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

Predlog za obravnavo bolnika z astmo na primarni in pulmološki specialistični ravni v Sloveniji

Z dokumentom želimo smernice, ki jih predlaga GINA, vključiti v slovenski prostor. Želimo, da bi dokument služil enotnemu in dogovorjenemu pristopu k obravnavi bolnikov z astmo na primarni in specialistični pulmološki ravni

The family medicine reference clinic: an example of interprofessional collaboration within a healthcare team

Since being introduced in 2011, family medicine reference clinics (FMRCs) have created several advantages in the treatment of patients, but have also drawn attention to areas where improvements could be made (Poplas Susič, et al., 2013). Consistent with competencies and experts, each chronic patient care protocol as well as the prevention protocol strictly follows guidelines or recommendations that define diagnostic and treatment as well as education pathways for patient care in a family medicine practice. They are harmonised and agreed with experts at different levels of healthcare (primary, secondary and tertiary) (Vodopivec Jamšek, 2013)

Uvajanje kazalnikov kakovosti za sladkorno bolezen in arterijsko hipertenzijo v družinski medicini v Sloveniji

Introduction: A new form of family practices was introduced in 2011 through a pilot project introducing nurse practitioners as members of team and determining a set of quality indicators. The aim of this article was to assess the quality of diabetes and hypertension management. Methods: We included all family medicine practices that were participating in the project in December 2015 (N=584). The following data were extracted from automatic electronic reports on quality indicators: gender and specialisation of the family physician, status (public servant/self-contracted), duration of participation in the project, region of Slovenia, the number of inhabitants covered by a family medicine practice, the name of IT provider, and levels of selected quality indicators. Results: Out of 584 family medicine practices that were included in this project at the end of 2015, 568 (97.3%) had complete data and could be included in this analysis. The highest values were observed for structure quality indicator (list of diabetics) and the lowest for process and outcome quality indicators. The values of the selected quality indicators were independently associated with the duration of participation in the project, some regions of Slovenia where practices were located, and some IT providers of the practices. Conclusion: First, the analysis of data on quality indicators for diabetes and hypertension in this primary care project pointed out the problems which are currently preventing higher quality of chronic patient management at the primary health care level.Uvod: Pilotni projekt na področju družinske medicine v Sloveniji je leta 2011 uvedel novo metodo dela v družinski medicini, pri čemer je nov član tima postala diplomirana medicinska sestra, prav tako pa se je uvedel nadzor kakovosti s pomočjo kazalnikov kakovosti. Namen tega članka je bil oceniti kakovost vodenja bolnikov s sladkorno boleznijo in hipertenzijo. Metode: V analizo smo vključili vse ambulante družinske medicine, ki so sodelovale v projektu konec decembra 2015. Iz avtomatične baze poročil smo izluščili in analizirali naslednje podatke: spol in specializacijo zdravnika, status zdravnika (javni uslužbenec, koncesionar), trajanje sodelovanja v projektu, regijo, v kateri je ambulanta, število prebivalcev na območju, ki ga pokriva ambulanta, računalniško hišo, ki nudi program, in raven izbranih kazalnikov kakovosti. Rezultati: Od 584 ambulant družinske medicine jih je imelo 568 (97,3%) popolne podatke in so bile vključene v analizo. Najvišja vrednost kazalnikov kakovosti je bila opazovana pri kazalnikih kakovosti pogojev (register diabetikov), najnižja pa pri kazalnikih procesa in izida. Vrednosti izbranih kazalnikov kakovosti so bile neodvisno povezane s trajanjem sodelovanja v projektu, nekaterimi regijami Slovenije in nekaterimi računalniškimi hišami, ki nudijo elektronsko podporo. Zaključek: Prva analiza podatkov kazalnikov kakovosti za diabetes in arterijsko hipertenzijo je pokazala na probleme, ki trenutno onemogočajo doseganje višje kakovosti obravnave bolnikov na primarni ravni zdravstvenega varstva

Prepričanja in stališča zdravnikov družinske medicine o pristopih k prepoznavanju in zdravljenju medicinsko nepojasnjenih stanj

