Did the Structure of Work in the Public Health Nurse Service of the Republic of Croatia Change in the Period 1995–2012?

In Croatia, public health nurses(PHN) have been members of family doctor (FD) teams for decades, conducting a multifunctional and polyvalent scope of activities, including health promotion, prevention, as well as part of the treatment for the inhabitants of a defined catchment area. The main aim of the study was to investigate the trends in the number and structure of PHN visits in the period from 1996 to 2012. The main sources of data were Croatian Health Service Yearbooks. The results strongly indicate that PHN’s are overloaded by a high number of visits, especially to chronic patients. While mothers and new-born children are in the PHN care, pregnant women and small children are rather neglected. Considering different working conditions and differences in population needs, a review of the standard is recommendable

REGIONAL DIFFERENCES IN COMMUNITY HEALTH SERVICE IN THE REPUBLIC OF CROATIA FROM 1995 TO 2012

Promjene koje su se dešavale u cjelokupnom zdravstvenom sustavu obuhvatile su i patronažnu djelatnost, ali s vrlo malo publiciranih istraživanja kojima bi se to evaluiralo. Stoga je cilj ovog rada bio istražiti postoje li regionalne razlike u broju patronažnih sestara (PS) i broju posjeta u periodu od 1995. do 2012. Kao osnovni izvor podataka poslužili su Hrvatski zdravstveno-statistički ljetopisi za te iste godine. Rezultati istraživanja su pokazali da broj PS blago raste do 2010. godine, nakon čega broj opada. Prosječan godišnji broj posjeta po jednoj PS sestri pokazuje kontinuirani rast tijekom cijelog perioda praćenja. Međutim, uočene su velike razlike između županija. U nekim županijama su relativno male varijacije u broju posjeta na jednu PS, dok su u drugima razlike velike. Najveće promjene su se dogodile u Splitsko-dalmatinskoj, Šibensko-kninskoj, Ličkosenjskoj i Brodsko-posavskoj županiji, a najmanje u Varaždinskoj, Primorsko-goranskoj i Krapinskozagorskoj županiji. To je djelomično objašnjivo povećnjem ili smanjenjem prosječnog broja stanovnika u skrbi jedne PS. Izrazito povećanje prosječnog broja posjeta po jednoj PS u Splitskodalmatinskoj županiji je najvjerojatnije posljedica izrazitog manjka patronažnih sestara. U Zadarskoj županiji zabilježen je najmanji broj stanovnika i najmanji broj posjeta po jednoj PS. Međutim, u nekim županijama su se događale promjene prosječnom broju posjeta nevezano uz broj stanovnika u skrbi. To je posebno vidljivo u Brodsko-posavskoj županiji gdje se uz povećanje broja PS povećao i broj posjeta po PS. Rezultati istraživanja mogli bi poslužiti planerima i ugovarateljima zdravstvene zaštite da pokušaju riješiti problem nejednake distribucije patronažne djelatnosti u RH.Changes that were going on in the total healthcare system included community health service as well but only a few studies on its evaluation were published. The aim of this study was to explore whether regional differences in the number of community health nurses and the number of their visits from 1995 to 2012 existed. Data from the Croatian Health Service Yearbooks were used for the study. The results showed that the number of community health nurses was slowly increasing until 2010 and decreasing afterwards. The average number of visits per one community health nurse was showing continued increase during the whole studied period. However there were big differences noticed among the counties. In some counties those differences were rather small while in the other they were high. The biggest changes occurred in Splitsko-dalmatinska, Šibensko-kninska, Ličkosenjska, and Brodsko-posavska counties and the smallest in Varaždin, Primorsko-goranska, and Krapinsko-zagorska counties. This could be explained by increasing or decreasing number of population in the care of one community health nurse. Significant increase of the average number of visits per one community health nurse in Splitsko-dlmatinska county is probably the result of their shortage. In the Zadar county the smallest number of inhabitants and visits was recorded. However in some counties changes in the average number of visits occurred regardless the number of inhabitants in care. It is especially evident in Brodsko-posavska county where together with the increased number of community health nurses the number of visits increased as well. The results of this study could be used by planners and health services’ negotiators in order to try to solve the problem of unequal distribution of community health services in the Republic of Croatia

Did the Structure of Work in the Public Health Nurse Service of the Republic of Croatia Change in the Period 1995–2012?

