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BACKGROUND: Measuring the safety culture in Healthcare is an important step in improving patient safety. One of the most commonly used instruments to measure the safety climate is the Safety Attitudes Questionnaire (SAQ). The aim of the current study was to establish the validity and reliability of the Slovenian version of the SAQ for the operating room SAQ-OR. METHODS: The SAQ, consisting of six dimensions, was translated and adapted to the Slovenian context and applied in operating rooms from seven out of ten Slovenian regional hospitals. Cronbach's alpha and confirmatory factor analysis (CFA) was used to evaluate the reliability and validity of the instrument. RESULTS: The sample consisted of 243 health care professionals who hold positions in the OR, divided into 4 distinct professional classes, namely, 76 surgeons (31%), 15 anesthesiologists (6%), 140 nurses (58%) and 12 auxiliary persons (5%). It was observed a very good Cronbach's alpha (0.77 to 0.88). The CFA and its goodness-of-fit indices (CFI 0.912, TLI 0.900, RMSE 0.056, SRMR 0.056) showed an acceptable model fit. There are 28 items in the final model. CONCLUSIONS: The Slovenian version of the SAQ-OR revealed good psychometric properties for studying the organisational safety culture.
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Actitud del Personal de Salud , Quirófanos , Humanos , Reproducibilidad de los Resultados , Administración de la Seguridad , Cultura Organizacional , Seguridad del Paciente , Encuestas y Cuestionarios , PsicometríaRESUMEN
Background and Objectives: Glaucoma is a major cause of irreversible visual impairment and blindness, so its timely detection is crucial. Retinal images from diabetic retinopathy screening programmes (DRSP) provide an opportunity to detect undiagnosed glaucoma. Our aim was to find out which retinal image indicators are most suitable for referring DRSP patients for glaucoma assessment and to determine the glaucoma detection potential of Slovenian DRSP. Materials and Methods: We reviewed retinal images of patients from the DRSP at the University Medical Centre Ljubljana (November 2019-January 2020, May-August 2020). Patients with at least one indicator and some randomly selected patients without indicators were invited for an eye examination. Suspect glaucoma and glaucoma patients were considered accurately referred. Logistic regression (LOGIT) with patients as statistical units and generalised estimating equation with logistic regression (GEE) with eyes as statistical units were used to determine the referral accuracy of indicators. Results: Of the 2230 patients reviewed, 209 patients (10.1%) had at least one indicator on a retinal image of either one eye or both eyes. A total of 149 (129 with at least one indicator and 20 without) attended the eye exam. Seventy-nine (53.0%) were glaucoma negative, 54 (36.2%) suspect glaucoma, and 16 (10.7%) glaucoma positive. Seven glaucoma patients were newly detected. Neuroretinal rim notch predicted glaucoma in all cases. The cup-to-disc ratio was the most important indicator for accurate referral (odds ratio 7.59 (95% CI 3.98-14.47; p < 0.001) and remained statistically significant multivariably. Family history of glaucoma also showed an impact (odds ratio 3.06 (95% CI 1.02-9.19; p = 0.046) but remained statistically significant only in the LOGIT multivariable model. Other indicators and confounders were not statistically significant in the multivariable models. Conclusions: Our results suggest that the neuroretinal rim notch and cup-to-disc ratio are the most important for accurate glaucoma referral from retinal images in DRSP. Approximately half of the glaucoma cases in DRSPs may be undiagnosed.
