Primary Health Care Challenges and Opportunities…

1. Primary Health CareChallenges and Opportunities… Jennifer Leuschner RN, BScN Manager, Primary Health Care GASHA

2. Lost in Translation… Primary, Secondary Tertiary Prevention Primary Care Primary Health Care Population Health Chronic Disease Prevention and Management Health Promotion

3. Health… …is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. World Health Organization 1948 ….is a resource for everyday life, not the object of living. It is a positive concept emphasizing social & personal resources as well as physical capability

4. evolution?

6. We Can’t focus on Risk Factors Alone

7. Poverty and Inequity

8. Challenges - What ‘s wrong with the system? • Too many patients are in acute care beds who should be receiving care elsewhere • Too many patients with chronic illnesses develop preventable complications • Too many people develop illnesses which are totally preventable • We are using our human resources poorly • The only determinant of health we seem to address is the health care services one

9. Every system is perfectly designed… To achieve the results it gets. W. Edwards Deming

10. Early Days of Primary Health Care

11. Primary Health Care Definition • Primary Health Care (PHC) is concerned with all the factors that promote health as they apply to a given population, not just personal health services. It addresses the factors that determine health such as income, social status, social support networks, education, employment, working conditions, social and physical environment, biology and genetic endowment, personal health practices and coping skills, healthy child development, gender, culture and health services • These factors are addressed within a system that has appropriate linkages. PHC is developed with the full participation of the people it serves. It empowers people to take care of their own health and to take an active part in planning, policy making and delivering health care services in their community

12. Principles of Primary Health Care • Population Health • Accessibility • Appropriateness • Intersectoral/Interprofessional • Continuity of Care • Community Participation • Efficiency • Affordable & Sustainable

13. Primary Care Definition • Primary Care is an important part of Primary Health Care and is a term used for the activity of a health care provider who acts as a first point of consultation for all patients. The aims of primary care are to provide the patient with a broad spectrum of care, both preventative and curative, over a period of time and to coordinate all of the care the patient receives.

15. The WHO recognizes that only a comprehensive primary health care approach will actually improve the quality of life and health outcomes of people in any society and that Primary Health Care must be modified to suit the differing needs of population groups.

17. Nova Scotia Priorities • Improving access to PHC services • Increase the emphasis on health promotion and wellness • Providers working in teams • Electronic Patient Record (EPR)

18. Opportunities • Primary prevention to avert illness entirely • Screening initiatives • Chronic disease management to decrease acute episodes • Chronic Disease Self Management • New Providers • Success

19. Opportunities cont’d • PHCTF – paid to get change started • Recommendations of a $1.0 M report in NS ….PHSOR report • …..(many more)

20. PHC in GASHA: the history • Sheila Sears hired in 2003 (PHC Transition Fund) • GASHA is innovative in finding money for projects – (AHTF, Drug Company $, Literacy $) • Roll out of NPs • GASHA hired first NP in 2005 – both clinical and community components • Approx 40 initiatives in our DHA in the first few years • LHCW, EMR, Cardiac Clinic, YHC Arichat

21. Our GASHA PHC team • 4 NPs • 1 RN • Dietitian • Behaviour Motivator • Coordinator • AHTF coordinator • Clerical support • Physiotherapist …team is growing

22. Role of the nurse in PHC • Population Health • Accessibility • Appropriateness • Intersectoral/Interprofessional • Continuity of Care • Community Participation • Efficiency • Affordable & Sustainable

23. PHC: What’s Cookin’ in GASHA? • Focus on Chronic Disease Prevention and Management

24. We are in the midst of crisis…..chronic disease is the cause. Our health system is not sustainable. We need a whole of community response to health, chronic disease and inequity

25. Chronic Disease in Nova Scotia 5800 people die per year from 4 chronic diseases • Cardiovascular Disease (Heart disease, stroke etc.) • Cancer • COPD (Chronic Obstructive Pulmonary Disorder) • Diabetes

26. Nova Scotia Context cont’d • 68% of Nova Scotians 12 years of age and over have at least one chronic condition (CCHS, 2002) • 70% of Health Care Costs related to Chronic Diseases (GPI Atlantic, 2002)

27. Impact of Chronic Disease In Canada: • NS highest death rate attributable to cancer • Second highest rate of diabetes • Chronic Disease account for 75% of all deaths in NS • Medical costs alone for chronic diseases in NS account for $1.2 billion/year • When combined with productivity losses they account for over $3 billion/year

28. U.S.A. Projected toll resulting from Quality Gap Healthcare Papers, Vol. 7, No. 4, 2007

29. Chronic Disease Prevention & Management Continuum (across the lifespan) Tertiary Prevention Prevent progression to complications and/or hospitalizations Prevent movement to at-risk group Prevent progression To established disease Draft – April 11, 2008

30. T.E.A.M.(Teaching Eating and Activity Management for Families)

31. Chronic Disease Prevention, Screening and Management Pilot Project in Culturally Diverse and Geographically Isolated Communities

35. Your Way to Wellness (Chronic Disease Self-Management Program)

36. Chronic Disease Self Management • Self-management is what people do every day: decide what to eat, whether to exercise, if and when they will take their medications. • Everyone self-manages; the question is whether or not people make decisions that improve their health-related behaviors and clinical outcomes.

37. Patient Contact with Health Professionals • GP visits per annum = 1 hour • Visits to specialists = 1 hour • PT, OT, Dietitian = 10 hours • Total = 12 hours with professionals • 364.5 days managing on their own or 8748 hours Barlow, J. Interdisciplinary Research Centre in Health, School of Health & Social Sciences, Coventry University, May 2003.

38. Aboriginal Health Transition Fund

39. Lindsay’s Health Centre for Women • Men’s Health Centre • Health Connections • Collaborative Practice Teams • Electronic Medical Record • Well Women’s strategy • Do I Need to See a Dr. Books • Patient Teaching Guides (Angina, COPD, Heart Failure, Heart Attack, Diverticular disease) • Health Literacy • Midwifery Program • Staff development (Cultural Safety, Motivational Interviewing

40. Tips For Better Health (adapted from Donaldson, 1999)  • 1. Don't smoke. • 2. Eat a balanced diet that includes plenty of fruit and vegetables. • 3. Keep physically active. • 4. Manage stress by making time to relax. • 5. If you drink alcohol, do so in moderation. • 6. Cover up in the sun and avoid sunburns. • 7. Practise safer sex. • 8. Take up cancer screening opportunities. • 9. Be safe on the roads: follow the Highway Code.

41. Tips for Staying Healthy(adapted from Dave Gordon Townsend Centre for International Poverty Research , University of Bristol) • Get yourself a good education. If you are illiterate, get some help. • Avoid being poor. If you are, try not to be poor for long. • Don't work in a stressful, low paid manual job. • Don't become unemployed. If you are, try not to stay unemployed for long. • Don't live in damp, low quality and crowded housing. • Don't live in a polluted environment.

42. What can you do now and in the future? • To improve health outcomes: • Don’t just moan about things (more $$) • Think outside the “health” services box (food security, literacy) • Be “p”olitical (lobby, join a board) • Ask “Why?” “If you always do what you have always done, you’ll always get what you always got” - PB

44. Thank you 