For the purpose of celebrating the 40th anniversary of Alma Ata declaration, the WHO published a successful model of integrated patient care being performed in Slovenia. After two years, the WHO ...experts evaluated the success in practise during a visit to the Slovenian primary care environment. This report showed that Slovenia was a notable exception regarding developing effective primary care systems. The country has an impressive primary care which performs very well.
In order to achieve a high standard in training programmes for future family medicine specialists, it is essential to have good tutors with well-organised family medicine practices. Proper working ...conditions for young doctors are essential for their satisfaction and future professional development. The aim of our study was to check the current working conditions of family medicine trainees in the practical modular part of the training programme in Slovenia, and to determine their satisfaction with working conditions.
A cross-sectional study was conducted. The data was collected through a questionnaire distributed to 105 family medicine trainees undergoing the practical modular part of their training programme.
The study showed that the following 7 out of 25 organisational and labour law factors are significantly associated with a trainee's general satisfaction with working conditions: the location where work with patients takes place, the privacy of the premises, the accessibility of the main tutor, a constant patient population, suitable places for rest, paid out-of-hours substitutions, and appropriate pay grade.
The results we obtained can be used to address certain aspects of trainees' working conditions in Slovenia that need improvement. By determining which working conditions significantly affect a trainee's satisfaction, we have the opportunity to modify these conditions and thereby improve the training programme. This could result in a less stressful and more efficient residency programme.
This editorial describes how research in primary health care can be used to influence policy. It draws on previous literature to give an example from the UK of how research in one part of primary ...care, the health-visiting service, has endeavoured to use evidence to influence policy and practice. The editorial considers frameworks for policy implementation such as Bardach’s eight phase approach and concepts that can inform policy implementation such as Lipsky’s Street-Level Bureaucrat approach.
Although the concept of integrated care for non-communicable diseases was introduced at the primary level to move from disease-centered to patient-centered care, it has only been partially ...implemented in European countries. The aim of this study was to identify and compare identified facilitators and barriers to scale-up this concept between Slovenia and Belgium.
This was a qualitative study. Fifteen focus groups and fifty-one semi-structured interviews were conducted with stakeholders at the micro, meso and macro levels. In addition, data from two previously published studies were used for the analysis. Data collection and analysis was initially conducted at country level. Finally, the data was evaluated by a cross-country team to assess similarities and differences between countries.
Four topics were identified in the study: patient-centered care, teamwork, coordination of care and task delegation. Despite the different contexts, true teamwork and patient-centered care are limited in both countries by hierarchies and a very heavily skewed medical approach. The organization of primary healthcare in Slovenia probably facilitates the coordination of care, which is not the case in Belgium. The financing and organization of primary practices in Belgium was identified as a barrier to the implementation of task delegation between health professionals.
This study allowed formulating some important concepts for future healthcare for non-communicable diseases at the level of primary healthcare. The results could provide useful insights for other countries with similar health systems.
The increase in the elderly population is causing changes and challenges that demand a comprehensive public health response. A specific characteristic of the elderly is their frailty. Today's ...problems with identifying levels of frailty are being resolved by numerous tools in the form of frailty assessment scales. This systematic review establishes which frailty assessment scales for the elderly are being used and what their applicability in primary care is like in Slovenia and around the world.
Documents published after 2010 were searched for in the PubMed database using keywords and other specific criteria.
A total of 177 search hits were obtained based on various search strings. The final analysis included 28 articles, of which three were systematic literature reviews. These three covered quantitative studies, mainly consisting of observational cross-sectional surveys or cohort studies. Three other studies featured non-systematic literature reviews. Quantitative studies (mainly cross-sectional surveys or cohort studies) prevailed among the remaining 22 articles. One study had a qualitative design (Delphi method). The main outcome measures observed by all studies were frailty assessment scales for the elderly, the majority of which were evaluated on a sample of the elderly.
