Zilvinas Padaiga

The future prospects of Lithuanian family physicians: a 10-year forecasting study

BackgroundWhen health care reform was started in 1991, the physician workforce in Lithuania was dominated by specialists, and the specialty of family physician (FP) did not exist at all. During fifteen years of Lithuanias independence this specialty evolved rapidly and over 1,900 FPs were trained or retrained. Since 2003, the Lithuanian health care sector has undergone restructuring to optimize the network of health care institutions as well as the delivery of services; specific attention has been paid to the development of services provided by FPs, with more health care services shifted from the hospital level to the primary health care level. In this paper we analyze if an adequate workforce of FPs will be available in the future to take over new emerging tasks.MethodsA computer spreadsheet simulation model was used to project the supply of FPs in 2006–2015. The supply was projected according to three scenarios, which took into account different rates of retirement, migration and drop out from training. In addition different population projections and enrolment numbers in residency programs were also considered. Three requirement scenarios were made using different approaches. In the first scenario we used the requirement estimated by a panel of experts using the Delphi technique. The second scenario was based on the number of visits to FPs in 2003 and took into account the goal to increase the number of visits. The third scenario was based on the determination that one FP should serve no more than 2,000 inhabitants. The three scenarios for the projection of supply were compared with the three requirement scenarios.ResultsThe supply of family physicians will be higher in 2015 compared to 2005 according to all projection scenarios. The largest differences in the supply scenarios were caused by different migration rates, enrolment numbers to training programs and the retirement age. The second supply scenario, which took into account 1.1% annual migration rate, stable enrolment to residency programs and later retirement, appears to be the most probable. The first requirement scenario, which was based on the opinion of well-informed key experts in the field, appears to be the best reflection of FP requirements; however none of the supply scenarios considered would satisfy these requirements.ConclusionDespite the rapid expansion of the FP workforce during the last fifteen years, ten-year forecasts of supply and requirement indicate that the number of FPs in 2015 will not be sufficient. The annual enrolment in residency training programs should be increased by at least 20% for the next three years. Accurate year-by-year monitoring of the workforce is crucial in order to prevent future shortages and to maintain the desired family physician workforce.

Cost-Utility Analysis of Methadone Maintenance Treatment: A Methodological Approach

Economic considerations influence the substance user treatment system. These considerations influence who gets treatment and for how long, as well as determining what services they receive and in what setting. Current medical literature argues that maintenance treatment reduces risk-taking behavior, such as injection drug use and needle sharing. Treatment also reduces the mortality associated with abuse of opiates by injection and can cause decreases in costs incurred by the criminal justice system and social services agencies. This suggests the need for complex economic evaluations of a maintenance treatment to find out the optimum treatment program. This paper describes methods of economic evaluation in healthcare and reviews the methodology of cost–utility analysis in economic evaluations of methadone maintenance treatment.

Do Lithuanian Pharmacists Intend to Migrate

The aim of this study is to examine the attitudes of Lithuanian pharmacists towards migration to other countries of the European Union or European Economic Area. Using a questionnaire developed by the Ministry of Social Affairs, Labour and Solidarity of France, surveys were sent to 654 Lithuanian pharmacists (response rate 47.5 per cent). Univariate logistic regression was used to estimate risk factors for intention of pharmacists to go abroad. More than one quarter of Lithuanian pharmacists intended to work in other EU/EEA countries; however this was a definitive decision of only 2.3 per cent. Target destination countries were the United Kingdom, Ireland, Germany, Norway, Sweden and Denmark. The major reasons for leaving were higher salary, better quality of life and better professional opportunities. English language skills significantly increased the potential risk of working abroad by four times. Other significant factors were age less than 30 years, graduation since 1990, urban residence, and friends/family abroad. Even though the study did not find evidence of large-scale migratory flows, it found a significant percentage of Lithuanian pharmacists who intended to migrate. The potential effects of migration ought to be tackled systematically and in a coordinated way, because emigration affects the health system and health workers remaining in the country. In order to observe future trends, the survey should be repeated every two or three years.

