[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. 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
[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. 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
[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.
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
[show abstract][hide abstract] ABSTRACT: AIM: To survey attitudes towards prescribing statins in a family practice setting and to develop an explanatory model of determinants
for prescribing statins. METHODS: A random sample of 250 GPs were drawn from a Slovenian Family Medicine Society register
and were contacted by anonymous postal questionnaire between June and October 2006. RESULTS: We found no major differences
in decisions among the GPs with regard to their age, sex or time in general practice. We identified six factors that influence
statin prescribing behavior in GPs and explain 63.5% of the variation: efficacy and utility explained 14.9% of the variation,
personal involvement in drug promotional activities accounted for a further 14.3%, attitudes towards drug marketing 10.3%,
patient expectations 9.5%, drug price 8.1% and peer pressure 6.5%. CONCLUSIONS: The determinants that influence statin prescribing
behavior among GPs in our study covered an array of explanatory items consistent with proposals in the literature but factors
differ to some extent from proposed theoretical models. The explanatory model explained a high proportion of the variation
in deciding on a particular statin. Efficacy and safety remain important factors in selection of an appropriate drug but are
far from being the most or only important factors.
KeywordsHydroxymethylglutaryl-CoA reductase inhibitors-Hypercholesterolemia-Cardiovascular disease-Prevention-Family practice
Wiener klinische Wochenschrift 04/2012; 122:79-84. · 0.81 Impact Factor
[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. · 1.25 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. · 1.79 Impact Factor
[show abstract][hide abstract] 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.
[show abstract][hide abstract] 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.
[show abstract][hide abstract] ABSTRACT: To assess whether demographic characteristics, self-rated health status, coping behaviors, satisfaction with important interpersonal relationships, financial situation, and current overall quality of life are determinants of sick leave duration in professional soldiers of the Slovenian Armed Forces.
In 2008, 448 military personnel on active duty in the Slovenian Armed Forces were invited to participate in the study and 390 returned the completed questionnaires (response rate 87%). The questionnaires used were the self-rated health scale, sick leave scale, life satisfaction scale, Folkman-Lazarus' Ways of Coping Questionnaire, and a demographic data questionnaire. To partition the variance across a wide variety of indicators of participants' experiences, ordinal modeling procedures were used.
A multivariate ordinal regression model, explaining 24% of sick leave variance, showed that the following variables significantly predicted longer sick leave duration: female sex (estimate, 1.185; 95% confidence interval [CI], 0.579-1.791), poorer self-rated health (estimate, 3.243; 95% CI, 1.755-4.731), lower satisfaction with relationships with coworkers (estimate, 1.333; 95% CI, 0.399-2.267), and lower education (estimate, 1.577; 95% CI, 0.717-2.436). The impact of age and coping mechanisms was not significant.
Longer sick leave duration was found in women and respondents less satisfied with their relationships with coworkers, and these are the groups to which special attention should be awarded when planning supervision, work procedures, and gender equality policy of the Armed Forces. A good way of increasing the quality of interpersonal relationships at work would be to teach such skills in teaching programs for commanding officers.
Croatian Medical Journal 12/2010; 51(6):543-51. · 1.25 Impact Factor
[show abstract][hide abstract] ABSTRACT: Aim To assess whether demographic characteristics, self-rated health status, coping behaviors, satisfaction with im-portant interpersonal relationships, financial situation, and current overall quality of life are determinants of sick leave duration in professional soldiers of the Slovenian Armed Forces. Methods In 2008, 448 military personnel on active duty in the Slovenian Armed Forces were invited to participate in the study and 390 returned the completed question-naires (response rate 87%). The questionnaires used were the self-rated health scale, sick leave scale, life satisfaction scale, Folkman-Lazarus' Ways of Coping Questionnaire, and a demographic data questionnaire. To partition the vari-ance across a wide variety of indicators of participants' ex-periences, ordinal modeling procedures were used. Results A multivariate ordinal regression model, explain-ing 24% of sick leave variance, showed that the following variables significantly predicted longer sick leave duration: female sex (estimate, 1.185; 95% confidence interval [CI], 0.579-1.791), poorer self-rated health (estimate, 3.243; 95% CI, 1.755-4.731), lower satisfaction with relationships with coworkers (estimate, 1.333; 95% CI, 0.399-2.267), and lower education (estimate, 1.577; 95% CI, 0.717-2.436). The im-pact of age and coping mechanisms was not significant. Conclusion Longer sick leave duration was found in wom-en and respondents less satisfied with their relationships with coworkers, and these are the groups to which special attention should be awarded when planning supervision, work procedures, and gender equality policy of the Armed Forces. A good way of increasing the quality of interper-sonal relationships at work would be to teach such skills in teaching programs for commanding officers.
[show abstract][hide abstract] ABSTRACT: With free movement of labour in Europe, European guidelines on cardiovascular care and the enlargement of the European Union to include countries with disparate health care systems, it is important to develop common quality standards for cardiovascular prevention and risk management across Europe.
Panels from nine European countries (Austria, Belgium, Finland, France, Germany, Netherlands, Slovenia, United Kingdom and Switzerland) developed quality indicators for the prevention and management of cardiovascular disease in primary care. A two-stage modified Delphi process was used to identify indicators that were judged valid for necessary care.
Forty-four out of 202 indicators (22%) were rated as valid. These focused predominantly on secondary prevention and management of established cardiovascular disease and diabetes. Less agreement on indicators of preventive care or on indicators for the management of hypertension and hypercholesterolaemia in patients without established disease was observed. Although 85% of the 202 potential indicators assessed were rated valid by at least one panel, lack of consensus among panels meant that the set that could be agreed upon among all panels was much smaller.
Indicators for the management of established cardiovascular disease have been developed, which can be used to measure the quality of cardiovascular care across a wide range of countries. Less agreement on how the quality of preventive care should be assessed was observed, probably caused by differences in health systems, culture and attitudes to prevention.
European Journal of Cardiovascular Prevention and Rehabilitation 09/2008; 15(5):509-15. · 2.63 Impact Factor