Uspješnost liječenja ovisnika o opijatima zamjenskom terapijom metadonom u obiteljskoj medicini u Hrvatskoj [The efficacy of tretment of patients with opioid dependence treated with methadone in a family medicine setting in Croatia]

Patients with opioid dependence are chronic patients represented in a family physician's everyday work. The aim of this study was to evaluate efficacy of treatment of patients with opioid dependence treated with methadone in a family medicine setting in Croatia. The study was carried out from January 31, 1995 to January 31, 2007 in Novi Zagreb. Data were collected through personal interviews with family physicians, as well as by examing personal medical information sheets and included sociodemographic data about patients and data about treatment characteristics. The data collected at the annual check-up included the data about treatment outcomes. There were 256(82.05%) male and 56(17.95%) female patients with opioid dependence, average aged 26 years at the beginning of the treatment. During the present study, 225(72,1%) patients with opioid dependence treated with methadone in a family medicine setting achieved continuity of care and better outcomes in a treatment and 229(73,4%) patients with opioid dependence treated with methadone in a family medicine setting achieved retention in a treatment and better outcomes in a treatment. Treatment of the patients with opioid dependence with methadone in a family medicine setting provides accessibility of treatment, continuity of care and retention in a treatment

Say it in Croatian - Croatian translation of the EGPRN definition of Multimorbidity using a Delphi consensus technique

Patients coming to their family physician (FP) usually have more than one condition or problem. Multimorbidity as well as dealing with it, is challenging for FPs even as a mere concept. The World Health Organization (WHO) has simply defined multimorbidity as two or more chronic conditions existing in one patient. However, this definition seems inadequate for a holistic approach to patient care within Family Medicine. Using systematic literature review the European General Practitioners Research Network (EGPRN) developed a comprehensive definition of multimorbidity. For practical and wider use, this definition had to be translated into other languages, including Croatian. Here presented is the Croatian translation of this comprehensive definition using a Delphi consensus procedure for Forward/Backward translation. 23 expert FPs fluent in English were asked to rank the translation from 1 (absolutely disagreeable) to 9 (fully agreeable) and to explain each score under 7. It was previously defined that consensus would be reached when 70 % of the scores are above 6. Finally, a backward translation from Croatian into English was undertaken and approved by the authors of the English definition. Consensus was reached after the first Delphi round with 100% of the scores above 6; therefore the Croatian translation was immediately accepted. The authors of the English definition accepted the backward translation. A comprehensive definition of multimorbidity is now available in English and Croatian, as well as other European languages which will surely make further implications for clinicians, researchers or policy makers

The efficacy of tretment of patients with opioid dependence treated with methadone in a family medicine setting in Croatia

