European General Practice Research Network (EGPRN)

Abstract

Latvia is a country by the Baltic Sea populated by 1 969 000 inhabitants. It is called a ‘green’ country due to its forests and abundance of wildlife. About half of inhabitants above 15 years of age (45% women and 55% men) are sure that they are in very good or good health. Inhabitants are in general appreciating family medicine as 62% are fully and 28% are partly satisfied with their family physician. Representative studies on health behaviour of the Latvian population show that there is still a significant effort needed by both family physicians and patients to implement favourable lifestyle changes. For example, half of working-age people (54.6%) are overweight or obese and traditions of riding bicycles are still to be enhanced, as 77% report not riding bicycles at all. Latvians are still to be encouraged to accept preventive measures as coverage of cancer screening programmes is below 40% and human papilloma virus vaccination rates in 12-year old females do not exceed 45%. As both healthy life expectancy at birth (67.1 years) and the public spending on health as a share of GDP per capita (below 4%) is one of the lowest in the European region, effective primary healthcare (PHC) teams are essential in Latvia.In clinical family medicine, Latvia has implemented an impressive change since 1993. It has switched from the Soviet polyclinic-based healthcare system with different specialists dealing with individual health problems of a patient towards a Western system based on a comprehensive patient-oriented approach of a family physician. Since then the number of family physicians in the country has grown from 0 to 1450. The opinion of family physicians is now considered as an effort of two powerful associations: Association of Latvian Family Physicians and Association of Latvian Rural Family Physicians. A total of 1329 physicians have public agreements with National Health Service (6.7 PHC physicians per 10 000 inhabitants) and on average 1530 patients are registered per physician. Most family physicians have their private practices supported by one or two nurses or physician’s assistants. Primary healthcare paediatricians and internists form a minor part of PHC. E-medicine is being currently piloted. After trying different financing systems and models, Latvia has now stopped at mixed capitation model. Quality criteria are set but seem to be non-motivating. In this set-up, the main challenge is to fit competencies of the family physician so well incorporated in the Wonca tree into the legislative and financial framework of Latvia.As 54% of primary healthcare physicians are older than 55, education of young family physicians is crucial. The education system of a family physician in Latvia is like Lithuania and Estonia with six undergraduate years and three post-graduate years. Two universities (Riga Stradins University and University of Latvia) are training both undergraduate and postgraduate physicians. Family medicine is incorporated in the last year of the programme for undergraduates and there is a great intention to introduce basics of family medicine earlier. The prestige and number of medical students is growing every year in Riga Stradins University, e.g., during the academic year 2016/2017, a total of 315 students (including 116 international students) undertook a basic course in family medicine. Most students are satisfied with the course and a new perspective of problem-solving. On average 40 postgraduates are trained in family medicine each year since 2014 with most training in family medicine during the last year.Research in family medicine has been slower, compared to other Baltic countries. Establishment of the Department of Family Medicine in Riga Stradins University in 2010 was a serious sign of changing attitudes towards family medicine. Now the department comprises 10 lecturers with only one assistant professor in family medicine. The main challenge is involvement of clinically active, competent physicians into academic and research environment. Capacity building in writing project proposals and publications is still essential. Postgraduates (residents) are a serious potential for further research activities. Latvia is ready to continue its journey towards academic family medicine, and hosting the EGPRN Riga Conference is another big step towards reaching this target.