Title: WELLNESS APPROACH IN PRIMARY HEALTH CARE
1WELLNESS APPROACH IN PRIMARY HEALTH CARE
- Dr Noridah Mohd Saleh
- Ketua Penolong Pengarah
- Bahagian Pembangunan Kesihatan Keluarga
- KKM
2Background
- Changing Paradigm Illness to Wellness (expanded
scope in 7MP)
- One of the 8 Future Health Goals
- One of the main focus in 9MP
- - TWG paper Achieving lifelong Wellness
3DEFINITION
- Health is a state of complete physical,
mental, and social well-being and not merely the
absence of disease" (WHO, 1947, p. 1)
- Illness the response a person has to a disease
it is an abnormal process in which the persons
level of functioning is changed compared with a
previous level - Wellness an active process by which an
individual progresses towards maximum potential
possible, regardless of current state of health.
Five dimensions of wellness (physical,
socialcultural, emotional, intellectual
environmental)
4PRIMARY HEALTH CARE
Primary Care
Family Health
FHD / BPKK
Illness wellness
5Future Health Goals
- Wellness Focus
- Person Focus
- Informed Person
- Self Care
- Care provided at/near home
- Seamless Continuous Care
- Service Tailored As Much As Possible
(Empowerment) (to individuals and groups)
- Affordable and Equitable
6The 8 HS Goals
- Wellness
- Not to be merely a theory
To be translated Into Action
well at risk
ill
7Why Wellness Approach?
8Challenges
- Disease Pattern
- - 1 in every 10 has Diabetes
- - 1 in every 5 deaths is due to
- Cardiovascular problems
- - 1 in every 8 has Asthma
- - Breast ,Cervix, Prostate Cancer
- Demographic
- - 1 in 20 is an elderly
- ( 1 in every 10 by Year 2020)
- Higher Demands and Expectations , Resource
constraints,
9Top 10 DALYs
10I - Prevent and Reduce Disease Burden
- 70 of total Health Budget
- 2m inpatients
- 40m outpatients
ILL
WITH RISKS
POTENTIAL RISKS
HEALTHY No identified Risks
11LIFE Expectancy
LIFE EXPECTANCY
AGE
12Health Expectancy
HEALTH EXPECTANCY
AGE
13Experience
- What have we learn from
- MCH services?
14Prevent and Reduce Disease Burden
- Experience from MCH WELLNESS Services
- 30 years of investment
- Maternal Mortality 282(P) 30 / 100,000
LB
- Infant Mortality 41(1970) 5 /100,000 LB
- Burden of Dis (2003) Leading cause of DALY
- Measles 126
- Polio 102
- Hypertension in Preg 1,268
- Maternal Sepsis - 171
- Obstructed Labour 14
IHD - 113,887 CVD/Stroke - 86,372 Major Depresn
- 67,211
Diabetes- 56,390
OBESITY from 5 to 10-13 in 10years??
15Prevent and Reduce Disease Burden
- Experience from the MCH wellness Services
- Screening
- Examination Immunisation
- Health Education
- Follow-Up Home Visits
- Treatment
IS
16MCH Services Investments
- Dedicated Clinics
- Dedicated Staff
- Trained Midwives and PHN
- Trained Doctors and Obstetrician
- Effective MCH FP Protocols
- Effective Referral System
17Current Promotive and Preventive Limitations
- Mass-address
- Not-specific to clients problems
- Behavior modification unassisted
- Big Bang effect much desired
- individualised
- and personalised
18Wellness approach
19ProposingPlan Preventive Maintenance Approach
Wellness..