Prediction of perinatal mortality at an early stage of pregnancy.

Aim: To define the probability of foetal and neonatal death (PFND) in Lithuania by means of the Medical Birth registry. Methods: The Medical Birth registry for the year 2002 (29,619 pregnancies resulting in delivery) was used, covering social, environmental, health behaviour factors, obstetric history, health status of pregnant women, and delivery. Results: A statistically significant model has been obtained in which 12 out of 45 analysed factors were significant for the risk of perinatal mortality (PM). In the case of previous neonatal pathology, e.g. damage to CNS, the risk of PM (OR 5.2; 95% CI=2.1—13.3) was similar to the reported manual work or harmful working conditions during pregnancy (OR 4.8; 95% CI=1.9—12.1 and OR 4.5; 95% CI=1.3—15.2, respectively). The influence of fathers alcohol abuse (OR 2.6; 95% CI=1.4— 4.7) was comparable to that of the stillborns or premature deliveries. The combination of several factors increased PFND significantly: maternal smoking during pregnancy and paternal smoking and alcohol abuse raised PFND to 0.03 (OR 6.8), mothers hard manual work in combination with harmful conditions during pregnancy increased OR more than 10 times (PFND 0.32) as compared with the situation when only one of those factors was present. Conclusions: The influence of social, environmental, and behavioural factors on the risk of PM was comparable to that of some of the complications during a previous pregnancy. The combination of risk factors significantly increased PFND. Using modelling, the individual prognosis may be presented to every pregnant woman at an early stage of pregnancy to potentially decrease the impact of unfavourable risk factors on PM.

Retaining physicians in Lithuania: integrating research and health policy.

Many of the strategic planning studies worldwide have made recommendations to the policy makers on the steps to be taken in eliminating the perceived shortages of physician workforce or in improving their distribution and retention. Policy makers have also considered various policy interventions to ensure adequate numbers of physicians. This study reviewed the research evidence and health policy decisions taken from 2000 to 2010 in Lithuania and evaluated the chronological links over time between scientific recommendations and policy decisions. From the analysis it would seem that Lithuanias success in retaining physicians between 2000 and 2010 was influenced by the timely implementation of particular research recommendations, such as increased salaries and increased enrolment to physician training programmes. In addition were the health policy interventions such as health sector reform, change in the legal status of medical residents and establishment of professional re-entry programmes. Based on this evidence it is recommended that policy makers in Lithuania as well as in other countries should consider comprehensive and systematic health policy approaches that combine and address various aspects of physician training, retention, geographic mal-distribution and emigration. Implementation of such an inclusive policy however is impossible without the integration of research into strategic decision making in workforce planning and effective health policy interventions.

Healthcare spending in the case of a HPV16/18 population-wide vaccination programme:

Background: The policy of population-wide human papillomavirus (HPV) vaccination has been debated as the introduction of such a programme in a low-resource country faces the risk of insufficient cost-effectiveness. Objectives: To assess the potential healthcare spending changes after the introduction of a HPV16/18 population-wide vaccination programme in Lithuania. Study design: For a cost-effectiveness analysis, we used mathematical simulation and epidemiological data modelling based on a Lithuanian female population. We performed comparative analysis of an annual 12-year-old girls population-wide vaccination programme combined with cervical cancer screening programme compared to the screening programme strategy only. Results: HPV vaccination would gain an average of 35.6 life years per death avoided or up to 284.8 thousand life years would be gained over 90 years in total. The programme costs would be 2932.58 EUR per life year gained. All costs associated with the introduction of the vaccination programme could be recovered in 48 years. The HPV vaccination programme in Lithuania has the potential to generate up to 40.07 million EUR of economic returns annually compared with the current practice of the cervical screening alone. Conclusions: In Lithuania the HPV16/18 vaccination programme would be economically effective only in the long term. The investment costs of HPV16/18 vaccination have the potential to be recovered.