is a very old saying, originating from England in the mid-to late 1800s. However, despite being in use for more than two centuries, its meaning is still not fully grasped in Slovenian healthcare. ...While we claim that the healthcare system serves the patient and that the care provided is patient-centred, we do not even measure the treatment outcomes that matter to patients. Without measuring these, we do not know whether the treatment provided value to the patients, i.e. what were the benefits of the treatment relative to the costs. Slovenian payment models do not reimburse the providers for created patient-relevant value, but rather for the planned number of services or cases based on average incurred costs. It is thus time to digitalise the system, and start collecting, curating and analysing the relevant data to ensure that all stakeholders within the healthcare system co-deliver value to patients. While relevant stakeholders highlight notable challenges of implementing value-based healthcare in Slovenia, these are far from insurmountable.
Clinical dietitians play a crucial role in the nutritional support of patients at risk of malnutrition in primary care settings. The study aimed to evaluate the effect of an individualized ...nutritional intervention on clinically relevant outcomes for patients with chronic disease at nutritional risk.
A longitudinal evaluation study was conducted in two Slovenian primary health centres. We used pre-test and post-test design. Patients with chronic disease were screened using the Malnutrition Universal Screening Tool and additional risk factors (≥70 years and BMI <22 kg/m
; lower food intake in the last five days). Patients at nutritional risk were referred to a clinical dietitian for individual nutritional intervention. The effect of the nutritional intervention was assessed six months after the patients' first visit with a clinical dietitian.
The sample included 94 patients. Nutritional risk was reduced significantly in high-risk and moderate-risk patients. In a subgroup of patients with a MUST score ≥1 (77 patients), body weight, BMI, Fat-Free Mass Index (FFMI), energy intake, and protein intake increased significantly (p<0.001). At the same time, the phase angle significantly increased (p<0.001), but there were no statistically significant changes in the improvement of grip strength. In a subgroup of patients with MUST score 0 (17 patients), we observed an increase in their median daily energy intake (p<0.001) and median protein intake (p=0.003).
Nutritional intervention delivered by a clinical dietitian improved patients' nutritional intake and nutritional and functional status.
Abstract Introduction Despite the high prevalence of malnutrition in patients at all levels of healthcare, early prevention and treatment of malnourished patients are often neglected and overlooked ...in clinical practice. The aim of this systematic literature review was to identify the factors considered most important by healthcare professionals in the identification and treatment of malnourished patients or those at risk of malnutrition. Methods A systematic literature review of qualitative research was conducted. Documents published in scientific journals in English from 2011 to 2021 were searched in the PubMed (MEDLINE), CINAHL and ProQuest databases. The results were analysed with a thematic analysis of qualitative research findings. Results From the search set of 1010 results, 7 sources were included in the final analysis. Factors identified by health professionals as important in the identification and treatment of malnourished patients in clinical practice were grouped into five themes: unclear organizational structure; indefinite structure of nutritional care; poor continuity of nutritional care; lack of knowledge and skills of health professionals; lack of time and human resources. Conclusions Health policy must provide resources for nutritional care for patients at all levels of health care on the initiative of the highest professional bodies at the state level. To improve the nutritional care of patients in clinical practice, the management of health care institutions must promote and enable the professional and organizational establishment of clinical nutrition as a regular medical activity of the institution, develop clinical nutritional pathways, and promote evidence-based clinical practice and interprofessional collaboration.
The contribution's aim is highlighting the differences in understanding non-governmental organizations' (NGOs) role in the mental health area within the public support network for patients with ...mental health problems from various viewpoints, in order to achieve progress in supporting patients with mental health problems in local communities.
Qualitative data gathered as a part of a cross-sectional study of NGOs in the support network for patients with mental health problems in two Slovenian health regions (56 local communities), carried out in 2013 and 2014, were used. Qualitative analysis of interviews, focus groups and answers to an open survey question was performed.
There are differences in understanding NGOs' role in the support network for patients with mental health problems, which stem from the roles of stakeholders (local community officials, experts, care providers, and patients) within this system and their experience.
The actual differences need to be addressed and overcome in order to provide integrated community care. The importance of knowing the current state of NGOs in their life cycle and the socio-chronological context of the local community support network is evident.
