which aims to strengthen primary health care services in the province. It describes the vision for an integrated primary health care system delivered through networks of health care providers. The plan establishes defined roles for Regional Health Authorities and the government in managing, operating and funding primary health care. It also outlines characteristics of the new system and a phased implementation approach over 10 years to establish primary health care teams accessible to all residents.
Financial Management In Healthcare PowerPoint Presentation SlidesSlideTeam
Presenting this set of slides with name - Financial Management In Healthcare Powerpoint Presentation Slides. This PPT deck displays fourty slides with in depth research. Our topic oriented Financial Management In Healthcare Powerpoint Presentation Slides presentation deck is a helpful tool to plan, prepare, document and analyse the topic with a clear approach. We provide a ready to use deck with all sorts of relevant topics subtopics templates, charts and graphs, overviews, analysis templates. Outline all the important aspects without any hassle. It showcases of all kind of editable templates infographs for an inclusive and comprehensive Financial Management In Healthcare Powerpoint Presentation Slides presentation. Professionals, managers, individual and team involved in any company organization from any field can use them as per requirement.
Patient Record System (Electronic Medical Records).pptxmamtabisht10
Electronic Medical Records also known as Patient record system is the digital version of the clinical information regarding a patient.
It involves collecting, storing, manipulating and using the available clinical information in delivering care to the patient.
Financial Management In Healthcare PowerPoint Presentation SlidesSlideTeam
Presenting this set of slides with name - Financial Management In Healthcare Powerpoint Presentation Slides. This PPT deck displays fourty slides with in depth research. Our topic oriented Financial Management In Healthcare Powerpoint Presentation Slides presentation deck is a helpful tool to plan, prepare, document and analyse the topic with a clear approach. We provide a ready to use deck with all sorts of relevant topics subtopics templates, charts and graphs, overviews, analysis templates. Outline all the important aspects without any hassle. It showcases of all kind of editable templates infographs for an inclusive and comprehensive Financial Management In Healthcare Powerpoint Presentation Slides presentation. Professionals, managers, individual and team involved in any company organization from any field can use them as per requirement.
Patient Record System (Electronic Medical Records).pptxmamtabisht10
Electronic Medical Records also known as Patient record system is the digital version of the clinical information regarding a patient.
It involves collecting, storing, manipulating and using the available clinical information in delivering care to the patient.
HL7
Health level 7
What is HL7?
What does it stand for
HL7 Mission
HL7 contains message standards
HL7 in HealthcareManagement System
Standards
Limitations of HL7
A health system, also sometimes referred to as health care system, is the organization of people, institutions, and resources that deliver health care services to meet the health needs of target populations.
Health systems are responsible for delivering services that improve, maintain or restore the health of individuals and their communities.
Common elements in virtually all health systems are primary healthcare and public health measures.
PUBLIC HEALTH POLICY & LEGISLATIONS Health is the right of all persons and the duty of the State and is guaranteed by means of social and economic policies aimed at reducing the risk of illness and other hazards and at universal and equal access to all actions and services for the promotion, protection and recovery of health.
Paper presented at 'Nepal Development Conference: Views and Visions of Nepali Ph.D. Scholars Residing in the UK for the Development of Nepal' organised by Embassy of Nepal, London, 7 November 2020
The Canadian healthcare system: May 20, 2011CFHI-FCASS
This presentation was given on May 20, 2011, as an overview of healthcare in Canada to a group of American Congressional Fellows on Parliament Hill. The Fellows were in Canada on an official visit, sponsored by the Department of Foreign Affairs and International Trade Canada (DFAIT), as part of an exchange with the Parliamentary Internship Programme. The group included 20 mid- to senior career professionals from various departments in the American and some foreign Governments, professors from American universities and journalists. They also include a number of Robert Wood Johnson Foundation Fellows, who are all medical professionals.
HL7
Health level 7
What is HL7?
What does it stand for
HL7 Mission
HL7 contains message standards
HL7 in HealthcareManagement System
Standards
Limitations of HL7
A health system, also sometimes referred to as health care system, is the organization of people, institutions, and resources that deliver health care services to meet the health needs of target populations.
Health systems are responsible for delivering services that improve, maintain or restore the health of individuals and their communities.
Common elements in virtually all health systems are primary healthcare and public health measures.
PUBLIC HEALTH POLICY & LEGISLATIONS Health is the right of all persons and the duty of the State and is guaranteed by means of social and economic policies aimed at reducing the risk of illness and other hazards and at universal and equal access to all actions and services for the promotion, protection and recovery of health.
