Центры укрепление здоровья в Словении: интеграция индивидуальных и популяционных услуг для снижения неравенства в здравоохранении на уровне сообществ: информационный обзор по передовому опыту

В 2002 году во всех 61 центре первичной медико-санитарной помощи (ПМСП) в Словении были созданы Центры укрепления здоровья (ЦУЗ). Их основная роль заключалась в осуществлении вмешательств в области образа жизни в борьбе с ключевыми факторами риска неинфекционных заболеваний (НИЗ) с использованием комбинации индивидуального подхода и подхода на уровне популяции. ЦУЗ интегрировали ранее разрозненные мероприятия и виды деятельности в центрах ПМСП, включая общественных медсестер. В период с 2013 по 2016 год проводилась опытная апробация новой парадигмы для обеспечения интеграции разных услуг, направленных на уязвимые группы. Новая роль ЦУЗ заключалась в построении партнерских отношений с ключевыми заинтересованными сторонами, включая социальные службы и неправительственные организации (НПО), в целях укрепления здоровья на уровне сообществ. Для подготовки локальных стратегий и планов действий, направленных на удовлетворение потребностей разных групп населения и выявление и снижение неравенства в здравоохранении, были образованы команды укрепления здоровья.

Health promotion centres in Slovenia: integrating population and individual services to reduce health inequalities at community level: good practice brief

Health promotion centres (HPCs) were created in 2002 in all 61 primary health care (PHC) centres across Slovenia. Their main role was to provide lifestyle interventions against key risk factors for noncommunicable diseases by combining population and individual approaches. HPCs integrated previously dispersed activities in PHC centres, including community nursing. Between 2013 and 2016, a new paradigm was piloted to assure integration of different services targeting vulnerable groups. The new role of HPCs was to create partnerships with key stakeholders, including social services and nongovernmental organizations, to improve health at community level. Health promotion teams were established to prepare local strategies and actions plans, which would address the needs of different population groups, and identify and reduce health inequalities.

Multimorbidity: What do we know? What should we do?

Multimorbidity, which is defined as the co-occurrence of two or more chronic conditions, has moved onto the priority agenda for many health policymakers and healthcare providers. Patients with multimorbidity are high utilizers of healthcare resources and are some of the most costly and difficult-to-treat patients in Europe. Preventing and improving the way multimorbidity is managed is now a key priority for many countries, and work is at last underway to develop more sustainable models of care. Unfortunately, this effort is being hampered by a lack of basic knowledge about the aetiology, epidemiology, and risk factors for multimorbidity, and the efficacy and cost-effectiveness of different interventions. The European Commission recognizes the need for reform in this area and has committed to raising awareness of multimorbidity, encouraging innovation, optimizing the use of existing resources, and coordinating the efforts of different stakeholders across the European Union. Many countries have now incorporated multimorbidity into their own healthcare strategies and are working to strengthen their prevention efforts and develop more integrated models of care. Although there is some evidence that integrated care for people with multimorbidity can create efficiency gains and improve health outcomes, the evidence is limited, and may only be applicable to high-income countries with relatively strong and well-resourced health systems. In low- to middle-income countries, which are facing the double burden of infectious and chronic diseases, integration of care will require capacity building, better quality services, and a stronger evidence base.