Šiame magistro darbe nagrinėjami žalos, padarytos pacientams, atlyginimo teisinio reguliavimo ypatumai, įvertinant Lietuvos valstybės pasirinktą žalos atlyginimo modelį, procedūrinius žalos atlyginimo klausimus, apžvelgiama pacientams padarytos žalos atlyginimo teisinio reguliavimo raida. Taip pat analizuojami mažai nagrinėti pacientams padarytos žalos atlyginimą reglamentuojančių teisės normų konkurencijos bei dualizmo klausimai bei šių normų taikymo skirtumai teismų praktikoje. Darbe analizuojamas pacientams padarytos žalos atlyginimo teisės normų taikymas teismų praktikoje, aprašomi probleminiai aspektai, susiję su šių normų praktikoje taikymu. Šio darbo tikslas yra nustatyti ar Lietuvos Respublikoje galiojantis pacientams padarytos žalos atlyginimo teisinis reglamentavimas yra tinkamas, efektyvus ir ar jis užtikrina sklandų paciento teisės į žalos atlyginimą įgyvendinimą praktikoje. Darbe nustatomi žalos pacientui atlyginimo teisiniai pagrindai, sąlygos, šalys, žalos atlyginimo būdai, taikomos atsakomybės rūšys ir ribos, nagrinėjami procedūriniai klausimai bei atliekamas šių teisės normų ir praktikos palyginimas. Pateikiamos išvados ir rekomendacijos galimam situacijos pagerinimui. / In this master thesis pecularities in legal regulation of damage remuneration caused to patients are analised, assessing the Lithuanian state selected damage compensation model, procedural damage compensation issues and an overview of evolution in legal regulation for remuneration of damages to patients is provided. The issues of competition and dualism in legal acts regulating remuneration of damage to patients and the differences in application of these legal acts in the cases of courts of law are analised, which were examined very little. In this thesis the application of legal acts regulating remuneration of damage to patients in judicial practice are analised, describing problematic aspects related to such application of these legal norms. The aim of this master thesis is to determine wheather the legal regulation for remneration of damages to patients in Lithuanian Republic is relevant, effective and whether it ensures a smooth patient's right to remuneration of damages in practice. In this work legal grounds, conditions, parties, means of compensation of damages, types of liability applied and its‘ limits are identified and procedural issues of compensation of damages to patients are analised, also the comparison of legal norms and judicial practice is carried out. Conclusions and recommendations for possible improvement are as well introduced.

Magistro baigiamąjį darbą sudaro 4 skyriai. Pirmajame skyriuje nagrinėta įrodymais grįstos politikos teorinė prieiga. Antrajame – įrodymų naudojimas sveikatos priežiūros srityje. Tuo tarpu trečiasis skyrius skirtas sveikatos priežiūros įstaigų bei paslaugų restruktūrizacijos analizei akcentuojant trečiojo restruktūrizacijos etapo pasiekimus. Galiausiai paskutiniame skyriuje koncentruojamasi į empirinę darbo dalį, išryškinant sveikatos priežiūros specialistų, sveikatos politikos formuotojų požiūrį į trečiojo restruktūrizacijos etapo rezultatus sveikatos priežiūros paslaugų bei trečiosios programos įgyvendinimo kontekste. Užsibrėžtas darbo tikslas: išanalizuoti trečiojo sveikatos priežiūros įstaigų ir paslaugų restruktūrizavimo etapo rezultatus remiantis įrodymais grįstos politikos teorine prieiga. Darbo uždaviniai: išanalizuoti įrodymais grįstos politikos teorinę koncepciją bei jos taikymą sveikatos priežiūros srityje; pasitelkus Lietuvos sveikatos ekspertų vertinimus, teisinį reglamentavimą, išnagrinėti sveikatos priežiūros įstaigų ir paslaugų restruktūrizacijos etapų pasiekimus; atskleisti paslaugų prieinamumo, kokybės ir saugumo pokyčius trečiojo restruktūrizacijos etapo kontekste; išanalizuoti stacionarinių paslaugų, finansavimo bei įstaigų tinklo optimizacijos rezultatus ir jų poveikį sveikatos priežiūrai; atskleisti trečiosios restruktūrizacijos programos tikslo bei uždavinių įgyvendinimo problemas; išnagrinėti trečiojo restruktūrizacijos etapo rezultatų... [toliau žr. visą tekstą] / The M.A. thesis consists of four chapters. In the first chapter the evidence-based theoretical approach to the political theory is analyzed. In the second chapter the use of evidence in the area of health care is discussed. The third chapter deals with the analysis of the restructuring of health care system, emphasizing results of the third stage of the restructuring. In the last chapter the empirical part of the research is presented. It shows the approaches of health care specialists and creators of health politics concerning the results of the third stage of restructuring in the context of health care delivery system and implementation of the third stage programme. The aim of the M.A. thesis is to analyze the results of the third stage of health care delivery system restructuring regarding the evidence-based theoretical approach to the political theory. In order to achieve the aim the following objectives have been set out: to review the thoretical conception of the evidence-based theoretical approach to the political theory and its application in the area of health care; to analyze the results of the stages of health care delivery system restructuring regarding the evaluation of Lithuanian health care experts and legal regulation; to show the changes in accessibility, quality and safety of health care delivery services in the context of the third stage of restructuring; to analyze the results of health care stationery services, financing and optimization of institution... [to full text]

