CARE QUALITY FOR PATIENTS WITH CORONARY ARTERY DISEASE IN FAMILY MEDICINE - GUIDELINE IMPLEMENTATION BY TAKING A GLANCE AT THE RISK FACTORS

Uvod: Bolesnici s koronarnom bolešću su velik izazov u skrbi liječnika obiteljske medicine (LOM) zbog brojnih komorbiditeta te primjene mjera sekundarne prevencije kojima se prate i istovremeno korigiraju rizični čimbenici koji se odnose na bolesnika, njegovu okolinu i stil života. Cilj: Istražiti uspješnost LOM-a u primjeni mjera sekundarne prevencije kardiovaskularnih bolesti i pronaći moguće rješenje za poboljšanje kvalitete skrbi. Ispitanici i metode: Opservacijsko istraživanje provedeno je 2017. godine u devet specijalističkih ordinacija obiteljske medicine diljem Hrvatske, a uključivalo je 169 bolesnika koji su ili preboljeli infarkt miokarda i/ili su bili podvrgnuti perkutanoj koronarnoj intervenciji i/ili operaciji aortokoronarnog premoštenja. Praćene su vrijednosti krvnog tlaka, LDL kolesterola i indeksa tjelesne mase, a ispitivano je pridržavanje poželjnih oblika ponašanja (nepušenje, tjelesna aktivnost, pravilna prehrana, redovno uzimanje dokazano djelotvornih lijekova) te prilagodba novom stilu života koja je mjerena Likertovom ljestvicom (1-5) kao i zadovoljstvo liječnika preglednošću elektroničkog zdravstvenog zapisa. Rezultati: Zadovoljavajuće vrijednosti arterijskog tlaka postignute su u 63,2 % ispitanika, razinu LDL kolesterola prema smjernicama imalo je 19,4 %, dok je 25,3 % ispitanika imalo uredan indeks tjelesne mase; 25,1 % ispitanika je i dalje pušilo, dok je 43,2 % ispitanika konzumiralo alkohol. Prehrambene navike promijenilo je 63,7 % ispitanika, a 63,4 % je povećalo svoju tjelesnu aktivnost. LOM je u većini slučajeva proveo savjetovanje oko promjene životnog stila nakon koronarnog incidenta. Liječnici su većinom bili zadovoljni sadržajem i količinom podataka u elektroničkom zdravstvenom zapisu, ali ne i njihove upotrebljivosti u svakodnevnoj, vremenski ograničenoj konzultaciji s bolesnikom. Osmišljeno rješenje u programu Adobe Illustrator® omogućilo bi i olakšalo bolju preglednost rizičnih čimbenika i time bi moglo imati utjecaja na učinkovitiju kontrolu provođenja mjera sekundarne prevencije. Zaključak: Skrb za bolesnike s koronarnom bolešću u obiteljskoj medicini je vrlo kompleksna, a dio kompleksnosti se odnosi na primjenu mjera sekundarne prevencije koje su od vitalne važnosti. Zbog toga je potrebno planirati i osigurati dovoljno vremena za konzultaciju s takvim bolesnicima kako bi se dobio uvid u kontrolu rizičnih čimbenika i pravovremeno učinile promjene sukladno važećim smjernicama. Rezultati istraživanja pokazali su da se u bolesnika svi rizični čimbenici ne nalaze unutar preporučenih vrijednosti te da je jedan od mogućih razloga tome što ne postoji njihov pregledan prikaz u elektroničkom zdravstvenom zapisu. Kvalitetnija skrb mogla bi se postići kada bi postojalo jasno vizualno rješenje stanja rizičnih čimbenika koje je u ovom radu osmišljeno i predloženo u obliku slika koje bi LOM-u dale brzi uvid u “profi l” bolesnika te poboljšale učinkovitost svake konzultacije s obzirom na njeno kratko vremensko ograničenje u svakodnevnim uvjetima rada u ordinacijama obiteljske medicine.Introduction: Patients with coronary artery disease represent a challenge in each family medicine practice because of many comorbidities and the application of secondary prevention measures which represent a tool for tracking and simultaneously correcting risk factors related to the patient, his surroundings and lifestyle. Objective: Explore the effectiveness of family medicine specialists in applying secondary prevention measures in cardiovascular diseases and to find a solution for improving quality of care. Participants and Methods: This observational study, was conducted in 2017. under nine specialised family medicine practices throughout Croatia and included 169 patients who suffered from myocardial infarction and/or underwent percutaneous coronary intervention and/or bypass surgery. Blood pressure, LDL cholesterol and body mass index were measured and it was examined whether the participants were abiding to the advised healthy habits (nonsmoking, physically active, good diet, regular use of medicaments according to the guidelines). Adjustment to the new lifestyle was measured with Likert scale (1-5) and the same scale was used to asses physicians satisfaction with transparency of electronic health record data. Results: 63.2% of participants had recommended values for blood pressure, 19.4% for LDL cholesterol and 25.3% had a normal body mass index according to the guidelines. 