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KERTAS KONSEP KAEDAH BARU DALAM PEMBERIAN PERKHIDMATAN DI KLINIK septicaemia

VIEWS: 1,193 PAGES: 56

									WELLNESS APPROACH IN
PRIMARY HEALTH CARE


 Dr Noridah Mohd Saleh
 Ketua Penolong Pengarah
 Bahagian Pembangunan Kesihatan
 Keluarga
 KKM




                      BPKK        1
    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              2
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                       3
      PRIMARY HEALTH CARE




Primary Care                            Family Health


                      FHD / BPKK


               “Illness”   +     “wellness”


                               BPKK                     4
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

                         BPKK               5
The 8 HS Goals
          “ Wellness”
    Not to be merely a theory


    To be translated Into Action


 “well”       “ at risk”          “ill”



                           BPKK           6
A.Why Wellness
   Approach?




      BPKK   7
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,




                                      BPKK   8
     Top 10 DALYs
                                         Males                                           Females
Rank          Disease                                              Disease
                                  DALYs           %                                   DALYs        %
1      IHD                      164,846          10.0     Ischemic Heart Disease    113,887      9.2

2      Road Traffic Accidents   133,789          8.2      Cerebrovascular Disease   86,372       7.0
3      CVD                      94,059           5.7      Uni-p Major Depression    67,211       5.4

4      Septicaemia              70,232           4.3      Septicaemia               57,483       4.6
5      ALRI                     49,649           3.0      Diabetes Mellitus         56,390       4.6
6      Diabetes Mellitus        47,060           2.9      Hearing Loss              38,994       3.1
7      COAD                     45,459           2.8      ALRI                      37,890       3.1

8      Hearing Loss             44,566           2.7      Asthma                    32,815       2.6
9      Unip Major Depression    42,259           2.6      Road Traffic Accidents    28,946       2.3

10     Cirrhosis                37,902           2.3      Osteoarthristis           26,925       2.2
Total (111 diseases)            1,646,896                 Total (111 Diseases)      1,240,997




                                                       BPKK                                  9
I - Prevent and Reduce Disease Burden
                       70% of total Health Budget
                              2m inpatients

               ILL            40m outpatients


                     WITH RISKS


                        POTENTIAL RISKS



                               „HEALTHY‟ – No identified Risks




                       BPKK                        10
LIFE Expectancy
LIFE EXPECTANCY

                         72, 76 (2005)




                              AGE



                  BPKK              11
Health Expectancy
HEALTH EXPECTANCY




              Raised                Periph   Diabetic Foot AGE
              Blood    Diabetes
                                    Neuro    /amputation AGE
              Sugar



                             BPKK                           12
Experience


   What have we learn from
         MCH services?




              BPKK        13
    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                       IHD -            113,887
    •   Hypertension in Preg – 1,268      CVD/Stroke -     86,372
    •   Maternal Sepsis - 171
                                          Major Depresn-   67,211

    •   Obstructed Labour – 14
                                          Diabetes-        56,390


    >>OBESITY       from 5% to 10-13 % in 10years??
                                   BPKK                       14
  Prevent and Reduce Disease Burden



Experience from the MCH wellness Services
 Screening

 Examination & Immunisation

 Health Education

 Follow-Up & Home Visits

 Treatment
                                      I
                                      S




                             BPKK         15
MCH Services Investments

   Dedicated Clinics
   Dedicated Staff
   Trained Midwives and PHN
   Trained Doctors and Obstetrician
   Effective MCH & FP Protocols
   Effective Referral System


                      BPKK             16
    Current Promotive and Preventive
    „Limitations‟

   Mass-address
   Not-specific to client‟s problems
   Behavior modification unassisted
   „Big Bang‟ effect much desired

                 individualised
                and personalised

                          BPKK          17
Wellness approach…



    How   to do it?




                BPKK   18
Wellness..



