ICHPO Edinburgh 2013ICHPO Edinburgh 2013

Priorities for primary care in Europe: a Priorities for primary care in Europe: a multi-disciplinary approachmulti-disciplinary approach

Diederik AarendonkDiederik Aarendonk

EFPC CoördinatorEFPC Coördinator

Created in 2005Created in 2005The European Forum for Primary Care is The European Forum for Primary Care is situated at the NIVEL institute in the situated at the NIVEL institute in the Netherlands.Netherlands.Multi-professional Advisory Board with Multi-professional Advisory Board with members from Belgium, UK, Italy, members from Belgium, UK, Italy, Sweden, France, Slovenia, Turkey, Sweden, France, Slovenia, Turkey, Norway, Greece, Portugal, Romania, Norway, Greece, Portugal, Romania, Hungary, Latvia, Spain, Macedonia, Hungary, Latvia, Spain, Macedonia, Austria and the Netherlands.Austria and the Netherlands.

Membership networkMembership networkMembershipMembership

(100 institutional & 50 individual members)(100 institutional & 50 individual members)Members from the 3 levels: Policy, Research & Members from the 3 levels: Policy, Research & PracticePractice

Membership is multi-professionalMembership is multi-professional

The main objectivesThe main objectives

• To provide information to and share the To provide information to and share the information between the membersinformation between the members

• Advocacy for Primary Care towards Advocacy for Primary Care towards policymakers and politicianspolicymakers and politicians

• Support to the development of research Support to the development of research and establishment of a research agendaand establishment of a research agenda

Why this Forum?Why this Forum? Dissemination of expertise and knowledge on Primary Dissemination of expertise and knowledge on Primary

Care systemsCare systems Support to members for implementationSupport to members for implementation To show the key principles of the World Health Report To show the key principles of the World Health Report

2008: “Primary Health Care Now More Than Ever”!!2008: “Primary Health Care Now More Than Ever”!!• universal coverage (focus of the WHR 2010)universal coverage (focus of the WHR 2010)• service delivery service delivery • public policypublic policy• leadershipleadership

And its relevance in relation to the WHO/Europe And its relevance in relation to the WHO/Europe emphasis on Health System initiated at the Tallinn emphasis on Health System initiated at the Tallinn 2008 Ministerial conference on "Health Systems, 2008 Ministerial conference on "Health Systems, Health and Wealth” Health and Wealth”

   

Function of Primary Care in the Function of Primary Care in the health care systemhealth care system

Navigation: “Tom Tom of the care”: Navigation: “Tom Tom of the care”:

Searching for the appropriate level of care Searching for the appropriate level of care that is needed:that is needed:

• Encouraging informal care/self-care, when Encouraging informal care/self-care, when possiblepossible

• Providing care when needed,Providing care when needed,• Referring to medical specialist care when Referring to medical specialist care when

necessarynecessary

Results of consultation by Results of consultation by GP / Primary Care teamGP / Primary Care team

82 %: treated by GP / Primary Care team82 %: treated by GP / Primary Care team 9 %: referral to specialist9 %: referral to specialist 2 %: X Ray2 %: X Ray 2 %: laboratory2 %: laboratory 3 %: therapy at secondary3 %: therapy at secondary

care levelcare level 2 %: other2 %: other

Demand & SupplyDemand & SupplyPopulation Health ManagementPopulation Health Management

Expected demand for care: Expected demand for care: Diabetes Mellitus (Wijkscan.com)Diabetes Mellitus (Wijkscan.com)

Vulnerable elderly (65+) in Vulnerable elderly (65+) in Almere-HavenAlmere-Haven

The patient perspective The patient perspective as a starting point as a starting point for service delivery!for service delivery!

