Osnovno zdravstvo je izpostavljeno velikim obremenitvam, ki so posledica demografskih sprememb, ozaveščenosti ljudi in tudi organizacijskih sprememb v zdravstvu. Ob pomanjkanju zdravnikov je potrebno najti rešitev, ki bo prerazporedila obremenitev zdravnike in ohranila visoko kakovost obravnave bolnikov.
Z uvedbo referenčnih ambulant se v osnovno zdravstvo uvaja nov koncept dela na področju: kadrovskih normativov (zdravniku in zdravstvenemu tehniku je dodana diplomirana medicinska sestra za polovico delovnega časa), vsebine dela (natančno je definirana pot obravnave kroničnih bolnikov, razširjena so področja preventivnega presejanja, hkrati pa je potrebno vzpostavljati registre kroničnih bolnikov in dosegati kazalnike kakovosti) ter organizacije dela (spremenjena struktura tima, spremenjena delitev dela).
Ob velikem zanimanju zdravnikov bo v letu 2011 z delom pričelo 105 referenčnih ambulant, ki so regijsko enakomerno zastopane. S tem je narejen korak, da bodo sčasoma vsi zdravniki prevzeli koncept dela referenčnih ambulant in tako omogočili načrtovano in nadzorovano kakovostno oskrbo bolnikov.
Zalika Klemenc-Ketiš, Igor Švab and Antonija Poplas Susič
A new form of family practices was introduced in 2011 through a pilot project introducing nurse practitioners as members of team and determining a set of quality indicators. The aim of this article was to assess the quality of diabetes and hypertension management.
We included all family medicine practices that were participating in the project in December 2015 (N=584). The following data were extracted from automatic electronic reports on quality indicators: gender and specialisation of the family physician, status (public servant/self-contracted), duration of participation in the project, region of Slovenia, the number of inhabitants covered by a family medicine practice, the name of IT provider, and levels of selected quality indicators.
Out of 584 family medicine practices that were included in this project at the end of 2015, 568 (97.3%) had complete data and could be included in this analysis. The highest values were observed for structure quality indicator (list of diabetics) and the lowest for process and outcome quality indicators. The values of the selected quality indicators were independently associated with the duration of participation in the project, some regions of Slovenia where practices were located, and some IT providers of the practices.
First, the analysis of data on quality indicators for diabetes and hypertension in this primary care project pointed out the problems which are currently preventing higher quality of chronic patient management at the primary health care level.
An effective leadership is critical to the development of a safety culture within an organization. With this study, the authors wanted to assess the self-perceived level of safety culture among the employees with a leadership function in the Ljubljana Community Health Centre.
This was a cross-sectional study in the largest community health centre in Slovenia. We sent an invitation to all employees with a leadership role (N=211). The Slovenian version of the SAQ – Short Form as a measurement of a safety culture was used. The data on demographic characteristics (gender, age, role, work experience, working hours, and location of work) were also collected. An electronic survey was used.
The final sample consisted of 154 (69.7%) participants, out of which 136 (88.3%) were women. The mean age and standard deviation of the sample was 46.2±10.5 years. The average scores for the safety culture domains on a scale from 1 to 5 were 4.1±0.6 for Teamwork Climate, Safety Climate, and Working Conditions and Satisfaction, 3.7±0.5 for Perception of Management, 3.6±0.4 for Communication, and 3.5±0.6 for Stress Recognition.
The safety culture among leaders in primary healthcare organizations in Slovenia is perceived as positive. There is also a strong organizational culture. Certain improvements are needed, especially in the field of communication and stress recognition with regards to safety culture.
Polona Selič, Zalika Klemenc-Ketiš, Erika Zelko, Andrej Kravos, Janez Rifel, Irena Makivić, Antonija Poplas Susič, Špela Tevžič, Metka Cerovič, Borut Peterlin and Nena Kopčavar Guček
Family history (FH) is an important part of the patients’ medical history during preventive management at model family medicine practices (MFMP). It currently includes a one (or two) generational inquiry, predominately in terms of cardiovascular diseases, arterial hypertension, and diabetes, but not of other diseases with a probable genetic aetiology. Beside family history, no application-based algorithm is available to determine the risk level for specific chronic diseases in Slovenia.
A web application-based algorithm aimed at determining the risk level for selected monogenic and polygenic diseases will be developed. The data will be collected in MFMP; approximately 40 overall with a sample including healthy preventive examination attendees (approximately 1,000). Demographic data, a three-generational FH, a medical history of acquired and congenital risk factors for the selected diseases, and other important clinical factors will be documented.
The results will be validated by a clinical genetic approach based on family pedigrees and the next-generation genetic sequencing method. After the risk of genetic diseases in the Slovenian population has been determined, clinical pathways for acting according to the assessed risk level will be prepared.
By means of a public health tool providing an assessment of family predisposition, a contribution to the effective identification of people at increased risk of the selected monogenic and polygenic diseases is expected, lessening a significant public health burden.