Sources and predictors of home-kept prescription drugs.

OBJECTIVE: To examine the extent of home-kept prescription drugs in the general population and to identify the predictors for a higher number of prescription drugs kept in people's homes. METHODS: The study included a random stratified sample of 1,000 Slovenian inhabitants. Participants answered a self-administered questionnaire regarding sources and contents of their home pharmacies. The main outcome measure was the presence and the number of home-kept prescription drugs. RESULTS: The response rate was 41%. At least one prescription drug in the home pharmacy was kept by 298 (75.4%) of the respondents, average number of prescription drugs was 3.1 ± 3.3. The majority of the respondents (319, 77.8%) bought the drugs for self-medication in pharmacies. Almost a quarter of the respondents obtained them from relatives and friends (82, 20.0%). Multivariate logistic regression analysis showed that a visit to a clinical specialist in the previous year and high blood pressure were independent predictors for the presence of any home-kept prescription drug. Multivariate linear regression analysis also showed that rural and suburban living areas, a visit to a clinical specialist, a need for a home visit by a doctor in the past year, and the presence of diabetes, high blood pressure, asthma or depression are independent predictors for a higher number of home-kept prescription drugs. CONCLUSION: Doctors have to take into account that their patients keep several prescription drugs in their home pharmacies. These patients are potential providers to their friends and relatives of potentially unsafe drugs for self-medication.

Attitudes of Slovene general practitioners towards generic drug prescribing and comparison with international studies.

BACKGROUND: Over the recent years there has been a steady 7% yearly increase in prescribing costs, which accounts for 17% of the Slovene national health care budget. Substitution of branded products by generic equivalents can offer savings. General practitioners (GPs) are often concerned about the quality of generic products and possible legal liabilities associated with their use. OBJECTIVE: We wanted to examine the attitudes of GPs in Slovenia towards generic drug prescribing. METHODS: We conducted a postal survey of a random sample of 200 out of 800 GPs in Slovenia from the National Health Insurance Institute database. GPs were asked 21 questions regarding their knowledge on generic drugs, awareness of prescribing costs, prices of generic drugs relative to brand name drugs and their attitude towards use of generic drugs. RESULTS: The 117 (58.5%) replies we received represent 15% of the GP population in Slovenia. 66.1% of GPs considered rising costs of medicines to be a serious problem for the health care budget. Each week, over 50% of GPs experienced demands from patients for specific drugs and the majority of GPs usually met their patients' demands or requests from hospital consultants for branded products. 38.3% of GPs did not take price into consideration when prescribing drugs. The majority of GPs (88.9%) perceived generics to have the same effectiveness as branded drugs. One quarter of GPs would prescribe more generics if additional clinical trials were presented. 37.3% would follow advice of academic detailers and 30.3% expected the generics to be even cheaper than they were. Independent detailing was welcomed by 63.8% of GPs because of the big influence of the pharmaceutical industry on the prescribing habits. 15.5% thought that the industry had a tremendous impact on their prescribing patterns. CONCLUSIONS: Slovene GPs are aware of the cost of prescribed drugs. They are willing to accept independent academic detailing to improve their prescribing and are willing to increase generic drugs under certain conditions.

Patients' recommendation of doctor as an indicator of patient satisfaction.

OBJECTIVES: To determine whether patients' recommendation of their family doctor to others correlates with patient satisfaction scores, and to investigate other factors influencing patients' recommendation of doctor. DESIGN: Self-administered patient questionnaire. SETTING: Thirty-six family practice clinics, Slovenia. PATIENTS AND METHODS: A total of 2160 consecutive adult patients attending the clinics were approached to complete a self-administered questionnaire, to be returned in a prepaid envelope. The questionnaire included validated tools, such as the EUROPEP questionnaire on patient satisfaction and gathered data on health-related quality of life, patient demographic, socio-economic and health characteristics, and attitudes and experience of health services. Patients also selected a response to the statement "I can strongly recommend my family doctor to my friends" on a five-point scale, from strongly disagree to strongly agree. RESULTS: Overall, 92% of respondents were in agreement with the statement that they would strongly recommend their family doctor to their friends. Patient satisfaction in the group of patients strongly agreeing with the statement was 11.1 points higher than that for the group responding they agreed only (92.4 versus 81.3 points; P<0.001). Multivariate analysis showed that 51.5% of the variation in the response to the statement could be explained by patient, doctor, and practice characteristics investigated. CONCLUSION: Higher agreement with the statement "I can strongly recommend my family doctor to my friends" was shown to be associated with higher patient satisfaction with the doctor's working style, with some patient demographic characteristics, aspects of patients' health care utilisation, and some doctor characteristics. Using a simple question regarding recommendation of the doctor to friends can be used as a surrogate measure of patient satisfaction, but should be interpreted with caution.

