School of health for patients
School of health for patients – a key factor in the quality of care.
A fundamental prerequisite for social and economic development of society is the health of an individual and the society as a whole. Despite the development of medical science in recent years, the health indicators of the population of Russia continues to rapidly deteriorate, dramatically increase mortality and disability, including persons of working age.
Against the background of these alarming facts reduced range of medical services under MHI, especially prevention, increasing the cost of paid medical services, are constantly increasing the price of medicines, zarubejnie domestic.
Health care as a public institution is not enough focus on the main object of medicine, the patient who is a consumer of medical care. In conditions of protracted economic crisis, our health care lags behind in the search of methods and means that would ensure the improvement of population health to the level of developed countries and simultaneously contribute to improve the medical and demographic situation in Russia.
The main goal of health of Russia at the present stage is improvement of quality of care. The introduction of modern technologies of organization of medical care, based on international standards will improve the quality of medical care, to create preconditions for the formation of a civilized medical space.
Currently delivered “conceptual question about continuous quality improvement health care – total quality management” (Vyalkov A. I. 2003) . The key principle of total quality management in health care is the following.
1. The health care system and shape the needs of patients.
2. Quality assurance is a priority in the activities of the health system.
3. High quality health care is a consequence of the quality systems organization, technological processes and resources.
4. The achievement of high quality is impossible without a fundamental change in the system of organization and management in health care, what is today called management [1.
Ensuring quality of care through the integration of industrial models of quality assurance in the medical sector (Total Quality Management – TQM) and MS ISO 9000:2000, will contribute to the effective use of all medical technologies, manipulation and of experience (evidence-based medicine) [1, 10, 11, 12, 21]. These standards open the way to the “ability to use knowledge properly”, i.e. “how to do the right thing” [1.
Introduction to the practice of LPU methodology of MS ISO 9000:2000 – direct and perhaps the only way to resolve quality problems in health care [1, 10, 11, 12, 21]. All the activities of MPI should be based on the needs and expectations of the patient. In these conditions the special urgency is the creation of the LPU Schools of the patient to patients with major noncommunicable diseases.
In recent years, more and more health professionals pay attention to the fact that all the achievements of modern medicine can go unrealized in practice, if between doctor and patient is a partnership and true cooperation [13, 17, 18, 20, 24]. For anybody not a secret that ultimately only the patient who chooses what and how to make : whether to follow only the doctor’s recommendations for medication, if change your diet in the direction of improvement, increase physical activity, give up bad health habits, etc. In this mutual process, the role of the doctor and the patient are inseparable. Only a partnership between doctor and patient will give a positive result and ensure the patient’s adherence to treatment, which, as proved by practice, research and life itself, will undoubtedly lead to improvement of prognosis, improvement and extension of the working life of patients.
One of the ways of forming a partnership “physician–patient” is a patient education, particularly in small groups.
The purpose of these schools: enhancing the motivation and commitment of patients to fulfill medical advice, the formation of a partnership with the doctor in the treatment, rehabilitation and prevention, their mutually beneficial cooperation.
We have no right to turn the patient in a passive and helpless “swallower” of drugs and consumers of treatments.
This problem can be successfully solved with the help of the concept of PDCA – concept of continuous improvement, when the patient (and/or relatives) understand that the therapy represents methods and tools to achieve specific goals and must not only faithfully comply with all the requirements of the doctor, but also to be an active participant in her rehabilitation, keeping track of all the nuances of their condition and informing the physician about the positive and negative facts with the purpose of correction and at the same time form skills of pre-medical control of the disease. Algorithm the concept of PDCA.
– planning (Plan) consists of two steps – setting goals and objectives, the justification and the provision of methods and means of achieving goals.
– implementation (Do) also consists of two stages – training for a specific task and then its implementation.
control (Check) involves checking the result from the point of view of detection of its compliance to the expected results.
– impact (Action) provides for the implementation and making adjustments where the actual result is not as expected. Correction shall be made on the basis of the analysis and identify reasons for discrepancies.
The doctor will have in the appointment of treatment to offer the patient a diary of self-control that represents the control paper (specially designed) specific (diagnosis and condition) for this particular patient. The medical staff needs to explain orally or in writing to the patient (or his relatives) the purpose and objectives of methods of treatment and dosage regimen of drugs and justify the purpose and scheme of control to help the doctor to assess the treatment results and to make timely necessary adjustments to eliminate or prevent possible undesirable effects and stabilize the positive results.
Management cycle PDCA should be a standard algorithm working with the patient. It is the concept of continuous improvement allows to enhance the strength of the patient and make it the active assistant of the doctor in the process of treatment, rehabilitation and prevention. Patient should be taught to take responsibility for their health.
In addition, active surveillance of their condition and awareness of the positive and negative aspects, encourages the patient to change certain habits and lifestyle changes. When it is done by internal conviction, there is always the effect. The violence in this issue, as a rule, does not lead to positive results: the quality of care starts with quality system of a medical institution and continues system the quality of life of the patient outside of hospitals. Objective: maintaining a stable condition of the patient at the highest possible level for this particular case.
Only such approach will allow to implement fully the concept of quality of care, increase the role of preventive (preventive) measures, will make health care cost effective and efficient. Moreover, this approach requires quite a few initially – properly regulated procedures “Maintaining (improving) state”, which is offered to the patient as a method of achieving the goal. Offer the patient the regulations have to be extremely identified, specific, intelligible, and real terms of its feasibility and is focused on the capabilities of the patient (and/or relatives.
Such a setting when medical assistance is fully consistent with the requirements of MS ISO 9000:2000, as it aims to meet the needs of all stakeholders (patient, family, physician, society and the state.
The structure of the school of health for the patient covers the sphere of interests of all stakeholders: patient, family, physician, society and the state.
The modern concept of health considers necessary the involvement of the patient (or his relatives) to the solution of his own problems.
In 1986, under the auspices of the who (world health organization) in Canada has adopted the “Ottawa Charter for health improvement,” which includes five aspects.
1. public policies that promote health.
2. health-friendly environment.
3. personal skills and abilities.
4. part of the population.
5. reorientation of health services.
The idea of “the Ottawa Charter for health improvement” is, “to create structures and mechanisms that would allow people to use all their potential in health, to take control of and improve their health. Health, therefore, is not just a life, free from fatal diseases, is a socially active life for the greatest number of people” [22.
In the European strategy “Health for all by the year 2000” also proposed to increase the priority of health promotion and disease prevention, to pay more attention to the roles of individuals, families and groups. The main is considered the increase of medical care quality . The proposed structure of school health for the patient is a modern, promising and essential factor improving the quality of care.
Thus, the concept of school health, aimed at the active position of the patient (and/or his relatives) to maintain improvements in your health, is relevant, promising from the viewpoint of improving the quality of medical care.