Izhodišča: Večino bolnikov z nezapleteno arterijsko hipertenzijo obravnavamo zdravniki družinske medicine. Namen raziskave je bil ugotoviti, kako poteka obravnava bolnikov z arterijsko hipertenzijo v ...timu družinske medicine v Sloveniji ter oceniti urejenost krvnega tlaka.
Metode: V prospektivni opazovalni raziskavi smo v obdobju od 21. 11. 2017 do 28. 3. 2019 šest mesecev spremljali obravnavo dotlej še nezdravljenih bolnikov z esencialno arterijsko hipertenzijo v 158 ambulantah družinske medicine v Sloveniji. Ob koncu spremljanja smo ocenili urejenost krvnega tlaka (KT).
Rezultati: Vključenih je bilo 1.060 bolnikov, katerih povprečna starost je bila 58,6 ± 12,1 let. Med vključenimi bolniki je bilo 579 (55 %) moških in 481 (45 %) žensk. Povprečna vrednost sistoličnega KT ob vstopu je bila 165,2 ± 14,5 mm Hg, diastoličnega pa 96,2 ± 10,0 mm Hg. 751 bolnikov (70,8 %) je imelo pridružene dejavnike tveganja za bolezni srca in ožilja. 408 (38,5 %) bolnikov je imelo ocenjeno srčno-žilno tveganje kot veliko oz. zelo veliko. Antihipertenzivna zdravila so bila uvedena pri 1.046 (98,7 %) bolnikih; pri 418 bolnikih (39,4 %) je bilo uvedeno kombinacijsko zdravljenje dveh ali več učinkovin v prosti ali fiksni kombinaciji. 331 bolnikov (31,6 %) je med spremljanjem opravilo obisk pri diplomirani medicinski sestri.
Raziskavo je zaključilo 929 (87,6 %) bolnikov. Povprečna vrednost sistoličnega KT ob zaključku raziskave je bila 135,4 ± 10,9 mm Hg, diastoličnega pa 81,8 ± 8,0 mm Hg, ciljni KT je dosegalo 63,3 % bolnikov.
Zaključek: Prepoznali smo nekatere priložnosti za izboljšanje vodenja. V prihodnje bo potrebno še okrepiti timsko obravnavo bolnikov ter spodbujati zdravnike k uvajanju kombinacijskega zdravljenja, najbolje v obliki dveh oziroma treh zdravilnih učinkovin v eni tableti.
A new organisation at the primary level, called model practices, introduces a 0.5 full-time equivalent nurse practitioner as a regular member of the team. Nurse practitioners are in charge of ...registers of chronic patients, and implement an active approach into medical care. Selected quality indicators define the quality of management. The majority of studies confirm the effectiveness of the extended team in the quality of care, which is similar or improved when compared to care performed by the physician alone. The aim of the study is to compare the quality of management of patients with diabetes mellitus type 2 before and after the introduction of model practices.
A cohort retrospective study was based on medical records from three practices. Process quality indicators, such as regularity of HbA1c measurement, blood pressure measurement, foot exam, referral to eye exam, performance of yearly laboratory tests and HbA1c level before and after the introduction of model practices were compared.
The final sample consisted of 132 patients, whose diabetes care was exclusively performed at the primary care level. The process of care has significantly improved after the delivery of model practices. The most outstanding is the increase of foot exam and HbA1c testing. We could not prove better glycaemic control (p>0.1). Nevertheless, the proposed benchmark for the suggested quality process and outcome indicators were mostly exceeded in this cohort.
The introduction of a nurse into the team improves the process quality of care. Benchmarks for quality indicators are obtainable. Better outcomes of care need further confirmation.
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
Uvod. Namen študije je predstaviti projekt Ministrstva za zdravje, referenčne ambulante, ki poteka v Sloveniji, in prikazati rezultate obravnave bolnikov z astmo in KOPB s strani tima, ki je ...dopolnjen in ga sestavljajo zdravnik, diplomirana medicinska sestra in zdravstveni tehnik.
Aim. This study aimed to evaluate a new project of the Slovene Ministry of Health - the Family Medicine Model Practices (MPs) Project in Slovenia, and to show its effectiveness in the management of ...asthma and COPD by family medicine practice teams, consisting of a family physician, a nurse practitioner and a practice nurse.
Methods. A total of 107 family practices with 203122 patients joined the project during the first year of its initiation. The effectiveness of the program in disease management was analysed in two phases according to the registration of family practices. The number of patients registered and the number of asthma and COPD patients (existing and newly detected) by model practice teams were being reported. Descriptive analyses were used to describe the study populations. Prevalence by diseases and phases was established after the initial round of data collection. Chi square (χ
) test was used to analyse the difference between the phases.
Results. The frequency of asthma was 2.12%, while the frequency of COPD was 1.15% throughout the study period. For both diseases, more than 30% of patients were newly diagnosed.
Conclusions. The project of implementing Family Medicine MPs in the area of COPD has given first positive results and the project is still ongoing to its full implementation.
Uvod. Namen študije je predstaviti projekt Ministrstva za zdravje, referenčne ambulante, ki poteka v Sloveniji, in prikazati rezultate obravnave bolnikov z astmo in KOPB s strani tima, ki je dopolnjen in ga sestavljajo zdravnik, diplomirana medicinska sestra in zdravstveni tehnik.
Metode. V prvem letu je bilo v projekt vključenih 107 ambulant z 203.122 opredeljenimi pacienti (glavarina). Uspešnost programa obravnave pacientov je bila analizirana dvofazno, ob prvi in naslednji vključitvi ambulant v projekt. Vse referenčne ambulante so poročale o številu opredeljenih bolnikov (glavarina) in o številu bolnikov z astmo in KOPB (že obstoječih in med presejanjem novo odkritih bolnikov). Deskriptivna analiza je bila uporabljena za opis obravnavane populacije. Prevalenca po boleznih je bila prikazana ločeno v prvi in drugi fazi analize. Test hi-kvadrat je prikazal razlike med obema fazama raziskave.
Rezultati. V opazovanem obdobju je bila pogostnost astme med opazovano populacijo 2,12%, pogostnost KOPB pa 1,15%. Tako med bolniki z astmo kot med bolniki s KOPB je bila bolezen novo odkrita pri več kot 30% bolnikov.
Zaključek. Projekt implementacije referenčnih ambulant, ki je še v razvoju, je na področju obravnave bolnikov s KOPB in astmo pokazal prve pozitivne rezultate.
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