Health Care In Albania Research Articles

The National Therapeutic and Rehabilitation Center for Children - A New Model for Children Mental Health Care in Albania

The National Therapeutic and Rehabilitation Center for Children - A New Model for Children Mental Health Care in Albania

Correlates of level of satisfaction among primary health care workers in Albania

Aim: The aim of this study was to explore the level of satisfaction of primary health care staff in Albania and the factors associated with it. Methods: A cross-sectional study was conducted in Tirana city, the Albanian capital, from 11 November 2020 until 25 November 2020. Among all health centers (HCs) and health centers of specialties (HCSs) of Tirana Municipality, there were selected randomly a HC in rural areas, a HC in urban areas and one HCS. All the staff (doctors and nurses) being present at the time of data collection was interviewed, using an international standardized tool (the Dartmouth-Hitchcock Medical Center instrument) assessing the satisfaction with various elements of the work in PHC, validated in Albanian. A total of 102 PHC staff were included in the study. Binary logistic regression was used to assess the association of staff satisfaction with independent factors. Results: The aspects of work most appreciated by PHC staff (% satisfied or very satisfied) were: respectful treatment by colleagues (78.2%), staff morale and their positive attitude towards work (73.2%). The most disliked aspects of work by PHC staff (% dissatisfied or very dissatisfied) were: current salary (60.8%), stress at work (38.3%), physical and medical infrastructure in the institution (27%). Staff in rural HCs, older staff, females and nurses and family doctors are more likely to be satisfied compared to their respective colleagues. Conclusion: Our findings suggest various factors associated with the satisfaction of PHC staff in Albania. These findings could be guiding future efforts aiming to improve the work conditions of the professionals working in primary health care in Albania.

Patient Satisfaction Relation with Sociodemographic Variables in Hospital Health Care in Albania

Patient satisfaction is an important factor, which should be considered by health care managers, to evaluate the quality of hospital service. This analysis aims to show the relationship between socio-demographic variables, such as gender, age, level of education, level of income, and patient satisfaction regarding the quality of private and public hospital service in Albania, as well as to determine which of these variables has the major impact, and if there are differences between different groups. The study was conducted in five public and three private hospitals in two of the biggest cities of Albania, Tirana and Durres, where 480 patients were interviewed, over 18 years old who had received services in the five largest hospitals in terms of number of patients, from March to June 2019. The questionnaire was constructed according to the SERVQUAL model with its five main dimensions, and ANOVA analysis of variance and Tukey procedure was used as the method to test the hypotheses. The results showed that the socio-demographic factors that affected patient satisfaction in Albania were mainly age and educational level, results confirmed also from the literature review, while no relationship with gender was observed. In terms of income level, we can say that as revenue increases, the level of patient satisfaction decreases. The results of this study are important to understand the behavior of patients in relation to their satisfaction with health services in Albania, so that different categories receive the appropriate importance when providing health care. The study provides important data for health managers to take measures in improving service quality.

Consumption of opioid analgesics in the primary health care in Albania, 2010–2019

Authors discuss the use of opioid drugs (morphine, fentanyl, oxycodone, pethidine, and tramadol) in Albania, mainly at the primary health care level; and differences of prescription patterns over a period of 10 years.

Updating Nursing Competencies in Primary Healthcare in Albania; Transforming Roles Through Tailored Education.

Updating Nursing Competencies in Primary Healthcare in Albania; Transforming Roles Through Tailored Education.

Nursing in Albania: A Catalytic Force in Transforming Health Professionals and Health Care.

Transitions in nursing education and professionalism that align with global nursing standards are elucidated as critical success factors in transforming health professionals and health care in Albania. Progressive educational and regulatory pathways throughout the 2000s (1999-2020) are emphasized for their impact on the Albanian health system, including the achievement of universal healthcare coverage. Data collected by the Ministry of Health and Sport and the Regulatory Authority for nursing and other healthcare professions in Albania were analyzed and outcomes explicated with regard to Albania's major health challenges. Three milestones affirmed nursing as a driving force in the Albanian healthcare system: (a) nurses constitute the largest health professional workforce via a nurse-patient ratio of 1:400 in contrast to a physician-patient ratio of 1:2,500; (b) nurses are frontline care providers via clinical leadership in the management of primary healthcare centers, which ensure universal healthcare coverage; and (c) nurses are first responders via their presence and compassionate caring in the primary healthcare centers, including making critical shifts in converting primary healthcare centers to urgent care centers as needed. Nursing advancements have implicated quality care and professionalism in Albania across the health professions via three critical pathways: (a) health professional education at a university degree level for entry into practice (since 1999), which was prompted by and driven by nursing's quest to be a self-regulated profession (achieved in 2007); (b) healthcare global standards sparked by nursing's mandate toward professional autonomy, as achieved via regulatory procedures and policies; and (c) interprofessional healthcare initiatives that serve as collaborative platforms for innovative educational, clinical, and research projects.

