A new form of family practices was introduced in 2011 through a pilot project introducing nurse practitioners as members of team and determining a set of quality indicators. The aim of this article ...was to assess the quality of diabetes and hypertension management.
We included all family medicine practices that were participating in the project in December 2015 (N=584). The following data were extracted from automatic electronic reports on quality indicators: gender and specialisation of the family physician, status (public servant/self-contracted), duration of participation in the project, region of Slovenia, the number of inhabitants covered by a family medicine practice, the name of IT provider, and levels of selected quality indicators.
Out of 584 family medicine practices that were included in this project at the end of 2015, 568 (97.3%) had complete data and could be included in this analysis. The highest values were observed for structure quality indicator (list of diabetics) and the lowest for process and outcome quality indicators. The values of the selected quality indicators were independently associated with the duration of participation in the project, some regions of Slovenia where practices were located, and some IT providers of the practices.
First, the analysis of data on quality indicators for diabetes and hypertension in this primary care project pointed out the problems which are currently preventing higher quality of chronic patient management at the primary health care level.
Cinemeducation is a teaching method where popular movies or movie clips are used. We aimed to determine whether family physicians' competencies as listed in the Educational Agenda produced by the ...European Academy of Teachers in General Practice/Family Medicine (EURACT) can be found in movies, and to propose a template for teaching by these movies.
A group of family medicine teachers provided a list of movies that they would use in cinemeducation. The movies were categorised according to the key family medicine competencies, thus creating a framework of competences, covered by different movies. These key competencies are Primary care management, Personcentred care, Specific problem-solving skills, Comprehensive approach, Community orientation, and Holistic approach.
The list consisted of 17 movies. Nine covered primary care management. Person-centred care was covered in 13 movies. Eight movies covered specific problem-solving skills. Comprehensive approach was covered in five movies. Five movies covered community orientation. Holistic approach was covered in five movies.
All key family medicine competencies listed in the Educational Agenda can be taught using movies. Our results can serve as a template for teachers on how to use any appropriate movies in family medicine education.
Therapeutic alliance is a term most commonly associated with psychotherapeutic treatment, but recently its use has become increasingly significant in the other fields of medicine. An increasing ...amount of evidence implies that the quality of the therapeutic alliance between the doctor and patient substantially affects treatment outcomes. A European consensus chose the Working Alliance Inventory - Short Revised (WAI-SR) scale as the most efficient for European primary care. This paper presents the process of establishing the semantic and cultural equivalence of the two WAI-SR scales in Slovene.
As a part of a larger international project, a group of four experts translated the two WAI SR scales (physician and patient versions) from English into Slovene. Twenty-six Slovenian family medicine doctors participated in the process of obtaining semantic, idiomatic, experiential and conceptual equivalence in translation using a Delphi consensus procedure. Afterward, a cultural equivalence was made to adapt the translations within the national context.
Agreement on translation was achieved after two Delphi rounds. The back-translation and cultural equivalence were accomplished without major problems, with some minor additional linguistic corrections.
A Slovene version of the WAI-SR scale was successfully adapted and is available for further scale validation and research on therapeutic alliance.
Uvod. V Sloveniji ima zdravnik družinske medicine pomembno vlogo pri izvajanju preventive. Delež cepljenih proti gripi je v Sloveniji nizek. Razlogi za to niso povsem jasni. Preučevali smo mnenje ...bolnikov glede cepljenja proti gripi pri njihovem družinskem zdravniku ter njihova stališča in prepričanja o gripi in cepljenju. Cilj naloge je bil odkriti dejavnike, ki vplivajo na odločitev o cepljenju v ambulanti družinske medicine.
There is a dearth of published literature on the organisation of family medicine/general practice undergraduate teaching in the former Yugoslavia.
A semi-structured questionnaire was sent to the ...addresses of 19 medical schools in the region. Questions covered the structure of Departments of Family Medicine (DFM), organisation of teaching, assessment of students and their involvement in departmental activities.
Thirteen medical schools responded, of which twelve have a formal DFM. Few DFM have full-time staff, with most relying upon external collaborators. Nine of 13 medical schools have family doctors teaching other subjects, covering an average of 2.4 years of the medical curriculum (range: 1-5). The total number of hours dedicated to teaching ranged from 30 - 420 (Md 180). Practice-based teaching prevails, which is conducted both in city and rural practices in over half of the respondent schools. Written exams are conducted at all but two medical schools, with the written grade contributing between 30 and 75 percent (Md=40%) of the total score. Nine medical schools have a formal method of practical skills assessment, five of which use Objective Structured Clinical Examinations. Student participation is actively sought at all but three medical schools, mainly through research.