The aim of the study – to evaluate patients‘ and physicians‘ opinion about the satisfaction of patients needs in primary health care. The objectives: 1. To explore patients‘ opinion about satisfaction of their needs in primary health care and dimensions of health care service quality. 2. To explore physicians‘ opinion about the satisfaction of patients’ needs in primary health care. 3. To compare patients‘ and physicians‘ opinion about the satisfaction of patients’ needs in primary health care. Methods. The study was conducted in Centro outpatient clinic in January-March, year 2006. The participants of the study were 394 patients 16-65 years old and 23 physicians. The study material was gathered using self-administrated anonymous questionnaires. The questionnaire for the patients covered 31 questions, questionnaire for the doctors – 29 questions. The data analysis was performed applying the statistical package SPSS version 12,0. The statistical procedures were employed by Chi- square’s (χ2) parameters, degree of freedom and statistical significance. Results. 48,9% of patients evaluate negatively the environment of the outpatient clinic waiting – room, 51,8% – the work of the registry, 56,85% of patients‘ - possibility to get medical consultation in convenient time, 64,28% - waiting time at the physician‘s office. 51,27 % of patients consider, that doctor is not attentive enough for them, 61,42% – doctors don‘t spare enough time for them, 53,81% - don‘t thoroughly evaluate... [to full text]

Aim of the paper: to analyze performance peculiarities of primary health care organizations (PHCO) and to propose possible ways for improvement. Methods: the analysis of scientific literature of Lithuanian and foreign authors, analysis of legal regulating documents, analysis of the results of the questionnaire of managers of PHCO, analysis of the results of the interview with experts. The object of research: performance assessment of primary health care organizations. Results: PHCO quality assessment and assessment performed by administrative organizations are the most often types of PHCO assessment in Lithuania. The results of the research show that data evaluating PHCO performance are fragmented and reflect only certain areas of PHCO activities. The quantity of the data does not correspond to the needs of PHCP managers in the strategic planning and implementation process. The assessment of PHCO performance is not dynamic and adjusted to the changing environment conditions. Experts unanimously pointed the need for the development of present PHCO performance assessment system and the need for its unification. Conclusions and practical recommendations: 1. Having done the analysis of scientific literature, we may conclude that problems of performance assessment are most often analyzed in business than in public sectors. The complex view to organization activities allows to analyze not only results of the organization, quality of performance but also to identify areas for... [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 PATIENT EVALUATION OF USING MARKETING ELEMENTS AT OUTPATIENT POLYCLINIC Aida Račienė Supervisor Ilona Bučiūnienė, Doc., dr. Departament of Social medicine, Faculty of Public Health, Kaunas University of Medicine.-Kaunas, 2005.- P. 83 Aim of the study - evaluate patient’s attitude towards the elements of marketing at Outpatient Polyclinic of Panevėžys region local administration. Objectives: 1) to investigate the existing patients satisfaction of marketing mix elements; 2) to investigate the evaluation of marketing mix elements according to patients social – demographic characteristics; 3) to estimate patients general level of satisfaction, repeated intention to use services; 4) to form basic direction of marketing improvement at polyclinic. Methods. The study was carried out in August, 2004. Questionnaires were used. 435 questionnaires were given out, 410 questionnaires were given back (frequency of response – 94,2). Likert’s five-point scale was used to investigate the satisfaction. Data was analysed using SPSS (version 10), Windows Microsoft Excel. Results. Experienced doctors (average 4,52), registration (4,51), physical evidence of polyclinic (4,13), information in the press (3,39) are the most important factors for respondents while choosing a medical institution. The respondents who seldom come to a medical institution are likely to come here again (4,51).The respondents who are signed at polyclinic for ≤ 10 years would recommend... [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]

