Kaja Polluste - Academia.edu (original) (raw)
Papers by Kaja Polluste
Stomatologija / issued by public institution "Odontologijos studija" ... [et al.], 2014
The aim of the study was to explore the role of managerial style, work environment factors and bu... more The aim of the study was to explore the role of managerial style, work environment factors and burnout in determining job satisfaction during the implementation of quality improvement activities in a dental clinic. Quantitative research was carried out using a prestructured anonymous questionnaire to survey 302 respondents in Kaarli Dental Clinic, Estonia. Dental clinic staff assessed job satisfaction, managerial style, work stress and burnout levels through the implementation period of ISO 9000 quality management system in 2003 and annualy during 2006-2009. Binary logistic regression was used to explain the impact of satisfaction with management and work organisation, knowledge about managerial activities, work environment and psychosocial stress and burnout on job satisfaction. The response rate limits were between 60% and 89.6%. Job satisfaction increased significantly from 2003 to 2006 and the percentage of very satisfied staff increased from 17 to 38 (p<0.01) over this perio...
Central European journal of public health, 2009
The aim of the study was to analyse the self-reported use of health services among the older Esto... more The aim of the study was to analyse the self-reported use of health services among the older Estonian population, to explain the predictors of health care utilisation and to study access to health services in comparison with other population groups. In November 2005, a randomly sampled Estonian residents aged 15-64 (n=1264) and 65-74 (n=182) was personally interviewed using structured questionnaires. Of the respondents aged 65-74, 81% reported having visited a general practitioner (GP) or specialist during the previous 12 months. Compared to younger people they used health services more often, except dental care. No significant differences were found in comparison with the waiting times to see the general practitioner or specialist between the younger and older population groups. Compared to the rest of the population people aged 65-74 were more satisfied with their access to health services. The probability of visiting a GP was higher for those respondents who had health problems a...
TheScientificWorldJournal, 2012
In this cross-sectional study we explained the possible determinants of satisfaction with access ... more In this cross-sectional study we explained the possible determinants of satisfaction with access to health services in patients with rheumatoid arthritis (RA). Of the 2000 randomly selected Estonian adult patients with RA, a total 1259 completed the survey. Regression analysis was used to analyse the predictors of patients' satisfaction with access to health services. Half of the respondents were satisfied with their access to health services. Factors that had a negative impact on satisfaction included pain intensity, longer waiting times to see the doctors, as well as low satisfaction with the doctors. Transportation costs to visit a rheumatologist and higher rehabilitation expenses also affected the degree of satisfaction. Patients who could choose the date and time at which they could visit the rheumatologist or who could visit their "own" doctor were more likely to be satisfied than patients whose appointment times were appointed by a healthcare provider.
Croatian medical journal, 2004
To analyze the population's view of the primary health care reform five years after the forma... more To analyze the population's view of the primary health care reform five years after the formal implementation of the reform investigating the acceptability of the primary health care system, patients' preferences, and satisfaction with their family doctors. Face-to-face interviews using structured questionnaires were preformed with a random sample of the Estonian residents aged 15-74 years (n=999). Out of 999 respondents, 35% prefer to first see their family doctor and if necessary to get a referral or a recommendation to see a specialist. The referral to the specialist by the family doctor is more preferred by older respondents, rural people, by the respondents with a lower level of education and income as well as by people who were more satisfied with their family doctor. The people who were more satisfied with their family doctor found that the whole health care system was functioning better than the previous primary health care system. Out of all the respondents who have...
Croatian medical journal, 2004
To investigate the accessibility of family doctors in Estonia from the patients' point of vie... more To investigate the accessibility of family doctors in Estonia from the patients' point of view. Face to face interviews using structured questionnaires were performed. A random sample of the Estonian residents, aged 15-74 years, was studied (n=999). The number of visits provided by family doctors has been continuously increasing since 1998. Out of 999 respondents, 59% visited the family doctor during the previous 12 months. The average number of visits per Estonian resident in one year is 2.48. Out of 999 interviewed persons, 72% said that they had a possibility of contacting their family doctor by phone. The waiting time for an appointment was short in most cases. The family doctor admitted 60% of the respondents on the same day the patients had requested; 22% of the patients were admitted within 1-2 days and 9% of the patients were admitted within 3-4 days. Only 9% of them had to wait more than 5 days. The current home visit fee in Estonia would have affected the decision of t...
