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

Opinion of patients on accessibility of primary health care centers in Siauliai region.

This article presents the data about the accessibility of primary health care in Siauliai region and about factors related to the patients’ perceived access to primary care. The survey was carried out in June 2004, in the context of a joint project of Kaunas University of Medicine and NIVEL, the Netherlands Institute of Health services research. Patients, treated in private and public health care centers in Siauliai region, took part in this survey. The majority of patients are positive about territorial accessibility of primary health care, indicating that it is easy to get to primary health care centers. Patients expressed a high level of satisfaction with the behavior of reception desk personnel. However, they are more critical about waiting time for the general practitioner’s consultation: every third noted that they had to wait for far too long. The majority of respondents pointed out that general practitioners rooms and waiting corridors are convenient and comfortable, and that general practitioners have sufficient medical equipment. Most of the patients are very well informed and satisfied with the opening hours of primary health care centers. The main factors related to the patients’ evaluations of primary health care accessibility were living place of patients and type of ownership of health care center. Patients living in the towns were less likely to evaluate the accessibility of primary health care centers positively, compared to those living in the city of Siauliai. Patients receiving health care services in private centers were much more positive about access to services than those receiving services in public centers. (aut. ref.

Ten years of primary care reform in Lithuania: comparing the task profiles of primary care doctors in 1994 and GPs in 2004.

Background: Since its independence in 1990 Lithuania is transforming health care from the previous Soviet system to a decentralised social insurance based system with a strong emphasis on primary care. Doctors have been re-trained to become GPs with a gatekeeping position. GPs can either work as employees in the public centres or in their own private practice, contracted to the system. Family medicine residency programmes have been developed. Health centres have been modernised and new centres have been established. This paper is an evaluation of changes between 1994 and 2004 with respect to the profile of specific tasks provided by Lithuanian primary care doctors to their patients. Methods: In 1994 and 2004 identical questionnaires have been completed by random samples of primary care physicians about the following services: minor surgical procedures, management and follow up of diseases, and prevention and health education. 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 paediatricians 262 (87%). In 2004 the response among GPs was 298 (73%). Nowadays GPs aresignificantly more involved than primary care doctors 10 years ago in the provision of most medical procedures considered in the questionnaire. Similarly, GPs were significantly more involved in the treatment of a number of diseases, though not with all diseases considered. With respect to prevention no increase was found. Despite the improvements overall, the current position of GPs in Lithuania in the aspects considered is still clearly behind the position of GPs in western Europe in 1994. Conclusions: GP task profiles are more comprehensive now than they were 10 years ago, but continued efforts and time will be needed to reach the profile of provision of GPs in western European countries. (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

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.

Differences in HEALTH complaints between university students from three European countries

Stock C, Kucuk N, Miseviciene I, et al. Differences in HEALTH complaints between university students from three European countries. EUROPEAN JOURNAL OF PUBLIC HEALTH. 2002;12(4):26-27