STAN ZDROWIA OKULISTÓW JAKO WARUNEK JAKOŚCI USŁUG MEDYCZNYCH
Stanislav G. Saksonov, Tetiana S. Gruzeva, Oksana P. Vitovska
Bogomolets National Medical University, Kyiv, Ukraine
Introduction: The effectiveness and efficiency of the medical sector workforce directly depend on health of medical professionals. Scientific literature pays considerable attention to the health of surgeons, physicians, obstetricians, gynecologists, infectionists and dentists paying very little, if any, attention to health problems of ophthalmologists. This study is intended to bridge this gap.
The aim at revealing the current situation and characteristics of health status of ophthalmologists using the results of sociological research and identifying health problems of the respondents in order to determine reliable preventive measures.
Materials and methods: The authors used bibliographic, medical-statistical, sociological and informational-analytical methods as well as analyzed questionnaires of the sociological survey conducted among ophthalmologists from various regions of Ukraine.
Results: The results of the sociological survey allowed determining the main medical-demographic and occupational characteristics of the ophthalmologists working at health facilities. It was found that11,1±2,1 per 100 respondents assess their health condition as very good and 34,3±3,2 per 100 respondents – as good. At the same time every third respondent reports own health condition as satisfactory, 18,5±2,6 per 100 respondents report their health condition as bad and 2,8±1,2 per 100 respondents – as very bad. Chronic diseases in the history were confirmed by 52,8±3,4 per 100 ophthalmologists, recurrent acute diseases were reported by 48,6±3,4 per 100 respondents. Some ophthalmologists reported their low medical activity due to a number of reasons.
The main factors that adversely affect the health of ophthalmologists include considerable workload, the need to work part-time for subsistence, neuro-emotional stress, insufficiently equipped medical and diagnostic process lacking modern technologies, poor team atmosphere, lack of comfort at the workplace and others.
Conclusions: Own health condition assessed by ophthalmologists, the prevalence of chronic and acute pathology, factors of the working environment affecting health serve as the ground for improving prophylaxis activities among ophthalmologists and strengthening their health as a prerequisite for the quality medical services.
Wiad Lek 2018, 71, 1 cz. II, -167
Health care provision to population requires a number of prerequisites. It is known that according to the Donabedian model the quality of the result can be drawn from maintaining the quality of structure and the quality of technology [1-2]. Appropriate resource provision, human resource in the first place, is important among performance measures of the structure. In their turn effectiveness and efficiency of the medical sector workforce directly depends on health condition of medical professionals. It is proved that good health of medical professionals facilitates them in appropriate performance of their professional functions, thereby increasing their productivity on the whole. On the contrary, poor health condition of doctors decreases performance and adversely affects quality of medical care and patients’ health.
It is known that the health care activities require considerable intellectual and physical efforts, endurance and alertness. Scientific research demonstrates that the work of health professionals is characterized by considerable nervous, mental and physical stress often with lack of information for appropriate decision-making. It is associated with big responsibility, stress situations, occupational harms and infection risks [3-5].
Analysis of health status of various health professionals shows a wide range of health impairments resulting in high levels of disease incidence including occupational illnesses, chronic pathologies, inadequate self-assessment of own health condition, the need in outpatient and inpatient treatment, and other negative characteristics. According to the research data, one fourth of the respondents have chronic diseases, however less than half of them are in regular medical care. Diseases of respiratory system prevail in disease distribution of referrals to the doctors. Diseases of blood circulation system, osteodermomuscular system and connective tissue, eyes and their appendages, the digestive apparatus and genitourinary system prevail among chronic pathologies. Only one fourth of the doctors-respondents assess their health as very good and good [6-8].
Infection diseases caused by unfavorable epidemiological situation, numerous exposures to patients with infection diseases, poorly equipped health facilities, shortages of personal protection means and others are serious challenges for health of the medical staff. Tuberculosis and hepatitis prevail among occupational infection diseases [9-12].
Scientific sources present the findings of the researches of health status among various health professionals including surgeons, obstetricians, gynecologists, physicians, infectionists, phthisiologists, otolaryngologists, dentists and other specialties [13-15]. However, researching information in the scientific literature shows that the situation with health status of ophthalmologists is not studied properly.
With this in mind, we have all grounds to consider that analysis of health condition of ophthalmologists including the contributing factors is one of the effective methods for providing sound preventive services, which will eventually facilitate improvement of health status of doctors and nurses including improvements in their performance and in quality of medical services to the population.
The need to identify current characteristics of health status of ophthalmologists grows with the magnitude of visual impairment, rapid rates of eye disease rising among population and negative tendencies of its acceleration, which condition considerable workload on eye specialists.
Considering the above, the aim of this work is to reveal modern trends in health condition of ophthalmologists using the sociological research findings related to health problems in order to justify the needed priventive measures.
Focus of this research corresponds to the Action Plan Framework “Universal eye health: a global action plan 2014-2019” in the WHO European region associated with medical staff capacity growing .
The objective of the study was to reveal health status of ophthalmologists using national and foreign scientific publications, to develop research tools and to conduct sociological survey of ophthalmologists concerning their health status, influence of occupational factors on health, self assessment of health condition etc.
MATERIALS AND METHODS
The research methodology provided the use of bibliographic, medical statistics, sociological and information-analytical methods. For achieving the objective of the study and revealing the health problems in ophthalmologists including their needs the authors developed a toolkit for attitude and opinion survey of ophthalmologists. The survey program included demographic and professional characteristics of the respondents, current health problems and health self-assessment.
