Has the COVID-19 Pandemic Led to Changes in the Tasks of the Primary Care Workforce? An International Survey among General Practices in 38 Countries (PRICOV-19)

peer reviewedThe COVID-19 pandemic has had a large and varying impact on primary care. This paper studies changes in the tasks of general practitioners (GPs) and associated staff during the COVID-19 pandemic. Data from the PRICOV-19 study of 5093 GPs in 38 countries were used. We constructed a scale for task changes and performed multilevel analyses. The scale was reliable at both GP and country level. Clustering of task changes at country level was considerable (25%). During the pandemic, staff members were more involved in giving information and recommendations to patients contacting the practice by phone, and they were more involved in triage. GPs took on additional responsibilities and were more involved in reaching out to patients. Problems due to staff absence, when dealt with internally, were related to more task changes. Task changes were larger in practices employing a wider range of professional groups. Whilst GPs were happy with the task changes in practices with more changes, they also felt the need for further training. A higher-than-average proportion of elderly people and people with a chronic condition in the practice were related to task changes. The number of infections in a country during the first wave of the pandemic was related to task changes. Other characteristics at country level were not associated with task changes. Future research on the sustainability of task changes after the pandemic is needed

The prevalence of self-reported underuse of medications due to cost for the elderly: Results from seven European urban communities

Background: The aim of this study was to evaluate the prevalence of self-reported underuse of medications due to procurement costs amongst older persons from seven European urban communities. Methods: The data were collected in a cross-sectional study (“ABUEL, Elder abuse: A multinational prevalence survey”) in 2009. Randomly selected people aged 60–84 years (n = 4,467) from seven urban communities: Stuttgart (Germany), Athens (Greece), Ancona (Italy), Kaunas (Lithuania), Porto (Portugal), Granada (Spain) and Stockholm (Sweden) were interviewed. Response rate - 45.2 %. Ethical permission was received in each country. Results: The results indicate that 3.6 % (n = 162) of the respondents self-reported refraining from buying prescribed medications due to cost. The highest prevalence of this problem was identified in Lithuania (15.7 %, n = 99) and Portugal (4.3 %, n = 28). Other countries reported lower percentages of refraining from buying medications (Germany – 2.0 %, Italy – 1.6 %, Sweden – 1.0 %, Greece – 0.6 %, Spain – 0.3 %). Females refrained more often from buying medications than males (2.6 % vs. 4.4 %, p < 0.0001). The prevalence of this refraining tended to increase with economic hardship. Discussion: These differences between countries can be only partly described by the financing of health-care systems. In spite of the presence of cost reimbursement mechanisms, patients need to make co-payments (or in some cases to pay the full price) for prescribed medications. This indicates that the purchasing power of people in 10.1186/s12913-015-1089-4 the particular country can play a major role and be related with the economic situation in the country. Lithuania, which has reported the highest refrain rates, had the lowest gross domestic product (at the time of conducting this study) of all participating countries in the study. Conclusions: Refraining from buying the prescribed medications due to cost is a problem for women and men in respect to ageing people in Europe. Prevalence varies by country, sex, and economic hardship.The ABUEL was supported by the Executive Agency for Health and Consumers (EAHC) (Grant No., A/2007123) and participating institutions

Patient Choice in the Post-Semashko Health Care System

The opportunity for patient choice in the health care system in CIS countries was created by the partial destruction of the referral system and the development of paid medical services. The data of two population surveys conducted in Russia in 2009 and 2011 show that patient choice of medical facility and physician is taking place in the post-Semashko health care system, and it is not restricted to the area of paid medical services. However for the majority of population the choice of medical facility and physician is not a necessity. Part of reason for patient choice is caused by the failure of the patient referral system to ensure the necessary treatment. For some Russian citizens, the choice of health care provider is a means to obtain better quality care, and in this respect the enhancement of patient choice is leading to the improved efficiency of the emerging health care system.Была создана возможность для выбора пациента в системе здравоохранения в странах СНГ путем частичного разрушения системы направлений и развития платных медицинских услуг. Данные двух исследований, проведенных в области народонаселения в России в 2009 и 2011 показывают, что выбор медицинского учреждения и врача пациентом происходит в после-семашковской системе здравоохранения, и не ограничивается областью платных медицинских услуг. Однако для большинства населения выбор медицинского учреждения и врача не является необходимостью. Часть причины для выбора пациента вызвано неспособностью пациента реферальной системы в обеспечить необходимое лечение. Для некоторых российских граждан, выбор медицинских услуг является средством для получения лучшего качества медицинской помощи, и в этом отношении поощрение выбора пациента ведет к повышению эффективности создаваемой системы здравоохранения

