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Social Prescribing is a mechanism by which primary care team members can refer patients to community groups to improve their health and well-being. It integrates health, social care, and community, allowing patients to actively improve their health and well-being by participating in community initiatives and activities. These activities have traditionally been part of community life in European countries, and the benefits need to be consistently recognized. [ABSTRACT FROM AUTHOR]

Introduction: Health and social care systems in Central and Eastern European (CEE) countries have undergone significant changes and are currently dealing with serious problems of system disintegration, coordination and a lack of control over the market environment. Description: The increased health needs related to the ageing society and epidemiological patterns in these countries also require funding needs to increase, rationing to be reformed, sectors to be integrated (the managed care approach), and an analytical information base to be developed if supervision of new technological approaches is to improve. The period of system transitions in CEE countries entailed significant changes in their health systems, including health care financing. Discussion: Large deficits in the public financing of health systems were just one of the challenges arising from the economic downturn of the 1990s, which was coupled with inflation, increasing unemployment, low salaries, a large informal sector and tax evasion in a number of CEE countries. During the communist period, there was universal access to a wide range of health services, proving it difficult to retain this coverage. As a result, many states sought to ration publicly funded health services - for example, through patient cost-sharing or decreasing the scope of basic benefits. Yet, not all of these reform plans were implemented, and in fact, some were rolled back or not implemented at all due to a lack of social or political consensus. Conclusion: CEE health systems had come to practice implicit rationing in the form of under-the-table payments from patients, quasi-formal payments to providers to compensate for lack of funding, and long waiting lists forcing patients to the private sector. All these difficulties pose a challenge to the implementation of integrated care. [ABSTRACT FROM AUTHOR]

During their transition, Central and Eastern European countries' health and social care systems have undergone significant changes, and are currently dealing with serious problems of disintegration, coordination, and a lack of control over the market environment, especially for meeting patients' needs. The increased health and social needs related to the ageing society and epidemiological patterns in these countries also require increased funding, reformation of rationing, sectors to be integrated (the managed care approach), and the development of an analytical information base for surveillance of new health and social care solutions. [ABSTRACT FROM AUTHOR]

Introduction: Preventive check-ups were a package of benefits in the pilot study of coordinated care POZ PLUS, available to patients aged 20 to 65. It included a medical interview and physical examination with basic or in-depth diagnostics. A detailed interview and summary of the patient's health was conducted on the basis of a unified check-up questionnaire. Aims, Objectives and Methods: One of the goals of preventive check-ups was providing patients with comprehensive prophylactic services, including assessment of the existing risks and their subsequent reduction, the possibility of referral patient to prevention programs, educational visits, diseases early detection or treatment. The check-up questionnaire was intended to help in collecting and integrating basic information about the patient's health condition (patient summary). It contained elements of standard medical history, assessment of basic life and anthropometric parameters; evaluation of the results of commissioned tests, verification of previous preventive interventions and commonly recognized tests (e.g. AUDIT-C, SCORE). Based on the results of the health check-up, the patient received an individual health management plan, and its elements were also presented on the patient's individual account. The check-up questionnaire was assessed in online survey by 100 medical professionals (doctors, nurses, coordinators) participating in the POZ PLUS pilot program. Results: The results of the study indicate that the scope of the prevention check-up questionnaire includes information: enabling the initial selection to commonly available prophylactic programs (93%), important in making clinical decisions (87%), important in patient education (87%), systematizing the knowledge about the patient's current health condition (86%), facilitating patient assignment to the dispensary group (85%), constituting a reliable source of information for determining the patient's health status (81%), facilitating communication and relationship with the patient (73%). Summarizing information about the patient on the basis of a questionnaire shortens the time of a medical visit (67%). At the same time, the results of the survey indicated a lack of consensus as to the level of detail of the questionnaire in its individual sections. This may require correction, e.g. developing the section on the patient's psychological interview, or reformulating questions regarding the family interview. Conclusions: The preventive check-up questionnaire was highly rated by its users, i.e. medical professionals implementing the POZ PLUS pilot. After possible modification, it should be a tool for assessing risk factors as part of the periodic assessment of the patient's health. It may also constitute the basis for further work in the area of prevention and integration of individual activities functioning separately in the health care system in Poland. [ABSTRACT FROM AUTHOR]