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Diabetes Mellitus , Retinopatía Diabética , Glaucoma , Humanos , Estudios Transversales , Retinopatía Diabética/diagnóstico por imagen , Glaucoma/diagnóstico , Derivación y Consulta , Eslovenia/epidemiologíaRESUMEN
INTRODUCTION AND PURPOSE: National cancer control plans cf. programmes (NCCPs) are policy instruments to structure, map and organise comprehensive cancer policies in a country or its region. One of their important objectives is improvement of quality in cancer care and control. METHODS: We explored several methodological papers on NCCPs and analyses on their implementation in the European Union as well as recommendations and guidelines concerning prostate cancer screening and management. RESULTS AND DISCUSSION: Quality is still not a very common feature of NCCPs as an independent, self-standing issue. Only a handful of countries structured and implemented specific activities to monitor quality of cancer care in their policy documents. In others, quantitative approaches focusing on epidemiology and provision of care are dominant, not focusing on indicators, especially those of process and outcome. In view of that and exploring its position in a broader sense, prostate cancer is poorly represented and insufficiently addressed, in particular with respect to screening, but also in after-care and survivorship challenges. CONCLUSIONS: Given that methodological tools on NCCPs envisage quality as a separate chapter and an overarching topic in NCCPs, the current situation shows that we are still a long way away from the goals set. Absence of structured approaches for a cancer, such as prostate cancer, in NCCPs demonstrates the lack of consistency on all phases of comprehensive control on a frequent cancer, where practices and outcomes show unacceptable variations.
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Neoplasias de la Próstata/terapia , Calidad de la Atención de Salud/normas , Europa (Continente) , Política de Salud , Humanos , MasculinoRESUMEN
INTRODUCTION: National Cancer Control Programmes (NCCPs) provide a country's policy framework for the development of cancer control, focussing on the reduction of cancer morbidity and mortality and improving quality of life of cancer patients. OBJECTIVE: Exploring and analysing to which extent some of the key elements of the European Guide for Quality National Cancer Control Programmes (Guide) are implemented in NCCPs in the EU. METHODS: Survey carried out through 30 countries, EU members, Iceland, Montenegro, Norway and Turkey, focussing on stakeholders' participation, inclusion of all the envisaged chapters from the Guide as well as implementation and dissemination. RESULTS: The results of the policy survey on European NCCPs carried out within Cancer Control Joint Action (CANCON JA) are presented. The response was 30 out of 35 countries. In total, 28 out of 30 countries, which completed the survey, had an NCCP or another cancer document. Cancer documents were mostly single documents, managed and supervised by the respective Ministries of Health and communicated to the public via websites and press. Nine documents were defined as programmes, eight as plans and six as strategies; in five countries, terminology was mixed. Regarding the content, recommended by the Guide from 2015, comprising ten chapter areas in three parts. Only 10 countries included in their NCCPs all elements suggested in the Guide. CONCLUSION: Based on our results, we can see that a more comprehensive approach in the process of NCCPs is needed. Policy should focus on the development of instruments for efficient cancer management, which would encompass the entire trajectory of the cancer care from diagnosis to survivorship and supportive care.
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Atención a la Salud/tendencias , Neoplasias/diagnóstico , Mejoramiento de la Calidad/tendencias , Encuestas y Cuestionarios , Europa (Continente)/epidemiología , Humanos , Morbilidad/tendencias , Neoplasias/epidemiologíaRESUMEN
Full integration of oncology and palliative care relies on the specific knowledge and skills of two modes of care: the tumour-directed approach, the main focus of which is on treating the disease; and the host-directed approach, which focuses on the patient with the disease. This Commission addresses how to combine these two paradigms to achieve the best outcome of patient care. Randomised clinical trials on integration of oncology and palliative care point to health gains: improved survival and symptom control, less anxiety and depression, reduced use of futile chemotherapy at the end of life, improved family satisfaction and quality of life, and improved use of health-care resources. Early delivery of patient-directed care by specialist palliative care teams alongside tumour-directed treatment promotes patient-centred care. Systematic assessment and use of patient-reported outcomes and active patient involvement in the decisions about cancer care result in better symptom control, improved physical and mental health, and better use of health-care resources. The absence of international agreements on the content and standards of the organisation, education, and research of palliative care in oncology are major barriers to successful integration. Other barriers include the common misconception that palliative care is end-of-life care only, stigmatisation of death and dying, and insufficient infrastructure and funding. The absence of established priorities might also hinder integration more widely. This Commission proposes the use of standardised care pathways and multidisciplinary teams to promote integration of oncology and palliative care, and calls for changes at the system level to coordinate the activities of professionals, and for the development and implementation of new and improved education programmes, with the overall goal of improving patient care. Integration raises new research questions, all of which contribute to improved clinical care. When and how should palliative care be delivered? What is the optimal model for integrated care? What is the biological and clinical effect of living with advanced cancer for years after diagnosis? Successful integration must challenge the dualistic perspective of either the tumour or the host, and instead focus on a merged approach that places the patient's perspective at the centre. To succeed, integration must be anchored by management and policy makers at all levels of health care, followed by adequate resource allocation, a willingness to prioritise goals and needs, and sustained enthusiasm to help generate support for better integration. This integrated model must be reflected in international and national cancer plans, and be followed by developments of new care models, education and research programmes, all of which should be adapted to the specific cultural contexts within which they are situated. Patient-centred care should be an integrated part of oncology care independent of patient prognosis and treatment intention. To achieve this goal it must be based on changes in professional cultures and priorities in health care.
