Family medicine in rural areas - perspectives and development opportunities

Access to health care should be universal and equal regardless of health needs, socio-economic status and place of residence. Empirical research confirms, however, that there are differences in access to health care between people in urban and rural areas. The main challenges for the health care system in rural areas are staff shortages, greater distance from large hospitals, difficult access to specialist and preventive services, and lower effectiveness of emergency care. The aim of the study was to analyze practical solutions to improve the organization of care in POZ, taking into account the principles of coordinated care in rural areas. As part of this study, an attempt was made to present practical solutions that may help to improve the organization of care in primary health care in rural areas. It is worth emphasizing once again that effective and efficient care for the population must be consistent with the concept of care coordination. In addition, the work shows how important from the perspective of the development of medicine in rural areas can be the inclusion of teamwork, financial motivators, including the so-called 'Rural addition' and the impact of modern technologies based on self-care and remote monitoring of patients' health

Behaviorism and the concepts of influencing the attitudes of patients towards health behaviors

Health professionals in primary care teams need to know how to effectively encourage patients to change health behaviors to achieve treatment goals. Understanding the behavioral patterns and psychological underpinnings of making changes can help healthcare professionals deliver interventions with a higher success rate. The aim of the study was to assess the importance of behavior patterns in shaping patients' health attitudes and behaviors. There are three types of theoretical models that explain how health behaviors are initiated and changed: motivational, post-intentional, and multistage models. Motivation models describe the role of individual cognitive variables in the process of creating the intention to change behavior. Changing habits in the context of health promotion takes place by influencing the perception of patients. This can be achieved using the TRA (Theory of Reasoned Action), TBP (Theory of Planned Behavior) and HBM (Health Belief Model) models by convincing the public about susceptibility to a given disease, disseminating knowledge about effective methods of prevention and generating persuasion, support, admiration or recognition in society after positive behaviors such as smoking cessation or regular physical activity. Post-intentional models indicate factors that increase the chance of translating motivation into action. They commit the individual to a certain action when certain environmental circumstances are met, thus helping to translate the intention of the goal into action. Multi-stage models describe health behaviors as involving several separate stages. These theories are based on the assumption that people at different stages will behave differently, so the types of interventions and information needed to change behavior will vary depending on the stage they are at. Helping patients set realistic goals, such as moving to the next stage, can facilitate the change process. Effective behavioral interventions must be based on changing the approach of medical staff to the interpersonal process with the patient. This approach should be patient-centred and collaborative. Medical staff should assess the importance that the patient attaches to his health and the treatment process, and thus also the willingness and motivation to comply with the recommendations. Merely providing information will not guarantee a change in their behavior. Healthcare professionals should use active listening techniques (using open-ended questions, explanations, reflective and summarizing statements), should encourage patients to express concerns, and should be able to weigh the pros and cons of different treatment approaches

Doświadczenia międzynarodowe w kontekście wdrożenia opieki farmaceutycznej w Polsce

The Pharmacist Profession Act and planned pharmaceutical services introduce many changes in community pharmacies, which require effective and efficient implementation. The below article aimed to analyse international experiences in the field of pharmaceutical care and to identify solutions that could be implemented in Poland. United States, United Kingdom, the Netherlands, Sweden, Austria and Australia were considered. These countries were analysed in terms of which pharmaceutical care services are provided, how pharmaceutical care was firstly introduced, what compensation pharmacists receive for additional services and what IT systems are used.Ustawa o zawodzie farmaceuty oraz świadczenia planowane w ramach opieki farmaceutycznej w Polsce wprowadzą szereg zmian w funkcjonowaniu aptek ogólnodostępnych, które wymagają skutecznego i efektywnego wdrożenia. Celem niniejszej pracy była analiza doświadczeń międzynarodowych w zakresie opieki farmaceutycznej oraz poszukiwanie rozwiązań, które byłyby możliwe do zaimplementowania w Polsce. Analizie poddano zakresy świadczeń udzielanych w ramach opieki farmaceutycznej w Stanach Zjednoczonych, Wielkiej Brytanii, Królestwie Niderlandów, Szwecji, Austrii i Australii. Kraje te przeanalizowano pod kątem zakresu świadczonych usług w ramach opieki farmaceutycznej, przebiegu wdrożenia opieki farmaceutycznej, premiowania farmaceutów za świadczenie dodatkowych usług oraz pod kątem oceny systemu IT.  &nbsp

Istota kwestionariusza przeglądu lekowego farmaceuty z perspektywy koordynowanej opieki zdrowotnej