Introduction: The POZ PLUS pilot study was carried out in the period from 1st July 2018 to 30th September 2021, by 47 GP practices. Health check-ups were one of the components of the POZ PLUS coordinated care model. It was a package of health benefits for patients aged 20 to 65. Health check-ups included a medical history and physical examination with basic or in-depth diagnostics. Depending on the result of the check-up, the patient could be referred to further interventions. Aims, Objectives and Methods: The aim of prevention check-ups, in addition to individual benefits for patients, was to stratify the population in the general practice (GP) by determining patients health status, in order to optimize the services provided, optimize the resources and management of the facility for patients, i.e. elements strengthening the process of care coordination. The entities implementing the pilot were divided according to the size of the population they looked after: small (up to 5,000), medium-sized (from 5,000 to 10,000) and large (over 10,000). They represented both urban and rural areas. As part of the summary of the prevention check-ups, the patient were assigned to 1 of 4 health statuses: (1) healthy - without risk factors, (2) healthy (without symptoms) - with risk factors, (3) chronically ill (currently without symptoms) - stable, (4) chronically ill (currently symptomatic) - requiring stabilization. Results: Over 50,000 patients were enrolled to health checks. The largest differences in statuses were observed in terms of the area of residence - people from urban areas are healthier; in rural areas, people with the status (1) or (2) are less than 35%, whereas in urban areas - 57%; The difference in percentage of chronically ill people in a condition requiring stabilization is also striking - there is 5 times more in rural areas compared to urban areas (24.15% vs 5.82% rural - urban areas, respectively). If we look at the size of the health care entity, the largest difference is in the status (4), i.e. 1.5% for people under the care of large facilities, 12.4% of medium-sized facilities and 11.9% of small facilities. The differences between the sexes are less pronounced: there is more healthy people without risk factors among women (15% vs 11.7%, women vs men, respectively), and men are more frequent in the group of healthy people with risk factors (41.9% vs 37.1%). For all categories the differences were statistically significant (p <0.0001). Conclusions: Prevention check-ups together with its summary in the form of health statuses is an effective tool for stratifying the population under care and a valuable source of knowledge about health inequalities in Poland. [ABSTRACT FROM AUTHOR]

Introduction: The obligation of integrated care was introduced in Poland on October 1, 2021 under the Act on health care services financed from public funds. Each healthcare provider should employ a coordinator who will be responsible for organizing patient care. In 2018-2021, a pilot of coordinated care - POZ PLUS in 45 primary care centers was carried out in Poland and covered a population of 300,000 patients. It was based on 3 pillars: primary health care, management of patients with chronic diseases and prophylaxis. It is carried out by a multidisciplinary team of doctors, nurses, coordinators and other professionals. Aims, Objectives, Theory or Methods: In order to build the potential of knowledge about integrated care for patients and medical professionals, the process of identification, planning and implementation of knowledge was used, formulated according to the principles set out in the Scirocco Exchange project. Interviews and focus studies were conducted with patients to determine their level of knowledge about managing their own health. Similar studies were conducted with the employees of healthcare providers to determine what they need to better coordinate patient care. Additionally, a review of available literature, good examples, educational materials and other media in English and Polish was carried out. Highlights or Results or Key Findings: On the basis of the Scirocco Maturity Assessment of primary health care facilities, deficit areas were identified among service providers participating in the pilot of integrated care in Poland. Citizen Empowerment was identified as the area requiring the greatest attention and strengthening. In cooperation with the leader of WP Knowledge transfer of the Scirocco Exchange project, the Polish group developed the Implementation Plan of knowledge transfer in Poland, indicating the goals and actions to be taken. Identified the needs of patients and medical staff and other health professionals. Examples of educational materials and videos on nutrition, physical activity and rehabilitation were collected and presented. Many of them, such as "8 Weeks For Health" or portal free diets, helped patients during the COVID pandemic. For people with chronic diseases, mobile applications have been developed to support their health selfmanagement. The project of NHF Knowledge Transfer HUB was created. Conclusions: Effective building of knowledge potential in the area of coordinated care requires the involvement of the National Health Fund as responsible for the implementation of the Scirocco Exchange Knowledge Transfer Plan in Poland. The consistency and effectiveness of the message depends on the cooperation of the National Health Fund with healthcare providers in Poland and international cooperation, consisting in meetings and exchange of know-how. Implications for applicability/transferability, sustainability, and limitations: Knowledge capacity building may be extended to other health centers joining coordinated care in Poland. The NFZ Knowledge Transfer HUB portal can be connected with the Scirocco Exchange Knowledge Managemet HUB as well as other national HUBs and provide a platform for mutual cooperation between healthcare providers in Europe. [ABSTRACT FROM AUTHOR]

