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Optimization of primary health care services through implementation of modern managerial methods

Author: Nemerenco Ala
Degree:doctor of medicine
Speciality: 14.00.33 - Social Medicine and Management
Scientific adviser: Dumitru Tintiuc
doctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Scientific council:


The thesis was presented on the 25 September, 2008
Approved by NCAA on the 23 October, 2008


Adobe PDF document0.29 Mb / in romanian


CZU 614.2

Adobe PDF document 1.13 Mb / in romanian
153 pages


Primary health care, family medicine, family physician, medical assistant of the family doctor, management, triage room, confidentiality


During the past few years, in the Republic of Moldova have been registered several important changes in the primary medical healthcare services sector. The analysis of the speciality literature has allowed to conclude that in many countries the reform of the primary healthcare systems are strongly supported with a renewed focus on the quality of health services and patient satisfaction. It has been recognized that the key driver influencing both patient satisfaction and the quality of healthcare services is the implementation of modern managerial methods in the administration of the primary healthcare services.

The studies performed as part of this report have identified that in the institutions at an advanced stage of reform implementation a significant difference in the new tasks of the family doctor has occurred: application of the managerial methods, utilization of medical equipment, performance of services destined for promotion of healthy lifestyles, administration of the chronical diseases, etc. As a result of different evaluations of the activities of the family doctor it has been proven that: the scheduling of patients, optimization of the work hours of family doctors, and the duration of consultations, allow for an increase in the accessibility of the population to the primary health care services of 1.6 times, at the same time improving the overall satisfaction with the services. The use of the scheduling service and screening systems allows for the optimization of the activities of family doctors as a result of a complex approach to scheduling the patient at the pre-consultation phase and preparation for consultation with a focus on prophylactic activities performed by the medical assistant.

An increase in the quality of a family doctor’s consultation can be achieved through: longer duration of the medical exam, focus on recommendation, advice, and consultation activities dedicated to the patient; focus on prophylactic discussions, implementation of confidentiality of the visit, separation of the activities of the family doctor and the medical assistants. The separation of activities results in a focus for the family doctor on activities which correspond to the professional preparation level of the doctor. At the same time it is possible to maximize the utilization of the medical assistant’s capacities through a deeper involvement during the visit, through the following: training and achievement of a higher number of practical skills; transfer of a higher number of the secretarial activities; continuous co-involvement of medical assistants in problem-solving and promotion of a healthy life style. In this report are presented evidence of the effectiveness of team work through synchronization and division of medical activities, optimization of services through reciprocal performance on the basis of well-defined functions of the family doctor and the medical assistants. The results of the studies have proven the importance of modern managerial methods and their impact on effectiveness of the work of the family doctor and the medical assistants through:

The implementation of the proposed methods demonstrated a significant impact in a short time on the accessibility, efficiency and quality of the primary healthcare services as well as on higher satisfaction of both patients and medical staff. The importance of the results of the scientific studies is significant also through the simple possibility of high-impact application in practice at the institutions of primary healthcare services, no matter their location – in urban or rural settings.

The implementation of the results of this study does not require significant financial allocations and does not depend on the financing power of the institutions, a proven fact by the institutions with advanced status of reforms.