European Perspective on How Social Prescribing Can Facilitate Health and Social Integrated Care in the Community.

Social Prescribing is a mechanism by which primary care team members can refer patients to community groups to improve their health and well-being. It integrates health, social care, and community, allowing patients to actively improve their health and well-being by participating in community initiatives and activities. These activities have traditionally been part of community life in European countries, and the benefits need to be consistently recognized.

Patient consultations during SARS-CoV-2 pandemic: a mixed-method cross-sectional study in 16 European countries.

INTRODUCTION: Remote consultations help reduce contact between people and prevent cross-contamination. Little is known about the changes in consultation in European rural primary care during the SARS-CoV-2 (COVID-19) pandemic. The purpose of this mixed-methods cross-sectional study was to find out more about the effects of the pandemic on changes in patient consultations in European rural primary care. METHODS: A key informant survey from 16 member countries of the European Rural and Isolated Practitioners Association (EURIPA) was undertaken using a self-developed questionnaire. The steering committee of this project, called EURIPA Covid-19 study, developed a semi-structured questionnaire with 68 questions, 21 of which included free-text comments. Proportions were calculated for dichotomized or categorized data, and means were calculated for continuous data. Multivariate analysis by logistic regression model was used to assess the association of multiple variables. RESULTS: A total of 406 questionnaires from primary care providers (PCPs) in 16 European countries were collected; 245 respondents (60.5%) were females, 152 PCPs were rural (37.5%), 124 semi-rural (30.5%). Mean age of the respondents was 45.9 years (standard deviation (SD) 11.30) while mean seniority (length of experience) was 18.2 years (SD 11.6). A total of 381 (93.8%) respondents were medical doctors. Significant differences were found between countries in adopting alternative arrangements to face-to-face consultation: remote teleconsultation is well appreciated by both healthcare professionals and patients, but the most common way of remote consultation remains telephone consultation. A factor significantly inversely associated with the adoption of video consultation was the seniority of the PCP (odds ratio 1.19, 95% confidence interval 1.02-1.40, p=0.03). CONCLUSION: Telephone consultation is the most common form of remote consultation. The adoption of video-consultation is inversely related to the seniority of the informants.

Effectiveness of letters to patients with or without Cochrane blogshots on 10-year cardiovascular risk change among women in menopausal transition: 6-month three-arm randomized controlled trial.

BACKGROUND: Health information and patient education on lifestyle changes may have a positive effect on the prevention of many chronic conditions, especially cardiovascular diseases (CVDs). We performed a parallel, three-arm randomized controlled trial (RCT) of 6-month educational intervention in a form of letters containing a reminder of the participant's CVD risk with or without Cochrane blogshots to reduce CVD risk among women aged 45-65 with one or more known CVD risk factors. METHODS: The control group received a letter about their CVD risk at the beginning of the trial. The intervention groups received the initial letter about their CVD risk and remainder letters about their CVD risk every 2 months, with or without Cochrane blogshots: (1) effect of calcium in the prevention of high blood pressure, (2) effect of reducing saturated fat acids in eating habits, and (3) effects of green and black tea in CVD prevention. The primary outcome was CVD risk reduction calculated as the difference between the baseline and 6-month score for a 10-year risk of fatal CVD according to the ACC/AHA guidelines. RESULTS: After both interventions, CVD risk reduction was significantly higher compared to the control group (P < 0.001, Kruskal-Wallis H test). The number of participants who decreased their CV risk was 29% (20/70) in the control group, 69% (48/70) in the group receiving the reminder letters, and 70% (49/70) in the group receiving the reminder letters and blogshots. The number needed to treat to achieve risk reduction was 2.41 (95% CI = 1.77 to 3.78) for letters with a CVD risk reminder and 2.50 (1.81 to 4.03) for letters with a reminder and a blogshot. The group receiving reminder letters with Cochrane blogshots had a significant change in the category of CVD risk, mainly from high to moderate and from moderate to low CVD risk category. CONCLUSIONS: A simple and inexpensive intervention method in a form of letters reminding women about their CVD risk with or without providing additional health information in the form of Cochrane blogshots about interventions for important CVD risk factors may be effective in CVD management and could be considered by primary care providers. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04601558. Retrospectively registered on October 19, 2020.

