The project of model practices in family medicine in Slovenia
Background: Primary health care has undergone great changes as a consequence of demographic changes, growing patients’ awareness and organizational changes in the healthcare system. Declining interest in family medicine specialization further worsens the situation. In the period of lack of GPs and their overloading, it is necessary to include a diploma graduate nurse in the team of GPs and to define competencies and activities in such a way that encourage more active approach to the patients, meeting the indicators of quality.
The purpose of the article is to describe the project of model practice in Slovenia and to present some results.
Methods: A model practice introduces a new concept in the areas of human resource standards (to existing team, a diploma graduate nurse is included on a part-time basis); work competences (use of protocols for the treatment of chronic patients, extended and well-defined preventive screenings, establishing registers of chronic patients and assessing quality by means of quality indicators) and work management (redistribution of workload ).
Results: Due to great interest of general practitioners, a total of 271 model practices were introduced in 2011 and 2012. MPs have been distributed evenly through different regions inSlovenia. Registers of patients with chronic diseases (COPD, asthma and diabetes) have been established and during the preventive screening, on average 2 patients with a chronic disease and 15 patients with risk factors have been detected. Patients are treated actively according to their needs rather than their preferences.
Conclusions: The project of MPs enables a high quality and cost effectiveness of patients’ treatment in family medicine. With a gradual introducing of new MPs, a well planed and monitored patients’ care will be implemented in the practice. In a long run, disburdening of a secondary care level and more rational consumption of drugs are expected
The World Health Report 2008: Primary Health care Now more than ever. World Health Organization; 2008.
Starfield B, Shi L, Macinko J. Contribution of Primary Care to Health Systems and Health. The Milbank Quarterly 2005. 83: 457–502.
Starfield B. Policy relevant determinants of health: an international perspective. Health Policy 2002, 60: 201–18.
Rawaf S, DeMaeseneer J, Starfield B. From Alma--Ata to Almaty: a new start for primary health care. Lancet 2008; 372: 1365–7.
Xu K et al. Protecting households from catastrophic health expenditures. Health Affairs 2007; 6: 972–83.
Lacroix A, Assal JP. Therapeutic Education of Patients. New approaches to chronic illness. Paris: Editions Vigot; 2000.
Švab I, Petek-Šter M, Kersnik J, Živčec-Kalan G, Car J. Presečna študija o delu zdravnikov dru-žinske medicine v Sloveniji. Zdrav Vars 2005; 44: 183–92.
Kersnik J. Osnove družinske medicine. Maribor: Medicinska fakulteta; 2007.
Donovan EF et al. Intensive home visiting is associated with decreased risk of infant death. Pediatrics 2007; 119: 1145−51.
Stewart M, Brown JB, Donner A, McWhinney I, Oates J, Weston W. The impact of patient-centered care on outcomes. J Fam Pract 2000; 49: 796–804.
Stange KC. The paradox of the parts and the whole in understanding and improving general practice.
International Journal for Quality in Health Care 2002; 14: 267−8.
Cabana MD, Jee SH. Does continuity of care improve patient outcomes? J Fam Pract 2004; 53: 974–80.
Zwarenstein M, Reeves S. Knowledge Translation and Interprofessional Collaboration:Where the Rubber of Evidence-Based Care Hits the Road of Teamwork The Journal of Continuing Education in the Health Professions 2006; 26: 46–54.
Bower P, Campbell S, Bojke C, Sibbald B. Team structure, team climate and the quality of care in primary care: an observational study Qual Saf Health Care 2003; 12: 273–279.
Grol R, Rooijackers-Lemmers N, van Kaathoven L, Wollersheim H, Mokkink H. Communication at the interface: do better referral letters produce better consultant replies? British Journal of General Practice 2003; 53: 217–219.
Cooper RA. New directions for nurse practitioners and physician assistants in the era of physician shortages. Acad Med 2007; 82: 827–8.
Sargen M, Hooker RS, Cooper RA. Gaps in the supply of physicians, advance practice nurses, and physician assistants. J Am Coll Surg 2011; 212: 991–9.
Phillips CB, Pearce C, Hall S, Kljakovic M, Sibbald B, Dwan K, Porritt J, Yates R. Enhancing care, improving quality: the six roles of the general practice nurse. Med J Aust 2009; 191: 92–7.
