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Lozan O, Mîţa V, Demişcan D, Buzeti T, Beznec P, Sava V, Curteanu A, Rîmiş C, Canavan R, Prytherch H. Assessing capacities to strengthen intersectoral collaboration in Territorial Public Health Councils in the Republic of Moldova. PLoS One 2024; 19:e0303821. [PMID: 38814932 PMCID: PMC11139316 DOI: 10.1371/journal.pone.0303821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 05/01/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND The government of the Republic of Moldova, endorsed the principle of Health in All Policies (HiAP) through its health sector reforms to address the rising burden of non-communicable diseases and health inequalities. Territorial Public Health Councils (TPHCs) were created to ensure the coordination and management of the population's health in their respective district. This study assessed the capacities of the TPHCs to identify areas in need of support for strengthening their intersectoral collaboration role in public health at local level. METHODS A mixed-method approach, using qualitative and quantitative techniques, was used to compare the perceptions of all TPHC members (n = 112) and invitees (n = 53) to council meetings from 10 districts covering all geographical areas of Moldova. The quantitative information was obtained using a cross-sectional survey, while the qualitative aspects were assessed within focus group discussions (FGDs). RESULTS Half of all TPHC members, including 75% from groups with a non-medical background, did not attend a public health course within the last three years. Overall, groups with a medical background were more aware of the legislation that governs TPHC activity and intersectoral collaboration compared with those with a non-medical background. The FGDs of TPHC meetings revealed that members had an insufficient level of understanding of intersectoral collaboration to solve public health issues and lacked clarity about their place and role within the TPHC. CONCLUSIONS HiAP implementation was found to be suboptimal with insufficient capacity at local level. TPHC members' ability to deal with public health issues were severely impaired by a general lack of knowledge and understanding of how to utilize the TPHC platform for maximum benefit. Reforming TPHC regulation is required in addition to extensive capacity building for TPHC members to increase member understanding of their roles as intended by TPHC regulations, including the facilitation of intersectoral collaborations.
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Affiliation(s)
- Oleg Lozan
- School of Public Health Management, Nicolae Testemitanu State University of Medicine and Pharmacy, Chișinău, Republic of Moldova
| | - Valentin Mîţa
- School of Public Health Management, Nicolae Testemitanu State University of Medicine and Pharmacy, Chișinău, Republic of Moldova
| | - Daniela Demişcan
- School of Public Health Management, Nicolae Testemitanu State University of Medicine and Pharmacy, Chișinău, Republic of Moldova
| | - Tatjana Buzeti
- WHO European Office for Investment for Health and Development, Venice, Italy
| | - Peter Beznec
- The Centre for Health and Development Murska Sobota (CHD), Murska Sobota, Slovenia
| | - Valeriu Sava
- Swiss Agency for Development and Cooperation (SDC), Chisinau, Republic of Moldova
| | - Ala Curteanu
- Healthy Life Project: Reducing the Burden of Non-Communicable Diseases in Moldova, Chisinau, Republic of Moldova
- Mother and Child Institute, Chisinau, Republic of Moldova
| | - Constantin Rîmiş
- Healthy Life Project: Reducing the Burden of Non-Communicable Diseases in Moldova, Chisinau, Republic of Moldova
| | - Robert Canavan
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Helen Prytherch
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
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Delvento G, Curteanu A, Rotaru C, Van Poel E, Willems S, Prytherch H, Curocichin G. The impact of the COVID-19 pandemic on primary health care practices and patient management in the Republic of Moldova - results from the PRICOV-19 survey. BMC PRIMARY CARE 2023; 24:221. [PMID: 37880576 PMCID: PMC10598887 DOI: 10.1186/s12875-023-02116-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 07/20/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND The COVID-19 pandemic has had an enormous impact on health systems in Europe and has generated unprecedented challenges for tertiary care. Less is known about the effects on the activities of local family doctors (FDs), who have shifted tasks and adapted their practice to accommodate the new services brought by the pandemic. The PRICOV-19 study was a multi-country survey aiming to understand the challenges posed by the pandemic in primary health care (PHC) practices around Europe. Within the framework of this study, we assessed the impact of the pandemic on PHC facilities in urban, rural, and mixed urban/rural areas in the Republic of Moldova. METHODS We present the results from the PRICOV-19 questionnaire designed at Ghent University (Belgium) and distributed between January and March 2021 to PHC facilities from the 35 districts of the Republic of Moldova. This analysis presents descriptive data on limitations to service delivery, staff role changes, implementation and acceptance of COVID-19 guidelines, and incidents reported on staff and patient safety during the pandemic. RESULTS Results highlighted the differences between facilities located in urban, rural, and mixed areas in several dimensions of PHC. Nearly half of the surveyed facilities experienced limitations in the building or infrastructure when delivering services during the pandemic. 95% of respondents reported an increase in time spent giving information to patients by phone, and 88% reported an increase in responsibilities. Few practices reported errors in clinical assessments, though a slightly higher number of incidents were reported in urban areas. Half of the respondents reported difficulties delivering routine care to patients with chronic conditions and a delay in treatment-seeking. CONCLUSIONS During the pandemic, the workload of PHC staff saw a significant increase, and practices met important structural and organizational limitations. Consequently, these limitations may have also affected care delivery for vulnerable patients with chronic conditions. Adjustments and bottlenecks need to be addressed, considering the different needs of PHC facilities in urban, rural, and mixed areas.
