Assessing psychosocial factors in depressed patients--accordance of patient's and physician's assessment.

Aim of this study was to investigate the differences in the assessment of psychosocial factors by depressed and non depressed patients, and their congruence with physicians' assessment for both groups. The cross-sectional study was conducted in three family physicians' practices in Zagreb, Croatia, during 2007. Sample of depressed patients included 76 patients out of 85, and randomized comparison group of 189 out of 235. Questionnaire recommended by the European Guidelines on Cardiovascular Disease Prevention in Clinical Practice was used for the assessment of psychosocial factors. Depressed patients significantly more frequently reported about social isolation (p(alone) = 0.013; p(close confident) = 0.005; p(help) = 0.001), family stress (p < 0.001), work stress (p(appropriate reward) = 0.029) and lower life satisfaction (p < 0.001) than non depressed. Their worse psychosocial functioning was noticed by family physicians who assessed social isolation (p(alone) = 0.013; p(close confident) = 0.032), family stress (p < 0.001) and life satisfaction (p < 0.001) significantly lower for depressed patients than for the random sample. Incongruence between family physicians and depressed patients assessment was valued by physicians to be of higher economic status (p < 0.001), and more intense family stress (p < 0.001). Assessment of psychosocial factors varied within the group of depressed patients and the random sample assessed either by themselves or by physicians. Congruence between family physicians and non depressed patients in the assessment of observed psychosocial factors was better than between physicians and depressed patients.

Comparison of depression treatment among different age groups in primary care setting.

BACKGROUND: The aim of this study was to explore the association between age and care of patients with depression in primary care setting. A comparison was made among the groups of elderly patients, middle aged patients and younger patients with diagnosis of depressive episode (F32). SUBJECTS AND METHODS: Patients (17.290) from ten GP offices in the city of Zagreb formed the representative sample for this study according to the estimated depression prevalence in Europe of 5%. A group of 231 (60%) patients with diagnosis Depressive episode (F32), out of 383 patients with Depression diagnosis according to ICD-10, were reviewed and extracted from GPs' standardized medical files. They were divided in three age groups: <45 years (n=58), 45-65 years (n=97) and >65 years (n=76). Data were tracked longitudinally and obtained retrospectively for one-year period from 1st January to 31th December 2009. Pharmacotherapy was classified according to the Anatomical Therapeutic Chemical (ATC) classification index. RESULTS: The youngest and the oldest age group mainly used only one drug in their therapy (47% vs 64%), but middle age group almost equally used one or two drugs (42 vs 45%). About 50% of all patients used SSRIs. Benzodiazepines were used most frequently in middle and in the oldest age group (71% vs 60%). The most frequent combinations of antidepressants in the youngest age group were SSRIs and combination of SSRIs and benzodiazepines; in middle age group it was combination of SSRIs and benzodiazepines and benzodiazepines; and in the oldest benzodiazepines, and SSRIs. Benzodiazepines were used mainly discontinuously in oppose to significant continuous usage in middle age group (P 0.043). In the oldest age groupe, depression diagnose was mostly given by GP and the most frequent therapy was combination of pharmacotherapy and GP's support. Unaided clinical assessment of depression outcome by GP did not differ significantly between age groups although some differences existed. CONCLUSION: Number and sort of antidepressants as well as sort of physician: GP or psychiatrist differed between age groups of depressed patients. Further investigation of specifical depression treatment compared with outcome measures should give answer whether those differences are justified.

[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.

[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.