The 1st year of the COVID-19 epidemic in Estonia: a population-based nationwide sequential/consecutive cross-sectional study.

OBJECTIVES: The objective of this study was to assess the population prevalence of SARS-CoV-2 and changes in the prevalence in the adult general population in Estonia during the 1st year of COVID-19 epidemic. STUDY DESIGN: This was a population-based nationwide sequential/consecutive cross-sectional study. METHODS: Using standardised methodology (population-based, random stratified sampling), 11 cross-sectional studies were conducted from April 2020 to February 2021. Data from nasopharyngeal testing and questionnaires were used to estimate the SARS-CoV-2 RNA prevalence and factors associated with test positivity. RESULTS: Between April 23, 2020, and February 2, 2021, results were available from 34,915 individuals and 27,870 samples from 11 consecutive studies. The percentage of people testing positive for SARS-CoV-2 decreased from 0.27% (95% confidence interval [CI] = 0.10%-0.59%) in April to 0.04% (95% CI = 0.00%-0.22%) by the end of May and remained very low (0.01%, 95% CI = 0.00%-0.17%) until the end of August, followed by an increase since November (0.37%, 95% CI = 0.18%-0.68%) that escalated to 2.69% (95% CI = 2.08%-2.69%) in January 2021. In addition to substantial change in time, an increasing number of household members (for one additional odds ratio [OR] = 1.15, 95% CI = 1.02-1.29), reporting current symptoms of COVID-19 (OR = 2.21, 95% CI = 1.59-3.09) and completing questionnaire in the Russian language (OR 1.85, 95% CI 1.15-2.99) were associated with increased odds for SARS-CoV-2 RNA positivity. CONCLUSIONS: SARS-CoV-2 population prevalence needs to be carefully monitored as vaccine programmes are rolled out to inform containment decisions.

Tackling antimicrobial resistance in primary health care through promoting the appropriate use of antibiotics in Estonia, EVIPNet evidence brief for policy, number 8

This report is the second evidence brief for policy produced in Estonia within the framework of the WHO European Evidence-informedPolicy Network. It was prepared by the Public Health Institute of University of Tartu in collaboration with the Ministry of Social Affairsof Estonia and WHO Country Office in Estonia. The working group identified, selected, appraised, and synthesized relevant researchevidence on the problem, three options for tackling it and considerations in implementing them. The three options are: (1) Strengthening post-graduate education and continuing the education of primary care clinicians about the appropriate use of antibiotics and antimicrobial resistance (AMR); (2) Providing clinical decision support to PHCP (primary health care providers) for the prudent use of antibiotics; and (3) Using audit and feedback to improve prescribing behaviour.

Prevalent obstacles and predictors for people living with type 2 diabetes.

Background. Type 2 diabetes (T2DM) is a chronic, progressive disease with serious micro- and macrovascular complications. A person affected by T2DM should learn to accept the new restricted lifestyle. Aims. The aim of the study was to identify the prevalence of obstacles in coping with daily life for people with T2DM and the magnitude of the relationships of the obstacles with various patient characteristics. Methods. Participants were recruited from randomly selected GPs' lists in Estonia. Respondents completed the Estonian version of the Diabetes Obstacles Questionnaire (DOQ). The statements were assessed on a 5-point scale. Biomedical and clinical variables were measured. The central tendency statistics and skewness and kurtosis for all statements were computed to find out those that reflect obstacles. Then obstacles of the DOQ were stratified. Multinomial logistic regression (MLR) was computed to estimate the influences of descriptive variables on the statements. Results and Conclusions. Altogether, 138 diabetic patients were enrolled in the study. Fourteen statements were identified as obstacles. Variables such as age, type of diabetes treatment, and BMI had significant effects on five of them. Younger age, BMI, and insulin nonuse were revealed as the strongest predictive characteristics for perceiving obstacles more often in coping with daily life.

Family doctors' assessment of patient- and health care system-related factors contributing to non-adherence to diabetes mellitus guidelines.

OBJECTIVE: The aim of this study was to assess family doctors' opinions on the patient- and health care system-related factors contributing to non-adherence to diabetes mellitus clinical practice guidelines (CPG) in Estonia. RESEARCH DESIGN AND METHODS: Descriptive postal survey using a self-administered questionnaire. RESULTS: Of the 354 doctors who received the questionnaire 46% (n=163) responded. Seventy-six percent of them have type 2 diabetes guidelines. Low awareness of diabetes and its complications as well as patients' low motivation to change their lifestyle were considered to be the biggest difficulties in managing individual patients. In addition to the most often listed problems non-compliance with medical regimen, patients' financial problems and their nonattendance were mentioned. The greatest health care system-related barriers to practices providing desirable care were the lack of special diabetes education for nurses and underfunding, and an inadequate number of patients' educational materials. The patient-related issues were regarded as problems in 96% of the cases and health care system-related factors were mentioned in 79% of the cases. CONCLUSIONS: Family doctors in Estonia consider patient-related factors to be key issues in non-adherence to diabetes mellitus clinical practice guidelines.

