Reform of the Health Care System in Croatia
The new Health Care Law introduced in January 2009 brought substantial changes in organization of the primary health care in Croatia. New organizational and quality standards have been introduced, including better recognition and validation of preventive work of family doctors promoted by incentives for specific preventive programs, stimulation of group practices, introduction of fee-for-service in addition to existing capitation-based model of payment, and other changes. These changes are being gradually introduced and evaluated according to the expert opinion of Working Group for Coordination, Monitoring and Steering of Health Care Reform in Family Medicine, formed at Ministry of Health and Social Welfare, that includes prominent experts in the field of family medicine, as well as according to opinion of the Croatian Medical Chamber and Croatian Medical Association.
Projects aimed at improving quality of care in family medicine in Croatia
«Improving quality of care in family medicine in Croatia – assessment of outcomes of care»
Project led by Professor Milica Katiæ, MD, PhD, Department of Family Medicine, «Andrija Štampar» School of Public Health, Medical School University of Zagreb. The aim was to investigate the quality of interpersonal care in general practice in Croatia using patient enablement as a consultation outcome measure and its association with patient, physician, and practice characteristics. Consultations in general practice in Croatia resulted in a relatively high average level of enablement compared to previous studes in UK and Poland; research has confirmed the strong positive relation between continuity of primary care in Croatia and patient’s ability to understand and cope with his life and illness (publication: Ožvaèiæ Adžiæ Z, Katiæ M, Kern J, Laziæ D, Ceroveèki Nekiæ V, Soldo D. Patient, physician, and practice characteristics related to patient enablement in general practice in Croatia: cross-sectional survey study. Croat Med J. 2008 Dec; 49: 813-23.)
For more information please contact:
Zlata Ozvacic Adzic, MD
Department of Family Medicine
«Andrija Stampar» School of Public Health
Medical School University of Zagreb
Rockefellerova 4, 10000 Zagreb, Croatia
Email: zlata.ozvacic@zg.t-com.hr
«Care for the Diabetic Patients in General Practice in Croatia»
Project led by Associate Professor Biserka Bergman Markoviæ, MD, PhD, supported by Department of Family Medicine, «Andrija Štampar» School of Public Health, Medical School University of Zagreb, and Association of Teachers in General Practice/Family Medicine.
Diabetes mellitus (DM) represents one of the prominent risk factors for cardiovascular diseases (CVD) and is associated with early disablement of the individuals as well as with higher total and specific, CVD related, mortality rates. Quality of care for DM patients depends upon general practiotioner's (GP's) professional knowledge, working conditions and organization of preventive activities on the primary health care level. To improve quality of care for DM patients, systematic and early detection and adequate treatment is required.
The aim of the study is to investigate the quality of care for DM patients in Croatia. Specific aims include antropometric measurements in DM patients (weight, height, BMI, waist and hips circumference, waist-hip ratio (WHR)); rate of overweight and obese DM patients; average blood pressure level; average blood level of glucose, HbA1c, total cholesterol, LDL, HDL, triglycerides and uric acid levels; presence of developed micro- and macrovascular complications; comorbidity of DM patients. Attitudes of GPs regarding obstacles related to initiation of insulin treatment in type 2 DM patients will be investigated. Differences between regions (coastal and continental part of Croatia) in the investigated variables will be tested.
The study is designed as a multicentric, cross-sectional study. Sample of 500 randomly assigned GPs is taken from Register of the Croatian Institute for Health Insurance (CIHI), year 2007. Every GP will include convenience sample of 20 DM patients aged ≥40 years who will meet the inclusion criteria and visit the GP during one month period. The patient’s inclusion criteria are: age ≥40 years, DM diagnosis (IDF criteria), DM treated with oral hypoglycaemic drugs in the last three years (minimum), signed informed consent to participate in the study. Exclusion criteria are also defined (patients with iatrogenic DM and other defined disorders of endocrine system, patients with diseases that affect life span of red blood cells, terminally ill patients with life expectancy < 6 months, reluctance to participate in the study).
Project’s final aim is contribution to improvement of quality of care for patients with DM type 2 in general practice through implementation of intervention model primarily based on adequate treatment of diabetic patients (oral hypoglycaemic drugs and as insulin).
