Primary Health Care Center Model

1
Primary Health Care Center Model
Friends may meet but mountains never

• Donetsk City Hospital 25

2
Goal of the Center
Take care of the pence and the pounds will take
care of themselves

• IN ORDER TO EFFICIENTLY USE HEALTH CARE
  RESOURCES ITS NECESSARY TO CREATE A MODEL
  COMMUNITY-BASED PRIMARY HEALTH CARE CENTER ON THE
  BASIS OF CITY HOSPITAL 25 AND DELIVER MEDICAL
  SERVICES TO ALL FAMILY MEMEBERS WITH AN ACCENT ON
  HEALTH PROMOTION OF MINERS, WOMEN AND CHILDREN.

3
Key Achievements in 2000
Little is better than non

• On the basis of Decree 989 of Cabinet of
  Ministers Ukraine integrated actions were
  developed to take place on Oblast and city levels
  aimed at Family Medicine integration into Health
  Care.
• With Executive authorities offices there were
  Oblast and City Coordination Committees
  established on integration of Family Medicine.
• With the purpose to study medical and social
  aspects of family there was a questionnaire
  distributed in the community, its results
  reviewed and priorities established.
• Out of nurses who were retrained some started to
  work as practicing nurses on their own on an
  experimental basis and cover age groups of
  patients who do not work. 3 nurses who graduated
  from Leadership School entered higher
  educational establishments 2 - Medical
  University (Health Care Administrators), 1 -
  Management Academy.

4
As a cockroach on a hot stove

• A patient questionnaire was developed for the
  Family Ambulatory which is used by a practicing
  nurse.
• In order to provide psychological and social
  support to families a mechanism of interaction
  with social services was developed.
• Hospital staff have worked out a Provision on
  Family Medicine Center and currently developing
  job description for physicians and nurses of
  Family Ambulatory
• There was a Community Council created under the
  auspices of the Hospital which includes members
  of different community groups, public
  organizations, professional associations of
  industrial enterprises, public education system,
  sponsors in order to promote community-oriented
  family medicine and attract non-budget funds.
• Learning Resources Center was opened, special
  program to train medical staff in computer use
  was developed and training is on-going

5
PHC Center Characteristic Features
Each bird loves to hear himself sing

• Catchment area population(total-19500
  people,including 7640-miners,11860-their family
  members)
• Morbidity Profile occupational diseases
  of miners and general morbidity of miners and
  their family members
• Specificity black lung, dust
  bronchitis, peripheral nervous system diseases,
  hearing disorders, acute carbon monoxide
  poisoning
• Opening date 27 February 2001

6
Organizational Structure
As the tree, so the fruit
Primary Health Care Center city of Donetsk
Center Women and Children Wellness
Center Family Medicine
Center Miners Health
Center Women and Children Wellness Kramatorsk
7
Center Women and Children Wellness 1) Center
Director -1 2)Senior midwife-1 3)OB-GYN-1 4)Ultras
onography doctor-1 5)Gynecol.-mammologist
-1 6)Family plan. physician-1 7)Internist-1 8)Pedi
atrician-1 9)Psychologist-1 10)Exam. office
midwife-1 11)District midwife-3 12)Family plan.
midwife-1 13)Pediatric nurse.-1 14)Receptionist-1
15)Junior nurse-2 TOTAL18
Center Miners Health 1)
Center Director -1 2) Senior nurse-administrat
-1 3)ENT doctor-1 4)Oncology surgeon-1 5)Neurologi
st-1 6)Ophthalmologist-1 7)Dermatologist-1 8)Funct
. Diagnostics speclst-1 9)Lab doctor-1 10)Radiolog
ist-1 11) Feldsher-labtech -3 12)Nurse -10 13)
Health promotion nurse -1 14)Receptionist-2 15)Jun
ior nurse-4 TOTAL30
Center Family Medicine 1)Center
Director-1 2)Senior nurse-administrat.-1 3)Family
physician-6 4)Family nurse-12 5)Lab
doctor-1 6)Feldsher-labtech-3 7)Social
worker-1 8)Procedure room nurse.-1 9)Health
promotion nurse 10)Receptionist-2 11)Junior
nurse-3 TOTAL33
8
Priorities- Shift to family medicine through
mechanisms of hospital shop and district
services - Training of physicians and nurses,
team building - Increasing role of a nurse in
treatment, diagnostics and prevention of diseases
by expanding her authority and increasing
responsibility - Delivery of accessible,
quality, timely consultation and diagnistics
services to miners and their family members at
center Miners Health -Carrying out a mutual
project together with University of Illinois on
program Black Lung (pneumoconiosis) -
Partnership expansion- Accent not to treatment
but prevention of diseases by increasing
community medical awareness and family
responsibility for their own health -
Implementation of principles, forms and methods
of professional activity of physicians and nurses
taking into account social-demographic,
medical-and-biological, psychological and hygiene
characteristic features of each family
In every beginning think of the end
9
Difficulties during PHC Center Creation
He deserves not the sweet that will not taste of
the sour

