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

Family physicians\u27 management of genetic aspects of a cardiac disease

The aim of this study was to find out how Slovenian family physicians (FPs) would manage a hypothetical clinical case, to explore their views about possible ethical dilemmas associated with this clinical case and to determine possible associations with demographic and other characteristics of FPs. This was an observational cross-sectional postal study in the Slovenian FPs’ surgeries. The study population consisted of the whole population of Slovenian FPs (n = 950). The main outcome measures were the percentages of the answers of FPs on different questions about the clinical case on the management of patient and his relative with hereditary cardiomyopathy. There were 271 FPs who answered the questionnaire (response rate was 27.1%). A sample included 66 (24.4%) men and the mean age of all respondents was 45.5 ± 10.6 years. When dealing with the clinical case, most FPs expressed willingness to take the patient’s family history. Only 34.2% FPs did not believe that ordering genetic tests was part of their job. Additionally, only 50.0% of them felt competent to interpret the genetic risk, 25.0% of them would give information about genetic testing and only 6.0% would interpret the results of the genetic testing. Family physicians in Slovenia were willing to include genetic tasks into routine management of their patients, but they do not feel competent enough to interpret the genetic risks and the results of genetic testing. However, an important part of FPs would not refer patients at risk to genetic counseling. The inclusion of genetic topics to family medicine specialization curriculum is needed

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

A Cross Sectional Study of Sex Differences in Self-Medication Practices among University Students in Slovenia

Self-medication patterns in adults depend on sex. Self-medication among students is very common, but little is known about the influence of sex. The aim of the study was to determine the incidence of self-medication college students and to determine the effect of sex on self-medication patterns. A web based incidence study conducted on a sample of Slovenian university students. The main outcome measures were percentages of male and female students reporting the use of self-medication in the past year. A majority of students (92.3%) reported the use of some sort of self-medication in the past year. Most female students (94.1%) and most male students (90.9%) reported the use of self-medication in the past year. The difference was not statistically significant. More female students than male ones (p<0.05) acquired the drugs for self-medication in pharmacies, used OTC drugs, herbal teas, herbs, vitamins and minerals, remedies for muscle mass gain, antibiotics, benzodiazepines, antacids, acetylsalicylic acid, topical corticosteroids, and nasal decongestives only with the advice of physicians or pharmacists, and thought that increasing drug dosage can be dangerous, that in case of side effects physicians’ help must be sought, that no drug can be used during pregnancy, and that self-treatment can mask the symptoms and signs of diseases so the physicians can overlook them easily. Sex appears to be important factor in self-medication patterns even in young adults, such as students. The physicians should actively seek the presence of self-medication in this population. Inappropriate or unsafe use should be properly addressed and managed

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

Vprašalnik za samooceno kompetenc zdravnika družinske medicine na področju izboljševanja kakovosti

Aim: To perform a cross-cultural adaptation of the Quality Improvement Competency Self Assessment (QICS) questionnaire for family physicians into the Slovenian language and to validate it in a representative sample of Slovenian FPs. Methods: This cross-sectional observational postal survey was conducted in a random sample of 398 Slovenian FPs. We used the QICS questionnaire that was developed on the basis of the new Quality Improvement Competency Framework for family medicine. The QICS questionnaire consists of 37 items included in six domains. The questions can be answered on a five-point Likert scale. The validity of the translation was provided by the backward translation from Slovenian to the English language and by the reference group consisting of experienced FPs in the consensus process. The reliability of the questionnaire was assessed by Cronbach’s alpha coefficient and Spearman rho to determine the test-retest reliability (the questionnaire was sent to the physicians in the sample twice in a period of two weeks). Results: The final sample consisted of 100 (25.1%) family physicians, out of which 71 (71.0%) were women. Mean age of the sample was 43.3 ± 9.6 years. Mean score of the QICS questionnaire was 127.0 ± 30.1 points (first round) and 127.8 ± 30.6 points (second round). Cronbach’s alpha scores were 0.984 (first round) and 0.988 (second round). Spearman’s rho for the summary score of the whole scale was 0.829 with p < 0.001. Conclusion: The Slovenian version of the QICS questionnaire proved to be a valid and reliable tool for selfassessment of quality improvement competencies by FPs in terms of continuous professional development.Namen: Izvesti medkulturno prilagoditev vprašalnika o samoocenjevanju kompetenc zdravnika družinske medicina na področju izboljševanju kakovosti (vprašalnik QICS) in ga validirati na reprezentativnem vzorcu slovenskih zdravnikov družinske medicine. Metode: Ta presečna opazovalna raziskava je bila izvedena v naključnem vzorcu 398 slovenskih zdravnikov družinske medicine. Uporabili smo vprašalnik QICS, ki je bil razvit na podlagi novega teoretičnega okvira izboljševanja kakovosti v družinski medicini. Vprašalnik QICS je sestavljen iz 37 vprašanj, vključenih v šest področij. Na vprašanja je mogoče odgovoriti po petstopenjski Likertovi lestvici. Veljavnost prevoda je bila zagotovljena z dvosmernim prevodom in s pomočjo referenčne skupine, ki so jo sestavljali izkušeni zdravniki družinske medicine. Zanesljivost vprašalnika smo ocenjevali s pomočjo koeficienta Cronbach alfa in koeficienta Spearman rho za ugotavljanje časovne stabilnosti (vprašalnik je bil poslan zdravnikom v vzorcu dvakrat v razmiku dveh tednov). Rezultati: Končni vzorec je bil sestavljen iz 100 (25,1 %) zdravnikov družinske medicine, od katerih je bilo 71 (71,0 %) žensk. Povprečna starost vzorca je bila 43,3 ± 9,6 leta. Povprečno število točk na vprašalniku QICS je bilo 127,0 ± 30,1 (prvo pošiljanje) in 127,8 ± 30,6 (drugo pošiljanje). Cronbach alfa je bil 0,984 (prvo pošiljanje) in 0,988 (drugo pošiljanje). Spearman rho je bil 0,829 s p < 0,001. Zaključki: Slovenska različica vprašalnika QICS je zanesljivo in veljavno orodje za samooceno kompetenc zdravnikov družinske medicine na področju izboljševanja kakovosti v sklopu stalnega podiplomskega izobraževanja oz. stalnega strokovnega dograjevanja

