Центры укрепление здоровья в Словении: интеграция индивидуальных и популяционных услуг для снижения неравенства в здравоохранении на уровне сообществ: информационный обзор по передовому опыту

В 2002 году во всех 61 центре первичной медико-санитарной помощи (ПМСП) в Словении были созданы Центры укрепления здоровья (ЦУЗ). Их основная роль заключалась в осуществлении вмешательств в области образа жизни в борьбе с ключевыми факторами риска неинфекционных заболеваний (НИЗ) с использованием комбинации индивидуального подхода и подхода на уровне популяции. ЦУЗ интегрировали ранее разрозненные мероприятия и виды деятельности в центрах ПМСП, включая общественных медсестер. В период с 2013 по 2016 год проводилась опытная апробация новой парадигмы для обеспечения интеграции разных услуг, направленных на уязвимые группы. Новая роль ЦУЗ заключалась в построении партнерских отношений с ключевыми заинтересованными сторонами, включая социальные службы и неправительственные организации (НПО), в целях укрепления здоровья на уровне сообществ. Для подготовки локальных стратегий и планов действий, направленных на удовлетворение потребностей разных групп населения и выявление и снижение неравенства в здравоохранении, были образованы команды укрепления здоровья.

Health promotion centres in Slovenia: integrating population and individual services to reduce health inequalities at community level: good practice brief

Health promotion centres (HPCs) were created in 2002 in all 61 primary health care (PHC) centres across Slovenia. Their main role was to provide lifestyle interventions against key risk factors for noncommunicable diseases by combining population and individual approaches. HPCs integrated previously dispersed activities in PHC centres, including community nursing. Between 2013 and 2016, a new paradigm was piloted to assure integration of different services targeting vulnerable groups. The new role of HPCs was to create partnerships with key stakeholders, including social services and nongovernmental organizations, to improve health at community level. Health promotion teams were established to prepare local strategies and actions plans, which would address the needs of different population groups, and identify and reduce health inequalities.

Results of the FIT-based National Colorectal Cancer Screening Program in Slovenia.

BACKGROUND: Colorectal cancer (CRC) is one of the most common malignancies in the western world. OBJECTIVE: We aimed to assess the first round of fecal immunochemical test (FIT)-based National CRC screening program (NCSP). METHODS: In the NCSP conducted in Slovenia, a FIT and colonoscopy for those tested positive was used. The NCSP central unit sent 536,709 invitations to Slovenian residents age 50 to 69 years old between 2009 and 2011. The adherence rate was 56.9% (303,343 participants). FIT was positive in 6.2% (15,310) of the participants (men, 7.8%; women, 5.0%; P<0.01). A total of 13,919 unsedated colonoscopies were performed with the cecal intubation rate of 97.8%. RESULTS: The overall adenoma detection rate was 51.3% [95% confidence interval (CI), 50.5%-52.1%] of which 61.0% (95% CI, 59.9%-62.1%) was in men, and 39.1% (95% CI, 37.8%-40.3%) in women (P<0.01). The mean number of adenoma per positive colonoscopy was 1.94 (95% CI, 1.90-1.97). Adenoma, advanced adenoma, or cancer were found in 7732 (55.5%) colonoscopies. A total of 862 (6.2%) CRC cases were found. Only 161 (18.7%) carcinomas were situated in the right colon. A total of 597 (70.2%) patients with cancer were in the early clinical stages (N, negative; 194 22.8%) of all cancers were cured with only endoscopic resection. CONCLUSIONS: In the NCSP, CRC was found in 6.2% of those participants attending colonoscopy, with 81.3% of carcinomas found in the left colon. A localized clinical stage was found in 70.2% participants. In 22.8% of CRC patients, cancer was cured with endoscopic resection only.

Faecal immunochemical test-based colorectal cancer screening programme SVIT in Slovenia: pilot phase.

Colorectal cancer (CRC) is the second most common cancer in Slovenia. The 5-year survival of patients depends on the clinical stage at presentation. More than 70% of patients with CRC are diagnosed as being in stage III or IV, with a 5-year survival rate of 52.7%. To improve the detection rate of CRC and to detect CRC in its early and more curable stage, a national screening programme is needed. In the year 2008, we started a pilot phase of the National CRC screening programme. We invited 9091 Slovene residents aged 64-68 years from Ljubljana, Kranj, and Celje regions, of whom 3807 responded to our invitation (41.9%). Two kits of the faecal immune test were sent to 3117 participants who met the inclusion criteria, and 2829 (90.7%) tests were returned. The compliance rate in our pilot programme was 32.9%. Among the patients who responded positively, 7.5% were positive. Until February 2009, 193 colonoscopies had been performed at DC Bled, DC Lipa and AM DC Rogaska. Intubation to the caecum was carried out in 99.4% of colonoscopies. Histology specimens were taken from 135 patients (70%). The adenoma detection rate was 53.8% (59.8% for men and 47.9% for women; P<0.05). We detected 1-17 adenomas per patient (2.4 on average). Advanced adenomas were detected in 60 patients (31%; 35.1% of men and 27.1% of women; P<0.05). Invasive carcinoma was detected in 15 patients (7.7%; 12.4% of men and 3.1% of women; P<0.05). Ten of them (73.3%) were in clinical stage I or II. In the pilot phase of the CRC screening programme the majority of CRCs were detected at early clinical stages. Invasive cancers were detected in 7.7% of patients. In almost all patients adenomas were resected at screening colonoscopy, thus reducing the possibility of later development of CRC in those patients.