Health Care In Serbia Research Articles

Cultural context of nursing in the field of outpatient healthcare in Serbia

Abstract Introduction. Modern world map characterizes existence of pluralistic and multicultural societies formed as a result of increased citizens’ mobility and globalization process. Cultural diversity realizes its implications in all the aspects of social functioning and in significant share through the system of healthcare. Accepting the concept of illness as a social construct, intercultural attitudes become leading principle of education and practice of healthcare workers at every level. By the nature of their profession, nurses in the primary healthcare institutions acquire key role in the process of implementation of inter-cultural principles in clinical practice, with the aim for the healthcare system to become more open and more sensitive to specific social occurrences and culturally driven healthcare need of its users. Aim. The expected contribution of the work is oriented towards the possibility of theoretical and practical foundation of multidimensional and multi-perspective approach to healthcare. Discussion. The discourse of the cultural context of nursing in the field of outpatient healthcare in Serbia is based on the axiomatic assumption that illness is a social construct and that sociological and anthropological perspective can change the clinical practice. The work comprises basic cultural factors as a dynamic factor of health and illness, principles, elements and significance of cultural assessment of the patient in nursing practice; presents the differences in patient’s position within the Parsons concept and contemporary concept of post-modern approach to the patient. Cultural concept of nursing in Serbia has been analyzed through the prism of “5D Cultural model” by Dr. Geert Hofsted with presentation and interpretation of its basic dimensions. Conclusions. Healthcare system in Serbia is facing challenges of reforms – the introduction of socio-cultural aspect in creating of primary healthcare policy in the spirit of modern multicultural social tendencies. Aiming to provide quality healthcare it is necessary to understand how a society acknowledges the terms of health and illness and which cultural aspects lies in the base of individual’s behavior. If one healthcare is not founded upon cultural values then it is impossible to achieve its therapeutic goal, it will be incomplete and unsuccessful. The treatment plan and patient’s care must be individual, holistic and culturally appropriate.

First outbreak of Clostridium difficile infections in Serbia: An experience of the department for orthopedic surgery

Objectives: Increased C. difficile infection rates were observed during the last decade, as well as the onset of complicated forms of the disease. The primary objective of this study was to report the first outbreak of C. difficile in a Serbian hospital, aiming to determine clinical and environmental factors associated with the outbreak. The secondary objective was to describe outbreak control measures taken.Design: The retrospective cohort study conducted from 18 April to 22 May 2013 in Serbian healthcare. Ninety-five patients hospitalized at the Department for orthopedic surgery during the CDI outbreak.Results: Prophylactic antibiotic therapy was identified among 93.3% patients with and 87.9% without C. difficile infection. The multivariate logistic regression analysis has shown that the independent risk factors for C. difficile infection incidence are the age beyond 70 (OR = 4.5; 95%CI = 1.1-18.2; p = .031) and the length of antibiotic therapy (OR = 1.5; 95%CI = 1.1-2.1; p = .017).Conclusion: The length of antibiotic prophylaxis is linked with the incidence. Orthopedic departments have a risk of C. difficileinfection. Infection control measure, antimicrobial stewardship programs and compliance to guidelines for the prescribing of antibiotics play important role in the prevention of C. difficile infection burden.

Quality indicators of dental health care in Serbia

Summary Health care has witnessed considerable progresses toward quality improvement over the past two decades. More precisely, there have been global efforts aimed to improve this aspect of health care along with experts and decision-makers reaching the consensus that quality is one of the most significant dimensions and features of health system. Quality health care implies highly efficient resource use in order to meet patient’s needs in terms of prevention and treatment. Quality health care is provided in a safe way while meeting patients’ expectations and avoiding unnecessary losses. The mission of continuous improvement in quality of care is to achieve safe and reliable health care through mutual efforts of all the key supporters of health system to protect patients’ interests. A systematic approach to measuring the process of care through quality indicators (QIs) poses the greatest challenge to continuous quality improvement in health care. Quality indicators are quantitative indicators used for monitoring and evaluating quality of patient care and treatment, continuous professional development (CPD), maintaining waiting lists, patients and staff satisfaction, and patient safety.

