Browsing by Author "Jorbenadze, Revaz"
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Item The Attitude of the Orthodox Parishioners Toward Euthanasia: Evidence From Georgia(SAGE Publications, 2019) Verulava, Tengiz; Mamulashvili, Mariam; Kachkachishvili, Iago; Jorbenadze, RevazItem Factors that influence tobacco use in Georgian youth(Malta Medical Journal, 2020-11-13) Verulava, Tengiz; Nemsadze, Davit; Jorbenadze, Revaz; Dangadze, BekaObjective: Social environment, especially education, levels of awareness, friends and parental behavior greatly affects the use of tobacco among teenagers. The research aims to identify various factors that promote tobacco use in youth. Method: Qualitative and analytic cross-sectional descriptive research method was carried in among students from Tbilisi State University. Results: Most respondents have started tobacco consumption at juvenile age. The community played a decisive role in starting tobacco use. Respondents started using tobacco with their classmates and close friends. The survey has shown that tobacco consumption was perceived as a positive social behavior among teenagers. Introducing the tobacco control laws that prohibit tobacco consumption and advertising in public places, particularly near schools are of paramount importance. Conclusion: Interventions that focus particularly on multiple risk factors may have an impact on the use of tobacco by adolescents. Where possible, such programs should be personalized to ensure that they address the specific set of risk factors that has a bearing on each individual's tobacco use.Item Family Support Policy in Georgia: Challenges and Reform Options(Bulletin of the Georgian National Academy of Sciences, 2020) Verulava, Tengiz; Jorbenadze, RevazGeorgia experienced demographic crisis in recent decades. The severe demographic situation is caused by low birth rate, increased mortality, aging and is also contributed by poor economic conditions, unemployment and high rate of migration. The study aims to document the drastic loss of population in Georgia and to asses which model best describes the current family support policy in Georgia according to the Gauthier’s typology (1996), which includes four models of family policies: pro-natalist, pro-traditional, pro-egalitarian and non-interventionist. The study argues that the overall outcome puts Georgia in the non-interventionist model of family support policies. The family support policy in Georgia does not create adequate conditions for settling demographic problems. The financial assistance measures, such as: one-time financial aid for a childbirth, help in covering childcare costs and tax benefits are not even available. It is recommended that the state develop a family support policy program that will target low and middle income families across the country to improve the demographic condition. The selective approach is more appropriate for a low-income countries to achieve a maximum efficacy. Targeted state program for improving demographic conditions, as a minimum basic package must be a standard for the whole country.Item Food products labeling in Georgia: problems and solutions(Science Publishing Corporation, 2018) Verulava, Tengiz; Gurchiani, Tamuna; Jorbenadze, RevazThe Georgian legislation is a very clear regarding food labeling and completely shares the regulations and fundamental principles of all EU member states at formal level, but there are no effective mechanisms and institutions in place to react to the violation of the established regulations of the law, as well as to be responsible on the increase of public awareness, raising the food purchase and consumption culture. The aim of the thesis is to show problems in the Georgian food market in terms of fulfillment of fundamental norms envisaged under the EU Association Agreement. Qualitative research methodology - Observation method was used for data gathering. Observation was conducted in agricultural hypermarkets of Tbilisi. The situation in Georgia in terms of food labeling norms is quite complicated. The fundamental rules are met in no object of food sales, the information printed on food products creates the obscure presentation for customers regarding its content and suitability, the level of awareness of consumers is very low, consumers are not interested in details about the label information. The consumers focus on the price of products not on the information about its characteristics. Despite regulations that exists on formal level and existence of National Food Agency and also several active projects within partnership with European Union, situation in Georgia is complicated with lack of information from consumers and spurning food safety norms from their side. It is important to increase consumers awareness and actively turning them into those processesItem The Gatekeeper Model: patient’s view on the role of the family physician(Family Medicine & Primary Care Review, 2020) Verulava, Tengiz; Dangadze, Beka; Jorbenadze, Revaz; Lordkipanidze, Ana; Karimi, Leila; Eliava, Ekaterine; Maglakelidze, TamarBackground. An adequate primary healthcare system substantially determines quality of population health and effective spending of healthcare resources. The family physician serving as a ‘gatekeeper’ can make judicious decisions about the appropriate use of medical services. Objectives. The goal of this study was to find out patients’ characteristics, preferences and behavior in regards to the role of the family physician as the gatekeeper in The Republic of Georgia. Materials and Methods. As part of a cross-sectional quantitative study, respondents were interviewed using a structured questionnaire. Results. Majority of the respondents (53.7%, n=245) had a permanent family physician, but were not satisfied with a level of family physician’s professionalism (56.6%, n=258) and preferred self-referral to specialists (55%, n=253). Only 19.5% (n=89) referred to specialists upon family physician’s advice who would coordinate all services and 23% (n=103) have used both family physicians and self-referral. Private health insurance companies were more interested in implementing cost reducing mechanisms rather than the Social Service Agency (which is responsible for Universal Health Care Program). Conclusions. It is appropriate to share private health insurance experiences for developing a model of gatekeeper in the UHCP. In order to improve a family physician institute and increase confidence in it, it is recommended to raise the level of family physicians’ skills of relations with patients as it has a significant effect on the patient preferences. It is advisable to develop a flexible and voluntary gatekeeper model which will better suit the needs of both patients and physicians.Item Left Ventricular Systolic Dysfunction After Myocardial Infarction(Gazi Medical Journal, 2021-01) Verulava, Tengiz; Shakinov, Giorgi; Jorbenadze, Revaz; Bakashvili, Naniko; Beka, DangadzeThe left ventricular systolic dysfunction is one of the most common complications after myocardial infarction. The damage of the large area of the cardiac muscle leads to a significant decrease in cardiac contractility. Our study presents a very unusual case of the left ventricular systolic dysfunction after myocardial infarction. A 76-year-old female was hospitalized at Chapidze Emergency Cardiology Center (Tbilisi, Georgia) with the diagnoses of ischemic heart disease and acute subendocardial myocardial infarction. Due to cardiac muscle ischemia, sinus bradycardia and diastole prolongation was revealed, which increased left ventricular end-diastolic volume and eventually caused left ventricular overload. It seemed to be a main predictor of developing compensatory ventricular premature contractions, followed by ventricular fibrillations. This argument was later supported by the stable medical condition reached by transcutaneous cardiac pacing. According to this result, the decision was made to implant a dual-chamber cardioverter - defibrillator as a non-standard treatment option, which turned out to be very successful. According to recent data, implanting permanent dual-chamber cardioverter-defibrillators as a preventive step for ventricular fibrillation has not been reported yet.Item Obstacles in the Development of Nonprofit Hospitals in Georgia(Taylor & Francis Group, 2019) Verulava, Tengiz; Lordkipanidze, Ana; Besiashvili, Nino; Todria, Mirian; Lobjanidze, Zviad; Jorbenadze, Revaz; Eliava, EkaterineThe most common form of ownership of medical establishments worldwide is a nonprofit organization. In contrast, the number of nonprofit medical institutions in Georgia is very scarce, while private profit organizations hold about 90% of the medical market. The goal of the research is to study the factors that affect the development of nonprofit hospitals in Georgia. Since there are very few nonprofit medial institutions in Georgia, we hypothesize that there is not enough motivation for functioning of such institutions. For the purposes of this research, six in-depth interviews were conducted with managers and experts of nonprofit organizations. As the research demonstrated, there is no sufficient motivation for functioning of the nonprofit form of medical organizations. Although the Tax Code provides tax benefits, they exist only in a token way and do not support the development of nonprofit medical organizations. It is necessary to improve the tax benefits provided for nonprofit hospitals in the Tax Code and share the world experience in order to increase number of nonprofit organizations in Georgia. It is recommended for Government to give more support to nonprofit organizations, in order to increase their functioning efficiency and bring incentive for development of new nonprofit medical institutions.Item Patients’ perceptions about access to health care and referrals to family physicians in Georgia(Balkan Medical Union, 2020) Verulava, Tengiz; Jorbenadze, Revaz; Karimi, LeilaIntroduction: Adequate utilization of primary health care directly reflects the health status of a population. In the Republic of Georgia many patients seek care without a referral by a primary-care provider; as a result, patient’s referral rate to a family physician is low. The tendency of patient’s self-referral behavior may reduce the effectiveness of the healthcare system. The objective of the study. The research aims to study the cause of low referral rate to a family physician in Georgia. Material and methods. An analytic cross-sectional study was conducted. Within the quantitative survey 300 patients and within the qualitative research 20 family physicians from different cities and regions of Georgia were interviewed. Results: Patient’s referral rate to a family physician was low. 55% of family physicians revealed that patients had often addressed them only for the referral to specialists. 