EFFECTIVENESS OF PRIMARY HEALTH CARE: IN MEMORY OF BARBARA STARFIELD

Rad je posvećen Barbari Starfield i u njemu su prezentirani radovi nje i njezinih suradnika, te radovi koji su bili njima inspirirani. Prikazani su rezultati istraživanja učinaka primarne zdravstvene zaštite (PZZ) na zdravstvene pokazatelje i učinaka pojedinih karakteristika PZZ-a na kliničke ishode kod individualnih bolesnika. Također su prezentirani rezultati o utjecaju broja liječnika PZZ-a, osobito obiteljske medicine, na zdravstvene pokazatelje. Na kraju je napravljena poveznica sa sadašnjim stanjem primarne zdravstvene zaštite u Hrvatskoj. Lista citirane literature je neobično dugačka, s ciljem da se kolegama nađe pri ruci.This short review article is dedicated to the memory of Barbara Starfield who passed away two years ago. It is mainly based on the results of her work and the work of her collaborators as well as of the works by other authors inspired by Barbara. The results of primary health care (PHC) effectiveness on population health care indicators as well as on the individual patients health were presented. Results on the role of the number of PHC doctors, espeially family doctors, are also presented. A short anylysis of Croatian situation in the light of Barabra’s works was presented at the end of the article, together with the long list of refernces which will help the colleagues interested in her work

Development of Family Medicine Specialist Curriculum in Croatia: Challenging Experiences

The specialization in family medicine (FM) was introduced in the academic year 1960/61, but there was an almost 12-year gap in its implementation. Specialized training (ST) was reintroduced in 2003 through the project »Harmonization of family medicine with EU standards introducing a FM specialization«. The aim of this paper is not to present all of the developmental phases of the ST curriculum, but to provide accounts of some of the challenging experiences which might be of help to the readers. Experience in several areas is examined: experience in educational need assessment using focus group method; introduction of a new specialist exam; development of the Study Guide, the Trainee Manual, and the Trainer Manual; selection procedure and training of trainers; and skill-lab training and peer-group learning. Systematic evaluation was planned for the next year, when the current project finishes and is to be replaced by another one. The general impression is that ST in FM is perceived as quite challenging, both for the trainees and for the teachers

A Role of Family Doctors in Taking Care of Men’s Health

The aim of this study was to investigate, based on routinely collected data, the scope of family doctors work in the field of men’s health. Based on the Croatian Health Service Yearbook in the period from 1995 to 2012, we collected the morbidity data related to male urogenital disorders. The total number of urogenital disorders almost doubled, but the number of diagnoses related to the men increased fourfold, mostly among the oldest patients. The number of prostate hyperplasia increased fivefold, again among the oldest people. The morbidity from other male-specific diseases increased threefold, mostly in the age group 7–19 years. In spite of the increase in the number of newly diagnosed cases of prostate cancer, the percentage of the deaths stabilized after 2001. Men’s health problems are frequent sees and with an upward trend.We are not sure if this means deterioration of men’s health, or just indicates the problem of »overdiagnosis«

Ambulatory Care Sensitive Conditions at Out-of-hospital Emergence Services in Croatia: A Longitudinal Study Based on Routinely Collected Data

Conditions for which a hospital and emergency utilization can be considered avoidable are often referred as ambulatory care sensitive conditions (ACSCs). Until now, there has been no published research related to ACSCs in Croatia. This study was undertaken with the aim of determining the trends relating to ACSCs in out-of-hospital ES from 1995– 2012. The study is based on data from the Croatian Health Service Yearbooks. Five chronic and three acute conditions were chosen: diabetes, hypertension, congestive heart failure, angina pectoris, asthma and COPD, bacterial pneumonia, urinary tract infections and skin infections. The results indicate that the ES in Croatia is overused, and consequently ACSCs are over-represented; 23.3% Croatian citizens visited the ES and around 15% of all diagnoses belonged to the ACSCs, with decreased trend. The leading diagnosis is hypertension, followed by asthma and COPD. For a better understanding of the importance of ACSC within the Croatian context, further research is needed

Health Care Expenditures in Croatia, 2000–2013: Is Primary Health Care in the Right Position?

