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Abstract A situation of emergency involving the whole population introduces changes in the dynamics of the health services that are provided. The magnitude of these shifts should be also linked to the medical speciality within which the health benefits are delivered. The aim of the paper was to identify changes in tendencies in inpatient medical service delivery during the COVID-19 pandemic by medical specialties. On the basis of a database extracted for in-patient treatment received from the public payer, a retrospective analysis was carried out. Comparing the values of the dynamics of the services provided in each medical speciality, the period before the COVID-19 pandemic was collated to the years of the pandemic (2020–2021). In the period before COVID-19, positive patient dynamics were observed in more than half of the specialities. Between 2020 and 2021, virtually all specialties reversed the trend and negative dynamics were recorded. The dynamics in 2021 indicate a process of return to the values from 2015 to 2019. Emergency situation has affected the dynamics of healthcare provision in different specialities to various extent. The most resistant to the negative impulses of the state of emergency were the areas that are strictly organisationally and financially defined (e.g. the group of “therapeutic and drug programmes”).

IntroductionBariatric surgery has known health benefits and may lower the medication-related costs. This study aimed to assess the cost of medications prior to and after bariatric surgery in the Polish nationwide registry.MethodsThe study included 2,390 adults. The analysis was conducted separately for a 12-month pre-operative period, and a 12-month postoperative period. The total costs of medication and cost per anatomical therapeutic chemical group were assessed and the mean cost per patient in the preoperative and postoperative periods was compared.ResultsThe study showed a significant increase in the overall medication costs and mean costs of medications per patient in the year after bariatric surgery. This increase was related mainly to low-molecular-weight heparins used in the 1st month after surgery. Alternatively, costs of medication used in the cardiovascular system diseases and anti-infectives decreased significantly. The total costs of hypoglycemic agents were reduced by 46%, antihypertensive medications by 29%, and lipid-lowering drugs by 38.ConclusionsIn general, medication costs are higher in the first year after surgery. The increase results from the perioperative use of low-molecular-weight heparins, whereas a significant cost reduction of glucose-, lipid-lowering, antihypertensive, and anti-infective medications was observed.

Introduction and objective In 2017, a regulation enabling the retrofitting of property rights from the State Treasury to state legal persons and state organizational units (Art. 51a of the Real Estate Management Act) was introduced in Poland. The policymakers intended to expand the catalogue of rights to real estate by allowing the equipment or retrofitting of property to state legal persons. The purpose of this article was to determine how the above-mentioned regulation is applied in praxis. Material and methods The authors presented a case study exemplifying the procedures necessary for retrofitting the Independent Public Health Unit, Health Farm, Ministry of Interior and Administration, in Krynica-Zdrój retrofitting of property rights under Art. 51a of the Real Estate Management Act. Additionally, a cross-study was conducted concerning the application of Art. 51 based on a survey addressed to entities that have applied for property rights assignment to investigate the success rate, usefulness, and difficulties related to the procedure. Results The research showed an excessive length of the conducted proceedings for equipment of property rights, which was partly due to factors beyond the control of the authority deciding on granting ownership of the property rights. Most often, the refusal to grant ownership resulted from inability to indicate a real estate that would meet the criteria of the applying entities. In praxis, mainly the transfer of ownership rights to (1) applicants who had already used a given property; or (2) applicants who have indicated the exact property that they would like to receive was successful. Conclusions The analyzed regulation has gained popularity. However, an intervention on the part of the legislator to strengthen the position of the applicant is needed. For example, it is necessary to indicate the maximum time public administration has for deciding on retrofitting of property rights. Otherwise, the regulation will not fulfil the purpose of enabling further development of entities applying for retrofitting of property rights.

Introduction and objective Cardiovascular diseases are the leading cause of death in Poland and worldwide. Medical services together with telemedicine provide complex health care for patients with cardiovascular diseases. The aim of this study is to analyze the use of telemedicine options for reimbursed cardiac services between 2018–2021. Material and methods From the database of the National Health Fund (the sole public payer of health services), teleconsultations between primary care physicians (PCPs, specialists, stationary consultations of primary care physicians with a cardiologist, and hybrid cardiac telerehabilitation were identified. Analysis was based on the number, age and gender of patients, as well as p;rovincial health centres. Results The largest number of teleconsultations of primary care physicians were with acardiologists, accounting for 25% of telemedicine consultations, 96% of which involved patients living in an area with 5–10 000 healthcare beneficiaries. Only 21% of all consultations between the primary care physicians and the cardiologists were stationary consultations. Hybrid cardiac telerehabilitation involved patients from 13 provincial centres (VCs), with the highest number of services recorded in the 60–64 age group. Conclusions Telemedicine services are the main means of consultation between specialists and primary care. physicians. An increasing trend in the use of hybrid cardiac telerehabilitation was found.

Introduction and objective Modern drug therapies are made available on the basis of specific legal and economic solutions. In Poland, a model for financing modern therapies by the public payer in the form of a drug programme has been developed. The basic principles of such a strictly defined therapeutic procedure, apart from ensuring maximum safety and clinical effectiveness, is the need to define a budget that can be used for these usually expensive drugs. The aim of the study was to identify and analyse the actual costs related to the treatment process of a patient within the framework of an oncological drug programme, incurred by a healthcare entity. Material and methods The oncological drug programme B.50 ‘Treatment of patients with ovarian cancer, fallopian tube cancer or peritoneal cancer’, implemented in an oncology centre in 2018–2021, was selected for the analysis. On average, 19 patients were treated annually. Results The lump-sum method of financing healthcare benefits under the drug programme, adopted by the public payer, does not cover the actual costs of treatment. Providing patients with all necessary medical services at every stage of the treatment process, which are not financed by the payer under the drug programme, creates a real risk of indebtedness to the healthcare entity. Conclusions The chronic nature and therapeutic process of many diseases generate additional costs for the treatment of complications. Without the valuation of benefits adequate to the actual costs of treatment, a significant increase in the availability of innovative therapies to patients may become impossible.