Ovisnici o opijatima su kronični bolesnici, a ovisnost o opijatima je kronična recidivirajuća bolest te je time prisutna u svakodnevnom radu liječnika obiteljske madicine. Cilj ovog istraživanja bio je evaluirati uspješnost u liječenju ovisnosti o opijatima zamjenskom terapijom metadonom u obiteljskoj medicini u Hrvatskoj. Istraživanje je provedeno kao prospektivno u periodu 31. siječnja 1995. do 31. siječnja 2007. godine na području Novog Zagreba u okviru rada liječnika obiteljske medicine. Podaci za istraživanje prikupljeni su temeljem osobnog kontakta sa obiteljskim liječnicima kao i na osnovu podataka iz medicinske dokumentacije, a uključivali su sociodemografske podatke o ispitanicima, podatke koji su opisivali uvijete i tijek same terapije prilikom uključivanja u istraživanje kao i druge moguće odrednice pri procjeni uspješnosti zamjenske terapije metadonom. Tijekom praćenja uspješnosti liječenja zamjenskom terapijom metadonom svake godine su prikupljeni podaci o rezultatima odnosno ishodima liječenja zamjenskom terapijom metadonom u obiteljskoj medicini. Ovom prospektivnom studijom dugotrajnog praćenja definirane skupine ispitanika obuhvaćeno je 312 ovisnika o opijatima od kojih je 256(82.05%) bilo muškaraca i 56(17.95%) žena koji su u svijetu heroina proveli 6 godina do trenutka uključivanja u sustav liječenja i pri tome su bili prosječne starosti 26 godina. Tijekom ovog prospektivnog istraživanja liječenje ovisnika o opijatima zamjenskom terapijom metadonom na terenu Novog Zagreba provođeno je u 46 od 60 timova obiteljske medicine te je za ovisnike skrbilo 57 liječnika od kojih je 30 imalo specijalističku izobrazbu iz obiteljske medicine. Tijekom istraživanog perioda u 225(72,1%) ovisnika postignut je kontinuitet skrbi te su u ovih ovisnika postignuti bolji ishodi u liječenju zamjenskom terapijom metadonom. Tijekom istraživanog perioda 229(73,4%) ovisnika zadržano je u programu liječenja zamjenskom terapijom metadonom dok u 83(26,6%) ovisnika nije postignuto zadržavanje u programu liječenja zamjenskom terapijom metadonom. Rezultati dobiveni logističkom regresijom vezani uz utjecaj remisije bolesti, sklonosti deliktu, životnog stila i ekonomske samostalnosti na zadržavanje u programu liječenja pokazali su da su zadržavani u programu liječenja bili oni ovisnici koji su bili u remisiji uz terapiju, oni koji su uzimali drogu uz terapiju, oni koji nisu bili suspektni bez terapije, stalno uposleni te oni koji nisu bili niti suspektno niti potvrđeno deliktuozni. Do zadržavanja u programu liječenja nije došlo u onih ovisnika koji su bili suspektni bez terapije, suspektno ili potvrđeno deliktuozni te neuposleni. Temeljna organizacija liječenja ovisnika o opijatima u Republici Hrvatskoj kao i specifičnost obiteljske medicine osigurala je stabilan i dostupan sustav liječenja ovisnika o opijatima uključenih u zamjensku terapiju metadonom hrvatskim modelom liječenja ovisnika o opijatima te kroz temeljnu odrednicu kontinuiteta skrbi osigurala i unapređenje kvalitete skrbi za ovisnike o opijatimaPatients with opioid dependence are chronic patients represented in a family physician's everyday work. The aim of this study was to evaluate efficacy of treatment of patients with opioid dependence treated with methadone in a family medicine setting in Croatia. The study was carried out from January 31, 1995 to January 31, 2007 in Novi Zagreb. Data were collected through personal interviews with family physicians, as well as by examing personal medical information sheets and included sociodemographic data about patients and data about treatment characteristics. The data collected at the annual check-up included the data about treatment outcomes. There were 256(82.05%) male and 56(17.95%) female patients with opioid dependence, average aged 26 years at the beginning of the treatment. During the present study, 225(72,1%) patients with opioid dependence treated with methadone in a family medicine setting achieved continuity of care and better outcomes in a treatment and 229(73,4%) patients with opioid dependence treated with methadone in a family medicine setting achieved retention in a treatment and better outcomes in a treatment. Treatment of the patients with opioid dependence with methadone in a family medicine setting provides accessibility of treatment, continuity of care and retention in a treatment

The efficacy of tretment of patients with opioid dependence treated with methadone in a family medicine setting in Croatia

