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Perinchery-Herman S. Primary Care Ethics is Just Medical Ethics: A Philosophical Argument for the Feasibility of Transitioning Acute Care Ethics to the Primary Care Setting. HEC Forum 2023; 35:73-94. [PMID: 33842989 DOI: 10.1007/s10730-021-09451-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2021] [Indexed: 11/25/2022]
Abstract
Whether practiced by ethics committees or clinical ethicists, medical ethics enjoys a solid foundation in acute care hospitals. However, medical ethics fails to have a strong presence in the primary care setting. Recently, some ethicists have argued that the reason for this disparity between ethics in the acute and primary care setting is that primary care ethics is distinct from acute care ethics: the failure to translate ethics to the primary care setting stems from the incorrect belief that acute care ethics can be applied to the primary care setting. In this paper, I argue that primary care ethics and acute care ethics are species of the same ethical genus, and that the ethical differences are not ones of kind but of circumstance. I do this by appealing to the role obligations that underlie acute care and primary care clinicians' medical ethical obligations and the shared institutions that ground those obligations.
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The Safety Culture of The Ljubljana Community Health Centre's Employees. Zdr Varst 2021; 60:145-151. [PMID: 34249160 PMCID: PMC8256766 DOI: 10.2478/sjph-2021-0021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 05/18/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction Patient safety is one of the key aspects of healthcare quality and a serious global public health concern. Patient safety culture is a part of the patient safety concept. In Slovenia, primary care is easily accessible, and for medical care, it serves as a gatekeeper to hospital care. For several years, the quality and safety at the primary healthcare level have been the focus of several studies. The present study aimed to assess patient safety culture among all employees of the Community Health Centre Ljubljana. Methods We conducted a cross-sectional study in 2017 using the Slovene version of “Medical Office Survey on Patient Safety Culture” from the Agency for Healthcare Research and Quality. Mean percent positive scores on all items in each composite were calculated according to a user guide. Results The final sample contained 1021 participants (67.8% response rate), of which 909 (89.0%) were women. The mean age of the sample was 43.0±11.0 years. The dimensions most highly rated by the respondents were: teamwork and patient care tracking/follow-up. The lowest scores came from leadership support for patients’ safety and work pressure and pace. Conclusion Patient safety culture in the Community Health Centre Ljubljana is high, but there are certain areas of patient safety that need to be evaluated further and improved. Our study revealed differences between professions, indicating that a customized approach per profession group might contribute to the successful implementation of safety strategies. Patient safety culture should be studied at national levels.
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Gágyor I, Heßling A, Heim S, Frewer A, Nauck F, Himmel W. Ethical challenges in primary care: a focus group study with general practitioners, nurses and informal caregivers. Fam Pract 2019; 36:225-230. [PMID: 29931146 PMCID: PMC6425460 DOI: 10.1093/fampra/cmy060] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND General practitioners (GPs), nurses and informal caregivers are often jointly involved in healthcare situations in which ethical issues play an important role. OBJECTIVES To describe ethical problems from the perspective of these three groups and to investigate whether there is a common experience of ethical issues in primary care. METHODS We conducted six focus groups with general practitioners, nurses and informal caregivers in Germany. We asked the participants to describe at least one experience of ethical problem in detail and documented the findings by an illustration software that visualized and structured the discussion. We used thematic analysis to identify ethical problems and to develop categories of ethical issues. RESULTS Problems reported barely overlapped. GPs had to do mainly with uncertainty about the scope and limits of their responsibility for patients. Nurses were concerned about bureaucratic and other barriers to professional care and about dual loyalty if they had to consider the conflicting interests of patients and family members. They often felt powerless and unable to act according to their professional standards. Informal caregivers reported problems that resulted from role strain and being both a family member and a caregiver. GPs, nurses and informal caregivers sometimes perceived the other parties as a source of ethical problems. CONCLUSIONS All parties may benefit from ethics support services, a rarity in German primary care so far. Furthermore, nurses' self-confidence towards GPs, demanding patients and family members has to be strengthened. Informal caregivers, the most vulnerable group, need more attendance and tailored support.
