Vasile Cepoi - Academia.edu (original) (raw)
Papers by Vasile Cepoi
Management in Health, 2016
During the first cycle of hospitals accreditation, which was conducted between July 2011 and July... more During the first cycle of hospitals accreditation, which was conducted between July 2011 and July 2016, a number of 433 hospitals went through the evaluation process. The measurement tools of compliance were the indicators included in The Accreditation Standards, realized by The National Commission of Hospitals Accreditation. From all the 433 hospitals that went through the process of evaluation of the first accreditation cycle, a number of 4 did not achieve the compliance of 45% and were declared unaccredited. The first hospital accreditation cycle was divided into three stages, according to the method of validating the indicators and to the method of calculating the the level of compliance: June 2011 - October 2014, October 2014 - September 2015, September 2015-June 2016. In the first phase, it have been assessed a number of 77 hospitals, in the second cycle a total of 182 hospitals and, in the third cycle, a total of 174 hospitals. During this process, certain problems were revea...
The prevalance of chronic kidney disease (CKD) continues to increase worldwide, and despite treat... more The prevalance of chronic kidney disease (CKD) continues to increase worldwide, and despite treatment advances, it remains an important global public health issue. Decision makers must account for multiple therapeutic options, comorbidities and complications. In the present review we aimed to synthesize the various public health approches to CKD control and compare them to the national policy in order to highlight key issues and possible solutions. Keywords: chronic kidney disease, prevalence, health systems, informatization informatizare.Prevalența bolii cronice de rinichi (BCR) este în continuă creștere și, în ciuda progreselor terapeutice, rămâne o importantă problemă de sănătate publică. Factorii decizionali trebuie să țină cont de multiplele opțiuni terapeutice, comorbidități și complicații ale BCR. Pentru a evidenția problemele principale și a oferi posibile soluții în managementul BCR, au fost sintetizate abordările sistemelor de sănătate internațional...
The problem of defining the Basic Medical Service Pack (BMSP) has been on the public agenda since... more The problem of defining the Basic Medical Service Pack (BMSP) has been on the public agenda since the introduction of the compulsory health insurances as a tertiary source of payment for illness care. The cost is determined by its contents and especially by its degree of usage which, in its turn, is influenced by the payment mechanisms and by possibilities of payment. No balance has been achieved yet. The payment capacity (incomes) has always been lower than the expenses generated by the medical services. Health revenues have two main sources: the unique national fund of health insurances (UNFHI) and the state budget. The UNFHI contribution should cover the expenses for services provided to diagnose and treat the insured patients who pay, while the state budget incomes should be granted to those patients that are exempted from paying insurances, should ensure financial support for personal contributions that the insured have to pay for some medicine, medical devices or other service...
Ovidius University Annals: Economic Sciences Series, 2019
Council of Europe, starting with 2000, emphasized that the improvement of the quality system is a... more Council of Europe, starting with 2000, emphasized that the improvement of the quality system is a set of integrated and planned activities and measures at various levels in the health care organization, aimed at continuously assuring and improving the quality of patient care. The quality management system, irrespective of the level of approach (organizational, local, national, European), needs to be implemented, assessed and, above all, developed on the basis of standards and practice models. The purpose of this analysis is to emphasise the fact that quality improvement efforts and the support of the management/decision-makers are the key drivers of quality and patient safety improvement at any level of the health system. Based on the latest theoretical and practical considerations, we could say that is necessary to evaluate continuously not only the results obtained from the analyses of the quantitative and qualitative data, but also the tools used in the field of quality managemen...
Introduction. This report describes the current status of nephrology and renal replacement therap... more Introduction. This report describes the current status of nephrology and renal replacement therapy (RRT) in Romania, a country with previously limited facilities, highlighting national changes in the European context. Methods. Trends in RRT development were analysed in 2003, on a national basis, using the same questionnaires as in previous surveys (1991, 1995). Survival data and prognostic risk factors were calculated retrospectively from a large representative sample of 2284 patients starting RRT between January 1, 1995 and December 31, 2001 (44% of the total RRT population investigated). Results. In 2003, RRT incidence [128 per million population (p.m.p.)] and prevalence (250 p.m.p.) were six and five times higher, respectively, than in 1995. The annual rate of increase in the stock of RRT patients (11%) was supported mainly by an exponential development of the continuous ambulatory peritoneal dialysis (CAPD) population (þ600%), while the haemodialysis (HD) growth rate was stable (þ33%) and renal transplantation made a marginal contribution. Renal care infrastructure followed the same trend: nephrology departments (þ100%) and nephrologists (þ205%). The characteristics of RRT incident patients changed accordingly to current European epidemiology (increasing age and prevalence of diabetes and nephroangiosclerosis). The estimated overall survival of RRT patients in Romania was 90.6% at 1 year [confidence interval (CI) 89.4-91.8] and 62.2% at 5 years (CI 59.4-65.0). Patients' survival was negatively influenced (Cox regression analysis) by age >65 years (P<0.001), lack of pre-dialysis monitoring by a nephrologist [P ¼ 0.01, hazards ratio (HR) ¼ 0.8], severe anaemia, lack of erythropoetin treatment (P<0.001, HR ¼ 0.6), and co-morbidity, e.g. cardiovascular diseases (P<0.001, HR ¼ 1.8) and diabetes mellitus (P<0.001, HR ¼ 2.2). Conclusions. Although the rate of increase in RRT patient stock in 1996-2003 in Romania was the highest in Europe, the prevalence remained below the European mean. As CAPD had the greatest expansion, followed by HD, an effective transplantation programme must be set up to overcome the imbalance. The quality of RRT appears to be good and survival was similar to that in other registries. Further evolution implies strategies of prevention, based on national surveys, supported by the Romanian Renal Registry.
