Primary Health, Care Concepts & Levels

• Primary Health Care is a comprehensive, multisectoral approach that focuses on empowered communities, primary care, and essential public health functions.

Roles and Benefits of Primary Health Care

• Roles include continuous and comprehensive care, connection to social welfare and public health services, and quality services for vulnerable populations.
• Benefits are a first point of professional care, preventative measures such as screenings and immunizations, and increased accessibility to healthcare services.

Primary Care vs. Primary Health Care

• Primary Care is the first point of contact, often involving doctors, nurses, and NPs, focusing on medical care for individuals.
• It emphasizes preventive care through vaccinations, screenings, health education, and lifestyle counseling.
• Physicians diagnose and treat common health issues, from minor ailments to chronic conditions, and provide specialist referrals.
• Continuity of Care emphasizes long-term patient-provider relationships for better understanding of health history.
• Coordination involves managing referrals, hospital admissions, and follow-ups.
• Primary Health Care encompasses a broader concept, including Social Determinants of Health (SDoH).
• It integrates health promotion, disease prevention, and public health initiatives.
• Equity and Access ensures access to essential healthcare services without financial hardship or discrimination.
• Community-Centered care engages communities in health decision-making and service planning.
• It utilizes an Interdisciplinary Approach, collaborating with healthcare professionals, social workers, nutritionists, and specialists to address health determinants.
• Health Promotion focuses on education, sanitation, nutrition, and lifestyle changes.
• Sustainability and Empowerment builds self-reliance and empowers individuals and communities to manage their health.

Levels of Health Care

• Primordial prevention avoids risk factors using tools like helmets and seatbelts.
• Primary care involves first contact, health promotion, and counseling.
• Secondary care includes screening, referrals, and early disease detection.
• Tertiary care focuses on chronic disease management and rehabilitation.
• Quaternary care provides advanced specialized care such as dialysis and chemotherapy.

Five Principles of Primary Health Care (AAHIP)

• Accessibility ensures health services for all.
• Appropriate Skills & Technology provides effective tools for healthcare delivery.
• Health Promotion focuses on education and prevention.
• Intersectoral Collaboration involves cooperation across sectors.
• Public Participation encourages community involvement in health decisions.

Five Elements of Primary Health Care

• The core elements include primary care, health, care, health promotion, and population health.

Health Care Delivery in Canada & BC

• There is a shift from hospitals to community-based primary care.
• Health Authorities include WHO (Global), PHAC (Canada), and BC Ministry of Health, along with regional health authorities.
• The First Nations Health Authority (FNHA) is a unique model providing culturally appropriate care.
• Primary Care Networks (PCNs) offer integrated community-based care and focus on marginalized populations.

Team-Based Primary Health Care

• Interdisciplinary Teams includes nurses, NPs, physicians, social workers, counselors, dietitians, OTs, and PTs.
• Tuckman's Team Phases encompasses forming, establishing roles, storming to resolve conflicts, norming to create collective identity, and performing to encourage innovation.

Benefits of Team-Based Care

• Results in seamless transitions, reduced duplication, better patient outcomes, improved communication, and cost reduction.

BC's Population and Public Health Framework

• It is part of the Strengthening Public Health Initiative.
• Community health is guided by outlining a vision for population and public health systems.

Ottawa Charter for Health Promotion

• It was signed at the First International Conference on Health Promotion (WHO, Ottawa, 1986).
• Prerequisites for health such as Social Determinants of Health are discussed.
• Fundamental conditions necessary for health are identified as peace, shelter, education, food, income, a stable ecosystem, sustainable resources, social justice, and equity.

Social Determinants of Health (SDoH)

• Key determinants from The Canadian Facts include Income & Distribution, Education, Employment, Food Security, and Housing.
• Indigenous Ancestry, Race & Social Exclusion, and Social Safety Net are also key determinants.
• The Canadian Nurses Association states nurses should integrate SDoH in assessments and interventions.
• Improved health requires a secure foundation in basic prerequisites.

Community/Public Health Nursing

• Combines primary healthcare and nursing practice in a community setting.
• Settings include homes, schools, community centers, care homes, and police custody.
• Its objective is to reduce hospital treatments by promoting preventative care.

Standards of Practice for Community Health Nursing

• Defined by Community Health Nurses of Canada.
• Provides a framework for RNs in community/public health nursing.

Primary Focus of Community Health Nursing

• Holistic approaches to Health & Wellness are used.
• Addressing Health Disparities.
• Promoting Active Lifestyles.
• Providing Mental Health Support & Awareness.

