Differences in the Pattern of Non-Recreational Sharing of Prescription Analgesics among Patients in Rural and Urban Areas.

INTRODUCTION: This study aimed to analyze differences in sharing of prescription analgesics between rural and urban populations. METHODS: We surveyed 1000 participants in outpatient family medicine settings in Croatia. We used a 35-item questionnaire to analyze patients' characteristics, pain intensity, prescription analgesic sharing behavior, and perception of risks regarding sharing prescription medications. RESULTS: Prescription analgesic sharing was significantly more frequent in the rural (64%) than in the urban population 55% (p = 0.01). Participants from rural areas more commonly asked for verbal or written information than those from urban areas when taking others' prescription analgesics (p < 0.001) or giving such analgesics (p < 0.001). Participants from rural areas more commonly informed their physician about such behavior compared to those from urban areas (p < 0.01), and they were significantly more often asked about such behavior by their physician (p < 0.01). Perceptions about risks associated with sharing prescription medication were similar between rural and urban populations. CONCLUSIONS: There are systematic differences in the frequency of prescription analgesics and associated behaviors between patients in family medicine who live in rural and urban areas. Patients from rural areas were more prone to share prescription analgesics. Future studies should examine reasons for differences in sharing prescription analgesics between rural and urban areas.

Impact of guidelines on antibiotic prescribing approach in primary care-a 10-year study.

BACKGROUND: Publication and implementation of clinical guidelines is an important educational measure that considerably helps physicians in choosing appropriate antimicrobial drug. OBJECTIVES: To evaluate long-term changes in antimicrobial prescribing habits before and after publishing the guidelines and to determine the factors that influence physician's decision to prescribe an antimicrobial drug. METHODS: The study among general practitioners in Primorsko-Goranska County was conducted in three periods (January 2009, January 2011 and April 2019) by using a structured questionnaire that included general data about the physician, questions about their habits in antibiotic prescribing, criteria that influenced decision to prescribe antibiotics and antimicrobial agent(s) preferred in treating common infections. RESULTS: Concomitant chronic (non-pulmonary) disease was the most important factor influencing decision to prescribe an antimicrobial drug. Over 88% of physicians that completed the survey declared themselves as rational prescribers of antimicrobials but more than half of them (53.3%) sometimes prescribed an antibiotic even though it was not indicated compared to 75% of self-reported non-rational prescribers (P ˂ 0.05). Self-reported adherence to the guidelines increased from 34.6% in 2011 to 51.8% in 2019. CONCLUSION: The research showed improvement in physicians' knowledge in choosing the right antibiotic based on the analysis of answers but indicated the necessity for improving communication skills and empowering physicians not to prescribe antibiotics 'just in case' because of diagnostic uncertainty or patient demand. Further qualitative research is needed to understand physicians' prescribing behaviour and decision-making processes in order to develop interventions that will effectively improve the use of antibiotics.

Awareness and use of evidence-based medicine information among patients in Croatia: a nation-wide cross-sectional study.

AIM: To determine the use of evidence-based medicine (EBM) information and the level of awareness and knowledge of EBM among patients in Croatia. METHODS: A cross-sectional study was conducted among 987 patients in 10 family medicine practices in Croatia. Patients from both urban (n=496) and rural (n=482) areas were surveyed. A 27-item questionnaire was used to collect data about sources that patients searched for medical information, patient awareness and use of Cochrane systematic reviews and other EBM resources, and their demographic characteristics. RESULTS: Half of the patients searched for medical information from sources other than physician. Internet was the most common place they searched for information. Very few patients indicated using EBM sources for medical information; one fifth of patients heard of EBM and 4% of the patients heard of the Cochrane Collaboration. Patients considered physician's opinion as the most reliable source of medical information. A logistic regression model showed that educational level and urban vs rural residence were the predictors of awareness about EBM and systematic reviews (P<0.001 for both). CONCLUSION: Our finding that patients consider a physician's opinion to be the most reliable source of health-related information could be used for promotion of high-quality health information among patients. More effort should be devoted to the education of patients in rural areas and those with less formal education. New avenues for knowledge translation and dissemination of high-quality health information among patients are necessary.

Knowledge and attitudes towards evidence-based medicine of mentors in general practice can be influenced by using medical students as academic detailers.