Management in Health, 2015
The prevalance of chronic kidney disease (CKD) continues to increase worldwide, and despite treat... more The prevalance of chronic kidney disease (CKD) continues to increase worldwide, and despite treatment advances, it remains an important global public health issue. Decision makers must account for multiple therapeutic options, comorbidities and complications. In the present review we aimed to synthesize the various public health approches to CKD control and compare them to the national policy in order to highlight key issues and possible solutions. Keywords: chronic kidney disease, prevalence, health systems, informatization informatizare. Normal 0 21 false false false RO X-NONE X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin-top:0cm; mso-para-margin-right:0cm; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0cm; line-height:115%; mso-pagination:widow-or...
Management in Health, 2017
During the first cycle of hospitals accreditation, which was conducted between July 2011 and July... more During the first cycle of hospitals accreditation, which was conducted between July 2011 and July 2016, a number of 433 hospitals went through the evaluation process. The measurement tools of compliance were the indicators included in The Accreditation Standards, realized by The National Commission of Hospitals Accreditation. From all the 433 hospitals that went through the process of evaluation of the first accreditation cycle, a number of 4 did not achieve the compliance of 45% and were declared unaccredited. The first hospital accreditation cycle was divided into three stages, according to the method of validating the indicators and to the method of calculating the the level of compliance: June 2011 - October 2014, October 2014 - September 2015, September 2015-June 2016. In the first phase, it have been assessed a number of 77 hospitals, in the second cycle a total of 182 hospitals and, in the third cycle, a total of 174 hospitals. During this process, certain problems were revea...
Indo Global Journal of Pharmaceutical Sciences, 2017
Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis, 2006
Background This report describes the status of renal replacement therapy (RRT), particularly cont... more Background This report describes the status of renal replacement therapy (RRT), particularly continuous ambulatory peritoneal dialysis (CAPD), in Romania (a country with previously limited facilities), outlines the fast development rate of CAPD, and presents national changes in a European context. Methods Trends in the development of RRT were analyzed in 2003 on a national basis using annual center questionnaires from 1995 to 2003. Survival data and prognostic risk factors were calculated retrospectively from a representative sample of 2284 patients starting RRT between 1 January 1995 and 31 December 2001 (44% of the total RRT population investigated). Results The annual rate of increase in the number of RRT patients (11%) was supported mainly by an exponential development of the CAPD population (+600%); the hemodialysis (HD) growth rate was stable (+33%) and renal transplantation had a marginal contribution. The characteristics of both HD and PD incident patients changed according ...
Introduction: Patients’ satisfaction was extensively researched over the last decades, given its ... more Introduction: Patients’ satisfaction was extensively researched over the last decades, given its role in building loyalty, compliance to treatment, prevention, and eventually higher levels of wellbeing and improved health status. Patients’ feedback on the perceived quality of health services can be incorporated into practice; therefore, understanding factors and mechanisms responsible for patients’ satisfaction allows providers to tailor targeted interventions. Method: A questionnaire assessing patients’ perception of the quality of health services was administered to a country-representative sample of 1500 Romanian patients. Using a partial least squares—path modeling approach (PLS-PM), with cross-sectional data, we developed a variance-based structural model, emphasizing the mediating role of trust and satisfaction with various categories of health services. Results: We confirmed the mediating role of trust in shaping the relationship between the procedural accuracy of health prof...
Revista Romana De Bioetica, Nov 2, 2014
In this study we focused on the ethical dilemmas that confront physicians while approaching thera... more In this study we focused on the ethical dilemmas that confront physicians while approaching therapeutical management of elderly patients, especially those exposed to polypragmasy and iatrogeny. We explore the main universal ethical principles such as autonomy, beneficence, non-maleficence, justice and equity and the challenges the medical team faces while trying to reconcile them with several particular aspects characteristic to elderly patients such as: fragility, disability, comorbidity, cognitive and functional impairment, and a greater risk of polypharmacy, polypragmasy, and iatrogeny. Building a strong physician – patient relationship based on mutual trust and respect is the key to understanding the needs and desires of the elderly, which may be completely different from other age groups, and their possibilities to adhere to medical recommendations. Multidisciplinary teams, representing professionals from diverse disciplines coordinated by the general practitioner and/or the geriatrician should help solving difficult ethical dilemmas.
