Polona Selič

What factors affect patients' recall of general practitioners' advice?

BackgroundIn order for patients to adhere to advice, provided by family doctors, they must be able to recall it afterwards. However, several studies have shown that most patients do not fully understand or memorize it. The aim of this study was to determine the influence of demographic characteristics, education, amount of given advice and the time between consultations on recalled advice.MethodsA prospective survey, lasting 30 months, was conducted in an urban family practice in Slovenia. Logistic regression analysis was used to identify the risk factors for poorer recall.Results250 patients (87.7% response rate) received at least one and up to four pieces of advice (2.4 ± 0.8). A follow-up consultation took place at 47.4 ± 35.2 days. The determinants of better recall were high school (OR 0.4, 95% CI 0.15-0.99, p = 0.049) and college education (OR 0.3, 95% CI 0.10-1.00, p = 0.050), while worse recall was determined by number of given instructions three or four (OR 26.1, 95% CI 3.15-215.24, p = 0.002; OR 56.8, 95% CI 5.91-546.12, p < 0.001, respectively) and re-test interval: 15-30 days (OR 3.3, 95% CI 1.06-10.13, p = 0.040), 31-60 days (OR 3.2, 95% CI 1.28-8.07, p = 0.013) and more than 60 days (OR 2.5, 95% CI 1.05-6.02, p = 0.038).ConclusionsEducation was an important determinant factor and warrants further study. Patients should be given no more than one or two instructions in a consultation. When more is needed, the follow-up should be within the next 14 days, and would be of a greater benefit to higher educated patients.

Association of Common Mental Disorders and Quality of Life with the Frequency of Attendance in Slovenian Family Medicine Practices: Longitudinal Study

Background Most research on frequent attendance has been cross-sectional and restricted to one year attendance rates. A few longitudinal studies suggest that frequent attendance is self-limiting. Frequent attenders are more likely to have social and psychiatric problems, medically unexplained physical symptoms, chronic somatic diseases (especially diabetes) and are prescribed more psychotropic medication and analgesics. Research Question To describe the attendance rates in a longitudinal study and to test if depression, panic syndrome, other anxiety syndrome, alcohol misuse and general quality of life are associated with frequent attendance in next two consecutive years. Methods 1118 consecutive family practice attendees, aged 18 to 75 years from randomly selected family medicine practices were recruited at baseline and followed up at 12 and 24 months. We identified frequent attenders in the top 10 centile within one year. Using a multivariate model, we ascertained if presence of common mental disorders and quality of life assessed at baseline in 2003 predict frequent attendance in 2004 and 2005. Results 40% of frequent attenders continue to be frequent attenders in the following year and 20% of the frequent attenders were so for the 24 month period. Lower physical scores on the SF-12 questionnaire were strongly associated with future frequent attendance at 12 and 24 months. There was a trend for people with greater than elementary school education to be less likely to become frequent attenders at both 12 and 24 months. For other variables these effects were less consistent. Presence of major depression, panic syndrome, other anxiety syndrome and alcohol misuse were not predictive of frequent attendance in the following two years. Conclusion Low physical quality of life is strongly predictive of higher frequent attendance and similar finding was observed for people with lower educational level but further confirmatory research is required to establish this association.

How many Slovenian family practice attendees are victims of intimate partner violence? A re-evaluation cross-sectional study report

