{"id":8011,"date":"2023-02-24T12:10:34","date_gmt":"2023-02-24T10:10:34","guid":{"rendered":"https:\/\/www.easistent.ro\/?p=8011"},"modified":"2023-03-27T10:38:39","modified_gmt":"2023-03-27T08:38:39","slug":"o-analiza-comparativa-a-starii-actuale-a-medicinei-de-familie-in-patru-tari-europene-danemarca-marea-britanie-olanda-si-spania-episodul-1-danemarca","status":"publish","type":"post","link":"https:\/\/www.easistent.ro\/?p=8011","title":{"rendered":"O analiz\u0103 comparativ\u0103 a st\u0103rii actuale a medicinei de familie \u00een patru \u021b\u0103ri europene: Danemarca, Marea Britanie, Olanda \u0219i Spania (Episodul 1 \u2013 Danemarca)"},"content":{"rendered":"\n<h3><em>Timp de lectur\u0103 \u2013 7 minute<\/em><\/h3>\n\n\n\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/www.easistent.ro\/new\/wp-content\/uploads\/2023\/02\/fam.jpg\"><img width=\"1024\" height=\"466\" src=\"https:\/\/www.easistent.ro\/new\/wp-content\/uploads\/2023\/02\/fam-1024x466.jpg\" alt=\"\" class=\"wp-image-7987\" srcset=\"https:\/\/www.easistent.ro\/new\/wp-content\/uploads\/2023\/02\/fam-1024x466.jpg 1024w, https:\/\/www.easistent.ro\/new\/wp-content\/uploads\/2023\/02\/fam-300x137.jpg 300w, https:\/\/www.easistent.ro\/new\/wp-content\/uploads\/2023\/02\/fam-768x350.jpg 768w, https:\/\/www.easistent.ro\/new\/wp-content\/uploads\/2023\/02\/fam-1536x700.jpg 1536w, https:\/\/www.easistent.ro\/new\/wp-content\/uploads\/2023\/02\/fam.jpg 1908w\" sizes=\"(max-width: 1024px) 100vw, 1024px\" \/><\/a><figcaption>Sursa foto: <a href=\"http:\/\/www.iamexpat.nl\">www.iamexpat.nl<\/a><\/figcaption><\/figure>\n\n\n\n<p>Asisten\u021ba primar\u0103, prin medicina de familie, reprezint\u0103 o baza solid\u0103 a sistemelor de s\u0103n\u0103tate din Danemarca, Olanda, Marea Britanie \u0219i Spania.<\/p>\n\n\n\n<p>\u00cencredin\u021barea c\u0103tre medicii de familie a rolului de gate-keeper, sau de prim punct de contact cu sistemul de s\u0103n\u0103tate, a fost posibil\u0103 datorit\u0103 aloc\u0103rii de suficiente resurse financiare \u0219i materiale.<\/p>\n\n\n\n<p>Practic, asisten\u021ba primar\u0103 asigur\u0103 eficien\u021ba cheltuielilor de s\u0103n\u0103tate public\u0103 prin limitarea accesului direct la asisten\u021ba medical\u0103 de specialitate.<\/p>\n\n\n\n<p>Acest sistem de control al accesului este conceput pentru a sus\u021bine principiul conform c\u0103ruia tratamentul ar trebui s\u0103 aib\u0103 loc la cel mai mic nivel de \u00eengrijire eficient\u0103, \u00eempreun\u0103 cu ideea de continuitate a \u00eengrijirii furnizate de un medic de familie.<\/p>\n\n\n\n<p>Acest articol este primul episod, din cele patru pe care ni le-am propus, al unei analize comparative a sistemelor de medicin\u0103 de familie din cele patru \u021b\u0103ri, considerate drept cele mai performante din Europa: Danemarca, Olanda, Marea Britanie \u0219i Spania.<\/p>\n\n\n\n<p><strong>Danemarca<\/strong> are 5,4 milioane de locuitori. Ca \u0219i celelalte \u021b\u0103ri scandinave, Danemarca are un stat social puternic, cu acces universal la asisten\u021b\u0103 medical\u0103 &#8211; to\u021bi reziden\u021bii danezi (cet\u0103\u021beni danezi, dar \u0219i non-cet\u0103\u021beni cu reziden\u021ba formal-\u00eenregistrat\u0103 \u00een Danemarca) au acces gratuit \u0219i direct la medicii de familie (care reprezint\u0103 circa 20% din totalul num\u0103rului medicilor), la oftalmologi \u0219i speciali\u0219ti \u00een otorinolaringologie \u0219i la serviciile de urgen\u021b\u0103.