Paper presented at 'Nepal Development Conference: Views and Visions of Nepali Ph.D. Scholars Residing in the UK for the Development of Nepal' organised by Embassy of Nepal, London, 7 November 2020
The Canadian healthcare system: May 20, 2011CFHI-FCASS
This presentation was given on May 20, 2011, as an overview of healthcare in Canada to a group of American Congressional Fellows on Parliament Hill. The Fellows were in Canada on an official visit, sponsored by the Department of Foreign Affairs and International Trade Canada (DFAIT), as part of an exchange with the Parliamentary Internship Programme. The group included 20 mid- to senior career professionals from various departments in the American and some foreign Governments, professors from American universities and journalists. They also include a number of Robert Wood Johnson Foundation Fellows, who are all medical professionals.
Primary Health Care, Objectives, Principles and Policy DirectionsHealth and Labour
Presentation by Dr.Hans Kluge e.a., director of Health Systems, WHO-Euro at the WHO/TNO/Dutchgovernment Congres 'Connecting Health and Labour' 29 - 1 December 2012
Launched as recommended by the national health policy 2017
To achieve the vision of universal health coverage (UHC).
This initiative has been designed to meet Sustainable Development Goals (SDGs) and its underlining commitment, which is to "leave no one behind.“
Wessex Health Partners Wessex Integrated Care, Population Health, Research & ...Wessex Health Partners
The Wessex Health Partners (WHP) strategic alliance has brought together partners from across Dorset, Hampshire and the Isle of Wight to explore how research and innovation (R&I) can improve population health.
The event, which was a first of its kind for Wessex, saw health and care and R&I leaders gather to discuss the key challenges and priorities for the region, and explore opportunities to address them through increased collaboration and partnership working.
More than 100 people attended the event, which took place at Southampton Science Park on Friday 15 March.
A new group of healthcare professionals who are not doctors are called community health officers CHOs . As a part of Comprehensive Primary Health Care, CHOs will be vital in providing an increased range of essential services. They are expected to direct the primary care staff at the Sub Centre, Health and Wellness Center, offer ambulatory care and clinical management to the neighborhood, and act as a crucial coordination link to guarantee the continuum of car. Mr. Saneesh CM | Dr. S. Victor Devasirvadam "Community Health Officer (CHO): An Overview" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-7 | Issue-1 , February 2023, URL: https://www.ijtsrd.com/papers/ijtsrd53840.pdf Paper URL: https://www.ijtsrd.com/medicine/nursing/53840/community-health-officer-cho-an-overview/mr-saneesh-cm
This presentation deals with advent of NRHM, backdrop of public health scenario prior to NRHM & discusses in details vision & core strategy of NRHM. It focuses on different schemes related to maternal & child health under NRHM with special reference to Maharashtra.
CHAPTER 84How Community-Based Organizations Are Addressing Nursi.docxtiffanyd4
CHAPTER 84
How Community-Based Organizations Are Addressing Nursing's Role in Transforming Health Care
Mary Ann Christopher, Ann Campbell
“The day may soon dawn when we Americans can enjoy a measure of life and health that is consistent with our extraordinary resources and the intelligence of our people. The pioneers have begun their work; it is far from finished. New fields, new enterprises, are visible. The times call for the high spirit of the courageous pioneers among physicians, scientists, and nurses.”
Lillian Wald
This is a time of rapid transformation in health care, one in which community health nursing has a critical role in advancing individual and public health. As the United States integrates the mandates of the Affordable Care Act (ACA), community health organizations have a pivotal role in affecting the health status of the nation, particularly for vulnerable populations. The Institute for Healthcare Improvement, through the construct of the Triple Aim, calls on all members of the health care team to improve the health of the population, improve the consumer experience and reduce the cost of care. The Institute of Medicine's (IOM) report on The Future of Nursing has charged nurses to become equal partners in the development of health policy and practice (IOM, 2011). The IOM report Public Health and Primary Care has challenged practitioners to coordinate efforts for the betterment of patients (IOM, 2012a).
