Primary health care is a part of health care chain, in which primary contact of individuals, families and society is made with national health system, making health care nearer to people’s living and work places. In Lithuanian health program it is estimated to decentralize the management of health care institutions and create conditions for the development of private health institutions. In Lithuanian national health system it is possible to distinguish three models (types) of institutions, providing primary health care, depending on service organization and ownership type. This research is seeking to evaluate the changes of primary health care institutions in the context of health care reform, evaluate them among institutions of different models, depending on service organization and ownership type. The aim: to distinguish the differences of Vilnius region institutions providing primary health care, depending on peculiarities of work organization. Methods: In years 2003 – 2005 a cross-sectional descriptive research was carried out. The data of State Patient Fund information system database Sveidra was analyzed. The research includes all institutions of Vilnius region, which provided primary health care services in years 1998 – 2003 and signed agreements with Vilnius Territorial Patient Fund. All the chosen institutions were divided into three groups: public institutions, providing primary care and secondary health care services, the establishers of which are... [to full text]

SUMMARY The aim of the study is to evaluate attitude of physicians and patients towards primary health care reform. The objectives: 1) to assess patients' attitude to primary health care reform and its relations to demographic and social factors. 2) to evaluate physicians' attitude to primary health care reform. 3) to compare viewpoint of patients and physicians on primary health care reform. Methods. The subject of the survey is the attitude of the patients and physicians towards primary health care reform. The survey was conducted in five primary health care centres and three private primary health care practices in Prienai region. Of the 400 questionnaires handed out to patients 82.5% were returned and of the 112 questionnaires given to doctors 87.5% were returned. The participants in the survey were 330 patients and 98 medical doctors. The questionnaires were compiled both for the patients and the doctors. The questionnaire for the patients covered 24 questions, for the doctors - 19 questions. The data analysis was done applying the statistical package SPSS 11.0 version. The statistical procedures were employed by Chi-square’s (χ2) parameters, degree of freedom and statistical significance. The difference of indices were statistical significant at p<0.05. Results. 55.9% of the patients’ attitude towards primary health care reform is positive, while 29.9% of the patients - negative. 18.3% of the patients have the opinion that due to health care reform the quality of... [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 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]

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]

Tyrimo metodai. 2006 kovo-balandžio mėnesiais atlikta pacientų anoniminė apklausa trijose poliklinikose: Antakalnio, Karoliniškių ir Šeškinės. Apklausti pirminio lygio paslaugomis (išskyrus moterų konsultacijas ir odontologų paslaugas) pasinaudoję pacientai (n=700). Užpildytos 534 anketos - atsako dažnis 76,28%. Statistinė duomenų analizė buvo atlikta personaliniu kompiuteriu, panaudojant statistinės analizės SPSS programinį paketą. Rezultatai: 79% apklaustųjų per paskutinius dvejus metus lankėsi sveikatos priežiūros įstaigose. Daugiau negu pusė (nuo 60,3% iki 73,6%) apklaustųjų nurodo, kad per paskutinius dvejus metus „pagerėjo“, net „labai pagerėjo“ gydytojų ir slaugytojų darbo kokybė bei dėmesys pacientui. Registratūros darbuotojų dėmesio pacientui ir poliklinikos darbo organizavimo pokyčius teigiamai vertina kiek mažiau nei pusė apklaustųjų – 49,3% ir 48,5% atitinkamai. 45,9% respondentų nurodė, kad patekimas pas gydytoją-konsultantą per paskutinius kelerius metus „pasunkėjo“, tačiau 46,3% respondentų nurodė, kad ambulatorinio ištyrimo galimybės pagerėjo. Jei reiktų kreiptis į gydytoją-specialistą, esantį kitoje gydymo įstaigoje, net 76,2% respondentų tai sukeltų nepatogumų. 63,3% respondentų vertina palankiai faktą, kad gydytojas rašydamas nukreipimą pas gydytoją-specialistą, nenurodo konkrečios gydymo įstaigos. 60,9% respondentų vertina nepalankiai, kad vietoj specialisto reikia kreiptis į bendrosios praktikos (BPG) / šeimos gydytoją. 72,5% respondentų nemano, kad... [toliau žr. visą tekstą] / Methods. Anonymous questionnaire survey of the patients (n=700) was carried out in March-April 2006 at three out- patients’ clinics in Vilnius city: Antakalnis, Karoliniškės and Šeškinė. The interview was conducted only with those patients who were seeking primary care service (excluding gynecology/obstetrics and odontologists). 534 questionnaires were filled in – the response rate was 76.28 %. The data were analyzed on PC using statistical analysis package SPSS. Results: 79 % of respondents indicated that during recent two years they visited medical care institution. More than a half (60.3 %-73.6 %) of respondents indicated that the attention to patients and the quality of work performed by doctors and nurses during recent two years became „better“ or even „extremely better“. Less than a half of respondents gave a positive evaluation concerning the changes of registration personal‘s attention to patients and organization of work at medical care institution – 49.3 % and 48.5 % respectively. 45.9 % of respondents indicated that access to a specialist doctor during recent several years became „more difficult“, but 46.3 % of respondents indicated that the capacity of medical investigation/diagnostics at primary care institution became better. 76.2 % of respondents would experience difficulties if they would be referred to a specialist based in another medical care institution. 63.3 % of respondents are positive towards the fact that in a referral to specialist there is no... [to full text]