Ovisnici o opijatima su kronični bolesnici, a ovisnost o opijatima je kronična recidivirajuća bolest te je time prisutna u svakodnevnom radu liječnika obiteljske madicine. Cilj ovog istraživanja bio je evaluirati uspješnost u liječenju ovisnosti o opijatima zamjenskom terapijom metadonom u obiteljskoj medicini u Hrvatskoj. Istraživanje je provedeno kao prospektivno u periodu 31. siječnja 1995. do 31. siječnja 2007. godine na području Novog Zagreba u okviru rada liječnika obiteljske medicine. Podaci za istraživanje prikupljeni su temeljem osobnog kontakta sa obiteljskim liječnicima kao i na osnovu podataka iz medicinske dokumentacije, a uključivali su sociodemografske podatke o ispitanicima, podatke koji su opisivali uvijete i tijek same terapije prilikom uključivanja u istraživanje kao i druge moguće odrednice pri procjeni uspješnosti zamjenske terapije metadonom. Tijekom praćenja uspješnosti liječenja zamjenskom terapijom metadonom svake godine su prikupljeni podaci o rezultatima odnosno ishodima liječenja zamjenskom terapijom metadonom u obiteljskoj medicini. Ovom prospektivnom studijom dugotrajnog praćenja definirane skupine ispitanika obuhvaćeno je 312 ovisnika o opijatima od kojih je 256(82.05%) bilo muškaraca i 56(17.95%) žena koji su u svijetu heroina proveli 6 godina do trenutka uključivanja u sustav liječenja i pri tome su bili prosječne starosti 26 godina. Tijekom ovog prospektivnog istraživanja liječenje ovisnika o opijatima zamjenskom terapijom metadonom na terenu Novog Zagreba provođeno je u 46 od 60 timova obiteljske medicine te je za ovisnike skrbilo 57 liječnika od kojih je 30 imalo specijalističku izobrazbu iz obiteljske medicine. Tijekom istraživanog perioda u 225(72,1%) ovisnika postignut je kontinuitet skrbi te su u ovih ovisnika postignuti bolji ishodi u liječenju zamjenskom terapijom metadonom. Tijekom istraživanog perioda 229(73,4%) ovisnika zadržano je u programu liječenja zamjenskom terapijom metadonom dok u 83(26,6%) ovisnika nije postignuto zadržavanje u programu liječenja zamjenskom terapijom metadonom. Rezultati dobiveni logističkom regresijom vezani uz utjecaj remisije bolesti, sklonosti deliktu, životnog stila i ekonomske samostalnosti na zadržavanje u programu liječenja pokazali su da su zadržavani u programu liječenja bili oni ovisnici koji su bili u remisiji uz terapiju, oni koji su uzimali drogu uz terapiju, oni koji nisu bili suspektni bez terapije, stalno uposleni te oni koji nisu bili niti suspektno niti potvrđeno deliktuozni. Do zadržavanja u programu liječenja nije došlo u onih ovisnika koji su bili suspektni bez terapije, suspektno ili potvrđeno deliktuozni te neuposleni. Temeljna organizacija liječenja ovisnika o opijatima u Republici Hrvatskoj kao i specifičnost obiteljske medicine osigurala je stabilan i dostupan sustav liječenja ovisnika o opijatima uključenih u zamjensku terapiju metadonom hrvatskim modelom liječenja ovisnika o opijatima te kroz temeljnu odrednicu kontinuiteta skrbi osigurala i unapređenje kvalitete skrbi za ovisnike o opijatimaPatients with opioid dependence are chronic patients represented in a family physician's everyday work. The aim of this study was to evaluate efficacy of treatment of patients with opioid dependence treated with methadone in a family medicine setting in Croatia. The study was carried out from January 31, 1995 to January 31, 2007 in Novi Zagreb. Data were collected through personal interviews with family physicians, as well as by examing personal medical information sheets and included sociodemographic data about patients and data about treatment characteristics. The data collected at the annual check-up included the data about treatment outcomes. There were 256(82.05%) male and 56(17.95%) female patients with opioid dependence, average aged 26 years at the beginning of the treatment. During the present study, 225(72,1%) patients with opioid dependence treated with methadone in a family medicine setting achieved continuity of care and better outcomes in a treatment and 229(73,4%) patients with opioid dependence treated with methadone in a family medicine setting achieved retention in a treatment and better outcomes in a treatment. Treatment of the patients with opioid dependence with methadone in a family medicine setting provides accessibility of treatment, continuity of care and retention in a treatment

The efficacy of tretment of patients with opioid dependence treated with methadone in a family medicine setting in Croatia

