Primary Care

• Establish a model family practice center (FPC) that would also serve as a training center preparing health professionals to work in new primary healthcare centers and that would provide innovation in integration of mental health services.
• Develop disease prevention and health promotion programs based upon community health assessment.
• Develop and implement clinical practice guidelines and protocols.
• Work with other agencies engaged in health care reform and policy development to facilitate replication of the model Family Practice Center.

Mental Health

• Integrate mental health services into the polyclinic setting and develop mental health referral protocols.

Health Management

• Support system-wide change in health care in the Darnitsky district by training the staff of the FPC and the faculty of the Kiev Post-graduate Medical Academy in health management topics.
• Implement a continuous quality improvement process at the FPC.

Medical Education

• Identify training needs and develop a training center for managers, family physicians, family physician preceptors and faculty, nurses, mental health workers and social workers within the FPC/Medical Territorial Unit, in collaboration with Mohyla Academy Department of Social Work, Kiev Post-graduate Medical Academy, and the Kiev Association of Family Physicians.
• Identify, provide and strengthen the training capacity of family physicians, family physician preceptors and faculty, nurses, mental health workers and social workers. Identify and train members of FPC staff to serve as trainers in Management and mental health integration.

• A Memorandum of Understanding was signed on October 14.
  
  

• September 27-29 the partners conducted a conference for West NIS AIHA PHC partners to present a strategy on the integration of mental health services into primary care.
• On October 27 the partners held a formal opening ceremony for the the new FPC. The Minister of Health of Ukraine and the US Ambassador to Ukraine were among the distinguished guests.
  
  

• From August 10 to 19, Kiev-Philadelphia partners and Mental Health Task Force members conducted training for AIHA West NIS partners in counseling, screening and early detection of mental disorders.
  
  

• The follow-up Behavioral Health Conference was conducted on in January 21-22 in Kiev and provided an opportunity for all West NIS partners to share their experiences, discuss the barriers and develop strategies for strengthening the mental health component in the scope of primary health care services.
• In November, the partners presented the patient database it developed at a meeting of the heads of statistical departments of Oblast Health Administrations.
  
  

• On October 23, over 100 participants from the city of Kiev attended a dissemination conference on CQI practices for Kiev area primary care providers and City Health Administration officials. The results of the CQI project as well as the methodology developed through the partnership collaboration were presented to conference participants through workshop format and site visit to Family Practice Center.
  
  

• On March 12, the partners conducted an all-Ukrainian conference on standardized patient approach to training and evaluation of clinical skills. The partnership presented the work of four standardized patients trained by specialists from the Kiev Medical Academy for Post Graduate Education and the Kiev FPC.

Primary Care

• The Kiev Family Practice Center established as part of the partnership serves a population of 10,500. The FPC provides comprehensive services, including preventive and educational programs, mental health and social services, prenatal care, and basic lab tests.
• The Family Practice Center adopted a multidisciplinary approach to healthcare and assembled a team of physicians, nurses, a psychologist, and a social worker.
• Partners completed three qualitative evaluations of the implementation process of this collaborative model. Results have been incorporated into center operations to enhance program performance.
• AIHA selected Kiev FPC as a pilot site to conduct a patient satisfaction survey in July 2002 and found that 83% of patients were completely satisfied with the services provided at the center. In March 2004 PHC clinic conducted a survey that showed that ratio of patients who have voluntarily chosen FMC personnel to be their family physicians exceeded 10% of the total catchment area population.
• FPC staff received training in the clinical skills necessary to operate a primary healthcare center and developed clinical protocols for asthma, diabetes and STDs.
• As a result of extensive training received through the partnership, nurses became actively involved in direct patient care, effectively reducing the workload of a physician. Nurses now act as a primary contact during patients' visit to the center. They also act as health educators and conduct health promotion and health education community outreach campaigns.
• The head nurse of the FPC developed a training program for healthcare providers on clinical breast exams. She teaches self-breast exam techniques and conducts training for the nurses at the FPC and other primary health care facilities in the district.
• Nursing staff organized school-based educational and community outreach programs designed to address a variety of health issues from encouraging healthy lifestyle choices among local children and young adults to child birth education and breast feeding. Program titles included: How to Develop Healthy Lifestyle Habits, TB Prevention, Smoking and Drug Abuse Cessation, Breast Self Exam, Child Birth Education, and Breast Feeding.
• In 2003 FPC staff provided clinical skills training to the multidisciplinary teams from the three replication sites, including training on the use of equipment that was purchased through the partnership and also donated to the sites through a collaborative program with Carelift.
• As a result of the implementation of primary health care model, developed by AIHA partners, the percentage of patients referred to specialists decreased from 60% in 2000 to 21% in 2002.