In Croatia, public health nurses(PHN) have been members of family doctor (FD) teams for decades, conducting a multifunctional and polyvalent scope of activities, including health promotion, prevention, as well as part of the treatment for the inhabitants of a defined catchment area. The main aim of the study was to investigate the trends in the number and structure of PHN visits in the period from 1996 to 2012. The main sources of data were Croatian Health Service Yearbooks. The results strongly indicate that PHN’s are overloaded by a high number of visits, especially to chronic patients. While mothers and new-born children are in the PHN care, pregnant women and small children are rather neglected. Considering different working conditions and differences in population needs, a review of the standard is recommendable

Changes in the Organizational Structure of Public Health Nurse Service in the Republic of Croatia 1995 to 2012

Since 1996, after the privatization of primary health care, public health nurse (PHN) in Croatia remained employed within the health center, mainly responsible for the preventive care of the inhabitants from defined catchment’s area. Before that time they were part of general practice teams. The main aim of the study was to investigate what are the trends in the organizational structure of PHN service in Croatia, from 1995–2012. The main source was the Croatian Health Service Yearbooks. The obtained results shows that they are college educated and mostly in full-time jobs. The important findings are the lack of nurses and theirs regional differences. In highly demanding societies, with growing numbers of elderly, mental, social and economic problems, it will be worthy to consider the lower standard then 5 100 inhabitants per one PHN. Also, it should be taken into account to invest into the lowering of regional disparities

Assessment of alcohol related disorders in family physician’s work – a pilot study

Uvod. Prema podacima Svjetske zdravstvene organizacije u Republici Hrvatskoj se godišnje u prosjeku popije 12,2 litara čistog alkohola po stanovniku starijem od 15 godina. Usprkos ovim podacima, poremećaji uzrokovani pijenjem alkohola rijetko se dijagnosticiraju u ordinacijama obiteljske medicine (OM). Cilj. Istražiti proporciju osoba u skrbi liječnika obiteljske medicine na području Općine Bednja koji ispunjavaju kriterije rizičnog pijenja, štetnog pijenja ili moguće ovisnosti o alkoholu. Metode i ispitanici. Pilot istraživanje je provedeno u dvije ordinacije OM u Općini Bednja u razdoblju ožujak-travanj 2013. godine na prigodnom uzorku ispitanika starijih od 18 godina (N=150). Upitnikom su prikupljeni podaci o ispitanicima (sociodemografski podaci, samoprocjena zdravlja, zadovoljstvo životom), podaci o rizičnom pijenju, štetnom pijenju te mogućoj ovisnosti o alkoholu (AUDIT upitnik). Rezultati. Od 150 upitnika, 75 je uključeno u statističku obradu (stopa odgovora 50%). Temeljem ukupnog broja bodova ostvarenog na AUDIT upitniku, kod 9 od 75 ispitanika utvrđeno je prekomjerno i štetno pijenje te postojanje moguće ovisnosti o alkoholu. Za većinu tih ispitanika (8 od 9) utvrđena je umjerena razina problema povezanih s alkoholom (AUDIT zbroj 8-15), dok je kod 1 od 9 ispitanika utvrđena visoka razina problema povezanih s alkoholom (AUDIT zbroj 16-19). Analizom pojedinačnih cjelina AUDIT upitnika, 11-27 od 75 ispitanika ispunjavalo je kriterij rizičnog pijenja, 3-10 od 75 ispitanika kriterij moguće ovisnosti o alkoholu, a 4-12 od 75 ispitanika ispunjavalo je kriterij postojanja štetnih posljedica pijenja alkohola. Zaključak. Značajan udio osoba u skrbi liječnika OM na području Općine Bednja ispunjava kriterije rizičnog pijenja, štetnog pijenja ili moguće ovisnosti o alkoholu. Analizom pojedinačnih cjelina upitnika (rizično pijenje; ovisnost o alkoholu; štetne posljedice pijenja) detektiran je još veći broj ispitanika koji ispunjavaju kriterije unutar pojedinačnih cjelina, što omogućuje rano prepoznavanje i ranu intervenciju liječnika OM.Introduction. According to WHO data, the average yearly alcohol consumption in the Republic of Croatia per capita resembles 12.2 L of pure alcohol in the age group >15 years. Despite these data, alcohol related disorders are rarely diagnosed in family medicine (FM) practices. Aim. Proportion of patients in care of family physicians in Bednja District that fulfill criteria of hazardous drinking, harmful drinking or possible alcohol dependence is investigated. Methods. A pilot study was conducted in two FM practices in Bednja District on an appropriate sample of respondents aged 18+ years (N=150) from March to April 2013. Data on respondents’ characteristics (sociodemographic data, health self-assessment, life satisfaction) and hazardous drinking, harmful drinking or possible alcohol dependence (AUDIT questionnaire) was collected. Results. There were 75 out of 150 questionnaires (response rate 50%) included in the analysis. According to total AUDIT score, 9 of 75 respondents fulfilled criteria of hazardous drinking, harmful drinking or possible alcohol dependence. Majority of these respondents (8 out of 9) had moderate level of alcohol related problems while in 1 respondent high level of alcohol related problems was detected. Analysis of 75 individual responses revealed that 11-27 fulfilled criteria of hazardous drinking, 3-10 of possible alcohol dependence and 4-12 of harmful drinking. Conclusion. A significant proportion of FM patients in Bednja District fulfilled criteria of hazardous drinking, harmful drinking or possible alcohol dependence. Analysis of individual responses revealed even higher rates of respondents that fulfilled those criteria in separate domains, enabling family physicians early detection and intervention in those patients