Ovisnici o opijatima su kronični bolesnici, a ovisnost o opijatima je kronična recidivirajuća bolest te je time prisutna u svakodnevnom radu liječnika obiteljske madicine. Cilj ovog istraživanja bio je evaluirati uspješnost u liječenju ovisnosti o opijatima zamjenskom terapijom metadonom u obiteljskoj medicini u Hrvatskoj. Istraživanje je provedeno kao prospektivno u periodu 31. siječnja 1995. do 31. siječnja 2007. godine na području Novog Zagreba u okviru rada liječnika obiteljske medicine. Podaci za istraživanje prikupljeni su temeljem osobnog kontakta sa obiteljskim liječnicima kao i na osnovu podataka iz medicinske dokumentacije, a uključivali su sociodemografske podatke o ispitanicima, podatke koji su opisivali uvijete i tijek same terapije prilikom uključivanja u istraživanje kao i druge moguće odrednice pri procjeni uspješnosti zamjenske terapije metadonom. Tijekom praćenja uspješnosti liječenja zamjenskom terapijom metadonom svake godine su prikupljeni podaci o rezultatima odnosno ishodima liječenja zamjenskom terapijom metadonom u obiteljskoj medicini. Ovom prospektivnom studijom dugotrajnog praćenja definirane skupine ispitanika obuhvaćeno je 312 ovisnika o opijatima od kojih je 256(82.05%) bilo muškaraca i 56(17.95%) žena koji su u svijetu heroina proveli 6 godina do trenutka uključivanja u sustav liječenja i pri tome su bili prosječne starosti 26 godina. Tijekom ovog prospektivnog istraživanja liječenje ovisnika o opijatima zamjenskom terapijom metadonom na terenu Novog Zagreba provođeno je u 46 od 60 timova obiteljske medicine te je za ovisnike skrbilo 57 liječnika od kojih je 30 imalo specijalističku izobrazbu iz obiteljske medicine. Tijekom istraživanog perioda u 225(72,1%) ovisnika postignut je kontinuitet skrbi te su u ovih ovisnika postignuti bolji ishodi u liječenju zamjenskom terapijom metadonom. Tijekom istraživanog perioda 229(73,4%) ovisnika zadržano je u programu liječenja zamjenskom terapijom metadonom dok u 83(26,6%) ovisnika nije postignuto zadržavanje u programu liječenja zamjenskom terapijom metadonom. Rezultati dobiveni logističkom regresijom vezani uz utjecaj remisije bolesti, sklonosti deliktu, životnog stila i ekonomske samostalnosti na zadržavanje u programu liječenja pokazali su da su zadržavani u programu liječenja bili oni ovisnici koji su bili u remisiji uz terapiju, oni koji su uzimali drogu uz terapiju, oni koji nisu bili suspektni bez terapije, stalno uposleni te oni koji nisu bili niti suspektno niti potvrđeno deliktuozni. Do zadržavanja u programu liječenja nije došlo u onih ovisnika koji su bili suspektni bez terapije, suspektno ili potvrđeno deliktuozni te neuposleni. Temeljna organizacija liječenja ovisnika o opijatima u Republici Hrvatskoj kao i specifičnost obiteljske medicine osigurala je stabilan i dostupan sustav liječenja ovisnika o opijatima uključenih u zamjensku terapiju metadonom hrvatskim modelom liječenja ovisnika o opijatima te kroz temeljnu odrednicu kontinuiteta skrbi osigurala i unapređenje kvalitete skrbi za ovisnike o opijatimaPatients with opioid dependence are chronic patients represented in a family physician's everyday work. The aim of this study was to evaluate efficacy of treatment of patients with opioid dependence treated with methadone in a family medicine setting in Croatia. The study was carried out from January 31, 1995 to January 31, 2007 in Novi Zagreb. Data were collected through personal interviews with family physicians, as well as by examing personal medical information sheets and included sociodemographic data about patients and data about treatment characteristics. The data collected at the annual check-up included the data about treatment outcomes. There were 256(82.05%) male and 56(17.95%) female patients with opioid dependence, average aged 26 years at the beginning of the treatment. During the present study, 225(72,1%) patients with opioid dependence treated with methadone in a family medicine setting achieved continuity of care and better outcomes in a treatment and 229(73,4%) patients with opioid dependence treated with methadone in a family medicine setting achieved retention in a treatment and better outcomes in a treatment. Treatment of the patients with opioid dependence with methadone in a family medicine setting provides accessibility of treatment, continuity of care and retention in a treatment

