Primary healthcare overhaul in Andalusia (Spain)

Abstract

Introduction: The concept of primary healthcare (PHC) has evolved since the Declaration of Alma-Ata in 1978. Today PHC is not only a gatekeeper but a much broader the healthcare system agent. As defined by WHO, PHC provides comprehensive, accessible, community-based care that meets the health needs of individuals throughout their life. This includes a spectrum of services from prevention to management of chronic health conditions and palliative care. Policy context: The Andalusian Public Health System (APHS) is responsible for the provision of healthcare and public health services to the entire population in Andalusia (8.5 million inhabitants). It is a wide network based on a high-quality, patient-centered, accessible healthcare system with over 1500 primary healthcare centers and 49 hospitals, spread throughout the territory. PHC is the backbone of the system and integrates preventive, curative, rehabilitative care and health promotion services, including research and training activities. Teams of multidisciplinary professionals, including family physicians, pediatricians, community nurses, liaison nurses, social workers, midwifes, dentists, physiotherapists, complemented by technicians and staff, form the basic units of care attending the health needs of the population, with a personalized, integrated and longitudinal perspective. PHC units are grouped in healthcare Districts for managerial purposes and supported by epidemiologists, vets, pharmacists and others. More than 24000 professionals are working at this level of care in Andalusia, with massive activity: 50 M family doctors’ consultations or 26 M nurses’ consultations annually. Highlights: After 30 years advancing in this model of care, current challenges such as chronicity and population ageing require an adaptation of the healthcare response. The Andalusian Strategy for Primary Healthcare Overhaul was launched in 2016, to strengthen its role as citizens’ healthcare agent and backbone of the entire healthcare system. This process is being carried out in collaboration with scientific societies, professionals and the civil society in the region. More time devoted to complex chronic patients with specific professionals’ agendas of multidisciplinary teams is allowing the implementation of personalized health plans together with patients and their carers. Until May 2018, more than 47000 complex chronic patients have their personalized plans of the 245000 chronic patients with complex healthcare needs. Shared common electronic health record (EHR) to support continuity of care (including hospital care and emergencies), health record in mobility, electronic prescription and telehealth services are key aspects in the development of this Strategy. The same patient EHR is accessible to all healthcare professionals at different levels of care. Moreover, patients can also access this information through Clicsalud+, Including new services such as appointments or lab results. PHC in Andalusia offers a wide portfolio of services currently being expanded to high-resolution diagnostic services (echography, radiology, …). Research is also encouraged, with a specific and permanent call for proposals. Comments and conclusions: The Andalusian PHC Overhaul seeks to achieve better health outcomes through integrated care processes and prioritizing more prevalent health problems, in collaboration with healthcare professionals and patients and putting citizens at the center of the healthcare system.