Costs of sequential multiple myeloma treatment for elderly transplant-ineligible patients in the Serbian health care system

Introduction. Multiple myeloma is an incurable plasma-cell pro?liferation mainly affecting the elderly population. The aim of this study was to analyze treatment patterns, utilization of health resources and treatment costs of multiple myeloma in the elderly patients ineligible for autologous hematopoietic stem cell transplantation in Serbia. Material and Methods. The analysis of the health?care costs, from the perspective of the Serbian healthcare system, took into account the costs of medications, diagnostic procedures, inpatient and outpatient care, as well as the costs of drug administration and management of drug adverse effects. Results. Thalidomide based regimens were less costly than bortezomib-based regimens (average per-protocol costs 6,000 ? vs. 64,700 ?, respectively). The most expensive treatment regimen was lenalidomide-dexamethasone (average per-protocol costs 145,200 ?). The sequential (four-line therapy) treatment costs varied from 85,800 ?, starting with melphalan-prednisone-thalidomide to 153,800 ?, starting with melphalan-prednisone-bortezomib. The estimated costs did not significantly differ during variation of the parameters in the sensitivity analysis. Conclusion. The costs of multiple myeloma treatment in the Republic of Serbia are mainly driven by the cost of antimyeloma drugs. The most expensive treatment sequence was starting with melpha1an-prednisone-bortezomib treatment protocol.

Aging and health care in Serbia. Data from EU-SILC 2016

Aging and health care in Serbia. Data from EU-SILC 2016

Migrants’ perceptions of equity in Serbian health care

Migrants’ perceptions of equity in Serbian health care

Interprofessional education and collaborative practice: Psychometric analysis of the Readiness for Interprofessional Learning Scale in undergraduate Serbian healthcare student context

BackgroundThere is an implicit expectation for medical sciences students to work together effectively as members of health-care team, and interprofessional education is therefore widely accepted. Students' attitudes, which are affected by various factors, have been recognized as the most important predictors of successful implementation of interprofessional education with the aim of developing collaborative practice. The Readiness for Interprofessional Learning Scale has often been used in studies to measure these perspectives. ObjectivesTo describe the psychometric properties of the Serbian cross-culturally adapted version of the original Readiness for Interprofessional Learning Scale, to assess the attitudes of undergraduate health science students towards interprofessional education and to evaluate whether a professional group and student characteristics have influence on attitudes towards collaborative practice and shared learning. DesignA descriptive/analytical and comparative cross-sectional study. SettingsFaculty of Medicine in Serbia. ParticipantsNursing and medical students after completed first clinical rotations (n = 257). MethodsThe Readiness for Interprofessional Learning Scale for assessing attitudes among students towards interprofessional learning, Professional Identity Questionnaire for Nursing Students for assessing professional identity in nursing students, Professional Nursing Image Survey for assessing attitudes of medical students towards the nursing profession, as well as a socio-demographic questionnaire were the instruments used in this research study. The data were analysed using descriptive and inferential statistics. ResultsExploratory factor analysis on 19 items revealed two-factors accounting for 51.1% of the total variance with the internal reliability α = 0.90. The mean total score of the Readiness for Interprofessional Learning Scale was 73.5 (SD = 11.5) indicating that students are ready for interprofessional learning. Nursing students, female students; students in their first years of studies, and those with previously completed education in the field of health care, have been more ready for interprofessional learning and collaborative practice. In the multiple linear regression analysis, gender and assessing professional nursing skills and abilities were significant predictors of medical students' readiness for interprofessional learning, whereas professional identity was for nursing students. ConclusionThe Serbian version of the Readiness for Interprofessional Learning Scale has proven to be reliable and valid for the “teamwork, collaboration and shared learning” subscale, while the “role and responsibilities” subscale showed lower stability. The results of this study revealed positive students' attitudes towards interprofessional learning, which is important for Serbia, as a candidate country for European Union membership, and thus making our educational system more inclusive for joining the European Higher Education Area.

Informal Payments and Health System Governance in Serbia: A Pilot Study

Few studies address Serbian providers’ perceptions of informal payments and the association between these perceptions and health system governance. The aim was to investigate civil servants’ perceptions on informal payments of the health care system in Serbia and to link these results with available evidence on informal payments in other Western Balkan countries. A literature review on informal payments in Western Balkan and in-depth interviews of civil servants working with Serbian health care were conducted. Informal payments were mostly taking place in inpatient care and were based on low salaries of doctors, poor resources, a desire to receive better or faster service, fear of being denied treatment, and an expression of gratitude through gifts. Policy measures had limited effect and vulnerable groups were more likely to pay informally. There is a need for further research to highlight how health system governance and prevailing policies affect informal payments in Western Balkan.

