community healthcenter hohenstein: challenges in ... · 9/4/2018 · working group "healthy...

Community Health Center Hohenstein: Challenges in development andimplementation of innovative, person-centred andmultiprofessional care in rural areas.

Prof. Dr. Barbara Steiner, Koordinatorin Gesundheitszentrum Hohenstein

Demografic, epidemiological and social change • Increasing chronic diseases, multiple diseases and diseases due to social change • Shortage of family doctors / rural doctors

• Specialist recognition: 90% specialists, 10% generalists• Age distribution of general practitioners: in the district of Reutlingen 75% of all GPs are 50 years or older (as of

1.10.2014). This can also be observed for other medical specialists and health professions.

• Information overload through the Internet (uncertainty, lack of self-management)• Altered patient role• Fragmentation of care (family doctor, specialist, health professionals ...)• Lack of importance of prevention and health promotion• Process of (re-) urbanization and decrease of younger population. Large and medium-sized cities

are perceived as more attractive. This can also be observed among junior physicians, which leads to an oversupply in cities and undersupply in rural areas.

• Decline in family networks and family support potential• Thinning of rural areas with age-mixed residents and infrastructure• Social distress (loneliness etc.)

Focus on solutions• Expert Council for the Assessment of the Development of Healthcare

(2014). Needs-based care - perspectives for rural regions and selected service areas. Berlin: German Bundestag.

→ Local health centers • Seventh Report on the Situation of the Older Generation in the Federal

Republic of Germany - Concern and Responsibility in the Community -Building and Securing Sustainable Communities (2016). Berlin: German Bundestag.

• Services of general interest and municipal responsibility • Subsidiarity as a framework for local structures and networks• Inequalities in an aging society • Regional disparities and the life situations of older people in Germany • Health care • “Sorge und Pflege”• Housing and living environment

Local health centers (Sachverständigenrat, 2014)

• District of Reutlingen in Baden –Württemberg

• Rural area of Schwäbische Alb –750 m over sea level, density 267/km²

• 5 villages with ca. 3750 inhabitants

• Next bigger city: 30min with caraway

Health Care Centre Hohenstein

Baden-Württemberg

Development

Implementation of the public health guideline of Baden-Württemberg into practice in the district of Reutlingen

2014Development of the public health guideline Baden-Württembergand implementation in the district of Reutlingen

Health Care planning / Healthy community Hohenstein

since 2015Public participation processes Working Group "Healthy Community" Health Care Center Implementation of projects e.g. grow up healthy (kindergarden) Implementation new job Health / Social Reconception of the Senior Residence "Im Adler“ (Sheltered Living and shared housing with care

Pilot project for the cross-sector care of Baden-Württemberg

2016-2018

Health Care Center 11 / 2016 PORT

11 / 2016 Starting Project PORTPlanning Health Care Center Hohenstein


• support health promotion and preventive healthcare in all policies and areas of life of the citizens of the district of Reutlingen

• focus on the prevention/reduction of non-communicable diseases (chronic diseases)

• intention to ensure primary care and health care in all stages of life, depending on the specific requirements of the district

public health guideline (2014)

Implementation in CommunalHealth Conference

chairman of the committee:

district administrator

health insurance

companies medical associations

politicians

sports clubs

pension insurance

chamber of crafts

chamber of industry and commerce

educational establish-

ments

support groups

district hospitals

district office

office of local health conference is located at the local public health office Reutlingen

Way of working

assessment

policy develop-

ment

assurance

evaluation

identify demandactual situation? requirements?expert interviews, health monitoring,SWOT analysis: strengths and weakness, opportunities and threats

face the need of actiondetermine measures andplan the realization

implement an action together with our partners

evaluate successachieved the aim?efficiency?effectifity?

all activities rely on the public-health-action-cycle:

Overview of key activities

shortage of primary care physicians (PCPs) in the countryside of the district

backpain (non-communicable disease)

physical activity for all ages and stages of life –starting in the kinder garden

diabetes mellitus (non-communicable disease)

continuous sectorial planning

health management especially in small and medium-sized companies in our district

healthy community program

dementia

SUBJECTS

Development






2016-2018



1. Population-based basic data 2. current health infrastructure and supply 3. health-promoting offers and structures

• Evaluation of the currently available data + information on quality and relevance

• Structuring of data according to relevance, quality, small-scale aspects, availability and determination of spatial viewing levels

• Presentation of spatial data in the Geoinformation-System• Networking with other technical planning

Preparation of a regional analysis

Data collection and structuring

Health Care Planning

Workshops with citizens as planning tool� Gathering ideas and visions� Attracting and motivating citizens for the process� Coordination of regional supply planning

Key results:

� The health center offers health care from a single source� The health center as an information and communication center on all issues

related to health� the health center as a central location in the region

What are the challenges?What are the prospects and potentials?

What can contribute the health center?

14

© Kreisgesundheitsamt Reutlingen

Healthy Community Design• assessment• demographic change (increasing number of older people, higher average age, increase in NCD)• shift in the disease spectrum• change in life-style (risk factors for NCD: physical inactivity, smoking, excess of weight,

high blood pressure, psychosocial workload)• shortage of skilled workers (health management)• identify demand: we need a nearby located, highly qualified healthcare (medical care,

health promotion and disease prevention)

→ health promotion strategies and programs should be adapted to the local needs and possibilities. → aim: All communities continually create and improve the social, environmental and economic assets

that support health and well-being.

