Wellness approach in primary health care
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WELLNESS APPROACH IN PRIMARY HEALTH CARE. Dr Noridah Mohd Saleh Ketua Penolong Pengarah Bahagian Pembangunan Kesihatan Keluarga KKM . Background. Changing Paradigm : Illness to Wellness (expanded scope in 7MP) One of the 8 Future Health Goals

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WELLNESS APPROACH IN PRIMARY HEALTH CARE

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Wellness approach in primary health care

WELLNESS APPROACH IN PRIMARY HEALTH CARE

Dr Noridah Mohd Saleh

Ketua Penolong Pengarah

Bahagian Pembangunan Kesihatan Keluarga

KKM

BPKK


Background

Background

  • Changing Paradigm : Illness to Wellness (expanded scope in 7MP)

  • One of the 8 Future Health Goals

  • One of the main focus in 9MP

    - TWG paper “Achieving lifelong Wellness”

BPKK


Definition

DEFINITION

  • Health: “ is a state of complete physical, mental, and social well-being and not merely the absence of disease" (WHO, 1947, p. 1)

  • Illness : the response a person has to a disease; it is an abnormal process in which the person’s level of functioning is changed compared with a previous level

  • Wellness : an active process by which an individual progresses towards maximum potential possible, regardless of current state of health. Five dimensions of wellness (physical, socialcultural, emotional, intellectual &environmental)

BPKK


Primary health care

PRIMARY HEALTH CARE

Primary Care

Family Health

FHD / BPKK

“Illness” + “wellness”

BPKK


Future health goals

Future Health Goals

  • Wellness Focus

  • Person Focus

  • Informed Person

  • Self Care

  • Care provided at/near home

  • Seamless & Continuous Care

  • Service Tailored As Much As Possible (Empowerment) (to individuals and groups)

  • Affordable and Equitable

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The 8 hs goals

The 8 HS Goals

“ Wellness”

Not to be merely a theory

To be translated Into Action

“well” “ at risk” “ill”

BPKK


Why wellness approach

Why Wellness Approach?

BPKK


Challenges

Challenges

Disease Pattern

  • - 1 in every 10 has Diabetes

  • - 1 in every 5 deaths is due to

    Cardiovascular problems

  • - 1 in every 8 has Asthma

  • - Breast ,Cervix, Prostate Cancer

    Demographic

  • - 1 in 20 is an elderly

    ( 1 in every 10 by Year 2020)

  • Higher Demands and Expectations , Resource constraints,

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Top 10 dalys

Top 10 DALYs

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I prevent and reduce disease burden

I - Prevent and Reduce Disease Burden

  • 70% of total Health Budget

    • 2m inpatients

    • 40m outpatients

ILL

WITH RISKS

POTENTIAL RISKS

‘HEALTHY’ – No identified Risks

BPKK


Life expectancy

72, 76 (2005)

LIFE Expectancy

LIFE EXPECTANCY

AGE

BPKK


Health expectancy

AGE

Raised Blood Sugar

Periph Neuro

Diabetic Foot /amputation

Diabetes

Health Expectancy

HEALTH EXPECTANCY

AGE

BPKK


Experience

Experience

  • What have we learn from

    MCH services?

BPKK


Prevent and reduce disease burden

Prevent and Reduce Disease Burden

  • Experience from MCH WELLNESS Services

  • 30 years of investment

    • Maternal Mortality : 282(P) – 30 / 100,000 LB

    • Infant Mortality: 41(1970) – 5 /100,000 LB

  • Burden of Dis(2003) – Leading cause of DALY

    • Measles – 126

    • Polio – 102

    • Hypertension in Preg – 1,268

    • Maternal Sepsis - 171

    • Obstructed Labour – 14

IHD -113,887

CVD/Stroke -86,372

Major Depresn-67,211

Diabetes-56,390

>>OBESITY from 5% to 10-13 % in 10years??