A crisis of protection and safe passage: violence experienced by migrants/refugees travelling along the Western Balkan corridor to Northern Europe

BackgroundPushed by ongoing conflicts and pulled by the desire for a better life, over one million migrants/refugees transited Balkan countries and arrived in Europe during 2015 and early 2016. To curb this influx, European countries instituted restrictive migration policies often characterized by building of razor-wire border fences and border closures. Among migrants/refugees who received mental health care in Serbia while travelling through Balkan countries to Northern Europe, we assessed the prevalence and patterns of violent events experienced including physical trauma.MethodsA mixed methods study among migrants/refugees attending mobile mental health clinics run by Médecins sans Frontières (MSF) between July 2015 and June 2016, in Serbia – a main transit hub to European countries. Clinics were conducted according to MSF guidelines by experienced psychologists who were supported by cultural mediators. The main outcome measures were violent events and associated physical trauma.ResultsOf 992 migrants/refugees attending MSF mental health clinics, the majority (72%) were from Syria and Afghanistan and included vulnerable groups (14%) such as unaccompanied minors and pregnant women. The most frequent mental health symptoms/signs were anxiety (29%) and adjustment reactions (26%). Of the 992 migrants/refugees, 270 (27%) had experienced violent events during their journey. Signs of physical trauma due to acts of violence were seen in 223(22%) of the 992 individuals, 144 (65%) being perpetrated by State authorities and involving women (11%) and children (13%).Border closures along the Balkan route were associated with a dramatic decrease in registered migrants/refugee arrivals in Serbia. Conversely, among those that made it across the borders, an increasing linear trend in reported violent events was observed at MSF mental health clinics (X2 for linear trend, P <0 · 001). Qualitative evidence corroborated with quantitative findings.ConclusionsNearly one-in-three migrants/refugees seen in MSF clinics experienced violent events including physical trauma along their journey. State authorities, including those in European countries were the perpetrators in over half of such events which were associated with border closures. There is “a crisis of protection and safe passage” which needs to change towards one of respect for the principles of international human rights and refugee law.

Medical Biochemistry as Subdiscipline of Laboratory Medicine in Serbia.

SummaryMedical biochemistry is the usual name for clinical biochemistry or clinical chemistry in Serbia, and medical biochemist is the official name for the clinical chemist (or clinical biochemist). This is the largest sub-discipline of the laboratory medicine in Serbia. It includes all aspects of clinical chemistry, and also laboratory hematology with coagulation, immunology, etc. Medical biochemistry laboratories in Serbia and medical biochemists as a profession are part of Health Care System and their activities are regulated through: the Health Care Law and rules issued by the Chamber of Medical Biochemists of Serbia. The first continuous and organized education for Medical Biochemists (Clinical Chemists) in Serbia dates from 1945, when the Department of Medical Biochemistry was established at the Pharmaceutical Faculty in Belgrade. In 1987 at the same Faculty a five years undergraduate study program was established, educating Medical Biochemists under a special program. Since the academic year 2006/2007 the new five year undergraduate (according to Bologna Declaration) and four-year postgraduate program according to EC4 European Syllabus for Postgraduate Training in Clinical Chemistry and Laboratory Medicine has been established. The Ministry of Education and Ministry of Public Health accredited these programs. There are four requirements for practicing medical biochemistry in the Health Care System: University Diploma of the Faculty of Pharmacy (Study of Medical Biochemistry), successful completion of the professional exam at the Ministry of Health after completion of one additional year of obligatory practical training in the medical biochemistry laboratories, membership in the Serbian Chamber of Medical Biochemists and licence for skilled work issued by the Serbian Chamber of Medical Biochemists. In order to present laboratory medical biochemistry practice in Serbia this paper will be focused on the following: Serbian national legislation, healthcare services organization, sub-disciplines of laboratory medicine and medical biochemistry as the most significant, education in medical biochemistry, conditions for professional practice in medical biochemistry, continuous quality improvement, and accreditation. Serbian healthcare is based on fundamental principles of universal health coverage and solidarity between all citizens.

Original article. The cost of individual health care in Serbia according to the international classification of diseases in the period 2010–2015

Summary Introduction There is growing interest in the world for estimating the cost for the treatment of a disease. This value can be used to determine to which extent a particular disease or group of diseases burden society in terms of the global crisis (Segel 2006). In 2000, Organization for Economic Countries Development (OECD) established a System of Health Accounts (SHA), and provided methodological guide for calculating the cost of treating the disease. The aim of this study was to determine the cost of individual health care in the Republic of Serbia according to the major International Classification of Diseases (ICD) for the period 2010-2015. Material and Methods A retrospective and comparative analysis of health statistics from the database of the Institute of Public Health of Serbia (IPHS) and financial information provided by the National Health Insurance Fund (NHIF) in the period 2010-2015 was performed. Financial information and data on hospital services, outpatient, home health care, auxiliary health care services, drug consumption and consumer goods in healthcare were analyzed using SHA methodology. Results showed that during observation period the maximum cost of individual health care in Serbia by main classification ICD was achieved in 2015 and it was 194,128,864,011 RSD (€1,580,853,941; $1,764,807,854) and the minimal cost was achieved in 2010, 151,333,139,835 RSD (€1,434,464,541; $1,908,843,843). Conclusion The cost of individual health care in the Republic of Serbia in the period 2010-2015 increased by thirty percent. The highest amount was allocated to treat people with diseases of the circulatory system.

