EFPC 2011 Conference | From patient centred innovation to organizational change
Foreword from EFPC
The biannual conference of the European Primary Care Forum in 2010 will explore a number of critical themes for primary care. Its aim is to enable participants to identify, define and appreciate the relevance of questions – ranging from policy to organization, management and clinical care – which are likely to determine the future of primary care in Europe.
For this the European Forum for Primary Care is happy to organize its’ 3rd biannual conference in close collaboration with the St Annaschool in Pisa, under the general theme “From patient centred innovation to organisational change”. This conference will be a great opportunity for Primary Care community to demonstrate its social accountability in Europe, operating in the context of a comprehensive patient centred and community oriented primary health care system. The members of the European Forum will be interested to discuss the key-aspects for reducing health inequalities, that are clearly present in the European context as well.
Although there are still 5 years to go, there are clear indications that the Millennium Development Goals (MDGs) will not be met by 2015. As one of the contributors to the development of the 2009 World Health Assembly resolution on Primary Care (WHA 62.12), the EFPC wants to take this resolution as the guideline for further development of policy advices.
Crucial for the success of the primary-health-care response to the MDGs is to ensure that Primary Care professionals continue to work in these communities. To make health care more effective, disease-specific vertical programmes should be implemented in the context of integrated primary health care (see: www.15by2015.org). Good practices can be found everywhere in Europe to integrate responsive primary care and provide a wide range of services. At the Pisa conference a number of these good practices, e.g.: Canada, The Netherlands, UK, Spain and of course hosting country Italy, will be presented through video presentations. A debate session will be held around the specific theme of Health Inequalities and Primary Care. All these examples will be underlined by high level key-note speeches from front-runners in this Community Oriented Primary Health Care system. We really look forward to the key-note address of Prof Barbara Starfield at the Conference.
We are happy to receive your contribution as well in this timely discussion on how to reach Health Equity in Europe as an example to the rest of the world.
In this context, six common pressures for change and development have been identified from a review of individual states’ current policies and relevant international research. These may be regarded as the formative influences on the future organisation of primary health care in Europe. Together they represent the imperative for shared learning.
The regional healthcare system of Tuscany is in itself interested in most of the themes as it is currently experimenting with chronic care management, interdisciplinary collaboration within primary care teams, performance evaluation systems and alternative prevention programs. In order to make this more concrete, the conference program will also include visits to local primary care centres and innovative service delivery facilities.
Conference: 30 & 31 August 2010
Scuola Superiore Sant’Anna – Pisa (Italy)
Dr. Giovanni Tognoni, Director, Consorzio Mario Negri Sud of Milan, Italy
Primary Care as a Permanent Opportunity of Research
A “good relationship” between Primary Care (PC) and research is most often presented as a recommendation, or a need, or an opportunity “for” PC: something however which appears more an optional strategy coming from outside of, and adapted for, PC.
Based on the most recent literature and working papers on this topic, but more specifically on the experience gained with large collaborative studies performed by Italian GPs, as well as on the emerging general trend towards the integration of the paradygm of efficacy (EBM) with the one on outcomes-effectiveness, the focus will be on the presentation of a concrete agenda of routine PC scenarios which cannot be managed appropriately nor responsibly, but with a formal (rigorous and highly pragmatic) research approach. The methodological and organizational challenges of translating these “protocols” into concrete projects will be given specific attention.
Prof Peter Groenewegen, director of the Netherlands Institute for Health Services Research, NIVEL in Utrecht, The Netherlands
Strengthening Primary Care in Weak Primary Care Systems
All European health care systems are facing a number of challenges, both relating to the demand for health care (such as increasing and changing health care needs; an ageing population that stays longer at home and has multiple health problems; better educated, more demanding patients) and to the organization of primary care (such as team organization, workforce problems, finding the right incentives, shifts between hospitals and primary care).
Strong primary care is helpful in dealing with these challenges.
European countries differ in how strong their health care systems are. Countries with weak primary care systems are e.g. Portugal, Belgium, Greece, Germany, Switzerland and France. In some of these countries, we see policy changes to strengthen primary care. These policy changes are usually small steps that are characterized by rather weak incentives and a voluntary basis for either or both the primary care providers and the patients
Prof Arnoldas Jurgutis at Klaipeda University, Lithuania. And member of the Primary health care expert group of the Northern Dimension Partnership in Public Health and Social Wellbeing, NDPHS
East Europe Experiences: Rethinking the Role of Primary Care
Primary health care reform was declared as a priority for all North East European countries since the early 1990s. External expertise from West European countries, through various technical assistant projects, guaranteed rapid changes and facilitated implementation of model PHC practices and development of human resources for PHC. There are a number of good PHC practices to demonstrate, nevertheless quite different development of primary health care organisation exist if compared between the countries and within the countries. Moreover there are examples that essential principles of PHC in some cases were neglected. Economic crisis and cuts in health care budgets forced to rationalise health care systems and one response to that is that the role of primary care was again reinforced. It is now high time for committed national policy makers to fortify genuine primary care in the East countries of the Baltic Sea region.
