Factors associated with burnout among hospital-based healthcare workers during the COVID-19 pandemic: A cross-sectional CRACoV-HHS study.

AIMS: To assess the prevalence of burnout and associated factors among healthcare workers (HCWs) working in a hospital admitting patients with COVID-19. BACKGROUND: Burnout among HCWs is related to age, gender and occupation. However, little is known about organisational factors associated with burnout during the COVID-19 pandemic. DESIGN: A cross-sectional study of 1412 hospital HCWs (748 nurses) was carried out via online survey during the COVID-19 pandemic between 4 and 19 January 2021. METHODS: The Maslach Burnout Inventory-Human Services Survey, the Checklist Individual Strength questionnaire, the interRAI items covering mental health, the WHO questionnaire items assessing HCWs' preparedness and exposure to SARS-CoV-2 were used. Univariable and multivariable linear regression analyses were conducted to clarify factors associated with emotional exhaustion (EE), depersonalisation (DP) and personal accomplishment (PA). This study adheres to the STROBE guidelines. RESULTS: Burnout prevalence varied from 10.0% to 22.0%. Most respondents (83.6%) reported low PA, 22.9% high EE and 18.7% high DP. Nurses and physicians had the highest levels of EE and DP. Staff exposed or uncertain if exposed to contaminated patients' body fluids and materials had higher levels of burnout. Preparedness (training) (b = 1.15; 95%CI 0.26 to 2.05) and adherence to infection prevention and control procedures (b = 1.57; 95%CI 0.67 to 2.47) were associated with higher PA, and accessibility of personal protective equipment (PPE) (b = -1.37; 95%CI -2.17 to -0.47) was related to lower EE. HCWs working in wards for patients with COVID-19 reported lower EE (b = -1.39; 95%CI -2.45 to -0.32). HCWs who contracted COVID-19 reported lower DP (b = -0.71, 95%CI -1.30 to -0.12). CONCLUSIONS: Organisational factors such as better access to PPE, training, and adherence to infection prevention and control procedures were associated with a lower level of burnout. RELEVANCE TO CLINICAL PRACTICE: Healthcare managers should promote strategies to reduce burnout among HCWs with regard to preparedness of all staff.

Relationship between administrative characteristics of long-term care institutions and use of antipsychotics and anxiolytics in residents with cognitive impairment.

OBJECTIVES: To identify the facility characteristics that are associated with prescribing practices of typical and atypical antipsychotics, and anxiolytics in residents with cognitive impairment in long-term care (LTC) institutions. METHODS: A cross-sectional analysis of a country-representative sample of 23 LTC institutions in Poland was conducted in 2015-2016. Trained staff from each facility used the InterRAI-LTCF tool and drug dispensary cards on the day of resident's assessment to collect data on medication use from 455 residents with cognitive impairment. We used the anatomical therapeutic chemical classification and a multiple correspondence analysis. RESULTS: We identified facility characteristics associated with higher rate of prescribing of: typical antipsychotics (nursing home, private ownership status, higher staff/bed ratio of physicians and nurses, and lower as refers to care assistants); atypical antipsychotics (residential home, public ownership status, higher staff/bed ratio of care assistants, and lower as refers to physicians); and anxiolytics (residential home, facilities of small size, public ownership status, higher staff/bed ratio of care assistants, lower of nurses and physicians). In the facilities where less residents received typical antipsychotics, anxiolytics were prescribed more often, and vice versa (rho = -0.442; p = 0.035). CONCLUSION: This study showed a considerable variation in the use of typical and atypical antipsychotics, and anxiolytics between nursing and residential homes, which was associated with their organization (type, size, ownership status, and employment rate). We found a negative correlation between prescribing typical antipsychotics and anxiolytics, which made us aware that these medications may be used interchangeably in LTC facilities, despite the fact that both should be avoided.

The systematic coronary risk evaluation (SCORE) for the prevention of cardiovascular diseases. Does evidence exist for its effectiveness? A systematic review.