Valjevo’s medical doctor Jovan Siber and pharmacist Klaudije Prikelmajer: A historical illustration of the role of immigrants from Slavonia to the development of health care in Serbia

In a short period of the late 1860s, three significant new institutions were founded in Valjevo: the hospital (1867), the grammar school (1869) and the pharmacy (1870). In the early stages of development of all three institutions, a big role was played by immigrants from Slavonia: medical doctor Jovan Sieber, pharmacist Klaudije Prikelmajer, and professor Djuro Kozarac. This paper aims to clarify the connections between these individuals that caused their relocation from the territories of the Habsburg Monarchy to Serbia and Valjevo, as well as to resolve the confusion caused by imprecise family memories and written chronicles that have been collected. Moreover, this paper additionally focuses on the origins of the Sieber family, which included Jovan Sieber, and the later arrival of other members of the family to Valjevo. Another member of the family was Jovan?s nephew Dr. Stevan Sieber, father of Dr. Djordje Sieber, who went on to become a general in the Medical Corps of the Royal Yugoslav Army.

Serbian Language version of the Modified Checklist for Autism in Toddlers, Revised, with Follow-Up: Cross-Cultural Adaptation and Assessment of Reliability.

Early detection of Autism Spectrum Disorder (ASD) has proven to be of high significance, however there is a limited availability of ASD screening tools in Serbian language. In this study we aim to translate, assess reliability and, in part, test the applicability of Modified Checklist for Autism in Toddlers, Revised, with Follow-Up (M-CHAT R/F) in Serbian Healthcare environment. We screened 128 children in three primary healthcare centres and 20 children in a tertiary psychiatric center, using M-CHAT R/F translated into Serbian language, between December 2014 and October 2015. At the end of the screening process 80% of participants in the risk group screened positive for ASD, while in the control group 4 (3.1%) participants screened positive, with a mean total scores of 8.25 and 0.66 respectively. The Cronbach’s α coefficient was 0.91 and Guttman’s λ6 was 0.93. Test – retest reliability was deemed as acceptable, and no significant correlation was found between M-CHAT-R/F scores and Epworth Sleepiness Scale for children scores. The Serbian version of the M-CHAT-R/F has shown satisfactory reliability. We can therefore assert that it is a reliable tool for identifying ASD and it can be used in clinical practice to improve early detection, assessment and treatment.

PSY44 - Costs of Multiple Myeloma Management And Treatment For Elderly Patients Who Are Not Transplant Candidates In The Serbian Health Care System

PSY44 - Costs of Multiple Myeloma Management And Treatment For Elderly Patients Who Are Not Transplant Candidates In The Serbian Health Care System

Encouraging employees to report verbal violence in primary health care in Serbia: A cross-sectional study.

IntroductionWorkplace violence is a serious and multidimensional problem that adversely affects professional and personal lives of employees. The aim of this study was to assess the prevalence and characteristics of verbal violence as a part of psychological violence among employees in primary health care in Belgrade, and to identify contributing factors of verbal violence in the workplace.MethodsIn this cross-sectional study, the final analysis included 1526 employees, using multi-stage sampling. Data were collected using the questionnaire Workplace Violence in the Health Sector Country Case Studies Research, developed by ILO/ICN/WHO/PSI. Descriptive statistics and logistic regression analysis were used to analyse the data. The general response rate was 86.8% (1526/1757).ResultsIt was found that 47.8% of the participants were subjected to verbal violence. The main source of verbal violence was patient/client, 55.6% of employees did not report the incident. Among those who did not report the incident, 74.9% believed that reporting violence was useless. The interaction with patients (OR, 1.45; 95% CI, 1.02-2.06) and work between 6pm and 7am (OR, 1.27; 95% CI, 1.01-1.60) were significant contributing factors of verbal violence.ConclusionThe results are indicative of a high prevalence of verbal violence against employees in primary health centres, which could have undesirable consequences. Conducting a better organizational measure and encouraging employees to report workplace violence could reduce the prevalence of verbal violence.

