[Show abstract][Hide abstract] ABSTRACT: 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
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.
[Show abstract][Hide abstract] ABSTRACT: The Chronic Care Model (CCM) is a conceptual framework that supports the evidence-based proactive and planned care of chronic diseases. Our aim was to validate a Slovenian translation of Patient Assessment of Chronic Illness Care (PACIC)--a self-reported instrument designed to measure the extent to which patients with chronic illnesses receive care congruent with CCM--on a sample of patients with coronary heart disease. Secondary analysis of patients' evaluation of general practice care (EPA Cardio study) was done in patients with coronary heart disease in Slovenia. Patients completed a written questionnaire, which included the instrument for assessing chronic illness care (PACIC), the EUROPEP questionnaire and demographical data. Internal consistency was expressed in terms of Cronbach's alpha. Reliability was expressed as the intra class correlation coefficient (ICC). Correlation between PACIC and EUROPEP was considered as a measure of construct validity. Factor analysis was done to identify number and types of domains in the instrument. Questionnaires of 843 patients were analysed. The mean age was 68.2 (SD 11.1) years, 34.6% of participants were female. 32.7% of PACIC questionnaires were not completely fulfilled. The internal consistency of the entire questionnaire assessed by Cronbach's alpha was 0.953 and reliability was 0.937. Construct validity was confirmed with important and significant correlation between PACIC and EUROPEP questionnaire (Spearman's correlation coefficient = 0.60, p < 0.001). Principal component factor analysis identifies two major factors which we labeled according to the PACIC domains as "Patient activation, decision support and problem solving" and "Goal settings and coordination". A translated and validated Slovenian version of PACIC questionnaire is now available. Further research on its validity in other groups of chronically ill patients and the use of instrument for monitoring changes of chronic care over time is recommended.
Collegium antropologicum 06/2014; 38(2):437-44. · 0.61 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background: Information and communication technology (ICT) and paperless practices have been shown to improve "existing processes in the workplace" "as well as being an important component of modern primary healthcare". The aim of our study was to analyse the attitudes of health-care professionals and patients with regard to paperless practice and the most frequently used information and communication technology tools in Slovenian primary healthcare. Methods and participants: Qualitative methodology using focus groups of 22 primary care physicians, 14 nurses and 18 patients. Results: The areas recognised by all participants as important for further information and communication technology development were: computer-supported decision making, accessibility and completeness of personal e-health data, emergency cases, support for chronic disease management, ICT related time savings, e-prescriptions and e-discharge letters. The most important identified barriers impeding the use of ICT were: the heavy workload of primary care physicians and nurses, health insurance reimbursement rules and duplication of work using both paper and electronic health records. Conclusions: This study highlighted a number of strengths of ICT use in primary care as well as numerous areas where changes in procedures and improvement of ICT tools to support them are needed.
[Show abstract][Hide abstract] ABSTRACT: Objective: Empathy is the most frequently mentioned humanistic dimension of patient care and is considered to be an important quality in physicians. The importance of fostering the development of empathy in undergraduate students is continuously emphasised in international recommendations for medical education. Our aim was to validate and adapt the Slovenian version of the Jefferson Scale of Empathy-Students version (JSE-S) on a sample of first-year medical students. Methods: First-year students of the Medical faculty in Ljubljana participated in the research. JSE-S version, a self-administered 20-item questionnaire, was used for collecting the data. Descriptive statistics at the item level and at the scale level, factor analysis, internal consistency and test-retest reliability (two weeks after the first administration) of the JSE-S were performed. Results: 234 out of 298 (response rate 78.5%) students completed JSE-S. The mean score for the items on the 7-point Likert scale ranged from 3.27 (SD 1.72) to 6.50 (SD 0.82). The mean score for the scale (possible range from 20 to 140) was 107.6 (from 71 to 131, SD 12.6). Using factor analysis, we identified six factors, describing 57.2% of total variability. The Cronbach alpha as a measure of internal consistency was 0.79. The instrument has good temporal stability (test-retest reliability ICC = 0.703). Conclusion: Findings support the construct validity and reliability of JSE-S for measuring empathy
