Organizational Model of the Primary Medical Care Center

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Organizational Model of the Primary Medical Care
Center

• Partnership between
• Odessa (Ukraine) Boulder (U.S.A.)
• Presented by V.V. Bespoyasnaya V.V.

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Partnership Objective

• The objective of the Odessa-Boulder partnership
  for 2001 is to develop the major components of
  the integrated Primary Medical Care System (PMCS)
  based on the principals of family medicine,
  including introduction of prevention programs and
  new technologies in psychosomatic medicine

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Principal Characteristics of the Populations
Served by the Primary Medical Care Center
Population Number of families Number of people in the population Number of people in the population
Population Number of families Total Children
Student families (Family and Youth Board) 50 150 50
Disadvantaged families 10 20 -
Families residing in the vicinity of the Center 100 350 85
Families of personnel of the Family Health Scientific Research Center 50 175 61
Families of port workers 30 105 22
Total 240 800 218
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• Date the Center opened and began to operateMay
  31, 2000
• Organizational Structure

Type of facility Designation Number of rooms
Offices of physicians and nurses Examination room, Nurses room 6 1
Clinical-diagnostic unit X-ray room Laboratory 2 1
Auxiliary rooms Registration Break room Laundry Rest rooms 1 1 1 2
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Principal members of the Primary Medical Care
Center Staff
Position Title Planned number Actual number on 01/01/2001
Family physician 2 1
Assistant to the department of family medicine 2 1
Radiologists 0,5 -
Nurse manager 1 1
Family nurse 5 2
X-ray and lab technician 1 -
Nurses aid 1 1

• Manning table (planned 12.5 positions, currently
  occupied 6.0)

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Work Priorities

• primary disease prevention services to the public
  (screening)
• clinical work
• preventive measures
• funding
• integration with other subdivisions of primary
  medical care

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Work Priorities (Continue)Primary prevention
(screening)

• Risk assessment
• Patient history
• Objective assessment
• Reservometry (examination protocol)
• Rating and possibility of follow up monitoring of
  preventive and therapeutic measures

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Work Priorities (Continue)Clinical Work

• Development of standards for evaluation the
  quality of medical care
• Enhancement of the role of nurses
• Adoption of new medical technologies

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Work Priorities (Continue) Preventative Measures

• Clinics first priority issues of reproductive
  health
• Prevention of early pregnancy and STD and
  HIV-infections
• Decrease of smoking rate
• Development of a tuberculosis prevention model

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Work Priorities (Continue)Preventative Measures

• Prevention programs to be implemented for
  high-priority issues and supported by the
  Information Processing and Analysis Center for
  Work with the Public
• Main principle of funding for prophylactic
  programs whatever resources remain after
  treatment programs shall be used to improve
  public health
• In the future, we plan to establish an
  Information and Health Maintenance Center to
  implement this principle

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Financing methods used by our Research Institute in the Past Most promising methods under the new PMCS model
Cash Agreements with employers Medical insurance and loans Charitable funds Funded scientific-research projects Instructional activity Investments Government funding
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Funding of Family Medical Center
Companies Payment at time of service Medical insurance Charitable medical services
Subscription fees At time of service (not involving cash) Cash Voluntary medical insurance Credit union Disadvantaged Students
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INTEGRATION OF PRIMARY MEDICAL CARE CENTER
Consulting polyclinic
Research Institute of the Public Health Center
Laboratory-diagnostic division
Family medicine clinic
Multi specialty daytime inpatient clinic
Family dentistry clinic
Poison control center
Hospice
Information processing and analysis center
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FAMILY DENTISTRY CLINIC

• Serves all members of the family
• Interacts closely with the family medicine clinic
• Emphasis on preventive care
• Treats patients at home

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POISON CONTROL CENTER

• Information and consulting aid
• To the public
• To companies
• To medical institutions
• Coordination of the activities of medical
  facilities providing emergency aid
• Study of the causes of poisoning in the region
• Information support to the analytic center for
  developing preventive programs

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HOSPICE

• Coordination of the activities of social,
  medical, and municipal services, public service
  organizations and volunteers
• Care of incurably ill at home
• Provision of necessary equipment and supplies
• Inpatient care

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INFORMATION PROCESSING AND ANALYTIC CENTER

• Analysis of indicators of health status and
  morbidity in the region
• Identification of the highest priority medical
  problems
• Development of therapeutic and preventive programs

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ISSUES IN SETTING UP A PRIMARY MEDICAL CARE
CENTER
ADMINISTRATIVE TECHNOLOGICAL ECONOMIC
need to change the traditional territorial principle of health care to which the directors of medical care facilities and the public are used to limited possibilities in expert assessment of fitness to work inadequate level of personnel training lack of standardized accounting and reporting documentation lack of an algorithm for interacting with other health care and maintenance facilities lack of indicators and parameters for evaluating the health of family members primary prevention technologies inadequate level of knowledge on primary prevention technologies inadequate knowledge of related specialties no criteria for assessing quality of performance no government funding lack of mechanism for attracting other sources of funding no mechanisms for including insured medical care
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PERIODIC ASSESSMENT OF CENTERS PRIORITIES

• Evaluation of the needs of the population served
  (Based on results of a sociological survey
  conducted in January, 2000)
• 30 of the population of Odessa experience
  difficulties obtaining adequate medical care
• 20 of the population evaluates the existing
  health care system positively
• 48 of the members population evaluate their own
  health as satisfactory
• 17 as poor
• 5 as very poor

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PERIODIC ASSESSMENT OF CENTER WORK PRIORITIES
(continued)

• Current priorities (revision of the model) and
  prediction of the way the Centers activities
  will develop
• Intensified work to prevent poisoning and
  accidents
• Help of public service organizations to recruit
  the public into the healthy lifestyle movement
• Development of an infrastructure for working with
  the public
• Improvement of methods for observation of
  patients according to the principles of risk
  assessment and reservometry
• Improvement of interactions with Health Care and
  Maintenance Organizations
• Improvement of mechanisms for funding and
  economic support of the Center

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USE OF EVALUATION METHODOLOGIES

• Social marketing to study public opinion in the
  area of health care
• Conducting patients surveys on the quality of
  the medical services they received
• Incorporation of quality standards for provision
  of medical care
• Medical cost effectiveness of the work of various
  primary medical care subdivisions

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PLANS TO DEVELOP THE PRIMARY MEDICAL CARE MODEL

• Continued development of the concepts for primary
  medical care based on specific strengths of our
  partnership program
• Plan for implementing this model in other regions
• Improve the multi-specialty approach to primary
  care
• Strengthen the role of nurses

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PLANS TO DEVELOP THE PRIMARY MEDICAL CARE MODEL
(continued)

• Continuation of work on clinical standards for
  primary medical care
• Development of programs to train medical
  personnel in primary care
• Development of strategies to ensure stable
  functioning of the program

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PRINCIPAL COMPONENTS OF THE PROGRAM STABILITY
STRATEGY

• Financial stability
• Social stability
• Administrative stability
• Technical stability