This article analysis the health promotion program for individuals at risk for cardiovascular diseases and diabetes implemented jointly by primary health care institutions and the public health bureau in the municipality of Panevėžio city. A qualitative study using a semi-structured interview method was performed in January – February 2018, involving ten representatives of primary health care institutions and the public health bureau which have concluded the cooperation agreement. In the context of the health promotion program implementation, the main collaboration forms between primary health care institutions and the public health bureau remain sending official documents by email and meetings in primary health care institutions. The key prerequisites for the development of closer collaboration are an active involvement of the public health bureau in increasing participation rates of individuals at risk, primary health care institutions actions to strengthen the coordination of the health promotion program implementation in primary health settings and to initiate collaboration with the public health bureau. The main barriers of the implementation of the health promotion program were identified at systemic, organizational and interpersonal levels: legal regulation; the lack of actions of the municipality doctor and administration of primary health care institutions, ineffective work organization of family physicians, insufficient coordination of the health promotion program in primary health settings, the lack of patients motivation, their and family physicians negative attitudes forwards the implementation of the health promotion program.
{"title":"THE HEALTH PROMOTION PROGRAM FOR INDIVIDUALS AT RISK FOR CARDIOVASCULAR DISEASES AND DIABETES IMPLEMENTATION IN MUNICIPALITY: THE STAKEHOLDERS’ PERSPECTIVE","authors":"Ž. Šedytė, G. Petronytė","doi":"10.13165/spv-19-1-11-02","DOIUrl":"https://doi.org/10.13165/spv-19-1-11-02","url":null,"abstract":"This article analysis the health promotion program for individuals at risk for cardiovascular diseases and diabetes implemented jointly by primary health care institutions and the public health bureau in the municipality of Panevėžio city. A qualitative study using a semi-structured interview method was performed in January – February 2018, involving ten representatives of primary health care institutions and the public health bureau which have concluded the cooperation agreement. In the context of the health promotion program implementation, the main collaboration forms between primary health care institutions and the public health bureau remain sending official documents by email and meetings in primary health care institutions. The key prerequisites for the development of closer collaboration are an active involvement of the public health bureau in increasing participation rates of individuals at risk, primary health care institutions actions to strengthen the coordination of the health promotion program implementation in primary health settings and to initiate collaboration with the public health bureau. The main barriers of the implementation of the health promotion program were identified at systemic, organizational and interpersonal levels: legal regulation; the lack of actions of the municipality doctor and administration of primary health care institutions, ineffective work organization of family physicians, insufficient coordination of the health promotion program in primary health settings, the lack of patients motivation, their and family physicians negative attitudes forwards the implementation of the health promotion program.","PeriodicalId":31875,"journal":{"name":"Health Policy and Management","volume":"363 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76573695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The majority of Lithuanian municipalities are facing the challenges of aging population – growing morbidity of chronic diseases and special nursing and health care needs for the aged citizens, demanding complex social and health care. These factors also induces the additional activities that are not directly associated with health care, and deficiency of resources in primary health care sector. In 2019 European Assessment of progress on structural reforms, prevention and correction of macroeconomic imbalances, and results of in-depth reviews is underlined, that institutional care model, dominating in Lithuania, is not sufficient for the aging society and growing needs for integrated and long-term care services. The aim of this article is to analyze and evaluate the needs of health care and social care services at home for long care patient hospitalized in the nursing hospital and to offer measures for developing for these services. The results of the study showed that more than half of patients with chronic illnesses had never received primary health care (57 %) and social care services at home (80 %), more than half (57 %) of the respondents didn’t know about the social services organized and provided by the municipality. Most respondents (59 %) would prefer long-term health care services provided at home, but respondents (80 %) would not agree to pay extra for these home care services. Differences in the legal framework for home health care and social services does not allow organize and delivery the flexible, long-term, integrated home-based health care and social care services.
