Primary health care (POZ)

Primary health care (polish “Podstawowa Opieka Zdrowotna”, shortened to “POZ”) is universally available and the most important part of the health care system. Services at POZ are provided to people who have selected a Primacy Care doctor, nurse and/or midwife.

They are usually carried out on an outpatient basis (in an office or clinic), but in medically justified cases, also at the patient’s home or at social welfare centers.

Services are provided on weekdays, from Monday to Friday, between 8.00 a.m. and 6.00 p.m., excluding public holidays. POZ branches may admit patients for shorter period, provided that patients have access to the main clinic during this time.

 

Choosing a Primary Care doctor, nurse, midwife

In order to have access to primary health care advice the patient should choose a doctor, nurse and / or midwife. The patient has the right to free choice of primary health care no more than twice a year. The selection or change is made directly at the service provider in the clinic and does not need to be confirmed at the Fund’s division.

For each subsequent change, a fee of 80 PLN must be paid. The fee should be paid to the account of the appropriate division of the National Health Fund.

No fees are charged in case of:

  • change of the patient’s place of residence;
  • cessation of providing healthcare services by selected primary care doctor/ nurse / midwife;
  • and also for other reasons beyond the control of the patient.

The choice is made on one’s own behalf. On behalf of another person, declarations may be made by adult guardians or legal guardians of minor children or other persons for whom a guardian has been appointed.The declaration of choice is made to a specific person providing services: by name to a doctor, nurse or midwife. A patient may submit a declaration to a doctor in one place and to a nurse or midwife in another, but the practical consequences of such a choice should be considered.

During a stay away from home, e.g. on vacation, on a business trip, with family, the patient has the right to basic health care in the event of a sudden illness or sudden deterioration in health.

The scope of activities of a Primacy Care doctor

Directing for laboratory tests.

The list of diagnostic tests that patient doesn’t have to pay for is strictly defined. All tests are performed at the request of a doctor. If Primacy Care doctor deems it is necessary to perform them, the doctor directs the patient to a laboratory where tests will be performed. In a medically justified case, material for laboratory tests may be collected at the patient’s home.

Directing for diagnostic tests

In medically justified cases, the Primacy Care doctor may refer the patient for diagnostic tests, such as gastroscopy and colonoscopy.

Referring to a specialist doctor or to a hospital.

A Primacy Care doctor referring the patient to a specialist doctor or to the hospital is obliged to perform and add  the results of the necessary diagnostic tests to the referral in accordance with the diagnosed disease, current medical knowledge and practice, in order to confirm the initial diagnosis.

Writing prescriptions as recommended by a specialist doctor.

The Primacy Care doctor may issue a prescription for drugs that were used by a doctor in a specialist clinic, if he receives information about the diagnosis, treatment method, prognosis, prescribed drugs (including the period of their use and dosage) and scheduled follow-up visits, issued by a specialist doctor.

Directing for treatments in the treatment room and at the patient’s home.

In the treatment room, treatments and procedures are performed that are within the competence of a Primacy Care doctor and require their participation, and are directly related to the medical advice provided by him.

In a situation justified by the patient’s health condition, treatments may also be performed at the patient’s home.

Referring for rehabilitation.

The Primacy Care doctor may refer the patient to physiotherapeutic procedures performed at the rehabilitation clinic or at the patient’s home. The exceptions are referrals to physiotherapeutic procedures related to the treatment of postural defects and motor organ dysfunction caused by these defects. In such cases, the primary care physician issues a referral to a rehabilitation clinic or orthopedic clinic.

A referral for physiotherapeutic procedures must be registered in the appropriate facility within 30 days from the date of issue, otherwise it will lose its validity. The Primacy Care doctor is obliged to inform the patient about the need to register the referral within the required time.

With regard to school children and adolescents, in cases not eligible for therapeutic rehabilitation, the family doctor sends the child to corrective and compensatory classes organized in schools and financed from public funds on the basis of separate regulations. The Primacy Care doctor may refer the patient to systemic rehabilitation carried out in a rehabilitation day center / ward.

Referring to spa treatment

When issuing a referral for spa treatment, the Primacy Care doctor takes into account the patient’s current health condition, indications and possibly contraindications. The referral is sent to the branch of NFZ (National Health Fund).

The doctor attaches to the referral the current results of basic tests performed at his request and at his own expense:

Examinations for adults:

  • ESR (Erythrocyte Sedimentation Rate)
  • morphology
  • urine,
  • Chest X-ray (validity of the X-ray examination is 2 years from the date of the examination),
  • ECG (validity of the test is 6 months from the date of the test)
  • and a certificate confirming the primary diagnosis being the basis for issuing the referral.

Examinations for kids:

  • ESR (Erythrocyte Sedimentation Rate)
  • morphology
  • urine,
  • stool examination for parasite eggs (valid on the day the child leaves the spa)

The referral is valid for 12 months from the date of issue. If the treatment could not be started within this period, the referral is send back to the referring physician for verification. The branch of the Fund shall also notify the patient in writing about the expiry of the referral validity.

 Diagnostic tests POZ

Medical laboratory diagnostics tests or imaging and non-imaging diagnostics related to the provision of services by a Primacy Care doctor.

Hematological research

  • peripheral blood count with platelets,
  • peripheral blood count with percentage formula and platelets,
  • reticulocytes,
  • ESR (Erythrocyte Sedimentation Rate).

