Results: QMS have been implemented in 63.9 per cent of the Lithuanian general hospitals. This system is currently under implementation in 22.2 per cent of the hospitals mentioned, and no QMS have been implemented so far in 13.9 per cent of the Lithuanian general hospitals. More than one third of institutions have implemented the ISO standard. Institutions wich have alredy implemented the QMS enjoy higer patient satisfaction (accordingly 5,36 (1,05) and 4,18 (2,14)), improved quality of the services provided (accordingly 6,09 (0,32) ir (4,83 (1,64)). The functioning QMS improves motivation of the employees (4,60) and the patient safety (5,83). Hospitals with the well-functioning QMS more actively record (accordingly 4,78 (2,19) and 2,73 (1,62)) and analyse adverse events (accordingly 5,41 (2,01) and 3,09 (1,97)). Recording of adverse events helps to identify problems (6,41), improve the quality of the services provided (6,13). Conclusions: 1. QMS have been implemented in more than a half of the Lithuanian general hospitals. The hospital managers and the managers of the local medical audit group acknowledge important role of the QMS. 2. Hospital managers and managers of the local medical audit group implementing the QMS in hospitals have encountered with the following problems: the employees avoid recording adverse events, the staff lacks motivation to engage in implementation of the quality management system, hospitals lack employees competent in the field of quality... [to full text]

SUMMARY Management of Public Health ORGANIZATION OF DISEASES PREVENTION IN PRIMARY HEALTH CARE Raminta Gečaitė Supervisor Skirmantė Starkuvienė, MD, PhD, Lecturer, Department of Social Medicine, Faculty of Public Health, Kaunas University of Medicine. – Kaunas, 2005. - P.56. Aim of the study – to evaluate patients’ attitude towards the non-communicable diseases (NCD) prevention in primary health care and to clarify the differences of the prevention between general practitioners (GP) and therapeutists. Methods. The anonymous questionnaire survey was performed among adult patients, who visited their family doctor in Kaunas Kalniečiu outpatient clinic, at the Department of General Practitioners and General clinic (the work is organized in a team principal). There were 120 questionnaires distributed to the patients of GP and 101 of them were fulfilled and returned back (response rate – 84.2%). There were also 120 questionnaires delivered to the patients, who visited therapeutists and 98 of them were filled in (response rate – 81.7%). The data was analyzed by the application of statistical package SPSS 11.03 for Windows. The associations between the variables were measured using the Chi-squared and the Student tests. Results. The survey disclosed that 15.6% of the respondents visited the family doctor in order to examine their health preventively. More than half (51.8%) of the patients were satisfied with the organization of diseases prevention carried out by their family... [to full text]

SUMMARY Management of Public Health JOB SATISFACTION AMONG COMMUNITY NURSES Danutė Adomavičiūtė Supervisor Jurgita Vladičkienė, Dr.Sc., Department of Social medicine. Faculty of Public Health, Kaunas University of Medicine.- Kaunas, 2005.- P.71 Primary health care is a priority field of health care in Lithuania. Community nursing as a part of primary health care meets with development difficulties. First of all, is paid too few attention to community nurses, in primary health care institutions is a shortage of them, but customers wishes more of community nurses lent services. Aim of the study is to investigate job satisfaction level among community nurses in Kaunas primary health care institutions. Objectives are to evaluate general job satisfaction level among community nurses, to establish relationship between job satisfaction and work factors, and relationship between job satisfaction and nurse’s efforts better to work, to establish needs of community nurses. Methods. Object of study is community nurse’s job satisfaction. A sample of 174 nurses was questioned with the aid of anonymous questionnaire. Statistic data reliability was tested by Chi square test of independence, degrees of freedom quantity (df) and statistical significance (α=0,05). Results. There was established, that 60,3% nurses are content with their own job and 39,7% - unsatisfied. Calculated common average of job satisfaction grade was 2,63 (±0,770), by evaluating in scale from 1 to 4 (where 1 is... [to full text]

