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GjilanHanover

Gjilan, Kosovo / Hanover, New Hampshire

2001-2004


Focus: Evidence Based Practice, Practice Guidelines, Preventive Medicine, Health Care Policy and Reform, Primary Care, Health Care & Hospital Administration



The Partners

US Partner: Dartmouth Medical School, one of the premier medical schools in the U.S., was one of the first medical schools to implement community-based primary care teaching into their curriculum. In 1999, Dartmouth Medical School partnered with the University of Pristina, School of Medicine in Kosovo with the primary goal of enhancing their medical education system. The program has expanded and now includes a biomedical library component and a partnership between the two orthopedic departments.

CEE Partner: The Gjilan/Gnjilane Municipality, located in southeast Kosovo, has a population of approximately 130,000 people. Primary care is provided by the Main Family Medicine Center/Health House in Gjilan (Gnjilane) and its network of twenty-two clinics located throughout the municipality.


Partnership Objectives

The partnership’s overall goal is to improve the quality of Family Medicine practice for the Gjilan Health Municipality by instituting continuous improvement systems, implementing clinical practice guidelines, improving team communication, and establishing community-based programs. Specific objectives are to:

  • Establish systems for chronic disease screening in the Main Family Medicine Center in Gjilan by January 2003.
  • Implement management strategies (prevention and treatment) for patients with chronic disease who are screened by February 2003.
  • Develop sustainable community-based program of chronic disease screening by April 2003.
  • Establish political and professional leadership support for the continuous improvement of primary health care systems at local, municipal and national levels by July 2003.
  • Institutionalize continuous improvement in the MFMC based on the microsystems approach including strengthened: team communication, patient focus, quality definition and measurement, information and analysis, and systematic improvement cycles by October 2003.


Achievements

   Access/Capacity Building
  • In October 2001, AIHA launched its first partnership in Kosovo. During the first several exchanges, partners completed a “SWOT” (strengths, weaknesses, opportunities, threats) analysis and gathered statistical information regarding key morbidity and mortality indicators for the Gjilan/Gnjilane region.
  • The hypertension program established by this partnership was selected because it is a major health concern for the people in the Gjilan Municipality; 21% of the population has cardiovascular disease according to the Kosovar Albanian Health Survey Report by Spiegel and Salama (1999). Partners work to improve the knowledge, skills, and practice for the prevention, diagnosis, and treatment of hypertension. However, the hypertension program’s main purpose is to teach the Gjilan partners quality improvement skills that can be repeated for other medical conditions and system problems.
  • The US partners conducted a TOT course on high blood pressure pathophysiology, screening, and treatment to two Kosovar physicians and two nurses.
  • In the summer of 2002, partners created five working groups at the Main Family Medicine Center (MFMC) to prepare for the implementation of the hypertension screening program. The working groups finalized guidelines for ten diseases to be provided to the Ministry of Health for publication and redefined many staff roles.
  • The MFMC received various supplies and equipment, including laptop computers, a scanner, wall clocks, scales, eye charts, growth charts, nurse uniforms, stethoscopes, mirrors, and portable blood pressure cuffs. The US partners also secured donated stethoscopes, glucometers and glucometer test strips, toothbrushes, and several medical textbooks for the center.
  • The physicians’ offices and patient waiting area were renovated and equipped with new furniture and the MFMC building was painted.
  • Implementation of the new patient flow and hypertension screening and management protocol began in October 2002. The new patient flow first directs patients to the central registration area where initial data is collected using new patient forms. Registration data for patient volume by gender, age category, residence zone, and reason for visit to the MFMC is recorded by day, week, and month. Since implementing the data collection system, the clinic has seen 29,895 patients.
  • The partners conducted a study on patient flow at the MFMC and found that the average patient visit, from registration to completion of visit, lasted 13 minutes.
  • The MFMC has seen increased quality of adult patient health care in several areas: improved patient flow has resulted in shorter waiting times, less confusion, and improved patient satisfaction; hypertensive patients are now being scheduled for follow-up visits with an assigned primary care physician, improving the continuity of care; medical records are becoming more accessible; and all adults who visit the MFMC now have their blood pressure measured and recorded by the nursing staff before being examined by a physician, improving the efficiency of the center.
  • The MFMC co-sponsored and partnership physicians led a multi-disciplinary, multi-ethnic workshop on implementation of family medicine and primary care in Kosovo.
  • Partners designed individual patient blood pressure records that record multiple blood pressure readings and provide information on hypertension.
  • Partners finalized the Gjilan Health House common algorithm for hypertension.