OBJECTIVES: The SCORE model predicts the ten-year risk of cardiovascular mortality but it is still unknown whether applying the SCORE in clinical practice subsequently improves cardiovascular disease (CVD) outcomes. The objective of this study is to assess the effect of total cardiovascular risk estimation using the SCORE in preventing serious cardiovascular events in European adults without prior CVD. METHODS AND RESULTS: Data sources: eight bibliographical databases (2003 - August 2015), other internet sources and reference lists of articles were checked. This was supplemented by contact with the board members of the European Society of Cardiology (ESC) and the authors of the SCORE model. STUDY ELIGIBILITY CRITERIA: all prospective studies in any language investigating the effect of using the SCORE on the clinical outcome (CVD death, major events and adverse outcomes) in an adult population were examined. Two reviewers assessed the studies independently (titles, abstracts, full texts). After removal of duplicates, 5,256 records were screened and 14 full text papers considered. No eligible studies were identified. An extensive literature search revealed no randomized control trial or other prospective study comparing significant clinical outcomes between groups that used the SCORE and those who did not. CONCLUSIONS: The effect of using the SCORE (with or without subsequent intervention) on CVD death, all-cause mortality, major CVD events like myocardial infarction and stroke, as well as adverse outcomes, is still unknown. A cluster randomised controlled trial is warranted to evaluate the use of the SCORE on important outcomes.

[The prevalence of chronic diseases and geriatric problems - a comparison of nursing home residents in the skilled and nonskilled long-term care facilities in Poland]. / Wystepowanie chorób przewleklych i problemów geriatrycznych - porównanie pacjentów zakladów opiekunczo-leczniczych z mieszkancami domów pomocy spolecznej.

UNLABELLED: In Poland long-term care services are provided by skilled care and treatment facilities (ZOL) and nursing and care facilities (ZPO) both functioning within the health sector as well as by non-skilled nursing homes (DPS) situated in social care sector. Determinants of medical and nursing care provided by both sectors vary considerably in terms of organization (availability) and economic issues (costs of care). AIM: The aim of the study is to compare characteristics of residents in two types of long term care facilities (LTCFs) in Poland with a special focus on geriatric issues. MATERIALS AND METHODS: The study sample comprised of 387 ZOL residents and 352 DPS residents living in 7 settings. Data was collected for 6 years period (2007-2013) using InterRAI-LTCF questionnaire. The data analysis was done with application of a Mann-Whitney U test, chisquare test and Fisher's exact test and using IBM SPSS Statistics 22. RESULTS: The DPS residents were significantly older than ZOL residents. Predominance of women (68,8%) in both LTCF types was observed. DPS residents significantly more often suffered from internal diseases: COPD (13,6% vs. 4,1%), overweight and obesity (56,1% vs. 34,9%), inflammatory polyarthropathies (4,0% vs. 0,8%), dorsopathies (8,9% vs. 1,3%), osteoporosis (7,1% vs. 1,6%), diseases of the digestive system (11,7% vs. 5,7%) and hyperplasia of prostate (4,3% vs. 0,5%). Among the residents living in ZOL more frequently were observed: significant cognitive impairment and impaired ability to perform activities of daily living (ADL), as well as significantly higher prevalence of neurological diseases (stroke 31,0% vs. 9,1%) and neurodegenerative diseases (Alzheimer's disease or dementia in 53,0% vs. 28,4%), hip fracture (8,5% vs. 2,0%) and geriatric problems (i.e. pressure ulcers 12,2% vs. 4,2%, bladder incontinence 89,9% vs. 39,6%, bowel incontinence 83,9% vs. 26,1%, and underweight BMI<18,5 kg/m2 in 17,2% vs. 2,8%). CONCLUSIONS: Significant differences between the ZOL and DPS residents in functional status and prevalence of diseases were observed. The results indicate considerable differences among the residents of different types of LTCFs, which should suggest physicians to adjust diagnostic and therapeutic approach in respect to those differences.

Prevalence of burnout among healthcare professionals during the COVID-19 pandemic and associated factors - a scoping review.

