Background. Patients use self-care to relieve symptoms of common colds, yet little is known about the prevalence and patterns across Europe. Methods/Design. In a cross-sectional study 27 primary care ...practices from 14 countries distributed 120 questionnaires to consecutive patients (≥18 years, any reason for consultation). A 27-item questionnaire asked for patients’ self-care for their last common cold. Results. 3,074 patients from 27 European sites participated. Their mean age was 46.7 years, and 62.5% were females. 99% of the participants used ≥1 self-care practice. In total, 527 different practices were reported; the age-standardized mean was 11.5 (±SD 6.0) per participant. The most frequent self-care categories were foodstuffs (95%), extras at home (81%), preparations for intestinal absorption (81%), and intranasal applications (53%). Patterns were similar across all sites, while the number of practices varied between and within countries. The most frequent single practices were water (43%), honey (42%), paracetamol (38%), oranges/orange juice (38%), and staying in bed (38%). Participants used 9 times more nonpharmaceutical items than pharmaceutical items. The majority (69%) combined self-care with and without proof of evidence, while ≤1% used only evidence-based items. Discussion. This first cross-national study on self-care for common colds showed a similar pattern across sites but quantitative differences.
Objective: European cancer survival rates vary widely. System factors, including whether or not primary care physicians (PCPs) are gatekeepers, may account for some of these differences. This study ...explores where patients who may have cancer are likely to present for medical care in different European countries, and how probability of presentation to a primary care clinician correlates with cancer survival rates.
Design: Seventy-eight PCPs in a range of European countries assessed four vignettes representing patients who might have cancer, and consensus groups agreed how likely those patients were to present to different clinicians in their own countries. These data were compared with national cancer survival rates.
Setting: A total of 14 countries.
Subjects: Consensus groups of PCPs.
Main outcome measures: Probability of initial presentation to a PCP for four clinical vignettes.
Results: There was no significant correlation between overall national 1-year relative cancer survival rates and the probability of initial presentation to a PCP (r = −0.16, 95% CI −0.39 to 0.08). Within that there was large variation depending on the type of cancer, with a significantly poorer lung cancer survival in countries where patients were more likely to initially consult a PCP (lung r = −0.57, 95% CI −0.83 to −0.12; ovary: r = −0.13, 95% CI −0.57 to 0.38; breast r = 0.14, 95% CI −0.36 to 0.58; bowel: r = 0.20, 95% CI −0.31 to 0.62).
Conclusions: There were wide variations in the degree of gatekeeping between countries, with no simple binary model as to whether or not a country has a "PCP-as-gatekeeper" system. While there was case-by-case variation, there was no overall evidence of a link between a higher probability of initial consultation with a PCP and poorer cancer survival.
KEY POINTS
European cancer survival rates vary widely, and health system factors may account for some of these differences.
The data from 14 European countries show a wide variation in the probability of initial presentation to a PCP.
The degree to which PCPs act as gatekeepers varies considerably from country to country.
There is no overall evidence of a link between a higher probability of initial presentation to a PCP and poorer cancer survival.
