Member Organisations

Slovakia
 

 

Pásztor, L.:

 

Association of Private Physicians of Slovakia started the work on new conception and curricula of General Medicine in Slovakia.

Here is the basic project.

 

Strategy of quality improvement in general practice and primary health care in Slovakia

 

1.  Introduction 

      

        Primary healthcare (PHC) is recognized as an essential element of the healthcare system of EU and OECD member countries. Currently, no unified model of healthcare exists in EU and discussions on possible structure of such model are held. Also, there is no single definition of PHC and different medical services are delivered across the EU countries. Significant changes in healthcare systems around EU are expected. However, from a short-time perspective, each EU member country is going to identify the healthcare issues using the subsidiarity principle. On the other hand, free movement of EU citizens will require adopting certain measures leading to standard quality and healthcare accessibility.      

With top-quality and generally accessible PHC in Slovakia, we are able to support improved and generally accessible out-patient specialized care and in-patient care.

 

2.  Overview of PHC in Slovakia

 

          Slovak medical professionals followed the healthcare model pursued by former Soviet Union until 2004. The model recognized four medical specialties in PHC:  general practitioner for adults,  general practitioner for children, primary care gynaecologist and  dentist. The four specializations remained in existence in PHC after the changes in 1989. Privatisation of healthcare system was permitted in November 1994 and is almost completed by now.

According to the act on healthcare providers (in effect since 01 January 2005), general practitioner, defined as a medical doctor with general medicine examination and a medical doctor with paediatrics examination. Thus, definition of PHC has changed considerably. Gynaecologists and dentists have become specialists, available directly.

Quality and accessibility of healthcare, particularly prevention, and generally accepted rules show that the term general practitioner, as defined in the latest act on healthcare providers, will remain in existence in Slovakia. This document will cover the general medicine issues and avoid primary healthcare problems.

           Situation in general medicine in Slovakia is far from satisfactory. Declining quality and worse accessibility of healthcare are the consequences of insufficient salaries and low social recognition for general practitioners in Slovakia, age structure of adult general practitioners (AGP) and apathy from large amount of AGPs.  Stakeholders in GM do activities that have no unified coordination (chief GM officer of the Ministry of Health, department of GM at the State Medical Institute, Family/General Medicine Society, section for AGPs at the Private Physician´s Association, section for AGPs at the Slovak Medical Chamber).

 

It is necessary to develop and implement reforms in general medicine as a part of the general healthcare reform in Slovakia.

The purpose of this document is to prepare the general strategy of the reform and particular measures to be takes.

 

                                                                                                                                                                                                                                              

3.  General purpose of the reform in general medicine (GM) in Slovakia

 

Recently adopted reform acts have created space for primary care to be introduced as a fundamental pillar of healthcare system in Slovakia in line with general practice usual in other EU member countries.

 

a/ The reform involves:

 

-   improvement of healthcare quality in general medicine, focus on prevention  (Points  1, 2, 3, 4, 5, 7)

 

-  better salaries and higher social recognition for GM in Slovakia, more stable network of GM providers taking into account the age structure of AGPs. (Points 6, 8, 9)

 

b/ Issues of main importance:

 

1.  To develop a general definition of general medicine in Slovakia, identifying a sufficient name   for GM in compliance with definition adopted by UEMO, WONCA .

     Reasons: Influential international and European organisations for GM developed new definitions of general medicine that are generally accepted in EU. Slovakia has not developed above mentioned definitions so far.

     

2.  Identify job descriptions of a GP

      Reasons: Accurate job description is prerequisite for identifying position of GPs in healthcare system in Slovakia, identifying competencies, defining relations between GPs and other medical specialties.

      

3.  Identifying further education for general medicine in compliance with EU standards, UEMO requirements and regional specifications.

 

4.  Developing system of further education for GPs in compliance with UEMO and SACCME / Slovakian Accreditation Council for CME/ standards including accreditation requirements for educational institutions.

      Reasons: To improve quality of GM involves new tasks for ongoing education of GPs. New situation in ongoing education after our accession into EU structures is clear for other medical specialties and quite unclear for GM. Ongoing education for GPs may be addressed through  SACCME. The Private Physician´s Association of SR, a co-founder of SACCME , would develop conditions for the implementation of CMU system in GM in Slovakia.

       

5.  Processing, adopting, implementing and applying standard diagnostic and therapeutic procedure in GM.

     Quality and audit of pharmacotherapy in GM – development and implementation.

     Reasons: Practical application of general diagnostic and therapeutic recommendations belongs to general assumptions for standards in healthcare and in GM.

     To adopt them, it is necessary to develop them in close cooperation with GM experts.

     Besides, it is necessary to develop conditions for audit of GM in pharmacotherapy as a basic tool for improved quality in GM pharmacotherapy.

 

6.  Develop conditions for implementation of quality systems in GM.

     Reasons: To implement quality systems is required by law since 01 January 2007. The Private Physician´s Association of SR has developed a special model of quality that would suit the requirements of GPs practices. Implementation of Point 4 is necessary.

   

7.  Assessment of GP´s work, salary for GPs, methods of PHC financing.

     Reasons: Financial assessment of GP´s work and improved reputation of GPs and PHC is necessary for better operation of PHC in Slovakia.

       

8.  Preventive programs: hypertension, ischemic heart disease, diabetes mellitus,

      osteoporosis,  large intestine cancer, etc.

     Reasons: high incidence of above diseases is good reason for prevention. National prevention programs are a must.

     Cooperation with the ministry of health is expected.

 

9.  Issues of special importance: peer visits, emergency units, healthcare in companies, ADOS (home care), etc.

    

10.  Current issues:

     -   ageing of GPs

     -   low income of GP practices

     -   transfer of doctors from other specialties to GM

     -   coordination of activities of GM managing subjects