Psychosocial effects of the quarantine during the first wave of the COVID-19 pandemic on the residents of the island of Brac.

BACKGROUND: An unprecedented health and economic crisis in small island communities during the COVID-19 pandemic indicated the importance of studying its harmful effects on residents' mental health. OBJECTIVES: To examine the differences in negative affectivity, perceived stressors, and social support both on the quarantined and not quarantined islands. METHODS: A web-based survey and correlational cross-sectional research design were used, based on a nonprobabilistic convenience sampling method to select 613 Croatian islands' residents during May 2020. The participants completed the Depression, Anxiety and Stress Scale (DASS-21) and the General Information Questionnaire, data on their exposures to stressors during the COVID-19 pandemic and the perceived social support. RESULTS: Compared with the nonquarantined residents of other islands, the island of Brac residents scored significantly higher on the symptoms of depression (M = 11.61; t = 2.13, P < 0.05) and stress (M = 13.06; t = 3.21, P = 0.001) subscales, receiving more support from religious communities (t = 2.34, P = 0.02) and less from the physicians (t = -2.68, P = 0.01). Lower sociodemographic status was associated with higher levels of depression, anxiety, and stress. CONCLUSION: The COVID-19 pandemic highlighted the urgent need to protect mental health in isolated island areas specially for singles and people of low socioeconomic status.

BACKGROUND: This study contributed to the recognition and understanding of the pandemic's impact on the mental health of the isolated island population. The aim was to examine the differences in perceived stressors, perceived social support, and negative affectivity (symptoms of depression, anxiety, and stress) between residents of Brac directly affected by the COVID-19 pandemic and residents of other islands not directly exposed to the pandemic. METHODS AND EXAMINEES: A total of 613 inhabitants of the Croatian islands were included in the analysis during pandemic in May 2020. All participants answered web-based survey about perceived stressors, social support, and psychological symptoms. RESULTS: Staying on the quarantined island during the pandemic significantly contributed to the levels of depressive, anxiety, and stress symptoms. It also highlighted the positive impact of connections with family members and the religious community as well as the negative impact of lower socioeconomic status on adaptation in times of pandemic. CONCLUSION: Despite the short duration, the psychological effects of a pandemic were more visible in residents of an island affected by a pandemic compared with residents of other islands not exposed to COVID-19 pandemic.

Effectiveness of treatment of newly diagnosed hypertension in family medicine practices in South Croatia.

BACKGROUND: Uncontrolled blood pressure remains an urgent issue in clinical practice worldwide. This study aimed to compare the characteristics and effectiveness of hypertension control in family medicine pratice in the first treatment year, in relation to the geographical position, socio-economic standard, and access to medical services and public pharmacies in urban, rural and island environments (city of Split vs. Dalmatian Hinterland vs. islands in Southern Croatia). METHODS: A historical cohort study included 213 patients diagnosed from 2008 to 2014 with essential arterial hypertension (AH) and without related complications or diabetes mellitus. Each patient was followed up for 365 days from the visit when the diagnosis of hypertension was ascertained. Normotension was defined as arterial pressure < 140/90 mmHg. The annual cost of drugs prescribed for treating newly diagnosed hypertensive patient and the total price for defined daily dose per patient were also evaluated. RESULTS: More than half patients achieved normotension within a year from the initial diagnosis in all family medicine practices (57.3%), without significant differences among the three geographic regions (P = 0.981). Higher initial systolic blood pressure was a positive predictive prognostic factor on achieveing normotension (odds ratio (OR) 0.96, 95% confidence interval 0.95-0.98). ACE inhibitors were the most commonly prescribed antihypertensive agents in monotherapy (35.1%), as well as considering overall prescriptions (25.2%). Calcium channel blockers were the most commonly prescribed initial BP-lowering single agents in urban areas (28.6%), whereas angiotensin-converting enzyme inhibitors were more common in rural (28.0%) and island areas (22.7%) (P = 0.037). The median annual antihypertensive drug cost was 169.4 (95% CI 151.5-201.8) Croatian kunas and was similar across the study sites. CONCLUSION: Multiple antihypertensive drugs, prescribed in accordance with the guidelines, lead to similar pharmacological effects. Primary care physicians seem to be able to overcome potential interfering socio-economic factors and successfully achieve normotension in newly diagnosed patients with uncomplicated AH after 1 year of treatment.