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Affiliation(s)
- Ildikó Gágyor
- Department of General Practice, Universitätsklinikum Würzburg, Germany.,Department of General Practice, University Medical Center Göttingen, Germany
| | - Arndt Heßling
- Department of General Practice, University Medical Center Göttingen, Germany
| | - Susanne Heim
- Department of General Practice, University Medical Center Göttingen, Germany
| | - Andreas Frewer
- Institute for History of Medicine and Medical Ethics, University of Erlangen-Nürnberg, Germany
| | - Friedemann Nauck
- Department of Palliative Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Wolfgang Himmel
- Department of General Practice, University Medical Center Göttingen, Germany
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Klemenc-Ketis Z, Deilkås ET, Hofoss D, Bondevik GT. Variations in patient safety climate and perceived quality of collaboration between professions in out-of-hours care. J Multidiscip Healthc 2017; 10:417-423. [PMID: 29184416 PMCID: PMC5687361 DOI: 10.2147/jmdh.s149011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To get an overview of health care workers perceptions of patient safety climates and the quality of collaboration in Slovenian out-of-hours health care (OOHC) between professional groups. Materials and methods This was a cross-sectional study carried out in all (60) Slovenian OOHC clinics; 37 (61.7%) agreed to participate with 438 employees. The questionnaire consisted of the Slovenian version of the Safety Attitudes Questionnaire – Ambulatory Version (SAQ-AV). Results The study sample consisted of 175 (70.0%) physicians, nurse practitioners, and practice nurses. Practice nurses reported the highest patient safety climate scores in all dimensions. Total mean (standard deviation) SAQ-AV score was 60.9±15.2. Scores for quality of collaboration between different professional groups were high. The highest mean scores were reported by nurse practitioners on collaboration with practice nurses (4.4±0.6). The lowest mean scores were reported by practice nurses on collaboration with nurse practitioners (3.8±0.9). Conclusion Due to large variations in Slovenian OOHC clinics with regard to how health care workers from different professional backgrounds perceive safety culture, more attention should be devoted to improving the team collaboration in OOHC. A clearer description of professional team roles should be provided.
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Affiliation(s)
- Zalika Klemenc-Ketis
- Department of Family Medicine, Faculty of Medicine, University of Maribor, Maribor.,Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana.,Community Health Centre Ljubljana, Ljubljana, Slovenia
| | | | - Dag Hofoss
- Institute of Health and Society, University of Oslo, Oslo
| | - Gunnar Tschudi Bondevik
- Department of Global Public Health and Primary Care, University of Bergen, Bergen.,National Centre for Emergency Primary Health Care, Uni Research Health, Bergen, Norway
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Klemenc-Ketiš Z, Deilkås ET, Hofoss D, Bondevik GT. Patient Safety Culture in Slovenian out-of-hours Primary Care Clinics. Zdr Varst 2017; 56:203-210. [PMID: 29062394 PMCID: PMC5639809 DOI: 10.1515/sjph-2017-0028] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 06/23/2017] [Indexed: 11/19/2022] Open
Abstract
Introduction Patient safety culture is a concept which describes how leader and staff interaction, attitudes, routines and practices protect patients from adverse events in healthcare. We aimed to investigate patient safety culture in Slovenian out-of-hours health care (OOHC) clinics, and determine the possible factors that might be associated with it. Methods This was a cross-sectional study, which took place in Slovenian OOHC, as part of the international study entitled Patient Safety Culture in European Out-of-Hours Services (SAFE-EUR-OOH). All the OOHC clinics in Slovenia (N=60) were invited to participate, and 37 agreed to do so; 438 employees from these clinics were invited to participate. We used the Slovenian version of the Safety Attitudes Questionnaire – an ambulatory version (SAQAV) to measure the climate of safety. Results Out of 438 invited participants, 250 answered the questionnaire (57.1% response rate). The mean overall score ± standard deviation of the SAQ was 56.6±16.0 points, of Perceptions of Management 53.6±19.6 points, of Job Satisfaction 48.5±18.3 points, of Safety Climate 59.1±22.1 points, of Teamwork Climate 72.7±16.6, and of Communication 51.5±23.4 points. Employees working in the Ravne na Koroškem region, employees with variable work shifts, and those with full-time jobs scored significantly higher on the SAQ-AV. Conclusion The safety culture in Slovenian OOHC clinics needs improvement. The variations in the safety culture factor scores in Slovenian OOHC clinics point to the need to eliminate variations and improve working conditions in Slovenian OOHC clinics.
