Browsing by Author "Simic, Snezana (57526929000)"

Objective: The aim of this study was to determine the perceptions and attitudes of health professionals toward violence against women in intimate relationships, and to discuss them as opportunities and barriers for improving health professionals' response. Methods: Six focus groups were conducted with 71 health professionals employed in the public primary health care centers in Belgrade (Serbia). The data were analyzed according to the direct approach of the qualitative content analysis. Results: Findings suggest that the majority of health professionals perceive IPV as an unjustifiable act. They showed an understanding for women; see their role as providing support to women and collaborating with other institutions. They are willing to help, but do not know how. However, some health professionals appeared to be judgmental in terms of what preceded violence, and would insist on extracting a woman's disclosure that violence had occurred. As barriers, they emphasized the lack of training and specific education on IPV, a weak support network, and overall social insecurity. Conclusion: There is a gap between health professionals' willingness to help and resources needed, along with prejudice and interrogative attitudes. Barriers appeared at individual, organizational and societal levels. Practice implications: Proper education and protocols are priorities in strengthening health professionals' response to IPV. © 2009 Elsevier Ireland Ltd.

Introduction: A key international issue in the health policy is the capability of the healthcare system to maintain and improve population health given the contextual challenges, including health workforce problems. Considering the possibility of the replication of strategically relevant contextual changes in transitional countries, it seemed important to ensure future health workforce planning is built on past successes and to avoid repeating mistakes. Objective: The study aimed at assessing the impact of key social and economic events on the development of the healthcare workforce by use of Joinpoint Regression Programme to analyse the main healthcare workforce (physicians and nurses) trends in Serbia between 1961 and 2007, and to yield recommendations for a more socially accountable approach to healthcare workforce planning. Methods: A literature search was done to identify the key social and economic changes in Serbia between 1961 and 2007. To capture the impact of key socioeconomic events on the development of healthcare workforce the joinpoint regression analyses was conducted to assess changes of healthcare workforce density rates per 100,000 of population (1961-2007) in the public sector. Estimates of jointpoint regression models included the annual per cent change and the average annual per cent change with the respective 95% confidence interval. Results: The joinpoint regression analysis demonstrated a significantly diverse trend over time in the ratio of general practitioners, medical specialists, and nurses to population (p<0.05). The average annual per cent change of specialist and nurse density was higher (4.6% and 3.6%, respectively), while the growth of general practitioner density was much more limited (1%). In Serbia, the main drivers for healthcare workforce policy changes include shifts from decentralisation to centralisation and private practice development, social and financial crises, and economic and constitutional reforms. The following policy implications were based on the evidence of some compatibility in the projections of observed density rates with links to socioeconomic events: a higher growth of workforce density rates occurred with decentralisation (general practitioner's by 33%, specialist's by 169% and nurse's by 221%), while a lower growth of workforce density rates was observed in centralisation and their decrease with a stronger financial control (general practitioner's by -6%, specialist's by 29% and nurse's by 24%). Conclusion: Making socially accountable policies in transitional countries requires capacity building for integrative workforce planning and management among health managers at all levels in the system. This study has highlighted several key lessons learned and policy implications, built on efforts, success and mistakes in health workforce policy making, local and global.

