The Effect of Demographic Characteristics on Self-Medication Patterns: A Cross-Sectional Nationwide Study from Slovenia

Self-medication is defined as the use of medicines without medical supervision to treat one’s own ailment. It is a part of a help-seeking behaviour that depends on socio-cultural and personal factors, which is why people react to the illness differently and also take different measures to cope with it. The aim of this study was to explore the Slovenian citizens’ attitudes towards self-medication. The study included a random sample of 1,000 Slovenian inhabitants, stratified to all Slovenian regions. This was a postal survey. Participants were mailed a self-administered questionnaire about attitudes towards self-treatment. In the statistical analysis we used independent t-test and c 2-test. We received 410 responses (41.0% response rate). In the past year, 389 (94.9%) respondents practiced self-medication. Most respondents (209, 52.1%) supported and used it in everyday life. The majority of the respondents (274, 77.2%) practiced self-medication when symptoms emerged. When symptoms lasted for one week or less, 210 (56.5%) of the respondents practising self-medication visited their doctor. The respondents agreed mostly with the statement that their doctor had a positive relationship towards self-medication. Younger people were more confident about the absolute safety of self-medication whereas older people were more certain that they could practice it no matter what disease they might have. As self-medication is very common among Slovenian population and various demographic factors affect the opinions about it and the reasons for its use and also a doctor-patients communication about it, it is important that doctors, especially those in primary health care settings always ask about its use. This is of a particular importance when dealing with older and retired patients, which are more likely to suffer from more chronic diseases and use alternative medicine, which is a common part of self-medication. Also, it is important to educate young people about possible unsafe practice of self-medication

HEALTH SEEKING BEHAVIOUR IN GENERAL POPULATION WITH PSYCHOLOGICAL SYMPTOMS

Background: Health seeking behaviour is a complex construct in patients with psychological symptoms. The aim of this study was to determine a one-month prevalence of psychological symptoms in Slovenian general population and to identify correlates of health seeking behaviour. Subjects and methods: This study was conducted in a representative sample of 1,002 randomly selected Slovenian citizens, stratified according to sex and age. We used a method of computer assisted telephone interview (CATI). The questionnaire consisted of demographic questions, questions about the prevalence and duration of preselected symptoms in the past month (irritability, nervousness), questions about the presence of chronic diseases, EQ-5D questionnaire and the questions on health seeking behaviour (self-treatment, lay advice seeking and medical advice seeking). Results: The self-reported prevalence of psychological symptoms in the past month was 38.0% (381/1,002). Multivariate analysis for the presence of self-reported psychological symptoms revealed that female sex, higher age, the presence of chronic disease, primary education, lay-advice seeking, pain and the presence of anxiety/depression on EQ-5D questionnaire were independently associated with psychological symptoms. Conclusions: Psychological symptoms are a major public health problem in Slovenian general adult population and the selfreported utilization of professional health care services by Slovenian population is high. Other patterns such as lay referral system might have a crucial influence on the final decision to seek medical help

The effect of carbon dioxide on near-death experiences in out-of-hospital cardiac arrest survivors: a prospective observational study