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Prestación Integrada de Atención de Salud/organización & administración , Oncología Médica/organización & administración , Neoplasias/terapia , Cuidados Paliativos/organización & administración , Grupo de Atención al Paciente/organización & administración , Actitud del Personal de Salud , Actitud Frente a la Muerte , Conducta Cooperativa , Vías Clínicas/organización & administración , Conocimientos, Actitudes y Práctica en Salud , Humanos , Comunicación Interdisciplinaria , Neoplasias/diagnóstico , Neoplasias/mortalidad , Calidad de Vida , Resultado del TratamientoRESUMEN
Background: General practitioners (GPs) will face cancer recurrences more frequently due to the rising number of cancer survivors and greater involvement of GPs in the follow-up care. Currently, GPs are uncertain about managing recurrence risks and may need more guidance. Objective: To explore what guidance is available for GPs on managing recurrence risks for breast cancer, colorectal cancer and melanoma, and to examine whether recurrence risk management differs between these tumour types. Methods: Breast cancer, colorectal cancer and melanoma clinical practice guidelines were identified via searches on internet and the literature, and experts were approached to identify guidelines. Guidance on recurrence risk management that was (potentially) relevant for GPs was extracted and summarized into topics. Results: We included 24 breast cancer, 21 colorectal cancer and 15 melanoma guidelines. Identified topics on recurrence risk management were rather similar among the three tumour types. The main issue in the guidelines was recurrence detection through consecutive diagnostic testing. Guidelines agree on both routine and nonroutine tests, but, recommended frequencies for follow-up are inconsistent, except for mammography screening for breast cancer. Only six guidelines provided targeted guidance for GPs. Conclusion: This inventory shows that recurrence risk management has overlapping areas between tumour types, making it more feasible for GPs to provide this care. However, few guidance on recurrence risk management is specific for GPs. Recommendations on time intervals of consecutive diagnostic tests are inconsistent, making it difficult for GPs to manage recurrence risks and illustrating the need for more guidance targeted for GPs.