Most medical schools of the former Yugoslavia recognise the importance of family medicine in undergraduate education, although considerable variations exist in the organisation of teaching. Where DFM do not exist, we hope our study will provide evidence to support their establishment and the employment of more GPs by medical schools.
Background: Primary health care has undergone great changes as a consequence of demographic changes, growing patients’ awareness and organizational changes in the healthcare system. Declining ...interest in family medicine specialization further worsens the situation. In the period of lack of GPs and their overloading, it is necessary to include a diploma graduate nurse in the team of GPs and to define competencies and activities in such a way that encourage more active approach to the patients, meeting the indicators of quality.The purpose of the article is to describe the project of model practice in Slovenia and to present some results.Methods: A model practice introduces a new concept in the areas of human resource standards (to existing team, a diploma graduate nurse is included on a part-time basis); work competences (use of protocols for the treatment of chronic patients, extended and well-defined preventive screenings, establishing registers of chronic patients and assessing quality by means of quality indicators) and work management (redistribution of workload ).Results: Due to great interest of general practitioners, a total of 271 model practices were introduced in 2011 and 2012. MPs have been distributed evenly through different regions inSlovenia. Registers of patients with chronic diseases (COPD, asthma and diabetes) have been established and during the preventive screening, on average 2 patients with a chronic disease and 15 patients with risk factors have been detected. Patients are treated actively according to their needs rather than their preferences.Conclusions: The project of MPs enables a high quality and cost effectiveness of patients’ treatment in family medicine. With a gradual introducing of new MPs, a well planed and monitored patients’ care will be implemented in the practice. In a long run, disburdening of a secondary care level and more rational consumption of drugs are expected
Medically unexplained symptoms (MUS) are very common in family medicine, despite being a poorly-defined clinical entity. This study aimed to evaluate the effect of an educational intervention (EI) on ...self-rated quality of life, treatment satisfaction, and the family physician-patient relationship in patients with MUS.
In a multi-centre longitudinal intervention study, which was performed between 2012 and 2014, patients were asked to rate their quality of life, assess their depression, anxiety, stress and somatisation, complete the Hypochondriasis Index, the Medical Interview Satisfaction Scale and the Patient Enablement Instrument for assessing the physician-patient relationship, before and after the EI.
The mean values before and after the intervention showed that after the EI, patients with MUS gave a lower (total) mean rating of their health issues and a higher rating of their quality of life, and they also had a more positive opinion of their relationship with the physician (p<0.05). However, there were no differences in the (total) rating of treatment satisfaction before and after the EI (p=0.423). Significant differences in the symptoms in patients with MUS before and after the intervention were confirmed for stress, somatisation and hypochondriasis (p<0.05).
It could be beneficial to equip family physicians with the knowledge, skills and tools to reduce hypochondriasis and somatisation in MUS patients, which would improve patients' self-rated health status.
Objectives. In Slovenia, the role of family physicians in primary care and preventive procedures is very important. Influenza vaccination rates in Slovenia are low. The reasons for low vaccination ...rates in Slovenia were not clear. We suppose that patient’s beliefs and attitudes are important factors. We assessed patients’ opinions regarding the acceptance of flu vaccination by their family physicians and their beliefs and attitudes about flu and vaccination. The aim was to check out factors that influence the decision to take the vaccine in family physician offices.
Methods. This was a cross-sectional, multicenter, observational study in the Styria region in Slovenia. We included patients from seven family physicians during regular office visits. They filled in a questionnaire about their general demographic data and attitudes regarding influenza and vaccination. The main outcome was the decision to be vaccinated.
Results. The logistic regression model identified five predictors for influenza vaccination, namely: heart disease, previous vaccination, an agreement with the beliefs ‘the vaccination is an efficient measure to prevent influenza’, ‘after the vaccination there are usually no important side effects’ and ‘the vaccination is also recommended for a healthy adult person’. The belief that vaccinations harm the immune system is negatively associated with vaccination.
Conclusions. Patients’ beliefs are an important factor to decide for vaccination or not. Family physician teams should discuss with patients their beliefs and concerns about vaccination.
Uvod. V Sloveniji ima zdravnik družinske medicine pomembno vlogo pri izvajanju preventive. Delež cepljenih proti gripi je v Sloveniji nizek. Razlogi za to niso povsem jasni. Preučevali smo mnenje bolnikov glede cepljenja proti gripi pri njihovem družinskem zdravniku ter njihova stališča in prepričanja o gripi in cepljenju. Cilj naloge je bil odkriti dejavnike, ki vplivajo na odločitev o cepljenju v ambulanti družinske medicine.
Metode. Raziskava je bila presečna multicentrična opazovalna. Vključili smo bolnike iz 7 ambulant družinske medicine na Štajerskem v Sloveniji. Vzorec je zajemal bolnike, ki so prišli v ambulanto. Izpolnili so vprašalnik z demografskimi podatki ter stališči o gripi in cepljenju. Glavni opazovani dogodek je bil odločitev za cepljenje.
