Clinical Health Promotion in the Czech Republic: Standards Compliance and Service Provision

Abstract

Background Clinical health promotion significantly improves treatment outcomes in hospitals and health services on both long and short term. Therefore, the World Health Organization (WHO) and the International Network of Health Promoting Hospitals & Health Services (HPH) developed and validated three easy-to-use tools that have been implemented by many national, regional and local health care organisations as part of their quality management framework. However, the compliance with and use of these standards and models, as well as the actual provision of health promotion services, are seldom published. The aim was to evaluate the compliance with the current WHO-HPH Standards and the related documentation models compared with the international baseline data from 3 historic control groups from 2005, 2008 and 2012. Methods In a cross-sectional design, 8 clinical departments from the Czech Republic were included, and 400 consecutive medical records from a random date were evaluated. Data were collected on standards compliance and service provision using 3 tools: the 5 overall WHO-HPH Standards (2005); the HPH DOC-ACT model (2007) on clinical health promotion intervention; and the HPH DATA model (2012) for medical records documentation of the patients’ need for health promotion intervention. The international baseline data originated from the historic control groups of 38 hospitals in 8 countries (2005); 17 from six countries (2007) and 68 from 11 countries (2012). Results The overall compliance with the WHO-HPH Standards is significantly higher at present compared to the international baseline data (2005); the compliance rates were 66% versus 53%, respectively (P < 0.01). The patients’ current needs for health promotion intervention were documented to a similar degree as in the historic control group, and the percentages were 66% (26-98%) versus 66% (29-94%), respectively. The provision of health promotion intervention to patients who need it is significantly lower at present, with an overall rate of 16% (13-24%) versus 30% (10-36%), with p < 0.05 for motivational activities. Additionally, 14% (13-20%) versus 23% (6-40%), with p < 0.01, had documented intervention programmes. Further 16-27% compared to 0-3% (p < 0.01) of the patients in need had insufficient information for identifying whether any interventions had taken place. Conclusion The overall compliance with the WHO-HPH standards is high at present. However, there is inadequate provision of clinical health promotion activities to patients in need, indicating that substantial benefits would result from implementing clinical health promotion. New research on implementation strategies is urgently needed. (Less)