Cellulite as an aesthetic problem has been known for many years. It is a physiological phenomenon found in women. There are many concomitant factors that can trigger, persist, or exacerbate it. Of particular importance among these factors is the architecture of connective tissue, the action of estrogen, micronucular lesions and genetic and hormonal characteristics. The article presents theories about the factors that affect the occurrence of cellulite. It was taken into account changes in the cross-section of connective tissue and in the flow of blood vessels ,the effect of chronic adipose tissue inflammation, as well as genetic or hormonal conditions on the occurrence of cellulite. Particular attention was paid to the inflow of changes in the subcutaneous cross-section of connective tissue to the occurrence of cellulite. Nürnberger and Müller in 1978 were the first to notice significant differences between men and women in the structure of subcutaneous fat. Considered the aging aspect of skin cells, which was studied by various scientists. Quaglino found that the diameter of collagen fibers is the largest between the ages of 10 and 29, and begins to decline after the age of 30, reaching minimum values at the age of 60. In addition, attention was paid to the relationship between the occurrence of vascular lesions and the localization of cellulite. In 1999, Gruber and Huber pointed out that ovarian hormones have many functions and are responsible for differences between men and women in the incidence of certain diseases. The distribution of subcutaneous tissue in the human body is genetically conditioned, and its thickness depends on the type of diet, state of health, influence of hormones. Cellulite usually appears in areas where adipose tissue is altered under the influence of estrogen. It was found that excessive weight increases the risk of cellulite. The most commonly used classification for cellulite degree characteristics was proposed by Nürnberger & Müller in 1978 and is still known today.

Introduction End-stage renal disease (ESRD) is an important complication of diabetes, which is the leading cause of ESRD worldwide The aim of the study was a comparative analysis of all-cause mortality in patients with ESRD with diagnosed diabetes mellitus (DM) and no diagnosed DM. Material and methods Data for the analysis were obtained from the resources of the Polish National Health Fund, and they concerned patients with end-stage renal disease from the entire population of Polish patients in the period from 01.01.2011 to 31.12.2013. In addition, the period from 01.01.2012 to 31.12.2012 was analysed for two subpopulations: diabetic and non-diabetic patients. Results The all-cause mortality in patients with end-stage renal disease in Poland per 100,000 representatives of the general population was 17.7, 15.9, and 12.50 persons in 2011, 2012, and 2013, respectively. The all-cause mortality rates for patients with ESRD and diabetes in Poland in 2012 were more than 15 times higher, for both men and women, than the all-cause mortality rates for non-diabetic patients with ESRD. Mortality in the study group of diabetic men with ESRD amounted to 147.59 ±29.07/100,000 men, whereas in the study group of diabetic women with ESRD it was 105.13 ±26.77/100,000 women. Regarding non-diabetic men with ESRD and non-diabetic women with ESRD, mortality amounted to 9.58 ±6.29/100,000 and 6.87 ±2.27/100,000 men and women, respectively. Conclusions The occurrence of diabetes in patients with ESRD significantly increases the risk of death compared to patients with ESRD without diabetes.

Introduction High amputation of the lower limb not only causes immense physical disability but also the destruction of the patient’s mental state, and helps to shorten life of patients with diabetes. The incidence of amputations in diabetic patients is 10 times higher in comparison to non-diabetic subjects (2.8% vs. 0.29%). The purpose of the study is an analysis of the geographic variability of major non-traumatic lower limb amputation in diabetic and non-diabetic patients in Poland. Material and methods All major non-traumatic lower limb amputations performed for the first time, in particular databetween 1 January 2013 – 31 December 2013, and between 1 January 2014 – December 2014, were identified in the National Health Fund (NHF) database. In the presented study, the patients were grouped in relevant provincial departments of the NHF according to their place of residence, and not according to the hospital where lower limb amputation was performed. Results In 2013 in Poland, 4,727 major non-traumatic lower limb amputation were performed in diabetic patients, and 4,350 in 2014. On the other hand, in non-diabetic patients, 3,469 major non-traumatic lower limb amputations were performed in 2013, and 3149 in 2014. The mean number indicator of major non-traumatic lower limb amputations in diabetic patients in Poland, compared to the average indicator of amputations in patients without diagnosed diabetes in Poland was 19.9-fold in 2013 and 19.4-fold higher in 2014. Conclusions In populations of diabetic patients and individuals without diagnosed diabetes major non-traumatic lower limb amputations are performed over 19-fold more frequently.

Introduction Multiple myeloma is the third most common blood cancer in Europe and accounts for approx. 10–15% of these cancers. The objective of this study was to determine the incidence, prevalence, mortality and survival in multiple myeloma (ICD code: C90.0) patients in Poland in the years 2008–2017. Material and methods The analysis used the data on healthcare services provided to patients with multiple myeloma defined with the ICD-10 (International Statistical Classification of Diseases and Related Health Problems) code C90.0 and reported by healthcare entities to the National Health Fund (NFZ). Results In 2009, the C90.0 incidence per 100,000 inhabitants was 6.4, while in 2017 it was 8.3. The prevalence in the same period increased by 76%, from 13.6/100,000 to 23.9/100,000. The mortality to prevalence ratio gradually decreased from 78% in 2008 to 22.8% in 2017. The 1-year, 3-year and 5-year survival rates in patients with this diagnosis made in the years 2009 and 2013 were 70.5%, 51.5% and 40.2% versus 78.4%, 60.3% and 48.3%, respectively. Conclusions The incidence and prevalence of multiple myeloma and survival rates in Poland were continuously increasing in the studied period. These trends may result from the aging of Polish society, better recognisability of multiple myeloma and/or improved access to increasingly more effective therapies in Poland. The impact of these factors on the epidemiology of multiple myeloma requires further studies.