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Affiliation(s)
- Zalika Klemenc-Ketiš
- University of Maribor, Faculty of Medicine, Department of Family Medicine, Taborska 8, 2000, Maribor, Slovenia
| | | | - Dag Hofoss
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Gunnar Tschudi Bondevik
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,National Centre for Emergency Primary Health Care, Uni Research Health, Bergen, Norway
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KOPČAVAR GUČEK N, PETEK D, ŠVAB I, SELIČ P. Barriers to Screening and Possibilities for Active Detection of Family Medicine Attendees Exposed to Intimate Partner Violence. Zdr Varst 2016; 55:11-20. [PMID: 27647084 PMCID: PMC4820177 DOI: 10.1515/sjph-2016-0002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 08/04/2015] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION In 1996 the World Health Organization declared intimate partner violence (IPV) the most important public health problem. Meta-analyses in 2013 showed every third female globally had been a victim of violence. Experts find screening controversial; family medicine is the preferred environment for identifying victims of violence, but barriers on both sides prevent patients from discussing it with doctors. METHODS In July 2014, a qualitative study was performed through semi-structured interviews with ten family doctors of different ages and gender, working in rural or urban environments. Sound recordings of the interviews were transcribed, and the record verified. The data were interpreted using content analysis. A coding scheme was developed and later verified and analysed by two independent researchers. The text of the interviews was analysed according to the coding scheme. RESULTS Two coding schemes were developed: one for screening, and the other for the active detection of IPV. The main themes emerging as barriers to screening were lack of time, staff turnover, inadequate finance, ignorance of a clear definition, poor commitment to screening, obligatory follow-up, risk of deterioration of the doctor-patient relationship, and insincerity on the part of the patient. Additionally, cultural aspects of violence, uncertainty/ helplessness, fear, lack of competence and qualifications, autonomy/negative experience, and passive role/stigma/ fear on the part of the patients were barriers to active detection. CONCLUSION All the participating doctors had had previous experience with active detection of IPV and were aware of its importance. Due to several barriers to screening for violence they preferred active detection.
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Affiliation(s)
| | - Davorina PETEK
- University of Ljubljana, Faculty of Medicine, Department of Family Medicine, Poljanski nasip 58, 1000 Ljubljana, Slovenia
| | - Igor ŠVAB
- University of Ljubljana, Faculty of Medicine, Department of Family Medicine, Poljanski nasip 58, 1000 Ljubljana, Slovenia
| | - Polona SELIČ
- University of Ljubljana, Faculty of Medicine, Department of Family Medicine, Poljanski nasip 58, 1000 Ljubljana, Slovenia
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González-de Paz L, Kostov B, López-Pina JA, Solans-Julián P, Navarro-Rubio MD, Sisó-Almirall A. A Rasch analysis of patients' opinions of primary health care professionals' ethical behaviour with respect to communication issues. Fam Pract 2015; 32:237-43. [PMID: 25381008 DOI: 10.1093/fampra/cmu073] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patients' opinions are crucial in assessing the effectiveness of the ethical theories which underlie the care relationship between patients and primary health care professionals. OBJECTIVES To study the ethical behaviour of primary health care professionals with respect to communication issues according to patients' opinions. METHODS Cross-sectional study using a self-administered questionnaire in patients from a network of 15 urban primary health centres. Participants were patients attended at the centres when the study was conducted. We used a Rasch analysis to verify the structure of the 17 questionnaire items, and to calculate interval level measures for patients and items. We analysed differences according to patient subgroups using analysis of variance tests and differences between the endorsement of each item. RESULTS We analysed 1013 (70.34%) of questionnaires. Data fit to the Rasch model was achieved after collapsing two categories and eliminating five items. Items with the lowest degree of endorsement were related to the management of differences in conflictive situations between patients and health care professionals. We found significant differences (P < 0.001) in patients' opinions according to the degree of confidence in professionals and their educational level. CONCLUSIONS Patients opined that empathy and traditional communication skills were respected by family physicians and nurses. However, opinions on endorsement were lower when patients disagreed with health care professionals. The differences found between patient subgroups demonstrated the importance of trust and confidence between patients and professionals.
