A snapshot of the organization and provision of primary care in Turkey

Contains fulltext : 96599.pdf (publisher's version ) (Open Access)BACKGROUND: This WHO study aimed to support Turkey in its efforts to strengthen the primary care (PC) system by implementing the WHO Primary Care Evaluation Tool (PCET). This article provides an overview of the organization and provision of primary care in Turkey. METHODS: The WHO Primary Care Evaluation Tool was implemented in two provinces (Bolu and Eskisehir) in Turkey in 2007/08. The Tool consists of three parts: a national questionnaire concerning the organisation and financing of primary care; a questionnaire for family doctors; and a questionnaire for patients who visit a family health centre. RESULTS: Primary care has just recently become an official health policy priority with the introduction of a family medicine scheme. Although the supply of family doctors (FDs) has improved, they are geographically uneven distributed, and nationwide shortages of primary care staff remain. Coordination of care could be improved and quality control mechanisms were lacking. However, patients were very satisfied with the treatment by FDs. CONCLUSIONS: The study provides an overview of the current state of PC in Turkey for two provinces with newly introduced family medicine, by using a structured approach to evaluate the essential functions of PC, including governance, financing, resource generation, as well as the characteristics of a "good" service delivery system (as being accessible, comprehensive, coordinated and continuous)

Raziskava o zagotavljanju kakovosti v slovenskem osnovnem zdravstvu

Namen: Članek predstavi rezultate pilotskega projekta Svetovne zdravstvene organizacije v Sloveniji, katerega cilj je bila izdelava in preizkus orodja zaocenjevanje zagotavljanja kakovosti v osnovnem zdravstvu oziroma v družinskimedicini. Metoda: Raziskava, ki jo je vodila Svetovna zdravstvena organizacija ob pomoči Inštituta Nivel in Katedre za družinsko medicino Medicinske fakultete Univerze v Ljubljani, je hkrati potekala v Ljubljani (mestno področje) in na Gorenjskem (mestno in podeželsko območje). Orodje raziskave so bili trije vprašalniki za tri ravni: raven odločanja (Ministrstvoza zdravje, Slovensko zdravniško društvo, Združenje zdravnikov družinske medicine, Zdravniška zbornica Slovenije, Medicinska fakulteta, Zavodza zdravstveno zavarovanje Slovenije, organizacije bolnikov), raven vodenja v zdravstvu (direktorji, vodje enot in vodje služb zdravstvenega varstva odraslih omenjenih področij) in raven izvajanja (vsi aktivni zdravnikidružinske medicine na obeh področjih). Odgovore na vprašalnike je analiziral Inštitut Nivel. Rezultati: Poslali smo 244 vprašalnikov, odgovorov pa smo dobili 106 (43,4 %). Na ravni odločanja je odgovorilo 11 udeležencev od17 naprošenih (65 %). Na ravni vodenja smo prejeli 9 odgovorov od 14 poslanih (64 %) vprašalnikov v Ljubljani in 5 (39 %) od 13 poslanih na Gorenjskem. V Ljubljani je odgovorilo 63 (49 %) od 130 aktivnih zdravnikov družinske medicine, na Gorenjskem pa 18 (26 %) od 70 aktivnih zdravnikov družinske medicine. Zaključek: Raziskava je pokazala, da kakovost še ni prioriteta slovenskega osnovnega zdravstva. Tvorci zdravstvene politike ji ne posvečajo dovolj pozornosti, vodstvene strukture zdravstvenih zavodov nimajo dovolj informacij in pogrešajo navodila, zdravniki družinske medicine pa pogrešajo rezervirani čas za sistematično izboljševanje kakovosti svojega dela, še posebej pa krovno institucijo družinske medicine na sekundarnem nivoju.Background: The article summarizes the main results of the WHO Primary Care Quality Management project, which has been implemented as a pilot study to identify and support mechanisms for quality management in primary health care.Methods: The project was commissioned by WHO Europe and carried out in 2007 by NIVEL in collaboration with the University of Ljubljana, Department ofFamily Medicine, Medical Faculty of Ljubljana, and National Health Instituteof Uzbekistan. In Slovenia it was implemented in the urban region of Ljubljana and in the semi-urban region of Gorenjska. Tree types of questionnaires were used: one for policy/decision makers (experts from the Ministry of Health, representatives of professional associations, National Health Insurance Institute, human rights ombudsman, association of patients and consumers), one for managers of primary health care facilities and one forall practicing family physicians in the two areas. All data were processed and analyzed by the NIVEL Institute. Results: Of the 244 questionnaires sent out,106(43.4%) were completed and returned. At the policy/decision-making level, 11 (65%) participants out of 17 returned the questionnaires. At the management level, nine (64%) of the14 questionnaires completed in Ljubljana and five (39%) of the 13 questionnaires filled in Gorenjska were returned. In Ljubljana, 63 (49%) out of the130 practicing family physicians completed the questionnaire, and in Gorenjska only 18 (26%) out of 70. Conclusions: The study showed that quality assurance is not yet a matter of priority in the Slovene health care system. Stake holders do not pay adequate attention to this issue, and managers lack information and guidelines on the subject. Practicing family physicians would need protected time for systematic quality control and improvement, and above all, assistance by a secondary level professional body for family medicine