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Neoplasias de la Mama/diagnóstico , Neoplasias Colorrectales/diagnóstico , Médicos Generales/educación , Melanoma/diagnóstico , Recurrencia Local de Neoplasia , Guías de Práctica Clínica como Asunto , Neoplasias de la Mama/terapia , Neoplasias Colorrectales/terapia , Medicina Familiar y Comunitaria , Femenino , Humanos , Mamografía , Melanoma/terapia , Pautas de la Práctica en Medicina/normas , Gestión de RiesgosRESUMEN
INTRODUCTION: Mental health inequalities are an increasingly important global problem. This study examined the association between mental health status and certain socioeconomic indicators (personal social position and the socioeconomic status of the family) in Slovenian 15-year-old adolescents. METHODS: Data originate from the WHO-Collaborative cross-national 'Health Behavior in School-aged Children' study conducted in Slovenia in 2010 (1,815 secondary school pupils, aged 15). Mental health status was measured by: KIDSCREEN-10, the Strength and Difficulties questionnaire (SDQ), a life satisfaction scale, and one question about feelings of depression. Socioeconomic position was measured by the socioeconomic status of the family (Family Affluence Scale, perceived material welfare, family type, occupational status of parents) and personal social position (number of friends and the type of school). Logistic regression and a multivariate analysis of variance (MANOVA) were performed. RESULTS: Girls had 2.5-times higher odds of suffering feelings of depression (p < 0.001), 1.5-times higher odds of low life satisfaction (p = 0.008), and a greater chance of a lower quality of life and a higher SDQ score than boys (p = 0.001). The adolescents who perceived their family's material welfare as worse had 4-times higher odds (p < 0.001) of a low life satisfaction, a greater chance of a low quality of life, and a higher SDQ score than those who perceived it as better (p < 0.001). Adolescents with no friends had lower KIDSCREEN-10 and higher SDQ scores than those who had more than three friends. CONCLUSIONS: Despite the fact that Slovenia is among the EU members with the lowest rates of social inequalities, it was found that adolescents with a lower socioeconomic position have poorer mental health than those with a higher socioeconomic position. Because of the financial crisis, we can expect an increase in social inequalities and a greater impact on adolescents' mental health status in Slovenia in the future.
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Depresión , Amigos , Disparidades en el Estado de Salud , Relaciones Interpersonales , Salud Mental , Padres , Clase Social , Adolescente , Depresión/etiología , Femenino , Conductas Relacionadas con la Salud , Humanos , Masculino , Percepción , Satisfacción Personal , Calidad de Vida , Instituciones Académicas , Factores Sexuales , Eslovenia , Encuestas y CuestionariosRESUMEN
Neurological conditions are the leading cause of death and disability combined. This public health crisis has become a global priority with the introduction of WHO's Intersectoral Global Action Plan on Epilepsy and Other Neurological Disorders 2022-2031 (IGAP). 18 months after this plan was adopted, global neurology stakeholders, including representatives of the OneNeurology Partnership (a consortium uniting global neurology organisations), take stock and advocate for urgent acceleration of IGAP implementation. Drawing on lessons from relevant global health contexts, this Health Policy identifies two priority IGAP targets to expedite national delivery of the entire 10-year plan: namely, to update national policies and plans, and to create awareness campaigns and advocacy programmes for neurological conditions and brain health. To ensure rapid attainment of the identified priority targets, six strategic drivers are proposed: universal community awareness, integrated neurology approaches, intersectoral governance, regionally coordinated IGAP domestication, lived experience-informed policy making, and neurological mainstreaming (advocating to embed brain health into broader policy agendas). Contextualised with globally emerging IGAP-directed efforts and key considerations for intersectoral policy design, this novel framework provides actionable recommendations for policy makers and IGAP implementation partners. Timely, synergistic pursuit of the six drivers might aid WHO member states in cultivating public awareness and policy structures required for successful intersectoral roll-out of IGAP by 2031, paving the way towards brain health for all.
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Salud Global , Política de Salud , Humanos , Formulación de Políticas , Salud Pública , EncéfaloRESUMEN
Introduction: Higher nursing workload increases the odds of patient deaths, as the work environment has a significant effect on patient outcomes. The aim of the study was to explore the relation between patient outcomes and nurses' working conditions in hospitals. Methods: Administrative data on discharges of surgical patients for the year 2019 in eight general hospitals and two university medical centres in Slovenia were collected to determine in-hospital mortality within 30 days of admission. The RN4CAST survey questionnaire was used to gather data from nurses in these hospitals, with 1,010 nurses participating. Data was collected at the beginning of 2020. The number of nurses per shift and the nurse-to-patient ratio per shift were calculated. Univariate, bivariate and multivariate statistical methods were used to analyse the data. Results: The 30-day in-hospital mortality for surgical patients was 1.00% in the hospitals sampled and ranged from 0.27% to 1.62%. The odds ratio for staffing suggests that each increase of one patient per RN is associated with a 6% increase in the likelihood of a patient dying within 30 days of admission. The mean patient-to-RN ratio was 15.56 (SD=2.50) and varied from 10.29 to 19.39. Four of the 13 tasks checked were not performed on patients during the last shift. Conclusion: The results are not encouraging, with an extremely critical shortage of RNs and thus a high RN workload. The number of patients per RN is the highest in Europe and also higher than in some non-European countries, and represents an extreme risk to the quality of nursing and healthcare as a whole. The recommendation for acute non-emergency internal medicine and surgery departments is four patients per RN per shift.
