Ministry
of Health of the Republic of Lithuania
Long wait
times to see specialists. Poor coordination between family doctors and
hospitals. Duplicated tests. And some of the highest rates of heart
disease-related death in Europe.
They were
some of the challenges facing Lithuania 20 years ago, particularly in the
country’s eastern region, where mortality from heart disease and stroke was
highest, especially among middle-aged men and women outside major cities.
Health
officials concluded that many of the problems patients experienced in getting
the care they needed stemmed from the way services were organized and provided.
Specialist cardiology centres were overstaffed while regional hospitals were
understaffed, particularly in rural areas. As a result, patients typically
sought out specialists, even for routine matters, cutting primary care
providers out of their traditional roles as first contact providers and
treatment coordinators. A failure to collaborate left family doctors, workers
in regional hospitals and those in tertiary-care centres working in separate
silos, unaware of what their colleagues had done.
Transforming
cardiology services
In
response, health professionals from Vilnius University Hospital Santariskiu
Klinikos and health care institutions in Eastern Lithuania founded the Eastern
Lithuanian Cardiology Programme (ELCP), which set out to transform the delivery
of cardiology services. Their goal: to break down the hospital-centric delivery
of care and the inequality of service between urban and rural areas.
“We tried
to bring them together and to convince them that organizing services in this
way was easier and would avoid more serious problems,” said Prof Aleksandras
Laucevicius, leader of the initiative working group from Vilnius University
Hospital Santariskiu Klinikos. “That took time.”
Boosting
the role of primary care and emphasising the coordination of services proved to
be key in reducing the need for hospital outpatient consultations and
admissions. A stronger referral system improved the flow of patients among
primary care settings, regional hospitals and central and tertiary facilities
and training helped to shift the provision of cardiovascular health services to
regional hospitals and local clinics.
Patients
were taught to manage their disease and given access to their health records,
giving them improved awareness of their health and greater confidence that
their health providers would be available when they needed them.
The
results? The availability of providers increased by 45%, with the biggest
increase at secondary-level health care facilities outside the capital city of
Vilnius; and the provision of outpatient services across secondary-level
hospitals outside Vilnius increased by 26%. Best of all, mortality from heart
attack and stroke has dropped, and the prevention and management of risk
factors such as high blood pressure, high cholesterol and diabetes has been
stepped up, including availability of medication.
Integrating
services improves results
“The
change has been dramatic,” said Prof Laucevicius. “Integrating services, from
cardiovascular prevention to advanced treatment, as well as from the primary
care level to specialized secondary and tertiary level , means people are
getting the services they need in less time, with improved results.”
Lithuania’s
example shows how an integrated, people-centred way of delivering health
services pays big dividends to patients, as well as the efficiency of the
health system. WHO’s framework on integrated people-centred health services,
adopted by WHO’s 194 member states at the World Health Assembly in May 2016,
sets out five strategies that countries can pursue to ensure that all people
have equal access to quality health services where and when they need them.
“Addressing
the needs of people rather than individual diseases, and improving coordination
of care, must be the focus of health services and public health programmes,”
said Dr Hernan Montenegro, coordinator of WHO’s Services Organization and
Clinical Interventions unit. “Countries and communities that make that shift
see some important gains: their health services become more effective and
efficient, they empower people to take charge of their own health, and they
become more trusted by the community.”
WHO is
helping other countries and regions learn from Lithuania’s example. A new
website on integrated people-centred care provides a database of resources and
real-life examples of people-centred health service reform.
The
website allows ministries of health, health-care providers, policy-makers and
other interested parties to access the latest knowledge on integrated
people-centred health services and to build a global network of people who work
towards the same goal.
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