Dr. Ri DeRidder, Member of the General Management Committee of NIHDI, National Institute for Health and Disability Insurance, Belgium NIHDI, Belgium
Prioritizing Patient Centeredness and Primary Care Development in an Access Free and Fee for Service Health Care System: The Belgian Experience
The Belgian health care system is characterized by direct accessibility of almost all services and a prevailing fee for service payment system for health care professionals. The system is governed by agreements between insurers and professionals for each separate professional sector. The policy framework for these agreements is more defined by short term budgetary constraints and short term political priorities rather than a more strategic and long term health care system development and change approach. Health care system sustainability debate therefore is more oriented on system financing, rather than on system design. Partial decentralization of health policy has added to health system governance complexity. Notwithstanding these structural hurdles, primary health care has gained political attention for the last decade and the need for balancing more responsibilities towards primary care becomes gradually more recognized. Also, some patient empowerment strategies are now being put in place. Some of strategic change inducing measures will be discussed, like professional support for multidisciplinary collaboration between primary care providers, disease management trajectories, web-based medical file support, preventive care management, primary care registries,… Finally opportunities and hurdles for primary care development in a social security (Bismarckian type) based fee for service healthcare insurance system
Prof. Barbara Starfield of the John Hopkins Bloomberg School of Public Health , Primary Care Policy Center, Baltimore, United States of America
Primary Care and Specialty Care in an Era of Multimorbidity
Neither the number of visits nor the supply of health professionals has a high correlation with costs or outcomes of care. However, the strength of primary care health infrastructures, coupled with a supply of specialists that is not excessive that are generally associated with better health outcomes, better equity in health, and lower costs. Comprehensiveness is an important feature of primary care yet there is great variability in its achievement across areas and types of primary care physicians. Comprehensiveness is important to achieve patient-focused care over time and reduce unnecessary visits to multiple types of practitioners. It is increasingly important when multimorbidity (the simultaneous presence of different types of health problems in individuals) is increasingly the rule in populations (and especially in socially-compromised subpopulations). Multimorbidity is the leading influence on referrals to specialists and on subsequent costs of care.
Prof. Sabina Nuti, Director of Management and Health Laboratory, MeS, ass. Prof at Sant’Anna School in Pisa, Italy | Ms. Daniela Scaramuccia, Tuscany Health Directorate, Italy | Prof. Gavino Maciocco at University of Firenze, Public Health department, Florence, Italy
Improving Primary Care for Patient with Chronic Illness: Tuscan experience
Medical science advances and improved living standards have saved lives and contributed to longer life expectancy, yet industrialized nations now face the growing challenge of caring for patients with chronic diseases. Health systems initially designed to respond to acute, episodic illness increasingly care for patients with ongoing conditions, where the goals include preventing complications or deterioration rather than cure. Often coping with multiple conditions, chronically ill patients may see multiple clinicians at different care sites, increasing the risks of errors and poor care coordination. Across industrialized nations, chronically ill patients account for a disproportionate share of national health spending, placing them at the center of initiatives to improve health system performance.
Considering the epidemiologic trends involving Tuscany Region, which reflect those ongoing in the rest of Italy and in most high-income countries, and moving from the intention to align the Region’s interventions on this matter to the best international experiences in management of chronic diseases, the policy makers have chosen to enhance primary care by mean of a strongly patient centered approach with a specific reference to the Chronic Care Model (CCM), defined by Mac-Coll Institute for Healthcare Innovation. Tuscany Region has recently started a project to test this model, where providers are represented by team of general practitioners, nurses and other health workers who take care of targeted populations, i.e. people with chronic conditions as diabetes type II and chronic hearth failure.
Mr. Giorgio Visentin
Ms. Val Lattimer
Prof. Gavino Maciocco
Mr. Niro Siriwardena
Ms. Mona-Lisa Hagvide
Mr. Diederik Aarendonk
Prof. Sabina Nuti
Mr. Paolo Tedeschi
Mr. Paolo Tedeschi
MeS Laboratory Staff coordinated by:
Ms. Chiara Seghieri and Ms. Manuela Dal Poggetto
Mr. Diederik Aarendonk
Ms. Anouk Faassen
Ms. Alice Riva