This paper presents a realistic evaluation of the prevalence of type 2 diabetes mellitus (T2DM) among Polish schizophrenic patients who have sought treatment through the Polish National Health Fund in the years 2010-2017. Data from the National Health Fund database was used and T2DM and schizophrenia groups were defined according to International Classification of Diseases (ICD-10) codes. Demographic data were collected from the web page of Statistics Poland (GUS). The annual prevalence of T2DM and schizophrenia was estimated, and the age groups were categorised into eight sets. The incidence of schizophrenia in T2DM patients in the years 2010-2017 was measured, including relative risk and 95% confidence interval (95% CI). The incidence of T2DM has been assessed in various subtypes of schizophrenia. In the eight years of follow-up study, 1,481,642 patients with schizophrenia were included, of which 185,205 were also diagnosed with T2DM. This accounted for 12.50% of all patients with schizophrenia. The trend of comorbid schizophrenia (F20) and T2DM (E11) in the general population of patients with schizophrenia, who sought treatment through the National Health Fund, was relatively stable in the years 2010-2017. The relative risk of T2DM in those with schizophrenia was 8.33 (95% CI 8.23-8.43) in 2017. Taking actions to enable the detection of diabetes in patients with concomitant schizophrenia is well-grounded, although these actions should be gender-dependent. There is also a need to take adequate actions to improve the efficiency of diabetological care among patients with schizophrenia.

Introduction The aim of the study was to estimate the overall survival of patients with EGFR mutation-positive non-small-cell lung cancer treated with erlotinib, gefitinib or afatinib. Material and methods Real-world patients who received afatinib, erlotinib or gefitinib between 1 July 2012 and 30 October 2017 were analysed in five subgroups. Results Among 267 patients treated with afatinib financed as the first line of treatment, 76 (28.46%) deaths occurred. Median observation time was 12.8 months (95% CI: 11.2–13.9). Median OS was 22.8 months (95% CI: 19.2–27.1). Among 83 patients who received erlotinib financed exclusively as the second line of treatment the number of deaths was 74 (89.16%). Median observation time was 64.3 months (95% CI: 60.4–64.6). Median OS was 16 months (95% CI: 13.2–22.9). Among 622 patients who received erlotinib financed both as first and second line treatment, there were 400 (64.3%) deaths. Median observation time was 33.3 months (95% CI: 31.2–37.6). Median OS was 17.8 months (95% CI: 16.4–19.7). Among 137 patients who received gefitinib financed only as the first line of treatment, there were 128 (93.4%) deaths. Median observation time was 58.3 months (95% CI: 49.4–62.5). Median OS was 16 months (95% CI: 13.8–19.7). Among 348 patients who received gefitinib financed both as the first and second line of treatment the number of deaths was 208 (59.8%). Median observation time was 23.7 months (95% CI: 20.7–28.7). Median OS was 15.5 months (95% CI: 12.9–17.5). Conclusions Our real-world data regarding OS confirm the benefits found in clinical trials from the use of afatinib, erlotinib or gefitinib. However, the lower overall survival rate of Polish patients compared to similar studies from other research centres suggests the need for deeper investigation of this issue.

Introduction Several studies have suggested, that diabetes is very important factor of the risk of the chronic a renal disease. The paper aims to present a retrospective analysis of incidence of end-stage renal disease in subgroups of patients with and without diabetes in Poland. Material and methods For assessing this problem an electronic search was performed using Polish National Health Fund data base from 01.01.2011 until 31.12.2013 in general population and from 01.01.2012 until 31.12.2012 in 2 populations: with diabetes and without diabetes mellitus. Results The 43.70 % patients with end-stage renal disease was diabetic. The incidence rate in 2012 was: 292.48 ± 90.97 diabetic men / 100,000 diabetic population; 203.10 ± 90.97 diabetic women / 100,000 diabetic population; 23.44 ± 6.34 non-diabetic men / 100,000 non-diabetic population; 17.88 ± 6.33 non-diabetic women / 100,000 non-diabetic population. Conclusions The incidence rate of end-stage renal failure in diabetics was multiple times higher than the incidence rate in non-diabetics. The incidence rate of new ESRD cases in Poland estimated to be 36.17 per 100,000 of general populations in 2011, 35.28% in 2012 and 30.46 per 100,000 of general populations in 2013. In 2012, the incidence rate of new ESRD cases in male diabetics was 292.48 ± 90.97 per 100,000 of diabetes men population, and in women diabetics 203.10 ± 66.06 per 100,000 of diabetes women population. In the same 2012 year, the incidence of new ESRD cases in men non-diabetics was 3.44 ± 6.34 per 100,000 of non-diabetes, and in women non-diabetes 17.58 ± 6.33 per 100,000 of non-diabetes women population.