Frequent attenders in general practice: quality of life, patient satisfaction, use of medical services and GP characteristics.

OBJECTIVE: To determine the predictors of frequent attendance in general practice. DESIGN: A postal survey using a questionnaire including instruments for measuring patient satisfaction (EUROPEP), quality of life (EUROQOL), anxiety and depression (DUKE-AD). SETTING: Primary health care in Slovenia. PATIENTS: A representative sample of 2160 adult patients. MAIN OUTCOME MEASURES: Number of contacts with the health care services, levels of self-care, patient satisfaction scores, quality of life scores, well-being scores, presence of chronic condition. RESULTS: Frequent attenders were more likely to have lower educational status, were more satisfied with their GP, had higher scores of anxiety and depression, and lower perceived quality of life. They were more likely to have a chronic disease. Frequent attenders were less likely to try self-care and more likely to use health services. They were more likely to visit more experienced GPs, GPs working a greater distance from other GPs and GPs who did not use the appointment system. The multivariable modelling explained 19.7% of the variation; 16.9% was attributed to patient characteristics and 3.1% to GP characteristics. CONCLUSIONS: The study confirmed that lower education levels, chronicity and higher use of other health services are predictors of higher attendance.

Determinants of customer satisfaction with the health care system, with the possibility to choose a personal physician and with a family doctor in a transition country.

Many Eastern and Central European counties are reforming their health care systems. The aim of this study was to determine customer satisfaction with a reformed health care system, with the possibility of free choice of a family physician and patient satisfaction with the family physician in Slovenia and their major determinants. We used a postal survey of the patients who attended their family physician's offices during the study period. We obtained an 84% response rate. Some 72.9% of the respondents were satisfied with the current organisation of health care services, 95.5% of the respondents were satisfied with the possibility of choosing their own family physician and 58% of participants were very satisfied with the level of care received from their personal family practitioners. It was shown that higher patient satisfaction with the family physician was the most powerful predictor of patients' satisfaction with the health care system. The results show that health care reform in Slovenia has a positive impact on the consumers' perceptions of health care quality, measured in terms of consumer satisfaction with the health care system, the possibility to choose a family physician and the overall satisfaction with the family physician.

Observational study of home visits in Slovene general practice: patient characteristics, practice characteristics and health care utilization.

BACKGROUND: Home visits are an important way of delivering primary health care, but there is a long-term decrease in home visit rates in many countries. OBJECTIVE: The aim of this study was to evaluate patient characteristics, morbidity, functional status, quality of life, satisfaction with care, practice characteristics and health care utilization in general practice patients visited at home at least once in a study year. METHODS: The design of the study was a cross-sectional survey of the patients of a stratified sample of 36 GP offices in Slovenia using a self-administered questionnaire. Sixty consecutive patients in sampled practices contacting the doctor in the office in the study period in March 1998 were included in the analysis. The age, sex, educational status, residence, presence of chronic condition, measures of anxiety or depressive symptoms, rates of patients who expressed a need for emergency care in 1 year, rates of self-care, measures of functional status, quality of life, satisfaction with care, rates of using GP practice visits and out-of-hours services and rates of using specialist or hospital services were recorded in a home-visited group versus a non-visited group. RESULTS: A total of 277 patients (15.4%) were reported to have at least one visit in the study year. Patients visited in their homes were older, predominantly female, better educated, had lower perceptions of their functional status and well-being and they used primary health services more frequently than others. Their GPs were more likely to be males, and were more likely to practise in rural areas, in solo practices as private practitioners. CONCLUSION: Home visits remain an important part of GP work in countries in transition, such as Slovenia, especially for more seriously ill patients.

An evaluation of patient satisfaction with family practice care in Slovenia.

