Primary Health Care In Poland Research Articles

Informal coordination of care in Praktyka Lekarza Rodzinnego (PHC facility)- the auto-ethnographic study on building the theoretical model of integrated care based on grassroots initiative

Since the adoption of the 2017 bill on primary health care (PHC) introducing a model of integrated care in PHC in Poland, family doctors have been obliged to coordinate the care and to manage the PHC teams. Till now only a small number of PHC facilities decided to conclude contracts on coordinated care with National Health Fund (NHF). There are serious reservations over rural and remote PHC facilities' capabilities to meet all the NHF's criteria regarding coordinated care. This auto-ethnographic study presenting the case of a family doctor in remote area in lubuskie voivodeship shows that mechanisms and models of integrated care are rooted in the primal idea of family medicine and may be successfully adopted and developed aside legally imposed solutions. These mechanisms create a specific grass-rooted system of organising the process of delivering care which is called informal coordination. The study presents the theoretical framework of informal model of integrated care based on 5 principles guaranteeing achieving the two most important goals of coordinated care: its complexity and continuity. It has been conducted as a participatory observation in PHC facility with active involvement of PHC facility's staff members. As long as there is still enough space in healthcare systems for new initiatives regarding coordination of care and new solutions are being developed, this perspective may be valuable for international audiences. The results will serve to develop alternative theoretical model of coordinated care which my be found useful in small, individual, self-sufficient facilities. 
  

Diagnosis of cognitive disorders in primary health care in Poland.

The aim of this study was to assess the knowledge, attitudes and the rules of proceeding concerning primary health care (PHC) doctors in the field of screening diagnostics for cognitive disorders in elderly people in Poland. The study included 175 PHC doctors. A validated anonymous questionnaire was used. The survey was conducted using the PAPI (Paper and Pencil Interviews) and CAWI (Computer Assisted Web Interviews) methods. The vast majority of the respondents (n=159; 91.4%) saw the advisability of screening for cognitive disorders in the age group >65 years of age, but only 53 subjects (30.29%) believed that these tests should be conducted by general practitioners (GPs). According to the surveyed doctors, the main obstacle in the diagnostics of cognitive functions is the lack of time - this was the opinion of 142 (81.14%) respondents. When dementia was suspected, the respondents usually ordered laboratory tests and referred patients to a neurologist (n=111; 63.4%). The Mini Mental Status Examination (MMSE) and the Clock Drawing Test (CDT) were the most popular scales assessing cognitive functions, known by 120 doctors (68.57%), and 122 respondents (69.71%), respectively. Polish GPs are aware of the necessity of screening for cognitive disorders in seniors. Currently, there are no mechanisms within primary health care system that would enable proper early screening for dementia in people at the high risk (i.e.> 65 years of age). The development of standards for the early detection of cognitive disorders within primary health care system in Poland seems to be an urgent need.

Consulting Obese and Overweight Patients for Nutrition and Physical Activity in Primary Healthcare in Poland.

The aim of this study was to evaluate the dietary and physical activity counseling provided to adults by family doctors. Predictors of counseling in primary healthcare were identified. A cross-sectional study was conducted from January 2020 to December 2021 among 896 adult primary care patients in the city of Łódź [Lodz], Poland. Almost 36% of the respondents were advised to change their eating habits, and 39.6% were advised to increase their physical activity. In a multivariate logistic regression analysis, people in poor health with chronic diseases related to overweight and obesity and with two, three or more chronic diseases, respectively, received advice on eating habits from their GP twice and three times more often than people in good health with no chronic conditions (OR = 1.81; p < 0.05 and OR = 1.63; p < 0.05; OR = 3.03; p < 0.001). People in the age groups 30–39 years and 40–49 years (OR = 1.71; p < 0.05 and OR = 1.58; p < 0.05), widowed (OR = 2.94; p < 0.05), with two, three or more chronic diseases (OR = 1.92; p < 0.01 and OR = 3.89; p < 0.001), and subjectively assessing overweight and obesity (OR = 1.61; p < 0.01) had a better chance of receiving advice on physical activity. The study found a higher proportion of advice on diet and physical activity provided to overweight and obese patients by primary care physicians than in other studies; however, still not all receive the necessary counseling. GPs should advise all patients not to become overweight and obese, not only those already affected by the problem.

