Friends may meet but mountains never
Primary Health Care
Center Model
Donetsk City Hospital 25
Take care of the pence and the pounds will take care of themselves
Goal of the Center
IN ORDER TO EFFICIENTLY USE HEALTH
CARE RESOURCES IT’S NECESSARY TO
CREATE A MODEL COMMUNITY-BASED
PRIMARY HEALTH CARE CENTER ON THE
BASIS OF CITY HOSPITAL #25 AND DELIVER
MEDICAL SERVICES TO ALL FAMILY
MEMEBERS WITH AN ACCENT ON HEALTH
PROMOTION OF MINERS, WOMEN AND
CHILDREN.
Little is better than non
Key Achievements in 2000
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On the basis of Decree #989 of Cabinet of Ministers
Ukraine integrated actions were developed to take place on
Oblast and city levels aimed at Family Medicine
integration into Health Care.
With Executive authorities offices there were Oblast and
City Coordination Committees established on integration
of Family Medicine.
With the purpose to study medical and social aspects of
family there was a questionnaire distributed in the
community, its results reviewed and priorities established.
Out of nurses who were retrained some started to work as
practicing nurses on their own on an experimental basis
and cover age groups of patients who do not work. 3
nurses who graduated from «Leadership School» entered
higher educational establishments: 2 - Medical University
(Health Care Administrators), 1 - Management Academy.
As a cockroach on a hot stove
•A patient questionnaire was developed for the Family
Ambulatory which is used by a practicing nurse.
•In order to provide psychological and social support to families
a mechanism of interaction with social services was developed.
•Hospital staff have worked out a «Provision on Family
Medicine Center» and currently developing job description for
physicians and nurses of Family Ambulatory
•There was a Community Council created under the auspices of
the Hospital which includes members of different community
groups, public organizations, professional associations of
industrial enterprises, public education system, sponsors in order
to promote community-oriented family medicine and attract
non-budget funds.
•Learning Resources Center was opened, special program to
train medical staff in computer use was developed and training
is on-going
Each bird loves to hear himself sing
PHC Center Characteristic Features
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Catchment area population(total-19500
people,including 7640-miners,11860their family members)
Morbidity Profile: occupational
diseases of miners and general morbidity
of miners and their family members;
Specificity: «black lung», dust
bronchitis, peripheral nervous system
diseases, hearing disorders, acute carbon
monoxide poisoning;
Opening date: 27 February 2001
As the tree, so the fruit
•Organizational Structure
Primary Health Care Center
city of Donetsk
Center
«Family Medicine»
Center
«Miners’ Health»
Center
«Women and
Children
Wellness»
Center «Women and
Children Wellness»
Kramatorsk
Center «Family
Medicine»
1)Center Director-1
2)Senior nurseadministrat.-1
3)Family physician-6
4)Family nurse-12
5)Lab doctor-1
6)Feldsher-labtech-3
7)Social worker-1
8)Procedure room
nurse.-1
9)Health promotion
nurse
10)Receptionist-2
11)Junior nurse-3
TOTAL:33
Center
«Miners’ Health»
1) Center Director -1
2) Senior nurseadministrat -1
3)ENT doctor-1
4)Oncology surgeon-1
5)Neurologist-1
6)Ophthalmologist-1
7)Dermatologist-1
8)Funct. Diagnostics
speclst-1
9)Lab doctor-1
10)Radiologist-1
11) Feldsher-labtech -3
12)Nurse -10
13) Health promotion
nurse -1
14)Receptionist-2
15)Junior nurse-4
TOTAL:30
Center
« Women and
Children Wellness»
1) Center Director -1
2)Senior midwife-1
3)OB-GYN-1
4)Ultrasonography doctor-1
5)Gynecol.-mammologist -1
6)Family plan. physician-1
7)Internist-1
8)Pediatrician-1
9)Psychologist-1
10)Exam. office midwife-1
11)District midwife-3
12)Family plan. midwife-1
13)Pediatric nurse.-1
14)Receptionist-1
15)Junior nurse-2
TOTAL:18
•Priorities:
In every beginning think of the end
- Shift to family medicine through mechanisms of hospital shop and
district services
- Training of physicians and nurses, team building
- Increasing role of a nurse in treatment, diagnostics and prevention
of diseases by expanding her authority and increasing responsibility
- Delivery of accessible, quality, timely consultation and diagnistics
services to miners and their family members at center «Miners’
Health»
-Carrying out a mutual project together with University of Illinois on
program «Black Lung» (pneumoconiosis)
- Partnership expansion
- Accent not to treatment but prevention of diseases by increasing
community medical awareness and family responsibility for their own
health
- Implementation of principles, forms and methods of professional
activity of physicians and nurses taking into account socialdemographic, medical-and-biological, psychological and hygiene
characteristic features of each family
He deserves not the sweet that will not taste of the sour