None of the assessment scales examined are used as the gold standard for primary care. A variety of tools are being used in clinical practice to assess frailty in elderly patients, highlighting the need for standardization and guidelines. This requires evaluating the current assessment scales in terms of validity and reliability, and suitably improving them.
Confidentiality is one of the oldest ethical principles in healthcare. However, confidentiality in adolescent healthcare is not a universally-accepted doctrine among scholars. The ethical ...acceptability of confidential services in adolescents' healthcare is based on perceptions of adolescent maturity and an appreciation of its importance to adolescents' access and utilization of healthcare services. Despite legal policies that promote adolescents' rights, physicians' attitudes toward adolescent confidentiality can be a determining factor in their ultimate decision to protect adolescents' confidentiality.
A new Attitude towards Adolescent Confidentiality Scale was developed based on the results of a qualitative interview study. This new instrument was administered to a sample of 152 physicians working at school pediatric and gynecology departments in 13 primary healthcare institutions in Belgrade. Principal component analysis was applied to determine the main components of the scale. Reliability was assessed by calculating Cronbach alpha and mean inter-item correlations.
Psychometric analysis of the final 19-item version of the scale showed a high level of reliability (Cronbach alpha of 0.83). Principal component analysis showed four components, which present subscales of the instrument: Confidentiality in clinical situation, Iimportance of confidentiality, Adolescent maturity, and Communication with parents.
The instrument showed satisfactory levels of reliability and validity. The results of the scale dissemination may be a valuable tool for needs assessment for future educational interventions and training programs that will raise physicians' awareness of the importance of adolescent confidentiality.
Objectives. The aim of the study is to assess the weight loss programme with regards to the long-term effectiveness of weight reduction and weight maintenance, using completion rate and BMI, blood ...sugar, cholesterol and blood pressure levels as outcomes. The aim of the study also includes identifying the factors associated with adherence to the programme.
Methods. The programme was developed by a multidisciplinary team. It included 6 months of introduction and another 18 months of maintenance. The data for 397 participants was collected after 24 months.
Results. 346 participants have completed the introduction and 123 have completed the programme. In the introduction, the average weight loss was 12% of the initial weight. The participants, who completed the full programme, lost 9.4% of their initial weight. The participants also significantly (p<0.05) reduced their blood sugar and cholesterol levels, as well as their blood pressure. The factors associated with adherence to the programme are: age over 50, lower educational levels, lower initial weight and higher weight loss in the introduction.
Conclusions. The multi-disciplinary approach to obesity treatment was effective for a selected group of people. The proportion of dropouts was relatively high, but still low compared to similar programmes. Group treatment and mutual support are of a great importance in bringing about and maintaining the changes.
Izhodišča. Namen raziskave je bil opredeliti kratkoročno in dolgoročno uspešnost programa glede na vztrajanje v njem, ITM, vrednost krvnega sladkorja, holesterola in krvnega tlaka pri udeležencih, ki so program zaključili. Želeli smo tudi opredeliti dejavnike, ki napovedujejo vztrajanje v programu.
Metode. V programu sodeluje multidisciplinarni tim strokovnjakov: zdravnik, diplomirana medicinska sestra, fizioterapevt in profesor telesne vadbe. Program ima dva dela: 6-mesečni shujševalni del in 18-mesečni vzdrževalni del. V program se je vključilo 397 udeležencev po nasvetu osebnega zdravnika. Podatke smo ocenili po 24 mesecih.
Rezultati. Prvi, shujševalni del programa je zaključilo 346 udeležencev, od tega jih je 123 zaključilo celotni program. V shujševalnem delu je bilo povprečno znižanje teže za 12% začetne teže, pri tistih, ki so zaključili vzdrževalni program, pa za 9,4% začetne teže. Udeležencem se je po dveh letih statistično pomembno (p<0,05) znižala vrednost krvnega sladkorja in holesterola, prav tako sta se znižala tudi sistolični in diastolični krvni tlak. Dejavniki, ki so vplivali na daljše vztrajanje v programu, so bili starost nad 50 let, nižja izobrazba, nižja vstopna teža in večja izguba kilogramov v prvem delu programa.
