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Original Article

Measures to Improve Integration of Healthcare in Federation of Bosnia and Herzegovina

Ahmed Novo, Bojana Knezevic, Bakir Omerbegovic, Zana Tafi, Vera Kerleta-Tuzovic.


Introduction: In its annual report for 2008, the World Health Organization (WHO) states fragmentation is one of the five most common shortcomings experienced by health systems in health care provision, while an integrated healthcare model can significantly improve efficacy/efficiency, reduce visits to doctors, improve patient satisfaction, and ensure safe and quality healthcare. Aim: The aim of our study is to point out importance of the cooperation between healthcare professionals from different sectors, institutions and levels of care involved in patient treatment and care and to propose measures for integration including criteria for clinical review and audit. Methods: In this paper, feedback and results from three workshops held in Tuzla on October 16th, 2007, Bihac on December 9th, 2013, and Sarajevo on November 24th, 2018, were analyzed. All three workshops used the same methodology: first they have had a lecture on the topic of “Interface theory and protection blocks in the health system” and the second part took the form of six working groups in accordance with participants’ affinities and places of employment. Results: The measures proposed to improve the interface are included: Development and adoption existing of clinical practice guidelines and pathways; Maintain joint working group meetings; Eliminate conflicts between PHC and hospital care and seek consensus through formal cooperation. Criteria for clinical audit of the PHC-hospital interface are: annual analysis of unnecessary or inadequate referrals as well as of any duplication of tests and prescriptions (failure to control costs); joint planning of preventive treatments (including the ministry and public health authorities); and clear responsibilities related to screening programs and patient path analysis. Discussion: Standardized communication protocols should be used to improve communication between health professionals at different levels and to moderate integration processes and protect data. Conclusion: Regular communication between healthcare professionals across the various institutions and levels of health care is a prerequisite for organizational, functional, service and clinical integration.

Key words: Integrative Care, Quality, Clinical Audit.

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