engleski

Integrated care in Mostar: priorities for the health system

Introduction: Integrated care could be defined differently and it is the reason why, in literature, could be found the following terms: integrated health, coordinated care, comprehensive care, seamless care, or trans- mural care. It became 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 services 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 capacity of healthcare institutions in Federation of Bosnia and Herzegovina to provide safe and quality care for the citizens. In the Agency firmly believe that wisely set and well-organized integrated care can help health professionals to deliver health care in accordance with patient needs and even expectations. Aim: The aim of the study is to find out how to implement measures for integration of healthcare, to find out are there any gaps in health care system and how to bridge it to application of the best solutions of integrated care in city of Mostar and Herzegovina - Neretva Canton (HNC). Methods: In this paper, we used feedback and results from the workshop held at Federal Public Health Institute in Mostar as part of a lectures for the participants of the course within for the Integrated Health Care module held in June 2019. Integrated Health Care module is part of the Continuous Professional Education for Health Managers in Federation of Bosnia and Herzegovina. Participants were experienced expert in different field of medicine and pharmacist divided in two groups. Results: Participants determined the most common problems for both, primary and hospital physicians, such as: unclear referral system to specialist examination, inadequate patient expectation from primary care, lack of communication path between primary care and hospital care and not common use clinical practice guidelines. To solve those problems both groups stress out importance of common strategy documents and guidelines which should give clear framework for cooperation and integration including levels of competence and prices for services. Furthermore, efficient information system is crucial for the integration or digitalization of, in strategy documents, agreed mechanisms of coordination and integration. Third, proposal is in light of old population and necessary need for hospice and development of geriatric medicine in the canton. Participants discussed and compared given results with feedback and results from three workshops held few years ago. Discussion: The results of our study stressed out importance of the better communication between different sectors, institutions and levels of healthcare involved in treatment of patients and to pointed out 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 inadequate 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 (include the ministry and public health authorities) ; clear responsibilities regarding screening programs and patient path analysis. Conclusions: Strong commitment of healthcare authorities and vision for integrated care and collaborative networks, as well as good communication and leadership were highlighted as key facilitators of integrated care. Healthcare institutions from all levels of care have to organize multidisciplinary teams to work more on better and effective communication and to exchange information between key stakeholders in the system.

integrated health care, quality, communication, education

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