Introduction Health and social care systems in Central and Eastern European (CEE) countries have undergone significant changes and are currently dealing with serious problems of system disintegration, coordination, and a lack of control over the market environment. Description The increased health needs related to the aging society and epidemiological patterns in these countries also require funding needs to increase, rationing to be reformed, sectors to be integrated (the managed care approach), and an analytical information base to be developed if supervision of new technological approaches is to improve. The period of system transitions in CEE countries entailed significant changes in their health systems, including health care financing. Discussion Large deficits in the public financing of health systems were just one of the challenges arising from the economic downturn of the 1990s, which in a number of CEE countries was coupled with inflation, increasing unemployment, low salaries, a large informal sector, and tax evasion. During the communist period, there had been universal access to a wide range of health services, and it proved difficult to retain this coverage. Many states sought to ration publicly funded health services - for example, through patient cost-sharing or decreasing the scope of basic benefits. Yet not all these reform plans were implemented, and in fact some were rolled-back or not even implemented at all due to a lack of social or political consensus. Conclusion CEE health systems had come to practice implicit rationing, in the form of under-the-table payments from patients, quasi-formal payments to providers to compensate for a lack of funding, and long waiting lists forcing patients to the private sector. All these difficulties pose a challenge to the implementation of integrated care. [ABSTRACT FROM AUTHOR]

Introduction: Coordinated care is planned to be implemented in Poland based on solutions developed in the project "Preparation, testing and implementation of coordinated care in the healthcare system, Stage II. Pilot phase - Primary Care PLUS model" co-financed from the European Social Fund under the Operational Program Knowledge Education Development financed under the European Commission Priority Axis 4 and 5. Adequate communication strategy is required to prepare Polish society for a significant change in the health care system, and to help all interested parties learning about the changes planned. Description of policy context and objective: Communication strategy is implemented by the National Health Fund (Narodowy Fundusz Zdrowia - NFZ), supported by The World Bank. A general objective is to create a positive approach to changes in the primary health care by promoting coordinated care as an effective form of medical service. Specific objectives of the project include informing medical entities about procedures necessary for the implementation of coordinated care. Participation in the project means taking a part in thechange in the health care system. Activities targeted at patients involve informing them about the implementation of coordinated care and attempt to create positive approach to the new system model. Activities targeted at medical entities include providing information about progress and results achieved, whereas activities targeted at the general public aim at showing that outpatient clinics and services provided are changing for the better. Communication channels are: project website, Twitter, Facebook, local and national media, online marketing and conferences. Targeted population: Communication strategy developed is targeted at all stakeholders: Ministry of Health, local administration, public officials, 45 medical entities participating in the pilot project, influencers and public opinion. A communication strategy to patients to be used use by participating entities is also prepared and proposed. Highlights: In June 2018 medical entities were chosen for the pilot project. Public opinion and interested parties will become acquainted with the results of the pilot project in October and November 2018. Transferability: Communication strategy can be used in the Stage III of the project - implementation of coordinated care across the country in Poland. Evaluation of the effectiveness of communication strategy can be of value for the future plan of broader implementation and for other countries in the region. Conclusions: Effective implementation of communication strategy requires a well-planned budget and involvement of the NFZ, responsible for the implementation of the strategy. Coherence and effectiveness of the messages depends on the cooperation between the NFZ and the World Bank, which involves meetings and exchange of know-how. Regarding technical aspects of the project, IT support and graphic design support are the most important for developing a project website and preparing information materials. [ABSTRACT FROM AUTHOR]

