1. Zagotavljanje enakosti v primarni zdravstveni oskrbi v povezavi z organizacijo dela in sistemom financiranja v Sloveniji in primerjava z državami centralne in vzhodne EvropeSuzana Kert, 2021, doktorska disertacija Opis: Izhodišča. Sestavni del zdravstvenih sistemov je primarna zdravstvena oskrba (PZO), prevladujoč model oskrbe v Evropi v PZO pa družinska medicina. Za funkcioniranje sistemov je potrebno ustrezno financiranje in organizacija dela, oboje je potrebno za ustrezen dostop, ki predstavlja element enakosti v PZO.
Namen. Namen raziskave je bil opredelitev KK in analiza dostopa do PZO glede organizacije dela in financiranja, cilji pa ocena KK za PZO glede strukture/pogojev, postopkov/procesov in izidov, ocena elementov kakovosti PZO, primerjava rezultatov za Slovenijo (SLO) z drugimi državami in oblikovanje priporočil za nosilce odločanja zdravstvenega sistema v SLO.
Bolniki in metode. Raziskava je bila del mednarodne raziskave Quality and Costs of Primary care in Europe (QUALICOPC) v 34 državah v obdobju od leta 2011 do 2013. Uporabili smo podatke desetih držav centralne in vzhodne Evrope (CEECs): Bolgarija, Češka, Estonija, Latvija, Litva, Madžarska, Poljska, Romunija, Slovaška in SLO. Analizirali smo odgovore iz dveh vprašalnikov za 2103 naključno izbranih zdravnikov družinske medicine ter 18819 njihovih bolnikov. Uporabili smo več statističnih metod: predstavitev podatkov z opisnimi statistikami, frekvenčnimi porazdelitvami, srednjimi vrednostmi in variacijskimi razmiki, definiranje KK z deleži, preizkušanje domnev z različnimi testi ter iskanje povezav med spremenljivkami s faktorsko analizo.
Rezultati. Glede organizacije dela je analiza odgovorov bolnikov v SLO in CEECs pokazala, da so bili nizki deleži bolnikov z negativnimi izkušnjami pri vprašanjih za potovalni čas več kot eno uro od doma do ambulante, nezmožnost dobiti obisk na domu, oddaljenost ambulante ter nepoznavanje, kako do storitev zvečer, ponoči in med vikendom, glede finančne dosegljivosti o tem, da bi zdravnika preveč skrbel denar, o preložitvi obiska zdravnika, ker niso imeli ali zavarovanja ali iz drugih finančnih razlogov in glede preložitve oz. opustitve obiska zdravnika. Najbolj značilne spremenljivke za organizacijo dela PZO so bile uporaba računalnika, število disciplin v posamezni ambulanti/centru, uporaba medicinske dokumentacije predhodnega zdravnika, delež naročenih bolnikov, dosegljivost ambulante/centra po 18 h in število ur, ko je ambulanta odprta.
Primerjava KK v SLO in CEECs je pokazala več statistično značilnih razlik. Za KK strukture/pogojev smo ugotovili, da so imeli slovenski zdravniki v primerjavi z zdravniki iz CEECs statistično značilno različno in 1) več pripomočkov za delo (SLO 15,30, CEECs 13,0), 2) večje število strokovnjakov (SLO 4,18, CEECs 2,60), 3) višje število bolnikov na listi zdravnika (SLO 1950,01, CEECs 1894,7), 4) v delovnem dnevu višje število stikov (SLO 45,27, CEECs 33,7), 5) in krajše posvete z bolniki (SLO 9,59 min, CEECs 13,1 min), 6) nižje število hišnih obiskov (SLO 2,21, CEECs 6,9), 7) je bila redna zaposlitev pogostejša oblika zaposlitve (Slovenija 73,7 %, CEECs 30,1 %), 8) je bila plača pogostejši dohodek (SLO 85,2 %, CEECs 61,5 %), 9) večkrat so delali z medicinsko sestro (SLO 98,1 %, CEECs 87,8 %), in 10) sodelovali s patronažno sestro (SLO 76 %, CEECs 41,8 %). Za KK postopkov/procesov smo dokazali, da so slovenski zdravniki uporabljali statistično značilno različno in 1) več kliničnih smernic (SLO 3,85, CEECs 3,15), 2) sodelovali v več programih obravnave kroničnih bolezni (SLO 1,71, CEECs 1,13), 3) sami obravnavali več diagnoz (SLO 11,42, CEECs 9,09) ter 4) izvajali več posegov (SLO 2,43, CEECs 1,30).
