Development of primary health care in Moscow: New polyclinic standard

Khader Y., Al Nsour M., Abu Khudair S., Saad R., Tarawneh M.R., Lami F.

Achieving Universal Health Coverage (UHC) is a strategic objective of the Jordanian government and has been prioritized in its strategies and plans. However, there are several challenges affecting primary healthcare in Jordan and the health system in general that prevent Jordan from achieving UHC. This paper highlights the importance of team-based care in the form of Family Health Teams (FHTs) to realize Jordan’s goal of achieving UHC. FHTs are a team-based approach that brings together diverse professionals to provide a comprehensive, efficient, patient-centered primary care system that meets the changing needs of Jordan’s population and refugees. However, the implementation of FHT may encounter obstacles, including individual, organizational, institutional, and external barriers. To overcome such obstacles, several actions and processes need to be taken, including political commitment and leadership, implementing good governance and policy frameworks, allocating resources and funding, multisectoral collaboration, and engagement of communities and stakeholders. The successful implementation of FHTs requires participation from government officials, parliamentarians, civil society, and influential community, religious, and business leaders. A strategic policy framework, effective oversight, coalition building, regulation, attention to system design, and accountability are also essential. In conclusion, adopting the FHT approach in Jordan’s Primary Healthcare system offers a promising path towards achieving UHC, improving healthcare access, quality, and efficiency while addressing the unique challenges faced by the country’s healthcare system.

Черкасов С.Н., Мартиросов А.В., Федяева А.В.

Вопросы удовлетворенности медицинской помощью актуальны во всем мире, однако данное понятие субъективно. Существует зависимость между объективными критериями качества медицинской помощи и уровнем удовлетворенности пациента. Профессиональный подход к анализу качества медицинской помощи со стороны пациента невозможен, однако именно он является главным заказчиком медицинской помощи и определяет оправданность использования ресурсов с точки зрения общества. Требуется создать инструмент, который позволит полученные результаты удовлетворённости пациента использовать как критерий социальной эффективности системы здравоохранения. Кроме того, при таком подходе уровень удовлетворенности пациентов можно использовать как индикатор результативности или эффективности проводимых мероприятий по улучшению системы оказания медицинской помощи. Решить задачу создания такого инструмента можно с помощью метода стандартизации.Цель исследования: выполнить анализ зависимостей между детерминантами, влияющими на уровень удовлетворённости пациента медицинской помощью, оказываемой в амбулаторных условиях.Материалы и методы исследования. Было рассмотрено 9 детерминант, влияющих на оценку пациентом качества организации медицинской помощи, оказываемой в амбулаторных условиях: демографические характеристики (возраст, пол), социальные детерминанты (уровень образования, признание пациента ответственности за собственное здоровье, семейное положение пациента, степень комплаенса пациента), экономическая детерминанта (величина располагаемого дохода), жизненные приоритеты пациента («стандартность структуры жизненных приоритетов, значимость жизненного приоритета «Здоровье»).Результаты. Была сформирована симметричная корреляционная матрица размерностью 9×9 элементов, анализ которой показал, что сильной зависимости нет. Однако в процессе анализа были выявлены сочетания признаков, которые необходимо учитывать в ходе дальнейшего исследования (на последующих этапах).Заключение. По результатам анализа зависимости уровня удовлетворенности пациента полученной медицинской помощи от каждого фактора или группы связанных факторов были отобраны 11 связанных признаков. Ни одного независимого признака выявлено не было. Зависимости между изучаемыми параметрами сложные, и типичные методы вариационной статистики не позволяют получить однозначные результаты. Только использование специальных методов может позволить получить результат в виде пригодном для использования его в практических целях.

Vanden Bossche D., Zhao Q.J., Ares-Blanco S., Peña M.P., Decat P., Kondo N., Kroneman M., Nishioka D., Petrazzuoli F., Rortveit G., Schaubroeck E., Stark S., Pinto A.D., Willems S.

