Dr. Erion Hamiti has been a family doctor at the Gjyrale Health Post, Gostimë Health Centre, Elbasan, since 2008. For over a year, Dr. Hamiti has also been covering the Shtëpanjë Health Post, providing healthcare services to a total of 5,765 citizens. In addition to his professional responsibilities, he is a volunteer with the Red Cross in Elbasan and a regular blood donor. As a facilitator, Dr. Hamiti has supported the establishment of Peer Groups for managing non-communicable diseases and elderly care. In this interview, he shares his experience on the role of trainings conducted with the support of HAP in improving daily clinical practice and achieving better health outcomes for patients.
How valuable do you think the training on implementing NCD protocols has been? How has this training impacted clinical practice and patient care?
This training has been one of the most unique and beneficial ones we’ve had on topics we frequently encounter in our daily practice. With many patients suffering from non-communicable diseases such as hypertension, dyslipidemia, diabetes, asthma, and COPD, this training has helped us, as healthcare personnel, improve our work. How valuable has it been? For us, it has been extremely valuable as we now examine our patients with greater attention, starting with the use of clinical decision-making tools/forms that provide more detailed information and focus our work on the key aspects of these diseases. Screening and prevention efforts for these illnesses have also improved. The care we provide to patients is now better because treatment and counselling, based on the new protocols, have improved. We now refer fewer patients to specialists because, with the help of the protocols and manuals, we can provide the necessary advice ourselves.
What challenges do you foresee in implementing these protocols in daily work?
One of the main challenges lies in preventing non-communicable diseases through counselling and educating patients to change behaviours and lifestyles. For example, smoking cessation. Smoking significantly contributes to atherosclerosis, COPD, and the worsening of asthma. When we advise patients to quit smoking due to its consequences on their condition, many find it difficult to accept. Some patients have even said, “I’d rather leave my wife than quit smoking.”
Another challenge is modifying patients’ therapies, especially for those accustomed to taking the same medication regimen for a long time. When we inform these patients that new protocols recommend changes in medication use or dosage, they often resist, creating a “conflict” between the specialist doctor and the family doctor trying to implement these protocols. How can this be resolved?
The solution would involve familiarising specialists with these protocols so that everyone aligns with the same guidelines, improving collaboration between specialists, patients, and family doctors.
How do you plan to engage and educate patients about managing their respective NCDs within the framework of these protocols?
We have increased collaboration with nurses, who primarily handle screening and counselling to prevent and better manage these diseases. Nurses consult with family doctors in specific situations, and as a team, we are becoming more persuasive with patients. Not all patients respond equally to counselling for preventing and managing NCDs, but we do our best and remain patient, believing that we will achieve results over time.
Have you noticed any changes in patients’ health and quality of life after implementing these protocols?
Yes, I have observed specific improvements. For example, two COPD patients with chronic bronchitis were advised to quit smoking. They partially adhered, reduced smoking, and aimed to quit entirely. As a result, their symptoms have eased, and they feel better.
Another COPD patient was advised to discontinue certain inhalers that were no longer indicated per the new protocols. After stopping their use, his diabetes improved significantly. This reduced his medication intake and alleviated diabetes-related complaints. This has greatly contributed to the patient’s well-being. Firstly, it has reduced the amount of medication they need to take, and secondly, they feel better, with complaints related to diabetes having completely disappeared.
In the case of dyslipidemia patients, based on the new protocols, treatment should not be discontinued after normalisation of lipid levels. Previously, patients would stop medication when their lipid levels normalised, only to see them rise again later. Now, patients are advised to continue treatment, resulting in sustained normal lipid levels and improved hypertension and diabetes management.
In summary, this training cycle has been highly beneficial for our daily practice and patients’ quality of life.
Do you think there is room for improvement in this training? In what areas?
I believe it is essential to have training in interpreting electrocardiograms (ECGs), an important tool for family doctors. A family doctor proficient in ECG interpretation could reduce unnecessary specialist referrals and reserve referrals for cases requiring specialist input.
Additionally, it is time for family doctors to start using ultrasound technology, as their counterparts in other European countries do. This would enhance our professional growth and greatly benefit patients, particularly those in rural areas far from city centres. For example, my area is 1.5 hours from Elbasan, the nearest centre for abdominal ultrasounds.
Is there anything else you would like to add?
I would like to take this opportunity to thank HAP for bringing many improvements not only through training but also through equipment, especially for home care. Items like wheelchairs and oxygen concentrators have directly improved the lives of patients who cannot visit healthcare centres. I want to highlight the portable ECG machine that provides interpretations, enabling us to diagnose before referring patients to specialists, not only during home care visits but also in the consultations in the health centre/post.
Previously, our health post had three staff members sharing a single blood pressure monitor. Thanks to HAP, each doctor and nurse now has their own kit. I would also like to mention the neurologic hammer, ophthalmoscope, and otoscope in our kits—essential tools we lacked before. In my 16 years of experience, the cooperation with HAP was the first time we were equipped with a complete set of instruments, allowing us to perform our work even better.