FINAL CONFERENCE 11 of June2009 , Łodz, POLAND ... conference...FROM PASIVE TO ACTIVE HEALTH...

BRIDGING THE GAP OF GENERAL PRACTITIONERS' COMPETENCIES ON EUROPEAN MARKET

Project n° 2008-1-PL1-LEO05-02080

(GAP PROJECT)

FINAL CONFERENCE

11 of June 2009 , Łodz, POLAND

Programme of the Final Conference

Presentations from the Final Conference

Photos from the Conference

Programme

BRIDGING THE GAP OF GENERAL PRACTITIONERS' COMPETENCIES ON EUROPEAN MARKET (GAP PROJECT)

Transfer of Innovation (2008-1-PL1-LEO05-02080, www.gapproject.klrwp.pl)(2008-1-PL1-LEO05-02080, www.gapproject.klrwp.pl)

Date: 11th June 2010Place: Hotel Andel’s, 17 Ogrodowa Street, Łódź, Poland

Conference room: violet

FINAL CONFERENCE OF THE LEONARDO DA VINCI PROJECT

Programme

11.00 – 11.30 Participants registration and welcoming coffee

11.30 – 13.00 Seminar session

• Participants welcome and presentations of the GAP Project’s aims and objectives – Adam Windak• Life-Long Learning Programme funds for educational development of Family Physicians – application possibilities –

Katarzyna Dubas• Family Physicians’ role in the field of health promotion and disease prevention in the Project’s partners countries:

- Greece – Athanasios Symeonidis- Lithuania – Gediminas Raila, Linas Sumskas- Lithuania – Gediminas Raila, Linas Sumskas- United Kingdom – Katarzyna Machaczek- Poland – Maciej Godycki-Ćwirko, Artur Mierzecki

• Internet based tool for measuring Family Physicians’ competencies in the field of health promotion and disease prevention –introduction to the workshop session – Tomasz Tomasik

13.00 – 14.00 Lunch break

14.00 – 15.30 Workshop session – part 1

• Workshop – measurement of the competencies level in the field of health promotion and disease prevention

15.30 – 16.00 Coffee break

16.00 – 17.30 Workshop session – part 2

• Workshop – measurement of the competencies level in the field of health promotion and disease prevention

Presentations

• GAP Project’s aims and objectives

• The Family Physicians’ role in the field of health promotion and disease prevention in Greece

• Family Physician Role in Health Promotion and Disease Prevention in Lithuania

• The role of the general practitioner in health promotion and disease prevention in the UK

GAP Project’s aims and objectives

GAP Project - general information

Project:

Bridging the gap of general practitioners‘ competence on European Market

Leonardo da Vinci under Life-Long learning Programme, Action: Transfer of InnovationAction: Transfer of Innovation

Partnership:

• The College of Family Physicians in Poland• Health & Management• Sheffield Hallam University• Greek Association Of General Practitioners• Kaunas University of Medicine

Duration:

November 2008 – November 2010

GAP Project

aims and objectives

„The main project goal is to define what are in practice the

competencies of the GP in the field of health promotion

and diseases prevention, in order to prepare educational

programme bridging the gap in this area and guidebook

with learning and teaching materials”

Standarization of the project procedures:Health Promotion

and Disease Prevention Framework

Tasks (work packages) Products

WP1 Analysis of the training programmes and description

of GP’s role in health promotion and diseases prevention

Report on educational system and the role ofFamily Physicians in the field of health

promotion and disease prevention

available at www.gapproject.klrwp.pl

WP2Analysis of the GP’s competences which should be

achieved during the specialization

Report on GP’s competencesin the field of health promotion

and disease prevention


WP3Development of the tool for measuring the level

GPs’ professional competences

Internet based tool for measuring gaps in Family Physicians’ competences in the field of health

promotion and disease prevention


WP4Defining the deficit competences of GP’s in the field

of diseases prevention and health promotion List of deficit competencies

WP5Creation of the VET programme and guidebook Educational programme and guidebook

Educational programme

and guidebook - structure

EDUCATIONAL PROGRAMME – what to teach?

1. Learning objectives

GUIDEBOOK

– how to teach?