The research was undertaken to determine the trends in the amount and the structure of the health care expenditures in Croatia from 2000 to 2013. It is based on routinely collected and publicly available data, The Annual Reports of the Croatian Health Insurance Fund and OECD data. The income of Croatian Health Insurance Fund (CHIF) increased by 66.9%, while total expenditures increased by 62.1%. The fastest growth of expenditure is noticed in expenditures on health care. The hospital and specialist-consultant services have the highest expenditures. Furthermore, the fastest growth is that of other expenses, from 7% of total health care expenditures in 2000, to 26.7% in 2013; which can partly be interpreted as part of hospital care expenses. In the contrast, total expenditures for primary health care decreased, from 22% in 2002, to 13.1% in 2013. The publicly available data are not sufficient enough to drown up any specific conclusions about the underlying reasons for such distribution of the costs

Are there differences in the trends of home visits between rural and urban regions in Croatia?1995-2014

Uvod. U europskim zemljama kao i u Hrvatskoj kućne posjete (KP) i liječenje su u djelokrugu obiteljske medicine (OM). Istraživanja pokazuju da je broj KP relativno nizak, sustavno opada od 2004. i različit je između županija. Cilj je bio istražiti postoje li razlike u trendovima broja KP između ruralnih i urbanih sredina RH u razdoblju od 1995. do 2014. godine. Metode. Istraživanje je opservacijsko (povijesno – prospektivno), temeljeno na rutinski prikupljenim podatcima Hrvatskih zdravstveno-statističkih ljetopisa od 1995. do 2014.: o broju liječnika OM (LOM), pacijenata koji su dolazili/koristili OM i KP u RH i po županijama. Grupirani su u 3 regije: pretežito ruralne, značajno ruralne i urbane. Izračunat je prosječan broj KP, broj posjeta po pacijentu i po LOM -u. Rezultati. Prosječan broj KP/pacijent bio je veći (0,16-0,12) u pretežito i značajno ruralnoj, nego u urbanoj regiji (0,11-0,06). U ruralnim regijama broj KP/LOM kretao se od 136,6 do 181,6, znatno više nego u pretežno ruralnim (129,2-189,2) ili urbanim (88,0-144,5). Zaključak. LOM-i u ruralnim regijama obavljaju više KP od kolega u urbanim. Da bi se zadovoljile potrebe populacije i zadržalo liječnike, ovo treba imati na umu pri planiranju i financiranju tih područja.Introduction and aims: Home visits are within the scope of family practice (FP) in Croatia as well as it is in other countries. The aim of the study was to determine the overall trends in home visits (HV) in Croatian FM. We investigated whether there were any differences in the trends of HV between Croatian rural and urban regions. Methods: This was perspective study, from 1995 to 2014. Data were collected from the Croatian Health Service Yearbooks. The number of family doctors and the number of home visits were collected for each study year in relation to regions; Croatia was divided in three regions: rural, semi-rural and urban. Results. Significantly higher number of home visits was found in rural regions than in semi-rural and urban ones. In 2000 the average number of home visits was higher in rural - 0.16 per patient - than in semi-rural (0.14) and urban (0.10) regions. In the same year, each family doctor in rural areas performed 189 home visits, in comparison to 178 in semi-rural and 120 in urban regions. The differences in trends were not found, the number of home visits increased until the year 2000 and then decreased in all regions. Conclusion. A higher number of home visits was found in Croatian rural regions than in semi-rural and urban ones. These results should be taken in consideration in FP delivery planning