Abstract Background The COVID-19 pandemic substantially magnified the inequity gaps among vulnerable populations. Both public health (PH) and primary health care (PHC) have been crucial in addressing the challenges posed by the pandemic, especially in the area of vulnerable populations. However, little is known about the intersection between PH and PHC as a strategy to mitigate the inequity gap. This study aims to assess the collaboration between PHC and PH with a focus on addressing the health needs of vulnerable populations during the COVID-19 pandemic across jurisdictions. Methods We analyzed and compared data from jurisdictional reports of COVID-19 pandemic responses in PHC and PH in Belgium, Canada (Ontario), Germany, Italy, Japan, the Netherlands, Norway, and Spain from 2020 to 2021. Results Four themes emerge from the analysis: (1) the majority of the countries implemented outreach strategies targeting vulnerable groups as a means to ensure continued access to PHC; (2) digital assessment in PHC was found to be present across all the countries; (3) PHC was insufficiently represented at the decision-making level; (4) there is a lack of clear communication channels between PH and PHC in all the countries. Conclusions This study identified opportunities for collaboration between PHC and PH to reduce inequity gaps and to improve population health, focusing on vulnerable populations. The COVID-19 response in these eight countries has demonstrated the importance of an integrated PHC system. Consequently, the development of effective strategies for responding to and planning for pandemics should take into account the social determinants of health in order to mitigate the unequal impact of COVID-19. Careful, intentional coordination between PH and PHC should be established in normal times as a basis for effective response during future public health emergencies. The pandemic has provided significant insights on how to strengthen health systems and provide universal access to healthcare by fostering stronger connections between PH and PHC.

Bowditch G.

Abstract When infrastructure is done well, it forms the fabric beneath us that enables individuals, businesses, and communities to experience more prosperous and inclusive living for current and future generations. In this brief commentary paper, I offer arguments and case examples from my recent book ‘BIG FIXES: Building Bridges to an Inclusive Future’. Unfortunately, as an infrastructure practitioner for over 30 years, I have observed a global shift among policymakers to exaggerate the benefits of investing in infrastructure without accountability and a framework for governance to assure positive long-term outcomes. In essence, infrastructure has fallen victim to short-termism. The central thesis of my book for readers and future contributors of Oxford Open Infrastructure and Health (OOIH) aligns well with the journal’s mission for infrastructure and health scholarship that fosters ‘Big Connections’. My argument is as follows. Is your vision of infrastructure about physical assets like roads, bridges, tunnels, power lines, water pipes, schools, and hospitals? If so, then it is too narrow. There is an urgent need for policymakers, investors and scholars to widen their perspective to consider infrastructure as a gift that current generations pay forward to future generations. The infrastructure decisions of our forebearers act like ripples on a lake, radiating out in time and space. These ripples can amplify benefits into the future, like favourable tailwinds. But equally, where short-sightedness has taken root in the past, the consequences of earlier infrastructure decisions (or none at all) can saddle future generations with the burden of headwinds – slowing, dragging upon efforts to improve. When a society invests in infrastructure, they express hope and optimism for the future. However, that aspiration implies a big bundle of expectations, including health and economic wellbeing and sustaining and building trust between people and the institutions created to serve them. Moreover, as environmental and social issues grow in importance, society has less room to be complacent with non-responsive infrastructure blocking adaptation and innovation to support new growth. These are examples of the lens to view ‘Big Connections’ referred to by OOIH.

Starshinin A.V., Kucheryavykh E.S., Gavrilenko O.F., Aksenova E.I., Kamynina N.N., Burkovskaya Y.V.

Windak A., Nessler K., Van Poel E., Collins C., Wójtowicz E., Murauskiene L., Hoffmann K., Willems S.