Aim of the study: to evaluate teenagers mental health care needs and correspondence to their expectations. Methods: Participants were 15-16 years old (9-10 form) schoolchildren from Kaunas town and region secondary schools. Respondents were interviewed by anonymous questionnaire. We examined 1000 participants. The response was 80,8 percents, but 759 cases were analysed. There were used Epi-Data and SPSS 11.5 statystical programs to count the data. Chi-criteria and correlated analysis methods were used to ensure statistical reliability. Statistical conclusion was confidential at p £0,05. Results: Teenagers mental health conception and official mental health definitions were different. In qualitying mental health schoolchildren mostly emphasized inner shape; 21,6 percent associated it with reason, 10 percent- with behaviour and reaction to surroundings, 8 percents- brains and nervous activity. Some of respondents mixed up mental health concept with mental non-health and then they emphasized particular physical complaints, malfunction of nervous system and etc. The fifth (23 percent) of schoolchildren had various mental health complaints, 16,3 percent- problems in family, 12,8 percent- in school and 10,8 percent had difficulties in relations with friends. Teenagers didn’t attributed subjective problems to the problems group, which would be the reason to go to specialists. Girls used specialists favours more often as boys. Teenagers, who lived in region, had bigger needs... [to full text]

Darbo tikslas. Numatyti N poliklinikos Moterų konsultacijos teikiamų akušerinių – ginekologinių paslaugų prieinamumo gerinimo perspektyvas. Uždaviniai. Įvertinti N poliklinikos Moterų konsultacijos teikiamų akušerinių – ginekologinių paslaugų prieinamumą pacienčių požiūriu; numatyti N poliklinikos Moterų konsultacijos teikiamų akušerinių – ginekologinių paslaugų prieinamumo gerinimo priemones. Tyrimo metodika. 2007 m. kovo – balandžio mėn. atlikta Moterų konsultacijos pacienčių anketinė apklausa. Išdalinta 400 anketų. Atsakas – 85,5 proc. Statistinė analizė atlikta naudojant SPSS 12 programinį paketą. Ryšys tarp kokybinių požymių buvo vertinamas pagal chi kvadrato (χ²) kriterijų. Kiekybinių rodiklių palyginimui taikytas Stjudento kriterijus (t). Rodiklių ryšys laikytas statistiškai reikšmingu, kai p<0,05. Rezultatai. 85,4 proc. pacienčių tenkino Moterų konsultacijos darbo laikas. Dauguma pacienčių paprastai neturi problemų patekdamos pas norimą gydytoją. 81,9 proc. pacienčių planiniam vizitui pateko pas gydytoją per 2 dienas. 90,2 proc. besikreipusių skubi pagalba buvo suteikta tą pačią dieną. Registratūroje pacienčių sugaišto laiko vidurkis 8,8 min., prie gydytojo kabineto 19,16 min. Personalo teikiamą dėmesį ir norą padėti dauguma apklaustųjų įvertino gerai. 73,9 proc. pacienčių teigė patenkančios pas gydytoją lengvai ir labai lengvai. Daugumai pakako personalo suteiktos informacijos apie gydymą, profilaktiką ir šeimos planavimą. 63,5 proc. pacienčių, žinančių apmokamų... [toliau žr. visą tekstą] / Aim of the study. To foresee prospects for improvement accessibility of obstetric – gynaecologic service in the Women's health department. Objectives. To estimate the accessibility of service in the Women's health department toward patients attitude; to provide the means for improvement of service accessibility. Methods. A survey was carried out at the Women's health department in March - April in 2007. 400 patients participated in it. Response rate was 85,5 %. Statistical analysis was carried out using SPSS 12 programe. Associations between the qualitative variables were tested by chi squared (χ²) test. The quantitative variables were compared using the Student test (t). p<0,05 was considered as statistically significant. Results. 85,4 % of patients were satisfied with the working time of the department. The majority of patients had no problems with visiting desirable doctor. 81,9 % of patients were waiting for visit less than 2 days. 90,2 % of patients have got the necessary urgent service at the same day. The average of waiting time at the registration room was 8,8 minutes, at the doctors room – 19,16 minutes. The majority of patients were satisfied with the staff attention and efforts to help. 73,9 % of patients evaluated the possibility of consultation as easy and very easy. The majority of patients were satisfied with the information about treatment, prevention and family planning. 63,5 % of patients who knew the costs of services evaluated them as reasonable... [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]