Introduction: Conflicts, social unrest, and disasters can significantly affect the ability of a healthcare system to provide for the needs of its citizens. The collapse of the primary healthcare system in Serbia is a model of the effects that civil unrest can have on the health of a population. However, with improving social and political conditions, focus now can be turned towards the greatly needed development and reorganization of the primary healthcare system in Serbia. Due to the complexity of health-system reform in the post-conflict/post-disaster setting, attempts to restructure health services are fraught with pitfalls that often are unanticipated because of inadequate preliminary assessments. A multimodal assessment involving quantitative and qualitative methodologies may provide a more robust mechanism to identify key programmatic priorities and critical barriers for appropriate and sustainable health-system interventions. The purpose of this study is to describe a multimodal assessment using primary healthcare in post-conflict Serbia as a model.Methods: Integrated quantitative and qualitative methodologies - system characterization and observation, focus group discussions, free-response questionnaires, and Q-methodology - were used to identify needs, problems, and potential barriers to primary healthcare development in Serbia. Participants included primary healthcare providers and administrators from 13 institutions throughout Belgrade.Results: Demographic data indicate a well-established infrastructure of primary health centers and stations. However, focus group discussions and free-response questionnaires reveal significant impediments to delivery of care: (1) Inadequate equipment, supplies, and medications; (2) Poor financial investment; (3) Discouraging worker salaries; (4) Few opportunities for professional development; and (5) Little emphasis on or respect for primary healthcare. Q-methodology of provider perceptions and opinions supports these concerns, shows remarkable consensus among participants, and provides further insights toward system development by grouping respondents into distinctive types.Conclusions: This study identified the critical needs and barriers to development of primary healthcare in Serbia. This combined methodology may serve as a model for future health system assessments in the post-conflict and post-disaster settings. © World Association for Disaster and Emergency Medicine 2003.

Introduction: Conflicts, social unrest, and disasters can significantly affect the ability of a healthcare system to provide for the needs of its citizens. The collapse of the primary healthcare system in Serbia is a model of the effects that civil unrest can have on the health of a population. However, with improving social and political conditions, focus now can be turned towards the greatly needed development and reorganization of the primary healthcare system in Serbia. Due to the complexity of health-system reform in the post-conflict/post-disaster setting, attempts to restructure health services are fraught with pitfalls that often are unanticipated because of inadequate preliminary assessments. A multimodal assessment involving quantitative and qualitative methodologies may provide a more robust mechanism to identify key programmatic priorities and critical barriers for appropriate and sustainable health-system interventions. The purpose of this study is to describe a multimodal assessment using primary healthcare in post-conflict Serbia as a model.Methods: Integrated quantitative and qualitative methodologies - system characterization and observation, focus group discussions, free-response questionnaires, and Q-methodology - were used to identify needs, problems, and potential barriers to primary healthcare development in Serbia. Participants included primary healthcare providers and administrators from 13 institutions throughout Belgrade.Results: Demographic data indicate a well-established infrastructure of primary health centers and stations. However, focus group discussions and free-response questionnaires reveal significant impediments to delivery of care: (1) Inadequate equipment, supplies, and medications; (2) Poor financial investment; (3) Discouraging worker salaries; (4) Few opportunities for professional development; and (5) Little emphasis on or respect for primary healthcare. Q-methodology of provider perceptions and opinions supports these concerns, shows remarkable consensus among participants, and provides further insights toward system development by grouping respondents into distinctive types.Conclusions: This study identified the critical needs and barriers to development of primary healthcare in Serbia. This combined methodology may serve as a model for future health system assessments in the post-conflict and post-disaster settings. © World Association for Disaster and Emergency Medicine 2003.

Database on clinically treated patients in Belgrade served as an example for analysis of possibilities for the use of Personal Identifying Number (PIN) as an Unique Patient Identifier. In the first part of the paper we analyzed filling up of the fields which contained data on PIN within complete databases in 1981, 1991 and 1996. Filling up of PIN was significantly changed in the three observed years: it was 18% in 1981; 68% in 1991, and 56% in 1996 respectively. Analysis of interactions among the chosen factors (type of hospital, demographic and social characteristics of patients, length of stay in hospital, manner of treatment, main diagnosis, treatment outcome) and measuring time, showed a different degree of statistical significance. In the second part of our paper we analyzed the unexpected decrease in filling up of PIN in 1996 (as compared to 1991) ussing the method of logistic regression, on 1% samples from the databases for the two respective years. On the basis of obtained models of filling up of UPI data, taken as dependent variable and the above factors (predictors) we analyzed the advantages and drawbacks of UPI application as an unique patient identifier.