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Affiliation(s)
- Luis González-de Paz
- Transverse Group for Research in Primary Care, IDIBAPS, Barcelona, School of Medicine and Health Sciences, Universitat Internacional de Catalunya. Sant Cugat del Vallés,
| | - Belchin Kostov
- Transverse Group for Research in Primary Care, IDIBAPS, Barcelona
| | - Jose A López-Pina
- Department of Basic Psychology and Methodology. University of Murcia, Murcia
| | - Pilar Solans-Julián
- Institut Català de la Salut. Àmbit d'Atenció Primària Barcelona Ciutat. Barcelona and
| | - M Dolors Navarro-Rubio
- School of Medicine and Health Sciences, Universitat Internacional de Catalunya. Sant Cugat del Vallés
| | - Antoni Sisó-Almirall
- Transverse Group for Research in Primary Care, IDIBAPS, Barcelona, University of Barcelona School of Medicine (Hospital Clinic), Barcelona, Spain
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ZELKO E, ŠVAB I, ROTAR PAVLIČ D. Quality of Life and Patient Satisfaction with Family Practice Care in a Roma Population with Chronic Conditions in Northeast Slovenia. Zdr Varst 2015; 54:18-26. [PMID: 27646618 PMCID: PMC4820145 DOI: 10.1515/sjph-2015-0003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 11/09/2014] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Health-related quality of life (HRQoL) measures a patient's subjective experience of his or her health status. We aimed to show how the presence of chronic diseases and satisfaction with family physicians (FPs) were associated with the HRQoL of a Roma population. METHODS A cross-sectional study was carried out in May 2011 on a representative sample of 650 Roma living in Prekmurje, Slovenia. The EQ-5D questionnaire was used for measuring the HRQoL of the Roma. Demographical data, 12 groups of diseases diagnosed in the last 12 months and satisfaction with FPs were included in the questionnaire. RESULTS The response rate was 88.3% 574), of which 56.4% were female, and the average age of the participants had a mean value of 40.2±12.7 years. The presence of cardiovascular problems with risk factors for them or presence of musculoskeletal disorders were strongly associated with the presence of pain (Cramer's V = 0.40 and 0.46 respectively). There was a strong association between the presence of mental disorders and anxiety and depression (Cramer's V = 0.58). The average satisfaction with the family physician was 3.9 (mean±1.10) on a five-point Likert scale. There was no significant association between HRQoL and satisfaction with the family physician. CONCLUSIONS Roma with chronic mental health problems had the lowest HRQoL in the Roma population. More attention should be paid to this subgroup of Roma in family medicine, and interventions should be provided. High satisfaction with their FPs is not associated with the observed quality of life variables.
