FINAL CONFERENCE 11 of June 2009, Łodz, POLAND. Programme of the Final Conference Presentations from the Final Conference Photos from the Conference

Transcription

1 BRIDGING THE GAP OF GENERAL PRACTITIONERS' COMPETENCIES ON EUROPEAN MARKET Project n PL1-LEO (GAP PROJECT) FINAL CONFERENCE 11 of June 2009, Łodz, POLAND Programme of the Final Conference Presentations from the Final Conference Photos from the Conference

2 Programme BRIDGING THE GAP OF GENERAL PRACTITIONERS' COMPETENCIES ON EUROPEAN MARKET (GAP PROJECT) Transfer of Innovation ( PL1-LEO , Date: 11th June 2010 Place: Hotel Andel s, 17 Ogrodowa Street, Łódź, Poland Conference room: violet FINAL CONFERENCE OF THE LEONARDO DA VINCI PROJECT

3 Programme Participants registration and welcoming coffee Seminar session Participants welcome and presentations of the GAP Project s aims and objectives Adam Windak Life-Long Learning Programme funds for educational development of Family Physicians application possibilities Katarzyna Dubas Family Physicians role in the field of health promotion and disease prevention in the Project s partners countries: - Greece Athanasios Symeonidis - Lithuania Gediminas Raila, Linas Sumskas - United Kingdom Katarzyna Machaczek - Poland Maciej Godycki-Ćwirko, Artur Mierzecki Internet based tool for measuring Family Physicians competencies in the field of health promotion and disease prevention introduction to the workshop session Tomasz Tomasik Lunch break Workshop session part 1 Workshop measurement of the competencies level in the field of health promotion and disease prevention Coffee break Workshop session part 2 Workshop measurement of the competencies level in the field of health promotion and disease prevention

4 Presentations GAP Project s aims and objectives The Family Physicians role in the field of health promotion and disease prevention in Greece Family Physician Role in Health Promotion and Disease Prevention in Lithuania The role of the general practitioner in health promotion and disease prevention in the UK

5 GAP Project s aims and objectives

6 GAP Project - general information Project: Bridging the gap of general practitioners competence on European Market Leonardo da Vinci under Life-Long learning Programme, Action: Transfer of Innovation Partnership: The College of Family Physicians in Poland Health & Management Sheffield Hallam University Greek Association Of General Practitioners Kaunas University of Medicine Duration: November 2008 November 2010

7 GAP Project aims and objectives The main project goal is to define what are in practice the competencies of the GP in the field of health promotion and diseases prevention, in order to prepare educational programme bridging the gap in this area and guidebook with learning and teaching materials

8 Standarization of the project procedures: Health Promotion and Disease Prevention Framework

9 Tasks (work packages) WP1 Analysis of the training programmes and description of GP s role in health promotion and diseases prevention WP2 Analysis of the GP s competences which should be achieved during the specialization Products Report on educational system and the role of Family Physicians in the field of health promotion and disease prevention available at Report on GP s competences in the field of health promotion and disease prevention available at WP3 Development of the tool for measuring the level GPs professional competences Internet based tool for measuring gaps in Family Physicians competences in the field of health promotion and disease prevention available at WP4 Defining the deficit competences of GP s in the field of diseases prevention and health promotion List of deficit competencies WP5 Creation of the VET programme and guidebook Educational programme and guidebook

10 Educational programme and guidebook - structure EDUCATIONAL PROGRAMME what to teach? 1. Learning objectives General Specific 2. Educational methods 3. Assessment methods / tools GUIDEBOOK how to teach? Contents References (ENG and in national languages) Learning and teaching styles Trainning settings Dictionary of used terms and definitions

11 Content 9 structured chapters Area Subarea Programme chapters Gudebook chapters I. Educational competencies 1. Child & maternal health Chapter 1 2. Lifestyle Chapter 2 3. Environmental Chapter 3 1. Screening Chapter 4 Chapter appendixes (educational tools) Chapter appendixes (educational tools) Chapter appendixes (educational tools) Chapter appendixes (educational tools) II. Clinical competencies 2. Chronic disease management Chapter 5 Chapter appendixes (educational tools) 3. Preventive interventions Chapter 6 Chapter appendixes (educational tools) III. Organisational competencies 1. Information Chapter 7 2. Patient relationship Chapter 8 3. Local communities Chapter 9 Chapter appendixes (educational tools) Chapter appendixes (educational tools) Chapter appendixes (educational tools)