In the pharmaceutical care the pharmacist cooperates with other representatives of the medical professions and caters the patient with holistic care. The pharmacist concentrates on identifying and solving drug problems. The tool that makes the process feasible is the pharmaceutical patient questionnaire. Introducing this pharmaceutical patient questionnaire is the main goal of the paper. This research investigates the issue of defining and creating pharmaceutical patient questionnaire, which can be used in coordinated pharmaceutical care process. The paper shows an original concept created by Medical and Diagnostical Center in Siedlce, Poland (MCD). In the research and analysis process the authors of the study have created an original concept of pharmaceutical patient questionnaire, which can be used in coordinated pharmaceutical care process in Poland. The pharmaceutical patient questionnaire comprises the following information:  patient’s personal data, patient’s subjective feelings concerning his health, different illnesses, allergies, vaccinations, preventive medical examinations and other basic medical indicators or parameters. At the core of the pharmaceutical patient questionnaire is the information on the type of medicine used taken by the patient, the name of the medicine, the doses, effectiveness of the therapy, side effects and own patient’s medicine supplies. This tool also comprises information on pharmacist- patient interview, the pharmacist’s recommendation and other concerning information.   Identification and reinforcement of the scope of information provided in the frame of pharmaceutical patient questionnairemay have a crucial influence on implementing and conducting coordinated pharmaceutical care.Idea opieki farmaceutycznej zakłada ścisłą współpracę farmaceuty z przedstawicielami innych profesji medycznych w celu objęcia pacjenta holistyczną opieka zdrowotną. Zadaniem farmaceuty jest rozpoznawanie oraz proponowanie rozwiązań w zakresie problemów i interakcji lekowych. Realizacji tego procesu nie byłaby możliwa bez odpowiednich narzędzi. W ramach niniejszej pracy zaprezentowano istotę i zakres kwestionariusza przeglądu lekowego farmaceuty. Kwestionariusz ten jest autorskim narzędziem stworzonym w oparciu o doświadczenie i praktykę medyczno-biznesową podmiotu leczniczego Centrum Medyczno-Diagnostyczne w Siedlcach. Kwestionariusz przeglądu lekowego farmaceuty umożliwia zbieranie następujących informacji: dane osobowe pacjenta, subiektywne odczucia pacjenta dotyczące jego stanu zdrowia, informacje o chorobach, alergiach, szczepieniach, badaniach okresowych i prewencyjnych oraz inne dodatkowe dane medyczne. Istotną częścią kwestionariusza jest blok informacji dot. farmakoterapii, w tym rodzaju i typie leków przyjmowanych przez pacjenta, dawkowaniu, efektywności terapii, działaniach niepożądanych związanych z przyjmowaniem produktów leczniczych oraz zasobach lekowych pacjenta. Prezentowane narzędzie zawiera także dodatkowe informacje bazujące na wywiadzie z pacjentem oraz odpowiednie zalecenia farmaceuty. Prawidłowa identyfikacja oraz poszerzenie zakresu informacji zawartych w ramach kwestionariusza przeglądu lekowego farmaceuty ma kluczowe znaczenie dla implementacji oraz realizacji koordynowanej opieki zdrowotnej, uwzgledniającej aspekt opieki farmaceutycznej

Zakres i metody pomiaru efektywności ambulatoryjnej opieki zdrowotnej

Effectiveness of medical care is one of the most reliable parameters to assess individual aspects of the health care system. However, it should be emphasized that there is no unified definition of effectiveness in health care, on the basis of which these aspects can be assessed and compared. The aim of the study was to draw attention to the inability to make a reliable and authoritative assessment of effectiveness in health care due to the lack of a uniform definition and to emphasize their importance in the light of international comparative analysis. A review of the literature relating to the assessment of the quality and effectiveness of services provided by healthcare entities was performed. It has been defined that efficiency grows as the quality of healthcare increases and/or the cost of healthcare decreases, and effectiveness measurement should refer to a specific member of a medical stuff

An overview of factors influencing cancer screening uptake in primary healthcare institutions

Screening significantly decreases the severity and incidence of conditions, as well as mortality, and therefore can improve the health of the population. Screening in Poland falls below the acceptable level of 45% of organised screening uptake and the recommended level of 65%. Multidimensional factors have been implicated as barriers and facilitators of screening uptake in the primary care setting. This paper summarises the existing evidence on factors influencing screening uptake in a Pap smear for cervical cancer (CC), mammography screening for breast cancer and faecal occult blood test (FOBT) for colorectal cancer (CRC). We performed a literature search in the MEDLINE (PubMed) and EMBASE databases and included articles of any study design published between 2010 and 2020. We also demonstrate the original concept of ‘Ugly Value’, which describes factors that may reduce screening uptake. Primary care practitioners play a vital role in increasing screening rates in the populations and can improve these rates through a variety of systematically implemented strategies and interventions. We determine four areas to improve cancer screening uptake in primary healthcare institutions: data gathering and data use (IT systems, meaningful use of Electronic Health Records to generate reminders, prompting healthcare professionals to refer patients for screening), cost effectiveness (avoiding overuse of screening in low-risk populations), innovative efficient management (use of effective interventions and thoughtful allocation of resources, e.g. engaging nurses into patient navigation instead of assigning them to answer patient concerns about screening by telephone), organisational system (team based, integrated care and patient navigation are ways to improve screening rates)