<\/p>\n\n\n\n<p>Asisten\u021ba medical\u0103 este finan\u021bat\u0103 \u00een mare parte prin taxe. Co-plata pacien\u021bilor reprezint\u0103 aproximativ 17% din totalul cheltuielilor de s\u0103n\u0103tate. Cele mai mari dou\u0103 servicii unde se aplic\u0103 coplata sunt medicamentele eliberate pe baz\u0103 de re\u021bet\u0103 \u0219i asisten\u021ba stomatologic\u0103 pentru adul\u021bi.<\/p>\n\n\n\n<p>Medicina de familie este piatra de temelie a asisten\u021bei medicale primare din Danemarca \u0219i este caracterizat\u0103 de urm\u0103toarele elemente principale:<\/p>\n\n\n\n<ol type=\"1\"><li>Un sistem bazat pe liste &#8211; cu o medie de aproape 1600 de persoane pe lista unui medic de familie tipic. Acest prag de m\u0103rime a listei este sc\u0103zut, \u00een compara\u021bie cu Olanda \u0219i Anglia. Sistemul de liste permite medicilor de familie s\u0103 dezvolte o mai bun\u0103 cunoa\u0219tere a pacientului individual (continuitatea \u00eengrijirii) \u0219i a familiei (so\u021bii \u0219i copiii au adesea acela\u0219i medic de familie, de unde \u0219i termenul sinonim de medic de familie) \u0219i le permite s\u0103 se concentreze mai bine asupra \u00eentregii popula\u021bii.<\/li><\/ol>\n\n\n\n<ul><li>Medicul de familie este gate-keeper \/ furnizor de prim\u0103 linie, \u00een sensul c\u0103 este necesar\u0103 o trimitere de la un medic de familie pentru majoritatea specialit\u0103\u021bilor medicale (cu excep\u021bia oftalmologilor \u0219i a speciali\u0219tilor \u00een otorinolaringologie) \u0219i \u00eentotdeauna pentru tratamentul spitalicesc \u00een regim de internare, dar \u0219i ambulatoriu.<\/li><\/ul>\n\n\n\n<p>\u00cen medie, danezii au \u00een jur de 7 contacte cu un medic de familie pe persoan\u0103 pe an, inclusiv consulta\u021bii \u00een clinici, vizite la domiciliu \u0219i consulta\u021bii telefonice.<\/p>\n\n\n\n<p>Accesul gratuit include, de asemenea, transportul cu ambulan\u021ba, reabilitarea \u0219i \u00eengrijirea paliativ\u0103.<\/p>\n\n\n\n<p>De notat c\u0103 serviciile de s\u0103n\u0103tate municipale, cum ar fi asisten\u021ba medical\u0103 la domiciliu, ajutorul la domiciliu (asistarea persoanelor cu handicap \u00een activit\u0103\u021bile de zi cu zi), serviciile de s\u0103n\u0103tate \u0219colar\u0103, vizitatorii de s\u0103n\u0103tate (pentru mamele cu nou-n\u0103scu\u021bi), reabilitarea \u0219i serviciile stomatologice pentru copii sunt, de asemenea, gratuite.<\/p>\n\n\n\n<p>Tariful pentru servicii le ofer\u0103 medicilor de familie un stimulent pentru a trata singuri pacien\u021bii, \u00een loc s\u0103 \u00eei trimit\u0103 \u00een alt\u0103 parte \u00een sistem. De exemplu, se presupune c\u0103 onorariul relativ ridicat pentru consulta\u021biile preventive \u00eencurajeaz\u0103 medicii de familie s\u0103 ofere consulta\u021bii mai lungi care se concentreaz\u0103 pe activit\u0103\u021bi mai ample de s\u0103n\u0103tate \u0219i prevenire.<\/p>\n\n\n\n<ul><li>Sistemul ofer\u0103 \u0219i o acoperire dup\u0103 orele de program tipic (after-hours), iar aceast\u0103 acoperire after-hours se realizeaz\u0103 cu personal din medicina de familie, prin rota\u021bie.<\/li><\/ul>\n\n\n\n<p>Astfel, medicii de familie organizeaz\u0103 acoperirea serviciilor de \u00eengrijire \u00een weekend \u0219i \u00een afara orelor de program. Medicii de familie dintr-o anumit\u0103 zon\u0103 geografic\u0103 asigur\u0103 prin rota\u021bie personalul centrelor regionale de servicii \u00een afara orelor de program. Aceste centre regionale de servicii sunt adesea situate \u00een incinta departamentului de urgen\u021b\u0103 al spitalului local, dar func\u021bioneaz\u0103 independent de acesta.