Health Care In Slovenia Research Articles

Enhancing LGBT + primary healthcare in Slovenia: A national qualitative study of experiences and expectations of LGBT + people and family doctors

Background Despite growing acceptance of LGBT + individuals, an underlying stigma persists even in healthcare, resulting in substandard care and worse healthcare outcomes for LGBT + individuals. Objectives To examine and compare the experiences and expectations regarding primary healthcare among LGBT + individuals and general practitioners (GPs) in Slovenia. Methods We conducted an online national qualitative study using open-ended questions. To reach LGBT + population snowball method of recruitment was employed by sharing the questionnaire through LGBT + organisations, while GPs were invited by email of Association of family doctors in Slovenia. Anonymous data was collected from October to December 2021 and the questionnaires of 25 GPs and 90 LGBT + individuals of various ages, backgrounds, gender identities and sexual orientations were reviewed using thematic analysis. Results Both LGBT + participants and GPs expressed a desire for equal treatment. However, while all GPs claimed to treat all patients equally, LGBT + participants reported more varied experiences. Specific knowledge, especially on LGBT + terminology and healthcare, was perceived as lacking among GPs, leading LGBT + individuals to seek advice from specialists or community counselling. Systemic barriers, including societal stigmatisation and limited formal education on LGBT + issues, were identified, highlighting the need for designated safe spaces and improved GP training. Safety emerged as a central theme, crucial for fostering trust and disclosure between patients and healthcare providers. Conclusion The study underscores the significance of a sense of safety in the patient-doctor relationship and highlights the need for improved training and attitudes to provide inclusive and affirming healthcare for LGBT + individuals.

Primary health care in Slovenia: Alternative payment models as a possible opportunity for further integration of health care

Since 1926, the primary health care system in Slovenia has been developing on its own successful path, which has from the very beginning included some elements of integrated care. Despite the continuous changes that occurred in the last 30 years in Slovenia (population 2 million), it is still based on primary Health centers (HC) complemented by primary and secondary level privately owned solo practices. The legislation describes HCs as health units owned by one or more municipalities that provide basic health care in the area of one or more of them. In contrast, regional hospitals and tertiary clinics are mostly owned by the state. HCs have by now developed into comprehensive multidisciplinary centers of primary health care supposed to serve an average of 50,000 people, depending on the geographical and demographic circumstances. According to the Health Care Act, HCs must provide medical and dental care, pediatric and gynecological specialist services, emergency medical assistance, outpatient services, physiotherapy, laboratory and other diagnostics, as well as health prevention and education in their geographical areas. Many HCs have established mental health centers, children's mental health centers and health promotion centers. HCs must provide an ambulance service if it is not organized in a hospital. As a rule, above activities take place in the same physical location, which makes the use of health services very easy for the local population. The primary level also includes pharmacies, which are often located in or near the HCs.
 In every HC family medicine teams include a specialist, an intermediate nurse and a part-time graduate nurse, who actively takes care of preventive examinations of the target population of patients (that is, for people over 30 years old) and for the comprehensive treatment of patients with chronic non-communicable diseases. Family medicine teams are supposed to treat adult patients with efficient and comprehensive care using the dispensary method of work.
 The Health Insurance Institute of Slovenia finances the activity of HCs with capitation fees (75%) and with fees for services (25%). The activity of acute hospitals, on the other hand, is financed mostly by the DRG system. There are no bundled payments or global payments, although there are efforts to start the implementation of payments based on outcomes of care. 
 As a rule, HCs in Slovenia guarantee services and their providers to patients in one physical location. However, health care can still be considered as hyper-fragmented. In particular, the information support available is not developed enough. The patients’ documents are only partly stored in electronic form without any horizontal or vertical connection between them. There are no electronic health records. The organization and geographical spread of the HCs represent an excellent opportunity for the integration of care, which should be encouraged by payment models such as bundled payments and global payments with population management.

Is Value-Based Health Care Just the Latest Fad or can it Transform the Slovenian Health Care System?

