Primary Health Care Primary Health Care Center Model Center Model

Donetsk City Hospital 25

Friends may meet but mountains never

Goal of the Center Goal of the Center IN ORDER TO EFFICIENTLY USE HEALTH

CARE RESOURCES IT’S NECESSARY TO CREATE A MODEL COMMUNITY-BASED PRIMARY HEALTH CARE CENTER ON THE BASIS OF CITY HOSPITAL #25 AND DELIVER MEDICAL SERVICES TO ALL FAMILY MEMEBERS WITH AN ACCENT ON HEALTH PROMOTION OF MINERS, WOMEN AND CHILDREN.

Take care of the pence and the pounds will take care of themselves

Key Achievements in 2000Key Achievements in 2000 On the basis of Decree #989 of Cabinet of Ministers Ukraine

integrated actions were developed to take place on Oblast and city levels aimed at Family Medicine integration into Health Care.

With Executive authorities offices there were Oblast and City Coordination Committees established on integration of Family Medicine.

With the purpose to study medical and social aspects of family there was a questionnaire distributed in the community, its results reviewed and priorities established.

Out of nurses who were retrained some started to work as practicing nurses on their own on an experimental basis and cover age groups of patients who do not work. 3 nurses who graduated from «Leadership School» entered higher educational establishments: 2 - Medical University (Health Care Administrators), 1 - Management Academy.

Little is better than non

•A patient questionnaire was developed for the Family Ambulatory which is used by a practicing nurse. •In order to provide psychological and social support to families a mechanism of interaction with social services was developed. •Hospital staff have worked out a «Provision on Family Medicine Center» and currently developing job description for physicians and nurses of Family Ambulatory•There was a Community Council created under the auspices of the Hospital which includes members of different community groups, public organizations, professional associations of industrial enterprises, public education system, sponsors in order to promote community-oriented family medicine and attract non-budget funds. •Learning Resources Center was opened, special program to train medical staff in computer use was developed and training is on-going

As a cockroach on a hot stove

PHC Center Characteristic Features PHC Center Characteristic Features Catchment area population(total-19500

people,including 7640-miners,11860-their family members)

Morbidity Profile: occupational diseases of miners and general morbidity of miners and their family members;

Specificity: «black lung», dust bronchitis, peripheral nervous system diseases, hearing disorders, acute carbon monoxide poisoning;

Opening date: 27 February 2001

Each bird loves to hear himself sing

•Organizational StructureOrganizational Structure

Primary Health Care Centercity of Donetsk

Center«Family Medicine»

Center«Miners’ Health»

Center«Women and

Children Wellness»

Center «Women and Children Wellness»

Kramatorsk

As the tree, so the fruit

Center «Family Medicine»1)Center Director-12)Senior nurse-administrat.-13)Family physician-64)Family nurse-125)Lab doctor-16)Feldsher-labtech-37)Social worker-18)Procedure room nurse.-19)Health promotion nurse10)Receptionist-211)Junior nurse-3TOTAL:33

Center «Miners’ Health»1) Center Director -12) Senior nurse-administrat -13)ENT doctor-14)Oncology surgeon-15)Neurologist-16)Ophthalmologist-17)Dermatologist-18)Funct. Diagnostics speclst-19)Lab doctor-110)Radiologist-111) Feldsher-labtech -312)Nurse -1013) Health promotion nurse -114)Receptionist-215)Junior nurse-4TOTAL:30

Center « Women and

Children Wellness»

1) Center Director -12)Senior midwife-13)OB-GYN-14)Ultrasonography doctor-15)Gynecol.-mammologist -16)Family plan. physician-17)Internist-18)Pediatrician-19)Psychologist-110)Exam. office midwife-111)District midwife-312)Family plan. midwife-113)Pediatric nurse.-114)Receptionist-115)Junior nurse-2TOTAL:18

•Priorities:Priorities:- - Shift to family medicine through mechanisms of hospital shop and Shift to family medicine through mechanisms of hospital shop and district services district services - Training of physicians and nurses, team building - Training of physicians and nurses, team building - Increasing role of a nurse in treatment, diagnostics and prevention - Increasing role of a nurse in treatment, diagnostics and prevention of diseases by expanding her authority and increasing responsibility of diseases by expanding her authority and increasing responsibility - Delivery of accessible, quality, timely consultation and diagnistics - Delivery of accessible, quality, timely consultation and diagnistics services to miners and their family members at center «Miners’ services to miners and their family members at center «Miners’ Health» Health» -Carrying out a mutual project together with University of Illinois on -Carrying out a mutual project together with University of Illinois on program «Black Lung» (pneumoconiosis) program «Black Lung» (pneumoconiosis) - Partnership expansion- Partnership expansion- Accent not to treatment but prevention of diseases by increasing - Accent not to treatment but prevention of diseases by increasing community medical awareness and family responsibility for their own community medical awareness and family responsibility for their own health health - Implementation of principles, forms and methods of professional - Implementation of principles, forms and methods of professional activity of physicians and nurses taking into account social-activity of physicians and nurses taking into account social-demographic, medical-and-biological, psychological and hygiene demographic, medical-and-biological, psychological and hygiene characteristic features of each family characteristic features of each family