The aim of our systematic review was to analyse the published literature on the psychosocial dimension of care in family medicine and its relationship with quality of care. We wanted to find out ...whether there is any evidence on the psychosocial approach in (family) medicine. The recommended bio-psycho-social approach, besides the biomedical model of illness, takes into account several co-influencing psychological, sociological and existential factors. An online search of nine different databases used Boolean operators and the following selection criteria: the paper contained information on the holistic approach, quality indicators, family medicine, patient-centred care and/or the bio-psycho-social model of treatment. We retrieved 743 papers, of which 36 fulfilled our inclusion criteria. Including the psychosocial dimension in patient management has been found to be useful in the prevention and treatment of physical and psychiatric illness, resulting in improved social functioning and patient satisfaction, reduced health care disparities, and reduced annual medical care charges. The themes of patient-centred, behavioural or psychosocial medicine were quite well presented in several papers. We could not find any conclusive evidence of the impact of a holistic biopsycho-social-approach. Weak and variable definitions of psychosocial dimensions, a low number of welldesigned intervention studies, and low numbers of included patients limited our conclusions.
Prispevek obravnava sleng iz dveh zornih kotov. Avtorica najprej opiše, kako sleng deluje v okviru družbe. Opisana je izjemno pomembna vloga, ki jo igra sleng – raba slenga lahko posameznika namreč ...obdrži v njegovem najožjem družbenem okolju, ali pa, na primer ob neustrezni rabi, povzroči, da je posameznik iz svoje družbene mreže izločen. Kot primer vloge, ki jo ima sleng v različnih družbenih mrežah, se avtorica posveti družbenim mrežam adolescentov. Poleg bolj sociološko usmerjenih vidikov slenga, je v članku opisana tudi releksikalizacija, jezikovni pojav, ki je v slengu pogosto prisoten. In ker sleng – ne glede na to, kaj bi si njegovi ustvarjalci in uporabniki morda želeli – ne more biti povsem ločen od ostalih ravni v jeziku, članek umesti sleng v širši, splošnejši okvir jezika. V nadaljevanju beremo, kako so slengovski in žaljivi izrazi obravnavani v slovarjih, tako enojezičnih kot dvojezičnih. Na koncu pa avtorica povzame ugotovitve, do katerih je prišla na podlagi poprejšnje daljše analize slovarske obravnave naključnega izbora slengovskih in žaljivih izrazov.
Cilj poslovanja bolnišnic, ki so organizirane kot javni zavodi, ni ustvarjanje dobička, ampak izvajanje dejavnosti, za katero so bile ustanovljene. Z izpeljavo tega načela lahko predpostavimo, da ...bodo bolnišnice stremele k doseganju minimalnega presežka prihodkov nad odhodki, in sicer ne glede na višino sredstev, ki jih prejmejo. Akutna bolnišnična obravnava se plačuje po sistemu skupin primerljivih primerov (SPP). V sistemu SPP zaradi zgodovinskega toka dogodkov bolnišnice prejemajo različno visoka sredstva za enake opravljene storitve, kar lahko vpliva na uspešnost njihovega poslovanja. Izbrani vzorec zajema 15 bolnišnic, ki so organizirane kot javni zdravstveni zavodi in izvajajo zdravstveno dejavnost le na sekundarni ravni. Obstaja povezava med višino cene uteži, ki jo posamezni izvajalec prejme po sistemu SPP, in presežkom prihodkov nad odhodki posameznega izvajalca (Spearmanov rho = 0,52, p=0,000). Zanimivo pa je dejstvo, da je ob upoštevanju enotne cene uteži in prilagoditvi izkazov nanjo poslovanje bolnišnic bolj neenakomerno kot ob različnih cenah uteži, standardni odklon presežka prihodkov pa se poveča za 59 %. Glede na navedeno je treba razmisliti o dokončnem poenotenju cen uteži v slovenskih bolnišnicah.
The aim of hospitals organised as public institutes, is not to make profit, but to perform the activities for which they were established. By the derivation of this principle, we may assume that hospitals will seek to achieve a minimum surplus of income over expenditure, irrespective of the amount of funds they receive. Acute hospital treatment is paid according to the Diagnosis Related Groups (DRG) system. Under the DRG system, due to the historical flow of events, hospitals receive different levels of resources for the same services performed, which in turn may affect their business performance. The selected sample includes 15 hospitals, which are organised as public health institutions and which perform health care services at the secondary level only. There is a link between the cost of weights an individual provider receives according to the DRG system, and the surplus of revenues over expenses of each provider (Spearman's rho = 0.52, p = 0.000). However, what is interesting is that with uniform cost of weights and statements adjusted accordingly, hospital performance is even more uneven than with different costs of weights, while the standard deviation of the surplus revenue increases by 59%. Given the above, reflection is needed on the final uniformity of cost of weights in Slovenian hospitals.
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