Journal of Health Policy,
Insurance and Management


Polityka Zdrowotna

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Journal of Health Policy, Insurance and Management – Polityka Zdrowotna Nō XII/II 2013

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LABORATORY DIAGNOSTICS IN HEALTH PROTECTION SYSTEM

Diagnostyka laboratoryjna w systemie ochrony zdrowia

Autor

Anna Augustynowicz, Centrum Medyczne Kształcenia Podyplomowego,
Warszawski Uniwersytet Medyczny

Henryk Owczarek, Uniwersytet Medyczny we Wrocławiu

Michał Waszkiewicz, Wydawnictwo Wiedza i Praktyka

ABSTRAKT

Laboratory diagnostics constitutes the essential role in recognition, treatment and monitoring of diseases. What is more, laboratory diagnostics is one of the elements of health protection system. There have been substantial differences in the organization and functioning of laboratory diagnostics for 9 years of the act being in force. Taking into consideration the fact that health protection system undergoes constant reformations, there are alterations relating to laboratory diagnostics as well. Below one could find laboratory diagnostics in the view of two fundamental systemic acts, namely medical activity act and healthcare service financed by public funds act.

Słowa kluczowe :

działalność lecznicza, podmiot leczniczy, laboratorium

curative activity, curative subject, laboratory


LABORATORY PATIENT’S CARE

Laboratoryjna opieka nad pacjentem

Autor

Mirosława Pietruczuk, Uniwersytet Medyczny w Łodzi

Ludmiła Kopczyńska-Hanuszko, Pfizer Polska

Makandjou-Ola Eusebio, Uniwersytet Medyczny w Łodzi

Piotr Kuna, Uniwersytet Medyczny w Łodzi

ABSTRAKT

Our paper presents clinical laboratory practices according to the code of ethics and guidelines. Laboratory patient care and sample processing in preanalytical, analytical and post-analytical phases we described. We also showed the necessity of harmonious cooperation between members of the healthcare team, in particular between medical doctors, clinical laboratory personnel and nursing staff, and limitations to such cooperation.

Słowa kluczowe :

zespół opieki medycznej, diagnostyka laboratoryjna, laboratoryjna opieka medyczna

healthcare team, laboratory diagnostics, clinical laboratory patient’s care


EVIDENCE-BASED LABORATORY MEDICINE AS A TOOL FOR LABORATORY DIAGNOSTICS ECONOMIZATION

Medycyna laboratoryjna oparta o dowody naukowe jako narzędzie ekonomizacji diagnostyki Laboratoryjnej

Autor

Bogdan Solnica, Uniwersytet Jagielloński-Collegium Medicum

ABSTRAKT

Laboratory diagnostics is under pressure from expectations of a reduction of related expenses. Evidence-based Laboratory Medicine (EBLM) is the systematic application of the best available scientific information when making decisions about the diagnostic procedures in the individual patient. EBML also creates a basis for the introduction of new tests with confirmed diagnostic usefulness including the principles of economic evaluation. Presented in the article the role of EBLM in laboratory diagnostics economization is mainly based on the optimal choice of tests in specific clinical situations and determination of appropriate methodological and organizational testing conditions. This information is now published in the clinical practice guidelines in the field of laboratory medicine.

Słowa kluczowe :

faza przedanalityczna, faza analityczna, skuteczność, efektywność, zalecenia praktyki klinicznej

preanalytical phase, analytical phase, effectiveness, efficiency, clinical practice guidelines


FINANCING OF THE LABORATORY COMPLEMENT IN THE CZECH REPUBLIC

Finansowanie sektora laboratoryjnego w REPUBLICE CZESKIEJ

Autor

Martin Radina, Laboratorium Diagnostyczne, Republika Czeska

Miloš Pollak, Laboratorium Diagnostyczne, Republika Czeska

Marcela Kučerová, Laboratorium Diagnostyczne, Republika Czeska

Dagmar Gotzmannová, Laboratorium Diagnostyczne, Republika Czeska

Zbigniew Kaczynski, Laboratorium Diagnostyczne, Polska

ABSTRAKT

Fundamental changes have happened in the financing of health services in the Czech Republic since 1990. Due to changes in legislation followed by subsequent adjustment of financing, significant expansion of laboratory domains have been facilitated.