BackgroundIntimate partner violence (IPV) can be considered a leading public health problem affecting approximately 50% of women during the course of their lifetimes. This study was carried out with the aim of re-testing the prevalence data and providing sufficient grounds for decision-makers in family medicine in Slovenia to adopt much-needed protocols for IPV management in the field.MethodsIn January 2012, every tenth general practitioner (GP) registered in Slovenia, of a total of 958, was invited to participate in a multi-centre cross-sectional study, and 9.4% of them, working in 90 family practices, agreed to participate. From February 1 to March 1, 2012, they asked every fifth family practice attendee aged 18 years and above, regardless of gender, to participate in the study. The short version of Domestic Violence Exposure Questionnaire was administered to 2572 patients.ResultsIn the sample, there were more women (62.9% (n = 1617)). The average age of all the participants was 49.0 ± 16.1 years. Of 2572 participants (95.3% response rate), 17.1% people had been exposed to either emotional or both physical and emotional abuse. The prevalence of psychological violence was 10.3%, and that of concurrent physical and psychological abuse 6.8%, with all the patients exposed to physical IPV disclosing concurrent psychological violence. Female gender and previous formal divorce were risk factors identified in all three multivariate logistic regression models. The odds of concurrent physical and psychological and either type of IPV exposure in patients were lessened by an age of 65 years or above. The odds for either type of IPV were also lower in single people, while in concurrent physical and psychological IPV exposure, living in urban settings acted as a protective factor.ConclusionsIn Slovenian family practice attendees, an IPV exposure prevalence of approximately 17% should be considered a valid estimation.

A structural model of burnout syndrome, coping behavior and personality traits in professional soldiers of the Slovene armed forces

Background: This study explored how adequately the additive and mediational models could explain the relationships between personality traits and coping behavior in predicting burnout syndrome in professional soldiers of the Slovene Army. The additive model suggests that personality and coping are independent, unique contributors to maladjustment outcomes. The mediational model, on the other hand, suggests that personality factors predispose people to use particular coping strategies that tend to be less effective for adjustment. Methods: A total of 390 soldiers (87 % response rate) completed the Eysenck Personality Questionnaire, the Ways of Coping Questionnaire and the Maslach Burnout Inventory. Results: The structural equation modeling confirmed an adequate fit only of the additive model. As hypothesized, emotional exhaustion was positively associated with neuroticism and emotionoriented coping. Depersonalization was positively associated with psychoticism, and personal accomplishment was positively associated with extraversion and problem-oriented coping, and inversely with neuroticism and emotion-oriented coping. Conclusions: To reduce burnout in the Slovenian Army, it may be of great benefit to provide training of effective stress-coping mechanisms, and create peer support groups among soldiers. Such intervention should be especially beneficial for soldiers with a vulnerable personality structure (high neuroticism and psychoticism and low extraversion).

Barriers to Screening and Possibilities for Active Detection of Family Medicine Attendees Exposed to Intimate Partner Violence

Abstract Introduction In 1996 the World Health Organization declared intimate partner violence (IPV) the most important public health problem. Meta-analyses in 2013 showed every third female globally had been a victim of violence. Experts find screening controversial; family medicine is the preferred environment for identifying victims of violence, but barriers on both sides prevent patients from discussing it with doctors. Methods In July 2014, a qualitative study was performed through semi-structured interviews with ten family doctors of different ages and gender, working in rural or urban environments. Sound recordings of the interviews were transcribed, and the record verified. The data were interpreted using content analysis. A coding scheme was developed and later verified and analysed by two independent researchers. The text of the interviews was analysed according to the coding scheme. Results Two coding schemes were developed: one for screening, and the other for the active detection of IPV. The main themes emerging as barriers to screening were lack of time, staff turnover, inadequate finance, ignorance of a clear definition, poor commitment to screening, obligatory follow-up, risk of deterioration of the doctor-patient relationship, and insincerity on the part of the patient. Additionally, cultural aspects of violence, uncertainty/helplessness, fear, lack of competence and qualifications, autonomy/negative experience, and passive role/stigma/fear on the part of the patients were barriers to active detection. Conclusion All the participating doctors had had previous experience with active detection of IPV and were aware of its importance. Due to several barriers to screening for violence they preferred active detection.