{"title":"THE NEED OF THE HEALTH AND SOCIAL CARE SERVICES AT HOME FOR PATIENTS HOSPITALIZED IN THE NURSING HOSPITAL","authors":"Renata Kudukytė-Gasperė, D. Jankauskienė","doi":"10.13165/spv-19-1-11-06","DOIUrl":"https://doi.org/10.13165/spv-19-1-11-06","url":null,"abstract":"The majority of Lithuanian municipalities are facing the challenges of aging population – growing morbidity of chronic diseases and special nursing and health care needs for the aged citizens, demanding complex social and health care. These factors also induces the additional activities that are not directly associated with health care, and deficiency of resources in primary health care sector. In 2019 European Assessment of progress on structural reforms, prevention and correction of macroeconomic imbalances, and results of in-depth reviews is underlined, that institutional care model, dominating in Lithuania, is not sufficient for the aging society and growing needs for integrated and long-term care services. The aim of this article is to analyze and evaluate the needs of health care and social care services at home for long care patient hospitalized in the nursing hospital and to offer measures for developing for these services. The results of the study showed that more than half of patients with chronic illnesses had never received primary health care (57 %) and social care services at home (80 %), more than half (57 %) of the respondents didn’t know about the social services organized and provided by the municipality. Most respondents (59 %) would prefer long-term health care services provided at home, but respondents (80 %) would not agree to pay extra for these home care services. Differences in the legal framework for home health care and social services does not allow organize and delivery the flexible, long-term, integrated home-based health care and social care services.","PeriodicalId":31875,"journal":{"name":"Health Policy and Management","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75759964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This article analyses the implementation cost of the physical activity intervention in primary health care settings and economic benefits from the healthcare and social systems perspective over 10 years. The economic evaluation of the physical activity intervention was carried out by estimating it’s the initial investment cost and the cost over 3 years. The cost - benefit analysis was used to estimate the savings of the health care costs per case of disease and the sickness benefits. Besides, the cost per life years saved of the physical activity intervention was estimated. One way sensitivity analysis was performed to assess two scenarios of the physical activity intervention effectiveness. The initial investment cost of the physical activity intervention would be around 25 200 Eur, whereas the implementation cost would be 1 513 935,37 Eur over 3 years. Its net benefit would be 4 533 373,29 Eur (optimistic scenario) or 1509185,72 Eur (pessimistic scenario) from the healthcare and social systems perspective over 10 years, respectively one euro invested in this intervention would yield a return of 4 Eur or 2 Eur. The cost of one physically inactive patient who would become physically active and prevent diseases would ranke from 1971 Eur (optimistic scenario) to 3953 Eur (pessimistic scenario). This intervention implementation in primary health care setting would safe from 407 (optimistic scenario) to 203 (pessimistic scenario) life years, whereas the cost per life years saved would ranke from 3949,11 Eur to 7918,85 Eur. The physical activity intervention implementation in primary health care setting may be economically beneficial from the healthcare and social systems perspective.
{"title":"ECONOMIC EVALUATION OF THE IMPLEMENTATION OF PHYSICAL ACTIVITY INTERVENTION FOR ADULT PATIENTS IN PRIMARY HEALTH CARE SETTINGS","authors":"G. Petronytė, Raimonda Janonienė","doi":"10.13165/spv-19-1-11-04","DOIUrl":"https://doi.org/10.13165/spv-19-1-11-04","url":null,"abstract":"This article analyses the implementation cost of the physical activity intervention in primary health care settings and economic benefits from the healthcare and social systems perspective over 10 years. The economic evaluation of the physical activity intervention was carried out by estimating it’s the initial investment cost and the cost over 3 years. The cost - benefit analysis was used to estimate the savings of the health care costs per case of disease and the sickness benefits. Besides, the cost per life years saved of the physical activity intervention was estimated. One way sensitivity analysis was performed to assess two scenarios of the physical activity intervention effectiveness. The initial investment cost of the physical activity intervention would be around 25 200 Eur, whereas the implementation cost would be 1 513 935,37 Eur over 3 years. Its net benefit would be 4 533 373,29 Eur (optimistic scenario) or 1509185,72 Eur (pessimistic scenario) from the healthcare and social systems perspective over 10 years, respectively one euro invested in this intervention would yield a return of 4 Eur or 2 Eur. The cost of one physically inactive patient who would become physically active and prevent diseases would ranke from 1971 Eur (optimistic scenario) to 3953 Eur (pessimistic scenario). This intervention implementation in primary health care setting would safe from 407 (optimistic scenario) to 203 (pessimistic scenario) life years, whereas the cost per life years saved would ranke from 3949,11 Eur to 7918,85 Eur. The physical activity intervention implementation in primary health care setting may be economically beneficial from the healthcare and social systems perspective.","PeriodicalId":31875,"journal":{"name":"Health Policy and Management","volume":"22 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77553290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The goal of every health care institution (HCI) is to provide safe and highquality services to patients, but sometimes the provision of health care (HC) services result in unavoidable adverse events (AE). AE