Includes the following values:Includes the following values:

AccessibilityAccessibilityContinuity of careContinuity of careCoordination of careCoordination of careComprehensiveness of servicesComprehensiveness of services

!! Integrated and Community Oriented !! Integrated and Community Oriented Primary Care including Interprofessional Primary Care including Interprofessional CollaborationCollaboration

Quality of primary care: messages for the third millenium

Problem versus goal oriented careoAbsence of disease as defined by the health care system versus Maximum desirable and achievable quality and/or quantity of life as defined by each individualoEradication of disease , prevention of death versus assistance in achieving a maximum individual health potential

Resulting in the need for patient/client/citizen orientation and involvementand even one step further:Patient/client/citizen involvement in the set-up of Primary Care provision

Quality of primary care: messages for the third millenium

Community Oriented Primary Care

Organisational developmentsOrganisational developments

Multiprofessional teams: integration of care is more easy.Multiprofessional teams: integration of care is more easy.

Integrated Multi Mono Solists Population based professional professional Healthcare healthcare care Organisations centre organisation

Scope of integrated care

More care standards

Selfmanagement and prevention

Soloist

Small group

practice

Caregroups

Anno 2011

Caregroups

with extra’s

Primary Care organisations that deliver integrated care

Big Primary Care organisations that deliver integrated care with backoffice

Clinical leadership and Operational management

Primary Care centres in the south of the Netherlands are uniting

Ref: Ref: Teamwork in primary care: perspectives of general practitioners and community nurses in Teamwork in primary care: perspectives of general practitioners and community nurses in Lithuania; Jaruseviciene et al. BMC Family Practice 2013, 14:118Lithuania; Jaruseviciene et al. BMC Family Practice 2013, 14:118

Activities of the Forum:Activities of the Forum:

• Alliance of Community Oriented Primary Care Alliance of Community Oriented Primary Care services (ACOPC) as a Working Group of the EFPCservices (ACOPC) as a Working Group of the EFPC

Members:Members:• CataloniaCatalonia• WalloonWalloon• FlandersFlanders• NetherlandsNetherlands• UKUK• PortugalPortugal• FranceFrance

Core member of the International federation of Core member of the International federation of Community Health Centres (IFCHC)Community Health Centres (IFCHC)

Improving health and primary health care around the world

through Community Health Centres

Learn more at: www.ifchc2013.org

Objectives

The core goals of the IFCHC are •to foster global collaboration in community-oriented primary health care and •to expand access to Community Health Centres as the optimal way to achieve the World Health Organization’s vision for equitable access to primary health care for all.

Global Partners• Canadian Association of Community Health Centr

es • Twitter: @CACHC_ACCSC

• Community Health Australia • Twitter: @CHCAustralia

• European Forum for Primary Care • Twitter: @PrimaryCare4um

• US National Association of Community Health Centers • Twitter: @NACHC

Primary care developments in Europe Primary care developments in Europe

At policy making levelAt policy making level

Page 6: "Also in the context of the demographic challenges Page 6: "Also in the context of the demographic challenges and the pressure on age-related expenditure, and the pressure on age-related expenditure, reforms of reforms of healthcare systems should healthcare systems should be undertaken to be undertaken to ensure ensure cost-effectiveness and sustainability, assessing the cost-effectiveness and sustainability, assessing the performance of these systems against the twin aim of a performance of these systems against the twin aim of a more efficient use of public resources and access to high more efficient use of public resources and access to high quality healthcarequality healthcare."."

Annual Growth Survey 2013; Communication from the Annual Growth Survey 2013; Communication from the Commission; Brussels, 28.11.2012, COM(2012) 750 finalCommission; Brussels, 28.11.2012, COM(2012) 750 final

Investing in sustainable health systems combines Investing in sustainable health systems combines innovative reforms aimed at improving costefficiency innovative reforms aimed at improving costefficiency and reconciling fiscal consolidation targets with the and reconciling fiscal consolidation targets with the continued provision of sufficient levels of public services.continued provision of sufficient levels of public services.