12 The Family Physicians role in the field of health promotion and disease prevention in Greece Athanasios Symeonidis

13 Basic law regulations Founding law of the NHS 1397/83 National Vaccines Scheme Personal Health Form PHC Health Centers GP/FM cure, prevention-promotion, rehabilitation, terminal care Network of 212 HC 1600 rural solo practices Nurses, visiting nurses, social workers, midwifes GP/FMs, Dentists, Pediatricians Involvement of Ministry of Education and Local Authorities

14 Practice running Health Education Program Personal initiative Cooperation: schools, local authorities, church, groups National Vaccines Scheme Personal Health Form Individual programs

15 Competence division between different levels of health care system National vaccines program PHC (GP/FM, Pediatrician, nurses) Personal Health Form PHC (GP/FM, Pediatrician, Dentist) Secondary Health Care - referals (specialists, e.g. cardiologist)

16 Competence division between different levels of health care system Cancer Prevention Ministry of Health Central Actions: campaign (TV, press, flyers etc) PHC (pap-test midwifes, GP/FM individualizedhealth education) Ministry of Education Health Education Program (trained teachers or/and GP/FM, specialists and other health professionals) Local Authorities Health Education Program (GP/FM, specialists, health professionals) Personal initiatives by GPs and specialists (individualized)

17 Competence division between different levels of health care system CVD prevention and life style changes promotion Central actions by Ministry of Health Individualized initiatives in practice running

18 Diagnosed competencies gaps (expert focus group) Analysis of curriculum of medical schools and existing legislations shows : Lack of orientation of medical studies (BME) towards to prevention and health promotion and of medical practice. There is a need of a clear job description of primary care physician (GP/FM). There is a need of description of educational objectives in BME and VT levels.

19 Diagnosed competencies gaps (expert focus group) More emphasis in acquiring of skills in developing, implementing and assessing of programs on prevention and health promotion. Lack of a comprehensive framework (laws, rules, roles, methods, assessment), on prevention and health promotion for GP/FM. Lack of motives: financial, technical, scientific.

20 Family Physician Role in Health Promotion and Disease Prevention in Lithuania Gediminas Raila, MD, PhD Linas Šumskas MD, PhD Kaunas University of Medicine, Kaunas, Lithuania

21 Lithuania is one of the three Baltic States, having regained independence in 1990.

22 HEALTH CARE REFORMS Congress of Physicians of Lithuania initiated Health Care Reforms National Health Care Concept was adopted 1997 Health Care Insurance system was started

23 FROM PASIVE TO ACTIVE HEALTH STRATEGY BIOMEDICAL DISEASE CONTROL MODEL THE MAIN AIM DEALING WITH OUTCOMES: SYMPTOMS DIAGNOSTICS TREATMENT & REHABILITATION SOCIAL-ENVIRONMENTAL DISEASE CONTROL MODEL THE MAIN AIM DEALING WITH PSYCHOSOCIAL RISK FACTORS - POSITIVE HEALTH, LIFE STYLE - ENVIRONMENT - MULTISECTORIAL COOPERATION

24 INIDIVIDUAL HEALTH CARE Three levels of Health Care: Highly specialized health care Specialized health care Primary health care (80-90% of services) Level III Level II Level I (PHC) Family Practice

25 POPULATION COVERAGE BY FAMILY PRACTICES Primary health care services provided by family doctors have been expanding: - 75% of total country population covered - 97 % of rural population covered

26 SERVICES OF FAMILY PHYSICIANS 200 public and 120 private FP clinics are operating in Lithuania (2009)

27 TRAINING FOR FAMILY PHYSICIANS Over 2200 family physicians have graduated from 2 universities 100 more have been studying at the residency