The outbreak of the COVID-19 pandemic exerted significant mental burden on healthcare workers (HCWs) operating in the frontline of the COVID-19 care as they experienced high levels of stress and burnout. The aim of this scoping review was to identify prevalence and factors associated with burnout among HCWs during the first year of the COVID-19 pandemic. A literature search was performed in PubMed, Web of Science, and CINAHL. Studies were selected based on the following inclusion criteria: cross-sectional, longitudinal, case-control, or qualitative analyses, published in peer-reviewed journals, between January 1, 2020 and February 28, 2021. Studies carried out on other occupations than healthcare workers or related to other pandemics than COVID-19 were excluded. Following the abstract screen, from 141 original papers identified, 69 articles were eventually selected. A large variation in the reported burnout prevalence among HCWs (4.3-90.4%) was observed. The main factors associated with increase/ decrease of burnout included: demographic characteristics (age, gender, education level, financial situation, family status, occupation), psychological condition (psychiatric diseases, stress, anxiety, depression, coping style), social factors (stigmatisation, family life), work organization (workload, working conditions, availability of staff and materials, support at work), and factors related with COVID-19 (fear of COVID-19, traumatic events, contact with patients with COVID-19, having been infected with COVID-19, infection of a colleague or a relative with COVID-19, higher number of deaths observed by nurses during the COVID-19 pandemic). The findings should be useful for policy makers and healthcare managers in developing programs preventing burnout during the current and future pandemics. Int J Occup Med Environ Health. Int J Occup Med Environ Health. 2023;36(1):21-58.

Measuring relatives' perceptions of end-of-life communication with physicians in five countries: a psychometric analysis.

The Family Perceptions of Physician-Family Caregiver Communication scale (FPPFC) was developed to assess quality of physician-family end-of-life communication in nursing homes. However, its validity has been tested only in the USA and the Netherlands. The aim of this paper is to evaluate the FPPFC construct validity and its reliability, as well as the psychometric characteristics of the items comprising the scale. Data were collected in cross-sectional study in Belgium, Finland, Italy, the Netherlands and Poland. The factorial structure was tested in confirmatory factor analysis. Item parameters were obtained using an item response theory model. Participants were 737 relatives of nursing home residents who died up to 3 months prior to the study. In general, the FPPFC scale proved to be a unidimensional and reliable measure of the perceived quality of physician-family communication in nursing home settings in all five countries. Nevertheless, we found unsatisfactory fit to the data with a confirmatory model. An item that referred to advance care planning performed less well in Poland and Italy than in the Northern European countries. In the item analysis, we found that with no loss of reliability and with increased coherency of the item content across countries, the full 7-item version can be shortened to a 4-item version, which may be more appropriate for international studies. Therefore, we recommend use of the brief 4-item FPPFC version by nursing home managers and professionals as an evaluation tool, and by researchers for their studies as these four items confer the same meaning across countries. Supplementary Information: The online version contains supplementary material available at 10.1007/s10433-022-00742-x.

Nonpharmacological interventions in patients with cognitive impairment: a comparison of residential and nursing homes in Poland.

INTRODUCTION: Availability of nonpharmacological interventions to manage neuropsychiatric symptoms is important to reduce the use of psychotropic drugs in residents with dementia in long­term care facilities (LTCFs). OBJECTIVES: We aimed to assess prevalence of nonpharmacological interventions in residents with cognitive impairment in LTCFs, and to find factors associated with their participation in cognitive therapy (CT). PATIENTS AND METHODS: A cross­sectional analysis of a country­representative sample of 23 LTCFs in Poland was conducted between 2015 and 2016. We used the InterRAI­LTCF tool to collect data from 455 residents with cognitive impairment. RESULTS: Most of the residents were involved in occupational therapy activities (73.4%) and medical rehabilitation (67.2%); however, less than half participated in CT (44.8%) and physical activity group (41.2%), and only 24.2% of individuals received psychological therapy (PT) and only 22.7% of residents were encouraged to enhance their ability with activities of daily living (ADL). We found a positive correlation between participation in enhancing ADL and CT (rho = 0.677; P <0.001), and a considerable variation between the LTCFs in prevalence of PT, CT, and encouraging maintaining ADL. The chance of participating in CT was higher in women (odds ratio [OR], 1.87; 95% CI, 1.15-3.04), residents of nursing homes (OR, 2.79; 95% CI, 1.69-4.60), of larger facilities (OR, 4.09; 95% CI, 2.45-6.81), and among residents having moderate cognitive impairment (OR, 2.27; 95% CI, 1.27-4.08), delusion (OR, 2.31; 95% CI, 1.34-3.98), diagnosis of depression (OR, 5.07; 95% CI, 2.31-11.14), or Alzheimer disease accompanied by behavioral disorders (OR for interaction, 5.25; 95% CI, 1.28-21.58). CONCLUSIONS: We found a relatively high use of medical rehabilitation and occupational therapy and significant diversity between facilities in use of CT, PT, and maintaining/enhancing ADL.

