STIGMA AND LOW SENSE OF COHERENCE AS LONG-TERM PREDICTORS OF DEPRESSIVE AND ANXIETY SYMPTOMS IN THE POPULATION AMID THE COVID-19 PANDEMIC

Background: The COVID-19 has had a profound negative impact on the population’s mental health. This study aimed to determine the prevalence of depressive and anxiety symptoms in the general population during the third wave of the COVID-19 pandemic and to identify risk factors associated with these symptoms after implementing initial prevention strategies. Subjects and methods: A cross-sectional study was conducted among 200 visitors to five general practices in February 2021 in Slovenia. The response rate was 82.0% (164/200). A structured survey was used to assess sociodemographic factors, depressive and anxiety symptoms, exposure to COVID-19 stressors, stress coping strategies used, and sense of coherence (SOC). A score of ≥10 points on the Patient Health Questionnaire-9 and ≥10 points on the General Anxiety Disorder-7 questionnaire were considered as cut-offs for screened depression and anxiety, respectively. The Mann-Whitney U test, chi-square test, and binary logistic regression were used for statistical analysis. Results: The prevalence of screened depression and anxiety was 24.4% and 12.9%, respectively. Independent predictors of depression were stigma related to COVID-19 (OR 2.42, 95% CI 1.57-3.73, p<0.001), low SOC (OR 5.89, 95% CI 2.21-15.72, p<0.001), and smoking (OR 3.53, 95% CI 1.23-10.10. p=0.019). Independent predictors of anxiety were religious rituals cancellation (OR 1.64, 95% CI 1.02-2.65, p=0.040), childcare responsibilities (OR 1.70, 95% CI 1.07-2.69, p=0.025), increased contact with close ones (OR 1.92, 95% CI 1.11-3.29, p=0.019), and low SOC (OR 5.21, 95% CI 1.22-22.31, p=0.026). Conclusions: Despite efforts to address the pandemic through prevention strategies and the burden of the pandemic decreasing, we still found a high prevalence of depressive and anxiety symptoms. While some risk factors can be addressed quickly, such as by providing stable childcare and schooling and enabling assess to mental health services for vulnerable families, others require a longer- term approach, such as strengthening SOC and reducing stigma

Psychotropic medication use among elderly nursing home residents in Slovenia: cross-sectional study

Aim To determine the prevalence of psychotropic medication prescribing in elderly nursing home residents in Slovenia and to explore the residents’, physicians’, and nursing home characteristics associated with prescribing. Methods In a cross-sectional study, we collected the data for 2040 nursing home residents aged 65 years and older in 12 nursing homes in Slovenia between September 25 and November 30, 2006. Prescribed medications lists were retrieved from patients’ medical records. Psychotropic medications were coded according to Anatomical Therapeutic Chemical Classification 2005, which we adjusted for the purposes of the study. Multivariate logistic regression analysis was performed to determine the residents’, physicians’, and nursing home characteristics associated with prescribing. Results Residents were from 65 to 104 years old (median, 83 years) and 1606 (79%) of them were female. A total of 970 (48%) residents had dementia and 466 had depression (23%). In 1492 (73%) residents, at least one psychotropic medication was prescribed. Nine hundred sixty residents were prescribed hypnotics and sedatives (47%), 572 (28%) antipsychotics, 460 (23%) antidepressants, and 432 (21%) anxiolytics. Residents’ characteristics associated with psychotropic medication use were female sex (odds ratio [OR], 1.36; 95% confidence interval [CI], 1.03-1.80), age (OR, 0.97; 95% CI, 0.95-0.98), permanent restlessness (OR, 2.54; 95% CI, 1.71-3.78), dementia (OR, 1.76; 95% CI, 1.33-2.34), depression (OR, 5.51; 95% CI, 3.50-7.58), and the number of prescribed medications (OR, 1.29; 95% CI, 1.23-1.35). Of physicians’ characteristics (sex, age, specialization in general practice, years of working experiences as a general practitioner, and years of experiences working in a nursing home), male sex was associated with psychotropic medication prescribing (OR, 1.80; 95% CI, 1.17-2.76). Conclusion Frequency of psychotropic medication prescribing in elderly nursing home residents in Slovenia is high and is comparable to Western European countries. Our next step should be optimizing the prescribing in patients with the highest prescription rate

Proportion and characteristics of patients who measure their blood pressure at home: Nationwide survey in Slovenia

