Aim Aim of this study was to describe and analyse associations of incidents and their improvement... more Aim Aim of this study was to describe and analyse associations of incidents and their improvement actions in hospital setting. Methods It was a retrospective document analysis of incident reporting systems' reports registered during 2018-2019 in two Estonian regional hospitals. Data were extracted, organised, quantified and analysed by statistical methods. Results In total, 1973 incident reports were analysed. The most commonly reported incidents were related to patient violent or self-harming behaviour (n=587), followed by patient accidents (n=379), and 40% of all incidents were non-harm incidents (n=782). Improvement actions were documented in 83% (n=1643) of all the reports and they were focused on (1) direct patient care, (2) staffrelated actions; (3) equipment and general protocols and (4) environment and organisational issues. Improvement actions were mostly associated with medication and transfusion treatment and targeted to staff. The second often associated improvement actions were related to patient accidents and were mostly focused on that particular patient's further care. Improvement actions were mostly planned for incidents with moderate and mild harm, and for incidents involving children and adolescents. Conclusion Patient safety incidents-related improvement actions need to be considered as a strategy for longterm development in patient safety in organisations. It is vital for patient safety that the planned changes related to the reporting will be documented and implemented more visibly. As a result, it will boost the confidence in managers' work and strengthens all staff's commitment to patient safety initiatives in an organisation. *Pearson's χ2 test. †Logistic regression model. ‡Fisher's exact test. !, Bold figures indicate statistically significant values.
Shìdnoêvropejsʹkij žurnal vnutrìšnʹoï ta sìmejnoï medicini, Dec 12, 2015
Питання організації охорони здоров'я One of the cornerstones of the Estonian health care reforms ... more Питання організації охорони здоров'я One of the cornerstones of the Estonian health care reforms has been the reorganization of the pri mary level medical care. It was started in 1991 by commencing training for family doctors [1, 2]. Since 1993, the list of medical specialties in Estonia also contains family medicine, and by the present time more than 800 family doctors have been trained. In 1998 a new financing scheme for family doctors came into force, foreseeing the establishment of patient lists. It introduced a combined payment mechanism and a partial gatekeeping function for family doctors, and rendered the status of an independent contractor to family practitioners [3]. The aim of the reform in primary health care was to establish the primary health care system that is easily accessible and is based on trained and fully responsible family practitioners. Several studies have shown that the access to the doctors is one of the most important determinants of patient satisfaction with the care [4, 5].Al though priorities regarding different aspects of family practice vary significantly among different countries, the absolute requirements for good family practice as reported by patients are: the possibility of making appointments with in a short time, quick service in urgent situations, a family physician who really takes his/her time to listen and talk during the consultation. All these priorities refer particularly to accessible clinical care [6]. The common policy in the Estonian family medicine is that patients with urgent problems should be seen on the same day, while other patients should be granted an appointment in three days. These standard rules are fixed in the family doctor's job description. Since October 2002, when the Health Insurance Act came into force, all patients who have health insurance can visit their family doctors for free. According to the same act, family practitioners may ask up to EEK50 (€3.3, US$3.9) for a home visit. The aim of the study was to investigate the temporal accessibility and financial accessibility of family doctors in Estonia from the patients' point of view.
Artiklis on kirjeldatud eriarsti pädevuse hindamise kriteeriumeid ja selle korraldamise põhimõtte... more Artiklis on kirjeldatud eriarsti pädevuse hindamise kriteeriumeid ja selle korraldamise põhimõtteid Eestis.
Objective: The aim of the study was to explore the role of managerial style, work environment fac... more Objective: 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. Method: 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 annually 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. Results: 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 period. In 2007, the proportion of very satisfied people dropped to 21% before increasing again in 2008-2009 (from 24% to 35%). Binary logistic regression analysis resulted in a model that included five groups of factors: managerial support, information about results achieved and progress to goals, work organisation and working environment, as well as factors related to career, security and planning. The average scores of emotional exhaustion showed significant decrease, correlating negatively with job satisfaction (p<0.05). Conclusion: The implementation of quality improvement activities in the Kaarli Dental Clinic has improved the work environment by decreasing burnout symptoms and increased job satisfaction in staff.