Page 5: "Page 5: "using financial incentives to encourage patients to using financial incentives to encourage patients to register with a general practitioner (GP) or family doctor register with a general practitioner (GP) or family doctor and using a referral system to define a cost-effective and using a referral system to define a cost-effective path of care: from GP, to outpatient specialist, to path of care: from GP, to outpatient specialist, to hospital, to emergency care, while encouraging patients hospital, to emergency care, while encouraging patients to have less recourse to unnecessary care and to have less recourse to unnecessary care and emergency servicesemergency services""

Suggested measures for Investing in Sustainable Health Suggested measures for Investing in Sustainable Health Systems two clear recommendations for Member States:Systems two clear recommendations for Member States:

• • Reducing the unnecessary use of specialists and hospital Reducing the unnecessary use of specialists and hospital carecare

• • Improving primary healthcare servicesImproving primary healthcare services

““Investing in Health - Key Messages”, ; European Commission, DG Investing in Health - Key Messages”, ; European Commission, DG Health and Consumers; February 2013Health and Consumers; February 2013

..

““Efficiency gains can be made by, for example, Efficiency gains can be made by, for example, reducing reducing unnecessary hospitalization and use of specialists, unnecessary hospitalization and use of specialists, strengthening primary carestrengthening primary care, encouraging the use of less , encouraging the use of less expensive equivalent (generic) drugs, and using health expensive equivalent (generic) drugs, and using health technology assessment to evaluate the cost-effectiveness technology assessment to evaluate the cost-effectiveness of health technologies as a basis for decision making.”of health technologies as a basis for decision making.”

““Investment in Health a priority in the Social Investment Package” Investment in Health a priority in the Social Investment Package” by Ms Paola Testori Coggi, Director General for Health and by Ms Paola Testori Coggi, Director General for Health and Consumers, European Commission; Health-EU newsletter 106Consumers, European Commission; Health-EU newsletter 106

Health 2020 –reaching higher and broader:Health 2020 –reaching higher and broader:

• • Going upstream Going upstream to address root causes such as social to address root causes such as social determinantsdeterminants

• • Invest in Invest in public health, public health, primary careprimary care, health protection and , health protection and promotion, and disease preventionpromotion, and disease prevention

• • Making the case for whole-of-government and whole-of-Making the case for whole-of-government and whole-of-society approachessociety approaches

• • Offering a Offering a framework for integrated and coherent framework for integrated and coherent interventionsinterventions

Health 2020: a new European policy framework for health and well-Health 2020: a new European policy framework for health and well-being; Zsuzsanna Jakab, WHO Regional Director for Europe, 20 being; Zsuzsanna Jakab, WHO Regional Director for Europe, 20 March 2013, Riga, LatviaMarch 2013, Riga, Latvia

Prof Alan Maynard, University of York:Prof Alan Maynard, University of York:

““the re-distribution of income & power of Health the re-distribution of income & power of Health Professionals is key Professionals is key to create solutions for the future”to create solutions for the future”

Representatives from Greek and Irish ministries of health: Representatives from Greek and Irish ministries of health: emphasizing the need to emphasizing the need to invest in Primary Careinvest in Primary Care..

Observatory: Observatory:

Accessibility of vulnerable groups is key, Primary Care is Accessibility of vulnerable groups is key, Primary Care is keykey! !

WHO Oslo conference 17-18 April 2013, Health Systems in Times of WHO Oslo conference 17-18 April 2013, Health Systems in Times of Global Economic CrisisGlobal Economic Crisis

Primary care was associated with better population health; Primary care was associated with better population health; lower rates of unnecessary hospitalizations; and lower rates of unnecessary hospitalizations; and relatively lower socioeconomic inequality, relatively lower socioeconomic inequality,

Overall health expenditures were higher in countries with Overall health expenditures were higher in countries with stronger primary care structures, perhaps because stronger primary care structures, perhaps because maintaining strong primary care structures is costly and maintaining strong primary care structures is costly and promotes developments such as decentralization of promotes developments such as decentralization of services delivery. services delivery.