Introduction: In Poland the health and social care operate independently. Public healthcare expenditures in 2017 accounted for 4,73% of gross domestic product (GDP). The target for public funding level to be achieved in 2025 was set at 6%. Polish health care system is focused on stationary and specialist care. People are rather passive, with low health awareness, and participation in prevention programs, what results in low detectability of diseases in early stage of development. Description of policy context and objective: Health check-ups are the components of "Preparation, testing and implementation of coordinated care in the healthcare system” - pilot phase: Primary Health Care PLUS (PHC PLUS) project ongoing in Poland, co-financed by European Social Fund, and is targeted at strengthening patient-centered care and increasing the role of primary health care. The main objective of health check-ups is to stratify the population to healthy and potentially ill patients to manage the number and type of services planned. Patients receive support from a team of medical professionals: doctors and coordinators, accompanied by dietitians, health educators and physiotherapists. Targeted population: Health check-ups are planned to be performed every five years to patients at the age of 20 to 65 years, who do not or rarely use PHC services (did not visited a doctor during last 12 months due to a chronic disease, not hospitalized in that time and did not have diagnostic tests within another prophylactic program). Performed at the very beginning of patient’s participation in the project, health check-up includes a set of tests aimed at stratification of the entire population included to one of 4 clusters: (1) healthy, without risk factors, (2) healthy, without symptoms but having risk factors, (3) chronic, without current symptoms but stable, (4) chronically ill,currently with symptoms and requiring stabilization. Check-ups can be performed as a basic or in-depth one. An integral part of the health check-up visit is referral for education in areas related to identified risk factors, to strengthen self-management skills and patient engagement in the treatment. As an outcome, an Individual Health Care Plan (IHCP) is prepared, during. IHCP recommendations include educational activities and referrals for diagnostic tests. Health check-ups started on 1st July 2018; until today, 7672 patients have participated in 45 medical entities. 1414 basic and 6258 in-depth check-ups were carried out. The target number within the project Primary Health Care PLUS is currently 41402. Transferability: The scheme used in the project may be adapted to other projects having the purpose of strengthening patient-centered care at the level of PHC and tailoring the care to patient`s needs. Conclusions: Health check-ups are of preventive nature and can be performed by the PHC staff in health centers with an elementary degree of coordinated care. However, the proposed check-up scheme requires further observation in a larger scale and in centers with different levels of coordinated care.

Introduction: Coordinated care is planned to be implemented in Poland based on solutions developed in the project "Preparation, testing and implementation of coordinated care in the healthcare system, Stage II. Pilot phase – Primary Care PLUS model” co-financed from the European Social Fund under the Operational Program Knowledge Education Development financed under the European Commission Priority Axis 4 and 5. Adequate communication strategy is required to prepare Polish society for a significant change in the health care system, and to help all interested parties learning about the changes planned. Description of policy context and objective: Communication strategy is implemented by the National Health Fund (Narodowy Fundusz Zdrowia - NFZ), supported by The World Bank. A general objective is to create a positive approach to changes in the primary health care by promoting coordinated care as an effective form of medical service. Specific objectives of the project include informing medical entities about procedures necessary for the implementation of coordinated care. Participation in the project means taking a part in thechange in the health care system. Activities targeted at patients involve informing them about the implementation of coordinated care and attempt to create positive approach to the new system model. Activities targeted at medical entities include providing information about progress and results achieved, whereas activities targeted at the general public aim at showing that outpatient clinics and services provided are changing for the better. Communication channels are: project website, Twitter, Facebook, local and national media, online marketing and conferences. Targeted population: Communication strategy developed is targeted at all stakeholders: Ministry of Health, local administration, public officials, 45 medical entities participating in the pilot project, influencers and public opinion. A communication strategy to patients to be used use by participating entities is also prepared and proposed. Highlights: In June 2018 medical entities were chosen for the pilot project. Public opinion and interested parties will become acquainted with the results of the pilot project in October and November 2018. Transferability: Communication strategy can be used in the Stage III of the project – implementation of coordinated care across the country in Poland. Evaluation of the effectiveness of communication strategy can be of value for the future plan of broader implementation and for other countries in the region. Conclusions: Effective implementation of communication strategy requires a well-planned budget and involvement of the NFZ, responsible for the implementation of the strategy. Coherence and effectiveness of the messages depends on the cooperation between the NFZ and the World Bank, which involves meetings and exchange of know-how. Regarding technical aspects of the project, IT support and graphic design support are the most important for developing a project website and preparing information materials.

Introduction: Coordinated care implementation plans in Poland will be based on solutions developed in Primary Health Care PLUS project co-financed from the European Social Fund. Adequate communication strategy is required to promote patients’ participation. Description of policy context and objective: The aim of communication strategy proposed by National Health Fund (Narodowy Fundusz Zdrowia – NFZ) was to invite patients by sending the message to the society that the new coordinated care model in their medical entities offers better services, easier access to doctors and free prevention programs. Key communication channels were: local media (interviews with site managers, articles and press releases), visuals (announcements, posters, leaflets, gadgets) and direct contact with coordinators, responsible for answering patients’ questions at the facility level. Regional branch of NFZ introduced "FOR PATIENT" tab on the own www.pozplus.pl portal. Targeted population: The project started on 1st July 2018. Current target number of its first component - health check-ups - is 41402 patients. 7923 patients (4582 females and 3341 males) were invited for health check-ups by 41 medical entities till the end of August 2018. The number of invitations and resulting numbers of receptions or refusals is monitored by NFZ. Highlights: There were 1429 (18%) refusals: 742 females and 687 males. The only entity which had no refusals - NZOZ Zdrowie in Janów Lubelski - having small rural population of 2700 participating in the project - invited 247 patients (159 females and 88 males) till end of September 2018, what resulted in 247 HCUs started; and 5 basic HCUs and 57 in-depth ones completed until cut-off date. To reveal the source of this success, interviews with 3 health educators working in the entity were conducted, followed by validation with 2 managers. They described own proven methods of communication with the local society added. The entity was experienced in similar activities (grant in chronic diseases area in 2013), and the local society appreciated carrying out effective and valuable preventive actions, for which they received local distinctions. The information about the program PHC PLUS was disseminated locally with help of: village administrator (printed materials), local priest (advertisements in the church), commune office and workplaces (information boards), local voluntary fire fighters (during local events) and physicians contacting individual patients for another reasons. Some patients joined NZOZ Zdrowie in Janów Lubelski thanks to this information action. This promotional campaign was conducted only for 2 months resulting in many patients willing to participate, spontaneous self-referrals, waiting lists and no refusals in case of an invitation obtained. Transferability: Adding locally used confident methods of communication, and reliance on an earlier authority was found to be very effective and such initiatives should be promoted in next steps of implementation of coordinated care across the country in Poland in wider scale or in other countries of the region. Conclusions: Past experiences and high level of engagement of local society resulted in effective implementation of communication strategy. Coherence and effectiveness of the messages would depend on the cooperation between the entities involved in such projects.