Barriers and attitudes towards cervical cancer screening in primary healthcare in Poland - doctors\u2019 perspective

BackgroundHealthcare systems have adopted different strategies to reduce the burden of cervical cancer. In Poland, a population-based screening program was implemented in 2006, leading to a downward trend in cervical cancer burden. However, screening rates are still low in relation to other EU member states. In Poland, Pap smears are mainly performed by gynecologists rather than Primary Health Care (PHC) physicians. Little is known about the experiences and attitudes of the latter regarding cervical cancer screening in a PHC setting.MethodsA cross-sectional questionnaire-based survey was carried out among 43 PHC physicians from the Malopolska region in Poland. Barriers and attitudes towards cytology in a PHC setting were evaluated.ResultsApproximately 35% of surveyed physicians reported having experience in performing cytology. Almost 75% of PHC physicians lacked the necessary equipment in their office to perform the screening. None of the studied physicians performed Pap smears in their office at the time. The reasons included: shortage of competence (78.57%) and time (69.05%), the perception of Pap smears as a task for gynecologists (69.05%), the lack of financial incentives (61.90%), and the belief that their patients would be unwilling to undergo the test in their PHC physician’s office (33.33%). More than three quarters (76.74%) declared they would be ready to perform Pap smears if the tests were additionally paid. No significant associations between PHC physicians’ characteristics and their willingness to perform cytology screening were found.ConclusionThe primary barrier to perform Pap smears by PHC physicians does not lie in their personal reluctance but in the organization of the healthcare system. Provision of required training and proper funding allocation can likely improve the screening rate of cervical cancer in Poland.

The prevalence of cardiovascular risk factors and cardiovascular disease among primary care patients in Poland: results from the LIPIDOGRAM2015 study

Abstract Background Cardiovascular disease (CVD) is currently one of the leading cause of mortality in the European Union. Well-established, modifiable cardiovascular (CV) risk factors include hypertension (HTN), hypercholesterolaemia, diabetes mellitus (DM), obesity, low activity levels, poor diet and smoking. There are no current estimates on the prevalence of CV risk factors among Polish patients solely in the primary care setting. Methods A nationwide cross-sectional study, LIPIDOGRAM2015, was carried out in Poland in the 4th quarter of 2015 and 1st and 2nd quarters of 2016. 438 primary care physicians enrolled 13,724 adult patients that sought medical care for any medical reason in primary health care practices. Results Nearly 19% of men and approximately 12% of women had CVD. Over 60% of the recruited patients had HTN, &amp;gt;80% had dyslipidaemia and &amp;lt;15% of patients were previously diagnosed with DM. All of these disorders were more frequent in men. Overweight and obesity were present in more than 75% of patients with 80% of them exceeding the waist circumference norm for the European population. Slightly less than half of the patients were current smokers or had smoked in the past. Patients with CVD had significantly higher blood pressure and glucose levels but lower low density lipoprotein-cholesterol level (LDL-C). In patients with CVD, HTN and dyslipidaemia were twice as frequent and DM three times more so than in patients without it (Figure 1). Conclusions The incidence of CVD and CV risk factors among patients attending primary healthcare in Poland is high. CVD is more common in men than in women. The most common CV risk factors are excess waist circumference, dyslipidaemia and HTN. Family physicians working in primary health care, as well as health authorities should conduct activities to prevent, diagnose early and treat CVD in the primary health care population. Funding Acknowledgement Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): The present study was an initiative of the Polish Lipid Association (PoLA) and the College of Family Physician in Poland (CFPiP). The present study was funded by an unrestricted educational grant from Valeant.

Collaboration between the family nurse and family doctor from the perspective of patients: a qualitative study.

There is increasing focus on collaboration in primary health care, but there is insufficient patient perspective on collaboration between the family nurse and family doctor. To explore how patients perceive collaboration between the family nurse and family doctor in primary health care in Poland. A qualitative approach and an inductive, naturalistic inquiry strategy were used. Thirty-seven patients from eight general practice clinics in the north-eastern part of Poland participated in semi-structured, face-to-face interviews. The qualitative data were examined by means of thematic analysis. The study was reported according to the consolidated criteria for reporting qualitative research (COREQ) checklist. Four subthemes emerged in the context of nurse-doctor collaboration, namely: (i) carrying out the doctor's orders; (ii) visit preparation; (iii) the family nurse as a source of information and (iv) participants' perceptions of the status of the family nurse. Nurses performing instrumental activities connected with a doctor's orders was understood by the participants to be collaboration and prevailed in their responses. The perception of collaboration (or lack thereof) between the family nurse and family doctor results from patients' varied experiences and observations during their visits to a primary care clinic. The traditional model of nursing care and the hierarchical relationship, in which the doctor has the dominant role, are evident in the patients' remarks. The autonomy of nursing could be strengthened by expanding, and highlighting, the primary care activities that a nurse can perform on her own.