Introduction. Home blood pressure monitoring has several advantages over blood pressure monitoring at a physician's office, and has become a useful instrument in the management of hypertension. Objective. To explore the rate and characteristics of patients who measure their blood pressure at home. Methods. A sample of 2,752 patients with diagnosis of essential arterial hypertension was selected from 12596 consecutive office visitors. Data of 2,639 patients was appropriate for analysis. The data concerning home blood pressure measurement and patients' characteristics were obtained from the patients' case histories. Results 1,835 (69.5%) out of 2,639 patients measured their blood pressure at home. 1,284 (70.0%) of home blood pressure patients had their own blood pressure measurement device. There were some important differences between these two groups: home blood pressure patients were more frequently male, of younger age, better educated, from urban area, mostly non-smokers, more likely to have diabetes mellitus and ischemic heart disease and had higher number of co-morbidities and were on other drugs beside antihypertensive medication. Using the logistic regression analysis we found that the most powerful predictors of home blood pressure monitoring had higher education level than primary school OR=1.80 (95% CI 1.37-2.37), non-smoking OR=2.16 (95% CI 1.40-3.33) and having a physician in urban area OR=1.32 (95% CI 1.02-1.71). Conclusion. Home blood pressure monitoring is popular in Slovenia. Patients who measured blood pressure at home were different from patients who did not. Younger age, higher education, non-smoking, having a physician in urban area and longer duration of hypertension were predictors of home blood pressure monitoring

Validation of the Slovenian Version of Patient Assessment of Chronic Illness Care (PACIC) in Patients with Coronary Heart Disease

The Chronic Care Model (CCM) is a conceptual framework that supports the evidence-based proactive and planned care of chronic diseases. Our aim was to validate a Slovenian translation of Patient Assessment of Chronic Illness Care (PACIC) – a self-reported instrument designed to measure the extent to which patients with chronic illnesses receive care congruent with CCM – on a sample of patients with coronary heart disease. Secondary analysis of patients’ evaluation of general practice care (EPA Cardio study) was done in patients with coronary heart disease in Slovenia. Patients completed a written questionnaire, which included the instrument for assessing chronic illness care (PACIC), the EUROPEP questionnaire and demographical data. Internal consistency was expressed in terms of Cronbach’s á. Reliability was expressed as the intra class correlation coefficient (ICC). Correlation between PACIC and EUROPEP was considered as a measure of construct validity. Factor analysis was done to identify number and types of domains in the instrument. Questionnaires of 843 patients were analysed. The mean age was 68.2 (SD 11.1) years, 34.6% of participants were female. 32.7% of PACIC questionnaires were not completely fulfilled. The internal consistency of the entire questionnaire assessed by Cronbach’s á was 0.953 and reliability was 0.937. Construct validity was confirmed with important and significant correlation between PACIC and EUROPEP questionnaire (Spearman’s correlation coefficient =0.60, p<0.001). Principal component factor analysis identifies two major factors which we labeled according to the PACIC domains as »Patient activation, decision support and problem solving« and »Goal settings and coordination«. A translated and validated Slovenian version of PACIC questionnaire is now available. Further research on its validity in other groups of chronically ill patients and the use of instrument for monitoring changes of chronic care over time is recommended

Raziskovanje v družinski medicini v Sloveniji

Primarni nivo zdravstvenega varstva predstavlja vstopno mesto v zdravstveni sistem in od njega je v veliki meri odvisna kakovost in stroškovna vzdržnost zdravstvenega sistema. Raziskovanje je gonilo strokovnega razvoja v skrbi za čim boljšo kakovost oskrbe pacientov. Družinska medicina (DM) v Sloveniji predstavlja največjo specialnost na primarnem nivoju zdravstvenega varstva, ki je na področju raziskovanja v zadnjih desetletjih dosegla velike uspehe. V preglednem prispevku bodo prikazane značilnosti raziskovanja v družinski medicini, predstavljena vključenost raziskovanja v različne nivoje izobraževalnega procesa in delo v praksi ter nakazani  izzivi, ki družinsko medicino kot znanstveno in raziskovalno vedo čakajo v prihodnje

Izkušnje zaposlenih z uporabo metode montessori pri delu s starejšimi in osebami z demenco v domu starejših občanov

Uvod: Pristop, usmerjen k uporabniku, prispeva h kakovosti življenja starejših in oseb z demenco v domu starejših občanov ter k dobremu počutju zaposlenih na delovnem mestu. Namen raziskave je bil ugotoviti izkušnje zaposlenih v domu starejših občanov z uporabo metode montessori pri delu s starejšimi in osebami z demenco. Metode: Narejena je bila študija primera v domu starejših občanov, kjer uporabljajo metodo montessori. Delno strukturirani intervjuji so bili izvedeni z enajstimi zaposlenimi v enem izmed domov za starejše občane v Sloveniji. Za analizo podatkov je bila uporabljena metoda analize vsebine. Rezultati: Identificirane so bile štiri kategorije: (1) vsebinski in organizacijski vidiki metode montessori pri obravnavi starejših in oseb z demenco; (2) sodelovanje med zaposlenimi, stanovalci in svojci; (3) osebni razvoj zaposlenih; (4) pomen izobraževanja za zaposlene. Raziskava pri izkušnjah zaposlenih v obravnavi starejših in oseb z demenco pokaže preplet vseh kategorij.kategorij. Diskusija in zaključek: Ugotovitve prispevajo novo znanje na področju uporabe metode montessori v domovih za starejše občane. Izkušnje zaposlenih so pokazale, da uporaba metode montessori pripomore k boljšemu razumevanju pomena sodelovanja, izobraževanja ter s tem povezanega osebnega razvoja zaposlenih. V praksi je priporočeno sistematično uvajati metodo montessori za starejše in osebe z demenco s poudarkom na izobraževanju, ki je nujna podlaga za praktično delo. Predlagamo nadaljnje raziskovanje izkušenj zaposlenih ter iskanje možnosti za uvajanje metode tudi v druge domove starejših občanov.

