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WELLNESS APPROACH IN PRIMARY HEALTH CARE

WELLNESS APPROACH IN PRIMARY HEALTH CARE. Dr Noridah Mohd Saleh Ketua Penolong Pengarah Bahagian Pembangunan Kesihatan Keluarga KKM . Background. Changing Paradigm : Illness to Wellness (expanded scope in 7MP) One of the 8 Future Health Goals

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WELLNESS APPROACH IN PRIMARY HEALTH CARE

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  1. WELLNESS APPROACH IN PRIMARY HEALTH CARE Dr Noridah Mohd Saleh Ketua Penolong Pengarah Bahagian Pembangunan Kesihatan Keluarga KKM BPKK

  2. 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

  3. 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

  4. PRIMARY HEALTH CARE Primary Care Family Health FHD / BPKK “Illness” + “wellness” BPKK

  5. 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

  6. The 8 HS Goals “ Wellness” Not to be merely a theory To be translated Into Action “well” “ at risk” “ill” BPKK

  7. Why Wellness Approach? BPKK

  8. 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

  9. Top 10 DALYs BPKK

  10. I - Prevent and Reduce Disease Burden • 70% of total Health Budget • 2m inpatients • 40m outpatients ILL WITH RISKS POTENTIAL RISKS ‘HEALTHY’ – No identified Risks BPKK

  11. 72, 76 (2005) LIFE Expectancy LIFE EXPECTANCY AGE BPKK

  12. AGE Raised Blood Sugar Periph Neuro Diabetic Foot /amputation Diabetes Health Expectancy HEALTH EXPECTANCY AGE BPKK

  13. Experience • What have we learn from MCH services? BPKK

  14. 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 • Hypertension in Preg – 1,268 • Maternal Sepsis - 171 • Obstructed Labour – 14 IHD - 113,887 CVD/Stroke - 86,372 Major Depresn- 67,211 Diabetes- 56,390 >>OBESITY from 5% to 10-13 % in 10years?? BPKK

  15. Prevent and Reduce Disease Burden Experience from the MCH wellness Services • Screening • Examination & Immunisation • Health Education • Follow-Up & Home Visits • Treatment IS BPKK

  16. MCH Services Investments • Dedicated Clinics • Dedicated Staff • Trained Midwives and PHN • Trained Doctors and Obstetrician • Effective MCH & FP Protocols • Effective Referral System BPKK

  17. 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

  18. Wellness approach… • How to do it? BPKK

  19. Wellness.. Proposing‘Plan Preventive Maintenance’Approach BPKK

  20. 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

  21. 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

  22. Prevent and Reduce Disease Burden Health Promotion, Screening, Early diagnosis, Prompt Treatment, Rehabilitation Integrated services BPKK

  23. Rajah 1 Jenis perkhidmatan yang disediakan di KK Klinik ibu dan anak Klinik sihat Klinik kesihatan mental Klinik berhenti merokok Klinik diabetes Klinik warga tua Klinik Perancang Keluarga Klinik hipertensi Klinik reproduktif Klinik remaja Klinik tibi Klinik OKU Klinik pesakit luar Klinik pekerja Perkd. Kecemasan Farmasi, Makmal, Radiologi Maklumat Kesihatan Existing Framework BPKK

  24. Kesihatan Ibu Ibu Mengandung Pemeriksaan kesihatan, kandungan dan darah Lawatan ke rumah Ibu Bersalin Menyambut Kelahiran Ibu Lepas Bersalin Pemeriksaan kesihatan Pemeriksaan bayi Lawatan susulan di rumah Khidmat perancang keluarga Promosi susu ibu Kesihatan Anak Pemeriksaan kesihatan Imunisasi ‘Early intervention Program’ Lawatan ke rumah Kesihatan Sekolah Pemeriksaan kesihatan murid-murid Tahun 1, 6 dan Ting 3 Pemeriksaan fizikal Imunisasi Rawatan dan rujukan Perkhidmatan pergigian Promosi kesihatan Kesihatan persekitaran sekolah Kesihatan Remaja Promosi Kesihatan Penyaringan, penilaian dan pengurusan risiko Pemeriksaan kesihatan Rawatan dan rujukan Kaunseling - pemakanan, merokok Kesihatan Warga dewasa Promosi Kesihatan b) Perkhidmatan penyaringan dan penilaian risiko Perkhidmatan pengurusan risiko Pemeriksaan kesihatan Perkhidmatan kesihatan reproduktif Kaunseling Rawatan dan rujukan Kesihatan Wargatua Promosi Kesihatan Pemeriksaan kesihatan Pemeriksaan pergigian Rawatan dan rujukan Kaunseling dan Rehabilitasi Kesihatan Mental Promosi Minda Sihat Penyaringan – faktor risiko, DASS, gaya tindak Intervensi awal / susulan – teknik relaxasi, urutan leher dan bahu Pengurusan pesakit – psikososial, farmakologikal Rujukan Rehabilitasi Rawatan pesakit luar Menerima dan membuat rujukan Penyiasatan awal Rawatan dan rawatan susulan (kes kronik) Khidmat pakar (kes akut, kronik, kecemasan) Perkhidmatan rawatan kecemasan (pra hospital/Ambulatory Medical Emergency) Rawatan pembedahan kecil Pengendalian kes perundangan perubatan (medico-legal) Notifikasi kes Promosi kesihatan Services Provided – KK (2)&(3) BPKK