Zakres badań naukowych w pielęgniarstwie rodzinnym. Przegląd piśmiennictwa z lat 1995–2015

ABSTRAKTWstęp: Pielęgniarstwo rodzinne jest rozwijającą się specjalizacją pielęgniarską podlegającą szybkim przemianom związanym z zapoczątkowaną w 1995 r. reformą podstawowej opieki zdrowotnej w Polsce. Szeroki zakres samodzielności pielęgniarek rodzinnych w realizacji świadczeń zdrowotnych wymaga od nich ustawicznego kształcenia oraz konieczności wykorzystania w codziennej praktyce wyników badań naukowych.Celem pracy jest określenie rodzaju i zakresu badań empirycznych w obszarze pielęgniarstwa rodzinnego prowadzonych w Polsce w latach 1995–2015.Materiały i metody: Zastosowano metodę analizy i krytyki piśmiennictwa. Bazę do wyszukiwania danych stanowiła Polska Bibliografia Lekarska, baza PubMed oraz wyszukiwarka Google Scholar. Poszukiwanie prac było ograniczone do artykułów opublikowanych w latach 1995–2015 i dotyczących świadczeń realizowanych przez pielęgniarki rodzinne w Polsce.Wyniki: Ustalono, że w analizowanych pracach przewagę stanowiły badania ilościowe z wykorzystaniem techniki ankiety. Opublikowane prace mieściły się w następujących grupach badawczych: 1) pacjenci – odbiorcy świadczeń; 2) realizatorzy świadczeń, tj. pielęgniarki rodzinne; 3) lekarze rodzinni oraz opiekunowie nieformalni osób objętych opieką pielęgniarki rodzinnej z uwzględnieniem relacji pielęgniarka–pacjent.Wnioski: 1. Widoczny jest brak różnorodności metodologicznej w badaniu roli pielęgniarki rodzinnej. 2. W pracach zmarginalizowana jest rola pielęgniarki rodzinnej w opiece nad osobami w wieku rozwojowym i produkcyjnym. 3. Pielęgniarki rodzinne wykonują niewiele zadań samodzielnych wynikających z posiadanych kompetencji.

Primary health care in Poland: certain health professional groups are placing self-interest before patients.

Since the beginning of 2016, the new Minister of Health in Poland has been conducting reforms of primary health care with the aim of improving its effectiveness. He appointed an expert panel consisting of physicians, nurses, public health specialists, and one patient representative. Its objective was to prepare proposals for changes in primary health care that would be the background for new law. The panel developed a strategic document containing 10 major changes needed in primary care in Poland. These were:

Wellbeing and older adults in primary health care in Poland.

The Polish health service is in need of improvement because of the increasing number of geriatric patients. Identifying the resources available to patients is important for ameliorating deficits. The goal of this research was to measure the health and wellbeing of seniors and to investigate to what extent health services meet their needs. Differences in access and scope of received services between patients from different localities (i.e villages, small towns and big cities) were analysed. Questionnaires (Satisfaction with Life Scale; VAS Numeric Pain Distress Scale) and a structured interview assessing the quality of healthcare were carried out in 2015 on a sample of 459 seniors. Each candidate gave consent for participation in the study. Statistica 12.5 software was used for analyses. The overall measure of satisfaction with life of the respondents (M=22.34 SD=5.78) was good. Inhabitants of small towns had a significantly lower sense of quality of life than seniors from big cities (Tukey HSD = 0.047, p<.05). Multimorbidity and polypharmacy were present to a limited extent. The issue of discrimination of older individuals by medical personnel affected a fifth of seniors living in villages, and one- third of those living in big cities. Geriatric patients did not have equal opportunities for access to medical services. State-provided geriatric care is insufficient and does not meet the real needs of patients. A holistic care approach and/or individualized care for older adults are often indicated but are only theoretical constructs in Poland. This inefficient system places the burden of caregiving on the family of the ageing patient. Anxiety among geriatric patients is growing regarding exclusion and lack of care.

Podstawowa Opieka Zdrowotna w systemie ochrony zdrowia i kształcenie lekarzy rodzinnych w Polsce. Co warto wiedzieć z historii?

