[Preventive work in family medicine--proactive approach]. / Proaktivni pristup preventivnom radu u obiteljskoj medicini.

The role of general practitioner/family physician (GP/FP) in disease prevention and health promotion is strongly supported by research and health policies. The position of GPs/FPs in the health care system and their close, sustained contact with their patients and local community makes preventive care an integral part of GP/FP routine work. The spectrum of caring for patients in general practice/family medicine is actually very large, going from intervention on health care determinants to palliative care. The prevention-related activities are more or less present at each step of this "healthcare continuum". The significant gaps between GP/FP knowledge and practices persist in the use of evidence-based recommendations for health promotion and disease prevention. We describe the role of GP/FP in preventive care and report data on preventive care activities in the Croatian Family Medicine Service. More objective evidence is needed to see what GPs/FPs actually do in practice. For this reason, it is critical that GPs/FPs systematically record the most relevant preventive and health promotion activities that they perform. Furthermore, their performance of the preventive program should be regularly monitored, evaluated and professionally and financially validated. We present the preventive program based on these principles in Family Medicine Service proposed by the Ministry of Health and Social Welfare Working Group on Reform of Primary Health Care.

[Differences between rural and urban general practice activities]. / Razlike u strukturi rada obiteljskih lijecnika na selu i u gradu.

OBJECTIVES: It is an established opinion that doctors working in rural setting are the "real general practitioners" doctors who have a broader working and responsibility range when compared to their colleagues who work in urban setting. AIM: The aim of the study was to explore whether there were differences in health care service between an urban and a rural GP office by comparing the number of visits, physical examinations, house calls and treatment costs, and to determine the impact of different age groups (regardless of the number of patients under GP care) on the frequency and type of visits to GP office, drug utilization and prescription. METHODS: The study was conducted at an urban GP office (Pozega) and a rural GP office (Velika) with a catchment population of 2063 and 2031 individuals, respectively (both offices employ family medicine specialists). Data were collected from monthly reports containing information on age groups, total number of visits, physical examinations, house calls, prescriptions and referrals during 2003. In addition, financial costs associated with prescribed drugs were compared between the two offices. On data analysis, descriptive distribution and distribution analysis were used. Differences between data were estimated by use of chi2-test. RESULTS: In the urban and rural GP offices 97.3% and only 69.6% of the population was older than 18, respectively. In urban GP office there was a mean of 7.35 visits per user per year, whereas in rural GP office the respective figure was 6.43, yielding a statistically significant difference (chi2 = 15.86; df = 1; p < 0.001). In urban GP office there were more house calls, the difference being statistically significant (chi2 = 51.91; df = 1; p < 0.001). Urban GP office also recorded a statistically significantly higher rate of referrals than rural office (chi = 31.22; df = 1; p < 0.001). The urban and rural GP offices differed in the mean number of prescriptions per patient (8.96 vs. 5.81), mean prescription cost (63.60 vs. 55.54 HRK); mean prescription cost per person (570.19 vs. 323.05 HRK), and index of financial expenditure of the predetermined amount assigned to drugs (135.7% vs. 92.32%). CONCLUSIONS: Results of this study showed the different age group structure (regardless of the catchment population size) to determine the number of visits to GP office, total prescription cost and number of referrals. It is therefore of utmost importance to acknowledge the importance of patient age group structure as it has great influence in determining the type of care a GP has to offer and the cost associated with it.

[Disease duration, patient compliance and presence of complications in diabetic patients]. / Trajanje bolesti, suradljivost bolesnika i postojanje komplikacija u bolesnika s dijabetesom.

UNLABELLED: Diabetes mellitus (especially type 2) is one of the most common metabolic diseases in care of general/family physician. AIM: The aim of the study was to investigate the duration of the disease, association of the disease duration with the onset of complications, and physician's assessment of patient compliance. The study was a part of the international Health Monitoring Project carried out by the Chair of Family Medicine, Andrija Stampar School of Public Health, School of Medicine, Zagreb, in cooperation with The Netherlands Institute of Primary Health Care (NIVEL). The aim was to assess the value of data on the incidence and prevalence of diabetes mellitus in primary health care. SUBJECTS AND METHODS: Family physicians, general/family practice specialists, teachers and heads of general/family practice practical teaching who were collecting data for the questionnaire structured for this purpose were included in the study. Description and distribution analysis was used on data analysis, and chi2-test on testing of differences. RESULTS: Out of 96 general/family physicians who agreed to participate in the study, 58 (60.4%) collected data on 3065 patients: 1275 (41.6%) men and 1790 (58.4%) women. In 1044 (34.1%) patients the disease lasted for 1-5 years, in 990 (32,3%) for 6-10 years and in 1031 (33.6%) for more than ten years. Complications were recorded in 1521 (49.62%) patients, showing a statistically significant correlation with the duration of the disease (chi2 = 627.889; df = 2; p < 0.001). Physicians estimated that good compliance was established in 1579 (51.52%) patients. There were significantly less complications in these patients (chi2 = 6.098; df =2; p = 0.047). DISCUSSION AND CONCLUSION: The number of complications in diabetes mellitus increased proportionally with the length of the disease, while the number of complications was lower in cases with better patient compliance. In the care for a patient with diabetes mellitus family physician should train the patient in self-care, tending to establish partnership in long lasting treatment, which is a precondition for good compliance.

