Anticholinergic burden in older adults has been correlated with cognitive decline, delirium, dizziness and confusion, falls and hospitalisations. Nevertheless, anticholinergic-acting medications ...remain commonly prescribed in up to a third of older adults in primary care population. Our aim was to study the anticholinergic burden in older adults in Slovenian ambulatory setting and explore the most commonly involved medications which could be avoided by the physicians.
A cross-sectional study was conducted in 30 general practices in Slovenia as part of a larger trial. Data on prescribed medications were collected for randomly chosen adults of over 65 years of age visiting general practice, who were taking at least one regularly prescribed medication. Anticholinergic burden was calculated using Duran's scale and Drug Burden Index.
Altogether, 622 patients were included, 356 (57.2%) female, average age of 77.2 (±6.2), with an average of 5.6 medications. At least one anticholinergic medication was present in 78 (12.5 %) patients. More than half (N=41, 52.6%) of anticholinergic prescriptions were psychotropic medications. Most common individual medications were diazepam (N=10, 1.6%), quetiapine (N=9, 1.4%) and ranitidine (N=8, 1.3%).
Though the prevalence of anticholinergic medications was low compared to international research, the most commonly registered anticholinergic prescriptions were medications that should be avoided according to guidelines of elderly prescriptions. It would be probably clinically feasible to further decrease the anticholinergic burden of older adults in Slovenian primary care setting by avoiding or replacing these medications with safer alternatives.
Most research on frequent attendance has been cross-sectional and restricted to one year attendance rates. A few longitudinal studies suggest that frequent attendance is self-limiting. Frequent ...attenders are more likely to have social and psychiatric problems, medically unexplained physical symptoms, chronic somatic diseases (especially diabetes) and are prescribed more psychotropic medication and analgesics.
To describe the attendance rates in a longitudinal study and to test if depression, panic syndrome, other anxiety syndrome, alcohol misuse and general quality of life are associated with frequent attendance in next two consecutive years.
1118 consecutive family practice attendees, aged 18 to 75 years from randomly selected family medicine practices were recruited at baseline and followed up at 12 and 24 months. We identified frequent attenders in the top 10 centile within one year. Using a multivariate model, we ascertained if presence of common mental disorders and quality of life assessed at baseline in 2003 predict frequent attendance in 2004 and 2005.
40% of frequent attenders continue to be frequent attenders in the following year and 20% of the frequent attenders were so for the 24 month period. Lower physical scores on the SF-12 questionnaire were strongly associated with future frequent attendance at 12 and 24 months. There was a trend for people with greater than elementary school education to be less likely to become frequent attenders at both 12 and 24 months. For other variables these effects were less consistent. Presence of major depression, panic syndrome, other anxiety syndrome and alcohol misuse were not predictive of frequent attendance in the following two years.
Low physical quality of life is strongly predictive of higher frequent attendance and similar finding was observed for people with lower educational level but further confirmatory research is required to establish this association.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Izhodišča: V času epidemije covida-19 v Sloveniji je bilo potrebno celotni teoretični del pouka družinske medicine izvesti po spletu.
Metode: Pouk družinske medicine smo prilagodili izvedbi preko ...videokonferenčnega sistema. Dodali smo aktualne teme o epidemiji, uvedli redne domače naloge, povečali uporabo spletne učilnice in vzpostavili možnost foruma. Uporabili smo nove metode, na primer predavanje z “obrnjeno učilnico”, problemsko usmerjeno učenje s kliničnimi vinjetami in video-posvet o pouku sporazumevanja. Posebej se je obnesla metoda igrifikacije oz. uvedba kviza v pouk.
Rezultati: Kakovost, prednosti in nevarnosti spletnega pouka smo ocenili z anketo študentov in mnenjem pedagogov. Študenti so ocenili, da je pouk dobro potekal, sodobne metode so jim ugajale, predlagali pa so več kliničnih primerov in predstavitev najpogostejših stanj v družinski medicini. Spletni pouk so ocenili enako visoko kot klinične vaje. Pedagogi so navedli visoko lastno motivacijo in inovativnost pri spremembi pouka, poudarili prednost časovne prilagodljivosti, po drugi strani pa časovno zahtevnost spletnega poučevanja. V prihodnosti bi lahko s pomočjo spletnega poučevanja določen delež študentov opravljal klinične vaje v domačem okolju, s čimer bi potrebovali manj mentorjev v Ljubljani. Spletno poučevanje ponuja možnost učenja modernih veščin zdravnika družinske medicine (npr. videoposvet), aktivacije študentov (npr. igra vlog) ter omogoči ustvarjanje repozitorija učnih gradiv in sodelovanje gostov iz tujine. Slabost pa je odsotnost osebnega stika s študenti ter neustreznost za učenje kliničnih veščin.