Factors associated with drug prescribing practices in long-term care patients with cognitive impairment.

PURPOSE: To examine factors associated with prescribing anti-dementia medicines (ADM), atypical antipsychotics (A-APM), typical antipsychotics (T-APM), anxiolytics and other psychostimulants (OP) in the residents of long-term care institutions (LTCIs). METHODS: A cross-sectional survey of a country-representative sample of randomly selected LTCIs in Poland, conducted in 2015-2016. First, we identified 1035 residents with cognitive impairment (CI) among all 1587 residents. Next, we randomly selected 20 residents from each institution. Study sample consists of 455 residents with CI: 214 recruited from 11 nursing homes and 241 from 12 residential homes. We used InterRAI-LTCF questionnaire and drug dispensary cards administered on the day of data collection to assess use of drugs. Multiple correspondence analysis (MCA), descriptive and logistic regression analyses were performed. RESULTS: The residents were treated with ADM (13.4%), OP (14.3%), antipsychotics (46.4%) including A-APM (24.2%) and T-APM (27.9%), and anxiolytics (28.4%). Hydroxyzine was used most often among anxiolytics (71.3%). Prescribing of ADM was more likely in Alzheimer's disease (OR = 4.378; 95%CI 2.173-8.823), while OP in other dementia (OR = 1.873; 95%CI 1.007-3.485). Administration of A-APM was more likely in older residents (OR = 1.032, 95%CI 1.009-1.055), and when delusions appeared (OR = 2.082; 95%CI 1.199-3.613), while there were no neuropsychiatric factors increasing the odds of T-APM use. Prescribing of anxiolytics was less likely in moderate CI (by 47.2%) than in residents with mild CI. CONCLUSION: Current practices of prescribing psychotropics are inadequate in Polish LTCIs, especially in terms of use of T-APM and hydroxyzine. More attention should be given to motivate physicians to change their prescribing practices.

Health, functional, psychological and nutritional status of cognitively impaired long-term care residents in Poland.

PURPOSE: To find if there are differences in health, functional, nutritional and psychological status among residents with cognitive impairment (CI) depending on where they stay, in nursing homes (NH) or residential homes (RH), and depending on the level of CI. To find factors increasing the probability that the resident with CI stays in the NH compared to RH. DESIGN: A cross-sectional survey of a country-representative sample of 23 LTCIs randomly selected from all six regions in Poland was conducted in 2015-2016. We included 455 residents with CI: 214 recruited from 11 NHs and 241 from 12 RHs. Data were collected using the InterRAI-LTCF tool. The descriptive analysis and logistic regression models were used. RESULTS: The NH residents more frequently had worse functional and nutritional status, and psychotic symptoms than RH ones, while they did not differ significantly in health status, frequency of behavioral problems and aggression. More advanced CI was associated with higher presence of functional disability (ADL, bowel and bladder incontinence), nutritional decline (BMI, swallowing problems, aspiration, pressure ulcers) and psychological problems (aggression, resistance to care, agitation, hallucinations and delusions). Nevertheless, the level of CI severity did not increase the chance to stay in NH compared to RH, but ADL dependency did (OR 1.52, 95% CI 1.31-1.76). CONCLUSION: The level of CI is significantly associated with physical, psychological and nutritional functioning of residents and thus may have an impact on care needs. Therefore, it is very important to use CI assessments while referring to NH or RH, to ensure that patients with CI are placed in an appropriate facility, where they may receive optimal care.

Associations between Length of Stay in Long Term Care Facilities and End of Life Care. Analysis of the PACE Cross-Sectional Study.