BPKK


Prevent and reduce disease burden1

Prevent and Reduce Disease Burden

Experience from the MCH wellness Services

  • Screening

  • Examination & Immunisation

  • Health Education

  • Follow-Up & Home Visits

  • Treatment

IS

BPKK


Mch services investments

MCH Services Investments

  • Dedicated Clinics

  • Dedicated Staff

  • Trained Midwives and PHN

  • Trained Doctors and Obstetrician

  • Effective MCH & FP Protocols

  • Effective Referral System

BPKK


Current promotive and preventive limitations

Current Promotive and Preventive ‘Limitations’

  • Mass-address

  • Not-specific to client’s problems

  • Behavior modification unassisted

  • ‘Big Bang’ effect much desired

    individualised

    and personalised

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Wellness approach

Wellness approach…

  • How to do it?

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Proposing plan preventive maintenance approach

Wellness..

Proposing‘Plan Preventive Maintenance’Approach

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Primary health care1

Primary Health Care

“ Primary Health Care is The Thrust of Health Services”

  • Kontek di peringkat temu-pertama di antara pesakit dengan sistem penjagaan kesihatan (personel kesihatan )

  • Menekankan ‘equity, accessibility, affordability and appropriate technology’

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Ninth mp consolidation

Ninth MP - Consolidation

Primary Goals

  • Prevent and Reduce Disease Burden

  • Enhance Health Care Delivery

    Supporting Goals

  • Optimisation of Resources

  • Enhance Research

  • Manage Crisis and Disasters

  • Strengthen Health Information MS

BPKK


Prevent and reduce disease burden2

Prevent and Reduce Disease Burden

Health Promotion, Screening, Early diagnosis, Prompt Treatment, Rehabilitation

Integrated services

BPKK


Existing framework

Rajah 1

Jenis perkhidmatan yang disediakan di KK

Klinik ibu dan anak

Klinik sihat

Klinik kesihatan mental

Klinik berhenti merokok

Klinik diabetes

Klinik warga tua

Klinik Perancang Keluarga

Klinik hipertensi

Klinik reproduktif

Klinik remaja

Klinik tibi

Klinik OKU

Klinik pesakit luar

Klinik pekerja

Perkd. Kecemasan

Farmasi, Makmal, Radiologi

Maklumat Kesihatan

Existing Framework

BPKK


Services provided kk 2 3

Kesihatan Ibu

Ibu Mengandung

Pemeriksaan kesihatan, kandungan dan darah

Lawatan ke rumah

Ibu Bersalin

Menyambut Kelahiran

Ibu Lepas Bersalin

Pemeriksaan kesihatan

Pemeriksaan bayi

Lawatan susulan di rumah

Khidmat perancang keluarga

Promosi susu ibu

Kesihatan Anak

Pemeriksaan kesihatan

Imunisasi

‘Early intervention Program’

Lawatan ke rumah

Kesihatan Sekolah

Pemeriksaan kesihatan murid-murid Tahun 1, 6 dan Ting 3

Pemeriksaan fizikal

Imunisasi

Rawatan dan rujukan

Perkhidmatan pergigian

Promosi kesihatan

Kesihatan persekitaran sekolah

Kesihatan Remaja

Promosi Kesihatan

Penyaringan, penilaian dan pengurusan risiko

Pemeriksaan kesihatan

Rawatan dan rujukan

Kaunseling - pemakanan, merokok

Kesihatan Warga dewasa

Promosi Kesihatan

b) Perkhidmatan penyaringan dan penilaian risiko

Perkhidmatan pengurusan risiko

Pemeriksaan kesihatan

Perkhidmatan kesihatan reproduktif

Kaunseling

Rawatan dan rujukan

Kesihatan Wargatua

Promosi Kesihatan

Pemeriksaan kesihatan

Pemeriksaan pergigian

Rawatan dan rujukan

Kaunseling dan Rehabilitasi

Kesihatan Mental

Promosi Minda Sihat

Penyaringan – faktor risiko, DASS, gaya tindak

Intervensi awal / susulan – teknik relaxasi, urutan leher dan bahu

Pengurusan pesakit – psikososial, farmakologikal

Rujukan

Rehabilitasi

Rawatan pesakit luar

Menerima dan membuat rujukan

Penyiasatan awal

Rawatan dan rawatan susulan (kes kronik)

Khidmat pakar (kes akut, kronik, kecemasan)