BACKGROUND: Regular use of evidence-based medicine (EBM) among general practitioners (GP) is insufficient. OBJECTIVE: To analyse whether knowledge and attitudes about EBM can be improved among mentors in general practice by involving sixth-year medical students as academic detailers. METHODS: An interventional non-randomized before-and-after study included 98 GPs (49 in the intervention group of mentors and 49 controls) and 174 medical students attending family medicine clinical rotations. A telephone survey on knowledge and attitudes towards EBM was conducted among participating physicians before, and six months after the rotation. During the rotation, each mentor chose two cases from real life, and the students' task was to form an answerable clinical question, find the evidence-based answer and to write a brief report. The mentor reviewed the report and discussed it with the student. RESULTS: Students' EBM detailing intervention led to significant improvement in knowledge and attitudes about EBM in the intervention group of mentors in general practice compared to control GPs (relative increase in knowledge was 20 ± 46.9% vs 6 ± 12.1%, respectively; P = 0.042). Among participants with Ph.D. or specialization in family medicine, the observed effects of the intervention were similar as in the total sample, and statistically significant, but not in the group of participants with neither scientific degree nor specialization in family medicine. CONCLUSION: Knowledge and attitudes of GP mentors towards EBM can be improved by involving medical students as academic detailers. Further studies should explore the effectiveness of this method among GPs that are not mentors, and who do not have a specialization or research degree.

Outcome of treatment with antidepressants in patients with hypertension and undetected depression.

OBJECTIVE: The objective of the research was to determine whether the administration of antidepressants, concurrently with antihypertensive therapy, leads to the better regulation of blood pressure in patients with hypertension and increased depressiveness. METHODS: Research was conducted in two outpatient family clinics in Rijeka, Croatia, on 452 patients with arterial hypertension who had not been diagnosed with depression prior to the study. The diagnosis of hypertension was made in accordance with the European Society of Hypertension and the European Society of Cardiology Guidelines for the Management of Arterial Hypertension. Using the Beck Depression Inventory and the ICD-10 criteria for depression, a group of depressed hypertensive patients (N = 134) was selected. Out of a total of 134 selected patients, 73 patients (N = 73) were receiving antidepressants together with antihypertensives for 24 weeks. They formed the experimental group. The rest of the patients (N = 61) continued to receive only antihypertensives and they formed the control group. RESULTS: After the end of the 24-week therapy, the experimental group of patients had significantly lower levels of both systolic and diastolic blood pressure (Z = 7.42; P < 0.001; and Z = 7.36; P < 0.001). The control group saw no significant difference between the level of blood pressure (both systolic and diastolic) prior to and after this period. CONCLUSION: The application of antidepressant therapy in patients with hypertension who are also depressed may be associated with the better control of blood pressure, which reduces the risk of cardiovascular disease in addition to alleviating depressive symptoms.

Comorbid chronic diseases in depressed and non-depressed patients in family practice.

INTRODUCTION: Depression is one of the five most frequent disorders in primary care practice and often remains unrecognized. One of the reasons why depression often passes unnoticed is comorbidity - a number of different chronic diseases coexist with depression, especially in elderly patients. AIM: The aim of this research was to assess the difference between depressed and non-depressed patients regarding somatic and mental comorbidity. The differences in drug use were also examined. SUBJECTS AND METHODS: Five hundred successive adult patients visiting family physicians in Rijeka, Croatia, were polled using the Beck Depression Inventory and a general questionnaire which was created for the purpose of the study. The existing medical records were also used. RESULTS: Elevated depression level was determined in 48.1% of the examinees. These patients were suffering from larger number of chronic diseases (X=1.23) than non-depressed patients (X=0.70; t=5.07; p<0.001; z=4.93; p<0.001), especially cardiac, mental, renal and osteomuscular diseases. Depressed persons used significantly more drugs (X=1.28) than non-depressed patients (X=0.58; t=6.10; p<0.001; z=5.78; p<0.001), especially antirheumatics, analgesics, sedatives, antidepressants, antiallergics and diuretics. CONCLUSION: The research results point to a necessity of routine screening and early treatment of depression in patients with chronic diseases in primary care practice.

[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.