Improving Family Medicine in Kosovo with Microsystems

The Journal of the American Board of Family Medicine

Donald O. Kollisch¹  Cristina S. Hammond³  Ellen Thompson²  James Strickler³ 

[1] Department of Community Health and Social Medicine, Sophie Davis School of Biomedical Education, The City College of New York, New York (DOK);Dartmouth-Hitchcock Medical Center, Lebanon, NH (ET);Department of Community and Family Medicine (CSH, JS), Dartmouth Medical School, Hanover, NH

关键词: Delivery of Health Care;    Family Medicine;    International Health;    Kosovo;    Microsystems;   

DOI  :  10.3122/jabfm.2011.01.100120

学科分类：过敏症与临床免疫学

来源: The American Board of Family Medicine

【 摘 要 】

Purpose: Family medicine is being adopted in many low-income countries to meet medical care needs. A systems approach may be useful for international organizations offering aid, in addition to providing resources and training. An established methodology called Microsystems was used to help implement family medicine in Kosovo, a small country seeking to rebuild after decades of turmoil and war.

Methods: Clinical and systems changes were implemented in 2 municipalities, resulting in improved quality of care within the established primary care system. The first 2-year project focused on hypertension and the second on antenatal care. Mutual exchanges were used to introduce Microsystems, addressing medical records, data systems, evidence-based guidelines, community outreach, supplemental training, and sustainability models.

Results: The Microsystems method successfully guided specific clinical, general management, and organizational improvements. Successes included improved teamwork; delivery of patient-centered care; empowered nursing staff; and data-driven decision making. Barriers to systems change included management systems impeding staff initiative; resistance to change by the larger health care “macrosystem”; marginal funding for prevention; and few models for clinical prevention and continuity care.

Conclusions: Microsystems methods are adaptable for use in low-income countries or those rebuilding after conflict that are implementing family medicine models to improve medical care and population health.

• Delivery of Health Care
• Family Medicine
• International Health
• Kosovo
• Microsystems

Many low-income countries are seeking to improve health care by following a family medicine model, ^1–3 embracing a team approach that is patient centered and data driven.⁴ Family physicians from wealthier systems, such as those in Western Europe and the United States, are increasingly providing support to countries with fewer resources.⁵ Most such aid programs focus primarily on training to improve providers’ knowledge and skills and on delivering additional material resources, such as equipment and medications.⁶

More than that is needed, however.⁷ It is becoming more recognized that attention to the systems of care is needed to effectively meld training and resources⁸ (Figure 1). The use of clinical quality improvement methods, such as Microsystems, can facilitate implementation by focusing on the development of efficient office structures, data use, and management styles. There is already evidence that Microsystems can be adapted for use outside of well-established settings in the West.⁹

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Figure 1.

Microsystems approach to implementing and sustaining healthcare change. Reproduced with permission from Little GA, Hammond CS. International perspectives: the Kosovo-Dartmouth Alliance for Healthy Newborns. NeoReviews 2008;9:e233–41.⁹ Copyright 2008 by the AAP.

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