Access and utilization of public and private Primary Health Care among adults and elderly people with chronic condition(s) in Albania

The burden of disease due to Non-Communicable Diseases (NCDs) is globally on the rise. Primary Health Care (PHC) services can contribute to NCD control and hold an important role. This dissertation provides insights into patient access and the perceived quality of care among 23 public and five private providers in two regions of Albania. Additionally, healthcare-seeking behaviors and Out-of-Pocket payment of the population suffering from NCDs were investigated through a household survey among nearly 1000 chronically ill. The findings show that users of public and private providers have similar views on the quality of non-clinical care. However, prompt attention and coordination of care need additional improvement. While most elderly people visited a PHC to initiate treatment (and follow-up) of their chronic conditions, adults (aged 18–59) initiated and sought regular NCD care at a hospital level through self-referral, bypassing PHC services. Out-of-pocket payments by NCD patients remain important and relate principally to purchasing prescribed drugs. Fostering the health literacy of patients and caregivers in NCD prevention, management, and control through the PHC level is essential, along with establishing well-structured referral mechanisms. Active engagement of local decision-makers is needed

The Burden of Disease due to COVID-19 (BoCO-19): A study protocol for a secondary analysis of surveillance data in Southern and Eastern Europe, and Central Asia

Introduction The COVID-19 pandemic has had an extensive impact on public health worldwide. However, in many countries burden of disease indicators for COVID-19 have not yet been calculated or used for monitoring. The present study protocol describes an approach developed in the project “The Burden of Disease due to COVID-19. Towards a harmonization of population health metrics for the surveillance of dynamic outbreaks” (BoCO-19). The process of data collection and aggregation across 14 different countries and sub-national regions in Southern and Eastern Europe and Central Asia is described, as well as the methodological approaches used. Materials and methods The study implemented in BoCO-19 is a secondary data analysis, using information from national surveillance systems as part of mandatory reporting on notifiable diseases. A customized data collection template is used to gather aggregated data on population size as well as COVID-19 cases and deaths. Years of life lost (YLL), as one component of the number of Disability Adjusted Life Years (DALY), are calculated as described in a recently proposed COVID-19 disease model (the ‘Burden-EU’ model) for the calculation of DALY. All-cause mortality data are collected for excess mortality sensitivity analyses. For the calculation of Years lived with disability (YLD), the Burden-EU model is adapted based on recent evidence. Because Covid-19 cases vary in terms of disease severity, the possibility and suitability of applying a uniform severity distribution of cases across all countries and sub-national regions will be explored. An approach recently developed for the Global Burden of Disease Study, that considers post-acute consequences of COVID-19, is likely to be adopted. Findings will be compared to explore the quality and usability of the existing data, to identify trends across age-groups and sexes and to formulate recommendations concerning potential improvements in data availability and quality. Discussion BoCO-19 serves as a collaborative platform in order to build international capacity for the calculation of burden of disease indicators, and to support national experts in the analysis and interpretation of country-specific data, including their strengths and weaknesses. Challenges include inherent differences in data collection and reporting systems between countries, as well as assumptions that have to be made during the calculation process.Peer Reviewe

Factors associated with the utilisation of primary care services: a cross-sectional study in public and private facilities in Albania

Objectives To identify key factors influencing the utilisation of governmental and private primary healthcare services in Albania.Design A cross-sectional health facility survey using a 4-point Likert scale questionnaire to rank the importance of factors driving services utilisation.Setting Exit interviews with patients who consulted one of 23 primary care providers (18 public and 5 private) in Fier district of Albania from the period of July–August 2018.Participants Representative sample of 629 adults ≥18 years of age.Main outcomes measures (1) Factors influencing the decision to visit a governmental or private primary care provider and (2) the association of sociodemographic characteristics and patients’ decision to attend a given provider. Data were analysed using mixed logistic regression models.Results Nearly half of the participants in this study were older than 60 years (45%). The majority (63%) reported to suffer from a chronic condition. Prevailing determinants for choosing a provider were ‘quality of care’ and ‘healthcare professionals’ attitudes. Solely looking at patients using a public provider, ‘geographical proximity’ was the most important factor guiding the decision (85% vs 11%, p<0.001). For private provider’s patients, the ‘availability of diagnostic devices’ was the most important factor (69% vs 9%, p<0.001). The odds of using public facilities were significantly higher among the patients who perceived their health as poor (OR 5.59; 95% CI 2.62 to 11.92), suffered from chronic conditions (OR 3.13; 95% CI 1.36 to 7.24) or were benefiting from a socioeconomic aid scheme (OR 3.52; 95% CI 1.64 to 7.56).Conclusion The use of primary healthcare is strongly influenced by geographical and financial access for public facility users and availability of equipment for private users. This study found that aspects of acceptability and adequacy of services are equally valued. Additional commitment to further develop primary care through engagement of local decision-makers and professional associations is needed