20Primary Health Care
- Primary Health Care is The Thrust of Health
Services
- Kontek di peringkat temu-pertama di antara
pesakit dengan sistem penjagaan kesihatan
(personel kesihatan )
- Menekankan equity, accessibility, affordability
and appropriate technology
-
21Ninth MP - Consolidation
- Primary Goals
- Prevent and Reduce Disease Burden
- Enhance Health Care Delivery
- Supporting Goals
- Optimisation of Resources
- Enhance Research
- Manage Crisis and Disasters
- Strengthen Health Information MS
22Prevent and Reduce Disease Burden
Health Promotion, Screening, Early diagnosis,
Prompt Treatment, Rehabilitation
Integrated services
23Existing Framework
24Services Provided KK (2)(3)
- Kesihatan Ibu
- Ibu Mengandung
- Pemeriksaan kesihatan, kandungan dan darah
- Lawatan ke rumah
- Ibu Bersalin
- Menyambut Kelahiran
- Ibu Lepas Bersalin
- Pemeriksaan kesihatan
- Pemeriksaan bayi
- Lawatan susulan di rumah
- Khidmat perancang keluarga
- Promosi susu ibu
- Kesihatan Anak
- Pemeriksaan kesihatan
- Imunisasi
- Early intervention Program
- Lawatan ke rumah
- Kesihatan Sekolah
- Pemeriksaan kesihatan murid-murid Tahun 1, 6 dan
Ting 3
- Kesihatan Warga dewasa
- Promosi Kesihatan
- b) Perkhidmatan penyaringan dan penilaian
risiko
- Perkhidmatan pengurusan risiko
- Pemeriksaan kesihatan
- Perkhidmatan kesihatan reproduktif
- Kaunseling
- Rawatan dan rujukan
- Kesihatan Wargatua
- Promosi Kesihatan
- Pemeriksaan kesihatan
- Pemeriksaan pergigian
- Rawatan dan rujukan
- Kaunseling dan Rehabilitasi
- Kesihatan Mental
- Promosi Minda Sihat
- Penyaringan faktor risiko, DASS, gaya tindak
- Intervensi awal / susulan teknik relaxasi,
urutan leher dan bahu
- Pengurusan pesakit psikososial, farmakologikal
25Services Provided - KK
- Pemakanan dan Dietetik
- Promosi makan secara sihat
- Pengurusan berat badan
- Pengurusan pemakanan pesakit kronik
- Rehabillitasi pemakanan
- Dapur sihat / kafeteria sihat
- Kesihatan Pergigian
- Promosi kesihatan pergigian
- Saringan dan Pemeriksaan kesihatan pergigian
- Rawatan
- Rujukan pakar
- Kesihatan Pekerja
- Pemeriksaan kesihatan pre employment, routine
medical examination
- Penilaian risiko pekerjaan / hazard
- Rawatan dan rujukan
- Siasatan penyakit/wabak
- Rehabilitasi
- Pemulihan anggota
- Pemulihan cara kerja
- Surveilan kesihatan
- Pengesanan kes secara aktif dan pasif
- Pengesanan kontak
- Pengesanan kes tercicir
- Promosi kesihatan
- Perkhidmatan sokongan
- Perkhidmatan patologi
- - Pengendalian spesimen
- - Ujian makmal
- Perkhidmatan pengimejan diagnostik
- - X Ray dan Ultrasound
- Perkhidmatan farmasi
- - Pendispensan ubat-ubatan
- - Kaunseling
26Current challenges - PHC
- High load of patients to doctor
- (30m 13m) 40 -50 m (total encounters)
- (Medical assistants / Nurses)
- 1000 drs (130 FMS)
- 6300 nurses (3700 SN)
- 2000 MAs
- Increasing scope of services
- Lack of building space and equipment
- Poor maintenance
- Increasing demands by clients
27Review the deliverables
- Process
- Integrated wellness screening adult
elderly
- Risk Management
- Reorg clinic illness
- Physical
- Outcome
- Percentage of the population / community
assessed, without risk, with risk,
28 Process of healthcare delivery Need to enhance
Fast Access, Safe and high quality ,Hassle-free
and greater comfort
- Optimisation of Resources
- Multi-skilling, Sharing, Remote management
- Enhance Research
- Participate towards evidence based planning and
intervention
- Manage Crisis and Disasters
- Increase HR capacity and capability
- Adequate and appropriate facilities
- Current protocols for management
- Strengthen Health Information MS
- Enhance sharing of data and info facilitate
continuity of care
29- What do we offer ?
