Policy challenges to the quality of child health services in Bulgaria.


Rechel, B; Spencer, N; Blackburn, C; Rechel, B; (2010) Policy challenges to the quality of child health services in Bulgaria. The International journal of health planning and management, 25 (4). pp. 350-67. ISSN 0749-6753 DOI: https://doi.org/10.1002/hpm.1030

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Abstract

BACKGROUND: Our study aimed to explore policy challenges to the quality of child health services in Bulgaria.<br/> METHODS: The study was based on qualitative in-depth interviews, analysis of regulatory documents, and review of the literature. Respondents included policy-makers, providers and users of health services, from both rural and urban areas.<br/> RESULTS: Problems identified included insufficient training of general practitioners, medical errors, delays in response to emergencies, inadequate information provided to patients, and underdeveloped child public health. A common view was that paediatricians provide better quality care than general practitioners. Respondents described a lack of clinical guidelines for rational use of pharmaceuticals, overprescribing of antibiotics, reliance on pharmaceutical companies for information, and unrestricted sales of drugs over-the-counter. 'Clinical pathways', introduced as a payment mechanism in hospitals, were perceived as lacking transparency, complicating clinical practice, and forcing doctors to record wrong diagnoses and conduct unnecessary investigations.<br/> CONCLUSIONS: Our findings indicate the need to develop evidence-based clinical guidelines for primary and secondary care, establish payment mechanisms that facilitate quality improvements, promote rational use of pharmaceuticals, improve continuing training of physicians and strengthen child public health.<br/>

Item Type: Article
Faculty and Department: Faculty of Public Health and Policy > Dept of Health Services Research and Policy
Faculty of Infectious and Tropical Diseases > Dept of Disease Control
Research Centre: ECOHOST - The Centre for Health and Social Change
PubMed ID: 20540077
Web of Science ID: 284213100005
URI: http://researchonline.lshtm.ac.uk/id/eprint/3473

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