42% of patients visited the family physician once or did not visit at all and 57% did not consult with a family physician for preventive purpose. Conclusion: The result suggested that patient’s low referral rate was due to distrust towards family physicians, which was related to the lack of qualification of physicians and the low public awareness of the family doctor’s competence. Due to an inadequate reimbursement, family physicians do not have enough motivation to provide adequate service and lack of continuous education negatively affects their professional development. It is recommended to raise public awareness about the primary care, to introduce effective methods for payment of family doctors, to increase the role and affordability of continuous professional education.Item Primary care gatekeeping and referrals: patient’s view on the family physician role(Ivane Javakhishvili Tbilisi State University Press, 2020) Verulava, Tengiz; Jorbenadze, RevazAn adequate primary healthcare system substantially determines quality of population health and effective spending of healthcare resources. The family physician serving as a ‘gatekeeper’ can make judicious decisions about the appropriate use of medical services. The goal of this study was to find out patients’ characteristics, preferences and behavior in regards to the role of the family physician as the gatekeeper in The Republic of Georgia. As part of a cross-sectional quantitative study, respondents were interviewed using a structured questionnaire. Majority of the respondents (53.7%, n=245) had a permanent family physician, but were not satisfied with a level of family physician’s professionalism (56.6%, n=258) and preferred self-referral to specialists (55%, n=253). Only 19.5% (n=89) referred to specialists upon family physician’s advice who would coordinate all services and 23% (n=103) have used both family physicians and self-referral. Private health insurance companies were more interested in implementing cost reducing mechanisms rather than the Social Service Agency (which is responsible for Universal Health Care Program). Study results demonstrated that attitudes of different demographic groups of population towards the ways of referral to specialists differ from each other. A certain part of patients preferred referring to family physicians who would coordinate all required medical services and be a sole agent protecting their interests. The study demonstrated that beneficiaries of the private health insurance prefer referring to specialists through their family physicians. It is due to the fact that private health insurance companies were more concerned with establishing cost reduction mechanisms rather than the beneficiaries of UHCP. Such a mechanism implies increasing a role of family physicians, i.e. the gatekeepers of the healthcare system. The model of gatekeeper has more benefits in regards to response to the patient’s needs, improvement of the medical service coordination and cost reduction. Such approach fits the key primary health values more, it accentuates the key role of family physicians in the process of treatment and the importance of confidence in the patient- physician relationship as well as responsiveness to the individual patient needs. In order to widely implement the gatekeeper model within the UHCP, each beneficiary should have a permanent family physician who would ensure continuous and comprehensive medical service provision. It is advisable to raise the level of skills of family physicians, to develop a continuous medical education, as the highly skilled physicians will enjoy more confidence among patients that in turn will increase the rate of referral to them. According to our study some beneficiaries preferred their family physician to co-ordinate their care and referral to specialists when needed, while others preferred self-referral. Therefore, implementing a flexible voluntary model of gatekeepers may be a recommended policy. The flexible voluntary model of gatekeepers means that the UHCP should explicitly offer all options and encourage their members to choose the option which fits their preferences: self-referral, gatekeeping or coordinated care with self-referral. A voluntary choice of the gatekeeper model is acceptable both for physicians and for patients since it has no negative effect on the relations between physicians and patients, plus it is responsive to patients’ needs. It can be assumed that implementing gatekeeping voluntarily will be acceptable to physicians, because a possible detrimental effect on patient relations, will not exist in a voluntary model. Furthermore, a voluntary choice increases even more a responsibility of the family physician as he/she ensures provision of comprehensive medical services, including having control over the course of treatment.Item Readmission after hospitalization for heart failure in elderly patients in Chapidze Emergency Cardiology