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Overview of Context and Performance of Primary Care System in Serbia

TRANSHIS Meeting, Amsterdam, March 31, 2011 Milan Jevtić, Predrag Životić. Overview of Context and Performance of Primary Care System in Serbia. Amended from: Bjegović V. and Rasmussen BL. 2002. Primary Health Care Service Providers. PC Doctors , “chosen by citizens”

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Overview of Context and Performance of Primary Care System in Serbia

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  1. TRANSHIS Meeting, Amsterdam, March 31, 2011 Milan Jevtić, Predrag Životić Overview of Context and Performance of Primary Care System in Serbia

  2. Amended from: Bjegović V. and Rasmussen BL. 2002

  3. Primary Health Care Service Providers • PC Doctors, “chosen by citizens” • Adults (Age 19+): a doctor of medicine or a doctor of medicine specialist in general practice, or a specialist in occupational medicine • Children (Age 15 –): a doctor of medicine, specialist in paediatrics,or a specialist in general practice • Women (Age 15 +): a doctor of medicine specialist in gynaecology • Dentists • Other Specialists (Consultants in PHC Centers) • Nurses, Midwifes, Physiotherapists, Lab technicians, Radiology Technicians, Pharmacy Technicians… • Pharmacists (Community)

  4. Key features Hospital Care “Driven” System 1 5 Fragmentated Health System 2 Compromised continuity of and access to care (effec. coverage) 3 Weak Primary Care 4 “Medicalized” Primary Care

  5. State of affairs in Primary Carein Serbia Overview of results from the WHO Primary Care Evaluation Tool (PCET) Wienke Boerma, Dionne Kringos (NIVEL, NL) Martina Pellny, Valentina Baltag (WHO Euro)

  6. PCET Serbia: 3 areas • Vojvodina • Novi Sad • Sombor • Indija • Belgrade • Stari Grad • Voždovac • Central Serbia • Niš • Doljevac • Smederovo

  7. Patients and doctors... • Patients are positive about professional skills of their • doctor (especially GPs) • Patients are positive and confident about their PC • doctors (especially patients of GPs) • (% patients feeling better to cope with condition after consultation)

  8. Continuity • Medical records are well kept but on paper • Difficult to retrieve information by categories • (% easy to generate this information; according to physicians)

  9. Strong regional variation in use of computers • (% using a computer; according to physicians) • Physicians use computers sparsely • (% using a computer; according to physicians)

  10. Computers are not used for searching information • (% using the computer for searching information; according to physicians)

  11. Key conclusions • At central level: fragmented coordination of PC • Recruitment problems for GPs • Weak organisation of PC physicians • Copayment in PC may threaten equity • PC physicians lack incentives for performance • Low use of guidelines; • Patients are positive about their PC doctor • Possibilities of ICT are hardly used • Cooperation and teamwork are poorly developed • Very limited clinical service profile in PC (spec. GPs) • PC physicians are poorly equipped

  12. Key conclusions (continued) • Regional variation in PC working conditions • Many patients referred from PC to secondary level • Regional variation in referrals to secondary level • ‘Chosen’ doctors are ‘by-passed’ • Curative home care services poorly available • CME not focused on improving individual capacity • Quality could benefit from more use of guidelines • Potentials of nurses in PC are not used • Health promotion is a priority not recognised by patients

  13. Overall: Extensive network of PC services, with devoted workers and patients who are positive about their doctor Fragmented system with little challenges to workers and many possibilities to improve service quality and efficiency

  14. Use of Transhis Based Software in Kraljevo TRANSHIS Meeting, Amsterdam, March 31, 2011

  15. Municipality of Kraljevo • Kraljevo • Population ≈ 127.000 • Surface ≈ 1.200 km2 • ≈No of PHC Doctors: 60 GPs, 15 Paed., 12 OB/GYN

  16. Key features Advanced organizational structure (compared to the rest of Serbia) 1 5 Allstaff of PHC center in Kraljevo use on a regular basis EPR 2 No system incentive to use EPR 3 Questionable reliability quality of data (compared to intl. standards) 4 Local staff initiatives

  17. Challenges and Issues • Absence of ownership • Frequent personal changes • Heath Care System design (ICPC vs. ICD) • Attitudes • Fragmentation • Data Quality and Reliability • Standardized approach

  18. Solid ground for further development • Many users in a defined catchment area • Large amount of generated data over time • Acceptance of certain principles (mainly in IT community) • Standards for PHC software development in Serbia inclusive of core concepts (RfE, Episode of Care)

  19. Use of Transhis Based Software in Kraljevo,GP Department Data Set 2008-2010 TRANSHIS Meeting, Amsterdam, March 31, 2011

  20. Age-sex profile of database 2007-2010, baseline population 127.000

  21. Scope of the Database, Basic Figures 2008-2010

  22. Top ten Episodes of Care, year 2008

  23. Top ten Episodes of Care, year 2009

  24. Top ten Episodes of Care, year 2010

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