Pirminės sveikatos priežiūros prieinamumas ir gyventojų pasitenkinimas paslaugomis šeimos medicinos plėtros konstekte

Show simple item record Plieskis, Mindaugas 2017-08-21T08:10:47Z 2017-08-21T08:10:47Z 2005
dc.description.abstract Introduction During the current decade, health care activities are being analyzed not only as a complex of measures that affect health but also as a national organizational structure with the mission to provide specific services. Managerial theory defines health care service as a whole of tangible and intangible benefits, which fulfills the requirements of the customer in the best way. During the Soviet era an extensive network of hospitals was created in Lithuania, and polyclinics with various specialists where responsible for the primary health care (PHC). After the fall of the totalitarian regime, the changes in the health care system where necessary in order to adjust the services to the new trends of social differentiation and new needs of the population. At the same time health care system becomes one of the many elements of the service system and functions according to the rules of the functioning of the consumer society (Geva 1996; Tse, Wilton 1988). The reform of the health care system in Lithuania started after regaining the independence. The reform was planed according to the recommendations of the World Health Organization (WHO); the aims of the reform where formulated, identifying the implementation of PHC (National Health Concept, adopted by the Seimas (Parliament) of the Republic of Lithuania, 1991) as a priority. The prioritization of PHC was done at the very beginning of the reform, but the real implementation of PHC can only be discussed since 1996, when the principles of compulsory health insurance where formulated and fixed by the law (the Law on Health Insurance, adopted by the Seimas of the Republic of Lithuania, 1996). This law defined the main principles of payment for health care services and the capitation was chosen as the payment model in PHC. The Lithuanian Health Program (adopted by the Seimas of the Republic of Lithuania, 1998) is also a very important strategic document that the clearly expressed the priority of PHC. The quality of the PHC services from the customer’s (the patient’s) perspective depends mostly on accessibility and effectiveness, i.e. whether the services are available at the right time and in the right place, and are of sufficient quality. It is widely recognized that the technical and interpersonal relations are among the most important elements of the effectiveness of PHC (Rosen, 2000). The quality of health care services is also defined as: 1) timely accessibility of health care; 2) high quality clinical care (diagnostics, treatment facilities, and clinical management); 3) high quality interpersonal relations (Ovretveit, 2000; Baker, 1998). The quality of the health is influenced by many factors. General assessment of the functioning of health care can be performed using the input indicators (e.g. medical personnel, its qualification, etc.), process indicators (e.g. the percent of immunized children in the population), and output indicators (Donabedian, 1966, 1980). Despite the wide discussion on how the quality should be measured, satisfaction of the customers and the level of this satisfaction are very important indications, since they reflect the perception of the customer if the right standards where achieved (Walsh, 1994), the customers’ decision concerning the “positiveness” of the service, and whether the provider of the services fulfilled the expectations and values of the customer (Donabedian, 1980). Avis and co-authors suggest that satisfaction should be used not as the only, but rather as a necessary indicator of quality (Avis, 1995). Overall quality of the health care system should be measured using a set of indicators, including both clinical and patient-oriented output indicators. Kaunas during the period of 2001-2003 in Lithuania was the city where the development and the expansion of private primary health care (PHC) was the fastest. The concentration of general practitioners (GP) is highest in Kaunas compared to the whole country. The biggest university that educates GPs – Kaunas University of Medicine - is operating in Kaunas. These are the reasons why the decentralization of PHC and the development of private PHC was faster compare to any other region of Lithuania. In this context Kaunas city could be regarded as the prediction model of PHC development in Lithuania, where the positive and negative experiences could be collected and afterwards used by implementing the PHC reform in whole country. This dissertation analyses the satisfaction of Kaunas habitants as the PHC customers with the PHC services during 2001-2003, when the decentralization of PHC, and the expansion of private PHC where most rapid. This study systematically analyses the differences in accessibility of and satisfaction with PHC according to the socio-demographic characteristics of the population groups, and also according to the proprietary form of the PHC unit (private vs. public owned). Health care reform is not self-oriented. Main aim of the reform is the patient, a citizen who is using health care services, and the satisfaction of the patient’s needs. Therefore the answer to the main