Effectiveness of Serbian Health Care System in 2014

SUMMARY The European Health Consumer Index (EHCI) is a project that since 2006 has been comparing and ranking health care systems of European countries, from the perspective of patients (consumers) - users of the health care system. Its purpose was to set standards for well functioning and organized health care. The aim of this study was to assess the state of Serbian health care system from the perspective of the European health consumer index and propose recommendations for its improvement and functioning in accordance with European standards. The assessment of the health care system is based on pre-determined forty-eight indicators divided into six groups. According to these indicators, scoring and ranking of countries was done (maximum score for a particular indicator was 3, and the minimum was 1). As per European Health Consumer Index the Republic of Serbia is ranked at 33rd place, with total of 473 points, while Netherlands has been found on the top of the list for years (this year 898 points).

Effectiveness of Serbian Health Care System in 2014 and 2015

Introduction: The European Health Consumer Index (EHCI) was founded as a project in 2006, and it has since been working on comparing and ranking the health systems of the European countries. Its main aim is to set standards for well-functioning and organization of health care from the perspective of patients (consumers) - users of the health system. Their assessment of the health system is based on forty-eight pre-determined indicators, divided into six groups. Countries are ranked with scores ranging from 1 to 3 [1]. The aim of this study was to assess the state of Serbian health care system in 2014 and 2015 and compare with neighboring countries, from the perspective of European health consumer index and propose recommendations for its improvement in accordance with the norms of European standards. Methods: A retrospective and comparative analysis of data on Serbian and neighboring countries healthcare system fuctioning in 2014 and 2015, based on the European Health Consumer Index indicators was performed. Results: The Republic of Serbia, according to the European Health Consumer Index, was ranked 33rd. in 2014 among selected European countries, with 473 points, while in 2015 was ranked 30 with 554 points. Conclusions and Recommendations: In order to get closer to European Union countries’ standards and to satisfy users of the health care system in the Serbia, the accessibility to diagnostic procedures, major elective surgery, cancer therapy, long term care for elderly and preventive activities should be improved, like FYR Macedonia already achieved.

Determinants of job satisfaction of healthcare professionals in public hospitals in Belgrade, Serbia - cross-sectional analysis

The quality of health care significantly depends on the satisfaction of the employees. The objective of this study was to establish the level of professional satisfaction of healthcare professionals in state hospitals in Belgrade, Serbia, and to determine and to rank the factors which impact on their satisfaction or dissatisfaction. Professional satisfaction survey was designed and conducted as a cross-sectional study in 2008. Completed questionnaires were returned by 6,595 healthcare professionals from Belgrade's hospitals. Statistical analysis was performed using the Student's t-test, χ² test and ANOVA. Factor analysis was applied in order to define determinants of professional satisfaction, i.e. dissatisfaction. This study showed that the degree of professional satisfaction of Serbian healthcare professionals was low. The main causes of professionals'dissatisfaction were wages, equipment, the possibility of continuous medical education/training and the opportunities for professional development. Healthcare professionals with university education were more satisfied with all the individual aspects of job satisfaction than those with secondary school and college education. There were significantly more healthcare professionals satisfied with their job among males, older than 60 years, in the age group 50-59 years, with managerial function, and with 30 or more years of service. Development strategy of human resources in the Serbian health care system would significantly improve the professional satisfaction and quality of the provided health care.

History of Medicine in Jagodina District

Summary The first record of scientific medicine in Serbia has been found in the early of 12th century. For centuries lifestyle, nutrition, natural environment, armies passing through, cultural heritage, and prejudice have affected healthcare in Serbia. Until 1820, Serbia has not had any educated doctor. Fourteen district physicians from 1839 and Dr. Karlo Beloni, to the last one, Dr. Selimir Djordjević – have spent part of their professional careers in Jagodina. All of them have had influence on raising health culture of Jagodina and its population and helped to overcome easily and quickly all existing diseases and epidemics. The Jagodina Hospital has been working without interruption for 147 years and represents one of the oldest healthcare institutions in Serbia.

Old Age Consumer’s Experience With Physician In Primary Health Care In Serbia

Background Patient experience reflects quality of care and it is an important parameter for monitoring and analyzing the health care quality. Aging population is getting larger, people getting older and have more needs from health services. Methods The data were extracted from The National Customer Satisfaction Surveys (2009-2013). Questionnaire consisted of questions about demographic characteristics, availability of health service, frequencies of using the …