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Affiliation(s)
- Giulia Delvento
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4002, Basel, Switzerland.
- University of Basel, P.O. Box, CH-4003, Basel, Switzerland.
| | - Ala Curteanu
- Healthy Life project: Reducing the Burden of Non-Communicable Diseases in Moldova, Chișinău, Moldova
- Swiss Agency for Development and Cooperation (SDC), Chișinău, Moldova
- Mother and Child Institute, Chișinău, Republic of Moldova
| | - Cristina Rotaru
- Healthy Life project: Reducing the Burden of Non-Communicable Diseases in Moldova, Chișinău, Moldova
- Swiss Agency for Development and Cooperation (SDC), Chișinău, Moldova
- Nicolae Testemitanu Medical University, Chișinău, Republic of Moldova
| | - Esther Van Poel
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Quality and Safety Ghent, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Sara Willems
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Quality and Safety Ghent, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Helen Prytherch
- Swiss Tropical and Public Health Institute, P.O. Box, CH-4002, Basel, Switzerland
- University of Basel, P.O. Box, CH-4003, Basel, Switzerland
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Chanasopon S, Saramunee K, Rotjanawanitsalee T, Jitsanguansuk N, Chaiyasong S. Provision of primary care pharmacy operated by hospital pharmacist. AIMS Public Health 2023; 10:268-280. [PMID: 37304590 PMCID: PMC10251043 DOI: 10.3934/publichealth.2023020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 04/10/2023] [Accepted: 04/11/2023] [Indexed: 06/13/2023] Open
Abstract
A primary care pharmacy (PCP) is operated by hospital pharmacists in Thailand. This study aims to explore the level of PCP provisions operated by hospital pharmacists, to identify health service components that affect PCP operation and to collect opinions from pharmacists regarding factors influencing PCP operation. A postal survey was conducted in northeastern Thailand. A questionnaire included: (1) the PCP checklist (36 items), (2) questions investigating the health service components required for PCP operation (13 items), and (3) queries to pharmacists concerning factors influencing PCP operation (16 items). Questionnaires were mailed to 262 PCP pharmacists. The PCP provision score was calculated with a max score of 36, and reaching at least 28.8 points was deemed as having 'met expectation'. Multivariate logistic regression with a backward approach was used to determine health service components which affected PCP operation. Most respondents were female (72, 60.0%), aged 36.0 years (IQR 31.0-41.0) and PCP work experience of 4.0 years (IQR 2.0-10.0). Overall, the PCP provision score had met expectation (median = 29.00, Q1-Q3 = 26.50-32.00). Tasks that met expectation involved managing the medicine supply, a home visit with a multidisciplinary team and protecting consumer health. Improving medicine dispensary and promotion of self-care and herbal use were below expectation. PCP operation depended on doctor involvement (OR = 5.63 95% CI 1.07-29.49) and public health practitioner involvement (OR = 3.12 95% CI 1.27-7.69). The pharmacist's responsibility, i.e., a good relationship with the community, likely increased PCP provision. The PCP has been widely instituted in Northeast Thailand. Doctors and public health practitioners should get involved regularly. Further research is needed to monitor the outcomes and value of PCPs.
