Primary Health Care

Primary Health Care DR DuaaHiasat Family Physician

Objectives: • Definition of health • Level of Care • Definition of PHC • Elements of PHC • Requirements for sound PHC • Difference between Out and Inpatient medicine • Fundamental Ethical principled in health care

Definition of health • it is a state of complete physical , mental ,social and spiritual wellbeing , the ability to lead a socially and economically productive life and not merely the absence of disease or infirmity.

Levels of Care • Primary health care • Secondary health care • Tertiary health care

Levels of Care Primary health care • The “first” level of contact between the individual and the health system. • Essential health care (PHC) is provided. • A majority of prevailing health problems can be satisfactorily managed. • The closest to the people. • Provided by the primary health centers.

Primary Health Care: • It is concerned with establishing a system of health which meets the essential needs of most of the population. • PHC aims to achieve full coverage with essential health care by distributing resources in order to obtain maximum benefit to people as a whole with lowest cost.

Levels of Care Secondary health care • More complex problems are dealt with. • Comprises curative services • Provided by the district hospitals • The 1st referral level

Levels of Care Tertiary health care • Offers super-specialist care • Provided by specialized center (institution). • Provide training programs

What is Primary Health Care? PHC is essential health care that is a socially appropriate, universally accessible, scientifically sound first level care provided by a suitably trained workforce supported by integrated referral systems and in a way that gives priority to those most in need, maximises community and individual self-reliance and participation and involves collaboration with other sectors. It includes the following: • health promotion • illness prevention • care of the sick • advocacy • community development

Primary Health Care (PHC) • PHC is: • Essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that community and the country can afford … (Alma-Ata, 1978)

Elements of Primary Health Care

Elements of Primary Health Care 1. Health Education concerning prevailing health problems and the methods of preventing and controlling them

Elements of Primary Health Care 2. Promotion of food supply and proper nutrition

Elements of Primary Health Care 3. An adequate supply of safe water and basic sanitation

Elements of Primary Health Care 4. Maternal and child health care, including family planning

Elements of Primary Health Care 5. Immunization against the major infectious diseases

Elements of Primary Health Care 6. Prevention and control of locally endemic diseases

Elements of Primary Health Care 7. Appropriate treatment of common diseases and injuries

Elements of Primary Health Care 8. Basic laboratory services and provision of essential drugs.

Elements of Primary Health Care 9. Training of health guides, health workers and health assistants.

Elements of Primary Health Care 10. Referral services

Mental health • Physical handicaps • Health and social care of the elderly

The Basic Requirements for Sound PHC (the 8 A’s and the 3 C’s) • Appropriateness • Availability • Adequacy • Accessibility • Acceptability • Affordability • Assessability • Accountability • Completeness • Comprehensiveness • Continuity

Appropriateness • Whether the service is needed at all in relation to essential human needs, priorities and policies. • The service has to be properly selected and carried out by trained personnel in the proper way.

Adequacy • The service proportionate to requirement. • Sufficient volume of care to meet the need and demand of a community

Affordability • The cost should be within the means and resources of the individual and the country.

Accessibility • Reachable, convenient services • Geographic, economic, cultural accessibility

Acceptability • Acceptability of care depends on a variety of factors, including satisfactory communication between health care providers and the patients, whether the patients trust this care, and whether the patients believe in the confidentiality and privacy of information shared with the providers.

Availability • Availability of medical care means that care can be obtained whenever people need it.

Assessability • Assessebility means that medical care can be readily evaluated.

Accountability • Accountability implies the feasibility of regular review of financial records by certified public accountants.

Completeness • Completeness of care requires adequate attention to all aspects of a medical problem, including prevention, early detection, diagnosis, treatment, follow up measures, and rehabilitation.

Comprehensiveness • Comprehensiveness of care means that care is provided for all types of health problems.

Continuity • Continuity of care requires that the management of a patient’s care over time be coordinated among providers.

The role of Primary Care Ultra – specialist Hospital – base General Specialist Community-based care Family Physician Threshold of care Phase of Symptoms Self Care Pre-symptomatic phaseUndetected disease Targets for preventive care Health The Clinical Iceberg and levels of care

Flow of Care Taking all symptoms, illnesses and health problems in a community 3 out of 4 are self managed by various means with only one in four being taken to primary care physician, of the latter only about one in ten consultation leads to referral to local hospital. Health Self – Care 75% Pry care Physician 25% Hospital 2.5% Flow of Care

*Reasons for increasing shift of health care from inpatient to outpatient setting • Expense: Outpatient care tends to be much less costly • Technologic advances: This allows sophisticated diagnostic and therapeutic measures to be performed without hospitalization

3)Patient preference: Managed care evolves to control costs while improving efficiency and quality of patient care. Managed care relies heavily on gatekeeper family physicians who try to solve their pt. problems before obtaining specialty consultation or expensive service and who efficiently coordinate pt. care.

Differences between outpatient & inpatient medicine: • Differences in disorders: a) Different spectrum of ailments (common things occur commonly) b) Symptoms often nonspecific e.g. tiredness & dizziness knowing how to approach this is skill unique to out p.t dr. d) Frequent psychosocial component 50% .

2) Differences in approach to evaluation & management a) More stepwise approach using time as ally. b) In addition to cure goals include prevention & maintenance of highest possible level of functioning. The focus not simply on disease or even symptoms but on P.T well being

3) Differences in physician – P.T relationship: in P.T setting physician – P.T relationship tends to be paternalistic physician write orders about their P.T& medical care is by team of doctors. P.T often unable to name the physician. In outpatient setting physician less paternalistic, more of health advisor & counselor whose ability to educate, persuade, and negotiate will determine whether the advice is followed or not.

Differences in physician rewards: Caring for p.t overtime, keeping them out of hospital and as healthy and functional as possible is both the challenge and the joy of out p.t primary care.

Society Housing Education Nutrition Safety Insurance PatientClinician Family norm Good Clinical setting / organization Cultural / ethic beliefs Health Knowledge / skills in prevention Personal lifestyle Communication Use of preventive services Patient education Readiness to change Practice style Access to care Role model Community resources Health insurance Public Health Immunization Preventive services Regulation Legislation Politics Media advocacy Factors in promoting good health and preventing illness

The physicians should understand • Why and when a person seeks medical attention • How he vies his own sickness • How he reports his symptoms and interrupts his feelings • What changes in his life occur because of his illness or treatment These factors are always influenced by the respective cultural background of patient and physicians.

Patients consider a good physician to be one who: 1) Shows genuine interest in them 2) Thoroughly evaluate their problems 3) Demonstrate compassion, understanding and warmth 4) Provide clear insight into what is wrong and what must be done to correct it.

Fundamental Ethical Principled in health care • Justice (or equity) • Respect for persons a) Respect for autonomy b) Informed consent c) Truth – telling d) Respect of confidentiality 3. Beneficence (doing good and not harming patient)

To Summarize Primary care is an approach that: • Focuses on the person not the disease, considers all determinants of health • Integrates care when there is more than one problem • Uses resources to narrow differences

Forms the basis for other levels of health systems • Addresses most important problems in the community by providing preventive, curative, and rehabilitative services • Organizes deployment of resources aiming at promoting and maintaining health.

THANK YOU

Primary Health Care