EGALITARISMUL ÎN DOMENIUL ASISTENȚEI MEDICALE-PRO ȘI CONTRA; IMPERATIVUL PENTRU UN OBIECTIV INOVATOR ÎN BALCANII DE VEST

Thematic “public versus private healthcare” has arisen thousands of lively debates through decades and has provoked reactions from academics each arguing for his own viewpoint, yet, in the light of actual healthcare reforms across systems, giving a second thought of “how and where to allocate resources” it is not a waste of time. As to the Western Balkan countries context, the eagerness to catch up with the free market system has been quite an appealing model (due to the historical-political common frame), and turning back to the one tier system would seem like turning back old times. In this viewpoint we strive to outlook and give a panorama of pros and cons of egalitarian-one tier system versus multiple tier system approach; going beyond the efficiency and pragmatist solutions, what does the literature suggest about egalitarianism in the modern society? We opt also to present the of Private-Public Partnership concept (new experiences) as a less discussed trend in these countries.   Keywords: Egalitarianism, healthcare, Eastern Europe, Public Private PartnershipTematica "”asistenţa medicală publică versus cea privată"” a dat naştere miilor de dezbateri aprinse de-a lungul deceniilor și a provocat reacţii în mediul academic, fiecare susținându-şi  propriul punct de vedere. Totuşi, având în vedere reformele reale din sistemele de sănătate, şi gândind bine cum "și  unde să fie alocate resursele ”ea s-a dovedit a nu fi o pierdere de timp”. În ceea ce privește țările din Balcanii de Vest, din dorința de a prinde din urmă sistemul de piață liberă, acesta a reprezentat un model destul de atractiv (ca urmare a cadrului comun istorico-politic), iar întoarcerea la sistemul egalitarist ar părea o reîntoarcere la vremurile trecute. Din acest punct de vedere, ne străduim să furnizăm o perspectivă cu argumente pro și contra a sistemului egalitarist versus abordarea sistemului pe niveluri multiple; dincolo de eficienţă și soluţiile pragmatice, ce sugerează literatura de specialitate despre egalitarism în societatea modernă? Optăm, de asemenea, să prezentăm conceptul de parteneriat public-privat (experiențe noi) ca o tendință mai puțin discutată în aceste țări.   Cuvinte cheie: Egalitarism, îngrijiri de sănătate, Europa de Est, Parteneriatul Public Priva

Reformele din domeniul asistenței medicale primare văzute prin prisma inovării - studii de caz, zona vest-balcanică și est-europeană