Quality of life and alcohol consumption: a review of the literature

Kakovost Življenja in Uživanje Alkohola: Pregled Literature Uvod: Koncept kakovosti življenja smo uporabili za oceno posledic uživanja alkohola. Namen sistematičnega pregleda literature s področja kakovosti življenja in uživanja alkohola je bil opredeliti teme, ki so bile na tem področju raziskovane, in metodologijo, ki so jo avtorji uporabili. Metode: Iz bibliografske baze Medline smo s pomočjo ključnih besed ‘quality of life’ in ‘alcohol drinking, alcoholism, alcohol-related disorders’ našli vse izvirne raziskovalne članke v angleškem jeziku, objavljene v zadnjih desetih letih, ki so vključevali prebivalstvo, starejše od 18 let. Ocenili smo ustreznost tako zbranih raziskav in v analizo vključili tiste, ki so obravnavale povezavo med uživanjem alkohola in kakovostjo življenja. Rezultati: V analizo pa je bilo vključenih 27 raziskav. Po temah lahko raziskave razdelimo v 2 skupini - prve so proučevale povezavo med kakovostjo življenja in uživanjem alkohola v splošnem prebivalstvu, druge pa pri odvisnih od alkohola. Metodološko gre večinoma za presečne in longitudinalne neintervencijske raziskave. Intervencijske raziskave so bile narejene na prebivalstvu odvisnih od alkohola. Nobena raziskava ni uporabila kvalitativne metodologije. Zaključki: Kakovost življenja je ustrezno merilo za ocenjevanje posledic uživanja alkohola. Manjkajo pa kvalitativne raziskave na tem področju. Quality of life and alcohol consumption: a review of the literature Background: The Quality of Life concept was used to evaluate the impact of alcohol consumption. The purpose of this systematic literature review was to determine the topics analysed and the research methodology used in the field of quality of life and alcohol drinking. Methods: A search of the Medline database was conducted to find original research articles in English focusing on certain keywords, i.e. ‘quality of life’ and ‘alcohol drinking’, ‘alcoholism’ or ‘alcohol-related disorders’, published in the last 10 years, which included population above the age of 18. The abstracts of the resulting articles were screened to select articles focusing on the association between alcohol consumption and the quality of life. These articles were systematically reviewed and analysed for study method and research theme. Results: 27 articles were included in further analysis. The researchers focussed on two major themes - the link between quality of life and alcohol consumption in the general population and in patients dependent on alcohol. Most of the studies were cross-sectional or longitudinal non-interventional studies. Intervention studies were mostly done on a population addicted to alcohol. Qualitative research methods were not used. Conclusions: Quality of life is a relevant criterion for assessing the effects of alcohol consumption. There is a lack of qualitative research in this area.

Intended Career Choice in Family Medicine in Slovenia: An Issue of Gender, Family Background or Empathic Attitudes in Final Year Medical Students? -

Background: Among a variety of complex factors affecting a decision to take family medicine as a future specialisation, this study focused on demographic characteristics and assessed empathic attitudes in final year medical students. Methods: A convenience sampling method was employed in two consecutive academic years of final year medical students at the Faculty of Medicine in Ljubljana, Slovenia, in May 2014 and May 2015. A modified version of the 16-item Jefferson Scale of Empathy – Student Version (JSE-S) was administered to examine self-reported empathic attitudes. An intended career in family medicine was reported using a five-point Likert scale. Results: Of the 175 medical school seniors in study year 2013/14, there were 64 (36.6%) men and 111 (63.4%) women, while in the second group (study year 2014/5), there were 68 (40.5%) men and 100 (59.5%) women; 168 students in total. They were 24.9±1.6 (generation 2013/4) and 24.9±1.7 (generation 2014/15) years old. Thirty-six percent of the students in the academic year 2013/14 intended to choose family medicine as a future career, and a similar proportion in academic year 2014/15 (31.7%). Gender (χ2=6.763, p=0.034) and empathic attitudes (c2=14.914; p=0.001) had a bivariate association with an intended career choice of family medicine in the 2014/15 generation. When logistic regression was applied to this group of students, an intended career choice in family medicine was associated with empathic attitudes (OR 1.102, 95% CI 1.040-1.167, p=0.001), being single (OR 3.659, 95% CI 1.150-11.628, p=0.028) and the father having only primary school education (OR 142.857 95% CI 1.868, p=0.025), but not with gender (OR 1.117, 95% CI 0.854-1.621, p=0.320). Conclusion: The level of students’ father’s education, and not living in an intimate partnership, increased the odds on senior medical students to choose family medicine, yet we expected higher JSE-S scores to be associated with interest in this speciality. To deepen our understanding, this study should be repeated to give us solid grounded insight into the determinants of career choice; associations with gender in particular need to be re-tested.

