Mateja Bulc

Faculty development for teachers of family medicine in Europe: Reflections on 16 years’ experience with the international Bled course

Background: Instruction in principles and methods of medical education is a core component of the training of medical teachers. Curricula for new medical teachers have developed across Europe, but few European courses have had the success of the EURACT Bled course for teachers of family medicine. The course focuses on practical issues in medicine and the professional development of physicians. This article describes 16 years’ experience with the Bled course for teachers in general practice/family medicine (GP/FM). Course structure: The course is centred on the preparation of a teaching module, exploring a specific theme in family medicine. The main teaching methods used are: keynote lectures, small group sessions, field work and preparation of a teaching module by the participants. Outcomes: This course has attracted 555 participants from 20 countries since 1992. The course and its outputs have been applied in undergraduate and postgraduate teaching, and in continuous professional development (CPD) in several countries. It is a respected forum for faculty development. The experience of the Bled course suggests that academic medicine may be better able to fulfil its responsibilities by paying attention to relevant topics and using appropriate methods in undergraduate and postgraduate medical curricula.

Specialist training of Slovene family physicians

Family medicine in Europe started to develop in the 1960s with the introduction of obligatory specialist training. Slovenia is a country with a long tradition of family medicine specialist training, but up until 2002 this was neither elaborated on nor conducted by peers in general practice/family medicine. When the countrys socialist system started to transform due to political reforms, Slovenia began to modify its system in order to meet the criteria of the European Union. One of the changes was the introduction of a new healthcare system with an influential Medical Chamber responsible for postgraduate training in all specialities. A new model for vocational training in family medicine was established in 2002, following the recommendations of the European Union of General Practitioners (UEMO). According to the new programme, which lasts 4 years, trainees spend half of their training in a hospital setting and half in general practice, where they are supervised by a trainer in practice. This article describes the legal process of introducing new forms of specialist training in Slovenia, and its content. Conclusion: A comparison with UEMO countries shows that the new model is comparable to other countries.

Healthy diet in primary care: views of general practitioners and nurses from Europe.

Background:Most of the national colleges of general practitioners (GPs) do not have their own dietary/nutritional tools, and GPs and nurses do not have the time, knowledge, or skills to advise their patients about desirable dietary practices.Objective:To assess the usefulness of a simple and practical guide on healthy diet to be used by European GPs and nurses.Design:A postal survey was mailed to 171 GPs and nurses from 12 European countries to obtain information about the usefulness of a guide on healthy diet developed by EUROPREV.Results:The perception of health professionals is that the main source of information on healthy diet for the population was the media. In all, 95% of GPs and nurses reported that the guide was useful; 93, 95, and 82% reported that the concepts were concise, easy to understand, and realistic, respectively. Also, 77% reported that the type of counselling recommended was feasible and could be applied, 94% reported that the implementation measures proposed could be effective and 88% reported that the Traditional Mediterranean Diet Pyramid is useful, but some concerns about the content were mentioned.Conclusions:GPs and nurses from Europe think that a practical guide on healthy diet developed by EUROPREV could be used to advise patients in primary care, although the Traditional Mediterranean Diet Pyramid should be modified.

Attitudes of Slovenian family practice patients toward changing unhealthy lifestyle and the role of family physicians: cross-sectional study.

Aim To assess patients’ attitudes toward changing unhealthy lifestyle, confidence in the success, and desired involvement of their family physicians in facilitating this change. Methods We conducted a cross-sectional study in 15 family physicians’ practices on a consecutive sample of 472 patients (44.9% men, mean age  [± standard deviation] 49.3 ± 10.9 years) from October 2007 to May 2008. Patients were given a self-administered questionnaire on attitudes toward changing unhealthy diet, increasing physical activity, and reducing body weight. It also included questions on confidence in the success, planning lifestyle changes, and advice from family physicians. Results Nearly 20% of patients planned to change their eating habits, increase physical activity, and reach normal body weight. Approximately 30% of patients (more men than women) said that they wanted to receive advice on this issue from their family physicians. Younger patients and patients with higher education were more confident that they could improve their lifestyle. Patients who planned to change their lifestyle and were more confident in the success wanted to receive advice from their family physicians. Conclusion Family physicians should regularly ask the patients about the intention of changing their lifestyle and offer them help in carrying out this intention.