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Affiliation(s)
- Erika ZELKO
- University of Maribor, Medical Faculty, Taborska 8, 2000 Maribor, Slovenia
| | - Igor ŠVAB
- University of Ljubljana, Medical Faculty, Department of Family Medicine, Poljanski nasip 58, 1000 Ljubljana, Slovenia
| | - Danica ROTAR PAVLIČ
- University of Ljubljana, Medical Faculty, Department of Family Medicine, Poljanski nasip 58, 1000 Ljubljana, Slovenia
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Family physicians' management of genetic aspects of a cardiac disease: a scenario-based study from slovenia. Balkan J Med Genet 2014; 17:15-22. [PMID: 25741210 PMCID: PMC4347472 DOI: 10.2478/bjmg-2014-0020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The aim of this study was to find out how Slovenian family physicians (FPs) would manage a hypothetical clinical case, to explore their views about possible ethical dilemmas associated with this clinical case and to determine possible associations with demographic and other characteristics of FPs. This was an observational cross-sectional postal study in the Slovenian FPs' surgeries. The study population consisted of the whole population of Slovenian FPs (n = 950). The main outcome measures were the percentages of the answers of FPs on different questions about the clinical case on the management of patient and his relative with hereditary cardiomyopathy. There were 271 FPs who answered the questionnaire (response rate was 27.1%). A sample included 66 (24.4%) men and the mean age of all respondents was 45.5 ± 10.6 years. When dealing with the clinical case, most FPs expressed willingness to take the patient's family history. Only 34.2% FPs did not believe that ordering genetic tests was part of their job. Additionally, only 50.0% of them felt competent to interpret the genetic risk, 25.0% of them would give information about genetic testing and only 6.0% would interpret the results of the genetic testing. Family physicians in Slovenia were willing to include genetic tasks into routine management of their patients, but they do not feel competent enough to interpret the genetic risks and the results of genetic testing. However, an important part of FPs would not refer patients at risk to genetic counseling. The inclusion of genetic topics to family medicine specialization curriculum is needed.
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Klemenc-Ketis Z, Peterlin B. Family physicians' self-perceived importance of providing genetic test information to patients: a cross-sectional study from Slovenia. Med Sci Monit 2014; 20:434-7. [PMID: 24632733 PMCID: PMC3962323 DOI: 10.12659/msm.890013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Management of patients with genetic problems, including provision of genetic testing, is increasingly becoming a part of primary health care. The aim of this study was to determine the family physicians' (FPs) self-perceived importance of providing genetic test information to their patients. MATERIAL AND METHODS This was an observational cross-sectional postal study in the whole population of Slovenian family physicians (N=950). Its main outcome measure was the perceived importance of providing genetic test information on each of 10 items on a 5-point Likert scale. RESULTS There were 271 (27.1% response rate) FPs that completed the questionnaire, out of which 205 (75.6%) were women. Mean age of the sample was 45.5 ± 10.6 years. More than 90% of Slovene FPs felt that it was their professional duty to discuss genetic testing issues with their patients. They were particularly prone to discuss clinical implications of positive and negative test results, as well as giving the patients information about the risk of passing a mutation onto children. CONCLUSIONS Most Slovene family physicians feel responsible and willing to offer and discuss genetic testing and implications with their patients. Additional education should be provided to empower them for this task.
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Affiliation(s)
| | - Borut Peterlin
- Clinical Institute of Medical Genetics, University Medical Center, Ljubljana, Slovenia
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Selic P, Svab I, Gucek NK. A cross-sectional study identifying the pattern of factors related to psychological intimate partner violence exposure in Slovenian family practice attendees: what hurt them the most. BMC Public Health 2014; 14:223. [PMID: 24593032 PMCID: PMC3975876 DOI: 10.1186/1471-2458-14-223] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 02/25/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intimate partner violence (IPV) is yet to be fully acknowledged as a public health problem in Slovenia. This study aimed to explore the health and other patient characteristics associated with psychological IPV exposure and gender-related specificity in family clinic attendees. METHODS In a multi-centre cross-sectional study, 960 family practice attendees aged 18 years and above were recruited. In 689 interviews with currently- or previously-partnered patients, the short form of A Domestic Violence Exposure Questionnaire and additional questions about behavioural patterns of exposure to psychological abuse in the past year were given. General practitioners (GPs) reviewed the medical charts of 470 patients who met the IPV exposure criteria. The Domestic Violence Exposure Medical Chart Check List was used, collecting data on the patients' lives and physical, sexual and reproductive, and psychological health status, as well as sick leave, hospitalisation, visits to family practices and referrals to other clinical specialists in the past year. In multivariate logistic regression modelling the factors associated with past year psychological IPV exposure were identified, with P<0.05 set as the level of statistical significance. RESULTS Of the participants (n=470), 12.1% (n=57) were exposed to psychological IPV in the previous year (46 women and 11 men). They expressed more complaints regarding sexual and reproductive (p=0.011), and psychological and behavioural status (p<0.001), in the year prior to the survey. Unemployment or working part-time, a college degree, an intimate relationship of six years or more and a history of disputes in the intimate relationship, increased the odds of psychological IPV exposure in the sample, explaining 41% of the variance. In females, unemployment and a history of disputes in the intimate relationship explained 43% of the variance. CONCLUSIONS The prevalence of psychological IPV above 10% during the past year was similar to earlier studies in Slovenia, although the predominance of better-educated people might be associated with lower tolerance toward psychological abuse. GPs should pay special attention to unemployed patients and those complaining about family disputes, to increase early detection.