This article summarizes fundamental milestones in adjustment of laboratory financing, development of charges in outpatient care as well as in hospital segments of health service. Positive and negative aspects of individual charge models from the point of view of the providers but also payees are underlined. The “Costing Model” that has been used until today to calculate the individual health service charges that are listed in the “Index of Health Service Charges” is explained.

Słowa kluczowe :

system zapłat, laboratorium diagnostyczne, system ochrony zdrowia

reimbursement, clinical laboratory, health service


CYTOGENETIC STUDIES IN HEALTHCARE SYSTEM. THE POTENTIAL ROLE IN PREVENTION

Badania cytogenetyczne w aspekcie klinicznym w ochronie zdrowia. Potencjalne znaczenie profilaktyczne

Autor

Agnieszka Stembalska, Ryszard Ślęzak, Robert Śmigiel, Maria Małgorzata Sąsiadek,
Uniwersytet Medyczny we Wrocławiu

ABSTRAKT

Chromosomal aberrations belong to the group of most frequent causes of infertility, congenital defects, mental retardation and sex disorders.

Identification of numerical and structural chromosome aberrations allows for pre- and postnatal genetic diagnosis and thus for genetic counseling focusing on both proband (an algorithm of further diagnosis and therapy, including options of rehabilitation) and proband's family.

In the paper the authors discuss the importance of cytogenetic studies in diagnosis and management of 1) infertility and reproductive failure, 2) prenatal diagnosis, 3) congenital defects and mental retardation syndromes as well as 4) basic roles in laboratory cytogenetic diagnosis.

Słowa kluczowe :

badania cytogenetyczne, kariotyp, niepłodność, poronienia, badania prenatalne, wady wrodzone

cytogenetic studies, karyotype, infertility, prenatal diagnosis, congenital defects


CYTOGENETIC TESTING IN MODERN HEMATOONCOLOGY AND ITS PLACE IN THE HEALTH CARE SYSTEM

Badanie cytogenetyczne we współczesnej hematoonkologii – miejsce w systemie ochrony zdrowia

Autor

Barbara Pieńkowska-Grela, Centrum Onkologii-Instytut im. M. Skłodowskiej-Curie w Warszawie

 

ABSTRAKT

Cytogenetic test is one of the most important diagnostic criteria for recognized the large part
of leukemias and lymphomas. Specific genetic changes detected by karyotyping and fluorescence in situ hybridization may also predict course of disease and advise specific treatment. Recently, in the era
of targeted therapy the last point is becoming increasingly important. Rising cancer incidence as well
as progress in diagnosis and effective therapy generate the need to carry out cytogenetic in the increasing number of patients. Polish base of cytogenetic laboratories in hematooncology is generally sufficient, but their functioning may be more effective. The condition of improvement is introduction of effective quality control procedures as well as a coherent legal system, including the creation of clear rules to referral for testing and research funding. The close cooperation with physicians and hematology clinics is essential for full advantage of cytogenetic in the interest of patients.

Słowa kluczowe :

cytogenetyka, kariotyp, FISH, diagnostyka, leczenie, białaczki, chłoniaki

cytogenetics, karyotype, FISH, diagnosis, treatment, leukemia, lymphoma


BIOCHEMICAL DIAGNOSTICS IN CANCER PATIENTS – EXPECTATIONS AND DOUBTS

Diagnostyka biochemiczna u chorych na nowotwory – oczekiwania i wątpliwości

Autor

Jan Kanty Kulpa, Urszula Rychlik, Ewa Wójcik, Instytut im. M. Skłodowskiej-Curie, Oddział w Krakowie

ABSTRAKT

The measurement of tumor markers is currently one of the most rapidly growing areas in laboratory medicine. Lack of diagnostic sensitivity and specificity preclude the use of most existing markers for the early detection of malignancy. For patients with diagnosed malignancy, however markers are potentially useful in determining prognosis, predicting therapeutic response, monitoring surveillance following curative surgery or radiotherapy, and monitoring therapy in advanced diseases. Testing for tumour markers should only be performed if it results a better patients outcome, increased quality of life or a reduced overall cost of care.