Perkhidmatan rawatan kecemasan (pra hospital/Ambulatory Medical Emergency)

Rawatan pembedahan kecil

Pengendalian kes perundangan perubatan (medico-legal)

Notifikasi kes

Promosi kesihatan

Services Provided – KK (2)&(3)

BPKK


Services provided kk

Pemakanan dan Dietetik

Promosi makan secara sihat

Pengurusan berat badan

Pengurusan pemakanan pesakit kronik

Rehabillitasi pemakanan

Dapur sihat / kafeteria sihat

Kesihatan Pergigian

Promosi kesihatan pergigian

Saringan dan Pemeriksaan kesihatan pergigian

Rawatan

Rujukan pakar

Kesihatan Pekerja

Pemeriksaan kesihatan – pre employment, routine medical examination

Penilaian risiko pekerjaan / hazard

Rawatan dan rujukan

Siasatan penyakit/wabak

Rehabilitasi

Pemulihan anggota

Pemulihan cara kerja

Pemulihan pertuturan

Pemulihan pendengaran

Surveilan kesihatan

Pengesanan kes secara aktif dan pasif

Pengesanan kontak

Pengesanan kes tercicir

Promosi kesihatan

Perkhidmatan sokongan

Perkhidmatan patologi

- Pengendalian spesimen

- Ujian makmal

Perkhidmatan pengimejan diagnostik

- X Ray dan Ultrasound

Perkhidmatan farmasi

- Pendispensan ubat-ubatan

- Kaunseling

Services Provided - KK

BPKK


Current challenges phc

Current challenges - PHC

  • High load of patients to doctor

    • (30m & 13m) = 40 -50 m (total encounters)

    • (Medical assistants / Nurses)

      • 1000 drs (130 FMS)

      • 6300 nurses (3700 SN)

      • 2000 MAs

  • Increasing scope of services

  • Lack of building space and equipment

  • Poor maintenance

  • Increasing demands by clients

BPKK


Review the deliverables

Review the deliverables

  • Process

    • Integrated wellness screening adult elderly

    • Risk Management

    • Reorg clinic illness

  • Physical

  • Outcome

    • Percentage of the population / community assessed, without risk, with risk,

BPKK


Wellness approach in primary health care

Process of healthcare delivery Need to enhance : Fast Access, Safe and high quality ,Hassle-free and greater comfort

  • Optimisation of Resources

    • Multi-skilling, Sharing, Remote management

    • Enhance Research

    • Participate towards evidence based planning and intervention

  • Manage Crisis and Disasters

    • Increase HR capacity and capability

    • Adequate and appropriate facilities

    • ‘Current’ protocols for management

  • Strengthen Health Information MS

    • Enhance sharing of data and info facilitate continuity of care

BPKK


Wellness approach in primary health care

  • What do we offer ?

    Wellness services

BPKK


Objektif klinik wellness

OBJEKTIF KLINIK WELLNESS

  • Meningkatkan kesedaran pemeriksaan kesihatan di kalangan komuniti ( Bilangan kedatangan kes baru)

  • Meningkatkan pengesanan awal kes-kes yang berisiko tinggi (Bilangan kes yang mempunyai risiko)

  • Memperkasakan komuniti untuk melakukan pemeriksaan kesihatan sendiri (Bilangan pelanggan yang dapat melakukan pemeriksaan sendiri dengan betul)

  • Mengurangkan morbiditi ( Bilangan intervensi yang berjaya)

BPKK


Wellness target groups

Wellness - Target groups

  • Healthy population

  • Aged from 10 to >70 years

  • Follow up interval every 5 years

  • Followed-up patients for counseling and health education

  • Patients for Rehab follow-up

BPKK


5 outcome

I - “Wellness Clinic”

Ibu

Anak

Remaja

Dewasa

Warga Tua

II - “illness Clinic”

Kecemasan

Akut

Kronik

Penyakit Berjangkit

  • III - Emergency

  • Support Pre-hospital

  • ‘Support Call centre’

  • Support Rapid Response

III - “Support Services”

- Makmal

- Farmasi

- Radiologi

- Sistem Informasi dan komunikasi

(5) Outcome -

Wellness Service

“ Womb – Tomb”