Health • As a communal task• As important location factor• As an economic factor

Healthy lifestyles. Physical Activity Levels.Access to Healthy FoodsA vibrant economy. Affordable housing. Protected parks & green space. Accessible community services. Clean air and water. A sustainable environment. Healthy public policy. Engaged citizens. Equal access to high quality prevention and health care services . Provision of healthy food and beverage. Age friendly.Social Connections.Water Quality.………….

Development






2016-2018



Pilot project for the cross-sector care of Baden-Württemberg• Coordination of supply requirements and provision of care in the

participating model region• Aims

• developing recommendations for care planning¾ cross-sectoral: improving cooperation at the interfaces

¾ ambulant / stationär ¾ Gesundheitsförderung und Prävention, Rehabilitation,

Pflege, ¾district-overarching: development of district-overarching

solution approaches

©fotomek-Fotolia.com

Development






2016-2018



Health Care Center Hohenstein• started in 2015 with an inquiry of all resident general

practitioners of the district concerning their situation, age and succession plan

• actual repeated survey in 2018 is in process

Health Care Center Hohenstein as a part ofcommunity care Medical

Primary supply Long-term

care and care

Continuity in care

Supporting the patient in

his illness

exchange with the citizens

Preventionand healthpromotion

Use of new

potentials (E-health,

telemedicine, AAL)

Cooperation with partners

from the region

Tailored to the needs

Meeting -place and impulse

generator of the

municipality

Multi-professional

team

Tasks:

•general practitioner•physiotherapy •occupational therapy•consultants (for example ophthalmologist)•consulting services of professional and civic actors, care center, municipal health conference

Integration of the PORT concept (patient-oriented centers for primary and long-term care) - funded by the Robert Bosch Foundation •Project Coordinator•“Guide" (case management, patient support, clarification of medical / health processes and assistance, agreement on treatment path, forwarding to diagnosis and therapy in the centre and externally).

http://www.bosch-stiftung.de/de/projekt/port-patientenorientierte-zentren-zur-primaer-und-langzeitversorgung

Integration PORT-Konzept(five initiatives across Germany)

http://www.bosch-stiftung.de/de/projekt/port-patientenorientierte-zentren-zur-primaer-und-langzeitversorgung

• are tailored to regional needs• provide coordinated, patient-centered care on an ongoing basis• help patients cope with their conditions• employ an multiprofessional team from the health and social care

sectors and other professions, cooperating as equals• use new potential such as e-health• integrate prevention and health promotion activities• are well integrated within their communities

Planning: architecture and equipmentInterdisciplinary approach of patients• Office pilot as a starting station,

common administration • common waiting areas in the "Piazza"

with different equipment (child area, Café meetingpoint, relaxation, etc.)

• Comprehensive information e.g. through digital Infoboard, exhibition (showcases)

Interprofessional work• Shared meeting room, classroom• Common Area Employees

E-Health – autonomous patient -community• "Online Office" for guidance, training,

search for patient, public, citizen terminal for research e.g. e-file

multidisciplinary physiotherapy

General practitioner consulting services, comprehensive

Occupational therapy

Current issues in the planning of the Center specifically

• Management Mission Statement/Governance/Civil Society• Question of the influence of municipalities and private practices on the common

developments• Influence of citizenship /civizens participation

• Social Systems/Understanding • “Versäulung” medical, nursing, social (each standing unconnected as a column)• What does "care" mean, what does "social work" mean? Cure? Care? “Sorge"?• What does “caring community” mean?

• Professional Concept (doctors and medical assistants, health professionals, occupational therapist, physiotherapists, social workers, etc.)

• Professional Socialization• Hierarchical Structures/Status• Division of Work • Professional content/competencies

• Funding • Where is the benefit for the participants in the short and long term?• More time needed for cooperation/savings in the joint organisation? • Who is responsible for infrastructure? The private practices or the municipality?

• Infrastructure issues • What does "central" mean in 5 municipalities? New communal spatial planning

strategies: consolidation of inner-local spaces instead of "neutral in the middle of nowhere?"

• Accessibility of the center: what will mobility look like in the future? Individual mobility? Bürgerbus?

• Technology, digitalisation• Where to start, what are the perspectives? Basic equipment, internal networking,

extensibility, range? • E-health, Ambient assisted living, smart home

• Interdisciplinary work and joint organisation• Shared Management – software? Employees: Competencies? Cost?• Pilot profile?

Community care

Health Care Center• Housing, Living

Environment• “Sorge” und “Pflege”• Health care

• Interdisciplinary medical, care, therapeutic, social support

How becoming part of Community Care?

Thank you very much for your attention!

Kontakt

• Prof. Dr. Barbara SteinerProjektkoordinatorin Gesundheitszentrum [email protected] 0049(0)1703433669

community healthcenter hohenstein: challenges in ... · 9/4/2018 · working group "healthy...

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