can harm and cause irreversible health problems to the patient, so patient safety and AE remain a global concern worldwide. Recently there has been a growing number of researches both locally and worldwide on how to ensure patient safety (PS), how to deliver quality services in HC sector, and how to reduce the number of AE. Council of Europe has issued recommendations on how to improve HC services, but according to the results of the survey conducted in 2014, AE remain a big problem in EU countries. Later in 2017, it has been noted that the recommendations were insufficiently implemented at a national level. The European Commission has pointed out some shortcomings: lack of cooperation between EU countries, deficiencies in safety culture implementation, lack of knowledge and skills in analyzing AE. This article analyzes the success of AE policy implementation in Lithuania, why Lithuania and the EU countries have created a mandatory AE register, but the registration of these events is slow, most of them are still unreported, their real number and frequency are still hidden, and their causes are not analyzed. Based on a case study and qualitative study in one large hospital, attempts are made to identify the factors of AE management that constitute a barrier to effective AE management policy in healthcare institutions. Prerequisites for successful AE management consist of electronisation of AE reporting system, development and control of quality standards, strategic, continuous and ongoing leadership of HC administration and staff involvement and their motivation, also adjusted training, creating organizational culture of confidentiality and learning from mistakes. Some shortcomings were also noted: lack of knowledge and skills, overcoming fears of being punished and humiliated, lack of feedback, lack of national AE IT system. This limits the efficiency of the AE management process both nationally and locally. Successful choice of AE management model directly depends on the internal policies, operations, and leadership of HC institution. Well-planned, organized and controlled measures, based on European recommendations, help to achieve the objectives by monitoring and evaluating their results in a consistent and long-term manner. It is confirmed, that AE registration and continuous analysis is key to prevent future AE. Therefore, the basis of EU countries’ AE management policy is choosing the right AE management model according to the maturity of the system, which includes the implementation of the reporting system in HC institutions and, most importantly, the analysis and development of prevention actions. This helps to share experience, constantly analyze, learn from mistakes, and shape a new approach and PS culture.
{"title":"MANAGEMENT OF ADVERSE EVENTS IN THE HOSPITAL","authors":"D. Jankauskienė, Aida Kostereva","doi":"10.13165/spv-19-1-11-03","DOIUrl":"https://doi.org/10.13165/spv-19-1-11-03","url":null,"abstract":"The goal of every health care institution (HCI) is to provide safe and highquality services to patients, but sometimes the provision of health care (HC) services result in unavoidable adverse events (AE). AE can harm and cause irreversible health problems to the patient, so patient safety and AE remain a global concern worldwide. Recently there has been a growing number of researches both locally and worldwide on how to ensure patient safety (PS), how to deliver quality services in HC sector, and how to reduce the number of AE. Council of Europe has issued recommendations on how to improve HC services, but according to the results of the survey conducted in 2014, AE remain a big problem in EU countries. Later in 2017, it has been noted that the recommendations were insufficiently implemented at a national level. The European Commission has pointed out some shortcomings: lack of cooperation between EU countries, deficiencies in safety culture implementation, lack of knowledge and skills in analyzing AE. This article analyzes the success of AE policy implementation in Lithuania, why Lithuania and the EU countries have created a mandatory AE register, but the registration of these events is slow, most of them are still unreported, their real number and frequency are still hidden, and their causes are not analyzed. Based on a case study and qualitative study in one large hospital, attempts are made to identify the factors of AE management that constitute a barrier to effective AE management policy in healthcare institutions. Prerequisites for successful AE management consist of electronisation of AE reporting system, development and control of quality standards, strategic, continuous and ongoing leadership of HC administration and staff involvement and their motivation, also adjusted training, creating organizational culture of confidentiality and learning from mistakes. Some shortcomings were also noted: lack of knowledge and skills, overcoming fears of being punished and humiliated, lack of feedback, lack of national AE IT system. This limits the efficiency of the AE management process both nationally and locally. Successful choice of AE management model directly depends on the internal policies, operations, and leadership of HC institution. Well-planned, organized and controlled measures, based on European recommendations, help to achieve the objectives by monitoring and evaluating their results in a consistent and long-term manner. It is confirmed, that AE registration and continuous analysis is key to prevent future AE. Therefore, the basis of EU countries’ AE management policy is choosing the right AE management model according to the maturity of the system, which includes the implementation of the reporting system in HC institutions and, most importantly, the analysis and development of prevention actions. This helps to share experience, constantly analyze, learn from mistakes, and shape a new approach and PS culture.","PeriodicalId":31875,"journal":{"name":"Health Policy and Management","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89504231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aida Budrevičiūtė, R. Kalediene, Renata Paukštaitienė, S. Sauliune, L. Valius
