The introduction of interprofessional primary care (IPC) as a model of collaborative patient care is increasingly vital in the context of complex healthcare systems and the growing needs of patients. ...Its benefits include improved patient outcomes, enhanced efficiency, and reduced costs. However, the successful implementation of IPC faces challenges due to the differences in training and backgrounds among healthcare professionals, emphasising the importance of effective teamwork and collaborative education.
Educational approaches utilising simulations have gained prominence, particularly in addressing the challenges of interprofessional primary care. Notably, simulations facilitate team learning, enhancing team management and confidence, which ultimately leads to improved performance in real-life scenarios. They also contribute to patient safety by providing comprehensive training and creating a safe environment for professionals to practice and refine their skills without risking real patient harm.
Moreover, simulations promote psychological safety, allowing healthcare workers to manage stress effectively and prepare for critical situations. Ethical considerations are met through simulation-based education, ensuring patient confidentiality, and creating a standardised and just learning environment for all students. Simulations contribute to promoting equity in medical education by providing equal access to high-quality training opportunities for all healthcare professionals.
In conclusion, successful IPC implementation requires a comprehensive approach that includes interprofessional education and the integration of simulations as an essential component of the curriculum at all levels of healthcare education. This approach fosters effective communication, teamwork, and confidence among primary care teams, ultimately leading to improved patient care and outcomes.
Background
In recent years, authors have repeatedly reported on the significance of social support in cancer survival. Although overall the studies appear to be convincing, little is known about ...which types of social support promote better survival rates, and which subgroups of cancer patients are more susceptible to the benefits of it. The aim of this study was to identify, organize, and examine studies reporting on the significance of social support in cancer survival.
Methods
The PubMed, CINAHL and EBSCO databases were searched using the keywords social support/marital status, cancer, and survival/mortality. Where possible we used a meta‐analytical approach, specifically a random effect model, in order to combine the results of the hazard ratios in studies from which this information could be obtained. When interpreting clinical relevance, we used the number needed to treat (NNT).
Results
Better survival was observed in married patients when compared to unmarried (single, never‐married, divorced/separated, and widowed) in overall and cancer‐specific survival. Gender group differences showed that the association was statistically significant only in cancer‐specific survival when comparing divorced/separated male and female cancer patients (p < 0.001), thus confirming results from the previous meta‐analysis.
Conclusions
Being unmarried is associated with significantly worse overall and cancer‐specific survival. The most vulnerable group found in our study were divorced/separated men. The results of this review can motivate physicians, oncologists, and other healthcare professionals to be aware of the importance of patients' social support, especially in the identified sub‐group.
Being married is associated with significantly better overall survival. Being unmarried male is associated with significantly worse survival. Marital status should be taken into consideration when providing cancer care.
Patient safety is a crucial element of quality healthcare, and endeavours to enhance it are vital for attaining universal health coverage and improving patient outcomes. This study aimed to evaluate ...the perception of patient safety culture among staff at the Community Health Centre Ljubljana (CHCL).
A cross-sectional study was conducted in December 2022. All CHCL staff (N=1,564) from different professional groups were invited to participate in an anonymous electronic survey using the validated Slovenian version of the "Medical Office Survey on Patient Safety Culture" (MOSPSC). Mean percent positive scores for all items in each composite were calculated.
The final sample included 377 participants (response rate, 24.1%), most of whom were women (91.5%, N=345) with different professional profiles. The mean age of the participants was 44.5 years (SD 11.1) with a mean work experience of 20.1 years (SD 12.1). The percentage of positive overall MOSPSC composite scores was 59.6%. A strong patient safety culture perception was identified in the following dimensions: Information exchange with other settings (93.5%), Organisational learning (90.2%), List of patient safety and quality issues (88.1%), Patient care tracking/follow-up (76.2 %) and Teamwork (75.0%). Weak patient safety culture was identified in the dimensions of Work pressure and pace (10.7%), Leadership support for patient safety (27.1%), Communication openness (40.9%), Office processes and standardisation (48.2%) and Overall ratings on quality and patient safety (49.4%).