Rezultati. V logističnem regresijskem modelu so bili najpomembnejši napovedni dejavniki odločitve za cepljenje srčna bolezen, cepljenje v preteklosti, strinjanje, da je cepljenje najbolj učinkovit ukrep proti gripi, strinjanje, da cepljenje običajno nima pomembnih stranskih učinkov, in strinjanje, da je cepljenje priporočljivo tudi za odraslo zdravo osebo. Prepričanje, da cepljenje škodi imunskemu sistemu, je negativni napovedni dejavnik odločitve za cepljenje.
Zaključki. Stališča bolnikov so pomemben dejavnik pri odločitvi za cepljenje. V ambulantah družinske medicine bi se morali z bolniki več pogovarjati o njihovih stališčih in pomislekih o cepljenju.
Izhodišča: Samoocena zdravja predstavlja bolnikov občutek lastnega zdravja; vključuje biološke, sociološke in psihološke dejavnike. Pogosto se uporablja v populacijskih raziskavah, osebni zdravnik pa ...lahko z njeno pomočjo pridobi dodatne informacije o bolniku in njegovih potrebah.
Aim: To perform a cross-cultural adaptation of the Quality Improvement Competency Self Assessment (QICS) questionnaire for family physicians into the Slovenian language and to validate it in a ...representative sample of Slovenian FPs.
This cross-sectional observational postal survey was conducted in a random sample of 398 Slovenian FPs. We used the QICS questionnaire that was developed on the basis of the new Quality Improvement Competency Framework for family medicine. The QICS questionnaire consists of 37 items included in six domains. The questions can be answered on a five-point Likert scale. The validity of the translation was provided by the backward translation from Slovenian to the English language and by the reference group consisting of experienced FPs in the consensus process. The reliability of the questionnaire was assessed by Cronbach’s alpha coefficient and Spearman rho to determine the test-retest reliability (the questionnaire was sent to the physicians in the sample twice in a period of two weeks).
The final sample consisted of 100 (25.1%) family physicians, out of which 71 (71.0%) were women. Mean age of the sample was 43.3 ± 9.6 years. Mean score of the QICS questionnaire was 127.0 ± 30.1 points (first round) and 127.8 ± 30.6 points (second round). Cronbach’s alpha scores were 0.984 (first round) and 0.988 (second round). Spearman’s rho for the summary score of the whole scale was 0.829 with p < 0.001.
The Slovenian version of the QICS questionnaire proved to be a valid and reliable tool for selfassessment of quality improvement competencies by FPs in terms of continuous professional development.
Namen: Izvesti medkulturno prilagoditev vprašalnika o samoocenjevanju kompetenc zdravnika družinske medicina na področju izboljševanju kakovosti (vprašalnik QICS) in ga validirati na reprezentativnem vzorcu slovenskih zdravnikov družinske medicine.
Ta presečna opazovalna raziskava je bila izvedena v naključnem vzorcu 398 slovenskih zdravnikov družinske medicine. Uporabili smo vprašalnik QICS, ki je bil razvit na podlagi novega teoretičnega okvira izboljševanja kakovosti v družinski medicini. Vprašalnik QICS je sestavljen iz 37 vprašanj, vključenih v šest področij. Na vprašanja je mogoče odgovoriti po petstopenjski Likertovi lestvici. Veljavnost prevoda je bila zagotovljena z dvosmernim prevodom in s pomočjo referenčne skupine, ki so jo sestavljali izkušeni zdravniki družinske medicine. Zanesljivost vprašalnika smo ocenjevali s pomočjo koeficienta Cronbach alfa in koeficienta Spearman rho za ugotavljanje časovne stabilnosti (vprašalnik je bil poslan zdravnikom v vzorcu dvakrat v razmiku dveh tednov).
Končni vzorec je bil sestavljen iz 100 (25,1 %) zdravnikov družinske medicine, od katerih je bilo 71 (71,0 %) žensk. Povprečna starost vzorca je bila 43,3 ± 9,6 leta. Povprečno število točk na vprašalniku QICS je bilo 127,0 ± 30,1 (prvo pošiljanje) in 127,8 ± 30,6 (drugo pošiljanje). Cronbach alfa je bil 0,984 (prvo pošiljanje) in 0,988 (drugo pošiljanje). Spearman rho je bil 0,829 s p < 0,001.
Slovenska različica vprašalnika QICS je zanesljivo in veljavno orodje za samooceno kompetenc zdravnikov družinske medicine na področju izboljševanja kakovosti v sklopu stalnega podiplomskega izobraževanja oz. stalnega strokovnega dograjevanja.
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