Introduction: Disease management programs are a component of the coordinated care project Primary Health Care PLUS (PHC PLUS) in Poland, co-financed from the European Social Fund under the Operational Program Knowledge Education Development, financed under the European Commission Priority Axis 4 and 5. Together with health check-ups, coordinators of care and patient education it constitutes a set of systemic solutions aimed at creating a coordinated care system. Description of policy context and objective: The essence of the disease management program is that health care providers offer active care for chronically ill patients. Disease management process starts with the diagnosis that is followed by in-depth diagnostics, and results in individual medical care plan preparation with the active patient’s involvement. It includes therapeutic measures aimed at treating the disease or minimizing its effects. Services financed under the disease management program include diagnostics and treatment of patients with selected diseases by a primary care physician in collaboration with specialists in diabetes, endocrinology, cardiology, neurology, pulmonology, rehabilitation and with physiotherapist. Targeted population: PHC PLUS pilot project is targeted at adult patients diagnosed with or suspected of at least one of 11 chronic diseases: type II diabetes, spontaneous hypertension, chronic coronary heart disease, chronic heart failure, persistent atrial fibrillation, bronchial asthma, COPD, hypothyroidism, parenchymal or nodular goiter, osteoarthritis of the peripheral joints and spinal pain syndrome. The stage of disease should allow treatment in primary health care. The disease management programs started on 1st July 2018 in 41 medical entities. Now, 1412 patients have agreed to participate in the cardiology program, 809 are treated in the rheumatology/neurology field, 440 in endocrinology, 370 are diabetic patients and only 149 use the pulmonology program. There were 16 refusals to participate in the disease management programs although the diagnosis has been made. Many patients are still in the process of classification, which gives a chance to increase theirs number soon. Transferability: Implementation of such a program can bring particularly great benefits in countries that do not allocate large amounts of money to health care. The implementation of the program in Poland will also result in the characterization of the model operating process and characteristics of pathways. The solutions developed can be used as a starting point for other countries willing to implement the disease management programs. Conclusions: The implementation of the disease management program increases the competence of the primary care physicians. They manage the budget entrusted, under which they can commission for example rehabilitation, which causes a significant acceleration of the healing process. In addition, the PHC physicians obtain access to: telemedicine, specialist consultations; a wider range and the number of preventive and educational activities; a wider range of diagnostic and physiotherapeutic services; and consulting with other outpatient care specialists. Thanks to the implementation of the PHC PLUS project patients can have a chance to actively participate in decision taking. This is an important step towards patient empowerment.

Introduction: The subject of this study was to collect patient opinions related to coordinated health care organization before pilot implementation phase of a coordinated care project Primary Health Care PLUS (PHC PLUS) in Poland, co-financed from the European Social Fund. The research was intended to verify hypotheses regarding patients’ satisfaction, the role of coordinator and patients’ health education, recruitment to health checkups, access to specialists and individual disease management. Methodology: The study employed qualitative (focus group interviews – FGIs – 24 adult patients in 3 subgroups, 17 questions) and quantitative (computer-assisted internet interviews – CAWI – representative sample of 1000 patients, 18 questions) techniques. CAWI questions derived from FGI discussions. To be enrolled, patients had to use public primary or specialist health care at least twice in the last two years. The study was carried out in April - May 2017. Results: FGIs revealed that the concept of regular health checkups performed among non-symptomatic patients was accepted, but the proposed exclusion of patients older than 65 years of age was contested. The idea of disease management met approval. The main benefit pointed out was the fast diagnosis followed by coordinated treatment in PHC with specialists’ support. 76,2% of patients in CAWI agreed for sharing their medical data to medical staff involved, if this improves the treatment process. 84.3% of patients appreciated adding their health information to patient accounts, 4.9% were against and 1.3% definitely excluded that. The risk of being treated by incompetent specialist was raised during FGIs and confirmed during CAWI, so patients expected to be allowed to change doctor in such a case. However, patients would be ready to give up their own choice of a specialist, if the waiting time for the diagnosis is reduced to about 2 weeks. The role of health care coordinator was appreciated. Discussion and conclusions: Respondents declared that coordinated care concept meets their expectations. They were interested in participation in health checkups and disease management programs, perceived as a solution to avoid queuing for specialists’ visits and to shorten the time needed to establish the diagnosis. The need for greater engagement in the treatment process did not deter the proposed solutions. Patients also positively evaluated the role of a health care coordinator. 62.2% of patients were ready to change the healthcare institution, if the existing one does not offer the coordinated care. Lessons learned: The common belief among patients is that the implementation of coordination in Poland will result in positive changes in the organization of public health care. Thus, changes planned in this sector might be welcomed by most of patients. Limitations: Opinions gathered could not be verified by patients in the real-life setting, but a high degree of trust was granted by them. Future studies: Further studies focused on patients’ satisfaction should be conducted after the implementation of coordinated care. Adjustment of the model dependent on geographical location (urban vs. rural) could be considered.