Revista Romana De Bioetica, Jan 23, 2014
Romania has one of the highest mortality and morbidity ratio from EU together with one of the hig... more Romania has one of the highest mortality and morbidity ratio from EU together with one of the highest number of hospital admissions per 100 inhabitants. As regards the outpatients’ consultations and treatments, important for the application of the medical prevention model, Romania has one of the lowest rates in Europe, about 6 %, below the EU average of almost 15%.This explains, in part, the high consumption of inpatient services,with reduced emphasis on the medical prevention of the main cause of mortality, the cardio-vascular diseases which are responsible for over 60% of all deaths recorded annually. For a significant reduction in cardiovascular mortality in Romania primary prevention measures- specific to public health- are necessary, together with medical prevention for individuals with proved changes in relevant biological constants. In order to reduce the cardiovascular mortality with 25%, by the 2025 year, in accordance with the WHO objective in this field, a multisectoral and integrated approach is needed; this approach needs to see health as an investment and to promote, besides clinical services, measures of an overall and sustained impact on major risk factors, both at the population and individual level
Management in Health, Jun 27, 2014
The problem of defining the Basic Medical Service Pack (BMSP) has been on the public agenda since... more The problem of defining the Basic Medical Service Pack (BMSP) has been on the public agenda since the introduction of the compulsory health insurances as a tertiary source of payment for illness care. The cost is determined by its contents and especially by its degree of usage which, in its turn, is influenced by the payment mechanisms and by possibilities of payment. No balance has been achieved yet. The payment capacity (incomes) has always been lower than the expenses generated by the medical services. Health revenues have two main sources: the unique national fund of health insurances (UNFHI) and the state budget. The UNFHI contribution should cover the expenses for services provided to diagnose and treat the insured patients who pay, while the state budget incomes should be granted to those patients that are exempted from paying insurances, should ensure financial support for personal contributions that the insured have to pay for some medicine, medical devices or other services provisioned by the framework contract on whose basis the contractual relationships within the system are carried out. The analysis of BMSP should take into account the elements that define the BMSP: the list of discounted services; the way services are accessed by the insured; the means of contracting; means of payment. In the Romanian context, the basic medical service pack has to be reconfigured in order to develop the payment and control mechanisms that allow for improvement in health indices, for higher expense effectiveness, that are easily controlled, that do not trigger inflation of services and stimulate the healthcare professionals to achieve the best results.
Mediterranean Journal of Social Sciences, 2013
This study aims to discuss the idea of decentralization process of local authorities in Albania a... more This study aims to discuss the idea of decentralization process of local authorities in Albania and also its impact on territorialadministrative organization. Using her experience of several years in audit structures of local government, the author of this study intends to show how much and how has affected the territorial division in the absence of efficiency of public services provided by local authorities. Why the governments (even though the issue of territorial reorganization was their priority) could not do anything in this regard in years? Albania's territorial reorganization, in the current stage when the decentralization reform has entered the third phase of its development is closely related to regional development of the territory. Both (as reorganization and regional development) require the design and implementation of macroeconomic strategies based on detailed analysis of costs and efficiency of public services provided by local governments, harmonizing the instruments in implementing the economic policies of general government (local and central government), but without affecting in any way the principle of decentralization.
Nephrology Dialysis Transplantation, 1997
performed (8 and 4%). The cost of HD treatment in Romania (87 USD) is low, even though dialyser r... more performed (8 and 4%). The cost of HD treatment in Romania (87 USD) is low, even though dialyser reuse Background. In the context of the transformation of the Health Systems of Central and Eastern European is not common practice. Conclusions. The increase in renal replacement therapy countries, the role of professional associations is increasing, especially as regards data collection, ana-in Romania was mainly due to the expansion of the number of haemodialysis centres. Although a signific-lysis, and implementation of programmes for development of nephrology and renal replacement therapy ant progress was realized, only one-third of the patients needing RRT could be treated in Romania in 1995. (RRT). Methods. The Romanian Renal Registry sent question-Key words: renal replacement therapy; chronic renal naires to the heads of Haemodialysis and Nephrology failure epidemiology; chronic haemodialysis costs; Centres. The need for renal replacement therapy was renal transplantation; Romania deduced from the annual incidence (127 patients p.m.p.) of chronic renal failure. Results. Although the rates of increase in the numbers of Nephrology Departments (+82%), HD Centres Introduction (+142%), and total number of patients alive on RRT (+196%) from 1991 to 1995 were higher than the The Health Systems of Central and Eastern European European mean, only 27-30% of the incident patients countries are undergoing a complex process of trans-(459 of 1000-1200 patients) could be provided with formations which, ideally, should lead to a more RRT. Sixty-two percent of the need for RRT in the flexible, efficient, and less expensive means of providing age group 25-44 years was met, while only 20% of health care. This process is supposed to be based on a children (age<15 years) and people over 55 years realistic view of the population's need and the available requiring RRT received this treatment. Primary renal resources. diseases in patients on RRT were glomerulonephritis In Romania, medicine is confronted with inconsist-(49%) or interstitial nephropathies (23%); diabetic ent legislation and deficient funding. The surging internephropathies, nephroangiosclerosis and systemic disest in nephrology and renal replacement therapy eases were rare (4, 2, and 1% respectively). Most of (RRT) obliged Romanian physicians to face many the CRF patients (88%) were treated by HD. Renal novel medical, technical, economic and ethical transplantation and peritoneal dialysis were seldom problems. Expensive treatments impose judicious and some-Correspondence and offprint requests to: Prof. Dr. N. Ursea, 'Carol times subtle decisions at the national level. Virtually Davila' Teaching Hospital of Nephrology, Calea Griviţei 4, Bucureşti all nephrological activities in Romania are dependent 1, CP 79804, Romania.