Medical Education

• Partners developed a family medicine residency program and piloted it on the first group of residents in February 2001. From 2001 till June 2004 18 residents received training in practical skills through the residency program at the FPC. Every year six residents graduate from the program.
• Partners introduced and implemented new skills training and assessment methodology using standardized patients. The standardized patient methodology helps develop the clinical skills of medical students and residents by having individuals pose as patients and simulate different medical conditions. These "patients"-trained to present with specific symptoms-are examined and diagnosed by medical students and residents and trained to assess the practical skills of future medical professionals.
• Partners presented the effectiveness of the standardized patient approach, tools of clinical skills training and assessment, methodology of training of standardized patients at a series of workshops and conferences.

Mental Health

• US partners provided training to the mental health team in detection and treatment of primary care mental health problems. As a result of the training partners identified the following objectives for mental health integration: the decentralization, increasing accessibility of mental health services, overcoming stigmatization of mental diseases, early detection of mental disorders, improved care of psycho-somatic and other conditions, team approach to prevention, diagnostics and treatment, acquiring new knowledge and skills by general practitioners.
• In collaboration with AIHA's mental health task force, partners developed a guide for PHC staff on marginal mental health disorder diagnostics and treatment. The concept of the guideline for the primary mental health services was developed, based on the World health Organization, National Institute of Mental Health, Institute for Clinical System Improvement and Ukrainian recommendations. The guide was presented at Behavioral Health Conference in 2000 and distributed among AIHA PHC professionals.
• The partnership sponsored a regional conference on behavioral health to present a strategy on the integration of mental health services into primary care. The conference was attended by the representatives from West NIS PHC partnerships, as well as the Ministry of Health and Kiev City Health Administrations. At the conference the partnership presented their model of mental health integration into primary health care. Representative from the Ministry of Health presented on reforms of mental health services in Ukraine. Eight workshops were held: Substance Abuse, Depression, Domestic Violence, HIV, Difficult patients, PTSD Studies, Continuous Quality Improvement, and Counseling Skills. Educational models for family doctors, mental health specialists, social workers, nurses and other staff were discussed. Following the conference all AIHA primary health care and women's wellness partnerships that attended made the decision to integrate mental health into their centers.
• The partners, in collaboration with members of the mental health task force, developed a training course to advance the practical skills of primary care practitioners in counseling, screening and early detection of mental disorders. Twenty eight representatives of PHC sites from Ukraine and Moldova attended the workshops held in L'viv and Odessa. The training provided practical tips and tools for AIHA partners on mental health integration into primary care.
• The partners served as faculty at the follow-up Behavioral Health Conference which was conducted in Kiev and provided an opportunity for all West NIS partners to share their experiences, discuss the barriers and develop strategies for strengthening the mental health component in the scope of primary health care services.

Health Management

• The partners adopted a US-style curriculum and conducted series of training on healthcare management to the representatives of the Darnitsy District. A team of healthcare management trainers was formed at the FPC and at the Department of Management at the Kiev Medical Academy for Post-Graduate Education.
• Partners established a system of automated medical records at the FPC.
• Partners have developed a continuous quality improvement tool based on healthcare quality indicators using such methods as CPG adaptation and implementation on institutional level, continuous monitoring of indicators and periodic chart audit.