Person-Centred Diabetes Care: Examining Patient Empowerment and Diabetes-Specific Quality of Life in Slovenian Adults with Type 2 Diabetes.

Patient empowerment is crucial for promoting and strengthening health. We aimed to assess patient empowerment and diabetes-specific health-related quality of life (HRQoL) in adults with type 2 diabetes (T2D). A multi-centre, cross-sectional survey was conducted among adults with T2D in urban and rural primary care settings in Slovenia between April and September 2023. The survey utilised convenience sampling and included sociodemographic and clinical data, the Diabetes Empowerment Scale (DES), and the Audit of Diabetes-Dependent QoL (ADDQoL). The study included 289 people with T2D and a mean age of 67.2 years (SD 9.2). The mean overall DES score was 3.9/5 (SD 0.4). In a multivariable linear regression model, higher empowerment was significantly associated with residing in a rural region (p = 0.034), higher education (p = 0.028), and a lack of comorbid AH (p = 0.016). The median overall ADDQoL score was -1.2 (IQR [-2.5, -0.6]). The greatest negative influence of diabetes on HRQoL was observed in the domain 'Freedom to eat', followed by 'Freedom to drink', 'Leisure activities', and 'Holidays'. Despite high empowerment among adults with T2D, the condition still imposes a personal burden. Integrated primary care models should prioritise the importance of implementing targeted interventions to enhance diabetes empowerment, address comorbidities, and improve specific aspects of QoL among individuals with T2D.

Towards Integrated Care for the Elderly: Exploring the Acceptability of Telemonitoring for Hypertension and Type 2 Diabetes Management.

Introduction: Telemonitoring has been proposed as an effective method to support integrated care for older people with hypertension and type 2 diabetes. This paper examines acceptability of telemontioring, its role in supporting integrated care, and identifies scale-up barriers. Methods: A concurrent triangulation mixed-methods study, including in-depth interviews (n = 29) and quantitative acceptability tool (n = 55) was conducted among individuals who underwent a 12-month telemonitoring routine. The research was guided by the Theoretical Framework of Acceptability. Interviews were analysed using template content analysis (TCA). Results: TCA identified seven domains of acceptability, with twenty-one subthemes influencing it positively or negatively. In the quantitative survey, acceptability was high across all seven domains with an overall score of 4.4 out of 5. Urban regions showed higher acceptability than rural regions (4.5 vs. 4.3), with rural participants perceiving initial training and participation effort as significantly more burdensome than their urban counterparts. Discussion: Patients described several instances where telemonitoring supported self-management, education, treatment, and identification elements of the integrated care package. However, there were barriers that may limit its further scale-up. Conclusion: For further scale-up, it is important to screen patients for monitoring eligibility, adapt telemonitoring devices to elderly needs, combine telemonitoring with health education, involve family members, and establish follow-up programmes.

Well-being of family physicians during COVID-19 pandemic in Slovenia.

BACKGROUND: During the COVID-19 pandemic, family physicians (FPs) served as the the initial point of contact for patients potentially infected with the virus, necessitating frequent updates to treatment protocols. However, practices also faced organizational challenges in providing care to other patients who also needed their medical attention. The pressure on FPs increased and affected their well-being. The international PRICOV-19 study, titled "Primary care in times of COVID-19 pandemic," investigated how FPs functioned during the COVID-19 pandemic. This article examines the correlation between various organizational and structural COVID-19-related variables and the well-being of FPs in Slovenia. METHODS: Between October 2020 and January 2021, we conducted an online cross-sectional survey. The questionnaire was distributed to 1040 Slovenian FPs and 218 family medicine (FM) trainees. Part of the questionnaire assessed the cooperation and well-being of FPs. The Mayo Clinic Well-being Index was used for the assessment. FP's well-being was also assessed descriptively by asking open-ended questions about maintaining mental health during the pandemic. Potential factors associated with FPs' well-being were identified using a multivariate linear regression method. RESULTS: The final sample comprised 191 participants (response rate 14.1%). The mean value ± standard deviation of the Mayo Well-being Index was 3.3 ± 2.6 points. The FPs with the poorest well-being had 5-15 years of work experience and worked in a practice where work could not be distributed in the absence of a co-worker without compromising the well-being of colleagues. Physical activity was identified as the most common method of maintaining mental health among FPs. CONCLUSIONS: The results of the study suggest that targeted interventions are needed to support FPs mid-career, increase resilience in practice, promote strong team dynamics, and prioritise physical activity in healthcare. Addressing these aspects can contribute to the well-being of individual FPs and the overall health of the healthcare workers.

