Determinants of self-rated health in elderly populations in urban areas in Slovenia, Lithuania and UK: findings of the EURO-URHIS 2 survey.

Background: Ageing imposes extra financial burdens on social and health services in developed countries. Self-rated health (SRH) is considered to be both a reliable measurement of overall health status including morbidity and mortality and an important predictor of hospitalization, functional impairment and greater demand for health-care services in the elderly. Our aim was to identify factors associated with poor SRH in elderly populations and investigate possible differences between urban areas in Slovenia, Lithuania and UK. Data were obtained from population-based surveys from the European Urban Health Indicator System Part 2 project. The stratified representative sample (41% men and 59% women) consisted of a total of 2547 respondents aged ≥65 from the urban areas in the three countries. The prevalence of poor SRH was highest in Lithuanian urban areas. The strongest factors associated with poor SRH were low education [OR (odds ratio) 4.3, 95% CI (confidence interval) 2.5-7.3, P < 0.001], restriction of activities attributable to a chronic disease (OR 2.6, 95% CI 2.2-3.0, P < 0.001), inadequate physical activity (OR 1.7, 95% CI 1.2-2.5, P = 0.007) and poor mental health (OR 1.1, 95% CI 1.1-1.2, P < 0.001). The main factors associated with poor SRH by country included the following: living alone (Slovenia) (OR 2.0, 95% CI 1.1-3.7, P = 0,023), female sex (Lithuania) (OR 2.0, 95% CI 1.0-4.2, P = 0.058) and inadequate physical activity (UK) (OR 2.2, 95% CI 1.3-3.6, P = 0,003). Despite different levels of poor SRH, the factors associated with poor SRH were similar for the urban areas of the three countries. Factors associated with poor SRH in the urban areas could also reflect either cultural differences or specific situations for elderly in that country, which need further research.

Role of nurse practitioners in reducing cardiovascular risk factors: a retrospective cohort study.

AIMS AND OBJECTIVES: To determine the impact of nurse practitioners' counselling on reducing cardiovascular risk factors in patients participating in routine preventive check-ups. BACKGROUND: A new model of 'renewed' family practice was introduced in Slovenia as a pilot project in 2011, in which nurse practitioners are included in a team carrying out preventive activities and managing patients with stable chronic diseases. DESIGN: A retrospective cohort study. METHODS: This study was conducted in 16 family medicine practices (eight renewed and eight regular family practices). In each family practice, a systematic sample was selected of registered patients participating in a cardiovascular preventive check-up. Data on sex, age, blood pressure, cholesterol, blood sugar, smoking, level of physical activity and cardiovascular risk were collected. Patients attending renewed family practices received counselling on risk factors from nurse practitioners (test group), and patients attending regular family practices received counselling from family physicians (control group). Data were collected again at least one and no more than five years after the baseline consultation. RESULTS: There were 128 patients in the test group and 129 patients in the control group. At the control visit, the patients counselled by nurse practitioners had significantly lower levels of systolic blood pressure and cholesterol and practiced regular physical activity significantly more often than patients counselled by family physicians. CONCLUSION: Nurse practitioners can be at least as successful as physicians when counselling patients on cardiovascular risk factors during their preventive check-ups. RELEVANCE TO CLINICAL PRACTICE: This study showed that nurse practitioners have an important role in managing patients at the primary care level.

Development and validation of a questionnaire for evaluation of students' attitudes towards family medicine.

The development of the EURACT (European Academy of Teachers in General Practice) Educational Agenda helped many family medicine departments in development of clerkship and the aims and objectives of family medicine teaching. Our aims were to develop and validate a tool for assessment of students' attitudes towards family medicine and to evaluate the impact of the clerkship on students' attitudes regarding the competences of family doctor. In the pilot study, experienced family doctors were asked to describe their attitudes towards family medicine by using the Educational Agenda as a template for brainstorming. The statements were paraphrased and developed into a 164-items questionnaire, which was administered to 176 final-year students in academic year 2007/08. The third phase consisted of development of a final tool using statistical analysis, which resulted in the 60-items questionnaire in six domains which was used for the evaluation of students' attitudes. At the beginning of the clerkship, person-centred care and holistic approach scored lower than the other competences. Students' attitudes regarding the competences at the end of 7 weeks clerkship in family medicine were more positive, with exception of the competence regarding primary care management. The students who named family medicine as his or her future career choice, found holistic approach as more important than the students who did not name it as their future career. With the decision tree, which included students' attitudes to the competences of family medicine, we can successfully predict the future career choice in family medicine in 93.5% of the students. This study reports on the first attempt to develop a valid and reliable tool for measuring attitudes towards family medicine based on EURACT Educational Agenda. The questionnaire could be used for evaluating changes of students' attitudes in undergraduate curricula and for prediction of students' preferences regarding their future professional career in family medicine.