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Affiliation(s)
- Polona Selic
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Poljanski nasip 58, Ljubljana, Slovenia
| | - Igor Svab
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Poljanski nasip 58, Ljubljana, Slovenia
| | - Nena Kopcavar Gucek
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Poljanski nasip 58, Ljubljana, Slovenia
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Klemenc-Ketis Z, Kersnik J. Which pharmaceutical sales representatives' features do slovenian family physicians value? Acta Inform Med 2014; 21:257-60. [PMID: 24554801 PMCID: PMC3916158 DOI: 10.5455/aim.2013.21.257-260] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Accepted: 11/02/2013] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION One of the key strategies for marketing new drugs to physicians is personal selling by pharmaceutical sales representatives (PSRs). GOAL The aim of this study was to determine which features of PSR's are most valued by Slovenian family physicians (FPs). METHODS We performed a cross-sectional observational postal survey in FPs. We sent the invitation for cooperation in the study to all Slovenian FPs working in family practices at the primary level of care (N = 895). Data was collected using a validated PSRs' assessment scale. It consists of 12 questions on PSRs' assessment that could be answered on a seven-point Likert scale. RESULTS The response rate was 27.6%. There were 174 (70.4%) of female physicians among the respondents. Average age of the respondents was 48.3 ± 9.0 years. Highly assessed PSRs' characteristics were "Provides objective product information", "Does not mislead", and "Shows good knowledge on the subject promoted". Worst rated PSRs' characteristics were "Possesses knowledge on health care system", "Same person for the product of company for a longer period of time", and "Acts friendly". CONCLUSIONS Slovenian FPs value PSRs' selling and communication skills and trustworthiness highly. FPs and PSRs develop a personal relationship which reflects in different perceptions of various PSRs' characteristics by FPs.
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Affiliation(s)
- Zalika Klemenc-Ketis
- Department of Family Medicine, Maribor Medical School, University of Maribor, Maribor, Slovenia ; Department of Family Medicine, Ljubljana Medical School, University of Ljubljana, Ljubljana, Slovenia
| | - Janko Kersnik
- Department of Family Medicine, Maribor Medical School, University of Maribor, Maribor, Slovenia ; Department of Family Medicine, Ljubljana Medical School, University of Ljubljana, Ljubljana, Slovenia
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Selic P, Svab I, Gucek NK. How many Slovenian family practice attendees are victims of intimate partner violence? A re-evaluation cross-sectional study report. BMC Public Health 2013; 13:703. [PMID: 23915036 PMCID: PMC3733985 DOI: 10.1186/1471-2458-13-703] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 07/30/2013] [Indexed: 11/18/2022] Open
Abstract
Background Intimate partner violence (IPV) can be considered a leading public health problem affecting approximately 50% of women during the course of their lifetimes. This study was carried out with the aim of re-testing the prevalence data and providing sufficient grounds for decision-makers in family medicine in Slovenia to adopt much-needed protocols for IPV management in the field. Methods In January 2012, every tenth general practitioner (GP) registered in Slovenia, of a total of 958, was invited to participate in a multi-centre cross-sectional study, and 9.4% of them, working in 90 family practices, agreed to participate. From February 1 to March 1, 2012, they asked every fifth family practice attendee aged 18 years and above, regardless of gender, to participate in the study. The short version of Domestic Violence Exposure Questionnaire was administered to 2572 patients. Results In the sample, there were more women (62.9% (n = 1617)). The average age of all the participants was 49.0 ± 16.1 years. Of 2572 participants (95.3% response rate), 17.1% people had been exposed to either emotional or both physical and emotional abuse. The prevalence of psychological violence was 10.3%, and that of concurrent physical and psychological abuse 6.8%, with all the patients exposed to physical IPV disclosing concurrent psychological violence. Female gender and previous formal divorce were risk factors identified in all three multivariate logistic regression models. The odds of concurrent physical and psychological and either type of IPV exposure in patients were lessened by an age of 65 years or above. The odds for either type of IPV were also lower in single people, while in concurrent physical and psychological IPV exposure, living in urban settings acted as a protective factor. Conclusions In Slovenian family practice attendees, an IPV exposure prevalence of approximately 17% should be considered a valid estimation.
