Polish Health System Research Articles

"Vaccinating your child during an emergency is more important than ever": a randomised controlled trial on message framing among Ukrainian refugees in Poland, 2023.

BackgroundSince February 2022, the start of the full-scale war in Ukraine, millions of women and children have fled the country. Vaccination of refugee children is important to protect this vulnerable population from disease.AimWe investigate the determinants of vaccination intention in refugee mothers from Ukraine residing in Poland and test the effect of three message frames.MethodsParticipants were randomised into either a control group or one of three intervention groups encouraging vaccination using a specific frame: (i) trust in the Polish health system, (ii) ease of access to vaccination or (iii) risk aversion. Primary outcomes were intention to vaccinate a child in Poland and clicking on a vaccination scheduling link.ResultsThe study was completed by 1,910 Ukrainian refugee mothers. Compared with the control group, the risk aversion message significantly increased vaccination intention (adjusted odds ratio (AOR): 2.35, 95% confidence interval (CI): 1.25-4.42) and clicking on the vaccine scheduling link (AOR: 1.53, 95%CI: 1.12-2.09). Messages around trust and ease of access did not have an effect. Important determinants of vaccination intention were perceived importance of vaccination (AOR: 1.12 95%CI: 1.01-1.25) and trusting vaccination information official health institutes (AOR: 1.40 95%CI: 1.06-1.83) and social media (AOR: 2.09 95%CI: 1.33-3.27).DiscussionUsing a risk aversion frame highlighting the vulnerability to infection that refugees face resulted in increased vaccination intention and clicks on a vaccination scheduler. Health workers who interact with Ukrainian refugees could use this frame in their vaccination communication.

Health Models – Financing and Effects: a Comparative Study of the Models in Poland and Italy

The purpose of the article. The study brings a comparative analysis between health systems in Poland and Italy. It is aimed at fulfilling the subject literature using economic comparative analyses between different health systems as well as straight comparisons between Polish and Italian health systems. Moreover, another aim of the study is to find out some weak points and to point out some good practices of each of the analyzed health systems. The research question for the purpose of this study is as follows: what changes can be implemented to improve the efficiency of each of the analyzed health systems?
 Methodology. The study is carried out on the background of health systems' theory. The critical literature review is conducted. A comparative analysis using such indicators as percentage of GDP and GDP per capita spent on financing health systems, healthcare spending components, life-expectancy data or Euro Health Consumer Index indicators are applied and analysed in the study.
 Results of the research. Health systems in Poland and Italy in the latest decades were transformed in a completely different way. Healthcare in Poland is based mainly on health insurance premiums whereas in Italy financing of healthcare is based mainly on taxes. Among similarities between the systems a high level of responsibility designated to local authorities may be mentioned. The comparative analysis indicates that the situation of the Italian health system seems to be much better as compared to its Polish counterpart. Though, some solutions, aimed at improving health system efficiency, can be transferred from one system to another in case of both analyzed systems.

Psychosocial ergonomics of the workplace of medical staff during the COVID-19 pandemic in three risk's dimensions: working hours, violence and the use of psychoactive drugs-a prospective pilot study.

Workplace ergonomics should also be considered in the context of psychosocial factors affecting the worker, which have a real impact on occupational risk. The present study examined psychosocial risk factors in medical personnel in three domains: working hours, violence and substance abuse. The purpose of the present study is to assess the current state of psychosocial ergonomics of medical personnels by measuring occupational risks in the domains of: working hours, violence and psychoactive substance abuse. The survey is consisted of two parts: socio-demographic information of participants and participants' assements of psychosocial risk factors. In more than half of the respondents (52%), increased risk was identified in the domain of working hours. Nearly half of the respondents (49.6%) have an identified high risk in the domain of violence, and more than half of the respondents (52%) are at high risk in the domain of psychoactive substance abuse. Our findings show that the present psychosocial ergonomics of the Polish health system must be improved. The COVID-19 pandemic has been a compelling test to assess the current state. Our findings highlighted the fact that HCWs often worked overtime and that many cases of workplace violence and substance abuse were reported.