Community-based organizations are strategically positioned to provide the leadership as well as the integration and coordination of services necessary to carry out these aims. Further, the community-based sector of the nursing profession is poised to influence the transformation of health care delivery by drawing on principles that are core to the discipline. By partnering with communities, creating innovative approaches to care as the system evolves, and engaging the communities they serve, community health nurses can deliver on the promise of quality health care for all. This chapter discusses the approaches of the Visiting Nurse Service of New York (VNSNY) to mobilize the strengths of the community to improve public health, establish cross-continuum interprofessional teams to affect the continuum of the patient care journey, and promote public policy to advance funding methodologies that more adequately consider risk factors of vulnerable populations.
Community as Partner and the Community Anchor
Community Anchor is a concept that is being developed by the VNSNY as a way to build healthier communities. The Community Anchor is a term that suggests if nursing is going to exercise its responsibility for the individual as well as public health, the profession must recommit to its traditional focus on grassroots needs assessment and service provision, so brilliantly illustrated by the work of Lillian Wald, founder of the Henry Street Settlement House, the VNSNY, public health nursing, 665occupational health nursing, the first pl.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Ocular injury ppt Upendra pal optometrist upums saifai etawah
The Sk Action Plan For Primary Health Care
1. Primary Health Services Branch
Saskatchewan Health
3475 Albert Street
Regina SK S4S 6X6
The Saskatchewan Action Plan
For
Primary Health Care
June 2002
2. PRIMARY HEALTH CARE
INTRODUCTION
The principal goal of the health system is to maintain and improve the health of the people
it serves. In Saskatchewan we have been striving for a system that is effective,
responsive and sustainable in the longer term. In order to achieve these broad goals we
must change how we think about primary health care services, how those services are
provided and by whom, and how they relate to the more specialized acute care system.
A system of primary health care should provide more than an entryway for the sick and
injured into the health system – it should play a substantial role in prevention of illness and
injury. In this respect, the primary health care system in Saskatchewan needs to be
strengthened and improved to provide better, more efficient and timely primary health care
to the people of Saskatchewan.
Primary health care is not new. Primary health care services exist presently throughout
the Province. They exist in 21 primary health care sites, 75 health centres, in district-run
programs and professional fee-for-service practice. What is needed is to better
co-ordinate and integrate services to improve the quality and accessibility for the people of
the Province.
This document describes the Saskatchewan Action Plan for Primary Health Care for a
reorganized primary health care system. It outlines the core primary health care services
that Saskatchewan residents can expect to receive and the role of Regional Health
Authorities and the Government. The plan builds on Saskatchewan Health’s Primary
Health Services’ Initiative, which was initiated in 1997, and the progressive work of many
of the previous health districts.
WHAT IS PRIMARY HEALTH CARE?
The Advisory Committee on Health Services (1996) Federal/Provincial/Territorial Ministers
defined primary health care as: “The foundation of our health system”.
Primary care refers to a focus on care provided to individuals to address a particular
problem or basic everyday day health need. It is the care provided at the first level of
contact with the health system – where people first enter the health system and where all
health services are mobilized and co-ordinated. It includes education and activities to
maintain health, as well as care for common illness, minor injury, and management of
ongoing problems.
The Saskatchewan Action Plan for Primary Health Care is about a primary health care
system that expands on primary care by focusing the delivery of services to include a
holistic approach, a continuum of services, inclusion of a range of health providers,
involvement of the public, and a recognition that health is influenced by many factors.
__________________________________________________________________________________________________
Primary Health Services Branch Page 1 of 16
Saskatchewan Health – 3475 Albert Street – Regina SK S4S 6X6
3. Primary health care:
! encompass preventive, promotive, curative, supportive and rehabilitative services;
! are provided by a range of professionals;
! serve to enhance people's physical, mental, emotional and spiritual well-being;
! work to address the factors which influence health (determinants of health); and
! is designed and delivered in conjunction with the public and community service providers.
Many programs and services are part of primary health care as it is the umbrella for all
basic frontline health services. Programs include home care, public health, mental health,
addictions and substance abuse, primary medical care, long term care, emergency
services, end of life care, laboratory and x-ray services and therapy services.
Many health care professionals provide basic services such as the public health nurse
who visits schools and new moms, the family doctor who sees patients in his or her office,
the nutritionist who provides education on diets for people with diabetes, the home care
worker who provides personal care, such as bathing, in peoples homes. All of these
professionals work very hard to meet people’s basic health needs.
Primary health care involves providing services to individuals, families, communities and
populations and involves a proactive approach to preventing health problems before they
occur and ensuring better management and follow-up once a health problem has
occurred. Since many of the factors that effect health occur outside of the health system,
a system of primary health care proactively works with intersectoral partners and
community groups to address broader community needs.
