Unmet Needs and Pro-health Behavior in Patients with Chronic Respiratory Diseases.

Coordinated healthcare paradigm addressing the biopsychosocial spheres of patients seems advantageous for the management of chronic diseases. The purpose of the study was to determine the influence of unmet needs on pro-health behavior in chronic respiratory diseases and to recognize the factors that help identify the unmet needs. The patients were asked to complete the Camberwell Assessment of Needs Inventory and the Health Behavior Inventory. The study group consisted of 171 adult patients with chronic respiratory diseases. The study participants were recruited from among the patients of 130 general practitioners between July 2011 and March 2016. The findings of this study indicate that any prevention program should focus on increasing the level of satisfied needs in patients with chronic respiratory diseases. For the most effective treatment, fragmented and disease-focused processes should be replaced by integrated health and social care. We conclude that the treatment process that involves interdisciplinary clinical approach, which, aside from the physical treatment, could recognize and address the psychological aspects of unmet needs would be conducive to undertake pro-health behavior by pulmonary patients.

Usage of Over-the-Counter and Herbal Products in Common Cold in Poland: Findings from Consumer Survey.

Upper respiratory tract infections are usually self-treated with synthetic and herbal over-the-counter products. The aim of the study was to assess the reasons for the purchase of those medications in Poland. We examined 413 adults, aged 18 and over (70.5% of them were women) using a questionnaire. The findings demonstrate that oral synthetic products were used by 76% of respondents, while herbal products by 30%. Synthetic products were used mainly by educated people under 65 years of age, students, and the employed. Herbal products were used mainly by older people. In conclusion, synthetic products against common cold are perceived as more effective. Such medications are used by people who probably would like to recover and return to professional activity as quickly as possible. As they generally use more medications, they are at increased risk of adverse effects resulting from drug interactions, and they should be a target group for health education programs.

The Influence of Online Health Information on the Attitude and Behavior of People Aged 50.

E-patients 'empowered' by Web information are much more likely to participate in health care decision processes and take responsibility for their own health. The purpose of the study was to determine the influence of Internet use and online health information on the attitude, behavior, and emotions of Polish citizens aged 50+, with special regard to their attitude towards health professionals and the health care system. A total of 323 citizens, aged 50 years and above, who used the Internet for health purposes, were selected from the Polish population by random sampling. The sample collection was carried out by Polish opinion poll agencies in 2005, 2007, and 2012. The Internet was used by 27.8 % of Polish citizens aged 50+ for health purposes in the years 2005-2012. 69.7 % of respondents were looking for health information that might help them to deal with a consultation, 53.9 % turned to the Internet to prepare for a medical appointment, and 63.5 % to assess the outcome of a medical consultation and obtain a 'second opinion'. The most likely effects of health related use of the Internet were: willingness to change diet or other life-style habits (48.0 % of respondents) and making suggestions or queries on diagnosis or treatment by the doctor (46.1 %). Feelings of reassurance or relief after obtaining information on health or illness were reported by a similar number of respondents as feelings of anxiety and fear (31.0 % and 31.3 % respectively). Online health information can affect the attitudes, emotions, and health behaviors of Polish citizens aged 50+ in different ways.

Respiratory tract infections in children in primary healthcare in Poland.

Respiratory tract infections are the most common diseases in children. The aim of the study was to assess their frequency and antibiotic treatment in Poland. We retrospectively analyzed 91 randomly-selected children aged 0-17 years receiving care from birth in a large primary healthcare establishment in the city of Wroclaw in Poland. Respiratory tract infections were responsible for 25-40 % of all primary healthcare visits. The median of visits due to upper respiratory tract infections was 1.8 per year in all children and 2.0 per year in children 0-3 years old. Antibiotics were overused; the majority (57.4 %) of the respiratory infections were treated with antibiotics: acute tonsillitis in 90.7 %, bronchitis in 67.5 %, otitis media in 65.9 %, pneumonia in 60.9 %, non-specific upper respiratory tract infections in 25.8 %, laryngitis in 22.2 %, and sinusitis in 12.5 %. The higher the number of antibiotic therapies, the higher the total number of visits including visits due to respiratory tract infections. In conclusion, implementation of careful and responsible management of a rational use of antibiotics is urgently needed since a reduction in their use may lead to a decrease in the number of visits due to upper respiratory tract infections and a total number of primary care visits.

