COMMUNICATION AND HEALTH OUTCOMES IN PATIENTS SUFFERING FROM GASTROINTESTINAL DISEASES

Unatoč rezultatima istraživanja koji ukazuju na jasnu povezanost komunikacije liječnika i pacijenta i zdravstvenog ishoda, nedovoljno su jasni mehanizmi njihova djelovanja. Iako razgovor sam po sebi može biti terapijski (umanjenjem pacijentove tjeskobe, pružanjem nade i utjehe), komunikacija između liječnika i pacijenta većinom utječe na zdravstvene ishode neizravnim putem. Proksimalni ishodi interakcije uključuju razumijevanje, povjerenje i dogovor liječnika i pacijenta. Navedeno utječe na intermedijarne ishode (povećanje adherentnosti, bolju vještinu samokontrole i samoliječenja) te u konačnici na zdravlje i blagostanje pacijenta. Sedam je domena putem kojih komunikacija može dovesti do unaprjeđenja zdravlja: povećanjem dostupnosti skrbi, povećanjem pacijentova poznavanja karakteristika bolesti i liječenja, zajedničkim razumijevanjem problema, donošenjem kvalitetnih medicinskih odluka, unaprjeđenjem terapijskog saveza, jačanjem socijalne podrške, jačanjem osnaženosti i zastupanja pacijenta, te povećanjem pacijentove sposobnosti nošenja s emocijama. Iako su ove domene utvrđene temeljem potreba onkološkog pacijenta, one su svakako primjenjive i u drugim zdravstvenim stanjima, pa tako i u skrbi bolesnika koji boluju od gastrointestinalnih bolesti.Although survey results indicate clear connection between the physician-patient communication and health outcomes, mechanisms of their action are still insuffi ciently clear. The aim was to investigate the specifi city of communication with patients suffering from gastrointestinal diseases and the impact of good communication on measurable outcomes. We performed PubMed (Medline) search using the following key words: communication, health outcomes, and gastrointestinal diseases. Seven pathways through which communication can lead to better health include increased access to care, greater patient knowledge and shared understanding, higher quality medical decisions, enhanced therapeutic alliances, increased social support, patient agency and empowerment, and better management of emotions. Although these pathways were explored with respect to cancer care, they are certainly applicable to other health conditions as well, including the care of patients suffering from gastrointestinal diseases. Although proposing a number of pathways through which communication can lead to improved health, it should be emphasized that the relative importance of a particular pathway will depend on the outcome of interest, the health condition, where the patient is in the illness trajectory, and the patient’s life circumstances. Besides, research increasingly points to the importance of placebo effect, and it is recommended that health professionals encourage placebo effect by applying precisely targeted communication skills, as the unquestionable and successful part of many treatments. It is important that the clinician knows the possible positive and negative effects of communication on health outcomes, and in daily work consciously maximizes therapeutic effects of communication, reaching its proximal (understanding, satisfaction, clinician-patient agreement, trust, feeling known, rapport, motivation) and intermediate outcomes (access to care, quality medical decision, commitment to treatment, trust in the system, social support, self-care skills, emotional management) to improve the health of patients he cares for

Assessment of alcohol related disorders in family physician’s work – a pilot study

