Needs and Experiences With Health Care Providers of Adult Rare Disease Patients and Caregivers of People With Rare Diseases: Protocol for a Qualitative Study.

BACKGROUND: Rare diseases in Europe are defined as diseases with a prevalence of less than 5 per 10,000 people. Despite their individual rarity, the total number of rare diseases is considerable. Rare diseases are often chronic and complex, affecting physical, mental, and neurological health. People with rare diseases face challenges such as delayed diagnosis, limited medical support, and financial burden. Caregivers, usually family members, bear significant physical and emotional burdens. Understanding the experiences of patients with rare disease and their caregivers is critical to effective care, but this is still underresearched. Better support and understanding of the challenges faced by both patients and caregivers is clearly needed. Our study will explore the experiences and needs of people with rare diseases and caregivers of people with rare diseases in relation to accessing health services. OBJECTIVE: This study aims to explore the experiences of patients with rare disease and their caregivers with Slovenian health care providers and to create a theoretical model of needs and experiences. METHODS: This is a qualitative thematic analysis study, using the codebook approach. The study will conduct semi-open-ended interviews to understand the experiences and needs of people with rare diseases and caregivers of people with rare diseases in relation to accessing health services. The interview questions will be based on an extensive literature review. Data from the interviews will be analyzed using thematic analysis to identify patterns and build a thematic map. Data will be analyzed by at least 2 coders. To ensure reliability, respondent validation will be conducted and negative cases investigated. Any discrepancies will be resolved by consulting the entire research team until a consensus is reached. RESULTS: This study was not specifically funded. However, author TC is supported by grant number P3-0339 from the Slovenian Agency for Research and Innovation. This study was approved by the Medical Ethics Committee of the Republic of Slovenia (0120-47/2022/3), and recruitment is expected to begin in May 2024, with data analysis results anticipated by the end of 2025. CONCLUSIONS: This study will fill an important research gap in Slovenia by exploring the needs and experiences of people living with rare diseases and their caregivers. The results will contribute to the broader field of rare diseases and add knowledge that can inform future research processes and intervention strategies. It also aims to identify neglected areas that have a significant impact on the lives of people with rare diseases. This study is important not only because it addresses the immediate needs of the Slovenian rare disease community, but also because it contributes to a discussion on patient-centered care, health policy design, and the inclusion of psychosocial components in health care. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/53362.

Content Validity and Cognitive Testing in the Development of a Motivational Interviewing Self-Assessment Questionnaire.

Aim: To develop and content validate a self-assessment questionnaire on motivational interviewing (MI) practice as the first stages in forming the questionnaire to be used in cross-sectional studies involving practitioners conducting the MI-based alcohol screening and brief intervention (ASBI). Methods: A comprehensive mixed methods approach included a literature review, 3 rounds of expert panel (EP) opinions (n=10), cognitive testing (CT) with 10 MI-based ASBI practitioners, and questionnaire piloting with 31 MI-based ASBI practitioners. Based on the EP opinions in the second round, content validity indices (CVIs) and the modified kappa coefficient (k*) were calculated, focusing on the relevance and understandability of questions and comprehensiveness and meaningfulness of the response options. This analysis was performed in 2020, at the conclusion of the national "Together for a Responsible Attitude Towards Alcohol Consumption" ("Skupaj za odgovoren odnos do pitja alkohola", SOPA) project's pilot implementation. Results: On a scale level, CVI values based on universal agreement for the entire questionnaire were high for 3/4 categories (S-CVI-UA>0.80), and CVI values based on average agreement were high across all categories (S-CVI-Ave>0.90). At the item level, CVI values (I-CVI) were never <0.50 (automatic item rejection), and the modified kappa value (k*) indicated poor validity for two items in the understandability category (k*=0.33). All problematic parts of the questionnaire were further tested and successfully modified based on the results of CT, and accepted in the third round of testing. Conclusions: The final version of the questionnaire demonstrated appropriate content validity for use in studies among Slovenian MI-based ASBI practitioners and is now ready for further psychometric testing.

Long COVID as a never-ending puzzle: the experience of primary care physicians. A qualitative interview study.

