Attitudes toward preventive services and lifestyle : the views of primary care patients in Europe. The EUROPREVIEW patient study

Background: For preventive interventions in general practice to succeed, patients' points of view must be taken into account in addition to those of GPs. Objective: To explore patients' views and beliefs about the importance of lifestyle and preventive interventions, to assess their readiness to make changes to their lifestyle and their willingness to receive support from GPs. Methods: Cross-sectional survey conducted by EUROPREV in primary care practices in 22 European countries. Patients were consecutively selected and interviewed from September 2008 to September 2009. Results: Seven thousand nine hundred and forty-seven participants, 52.2% females. Only 30.5% of risky drinkers think they need to change, as opposed to 64% of smokers, 73.5% of patients with unhealthy eating habits and 73% with lack of physical activity. Risky drinkers reported that GPs initiated a discussion on alcohol consumption less often (42%) than on smoking (63%), eating habits (59%) or physical activity (55%). Seventy-five per cent, 66% and 63% of patients without hypertension, diabetes or hypercholesterolaemia, respectively, think blood pressure, blood sugar and serum cholesterol should be checked yearly. Women (80%) think they should be screened with the cervical smear test and 72.8% of women aged 30-49 years with mammography, yearly or every 2 years. Conclusions: A high proportion of patients attending primary care with unhealthy lifestyles (especially risky drinkers) do not perceive the need to change their habits, and about half the patients reported not having had any discussion on healthy lifestyles with their GPs. Patients overestimate their need to be screened for cardiovascular risk factors and for cancer.peer-reviewe

What is more risky – to drive a car or to take aspirin? Rational approach to consumation of medicines

Daugelis praktikuojančių medikų su pagarba prisimena šviesios atminties profesoriaus Algio Mickio farmakologijos paskaitas. Jis mėgo kartoti: vaistai ne tik gydo, bet ir sukelia nepageidaujamų reiškinių, ir atvirkščiai, jeigu vaistas nesukelia šalutinio poveikio, tai ir gydomasis poveikis abejotinas. Gausi maisto papildų reklama per televiziją, atrodo, dar nesudomino visuomenės sveikatos saugotojų. Bet gera vieta tuščia ilgai nebūna. Uždraudus receptinių ir nereceptinių vaistų reklamą žiniasklaidoje, „stebuklingus“ maisto papildus ėmėsi reklamuoti savigydos asociacijos tikrieji nariai, skatindami tuštinti ir taip apytuštes pensininkų kišenes, žadėdami, pavyzdžiui, magnio preparatais sureguliuoti pavojingai padidėjusį arterinį kraujo spaudimą. Beje, tai ne tik Lietuvos problema. Nepakanka gydytojui žinoti gydomąjį ir šalutinį vaistų poveikį. Reikia tinkamai paaiškinti pacientui, kodėl skiriamas tam tikras vaistas, kokia vaisto vartojimo rizika ir nauda. Senas geras vaistas aspirinas tiek pat didina mirtingumo riziką, kaip ir važiavimas automobiliu. Jeigu automobiliu galima nekeliauti, tai penkiasdešimties metų vyras aspiriną privalo gerti. Štai kodėl rekomenduoju straipsnį, parengtą pagal užsienio literatūrą (Cohen, Joshua T.; Neumann, Peter J. What’s More Dangerous, Your Asiin or Your Car? Thinking Rationally About Drug Risks (and Benefits). Health Aff. 2007;26(3):636-646). Šio straipsnio autoriai lygino mirtingumo riziką nuo keleto dažnai vartojamų vaistų su rizika, kuri... [to full text

