Screening and Registering Patients with Asthma and Copd in Slovenian Primary Care: First Results.

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(2)) test was used to analyse the difference between the phases. RESULTS: The frequency of asthma was 2.12%, while the frequency of COPD was 1.15% throughout the study period. For both diseases, more than 30% of patients were newly diagnosed. CONCLUSIONS: The project of implementing Family Medicine MPs in the area of COPD has given first positive results and the project is still ongoing to its full implementation.

New tool for patient evaluation of nurse practitioner in primary care settings.

AIMS AND OBJECTIVES: To validate a tool for patient evaluation of nurse practitioners. BACKGROUND: The roles of nurse practitioners in family practice settings are health promotion and routine follow-up of patients with chronic diseases. So far, several tools for patient evaluation of nurse practitioners have been developed. They revealed several dimensions of nurse practitioners' work and high levels of patient satisfaction with their work. The studies also reported conflicting data on the associations between demographic and other variables and the level of nurse practitioners' evaluation by patients. DESIGN: A cross-sectional study. METHODS: This study was performed in a sample of seven model family medicine practices in Slovenia. We included 30 consecutive adult patients in each model family practice aiming at the final sample of 210 respondents. Patient evaluation of nurse practitioners was assessed using a Nurse Practitioner Evaluation Scale. RESULTS: The response rate was 80·9%. Mean total score on Nurse Practitioner Evaluation Scale was 87·9 ± 12·4 points. Cronbach's alpha of Nurse Practitioner Evaluation Scale was 0·941. Factor analyses revealed three factors: clinical approach factor, comprehensive approach factor and patient-centred approach factor. CONCLUSIONS: Nurse Practitioner Evaluation Scale proved to be a reliable tool for patient evaluations of nurse practitioners in primary care settings. Nurse Practitioner Evaluation Scale can be used in terms of a whole scale as well as in terms of three separate subscales. RELEVANCE TO CLINICAL PRACTICE: This newly developed tool can be used to monitor quality performance of nurse practitioners and to plan quality improvement actions in nurse practitioners' performance in primary care settings.

Slovenian adaptation of the original AUDIT-C questionnaire.

BACKGROUND: Alcohol Use Disorders Identification Test Consumption (AUDIT-C) questionnaire as a screening instrument for identification of hazardous and harmful drinkers give some false-positive and negative results. Changes of answers decrease the number of false results. METHODS: Changes in second and third questions with theoretical simulation of possible answers' combinations was made; cutoff scores have to be changed. Study with original and adapted AUDIT-C was conducted among 298 students to analyze the differences. RESULTS: Adapted Slovenian version of AUDIT-C gives less false-positive and less false-negative results. CONCLUSIONS: Changes of AUDIT-C questionnaire that give less false results means less potential disharmony in doctor-patient relationship, less unnecessary questioning, less time spent inadequately, and also less missed hazardous drinkers.

Opinions of Slovenian family physicians on medically unexplained symptoms: a qualitative study.

OBJECTIVES: To determine the views of Slovenian family physicians on medically unexplained symptoms (MUS) and learn more about potential types of treatment for such patients. METHODS: Five focus groups, comprising 24 family medicine physicians (FMPs) from two Slovenian University centres, were convened. Conversations were led towards the research objectives by professionally trained researchers and followed a preliminarily established protocol. Qualitative content analysis of audio and transcripts of the discussions was performed using ATLAS.ti software to establish categories ('codes') relevant to issues regarding MUS. RESULTS: Slovenian FMPs emphasized the importance of good communication and trust between physicians and patients with MUS. Systemic barriers to effective management of MUS arising from the Slovenian health system were highlighted. FMPs stressed the need for more education in the recognition and treatment of MUS in primary care. From the discussions, 64 codes comprising broader research fields of MUS were developed, then grouped into a further eight categories: communication; doctor-patient relationship; causes of MUS; patient characteristics; physician characteristics; courses of action so far; positive relationship with patients; proposals for treatment. CONCLUSIONS: The results are valuable in terms of investigating the treatment of patients with MUS in Slovenia, thereby opening new avenues of research on the subject of MUS.

Family doctors' views of pharmaceutical sales representatives: assessment scale development.

BACKGROUND: The prescribing patterns depend on the physicians' attitudes and their subjective norms towards prescribing a particular drug, as well as on their personal experience with a particular drug. The physicians are affected by their interactions with pharmaceutical industry. OBJECTIVE: The objectives were to develop a scale for assessment of pharmaceutical sales representatives (PSRs) by the family doctors (FDs) and to determine factors for their evaluation. METHOD: Cross-sectional anonymous postal study. We included a random sample of 250 Slovenian FDs. Settings. Slovenian FDs' surgeries. MAIN OUTCOME MEASURE: The score of various items regarding FDs' assessment of PSRs on a 7-point Likert scale. RESULTS: We got 163 responses (65.2% response rate). The most important characteristic of PSRs, as rated by respondents on the scale from 1 to 7, was the fact that they did not mislead when presenting products' information. The second most important characteristic was the ability to provide objective information about the product. The first three most important characteristics, as rated by the respondents by themselves, were 'Shows good knowledge on the promoted subject', 'Provides objective product information' and 'Makes brief and exact visits'. Cronbach's alpha of the composite scale was 0.844. Factor analysis revealed three PSRs' factors: selling skills, communicating skills and sense of trustworthiness. CONCLUSION: FDs evaluate PSRs mainly by their managerial skills and trustworthiness. The scale proved to be a reliable tool for assessing PSRs by FDs.