Long term care facilities (LTCFs) are increasingly a place of care at end of life in Europe. Longer residence in an LTCF prior to death has been associated with higher indicators of end of life care; however, the relationship has not been fully explored. The purpose of this analysis is to explore associations between length of stay and end of life care. The analysis used data collected in the Palliative Care for Older People in care and nursing homes in Europe (PACE) study, a cross-sectional mortality follow-back survey of LTCF residents who died within a retrospective 3-month period, conducted in Belgium, England, Finland, Italy, the Netherlands and Poland. Primary outcomes were quality of care in the last month of life, comfort in the last week of life, contact with health services in the last month of life, presence of advance directives and consensus in care. Longer lengths of stay were associated with higher scores of quality of care in the last month of life and comfort in the last week of life. Longer stay residents were more likely to have advance directives in place and have a lasting power of attorney for personal welfare. Further research is needed to explore the underlying reasons for this trend, and how good quality end of life care can be provided to all LTCF residents.

Factors Associated with Perception of the Quality of Physicians' End-of-life Communication in Long-Term Care Facilities: PACE Cross-Sectional Study.

OBJECTIVE: To examine factors associated with perceived quality of communication with physicians by relatives of dying residents of long-term care facilities (LTCFs). DESIGN: A cross-sectional retrospective study in a representative sample of LTCFs conducted in 2015. In each LTCF, deaths of residents during the 3 months before the researcher's visit were reported. Structured questionnaires were sent to the identified relatives of deceased residents. SETTINGS AND PARTICIPANTS: A total of 736 relatives of deceased residents in 210 LTCFs (in Belgium, Finland, Italy, the Netherlands, and Poland). METHODS: The Family Perception of Physician-Family Communication scale (FPPFC) was used to assess the quality of end-of-life (EOL) communication with physicians as perceived by relatives. We applied multilevel linear regression models to find factors associated with the FPPFC score. RESULTS: The quality of EOL communication with physicians was perceived by relatives as higher when the relative spent more than 14 hours with the resident in the last week of the resident's life (b = 0.205; P = .044), and when the treating physician visited the resident at least 3 times in the last week of the resident's life (b = 0.286; P = .002) or provided the resident with palliative care (b = 0.223; P = .003). Relatives with higher emotional burden perceived the quality of EOL communication with physicians as lower (b = -0.060; P < .001). These results had been adjusted to countries and LTCF types with physicians employed on-site or off-site of the facility. CONCLUSION: The quality of EOL communication with physicians, as perceived by relatives of dying LTCF residents, is associated with the number of physician visits and amount of time spent by the relative with the resident in the last week of the resident's life, and relatives' emotional burden. IMPLICATIONS: LTCF managers should organize care for dying residents in a way that enables frequent interactions between physicians and relatives, and emotional support to relatives to improve their satisfaction with EOL communication.

Perception of the Quality of Communication With Physicians Among Relatives of Dying Residents of Long-term Care Facilities in 6 European Countries: PACE Cross-Sectional Study.

OBJECTIVE: To examine how relatives evaluate the quality of communication with the treating physician of a dying resident in long-term care facilities (LTCFs) and to assess its differences between countries. DESIGN: A cross-sectional retrospective study in a representative sample of LTCFs conducted in 2015. Relatives of residents who died during the previous 3 months were sent a questionnaire. SETTINGS AND PARTICIPANTS: 761 relatives of deceased residents in 241 LTCFs in Belgium, England, Finland, Italy, the Netherlands, and Poland. METHODS: The Family Perception of Physician-Family Communication (FPPFC) scale (ratings from 0 to 3, where 3 means the highest quality) was used to retrospectively assess how the quality of end-of-life communication with treating physicians was perceived by relatives. We applied multilevel linear and logistic regression models to assess differences between countries and LTCF types. RESULTS: The FPPFC score was the lowest in Finland (1.4 ± 0.8) and the highest in Italy (2.2 ± 0.7). In LTCFs served by general practitioners, the FPPFC score differed between countries, but did not in LTCFs with on-site physicians. Most relatives reported that they were well informed about a resident's general condition (from 50.8% in Finland to 90.6% in Italy) and felt listened to (from 53.1% in Finland to 84.9% in Italy) and understood by the physician (from 56.7% in Finland to 85.8% in Italy). In most countries, relatives assessed the worst communication as being about the resident's wishes for medical treatment at the end of life, with the lowest rate of satisfied relatives in Finland (37.6%). CONCLUSION: The relatives' perception of the quality of end-of-life communication with physicians differs between countries. However, in all countries, physicians' communication needs to be improved, especially regarding resident's wishes for medical care at the end of life. IMPLICATIONS: Training in end-of-life communication to physicians providing care for LTCF residents is recommended.