Factors that affect readiness to change lifestyle: A 22-country survey from primary care

Abstract Background: The family physicians task in prevention is not only an assessment of patients’ health risks but also counselling individual patients. Aim: Aim of this primary care based study was to find how patients’ characteristics relate to their readiness to change. Methods: This multinational cross-sectional survey was conducted in primary care in 22 European countries, coordinated by EUROPREV. Consecutive attenders from randomly selected family practices answered a questionnaire about attitudes towards prevention and about lifestyle. Results: The questionnaire was answered by 7947 patients in 224 primary care practices in 22 European countries. Smoking was reported by 828 women (23.2%) versus 1238 (32.57%) men, unhealthy diet by 637 (11.6%) women versus 830 men (17.62%), risky alcohol consumption by 348 women (8.19%) versus 1009 men (23.07%) and the lack of physical activity by 617 women (12.68%) versus 614 men (16.45%). The need for change was declared by 432 (31.8%) of 1357 risky drinkers, 612 (29.6%) of 2066 smokers, 1210 (82.4%) of 1467 patients with unhealthy diet and by 2456 (30.9%) of all participants, 1231 of them were not physically active at all. Among patients with unhealthy dietary habits, 681 (56.3%) were confident of successfully changing their behaviour, among physically inactive it was 1561 (63.6 %), among smokers 284 (46.4%), and among risky drinkers 214 (49.5%). Conclusion: More likely to be ready to change unhealthy lifestyles are frequent attenders, European Union citizens, women and patients under 50 years of age.

The countrywide integrated non-communicable disease intervention programme (CINDI) and the effects of healthcare system reform in Slovenia

Objectives: The aim of this paper is to describe the organisation of the CINDI programme in Slovenia, to present the results of a survey of risk factors of chronic disease in the adult population and to describe the effects of political changes on the programme. Methods: Assessment of the health status of a random sample of 1692 adults from the Ljubljana population was performed in 1990. A series of medical and nonmedical interventions were introduced as a result of the survey and a follow-up assessment on a second representative sample of adults was performed in 1995. Results: Due to high prevalence of risk factors (hyperlipidaemia (64%), overweight (57%), hypertension (42%), smoking (39%), inactivity (15%)) found at the initial survey, almost all adults were entitled to some form of intervention. At the follow-up survey, reductions in the prevalence of overweight (48%) and smoking (28%) were noted along with increases in the prevalence of hyperlipidaemia (67%), hypertension (48%) and physical inactivity (26%). Initially, the main focus of the programme was on office-based interventions. With healthcare reform in Slovenia in 1993 and the introduction of a new financing scheme, the health-care system stopped payment for the majority of preventive medical activities. In 1998, prevention activities recommenced and negotiations began for reimbursement of general practitioners involved in prevention. In 2001, a new law obliged general practitioners to assess coronary risks in selected groups of patients. Conclusion: CINDI in Slovenia has faced unexpected political changes and managed to evolve towards more comprehensive health promotion activities at a national level.

Twenty-five years of the international Bled course for teachers of family medicine in Europe: Glancing back and looking forward

Abstract The international Bled course for teacher training has played a central role in faculty development in family medicine for the past 25 years. The course was originally designed to promote faculty development for family medicine teachers in the new academic discipline of family medicine in Slovenia in 1990 and to introduce new topics into the family medicine curriculum. In this background paper, we perform a SCOT analysis (strengths, challenges, opportunities, and threats) of the current course, evaluating participant feedback and reviewing past topics and their impact on local and international teaching programmes. We also review the place of the course in the context of other teacher-training programmes in family medicine in Europe. We found that the structure and learning aims of the Bled course have remained stable over 25 years. It provides a safe, well-structured learning environment for the participants even though the course topic is different every year. The course has had a significant impact on curriculum development and teacher training in Slovenia as well as in many other countries in Europe and beyond. Because of the positive impact of the course and the high degree of satisfaction of the participants and course directors, it seems worthwhile to continue this endeavour. New directions for the course will depend on the learning needs of the participants and the evolving medical curricula in the countries they represent.