The variety of providers engaged in the delivery of primary health care could include:
! family physicians; ! chiropractors;
! medical health officers; ! home care nurses and workers;
! primary care nurses; ! mental health nurses and workers;
! public health nurses; ! addictions workers;
! nutritionists/dieticians; ! psychologists;
! physiotherapists; ! optometrists;
! social workers; ! pharmacists;
! dentists; ! paramedics/emergency medical technicians;
! chiropodists; ! exercise and fitness specialists.
THE SASKATCHEWAN ACTION PLAN FOR PRIMARY HEALTH CARE
The Saskatchewan Action Plan for Primary Health Care is an integrated system of health
services available on a 24 hour 7 day a week basis through Regional Health Authority
managed networks and teams of health care providers. Implementation of the plan will be
a gradual process. The goal will be to have networks and teams established in all regions
with accessibility to 100% of the population by the end of 10 years.
__________________________________________________________________________________________________
Primary Health Services Branch Page 2 of 16
Saskatchewan Health – 3475 Albert Street – Regina SK S4S 6X6
4. The Saskatchewan Action Plan for Primary Health Care is based on a set of defined
characteristics, defined roles for the Government and Regional Health Authorities (RHAs),
integrated structures and clear entry points. The overarching principles are those of
quality and access.
Defined Characteristics
The plan for primary health care is based on the following characteristics:
! Serving a defined population – Each Regional Health Authority will be responsible
to provide a core set of primary health care services to a defined population. Within
the Region, the Health Authority may wish to create sub-populations based on
geography, social conditions or chronic diseases in order to effectively deliver the
services.
! Client choice – Clients will be able to choose their health care provider and
intervention strategies within reasonable parameters.
! Integration and co-ordination of services – A comprehensive range of co-ordinated
health promotion, prevention, primary curative care, rehabilitative and supportive
services will be provided by integrated, interdisciplinary, multi-service networks of
providers with care co-ordination for each high-risk client or family. This will involve
further development of group medical practices and a continuous client record.
! Community participation – The development of partnerships between consumers
and providers will facilitate community participation in the planning, delivery and
evaluation of the primary health care delivery system.
! Community development – This approach involves consumers and providers
working together to enhance the community’s overall capacity to address issues and
needs affecting the health of the community.
! Defined access and service standards – Access and service standards will be
developed along with accountability mechanisms (outcomes, performance indicators).
! Effective partnerships with other community organizations – This ensures that
health services are continuous with and complementary to other community services
and have capacity to address the social and physical environmental determinants of
health.
! A human resources continuum which:
− uses the most effective and economically efficient health service providers;
− ensures training/education of health service providers consistent with the
principles of primary health care;
− incorporates the appropriate use of and support for self-care, and informal and
formal service providers.
! Non fee-for-service remuneration for physicians.
__________________________________________________________________________________________________
Primary Health Services Branch Page 3 of 16
Saskatchewan Health – 3475 Albert Street – Regina SK S4S 6X6
5. Defined Roles
1. The Government will define the core services to be provided in the primary health care
system, set standards and establish performance indicators.
2. The RHAs will manage, operate and fund the primary health care system.
3. Each RHA will have the capacity to provide the full range of core primary health care
services.
Core Primary Health Care Services Delivered By RHAs Will Include:
! Primary Medical Care;
! Emergency Medical Services;
! Community Mental Health;
! Addictions;
! Public Health (Population Health);
! Supportive Care (i.e. special care homes, respite care, adult day care);
! Home Care;
! End-of-Life Care (Palliative Care);
! Laboratory and x-ray Services;
! Support for informal caregivers; and
! Therapy Services (i.e. physio, occupational, speech and language).
(Note: A more detailed document outlining core primary health care services is
under development.)
Integrated Structures
1. Each RHA will develop a network of providers to deliver primary health care services.
The network will consist of teams to deliver the service and provide case management
to co-ordinate the service.
2. There will be a variety of team structures within each network (RHA).
! The most common team would consist of a group family physician practice,
primary care nurse practitioner, home care, public health nursing, therapies, and
mental health. Other team members might belong to more than one team (e.g.
dieticians, pharmacy, social work, speech and language pathologists, and
psychologists) where a full-time person is not required on the team. A team would
be situated at (or around) a central location and could serve a number of
communities.
! A team could consist of personnel that provide a particular program that serves the
entire RHA. Examples of teams of this nature would be a diabetic education
program or a maternal/child program. These teams would link to the other teams
and the network.