International Urology and Nephrology, 2011
Introduction Chronic kidney disease (CKD) is a major public health problem worldwide, due to its ... more Introduction Chronic kidney disease (CKD) is a major public health problem worldwide, due to its epidemic proportions and to its association with high cardiovascular risk. Therefore, screening for CKD is an increasingly important concept, aiming for early detection and prevention of progression and complications of this disease. Materials and methods We studied the prevalence of CKD in the adult population of Iaşi, the largest county in Romania, based on the results of a national general health screening program from 2007 to 2008. The patients were tested for CKD with serum creatinine and urinary dipstick. We used two different methods to estimate the glomerular filtration rate (eGFR): the simplified Modification of Diet in Renal Disease (MDRD) and the CKD Epidemiology Collaboration (CKD-EPI) equations. Based on the Kidney Disease Improving Global Outcomes (KDIGO) criteria, we defined CKD as the presence of either eGFR \ 60 ml/min/1.73 m 2 and/or dipstick proteinuria. The classification of CKD by stage was also done according to the KDIGO criteria. Results The study population included 60,969 people. The global prevalence of CKD was found to be 6.69% by the MDRD formula and 7.32% when using the CKD-EPI equation. The prevalence of CKD was much higher in women than in men: 9.09% versus 3.7%, by MDRD, and 9.32% versus 4.85%, by CKD-EPI. By age groups, the prevalence of CKD was 0.95% and 0.64% in persons aged 18-44 years old, 4.27% and 3.57% (45-64 years old), 13.36% and 15.34% (65-79 years old), and 23.59% and 34.56% ([80 years old), according to MDRD and CKD-EPI, respectively. By stages, the prevalence of CKD stage 3a (eGFR 59 to 45 ml/min/1.73 m 2) was 5.72% by MDRD and 5.96% according to CKD-EPI, whereas the prevalence of stages 3b, 4, and 5 taken together (eGFR \ 45 ml/min/1.73 m 2) was 0.96% (MDRD) and 1.35% (CKD-EPI). Patients with CKD were significantly older (71.0 years versus 53.7 years) and had lower levels of serum Hb, total cholesterol, and glutamic pyruvic transaminase, and significantly higher serum creatinine and blood glucose, in comparison with the individuals without CKD. Impaired fasting glucose (106 mg/dl) was found in the CKD population, but not in non-CKD individuals. Conclusions Our study is one of the largest ever reported on the prevalence of CKD worldwide, the first one in Romania, and one of the very few of its kind in Europe (particularly in Eastern Europe).
Internal Medicine Journal, 2014
The proportion of older people in the general population is steadily increasing worldwide, with t... more The proportion of older people in the general population is steadily increasing worldwide, with the most rapid growth in low and middle-income countries. 1 This demographic change is to be celebrated, because it is the consequence of socioeconomic development and better life expectancy. However, population ageing also has important implications for society-in diverse areas including health systems, labour markets, public policy, social programmes and family dynamics. 2 A successful response to the ageing population will require capitalising on the opportunities that this transition offers, as well as effectively addressing its challenges. Chronic kidney disease (CKD) is an important public health problem that is characterised by poor health outcomes and very high healthcare costs. CKD is a major risk multiplier in patients with diabetes, hypertension, heart disease and stroke-all of which are key causes of death and disability in older people. 3 Since the prevalence of CKD is higher in older people, the health impact of population ageing will depend in part on how the kidney community responds. March 13, 2014 will mark the celebration of the 9th World Kidney Day (WKD), an annual event jointly sponsored by the International Society of Nephrology and the International Federation of Kidney Foundations. Since its inception in 2006, WKD has become the most successful effort to raise awareness among policy makers and the general public about the importance of kidney disease. The topic for WKD 2014 is 'CKD in older people'. This article reviews the key links between kidney function, age, health and illness-and discusses the implications of the ageing population for the care of people with CKD.