  • Maternal

  • Child

  • Adolescent

  • Adult

  • Geriatric

School Health

Home Visits

Home Nursing

BPKK


Prevent and reduce disease burden3

Prevent and Reduce Disease Burden

  • Treat the ill

  • Manage those with risk

  • Prevent the onset of preventable risks

    IMPROVE HEALTH EXPECTANCY

WELLNESS SERVICES

BPKK


Approach

Medical

Nutrition

Exercise

Smoking

Minda Sihat

PT/OT

HEd

- Occ Health

Maternal

Childhood

Remaja

Dewasa Wanita

Dewasa Lelaki

Wargatua

Approach :

BPKK


Health services in clinic

Health Services In Clinic

Adolescent

Adult

Geriatric

Mental health

BPKK


Reviewed approach physical

Reviewed Approach - Physical

I - “Wellness Clinic”

Ibu

Anak

Remaja

Dewasa

Warga Tua

II - “illness Clinic”

Kecemasan

Akut

Kronik

Penyakit Berjangkit

School Health

Home Visits

Home Nursing

  • III - Emergency

  • Support Pre-hospital

  • ‘Support Call centre’

  • Support Rapid Response

III - “Support Services”

- Makmal

- Farmasi

- Radiologi

- Sistem Informasi dan komunikasi

Wellness

Illness

Support

Emergency

BPKK


Wellness approach in primary health care

BPKK


Wellness approach1

Wellness -approach

  • Appointment

  • Integrated, Comprehensive Screening according to age group

  • Clinical Pathway in management of risks (Evidence Based)

  • Health education and Behavior modification / rehabilitation

BPKK


Risks reduction prevention

Risks reduction / prevention

  • Maternal and Child Mortality and Morbidity

  • Adolescent – Geriatric Mortality and Morbidity

    - 10 top Disease Priorities

    • IHD & Cardiovascular

    • Cerebrovascular

    • Diabetes

    • Depression, anxiety, stress, schizophrenia

    • Injury

    • Cancer

    • Congenital

    • Asthma

BPKK


Risk assessment by age gp

Risk Assessment by Age Gp

For Female Adult

Osteoporosis

For Older Adult

Stroke

For Child and Adolescent

Child and Adolescent Health Risk Profile (Text Version)

BPKK


Screening tool

screening tool

  • Self

  • Assisted

BPKK


Wellness ppp activities services

Guided Self-Check

Checklist for Risk Screening according to age group

Triage

Counseling and Health Education

Risk Assessment

Risk Management

Wellness (PPP) Activities / Services

Resource Implications:

  • Space - BIG

  • Equipments

  • Training

  • HR

    • Dr

    • Dietician

    • Health Education Officer

    • Medical Assistant

    • Nurses

    • Clerical

Process Implications:

  • Consolidation of islands of clinics

Adolescent, Paps smear, BSE, HRT, Men’s, OKU, CVD, PSR, Occ health, geriatric health, ….

BPKK


Self risk assessment

Self Risk Assessment

  • Butir peribadi (perubatan peribadi & keluarga)

  • Penilaian Fizikal (BMI, secondary sexual development/reproduktif, pemakanan, pergigian,

  • Senaman

  • Penilaian Minda Sihat (Risiko Murung /Resah/ )

  • Penilaian Tingkahlaku Berisiko (dadah/rokok / sexual habits penderaan/ Kecederaan)

  • Pengurusan Risiko :

    - Klinikal /pemakanan/senaman/minda sihat

    sokongan moral (e.g kaunselor, psikologis

BPKK


Achieving lifelong wellness

- “Achieving lifelong Wellness”