Writing letters to patients as an educational tool for medical students.

BACKGROUND: Despite rapid growth and development of medical technology, personal relationship between the patient and physician remains the basis of high quality treatment. The aim of our study was to develop, implement and evaluate patient therapeutic letters written by students as a tool in teaching family medicine. METHODS: The study included all 6th year students attending their rounds in family medicine, structured into two 10-day cycles, one in urban offices and one in offices on the Adriatic islands (rural). After receiving detailed instructions, students wrote letters to two patients after a consultation in the office. The letters were audited by patients and 3 family medicine experts who used a grading instrument (scale 0 - poor, 1 - medium, 2 - good) for 1) adequacy and clarity of description of patients' disease/state, 2) knowledge, 3) adequacy of recommendations, 4) courtesy and respect and 5) language and style. Patients and experts were also asked to underline phrases they thought would be difficult to understand; the underlined text was subjected to content analysis. RESULTS: Both the patients and the experts gave high scores for the value and quality of the letters in terms of the description of the problem, adequacy of recommendations given, and courtesy and respect (mean (±standard deviation) 5.65 ± 0.79 for patients vs. 4.87 ± 0.79 for experts out of maximum score of 6). Family medicine experts were stricter than patients in their evaluation of the content of the letters (adequacy and clarity of disease description (P < 0.001) and adequacy of recommendations (P < 0.001). Both the patients and the experts seemed to like longer letters as the length of the letter showed significant positive correlation with the quality summary score (correlation r = 0.492 vs. r = 0.338, respectively, P < 0.010). Overlapping of the text underlined as difficult to understand by patients and experts was found in 10 (11.6%) out of 86 letters. The highest overlap (20 terms) was found for the category "Technical terms unclear to a lay reader". CONCLUSIONS: Writing of a letter to their first patients may be a useful tool for students to personally experience the practice of medicine and establish better partnership with patients in health care.

Job satisfaction among medical doctors in one of the countries in transition: experience from Croatia.

Our aim was to explore and compare the job satisfaction between family physicians and hospital specialists in Split, Croatia. The survey was carried out in 2005 and 2006. A validated questionnaire was composed of two parts: 92 statements and questions about job satisfaction in the form of a Lickert scale (range 1-5) and eight questions concerning demographic issues. The questionnaire was completed and returned by 165 hospital specialists from the University Hospital and by 131 family physicians from the Split County. Response rate for family physicians was 39.81% and 41.46% for hospital specialists. Hospital doctors were divided in two groups: internal and surgical. There were no significant differences between family physicians and hospital specialists in total job satisfaction (F = 1.02; p = 0.41). Family physicians were more satisfied with their workplace conditions than internal medicine specialists (19.37 +/- 4.23 vs. 17.37 +/- 4.59; F = 5.93; p = 0.003), and less satisfied with the possibilities for postgraduate training than surgeons (5.27 +/- 1.90 vs. 6.59 +/- 2.07; F = 9.26; p < 0.001). Global job satisfaction was rather low but does not differ between the three medical groups. Disparities were observed in some segments (opportunity for further training and academic advancement, vacation, and salary). The reason for the family physician's relative satisfaction may be due to stable working conditions, independence in organizing work schedules and personal responsibility.

