Ten years of primary care reform in Lithuania: comparing the task profiles of primary care doctors in 1994 and GPs in 2004.

Background: Since its independence in 1990 Lithuania is transforming health care from the previous Soviet system to a decentralised social insurance based system with a strong emphasis on primary care. Doctors have been re-trained to become GPs with a gatekeeping position. GPs can either work as employees in the public centres or in their own private practice, contracted to the system. Family medicine residency programmes have been developed. Health centres have been modernised and new centres have been established. This paper is an evaluation of changes between 1994 and 2004 with respect to the profile of specific tasks provided by Lithuanian primary care doctors to their patients. Methods: In 1994 and 2004 identical questionnaires have been completed by random samples of primary care physicians about the following services: minor surgical procedures, management and follow up of diseases, and prevention and health education. Data entry, processing, and analysis were carried out using SPSS software. Results: In 1994 the response among district doctors was 333 (87%) and among primary care paediatricians 262 (87%). In 2004 the response among GPs was 298 (73%). Nowadays GPs aresignificantly more involved than primary care doctors 10 years ago in the provision of most medical procedures considered in the questionnaire. Similarly, GPs were significantly more involved in the treatment of a number of diseases, though not with all diseases considered. With respect to prevention no increase was found. Despite the improvements overall, the current position of GPs in Lithuania in the aspects considered is still clearly behind the position of GPs in western Europe in 1994. Conclusions: GP task profiles are more comprehensive now than they were 10 years ago, but continued efforts and time will be needed to reach the profile of provision of GPs in western European countries. (aut.ref.)