Why do general practitioners not screen and intervene regarding alcohol consumption in Slovenia? A focus group study.

AIM: To identify barriers influencing general practitioners' decisions regarding alcohol screening and brief intervention (SBI) in Slovenia. BACKGROUND: Slovenia occupies third place in a league of 51 European countries with respect to alcohol consumption. General practitioners in Slovenia have the majority of contacts with patients in primary healthcare but they rarely or never ask patients about their drinking habits. METHOD: Six focus groups with a total of 32 general practitioners from different parts of the country were set up. Participants discussed varied topics and the most significant barriers were identified through qualitative analysis. RESULTS: The identified barriers were lack of funding, absence of societal support, lack of knowledge and guidelines, inadequate counselling skills, different interpretations regarding definitions of what constitutes an alcoholic beverage, lack of time, alcohol screening not considered to be an integral part of general practice, personal characteristics of general practitioners, patients' unwillingness to participate in SBI, and ethical dilemmas. CONCLUSION: Lack of knowledge and guidelines, and inadequate counselling skills can be solved through educational programs. In order to change drinking habits, substantial changes in public and personal attitudes towards alcohol consumption, involving many partners, are necessary.

Glasgow Coma Scale in acute poisonings before and after use of antidote in patients with history of use of psychotropic agents.

INTRODUCTION: Data on emergency interventions in poisonings are scarce. Objective To determine the effectiveness of antidote therapy in acute poisoning-related emergency medical services (EMS) interventions. METHODS: A prospective observational study included all poisoning-related intervention cases over 3 years (1999-2001) in the Celje region, Slovenia, covering 125,000 inhabitants. Data were recorded on an EMS form. RESULTS: Psychoactive agents were present in 56.5% out of 244 poisoning-related EMS interventions. Prescription drugs were a cause of intoxication in 93 (39.2%) cases alone or in combination with alcohol or illegal drugs. More than one fifth of poisonings were due to the use of illegal drugs in 52 (21.9%) cases, 43 (18.1%) out of them heroin related. At the time of EMS arrival, more patients who ingested illegal drugs were in coma or comatose than the rest. 24 (45.3%) vs. 32 (17.3%) of poisoned patients were in coma (p < 0.001). Glasgow Coma Scale (GCS) at the first contact was lower in patients who ingested illegal drugs than in the remaining patients (9.0 vs. 11.6, p = 0.001). In 23.2% of the cases, an antidote was administered. In 29 (12.2%) naloxone and in 16 (6.7%) flumazenil was administered. Mean GCS after intervention was higher in all cases but significantly higher in illegal drug cases, 13.4 vs. 12.2 (p = 0.001), with a mean positive change in GCS of 4.5 vs. 0.6 (p < 0.001). In illegal drug users, mean change after antidote administration was 8.2 vs. 0.5 without antidote administration (p < 0.001). CONCLUSION: High rate of successful antidote use during the intervention indicated the importance of good EMS protocols and the presence of a skilled doctor in the EMS team.

Aetiological and demographical characteristics of acute poisoning in the Celje region, Slovenia.

BACKGROUND: Data on emergency treatment of poisonings are scarce. OBJECTIVE: To determine the annual rate of poisoning-related emergency medical services (EMS) interventions and to determine the aetiology and demographic characteristics of poisoning cases. METHODS: A prospective observational study included all poisoning-related intervention cases over 3 years (1999-2001) in the Celje region, Slovenia, covering 125 000 inhabitants. Data were recorded on an EMS form. RESULTS: Two hundred and forty-four poisoning-related EMS interventions were recorded among a total of 4486 interventions (5.4%) corresponding to an average annual rate of 0.56 poisonings per 1000 inhabitants per year. Psychoactive agents were detected in 56.5% of the cases. Two-thirds of the poisonings took place outside patients' home. In 30% of the cases, the administration of poison was because of suicidal intentions. The most common substance ingested was alcohol alone or in combination with prescription or illegal drugs in 42.6% of cases, followed by drugs alone or in combination with alcohol in 39.2% cases. More than one-fifth of the poisonings were because of the use of illegal drugs. At the time of the arrival of EMS 23.5% of the patients were in coma. EMS applied antidote in 23.2% of the patients. After emergency care, 9.3% of the patients were still in coma, 15.6% were comatose, 26.6% were somnolent, 18.6% were disoriented and 30% had complete consciousness. Of these, 84.4% of the patients were admitted to hospital or specialized care and 15.6% were sent back home. CONCLUSION: The pattern of poisoning is contrasted with that in other countries. The EMS proved to be a valuable resource for treatment of acute poisoning.