__________________________________________________________________________________________________
Primary Health Services Branch Page 4 of 16
Saskatchewan Health – 3475 Albert Street – Regina SK S4S 6X6
6. ! Teams would exist in institutions as well. Much of what happens in a hospital or
Emergency Room is considered primary health care. For example, obstetrics is
primary health care. Prenatal care and postnatal care should be one continuum,
not interrupted by the short stay in hospital at the time of delivery. The
management of many medical conditions is done by family physicians or doctors
and involves some time in hospital. The hospital and Emergency Rooms teams
must be linked with the community team. Further, most of the health care needs
that are being met in special care homes are primary health care services. Teams
that provide service in special care homes should function on primary health care
principles.
3. A network of primary health care teams and other primary health care services
provides the opportunity for better case management of complex and/or chronic
conditions.
4. The primary health care system provides services to individuals, families, groups and
communities. In the majority of cases the client seeks out the service. In some cases,
particularly health promotion and health protection activities, the service seeks out the
client. For clients seeking service, the entry points must be clear. For providers at the
entry points there must be sufficient knowledge to know where to access the services
the client requires and the responsibility to initiate case management protocols when
required. Most times the entry point is the family physician. In the Saskatchewan
Action Plan for Primary Health Care this becomes the primary health care team and
the entry point is usually with the family physician or a primary care nurse. The
primary health care plan seeks to strengthen the role of providers at other entry points
such as home care, mental health or public health. It also integrates emergency
medical services and emergency room services so that they become clear and
functional entry points.
Quality
The Saskatchewan Action Plan for Primary Health Care will improve the quality of existing
services in the following ways:
1. Improve follow-up and treatment for chronic conditions based on accepted practice
guidelines;
2. Improve case management for clients with complex needs;
3. Introduce more proactive approaches to reaching high-risk populations;
4. Ensure that care is provided by the professionals who can best meet the needs of the
client;
5. Improve screening and monitoring programs to support early detection and
intervention; and
6. Ensure health services are continuous with and complementary to other community
services.
7. Supporting and enabling self care.
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7. Access
The Saskatchewan Action Plan for Primary Health Care will improve access to primary
health care services in the following ways:
1. Establish access standards for primary health care services:
! team locations within the RHA will be based on standards such as:
− “95% of communities are within 30 minutes travel time of a primary health care
practitioner.”
! establish reasonable wait times for services such as therapies (i.e. speech and
language pathologist).
2. Provide access to basic services (physician and/or nurse) 24/7;
3. Establish a 24-hour telephone advice service;
4. Improve co-ordination of referrals to other primary health care services, diagnostic
services, and tertiary services; and
5. Improve referrals to primary health care services by hospitals and emergency rooms.
IMPLEMENTATION OF THE SASKATCHEWAN ACTION PLAN FOR PRIMARY
HEALTH CARE – THE FIRST FOUR YEARS
The pace at which the plan is implemented will be gradual and may vary from community
to community. During the first four years, RHAs will require support to build capacity to
implement the changes. Work will need to continue with all stakeholder groups, as to how
the plan is best implemented and what it means for individual team members. The initial
implementation will need to begin with the organization of front line providers into teams.
By The End Of Four Years There Will Be:
! Defined core services mandated within each RHA;
! defined access standards in place;
! defined performance measures and indicators in place;
! implementation plans in place for each RHA;
! tools and operational supports for RHAs and teams;
! development of information systems, and
! 25% of the population will have access to primary health care teams.
IMPLEMENTATION OF THE SASKATCHEWAN ACTION PLAN FOR PRIMARY
HEALTH CARE – FOUR TO TEN YEARS
An evaluation will be undertaken of the first phase of implementation to ensure the goals
and objectives of the plan are being reached.
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8. By The End Of Ten Years The Plan Will Be Fully Implemented With:
! a full set of access and outcome standards in place;
! teams and networks accessible to 100% of the population; and
! family physicians paid through an alternate payment method.
REGIONAL HEALTH AUTHORITY PLANS
Submission of Plans
RHAs will be required to submit a plan outlining how they will implement the core
elements of the Saskatchewan Action Plan for Primary Health Care. Criteria for RHA
primary health care plans are under development. Initially plans should include the
following:
! how the RHA’s plan meets the overall provincial strategic approach for primary health
care;
! general profile of how primary health care is currently organized in the RHA;
! description of how the plan will move from the current system to the future one (i.e.
outline strategic approaches that will be implemented to advance change);
! the network of providers and teams;
! evidence that planning is based on needs assessment;
! service delivery strategy for the general population as well as high-risk groups and
under-resourced areas;
! challenges to implementing the plan;
! transitional costs required to implement the plan; and
! strategies to build physician, staff and stakeholder support for the plan.