Significant Hearing Loss Found in Ukrainian Refugees

Significant Hearing Loss Found in Ukrainian Refugees

Janina Bortkiewicz and Public Hygiene Education in Popular Magazines Published in Vilnius, 1930–1939

Because General Żeligowski’s troops occupied Vilnius in the autumn of 1920 and Poland annexed it two years later, the health-care system that operated in Poland at the time began to be introduced in the city and the region. The official guidelines for health policy in Poland derived from the concept of hygiene proposed by Tomasz Janiszewski, the founder of the health system in the country, which focused on social hygiene. Universities played an advisory role in the Polish health system and were involved in educating the public on hygiene issues. In interwar Vilnius, the most prominent figure in this field was Janina Bortkiewicz-Rodziewiczowa, a researcher and senior assistant in the Department of Hygiene of the Faculty of Medicine at Stephen Bathory University. This article analyses her publications aimed at promoting science. It examines the means by which Bortkiewicz-Rodziewiczowa conveyed specific medical knowledge to a lay audience. It also discusses what topics she emphasised most and what reasons led to her choices, and how this correlated with priorities in medical science and health policy at that time. Finally, it touches on an interesting practical aspect, namely what public education strategies applied at the time can still be applied today.

Impact of the COVID-19 pandemic and lockdown on mental health among the general population in Poland and on the availability of psychological support

ABSTRACT The objective of this paper was to assess the impact of the COVID-19 pandemic on the mental health of Poles and the availability of psychiatric and psychological support during the pandemic. A prospective, cross-sectional web-based survey design was adopted. It was carried out on a sample of 1080 Polish citizens above 18 years old. The majority of Poles (70%) experienced symptoms of mental disorders during the COVID-19 pandemic. Sleep disturbance (63.79%), anxiety (48.79%), low mood for most of the day (44.63%), sadness, tearfulness (41.29%), and concentration disorders (35.93%) were the mental disorder symptoms reported most often by the survey subjects. To reduce the potential acute and long-lasting effects of the COVID-19 pandemic on mental health, decision-makers of the Polish health system should implement stepped multilevel and multi-target psychological support services.

European Union Structural Funds as the Source of Financing Health Care Infrastructure Investments in Poland-A Longitudinal Analysis.

European Union (EU) structural funds aim at reducing economic and social disparities between the member states regions. The objectives of the study were to (1) provide a summary overview of all health related projects co-financed by EU structural funds in Poland between 2004 and 2020, (2) define the share of projects/funds devoted to infrastructure investments, and (3) assess the total value of EU structural funds' contribution to health care infrastructure investments in comparison to the national public budgets. Data on projects co-financed by EU structural funds covered all projects realized under three financial perspectives: 2004–2006; 2007–2013; 2014–2020. The extraction of “health-related” projects was done according to both the type priority under which the project was realized as well as the type of beneficiary. Results showed that between 2004 and 2020, 14,179 health related projects were implemented, with a total value of 33.2 billion PLN, including EU contribution of 22.8 billion PLN (68.7%). Although projects focused on education and public health prevailed in terms of their total number, infrastructural projects consumed the vast majority of funds. Within the analyzed period, a total of 6,689 health infrastructure projects were implemented with a total value of 29.5 billion PLN, including 19.7 billion PLN of EU contributions. The results confirm that the EU structural funds constituted an important source of infrastructural investments in the Polish health system and majority of them were consumed by investments in public hospitals.

Changes in the relative situation of district hospitals in Poland after the introduction of a system of basic hospital service provision in 2017

The most recent big reform of the Polish health system took place in 2017 and introduced a basic hospital service provision system. Hospitals were able to be included in the network and receive flat-rate financing from the National Health Fund. The current paper aims to assess how the relative situation of hospitals changed between 2015 and 2018. This study is based on multicriteria rankings which take into account the values of profit/loss on sales, the contract with the NHF, the income from health services outside the NHF, the income from rental and lease, the employment of doctors, the employment of nurses, liabilities, operating costs, and interns and residents per hospital bed. The similarity of rankings constructed using different methods is shown. Based on the results of the Chi-squared test, it can be concluded that the inclusion in the network does not affect whether the relative situation of a hospital between 2015 and 2018 improved or not. In the regression analysis, the dummy variable for level 1 hospital was negatively related to the median rank; however, this impact was not statistically significant.