New tool for patient evaluation of nurse practitioner in primary care settings.

AIMS AND OBJECTIVES: To validate a tool for patient evaluation of nurse practitioners. BACKGROUND: The roles of nurse practitioners in family practice settings are health promotion and routine follow-up of patients with chronic diseases. So far, several tools for patient evaluation of nurse practitioners have been developed. They revealed several dimensions of nurse practitioners' work and high levels of patient satisfaction with their work. The studies also reported conflicting data on the associations between demographic and other variables and the level of nurse practitioners' evaluation by patients. DESIGN: A cross-sectional study. METHODS: This study was performed in a sample of seven model family medicine practices in Slovenia. We included 30 consecutive adult patients in each model family practice aiming at the final sample of 210 respondents. Patient evaluation of nurse practitioners was assessed using a Nurse Practitioner Evaluation Scale. RESULTS: The response rate was 80·9%. Mean total score on Nurse Practitioner Evaluation Scale was 87·9 ± 12·4 points. Cronbach's alpha of Nurse Practitioner Evaluation Scale was 0·941. Factor analyses revealed three factors: clinical approach factor, comprehensive approach factor and patient-centred approach factor. CONCLUSIONS: Nurse Practitioner Evaluation Scale proved to be a reliable tool for patient evaluations of nurse practitioners in primary care settings. Nurse Practitioner Evaluation Scale can be used in terms of a whole scale as well as in terms of three separate subscales. RELEVANCE TO CLINICAL PRACTICE: This newly developed tool can be used to monitor quality performance of nurse practitioners and to plan quality improvement actions in nurse practitioners' performance in primary care settings.

Validation of the Slovenian version of patient assessment of chronic illness care (PACIC) in patients with coronary heart disease.

The Chronic Care Model (CCM) is a conceptual framework that supports the evidence-based proactive and planned care of chronic diseases. Our aim was to validate a Slovenian translation of Patient Assessment of Chronic Illness Care (PACIC)--a self-reported instrument designed to measure the extent to which patients with chronic illnesses receive care congruent with CCM--on a sample of patients with coronary heart disease. Secondary analysis of patients' evaluation of general practice care (EPA Cardio study) was done in patients with coronary heart disease in Slovenia. Patients completed a written questionnaire, which included the instrument for assessing chronic illness care (PACIC), the EUROPEP questionnaire and demographical data. Internal consistency was expressed in terms of Cronbach's alpha. Reliability was expressed as the intra class correlation coefficient (ICC). Correlation between PACIC and EUROPEP was considered as a measure of construct validity. Factor analysis was done to identify number and types of domains in the instrument. Questionnaires of 843 patients were analysed. The mean age was 68.2 (SD 11.1) years, 34.6% of participants were female. 32.7% of PACIC questionnaires were not completely fulfilled. The internal consistency of the entire questionnaire assessed by Cronbach's alpha was 0.953 and reliability was 0.937. Construct validity was confirmed with important and significant correlation between PACIC and EUROPEP questionnaire (Spearman's correlation coefficient = 0.60, p < 0.001). Principal component factor analysis identifies two major factors which we labeled according to the PACIC domains as "Patient activation, decision support and problem solving" and "Goal settings and coordination". A translated and validated Slovenian version of PACIC questionnaire is now available. Further research on its validity in other groups of chronically ill patients and the use of instrument for monitoring changes of chronic care over time is recommended.

Predictors of high prescribing rates in family practice during actual consultation: a cross-sectional study from Slovenia.

