Zalika Klemenc-Ketis

Self-medication among healthcare and non-healthcare students at University of Ljubljana, Slovenia.

Objective: To determine the incidence of self-medication among University of Ljubljana students and the effect of the type of curriculum on the pattern of self-medication. Subjects and Methods: The study included a sample of 1,294 students who freely accessed a self-administered web-based questionnaire in the Slovene language that consisted of a preliminary letter introducing the term ‘self-treatment’ and 2 sections about self-medication. The preliminary letter asked participants to report the practice of self-treatment during the past year. The main outcome measures were percentages of those reporting self-medication during the past year, which were then used to compare healthcare and non-healthcare students. Results: A majority of students (1,195, 92.3%), both healthcare and non-healthcare, reported the use of some sort of self-medication during the study period. More healthcare students in their senior year (353, 94.1%) than those in their junior year (245, 89.4%) used self-medication (p = 0.04). Healthcare students (p = 0.05) thought that self-medication without improvement of the symptoms should last for 1 week or less. They acquired the drugs for self-medication from pharmacies; thought that previous doctors’ advice in a similar situation was a more important reason for self-medication; would seek the advice of a physician or pharmacist for different ways of self-treatment, and quite interestingly thought that self-medication was not very safe. On the other hand, non-healthcare students acquired the drugs from healers and friends. Conclusion: The study showed that self-medication was common among all University of Ljubljana students, but that healthcare-related education in students and young adults led to more responsible use of self-medication.

Seeking health advice on the Internet in patients with health problems: A cross-sectional population study in Slovenia

Aim To determine the one-month prevalence of the seeking of web-based health information in the general adult population and to identify the symptoms associated with more frequent searching for information online. Methods This was an observational cross-sectional study in a representative sample of 1,002 randomly selected Slovenian inhabitants. We used the method of computer-assisted telephone interviews. The questionnaire consisted of demographic questions, questions about the prevalence and duration of pre-selected symptoms in the past month, questions on the presence of chronic disease and a question about using the Internet for seeking health advice in the past month. Results Among 774 respondents who reported having had symptoms in the past month, 25.8% of them reported seeking health information on the Internet. The factors found to be independently associated with the seeking of health information on the Internet were a younger age, a higher education level and the presence of constipation, irritability, fatigue, memory impairment and excessive sweating in the past month. Conclusions The study showed that the Internet was a common source of health information in the general adult population, particularly used for symptoms which are common but not well defined and not associated with a particular disease.

The role of the European Academy of Teachers in General Practice and Family Medicine in family medicine education in Europe – the experience of the University of Maribor

Primary health care is important item of political agendas since Alma Ata conference in 1978. West Balkans share common history in development of primary care since 1920s when Andrija Stampar introduced social and community based primary care concepts. The first known specialist training in general practice in the world started in former Yugoslavia in the early 1960s. Since then, much has been done in the field of general practice and family medicine and this is reflected in The European Academy of Teachers in General Practice and Family Medicine (EURACT), which is a network organisation within World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians Region Europe (WONCA Europe). Its aim is to foster and maintain high standards of care in European general practice by promoting general practice as a discipline by learning and teaching. EURACT developed several documents and teachers courses which can serve the development of family medicine curricula in new established departments of medical schools. This is also the case at Maribor Medical School, where learning outcomes and teaching methods are in concordance with EURACT teaching agenda, but also some innovative approaches are used, such as art and e-learning environment as teaching methods.

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.

Determinants of depression and anxiety in family practice patients with comorbidities

SummaryAIM: To identify the prevalence of anxiety and depression in patients with chronic conditions in Slovenian family practices and to identify predictors for anxiety and depression. METHODS: Self-administered questionnaires (Zungs self-rating depression scale and Zungs self-rating anxiety scale) in a sample of 800 consecutive family-practice patients. The main outcome measures were depression and anxiety scores in patients with various comorbidities. RESULTS: A binary logistic regression model for the presence of depression showed that widowed/divorced status, elementary/vocational education, cardiac diseases, migraine and higher levels of chronic pain were independent predictors for the presence of depression. A binary logistic regression model for the presence of anxiety showed that female gender, lower income, cardiac diseases, osteoarthritis and rheumatologic diseases, and higher levels of chronic pain were independent predictors for with the presence of anxiety. CONCLUSIONS: Family physicians should actively and routinely look for the presence of depression and anxiety among their patients, especially among women, patients with lower levels of education, widowed and divorced patients, patients with chronic pain, patients with cardiac and rheumatologic diseases, and patients with migraine. Family doctors should provide better analgesic treatment for patients with chronic pain in order to prevent the development of depression and anxiety.