Moving forward after the COVID-19 pandemic: Lessons learned in primary care from the multi-country PRICOV-19 study.

BACKGROUND: The COVID-19 pandemic has accentuated the indispensable role of primary care. Objectives: Recognising this, the PRICOV-19 study investigated how 5,489 GP practices across 38 countries (Austria, Belgium, Bosnia and Herzegovina, Bulgaria, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Israel, Italy, Kosovo*, Latvia, Lithuania, Luxembourg, Malta, Republic of Moldova, Netherlands, North Macedonia, Norway, Poland, Portugal, Romania, Serbia, Slovenia, Spain, Sweden, Switzerland, Turkey, Ukraine, and United Kingdom) adapted their care delivery during the pandemic. METHODS: Based on a series of discussions on the results of the PRICOV-19 study group, eight recommendations to enhance primary care's preparedness for future crises were formulated and endorsed by EQuiP and WONCA Europe. RESULTS: The recommendations underscore the importance of recognising and sustaining the substantial strides made in patient safety within GP practices during the pandemic in current daily practices; acknowledging and supporting the pivotal role of GP practices in addressing health inequalities during crises; adopting interprofessional care models to enhance practices' resilience and adaptability to change; supporting training practices; creating healthy working environments; investing in infrastructure that supports adequate and safe care; and increasing funding for research on patient safety and primary care quality to inform evidence-based health policies and fostering international knowledge exchange among healthcare professionals and policymakers. CONCLUSION: Policymakers, primary care associations, and the broader healthcare system are urged to collaboratively take responsibility and increase support for GP practices to enhance their resilience, adaptability, and capacity to deliver safe and equitable healthcare during future crises.

Governments should recognise the critical role of family medicine in addressing inequity and prioritise carers' wellbeing to maintain quality care during crises.Associations for practitioners should lead in crisis management developments and advocate for primary care.PC facilities should participate in health system design to answer challenges posed by crises.

Assessing the reliability and validity of the Slovenian version of the Appraisal of Diabetes Scale (ADS-S) in type 2 diabetes patients.

Managing type 2 diabetes (T2D) effectively is a considerable challenge. The Appraisal of Diabetes Scale (ADS) has proven valuable in understanding how individuals perceive and cope with their condition. This study aimed to evaluate the psychometric properties of the Slovenian version of ADS (ADS-S). We recruited a sample of 400 adult individuals with T2D from three primary healthcare centers in Slovenia, ensuring an average of 57 cases per individual item. The psychometric evaluation included internal consistency, test-retest reliability, construct validity, and discriminant validity. Confirmatory factor analysis (CFA) was additionally performed to evaluate the fit of one- and two-factor models. After excluding incomplete questionnaires, 389 individuals participated, averaging 72.0±7.5 years, with 196 men and 193 women. ADS-S exhibited acceptable internal consistency (Cronbach's α = 0.70) and strong test-retest reliability (interclass correlation = 0.88, p <0.001). Criterion validity was established through significant correlations between ADS-S score and EQ-5D utility score (r = -0.34, p <0.001), EQ-VAS score (r = -0.38, p <0.001), and HbA1c >7.5% (r = 0.22, p = 0.019). Discriminant validity assessment found no significant correlation between ADS-S score and age, but a significant correlation with female gender (r = 0.17, p = 0.001). CFA results supported a two-factor structure (psychological impact of diabetes and sense of self-control) over a one-factor structure, as indicated by model fit indicators. ADS-S stands as a valid and reliable tool for assessing psychological impact and self-control in Slovenian T2D patients. Future research should explore adding items for capturing secondary appraisal of diabetes and studying the influence of female gender on ADS scores.