Quality of life and health care utilization in patients with chronic respiratory diseases.

High quality of life (QoL) may reduce the costs of medical care of chronically ill patients due to lower health care utilization. The purpose of this study was to establish the influence of the QoL of primary care patients with chronic respiratory diseases on the level of health care utilization and the predictors of hospitalization. The study group consisted of 594 adult patients with chronic respiratory diseases of the mean age 59.8±14.9 years. The highest QoL was observed in the social relationship domain and the lowest in the physical domain. Low QoL was associated with a low level of health care utilization among patients with chronic respiratory diseases. Most patients were hospitalized during the past 3 years. In a group of patients with chronic respiratory diseases, chances for hospitalization were: higher among patients with low QoL and health satisfaction, low QoL levels in the physical and social relationship domains, high QoL levels in the psychological domain, those with higher education, residents of rural areas, patients using frequent consultations over the phone, and those with at least an average index of services.

The Influence of Asthma Exacerbations on Health-Related Quality of Life.

The purpose of this study was to determine the influence of asthma on the quality of life (QoL) of patients hospitalized for an exacerbation of the disease and those with controlled asthma receiving outpatient treatment, and to establish the patients' somatic status and the level of health care utilization. This study involved 239 adults with asthma (123 hospitalized patients and 116 outpatients of family physicians). The authors used: WHOQOL-BREF questionnaire and a questionnaire measuring health care utilization. There were no differences in QoL levels between the patients with severe and controlled asthma. The psychological domain was assessed higher by hospitalized patients (p = 0.02). QoL levels correlated negatively with age, place of residence, and marital status, and positively with education. The general QoL level was most strongly influenced by gender, age, education, the number of home visits and interventions of a district nurse, and the somatic index (p < 0.05). Somatic symptoms were more severe in hospitalized patients. The QoL assessment of asthma patients in relation to somatic symptoms, health care services and socio-demographic variables allows better understanding of the complex health situation of patients at various stages of the disease, and tailoring the therapy to individual needs. Patients receiving outpatient treatment require professional psychotherapeutic support.

Factors Influencing Utilization of Primary Health Care Services in Patients with Chronic Respiratory Diseases.

The purpose of our study was to determine the factors affecting the level of services provided in primary health care among patients with chronic respiratory diseases. The study group consisted of 299 adults (median age: 65, min-max: 18-92 years) with mixed chronic respiratory diseases, recruited from patients of 135 general practitioners. In the analysis, in addition to the assessment of the provided medical services, the following were used: Patient Satisfaction Questionnaire, Camberwell Assessment of Needs Short Appraisal Schedule, Acceptance of Illness Scale, and WHO Quality of Life Instrument Short Form. Variables that determined the level of services were the following: age, place of residence, marital status, number of chronic diseases, and level of disease acceptance, quality of life, and health behaviors. The level of provided services correlated with variables such as gender, severity of somatic symptoms, level of satisfied needs, and satisfaction with health care. We concluded that in patients with mixed chronic respiratory diseases a higher level of health care utilization should be expected in younger patients, those living in the countryside, those having a partner, with multimorbidity, a low level of disease acceptance, those satisfied with their current quality of life, with positive mental attitudes, and maintaining health practices.

Does health status influence acceptance of illness in patients with chronic respiratory diseases?