25.1% of participants continued to smoke and 43.2% continued alcohol consumption. In terms of diet, a change was observed in 63.7% and physical activity increase in 63.4% of participants. In most cases, after coronary incident, physician consulted them regarding lifestyle changes. Family medicine specialists were mostly pleased with the content and the amount of data in electronic health records, but not with their transparency and ease of use in everyday, usually time constrained, patient - doctor consultations. A software application Adobe Illustrator® was used to visually represent the relevant risk factors which could provide more effective control for conducting secondary prevention measures. Conclusion: The care for coronary artery disease patients in family medicine is very complex, and a part of it is related to providing effective measures of secondary prevention which are of crucial importance. Therefore it is imperative to plan ahead and allow sufficient consultation time to obtain control over the risk factors and make timely changes according to the guidelines. Research results have shown that not all risk factors are within recommended values and one of the reasons could be the lack of clear presentation in the electronic health record. Better quality of care could be achieved with the proposed visual solution using pictures that allows the family physician fast access to the patient’s “profile” and improves efficiency of every consultation despite its constrained duration in everyday conditions

Čimbenici koji utječu na želju studenata medicine za specijalizacijom iz obiteljske medicine [Factors influencing medical students in their career choice of family medicine]

The motivation and other factors used by medical students in making their career choices for specific medical specialties have been looked at in a number of studies in the literature. The reasons why medical students choose their careers are complex. Factors include lifestyle preferences, personal fit and workforce factors, including expected income, prestige, job opportunities, longitudinal care and societal need. In many countries, lower interest in family medicine than in other specialties is noticeable. Although most of the students will have to work in primary health care, family medicine does not seem to be an attractive area. Students generally believe that primary health care is not an effective area for personal development. There are ongoing efforts to improve this situation. In Zagreb School of Medicine this research is conducted in order to determine whether social and economic transition, including health care reforms, influences young people motivation to choose medical study and their career choices for medical specializations. The aims of this research were (1) to identify different factors affecting career choice in family medicine, (2) to define differences in career preferences students have at entry to medical school and at the end of study and (3) to explore changes in ten-years period in their career choice of family medicine as a first choice career option. This is retrospective study in the period from academic year 2004./2005. to 2013./2014. and comprised 2490 first-year and 1828 six-year medical students from School of Medicine, University of Zagreb. The pre-validated anonymous questionnaire was administrated to students entering and finishing medical school. The questionnaire included questions on demographic data, opinion about certain specialists in societies and their career choice. Required data were analyzed using descriptive statistics. A logistic regression was performed using career choice (family medicine versus others) as the criterion variable and the factors (social, demographic characteristics and motivation to choose medical study) as predictor variables. Results showed that 2,9% first year medical students and 13% sixth year medical students see themselves as future family medicine specialist. Statistically higher significant differences were found within the categories of gender (females had a higher preferences for family medicine than males), in place of birth (born in rural areas) and parents with lower formal education levels. The first year medical students are less interested to be family practitioners in comparation with those who are at the end of their study. In the last ten years, there is an increasing interest for family medicine among sixth year students. Since School of Medicine has a social responsibility to be accountable for the health care needs, these results could recommend whether to change the admission policies and increase number of students choosing family medicine and/or to modify and reorient medical school curricula towards primary health care