Beyond diagnosis: Investigating factors influencing health-related quality of life in older people with type 2 diabetes in Slovenia.

AIMS: To examine the present state of health-related quality of life (HRQOL) among elderly individuals with type 2 diabetes (T2D) receiving integrated care and identify risk factors associated with low HRQOL. METHODS: A multi-centre cross-sectional survey among elderly individuals with T2D, treated in Slovenian urban and rural primary care settings was performed. HRQOL was investigated using EuroQol 5-dimension (EQ-5D) questionnaire and Appraisal of Diabetes Scale (ADS). Furthermore, socio-demographic, clinical, and laboratory data were collected. Low HRQOL was defined as EQ-5D utility score <10%. Statistical analysis was performed using univariate and multivariate binary logistic regression statistics. RESULTS: Examining 358 people with median age of 72 (range 65-98) years and with a mean EQ-5D utility score of 0.80, the study found that lower HRQOL correlated with older age, higher body mass index (BMI), lower education, elevated depressive symptoms, increased challenges across all EQ-5D dimensions, and less favourable appraisal of diabetes. When considering age, gender, education, and HbA1c, the main predictors of low HRQOL were BMI (OR 1.35, 95% CI 1.04-1.76, p = 0.025) and ADS score (OR 1.63, 95% CI 1.13-2.35, p = 0.009). CONCLUSIONS: To improve HRQOL, integrated care models should consider interventions that target mental health, obesity prevention, chronic pain management, diabetes education, self-management, and treatment plan personalisation.

Developing a competency framework for training with simulations in healthcare: a qualitative study.

BACKGROUND: Simulation is a technique used to create an experience without going through the real event. Competency-based medical education focuses on outcomes and ensures professionals have the necessary knowledge, skills, and attitudes. The purpose of this study was to develop a set of competencies for the instructors providing basic and advanced levels of simulation-based training in healthcare. METHODS: We conducted a qualitative study in three steps, with each next step building on and influenced by the previous one. First, we conducted a literature review, then a consensus development panel, and finally a three-step Delphi process. The participants were experts in the fields of healthcare, education, and simulations. RESULTS: The six main competencies identified for the instructor providing simulation-based training at the basic level in healthcare include knowledge of simulation training, education/training development, education/training performance, human factors, ethics in simulation, and assessment. An instructor providing simulation-based training at an advanced level in healthcare should also possess the following five competencies: policies and procedures, organisation and coordination, research, quality improvement, and crisis management. CONCLUSION: The identified competencies can serve as a valuable resource for simulation educators and organisations involved in simulation education, to plan curriculum and implement a continuous train-the-trainers programme.

Facilitators and Barriers to Scaling-Up Integrated Care for Arterial Hypertension and Type 2 Diabetes in Slovenia: Qualitative Study.

Introduction: Arterial hypertension and type 2 diabetes are significant contributors to global non-communicable disease-related mortality. Integrated care, centred on person-centred principles, aims to enhance healthcare quality and access, especially for vulnerable populations. This study investigates integrated care for these diseases in Slovenia, providing a comprehensive analysis of facilitators and barriers influencing scalability. Methods: Qualitative methods, including focus group discussions and semi-structured interviews, were employed in line with the grounded theory approach. Participants represented various levels (micro, meso and macro), ensuring diverse perspectives. Data were collected from May 2019 to April 2020, until reaching saturation. Transcripts were analysed thematically using NVivo software. Results: Nine categories emerged: Governance, Health financing, Organisation of healthcare, Health workforce, Patients, Community links, Collaboration/Communication, Pharmaceuticals, and Health information systems. Some of identified barriers were political inertia and underutilisation of research findings in practice; outdated health financing system; accessibility challenges, especially for vulnerable populations; healthcare workforce knowledge and burnout; patients' complex role in accepting and managing their conditions; collaboration within healthcare teams; and fragmentation of health information systems. Peer support and telemedicine were the only two potential solutions identified. Conclusions: This study offers a comprehensive evaluation of integrated care for hypertension and type 2 diabetes in Slovenia, featuring insights into facilitators and barriers. These findings have implications for policy and practice. Monitoring integrated care progress, refining strategies, and enhancing care quality for patients with these two diseases should be priorities in Slovenia.

