NVAG April 2014

Healthy Health Care

The integrated approach to lifestyle support in deprived urban areas, is, despite good initiatives, insufficient.

Geesje NijhofCoordinating/Specialist Senior Inspector

My background

• Medical doctor

• Specialised in public health• Worked for GGD, MOA, RIVM and now for the Dutch Health Care Inspectorate for five and half years• The first five years for public health topics with a focus on low SES and ethnic minorities and network inspection. Mainly stimulating inspection.• After a reduction of the public health department and a reorganisation I now work for elderly health care inspection.

Preliminary stage, research issue and goal

State of the healthcare 2012: Preconditions integrated approach to lifestyle support in deprived urban areas. Follow up research.

What is the view of the inspectorate on the cooperation of the joint health care providers in 20 deprived urban areas when looking at the preconditions for healthy health care?

Primary health care centres, community health services and home care institutions cooperate in all deprived urban areas according to the preconditions of healthy health care.

Method Selection 20 deprived urban areas were selected (NIVEL) 3 parties, if involved, an external director

QuestionnaireWeb based questionnaire with a 100% response rate

Visit1 conversation with the three parties involved and if needed anexternal director. Presence: 100%

20 area reports: assesment was based on the preconditions Present/not present = insufficient Operational/secured = sufficient

Preconditions on which the assesment is based

1. Joint problem analysis2. Joint goals3. Systematic evaluation and improvement4. Structured consultation of relevant care givers in the area5. Network control6. Involvement of the municipality and health insurance company

Results – total score per area

* * * * * * * * * * * * * *0

1

2

3

4

5

6

Totaal geborgd Totaal operationeel Totaal aanwezig Totaal afwezig

Wijken (N=20)* = LVG -lid

Aan

tal

ran

dvo

orw

aard

en

Results – overview of the preconditions

0 5 10 15 20

Gezamenlijke probleemstelling

Gezamenlijke doelstellingen

Systematische evaluatie en verbetering

Gestructureerd overleg

Netwerkregie

Betrokkenheid zorgverzekeraar-gemeente

Aantal wijken (N=20)

geborgd operationeel aanwezig afwezig

1. Joint problem analysis2. Joint goals

5 13 1Gezamenlijke doelstellingen

Aantal wijken (N=20)

operationeel aanwezig afwezig

2 5 12 1Gezamenlijke probleemanalyse

Aantal wijken (N=20)

geborgd operationeel aanwezig afwezig

3. Systematic evaluation and improvement4. Structured consultation

6 13 1Systematische evaluatie en verbetering

Aantal wijken (N=20)

operationeel aanwezig afwezig

1 5 11 3Gestructureerd overleg

Aantal wijken (N=20)

geborgd operationeel aanwezig afwezig

1 8 11Netwerkregie

Aantal wijken (N=20)

geborgd aanwezig afwezig

5. Network control 6. Involvement of the municipality and health insurance company

2 11 5 2Betrokkenheid zorgverzekeraar -gemeente

Aantal wijken (N=20)

geborgd operationeel aanwezig afwezig

Promoting factors, from the field

Knowing each other and who is in charge of what

Trusting each other

Grant each other things

Using each others expertise

Being enthousiastic

Taking the iniative

bottom-up, the patient should be the focal point

Conclusion Many lifestyle support activities, but no integrated approach

Little connection of universal prevention and lifestyle support activities of individuals

Active management of cohesion and cooperation of well structured primary health care centres

Convenants of the municipality and health care insurances are available, but there is inssuficient overall coordination with the health care providers

Consequences and continuation 1/21. All parties with an insufficient score on one or more of the

preconditions will implement the preconditions before the first of January 2015.

2. Reporting to the health care inspectorate: the progress on the implementation needs to be on a sufficient level.

3. Coordination with primary health care centre, home care and the GGD. Participation is requiered.

The ministry of Health, Welfare and Sport is using the results ofthis research for the development of the National Prevention Programme

Parties of the Agenda of Health care is using the preconditions

The health care inspectorate publishes the progress reports of the 20 deprived urban areas in 2015 on the website of the inspectorate

Consequences and continuation 2/2The focus of the of the Health Care Inspectorate shifted by order of the minister of Health, Welfare and Sport.  The current focus: 1. Thematic Inspection Research on hold and reduction for the future.

 2. An emphasis on the risk to patient safety. Consequences for the practice:  Monitoring of incidents Risk based supervision Incentive supervision has been put on hold We are waiting for better times for this subject.

15

Challenge for (public) healthcare in the Netherlands

Focus on integrated care in low SES neighbourhoods Awareness of the influence of different ehtnic backgrounds in healhtcare Attention for and action on health illiteracy

NVAG april 2014

16

My pledge

NVAG april 2014