Influence of practice location on prescribing, diabetes care, and colorectal cancer screening among Czech general practitioners during the COVID-19 pandemic.

OBJECTIVES: The provision of primary health care was not interrupted during the coronavirus disease 2019 (COVID-19) pandemic in Czechia, although the capacity and resources of providers changed. We examined how the pandemic affected individual general practices throughout 2017-2021, focusing on differences between urban and rural practices. METHODS: We analysed data from the largest health insurance company in Czechia, which provides care to 4.5 million people (60% of the population). We evaluated the prescription volume, diabetes care procedures, and faecal immunochemical test (FIT) in preventive care and new pandemic-related procedures (remote consultations, testing, and vaccinations). For the spatial distribution of practices, we adapted the Organisation for Economic Cooperation and Development typology. RESULTS: We observed minimal declines in 2020 in the rate of prescribing (-1.0%) and diabetes care (-5.1%), with a rapid resumption in 2021, but a substantial decline in FIT (-17.8% in 2020) with slow resumption. Remote consultations were used by 94% of all practices regardless of location, with testing and vaccinations more commonly performed by rural general practitioners (GPs). CONCLUSIONS: Primary care in Czechia rose to the challenge of the COVID-19 pandemic, as shown by the finding that the volume of healthcare services provided through primary care did not decrease across most of the monitored parameters. This study also confirmed that rural GPs provide more care in-house, both in terms of prescribing and procedures performed in their practices. Future studies will need to focus on preventive care, which the pandemic has dampened in GP practices in Czechia.

Does advanced maternal age explain the longer hospitalisation of mothers after childbirth?

BACKGROUND: Fertility postponement, which has comprised the most significant reproductive trend in developed countries over the last few decades, involves a number of social, personal and health consequences. The length of stay (LOS) in hospital following childbirth varies considerably between countries. Czechia, where the fertility postponement process has been particularly dynamic, has one of the longest mean LOS of the OECD member countries. OBJECTIVE: We analyse the influence of the age of mothers on the LOS in hospital associated with childbirth. DATA AND METHODS: We employed anonymised individual data provided by the General Health Insurance Company of the Czech Republic on women who gave birth in 2014. Kaplan-Meier survival plots and binary logistic regression were employed to identify factors associated with long stays (> = 7 days for vaginal births, > = 9 days for CS births). RESULTS: The impact of the maternal age on the LOS is U-shaped. A higher risk of a longer hospitalisation period for young mothers was identified for both types of birth (OR = 1.58, 95% CI 1.33-1.87, p˂0.001 for age less than 20, OR = 1.31, 95% CI 1.20-1.44, p˂0.001 for age 20-24 compared to 30-34). The risk of a longer stay in hospital increases with the increasing age of the mother (OR = 1.23, 95% CI 1.13-1.35, p˂0.001 for age 35-39, OR = 2.05, 95% CI 1.73-2.44, p˂0.001 for age 40+ compared to 30-34), especially with concern to vaginal births. CONCLUSION: The probability of a long LOS increases significantly after the age of 35, especially in the case of vaginal births. Thus, the fertility postponement process with the significant change in the age structure of mothers contributes to the increase in health care costs associated with post-birth hospitalisation.

Has the cesarean epidemic in Czechia been reversed despite fertility postponement?

BACKGROUND: Although the percentage of cesarean sections (CS) in Czechia is below the average of that of other developed countries (23.6%), it still exceeds WHO recommendations (15%). The first aim of the study is to examine the association between a CS birth and the main health factors and sociodemographic characteristics involved, while the second aim is to examine recent trends in the CS rate in Czechia.  METHODS: Anonymized data on all mothers in Czechia for 2018 taken from the National Register of Expectant Mothers was employed. The risk of cesarean delivery for the observed factors was tested via the construction of a binary logistic regression model that allowed for adjustments for all the other covariates in the model. RESULTS: Despite all the covariates being found to be statistically significant, it was determined that health factors represented a higher risk of a CS than sociodemographic characteristics. A previous CS was found to increase the risk of its recurrence by 33 times (OR = 32.96, 95% CI 30.95-35.11, p<0.001). The breech position increased the risk of CS by 31 times (OR = 31.03, 95% CI 28.14-34.29, p<0.001). A multiple pregnancy increased the odds of CS six-fold and the use of ART 1.8-fold. Mothers who suffered from diabetes before pregnancy were found to be twice as likely to give birth via CS (OR = 2.14, 95% CI 1.76-2.60, p<0.001), while mothers with gestational diabetes had just 23% higher odds of a CS birth (OR = 1.23, 95% CI 1.16-1.31, p<0.001). Mothers who suffered from hypertension gave birth via CS twice as often as did mothers without such complications (OR = 2.01, 95% CI 1.86-2.21, p<0.001). CONCLUSIONS: The increasing age of mothers, a significant risk factor for a CS, was found to be independent of other health factors. Accordingly, delayed childbearing is thought to be associated with the increase in the CS rate in Czechia. However, since other factors come into play, further research is needed to assess whether the recent slight decline in the CS rate is not merely a temporal trend.