Antipsychotic Drugs Consumption in Primary Health Care in Albania During the 2004 - 2016 Period

Antipsychotic Drugs Consumption in Primary Health Care in Albania During the 2004 - 2016 Period

Consumption of Anti-Epileptic Drugs in Primary Health Care in Albania, 2004-2016.

BACKGROUND:Epilepsy is a serious neurological condition requiring sometimes lifelong pharmacological treatment, and continuous specialist monitoring.AIM:To investigate the use of Anti-Epileptic Drugs (AEDs) in epilepsy, with focus on the exposure of AEDs, differences and changes in prescription patterns over time; to evaluate the relation between the consumption data of AED and the level of epileptic morbidity for the period 2004-2016.STUDY DESIGN:Official data regarding the consumption of AEDs within Albania were collected retrospectively. Every year of the period, 2004-2016 has been considered separately.METHODS:The data were assembled from Health Insurance Institute (HII) in Tirana, Albania and analysed for the period 2004-2016. The consumption of drugs was expressed as several Defined Daily Dose (DDDs)/1000 inhabitants/day. Also, for all the period under study 2004-2016, we analysed the data of import and domestic production of drugs, which represent the real consumption of drugs in the country. These data were subsequently involved in a comparative analysis with the utilisation data according to the HII, as well as through performing international comparisons of the consumption of AEDs drugs.RESULTS:Epilepsy morbidity data indicate that there exists a correlation statistically significant between this disease and the trend of consumption of AEDs.CONCLUSION:The present study suggests that the level of consumption for AEDs in Albania is very low when compared globally; with a decrease in the consumption of classic antiepileptic drugs and a parallel increase in the consumption of new generation drugs.

Utilization Patterns of Anti-Asthmatic Drugs Use in Albania During 2004-2014

Aim: To evaluate the patterns of use of the out-of-hospital Anti-Asthmatic drugs in Albania during the period 2004-2014. Methods: The study was retrospective and we analyzed the prescription and consumption of these drug classes in the primary health care in Albania during 2004-2014. All data were collected from Health Insurance Institute (HII)[1] and analysed reflecting the ambulatory and outpatient use for the period 2004-2014. The data about the consumption of drugs were expressed as a number of Defined Daily Dose (DDDs) /1000 inhabitants/day. Utilization was measured in DDD/1000 inhabitants/day and was also compared with Bronchial Asthma morbidity/1000 inhabitants, to understand the covering of the population from the reimbursement scheme. For all the period under study 2004-2014, there were collected and analysed the data of import and domestic production of drugs, which altogether represent the real consumption of drugs in the country. These data were subsequently included in a comparative analysis with the utilization data according to the HII. Results: The values of consumption of Anti-Asthmatic drugs were 6.62-8.48 DDD/1000 inhabitants/day respectively in 2004-2014. 2.14-3.76 DDD/1000 inhabitants/day constitute the consumption of beta2 agonists and 2.66-3.69 DDD/1000 inhabitants/day is the consumption of corticosteroids. In addition, it turns out that the consumption of beclometasone and the association Beta-2-mimetic-corticosteroids (salmeterol+fluticasone) based on HII data is superior to the consumption of this forms based on Import data, which cannot be true. This finding probably reflects fictive prescriptions and the entry of drugs by contraband. During some years of our study we notice that the consumption of Antiasthmatic drugs is higher than the morbidity level (cases/1000 inhabitants). Conclusions There is only a small increase in the national consumption of Anti-Asthmatic drugs during these years, but the values still remain very low in comparison with other countries. Less than 40% of the consumption of beta2 agonists is covered from the reimbursement scheme. In addition, it results that the scheme covers about 50% of antiasthmatic drugs consumption.