With a cross-sectional survey wich was held on in Slovenia we would like to define the predictors of high prescribing rates in family practice. 42 involved family doctors reported 300 office contacts, i.e., a total of 12,596 contacts. The participants were asked to fulfil the questionnaire for each patient-doctor encounter in one day. In 12,596 recorded contacts, 14,485 prescriptions were issued to the patients. The patients got from 0 to 10 prescriptions per visit (X +/- SD: 1.2 +/- 1.4). Among 7,363 (58.5%)patients, who got at least one prescription, the mean number of prescriptions was 2.0 +/- 1.4. The majority ofprescribed drugs were for cardiovascular system. The multivariate model for higher number ofprescribed drugs explained 20.2% of the variation. Independent predictors for higher prescribing rates during a consultation were female sex, older age, higher number of problems dealt within the consultation (comorbidity), longer consultation times, lower education grade, higher patient quota on the list, higher prescribing quota indexed by NHII for the past year, being a spe- cialist in family medicine, male doctor and age of doctor more than 44 years. Practice characteristics did not show any correlations with high prescribing volumes. The results of this survey show that some patients' and doctors' characteristics and also some consultations' characteristics affect the prescribing rate. Additional analyses should be performed to identify reasons for that and to propose proper actions.

Health seeking behaviour in general population with psychological symptoms.

BACKGROUND: Health seeking behaviour is a complex construct in patients with psychological symptoms. The aim of this study was to determine a one-month prevalence of psychological symptoms in Slovenian general population and to identify correlates of health seeking behaviour. SUBJECTS AND METHODS: This study was conducted in a representative sample of 1,002 randomly selected Slovenian citizens, stratified according to sex and age. We used a method of computer assisted telephone interview (CATI). The questionnaire consisted of demographic questions, questions about the prevalence and duration of preselected symptoms in the past month (irritability, nervousness), questions about the presence of chronic diseases, EQ-5D questionnaire and the questions on health seeking behaviour (self-treatment, lay advice seeking and medical advice seeking). RESULTS: The self-reported prevalence of psychological symptoms in the past month was 38.0% (381/1,002). Multivariate analysis for the presence of self-reported psychological symptoms revealed that female sex, higher age, the presence of chronic disease, primary education, lay-advice seeking, pain and the presence of anxiety/depression on EQ-5D questionnaire were independently associated with psychological symptoms. CONCLUSIONS: Psychological symptoms are a major public health problem in Slovenian general adult population and the self-reported utilization of professional health care services by Slovenian population is high. Other patterns such as lay referral system might have a crucial influence on the final decision to seek medical help.

The assessment of pharmaceutical sales representatives by family physicians--does it affect the prescribing index?

BACKGROUND: Physicians' prescribing patterns depend on fixed and influence-sensitive factors. The latter include the influence of interactions with the pharmaceutical industry. OBJECTIVE: To determine whether the assessment of pharmaceutical sales representatives (PSRs) by family physicians was associated with their actual prescribing index. METHODS: Cross-sectional anonymous postal study. We included all family physicians working in practice settings in Slovenia in 2011. SETTINGS: Slovenian family physicians' surgeries. MAIN OUTCOME MEASURE: Prescribing index of Slovenian family physicians. RESULTS: We received 247 responses (27.6% response rate). A prescribing index >100% was present in 57 (23.1%) of the respondents. Multivariate analysis revealed that working in regions of Slovenia other than the central region might be associated with a prescribing index >100%. Assessment of PSRs by family physicians was not significantly associated with a prescribing index >100%. CONCLUSION: The assessment of PSRs by family physicians does not have any substantial correlations with their prescribing index.

Did past economic prosperity affect the health related quality of life predictors? A longitudinal study on a representative sample of Slovenian family medicine patients.

BACKGROUND: Health related quality of life (HRQOL) as an important measure of medical outcomes has been shown to be associated with demographic factors and the most common mental and chronic somatic diseases. This study's aim was to identify factors predicting changes in HRQOL over a follow-up period in a representative sample of Slovenian family medicine patients. METHODS: In a longitudinal multi-centred study between 2003 and 2005, data were collected from 1118 consecutive attendees from 60 family medicine practices in Slovenia on quality of life, socio-demographic factors and the presence of mental disorders, with follow-up after 6 and 24 months. Retrospective information on chronic diseases was obtained from patients` health records. In three time-sequential multiple linear regression models, data on 601 patients (53.8%) was analysed to determine factors associated with each component score of quality of life. RESULTS: At baseline the patients were 48.58 (SE = 0.58) years of age, over half were women (386 (64.2%)) and most were Slovenian (548 (91.2%)). Quality of life was seen to improve over the two-year period. Factors significantly and consistently associated with a better mental component score of quality of life were social support, satisfactory circumstances in patients` household and absence of anxiety. Major life events in the past year and depression were shown to be risk factors for mental and physical components, while level of education, absence of long-term disability and chronic pain were identified as predictors of the physical component. CONCLUSIONS: Detection and successful treatment of depression and anxiety has a potential to lead to improved quality of life in family medicine attendees; family physicians should be alert for the early onset of these conditions, knowing that symptoms of chronic pain, depression and anxiety often overlap in patients. Poorly educated patients and those lacking social support and/or satisfactory household circumstances should be recognised and empowered, and appropriate coping mechanisms should be introduced.