Factors influencing medical students in their career choice of family medicine

Brojna su istraživanja o motivaciji studenata medicine u izboru buduće specijalizacije. Studije ističu složenost čimbenika koji na to utječu, a najčešće se ističu oni vezani uz osobnost, sustav vrijednosti, odrednice životnog stila te položaj liječnika u društvu. Iako će najveći broj liječnika raditi u primarnoj zdravstvenoj zaštiti, želja za izborom tih specijalizacija je mala. Zbog potreba u sustavu zdravstva, u svijetu se nastoji povećati interes za obiteljsku medicina, a moguće je da su socijalne i ekonomske promjene u Hrvatskoj te promjene u sustavu zdravstva utjecale na izbor studija medicine i želju za specijalizacijom mladih. Ciljevi ovog istraživanja bili su: (1) ispitati i utvrditi međuzavisnost čimbenika koji utječu na odabir specijalizacije obiteljske medicine kao buduće profesije, (2) istražiti razlike u namjerama za specijalizacijom iz obiteljske medicine kod studenata na početku i kraju studija te (3) povezati promjene u sustavu zdravstva i njihov utjecaj na izbor specijalizacije iz obiteljske medicine u desetgodišnjem razdoblju. Radi se o retrospektivnoj studiji u desetgodišnjem periodu od akademske godine 2004./05. do 2013./14. koja je obuhvatila 2490 studenata prve godine i 1828 studenata šeste godine Medicinskog fakulteta u Zagrebu. Instrument u istraživanju bio je validirani upitnik koji je obuhvaćao nekoliko skupina pitanja. Uz osobne podatke, studenti su naveli motive svog izbora studija i želju za specijalizacijom te stavove prema pojedinim specijalistima u društvu. Pri istraživanju u potpunosti su korištena etička načela i potpuna tajnost ispitanikovih podataka. Podaci su se analizirati deskriptivnim i kvalitativnim metodama, uz korištenje linearne regresije. Rezultati pokazuju da 2,9% studenata prve godine i 13% studenata završne godine studija želi odabrati specijalizaciju iz obiteljske medicine kao budući poziv. Statistički značajne razlike utvrđene su prema spolu (ispitanice ženskog spola češće žele biti specijalistice obiteljske medicine), mjestu rođenja (želju za obiteljskom medicinom više pokazuju oni koji dolaze s ruralnog područja) te prema formalnoj edukaciji roditelja (ispitanici čini roditelji imaju nižu naobrazbu češće biraju obiteljsku medicinu). U skupini studenata prve godine studija utvrđen je statistički značajan linearni trend porasta onih koji izabiru obiteljsku medicinu. S druge strane, u skupini studenata šeste godine nije utvrđen trend porasta u zadnjih deset godina. Od istraživanja se očekuje da doprinese objašnjenju čimbenika koji utječu na izbor specijalizacije studenata medicine, posebice obiteljske medicine. Kako je uloga Medicinskog fakulteta slijediti potrebe prakse, rezultati mogu biti doprinos odgovoru na pitanje treba li mijenjati izbor pristupnika za studij, i/ili kurikulum studija re-orijentirati prema izvanbolničkoj zaštiti.The motivation and other factors used by medical students in making their career choices for specific medical specialties have been looked at in a number of studies in the literature. The reasons why medical students choose their careers are complex. Factors include lifestyle preferences, personal fit and workforce factors, including expected income, prestige, job opportunities, longitudinal care and societal need. In many countries, lower interest in family medicine than in other specialties is noticeable. Although most of the students will have to work in primary health care, family medicine does not seem to be an attractive area. Students generally believe that primary health care is not an effective area for personal development. There are ongoing efforts to improve this situation. In Zagreb School of Medicine this research is conducted in order to determine whether social and economic transition, including health care reforms, influences young people motivation to choose medical study and their career choices for medical specializations. The aims of this research were (1) to identify different factors affecting career choice in family medicine, (2) to define differences in career preferences students have at entry to medical school and at the end of study and (3) to explore changes in ten-years period in their career choice of family