Abstract 9496: 30-days Mortality Risk in the Patients Following Atrial Fibrillation Ablation in the Entire Nation of Poland: An 8-Year Analysis from National Health Fund of Poland

Introduction: Atrial fibrillation (AF) is the most common sustained arrhythmia. Catheter Ablation (CA) is considered as a first-line therapy for AF. The risk of 30-days all-cause mortality associated with CA for AF may be underestimated in clinical trials and selected-cohort studies due to selection bias. Hypothesis: We evaluated 30-days all-cause mortality associated with CA for AF in the entire country of Poland Methods: The data was collected from the Polish national healthcare service (the National Health Fund of Poland). In the Polish health system covers >99% of CA for AF for the entire country. All consecutive CA in patients >18 years of age, between Jan 2012 and Dec 2019 were included in the study. CA for AF was identified by unique codes assigned to pulmonary vein isolation and CA for AF. The mortality rate was calculated for each age group. Results: During 8-year follow-up period, 31,214 CA of AF were performed in 26,767 patients. 9315 (34.8%) patients were female. 13758 (51.4%) patients had Cryoballoon ablation. Thirty-two deaths (0.1%) within 30-days of the CA were identified. The mortality rate was low and similar in each age group except in the oldest age group (age>80). The oldest age group had significantly higher 30-days mortality than any other age group. (Figure). Conclusions: In the large, consecutive patient population in the entire country of Poland, 30- days mortality following AF ablation for past 8-years remains low. In real-world clinical practice patients over the age of 80 have higher risk of 30-day all-cause mortality than any other age group found over last seven years. Systematic review is needed to further risk-stratify these findings.

Self-Medication-Related Behaviors and Poland's COVID-19 Lockdown.

(1) Background: The SARS-CoV-2 pandemic has changed the functioning of Polish health systems. Telemedicine has been developed and access to prescription drugs (Rx) has been facilitated. This study examined whether these changes and the imposition of a three-month lockdown caused Polish people to engage in more self-medication-related behaviors. (2) Method: After the fourth (final) stage of defrosting the Polish economy, an online survey of a quota sample of 1013 Polish respondents was conducted. (3) Results: Almost half of the respondents (45.6%) indicated that they had engaged in at least one behavior associated with inappropriate self-medication during the lockdown (e.g., 16.6% took medication as a precaution, and 16.8% took an Rx formulation without consultation). Some of these people had never engaged in such behaviors prior to the lockdown. Linear regression showed that higher values of a composite (“lockdown”) index of self-medication-related behaviors occurring during lockdown were predicted by greater religiosity and the presence of children in a household. Also, independent samples t-tests showed that people who were afraid for their financial future and people who feared for their health obtained higher lockdown index scores than people not having such worries. (4) Conclusions: Self-medication-related behaviors were more common among Poles before lockdown than during the lockdown (which is unsurprising given that the lengths of the periods compared were hugely different), worryingly, many people exhibited such behaviors for the first time during the lockdown.

Multicentre early experience with totally subcutaneous cardioverter-defibrillators in Poland.

IntroductionImplantable cardioverter-defibrillators (ICD) have a strong position in the prevention of sudden death. Nowadays, the most commonly used high-energy cardiac devices are transvenous ICDs. A new technology of totally subcutaneous ICDs (S-ICD) was invented and recently introduced into clinical practice in order to reduce lead-related complications of conventional ICDs. The aim of this paper is to present early experience with this new technology implemented in a few centres in Poland.Material and methodsMedical records of patients who had S-ICD-related interventions in Poland were retrospectively analysed.ResultsDuring the first year of S-ICD introduction into the Polish health system 18 patients underwent surgery connected with S-ICDs. Majority of them (17 patients) were implanted de novo. In one patient surgical revision of a device implanted abroad was performed. Most of patients (78%) had S-ICDs implanted for secondary prevention. Inability of transvenous system implantation due to venous access obstruction or high risk of infection related with transvenous leads accounted for 83% of indications for S-ICD. Only in three patients were S-ICDs implanted due to young age and active mode of life. The implantations of S-ICDs were performed without important early or late complications. During follow-up one patient had episodes of ventricular arrhythmia successfully terminated with high-energy shocks. One patient died due to progression of heart failure.ConclusionsS-ICD implantation procedure has been successfully and safely introduced in Polish clinical routine. Nevertheless, despite clear indications in recent ESC guidelines, this therapy is not directly reimbursed in Poland and needs individual application for refund.

