Abstract
Introduction
A smoking-cessation program was implemented as a randomized non-inferiority trial in primary care practices in Croatia and Slovenia to investigate whether a standard 4-week ...treatment with cytisine was at least as effective and feasible as a standard 12-week treatment with varenicline in helping smokers quit.
Aims and Methods
Out of 982 surveyed smokers, 377 were recruited to the non-inferiority trial: 186 were randomly assigned to cytisine and 191 to varenicline treatment. The primary cessation outcome was 7-day abstinence after 24 weeks, while the primary feasibility outcome was defined by adherence to the treatment plan. We also compared the rates of adverse events between the two treatment groups.
Results
The cessation rate after 24 weeks was 32.46% (62/191) in the varenicline group and 23.12% (43/186) in the cytisine group (odds ratio OR: 0.63, 95% credible interval CI: 0.39 to 0.98). Of 191 participants assigned to varenicline treatment 59.16% (113) were adherent, while 70.43% (131 of 186) were adherent in the cytisine group (OR: 1.65, 95% CI: 1.07 to 2.56). Participants assigned to cytisine experienced fewer total (incidence rate ratio IRR: 0.59, 95% CI: 0.43 to 0.81) and fewer severe or more extreme adverse events (IRR: 0.72, 95% CI: 0.35 to 1.47).
Conclusions
This randomized non-inferiority trial (n = 377) found the standard 4-week cytisine treatment to be less effective than the standard 12-week varenicline treatment for smoking cessation. However, adherence to the treatment plan, ie, feasibility, was higher, and the rate of adverse events was lower among participants assigned to cytisine treatment.
Implications
The present study found the standard 12 weeks of varenicline treatment to be more effective than the standard 4 weeks of cytisine treatment for smoking cessation in a primary care setting in Croatia and Slovenia. Participants assigned to cytisine, however, had a higher adherence to the treatment plan and a lower rate of adverse events. Estimates from the present study may be especially suitable for generalizations to high-smoking prevalence populations in Europe. Given the much lower cost of cytisine treatment, its lower rate of adverse events, and higher feasibility (but its likely lower effectiveness with the standard dosage regimen), future analyses should assess the cost-effectiveness of the two treatments for health policy considerations.
This research aimed to present public data describing the Croatian family doctors (FDs) workload, presented as the average number of patients on the lists, and annual and daily number of ...consultations per one FD team during the period 1995-2012. Croatian Health Service Yearbook for consecutive years was used as basis for data collection. Impressive increase number of persons on FD lists and significant increase of rate of persons per FD team were observed. Average number of contact to FD team also showed constant increase, starting at level of 5.9 per year in 1995 and reaching 9.6 per year in 2012. However, average number of direct consultation (including physical examination) to FD showed modest increase from level of 4.1 per year in 1995 till level of 5.8 per year in 2005. The number of referrals per one visit remain stable, but the number of referrals per one direct consultation decreased. The data stress problem of discrepancy of increasing number of persons on FD lists and stagnation trend of number of FD teams in Croatian primary health care. Results suggested problem of increasing workload of FD teams, but further research are needed for deeper amylases of the FDs workload.
Integriranje novih znanstvenih spoznaja u kurikule medicinskih fakulteta (MF) i programe specijalističkog usavršavanja doktora medicine te postizanje podudarnosti stečenih kompetencija sa stvarnom ...zdravstvenom potrebom pučanstva izazovi su obrazovanja doktora medicine 21. stoljeća. Kako je obiteljski liječnik temelj dobro organiziranoga zdravstvenog sustava, neophodno je osigurati njegovu dobro strukturiranu izobrazbu. Cilj ovoga rada jest opisati obrazovanje obiteljskih liječnika u Republici Hrvatskoj i usporediti ga sa standardima izobrazbe obiteljskih liječnika Europske unije. Europska akademija nastavnika opće/obiteljske medicine (EURACT) dala je preporuke za petnaest obveznih tema koje treba sadržavati predmet Obiteljska medicina u okviru studija medicine te preporuke za specijalističko usavršavanje iz obiteljske medicine koje treba biti više praktičnog nego teorijskog karaktera. U RH kurikuli svih četiriju MF imaju predmet Obiteljska medicina. Predmet Obiteljska medicina MF-a u Zagrebu uključuje svih petnaest tema sukladno preporukama EURACT-a, implementaciju instrumenta za neposredno nadgledanje proceduralnih vještina, izradu e-portfolija i poticanje učenja kroz stjecanje kliničkoga iskustva tijekom boravka u nastavnim praksama obiteljske medicine (OM). Predmet Obiteljska medicina MF-a u Splitu uključuje svih petnaest tema sukladno preporukama EURACT-a za diplomski studij medicine te organizaciju kliničke nastave koja uključuje boravak studenata i u gradskim i u otočkim nastavnim praksama OM. Nastava predmeta Obiteljska medicina na MF-u u Rijeci podrazumijeva teorijsku i praktičnu nastavu u nastavnim praksama OM te izradu pismenih odgovora na odabrano kliničko pitanje koje se temelji na iskustvu rada s bolesnikom. Nastava iz OM na MF-u u Osijeku izvodi se kroz integrirani program „Obiteljska medicina, školska medicina i medicinska sociologija” te uključuje kombinaciju kliničke nastave u nastavnim praksama OM i vježbi u kabinetu vještina. Četverogodišnji program specijalističkog usavršavanja iz OM temelji se na definiranim kompetencijama te podrazumijeva da specijalizant polovinu specijalističkog usavršavanja provodi u ordinaciji mentora koja je akreditirana za specijalističko usavršavanje iz OM. Slijedom navedenoga izobrazba obiteljskih liječnika u RH u skladu je s europskim i globalnim preporukama.