You get what you pay for is a very old saying, originating from England in the mid-to late 1800s. However, despite being in use for more than two centuries, its meaning is still not fully grasped in Slovenian healthcare. While we claim that the healthcare system serves the patient and that the care provided is patient-centred, we do not even measure the treatment outcomes that matter to patients. Without measuring these, we do not know whether the treatment provided value to the patients, i.e. what were the benefits of the treatment relative to the costs. Slovenian payment models do not reimburse the providers for created patient-relevant value, but rather for the planned number of services or cases based on average incurred costs. It is thus time to digitalise the system, and start collecting, curating and analysing the relevant data to ensure that all stakeholders within the healthcare system co-deliver value to patients. While relevant stakeholders highlight notable challenges of implementing value-based healthcare in Slovenia, these are far from insurmountable.

Comparison of community health nurses' preventive home visits to older adults in Sweden and Slovenia:

Introduction: Community health nurses contribute significantly to better health, well-being and independence of older adults. The aim of the study is to compare preventive services for older adults in community health care between Sweden and Slovenia.Methods: Literature review and document analysis were used to conduct a qualitative comparative analysis. Literature was retrieved from the MEDLINE, CINAHL and COBIB databases. An analysis of documents such as sectoral legal bases, guidelines and expert recommendations in Slovenia and Sweden was also conducted. The analysis included sources related to preventive services for older adults living at home published between January 2000 and December 2020 in Slovene, English or Swedish.Results: Twenty units of literature were included in the review. Four comparative factors were identified: system and legal basis, organisation and scope, providers, and content. In Slovenia, all older adults are entitled to the same range of preventive services. Compared to Sweden, the organisation of community health care in Slovenia is more centralised, all older adults are entitled to the same scope of preventive health visits, while the level of education and scope of competences of healthcare providers are lower. In both countries, the content of preventive home visits to older adults is similar.Discussion and conclusion: In Slovenia, community health nurses with additional knowledge could prescribe medical devices and medications form a limited list, as well as coordinate care. This would allow them to act more independently in patients' home environment. Further development of more personalised preventive services for older adults depends on research, resource provision and consideration of the organisational culture.

Challenges of the development of mental health care in Slovenia

With the implementation of The Mental Health Act in 2008 and The National Mental Health Programme in 2018, Slovenia made important progressive steps in the development of mental health care in the direction of community-based multidisciplinary approach on the primary level of the health and social care system. One of the main obstacles in the realization is the lack of mental health professionals – psychiatrists, psychologists and psyhotherapists. The increase of mental health problems during COVID-19 pandemic, like increased number of suicidal attempts, alcohol abuse, number of criminal attempts of domestic violence and mental health problems of children and adolescents, have further increased the need for the development of various forms of community-based multidisciplinary mental health services on the primary level.

Self-reported Sexually Transmitted Infections and Healthcare in Slovenia: Findings from the Second National Survey of Sexual Lifestyles, Attitudes and Health, 2016-2017.

IntroductionObjectives were to estimate the lifetime prevalence of self-reported sexually transmitted infections (STIs) and describe STIs healthcare.MethodsData was collected in the period 2016-2017 from a probability sample of the general population, 18-49 years old, at respondents’ homes by a combination of face-to-face interviews and self-administration of more sensitive questions. Statistical methods for complex survey data were used to account for stratification, clustered sampling, and weighting.ResultsApproximately every tenth sexually experienced individual reported to have had genitourinary symptoms suggestive of STIs, but only a minority of them reported to have had those respective STIs diagnosed. The proportion of sexually experienced individuals that reported to have ever been diagnosed with an STI (excluding trichomoniasis, pubic lice for men and women, and pelvic inflammatory disease, vaginal thrush, bacterial vaginosis for women) was 2.4% for men and 6.7% for women (p<0.001). Independent risk factors associated with self-reported STIs in women included at least 10 lifetime sexual partners and having been forced into sex. The majority of the last STI episodes in women were treated by gynaecologists accessible at the primary healthcare level and in men by a dermatovenerologist, after referral by a general practitioner. Approximately half of STI patients were counselled for safer sex and majority reported to have notified their sexual contacts.ConclusionsOur estimates for lifetime prevalence of self-reported STIs in a probability sample of Slovenian sexually experienced men and women, 18-49 years old, indicate a substantial national burden of STIs. The results will inform national STI prevention and control policies and strategies.