[Show abstract][Hide abstract] ABSTRACT: Background: Self-rated health (SRH) reflects a person's experience of their own health, including the biological, sociological and psychological factors. It is frequently used in population studies but can provide primary physicians with additional information regarding patients' needs. Objectives: To analyse determinants of SRH according to physical health, patient demographic characteristics and frequency of practice attendance. Methods: Analysed data derived from the national part of the EPA-Cardio project. Several patient characteristics and SRH as an outcome measure were analysed in three groups of patients: with coronary disease, with high risk for cardiovascular disease and with low risk for cardiovascular disease, randomly chosen from the practice registers and lists of 36 practices. Results: 2524 patients participated (response rate 70.1%). Coronary patients and those with the highest number of chronic diseases rated their health the lowest. Low SRH was found in women, older patients, the unemployed and in patients with a lower level of education. Low SRH was associated with higher body weight, lower satisfaction with the practice and a higher number of practice visits. Conclusion: Several determinants were shown to be important for SRH. Physical health reflected by chronic disease and multimorbidity and life-style determined by body weight were shown to be important for SRH in the population of family practice. Socio-economic characteristics (employment, education level) were also reflected in SRH. Lower SRH, associated with higher frequency of attendance of the practice and lower satisfaction with the practice, points to the unmet needs of the patients. Izvirni znanstveni članek UDK 613.99:316.653 Izvleček Izhodišča: Samoocena zdravja predstavlja bolnikov občutek lastnega zdravja; vključuje biološke, sociološke in psihološke dejavnike. Pogosto se uporablja v populacijskih raziskavah, osebni zdravnik pa lahko z njeno pomočjo pridobi dodatne informacije o bolniku in njegovih potrebah. Cilji: Analizirati dejavnike samoocene zdravja glede na telesno zdravje, demografske značilnosti in pogostost bolnikovih obiskov v ambulanti družinske medicine. Metode: Analizirali smo nacionalne podatke, pridobljene v okviru mednarodne raziskave EPA – Cardio. V treh skupinah bolnikov – koronarnih bolnikih, osebah z visokim tveganjem za srčno-žilne bolezni in osebah z nizkim tveganjem –, naključno izbranih iz registrov 36 slovenskih ambulant družinske medicine, smo analizirali povezavo bolnikovih značilnosti z njegovo samooceno zdravja kot odvisno spremenljivko. Analizirali smo podatke 2.524 bolnikov (70,1% predvidenega vzorca). Bolniki z več kroničnimi boleznimi, koronarni bolniki in tisti z višjo telesno težo so slabše ocenili svoje zdravje. Svoje zdravje so slabše ocenili ženske, starejši, pogostejši obiskovalci ambulante in tisti, ki so bili manj zadovoljni z ambulanto. Zaključki: Ugotovili smo več pomembnih dejavnikov, povezanih s samooceno zdravja. Občutek slabšega telesnega zdravja pri bolnikih z več sočasnimi boleznimi in nezdrav življenjski slog, predstavljen s prekomerno telesno težo, sta bila povezana s slabšo samooceno zdravja v populaciji obiskovalcev ambulante družinske medicine. Pomembne so bile tudi socioekonomske značilnosti bolnikov (izobrazba, zaposlitev). Nižja samoocena zdravja v povezavi z višjo frekvenco obiskov v ambulanti in s slabšim zadovoljstvom bolnikov kaže na neizpolnjene potrebe bolnikov. Ključne besede: samoocena zdravja, družinska medicina, tveganje za srčno-žilne bolezni
[Show abstract][Hide abstract] ABSTRACT: Background: In most European countries, cardiovascular diseases (CVD) are still the leading cause of mortality. Preventing them is an important task of primary care. Assessment of risk factors and preventive activities are especially important for patients at high risk for CVD. Moreover, it is important to know effect factors that influence the successfulness of prevention. Methods: A cross-sectional study of a stratified random sample of 36 practices. Each practice included 30 high risk patients from the register. Data on patient characteristics (life-style, quality of life, self-assessment of health, use of health services, state of risk factors) and practice characteristics (practice load, cooperation in quality projects, education, information technology, preventive practice) were collected by questionnaire for patients, physicians and audit of medical record. Results: 871 patients from 36 practices participated (80.6% response rate), mean age was 62.4 years (SD±8.6).22.4% were smokers, adequate level of aerobic physical activity was implemented by 330 (48.8%) participants, the least regulated was body mass index (29.3kg/m2). All variables (practice, patient, doctor characteristics) together significantly predicted regulation of risk factors (p<0.005, F=2.7, R2 =0.087). Independent variables of better-regulated risk factors were female gender, higher education, higher age of the patient, information system and organization of cardiovascular prevention and physician’s professional activity. Conclusions: Good regulation of risk factors is mostly dependent on practice characteristics, especially on organization of prevention and doctor’s professional activity. Some patient characteristics are important as well and besides that other characteristics not included in the model seem to be important also.