Uvod: Pristop, usmerjen k uporabniku, prispeva h kakovosti življenja starejših in oseb z demenco v domu starejših občanov ter k dobremu počutju zaposlenih na delovnem mestu. Namen raziskave je bil ...ugotoviti izkušnje zaposlenih v domu starejših občanov z uporabo metode montessori pri delu s starejšimi in osebami z demenco.Metode: Narejena je bila študija primera v domu starejših občanov, kjer uporabljajo metodo montessori. Delno strukturirani intervjuji so bili izvedeni z enajstimi zaposlenimi v enem izmed domov za starejše občane v Sloveniji. Za analizo podatkov je bila uporabljena metoda analize vsebine.Rezultati: Identificirane so bile štiri kategorije: (1) vsebinski in organizacijski vidiki metode montessori pri obravnavi starejših in oseb z demenco; (2) sodelovanje med zaposlenimi, stanovalci in svojci; (3) osebni razvoj zaposlenih; (4) pomen izobraževanja za zaposlene. Raziskava pri izkušnjah zaposlenih v obravnavi starejših in oseb z demenco pokaže preplet vseh kategorij.kategorij.Diskusija in zaključek: Ugotovitve prispevajo novo znanje na področju uporabe metode montessori v domovih za starejše občane. Izkušnje zaposlenih so pokazale, da uporaba metode montessori pripomore k boljšemu razumevanju pomena sodelovanja, izobraževanja ter s tem povezanega osebnega razvoja zaposlenih. V praksi je priporočeno sistematično uvajati metodo montessori za starejše in osebe z demenco s poudarkom na izobraževanju, ki je nujna podlaga za praktično delo. Predlagamo nadaljnje raziskovanje izkušenj zaposlenih ter iskanje možnosti za uvajanje metode tudi v druge domove starejših občanov.
In more than half of elderly chronically-ill family clinic attendees, drug prescribing deviates from the internationally acknowledged STOPP/START recommendations. Our study will determine whether it ...is possible to improve the quality of drug prescriptions in chronically-ill elderly people living at home by regularly monitoring the prescribed drugs according to STOPP/START criteria.
The project started in 2014 and will run until 2017. Forty general practitioners (GPs) are participating in a pragmatic randomized controlled trial. From the patient register, GPs randomly selected 20 patients older than 65 years who regularly receive at least one drug and invited them to participate in the study. We will use the START/STOPP criteria to determine the (in)adequacy of drug prescribing in the elderly by a web application (WA). Expected.
The use of the WA will be the basis of the implementation of the final version of the application into the regular family medicine practice, thereby reducing the problems of inappropriate prescribing, correct medication, polypharmacy and adherence; we will identify the stability of the factors of drug prescribing in the elderly. By comparing the test and control groups, it will be possible to distinguish which are related to the WA and which act independently.
To examine the present state of health-related quality of life (HRQOL) among elderly individuals with type 2 diabetes (T2D) receiving integrated care and identify risk factors associated with low ...HRQOL.
A multi-centre cross-sectional survey among elderly individuals with T2D, treated in Slovenian urban and rural primary care settings was performed. HRQOL was investigated using EuroQol 5-dimension (EQ-5D) questionnaire and Appraisal of Diabetes Scale (ADS). Furthermore, socio-demographic, clinical, and laboratory data were collected. Low HRQOL was defined as EQ-5D utility score <10%. Statistical analysis was performed using univariate and multivariate binary logistic regression statistics.
Examining 358 people with median age of 72 (range 65–98) years and with a mean EQ-5D utility score of 0.80, the study found that lower HRQOL correlated with older age, higher body mass index (BMI), lower education, elevated depressive symptoms, increased challenges across all EQ-5D dimensions, and less favourable appraisal of diabetes. When considering age, gender, education, and HbA1c, the main predictors of low HRQOL were BMI (OR 1.35, 95% CI 1.04–1.76, p = 0.025) and ADS score (OR 1.63, 95% CI 1.13–2.35, p = 0.009).
To improve HRQOL, integrated care models should consider interventions that target mental health, obesity prevention, chronic pain management, diabetes education, self-management, and treatment plan personalisation.
•Older age, lower education, and depression were linked to lower quality of life.•Patients with low quality of life faced more challenges in all EQ-5D dimensions.•Main determinants of low quality of life were obesity and appraisal of diabetes.•Future interventions should target mental health, resilience, obesity, and pain.•Integrated care models should boost self-management and tailored care support.
One of the aims of health care reform in Montenegro is to strengthen primary care. An important step forward is the implementation of specialty training in family medicine (FM). The aim of this ...article is to evaluate the implementation of specialty training in family medicine in Montenegro, regarding the content, structure and methods, by the first generation of trainees and the coordinator of the training.