Sveikatos priežiūros paslaugų prieinamumas – tai kiekvieno gyventojo galimybė ligos ar kito patologinio proceso atveju pasinaudoti sveikatos priežiūros teikiamomis paslaugomis. Darbo tikslas – įvertinti sveikatos priežiūros paslaugų prieinamumą sveikatos priežiūros įstaigoje „Telšių sveikata“, priklausomai nuo demografinių – socialinių pacientų charakteristikų. Tyrimo metodika. 2006 m. balandžio mėn. atliktas anoniminis anketinis pacientų tyrimas. Apklausoje dalyvavo UAB „Telšių sveikata“ pas bendrosios praktikos gydytojus besilankantys pacientai. Buvo išdalinta 400 apklausos anketų, užpildyta ir grąžinta – 359, atsakas – 89,75 proc. Statistinė duomenų analizė atlikta SPSS 10 versijos programiniu paketu. Rezultatai. Daugiau kaip pusė visų respondentų (62,8 proc.) į bendrosios praktikos gydytojus kreipiasi dėl ligos. Dažniau moterys (5,4 karto), negu vyrai (4,5 karto). Pirminės sveikatos priežiūros prieinamumas teritoriniu požiūriu geresnis miesto respondentams. Jie greičiau pasiekia savo gydymo ���staigą, todėl patenkintų kelionės laiku iki UAB „Telšių sveikata“ dvigubai daugiau yra miesto respondentų (92,0 proc.), kaimo (47,3 proc.). Dažniausiai registracijos talone nurodytu laiku pas gydytoją nepatenka vyriausi respondentai (31,6 proc.). Laiku nepatekę, prie gydytojo kabineto durų ilgiau priėmimo laukia kaimo respondentai. Taip pat ilgiau laukia vyrai, negu moterys. Daugiau kaip valandą laukia 11,0 proc. vyrų ir 1,5 proc. moterų. Organizaciniu požiūriu sveikatos... [toliau žr. visą tekstą] / Introduction. The accessibility of primary health care – in the chance for the each citizen to avail oneself of health care services in case of illness or pathological process. The aim of study. To evaluate the accessibility of health care services in primary health care service office „Telšių sveikata“ depending on the patients demografic – social characteristics. Methods. An anonymous questionnaire study was carried out in April 2006. Patients visiting the doctors of primary health care service office “ Telšių sveikata” filled in the questionnaire. 400 questionnaires were distributed among patients, of which 359 questionnaires were completed. The response rate of completed questionnaires was 89,75. Statistical analysis of the data was conducted using SPSS programming packet. Results. More than half of all respondents (62,8%) consulted a doctor due to illness. More frequently female patients (5,4 times), male patients (4,5 times). The territorial access of primary health care is better for urban respondents, because they could easies to reach their health care institution 92 % of them are satisfied in time, reaching the places only 47,3 % of rural patients. 31,6 % of senior patients can’t see the doctor at the fixed time. Rural respondents waited at the physician room longer than urban respondents, longer waited male patients than female. More than one hour had waited 11,0 % males and 1,5 % females. The organizational access was better for urban young... [to full text]

Despite the fact that patients‘ participation has become an integral part of health care system in health problem solving, it is little known, however, about the preparation of society for these changes. Aim of the study – to evaluate patients‘ role in health care decision-making in primary health care system. Methods. Research instrumentation was developed by using descriptive-analytical method of literature analysis. 464 questionnaires returned out of 550 questionnaires provided. The frequency of response is 84.4 %. Independence of two features was examined by (2 chi-square test of independence. Spearman correlation coefficient was used to evaluate the level of dependence. The data were analyzed by SPSS 9.0 programme. Results. More than a half (56 %) of respondents, especially women (87.8 %) and respondents with university education (88.1 %) know the rights of patients. Respondents with university education (90.8 %) and medical workers (95 %) mostly know about The Act of Patients‘ Rights and Harm Recompense. According to patients, independently from sex, age etc., the most secured rights to health care are the following: to know diagnosis, methods of treatment, risk factors, the right to patients‘ inviolability of private life and confidentiality of health state. From the point of view of medical workers, the most secured rights to health are the following : the right to choose a doctor, a nurse, an institution of health care; the rigth to information about... [to full text]

Aim of the study. To evaluate patients’ attitude towards the accessibility of primary odontology care and their satisfaction with the services in public health care institution. Investigation methods. The patients were questionared in Odontology department for primary health care of public institution Kaunas “Kalniečių“ policlinic. 230 questionnaires were delivered, 198 respondents answered the questions (response rate 86%). Statistical data analysis was carried out on the basis of program package SPSS 10.0. Correlation between peculiarities was estimated according to the Chi square criterion test (χ2). The hypothesis concerning the comparison of two independent variables average was tested on the basis of Stjudent ( t ) criterion. Correlation strength among range variables was tested on the basis of Spearman correlation coefficient. As the basis for hypotheses checking was chosen significance level equal to 0,05 or less. Results. The majority of respondents evaluated primary health care odontolgy department from the financial point of view, communication and organization as satisfactory. The bigger part of respondents did not face any problems in: fee for odontology materials (73,2%), arrival to doctor – odontologist (66,5%), 79,2% claimed having had a possibility to select a doctor, 42,8% of the respondents had to spend up to 10 minutes at the receptionists’, while 42,3% of them spent at the receptionists from 10 to 15 minutes. Some accessibility specimen had a primary... [to full text]

