Zdravotná a sociálna problematika všeobecnej praxe - primárna, sekundárna a terciárna starostlivosť. včera dnes zajtra. Peter Lipták, 2014
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1 Zdravotná a sociálna problematika všeobecnej praxe - primárna, sekundárna a terciárna starostlivosť včera dnes zajtra Peter Lipták, 2014 všeobecný/ praktický/ obvodný lekár
2 Prečo zdravotný systém? PST zdravotný systém.
3 Potrebné prvky, prekážky: Pacient Lekár Liek Sestra Lôžko ZP MZ Politici...
4 Primárna/ Sekundárna+Terciárna Angiologické ambulancie Angiochirurgické ambulancie Chirurgická ambulancia Špecializovaná starostlivosť Dermatologická ambulancia Diabetotogická Diabetotogická ambulancia Diabetotogická ambulancia Diabetotogická Mentálne zdravie stacionáre CP a RZP nemocničné ambulancie Nemocnice Kliniky a oddenia Diagnostický komplement Rtg, USG, CT... KV diagnostika Laboratóriá biochemia serolog. mikrobiol. cytologické Funkčná diagnostika Pacientske organizácie a svojpomocné skupiny Komunitní pracovníci DBRVĽNÍC Tím primárnej starostlivosti: kontinuálna komplexná na osobu zameraná starostlivosť Sociálny servis a ADS opatrovateľky ošetrovateľky Fitnes a tréningové centrá Kúpele, Liečebne ÚVZ, RÚVZ environment Prevencia a podpora zdravia Komunita Prevenia závislostí alkohol, drogy... Štátne a mimovládne organizácie a inštitúcie prevencia prevencia násilia prevencia (ženy, násilia (ženy, deti, násilia muži) (ženy, deti, muži) deti, muži)
5 P N U M L Ó G N T R N S T A G R A T R A L R G L G P S Y C H A T R K A R D L Ó G NTGRVANÝ ZDRAVTNÝ SYSTÉM ŠPCALST... N U R L Ó G D A B T L Ó G N F K T L Ó G... Všeobecní lekári Populácia
6
7 S+T??? P
8 Primárna...sekundárna...terciárna starostlivosť vysoké THC FN, kliniky, vedecké a špecializované liečebné ústavy (NDÚ, NÚSCH, NÚ, VURCH, ÚVĽ, SAV) Kúpele... Cybermedicína, nternet... náklady SHC Všeobecné nemocnice, ambulantní špecialisti nízke PHC VL, Farmaceuti, sestry, komunitní pracovníci, dobrovoľníci...v komunite
9
10 Vplyv rozvoja PZS na predčasnú mortalitu v 18 krajinách CD PYLL Low PC Countries* 5000 High PC Countries* Year *Predicted PYLL Potential Years of Life Lost (both genders) estimated by fixed effects, using pooled cross-sectional time series design. Analysis controlled for GDP, percent elderly, doctors/capita, average income (ppp), alcohol and tobacco use. R 2 (within)=0.77. Starfield 10/04 09/04 Source: Macinko et al, Health Serv Res 2003; 38: C 2953
11 Spracovanie informácií
12 K A R D L Ó G?? N T R N S T A? D T L Ó G R Ú V Z - PZ?? T R É N R B Z T L Ó G? VL PRMÁRNA ZS horizontálna štruktúra. Kompetencie? PRVÝ KNTAKT, 100% zdravých občanov!! ŠPCALST x % chronických polymorbídnych pacientov, 0% zdravých občanov (vertikálne veže) D A B T L Ó G? N K L Ó G??... Populácia a jej problémy sú uložené horizontálne... Národné preventívne programy DM, KV...
13 kto?
14 všeobecný lekár
15
16 kedy upozorniť...
17 teraz
18 MDRNÝ trend Ú/WH - zmena modelu ZS Motorom zmeny sú potreby pacientov nová rovnováha Ú nová rovnováha SR PYLL (PTNTAL YARS F LF LST) je ukazovateľom MRY ZLYHANA SYSTÉMU nemocničná starostlivosť (M, NCMP, amputácie,pneumónie, dekompenzácie, rakovina., úmrtia...) prednemocničná zdravotná starostlivosť PRMÁRNA ZDRAVTNÁ STARSTLVSŤ podpora zdravia, prevencia, včasná diagnostika a liečba, očkovanie... Upravené podľa: Christopher Riley, Department for Health and Social Services, Welsh Assembly Government, 2008
19 Vplyv rozvoja PZS na predčasnú mortalitu v 18 krajinách CD PYLL Low PC Countries* 5000 High PC Countries* Year *Predicted PYLL Potential Years of Life Lost (both genders) estimated by fixed effects, using pooled cross-sectional time series design. Analysis controlled for GDP, percent elderly, doctors/capita, average income (ppp), alcohol and tobacco use. R 2 (within)=0.77. Starfield 10/04 09/04 Source: Macinko et al, Health Serv Res 2003; 38: C 2953
20 MDRNÝ trend Ú/WH - zmena modelu ZS Motorom zmeny sú potreby pacientov nová rovnováha Ú nová rovnováha SR PYLL (PTNTAL YARS F LF LST) je ukazovateľom MRY ZLYHANA SYSTÉMU nemocničná starostlivosť (M, NCMP, amputácie,pneumónie, dekompenzácie, rakovina., úmrtia...) prednemocničná zdravotná starostlivosť PRMÁRNA ZDRAVTNÁ STARSTLVSŤ podpora zdravia, prevencia, včasná diagnostika a liečba, očkovanie... Upravené podľa: Christopher Riley, Department for Health and Social Services, Welsh Assembly Government, 2008
21 Systém spolupráce
22 tímová vedomosť
23 ntegrácia PST
24 Primárna...sekundárna...terciárna starostlivosť PST systém zdravotnej starostlivosti vysoké THC FN, kliniky, vedecké a špecializované liečebné ústavy (NDÚ, NÚSCH, NÚ, NÚRCH, ÚVĽ, SAV) +kúpele......cybermedicína, internet... náklady SHC Všeobecné nemocnice, ambulantní špecialisti PHC VL, farmaceuti...v komunite nízke
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