Patient Reported Indicator Surveys (Paris): Methodological Considerations of a Field Trial in Slovenia.

Introduction: Healthcare systems collect little information about the experiences and outcomes of care from the perspectives of patients. Patient Reported Indicator Surveys (PaRIS) is an OECD initiative to measure the outcomes and experiences of people living with chronic conditions, who are managed in primary care. Objectives: To evaluate the feasibility of the methodology employed in the Field Trial of the PaRIS survey in Slovenia and propose adjustments to enhance sampling in the Main Survey. Methods: In 2022, we conducted a cross-sectional observational study in 50 family medicine practices in Slovenia with a target of recruiting 70 patients per practice. We used the Slovenian version of the PaRIS questionnaires, and evaluated sampling and data collection. Results: The sample contained 21 providers (42.0% response rate) and 454 patients (50.7% response rate). The provider sample did not differ from the population characteristics, while the patient sample differed significantly from the patient population. All providers completed the survey online, in 20.9±11.1 minutes and had 1.5±1.5 restarts. Most patients (74.9%) completed the survey online and needed 36.0±22.6 minutes, and the mean number of restarts was 1.4±2.2. Conclusion: Based on the results, we recommend conducting a methodology test for quality assessment studies before initiating the main survey. Legal issues should be addressed and considered early when developing the methodology. It is also necessary to be aware of the feasibility of the study in practice, to avoid a low participation rate.

Symptoms of Anxiety and Depression Among Slovenian Breast Cancer Survivors Post-Treatment During the COVID-19 Pandemic: A Cross-Sectional Study.

Background: Although anxiety and depression are important determinants of mental health, the literature in this area is sparse as most studies focus on the period during treatment. Mental health problems can affect cancer recovery as well as quality of life and survival. In this cross-sectional study, we investigated the prevalence of anxiety and depression in Slovenian cancer survivors after treatment and assessed the associated correlates during the COVID-19 pandemic. Methods: From September 2021 to January 2022, we collected data from 430 breast cancer survivors one to five years after receiving post-local treatment and (neo)adjuvant chemotherapy. We used the Hospital Anxiety and Depression Scale (HADS) to measure anxiety and depression levels. Multivariate linear regression was used to identify factors associated with higher levels of anxiety and depression. Results: Key findings from this study are increased levels of psychological distress and identification of relevant factors associated with those elevated levels. Approximately one-third of breast cancer survivors exhibited symptoms of elevated anxiety and depression, with one in eight meeting clinical thresholds. Multivariate linear regression revealed that age, lower quality of life, heightened fear of cancer recurrence (FCR), reduced resilience, limited social support, and unmet psychosocial and emotional needs correlated with increased anxiety symptoms. Additionally, lower quality of life, higher FCR, diminished resilience, and limited social support were associated with higher depression symptomatology. Conclusions: Our study of Slovenian breast cancer survivors one to five years post-treatment observed a significant increase in anxiety and depression symptoms, possibly exacerbated by the COVID-19 pandemic. The demographic and psychosocial factors identified in this study offer valuable insights for future research. The study emphasises the importance of recognising and addressing the psychological needs of breast cancer survivors and the need to follow them throughout their cancer journey.

Perception Of Patient Safety Culture At The Primary Care Level: The Case Of The Community Health Centre Ljubljana.

