Aktualni proces pristupanja Hrvatske Organizaciji za ekonomsku suradnju i razvoj (OECD) jedinstvena je prilika za opis djelovanja ove međunarodne organizacije u području zdravstva te pregled ...predviđenih implikacija za hrvatski zdravstveni sustav. Pregled se posebno osvrće na rad OECD-a u području pokazatelja kvalitete, sigurnosti i ishoda zdravstvene zaštite te je zasnovan na znanstvenoj i sivoj literaturi kao i višegodišnjem iskustvu autora u radu s OECD-om. OECD je prepoznat po svojim naporima u prikupljanju i analizi podataka i izvještavanju o zdravstvenoj kvaliteti, sigurnosti i ishodima na globalnoj razini. Rad OECD-a u području zdravstva uključuje komparativnu analiza podataka, procjenu kvalitete zdravstvene skrbi u zemljama članicama, mjerenje ishoda zdravstvene skrbi te analizu učinkovitosti i pravednosti zdravstvenih sustava. Implikacije za hrvatski zdravstveni sustav u svjetlu pristupnog procesa mnogostruke su i odnose se na zdravstveni sustav, ustanove, zdravstvene djelatnike kao i pacijente. U ovom procesu prije, ali i nakon pristupa OECD-u, pridržavajući se međunarodnih standarda, učeći iz najboljih praksi i poboljšavajući podatkovnu kulturu, Hrvatska može raditi na postizanju bolje kvalitete zdravstvene skrbi, poboljšanih zdravstvenih ishoda i učinkovitijeg zdravstvenog sustava. U ovom je procesu važno da se kreatori politike (engl. policy-makers) i dionici u Hrvatskoj pozabave izazovima koji se mogu pojaviti tijekom ovog procesa kako bi se osigurala uspješna tranzicija u članstvo u OECD-u i povezane koristi za zdravstveni sektor.
Dojenje je neupitno najbolja hrana za novorođenče i dojenče. U procesu dojenja dijete uspostavlja temelje privrženosti, na kojima će graditi osnove svih kasnijih odnosa. Dojenje ima zdravstvene ...prednosti ne samo za dijete, nego i za majku. Pozivu za sudjelovanjem u ovom istraživanju u malom broju su se odazvali muškarci (gledano po spolu), a prema zanimanju liječnici. Prema rezultatima istraživanja zdravstveni djelatnici rijetko sudjeluju u edukacijama o dojenju (često/redovito manje od 20%). Savjeti koje zdravstveni djelatnici daju roditeljima o isključivom i ukupnom dojenju često nisu u skladu s uputama UNICEF-a/WHO. Najlošiji rezultati na ljestvici stavova su postignuti na pitanjima dojenja na javnom mjestu, prihvaćanja dojenja kao temeljnog ljudskog odnosa i uloge oca u podršci majci koja doji. Na ljestvici znanja najlošiji su odgovori po pitanju poznavanja zakonske regulative zabrane javnog oglašavanja zamjena za majčino mlijeko, prekida dojenja kada je majka febrilna ili prima neki lijek, važnosti „rooming-ina“ i potrebi prekida dojenja kada dijete polazi u jaslice/vrtić. Treba poboljšati edukaciju o dojenju budućih zdravstvenih djelatnika tijekom njihova školovanja. U radu sa zdravstvenim djelatnicima koji su već u radnom odnosu treba raditi na osvješćivanju obveze davanja informacija o dojenju sukladno preporukama WHO/UNICEF-a. Roditelji koji su već odlučili dojiti svoje dijete imaju pravo na kontinuiranu podršku tijekom cijelog perioda dojenja djeteta. Za ostvarenje ciljeva WHO/UNICEF-a za 2030. godinu neće biti dovoljni samo pozitivni pomaci u zdravstvenom sustavu, već na razini cijelog društva.