<\/p>\n\n\n\n<p>Pacien\u021bii pot suna la centrul de servicii \u00een afara orelor de program pentru a vorbi cu medicul de familie de gard\u0103, pot fi consulta\u021bi \u00een centrul de servicii \u00een afara orelor de program sau pot aranja o vizit\u0103 la domiciliu de c\u0103tre unitatea mobil\u0103 de medici de familie &#8222;itinerant\u0103&#8221; din zona geografic\u0103 respectiv\u0103.<\/p>\n\n\n\n<p>Actuala organizare a serviciilor de medicin\u0103 de familie \u00een afara orelor de program a inspirat aranjamente similare \u00een alte \u021b\u0103ri.<\/p>\n\n\n\n<ul><li>Medicii de familie sunt independen\u021bi, lucr\u00e2nd pentru finan\u021batorul public pe baz\u0103 de contract, construit pornind de la un acord na\u021bional care detaliaz\u0103 nu numai serviciile \u0219i rambursarea, ci \u0219i orele de func\u021bionare \u0219i educa\u021bia postuniversitar\u0103 necesar\u0103.<\/li><\/ul>\n\n\n\n<ul><li>Pentru a deveni medic de familie este nevoie de 6 ani de formare dup\u0103 facultatea de medicin\u0103: 1 an de formare de baz\u0103 \u0219i 5 ani de formare de specialitate, dup\u0103 care medicul prime\u0219te titlul de specialist \u00een medicin\u0103 general\u0103. Nu exist\u0103 nicio cerin\u021b\u0103 de recertificare, dar se aloc\u0103 fonduri pentru formarea continu\u0103 pentru fiecare medic de familie.<\/li><\/ul>\n\n\n\n<ul><li>Programele generale de vaccinare sunt realizate de c\u0103tre medicii de familie \u0219i sunt finan\u021bate de c\u0103tre autorit\u0103\u021bile publice regionale pe baz\u0103 de plat\u0103 pentru servicii. Acoperirea vaccinal\u0103 \u00eempotriva difteriei, tetanosului, tusei convulsive, poliomielitei \u0219i Hib (haemophilus influenza de tip b) este relativ ridicat\u0103 \u00een Danemarca, exist\u00e2nd \u00eens\u0103 anumite probleme \u00een ceea ce prive\u0219te vaccinarea \u00eempotriva rujeolei, oreionului \u0219i rubeolei (ROR) din cauza \u00eendoielilor p\u0103rin\u021bilor cu privire la efectele adverse \u0219i complica\u021biile rezultate \u00een urma vaccinului.<\/li><\/ul>\n\n\n\n<p>Danemarca a introdus progresiv programe regionale de screening pentru depistarea cancerului de s\u00e2n, de exemplu femeile din grupa de v\u00e2rst\u0103 50-69 de ani sunt invitate la screening o dat\u0103 la doi ani. De asemenea, femeile sunt invitate s\u0103 fac\u0103 un test Papanicolau \u00een fiecare an, iar acestea sunt efectuate de c\u0103tre medicii de familie.<\/p>\n\n\n\n<p><em>Mirela Musta\u021b\u0103, Redactor executiv E-asistent<\/em><\/p>\n\n\n\n<p><em><u>Surse de documentare:<\/u><\/em><\/p>\n\n\n\n<ol type=\"1\"><li><a href=\"https:\/\/www.jabfm.org\/content\/25\/Suppl_1\/S34\" target=\"_blank\" rel=\"noreferrer noopener\">General Practice and Primary Health Care in Denmark | American Board of Family Medicine (jabfm.org)<\/a><\/li><li><a href=\"https:\/\/www.tandfonline.com\/doi\/full\/10.1080\/13814780600757187\" target=\"_blank\" rel=\"noreferrer noopener\">Full article: Western European best practice in primary healthcare (tandfonline.com)<\/a><\/li><li><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK459018\/\" target=\"_blank\" rel=\"noreferrer noopener\">The Netherlands &#8211; Building primary care