Exploring End-of-Life Care for Patients with Breast Cancer, Dementia or Heart Failure: A Register-Based Study of Individual and Institutional Factors.

OBJECTIVE: To examine variations in end-of-life care for breast cancer, heart failure, and dementia patients. DATA AND METHODS: Data from four Norwegian health registries were linked using a personal identification number. Longitudinal trends over 365 days and the type of care on the final day of life were analyzed using descriptive techniques and logistic regression analysis. RESULTS: Patients with dementia were more commonly placed in nursing homes than patients in the two other groups, while patients with heart failure and breast cancer were more frequently hospitalized than the dementia patients. Breast cancer and heart failure patients had a higher likelihood of dying at home than dementia patients. The higher the number of general practitioners, the higher was the probability of home-based end-of-life care for cancer patients, while an increasing non-physician healthcare workers increased the likelihood of home-based care for the other patient groups. CONCLUSIONS: Diagnoses, individual characteristics, and service availability are all associated with the place of death in end-of-life care. The higher the availability of health care services, the higher also is the probability of ending the life at home.

Palliative Care Survey: Awareness, Knowledge and Views of the Styrian Population in Austria.

BACKGROUND: No population-based data on awareness and knowledge of palliative care currently exist in Austria. We therefore conducted a survey to determine the general awareness and knowledge of palliative care in Styria, a federal state in Austria. We also asked participants to imagine what services they would need as a patient or family member, where they themselves would like to receive such services, and what fears they imagined patients with a terminal illness would have. METHODS: A descriptive cross-sectional survey consisting of 18 questions that address several aspects of palliative care was carried out in the adult population of Styria, Austria, from October 2019 to March 2020. RESULTS: A total of 419 questionnaires were analyzed, whereby 70.3% of respondents had at least heard of palliative care. Of these, significantly more were female, had a university degree and were aged 50 to 64. The main goal of palliative care was chosen correctly by 67.1% of participants, with the proportion of correct answers increasing in line with education and reaching 82.0% among university graduates. Overall, 73.2% believed that the greatest need of terminally ill persons was a reduction in physical suffering, whereas the greatest perceived need of relatives was the availability of specialist care around the clock. About one-third believed that the greatest fear of palliative patients was that of death, which was chosen significantly more often by men than women. If terminally ill, some 39% of respondents would wish to be looked after at home by professional carers, and women and people that had completed high school chose this answer significantly more often. The most desired service that should be provided to patients and relatives was home pain management at 69.9%, followed by time off for family caregivers at 58.0%. This item was chosen significantly more often by women. CONCLUSIONS: To facilitate the care of severely ill patients at home, it would make sense to develop targeted information campaigns. These should also attempt to deliver targeted information to less informed groups of people, such as young, poorly educated men, in order to raise their awareness of the difficulties and challenges of providing care to terminally ill patients and thus increase the acceptance of support options.

Report from the Third International Last Aid Conference: cultural diversity in palliative care.

The Third International Last Aid Conference was held from October 28 to 29, 2022, as a hybrid event. Altogether, there were 85 participants from 14 different countries. The main topics of the conference were cultural diversity in palliative care, public palliative care education (PPCE), experience with Last Aid courses from different countries, and founding possibilities for courses and research in Last Aid. The speakers from different countries presented their experiences with Last Aid courses for adult and children, as well as the online courses. The contribution of the work of the Last Aid Research Group International (LARGI) for the development of Last Aid was presented. This report provides an overview of the conference and the content of presentations and highlights the most interesting discussions points.

Gender Differences in Perceived Working Conditions of General Practitioners During the COVID-19 Pandemic-a Cross-Sectional Study.