Proposing
„Plan Preventive Maintenance‟
Approach




                BPKK            19
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‟



                             BPKK                20
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              21
   Prevent and Reduce
     Disease Burden
Health Promotion, Screening, Early diagnosis,
      Prompt Treatment, Rehabilitation


             Integrated services




                      BPKK                      22
Existing Framework

                                  Rajah 1
                  Jenis perkhidmatan yang disediakan di KK

     Klinik ibu      Klinik sihat      Klinik       Klinik warga    Klinik        Klinik
     dan anak                        kesihatan           tua       berhenti     diabetes
                      Klinik          mental                       merokok
       Klinik       Perancang                          Klinik                     Klinik
    reproduktif      Keluarga         Klinik tibi     remaja       Klinik OKU   hipertensi

      Klinik           Klinik
    pesakit luar      pekerja        Perkd. Kecemasan

                          Farmasi,        Makmal,         Radiologi

                                    Maklumat Kesihatan




                                                    BPKK                                     23
Services Provided – KK (2)&(3)
       Kesihatan Ibu                                              Kesihatan Warga dewasa
    •         Ibu Mengandung                                          • Promosi Kesihatan
          •           Pemeriksaan kesihatan, kandungan dan         b) Perkhidmatan penyaringan dan penilaian risiko
          •
                      darah
                      Lawatan ke rumah                                • Perkhidmatan pengurusan risiko
    •         Ibu Bersalin                                            • Pemeriksaan kesihatan
          •           Menyambut Kelahiran                             • Perkhidmatan kesihatan reproduktif
    •         Ibu Lepas Bersalin                                      • Kaunseling
          •
          •
                      Pemeriksaan kesihatan
                      Pemeriksaan bayi                                • Rawatan dan rujukan
          •           Lawatan susulan di rumah                     Kesihatan Wargatua
    •         Khidmat perancang keluarga                              • Promosi Kesihatan
    •         Promosi susu ibu                                        • Pemeriksaan kesihatan
       Kesihatan Anak                                                • Pemeriksaan pergigian
    •         Pemeriksaan kesihatan                                   • Rawatan dan rujukan
    •         Imunisasi                                               • Kaunseling dan Rehabilitasi
    •         „Early intervention Program‟                         Kesihatan Mental
    •         Lawatan ke rumah                                        • Promosi Minda Sihat
       Kesihatan Sekolah                                             • Penyaringan – faktor risiko, DASS, gaya tindak
    •         Pemeriksaan kesihatan murid-murid                       • Intervensi awal / susulan – teknik relaxasi, urutan
              Tahun 1, 6 dan Ting 3                                         leher dan bahu
          •
          •
                     Pemeriksaan fizikal
                     Imunisasi                                        • Pengurusan pesakit – psikososial, farmakologikal
          •          Rawatan dan rujukan                              • Rujukan
    •         Perkhidmatan pergigian                                  • Rehabilitasi
    •         Promosi kesihatan                                    Rawatan pesakit luar
    •         Kesihatan persekitaran sekolah                          • Menerima dan membuat rujukan
       Kesihatan Remaja                                              • Penyiasatan awal
    •         Promosi Kesihatan                                       • Rawatan dan rawatan susulan (kes kronik)
    •         Penyaringan, penilaian dan pengurusan                   • Khidmat pakar (kes akut, kronik, kecemasan)
              risiko                                                  • Perkhidmatan rawatan kecemasan (pra
    •         Pemeriksaan kesihatan                                         hospital/Ambulatory Medical Emergency)
    •         Rawatan dan rujukan                                     • Rawatan pembedahan kecil
    •         Kaunseling - pemakanan, merokok                         • Pengendalian kes perundangan perubatan
                                                                            (medico-legal)
                                                                      • Notifikasi kes
                                                                      • Promosi kesihatan
                                                             BPKK                                                      24
Services Provided - KK
   Pemakanan dan Dietetik                               Surveilan kesihatan
     •   Promosi makan secara sihat                        •   Pengesanan kes secara aktif dan pasif
     •   Pengurusan berat badan                            •   Pengesanan kontak
     •   Pengurusan pemakanan pesakit kronik               •   Pengesanan kes tercicir
     •   Rehabillitasi pemakanan                           •   Promosi kesihatan
     •   Dapur sihat / kafeteria sihat                   Perkhidmatan sokongan
   Kesihatan Pergigian                                    •   Perkhidmatan patologi
     •   Promosi kesihatan pergigian                     - Pengendalian spesimen
     •   Saringan dan Pemeriksaan kesihatan
                                                         - Ujian makmal
         pergigian
     •   Rawatan                                           •   Perkhidmatan pengimejan diagnostik
     •   Rujukan pakar                                   - X Ray dan Ultrasound
   Kesihatan Pekerja                                      •   Perkhidmatan farmasi
     •   Pemeriksaan kesihatan – pre employment,         - Pendispensan ubat-ubatan
         routine medical examination
                                                         - Kaunseling
     •   Penilaian risiko pekerjaan / hazard
     •   Rawatan dan rujukan
     •   Siasatan penyakit/wabak
   Rehabilitasi
     •   Pemulihan anggota
     •   Pemulihan cara kerja
     •   Pemulihan pertuturan
     •   Pemulihan pendengaran