BACKGROUND: Long COVID provides a new context in which primary health care needs to be re-examined, especially because it has health and social dimensions. Primary care physicians' experiences and perceptions of caring for patients with long COVID are an underexplored area. AIM: To explore the experiences of Slovenian primary care physicians in management and treatment of patients with long COVID. DESIGN & SETTING: A qualitative interview study of physicians in Slovenian primary care. METHOD: Semi-structured interviews were held with physicians who had treated patients with long COVID until saturation was reached. The interviews were carried out between November 2021 and April 2022. Qualitative content analysis (QCA) was used to analyse the data collected. RESULTS: Seventeen participants were interviewed. The following five categories were defined based on the coding process: the definition and symptoms of long COVID; social exclusion; sick leave and returning to the work environment; cooperation with rehabilitation centres; and the importance of trust and good communication with the patient. CONCLUSION: The study showed the experiences of Slovenian primary care physicians in the management and treatment of long COVID. The problems related to long COVID were divided into two groups: health problems and psychosocial problems. Slovenian physicians have the greatest problems with dealing with the patient's ability to work. It was found that adequate communication and trust between physicians and patients are two important indicators for an integrated model of managing long COVID.

Prevalence of alcohol consumption among high school students: A cross-sectional study.

AIM: This study addresses the risk and protective factors for alcohol consumption among medical-technology high school students. The specific objectives of the study were to analyse standard influences on excessive alcohol consumption (influence of parents and upbringing) and possible modern influences, represented by social networks and internet use. DESIGN: A cross-sectional analysis. METHODS: The sample included the entire cohort of third-year students attending high school in Varazdin (n = 1,352). Data were collected using an anonymous questionnaire. The bivariate analysis used an independent t test and a Chi-squared test. The multivariate analysis used logistic regression. The study was conducted from September 2018 to February 2019. RESULTS: Alcohol consumption was most prevalent among vocational students, followed by college-preparatory students and medical-technology students. Style of parenting and maternal authority have a positive influence on less alcohol use among students. The results showed that smartphone ownership and internet use do not correlate with alcohol use among high school students.

The Effect of an Educational Intervention on Self-Care in Patients with Venous Leg Ulcers-A Randomized Controlled Trial.

BACKGROUND: Although patients with venous leg ulcers are involved in ulcer management, little is known about why and how these patients self-treat their ulcers without direct supervision by health professionals. Yet patients' knowledge of ulcer management can be important for achieving ulcer closure and/or preventing recurrence. This study thus investigates the effects of an educational intervention on knowledge of self-care among patients with venous leg ulcers, mainly on wound dressing practice, compression therapy, physical activity and nutrition. METHODS AND PARTICIPANTS: This research was conducted in three outpatient hospitals in central Croatia. An educational brochure was made and distributed to patients; patients were surveyed about caring for venous leg ulcers before the brochure was distributed and after 3 months. RESULTS: In total, 208 patients were involved in the study: 112 in the experimental group and 96 in the control group. The educational intervention increased awareness of compression therapy, knowledge of recurrence prevention, appropriate lifestyle habits, and warning signs related to venous leg ulcers. CONCLUSIONS: Patient education on illness and self-care is necessary to achieve positive effects in self-care knowledge. In this study, patients learned how to change dressings, learned how to improve their lifestyle, and were empowered to deal with their illness.

Medical students' perception of distance-based education during the COVID-19 pandemic in Slovenia: A qualitative study.