SCREENING AND REGISTERING PATIENTS WITH ASTHMA AND COPD IN SLOVENIAN PRIMARY CARE: FIRST RESULTS

Abstract Aim. This study aimed to evaluate a new project of the Slovene Ministry of Health - the Family Medicine Model Practices (MPs) Project in Slovenia, and to show its effectiveness in the management of asthma and COPD by family medicine practice teams, consisting of a family physician, a nurse practitioner and a practice nurse. Methods. A total of 107 family practices with 203122 patients joined the project during the first year of its initiation. The effectiveness of the program in disease management was analysed in two phases according to the registration of family practices. The number of patients registered and the number of asthma and COPD patients (existing and newly detected) by model practice teams were being reported. Descriptive analyses were used to describe the study populations. Prevalence by diseases and phases was established after the initial round of data collection. Chi square (χ2) test was used to analyse the difference between the phases. Results. The frequency of asthma was 2.12%, while the frequency of COPD was 1.15% throughout the study period. For both diseases, more than 30% of patients were newly diagnosed. Conclusions. The project of implementing Family Medicine MPs in the area of COPD has given first positive results and the project is still ongoing to its full implementation. Izvleček Uvod. Namen študije je predstaviti projekt Ministrstva za zdravje, referenčne ambulante, ki poteka v Sloveniji, in prikazati rezultate obravnave bolnikov z astmo in KOPB s strani tima, ki je dopolnjen in ga sestavljajo zdravnik, diplomirana medicinska sestra in zdravstveni tehnik. Metode. V prvem letu je bilo v projekt vključenih 107 ambulant z 203.122 opredeljenimi pacienti (glavarina). Uspešnost programa obravnave pacientov je bila analizirana dvofazno, ob prvi in naslednji vključitvi ambulant v projekt. Vse referenčne ambulante so poročale o številu opredeljenih bolnikov (glavarina) in o številu bolnikov z astmo in KOPB (že obstoječih in med presejanjem novo odkritih bolnikov). Deskriptivna analiza je bila uporabljena za opis obravnavane populacije. Prevalenca po boleznih je bila prikazana ločeno v prvi in drugi fazi analize. Test hi-kvadrat je prikazal razlike med obema fazama raziskave. Rezultati. V opazovanem obdobju je bila pogostnost astme med opazovano populacijo 2,12%, pogostnost KOPB pa 1,15%. Tako med bolniki z astmo kot med bolniki s KOPB je bila bolezen novo odkrita pri več kot 30% bolnikov. Zaključek. Projekt implementacije referenčnih ambulant, ki je še v razvoju, je na področju obravnave bolnikov s KOPB in astmo pokazal prve pozitivne rezultate.

Perception of preventive care and readiness for lifestyle change in rural and urban patients in Poland: a questionnaire study

INTRODUCTION AND OBJECTIVE The idiosyncrasies of rural health demand further research to instigate rural health initiatives and to monitor progress in rural health care. In 2008, a study examined health-related behaviour, perception of importance of preventive interventions, readiness to change lifestyle and willingness to receive support from GPs, according to gender and place of residence. MATERIAL AND METHODS A cross-sectional survey was conducted among patients who visited any of ten randomly-selected general practices in Poland. RESULTS Four hundred patients were enrolled: 50% from rural areas, 50.3% were females; 23.8% declared a primary level of education (35% rural vs. 12.5% urban) respondents; the median age was 50 years (IQR=18), The predicted means for prevention importance scores for rural residents were 0.623 and for urban residents - 0.682. Place of residence had a significant effect on the importance of prevention (p<0.05; ICC=0.048). Area and gender have a statistically significant effect on preventive behaviour importance scores (p<0.05; ICC=0.0526). Patient expectations of individual counselling by GPs were highest for eating habits - 35.5% rural vs. 16% urban residents (p<0.0001). CONCLUSIONS Patient importance scores for prevention were associated with residence and gender. The villagers attached less importance to prevention. They also declared less willingness to change their lifestyle. Women had higher scores regarding prevention than men. More rural respondents would like to receive individual counselling from their GP regarding eating habits, physical activity, body weight, giving up smoking and safe alcohol use. Urban respondents were more likely to expect leaflets from their GPs on normalizing body weight.

EURACT: EUROPEAN ACADEMY OF TEACHERS IN GENERAL PRACTICE22nd INTERNATIONAL EURACT BLED COURSE Bled, Slovenia: 24–28 September 2013

EURACT: EUROPEAN ACADEMY OF TEACHERS IN GENERAL PRACTICE22nd INTERNATIONAL EURACT BLED COURSE Bled, Slovenia: 24–28 September 2013 Mateja Bulc & Jo Buchanan To cite this article: Mateja Bulc & Jo Buchanan (2014) EURACT: EUROPEAN ACADEMY OF TEACHERS IN GENERAL PRACTICE22nd INTERNATIONAL EURACT BLED COURSE Bled, Slovenia: 24–28 September 2013, European Journal of General Practice, 20:1, 82-82 To link to this article: http://dx.doi.org/10.3109/13814788.2013.872622