Background: Patient safety is a crucial element of quality healthcare, and endeavours to enhance it are vital for attaining universal health coverage and improving patient outcomes. This study aimed to evaluate the perception of patient safety culture among staff at the Community Health Centre Ljubljana (CHCL). Methods: A cross-sectional study was conducted in December 2022. All CHCL staff (N=1,564) from different professional groups were invited to participate in an anonymous electronic survey using the validated Slovenian version of the "Medical Office Survey on Patient Safety Culture" (MOSPSC). Mean percent positive scores for all items in each composite were calculated. Results: The final sample included 377 participants (response rate, 24.1%), most of whom were women (91.5%, N=345) with different professional profiles. The mean age of the participants was 44.5 years (SD 11.1) with a mean work experience of 20.1 years (SD 12.1). The percentage of positive overall MOSPSC composite scores was 59.6%. A strong patient safety culture perception was identified in the following dimensions: Information exchange with other settings (93.5%), Organisational learning (90.2%), List of patient safety and quality issues (88.1%), Patient care tracking/follow-up (76.2 %) and Teamwork (75.0%). Weak patient safety culture was identified in the dimensions of Work pressure and pace (10.7%), Leadership support for patient safety (27.1%), Communication openness (40.9%), Office processes and standardisation (48.2%) and Overall ratings on quality and patient safety (49.4%). Conclusions: CHCL leadership should address weaknesses, redesign processes, and implement strategies to reduce patient safety incidents. Establishing a just culture that encourages employees to report errors fosters transparency and facilitates learning from errors.

Bottom-Up Analysis of Telemonitoring Costs: A Case Study in Slovenian Primary Care.

Introduction: Telemonitoring improves clinical outcomes in patients with arterial hypertension (AH) and type 2 diabetes (T2D), however, cost structure analyses are lacking. This study seeks to explore the cost structure of telemonitoring for the elderly with AH and T2D in primary care and identify factors influencing costs for potential future expansions. Methods: Infrastructure, operational, patient participation, and out-of-pocket costs were determined using a bottom-up approach. Infrastructure costs were determined by dividing equipment and telemonitoring platform expenses by the number of participants. Operational and patient participation costs were determined by considering patient training time, data measurement/review time, and teleconsultation time. The change in out-of-pocket costs was assessed in both groups using a structured questionnaire and 12-month expenditure data. Statistical analysis employed an unpaired sample t-test, Mann-Whitney U test, and chi-square test. Results: A total of 117 patients aged 71.4±4.7 years were included in the study. The telemonitoring intervention incurred an annual infrastructure costs of €489.4 and operational costs of €97.3 (95% CI 85.7-109.0) per patient. Patient annual participation costs were €215.6 (95% CI 190.9-241.1). Average annual out-of-pocket costs for both groups were €345 (95% CI 221-469). After 12 months the telemonitoring group reported significantly lower out-of-pocket costs (€132 vs. €545, p<0.001), driven by reduced spending on food, dietary supplements, medical equipment, and specialist check-ups compared to the standard care group. Conclusion: To optimise the cost structure of telemonitoring, strategies like shortening the telemonitoring period, developing a national telemonitoring platform, using patient devices, integrating artificial intelligence into platforms, and involving nurse practitioners as telemedicine centre coordinators should be explored.

Interprofessional Education with Simulations in Primary Care.

The introduction of interprofessional primary care (IPC) as a model of collaborative patient care is increasingly vital in the context of complex healthcare systems and the growing needs of patients. Its benefits include improved patient outcomes, enhanced efficiency, and reduced costs. However, the successful implementation of IPC faces challenges due to the differences in training and backgrounds among healthcare professionals, emphasising the importance of effective teamwork and collaborative education. Educational approaches utilising simulations have gained prominence, particularly in addressing the challenges of interprofessional primary care. Notably, simulations facilitate team learning, enhancing team management and confidence, which ultimately leads to improved performance in real-life scenarios. They also contribute to patient safety by providing comprehensive training and creating a safe environment for professionals to practice and refine their skills without risking real patient harm. Moreover, simulations promote psychological safety, allowing healthcare workers to manage stress effectively and prepare for critical situations. Ethical considerations are met through simulation-based education, ensuring patient confidentiality, and creating a standardised and just learning environment for all students. Simulations contribute to promoting equity in medical education by providing equal access to high-quality training opportunities for all healthcare professionals. In conclusion, successful IPC implementation requires a comprehensive approach that includes interprofessional education and the integration of simulations as an essential component of the curriculum at all levels of healthcare education. This approach fosters effective communication, teamwork, and confidence among primary care teams, ultimately leading to improved patient care and outcomes.