Database on clinically treated patients in Belgrade served as an example for analysis of possibilities for the use of Personal Identifying Number (PIN) as an Unique Patient Identifier. In the first part of the paper we analyzed filling up of the fields which contained data on PIN within complete databases in 1981, 1991 and 1996. Filling up of PIN was significantly changed in the three observed years: it was 18% in 1981; 68% in 1991, and 56% in 1996 respectively. Analysis of interactions among the chosen factors (type of hospital, demographic and social characteristics of patients, length of stay in hospital, manner of treatment, main diagnosis, treatment outcome) and measuring time, showed a different degree of statistical significance. In the second part of our paper we analyzed the unexpected decrease in filling up of PIN in 1996 (as compared to 1991) ussing the method of logistic regression, on 1% samples from the databases for the two respective years. On the basis of obtained models of filling up of UPI data, taken as dependent variable and the above factors (predictors) we analyzed the advantages and drawbacks of UPI application as an unique patient identifier.

[No abstract available]

The aim of this study is to identify vendors of software packages applicable to health care system as well as to evaluate software packages offered to the health sector by a variety of sources, namely state owned software development companies, privately operated software development companies as well as sole traders. The approach undertaken was to preselect the potential suppliers via an initial targeted interview. Subsequently a questionnaire, consisting of 23 questions, was addressed to the selected vendors and suppliers. The response rate to the questionnaire was 58%. Investigation of 113 has revealed the non government software suppliers clearly lead in copyright ownership, I B M compatible personal computers were the platform of choice whereas majority of code was written utilising languages capable of supporting relational data base queries. The final outcome of the above study is a database of software packages and applications available to the health sector offering the health professionals and institutions guide lines and support in developing information systems, relevant subsystems and modules.

The aim of this study is to identify vendors of software packages applicable to health care system as well as to evaluate software packages offered to the health sector by a variety of sources, namely state owned software development companies, privately operated software development companies as well as sole traders. The approach undertaken was to preselect the potential suppliers via an initial targeted interview. Subsequently a questionnaire, consisting of 23 questions, was addressed to the selected vendors and suppliers. The response rate to the questionnaire was 58%. Investigation of 113 has revealed the non government software suppliers clearly lead in copyright ownership, I B M compatible personal computers were the platform of choice whereas majority of code was written utilising languages capable of supporting relational data base queries. The final outcome of the above study is a database of software packages and applications available to the health sector offering the health professionals and institutions guide lines and support in developing information systems, relevant subsystems and modules.

Aims: The aim of this study was to analyse the impact of demographic and socioeconomic factors on morbidity in Serbia. Additionally, knowing that there is no a gold standard for measuring morbidity we were concerned whether the results of this study depend on the choice of morbidity indicator. Methods: Data from the 2006 National Health Survey for Serbia were used. A representative sample of 14,522 persons aged ≥20 years were interviewed. The associations between demographic factors (age, gender, marital status, and type of settlement), socioeconomic indicators (education and wealth index), and health status (morbidity index derived from self-reported data) were examined using linear and logistic regression analyses. Results: Women, elderly people, those who live in urban settings, and those with lower education had higher morbidity regardless of using a morbidity index as a continuous variable (composite index ranging from 0 to 20) or a categorical variable (morbidity status tertiles). Respondents who belong to the most deprived group had higher scores of morbidity index in comparison with the respondents from the most affluent group, but no significant association was found when morbidity status was examined as the outcome. In addition, when those who belong to the middle class group were compared to the most affluent group, they had good more frequently than average morbidity status. Conclusions: This study suggests that demographic and socioeconomic inequalities in morbidity exist in Serbia. Wise and comprehensive health policies and interventions for reducing these inequalities are urgently needed which primarily focus on the most disadvantaged socioeconomic groups. © 2011, the Nordic Societies of Public Health. All rights reserved.