In every beginning think of the end

Difficulties during PHC Center Difficulties during PHC Center CreationCreation Attracting funds for reconstruction of an out-patient

facility building Family physicians and nurses lack work motivation Inadequate practical training of physicians and nurses

in the course of their retraining at Medical University and College

Nurses are not ready for expansion of their authority and increasing role and responsibility

Little medical awareness of community and little responsibility of a family for family members’ health

He deserves not the sweet that will not taste of the sour

Regular Assessment of Center’s Regular Assessment of Center’s Priorities of WorkPriorities of Work

Prospective needs of the catchemnt area population (assessment before Center opening):

In order to collect initial medical data about community health there was an anonymous questionnaire distributed among miners and their family members, and the following needs were established as a result of this effort: :

- Desire of the community to improve their health;- To have accessible, skilled medical care with capacity to

provide up-to-date diagnostics in a comfortable setting;- Medical providers need to have better attitude towards their

patients- To increase level of medical awareness of the community

Bind the sack before it is full

Indicators of Good PerformanceIndicators of Good Performance Increased level of medical personnel clinical practice knowledge in

the area of PHC, health of miners and women through development treatment protocols and guidelines

Increased number of medical providers who can deliver maximum care in the setting of Family Ambulatory and Consultation-and-Diagnostics Center «Miners’ Health»

Increased number of PHC Center medical providers who routinely use computers in their work

Assessment of current patient satisfaction with medical services and specialists by obtaining results of anonymous questionnaire from community once every 6 months

Improved access of patients to medical knowledge through development and carrying out educational programs and patient involvement into these programs

Proof of the pudding is the eating

Levels of Health Care Delivery to Community at Levels of Health Care Delivery to Community at City Hospital #25.City Hospital #25.

Out-patient facility №1 at city hospital №25Out-patient facility №1 at city hospital №25

1 Level

2 Level 2 Level

3 Level In-Patient Wards at №25

Family Ambulatory

Hospital Administration

Center«Miners Health»

Center «Women and Children

Health»

Internal Diseases Neurology Oncology Cardiology

Things past cannot be recalled

1 LEVEL:Family Ambulatory

Family physician –holds and distributes funds

2 LEVEL:Consultation-and-diagnostic centers

3 LEVEL:Specialized

in-patient care

Budget allocations per capita

Non-Budget Funds

Funds attracted through insurance companies

Payment from family physician fund for each patient on a completed visit basis

Consultations by subspecialists without refferal by family physician through purchasing insurance polices

Diagnostic examinations are provided through purchasing insurance policies

Payment from family physician fund per diesease groups requiring involvement of a clinic

Funds attracted by insurance companies

Scheme of Financing Levels of Medical Care at City Hospital #25 of Donetsk

Every cock sings in his own manner

Click for larger picture

•Social Sustainability:Social Sustainability:- - Primary health care has to be transformed with active Primary health care has to be transformed with active participation of community and regional public participation of community and regional public organizations with support of Community Council organizations with support of Community Council authority authority ..Management (organizational sustainability):Management (organizational sustainability):- With limited resources it’s important to distribute them - With limited resources it’s important to distribute them correctly as well as correctly distribute assignments correctly as well as correctly distribute assignments between personnel. Increased competency, expanded between personnel. Increased competency, expanded responsibilities and leadership of nurses shall bring responsibilities and leadership of nurses shall bring down the cost of in-hospital medical services. down the cost of in-hospital medical services. ..Technical Sustainability:Technical Sustainability:- Equipment provided by Partners shall improve - Equipment provided by Partners shall improve accessibility, quality of medical services and shall raise accessibility, quality of medical services and shall raise the hospital ratingthe hospital rating

It is easy to swim if another holds up your head

Cooperation with OthersCooperation with OthersOblast, City and District Power Authorities (executive

authorities)Project «Donetsk-Pittsburg-Twin Cities»Administration and Trade Unions of Coal Mines named

after E.T. Abakumov, A.A. Skochinskiy and «Lidiyevka»American Miners’ UnionScientific-Research Institute of Ecology and Problems of

Donbass Coal Industry (Donetsk)Academy of Medical Sciences Ukraine, Institute of

Occupational Medicine (Kiev)University of Illinois (Chicago)

There is safety in numbers

Cooperation with OthersCooperation with Others

Medical University and Medical College (Donetsk)Business and Professional Women League, Center

«Women for Women» (Donetsk)Women Council of Kirovskiy district (Donetsk)Trust «Donbasstransstroy» Donetsk Regional Educational Center under the auspices

of «Communities Partnership» Program International Volunteers Center (Pittsburg)Company «Carelift International»«Centerville Clinics» (Western Virginia)

There is safety in numbers