Spatial Healthcare Accessibility: A District-Level Analysis of Travel for Outpatient Diabetology in Czechia.

Assessments of regional differences in the accessibility and capacity of health services often rely on indicators based on data from the permanent residents of a given region. However, a patient does not always use health services in their place of residence. The objective of this article is to evaluate the influence of spatial healthcare accessibility on regional differences in the provision and take-up of health services, using outpatient diabetology in Czechia as a case study. The analysis is grounded in monitoring the differences in the patient's place of residence and the location of the healthcare provided. Anonymized individual data of the largest Czech health insurance company for 2019 are used (366,537 patients, 2,481,129 medical procedures). The data are aggregated at the district level (LAU 1). It has been identified that regions where patients travel outside their area of residence to access more than half of their healthcare needs are mostly in local/regional centres. Moreover, these patients increase the number of medical services provided in local/regional centres, often by more than 20%, which has been reflected in greater healthcare capacity in these centres. To assess regional differences, it is important to take the spatial healthcare accessibility into account and also consider why patients travel for healthcare. Reasons could be the insufficient local capacity, varied quality of health services or individual factors. In such cases, healthcare actors (health insurance companies, local government etc.) should respond to the situation and take appropriate action to reduce these dissimilarities.

Using selected POCT methods by general practitioners in the Czech Republic.

Point-of-care tests allows for the more effective and rapid diagnosis of acute conditions, better management of chronic disease and the rational use of prescribed medicines. The use of selected non-mandatory tests was analysed in relation to their availability across urban and rural general medical practices in Czechia. Data for 2016 were obtained from the largest health insurance company in Czechia. To categorise the different types of surgery, a spatial model was created applying the OECD regional typology to primary care in Czechia. International normalised ratio (INR) was the most commonly available test, with 53.1 %. In acute care, C-reactive protein (CRP) testing was most extensively present, with 50.9 %. In practice, though, 90 % of these surgeries performed these tests. Both INR and CRP accounted for 42.7 %, whereas 61.3 % used at least one. Contracts of haemoglobin A1c amounted 14.8 %, 38.6 % of practices were not contracted to perform any of three tests, and 43.4 % reported no usage at all. Around half of all general practitioners in Czechia are contracted to provide the most popular non-mandatory point-of-care tests. Reported usage differed among the various surgery typologies, with more peripheral surgeries reporting higher rates.

Urban or Rural GP? In the Czech Republic It Is not just Distances That Matter.

This article proposes a combined mixed methods approach to categorising GP practices. It looks not only at location but also at differences in the nature of the work that rural GPs perform. A data analysis was conducted of the largest health insurance company in the Czech Republic (5.9 million patients, 60% of the population, 100% coverage within the Czech Republic). We performed two data analyses, one for 2014-2015 and one for 2016, and divided GP practices into urban, intermediate, and rural groups (taking into account the OECD methodology). We compared groups in terms of the total annual cost in CZK per adult registered insurance holders. The total volume of data indicated the financial costs of €1.52 billion and €2.57 billion respectively. Both analysis showed differences between all groups of practises which confirmed the assumption that the work of the GP is influenced by regionality. A multidisciplinary hospital is the main factor that fundamentally affects the way a GP's work in that area. The proposed principle of categorising general practices combines geographical and cost characteristics. This requires knowledge of the cost data of healthcare payer and on the basic demographic knowledge of the area. We suggest this principe may be transferrable and particularly suitable for categorising general practice.

Impact of the mothers age at childbirth on the birth weight of new-born children.