Savič B, Kydd A. Nursing knowledge as a response to societal needs: a framework for promoting nursing as a profession. Slovenian Journal of Public Health 2011; 50: 286–296.
Poplas Susič T, Vodopivec Jamšek V, Košnik M, Živčec Kalan G, Šuškovič S. Astma – protokol vodenja kroničnega bolnika in ukrepanje ob zapletih/poslabšanjih. Isis 2010; 19: 52–6. Dosegljivo na : http://www.zdravniskazbornica.si/f/2311/isis-2–2010.
Poplas Susič T, Vodopivec Jamšek V, Košnik M, Šuškovič S, Živčec Kalan G. Kronična obstruktivna pljučna bolezen (KOPB). Protokol vodenja kroničnega bolnika na primarnem nivoju in ukrepanje ob zapletih/poslabšanjih. Isis 2010; 19: 59–62. Dosegljivo na: http://www.zdravniskazbornica.si/f/2394/isis-3–2010.
Crabtree BF, Miller WL, Tallia AF, Cohen DJ, DiCicco-Bloom B, McIlvain HE, Aita VA, Scott JG, Gregory PB, Stange KC, McDaniel RR, Delivery of Clinical Preventive Services in Family Medicine Offices. Ann Fam Med 2005; 3: 430–5.
Laurant M, Hermens R, Braspenning J, Sibbald B, Grol R. Impact of nurse practitioners on workload of general practitioners: randomised controlled trial. BMJ 2004; 328: 927–33.
Zbornica zdravstvene in babiške nege Slovenije- Zveza strokovnih društev medicinskih sester, babic in zdravstvenih tehnikov Slovenije. Aktivnosti zdravstvene nege za DMS in tehnike zdravstvene nege v ambulanti družinske medicine. Ljubljana; 2011.
Taggart J, Schwartz A, Harris MF, Perkins D, Powell Davies G, Proudfoot J, Fanaian M, Crookes P. Facilitating teamwork in general practice: moving from theory to practice. Australian Journal of Primary Health 2009; 15: 24–28.
Pearce C, Hall S, Phillips C. When policy meets the personal: general practice nurses in Australia. J Health Serv Res Policy 2010; 15 Suppl 2: 26–34.
Pearce C, Hall S, Phillips C, Dwan K, Yates R, Sibbald B. A spatial analysis of the expanding roles of nurses in general practice. BMC Nurs 2012; 11: 13.
Wilson A, Pearson D in Hassey A. Barriers to developing the nurse practitioner role in primary care-the GP perspective. Family Practice 2002; 19: 641–6.
Charles-Jones H, Latimer J, May C. Transforming general practice: the redistribution of medical
work in primary care. Sociol Health Illn 2003; 25: 71–92.
Soklaridis S, Oandasan I, Kimpton S. Family health teams: can health professionals learn to work together? Can Fam Physician 2007; 53: 1198–9.
Pearce C, Phillips C, Hall S, Sibbald B, Porritt J, Yates R. Contributions from the lifeworld: quality, caring and the general practice nurse. Qual Prim Care 2009; 17: 5–13.
Farmer J, West C, Whyte B, Maclean M. Primary health-care teams as adaptive organizations: exploring and explaining work variation using case studies in rural and urban Scotland. Health Serv Manage Res 2005; 18: 151–64.
Mousquèsa J, Bourgueila Y, Le Fura P, Yilmazc E. Effect of a French experiment of team work between general practitioners and nurses on efficacy and cost of type 2 diabetes patients care. Health Policy 2010; 98: 131–143.
Kavčič M, Hrast M, Hlebec V. Older people and their strategies for coping with health risks. Slovenian Journal of Public Health 2012; 51: 163–172.
Softič N, Smogavec M, Klemenc-Ketiš Z, Kersnik J. Prevalence of chronic diseases among adult Slovene population. Slovenian Journal of Public Health 2011; 50: 185–190.
Bahun M, Savič B. Peer support in patients with tipe 2 diabetes. Slovenian Journal of Public Health 2011; 50: 191–200.
Rumboldt M, Kuzmanić M, Petrić D, Rumboldt Z. Unsatisfactory cardiovascular risk control–opportunities for family medicine. Slovenian Journal of Public Health 2011; 50: 75–81