Advance directives in European long-term care facilities: a cross-sectional survey.

BACKGROUND: End-of-life care practices in long-term care facilities (LTCFs) are the focus of growing attention in Europe, due to rapidly increasing number of older persons living in LTCFs. The knowledge about end-of-life discussions or existence of written advance directives in the European LTCFs is scarce. This study's aim is to investigate the prevalence of written advance directives and their sociodemographic associates, among recently deceased LTCF residents, in six European countries. METHODS: Data from the European Union-funded PACE database were collected from 322 LTCFs in six European countries in 2014. The assessments were performed by using two questionnaires designed for LTCF administrative staff and for staff member.LTCFs were selected within each country by using proportional stratified random sampling procedure. Facilities with certain types and sizes were included from each country.Multilevel multivariate analyses were performed to evaluate associations between written advance directives and selected predictors. RESULTS: In total, 32.5 % of the 1384 deceased LTCF residents had a written advance directive with a range from 0% to 77 % between countries. The proportion of the most common advance directive, 'Do not resuscitate in case of cardiac or respiratory arrest (DNR)', varied correspondingly from 0% to 75%.LTCF type (OR 2.86 95% CI 1.59 to 5.23) and capability of expressing at the time of admission (OR 3.26 95% CI 2.26 to 4.71) were the independent predictors for advance directive. Residents living in LTCFs where physician was available were less likely to have advance directive compared with residents from LTCFs where physician was not available. CONCLUSION: Extensive differences for prevalence of written advance directive exist between countries among older LTCF residents in Europe. Timely and appropriate response to LTCF resident's health needs and preferences efforts advance care planning.

Evaluating the implementation of the PACE Steps to Success Programme in long-term care facilities in seven countries according to the RE-AIM framework.

BACKGROUND: The PACE 'Steps to Success' programme is a complex educational and development intervention for staff to improve palliative care in long-term care facilities (LTCFs). In a cluster randomized controlled trial, this programme has been implemented in 37 LTCFs in 7 European countries. Alongside an effectiveness study, a process evaluation study was conducted. This paper reports on the results of this process evaluation, of which the aim was to provide a more detailed understanding of the implementation of the PACE Programme across and within countries. METHODS: The process evaluation followed the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework and involved various measures and tools, including diaries for country trainers, evaluation questionnaires for care staff, attendance lists and interviews (online and face-to-face, individual and in groups) with country trainers, managers, PACE coordinators and other staff members. Based on key elements of the PACE Programme, a priori criteria for a high, medium and low level of the RE-AIM components Reach, Adoption, Implementation and intention to Maintenance were defined. Qualitative data on factors affecting each RE-AIM component gathered in the online discussion groups and interviews were analysed according to the principles of thematic analysis. RESULTS: The performance of the PACE Programme on the RE-AIM components was highly variable within and across countries, with a high or medium score for in total 28 (out of 37) LTCFs on Reach, for 26 LTCFs on Adoption, for 35 LTCFs on Implementation and for 34 LTCFs on intention to Maintenance. The factors affecting performance on the different RE-AIM components could be classified into three major categories: (1) the PACE Programme itself and its way of delivery, (2) people working with the PACE Programme and (3) contextual factors. Several country-specific challenges in implementing the PACE Programme were identified. CONCLUSIONS: The implementation of the PACE Programme was feasible but leaves room for improvement. Our analysis helps to better understand the optimal levels of training and facilitation and provides recommendations to improve implementation in the LTC setting. The results of the process evaluation will be used to further adapt and improve the PACE Programme prior to its further dissemination. TRIAL REGISTRATION: The PACE study was registered at www.isrctn.com-ISRCTN14741671 (FP7-HEALTH-2013-INNOVATION-1 603111) July 30, 2015.

Prevalence of cognitive impairment among long-term care residents: a comparison between nursing homes and residential homes in Poland.