COVID-19 proved that primary care (PC) providers have an important role in managing health emergencies, such as epidemics. Little is known about the preparedness of primary care practice infrastructure to continue providing high quality care during this crisis. The aim of this paper is to describe the perceived limitations to the infrastructure of PC practices during COVID-19 and to determine the factors associated with a higher likelihood of infrastructural barriers in providing high quality care. This paper presents the results of an online survey conducted between November 2020 and November 2021 as a part of PRICOV-19 study. Data from 4974 practices in 33 countries regarding perceived limitations and intentions to make future adjustments to practice infrastructure as a result of the COVID-19 pandemic were collected. Approximately 58% of practices experienced limitations to the building or other practice infrastructure to provide high-quality and safe care during the COVID-19 pandemic, and in 54% making adjustments to the building or the infrastructure was considered. Large variations between the countries were found. The results show that infrastructure constraints were directly proportional to the size of the practice. Better pandemic infection control equipment, governmental support, and a fee-for-service payment system were found to be associated with a lower perceived need for infrastructural changes. The results of the study indicate the need for systematic support for the development of practice infrastructure in order to provide high-quality, safe primary care in the event of future crises similar to the COVID-19 pandemic.

Akman M., Ayhan Başer D., Usanma Koban B., Marti T., Decat P., Lefeuvre Y., Miller R.

Abstract Strong primary care does not develop spontaneously but requires a well-developed organizational planning between levels of care. Primary care-oriented health systems are required to effectively tackle unmet health needs of the population, and efficient primary care organization (PCO) is crucial for this aim. Via strong primary care, health delivery, health outcomes, equity, and health security could be improved. There are several theoretical models on how primary care can be organized. In this position paper, the key aspects and benchmarks of PCO will be explored based on previously mentioned frameworks and domains. The aim of this position paper is to assist primary care providers, policymakers, and researchers by discussing the current context of PCO and providing guidance for implementation, development, and evaluation of it in a particular setting. The conceptual map of this paper consists of structural and process (PC service organization) domains and is adapted from frameworks described in literature and World Health Organization resources. Evidence we have gathered for this paper shows that for establishing a strong PCO, it is crucial to ensure accessible, continuous, person-centered, community-oriented, coordinated, and integrated primary care services provided by competent and socially accountable multiprofessional teams working in a setting where clear policy documents exist, adequate funding is available, and primary care is managed by dedicated units.

Cederbaum J.A., Ross A.M., Zerden L.D., Estenson L., Zelnick J., Ruth B.J.

Social work has been a part of the essential workforce historically and throughout the COVID-19 pandemic, yet lack recognition. This work explores the experiences and invisibility of social workers within the pandemic response. Data are drawn from a large cross-sectional survey of US-based social worker from June to August of 2020. A summative content analysis of responses to the question 'What do you wish people knew about social work during the COVID-19 pandemic' was undertaken. Participants (n = 515) were majority white (72.1%) and female (90.8%). Seven coding categories were subsequently collapsed into three domains: (1) meeting basic needs, (2) well-being (emotional distress and dual role) and (3) professional invisibility (workplace equals, physical safety, professional invisibility and organisational invisibility). Meeting social needs requires broad-based policies that strengthen the health and social safety net. Social workers have and will continue to play a critical role in the response, and recovery from COVID-19. Organisational and governmental policies must expand to increase the visibility and responsiveness to the needs of social care providers.

Singer S.J., Glassman J., Glaseroff A., Joseph G.A., Jauregui A., Mulaney B., Kelly S.S., Thomas S., Vilendrer S., Tietschert M.V.

Ruíz-Fernández M.D., Fernández-Medina I.M., Gálvez Ramírez F., Granero-Molina J., Fernández-Sola C., Hernández-Padilla J.M.