Nursing Research and Practice, 2013
The world population is rapidly aging. Between 2000 and 2050, the proportion of the world's popul... more The world population is rapidly aging. Between 2000 and 2050, the proportion of the world's population over 60 years will double from about 11% to 22%. The absolute number of people aged 60 years and over is expected to increase from 605 million to 2 billion over the same period . Although more developed countries have the oldest population profiles, the vast majority of older people-and the most rapidly aging populations-are in less developed countries. Between 2010 and 2050, the number of older people in less developed countries is projected to increase more than 250 percent, compared with a 71-percent increase in the developed countries .
Scandinavian Journal of Rheumatology, 2007
Rheumatology International, 2014
The objective of this paper was to find out how many patients with rheumatoid arthritis (RA) know... more The objective of this paper was to find out how many patients with rheumatoid arthritis (RA) know about several aspects of disease, to explain the associations between the level of self-rated knowledge and patients&amp;amp;amp;#39; background and health status and to compare the importance of the main sources of information. A random sample (n = 1,259) of adult Estonian RA patients was selected from the Estonian Health Insurance Fund Database. The patients completed a self-administered questionnaire, which included information about their socio-demographic and disease characteristics, use of health services, information about the disease, and sources of information. Regression analysis was used to calculate the associations between the independent variables and level of self-rated knowledge about several aspects of RA. The results of the study indicated that the self-reported ratings of knowledge about the disease in Estonian RA patients were rather low. Health professionals were mentioned as the primary sources of information, but the longer disease history and more frequent use of health services as considerable predictors of higher ratings of knowledge refer to role of personal experience in obtaining knowledge about the disease as well.
Rheumatology International, 2012
Rheumatoid arthritis (RA) is a chronic, progressive, debilitating disease that demands continuous... more Rheumatoid arthritis (RA) is a chronic, progressive, debilitating disease that demands continuous therapy with multiple medications. Noncompliance with disease-modifying drugs may cause disease flares, preventable functional impairment, unnecessary treatment changes, and loss of health care resources. The aim of the current study was to explore self-reported compliance with treatment and the factors contributing to this compliance using a representative sample of an RA patient population in Estonia. Two thousand patients diagnosed with RA were randomly selected from the Estonian Health Insurance Fund database. The eligible response rate of the study was 60%. Using prestructured questionnaires, the following information about the disease and treatment was evaluated: self-reported compliance with treatment, reasons for noncompliance, disease history, sociodemographic variables, health care utilization, and satisfaction with health care providers. The self-reported compliance rate was 80.3%, reflecting the percentage of patients who reported that they always took their medications exactly as described. The most often reported reasons for noncompliance were side effects and fear of side effects. Compliance was found to be the lowest in a group of younger and active patients with higher income. Higher frequency of visits to the rheumatologist, satisfaction with health care providers, and sufficient information about RA treatment correlated with better compliance.
Journal of Clinical Nursing, 2010
To describe rheumatoid arthritis patients&amp;amp;amp;#39; perceptions of being informed ... more To describe rheumatoid arthritis patients&amp;amp;amp;#39; perceptions of being informed and of the value of the information obtained. About the accessibility of the disease-specific information to the patients, a prerequisite for any kind of the patient empowerment, can be considered as a priority area for investigation. Six focus groups (involving 27 patients) were conducted. For analysing the data, thematic analysis was applied. The participants referred to the media and the Internet, in-patient units, physicians at out-patient consultations, patients organisations, fellow patients and their own experience as the sources of disease-related information. The information delivered by the physicians was valued highest; satisfaction with the information received from the in-patient units was expressed. The knowledge acquired through the experience was mentioned as being important for coping with the disease. The media was an easily accessible information channel, although the information from this source was less trusted. The access to the Internet was seen as being limited for certain patients groups. The availability of physician-delivered information was described as unsatisfactory due to the organisation of information transmittal in out-patient settings. The results indicated the current balance of information sources as being incongruous with the provision of systematic and reliable disease-related information. The available information may also be qualitatively incomplete. Recognition of the weak and strong points of the structure of information provision is valuable when considering the development of educational opportunities for rheumatoid arthritis patients.
International Journal for Quality in Health Care, 2006
To assess the quality of the Estonian health system with the assessment tool provided by the Worl... more To assess the quality of the Estonian health system with the assessment tool provided by the World Health Organization (WHO). Situation analysis of health care quality using the self-assessment questionnaire proposed by the Council of Europe and WHO Regional Office for Europe as a framework for evaluating national quality activities. Estonia. Four domains for evaluating the national quality activities: policy, organization, methods, and resources. The quality policy of Estonian health care developed in the late 1990s defines the scope of quality and reflects the different viewpoints of stakeholders. Nevertheless, it is not comprehensive enough, activities planned for the involvement of consumers in defining and assessing quality are lacking, and key roles of institutions in quality improvement and incentives for quality are not clearly defined. At present, the responsibilities for quality assurance are distributed among the different stakeholders, but there is no single coordinating structure or mechanism for facilitating or assessing the implementation of the quality activities. Many regulations are established to assure the quality of health services and to protect patients&amp;amp;amp;amp;amp;#39; rights, but the implementation of voluntary mechanisms for quality assurance should be promoted. Access to the sources of information is good, but there is a shortage of unified quality and performance indicators at the national level. The results of this study indicated the strengths and shortages of the present organization of quality activities in Estonia and the ways for improvement. Strengthening coordination with explicit quality monitoring was found as a key factor for improvement.
