monitoring primary health care in finland - ndphs...six dimensions of healthcare quality by...
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Monitoring primary health care
in FinlandPaula Vainiomäki
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Quality, control, monitoring
• Finnish attitude has been more on the side on
leadership by information distribution, not by
control methods
• “Not everything that can be counted counts,
and not everything that counts can be
counted.”
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Six dimensions of healthcare quality
by Institute of Medicine
• Safe
– Avoiding harm to patients from the care that is intended to help them.
• Effective
– Providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit (avoiding underuse and misuse, respectively).
• Patient-centered (person-centred, people-centred)
– Providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.
• Timely
– Reducing waits and sometimes harmful delays for both those who receive and those who give care.
• Efficient
– Avoiding waste, including waste of equipment, supplies, ideas, and energy.
• Equitable
– Providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status.
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National monitoring, AVO Hilmo
Primary care register of care given
• All health centers send automatically data from
their electronic healthcare records to the
National Institute for Health and Wellfare (THL)
https://www2.thl.fi/avohilmo_report/report?id=diagnosis&palvelumuoto=7437&yhteystapa=
9407&ammatti=7390&year=2016&l=fi
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National primary care register of care given
• When and where who its treated by whom and how and when the first contact was made
• Diagnosis ICD-10, ICPC
• SPAT classification - What happens during consultations (400+ codes) (not used much)
• Vaccinations
• Dental care
• What followed after the episode
– Case closed, referral to hospital, follow-up visit …..
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Visits to health care centre doctors this year
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Registered causes of appointments ICD and ICPC, 70 percents
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Doctors are not registerating procedures according to SPAT system
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Close to 90 percents of appointments deal with medication
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Much more is done?
• Patient satisfaction studies locally
• Local projects around quality run by locals
• Control locally by management, how many
patients/ working hour, how is access to care, is
there waiting time, how quickly the phone is
responded, how many referrals, costs/doctor,
pDRG (classification and productization of
services), sickness leaves of staff etc.
• Some private ”quality” enterprises helping staff
to audit their own work, quite expensive ones.
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Prescriptions are done
through
national electronic system,
www.kanta.fi/en
All records are saved in
a national archive system
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Health promotion
in municipalities
TEA-viisari (sign/hand)
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TEA-Viisari
• Health promotion capacity building in municipalities. Search and compare results.
• https://www.teaviisari.fi/teaviisari/en/index
• TEAviisari describes municipalities' activities to promote their residents' health.
• TEAviisari is designed to support municipalities, regions and schools in the planning and management of health promotion work.
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How about information distribution?
• Official advices and recommendations by
ministries, county councils, THL etc.
• Quite few strict orders
• Health care staff is supposed to take care that
they work in an updated way.
• Very beneficial have been tools by the Finnish
Medical Society of Duodecim. The functions
are supported by the state, this far.
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Health gate at every GPs monitor, available for nurses as well
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Nearly every GP uses these every day
• An electronic manual for primary care, most useful. This is always open during appointments.
• More than 100 clinical current care guidelines in Finnish and in Swedishhttp://www.kaypahoito.fi/web/kh/suositukset
• Patient-versions (health library) http://www.terveyskirjasto.fi/terveyskirjasto/tk.koti?p_osio=109&p_teos=khr
• Electronic decision support system connects current care guidelines with the patient records, and informs the doctor. Integrated in most record systems. Supports with diagnoses, medication, laboratory results, drug interactions
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No recertification -
Continuing Professional Development?
• Resertification will come in the next years, but picking points, is it worth? No decision yet
• Currently doctors take care of their professional development themselves, as it is their moral obligation,
• The employers are responsible for the CPD and CME of the staff. They have to organised prerequisites for development and CME
• It is possible to record own careers to a special portfolio www.taitoni.fi
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This sounds fine, but is it?
• Are our indicators valid? Do they measure important and right issues?
• In the future Finland, all primary care providers must publish their quality data, so the patients can choose their primary care provider
• Do we know, how people feel, are they recovering, coping, are they empowered, how do they experience our services, how is the life-satisfaction.
• We know mainly figures and numbers
– Not everything that can be counted counts, and not everything that counts can be counted
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