The safety of patient management in family medicine in Slovenia during Covid-19: a cross-sectional study.

BACKGROUND: During the Covid-19 pandemic, family medicine practices (FMPs) changed to improve safety against new coronavirus infections for both patients and employees. Protocols for treating patients with suspected Sars-Cov-2 infections were established to protect medical staff and other patients from being infected. However, these protocols also led to increased safety risks, such as delays in treating patients with other medical conditions. This exploratory study aimed to investigate safety risks in treating patients in FMPs during the Covid-19 pandemic and to suggest improvements to prevent Covid-19 in FMPs in Slovenia. METHODS: A cross-sectional study was rolled out in FMPs in Slovenia as part of the international Pricov-19 study. Data collection on safety management during the Covid-19 pandemic in FMPs in Slovenia took place from November 2020 until January 2021 using a self-administered online survey for FP working in Slovenia. A chi-square test, ANOVA, independent samples t-test or bivariate correlation test was performed to explore associations regarding the safety of patients' management variables. RESULTS: From the 191 participating family physicians (FPs) (15.2% response rate), 54.8% reported having treated patients with fever (not Covid-19) late due to the new protocols at least once, and 54.8% reported patients with urgent conditions having been seen late at least once due to not coming. In the suburbs and rural environments FPs more often reported that at least once patient with a fever (not Covid-19) was seen late due to the protocol (p = 0.017) and more often reported that at least once patient with an urgent condition was seen late due to not coming to their FP (p = 0.017). The larger the practice, the more they reported that at least once a patient with fever (not Covid-19) was seen late due to the protocol (p = 0.012) and the more they reported at least once a patient with an urgent condition was seen late due to not coming to their FP (p = 0.012). CONCLUSION: Covid-19 affected the safety of patient management in FMP in Slovenia. The most common problem was foregone care. Therefor, protocols for chronic patient management in the event of epidemics need to be established.

The Impact of Psychological Interventions with Elements of Mindfulness on Burnout and Well-Being in Healthcare Professionals: A Systematic Review.

Background: Healthcare professionals are highly likely to experience various causes of work-related stress, which often leads to burnout. This became even more obvious during the Covid-19 pandemic. This systematic review aimed to analyze articles where psychological interventions with elements of mindfulness (PIM) were used to support healthcare professionals to foster well-being and reduce burnout levels. Compared to other recently published reviews, it is unique, due to its focus on a wide group of healthcare professionals, a broader selection of psychological interventions, and the evaluation of any sustained effects. Methods: Systematic searches were carried out in February 2021 with different combinations of Boolean operators within six electronic databases: PubMed, EBSCOhost, MEDLINE, PsycArticles, Cochrane Library, JSTOR and Cobiss. We included articles that had been published in the last ten years (2011 to 2021) and which reported on original research focused on evaluating the influence of PIM on healthcare professionals. MERSQI was used to assess the quality of the included studies. Results: Of 1315 identified studies, 15 were included in this systematic review. Regardless of the specific type, duration and setting (individual vs group) of PIM applied, the results demonstrated a positive impact on well-being and burnout in participating healthcare professionals. The most studied interventions involved MBSR (mindfulness-based stress reduction) and other mindfulness training programmes, in online as well as in-person versions. Conclusion: Given the new reality with the presence of the SARS-Cov-2 virus, it is of the utmost importance to offer feasible, effective interventions for burnout reduction to vulnerable groups of healthcare professionals. By focusing on their needs, several key aspects of burnout and mindfulness could be efficiently improved; this review demonstrates that short, online interventions could be as effective as longer, in-person ones.

Cytisine Versus Varenicline for Smoking Cessation in a Primary Care Setting: A Randomized Non-inferiority Trial.