Management in Health, 2016
During the first cycle of hospitals accreditation, which was conducted between July 2011 and July... more During the first cycle of hospitals accreditation, which was conducted between July 2011 and July 2016, a number of 433 hospitals went through the evaluation process. The measurement tools of compliance were the indicators included in The Accreditation Standards, realized by The National Commission of Hospitals Accreditation. From all the 433 hospitals that went through the process of evaluation of the first accreditation cycle, a number of 4 did not achieve the compliance of 45% and were declared unaccredited. The first hospital accreditation cycle was divided into three stages, according to the method of validating the indicators and to the method of calculating the the level of compliance: June 2011 - October 2014, October 2014 - September 2015, September 2015-June 2016. In the first phase, it have been assessed a number of 77 hospitals, in the second cycle a total of 182 hospitals and, in the third cycle, a total of 174 hospitals. During this process, certain problems were revea...
The prevalance of chronic kidney disease (CKD) continues to increase worldwide, and despite treat... more The prevalance of chronic kidney disease (CKD) continues to increase worldwide, and despite treatment advances, it remains an important global public health issue. Decision makers must account for multiple therapeutic options, comorbidities and complications. In the present review we aimed to synthesize the various public health approches to CKD control and compare them to the national policy in order to highlight key issues and possible solutions. Keywords: chronic kidney disease, prevalence, health systems, informatization informatizare.Prevalența bolii cronice de rinichi (BCR) este în continuă creștere și, în ciuda progreselor terapeutice, rămâne o importantă problemă de sănătate publică. Factorii decizionali trebuie să țină cont de multiplele opțiuni terapeutice, comorbidități și complicații ale BCR. Pentru a evidenția problemele principale și a oferi posibile soluții în managementul BCR, au fost sintetizate abordările sistemelor de sănătate internațional...
The problem of defining the Basic Medical Service Pack (BMSP) has been on the public agenda since... more The problem of defining the Basic Medical Service Pack (BMSP) has been on the public agenda since the introduction of the compulsory health insurances as a tertiary source of payment for illness care. The cost is determined by its contents and especially by its degree of usage which, in its turn, is influenced by the payment mechanisms and by possibilities of payment. No balance has been achieved yet. The payment capacity (incomes) has always been lower than the expenses generated by the medical services. Health revenues have two main sources: the unique national fund of health insurances (UNFHI) and the state budget. The UNFHI contribution should cover the expenses for services provided to diagnose and treat the insured patients who pay, while the state budget incomes should be granted to those patients that are exempted from paying insurances, should ensure financial support for personal contributions that the insured have to pay for some medicine, medical devices or other service...
Ovidius University Annals: Economic Sciences Series, 2019
Council of Europe, starting with 2000, emphasized that the improvement of the quality system is a... more Council of Europe, starting with 2000, emphasized that the improvement of the quality system is a set of integrated and planned activities and measures at various levels in the health care organization, aimed at continuously assuring and improving the quality of patient care. The quality management system, irrespective of the level of approach (organizational, local, national, European), needs to be implemented, assessed and, above all, developed on the basis of standards and practice models. The purpose of this analysis is to emphasise the fact that quality improvement efforts and the support of the management/decision-makers are the key drivers of quality and patient safety improvement at any level of the health system. Based on the latest theoretical and practical considerations, we could say that is necessary to evaluate continuously not only the results obtained from the analyses of the quantitative and qualitative data, but also the tools used in the field of quality managemen...
Introduction. This report describes the current status of nephrology and renal replacement therap... more Introduction. This report describes the current status of nephrology and renal replacement therapy (RRT) in Romania, a country with previously limited facilities, highlighting national changes in the European context. Methods. Trends in RRT development were analysed in 2003, on a national basis, using the same questionnaires as in previous surveys (1991, 1995). Survival data and prognostic risk factors were calculated retrospectively from a large representative sample of 2284 patients starting RRT between January 1, 1995 and December 31, 2001 (44% of the total RRT population investigated). Results. In 2003, RRT incidence [128 per million population (p.m.p.)] and prevalence (250 p.m.p.) were six and five times higher, respectively, than in 1995. The annual rate of increase in the stock of RRT patients (11%) was supported mainly by an exponential development of the continuous ambulatory peritoneal dialysis (CAPD) population (þ600%), while the haemodialysis (HD) growth rate was stable (þ33%) and renal transplantation made a marginal contribution. Renal care infrastructure followed the same trend: nephrology departments (þ100%) and nephrologists (þ205%). The characteristics of RRT incident patients changed accordingly to current European epidemiology (increasing age and prevalence of diabetes and nephroangiosclerosis). The estimated overall survival of RRT patients in Romania was 90.6% at 1 year [confidence interval (CI) 89.4-91.8] and 62.2% at 5 years (CI 59.4-65.0). Patients' survival was negatively influenced (Cox regression analysis) by age >65 years (P<0.001), lack of pre-dialysis monitoring by a nephrologist [P ¼ 0.01, hazards ratio (HR) ¼ 0.8], severe anaemia, lack of erythropoetin treatment (P<0.001, HR ¼ 0.6), and co-morbidity, e.g. cardiovascular diseases (P<0.001, HR ¼ 1.8) and diabetes mellitus (P<0.001, HR ¼ 2.2). Conclusions. Although the rate of increase in RRT patient stock in 1996-2003 in Romania was the highest in Europe, the prevalence remained below the European mean. As CAPD had the greatest expansion, followed by HD, an effective transplantation programme must be set up to overcome the imbalance. The quality of RRT appears to be good and survival was similar to that in other registries. Further evolution implies strategies of prevention, based on national surveys, supported by the Romanian Renal Registry.