International Journal for Quality in Health Care, 2004
To evaluate the level of job satisfaction among the staff at an Estonian hospital and to describe... more To evaluate the level of job satisfaction among the staff at an Estonian hospital and to describe factors related to their job satisfaction.
International Journal for Quality in Health Care, 2000
To find out how Estonian people evaluate the changes in primary health care (PHC), how they perce... more To find out how Estonian people evaluate the changes in primary health care (PHC), how they perceive the acceptability of the new PHC system, and to assess patients' satisfaction with their primary care doctor. Face-to-face interviews using structured questionnaires. Estonia. A random sample of Estonian residents aged 15-74 years (n = 997). Acceptability of PHC system (accessibility, the patient-practitioner relations, amenities, and patient's preferences) and patients' satisfaction with primary care doctor. Of the 997 respondents, 46% were sufficiently informed about the transition to the general practitioner (GP)-based PHC system; however, 45% of respondents had not personally experienced any changes. Of the 997 persons interviewed, 68% were registered on the patient list of a GCP, and 62% of those who had health problems preferred to consult the primary care doctor first. The waiting time for an outpatient appointment was brief (0-2 days). Of the 997 respondents, 68% were satisfied with their primary care doctor. Satisfaction was dependent on: (i) how patients evaluated the competence of the physician; (ii) comprehensibility of doctor's explanations; and (iii) comfort of the clinic. The right of patients to choose their own primary care doctor and having sufficient information about the changes in PHC system had a positive influence on the level of satisfaction. Patients' opinions are important in the evaluation of PHC. To increase the level of satisfaction, people need to understand the nature and intent of the primary care reforms. Personal choice of primary care doctor and good patient-doctor relationships are important factors too.
Health Policy, 2013
This study aims to compare the organisation of primary care (PC) systems in Estonia, Latvia and L... more This study aims to compare the organisation of primary care (PC) systems in Estonia, Latvia and Lithuania, focusing on the structure and process of service delivery, and to discuss the suitability of the PHAMEU instrument for international comparison of PC systems. The data were collected in the framework of PHAMEU project during 2009-2010. The selected indicators were used to describe and compare the structure and process of PC in Estonia, Latvia and Lithuania. The results showed that the coordination of PC services, legislative framework, service delivery, quality requirements and PC financing principles are rather similar in all three Baltic countries. Population coverage for PC services, cost sharing for some services, and the employment status of family doctors differs by country. The PHAMEU instrument was most applicable for the description and comparison of the structure of PC and some aspects of the process. Information about patient outcome and quality of care was neither available nor reliable enough. The development of PC systems in Baltic countries has been rather similar, but some aspects also differ between the countries. Use of a standardized instrument allows for international comparison, but assumes standardised data collection procedures in comparable countries.
Health Policy, 2003
To evaluate whether choosing one's own primary care doctor is associated with patient sat... more To evaluate whether choosing one's own primary care doctor is associated with patient satisfaction with primary health care. To evaluate factors related to population's satisfaction with primary health care. A random sample of Estonian adult population (N=997). Cross-sectional study using a pre-categorized questionnaire which was compiled by the research group of the University of Tartu and the research provider EMOR. Altogether 68% of the respondents had been listed in their personal physician. Their overall satisfaction with the physician as well as satisfaction with several aspects of primary health care were significantly higher compared with those of unregistered respondents. Although some other factors (practice size, patient age, health status) also influenced patient satisfaction, presence of a personal physician appeared the most important predictor of high satisfaction with physician's punctuality and understanding, effectiveness of prescribed therapy, clarity of explanations given by the physician as well as with overall satisfaction with the physician. Personal doctor system is associated with patient satisfaction with different aspects of care.
