Purpose
An increasing number of older adults suffer from multimorbidity and receive multiple medications. Despite that, underprescribing of potentially beneficial medications is widespread in this ...population. Our aim was to examine influence of polypharmacy and multimorbidity on the presence of prescribing omissions (PO) in general practice attenders.
Methods
We conducted a cross-sectional study of older adults attending general practices in Slovenia who were regularly prescribed at least one medication. Patients’ data was entered into a computer application evaluating the presence of START (Screening Tool to Alert doctors to Right Treatment) criteria for PO. Demographic data, CIRS-G (Cumulative Illness Rating Scale for geriatric patients) questionnaire, number of medications, and healthcare utilization data were also collected. We defined polypharmacy as five or more concurrent medications.
Results
Five hundred three patients were enrolled, 258 (56.7%) female. The average age was 74.9 and average value of CIRS-G index 1.48 (± 0.6). Patients took on average 5.6 medications and 216 (42.9%) patients had at least one PO according to START criteria. In bivariate analysis, there was a significant association between age, number of medications, polypharmacy and CIRS-G index measures, and presence of PO. In multivariate analysis, only age and number of affected CIRS-G categories significantly predicted PO (
p
< 0.05).
Conclusions
Older patients with more affected CIRS-G categories were at higher risk for PO. Polypharmacy was not an independent risk factor for the presence of PO. A possible reason is that in multimorbid older people, physicians and patients set individual priorities to treatment instead of treating all diseases and conditions.
Managing type 2 diabetes (T2D) effectively is a considerable challenge. The Appraisal of Diabetes Scale (ADS) has proven valuable in understanding how individuals perceive and cope with their ...condition. This study aimed to evaluate the psychometric properties of the Slovenian version of ADS (ADS-S). We recruited a sample of 400 adult individuals with T2D from three primary healthcare centers in Slovenia, ensuring an average of 57 cases per individual item. The psychometric evaluation included internal consistency, test-retest reliability, construct validity, and discriminant validity. Confirmatory factor analysis (CFA) was additionally performed to evaluate the fit of one- and two-factor models. After excluding incomplete questionnaires, 389 individuals participated, averaging 72.0±7.5 years, with 196 men and 193 women. ADS-S exhibited acceptable internal consistency (Cronbach's α = 0.70) and strong test-retest reliability (interclass correlation = 0.88, p <0.001). Criterion validity was established through significant correlations between ADS-S score and EQ-5D utility score (r = -0.34, p <0.001), EQ-VAS score (r = -0.38, p <0.001), and HbA1c >7.5% (r = 0.22, p = 0.019). Discriminant validity assessment found no significant correlation between ADS-S score and age, but a significant correlation with female gender (r = 0.17, p = 0.001). CFA results supported a two-factor structure (psychological impact of diabetes and sense of self-control) over a one-factor structure, as indicated by model fit indicators. ADS-S stands as a valid and reliable tool for assessing psychological impact and self-control in Slovenian T2D patients. Future research should explore adding items for capturing secondary appraisal of diabetes and studying the influence of female gender on ADS scores.
Health care professionals are exposed to the psychological and physiological effects of stress, which is a well-known risk factor for various mental and physical health problems.
The aims of this ...study were to assess the adherence of female health care workers to use a web-based tool for improving and modifying lifestyle and to identify the potential factors influencing their adherence.
A prospective, observational study was performed. A total of 80 female health care workers (physicians and gradated nurses) from 2 university medical centers and female members of a family medicine society participated. Participants completed a questionnaire that inquired about their basic demographic data and physical fitness. Physical fitness was assessed by the Rockport Fitness Walking Test. Adherence to a web-based application (24@life) was followed for 3 months and the number of log-ins into the application was counted.
