Training experts in family medicine teaching.

Family medicine teachers require specific educational skills. A framework for their professional development is essential for future development of the discipline in Europe. EURACT developed a framework on educational expertise, and subsequently applied it in a curriculum of teaching-skills courses of various levels. The aim of this article is to describe the development of the teaching framework, and of an international three-level course programme for 'teaching-the-teachers'. Furthermore, we describe our experiences and lessons learned, in particular with regard to the level-three programme for proficient teachers, which was new. We conclude that it is possible to develop a theoretical framework of family medicine teaching expertise and to apply it in an international high-level educational programme for future experts in family medicine education. Research evidence of the usefulness of this approach is needed, and the threats for its further development into a sustainable activity are its high teacher/student ratio associated with relatively high costs and difficulties in recruiting suitable participants.

Satisfaction with organizational aspects of health care provision among Lithuanian physicians.

BACKGROUND: Physician satisfaction is considered an important factor influencing quality of health care provision, patient compliance, and costs to health care systems. Dissatisfaction leads to an increase in turnover of physicians and early retirement, which has a negative impact on continuity and quality of health care. Physician dissatisfaction with certain aspects of health care provision may also help to identify potential weaknesses in satisfactory functioning of health care systems. The aim of the current research project is to study the satisfaction with different organizational aspects of health care provision in Lithuania as judged by a selection of physicians. METHOD: The study was conducted in Lithuania in June 2004. Physicians in randomly selected health care centers were invited to take part in the survey, 505 primary and secondary care physicians were interviewed by external interviewers during the study period. Physicians were asked to express their satisfaction on items presented in a questionnaire. The questionnaire consisted of 22 questions, evaluating different aspects of health care services - working conditions, workload, financial remuneration, organization of health care infrastructure and availability of laboratory services. Answers were presented by the 5 point Likert type scale, ranging from "very satisfied" (5) to "very dissatisfied" (1). RESULTS: Physicians who were most satisfied with their working conditions were working in private primary health care practices (91.1% satisfied or very satisfied), as compared with 54% of physicians working in state-owned primary care institutions and 49.7% in hospitals. Physicians working in cities and regional centers or towns were more satisfied with organizational aspects of health care services than physicians working in rural health care centers. Satisfaction with their financial remuneration showed that 74% of respondents stated they were "dissatisfied" or "very dissatisfied". While asked about potential deficiencies in their health care institutions, the most important identified by respondents in all localities was a perceived lack of financial support for these institutions. CONCLUSIONS: There is a significant difference in the perception of physicians in private and state health care institutions with regard to financial remuneration as well as availability of laboratory diagnostic and treatment equipment and working conditions. Based on the study findings, possibilities to increase Primary Care financing should be considered in order to improve the quality of the delivery of health care services as well as retain physicians within the health care system. Results of this study demonstrate a need of further research to quantify what could be reasonably expected from diagnostic and investigative resources to support health care in Lithuania in current economic situation.

[Influence of patient's social and demographic characteristics on patient's expectations for medical consultation]. / Paciento medicinines konsultacijos lukesciu priklausomumas nuo socialiniu bei demografiniu paciento charakteristiku.

UNLABELLED: Most of the patients, coming to see their primary care physician, have explicit expectations and priorities for the medical consultation. Recognition of these expectations is an important step in organizing patient-oriented health care services. Patient expectations depend on a number of factors: health problem and its severity, as well as social and demographic characteristics of patient and physician. Objective of this survey was to evaluate influence of patient's socio-demographic characteristics and some health status indicators on expectations for primary care consultation. MATERIAL AND METHODS: During the study 403 patients and 162 physicians were surveyed. Pre-visit expectations of patients coming to see their primary care physician for health problem were investigated using self-addressed original questionnaire. RESULTS: Factor analysis revealed three main factors: biomedical expectations, emotional support expectations and expectations for partnership. Analysis of influence of socio-demographic characteristics on patient expectations showed that statistically significant differences in different age groups were found only for emotional support factor. Patients' desire for emotional support from doctor increased with age. Relationship was observed between expectations for emotional support and health status as perceived by patient. Patients evaluating their health problem as not serious had mean score of expectations for emotional support 3.4, patients with moderate health problem--3.5, patients with serious health problem--4.0 out of 5. CONCLUSIONS: Patient's need for emotional support from physician depends on his age, marital status, frequency of his visits to physician during the year, self-perception of the health status and course of disease. Analysis of relationship between patient's expectations and his sex, education, physician's sex or type of practice did not show statistically significant differences between groups. No influence of analyzed social and demographic characteristics or perceived health status on biomedical expectations (laboratory tests, specialist consultations, and hospital treatment) was found during our study.

[Evaluation of patient needs and quality of outpatient health care services in large cities, district centers, villages and townships of Lithuania]. / Ambulatorines sveikatos prieziuros paslaugu poreikio bei kokybes vertinimas Lietuvos didziuosiuose miestuose, rajonu centruose, kaimuose bei miesteliuose.

Opinion of patients concerning some aspects of patient needs and quality of ambulatory care services was investigated by survey, performed in ambulatory health care institutions of Lithuania in May, 2002. Results of survey included comparison of patient opinion in cities, regional centers, villages and townships. Representative number of 1003 inhabitants was selected as a study sample. Inhabitants were interviewed by means of standardized questionnaire developed by study team. According to the results of survey, patients evaluate changes in quality of the health care services more negatively that positively. Positive changes, by opinion of respondents, were in physician attitudes towards patient, this opinion was supported by 27% of respondents. Most negative changes, reported by patients, were changes in management of health care institutions, including functioning of registration office. Forty percent of inhabitants, participating in the study, expressed the opinion that accessibility of consultant services became more complicated, 35% did not notice any changes, 15% thought that procedure became easier; 38% of respondents thought that accessibility to ambulatory health care services worsened. Respondents also had different opinions concerning development of institution of family physician; 45% evaluated it as a positive change in health care system, and 42% expressed negative opinion. Main problems in functioning of ambulatory care institutions, by opinion of respondents, are long queues at the physician office, difficulties in registration in advance and out-of-pocket payments to physicians.