OBJECTIVE: To describe the level of patient satisfaction with family practice in Slovenia. DESIGN: An internationally developed instrument for patients' evaluations of general practice care was used in a postal survey. SETTING: A representative sample of 36 family practices in Slovenia. STUDY PARTICIPANTS: Sixty consecutive patients in every practice were approached and offered a self-administered questionnaire. A total of 2160 questionnaires were handed out. MAIN OUTCOME MEASURE: Percentages of patients reporting level of satisfaction on a 5-point Likert scale for the items in the questionnaire. RESULTS: On average 58.2% of respondents rated the level of care received as excellent. Waiting in the waiting room was the item rated poorest (26.0%). Participants were also less satisfied with perceived time during the consultation (51.6%) and with connectional aspects of care: the feeling that family practitioners showed interest in their personal situation (46.5%); the feeling that family practitioners made it easy to explain problems (49.1%). On the other hand patients praised many other aspects of family practice care in Slovenia: confidentiality of medical records (77.0%); listening capacity of their family physicians (69.4%); being able to speak to the family practitioner on the 'phone (72%). CONCLUSIONS: Patient satisfaction with family practice care in Slovenia was shown to be relatively high and can be compared to other European countries. The results showed areas in which quality improvement is required: organizational changes to shorten the waiting time in the waiting room and greater emphasis on communication skills.

Predictive characteristics of users of alternative medicine.

BACKGROUND: The use of alternative medicine has become an important factor in health care delivery. OBJECTIVES: To evaluate patient characteristics, morbidity, functional status, quality of life, satisfaction with care, practice characteristics and health care utilisation in general practice patients using alternative medicine. DESIGN: Cross-sectional survey of GP patients completing a self-administered questionnaire. SETTING: A stratified sample of 36 GP offices in Slovenia. MAIN OUTPUT DATA: Patient's age, sex, educational status, residence, presence of chronic condition, incidence of anxiety or depressive symptoms, incidence of patient-expressed need for emergency care in one year, data on self-care, data on functional status, quality of life, satisfaction with care, incidence of use of out-of-hours services and specialist or hospital services in users versus non-users. RESULTS: 115/1753 patients (6.6%) reported visits to alternative practitioners in 1997. Users of alternative medicine were from midlife age groups, were more likely to have a chronic condition, had a lower perception of life quality and a higher incidence of anxiety and depressive symptoms, and had had more need for emergency treatment. They are heavier users of primary as well as secondary care services; they have changed their GP recently but are not significantly dissatisfied with their current regular GP. CONCLUSIONS: Use of alternative medicine appears to be characteristic of patients with a more active approach to managing their problems. GPs should enquire about the use of alternative medicine by their patients, especially those more likely to seek such help. Raising the question of alternative medicine will improve doctor-patient communication and help to resolve underlying health problems.

Management of sickness absence: a quality improvement study from Slovenia.

PROBLEM: A need to improve the communication system between general practitioners (GPs) and the national health insurance institute's (NHII) committee of experts for the referral and approval of sickness leave for patients. DESIGN: A structured low cost quality improvement method for motivating GPs to change their current practice was developed. BACKGROUND AND SETTING: The study was done in Kranj health district in Slovenia. GPs and members of the committee of experts identified potential problems using a cause and effect diagram. The study period for baseline data collection was from November 1996 to December 1996, and the re-evaluation took place in May 1997. All GPs in Kranj health district (n = 78) took part. Data were collected on 443 patients referred by GPs to the NHII committee during the first phase of the study and 590 patients during the re-evaluation phase. KEY MEASURES FOR IMPROVEMENT: Reducing the number of cases reported by members of the committee of experts as causing problems after the intervention. Feedback to GPs about the success of the process. STRATEGIES FOR CHANGE: A combination of methods was used: posted feedback, a guideline on record keeping, and a guideline, called AID (analysis of incidental deviations from expected service--in Slovene: analiza izjemnih dogodkov), on processing medical documentation. EFFECTS OF CHANGE: An overall drop was observed in the number of cases that caused problems (from 44% to 26%, p < 0.001). The most common problem at baseline (19.4% of the problems) was the seventh most common at the re-evaluation, then contributing only 9.2% of total problems (p = 0.02). LESSONS LEARNT: The results support a quality improvement philosophy that empowers "owners" of the process to be the key resource in managing change, and they show the importance of the inner motivation of those involved. Despite working in a country undergoing transition, medical professionals were still willing to improve their performance. Nevertheless, structures and funding are needed to foster quality improvement initiatives and implement national policy on quality in health care.