Center, Georgia(Emerald Publishing, 2021) Verulava, Tengiz; Jorbenadze, Revaz; Lordkipanidze, Ana; Ghonghadze, Ana; Tsverava, Michael; Donjashvili, MananaPurpose: Heart Failure (HF) is one of the leading mortality causes in elderly people. The goal of our study is the assessment of readmission in elderly patients with HF. Methodology: We explored medical records of elderly patients with HF (75 years and more) at Chapidze Emergency Cardiology Center (Georgia) within 2015-2019 years. We analyzed the structure of the cardiovascular diseases and readmission rates of hospitalized patients with HF (I50, I50.0 I50.1). A multivariate logistic regression model was used to identify factors, associated with readmission for any reason during 6-9 months after the initial hospitalization for HF. Findigs: The major complication of cardiovascular diseases in elderly patients is Heart Failure (68.6%). Hospitalization rates due to the HF in elderly patients were increased during the past years, which is associated with the population aging process. This trend will be most likely continued during the next years. Despite significant improvements in the HF treatment, readmission rates are still high. HF is the most commonly revealed cause of readmission (48% of all readmissions). 6-9 months after the primary hospitalization due to HF, readmission for any reason was 60%. Patients had concomitant diseases including hypertension (43%), myocardial infarction (14%), diabetes (36%), and stroke (8%), affecting the readmission rate. Originality/value: HF remains an important problem in Public Health. During HF associated hospitalization both cardiac and non-cardiac conditions should be addressed, which has the potential for health problems and disease progression. Some readmissions may be prevented by the proper selection of medicines and monitoring.Item The Role of Social Workers in Pediatric Oncology(Archives of the Balkan Medical Union, 2019) Verulava, Tengiz; Asatiani, Tinatin; Jorbenadze, Revaz; Dangadze, BekaIntroduction. In the past years, the role of social workers in the oncological disease treatment processes has significantly increased. The role implies supporting patient’s psychosocial conditions. This study aims at studying psycho-social challenges of oncological children and their families and defining a role of social work in this area. Methods. As part of a qualitative study, five interviews were conducted with pediatric oncologists, also 15 in-depth interviews with family members of oncological patients and a focus group with 8 members. For the quantitative study, 62 beneficiaries and 12 medical specialists were interviewed. Results. The children with oncology conditions and their families faced psycho-social challenges and were in need of social workers’ support in overcoming those challenges. The study demonstrated a low level of public awareness. There is a lack of information among both doctors and beneficiaries. Both psychologists and social workers are involved in re-socialization of oncological children and they care for the improvement of children’s quality of life and support their families. However, there are only a few of such organizations. Therefore, many people who need their support have no chance to take such services. Conclusion. Implementing the social work in the pediatric oncology will be a major step toward the medical quality standards.Item Socialization among the rural-to-urban migrant students in Georgia(Youth Voice Journal, 2019) Verulava, Tengiz; Kapanadze, Nino; Chilingarashvili, Sophiko; Panchulidze, Tamar; Kachkachishvili, Iago; Jorbenadze, Revaz; Dangadze, BekaPurpose. Difficulties and stress associated with cultural adjustment are significant issues affecting the life experience of the rural-to-urban migrant students. They may experience problems such as culture shock, psycho-social difficulties and interpersonal conflicts, which may negatively affect migrant students’ socialization. The goal of this research was to identify socialization and adaptation related problems that migrant students encounter. Design/methodology/approach. In the framework of qualitative research method, the focus groups were identified and studied. Findings. Majority of students had difficulties adapting to the urban environment. They felt uncomfortable in urban noise, traffic jams and crowded streets. For the majority of students living conditions worsened after arriving to the capital city. Because of the lack of free time, most of the migrant students could visit their families only on holidays. Some of them felt discriminated because of their language accent, taste and style. Most students plan to return to their home region and use experience and knowledge gained in urban places. However, some students do not plan to return because they don’t see any career prospects back home. Recommendations. It is recommended to develop specific types of interventions that will target the unique needs of rural-to-urban migrant students. Training and educational programs can be done to increase students’ awareness of available services. In addition, creating a more flexible and tailored environment, where students can actively engage in various activities in order to increase the quality of their socialization, will be beneficial.