Health Centres for Primary and Long-Term Care

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Health Centres for Primary and Long-Term Care

Lessons Learned and Further Perspectives

Prof. Dr. Kerstin Hämel Carina Vössing, MPH

Universität Bielefeld

Fakultät für Gesundheitswissenschaften

AG6 Versorgungsforschung/Pflegewissenschaft

International Conference on Patient-Oriented Centres for Primary and Long-Term Care, Robert Bosch Stiftung

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Outline

I. Lessons to be learned from an international comparison of primary health centres

What can Germany learn from the primary care models of other countries?

II. On-Going Research

Project „Primary Health Centres – Concepts and Practices“ (Funding: Robert Bosch Stiftung)

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Lessons to be learned

1. Different countries – common challenges: Health and wellbeing for an ageing population. More and more people must cope with chronic conditions, multimorbidity and long-term care needs. For them, access to a continuum of health and social services is

necessary.

2. Comprehensive Primary Health Care – from the 1970’s till today

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Lessons to be learned

Jahrbuch 2014 Schaeffer et al. 2015 SVR 2014

3. Germany lacks a comprehensive primary health care model. Changing health needs as well as physician shortages in rural communities have opened the door to new approaches linked to international developments.

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Primary Care Definition

(Expert panel on effective ways of investing in health, July 2014)

„...primary care is the provision of universally accessible, integrated, person-centred, comprehensive health and community services,

provided by a team of professionals accountable for addressing a large majority of personal health needs.

These services are delivered in a sustained partnership with patients and informal care givers, in the context of family and community and play a central role in the overall coordination and continuity of peoples care“

Strong primary care:

•

•

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Lessons to be learned

4. Health Centresbringing professionals from different professions together under one roof to provide integrated health and social care have been established worldwide – to take over the responsibility for patient-oriented health care.

5. Multi-professional teamwork as an crucial factor for providing an holistic view of patients’ situation and addressing their multiple care needs.

6. In Germany, hierarchies between the health professions hinder new methods of team collaboration.

7. Professionalisation of nurses and therapeutic professionsis an important prerequisite of a cooperation on equal footing, and thus, providing chances for the further development of multi-professional teams.

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Interim Conclusion

Are there many ways to Rome?

Howdo we integrate international ‚best practices‘ into innovative health centre models in Germany?

Whatworks within the German health care system?

Howcan we meet patients‘ needs?

Further research is needed...

.... to analyse the models in depth, identify variations and understand potentials and challenges of different models.

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On-going Research:

Project PriKon

• Primary Health Centres − Concepts and Practices (4/2015 – 5/2017)

• Project coordination: Kerstin Hämel, Doris Schaeffer, Bielefeld

• Cooperation: Michael Ewers, Berlin, Andreas Büscher, Osnabrück

• Objective:comparative analysis of concepts and practices of health centres in different countries

• Proposals for the development of health centres in Germany

• Methods:literature research, expert interviews, field visits

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Slovenia

• First Health Centres were established in the 1920s; today they are widespread.

• Comprehensive services:general practice, community nursing, health education centre, physiotherapy, womens health, child and youth health, dental care, occupational health etc.

• New developments in chronic care, health

promotion and multiprofessional teamwork

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Slovenia: model practice

• 2011 model program; nationwide implementation until 2017

• New model of general practice: general practitioner (GP) + Assistant

Nurse + Primary Care Practice Nurse (bachelor degree)

• Tasks of the Primary Care Practice Nurse:

• assessment and monitoring of health status (8 chronic ilnesses)

• people with (high risk of) chronic conditions

• health education and promotion

• Coordination of care through shared patient records, close by offices (consultative involvement)

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Spain

• Health centres widespread

• Compact services: general practice, child and youth health, dental care, social work

• In the 1980s, primary care teams

were introduced at the national level

• Different implementation at the local level

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Spain:

Primary care teams

• Team: general practitioner, general nurse, assistant nurse, social worker, pediatrician, dentist, receptionist

• health professionals work independently within their scope of their practice

• general nurse: growing responsibilities for nurses in chronic and acute care, based on (local) protocols developed by multiprofessional teams

• regular weekly team meetings, multidisciplinary case discussion, shared patient records

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Outlook

• Slovenia did first steps towards GP-nurse tandems, in Spain primary care teams work in well-defined teamwork structures

– and Germany?

• Models and experiences from other countries can provide us with

ideas and guidance but we must develop our own method of implementing health centres in Germany.

• Systematic, documented concept development and well defined pilots