THE ROLE OF GPS IN WOMEN’S HEALTH CARE – THE EU EXPERIENCE

Primarna zdravstvena zaštita žena u Hrvatskoj je tradicionalno bila organizirana kroz dispanzere za žene, s ginekologom kao vođom tima. Liječnici obiteljske medicine (LOM) su znatno rijeđe sudjelovali, a osobito u zadnjih dvadesetak godina. Stoga je cilj ovog rada bio ispitati ulogu LOM-a u zaštiti zdravlja žena u zemljama Europske Unije (EU). Istraživanje je presječno, temeljeno na posebno priređenom anketnom upitniku kojeg su ispunjavali predstavnici svih 27 zemalja EU (osim Hrvatske); sudionici Vasco da Gama Projekta razmjene specijalizanata i mladih specijalista obiteljske medicine, kojeg je Hrvatska bila domaćin u 2013. godini, te Foruma Vasco da Gama u Barceloni 2014. godine. U 24 od 27 zemalja Europske Unije (EU), LOM-ovi su uključeni u provođenje PZZ žena, u 22 zajedno s ginekolozima, a u dvije potpuno samostalno. U 23 države provode preventivne i kurativne mjere zaštite, a u samo jednoj zemlji preventivne mjere. Provode se istovremeno različite preventivne aktivnosti, najčešće kontracepcija, zatim prekoncepcijsko savjetovanje i rano otkrivanje malignih bolesti. Primjenjuju su različite metode kontracepcije, doduše najčešće hormonalna kontracepcijska sredstva, ali i intrauterini ulošci. U 16 zemalja ordinacije LOM-a su opremljene ginekološkom opremom, a u 13 država su LOM dodatno plaćali za brigu o zdravlju žena. U 26 zemalja LOM su tijekom specijalizacije educirani za provođenje zaštite zdravlja žena, najčešće je to kombinacija teoretske i praktične nastave, ali se modeli edukacije razlikuju. Rezultati istraživanja su nedvojbeno pokazali da su LOM-ovi u zemljama EU uključeni u zaštitu zdravlja žena. Rezultatima istraživanja nije moguće obrazložiti zbog čega LOM-ovi u Hrvatskoj nisu uključeni u te aktivnosti, pa su potrebna dodatna istraživanja. Problem je osobito važan u svijetlu prava pacijenata na prekograničnu zdravstvenu zaštitu, jer su pacijenti s prostora EU navikli na taj oblik zaštite unutar djelatnosti obiteljske medicine.Primary health care was traditionally organized through women’s health services having a gynaecologist for the team leader in Croatia. General practitioners (GPs) participated in women’s health care especially during the last twenty years. Therefore the aim of this study was to examine the role of GPs in the countries of the European Union. The study was based on the questionnaire especially prepared for this purpose and answered by representatives from all 27 countries of the European Union (except Croatia); participants of the Vasco de Gama Project on exchange of residents and young specialist in family medicine hosted by Croatia in 2013 as well as from the Vasco de Gama Forum in Barcelona in 2014. In 24 out of 27 countries of the EU GPs are included in women’s primary health care, in 22 countries together with the gynaecologists and in 2 countries they are on their own. In 23 countries they carry out preventive and curative measures while only in one country just preventive measures are carried out. Preventive measures are carried out simultaneously, mostly contraception, then preconceptual consultation and early detection of malignant diseases. Various contraceptive methods are applied, most frequently hormonal contraceptives but intrauterine devices as well. Gynaecological equipment could be found in general practitioner’s offices in 16 countries and in 13 country GPs are additionally paid for women’s health care. GPs are educated for women’s health care during their specialization in 26 countries. It is mostly a combination of theory and practical education, but education models are different. Results of the study undoubtedly showed that GPs are involved in women’s health care in the EU. Those results do not explain the reason why Croatian GPs are not involved in this activity. Therefore additional studies are necessary. This problem is especially important regarding patients’ rights to over-the-border health protection because the patients from the EU are used to this form of service to be included in general practice activities