Objective: This review summarizes and synthesizes the evidence on follow-up activities regarding ... more Objective: This review summarizes and synthesizes the evidence on follow-up activities regarding patient safety incidents reported in hospitals. Methods: Peer-reviewed papers were retrieved with electronic searches from CINAHL, Web of Science, PubMed and Scopus databases and with manual searches in most relevant journals and in the reference lists of included studies, limiting searches to papers published in English between 2014 and 2018. A systematic review was conducted in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Two authors extracted the data following a predefined extraction form. Results: All together 16 studies were selected for analysis. All studies described incidents and gave insight into problems, risks and unsafe situations which were responded to with recommended improvements. Recommended improvements in response to incidents involved guidelines, staff training, technical improvements and general safety improvements. Only five studies reported feedback and knowledge dissemination activities, referring to meetings, written support and visual support. Conclusions: Limited research has described the systematic use of report outcomes for knowledge application in organizations. However, the development of patient safety requires that reported incidents are responded to by knowledge application within feedback and knowledge dissemination activities. Therefore, healthcare professionals need to have sufficient competences in patient safety, and more research is needed on the content and effectiveness of the responding activities.
Aim: To analyze the population's view of the primary health care reform five years after the form... more Aim: 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. Methods: Face-to-face interviews using structured questionnaires were preformed with a random sample of the Estonian residents aged 15-74 years (n=999). Results: 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 had a contact with their family doctor during the last 12 months 87% (n=585) were satisfied with his work. The overall satisfaction with the family doctor depended on 1) perceived competence of the physician (OR=0.624, 95% confidence interval (CI)=0.419-0.933); 2) understanding the patient's problem (OR=0.699, 95%CI=0.496-0.984); 3) punctuality of the physician (OR=1.533, 95%CI=1.075-2.186); and 4) the location of the primary health care center/clinic (OR=0.751, 95%CI=0.574-0.983). Conclusion: During the five-year-period most of the Estonian population has accepted the new primary health care system and the satisfaction rate has increased. Family doctors are in the center of the primary health care systems and their professional competence plays a great role in making the system acceptable for the patients.
The aim of the study was to compare the prevalence of metabolic syndrome (MetS) in early RA patie... more The aim of the study was to compare the prevalence of metabolic syndrome (MetS) in early RA patients with age-gender-matched population controls focusing on the presence of MetS in different weight categories. The study group consisted of 91 consecutive patients with early RA and 273 age- and gender-matched controls subjects. MetS was diagnosed according to the National Cholesterol Education Program (NCEP-ATP III) criteria. Mean age in both groups was 52 years, and 72.5 % were female. The prevalence of MetS did not differ between the two groups (35.2 % in RA, 34.1 % in control group). Mean systolic blood pressure in the RA group was 137 mmHg, in control group 131 mmHg, P = 0.01, and diastolic blood pressure 85 versus 81 mmHg, respectively (P &amp;amp;lt; 0.01). We found that 20 of 65 (30.8 %) of RA patients compared to 80 of 152 (52.6 %) of the control subjects with elevated blood pressure received antihypertensive treatment (P &amp;amp;lt; 0.01). When comparing subgroups with normal BMI, the odds of having MetS (being metabolically obese) were higher among early RA subjects (OR 5.6, CI 1.3-23.8). Of the individual components of metabolic syndrome, we found increased prevalence of hypertension (OR 2.8, CI 1.3-6.0) and hyperglycemia (OR 2.9, CI 1.0-8.0) in the RA group. Recognition of abnormal metabolic status among normal-weight RA patients who have not yet developed CVD could provide a valuable opportunity for preventative intervention.