Depression in Intimate Partner Violence Victims in Slovenia: A Crippling Pattern of Factors Identified in Family Practice Attendees

This multi-centre cross-sectional study explored associations between prevalence of depression and exposure to intimate partner violence (IPV) at any time in patients’ adult life in 471 participants of a previous IPV study. In 2016, 174 interviews were performed, using the Short Form Domestic Violence Exposure Questionnaire, the Zung Scale and questions about behavioural patterns of exposure to IPV. Family doctors reviewed patients’ medical charts for period from 2012 to 2016, using the Domestic Violence Exposure Medical Chart Check List, for conditions which persisted for at least three years. Depression was found to be associated with any exposure to IPV in adult life and was more likely to affect women. In multivariable logistic regression modelling, factors associated with self-rated depression were identified (p < 0.05). Exposure to emotional and physical violence was identified as a risk factor in the first model, explaining 23% of the variance. The second model explained 66% of the variance; past divorce, dysfunctional family relationships and a history of incapacity to work increased the likelihood of depression in patients. Family doctors should consider IPV exposure when detecting depression, since lifetime IPV exposure was found to be 40.4% and 36.9% of depressed revealed it.

The Effects of a Web Application and Medical Monitoring on the Quality of Medication, Adverse Drug Events and Adherence in the Elderly Living at Home: a Protocol of the Study -

Background: In more than half of elderly chronically-ill family clinic attendees, drug prescribing deviates from the internationally acknowledged STOPP/START recommendations. Our study will determine whether it is possible to improve the quality of drug prescriptions in chronically-ill elderly people living at home by regularly monitoring the prescribed drugs according to STOPP/START criteria. Methods: The project started in 2014 and will run until 2017. Forty general practitioners (GPs) are participating in a pragmatic randomized controlled trial. From the patient register, GPs randomly selected 20 patients older than 65 years who regularly receive at least one drug and invited them to participate in the study. We will use the START/STOPP criteria to determine the (in)adequacy of drug prescribing in the elderly by a web application (WA). Expected Results: The use of the WA will be the basis of the implementation of the final version of the application into the regular family medicine practice, thereby reducing the problems of inappropriate prescribing, correct medication, polypharmacy and adherence; we will identify the stability of the factors of drug prescribing in the elderly. By comparing the test and control groups, it will be possible to distinguish which are related to the WA and which act independently.

Empathy and burnout in Slovenian family medicine doctors: The first presentation of jefferson scale of empathy results

Abstract Background Study aimed to assess the burnout prevalence and level of empathic attitude in family medicine doctors (FMDs) and its associations with demographic factors, working conditions and physician health, using the Jefferson Scale of Empathy – Health Professional version (JSE-HP). Methods Slovenian FMDs (n=316, response rate 56%) completed an online socio-demographic questionnaire, with questions on working conditions, physician health, and the Slovenian versions of the Maslach Burnout Inventory (MBI) and the JSE-HP. Univariate and multivariate analyses were used, applying linear regression to calculate associations between demographic variables, factors of empathy and burnout dimensions, P<0.05 was set as a limit of statistical significance. Results Of the 316 participants, aged 40±10.2 years, 57 (18%) were men. The FMDs achieved mean scores on the JSE-HP (JSEtot of 112.8±10.2 and on the MBI 27.8±11.6 for EE, 10.8±5.5 for D and 33.5±6.0 for PA. High burnout was reported in one dimension by 24.8% of participants, in two by 17.2%, and by 6% in all three dimensions. Multivariate analysis revealed a higher EE and D and lower PA in specialists as opposed to trainees. Higher EE was also identified in older physicians having longer work experience, working in a rural setting, dealing with more than 40 patients/day and having a chronic illness. The latter was also associated with higher JSEtot. JSEtot was negatively associated with D, while PA was positively associated with JSEtot and Perspective Taking. Conclusion The incidence of burnout warns both physicians and decision-makers against too heavy workload, especially in older professionals.