Integrating the community health perspective into the health care provision system: the Basque Country case

Abstract

Introduction : Integrated care has been recognized as a useful strategy to avoid the existing gaps in health care provision and, consequently, to improve the efficacy of the provided care and to improve patients’ health outcomes, quality of life and satisfaction. Community care is based on the assessment and intervention over the local health determinants, needs and resources. This process, in order to constitute a true community health approach, needs to be performed in a participatory manner by professionals and community stakeholders. Even though integration is being facilitated and promoted though numerous health systems, frequently is focused around care levels (primary care and specialized care) or adjacent health systems (primary care and mental health care), and rarely considers other related aspects as social care or community health. The Basque Country Health Department, since 2013 has been developing an overall strategy aimed to generalize some integrative experiences previously tested. At this point all health care organization at the Basque Health System has functionally integrated primary and secondary care, and several plans are being developed in order to advance towards a comprehensive integration of systems. One of these specific plans is aimed to integrate the community health perspective into the primary care health system and this process and the first results are the subject of this communication. Short description of practice change implemented, aims, target population and key stakeholders involved With the aim of integrating community health perspective into the primary care network, the Public Health Department and Osakidetza (the Public Basque Health System), constituted a work team appointed to lead the necessary process. This group was constituted by health promotion, primary care and research professionals of both institutions. The group proposed a plan based on three main elements: communication of the interest of integrated community care practice; capacitation of professionals; provision of a theoretical framework fitting the Basque Country reality. All these three elements were oriented to promote the integration of health professionals (primary care and health promotion) in local health networks (already existing or newly developed) working in the assessment and intervention over the main local health determinants. The local health network was considered key of the whole process. Key findings : results, outcomes and impact. Regarding the three main elements of the plan, the communication of the interest of integrating community health was based on multilevel plenary sessions attended by the managers of care organizations and primary care units. Also a work cafe was celebrated with the participation of interdisciplinary stakeholders from the health system but also from the local authorities, education, social system and citizenship. Regarding capacitation of professionals, a peer based education process is being developed. Around 70 professionals are taking part on it and at the same time that theoretical contents are being provided, each attendant is putting on place at his/her own local community the lessons learned. Finally a guide for the integration of community health perspective has been composed by some of the members of the team. This guide is based on published evidence and its being used as the base for the education process. It dedicates special attention to the evaluation of the process and the local networks results. Highlights: (discussions, lessons learned from the process of implementation, timeline, contingencies developed) Community care was not a new issue for several health organizations. Abundant experiences were already put in place and, for the professionals already involved, this new plan constitutes a great opportunity to consolidate their advances. It is very important to consider these previous experiences, never neglect them and use that knowledge to improve the new initiative. The process to participate in local health networks is difficult for non-trained professionals. It is necessary to capacitate health professionals in participatory techniques in order to made them feel comfortable with the task and also to enable them to play an active role in the participatory processes. Health care managers need to facilitate the participation of health professionals in local health networks as the key point to integrate community care in the health system. Community stakeholders welcome health professionals to be a part of the existing networks and are willing to promote and work on new ones. Conclusion: (include comments on sustainability and on transferability) Integration of community perspective in the health care provision is a complex task that only can be tackled through the dedication and work of health professionals, the facilitation of the managers and the determination of the whole health system.