The level of illness acceptance correlates positively with compliance to the doctor's recommendations, and negatively with the frequency and intensity of complications of chronic diseases. The purpose of this study was to determine the influence of the clinical condition on the level of illness acceptance, and to find variables which would have the most profound effect on the level of illness acceptance in patients with chronic respiratory diseases. The study group consisted of 594 adult patients (mean age: 60 ± 15 years) with mixed chronic respiratory diseases, recruited from patients of 136 general practitioners. The average score in the Acceptance of Illness Scale was 26.2 ± 7.6. The low level of illness acceptance was noted in 174 (62.6 %) and high in 46 (16.6 %) patients. Analysis of multiple regressions was used to examine the influence of explanatory variables on the level of illness acceptance. The variables which shaped the level of illness acceptance in our patients included: improvement of health, intensity of symptoms, age, marital status, education level, place of residence, BMI, and the number of chronic diseases. All above mentioned variables should be considered during a design of prevention programs for patients with mixed chronic respiratory diseases.

Antibiotic consumption pattern in the neonatal special care unit before and after implementation of the hospital's antibiotic policy.

Current and detailed knowledge of antibiotic use is essential in order to implement strategies for reducing the overuse of antibiotics. The objective of our study was to determine the effectiveness of the implementation of the hospital antibiotic policy (HAP) by assessing antibiotic consumption in the Special Neonatal Care Unit (SNCU) in Warsaw, Poland, before and after this intervention. Antibiotic use was calculated in daily defined doses (DDDs) per 100 patient-days and DDDs per 100 admissions. The antibiotics were ranked by volume of DDDs and the number of antibiotics, which accounted for 90 % and 100 % of the total volume, respectively: DU90% and DU100% (where DU stands for drug use). Total antibiotic consumption increased slightly after the introduction of the HAP: the total DDDS was 707.87 and 753.12 in 2011 and 2012, while the number of DDDs/100 admissions was 352.17 and 369.12 in 2011 and 2012, respectively. After the introduction of the HAP, an increase in ampicillin and aminoglycoside use was observed, along with a reduction in the DU100% and DU90% rates (15 vs. 9 and 4 vs. 3, respectively). The introduction of the HAP resulted in changes in antibiotic consumption patterns, but the general antibiotic consumption density remained the same.

Unmet Needs of Patients with Chronic Respiratory Diseases Within Primary Healthcare.

There is no data on the level of unmet needs in the heterogenic group of chronically ill patients. The purpose of this study was to define the degree of unmet needs in patients with chronic respiratory diseases and to identify the factors that determine them. The study group consisted of 214 adult patients with the median age of 65 (min-max: 18-90 years). Variables affecting the level of satisfied needs were the following: gender, age, marital status, place of residence, number of chronic diseases, somatic symptoms, level of disease acceptance, level of quality of life (QoL), and health behaviors. The prevention program to increase the level of satisfied needs in patients with chronic respiratory diseases, apart from obviously being addressed to those with low levels of health satisfaction and quality of life indices, should be addressed to men, the elderly, those having no partner, living in the countryside, and having multiple somatic symptoms. Patients with a high level of disease acceptance, those maintaining physical quality of life and advantageous health behaviors should be considered as well.

Rural and urban disparities in quality of life and health-related behaviors among chronically ill patients.

INTRODUCTION: The purpose of this study was to describe rural and urban disparities in quality of life and health-related behaviors among chronically ill patients. Additionally, effects of health status and health-related behaviors on healthcare utilization were investigated. METHODS: The study included 1239 chronically ill patients from primary care centers in rural areas (eligible patients; response rate: 62.0%). The analyzed group was compared with the urban group, homogeneous in respect of gender and age (n=1886). Quality of life (QoL) was measured using the World Health Organization Quality of Life Instrument Short Form (WHOQoL-Bref). The authors also used the Health Behavior Inventory (HBI). RESULTS: Only the results in Domain 4 (Environmental) were higher among patients from rural areas (13.6 vs 13.4, p=0.015) within the WHOQoL-Bref. Differences between rural and urban areas in the contributors to lower QoL referred to such variables as gender, height, body mass, BMI and level of healthcare utilization. Results of HBI were higher in patients from urban areas (85.0 vs 83.1, p<0.001). The differences in factors potentially contributing to lower levels of health behavior concerned gender, age, height, body mass, BMI, having a partner, number of chronic diseases and level of healthcare utilization. The authors observed among the rural patients fewer visits of district nurses (12.1 vs 15.3, p=0.003). Odds ratio (OR) for QoL in the case of place of residence (rural vs urban) was OR=1.341 (95% CI: 1.067-1.687). CONCLUSIONS: Higher quality of life may reduce the level of healthcare utilization among residents of rural and urban areas. Educational programs, promoting health behaviors, should be primarily addressed to rural patients, men, younger individuals, patients with a lower number of chronic diseases, and those using healthcare services less often.