Uvod. Prema podacima Svjetske zdravstvene organizacije u Republici Hrvatskoj se godišnje u prosjeku popije 12,2 litara čistog alkohola po stanovniku starijem od 15 godina. Usprkos ovim podacima, poremećaji uzrokovani pijenjem alkohola rijetko se dijagnosticiraju u ordinacijama obiteljske medicine (OM). Cilj. Istražiti proporciju osoba u skrbi liječnika obiteljske medicine na području Općine Bednja koji ispunjavaju kriterije rizičnog pijenja, štetnog pijenja ili moguće ovisnosti o alkoholu. Metode i ispitanici. Pilot istraživanje je provedeno u dvije ordinacije OM u Općini Bednja u razdoblju ožujak-travanj 2013. godine na prigodnom uzorku ispitanika starijih od 18 godina (N=150). Upitnikom su prikupljeni podaci o ispitanicima (sociodemografski podaci, samoprocjena zdravlja, zadovoljstvo životom), podaci o rizičnom pijenju, štetnom pijenju te mogućoj ovisnosti o alkoholu (AUDIT upitnik). Rezultati. Od 150 upitnika, 75 je uključeno u statističku obradu (stopa odgovora 50%). Temeljem ukupnog broja bodova ostvarenog na AUDIT upitniku, kod 9 od 75 ispitanika utvrđeno je prekomjerno i štetno pijenje te postojanje moguće ovisnosti o alkoholu. Za većinu tih ispitanika (8 od 9) utvrđena je umjerena razina problema povezanih s alkoholom (AUDIT zbroj 8-15), dok je kod 1 od 9 ispitanika utvrđena visoka razina problema povezanih s alkoholom (AUDIT zbroj 16-19). Analizom pojedinačnih cjelina AUDIT upitnika, 11-27 od 75 ispitanika ispunjavalo je kriterij rizičnog pijenja, 3-10 od 75 ispitanika kriterij moguće ovisnosti o alkoholu, a 4-12 od 75 ispitanika ispunjavalo je kriterij postojanja štetnih posljedica pijenja alkohola. Zaključak. Značajan udio osoba u skrbi liječnika OM na području Općine Bednja ispunjava kriterije rizičnog pijenja, štetnog pijenja ili moguće ovisnosti o alkoholu. Analizom pojedinačnih cjelina upitnika (rizično pijenje; ovisnost o alkoholu; štetne posljedice pijenja) detektiran je još veći broj ispitanika koji ispunjavaju kriterije unutar pojedinačnih cjelina, što omogućuje rano prepoznavanje i ranu intervenciju liječnika OM.Introduction. According to WHO data, the average yearly alcohol consumption in the Republic of Croatia per capita resembles 12.2 L of pure alcohol in the age group >15 years. Despite these data, alcohol related disorders are rarely diagnosed in family medicine (FM) practices. Aim. Proportion of patients in care of family physicians in Bednja District that fulfill criteria of hazardous drinking, harmful drinking or possible alcohol dependence is investigated. Methods. A pilot study was conducted in two FM practices in Bednja District on an appropriate sample of respondents aged 18+ years (N=150) from March to April 2013. Data on respondents’ characteristics (sociodemographic data, health self-assessment, life satisfaction) and hazardous drinking, harmful drinking or possible alcohol dependence (AUDIT questionnaire) was collected. Results. There were 75 out of 150 questionnaires (response rate 50%) included in the analysis. According to total AUDIT score, 9 of 75 respondents fulfilled criteria of hazardous drinking, harmful drinking or possible alcohol dependence. Majority of these respondents (8 out of 9) had moderate level of alcohol related problems while in 1 respondent high level of alcohol related problems was detected. Analysis of 75 individual responses revealed that 11-27 fulfilled criteria of hazardous drinking, 3-10 of possible alcohol dependence and 4-12 of harmful drinking. Conclusion. A significant proportion of FM patients in Bednja District fulfilled criteria of hazardous drinking, harmful drinking or possible alcohol dependence. Analysis of individual responses revealed even higher rates of respondents that fulfilled those criteria in separate domains, enabling family physicians early detection and intervention in those patients

Stavovi obiteljskih liječnika o elektroničkim alatima i dostupnosti, uporabi i pridržavanju smjernica za prevenciju kardiovaskularnih bolesti u Hrvatskoj