PURPOSE: Large-scale nationwide comparative studies of older adults with cognitive impairment (CI) in long-term care institutions (LTCI) hardly exist in Poland. This paper compares the prevalence of CI and its symptoms in residents of nursing homes (NHs) and residential homes (RHs) in Poland. METHODS: A cross-sectional survey of a country-representative sample of 23 LTCIs was conducted in the years 2015-2016. In total, 1587 residents were included: 626 residents in 11 NHs and 961 residents in 12 RHs. All individuals were assessed with a Cognitive Performance Scale (CPS) using a cutoff of ≥ 2 points to define the presence of CI. Descriptive statistics and Chi square test were used. RESULTS: The median age was 80 years, 67.7% were women. Overall, 65.2% of residents (n = 1035) were identified as having CI, ranging from 59.2% in RHs to 74.5% in NHs, after excluding residents in a coma. Furthermore, the prevalence of severe CI was significantly higher in NHs than in RHs (respectively, 41.2 and 20.5%). It concerned specifically impairment of memory: procedural (72.3 vs 55.2%), long-term (56.5 vs 32.1%), short-term (46.8 vs 33.4%), and situational one (40.2 vs 26.4%), as well as problems with being understood by others (44.6 vs 24.7%) and severely impaired capacity of daily decision making (44.7 vs 21.5%). CONCLUSIONS: A high prevalence of CI was found in both LTCI types, but its severity differed, with statistically significantly higher rates in NHs compared to RHs. Therefore, we call for more attention to be paid to better recognition of CI in LTCI residents, regardless of the facility type.

Comparing Palliative Care in Care Homes Across Europe (PACE): Protocol of a Cross-sectional Study of Deceased Residents in 6 EU Countries.

OBJECTIVES: Although a growing number of older people are dying in care homes, palliative care has developed in these settings only recently. Cross-country representative comparative research hardly exists in this area. As part of a large EU-funded project, we aim to undertake representative comparative research in care homes in Europe, to describe and compare 6 countries in terms of (1) resident outcomes, quality and costs of palliative and end-of-life care; and (2) palliative care structures and staff knowledge and attitudes toward palliative care. We also aim to explore country, facility, staff, patient, and care characteristics related to better outcomes at resident level. DESIGN AND METHODS: To obtain a representative nationwide sample, we will conduct a large-scale cross-sectional study of deceased residents in care homes in Belgium, Finland, Italy, the Netherlands, Poland, and the United Kingdom, using proportional stratified random sampling (taking into account region, facility type and bed capacity). In each country, all participating care homes retrospectively report all deaths of residents in and outside the facilities over the previous 3-month period. For each case, structured questionnaires, including validated instruments, are sent to (1) the administrator/manager, (2) staff member most involved in care, (3) treating physician (general practitioner or elderly care physician), and (4) a closely involved relative. It is estimated that, per country, 50 care homes are needed on average to obtain a minimum of 200 deceased residents. Collected data include clinical and sociodemographic characteristics, quality of dying, quality and costs of palliative care and end-of-life care, and palliative care structures at the facility level and country level. To obtain a representative view of staff knowledge and attitudes regarding palliative care, PACE will conduct a cross-sectional study of staff working in the participating care homes. CONCLUSION: Considering the growing challenges associated with aging in all European countries, there is an urgent need to build a robust international comparative evidence base that can inform the development of policies to target improved palliative care in care homes. By describing this research protocol, we hope to inform international research in care homes on how to perform representative end-of-life care research in these settings and better understand which systems are associated with better outcomes.

Lipid-lowering pharmacotherapy in Central and Eastern European countries in cardiovascular prevention: self-reported prescription patterns of primary care physicians.

AIMS: The aims of this study were (1) to explore physicians' self-reported treatment of patients with dyslipidemia and (2) to identify intercountry differences and associations between physicians' characteristics and treatment patterns. METHODS: A cross-sectional survey was performed in primary health care in 9 Central and Eastern European countries. An anonymous questionnaire, which included questions devoted to dyslipidemia treatment, was distributed. RESULTS: A total of 3000 physicians were randomly chosen and 867 responded. The mean percentage of physicians in all countries who reported regular use of statins in primary prevention of cardiovascular diseases (CVD) was 86.4 (range between 91.0% of Polish physicians and 75.7% of Czech physicians; P < .01). In secondary prevention, the mean percentage was only a little higher, 89.9. The use of fibrates for primary prevention was reported by 40.3% of the respondents from Bulgaria and by 2% of the respondents from Estonia (P < .01). Also, significant differences between countries were found in the use of fibrates and combination therapy in secondary prevention. Atorvastatin and simvastatin were the most prescribed drugs in everyday practice (the mean percentage of physicians in all countries was 72.5% and 68.0%, respectively). More than three-fourth of the respondents reported prescribing lifelong treatment with statins. Inconsistent associations were found between the characteristics of physicians and their treatment patterns. CONCLUSIONS: There are significant variations in the use of lipid-lowering drugs in Central and Eastern European countries; however, statin monotherapy predominates. Some physicians' decisions are made without supporting evidence from clinical trials. There is still scope to improve preventive care of CVD.