Population Health Promotion Model

• Key guiding questions for nursing action are:
  • With whom? (Individuals, families, communities, systems).
  • How? (Strategies from the Ottawa Charter).
  • What? (Addressing health determinants).
• Focuses on primary and secondary prevention.

Client-Centered Care Approach

• Principles include improving health outcomes, utilizing evidence-based practices, maintaining access and capacity, streamlining patient flow, and supporting self-care.
• Upstream Health Care Focus:
  • Strengths and assets of individuals, families, communities.
  • Knowing where the client is at– “recognize and provide care from where the client is at".
  • Building Collaborative relationships.
  • Capacity building.
  • Empowering.
  • Providing Health education to promote behavior change.

Community Assessments

• A community assessment is the ongoing systematic quantitative and qualitative appraisal of a community.
• Its purpose is to identify community needs, gaps, and strengths, and also assess resources to develop health improvement strategies.
• Methods include Windshield Surveys– observational data collection (primary data) that is the most common tool used to conduct a community assessment.
• These include informal surveys where health professionals observe and document community strengths and gaps, epidemiological data, census reports, and interviews with key informants.
• Assessments include community fitness centers, childcare, trending health issues, health services, cooling and warming spaces, walkability/accessibility, transit, and housing.

Public Health Nursing Process (ADPIE)

• Community Assessment involves gathering data on community health.
• Diagnosis involves health needs.
• Planning & Interventions are to develop strategies
• Evaluation assess the effectiveness of interventions.

Nursing Diagnosis Example

• Format follows "Problem", "due to", "as evidenced by".
• An example is, "Decreased senior physical fitness due to lack of walkability as evidenced by absence of safe sidewalks."

The 7 A's for Community Health Services Assessment

1. Acceptability – Cultural congruence
2. Access – Availability when needed
3. Adequacy – Sufficient quantity of services
4. Affordability – Financial feasibility
5. Appropriateness – Relevance to population needs
6. Availability – Convenience in time and location
7. Awareness – Community knowledge of services

Health Equity and Equality, Disparities, and Discrimination

• Health Equity vs. Equality:
  • Equality treats everyone the same, assuming equal starting points.
  • Equity provides resources based on individual needs to ensure fair outcomes.
• Health Disparities are differences in health outcomes between populations.
• Discrimination is unequal treatment based on group membership.

Social Determinants of Health (SDoH)

• Key Factors: Income, Education, Employment, Food Security, Housing.
• Vulnerable Populations:
  • 2SLGBTQIA+
  • Those with disabilities
  • Immigrants
  • Indigenous populations
  • Racialized groups
  • Canadians in remote areas

Health Inequality vs. Health Inequity

• 4 main concepts that affect the health of individuals, groups, populations
  • 1. Health equality
  • 2. Health inequality
  • 3. Health equity
  • 4. Health inequity
• Health Inequality: Differences in health status due to varying life conditions.
• Health Inequity: Unfair differences in health outcomes due to systemic barriers.
• Causes of Health Inequities:
  • Unequal distribution of income, power, and wealth.
  • Structural barriers (e.g., access to healthcare, nutritious food, clean water).
  • Differences peoples' health status and differences in the care that people receive and the opportunities they have to lead healthy lives
• Differences in:
  • Health status (e.g. life expectancy)
  • Access to care (e.g. availability of given services)
  • Quality and experience of care (e.g. levels of patient satisfaction)
  • Behavioral risks to health (e.g. smoking rates)
  • Wider determinants of health (e.g. quality of housing)

Addressing Health Inequities

• Solutions include removing systemic barriers, addressing discrimination and biases in healthcare, and providing universal and targeted health services.
• Proportionate Universality supports universal programs with additional support for those in greater need.
• Examples:
  • Mobile screening clinics for underserved populations.
  • Health education targeted at specific cultural or racial groups.

The Social Gradient in Health

• Definition: Higher income levels correlate with better health outcomes.
• Lower socioeconomic status = Higher health risks.
• Affects life expectancy and chronic disease prevalence.

Systemic Racism and Indigenous Health

• Joyce's Principle ensures equitable access for Indigenous peoples.
• In Plain Sight Report addresses racism in BC's healthcare system.
• Discrimination leads to lower healthcare access and poorer health outcomes.
• Indigenous communities face disproportionately high chronic disease rates.

Nurses' Roles in Health Equity

• Equity-Oriented Care Strategies involve:
  • Recognizing social determinants of health.
  • Implementing trauma and violence-informed care.
  • Advocating for policy changes to reduce systemic barriers

Marc Lalonde Report

• Key Ideas:
  • Shifted focus from just doctors and hospitals to biology, environment, lifestyle, and healthcare as determinants of health called Social Determinants of Health - SDOH.
  • It took years for politicians to recognize the importance of SDoH and redirect funds to community-based health care.
• One of the most influential documents in health promotion.