Utilization Patterns of Anti-Asthmatic Drugs Use in Albania During 2004-2014

Aim: To evaluate the patterns of use of the out-of-hospital Anti-Asthmatic drugs in Albania during the period 2004-2014. Methods: The study was retrospective and we analyzed the prescription and consumption of these drug classes in the primary health care in Albania during 2004-2014. All data were collected from Health Insurance Institute (HII)[1] and analysed reflecting the ambulatory and outpatient use for the period 2004-2014. The data about the consumption of drugs were expressed as a number of Defined Daily Dose (DDDs) /1000 inhabitants/day. Utilization was measured in DDD/1000 inhabitants/day and was also compared with Bronchial Asthma morbidity/1000 inhabitants, to understand the covering of the population from the reimbursement scheme. For all the period under study 2004-2014, there were collected and analysed the data of import and domestic production of drugs, which altogether represent the real consumption of drugs in the country. These data were subsequently included in a comparative analysis with the utilization data according to the HII. Results: The values of consumption of Anti-Asthmatic drugs were 6.62-8.48 DDD/1000 inhabitants/day respectively in 2004-2014. 2.14-3.76 DDD/1000 inhabitants/day constitute the consumption of beta2 agonists and 2.66-3.69 DDD/1000 inhabitants/day is the consumption of corticosteroids. In addition, it turns out that the consumption of beclometasone and the association Beta-2-mimetic-corticosteroids (salmeterol+fluticasone) based on HII data is superior to the consumption of this forms based on Import data, which cannot be true. This finding probably reflects fictive prescriptions and the entry of drugs by contraband. During some years of our study we notice that the consumption of Antiasthmatic drugs is higher than the morbidity level (cases/1000 inhabitants). Conclusions There is only a small increase in the national consumption of Anti-Asthmatic drugs during these years, but the values still remain very low in comparison with other countries. Less than 40% of the consumption of beta2 agonists is covered from the reimbursement scheme. In addition, it results that the scheme covers about 50% of antiasthmatic drugs consumption.

Utilization Trends of Endocrine Therapies for Breast Cancer in Albania During 2004-2014

Aim: To evaluate the patterns of use of the out-of-hospital endocrine therapies for breast cancer in Albania during the period 2004-2014. Methods: The study was retrospective and we analyzed the prescription and consumption of these drug classes in the primary health care in Albania during 2004-2014. All data were collected from Health Insurance Institute (HII)(1) and analysed reflecting the ambulatory and outpatient use for the period 2004-2014. The data about the consumption of drugs were expressed as a number of Defined Daily Dose (DDDs) /1000 inhabitants/day. Utilization was measured in DDD/1000 inhabitants/day and was also compared with breast cancer morbidity/1000 inhabitants, to understand the covering of the population from the reimbursement scheme. For all the period under study 2004-2014, there were collected and analysed the data of import and domestic production of drugs, which altogether represent the real consumption of drugs in the country. These data were subsequently included in a comparative analysis with the utilization data according to the HII. Results: The drug with the highest values of consumption is Letrozole 0.05-0.37 DDD/1000 inhabitants/day2004-2014). Anastrazole was introduced to the scheme in 2008. Its consumption in2014 was 0.26 DDD/1000 inhabitants/day. The consumtion of Tamoxifen is reduced through these years with values 0.32-0.17 DDD/1000 inhabitants/day respectively 2004-2014. Breast cancer morbidity data indicate that there does exist a correlation statistically significant between this disease and the trend of consumption of endocrine therapies drugs (p = 0,0009) Conclusions: It is evident that a non-small part of the patients remain untreated under the scheme. There is noted a shift in use of endocrine therapy from tamoxifen to aromatase inhibitors. This trend is consistent with major international clinical guidelines that recomend preferential use of aromatase inhibitors in post-menopausal women.