Direct and indirect diabetes costs in the world

Diabetes is becoming one of the major public health problems because a great proportion of the healthcare expenditure has been spent on the treatment of its associated morbidity and mortality. Diabetes is also a major cause of premature mortality, stroke, cardiovascular disease, peripheral vascular disease, congenital malformations as well as long- and short-term disability. In addition, persons with diabetic complications have a lower quality of life compared with persons without diabetes. The goal of this paper is to review the studies on the costs of diabetes, to identify the strengths and limitations of currently available diabetes cost studies, and to identify future research areas that will help us to better understand the economic burden of diabetes. The economic burden of diabetes mellitus is enormous in the world. Cost or illness estimates are often cited as an important element in the choices made regarding diabetes care and management. Studying these economic aspects presents several challenges, such as collecting the appropriate epidemiological and cost data, determining the diabetes attributable factors for premature morbidity and mortality, and determining methods to account for premature morality, disability, and reduced quality of life. The cost to care for diabetes puts a tremendous burden on both the patient and the payer. The direct cost of diabetes increased from 1.7 billion US dollars in 1969 to 44.4 billion US dollars in 1997. Several studies over the years have found that indirect costs related to diabetes are higher than direct. Indirect costs during 28 years increased 33 times, from 1.6 billion US dollars in 1969 to 54.1 billion US dollars in 1997. The expenses of one diabetic patient highly vary in different countries: from 13 US dollars in Bangladesh to 11,157 US dollars in USA per one year. [...]

An analysis of the causes of exhaustion among physicians working in family physician teams during the COVID-19 pandemic in Lithuania.

BackgroundThe COVID-19 pandemic had a severe impact on public life around the world, influencing medicine and health, the economy, employment, science, and education. Health care specialists are key workers who faced extreme challenges posed by the pandemic, including threats to their own lives due to the rapid spread of the virus, a huge increase in workload, and professional burnout syndrome. Analysis of the factors that physicians found most exhausting during the pandemic could lay the groundwork for the effective management of future crises.ObjectiveTo identify the factors that physicians working in family physician (family and internal medicine) teams found most exhausting during the COVID-19 pandemic in Lithuania and assess their causes.MethodsAn anonymous survey of physicians (n = 191) working in family physician teams was carried out from 21 June 2021 to 17 September 2021. Physicians signed an informed consent form prior to completion of the questionnaire. Mixed data analysis was performed, consisting of statistical analysis using the SPSS 27 software and a qualitative causal analysis.ResultsDuring the pandemic, physicians were most exhausted by: chaotic vaccination priorities (44.5%); unsatisfied patients (52.4%); constantly changing legislation (71.7%); the large workload (75.9%); and the malfunctioning of online systems (81.2%).ConclusionsPhysicians in family physician teams indicated the following aspects that require improvement: service provision; effective work organization for physicians; and the satisfaction of patients with decisions made during the pandemic

Evaluation of the Quality of Services in Primary Health Care Institutions

The aim of the study was to evaluate patients’ satisfaction with the quality of provided services in private primary health care institutions in Kaunas. Material and Methods. A questionnaire-based inquiry of 280 persons registered to family physicians at primary health care settings was performed. The study was carried out using 20-item anonymous questionnaires with questions about the quality of services provided in primary health care settings. Results. More than 50.0% of the respondents stated that they waited for more than 15 minutes at the physician’s office, while 17.0% of the respondents stated that the waiting time exceeded 30 minutes. More than 25.0% of the respondents positively evaluated the possibility to consult their family physician by phone. In 67.0% of patients, the family physician determined the cause of the disorder and administered treatment; in 32.0% of patients, the family physician referred them to a specialist, and 1.0% of patients were urgently sent to hospital. More than 90.0% of the respondents were satisfied with the services provided by their family physicians. Those who were dissatisfied with these services indicated that the provided treatment failed to eliminate the disorder, that they wanted to be referred to a specialist, and that they expected more diagnostic tests to be performed for more effective treatment. Conclusions. A greater part of the patients indicated that the main reason for long waiting at the physician’s office was physicians’ wish to serve too many patients. More than two-thirds (67.0%) of the patients stated that their family physicians determined the cause of the disorder and prescribed treatment. The overwhelming majority (more than 90.0%) of the patients were satisfied with the services provided by their family physicians

Avoidable mortality in Lithuania: 1991-199 compared with 1970-1990.