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

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

Burden of cardiovascular disease across 29 countries and GPs' decision to treat hypertension in oldest-old

OBJECTIVES: We previously found large variations in general practitioner (GP) hypertension treatment probability in oldest-old (>80 years) between countries. We wanted to explore whether differences in country-specific cardiovascular disease (CVD) burden and life expectancy could explain the differences. DESIGN: This is a survey study using case-vignettes of oldest-old patients with different comorbidities and blood pressure levels. An ecological multilevel model analysis was performed. SETTING: GP respondents from European General Practice Research Network (EGPRN) countries, Brazil and New Zeeland. SUBJECTS: This study included 2543 GPs from 29 countries. MAIN OUTCOME MEASURES: GP treatment probability to start or not start antihypertensive treatment based on responses to case-vignettes; either low (/=50% started treatment). CVD burden is defined as ratio of disability-adjusted life years (DALYs) lost due to ischemic heart disease and/or stroke and total DALYs lost per country; life expectancy at age 60 and prevalence of oldest-old per country. RESULTS: Of 1947 GPs (76%) responding to all vignettes, 787 (40%) scored high treatment probability and 1160 (60%) scored low. GPs in high CVD burden countries had higher odds of treatment probability (OR 3.70; 95% confidence interval (CI) 3.00-4.57); in countries with low life expectancy at 60, CVD was associated with high treatment probability (OR 2.18, 95% CI 1.12-4.25); but not in countries with high life expectancy (OR 1.06, 95% CI 0.56-1.98). CONCLUSIONS: GPs' choice to treat/not treat hypertension in oldest-old was explained by differences in country-specific health characteristics. GPs in countries with high CVD burden and low life expectancy at age 60 were most likely to treat hypertension in oldest-old. Key Points * General practitioners (GPs) are in a clinical dilemma when deciding whether (or not) to treat hypertension in the oldest-old (>80 years of age). * In this study including 1947 GPs from 29 countries, we found that a high country-specific cardiovascular disease (CVD) burden (i.e. myocardial infarction and/or stroke) was associated with a higher GP treatment probability in patients aged >80 years. * However, the association was modified by country-specific life expectancy at age 60. While there was a positive association for GPs in countries with a low life expectancy at age 60, there was no association in countries with a high life expectancy at age 60. * These findings help explaining some of the large variation seen in the decision as to whether or not to treat hypertension in the oldest-old

General practitioners' deprescribing decisions in older adults with polypharmacy: a case vignette study in 31 countries.

BACKGROUND General practitioners (GPs) should regularly review patients' medications and, if necessary, deprescribe, as inappropriate polypharmacy may harm patients' health. However, deprescribing can be challenging for physicians. This study investigates GPs' deprescribing decisions in 31 countries. METHODS In this case vignette study, GPs were invited to participate in an online survey containing three clinical cases of oldest-old multimorbid patients with potentially inappropriate polypharmacy. Patients differed in terms of dependency in activities of daily living (ADL) and were presented with and without history of cardiovascular disease (CVD). For each case, we asked GPs if they would deprescribe in their usual practice. We calculated proportions of GPs who reported they would deprescribe and performed a multilevel logistic regression to examine the association between history of CVD and level of dependency on GPs' deprescribing decisions. RESULTS Of 3,175 invited GPs, 54% responded (N = 1,706). The mean age was 50 years and 60% of respondents were female. Despite differences across GP characteristics, such as age (with older GPs being more likely to take deprescribing decisions), and across countries, overall more than 80% of GPs reported they would deprescribe the dosage of at least one medication in oldest-old patients (> 80 years) with polypharmacy irrespective of history of CVD. The odds of deprescribing was higher in patients with a higher level of dependency in ADL (OR =1.5, 95%CI 1.25 to 1.80) and absence of CVD (OR =3.04, 95%CI 2.58 to 3.57). INTERPRETATION The majority of GPs in this study were willing to deprescribe one or more medications in oldest-old multimorbid patients with polypharmacy. Willingness was higher in patients with increased dependency in ADL and lower in patients with CVD