Training for caring complex health needs in the community: the impact of the synergy between top and bottom

Abstract

The Ministry of Health (MH) of Catalonia promotes the formal implementation of a new model of integrated care, comprehensive and person-centred, from a community and population-based approach, and primarily addressed to those who have social or health complex needs. All systematic focus groups conducted by MH about implementing strategies emphasize continuing education as a key element of success, especially when it is carried out in a massive manner and it’s approachable to all the professional profiles related to public integrative policies. Moreover, the Catalan Society of Family and Community Medicine (CAMFiC) has a long tradition in an online learning problem-based program called CAAPS (Course Self-related in Primary Health Care) in which, from pre-established learning objectives, several scenarios based on significant community clinical cases are developed, chosen because of their prevalence or difficulty. In CAAPS, family physicians with the support of experts from other disciplines produce a series of e-textbooks and monographs that gather these scenarios, and compile the evidence and best practices related with. Finally, after reading the books, additional material to assess the progress of learning is provided to learners. In this context, the MH and CAPPS’ editorial committee agreed the publication of two books about caring flail, chronic complex and advanced patients, according to the Catalan governmental model of integrated care. This material has been prepared in 2014 by three family physicians, with the co-operation of 18 expert reviewers, from several specialties and professions, from social and health services. The books were accompanied by several additional educational tools: - Training of trainers in every health care centre, transferring material to carry out standardized formative sessions - Multimedia website where trainers can access to supplemental pedagogic material - Open access to CAPPS notebooks funded by the Ministry of Health for people not subscribed to formal on-line version. - Supportive website to CAPPS-based learning where tutors answer students questions. This training package has been widely spread, addressing it to all professional profiles working at the community level (family physicians, community nurses, case managers and social workers). At present, the results of this educational action are: - People formally subscribed to the CAAPS 1005 registered. Notebook 1: 330 exams done; 313 approved. Notebook 2: 252 exams done; 250 approved - Session of Training of Trainers: 305 students with a degree of satisfaction with the activity average of 4.5 out of 5 - Sessions at health centres, perform up to 31 January, 2016, 96 carried out, 11 scheduled - Access to the web material support: 1248 different people have accessed the website and 324 have viewed the videos. - Enrolled in the Ministry funded version, to perform from November 2015 to February 2016: 3132 registered (1851 Barcelona, 377 Girona, 193 Lleida, 431 Tarragona) 556 men and 2576 women, 1594 nurses, 1344 doctors, 65 social workers. In terms of coverage, these results imply that this training proposal reaches 100% of territory and community teams, virtually 100% of clinical leaders and healthcare mentors and that 25% of primary care professionals have been exposed to it, allowing a) sharing terminology and a common vision on integrated care for complex needs, b) knowing the conceptual basis of this model of care and c) providing tools for managing most common clinical situations that arise in day-to-day care of complex patients. Currently we are designing the method to assess the impact of this educational strategy on professional performance. Conclusions : Training is a key element for the dissemination of integrated care on chronic complex conditions. The co-operation between government and scientific societies can be crucial to achieve high impacts in educational coverage. This synergistic action multiplies results and facilitates training to all territories and all stakeholders.