Health Policy, 2007
After the implementation of the primary health care reform in Estonia, most of chronic conditions... more After the implementation of the primary health care reform in Estonia, most of chronic conditions are managed by family doctors (FD) in collaboration with specialists. Although the general population has demonstrated the increase in satisfaction with health care after the reform, it has been questioned if people with chronic diseases have been left on a more disadvantaged position in the new system with some restrictions in the access to specialists. To investigate the satisfaction of people with chronic conditions with the access to the health services and compare them to those who did not have a chronic illness. In November 2005, a random sample of Estonian residents aged 15-74 were personally interviewed using structured questionnaires (n=1446), 29% of them reported to have a chronic illness. The people with chronic conditions were less satisfied with the access to the health services. They were more satisfied with their family doctors, but less with the health insurance system and they often reported their problems in seeing the specialist. Compared to other respondents, the people with chronic conditions visited their FDs and specialists more often, but no significant differences were found between their waiting times to see the FD or a specialist. In Estonia, the people with chronic conditions do not have organisational barriers in their access to the health services. As frequent users of health services, they perceive the shortages of the health system more obviously than the rest of the population and it may reflect their satisfaction with the different aspects of the health system as well as the access to the health services.
Family Practice, 2012
Patients with rheumatoid arthritis (RA) should be treated in close cooperation between GPs and rh... more Patients with rheumatoid arthritis (RA) should be treated in close cooperation between GPs and rheumatologists and following treatment guidelines. In this study, we analyse the utilization of health care among patients with RA and explain the determinants of the frequency of use of GP and rheumatologist services. A random sample (n = 1259) of adult Estonian patients with RA was investigated in 2007. A pre-structured questionnaire included questions regarding respondents&amp;amp;amp;#39; socio-economic status, quality of life, self-reported use of health care, time, distance and financial aspects of access to health care. The impact of the variables on the frequency of use of health care was analysed with regression analysis. Use of GP services was higher among people who lived outside the capital, had more health problems and experienced disability due to their RA. Time and distance limits had an effect on the frequency of use of both primary and specialist care. A shorter waiting time to the GP and a longer waiting time to the rheumatologist were associated with more frequent use of GP services, but a shorter waiting time to the rheumatologist was related to more frequent visits to the rheumatologist. Patient&amp;amp;amp;#39;s costs were not associated with the frequency of health care use. Use of health care among people with RA depends primarily upon doctors&amp;amp;amp;#39; waiting times, patients&amp;amp;amp;#39; place of residence and their health status. The GP has a significant role in the management of RA patients, especially for those who have multiple health problems and those living in rural areas.
Disability and Rehabilitation, 2012
To explain the determinants of adaptation with disease and self-management of patients with rheum... more To explain the determinants of adaptation with disease and self-management of patients with rheumatoid arthritis (RA) in Estonia, focusing on the use of assistive devices, home adjustments and the need for external help. A random sample (n = 1259) of adult Estonian RA patients was selected from the Estonian Health Insurance Fund Database. The patients completed a self-administered questionnaire, which included information about their socio-demographic and disease characteristics, the costs of care, quality of life, use of assistive devices, home adjustments and the need for external help. Regression analysis was used to analyse the predictors of patient&amp;amp;amp;#39;s adaptation with disease and self-management. Twenty-six percent of the respondents used assistive devices, 20% had made home adjustments and 37% needed external help. Disabilities and physical impairments predicted the use of assistive devices, home adjustments and the need for external help. The use of medical rehabilitation services predicted the less frequent use of assistive devices, while female gender and single status predicted a more expressed need for external help. Disability and physical impairment are the most important determinants of the use of various technical aids and home adjustments. These factors, along with the female gender and single status of the patient, predict help-dependence.
Health Promotion International, 2007
The health-promoting hospitals (HPH) movement in Estonia was initiated in 1999. This study aimed ... more The health-promoting hospitals (HPH) movement in Estonia was initiated in 1999. This study aimed to compare the implementation of health-promoting and quality-related activities in HPH and those which have not joined the HPH network (non-HPH). In the beginning of 2005, a postal survey was conducted among the top managers of 54 Estonian hospitals. The questionnaire was based on the WHO standards for HPH and on the set of the national quality assurance (QA) requirements for health services. The study demonstrated some significant differences in the uptake of health promotion and QA activities between HPH and non-HPH. For example, regular patient satisfaction studies were conducted in 83% of HPH and 46% of non-HPH (P , 0.03) and 65% of HPH and 46% of non-HPH cooperated with various patient organizations (P , 0.03). Systems for reporting and analysis of complications were implemented in 71% of HPH and 33% of non-HPH (P , 0.03); also, the implementation of various guidelines was more developed in HPH. All HPH have carried out a risk analysis on the workplace and staff job satisfaction studies were conducted in 89% of HPH and 41% non-HPH (P , 0.05). This study indicates that the concepts of HPH and QA are closely related. Making progress in health promotion is accompanied with QA and vice versa. Implementation of health-promoting activities in hospitals will promote the well-being and health of patients and hospital staff, and creates a supportive environment to provide safe and high-quality health services.