Namen: Namen prispevka je na podlagi analize mnenj identificirati prepričanja in stališča zdravnikov družinske medicine (ZDM) o pristopih k prepoznavanju in zdravljenju medicinsko nepojasnjenih stanj (MNS). Metode: Uporabljene so bile kvalitativne in kvantitativne metode raziskovanjanamenski vzorec za izvedbo je predstavljalo pet fokusnih skupin (Maribor in Ljubljana) v obdobju od julija do septembra 2011. Ugotovitve so bile kot vprašanja uporabljene v kvantitativnem delu raziskave s slučajnostnim vzorčenjem (N = 90), povabljeni pa so bili ZDM iz celotne Slovenije (januar - marec 2012). Za analizo kvalitativnega materiala in proces kodiranja smo uporabili računalniško orodje ATLAS.ti 7, kvantitativne podatke smo statistično obdelali s statističnim programskim paketom SPSS 21.0. Rezultati: V procesu kodiranja smo oblikovali 64 kod in jih razvrstili v osem kategorij. V kvantitativnem delu se je odzvalo 63 (70 %) povabljenih ZDM, ki so poudarili preprečevanje in zdravljenje bolnikov z MNS (84,1 %n = 53), pomen dobre komunikacije z bolnikom v 77,8 % (n = 49), medtem ko je bilo 93,7 % (n = 59) ZDM mnenja, da jih bolniki z MNS izčrpajo, utrudijo in frustrirajo. Kot potencialne vzroke za MNS so ZDM opisali težave v bolnikovi interakciji z okolico (100 % , n = 63), pretekle in sedanje stresne dogodke (96,8 %, n = 61) ter skrite psihiatrične bolezni (68,3 %, n = 43). Kvaliteto obravnave bolnikov z MNS bi v največji meri izboljšalo izobraževanje s področja osnovnih psihoterapevtskih tehnik in na temo pristopa k težavnemu bolniku (95,2 %, n = 60) ter s področja veščin komuniciranja (95,2 %, n = 60). Zaključek: Ugotovili smo, da slovenski ZDM namenjajo velik poudarek preprečevanju in zdravljenju bolnikov z MNS, hkrati pa jih ti bolniki izčrpajo, utrudijo in frustriraj

Izkušnje medicinskih sester v patronažnem varstvu z obiski na domu v okviru projekta Nadgrajena celovita obravnava pacienta: rezultati pilotne raziskave

Uvod: Patronažno zdravstveno varstvo je pomemben člen pri odkrivanju, spremljanju in obravnavi kroničnih bolezni na primarni ravni. Namen raziskave je bil predstaviti izkušnje in stališča do nadgrajene preventivne obravnave ter obiskov na domu. Metode: Uporabljen je bil mešani raziskovalni dizajn. Podatki so bili zbrani z delno strukturiranim vprašalnikom (Cronbach α = 0,92). Sodelovalo je 50 diplomiranih medicinskih sester, odzivnost je bila 81-% (n = 41). Opravljena je bila tematska analiza odprtih vprašanj. Za kvantitativne podatke je bila uporabljena opisna statistika, t-test, analiza variance in korelacijska analiza. Rezultati: Prispevek preventivnih obiskov na domu anketiranci vidijo v zdravstvenovzgojnem delovanju (x = 4,34, s = 0,85), odkrivanju rizičnih dejavnikov (x = 4,12, s = 0,81) in ohranjanju kakovosti življenja pacientov ( x= 4,10, s = 0,92). Zadovoljstvo anketirancev je povezano s sprejemanjem obiskov s strani pacientov in družin (r = 0,754, p < 0,001), s prispevkom k stroki patronažnega varstva (r = 0,766, p < 0,001) ter z obravnavo posameznika z družino (r = 0,693, p < 0,001). V tematski analizi sta bili identificirani dve temi, in sicer (1) pozitivne izkušnje z obiski in (2) negativne izkušnje z obiski. Diskusija in zaključek: Novo obliko preventivnih patronažnih obiskov v domačem okolju anketirani podpirajo, še posebej možnost celovite obravnave posameznika in njegove družine. Glede na ugotovitve se predlaga, da medicinska sestra v patronažnem varstvu postane enakovreden partner v timu referenčne ambulante na nacionalnem nivoju

Perceptions of the primary health care team about the implementation of integrated care of patients with type 2 diabetes and hypertension in Slovenia

Background Integrated care involves good coordination, networking, and communication within health care services and externally between providers and patients or informal caregivers. It affects the quality of services, is more cost-effective, and contributes to greater satisfaction among individuals and providers of integrated care. In our study, we examined the implementation and understanding of integrated care from the perspective of providers - the health care team - and gained insights into the current situation. Methods Eight focus groups were conducted with health care teams, involving a total of 48 health care professionals, including family physicians, registered nurses, practice nurses, community nurses, and registered nurses working in a health education center. Prior to conducting the focus groups, a thematic guide was developed based on the literature and contextual knowledge with the main themes of the integrated care package. The analysis was conducted using the NVivo program. Results We identified 12 main themes with 49 subthemes. Health care professionals highlighted good accessibility and the method of diagnostic screening integrated with preventive examinations as positive aspects of the current system of integrated care in Slovenia. They mentioned the good cooperation within the team, with the involvement of registered nurses and community nurses being a particular advantage. Complaints were made about the high workload and the lack of workforce. They feel that patients do not take the disease seriously enough and that patients as teachers could be useful. Conclusion Primary care teams described the importance of implementing integrated care for diabetes and hypertension patients at four levels: Patient, community, care providers, and state. Primary care teams also recognized the importance of including more professionals from different health care settings on their team