• Attracting funds for reconstruction of an
  out-patient facility building
• Family physicians and nurses lack work motivation
• Inadequate practical training of physicians and
  nurses in the course of their retraining at
  Medical University and College
• Nurses are not ready for expansion of their
  authority and increasing role and responsibility
• Little medical awareness of community and little
  responsibility of a family for family members
  health

10
Regular Assessment of Centers Priorities of Work
Bind the sack before it is full

• Prospective needs of the catchemnt area
  population (assessment before Center opening)
• In order to collect initial medical
  data about community health there was an
  anonymous questionnaire distributed among miners
  and their family members, and the following needs
  were established as a result of this effort
• - Desire of the community to improve
  their health
• - To have accessible, skilled medical
  care with capacity to provide up-to-date
  diagnostics in a comfortable setting
• - Medical providers need to have better
  attitude towards their patients
• - To increase level of medical awareness
  of the community

11
Indicators of Good Performance
Proof of the pudding is the eating

• Increased level of medical personnel clinical
  practice knowledge in the area of PHC, health of
  miners and women through development treatment
  protocols and guidelines
• Increased number of medical providers who can
  deliver maximum care in the setting of Family
  Ambulatory and Consultation-and-Diagnostics
  Center Miners Health
• Increased number of PHC Center medical providers
  who routinely use computers in their work
• Assessment of current patient satisfaction with
  medical services and specialists by obtaining
  results of anonymous questionnaire from community
  once every 6 months
• Improved access of patients to medical knowledge
  through development and carrying out educational
  programs and patient involvement into these
  programs

12
Things past cannot be recalled
Levels of Health Care Delivery to Community at
City Hospital 25.Out-patient facility ?1 at
city hospital ?25
Family Ambulatory
1 Level 2 Level
2 Level

3 Level
In-Patient Wards at ?25
Hospital Administration
Center Miners Health
Center Women and Children Health
Neurology
Oncology
Cardiology
Internal Diseases
13
Every cock sings in his own manner
Scheme of Financing Levels of Medical Care
at City Hospital 25 of Donetsk
1 LEVEL Family Ambulatory Family physician
holds and distributes funds
Budget allocations per capita
Non-Budget Funds
Funds attracted through insurance companies
Payment from family physician fund for each
patient on a completed visit basis
2 LEVEL Consultation-and- diagnostic centers
Consultations by subspecialists without refferal
by family physician through purchasing insurance
polices
Diagnostic examinations are provided through
purchasing insurance policies
Payment from family physician fund per diesease
groups requiring involvement of a clinic
3 LEVEL Specialized in-patient care
Funds attracted by insurance companies
Click for larger picture
14
Social Sustainability- Primary health care has
to be transformed with active participation of
community and regional public organizations with
support of Community Council authority
.Management (organizational sustainability)-
With limited resources its important to
distribute them correctly as well as correctly
distribute assignments between personnel.
Increased competency, expanded responsibilities
and leadership of nurses shall bring down the
cost of in-hospital medical services. .Technical
Sustainability- Equipment provided by Partners
shall improve accessibility, quality of medical
services and shall raise the hospital rating
It is easy to swim if another holds up your head
15
Cooperation with Others
There is safety in numbers

• Oblast, City and District Power Authorities
  (executive authorities)
• Project Donetsk-Pittsburg-Twin Cities
• Administration and Trade Unions of Coal Mines
  named after E.T. Abakumov, A.A. Skochinskiy and
  Lidiyevka
• American Miners Union
• Scientific-Research Institute of Ecology and
  Problems of Donbass Coal Industry (Donetsk)
• Academy of Medical Sciences Ukraine, Institute of
  Occupational Medicine (Kiev)
• University of Illinois (Chicago)

16
Cooperation with Others
There is safety in numbers

• Medical University and Medical College (Donetsk)
• Business and Professional Women League, Center
  Women for Women (Donetsk)
• Women Council of Kirovskiy district (Donetsk)
• Trust Donbasstransstroy
• Donetsk Regional Educational Center under the
  auspices of Communities Partnership Program
• International Volunteers Center (Pittsburg)
• Company Carelift International
• Centerville Clinics (Western Virginia)