Patient, Physician, and Practice Characteristics Related to Patient Enablement in General Practice in Croatia: Cross-sectional Survey Study

AIM: To investigate the quality of general practice care in Croatia by using patient enablement as a consultation outcome measure and its association with patient, physician, and practice characteristics. ----- METHODS: A cross-sectional questionnaire-based study performed from November 2003 to March 2004 included a national stratified random sample of 350 general practitioners, who were asked to collect data on 50 consecutive consultations with their patients aged ≥18 years. Patients provided data on patient enablement (Patient Enablement Instrument, score range 0-12), consultation length, sociodemographic data, how well they knew the physician, health self-assessment, quality of life, and reason for the visit. Physicians provided data on age, sex, vocational training, working experience, educational work, average number of patients per day, and type of practice. ----- RESULTS: In 5527 patients, the mean score (±standard deviation) for enablement at consultation was 6.6 ± 3.3 and the mean consultation length was 11.5 ± 5.5 minutes. Logistic regression analysis showed that lack of continuity of care (men: OR, 0.56; 95% CI, 0.47-0.67; women: OR, 0.52; 95% CI, 0.45-0.61), poor self-perceived health (men: OR, 1.76; 95% CI, 1.49-2.07; women: OR, 1.77; 95% CI, 1.53-2.04), low educational level, low quality of life for both sexes and older age in male patients predicted low enablement (P < 0.05 for each). Physician age, sex, and average number of patients per day were significantly correlated with enablement for male patients and physician working experience with enablement for female patients (P < 0.05 for each). ----- CONCLUSION: Patient enablement score in Croatia is high in comparison with countries such as the UK and Poland. Enablement at consultations was related to the continuity of care and patient health status, and other patient, physician, and practice characteristics, suggesting that these parameters should be considered when assessing quality of care in general practice

Patient, Physician, and Practice Characteristics Related to Patient Enablement in General Practice in Croatia: Cross-sectional Survey Study Public Health Public Health

Aim To investigate the quality of general practice care in Croatia by using patient enablement as a consultation outcome measure and its association with patient, physician, and practice characteristics. Methods A cross-sectional questionnaire-based study performed from November 2003 to March 2004 included a national stratified random sample of 350 general practitioners, who were asked to collect data on 50 consecutive consultations with their patients aged ≥18 years. Patients provided data on patient enablement (Patient Enablement Instrument, score range 0-12), consultation length, sociodemographic data, how well they knew the physician, health self-assessment, quality of life, and reason for the visit. Physicians provided data on age, sex, vocational training, working experience, educational work, average number of patients per day, and type of practice. Results In 5527 patients, the mean score (±standard deviation) for enablement at consultation was 6.6 ± 3.3 and the mean consultation length was 11.5 ± 5.5 minutes. Logistic regression analysis showed that lack of continuity of care (men: OR, 0.56; 95% CI, 0.47-0.67; women: OR, 0.52; 95% CI, 0.45-0.61), poor self-perceived health (men: OR, 1.76; 95% CI, 1.49-2.07; women: OR, 1.77; 95% CI, 1.53-2.04), low educational level, low quality of life for both sexes and older age in male patients predicted low enablement (P &lt; 0.05 for each). Physician age, sex, and average number of patients per day were significantly correlated with enablement for male patients and physician working experience with enablement for female patients (P &lt; 0.05 for each). Conclusion Patient enablement score in Croatia is high in comparison with countries such as the UK and Poland. Enablement at consultations was related to the continuity of care and patient health status, and other patient, physician, and practice characteristics, suggesting that these parameters should be considered when assessing quality of care in general practice