[Show abstract][Hide abstract] ABSTRACT: Background
One of the main family practice interventions in the younger healthy population is advice on how to keep or develop a healthy lifestyle. In this study we explored the level of counselling regarding healthy lifestyle by family physicians and the factors associated with it.
A cross-sectional study with a random sample of 36 family practices, stratified by size and location. Each practice included up to 40 people aged 18–45 with low/medium risk for cardiovascular disease (CVD). Data were obtained by patient and practice questionnaires and semi-structured interviews. Several predictors on the patient and practice level for received advice in seven areas of CVD prevention were applied in corresponding models using a two-level logistic regression analysis.
Less than half of the eligible people received advice for the presented risk factors and the majority of them found it useful. Practices with medium patient list-sizes showed consistently higher level of advice in all areas of CVD prevention. Independent predictors for receiving advice on cholesterol management were patients’ higher weight (regression coefficient 0.04, p=0.03), urban location of practice (regression coefficient 0.92, p=0.04), organisation of education by the practice (regression coefficient 0.47, p=0.01) and practice list size (regression coefficient 6.04, p=0.04). Patients who self-assessed their health poorly more frequently received advice on smoking (regression coefficient −0.26, p=0.03). Hypertensive patients received written information more often (regression coefficient 0.66, p=0.04). People with increased weight more often received advice for children’s lifestyle (regression coefficient 0.06, p=0.03). We did not find associations with patient or practice characteristics and advice regarding weight and physical activity. We did not find a common pattern of predictors for advice.
Counselling for risk diseases such as increased cholesterol is more frequently provided than basic lifestyle counselling. We found some doctors and practice factors associated with counselling behaviour, but the majority has to be explained by further studies.
BMC Family Practice 06/2013; 14(1):82. DOI:10.1186/1471-2296-14-82 · 1.67 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Prevention of cardiovascular diseases (CVD) is a major health issue worldwide. Primary care plays an important role in cardiovascular risk management (CVRM). Guidelines and quality of care measures to assess CVRM in primary care practices are available. In this study, we assessed the relationship between structural and organisational practice characteristics and the quality of care provided in individuals at high risk for developing CVD in European primary care.
An observational study was conducted in 267 general practices from 9 European countries. Previously developed quality indicators were abstracted from medical records of randomly sampled patients to create a composite quality measure. Practice characteristics were collected by a practice questionnaire and face to face interviews. Data were aggregated using factor analysis to four practice scores representing structural and organisational practice features. A hierarchical multilevel analysis was performed to examine the impact of practice characteristics on quality of CVRM.
The final sample included 4223 individuals at high risk for developing CVD (28% female) with a mean age of 66.5 years (SD 9.1). Mean indicator achievement was 59.9% with a greater variation between practices than between countries. Predictors at the patient level (age, gender) had no influence on the outcome. At the practice level, the score 'Preventive Services' (13 items) was positively associated with clinical performance (r = 1.92; p = 0.0058). Sensitivity analyses resulted in a 5-item score (PrevServ_5) that was also positively associated with the outcome (r = 4.28; p < 0.0001).
There was a positive association between the quality of CVRM in individuals at high risk for developing CVD and the availability of preventive services related to risk assessment and lifestyle management supported by information technology.
