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.
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.
Abstract Aim: To gain insight into the trend of career choice for family medicine in Croatia in recent years. Methods: Six surveys were performed in the academic years 2006/07-2011/12 at the ...University of Zagreb, School of Medicine. Altogether, 1140 6th year students participated. They anonymously completed a questionnaire containing questions on desired future specialisation as well as other selected characteristics (e.g. gender, desired area and place of work, motivation to study medicine, etc.). Binary logistic regression was used to determine unadjusted and adjusted trends. Results: After adjustment for selected factors, the relationship between observed outcome and the year of observation showed an evident decreasing trend. The odds for intention to specialise in family medicine were in the academic year 2006/2007 1.43-times higher than in the year 2007/2008 (p=0.412), 1.85-times higher than in the year 2008/2009 (p=0.168), 2.38-times higher than in the year 2009/2010 (p=0.051), 2.63-times higher than in the year 2010/2011 (p=0.027) and 3.85-times higher than in the year 2011/2012 (p=0.003). Conclusions: The results of the present study offer evidence that Croatia is experiencing a constantly decreasing trend of career choice for family medicine in recent years. It is obvious that final year medical students are not very much interested in working as family practitioners. At the same time, demand for family practitioners in Croatia is increasing. Both academic and professional societies have a social responsibility to reorient the health care system and medical curricula towards comprehensive primary health care in which family medicine has a key role.
Izvleček Izhodišče: Pridobitev vpogleda v trend izbire poklica zdravnik specialist družinske medicine na Hrvaškem v zadnjih letih. Metode: V študijskih letih 2006/7-2011/12 je bilo na Medicinski fakulteti Univerze v Zagrebu opravljenih šest raziskav, v katerih je skupaj sodelovalo 1.140 študentov 6. letnika. Ti so anonimno izpolnili vprašalnik z vprašanji o želeni prihodnji specializaciji in drugih izbranih karakteristikah (npr. spol, želeno področje in kraj dela, motivi za študij medicine itn.). Za določitev neprilagojenih in prilagojenih trendov je bila uporabljena binarna logistična regresija. Rezultati: Po prilagoditvi izbranih dejavnikov je bil pri povezavi med opazovanim rezultatom in letom opazovanja ugotovljen jasen padajoči trend. Verjetnost izbire specializacije iz družinske medicine je bila v študijskem letu 2006/2007 1,43-krat večja kot v letu 2007/2008 (p = 0,412), 1,85-krat večja kot v letu 2008/2009 (p = 0,168), 2,38- krat večja kot v letu 2009/2010 (p = 0,051), 2,63-krat večja kot v letu 2010/2011 (p = 0,027) in 3,85-krat večja kot v letu 2011/2012 (p = 0,003). Zaključki: Rezultati te raziskave dokazujejo, da je v zadnjih letih na Hrvaškem prisoten stalno padajoči trend pri izbiri poklica zdravnik specialist družinske medicine. Očitno je, da študenti zadnjega letnika medicine niso preveč zainteresirani za delo zdravnika družinske medicine. Hkrati pa se na Hrvaškem povečuje potreba po tovrstnih zdravnikih. Tako akademska kot strokovna združenja so družbeno odgovorna za preoblikovanje sistema zdravstvenega varstva in študijskih programov medicine v celovito primarno zdravstveno varstvo, v katerem ima družinska medicina ključno vlogo.
Although theoretically very effective and apparently quite straightforward, cardiovascular prevention leaves much to be desired in practice. Several reasons, including ethical, conceptual, ...psychological, and operative pitfalls (lifestyle changes are mostly ignored; drug therapy is too often prescribed with no good reason, and performed in an episodic or on/off way) are presented in this essay. Discussed are the grounds of these aberrations and suggested are some intuitive solutions, best achievable in family practice.
Preprečevanje srčno-žilnih bolezni je teoretično zelo učinkovito in na videz precej enostavno, vendar pa je treba v praksi na tem področju še marsikaj storiti. Prispevek opisuje razloge takšnega stanja, tj. etične, konceptualne in psihološke dejavnike ter težave pri izvajanju. Zdravljenje z zdravili prevečkrat predpišemo brez pravega razloga, poteka pa občasno in neredno. Prispevek obravnava vzroke teh slabosti in predlaga nekaj rešitev, ki jih najlaže ponudi družinska medicina.
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