engleski

Lack of manpower, increased family practitioners workload and solutions (Croatian experience).

Introduction: The lack of manpower in Family Medicine is evident among many European countries. Croatia is suffering from the same problem which became more and more disturbing in last decade. Method: Data search of official medical and health statistics reports regarding Family Practice in Croatia covering period 2001 to 2012. Results: The number of health insured persons within Croatian Institute of Health Insurance scheme (CIHI) increased by 400.000 during 10-year period (2001-2010). At the same period number of Family Practitioners (FP) who had contract to CIHI decreased by 100. Consecutively, average number of persons on FP patients list increased from 1584 in 2001 to 1854 in 2012. Rate of persons who asked for medical help did not change in the same period: 71% to 75% of enlisted patients contacted FP at least ones yearly. Average number of contacts to FP service increased dramatically from 9579 per FP team in 2001 to 13752 per FP team in 2011. It means that average number of contacts to FP team per patient was 7, 6 in 2001 and 9, 7 in 2011. Trends in observed period was constant i.e. figures increased year by year without significant oscillations. However, average number of direct consultation to FP per enlisted patients decreased minimally during the observed period: 5, 4 in 2001 to 4, 8 in 2012. Average number of direct consultation to FP showed specific trend by increasing from 5, 4 in 2001 to 5, 8 in 2005, decreasing trend till 4, 6 in 2008 and stabile average number to 4, 8 in 2012. Discussion: Two mainstream CIHI projects were oriented to diminish problem of FPs’ workload in Croatia in last decade. First one was to impose financial participation to each direct consultation to FP. Participation was imposed in 2005 and resulted in evident decrease of direct FP consultations. Second project was introducing electronic prescription scheme which allowed FP to prescribe medicament through E-prescriptions and patients to get theirs medication in every pharmacy within CIHI network. A result was 25-40% increase of contacts (all procedures) performed in FP while direct consultation to FP decreased by 10%. One must be aware that every procedures performed in FP have to be supervised by FP. Delegation of some tasks to other members of FP team, as well as E-health consultation and E-prescribing also demands specific time from FP who is in charge. Observed increased number of contacts alerts that FPs workload problems cannot be resolved by simple interventions.

Family Practice; manpower; workload; intreventions; E-health; Croatia

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