Zaključek. Z raziskavo smo želeli dokazati, da je multidisciplinarni pristop zdravljenja debelosti za tiste, ki zaključijo program v celoti, učinkovit. Delež tistih, ki so program zaključili predčasno, je relativno visok, vendar v primerjavi z ostalimi podobnimi programi še vedno nizek. Izkazalo se je, da so pogost stik s strokovnjakom, skupinska obravnava ter podpora ljudem z enakimi težavami izrednega pomena pri spreminjanju in vzdrževanju sprememb.
Izhodišča. Namen raziskave je bil opredeliti kratkoročno in dolgoročno uspešnost programa glede na vztrajanje v njem, ITM, vrednost krvnega sladkorja, holesterola in krvnega tlaka pri udeležencih, ki ...so program zaključili. Želeli smo tudi opredeliti dejavnike, ki napovedujejo vztrajanje v programu.
Uvod. Namen študije je predstaviti projekt Ministrstva za zdravje, referenčne ambulante, ki poteka v Sloveniji, in prikazati rezultate obravnave bolnikov z astmo in KOPB s strani tima, ki je ...dopolnjen in ga sestavljajo zdravnik, diplomirana medicinska sestra in zdravstveni tehnik.
Aim. This study aimed to evaluate a new project of the Slovene Ministry of Health - the Family Medicine Model Practices (MPs) Project in Slovenia, and to show its effectiveness in the management of ...asthma and COPD by family medicine practice teams, consisting of a family physician, a nurse practitioner and a practice nurse.
Methods. A total of 107 family practices with 203122 patients joined the project during the first year of its initiation. The effectiveness of the program in disease management was analysed in two phases according to the registration of family practices. The number of patients registered and the number of asthma and COPD patients (existing and newly detected) by model practice teams were being reported. Descriptive analyses were used to describe the study populations. Prevalence by diseases and phases was established after the initial round of data collection. Chi square (χ
) test was used to analyse the difference between the phases.
Results. The frequency of asthma was 2.12%, while the frequency of COPD was 1.15% throughout the study period. For both diseases, more than 30% of patients were newly diagnosed.
Conclusions. The project of implementing Family Medicine MPs in the area of COPD has given first positive results and the project is still ongoing to its full implementation.
Uvod. Namen študije je predstaviti projekt Ministrstva za zdravje, referenčne ambulante, ki poteka v Sloveniji, in prikazati rezultate obravnave bolnikov z astmo in KOPB s strani tima, ki je dopolnjen in ga sestavljajo zdravnik, diplomirana medicinska sestra in zdravstveni tehnik.
Metode. V prvem letu je bilo v projekt vključenih 107 ambulant z 203.122 opredeljenimi pacienti (glavarina). Uspešnost programa obravnave pacientov je bila analizirana dvofazno, ob prvi in naslednji vključitvi ambulant v projekt. Vse referenčne ambulante so poročale o številu opredeljenih bolnikov (glavarina) in o številu bolnikov z astmo in KOPB (že obstoječih in med presejanjem novo odkritih bolnikov). Deskriptivna analiza je bila uporabljena za opis obravnavane populacije. Prevalenca po boleznih je bila prikazana ločeno v prvi in drugi fazi analize. Test hi-kvadrat je prikazal razlike med obema fazama raziskave.
Rezultati. V opazovanem obdobju je bila pogostnost astme med opazovano populacijo 2,12%, pogostnost KOPB pa 1,15%. Tako med bolniki z astmo kot med bolniki s KOPB je bila bolezen novo odkrita pri več kot 30% bolnikov.
Zaključek. Projekt implementacije referenčnih ambulant, ki je še v razvoju, je na področju obravnave bolnikov s KOPB in astmo pokazal prve pozitivne rezultate.
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