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PRIMARY CARE:

W O R K S H O P. PRIMARY CARE: Regional strategies to improve efficacy and equity while guarateeing economic sustainability. Strategies and results in Primary Healthcare in Andalusia. José L. ROCHA General Secretary for Quality and Modernisation Regional Ministry of Health

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PRIMARY CARE:

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  1. W O R K S H O P PRIMARY CARE: Regional strategies to improve efficacy and equity while guarateeing economic sustainability Strategies and results in Primary Healthcare in Andalusia José L. ROCHA General Secretary for Quality and Modernisation Regional Ministry of Health Government of Andalusia, Spain. josel.rocha@juntadeandalucia.es

  2. Overview • Andalusia and the APHS: Quick facts • Primary Care in Andalusia: • Historical overview • Main Features • Outcomes • Troubles and Challenges

  3. Andalusia and the Andalusian Public Healthcare System: Quick Facts

  4. Andalusia: Geographical situation and population • 87,597 Km2. • 8.302.923 inhabitants • 526.942 foreigners • 50% Europeans • 24% Americans • 21% Africans • 3% Asian • + 1.531.668 andalusian people living in other Spanish regions • + 140.000 andalusian people living outside Spain

  5. Andalusia: Political context • Political Autonomy since 1981 • Regional Institutions • Parliament • Government (“Junta de Andalucía”) • Court of Justice (TSJA) Jose A Griñán. President of Government Fuensanta Coves. Speaker of the Parliament Regional Parliament Regional Government Regional Court of Justice Lorenzo del Río. Chief Justice

  6. Andalusia: Social and Economic trends Source: Eurostat Source: Centro de Estudios Andaluces

  7. Andalusian Public Healthcare System: Main features 1,146 Primary care centers 360 Auxiliary offices for primary care 47 Public Hospitals (16,821 beds) 102,000 Healthcare professionals 9,390 M € Health Budget 2011, 6.67% GDP

  8. Primary Care in Andalusia Historic overview

  9. Legislation Timeline • 1978: Spanish Constitution • Establishment of the Autonomous Communities • Settlement of the Health protection as a fundamental right • 1978: Creation of the Family Medicine specialty • 1981: Statute of Autonomy of Andalusia • 1981: Transfer to the Andalusia Region’s Administration the responsibility on Public Health • 1984: Transfer to the Andalusia Region’s Administration the public network of hospitals, ambulatory clinics and rural offices • 1984: National Decree on basic structures for primary care (1st step of primary care reform) • 1986: Healthcare National Act • Change from a social security model to a NHS model • Healthcare as a right for all the population • Consolidation and extension of primary care level

  10. Situation Before the reform: Individual work of general practitioners No specific training No health prevention/promotion/education Isolated rural medicine Hospital-centric model Lower salaries than specialists Low prestige and self-esteem

  11. Primary Care in Andalusia Main Features

  12. Primary Care in Andalusia: Main features Organisation and planning Accessibility Teamwork Extended care Intensive use of ICT

  13. GP as a Gatekeeper Capitation: 1 GP/1,400 inhabitants Team of professionals working in a PC Centre Homogeneous territorial distribution Aggregation of PC Centres in “Districts” Supportive teams at Districts for Public Health purposes: Epidemiologists, Vets, Pharmacists… Professionals are civil servants Focus on health promotion and prevention

  14. Primary Care in Andalusia: Main features Organisation and planning Accessibility Teamwork Extended care Intensive use of ICT

  15. Accessibility 1146 Primary Care Centers (and 360 auxiliary offices) vs. 33 at 1986 Less than 15 min away for anybody 1 Family Physician every 1.400 people on average Primary care doctors represent 41% of APHS doctors (29% at 1986)

  16. Primary Care in Andalusia: Main features Organisation and planning Accessibility Teamwork Extended care Intensive use of ICT

  17. Primary Care in Andalusia: Main features: Organisation and planning Accessibility Teamwork Extended care Intensive use of ICT

  18. Primary Care professionals Family Physicians Community Nurses Pediatricians Midwives Dentists Physiotherapists Social Workers Psychiatrists/psychologists Epidemiologists Community Pharmacists Veterinaries Administration workers Auxiliary workers

  19. Primary Care in Andalusia: Main features: Organisation and planning Accessibility Teamwork Extended care Intensive use of ICT

  20. 105 Million of e-prescriptions/year 95 Million of appointments/year 3 Million of e-referrals/year Appointment Prescription Referrals Waiting lists Pathology Hospital admission Lab tests Functional tests Data warehouse Radiology Emergency care Inpatient care 3.5 Million of x-Ray images/year Outpatient care Primary care 7.9 Million of individual EHR Health Care Information and Management Integrated System

  21. Primary Care in Andalusia Outcomes

  22. Outcomes: Life expectancy and amenable mortality

  23. 2005 - Women 15-44 years old Mortality index in Andalusian municipalities vs. Spanish average Trend to convergence to Spanish average 2005 - Women 45-64 96%of municipalities have an index equal or lower than the Spanish average for people 65 years old or less Higher than Spanish average Non significative differences Lower than Spanish average 2005 - Women 65-74 The south-west area of Andalusia shows a mortality index higher than the Spanish average for the group of 65-74 years old people 2005 - Women 75-84 Source: Atlas Interactivo de Mortalidad en Andalucía (AIMA). Revista Española de Salud Pública 2008; 82(4) The majority of municipalities have a mortality index higher than the Spanish’ one for people with more than 75

  24. Outcomes: Health Expenditure OECD Health Data 2010.

  25. Outcomes: Health Expenditure Regional health expenditure (€ per capita). Spain 2007 Social and Economic Council of Spain, 2010.

  26. Outcomes: Health Expenditure on Primary Care Spain Andalusia Madrid Valencia Catalonia Ministry of Health and Social Policy. Spain, 2010.

  27. The Swedish Healthcare System: How does it compare with other EU countries, the United States and Norway? Swedish Association of Local Authorities and Regions,2008 Outcomes: Efficiency Desired direction

  28. Health spending in OECD countries: Obtaining value per dollars. GF Anderson, BK Frogner. Health Affairs 2008; 27:1718-1727

  29. Outcomes: Patient satisfaction General satisfaction on Primary care. Satisfied + Very satisfied (2/5). Institute for Social Studies of Andalusia. Spanish Scientific Research Council (CSIC)

  30. Primary Care in Andalusia: Key factors: Universality Lack of economic barriers for people Decentralisation Equitable planning of public resources Coordination and integration of care Community focus Extended basket of services Teamwork Clinical Management Professional commitment & leadership Long-term policies

  31. Troubles and Challenges • High Frequentation • Work overload • Chronic Patients • Excess of bureaucracy • Lack of Coordination with Hospitals • Continuous Medical Training • Impact of Feminisation • Desertification of Rural areas • Projected physician Shortage • Professional Migration • …

  32. http://www.opimec.org/

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