INTRODUCTION: The COVID-19 pandemic has had a broad direct impact on education, and at the same time it has significantly changed students' lives. This study examines how Slovenian medical students experienced the shift to distance-based education following multiple lockdowns. METHODS: The aim of this study is to examine experiences of medical students about distance-based education in the period of multiple lockdowns in 2020/2021. We used focused interviews to collect data. The questionnaire was developed in the following manner: the first set of questions was developed after studying the literature from Slovenia and abroad about distance-based education in higher education during COVID-19 lockdowns. The researchers then discussed this set to narrow the topics. In addition to preformulated questions, additional sub-questions also typical for focused interviews were asked as part of the research. We carried out a qualitative study using a qualitative content analysis method to analyze the data. RESULTS: Sixteen interviews were conducted. We defined four categories summarizing students' experiences with distance-based education during the COVID-19 pandemic: 1) technical issues, 2) organization of distance-based education, 3) social exclusion of students, and 4) suggestions for improvement. The categories are exclusive and represent individual topics for further analysis of students' experiences with DBE during the COVID-19 pandemic. The results are supported by quotes from the interviews. CONCLUSIONS: Medical students' experiences with DBE mainly revealed shortcomings in computer literacy. Technical issues were largely an indicator that significantly marked students' transition to DBE. Another important finding is that medical students emphasized problems related to social exclusion. Students made suggestions for improvements that broadly relate to the higher education system, and not only to the COVID-19 pandemic.

Forms and Frequency of Sanctions against General Practitioners and Family Medicine Specialists in Macedonia.

OBJECTIVE: The goal of this study is to evaluate the reasons for sanctioning and the types of sanctions used on general medicine primary healthcare practitioners (GM-PHPs) in the Republic of Macedonia. MATERIALS AND METHOD: This is a cross-sectional study for which we used an anonymous survey. This survey was distributed in a printed and electronic form to GM-PHPs in different parts of Macedonia and 438 of them responded. We used the SPSS statistical program to process the quantitative data. RESULTS: The GM-PHPs' sex was not associated with the sanctioning in the univariable analysis, but it was in the multivariable. GM-PHPs with ≥30 years of experience have 8.7 times higher odds to be sanctioned than those with ≤5 years of experience. GM-PHPs that worked in the hospital or ≤19 km from the nearest hospital were significantly more frequently sanctioned. The most common three reasons for sanctioning were: "Financial consumption of prescriptions and referrals above the agreed amount", "Higher rate of sick leaves and/or unjustified sick leaves" and "Unrealized preventative goals or education". "Financial sanction by scale" was the most common type of sanction - 49.8% of participants. GM-PHPs who followed the guidelines, but were exposed to violence by patients or their family/companion were sanctioned significantly more frequently. CONCLUSIONS: In our sample, we can observe that in the univariable analysis age, years of experience, family medicine speciality, the distance of the workplace from the nearest hospital and violence are associated with sanctioning. In the multivariable analysis: sex, years of experience, the distance of the workplace from the nearest hospital and violence are associated with sanctioning. The majority of sanctions were financial sanctions (84.5%).

The Frequency and Form of Controls by HIIS over Primary Health Care Physicians in Slovenia.

OBJECTIVE: The aim of this study was to evaluate the pattern of controls and sanctions by the Health Insurance Institute (HIIS) over primary healthcare practitioners (PHCPs) in Slovenia, the reasons for sanctions and the violence against PHCPs if they followed the HIIS rules. MATERIALS AND METHODS: We performed analyses using survey data from a cross-sectional study, across public health centres and individual contractors in which 1,458 PHCPs were invited to answer a questionnaire anonymously via an online system used to collect data for the Slovenian Medical Chamber and the Association of General Practice/Family Medicine of South-East Europe. Quantitative data were presented by descriptive statistics and analysed using Pearson's chisquared test. RESULTS: Responses were obtained from 462 female and 138 male PHCPs. Of the total number of 600 participants, 430 were family medicine specialists. 263 (43.8%) responded that they have been sanctioned for various reasons. PHCPs that are more likely to be sanctioned include family medicine specialists and individual contractors. PHCPs working in areas smaller than 20 000 inhabitants were sanctioned in a bigger proportion than their counterparts. Monetary penalties levied against those working at health centres were usually covered by the health centre. Family medicine specialists, more often than other PHCPs experienced violence from patients or patients' relatives if they followed HIIS rules. CONCLUSION: Family medicine specialists are sanctioned more frequently than other PHCPs, individual contractors are sanctioned more frequently than public healthcare PHCPs and PHCPs in working area with a population less than 20.000 are more frequently sanctioned than those working in an area with a bigger population count.

COVID-19 and Care for the Elderly in Long-Term Care Facilities: The Role of Information Communication Technology.