Zaključek. Izsledki raziskave kažejo, da bi bilo potrebno v Sloveniji na področju PZO izpeljati nekatere spremembe. Glede financiranja bi bilo razen glavarine in plačila za storitve, koristno vključiti nagrajevanje kakovosti dela, kot orodje za merjenje kakovosti predlagamo KK za postopke/procese in izide oskrbe, glede organizacije dela multidisciplinarni model oskrbe, nadaljevanje nižanja glavarin in vključevanje novih zdravnikov družinske medicine, na nivoju države pa vzpostavitev neodvisne tehnične ustanove.
Ključne besede: primarna zdravstvena oskrba, družinska medicina, organizacija dela, sistem financiranja, enakost, dostop do oskrbe, Slovenija, države centralne in vzhodne Evrope, kazalci kakovosti, priporočila
Objavljeno v DKUM: 18.03.2021; Ogledov: 1323; Prenosov: 162
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2. Process quality indicators in family medicine : results of an international comparisonDanica Rotar-Pavlič, Maja Sever, Zalika Klemenc-Ketiš, Igor Švab, 2015, izvirni znanstveni članek Opis: Background: The aim of our study was to describe variability in process quality in family medicine among 31 European countries plus Australia, New Zealand, and Canada. The quality of family medicine was measured in terms of continuity, coordination, community orientation, and comprehensiveness of care.
Methods: The QUALICOPC study (Quality and Costs of Primary Care in Europe) was carried out among family physicians in 31 European countries (the EU 27 except for France, plus Macedonia, Iceland, Norway, Switzerland, and Turkey) and three non-European countries (Australia, Canada, and New Zealand). We used random sampling when national registers of practitioners were available. Regional registers or lists of facilities were used for some countries. A standardized questionnaire was distributed to the physicians, resulting in a sample of 6734 participants. Data collection took place between October 2011 and December 2013. Based on completed questionnaires, a three-dimensional framework was established to measure continuity, coordination, community orientation, and comprehensiveness of care. Multilevel linear regression analysis was performed to evaluate the variation of quality attributable to the family physician level and the country level.
Results: None of the 34 countries in this study consistently scored the best or worst in all categories. Continuity of care was perceived by family physicians as the most important dimension of quality. Some components of comprehensiveness of care, including medical technical procedures, preventive care and health care promotion, varied substantially between countries. Coordination of care was identified as the weakest part of quality. We found that physician-level characteristics contributed to the majority of variation.
Conclusions: A comparison of process quality indicators in family medicine revealed similarities and differences within and between countries. The researchers found that the major proportion of variation can be explained by physicians' characteristics.
Ključne besede: family physician, process quality, comparison
Objavljeno v DKUM: 28.06.2017; Ogledov: 6811; Prenosov: 298
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3. Do the experiences of patients of state-employed family physicians and concessionaires in Slovenia differ?Danica Rotar-Pavlič, Maja Sever, Zalika Klemenc-Ketiš, Igor Švab, Janko Kersnik, Wienke Boerma, 2015, izvirni znanstveni članek Opis: Background: Family practice healthcare in Slovenia is provided by state-employed family physicians as well as concessionaires. However, both work under a contract with the National Health Insurance Institute. This study focuses on comparing patients’ experiences with Slovenian concessionaires and state-employed physicians.
Methods: We performed analyses using survey data from a cross-sectional study on patient experiences, which took place from September 2011 to April 2012 as a part of the international QUALICOPC study. The Slovenian branch of this study included 1,962 patients visiting family practices. Patients were classified into two groups with respect to the registered status of their family physician. They completed the questionnaires immediately aſter visiting their family physicians. Data used in the analyses included 76 variables: 18 socio-economic and 58 variables linked to the patient’s experience.