Introduction: Disease management programs are a component of the coordinated care project Primary Health Care PLUS (PHC PLUS) in Poland, co-financed from the European Social Fund under the Operational Program Knowledge Education Development, financed under the European Commission Priority Axis 4 and 5. Together with health check-ups, coordinators of care and patient education it constitutes a set of systemic solutions aimed at creating a coordinated care system. Description of policy context and objective: The essence of the disease management program is that health care providers offer active care for chronically ill patients. Disease management process starts with the diagnosis that is followed by in-depth diagnostics, and results in individual medical care plan preparation with the active patient's involvement. It includes therapeutic measures aimed at treating the disease or minimizing its effects. Services financed under the disease management program include diagnostics and treatment of patients with selected diseases by a primary care physician in collaboration with specialists in diabetes, endocrinology, cardiology, neurology, pulmonology, rehabilitation and with physiotherapist. Targeted population: PHC PLUS pilot project is targeted at adult patients diagnosed with or suspected of at least one of 11 chronic diseases: type II diabetes, spontaneous hypertension, chronic coronary heart disease, chronic heart failure, persistent atrial fibrillation, bronchial asthma, COPD, hypothyroidism, parenchymal or nodular goiter, osteoarthritis of the peripheral joints and spinal pain syndrome. The stage of disease should allow treatment in primary health care. The disease management programs started on 1st July 2018 in 41 medical entities. Now, 1412 patients have agreed to participate in the cardiology program, 809 are treated in the rheumatology/neurology field, 440 in endocrinology, 370 are diabetic patients and only 149 use the pulmonology program. There were 16 refusals to participate in the disease management programs although the diagnosis has been made. Many patients are still in the process of classification, which gives a chance to increase theirs number soon. Transferability: Implementation of such a program can bring particularly great benefits in countries that do not allocate large amounts of money to health care. The implementation of the program in Poland will also result in the characterization of the model operating process and characteristics of pathways. The solutions developed can be used as a starting point for other countries willing to implement the disease management programs. Conclusions: The implementation of the disease management program increases the competence of the primary care physicians. They manage the budget entrusted, under which they can commission for example rehabilitation, which causes a significant acceleration of the healing process. In addition, the PHC physicians obtain access to: telemedicine, specialist consultations; a wider range and the number of preventive and educational activities; a wider range of diagnostic and physiotherapeutic services; and consulting with other outpatient care specialists. Thanks to the implementation of the PHC PLUS project patients can have a chance to actively participate in decision taking. This is an important step towards patient empowerment. [ABSTRACT FROM AUTHOR]