medicine as a first choice career option. This is retrospective study in the period from academic year 2004./2005. to 2013./2014. and comprised 2490 first-year and 1828 six-year medical students from School of Medicine, University of Zagreb. The pre-validated anonymous questionnaire was administrated to students entering and finishing medical school. The questionnaire included questions on demographic data, opinion about certain specialists in societies and their career choice. Required data were analyzed using descriptive statistics. A logistic regression was performed using career choice (family medicine versus others) as the criterion variable and the factors (social, demographic characteristics and motivation to choose medical study) as predictor variables. Results showed that 2,9% first year medical students and 13% sixth year medical students see themselves as future family medicine specialist. Statistically higher significant differences were found within the categories of gender (females had a higher preferences for family medicine than males), in place of birth (born in rural areas) and parents with lower formal education levels. The first year medical students are less interested to be family practitioners in comparation with those who are at the end of their study. In the last ten years, there is an increasing interest for family medicine among sixth year students. Since School of Medicine has a social responsibility to be accountable for the health care needs, these results could recommend whether to change the admission policies and increase number of students choosing family medicine and/or to modify and reorient medical school curricula towards primary health care

Factors influencing medical students in their career choice of family medicine

Brojna su istraživanja o motivaciji studenata medicine u izboru buduće specijalizacije. Studije ističu složenost čimbenika koji na to utječu, a najčešće se ističu oni vezani uz osobnost, sustav vrijednosti, odrednice životnog stila te položaj liječnika u društvu. Iako će najveći broj liječnika raditi u primarnoj zdravstvenoj zaštiti, želja za izborom tih specijalizacija je mala. Zbog potreba u sustavu zdravstva, u svijetu se nastoji povećati interes za obiteljsku medicina, a moguće je da su socijalne i ekonomske promjene u Hrvatskoj te promjene u sustavu zdravstva utjecale na izbor studija medicine i želju za specijalizacijom mladih. Ciljevi ovog istraživanja bili su: (1) ispitati i utvrditi međuzavisnost čimbenika koji utječu na odabir specijalizacije obiteljske medicine kao buduće profesije, (2) istražiti razlike u namjerama za specijalizacijom iz obiteljske medicine kod studenata na početku i kraju studija te (3) povezati promjene u sustavu zdravstva i njihov utjecaj na izbor specijalizacije iz obiteljske medicine u desetgodišnjem razdoblju. Radi se o retrospektivnoj studiji u desetgodišnjem periodu od akademske godine 2004./05. do 2013./14. koja je obuhvatila 2490 studenata prve godine i 1828 studenata šeste godine Medicinskog fakulteta u Zagrebu. Instrument u istraživanju bio je validirani upitnik koji je obuhvaćao nekoliko skupina pitanja. Uz osobne podatke, studenti su naveli motive svog izbora studija i želju za specijalizacijom te stavove prema pojedinim specijalistima u društvu. Pri istraživanju u potpunosti su korištena etička načela i potpuna tajnost ispitanikovih podataka. Podaci su se analizirati deskriptivnim i kvalitativnim metodama, uz korištenje linearne regresije. Rezultati pokazuju da 2,9% studenata prve godine i 13% studenata završne godine studija želi odabrati specijalizaciju iz obiteljske medicine kao budući poziv. Statistički značajne razlike utvrđene su prema spolu (ispitanice ženskog spola češće žele biti specijalistice obiteljske medicine), mjestu rođenja (želju za obiteljskom medicinom više pokazuju oni koji dolaze s ruralnog područja) te prema formalnoj edukaciji roditelja (ispitanici čini roditelji imaju nižu naobrazbu češće biraju obiteljsku medicinu). U skupini studenata prve godine studija utvrđen je statistički značajan linearni trend porasta onih koji izabiru obiteljsku medicinu. S druge strane, u skupini studenata šeste godine nije utvrđen trend porasta u zadnjih deset godina. Od istraživanja se očekuje da doprinese objašnjenju čimbenika koji utječu na izbor specijalizacije studenata medicine, posebice obiteljske medicine. Kako je uloga Medicinskog fakulteta slijediti potrebe prakse, rezultati mogu biti doprinos odgovoru na pitanje treba li mijenjati izbor pristupnika za studij, i/ili