BACKGROUND: The ongoing COVID-19 pandemic has revealed gender-specific differences between general practitioners in adapting to the posed challenges. As primary care workforce is becoming increasingly female, in many countries, it is essential to take a closer look at gender-specific influences when the global health care system is confronted with a crisis. OBJECTIVE: To explore gender-specific differences in the perceived working conditions and gender-specific differences in challenges facing GPs at the beginning of the COVID-19 pandemic in 2020. DESIGN: Online survey in seven countries. PARTICIPANTS: 2,602 GPs from seven countries (Austria, Australia, Switzerland, Germany, Hungary, Italy, Slovenia). Of the respondents, 44.4% (n = 1,155) were women. MAIN MEASURES: Online survey. We focused on gender-specific differences in general practitioners' perceptions of working conditions at the beginning of the COVID-19 pandemic in 2020. KEY RESULTS: Female GPs rated their skills and self-confidence significantly lower than male GPs (f: 7.1, 95%CI: 6.9-7.3 vs. m: 7.6, 95%CI 7.4-7.8; p < .001), and their perceived risk (concerned about becoming infected or infecting others) higher than men (f: 5.7, 95%CI: 5.4-6.0 vs. m: 5.1, 95%CI: 4.8-5.5; p = .011). Among female GPs, low self-confidence in the treatment of COVID-19 patients appear to be common. Results were similar in all of the participating countries. CONCLUSIONS: Female and male GPs differed in terms of their self-confidence when dealing with COVID-19-related issues and their perceptions of the risks arising from the pandemic. To ensure optimal medical care, it is important that GPs realistically assess their own abilities and overall risk.

The Impact of Caregiving on Successful Ageing of Informal Carers: A Qualitative Study among Respiratory Patients' Caregivers.

Providing intensive informal caregiving can cause caregivers' overburden, possibly impacting successful ageing factors such as physical and mental health and social life. This article aimed to investigate how informal caregivers experience the impact of providing care for chronic respiratory patients on the process of caregiver ageing. A qualitative exploratory study was performed using semi-structured interviews. The sample comprised 15 informal caregivers who provided intensive care for patients with chronic respiratory failure for more than six months. They were recruited while accompanying the patients on their examination for chronic respiratory failure in Special Hospital for Pulmonary Disease in Zagreb between January 2020 and November 2020. Semi-structured interviews were used with informal caregivers, and interview transcripts were analysed by the inductive thematic analysis method. Similar codes were organised into categories, and categories were grouped into themes. Two themes were identified in the domain of physical health relating to informal caregiving activities and inadequate treatment of their difficulties, three themes were in the domain of mental health relating to satisfaction with the recipient of care and feelings, and two themes were in the domain of social life, relating to social isolation and social support. Informal caregivers of patients with chronic respiratory failure experience a negative impact on the factors that contribute to the successful ageing of informal caregivers. The results of our research suggest that caregivers need support in maintaining their own health and social inclusion.

Remote Consultations in General Practice - A Systematic Review.

Introduction: Remote consultations in general practice can be very useful form of telemedicine, which is basically a way to exchange medical information to improve the clinical health of patients when the patient and their general practitioner (GP) are not on the same place at the same time. This concept was developed in the 1980s to provide health care to patients who lived in remote areas. Methods: We were interested in researching what kind of remote consultations are available in general practice and what is the usage of these methods. We used four keywords - remote consultation and general practice or family medicine or primary care - and we searched in four different scientific databases: Medline-PubMed, Scopus, Web of Science and IEEX Xplore. Results: We used a PRISMA diagram to identify studies and search the four main databases, we investigated 48 full text articles and when we applied our inclusion and exclusion criteria, 12 studies were included in this systematic review. Conclusions: This systematic review covers the topics of remote consultation versus a traditional or classic physical consultation. Studies have shown its importance prior to the COVID-19 pandemic, and its value while in the mist of the pandemic then caring for infected patients. We have found that remote consultation is necessary, but it must be an improvement on the previous system. Teleconsultations can reduce the number of visits, especially during lockdown situations, with both patients and GPs satisfied with the method, but we should not forget that a physical consultation cannot be fully replaced by a remote consultation due to the limitations of the latter.

Differences in Treating Patients with Palpitations at the Primary Healthcare Level Using Telemedical Device Savvy before and during the COVID-19 Pandemic.