CHCL leadership should address weaknesses, redesign processes, and implement strategies to reduce patient safety incidents. Establishing a just culture that encourages employees to report errors fosters transparency and facilitates learning from errors.
Healthcare systems collect little information about the experiences and outcomes of care from the perspectives of patients. Patient Reported Indicator Surveys (PaRIS) is an OECD initiative to measure ...the outcomes and experiences of people living with chronic conditions, who are managed in primary care.
To evaluate the feasibility of the methodology employed in the Field Trial of the PaRIS survey in Slovenia and propose adjustments to enhance sampling in the Main Survey.
In 2022, we conducted a cross-sectional observational study in 50 family medicine practices in Slovenia with a target of recruiting 70 patients per practice. We used the Slovenian version of the PaRIS questionnaires, and evaluated sampling and data collection.
The sample contained 21 providers (42.0% response rate) and 454 patients (50.7% response rate). The provider sample did not differ from the population characteristics, while the patient sample differed significantly from the patient population. All providers completed the survey online, in 20.9±11.1 minutes and had 1.5±1.5 restarts. Most patients (74.9%) completed the survey online and needed 36.0±22.6 minutes, and the mean number of restarts was 1.4±2.2.
Based on the results, we recommend conducting a methodology test for quality assessment studies before initiating the main survey. Legal issues should be addressed and considered early when developing the methodology. It is also necessary to be aware of the feasibility of the study in practice, to avoid a low participation rate.
Aims and objectives
To determine the possible associations between higher levels of selected quality indicators and the characteristics of providers.
Background
In 2011, an ongoing project on a new ...model of family medicine practice was launched in Slovenia; the family physicians’ working team (a family physician and a practice nurse) was extended by a nurse practitioner working 0.5 full‐time equivalents. This was an example of a personalised team approach to managing chronic patients.
Methods
We included all family medicine practices in the six units of the Community Health Centre Ljubljana which were participating in the project in December 2015 (N = 66). Data were gathered from automatic electronic reports on quality indicators provided monthly by each practice. We also collected demographic data.
Results
There were 66 family medicine teams in the sample, with 165 members of their teams (66 family physicians, 33 nurse practitioners and 66 practice nurses). Fifty‐six (84.4%) of the family physicians were women, as were 32 (97.0%) of the nurse practitioners, and 86 (95.5%) of the practice nurses. Multivariate analysis showed that a higher level of the quality indicator “Examination of diabetic foot once per year” was independently associated with nurse practitioners having attended additional education on diabetes, duration of participation in the project, age and years worked since graduation of nurse practitioners, working in the Center unit and not working in the Bezigrad unit.
Conclusions
Characteristics of team members are important in fostering quality management of chronic patients. Nurse practitioners working in new model family practices need obligatory, continuous professional education in the management of chronic patients.
Relevance to clinical practice
The quality of care of chronic patients depends on the specific characteristics of the members of the team, which should be taken into account when planning quality improvements.
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.
Professionalism topics are usually not covered as a separate lesson within formal curriculum, but in subtler and less officially recognized educational activities, which makes them difficult to teach ...and assess. Interactive methods (e.g. movies) could be efficient teaching methods but are rarely studied. The aims of this study were: 1) to test the relevance and usefulness of movies in teaching professionalism to fourth year medical students and, 2) to assess the impact of this teaching method on students' attitudes towards some professionalism topics.
This was an education study with qualitative data analysis in a group of eleven fourth year medical students from the Medical School of University Maribor who attended an elective four month course on professionalism. There were 8 (66.7%) female students in the group. The mean age of the students was 21.9 ± 0.9 years. The authors used students' written reports and oral presentations as the basis for qualitative analysis using thematic codes.
Students recognised the following dimensions in the movie: communication, empathy, doctors' personal interests and palliative care. It also made them think about their attitudes towards life, death and dying.
The controlled environment of movies successfully enables students to explore their values, beliefs, and attitudes towards features of professionalism without feeling that their personal integrity had been threatened. Interactive teaching methods could become an indispensible aid in teaching professionalism to new generations.