Family physicians are burdened with a great number of guidelines considering different conditions they treat. We analyzed opinions of family physicians on electronic tools which help managing chronic conditions and their influence on patient care by cardiovascular disease (CVD) prevention guideline availability, usage and adherence. A descriptive study was performed on a convenient sample of 417 (response rate 56.0%) Croatian family physicians. Data on physician characteristics and availability, usage and adherence to CVD prevention guidelines were analyzed. The χ2-test was used for comparisons. Significance was defined as p<0.05. Family physicians who used additional electronic tools in Electronic Health Record software on more than 80% of their patients had CVD prevention guidelines more available (p<0.01) and used them more frequently (p<0.01). A group who used electronic tools on more than 80% of their patients had CVD prevention guidelines available to them frequently and used them on more than 60% of their patients, also strictly adhering to the guidelines (p<0.01). Physicians who used CVD prevention guidelines on more than 60% of their patients spent more time doing patient education (p=0.036). Using electronic tools helps Croatian family physicians in terms of availability, usage and adherence to the guidelines and quality improvement.Obiteljski liječnici su u radu opterećeni velikim brojem smjernica za različite bolesti. Analizirali smo njihovo mišljenje o elektroničkim alatima koji im pomažu u skrbi za bolesnike s kroničnim bolestima i njihovom utjecaju na dostupnost, uporabu i pridržavanje smjernica za prevenciju kardiovaskularnih bolesti (KVB). Provedeno je opisno istraživanje na uzorku od 417 (stopa odgovora 56,0%) hrvatskih obiteljskih liječnika. Analizirani su podaci o značajkama liječnika, dostupnosti, upotrebi i pridržavanju smjernica za prevenciju KVB. Za usporedbe je primijenjen χ2-test. Statistička značajnost je definirana kao p<0,05. Obiteljski liječnici koji su rabili dodatne elektroničke alate za više od 80% svojih bolesnika imali su dostupnije smjernice za prevenciju KVB (p<0,01) i više su ih upotrebljavali (p<0,01). Liječnici koji su istodobno rabili elektroničke alate na više od 80% svojih bolesnika često su imali na raspolaganju smjernice za prevenciju KVB i upotrebljavali su ih na više od 60% svojih bolesnika, a ujedno su se strogo pridržavali smjernica (p<0,01). Liječnici koji su rabili smjernice za prevenciju KVB na više od 60% svojih bolesnika proveli su i više vremena obrazujući svoje bolesnike (p=0,036). Primjena elektroničkih alata pomaže obiteljskim liječnicima u Hrvatskoj u pogledu dostupnosti, upotrebe i pridržavanja smjernica te unaprjeđenju kvalitete skrbi

Risk factors for fatal outcome in patients with opioid dependence treated with methadone in a family medicine setting in Croatia

Aim To determine the risk factors for fatal outcome in patients with opioid dependence treated with methadone at the primary care level. Methods A group of 287 patients with opioid dependence was monitored prospectively from 1995 to 2007. At the beginning of the study, we collected the data on patient baseline characteristics, treatment characteristics, and living environment. At the annual check-up, we collected the data on daily methadone dose, method of methadone therapy administration, and family physician’s assessment of the patient’s drug use status. Results Out of 287 patients, 8% died. Logistic regression analysis showed that the predictors of fatal outcome were continuation of drug use during previous therapeutic attempts (odds ratio [OR], 19.402; 95% confidence interval [CI], 1.659-226.873), maintenance therapy as the planned treatment modality (OR, 3.738; 95% CI, 1.045-13.370), living in an unstable relationship (OR, 9.275; 95% CI, 2.207- 38.984), and loss of continuity of care (OR, 12.643; 95% CI, 3.001-53.253). Conclusion The patients presenting these risk factors require special attention. It is important for family physicians to insist on compliance with the treatment protocol and intervene when they lose contact with the patient to prevent the fatal outcome

“Grandma’s Old Tricks“- A Qualitative Study of Lay People’s Experiences in Treatment and Prevention of Common Cold and Influenza

We aimed to explore lay people’s perception of common cold and influenza as well as their experience in treatment and prevention of those conditions, with emphasis on the reasons impacting their decision towards influenza vaccination. 24 semi-structured, individual interviews were conducted, then transcribed and analysed to find emerging themes and sub-themes. Textual data were explored inductively using content analysis to generate categories and explanations. Five major themes and explanatory models of lay people’s perspective emerged from the data. The participants expressed satisfying knowledge regarding influenza and common cold symptoms, length, transfer and treatment options as well as described a clear distinction between those two diseases. On the other hand, they emphasized the same general preventative measures for both common cold and influenza, considering influenza vaccination primarily an option for chronic, old or bedridden patients and health workers. Facilitators in the vaccination decision making process were health professionals’ (mostly general practitioners’) recommendation, anxiety regarding influenza and possible complications, existence of chronic diseases and positive vaccination experience. As main reasons against vaccination participants stated perception of being at low risk for influenza, opinion that vaccination is necessary only for bedridden and old people, chronic patients or health workers and questionable effectiveness of the vaccine. Participants’ influenza vaccination knowledge was insufficient, which should direct further interventions, especially having in mind low vaccination rates. Since participants perceived general practitioner’s recommendation as a crucial facilitator in forming their positive attitude towards vaccination, practitioners are invited to assess and, when needed, modify inappropriate perception towards influenza prevention when leading person centred consultations

Long-term care for a patient following liver transplantation from a perspective of a family physician