CONTEXT: Innovation within healthcare can take many forms, ranging from drug therapies, through to new forms of financing. Most transition countries in CEE are engaged in health reform initiatives aimed at introducing primary health care (PHC) to enhance performance of their health systems. This has been challenging with examples of unequal adoption, professional resistance and poor sustainability. PURPOSE OF THIS PAPER: We aim to explore the introduction and diffusion of family-medicine-centered PHC reforms in Western Balkans and Eastern European Context; THROUGH THE LENS OF INNOVATION.DESIGN/METHODOLOGY/APPROACH: A comparative case studies analysis using cases selected from the Western Balkans and Eastern European Countries. We identified our cases based on a systematic search of peer-reviewed articles the grey literature. Overall 5 cases met the inclusion criteria; then developed an analytical framework based on key aspects of the innovation process FINDINGS: PHC reform is a complex innovation, involving organizational, financial, clinical and relational changes. The framework clearly highlights the value of early analysis of change programmes in order that the leaders of these programmes can anticipate and develop strategies which would ensure a more successful and sustainable change process. THE ORIGINAL/VALUE OF PAPER: The study merges different features of PHC in different post-communist countries, providing empirical evidence on PHC reforms in particular CEE countries both in developed and remote areas.                                                                                            Keywords - Innovation, Primary Healthcare Reforms, Post-Communist Countries,   Systems in Transition,CONTEXT: Inovarea în domeniul asistenței medicale poate îmbrăca diverse forme, variind de la terapiile medicamentoase, până la noi forme de finanțare. Majoritatea țărilor din Europa Centrală, aflate în tranziție sunt implicate în inițiative de reformare a sistemului medical ce vizează introducerea asistenței medicale primare (AMP) în scopul îmbunătățirii performanței sistemelor lor de sănătate. Acest lucru a fost provocator, cu exemple de adoptare diversă și inegală, rezistență din partea profesioniștilor și sustenabilitate scăzută.SCOPUL ARTICOLULUI: Scopul nostru este de a studia introducerea și extinderea reformelor din domeniul AMP centrate pe medicina de familie, în regiunea vest Balcanică și est-Europeană, prin prisma inovării.METODOLOGIE: Studiul de față este o analiză comparativă, utilizând studii de caz selectate din regiunea vest Balcanică și est-Europeană. Am identificat cazurile din studiu pe baza căutării sistematice a articolelor din literatura gri, revizuite pe modelul peer-reviewed . Per ansamblu, 5 cazuri au îndeplinit criteriile de includere; apoi am dezvoltat un cadru de analiză bazat pe aspectele cheie ale procesului de inovare.REZULTATE: Reforma din domeniul AMP reprezintă o inovație complexă, implicând schimbări organizaționale, financiare, clinice și relaționale. Cadrul de lucru pune în evidență, în mod clar, valoarea analizei precoce a programelor și planurilor de schimbare, astfel încât liderii acestor programe să poată anticipa și dezvolta strategii care să asigure un proces de schimbare mai sustenabil și de succes.                                                                                                                                                                                                                                    AUTENTICITATEA/ VALOAREA ARTICOLULUIStudiul combină aspecte diferite ale AMP din diferite țări post-comuniste, oferind dovezi empirice privind reformele AMP, în special în țările Europei Centrale și de Est (ECE), atât din zone dezvoltate cât și din celelalte zone, izolate.  Cuvinte cheie: inovare, reforme asistență medicală primară, țări post-comuniste, sisteme în tranziţi

EPIDEMIOLOGIA UTILIZĂRII DROGURILOR ÎN RÂNDUL ELEVILOR DE LICEU DIN TIRANA, ALBANIA

INTRODUCTION. The use of Marijuana is on the increase worldwide especially among adolescents and youths. Adolescent substance use has a number of adverse consequences for both the individual and society. OBJECTIVES. The objectives of the study were to examine the relationship between the social and demographic determinants and adolescents behavior with marijuana use. METHODS. This was a cross-sectional study. This is a cross-sectional study conducted in the 2011-2012 academic year, in 5 high schools in the city of Tirana. A two-stage cluster sampling technique was used. The schools were randomly selected from the list of high-schools in Tirana city. RESULTS. The prevalence of lifetime use in our study was 13%. The prevalence among boys was 26% and among girls 3%. The median age of students upon the first use of marijuana was 16 years. No significant difference was found between boys and girls regarding the age of initiation or the first use. The prevalence of last month use 7.9%. The prevalence among boys was 16.1% boys and among girls was 2.7%. Regarding the frequency of use more than half of students (54.7%) reported two to three times a week. 13.2% of students who used marijuana reported hallucinations in the last month. Friends using marijuana and away from home more than one month resulted significant predictors. CONCLUSION. The results of the study suggest that environment and peer pressure influence the marijuana use among high school students in Tirana. Keywords: Drug consumption, prevalence, marijuana, students, AlbaniaINTRODUCERE. Utilizarea de marijuana este în creștere la nivel mondial în special în rândul adolescenților și tinerilor. Utilizarea de droguri de către adolescenți determină o serie de efecte adverse atât la nivel individual, cât și la nivelul societății. OBIECTIVE. Obiectivele studiului au fost de a examina relația dintre determinanții sociali și demografici și comportamentul adolescenților utilizatori de marijuana. METODE. Acesta a fost un studiu transversal derulat în anii 2011-2012 în licee din Tirana. A fost utilizată tehnica de eșantionaj pe clustere în 2 pași. Școlile au fost selectate randomizat dintr-o listă a liceelor din Tirana. REZULTATE. Prevalența utilizării în timpul vieții a fost, în cadrul studiului nostru, de 13%. Prevalența în rândul elevilor a fost de 26%, iar în cadrul elevelor, de 3%. Vârsta mediană a elevilor pentru prima utilizare de marijuana a fost de 16 ani. Nu a fost găsită o diferență semnificativă între elevi și eleve cu privire la vârsta inițierii sau a primului consum de marijuana. Prevalența utilizării în ultima lună a fost de 7.9%. Prevalența în rândul elevilor a fost de 16.1%, iar în rândul elevelor, de 2.7%. Cu privire la frecvența utilizării, mai mult de jumătate dintre elevi (54.7%) au raportat o frecvență de 2-3 ori pe săptămână. 13.2% dintre elevii consumatori de marijuana au raportat halucinații în ultima lună. Utilizarea marijuanei în rândul celor care sunt departe de casă pentru mai mult de o lună a reprezentat un factor de predicție important. CONCLUZII. Rezultatele studiului sugerează că presiunea anturajului și a colegilor influențează consumul marijuanei în rândul elevilor din liceele din Tirana. Cuvinte cheie: Consum droguri, prevalență, marijuana, elevi, Albania