Jedan od načina mjerenja kvalitete pružene zdravstvene skrbi jest procjena zadovoljstva iz perspektive korisnika. Dosadašnja istraživanja pokazala su da ove procjene determinira veći broj različitih ...čimbenika, među kojima su i neke socio-demografske i osobne karakteristike korisnika. Međutim, efekti ovih čimbenika su često posredni, a njihovi međusobni odnosi isprepleteni. Stoga je cilj ovoga istraživanja bio ispitati zadovoljstvo korisnika pruženom zdravstvenom uslugom liječnika opće i obiteljske medicine kod kroničnih i akutnih bolesnika, vodeći računa o značajnim kovarijatama njihovih procjena. U ispitivanju je sudjelovao 291 sudionik/korisnik opće i obiteljske medicine oba spola, prosječne dobi od 42,5 godine. Osim kratkog upitnika o glavnim socio-demografskim obilježjima i pitanjima vezanim uz razloge i učestalost posjeta liječniku, primijenjen je i međunarodno standardizirani mjerni instrument za procjenu kvalitete opće/obiteljske/primarne zaštite u Europi; EUROPEP upitnik. Od ispitivanih karakteristika korisnika, značajnim kovarijatima procjene zadovoljstva zdravstvenom skrbi izdvojili su se dob, učestalost posjeta liječniku i postojanje kroničnog oboljenja. Pozitivnije procjene vezane su uz višu dob korisnika i učestalije posjete liječniku. Korisnici s kroničnim bolestima daju pozitivnije ocjene za sve ispitivane aspekte kvalitete zdravstvene skrbi od strane liječnika opće i obiteljske medicine. Međutim, ove razlike se ne mogu ciljano pripisati zdravstvenom statusu korisnika, već posrednom efektu dobi bolesnika, koji se pokazao ključnom determinantom procijenjenog zadovoljstva. Iznimka je poznavanje tegoba od strane liječnika, gdje efekt postojanja kronične bolesti i nakon kontrole kovarijata (dob i učestalost posjeta) ostaje i dalje značajan.
One of the ways to measure the quality of the health care provided is to assess satisfaction from theuser's perspective. Previous research has shown that these assessments are determined by a number ofdifferent factors, including some socio-demographic and personal characteristics of the users. However, theeffects of these factors are often indirect, and their interrelationships are intertwined. Therefore, the goal ofthis research was to examine user satisfaction with the health services provided by general and familymedicine doctors for chronic and acute patients, taking into account significant covariates in theirassessments.A total of 291 participants/users of general practice and family health services, of both genders, with anaverage age of 42.5 years, took part in the study. In addition to a brief questionnaire on the main socio-demographic characteristics and questions related to the reasons and frequency of visits to the doctor, aninternationally standardized measurement instrument for assessing the quality of general/family/primarycare in Europe, the EUROPEP questionnaire was applied.Among the user characteristics, age, frequency of doctor visits, and the presence of chronic illnessemerged as significant covariates in the assessment of satisfaction with healthcare. Positive evaluationswere associated with the higher age of users and more frequent visits to the doctor. Users with chronicillnesses gave more positive ratings for all aspects of the quality of healthcare. However, these differencescannot be attributed to the specific health status of the users but rather to the indirect effect of patient age,which proved to be a key determinant of perceived satisfaction. An exception is the knowledge of thecomplaints/health issues by the physician, where the effect of the presence of chronic illness remainssignificant even after controlling covariates (age and frequency of visits).
Cilj istraživanja: Pandemija koronavirusa ima značajan utjecaj na društvo i zdravstveni sustav. Cilj ovoga rada je usporediti podatke o broju i strukturi dijagnoza i obavljenih pregleda iz područja ...otorinolaringologije i kirurgije glave i vrata na razini primarne (PZZ) i tercijarne zdravstvene zaštite, u razdoblju od godinu dana prije i godinu dana nakon proglašenja pandemije koronavirusa. Bolesnici i metode: Podaci su prikupljani retrospektivno, za razdoblja od 20.3.2019. do 19.3.2020. i od 20.3.2020. do 20.3.2021. Uzorak je prigodan, prikupljen iz jedne ustanove na razini primarne i jedne ustanove na razini tercijarne zdravstvene zaštite. Iz dobivenih podataka isključene su one dijagnoze koje se ne odnose na stanja i bolesti iz otorinolaringologije i kirurgije glave i vrata. Rezultati: Tijekom promatranog razdoblja 20.3.2020.-20.3.2021. došlo je do značajnog pada broja pregleda u objema ustanovama u odnosu na razdoblje 20.3.2019.-19.3.2020. Na razini PZZ bilo je ukupno 533 pregleda, što predstavlja 50,5% pregleda obavljenih u istom razdoblju 2019.godine, dok je na razini specijalističko-konzilijarne zdravstvene zaštite (SKZZ) obavljeno 1672 pregleda, odnosno 56,4% pregleda obavljenih 2019. godine. Do najvećeg pada broja pregleda na razini PZZ došlo je među dijagnozama: zloćudni melanom kože, gripa, akutni bronhitis i bronhiolitis, akutne infekcije gornjeg dišnog sustava i bronhitis, emfizem, astma i druge kronične opstruktivne bolesti. Analizirajući preglede obavljene u SKZZ, najveći pad broja pregleda zabilježen je za dijagnoze: pneumonija, bronhitis, emfizem, astma i druge kronične opstruktivne bolesti, oštećenje sluha, zloćudni melanom kože i ostale bolesti dišnog sustava. Zaključci: Smanjeni broj pregleda i hospitalizacija u odnosu na vrijeme prije početka pandemije kao posljedicu mogu imati povećani broj bolesnika s novim dijagnozama, među kojima i karcinoma otkrivenih u kasnijim stadijima bolesti, što će u konačnici rezultirati kasnijim početkom liječenja i lošijim ishodom bolesti, ali i povećanim opterećenjem zdravstvenog sustava i povećanim troškovima liječenja.
