Davorina Petek

University of Ljubljana, Lubliano, Ljubljana, Slovenia

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Publications (36)19.09 Total impact

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    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
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    Mehmet Ungan, Davorina Petek
    The European journal of general practice 09/2013; 19(3):201-2.
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    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. METHODS: 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. RESULTS: 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 coeff icient 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. CONCLUSIONS: 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. · 1.61 Impact Factor
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    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.
    Implementation Science 01/2013; 8:27. · 2.37 Impact Factor
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    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
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    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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. · 1.61 Impact Factor
  • Davorina Petek, Marija Petek Ster
    The European journal of general practice 09/2012; 18(3):192-3.
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    Marija Petek Ster, Davorina Petek, Hanny Prick
    The European journal of general practice 06/2012; 18(2):123-4.
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    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. This observational cross-sectional study in 36 randomly selected family doctors' practices, stratified to practices' size and urbanization was performed between 2008 and 2009. Each practice included 100 randomly selected adult patients: 30 high-risk patients for CVD, but without a history of CVD, 30 patients with an established coronary disease, and 40 healthy adult patients (aged 18-45 years). Data was collected with a questionnaire, used in European Practice Assessment of Cardiovascular risk management (EPA Cardio study), and with European Patients Evaluation of general practice care (EUROPEP) questionnaire. Final sample consisted of 2482 patients (68.9% response rate). Higher satisfaction scores were associated with worse self-rated patients' health status, with patients visiting practices where quality report was provided, where clinical audit in the past 12 months existed, where number of population attending practice quarterly was lower, where systematic reviewing of prescribed medication was not available, where annual report was not provided, where doctor did not have access to medical literature, and where patients' attendance rate for preventive check-ups was not available. Patients with higher risk for CVD were also more satisfied. The effect of practice characteristics associated with organisational access to services, chronic patients' management and some quality improvement factors is unclear and not always in favour of higher satisfaction score. Further studies are needed.
    Health Policy 05/2012; 106(3):269-75. · 1.51 Impact Factor
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    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).
    Zdravniški vestnik 04/2012; 81(4):326-336. · 0.17 Impact Factor
  • The European journal of general practice 03/2012; 18(1):67-8.
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    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. · 1.25 Impact Factor
  • Wonca; 09/2011
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    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. · 1.79 Impact Factor
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    The European journal of general practice 06/2011; 17(2):135-6.
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    ABSTRACT: Detection and registration of high risk for cardiovascular diseases (CVD) by assessing individual's absolute cardiovascular risk is recommended in clinical guidelines. Effective interventions to reduce cardiovascular risk are available, but not optimally implemented. The aim of this study was to assess the quality of cardiovascular risk-factor recording and lifestyle counselling in high-risk patients in European primary care and to identify factors related to these clinical processes. An international cross-sectional observational study was conducted in stratified samples of primary care practices in nine European countries. Patient records were audited, using a structured data-abstraction tool based on internationally developed quality indicators. To identify factors associated with the recording, additional data were collected in a patient survey. Descriptive and multilevel data analyses were conducted. In 268 general practices across Europe, 3723 records of individuals at high risk for cardiovascular diseases were audited. We found important variations in the quality of documentation of risk factors and lifestyle interventions. Recording of risk factors was best for blood pressure (92.5% of audited records, 95% CI 0.89-0.96). Lifestyle advice was recorded best for smoking cessation (65.6%, 95% CI 0.58-0.73) and worst for physical activity (38.8%, 95% CI 0.31-0.47). Of the study population, 50.6% (0.42-0.59) had elevated blood pressure levels, 59.8% (0.51-0.69) had total cholesterol >5 mmol/l, and 30.5% (0.22-0.39) were smokers. Multivariate analyses showed that recording of risk factors and counselling were related to specific patient characteristics more than to country effects. Analysis of different country results can be helpful for developing quality-improvement strategies.
    European journal of preventive cardiology. 03/2011; 19(2):258-66.