[The characteristics of depression in the elderly]. / Karakteristike depresije u starijih osoba.

UNLABELLED: Depression is a patologic condition found in all age groups, including the elderly. It is not a normal part of aging. Because of the various symptoms and signs and gradual course of depression, it is very often unrecognized. PATIENTS AND METHODS: Study group included 223 patients aged over 65, who visited their family doctor at Postira and Milna clinics, island of Brac, in period from December 1, 2003 till March 1, 2004. Study subjects filled out three questionnaires: personal data, geriatric depression scale, and a short questionnaire about pain, designed by the Croatian Society for Pain Control. RESULTS: According to the score on the geriatric depression scale, 15% of patients had symptoms of severe depression and 34% of mild depression. Both sexes were equally represented. In those with depression, anxiety, irritability and nervousness were markedly expressed as compared with those without depression. In patients with ICV, the symptoms of depression were considerably more pronounced than in healthy population. The experience of pain was much more intense in depressive subjects. Painkillers were much more effective in the group of nondepressed subjects. In the depressed group, insomnia, insecurity and disturbing thoughts about future disease were more intense. Interpersonal relationships were disturbed, and the quality of life impaired due to the pain. CONCLUSION: Primary care physician is mostly the doctor of first contact for the elderly. Therefore, it is very important that general practitioners know how to recognize depressive symptoms.

[Medical students' interest in general practitioners career]. / Stavovi studenata medicine o zvanju obiteljskog lijecnika.

AIM: To assess the reasons for entering medical school, to explore the attitudes and opinions of final year students regarding medical education and their future career preferences, including family medicine. METHODS. During four years period, 111 (73%) final year students of Split Medical School were surveyed [31 (96,8%) of them in academic year 1996/7, 23 (62%) in 2001/2, 30 (62,5%) in 2003/4 and 27 (77%) in 2004/5]. Semi-structured questionnaire about motivations and expectations was used and answered during the family medicine course. RESULTS: . Most of the students 59/111 (53%) entered medical school by their own wish, 34 (31%) were not sure about their choice at the entry and in 17 (16%) students, it was a result of circumstances. The main motivations were interest in medical knowledge (35.6%) and (24.8%) desire to work with patients and to help people. Clinical specialization was the future career of first choice in 62%, family medicine in 16.2% of them, while 16.2% were still undecided. In rating social esteem and reputation (scale 1-6), the students rated surgeons on average: surgeon 5.48, cardiologist 4.85, gynaecologist 4.6, psychiatrist 2.70, family physician 2.30 and specialist in preventive medicine 1.27. DISCUSSION: The essential reasons to enter a medical school are humanistic and not socioeconomic. Students prefer clinical specializations to family medicine. Final year medical students from Split Medical School suggest more practical work and field practice in order to improve the study quality. CONCLUSION: Although the majority of the polled students stated to have chosen medicine for humanistic reasons, more than half of them prefer to work in a hospital, and less than quarter as family physician in a city. Substantial changes in curriculum including an early contact with family physicians could motivate medical students to select family medicine as their future career more often.

Do we need the "adolescent crisis" diagnosis?

The aim of the study was to examine patients in adolescent crisis at the beginning of treatment and after a period of 12 months in order to evaluate the relative diagnostic and therapeutic validity. The study included 153 Split University students in adolescent crisis; 90 of them were treated by counseling and 63 served as controls. For diagnosis, Hampstead index and Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) multiaxial evaluation were used, allowing a wider insight into personal functioning. The study sample was split in 7 significantly different diagnostic subgroups. The counseling-treated examinees had better personality functioning after 12 months, but did not differ significantly from the control group. Some of their single functions were more severely disturbed at the very beginning. Counseling is a valuable therapeutic and diagnostic tool for adolescent crisis. The assessment must evaluate the entire person, because looking at only one aspect, due to different development and its place, a wrong conclusion may be reached. The "adolescents crisis" entity is clinically relevant.