Monitoring primary health care

in FinlandPaula Vainiomäki

Quality, control, monitoring

• Finnish attitude has been more on the side on

leadership by information distribution, not by

control methods

• “Not everything that can be counted counts,

and not everything that counts can be

counted.”

Six dimensions of healthcare quality

by Institute of Medicine

• Safe

– Avoiding harm to patients from the care that is intended to help them.

• Effective

– Providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit (avoiding underuse and misuse, respectively).

• Patient-centered (person-centred, people-centred)

– Providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.

• Timely

– Reducing waits and sometimes harmful delays for both those who receive and those who give care.

• Efficient

– Avoiding waste, including waste of equipment, supplies, ideas, and energy.

• Equitable

– Providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status.

National monitoring, AVO Hilmo

Primary care register of care given

• All health centers send automatically data from

their electronic healthcare records to the

National Institute for Health and Wellfare (THL)

https://www2.thl.fi/avohilmo_report/report?id=diagnosis&palvelumuoto=7437&yhteystapa=

9407&ammatti=7390&year=2016&l=fi

National primary care register of care given

• When and where who its treated by whom and how and when the first contact was made

• Diagnosis ICD-10, ICPC

• SPAT classification - What happens during consultations (400+ codes) (not used much)

• Vaccinations

• Dental care

• What followed after the episode

– Case closed, referral to hospital, follow-up visit …..

Visits to health care centre doctors this year

Registered causes of appointments ICD and ICPC, 70 percents

Doctors are not registerating procedures according to SPAT system

Close to 90 percents of appointments deal with medication

Much more is done?

• Patient satisfaction studies locally

• Local projects around quality run by locals

• Control locally by management, how many

patients/ working hour, how is access to care, is

there waiting time, how quickly the phone is

responded, how many referrals, costs/doctor,

pDRG (classification and productization of

services), sickness leaves of staff etc.

• Some private ”quality” enterprises helping staff

to audit their own work, quite expensive ones.

Prescriptions are done

through

national electronic system,

www.kanta.fi/en

All records are saved in

a national archive system

Health promotion

in municipalities

TEA-viisari (sign/hand)

TEA-Viisari

• Health promotion capacity building in municipalities. Search and compare results.

• https://www.teaviisari.fi/teaviisari/en/index

• TEAviisari describes municipalities' activities to promote their residents' health.

• TEAviisari is designed to support municipalities, regions and schools in the planning and management of health promotion work.

How about information distribution?

• Official advices and recommendations by

ministries, county councils, THL etc.

• Quite few strict orders

• Health care staff is supposed to take care that

they work in an updated way.

• Very beneficial have been tools by the Finnish

Medical Society of Duodecim. The functions

are supported by the state, this far.

Health gate at every GPs monitor, available for nurses as well

Nearly every GP uses these every day

• An electronic manual for primary care, most useful. This is always open during appointments.

• More than 100 clinical current care guidelines in Finnish and in Swedishhttp://www.kaypahoito.fi/web/kh/suositukset

• Patient-versions (health library) http://www.terveyskirjasto.fi/terveyskirjasto/tk.koti?p_osio=109&p_teos=khr

• Electronic decision support system connects current care guidelines with the patient records, and informs the doctor. Integrated in most record systems. Supports with diagnoses, medication, laboratory results, drug interactions

No recertification -

Continuing Professional Development?

• Resertification will come in the next years, but picking points, is it worth? No decision yet

• Currently doctors take care of their professional development themselves, as it is their moral obligation,

• The employers are responsible for the CPD and CME of the staff. They have to organised prerequisites for development and CME

• It is possible to record own careers to a special portfolio www.taitoni.fi

This sounds fine, but is it?

• Are our indicators valid? Do they measure important and right issues?

• In the future Finland, all primary care providers must publish their quality data, so the patients can choose their primary care provider

• Do we know, how people feel, are they recovering, coping, are they empowered, how do they experience our services, how is the life-satisfaction.

• We know mainly figures and numbers

– Not everything that can be counted counts, and not everything that counts can be counted