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Development of family medicine-based primary care in the republic of moldova and effectiveness determinants


Author: Zarbailov Natalia
Degree:doctor habilitat of medicine
Speciality: 14.00.33 - Social Medicine and Management
Year:2023
Scientific consultant: Mihail Ciocanu
doctor habilitat, professor, Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova
Institution: Nicolae Testemitanu State University of Medicine and Pharmacy of the Republic of Moldova

Status

The thesis was presented on the 14 December, 2022
Approved by NCAA on the 24 February, 2023

Abstract

Adobe PDF document – 1.00 Mb / in romanian
Adobe PDF document – 0.92 Mb / in english

Thesis

CZU 614.25(478)

Adobe PDF document 5.76 Mb / in romanian
316 pages

Keywords

primary care, family medicine, development, quality, effectiveness, evaluation

Summary

Thesis structure: introduction, 5 chapters, including literature review, material and methods, 3 original chapters, discussions, general conclusions and recommendations, bibliography of 296 titles, 10 annexes, 216 pages of basic text, 19 figures, 29 tables. The obtained results are published in 44 scientific papers.

Purpose and objectives of the research: The purpose of the research consisted in the evaluation of primary medical care based on family medicine in the Republic of Moldova in order to assess the level of development of the field and elucidate the factors that determine its effectiveness. The following objectives have been established: 1. Exploring the historical landmarks of primary care and the context of the dimensions of the quality of health services. 2. Nomination of factors with potential influence on the development of primary care, identification or development and application of appropriate tools for evaluating effectiveness. 3. Elucidation of the level of development of primary health care and the stages of establishing family medicine in the Republic of Moldova. 4. Examining the professional satisfaction and work motivation of family doctors and the competence of family nurses to ensure the effectiveness of health services. 5. Evaluating the opinion of the beneficiaries of primary health care regarding the primary health care provided within the family medicine.

Novelty and scientific originality. The research solves the problem of the appropriate instrumentation and the right methodology, necessary for the assessment of the primary healthcare sector (PHC) in one of the countries of the South-Eastern Europe region, taking into account the specifics of the development of the health system and the implementation process of the Family Medicine specialty as a basic specialty for the PHC sector in the Republic of Moldova.

The fundamentally new results for science and practice. The exploration of the real possibilities for the evaluation of the effectiveness of primary medical care based on family medicine confirmed the systemic approach of the transformation process, identified the influencing factors on the professional satisfaction and work motivation of family doctors by validating and applying the assessment tools developed in the study , by identifying new aspects regarding the opinion of medical care beneficiaries about the primary medical assistance received.

The theoretical significance of the research. Evidence has been demonstrated regarding the influence of certain contextual factors on the effectiveness of PHC services: regulatory aspects of primary health care at the policy level, professional satisfaction and work motivation of family doctors, as well as the opinion of health care beneficiaries

Application value. Through the conducted research, new data were obtained about the level of development of primary medical care in the Republic of Moldova in comparison with other countries. PHC assessment tools have been validated, which allows for the planning of monitoring interventions in the health system in the near future.

Implementation of scientific results. The results of the study were reported at 6 national and 15 international forums. The following were validated on the research: the Policy Information Note, 2 Author Certificates, 3 Innovation Certificates, and 3 Implementation Acts.