Ivančica Pavličević

Students’ letters to patients as a part of education in family medicine

Family medicine fosters holistic approach to patient-centered practice. Current medical curriculum in Croatia does not have well-structured courses or tools to prepare medicals students for successful communication with the patient and for building lasting and beneficial doctor- patient relationship. We explored the value of students practice in writing letters to patients about their illness as a way of building personal and compassionate relationship with patients. Sixth year students at the School of Medicine in Split wrote letters to the patients from consultations under the supervision of the supervisor in a family medicine practice. Structured teaching of communication with the patient brings family medicine back to what has actually always been its main part- communication and doctor-patient relationship. Our future aim is to develop students letters to patients as a new tool in the family medicine course examination. Moreover, we will investigate how they can be used in everyday practice of family medicine.

The new curriculum for family medicine at the University of Split, School of Medicine.

According to the new curriculum at the University of Split School of Medicine for the 2010/2011 academic year, the Department of Family Medicine based its teaching on its own expert and research work. The adequacy of the communication with the patient, his or her family and the social environment, as well as the concept of evidence-based medicine (EBM) have been defined as the foundation of expert and research work in family medicine. In accordance with this strategy, the members of the Department are involved in conducting journal clubs, Cochrane systematic reviews, research into the health of families where the father is absent working abroad (there are many such families with emigrant fathers in the region), and some are working on developing student letters to patients as an instrument for encouraging communication and empathy. The proportion of theoretical classes was reduced to provide more time for practice-based classes for students. The Work Diary was also introduced, as well as the student letter to the patient, practice of clinical skills and objective, structured, clinical examination (OSCE). The assessment of students is performed in four parts: the grade given by the students practice supervisor, the grade for student letters to patients, the OSCE exam grade and the written exam grade. Students achieved, on average, very high grades. The Department is also involved in the course on clinical and social skills to first and second year students, taking on the task of introducing students to patients and their surroundings.

Family medicine defines its academic niche: the Split Initiative.

Increasingly, medical education is gaining its importancein the academic arena. Although it is still considered tobe less important than research, it is now widely acknowledgedthat this area of science also needs attention. It isno longer acceptable for the medical schools not to payclose attention to teaching aims, methods of teaching andassessment (1-8). Teachers of medicine at all levels mustalso be in contact with the latest developments in education,not only in science.In the last decades, medical education has changedconsiderably. The old fashioned methods of passiveteaching methods are slowly giving way to more activemethods of teaching (9). The aims of medical educationare changing and more emphasis is given to changing attitudesand shaping the future doctors so that they willbecome self-directed learners for the rest of their professionalcareers (10).

Decisional conflict and vaccine uptake: cross-sectional study of 2012/2013 influenza season in Croatia

Introduction As scientific, media and individual opinions on the need for seasonal influenza vaccination differ, we explored patients’ decisional conflict and perceived physician and social support when making a vaccination choice. Material and methods We conducted a survey of patients with previous vaccination experience in a single family medicine office in Split, Croatia. The questionnaire included the Decisional Conflict Scale (DCS), perceived social support, and attitudes and knowledge concerning vaccination. Results Out of 203 (86%) adult patients with previous vaccination experience, 182 (40.4%) opted to vaccinate in the current season, 98 (48.3%) refused, and 22 (11.3%) were undecided. The median decisional conflict score was highest among those undecided (43.8 out of the maximum 100, interquartile range (IQR) 33.2–52.3), lowest among those opting to vaccinate (17.2, IQR 9.4–26.6), and intermediate among those who refused vaccination (25.0, IQR 17.2–39.1) (p < 0.001, Kruskal-Wallis test and post-hoc Mann-Whitney U tests). The most common self-reported reasons for vaccination were previous vaccination experience (n = 85, 42%) and media information (n = 62, 30%). Those who refused vaccination felt less satisfied with the support they received from their family physician than those who decided to vaccinate (median 6.5 (IQR 0–9) vs. 9 (IQR 5–10) on a scale from 0 to 10), respectively; p = 0.001, Mann-Whitney U test). Conclusions Higher decisional conflict of patients who refuse influenza vaccination and those undecided, alongside their perceived low support of the family physician in making that choice, emphasize the importance family doctors play in advising and helping patients make informed decisions about seasonal influenza vaccination.

Research projects in family medicine funded by the European Union.