Background: Palpitations are one of most common reasons why a patient visits a general practitioner (GP) and is referred to a cardiologist. Coronavirus disease 2019 (COVID-19) has been associated with new-onset arrhythmias, which are difficult to diagnose at the primary healthcare level during pandemic-related lockdown periods. Methods: A total of 151 patients with a complaint of heart rhythm disorder were included from before and during the COVID-19 pandemic, as well as after the start of vaccination, in this cohort retrospective study. We used a telemedical device-namely, a personal electrocardiographic (ECG) sensor called Savvy-to investigate heart rhythm in patients. The primary outcome of the study was to evaluate the number of actual heart rhythm disorder patients and any differences that infection with or vaccination for COVID-19 had on patients handled in a primary healthcare setting. Results: We found a heart rhythm disorder in 8.6% of patients before the COVID-19 pandemic and in 15.2-17.9% of patients during the COVID-19 pandemic, where the difference was statistically significant (p = 0.002). During the COVID-19 pandemic, we found a heart rhythm disorder in almost 50% of patients that had tested positive for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 virus) more than one month ago. After the vaccinations started, we also found a heart rhythm disorder in almost 50% of non-vaccinated patients. Conclusions: Using a telemedical approach or remote consultation is a useful method, at the primary healthcare level, for diagnosing and treating patients with palpitations during times of lockdown.

Last Aid Course-The Slovenian Experience.

Educating and raising awareness among lay members of the public about palliative care can significantly improve the care for terminally ill patients and their quality of life. This paper reports on the survey aimed at assessing the experience and expectations of participants in the Last Aid course launched in Slovenia in 2019 to train hospice volunteers and promote dialogue on death and dying. The course implementation was supported by materials prepared, translated, and/or adapted from German under the PO-LAST project, which linked Slovenian medical and healthcare professionals, hospice representatives, and university students. The Last Aid course follows an international four-module curriculum that has been successfully applied in 18 countries so far. In Slovenia, the course was delivered 30 times with 21 in-person deliveries and 9 online events attended by 450 participants of different sexes, ages, and professions. The surveyed population included 250 people who returned the evaluation questionnaires by October 2020. The aim of the analysis was to gain insight that can be applied broadly in future work and research on adult education on palliative care and the erasure of death-related taboos.

An Innovative Approach for Improving Information Exchange between Palliative Care Providers in Slovenian Primary Health-A Qualitative Analysis of Testing a New Tool.

BACKGROUND: Interprofessional collaboration is an important part of palliative care. Effective communication and information exchange is essential for a high quality of care. The aim of this study was to test the effectiveness of a new tool for exchanging information between professionals in palliative care on primary healthcare level. METHODS: With suggestions from the experts regarding palliative care needs in an interprofessional team from the Delphi study and community nurses from the field, we developed a paper version of the tool. The paper version was tested in a pilot phase, and subsequently, we conducted ten semi-structured interviews with the users of the new tool to test its feasibility and usability. The data were analyzed using qualitative content analysis, leading to improvement and development of the digital version of the new tool. RESULTS: After completing the pilot phase of the research, we identified the following four categories: a systematic tool for more consistent treatment and better communication during the patient's visit; training and empowerment; quality, safety and digitalization; these categories were later included in the final version of the digital communication tool. CONCLUSION: Effective palliative care requires a good exchange of information and communication between all care professionals who work with the patient. Effective communication contributes to making patients and their relatives feel safe in their home environment and allows patients to stay in their homes even as their disease progresses. The systematical new tool was assessed as useful to improve interdisciplinary cooperation and prepared in a digital version. Further research after the long-term use of the developed digital tool in everyday work might confirm its sustaining importance.

The Impact of the Community Psychiatric Treatment Program on the User's Quality of Life - experience of the Study Participants.