-
- Wellness services
30OBJEKTIF KLINIK WELLNESS
- Meningkatkan kesedaran pemeriksaan kesihatan di
kalangan komuniti ( Bilangan kedatangan kes
baru)
- Meningkatkan pengesanan awal kes-kes yang
berisiko tinggi (Bilangan kes yang mempunyai
risiko)
- Memperkasakan komuniti untuk melakukan
pemeriksaan kesihatan sendiri (Bilangan pelanggan
yang dapat melakukan pemeriksaan sendiri dengan
betul) - Mengurangkan morbiditi ( Bilangan intervensi yang
berjaya)
31Wellness - Target groups
- Healthy population
- Aged from 10 to 70 years
- Follow up interval every 5 years
- Followed-up patients for counseling and health
education
- Patients for Rehab follow-up
-
32(5) Outcome -
- Wellness Service
- Womb Tomb
- Maternal
- Child
- Adolescent
- Adult
- Geriatric
School Health Home Visits Home Nursing
33Prevent and Reduce Disease Burden
- Treat the ill
- Manage those with risk
- Prevent the onset of preventable risks
- IMPROVE HEALTH EXPECTANCY
WELLNESS SERVICES
34Approach
- Medical
- Nutrition
- Exercise
- Smoking
- Minda Sihat
- PT/OT
- HEd
- - Occ Health
- Maternal
- Childhood
- Remaja
- Dewasa Wanita
- Dewasa Lelaki
- Wargatua
35Health Services In Clinic
Adolescent Adult Geriatric Mental health
36Reviewed Approach - Physical
I - Wellness Clinic Ibu Anak Remaja Dewasa
Warga Tua
II - illness Clinic Kecemasan Akut Kronik Pe
nyakit Berjangkit
School Health Home Visits Home Nursing
- III - Emergency
- Support Pre-hospital
- Support Call centre
- Support Rapid Response
III - Support Services - Makmal - Farmasi - R
adiologi
- Sistem Informasi dan komunikasi
Wellness Illness Support Emergency
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38Wellness -approach
- Appointment
- Integrated, Comprehensive Screening according to
age group
- Clinical Pathway in management of risks (Evidence
Based)
- Health education and Behavior modification /
rehabilitation
39Risks reduction / prevention
- Maternal and Child Mortality and Morbidity
- Adolescent Geriatric Mortality and Morbidity
- - 10 top Disease Priorities
- IHD Cardiovascular
- Cerebrovascular
- Diabetes
- Depression, anxiety, stress, schizophrenia
- Injury
- Cancer
- Congenital
- Asthma
40Risk Assessment by Age Gp
For Female Adult Osteoporosis
For Older Adult Stroke
For Child and Adolescent
Child and Adolescent Health Risk Profile (Text
Version)
41screening tool
42Wellness (PPP) Activities / Services
- Resource Implications
- Space - BIG
- Equipments
- Training
- HR
- Dr
- Dietician
- Health Education Officer
- Medical Assistant
- Nurses
- Clerical
- Guided Self-Check
- Checklist for Risk Screening according to age
group
- Triage
- Counseling and Health Education
- Risk Assessment
- Risk Management
- Process Implications
- Consolidation of islands of clinics
Adolescent, Paps smear, BSE, HRT, Mens, OKU,
CVD, PSR, Occ health, geriatric health, .