Scaling-up an Integrated Care for Patients with Non-communicable Diseases: An Analysis of Healthcare Barriers and Facilitators in Slovenia and Belgium.

IntroductionAlthough the concept of integrated care for non-communicable diseases was introduced at the primary level to move from disease-centered to patient-centered care, it has only been partially implemented in European countries. The aim of this study was to identify and compare identified facilitators and barriers to scale-up this concept between Slovenia and Belgium.MethodsThis was a qualitative study. Fifteen focus groups and fifty-one semi-structured interviews were conducted with stakeholders at the micro, meso and macro levels. In addition, data from two previously published studies were used for the analysis. Data collection and analysis was initially conducted at country level. Finally, the data was evaluated by a cross-country team to assess similarities and differences between countries.ResultsFour topics were identified in the study: patient-centered care, teamwork, coordination of care and task delegation. Despite the different contexts, true teamwork and patient-centered care are limited in both countries by hierarchies and a very heavily skewed medical approach. The organization of primary healthcare in Slovenia probably facilitates the coordination of care, which is not the case in Belgium. The financing and organization of primary practices in Belgium was identified as a barrier to the implementation of task delegation between health professionals.ConclusionsThis study allowed formulating some important concepts for future healthcare for non-communicable diseases at the level of primary healthcare. The results could provide useful insights for other countries with similar health systems.

Post-World War I Children’s Healthcare in Slovenia as Experienced by Angela Boškin, the First Slovenian Nurse

This paper addresses children’s healthcare in the first post-World War I decade in the area of present-day Slovenia. During a time when school physicians were returning from military service and paediatricians were becoming more active, the first Slovenian home care nurse Angela Boškin played a significant role in caring for infants and mothers as well as in organising and developing the home care service. By analysing her work, this paper will attempt to reconstruct the demanding post-war social conditions which required healthcare improvements for all children.Boškin’s work is distinguished by two key achievements: the establishment of the first Slovenian counselling service for mothers and infants in Jesenice in 1919 which Boškin achieved in cooperation with physicians, thereby laying the foundation for the social and healthcare work of home care nurses. In 1922, she established a children’s shelter in collaboration with Dr. Matija Ambrožič in a rundown and overcrowded orphanage on Bohoričeva Street in Ljubljana that developed into the first childcare institution (Zavod za socialno higiensko zaščito dece), where she worked as the first professionally qualified nurse.

Defining the Optimal Size of Medical Laboratories at the Primary Level of Health Care with Data Envelopment Analysis: Defining the Efficiency of Medical Laboratories.

Introduction:As an integral part of health care, biomedical laboratories are an important contributor to quality patient care. There are only few studies on technical and economic efficiency in the field of laboratory medicine. Nevertheless, such research is crucial to further optimize public resources.Aim:The aim of our research is to create and verify a model for defining the scale efficiency of medical laboratories at the primary level of health care.Methods:Twenty-one laboratories at the primary level of health care in Slovenia were included in the analysis. The efficiency of medical laboratories was determined using data envelopment analysis. We additionally used hierarchical cluster analysis to determine the homogeneous groups within the analyzed sample of units.Results:We determined the high technical and pure technical efficiency of the analyzed laboratories. The analysis results showed that changes in work processes represent only a minuscule improvement in efficiency, while more can be achieved through a proper scaling of laboratory services. The impact of the operating scale on the efficiency of laboratories is up to twice as high as the process inefficiency. If we take into account the operating modes of laboratories, the optimal scale of services starts at 237,570 automatic tests.Conclusions:We note that increased automation and consolidation of laboratory activities could contribute to a greater efficiency of medical laboratories and consequently reduce public spending. DEA is an appropriate tool for the efficiency analysis of public medical laboratories and of appropriate support for policy creation and evaluation in the field of laboratory medicine.

