Say it in Croatian--Croatian translation of the EGPRN definition of multimorbidity using a Delphi consensus technique.

Patients coming to their family physician (FP) usually have more than one condition or problem. Multimorbidity as well as dealing with it, is challenging for FPs even as a mere concept. The World Health Organization (WHO) has simply defined multimorbidity as two or more chronic conditions existing in one patient. However, this definition seems inadequate for a holistic approach to patient care within Family Medicine. Using systematic literature review the European General Practitioners Research Network (EGPRN) developed a comprehensive definition of multimorbidity. For practical and wider use, this definition had to be translated into other languages, including Croatian. Here presented is the Croatian translation of this comprehensive definition using a Delphi consensus procedure for forward/backward translation. 23 expert FPs fluent in English were asked to rank the translation from 1 (absolutely disagreeable) to 9 (fully agreeable) and to explain each score under 7. It was previously defined that consensus would be reached when 70% of the scores are above 6. Finally, a backward translation from Croatian into English was undertaken and approved by the authors of the English definition. Consensus was reached after the first Delphi round with 100% of the scores above 6; therefore the Croatian translation was immediately accepted. The authors of the English definition accepted the backward translation. A comprehensive definition of multimorbidity is now available in English and Croatian, as well as other European languages which will surely make further implications for clinicians, researchers or policy makers.

[Referring process in family medicine--contribution assessment]. / Upucivanje iz ordinacije obiteljskog lijecnika--procjena doprinosa.

AIMS: The aim of the study was to follow and analyze patient referrals from general practice (GP) to diagnostic procedures and specialist consultations. Data on the kinds of diagnostic procedures, specialist consultations and requests for referrals were collected. Specific aim was to assess the contribution of referring for definitive diagnosis and to compare the frequency and contribution of first and repeat consultations. METHODS: This prospective study was conducted in the course of one month at six GP practices (three urban and one rural practice in inland area, and one urban and one rural practice in coastal area of Croatia). Patient sociodemographic data (age and sex), referral request (by patient, GP, GP and specialist in agreement, specialist only) and kind of visit (first, follow-up) were collected. The contribution of referrals was assessed by GPs using modified Likert's scale (1-markedly significant, 2-significant, 3-undetermined, 4-small and 5-insignificant). On comparison of frequencies chi square test was used. Statistical analyses were done by use of licensed software (SAS Institute Inc, Cary, NC, USA). RESULTS: During one month, 1815 patients were referred, 979 for diagnostic procedures and 836 for specialist consultation (mean age 55.25 +/- 19.70; male 56.30 +/- 19.10, female 54.50 +/- 20.30). Most frequent diagnostic procedures requested were biochemical laboratory in primary health care setting (n = 331; 33.41%) and secondary care (n =1 18; 12.05%), basic radiology (n=106; 10.83%), ultrasonography (n=87; 8.80%) and microbiological laboratory (n = 68; 6.95%). The contribution of diagnostic procedures was mostly assessed as significant (54.84%). When GP and specialist indicated diagnostic procedure concordantly, its contribution was mostly assessed as significant (61.90%) and markedly significant (10.12%). Specialist consultations were used as follows: physical medicine in 131 (19%), surgeon in 90 (13%) and psychiatrist in 69 (10%) patients from inland area, cardiologist in 53 (37%), psychiatrist in 17 (12%) and oncologist in 12 (8%) patients from coastal area. Both in rural and urban practices in inland and coastal area surgeon consultations were assessed as markedly significant. Urban GPs assessed the contribution of first and follow-up check ups as undetermined or small more often than rural GPs (first check ups Xchi =21.66; P<0.0001; follow-up check ups chi2 = 196.38; P < 0.0001). Rural GPs assessed the contribution of first check ups more often as undetermined or small than significant (chi2 = 12.02; P = 0.0005), with the same tendency recorded for follow-up check ups (Xchi =32.01; P < 0.0001). CONCLUSION: GP should maintain the gatekeeping role to assure good quality of care and rationality in using available resources. Cooperation between GPs and specialists is essential to achieve good quality of care. GPs should restore role in indicating follow-up check ups.