Stomatologija / issued by public institution "Odontologijos studija" ... [et al.], 2014
The aim of the study was to explore the role of managerial style, work environment factors and bu... more The aim of the study was to explore the role of managerial style, work environment factors and burnout in determining job satisfaction during the implementation of quality improvement activities in a dental clinic. Quantitative research was carried out using a prestructured anonymous questionnaire to survey 302 respondents in Kaarli Dental Clinic, Estonia. Dental clinic staff assessed job satisfaction, managerial style, work stress and burnout levels through the implementation period of ISO 9000 quality management system in 2003 and annualy during 2006-2009. Binary logistic regression was used to explain the impact of satisfaction with management and work organisation, knowledge about managerial activities, work environment and psychosocial stress and burnout on job satisfaction. The response rate limits were between 60% and 89.6%. Job satisfaction increased significantly from 2003 to 2006 and the percentage of very satisfied staff increased from 17 to 38 (p<0.01) over this perio...
Central European journal of public health, 2009
The aim of the study was to analyse the self-reported use of health services among the older Esto... more The aim of the study was to analyse the self-reported use of health services among the older Estonian population, to explain the predictors of health care utilisation and to study access to health services in comparison with other population groups. In November 2005, a randomly sampled Estonian residents aged 15-64 (n=1264) and 65-74 (n=182) was personally interviewed using structured questionnaires. Of the respondents aged 65-74, 81% reported having visited a general practitioner (GP) or specialist during the previous 12 months. Compared to younger people they used health services more often, except dental care. No significant differences were found in comparison with the waiting times to see the general practitioner or specialist between the younger and older population groups. Compared to the rest of the population people aged 65-74 were more satisfied with their access to health services. The probability of visiting a GP was higher for those respondents who had health problems a...
TheScientificWorldJournal, 2012
In this cross-sectional study we explained the possible determinants of satisfaction with access ... more In this cross-sectional study we explained the possible determinants of satisfaction with access to health services in patients with rheumatoid arthritis (RA). Of the 2000 randomly selected Estonian adult patients with RA, a total 1259 completed the survey. Regression analysis was used to analyse the predictors of patients' satisfaction with access to health services. Half of the respondents were satisfied with their access to health services. Factors that had a negative impact on satisfaction included pain intensity, longer waiting times to see the doctors, as well as low satisfaction with the doctors. Transportation costs to visit a rheumatologist and higher rehabilitation expenses also affected the degree of satisfaction. Patients who could choose the date and time at which they could visit the rheumatologist or who could visit their "own" doctor were more likely to be satisfied than patients whose appointment times were appointed by a healthcare provider.
Croatian medical journal, 2004
To analyze the population's view of the primary health care reform five years after the forma... more To analyze the population's view of the primary health care reform five years after the formal implementation of the reform investigating the acceptability of the primary health care system, patients' preferences, and satisfaction with their family doctors. Face-to-face interviews using structured questionnaires were preformed with a random sample of the Estonian residents aged 15-74 years (n=999). Out of 999 respondents, 35% prefer to first see their family doctor and if necessary to get a referral or a recommendation to see a specialist. The referral to the specialist by the family doctor is more preferred by older respondents, rural people, by the respondents with a lower level of education and income as well as by people who were more satisfied with their family doctor. The people who were more satisfied with their family doctor found that the whole health care system was functioning better than the previous primary health care system. Out of all the respondents who have...
Croatian medical journal, 2004
To investigate the accessibility of family doctors in Estonia from the patients' point of vie... more To investigate the accessibility of family doctors in Estonia from the patients' point of view. Face to face interviews using structured questionnaires were performed. A random sample of the Estonian residents, aged 15-74 years, was studied (n=999). The number of visits provided by family doctors has been continuously increasing since 1998. Out of 999 respondents, 59% visited the family doctor during the previous 12 months. The average number of visits per Estonian resident in one year is 2.48. Out of 999 interviewed persons, 72% said that they had a possibility of contacting their family doctor by phone. The waiting time for an appointment was short in most cases. The family doctor admitted 60% of the respondents on the same day the patients had requested; 22% of the patients were admitted within 1-2 days and 9% of the patients were admitted within 3-4 days. Only 9% of them had to wait more than 5 days. The current home visit fee in Estonia would have affected the decision of t...
Nursing Research and Practice, 2013
The world population is rapidly aging. Between 2000 and 2050, the proportion of the world's popul... more The world population is rapidly aging. Between 2000 and 2050, the proportion of the world's population over 60 years will double from about 11% to 22%. The absolute number of people aged 60 years and over is expected to increase from 605 million to 2 billion over the same period . Although more developed countries have the oldest population profiles, the vast majority of older people-and the most rapidly aging populations-are in less developed countries. Between 2010 and 2050, the number of older people in less developed countries is projected to increase more than 250 percent, compared with a 71-percent increase in the developed countries .