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Mousavi SF, Peimani M, Moghaddam SS, Tabatabaei-Malazy O, Ghasemi E, Shobeiri P, Rezaei N, Nasli-Esfahani E, Larijani B. National and subnational survey on diabetes burden and quality of care index in Iran: a systematic analysis of the global burden of disease study 1990-2019. J Diabetes Metab Disord 2022; 21:1599-1608. [PMID: 36404869 PMCID: PMC9672253 DOI: 10.1007/s40200-022-01108-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/08/2022] [Indexed: 10/10/2022]
Abstract
Purpose Diabetes care is one of the major healthcare problems . This study aimed to introduce a recently-developed Quality of Care Index (QCI) for type 2 diabetes and utilized it to compare different genders, age groups, and Iranian provinces. Methods From the Global Burden of Disease 1990-2019 database, we obtained primary epidemiologic measures and combined them to build four secondary indices, all indicating the quality of care provided to patients. We utilized the principal component analysis (PCA) method to calculate the substantial component named QCI (with a scale of 0-100). Gender inequality was shown by the gender disparity ratio (GDR), defining female to male QCI. Results National QCI ranged from 43.0 in 1990 to 38.6 in 2019. By excluding the more frequent outlier province; Tehran as the Capital of Iran, the QCI score reached 50.27 in 2019. The GDR decreased from 1.04 to 0.95. QCI indicated rather more favorable conditions in Iranian provinces with a higher socio-demographic index (SDI). Conversely, provinces with a lower SDI had worse QCI. In 2019, Tehran, the capital of Iran, with the highest (58.5), and South Khorasan with the lowest QCIs (0.4) were the two Iranian provinces' extremes. Moreover, the elderly QCI improved in 2019. Conclusion During 1990-2019, there are remarkable disparities between Iran's provinces, genders and age groups. The equitable and widespread provision of facilities should be considered along with the decentralization of healthcare resources. Supplementary Information The online version contains supplementary material available at 10.1007/s40200-022-01108-x.
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Affiliation(s)
- Seyedeh Farzaneh Mousavi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Peimani
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Saeedi Moghaddam
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ozra Tabatabaei-Malazy
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Erfan Ghasemi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Parnian Shobeiri
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Negar Rezaei
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ensieh Nasli-Esfahani
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Institute, Postal box: 1411713137, North Kargar Ave., Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Institute, Postal box: 1411713137, North Kargar Ave., Tehran, Iran
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Strategies to address non-communicable diseases in the Commonwealth of Independent States countries: a scoping review. Prim Health Care Res Dev 2022; 23:e73. [DOI: 10.1017/s1463423622000639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
Aim:
The aim of this study is to review the literature in Commonwealth of Independent States (CIS) countries with regard to their response to non-communicable diseases (NCDs) and the implementation of the World Health Organization (WHO) Package of Essential Non-communicable (PEN) disease interventions for primary health care.
Background:
NCDs are estimated to account from 62% to 92% of total deaths in CIS countries. Current management of NCDs in CIS countries is focused on specialists and hospital care versus primary health care (PHC) as recommended by the WHO.
Methods:
This paper uses a scoping review of published and grey literature focusing on diabetes and hypertension in CIS countries. These two conditions are chosen as they represent a large burden in CIS countries and are included in the responses proposed by the WHO PEN.
Findings:
A total of 96 documents were identified and analysed with the results presented using the WHO Health System Building Blocks. Most of the publications identified focused on the service delivery (41) and human resources (20) components, while few addressed information and research (17), and only one publication was related to medical products. As for their disease of focus, most studies focused on hypertension (14) and much less on diabetes (3). The most studies came from Russia (18), followed by Ukraine (21) and then Kazakhstan (12). Only two countries Moldova and Kyrgyzstan have piloted the WHO PEN. Overall, the studies identified highlight the importance of the PHC system to better control and manage NCDs in CIS countries. However, these present only strategies versus concrete interventions. One of the main challenges is that NCD care at PHC in CIS countries continues to be predominantly provided by specialists in addition to focusing on treatment versus preventative services.
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