Utilization Trends of Endocrine Therapies for Breast Cancer in Albania During 2004-2014

Aim: To evaluate the patterns of use of the out-of-hospital endocrine therapies for breast cancer in Albania during the period 2004-2014. Methods: The study was retrospective and we analyzed the prescription and consumption of these drug classes in the primary health care in Albania during 2004-2014. All data were collected from Health Insurance Institute (HII)(1) and analysed reflecting the ambulatory and outpatient use for the period 2004-2014. The data about the consumption of drugs were expressed as a number of Defined Daily Dose (DDDs) /1000 inhabitants/day. Utilization was measured in DDD/1000 inhabitants/day and was also compared with breast cancer morbidity/1000 inhabitants, to understand the covering of the population from the reimbursement scheme. For all the period under study 2004-2014, there were collected and analysed the data of import and domestic production of drugs, which altogether represent the real consumption of drugs in the country. These data were subsequently included in a comparative analysis with the utilization data according to the HII. Results: The drug with the highest values of consumption is Letrozole 0.05-0.37 DDD/1000 inhabitants/day2004-2014). Anastrazole was introduced to the scheme in 2008. Its consumption in2014 was 0.26 DDD/1000 inhabitants/day. The consumtion of Tamoxifen is reduced through these years with values 0.32-0.17 DDD/1000 inhabitants/day respectively 2004-2014. Breast cancer morbidity data indicate that there does exist a correlation statistically significant between this disease and the trend of consumption of endocrine therapies drugs (p = 0,0009) Conclusions: It is evident that a non-small part of the patients remain untreated under the scheme. There is noted a shift in use of endocrine therapy from tamoxifen to aromatase inhibitors. This trend is consistent with major international clinical guidelines that recomend preferential use of aromatase inhibitors in post-menopausal women.

Utilization Trends of Endocrine Therapies for Breast Cancer in Albania During 2004-2014

Aim: To evaluate the patterns of use of the out-of-hospital endocrine therapies for breast cancer in Albania during the period 2004-2014. Methods: The study was retrospective and we analyzed the prescription and consumption of these drug classes in the primary health care in Albania during 2004-2014. All data were collected from Health Insurance Institute (HII)(1) and analysed reflecting the ambulatory and outpatient use for the period 2004-2014. The data about the consumption of drugs were expressed as a number of Defined Daily Dose (DDDs) /1000 inhabitants/day. Utilization was measured in DDD/1000 inhabitants/day and was also compared with breast cancer morbidity/1000 inhabitants, to understand the covering of the population from the reimbursement scheme. For all the period under study 2004-2014, there were collected and analysed the data of import and domestic production of drugs, which altogether represent the real consumption of drugs in the country. These data were subsequently included in a comparative analysis with the utilization data according to the HII. Results: The drug with the highest values of consumption is Letrozole 0.05-0.37 DDD/1000 inhabitants/day2004-2014). Anastrazole was introduced to the scheme in 2008. Its consumption in2014 was 0.26 DDD/1000 inhabitants/day. The consumtion of Tamoxifen is reduced through these years with values 0.32-0.17 DDD/1000 inhabitants/day respectively 2004-2014. Breast cancer morbidity data indicate that there does exist a correlation statistically significant between this disease and the trend of consumption of endocrine therapies drugs (p = 0,0009) Conclusions: It is evident that a non-small part of the patients remain untreated under the scheme. There is noted a shift in use of endocrine therapy from tamoxifen to aromatase inhibitors. This trend is consistent with major international clinical guidelines that recomend preferential use of aromatase inhibitors in post-menopausal women.

Utilization Trends of Endocrine Therapies for Breast Cancer in Albania During 2004-2014