Difficulties during PHC Center
Creation
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Attracting funds for reconstruction of an out-patient
facility building
Family physicians and nurses lack work motivation
Inadequate practical training of physicians and nurses
in the course of their retraining at Medical University
and College
Nurses are not ready for expansion of their authority
and increasing role and responsibility
Little medical awareness of community and little
responsibility of a family for family members’ health
Bind the sack before it is full
Regular Assessment of Center’s
Priorities of Work
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Prospective needs of the catchemnt area population
(assessment before Center opening):
In order to collect initial medical data about community
health there was an anonymous questionnaire distributed
among miners and their family members, and the following
needs were established as a result of this effort: :
Desire of the community to improve their health;
To have accessible, skilled medical care with capacity to
provide up-to-date diagnostics in a comfortable setting;
Medical providers need to have better attitude towards
their patients
To increase level of medical awareness of the community
Proof of the pudding is the eating
Indicators of Good Performance
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Increased level of medical personnel clinical practice
knowledge in the area of PHC, health of miners and
women through development treatment protocols and
guidelines
Increased number of medical providers who can deliver
maximum care in the setting of Family Ambulatory and
Consultation-and-Diagnostics Center «Miners’ Health»
Increased number of PHC Center medical providers who
routinely use computers in their work
Assessment of current patient satisfaction with medical
services and specialists by obtaining results of anonymous
questionnaire from community once every 6 months
Improved access of patients to medical knowledge through
development and carrying out educational programs and
patient involvement into these programs
Things past cannot be recalled
Levels of Health Care Delivery to Community at
City Hospital #25.
Out-patient facility №1 at city hospital №25
Family Ambulatory
1 Level
2 Level
Center
«Miners Health»
Internal Diseases
3 Level
Hospital
Administration
Neurology
2 Level
Center «Women
and Children
Health»
Oncology
In-Patient Wards at №25
Cardiology
Every cock sings in his own manner
Scheme of Financing Levels of Medical Care
at City Hospital #25 of Donetsk
1 LEVEL:
Family Ambulatory
Family physician –holds
and distributes funds
2 LEVEL:
Consultation-anddiagnostic centers
3 LEVEL:
Specialized
in-patient care
Budget allocations per capita
Non-Budget Funds
Funds attracted through insurance companies
Payment from family physician fund for each patient
on a completed visit basis
Consultations by subspecialists without refferal by
family physician through purchasing insurance polices
Diagnostic examinations are provided through
purchasing insurance policies
Payment from family physician fund per diesease groups
requiring involvement of a clinic
Funds attracted by insurance companies
Click for larger picture
It is easy to swim if another holds up your head
•Social Sustainability:
- Primary health care has to be transformed with active
participation of community and regional public
organizations with support of Community Council
authority
.Management (organizational sustainability):
- With limited resources it’s important to distribute them
correctly as well as correctly distribute assignments
between personnel. Increased competency, expanded
responsibilities and leadership of nurses shall bring
down the cost of in-hospital medical services.
.Technical Sustainability:
- Equipment provided by Partners shall improve
accessibility, quality of medical services and shall raise
the hospital rating
There is safety in numbers
Cooperation with Others
Oblast, City and District Power Authorities
(executive authorities)
 Project «Donetsk-Pittsburg-Twin Cities»
 Administration and Trade Unions of Coal Mines
named after E.T. Abakumov, A.A. Skochinskiy
and «Lidiyevka»
 American Miners’ Union
 Scientific-Research Institute of Ecology and
Problems of Donbass Coal Industry (Donetsk)
 Academy of Medical Sciences Ukraine,
Institute of Occupational Medicine (Kiev)
 University of Illinois (Chicago)
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There is safety in numbers
Cooperation with Others
Medical University and Medical College (Donetsk)
 Business and Professional Women League, Center
«Women for Women» (Donetsk)
 Women Council of Kirovskiy district (Donetsk)
 Trust «Donbasstransstroy»
 Donetsk Regional Educational Center under the
auspices of «Communities Partnership» Program
 International Volunteers Center (Pittsburg)
 Company «Carelift International»
 «Centerville Clinics» (Western Virginia)
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