Tyrimo tikslas – nustatyti antibiotikų skyrimo ypatumus Lietuvos pirminės sveikatos priežiūros įstaigose gydant suaugusių žmonių (nuo 18 m. amžiaus) kvėpavimo takų infekcijas. Tyrimo uždaviniai: 1. Nustatyti kvėpavimo takų infekcijų struktūrą. 2. Įvertinti mikrobiologinių tyrimų ir kitų diagnostinių tyrimų naudojimą suaugusiems sergantiems kvėpavimo takų infekcijomis (KTI). 3. Nustatyti antibiotikų skyrimo dažnumą gydant suaugusių KTI privačiuose centruose ir poliklinikose. 4. Nustatyti skiriamų antibiotikų struktūrą gydant suaugusių KTI privačiuose centruose ir poliklinikose. Tyrimo metodika ir apimtis. Atliktas aprašomasis retrospektyvinis paplitimo tyrimas. Daugiapakopės atsitiktinės atrankos būdu atrinktos 1767 ambulatorinės kortelės suaugusių asmenų, kurie 2004 m. gydėsi ambulatorinėse įstaigose. Surinkti ir išanalizuoti bendri duomenys apie ligonį (amžius, lytis), duomenys apie 1 metų bėgyje nustatytas infekcijas, paskirtą antimikrobinį gydymą, atliktus diagnostinius tyrimus. Duomenų tvarkymui ir analizei naudotos Epi Data, SPSS, WinPepi, Epi 6 programos. Rezultatai. Iš viso tirtiems asmenims diagnozuota 1141 infekcija, iš kurių didžiausią dalį (84,1%, 959) sudarė KTI. Daugiau diagnozuota VKTI (66,0%, 633) nei AKTI (34,0%, 326). Dažniausiai diagnozuota tarp VKTI buvo ūmi virusinė KTI (41,5%), faringitai (28,9%), o tarp AKTI - ūmūs bronchitai (52,1 %). KTI paplitimas privačiuose centruose buvo didesnis (74,1%) nei poliklinikose (36,0%) (p<0,001). Vyrų ir moterų tarpe KTI... [toliau žr. visą tekstą] / The aim of this study was to describe prescription of antimicrobials to treat adult respiratory tract infections in Lithuanian primary health care. The tasks of the investigation: 1. To define the structure of respiratory tract infections (RTIs). 2. To rate the use of microbiological and other diagnostic tests in adult patients with RTIs. 3. To determine the antibiotic prescription rates for adult RTIs in private centers and polyclinics. 4. To define the structure of prescribed antibiotics for the treatment adult RTIs in private centers and polyclinics. Methods and volume of the investigation. The retrospective prevalence study was carried. Randomly selected 1767 medical records of adult pacients, who visited physician during 2004 year were analysed. Data about patients (age, sex), infection, antimicrobial treatment, diagnostic tests were registered and analysed. Data were managed and analysed using Epi Data, SPSS, Win Pepi, Epi 6 statistical programmes. Results. There were 1141 infections diagnosed overall. RTIs were the most prevalent and composed 84,1% (959) of all diagnosed infections. Upper respiratory tract infections (URTIs) were more frequent (66,0%, 633) than lower respiratory tract infections (LRTIs) (34,0%, 326). The most frequent diagnoses were acute viral respiratory tract infection (41,5%), pharyngitis (28,9%) among URTIs and acute bronchitis (52,1 %) among LRTIs. Prevalence of RTIs was higher in private centers (74,1%0 than in polyclinics (36,0%) (p<0,001)... [to full text]