We are faced with the adoption of another law on primary health care in Poland, which was adopted by the government in August 2017. Before we present and evaluate this project we want to remind, and for young readers pass unfamiliar history about how concept of primary health care in Poland was transformed. What has been implemented and what is not and in what direction they are evaluating the current changes. This story will be presented by persons who participated in the transformation of the health care system in Poland – Krzysztof Kuszewski, Slawomir Radiukiewcz and Cezary Wlodarczyk.

Chronic heart failure management in primary healthcare in Poland: Results of a nationwide cross-sectional study

Background: Organizational and educational activities in primary care in Poland have been introduced to improve the chronic heart failure (CHF) management.Objectives: To assess the use of diagnostic procedures, pharmacotherapy and referrals of CHF in primary care in Poland.Methods: The cross-sectional survey was conducted in 2013, involving 390 primary care centres randomly selected from a national database. Trained nurses contacted primary care physicians who retrospectively filled out the study questionnaires on the previous year’s CHF management in the last five patients who had recently visited their office. The data on diagnostic and treatment procedures were collected.Results: The mean age ± SD of the 2006 patients was 72 ± 11 years, 45% were female, and 56% had left ventricular ejection fraction <50%. The percentage of the CHF patients diagnosed based on echocardiography was 67% and significantly increased during the last decade. Echocardiography was still less frequently performed in older patients (≥80 years) than in the younger ones (respectively 50% versus 72%, Ρ <0.001) and in women than in men (62% versus 71%, P <0.001). The percentage of the patients treated with β-blocker alone was 88%, but those with a combination of angiotensin inhibition 71%. The decade before, these percentages were 68% and 57%, respectively. Moreover, an age-related gap observed in the use of the above-mentioned therapy has disappeared.Conclusion: The use of echocardiography in CHF diagnostics has significantly improved in primary care in Poland but a noticeable inequality in the geriatric patients and women remains. Most CHF patients received drug classes in accordance with guidelines.

Quality of primary health care in Poland from the perspective of the physicians providing it.

BackgroundPrimary care (PC) allows patients to address most of their health needs and is essential for high quality healthcare systems. The aim of the study was to analyze the insight of nine core dimensions of Polish PC system: “Economic conditions”, “Workforce”, “Accessibility”, “Comprehensiveness”, “Continuity”, “Coordination”, “Quality of care”, “Efficiency” and “Equity” and to identify the characteristics of the providing physicians that influence their perception of the quality of care.MethodsA cross-sectional study was conducted as part of an international QUALICOPC project. In Poland a nationally representative sample of 220 PC physicians was selected from the database of Polish National Health Fund by a stratified random sampling procedure. The research tool was a standardized 64-item questionnaire. Each of the respondents’ answers were assigned a numerical value ranging from−1 (extremely negative) to +1 (extremely positive). The quality indicators were calculated as an arithmetic mean of variables representing particular PC dimensions.ResultsThe mean scores for the majority of the dimensions had negative values. Accessibility of care was perceived as the best dimension, while the economic conditions were evaluated most negatively. Only a small part of variation in quality evaluation could be explained by physicians’ characteristics.ConclusionsThe negative evaluation of primary care reflects the growing crisis in the health care system in Poland. There is an urgent need to apply complex recovery measures to improve the quality of primary care.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-016-0550-8) contains supplementary material, which is available to authorized users.

The Computer-Assisted Web Interview Method as Used in the National Study of ICT Use in Primary Healthcare in Poland – Reflections on a Case Study

Abstract The development and widespread use of ICT in society are reflected by the way research is designed and conducted. The Computer Assisted Web Interview method is becoming more attractive and is a frequently used method in health sciences. The National Study of ICT Use in Primary Healthcare in Poland was conducted using this method. The aim of this paper is to present the major advantages and disadvantages of web surveys. Technical aspects of methodology and important stages of the aforementioned study, as well as key elements for its procedure, are mentioned. The authors also provide reflections based on their analysis of this national study, conducted between January and April 2014.

