Long wait times to see specialists. Poor coordination between family doctors and hospitals. Duplicated tests. And some of the highest rates of heart disease-related death in Europe.
They were some of the challenges facing Lithuania 20 years ago, particularly in the country’s eastern region, where mortality from heart disease and stroke was highest, especially among middle-aged men and women outside major cities.
Health officials concluded that many of the problems patients experienced in getting the care they needed stemmed from the way services were organized and provided. Specialist cardiology centres were overstaffed while regional hospitals were understaffed, particularly in rural areas. As a result, patients typically sought out specialists, even for routine matters, cutting primary care providers out of their traditional roles as first contact providers and treatment coordinators. A failure to collaborate left family doctors, workers in regional hospitals and those in tertiary-care centres working in separate silos, unaware of what their colleagues had done.
Transforming cardiology services
In response, health professionals from Vilnius University Hospital Santariskiu Klinikos and health care institutions in Eastern Lithuania founded the Eastern Lithuanian Cardiology Programme (ELCP), which set out to transform the delivery of cardiology services. Their goal: to break down the hospital-centric delivery of care and the inequality of service between urban and rural areas.
“We tried to bring them together and to convince them that organizing services in this way was easier and would avoid more serious problems,” said Prof Aleksandras Laucevicius, leader of the initiative working group from Vilnius University Hospital Santariskiu Klinikos. “That took time.”
Boosting the role of primary care and emphasising the coordination of services proved to be key in reducing the need for hospital outpatient consultations and admissions. A stronger referral system improved the flow of patients among primary care settings, regional hospitals and central and tertiary facilities and training helped to shift the provision of cardiovascular health services to regional hospitals and local clinics.
Patients were taught to manage their disease and given access to their health records, giving them improved awareness of their health and greater confidence that their health providers would be available when they needed them.
The results? The availability of providers increased by 45%, with the biggest increase at secondary-level health care facilities outside the capital city of Vilnius; and the provision of outpatient services across secondary-level hospitals outside Vilnius increased by 26%. Best of all, mortality from heart attack and stroke has dropped, and the prevention and management of risk factors such as high blood pressure, high cholesterol and diabetes has been stepped up, including availability of medication.
Integrating services improves results
“The change has been dramatic,” said Prof Laucevicius. “Integrating services, from cardiovascular prevention to advanced treatment, as well as from the primary care level to specialized secondary and tertiary level , means people are getting the services they need in less time, with improved results.”
Lithuania’s example shows how an integrated, people-centred way of delivering health services pays big dividends to patients, as well as the efficiency of the health system. WHO’s framework on integrated people-centred health services, adopted by WHO’s 194 member states at the World Health Assembly in May 2016, sets out five strategies that countries can pursue to ensure that all people have equal access to quality health services where and when they need them.
“Addressing the needs of people rather than individual diseases, and improving coordination of care, must be the focus of health services and public health programmes,” said Dr Hernan Montenegro, coordinator of WHO’s Services Organization and Clinical Interventions unit. “Countries and communities that make that shift see some important gains: their health services become more effective and efficient, they empower people to take charge of their own health, and they become more trusted by the community.”
WHO is helping other countries and regions learn from Lithuania’s example. A new website on integrated people-centred care provides a database of resources and real-life examples of people-centred health service reform.
The website allows ministries of health, health-care providers, policy-makers and other interested parties to access the latest knowledge on integrated people-centred health services and to build a global network of people who work towards the same goal.
The website for the initiative is a collaboration between WHO and the Andalusian School of Public Health.