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Affiliation(s)
- Polona Selic
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Poljanski nasip 58, Ljubljana, Slovenia.
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Petek D, Ferligoj A, Platinovsek R, Kersnik J. Predictors of the quality of cardiovascular prevention--a multilevel cross-sectional study. Croat Med J 2011; 52:718-27. [PMID: 22180271 PMCID: PMC3243324 DOI: 10.3325/cmj.2011.52.718] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIM To attempt to develop a model of predictors for quality of the process of cardiovascular prevention in patients at high risk of cardiovascular disease (CVD). METHODS We formed a random sample of patients from a stratified sample of 36 family practice registers of patients at high risk of CVD without diabetes and without established CVD. Data were gathered by chart audit and questionnaires about patient and practice characteristics. We defined the process of care as a dependent variable by principle component analysis and tested the relationship of the process with several independent variables (family physicians', patients', and practice characteristics). To study the effects of independent variables (predictors) on the process of care we carried out multilevel regression analysis with the patients constituting the lower level and nested within the family physician/practice (the second level). RESULTS Multilevel regression analysis included 645 patients from 36 practices (74.1% from the final sample). Patients' characteristics that predicted the higher-quality process of CVD prevention were younger age (t=-4.94, 95% confidence interval [CI] -0.018 to -0.008) and lower socioeconomic status (t=-2.18, 95%CI -0.195 to -0.010). Practice characteristics that predicted the higher-quality process of CVD prevention were smaller practice size (t=2.83, 95% CI 0.063 to 1.166), a good information system for CVD prevention (t=3.15, 95% CI 0.030 to 0.282), and the organization of education on CVD prevention (t=3.19, 95%CI 0.043 to 0.380). CONCLUSION This study shows that the quality of cardiovascular prevention could be measured as a composite outcome and future studies should further develop this approach and test the impact of several practice/patient characteristics on the quality of CVD prevention with the international data.
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Affiliation(s)
- Davorina Petek
- Department of Family Medicine, Faculty of Medicine, University of Ljubljana, Poljanski nasip 58, Ljubljana, Slovenia.
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Kersnik J, Klemenc-Ketis Z, Petek-Ster M, Tusek-Bunc K, Poplas-Susic T, Kolsek M. Family doctors' views of pharmaceutical sales representatives: assessment scale development. Fam Pract 2011; 28:456-60. [PMID: 21292626 DOI: 10.1093/fampra/cmq105] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The prescribing patterns depend on the physicians' attitudes and their subjective norms towards prescribing a particular drug, as well as on their personal experience with a particular drug. The physicians are affected by their interactions with pharmaceutical industry. OBJECTIVE The objectives were to develop a scale for assessment of pharmaceutical sales representatives (PSRs) by the family doctors (FDs) and to determine factors for their evaluation. METHOD Cross-sectional anonymous postal study. We included a random sample of 250 Slovenian FDs. Settings. Slovenian FDs' surgeries. MAIN OUTCOME MEASURE The score of various items regarding FDs' assessment of PSRs on a 7-point Likert scale. RESULTS We got 163 responses (65.2% response rate). The most important characteristic of PSRs, as rated by respondents on the scale from 1 to 7, was the fact that they did not mislead when presenting products' information. The second most important characteristic was the ability to provide objective information about the product. The first three most important characteristics, as rated by the respondents by themselves, were 'Shows good knowledge on the promoted subject', 'Provides objective product information' and 'Makes brief and exact visits'. Cronbach's alpha of the composite scale was 0.844. Factor analysis revealed three PSRs' factors: selling skills, communicating skills and sense of trustworthiness. CONCLUSION FDs evaluate PSRs mainly by their managerial skills and trustworthiness. The scale proved to be a reliable tool for assessing PSRs by FDs.