Comprehensive primary care was also associated with Comprehensive primary care was also associated with slower growth in health care spending. slower growth in health care spending.

Evidence grows that strong primary care in Europe is Evidence grows that strong primary care in Europe is conducive to reaching important health system goalsconducive to reaching important health system goals..

Europe’s Strong Primary Care Systems Are Linked To Better Europe’s Strong Primary Care Systems Are Linked To Better Population Health, But Also To Higher Health Spending. Kringos Population Health, But Also To Higher Health Spending. Kringos DS, Boerma WGW, Van der Zee J, Groenewegen PP; doi: DS, Boerma WGW, Van der Zee J, Groenewegen PP; doi: 10.1377/hlthaff.2012.1242 Health Affairs April 2013 vol. 32 no. 10.1377/hlthaff.2012.1242 Health Affairs April 2013 vol. 32 no. 4, pp. 686-694.4, pp. 686-694.

Page 67: “There is some evidence that Quality and Page 67: “There is some evidence that Quality and Outcomes Framework has not resulted in better access Outcomes Framework has not resulted in better access to care or interpersonal elements of care, may have to care or interpersonal elements of care, may have negative effect on inequalities as it encourages linear negative effect on inequalities as it encourages linear care pathways and a ‘one solution fits all’ approach, and care pathways and a ‘one solution fits all’ approach, and is not sufficiently responsive to local needs. It has also is not sufficiently responsive to local needs. It has also tended to measure treatment procedures rather than tended to measure treatment procedures rather than clinical outcomes. clinical outcomes. It seems that QOF may have reduced It seems that QOF may have reduced inequalities in measured outputs, but this has not inequalities in measured outputs, but this has not translated into a reduction of inequalities in the health translated into a reduction of inequalities in the health outcomes experienced by patientsoutcomes experienced by patients.”.”

Working for Health Equity: The Role of Health Professionals Working for Health Equity: The Role of Health Professionals Matilda Allen, Jessica Allen, Sue Hogarth and Michael Marmot; Matilda Allen, Jessica Allen, Sue Hogarth and Michael Marmot; UCL Institute of Health Equity, Department of Epidemiology & UCL Institute of Health Equity, Department of Epidemiology & Public Health, University College London; March 2013Public Health, University College London; March 2013

Conclusion (1):Conclusion (1):

Europe is a natural laboratory for learning about health Europe is a natural laboratory for learning about health policies and health systems. policies and health systems.

With diverse systems to finance, provide, and govern With diverse systems to finance, provide, and govern health care across the 27 member states of the health care across the 27 member states of the European Union and the wider European region there are European Union and the wider European region there are many opportunities for international comparative many opportunities for international comparative analyses and natural experiments.analyses and natural experiments.

Health systems and policy research in Europe: Horizon 2020Health systems and policy research in Europe: Horizon 2020

Kieran Walshe, Martin McKee, Mark McCarthy, Peter Groenewegen, Kieran Walshe, Martin McKee, Mark McCarthy, Peter Groenewegen, Johan Hansen, Josep Figueras, Walter RicciardiJohan Hansen, Josep Figueras, Walter Ricciardi

The Lancet, Early Online Publication, 18 March 2013The Lancet, Early Online Publication, 18 March 2013

Conclusion (2):Conclusion (2):

In this respect Primary Care gets a lot of attention and is In this respect Primary Care gets a lot of attention and is seen by Policy Makers as well as Researchers as an area seen by Policy Makers as well as Researchers as an area with enormous potential.with enormous potential.

It is up to the Primary Care professionals to make the caseIt is up to the Primary Care professionals to make the case

In order to achieve this, the different professional groups In order to achieve this, the different professional groups should share their interests and strive together for a should share their interests and strive together for a strong Primary Care movement!strong Primary Care movement!