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to test the association between self-rated health status (i.e. psychological and interpersonal welfare, physical health, coping mechanisms) and absence from work due to illness in the Slovenian armed forces. 390 military personnel were included in the study. Two groups of soldiers, healthy (G1-H) and sick/less healthy (G2-S), were created according to the median value of their annual sick leave. A third group consisted of soldiers on a mission (G3-M). A background questionnaire (demographic data, lifestyle habits, a list of life problems and a list of health problems in the last three years), a Self-Rated Health Scale and the Folkman-Lazarus Ways of Coping Questionnaire were administered. Self-rated physical health was best in group G1-H and worst in G2-S, with differences between the groups being statistically significant. No gender differences were found either between the groups or in the whole sample. The most common coping strategies amongst all the soldiers were found to be problem solving, positive re-evaluation of the situation and self-control. The groups differed only in their use of the distancing strategy. The self-rated health of all the participants was found to be in strong negative correlation with the escape/avoidance coping strategy. In group G2-S, more soldiers assessed their health as poor; the differences between the groups were statistically significant. Strong positive correlations between self-rated health and satisfaction with interpersonal relationships were found. Self-rated health was found to be significantly associated with the quality of interpersonal relationships and the socio-economic and psycho-physical conditions of the soldiers.
Collegium antropologicum 12/2012; 36(4):1175-82. · 0.61 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background
Primary care has an important role in cardiovascular risk management (CVRM) and a minimum size of scale of primary care practices may be needed for efficient delivery of CVRM . We examined CVRM in patients with coronary heart disease (CHD) in primary care and explored the impact of practice size.
In an observational study in 8 countries we sampled CHD patients in primary care practices and collected data from electronic patient records. Practice samples were stratified according to practice size and urbanisation; patients were selected using coded diagnoses when available. CVRM was measured on the basis of internationally validated quality indicators. In the analyses practice size was defined in terms of number of patients registered of visiting the practice. We performed multilevel regression analyses controlling for patient age and sex.
We included 181 practices (63% of the number targeted). Two countries included a convenience sample of practices. Data from 2960 CHD patients were available. Some countries used methods supplemental to coded diagnoses or other inclusion methods introducing potential inclusion bias. We found substantial variation on all CVRM indicators across practices and countries. We computed aggregated practice scores as percentage of patients with a positive outcome. Rates of risk factor recording varied from 55% for physical activity as the mean practice score across all practices (sd 32%) to 94% (sd 10%) for blood pressure. Rates for reaching treatment targets for systolic blood pressure, diastolic blood pressure and LDL cholesterol were 46% (sd 21%), 86% (sd 12%) and 48% (sd 22%) respectively. Rates for providing recommended cholesterol lowering and antiplatelet drugs were around 80%, and 70% received influenza vaccination. Practice size was not associated to indicator scores with one exception: in Slovenia larger practices performed better. Variation was more related to differences between practices than between countries.
CVRM measured by quality indicators showed wide variation within and between countries and possibly leaves room for improvement in all countries involved. Few associations of performance scores with practice size were found.
BMC Family Practice 10/2012; 13(1):96. DOI:10.1186/1471-2296-13-96 · 1.67 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Patients’ evaluations of primary care are influenced by three major dimensions: patients’, family doctors’ and practices’ characteristics. A lot of primary care practices use possibilities of new information technologies, such as chronic patients’ electronic registers, clinical guideline support systems, electronic medical records and clinical decision system. The aim of this study was to determine possible effects of quality characteristics of family doctors’ practices on patients’ satisfaction.