For more information please contact:
Assoc. Prof. Biserka Bergman Markovic, MD, PhD
Department of Family Medicine
«Andrija Stampar» School of Public Health
Medical School University of Zagreb
Rockefellerova 4, 10000 Zagreb, Croatia
Email: biserkabergmanmarkovic@yahoo.com
«Cardiovascular Risk and Intervention Study in Croatia-family medicine (CRISIC-fm)»
Project led by Associate Professor Biserka Bergman Markoviæ, MD, PhD, supported by Department of Family Medicine, «Andrija Štampar» School of Public Health, Medical School University of Zagreb, and of Association of Teachers in General Practice/Family Medicine. Project is registered at International database of controlled clinical trials in March 2009. (RCS ISCTN31857696).
Cardiovascular diseases (CVD) represent leading cause of death in Croatia and worldwide and great economic burden for the health care systems. There is a need for implementation of international and national guidelines on CVD primary prevention in general practice setting in Croatia, resulting in systematic intervention on CVD risk factors. CVD prevention should include proactive approach to all with additional care for high risk groups.
This project aims to investigate the efficiency of general practitioner’s systematic intervention in the population of patients aged 40+ years regarding reduction of the total risk for coronary hearth disease and cerbrovascular disease, as well as decrease in the incidence of the metabolic syndrome. Additionally, regional distribution of the 10-year total risk for fatal outcome in CVD (SCORE) and cerebrovascular disease (Framingham risk-chart), individual risk factors, metabolic syndrome, participants’nutritional status, attitudes towards preventive activities and changes in these attitudes at the end of the research period, will be investigated.
The study is a multicentric, prospective, randomised, cohort one. Sample of 64 general practitioners (GP) will be stratified into two groups: 32 GPs in intensified intervention group (IIG) using measures (pharmacological and non-pharmacological) recommended by professional guidelines (European Society of Cardiology Guidelines 2007), and 32 GPs in conventional intervention group (CIG), using present, non-systematic, single- factor approach. Every GP will include systematic random sample of 55 patients aged 40+ years who will meet inclusion criteria and visit GPs practice during two months period for whatever the reason.
Project’s final aim is to contribute to improvement of quality of care in CVD primary prevention by presenting successful implementation model of existing professional guidelines in routine general practice consultations.
For more information please contact:
Assoc. Prof. Biserka Bergman Markovic, MD, PhD
Department of Family Medicine
«Andrija Stampar» School of Public Health
Medical School University of Zagreb
Rockefellerova 4, 10000 Zagreb, Croatia
Email: biserkabergmanmarkovic@yahoo.com
«Opportunistic screening for detection of impaired glucose regulation and diabetes mellitus in Croatia»
Project coordinated by Assistant Professor Marija Vrca Botica, MD, PhD, Department of Family Medicine, «Andrija Štampar» School of Public Health, Medical School University of Zagreb. Associates: Assist Prof Ivana Pavliæ Renar, MD, PhD; Prof Milica Katiæ, MD, PhD; Assoc Prof Biserka Bergman Markoviæ, MD, PhD; Goranka Petrièek, MD; Ines Zeliæ, MD; Ivana Katiæ Miloševiæ, MD.
A dramatic increase in the prevalence of type 2 diabetes mellitus in Croatia has been noted. There is 6.1% of patients with type 2 diabetes in the age group 18 to 65 years in Croatia and it is estimated that there is a total of 9.1% people with diabetes. Previous research showed that diabetes mellitus already lasted 7 to 12 years when it was first clinically detected and 30% of complications developed during that period. Effective primary detection of impaired glucose regulation and change of lifestyle can delay onset of diabetes mellitus. Effective primary detection of diabetes mellitus can prevent complications of diabetes. General practitioner (GP) is the right person to perform this opportunistic screening program.
The aim of this study is to evaluate prevalence of newly diagnosed type 2 diabetes mellitus and impaired glucose regulation in the patients aged 45 to 70 years in Croatia. Specific aims: to establish how to form risk groups for opportunistic screening for type 2 diabetes in Croatia. (problem of collecting relevant data); to determine which are known risk factors for making a decision about the opportunistic screening process; to find out what is the response of patients to the screening process; to investigate attitudes of patients and GPs to the screening process; to investigate the attitudes of patients after being advised to change their lifestyle.
The study is designed as a prospective study. In the first year patient's status will be detected, followed by three years of preventive program for patients with impaired glucose regulation. Opportunistic screening will be performed by 100 randomly selected GPs in patients aged 45-70 years with existing risk factors but without established diagnosis of diabetes. Measurements: «gold standard for opportunistic screening».
For more information please contact:
Assist Prof Marija Vrca Botica, MD, PhD
Department of Family Medicine
«Andrija Štampar» School of Public Health
Medical School University of Zagreb
Rockefellerova 4, 10000 Zagreb, Croatia
E-mail: vrcabotica@yahoo.com