Introduction: Near-death experiences (NDEs) are reported by 11-23% of cardiac arrest survivors. Several theories concerning the mechanisms of NDEs exist - including physical, psychological, and transcendental reasons - but so far none of these has satisfactorily explained this phenomenon. In this study, we investigated the effect of partial pressures of O2 and CO2, and serum levels of Na and K on the occurrence of NDEs in out-of-hospital cardiac arrest survivors. Methods: A prospective observational study was conducted in the three largest hospitals in Slovenia. Fifty-two consecutive patients (median age 53.1 years, 42 males) after out-of-hospital cardiac arrest were included. The presence of NDEs was assessed with a self-administered Greyson\u27s NDE scale. The initial partial pressure of end-tidal CO2, the arterial blood partial pressures of O2 and CO2 and the levels of Na and K in venous blood were analysed and studied. Univariate analyses and multiple regression models were used. Results: NDEs were reported by 11 (21.2%) of the patients. Patients with higher initial partial pressures of end-tidal CO2 had significantly more NDEs (P < 0.01). Patients with higher arterial blood partial pressures of CO2 had significantly more NDEs (P = 0.041). Scores on a NDE scale were positively correlated with partial pressures of CO2 (P = 0.017) and with serum levels of potassium (P = 0.026). The logistic regression model for the presence of NDEs (P = 0.002) explained 46% of the variance and revealed higher partial pressures of CO2 to be an independent predictor of NDEs. The linear regression model for a higher score on the NDE scale (P = 0.001) explained 34% of the variance and revealed higher partial pressures of CO2, higher serum levels of K, and previous NDEs as independent predictors of the NDE score. Conclusions: Higher concentrations of CO2 proved significant, and higher serum levels of K might be important in the provoking of NDEs. Since these associations have not been reported before, our study adds novel information to the field of NDEs phenomena

Double venous drainage through the superior vena cava in minimally invasive aortic valve replacement: a retrospective study

Aim To compare the outcomes of patients who underwent upper mini-sternotomy or right mini-thoracotomy and those who underwent full sternotomy and to report a technical improvement in venous drainage by means of double venous cannulation of the superior vena cava (SVC) in mini surgical procedures. Methods We retrospectively analyzed the outcome of 217 patients who underwent aortic valve replacement through upper mini-sternotomy or right mini-thoracotomy at the Department of Cardiovascular Surgery, University Medical Centre Ljubljana, Slovenia from 1996 till 2010. Cannulation of SVC and right atrial appendage was performed in 142/217 (65%) patients, while in the remaining 75 (35%) patients, double cannulation of SVC was used for venous drainage. The results of patients who underwent mini approaches were compared to 236 patients who underwent full sternotomy for the same purpose from 2009 to 2010 at the same center. Results We found a shorter mean length of intensive care unit stay, less volume chest-tube drainage, shorter crossclamp and cardio pulmonary bypass times, and less postoperative permanent pacemaker implantations in the minimally invasive group patients than in full sternotomy group patients. Using double cannulation of the SVC for venous drainage made venous cannulation in mini approaches easier and eliminated the need for obtaining femoral venous access. Conclusion Our study confirmed that even though technically challenging, upper mini-sternotomy and right minithoracotomy approaches for aortic valve replacement have potential advantages over conventional median sternotomy. They were proved to be safe, efficacious, and can significantly reduce surgical trauma and are therefore particularly valuable in some higher risk, obese, diabetic and elderly patients. Using double cannulation of SVC for venous drainage made venous cannulation easier and eliminated the need for obtaining femoral venous access

Near-death experiences and electrocardiogram patterns in out-of-hospital cardiac arrest survivors: a prospective observational study

Aim. To determine the effect of several factors, that are a part of cardiac arrest and resuscitation, on the incidence of neardeath experiences (NDEs). Methods. We conducted a prospective observational study in the three largest hospitals in Slovenia in a consecutive sample of patients after out-of-hospital primary cardiac arrest. The presence of NDE was assessed with the self-administered Greyson’s near-death experiences scale. The electrocardiogram pattern at the beginning of resuscitation was recorded. Main outcome measure was the presence of near-death experiences. Univariate analysis was used. Results. The study included 52 patients. There were 42 (80.8%) males in the sample; median age ± standard deviation of the patients was 53.1 ± 14.5 years. Near-death experiences were reported by 11 (21.2%) patients. Patients with ventricular fibrillation had significantly less NDEs than other patients (12.2% vs. 54.5%, P = 0.006). Patients with pulseless electrical activity had significantly more NDEs than others (60.0% vs. 11.9%, P = 0.003). Patients with asystole and pulseless electrical fibrillation had significantly more NDEs than patients who had ventricular fibrillation and ventricular tachycardia (60.0% vs. 11.9%, P = 0.003). Patients with at least one defibrillation attempt had significantly less near-death experiences than others (62.5% vs. 13.6%, P = 0.007). Conclusion. Our study found a possible correlation between electrocardiogram pattern in cardiac arrest patients and the incidence of near-death experiences. Further studies should address this problem in larger samples