RHAs will submit an annual progress report on the status of implementation identifying
key milestones achieved and continued plans to achieve the goals and objectives of the
Saskatchewan Action Plan for Primary Health Care.
Funding
Transitional funding will be available to RHAs over four years to move to full
implementation of the plan. The following may be considered as transition costs:
! Senior management position within each RHA;
! program development activities (community development, team training,
implementation of monitoring and recall programs);
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9. ! education costs to upgrade the skills of health providers to meet a specific need of a
community (i.e. upgrade RNs to PCNs);
! cost for physicians to integrate within RHA structure (i.e. lease/buy-out); and
! renovations and one-time set-up costs to accommodate networks and teams.
RHA plans should address why the funding is needed and how it will advance regional
primary health care plans.
PHYSICIAN PARTICIPATION
The plan involves the voluntary integration of physicians into networks within RHAs to
ensure a team-based approach to the delivery of primary health care and ensure a
seamless system of care.
The plan favours paying physicians on an alternate form of payment other than a fee for
each service, which is presently how the majority of physicians in Saskatchewan are paid.
An alternate way of paying physicians best fits the plan as the physicians unique skills are
often needed for clients who have more complex health needs and require more time than
clients who are sick with the flu or are having their annual check-up. Being on an
alternate payment will insure that a physician’s income does not suffer because they
spend needed time with a client, attend a team meeting or do a presentation to a
community group.
RHAs will contract with physicians as part of the team approach to care. RHAs and the
Government will work with the Saskatchewan Medical Association on the development of
a model contract for physicians, which includes remuneration, service delivery and
performance expectations.
TELEPHONE ADVICE LINE
The telephone advice line will provide an assessment and referral service whereby
nurses, assisted by specialized software, assess the severity and urgency of a caller’s
symptoms. Based on the assessment the nurse guides the callers to an appropriate level
of care such as an emergency room, physician/clinic or provides information and
education so that the caller can take care of himself or herself.
The goals of the service are to:
! improve access to quality health information and assessment;
! reinforce self-care where appropriate;
! guide callers to the most appropriate source of care; and
! decrease the use of costly services such as emergency room visits.
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10. The Department issued a request for proposals to select a vendor to develop, implement
and manage the service on May 1, 2002. The public will have access to the service
through a toll free number beginning in 2003.
Telephone Advice Line
! Telephone advice lines have been well received by the public with reported user
satisfaction generally high at 90%.
! Studies have consistently shown that a telephone advice line has enabled more
appropriate utilization of emergency departments by distributing calls: 15%-20% to the
emergency department, 25 - 40% to the physician office, and 45 - 60% to self care.
! In a pilot study completed in New Brunswick, emergency room visits for specific
diagnosis such as sprains and strains and cold and flu were reduced 45% and 22%
respectively.
! Telephone advice lines save patients’ time and money. They help eliminate
unnecessary trips to a physician’s office or an emergency room and prevent
unnecessary ambulance trips.
! Services have also reported that callers have been directed to go to an emergency
room and as a result more serious problems have been prevented through seeking
the most appropriate care sooner.
BACKGROUND
DEVELOPMENT OF PRIMARY HEALTH SERVICE SITES
In September 1997, Saskatchewan Health launched the Primary Health Services’ Initiative
to promote the development of primary health service sites on a voluntary basis. The
sites were to demonstrate the benefits of a new integrated delivery model for basic health
services.
Saskatchewan Health presently supports 21 primary health service sites in the province
through the Primary Health Services’ Initiative. The sites serve an estimated 80,000
people. Although each is unique in size and complexity, they have in common a primary
care nurse practitioner with at minimum, visiting physician services. The sites presently
involve 44 physicians and 21 primary care nurse practitioners and many other health
professionals.
The initiative focused on the following goals:
! building interdisciplinary teams;
! further integrating district services;
! linking physician services to districts;
! incorporating primary care nurses to work in expanded nursing roles;
! targeting programs and services to high-risk populations;
! focusing on anticipatory and preventive care;
! adopting an intersectoral approach; and
! incorporating new programs and approaches to achieve the desired changes in
service delivery thereby leading to improvements in health status.