Health behaviors and quality of life among patients with chronic respiratory disease.

The purpose of this study was to analyze health behaviors of patients with chronic respiratory disease and the correlations between health behaviors (HB) and quality of life (QoL). The study involved 256 adult patients (135 women and 121 men), mean age was 62.6 ± 16.1 years, with chronic respiratory disease. The research tools consisted of the Health Behavior Inventory (HBI) and the World Health Organization Quality of Life Instrument Short Form. The mean general score for HB was 85.6 ± 17.8. Most patients (74 persons) obtained high scores (7-10 stens). The strongest correlations between QoL and HB were as follows: Psychological Domain correlated with positive mental attitude (r = 0.308, p < 0.001), healthy eating habits (r = 0.224, p = 0.001), and with the level of health behaviors (r = 0.222, p = 0.003); Social Relationship Domain correlated with positive mental attitude (r = 0.282, p < 0.001) and healthy eating habits (r = 0.238, p < 0.001). We conclude that QoL in patients with chronic respiratory diseases is significantly shaped by their health behaviors.

The correlation between quality of life, acceptance of illness and health behaviors of advanced age patients.

The purpose of this study was to analyze correlations between quality of life (QoL), acceptance of illness (AI), and health behaviors (HB) demonstrated by chronically ill patients of advanced age. The study was comprised of 1974 chronically ill primary care patients (mean age 71.60±7.98 years) recruited from 131 primary care practices. QoL was assessed with the World Health Organization Quality of Life Instrument Short Form. The patients' AI with the Acceptance of Illness Scale (AIS) and the Health Behavior Inventory (HBI) measured four categories of HB: healthy eating habits (HEH), preventive behaviors (PB), positive mental attitudes (PMA) and health practices (HP). The Spearman rank correlation test was used to check correlations between the variables and analysis of multiple regression was used in order to examine the impact of explanatory variables on the response variable. The highest scores were obtained in the Social Relationship Domain of QoL (M=13.68±2.75) and the lowest in the Psychological Domain of QoL (M=12.38±2.66) of the patients. The low AI was noted in 65.68% (1221). Lower level of QoL and AI were observed in patients with a larger number of chronic diseases and higher health care utilization. The lowest HB scores were obtained in the category of PMA (M=3.61±0.73) and HEH (M=3.36±0.84). The AI level correlated strongest with: Physical Domain of QoL (r(S)=0.49, p<0.0001) and PMA (r(S)=0.23, p<0.0001). HB correlated strongest with Psychological Domain of QoL (r(S)=0.33, p<0.0001). Health behavior programs for chronically ill patients of advanced age should stimulate health behavior categories such as PMA and HEH, and raise the AI level. This would result in a higher QoL and, consequently, a lower health care utilization.

Principles of family practitioners and nephrologists collaboration.

There is a need to establish clear standards of cooperation family doctors with specialists and arrange specialist service for family practitioners to improve a care for patients with urinary system diseases. Our paper presents attempt on the estimation of medical care system reform and state of general practitioners with specialists cooperation level as well as draw conclusions regarding possibilities of specialist and primary care contacts improvement and by this--increasing of comprehensive patients care quality. Family doctor never tried to replace with a specialist. Only constructive and professional cooperation specialists with family doctors can secure proper care for patients.