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Medical rehabilitation without priorities, supervision and evaluation of results

08/01/2019 Drukāt šo rakstu

Lack of data on both patient needs in medical rehabilitation and achieved results prevents to evaluate efficiency of state-funded rehabilitation services and needs of the population in conjunction with state budget possibilities. As there is also lack of clear understanding about how the field of rehabilitation should develop in the long run and what the objectives and priorities in the field are, it is practically impossible to judge the quality of rehabilitation services in the country. The State Audit Office has come to such conclusion after an audit in the field of rehabilitation services.

“Many measures for development in the field, that can be found in the policy documents of the Ministry of Health, have remained “on paper”. While it is so, the patient who does not receive the necessary help suffers. E.g. in a time when we hear worries about labour shortage more and more, people of working age are not provided with medical rehabilitation in time and in the necessary amount, although the number or incapacity cases among people of working age has increased by 15% within two years. Also, none of the tasks to improve rehabilitation services for people with oncology or cardio-vascular diseases have been fulfilled”, Auditor General Elita Krūmiņa tells about the conclusions of the audit.

Working population – increasingly diseased

An earlier start of rehabilitation is one of instruments for people to be able to return to work after a disease as soon as possible. However, in the audit it was found that patients of working age do not receive necessary rehabilitation services soon enough. Besides, from the total number of people receiving outpatient rehabilitation services only 8% work. Also the number of people receiving sickness benefits whose diseases have lasted longer than half a year and the number of people with “occupational disease” stated as cause in their incapacity certificates are increasing.

Audit results lead to the conclusion that at the moment rehabilitation does not sufficiently focus on health maintenance and improvement, and recovery of working ability.  E.g. one of musculosceletal system diseases is indicated as cause of disability for approximately quarter of all working people with first-time disability . Specialists claim that rehabilitation in the initial stage of a disease has a huge role in shortening the period of incapability. However, 75 % of patients with musculosceletal system diseases have not received any rehabilitation at all.

Oncology and cardio-vascular disease patients – in “paper” value

From 2014 to 2017 rehabilitation funding has increased by approx. 30 % and the Ministry of Health has planned that rehabilitation services shall be improved especially for oncology and cardio-vascular disease patients. However, in the audit it was found that so far none of the set tasks has been fulfilled. Availability of services for oncology patients is not increased, cardiology rehabilitation programme for improvement of patient life quality, maintenance or improvement of working ability and prevention of the need of stationary rehabilitation is not prepared.

The number of oncology patients who have received rehabilitation services does not reach even 1 % of the total amount of diseased people. Neither does the Ministry of Health have data on the total amount of insult patients who would need the services of day in-patient departments, outpatient medical institutions and home care for medical rehabilitation. However, it is early rehabilitation that would ensure treatment continuity and a more efficient treatment for insult patients. As the services necessary for insult patients are not coordinated on a state-level, the task to look for rehabilitation possibilities is left for patients themselves and their relatives.

In order to reduce the time spent in hospitals for insult patients, it is possible to receive rehabilitation services at home. However, in rural territories the lack of specialists and disadvantageous tariff for medical institutions restrict the availability of these services.

General practitioners shall become key people in improving rehabilitation process

In Latvian health care model, the central person who coordinates patients’ course of treatment, is the general practitioner. However, in the audit it was concluded, that the Ministry of Health has not sufficiently strengthened the role of general practitioners in patients’ rehabilitation. General practitioners are the ones who need to be able to recognise disability risks in time and they need to offer rehabilitation options to patients, in such way reducing the risk of disability and using health care resources more efficiently. If a patient’s rehabilitation needs are not identified in time, the patient receives necessary rehabilitation late and that means that more resources are used for the recovery of this patient’s functional abilities. Also medical institutions which provide rehabilitation services, being questioned during audit indicated general practitioners’ insufficient understanding of the significance of rehabilitation services on the improvement of patients’ health.

Besides, patient’s participation in maintenance of his health and in problem solving has great importance. Specialists indicated to auditors that patients’ understanding of the significance of rehabilitation is not sufficient, and sometimes people lack motivation to actively participate in the improvement of their own health. In the opinion of the State Audit Office, general practitioners should be the ones “leading” patients’ rehabilitation process, and so helping them to reach positive treatment result.

Qualitative, effective, available services are necessary

Rehabilitation has to become a full component of health care. In order to achieve that, State Audit Office has given recommendations to the Ministry of Health to strengthen the role of rehabilitation in the course of treatment, which will ensure qualitative, effective and available state-funded rehabilitation services. State Audit Office believes that general practitioners’ understanding of the significance of rehabilitation shall be improved, and the possibility to set priorities to state-funded medical rehabilitation services shall be assessed. In rehabilitation, service quality shall be evaluated according to the achieved result. In other countries, in order to evaluate the efficiency of medical rehabilitation, usually a reference point is chosen, e.g. the number of incapacity certificates, incapacity days or hospitalization cases. Therefore an exhaustive system analysis shall be carried out in cooperation with specialists of the field and medical institutions, and data monitoring and information exchange system about patients in their different stages of health care shall be improved.

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