Family practice in Lithuania during ten years of Primary Health Care reform: task profiles, job satisfaction and patients’ attitudes ; Šeimos medicina Lietuvoje per pirminės sveikatos priežiūros reformos dešimtmetį: gydytojo veiklos apimtys, pasitenkinimas darbu bei pacientų požiūris

Edita Sueiras

Sujets

• Family medicine
• Public health
• Workload

Informations

• Publié par: kaunas_university_of_medicine
• Publié le: 01 janvier 2009
• Nombre de lectures: 25
• Langue: English
• Poids de l'ouvrage: 19 Mo

Extrait

KAUNAS UNIVERSITY OF MEDICINE









Ida Liseckien



FAMILY PRACTICE IN LITHUANIA
DURING TEN YEARS OF PRIMARY
HEALTH CARE REFORM:
TASK PROFILES, JOB SATISFACTION
AND PATIENTS’ ATTITUDES


Doctoral Dissertation
Biomedical Sciences, Public Health (10 B)














Kaunas, 2009
1 The doctoral dissertation was prepared during 2004–2009 at Institute for
Biomedical Research of Kaunas University of Medicine, the laboratory of
Health care services research.
Scientific supervisor:
Prof. Dr. Habil. Irena Misevičien÷ (Kaunas University of Medicine, Bio-
medical Sciences, Public health – 10 B)
Consultant:
Prof. Dr. Wienke G. W. Boerma (Netherlands Institute for Health Servi-
ces Research, Utrecht (NL), Biomedical sciences, Public Health – 10 B)
2 CONTENTS
ABBREVIATIONS ...................................................................................... 5
INTRODUCTION........................................................................................ 6
1. AIM AND OBJECTIVES OF THE STUDY ................................... 8
1.1. Aim of the study.......................................................................... 8
1.2. Objectives of the study................................................................ 8
1.3. The novelty of the study.............................................................. 8
1.4. Personal contribution to the survey............................................. 9
2. LITERATURE REVIEW 10
2.1. Primary health care policy and its conception .......................... 10
2.2. The implementation of primary health care in Lithuania.......... 14
2.2.1. Preconditions to PHC development ................................ 14
2.2.2. Conceptual primary health care reform........................... 15
2.2.3. Financial primary health care reform.............................. 16
2.2.4. Structural primary health care reform............................. 16
2.3. The importance of the research in primary health care............. 18
2.4. Evaluations of patients’ attitudes .............................................. 19
2.4.1. Characteristics influencing patients’ satisfaction............ 21
2.4.2. Patients’ attitude to different health care aspects 22
2.4.3. Results of patients’ attitudes surveys in Lithuania.......... 23
2.5. Family physicians’ surveys regarding their task profiles, job
satisfaction................................................................................. 26
2.6. Data regarding family physicians’ surveys in Lithuania........... 28
3. STUDY DESIGN AND METHODS ............................................... 33
3.1. District and family physicians’ surveys .................................... 33
3.2. The patients’ attitudes surveys.................................................. 36
3.3. Statistical analysis ..................................................................... 39
3 4. RESULTS ..........................................................................................43
4.1. Physicians’ workload and task profiles.....................................43
4.1.1. Changes in physicians’ workload....................................43
4.1.2. The use of equipment ......................................................49
4.1.3. Involvement in the medical procedures ..........................54
4.1.5. Preventive care ................................................................61
4.1.6. Involvement in particular services ..................................66
4.2. Family physicians job satisfaction and their attitudes towards
health care in Lithuania .............................................................68
4.2.1. Family physicians’ satisfaction with their job.................68
4.2.2. Family physicians’ attitudes regarding health care in
Lithuania....................................................................................73
4.3. Patients’ attitudes ......................................................................84
4.3.1 Patients attitudes about the different health care
aspects in general84
4.3.2 Patients attitudes according their different
characteristics ............................................................................90
5. DISCUSSION..................................................................................109
5.1. Physicians’ workload and tasks...............................................109
5.2. Family physicians job satisfaction ..........................................114
5.3. Patients’ attitudes towards PHC..............................................116
CONCLUSIONS ......................................................................................125
RECOMMENDATIONS.........................................................................127
For PHC policy makers and authorities .............................................127
For future researchers128
LIST OF PUBLICATIONS.....................................................................129
REFERENCES.........................................................................................131
SUPPLEMENTS ......................................................................................146
4 ABBREVIATIONS
BMTI – Institute for Biomedical Research of Kaunas University of
Medicine (LT)
CME – Continues Medical Eduction
FM – Family medicine
GPAS – General Practice Assessment Survey
KMU – Kaunas University of Medicine (LT)
Min – Minimum
Max – Maximum
NIVEL – Netherlands Institute for Health Services Research,
Utrecht (NL)
PHC – Primary Health Care
TSF – Terrtorial Sick Funds
QUOTE – Quality Of care Through the patients' Eyes
WHO – World Health Organization
5 INTRODUCTION
The primary health care (PHC) institution has a core value in comprehen-
sive health care systems. PHC have been presented as an effective resolution
in improving health care since Alma-Ata conference in 1978 [122]. The
importance of PHC has been continued by “Health for all in the twenty-first
century” policy, based on the integrated family and community oriented
PHC, supported by a flexible and responsive hospital system [59]. The
importance of PHC was highlighted “more then ever” in World Health
Organization (WHO) Health report (2008), because the globalization is
putting the social cohesion of many countries under stress, and health
systems as well, people are increasingly inpatient with the inability of health
services, in addition health care systems should correspond to their needs
and expectations [176]. Why PHC is so important? Firstly, it is associated
with the better health outcomes. It was proved that primary care system and
practice characteristics such as geographic regulation, longitudinally, co-
ordination, and community orientation are improving population health
[100]. In addition having more specialists, or higher specialist to population
ratios, reflects no advantages in meeting population health needs [142].
Secondly, PHC lower health costs: patients who are visiting the same family
physician had a lower total cost for medical care [101]. Thirdly, PHC is
related to a greater equity in health [143].
Problems regarding the increasing aging, multimortidity [155], prevalen-
ce of the risk factors may be solved by professionals who have holistic
approach, skills in cooperation and communication, are able to guarantee
continuity [50]. Regarding the mentioned above, PHC system is very
important for the future of our society.
PHC institution was newly presented in Lithuania since the beginning of
health care reform. There were introduced conceptual, structural and finan-
cial changes in the PHC level [48]. The most similar family physicians func-
tions were provided by contemporary district physicians (i. e. pediatricians
and internists). Consequently there were decided to qualify family
physicians: some of them were retrained from district physicians and others
graduated family medicine residency.
There is no doubt that recent years have been challenging for Lithuanian
family medicine institution and family physicians. There were delegated
new functions to family physicians: they supposed to provide a wide range
of services: children, antenatal, adolescent care; be involved in the treatment
of acute and chronic diseases and palliative care. Family physicians were
also obligated in provision of preventive services and in patients’ education
6 as well. Summarizing family physician was presented as the central figure
in the reformed health care system. It was a great challenge for family
physicians to cooperate with other medical professionals (medical specialist,
social workers, and public health institutions), ensure a gate keeping
function and provide patient centered care. Have the mentioned challenges
been achieved? Do retrained district physicians and newly developed
physicians after family medicine residency provide similar PHC services,
what are the workload and organizational aspects of family physicians
performance? Doesn’t family physician feel exhausted? On the other hand it