Biochemical and immunochemical tests:

  • sodium,
  • potassium,
  • ionized calcium,
  • iron,
  • total iron-binding capacity (TIBC),
  • transferrin,
  • glycated hemoglobin (HbA1c),
  • urea,
  • creatinine,
  • glucose,
  • glucose tolerance test,
  • total protein,
  • gel electrophoresis of proteins,
  • albumin,
  • c-reactive protein (CRP),
  • uric acid,
  • total cholesterol,
  • cholesterol-HDL,
  • cholesterol-LDL,
  • triglycerides (TG),
  • total bilirubin,
  • direct bilirubin,
  • alkaline phosphatase (ALP),
  • aspartate aminotransferase (AST),
  • alanine aminotransferase (ALT),
  • gamma-glutamyltranspeptidase(GGTP),
  • amylase,
  • creatine kinase (CK),
  • total acid phosphatase (ACP),
  • rheumatoid factor (RF),
  • Antistreptolysin O titer (ASO),
  • thyroid stimulating hormone (TSH),
  • antigen HBs-AgHBs,
  • VDRL,
  • FT3,
  • FT4,
  • PSA (Positive prostate-specific antigen).

Urine test:

  • general urine examination with assessment of physical and chemical properties and microscopic evaluation of sediment,
  • quantitative determination of protein,
  • quantitative determination of glucose,
  • quantitative determination of calcium,
  • quantitative determination of amylase.

Stool tests:

  • general examination,
  • parasites,
  • occult blood (by immunochemical method).

Coagulation tests:

  • prothrombin index (INR),
  • kaolin-cephalin clotting time (APTT),
  • fibrinogen.

Microbiological testing:

  • urine culture with an antibiogram,
  • throat swab culture with antibiogram,
  • stool culture for Salmonella and Shigella.

Electrocardiographic examination

  • (ECG) at rest.

Ultrasound (US) diagnosis:

  • Ultrasound of the thyroid and parathyroid glands,
  • Ultrasound of the salivary glands,
  • Ultrasound of the kidneys, ureters and bladder,
  • Ultrasound of the abdomen and retroperitoneal space, including the initial assessment of the prostate gland,
  • Ultrasound of peripheral lymph nodes.

Spirometry.

Radiological imaging:

  • chest imagining in AP and lateral projection,
  • bone scan – in the case of the spine; limbs and pelvis in AP and lateral projection,
  • skull imaging,
  • sinuses imagining,
  • plain abdominal.

Primary care doctor can issue a referral for endoscopic examination:

  • gastroscopy,
  • colonoscopy.

Night and holiday health care

POZ duty hours – in the evening, at night and on public holidays

After 6.00 p.m. to 8.00 a.m. on the following day (24 hours a day on public holidays), the patient may benefit from medical and nursing care as part of night and holiday health care.

Since March 2011, services are provided in an outpatient clinic appropriate for the patient’s place of residence, but the patient may use the services of another facility.Information on where in a given region is provided night and holiday medical and nursing care, can be obtained by the patient from his Primacy Care doctor or in the proper voivodeship branch of the National Health Fund.

List of night and holiday health care facilities for the voivodeship Mazowsze (XLS file)

The doctor on duty at the clinic gives advice::

  • on an outpatient basis,
  • by phone,
  • in medically justified cases – at the patient’s home

The patient may benefit from this form of healthcare in the case of:

  • sudden illness,
  • sudden health deterioration, when there are no symptoms suggesting a direct threat to life or significant damage to health, and the applied home remedies or over-the-counter medications did not bring the expected improvement,
  • when there is a suspicion that waiting for the clinic to open may have a significant adverse effect on his health.

Using the POZ benefits at night and on holidays is justified, among others, by:

  • exacerbation of the symptoms of a known chronic disease (e.g. another attack of bronchial asthma with moderate dyspnoea)
  • respiratory tract infection with high fever (higher than 39°C), especially among young children and the elderly,
  • abdominal pain that persists despite the use of antispasmodics,
  • headaches that persist despite the use of painkillers,
  • diarrhea or vomiting, especially amoung children or the elderly
  • wind, stool or urine retention
  • sudden pain in the lower back, spine, joints, limbs, etc.,
  • mental disorders (with the exception of aggression or a suicide attempt – then an ambulance should be called).

Patients are also entitled to nursing treatments as part of the advice provided by the physician on duty at the POZ and treatments resulting from the continuity of treatment. These procedures can be performed by a nurse in the treatment room or at the patient’s home.

As part of night and holiday medical care it is not possible to obtain:

  • a follow-up visit due to previously started treatment,
  • prescriptions for constantly used drugs in connection with a chronic disease,
  • routine declaration of good health,
  • referral to a specialist.

Medical Center of the Medical University of Warsaw provides night and holiday health care under the National Health Fund for the following districts:

WARSZAWA – WILANÓW
ul. Wiertnicza 81, 02-952 Warszawa
tel.: (22) 250 28 01

WARSZAWA – URSUS
pl. Czerwca 1976r. 1, 02-495 Warszawa – Ursus
tel.: (22) 250 28 01

The phone of the Night and Christmas Healthcare is picked up:

  • Monday-Friday from 6.00 p.m. to 8.00 a.m.
  • on non-working days and public holidays around the clock