Senior researcher Organisation and Quality of Healthcare, Person-centred Integrated Care
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The POTKU project (Potilas kuljettajan paikalle, Putting the Patient in the Driver's Seat), Finland. ICARE4EU Case Report.
Hujala, A., Rijken, M., Oksman, E., Taskinen, H., Rissannens, S. The POTKU project (Potilas kuljettajan paikalle, Putting the Patient in the Driver's Seat), Finland. ICARE4EU Case Report. Bruxelles: European Union, 2015. 22 p.
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The Finnish POTKU project (2010–2014) aimed at improving patient-centred care by developing care for people with chronic illnesses.
The POTKU project was targeted at all people with a chronic disease seeking care from the local primary care health centres in the regions covered by the project. A considerable part of them were people with multimorbidity.
The POTKU project consisted of several sub-programmes in five hospital districts in Middle Finland, covering 61 municipalities and about one million inhabitants. 420 health care professionals in local health centres were involved in care development activities during the project. A slightly modified version of the Chronic Care Model was used as a theoretical framework for development.
A key development tool for patient-centredness was a personal health and care plan (HCP), which were developed for 16 000 patients during the project. Clientship profiles were used to assess a patient’s self-management skills and the support they need.
A pathway for people with multimorbidity was developed to integrate care services and improve patient-centred cooperation among care professionals.
The patient-centred approach using a HCP suits the comprehensive non-disease specific needs of people with multimorbidity well. However, while these people may also need specialist care and non-medical support, the relationship with secondary care and social care needs to be improved further in the future.
Although funding for the four-year programme has finished, some elements of the programme are now structurally embedded in the care processes in the health centres (such as the involvement and collaboration with the third care sector). Some elements, however, are hindered by a lack of resources, lack of support from management or the lack of integration with regard to IC. (aut. ref.)
The POTKU project was targeted at all people with a chronic disease seeking care from the local primary care health centres in the regions covered by the project. A considerable part of them were people with multimorbidity.
The POTKU project consisted of several sub-programmes in five hospital districts in Middle Finland, covering 61 municipalities and about one million inhabitants. 420 health care professionals in local health centres were involved in care development activities during the project. A slightly modified version of the Chronic Care Model was used as a theoretical framework for development.
A key development tool for patient-centredness was a personal health and care plan (HCP), which were developed for 16 000 patients during the project. Clientship profiles were used to assess a patient’s self-management skills and the support they need.
A pathway for people with multimorbidity was developed to integrate care services and improve patient-centred cooperation among care professionals.
The patient-centred approach using a HCP suits the comprehensive non-disease specific needs of people with multimorbidity well. However, while these people may also need specialist care and non-medical support, the relationship with secondary care and social care needs to be improved further in the future.
Although funding for the four-year programme has finished, some elements of the programme are now structurally embedded in the care processes in the health centres (such as the involvement and collaboration with the third care sector). Some elements, however, are hindered by a lack of resources, lack of support from management or the lack of integration with regard to IC. (aut. ref.)
The Finnish POTKU project (2010–2014) aimed at improving patient-centred care by developing care for people with chronic illnesses.
The POTKU project was targeted at all people with a chronic disease seeking care from the local primary care health centres in the regions covered by the project. A considerable part of them were people with multimorbidity.
The POTKU project consisted of several sub-programmes in five hospital districts in Middle Finland, covering 61 municipalities and about one million inhabitants. 420 health care professionals in local health centres were involved in care development activities during the project. A slightly modified version of the Chronic Care Model was used as a theoretical framework for development.
A key development tool for patient-centredness was a personal health and care plan (HCP), which were developed for 16 000 patients during the project. Clientship profiles were used to assess a patient’s self-management skills and the support they need.
A pathway for people with multimorbidity was developed to integrate care services and improve patient-centred cooperation among care professionals.
The patient-centred approach using a HCP suits the comprehensive non-disease specific needs of people with multimorbidity well. However, while these people may also need specialist care and non-medical support, the relationship with secondary care and social care needs to be improved further in the future.
Although funding for the four-year programme has finished, some elements of the programme are now structurally embedded in the care processes in the health centres (such as the involvement and collaboration with the third care sector). Some elements, however, are hindered by a lack of resources, lack of support from management or the lack of integration with regard to IC. (aut. ref.)
The POTKU project was targeted at all people with a chronic disease seeking care from the local primary care health centres in the regions covered by the project. A considerable part of them were people with multimorbidity.
The POTKU project consisted of several sub-programmes in five hospital districts in Middle Finland, covering 61 municipalities and about one million inhabitants. 420 health care professionals in local health centres were involved in care development activities during the project. A slightly modified version of the Chronic Care Model was used as a theoretical framework for development.
A key development tool for patient-centredness was a personal health and care plan (HCP), which were developed for 16 000 patients during the project. Clientship profiles were used to assess a patient’s self-management skills and the support they need.
A pathway for people with multimorbidity was developed to integrate care services and improve patient-centred cooperation among care professionals.
The patient-centred approach using a HCP suits the comprehensive non-disease specific needs of people with multimorbidity well. However, while these people may also need specialist care and non-medical support, the relationship with secondary care and social care needs to be improved further in the future.
Although funding for the four-year programme has finished, some elements of the programme are now structurally embedded in the care processes in the health centres (such as the involvement and collaboration with the third care sector). Some elements, however, are hindered by a lack of resources, lack of support from management or the lack of integration with regard to IC. (aut. ref.)