Hrvatska je među vodećim zemljama u svijetu po stopi transplantacija jetre. Zahvaljujući sve dužem preživljenju nakon transplantacije povećana je potreba za dugoročnom skrbi pacijenata, pri čemu sve veći dio skrbi preuzimaju obiteljski liječnici. Kasne komplikacije transplantacije jetre uključuju širok spektar metaboličkih poremećaja koji se javljaju u značajnom postotoku transplantiranih; šećerna bolest (do 30%), dislipidemija (45 – 69%), hipertenzija (50 – 90%), pretilost (do 40%), osteoporoza (37%), hiperuricemija (14 – 47%), dok je pojava pojedinih malignih bolesti i do 4 puta viša nego u netransplantiranoj populaciji. Kardiovaskularne bolesti i malignomi vodeći su uzroci smrtnosti dugoročno nakon transplantacije jetre. Uz ostale faktore rizika, imunosupresivni lijekovi, kalcijneurinski inhibitori, antimetaboliti i mTOR inhibitori značajno pridonose razvitku navedenih komplikacija. Nadalje, kod 22 – 33% pacijenata nakon transplantacije jetre prisutan je neki oblik poremećaja raspoloženja, od kojih najčešće anksioznost i depresija. Prevencija, prepoznavanje i zbrinjavanje komplikacija nakon transplantacije jetre ključni su za poboljšanje dugoročnih ishoda. Cilj ovog preglednog rada jest približiti problematiku dugoročnog zbrinjavanja pacijenata nakon transplantacije jetre u primarnoj zdravstvenoj zaštitiCroatia is among the leading countries in the world according to the liver transplants rates. Owing to the longer post-transplant survival, the need for long-term care for patients is increasing, with an increasing proportion of care being provided by family physicians. Late complications after liver transplantation include a wide range of metabolic disorders that occur in a significant percentage of patients: diabetes (up to 30%), dyslipidemia (45–69%), hypertension (50–90%), obesity (up to 40%), osteoporosis (37%), hyperuricemia (14– 47%), while the occurrence of certain malignant diseases remains up to four times higher than in the non-transplant population. Cardiovascular disease and malignancies are the leading causes of long-term mortality following liver transplantation. In addition to other risk factors, immunosuppressive drugs: calcineurin inhibitors, antimetabolites and mTOR inhibitors contribute significantly to the development of these complications. Furthermore, in 22–33% of patients after liver transplantation, some form of mood disorder develops, most commonly anxiety and depression. Prevention, recognition, and management of complications after liver transplantation are the key to improving long-term outcomes. The aim of this review paper is to address the issue of long-term care for patients after liver transplantation in primary care

Family medicine - A safe future

Cilj: Istražiti stavove pacijenata prema obiteljskoj medicini, odnosno ustanoviti pridonosi li obiteljska medicina kvalitetnijoj zdravstvenoj skrbi pojedinca i obitelji, kao i doznati razloge koji su važni za postojanje obiteljske medicine u zdravstvenom sustavu urbanih i ruralnih područja. Ispitanici i metode: U četiri gradske i četiri seoske ordinacije provedeno je presječno istraživanje. Anketama koje su ispunjavali pacijenti stariji od 18 godina prikupljeni su podaci o dobi, spolu, stručnoj spremi, te broju članova obitelji koji su u skrbi istog obiteljskog liječnika. Ispitanici su odgovarali na pitanje drže li da obiteljska medicina pridonosi kvalitetnijoj zdravstvenoj skrbi za pojedinca i obitelj, te što drže razlozima koji su važni za postojanje obiteljske medicine. Rezultati: Uzorak je sačinjavalo 960 ispitanika, od čega 428 (44,58%) muškaraca i 532 (55,42%) žene. Većina ispitanika (N = 382, 39,79%) bila je starija od 60 godina. 494 (51,46%) ispitanika registrirano je u seoskim, a 466 (48,54%) u gradskim ordinacijama obiteljske medicine. Većina ispitanika u seoskim ordinacijama imala je nižu stručnu spremu (N = 277, 56,07%), dok je većina ispitanika u gradskima ordinacijama imala srednju stručnu spremu (N = 302, 64,81%). Značajno veći udio ispitanika u seoskim ordinacijama (N = 145, 29,35%) naveo je da su svi članovi obitelji u skrbi istoga liječnika (χ 2 = 23,27, p < 0,001). Od 960 ispitanika, njih 736 (76.67%) u potpunosti se složilo da obiteljska medicina pridonosi kvalitetnijoj skrbi. Za 510 (53.13%) ispitanika najvažniji razlog postojanja obiteljske medicine bio je poznavanje pacijenta. Zaključak: Sukladno stavovima pacijenata obiteljska medicina osigurava cjelokupnu, kontinuiranu skrb za pacijenta i doprinosi kvaliteti zdravstvene skrbi u cjelini.Aim: To investigate patients’ attitudes regarding family medicine, their opinion on the contribution of family medicine to the quality of health care and their perception of family medicine advantages. Participants and methods: A cross-sectional questionnaire-based study was performed in four urban and four rural family practices. Patients aged 18 years or more provided data on their age, sex, educational level and proportion of family members who were in care of the same family doctor. Patients expressed their opinion on the contribution of family medicine to the quality of health care and their perception of family medicine advantages. Results: Out of 960 patients, 428 (44.58%) men and 532 (55.42%) women, 494 (51.46%) patients were registered in urban and 466 (48.54%) in rural family practices. Most of the patients (N = 382, 39.79%) were aged 60 years or more. The majority of patients in rural practices had finished primary school (N = 277, 56.07%) and the majority of patients in urban practices had finished secondary school (N = 302, 64.81%). A significantly higher proportion of patients in rural practices reported having one family doctor taking careof all family members (N = 145, 29.35%) (χ 2 = 23.27, p < 0.001), 736 (76.67%) patients fully agreed that family medicine contributes to higher care quality. For 510 (53.13%) patients, the main advantage of family medicine was knowing the patient. Conclusion: According to patients’ opinion, family medicine provides holistic, continuing care to patients and contributes to a higher quality of health care