European Forum for Primary Care!European Forum for Primary Care!www.euprimarycare.org www.euprimarycare.org

Activities of the Forum:Activities of the Forum:

• Website & Two weekly NewsflashWebsite & Two weekly Newsflash• Position Papers in developmentPosition Papers in development

PC and Interprofessional EducationPC and Interprofessional Education Impact of continuity on quality of care within Impact of continuity on quality of care within

Primary Care – the perspective of preferences of citizensPrimary Care – the perspective of preferences of citizens

• Conferences/workshopsConferences/workshops "Balancing the Primary Care and Secondary Care "Balancing the Primary Care and Secondary Care

provision for more integration and better health provision for more integration and better health outcomes!“ 9/10 September 2013 Istanbul, Turkeyoutcomes!“ 9/10 September 2013 Istanbul, Turkey

Barcelona, 1/2 Sept 2014, 5th EFPC biannual conf.Barcelona, 1/2 Sept 2014, 5th EFPC biannual conf.

• Advocacy (EU, National Governments, WHO)Advocacy (EU, National Governments, WHO) EC Expert Panel on effective ways of investing in healthEC Expert Panel on effective ways of investing in health EC Consultations on Health topics like NCD’s & agingEC Consultations on Health topics like NCD’s & aging

• Multi Country Study VisitsMulti Country Study Visits Visits to Primary Care innovations based on WHR ‘08Visits to Primary Care innovations based on WHR ‘08

Advocacy Advocacy

(EU)(EU)European Commission Expert Panel on European Commission Expert Panel on

effective ways of investing in healtheffective ways of investing in health• EFPC Chairman Prof Jan De Maeseneer member of the EFPC Chairman Prof Jan De Maeseneer member of the

expert panelexpert panel• Mandate 2: Definition of a frame of reference in Mandate 2: Definition of a frame of reference in

relation to primary care with a special emphasis on relation to primary care with a special emphasis on financing systems and referral systemsfinancing systems and referral systems

1. Provide a definition of primary healthcare and 1. Provide a definition of primary healthcare and community-based carecommunity-based care

2. Identify main investigation lines to analyze financing 2. Identify main investigation lines to analyze financing of primary care and integrated careof primary care and integrated care

3. Pronounce itself on the role of effective referral 3. Pronounce itself on the role of effective referral systems in ensuring integration between all levels of systems in ensuring integration between all levels of

the health system and provision of best the health system and provision of best possible possible care closest to home.care closest to home.

Advocacy Advocacy

(EU)(EU)

European Commission Consultations on Health European Commission Consultations on Health topics like NCD’s & aging in the framework of topics like NCD’s & aging in the framework of Healthy AgingHealthy Aging

• EU project ProFouND is to embed evidence based fall EU project ProFouND is to embed evidence based fall prevention programs for senior citizens at risk of falls prevention programs for senior citizens at risk of falls by using effective training programs and ICT-support by using effective training programs and ICT-support solutions in as many countries in Europe solutions in as many countries in Europe

www.profound.eu.com www.profound.eu.com

EFPC invited to EU-level stakeholder group to EFPC invited to EU-level stakeholder group to provide multi-professional Primary Care expertiseprovide multi-professional Primary Care expertise

V bi-annual EFPC conference

1/2 September

“Twinning Population Health and Primary Care”

The Future of Primary Care in Europe V

EFPC at the WebEFPC at the Web

www.euprimarycare.orgwww.euprimarycare.orgWebbased database on European Primary CareWebbased database on European Primary Care

LinkedIn discussion group “Primary Care LinkedIn discussion group “Primary Care Forum” Currently 3500 members from all Forum” Currently 3500 members from all over the worldover the world

Twitter: (@PrimaryCare4um) 570 followers, Twitter: (@PrimaryCare4um) 570 followers, rapidly growingrapidly growing

Facebook-page: Primary Care ForumFacebook-page: Primary Care Forum