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Organizational Model of the Primary Medical Care Center
Partnership between
Odessa (Ukraine) – Boulder (U.S.A.)
Presented by V.V. Bespoyasnaya V.V.
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Partnership Objective:
The objective of the Odessa-Boulder partnership for 2001 is to develop the major components of the integrated
Primary Medical Care System (PMCS) based on the principals of family
medicine, including introduction of prevention programs and new
technologies in psychosomatic medicine
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Population Number of families Number of people in the population
Total Children
Student families (Family and Youth
Board)
50 150 50
Disadvantaged families
10 20 -
Families residing in the vicinity of the Center
100 350 85
Families of personnel of the Family Health Scientific Research
Center
50 175 61
Families of port workers
30 105 22
Total 240 800 218
Principal Characteristics of the Populations Served by the Primary Medical Care Center
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Date the Center opened and began to operate:May 31, 2000Organizational Structure
Type of facility Designation Number of rooms
Offices of physicians and nurses
Examination room,
Nurse’s room
6
1
Clinical-diagnostic unit X-ray room
Laboratory
2
1
Auxiliary rooms Registration
Break room
Laundry
Rest rooms
1
1
1
2
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Principal members of the Primary Medical Care Center Staff
Manning table (planned –12.5 positions, currently occupied – 6.0)
Position Title Planned number Actual number on 01/01/2001
Family physician 2 1
Assistant to the department of family medicine
2 1
Radiologists 0,5 -
Nurse manager 1 1
Family nurse 5 2
X-ray and lab technician 1 -
Nurse’s aid 1 1
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primary disease prevention services to the public (screening)
clinical work
preventive measures
funding
integration with other subdivisions of primary medical care
Work Priorities
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Work Priorities (Continue)Primary prevention (screening)
Risk assessment Patient history
Objective assessment
Reservometry (examination protocol)
Rating and possibility of follow up monitoring of preventive and therapeutic measures
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Work Priorities (Continue)Clinical Work
Development of standards for evaluation the quality of medical care
Enhancement of the role of nursesAdoption of new medical technologies
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Work Priorities (Continue) Preventative Measures
Clinic’s first priority – issues of reproductive health
Prevention of early pregnancy and STD and HIV-infections
Decrease of smoking rateDevelopment of a tuberculosis prevention
model
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Prevention programs to be implemented for high-priority issues and supported by the Information Processing and Analysis Center for Work with the PublicMain principle of funding for prophylactic programs: whatever resources remain after treatment programs shall be used to improve public healthIn the future, we plan to establish an Information and Health Maintenance Center to implement this principle
Work Priorities (Continue)Preventative Measures
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ФИНАНСИРОВАНИЕFinancing methods used by our Research Institute in the Past:
Most promising methods under the new PMCS model
Cash
Agreements with employers
Medical insurance and loans
Charitable funds
Funded scientific-research projects
Instructional activity
Investments
Government funding
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Funding of Family Medical Center
Companies Payment at time of service
Medical insurance Charitable medical services
Subscription fees
At time of service
(not involving cash)
Cash Voluntary medical insurance
Credit union
Disadvantaged
Students
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INTEGRATION OF PRIMARY MEDICAL CARE CENTER
Consulting polyclinic
Research Institute of the Public Health
Center
Laboratory-diagnostic division
Family medicine clinic
Multi specialty daytime
inpatient clinic
Family dentistry
clinic
Poison control center
Hospice Information processing and analysis center
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FAMILY DENTISTRY CLINIC Serves all members of the familyInteracts closely with the family medicine
clinicEmphasis on preventive careTreats patients at home
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POISON CONTROL CENTER
Information and consulting aid To the public To companies To medical institutions
Coordination of the activities of medical facilities providing emergency aidStudy of the causes of poisoning in the regionInformation support to the analytic center for developing preventive programs
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HOSPICE Coordination of the activities of social, medical, and
municipal services, public service organizations and volunteers
Care of incurably ill at home Provision of necessary equipment and supplies Inpatient care
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INFORMATION PROCESSING AND ANALYTIC CENTER
Analysis of indicators of health status and morbidity in the region
Identification of the highest priority medical problems
Development of therapeutic and preventive programs
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ISSUES IN SETTING UP A PRIMARY
MEDICAL CARE CENTER: ADMINISTRATIVE TECHNOLOGICAL ECONOMIC -need to change the traditional territorial principle of health care to which the directors of medical care facilities and the public are used to-limited possibilities in expert assessment of fitness to work-inadequate level of personnel training-lack of standardized accounting and reporting documentation-lack of an algorithm for interacting with other health care and maintenance facilities
-lack of indicators and parameters for evaluating the health of family members-primary prevention technologies-inadequate level of knowledge on primary prevention technologies-inadequate knowledge of related specialties-no criteria for assessing quality of performance
-no government funding-lack of mechanism for attracting other sources of funding-no mechanisms for including insured medical care
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PERIODIC ASSESSMENT OF CENTER’S PRIORITIES
Evaluation of the needs of the population served (Based on results of a sociological survey conducted in January, 2000)
30% of the population of Odessa experience difficulties obtaining adequate medical care20% of the population evaluates the existing health care system positively48% of the members population evaluate their own health as satisfactory17% as poor5% as very poor
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PERIODIC ASSESSMENT OF CENTER WORK PRIORITIES (continued)
Current priorities (revision of the model) and prediction of the way the Center’s activities will develop
Intensified work to prevent poisoning and accidents Help of public service organizations to recruit the public into the
healthy lifestyle movement Development of an infrastructure for working with the public Improvement of methods for observation of patients according to
the principles of risk assessment and reservometry Improvement of interactions with Health Care and Maintenance
Organizations Improvement of mechanisms for funding and economic support of
the Center
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USE OF EVALUATION METHODOLOGIES
Social marketing to study public opinion in the area of health care
Conducting patients’ surveys on the quality of the medical services they received
Incorporation of quality standards for provision of medical care
Medical cost effectiveness of the work of various primary medical care subdivisions
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Continued development of the concepts for primary medical care based on specific strengths of our partnership programPlan for implementing this model in other regionsImprove the multi-specialty approach to primary careStrengthen the role of nurses
PLANS TO DEVELOP THE PRIMARY
MEDICAL CARE MODEL
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PLANS TO DEVELOP THE PRIMARY
MEDICAL CARE MODEL (continued)
Continuation of work on clinical standards for primary medical care
Development of programs to train medical personnel in primary care
Development of strategies to ensure stable functioning of the program
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PRINCIPAL COMPONENTS OF THE PROGRAM STABILITY STRATEGY
Financial stabilitySocial stabilityAdministrative stabilityTechnical stability