International Journal for Quality in Health Care, Jun 1, 2004
Objective. To evaluate the level of job satisfaction among the staff at an Estonian hospital and ... more Objective. To evaluate the level of job satisfaction among the staff at an Estonian hospital and to describe factors related to their job satisfaction. Design. Questionnaire survey. Setting. Pärnu County Hospital in Estonia. Study participants. All staff members of the Pärnu County Hospital (n = 673), except 56 staff members who were away from work during the study. Results. Respondents (n = 473) indicated an average job satisfaction level of 3.86 ± 0.81 on a 5-point scale. The efficiency of hospital management as measured by planning, relationships with supervisors, knowledge and communication regarding hospital goals, plans, quality of services, budgetary situation, and staffing problems was positively correlated with job satisfaction. Stress and unrealistic expectations were negatively correlated with job satisfaction. The feeling of being part of the organization was also correlated with job satisfaction. Recognition from supervisors and discussions with colleagues were found to be weakly correlated with job satisfaction. There were differences between occupational categories. Conclusion. The management of Pärnu County Hospital has been able to create good supervisory relationships with staff by providing sufficient information about the goals of the hospital, the quality of services, the budgetary situation, and staffing problems that arise. Stress levels reported are not excessive and staff are loyal to their hospital.
Background. Health-related quality of life (HRQoL) is an important component of comprehensive man... more Background. Health-related quality of life (HRQoL) is an important component of comprehensive management in primary care. Objec ves. The purpose of this study was to inves gate the rela onships between physical performance measures and self-reported HRQoL and to fi nd op mal values of muscle func on tests associated with lower HRQoL. Material and methods. From a single primary health care center pa ent list, 330 subjects were randomly selected. Informa on about the pa ent's age, gender, body mass index and presence of self-reported chronic diseases was collected, as well as analyses for systemic infl amma on and vitamin D. Physical performance was measured by dominant hand grip strength (GS) and a 30-second chair stand test (30-CST). The physical (PCS) and mental (MCS) component scores of the Short-Form-36 Ques onnaire (SF-36) were used to evaluate HRQoL. The predic ve power of physical func on measures were tested with mul variate linear regression analyses. Threshold values for physical func on tests were calculated by receiver opera ng characteris c curves. Results. Mul variate analyses demonstrated that 30-CST was signifi cantly (p < 0.0001) associated with SF-36 summary scores for both genders. Males with 30-CST results under 7 stands and females with results of fewer than 13 stands were in the risk group for having the lowest PCS scores. Results in 30-CST under 12 stands in males and under 13 stands in females were associated with the lowest scores of MCS. Conclusions. 30-CST had the most expressed associa on with the outcomes of HRQoL in the Estonian popula on. Subjects with physical performance results under threshold values are at risk of lower HRQoL; therefore, 30-CST is a poten al screening indicator for HRQoL assessment.
19. sajandi lõpus hakkasid haiglad põetuse kõrval üha enam tegelema haigete raviga. Arsti tea dus... more 19. sajandi lõpus hakkasid haiglad põetuse kõrval üha enam tegelema haigete raviga. Arsti tea duse ja tehnika kiire areng aga suurendas omakorda haiglakulusid. Otsimaks võimalusi kulude kontrollimatu kasvu piiramiseks on tehtud mitmeid uurimusi haiglaravi efektiivsuse ja seda mõjutavate tegurite kohta (1). Aastatel 1993-1997 korraldas Maailma Tervise organisatsioon (WHO) katseprojekti, et lisaks diagnostikale ja ravile pöörata rohkem tähelepanu tervis eden du sele ning haiguste ennetamisele. Sellest tulenevalt hakati rohkem tähelepanu pöörama pat siendi ja personali tervisele ning tervist edendavatele tegevustele nii organisatsiooni kui ka paikkonna tasandil (2). Kogemuste vahetamise eesmärgil loodi katseprojekti lõppedes tervist edendavate haiglate (TEH) võrgustik. Eestis algatati TEH-liikumine katseprojektina juba 1999. aastal Tallinna Järve Haigla baasil, Eesti TEH-võrgustik asutati 25. jaanuaril 2000. aastal. 2005. aasta alguseks oli võrgustikuga liitunud 20 haiglat, mis kõik kuuluvad ka WHO rahvus vahelisse võrgustikku Health Promoting Hospitals (2). Ottawa harta põhimõtete järgi tähendab tervise edendamine haiglas olukorra loomist, kus nii patsiendil kui ka personalil on suurem kontroll oma tervise
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