Economic considerations for mental health policy development in Lithuania

Lithuanian mental health care system is structured to serve mental health care needs of children and adolescents, as well as of adults. The provision of mental health care is based on equity, solidarity assuring accessibility of mental health services of those in need. The structure of mental health care system is based on a primary level (family phy- sicians, outpatient mental health centres), secondary level (outpatient specialist care, inpatient specialized care in hos- pitals or day care centres) and tertiary level (this is special- ized mental health care, outpatient or inpatient in university clinics). Mental patients are eligible for social care under both institutional and non-institutional arrangements. Throughout the last decade Lithuanian mental health care system has undergone changes applied to the improved ac- cessibility of care and assurance of the quality of care in the framework of deinstitutionalization. Due to the absence of periodic assessments, a study of public funding for mental health was undertaken at the end of 2009. Data on health system financing and spending, including certain time and structure dimensions, could be considered as significant input into health policy. The main aim of the study was to look at Lithuanian mental health sector development in the financing of mental health dimension, thus to provide evidences on implementation of the national mental health strategy. Correspondingly, two main fields of research were a) an estimation of govern- ment costs and societal economic burden related to poor mental health in Lithuania by assessing 2008 data; and b) an assessment the changes in public mental health financing in the country during 2000-2008

Migrants’ access to social protection in Lithuania

This chapter aims to discuss the link between migration and welfare in Lithuania. We start with presentation of the main characteristics of the Lithuanian welfare system emphasizing the access to social benefits for resident nationals, non-national residents, and non-resident nationals. Later we examine key developments of population migration to and from Lithuania. Finally, we present a detailed analysis of five social policy schemes - unemployment, health care, family benefits, pensions, and guaranteed minimum resources – from the perspective of access to social benefits of these different groups

Informal Payments for Healthcare Services in Lithuania and Ukraine

Informed by in-depth case studies focusing on a wide spectrum of micro and macro post-socialist realities, this book demonstrates the multi-faceted nature of informality and suggests that it is a widely diffused phenomenon, used at all levels of a society and by both winners and losers of post-socialist transition

Hospital reforms in 11 Central and Eastern European countries between 2008 and 2019 : a comparative analysis

This paper aims to: (1) provide a brief overview of hospital sector characteristics in 11 Central and East-ern European countries (Bulgaria, Czech Republic, Estonia, Croatia, Latvia, Lithuania, Hungary, Poland,Romania, Slovakia, Slovenia); (2) compare recent (2008 – 2019) hospital reforms in these countries; and(3) identify common trends, success factors and challenges for reforms. Methods applied involved fivestages: (1) a theoretical framework of hospital sector reforms was developed; (2) basic quantitative datacharacterizing hospital sectors were compared; (3) a scoping review was performed to identify an initiallist of reforms per country; (4) the list was sent to national researchers who described the top threereforms based on a standardized questionnaire; (5) received questionnaires were analysed and vali-dated with available literature. Results indicate that the scope of conducted reforms is very broad. Yet,reforms related to hospital sector governance and changes in purchasing and payment systems are muchmore frequent than reforms concerning relations with other providers. Most governance reforms aimedat transforming hospital infrastructure, improving financial management and/or improving quality ofcare, while purchasing and payment reforms focused on limiting hospital activities and/or on incen-tivising a shift to ambulatory/day care. Three common challenges included the lack of a comprehensiveapproach; unclear outcomes; and political influence. Given similar reform areas across countries, thereis considerable potential for shared learning