Post on 31-Jul-2020
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
Implementation of the public health guideline of Baden-Württemberg into practice in the district of Reutlingen
• 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
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
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
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
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
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
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 Hohensteinsteiner@dhbw-heidenheim.deMobil 0049(0)1703433669