Słowa kluczowe :

nowotwory złośliwe, diagnostyka biochemiczna, markery nowotworowe

cancer, biochemical diagnostics, tumor markers


IMMUNODIAGNOSTICS IN POLAND AT THE BEGINNING OF XXI CENTURY

Immunodiagnostyka w Polsce na początku XXI wieku

Autor

Jan Żeromski, Uniwersytet Medyczny w Poznaniu

ABSTRAKT

Immunodiagnostics is the application of immunological know-how to medical practice,
to both, diagnosis and monitoring the course of some diseases. Immunology, the science devoted
to immunity, is an interdisciplinary area, able to elucidate pathogenesis of several diseases
in almost all medical specialties. It is a relatively new discipline formed at the turn of XIX and XX centuries and originates from microbiology. Rich methodology of immunological laboratory practice appeared invaluable when applied to immunodiagnostics. Creation of the latter turned out to be necessary, because routine laboratory procedures were unsatisfactory to diagnose such pathologies as autoimmune diseases, immunodeficiencies or transplant-recipient interactions. Immunodiagnostics detached soon from general diagnostic lab, due to the differences in methodology, distinct equipment and relatively high cost of immunoassays.

Immunodiagnostics in Poland after II world war, was slowly growing in parallel
to European one, but due to the gap in technical and financial resources , gradually was left behind
as compared to Western standards. This situation was met in the initiative of the Polish Ministry and Informatization by the announcement at the beginning of 2005 year of ordered research project entitled: “Formulation, perfection and implementation of complex diagnostic procedures for diseases
of immunological background”. The task of its realization was undertaken by 32 centers from various parts of the country and lasted 3 years. Results of this activity are several publications, scientific meetings open to physicians, the creation of precise laboratory procedures for various immunological diseases etc. The website was created (www.diagnostyka.immuno.net.pl). Meanwhile some improvement has been noticed in standardization and quality control of immunodiagnostic assays. Owing to the dissemination
of knowledge of clinical immunology among clinicians and general practitioners in the course
of the Project there is growing number of immunodiagnostic laboratories throughout the country. Some of them possess modern equipment and have excellent facilities. In summary, it seems, that modern immunodiagnostics became already indispensable element of the Polish clinical medicine.

Słowa kluczowe :

immunodiagnostyka, choroby autoimmunizacyjne, niedobory odporności, projekt zamawiany, procedury immunodiagnostyczne, standaryzacja, kontrola

immunodiagnostics, autoimmune diseases, immunodeficiencies, ordered project, immunodiagnostic procedures, standardization, quality control


LABORATORY DIAGNOSTICS OF PARASITIC DISEASES IN POLAND WITH CONSIDERATION OF THE COSTS

Diagnostyka laboratoryjna chorób pasożytniczych w Polsce z uwzględnieniem kosztów badań

Autor

Elżbieta Gołąb, Elżbieta Buczak-Stec, Narodowy Instytut Zdrowia Publicznego -Państwowy Zakład Higieny

Przemysław Myjak, Uniwersytet Medyczny w Gdańsku

ABSTRAKT

The problem of parasitic diseases such as an important problem for public health
– is discussed in the article. The most significant laboratory methods for disease confirmation are described. The ways of funding laboratory diagnosis in Poland and its costs for the healthcare system are also presented.

To confirm a case of parasitic infection and to introduce treatment, diagnostics tests such
as: microscopic, immunological, molecular or sometimes in vitro/in vivo culture are needed.

Microscopic methods are a “gold standard” in the detection of parasites of the intestinal and urinary tracts and the cardiovascular system; they are easy to perform and do not demand high material outlays. To obtain correct results of microscopic examination an experienced parasitologist and a calibrated microscope are needed. Positive control preparation should be added to a panel of examined samples.

Serological tests for specific antibodies for parasites are often used by microbiological laboratories.
In Poland the tests are most often used for the diagnosis of: toxoplasmosis, toxocarosis, trichinellosis, alveococosis, hydatidosis and seldom for other parasitic diseases detection for example:the tropical.

Immunological methods for detection of antigens of parasites are more valuable than antibodies detection because positive results point to an actual presence of parasites in the body. Because of the possibility of false positive results of these methods confirmation tests: microscopic or molecular should be performed. Molecular techniques are used in cases when the similarity of parasites is too high or the level of infection is below the detection level of microscopy. Molecular tests should be performed in reference laboratories with proper infrastructure and highly qualified personnel and for these reasons they are among the most costly diagnostic tests.Financing of parasitological diagnosis by the NHF (National Health Fund) is conducted in different ways dependent on the healthcare level. At the level of primary health care (PHC) diagnostic tests are financed within the framework of capitation fee. Within the specialized outpatient care (AOS), until 1 July 2011, financing of tests was enclosed in the framework of financing the medical consultation (such as a comprehensive, specialized, treatment-diagnostic consultation). In hospital care costs of testing are included in the reimbursement of hospital stay by Diagnosis Related Groups (DRG).