Do family physicians advise younger people on cardiovascular disease prevention? A cross-sectional study from Slovenia.

BACKGROUND: One of the main family practice interventions in the younger healthy population is advice on how to keep or develop a healthy lifestyle. In this study we explored the level of counselling regarding healthy lifestyle by family physicians and the factors associated with it. METHODS: A cross-sectional study with a random sample of 36 family practices, stratified by size and location. Each practice included up to 40 people aged 18-45 with low/medium risk for cardiovascular disease (CVD). Data were obtained by patient and practice questionnaires and semi-structured interviews. Several predictors on the patient and practice level for received advice in seven areas of CVD prevention were applied in corresponding models using a two-level logistic regression analysis. RESULTS: Less than half of the eligible people received advice for the presented risk factors and the majority of them found it useful. Practices with medium patient list-sizes showed consistently higher level of advice in all areas of CVD prevention. Independent predictors for receiving advice on cholesterol management were patients' higher weight (regression coefficient 0.04, p=0.03), urban location of practice (regression coefficient 0.92, p=0.04), organisation of education by the practice (regression coefficient 0.47, p=0.01) and practice list size (regression coefficient 6.04, p=0.04). Patients who self-assessed their health poorly more frequently received advice on smoking (regression coefficient -0.26, p=0.03). Hypertensive patients received written information more often (regression coefficient 0.66, p=0.04). People with increased weight more often received advice for children's lifestyle (regression coefficient 0.06, p=0.03). We did not find associations with patient or practice characteristics and advice regarding weight and physical activity. We did not find a common pattern of predictors for advice. CONCLUSIONS: Counselling for risk diseases such as increased cholesterol is more frequently provided than basic lifestyle counselling. We found some doctors and practice factors associated with counselling behaviour, but the majority has to be explained by further studies.

Slovenian adaptation of the original AUDIT-C questionnaire.

BACKGROUND: Alcohol Use Disorders Identification Test Consumption (AUDIT-C) questionnaire as a screening instrument for identification of hazardous and harmful drinkers give some false-positive and negative results. Changes of answers decrease the number of false results. METHODS: Changes in second and third questions with theoretical simulation of possible answers' combinations was made; cutoff scores have to be changed. Study with original and adapted AUDIT-C was conducted among 298 students to analyze the differences. RESULTS: Adapted Slovenian version of AUDIT-C gives less false-positive and less false-negative results. CONCLUSIONS: Changes of AUDIT-C questionnaire that give less false results means less potential disharmony in doctor-patient relationship, less unnecessary questioning, less time spent inadequately, and also less missed hazardous drinkers.

New virtual case-based assessment method for decision making in undergraduate students: a scale development and validation.

BACKGROUND: There are many Internet forums where patients can ask medical question and get an answer from doctors. The aim of this study was to develop and validate the rating scale for the assessment of decision-making skills in undergraduate medical students based on such Internet questions. METHODS: This cross-sectional observational study carried out in Medical School of University of Maribor in Slovenia during the family medicine teaching course in the fourth study year. The sample consisted of 159 students. The source of data were the scoring sheets of the students' reports, assesses by two independent researchers. The assessment tool consisted of 10 items on a five-point Likert scale. RESULTS: Our final sample consisted of 147 (92.5%) students' reports. The ICC for matching of the final total scores on assessment tool of both assessors was 0.742. Cronbach's alpha of the assessment scale was 0.848. Factor analysis revealed four factors: initial assessment, physical examination planning, planning patient management and patient education/involvement. CONCLUSIONS: This assessment tool can be used for assessing undergraduate students' decision-making based on medical questions asked by real patients in a virtual setting.