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11. BENEFITS OF A RE-ORGANIZED PRIMARY HEALTH CARE SYSTEM
Evidence from the experiences of other parts of the world show the following benefits of
an efficient and effective primary health care system:
! a multidisciplinary team approach will show improved blood sugars in diabetics;
! hypertension will be better controlled with a more consistent team of primary health
care providers available;
! there will be a decrease in deaths from cervical cancer as 90% of deaths are
preventable;
! rates of readmission to hospital will be reduced;
! an increased number of women under 20 years of age will receive adequate prenatal
care;
! mental health workers as part of a primary health services team will improve access to
appropriate mental health services as indicated by reduced waiting times, decreases
in the percentage of visits to a psychiatrist and the emergency room, more referrals by
primary care provides for mental health consults at their own site and high rates of
patient satisfaction;
! a provincial telephone advice line, utilizing trained nurses will:
− enable more appropriate use of emergency departments, primary health care
services and home care and support self-care; and
− provide callers better access to health information and advice;
! patients will be highly satisfied with the care provided by nurse practitioners; and
! recognizing that almost 22% of Saskatchewan children live in poverty, programs will
be in place for these children that will show a dramatic decrease in teenage pregnancy
and illicit drug use and increases in education and employment levels as these
children reach adolescence and adulthood.
NEXT STEPS
To assist RHAs in the development of their primary health care plans, Saskatchewan
Health has put in place a team of primary health care consultants, in addition to other
consultant services within the Department. RHAs may wish to discuss potential plans with
a consultant who can expand upon the information in this package.
The role of the primary health care team will be to support RHAs to build on the policy
framework, facilitate co-operation among partners, assist with program development and
design, and help solve problems during development.
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12. If you have questions or wish to discuss the primary health care plan, you may contact a
member of the primary health care team at Saskatchewan Health in Regina at
(306) 787-0889 or by email at phsbweb@health.gov.sk.ca:
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13. QUESTIONS & ANSWERS
Is additional funding available to support implementation of the primary health care
plan?
Initially there will be additional costs to reorganize the system. Saskatchewan will invest
an additional $18.6M over the next four years. It is anticipated that health system costs
will be contained with improved management of disease and increased health prevention
efforts to improve the health and well being of Saskatchewan people. The plan for
primary health care will contribute to a sustainable health system into the future.
Will Regional Health Authorities (RHAs) be required to submit a written proposal to
Saskatchewan Health to receive any additional funding?
RHAs will be required to submit a plan outlining how they will implement the core
elements of the provincial primary health care plan.
Transitional funding is available to RHAs over four years to move to full implementation of
the plan. The following may be considered as transition costs:
! senior management position within each RHA;
! program development activities (community development, team training,
implementation of monitoring and recall programs);
! education costs to upgrade the skills of health providers to meet a specific need of a
community (i.e. upgrade RNs to PCNs);
! cost for physicians to integrate within RHA structure (i.e. lease/buy-out); and
! renovations and one-time set-up costs to accommodate networks and teams.
RHA plans should address how the funding will advance regional primary health care
plans.
How does the Government plan to staff the new primary health care teams when the
province currently has shortages of health professionals?
The development of primary health care teams will mean a better work environment,
where providers enjoy the collegial nature of practising as part of the team. Team
members will use their time more effectively and have the satisfaction of using the full
range of their skills. Program development funding will be available to assist teams in
meeting the needs of their at-risk populations. This work environment will help to retain
health professionals in Saskatchewan.
Will all teams provide all of the core primary health care services?
Each RHA will have a network of teams. The network will have the capacity to provide
and deliver all of the core services. All residents of Saskatchewan will have access to the
core services through their local team members. For example, a community may not
require a full time speech and language therapist but the core service is provided to the
community by the network. Local team members ensure that access to this service is
available.
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14. What is the role of the primary care nurse practitioner?
Primary care nurse practitioners can:
! provide health education, teaching and illness prevention services;
! assess and counsel well clients;
! assess, diagnose and treat clients with common illness and clients with stable chronic
conditions; and
! play a significant role in co-ordination of client services, monitoring and follow-up,
developing programs and assessing individual and community health needs.
The nurse works collaboratively with a physician and other members of the team. The
nurse, while working in an expanded clinical role, is not intended to replace the physician
but rather to bring his/her own unique skills to the team.
How will physicians become members of primary health care networks and teams
and will a physician be able to participate on a primary health care team if they
don’t go on alternate payment?
