Sveikatos ir socialinių paslaugų integracija. Atvejo analizė VšĮ Centro poliklinikoje
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The article is pending problems related with integration of health care, nursing and social care services providing for patients at home. It is assessed that demographical aging determines increasing demands of services for older and disable people, especially demands for home nursing. Also, providing services at patient’s home is proven to have positive effect to quality of life for older and disable people and it saves financial resources, dedicated to in-patient services for these patients. However, in Lithuania dominates institutional model of patient’s care, when lonely, disabled people are hospitalized in in-patient health or social care institutions, and demand of out-patient service network is only on development stage in several municipalities of Lithuania. The aim article: to evaluate nursing and social care effectiveness in Centro out-patient clinics, providing nursing and social care services at patient’s home. During the study the experience of providing integrated nursing and social services for patients at home in European Union and countries outside EU, as well as national legal acts was evaluated. Aiming to measure changes in Centro out-patient clinics, tendencies of activities related with providing health and social care services for patients at home were examined. 150 patients and 173 service providers were surveyed in two empirical-sociological surveys. Data analysis made using SPSS v.19. Nonparametric (Pearson‘s Chi-square, Mann-Whitney U (M-W), Kruskall-Wallis H) tests were used to measure the frequency of distribution, Spearman‘s correlation (rho) was used to identify the strength of correlation, and whether the correlation is positive or negative. Statistical significance level used – p<0,05. Results: It was found the tendency of growth in provided services of home nursing in Centro out-patient clinic 2008 – 2011 (R² = 0,995). This growth tendency first of all depends from activities by Nursing, palliative medicine and social care clinic. It was estimated, that 73,3 % of patients rated quality of nursing services as very good, however this rating was significantly different depending on the frequency of visits of nurse (Kruskall-Wallis χ²=16,422, df=5, p=0,006). 64,2 % of surveyed employers rated quality of nursing services as very good, however this rating was significantly different depending on service provider (Nursing, palliative medicine and social care clinic specialists or nurse, working with family doctor) (Kruskall-Wallis χ²= 35,630, df=4, p=0,0001). Conclusions: Hereunder the assessment of experience in European Union and countries outside EU can be stated, that specialized nursing clinics, which actions are coordinated by patient’s care providing specialist are likely to achieve better results, comparing with traditional model of care provision led only by doctor. This conclusion is also supported in our study, where it was founded that since care activities was taken by Nursing, palliative medicine and social care clinic, the home nursing services became more accessible. Doctors are also more willing to assign home nursing services for Nursing, palliative medicine and social care clinic specialists.
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