Age- and gender-specific prevalence of self-reported symptoms in adults.

OBJECTIVE: The aim of the study was to determine the age- and gender-specific prevalence of predefined symptoms in adults. METHODS: Cross-sectional study using a method of computer assisted telephone interview. RESULTS: At least one of the symptoms was experienced by 71.4% of men and 84.6% of women in the past month. Most common symptoms in men were back pain, joint pain, irritability, nervousness, and muscle pain; in women back pain, joint pain, fatigue, headache, and nervousness. The trend of symptoms' prevalence through the age groups was increasing, stable or biphasic. CONCLUSIONS: The results from this study are important for recognizing and understanding of symptoms' self-perception in both genders.

Airway obstruction and bronchodilator responsiveness in adults with acute cough.

PURPOSE: We sought to determine the prevalence of airway obstruction and bronchodilator responsiveness in adults consulting for acute cough in primary care. METHODS: Family physicians recruited 3,105 adult patients with acute cough (28 days or shorter) attending primary care practices in 12 European countries. After exclusion of patients with preexisting physician-diagnosed asthma or chronic obstructive pulmonary disease (COPD), we undertook complete case analysis of spirometry results (n = 1,947) 28 to 35 days after inclusion. Bronchodilator responsiveness was diagnosed if there were recurrent complaints of wheezing, cough, or dyspnea and an increase of the forced expiratory volume in 1 second (FEV(1)) of 12% or more after bronchodilation. Airway obstruction was diagnosed according to 2 thresholds for the (postbronchodilator) ratio of FEV(1) to forced vital capacity (FEV(1):FVC): less than 0.7 and less than the lower limit of normal. RESULTS: There were 240 participants who showed bronchodilator responsiveness (12%), 193 (10%) had a FEV(1)/FVC ratio of less than 0.7, and 126 (6%) had a ratio of less than the lower limit of normal. Spearman's correlation between the 2 definitions of obstruction was 0.71 (P <.001), with discordance most pronounced among those younger than 30 years and in older participants. CONCLUSIONS: Both bronchodilator responsiveness and persistent airway obstruction are common in adults without established asthma or COPD who consult for acute cough in primary care, which suggests a high risk of undiagnosed asthma and COPD. Different accepted methods to define airway obstruction detected different numbers of patients, especially at the extremes of age. As both conditions benefit from appropriate and timely interventions, clinicians should be aware and responsive to potential underdiagnosis.

Incidental chest radiographic findings in adult patients with acute cough.

PURPOSE: Imaging may produce unexpected or incidental findings with consequences for patients and ordering of future investigations. Chest radiography in patients with acute cough is among the most common reasons for imaging in primary care, but data on associated incidental findings are lacking. We set out to describe the type and prevalence of incidental chest radiography findings in primary care patients with acute cough. METHODS: We report on data from a cross-sectional study in 16 European primary care networks on 3,105 patients with acute cough, all of whom were undergoing chest radiography as part of a research study workup. Apart from assessment for specified signs of pneumonia and acute bronchitis, local radiologists were asked to evaluate any additional finding on the radiographs. For the 2,823 participants with good-quality chest radiographs, these findings were categorized according to clinical relevance based on previous research evidence and analyzed for type and prevalence by network, sex, age, and smoking status. RESULTS: Incidental findings were reported in 19% of all participants, and ranged from 0% to 25% by primary care network, with the network being an independent contributor (P <.001). Of all participants 3% had clinically relevant incidental findings. Suspected nodules and shadows were reported in 1.8%. Incidental findings were more common is older participants and smokers (P <. 001). CONCLUSIONS: Clinically relevant incidental findings on chest radiographs in primary care adult patients with acute cough are uncommon, and prevalence varies by setting.

HEMS in Slovenia: one country, four models, different quality outcomes.

