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Introduction: The main responsibility of health care entities is to improve public health and stimulate patients to take care of their own health. An inseparable element of health promotion is the health education. It consists of developing skills of maintaining and improving health, of individuals and society in general and creating a health-friendly environment. Introduction of high quality health education is the main aim of the project `Explore the Value of Primary Health Care – Value of PHC` project in Poland. Description of political context and objectives: Health education in Poland is provided to a limited extent. Health care system focuses rather on specialist and hospital care. Patients in Poland pay only little attention to prophylaxis; they do not want to participate willingly in activities promoting healthy lifestyle nor visit education centers. The main objective of the “Explore the value of primary health care” program is to change this. The biggest challenge for health education in Poland is to develop a systemic solution offering comprehensive support for patients. This could be achieved by appointing health educators in primary health care and promoting their services. The program started in March 2018 and is planned for 2 years. Population targeted: The project is targeted at 26,168 patients and 434 health professionals will be involved. Ultimately, health education should cover all population of Poland. Highlights: The aim of the project is to develop and implement tools for educating the medical and non-medical staff, which is to be responsible for patient education. Health education activities include a comprehensive doctor’s visit, health checkup, and educational consultation made by nurse, dietitian and/or psychologist. Medics are involved in this project as well. They participate in trainings on customer service, patients’ rights, prophylactic programs and rules governing health care system. In the project, certain tools facilitating cooperation between primary health care doctors and outpatient doctors will also be developed and implemented. Transferability: An effective health education system requires the implementation of three health care policy instruments: adjustment to environmental conditions, support for self-health care and financial determinants. Top-down guidelines are to be created by a team of specialists, to be provided to patients by health educators. The educators have to be thoroughly prepared and trained with regard to health knowledge and communication. A patient-educator conversation should be preceded by an analysis of patient’s knowledge and studying preferences, i.e. based on words (lecture, conversation, discussion), observation and assessment (measurement of patient’s parameters, presentation of appropriate pro-health behavior with regard to a particular illness) or practical activities (brainstorming, problem solving role play). Conclusions: Simple education programs in primary health care have shown to be ineffective. Implementation of coordinated activities might improve health condition of the population. A substantive and commonly available education system can help to reduce the costs of health care by exerting a positive influence on patient’s behavior.

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.