Safety culture in the primary health care settings based on workers with a leadership role: the psychometric properties of the Slovenian-language version of the safety attitudes questionnaire \u2013 short form

BackgroundSafety culture describes leader and staff interactions, attitudes, routines, awareness, and practices within an organisation. With this study, we aimed to determine the psychometric properties of the Slovenian-language version of the Safety Attitudes Questionnaire (SAQ) – Short Form in primary health care settings.MethodsThis was a cross-sectional study in the largest primary health care in Slovenia. We invited all employees with a leadership role to participate in the study (N = 211). We used the Slovenian-language version of the SAQ – Short Form.ResultsThere were 154 participants in the final sample (73.0% response rate), of which 136 (88.3%) were women. The mean age of the sample was 46.2 ± 10.0 years. Exploratory factor analysis put forward six factors: 1) Perceptions of Management; 2) Stress recognition; 3) Teamwork Climate; 4) Communication; 5) Safety Climate; 6) Working Conditions and Satisfaction. This model explained 61.7% of the variance of the safety culture in the primary health care setting. The reliability of the whole scale and of the six factors, assessed using Cronbach’s alpha, was all above 0.78.ConclusionThe results of our study suggests that the Slovenian-language version of the SAQ – Short Form with six factors could be a reliable and valid tool for measuring the safety culture in the primary health care workers with leadership role In Slovenia. The Slovenian version differed from the original SAQ – Short Form and the majority of other translated versions. Also, the data was from one health centre only and therefore we cannot draw strong conclusions on its external validity.

User involvement in Slovenian healthcare

The purpose of this paper is to report on current developments in user involvement in healthcare in Slovenia and to explore the issue from the macro-, mezzo- and micro-levels. User involvement is first contextualised within history of the organisation of healthcare system, from its socialist past through to its post-transitional developments. Second, user involvement is tracked through an analysis of healthcare policies and legislation as well as at its institutional and organisational levels. Finally, user involvement practices are illustrated from the perspective of individual patients. A descriptive and exploratory case study design was employed, including a literature review, document analysis and qualitative thematic analysis of nine in-depth and four semi-structured interviews. The findings reveal a complex and at times ambivalent picture in which user involvement is still not firmly embedded into the healthcare system, despite being generally accepted. No systematic qualitative research of patient involvement in Slovenia has previously been published. This research will establish a basis for further investigations of the topic.

Prevalence of isolated systolic hypertension (ISH) in Slovene hypertensive patients: insights from the "Quality of Healthcare in Slovenia" project.

The aim of the present study was mainly to evaluate age- and gender-dependent isolated systolic hypertension (ISH) prevalence before and during antihypertensive treatment, and to evaluate pulse pressure (PP) distributions during antihypertensive treatment in almost 20,000 Slovene hypertensive patients. The study was conducted as part of the "Quality of Healthcare in Slovenia" project, in agreement with the National Medical Ethics Committee of the Republic of Slovenia. Appropriate statistical analyses and evaluations were performed. The prevalence of ISH before the treatment was 19.6 % (17.0 % for men and 21.4 % for women) and it was significantly (p < 0.001) higher during the treatment (29.6 %; 26.4 % for men and 31.9 % for women). The mean PP before the treatment for the whole study patient sample was (71.2 ± 16.9) mmHg and was significantly (p < 0.001) reduced during the treatment to (57.4 ± 12.5) mmHg. With regard to high ISH in treated Slovene hypertensive patients, quality of ISH control may not be optimal and should be improved. On the other hand, the adequate arterial hypertension (AH) control (systolic blood pressure (SBP) < 140 mmHg and diastolic blood pressure (DBP) < 90 mmHg) was achieved in 55.6 % of patients. Our observations may have useful therapeutic implications in the management of AH, particularly ISH in the elderly.