Differences in the organisation and functioning public health nurse service between rural and urban regions in Croatia

Cilj istraživanja bio je analizirati postoje li razlike u organizaciji i opsegu rada patronažnih sestara (PS) u ruralnim, djelomično ruralnim i urbanim područjima u Hrvatskoj (RH). Metoda: Prema Strategiji ruralnog razvoja RH,14 županija pripada ruralnim, 6 djelomično-ruralnim, a samo Grad Zagreb pripada urbanoj regiji. Podaci o broju PS, njihovom obrazovnom i radnom statusu, te broju i vrsti posjeta prikupljeni su iz Hrvatskih zdravstveno-statističkih ljetopisa, 1995.-2014. Rezultati: Broj PS u cijeloj je RH porastao, a najviše u ruralnim regijama, što je dovelo do manjega broja pacijenata u skrbi jedne PS, ali je taj broj još uvijek veći od standardom propisanoga. Obrazovna struktura također se poboljšala: najveći broj patronažnih sestara ima visoku školsku spremu, ali njihov je broj najmanji u ruralnim regijama. U ruralnim regijama veći broj PS radi s djelomičnim radnim vremenom. Razlike su vidljive i u većem ukupnom broju posjeta i posjeta trudnicama u ruralnim regijama, dok je broj posjeta babinjačama i novorođenčadi izjednačen s urbanom regijom. Međutim, godišnji broj posjeta dojenčadi i maloj djeci, kao i broj posjeta kroničnim bolesnicima po jednoj PS veći je u ruralnim regijama. Zaključci: Na temelju navedenih parametara možemo zaključiti da je, usprkos napretku, patronažna djelatnost u ruralnim sredinama još uvijek manje dostupna i više opterećena poslom, od one u urbanim regijama RH.Aim: The main aim of this study was to investigate if there are any differences in the number and the daily work structure of a public health nurse (PHN) in rural, semi-rural and urban regions in Croatia. Methods: According to the Strategy for the Development of Rural Regions, 14 counties belong to the rural, six to semi-rural, and only the City of Zagreb to urban regions. Data on the number of PHN, their education and the number of visits were collected from the Croatian Health Service Yearbooks, 1995-2014. Results: The number of PHN in Croatia increased during the observed period as well as the percentages of PHC with college education. Those numbers are lower in rural regions in comparison to urban ones, while the average numbers of total visits are always higher in rural regions. The average number of visits to pregnant women is also higher in rural and semi-rural regions. The annual number of visits to post-partum women and to new-born babies shows an increased trend, independently of the regions. The annual number of visits to the babies has decreased in urban regions, while it is slightly increasing in rural and semi-rural regions. The annual number of visits to chronic patients is stable in urban regions, but it has increased two times in rural and semi-rural regions. Conclusions: Besides certain improvements, the obtained results indicate that PHN service in Croatian rural regions is still less available to patients and PHN are overburdened with the number of visits