Acta medica Croatica : c̆asopis Hravatske akademije medicinskih znanosti
-
Emergency medical services (EMS) in the Republic of Croatia are currently organized as part of the existing health care system and delivered in the form of pre-hospital and hospital EMS. The pre-hospital EMS are delivered by standalone EMS Centers, EMS units set up in community health centers, and by general practitioners working in shifts and on call in remote and scarcely populated areas. In hospitals, each ward usually has its own emergency reception area, and only in a couple of cases there is an integrated emergency admission unit for the entire hospital. ⋯ The introduction of EMS specialty for physicians and additional specialized training for nurses/ technicians is going to increase competencies of all EMS team members. The main objectives of the EMS Restructuring Project to be achieved in the 5-year period are the following: to reduce the response time of pre-hospital EMS teams to 10 minutes in urban areas and 20 minutes in rural areas in 20% of team interventions; to bring patients to hospital within the "golden hour" in 80% of cases; to have 200 physicians specialized in emergency medicine; and to have 220 nurses/technicians that have successfully completed their specialized training in emergency medicine. The objectives are going to be monitored through indicators as part of the World Bank Project for which data have already been collected throughout Croatia: number of interventions; number of emergency interventions; time between call receipt and arrival to scene; time between call receipt and arrival to hospital emergency reception area; percentage of arrivals to hospital by EMS vehicles within 12 hours of symptom onset; polytrauma and cardiac arrest survival rate before admission to hospital; time spent in hospital emergency reception areas and integrated hospital emergency admission units; polytrauma and cardiac arrest survival rate within 24 hours of hospital admission; number of integrated hospital emergency admission units per county; and number of pre-hospital EMS teams per capita.
-
The aim of this study was to determine the scope and contents of peer-reviewed scientific publications that bring the results of the Health System Research (HSR) in the Republic of Croatia during the 1990-2010 period. The basic guidelines are in line with the research project, Health Services Research into European Policy and Practice (HSREPP). This project is being implemented with the aim of identifying, evaluating and improving the contribution of Health System Research to the development of Health Policy in Europe. This study included scientific publications indexed in the PubMed database and master theses and doctoral dissertations published at Schools of Medicine in Zagreb, Osijek, Rijeka and Split during the 1990-2010 period. In accordance with the project methodology, scientific publications indexed in PubMed (http://www.ncbi.nlm.nih.gov/pubmed) were searched for by the key words "Croatia AND (Health Care System OR Health System OR Healthcare System)". Then, the database of scientific publications indexed in PubMed was narrowed by key words divided into 4 groups according to HSREPP instructions. The search for master theses and doctoral dissertations was carried out by direct inspection of the completed works in the library of Andrija Stampar School of Public Health, School of Medicine, University of Zagreb. Access to master theses and doctoral dissertations at the other three medical schools was done by the Internet. We analyzed the collected summaries of all publications, master theses and doctoral dissertations and excluded all those that did not correspond to our research. ⋯ Using this method, we found a total of 536 publications indexed in PubMed-in, 70 master theses and 22 doctoral dissertations meeting the study criteria. For further analysis, we separately considered master theses and doctoral dissertations on the one side, and scientific publications indexed in PubMed on the other side. All papers were listed by the year of publication, the author and the means of publication. Upon inclusion of the key words, 277 papers met the required criteria. After abstract analysis, 158 PubMed indexed papers were found to meet all the criteria and addressed the Health System Research in Croatia. There was a significant increase in the number of published papers during the 5-year study period. Upon analysis of the summary contents of master theses and doctoral dissertations, we separated 6 doctoral dissertations and 35 master theses that met the criteria of the research. They were divided into four groups: research of macro-, mezzo- and micro-level of Health System and assessment of Health Care System results. The group investigating the organization and delivery of health services (meso-level) and the group investigating health technology assessment (micro/meso-level) predominated. There were only a small number of high quality researches dealing with HSR in Croatia. Descriptive approach to the analysis predominated. Reform interventions require research, but are not part of the designed strategy. Funding of HSR is an important issue. The research in Croatia is financed by the Croatian Ministry of Science, Education and Sports. In the UK and the USA, HSR is funded by the National Health Services. In all publications, we could not find a systematic research of the Health System; however, we recognized a growing trend in the number of articles dealing with HSR in Croatia over the past 20 years. Comparison of the number of papers on the Health Care System in Croatia indicated a significant lag in comparison to Western Europe, and similarity with the countries of Eastern Europe.
-
Avedis Donabedian defined the quality of care as the kind of care, which is expected to maximize an inclusive measure of patient welfare, after taking into account the balance of expected gains and losses associated with the process of care in all its segments. According to the World Medical Assembly, physicians and health care institutions have an ethical and professional obligation to strive for continuous quality improvement of services and patient safety with the ultimate goal to improve both individual patient outcomes as well as population health. Health technology assessment (HTA) is a multidisciplinary process that summarizes information about the medical, social, economic and ethical issues related to the use of a health technology in a systematic, transparent, unbiased, robust manner, with the aim to formulate safe and effective health policies that are patient focused and seek to achieve the highest value. ⋯ TAIEX project has been approved as a two-day workshop in December 2010. The Croatian HTA Guidelines have been issued with the aim to start the HTA process and reports that should serve as recommendations, as a support to policy-makers at the national level, in particular the Croatian Ministry of Health and Social Welfare, and Croatian Institute of Health Insurance, in making evidence-informed decisions on the strategic planning, investment, management and implementation of technologies in health care, on funding (reimbursement) and coverage of health technologies, and at hospital level on the request from hospital directors and policy teams. In conclusion, establishment of all these measures in Croatia is by no means an easy and quick process, however, we do believe that it is feasible through continuous and close collaboration of all those involved.