Validity of and interrater agreement on the LINNEAUS Euro-PC medication safety incident classification system in primary care in Poland

Medication safety incidents occur in all health care sectors and cause considerable morbidity and mortality, with 8.5% of all related incidents reported estimated to occur in primary care. A common incident classification system could facilitate collective learning from the analysis of medication-related errors and improve patient safety The objective of this study was to assess the validity of a new classification system of medication safety incidents in primary care in Poland. Analysis of data from a descriptive, cross-sectional, self-reported survey on the Learning from International Networks about Errors and Understanding Safety in Primary Care (LINNEAUS Euro-PC) medication safety incident classification for primary care with assessment of 10 case-based clinical scenarios done by doctors and pharmacists form community-based family medicine clinics and pharmacies in Lodz. The percentages of overall agreement on judgements and a fixed-marginal multirater kappa (κ) coefficient as statistical measures of interrater agreement for categorical items. The overall agreement levels were: category 1 - 86.3%; category 2 - 85.6%; category 3 - 72.1%; category 4 - 71.8%; and category 5 - 70.4%. The interrater agreement between the 15 evaluators varied as follows: category 1 fixed-marginal κ = 0.144; category 5 fixed-marginal κ = 0.565; category 3 fixed-marginal κ = 0.607; category 4 fixed-marginal κ = 0.634; and category 2 fixed-marginal κ = 0.807. This is the first known study on levels of agreement on the perception of medication safety incidents and assessment of the validity of a related classification system in primary health care in Poland. Interrater agreement in this study was surprisingly high, but still leaves room for improvement.

Immunizations against respiratory infections in children in primary health care in poland: coverage and delays.

Pneumococcal infections, pertussis, and influenza are vaccine-preventable diseases. The aim of this study was to determine vaccine coverage and compliance with the dosage regimen among children in Poland. We performed a retrospective chart analysis of 1,356 children in a large primary healthcare establishment. The complete primary pertussis vaccination, 3 doses in the first year of life, was administered to 1,310/1,356 patients (96.6 %). The self-paid combined acellular vaccine was given in 55.2 % of children. The first dose of the pertussis vaccine was administered in a timely manner to 67.1 % of children. The self-paid pneumococcal vaccine was administered in 499/1,356 (36.8 %) children. In 46.1 % of them immunization started within the first 6 months of life; in 12.6 % aged 7-11 months, in 12.6 % aged 12-23 months, and in 28.7 % aged over 24 months. The dosage regimen was compliant in 49.2 % of patients. Only 3.5 % of patients were immunized against both pneumococci and influenza. Compliance with the Polish immunization program should be increased by reducing the number of injections and the cost of vaccines. Education is essential to facilitate simultaneous administration of vaccines during one visit and to prepare the parents for judicious decision-making when it comes to vaccinations.

Respiratory tract infections in children in primary healthcare in Poland.

Respiratory tract infections are the most common diseases in children. The aim of the study was to assess their frequency and antibiotic treatment in Poland. We retrospectively analyzed 91 randomly-selected children aged 0–17 years receiving care from birth in a large primary healthcare establishment in the city of Wroclaw in Poland. Respiratory tract infections were responsible for 25–40 % of all primary healthcare visits. The median of visits due to upper respiratory tract infections was 1.8 per year in all children and 2.0 per year in children 0–3 years old. Antibiotics were overused; the majority (57.4 %) of the respiratory infections were treated with antibiotics: acute tonsillitis in 90.7 %, bronchitis in 67.5 %, otitis media in 65.9 %, pneumonia in 60.9 %, non-specific upper respiratory tract infections in 25.8 %, laryngitis in 22.2 %, and sinusitis in 12.5 %. The higher the number of antibiotic therapies, the higher the total number of visits including visits due to respiratory tract infections. In conclusion, implementation of careful and responsible management of a rational use of antibiotics is urgently needed since a reduction in their use may lead to a decrease in the number of visits due to upper respiratory tract infections and a total number of primary care visits.

Awareness of hypertension guidelines in primary healthcare in Poland

The study was aimed at evaluating knowledge of the recent ESH‐ESC Guidelines for the management of hypertension among Polish primary care physicians. A validated questionnaire including 30 multiple‐choice questions was developed. A representative sample of primary care physicians in Poland was asked to complete the questionnaire. The influence of physicians' characteristics and features of their practices on the quality of the answers was analyzed. The sample included 192 physicians; 125 of them responded to the questionnaire. The mean number of correct answers was 13.4±3.1. The best results were observed with regard to treatment (61.2% correct answers), with weaker scores for diagnosis of hypertension (35.2%) and diagnostic tests (31.8%). The results were significantly better among female physicians and physicians working in large towns. The final score was significantly correlated with length of professional experience in practice (r = −0.246, p<0.01). A similar but non‐significant correlation with the age of the physician was observed. The study showed that knowledge of hypertension guidelines among primary care physicians in Poland is modest. Educational programs must be especially directed at practitioners with longer primary care experience and those from smaller towns and villages.