The study was conducted from March to October 2019. Significantly high workload has been detected in all groups (P<.05), except in the general practitioner with normal workload group. The graduated nurse working in the surgery room group showed chronic stress with elevated S-cortisol levels (>690 nmol/L); activated cellular immune system with elevated concentrations of lymphocytes (reference 1.1-2.5 × 10
cells/L), CD3 cells (reference 0.7-1.9 × 10
cells/L), CD8 cells (reference 0.2-0.7 × 10
cells/L), and HLA-DR/CD3 cells (reference 0.04-0.2 × 10
cells/L); and the worst quality of sleep (mean 2.8 SD 1.2). Only 32 of 80 participants (40%) were adherent to the web-based application. Participants most frequently viewed web pages on areas of physical activity (497 times) and nutrition (332 times). No factors or participant's characteristics such as weight (odds ratio OR 1.026, 95% CI 0.977-1.078), BMI (OR 0.993, 95% CI 0.834-1.184), age (OR 0.970, 95% CI 0.910-1.034), or stress level (OR 0.997, 95% CI 0.995-1.000) were identified to affect the adherence rates.
Female health care workers exposed to high workload did not find the web-based application useful for improving and modifying their lifestyle. Therefore, other strategies that might help health care workers facing stress and improve their lifestyle should be identified.
The aim of our study was to validate the Slovene translation of the STOP-BANG (SBQ) questionnaire for use in the primary practice setting.
We recruited 158 randomly selected visitors at four primary ...practice clinics who came to the practice for any reason. Participants completed the Slovene SBQ and underwent type 3 respiratory polygraphy, which was analysed by an experienced somnologist. The SBQ was previously translated in to Slovene and validated for the sleep clinic.
Of 158 participants, 153 had valid recordings. The mean age of the participants was 49.5 years (±13.0 years), and 47.7% were male. OSA was identified in 49.0% of the participants. The questionnaire, with a cutoff of ≥3, demonstrated an area under the curve of 0.823 for any OSA (REI≥5), 0.819 for moderate and severe OSA (REI≥15) and 0.847 for severe OSA (REI≥30). Sensitivity was 65.3%, 81.8%, and 90.0%, and specificity was 87.2%, 73.3% and 65.0% for any, moderate to severe and severe OSA, respectively.
The Slovene translation of the SBQ is a reliable instrument for OSA risk stratification in the primary practice setting.
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.
Background: The COVID-19 has had a profound negative impact on the population’s mental health. This study aimed to determine
the prevalence of depressive and anxiety symptoms in the general ...population during the third wave of the COVID-19 pandemic
and to identify risk factors associated with these symptoms after implementing initial prevention strategies.
Subjects and methods: A cross-sectional study was conducted among 200 visitors to five general practices in February 2021
in Slovenia. The response rate was 82.0% (164/200). A structured survey was used to assess sociodemographic factors, depressive and
anxiety symptoms, exposure to COVID-19 stressors, stress coping strategies used, and sense of coherence (SOC). A score of ≥10 points
on the Patient Health Questionnaire-9 and ≥10 points on the General Anxiety Disorder-7 questionnaire were considered as cut-offs for
screened depression and anxiety, respectively. The Mann-Whitney U test, chi-square test, and binary logistic regression were used for
statistical analysis.
Results: The prevalence of screened depression and anxiety was 24.4% and 12.9%, respectively. Independent predictors of depression
were stigma related to COVID-19 (OR 2.42, 95% CI 1.57-3.73, p<0.001), low SOC (OR 5.89, 95% CI 2.21-15.72, p<0.001),
and smoking (OR 3.53, 95% CI 1.23-10.10. p=0.019). Independent predictors of anxiety were religious rituals cancellation (OR 1.64,
95% CI 1.02-2.65, p=0.040), childcare responsibilities (OR 1.70, 95% CI 1.07-2.69, p=0.025), increased contact with close ones (OR
1.92, 95% CI 1.11-3.29, p=0.019), and low SOC (OR 5.21, 95% CI 1.22-22.31, p=0.026).
Conclusions: Despite efforts to address the pandemic through prevention strategies and the burden of the pandemic decreasing,
we still found a high prevalence of depressive and anxiety symptoms. While some risk factors can be addressed quickly, such as by
providing stable childcare and schooling and enabling assess to mental health services for vulnerable families, others require a longer-
term approach, such as strengthening SOC and reducing stigma.
To assess the feasibility of a remote care model for high-risk COVID-19 patients, identify risk factors for hospital admission, and propose modifications to the tested model.