Zaključek: Ob takojšnjem prehodu na spletno poučevanje smo preizkusili nove metode pouka, ugotovili nekatere prednosti in pomanjkljivosti. Te izkušnje bodo pomembne za spremembe pouka v naslednjih letih.
Background: Different authors define fatigue in different ways even though it is considered a very common symptom in the primary medical care. Objective: To explore level of fatigue among Slovene ...family physicians and factors contributingto fatigue. Methods: Modified Fatigue Impact Scale was used in our research. The link to the questionnaire website was sent through the mailing list of Medical Chamber of Slovenia, the Family Medicine Union - Praktik.urn, the Family Medicine Association and the Young Physicians. Results: Total amount of 231 physicians answered the questionnaire in full. There were 180 (77.9%) females and 51 (22.1%) males. The average age was 45.3±10.4 years and their capitation amounted to averagely 2245.8±544.2. On average they had spent 13.1111.3 years working as specialists. Women have significant higher levels of fatigue, 57.2% have scored above the threshold of 38 points. Working in the office after working hours at least three times in a week was significantly associated with total fatigue, adding 10.07 points to the score. The years working as a specialist is not an important statistical factor in differentiating fatigue among physicians, nor is the level of patient load. Working irregular hours is also not an important statistical factor. Conclusion: Slovenian family physicians are tired, as they have exceeded the limit given in the literature. Women are more tired, the most characteristic factor that contributes to fatigue is the extension of work in the clinic at least three times a week.
BackgroundDifferent authors define fatigue in different ways even though it is considered a very common symptom in the primary medical care. ObjectiveTo explore level of fatigue among Slovene family ...physicians and factors contributing to fatigue. MethodsModified Fatigue Impact Scale was used in our research. The link to the questionnaire website was sent through the mailing list of Medical Chamber of Slovenia, the Family Medicine Union - Praktik.um, the Family Medicine Association and the Young Physicians. Results231 physicians answered the questionnaire in full. There were 180 (77.9%) females and 51 (22.1%) males. The average age was 45.3±10.4 years and their capitation amounted to averagely 2245.8±544.2. On average they had spent 13.1±11.3 years working as specialists. Women have significant higher levels of fatigue, 57.2% have scored above the threshold of 38 points. Working in the office after working hours at least three times in a week was significantly associated with total fatigue, adding 10.07 points to the score. The years working as a specialist is not an important statistical factor in differentiating fatigue among physicians, nor is the level of patient load. Working irregular hours is also not an important statistical factor. ConclusionSlovenian family physicians are tired, as they have exceeded the limit given in the literature. Women are more tired, the most characteristic factor that contributes to fatigue is the extension of work in the clinic at least three times a week.
Family history (FH) is an important part of the patients' medical history during preventive management at model family medicine practices (MFMP). It currently includes a one (or two) generational ...inquiry, predominately in terms of cardiovascular diseases, arterial hypertension, and diabetes, but not of other diseases with a probable genetic aetiology. Beside family history, no application-based algorithm is available to determine the risk level for specific chronic diseases in Slovenia.
A web application-based algorithm aimed at determining the risk level for selected monogenic and polygenic diseases will be developed. The data will be collected in MFMP; approximately 40 overall with a sample including healthy preventive examination attendees (approximately 1,000). Demographic data, a three-generational FH, a medical history of acquired and congenital risk factors for the selected diseases, and other important clinical factors will be documented.
The results will be validated by a clinical genetic approach based on family pedigrees and the next-generation genetic sequencing method. After the risk of genetic diseases in the Slovenian population has been determined, clinical pathways for acting according to the assessed risk level will be prepared.
By means of a public health tool providing an assessment of family predisposition, a contribution to the effective identification of people at increased risk of the selected monogenic and polygenic diseases is expected, lessening a significant public health burden.
In Slovenia, there is little data available on pneumococcal vaccination rates and no data on asymptomatic NPCR and serotypes in the population of nursing home residents in comparison to the elderly ...living in domestic environment, therefore the goal was to gain these data.
A cross sectional epidemiological study was performed. Nasopharyngeal swabs from 151 nursing home residents, 150 elderly living in domestic environment, and 38 adults less than 65 years old were collected twice (in two consecutive years). The swabs were analysed for pneumococcal identification and serotyping. Patient data were collected from medical files and medical history.