Aim: To evaluate the patterns of use of the out-of-hospital endocrine therapies for breast cancer in Albania during the period 2004-2014. Methods: The study was retrospective and we analyzed the prescription and consumption of these drug classes in the primary health care in Albania during 2004-2014. All data were collected from Health Insurance Institute (HII)(1) and analysed reflecting the ambulatory and outpatient use for the period 2004-2014. The data about the consumption of drugs were expressed as a number of Defined Daily Dose (DDDs) /1000 inhabitants/day. Utilization was measured in DDD/1000 inhabitants/day and was also compared with breast cancer morbidity/1000 inhabitants, to understand the covering of the population from the reimbursement scheme. For all the period under study 2004-2014, there were collected and analysed the data of import and domestic production of drugs, which altogether represent the real consumption of drugs in the country. These data were subsequently included in a comparative analysis with the utilization data according to the HII. Results: The drug with the highest values of consumption is Letrozole 0.05-0.37 DDD/1000 inhabitants/day2004-2014). Anastrazole was introduced to the scheme in 2008. Its consumption in2014 was 0.26 DDD/1000 inhabitants/day. The consumtion of Tamoxifen is reduced through these years with values 0.32-0.17 DDD/1000 inhabitants/day respectively 2004-2014. Breast cancer morbidity data indicate that there does exist a correlation statistically significant between this disease and the trend of consumption of endocrine therapies drugs (p = 0,0009) Conclusions: It is evident that a non-small part of the patients remain untreated under the scheme. There is noted a shift in use of endocrine therapy from tamoxifen to aromatase inhibitors. This trend is consistent with major international clinical guidelines that recomend preferential use of aromatase inhibitors in post-menopausal women.

TRENDS IN PRESCRIBING AND UTILIZATION OF ANTIDIABETIC DRUGS IN PRIMARY HEALTH CARE IN ALBANIA DURING 2004-2014

Aim: To describe trends in out-of-hospital utilization and prescribing of antidiabetic drugs in Albania using the Anatomic Therapeutic Chemical Classification/ Defined Daily Dose -(ATC/DDD methodology). Methods: The study was retrospective and we analyzed the prescription and consumption of these drugs classes in the primary health care in Albania during 2004-2014. All data were collected from Health Insurance Institute (HII) and analysed reflecting the ambulatory and outpatient use for the period 2004-2014. The data about the consumption of drugs were expressed as a number of Defined Daily Dose (DDDs) /1000 inhabitants/day. For all the period under study 2004-2014, there were collected and analysed the data of import and domestic production of drugs, which altogether represent the real consumption of drugs in the country. These data were subsequently included in a comparative analysis with the utilization data according to the HII. Results: The consumption of all insulins were 1.80-5.64 DDD/1000 inhabitants/day (respectively 2004-2014). The consumption of insulin fast-acting were 0.47-2.59 DDD/1000 inhabitants/day (respectively 2004-2014). The consumption of insulin intermediate-acting were 0.38-0.70 DDD/1000 inhabitants/day (respectively 2004-2014). The consumption of insulin intermediate-acting combined with insulin fast-acting were 0.95-1.18 DDD/1000 inhabitants/day. The consumption of insulin long-acting were 0.00-1.41 DDD/1000 inhabitants/day. The most prescribed oral antidiabetic agent was metformin 3.04-7.45 DDD/1000 inhabitants/day (respectively 2004-2014). The consumption of glibenclamide was 3.55-5.76 DDD/1000 inhabitants/day (respectively 2004-2007). Conclusions: There is an increase in Antidiabetic drugs use from HII covering, while there is a significant increase in their use from out-of-pocket expenditure during 2004-2014. There can be noted a visible discrepancy between the consumption of antidiabetic drugs and the diabetes mellitus morbidity, which indicates that only a part of patients with diabetes mellitus do benefit from the reimbursement scheme.

Paying Out-of-Pocket and Informally for Health Care in Albania: The Impoverishing Effect on Households.

The health care system in Albania, as in all other ex-communist countries of Central and Eastern Europe (CEE), is rooted in the Soviet “Semashko” model. The legacies of the Semashko system still remain visible especially in the state ownership of public healthcare institutions, public provision of the services, as well as the funding from the general tax base (especially for secondary and tertiary care) (1). WHO data show that in 2013, the total health care expenditure for the country amounted to 5.9% of its GDP (2). This is relatively high compared to other former communist CEE or Former Soviet Union (FSU) countries, but still much lower than the average 8.5% for the EU15 countries (2). However, only about 48.4% of the total health care spending in Albania comes from the general state budget (2), and the share of private expenditures and out-of-pocket expenditures is relatively high (3). The utilization of health insurance in Albania remains low (4). In addition to this, almost 19% of all patients visiting outpatient services and almost 44% of patients visiting inpatient services in 2008 pay informally as well (5). But, are out-of-pocket and informal payments in Albania catastrophic to households’ budgets? If yes, what are their effects on poverty? And more importantly, what are the main policy implications for a fast-developing country like Albania?

Paying informally for public health care in Albania: scarce resources or governance failure?

