Rechel, Boika, Spencer, Nick, 1943-, Blackburn, Clare, 1957- and Rechel, Bernd. (2010) Policy challenges to the quality of child health services in Bulgaria. International Journal of Health Planning and Management, Vol.25 (No.4). pp. 350-367. ISSN 0749-6753

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Abstract

Background Our study aimed to explore policy challenges to the quality of child health services in Bulgaria. Methods The study was based on qualitative in-depth interviews, analysis of regulatory documents, and review of the literature. Respondents included policy-makers, providers and users of health services, from both rural and urban areas. Results Problems identified included insufficient training of general practitioners, medical errors, delays in response to emergencies, inadequate information provided to patients, and underdeveloped child public health. A common view was that paediatricians provide better quality care than general practitioners. Respondents described a lack of clinical guidelines for rational use of pharmaceuticals, overprescribing of antibiotics, reliance on pharmaceutical companies for information, and unrestricted sales of drugs over-the-counter. 'Clinical pathways', introduced as a payment mechanism in hospitals, were perceived as lacking transparency, complicating clinical practice, and forcing doctors to record wrong diagnoses and conduct unnecessary investigations. Conclusions Our findings indicate the need to develop evidence-based clinical guidelines for primary and secondary care, establish payment mechanisms that facilitate quality improvements, promote rational use of pharmaceuticals, improve continuing training of physicians and strengthen child public health. Copyright (C) 2010 John Wiley & Sons, Ltd.

Item Type:	Journal Article
Subjects:	H Social Sciences > HV Social pathology. Social and public welfare R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Divisions:	Faculty of Social Sciences > School of Health and Social Studies
Journal or Publication Title:	International Journal of Health Planning and Management
Publisher:	John Wiley & Sons Ltd.
ISSN:	0749-6753
Date:	October 2010
Volume:	Vol.25
Number:	No.4
Number of Pages:	18
Page Range:	pp. 350-367
Identification Number:	10.1002/hpm.1030
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Restricted or Subscription Access
URI:	http://wrap.warwick.ac.uk/id/eprint/4853

Data sourced from Thomson Reuters' Web of Knowledge

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