28 TRAINING FOR FAMILY PHYSICIANS 2 types of training: - residenship studies of new GPs - retraining of former pediatricians and therapeutists

29 PRIMARY HEALTH CARE FINANCING I. Compulsory health insurance (as the main source) II. State budget financing III. Private financing (persons and private services) IV. EU financing

30 PRIMARY HEALTH CARE FINANCING Health care system financing is based on compulsory health insurance

31 PRIMARY HEALTH CARE FINANCING Health care system financing is based on compulsory health insurance Capitation model: - PHC services are reimbursed for the list of patients - EUR 25 per patient per year Fee for services (since 2003, some elements implemented), covers % of the whole physician/nurse reimbursement

32 FAMILY PRACTICE INSTITUTION PROBLEMS Teaching curriculum covers the major areas of clinical, educational and organizational competencies. However, the methods of training are more theory and less practice oriented. Legal documents of health care fail to promote implementation into the practice of the skills acquired during the medical studies Family physicians are more likely to be involved in the clinical areas of the preventive work rather than in health education and especially in organizational work at the community level

33 FAMILY PRACTICE INSTITUTION PROBLEMS FPs does not operate at full professional competence Lack of motivation to perform quality and/or comprehensive services by FPs is observed Overloaded by paperwork: about 60 % of daily working time is spent by FPs on paperwork Insufficient financing does not allow to provide patient friendly services (short consultation time, long waiting list, bureaucratic referral system, lack of preventive activities) and keeps physicians on looking for additional earning regime

34 FP LEGISLATION THE MAIN DOCUMENT: Medical Norm MN 14: 2005 Functions, Competencies and Responsibilities of Family Doctors, 22 Dec 2005, No. V-1013

35 Section 13 is titled Domain of Health Care and Social Medicine, where the core public health and preventive care competencies are defined in very general terms: Family doctor should have competencies in the following: 1.Basics of organization of health care and primary health care 2.Should have knowledge and be competent in the following: A. Prevention of diseases and management of risk factors for diseases B. Principles of healthy life style and methods of health education C. Basics of occupational health D. Infectious disease prevention E. Cancer prevention

36 PRIMARY PREVENTION Children and adults immunisation Medical advices and health education Voluntary participation in community prevention programs

37 IMMUNISATION Lithuanian Immunisation Schedule concerns children under 18 years According to Lithuanian legal documents, a family practitioner must receive a signed agreement from parents before child vaccination Majority of vaccines are funded from the state budget

38 IMMUNISATION Schedule of vaccination is based on the international recommendations

39 LITHUANIAN IMMUNISATION SCHEDULLE Age Vaccine DTP Polio HiB MMR HepB BCG Birth HepB1 BCG 1 mo HepB2 2 mo DTP IPV HiB 4 mo DTP IPV HiB 6 mo DTP IPV HiB HepB ,516,5 mo MMR1 18 mo DTP IPV HiB 6-7 y. DTP IPV MMR y. Td

40 IMMUNISATION Influenza vaccine is suggested for people over 65 years and for the risk groups Diphteria and tetaus vaccine is suggested for everybody every 10 years These two vaccines are not obligatory Other vaccines are available in Lithuania too, but they are not free of charge for patients

41 SECONDARY PREVENTION Regular preventive health examination screenings Preventive early disease diagnostic programs

42 PREVENTIVE HEALTH EXAMINATION Regular health examination: A. Drivers health examination B. Employees health examination C. Children health examination

43 PREVENTIVE PROGRAMS Cardiovascular diseases risk screening Colorectal cancer screening Breast cancer screening Prostate cancer screening Cervical cancer screening

44 CARDIOVASCULAR DISEASES RISK EVALUATION Screen population includes years old men and years old women Family practitioner evaluates ECG, lipidogram, glucose, BMI, waist circumference, blood pressure, smoking status, patient s family history. Calculates SCORE index Evaluation should be repeated every 12 months If one of the following: total cholesterol over 7.5, SCORE index over 11, diabetes mellitus or metabolic syndrome, unfavourable family history are found, the patient should be sent to cardiologist consultation for further evaluation