Introduction: The subject of this study was to collect patient opinions related to coordinated health care organization before pilot implementation phase of a coordinated care project Primary Health Care PLUS (PHC PLUS) in Poland, co-financed from the European Social Fund. The research was intended to verify hypotheses regarding patients' satisfaction, the role of coordinator and patients' health education, recruitment to health checkups, access to specialists and individual disease management. Methodology: The study employed qualitative (focus group interviews - FGIs - 24 adult patients in 3 subgroups, 17 questions) and quantitative (computer-assisted internet interviews - CAWI - representative sample of 1000 patients, 18 questions) techniques. CAWI questions derived from FGI discussions. To be enrolled, patients had to use public primary or specialist health care at least twice in the last two years. The study was carried out in April - May 2017. Results: FGIs revealed that the concept of regular health checkups performed among nonsymptomatic patients was accepted, but the proposed exclusion of patients older than 65 years of age was contested. The idea of disease management met approval. The main benefit pointed out was the fast diagnosis followed by coordinated treatment in PHC with specialists' support. 76,2% of patients in CAWI agreed for sharing their medical data to medical staff involved, if this improves the treatment process. 84.3% of patients appreciated adding their health information to patient accounts, 4.9% were against and 1.3% definitely excluded that. The risk of being treated by incompetent specialist was raised during FGIs and confirmed during CAWI, so patients expected to be allowed to change doctor in such a case. However, patients would be ready to give up their own choice of a specialist, if the waiting time for the diagnosis is reduced to about 2 weeks. The role of health care coordinator was appreciated. Discussion and conclusions: Respondents declared that coordinated care concept meets their expectations. They were interested in participation in health checkups and disease management programs, perceived as a solution to avoid queuing for specialists' visits and to shorten the time needed to establish the diagnosis. The need for greater engagement in the treatment process did not deter the proposed solutions. Patients also positively evaluated the role of a health care coordinator. 62.2% of patients were ready to change the healthcare institution, if the existing one does not offer the coordinated care. Lessons learned: The common belief among patients is that the implementation of coordination in Poland will result in positive changes in the organization of public health care. Thus, changes planned in this sector might be welcomed by most of patients. Limitations: Opinions gathered could not be verified by patients in the real-life setting, but a high degree of trust was granted by them. Future studies: Further studies focused on patients' satisfaction should be conducted after the implementation of coordinated care. Adjustment of the model dependent on geographical location (urban vs. rural) could be considered. [ABSTRACT FROM AUTHOR]

Introduction: In Poland the health and social care operate independently. Public healthcare expenditures in 2017 accounted for 4,73% of gross domestic product (GDP). The target for public funding level to be achieved in 2025 was set at 6%. Polish health care system is focused on stationary and specialist care. People are rather passive, with low health awareness, and participation in prevention programs, what results in low detectability of diseases in early stage of development. Description of policy context and objective: Health check-ups are the components of "Preparation, testing and implementation of coordinated care in the healthcare system" - pilot phase: Primary Health Care PLUS (PHC PLUS) project ongoing in Poland, co-financed by European Social Fund, and is targeted at strengthening patient-centered care and increasing the role of primary health care. The main objective of health check-ups is to stratify the population to healthy and potentially ill patients to manage the number and type of services planned. Patients receive support from a team of medical professionals: doctors and coordinators, accompanied by dietitians, health educators and physiotherapists. Targeted population: Health check-ups are planned to be performed every five years to patients at the age of 20 to 65 years, who do not or rarely use PHC services (did not visited a doctor during last 12 months due to a chronic disease, not hospitalized in that time and did not have diagnostic tests within another prophylactic program). Performed at the very beginning of patient's participation in the project, health check-up includes a set of tests aimed at stratification of the entire population included to one of 4 clusters: (1) healthy, without risk factors, (2) healthy, without symptoms but having risk factors, (3) chronic, without current symptoms but stable, (4) chronically ill, currently with symptoms and requiring stabilization. Check-ups can be performed as a basic or in-depth one. An integral part of the health check-up visit is referral for education in areas related to identified risk factors, to strengthen selfmanagement skills and patient engagement in the treatment. As an outcome, an Individual Health Care Plan (IHCP) is prepared, during. IHCP recommendations include educational activities and referrals for diagnostic tests. Health check-ups started on 1st July 2018; until today, 7672 patients have participated in 45 medical entities. 1414 basic and 6258 in-depth check-ups were carried out. The target number within the project Primary Health Care PLUS is currently 41402. Transferability: The scheme used in the project may be adapted to other projects having the purpose of strengthening patient-centered care at the level of PHC and tailoring the care to patient's needs. Conclusions: Health check-ups are of preventive nature and can be performed by the PHC staff in health centers with an elementary degree of coordinated care. However, the proposed check-up scheme requires further observation in a larger scale and in centers with different levels of coordinated care. [ABSTRACT FROM AUTHOR]