                                                   BPKK                                       25
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                 26
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                   27
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                       28
   What do we offer ?



    Wellness services


               BPKK      29
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                 30
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               31
(5) Outcome -
Wellness Service                          I - “Wellness    II - “illness
                                          Clinic”          Clinic”

 “ Womb – Tomb”           School Health
                          Home Visits
                                          Ibu
                                          Anak
                                          Remaja
                                                           Kecemasan
                                                           Akut
                                                           Kronik
                          Home Nursing
                                          Dewasa           Penyakit
 Maternal                                Warga Tua        Berjangkit


                                          III - “Support     III - Emergency

 Child                                   Services”
                                          - Makmal
                                                             -Support Pre-
                                                             hospital
                                          - Farmasi          -‘Support Call
                                          - Radiologi        centre’
 Adolescent                              - Sistem
                                          Informasi dan
                                                             -Support Rapid
                                                             Response
                                          komunikasi

 Adult

 Geriatric


                   BPKK                                      32
Prevent and Reduce Disease Burden

   • Treat the ill
   • Manage those with risk
   • Prevent the onset of preventable risks
     IMPROVE HEALTH EXPECTANCY


                         WELLNESS SERVICES




                           BPKK               33
Approach :
- Medical        Maternal
- Nutrition      Childhood
- Exercise       Remaja
- Smoking        Dewasa Wanita
- Minda Sihat    Dewasa Lelaki
- PT/OT          Wargatua
- HEd
- Occ Health


                BPKK             34
Health Services In Clinic

                                                       Medical Care
                Community                              (Infectious )
                                              Life-                             Rehabi
                  Action     Maternal and                             Emergency
                                             course                             litative
                  (Panel     Child Health            (Non-Infectious)   Care
                                            wellness                             Care
                Penasihat)                               - Acute
                                                        - Chronic



                                             Clinical Support



                                            Information Support
Adolescent
Adult
Geriatric
Mental health



                                                 BPKK                                      35
Reviewed Approach - Physical


                 I - “Wellness        II - “illness
                 Clinic”              Clinic”
 School Health   Ibu                  Kecemasan
 Home Visits     Anak                 Akut
 Home Nursing    Remaja               Kronik
                 Dewasa               Penyakit
                 Warga Tua            Berjangkit
                 III - “Support         III - Emergency
                 Services”              -Support Pre-
                 - Makmal               hospital          Wellness
                 - Farmasi              -‘Support Call    Illness
                 - Radiologi            centre’           Support
                 - Sistem Informasi     -Support Rapid    Emergency
                 dan komunikasi         Response


                                            BPKK          36
PERKHIDMATAN DI KLINIK KESIHATAN
                                         Rajah 3 - Carta Alira : Klinik Kesihatan Bersepadu


                                                                                Pelanggan




                                                                                  Triage




                                                                                  Perkhd
                                                    Perkhid                   Klinik demam             Perkd
                                    Perkhd.                                                                               Perkhid
                                                 Pesakit Luar dan             dan penyakit          Klinik sihat
                                   Kecemasan                                                                             Pergigian
                                                 Penyakit Kronik                berjangkit          bersepadu




                                                                                                  Temujanji dan
                                                                                                   pendaftaran
PROSES DI KLINIK SIHAT




