Ksenija Tušek-Bunc

MEDICATION ADHERENCE IN ELDERLY WITH POLYPHARMACY LIVING AT HOME: A SYSTEMATIC REVIEW OF EXISTING STUDIES.

Background: We wanted to systematically review the available evidence to evaluate the drug adherence in elderly with polypharmacy living at home. Methods: We performed a literature search using MEDLINE, ISI Web of Science, ProQuest, EMBASE, SCOPUS, Springer Link, Sage Journals and CINAHL. We used the following terms: Medication Adherence, Medication Compliance, Polypharmacy, and Elderly. The search was limited to English-language articles. We included only clinical trials, systematic reviews, meta-analysis and cross-sectional studies. Results: A total of seven articles were included in this systematic review after applying the search strategy. Six studies dealt with the prevalence of medication adherence and its correlates in patients aged 65 years or more with polypharmacy. Two studies dealt with the effect of various interventions on medication adherence in patients aged 65 years or more with polypharmacy. Conclusion: The available literature on the polypharmacy and drug adherence in elderly living at home is scarce and further studies are needed.

Explanatory model of prescribing behavior in prescription of statins in family practice

SummaryAIM: To survey attitudes towards prescribing statins in a family practice setting and to develop an explanatory model of determinants for prescribing statins. METHODS: A random sample of 250 GPs were drawn from a Slovenian Family Medicine Society register and were contacted by anonymous postal questionnaire between June and October 2006. RESULTS: We found no major differences in decisions among the GPs with regard to their age, sex or time in general practice. We identified six factors that influence statin prescribing behavior in GPs and explain 63.5% of the variation: efficacy and utility explained 14.9% of the variation, personal involvement in drug promotional activities accounted for a further 14.3%, attitudes towards drug marketing 10.3%, patient expectations 9.5%, drug price 8.1% and peer pressure 6.5%. CONCLUSIONS: The determinants that influence statin prescribing behavior among GPs in our study covered an array of explanatory items consistent with proposals in the literature but factors differ to some extent from proposed theoretical models. The explanatory model explained a high proportion of the variation in deciding on a particular statin. Efficacy and safety remain important factors in selection of an appropriate drug but are far from being the most or only important factors.

Does wearing a white coat or civilian dress in the consultation have an impact on patient satisfaction

A white coat might be one of the barriers in building a doctor-patient partnership and can even influence clinical measurements.’ However, some recent research involving hospital doctors has shown that patients have the opposite view in this issue.2 The majority of the patients do not mind what the doctor is wearing and only one fifth of them dislike doctors in white There are several reasons in favour of a white coat ~niform.~ It is easier for the patients to identify the doctor if he/she is wearing a white coat. The uniform is also easier to clean and provides better protection against microbes for the doctor and for the patient. A white coat also enhances a professional, authoritarian and scientific appearance.2 Also paediatric patients and their parents were in favour of doctors wearing white coats and did not consider that this damaged the doctor-patient relationship.’ The studies report on patients having more confidence in doctors wearing white coat~.~,~J,’

Management of patients with coronary heart disease in family medicine: correlates of quality of care

Objectives Family medicine plays an important role in quality of care (QoC) of coronary heart disease (CHD) patients. This studys aim was to determine the quality of secondary cardiovascular disease prevention in the everyday practice of family physicians. Design This study was observational cross-sectional. Setting About 36 randomly selected family medicine practices stratified by size and location in Slovenia. Participants CHD patients randomly selected from a patient register available in family medicine practices. Main Outcome Measure(s) The instrument for assessment of quality included a form for collecting data from medical records, a general practice assessment questionnaire and a patient questionnaire. QoC was defined by two composite variables, namely risk factor registration and CHD patient process of care, as the two care outcomes. In multivariate analysis, we performed multilevel regression analysis to identify the associations between QoC, the patient and the practice characteristics. Results The final sample included 423 CHD patients from 36 family medicine practices. Risk factor registration was associated with the practice organisation score (P = 0.004), practice size (P = 0.042), presence of comorbid atherosclerotic diseases (P = 0.043) and a lower age of CHD patients (P = 0.001). CHD patient process of care was associated with the practice organisation score (0.045) and a lower age of CHD patients (P = 0.035). Conclusions The most important factors affecting the quality of CHD patient care were linked to the organisational characteristics of the family medicine practices.

Early detections of cancer in family practice – a case of colorectal cancer

Background: Malignant diseases present a serious public health problem in the world as well in Slovenia. In the last years, colon and rectum are (with the exception of skin) the most common cancer sites in the developed world, including Slovenia. Colorectal carcinoma is the most frequent cancer of the gastrointestinal tract occurring in Slovenia and it is second leading cause of mortality due to malignancies. The incidence of colorectal carcinoma is rising in the past few years. In spite of better five-year survival rates in patients with the disease, there are many patients diagnosed in advanced stages with worse prognosis. Conclusions: Early detection of colorectal carcinoma in Slovenia has not been introduced in a systematic way yet. There is no doubt that screening is feasible in family practice. Family doctors have a unique role in preventing, early detection and screening of colorectal carcinoma. Guidelines for management of predisposing factors, for early detection of the disease and for healthier life style are an important tool in the hands of family doctors with the aim to reduce morbidity and mortality due to colorectal carcinoma.