Scandinavian Journal of Rheumatology, 2007
Rheumatology International, 2014
The objective of this paper was to find out how many patients with rheumatoid arthritis (RA) know... more The objective of this paper was to find out how many patients with rheumatoid arthritis (RA) know about several aspects of disease, to explain the associations between the level of self-rated knowledge and patients&amp;amp;amp;#39; background and health status and to compare the importance of the main sources of information. A random sample (n = 1,259) of adult Estonian RA patients was selected from the Estonian Health Insurance Fund Database. The patients completed a self-administered questionnaire, which included information about their socio-demographic and disease characteristics, use of health services, information about the disease, and sources of information. Regression analysis was used to calculate the associations between the independent variables and level of self-rated knowledge about several aspects of RA. The results of the study indicated that the self-reported ratings of knowledge about the disease in Estonian RA patients were rather low. Health professionals were mentioned as the primary sources of information, but the longer disease history and more frequent use of health services as considerable predictors of higher ratings of knowledge refer to role of personal experience in obtaining knowledge about the disease as well.
Rheumatology International, 2012
Rheumatoid arthritis (RA) is a chronic, progressive, debilitating disease that demands continuous... more Rheumatoid arthritis (RA) is a chronic, progressive, debilitating disease that demands continuous therapy with multiple medications. Noncompliance with disease-modifying drugs may cause disease flares, preventable functional impairment, unnecessary treatment changes, and loss of health care resources. The aim of the current study was to explore self-reported compliance with treatment and the factors contributing to this compliance using a representative sample of an RA patient population in Estonia. Two thousand patients diagnosed with RA were randomly selected from the Estonian Health Insurance Fund database. The eligible response rate of the study was 60%. Using prestructured questionnaires, the following information about the disease and treatment was evaluated: self-reported compliance with treatment, reasons for noncompliance, disease history, sociodemographic variables, health care utilization, and satisfaction with health care providers. The self-reported compliance rate was 80.3%, reflecting the percentage of patients who reported that they always took their medications exactly as described. The most often reported reasons for noncompliance were side effects and fear of side effects. Compliance was found to be the lowest in a group of younger and active patients with higher income. Higher frequency of visits to the rheumatologist, satisfaction with health care providers, and sufficient information about RA treatment correlated with better compliance.
Journal of Clinical Nursing, 2010
To describe rheumatoid arthritis patients&amp;amp;amp;#39; perceptions of being informed ... more To describe rheumatoid arthritis patients&amp;amp;amp;#39; perceptions of being informed and of the value of the information obtained. About the accessibility of the disease-specific information to the patients, a prerequisite for any kind of the patient empowerment, can be considered as a priority area for investigation. Six focus groups (involving 27 patients) were conducted. For analysing the data, thematic analysis was applied. The participants referred to the media and the Internet, in-patient units, physicians at out-patient consultations, patients organisations, fellow patients and their own experience as the sources of disease-related information. The information delivered by the physicians was valued highest; satisfaction with the information received from the in-patient units was expressed. The knowledge acquired through the experience was mentioned as being important for coping with the disease. The media was an easily accessible information channel, although the information from this source was less trusted. The access to the Internet was seen as being limited for certain patients groups. The availability of physician-delivered information was described as unsatisfactory due to the organisation of information transmittal in out-patient settings. The results indicated the current balance of information sources as being incongruous with the provision of systematic and reliable disease-related information. The available information may also be qualitatively incomplete. Recognition of the weak and strong points of the structure of information provision is valuable when considering the development of educational opportunities for rheumatoid arthritis patients.
International Journal for Quality in Health Care, 2006
To assess the quality of the Estonian health system with the assessment tool provided by the Worl... more To assess the quality of the Estonian health system with the assessment tool provided by the World Health Organization (WHO). Situation analysis of health care quality using the self-assessment questionnaire proposed by the Council of Europe and WHO Regional Office for Europe as a framework for evaluating national quality activities. Estonia. Four domains for evaluating the national quality activities: policy, organization, methods, and resources. The quality policy of Estonian health care developed in the late 1990s defines the scope of quality and reflects the different viewpoints of stakeholders. Nevertheless, it is not comprehensive enough, activities planned for the involvement of consumers in defining and assessing quality are lacking, and key roles of institutions in quality improvement and incentives for quality are not clearly defined. At present, the responsibilities for quality assurance are distributed among the different stakeholders, but there is no single coordinating structure or mechanism for facilitating or assessing the implementation of the quality activities. Many regulations are established to assure the quality of health services and to protect patients&amp;amp;amp;amp;amp;#39; rights, but the implementation of voluntary mechanisms for quality assurance should be promoted. Access to the sources of information is good, but there is a shortage of unified quality and performance indicators at the national level. The results of this study indicated the strengths and shortages of the present organization of quality activities in Estonia and the ways for improvement. Strengthening coordination with explicit quality monitoring was found as a key factor for improvement.