OBJECTIVE This study aimed at synthesizing funding opportunities in the field of family medicine by determining the number of family medicine projects, as well as number of project leaderships and/ or participations by each country. This was done in order to encourage inclusion of physicians in countries with underdeveloped research networks in successful research networks or to encourage them to form new ones. METHODS We searched the Community Research and Development Information Service project database in February 2013. Study covered the period from years 1992 - 2012, selecting the projects within the field of general/family medicine. The search was conducted in February 2013. RESULTS First search conducted in the CORDIS database came up with a total of 466 projects. After excluding 241 projects with insufficient data, we analysed 225 remaining projects; out of those, 22 (9.8%) were in the field of family medicine and 203 (90.2%) were from other fields of medicine. Sorted by the number of projects per country, Dutch institutions had the highest involvement in family medicine projects and were partners or coordinators in 18 out of 22 selected projects (81.8%), followed by British institutions with 15 (68.8%), and Spanish with 10 projects (45.5%). Croatia was a partner in a single FP7 Health project. CONCLUSION Research projects in family medicine funded by the European Union show significant differences between countries. Constant and high-quality international cooperation in family medicine is the prerequisite for improvement and development of scientific research and the profession.

Level of hypertension control: comparison of a rural and urban family practice centre in South Croatia

SummaryAimArterial hypertension is a serious public health problem because of its frequency and poor management. We compared hypertension control between rural and urban environment over 5 years. Initial hypothesis: arterial pressure control is better in urban (Split) than in rural (Trilj) environment.MethodsHistoric prospective study was conducted in two family medicine outpatient clinics. Data for the years 2005, 2006, and 2010 were analyzed. One hundred and seventeen subjects diagnosed with arterial hypertension in 2005 were examined: 66 in a rural and 51 in urban outpatient clinic. Their average age was 60.92 ± 10.03 (range 30–82 years). Blood pressure records at the onset of the study, the first, and fifth year of treatment, risk factors, and therapy were analyzed. T-test and χ2-test were used in statistical data analysis.ResultsIn the urban clinic, more subjects were smokers, had positive family history, were overweight, and had registered hyperlipidemia. Initial mean arterial pressure readings were similar in both the clinics. Decrease was recorded in the following 5 years. During this study the use of ACE inhibitors (ACEI) (Split by 45 %, Trilj by 133 %) and calcium channel blockers (CCB) (Split by 76.9 %, Trilj by 525 %) was increased. The number of patients receiving monotherapy was reduced.ConclusionsBetter arterial pressure control was recorded in the urban clinic, where, after 5 years, despite increased frequency of additional risk factors, the number of normotensive patients was higher than that in the rural one. Hypertension control in both settings was still poor. Hypertensive patients should participate actively in the treatment.ZusammenfassungZiel der StudieAuf Grund der Häufigkeit und des oft schlechten Managements ist die Hypertonie ein ernstes Problem des öffentlichen Gesundheitswesens. Wir verglichen die Einstellung der Hypertonie über 5 Jahre in einer ländlichen Umgebung mit der einer städtischen. Die anfängliche Hypothese war, dass die Hypertonie- Kontrolle in einer Stadt (Split) besser als am Land (Trilj) sein müsste.MethodikIn einer historisch-prospektiven Studie wurden die Daten von 2005, 2006 und 2010 zweier Familienpraxen ausgewertet. 117 Patienten (66 aus der ländlichen, 51 aus der städtischen Praxis), bei denen 2005 eine Hypertonie festgestellt worden war, wurden untersucht: das mittlere Alter war 60,92 ± 10,03 (30–82) Jahre. Die RR-Werte vom Beginn der Studie, nach einem Jahr und nach 5 Jahren wurden erhoben. T-Test und χ2-Test wurden zu statistischen Auswertung verwendet.ErgebnisseIn der städtischen Praxis war die Anzahl der Raucher, der Patienten mit einer positiven Familienanamnese, mit Übergewicht und mit dokumentierter Hyperlipidämie höher. Die initialen RR-Werte waren in beiden Praxen ähnlich. In den folgenden 5 Jahren wurde ein Abfall festgestellt. Während der Studie stieg der Einsatz von ACE-Hemmern (in Split um 45 %, in Trilj um 133 %) und Calciumkanalblocker (in Split um 76,9 %, in Trilj um 525 %). Die Anzahl der Patienten mit Monotherapie wurde reduziert.SchlussfolgerungenDie Blutdruckeinstellung war in der städtischen Praxis besser. Nach 5 Jahren war die Zahl der normotensiven Patienten trotz der höheren Häufigkeit von zusätzlichen Risikofaktoren höher als in der Land-Praxis. Die Kontrolle des Hochdrucks war in beiden Praxen noch immer mangelhaft. Patienten mit Hypertonie sollten aktiv an der Behandlung teilnehmen.