Search Results (12)

Background/Objectives: The COVID-19 pandemic underscored the need for adaptive public health strategies and effective decision-making tools to optimize clinical responses and policy measures based on regional contexts. This study aims to identify key criteria for developing a patient-centered strategy to enhance the resilience of Romania’s healthcare system during the pandemic. Methods: This research introduces a Multi-Criteria Decision Analysis (MCDA) model using the Simple Multiple Attribute Assessment Technique (SMART) to integrate quantitative and qualitative data, providing decision-makers with a structured tool for improving healthcare resilience. A survey of 412 Romanian healthcare professionals identified critical risks and opportunities. The study followed a two-phase approach: first, analyzing expert perceptions to determine key challenges; second, applying a mixed-methods evaluation to prioritize resilience-building strategies. Results: Four main challenges emerged: (1) healthcare workforce shortages causing excessive workload and stress, (2) poor communication and systemic inefficiencies limiting patient access, (3) weak crisis management due to delayed control measures, and (4) regulatory gaps leading to fragmented responses. Proposed solutions included workforce training, improved communication, telemedicine integration, increased financial support, and a unified legal framework. The SMART method facilitated the structured prioritization of these measures, with long-term system sustainability emerging as the most effective strategy for preventing future crises. Conclusions: This study demonstrates the value of integrating MCDA into healthcare decision-making, offering a scalable model for policymakers to enhance crisis response and resource allocation. By incorporating expert insights and patient needs, the proposed framework strengthens healthcare system preparedness, contributing to informed, patient-centered decision-making and long-term resilience. Ultimately, our findings not only contribute to the existing literature but may also open new directions to facilitate informed, patient-centered decision making, thereby strengthening the resilience of healthcare systems in crisis situations. Full article

Background/Objectives: The objective of this study is to evaluate the evolution of Romanian legislation related to HAIs. The evolution of healthcare-associated infections (HAIs)’s definitions and surveillance frameworks in Romania reflects progressive advancement in diagnostic criteria, reporting, and prevention. Recent changes emphasize the need for accurate and centralized electronic reporting, inclusion of medico-social and palliative care institutions, and modernized hospital infrastructure standards. However, workforce deficits, insufficient infrastructure, and punitive sanctions remain barriers to effective implementation. Methods: This study analyzed publicly available Romanian legislative texts and their evolution, comparing definitions, diagnostic criteria, and surveillance structures. Key informant insights supplemented findings to contextualize legislative impacts. Legislative acts were reviewed sequentially to identify updates in regulatory frameworks and barriers to effective HAI management. Results: The legislative evolution demonstrates a shift from basic diagnostic criteria to a comprehensive surveillance framework aligned with European standards. However, challenges persist, including workforce capacity deficits, under-reporting due to fear of sanctions, and infrastructure inadequacies. The prevalence of HAIs remains largely under-reported (4.1%), with studies revealing rates well below the European average (7.1%). Manual and isolated reporting systems further hinder real-time surveillance and accuracy. Legislative advancements in Romania reflect progress in HAI management but highlight systemic barriers that impede effective implementation. Conclusions: Collaborative efforts across individual, organizational, and system levels are required to address workforce training, reduce under-reporting, and invest in infrastructure and electronic reporting systems. Promoting a blame-free organizational culture, combined with training, is essential to encourage behavior of accurate reporting and improve HAI prevention strategies. Full article

Background: Cardiovascular deserts are areas that lack medical facilities, specialists and equipment to effectively diagnose, treat and manage cardiovascular diseases (CVDs). Romania registers the highest incidence and the highest mortality due to CVDs in Europe. Population ageing is a significant concern, as it increases the risk of CVDs and the demand for specialised care. Although almost 50% of Romanians still live in rural areas, most medical resources are concentrated in a few large cities, leaving large parts of the country underserved. Methods: This study used the Application Programming Interface (API) Matrix service from Google Maps and open data sources to identify cardiovascular (CV) deserts. Results: This research indicates that over 64% of the Romanian population resides in areas lacking CV care, having to travel more than 60 km and over 30 min to reach the nearest facility that offers specialised treatment. Moreover, 14% live in areas affected by a high degree of cardiovascular desertification. These areas are primarily located in northeastern, southern and western Romania. They experience higher mortality rates from CVDs and an ageing population, along with a shortage of general physicians and a scarcity of cardiologists. Conclusions: The identified cardiovascular deserts in this study overlap mountainous regions, the Danube Delta and remote rural areas with poor transportation infrastructure. Implementing telemedicine or mobile healthcare services, involving community healthcare workers and policy support could be solutions to expand access to specialised care in cardiovascular deserts. Full article

