The tasks of primary health care in the chronically ill care

Chronically ill care, carried out within primary care by physicians specialized in family medicine, is the most effective clinically, socially and economically. In countries that have attempted to shape health care in the direction of meeting the chronically ill expectations, it was noticed the evolution of patient care from reactive, that activates when the patient reports with the disorder, to proactive - aiming at maintain a high quality of life. Primary health care, which is shaped and evaluated in accordance with the guidelines set out in the paper, improves the functioning of the chronically ill patients, which is evaluated within the biopsychosocial model. Such primary health care has also been recognized as the level of health care system that fully realizes assumptions of the Chronic Care Model.

For the last twenty five years in the Polish countryside, there have been observed significant changes in the socio-economic sphere, which result in the inhibition of urbanization processes and the reduction of the number of farmers. Alongside, farmers’ work has become less and less manual. However, there have been constant disparities, unfavorable for the rural population, in the education level and obtained income. The state of health of people living in rural areas has not been recently diagnosed and views on this issue are based on the estimated data or studies involving small groups of the population. However, these studies indicate increasing number of obese people and people with lipid disorders in rural areas, which may result in the near future in the increasing number of patients with type 2 diabetes and cardiovascular disease. Moreover, in the years to come, the future of PH care in rural areas seems to be far from promising, as family medicine faces the prospect of growing number of retiring physicians and declining of those who wish to enter the specialization. Unless systemic measures are taken the state of health of rural population can be significantly degraded.
 

The article highlights the social determinants of diseases within the primary care setting. Since the introduction of the new paradigm of the bio-psycho-social model into medicine, the social impact on illness has gained recognition. This article discusses the new approach to patients, as well as the impact that socio-economic status, emotional factors and stress have on health. Furthermore, factors such as the stages of patients’ lives and their ethnic and cultural identity (as well as approaches, such as the general theory of systems) are taken into consideration. New problems in primary care, including multimorbidity, patient frailty and medically unexplained symptoms, which have recently come under intense scrutiny, are also presented. Finally, clinical aspects of frail patients and the economic cost of the treatment of patients who suffer from unexplained symptoms are pointed out.

Patient safety is part of a health care quality. According to the World Health Organization patient safety is “a freedom, for a patient, from unnecessary harm or potential harm associated with healthcare”. The process of patient's safety improvement needs to engage all stakeholders and gain their understanding that the investment in safety could be recouped with efficiency gains and fewer adverse events. The article presents the selected aspects of patients safety in primary health care.

Patient nonadherence is one of the major clinical problems in primary care settings. Patients who deviate from treatment, or completely discontinue therapy, expose themselves to deterioration of health, additional costs and sometimes even death. Despite that facts, on average, one in every two patients, suffering from chronic disease, does not follow therapeutic recommendations. Unexpectedly, similar is true with acute symptomatic diseases, such as infections. Patient nonadherence is associated with more frequent visits to the doctors, higher number of complications, and therapy ineffectiveness. Fortunately, poor adherence can be effectively prevented. This paper provides comprehensive review of reasons and consequences of nonadherence, as well as methods that family doctors can use in order to improve adherence to therapy in their patients

Cardiovascular diseases (CVD) are the leading cause of lost productivity, morbidity, disability and mortality in Poland.The aim of this article is to present feasible in primary health care (PHC) actions to prevent or delay the onset of CVD. The role of the family doctor in these activities is discusses.Both in the Polish and European publications special attention is paid to health promotion and disease prevention as an important task of family doctors. Preventive measures should be implemented in all age groups (children, adults, elderly), and regardless of gender. This article highlights the need to assess the total CVD risk, which is the basis for selection of the best treatment decisions; discusses the risk factors for CVD; presents their occurrence in the Polish population and the methods used in PHC for their early diagnosis. It also describes the method of "brief interventions", which is a technique  that allows altering the lifestyle of patients.CVD prevention should include the correction of all modifiable risk factors. In our country, there are still areas in which there is much room for improvement of the quality of preventive care. In addition to the activities conducted in PHC, it is advisable to take action at other levels of health care system.

The scope of responsibilities and services of a nurse and midwife in primary health care was presented on the basis of a review of literature and current legal acts. The scope of responsibilities of a primary care nurse and midwife includes services provided at the patient's home and at an outpatients’ clinic concerning health promotion and disease prevention, as well as nursing, diagnostic, therapeutic and rehabilitation services. Services provided by a nurse in educational environment include carrying out and interpreting screening tests, counselling for students with health problems, care for students with chronic illnesses and disabilities, first aid, consultancy for the head teacher and participation in health education, including oral health issues. The objective of long-term home nursing care is to provide nursing care services at the patient's home, to instruct caregivers regarding proper care for the patient and to prepare the patient and their family to self-care and self-management.

Nowadays is need for developing grater system-wide support for managing our geriatric population. Improvement of common geriatric syndromes is important (urinary incontinence, falls, depressive symptoms, high risk medications or functional impairment).

The new model of geriatric care is needed.  Does this model should wide connected to primary system? Which aspects of primary geriatrics care are important?  Do primary care doctors prepare for better care of geriatric population? Many of those questions still are not resolved. European Union prepared some instruments for care of older and aging population.

Increasing hospitalization rate and out patients visit are a big problem in many health care systems. Out patterns of the look at the older population need change. We need to be preparing for new ideas of geriatric care. The voice of patients and their families is important

This article presents the changes in the number, quality structure as well as in personnel structure of microbiological laboratories in Poland in 2007-2013. The legal background of the above changes was also analysed, indicating that the issues concerning the operation of laboratories have been adopted relatively late compared to other healthcare institutions. As a result of the analysis, it was found that the number of the laboratories changes, and their number per capita in the different provinces is significantly different. These differences are also found in the number of staff per capita. At the same time an increased interest in the pro-quality activities was identified – an increasing number of laboratories have quality certificates.