Perceived needs for attaining a 'new normality' after surviving myocardial infarction: A qualitative study of patients' experience.

BACKGROUND: A comprehensive understanding of the various aspects of patients' myocardial infarction (MI) experiences may help to guide these patients and their relatives through the many uncertainties they face and help them to stabilize their lives after the disruption they experienced. OBJECTIVES: To explore MI patients' experiences of life with MI, the challenges they face during the process of accepting their condition, and the setting and resetting of their personal goals. METHODS: Thirty semi-structured, individual interviews were conducted. The grounded theory method was used, and Atlas.ti qualitative data analysis software was used to facilitate the analysis. RESULTS: Three main themes and explanatory models emerged from the data analysis: a good adaptation - the 'new normality;' maladjustment - a continuous search for a 'new normality;' and perceived needs in the search for a new normality. Patients perceived several areas of need that they felt must be met before they could reach the state of a new normality. These needs included overcoming the anxiety of a possible MI recurrence; acquiring knowledge about MI in general and about 'my MI' in particular; the need for a timeline; for patience and steadiness; for both objective and subjective health status improvement; for taking control over the disease; and living within a supportive context. CONCLUSION: When faced with a dramatic life event, most patients succeed in achieving a new normality in which they live changed but still satisfying lives. The needs experienced by patients when searching for a new normality may guide practitioners in leading patient-centred consultations. [Box: see text].

Facing the diagnosis of myocardial infarction: a qualitative study.

BACKGROUND: Patient experience is increasingly recognized as one of the three pillars of quality in health care, alongside clinical effectiveness and patient safety. However, little attention has been paid to the patients' experience from the point of view of health care delivery. OBJECTIVE: To explore the initial experience of patients facing a new diagnosis of myocardial infarction (MI). METHODS: Thirty semi-structured, individual interviews were performed. The Grounded Theory method was used. Atlas.ti qualitative data analysis software facilitated the analysis. RESULTS: Three patterns of MI diagnosis experience were found: a close encounter with death, severe pain, and 'silent' MI. Newly-diagnosed MI patients who experienced a close encounter with death expected that, after necessary life-saving measures, their physician would not force immediate conversation, but leave them alone, simply to take pleasure in being alive. Newly-diagnosed MI patients who did not experience a close encounter with death expected that their physician would provide not only medical care but also immediate emotional support and opportunities to discuss in their own words their ideas, thoughts, concerns and fears. Six factors facilitated patients coping with a new diagnosis of MI: stay in hospital, completion of diagnostic tests, trust in physicians, the patient's previous expectation that he/she could have a heart attack, the patient's personality, and the need for solitude. CONCLUSION: Physicians should be aware that different patterns of patient experience when facing MI could indicate patients' differing needs for immediate emotional support and communication.

Trends in the use of physical medicine and rehabilitation in Croatia between 1995 and 2012.

Until now, there have been no published researches evaluating referrals from family doctors (FDs) or utilizations of physical medicine and rehabilitation (PMR) in Croatia. The main study aim was of determining the referral trend and the trends in the number of PMR consultations. The data were collected from the Croatian Health Statistics Yearbook, 1995-2012. The results of this study pointed out to the large number of FDs referrals as well as the large number of consultations performed in PMR: about 11% of all specialists' consultations, or the first rank in 2012. While the number of referrals decreased until 2008, the number PNR consultations continuously increased. In the same time the number of the musculoskeletal diagnosed registered by FDs also increased. The geographical variations were observed too. The new researches are needed to get deeper inside in the problem of PMR utilization.

Organization and functioning of primary healthcare for pre-school children in Croatia: a longitudinal study from 1995 to 2012.

Primary health care for children in Croatia are mostly provided by primary pediatricians (PP) in the urban and by family doctors in rural areas. During past decades, as apart of health care reforms, primary pediatric care experiences several changes. This study was undertaken in order to investigate the trends in organizational structure and functioning of the PPs, based on routinely collected data from Croatian Health Service Yearbooks, 1995 to 2012. The results have consistently shown a shortage of PPs in Croatia. The shortage obviously affects the average number of children per PP; number increased from 994 in 1995, to 1556 children in 2010, which was far above the standard. The shortage of PPs is also related to the high number of visits (30 to 40) per PP and per working day. The obtained results clearly show only the trends, therefore further research is needed for a full understanding of the PHC for pre-school children.

Preventive health care for pre-school children in Croatia: ongoing trends from 1995 to 2012.

In Croatia, primary health care for pre-school children is organized by pediatricians (PPs) for children in urban and family doctors (FDs) for children in remote areas. This study was undertaken with the aim to determine the trends in preventive activities (general, targeting, and control check-ups and total visits) in both services (FDs, PPs), between 1995 and 2012. The main adapt source was the Croatian Health Service Yearbooks. According to the results, the number and the structure of preventive activities performed by PPs are relatively stable, while those performed by FDs decreased rapidly, primarily because the number of children under the care decreased. It is probable in relations with the regulations to direct the children to PPs and not to the FDs. The average numbers of all preventive activities are under the optimum. There are many similarities between FDs' and PPs', some activities were frequently performed by FDs and others by PPs'.

[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.