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Improvement of public health by promotion of equitably distributed high quality primary health care systems (ImPrim )
Start date: Nov 30, 2009, End date: Dec 15, 2012 PROJECT  FINISHED 

ImPrim – a Primary Health Care flagship project. There are substantial health differences between the countries in the Baltic Sea Region (BSR). These inequalities have a relationship to social problems. The ImPrim project aims at promoting equitably distributed high quality Primary Health Care services in the BSR in order to increase the cost-efficiency of the public health system and more efficiently counteract communicable diseases and health problems related to social factors. Primary Health Care is the level of care nearest to the community. It coordinates care with other community stakeholders and health services and helps to control the costs of the public health systems. Hence, Primary Health Care is an efficient tool for health promotion and disease prevention, and contributes to increasing the attractiveness of regions.The equitable availability of high quality Primary Health Care personnel and resources is a big challenge for all countries around the Baltic Sea and Belarus.ImPrimt tackles three core areas: Access to Primary Health Care; Financial resources for Primary Health Care; Professional development of Primary Health Care staff. The project has been managed by the Centre for Competence at the Blekinge County Council. Ministries of health, national and regional authorities, universities and professional associations from Sweden, Finland, Estonia, Latvia, Lithuania, Russia and Belarus, and ministries of health from all countries are associated members. In addition to the project countries, the work has been linked with other EU-projects, with British and Danish institutions, among others. The project, which has been awarded flag ship status, was finalised in December 2012. To widen the ImPrim concept a parallel project on eHealth, funded by Swedish Sida BSR Unit, was implemented during 2011 and 2012 with three international thematic conferences. Postgraduate training in PHC programs for physicians and nurses working outside the health care sector wishing to return to their profession has been offered. The economic impact of returning physicians is huge and of transnational significance. Health Synergy - a model on How to join Primary Health Care and Public Health activities. A model for holistic preventive health care through collaboration and integration of public health and PHC professionals. The advantages and challenges are illustrated in several studies carried out within the framework of the project. The project has achieved important aims in meeting community health care, preventive care and effective clinical management of health problems.The ImPrim project is from many aspects unique in the wide perspective of primary care and public health working on the two levels – basic health care and the overall planning and steering national level. Numerous results with strong impact can be shown from the ImPrim project. Achievements: Within Remuneration of Primar Health Care (PHC) the results are already overwhelming because of the radical shift in the health budget in Latvia. The Latvian minister of health has acknowledged the importance of ImPrim in the work following the budget changes which shifted resources from hospital services to PHC and introduction of a new Quality Bonus System for PHC was introduced in Latvia in July 2011. The change is part of a long structural reform process, partly also a consequence of the financial crisis which hit Latvia hard. In the framework of ImPrim it has been shown that it is possible to develop PHC to take a larger responsibility in the health system. The strong focus on quality development in the project has been important to show that the content of PHC visits, the medical need of the patient, and the providers ability to contribute to health, are a needed components to complement the traditionally good accessibility.Within Professional Development the role of the nurse in PHC is accentuated. The projects hands-on approach and proximity to clinical work is very important. In all participating countries, groups of nurses have used the medical audit method to advance and claim competence and ambition within their own profession, and vis-à-vis management and administrative levels. In Lithuania results are especially prominent. The nurses clearly aspire to leave their traditional role of assisting and conducting secretarial tasks, to gain independence in their own profession with patient meetings incl. motivational counselling and life style changes.It stresses the differences in competence between doctors and nurses, but also the differences in content of the doctor-patient meeting compared to the nurse-patient meeting. The medical audit method has shown to be an effective clinical tool also for the development of doctors skills.The problem of brain-drain is evident in all project countries. The Estonian pilot on repatriating doctors and nurses from outside the health sector by offering postgraduate training and preparation to pass required qualification exam is a new way mitigating the effects of emigration, with significant economic impact. The Estonian Ministry of Social Affaires is planning a similar project based on these experiences. Within Regional Planning a Health Synergy model has been developed, emphasizing the responsibility for public health in the provision of PHC, incl. guidelines on how to improve health promotion activities. The regional strategy on containment of antimicrobial resistance and implementation of rational antibiotic has brought forward intensive discussions among general practitioners and narrow specialists from hospitals. A centre for medical audit at Klaipeda University was created and started a study of the use of antibiotics in PHC in case of urinary tract infection.
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