Alma-Ata Declaration

• Goal is commitment to primary health care.
• Advocated for community and individual self-reliance in health.
• Emphasized equitable and sustainable improvements in health.
• Strengthened the global movement toward universal healthcare and primary care models: Everyone deserves care.

Framework for Health Promotion – Jake Epp Report

• Goal: To help Canadians meet emerging health challenges.
• Introduced the term "Health Promotion".
• Laid the foundation for policies supporting preventative care and health education.

Ottawa Charter for Health Promotion

• Built on the Lalonde Report (1974), Alma-Ata Declaration (1978), and the Jake Epp Report (1986).
• Key Strategies for Health Promotion:
  • Building healthy public policies.
  • Creating supportive environments.
  • Strengthening community action.
  • Developing personal skills.
  • Reorienting health services toward prevention.
• Defined health promotion as a process that enables people to take control of their health.

Astana Declaration of the Alma-Ata Declaration

• Key Ideas: reaffirming alma-atma.
• Reaffirmed global commitment to primary health care and universal health coverage.
• A renewed push for stronger public health systems worldwide.

Introduction to Palliative Care

• Palliative Care is an approach to care focusing on quality of life, prevention, and relief of suffering.
• It is provided from the time of diagnosis of a life-limiting illness through to death and bereavement.
• Palliative Care uses an interdisciplinary team, with the client/family as central decision-makers, and is available 24/7.

Key Objectives of Palliative Care

• Provides relief (physical, psychosocial, spiritual).
• Affirms life and sees death as a natural process.
• Helps clients live fully according to their goals.
• Supports families during illness and bereavement.

The Palliative Approach

• Early Integration: Ideally incorporated early in an illness but was not widely adopted initially.
• Modern Approach: Focuses on goals, wishes, and serious illness conversations.
• More Flexible Criteria: Access to services is no longer rigidly restricted.

How Clients Access Palliative Care

• Referral Pathways:
  • Internal referral (within healthcare system).
  • External referral (e.g., from BC Cancer Agency).

Support Systems in Palliative Care

• Healthcare Team Members include:
  • Home Health Nurse
  • Palliative Access Line (RNs)
  • Palliative Resource Nurse
  • Nurse Practitioner
  • Palliative Physicians
  • Spiritual Care Practitioner
  • Social Worker
• Care Facilities include:
  • Freestanding Hospices (e.g., Cottage Hospice, May's Place)
  • Palliative Care Units (Hospitals)
  • Long-term Care Facilities

Considerations for Dying at Home

• Factors influencing if a client can remain at home:
  • Family & caregiver availability
  • Client & family values
  • Access to home care services
• "People with terminal illness spend most of their dying time at home." Home Health Nursing Role:
• Assess needs (physical, emotional, psychosocial).
• Support caregivers and prepare them for changes.
• Plan medication and symptom management.

Palliative Performance Scale (PPS)

• Measures functional decline in patients, scoring (0-100% in 10% increments).
• Stable = (100-70%): Early education, symptom management, psychosocial support.
• Transitional = (60-40%): Increased nursing care and family support.
• End-of-Life = (<30%): Focus on symptom relief, caregiver support, and preparation for death.

Benefits & Support Programs

• Palliative Care Benefits are available for patients with less than 6 months prognosis, covers medications & equipment, and requires yearly reassessment.
• Compassionate Care Benefits (EI Program) provides 26 weeks leave for caregivers, covers 55% of income, and applies to family of origin or chosen family.
• Home Support & Shift Care includes palliative home care hours (varies by region) and shift care nursing (1-5 days, up to 4 hrs/day), plus increased home visits in the last days of life.

Medical Assistance in Dying (MAID)

• Interdisciplinary Team: Pharmacist, Educator, Nurse, Physicians, NPs.
• Requirements include two physician assessments and the physician who administers MAID must have done one assessment.
• Parallel Care Plans: Palliative care that is provided alongside MAID care.

Preparing for the End of Life

• Educate caregivers on expectations & actions.
• Frequent reassessments and care adjustments.
• Medication planning:
  • Switch to subcutaneous meds if needed.
  • Prepare a Palliative Medication Box.
• Legal & personal affairs:
  • Power of Attorney (POA)
  • Wills
  • Custody arrangements for dependents

Explore the differences between primary health care and primary care, levels of healthcare (primordial, tertiary, secondary), and the role of community engagement. Addresses client-centered approaches in healthcare.