Not much is known about the fall risk among the adult population of those who rarely visit doctors. We wanted to determine the prevalence of increased fall risk in a population of family practice ...non-attenders and the factors associated with it.
We included participants from family medicine practices in this cross-sectional study. To be included in the study, the participants had to be adults living in the community (home-dwelling people) who had not visited their chosen family physician in the last five years (non-attenders). The identification of the eligible persons was done through a search of electronic medical records, which yield 2,025 non-attenders. Community nurses collected data in the participants' homes. The outcome measure was increased fall risk as assessed by the Morse fall scale: increased risk (≥25) vs. no risk.
The sample consisted of 1,945 patients (96.0% response rate) with a mean age of 60.4 years (range 20.5 to 99.7 years). An increased fall risk was determined in 482 or 24.8% (95% CI: 22.9, 26.8) of the patients. The multivariate model showed a significant association of increased fall risk with higher age (p<0.001), lower systolic blood pressure (p=0.047), poor family function (p=0.016), increased risk of malnutrition (p=0.013), higher number of chronic diseases (p=0.027), higher pain intensity (p<0.001), lower self-assessment of current health (p=0.002), and higher dependence in daily activities (p<0.001).
Non-attenders may have an increased risk of falling which depends on their health status and age. The inclusion of community nurses in primary healthcare teams could be of use not only to identify the non-attenders' health needs, but also to better manage their health, especially the factors that were identified to be associated with greater fall risk.
Type 2 diabetes (T2D) and arterial hypertension (AH) are among the greatest challenges facing health systems worldwide and require comprehensive patient-centred care. The key to successful management ...in chronic patients is self-management support, which was found to be only weakly implemented in Slovenia. The aim of the study is to develop an evidence-based model of peer support for people with T2D and AH at the primary healthcare level in Slovenia, which could represent a potential solution for upgrading integrated care for these patients.
A prospective interventional, mixed-methods pilot study will begin by recruiting approximately 40 eligible people with T2D and AH through purposive sampling. The participants will receive structured training, led by a specialist nurse, to become trained peer supporters. Each will voluntarily share their knowledge and experience at monthly group meetings with up to 10 people with T2D and AH over a three-month period in the local community. Data will be collected through interviews and focus groups and questionnaires about socio-demographic and clinical data, knowledge about T2D and AH, participants' quality of life, level of empowerment and acceptability of the intervention.
The study will provide an evidence-based model for integrating peer support into the local community. It is expected that the intervention will prove feasible and acceptable with educational, psychosocial and behavioural benefits.
Peer support through empowerment of people with T2D and AH, family members and other informal caregivers in the local community could scale-up the integrated care continuum and contribute to sustainability of the healthcare system.
Aims and objectives
To determine the impact of nurse practitioners' counselling on reducing cardiovascular risk factors in patients participating in routine preventive check‐ups.
Background
A new ...model of ‘renewed’ family practice was introduced in Slovenia as a pilot project in 2011, in which nurse practitioners are included in a team carrying out preventive activities and managing patients with stable chronic diseases.
Design
A retrospective cohort study.
Methods
This study was conducted in 16 family medicine practices (eight renewed and eight regular family practices). In each family practice, a systematic sample was selected of registered patients participating in a cardiovascular preventive check‐up. Data on sex, age, blood pressure, cholesterol, blood sugar, smoking, level of physical activity and cardiovascular risk were collected. Patients attending renewed family practices received counselling on risk factors from nurse practitioners (test group), and patients attending regular family practices received counselling from family physicians (control group). Data were collected again at least one and no more than five years after the baseline consultation.
Results
There were 128 patients in the test group and 129 patients in the control group. At the control visit, the patients counselled by nurse practitioners had significantly lower levels of systolic blood pressure and cholesterol and practiced regular physical activity significantly more often than patients counselled by family physicians.
Conclusion
Nurse practitioners can be at least as successful as physicians when counselling patients on cardiovascular risk factors during their preventive check‐ups.
Relevance to clinical practice
This study showed that nurse practitioners have an important role in managing patients at the primary care level.