Physical activity promotion in primary health care in Slovenia

In Slovenia, the role of general practitioners in counselling physical activity for prevention of cardiovascular disease (CVD) is well recognized. The role of general practitioners in advising healthy lifestyle for individuals who are at risk of developing CVD is formally defined in the National Program for Primary Prevention of Cardiovascular Disease, which has been running since 2001. Part of the program is counselling on healthy lifestyle including physical activity, performed in all health centres across the country. First a screening and medical examination is performed. In case of higher risk for CVD (&gt;20%) the physician should give advice on the particular risk factor and direct patients to health-education centres, where they can participate in healthy lifestyle workshops lead by health professionals. Physicians and other health professionals who are involved in the implementation of prevention activities within the program need knowledge and skills that are crucial for successful counselling on healthy lifestyle. The educational program “basic education in health promotion and prevention of chronic non-communicable diseases in primary health care/family medicine” consists of two parts. The first part of the training is open to all health professionals working within the program. The second part is intended for health professionals working in health-education workshops. In the last few years a new family practice model has been introduced and disseminated. Some duties of the family physician, including health promotion and counselling, are being transferred to graduate nurses who become part of the family practice team. This new division of work undoubtedly brings many advantages, both in terms of the work organization, and of high-quality patient care. Nevertheless preventive action cannot be fully passed on to graduate nurses. Careful planning and education are needed to ensure a comprehensive approach in healthy life style counselling.

Rethinking Healthcare in Slovenia: An analysis of Challenges and Opportunities of EHealth

Rethinking Healthcare in Slovenia: An analysis of Challenges and Opportunities of EHealth

Public and Private Healthcare in Slovenia in Relation to Choice and Accessibility of Services

This article starts with background information on the Slovenian healthcare system and the description of the evolutionary process and privatisation reforms that bring a mix of public and private healthcare services. The authors' aim is to conceptualise existing modes of public and private healthcare provision and discuss possible implications for user choice and accessibility of services. A descriptive and exploratory case study approach was employed. Literature and document analysis was complemented by secondary data and semi-structured interviews. The results demonstrate four modes of healthcare services in relation to public-private delivery. The ‘public non-profit' type refers to publicly financed and delivered services. The ‘private within public' type addresses services provided within and by the public sector for patients who pay out-of-pocket. The ‘private for public' type deals with services provided by private entities with concessions. The ‘private for-profit' type refers to completely private provision (without concession) of self-pay services. The strengths and weaknesses of each mode with respect to choice, space-time accessibility, financial accessibility and quality of services are critically discussed. The results of the study show that private healthcare services significantly complement and compete with public sector. In addition, there is a risk that uncontrolled mixing of public and private modes of practice may bring about unethical behaviour and corruption.

Strošek In Učinkovitost Zdravljenja Shizofrenije Z Atipičnimi Antipsihotiki V Sloveniji: Raziskava Stroškovne Učinkovitosti / The Cost And Effects Of Atypical Antipsychotic Agents In Patients With Schizophrenia In Slovenia: A Cost Effectiveness Study

Izvleček Uvod: Zdravljenje z atipičnimi antipsihotiki predstavlja najpomembnejši način zdravljenja bolnikov z akutno shizofrenijo in predstavlja veliki strošek. V Sloveniji nam primanjkuje raziskav stroškovne učinkovitosti atipičnih antipsihotikov, ki jih lahko uporabimo v klinični praksi. Namen: Osnovni namen raziskave je bil primerjava stroškov in učinkovitosti petih atipičnih antipsihotikov z največjim tržnim deležem v letu 2011 v Sloveniji. V raziskavo smo vključili aripiprazol, kvetiapin, paliperidon, risperidon in olanzapin. Metode: Ciljna populacija v raziskavi so bili slovenski bolniki z akutno shizofrenijo. Vsak izmed petih antipsihotikov predstavlja glavno vejo odločitvenega drevesa. Terapevtska učinkovitost je bila določena kot verjetnost letne remisije. Ceno dnevnega zdravljenja s posameznim zdravilom smo pridobili iz podatkov tržnega deleža in prometa v letu 2011, stroške mentalnega zdravstvenega varstva v Sloveniji pa smo pridobili iz podatkov Zavoda za zdravstveno zavarovanje Republike Slovenije. Raziskava je bila zasnovana z vidika plačnika, tj. Zavoda za zdravstveno zavarovanje Republike Slovenije. Rezultati: Zdravljenje z risperidonom je najcenejše, najučinkovitejše pa z olanzapinom. Strategija zdravljenja z risperidonom ima najmanjši kvocient med stroški in učinkovitostjo. Strategije zdravljenja z aripiprazolom, s kvetiapinom in paliperidonom so prevladujoče. Cene letnega zdravljenja so: 6.812 EUR za risperidon, 7.509 EUR za kvetiapin, 7.295 EUR za olanzapin, 8.229 EUR za aripiprazol in 8.044 EUR za paliperidon. Učinkovitosti, podane v deležu letne remisije, so: 0,605 - kvetiapin, 0,603 - aripiprazol, 0,671 - risperidon, 0,723 - olanzapin in 0,712 - paliperidon. Sklep: Rezultati študije kažejo, da je najbolj stroškovno učinkovito zdravljenje akutne shizofrenije z risperidonom in olanzapinom