                                                                                                  Pakej Saringan




                                                                                                      Pakej
                                                                                                   Penjagaan
                                                                    Sembuh dan Sihat                               Tidak sembuh
                                                                                                    Kesihatan
                                                                                                  dan Keafiatan




                                                                                           BPKK                                      37
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             38
    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              39
   Risk Assessment by Age Gp
For Child and Adolescent   For Older Adult   For Female Adult
                               Stroke          Osteoporosis

   Child and
   Adolescent
   Health Risk
   Profile (Text
   Version)




                                  BPKK                40
screening tool
   Self
   Assisted




                 BPKK   41
Wellness (PPP)
Activities / Services
                                         Resource Implications:
   Guided Self-Check                     Space - BIG
     •   Checklist for Risk               Equipments
         Screening according to           Training
         age group
                                          HR
   Triage                                    •   Dr
   Counseling and Health                     •   Dietician
    Education                                 •   Health Education Officer
                                              •   Medical Assistant
   Risk Assessment                           •   Nurses
   Risk Management                           •   Clerical

                                         Process Implications:
    Adolescent, Paps smear, BSE,
    HRT, Men‟s, OKU, CVD, PSR,            Consolidation of islands of
    Occ health, geriatric health, ….        clinics

                                       BPKK                          42
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                 43
- “Achieving lifelong Wellness”
5 Areas to be strengthened
   Healthy Eating
   Regular exercise
   Healthy Mind
   Stop Smoking
   Healthy and Safe Environment




         EMPOWERMENT

                               BPKK   44
                                            Pelanggan                                     Komuniti, OPD, MCH, Sekolah



                                                                              Kecemasan            Pegawai perhubungan
           Pesakit Luar                       Kaunter
                                             informasi
                                                                                                   pelanggan


                                                                        ** Isi borang saringan
                                      Kaunter Pendaftaran          asas(mengikut kumpulan umur             Pembantu
                                        Klinik Wellness              dan jantina) dan dapatkan              Tadbir
                                                                             temujanji


                             Lengkapkan Saringan Asas & Ukuran Biometri                          Jururawat Masyarakat /
                                     & Pemeriksaan Fizikal Asas                                  Pembantu Perubatan


                                           Penentuan                                              Pakar Perubatan
                                             Risiko                                               Kesihatan Awam
                                                                     Ada penyakit
           Ada risiko

                                    Tiada risiko                                                   Pakar Perubatan Kesihatan
                                                                          Rujuk FMS                Awam, Pembantu
              Pakej                                                                                Perubatan, Jururawat
                                    Promosi Kesihatan                                              Terlatih, Kaunselor,
         Minda sihat                   Temujanji
Berhenti merokok                                                                                  Jurupulih carakerja/
                                         Discaj
/Substance abuse                                                                                   Anggota, Pegawai Zat
Pemakanan sihat                                                                                   Makanan / Dietician,
Senaman (termasuk PT, OT)
                                                                                                   Pegawai Pendidikan
                                                                                                   Kesihatan


                                                                  BPKK                                          45
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                   46
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                    47
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         48
On going now:

 merangka    pelaksanaan
 Pendekatan Baru(Wellness)
 di klinik-klinik kesihatan dan
 menyediakan pakej
 komprehensif perkhidmatan
 Wellness secara integrasi
                BPKK        49
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               50
On going now:

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




                BPKK         51
      PELAN PERANCANGAN PELAKSANAAN PROJEK PERINTIS KLINIK WELLNESS




Bil                Aktiviti                       2007                                 2008
                                  M   A   M   J   J    O   S   O   N   D   J   F   M    A     M    J   J


1        Briefing / Training at
         KKM level

2        Briefing at State /
         District/ KK level

3        Create awareness to
         community
           - promotion
4        Logistic preparation


5        Pelaksanaan


6        Pemantauan


7        Penilaian



                                                      BPKK                                        52
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                 53
BPKK   54
Targets – What % of population ??
                         ILL

                                         HEALTH EXPECTANCY
                       WITH RISKS



                       POTENTIAL RISKS




                      „HEALTHY‟ – No
                      identified Risks


                                                          AGE

   What gradient of change?
   How much can we invest?
   Can this new strategies make a difference?

                               BPKK                  55
BPKK   56

								
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