MATRA

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MATRA

• Projects in Romania

MATRA Project - Training the trainers 1998 -
2000 Qualy-Med - Increasing the Quality in
Romanian Primary Care 2002-2005
MATRA Projects developed by The Foundation
National Centre for Studies in Family Medicine,
Romania The Foundation Improving Quality of
Health Care in Romania, Holland
Dr. Marius MargineanPresidentNational Centre
for Studies in Family Medicine
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• Slide 2 a map with a few characteristics of your
  country (number of inhabitants, main
• cities, etc)

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15 years of
15 years of ...

• Financial and Moral support from
• Prof. Dr. Jan van Es
• Dutch experts of Maastricht University, Dutch
  College of General Practitioners, Utrecht
  University, NIVEL Institute, Diabetes Fund
• Dutch Government through MATRA Projects

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• Training the trainers project (1998-2000)

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Training the trainers project (1998-2000)
MATRA Project- Training the trainers 1998 - 2000

• 3 years programme of training in
• research methods coordinator Prof. Hertjan
• practice management
• coordinator Dr. Pieter van DEN Homberg
• teaching methods
• coordinator Prof. Victor Dubois
• Program coordinator Prof. Dr. Jan van Es

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Training the trainers project (1998-2000)

• Results
• 54 GPs trainers (Dutch Institute for Post
  Academic Training - CARE, MH)
• 6 PhD theses
• MATRA spirit - dedication for FM and desire for
  high quality performance
• ? 2001 NCSFM was born

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• Qualy-Med Project
• (2002 - 2005)

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Qualy-Med (2002-2005)
Qualy-Med Matra Project2002 - 2005

• Goal the improvement of
• quality in primary care
• Specific objective
• development of 5 evidence-based guidelines on
• Hypertension
• Diabetes type 2
• Prenatal care
• Low back pain
• Urinary tract infection

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Qualy-Med (2002-2005)

• Results
• Development of a methodology for making
  evidence-based guidelines for Romania
• 40 GPs were trained for using this methodology
  and for evidence-based medicine
• Development of 5 EB guidelines
• Implementation of these 5 guidelines

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Qualy-Med (2002-2005)
Results

• a methodology based on international
  recommendations
• 3 forms of each guideline doctors and patients
  versions and a 2 pages algorithm
• NCSFM - member of Interdisciplinary Group for
  Guidelines in Romania
• NCSFM - member of GIN Guidelines International
  Network
• Implementing guidelines - workshops
• Pilot project (2006-07) USAID for
  implementation of hypertension and diabetes
  guidelines
• www.ghidurimedicale.ro

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Qualy-Med (2002-2005)

• Main obstacles during the implementation of
  the project
• No clear regulation regarding guidelines
  development (CoP, MoH)
• Access to information to get full text articles
  was quite complicated
• Big area members of guidelines groups were from
  all the country, big distances
• The working time of a GP no possibility to
  reduce the daily workload (part time job etc)
• Costs of implementation, no help from health
  authorities

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Position pf primary care in Romania

• Primary care in Romania
• Family medicine is in the centre of the health
  system on declaration level
• 11000 GPs in private practices in contract with
  the Insurance House
• GPs should act like gate keepers (but not in the
  reality)
• The percent of the budget allocated to primary
  care is too small GPs are underpaid

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Defenders

• Who (which organisations) are the strong
  defenders of primary care in your country ?
• The strongest defender of primary care are GPs
  organizations Romanian Society of Family
  Medicine/General Medicine
• The Ministry of Health, affirmatively wants to
  support family medicine
• Universities, at this moment are not able to
  defend FM because of many inconsistencies
• The College of Physicians doesnt have a clear
  position for the development of Family Medicine

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Further development

• Further development. Priorities
• Stable Romanian legislation
• Normal finance conditions
• Improvement of the position of GP (reorganisation
  of the National Society of FM, development of a
  union/patronage organisation), lobby, awareness,
  job description
• Property of practices (under development now)
• Quality Improvement of GP practices

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International support

• In what way international support may be
  helpful to develop Primary Care in your country?
• The EU regulation, recommendations are too weak
  and not very specific
• European standards must be developed for
  primary care also
• Development of common position regarding family
  medicine on all aspect. Solidarity.
• International Projects disseminate European
  experiences and standards
• Help with developing the training (academic
  especially) in family medicine

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• Thank you !