Outcome predictors of Glasgow Outcome Scale score in patients with severe traumatic brain injury

BACKGROUND Traumatic brain injury is a major public health problem due to high mortality and morbidity among survivors. METHODS We performed a retrospective cohort study of patients with severe traumatic brain injury. We recorded the attending physicians evaluation of the patients consciousness, the patients demographics, routine physical measurements, and medical interventions. We used Glasgow Coma Scale and Extended Glasgow Outcome Scale. RESULTS We included 60 patients (83.3% males, mean age: 49.5 years). The Glasgow Coma Scale score was 4.8±1.9 and the Extended Glasgow Outcome Scale score was 2.9±2.5 points. Linear regression for higher Extended Glasgow Outcome Scale score explained 59.8% of the variance and revealed the duration of hospital stay and the presence of epidural hematoma as significant predictors. The classification tree for the higher Extended Glasgow Outcome Scale score revealed the following variables to be important: the duration of hospital stay, Glasgow Coma Scale score, partial pressure of carbon dioxide, surgery, response time of out-of-hospital emergency team, systolic and diastolic blood pressure, fall, and basis fracture. CONCLUSION Standardized inpatient protocol on monitoring, intervention and outcome recording should be adopted to make future comparisons more useful and to promote benchmarking between trauma centers in order to improve care for patients with severe traumatic brain injury.

Enhancing primary care clerkships with virtual patients

Abstract Background: Virtual patients, computer-assisted patient scenarios, have been used in different medical disciplines over several years. Researchers have already gained knowledge on how it helps foster clinical thinking, fills knowledge gaps and enables patient management. Nonetheless, despite these advances in knowledge, the use of virtual patients in Family Medicine education remains limited. Objectives: We point out the current knowledge, benefits and potential ways of using virtual patients in the Family Medicine setting. Discussion: Virtual patients can be used as a preparation tool for clinical clerkships as well as learning about patient treatment not usually encountered in every day practice. Regardless of the means of implementation, students benefit from acquiring skills through multifaceted virtual patients. We firmly believe that, when intelligently applied, virtual patients can enhance and improve future Family Medicine education.

Is a practice-based rural research network feasible in Europe?

Abstract Research in family medicine is a well-established entity nationally and internationally, covering all aspects of primary care including remote and isolated practices. However, due to limited capacity and resources in rural family medicine, its potential is not fully exploited yet. An idea to foster European rural primary care research by establishing a practice-based research network has been recently put forward by several members of the European Rural and Isolated Practitioners Association (EURIPA) and the European General Practice Research Network (EGPRN). Two workshops on why, and how to design a practice-based research network among rural family practices in Europe were conducted at two international meetings. This paper revisits the definition of practice-based research in family medicine, reflects on the current situation in Europe regarding the research in rural family practice, and discusses a rationale for practice-based research in rural family medicine. A SWOT analysis was used as the main tool to analyse the current situation in Europe regarding the research in rural family practice at both meetings. The key messages gained from these meetings may be employed by the Wonca Working Party on research, the International Federation of Primary Care Research Network and the EGPRN that seek to introduce a practice-based research approach. The cooperation and collaboration between EURIPA and EGPRN creates a fertile ground to discuss further the prospect of a European practice-based rural family medicine research network, and to draw on the joint experience.

Deficiency areas in decision making in undergraduate medical students

Background In family medicine, decisions can be difficult due to the early presentation of often poorly developed symptoms or the presentation of undifferentiated conditions that require competencies unique to family medicine, such as; primary care management, specific problem-solving skills, and a comprehensive and holistic approach to be taught to medical students. Purpose The aim of this study was to assess the decision-making process covering all theoretical aspects of family practice consultation and to recognize possible areas of deficiency in undergraduate medical students. Materials and methods This was a cross-sectional, observational study performed at the Medical School of the University of Maribor in Slovenia. The study population consisted of 159 fourth-year medical students attending a family medicine class. The main outcome measure was the scores of the students’ written reports on solving the virtual clinical case. An assessment tool consisted of ten items that could be graded on a 5-point Likert scale. Results The final sample consisted of 147 (92.5%) student reports. There were 95 (64.6%) female students in the sample. The mean total score on the assessment scale was 35.1±7.0 points of a maximum 50 points. Students scored higher in the initial assessment items and lower in the patient education/involvement items. Female students scored significantly higher in terms of total assessment score and in terms of initial assessment and patient education/involvement. Conclusion Undergraduate medical education should devote more time to teaching a comprehensive approach to consultation, especially modification of the health behavior of patients and opportunistic health promotion to patients. Possible sex differences in students’ performance should be further evaluated.

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.