We read with interest the article entitled ‘The Rheumatoid Arthritis Quality of Life (RAQoL) for ... more We read with interest the article entitled ‘The Rheumatoid Arthritis Quality of Life (RAQoL) for Sweden: adaptation and validation’ by Hedin et al, which was published in the Scandinavian Journal of Rheumatology (1). A new language version of this internationally accepted outcome measure opens opportunities to broaden multinational research on the quality of life (QoL) of rheumatoid arthritis (RA) patients. This official version of the Swedish RAQoL, produced by the dual panel translation method, has shown psychometric properties similar to those demonstrated for the Estonian version of the RAQoL (2). Because of its geographical proximity and tradition of scientific cooperation, Sweden is one of the countries Estonia would be expected to join with in medical research projects. Therefore, the development of a Swedish version of the RAQoL that used the approved adaptation procedure is of importance to rheumatological research in Estonia. Despite the proximity of Sweden and Estonia there are considerable differences between the countries in terms of history and culture that should be considered when comparative QoL research is planned. Different cultures and societies have unique concepts of QoL. This diversity of concepts can confound QoL research in the health sciences. Before selecting a QoL tool developed in and for another country, it is necessary to determine how the instrument will work in the context of the proposed research study. An instrument that has performed well in the country of origin can lose validity when applied in a different social context. Standard validation processes are less likely to be of value where the local QoL concept differs from that of the culture where the measure was developed. Ten semi-structured qualitative interviews with RA patients were conducted during the development of the Estonian version of the RAQoL to assess the suitability of the instrument. Thematic analysis conducted on the generated data indicated that the measure was highly relevant to patients; it was concluded that the RAQoL was an appropriate measure of QoL for use with Estonian RA patients (3). However, three QoL issues that were important for Estonian RA patients were not covered by the RAQoL. These were changes in role performance, communication with the medical system and financial issues related to obtaining the necessities of life. An assumption was made that failure to assess these specific issues might lead to an underestimation of the impact of RA on Estonian patients’ QoL. To determine the importance of the missing issues for Estonian RA patients, two additional validation strategies were applied. First, analysis was undertaken of data derived from a separate study that had used six focus groups to investigate RA patients’ satisfaction with health care. The transcripts of these
Aim Aim of this study was to describe and analyse associations of incidents and their improvement... more Aim Aim of this study was to describe and analyse associations of incidents and their improvement actions in hospital setting. Methods It was a retrospective document analysis of incident reporting systems' reports registered during 2018-2019 in two Estonian regional hospitals. Data were extracted, organised, quantified and analysed by statistical methods. Results In total, 1973 incident reports were analysed. The most commonly reported incidents were related to patient violent or self-harming behaviour (n=587), followed by patient accidents (n=379), and 40% of all incidents were non-harm incidents (n=782). Improvement actions were documented in 83% (n=1643) of all the reports and they were focused on (1) direct patient care, (2) staffrelated actions; (3) equipment and general protocols and (4) environment and organisational issues. Improvement actions were mostly associated with medication and transfusion treatment and targeted to staff. The second often associated improvement actions were related to patient accidents and were mostly focused on that particular patient's further care. Improvement actions were mostly planned for incidents with moderate and mild harm, and for incidents involving children and adolescents. Conclusion Patient safety incidents-related improvement actions need to be considered as a strategy for longterm development in patient safety in organisations. It is vital for patient safety that the planned changes related to the reporting will be documented and implemented more visibly. As a result, it will boost the confidence in managers' work and strengthens all staff's commitment to patient safety initiatives in an organisation. *Pearson's χ2 test. †Logistic regression model. ‡Fisher's exact test. !, Bold figures indicate statistically significant values.