Patient satisfaction with care is associated with personal choice of physician.

OBJECTIVE: To evaluate whether choosing one's own primary care doctor is associated with patient satisfaction with primary health care. To evaluate factors related to population's satisfaction with primary health care. POPULATION: A random sample of Estonian adult population (N=997). STUDY DESIGN: Cross-sectional study using a pre-categorized questionnaire which was compiled by the research group of the University of Tartu and the research provider EMOR. RESULTS: Altogether 68% of the respondents had been listed in their personal physician. Their overall satisfaction with the physician as well as satisfaction with several aspects of primary health care were significantly higher compared with those of unregistered respondents. Although some other factors (practice size, patient age, health status) also influenced patient satisfaction, presence of a personal physician appeared the most important predictor of high satisfaction with physician's punctuality and understanding, effectiveness of prescribed therapy, clarity of explanations given by the physician as well as with overall satisfaction with the physician. CONCLUSION: Personal doctor system is associated with patient satisfaction with different aspects of care.

Setting national standards for practice equipment. Presence of equipment in Estonian practices before and after introduction of guidelines with feedback.

BACKGROUND: During the last few years quality assurance has received increasing attention in Estonian health care as well as in family medicine, which is a new speciality in Estonia (since 1993). The modest equipment that district doctors (former primary care doctors) had at their disposal, appeared inadequate considering family doctors' work tasks. AIM: To determine the type of equipment available in primary care practices before setting a standard, and 1 year after the minimal standard of practice equipment was introduced. To follow how well family doctors adhere to this standard. METHOD: A questionnaire was sent to a random sample of district doctors (n=157) in 1992 and to all family doctors practising as independent contractors in 1998 (n=376). Quality of equipping was assessed against the standard set by consensus of the representatives of Family Doctors' Society, based on the country's needs and family doctor's job description. RESULTS: The level of primary care doctors' office equipment in 1992 was quite low. However, by the spring of 1998, substantial improvement of the equipment in family doctors' practices was estimated. The number of doctors possessing instruments for otorhinolaryngological, ophthalmological and gynaecological work as well as for taking care of children had increased two- to three-fold. About one-half of the family doctors reported that they had all the instruments listed in the standard. CONCLUSIONS: Setting a national standard helps to improve practice equipment--an important structural aspect of quality of care. Although improvement of equipment alone cannot guarantee quality of care, it may provide an important first step towards promoting it.

Primary health care system in transition: the patient's experience.

OBJECTIVE: To find out how Estonian people evaluate the changes in primary health care (PHC), how they perceive the acceptability of the new PHC system, and to assess patients' satisfaction with their primary care doctor. DESIGN: Face-to-face interviews using structured questionnaires. SETTING: Estonia. STUDY PARTICIPANTS: A random sample of Estonian residents aged 15-74 years (n = 997). MAIN MEASURES: Acceptability of PHC system (accessibility, the patient-practitioner relations, amenities, and patient's preferences) and patients' satisfaction with primary care doctor. RESULTS: Of the 997 respondents, 46% were sufficiently informed about the transition to the general practitioner (GP)-based PHC system; however, 45% of respondents had not personally experienced any changes. Of the 997 persons interviewed, 68% were registered on the patient list of a GCP, and 62% of those who had health problems preferred to consult the primary care doctor first. The waiting time for an outpatient appointment was brief (0-2 days). Of the 997 respondents, 68% were satisfied with their primary care doctor. Satisfaction was dependent on: (i) how patients evaluated the competence of the physician; (ii) comprehensibility of doctor's explanations; and (iii) comfort of the clinic. The right of patients to choose their own primary care doctor and having sufficient information about the changes in PHC system had a positive influence on the level of satisfaction. CONCLUSIONS: Patients' opinions are important in the evaluation of PHC. To increase the level of satisfaction, people need to understand the nature and intent of the primary care reforms. Personal choice of primary care doctor and good patient-doctor relationships are important factors too.

Sex education and contraceptive methods: knowledge and sources of information among the Estonian population.

A survey on sex education and contraceptive methods was carried out within a monthly EMOR Omnibus Survey. By using a questionnaire, knowledge and attitudes, as well as the main sources of information on contraceptive methods and sex education, among the Estonian adult population (n = 618) was investigated. Of the respondents, 68% were female and 32% were males: the mean age was 34 years. Almost all respondents expressed the opinion that sex education should start at school and that education on contraceptive methods would reduce the number of abortions. The majority of the respondents believed that it would be more convenient to visit a family doctor than a gynecologist for family planning. Main sources of information on contraception were: literature, doctors and journals, as rated by females; and literature, partners and television, as rated by males. The roles of the school nurse, father and siblings were rated as comparatively small. The level of respondents' knowledge of contraceptive methods was not too high. It is concluded that the prerequisites for changing sexual behavior and knowledge over a short time are wider use of mass media and better sex education at schools. Also, it is necessary to prepare family doctors to offer family planning services to their patients.