kurikulum studija re-orijentirati prema izvanbolničkoj zaštiti.The motivation and other factors used by medical students in making their career choices for specific medical specialties have been looked at in a number of studies in the literature. The reasons why medical students choose their careers are complex. Factors include lifestyle preferences, personal fit and workforce factors, including expected income, prestige, job opportunities, longitudinal care and societal need. In many countries, lower interest in family medicine than in other specialties is noticeable. Although most of the students will have to work in primary health care, family medicine does not seem to be an attractive area. Students generally believe that primary health care is not an effective area for personal development. There are ongoing efforts to improve this situation. In Zagreb School of Medicine this research is conducted in order to determine whether social and economic transition, including health care reforms, influences young people motivation to choose medical study and their career choices for medical specializations. The aims of this research were (1) to identify different factors affecting career choice in family medicine, (2) to define differences in career preferences students have at entry to medical school and at the end of study and (3) to explore changes in ten-years period in their career choice of family medicine as a first choice career option. This is retrospective study in the period from academic year 2004./2005. to 2013./2014. and comprised 2490 first-year and 1828 six-year medical students from School of Medicine, University of Zagreb. The pre-validated anonymous questionnaire was administrated to students entering and finishing medical school. The questionnaire included questions on demographic data, opinion about certain specialists in societies and their career choice. Required data were analyzed using descriptive statistics. A logistic regression was performed using career choice (family medicine versus others) as the criterion variable and the factors (social, demographic characteristics and motivation to choose medical study) as predictor variables. Results showed that 2,9% first year medical students and 13% sixth year medical students see themselves as future family medicine specialist. Statistically higher significant differences were found within the categories of gender (females had a higher preferences for family medicine than males), in place of birth (born in rural areas) and parents with lower formal education levels. The first year medical students are less interested to be family practitioners in comparation with those who are at the end of their study. In the last ten years, there is an increasing interest for family medicine among sixth year students. Since School of Medicine has a social responsibility to be accountable for the health care needs, these results could recommend whether to change the admission policies and increase number of students choosing family medicine and/or to modify and reorient medical school curricula towards primary health care

Factors influencing medical students in their career choice of family medicine

Brojna su istraživanja o motivaciji studenata medicine u izboru buduće specijalizacije. Studije ističu složenost čimbenika koji na to utječu, a najčešće se ističu oni vezani uz osobnost, sustav vrijednosti, odrednice životnog stila te položaj liječnika u društvu. Iako će najveći broj liječnika raditi u primarnoj zdravstvenoj zaštiti, želja za izborom tih specijalizacija je mala. Zbog potreba u sustavu zdravstva, u svijetu se nastoji povećati interes za obiteljsku medicina, a moguće je da su socijalne i ekonomske promjene u Hrvatskoj te promjene u sustavu zdravstva utjecale na izbor studija medicine i želju za specijalizacijom mladih. Ciljevi ovog istraživanja bili su: (1) ispitati i utvrditi međuzavisnost čimbenika koji utječu na odabir specijalizacije obiteljske medicine kao buduće profesije, (2) istražiti razlike u namjerama za specijalizacijom iz obiteljske medicine kod studenata na početku i kraju studija te (3) povezati promjene u sustavu zdravstva i njihov utjecaj na izbor specijalizacije iz obiteljske medicine u desetgodišnjem razdoblju. Radi se o retrospektivnoj studiji u desetgodišnjem periodu od akademske godine 2004./05. do 2013./14. koja je obuhvatila 2490 studenata prve godine i 1828 studenata šeste godine Medicinskog fakulteta u Zagrebu. Instrument u istraživanju bio je validirani upitnik koji je obuhvaćao