Thursday, November 18, 2010

Do The Survey, Do The Duty

Surveillance is the ongoing, systematic collection, analysis, interpretation, and dissemination of data regarding a health-related event for use in public health action to reduce morbidity and mortality and to improve health.
(Center for Disease Control and Prevention/CDC)

"Why is surveillance needed?"

Surveillance serves as an early warning system of which it helps to identify public health emergencies. It also guide public health policy and strategies besides documenting the impact of an intervention or progress towards specified public health targets/goals. This system at most, understand or monitor the epidemiology of a condition to set priorities and guide public health policy and strategies.

The effectiveness of surveillance depends on its functions which represents by the table below:

Detection and notification
About health events
Investigation and confirmation
The epidemiological, clinical and/or laboratory matters of any case or outbreak.
Data collection and consolidation
About the pertinent data
Data analysis
Done routinely and also having the creation of reports
About the  information to those providing the data
The forwarding of data to more central levels
reporting data to the next administrative level

A surveillance system is an information loop or cycle that involves 3 main roles which are the health care providers, public health agencies, and the public. The loop shown here is the summary to briefly explain how the things going between the 3 roles.

One of the many examples of uses of surveillance can be seen in Thailand. Thailand was host to one of the largest epidemics of avian influenza (bird flu) identified in eight Asian countries in early 2004. 

Later that year, the disease spread from birds to humans, killing almost all the infected people. Recognizing the global threat posed by such a disease, the Thai Ministry of Health, in partnership with field epidemiologists and WHO, supported laboratory studies that showed that the disease was being spread from human to human.

The Thai example was critical in raising public awareness of the possibility of a global catastrophe caused by avian flu. It also showed that the disease can be controlled with proven epidemiological methods; including rapid, on-site investigation by trained specialists and good communications.

"Medical doctor in pandemic preparedness"

One critical role of medical doctors of which may have been underplayed in importance, is to educate, manage and communicate with the public. In a survey of the public organized by the College of Family Physicians of Canada, an overwhelming majority of the respondents indicated that they should be able to turn to their family doctors for information and advice in the event of a serious medical emergency such as a widespread influenza outbreak (source: Influenza pandemic and the duties of healthcare professionals).

As trusted and credible sources of information, medical doctors play an important role in guiding the public even on mundane decisions such as whether and how to seek medical help. Public guidance increases in ethical significance during a potential or actual pandemic. Therefore, medical doctors should be well-informed about the spectrum of clinical presentations and severity of the pandemic matter. Doctors have to be one of the most up- to- date individuals ever :)

Furthermore, as primary medical care providers, doctors care for and report suspected or confirmed infectious diseases that threaten the health of their patients and the populations in which their patients reside. By identifying outbreaks through screening, diagnosis and reporting, doctors play a major role in helping to reduce the severity of outbreaks.

Tuesday, November 16, 2010

The Power of Maintenance

Ever wonder how the licensing and standardization actually are in the quality regulation, especially for the doctors? In this post, I'll briefly explain the matter including what standards are actually important to be listed down to.

      A physician is amongst the health personnel which refer any person who devoted themselves in the health sector and have knowledge and / or skills through education in the health sector, which to a certain type requires authority to carry out health services. (Peraturan Pemerintah RI No. 32 th 1996)


      1. Certification
      From educational institutions. It's just the way how things going on for me. I'm studying medicine in University of Gadjah Mada, and after 5 years here, I'll have my Medical Doctor certificate. Insya Allah:)

      2. Competency test
      MTKP i.e. the provincial health personnel board. This is important in such a way to ensure that doctors are not a health personnel just because of their tittle or certificate, but also because of their knowledge, skill, and ability to really perform as ones.

      3. Registration
      KKI i.e. Indonesian Medical Council. It's somewhat like letting ourselves to be officially being acknowledged in the field. Well.. WELCOME TO THE CLUB:)

      4. Practice permit
      Government at district level. The analogy is like having a driving silence to drive a car legally.

      5. Credential
      Under the hospital medical board. It's an attestation of qualification, competence, or authority issued to an individual by a third party with a relevant. It may include academic diploma, academic degrees, certifications, or identification documents.

      6. Clinical privilege
      Board of director:)

      Besides obtaining medical practice permit (from government), h, health personnel is responsible on other obligations which is especially to comply with professional standards.
      • Education standards: The physician is graduated from a medical a school.
      • Competency standards: Performing jobs and role as a physician based on appropriate guidelines.
      • Service standards: Able to provide the service that patients are entitled to receive.
      • Ethics standard: Performing role in good and suitable moral value. 

      My second point, SURVEILLANCE will be posted soon. Thank you very much..

      Reference:"Physician Regulation", lecture by dr. Rukmono Siswishanto

        Monday, November 15, 2010

        From Health Care with Love


        Patients are the consumers which have their own rights; be it on medications, treatments, safety, and so on. In this post, I'll share my understandings based on the notes I made on how much the Health System is set up in rolling the red carpet for the patients:)

        Quoting from Prof. dr. Laksono Trisnantoro when he conducted our practical session about SYSTEM THINKING, "Every complex things have system which followed by subsystems that strengthening it". For Health System, Clinical Governance is one system which works by maintaining and improving the quality of patient care. One of the best examples for its implementation is the national quality standards in delivering care: clinical guidelines based on evidence.

        Clinical Governance to which I can simplified is a vehicle that takes us from a problem to solution:

        Problem -----> Clinical Governance -----> Solution

        The strategies employed to achieve quality and excellence, are those of teamwork, leadership, ownership and communication. All key skills to utilize when attempting to bring about changes to health care and more particularly in shared care services.

        There are 4 main pillars in Clinical Governance based on the lecture given by Prof. dr. Adi Utarini: Consumer value, Clinical risk management, and Professional Development and Management, and Clinical Performance and Evaluation. Some other sources I found give out 7 main pillars, and even 11, but as to go through those, the fundamental pillars are actually the same.

        Clinical performance and evaluations help to reach the target through Clinical Indicators which measure those, such as AHRQ, WHO-PATH, or ACHS.

        Aim of Clinical Indicator:

        2 types of clinical indicators:

        Sounds too wide, isn't it? But well, indicators come in level, hence narrowing the aspect of management, therefore, more effective initiatives :)

        All health care providers, both institutional and individual, must make every effort to ensure that every person who seeks their medical care is offered competent, sincere, and equal treatment options.

        With all these, the aims are managed to be reached or at least, very close :)
        • Ensuring appropriate access and high quality
        •  Provide the best care for all patients
        •  Protect patients from unexpected risk 
        As the aims are reached, it directly or indirectly protects and leads to patient's equality. Patient's equality is fact that all the people have the right to receive health services. You can read my post about WHO declaration (Health for all by the year 2000) in the topic og GLOBAL HEALTH SYSTEM, discussing about patient's equality in global aspect:) As you can see in Indonesia for example, in every level of the country- district --> provincial --> national;  there are health system facilities, care, and regulations being provided thoroughly.

        All of all, when clinical Governance works, it allows us to make the service changes or improvements that we want to see happen. It's not only improving the quality of care for the patients, but also provides a better experience for us. This in fact, supports the equality of utilization, distributing according to need, equality of access, and equality of health which by far, enables the strong EQUITY IN HEALTH CARE:)