The various health risks associated with the increasing age of mothers at childbirth include the low birth weight of new-born children. The aim of the article is to verify the relationship between the birth weight of new-born children and the age of mothers at childbirth employing data on new-born children from the General Health Insurance Company of the Czech Republic. The data also allow take into consideration other characteristics such as the gender of the child, the frequency of childbirth, complications during hospitalisation and the type of conception (spontaneous or following IVF treatment). It was found that the proportion of new-born children with birthweights of 2500+ g exceeded 93% for women aged 25-39 and that the proportion is only slightly lower for women aged 40 and over. The lowest proportion (less than 88 %) was determined for women below the age of 20, while the proportion for women aged 20-24 years stood at 92 %. No relationship was proved between a higher proportion of children born with low weights and the higher age of women with respect either to single or multiple births. However, the research did reveal the significantly higher proportion of children from single births with lower birth weights most likely born following IVF treatment. Moreover, the proportion of new-born children hospitalised due to health complications increases with the increasing age of mothers at childbirth with respect to both normal and lower birth weights.

Reproduction ageing in Czechia in the European context.

The shift in fertility to higher ages over the last few decades represents one of the most distinctive features of reproductive behaviour in Czechia. The aim of this article is to provide an overview of the process of fertility postponement in the European context and assessment of the Czech situation. While the fertility postponement is a universal trend in developed countries, significant differences are evident between European countries in terms of both the commencement and speed of postponement concerning the mean age of mothers at first birth. The article also discusses the main factors that influence the fertility postponement. While at the beginning of the 1990s Czech first-time mothers were among the youngest in the worlds developed countries, during the 1990s Czech women experienced one of the most rapid increases in the mean age of first birth. Nevertheless, in the European context Czechia continues to have slightly younger first-time mothers (28.2 years in 2016, 0.8 years younger than the EU average). It also appears that currently no direct correlation is evident with concern to the mean age of mothers at first birth and the total fertility rate.

General paediatricians views on their plans to leave medical practice: Has the "twelfth hour" passed?

Up to a third of general paediatricians plan to stop practicing within five years, mainly for age reasons. This finding, based on paediatricians responses, indicates potential problems that may significantly affect the availability of paediatric health services and quality of care. The age structure of the general paediatric population is already alarming in the short term, as the number of practitioners in the younger age categories is very low, and more than half are aged 60 and over. Can this alarming situation still be resolved? The article presents the results of a questionnaire-based survey conducted in mid-2018 regarding paediatricians plans to leave medical practice, as part of research looking at the consequences of the current situation and suggests possible steps to mitigate the expected negative impacts. Keywords: general paediatrics, physician ageing, generational change, reasons for ceasing to practice, availability of health services, Czechia.

[Assessing health care accessibility in the Czech republic]. / K otázce hodnocení dostupnosti zdravotní péce v Ceské republice.

The article looks at the accessibility of health care in the Czech republic in relation to the relevant legislation. Health care access is a frequently debated issue, but quantifying it is a difficult task. There are no official regulations in our country for determining the capacity of health care workers by category and type of health care provision that could be used to ensure health care is accessible to the inhabitants of a given region. Nonetheless, a government regulation came into force in 2013 regulating local health care access and travel time. This regulation is the first of its kind in the Czech rep., but (perhaps because of this) it contains a number of ambiguities, and this lack of detail makes it impossible to ensure the regulation is fully implemented and adhered to.The aim of this article is to attempt to identify these ambiguities and to broadly pinpoint the main factors potentially affecting health care access. To achieve this, an analysis is performed on the data on health care providers and methods using advanced GIS (geographic information systems) are utilized. Given the wide range of health care services on offer, the examples relate to primary health care, specifically practical medicine for children and adolescents.

[Demographic view on primary health care physicians in the Czech Republic--present state as headstone for the future development]. / Lékari primární zdravotní péce v Ceské republice z pohledu demografie--soucasný stav jako zakládní kámen budoucího vývoje.

The number of primary health care physicians in the Czech Republic in recent years has been relatively stable. Nothing indicates that already in a few years there could be considerable problems in terms of quality and accessibility of primary health care. The reason for this assertion is the irregular age structure of the particular branches of this type of care, where a significant number of physicians is concentrated in the age range of 50-60 years. There is currently no adequate substitute for physicians in the form of young doctors; problems will not be solved even by the possible influx of physicians from abroad. After leaving of the strong generation of physicians from primary health care, especially to retirement, there is a risk of collapse, especially in branches of the practical medicine for children and youth and general practical medicine. Future development of the negative number and structure of physicians in primary health sector is an irreversible process, which could be currently eliminated only by the quick action of the authorities involved--the relevant ministries, health insurance companies and/or professional associations.