OBJECTIVE: To review the changes in communication in long-term care facilities (LTCF) during the COVID-19 pandemic. METHODS: A systematic literature review was conducted through a keyword search of the PubMed and Ovid Embase databases. In accordance with the inclusion and exclusion criteria, 11 articles were selected and analysed qualitatively. RESULTS: The use of information communication technology was heterogeneous, and it was used to bring together several different groups of users: LCTF residents' families, hospitals, specialists, and general practitioners. The modes of communication and preferred ways to reduce the social isolation of LTCF residents from their family members were described. Various smartphone applications have been designed for both socializing and the use of telemedical solutions. Opportunities for peer-to-peer social interaction between the elderly through information communication technologies have been neglected. CONCLUSION: Video calls may bring greater satisfaction to residents and their families. Telemedicine and interdisciplinary cooperation between healthcare professionals have increased the quality of medical care in long-term care institutions during the COVID-19 pandemic.

Palliative care in primary care: European Forum for Primary Care position paper.

AIM: The aim of this position paper is to assist primary health care (PHC) providers, policymakers, and researchers by discussing the current context in which palliative health care functions within PHC in Europe. The position paper gives examples for improvements to palliative care models from studies and international discussions at European Forum for Primary Care (EFPC) workshops and conferences. BACKGROUND: Palliative care is a holistic approach that improves the quality of life of patients and their families facing problems associated with terminal illness, through the prevention and relief of suffering by means of early identification and diligent assessment and treatment of pain and other problems, whether physical, psychosocial, or spiritual. Unfortunately, some Europeans, unless they have cancer, still do not have access to generalist or specialist palliative care. METHODS: A draft of this position paper was distributed electronically through the EFPC network in 2015, 2016, and 2017. Active collaboration with the representatives of the International Primary Palliative Care Network was established from the very beginning and more recently with the EAPC Primary Care Reference Group. Barriers, opportunities, and examples of good and bad practices were discussed at workshops focusing on palliative care at the international conferences of Southeastern European countries in Ljubljana (2015) and Budva (2017), at regular conferences in Amsterdam (2015) and Riga (2016), at the WONCA Europe conferences in Istanbul (2015), Copenhagen (2016), and Prague (2017), and at the EAPC conference in Madrid (2017). FINDINGS: There is great diversity in the extent and type of palliative care provided in primary care by European countries. Primary care teams (PCTs) are well placed to encourage timely palliative care. We collected examples from different countries. We found numerous barriers influencing PCTs in preparing care plans with patients. We identified many facilitators to improve the organization of palliative care.

Through health workers' eyes: a qualitative study of health service provision for migrants at Schengen border.

BACKGROUND: Croatia and Slovenia were the transit countries on the Balkan route for migrants and refugees from Middle East countries in 2015 and 2016. They had to optimize health care delivery in the special circumstances in refugee camps and transit centres. Little is known about health care provision in border camps where a large number of migrants stay for only couple of hours. Previous studies emphasize that language barriers and cultural differences play a central part in the relationship between health workers and migrants inside the transit zone. The aim of the study was to identify specific characteristics of health care provision experienced by primary healthcare providers in order to prepare solutions on how to organise health care in refugee settings. METHODS: Twelve thematic interviews were conducted in the middle of the most intense migration movements to the North-West Europe between November and December 2015 with health workers from Croatia and Slovenia. Interview transcripts were read, coded, reviewed, and labelled. We used qualitative content analysis. RESULTS: Four themes about the health service provision for refugees at Schengen border were identified. The circumstance when mutual understanding is poor and the consultation not successful, cultural differences represent a central barrier. Participants highlighted that the importance of respecting human dignity is crucial for the provision of basic medical care for migrants in transit. CONCLUSION: Successful overcoming language barriers, respecting cultural differences, humanity, susceptibility to social deprivation and traumatic experiences are the key factors important for organisation of health care in transit centers and camps. This article gives some useful tips for healthcare workers and policy makers who are participating in health services provision for migrants and other refugees. Health workers should be prepared to work in special working conditions with a lack of resources. Their work would require timely planning and reflection on the organization of more transit camps. TRIAL REGISTRATION: Ethical Committee of the Republic of Slovenia approved the study as a project number 112/02/16.