Introduction: Coordinated care implementation plans in Poland will be based on solutions developed in Primary Health Care PLUS project co-financed from the European Social Fund. Adequate communication strategy is required to promote patients' participation. Description of policy context and objective: The aim of communication strategy proposed by National Health Fund (Narodowy Fundusz Zdrowia - NFZ) was to invite patients by sending the message to the society that the new coordinated care model in their medical entities offers better services, easier access to doctors and free prevention programs. Key communication channels were: local media (interviews with site managers, articles and press releases), visuals (announcements, posters, leaflets, gadgets) and direct contact with coordinators, responsible for answering patients' questions at the facility level. Regional branch of NFZ introduced "FOR PATIENT" tab on the own www.pozplus.pl portal. Targeted population: The project started on 1st July 2018. Current target number of its first component - health check-ups - is 41402 patients. 7923 patients (4582 females and 3341 males) were invited for health check-ups by 41 medical entities till the end of August 2018. The number of invitations and resulting numbers of receptions or refusals is monitored by NFZ. Highlights: There were 1429 (18%) refusals: 742 females and 687 males. The only entity which had no refusals - NZOZ Zdrowie in Janów Lubelski - having small rural population of 2700 participating in the project - invited 247 patients (159 females and 88 males) till end of September 2018, what resulted in 247 HCUs started; and 5 basic HCUs and 57 in-depth ones completed until cut-off date. To reveal the source of this success, interviews with 3 health educators working in the entity were conducted, followed by validation with 2 managers. They described own proven methods of communication with the local society added. The entity was experienced in similar activities (grant in chronic diseases area in 2013), and the local society appreciated carrying out effective and valuable preventive actions, for which they received local distinctions. The information about the program PHC PLUS was disseminated locally with help of: village administrator (printed materials), local priest (advertisements in the church), commune office and workplaces (information boards), local voluntary fire fighters (during local events) and physicians contacting individual patients for another reasons. Some patients joined NZOZ Zdrowie in Janów Lubelski thanks to this information action. This promotional campaign was conducted only for 2 months resulting in many patients willing to participate, spontaneous self-referrals, waiting lists and no refusals in case of an invitation obtained. Transferability: Adding locally used confident methods of communication, and reliance on an earlier authority was found to be very effective and such initiatives should be promoted in next steps of implementation of coordinated care across the country in Poland in wider scale or in other countries of the region. Conclusions: Past experiences and high level of engagement of local society resulted in effective implementation of communication strategy. Coherence and effectiveness of the messages would depend on the cooperation between the entities involved in such projects. [ABSTRACT FROM AUTHOR]

Introduction: The growing population of patients with chronic cardiovascular disease has many complex biomedical and psychosocial needs and requires an integrated teamwork approach. There is a need to develop a model for assessing the effectiveness of home care in patients with chronic cardiovascular disease, which would take the needs of informal caregivers into account. The purpose of the study was to determine the variables affecting the level of effectiveness of home care, defined as the co-occurrence of high: quality of life (QoL), health behaviours and met needs. Subjects and method: The study involved 193 patients under the care of district nurses and 161 informal caregivers. The study tools included: the Camberwell Modified Short Assessment, the Health Behavior Inventory (HBI) Questionnaire, WHOQOL-BREF (Quality of Life Questionnaire) and the HADS-M Questionnaire. Results: It was found that patients with a potentially low efficiency of health care (LEHC) were older compared to people with a high efficiency of health care (HEHC) (Me 77.5 vs Me 70, p=0.032). They were characterized mostly by primary education (40.5% LEHZ vs 22.4% HEHC) and professional education (26.2% LEHC vs 25.9% HEHC) p=0.025, a smaller number of people with a good financial situation (15.9% LEHC vs 34.6% HEHC, p=0.004). More people in this group received benefits from a social assistance center (21.4% LEHC vs 7.2% HEHC, p=0.007). There were statistically significant differences in good physical wellbeing (22.6% LEHC vs 52.9% HEHC, p<0.001) and mental wellbeing (24.1% LEHC vs 59.5% HEHC, p<0.001). Among patients with LEHC, more people suffered from disease-related ailments (61.3% LEHC vs 42.9% HEHC, p=0.011) and less systematically adopted prescribed drugs (64.3% LEHC vs 85.9% HEHC, p=0.001). Among the caregivers of patients with LEHC, divorced and widowed predominated (51.5% LEHC vs 77.5% HEHC) and unmarried persons (29.4% LEHC vs 12.5% HEHC) p=0.006. There were statistically significant differences regarding: satisfaction with the level of QoL among the group of caregivers (Me 2 LEHC vs 1 HEHC, p<0.001), QoL values in the physical (Me 12 LEHC vs 14.57 HEHC, p<0.001), psychological (Me 12 LEHC vs 14 HEHC, p<0.001), Social Relationships (Me 13.33 LEHC vs 16 HEHC, p<0.001) and Environmental domain (Me 11.5 LEHC vs Me 12.5 HEHC, p<0.001), health behaviors (Me 73 LEHC vs Me 93.5 HEHC, p<0.001), the level of met needs (Me 0.76 LEHC vs 0.89 HEHC, p<0.001) and the assessment of the fulfillment of expectations towards the PHC doctor (39.1% LEHC vs 60% HEHC, p=0.014). Conclusions: There is a need to improve the efficiency of home care in patients older than 77 years, with a lower education, difficult financial situation and recipients from social assistance centers, as well as with worse self-esteem of physical and mental well-being. Analyzing the needs and expectations of informal carers in the somatic, mental, social and environmental domains, especially in the case of the coexistence of unmarried status, higher level of satisfaction with the QoL and lower expectations of the physician in terms of courtesy and understanding is necessary as part of effective care model in primary healthcare settings. [ABSTRACT FROM AUTHOR]