The plan involves the voluntary integration of physicians into networks within RHAs to
ensure a team-based approach to the delivery of primary health care and ensure a
seamless system of care.
The plan favours paying physicians on an alternate form of payment other than a fee for
each service, which is presently how the majority of physicians in Saskatchewan are paid.
An alternate way of paying physicians best fits the plan as the physicians unique skills are
often needed for clients who have more complex health needs and require more time than
clients who are sick with the flu or are having their annual check-up.
What if doctors choose not to volunteer to work on these teams?
We are confident that physicians will see the benefits of working as part of a health care
team. Surveys have shown that more physicians than ever are interested in alternate
payment mechanisms that allow them to fully utilize their advanced skills and provide
them with an improved lifestyle. Currently there are 44 physicians working in
demonstration primary health care sites and approximately 34 in community clinics.
How will physician contracts/salaries be established? Who will be responsible for
negotiating these contracts?
The Government will work with the Saskatchewan Medical Association on the
development of a model contract for physicians, which includes remuneration, service
delivery and performance expectations. RHAs will contract with individuals or groups of
physicians based on the model contract.
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15. Will the new system for primary health care limit a citizen's ability to choose their
physician?
Each person will continue to choose their own family doctor, just as they have in the past.
What is new is a team approach to providing care. There are many patient needs that can
only be met by a physician. However for some routine illness and injuries, a nurse with
advanced training could provide the necessary care or the visit to the doctor could be
followed up with visits to a nutritionist, pharmacist or mental health counsellor.
Has there been any evaluation completed on the 21 demonstration sites?
Demonstration sites have been in operation for one to three years. The intent is to
complete a comprehensive evaluation at the end of five years. Demonstrations sites will
reach the five-year mark at various times depending on their start date. A report will be
completed with the evaluation findings in 2005.
When will Saskatchewan Residents have access to the Telephone Advice Service?
A request for proposals was issued May 1, 2002 to select an operator for the service.
The plan is to have the service available to Saskatchewan residents in 2003.
What will be the benefits of a telephone advice service?
The service will:
− improve access to quality health information and assessment;
− reinforce self-care where appropriate;
− guide callers to the most appropriate source of care; and
− decrease the use of costly services such as emergency room visits.
This service complements and enhances primary health care and will facilitate better
access to health information for residents in rural and remote areas of Saskatchewan.
How will the plan for primary health care be better for Saskatchewan residents?
The People Of Saskatchewan Will Benefit From A System That:
! improves access to comprehensive primary health care services including illness and
injury prevention and health promotion;
! improves co-ordination and integration of primary health care services with other
levels of care;
! provides 24-hours a day, 7 days a week availability of information, advice, care and
co-ordination of care through extended hours and telephone advice service;
! provides care by the professionals who can best meet their health care needs;
! provides ongoing, consistent access to a primary health care provider of choice;
! recognizes that social, cultural and economic factors are central to health;
! measures and rewards quality and continuity of care; and
! provides improved co-ordination of care through a secure, centralized health care
record for each consumer.
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16. Providers Should Benefit From:
! greater recognition for taking responsibility and providing quality of care;
! improved professional environment that supports clinical practice, ensures greater
predictability of practice, and allows for lifestyle needs;
! more efficient use of time which may lead to greater job satisfaction as professional
goals are achieved;
! collegiality when working as part of a team; and
! access to information technology to support primary health care practice.
Government Should Benefit From:
! improved management of costs;
! mechanisms to better assure access to care for the entire population;
! accountability measures linked to health outcomes; and
! greater co-ordination of all levels of health care, leading to more effective use of health
care resources (e.g. better management of the front end of the system, less
duplication and fragmentation of services and more appropriate use of services).
The element of the change which is less visible to the general public as a whole, but
which is more significant than the structural change, is the impact that working together in
a more integrated manner can have on the overall health of the population.
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17. COPYRIGHT AND PERMISSION
This paper is protected by copyright by Her Majesty the Queen in right of
Saskatchewan.
This paper may be used and reproduced by the User for information purposes and
for the Users own purposes. The User shall not otherwise reproduce the Paper or
distribute the Paper to any third party, in whole or in part, for commercial or for any
other purposes by any means without the prior written permission of
Saskatchewan Health. Requests for permission may be made to Saskatchewan
Health as follows:
Saskatchewan Health
Primary Health Services Branch
3475 Albert Street
REGINA SK S4S 6X6
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