[Care for terminal cancer patients at general practitioner office]. / Skrb za umiruce od karcinoma u ordinacijama obiteljske medicine.

The final goal of palliative care is symptom relief and improving the quality of life. Around 70% of cencer patients suffer pain. Therapy and care provided for dying cancer patients by general practitioners at Dugave-Travno GP Office were investigated. Medical records of 70 cancer patients were collected and analyzed. Sixty-seven patients had died. A total of 76 cancers at 22 various sites were diagnosed. There were 79 associated diseases diagnosed in 44 patients, along 43 diseases related to malignant disease in 26 patients. Physicians provided home nursing for 30 patients. In 66 cases family provided support. Physicians collaborated with community health nurses in 38 cases. A total of 66 patients were using analgesic therapy, 37 patients continuously, and 48 patients for up to one year. In 56 patients analgesic drugs were administered orally, in 25 parenterally, in 16 rectally, and in 21 patients transdermally. Physicians prescribed opioid therapy in 55 patients: codeine in 2, tramadol in 46, pentazocine in 7, methadone in 5, Kapanol in 15 and fentanyl in 21 patients. Sixty patients received adjuvant drug therapy. A total of 59 patients were hospitalized in terminal stage of the disease. Study results showed a high rate of associated diseases and diseases related to malignant disease in cancer patients. The collaboration between general practitioners and family members was satisfactory. Community health services should be improved, and the World Health Organization guidelines on palliative care, management of malignant pain in particular, should be more thoroughly followed.

[Is family physician concept possible to resume?]. / Je li moguc povratak konceptu obiteljskog lijecnika?

AIM: An anonymous survey was performed in a sample of 454 adult patients from the catchment population of eight family medicine teams at Dugave-Travno Clinic in Zagreb to assess their attitudes towards the family physician concept, its advantages and shortcomings. These family medicine teams providing care for 16,077 insures also the number of families with all their members receiving care from these teams. METHOD: The method of descriptive statistics was used. RESULTS: Data were obtained on the number of families where only some members received care at the same physician's office and on the proportion of individual family members receiving care at family medicine offices. The sample indicated that more than half of patients received care from the same family physician, and that only one tenth of patients were without their family medical file. Study subjects considered that the family doctor institution contributed to improved care and were aware of the advantages of the family doctor concept. The concept of comprehensive family treatment could currently be implemented in half of the patients. However, the other half are broken up, receiving medical care at offices of different teams. CONCLUSION: The family physician concept could be implemented in two ways: exchange of the insures among the teams at a particular clinic providing care for defined populations, and in administrative way. The family physician concept would require two strategic decisions: establishment and development of group practice, and virtual linkage of the family member medical data through an integrated primary health care information system.