Management in Health, 2015
The prevalance of chronic kidney disease (CKD) continues to increase worldwide, and despite treat... more The prevalance of chronic kidney disease (CKD) continues to increase worldwide, and despite treatment advances, it remains an important global public health issue. Decision makers must account for multiple therapeutic options, comorbidities and complications. In the present review we aimed to synthesize the various public health approches to CKD control and compare them to the national policy in order to highlight key issues and possible solutions. Keywords: chronic kidney disease, prevalence, health systems, informatization informatizare. Normal 0 21 false false false RO X-NONE X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin-top:0cm; mso-para-margin-right:0cm; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0cm; line-height:115%; mso-pagination:widow-or...
Management in Health, 2017
During the first cycle of hospitals accreditation, which was conducted between July 2011 and July... more During the first cycle of hospitals accreditation, which was conducted between July 2011 and July 2016, a number of 433 hospitals went through the evaluation process. The measurement tools of compliance were the indicators included in The Accreditation Standards, realized by The National Commission of Hospitals Accreditation. From all the 433 hospitals that went through the process of evaluation of the first accreditation cycle, a number of 4 did not achieve the compliance of 45% and were declared unaccredited. The first hospital accreditation cycle was divided into three stages, according to the method of validating the indicators and to the method of calculating the the level of compliance: June 2011 - October 2014, October 2014 - September 2015, September 2015-June 2016. In the first phase, it have been assessed a number of 77 hospitals, in the second cycle a total of 182 hospitals and, in the third cycle, a total of 174 hospitals. During this process, certain problems were revea...
Indo Global Journal of Pharmaceutical Sciences, 2017
Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis, 2006
Background This report describes the status of renal replacement therapy (RRT), particularly cont... more Background This report describes the status of renal replacement therapy (RRT), particularly continuous ambulatory peritoneal dialysis (CAPD), in Romania (a country with previously limited facilities), outlines the fast development rate of CAPD, and presents national changes in a European context. Methods Trends in the development of RRT were analyzed in 2003 on a national basis using annual center questionnaires from 1995 to 2003. Survival data and prognostic risk factors were calculated retrospectively from a representative sample of 2284 patients starting RRT between 1 January 1995 and 31 December 2001 (44% of the total RRT population investigated). Results The annual rate of increase in the number of RRT patients (11%) was supported mainly by an exponential development of the CAPD population (+600%); the hemodialysis (HD) growth rate was stable (+33%) and renal transplantation had a marginal contribution. The characteristics of both HD and PD incident patients changed according ...
Introduction: Patients’ satisfaction was extensively researched over the last decades, given its ... more Introduction: Patients’ satisfaction was extensively researched over the last decades, given its role in building loyalty, compliance to treatment, prevention, and eventually higher levels of wellbeing and improved health status. Patients’ feedback on the perceived quality of health services can be incorporated into practice; therefore, understanding factors and mechanisms responsible for patients’ satisfaction allows providers to tailor targeted interventions. Method: A questionnaire assessing patients’ perception of the quality of health services was administered to a country-representative sample of 1500 Romanian patients. Using a partial least squares—path modeling approach (PLS-PM), with cross-sectional data, we developed a variance-based structural model, emphasizing the mediating role of trust and satisfaction with various categories of health services. Results: We confirmed the mediating role of trust in shaping the relationship between the procedural accuracy of health prof...
Revista Romana De Bioetica, Nov 2, 2014
In this study we focused on the ethical dilemmas that confront physicians while approaching thera... more In this study we focused on the ethical dilemmas that confront physicians while approaching therapeutical management of elderly patients, especially those exposed to polypragmasy and iatrogeny. We explore the main universal ethical principles such as autonomy, beneficence, non-maleficence, justice and equity and the challenges the medical team faces while trying to reconcile them with several particular aspects characteristic to elderly patients such as: fragility, disability, comorbidity, cognitive and functional impairment, and a greater risk of polypharmacy, polypragmasy, and iatrogeny. Building a strong physician – patient relationship based on mutual trust and respect is the key to understanding the needs and desires of the elderly, which may be completely different from other age groups, and their possibilities to adhere to medical recommendations. Multidisciplinary teams, representing professionals from diverse disciplines coordinated by the general practitioner and/or the geriatrician should help solving difficult ethical dilemmas.
