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Role of Nurse in Primary Health Care
Modern primary health care emerged when gross health inequalities became a global concern (1).
The Declaration of Alma-Ata, 40 years ago, endorsed primary health care as the means of attaining the World Health Organization’s goal of health for all (2,3).
It was a global health milestone of the 20th century and, crucially, identified primary health care as a fundamental human right and a key factor in attaining equitable health for everyone.
Strong health systems founded on the primary health care approach have made substantial gains in population health.
Coupled with improvements in living standards and socioeconomic development, people are living longer, with a more healthy life, and premature mortality has declined (4–6).
However, such progress is in jeopardy as the burden of chronic conditions and associated risk factors are on the rise (5,7,8). Many of these risk factors, such as smoking, obesity and diabetes, are linked closely to the social, economic, environmental and commercial determinants of health that, in turn, influence behaviour.
An additional challenge to health is that the people most affected by these determinants are also more likely to have poor health literacy and are less likely to access health services (9,10).
Primary health care has three main elements: 1) primary care and essential public health functions as the core of integrated services, 2) multisectoral policy and action, 3) empowered people and communities.
This paper focuses on the first element and describes ways in which primary care and public health can be effectively integrated to achieve population health benefits.
In many settings, primary care, which is the first contact of people with health services that are continuous, comprehensive and coordinated, has, too often, been focused on treating illness as and when it arises rather than preventing disease in the first place.
Modern public health interventions at the individual and population levels aim to prevent disease, protect and promote health, and ensure the greatest threats to population health are addressed (including surveillance and monitoring) (11,12).
Integrating a public health approach into primary care could be an effective way of preventing disease in local communities, thus reducing the demand on primary care and improving the health of the population. Integrating public health functions into primary care involves many different actions including:
enabling primary care to deliver more protective, promotive and preventive services to a defined population; improving communication and coordination between public health authorities and primary care providers and managers; sharing knowledge and data to evaluate the impact of both individual- and population focused services on health; and strengthening the surveillance function of primary care and more effectively linking this to public health surveillance.
Methods for integration of primary care and public health should consider the existing structures, goals, needs, capacities, resources and competencies available within the given context (11).
Integration should also address the inequities in health service provision.
This paper reviews the various approaches reported in the literature that have been taken to integrate public health and primary care and summarizes both the strengths and weaknesses of each approach in order to advise policy-makers of the different approaches available.
We have used the WHO definition for health, the Starfield definition for primary care and Acheson (1988) for public health (based on Winslow 1920) (13–17).
Primary care Worldwide primary care has been shown to be associated with enhanced access to health services, better health outcomes, and a decrease in hospitalization and emergency department visits (18).
Primary care can also help counteract the negative effect of poor economic conditions on health (19).
Traditional primary care focuses on personal health care services and continuity of care. The curative, “disease model” of the 1970s, which is still common today in many countries, is changing rapidly.
Ageing, population growth, a rising burden of chronic, noncommunicable diseases and multimorbidity, and technological advances are driving the transformation of primary care.
These demographic and epidemiological shifts require primary care to focus on prevention and quality of life, and encourage a proactive population management approach that targets individuals and groups that are most affected by the structural determinants of health.
To do this effectively requires linking with public health (20).
Proactive primary care means that radical changes need to be made to the current model of service, which include integrating key public health functions and interventions into primary care services.
In her definition of primary care, Barbara Starfield indicated the need to move to a health model that provides “the first level of contact with the health system to promote health, prevent illness, care for common illnesses, and manage on-going health problems” (16,21). With this comprehensive and holistic approach, over 95% of patient contact with the health service would take place in primary care (17).
It can therefore be argued that primary care is the backbone of any effective health system that aims for better population health.
In settings where primary care has been effectively deployed and supported with adequate training and resources, family physicians only refer around 5% of patients from consultations onto secondary care (22–24).
Patient satisfaction is high and at a decidedly low cost to the health system (19,25,26).
The evidence is very clear, a health system that is not primary care-led is a weak and expensive system.
Indeed, countries more oriented to primary care have populations with better health and services that are delivered at a lower cost (19,20,27,28).
Transforming primary care to have a proactive role in promoting health and preventing disease in addition to diagnosis, treatment and care is a logical next step in primary care development.
Primary care, particularly when established with a clear responsibility for a population (empanelment or registration), is the building block of public health and is the appropriate location for local public health interventions.
This raises the question: what is public health in the context of primary care? And, how can integration be achieved?
Public health Public health, which is described in some countries as public health medicine, or community medicine, is a multidisciplinary specialty, defined as “the science and art of preventing disease, prolonging life and promoting health through the organized efforts of society” (13).
The multifaceted functions of public health provide the necessary tools to improve health through health promotion, protection and disease prevention at population and individual levels.
Not all public health functions however can be delivered at the primary care level.
In the WHO European Region, the five core essential public health operations are:
1. Surveillance 2. Monitoring preparedness for response 3. Health protection 4. Health promotion 5. Disease prevention.
There is enormous potential for primary care to take a more proactive role in contributing to tackling some of these essential public health operations, especially, promoting health and disease prevention.
Public health guidance from the United Kingdom’s National Institute for Health and Care Excellence advises primary care professionals such as family physicians to opportunistically and proactively carry out activities such as short interventions to identify, reduce and prevent problematic use, abuse and dependence on alcohol, tobacco and illicit drugs, among others (27–32).
However, in the case of smoking, for example, primary care professionals tend only to respond to requests for help with giving up smoking rather than proactively engaging with existing smokers.
Such reactive approaches to health must become more proactive ones (12,31).
Evidence of the benefits of health promotion within primary care is growing, and primary care and public health professionals and academics are working together to expand the evidence base with a particular interest in return on investment.
| Language | English |
| No. of Pages | 20 |
| PDF Size | 2 MB |
| Category | Health |
| Source/Credits | who.int |
Functions Of Primary Health Care PDF Free Download