TBL 3

Community Medicine
Posting
Group 3
MBBS 0809
26/1/2011

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Level of Primary Care
Concept

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Y
Level of Care

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 Primary level

‡ Focus on preventive medicine

‡ Screening activities
‡ Community clinic, community
polyclinic, general practitioner

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 Secondary level
‡ Level of care in the health care
system that consists of emergency
treatment and critical care

‡ Received referred case from primary

healthcare

‡ District hospital
À
 Tertiary level
‡ A specialized, highly technical level
of health care that includes diagnosis
and treatment of disease and
disability
‡ Received cases referred by
secondary healthcare
‡ IJN
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 Primary Care Concept
‡ Primary care is:

‡ Essential health care made universally

accessible to individuals and families in
the community by means acceptable to
them through their full participation and
at cost that the community and country
can afford
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‡ It stresses on:
± Its µessentiality¶ by observing that µprimary health
is essential health care¶
± It µaccessibility¶ by observing: µmade universally
accessible to individuals and families in the
community
± Its µacceptability¶ by observing: µby means
acceptable to them¶
± Its µparticipancy¶ by observing: µat a cost that the
community and the country can afford¶
± Its µintegrality¶ by observing:¶ it forms an integral
part both of the country¶s health system of which
it is the nucleus and the overall social and
economic development of the community
’
Organisation & Staff
u
Vs. Health Clinic

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 p
 
 



 District Health Officer Medical Officer Of

 Health

 Food Safety and Quality Maternal and Child

Health
Drinking Water Quality Reproductive Health

Vector-borne Disease School Health

Infectious Disease Out-patient Dpt.

Water Supply & Env. Health Emergency Dpt.

Legislation & Enforcement Rehabilitation

General Health Pharmacy

Health Promotion Diagnostic imaging

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PEGAWAI KESIHATAN DAERAH

U54

PEGAWAI KESIHATAN
U52/U48

Pengurusan Pembangunan Kesihatan

& Kesihatan Environmen
Pentadbiran Keluarga KPPKP U36

Klinik Kesihatan Salak Klinik Kesihatan Sg. Klinik Kesihatan PPKP U32 PPKP U32
Tinggi Pelek Dengkel Kawalan Penyakit Kawalan Penyakit
dan Tidak dan Tidak
Berjangkit Berjangkit

Klinik Klinik Klinik Klinik Klinik Klinik

Desa Desa Desa Desa Desa Desa

Bahagian Bahagian Bahagian Bahagian Unit Kesihatan Unit Keselamatan Unit Kawalan
Pentadbiran Kewangan Perkhidmatan Hasil Am/KPAS dan Kualiti Penyakit
Makanan Berjangkit

Unit Kawalan Unit Bekalan Air dan Kesihatan Unit Kawalan Unit Penyiasatan
Mutu Air Minum Alam Sekeliling Penyakit Bawaan dan Pendakwaan
BAKAS Vektor
 Organization Chart: KK
District Health Officer/
Medical Officer of Health
(Specialist in PH/DOH/MOH)

Medical and Health Officer in charge

UD 48/UD54 (MNHO)

MNHO (UD48) Family Medicine Specialist

School Health Team X-Ray OPD Unit

MCHC Lab Pharmacy

Expanded Scopes &
Support Service
Hospital Vs. Health Clinic

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 Expanded Scope Programmes

Reproductive Health
Diabetic / CVD Screening
Elderly
Tuberculosis ( dots)
HIV/STI-- MSA (Modified syndromic approach)
HIV/STI
Mental Health
Quit Smoking
Adolescent
Methadone replacement therapy (Drug addiction)

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 Expanded scope
programmes
1. Reproductive Health
‡ Planning, reproductive tract infections,
infertility, menopause/ andropause, marriage
counseling, male responsibility/ gender issues
2. Diabetic / CVD Screening
‡ assess high risk population for detection of
diabetes and cardiovascular disease and to
start on management if necessary
‡ Several test done such as random/fasting
blood sugar, cholesterol level.
Expanded scope programs
( cont.)
3. Quit smoking clinic
r Therapies provided :-
:-
‡ Nicotine gums
‡ Counseling
‡ Nicotine patch
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 Expanded scope
programs ( cont.)
4. Elderly
‡ Rehabilitation Services
‡ Home Visits
‡ Elderly Club
‡ Health Education
‡ Visit to old folks home
5. Tuberculosis
‡ Centre 1: start treatment
‡ Centre 2: continues treatment ( dots)
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Expanded scope programs
( cont.)
6. HIV/STI
‡ Counseling
‡ Antenatal rapid screening for all pregnant
mother
‡ Pre
Pre--marital HIV screening
‡ HAART therapy
7. Mental Health
‡ Give counseling on how to handle stress
Expanded scope programs
( cont.)

