title: [Productivity and practice profiles of general practitioners in Tirana, Albania].
abstract: BACKGROUND
  Albania, as with all Central and Eastern European countries whose health systems were highly centralized, has undertaken a number of reforms aiming to transform, among many items, the financing and delivery of primary health care services.
  
  
  OBJECTIVE
  This study assesses the practice activities of general practitioners working in the region of Tirana, over a period of 12 months.
  
  
  METHODS
  Production is measured by the number of monthly visits carried out by the practitioner, and practice profiles are determined by referral rates for specialist care and prescription rates per visit. Multi-level regression analyses, taking into account the hierarchical structure of the data, were performed to identify the factors associated with productivity and profiles of practice.
  
  
  RESULTS
  Results show large urban-rural variations with respect to practice conditions, characteristics of practitioners, productivity, and profiles of practice. Productivity was weak in the city of Tirana (an average of 277 monthly visits), 18% of patients were referred to specialists, and 66% received prescriptions. In rural areas, productivity was weaker (an average of 179 monthly visits), referral rates were lower (11%), and the prescription rate was 74%. In urban and rural areas, productivity and profiles of practice were related to the characteristics of both the client and the health centre and to the type of practice.
  
  
  CONCLUSIONS
  There are only a few available epidemiological studies documenting the ongoing health transition and the concomitant increase in demand for primary health care services; therefore, we are unable to (causally) link the reported low productivity of general practitioners with population needs. Physician productivity and patient care is better for certain groups and in health care settings where a wide range of services and sophisticated medical technologies are available. The capacity to efficiently plan for medical manpower is limited - this may be attributed to deficiencies of the patient registration system on the lists of physicians who are paid on the basis of capitation. Additional studies examining utilization of health services, and satisfaction of patients and providers, is needed in order to provide sound recommendations for improving Albania's health care system.
authors.affiliation: Centre de recherches du CHUM et Unité de santé internationale, Université de Montréal, Montreal, Québec. pierre.fournier@umontreal.ca
authors.forename: Pierre
authors.initials: P
authors.lastname: Fournier
authors.forename: Caroline
authors.initials: C
authors.lastname: Tourigny
authors.forename: Alban
authors.initials: A
authors.lastname: Ylli
authors.forename: Besim
authors.initials: B
authors.lastname: Nuri
authors.forename: Slim
authors.initials: S
authors.lastname: Haddad
mesh_terms: D000328:Adult; D000415:Albania; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004363:Drug Utilization / Q000706:statistics & numerical data; D004526:Efficiency; D005194:Family Practice / Q000458:organization & administration / Q000706:statistics & numerical data*; D018166:Health Care Reform; D006301:Health Services Needs and Demand; D019456:Health Transition; D006801:Humans; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000458:organization & administration / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D019035:Rural Health Services / Q000600:supply & distribution; D019037:Urban Health Services / Q000600:supply & distribution