Professional paper
INTEGRATED CARE IN MOSTAR: PRIORITIES FOR THE HEALTH SYSTEM
AHMED NOVO
orcid.org/0000-0002-4571-5961
; University of Sarajevo, Faculty of Medicine, Sarajevo, Bosnia and Herzegovina
JADRANKA KNEŽEVIĆ
; Mostar University Hospital, Mostar, Bosnia and Herzegovina
VAJDANA TOMIĆ
; Mostar University Hospital, Mostar, Bosnia and Herzegovina
KRISTINA GALIĆ
; Mostar University Hospital, Mostar, Bosnia and Herzegovina
DAVOR TOMIĆ
; Mostar University Hospital, Mostar, Bosnia and Herzegovina
ANTONIO SESAR
; Mostar University Hospital, Mostar, Bosnia and Herzegovina
IVAN ĆAVAR
; Mostar University Hospital, Mostar, Bosnia and Herzegovina
IRENA SESAR
; Mostar University Hospital, Mostar, Bosnia and Herzegovina
BOJANA KNEŽEVIĆ
orcid.org/0000-0001-5525-3775
; Zagreb University Hospital Centre, Zagreb, Croatia
Abstract
Introduction: Integrated care could be defi ned differently and that is why the following terms can be found in the literature: integrated health, coordinated care, comprehensive care, seamless care, or trans-mural care. It has become a worldwide trend in health care reforms and new organizational arrangements focusing on more coordination between professionals and institutions and integrated forms of care or service provision. The Agency for Quality and Accreditation in Health Care in the Federation of Bosnia and Herzegovina (AKAZ) is using accreditation standards as a tool for quality improvement process aiming to increase the capacity of health care institutions in the Federation of Bosnia and Herzegovina in order to provide safe and quality care for the citizens. In the Agency, it is fi rmly believed that a wisely set and well-organized integrated care can help health professionals deliver health care in accordance with patient needs and even expectations. Aim: The aim of the study was to fi nd out how to implement measures for integration of health care, to fi nd out whether there are any gaps in the health care system, and how to bridge to the application of the best solutions of integrated care in the city of Mostar and Herzegovina-Neretva Canton (HNC). Methods: In this paper, we used feedback and results from the workshop held at the Federal Public Health Institute in Mostar as part of lectures for participants of the course within the Integrated Health Care module held in June 2019. The Integrated Health Care module is part of the Continuous Professional Education for Health Managers in the Federation of Bosnia and Herzegovina. Participants were experienced experts in different fi elds of medicine and pharmacists divided into two groups. Results: Participants identifi ed the most common problems for both primary and hospital physicians, such as unclear referral system to specialist examination, inappropriate patient expectations from primary care, lack of communication between primary care and hospital care, and inadequate use of clinical practice guidelines. To solve these problems, both groups stressed the importance of common strategy documents and guidelines, which should provide clear framework for cooperation and integration including levels of competence and service prices. Furthermore, effi cient information system is crucial for the integration or digitalization of, in strategy documents, agreed mechanisms of coordination and integration. Third, the growing proportion of elderly population should be taken in consideration, including the need of hospice and development of geriatric medicine in the Canton. Participants discussed and compared the results with feedback and results from three workshops held several years before. Discussion: The results of our study stressed the importance of better communication among different sectors, institutions and levels of health care involved in the treatment of patients, pointed to some measures for integration including standardized models of communication, training and education and highlighted priorities for integration. Analysis indicated the necessity for the following: regular analysis of unnecessary or inappropriate referrals and evaluation of such practices, as well as of any duplication of tests and prescriptions (failure to control costs); joint planning of preventive treatments (including the ministry and public health authorities); and clear responsibilities regarding screening programs and patient path analysis. Conclusions: Strong commitment of health care authorities and vision of integrated care and collaborative networks, as well as good communication and leadership were highlighted as key integrated care facilitators. Health care institutions at all levels of care have to organize multidisciplinary teams to work more on better and effective communication and to exchange information among key stakeholders in the system.
Keywords
integrated health care; quality; communication; education
Hrčak ID:
231126
URI
Publication date:
5.12.2019.
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