Revista Romana De Bioetica, Jan 23, 2014
Romania has one of the highest mortality and morbidity ratio from EU together with one of the hig... more Romania has one of the highest mortality and morbidity ratio from EU together with one of the highest number of hospital admissions per 100 inhabitants. As regards the outpatients’ consultations and treatments, important for the application of the medical prevention model, Romania has one of the lowest rates in Europe, about 6 %, below the EU average of almost 15%.This explains, in part, the high consumption of inpatient services,with reduced emphasis on the medical prevention of the main cause of mortality, the cardio-vascular diseases which are responsible for over 60% of all deaths recorded annually. For a significant reduction in cardiovascular mortality in Romania primary prevention measures- specific to public health- are necessary, together with medical prevention for individuals with proved changes in relevant biological constants. In order to reduce the cardiovascular mortality with 25%, by the 2025 year, in accordance with the WHO objective in this field, a multisectoral and integrated approach is needed; this approach needs to see health as an investment and to promote, besides clinical services, measures of an overall and sustained impact on major risk factors, both at the population and individual level
Management in Health, Jun 27, 2014
The problem of defining the Basic Medical Service Pack (BMSP) has been on the public agenda since... more The problem of defining the Basic Medical Service Pack (BMSP) has been on the public agenda since the introduction of the compulsory health insurances as a tertiary source of payment for illness care. The cost is determined by its contents and especially by its degree of usage which, in its turn, is influenced by the payment mechanisms and by possibilities of payment. No balance has been achieved yet. The payment capacity (incomes) has always been lower than the expenses generated by the medical services. Health revenues have two main sources: the unique national fund of health insurances (UNFHI) and the state budget. The UNFHI contribution should cover the expenses for services provided to diagnose and treat the insured patients who pay, while the state budget incomes should be granted to those patients that are exempted from paying insurances, should ensure financial support for personal contributions that the insured have to pay for some medicine, medical devices or other services provisioned by the framework contract on whose basis the contractual relationships within the system are carried out. The analysis of BMSP should take into account the elements that define the BMSP: the list of discounted services; the way services are accessed by the insured; the means of contracting; means of payment. In the Romanian context, the basic medical service pack has to be reconfigured in order to develop the payment and control mechanisms that allow for improvement in health indices, for higher expense effectiveness, that are easily controlled, that do not trigger inflation of services and stimulate the healthcare professionals to achieve the best results.
Mediterranean Journal of Social Sciences, 2013
This study aims to discuss the idea of decentralization process of local authorities in Albania a... more This study aims to discuss the idea of decentralization process of local authorities in Albania and also its impact on territorialadministrative organization. Using her experience of several years in audit structures of local government, the author of this study intends to show how much and how has affected the territorial division in the absence of efficiency of public services provided by local authorities. Why the governments (even though the issue of territorial reorganization was their priority) could not do anything in this regard in years? Albania's territorial reorganization, in the current stage when the decentralization reform has entered the third phase of its development is closely related to regional development of the territory. Both (as reorganization and regional development) require the design and implementation of macroeconomic strategies based on detailed analysis of costs and efficiency of public services provided by local governments, harmonizing the instruments in implementing the economic policies of general government (local and central government), but without affecting in any way the principle of decentralization.
Nephrology Dialysis Transplantation, 1997
performed (8 and 4%). The cost of HD treatment in Romania (87 USD) is low, even though dialyser r... more performed (8 and 4%). The cost of HD treatment in Romania (87 USD) is low, even though dialyser reuse Background. In the context of the transformation of the Health Systems of Central and Eastern European is not common practice. Conclusions. The increase in renal replacement therapy countries, the role of professional associations is increasing, especially as regards data collection, ana-in Romania was mainly due to the expansion of the number of haemodialysis centres. Although a signific-lysis, and implementation of programmes for development of nephrology and renal replacement therapy ant progress was realized, only one-third of the patients needing RRT could be treated in Romania in 1995. (RRT). Methods. The Romanian Renal Registry sent question-Key words: renal replacement therapy; chronic renal naires to the heads of Haemodialysis and Nephrology failure epidemiology; chronic haemodialysis costs; Centres. The need for renal replacement therapy was renal transplantation; Romania deduced from the annual incidence (127 patients p.m.p.) of chronic renal failure. Results. Although the rates of increase in the numbers of Nephrology Departments (+82%), HD Centres Introduction (+142%), and total number of patients alive on RRT (+196%) from 1991 to 1995 were higher than the The Health Systems of Central and Eastern European European mean, only 27-30% of the incident patients countries are undergoing a complex process of trans-(459 of 1000-1200 patients) could be provided with formations which, ideally, should lead to a more RRT. Sixty-two percent of the need for RRT in the flexible, efficient, and less expensive means of providing age group 25-44 years was met, while only 20% of health care. This process is supposed to be based on a children (age<15 years) and people over 55 years realistic view of the population's need and the available requiring RRT received this treatment. Primary renal resources. diseases in patients on RRT were glomerulonephritis In Romania, medicine is confronted with inconsist-(49%) or interstitial nephropathies (23%); diabetic ent legislation and deficient funding. The surging internephropathies, nephroangiosclerosis and systemic disest in nephrology and renal replacement therapy eases were rare (4, 2, and 1% respectively). Most of (RRT) obliged Romanian physicians to face many the CRF patients (88%) were treated by HD. Renal novel medical, technical, economic and ethical transplantation and peritoneal dialysis were seldom problems. Expensive treatments impose judicious and some-Correspondence and offprint requests to: Prof. Dr. N. Ursea, 'Carol times subtle decisions at the national level. Virtually Davila' Teaching Hospital of Nephrology, Calea Griviţei 4, Bucureşti all nephrological activities in Romania are dependent 1, CP 79804, Romania.
