Dept. Gen.Practice, CPH, Medical University of Vienna COMMUNITY ORIENTED PRIMARY HEALTH CARE Manfred...

Dept. Gen.Practice, CPH, Medical University of Vienna

COMMUNITY ORIENTED PRIMARY HEALTH CARE

Manfred Maier

Chairman,

Department for General Practice

Head,

Center for Public Health

Medical University of Vienna


CONTENT

• Roots of COPC• Determinants of Health- public health approach• Duties and opportunities for Primary Care

- clinical duties

- education – training – teaching

- mutual interaction with „Public Health – programs“


COPC - YESTERDAY

Pieter Brueghel, 1563, KHM Vienna


COMMUNITY ORIENTED PRIMARY CARE

HISTORY• South Afrika 1940• „Homelands“, rural areas • Nutritional deficits, Syphilis, Malaria, Bilharziosis,

Tuberkulosis, ...• Health Centres

- Prevention und treatment- health education- inclusion / activation of the „community“


HEALTH CENTERS

• methods- demography- influence on health- assessing morbidity- „community health status“- monitoring

• implementation - physicians - nurses- social workers Pieter Brueghel, 1568, Musée du Louvre


Incidence of new cases of syphilis in the Pholela defined area

Year No. of new cases Mid-year

population

Incidence per

1000 population

1943 12 887 13,52

1945 347 5184 6,69

1947 287 6524 4,40

1949 228 6622 3,44

1951 128 8549 1,50

1957 83 10496 0,79


COPC - TODAY


COMMUNITY ORIENTATION

• Community– A group of people, which live in a certain region and

under the same circumstances (politics, environment, occupation, social system,…).

• Characteristics– socioeconomic status– religious groups– ethnic – cultural groups– occupational groups– age groups


CONTENT

• Roots of COPC• Determinants of Health- public health approach• Duties and opportunities for Primary Care

- clinical duties




POPULATION HEALTH MODEL

• societies that enjoy a higher level and relatively equitable distribution of wealth enjoy a higher level of health status

• at the individual level, health status is determined by the social and economic environment and the way in which this environment interacts with individual psychological resources and coping skills.

Evans, 1994


NEJM 2007; 357:1221-1228


PUBLIC HEALTH - STRUCTURES AND STRATEGIES

• addressing all determinants of health• vaccinations, disease management programs,

health checks, … • working with different professionals and

organisations to improve health• influencing policy and plans for improving public

health • gaining visibility/awareness for public health


EXAMPLE FOR COPC: SUBSTITUTION PROGRAMM VIENNA

• appr. 10 000 drug addicts• withdrawal - substitution • goal: decent life in society• legal basis: SMG• agreement city – ÄK – WGGK• approx. 70 % cared for by GP´s


EVALUATION

• increase in patients and attendance• advantages of treatment by GP

– low threshold- easy access– existing relationship– „difficult“ patients– GP is „flexible“– decentralized care


GLOBAL HEALTH 2005

• One child dies of malaria in Africa every 29 seconds

• One person is infected with HIV every 6.4 seconds

• Someone in the world dies of TB every 18 seconds

• One pregnant woman dies of complications every 60 seconds

nature 2007


FACTS ARE NOT APPRECIATED:

• 95% of health care economy spent for direct medical care

• 5% invested in population - wide approaches to health improvement


CITIZENS PER PHYSICIAN:

Austria 212Belgium 299Denmark 372France 328Germany 333Netherlands 420USA 472

Malawi 158000


POOR COUNTRIES WITH SUPERIOR OUTCOME

• Emphasis on educational attainment• Empowerment of women• Well organized Primary Health Care System


CONTENT

• Roots of COPC• Determinants of Health - public health approach • Duties and opportunities for Primary Care

- clinical duties




THE PRIMARY CARE PHYSICIAN IN THE COMMUNITY

• Clinical responsibility• Role model – educator, teacher ?• Research opportunities ?• Initiator of change ?

• goal: improving the health status in the community


CLINICAL RESPONSIBILITIES

• Epidemiology in the community– documentation of health problems / diseases– identification of risks and needs

• Vulnerable groups / people in the community – psychiatric diseases, drug dependency, homeless

people, minorities, violence, …

• Allocation of resources / possibilities– rationalisation - rationing – overuse – misuse – underuse


BARRIERS FOR RECEIVING ADEQUATE HEALTH CARE

• financial reasons ?• distances, transportation ?• competing needs, priorities ?• educational level ?• psychiatric diseases ?• social context ?• fear, sense of shame ?• access to health care services ?• attitude of health care personnel ?


ACCESS TO HEALTH CARE

• Dependant on

- Availability in a community

- Personal care seeking behavior• Having an usual source of care improves

– Continuity of care– Preventive care– Prenatal care– Management of chronic diseases


THE PRIMARY CARE PHYSICIAN AS ROLE MODEL – EDUCATOR - TEACHER

• medical students, trainees, colleagues• patients

– disease specific information / education– general patient information

• industry, schools, institutions, associations, ...


RESEARCH OPPORTUNITIES

• participation in „community based projects“– population based studies– evaluation of research results / recommendations /

guidelines for daily practice– monitoring – documentation - registry for morbidity


INITIATIVES FOR CHANGE

• implementation of public health strategies– environment – drugs – alcohol – obesity – vaccinations – health checks


INITIATIVES FOR CHANGE - 2

• Feedback to health politics on health care aims or health care reforms– social disadvantages– social isolation– drug policy– violence– interface problems– injustice / inequity


Politics, Public Health

Programms

Patient centeredGP

implementation ?

disease centered

PHC

Family, Community, Population

Patient


THANK YOU FOR YOUR ATTENTION !

Dept. Gen.Practice, CPH, Medical University of Vienna COMMUNITY ORIENTED PRIMARY HEALTH CARE Manfred...

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