Shìdnoêvropejsʹkij žurnal vnutrìšnʹoï ta sìmejnoï medicini, Dec 12, 2015
Питання організації охорони здоров'я One of the cornerstones of the Estonian health care reforms ... more Питання організації охорони здоров'я One of the cornerstones of the Estonian health care reforms has been the reorganization of the pri mary level medical care. It was started in 1991 by commencing training for family doctors [1, 2]. Since 1993, the list of medical specialties in Estonia also contains family medicine, and by the present time more than 800 family doctors have been trained. In 1998 a new financing scheme for family doctors came into force, foreseeing the establishment of patient lists. It introduced a combined payment mechanism and a partial gatekeeping function for family doctors, and rendered the status of an independent contractor to family practitioners [3]. The aim of the reform in primary health care was to establish the primary health care system that is easily accessible and is based on trained and fully responsible family practitioners. Several studies have shown that the access to the doctors is one of the most important determinants of patient satisfaction with the care [4, 5].Al though priorities regarding different aspects of family practice vary significantly among different countries, the absolute requirements for good family practice as reported by patients are: the possibility of making appointments with in a short time, quick service in urgent situations, a family physician who really takes his/her time to listen and talk during the consultation. All these priorities refer particularly to accessible clinical care [6]. The common policy in the Estonian family medicine is that patients with urgent problems should be seen on the same day, while other patients should be granted an appointment in three days. These standard rules are fixed in the family doctor's job description. Since October 2002, when the Health Insurance Act came into force, all patients who have health insurance can visit their family doctors for free. According to the same act, family practitioners may ask up to EEK50 (€3.3, US$3.9) for a home visit. The aim of the study was to investigate the temporal accessibility and financial accessibility of family doctors in Estonia from the patients' point of view.
Artiklis on kirjeldatud eriarsti pädevuse hindamise kriteeriumeid ja selle korraldamise põhimõtte... more Artiklis on kirjeldatud eriarsti pädevuse hindamise kriteeriumeid ja selle korraldamise põhimõtteid Eestis.
Objective: The aim of the study was to explore the role of managerial style, work environment fac... more Objective: 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. Method: 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 annually 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. Results: 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 period. In 2007, the proportion of very satisfied people dropped to 21% before increasing again in 2008-2009 (from 24% to 35%). Binary logistic regression analysis resulted in a model that included five groups of factors: managerial support, information about results achieved and progress to goals, work organisation and working environment, as well as factors related to career, security and planning. The average scores of emotional exhaustion showed significant decrease, correlating negatively with job satisfaction (p<0.05). Conclusion: The implementation of quality improvement activities in the Kaarli Dental Clinic has improved the work environment by decreasing burnout symptoms and increased job satisfaction in staff.
Objective: This review summarizes and synthesizes the evidence on follow-up activities regarding ... more Objective: This review summarizes and synthesizes the evidence on follow-up activities regarding patient safety incidents reported in hospitals. Methods: Peer-reviewed papers were retrieved with electronic searches from CINAHL, Web of Science, PubMed and Scopus databases and with manual searches in most relevant journals and in the reference lists of included studies, limiting searches to papers published in English between 2014 and 2018. A systematic review was conducted in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Two authors extracted the data following a predefined extraction form. Results: All together 16 studies were selected for analysis. All studies described incidents and gave insight into problems, risks and unsafe situations which were responded to with recommended improvements. Recommended improvements in response to incidents involved guidelines, staff training, technical improvements and general safety improvements. Only five studies reported feedback and knowledge dissemination activities, referring to meetings, written support and visual support. Conclusions: Limited research has described the systematic use of report outcomes for knowledge application in organizations. However, the development of patient safety requires that reported incidents are responded to by knowledge application within feedback and knowledge dissemination activities. Therefore, healthcare professionals need to have sufficient competences in patient safety, and more research is needed on the content and effectiveness of the responding activities.
Aim: To analyze the population's view of the primary health care reform five years after the form... more Aim: 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. Methods: Face-to-face interviews using structured questionnaires were preformed with a random sample of the Estonian residents aged 15-74 years (n=999). Results: 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 had a contact with their family doctor during the last 12 months 87% (n=585) were satisfied with his work. The overall satisfaction with the family doctor depended on 1) perceived competence of the physician (OR=0.624, 95% confidence interval (CI)=0.419-0.933); 2) understanding the patient's problem (OR=0.699, 95%CI=0.496-0.984); 3) punctuality of the physician (OR=1.533, 95%CI=1.075-2.186); and 4) the location of the primary health care center/clinic (OR=0.751, 95%CI=0.574-0.983). Conclusion: During the five-year-period most of the Estonian population has accepted the new primary health care system and the satisfaction rate has increased. Family doctors are in the center of the primary health care systems and their professional competence plays a great role in making the system acceptable for the patients.