nekoliko skupina pitanja. Uz osobne podatke, studenti su naveli motive svog izbora studija i želju za specijalizacijom te stavove prema pojedinim specijalistima u društvu. Pri istraživanju u potpunosti su korištena etička načela i potpuna tajnost ispitanikovih podataka. Podaci su se analizirati deskriptivnim i kvalitativnim metodama, uz korištenje linearne regresije. Rezultati pokazuju da 2,9% studenata prve godine i 13% studenata završne godine studija želi odabrati specijalizaciju iz obiteljske medicine kao budući poziv. Statistički značajne razlike utvrđene su prema spolu (ispitanice ženskog spola češće žele biti specijalistice obiteljske medicine), mjestu rođenja (želju za obiteljskom medicinom više pokazuju oni koji dolaze s ruralnog područja) te prema formalnoj edukaciji roditelja (ispitanici čini roditelji imaju nižu naobrazbu češće biraju obiteljsku medicinu). U skupini studenata prve godine studija utvrđen je statistički značajan linearni trend porasta onih koji izabiru obiteljsku medicinu. S druge strane, u skupini studenata šeste godine nije utvrđen trend porasta u zadnjih deset godina. Od istraživanja se očekuje da doprinese objašnjenju čimbenika koji utječu na izbor specijalizacije studenata medicine, posebice obiteljske medicine. Kako je uloga Medicinskog fakulteta slijediti potrebe prakse, rezultati mogu biti doprinos odgovoru na pitanje treba li mijenjati izbor pristupnika za studij, i/ili kurikulum studija re-orijentirati prema izvanbolničkoj zaštiti.The motivation and other factors used by medical students in making their career choices for specific medical specialties have been looked at in a number of studies in the literature. The reasons why medical students choose their careers are complex. Factors include lifestyle preferences, personal fit and workforce factors, including expected income, prestige, job opportunities, longitudinal care and societal need. In many countries, lower interest in family medicine than in other specialties is noticeable. Although most of the students will have to work in primary health care, family medicine does not seem to be an attractive area. Students generally believe that primary health care is not an effective area for personal development. There are ongoing efforts to improve this situation. In Zagreb School of Medicine this research is conducted in order to determine whether social and economic transition, including health care reforms, influences young people motivation to choose medical study and their career choices for medical specializations. The aims of this research were (1) to identify different factors affecting career choice in family medicine, (2) to define differences in career preferences students have at entry to medical school and at the end of study and (3) to explore changes in ten-years period in their career choice of family medicine as a first choice career option. This is retrospective study in the period from academic year 2004./2005. to 2013./2014. and comprised 2490 first-year and 1828 six-year medical students from School of Medicine, University of Zagreb. The pre-validated anonymous questionnaire was administrated to students entering and finishing medical school. The questionnaire included questions on demographic data, opinion about certain specialists in societies and their career choice. Required data were analyzed using descriptive statistics. A logistic regression was performed using career choice (family medicine versus others) as the criterion variable and the factors (social, demographic characteristics and motivation to choose medical study) as predictor variables. Results showed that 2,9% first year medical students and 13% sixth year medical students see themselves as future family medicine specialist. Statistically higher significant differences were found within the categories of gender (females had a higher preferences for family medicine than males), in place of birth (born in rural areas) and parents with lower formal education levels. The first year medical students are less interested to be family practitioners in comparation with those who are at the end of their study. In the last ten years, there is an increasing interest for family medicine among sixth year students. Since School of Medicine has a social responsibility to be accountable for the health care needs, these results could recommend whether to change the admission policies and increase number of students choosing family medicine and/or to modify and reorient medical school curricula towards primary health care