Yliopistologo

Lääketieteen kandidaatti Margus Lemberin yleislääketieteen alaan kuuluva väitöskirja

Implementing modern general practice in Estonia (Moderni yleislääketiede Virossa - aluelääkäristä perhelääkäriksi)

tarkastetaan lauantaina 16.5.1998 klo 12.15 Tampereen yliopiston lääketieteen laitoksen K-rakennuksessa, osoitteessa Teiskontie 35.

Vastaväittäjänä on dosentti Marjukka Mäkelä STAKESista. Kustoksena toimii professori Kari Mattila.

Lember on toiminut Tarton yliopistossa tutkijana vuosina 1989-1993 ja dosenttina vuodesta 1993 lähtien. Hän on Viron Perhelääkäriyhdistyksen puheenjohtaja. Lemberin väitöskirja ilmestyy sarjassa Acta Universitatis Tamperensis, Vammalan Kirjapaino Oy, Vammala 1998. ISBN 951-44-4359-4. ISSN 1455-1616

Väitöskirjan tilausosoite: Tampereen yliopiston julkaisujen myynti, PL 617, 33101 Tampere, puh. (03) 215 6055.

Lisätietoja: professori Kari Mattila (03) 215 7100 (työ).

Margus Lember: IMPLEMENTING MODERN GENERAL PRACTICE IN ESTONIA

The last decade has demonstrated the need for change in health care systems throughout the world. Changing polyclinic-based primary care into largely GP-based primary care in the countries of Central and Eastern Europe is a great challenge which requires the fulfilment of several preconditions and a clear vision of a reform. Estonia was among the first countries to start changing its health care and medical education.

The purpose of the present study is to monitor change in health care related to the introduction of family practice into health care and medical education.

The material and methods of the present study were drawn from four different projects: l) analysis of the process of change in medical education and health care system using the methods of action research; 2) TATATU (Tartu-Tampere-Turku) project "Preconditions of Family Doctors' Work": a mailed questionnaire to 469 Estonian and Finnish experienced primary health care doctors; 3) "GPs' Task Profiles'Study in Europe" was carried out in 30 countries of Europe, mailed questionnaires to 224 Estonian and 569 Finnish primary care doctors were analysed; 4) a random sample of the adult population in Tartu was studied by a postal questionnaire sent to 350 persons.

Results: A general trend in medical education since 1991 was towards more general training instead of early specialization. Postgraduate training for family medicine was implemented in 1991, and family medicine was formally recognized as a specialty in 1993. In 1992 a university department of Family Medicine was established. Additional training of currently practising primary care doctors (district doctors for adults and pediatricians) has been the main source of family doctors. Estonian district doctors' self-perception has been quite consistent with the role of GPs: they have been first-line doctors who accept both the medical and social roles. Their orientation to modern technology has not been strong. Listener, comforter, vocational doctor and helper were the phrases that the Estonian district doctors felt described them best. The main difference from the role of the GP was a relatively narrow scope of services provided by the Estonian district doctors. The office equipment of the Estonian district doctors was rather poor in 1992, which corresponded to their task profiles. As most procedures were performed by specialists, respective equipment was not available at district doctors' offices. The ratings given by the district doctors on the necessity for different items of equipment, corresponded to their task profiles. There occurred significant differences in the availability of equipment and in ratings for necessity of equipment between the Estonian district doctors and the Finnish GPs. Several differences were revealed in ratings on the necessity for common drugs between the Estonian district doctors and the Finnish GPs. The reasons can be related to the education of doctors, availability of medicines in the market as well as to different therapeutic traditions. The population survey of Tartu revealed that GPs were welcomed to the health care system by the population, who placed great expectations on them.


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