question, i.e. if the implemented reforms increase the quality of health care and make it more accessible and more satisfactory – is very important to those who are responsible for these reforms. Observation of the customer’s satisfaction is crucial in achieving the best quality. From another perspective, this observation and satisfaction are determinants of the result of health care (Fitzpatrick, 1991). Satisfied patients more positively evaluate their own health and are more prone to cooperation, more precisely follow the physicians’ recommendations, and more actively participate in the treatment process (Stewart, 1989). Vice versa, the treatment of frustrated and unsatisfied patient is more complicated (Strasen, 1988). The understanding of the determinants of the patient’s satisfaction, and orientation to the aspects of health care, which are most important to the patient’s satisfaction is a potential condition for positive feedback, more rational usage of limited resources, and more smooth achievement of positive individual treatment results. The aim of the study The aim of the study was to determine and to evaluate the accessibility of and satisfaction with the primary health care services in Kaunas city, and to evaluate the inequalities and the trends in 2001 – 2003. The objectives of the study 1. To assess the usage of primary health care services in Kaunas city, the inequalities of the usage, and the trends in 2001 – 2003. 2. To evaluate the accessibility of primary health care services, and its relations with the social, demographic, and economic characteristics. 3. To evaluate the satisfaction of the inhabitants of Kaunas city with the primary health care services, and the dependence of the satisfaction on the social, demographic, and economic characteristics, and the factors of the doctor–patient relationship, proper information of the patient, and accessibility. 4. To evaluate inequalities of the accessibility of and satisfaction with primary health care with respect to the proprietary form of the primary health care unit (public versus private). 5. To determine the trends of the accessibility of and satisfaction with primary health care in 2001 – 2003. The hypothesis of the study The implementation and decentralization of the primary health care increases both the accessibility of primary health care services, and the patients’ satisfaction with them. However, the accessibility and satisfaction differ in different social, demographic, and economic groups. The accessibility of to and satisfaction with the PHC is related to the patient–doctor relations, proper patient information, and some organizational aspects of the PHC. The scientific novelty of the study The studies on the investigation of customers’ satisfaction with the health care services are quite popular, but in Lithuania they are only episodic, and do not evaluate changes of the satisfaction and accessibility over a certain time period. This study covers two main aspects – the accessibility of the PHC services and satisfaction with the PHC services - and these two aspects were analyzed coherently using the multidimensional model of the satisfaction. When evaluating patients’ satisfaction, we used the model of the patient’s self-positioning with respect to the whole health system. Two groups of patients were differentiated: the first group – those who accept the biomedical model of the relationship with the healthcare system (the patient follows physician’s directives closely and without asking any questions), and second group – those who favor bio-psychosocial or holistic model (active behavior and active communication during the treatment process (“I do not intend to follow the physician’s directives without asking any questions”). This study is the first one that covers the assessment and evaluation of the accessibility of and satisfaction with PHC during the period of changes (2001 – 2003). Practical significance of the study This study helps to develop the understanding of the accessibility of and satisfaction with PHC, and the relation, dependences and trends of this accessibility and satisfaction during 2001 – 2003. According to the results of this study, better accessibility and higher satisfaction can be achieved in PHC, and the results can help to estimate the priorities in the development of PHC, and at the same time – in the implementation of the Lithuanian Health Program. The results of the study are publicized in the lectures and seminars for the students of Kaunas University of Medicine, have been presented in conferences, and published in peer-reviewed journals. 2. Material and methods The contingent of the study The contingent of the study consisted of adult (aged 18 years and older) inhabitants of Kaunas city of both sexes. Two sectional studies were performed – the questionnaire-based surveys of
dc.language.iso lit
dc.subject Medicinos plėtra
dc.subject Sveikatos priežiūra
dc.subject Šeimos medicina
dc.title Pirminės sveikatos priežiūros prieinamumas ir gyventojų pasitenkinimas paslaugomis šeimos medicinos plėtros konstekte
dc.title.alternative The accessibility of the primary health care and the citizens sutisfaction with the services in the context of the development of family medicine
dc.type Daktaro disertacija

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