8. Cancer screening
r Pap smear
r Breast examination
r Mammogram

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 Expanded scope
programs ( cont.)
9. Adolescent clinic
‡ Counseling for common problems-
problems-
smoking, diabetes, drug addiction
‡ Methadone replacement therapy
(Drug addiction)
‡ Health Advisory panels
‡ assist in terms of health information,
health activities and programmes.
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 Support Services
‡ LAB SERVICES
‡ PHARMACY SERVICES
‡ DIAGNOSTIC AND IMAGING SERVICES

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 Support services
‡ LAB SERVICES
‡ clinic:
‡ FBC, RP, LFT, UA, VDRL, Bld Gp, ESR
‡ MGTT, FBS, 2HPP,BFMP, BFF
‡ HIV Rapid test, Sr Bilirubin
‡ Direct smear ± GC, TV, Candida
‡ UFEME, Stool for ova& cyst
‡ Sputum AFB
‡ Scraping for fungus
 Support services(cont.)
‡ PHARMACY SERVICES
r Prescribe drugs.
r Discuss with doctor about amount or types of drugs
need to prescribe if problem occur.
r Methadone replacement therapy.
r Refer to hospital if drugs need to prescribe.
‡ DIAGNOSTIC AND IMAGING SERVICES
‡ Clinic: x-
x-ray
‡ Hospital: X-
X-ray, MRI, CT
CT--scan
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 Support services: Hospital vs clinic
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Lab services Lab services

Pharmacy services Pharmacy services

Diagnostic and imaging services Diagnostic and imaging services

Dietetic and food services( for maternal Dietetic and food services
and child)
Rehabilitation services

Infection control

Social medical

Sterilize item supply

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Health Clinic Advisory Panel
Vs.
Hospital¶s Visitors Board

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Group of people from the residents Group of local residents that is

+ health clinic that is appointed by appointed by the Ministry of Health.
the Ministry of Health

Objective: Objective:
‡to strengthen relationship between
‡ to assist in terms of health public and hospital in order to
information, health activities and improve the services provided by
programmes. the hospital
Scope: Scope:

‡Driving force for community ‡Deal and provide information to the

involvement activity arranged by community regarding hospital
the health clinic services
‡Health Management Activities
Members: 13 people Members: 15 people

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Functions:
‡Serves as an intermediate
between the community and
Health Department
‡Serves as a motivator for the
participation of the community
‡Management of health activities
Functions:
‡ as an intermediate between the
patient in the hospital/ in public and the
hospital administration.
‡ this is to explain the management of
the hospital to the patients to ensure
that all the patients are well briefed on
the on going situation

Organization: Organization:
1 chairman
1 vice-chairman 1 president
1 secretary 1 vice-president
1 vice secretary 1 secretary
1 person for account checking 1 treasurer
1 treasurer

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QAP Indicators in
Primary Care
a
&
S

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 Aims

‡ To improve the quality, efficiency

and effectiveness of the delivery
of health services

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 Problem identification

Problem
Prioritisation

Re--evaluation of the
Re
Problem

Quality Assurance Problem Analysis

Cycle
Implementation of
Remedial Actions
Quality Assurance
Study

Identification of
Remedial Actions

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 NIA (National Indicator Approach)

‡ It is a µcheck mechanism¶ approach to assist

managers and policy makers to promptly
recognize shortfall in quality of care for the
chosen area being measured.
‡ The standard is set at national level and
monitored at national level.
‡ Investigation will be done if there is shortfall in
quality using protocol made available by ministry
and appropriate remedial measure will be
implemented.
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NIA in Primary Healthcare

 
 

Incidence rate of eclampsia <10/10000 live birth

Incidence rate of tetanus neonatorum No cases

Incidence rate of puerperal sepsis <30/1000 live birth

Severe neonatal jaundice <100/10000

Antenatal check-up Minimum 8 times/pregnancy

Uneventful deliveries >99% of cases

HbA1C <7% >30% of patients

3rd dose of hepatitis vaccination > 50%

Visual defect among standard 1

<5 %
children YY
 District Specific Approach (DSA)

‡ The rate of family planning by high risk mothers in the

district
‡ Anaemia in pregnancy
‡ Problems in tracing of high risk and defaulter cases
among antenatal mothers
‡ Waiting time of patients
‡ Early antenatal booking
‡ Prescription errors
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