Frailty Assessment Scales for the Elderly and their Application in Primary Care: A Systematic Literature Review.

BACKGROUND: The increase in the elderly population is causing changes and challenges that demand a comprehensive public health response. A specific characteristic of the elderly is their frailty. Today's problems with identifying levels of frailty are being resolved by numerous tools in the form of frailty assessment scales. This systematic review establishes which frailty assessment scales for the elderly are being used and what their applicability in primary care is like in Slovenia and around the world. METHODS: Documents published after 2010 were searched for in the PubMed database using keywords and other specific criteria. RESULTS: A total of 177 search hits were obtained based on various search strings. The final analysis included 28 articles, of which three were systematic literature reviews. These three covered quantitative studies, mainly consisting of observational cross-sectional surveys or cohort studies. Three other studies featured non-systematic literature reviews. Quantitative studies (mainly cross-sectional surveys or cohort studies) prevailed among the remaining 22 articles. One study had a qualitative design (Delphi method). The main outcome measures observed by all studies were frailty assessment scales for the elderly, the majority of which were evaluated on a sample of the elderly. CONCLUSIONS: None of the assessment scales examined are used as the gold standard for primary care. A variety of tools are being used in clinical practice to assess frailty in elderly patients, highlighting the need for standardization and guidelines. This requires evaluating the current assessment scales in terms of validity and reliability, and suitably improving them.

"Wounds Home Alone"-Why and How Venous Leg Ulcer Patients Self-Treat Their Ulcer: A Qualitative Content Study.

BACKGROUND: Venous leg ulcers (VLUs), the most common type of leg ulcerations, have long healing times and high recurrence rates; reimbursement rules and a general shortage of nursing staff have put self-treatment into focus. The study aimed to investigate why and how patients with VLUs self-treat their ulcers. METHODS: Patients with VLUs (N = 32) were selected by criterion sampling for a multicentric qualitative study using semi-structured interviews. The interviews were analyzed via inductive qualitative content analysis. RESULTS: More than two-thirds of participants sometimes self-treated VLU and one quarter changed their prescribed treatment. Experiences were expressed through four themes as follows: (a) current local VLU therapy; (b) VLU self-treatment; (c) patient education; and (d) psychosocial issues. The main reasons for self-treatment were a lack of healthcare resources, reimbursement restrictions, and dissatisfaction with conventional treatment together with insufficient knowledge about the wound-healing process and possible side effects. No educational materials were provided for patients or caregivers. Many patients adopted homemade remedies. CONCLUSION: Patients with VLUs practice self-care due to limited healthcare availability, a low awareness of the causes of their condition, and the effects of therapy on VLU healing. Future educational intervention is needed to enhance self-treatment.

Development and evaluation of a web-based capacity building course in the EUR-HUMAN project to support primary health care professionals in the provision of high-quality care for refugees and migrants.

BACKGROUND: The ongoing refugee crisis has revealed the need for enhancing primary health care (PHC) professionals' skills and training. OBJECTIVES: The aim was to strengthen PHC professionals in European countries in the provision of high-quality care for refugees and migrants by offering a concise modular training that was based on the needs of the refugees and PHC professionals as shown by prior research in the EUR-HUMAN project. METHODS: We developed, piloted, and evaluated an online capacity building course of 8 stand-alone modules containing information about acute health issues of refugees, legal issues, provider-patient communication and cultural aspects of health and illness, mental health, sexual and reproductive health, child health, chronic diseases, health promotion, and prevention. The English course template was translated into seven languages and adapted to the local contexts of six countries. Pre- and post-completion knowledge tests were administered to effectively assess the progress and knowledge increase of participants so as to issue CME certificates. An online evaluation survey post completion was used to assess the acceptability and practicability of the course from the participant perspective. These data were analyzed descriptively. RESULTS: A total of 390 participants registered for the online course in 6 countries with 175 completing all modules of the course, 47.7 % of them medical doctors. The mean time for completion was 10.77 hours. In total, 123 participants completed the online evaluation survey; the modules on acute health needs, legal issues (both 44.1%), and provider-patient communication/cultural issues (52.9%) were found particularly important for the daily practice. A majority expressed a will to promote the online course among their peers. CONCLUSION: This course is a promising learning tool for PHC professionals and when relevant supportive conditions are met. The course has the potential to empower PHC professionals in their work with refugees and other migrants.