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European cancer research stakeholders met in October 2022 in Heidelberg, Germany, at the 5th Gago conference on European Cancer Policy, to discuss the current cancer research and cancer care policy landscape in Europe. Meeting participants highlighted gaps in the existing European programmes focusing on cancer research, including Europe's Beating Cancer Plan (EBCP), the Mission on Cancer (MoC), Understanding Cancer (UNCAN.eu), and the joint action CRANE, and put forward the next priorities, in the form of the Heidelberg Manifesto for cancer research. This meeting report presents all discussions that shed light on how infrastructures can be effectively shaped for translational, prevention, clinical and outcomes cancer research, with a focus on implementation and sustainability and while engaging patients and the public. In addition, we summarize recommendations on how to introduce frameworks for the digitalization of European cancer research. Finally, we discuss what structures, commitment, and resources are needed to establish a collaborative cancer research environment in Europe to achieve the scale required for innovation.
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Neoplasias , Humanos , Neoplasias/terapia , Europa (Continente) , Alemania , PolíticasRESUMEN
In the pre-PSA-detection era, a large proportion of men were diagnosed with metastatic prostate cancer and died of the disease; after the introduction of the serum PSA test, randomized controlled prostate cancer screening trials in the USA and Europe were conducted to assess the effect of PSA screening on prostate cancer mortality. Contradictory outcomes of the trials and the accompanying overdiagnosis resulted in recommendations against prostate cancer screening by organizations such as the United States Preventive Services Task Force. These recommendations were followed by a decline in PSA testing and a rise in late-stage diagnosis and prostate cancer mortality. Re-evaluation of the randomized trials, which accounted for contamination, showed that PSA-based screening does indeed reduce prostate cancer mortality; however, the debate about whether to screen or not to screen continues because of the considerable overdiagnosis that occurs using PSA-based screening. Meanwhile, awareness among the population of prostate cancer as a potentially lethal disease stimulates opportunistic screening practices that further increase overdiagnosis without the benefit of mortality reduction. However, in the past decade, new screening tools have been developed that make the classic PSA-only-based screening an outdated strategy. With improved use of PSA, in combination with age, prostate volume and with the application of prostate cancer risk calculators, a risk-adapted strategy enables improved stratification of men with prostate cancer and avoidance of unnecessary diagnostic procedures. This combination used with advanced detection techniques (such as MRI and targeted biopsy), can reduce overdiagnosis. Moreover, new biomarkers are becoming available and will enable further improvements in risk stratification.
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Antígeno Prostático Específico , Neoplasias de la Próstata , Detección Precoz del Cáncer/métodos , Europa (Continente) , Humanos , Masculino , Tamizaje Masivo/métodos , Próstata/patología , Neoplasias de la Próstata/patología , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
Efficiency in healthcare is crucial since available resources are scarce, and the cost of inefficient allocation is measured in prior outcomes. This is particularly relevant for cancer. The aim of this paper is to gain a comprehensive overview of the areas and dimensions to improve efficiency, and establish the indicators, different methods, perspectives, and areas of evaluation, to provide recommendations for how to improve efficiency and measure gains in cancer care. METHODS: We conducted a two-phase design. First, a comprehensive scoping literature review was conducted, searching four databases. Studies published between 2000 and 2021 were included if they described experiences and cases of efficiency in cancer care or methods to evaluate efficiency. The results of the literature review were then discussed during two rounds of online consultation with a panel of 15 external experts invited to provide insight and comments to deliberate policy recommendations. RESULTS: 46 papers met the inclusion criteria. Based on the papers retrieved we identified six areas for achieving efficiency gains throughout the entire care pathway and, for each area of efficiency, we categorized the methods and outcomes used to measure efficiency gain. CONCLUSION: This is the first attempt to systemize a scattered body of literature on how to improve efficiency in cancer care and identify key areas of improvement. POLICY SUMMARY: There are many opportunities to improve efficiency in cancer care. We defined seven policy recommendations on how to improve efficiency in cancer care throughout the care pathway and how to improve the measurement of efficiency gains.
