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Izpis gradiva

Naslov:Zagotavljanje enakosti v primarni zdravstveni oskrbi v povezavi z organizacijo dela in sistemom financiranja v Sloveniji in primerjava z državami centralne in vzhodne Evrope
Avtorji:Kert, Suzana (Avtor)
Gomišček, Boštjan (Komentor)
Rotar-Pavlič, Danica (Mentor) Več o mentorju... Novo okno
Datoteke:.pdf DOK_Kert_Suzana_2021.pdf (5,98 MB)
MD5: 07DD7233284393A662576C0BF5FD0068
 
Jezik:Slovenski jezik
Vrsta gradiva:Doktorsko delo/naloga (mb31)
Tipologija:2.08 - Doktorska disertacija
Organizacija:MF - Medicinska fakulteta
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
Leto izida:2021
Izvor:Maribor
COBISS_ID:55717635  Novo okno
NUK URN:URN:SI:UM:DK:F6SBAT8M
Število ogledov:95
Število prenosov:21
Metapodatki:XML RDF-CHPDL DC-XML DC-RDF
Področja:MF
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Licence

Licenca:CC BY-NC-ND 4.0, Creative Commons Priznanje avtorstva-Nekomercialno-Brez predelav 4.0 Mednarodna
Povezava:http://creativecommons.org/licenses/by-nc-nd/4.0/deed.sl
Opis:Najbolj omejujoča licenca Creative Commons. Uporabniki lahko prenesejo in delijo delo v nekomercialne namene in ga ne smejo uporabiti za nobene druge namene.
Začetek licenciranja:30.06.2020

Sekundarni jezik

Jezik:Angleški jezik
Naslov:Ensuring equity in primary health care considering the organization of work and the financing system in Slovenia in comparison to other Central and Eastern European countries
Opis:Background. Primary health care (PHC) is an integral part of health care systems, and the predominant model of care in Europe in PHC is family medicine. Functional systems need adequate financing and work organization, both of which are necessary for good access, which is an element of equity in PHC. Purpose. To define quality indicators (QI) and analysis of access to PHC in terms of work organization and financing. The goals were to assess QI for PHC in terms of structure/conditions, procedures/processes and outcomes, evaluation of PHC quality elements and comparison of results for Slovenia (SLO) with other countries. Patients and methods. The survey was part of the survey Quality and Costs of Primary care in Europe (QUALICOPC) in 34 countries in the period from year 2011 to 2013. Data for ten Central and Eastern European countries (CEECs): Bulgaria, Czech Republic, Estonia, Latvia, Lithuania, Hungary, Poland, Romania, Slovakia and SLO were used. We analyzed the answers from two questionnaires for 2103 randomly selected family physicians and 18819 of their patients. Used statistical methods were: presentation of data with descriptive statistics, frequency distributions, means and variations, definition of QI with proportions, testing assumptions with different tests and finding connections between variables with factor analysis. Results. Analysis of the patient's answers in SLO and CEECs regarding their assessment of the organization of PHC work showed a small number of patients with negative experiences for longer time and distance to the practice, inability to get a home visit, ability to obtain evening, night and weekend services, and regarding their assessment of the affordability: the doctor was too much concerned about money, having to postpone a doctor's visit because they did not have insurance or for other financial reasons, or having to postpone or cancel a doctor's visit for other reasons. Typical variables for the organization of work were computer use, number of disciplines in the practice/centre, the use of medical records from previous doctor, the percentage of patient consultations by appointment, the possibility for patients to visit the practice/medical centre after 6:00 p.m., and how many hours in working day the practice/medical centre is open for patients. Statistically significant differences were found in a comparison of QI between SLO and CEECs. In the structure QI, Slovenian doctors, compared to doctors in CEECs, had a statistically significantly different and 1) more equipment (SLO 15,30, CEECs 13,0), 2) larger number of disciplines of experts (SLO 4,18, CEECs 2,60), 3) higher capitation (SLO 1950,01, CEECs 1894,7), 4) higher number of contacts with patients during the working day (SLO 45,27, CEECs 33,7), 5) shorter consultations with patients (SLO 9,59, CEECs 13,1 minutes), 6) lower number of home visits (SLO 2,21, CEECs 6,9), 7) the most common form of their employment was salaried employment (SLO 73,7 %, CEECs 30,1 %), 8) more frequent source of their income was salary (SLO 85,2 %, CEECs 61,5 %), 9) working more often with a nurse (SLO 98,1 %, CEECs 87,8 %), 10) cooperating more often with practice nurses (SLO 76 %, CEECs 41,8 %). For the process QI, Slovenian physicians used statistically significantly different and 1) more clinical guidelines (SLO 3,85, CEECs 3,15), 2) participated in more chronic disease treatment programs (SLO 1,71, CEECs 1,13), 3) were involved in the treatment of more diagnoses (SLO 11,42, CEECs 9,09), and 4) performed more procedures (SLO 2,43 , CEECs 1,30). Conclusion. Several changes should be made to PHC in SLO. In terms of funding, we propose to implement financial incentives for quality of work, as a tool for measuring quality QI for procedures/processes and outcomes of care, in terms of work organization multidisciplinary model of care, continuing to reduce capitation and at the state level, the establishment of an independent technical institution.
Ključne besede:primary health care, family medicine, work organization, financing system, equity, access to care, Slovenia, Central and Eastern European countries, quality indicators, recommendations


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