Results: The analyses showed few differences between concessionaires and state-employed family physicians. In comparison with patients of state-employed family physicians, patients of concessionaires were less likely to make an appointment for a visit (19.8 % vs. 29.2 %), were generally more frequent visitors (43.7 % vs. 50.7 %), and more oſten felt that opening hours were too restricted (25.7 % vs. 31.9 %). Patients of concessionaires believed more oſten that in general, doctors can be trusted (40.1 % vs.47.1 %). A smaller percentage of patients of concessionaires felt that their physician had the capacity to deal with personal problems as well as to provide medical care (61.9 % vs. 54.7 %).
Conclusions: There are few differences in patients’ experiences of state-employed family physicians and concessionaires. Slovenian patients have a generally positive experience with family practice services regardless of the family physicians’ status. Plans for organizational change of the health sector should include patients’ perceptions of services.
Ključne besede: patient, experience, family physician, state-employed, concessionaire
Objavljeno v DKUM: 10.05.2017; Ogledov: 1352; Prenosov: 359
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4. Quality of life and patient satisfaction with family practice care in a roma population with chronic conditions in northeast SloveniaErika Zelko, Igor Švab, Danica Rotar-Pavlič, 2015, izvirni znanstveni članek Opis: Objectives: Health-related quality of life (HRQoL) measures a patient's subjective experience of his or her health status. We aimed to show how the presence of chronic diseases and satisfaction with family physicians (FPs) were associated with the HRQoL of a Roma population.
Methods: A cross-sectional study was carried out in May 2011 on a representative sample of 650 Roma living in Prekmurje, Slovenia. The EQ-5D questionnaire was used for measuring the HRQoL of the Roma. Demographical data, 12 groups of diseases diagnosed in the last 12 months and satisfaction with FPs were included in the questionnaire.
Results: The response rate was 88.3% (574), of which 56.4% were female, and the average age of the participants had a mean value of 40.2+-12.7 years. The presence of cardiovascular problems with risk factors for them or presence of musculoskeletal disorders were strongly associated with the presence of pain (Cramer's V = 0.40 and 0.46 respectively). There was a strong association between the presence of mental disorders and anxiety and depression (Cramer's V = 0.58). The average satisfaction with the family physician was 3.9 (mean+-1.10) on a five-point Likert scale. There was no significant association between HRQoL and satisfaction with the family physician.
Conclusions: Roma with chronic mental health problems had the lowest HRQoL in the Roma population. More attention should be paid to this subgroup of Roma in family medicine, and interventions should be provided. High satisfaction with their FPs is not associated with the observed quality of life variables.
Ključne besede: quality of life, Roma, patient satisfaction
Objavljeno v DKUM: 05.04.2017; Ogledov: 1422; Prenosov: 187
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5. Health beliefs and practices among Slovenian Roma and their response to febrile illnesses : a qualitative studyDanica Rotar-Pavlič, Erika Zelko, Janko Kersnik, Verica Lolič, 2011, izvirni znanstveni članek Opis: Introduction: When the Roma fell ill in the past, they used herbal home remedies to treat diseases. If the remedy failed to cure the illness, they called the local healer. Today, most Roma visit physicians. This study investigates health beliefs and practices held by the Roma people in Slovenia and their response to febrile illnesses.
Methods: Field interviews using a semi-structured questionnaire were conducted in the vicinity of Kočevje. Sociodemographic data were gathered and recorded manually, and the interviews were tape recorded. Qualitative analysis was performed by three researchers. Special attention was paid to data validation.
Results: The majority of Roma are not acquainted with thermometers and therefore do not use them. About onethird of the interviewees knew what the normal body temperature should be. Only 15% of the Roma population take their body temperature when they are feeling unwell. One-half visit their physicians. More than half of the population take paracetamol or aspirin when they feel feverish. More often, they resort to tea and emphasize the healing effect of sweating.
Conclusion: The Roma beliefs and practices regarding health and fever are instructive and show how impoverished a narrow biomedical approach can be. Failure to use technical devices, such as thermometers, and lack of familiarity with the numerical values defining the border between normal and elevated body temperature, nonetheless do not mean that the Roma take inappropriate measuresin response to illness. Illnesses (including fever) can also be recognized without these tools and can be appropriately responded to by drinking teas, using compresses, and taking fever-reducing medications.