The aim of this article is to determine the trends in absenteeism from 2000 to 2012 in Croatia and to examine if the observed trends could be related to the regulations implemented to keep the ...absenteeism on low level. In Croatia only family doctors keep the responsibility for sick leave and were always been targeted by many regulations to keep absenteeism on appropriate level. A study was observational and retrospective based on the official CHIF data available from the web-page. Although the average number of sick leave days had been bisected (from 30.58 to 15.08 days per patient) sick leave rate only slightly fell down (from 3.32% to 3.11%). It seems that the restrictive measures did not significantly affect the number of sick leave cases. Such a results and other European research studies indicates that without reduction of the institutional rights there will be no reducing of sick leave rates.
The specialization in family medicine (FM) was introduced in the academic year 1960/61, but there was an almost 12-year gap in its implementation. Specialized training (ST) was reintroduced in 2003 ...through the project "Harmonization of family medicine with EU standards introducing a FM specialization". The aim of this paper is not to present all of the developmental phases of the ST curriculum, but to provide accounts of some of the challenging experiences which might be of help to the readers. Experience in several areas is examined: experience in educational need assessment using focus group method; introduction of a new specialist exam; development of the Study Guide, the Trainee Manual, and the Trainer Manual; selection procedure and training of trainers; and skill-lab training and peer-group learning. Systematic evaluation was planned for the next year, when the current project finishes and is to be replaced by another one. The general impression is that ST in FM is perceived as quite challenging, both for the trainees and for the teachers.
The implementation of information systems into primary health care opened the possibilities of providing integrated and co-ordinated health care, improved in quality and focused on the healthcare ...user. The healthcare system, researchers, physicians, and patients have recognised the benefits offered by informatics, but also raised questions that have yet to be answered.
The main aim of this study was to investigate trends in the organization and functioning of the HC service. The Croatian Health Service Yearbooks, from 1995 to 2012, served as the basis for the data. ...The results showed that the HC reforms aimed at the organization and functioning of primary care for women somehow compromised their accessibility. A general lack of around 100 gynecologists, the huge number of women on the lists, from 4, 350 to 8,061 women, and excessively heavy daily consultations, between 23.8 and 28.4, were all observed. The location of the majority of gynecological practices in the big cities also makes the service inaccessible to women from the rural areas. A flow of service away from the public to the private providers was also observed. Since, the results of this study can be viewed only in terms of trends and more detailed research will be needed in future.
To identify users' reasons to look for physician consultation on the internet instead of visiting a physician and to explore their general characteristics, motivation, and satisfaction with internet ...medical consultation service 'Your Questions.'
Users of a free internet medical consultation service 'Your Questions' (www.plivazdravlje.hr) were invited to participate in a web-based survey designed to explore their general characteristics (age, sex, etc), reasons for using the service, the nature of their health problem or question, and their satisfaction with the service. Respondents were divided into two groups: users who consulted an internet physician only (Group I) and users who used internet consulting before or after visiting a physician (Group II).
The response rate was 38% (1036/2747), with 79% female respondents. A fifth of the respondents (21%) consulted an internet physician only (Group I). Multivariate analysis revealed that the respondents in Group I were younger (median 24 vs 28 years in Group II), more interested into questions about pregnancy (odds ratio OR, 1.984; 95% confidence interval CI, 1.203-3.272), more often embarrassed to talk to a physician in person (OR, 1.828; 95% CI, 1.119-2.989), and more motivated to protect their privacy (OR, 1.727; 95% CI, 1.252-2.380). They also had greater satisfaction with the service (77% vs 60%, P<0.001).
The factors associated with the use of internet-based medical consultation services were younger age, need for privacy protection, avoidance of embarrassment at the physician's office, and having a question related to pregnancy. This reveals the internet medical consultation service as a useful health promotion supplement that is particularly applicable for the population of young adults.
The aim of this paper is to determine the differences in the outpatient consumption of cardiovascular drugs between Croatian regions: the City of Zagreb and Lika-Senj County. The data on the number ...of packages and the purchase price for each drug have been obtained from all pharmacies in Lika-Senj County and all pharmacies in the City of Zagreb. Defined daily doses/1000 inhabitants/day (DDD/1000/day) was calculated for every drug in accordance with its code name and Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD) index of the World Health Organization (WHO) for 2007. For drug combinations without defined daily doses, equivalent doses (ED) were used. The quality of drug prescribing within the group of cardiovascular drugs was assessed using the Drug Utilization (DU90%) method and the adherence of the DU90% segment to the guidelines for prescribing individual drug groups. The statistical significance of differences in results between the City of Zagreb and Lika-Senj County was tested using the chi-square test at the level of statistical significance p < 0.05. The comparison of the share of the five most often prescribed drug groups in Lika-Senj County has shown statistically significant differences when compared to the City of Zagreb (chi2 = 28.93, df = 4, p < 0.001). The total outpatient consumption of cardiovascular drugs in the City of Zagreb and Lika-Senj County differs significantly. The consumption, quality of prescribing drugs and cost/DDD in the City of Zagreb is higher than in Lika-Senj County; in the City of Zagreb, newer and more expensive drugs are prescribed to a higher extent.
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