POSSIBILITY AND

BOUNDARY IN PRIMARY
MEDICAL ASSISTANCE

Matei Dumitru MD, PhD

UMF Carol Davila
Family Medicine Department
 AMP = PMA Primary medical assistance
AMS = SMA Secundary medical assistance
AMT =TMA Tertiary medical assistance
1.Problem dimension
PMA concept was born to the begin of 80 years- so much
with a view to obtain efficiency and cheap MA.
PMA is as important as respective society have a big
economic and health problems.
Appearance PMA concept concomitently with appearance
the news states excolonials.(70 years).
OMS and UNESCOThe first international conference by
PMA- Alma Ata 1978- which revolutionized the health
concept
PMA concept- make actual again with 15 years ago, in the
same time with politics changs of Est Europe(Conference
concerning of european health system-Copenhaga-1996)
 PMA- definition and contents
PMA the first contact of population with
health system , represent the first line of
sanitary system.

TMA
Sectii specializate
Institute de cercetare
Sectii de specialitate
Centre de sanatate SMA
Laboratoare
Servicii de recuperare

Cabinetele de MF, medicina scolara , medicina muncii PMA

Servicii de ambulanta , Servicii de garda
Politia sanitara
Farmaciile de comunitate

MEDICAL SYSTEM
Specializeded department
Research institute TMA
Specialites department
Health centers SMA
Laboratory
Recovery services
MF, school medicine,
guard services, sanitary police, PMA
communitary chemists shop
PMA rol is that to answer in concrete manner to medical
needs of population:
ensure medical assistance of the first contact;

medical ensurence of emergency;

granting the first medical assistance untill hospitalization;

selection the cases which he can take care single;

selection the cases which must send to the specialists;

ensurence continuity of medical assistance;

supervision the health status of population;

effected diseases prevention

 Difference between PMA and SMA
PMA SMA
Orientated to health
Orientated to prevention
Orintated to community
Grant assistance of first contact
Ensure continuity of medical
assistance
Dont solicit special endowment
Is more cheap
Orientated to patient
Orientated to curative
Orientated to individual
Grant secondary assistance
Ensure episodic medical
assistance
Solicit special endowment
Is more expansive
 Primary medical assistance in
Romania
In Romania, services of primary sanitary assistance include
service of primary medical assistance and communitary social
assistance service.
Primary medical assistance include prophylactic activity,
diagnostics and curative activity:
-ambulatory medical services of health public
-family medicine
-school medicine
-ambulance service
-medical emergency
-sanitary police
-communitary chemists
Possibility and boundary in PMA

PMA confront with problems which can solve and

problems which cant solve, for which need to
help of other specialists by health system.

Thus, PMA confront in permanence with possibility

and their boundary.
 Possibility and boundary in
prophylactic activity
Prophylactic activity involve primary, secondary and tertiary activity.
This activities achieve to family medicine , school medicine level,
work medicine, sanitary epidemiologic service level (sanitary police
and preventive medicine).
The needs Declaration from Alma Ata, concerning of prophylaxis
measure
-communitary education of health problems and diseases prevention
-suitable nourishment promotion, water consumption, elementary
measure of hygiene
-care addressed mother and child, inclusive family planning
-immunisation against the principal infection diseases
-prevention and control of local endemic diseases
-supplied essential drug
 Possibility and boundary in
prophylactic activity
1)Obligatory immunisation of national calendar to age group -2 month-
5 years, antiepidemic measures in hotbed of transmissible diseases,
preventive hygiene measures

2)Breaking-up responsibility concerning of vaccination programmes

take to omit nonschool children
Existence of children without status civile act(CNP) which cant exist in
MF list
Difficulty to application of national programm of vaccination in rural
isolated region
Possible solution: Distributions this responsibility toward ones level: MF
or created some vaccination centers
 Possibility and boundary in
curative activity

1) PMA solve over 80-90% by current medical problems of populations.

After how show any authors, approximately 75% of patients with minor
symptomatology treated singles, just25% of them to present to MF
and2,5% of them are hospitalized. In conclusion, just 1/10 of patients
which to present to MF are hospitalized.

2) In Romania are hospitalized yearly appro. 25% of population.(5 000.000)

 Solutions

After how show any authors, in condition which PMA could benefit by
15% by health budget it could solve aprox 90% of curent medical problems
of population.

Medical problems solved Health budget

1% Tertiary assistance 40%
9% Secondary assistance 45%
90% Primary assistance 15%
 Conclusions
1.PMA represent a complete activity which solicit as medical factors as socio-
economic and politico-administrative in common effort by promotion of health
status and diseases prevention.

2.Investment in PMA process at communitary level is more efficiency , more

acceptable and more supporting than other promotion roads of health.

3.Necessity of permanent harmonization of those three levels at medical

assistance for avoidance generation by negatives repercussion concerning of
health status.

4.An healthy individual cant exist without a healthy society, in this context,
AMP is permanent submissive by provocations resulting of society evolution;
which in initially stage is constituted in boundary and further in possibility.
 Bibliography

1. Dumitru MATEI, Essential of Family

Medicine, Editura Amaltea 2011