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Atención a la Salud , Neoplasias , Neoplasias/terapiaRESUMEN
Lung cancer is the leading cause of cancer-related deaths in Europe. Europe's Beating Cancer Plan calls for a comprehensive approach to the disease in general but not specifically to lung cancer. Such a comprehensive approach, integrating efforts to strengthen anti-tobacco policies, early detection and underlying models of care, is sorely needed for lung cancer - particularly considering disruptions to care during the COVID-19 pandemic. In a recently published think piece, a multidisciplinary group of experts proposed four key policy priority areas. First, to reduce stigma and improve awareness of potential symptoms, there is a need to foster a better understanding of lung cancer - among the public and healthcare professionals. Second, opportunities for early detection should be enhanced, and the implementation of targeted screening through low-dose computed tomography should be encouraged as a complement to smoking cessation services. This complementarity should be recognised and built into joint policy proposals, with development and better integration of screening and smoking cessation programmes on the ground. Third, the socioeconomic inequalities underpinning disparities in outcomes in people with lung cancer must be addressed, with targeted approaches to overcome barriers to access Finally, the overall quality of lung cancer care must be improved, making multidisciplinary care available to all and ensuring survivorship is given due attention.
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COVID-19 , Neoplasias Pulmonares , COVID-19/epidemiología , COVID-19/prevención & control , Detección Precoz del Cáncer/métodos , Europa (Continente)/epidemiología , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/epidemiología , Neoplasias Pulmonares/terapia , Pandemias , PolíticasRESUMEN
Countries with social health insurance (SHI) systems display some common defining characteristics - pluralism of actors and strong medical associations - that, in dealing with crisis times, may allow for common learnings. This paper analyses health system responses during the COVID-19 pandemic in eight countries representative of SHI systems in Europe (Austria, Belgium, France, Germany, Luxembourg, the Netherlands, Slovenia and Switzerland). Data collection and analysis builds on the methodology and content in the COVID-19 Health System Response Monitor (HSRM) up to November 2020. We find that SHI funds were, in general, neither foreseen as major stakeholders in crisis management, nor were they represented in crisis management teams. Further, responsibilities in some countries shifted from SHI funds to federal governments. The overall organisation and governance of SHI systems shaped how countries responded to the challenges of the pandemic. For instance, coordinated ambulatory care often helped avoid overburdening hospitals. Decentralisation among local authorities may however represent challenges with the coordination of policies, i.e. coordination costs. At the same time, bottom-up self-organisation of ambulatory care providers is supported by decentralised structures. Providers also increasingly used teleconsultations, which may remain part of standard practice. It is recommended to involve SHI funds actively in crisis management and in preparing for future crisis to increase health system resilience.
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COVID-19 , Europa (Continente)/epidemiología , Humanos , Seguro de Salud , Pandemias , Seguridad SocialRESUMEN
Provider payment mechanisms were adjusted in many countries in response to the COVID-19 pandemic in 2020. Our objective was to review adjustments for hospitals and healthcare professionals across 20 countries. We developed an analytical framework distinguishing between payment adjustments compensating income loss and those covering extra costs related to COVID-19. Information was extracted from the Covid-19 Health System Response Monitor (HSRM) and classified according to the framework. We found that income loss was not a problem in countries where professionals were paid by salary or capitation and hospitals received global budgets. In countries where payment was based on activity, income loss was compensated through budgets and higher fees. New FFS payments were introduced to incentivize remote services. Payments for COVID-19 related costs included new fees for out- and inpatient services but also new PD and DRG tariffs for hospitals. Budgets covered the costs of adjusting wards, creating new (ICU) beds, and hiring staff. We conclude that public payers assumed most of the COVID-19-related financial risk. In view of future pandemics policymakers should work to increase resilience of payment systems by: (1) having systems in place to rapidly adjust payment systems; (2) being aware of the economic incentives created by these adjustments such as cost-containment or increasing the number of patients or services, that can result in unintended consequences such as risk selection or overprovision of care; and (3) periodically evaluating the effects of payment adjustments on access and quality of care.