Ključne besede: Roma, illness, thermometer, fever, activity, doctor
Objavljeno v DKUM: 05.04.2017; Ogledov: 1328; Prenosov: 209
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6. Self-reported chronic conditions in student population in SloveniaZalika Klemenc-Ketiš, Žiga Hladnik, Danica Rotar-Pavlič, Mieke Post, Janko Kersnik, 2010, izvirni znanstveni članek Opis: Purpose/Objective: The aims of this study were (1) to determine the prevalence of chronic diseases in a student population in Slovenia, (2) to determine the effects of chronic diseases on the use of health services.
Methods: A cross-sectional web-survey among university students in Ljubljana and Maribor, Slovenia took place in March and April 2008. Data were analyzed using SPSS version 13.0 (SPSS Inc, Chicago, IL, USA),and chi-square test, t-test and binary logistic regression analysis were performed.
Results: The prevalence of chronic diseases in the student population was 40.3 %. The most common chronic diseases were allergies (excluding hay fever) (14.9 %), hay fever (11.4 %), followed by skin diseases (9.2 %) and anxiety (5.3 %). Both high blood pressure and asthma had a higher prevalence in men than in women (p < 0.001 and p = 0.023, respectively). Students with chronic conditions less often thought that they can influence their own health by self-treatment, experienced stress in the previous week, more likely visited or contacted his/her personal doctor in the past year, more likely purchased medications for self-treatment from a pharmacist in the past year, were more aware of the facts that self-treatment may hide the symptoms and signs of illness to such extent that the doctor may not be able to recognize it or overlook it completely.
Conclusion: A greater awareness of the prevalence and impact of chronic diseases in students is warranted and the existing interventions should be changed in order to achieve a better life quality of university students.
Ključne besede: students, chronic disease, prevalence, self-care, quality of life
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7. DOLOČEVANJE KRVNE SLIKE S HEMATOLOŠKIMI ANALIZATORJIDanica Rotar, 2014, diplomsko delo Opis: Namen diplomske naloge je kontrola kakovosti rezultatov hematološkega analizatorja ABX Pentra XL 80, proizvajalca HORIBA Medical, ki smo jo izvajali v diagnostičnem laboratoriju Zdravstvenega doma Ormož. Ugotavljali smo točnost in natančnost meritev omenjenega hematološkega analizatorja. Nadzor kakovosti v laboratoriju je namenjen za odkrivanje, zmanjšanje in odpravo pomanjkljivosti v analitskem procesu v medicinskem laboratoriju. Kontrola kakovosti je ključnega pomena pri izboljšanju kakovosti rezultatov meritev parametrov krvne slike pri pacientih, ki jih vsak dan sporočamo zdravnikom in naročnikom.
Naključnim pacientom v ZD Ormož smo odvzeli vzorce polne krvi z dodatkom antikoagulanta K3EDTA in izvedli meritve krvnih slik. Primerljivost izmerjenih rezultatov smo ugotavljali z referenčnim hematološkim analizatorjem ABX Pentra 60. Dobljene rezultate smo statistično ovrednotili s parnim t-testom in linearno regresijo. Ponovljivost smo izvajali z večkratnimi meritvami vzorcev znotraj delovnega dne. Izračunane koeficiente variacij smo primerjali s podanimi koeficienti variacij proizvajalca hematološkega analizatoja HORIBA Medical. Merjenje točnosti smo izvajali s komercialnimi kontrolnimi vzorci ABX Difftrol na dveh koncentracijskih nivojih (normalni in visoki nivo). Dobljene rezultate kontrolnih vzorcev smo statistično ovrednotili s t-testom in jih hkrati tudi vnesli v kontrolne karte, ter jih ocenili z Westgardovimi pravili. Diferencialne krvne slike levkocitov smo primerjali z mikroskopskim diferenciranjem krvnih razmazov, ki smo jih izdelali sami in pobarvali po metodi May-Grünwald Giemsa.
Ugotovili smo, da statistično ovrednotenje hematoloških vrednosti s t-testom in parnim t-testom ni najbolj primerno. S pomočjo linearne regresije in kontrolnih kart smo prišli do sklepa, da je hematološki analizator dovolj točen in natančen za uporabo analize krvnih slik.
Ključne besede: hematološki analizator, kompletna krvna slika, kontrola kakovosti
Objavljeno v DKUM: 17.10.2014; Ogledov: 2590; Prenosov: 445
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