POPLHLTH101 NOTES

Triple Aim and Health System Goals

• Triple Aim concept focuses on three key areas:

  • Reducing cost per capita of care

  • Improving the experience of care

  • Improving the health of populations

• Berwick's Resource Allocation

  • Aims for best value for public health system resources

  • Focuses on improved health and equity for all populations

  • Enhances quality, safety, and experience of care

• Comparative Analysis

  • Berwick vs. Roberts and NZ Triple Aim:

    • While dimensions don't overlap perfectly, similarities exist.

    • A good system addresses all dimensions, and failure occurs if any are neglected.

    • Roberts' dimensions align closely with NZ Triple Aim and WHO objectives.

Learning Objectives for Lecture 3

• By the end of this lecture, students should be able to:

  • Distinguish between primary, secondary/tertiary care, and public health activities/staff.

  • Identify boundaries of these domains and understand their significance.

  • Differentiate between primary medical care and primary health care and assess how broadening general practice can facilitate delivery.

  • Recognize potential gaps between primary and secondary care and how health systems aim to address these issues.

Parts of the Health System

• Lecture Focus: Health system domains and their disparities.

  • Emphasizes 'Mind the Gaps' pertaining to health system capacity.

Medical Interventions

• Primary Care

  • Most medical interventions occur here, often less visible than secondary care.

  • Clinicians in primary care play a crucial role as a link to secondary care.

  • Key domains of health systems:

    • Active Medical Interventions: Conducted by clinicians.

    • Tertiary Care: For individuals referred by secondary providers.

    • Public Health: Focused on improving health outcomes and reducing future care determinants.

Overview of Care Types

• Primary (Medical) Care

  • Delivered by health care professionals in community settings; often the first contact point for patients.

  • Providers include general practitioners, midwives, dentists, physiotherapists, and more.

• Locations for Primary Care

  • Typical settings include general practices, urgent care centers, and community pharmacies.

• Secondary and Tertiary Care

  • Secondary Care: Involves specialized medical services, typically accessed via referrals from primary care.

  • Tertiary Care: Highly specialized, complex care usually provided in hospitals and often requiring referrals.

Distinguishing Care Types

• Primary vs. Secondary Care

  • Primary care is predominantly community-based while secondary and tertiary care is typically delivered in hospitals.

  • Replacement roles and exceptions exist, such as community specialist clinics and mixed emergency department services.

Defining Public Health

• Public Health:

  • Organized measures to prevent disease and promote health among populations.

  • Emphasizes conditions conducive to health rather than focusing solely on individual patients.

  • Main functions include:

    • Assessing and monitoring community health.

    • Developing public policies to address health issues.

    • Enabling access to cost-effective care, including health promotion.

Public Health Services

• Services provided include:

  • Prevention programs (e.g., vaccination, screenings)

  • Health promotion and education (e.g., nutrition, sexual health)

  • Environmental health measures and disease control (e.g., food safety, water quality)

Differences in Healthcare Structure

• Cultural and Organizational Influences

  • Distinctions arise from historical, cultural factors impacting roles and prestige within healthcare.

  • Primary care practitioners have greater autonomy; public health roles might be seen as less prestigious.

Vulnerabilities Within Health Systems

• Proposed cuts threaten roles in vulnerable communities, particularly those in hauora Māori and public health sectors, raising concerns about the inequity in health resource allocation.

Patient Journey Examples

• Traumatic Brain Injury: Involves a pathway from general practitioners to emergency care, hospital admission, and subsequent rehabilitation.

• Bowel Cancer: Highlights the importance of early detection, screening, and the transition of patients from public health initiatives back to the community.

Primary vs. Primary Health Care

• Primary Care: Focus on treatment and episodic care by specialized healthcare providers.

• Primary Health Care (PHC): More holistic, incorporating health promotion, prevention, and community development strategies.

Enhancing Primary Health Care

• Six elements deemed essential for stronger PHC include:

  • Accessibility, continuity, comprehensiveness, coordinated care, community orientation, and family orientation.

Gatekeeping in Health Systems

• Gatekeeping roles in health systems prevent inappropriate transfers between care levels and ensure that primary care acts as the initial contact for patients seeking secondary care.