No statistically significant differences in NPCR were seen between compared groups in two consecutive years. An average NPCR in two consecutive years in nursing home residents was 1.45%, in the elderly living in domestic environment 0.85%, and in adults less than 65 years old 7.05%. Serotypes identified among nursing home residents were 6B and 9N, among the group of elderly living in domestic environment, 6A and among adults less than 65 years old, 35F, 18C and 3. Pneumococcal vaccination rates were low (3.3% in nursing home residents, 6% in the elderly from domestic environment and 0% in the group of adults less than 65 years old).
Our data suggests that NPCR and the proportion of people vaccinated with pneumococcal vaccine among the elderly are low. We identified different serotypes in all groups, only one person was a chronic carrier (serotype 35F).
Frequent attendance in family medicine practices is associated with elderly patients and those with chronic diseases. Longstanding frequent attendees have more social and psychiatric problems, ...medically unexplained conditions, and chronic diseases, and are prescribed more psychotropic drugs and analgesics.
To fill the lack of data on the factors associated with frequent attendance at family medicine practices by the elderly.
Forty family physicians (FPs) participated in this cross-sectional study in 2017 and randomly recruited up to 20 of their patients; 624 patients were recruited. From the patients' health records, the FPs collected demographic data, lifestyle factors, all the patients' diagnoses, all the drugs prescribed in the previous 12 months, multi-morbidity (CIRS-G index), the quality of life index (EQ-5D) and the number of visits to the family medicine practice in the previous 12 months. The Self-Rating Depression Scale was administered to the patients. Statistical analysis was carried out using the IBM SPSS 20.0 package, with appropriate non-parametric tests (Mann-Whitney U test, chi-square test) to check significant differences between groups of patients. Multivariate modelling was carried out to evaluate the associations between the number of visits to the FP and independent variables.
The number of prescribed drugs (p=0.026), haematological problems (p=0.005) and genitourinary problems (p=0.001) were associated with frequent attendance. Patients with borderline depression were approximately three times more likely to be frequent attendees than non-depressed patients.
Polypharmacy, haematological and genitourinary problems are associated with frequent attendance in elderly patients. Further longitudinal studies are required to validate our findings.
Prevention of depression must address multiple risk factors. Estimating overall risk across a range of putative risk factors is fundamental to prevention of depression. However, we lack reliable and ...valid methods of risk estimation. This protocol paper introduces PREDICT, an international research study to address this risk estimation.
This is a prospective study in which consecutive general practice attendees in six European countries are recruited and followed up after six and 12 months. Prevalence of depression is assessed at baseline and each follow-up point. Consecutive attendees between April 2003 and September 2004 who were aged 18 to 75 were asked to take part. The possibility of a depressive episode was assessed using the Depression Section of the Composite International Diagnostic Interview. A selection of presumed risk factors was based on our previous work and a systematic review of the literature. It was necessary to evaluate the test-retest reliability of a number of risk factor questions that were developed specifically, or adapted, for the PREDICT study. In a separate reliability study conducted between January and November 2003, consecutive general practice attendees in the six participating European countries completed the risk factor items on two occasions, two weeks apart. The overall response rate at entry to the study was 69%. We exceeded our expected recruitment rate, achieving a total of 10,048 people in all. Reliability coefficients were generally good to excellent.
Response rate to follow-up in all countries was uniformly high, which suggests that prediction will be based on almost a full cohort. The results of our reliability analysis are encouraging and suggest that data collected during the course of PREDICT will have a satisfactory level of stability. The development of a multi-factor risk score for depression will lay the foundation for future research on risk reduction in primary care. Our data will also provide the necessary evidence base on which to develop and evaluate interventions to reduce the prevalence of depression.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Communicating with patients is a basic skill of a family doctor. It includes taking the history while following the patient’s feelings and expectations and explaining the intended tests and ...treatment. Good communication between the doctor and the patient enables maintaining their long-term quality relationship based on trust. Such a relationship significantly contributes to the quality of medical care of the patient and brings satisfaction not only to the patient but also to the entire medical staff involved in the treatment. Communication skills can be learned. But teaching such communication in the classic medical education has long been neglected. The Department of Family medicine at the Medical Faculty of Ljubljana has contributed considerably to some changes in this area. Results of several researches have shown that changes in learning communication skills cannot be made by simply learning from books or attending lectures. Therefore, the Department of Family medicine has been enabling their students to improve their skills of communication through different forms of practical work for 15 years. The purpose of this article is to present 15 years of experience in teaching communication especially with the help of video at the Department of Family Medicine at the Medical Faculty of Ljubljana.
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