Family medicine in post-communist Europe needs a boost. Exploring the position of family medicine in healthcare systems of Central and Eastern Europe and Russia

<p>Abstract</p> <p>Background</p> <p>The countries of Central and Eastern Europe have experienced a lot of changes at the end of the 20th century, including changes in the health care systems and especially in primary care. The aim of this paper is to systematically assess the position of family medicine in these countries, using the same methodology within all the countries.</p> <p>Methods</p> <p>A key informants survey in 11 Central and Eastern European countries and Russia using a questionnaire developed on the basis of systematic literature review.</p> <p>Results</p> <p>Formally, family medicine is accepted as a specialty in all the countries, although the levels of its implementation vary across the countries and the differences are important. In most countries, solo practice is the most predominant organisational form of family medicine. Family medicine is just one of many medical specialties (e.g. paediatrics and gynaecology) in primary health care. Full introduction of family medicine was successful only in Estonia.</p> <p>Conclusions</p> <p>Some of the unification of the systems may have been the result of the EU request for adequate training that has pushed the policies towards higher standards of training for family medicine. The initial enthusiasm of implementing family medicine has decreased because there was no initiative that would support this movement. Internal and external stimuli might be needed to continue transition process.</p

A Methodological Approach for Implementing an Integrated Multimorbidity Care Model: Results from the Pre-Implementation Stage of Joint Action CHRODIS-PLUS

Patients with multimorbidity (defined as the co-occurrence of multiple chronic diseases) frequently experience fragmented care, which increases the risk of negative outcomes. A recently proposed Integrated Multimorbidity Care Model aims to overcome many issues related to fragmented care. In the context of Joint Action CHRODIS-PLUS, an implementation methodology was developed for the care model, which is being piloted in five sites. We aim to (1) explain the methodology used to implement the care model and (2) describe how the pilot sites have adapted and applied the proposed methodology. The model is being implemented in Spain (Andalusia and Aragon), Lithuania (Vilnius and Kaunas), and Italy (Rome). Local implementation working groups at each site adapted the model to local needs, goals, and resources using the same methodological steps: (1) Scope analysis; (2) situation analysis-"strengths, weaknesses, opportunities, threats" (SWOT) analysis; (3) development and improvement of implementation methodology; and (4) final development of an action plan. This common implementation strategy shows how care models can be adapted according to local and regional specificities. Analysis of the common key outcome indicators at the post-implementation phase will help to demonstrate the clinical effectiveness, as well as highlight any difficulties in adapting a common Integrated Multimorbidity Care Model in different countries and clinical settings

Experiences and opinions of patients with the reformed primary health care system in Lithuania.

ABSTRACT: Background After the independence of Lithuania in 1990, primary health care was introduced to achieve better accessibility and availability of care and to ensure patient’s needs. Consequently, patients’ experiences and opinions have become more important. The study aimed to assess patients’ views on reformed health care, taking into account urbanization, visiting public or private practice and sociodemographic characteristics. Methods In 2004, questionnaires were handed to visitors of a stratified random sample of 75 general practitioner (GP) practices. Per practice, 30 patients were recruited. Aspects of availability and accessibility of primary care services and experiences with health care reform in general have been evaluated in the questionnaire. The number of respondents was 2250 (89.1%). Descriptive statistics and multi-level regression analyses were applied. Results The analyses showed that two-thirds (68.5%) of patients thought that at present health care in Lithuania is better than it was 5 years ago. Patients’ evaluations of accessibility, physical and technical environment, knowledge of GP and nurses were mostly positive. Half of the respondents (49%) agreed that, with rising cost of health care, co-payments are acceptable. Patients treated in private GP practices were more satisfied with current health care, premises and equipment, and noted that privately working GPs were better than those in public practice. Patients in towns and rural places were more satisfied with accessibility and organizational work of primary care; but equipment and premises were evaluated higher in cities. Opinions about the health care reforms were more positive among those with a higher education and among younger people. Conclusion Patients positively assessed the implementation of the reform of the health care system and the expansion of private primary care practices. However, inequality of health care related to the type of primary care setting and urbanization continued to exist

Primary care in a post-communist country 10 years later: comparison of service profiles of Lithuanian primary care physicians in 1994 and GPs in 2004.

OBJECTIVES: The study aimed, firstly, to assess changes in the service profile of primary care physicians between 1994, when features of the Soviet health system prevailed, and 2004, when retraining of GPs was completed. Secondly, to compare service profiles among current GPs, taking into account their positions before being retrained. METHODS: A cross-sectional repeated measures study was conducted among district therapists and district pediatricians in 1994 and GPs in 2004. A questionnaire was used containing identical items on the physicians' involvement in curative and preventive services. The response rates in both years were 87% and 73%, respectively. RESULTS: In 2004, physicians had much more office contacts with patients than in 1994. Modest progress was made with the provision of technical procedures. Involvement in disease management was also stronger in 2004 than in 1994, particularly among former pediatricians. Involvement in screening activities remained stable among former therapists and increased among former pediatricians. At present, GPs who used to be therapists provide a broader range of services than ex pediatricians. GPs from the residency programme hold an intermediate position. CONCLUSIONS: Lithuanian GPs have taken up new tasks but variation can be reduced. The health care system is still in the midst of transition. (aut. ref.

Organizational and structural changes in PHC centres during health care reform in Lithuania.

Background: The increasing health care inequalities and morbidity, inefficient payment system challenged to a new health care reform with its priority primary health care after Lithuania’s independence in 1990. Former district doctors have been re-trained to become GPs and former policlinics have been modernized and decentralized. The private medicine was introduced. This paper is an evaluation of structural and organizational changes in PHC centres between 1994 and 2004. Research question: Are PHC centres better organized after PHC reform? Are there any differences between private and public PHC centres in 2004? Methods: In 1994 and 2004 identical questionnaires have been completed by random samples of primary care physicians about the: workload, working arrangement, practice equipment. Data entry, processing and analysis were carried out using SPSS software. Results: In 1994 the response among district doctors was 333 (87%) and among primary care pediatricians 262 (87%). In 2004 the response among GPs was 298 (73%). The number of the patients per GP decreased in 2004, but the number of office contacts, consultations by phone and workload increased in 2004. There were more equipment items in 2004. The number of home visits decreased in 2004. The distance of PHC centres were longer and there were less possibility to make an advanced appointment for a consultation in 1994. Comparing private and public PHC centres there were some differences: more patients per GP in public practice, but normal working hours higher in private PHC centres. The public PHC centres had more equipment. Conclusions: PHC centres are better organized then they were ten years ago. Private PHC centres have less equipment and less patients per GP, but private GPs have more time for their patients. Continued efforts, finance and time will be needed to reach the organization principles of western European countries