Institute for Biomedical Research of Lithuanian University of Health Sciences, Laboratory of Health Systems Research, Lithuania.
Health Policy. 2012 Aug;106(3):276-83. doi: 10.1016/j.healthpol.2012.03.011. Epub 2012 May 4.
To assess the organizational changes in Lithuanian Primary Health Care (PHC) in the period from 1994 to 2010, and to highlight the differences with respect to the background of family physicians, the level of urbanization and the type of PHC centers.
Three cross-sectional, comparative questionnaire surveys were conducted before the start of the PHC reform (in 1994) and in the course of the PHC reform (in 2004 and 2010) in Lithuania. The anonymous questionnaires were sent by mail to district physicians (i.e. internists, who provided health care for adults, and pediatricians, who provided care for children younger than 18 years old) in 1994, and to family physicians (i.e. retrained district physicians and family physicians-graduates from residency in family medicine) in 2004 and 2010.
The differences observed in 1994 between former district physicians and those who had completed residency in family medicine, private and public PHC centers and different level of urbanization dissolved in the years of the PHC reform. Physicians' age tended to be higher in the course of the PHC reform. Numbers of patients' consultations were increasing in the period after 1994 till 2010, though numbers of CME hours and home visits were decreasing.
The idea to retrain district physicians into family physicians was a valuable decision. In the years of the PHC reform the workload of family physicians in Lithuania approached the level existing in the EU. The aging of workforce, high workload and reduction of CME hours are the major concerns for future PHC policy.
评估 1994 年至 2010 年期间立陶宛初级卫生保健（PHC）的组织变化，并突出家庭医生背景、城市化水平和 PHC 中心类型方面的差异。
在 PHC 改革开始前（1994 年）和 PHC 改革过程中（2004 年和 2010 年）进行了三次横断面、比较性问卷调查。1994 年，匿名问卷通过邮件发送给地区医生（即提供成人保健的内科医生和提供 18 岁以下儿童保健的儿科医生），2004 年和 2010 年发送给家庭医生（即经过家庭医学住院医师培训的原地区医生和家庭医生）。
1994 年，在原地区医生和接受家庭医学住院医师培训的医生、私人和公共 PHC 中心以及不同城市化水平之间观察到的差异在 PHC 改革期间消失了。在 PHC 改革过程中，医生的年龄趋于更高。1994 年后，患者就诊人数不断增加，但继续教育小时数和家访次数却在减少。
将地区医生培训为家庭医生的想法是一个有价值的决定。在 PHC 改革期间，立陶宛家庭医生的工作量接近欧盟的水平。劳动力老龄化、高工作量和继续教育小时数减少是未来 PHC 政策的主要关注点。