[Primary care of refugees and migrants. Lesson learnt from the EUR-HUMAN project]. / Menekültek, migránsok az alapellátásban. Mit tanulhattunk az EUR-HUMAN projekt eredményeibol?

In 2015, local wars, starvation and misery in some Middle Eastern, Asian and African countries forced millions of people to leave their homelands. Many of these people migrated toward Europe, reaching Hungary as well. The refugee crisis created significant challenges for all national healthcare systems across Europe. Limited attention has been given to the extent to which health service provision for refugees and migrants has become a task for primary health care (PHC), which has been unprepared as a profession and pressured by the enormous workload. Hungarian primary care was involved only to an extent in the refugees' health care, as most of the migrants entering Hungary wanted to move forward to other countries. The need for evidence-based patient-centred interventions to assess refugee healthcare needs, and for training programmes for rapid capacity-building for integrated PHC was addressed by the EUropean Refugees - HUman Movement and Advisory Network (EUR-HUMAN) project, which 7 European countries developed together. The overall aim of the EUR-HUMAN project is to enhance the knowledge and expertise of European member states who accept refugees and migrants in addressing their health needs, safeguarding them from risks, while at the same time to minimize cross-border health risks. This initiative focuses on addressing the early arrival period, transition and longer-term settlement of refugees in European host countries. A primary objective of this project is to identify, design and assess interventions to improve PHC delivery for refugees and migrants with a focus on vulnerable groups. The structure, the main focus and outputs of the project are described and summarized in this paper, providing relevant information and access to educational materials for Hungarian (primary care) physicians. The EUR-HUMAN project was operated in 2016 under the auspices of the European Commission and funded by the Consumers, Health, Agriculture and Food Executive Agency (CHAFEA). Orv Hetil. 2018; 159(35): 1414-1422.

General practitioners' needs for support after the suicide of patient: A qualitative study.

BACKGROUND: Most patients that commit suicide consult their GPs before their death. This topic is often surrounded by secrecy and associated with guilt and shame. There is a lack of knowledge about support for GPs after patient suicide. OBJECTIVES: To identify the widest range of Slovenian GPs' problems and needs in connection with patient suicide, and, based on the findings of the study, to prepare ways to assist GPs after patient suicide. METHODS: Semi-structured interviews were held with GPs that had experienced a patient's suicide during their professional career until saturation was reached. The interview guide was piloted. Twenty-two in-depth interviews were carried out between April 2012 and February 2013. Transcripts were coded and thematically analysed using qualitative content analysis. RESULTS: Participating GPs suggested possible forms of support, most frequently individual consultation with a psychologist or a psychiatrist, in person, by phone, or via e-mail. Balint groups, group consultations and various workshops on suicide or depression would be a preferable form of support. Some GPs perceived critical incident review as an attempt to blame them, whereas others saw it as an opportunity for support. A group of peers that could discuss professional dilemmas in which more experienced GPs would help younger GPs would be helpful. CONCLUSION: Slovenian GPs did not have any formal support system at the time of the research, but they would appreciate such a possibility.

Early Identification of Patients in Need of Palliative Care in Slovenian General Practice.

