Pediatrics in the Pyrinees, an innovative experience in the Alt Urgell (Catalonia)

16 Mar

Today we interview Jordi Fàbrega (@jorfabrega), director of Pediatria en els Pirineus (Pediatrics in the Pyrenees), a cooperative of pediatricians that already has 7 years of life.

Glòria Ruiz, Neus Méndez, Toñi Parra, Jordi Fàbrega

The existence of rural areas hard to reach, remoteness with respect to large urban centres, an extensive area of land, a low population density and something of a shortfall of paediatricians in the area are the characteristics of the Alt Urgell that have given rise to the Pediatrics initiative in the Pyrenees., an innovative initiative from the Observatori d’Innovació en Gestió de la Sanitat a Catalunya (OIGS).

Observatori d’Innovació en Gestió de la Sanitat a Catalunya (OIGS)

With the experience acquired during these seven years, what improvements has the project provided in your opinion?

I think the most important has been stability and in ensuring a health care continuum for our boys and girls. We have been able to give 100% cover from the start in primary and hospital paediatric care and in on-going medical care including localised standby calls. This has meant excellent access for the population, with a 100% success rate of pre-arranged appointments for the same day, and, in addition, with a high success rate at primary level, with an increase in standards in the quality of care.

This has led to a drastic decrease in emergency visits to hospitals as well as in admissions and transfers beyond the borders of the territory. Although there are fewer admissions, a fact that brings with it an increase in the complexity of child admissions, the average hospital stays for these admissions have been reduced.

In keeping the umbilical cord tied to the Hospital Sant Joan de Déu for training paediatricians and in the referral our patients, it has meant that this rate of success has in fact increased in our territory.

In this way, children and their parents are always attended by the same paediatrician, or team of paediatricians, where all know the problem at hand and provide solutions following the same protocols that would be followed in the Hospital Sant Joan de Déu.

Another noteworthy element is that by integrating ourselves within the Maternal and Child Unit of the Alt Urgell, with obstetricians and midwives, we have widened the homogeneity of interventions to include the whole mother-baby area and this has allowed us to begin projects such as early postpartum discharges with follow ups by paediatricians/midwives together and postpartum support groups which have been very well received by the population.

The web set up in 2011 has also brought us closer to the population enabling us to spread information on paediatric subjects. In particular, the virtual doctor’s consulting room is a frequently used tool by parents to clarify doubts with great flexibility and without having to travel to the doctor’s rooms.

Good results and awards endorse the entity’s task that you began which has been able to guarantee efficient paediatric, primary and hospital care. What are the keys of this success?

I think having the autonomy to manage ourselves is fundamental. Being able to manage our own agendas, timetables and cover for each other, among other things, has allowed us to adapt the task of caring to the reality of the territory and also to the realities of each professional by trying to reconcile our work and family life. What is more, it allows for on-going training.

The other key point is the relationship with a top-level centre like the Hospital Sant Joan de Déu which ensures we get on-going training and it solves problems of professional isolation that we might experience in zones a long way from the metropolis.

In a way, we feel we have a ‘big brother’ that helps us when there are difficulties and who accompanies along our journey.

Do you think this innovative model of self-management could be applied to other medical specialities and extrapolated to other regions?

I am absolutely convinced that it is a model which can be reproduced in almost all areas of care and in all regions. The important thing is to find professionals who are willing to accept the challenge and that the administration believes in it and is willing to back it.

Information and communication technologies (ICT) have played a key role from the beginning. Of all the innovative actions you have fostered, which one has worked the best?

The web page and virtual consulting room without a shadow of a doubt.

The web page, with its internal part, gives us access to all professionals and it is where all protocols are hung and this means we all work in the same way, including family doctors that are on call in different doctor’s rooms in the Alt Urgell and who have access to it.

The virtual doctor’s consulting room, likewise, means parents’ doubts can be clarified in a relaxed way and without interrupting visits (as always happens with untimely phone calls). On-site visits that require time investment by parents and, above all, discomfort are thus avoided.

You opened a virtual doctor’s consulting room on your web page five years ago, addressed to parents and tutors. Do you receive a lot of consultations via this channel?

As a matter of fact, no. We get 12 consultations a day on average, shared between the four paediatricians on duty in the region (paediatrician and paediatric nurse).

It must be stressed that we have very good accessibility to on-site visits and we attend a total of 3400 children meaning that numbers are logically not very high. The family’s and professional’s satisfaction, respectively, is very high.

Innovation has been the motor of your initiative. Do you have plans for implementing a new project this year?

In December last year, we incorporated the obstetricians from La Seu d’Urgell into the cooperative society. In practical terms, they were already working in close collaboration since 2012 and now form part of the cooperative; this fact consolidates the project a lot.

We would like to have the midwives from the Alt Urgell in the cooperative because with a few small changes, this would allow us to improve care, especially in community health which is lacking at the moment in our region.

This year, CatSalut has asked us to implement the model in other areas of the Pyrenees where there are problems of cover and it is now one of the issues we are looking into.

Interview prepared by Neus Solé Peñalver (@neussolep).

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