 

   Skills Building

  • The four Kosovar trainers who participated in the TOT course assisted in training 80 doctors and nurses. Later, the Gjilan partners trained 152 nurses and 61 doctors in hypertension screening, treatment, and clinical practice. All trainees were administered a pre- and post-test to assess their knowledge of hypertension. Of the 149 trained, 97% passed; the remaining 3% were retrained and will be re-evaluated. Thirty-four general practitioners and 55 nurses received a perfect score of 20.
  • To date, training on hypertension assessment, treatment, and management strategies has been provided for most of the Main Family Medicine Center and other Gjilan Health House staff. Altogether, 54 physicians and 144 nurses 95% of the staff has completed hypertension training, including pre- and post-tests to determine the level of knowledge gained. In addition, some trainees took part in on-going blood-pressure measurement workshops to improve their confidence and skills.
  • Kosovar partners also received training on leadership skills and micro-systems and quality improvement.
  • The Education Focus Group trained 18 nurses on patient health education, bringing the total number of nurses trained to 30. In March, nurse supervisors began using double-headed stethoscopes to assess the accuracy of nurses taking blood pressures.
  • During the January exchange, physicians and nurses were trained in: performance assessment using “Objective Structured Clinical Exam” methodology, patient satisfaction, behavior change theory and methods, and patient education. Physicians received additional training in access and use of the electronic library and internet resources as well as improve patient care, data aggregation, display, reporting, and use.
  • The Patient Education Focus Group adapted behavior change materials from the US and led three nurse training sessions in Kosovo. Fifty-nine (59) nurses were trained in patient education and behavior change methodologies.
  • The Health Education Focus Group held a training course at the MFMC and the Zheger FMC on the role of the nurse in community screenings for 96 nurses. The methodology of this training involved transparency, interactive discussions, and feedback to participants. At the end of the training, an anonymous evaluation was conducted. Evaluation results showed that 95 percent of participants would like additional courses focusing on better health for the people of Gjilan. All participants received a copy of the materials used during the lesson.
  • To meet health education needs of the staff, the Health Education Focus Group published a series of short messages on the importance of staff washing their hands before and after any procedures. The health group also created relevant brochures and posters.
  • Nurses at the MFMC received training in the use of Microsoft Access and data entry.
  • The Gjilan partners received training on domestic violence and infection control.

 

   Community Awareness/Participation

  • The patient education working group designed and printed posters and pamphlets about hypertension and the partnership’s hypertension project. The posters are displayed in the MFMC and selected community sites, and pamphlets are available at the MFMC and provided to hypertensive and at-risk patients.
  • In December, partners formed a preliminary community group that identified goals, key objectives, and future plans. The overall goal of the group is to forge a relationship between community members and the Gjilan Health House. In addition, partners met with hospital and community leaders to introduce the partnership program and garner support.
  • After observing a community blood pressure screening clinic at a senior citizen’s center in rural New Hampshire, the partners prepared a pilot screening to be held at the Arberia Family Medicine Center in Gjilan. The partners finalized the logistics; printed advertisements and patient forms; and visited local mosques, clinics, and schools to promote the pilot screening. In addition, several advertisements were aired on the local television and radio stations. In January, the pilot community blood pressure screening clinic was held at the center, and a total of 76 individuals were screened. Thirty-two people (42 percent) were found to have blood pressures that fall into the WHO categories of ‘severe’ and ‘very severe’ (see chart below). Fifty individuals were referred to a primary care physician who was present at the screening clinic.
  • In April, the Community Focus Group ran two community-based blood pressure screening clinics—the first at the Arberia Family Medicine Center in Gjilan and the second at the Zheger Family Medicine Center in the village of Zheger.
  • On May 12, partners celebrated Nursing Day by running six volunteer community-based hypertension screenings. The partners screened 280 patients during the day. They used the forms and protocols developed by the MFMC All materials developed by the partnership were shared with national-level nursing advisors.
  • The partners conducted two additional community-based screenings in May. On May 20, partners screened 84 patients in front of the local theater and, on May 22, they saw 122 patients in front of a department store. At the May 22 screening, the partners introduced the use of a patient “passport” to help track patient visits and blood pressure readings.
  • In June, partners participated in a local meeting with United Nations Mission in Kosovo (UNMIK) officials, Kosovo Ministry of Health representatives, faculty from the Medical School in Pristina, and Serbian health workers to discuss ways to include Serbian physicians in the family medicine trainings being conducted throughout the country by international organizations.

 



Partnership Data

  • As of February 2003, the partnership has had a total of 20 exchanges involving 32 person trips to Gjilan (Gnjilane) and 22 to Hanover.

 

 

Participating Institutions



Contact Information for Gjilan, Kosovo / Hanover, New Hampshire

NIS/CEE Partner

Information Coordinator
Mr. Kastrati, Arsim
Individual
Kosovo
Email:  arsimkastrati@yahoo.com

US Partner

US Partnership Coordinator
Hammond, Cristina
Project Manager
Dartmouth Medical School
Hanover, NH, United States
Email:  Cristina.S.Hammond@Hitchcock.org


Updated on August 27, 2003