The objective of the study was the realistic evaluation of the prevalence of eating disorders (ED) among Polish men who sought treatment through the National Health Fund (NFZ) in the years 2010–2017. According to ICD-10, four types of ED were analyzed: anorexia nervosa—AN (F50.0), atypical anorexia nervosa (F50.1), bulimia nervosa—BN (F50.2), and atypical bulimia nervosa (F50.3). The NFZ database was used. The ED groups were defined according to ICD-10 codes. Demographic data were collected from the web page of Statistics Poland (GUS). The annual prevalence of EDs was estimated, and the age groups were categorized into nine groups. For the incidence of EDs in male patients in the years 2010–2017, relative risk (RR) with 95% confidence interval (95% CI) was calculated. The frequency trend of AN in males remains relatively stable. AN occurred mainly in young men (between 11 and 30 years). It was noted that AN affected approximately 100 men in each year of observation, while atypical anorexia nervosa affected about 40 men. In 2017, the RR for EDs in young males was 0.041 (95% CI [0.033, 0.051]). Bulimia was relatively rare (about 35 males each year). The incidence of EDs in males is a relatively constant phenomenon. The real number of male patients with EDs may be higher. The current conceptualizations of ED pathology should be modified and better adapted to men. Clinical guidelines for specialists working with males with EDs should be developed.

Objective : The objective of the study was to analyse the prevalence of psoriatic arthritis (PsA) in Poland and to assess the costs generated by treatment of PsA patients in the system of public healthcare. Material and methods : The analysis was based on the database of the public payer, the National Health Fund (NFZ). PsA was defined by the diagnostic ICD-10 codes M07 (Enteropathic arthropathies) and L40.5 (Psoriatic arthropathies). The estimate of the costs was based on the reports submitted to the NFZ by health service providers. The prevalence rates were calculated using the NFZ data and the population estimates from the Central Statistical Office of Poland (GUS). Results : In 2015, the prevalence of PsA (ICD-10: L40.5 and M07) in Poland was 3.2 per 10 000 population (3.7 in women and 2.6 in men). In 2015, nearly 7.3 thousand patients with the diagnosis of M07 and 6.3 thousand patients with the diagnosis of L40.5 received healthcare benefits. Women accounted for 60.6% of those patients. Nearly three fourths of PsA patients were aged 40 to 69 years with the median age of 54 years (56 years in women and 50 years in men). Between 2008 and 2015 the NFZ expenditure on the treatment of PsA increased from 6.6 million Polish zloty (PLN) (1.9 million EUR) to PLN 50.8 million (12.1 million EUR). In the same period, the number of PsA patients increased from 3.4 thousand to 11.9 thousand. In 2015, the mean cost of treatment per PsA patient was PLN 3.8 thousand. Conclusions : The PsA prevalence rates estimated by the authors from the NFZ database are clearly lower than those derived from studies in other European countries, which may suggest that the actual number of PsA patients in Poland may be underestimated. Still the number of patients treated for PsA increased nearly 3.5-fold during 2008–2015, when the cost of PsA treatment rose more than 7 times.

Objective The aim of this study is to investigate the morbidity rate due to Rheumatoid Arthritis (RA) in the Polish population during 2008–2012, calculated per 1,000 inhabitants, and taking into account the differences between provincess, area of residence (urban or rural) and gender. Material and Methods From the NFZ IT systems, PESEL number information was obtained for all 17 types of services contracted in 2008–2012, for patients whose main diagnosis in the report was the ICD-10 disease code: M05.X – seropositive rheumatoid arthritis, or M06.X – other rheumatoid arthritis. The number of patients, gender and age were calculated based on the PESEL number provided in the statistical reports of the patient with the analysed ICD-10 diagnosis. Urban and rural cases were compared using commune zip codes. The basis for classifying the patient as a member of an urban or rural population was the Zip Code of the declared place of residence. Urban and rural areas are classified based on administrative criteria provided by the Central Statistical Office: the National Official Register of Territorial Division of the Country (TERYT). Results During the studied period the number of RA patients increased from 173,844–230,892. In urban areas, the most patients were recorded in the Śląskie Province, the least in Lubuskie Province. Patients from rural areas were approx. 1/3[sup]rd[/sup] of the total population of patients in Poland. In rural areas, the most patients were recorded in the Mazowieckie Province, the least in Lubuskie Province. The morbidity rate in cities was 5.08 in 2008 and increased to 8.14 in 2012 in rural areas, respectively, it was 3.74 and increased to 3.98. Regardless of the place of residence the women fell ill 3.5 times more frequently. The lowest morbidity rate, both in rural and urban areas, was recorded in the Lubuskie Province, the largest in Świętokrzyskie Province. The the most probable explanation of the highest morbidity rate in the latter province is a worse access to a rheumatologist: in this province there is the lowest number of inhabitants per one employed rheumatologist. Conclusions In Poland, the number of RA sufferers is increasing, which is probably a result of increasing life expectancy. In Poland, also exists a differences in morbidity between urban and rural inhabitants. Differences may also derive from undiagnosed cases of the disease.