[Private contracted primary health physician: today and tomorrow]. / Privatni ugovorni lijecnik: danas i sutra.

Contracted primary health physician is the cornerstone of health care system. He is the main provider of all contracted obligations. It is necessary to evaluate the role of other contributors and organizational forms. Not the practice ownership but contract with the Croatian Institute of Health Insurance is fundamental for the status of general practitioners. Primary care should be based on Group Practice and Primary Health Trusts.

[Health care professionals--attitudes towards their own health]. / Zdravstveni radnici--odnos prema vlastitom zdravlju.

AIM: The aim of the study was to investigate differences in health behavior and life habits between physicians and medical nurses as related to their own health. EXAMINEES AND METHODS: Study subjects were health professionals from various parts of Croatia attending a scientific meeting, who filled out a special questionnaire (36 males and 178 females). They were divided into two groups according to education and work performed: physicians (n = 125) and medical nurses (n = 89). The questionnaire designed for the study, How medical workers keep their health, was used to estimate the factors influencing their health. The study was performed during 2005. RESULTS: The results showed that, regardless of education or work, our health professionals did not have healthy life habits. Both physicians and nurses were equally obese (p = 0.423) and physically inactive (p = 0.403). There was a significant difference between these two groups in smoking habits (p = 0.008), occasional alcohol consumption, regularity of breakfast intake (p = 0.019), and number of daily meals (p = 0.047). The following was done for the control of risk factors: laboratory tests of cholesterol and glucose, measurement of blood pressure, dental examination (p = 0.404), prostate examination (p = 0.406), breast self examinations (p = 0.810), mammography (p = 0.289), and Pap test (p = 0.683). None of these factors showed significant between group differences. There was a statistically higher number (64.9%; p < 0.001) of physicians without family physicians than among medical nurses (8.1%). CONCLUSION: Medical nurses consulted their family physicians more frequently than doctors, but most physicians were inclined to self treatment. A great proportion of nurses were smokers, whereas many physicians reported alcohol consumption. Physicians used sedatives more than nurses, and their physical activity was better. Nurses had more frequent control laboratory tests of cholesterol and glucose, and measurements of blood pressure. They were also better in the number of daily meals. A vast majority of patients cite their physicians as their primary source of information regarding healthy lifestyle decisions. These findings suggest strategies to improve the physicians' health behavior.

[Acute infections of the upper respiratory tract--factors that contribute to diagnosis and antibiotic prescription decisions]. / Akutne infekcijev gornjeg disnog sustava--sto pridonosi dijagnozi, a sto odluci o propisivanju antibiotika?

UNLABELLED: Acute infections of the upper respiratory tract contribute to over 20% of the morbidity of the population in ambulatory care, with the highest incidence in children. A noted problem in the treatment of these diseases is overprescription of antibiotics. In addition, there is a high degree of variability among physicians in the frequency and cost of antibiotic prescription. AIM: The aim of this study was to evaluate the factors that contribute to the diagnosis, and those that affect the decision of a family care physician or otolaryngologist to prescribe an antibiotic to a patient suffering from an upper respiratory tract infection. PATIENTS AND METHODS: In this prospective study, data were collected on 75 patients with acute middle ear infection, 49 with acute tonsillitis, 57 with acute sore throat, and 39 with a streptococcal sore throat and tonsillitis, in 6 family physician offices and otolaryngological practices in Zagreb University Hospital and Osijek University Hospital, Osijek. The questionnaire included general patient data, data on the current disease (patient history and the relevant clinical status), diagnostic and therapeutic procedures and patient follow-up. Doctors noted patients' symptoms and rated (from one to five) the influence of a particular symptom to arriving at the diagnosis, and to deciding to prescribe antibiotics. The physicians also noted any additional factors that influenced antibiotic prescription. The data were analysed using appropriate statistical measures, such as chi2-test, chi2-test using the hypothesis of rectangular distribution and t-test for independent samples. RESULTS AND CONCLUSION: The results show that diagnostic criteria for these diseases and decisions for prescribing antibiotics are based on clinical criteria and in concordance with current guidelines. Otolaryngologists recommended microbiological analyses for 54% of patients, while GPs did so for only 4.2% of the patients. While the clinical status is the most important factor for antibiotic prescription, the results of this study indicate that other additional factors such as familiarity with the patient, likelihood of complications, and knowing the patient's living circumstances and his/her ability to use health care facilities should be considered in the complex process of antibiotic prescribing.

[Balint group--aid to general practitioner]. / Balintova grupa--pomoc u radu lijecnika obiteljske medicine.

Professional education of general practitioner is mainly focused on biomedical aspects of treating somatic diseases, while psychological components of somatic diseases, as well as doctor-patient relationship, are generally neglected. General practitioner is in healing process daily exposed to considerable frustrations in relationships with patients. Some frustrations stem from unrecognized and neglected psychological and emotional aspects of somatic diseases which manifest in the doctor-patient relationship. The aim of this work is to show that Balint group can enhance general practitioner's professional capability, as well as his professional satisfaction, teaching him how to recognize psychological needs and problems which are integral part of somatic diseases and doctor-patient relationship as well.