43Self Risk Assessment
- Butir peribadi (perubatan peribadi keluarga)
- Penilaian Fizikal (BMI, secondary sexual
development/reproduktif, pemakanan, pergigian,
- Senaman
- Penilaian Minda Sihat (Risiko Murung /Resah/ )
- Penilaian Tingkahlaku Berisiko (dadah/rokok /
sexual habits penderaan/ Kecederaan)
- Pengurusan Risiko
- - Klinikal /pemakanan/senaman/minda sihat
- sokongan moral (e.g kaunselor, psikologis
44- Achieving lifelong Wellness
- 5 Areas to be strengthened
- Healthy Eating
- Regular exercise
- Healthy Mind
- Stop Smoking
- Healthy and Safe Environment
-
- EMPOWERMENT
45Pelanggan
Komuniti, OPD, MCH, Sekolah
Kaunter informasi
Pegawai perhubungan pelanggan
Kecemasan
Pesakit Luar
Isi borang saringan asas(mengikut kumpulan
umur dan jantina) dan dapatkan temujanji
Kaunter Pendaftaran Klinik Wellness
Pembantu Tadbir
Lengkapkan Saringan Asas Ukuran Biometri
Pemeriksaan Fizikal Asas
Jururawat Masyarakat / Pembantu Perubatan
Penentuan Risiko
Pakar Perubatan Kesihatan Awam
Ada penyakit
Ada risiko
Tiada risiko
Pakar Perubatan Kesihatan Awam, Pembantu
Perubatan, Jururawat Terlatih, Kaunselor,
Jurupulih carakerja/ Anggota, Pegawai Zat Makanan
/ Dietician, Pegawai Pendidikan Kesihatan
Rujuk FMS
Pakej
Promosi Kesihatan Temujanji Discaj
- Minda sihat
- Berhenti merokok /Substance abuse
- Pemakanan sihat
- Senaman (termasuk PT, OT)
46- PERANAN PEMBANTU PERUBATAN
- menjalankan saringan asas ukuran biometri
- membantu menyelaras dan memantau perjalanan
klinik
- melakukan pemeriksaan kesihatan
- membuat penilaian kesihatan dan penentuan
risiko
- membantu menjalankan pakej intervensi yang
berkaitan
- membantu membuat penilaian keberkesanan pakej
intervensi yang ditawarkan kepada pelanggan
- membantu menilai pencapaian objektif klinik
wellness.
- Membantu menyelaras penyelengaraan peralatan
47Keperluan Latihan
- Post- Basic Primary Health Care
- Post-Basic in risk identification and management
- Post-Basic in wellness management
- Post-Basic in Emergency Management,( Basic Life
Support Advance Life Support)
- Post-Basic in Chronic Disease Management
48Latihan Perkembangan Kerjaya
- bidang pengkhususan (kepakaran)
- On Job Training
- In ServiceTraining
- Aktiviti CPD CME points
- Practice Standards
- Credentialing/Priviliging (coming soon!)
- Latihan tambahan diperlukan
- - jenis-jenis latihan dikenal pasti
- - melibatkan penukaran skima kerja
- baru
- - Penilaian Tahap Kecekapan (SSM)
49On going now
- merangka pelaksanaan Pendekatan Baru(Wellness)
- di klinik-klinik kesihatan dan menyediakan
pakej komprehensif perkhidmatan Wellness secara
integrasi
50On going now
- Menguji-cuba tool yang disediakan bagi tujuan
saringan dan pengurusan risiko kesihatan kumpulan
umur remaja , dewasa lelaki dan wanita serta
wargatua dengan menggunakan Clinical Pathway - Mengenalpasti kriteria kriteria untuk tahap
risiko dan pakej pengurusan risiko berkaitan
(mengikut prioriti) bagi setiap kumpulan umur
- Menyediakan pelan pelaksanaan projek
51On going now
- - Mengemaskini tool content saringan
dan pakej pengurusan risiko kes-kes di
perkhidmatan wellness secara integrasi
52PELAN PERANCANGAN PELAKSANAAN PROJEK PERINTIS
KLINIK WELLNESS
53Expected Standard Of Care
- High level Primary clinical Care
- - Specialist care
- - Comprehensive care
- - Continuity of care
- - Seamless from womb to tomb
- - Promote wellness
- - Care close to home
- - Cost-effective care
- - Evidence based practice
- Performance through several indicators and QA
Programme
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55Targets What of population ??
ILL
WITH RISKS
POTENTIAL RISKS
HEALTHY No identified Risks
- What gradient of change?
- How much can we invest?
- Can this new strategies make a difference?
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