RESULTS AND DISCUSSION
The surveyed group provided demographic characteristics, including age and gender. Among respondents specialists under 30 years accounted for 13,8 ±2,3 per 100 respondents, from 30 to 39 years inclusive –22,0 ±2,8 per 100 respondents, from 40 to 49 years inclusive –23,9±2,9 per 100 respondents, from 50 to 59 years inclusive –21,1±2,8 per 100 respondents, older than 60 years –19,3±2,7 per 100 respondents.
Gender composition of the sample shows predominance of women with 56,9±3,4 per 100 respondents as compared to men with 43,9±3,4 per 100 respondents.
Specialists of the set sample work mostly at the health facilities in the urban area. For example, 32,1±3,2 per 100 respondents live and work in the oblast capital, 47,2±3,4 per 100 respondents in the towns and 20,8±2,3 per 100 respondents in the rural area.
Formation of many professional opinions is affected by the length of work and qualification category. The survey was conducted among specialists with following lengths of work – under 5 years 13,0±2,3 (per 100 respondents), from 5 to 9 years inclusive (21,0±2,9 per 100 respondents), from 10 to 14 years inclusive (24,0±3,0 per 100 respondents), from 15 to 19 years inclusive (20,0±2,8 per 100 respondents), above 20 years (22,0±2,9 per 100 respondents).
Survey questionnaire also included a question about material standing of the respondents. The sample provided only 5,7±2,1 well off individuals per 100 respondents. Furthermore, most surveyed ophthalmologists assess their material standing as comfortably off, (33,0±3,2 per 100 respondents – as low income, 9,4±2,0 per 100 respondents – as disadvantaged).
Opinions of ophthalmologists about their health status are of particular interest. In the course of the study it was established that 11,1±2,1 per 100 respondents assess their health as very good, 34,3±3,2 per 100 – as good. At the same time every third respondent reports own health condition as satisfactory (33,3±3,2 per 100), 18,5±2,6 respondents report their health condition as bad and 2,8±1,2 per 100 respondents – as very bad. The presented data show that though more than half of the respondents assess their health condition as good, one fourth of them tend to assess health as satisfactory, while 21,3±2,8 per 100 respondents consider it bad or very bad.
Chronic diseases in the history are confirmed by 52,8±3,4 per 100 respondents, recurrent acute diseases are reported by 48,6±3,4 per 100 respondents.
The structure of chronic diseases shows the following pattern: 27,8% falls under diseases of the respiratory system, 15,2% – diseases of digestive system, 10,6 %, – diseases of blood circulatory system 9,6% – diseases of genitourinary system and 10,2% – diseases of osteodermomuscular system and connective tissue.
What is alarming is that ophthalmologists do not always consult a GP or a relevant medical specialist about diseases they suffer and their exacerbation. Only 40,6±3,4 per 100 respondents confirmed their referral to the medical specialist for treatment. At the same time about half of the respondents (48,6±3,4 per 100 respondents) admitted self-treatment, shortage of time, big workload, lack of substitute specialists, light diseases symptoms etc. Insufficient attention to own health problems by a part of ophthalmologists is a negative predictive value towards potential development of diseases and deterioration of health in the future.
Among major factors adversely affecting health of ophthalmologists most of the respondents reported considerable workload (38,5±3,3 per 100 respondents), the need to work part-time for subsistence (36,4±3,3 per 100 respondents), neuro-emotional stress (33,3±3,2 per 100 respondents), insufficiently equipped medical and diagnostic process lacking modern technologies (39,8±3,3 per 100 respondents), poor team atmosphere (6,9±1,7 per 100 respondents), lack of comfort at the workplace (18,2±2,7 per 100 respondents) and others.
The revealed characteristics of health of ophthalmologists, factors adversely affecting the health condition, lack of attention to own health problems should be taken into consideration in development of the reliable prevention programs.
In order to provide high quality and accessible eye care system for population it is of paramount importance to provide appropriate resources to support diagnosis and treatment process, where eye medical staff plays the major role. Efficiency and effectiveness of ophthalmologists’ performance directly depend on their health status.
The sociological survey of the ophthalmologists with a help of the specially developed the toolkit, which allowed learning their opinion about own health, its deterioration and contributing factors of the working environment.
The survey findings show that most ophthalmologists working at the health facilities are women, mostly in rural area, ranging from young to pension age, with various lengths of service. At the same time, every fifth employee has a retirement age, which, with a small proportion of young specialists in the structure of specialists in the ophthalmologic service, may show a unfavorable proposal for staffing in opthalmological domain of medical care in the future. Despite the fact that more than half of respondents assess their material condition as good, one third of respondents consider themselves insufficiently secured, and every tenth is low-income, more than one third of the respondents have to work part-time for subsistence.
According to the health self-assessment data, 45 per 100 of the respondents consider it good or very good. At the same time one third of the respondents assess it as satisfactory and more than every fifth – as bad. The reason for low self-assessment is in the chronic diseases indicated by almost half of the respondents. Diseases of the respiratory system, the digestive apparatus, the blood circulatory system, the genitourinary system and the osteodermomuscular system and connective tissue prevail in the structure of chronic diseases.
Unfavorable occupational factors, which adversely affect health of ophthalmologists serve a negative predictive value towards potential development of diseases and deterioration of health in the future.
Multiple information on health of ophthalmologists and influence of the occupational factors are the ground for planning actions to prevent adversities, manage health disorders of ophthalmologists for strengthening their health,. which is a prerequisite for quality performance of medical staff.
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Address for correspondence
Tetiana S. Gruzeva
ul. Saksaganskogo, 42,43
01033 Kyiv, Ukraine