Introduction: The SARS-CoV-2 pandemic has a profound impact on our society and health system.This paper aims to report the impact of the COVID-19 pandemic on patients referred to tertiary health care,as well as primary health care practice settings.Patients and methods: The number of patient referrals to a University Hospital CenterOtorhinolaryngology and Head and Neck Surgery department and a primary care office requiring patientconsultations regarding otorhinolaryngologic conditions between March 20th, 2019 and March 19th, 2020,and March 20th, 2020 and March 20th, 2021, was retrospectively collected. Diagnoses that do not relate toconditions related to otorhinolaryngology and head and neck surgery, or those that were not found in bothhealth care settings, were excluded.Results: A significant reduction in the total number of consultations during the pandemic was observed,at both levels of health care. In primary care, 533 consultations were performed (50.5% of the total numberin 2019), and at the tertiary level, 1672 consultations were performed (56.4% consultations performed in2019). When analyzing the conditions treated in primary care, the most relevant reduction regarded skinmelanoma, influenza, acute bronchitis and bronchiolitis, acute upper respiratory infections, bronchitis,emphysema, asthma, and other chronic obstructive pulmonary diseases. When analyzing the conditionstreated at the ENT department, the most relevant reduction regarded pneumonia, bronchitis, emphysema,asthma, other chronic obstructive pulmonary diseases, hearing impairment, skin melanoma, and otherrespiratory tract diseases.Conclusions: A reduced number of consultations and hospitalizations compared to pre-pandemic timemay result in an increased number of patients with new diagnoses, including cancer detected in later stagesof the disease, which will lead to later treatment and worse disease outcome, and also higher burden oftreatment costs.
The paper analyses and considers the character and consequences of reforms in the eldercare system in Croatia, putting reforms in comparative perspective and taking into account the existing ...knowledge on the effects of similar reforms in European countries. The analysis begins with the period of socialism when the eldercare policy started to develop and continues through the 1990s marked by pluralization of service providers and the beginnings of decentralization, and the period of the 2000s until today marked by growing fragmentation of the system and the professionalization of non-institutional forms of care. The social risk of dependence in older age does not have the necessary attention of policymakers. Reforms of the past twenty years aimed at cost-containment in the eldercare system and the reduced role of the state, and were reflected in marketization, individualisation and professionalization of care. The eldercare system failed to cope with the growing demand for services and remains of residual character, fragmented and characterized by social assistance orientation. Future reforms will have to seriously address the sustainability of the eldercare system, in particular sustainable solutions of financing long-term care.
Homelessness is a social problem that represents a challenge for the entire society, therefore policy holders and social welfare systems should have the obligation and responsibility of creating ...measures for the effective fight against homelessness based on professional and scientific indicators. Croatia still does not have a clear methodology for monitoring the number of homeless people and indicators of homelessness. There is a significant difference in the number of officially registered homeless people in the social welfare system and data from civil society organizations and homeless service providers. The absence of relevant data on the number of homeless people has an effect on the attitude of the profession towards the problem of homelessness and the system for organizing comprehensive care for the homeless. Also, the fact that the homeless were only defined as beneficiaries in the social welfare system for the first time in 2011 indicates that it was a social problem that was not recognized in our society for a long time. Therefore, this work aims to describe and problematize insurance in the social welfare system as a competent system for exercising rights and benefits for combating poverty and organizing the provision of assistance to socially vulnerable persons. The homeless represent one of the most vulnerable social groups, exposed to extreme poverty, risk of social exclusion, prejudice and stigma. The complexity of the problem of homelessness, the individual specificities of the homeless and the difficult access to exercising rights and social services, requires a good knowledge of the problem, sensitization and a highly individualized approach of experts in the social care system. Key words: homelessness; social welfare system; individualized approach
The aim of this research is to gain insight into parents‘ of children with developmental disabilities perspectives about rights and services in Croatian social welfare system. This qualitative ...research was conducted with 13 participants. The results show positive and negative aspects about the realization of rights and services in social welfare system from parents´ of children with developmental disabilities perspectives. Social welfare system as formal support system provides different types of emotional, informational and practical support to families of children with developmental disabilities. The positive aspects indicate professionalism of social workers, improvement of family members´ quality of life, and realization of services, while negative aspects show problems and challenges facing social welfare centers and realization of rights and services. Key words: social welfare system, parents of children with developmental disabilities, rights in social welfare system, services in social welfare system.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Cilj ovog rada je istražiti i opisati doživljaj uloge mentora za mlade koji izlaze iz alternativne skrbi te opisati izazove u radu s kojima se mentori susreću iz njihove perspektive. Stoga su ...provedena tri grupna intervjua s devet mentora. Podaci su analizirani metodom tematske analize i izolirane su tri teme. To su: Višestruke mentorske funkcije i različiti pristupi u radu, Kvalitete mentora i Izazovi mentoriranja. Rezultati pokazuju da je uloga mentora zahtjevna, kompleksna i važna za mlade iz skrbi, no povremeno i zbunjujuća i nejasna za same mentore. Doprinos rada ogleda se u produbljivanju razumijevanja uloge mentora i izazova u njihovom radu, ponuđene su smjernice za rad budućim mentorima i voditeljima mentorskih programa, te formalnom sustavu s ciljem što kvalitetnije podrške mladima koji izlaze iz skrbi.
