2 research outputs found
Designing integrated care services in the Republic of Moldova – experiences of the Healthy Life Project
Healthy Life project, State University of Medicine and Pharmacy
Nicolae Testemitanu, Republic of Moldova, Swiss Tropical and Public Health Institute,
Basel, Switzerland, University of Basel, SwitzerlandDriven by the increase of non-communicable
diseases (NCDs) worldwide, WHO has launched
its Global Framework for Integrated People centred
Health Services (IPCHS) during the 2016 World Health
Assembly [1]. This approach combines the horizontal
integration of health, social and community services
centred around people’s needs with the vertical
organization of a specialized referral system with
the aim to improve the quality of live for patients
suffering from chronic disease – as well as for the
people who take care of them. Health promotion
and NCD risk reduction play an important role in
this approach. The Republic of Moldova supported by the
Swiss Cooperation Office (SCO) through the Healthy
Life Project, is working to decentralize and integrate
the management of NCDs; to improve the quality
of integrated services; to reduce NCD risk and to
strengthen peoples’ health-seeking behavior. Initial
data show that there are significant gaps in terms
service quality, such as insufficient medical equipment (24% in health centres (HC) and 37% in family
doctors’ offices (FDO)) and particularly for medical
supplies (44% HC and 75% FDO) [2]. There are some
weaknesses in clinical consultations but clinical history taking and recording was quite common. Health
promotion activities are limited, particularly in FDOs
with more than a third (37.5%) not having a plan or
training staff to carry out respective activities.
The Healthy Life Project combines risk reduction and demand side interventions (health promotion, risk reduction and improved health-seeking
behavior), with improved targeting of provider
services (community nursing, care-taker support,
better self-management, improvement of quality of
care, service integration, people-centred planning
of health interventions). Integrating people centred
services means amongst others to be highly familiar
with peoples’ needs (both patients and care-providers),
to plan and evaluate services in a participatory manner; prioritize targeted interventions; provide high
quality services and foster partnering amongst and
across service providers, patients, care-takers and
communities in the wider sense.
Community nursing plays a key role in integrated
care systems by forming the interface between
community and people’s needs, coordinating and
informing service providers, participatory services
planning for patients in need (case-management)
and helping patients and care-takers to self-manage
their conditions. The Healthy Life project supports
the development of a consistent community nursing
concept and helps build staff capacity with regards
to integrated care. Local authorities play a key role in
prioritizing the health of their people and mobilizing
expertise to reduce public health risk factors and
establish healthy communities. Linking health, social
and complementary services (e.g. palliative care,
physical and social mobilization of chronically ill) in
one planning framework improves responsiveness of
services to people’s needs (e.g. case management).
The project supports the development of health
and service profiles to identify priorities and needs
in terms of information gasps, areas to promote
health, but also the identification of relevant services
at community and rayon levels, which will lead to
health action plans guiding priority activities.
With regards to quality of care, basic equipment
that is needed to implement the key clinical protocols at PHC level will be provided to the pilot rayon’s.
This will be accompanied by capacity building
measures and the introduction of peer exchanges
as well as facility-based continuous quality improvement “projects”. Capacity building on updated NCD
guidelines (e.g. WHO PEN protocols are another
important pillar towards quality of care. The 2017
quality of care study shows that up to 28% of primary care facilities have not received any training on
relevant guidelines during the last year with a clear
geographic disadvantage of the north of the country.
Main focus is to provide comprehensive services for
the management of NCDs and to reduce the likelihood of unnecessary hospitalization [3].
The Viatasan project supports the newly created National Agency for Public Health and its substructures by building expertise in health promotion
and risk reduction activities at national and rayon
levels. This expertise will strengthen intersectoral
planning (e.g. with health, social, community and
other relevant services and together with people’s
representatives), coordination and implementation
capacity of Rayon Health Councils based on jointly
developed health action plans. Jointly with the National Agency for Public Health highly practical and
skills based training activities in health promotion
will be conducted to enable rayon and community
level actors to plan, implement and evaluate their
own health promotion activities. Community interventions such as local health promotion activities,
interventions towards the development of “healthy
communities” are also supported in form of small
projects.
The Healthy Life Project supports the Moldovan
Government to strengthen its primary care services
to cope with the increasing burden of NCDs. Using
the conceptual framework of “Integrated People
centred Health Services (IPCHS)” promoted by
WHO it facilitates the reform of services, and the
empowerment of patients, care-takers, families and
communities to be knowledgeable about health risk
and individual risk behavior in order to form a care
partnership, with the aim of improving quality of
life. Local authorities play a strong role to organize
and provide coordinate platforms for interventions
from health, social and complementary services and
create healthy communities. The primary health
team in health centers and family doctor’s offices
are the health experts to manage NCDs, reduce the
likelihood of hospitalization and coordinate expert
services around patient’s needs following a more
patient centred and less professional group centred
approach
Factorii de risc ai abandonului şi ai eşecului tratamentului strict supravegheat al tuberculozei
Summary.
Risk Factors Associated with Default and Failure of Directly
Observed Treatment for Tuberculosis.
BACKGROUND: In the Republic of Moldova the success
rates of TB treatment remain low (62% in 2007). GOAL: To
identify and measure factors associated with DOT failure and
default. METHODS: a retrospective case-control study of 99
cases (registered cases of treatment failure or default) and 198
controls (new TB cases that were still under TB treatment).
RESULTS: Outpatient DOT program was correctly implemented
in only 21.3% of cases and 33.2% of controls. Most
significant predictors of adherence to treatment were: attending
a physician for outpatient DOT within 5 days after
hospital discharge (55.6% of cases and 74.2% of controls)
and correct knowledge of length of treatment (62.8% cases
and 80.2% controls). CONCLUSIONS: TB treatment success
rate depends mostly on the health care providers, such as
patient management, quality of medical care, continuity of
health care, and information given to the patient about TB
disease and treatment.Резюме.
Факторы риска, ассоциированные с прерыванием курса
противотуберкулезной контролируемой терапии.
АКТУАЛЬНОСТЬ. В Республике Молдова уровень успешного лечения туберкулеза остается низким (62% в 2007
г.). ЦЕЛЬ. Oпределить и измерить факторы, связанные
с прерыванием лечения ТБ. МЕТОДЫ. Pетроспективное
исследование типа „случай-контроль”, основанноe на
опросе 99 случаев (зарегистрированных случаев прерывания лечения туберкулеза) и 198 случяев в контрольной
группе (новых случаев заболевания туберкулезом, которые
находятся в фазе продолжения лечения туберкулеза). РЕЗУЛЬТАТЫ. Амбулаторный DOT был соблюден только в
21,3% случаев и 33,2% случяев в контрольной группе. Наиболее значимыми факторами приверженности к лечению
ТБ были обращаемость к врачу для амбулаторного DOT
в течение 5 дней после выписки из стационара (55,6%
случаев и 74,2% – в контрольной группе) и правильные
знания о продолжительности лечения (62,8% случаев и
80,2% – в контрольной группе). ВЫВОДЫ. Успех лечения
туберкулеза в основном зависит от поставщиков медицинских услуг, своевременного перенаправления пациента,
качества медицинской помощи, преемственности, и таже от качества информации, предоставляемой пациенту
о болезни и лечении туберкулеза