Introduction: Risk stratification is a key process in delivering large-scale integrated care, as it allows cluster assignment, tailored services' design and case identification. Objectives: To assess the resource use for performing risk assessment visits in patients of an Integrated Care Organization ICO in Poland. Targeted population: Patients belonging to ICO - Medical and DiagnosticCenter in Siedlce 27 primary health care units PHC, over 84,000 patients belonging to PHC located in Mazovian and Lublin provinces of Poland. The pilot study was conducted in 13 PHC sites of this ICO 3 urban and 10 rural. 22 PHC doctors, 8 nurses, 7 medical receptionists 1 dietician were involved. Adult patients with no health examination within last 12 months were recruited - they were invited by phone call or redirected from the PHC doctor's office. 122 patients participated in the study: 71 women 58.2% and 51 men 41.8% with a median age of 45 range: 18-65. Time range: October 10-30, 2017. Methods: The 1st part of risk assessment visit, performed by a nurse coordinator, was a medical interview, assessment of basic vital and anthropometric parameters. The 2nd part of visit, performed as appropriate by nurse, nurse coordinator, receptionist or dietician, was planning and filling in the data of obtained diagnostic tests results. The 3rd part of visit, performed by PHC doctor, was physical examination, discussion of tests' results and other data obtained, and patient's health status defining. 135 variables were analyzed to perform risk assessment, including personal details, detailed interview, anthropometric measurements, physical examination, results of diagnostic tests, diagnosis and patient's health status. The patient interview questionnaire enclosed questions used to determine general health state, physical activity, mental mood, occurrence of familial cancers and chronic diseases, medical history, presence of chronic conditions, participation in preventive programs, smoking, alcohol intake, medications taken and other complaints. Each stage of performing health risk assessment visit was measured in terms of time spent by PHC doctors, nurses, nurse coordinators, medical receptionists and dieticians. Results: The average duration of the whole health risk assessment process was 95 minutes. Average time spent by nurse or medical receptionist was 62 minutes and average time spent by doctor was 33 minutes. The maximal time of health risk assessment visit was 157 minutes with nurse coordinator or other nurse participation through 110 minutes and PHC doctor - 47 minutes. The minimal time of health risk assessment visit was 70 minutes nurse- 45 minutes and doctor- 25 minutes. Average duration of the first part of visit was 49 minutes range 30 - 90. Average duration of second part was 13 minutes range 5-30. Average duration of the third part of visit was 33 minutes range 16-65. Conclusions: Appropriate division of duties in the team is required for adult patients heaving no health examination within last 12 months, as it requires significant amount of time. Lessons learned: Resource utilization was assessed for the purpose of economical assessments. [ABSTRACT FROM AUTHOR]