This paper assesses the changes in avoidable mortality in Lithuania in 1991-1999 compared with 1970-1990. Causes of death were disaggregated into causes most amenable to treatment and those amenable to prevention. Trends in age-standardised death rates were calculated. In 1970-1990, avoidable causes of death accounted for 26.3% of all deaths. By 1991-1999 this figure had decreased slightly to 24.6%. At the same time, age-standardised death rates from avoidable causes increased by 8%, from 118.1 per 100000 in 1970-1990 to 127.9 in 1991-1999. Avoidable mortality among men was considerably higher than for women in both periods. There was considerable fluctuation in both treatable and preventable mortality during the 1990s, reflecting diversity in trends in different causes of death. Increases occurred in death rates from tuberculosis, cervical cancer and liver cirrhosis and, immediately after independence, also in hypertensive and cerebrovascular diseases and, among men, lung cancer, followed by subsequent declines. Deaths from chronic rheumatic heart disease, asthma and other respiratory diseases, appendicitis, abdominal hernia, cholelithiasis and maternal mortality consistently declined. In conclusion, avoidable mortality declined as a proportion of total mortality in Lithuania during 1991-1999 compared with 1970-1990. This reflected the combined impact of an initial rise in death rates from treatable and, to a lesser extent, preventable causes, followed by subsequent declines. While this indicates some success in the development of medical care, it emphasises the need for more effective public health policies directed at the major determinants of health

Medically unexplained illnesses from the point of view of primary health care system’s interests summary

In the primary health care system (PHCS) there are illnesses unrelated to any organic pathology. They are described as medically unexplained illnesses (MUI). The debatable origin of the symptoms raises a number of questions for PHCS. Difficult diagnosis requiring a large number of various tests. Patients complaining of medically unexplained illnesses are considered to be an economic burden to the health care system and undermine the image of the medical profession. The article discusses the interest of the PHCS from the point of MUI. The analysis is grounded on the data of interview with directors of primary health care institutions (policlinics). According to R. Collins, the managers of very high positions of the hierarchical systems identify themselves with the system. They identify their interests with the interests of the system. It means that from the point of the MUI the directors are in a very controversial position. On one hand, they are inclined to maintain the biomedical conception of disease. This conception allows to define a very strict line between the biomedical reasons of diseases and speculations about diseases. In this case they prefer a clearer diagnosis because it improves the image of a PHC institution and doctors. On the other hand, the MUI serves as a very easy way to get more money from the National Health Insurance Fund. Every PHC institution have second-level-specialists and get money for each consultation of a specialist. The institutions’ interest is to direct more patients from the first level to the second level and get more money

The Quality of anticoagulation therapy among warfarin-treated patients with atrial fibrillation in a primary health care setting

Background and objectives: Long-term therapy with oral anticoagulants is recommended for stroke prevention in patients with atrial fibrillation (AF). This study evaluated the quality of anticoagulation therapy among warfarin-treated AF patients in selected primary health care centres in Lithuania. Materials and Methods: This was a retrospective study conducted in nine primary health care centres in Lithuania. Existing medical records of randomly selected adult patients with AF who were treated with warfarin for at least 12 months were reviewed and analysed. Physicians’ decisions to adjust warfarin dose were considered as consistent with the approved warfarin posology if warfarin dose was increased in case of international normalized ratio (INR) 3.0 or unchanged in case of INR within 2.0 to 3.0. Results: The study population included 406 patients. The mean duration of treatment with warfarin was 5.4 years. The median number of INR measurements per patient per year was 8.0. More than half (57.3%) of available INR values were outside the target range, with 13.6% INR values being above 3.0 and 43.7% INR values—below 2.0. The median time in therapeutic range (TTR) was 40.0%; only 20% of patients had TTR of 65%. In about 40% of the cases with INR values outside the target range, no dose corrections were implemented. About 27% of decisions on warfarin dose adjustment were not consistent with the recommended warfarin posology. The median number of INR measurements was lower among patients living in urban areas, while the median TTR was significantly higher in urban patients than in rural patients. In the multivariate regression model, gender, HAS-BLED score and warfarin treatment duration were associated with a TTR of 65%. Conclusions: Anticoagulation control is suboptimal in routine clinical practice with a median TTR of 40%. [...]