Improving family medicine in Kosovo with microsystems.

Purpose: family medicine is being adopted in many low-income countries to meet medical care needs. A systems approach may be useful for international organizations offering aid, in addition to providing resources and training. An established methodology called Microsystems was used to help implement family medicine in Kosovo, a small country seeking to rebuild after decades of turmoil and war.

Methods: clinical and systems changes were implemented in 2 municipalities, resulting in improved quality of care within the established primary care system. The first 2-year project focused on hypertension and the second on antenatal care. Mutual exchanges were used to introduce Microsystems, addressing medical records, data systems, evidence-based guidelines, community outreach, supplemental training, and sustainability models.

Results: the microsystems method successfully guided specific clinical, general management, and organizational improvements. Successes included improved teamwork; delivery of patient-centered care; empowered nursing staff; and data-driven decision making. Barriers to systems change included management systems impeding staff initiative; resistance to change by the larger health care "macrosystem"; marginal funding for prevention; and few models for clinical prevention and continuity care.

Conclusions: microsystems methods are adaptable for use in low-income countries or those rebuilding after conflict that are implementing family medicine models to improve medical care and population health.