Nine-year trends in the morbidity of mental disorders and psychotropic drug utilization in Croatia: over-diagnosis and over-utilization?

Overall drug overuse, including psychotropic, is the Croatian reality. Therefore, in between 2000 and 2012, the interventions to control drug overspending were undertaken. The main aims of the study are: to determine the morbidity trends of mental disorders registered in family medicine (FM), the trends in psychotropic drug utilization and to identify whether the trends of utilization have any relation to the interventions. The results indicate that mental disorders represent a high disease burden in Croatia. It was also present a higher burden of psychotropic drug utilization; second ranked in the total drug utilization during the nine-year follow up period. The utilization of psycholeptic's, was even higher; from 2004 to 2008; those drugs were ranked first in terms of utilization. Between 20-25% of Croatia's total health care budget is usually spent on drugs. The interventions that are currently being implemented to control drug utilization have not brought about any changes.

A role of family doctors in taking care of men's health.

The aim of this study was to investigate, based on routinely collected data, the scope of family doctors work in the field of men's health. Based on the Croatian Health Service Yearbook in the period from 1995 to 2012, we collected the morbidity data related to male urogenital disorders. The total number of urogenital disorders almost doubled, but the number of diagnoses related to the men increased fourfold, mostly among the oldest patients. The number of prostate hyperplasia increased fivefold, again among the oldest people. The morbidity from other male-specific diseases increased threefold, mostly in the age group 7-19 years. In spite of the increase in the number of newly diagnosed cases of prostate cancer, the percentage of the deaths stabilized after 2001. Men's health problems are frequent sees and with an upward trend. We are not sure if this means deterioration of men's health, or just indicates the problem of "overdiagnosis".

Exacerbation of chronic obstructive pulmonary disease: a role of antibiotics?

In order to discuss a role of antibiotics, a 73-year old patient was presented, having an exacerbation of Chronic Ob- structive Pulmonary Disease (COPD) and to whom amoxicillin/clavulanate antibiotic was prescribed. Literature search has indicated that antibiotics are recommended for COPD patients in two cases. Firstly, they are recommended in the patients having an acute exacerbation with increased dyspnoea, sputum volume, and sputum purulence. Common options usually include amoxicillin, amoxicillin/clavulanate, azithromycin, and doxycycline. Secondly, it is also recommended for preventive purposes in patients with severe COPD having frequent exacerbations. But, still remain uncertainty on the antibiotic used in outpatients, having mild or moderate COPD.

[CroDiab GP--follow up of diabetics protection in general medicine]. / CroDiab GP--pracenje zastite dijabetickih bolesnika u obiteljskoj medicini.

INTRODUCTION: There is an increasing number of diabetics in the population. Care of diabetes mellitus type 2 has been transferred from specialist care to the level of general practice. Collecting data and making database of diabetic care are set as quality indicators of diabetic care. AIM: The aim is to present the electronic CroDiab GP program as a tool for collecting data on diabetics in family practice in Croatia. Another aim is to track diabetic quality care and include patients in the national registry of diabetics. METHODS: The program was demonstrated on a sample of 10 family practice units with approximately 18,000 patients from four districts in north Croatia. These units are involved in the project of tracking diabetic care quality in family medicine. The core population for data collection is set by the basic diagnostic unit according to ICD-10: E10-E14. The program mainframe is the CroDiab NET computer system. The central module of CroDiab NET is BIS (Basic Information Sheet). It is set as optimal data collection that allows tracking diabetic care quality. Sixteen diabetic variables were analyzed. These variables refer to the type of disease, duration, treatment, and procedure for early detection of complications. RESULTS: In the population of 18,0000 patients there were 822 (4.6%) diabetics. There were 6.3% of patients with type 1 diabetes and 87.4% with type 2 diabetes; 6.3% were unknown. There were 16.0% diabetics on diet therapy, 60.7% on oral medication (1 to 3 medications), and 13.4% on insulin therapy, 8.4 diabetics were on both insulin and oral medication. CONCLUSION: Family medicine should present parameters of the quality of diabetic care. It is possible to collect data in electronic media, make statistical analysis and present data. The next step is entering patient data in the national registry of diabetics.

Frequent attenders in family practice in Croatia: retrospective study.

AIM: To determine the number of "frequent attenders" in family practice offices in Croatia according to the number and proportion of frequent attender visits in the total number of visits, and to follow up the frequent attenders and the number of visits they made over a period of three years. METHODS: The retrospective study involved 8 family practice offices in Northern Croatia. The number of visits to family practice was determined for 4,312 patients aged over 18 years. There were 1,826 men (42.3%) and 2,486 (57.7%) women. The follow up period lasted from January 1, 1997 to December 31, 1999. The borderline value that divided the frequent from non-frequent attenders was the value at the third quartile of the number of visits in a single age-sex group of patients. RESULTS: We recorded a total of 58,088 visits of patients older than 18 years to 8 family practice offices in the three-year period. In 1997, out of 4,312 patients who made a total of 17,938 visits, 944 (22%) frequent attenders made 11,257 (63%) visits. In 1998, there were a total of 20,350 visits made, with 966 (22%) frequent attenders making 12,145 (60%) visits. In 1999, a total of 20,725 visits were made, with 988 (23%) frequent attenders making 12,259 (59%) visits. The differences in the distribution of frequent vs non-frequent attenders according to age and sex were not statistically significant in any of the three study years (chi-square, p=0.727). Older men and older women were not more often frequent attenders than younger men and younger women, respectively. Out of 4,312 patients, 1,714 (40%) were frequent attenders in one of the three study years. Of these, 884 (21%) were frequent attenders in one year, 476 (11%) in two years, and 354 (8%) in all three subsequent study years. Out of 4,312 patients, 1,762 (41%) patients in 1997, 1,139 (26%) in 1998, and 1,116 (26%) patients in 1999 did not make a single visit to a family physician. CONCLUSION: Frequent attender visits make a great proportion of the total number of visits to family practice offices in Croatia, a country with a health care system in transition. Eight percent of patients remained being frequent attenders during all three study years.