Sveikatos priežiūros paslaugų sergantiesiems erkiniu encefalitu prieinamumo ir kokybės vertinimas Kauno regione

Abstract

SUMMARY Assessment of health care services quality and accessibility for tick-borne encephalitis patients in Kaunas region Liucijus Ambraška Supervisor Janina Petkevičienė, Dr.Sc.Assoc. Prof., Department of Social Medicine. Faculty of Public Health, Kaunas University of Medicine.- Kaunas, 2005.-P.68 Key words: tick-borne encephalitis, quality and accessibility of health care services Incidence of tick-borne encephalitis (TBE) is increasing by data of Lithuanian health information center. Aim of the study – to assess accessibility and quality of health care services for TBE patients in Kaunas region. Objectives: to establish peculiarities of transmission TBE infection and opinion about TBE prophylaxis of reconvalescents; to evaluate duration of admission period of TBE patients to specialized hospital and peculiarities of monitoring after discharging and satisfaction with health care services; to determine standpoint of general practitioners (GP) on TBE prophylaxis and reconvalescents monitoring problems. Methods. Case histories of TBE patients treated in Kaunas Clinical Hospital of Infectious Diseases in years 2001-2002 (n=187) analyzed. Questionnaires about state of health and assessment of quality of health care services during period of illness and reconvalescence were posted. 104 answers received. Questionnaires about standpoint on TBE control problems handed to 150 GP and returned by 101. Original questionnaires used. Differences between groups assessed using Mann-Whitney, Kruskal-Wallis tests, c2 criterion, satisfaction dependences upon different factors analyzed by method of logistic regression. Results. Tick bites were noticed by 64.7 percent of patient, 86.1 percent of them visited forest. Patients have taken medical advice after 4.2 (3.6) days from symptoms onset, were admitted to hospital after 4.5 (3.6) days and to hospital of infectious diseases after 5.1 (3.8) days. Older patients and Kaunas and Kaunas district inhabitants were admitted to hospital after medical examination more quickly. TBE reconvalescents returned to work activities after 6(5.8) weeks, men more quickly than women. Disability established to 19.2 percent of patients. After discharging 58.7 percent of them observed in primary health care centers. Major part (91.8 percent) observed by GP, 55.7 percent by neurologist and only fifth part by infectologist. Almost half (46 percent) TBE reconvalescents don’t satisfied health care services in primary health care centers during period before admission and 12.3 percent after discharging. Health care services in hospital and sanatorium assessed well by major part of patients. Respondents who described their state of health as poor assessed health care services worse more than those who described their state of health as good. GP suppose TBE as important problem of public health, but they are lacking knowledge of early diagnosing TBE and therapy principles. Ninety-two percent of GP think monitoring of reconvalescents with cooperation GP, neurologist and infectologist necessary. Conclusions and practical recommendations. It is necessary to decrease incidence of TBE by improving prophylaxis, explaining causes of TBE and increasing vaccination. In most cases patient were not satisfied primary health care services, so GP must have more knowledge in early differencial diagnostics of TBE and introduce universal system of monitoring and rehabilitation.