Įvadas. Pertvarkant pirminės sveikatos priežiūros (PSP) įstaigų tinklą, siekiama gerinti sveikatos priežiūros paslaugų prieinamumą, priimtinumą ir kokybę. Todėl, aktualu periodiskai tirti pacientų požiūrį į sveikatos priežiūros paslaugų prieinamumą bei priimtinumą įvairioms socialinėms grupėms. Darbo tikslas: nustatyti ir įvertinti pacientų požiurį į sveikatos paslaugų prieinamumą bei priimtinumą Varėnos pirminės sveikatos priežiūros įstaigoje ir jų ryšius su socialiniais demografiniais veiksniais. Tyrimo metodika. 2006.03.01 – 2006.03.10 laikotarpiu VšĮ Varėnos PSP centre buvo atliekama anoniminė anketinė pacientų apklausa. Apklausoje dalyvavo VšĮ Varėnos PSP centre(miesto gyventojai) ir jo filialuose (kaimo gyventojai) besilankantys pacientai. Buvo išdalinta 280 anketų, atsakė – 208 respondentai (atsakas – 74 proc.). Statistinė duomenų analizė atlikta SPSS 9 versijos programiniu paketu. Rezultatai. Pagrindinis šeimos gydytojo pasirinkimo motyvas yra gydytojo profesionalumas, žinios ir patirtis (72,6 proc.).Centre sveikatos priežiūros paslaugų teritorinis, finansinis, organizacinis ir informacinis prieinamumas buvo geresnis negu jo filialuose.Visi centro pacientai per vieną valandą pasiekdavo PSP įstaigą, tuo tarpu filialų – tik 54,1 proc. respondentų (p<0,05). 32,3 proc. centro respondentų buvo finansiškai pajėgūs įsigyti vaistus, o filialų – tik 15,6 proc. (p<0,05). Prie registratūros langelio ilgiau negu 15 min. laukė 11,1 proc. centro respondentų, o filialų – 26... [toliau žr. visą tekstą] / Introduction. The reorganization of the network of primary healthcare (PHC) institutions is aimed at the improvement of the accessibility, acceptability, and quality of healthcare services. For this reason, periodical investigations of the patients’ attitude towards the accessibility and acceptability of healthcare services to various social groups are relevant. The aim of the study was to determine and evaluate patients’ attitudes towards the accessibility and acceptability of healthcare services in Varėna district primary healthcare unit, and to evaluate the relationships of these attitudes with socio-demographic factors. The methods of the study. During the period of March 1, 2003 to March 10, 2006, we performed an anonymous questionnaire-based inquiry of patients at Public institution Varėna PHC center. The participants of the inquiry were patients who visited Public institution Varėna PHC center (patients living in the city) and its branch offices (patients living in the countryside). In total, 280 questionnaires were distributed, 208 of which were returned (the response rate was 74%). Statistical analysis of the obtained data was performed using the SPSS v. 9 software package. Results. The main motive for the choice of the family physician was the physician’s professionalism, knowledge, and experience (72.6% of answers). The territorial, financial, organizational, and informational accessibility of services at the PHC center was better than in its branch offices... [to full text]

Globally neonatal mortality accounts for 40% of under-five deaths. Participatory interventions where the local problems are addressed have been successful in some settings. The aim of this thesis was to describe challenges in perinatal health in a Vietnamese province, and to evaluate the effect of a facilitated intervention with local stakeholder groups that used a problem-solving approach to neonatal survival during three years. The NeoKIP trial (Neonatal Knowledge Into Practice, ISRCTN44599712) had a cluster-randomized design (44 intervention communes, 46 control). Laywomen facilitated Maternal-and-Newborn Health Groups (MNHGs) and used Plan-Do-Study-Act cycles to address perinatal health problems. Births and neonatal deaths were monitored. Interviews were performed in households of neonatal deaths and randomly selected live births. Use of health services was mapped. The primary healthcare staff’s knowledge on newborn care was assessed before and after the intervention. Neonatal mortality rate (NMR) was 16/1000 live births (variation 10 - 44/1000 between districts). Home deliveries accounted for one fifth of neonatal deaths, and health facilities with least deliveries had higher NMR. Main causes of death were prematurity/low birth-weight (37.8 %), intrapartum-related deaths (33.2 %) and infections (13.0 %). Annual NMR was 19.1, 19.0 and 11.6/1000 live births in intervention communes (18.0, 15.9 and 21.1 in control communes); adjusted OR 1.08 [0.66-1.77], 1.23 [0.75-2.01], and 0.51 [0.30-0.89], respectively. Women in intervention communes more frequently attended antenatal care, prepared for delivery and gave birth at institutions. Primary healthcare staff’s knowledge on newborn care increased slightly in intervention communes. This model of facilitation of local stakeholder groups using a perinatal problem-solving approach was successful and may be feasible to scale-up in other settings. / NeoKIP project in Vietnam

Purpose: The purpose of this thesis was to perform a scoping review of the current literature and available clinical practice guidelines to generate an understanding of the primary health care needs of women following treatment for breast cancer. Methods: Based on an extensive scoping review of the literature, research findings regarding the complications of breast cancer treatments and corresponding primary care interventions were synthesized. Additionally, validation of the findings of the scoping review was performed through semi-structured interviews with two primary care physicians and three post-treatment breast cancer patients. Results: Eleven broad categories related to the primary health care needs of women after undergoing treatments for breast cancer were identified. These included concerns related to: surgical complications, lymphedema, gynecologic and menopausal symptoms, psychosocial issues, additional primary cancers, cardiovascular implications, osteoporosis, lifestyle changes, fatigue, cognitive dysfunction, and pregnancy. Additionally, it was determined that the majority of existing clinical practice guidelines for breast cancer were outdated, and related to cancer detection and treatment as opposed to survivorship care. Summary: Findings from the scoping review and interviews demonstrate the vast range of primary care needs of women after undergoing treatment for breast cancer. Additionally, these results highlight the critical need for the development of a comprehensive set of current clinical practice guidelines which target primary care physicians and are specifically focused on the survivorship needs of women following breast cancer treatment. / Thesis (Master, Rehabilitation Science) -- Queen's University, 2011-07-22 16:09:35.682