Development and Validation of a Questionnaire for Evaluation of Students’ Attitudes towards Family Medicine

The development of the EURACT (European Academy of Teachers in General Practice) Educational Agenda helped many family medicine departments in development of clerkship and the aims and objectives of family medicine teaching. Our aims were to develop and validate a tool for assessment of students’ attitudes towards family medicine and to evaluate the impact of the clerkship on students’ attitudes regarding the competences of family doctor. In the pilot study, experienced family doctors were asked to describe their attitudes towards family medicine by using the Educational Agenda as a template for brainstorming. The statements were paraphrased and developed into a 164-items questionnaire, which was administered to 176 fi nal-year students in academic year 2007/08. The third phase consisted of development of a fi nal tool using statistical analysis, which resulted in the 60-items questionnaire in six domains which was used for the evaluation of students’ attitudes. At the beginning of the clerkship, person-centred care and holistic approach scored lower than the other competences. Students’ attitudes regarding the competences at the end of 7 weeks clerkship in family medicine were more positive, with exception of the competence regarding primary care management. The students who named family medicine as his or her future career choice, found holistic approach as more important than the students who did not name it as their future career. With the decision tree, which included students’ attitudes to the competences of family medicine, we can successfully predict the future career choice in family medicine in 93.5% of the students. This study reports on the fi rst attempt to develop a valid and reliable tool for measuring attitudes towards family medicine based on EURACT Educational Agenda. The questionnaire could be used for evaluating changes of students’ attitudes in undergraduate curricula and for prediction of students’ preferences regarding their future professional career in family medicine

The safety attitudes questionnaire - ambulatory version

Background: Several tools have been developed to measure safety attitudes of health care providers, out of which the Safety Attitudes Questionnaire (SAQ) is regarded as one of the most appropriate ones. In 2007, it was adapted to outpatient (primary health care) settings and in 2014 it was tested in out-of-hours health care settings in Norway. The purpose of this study was to translate the English version of the SAQ-Ambulatory Version (SAQ-AV) to Slovenian languageto test its reliabilityand to explore its factor structure. Methods: This was a cross-sectional study that took place in Slovenian out-of-hours primary care clinics in March- May 2015 as a part of an international study entitled Patient Safety Culture in European Out-of-hours services. The questionnaire consisted of the Slovenian version of the SAQ-AV. The link to the questionnaire was emailed to health care workers in the out-of-hours clinics. A total of 438 participants were invited. We performed exploratory factor analysis. Results: Out of 438 invited participants, 250 answered the questionnaire (response rate 57.1%). Exploratory factor analysis put forward five factors: 1) Perceptions of management, 2) Job satisfaction, 3) Safety climate, 4) Teamwork climate, and 5) Communication. Cronbach\u27s alpha of the whole SAQ-AV was 0.922. Cronbach\u27s alpha of the five factors ranged from 0.587 to 0.791. Mean total score of the SAQ-AV was 56.6 +- 16.0 points. The factor with the highest average score was Teamwork climate and the factor with the lowest average was Job satisfaction. Conclusions: Based on the results in our study, we cannot state that the SAQ-AV is a reliable tool for measuring safety culture in the Slovenian out-of-hours care setting. Our study also showed that there might be other safety culture factors in out-of-hours care not recognised before. We therefore recommend larger studies aiming to identify an alternative factor structure