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ImPrim Report #3. Karlskrona, Sweden: ImPrim.
Klaipeda University, Klaipeda, Lithuania
Quality improvement of primary health care is the topic requiring attention from all stakeholders throughout all Baltic Sea Region (BSR) countries. There is strong scientific evidence that health systems with better quality of PHC have better health outcomes, more equity and lower costs. Efforts to improve the quality of care through development of quality indicators and pay-for-performance systems become very actual in recent years. Development of quality indicators and more advanced payment schemes for high quality PHC performance in BSR is one of the most important ImPrinl project1 targets.
Objective of this document is to report the process of selection and piloting of new PHC quality indicators in Klaipeda region, Lithuania. Proposal document Operational System of Evidence Based and Wide/y Recognised Quality Indicators for PHC Performance. Initial proposal of 30 quality indicators for PHC performance have been selected based on the proposal document Operational System of Evidence Based and Widely Recognised Qualiry Indicators for PHC performance, developed by Imprim project team (Jurgutis, Vainiomaki, 2011).
The qualitative Delphi method was used for selection process of quality indicators. Experts for the Delphi study were selected from different local and national stakeholders. The Delphi method consisted of two rounds. Workshops with various stakeholders have been used to select final indicators. Representatives of primary health care institutions considered as most important group of stakeholders. Finally it was agreed to pilot new indicators for monitoring:
Finally it was agreed that there will be piloted indicators to measure following:
1. Advance care of patients with NCDs through provision by nurses services on consultation-motivational counselling of patients with NCDs. As an obstacle – in Lithuania was no approved methodology for in depended consultation of nurses in primary health care, with exception of consultation for diabetes patients – approved consultation by nurses, which was funded through fee for service payment.
2. Avoidable hospitalization of patients with chronic conditions: rates of emergency hospitalization of asthma, diabetes and hypertension;
3. Consumption of outpatient secondary health care specialists;
4. Prescription of antibiotics for children respiratory tract infections.
Consulting and motivation services for NCD patients have been piloted in two PHC institutions in Klaipeda region by four consulting nurses. The target group were patients with ischemic heart disease, arterial hypertension, bronchial asthma and chronic obstructive pulmonary disease. Community nurses training on motivational counselling and chronic disease management was very useful for nurses’ professional development. Gained skills nurses applied in their daily practice and got practical motivational counselling experience. Positive patients’ evaluation showed high demand of such services in PHC settings. However, the period of the project was too short to evaluate long-term effect of consultation and motivation services on NCD patients’ health and significant changes in health behaviour.
Monitoring of secondary health care consumption (visits to secondary health care level and hospitalization rates for arterial hypertension, diabetes and asthma) showed existing inequalities in PHC clinics in Kaipeda region. The consumption of higher health care levels is associated with higher comorbidity. Monitoring of hospitalizations showed high rate of undiagnosed conditions in PHC clinics. The prevalence of arterial hypertension varied from 8.66% to 30.22% in different PHC clinics. Rate of hospitalization for arterial hypertension varied from 0.58 to 8.33 per 100 inhabitants.
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