Combatting social exclusion by strengthening primary care The Rotterdam experience

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Combatting social exclusion by strengthening
primary careThe Rotterdam experience
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Structure

• 1. Dutch primary care developments two ways of
  intervening
• 2.The Rotterdam experience
• 3. Conclusions
• 4. Group discussion

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1. Dutch Primary Care

• Developments and anticipation
• emphasis on organisation
• Horizontal program planning
• ROS
• Vertical program planning
• multidisciplinary care programs

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Horizontal program planning

• Strengthening primary care on organisational
  level
• ROS-structure
• Characteristics
• - continuity of care and cooperation
• - quality staff training
• - innovation
• Zorgimpuls ROS Rotterdam

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Vertical program planning

• Development of multidisciplinary care programs

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The Rotterdam experience

• Three examples
• 1 Diabetes, depression and overweight
• 2 Domestic violence
• 3 Chronic medically unexplainable pain
• But, first zooming in on Rotterdam

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• Europe
• The Netherlands

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• The Netherlands
• Rotterdam

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Rotterdam

• Largest harbour in Europe
• International Film Festival
• Rotterdam Marathon
• Cultural Capital 2001
• European Capital of Sport 2005
• City of Architecture 2007
• Rotterdam European Youth Capital 2009
• 600.000 inhabitants
• 46 of non-Dutch origin
• 170 nationalities
• Relatively young population
• (55 under age of 40vs. 50 NL)
• unemployment rate 11 (vs. 6,5 NL)

Population by age (COS, 2008)
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Diabetes, depression and exercise

• Context
• Increase of diabetes and depression

Incidence diabetes type II Incidence depression
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From illness to strength

• Intervention program getting people in motion
• Three phases
• - I can move!
• - Im exercising!
• - I keep on exercising!
• Objectives
• - Take own responsibilty for enough and healty
  exercise
• Outcome and results
• Motivation and enthusiasm
• New exercise groups
• Weight loss

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From Illness to Strength

• Partners
• Primary healthcare centres
• Municipality
• Healthcare insurer
• Mental healthcare organisations
• Connection with social work

• Source www.vankasteel.nl/informatie/infoaf
  b/fitkids/nieuws1.jpg

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Domestic Violence

• Context
• From private to social problem to health problem
• Intervention for primary care workers
• Local meetings and a intensification course
• - raising awareness and recognize signals
• - learning consultation skills
• - dealing with conflict of interest
• - cooperation with other parties involved
• Objectives
• Outcome and results

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Domestic Violence 2

• Partners
• Connection with social work

Come on Bart, take your pills
Otherwise you start
crying again when dad hits mum!
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Chronic medically unexplainable pain

• Ideas about chronic pain
• Causes
• Ones own possibilities to influence causes

Context
Cognitive emotional effects Fear Anger Sadnes
s Concentration problems
Behavioral effects Inactivity Avoidance Focus
on body
Physical effects Muscle tension Loss of
fitness Continuous arousal Respiratory
problems Pain
Social effects Unemployment Loss of social
contacts/ decreasing social network Family
problems
Source Speckens e.a. 1995
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Chronic pain in primary care

• Intervention
• Meetings on local level
• Cooperation between professionals
• GP, physiotherapist,psychologist and social
  worker
• Integrated care
• Objectives
• Development of local multidisciplinary standard
• - Chain approach on local level

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Chronic pain

• Outcome and results
• Professionals know each other and know their
  professional skills
• - integrated treatment
• Connection with social work

Sourcewww.hln.be/hln/nl/33/Fit-Gezond/article/det
ail/265547/2008/05/05/Arme-mensen-hebben-meer-pijn
.dhtml
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Conclusions

• Health problems often have a social component
• Social problems appear as health problemes or
  cause health problems
• Interaction between professionals is necessary
  for effective results
• Especially in neighbourhoods whith low SES an
  integrated approach is needed because the
  presented problems are integrated also
• Primary care (i.c. healthcare centres) serves as
  a save and non-stigmatising environment to work
  along with other partners on social inclusion and
  wellbeing

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4. Group discussion

• Questions/ themes for group discussion
• What do the different professionals have in
  common in relation to patients/clients problems,
  what are their joined objectives?
• What would you need to improve your cooperate
  with other professionals in the care process and
  on what issues would you like to cooperate?
• Is social work part of primary care or vice
  versa?
• Would it be useful to merge or mix the services?
  If yes, what is the added value. If not, what are
  the arguments?

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