OBJECTIVE: The objective of this study was to determine the quality of patient care using quality indicators in 4 different Slovenian helicopter emergency medical service (HEMS) models. METHODS: This was a cross-sectional study of all 4 HEMS in Slovenia. We collected data on quality for the period from July 2003 to August 2008, in a sample of all eligible patients that were managed by HEMS during the study period (N = 833). We obtained the following data on emergency operations: the time and organizational features of the operation; the description of the patients' condition; and the on-site diagnostic and treatment procedures. We used the following as quality indicators: the number of resuscitated patients that were intubated; the number of patients with a Glasgow Coma Scale (GCS) score of # 8 that were intubated; the number of patients with acute coronary syndrome that received treatment with morphine, oxygen, nitroglycerine, and aspirin (MONA); the number of patients with a National Advisory Committee on Aeronautics (NACA) scale score of $ 4 with an intravenous line; the number of patients with a NACA score of $ 5 that were given oxygen; and the number of patients with a NACA score of $ 4 that were given appropriate analgesic treatment. RESULTS: Across all HEMS bases, 36 (87.8%) resuscitated patients were intubated; 122 (81.9%) patients with GCS # 8 were intubated; 149 (89.2%) patients with ACS were given MONA treatment; 52 (92.9%) patients with a NACA score of $ 4 were given an intravenous line; 254 (92.7%) patients with a NACA score of $ 5 were given oxygen; and 18 (32.7%) trauma patients with a NACA score of $ 4 were given intravenous analgesics. The quality of patient management in HEMS in Slovenia is affected by the callout procedure, the presence or absence of a fixed rope, the type of helicopter operator, and the provider of the doctor in the helicopter team. CONCLUSIONS: The data from our study indicates that the quality of patient management in HEMS in Slovenia is high. It also seems that organizational factors play a role in the quality management of patients in HEMS as well, but their effect remains unclear and needs further evaluation.

Family doctors' views of pharmaceutical sales representatives: assessment scale development.

BACKGROUND: The prescribing patterns depend on the physicians' attitudes and their subjective norms towards prescribing a particular drug, as well as on their personal experience with a particular drug. The physicians are affected by their interactions with pharmaceutical industry. OBJECTIVE: The objectives were to develop a scale for assessment of pharmaceutical sales representatives (PSRs) by the family doctors (FDs) and to determine factors for their evaluation. METHOD: Cross-sectional anonymous postal study. We included a random sample of 250 Slovenian FDs. Settings. Slovenian FDs' surgeries. MAIN OUTCOME MEASURE: The score of various items regarding FDs' assessment of PSRs on a 7-point Likert scale. RESULTS: We got 163 responses (65.2% response rate). The most important characteristic of PSRs, as rated by respondents on the scale from 1 to 7, was the fact that they did not mislead when presenting products' information. The second most important characteristic was the ability to provide objective information about the product. The first three most important characteristics, as rated by the respondents by themselves, were 'Shows good knowledge on the promoted subject', 'Provides objective product information' and 'Makes brief and exact visits'. Cronbach's alpha of the composite scale was 0.844. Factor analysis revealed three PSRs' factors: selling skills, communicating skills and sense of trustworthiness. CONCLUSION: FDs evaluate PSRs mainly by their managerial skills and trustworthiness. The scale proved to be a reliable tool for assessing PSRs by FDs.

The prevalence of exposure to domestic violence and the factors associated with co-occurrence of psychological and physical violence exposure: a sample from primary care patients.

BACKGROUND: Since many health problems are associated with abuse and neglect at all ages, domestic violence victims may be considered as a group of primary care patients in need of special attention. METHODS: The aim of this multi-centre study was to assess the prevalence of domestic violence in primary care patients, and to identify those factors which influence the co-occurrence of psychological and physical violence exposure and their consequences (physical, sexual and reproductive and psychological) as obtained from medical records.A study was carried out in 28 family practices in Slovenia in 2009. Twenty-eight family physicians approached every fifth family practice attendee, regardless of gender, to be interviewed about their exposure to domestic violence and asked to specify the perpetrator and the frequency. Out of 840 patients asked, 829 individuals, 61.0% women (n = 506) and 39.0% men (n = 323) were assessed (98.7% response rate). They represented a randomised sample of general practice attendees, aged 18 years and above, who had visited their physician for health problems and who were given a physical examination. Visits for administrative purposes were excluded.Multivariate binary logistic regression analysis was used to determine the factors associated with exposure to both psychological and physical violence. RESULTS: Of 829 patients, 15.3% reported some type of domestic violence experienced during the previous five years; 5.9% reported physical and 9.4% psychological violence; of these 19.2% of men and 80.8% of women had been exposed to psychological violence, while 22.4% of men and 77.6% of women had been exposed to physical violence. The domestic violence victims were mostly women (p < 0.001) aged up to 35 years (p = 0.001). Exposure to psychological violence was more prevalent than exposure to physical violence. Of the women, 20.0% were exposed to either type of violence, compared to 8.0% of male participants, who reported they were rarely exposed to physical violence, while women reported often or constant exposure to physical violence. Their partners were mostly the perpetrators of domestic violence towards women, while amongst men the perpetrators were mostly other family members.In univariate analysis female gender was shown to be a risk factor for domestic violence exposure. Regression modelling, explaining 40% of the variance, extracted two factors associated with psychological and physical violence exposure: the abuse of alcohol in the patient (OR 4.7; 95% CI 1.54-14.45) and their unemployment (OR 13.3; 95% CI 1.53-116.45). CONCLUSIONS: As far as the study design permits, the identified factors associated with both psychological and physical violence exposure could serve as determinants to raise family physicians' awareness when exploring the prevalence of domestic violence. The results of previous research, showing at least 15% prevalence of exposure to domestic violence among primary care patients in Slovenia, and the female gender as a risk factor, were confirmed.