The aim of the study was to compare the prevalence of metabolic syndrome (MetS) in early RA patie... more The aim of the study was to compare the prevalence of metabolic syndrome (MetS) in early RA patients with age-gender-matched population controls focusing on the presence of MetS in different weight categories. The study group consisted of 91 consecutive patients with early RA and 273 age- and gender-matched controls subjects. MetS was diagnosed according to the National Cholesterol Education Program (NCEP-ATP III) criteria. Mean age in both groups was 52 years, and 72.5 % were female. The prevalence of MetS did not differ between the two groups (35.2 % in RA, 34.1 % in control group). Mean systolic blood pressure in the RA group was 137 mmHg, in control group 131 mmHg, P = 0.01, and diastolic blood pressure 85 versus 81 mmHg, respectively (P &amp;amp;lt; 0.01). We found that 20 of 65 (30.8 %) of RA patients compared to 80 of 152 (52.6 %) of the control subjects with elevated blood pressure received antihypertensive treatment (P &amp;amp;lt; 0.01). When comparing subgroups with normal BMI, the odds of having MetS (being metabolically obese) were higher among early RA subjects (OR 5.6, CI 1.3-23.8). Of the individual components of metabolic syndrome, we found increased prevalence of hypertension (OR 2.8, CI 1.3-6.0) and hyperglycemia (OR 2.9, CI 1.0-8.0) in the RA group. Recognition of abnormal metabolic status among normal-weight RA patients who have not yet developed CVD could provide a valuable opportunity for preventative intervention.
International Journal for Quality in Health Care, Jun 1, 2004
Objective. To evaluate the level of job satisfaction among the staff at an Estonian hospital and ... more Objective. To evaluate the level of job satisfaction among the staff at an Estonian hospital and to describe factors related to their job satisfaction. Design. Questionnaire survey. Setting. Pärnu County Hospital in Estonia. Study participants. All staff members of the Pärnu County Hospital (n = 673), except 56 staff members who were away from work during the study. Results. Respondents (n = 473) indicated an average job satisfaction level of 3.86 ± 0.81 on a 5-point scale. The efficiency of hospital management as measured by planning, relationships with supervisors, knowledge and communication regarding hospital goals, plans, quality of services, budgetary situation, and staffing problems was positively correlated with job satisfaction. Stress and unrealistic expectations were negatively correlated with job satisfaction. The feeling of being part of the organization was also correlated with job satisfaction. Recognition from supervisors and discussions with colleagues were found to be weakly correlated with job satisfaction. There were differences between occupational categories. Conclusion. The management of Pärnu County Hospital has been able to create good supervisory relationships with staff by providing sufficient information about the goals of the hospital, the quality of services, the budgetary situation, and staffing problems that arise. Stress levels reported are not excessive and staff are loyal to their hospital.
Background. Health-related quality of life (HRQoL) is an important component of comprehensive man... more Background. Health-related quality of life (HRQoL) is an important component of comprehensive management in primary care. Objec ves. The purpose of this study was to inves gate the rela onships between physical performance measures and self-reported HRQoL and to fi nd op mal values of muscle func on tests associated with lower HRQoL. Material and methods. From a single primary health care center pa ent list, 330 subjects were randomly selected. Informa on about the pa ent's age, gender, body mass index and presence of self-reported chronic diseases was collected, as well as analyses for systemic infl amma on and vitamin D. Physical performance was measured by dominant hand grip strength (GS) and a 30-second chair stand test (30-CST). The physical (PCS) and mental (MCS) component scores of the Short-Form-36 Ques onnaire (SF-36) were used to evaluate HRQoL. The predic ve power of physical func on measures were tested with mul variate linear regression analyses. Threshold values for physical func on tests were calculated by receiver opera ng characteris c curves. Results. Mul variate analyses demonstrated that 30-CST was signifi cantly (p < 0.0001) associated with SF-36 summary scores for both genders. Males with 30-CST results under 7 stands and females with results of fewer than 13 stands were in the risk group for having the lowest PCS scores. Results in 30-CST under 12 stands in males and under 13 stands in females were associated with the lowest scores of MCS. Conclusions. 30-CST had the most expressed associa on with the outcomes of HRQoL in the Estonian popula on. Subjects with physical performance results under threshold values are at risk of lower HRQoL; therefore, 30-CST is a poten al screening indicator for HRQoL assessment.
