New requirements of medical documentation in the area of chronic patients care in family medicine

Liječnik obiteljske medicine dužan je osigurati kontinuitet zdravstvene zaštite za populaciju u skrbi, što je moguće jedino uz kvalitetnu i preglednu medicinsku dokumentaciju iz koje je moguće na jednostavan i brz način prikupiti sve potrebne podatke. Podaci o pacijentu u njegovom elektronskom kartonu trebali bi biti raspoređeni u tri područja: listu epizoda zdravstvene zaštite, listu pacijentovih problema, te ostale informacije o pacijentu. Zabilježeni podaci se za liječenje kroničnih bolesti koriste po strukturiranom modelu: prevencija i rano otkrivanje bolesti, liječenje, rano otkrivanje komplikacija, te analiza kvalitete zaštite. Podaci također trebaju biti dostupni ostalim razinama zdravstvene zaštite, te se trebaju iskoristiti za nacionalne registre. Ovako zabilježeni podaci temelj su kvalitetnijega rada liječnika, te olakšavaju rad s kroničnim pacijentima, kako obiteljskom liječniku koji vodi populaciju, tako i ostalim liječnicima koji dolaze u kontakt s njegovim pacijentima.The family physician must ensure the continuity of health care for his patients, which is possible only using adequate medical documentation where a physician can find and collect all the necessary data. The data about a patient in his electronic medical record must be divided into three areas: list of episodes of care, list of patient\u27s problems and other information on the patient. Collected data are used for management of chronic diseases according to structured model:-prevention and early detection of diseases, treatment, early detection of complications and analysis of quality of care. The data must be available to other levels of health care and also be transferred automatically to national registers. The data thus collected make the work of the family physician with chronic patients easier, as well as the work of all other physicians who participate in the patient care process

QUATERNARY PREVENTION AS A BASIS FOR RATIONAL APPROACH TO THE PATIENT IN FAMILY PRACTICE

Kvartarna prevencija definirana je kao postupak identificiranja pacijenta rizičnog podlijeganju prekomjernoj medikalizaciji ali i zaštite pacijenta od nove medicinske invazije te predlaganja takvom pacijentu etički prihvatljivih intervencija. Njeno primarno mjesto je u obiteljskoj medicini zbog pozicije obiteljskog liječnika koji predstavlja prvu liniju kontakta s pacijentom te »voditelja« pacijenta kroz zdravstveni sustav. Veliko umijeće liječnika obiteljske medicine je odrediti kojem tjelesnom sustavu pripada simptom kojega prezentira pacijent, te odrediti optimalni daljnji postupak s pojedinim pacijentom. To je posebno složeno u situaciji kada pacijent ima tegobe, a liječnik ne nalazi bolest. U tim situacijama individualni pristup pacijentu, dobra komunikacija, balans između indiciranja odgovarajućih pretraga i utvrđivanja nužnih postupaka uz oslanjanje na medicinu temeljenu na dokazima čine kvartarnu prevenciju, koja postaje nužnost u vođenju pacijenta kroz suvremeni sustav zdravstvene zaštite.Quaternary prevention is an action taken to identify a patient at risk of overmedicalisation, to protect him from new medical invasion, and to suggest to him interventions which are ethically acceptable. It belongs mostly to family medicine because of the family physician’s position who is the first contact to the patient and »leader« of patient through health care system. Family physician must have a skill to locate the patient’s symptom to the proper organ system and also to find the appropriate procedure for the patient. This is very complex in a situation when the patient has symptoms and complaints and the physician doesn’t find the disease. In these situations individual approach to the patient, good communication, balance between finding appropriate procedures and defining neccessary procedures together with evidence based medicine make quaternary prevention, which becomes a neccessity in the process of leading the patient through modern health care system

What, when and how to measure the assessment of quality of care for chronic diseases in family practice? Applying indicators of quality for diabetes mellitus

Proučavanje kvalitete zdravstvene zaštite u primarnoj zaštiti sa znanstvenog i stručnog stajališta danas je vrlo izazovna tema. O toj temi nema još dovoljno sveobuhvatnih i usporedivih podataka na internacionalnoj razini (Europe) koji bi se mogli šire primjenjivati i poslužiti za poboljšanje strategije primarne zaštite. U definiciji kvalitete zaštite uobičajeno se perspektiva pacijenta stavlja kao prioritet. Obiteljski liječnik kao davatelj zdravstvenih usluga po modelu strukturirane zaštite, bolesnicima s kroničnim bolestima na jednom mjestu pruža jedinstvo postupaka: prevencije i ranog otkrivanja bolesti, liječenja i prevencije komplikacija. Kompleksnu ulogu obiteljskoga liječnika u postizanju kvalite zaštite treba sagledavati u uvjetima položaja primarne zaštite u sustavu. Tri su dimenzije primarne zaštite bitne kao polazište za kvalitetnu skrb: struktura sustava koja pruža mogućnosti procesa zaštite, a procesi dovode do određenih ishoda u zaštiti. Što, kada, kako mjeriti, koji mjerni instrument upotrijebiti za procjenu kvalitete skrbi pacijenata sa šećernom bolešću? Indikator je definiran kao mjerljivi element izveden u procesu zaštite za koji postoji dokaz ili dogovor da se može uzeti kao posredni, prijelazni pokazatelj rezultata zaštite. Može se protumačiti da se njihovom primjenom ili ne primjenom mijenja kvaliteta zaštite. Indikatori procesa zaštite odgovaraju na pitanje: tko čini, što čini, gdje, kada i kako često? Indikatori rezultata zaštite odgovaraju na pitanje: koji postupak ili intervencija u procesu zaštite donosi pojedini rezultat u zaštiti? U procjeni kvalitete zaštite osoba sa šećernom bolešću, 34 indikatora (svrstana u 5 skupina) izvedena u procesu zaštite, prihvaćena su kao prijelazni indikatori kvalitete zaštite.Health care quality research of chronic diseases in primary care according to the scientific and professional point of view is very challenging. There are not enough comprehensive and comparable data on the international level (Europe) that could be applied to improve primary health care. In defining quality care, the patient’s perspective is a priority. The general physician as a provider of health care service for patients with chronic diseases offers joint procedure all in one place: prevention and early detection of diseases, treatment and prevention of complications. The complex role of the family doctor in reaching quality care should be observed according to the position of primary care in the health care system. Three dimensions of primary health care are important as a starting point in the assessment of quality care: the system of structure which offers an opportunity for the process of care, which leads to outcomes in protection. What, when and how to measure, which measure instrument to use in assessment quality care for patients with diabetes mellitus? The indicator is defined as a quantifiable element performed in the process of care for which there is proof or agreement that it can be taken as an indirect transient indicator for quality care. Or, it can be interpreted that its usage or not usage changes quality care. Indicators of process health care are answering the questions: who is doing, what is being done, where, when and how often. Indicators of results (outcomes) of health care are answering the question: which procedures or interventions performed in the health care process are giving which outcomes? In quality care assessment for patients with diabetes mellitus, 34 indicators performed in the process of care (divided in 5 groups) are accepted as transient indicators for quality care