What, when and how to measure the assessment of quality of care for chronic diseases in family practice? Applying indicators of quality for diabetes mellitus

Proučavanje kvalitete zdravstvene zaštite u primarnoj zaštiti sa znanstvenog i stručnog stajališta danas je vrlo izazovna tema. O toj temi nema još dovoljno sveobuhvatnih i usporedivih podataka na internacionalnoj razini (Europe) koji bi se mogli šire primjenjivati i poslužiti za poboljšanje strategije primarne zaštite. U definiciji kvalitete zaštite uobičajeno se perspektiva pacijenta stavlja kao prioritet. Obiteljski liječnik kao davatelj zdravstvenih usluga po modelu strukturirane zaštite, bolesnicima s kroničnim bolestima na jednom mjestu pruža jedinstvo postupaka: prevencije i ranog otkrivanja bolesti, liječenja i prevencije komplikacija. Kompleksnu ulogu obiteljskoga liječnika u postizanju kvalite zaštite treba sagledavati u uvjetima položaja primarne zaštite u sustavu. Tri su dimenzije primarne zaštite bitne kao polazište za kvalitetnu skrb: struktura sustava koja pruža mogućnosti procesa zaštite, a procesi dovode do određenih ishoda u zaštiti. Što, kada, kako mjeriti, koji mjerni instrument upotrijebiti za procjenu kvalitete skrbi pacijenata sa šećernom bolešću? Indikator je definiran kao mjerljivi element izveden u procesu zaštite za koji postoji dokaz ili dogovor da se može uzeti kao posredni, prijelazni pokazatelj rezultata zaštite. Može se protumačiti da se njihovom primjenom ili ne primjenom mijenja kvaliteta zaštite. Indikatori procesa zaštite odgovaraju na pitanje: tko čini, što čini, gdje, kada i kako često? Indikatori rezultata zaštite odgovaraju na pitanje: koji postupak ili intervencija u procesu zaštite donosi pojedini rezultat u zaštiti? U procjeni kvalitete zaštite osoba sa šećernom bolešću, 34 indikatora (svrstana u 5 skupina) izvedena u procesu zaštite, prihvaćena su kao prijelazni indikatori kvalitete zaštite.Health care quality research of chronic diseases in primary care according to the scientific and professional point of view is very challenging. There are not enough comprehensive and comparable data on the international level (Europe) that could be applied to improve primary health care. In defining quality care, the patient’s perspective is a priority. The general physician as a provider of health care service for patients with chronic diseases offers joint procedure all in one place: prevention and early detection of diseases, treatment and prevention of complications. The complex role of the family doctor in reaching quality care should be observed according to the position of primary care in the health care system. Three dimensions of primary health care are important as a starting point in the assessment of quality care: the system of structure which offers an opportunity for the process of care, which leads to outcomes in protection. What, when and how to measure, which measure instrument to use in assessment quality care for patients with diabetes mellitus? The indicator is defined as a quantifiable element performed in the process of care for which there is proof or agreement that it can be taken as an indirect transient indicator for quality care. Or, it can be interpreted that its usage or not usage changes quality care. Indicators of process health care are answering the questions: who is doing, what is being done, where, when and how often. Indicators of results (outcomes) of health care are answering the question: which procedures or interventions performed in the health care process are giving which outcomes? In quality care assessment for patients with diabetes mellitus, 34 indicators performed in the process of care (divided in 5 groups) are accepted as transient indicators for quality care

