Background: A comprehensive understanding of the various aspects of patients' myocardial infarction (MI) experiences may help to guide these patients and their relatives through the many ...uncertainties they face and help them to stabilize their lives after the disruption they experienced.
Objectives: To explore MI patients' experiences of life with MI, the challenges they face during the process of accepting their condition, and the setting and resetting of their personal goals.
Methods: Thirty semi-structured, individual interviews were conducted. The grounded theory method was used, and Atlas.ti qualitative data analysis software was used to facilitate the analysis.
Results: Three main themes and explanatory models emerged from the data analysis: a good adaptation - the 'new normality;' maladjustment - a continuous search for a 'new normality;' and perceived needs in the search for a new normality. Patients perceived several areas of need that they felt must be met before they could reach the state of a new normality. These needs included overcoming the anxiety of a possible MI recurrence; acquiring knowledge about MI in general and about 'my MI' in particular; the need for a timeline; for patience and steadiness; for both objective and subjective health status improvement; for taking control over the disease; and living within a supportive context.
Conclusion: When faced with a dramatic life event, most patients succeed in achieving a new normality in which they live changed but still satisfying lives. The needs experienced by patients when searching for a new normality may guide practitioners in leading patient-centred consultations.
KEY MESSAGES
Most MI patients achieve a new normality.
My physical identity is new: my body is different but still functional.
My personal identity is new: I am not the same as before, the disease is part of me, but I retain parts of my previous self.
The research aim was to determine the overall morbidity trends in Croatian elderly population. The morbidity data recorded in family practice (FP) were extracted from Croatian Health Service ...Yearbooks for the years 1995-2012. The percentage of diagnoses in elderly people registered in FM was always higher then their shares in overall population, and with increased trend by 121%. The most frequently registered diagnostic groups were cardiovascular and neoplasms, followed by the groups of endocrine, urogenital and musculoskeletal diseases. The less frequently registered were the groups of infectious disease, injuries and ear diseases. However, the situation is somewhat different when looking at the amount of the increase. The Z codes increased the most, followed by endocrine diseases and neoplasms. Again, the less pronounced increase was observed in the groups of respiratory diseases, musculoskeletal, infectious diseases and injuries. The growing number of the older people and changing morbidity patterns will obviously influence both the entire society and the health care system. A new clinical and cost effective models of practice would be needed as well as the different models of personnel training.
Conditions for which a hospital and emergency utilization can be considered avoidable are often referred as ambulatory care sensitive conditions (ACSCs). Until now, there has been no published ...research related to ACSCs in Croatia. This study was undertaken with the aim of determining the trends relating to ACSCs in out-of-hospital ES from 1995-2012. The study is based on data from the Croatian Health Service Yearbooks. Five chronic and three acute conditions were chosen: diabetes, hypertension, congestive heart failure, angina pectoris, asthma and COPD, bacterial pneumonia, urinary tract infections and skin infections. The results indicate that the ES in Croatia is overused, and consequently ACSCs are over-represented; 23.3% Croatian citizens visited the ES and around 15% of all diagnoses belonged to the ACSCs, with decreased trend. The leading diagnosis is hypertension, followed by asthma and COPD. For a better understanding of the importance of ACSC within the Croatian context, further research is needed.
The aim of this study was to investigate how often Croatian FDs are involved in the provision of women's health, having in mind that women's health is primarily organized by the gynecological ...service. Only the data related to women's health were collected from the Croatian health statistical yearbooks from 1995 to 2012, in which ICD X was used. Results showed that total number of diagnoses are increasing. The greatest increase is observed in the category named as other diseases of female organs, then diagnoses related to the pregnancy, delivery and postpartum and malignant diseases, especially, breast cancer. Contrary, number of menopausal disorders continuing decreased. Diagnoses related to family planning (Z30) are relative small in amount and stabile. Results indicated that policy makers should take in account readiness of FDs to be involved in the provision of women's health.
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 research was undertaken to determine the trends in the amount and the structure of the health care expenditures in Croatia from 2000 to 2013. It is based on routinely collected and publicly ...available data, The Annual Reports of the Croatian Health Insurance Fund and OECD data. The income of Croatian Health Insurance Fund (CHIF) increased by 66.9%, while total expenditures increased by 62.1%. The fastest growth of expenditure is noticed in expenditures on health care. The hospital and specialist-consultant services have the highest expenditures. Furthermore, the fastest growth is that of other expenses, from 7% of total health care expenditures in 2000, to 26.7% in 2013; which can partly be interpreted as part of hospital care expenses. In the contrast, total expenditures for primary health care decreased, from 22% in 2002, to 13.1% in 2013. The publicly available data are not sufficient enough to drown up any specific conclusions about the underlying reasons for such distribution of the costs.
The aim of this study was to investigate, based on routinely collected data, the scope of family doctors work in the field of men's health. Based on the Croatian Health Service Yearbook in the period ...from 1995 to 2012, we collected the morbidity data related to male urogenital disorders. The total number of urogenital disorders almost doubled, but the number of diagnoses related to the men increased fourfold, mostly among the oldest patients. The number of prostate hyperplasia increased fivefold, again among the oldest people. The morbidity from other male-specific diseases increased threefold, mostly in the age group 7-19 years. In spite of the increase in the number of newly diagnosed cases of prostate cancer, the percentage of the deaths stabilized after 2001. Men's health problems are frequent sees and with an upward trend. We are not sure if this means deterioration of men's health, or just indicates the problem of "overdiagnosis".
It is well known that countries with strong primary care achieve better health outcomes at lower costs. Therefore, the effort of World Health Organization in promoting primary care as a basic ...principal of successful health care system is an ongoing process. Although Croatia was recognized as a country with primary care orientation due to the development of health centers and introduction of specialist training of general practitioners, it seems that many health care reforms aimed at better organization of health institutions and decreasing of health care costs did not result with higher primary care orientation. By application of the Primary Care Score instrument in 2014 (Croatia received 11.2 out of 20 possible points), and international comparison performed in 2002, it was concluded that among the eighteen OECD countries Croatia could be categorized as an "intermediate primary care country", obtaining the scores just a bit above the average.
This study was undertaken with the main aim of determining the trends in the number of family doctors' (FD), gender and educational structure, working status and the number of patients per FD between ...1995 and 2013. As the main source of data collection served the Croatian Health Service Yearbooks and Croatian Health Insurance Fund (CHIF) databases on practices and FDs contracting in 2013. Obtained results indicated that the number of contracted FDs increased until 2007, then decreased, and again increased until 2350 in 2013. Average number of patients on FDs list was 1987 in 2012. Less than 50% FDs were specialist in family medicine, 70.3% of them were self-employed with the CHIF contract, and 81% were women. 123 practices planned by the Network did not have contracting FD in 2013. The lack of FDs, the huge number of patients over the standard number, and the location of the missing practices within the rural communities, together make Croatian FM practices less accessible.
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