Analysis of the prevalence of diseases in the rural areas of Warmia and Mazury

Int roduc t ion: General practitioners (GPs), are the foreground of all medicine. When a disease starts, most patients have their first contact with medicine in the GP’s offices. For this reason, it is likely that the illnesses diagnosed by GPs are consistent with the real number of illnesses occurring in the area of their region. Aim: To preset in this research we focused on the frequency of cases of disease where there was a problem with receiving prompt medical advice. Ma t e r i a l and me thods : We obtained data of 14 279 visits of 2774 patients from January 1 to December 31, 2017, containing an ICD-10 diagnosis, the statistical number of the patient and the patient’s age at the time of visit from the 3 GPs facilities belonging to one practice in a rural area near to Olsztyn. Re sul t s and di s cus s ion: Analysis has shown that the most popular cardiovascular system disease is essentially hypertension. We found out that hypertension was affecting even the youngest people – males from 20 to 30 years old. Under the age group of 40–50 years old, mainly men suffered from hypertension. The family doctor institution should be the basis of the Polish Health System. It is the place where all the patients’ basic needs should be met. This institution should be the first filter of patients, which refers patients to more highly-specialistic medical providers. Conc lus ions : The top 15 diagnoses in our study contains prescribing medication, which is the same in Australia.The difference between the two countries is the percentage of this problem – 24.1% in Polish GPs vs. 1.6% in Australian GPs.

Influences on Polish migrants' breast screening uptake in Lothian, Scotland

ObjectivesEthnic minorities are known to have low uptake of cancer screening programmes and Polish populations to have low breast screening uptake. Breast screening uptake by women in Poland and Polish migrants to Scotland is low. We interviewed Polish women living in Lothian, Scotland, about their attitudes to breast screening. Study design and methodTelephone interviews were held with a sample of 11 Polish women registered with Lothian general practices and invited for breast screening in 2013 or 2014. Interviews were between November 2014 and February 2015 and were held in Polish then translated, transcribed and analysed thematically. ResultsWomen interviewed (mean age 58 years) had lived in Scotland for an average of 7.5 years. Seven had undergone breast screening in both Poland and Scotland, three in only Scotland and one in Poland alone. Respondents usually used Scottish and Polish health systems and screening programmes in parallel. Convenience and familiarity shaped screening choices with written information neither accessed nor answering key questions e.g. about coordination between programmes. ConclusionPolish women living in Scotland have difficulties in accessing screening there and often use both Polish and Scottish system. Language issues, misunderstandings about screening and different health cultures are key barriers. Combined information in Polish about all cancer screening programmes could help address low uptake.

Planning of Polish physician workforce – Systemic inconsistencies, challenges and possible ways forward

BackgroundPoland has the lowest number of physicians per 1000 population (2.2/1000) in the EU. This is accompanied by a considerable migration rate of Polish physicians to other EU countries (estimated at above 7%). Among other consequences, this results in waiting lists and unmet health needs. ObjectiveThe aim of this article is an identification of the main challenges for physician workforce planning in Poland. MethodsThe authors analysed national and international documents, reports, official statements, publications and statistical databases. Main findingsIn Poland health workforce planning is inadequate and insufficient. There is no formal structure and no strategy regarding human resource planning or regular forecasts for the health workforce, which results in many negative effects for the healthcare system. Currently the shortage of physicians in some specialties is becoming one of the most important reasons for limited access to care and lengthening the average wait time. ConclusionsTo improve this situation operational and strategic actions should be undertaken without unnecessary delay. Effective and close cooperation between key stakeholders is needed. Health workforce planning needs to become one of the key building blocks of the Polish health system’s reforms, strongly connected to the other functions of the health system. It is essential for Poland to follow available good practices in health workforce planning.

