Primary health-care reforms in North Macedonia mean GPs can prescribe medicines for diseases without referral to a specialist, in accordance with new clinical guidelines.
An amendment to the Law on Health Insurance, which comes into effect in August, means that patients will no longer have to travel to the capital, Skopje, for diagnosis and treatment of conditions including hypertension, diabetes and chronic obstructive pulmonary disease (COPD). As part of the WHO-supported reforms, the Ministry of Health has also initiated a revision of the positive medicines list and the digitization of the health information system in the country.
“To enable GPs to manage these illnesses, the government passed an amendment to the law that gives GPs the right to officially diagnose these diseases and prescribe medications, when needed, as specified in the new clinical guidelines. These will also include up-to-date prescriptions, which are to be included in the next revision of the positive list, currently underway,” said Minister of Health Dr Fatmir Mexhiti.
The reforms, which are expected to improve efficiency as well as patient and provider satisfaction, demonstrate the country's commitment to ensuring a minimum quality of care and promoting evidence-based interventions in primary health-care practices.
New protocols and pathways
To prioritize the allocation of resources effectively, an analysis of ambulatory care sensitive conditions in North Macedonia was conducted. These conditions are health issues that can be effectively prevented, diagnosed and treated in primary health care. Based on the analysis, five health conditions were selected to be addressed through the clinical protocols and pathways. These are:
- hypertension
- diabetes
- COPD
- asthma
- hypothyroidism.
With the support of WHO, a training programme for GPs, family doctors and their nurses was designed and delivered through 16 regional workshops. Educators presented the protocols through case scenarios, allowing participants to apply them in practice. Small group discussions and plenary sessions provided opportunities for in-depth exploration and understanding of each disease and its management. In total, 623 health-care workers received comprehensive training.
The protocols not only define the competencies, responsibilities and skills of health-care providers but also emphasize the important role of nurses as health promoters in the new primary health-care model. The introduction of primary care protocols and pathways is considered the most important strategy to guarantee a minimum standard for care delivered in all primary care practices. They play a crucial role in monitoring quality and introducing evidence-based interventions into daily practice.
Long-term savings
“When we speak about protocols in primary health care we need to understand that protocols existed before. These, however, which are being introduced in practice as of end of August 2023, are upgraded protocols that contain many more components such as clinical pathways and quality indicators, and this is what makes them different from the ones previously used,” says WHO focal point Dr Zlate Mehmedovikj.
Dr Mehmedovikj also highlighted the fiscal implications of the reforms, emphasizing the need to allocate resources efficiently and consider primary health-care as an investment that can lead to long-term savings in secondary and tertiary systems. He said the new protocols aim to establish standardized teamwork, reduce administrative burdens and enable task sharing among health-care providers.
“The introduction of these new protocols will improve the accessibility of health services by equipping general practitioners with the authority to prescribe specific therapies that were previously only accessible through referrals to secondary or tertiary health-care institutions,” explained Dr Kiril Soleski, a GP and member of the Steering Committee for PHC Reforms.
“Moreover, these protocols empower them to conduct pertinent diagnostic procedures within their domain of expertise. This will ultimately enable a substantial proportion of over 80% of patients in need of medical attention to receive comprehensive care at the primary health-care level, fostering more efficient and effective health-care delivery," he continued.