Background/Objectives: Moral hazard represents a significant challenge in healthcare systems globally, reflecting the tendency of insured individuals to over-utilize medical services when shielded from the full costs of care. Methods: This paper investigates the dynamics and implications of moral hazard within the Romanian public hospital sector, offering practical recommendations for healthcare policymakers to mitigate the financial risks associated with excessive healthcare utilization and ensure long-term sustainability. To achieve the objectives of this study, a quantitative research approach utilizing vignettes was employed. Vignettes allow for the simulation of real-world decision-making under conditions of insurance coverage, capturing nuanced behaviors that traditional surveys may overlook. Results: The study examined patient behaviors in the context of moral hazard in public hospitals in Romania, employing a quantitative approach based on vignettes. A total of 303 valid responses were collected. The findings indicate a significant tendency among insured patients, both publicly and privately insured, to opt for more expensive treatments compared to uninsured patients, who preferred more affordable options such as medication or physiotherapy. In the case of treatments for severe conditions, insured patients frequently chose combinations of higher-cost therapies, while uninsured individuals either delayed treatment or opted for less expensive alternatives. These results highlight the impact of moral hazard, driven by a reduced sensitivity to costs in the presence of insurance, and underscore the need for cost-sharing policies to mitigate the overutilization of medical resources. Conclusions: This paper uniquely contributes to the understanding of moral hazard by integrating insights from both Romanian public hospitals and international case studies, offering practical policy recommendations for mitigating the financial risks associated with excessive healthcare utilization. Full article

Pharmacists, essential healthcare providers, face significant challenges in professional satisfaction and well-being. This study investigates the factors influencing pharmacists’ professional satisfaction, mainly focusing on workload, organizational support, job autonomy, work–life balance, and resilience against burnout. Data were collected from relevant online forums on Facebook and Reddit using a netnographic methodology. The data were anonymized and thematically coded to identify key themes from 23 conversation threads, primarily involving or concerning Romanian pharmacists. The analysis revealed several critical issues: widespread dissatisfaction with salaries, challenges in professional recognition, and the demanding nature of university education. Additional themes included economic and financial insights, global trends and technological impacts, personal experiences and satisfaction, professional growth and education, regulatory and market environment, and workplace dynamics. Findings indicate these factors significantly impact pharmacists’ job satisfaction and overall well-being. The study concludes that addressing these issues through targeted interventions, such as policy reforms, educational updates, and enhanced organizational support, can improve the professional lives of pharmacists, thereby enhancing their contributions to healthcare outcomes. Full article

Background/Objectives: Numerous European countries, including Romania, are facing the concern of rapid ageing of their populations. Moreover, Romania’s life expectancy ranks among the lowest in the European Union. In light of this, it is imperative that the assessment of medication-related harm be given national priority in order to secure and enhance pharmacotherapy and the medical act. In this study, we sought to describe and evaluate the under-prescribing practices among the Romanian elderly population. Methods: We conducted a cross-sectional study in urban areas of two counties in Western Romania (Timis and Arad) from November 2017 to February 2019. We collected chronic electronic prescriptions issued for elderly patients (>65 years old) with chronic conditions. The medication was prescribed by generalist or specialist physicians for periods ranging between 30 and 90 days. To assess inappropriate prescribing behaviours, a multidisciplinary team of specialists applied the Screening Tool of Older Persons’ Prescriptions/Screening Tool to Alert to Right Treatment (STOPP/START) v.2 criteria to the collected prescriptions. Results: Within the 1498 prescriptions included in the study, 57% were issued to females, the mean age was 74.1 ± 6.95, and the average number of medicines per prescription was 4.7 ± 1.51. The STOPP criteria most commonly identified were the (1) long treatment duration (23.6%) and (2) prescription of neuroleptics (14.6%) or zopiclone (14.0%) as medications that increase the risk of falls. According to START criteria, the following medicines were under-prescribed: (1) statins (47.4%), (2) beta-blockers (24.5%), (3) antiresorptive therapy (10.0%), and (4) β2-agonists and muscarinic antagonists for chronic obstructive pulmonary disease (COPD) (4.5%). Within our study group, the prevalence of potentially inappropriate medications was 18.58%, whereas the prevalence of potential prescribing omissions was 49.2%. Conclusions: To decrease medication-related harm and morbid-mortality, and to increase the quality of life for elderly people in Romania, immediate actions are needed from national authorities. These actions include reinforcing primary care services, providing periodic training for physicians, implementing medication review services by pharmacists, and utilising electronic health records at their full capacity. Full article

Background and Objectives: This study aims to assess the health status and factors influencing healthy choices among children and young people in Romania, as well as the efficacy of related health education programs. Through understanding these dynamics, the study seeks to provide insights that can shape targeted interventions, policies, and educational strategies to improve this demographic’s overall health and well-being. Materials and Methods: For this study, we performed a literature review of original published papers on the health status, healthy habits, health education, predisposition to making healthy choices in the future, and accessibility to the paediatric health system of Romanian children and young people, as well as the effects of different types of educational interventions on this demographic in Romania. Results: The prevalence of dental caries is high in Romania. In terms of eating habits and nutritional status, a worrying proportion of children are overweight or obese, which can lead to a variety of future physical and psychological problems. In terms of physical activity, few adolescents demonstrate regular fitness practices. Romania presents an increase in alcohol and tobacco consumption among adolescents. The mental health of students has become a pressing public health concern, exacerbated by the COVID-19 pandemic. The use of social networks is linked to mental health issues among young people. Romania still has one of the highest rates of sexually transmitted diseases and faces a high incidence of cervical cancer, with a mortality rate three times higher than the EU average. High rates of teenage pregnancies are linked to limited information about sexuality and a lack of access to family planning at a young age. There are large discrepancies in the accessibility of medical services between urban and rural areas. Conclusions: Romania faces significant obstacles to providing high-quality healthcare to children and young people. Improving nutrition, immunisation rates, and access to medical services represent essential areas for enhancing the health of children and young people in Romania. Full article