Cross-cultural Adaptation of a Questionnaire on Self-perceived Level of Skills, Abilities and Competencies of Family Physicians in Albania.

OBJECTIVE: Our aim was to validate an international instrument measuring self-perceived competency level of family physicians in Albania. METHODS: A representative sample of 57 family physicians operating in primary health care services was interviewed twice in March-April 2012 in Tirana (26 men and 31 women; median age: 46 years, inter-quartile range: 38-56 years). A structured questionnaire was administered [and subsequently re-administered after two weeks (test-retest)] to all family physicians aiming to self-assess physicians' level of abilities, skills and competencies regarding different domains of quality of health care. The questionnaire included 37 items organized into 6 subscales/domains. Answers for each item of the tool ranged from 1 ("novice" physicians) to 5 ("expert" physicians). An overall summary score (range: 37-185) and a subscale summary score for each domain were calculated for the test and retest procedures. Cronbach's alpha was used to assess the internal consistency for both the test and the retest procedures, whereas Spearman's rho was employed to assess the stability over time (test-retest reliability) of the instrument. RESULTS: Cronbach's alpha was 0.87 for the test and 0.86 for the retest procedure. Overall, Spearman's rho was 0.84 (P<0.001). The overall summary score for the 37 items of the instrument was 96.3±10.0 for the test and 97.3±10.1 for the retest. All the subscale summary scores were very similar for the test and the retest procedure. CONCLUSION: This study provides evidence on cross-cultural adaptation of an international instrument taping self-perceived level of competencies of family physicians in Albania. The questionnaire displayed a satisfactory internal consistency for both test and retest procedures in this sample of family physicians in Albania. Furthermore, the high test-retest reliability (stability over time) of the instrument suggests a good potential for wide scale application to nationally representative samples of family physicians in Albanian populations.

Quality improvement competency gaps in primary care in Albanian, polish and slovenian contexts: a study protocol.

BACKGROUND: Nowadays, general practitioners (GPs) and family doctors (FDs) face increasing demands, as a consequence of complex patients' expectations, developments in science and technology, and limitations within healthcare systems which can result in competency gaps. Therefore, there is a need to identify which competencies in quality improvement (QI) are most important for GPs and FDs to possess in order to meet the demands of contemporary health care practice. To date, however, little information is available on the self-assessment of competencies related to QI among GPs and FDs. To deal with these issues, a project on QI in continuous medical education was launched in 2011. The project aims to broaden the GPs'/ FDs' continuous education offer, its quality and attractiveness, as well as provide them with opportunities for vocational advancement and enable the development of common, European frame of reference for GPs'/FDs' occupational competencies. The third work package of the project consists of the validation research of the questionnaire developed on the basis of the competency framework in QI for GPs/FDs in Europe. METHODS: A cross-sectional study will be carried out using the self-assessment QI questionnaire which was originally developed in English and subsequently it was cross-culturally adapted in Slovenian, Albanian and Polish settings by use of a pilot study on a conveniently selected group of FDs/GPs (N=10) in each participating country. The final version of the questionnaire will be administered to large samples in each country involved in the survey. Two weeks after the first administration of the questionnaire, a second round, with the same procedure and including the same group of respondents, will follow. Psychometric tests will be conducted including internal consistency (after the initial and subsequent application of the instrument) and stability over time (two-week test-retest reliability). DISCUSSION: This self-assessment study will demonstrate the complex environment in which general practice/family medicine operates and, eventually, this gap analysis will set out strategically important areas for collaborative efforts related to QI in primary care. The authors consider that the study should be extended to other European countries to help identify most required competencies that GPs/FDs should possess in Europe and thus stir system and educational debate around QI curricula and training for primary care in Europe.