ANTIBIOTIC PRESCRIPTION FOR ACUTE RESPIRATORY INFECTIONS IN FAMILY MEDICINE IN SPLIT

Akutne respiratorne infekcije (ARI) su jedan od najčešćih razloga za dolazak u ordinaciju obiteljske medicine (OOM); prema podatcima Hrvatskog zdravstveno-statističkog ljetopisa za 2014. godinu ARI su činile 11,6% svih utvrđenih stanja i bolesti u OOM. Virusi su odgovorni za oko 85% ARI, ali se bez obzira na to, u liječenju često uptrebljavaju antibiotici. Cilj našeg istraživanja bio je pokazati koliko antibiotika, koju vrstu i u kojem postotku propisujemo pacijentima za najčešće zabilježene dijagnoze ARI. Istraživanje je provedeno u četiri specijalističke ordinacije obiteljske medicine na području grada Splita. Prikupljeni su podatci o pacijentima kojima je propisan antibiotik za ARI u razdoblju od 01. siječnja do 31. prosinca 2015. godine. Najčešće propisivana skupina antibiotika su penicilini s 50,75%, dok su na drugom mjestu makrolidi s 35,50%. U akutnoj upali tonzila najviše je propisivan azitromicin (35,03%) i penicilini širokog spectra (36,73%). Penicilini uskog spektra su propisani u 25,71%, a doksiciklin u 0,56% slučajeva. Prekomjerna i neprimjerena uporaba antibiotika pogoduje širenju bakterijske rezistencije pa su njihovo primjereno propisivanje i odgovorno uzimanje izuzetno važni.Acute respiratory infections (ARI) are most common reasons for family medicine practice (FMP) visits according to the Croatian Health Statistical Yearbook for the year 2014. ARI represent 11.6% of all conditions and diseases diagnosed in FMP. Viruses are responsible for about 85% of ARI, but antibiotics are often applied. The aim of our study was to show how many antibiotics we prescribed, what kind of antibiotics and in which percentage to the patients with ARI. The study was conducted in four FMPs in the city of Split, Republic of Croatia. We collected data for patients who were prescribed antibiotics for ARI in the period from January 1st to December 31st, 2015. The most commonly prescribed group of antibiotics was penicillin (50.75%), followed by macrolides (35.50%). In acute tonsillitis azithromycin was mostly prescribed (35.03%) and broad spectrum penicillin (36.73%). Narrow spectrum penicillin were prescribed to 25.71% of patients and doxycycline only to two patients, i.e. 0.56%. Excessive and inappropriate use of antibiotics promotes the spread of antibiotic-resistant bacteria. It is, therefore, extremely important to know when it is appropriate to prescribe antibiotics and how to take them responsibly

Writing letters to patients as an educational tool for medical students

BACKGROUND: Despite rapid growth and development of medical technology, personal relationship between the patient and physician remains the basis of high quality treatment. The aim of our study was to develop, implement and evaluate patient therapeutic letters written by students as a tool in teaching family medicine. METHODS: The study included all 6(th) year students attending their rounds in family medicine, structured into two 10-day cycles, one in urban offices and one in offices on the Adriatic islands (rural). After receiving detailed instructions, students wrote letters to two patients after a consultation in the office. The letters were audited by patients and 3 family medicine experts who used a grading instrument (scale 0 – poor, 1 – medium, 2 – good) for 1) adequacy and clarity of description of patients’ disease/state, 2) knowledge, 3) adequacy of recommendations, 4) courtesy and respect and 5) language and style. Patients and experts were also asked to underline phrases they thought would be difficult to understand; the underlined text was subjected to content analysis. RESULTS: Both the patients and the experts gave high scores for the value and quality of the letters in terms of the description of the problem, adequacy of recommendations given, and courtesy and respect (mean (±standard deviation) 5.65 ± 0.79 for patients vs. 4.87 ± 0.79 for experts out of maximum score of 6). Family medicine experts were stricter than patients in their evaluation of the content of the letters (adequacy and clarity of disease description (P < 0.001) and adequacy of recommendations (P < 0.001). Both the patients and the experts seemed to like longer letters as the length of the letter showed significant positive correlation with the quality summary score (correlation r = 0.492 vs. r = 0.338, respectively, P < 0.010). Overlapping of the text underlined as difficult to understand by patients and experts was found in 10 (11.6%) out of 86 letters. The highest overlap (20 terms) was found for the category “Technical terms unclear to a lay reader”. CONCLUSIONS: Writing of a letter to their first patients may be a useful tool for students to personally experience the practice of medicine and establish better partnership with patients in health care