BACKGROUND: To help general practitioners (GPs) in early identification of patients with palliative care (PC) needs, this pilot study aimed to determine the potential of the combined original surprise question (SQ1) ('Would I be surprised if this patient died within the next 12 months?') and the second surprise question (SQ2) ('Would I be surprised if this patient was still alive after 12 months?'). We hypothesized that answering these SQs would trigger them to make a multidimensional care plan. METHODS: 26 Slovenian GPs, randomized into 4 groups, were invited to write a care plan for each of the four patients described in case vignettes (2 oncologic, 1 organ failure and 1 frailty case). GPs in group 1 were only asked to write a care plan for each patient. GPs in group 2 answered SQ1 and GPs in groups 3 and 4 answered SQ1 and SQ2 before writing the care plan. The type and number of PC aspects mentioned in the respective care plans were quantified into a numeric RADboud ANTicipatory (RADIANT) score. RESULTS: Mean RADIANT scores in groups 1-4 were 2.2, 3.6, 2.5 and 3.1, respectively. When comparing the different vignettes, vignette B (terminal oncologic patient) scored best (3.6). Mean RADIANT scores in groups 3 and 4 were slightly higher for GPs who would be surprised compared to GPs who would not be surprised if the patient was still alive in 12 months. CONCLUSION: The combined SQs were considered helpful in the early identification of patients in need of PC in Slovenian general practice.

Patients' perception of differences in general practitioners' attitudes toward immigrants compared to the general population: Qualicopc Slovenia.

INTRODUCTION: Globally, the number of immigrants is rising every year, so that the number of immigrants worldwide is estimated at 200 million. In Slovenia, immigrants comprise 6.5% of the overall population. Immigrants bring along to a foreign country their cultural differences and these differences can affect immigrants' overall health status and lead to chronic health conditions. The aim of this study was to identify patients' perception of general practitioners' (GPs') attitudes toward immigrants in Slovenia. METHODS: This study was based on the Qualicopc questionnaire. We used the questions that targeted patients' experience with the appointment at their GP on the day that the study was carried out. RESULTS: There were no differences in GPs' accessibility based on groups included in our study (p>0.05). Compared to the non-immigrant population, first-generation immigrants answered that their GPs were impolite (p=0.018) and that they did not take enough time for them (p=0.038). In addition, they also experienced more difficulties understanding their GP's instructions (p<0.001). Second-generation immigrants experienced more negative behaviour from GPs, and first-generation immigrants had more difficulties understanding GPs' instructions. CONCLUSION: There may be some differences in patients' perception of GPs' attitudes towards immigrants in comparison with the general Slovenian population. However, based on the perception of the immigrants that do benefit from the medical care it is not possible to judge the GPs' attitudes towards immigrants as worse compared to their attitude towards the non-immigrant population. Indeed, there may be other reasons why the patients answered the way they did.

Primary care for the Roma in Europe: Position paper of the European forum for primary care.

Roma populations' low health status and limited access to health services, including primary care, has been documented in many European countries, and warrants specific health policies and practices. A variety of experiences shows how primary care can adjust its practices to reduce the barriers to primary care for Roma populations. At local level, establishing collaboration with Roma organisations helps primary care to improve mutual relations and quality of care. Mediation has proved to be an effective tool. Skills training of primary care practitioners may enhance their individual competences. Research and international sharing of experiences are further tools to improve primary care for the Roma people.

The Analysis of Slovenian Political Party Programs Regarding Doctors and Health Workers from 1992 to 2014.

INTRODUCTION: The study focuses on the programmatic bases of Slovenian political parties since independence. It presents an analysis of party programs and their preferences regarding doctors and other health workers, as well as the contents most commonly related to them. At the same time, the study also highlights the intensity of the presence of doctors on the policy agenda through time. METHODS: In the study, 83 program documents of political parties have been analysed. The study includes programmes of political parties that have occurred in parliamentary elections in Slovenia between 1992 and 2014 and have exceeded the parliamentary threshold. The data were analysed using the content analysis method, which is suitable for analysing policy texts. The analysis was performed using ATLAS.ti, the premier software tool for qualitative data analysis. RESULTS: The results showed that doctors and other health workers are an important political topic in non-crisis periods. At that time, the parties in the context of doctors mostly dealt with efficiency and the quality of services in the health system. They often criticize doctors and expose the need for their control. In times of economic crisis, doctors and other health workers are less important in normative commitments of parties. CONCLUSIONS: Slovenian political parties and their platforms cannot be distinguished ideologically, but primarily on the principle of access to government. It seems reasonable to conclude that parties do not engage in dialogue with doctors, and perceive the latter aspassive recipients of government decisions-politics.