• Contents• References (ENG and in national

1. Learning objectives• General• Specific

2. Educational methods

3. Assessment methods / tools

• References (ENG and in national languages)

• Learning and teaching styles• Trainning settings• Dictionary of used terms and

definitions

Content

– 9 structured chapters

Area Subarea Programme chapters Gudebook chapters

I.Educational

competencies

1. Child & maternal health

Chapter 1 Chapter 1 + 2 appendixes (educational tools)

2. Lifestyle Chapter 2 Chapter 2 + 2 appendixes (educational tools)

3. Environmental Chapter 3 Chapter 3 + 2 appendixes (educational tools)

Chapter 4 + 2 appendixes

II.Clinical

competencies

1. Screening Chapter 4 Chapter 4 + 2 appendixes (educational tools)

2. Chronic disease management


3. Preventive interventions


III. Organisational competencies

1. Information Chapter 7 Chapter 7 + 2 appendixes (educational tools)

2. Patient relationship


3. Local communities Chapter 9 Chapter 19+ 2 appendixes (educational tools)

The Family Physicians’ role

in the field of health promotion

and disease prevention in Greeceand disease prevention in Greece

Athanasios Symeonidis

Basic law regulations

• Founding law of the NHS 1397/83• National Vaccines Scheme• Personal Health Form • PHC – Health Centers – GP/FM• PHC – Health Centers – GP/FM

• cure, prevention-promotion, rehabilitation, terminal care

• Network of 212 HC – 1600 rural solo practices• Nurses, visiting nurses, social workers, midwifes • GP/FMs, Dentists, Pediatricians

• Involvement of Ministry of Education and Local Authorities

Practice running

• Health Education Program– Personal initiative– Cooperation: schools, local authorities, church, groups

National Vaccines Scheme• National Vaccines Scheme• Personal Health Form• Individual programs

Competence division between different levels of health

care system

• National vaccines program – PHC (GP/FM, Pediatrician, nurses)

• Personal Health Form– PHC (GP/FM, Pediatrician, Dentist)– Secondary Health Care - referals (specialists, e.g. cardiologist)


care system

• Cancer Prevention• Ministry of Health

– Central Actions: campaign (TV, press, flyers etc)– PHC (pap-test midwifes, GP/FM individualized-

health education)health education)• Ministry of Education

– Health Education Program (trained teachers or/and GP/FM, specialists and other health professionals)

• Local Authorities– Health Education Program (GP/FM, specialists,

health professionals)• Personal initiatives by GPs and specialists

(individualized)


care system

• CVD prevention and life style changes promotion

– Central actions by Ministry of Health– Central actions by Ministry of Health

– Individualized initiatives in practice running

Diagnosed competenciesgaps (expert – focus group)

• Analysis of curriculum of medical schools and existing legislations shows :– Lack of orientation of medical studies (BME)

towards to prevention and health promotion and towards to prevention and health promotion and of medical practice.

• There is a need of a clear job description of primary care physician (GP/FM).

• There is a need of description of educational objectives in BME and VT levels.

Diagnosed competenciesgaps (expert – focus group)

• More emphasis in acquiring of skills in developing, implementing and assessing of programs on prevention and health promotion.

• Lack of a comprehensive framework (laws, rules, roles, • Lack of a comprehensive framework (laws, rules, roles, methods, assessment), on prevention and health promotion for GP/FM.

• Lack of motives: financial, technical, scientific.

Family Physician Role in Health Promotion Family Physician Role in Health Promotion and Disease Prevention

in Lithuania

Gediminas Raila, MD, PhDLinas Šumskas MD, PhD

Kaunas University of Medicine, Kaunas, Lithuania

Lithuania is one of the three Baltic States, having regained independence in 1990.

HEALTH CARE REFORMS

1989 - Congress of Physicians of Lithuania

initiated Health Care Reforms

1991 - National Health Care Concept was adopted1991 - National Health Care Concept was adopted

1997 – Health Care Insurance system was started

FROM PASIVE TO ACTIVEHEALTH STRATEGY

BIOMEDICAL DISEASE CONTROL MODEL

THE MAIN AIM → DEALING WITH OUTCOMES:

•SYMPTOMS•SYMPTOMS•DIAGNOSTICS•TREATMENT & REHABILITATION

SOCIAL-ENVIRONMENTAL DISEASE CONTROL MODEL

THE MAIN AIM → DEALING WITH PSYCHOSOCIAL RISK FACTORS- POSITIVE HEALTH, LIFE STYLE- ENVIRONMENT- MULTISECTORIAL COOPERATION

INIDIVIDUAL HEALTH CARE

Three levels of Health Care:

Highly specialized health careLevel

III

Specialized health care

Primary health care(80-90% of services)

Level II

Level I (PHC)Family Practice

Primary health care services provided by family doctors have been expanding:

POPULATION COVERAGEBY FAMILY PRACTICES

doctors have been expanding:

- 75% of total country population covered

- 97 % of rural population covered

SERVICES OF FAMILYPHYSICIANS

200 public and 120 private FP clinics are operating in Lithuania (2009)

TRAINING FOR FAMILYPHYSICIANS

• Over 2200 family physicians have graduated from 2 universities

• 100 more have been studying at the residency • 100 more have been studying at the residency

2 types of training:

- residenship studies of new GPs

TRAINING FOR FAMILYPHYSICIANS

- retraining of former pediatricians and therapeutists

I. Compulsory health insurance(as the main source)

II. State budget financing

PRIMARY HEALTH CARE FINANCING

II. State budget financing

III. Private financing (persons and private services)

IV. EU financing

PRIMARY HEALTH CAREFINANCING

• Health care system financing is based on compulsory health insurance

PRIMARY HEALTH CAREFINANCING

Health care system financing is based on compulsory health insurance

Capitation model:Capitation model:- PHC services are reimbursed for the list of

patients- EUR 25 per patient per year

Fee for services (since 2003, some elements implemented), covers 25-30 % of the wholephysician/nurse reimbursement

FAMILY PRACTICEINSTITUTION PROBLEMS

• Teaching curriculum covers the major areas of clinical, educational and organizational competencies. However, the methods of training are more theory and less practice oriented.

• Legal documents of health care fail to promote implementation into the practice of the skills acquired during the medical studies

• Family physicians are more likely to be involved in the clinical areas of the preventive work rather than in health education and especially in organizational work at the community level

FAMILY PRACTICEINSTITUTION PROBLEMS

• FPs does not operate at full professional competence• Lack of motivation to perform quality and/or

comprehensive services by FPs is observed• Overloaded by paperwork: about 60 % of daily working

time is spent by FPs on paperwork• Overloaded by paperwork: about 60 % of daily working

time is spent by FPs on paperwork• Insufficient financing does not allow to provide “patient

friendly” services (short consultation time, long waiting list, bureaucratic referral system, lack of preventive activities) and keeps physicians on “looking for additional earning” regime

FP LEGISLATION

THE MAIN DOCUMENT:

Medical Norm MN 14: 2005 “Functions, Competencies and Responsibilities of Family Doctors”, 22 Dec 2005, and Responsibilities of Family Doctors”, 22 Dec 2005, No. V-1013

Section 13 is titled “Domain of Health Care and Social Medicine”, where the core public health and preventive care competencies are defined in very general terms:

Family doctor should have competencies in the following:

1.Basics of organization of health care and primary health care

2.Should have knowledge and be competent in the following:

A. Prevention of diseases and management of risk factors for diseasesB. Principles of healthy life style and methods of health educationC. Basics of occupational healthD. Infectious disease preventionE. Cancer prevention

PRIMARY PREVENTION

• Children and adults immunisation• Medical advices and health education• Voluntary participation in community prevention

programsprograms

IMMUNISATION

• Lithuanian Immunisation Schedule concerns children under 18 years

• According to Lithuanian legal documents, a family practitioner must receive a signed agreement from practitioner must receive a signed agreement from parents before child vaccination

• Majority of vaccines are funded from the state budget

IMMUNISATION

• Schedule of vaccination is based on the international recommendations

LITHUANIAN IMMUNISATIONSCHEDULLE

AgeAge VaccineVaccine

DTPDTP PolioPolio HiBHiB MMRMMR HepBHepB BCGBCG

BirthBirth HepB1HepB1 BCGBCG

1 mo1 mo HepB2HepB2

2 mo2 mo DTPDTP IPVIPV HiBHiB


6 mo6 mo DTPDTP IPVIPV HiBHiB HepB3HepB3

1515--16,5 mo16,5 mo MMR1MMR1


66--7 y.7 y. DTPDTP IPVIPV MMR2MMR2

1515--16 y.16 y. TdTd

IMMUNISATION

• Influenza vaccine is suggested for people over 65 years and for the risk groups

• Diphteria and tetaus vaccine is suggested for everybody • Diphteria and tetaus vaccine is suggested for everybody every 10 years

• These two vaccines are not obligatory

• Other vaccines are available in Lithuania too, but they are not free of charge for patients

SECONDARY PREVENTION

• Regular preventive health examination – screenings

• Preventive early disease diagnostic programs• Preventive early disease diagnostic programs

PREVENTIVE HEALTHEXAMINATION

Regular health examination:

A. Drivers health examinationA. Drivers health examinationB. Employees health examinationC. Children health examination

PREVENTIVE PROGRAMS

• Cardiovascular diseases risk screening• Colorectal cancer screening• Breast cancer screening• Breast cancer screening• Prostate cancer screening• Cervical cancer screening

CARDIOVASCULAR DISEASESRISK EVALUATION

• Screen population includes 40-55 years old men and 50-55 years old women

• Family practitioner evaluates ECG, lipidogram, glucose, BMI, waist circumference, blood pressure, smoking BMI, waist circumference, blood pressure, smoking status, patient’s family history. Calculates SCORE index

• Evaluation should be repeated every 12 months• If one of the following: total cholesterol over 7.5,

SCORE index over 11, diabetes mellitus or metabolic syndrome, unfavourable family history are found, the patient should be sent to cardiologist consultation for further evaluation

COLORECTAL CANCERSCREENING

• Screen population includes 50-74 years old men and women

• Immunochemical test of occult blood in faeces should be • Immunochemical test of occult blood in faeces should be done