Background: Community psychiatric treatment (CPT) is a novelty in the primary health care system for the people with mental health problems. The service operates according to the Flexible Assertive Community Treatment (FACT) model. FACT is a rehabilitation-oriented clinical case management model based on the ACT model (Assertive Community Treatment). Objective: This study aimed to assess how involvement in a community psychiatry program affects the quality of life of program participants. Methods: Between December 2020 and March 2021 we conducted a qualitative study. To obtain information, semi-structured interviews with twelve patients treated in the Community Psychiatric Treatment program were conducted. All restriction regarding COVID pandemic were considered at the research. Content analysis of the text was used for data analysis, which means that we interpreted the analysed text and determine the meaning of individual parts of the text. Results: Twelve persons participated in the interviews, six of which were women (50%) and six men (50%). All the participants were of Slovenian nationality. They were from 28 to 80 years old, with a mean age of 47 years. We identified twelve categories and four themes: treatment problems, principles of operating of CPT program, satisfaction with inclusion in the CPT and improvement of quality of life through inclusion in the program. Conclusion: Quality of life is essential for every individual, as well as for people with mental health problems. In our study we have proved that the Community psychiatric programs could significantly impact the quality of life of people with mental health problems.

COVI-Prim international: Similarities and discrepancies in the way general practices from seven different countries coped with the COVID-19 pandemic.

Objectives: General practitioners (GPs) are frequently patients' first point of contact with the healthcare system and play an important role in identifying, managing and monitoring cases. This study investigated the experiences of GPs from seven different countries in the early phases of the COVID-19 pandemic. Design: International cross-sectional online survey. Setting: General practitioners from Australia, Austria, Germany, Hungary, Italy, Slovenia and Switzerland. Participants: Overall, 1,642 GPs completed the survey. Main outcome measures: We focused on how well-prepared GPs were, their self-confidence and concerns, efforts to control the spread of the disease, patient contacts, information flow, testing procedures and protection of staff. Results: GPs gave high ratings to their self-confidence (7.3, 95% CI 7.1-7.5) and their efforts to control the spread of the disease (7.2, 95% CI 7.0-7.3). A decrease in the number of patient contacts (5.7, 95% CI 5.4-5.9), the perception of risk (5.3 95% CI 4.9-5.6), the provision of information to GPs (4.9, 95% CI 4.6-5.2), their testing of suspected cases (3.7, 95% CI 3.4-3.9) and their preparedness to face a pandemic (mean: 3.5; 95% CI 3.2-3.7) were rated as moderate. GPs gave low ratings to their ability to protect staff (2.2 95% CI 1.9-2.4). Differences were identified in all dimensions except protection of staff, which was consistently low in all surveyed GPs and countries. Conclusion: Although GPs in the different countries were confronted with the same pandemic, its impact on specific aspects differed. This partly reflected differences in health care systems and experience of recent pandemics. However, it also showed that the development of structured care plans in case of future infectious diseases requires the early involvement of primary care representatives.

Clinical pharmacist interventions in cardiovascular disease pharmacotherapy in elderly patients on excessive polypharmacy : A retrospective pre-post observational multicentric study.

BACKGROUND: Cardiovascular diseases (CVD) are often treated with excessive polypharmacy (10 or more medications) in primary care, and these patients are mostly excluded from trials. Collaborative care, including clinical pharmacists (CP), is one of the possible approaches to address these problems; however, it has not been studied yet in this part of Europe. Hence, the main aim of the study was to determine how CP interventions in a medical review form (MR) can have an impact on the pharmacotherapy in patients on excessive polypharmacy with CVD (number of medications, potential drug-drug interactions of type X-pXDDI, potentially inappropriate medications in the elderly-PIM and treatment guidelines adherence). METHODS: This retrospective, observational pre-post multicentric study included elderly patients with CVDs aged 65 years or above, treated with 10 or more medications concomitantly (excessive polypharmacy) in Slovenian primary care (2012-2014). The MR provided by CPs included drug-related problems and potential pXDDIs, as well as PIMs. The pXDDIs were determined with Lexicomp Online. The German Priscus lists was used to determine PIMs. A binary logistic regression model was chosen to examine the influence of independent variables on the dependent variable (treatment guidelines adherence). RESULTS: In this study 243 patients were included and 980 interventions were proposed in the MR form of which 479 (48.9%) were accepted by the general practitioners (GP). The CPs proposed 320 interventions in CVDs treatment, of which 140 were accepted by the GPs (43.8%). The acceptance of the CPs' recommendations reduced the number of medications by 7.3% (from 13.1 to 12.1 per patient; p < 0.05), the number of pXDDIs by 47.8% (from 40 to 12 patients; p < 0.05), the total of prescribed PIMs by 26.6% (p = 0.752) and adherence to arterial hypertension treatment guidelines was improved (p < 0.05). CONCLUSION: CPs' interventions significantly improved the quality of pharmacotherapy prescribing by reducing the total number of medications and pXDDIs and led to better hypertension treatment guidelines adherence.