19. sajandi lõpus hakkasid haiglad põetuse kõrval üha enam tegelema haigete raviga. Arsti tea dus... more 19. sajandi lõpus hakkasid haiglad põetuse kõrval üha enam tegelema haigete raviga. Arsti tea duse ja tehnika kiire areng aga suurendas omakorda haiglakulusid. Otsimaks võimalusi kulude kontrollimatu kasvu piiramiseks on tehtud mitmeid uurimusi haiglaravi efektiivsuse ja seda mõjutavate tegurite kohta (1). Aastatel 1993-1997 korraldas Maailma Tervise organisatsioon (WHO) katseprojekti, et lisaks diagnostikale ja ravile pöörata rohkem tähelepanu tervis eden du sele ning haiguste ennetamisele. Sellest tulenevalt hakati rohkem tähelepanu pöörama pat siendi ja personali tervisele ning tervist edendavatele tegevustele nii organisatsiooni kui ka paikkonna tasandil (2). Kogemuste vahetamise eesmärgil loodi katseprojekti lõppedes tervist edendavate haiglate (TEH) võrgustik. Eestis algatati TEH-liikumine katseprojektina juba 1999. aastal Tallinna Järve Haigla baasil, Eesti TEH-võrgustik asutati 25. jaanuaril 2000. aastal. 2005. aasta alguseks oli võrgustikuga liitunud 20 haiglat, mis kõik kuuluvad ka WHO rahvus vahelisse võrgustikku Health Promoting Hospitals (2). Ottawa harta põhimõtete järgi tähendab tervise edendamine haiglas olukorra loomist, kus nii patsiendil kui ka personalil on suurem kontroll oma tervise
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
We read with interest the article entitled ‘The Rheumatoid Arthritis Quality of Life (RAQoL) for ... more We read with interest the article entitled ‘The Rheumatoid Arthritis Quality of Life (RAQoL) for Sweden: adaptation and validation’ by Hedin et al, which was published in the Scandinavian Journal of Rheumatology (1). A new language version of this internationally accepted outcome measure opens opportunities to broaden multinational research on the quality of life (QoL) of rheumatoid arthritis (RA) patients. This official version of the Swedish RAQoL, produced by the dual panel translation method, has shown psychometric properties similar to those demonstrated for the Estonian version of the RAQoL (2). Because of its geographical proximity and tradition of scientific cooperation, Sweden is one of the countries Estonia would be expected to join with in medical research projects. Therefore, the development of a Swedish version of the RAQoL that used the approved adaptation procedure is of importance to rheumatological research in Estonia. Despite the proximity of Sweden and Estonia there are considerable differences between the countries in terms of history and culture that should be considered when comparative QoL research is planned. Different cultures and societies have unique concepts of QoL. This diversity of concepts can confound QoL research in the health sciences. Before selecting a QoL tool developed in and for another country, it is necessary to determine how the instrument will work in the context of the proposed research study. An instrument that has performed well in the country of origin can lose validity when applied in a different social context. Standard validation processes are less likely to be of value where the local QoL concept differs from that of the culture where the measure was developed. Ten semi-structured qualitative interviews with RA patients were conducted during the development of the Estonian version of the RAQoL to assess the suitability of the instrument. Thematic analysis conducted on the generated data indicated that the measure was highly relevant to patients; it was concluded that the RAQoL was an appropriate measure of QoL for use with Estonian RA patients (3). However, three QoL issues that were important for Estonian RA patients were not covered by the RAQoL. These were changes in role performance, communication with the medical system and financial issues related to obtaining the necessities of life. An assumption was made that failure to assess these specific issues might lead to an underestimation of the impact of RA on Estonian patients’ QoL. To determine the importance of the missing issues for Estonian RA patients, two additional validation strategies were applied. First, analysis was undertaken of data derived from a separate study that had used six focus groups to investigate RA patients’ satisfaction with health care. The transcripts of these
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