[b][/b][b]Objective. [/b]The aim of this study was to investigate the juvenile idiopathic arthritis (JIA) morbidity rate in the Polish population, calculated per 1,000 inhabitants of a given province, taking into account the differences between urban and rural areas, gender and area of residence (province) 2008–2012. [b]Method.[/b] From the NFZ IT systems information was obtained on the treatment of patients who had M08 and M09 juvenile arthritis, diseases classified elsewhere by the ICD-10 diagnosis code in the settlement report of the hospital. The number of patients, their gender and age at individual diagnoses were calculated based on the PESEL number provided in the statistical reports of the patient with the analysed ICD-10 diagnosis. Urban and rural cases were compared using commune zip codes. The basic for classifying the patient as a member of a urban or rural population was the zip code of the declared place of residence. [b]Results[/b]. In Poland, the number of patients suffering from juvenile idiopathic arthritis has been increasing since 2008 – from 9.2 thousand in 2008 to 11.4 thousand in 2012. The majority were girls (approx. 62%). Most patients were living in urban areas; in 2008, 5.9 thousand: urban areas – 64% of women and 36% of men; 3.2 thousand: rural areas – 62% of women, 38% of men); in 2012, 7.2 thousand – urban areas); 4.2 thousand – rural areas. The morbidity indicators ranged from 0.195 – 0.357 per 1,000 inhabitants, depending on the year, gender and place of residence (province and commune).

Objectives: To analyze perforation rate in sterile gloves used by surgeons in the operating theatre of the Department of Endocrinological and General Surgery of Medical University of Lodz. Material and Methods: Randomized and controlled trial. This study analyses the incidents of tears in sterile surgical gloves used by surgeons during operations on 3 types of thyroid diseases according to the 10th revision of International Statistical Classification of Diseases and Related Health Problems (ICD-10) codes. Nine hundred seventy-two pairs (sets) of gloves were collected from 321 surgical procedures. All gloves were tested immediately following surgery using the water leak test (EN455-1) to detect leakage. Results: Glove perforation was detected in 89 of 972 glove sets (9.2%). Statistically relevant more often glove tears occurred in operator than the 1st assistant (p < 0.001). The sites of perforation were localized mostly on the middle finger of the non-dominant hand (22.5%), and the non-dominant ring finger (17.9%). Conclusions: This study has proved that the role performed by the surgeon during the procedure (operator, 1st assistant) has significant influence on the risk of glove perforations. Nearly 90% of glove perforations are unnoticed during surgery.

Objectives : The goal of the article is to present the changes in morbidity and costs of systemic lupus erythematosus (SLE) in Poland in the 2008–2012 period, depending on the province of residence of the patients based on data reported to the public payer – the National Health Fund. Material and methods : Based on the ICD-10 code and the patient’s personal identity number, the number of patients and medical costs (cost of hospitalization, pharmaceutical, medical procedures, dialysis and specialist consultations) were calculated by province (voivodeship) and urban or rural residence. Results : Annually on average in the assessed period in Poland approximately 20 000 patients were diagnosed with SLE. The studied group was dominated by women (they were 5.2 times more numerous). The morbidity rate was 52.183 patients per 100 thousand inhabitants. Most patients were in the age range of 48–56 years. Average annual expenses for this group of patients over the examined period were USD 16,327 million. Two times more was expended on patients inhabiting cities, approximately 4 times more on women. Calculated per patient, the average cost of therapy was USD 810.63. Conclusions : The population of SLE patients in Poland is highly stable. The results of analysis indicate 1.64 times more frequent occurrence in urban areas, which may be connected with availability of doctors. The SLE treatment costs in Poland are much lower than in other countries, which is related mainly to the fact that therapy with biological drugs is not financed.

OBJECTIVES:The aim of the study was to compare short and long-term mortality and readmissions in patients with non-ruptured abdominal aortic aneurysm (AAA) treated with endovascular aortic repair (EVAR) or open aneurysm repair (OAR). DESIGN:Retrospective survival analysis based on prospectively collected medical records of the national Polish public health insurer. MATERIALS:In the National Health Fund database we identified all patients who underwent elective open or endovascular treatment of AAA between January 1st 2011 and March 22nd 2016. The data on mortality, selected concomitant diseases and readmissions were collected. A total of 7805 patients (mean age 70.9±8.1 yrs, 85.8% males) underwent OAR (n = 2336) or EVAR (n = 5469). A median follow up was 27.5 months (IQR range 10.0-38.4 months). METHODS:The primary outcome variable was all-cause mortality, secondary outcomes included 30-day mortality and readmissions. Kaplan-Meier (K-M), Cox proportional-hazards and propensity score analyses were performed for primary and secondary outcomes adjusting for repair type of AAA (OAR vs. EVAR), age, sex and concomitant diseases. RESULTS:EVAR patients had higher all-cause mortality (6.4% vs. 4.6% P = 0.002, adjHR 1.34, 95%CI 1.07-1.67, P = 0.010) compared with OAR. The mortality risks for OAR patients decreased below those for EVAR patients after 9.9 months. Of all the tested confounding factors only age independently and significantly influenced long-term mortality. Readmissions occurred more often in EVAR than in OAR (16.5% vs. 8.4% P