Health Policy 05/2012; 106(3):269-75. DOI:10.1016/j.healthpol.2012.04.009 · 1.91 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A structural model of burnout syndrome, coping behavior and personality traits in professional soldiers of the Slovene armed forces Strukturni model povezanosti med izgorelostjo, strategijami spoprijemanja s stresom in osebnostnimi značilnostmi pri vojakih Slovenske vojske Izvleček Izhodišča: V študiji smo ugotavljali ustreznost aditivnega in mediacijskega modela povezano-sti med osebnostnimi značilnostmi in spoprije-manjem s stresom pri napovedovanju sindroma izgorelosti med vojaki Slovenske vojske. Aditivni model predvideva, da osebnostne značilnosti in spoprijemanje s stresom medsebojno neodvisno prispevajo k razvoju izgorelosti. Po drugi strani pa mediacijski model nakazuje, da so posame-zniki z določenimi osebnostnimi značilnostmi nagnjeni k manj učinkovitim vrstam spoprije-manja s stresom, ki nato vodijo v izgorelost. Metode: 390 vojakov (87-odstotna odzivnost) je izpolnilo Eysenckove osebnostne lestvice, Vpra-šalnik spoprijemanja s stresom in Vprašalnik iz-gorelosti Maslachove. Rezultati: Strukturno modeliranje je pokazalo ustreznost aditivnega modela. Kot smo predvi-devali, je bila čustvena izčrpanost v pozitivni po-vezavi z nevroticizmom in na čustva usmerjenim spoprijemanjem s stresom. Depersonalizacija je bila povezana s psihoticizmom, občutek delov-ne učinkovitosti pa je bil v pozitivni povezavi z ekstravertiranostjo in na problem usmerjenim spoprijemanjem s stresom ter v negativni pove-zavi z nevroticizmom in na čustva usmerjenim spoprijemanjem s stresom. Zaključki: Za zmanjšanje izgorelosti v vojski bi bilo koristno uvesti treninge učinkovitega spo-prijemanja s stresom in sestaviti podporne sku-pine med vojaki. Takšni ukrepi bi bili še posebej koristni za vojake z občutljivo osebnostno struk-turo (nagnjene k čustveni labilnosti, psihoticiz-mu in introvertiranosti).
[Show abstract][Hide abstract] ABSTRACT: To attempt to develop a model of predictors for quality of the process of cardiovascular prevention in patients at high risk of cardiovascular disease (CVD).
We formed a random sample of patients from a stratified sample of 36 family practice registers of patients at high risk of CVD without diabetes and without established CVD. Data were gathered by chart audit and questionnaires about patient and practice characteristics. We defined the process of care as a dependent variable by principle component analysis and tested the relationship of the process with several independent variables (family physicians', patients', and practice characteristics). To study the effects of independent variables (predictors) on the process of care we carried out multilevel regression analysis with the patients constituting the lower level and nested within the family physician/practice (the second level).
Multilevel regression analysis included 645 patients from 36 practices (74.1% from the final sample). Patients' characteristics that predicted the higher-quality process of CVD prevention were younger age (t=-4.94, 95% confidence interval [CI] -0.018 to -0.008) and lower socioeconomic status (t=-2.18, 95%CI -0.195 to -0.010). Practice characteristics that predicted the higher-quality process of CVD prevention were smaller practice size (t=2.83, 95% CI 0.063 to 1.166), a good information system for CVD prevention (t=3.15, 95% CI 0.030 to 0.282), and the organization of education on CVD prevention (t=3.19, 95%CI 0.043 to 0.380).
This study shows that the quality of cardiovascular prevention could be measured as a composite outcome and future studies should further develop this approach and test the impact of several practice/patient characteristics on the quality of CVD prevention with the international data.
Croatian Medical Journal 12/2011; 52(6):718-27. DOI:10.3325/cmj.2011.52.718 · 1.31 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In the last decade many things have changed in healthcare systems, primary care practices and populations.
To describe evaluations of general practice care by patients with a chronic illness in 2009 and compare these with a previous study done in 1998.
A descriptive analysis of patients' evaluations, using data from the European practice assessment Cardio study on cardiovascular patients in eight European countries in 2009. We compared these evaluations with a subgroup of patients with self-defined chronic illness from the study in 1998, using a linear regression model.
Patients' evaluation of general practice using the EUROPEP questionnaire. The EUROPEP is a 23-item validated measure of patient evaluations of general practice care.
In 2009, 7472 patients from 251 practices participated in the study with an overall response rate of 49.6%. The percentage of patients with positive evaluations (good/excellent) was 80% or higher for all items, except for the waiting time. More positive evaluations were found in older patients, patients with a longer attachment to the practice, patients with a higher self-evaluation of their health, patients with fewer mental health problems and less pain/discomfort. The comparison between 1998 and 2009 showed no overall trends for all countries combined. Whereas English patients became fairly more positive about general practice in 2009, German patients became slightly less positive, although still more positive than English patients.
Overall, the patients' evaluations of general practice were very positive in family practice care in the years 1998 and 2009. The trends over the years need to be carefully interpreted over time.
International Journal for Quality in Health Care 08/2011; 23(6):621-8. DOI:10.1093/intqhc/mzr052 · 1.76 Impact Factor