International Journal for Quality in Health Care, 2004
To evaluate the level of job satisfaction among the staff at an Estonian hospital and to describe... more To evaluate the level of job satisfaction among the staff at an Estonian hospital and to describe factors related to their job satisfaction.
International Journal for Quality in Health Care, 2000
To find out how Estonian people evaluate the changes in primary health care (PHC), how they perce... more To find out how Estonian people evaluate the changes in primary health care (PHC), how they perceive the acceptability of the new PHC system, and to assess patients' satisfaction with their primary care doctor. Face-to-face interviews using structured questionnaires. Estonia. A random sample of Estonian residents aged 15-74 years (n = 997). Acceptability of PHC system (accessibility, the patient-practitioner relations, amenities, and patient's preferences) and patients' satisfaction with primary care doctor. Of the 997 respondents, 46% were sufficiently informed about the transition to the general practitioner (GP)-based PHC system; however, 45% of respondents had not personally experienced any changes. Of the 997 persons interviewed, 68% were registered on the patient list of a GCP, and 62% of those who had health problems preferred to consult the primary care doctor first. The waiting time for an outpatient appointment was brief (0-2 days). Of the 997 respondents, 68% were satisfied with their primary care doctor. Satisfaction was dependent on: (i) how patients evaluated the competence of the physician; (ii) comprehensibility of doctor's explanations; and (iii) comfort of the clinic. The right of patients to choose their own primary care doctor and having sufficient information about the changes in PHC system had a positive influence on the level of satisfaction. Patients' opinions are important in the evaluation of PHC. To increase the level of satisfaction, people need to understand the nature and intent of the primary care reforms. Personal choice of primary care doctor and good patient-doctor relationships are important factors too.
Health Policy, 2013
This study aims to compare the organisation of primary care (PC) systems in Estonia, Latvia and L... more This study aims to compare the organisation of primary care (PC) systems in Estonia, Latvia and Lithuania, focusing on the structure and process of service delivery, and to discuss the suitability of the PHAMEU instrument for international comparison of PC systems. The data were collected in the framework of PHAMEU project during 2009-2010. The selected indicators were used to describe and compare the structure and process of PC in Estonia, Latvia and Lithuania. The results showed that the coordination of PC services, legislative framework, service delivery, quality requirements and PC financing principles are rather similar in all three Baltic countries. Population coverage for PC services, cost sharing for some services, and the employment status of family doctors differs by country. The PHAMEU instrument was most applicable for the description and comparison of the structure of PC and some aspects of the process. Information about patient outcome and quality of care was neither available nor reliable enough. The development of PC systems in Baltic countries has been rather similar, but some aspects also differ between the countries. Use of a standardized instrument allows for international comparison, but assumes standardised data collection procedures in comparable countries.
Health Policy, 2003
To evaluate whether choosing one's own primary care doctor is associated with patient sat... more To evaluate whether choosing one's own primary care doctor is associated with patient satisfaction with primary health care. To evaluate factors related to population's satisfaction with primary health care. A random sample of Estonian adult population (N=997). Cross-sectional study using a pre-categorized questionnaire which was compiled by the research group of the University of Tartu and the research provider EMOR. Altogether 68% of the respondents had been listed in their personal physician. Their overall satisfaction with the physician as well as satisfaction with several aspects of primary health care were significantly higher compared with those of unregistered respondents. Although some other factors (practice size, patient age, health status) also influenced patient satisfaction, presence of a personal physician appeared the most important predictor of high satisfaction with physician's punctuality and understanding, effectiveness of prescribed therapy, clarity of explanations given by the physician as well as with overall satisfaction with the physician. Personal doctor system is associated with patient satisfaction with different aspects of care.