introduction. Diabetes is one of the 10 most important chronic diseases in the world. According to the data of the International Diabetes Federation, in Poland 9% of the population between the ages of 20–79 suffer from diabetes. objective. The aim of this study was to investigate the differences in the prevalence of diabetes in urban and rural areas in Poland, and the preparation of a model describing the phenomenon. materials and method. Differences between urban and rural areas were studied for the occurrence of patients treated with diabetes per 100,000 inhabitants, the number of patients, structure of treatment per the used products, and the costs of reimbursement of treatment products between 2008–2012. Urban and rural cases were compared using zip codes. The basis for classifying a patient as being an inhabitant of an urban or rural area was an urban zip code of the declared place of residence. results. Differences were observed both between various areas of Poland, as well as depending on whether the declared place of residence of the patient was urban or rural. Differences between urban and rural areas within the studied period have increased. The difference in the prevalence of diabetes among the inhabitants of Podlaskie, Śląskie or Świętokrzyskie provinces is striking. conclusion. Differences between urban and rural areas which depend on morbidity and detection of patients in the earlier phase of illness, the structures of medical technologies used in the treatment process, the number of purchased pharmaceuticals, enable better monitoring of effectiveness and quality of politics on prevention and treatment of chronic diseases. It is important for the creation of a health policy to devise a system of indicators, which will enable a decrease in the existing differences between regions, and between the urban and rural areas within the provinces.

Aim. To analyze tears in sterile surgical gloves used by surgeons in the operating theatre of the Trauma and Orthopedic Surgery Department, Copernicus Memorial Hospital, Łódź, Poland Materials and Method. This study analyzes tears in sterile surgical gloves used by surgeons by ICD-9 and ICD-10 codes. 1,404 gloves were collected from 581 surgical procedures. All gloves were tested immediately following surgery using the test method described in Standard EN455–1 (each glove was inflated with 1,000 ± 50 ml of water and observed for leaks for 2–3 min.). Results. Analysis of tears took into consideration the role of medical personnel (operator, first assistant, second assistant) during surgical procedure, the type of procedure according to ICD-9 and ICD-10 codes, and the elective or emergency nature of the procedure. The results of the study show that these factors have a significant influence on the risk of glove tears. Significant differences were observed in tear frequency and tear location depending on the function performed by the surgeon during the procedure. Conclusion. The study proved that the role performed by the surgeon during the procedure (operator, first assistant, second assistant) has a significant influence on the risk of glove tearing. The role in the procedure determines exposure to glove tears. Implementing a double gloving procedure in surgical procedures or using single gloves characterized by higher tear resistance should be considered.

to investigate the drug-class-specific changes in the volume and cost of antidiabetic medications in Poland in 2012-2015.This retrospective analysis was conducted based on the National Health Fund database covering an entire Polish population. The volume of antidiabetic medications is reported according to ATC/DDD methodology, costs-in current international dollars, based on purchasing power parity.During a 4-year observational period the number of patients, consumption of antidiabetic drugs and costs increased by 17%, 21% and 20%, respectively. Biguanides are the basic diabetes medication with a 39% market share. The insulin market is still dominated by human insulins, new antidiabetics (incretins, thiazolidinediones) are practically absent. Insulins had the largest share in diabetes medications expenditures (67% in 2015). The increase in antidiabetic medications costs over the analysed period of time was mainly caused by the increased use of insulin analogues.The observed tendencies correspond to the evidence-based HTA recommendations. The reimbursement status, the ratio of cost to clinical outcomes and data on the long-term safety have a deciding impact on how a drug is used.

Celem pracy była ocena realizacji obowiązujących w Polscew latach 2004–2008 programów leczenia lekami biologicznymichorych na reumatoidalne i młodzieńcze idiopatyczne zapaleniastawów. Leczenie jest prowadzone przez 81 ośrodków rozmieszczonychrównomiernie w całym kraju. W tym okresie leczonołącznie 8160 chorych. W 2008 r. leczonych było 2282 chorych, costanowi około 2% wszystkich chorych na reumatoidalne zapaleniestawów; 72% z nich stanowiły kobiety, najczęściej w wieku45–55 lat. Lekiem najczęściej stosowanym był etanercept, rzadziejinfliksymab, bardzo rzadko adalimumab i rituksymab. Pieniądzeprzeznaczane przez NFZ na ten rodzaj leczenia nie sąwykorzystywane w pełni, w 2008 r. nie wykorzystano 13,5%.W podsumowaniu podkreślono, że należy zwiększyć liczbę leczonychchorych poprzez poprawienie wykorzystania przeznaczanychnakładów, a następnie ich zwiększenie.

A population-based organised cervical cancer screening programme (OCCSP) was introduced in Poland in 2006. In this study we have aimed to analyse whether selected parameters related to invasive cervical cancer (ICC) of patients diagnosed in two distant gynaecological oncology centres changed after the first screening round of the programme run between 2006-2008. We have run a retrospective cross-sectional analysis of 189 women diagnosed with ICC between 2002-2005 (directly before introduction of the programme) and 165 patients diagnosed between 2009-2012 (just after the first screening round of the programme) and compared their age at diagnosis, histology, stage of tumours and overall survival (OS). Mean age of patients diagnosed in years 2002-2005 and 2009-2012 was 52.1 and 52.6 years respectively. Squamous cell carcinomas constituted 90.5% and 86.1% of tumours diagnosed in years 2002-2005 and 2009-2012 respectively and the rest of tumours had glandular and other histologies. 74.5% and 61.0% of women diagnosed in years 2002-2005 and 2009-2012 respectively had early ICC (FIGO-International Federation of Gynaecology and Obstetrics stages I-IIA) and the rest had advanced disease (FIGO IIB-IV). We have noticed no significant differences in mean age of patients, histology of tumours and OS of patients with ICC diagnosed before and after the first screening round of OCSSP in Poland. Advanced stages of ICC were more commonly diagnosed after the introduction of OCSSP. Changes only in some clinical parameters of patients with ICC were noticed before and after the first screening round of OCSSP in Poland but OS of patients remained the same.