Background. Type 2 diabetes mellitus (T2DM) is a complex disease that leads to continuous medical care with comprehensive, multifactorial strategies for reducing disease risk for patients. There is an ongoing discussion on how to better manage chronic diseases at primary health care facility level. It is recognized that continuous management of chronic diseases needs to find new ways in managing risk and outcomes of chronic diseases. Aim of the study. To find the elements of value creation management with perspectives of priorities management and to examine the impact of factors on chronic diseases state with prognosis of T2DM progress in primary health care. Materials and methods. The methods of the research were based on the group discussions of managers from primary health care and the survey of patients with T2DM that was conducted after the consultation of family doctor in primary health care facilities in Lithuania. Focus group discussions (n = 48) were conducted from May 2015 to March 2016 in 10 counties of Lithuania (31 executives of public primary health care facilities and 17 executives of private primary health care facilities). From October 2017 to January 2018, the survey of patients (n = 510) with T2DM was conducted (258 from public and 252 from primary health care facilities). Multinomial logistic regression was used for the analysis. Results. The main elements of value management with focus on chronic diseases management were health promotion, quality of life, time management, satisfaction, communication, partnership with health care professionals, values and lifestyle of patients. Significant distribution among sociodemographic (income, place of residence, gender), non - clinical (affiliation to primary health care facility, self - perceived health, satisfaction with T2DM treatment, treatment options) factors were investigated. Age, gender, place of residence, self - perceived health, education, treatment options of T2DM were the factors that predicts the prognosis of T2DM progress. Conclusions. The foundation of value elements with perspectives of priorities management provides insights to develop interventions programs and projects that would increase patient satisfaction with primary health care services. The factors evaluation on T2DM progress is the opportunity to find effective management tools that helps predict a disease evolution. The prediction of T2DM is basis for clinicians and managers in priorities setting and decision making. The results of the research can be ground for the continuous management of T2DM disease improvement in primary health care facility. The determination of elements of value management, the distribution of factors among T2DM disease states, the factors examination on chronic diseases states can be the principles of building theories.
{"title":"MANAGEMENT OF TYPE 2 DIABETES MELLITUS AT PRIMARY HEALTH CARE LEVEL IN LITHUANIA","authors":"Aida Budrevičiūtė, R. Kalediene, Renata Paukštaitienė, S. Sauliune, L. Valius","doi":"10.13165/spv-19-1-11-01","DOIUrl":"https://doi.org/10.13165/spv-19-1-11-01","url":null,"abstract":"Background. Type 2 diabetes mellitus (T2DM) is a complex disease that leads to continuous medical care with comprehensive, multifactorial strategies for reducing disease risk for patients. There is an ongoing discussion on how to better manage chronic diseases at primary health care facility level. It is recognized that continuous management of chronic diseases needs to find new ways in managing risk and outcomes of chronic diseases. Aim of the study. To find the elements of value creation management with perspectives of priorities management and to examine the impact of factors on chronic diseases state with prognosis of T2DM progress in primary health care. Materials and methods. The methods of the research were based on the group discussions of managers from primary health care and the survey of patients with T2DM that was conducted after the consultation of family doctor in primary health care facilities in Lithuania. Focus group discussions (n = 48) were conducted from May 2015 to March 2016 in 10 counties of Lithuania (31 executives of public primary health care facilities and 17 executives of private primary health care facilities). From October 2017 to January 2018, the survey of patients (n = 510) with T2DM was conducted (258 from public and 252 from primary health care facilities). Multinomial logistic regression was used for the analysis. Results. The main elements of value management with focus on chronic diseases management were health promotion, quality of life, time management, satisfaction, communication, partnership with health care professionals, values and lifestyle of patients. Significant distribution among sociodemographic (income, place of residence, gender), non - clinical (affiliation to primary health care facility, self - perceived health, satisfaction with T2DM treatment, treatment options) factors were investigated. Age, gender, place of residence, self - perceived health, education, treatment options of T2DM were the factors that predicts the prognosis of T2DM progress. Conclusions. The foundation of value elements with perspectives of priorities management provides insights to develop interventions programs and projects that would increase patient satisfaction with primary health care services. The factors evaluation on T2DM progress is the opportunity to find effective management tools that helps predict a disease evolution. The prediction of T2DM is basis for clinicians and managers in priorities setting and decision making. The results of the research can be ground for the continuous management of T2DM disease improvement in primary health care facility. The determination of elements of value management, the distribution of factors among T2DM disease states, the factors examination on chronic diseases states can be the principles of building theories.","PeriodicalId":31875,"journal":{"name":"Health Policy and Management","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78153388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：