Health Policy, 2007
After the implementation of the primary health care reform in Estonia, most of chronic conditions... more After the implementation of the primary health care reform in Estonia, most of chronic conditions are managed by family doctors (FD) in collaboration with specialists. Although the general population has demonstrated the increase in satisfaction with health care after the reform, it has been questioned if people with chronic diseases have been left on a more disadvantaged position in the new system with some restrictions in the access to specialists. To investigate the satisfaction of people with chronic conditions with the access to the health services and compare them to those who did not have a chronic illness. In November 2005, a random sample of Estonian residents aged 15-74 were personally interviewed using structured questionnaires (n=1446), 29% of them reported to have a chronic illness. The people with chronic conditions were less satisfied with the access to the health services. They were more satisfied with their family doctors, but less with the health insurance system and they often reported their problems in seeing the specialist. Compared to other respondents, the people with chronic conditions visited their FDs and specialists more often, but no significant differences were found between their waiting times to see the FD or a specialist. In Estonia, the people with chronic conditions do not have organisational barriers in their access to the health services. As frequent users of health services, they perceive the shortages of the health system more obviously than the rest of the population and it may reflect their satisfaction with the different aspects of the health system as well as the access to the health services.
Family Practice, 2012
Patients with rheumatoid arthritis (RA) should be treated in close cooperation between GPs and rh... more Patients with rheumatoid arthritis (RA) should be treated in close cooperation between GPs and rheumatologists and following treatment guidelines. In this study, we analyse the utilization of health care among patients with RA and explain the determinants of the frequency of use of GP and rheumatologist services. A random sample (n = 1259) of adult Estonian patients with RA was investigated in 2007. A pre-structured questionnaire included questions regarding respondents&amp;amp;amp;#39; socio-economic status, quality of life, self-reported use of health care, time, distance and financial aspects of access to health care. The impact of the variables on the frequency of use of health care was analysed with regression analysis. Use of GP services was higher among people who lived outside the capital, had more health problems and experienced disability due to their RA. Time and distance limits had an effect on the frequency of use of both primary and specialist care. A shorter waiting time to the GP and a longer waiting time to the rheumatologist were associated with more frequent use of GP services, but a shorter waiting time to the rheumatologist was related to more frequent visits to the rheumatologist. Patient&amp;amp;amp;#39;s costs were not associated with the frequency of health care use. Use of health care among people with RA depends primarily upon doctors&amp;amp;amp;#39; waiting times, patients&amp;amp;amp;#39; place of residence and their health status. The GP has a significant role in the management of RA patients, especially for those who have multiple health problems and those living in rural areas.
Disability and Rehabilitation, 2012
To explain the determinants of adaptation with disease and self-management of patients with rheum... more To explain the determinants of adaptation with disease and self-management of patients with rheumatoid arthritis (RA) in Estonia, focusing on the use of assistive devices, home adjustments and the need for external help. A random sample (n = 1259) of adult Estonian RA patients was selected from the Estonian Health Insurance Fund Database. The patients completed a self-administered questionnaire, which included information about their socio-demographic and disease characteristics, the costs of care, quality of life, use of assistive devices, home adjustments and the need for external help. Regression analysis was used to analyse the predictors of patient&amp;amp;amp;#39;s adaptation with disease and self-management. Twenty-six percent of the respondents used assistive devices, 20% had made home adjustments and 37% needed external help. Disabilities and physical impairments predicted the use of assistive devices, home adjustments and the need for external help. The use of medical rehabilitation services predicted the less frequent use of assistive devices, while female gender and single status predicted a more expressed need for external help. Disability and physical impairment are the most important determinants of the use of various technical aids and home adjustments. These factors, along with the female gender and single status of the patient, predict help-dependence.
Health Promotion International, 2007
The health-promoting hospitals (HPH) movement in Estonia was initiated in 1999. This study aimed ... more The health-promoting hospitals (HPH) movement in Estonia was initiated in 1999. This study aimed to compare the implementation of health-promoting and quality-related activities in HPH and those which have not joined the HPH network (non-HPH). In the beginning of 2005, a postal survey was conducted among the top managers of 54 Estonian hospitals. The questionnaire was based on the WHO standards for HPH and on the set of the national quality assurance (QA) requirements for health services. The study demonstrated some significant differences in the uptake of health promotion and QA activities between HPH and non-HPH. For example, regular patient satisfaction studies were conducted in 83% of HPH and 46% of non-HPH (P , 0.03) and 65% of HPH and 46% of non-HPH cooperated with various patient organizations (P , 0.03). Systems for reporting and analysis of complications were implemented in 71% of HPH and 33% of non-HPH (P , 0.03); also, the implementation of various guidelines was more developed in HPH. All HPH have carried out a risk analysis on the workplace and staff job satisfaction studies were conducted in 89% of HPH and 41% non-HPH (P , 0.05). This study indicates that the concepts of HPH and QA are closely related. Making progress in health promotion is accompanied with QA and vice versa. Implementation of health-promoting activities in hospitals will promote the well-being and health of patients and hospital staff, and creates a supportive environment to provide safe and high-quality health services.