BY: DR EDWARD CHAGONDA MBChB (UZ), DIP. VEN. (UZ), DIP. VEN FOOTBALL MEDICINE (FIFA), MMED (Fam. Med) STELLENBOSCH (RSA) Family Medicine Specialist

Transcription

1 BY: DR EDWARD CHAGONDA MBChB (UZ), DIP. VEN. (UZ), DIP. VEN FOOTBALL MEDICINE (FIFA), MMED (Fam. Med) STELLENBOSCH (RSA) Family Medicine Specialist CPCPZ PRESIDENT

2 No financial association with any Health funders 2

3 13/9/2017 3

4 Definition of gatekeeping Quality Health care Ethical implications Advantages of gatekeeping Disadvantages Auditing Conclusion 13/9/2017 4

5 Patient Doctor/Care Provider Funder Resources Outcomes 13/9/2017 5

6 Holistic feeling of an individual or group of individuals that they have good health which they would actually have made an effort to achieve Patient Doctor/Care Provider Funder 13/9/2017 6

7 National policy issue Requirement of a 1 st point of care African context Gatekeepers as sieves Reduces care fragmentation Spain/ UK / USA / Scandinavian countries regulatory Belgium/ Australia/ Switzerland- not stringent 13/9/2017 7

8 Autonomy Truth telling, effective communication, Informed consent, Confidentiality Non maleficence (Do no harm) Beneficence (Do good) Justice- Fairness Giving to each that which is his due, distributive 13/9/2017 8

9 Extent to which health services provided to individuals and patient populations improve desired health outcomes 13/9/2017 9

10 Safe Effective Patient-centered Timely Efficient Equitable 13/9/

11 Clear health care path Equity in health Nil/ minimal co-payment Enhanced continuity ER visit decrease (Observation studies) Fewer hospitalisation Shorter length of stay 13/9/

12 Lower use of vertical Specialist Care Improves quality health Contains cost- unnecessary interventions reduced Holistic care Addresses co- morbidities Higher patient satisfaction with health care system 13/9/

13 Effective co-ordination of conditions Health promotion Preventative health Reduces duplication- waste Complete follow-up enhanced Room for effective co-management 13/9/

14 Poorly remunerated Administrators?? Not service providers!! Delayed referral Non-medical negative interference on the care path May lead to needy vertical specialist shortage Avoiding competition for patients Poor utilisation of health services? 13/9/

15 Patient satisfaction Health and patient related outcomes Financial sustainability: utilisation and expenditure 13/9/

16 Measure United Kingdom United States No of referrals to specialists per 100 consultations with UK general practitioners 8 or US family physicians % of referred patients keeping appointments * with specialists 8 % of patients with 1 referral to a specialist per year by a general practitioner or primary care physician gatekeeper No of specialists per population /9/2017 Gatekeeping 16 and Wellness Edward

17 Gate keeping Free access Notes Symptoms, morbidity No difference Quality of life Better Bodily pain and role limitations Satisfaction with care (64% vs. 75%, p < 0.05) 1 RCT Quality of care Better Few studies Utilisation of health care Overall reduction * Length of stay Hospitalisations* Ambulatory care Emergency department visits Expenditures 6-80% 13/9/2017 Gatekeeping 17 and Wellness Edward

18 Health care ecosystem survives on effective referral system 13/9/

19 6 Domains of quality health care. Available online at: hvsdcakhwgjd0gqfggkmaa&url=https%3a%2f%2fwww.ahrq.gov%2fprofessionals%2fquality-patientsafety%2ftalkingquality%2fcreate%2fsixdomains.html&usg=afqjcnf9tdsqcgvpvocizdll9xg76dz8bq. Accessed on 15 August Balancing rationalities: Gatekeeping in health care. Available online at: AhVIIMAKHTkxANYQFghsMAs&url=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC %2 F&usg=AFQjCNHJqx4mcmW8KtM4DMzewHTdUL3JUw. Accessed on 15 August Principles of bio ethics by Beuchamp and Childress. Available online at: AhXMK8AKHdWFA6AQFggnMAA&url=http%3A%2F%2Fblogs.biomedcentral.com%2Fbmcseriesblog%2F2012%2F07% 2F13%2Fmeasuring-the-four-principles-of-beauchamp-andchildress%2F&usg=AFQjCNH_4ZFI04A2V4wDAdRvmI45utQ0iw. Accessed on 15 August Primary care gate keeping and referrals effective filter or failed experiment?-ncbi The Effects of gate keeping: A systematic review of the literature- NCBI-NIH 13/9/