Kvartarna prevencija kao temelj racionalnog pristupa pacijentu u obiteljskoj medicini [Quaternary prevention as a basis for rational approach to the patient in family practice]

Quaternary prevention is an action taken to identify a patient at risk of overmedicalisation, to protect him from new medical invasion, and to suggest to him interventions which are ethically acceptable. It belongs mostly to family medicine because of the family physician's position who is the first contact to the patient and "leader" of patient through health care system. Family physician must have a skill to locate the patient's symptom to the proper organ system and also to find the appropriate procedure for the patient. This is very complex in a situation when the patient has symptoms and complaints and the physician doesn't find the disease. In these situations individual approach to the patient, good communication, balance between finding appropriate procedures and defining neccessary procedures together with evidence based medicine make quaternary prevention, which becomes a neccessity in the process of leading the patient through modern health care system

What, when and how to measure the assessment of quality of care for chronic diseases in family practice? Applying indicators of quality for diabetes mellitus

Proučavanje kvalitete zdravstvene zaštite u primarnoj zaštiti sa znanstvenog i stručnog stajališta danas je vrlo izazovna tema. O toj temi nema još dovoljno sveobuhvatnih i usporedivih podataka na internacionalnoj razini (Europe) koji bi se mogli šire primjenjivati i poslužiti za poboljšanje strategije primarne zaštite. U definiciji kvalitete zaštite uobičajeno se perspektiva pacijenta stavlja kao prioritet. Obiteljski liječnik kao davatelj zdravstvenih usluga po modelu strukturirane zaštite, bolesnicima s kroničnim bolestima na jednom mjestu pruža jedinstvo postupaka: prevencije i ranog otkrivanja bolesti, liječenja i prevencije komplikacija. Kompleksnu ulogu obiteljskoga liječnika u postizanju kvalite zaštite treba sagledavati u uvjetima položaja primarne zaštite u sustavu. Tri su dimenzije primarne zaštite bitne kao polazište za kvalitetnu skrb: struktura sustava koja pruža mogućnosti procesa zaštite, a procesi dovode do određenih ishoda u zaštiti. Što, kada, kako mjeriti, koji mjerni instrument upotrijebiti za procjenu kvalitete skrbi pacijenata sa šećernom bolešću? Indikator je definiran kao mjerljivi element izveden u procesu zaštite za koji postoji dokaz ili dogovor da se može uzeti kao posredni, prijelazni pokazatelj rezultata zaštite. Može se protumačiti da se njihovom primjenom ili ne primjenom mijenja kvaliteta zaštite. Indikatori procesa zaštite odgovaraju na pitanje: tko čini, što čini, gdje, kada i kako često? Indikatori rezultata zaštite odgovaraju na pitanje: koji postupak ili intervencija u procesu zaštite donosi pojedini rezultat u zaštiti? U procjeni kvalitete zaštite osoba sa šećernom bolešću, 34 indikatora (svrstana u 5 skupina) izvedena u procesu zaštite, prihvaćena su kao prijelazni indikatori kvalitete zaštite.Health care quality research of chronic diseases in primary care according to the scientific and professional point of view is very challenging. There are not enough comprehensive and comparable data on the international level (Europe) that could be applied to improve primary health care. In defining quality care, the patient’s perspective is a priority. The general physician as a provider of health care service for patients with chronic diseases offers joint procedure all in one place: prevention and early detection of diseases, treatment and prevention of complications. The complex role of the family doctor in reaching quality care should be observed according to the position of primary care in the health care system. Three dimensions of primary health care are important as a starting point in the assessment of quality care: the system of structure which offers an opportunity for the process of care, which leads to outcomes in protection. What, when and how to measure, which measure instrument to use in assessment quality care for patients with diabetes mellitus? The indicator is defined as a quantifiable element performed in the process of care for which there is proof or agreement that it can be taken as an indirect transient indicator for quality care. Or, it can be interpreted that its usage or not usage changes quality care. Indicators of process health care are answering the questions: who is doing, what is being done, where, when and how often. Indicators of results (outcomes) of health care are answering the question: which procedures or interventions performed in the health care process are giving which outcomes? In quality care assessment for patients with diabetes mellitus, 34 indicators performed in the process of care (divided in 5 groups) are accepted as transient indicators for quality care