Netolygus geografinis gydytojų pasiskirstymas : sisteminė kitų šalių patirties apžvalga

Background. According to the World Health Organization, approximately one half of the global population lives in rural areas, but these are served by less than a quarter of total physician workforce. This is a global problem that affects almost all countries: some countries are affected to a higher degree and some to a lower degree. Over the last fifty years, various attempts to solve this problem have been observed in different parts of the world. Material and methods. The author carried out a systematic literature search of PubMed for studies describing intervention programmes aimed at improvement of recruitment and retention of physicians to geographically remote or rural areas. The following inclusion criterion was used: full-text articles, describing programmes aimed at physicians and published in English in 2000- 2013. In the initial search, 922 articles were identified, 856 of which were excluded as duplicates or based on their titles or abstracts. Full-text reviews of the remaining 66 articles were conducted. Eighteen articles, which described 14 programmes, were included in the final review. Results. Considering the reviewed 14 programmes, the earliest programme was started in Chille in 1963 and the latest – in Senegal in 2006. Four programmes were implemented in North America (three in the USA and one in Canada) and Asia (Philippines, India, Indonesia and Japan), two in Australia (nationally and in New South Wales) and Africa (South Africa and Senegal), one in Europe (Norway) and South America (Chille). The following types of programmes were analysed: educational programmes, which train medical students for rural and remote areas (with scholarships and obligations), educational programmes, which train medical students for rural and remote areas (without scholarships and obligations), short-term oriented programmes,
professional support programmes and programmes aimed at bringing international medical graduates to rural and remote areas. Programmes, which were aimed at resolving physician shortage in the short-term, usually included financial incentives and some of them included other benefits (social benefits, free housing, etc.). These programmes were successful in retaining physicians for duration of contract (2-6 years), and so were international medical graduates-oriented programmes. Educational programmes, which train medical students for rural and remote areas, showed some promise, as their results were better compared to other programmes. These programmes contribute to solving the issue in the long-term. Conclusion. Even though different countries have implemented different intervention programmes to address geographic maldistribution of physicians, the design of studies, which were included in this systematic review, did not allow to confirm whether any of the reviewed programmes were effective or not. Rigorous studies are needed to evaluate the true effect of these programmes to increase the number of physicians working in remote and rural areas.

Pusė visų pasaulio gyventojų gyvena kaimo vietovėse, tuo tarpu jose dirba mažiau nei ketvirtadalis pasaulio gydytojų. Sisteminė literatūros šaltinių paieška, atrenkant kitose šalyse vykdytas netolygiam gydytojų pasiskirstymui spręsti skirtas programas, buvo atlikta pagal šiuos kriterijus: ieškota tik gydytojams skirtas veikiančias programas aprašančių visateksčių straipsnių, paskelbtų 2000‒2013 m. anglų kalba, naudojant PubMed duomenų bazės paieškos sistemą. Nustatytus kriterijus atitiko 18 straipsnių, kuriuose aprašoma 14 gydytojų pritraukimo ir išlaikymo geografiškai nepatraukliose vietovėse programų. Nustatyta, jog programos, kuriose taikomos tik finansinės paskatos, dažniausiai pasiteisina, pritraukiant gydytojus į geografiškai nepatrauklias vietoves ir išlaikant juos ten trumpą laikotarpį (2‒6 m.). Užsieniečių gydytojų įdarbinimo programos taip pat nėra ilgalaikis sprendimas, kadangi jis veiksmingas iki sutarties galiojimo pabaigos. Medicinos studentų rengimo darbui geografiškai nepatraukliose vietovėse programos (tiek su stipendija ir įsipareigojimais, tiek be jų), nors ir nepadeda greitai išspręsti gydytojų trūkumo problemos, tačiau yra labai naudingos ilguoju laikotarpiu.