in a changing Europe &#8211; NCBI Bookshelf (nih.gov)<\/a><\/li><li><a href=\"https:\/\/www.economist.com\/britain\/2023\/01\/09\/general-practitioners-are-a-big-part-of-britains-health-care-crisis\" target=\"_blank\" rel=\"noreferrer noopener\">General practitioners are a big part of Britain\u2019s health-care crisis | The Economist<\/a><\/li><li><a href=\"https:\/\/www.economist.com\/leaders\/2023\/01\/12\/fixing-britains-health-service-means-fixing-its-family-doctors\" target=\"_blank\" rel=\"noreferrer noopener\">Fixing Britain\u2019s health service means fixing its family doctors | The Economist<\/a><\/li><li><a href=\"https:\/\/iwcn.nl\/newcomers\/settling-in\/health-matters\/general-practitioner-or-family-doctor\/?cn-reloaded=1\" target=\"_blank\" rel=\"noreferrer noopener\">General Practitioner or Family Doctor \u00ab The International Welcome Center North \u2013 IWCN<\/a><\/li><li><a href=\"https:\/\/bmcprimcare.biomedcentral.com\/articles\/10.1186\/1471-2296-13-47\" target=\"_blank\" rel=\"noreferrer noopener\">Medical student attitudes towards family medicine in Spain: a statewide analysis | BMC Primary Care | Full Text (biomedcentral.com)<\/a><\/li><li><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK459029\/\" target=\"_blank\" rel=\"noreferrer noopener\">Spain &#8211; Building primary care in a changing Europe &#8211; NCBI Bookshelf (nih.gov)<\/a><\/li><li><a href=\"http:\/\/www.stmarkshospital.org.uk\/best-ranking-healthcare-systems-in-europe\/\" target=\"_blank\" rel=\"noreferrer noopener\">Best Ranking Healthcare Systems In Europe &#8211; St Marks Hospital<\/a><\/li><\/ol>\n","protected":false},"excerpt":{"rendered":"<p>Timp de lectur\u0103 \u2013 7 minute Asisten\u021ba primar\u0103, prin medicina de familie, reprezint\u0103 o baza solid\u0103 a sistemelor de s\u0103n\u0103tate din Danemarca, Olanda, Marea Britanie \u0219i Spania. \u00cencredin\u021barea c\u0103tre medicii de familie a rolului de gate-keeper, sau de prim punct de contact cu sistemul de s\u0103n\u0103tate, a fost posibil\u0103 datorit\u0103 aloc\u0103rii de suficiente resurse financiare [&hellip;]<\/p>\n","protected":false},"author":3,"featured_media":7987,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[152,13],"tags":[],"_links":{"self":[{"href":"https:\/\/www.easistent.ro\/index.php?rest_route=\/wp\/v2\/posts\/8011"}],"collection":[{"href":"https:\/\/www.easistent.ro\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.easistent.ro\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.easistent.ro\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/www.easistent.ro\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=8011"}],"version-history":[{"count":1,"href":"https:\/\/www.easistent.ro\/index.php?rest_route=\/wp\/v2\/posts\/8011\/revisions"}],"predecessor-version":[{"id":8012,"href":"https:\/\/www.easistent.ro\/index.php?rest_route=\/wp\/v2\/posts\/8011\/revisions\/8012"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.easistent.ro\/index.php?rest_route=\/wp\/v2\/media\/7987"}],"wp:attachment":[{"href":"https:\/\/www.easistent.ro\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=8011"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.easistent.ro\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=8011"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.easistent.ro\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=8011"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}