The entire healthcare system’s costs of parasitological tests are the sum of products of given test cost and the number of tests performed. There are no complete data on the number of diagnostic tests performed, also the tests price for parasitic infections may be different in the individual diagnostic entities. Therefore, it is not possible to perform a complete economic analysis of parasitological tests.

Słowa kluczowe :

pasożyty, choroby pasożytnicze, koszt badań diagnostycznych inwazji pasożytniczych, badania laboratoryjne parazytoz

parasites, parasitic diseases, costs of parasitic infections diagnostics, laboratory diagnostics of parasitoses


HOSPITAL MICROBIOLOGICAL DIAGNOSTICS IN ACCORDANCE WITH NEW LEGISLATION

Diagnostyka mikrobiologiczna w szpitalu w świetle nowych aktów prawnych

Autor

Anna Przondo-Mordarska, Danuta Smutnicka, Uniwersytet Medyczny we Wrocławiu

ABSTRAKT

The identification and estimation of infective etiological factors are the basic tasks of hospital microbiological diagnostics, defining further procedures and prognostics of infection development. Microbiological procedures allows to control infection epidemiology in hospital and to control data necessary for nosocomial infections prevention. Analysis of community and nosocomial strain’s antibiotic resistance, creates a basis for rational antibiotic therapy. Another important task of microbiological laboratory is detection of nosocomial outbreaks and alert – pathogens.

Above mentioned pathways of processing, performed with cooperation with Group of Control
of Nosocomial Infections serves to improvement of medical procedures quality and rationalization
of treatment costs by decrease of: infections number, patient’s length of stay and introduction of rational antibiotic therapy.

Słowa kluczowe :

zakażenia szpitalne, procedury laboratoryjne, alert patogeny, rozporządzenia w sprawie laboratoriów mikrobiologicznych

hospital acquired infection, laboratory procedures, alert pathogen, microbiology laboratory directives


DIAGNOSTIC PROCEDURES PREVENTING HOSPITAL – ACQUIRED INFECTIONS

Postępowanie diagnostyczne szpitala zapobiegające zakażeniom szpitalnym

Autor

Marzenna Bartoszewicz, Adam Junka, Uniwersytet Medyczny we Wrocławiu

ABSTRAKT

The problem of increasing number of nosocomial infections concerns hospitals all over the world. Microorganisms being an etiological factors of infections are often transmitted via hands of hospital staff, physicians and nurses, especially. Hospital laboratory is the vital link in chain of prevention of nosocomial infections. Microbiological procedures allows to introduce rational antibiotic therapy and to stop nosocomial outbreaks, shortening patient’s length of stay and decreasing hospital costs.

Słowa kluczowe :

zakażenie szpitalne, procedury mikrobiologiczne, kontrola zakażeń

nosocomial infection, microbiological infections, infection control


THE BENEFITS OF INTRODUCING A SYSTEM OF EUCAST FOR THE RATIONALIZATION OF HOSPITAL ANTIBIOTIC THERAPY

Korzyści z wprowadzenia systemu EUCAST dla racjonalizacji szpitalnej antybiotykoterapii

Autor

Beata Kowalska-Krochmal, Uniwersytet Medyczny we Wrocławiu

ABSTRAKT

Since April 1 2011, in Poland, there are New European recommendations for the estimation
of microbial susceptibility testing, approved by the National Consultant for Microbiology. Recommendations contain important guidance for microbiologists and many valuable data intended for physicians, concerning antimicrobial drugs. Introductions of these recommendations by microbiological laboratories to hospitals associates with changes in the antibiograms interpretation. The breakpoints that determine the classification of organisms into sensitive or resistant group, have been altered. Along with new limits, the way of dosage of many antibiotics has been updated, too. New EUCAST recommendations are fully accepted by the EMA (European Medicines Agency) and they are backed by long-lasting researches on microorganisms pathogenesis and drugs pharmacokinetics. The aim of the new recommendations is standardization of rules concerning assessment and interpretation of antimicrobial susceptibility testing as well as increase of usefulness of research results in the effective treatment
of microbiological infections.