• If negative, test should be repeated every 2 years• If positive, colonoscopy exam should be done

BREAST CANCER SCREENING

• Screen population includes 50-69 years old women• Mammography examination should be done• Exam should be repeated every 2 years• Exam should be repeated every 2 years• If result positive or doubtful, the patient should be sent

to oncologist-mammologist consultation

PROSTATE CANCERSCREENING

• Screen population includes 50-75 years old men• Prostate specific antigen is checked• Diagnostic test should be repeated every 2 years• Diagnostic test should be repeated every 2 years• If PSA is greater than 3 ng/ml, the patient should be

sent to urologist consultation for further evaluation

CERVICAL CANCER/DYSPLASIA SCREENING

• Includes 25-60 years old women• Women should be screened every 3 years• PAP test should be done. If it is positive, the patient

should be sent to gynecologist consultation• PAP test should be done. If it is positive, the patient

should be sent to gynecologist consultation

PREVENTIVE PROGRAMS IN KAUNAS REGION:

PERCENTAGE OF SCREENABLE PATIENTS

• Cervical cancer – 69.7 % • Prostate cancer – 27.79 %• Breast cancer – 14.80 %• Breast cancer – 14.80 %• Colorectal cancer – 13.00 %

Results of the Year 2009. Data Obtained From the State Patient Funds

Any further questions?Any further questions?

The role of the general practitioner The role of the general practitioner in health promotion and disease

prevention in the UK

Katarzyna Karolina Machaczek

Centre for Health & Social Care Research

Regulations setting out the responsibilities of the General Practitioner in relation to health promotion and disease prevention in the UK

� There is no one document that regulates the role of the GPin health promotion

� There is no one document that regulates the role of the GPin health promotion

� The emphasis on prevention was supported by the UKGovernment in in its White Paper (& implemented in thenew GP contract in 1990*

� The responsibility of health promotion and diseaseprevention has been devoted to Primary Care Trusts

*Department of Health and Welsh Office, General Practice in the NHS: the new contract: London, HMSO 1989


The methods of regulating the role of GPs in health promotion:• Contractual arrangements with General Medical Council

(GMC)• 13 November 2006 : 'Good Medical Practice' states that

doctors should 'Protect and promote the health of patientsand the public'


Primary Care Trusts develop guidelines on health promotion in their areas and on what General Practitioners should

concentrate on

The strongest incentives for the general practitioner – QOF

The Quality and Outcomes Framework (QOF)

Introduced in 2004 as part of the General Medical ServicesContract, the QOF is a voluntary incentive scheme for GPpractices in the UK, rewarding them for how well theycare for patients.

The strongest incentives for the general practitioner - QoF

• The Quality and Outcomes Framework (QOF)• The QOF contains groups of indicators, against which• The QOF contains groups of indicators, against which

practices score points according to their level ofachievement.

• The QOF gives an indication of the overallachievement of a practice through a points system.Practices aim to deliver high quality care across arange of areas, for which they score points. Putsimply, the higher the score, the higher the financialreward for the practice.


Other sources of guidelines on health promotion and disease prevention:Other sources of guidelines on health promotion and disease prevention:associated with the Department of Health’s health priorities

DEPARTMENT OF HEALTH. National Service Framework for Older People. London:DOH, 2001;

http://www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/PublicationsPolicyAndGuidanceArticle/fs/en?CONTENTID=4003066&

chk=wg3bg0.

ROYAL COLLEGE OF GENERAL PRACTITIONERS CURRICULUM STATEMENT 15.1Cardiovascular Problems (a section on responsibilities in promoting health and

preventing disease)

What does it look like in practice?

• There is an increased involvement of primary care inhealth promotion and disease prevention

•• NHSNHS formulateformulate variousvarious strategiesstrategies toto achieveachieve healthhealthpromotionpromotion andand preventativepreventative carecare inin peoplepeople throughthroughbroadbroad--basedbased screeningscreening andand assessmentassessment inin primaryprimary carecare

• This means a greater involvement in health educationsuch as giving advice about diet, alcohol and smoking.

The division of responsibilities in health promotion and disease prevention

�General practice in the UK act as a team (including doctors and nurses)

�Often nurses screen for risk factors and provide advice on how tomanage health-related behaviour, or may refer an individual for a doctortreatment

�As nurse-lead approach has a limited effectiveness, there is anincreasing emphasis on the GP as a health educator

Photos from the Conference

FINAL CONFERENCE 11 of June2009 , Łodz, POLAND ... conference...FROM PASIVE TO ACTIVE HEALTH...

Documents

Transcript of FINAL CONFERENCE 11 of June2009 , Łodz, POLAND ... conference...FROM PASIVE TO ACTIVE HEALTH...