Birinci Basamak ve Bütünleşik Sağlık Hizmetleri

Abstract

Hizmetlerin girdilerinin, sunumunun, yönetiminin ve organizasyonunun erişim, kalite, kullanıcı memnuniyeti ve verimliliğin artırılması amacıyla bir araya getirilmesi olarak tanımlanan bütünleşik sağlık hizmetlerinin amacı birbirinden kopuk ve bağımsız sunulan bazı sağlık hizmetlerine bağlı olarak ortaya çıkabilecek hasta güvenliği sorunları ile maliyet sorunlarını azaltmaktır. Bütünleştirme yatay ya da dikey şekilde olabilmektedir. Hangi tür sağlık hizmetlerinin, hangi hizmet basamağında, hangi sağlık kuruluşları ve profesyonelleri tarafından bütünleşik şekilde sunulması gerektiği konusunda tüm toplumlara uyarlanabilecek standart formüller bulunmamaktadır. Ülkelerin, aynı ülkedeki farklı bölgelerin coğrafi, sosyal ve ekonomik koşullarına bağlı olarak farklı bütünleştirme yöntemleri uygulanabilmektedir. Teknolojik ve bilimsel gelişmelere bağlı olarak zaman içerisinde yeni hizmet türlerinin, yeni mesleklerin ortaya çıkması yeni örgütlenmeleri ve yeni iş birliklerini gerektirebildiğinden bütünleşik hizmet konusunu sabit bir uygulama olarak değil dinamik bir değişim süreci olarak görmek gerekir. Sağlık politikaları, yönetimi ve örgütlenmesi alanındaki karar vericilerin ve yetkili profesyonellerin bu konuda donanımlı olması önemlidir.

Keywords

• Bütünleşik sağlık hizmeti
• Birinci basamak sağlık hizmeti
• Yatay bütünleşme
• Dikey bütünleşme

PRIMARY CARE AND INTEGRATED HEALTH CARE

Abstract

The aim of integrated health services, which is defined as bringing together the inputs, delivery, management and organization of services with the aim of increasing access, quality, user satisfaction and efficiency, is to reduce patient safety problems and cost problems that may arise due to some health services that are disconnected and independent from each other. Integration can be horizontal or vertical. There are no standard formulas that can be adapted to all societies about which types of health services, at which service level, by which health institutions and professionals should be provided in an integrated manner. Different integration methods can be applied depending on the geographical, social and economic conditions of countries as well as different regions within the same country. Since the emergence of new types of services and new professions over time due to technological and scientific developments may require new organizations and new collaborations, the issue of integrated services should not be seen as a fixed practice but as a dynamic process of change. It is important that decision-makers and authorized professionals in the field of health policies, management and organization are equipped in this regard.

Keywords

• Integrated health care
• Primary care
• Horizontal integration
• Vertical integration

References

1. World Health Organization. Primary Care. https://www.who.int/teams/integrated-health-services/clinical-services-and-systems/primary-care
2. Bourgueil Y, Marek A, Mousquès J. Three Models of Primary Care Organisation in Europe, Canada, Australia and New-Zealand. Issues Heal Econ. Published online 2009:n° 141. https://www.irdes.fr/EspaceAnglais/Publications/IrdesPublications/QES141.pdf
3. Gröne O, Garcia-Barbero M, WHO European Office for Integrated Health Care Services. Integrated care: a position paper of the WHO European Office for Integrated Health Care Services. Int J Integr Care. 2001;1:e21. http://www.ncbi.nlm.nih.gov/pubmed/16896400
4. Kodner DL, Spreeuwenberg C. Integrated care: meaning, logic, applications, and implications – a discussion paper. Int J Integr Care. 2002;2(4). doi:10.5334/ijic.67
5. Baker LC, Bundorf MK, Kessler DP. Vertical Integration: Hospital Ownership Of Physician Practices Is Associated With Higher Prices And Spending. Health Aff. 2014;33(5):756-763. doi:10.1377/hlthaff.2013.1279
6. Khullar D, Casalino LP, Bond AM. Vertical Integration and the Transformation of American Medicine. N Engl J Med. 2024;390(11):965-967. doi:10.1056/NEJMp2313406
7. Donaldson L. The Normal Science of Structural Contingency Theory. In: Studying Organization: Theory & Method. SAGE Publications Ltd; :51-70. doi:10.4135/9781446218556.n2
8. Contandriopoulos D, Perroux M, Duhoux A. Formalisation and subordination: a contingency theory approach to optimising primary care teams. BMJ Open. 2018;8(11):e025007. doi:10.1136/bmjopen-2018-025007

9. Contandriopoulos D, Perroux M, Cockenpot A, Duhoux A, Jean E. Analytical typology of multiprofessional primary care models. BMC Fam Pract. 2018;19(1):44. doi:10.1186/s12875-018-0731-8
10. 1Nursing and Midwifery Board of Australia. Codes Guidelines Statements: Professional Standards. https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards.aspx
11. College and Association of Registered Nurses of Alberta (CARNA). Scope of Practice for Nurse Practitioners.; 2017.
12. Changing role of nursing profession. Irish Independent. https://www.independent.ie/regionals/sligo/news/changing-role-of-nursing-profession/39549757.html. Published 2020.
13. Shrivastava S, Shrivastava P. AYUSH’u Hindistan’ın sağlık dağıtım sistemine entegre etmek. Cukurova Med J. 2019;44(4):1527-1528. doi:10.17826/cumj.536761
14. Wan G, Wei X, Yin H, Qian Z, Wang T, Wang L. The trend in primary health care preference in China: a cohort study of 12,508 residents from 2012 to 2018. BMC Health Serv Res. 2021;21(1):768. doi:10.1186/s12913-021-06790-w
15. Jiang M zhu, Fu Q, Xiong J yang, et al. Preferences heterogeneity of health care utilization of community residents in China: a stated preference discrete choice experiment. BMC Health Serv Res. 2020;20(1):430. doi:10.1186/s12913-020-05134-4
16. Kato D, Ryu H, Matsumoto T, et al. Building primary care in Japan: Literature review. J Gen Fam Med. 2019;20(5):170-179. doi:10.1002/jgf2.252
17. Katori T. Japan’s healthcare delivery system: From its historical evolution to the challenges of a super-aged society. Glob Heal Med. 2024;6(1):2023.01121. doi:10.35772/ghm.2023.01121
18. Health at a Glance 2023. OECD; 2023. doi:10.1787/7a7afb35-en