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    ABSTRACT: The Research Agenda should be used as a key reference point to which new research should relate its usefulness and added value. Primary care evolves towards more interdisciplinary care, and research should focus more on the core competency of person-centred team care. There is an urgent need to develop clear definitions and appropriate research instruments for this domain. It will be a particular challenge to study comprehensive approaches in primary-care patients with multi-morbidity. The Research Agenda and the commentaries on it show future directions for primary care research. There are challenges related to a changing society, the shared responsibility and guidance of research by professionals and citizens (patients), and the need to fully integrate research as part of primary healthcare provision. There will be a need for a prioritization of spearheads to guide primary care research for the next decade: translational research, research on equity and health differences, on chronic disease and health systems research. This can not be realized without the development and maintenance of a solid research infrastructure: easily maintained and accessed observational databases, helpful information technology, strategies and techniques for patient involvement, advanced research training possibilities, and the development and validation of appropriate research instruments and outcome measures to capture the different challenges. Worldwide, primary care not only is a priority for health care policy, but it needs to become a research priority as well.
    The European journal of general practice 02/2011; 17(1):58-61.
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    ABSTRACT: Problem: The main objectives of this study were to identify differences in the psychosocial status of military personnel who had and who had no traumatic event experience, and to screen for potential mental health vulnerability related to post-traumatic stress. Methods: 390 military personnel were included in the study, with 103 of them reporting traumatic event experience. The Mini-International Neuropsychiatric Interview Screening for Post-Traumatic Stress Disorder, the CAGE instrument, the Eysenck Personality Scales, the Folkman-Lazarus Ways of Coping Questionnaire, the Rosenberg Self-Esteem scale and self-evaluative questions about important relationships were administered. Results: The respondents who reported traumatic event experience (TEE) also reported a significantly higher frequency of other stressful events, a significantly more frequent past history of depression (16.5 % of respondents with TEE and 6.2 % of respondents without TEE) and significantly higher risky alcohol drinking; the latter, however, is not higher than the estimate for the total Slovenian population (10.7 % of respondents with TEE and 2.7 % of participants without TEE). Respondents with TEE smoke less frequently than respondents who reported no TEE (46.6 % vs. 60.1 %), and more often rely on self in stressful situations. There was no significant difference between the respondents with reported TEE and those without TEE in their personality traits, coping styles, and self-esteem, or in the majority of job-and family-related factors. No difference was found between male and female personnel as concerns intra-personal factors and in stress-related behaviour. Conclusions: Intra-personal factors (personality, coping styles, and self-esteem) of military personnel indicate good personal potential for resilience. Stress-related substance (ab)use, especially smoking rates well above the Slovenian average, need further attention. Professional support needs to be promoted, especially in female personnel, who are less likely than men to seek social support in times of stress, and in military personnel exposed to cumulative stressors.
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    ABSTRACT: The recently published 'Research Agenda for General Practice/Family Medicine and Primary Health Care in Europe' summarizes the evidence relating to the core competencies and characteristics of the Wonca Europe definition of GP/FM, and highlights related needs and implications for future research and policy. The European Journal of General Practice publishes a series of articles based on this document. In a first article, background, objectives, and methodology were discussed. In three subsequent, articles the results for the six core competencies of the European Definition of GP/FM were presented. This article formulates the common aims for further research and appropriate research methodologies, based on the missing evidence and research gaps identified form the comprehensive literature review. In addition, implications of this research agenda for general practitioners/family doctors, researchers, research organizations, patients and policy makers are presented. The concept of six core competencies should be abandoned in favour of a model with four dimensions, including clinical, person related, community oriented and management aspects. Future research and policy should consider more the involvement and rights of patients; more attention should be given to how new treatments or technologies are effectively translated into routine patient care, in particular primary care. There is a need for a European ethics board. The promotion of GP/FM research demands a good infrastructure in each country, including access to literature and databases, appropriate funding and training possibilities.
    The European journal of general practice 12/2010; 16(4):244-8.

Publication Stats

142 Citations
19.09 Total Impact Points

Institutions

  • 2007–2013
    • University of Ljubljana
      • Department of Family Medicine
      Lubliano, Ljubljana, Slovenia
  • 2011
    • Universität Heidelberg
      • Department of General Medicine and Health Services Research
      Heidelberg, Baden-Wuerttemberg, Germany
  • 2007–2011
    • University of Antwerp
      • Eerstelijns- en interdisciplinaire zorg
      Antwerpen, VLG, Belgium
  • 2009–2010
    • Hannover Medical School
      • Institute for General Practice
      Hannover, Lower Saxony, Germany