Implementation of a Savvy Mobile ECG Sensor for Heart Rhythm Disorder Screening at the Primary Healthcare Level: An Observational Prospective Study.

INTRODUCTION: The Jozef Stefan Institute developed a personal portable electrocardiogram (ECG) sensor Savvy that works with a smartphone, and this was used in our study. This study aimed to analyze the usefulness of telecardiology at the primary healthcare level using an ECG personal sensor. METHODS: We included 400 patients with a history of suspected rhythm disturbance who visited their family physician at the Healthcare Center Ljubljana and Healthcare Center Murska Sobota from October 2016 to January 2018. RESULTS: The study found that there was no statistically significant difference between the test and control groups in the number of present rhythm disorders and actions taken to treat patients with either observation or administration of a new drug. However, in the test group, there were significantly fewer patients being referred to a cardiologist than in the control group (p < 0.001). DISCUSSION: The use of an ECG sensor helps family physicians to distinguish between patients who need to be referred to a cardiologist and those who can be treated by them. This method is useful for both physicians and patients because it shortens the time taken to start treatment, can be used during pandemics such as COVID-19, and reduces unnecessary cost.

A Collaborative Care Model between General Practitioners and Clinical Pharmacists in a Community Health Centre Setting in Depression Treatment.

BACKGROUND: A collaborative care model between clinical pharmacists (CP) and general practitioners (GPs) for treating patients with treatment-resistant depression (TRD) and major depressive disorder (MDD) has not been described yet in the medical literature in Central Europe. Therefore, the main aim of this paper was compared standard of care and collaborative care model including clinical pharmacist in a systematic review form. SUBJECTS AND METHOD: A systematic search in Pubmed/Medline using the terms pharmacist, depression, and primary care in Medline through to September 2016 was conducted to identify randomized controlled clinical trials (RCTs). The patient's data for the case report was obtained from the medical records. RESULTS: 23 RCTs were found. In total 3 RCTs were included in this systematic review. Efficacy in reducing depressive symptoms in collaborative care model compared to the standard of care (without clinical pharmacist) were shown in all RCTs. A collaborative care model also showed positive treatment outcomes in case report. CONCLUSION: This systematic review shows positive treatment outcomes in patients included in collaborative care model compared to current standard of care. This positive case report shows evidence for the effectiveness of a collaborative care model with a CP in a primary care setting. CPs can assist GPs in choosing the appropriate pharmacotherapy.

Attitudes of medical students to general practice: a multinational cross-sectional survey.

BACKGROUND: A shortage of general practitioners (GPs) is common to many European countries. To counteract this, it is essential to understand the factors that encourage or discourage medical students from choosing to become a GP. OBJECTIVE: To evaluate medical students' attitudes towards general practice and to identify factors that discourage them from considering a career as a GP. METHODS: In this multinational cross-sectional online survey, 29 284 students from nine German, four Austrian and two Slovenian universities were invited to answer a questionnaire consisting of 146 closed and 13 open-ended items. RESULTS: Of the 4486 students that responded (response rate: 15.3%), 3.6% wanted to become a GP, 48.1% were undecided and 34.6% did not want to be a GP. Significant predictors for interest in becoming a GP were higher age [odds ratio (OR) = 1.06; 95% confidence interval (CI) = 1.02-1.10], positive evaluation of the content of a GP's work (OR = 4.44; 95% CI = 3.26-6.06), organizational aspects (OR = 1.42; 95% CI = 1.13-1.78), practical experience of general practice (OR = 1.66; 95% CI = 1.08-2.56) and the country of the survey [Slovenian versus German students (Reference): OR = 2.19; 95% CI = 1.10-4.38; Austrian versus German students (Reference): OR = 0.50; 95% CI = 0.32-0.79]. CONCLUSION: Strategies to convince undecided students to opt for a career as a GP should include a positive representation of a GP's work and early and repeated experience of working in a general practice during medical school.