The COVID-19 pandemic has provoked several changes in home care. Understanding home care nurses' experiences during the COVID-19 pandemic plays an essential role in home care management.This study aimed to explore and articulate the experience of home care nurses during the COVID-19 pandemic in Spain.A qualitative study using hermeneutic phenomenology was carried out. Twenty home care nurses were interviewed by teleconference between January and March 2021. Interviews were audio-recorded, transcribed verbatim, and analyzed using qualitative data analysis software.Three main themes with five subthemes emerged from the data analysis: (a) "The effect of COVID-19 pandemic on home care," with the subtheme "the reorganization of home care nurses' competencies"; (b) "The role of telehealth in home care," which included the subthemes "home care nurses' satisfaction with telehealth" and "barriers to implement telehealth in home care"; and (c) "Effects of the pandemic on home care nurses' lives," including the subthemes "working in a pandemic is emotionally draining" and "the continuing fear of infecting others."The findings from this study demonstrate the profound effect that home care has experienced during the COVID-19 pandemic. Home care nurses' competencies were modified to care for and diagnose COVID-19 patients. Face-to-face home care was replaced by telehealth. All home care nurses experienced physical and psychological symptoms and the fear of infecting others.

Sanina N.P., Kravtsova M.V.

Aim. The presented study aims to identify problems in the implementation of the primary health care modernization program and to propose possible solutions through the example of the Moscow region.Tasks. The authors determine the role of modernization in the health care industry; analyze the experience of implementing the primary health care modernization program in the Moscow region; build a model of demand for medical services that reflects the impact of such factors as physical accessibility and time costs on the achievement of program goals.Methods. This study uses comparative analysis, description, generalization, systematization, and modeling to analyze program data for 2020-2021.Results. Human resources have the most potential for health care activities, which requires support through economic incentives and benefits to stimulate employees. The roles of stakeholders in the organizational management system of the departmental target program are determined, which affects the allocation of limited resources. The spending of budget funds during the unstable growth of modernization costs, where public procurement serves as the main means for achieving goals, is analyzed. Measures to monitor the progress of events and decision-making, engaging specialists and independent experts for a transparent modernization process, are proposed. A model of demand for medical services is built, where time costs are a factor limiting the accessibility of medical care for consumers with low income. It is determined that the demand for medical services becomes more sensitive to changes in time costs, which affects the accessibility of medical care.Conclusions. The health care modernization program is an instrument of state regulation of socio-economic policy in the field of medicine. The results of this study can be used by economic entities to effectively manage government programs with limited resources. Special attention should be paid to logistics, which is a functional area of project management. There is a need for an independent commission to independently evaluate the interim results of the program.

Deev I.A., Kobyakova O.S., Shibalkov I.P., Protasova L.M., Boykov V.A., Baranovskaya S.V., Suvorova T.A., Babeshina M.A.

Introduction. The problem of access to medical care remains extremely relevant in many countries in the world nowadays. In this context, it is advisable to optimize patients’ flow, that is, primary and repeated admissions and appointments for preventive and medical care purposes, and information. The document titled “The Standard for Organizing Outpatient Care in the Tomsk Region” was developed to solve this problem in the region. The document regulates the organizational features of providing medical care to the residents in state polyclinics. The document addresses the following: service parameters, issues of routing patient flows, and the procedures for organizing workplaces and specialists’ behavior.Objective. To evaluate the effectiveness of the solutions proposed in “the Standard for Organizing Outpatient Care in the Tomsk Region” for routing patient flows in outpatient clinics.Material and Methods. The effectiveness of measures was evaluated for 35 medical organizations with outpatient departments based on the temporal changes in eight indicators in 2018–2019.Results and discussion. Except for the percentage of children who passed preventive examination out of the number of children subject to preventive examination, positive dynamics were observed for all study parameters. First of all, this observation suggests the adequacy of proposed solutions from the perspective of the health care system, and secondly, it indicates their acceptance by the patient community. However, the extent of growth/decline is extremely uneven depending on the medical organization, which requires further research.Conclusion. Standardization of patient flow routing within the state regional health system through the issuance of appropriate orders and further monitoring of their implementation is an effective way to increase the medical care availability.

Pollock A.M., Clements L., Harding-Edgar L.

Neglect of social care during the pandemic shames the UK

Protasova L.M., Masunov V.N., Boykov V.A., Deev I.A., Kobyakova O.S., Suvorova T.A., Shibalkov I.P., Shnaider G.V.