Towards unity for health in the Barceloneta: an innovative experience in community-based primary health care.
BACKGROUND
This paper describes a unique experience in community-based primary care in the Barceloneta, an economically deprived neighbourhood in Barcelona, Spain. The paper analyzes the reasons for the successes and failures of the project in light of TUFH principles.


METHODS
The Primary Care Team (PCT) that staffed and ran the Health Centre in the Barceloneta facilitated the active participation of entities and individuals from the neighbourhood in deciding questions of care provision and resource allocation. They also collaborated with other service providers in the neighbourhood including pharmacists, with whom the PCT developed a program for monitoring diabetic and hypertensive patients in the local pharmacies.


RESULTS
The health centre registered some of the best outcomes in Barcelona, including: time spent with each patient; capacity for the physicians to resolve patient visits without a referral; and patient satisfaction. Outcomes for patients followed by their local pharmacists were equivalent to those seen in the clinic, with lower costs. Despite these impressive results, conflicts among and between various stakeholders led to the project's termination.


CONCLUSIONS
Innovations in any system can lead to conflicts of interest between stakeholders, derailing even demonstrably effective programs. A stable partnership with other stakeholders, particularly the community and health care administrators, in this case, is key. However, the community is not monolithic, and efforts must be made to ensure that other stakeholders do not widen intercommunity disputes. Effective dissemination of information on the impact of the project on the population is important to maintain relationships with the various stakeholders.
Segura
Andreu
A
Division of Research in Public Health Services, Institut d'Estudis de la Salut, Barcelona, Spain. andreu.segurab@gencat.net
Miller
Frederick A
FA
Foz
Goncal
G
Oriol y Bosch
Albert
A
D003153:Community Health Services / Q000458:organization & administration*; D003159:Community-Institutional Relations; D003299:Cooperative Behavior; D006801:Humans; D007400:Interprofessional Relations; D017146:Models, Organizational; D019982:Organizational Case Studies; D017063:Outcome Assessment, Health Care; D011320:Primary Health Care / Q000458:organization & administration*; D013030:Spain; D035862:Vulnerable Populations