Development of an Algorithm for Determining of Genetic Risk at the Primary Healthcare Level - A New Tool for Primary Prevention: A Study Protocol.

INTRODUCTION: Family history (FH) is an important part of the patients' medical history during preventive management at model family medicine practices (MFMP). It currently includes a one (or two) generational inquiry, predominately in terms of cardiovascular diseases, arterial hypertension, and diabetes, but not of other diseases with a probable genetic aetiology. Beside family history, no application-based algorithm is available to determine the risk level for specific chronic diseases in Slovenia. METHODS: A web application-based algorithm aimed at determining the risk level for selected monogenic and polygenic diseases will be developed. The data will be collected in MFMP; approximately 40 overall with a sample including healthy preventive examination attendees (approximately 1,000). Demographic data, a three-generational FH, a medical history of acquired and congenital risk factors for the selected diseases, and other important clinical factors will be documented. RESULTS: The results will be validated by a clinical genetic approach based on family pedigrees and the next-generation genetic sequencing method. After the risk of genetic diseases in the Slovenian population has been determined, clinical pathways for acting according to the assessed risk level will be prepared. CONCLUSION: By means of a public health tool providing an assessment of family predisposition, a contribution to the effective identification of people at increased risk of the selected monogenic and polygenic diseases is expected, lessening a significant public health burden.

The Role of Telecardiology in Dealing with Patients with Cardiac Rhythm Disorders in Family Medicine - Systematic Review.

PURPOSE: Heart rhythm disorders (HRD) are often present in patients visiting their family physician (FP). Dealing with their problems is not always simple, efficient and cost effective. The aim of this paper is to review the existing literature about the use and experience of telecardiology in patients experiencing HRD. METHODS: We conducted a review of literature in PubMed biographical databases (MeSH thesaurus), Web of Science and Cochrane, between 1995 and 2019. We included original articles in English that describe the use of telecardiology at primary and secondary healthcare levels. Exclusion criteria are those publications that discuss heart failure or observation of the activity of pacemakers or defibrillators and the age of patients under 18 years. A total of 19 papers met the inclusion criteria, thirteen of them were original scientific articles and we included them in the analysis. RESULTS: Use of telemedicine can shorten the time from diagnosis to the necessary treatment (2/13), telemedicine can reduce mortality in patients with acute myocardial infarction (4/13), it can shorten the time to diagnose atrial fibrillations (4/13), it can help determine the diagnosis for patients complaining about heart rhythm disorders which were not detected on the standard ECG recording (2/13) and can also help identify cardiac causes for syncope or collapse (2/13). All studies have confirmed that the use of telecardiology significantly reduces the number of unnecessary referrals to a cardiologist or hospitalization, and shortens the time needed to treat patients with life-threatening conditions. CONCLUSION: The use of telecardiological techniques increases the quality and safety of work in managing patients with cardiovascular disease in FP practice. Usage of telecardiologic devices can also save money and bridge the gap between the primary and secondary healthcare levels.

Evaluation of a collaborative care approach between general practitioners and clinical pharmacists in primary care community settings in elderly patients on polypharmacy in Slovenia: a cohort retrospective study reveals positive evidence for implementation.