Patients' evaluations of European general practice--revisited after 11 years.

BACKGROUND: In the last decade many things have changed in healthcare systems, primary care practices and populations. OBJECTIVE: To describe evaluations of general practice care by patients with a chronic illness in 2009 and compare these with a previous study done in 1998. DESIGN: A descriptive analysis of patients' evaluations, using data from the European practice assessment Cardio study on cardiovascular patients in eight European countries in 2009. We compared these evaluations with a subgroup of patients with self-defined chronic illness from the study in 1998, using a linear regression model. MAIN OUTCOME MEASURE: Patients' evaluation of general practice using the EUROPEP questionnaire. The EUROPEP is a 23-item validated measure of patient evaluations of general practice care. RESULTS: In 2009, 7472 patients from 251 practices participated in the study with an overall response rate of 49.6%. The percentage of patients with positive evaluations (good/excellent) was 80% or higher for all items, except for the waiting time. More positive evaluations were found in older patients, patients with a longer attachment to the practice, patients with a higher self-evaluation of their health, patients with fewer mental health problems and less pain/discomfort. The comparison between 1998 and 2009 showed no overall trends for all countries combined. Whereas English patients became fairly more positive about general practice in 2009, German patients became slightly less positive, although still more positive than English patients. CONCLUSION: Overall, the patients' evaluations of general practice were very positive in family practice care in the years 1998 and 2009. The trends over the years need to be carefully interpreted over time.

Diagnostic scope in out-of-hours primary care services in eight European countries: an observational study.

BACKGROUND: In previous years, out- of-hours primary care has been organised in large-scale organisations in many countries. This may have lowered the threshold for many patients to present health problems at nights and during the weekend. Comparisons of out-of-hours care between countries require internationally comparable figures on symptoms and diagnoses, which were not available. This study aimed to describe the symptoms and diagnoses in out-of-hours primary care services in regions in eight European countries. METHODS: We conducted a retrospective observational study based on medical records from out-of-hours primary care services in Belgium, Denmark, Germany, the Netherlands, Norway, Slovenia, Spain, and Switzerland. We aimed to include data on 1000 initial contacts from up to three organisations per country. Excluded were contacts with an administrative reason. The International Classification for Primary Care (ICPC) was used to categorise symptoms and diagnoses. In two countries (Slovenia and Spain) ICD10 codes were translated into ICPC codes. RESULTS: The age distribution of patients showed a high consistency across countries, while the percentage of males varied from 33.7% to 48.3%. The ICPC categories that were used most frequently concerned: chapter A 'general and unspecified symptoms' (mean 13.2%), chapter R 'respiratory' (mean 20.4%), chapter L 'musculoskeletal' (mean 15.0%), chapter S 'skin' (mean 12.5%), and chapter D 'digestive' (mean 11.6%). So, relatively high numbers of patients presenting with infectious diseases or acute pain related syndromes. This was largely consistent across age groups, but in some age groups chapter H ('ear problems'), chapter L ('musculoskeletal') and chapter K ('cardiovascular') were frequently used. Acute life-threatening problems had a low incidence. CONCLUSIONS: This international study suggested a highly similar diagnostic scope in out-of-hours primary care services. The incidence rates of acute life-threatening health problems were low in all countries.