Informal payments for health care are common in most former communist countries. This article explores the demand side of these payments in Albania. Using tobit and Heckman selection models we control for individual determinants of informal payments in outpatient and inpatient health care. Propensity score matching (PSM) techniques are used to investigate the changes in the characteristics of people paying informally over the different years. Our findings suggest that vulnerable groups in society remain less protected against such payments and policy measures have not reached the most deprived regions of the country.

Catastrophic and impoverishing effects of out-of-pocket payments for health care in Albania: evidence from Albania Living Standards Measurement Surveys 2002, 2005 and 2008

The absence of or poorly functioning risk pooling mechanisms and high amounts of out-of-pocket payments for health care expose households to financial risks associated with major illnesses or accidents. The aim of this article is to analyse the extent to which out-of-pocket health spending impoverishes households in Albania. The study augments existing evidence by analysing the dynamics of such payments over different years and the weight that informal payments have in the total out-of-pocket health spending. The data used in the study come from the Albania Living Standards Measurement Survey (ALSMS) for 2002, 2005 and 2008. We measure headcount catastrophic payments using different thresholds and the decomposition of indicators by expenditure quintiles to better understand their effects. We find that out-of-pocket and informal payments have increased in real value throughout the years. Even though their catastrophic effect has gone down (due also to declining trends in absolute poverty), the effect for the poorest expenditure quintiles remains high. Out-of-pocket payments deepen the poverty headcount and also enlarge the poverty gap and again the effect is larger for the poorest quintiles. Future policy interventions should provide better protection mechanisms for the poor by providing exemption criteria or subsidized transport. They should also seek to address the widespread informal payments in the country.

Informal payments and intra-household allocation of resources for health care in Albania

BackgroundInformal payments for health care services can impose financial hardship on households. Many studies have found that the position within the household can influence the decision on how much is spent on each household member. This study analyses the intra-household differences in spending on informal payments for health care services by comparing the resources allocated between household heads, spouses and children.MethodsPooled data from two cross sectional surveys, the Albanian Living Standard Measurement Survey 2002 and 2005, are used to analyse both the probability and the amount paid in inpatient and outpatient health care services. A generalised Hausman specification test is used to compare the coefficients of probit and OLS models for nuclear and extended households.ResultsWe find that due to the widespread informal payments there are no significant differences between households in the incidence of informal payments for households' members, but there are more differences in the amount paid informally. Results suggest that households strategically allocate their resources on health care by favouring individuals with higher earning potential who have invested more in human capital. Extended households pay higher amounts for spouses with higher education compared to nuclear households. On the other hand, nuclear households choose to pay higher amounts for children with a higher level of education compared to extended households.ConclusionsThe differences between households should be taken into account by public policies which should compensate this by redistribution mechanisms targeting disadvantaged groups. Governments should implement effective measures to deal with informal patient payments.JEL Codes: I10, I19, D10

Adoption of the WHO Assessment Tool on the Quality of Hospital Care for Mothers and Newborns in Albania

Aim:The aim of the adoption process of the “Quality of hospital care for mothers and newborns babies, assessment tool” (WHO, 2009) was to provide the Albanian health professionals of maternity hospitals with a tool that may help them assess the quality of perinatal care and identify key areas of pregnancy, childbirth and newborn care that need to be improved.Methods:Four maternity hospitals (one university hospital and three regional hospitals) were selected for the assessment using this standard tool covering over 600 items grouped into 13 areas ranging from supportive services to case management. Sources of information consisted of site visits, hospital statistics, medical records, observation of cases and interviews with staff and patients. A score was assigned to each item (range 0-3) and area of care. The assessments were carried out in two rounds: in 2009 and in 2011. These assessments provided semi-quantitative data on the quality of hospital care for mothers and newborns.Results:Data collected on the first round established a baseline assessment, whereas the second round monitored the subsequent changes. The findings of the second round revealed improvements encountered in all maternities, notwithstanding differences in the levels of improvement between maternities, not necessarily linked with extra financial inputs.Conclusions:The Albanian experience indicates a successful process of the adoption of the WHO tool on the quality of hospital care for mothers and newborn babies. The adopted tool can be used country-wide as a component of a quality improvement strategy in perinatal health care in Albania.