International Urology and Nephrology, 2011
Introduction Chronic kidney disease (CKD) is a major public health problem worldwide, due to its ... more Introduction Chronic kidney disease (CKD) is a major public health problem worldwide, due to its epidemic proportions and to its association with high cardiovascular risk. Therefore, screening for CKD is an increasingly important concept, aiming for early detection and prevention of progression and complications of this disease. Materials and methods We studied the prevalence of CKD in the adult population of Iaşi, the largest county in Romania, based on the results of a national general health screening program from 2007 to 2008. The patients were tested for CKD with serum creatinine and urinary dipstick. We used two different methods to estimate the glomerular filtration rate (eGFR): the simplified Modification of Diet in Renal Disease (MDRD) and the CKD Epidemiology Collaboration (CKD-EPI) equations. Based on the Kidney Disease Improving Global Outcomes (KDIGO) criteria, we defined CKD as the presence of either eGFR \ 60 ml/min/1.73 m 2 and/or dipstick proteinuria. The classification of CKD by stage was also done according to the KDIGO criteria. Results The study population included 60,969 people. The global prevalence of CKD was found to be 6.69% by the MDRD formula and 7.32% when using the CKD-EPI equation. The prevalence of CKD was much higher in women than in men: 9.09% versus 3.7%, by MDRD, and 9.32% versus 4.85%, by CKD-EPI. By age groups, the prevalence of CKD was 0.95% and 0.64% in persons aged 18-44 years old, 4.27% and 3.57% (45-64 years old), 13.36% and 15.34% (65-79 years old), and 23.59% and 34.56% ([80 years old), according to MDRD and CKD-EPI, respectively. By stages, the prevalence of CKD stage 3a (eGFR 59 to 45 ml/min/1.73 m 2) was 5.72% by MDRD and 5.96% according to CKD-EPI, whereas the prevalence of stages 3b, 4, and 5 taken together (eGFR \ 45 ml/min/1.73 m 2) was 0.96% (MDRD) and 1.35% (CKD-EPI). Patients with CKD were significantly older (71.0 years versus 53.7 years) and had lower levels of serum Hb, total cholesterol, and glutamic pyruvic transaminase, and significantly higher serum creatinine and blood glucose, in comparison with the individuals without CKD. Impaired fasting glucose (106 mg/dl) was found in the CKD population, but not in non-CKD individuals. Conclusions Our study is one of the largest ever reported on the prevalence of CKD worldwide, the first one in Romania, and one of the very few of its kind in Europe (particularly in Eastern Europe).
Internal Medicine Journal, 2014
The proportion of older people in the general population is steadily increasing worldwide, with t... more The proportion of older people in the general population is steadily increasing worldwide, with the most rapid growth in low and middle-income countries. 1 This demographic change is to be celebrated, because it is the consequence of socioeconomic development and better life expectancy. However, population ageing also has important implications for society-in diverse areas including health systems, labour markets, public policy, social programmes and family dynamics. 2 A successful response to the ageing population will require capitalising on the opportunities that this transition offers, as well as effectively addressing its challenges. Chronic kidney disease (CKD) is an important public health problem that is characterised by poor health outcomes and very high healthcare costs. CKD is a major risk multiplier in patients with diabetes, hypertension, heart disease and stroke-all of which are key causes of death and disability in older people. 3 Since the prevalence of CKD is higher in older people, the health impact of population ageing will depend in part on how the kidney community responds. March 13, 2014 will mark the celebration of the 9th World Kidney Day (WKD), an annual event jointly sponsored by the International Society of Nephrology and the International Federation of Kidney Foundations. Since its inception in 2006, WKD has become the most successful effort to raise awareness among policy makers and the general public about the importance of kidney disease. The topic for WKD 2014 is 'CKD in older people'. This article reviews the key links between kidney function, age, health and illness-and discusses the implications of the ageing population for the care of people with CKD.