Attitudes of Slovenian family practice patients toward changing unhealthy lifestyle and the role of family physicians: cross-sectional study

Aim To assess patients’ attitudes toward changing unhealthy lifestyle, confidence in the success, and desired involvement of their family physicians in facilitating this change. Methods We conducted a cross-sectional study in 15 family physicians’ practices on a consecutive sample of 472 patients (44.9% men, mean age (± standard deviation) 49.3 ± 10.9 years) from October 2007 to May 2008. Patients were given a self-administered questionnaire on attitudes toward changing unhealthy diet, increasing physical activity, and reducing body weight. It also included questions on confidence in the success, planning lifestyle changes, and advice from family physicians. Results Nearly 20% of patients planned to change their eating habits, increase physical activity, and reach normal body weight. Approximately 30% of patients (more men than women) said that they wanted to receive advice on this issue from their family physicians. Younger patients and patients with higher education were more confident that they could improve their lifestyle. Patients who planned to change their lifestyle and were more confident in the success wanted to receive advice from their family physicians. Conclusion Family physicians should regularly ask the patients about the intention of changing their lifestyle and offer them help in carrying out this intention

Uporabnost pisne informacije o zdravilu (PMIL) in informacije o zdravilih, ki jih poda strokovnjak

Background: The Patient information leaflet (PIL) is an important source of information for every patient. Little is known about whether patients read the PIL and whether it contains useful information. Other sources of drug-related information are professionals (a family practitioner, a pharmacist and a nurse). Informing patients on drugs improves their compliance. The aim of the study was to identify the usefulness of PIL from the perspective of the patient, to assess professionals as a source of drug-related information and to suggest changes that can improve informing and therefore patients\u27 compliances. Methods: Four focus group interviews were conducted across different primary health care centres in the North East of Slovenia. Focus groups were composed of randomly selected patients (in total 20) who were willing to express their views on PILs, on other drug information sources and on possible improvements. A qualitative analysis of the data was based of the transcription of the audiotapes. Results: Patients read the PILs selectively. They were most interested in side effects, contraindications and the purpose of the prescribed drug. Participants reported that the language in PILs is too scientific. In the case they do not understand PILs or they recognise some of the side effects, a majority of participants decide to contact a family physician first, and less frequently a pharmacist or a nurse. A family physician is considered to be the most trustworthy source of information and patients think that pharmacists could play a more active role in patients% education. Conclusion: Current PILs offer enough partial information to patients but need some improvements in terms of better legibility and access to the most crucial information. PIL does not enable a comprehensive information with respect to patient%s health status. Most reliable source of information is considered to be a family practitioner. Pharmacists could play a more active role in the education of patients.Izhodišče: Informacija o zdravilu za bolnika (PMIL) je pomemben vir informacij o zdravilih. Manj je znano, ali bolniki ta navodila berejo in, ali pri tem dobijo potrebne informacije. Bolniki dobivajo ustrezne informacije tudi od strokovnjakov (zdravnik, farmacevt, medicinska sestra). Informiranje bolnika o zdravilu je pomemben dejavnik, ki pozitivno vpliva na komplianco. Namen študije je preveriti uporabnost PMIL z vidika bolnika in ugotoviti, katerim drugim virom informacij o zdravilih bolniki zaupajo ter predlagati izboljšave, ki bodo pri bolnikih povečale informiranost in s tem komplianco. Metode: 4 fokusne skupine so bile oblikovane v različnih zdravstvenih zavodih v severovzhodni Sloveniji. Udeleženci, skupaj 20, so bili naključni bolniki, ki so bili pripravljeni izraziti svoja stališča o PMIL, o drugih virih informacij o zdravilih in o možnih spremembah. Pogovori so bili posneti in po prepisu je bilo besedilo analizirano po kakovosti. Rezultati: Bolniki berejo PMIL selektivno: najbolj jih zanimajo stranski učinki, kontraindikacije in namen, zakaj se zdravilo uporablja. Bolniki so poudarili, da je jezik v PMIL preveč strokoven. Če ne razumejo prebranega ali prepoznajo stranski učinek, se večina bolnikov odloči poiskati izbranega zdravnika in precej manjkrat medicinsko sestro ali farmacevta. Zdravnik jim je najbolj zanesljiv vir informacij. Menijo pa, da bi farmacevti lahko zavzemali bolj dejavno vlogo pri poučevanju o zdravilih. Zaključek: PMIL nudi zadosti delnih odgovorov, vendar bolniki v njem ne dobijo celovite informacije o zdravilu glede na svoje zdravstveno stanje, zato ga nimajo kot zadostni vir informacij. V PMIL pogrešajo večji poudarek ključnim informacijam in boljšo čitljivost besedila. Najbolj zanesljiv vir informacij o zdravilih je zanje družinski zdravnik. Farmacevti bi lahko prevzeli dejavnejšo vlogo pri poučevanju bolnikov