INTRODUCTION: A smoking-cessation program was implemented as a randomized non-inferiority trial in primary care practices in Croatia and Slovenia to investigate whether a standard 4-week treatment with cytisine was at least as effective and feasible as a standard 12-week treatment with varenicline in helping smokers quit. AIMS AND METHODS: Out of 982 surveyed smokers, 377 were recruited to the non-inferiority trial: 186 were randomly assigned to cytisine and 191 to varenicline treatment. The primary cessation outcome was 7-day abstinence after 24 weeks, while the primary feasibility outcome was defined by adherence to the treatment plan. We also compared the rates of adverse events between the two treatment groups. RESULTS: The cessation rate after 24 weeks was 32.46% (62/191) in the varenicline group and 23.12% (43/186) in the cytisine group (odds ratio [OR]: 95%, credible interval [CI]: 0.39 to 0.98). Of 191 participants assigned to varenicline treatment 59.16% (113) were adherent, while 70.43% (131 of 186) were adherent in the cytisine group (OR: 1.65, 95% CI: 1.07 to 2.56). Participants assigned to cytisine experienced fewer total (incidence rate ratio [IRR]: 0.59, 95% CI: 0.43 to 0.81) and fewer severe or more extreme adverse events (IRR: 0.72, 95% CI: 0.35 to 1.47). CONCLUSIONS: This randomized non-inferiority trial (n = 377) found the standard 4-week cytisine treatment to be less effective than the standard 12-week varenicline treatment for smoking cessation. However, adherence to the treatment plan, ie, feasibility, was higher, and the rate of adverse events was lower among participants assigned to cytisine treatment. IMPLICATIONS: The present study found the standard 12 weeks of varenicline treatment to be more effective than the standard 4 weeks of cytisine treatment for smoking cessation in a primary care setting in Croatia and Slovenia. Participants assigned to cytisine, however, had a higher adherence to the treatment plan and a lower rate of adverse events. Estimates from the present study may be especially suitable for generalizations to high-smoking prevalence populations in Europe. Given the much lower cost of cytisine treatment, its lower rate of adverse events, and higher feasibility (but its likely lower effectiveness with the standard dosage regimen), future analyses should assess the cost-effectiveness of the two treatments for health policy considerations.

Fall Risk in Adult Family Practice Non-Attenders: A Cross-Sectional Study from Slovenia.

Introduction: Not much is known about the fall risk among the adult population of those who rarely visit doctors. We wanted to determine the prevalence of increased fall risk in a population of family practice non-attenders and the factors associated with it. Methods: We included participants from family medicine practices in this cross-sectional study. To be included in the study, the participants had to be adults living in the community (home-dwelling people) who had not visited their chosen family physician in the last five years (non-attenders). The identification of the eligible persons was done through a search of electronic medical records, which yield 2,025 non-attenders. Community nurses collected data in the participants' homes. The outcome measure was increased fall risk as assessed by the Morse fall scale: increased risk (≥25) vs. no risk. Results: The sample consisted of 1,945 patients (96.0% response rate) with a mean age of 60.4 years (range 20.5 to 99.7 years). An increased fall risk was determined in 482 or 24.8% (95% CI: [22.9, 26.8]) of the patients. The multivariate model showed a significant association of increased fall risk with higher age (p<0.001), lower systolic blood pressure (p=0.047), poor family function (p=0.016), increased risk of malnutrition (p=0.013), higher number of chronic diseases (p=0.027), higher pain intensity (p<0.001), lower self-assessment of current health (p=0.002), and higher dependence in daily activities (p<0.001). Conclusion: Non-attenders may have an increased risk of falling which depends on their health status and age. The inclusion of community nurses in primary healthcare teams could be of use not only to identify the non-attenders' health needs, but also to better manage their health, especially the factors that were identified to be associated with greater fall risk.

Peer Support as Part of Scaling-Up Integrated Care in Patients with Type 2 Diabetes and Arterial Hypertension at the Primary Healthcare Level: A Study Protocol.