Słowa kluczowe :

EUCAST, antybiotykoterapia, skuteczność kliniczna

EUCAST, antibiotic therapy, clinical efficacy


ORGANIZATIONAL CULTURE AND IDENTITY IN THE PROCESS OF CHANGE MANAGEMENT – RESULTS OF EMPIRICAL RESEARCH

Kultura i tożsamość organizacyjna w procesie zarządzania zmianami w polskich szpitalach – rezultaty badań

Autor

Łukasz Sułkowski, Uniwersytet Jagielloński, Społeczna Akademia Nauk

ABSTRAKT

The purpose of this article is to identify barriers to change, which is a source of organizational culture and identify opportunities to reduce these barriers. Analysis of the literature indicates that organizational culture plays a key role in the process of organizational change, which means that in some situations it can be a catalyst, and in the other an inhibitor of change. Analysis of changes in organized cultural barriers was based on empirical research carried out under the grant, "Barriers to organizational changes in the culture of Polish hospitals" and the earlier pilot studies (Uniwersytet Jagiellonski, Społeczna Akademia Nauk 2010-2012). The article begins with a description of the objectives, research questions and methodology of the study. Then, based on the results of trying to find a Polish cultural specificity of the hospital, especially in relation to the change management process. Analysis was carried out organizational cultures allows for the identification of their characteristics. These are symptoms of conservatism and cultural duality, which are manifestations of the culture barrier which organizational changes.

Słowa kluczowe :

kultura organizacyjna szpitala, tożsamość organizacyjna szpitala, zarządzanie zmianą w szpitalach

organizational culture of the hospital, hospital organizational identity, change management in hospitals


SMOKING PREVALENCE AMONG MEDICAL STUDENTS IN UKRAINE

Rozpowszechnienie palenia wśród studentów medycyny na Ukrainie

Autor

Olena Gruzieva, National O.O. Bohomolets Medical University, Ukraine

ABSTRAKT

Tobacco use is one of the leading preventable causes of premature death and disease in the world. Recently, literature has emerged suggesting that health professionals can play a critical role in reducing of tobacco use. Importantly, the effectiveness of disease prevention activities and a healthy lifestyle promotion by medical personnel largely depends on their own attitude to smoking, their smoking status, understanding of the importance of this problem, and their responsibility for tobacco control activities among patients and the public. This article describes the methodology and results of the study on the prevalence of smoking among students of higher medical educational institutions in different regions of Ukraine, carried out within the framework of global survey under the egis of the World Health Organization’s European Region, and the United States Centers for Disease Control and Prevention (CDC). The data on the tobacco use prevalence, presense in tobacco smoke polluted environment, attitudes towards smoking, desire to quit smoking, and training received to provide patient counseling on cessation techniques have been collected and analyzed.

Słowa kluczowe :

rozpowszechnianie palenia, zanieczyszczenie powietrza, zaprzestanie palenia tytoniu, potrzeby edukacyjne

smoking prevalence, air pollution, attitude towards smoking, smoking cessation, educational needs


HEALTH CARE SYSTEMS IN UKRAINE AND TURKEY

System ochrony zdrowia na Ukrainie i w Turcji

Autor

Barbara Foczpaniak, Społeczna Akademia Nauk

ABSTRAKT

At the beginning of the 21st century it became clear that along with extending the European Union, Eastern European countries would be the closest neighbours of the Community. From all countries endeavouring to EU membership, Turkey and Ukraine are close to achieve it.

Ukraine is the most advanced former Soviet republic regarding cooperation and partnership with EU institutions. In 1994 the Partnership and Cooperation Agreement was signed and on 30 March 2012 both countries initialed the association agreement in Brussels. One of the next steps for both countries will be implementation of acquis communautaire – the body of law accumulated by the EU, regarding also health care sector.

Turkey turned out to be one of partners of European initiatives such as the European Neighbourhood Policy and the Black Sea Synergy – programmes strengthening cooperation with EU neighbours. It has to do with the accession process started in 1959, when Turkey applied for associate membership of the European Economic Community. In 1963 the Ankara agreement was signed, granting Turkey the status of associated country and forseeing its possibility to become an EU member. By the decision of the European Council accession negotiations were begun in October 2005.

Słowa kluczowe :

systemy ochrony zdrowia, model Siemaszki

health care system, Semashko model, National Health Account


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