  25. Pemakanan dan Dietetik Promosi makan secara sihat Pengurusan berat badan Pengurusan pemakanan pesakit kronik Rehabillitasi pemakanan Dapur sihat / kafeteria sihat Kesihatan Pergigian Promosi kesihatan pergigian Saringan dan Pemeriksaan kesihatan pergigian Rawatan Rujukan pakar Kesihatan Pekerja Pemeriksaan kesihatan – pre employment, routine medical examination Penilaian risiko pekerjaan / hazard Rawatan dan rujukan Siasatan penyakit/wabak Rehabilitasi Pemulihan anggota Pemulihan cara kerja Pemulihan pertuturan Pemulihan pendengaran Surveilan kesihatan Pengesanan kes secara aktif dan pasif Pengesanan kontak Pengesanan kes tercicir Promosi kesihatan Perkhidmatan sokongan Perkhidmatan patologi - Pengendalian spesimen - Ujian makmal Perkhidmatan pengimejan diagnostik - X Ray dan Ultrasound Perkhidmatan farmasi - Pendispensan ubat-ubatan - Kaunseling Services Provided - KK BPKK

  26. 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

  27. 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

  28. 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

  29. What do we offer ? Wellness services BPKK

  30. 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

  31. 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

  32. I - “Wellness Clinic” Ibu Anak Remaja Dewasa Warga Tua II - “illness Clinic” Kecemasan Akut Kronik Penyakit Berjangkit • III - Emergency • Support Pre-hospital • ‘Support Call centre’ • Support Rapid Response III - “Support Services” - Makmal - Farmasi - Radiologi - Sistem Informasi dan komunikasi (5) Outcome - Wellness Service “ Womb – Tomb” • Maternal • Child • Adolescent • Adult • Geriatric School Health Home Visits Home Nursing BPKK

  33. Prevent and Reduce Disease Burden • Treat the ill • Manage those with risk • Prevent the onset of preventable risks IMPROVE HEALTH EXPECTANCY WELLNESS SERVICES BPKK

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

  35. Health Services In Clinic Adolescent Adult Geriatric Mental health BPKK

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

  37. BPKK

  38. 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

  39. 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

  40. Risk Assessment by Age Gp For Female Adult Osteoporosis For Older Adult Stroke For Child and Adolescent Child and Adolescent Health Risk Profile (Text Version) BPKK

  41. screening tool • Self • Assisted BPKK

  42. Guided Self-Check Checklist for Risk Screening according to age group Triage Counseling and Health Education Risk Assessment Risk Management Wellness (PPP) Activities / Services Resource Implications: • Space - BIG • Equipments • Training • HR • Dr • Dietician • Health Education Officer • Medical Assistant • Nurses • Clerical Process Implications: • Consolidation of islands of clinics Adolescent, Paps smear, BSE, HRT, Men’s, OKU, CVD, PSR, Occ health, geriatric health, …. BPKK

  43. 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

  44. - “Achieving lifelong Wellness” 5 Areas to be strengthened • Healthy Eating • Regular exercise • Healthy Mind • Stop Smoking • Healthy and Safe Environment EMPOWERMENT BPKK

  45. Pelanggan Komuniti, OPD, MCH, Sekolah Kaunter informasi Pegawai perhubungan pelanggan Kecemasan Pesakit Luar ** Isi borang saringan asas(mengikut kumpulan umur dan jantina) dan dapatkan temujanji Kaunter Pendaftaran Klinik Wellness Pembantu Tadbir Lengkapkan Saringan Asas & Ukuran Biometri & Pemeriksaan Fizikal Asas Jururawat Masyarakat / Pembantu Perubatan Penentuan Risiko Pakar Perubatan Kesihatan Awam Ada penyakit Ada risiko Tiada risiko Pakar Perubatan Kesihatan Awam, Pembantu Perubatan, Jururawat Terlatih, Kaunselor, Jurupulih carakerja/ Anggota, Pegawai Zat Makanan / Dietician, Pegawai Pendidikan Kesihatan Rujuk FMS Pakej Promosi Kesihatan Temujanji Discaj • Minda sihat • Berhenti merokok /Substance abuse • Pemakanan sihat • Senaman (termasuk PT, OT) BPKK

  46. 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

  47. 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

  48. 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

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

  50. 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

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