CREŞTEREA NUMĂRULUI DE CAZURI DE PSIHOZĂ ÎN RÂNDUL GRUPURILOR DE EMIGRANŢI: ESTE MIGRAŢIA UN FACTOR DE RISC PENTRU PSIHOZĂ?

Background: Emigration is a process of social changing through which an individual moves from a certain cultural environment/context to another, aiming to achieve persistent or long-term residency.  This process is inevitably distressing, and the stress could be the cause of any mental disorder.   Objective: Summary of data from different studies, regarding emigration as a risk factor for development of different psychosis. Method: Search of scientific articles (written in English language) from MEDLINE, which study the incidence of mental disorders in different emigrant populations, for period 1990 - 2010. Results: The average relative risk of schizophrenia and of other psychosis occurrence among first generation emigrants was 2.7 (95% confidence interval [CI]=2.3-3.2). Statistical analysis performed among studies of first and second generation of emigrants, and among studies which don’t make difference between generations, results in a relative risk of 2.9 (95% CI=2.5-3.4) of mental illness. Conclusions: Emigration process, cultural and social adaptation, plays an important role on the individual mental health. A personal or family emigration history represents an important risk factor for developing schizophrenia and other psychosis.      Keywords: emigrants, psychosis, prevalenceContext: Emigraţia este un proces social de schimbare, prin care un individ trece dintr-un anumit mediu cultural în altul, având drept scop obţinerea rezidenţei pe termen lung. Inevitabil, acest proces este unul dureros, iar stresul ar putea fi cauza oricărei tulburări psihice. Obiectiv: Sinteza datelor provenite din studii diferite, în ceea ce privește emigrarea ca factor de risc pentru dezvoltarea diferitelor psihoze. Metodă: Revzia articolelor științifice (scrise în limba engleză) din MEDLINE, care studiază incidența tulburărilor mentale, în diferite populații emigrante, pentru perioada 1990-2010. Rezultate: Riscul relativ mediu al schizofreniei și a aparitiei altor psihoze în rândul imigranţilor din prima generație a fost de 2,7 (interval de încredere 95% [CI] = 2.3-3.2). Analiza statistică realizată pe studii referitor la prima și a doua generație de imigranți, dar şi pe studiile care nu fac diferența între generații, a avut ca rezultat un risc relativ de boli psihice de 2,9 (interval de încredere 95% = 2.5-3.4). Concluzii: Procesul emigrării, adaptarea culturală și socială, joacă un rol important asupra sănătății mintale individuale. Antecedentele personale sau familiale de emigrare reprezintă un factor de risc important pentru dezvoltarea schizofreniei şi a altor psihoze.   Cuvinte cheie: emigranți, psihoză, prevalenț