GENERAL OBJECTIVES. Measuring the strength of primary care systems in Europe SPEC. OBJECTIVE / METHODS. METHOD for Instrument Development

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1 Measuring the strength of primary s in Europe Dionne Sofia Kringos, MSc Wienke Boerma, PhD NIVEL-Netherlands Institute for Health Services Research / Consortium - NIVEL (consortium leader) - University of Tartu -IRDES - Heinrich Heine University - University Witten/Herdecke - CERGAS - University of Tromso - Jagiellonian University - University of Ljubljana - IDIAP Jordi Gol - ScHARR - University of Leicester - WHO Europe - European Forum for PC - EUPHA -EGPRN - European Commission EUPHA Conference November 2009, Lodz, Poland GENERAL OBJECTIVES Establish information and knowledge on the state and of PC in Europe Create an infrastructure for repeated application Support exchange of PC information and good practice SPEC. OBJECTIVE / METHODS 1) PC Monitoring Instrument 2) Data collection in 31 countries Int./Nat. statistical datasets Policy documents Published literature Expert enquries Devoted network: National PC experts WHO-Euro EUPHA Eur. Forum PC EGPRN METHOD for Instrument Development Systematic literature review - key PC dimensions - relevance for health () outcomes - identification of PC indicators - expert consultation round 1

2 Preventable hospitalizations / ACSCs are an indication of potential inadequacies in PC, which can be related to: - maldistribution of PC resources - barriers to accessing PC - problems in continuity/coordination of - suboptimal prevention or early diagnosis Governance of PC Primary goals Policy on equality in access (De)centralization of PC management & service PC Quality Management Infrastructure PC Governance Primary goals Policy on distribution of human resources PC within the Ministry of Health; PC policy at regional or local level; (De)centralization of PC service delivery Etc... Coordination of quality management; Certification of providers; Licensing of facilities; Development of clinical guidelines Governance of PC Economic conditions of PC Patient advocacy Multidisciplinary collaboration Patient rights Has a governmental policy on cooperation or integration of PC sesrvices been laid down in a law or policy paper? Etc 2

3 PC expenditure Economic conditions Health coverage Employment status of PC workforce Total PC expenditure; Expenditure on prevention and public health Total PC coverage; Uninsured population; Out-patient medical coverage by social insurance Employment status of GPs of PC Remuneration of PC workforce Income of PC workforce Remuneration for salaried GPs; Remuneration for selfemployed GPs Income of GPs PC workforce Profile of PC workforce Status & Responsibilities of PC disciplines PC Workforce supply and planning Academic status of PC Medical associations Type of PC professionals; Age distribution GPs; Workload GPs etc.. Recognition/responsibilities of GPs; Financial status of GPs compared to a specialist; Attractiveness of FM among medical students Development of workforce supply in 5 yrs time; GP-specialist ratio; data available from planning Academic status of FM/general practice; Training in FM/ general practice; Training of PC (community/practice) nurses Professional association of GPs/nursed; Professional Journal on GP/nurses of PC Accessibility National Availability of PC Density available PC disciplines (per 100,000 pop.) of PC Geographic availability of PC Availability of GPs by region; Urban-Rural availability of GPs; Shortage of GPs; shortage of community pharmacists Accommodation of accessibility Affordability of PC To what extent do certain org. access arrangements exist in PC centres?; Appointment ; Opening hours; After-hours PC Cost-sharing for GP ; Patient dissatisfaction with PC prices Acceptability of PC Patient satisfaction with access of PC in general 3

4 Medical equipment available First contact for common health problems Treatment and follow-up of diagnoses Medical technical procedures Preventive Mother and child & Reproductive health Health promotion Range of medical equipment available Child with cough; Oral contraception; Pregnancy confirmation; Breast examination; Suicidal inclination; etc Chronic bronchitis; Congestive heart failure; Pneumonia; Diabetes; etc. Wound suturing; Excision of warts; joint injection; strapping an ankle etc. Allergy vaccination; testing for STDs; cervical cancer screening etc. Family planning; Routine antenatal ; Routine paediatric surveillance; etc.. Obesity counselling; Physical activity counselling; etc.. of PC Continuity of PC Longitudinal continuity of Relational continuity of Informational continuity of Continuity of PC Patient list ; Stability of Patient-Provider relationship Physician choice; Patient satisfaction - Electronic clinical support s - Referral - Incoming clinical information procedures - Specialist-GP communication of PC Gatekeeping Coordination of PC Do patients need a referral to access of PC Skill-mix of PC providers Shared practice; Cooperation within PC; substitution Integration of public health in PC Collaboration of PCsecondary Epidemiological data set; community health surveys Specialist outreach models 4

5 Prescribing behaviour of PC providers Quality of diagnosis and treatment in PC Quality of chronic diseases management Quality of PC Annual prescriptions Antibiotics consumption Avoidable hospitalization: -Dehydration/gastroenteritis; - Kidney infection; - Perforated ulcer; -Pelvic inflammatory disease; -ENT infections Diabetes (e.g. cholest. 5>mmol/l) COPD (e.g. lung function measurement) Asthma (e.g. hospital admissions) of PC Access to PC of PC Quality of Maternal and Child health Infant vaccination Quality of preventive Vaccine preventable ACSC (e.g. flu) Breast cancer screening Cervical cancer screening Quality of PC Efficiency of PC General practice efficiency Efficiency of PC Home visits Telephone consultations Duration of GP consultation GP consultations Referrals to medical specialists EXPECTED OUTCOME PC activity database 31 country reports Fact sheets Book on the state of PC in Europe Benchmark information Models of good practice Policy briefs Policy recommendations Thank You Dionne Sofia Kringos, MSc d.kringos@nivel.nl 5