Quality indicators of cardiovascular disease prevention for primary care in Slovenia

Aim: National validation of quality indicators for cardiovascular prevention in primary care in Slovenia and comparison with a set of internationally validated indicators. Methods: A list of indicators derived from guidelines, recommendations and good clinical practice was developed internationally within a wider Epa-cardio study. In each participating country a panel of national experts were recruited to assess the indicators using a Delphi Technique methodology in two rounds for clarity, validity and feasibility. In Slovenia, 14 national experts, all general practitioners with special interest in cardiovascular diseases, were recruited. Results: Most of validated indicators belonged to the health-care management of people with established cardiovascular disease. Fewer numbers of indicators were validated for primary prevention, mostly on life style recording and advice. Only very few indicators on outcome measures (level of risk factors) were validated. No indicators of patients’ involvement or new risk factors, such as socioeconomic circumstances, got consensus. Conclusion: Slovenia validated more indicators than the international study, especially indicators of primary prevention. The experts did not achieve consensus on indicators of patients’ perspective, despite the paradigm of family medicine that the patient is in the centre of care. Validated indicators can now be tested for systematic quality assessment of cardiovascular prevention in the country

Predictors of High Prescribing Rates in Family Practice during Actual Consultation: A Cross-sectional Study from Slovenia

With a cross-sectional survey wich was held on in Slovenia we would like to define the predictors of high prescribing rates in family practice. 42 involved family doctors reported 300 office contacts, i.e. a total of 12,596 contacts. The participants were asked to fulfil the questionnaire for each patient-doctor encounter in one day. In 12,596 recorded contacts, 14.485 prescriptions were issued to the patients. The patients got from 0 to 10 prescriptions per visit (X±SD: 1.2±1.4). Among 7,363 (58.5%) patients, who got at least one prescription, the mean number of prescriptions was 2.0±1.4. The majority of prescribed drugs were for cardiovascular system. The multivariate model for higher number of prescribed drugs explained 20.2% of the variation. Independent predictors for higher prescribing rates during a consultation were female sex, older age, higher number of problems dealt within the consultation (comorbidity), longer consultation times, lower education grade, higher patient quota on the list, higher prescribing quota indexed by NHII for the past year, being a specialist in family medicine, male doctor and age of doctor more than 44 years. Practice characteristics did not show any correlations with high prescribing volumes. The results of this survey show that some patients’ and doctors’ characteristics and also some consultations’ characteristics affect the prescribing rate. Additional analyses should be performed to identify reasons for that and to propose proper actions