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Social Welfare Information System (SWIS) – Social Card is digital transformation in the service of the social and child protection system reform in Montenegro, with the aim of providing the highest ...quality of social protection for the poor and socially endangered, in the area of material benefits and social and child protection services. This capital project of the Montenegrin Government has significantly improved the way social work centers’ work, because it has supported all business processes and enabled the creation of a single “social card” of the citizens involved in the system of social welfare and child protection services. This paper presents the information system in social work centers and public institutions for accommodation of beneficiaries (which include direct practice, decision-making and case management, information flow management, storage of historical and up-to-date data on beneficiaries and their families), as well as the benefits of this system for beneficiaries, social and child welfare employees and policy makers. SWIS is an important instrument for targeted funding, provision, monitoring and control of material benefits and services provided to families and individuals, and it has improved the capacity of the Government of Montenegro to plan, monitor and manage social and child protection services. The development and introduction of this software required intensive cooperation of experts, employees in the field of social and child protection, software company S&T (Serbia and Montenegro), UNDP and the Directorate for Informatics and Analytical and Statistical Affairs of the Ministry of Labor and Social Welfare. Key words: digitalization in social protection; SWIS; material benefits; social and child protection services; institutions for accommodation of users
Cilj rada je dobiti uvid u prisutne stresore kod udomiteljica za djecu te teškoće koje udomiteljice doživljavaju pri obavljanju udomiteljstva. U radu se prikazuje dio rezultata kvalitativnog ...predistraživanja provedenog u sklopu istraživanja pod nazivom ”Odrednice profesionalnog stresa, sagorijevanja i mentalnog zdravlja udomiteljica za djecu” u kojem je sudjelovalo 16 udomiteljica za djecu s područja Osječko-baranjske županije, a koje je provedeno u svibnju 2022. godine. Ovo je prvo istraživanje u Hrvatskoj u kojemu su udomiteljice izravno upitane o izvorima stresa - stresorima, a rezultati su pokazali podudaranje s ranijim istraživanjima koji posredno dotiču teme stresora kod udomitelja u Hrvatskoj i svijetu, osobito u odnosu na stresore povezane s obilježjima udomljenog djeteta (kada udomljeno dijete pokazuje internalizirane i eksternalizirane probleme u ponašanju). U objašnjenju i samom prikazu rezultata slijeđen je teorijski okvir transakcijskog modela stresa i podjela profesionalnih izvora stresa na obilježja koja su povezana s osobama i prirodom izvanjskih događaja. Prisutni izvori stresa kod udomiteljica za djecu su povezani s obilježjima osoba (udomiteljica i udomljenog djeteta), kao i s prirodom izvanjskih događaja (koji se dijele na izvore stresa povezane uz organizaciju rada, radne uvjete i socijalne odnose).
The aim of the paper is to gain insight into the stressors present in foster carers for children and the difficulties that foster carers experience when performing foster care. The paper presents part of the results of qualitative pre-research conducted as part of the research entitled "Determinants of professional stress, burnout and mental health of foster carers for children" in which 16 foster carers from the Osijek-Baranja County participated from all six Regional Offices (Osijek, B. Manastir, D. Miholjac, Valpovo, Našice, Đakovo) of the Croatian Institute for Social Work. The research was carried out in May 2022. This is the first research in Croatia in which foster carers were directly asked about sources of stress, and the results showed a match with earlier research that indirectly engage in the topic of stressors in foster carers in Croatia and the world; especially in relation to stressors related to the characteristics of the foster child (when the foster child exhibits internalized and externalized behaviour problems). In the explanation and presentation of the results, the theoretical framework of the transaction model of stress and the division of professional sources of stress into characteristics related to people and the nature of external events were followed. The sources of stress present in foster carers for children are related to the characteristics of the persons (foster and foster child), as well as to the nature of external events (which are divided into sources of stress related to the organization of work, working conditions and social relations).
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