Date post: | 22-Dec-2015 |
Category: |
Documents |
View: | 215 times |
Download: | 1 times |
The accessibility of healthcare for poor people in Slovenia
Danica Rotar Pavlic, MD, PhD, Jantien Altena, medical student
Pisa, 2010
Contents
IntroductionMethodsResultsDiscussionConclusion
Introduction
Health inequalities between socioeconomic classes
Health outcomes Self-reported health Specific conditions Mortality
Utilization Primary care practioner Secondary care Hospital admissions
Introduction-Methods-Results-Discussion-Conclusion
Introduction
Healthrisk Unhealthy behaviour Material circumstances Childhood circumstances Psychosocial factors
Barriers patient’s side Patient’s attitude Lack of knowledge
health literacy Lack of skills: coping,
decision making and concordance
Barriers provider’s side Characteristics of
healthcare system Personal attributes of
healthcare provider
Lack of money
Introduction-Methods-Results-Discussion-Conclusion
Introduction
In 1971 the death rate for adult men in social class V (unskilled workers) was nearly twice that of adult men in social class I (professional workers).
People from low socio-economic classes experience barriers in healthcare after they develop an illness.
Problems originate in some adverse psychosocial factors: the patient’s attitude toward illness and towards the healthcare system and insufficient coping styles .
This is closely linked to a lack of knowledge and health literacy which is more common among the poor and can lead to problems with the awareness of their own health condition, treatment options, diagnostic possibilities and recurrence.
To explore the accessibility of healthcare for poor people.
The results can act as an guide for further studies about this subject needed for reformations in the primary healthcare
Aim of the study
Introduction-Methods-Results-Discussion-Conclusion
Methods: subjects and settings
Ljubljana fieldworkQualitative method (the complex details about
feelings, thoughts and social interactions)Ten participants selected by the district nurse
and the GPCriteria:
Income below poverty line Health problems
Introduction-Methods-Results-Discussion-Conclusion
Methods: interviews
Semi-structuredDeveloped by literature review about health
and income inequalities in the worldTen questions GP conducted the interviews at participant’s
homeTape-recorderd, transcribed and translated to
EnglishObservation by the researcher
Introduction-Methods-Results-Discussion-Conclusion
Methods: analysis
Grounded theory from Glaser and StraussIndepently coded by two researchersValidity controlAfter third coding agreement was reached
Introduction-Methods-Results-Discussion-Conclusion
Results
Citizins of Ljubljana or near LjubljanaCaucasianAverage age: 66,5 year (55-92)6 males and 4 femalesUnemployed
Introduction-Methods-Results-Discussion-Conclusion
Results
Multimorbidity
Mental State Stress Being captured Family history Loneliness (lack of social support)
“I often feel so lonely. I have no one who would talk to me or help me when I feel the most down.” (male, interview 9)
Introduction-Methods-Results-Discussion-Conclusion
Results: accessibility problems
Transportation: Low mobility No car No driving license or driver Difficulties to get on the bus Poor access from and to home Fear of walking Not an appropiate way
“ I do not have enough money to buy a car adjusted to my needs.” (female, interview 1)
“ I cannot walk there, not with my feet.” (female, interview 6)
Introduction-Methods-Results-Discussion-Conclusion
Results: accessibility problems
Dependence Other people:
Transportation Medical supplies Help with contact
Material: Mean of transport Portable oxygen bottle Crutches, wheelchair
Insurance coverage
“The neighbours would help me call” (male, interview 3)
Introduction-Methods-Results-Discussion-Conclusion
Barriers on patient’s side
Lack of knowledge Low education
Attitude towards healthcare
Dissatisfaction GP
Secondary care
Health visitor
Health systemAtmosphere health centre
Barriers on patient’s side Clinic for the homeless
Emotions associated with healthcare
Fear of doctors
Shame
Stubborn
Reminder of bad times
Dislike
Caring for family members Bedridden husband
Barriers on the providers side
Availability GP Absent at practice
Long waiting time
Low frequency of home visits
Barriers on the provider’s side Problems to reach GP on the phone
Little time, busy
Absence of personal GP
Specialist Absence
Ambulance Waiting time
Attitude Not taking patients serious
Results: solutions
Self-managementAnother form of contactAnother mean of transport: ambulanceAnother type of medical servicePlanningHelp from others
Introduction-Methods-Results-Discussion-Conclusion
Results: consequences
Lower use of healthcareDistrict nurse most important person in primary
careDelay: late stage of disease
“The district nurse comes to see me every Thursday to control my blood sugar and pressure and to bring prescriptions and referral forms, if necessary. She is very kind to me and always asks me if I need anything else from the doctor.” (Male, interview 3)
Introduction-Methods-Results-Discussion-Conclusion
Discussion
Marital status, household composition and social support
Multiple barriersUse of emergency serviceInsufficient engagement of GPFurther researchLimitations
Introduction-Methods-Results-Discussion-Conclusion
Conclusion
Problems Barriers on patient’s side
Tranportation
Dependence
Barriers on provider’s side
Solutions Self-management
Other form of contact
Accessibility Other way of transport
Other medical service
Planning
Help from others
Consequences Low utilization
Important role of healthvisitor/district nurse
DelayIntroduction-Methods-Results-Discussion-Conclusion
Questions?