Information systems and the electronic health record in primary health care.

The implementation of information systems into primary health care opened the possibilities of providing integrated and co-ordinated health care, improved in quality and focused on the healthcare user. The healthcare system, researchers, physicians, and patients have recognised the benefits offered by informatics, but also raised questions that have yet to be answered.

[Quality of life assessment of the male with benign prostate hypertrophy]. / Procjena kvalitete zivota muskaraca s benignom hiperplazijom prostate.

INTRODUCTION: Benign prostate hypertrophy (BPH) is prostate enlargement caused by the proliferation of the glandular, fibrous and muscular parenchyma of periurethral formations. BPH is a histological diagnosis with clinical manifestation of the lower urinary system symptoms. AIM: The aim of the study was to assess the patients' quality of life and to identify BPH symptoms that do and do not influence the patients' quality of life. Assessment was made by use of IPSS questionnaire (International Prostate Symptom Score) and patients' own assessment. METHOD: A prospective study of the BPH patients' quality of life was conducted at 5 family medicine practices. Statistical analysis was performed by use of SPSS software. RESULTS: Data analysis showed the mean patient age to be 65.4 +/- 7.1 (X +/- SD) years. Medicamentous therapy was used in 86 and surgical therapy in 14 patients. The mean symptom duration was 8 +/- 4.3 (X +/- SD) years. Considering correlation of the quality of life with particular disease symptoms, results of this study showed only some BPH symptoms to influence the quality of life. The feeling of incomplete bladder emptying, weak urine stream and nocturnal frequency symptoms showed a statistically significant correlation with quality of life. Symptom score showed a statistically significant correlation with patients' quality of life assessment, i. e. the lower the quality of life assessment, the higher the symptom score. DISCUSSION: The influence of only some disease symptoms on the patients' quality of life observed in this study could be explained by the small sample size, unfavorable distribution according to symptom presence, and treatment effects. CONCLUSION: Most of our BPH patients had mild symptoms, however, in some patients symptoms were rather pronounced, requiring medicamentous or even surgical treatment. This prospective study included 100 patients from 5 family medicine practices, who filled out the IPSS questionnaire. Data analysis showed the mean patient age to be 65.4 years and mean duration of disease symptoms 8 years. Statistical analysis yielded no statistically significant difference in symptom duration among patients with mild, moderate and severe BPH symptoms. Considering correlation of the quality of life with particular disease symptoms, study results showed only some BPH symptoms to influence the quality of life. The feeling of incomplete bladder emptying, two urination intervals of less than 2 hours, weak urine stream and nocturnal urination frequency showed a statistically significant correlation with quality of life. The patients with mild BPH symptoms assessed their quality of life better than patients reporting moderate or even severe BPH symptoms. As BPH symptoms are significantly present in the male population over age 50, general/family practitioners should take in consideration the diagnosis of BPH, because this condition influences the quality of life as well sexual function in this male population age group.

[Specialization in family medicine--has all the planned been achieved?]. / Specijalizacija iz obiteljske medicine--je li ostvareno ono sto je planirano?

The planned, comprehensive inclusion of general practitioners/family physicians in specialist education has begun with the project entitled Harmonization of Family Medicine Service with European Standards by the Implementation of Compulsory Residency. According to the Project, all physicians working in family medicine practice should have an opportunity to complete the respective residency by 2015. Analysis of the planned and completed family medicine residency in Croatia during the 2002-2006 period is presented. Of the total family medicine residency positions planned during the four-year period, 543 (90.5%) have been completed, with the greatest discrepancy recorded in program A applying to physicians younger than 35 having concluded a contract with the Croatian Institute of Health Insurance. In addition, this relationship varied among different countries. There are a number of obstacles hindering the Project implementation. However, it should be noted that the Project has made a breakthrough in upgrading the quality of family medicine practice, as a pledge of future development and rational performance of the entire health care system in Croatia, in order to promote the health care of the population at large.

[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.