Public-private partnership in health care in Slovenia

Introduction. Public-private partnerships introduce new socioeconomic relations between the public and private sectors. A public-private partnership is a general term that comprises all forms of cooperation between the public and private sector. The position of public service providers must be clearly defined, particularly when a public service is provided by both public entities as well as private entities with concessions.Methods. Research has shown that changes are needed both in the field of management of health organisations and in the field of better and more rational use of health care funds. Health institutions should remain under state ownership, while the private sector, in the form of providers of health care services, should rent premises in these facilities. It is interesting that the majority of doctors state, as their first reason for starting a private practice, the possibility of greater independence, more rational use of funds, better use of knowledge and technology, and only in the last place do they state better pay.Results. Utilising scientific methods, it has been proven that there are differences between providing health care services in the public health care sector, public-private health care sector and the private health care sector. Research has ascertained that public-private partnerships are the most suitable form of providing health care services for both patients and for providers of health care services.

Accessibility and providers of primary women's reproductive health care in Slovenia in 2010

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Quality indicators and accreditation as a tool for quality management in healthcare in Slovenia

Introduction. Investigating deviations in the expected outcome of activities is recognised as a basic tool for quality improvement. In the healthcare sector such analysis is done mainly through the definition of quality indicators, the determination of standards, and the evaluation of compliance to them through a system of accreditation. In Slovenia, particularly in the last year, a number of activities have been undertaken to further develop this area.Methods. It was necessary to agree on a national set of quality indicators and on a model for accreditation of healthcare institutions in Slovenia. Such an agreement requires the participation of all key stakeholders and it significantly helps in clarifying accountability relationships between the partners in the healthcare system.Results. A set of 72 quality indicators to be monitored at the national level has been set. Recommendations regarding accreditation of healthcare institutions have also been formulated. These recommendations focus on developing incentives for accreditation through internationally recognised institutions. In this context, national and international documents, particularly the Directive on patients' rights in cross-border healthcare need to be taken into account.Conclusion. The common goal of all the partners is ensuring high quality and safe healthcare for the patients.

Privatisation of health care in Slovenia in the period 1992–2008

To discuss the background, nature and facilitating and hindering factors of the privatisation process in health care in Slovenia. Descriptive analyses of legal and policy documents mapping the situation in Slovenia against an internationally established taxonomy and typology. Description of the scope and volume of the different types of privatisation. Determined by the political will, privatisation in health care in Slovenia has been a gradual process. In 2008, it applies to 30% of the primary care providers (GPs, paediatricians and school medicine doctors), almost 60% of providers in dentistry and about 20% of providers of outpatient specialist care. In the hospital setting, privatisation remained limited and there have not been significant private investments in health infrastructure. Privatisation of health insurance (including insurance to cover co-payments) has steeply risen to 15% of the total health expenditure (THE), while out-of-pocket payments reached 12% of the THE. Slovenia's privatisation in health care is focused on primary health care and on health expenditures. Controversies over its extent kept privatisation contained and controlled. Today's share of private provision of health services remains at the conservative end of the European Union. Private expenditures for health services increased considerably, while privatisation of health infrastructure and management has so far been limited. Concerns about the future course of privatisation relate to the issues of equity, fairness and solidarity.