Psihometrijska analiza činilaca ekonomskog rasuđivanja zdravstvenih stručnjaka u procesu donošenja kliničke odluke

Abstract

Struktura ekonomskog rasuđivanja zdravstvenih stručnjaka (ERZS) je još uvek nepoznata. CILjEVI: Procenjena je konstrukcona validnost i pouzdanost upitnika ERZS. Procenjena je njegova diskriminaciona validnost prema tipu zdravstene ustanove, nivou pružanja zdravstvene zaštite i uticaju sistemskih ekonomskih ograničavanja zdravstvenih ustanova. METOD: Sprovedena je retrospektivno-prospektivna, multicentrična, psihometrijska studija procene uticaja zdravstveno ekonomske intervencije na činioce ERZS. Studija je sprovedena u 60 ustanova. Anketirani su zdravstveni stručnjaci, zaposleni u državnom i privatnom sektoru zdravstva Republike Srbije. Upitnik ERZS sačinjen je od 29 pitanja. Period pre intervencije bio je od početka 2010. do sredine 2011. godine. Period posle intervencije bio je od sredine 2012. do kraja 2013. godine. REZULTATI: Definisano je sedam faktora ERZS: (1) zanemarivanje troškova kvaliteta od strane nemedicinskih organa uprave; (2) razmatranje tržišne cene i zdravstvene dobiti; (3) tržišna orijentisanost u pogledu zahteva pacijenta; (4) prepoznavanje neadekvatne alokacije sredstava nemedicinskih organa uprave; (5) stav o preusmeravanju profita iz državnog u privatni sektor zdravstva; (6) prepoznavanje neopravdane potrošnje zdravstvenih profesionalaca i (7) odnos lekar – pacijent. Postoji negativna korelacija između perioda posle intervencije sa ukupnim stepenom ERZS, u odnosu na period pre intervencije. ZAKLjUČAK: Upitnik ERZS ima visoku konstrukcionu i diskriminacionu validnost i pouzdanost u merenju komponenti ERZS.

The structure of health professionals’ economic reasoning (HPER) is still unknown. OBJECTIVES: The validity and reliability of the HPER questionnaire has been estimated. Its discriminant validity of the HPER questionnaire has also been estimated according to the type of healthcare facilities, the healthcare provision level and the impact of systemic economic restrictions in the healthcare facilities. METHODS: We performed a retrospective-prospective, multicentric, psychometric study of the impact assessment of health economic interventions on the HPER factors. The study was conducted in 60 facilities. Respondents were health professionals, employees of public and private health sector of the Republic of Serbia. The HPER questionnaire was composed of 29 items. The period before the intervention lasted from the beginning of 2010th until mid-2011. The period after the intervention lasted from the middle of 2012th until the end of 2013. RESULTS: We defined seven HPER factors: (1) the neglect of quality costs by non-medical administrative authorities (2) consideration of the market value and health benefits; (3) market orientation with respect to the patient's needs; (4) recognition of inadequate allocation of resources from non-medical administrative authorities (5) the attitude about diverting profits from the state to the private health sector; (6) identification of unjustified consumption of health professionals, and (7) doctor - patient relationship. There is a negative correlation between the period after intervention with the total HPER degree, compared to the period before intervention. CONCLUSION: The HPER questionnaire has high constructional and discriminatory validity and reliability in measuring HPER components.