Integrated service delivery in Portuguese primary health care

Integrated service delivery

in Portuguese primary

health care

23rd European Social Services Conference – Lisbon 2015, 6-8 July

Workshop session:

Connecting primary care and prevention for

integrated service delivery

António Pereira

, André Biscaia, Sílvia Machaqueiro

Research project:

Commissioning in Primary Health Care in Portugal:

Research and Practice – A Joint Approach

(“Contratualização em Cuidados de Saúde Primários: Investigação e Prática – uma abordagem conjunta”, ref. INSA/2011554EXT)

Outline

Why do we need integrated care?

What do we mean by ‘integrated care’?

Integrated service delivery

How to achieve health care integration?

Integration of care in Portugal

Measuring Integrated Care

Why do we need integrated

care?

•

One of the responses to current health system challenges

(ageing societies, burden of chronic disease,

multi-morbidity…)

•

Care patterns with multiple providers

“…a typical patient sees a median of two primary care physicians and

five specialists each year, in addition to accessing diagnostics,

pharmacy, and other services”

•

Achieving greater efficiency and value from health delivery

systems by:

•

Addressing fragmentation in patient services

•

Providing better coordinated and more continuous care

What do we mean by „integrated

care‟?

Organising principle for delivering

health care aiming at:

•

Improvement of patient

experience

•

Achieving greater value from

health delivery systems

•

Addressing fragmentation in

patient services

•

Enabling better coordinated and

more continuous care

Integration

involves connecting the

health

care system

(acute, community and

primary medical) with

other service

systems

(such as long-term care,

education or housing services) in order to

improve

outcomes

(clinical, satisfaction,

efficiency).

4

The Nuffield Trust, 2011; Leutz, 1999; Gröne & Garcia-Barbero, 2001

Concept bringing together

inputs

,

delivery

,

management

and

organization of services

related to diagnosis, treatment, care,

rehabilitation and health promotion.

Means to improve the services in relation to

access, quality, user satisfaction and efficiency.

5

The King’s Fund, 2013

Planning

Financing

Patient needs

at the centre

Different health

and social care

providers coming

together

Policy-makers

Leaders

Information systems

Information sharing

What do we mean by „integrated

care‟?

6

What do we mean by „integrated care‟?

Integrated Service Delivery

“The management and delivery of health services so that

patients receive a

continuum of preventive and curative

services

, according to their needs over time and

across

different levels of the health system

.”

Poor integration

of primary, secondary and tertiary care

lead to

inefficiency

and

lack of quality

, creating

unnecessary

difficulties

for health care users.

7

How to achieve health care

integration?

•

Development of disease

management programmes

•

Sharing of activity plans and

budget

•

Sharing of administrative

procedures

•

Integration of clinical data

•

Implementation of

communication systems

•

Case management

•

Creation of cross-disciplinary

teams

•

Training programmes involving

different medical professionals

•

Development of patient referral

systems

8

Integration of care in

Portugal

10

Horizontal integration

11

Still some barriers to integration of care:

•

Different

entry points

into the health system

•

Difficult

information flow

between institutions and

professionals

•

Separation between

health and social care

•

Little public provision of

community care services

in

Portugal (including long-term care)

However, some integration

mechanisms are already in place:

•

Clinical guidelines

•

Strengthening of the evaluation and quality culture

•

Development of

training and development plans

between clinical

leaderships in ACES and hospitals – emphasis on

interfaces among levels

of care

•

Implementation of

RNCCI

(2006) – under two different Ministries + links

with acute care hospitals and health centres

•

Creation of

Family Health Units

(USF) – primary care

13

Combines teams providing long-term care, social support and palliative activity within community services,

covering hospitals, local and district social security services, the Solidarity Network and municipalities.

14

Implementation of USF/FHU (Family

Health Units)

Restructuring of health centres →

Health Centre Groups

•

Population: 50.000 to 200.000

•

Management structure, shared

resources and tools

•

USF – self-organised,

multi-professional care-providing teams

•

UCSP – Equivalent to USF but under

the traditional model

•

URAP – Shared Resources

(psychologists; nutritionists; social

workers)

•

USP – Public Health Services

•

UCC – Community Care Unity (run

by nurses)

•

UAG - Management support unit

ARS – Regional Health

Administrations (x 5)

Ministry of Health

ACES - Health centre groups x 74 (55)

Hospitals

USF x 421

UCC x 232

UCSP x 459

USP x 74

URAP

UAG

Board

Executive Director

Executive Council

Clinical Council

Comunity Council

Functional Units

PHC Reform 2005

•

Integrated care processes

•

Joint action plans

Through cooperation between ACES’ and hospitals’ clinical

boards for some types of conditions

15

16

E

XAMPLE

OF

AN

INTEGRATED

CARE

PROCESS

FOR

PATIENTS

WITH

VASCULAR

RISK

Integration of care in Portugal

Some tools and mechanisms

Electronic referral system

PHC



hospital

(

Consulta a

tempo e horas

– CTH)

Development of referral

mechanism from a

whole-referral-cycle perspective: “starting point →

assessment → response → arrival

→ assessment” and conclusion of

the process in PHC.

Health Data Platform

Access to essential available

information:

•

Clinical assessment

•

Active problems

•

Exam results (including imaging,

therapies, risks and specific

alerts)

Integration of care in Portugal

Some tools and mechanisms

Portal BI|USF

•

Accountability

•

Sharing

procedures

http://www.biusf.pt/

19

http://www.biusf.pt/

Portal BI|USF

•

Accountability

•

Sharing

procedures

Integration of care in Portugal

Attempts at integrating care

provision

Organisational models

Source: Machaqueiro & Lapão, 2013

Family Health Unit Personalise d care Unit Community Care Unit Manageme nt Support Unit Public Health Unit

ACES

LOCAL HEALTH UNIT

(ULS)

Secondary care

(hospital)

Secondary care

(hospital)

Tertiary care

Family Health Unit Personalise d care Unit Community Care Unit Manageme nt Support Unit Public Health Unit

ACES

However, evidence shows ULSs

haven‟t met

integration and performance expectations

21

22

Source: Jornal Público

Source: Jornal de Negócios

However, evidence shows ULSs

haven‟t met

23

Source: Jornal Público

Source: Jornal de Negócios

However, evidence shows ULSs

haven‟t met

integration and performance expectations

Positive steps taken towards integrated

care in Portugal

24

OECD, 2015

•

Integration of clinical data

•

Implementation of

communication systems

•

Case management

•

Creation of cross-disciplinary

teams

•

Training programmes involving

different medical professionals

•

Development of patient referral

Challenges to integrated care

25

Measuring integrated care

26

Measuring integrated care

27

Thank you

23rd European Social Services Conference – Lisbon 2015, 6-8 July

Workshop session:

Connecting primary care and prevention for

integrated service delivery

António Pereira

, André Biscaia, Sílvia Machaqueiro

Research project:

Commissioning in Primary Health Care in Portugal:

Research and Practice – A Joint Approach

(“Contratualização em Cuidados de Saúde Primários: Investigação e Prática – uma abordagem conjunta”, ref. INSA/2011554EXT)

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