MA01.11 Implementation of LDCT Lung Cancer Screening into Practice. Results of Regional Early Detection Program

Lung cancer is the leading cause of cancer deaths both in men and women in either Wielkopolska and the whole Poland. Wielkopolska is one of Polish regions (voivodships) with about 3,4 mln inhabitants and incidence of lung cancer approx. 1900 new cases every year. Screening by low dose computer tomography (LDCT) showed reduction of lung cancer mortality in NLST trial. Regional authorities covered this program from local budget beside Polish health system. Since October 2009 program of early detection of lung cancer started in 5 centers of Wielkopolska region. Till the end of 2015 N=17222 subjects were screened. The entry criteria were: age between 55 and 70 years and smoking ≥ 20 pack/years. Every person has the LDCT performed. Results were first classified as normal or abnormal. Abnormalities were divided into 6 categories: <5mm single, <5 mm multiple, 5-15 mm single, 5-15 mm multiple, >15 mm single, >15 mm multiple. Patient received also recommendation for further actions. Results presented are based on annual reports for regional authorities. More than 85% of the images were classified as abnormal. Nodes of any kind were found in about 47% of entire population. More than 3000 patient received recommendation for further diagnostic evaluation. Finally 108 patients underwent surgery (37 lobectomies, 41 wedge resections, 30 thoracotomies/thoracoscopies). There were 92 cases of lung cancer confirmed (11 SCLC, 78 NSCLC, 3 carcinoids) and 1 case of mesothelioma. Lung cancer screening program identifies magnitude of lung changes. Many patients require further diagnostic procedures. Most of them are fibrotic, post inflammatory changes. It is possible to diagnose lung cancer in early presymptomatic stage but numbers are low and risk models or biomarkers should be implemented to better define patients / nodules at risk.

Health literacy as an element of the Polish occupational health system

Nowadays it is believed that a comprehensive approach towards one's health requires the development and subsequent mastering of health literacy. Although this term has no Polish equivalent, it applies to the ability of individuals to access, analyze and understand information necessary to make informed health decisions. In this publication it is suggested that 'biegłość zdrowotna' can be used as a corresponding Polish term. This publication is based on the review of the available literature (in Polish and in English) on health literacy. To illustrate the hypothetical level of health literacy among Polish employers and employees reports of the Chief Labour Inspectorate and individual items from the Second European Survey of Enterprises on New and Emerging Risks (ESENER-2) were used. The analysis proves that health literacy is a multidimensional concept which has been studied and investigated so far only in relation to chosen nosological units, but practically it does not appear in relation to occupational health. There are reasons to believe that in Poland the low level of health literacy among both employers and employees, lies at the forefront of a passive approach towards the safeguarding of workers health. The concept of health literacy needs further dissemination in Poland, whereas the main area of future research should be the design of the Polish tool for assessing health literacy. The national system of occupational health seems to offer a possible ground for implementing such a concept, especially bearing in mind that within the current system there are several entities and services, which have the legal mandate to undertake informative and advisory duties - exactly those, which help build and master health literacy skills. Med Pr 2016;67(5):681-689.

Diagnostics and Treatment of Thyroid Carcinoma.

