Czech Republic - an update April 2010
BASIC FIGURES
General practice has been recognised as a speciality with own postgraduate curriculum since 1978 in the Czech Republic. Currently 5100 general practitioners (GP) are working independently as privat providers in primary care; 92% of them in single-handed practices,. the others in group practices or in outpatients clinics. An average number of patients registered with one GP is 1600. The reimbursement of GPs is mixed capitation and fee for service payment. The concept of family medicine does not exist and children up to 15 or 19 are registered with practising pediatricians (n=2150).
GPs don´t play the strict gate-keeping role but the most of patients seek for health care first in general practice. GPs consult in average 160 patients and do 4 house calls a week. 80-90% contacts are handled solely by GPs without referrals to other provider..
94% GPs have computer in practice and 77% of them use electronical medical records. The average age of GPs is 53 years.
EDUCATION
General Practice/Primary Care is a part of curriculum in all 7 medical schools, but only two faculties have established GP chair. The extent and structure of curriculum varies but all faculties ensure that students visit general practice before they leave school.
The postgraduate programme was shortened to 36 months in 2009. The reasons were imminent lack of doctors and limited potential to cover expenses of residency programme.
The programme includes a common hospital trunk (Internal medicine, Surgery, Gynaecology, Pediatrics, Neurology), outpatient part (ENT, Ophtalmology, Psychiatry, Hygiene and Epidemiology, etc) dominated by training in General Practice and obligative and facultative courses. All teaching practices have to pass through a process of accreditation. The final assessment before specialization is guaranteed by the Postgraduate Medical School.
The continuous medical education is supervised by Medical Chamber via a credit system and dominated by The Society of General Practice. The offer of educational events of different character is rich, including regional CME, national conferences and special educational programmes on leading actual topics. The attendance of annual GP conference exceeded 1200 participants in 2009. The Society of GP in cooperation with other specialities introduces 5-10 new practical guidelines yearly. An information for lay persons is a part of each practical guideline. Another source of information are peer reviewed journals and internet. A project of EUNI (e-university) has been successfully developed with more than one third of GPs from all over the country registered in 2010.
The Primary Care Research Fund has been working since 2001 to support research and quality improvement projects in primary care. Practical guidelines development project has been supported from this Fund. The Society of General Practice has also recieved several grants during last years. The ethical issues concerning cooperation with Pharma Industry are becoming more and more important and are carefully considered by The GP Society.
QUALITY INITIATIVES
General practice is represented in „Committee for Quality and Safety in Health Care“ . The purpose of this committee is to prepare system of quality management closely related to the European health care quality management activities and the relevant programmes of WHO/EURO, putting the main accent to the comparison of key indicators, parametres and evaluations. Two projects concerning primary care were completed in 2009:
1) Accredition standards for general ambulances
2) Reporting on critical incidents and medical errors in primary care
The awareness on quality issues in primary care, which was slightly delayed compare to hospitals, is now rising and become a very important topic. The GP representatives also negotiate the inclusion of quality aspects in the system of reimbursement in primary care. Examples of other quality and research projects which have been conducted in general practice:
• Management of diabetic patients of the 2nd type
Diabetic patients 2nd type were managed by specialists for years in the Czech Republic. Nowadays GPs are ready to overtake the care for non-complicated patients with diabetes 2nd type. This change needs a carefull interdisciplinary management, economic considerations and rises a lot of quality issues.
• Study on cardiovascular prevention in general practice
• Early diagnostics and treatment of peripherial ischaemic disease
Studies about risk factors intervention in primary care. Electronically driven and monitored research in practices
• Monitoring of Colorectal Cancer Screening
New design of Colorectal Cancer Screening Programme brings new challenges and possibilities for primary care physicians. The monitoring covers the gaps in the process of data collection on screening with particular focus on GP performance.
The Czech Society of General Practice is working on the preparation of WONCA WORLD Conference in Prague, June 26-29, 2013.
The committees and responsible persons
Chair of the Host Organizing Committee: Bohumil Seifert, assoc.prof., M.D., Ph.D.
Vicechair of the Host Organizing Committee: Vaclav Benes, M.D.
Chair of the Scientific Committee: Jaroslava Lankova, M.D.
Chairman of the Internationl Advisory Board: Igor Svab, prof., M.D., Ph.D:
President of the Czech Society of GP Svatopluk Byma, assoc.prof., M.D., Ph.D.
Bohumil Seifert
Representative of EQuiP, Czech Republic
seifert@terminal.cz
April 2010