5 Areas to be strengthened

  • Healthy Eating

  • Regular exercise

  • Healthy Mind

  • Stop Smoking

  • Healthy and Safe Environment

    EMPOWERMENT

BPKK


Wellness approach in primary health care

Pelanggan

Komuniti, OPD, MCH, Sekolah

Kaunter informasi

Pegawai perhubungan pelanggan

Kecemasan

Pesakit Luar

** Isi borang saringan asas(mengikut kumpulan umur dan jantina) dan dapatkan temujanji

Kaunter Pendaftaran Klinik Wellness

Pembantu Tadbir

Lengkapkan Saringan Asas & Ukuran Biometri & Pemeriksaan Fizikal Asas

Jururawat Masyarakat / Pembantu Perubatan

Penentuan Risiko

Pakar Perubatan Kesihatan Awam

Ada penyakit

Ada risiko

Tiada risiko

Pakar Perubatan Kesihatan Awam, Pembantu Perubatan, Jururawat Terlatih, Kaunselor, Jurupulih carakerja/ Anggota, Pegawai Zat Makanan / Dietician, Pegawai Pendidikan Kesihatan

Rujuk FMS

Pakej

Promosi Kesihatan Temujanji

Discaj

  • Minda sihat

  • Berhenti merokok /Substance abuse

  • Pemakanan sihat

  • Senaman (termasuk PT, OT)

  • BPKK


    Wellness approach in primary health care

    PERANAN PEMBANTU PERUBATAN

    menjalankan saringan asas & ukuran biometri

    membantu menyelaras dan memantau perjalanan klinik

    melakukan pemeriksaan kesihatan

    membuat penilaian kesihatan dan penentuan risiko

    membantu menjalankan pakej intervensi yang berkaitan

    membantu membuat penilaian keberkesanan pakej intervensi yang ditawarkan kepada pelanggan

    membantu menilai pencapaian objektif klinik wellness.

    Membantu menyelaras penyelengaraan peralatan

    BPKK


    Keperluan latihan

    Keperluan Latihan

    • Post- Basic Primary Health Care

    • Post-Basic in risk identification and management

    • Post-Basic in wellness management

    • Post-Basic in Emergency Management,( Basic Life Support – Advance Life Support)

    • Post-Basic in Chronic Disease Management

    BPKK


    Latihan perkembangan kerjaya

    Latihan & Perkembangan Kerjaya

    • bidang pengkhususan (kepakaran)

    • On Job Training

    • In –ServiceTraining

    • Aktiviti CPD – CME points

    • Practice Standards

    • Credentialing/Priviliging (coming soon!)

    • Latihan tambahan diperlukan

      - jenis-jenis latihan dikenal pasti

      - melibatkan penukaran skima kerja

      baru

      - Penilaian Tahap Kecekapan (SSM)

    BPKK


    On going now

    On going now:

    • merangka pelaksanaan Pendekatan Baru(Wellness)

      di klinik-klinik kesihatan dan menyediakan pakej komprehensif perkhidmatan Wellness secara integrasi

    BPKK


    On going now1

    On going now:

    • Menguji-cuba ‘tool’ yang disediakan bagi tujuan saringan dan pengurusan risiko kesihatan kumpulan umur – remaja , dewasa lelaki dan wanita serta wargatua dengan menggunakan Clinical Pathway

    • Mengenalpasti kriteria –kriteria untuk tahap risiko dan pakej pengurusan risiko berkaitan (mengikut prioriti) bagi setiap kumpulan umur

    • Menyediakan pelan pelaksanaan projek

    BPKK


    On going now2

    On going now:

    - Mengemaskini “tool content” saringan dan pakej pengurusan risiko kes-kes di perkhidmatan wellness secara integrasi

    BPKK


    Wellness approach in primary health care

    PELAN PERANCANGAN PELAKSANAAN PROJEK PERINTIS KLINIK WELLNESS

    BPKK


    Expected standard of care

    Expected Standard Of Care

    • High level Primary clinical Care

      - Specialist care

      - Comprehensive care

      - Continuity of care

      - Seamless from ‘womb to tomb’

      - Promote wellness

      - Care close to home

      - Cost-effective care

      - Evidence based practice

    • Performance through several indicators and QA Programme

    BPKK


    Wellness approach in primary health care

    BPKK


    Targets what of population

    HEALTH EXPECTANCY

    AGE

    Targets – What % of population ??

    ILL

    • What gradient of change?

    • How much can we invest?

    • Can this new strategies make a difference?

    WITH RISKS

    POTENTIAL RISKS

    ‘HEALTHY’ – No identified Risks

    BPKK


    Wellness approach in primary health care

    Thank You

    BPKK


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