Sustainable healthcare is “healthcare that is economical and has a positive impact on society”. Considering the definition of sustainable healthcare and the increase in life expectancy, the healthcare system is expected to face an increase in presentations addressed to healthcare facilities of older persons with multiple chronic diseases. Age-friendly environments support active living of older persons and healthcare support in their home. Our goal was to assess how the regulatory landscape undertaken in Romania and the ongoing research project initiatives with Romanian partners reflect the concept of age-friendly environments. Romania had a poor overall active aging index (rank 26/28) and a decrease in life expectancy by 1.4 years in 2020, with a high gender gap of 8 years in favor of women. Key findings highlight the integration of EU principles into Romania’s policies, which emphasize inclusivity, non-discrimination, and active aging. Romania’s involvement in European collaborative initiatives is primarily through private associations, lacking representation from governmental structures. National focus in Romania has been on social services for the elderly. The partners in ongoing research projects range from enterprises to universities and research institutes. The majority of ongoing research focuses on assistive technology solutions. The findings underscore the importance of national, regional, and local attention to the environmental and societal aspects of age-friendly initiatives, alongside promoting technology acceptance and adoption. Full article

Self-medication represents a significant healthcare and health policy issue worldwide, both in developed and underdeveloped countries. Currently, the COVID-19 pandemic is considered a relevant context that could subtly trigger self-medication behavior because of limited access to health care services and the threat of infection with the SARS-CoV-2 virus. While the previous research conducted with quantitative methodologies reported a dramatically increased rate of self-medication around the world, qualitative inquiries on the subjective experience with self-medicine remain scarce in medical and related fields of study. For this purpose, a qualitative study with semi-structured interviews was undertaken to better understand how Romanian mothers (n = 18) applied self-treatment with their children by avoiding medical advice during the COVID-19 pandemic. The results showed that the COVID-19 pandemic did not affect the prevalence of self-medicine among the pediatric population as parents achieved a degree of awareness of self-treatment of their children due to the general context of the outbreak of the COVID-19 pandemic. Full article

Green Public Procurement (GPP) became an efficient instrument to achieve the objectives of environmental policy expressed by the European Commission in its Communications. At the same time, it must be addressed by the public authorities as a complex process, in which all purchased goods and services must integrate perfectly into an entire puzzle-like system of legislation, the construction field, innovation, healthcare, food, and education. Scientific references published in the Web of Science (WoS) mainly between 2017 and 2020 were investigated, and they analyze the implications of green public procurement in various fields, as presented by scientific communities. This article brings as a novelty in this context the identification of some barriers in the adoption of these processes, so that they can be overcome. Based on good practices and international standards and trends, the article shows how aspects related to the implementation of green procurement in society can be taken into account. In the second stage, we added a case study on Romanian green agriculture and discussions regarding inter-correlation between different fields and GPP. Full article

Measuring patient satisfaction of healthcare service quality represents a significant element of a healthcare’s system (HS) overall evaluation. It is the starting point for creating policies in national healthcare. The purpose of this paper was to evaluate Romanian patients’ perception and satisfaction of the quality of the national HS as a whole and of its components. Exploratory and descriptive research was used. Data were collected through face-to-face interviews with Romanian patients, based on a questionnaire. Out of the 2305 respondents, 83% used the Romanian HS in the past 12 months and 58% of the respondents did not trust the system. The accommodation, food, and other facilities of Romanian hospitals were perceived as being at a low level. One third of the respondents were unsatisfied and very unsatisfied with respect to the overall impression of the Romanian HS. In addition, our research found a statistically significant relationship between confidence in the HS, age, and gender, and also between the overall impression on the HS, age and income. Full article

Cardiovascular diseases (CVDs) are the main cause of death in Romania. The objective of the paper is to explain the number of deaths caused by the diseases of circulatory system in relation to health expenditures per capita, the number of public hospitals with cardiology sections and the number of cardiologists. The analysis in the paper is based on panel data models and Bayesian linear models. A panel data approach for Romanian macro-regions in the period from 1995–2016 was used to show that an increase in the number of cardiologists would reduce the number of deaths caused by the diseases of circulatory system. The Bayesian approach to national data indicated that the increase in expenditures per capita would alleviate the incidence of deaths caused by CVD. The public health policies in relation to patients with CVD should focus on the future on higher expenditures per person, but the number of public hospitals and doctors treating these diseases should also continue to grow. Future healthcare policies should be also focused on reducing the number of specialists migrating to wealthier countries. Full article