Revised Guidelines of Polish National Societies Prepared on the initiative of the Polish Group for Endocrine Tumours approved in their final version between November 16th and 28th, 2015 by the Scientific Committee of the V Conference "Thyroid Cancer and other malignancies of endocrine glands" organised between November 14th and 17th, 2015 in Wisla, Poland; called by the following Societies: Polish Endocrine Society, Polish Society of Oncology, Polish Thyroid Association, Polish Society of Pathologists, Society of Polish Surgeons, Polish Society of Surgical Oncology, Polish Society of Clinical Oncology, Polish Society of Radiation Oncology, Polish Society of Nuclear Medicine, Polish Society of Paediatric Endocrinology, Polish Society of Paediatric Surgeons, Polish Society of Ultrasonography Gliwice-Wisła, 2015 DECLARATION: These recommendations are created by the group of delegates of the National Societies, which declare their willingness to participate in the preparation of the revised version of the Polish Guidelines. The members of the Working Group have been chosen from the specialists involved in medical care of patients with thyroid carcinoma. Directly before the preparation of the Polish national recommendations the American Thyroid Association (ATA) published its own guidelines together with a wide comment fulfilling evidence-based medicine (EBM) criteria. ATA Guidelines are consistent with National Comprehensive Cancer Network (NCCN) Recommendation. According to the members of the Working Group, it is necessary to adapt them to both the specific Polish epidemiological situation as well as to the rules referring to the Polish health system. Therefore, the Polish recommendations constitute a consensus of the experts' group, based on ATA information. The experts analysed previous Polish Guidelines, published in 2010, and other available data, and after discussion summed up the results in the form of these guidelines. It should be added that Part II, which constitutes a pathological part, has been available at the website of the Polish Society of Pathologists for acceptance of the members of the Society, and no essential comments have been proposed. The Members of the Group decided that a subgroup elected from among them would update the Guidelines, according to EBM rules, every year. The Revised Guidelines should help physicians to make reasonable choices in their daily practice; however, the final decision concerning an individual patient should be made by the caring physician responsible for treatment, or optimally by a therapeutic tumour board together with the patient, and should take into consideration the patient's health condition. It should be emphasised that the recommendations may not constitute a strict standard of clinical management imposed on medical staff. The data from clinical trials concerning numerous clinical situations are scarce. In such moments the opinion of the management may differ from the recommendations after considering possible benefits and disadvantages for the patient.

Realia profilaktycznej opieki zdrowotnej nad pracownikami w Polsce

The Polish occupational health system (OHS), existing over the past 17 years, has recently been contested as never before. Critical voices pertain to both legislative and executive aspects of the system, in which key roles are played by employers and occupational medicine service. There are some reasons for making a hypothesis that relevant norms are not always respected by the main actors. The data on the observance of norms by entities responsible for providing workers with prophylactic health care were analyzed. They were obtained from the existing external resources and materials collected during the implementation of tasks assigned by the Ministry of Health. Legal norms, which constitute OHS in Poland are generally neither respected by the employers, nor by the representatives of occupational medicine service. Nearly half (45-47%) of employers infringe provisions relating to medical examinations of workers. Such a degree of non-observance of respective laws would have not been the case if it was not for the attitudes and "silent approval" of many (but not all) occupational physicians. Laws defining the responsibilities of occupational medicine service units on one hand, and of employers on the other, are for many reasons infringed by both groups. The data analyses indicate that the Polish OHS is, to a large extent, not acceptable and should be replaced with another one founded on other assumptions and responsive to contemporary occupational health challenges. New provisions should be formulated on the basis of merit and guided by socially accepted norms.

Elementy Nowego Zarządzania Publicznego w systemie ochrony zdrowia w Polsce

The paper analyzes two elements of New Public Management introducedin the Polish public health system: public – private partnership and evaluationof performance.

There is no place for targeted therapy neoadjuvant treatment in Polish Health System – An analysis of radical nephrectomies in patients with large kidney tumors

IntroductionDespite the introduction of better diagnostic tools, very large kidney tumors are still not so rare in our country. The paper presents our experience in the treatment of 12 patients with kidney tumors larger than 14 cm in size.Material and methodsBetween spring 2009 and autumn 2011, radical nephrectomies were performed in 12 patients due to a large kidney tumor (larger than 14 cm in size). Symptoms (hematuria, weight loss, anemia, etc.) were not present in all the patients, but the kidney tumor was confirmed by imaging studies (ultrasound, CT, MRI) in all of them.ResultsFull recovery was observed with no severe complications in all of the patients treated with radical nephrectomy. Pathological staging was correctly established by imaging studies in all of them. After a few months, five of patients (41.6%) required systemic therapy due to lymph node involvement.ConclusionsPatients with large kidney tumors should be treated in selected medical centers that have experience in the treatment of such cases. Radical nephrectomy has to be the method of choice in the treatment of patients with this kind of tumor and its diameter should not disqualify from surgical treatment, which is still the only chance for the patients to be cured, as no adjuvant chemotherapy treatment has proved to be significantly effective.