Introduction: Type 2 diabetes (T2D) and arterial hypertension (AH) are among the greatest challenges facing health systems worldwide and require comprehensive patient-centred care. The key to successful management in chronic patients is self-management support, which was found to be only weakly implemented in Slovenia. The aim of the study is to develop an evidence-based model of peer support for people with T2D and AH at the primary healthcare level in Slovenia, which could represent a potential solution for upgrading integrated care for these patients. Methods: A prospective interventional, mixed-methods pilot study will begin by recruiting approximately 40 eligible people with T2D and AH through purposive sampling. The participants will receive structured training, led by a specialist nurse, to become trained peer supporters. Each will voluntarily share their knowledge and experience at monthly group meetings with up to 10 people with T2D and AH over a three-month period in the local community. Data will be collected through interviews and focus groups and questionnaires about socio-demographic and clinical data, knowledge about T2D and AH, participants' quality of life, level of empowerment and acceptability of the intervention. Expected results: The study will provide an evidence-based model for integrating peer support into the local community. It is expected that the intervention will prove feasible and acceptable with educational, psychosocial and behavioural benefits. Conclusion: Peer support through empowerment of people with T2D and AH, family members and other informal caregivers in the local community could scale-up the integrated care continuum and contribute to sustainability of the healthcare system.

New Challenges in Scientific Publications: Referencing, Artificial Intelligence and ChatGPT.

The COVID-19 pandemic has led to a surge in scientific publications, some of which have bypassed the usual peer-review processes, leading to an increase in unsupported claims being referenced. Therefore, the need for references in scientific articles is increasingly being questioned. The practice of relying solely on quantitative measures, such as impact factor, is also considered inadequate by many experts. This can lead to researchers choosing research ideas that are likely to generate favourable metrics instead of interesting and important topics. Evaluating the quality and scientific value of articles requires a rethinking of current approaches, with a move away from purely quantitative methods. Artificial intelligence (AI)-based tools are making scientific writing easier and less time-consuming, which is likely to further increase the number of scientific publications, potentially leading to higher quality articles. AI tools for searching, analysing, synthesizing, evaluating and writing scientific literature are increasingly being developed. These tools deeply analyse the content of articles, consider their scientific impact, and prioritize the retrieved literature based on this information, presenting it in simple visual graphs. They also help authors to quickly and easily analyse and synthesize knowledge from the literature, prepare summaries of key information, aid in organizing references, and improve manuscript language. The language model ChatGPT has already greatly changed the way people communicate with computers, bringing it closer to human communication. However, while AI tools are helpful, they must be used carefully and ethically. In summary, AI has already changed the way we write articles, and its use in scientific publishing will continue to enhance and streamline the process.

Perceptions of the primary health care team about the implementation of integrated care of patients with type 2 diabetes and hypertension in Slovenia: qualitative study.

BACKGROUND: Integrated care involves good coordination, networking, and communication within health care services and externally between providers and patients or informal caregivers. It affects the quality of services, is more cost-effective, and contributes to greater satisfaction among individuals and providers of integrated care. In our study, we examined the implementation and understanding of integrated care from the perspective of providers - the health care team - and gained insights into the current situation. METHODS: Eight focus groups were conducted with health care teams, involving a total of 48 health care professionals, including family physicians, registered nurses, practice nurses, community nurses, and registered nurses working in a health education center. Prior to conducting the focus groups, a thematic guide was developed based on the literature and contextual knowledge with the main themes of the integrated care package. The analysis was conducted using the NVivo program. RESULTS: We identified 12 main themes with 49 subthemes. Health care professionals highlighted good accessibility and the method of diagnostic screening integrated with preventive examinations as positive aspects of the current system of integrated care in Slovenia. They mentioned the good cooperation within the team, with the involvement of registered nurses and community nurses being a particular advantage. Complaints were made about the high workload and the lack of workforce. They feel that patients do not take the disease seriously enough and that patients as teachers could be useful. CONCLUSION: Primary care teams described the importance of implementing integrated care for diabetes and hypertension patients at four levels: Patient, community, care providers, and state. Primary care teams also recognized the importance of including more professionals from different health care settings on their team.