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COVID-19 , Presupuestos , Honorarios y Precios , Humanos , Motivación , PandemiasRESUMEN
This analysis of the Slovene health system reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. Slovenia has a statutory health insurance system with a single public insurer, providing almost universal coverage for a broad benefits package, though some services require relatively high levels of co-insurance (called co-payments in Slovenia). To cover these costs, about 95% of the population liable for cost-sharing purchases complementary, voluntary health insurance. Health expenditure per capita and as a share of GDP has increased slightly, but still trails behind the EU average. Among statutory health insurance countries, Slovenia is rather unique in that it relies almost exclusively on payroll contributions to fund its system, making health sector revenues vulnerable to economic and labour market fluctuations, and population ageing. Important organizational changes are underway or have been implemented, especially in prevention, primary, emergency and long-term care. Access to services is generally good, given wide coverage of statutory health insurance. Further, Slovenia has some of the lowest rates of out-of-pocket and catastrophic spending in the EU, due to extensive uptake of complementary voluntary health insurance. Yet long waiting times for some services are a persistent issue. Though population health has improved in the last decades, health inequalities due to gender, social and economic determinants and geography remain an important challenge. There is variation in health care performance indicators, but Slovenia performs comparatively well for its level of health spending overall. As such, there is clear scope to improve health and efficiency, including balancing population needs when planning health service volumes. Recently, the Slovene health care system was overwhelmed by the demand for COVID-19-related care. The pandemicâs longer-term effects are still unknown, but it has significantly impacted on life expectancy in the short-term and resulted in delayed or forgone consultations and treatments for other health issues, and longer waiting times. Additional challenges, which are necessary to address to ensure long-term sustainability, strengthen resiliency and improve the capacity for service delivery and quality of care of the health system include: 1) health workforce planning; 2) outdated facilities; 3) health system performance assessment; and 4) implementation of current LTC reform.
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COVID-19 , Reforma de la Atención de Salud , Gastos en Salud , Financiación de la Atención de la Salud , Humanos , Seguro de Salud , Calidad de la Atención de Salud , SARS-CoV-2 , EsloveniaRESUMEN
There are considerable disparities between the quality of cancer care and clinical outcomes for cancer patients in different European countries, regions, hospitals and communities. These have persisted despite the introduction of many European and National Cancer Plans, an extensive portfolio of clinical guidelines and the existence of evidence based guidelines for the good practice in planning cancer healthcare systems. We describe the European Code of Cancer Practice which is a citizen and patient-centred accessible widely disseminated statement of the core requirements for good clinical cancer practice. The Code sets out 10 key overarching Rights of what a patient should expect from their healthcare system each supported by a plain language explanation. The Rights highlight the importance of equal access to affordable and optimal cancer care, good quality information about an individual patient's disease and treatment and about the quality and outcomes of the cancer service they will use. Specialised multidisciplinary cancer care teams, shared decision-making, research and innovation, a focus on quality of life, the integration of supportive and palliative care within oncology are all emphasised. There is a need for a systematic approach to supporting cancer survivors with a survivorship care plan including their rehabilitation, reintegration into society and return to work where appropriate without discrimination. The Code has been co-produced by a team of cancer patients, patient advocates and cancer professionals to bridge the gap between clinical guidelines, healthcare policies and patients' everyday experience. It is robustly evidence-based and supported by a comprehensive review of the medical literature and evidence for good clinical practice. The Code is strongly endorsed by Europe's professional and patient cancer organisations and the European Commission.