45 COLORECTAL CANCER SCREENING Screen population includes years old men and women Immunochemical test of occult blood in faeces should be done If negative, test should be repeated every 2 years If positive, colonoscopy exam should be done

46 BREAST CANCER SCREENING Screen population includes years old women Mammography examination should be done Exam should be repeated every 2 years If result positive or doubtful, the patient should be sent to oncologist-mammologist consultation

47 PROSTATE CANCER SCREENING Screen population includes years old men Prostate specific antigen is checked Diagnostic test should be repeated every 2 years If PSA is greater than 3 ng/ml, the patient should be sent to urologist consultation for further evaluation

48 CERVICAL CANCER /DYSPLASIA SCREENING Includes years old women Women should be screened every 3 years PAP test should be done. If it is positive, the patient should be sent to gynecologist consultation

49 PREVENTIVE PROGRAMS IN KAUNAS REGION: PERCENTAGE OF SCREENABLE PATIENTS Cervical cancer 69.7 % Prostate cancer % Breast cancer % Colorectal cancer % Results of the Year Data Obtained From the State Patient Funds

50 Any further questions?

51 The role of the general practitioner in health promotion and disease prevention in the UK Katarzyna Karolina Machaczek Centre for Health & Social Care Research

52 Regulations setting out the responsibilities of the General Practitioner in relation to health promotion and disease prevention in the UK There is no one document that regulates the role of the GP in health promotion The emphasis on prevention was supported by the UK Government in in its White Paper (& implemented in the new GP contract in 1990* The responsibility of health promotion and disease prevention has been devoted to Primary Care Trusts *Department of Health and Welsh Office, General Practice in the NHS: the new contract: London, HMSO 1989

53 Regulations setting out the responsibilities of the General Practitioner in relation to health promotion and disease prevention in the UK The methods of regulating the role of GPs in health promotion: Contractual arrangements with General Medical Council (GMC) 13 November 2006 : 'Good Medical Practice' states that doctors should 'Protect and promote the health of patients and the public'

54 Regulations setting out the responsibilities of the General Practitioner in relation to health promotion and disease prevention in the UK Primary Care Trusts develop guidelines on health promotion in their areas and on what General Practitioners should concentrate on

55 The strongest incentives for the general practitioner QOF The Quality and Outcomes Framework (QOF) Introduced in 2004 as part of the General Medical Services Contract, the QOF is a voluntary incentive scheme for GP practices in the UK, rewarding them for how well they care for patients.

56 The strongest incentives for the general practitioner - QoF The Quality and Outcomes Framework (QOF) The QOF contains groups of indicators, against which practices score points according to their level of achievement. The QOF gives an indication of the overall achievement of a practice through a points system. Practices aim to deliver high quality care across a range of areas, for which they score points. Put simply, the higher the score, the higher the financial reward for the practice.

57 Regulations setting out the responsibilities of the General Practitioner in relation to health promotion and disease prevention in the UK Other sources of guidelines on health promotion and disease prevention: associated with the Department of Health s health priorities DEPARTMENT OF HEALTH. National Service Framework for Older People. London: DOH, 2001; AndGuidance/PublicationsPolicyAndGuidanceArticle/fs/en?CONTENTID= & chk=wg3bg0. ROYAL COLLEGE OF GENERAL PRACTITIONERS CURRICULUM STATEMENT 15.1 Cardiovascular Problems (a section on responsibilities in promoting health and preventing disease)

58 What does it look like in practice? There is an increased involvement of primary care in health promotion and disease prevention NHS formulate various strategies to achieve health promotion and preventative care in people through broad-basedbased screening and assessment in primary care This means a greater involvement in health education such as giving advice about diet, alcohol and smoking.

59 The division of responsibilities in health promotion and disease prevention General practice in the UK act as a team (including doctors and nurses) Often nurses screen for risk factors and provide advice on how to manage health-related behaviour, or may refer an individual for a doctor treatment As nurse-lead approach has a limited effectiveness, there is an increasing emphasis on the GP as a health educator

60 Photos from the Conference

61

62

63