GUIDELINES FOR THE MANAGEMENT OF COMMUNITY-ACQUIRED PNEUMONIA IN ADULTS

Pneumonija iz opće populacije, odnosno stečena izvan bolnice vrlo je česta bolest uzrokovana brojnim mikro­organizmima s različitom kliničkom pojavnošću, težinom i prognozom te ima važan udio u pobolu i smrtnosti pučanstva s rastućim troškovima liječenja u cijelom svijetu. Izjednačavanje i poboljšanje liječenja odraslih bolesnika propisuju smjernice mnogih institucija i profesionalnih udruženja. Sve moderne smjernice za liječenje pneumonija iz opće populacije ­temelje se na kliničkoj dijagnozi pneumonije potvrđene rendgenskom slikom pluća i empirijskom izboru antibiotika. Poput ostalih najpoznatijih (američke, europske, britanske), naše smjernice s racionalnim pristupom baziraju se na procjeni težine bolesti, dobi bolesnika, popratnim kroničnim bolestima, rizičnim čimbenicima i epidemiološkim podatcima. Na osnovi težine bolesti propisuju dijagnostičke i terapijske postupke prema mjestu zbrinjavanja pneumonija: ambulantno, na bolničkom odjelu, odnosno u jedinicama za intenzivno liječenje. Liječenje pneumonija antibiotikom treba započeti odmah, odnosno u roku od četiri sata nakon postavljanja kliničke dijagnoze. Parenteralna primjena antibiotika može se zamijeniti peroralnom najčešće 48 – 96 sati od početka liječenja, čak i u bolesnika s težim oblikom bolesti ako su zadovoljeni krite­riji. Cijepljenje protiv influence i pneumokokne bolesti preporučuje se svim osobama s povišenim rizikom. U izradi smjernica sudjelovali su ekspertni predstavnici pet relevantnih društava HLZ-a i Hrvatskoga torakalnog društva te Referentnog centra za dijagnostiku i liječenje infektivnih bolesti Ministarstva zdravstva Republike Hrvatske. Namijenjene su liječnicima obiteljske medicine i specijalistima različitih struka koji liječe bolesnike s pneumonijom ambulantno ili u bolnici.Community-acquired pneumonia (CAP), or pneumonia acquired outside the hospital, is a very common disease caused by numerous microorganisms with various clinical presentations, disease severity and outcome. CAP is associated with significant morbidity and mortality in affected population and rising costs of medical treatment worldwide. Uniform and improved clinical approach and treatment of adult patients with CAP is advocated in many guidelines developed by various institutions and professional associations. All current guidelines for the treatment of CAP are based on clinical ­diagnosis of pneumonia confirmed by chest radiography and empirical choice of antibiotics. As other well-known guidelines (American, European, British), the Croatian guidelines are trying to rationalize clinical approach based on the assessment of disease severity, patient age, comorbidities, risk factors and epidemiological data. Depending on disease severity, diagnostic and therapeutic procedures are prescribed according to the site of care for CAP patients: outpatient setting, hospital wards or the intensive care unit. Antibiotic treatment of pneumonia should be initiated immediately, or within four hours after establishing the clinical diagnosis. Parenteral administration of antibiotics can be switched to oral usually 48 to 96 hours from the start of treatment, even in patients with severe clinical presentation of disease if all criteria are met. Vaccination against influenza and pneumococcal disease is recommended for all high-risk persons. Expert representatives of five professional societies of the Croatian Medical Association and Croatian Thoracic Society and the Reference Center for Diagnosis and Treatment of Infectious Diseases of the Croatian Ministry of Health participated in the preparation of these guidelines. They are designed for general practitioners and specialists from different medical disciplines who treat patients with pneumonia in outpatient or hospital setting

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