We conducted a ...multicenter observational study of 225 patients (55.1% male) treated at three primary care centers between October 2020 and February 2022. Patients were enrolled into a telemonitoring program if they had a mild-moderate course of COVID-19 confirmed by polymerase chain reaction testing and were classified as high-risk for COVID-19 deterioration. Patients measured their vital signs three times daily, consulted their primary care physician every other day, and were followed up for 14 days. At inclusion, data were collected with a semi-structured questionnaire, and blood was drawn for laboratory analysis. A multivariable Cox regression model was used to determine predictors of hospital admission.
The median age was 62 years (range 24-94). The hospital admission rate was 24.4%, and the mean time from inclusion to hospital admission was 2.7±2.9 days. A total of 90.9% of patients were hospitalized within the first five days. A Cox regression model, adjusted for age, sex, and the presence of hypertension, revealed that the main predictors of hospital admission were type-2 diabetes (hazard ratio HR 2.38, 95% confidence interval CI 1.19-4.77, P=0.015) and thrombocytopenia (HR 2.46, 95% CI 1.33-4.53, P=0.004).
Telemonitoring of vital signs is a feasible method of remote care that helps identify patients requiring immediate hospital admission. For further scale-up, we suggest shortening call intervals in the first five days, when the risk of hospital admission is highest, and giving special attention to patients with type-2 diabetes and thrombocytopenia at inclusion.
To translate, culturally adapt and evaluate the Slovene version of the STOP-Bang questionnaire (SBQ) for use in the sleep clinic.
Standard forward-backward translation and harmonisation of the ...Slovene translation of the SBQ were performed. Test-retest reliability was performed on a sample of healthy subjects. A cross-sectional study was performed with patients referred for a sleep study. Patients filled out the Slovene translation of the SBQ before undergoing sleep study.
The validation group consisted of 256 patients, of which 237 (92.6%) were included. Mean age was 52.5 ± 14.6, 63.3% of patients were male. Obstructive sleep apnoea (OSA) (apnoea-hypopnea index (AHI) ≥ 5) was present in 69.6% of patients, of whom 22.4% had mild (AHI ≥ 5 and < 15), 21.9% moderate (AHI ≥ 15 and < 30), and 25.3% severe (AHI ≥ 30) OSA. A SBQ score of 3 had a sensitivity of 92.1 (86.9-95.7), specificity of 44.4 (32.7-56.6), PPV of 79.2 (75.5-82.4) and AUC of 0.757 (95% CI 0.692-0.823; p < 0.001) for all OSA (AHI ≥ 5). Each increase in the SBQ score was associated with an increase in the probability of OSA.
This study shows that the Slovene version of the SBQ is a valid tool for evaluating the risk of OSA in a sleep clinic.
Abstract
Introduction
Arterial hypertension (AH) and type 2 diabetes (T2D) represent a significant burden for the public health system, with an exceptionally high prevalence in patients aged ≥65 ...years. This study aims to test the acceptability, clinical effectiveness, and cost-effectiveness of telemonitoring in elderly patients with AH and T2D at the primary care level.
Methods
A m ulti-centre, prospective, randomized, controlled t rial w ill be conducted. Patients a ged ≥ 65 y ears with AH and T2D will be randomized in a 1:1 proportion to a mHealth intervention or standard care group. Patients in the intervention group will measure their blood pressure (BP) twice weekly and blood glucose (BG) once monthly. The readings will be synchronously transmitted via a mobile application to the telemonitoring platform, where they will be reviewed by a general practitioner who will indicate changes in measurement regimen or carry out a teleconsultation. The primary endpoint will be a change in systolic BP (SBP) and glycated haemoglobin (HbA1c) relative to standard care up to 12 months after inclusion. Secondary endpoints will be a change in other observed clinical variables, quality-of-life indexes, and costs.
Expected results
Telemonitoring will be an acceptable method of care associated with significant reductions in SBP and HbA1c levels and an increase in quality-of-life indexes in the intervention group. However, the cost-effectiveness threshold (incremental cost-effectiveness ratio below €25,000/quality-adjusted life year) might not be reached.
Conclusion
This study will provide new evidence for scaling up telemonitoring network at the primary care level and modifying telemonitoring protocols to achieve the best clinical and cost-effective outcomes.
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