A questionnaire was sent by mail in July and August 2017 to all 26 eligible trainees who started specialty training in 2013. Twenty-two of the 26 trainees (84.6%) responded. The questionnaire consisted of closed and open-ended questions related to the evaluation of the training. A descriptive quantitative and qualitative analysis with predefined themes and a semi-structured interview with the coordinator were carried out.
The process of training in FM was assessed positively by both trainees and the coordinator. The positive assessment included that the specialisation course offered modern design through modules and practice, and trainees both improved their existing knowledge and skills and acquired new ones necessary for everyday work. The coordinator emphasised the importance of the introduction of new teaching methods and formative assessment, the important role of mentors, and the involvement of Slovenian colleagues in the teaching process and supervision of the programme.
The implementation of speciality training in FM in Montenegro was successful. Several assessment methods were used that can be further developed in individual structured feedback, which could stimulate the continual improvement of trainees' knowledge and competencies.
In oldest-old patients (>80), few trials showed efficacy of treating hypertension and they included mostly the healthiest elderly. The resulting lack of knowledge has led to inconsistent guidelines, ...mainly based on systolic blood pressure (SBP), cardiovascular disease (CVD) but not on frailty despite the high prevalence in oldest-old. This may lead to variation how General Practitioners (GPs) treat hypertension. Our aim was to investigate treatment variation of GPs in oldest-olds across countries and to identify the role of frailty in that decision.
Using a survey, we compared treatment decisions in cases of oldest-old varying in SBP, CVD, and frailty. GPs were asked if they would start antihypertensive treatment in each case. In 2016, we invited GPs in Europe, Brazil, Israel, and New Zealand. We compared the percentage of cases that would be treated per countries. A logistic mixed-effects model was used to derive odds ratio (OR) for frailty with 95% confidence intervals (CI), adjusted for SBP, CVD, and GP characteristics (sex, location and prevalence of oldest-old per GP office, and years of experience). The mixed-effects model was used to account for the multiple assessments per GP.
The 29 countries yielded 2543 participating GPs: 52% were female, 51% located in a city, 71% reported a high prevalence of oldest-old in their offices, 38% and had >20 years of experience. Across countries, considerable variation was found in the decision to start antihypertensive treatment in the oldest-old ranging from 34 to 88%. In 24/29 (83%) countries, frailty was associated with GPs' decision not to start treatment even after adjustment for SBP, CVD, and GP characteristics (OR 0.53, 95%CI 0.48-0.59; ORs per country 0.11-1.78).
Across countries, we found considerable variation in starting antihypertensive medication in oldest-old. The frail oldest-old had an odds ratio of 0.53 of receiving antihypertensive treatment. Future hypertension trials should also include frail patients to acquire evidence on the efficacy of antihypertensive treatment in oldest-old patients with frailty, with the aim to get evidence-based data for clinical decision-making.
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 alpha = 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 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.
Raziskovanje v družinski medicini v Sloveniji Petek Šter, Marija; Švab, Igor; Petek, Davorina
Zdravniški vestnik (Ljubljana, Slovenia : 1992),
01/2019, Letnik:
87, Številka:
11-12
Journal Article
Recenzirano
Odprti dostop
Primarni nivo zdravstvenega varstva predstavlja vstopno mesto v zdravstveni sistem in od njega je v veliki meri odvisna kakovost in stroškovna vzdržnost zdravstvenega sistema. Raziskovanje je gonilo ...strokovnega razvoja v skrbi za čim boljšo kakovost oskrbe pacientov.Družinska medicina (DM) v Sloveniji predstavlja največjo specialnost na primarnem nivoju zdravstvenega varstva, ki je na področju raziskovanja v zadnjih desetletjih dosegla velike uspehe.V preglednem prispevku bodo prikazane značilnosti raziskovanja v družinski medicini, predstavljena vključenost raziskovanja v različne nivoje izobraževalnega procesa in delo v praksi ter nakazani izzivi, ki družinsko medicino kot znanstveno in raziskovalno vedo čakajo v prihodnje.
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