BACKGROUND: The population of developed countries is aging, leading to an increase in the use of medication in daily practice, which can lead to serious treatment costs and irrational polypharmacy. A collaborative care approach, such as providing medication review service provided by a clinical pharmacist (CP), is a possible way to reduce drug-related problems and irrational polypharmacy. The aim of this study was to determinate whether a CP's medication review service can improve the quality of drug prescribing in elderly patients treated with polypharmacy in primary care. METHODS: In a retrospective observational medical chart review study, patients aged 65 years or more in the period 2012-2014 who received 10 or more medications concomitantly and who were screened by a CP were included. Data on pharmacotherapy and CPs' interventions were obtained from the patients' medical records (non-electronic chart review). Potential drug-drug interactions (pDDIs) were determined with Lexicomp Online™ 3.0.2. Only potential X-type DDIs (pXDDIs) were included. Potentially inappropriate medications in the elderly (PIMs) were identified using the PRICUS list. RESULTS: Ninety-one patients were included. The CPs suggested 625 interventions, of which 304 (48.6%) were accepted by the general practitioners (GPs). After adopting the CPs' interventions, the number of total medications decreased by 11.2% (p <  0.05) and the number of pXDDIs decreased by 42% (p <  0.05). The number of clinically important pXDDIs decreased by 50% (3 cases). The number of prescribed PIMs decreased by 20% (p = 0.069). The acceptance of CP's recommendations reduced the number of pXDDIs (p < 0.05) and improved the adherence to heart failure treatment guidelines. CONCLUSIONS: A collaborative care approach offering a CP medication review service significantly improved the quality of pharmacotherapy by reducing the total number of medications and pXDDIs. The results support the implementation of this service in the Slovenian healthcare system.

Primary care for refugees and newly arrived migrants in Europe: a qualitative study on health needs, barriers and wishes.

Background: In order to provide effective primary care for refugees and to develop interventions tailored to them, we must know their needs. Little is known of the health needs and experiences of recently arrived refugees and other migrants throughout their journey through Europe. We aimed to gain insight into their health needs, barriers in access and wishes regarding primary health care. Methods: In the spring of 2016, we conducted a qualitative, comparative case study in seven EU countries in a centre of first arrival, two transit centres, two intermediate-stay centres and two longer-stay centres using a Participatory Learning and Action research methodology. A total of 98 refugees and 25 healthcare workers participated in 43 sessions. Transcripts and sessions reports were coded and thematically analyzed by local researchers using the same format at all sites; data were synthesized and further analyzed by two other researchers independently. Results: The main health problems of the participants related to war and to their harsh journey like common infections and psychological distress. They encountered important barriers in accessing healthcare: time pressure, linguistic and cultural differences and lack of continuity of care. They wish for compassionate, culturally sensitive healthcare workers and for more information on procedures and health promotion. Conclusion: Health of refugees on the move in Europe is jeopardized by their bad living circumstances and barriers in access to healthcare. To address their needs, healthcare workers have to be trained in providing integrated, compassionate and cultural competent healthcare.

Palliative Care: a Cross Sectional Study Focused on Different Capacity Building Programmes Evaluated Through Self- Rated Knowledge and Efficiency in Family Medicine Tutors.

AIM: Educational possibilities in palliative care have been overseen in this part of Europe and therefore this important issue should be addressed to implement current treatment palliative care in Slovenia. This study was the first in Slovenia dealing with the self-rated knowledge and self-efficacy associated with educational programmes attended about palliative medicine at primary health care level. MATERIAL AND METHODS: Material for our work was general practitioner (GP) who work in education like tutors. A cross-sectional study was carried out from July to November 2015 with participation of them. For the purpose of the study (self-assessment of knowledge and efficacy), the validated questionnaire Palliative Kompetenztest (PKT) was applied with added some demographical data. 138 of the 250 invited GP answered the questionnaire. RESULTS: Knowledge was averagely assessed with 23.0 ± 4.0 (out of 34) and self-efficacy achieved 38.5 ± 8.6 out of 54 points. Physicians who attended "Step by step" educational model, rated their knowledge (26.2 ± 3.4 (p < 0.001)) and self-efficacy higher (41.9 ± 7.7 (p < 0.010)) in comparison with those who attended conferences and other palliative care related capacity building programmes. CONCLUSION: When taking into account self-assessed knowledge and efficacy in palliative care, it was shown the capacity-building program "Step by step" to be an effective model for GPs. However, self-perceived efficiency due to past experience was also shown to be associated with the efficiency score, therefore we should be restrained in favouring specific capacity building programme at this time.