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Affiliation(s)
- Janko Kersnik
- Department of Family Medicine, University Ljubljana and Maribor, Ljubljana, Slovenia.
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16
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Petek Šter M, Cedilnik Gorup E. Psychotropic medication use among elderly nursing home residents in Slovenia: cross-sectional study. Croat Med J 2011; 52:16-24. [PMID: 21328716 PMCID: PMC3046495 DOI: 10.3325/cmj.2011.52.16] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIM To determine the prevalence of psychotropic medication prescribing in elderly nursing home residents in Slovenia and to explore the residents', physicians', and nursing home characteristics associated with prescribing. METHODS In a cross-sectional study, we collected the data for 2040 nursing home residents aged 65 years and older in 12 nursing homes in Slovenia between September 25 and November 30, 2006. Prescribed medications lists were retrieved from patients' medical records. Psychotropic medications were coded according to Anatomical Therapeutic Chemical Classification 2005, which we adjusted for the purposes of the study. Multivariate logistic regression analysis was performed to determine the residents', physicians', and nursing home characteristics associated with prescribing. RESULTS Residents were from 65 to 104 years old (median, 83 years) and 1606 (79%) of them were female. A total of 970 (48%) residents had dementia and 466 had depression (23%). In 1492 (73%) residents, at least one psychotropic medication was prescribed. Nine hundred sixty residents were prescribed hypnotics and sedatives (47%), 572 (28%) antipsychotics, 460 (23%) antidepressants, and 432 (21%) anxiolytics. Residents' characteristics associated with psychotropic medication use were female sex (odds ratio [OR], 1.36; 95% confidence interval [CI], 1.03-1.80), age (OR, 0.97; 95% CI, 0.95-0.98), permanent restlessness (OR, 2.54; 95% CI, 1.71-3.78), dementia (OR, 1.76; 95% CI, 1.33-2.34), depression (OR, 5.51; 95% CI, 3.50-7.58), and the number of prescribed medications (OR, 1.29; 95% CI, 1.23-1.35). Of physicians' characteristics (sex, age, specialization in general practice, years of working experiences as a general practitioner, and years of experiences working in a nursing home), male sex was associated with psychotropic medication prescribing (OR, 1.80; 95% CI, 1.17-2.76). CONCLUSION Frequency of psychotropic medication prescribing in elderly nursing home residents in Slovenia is high and is comparable to Western European countries. Our next step should be optimizing the prescribing in patients with the highest prescription rate.
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Affiliation(s)
- Marija Petek Šter
- Medical Faculty, Department of Family Medicine, University of Ljubljana, Poljanski nasip 58, 1000 Ljubljana, Slovenia.
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Hren D, Marušić M, Marušić A. Regression of moral reasoning during medical education: combined design study to evaluate the effect of clinical study years. PLoS One 2011; 6:e17406. [PMID: 21479204 PMCID: PMC3068134 DOI: 10.1371/journal.pone.0017406] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Accepted: 02/02/2011] [Indexed: 11/18/2022] Open
Abstract
Background Moral reasoning is important for developing medical professionalism but current evidence for the relationship between education and moral reasoning does not clearly apply to medical students. We used a combined study design to test the effect of clinical teaching on moral reasoning. Methods We used the Defining Issues Test-2 as a measure of moral judgment, with 3 general moral schemas: Personal Interest, Maintaining Norms, and Postconventional Schema. The test was applied to 3 consecutive cohorts of second year students in 2002 (n = 207), 2003 (n = 192), and 2004 (n = 139), and to 707 students of all 6 study years in 2004 cross-sectional study. We also tested 298 age-matched controls without university education. Results In the cross-sectional study, there was significant main effect of the study year for Postconventional (F(5,679) = 3.67, P = 0.003) and Personal Interest scores (F(5,679) = 3.38, P = 0.005). There was no effect of the study year for Maintaining Norms scores. 3rd year medical students scored higher on Postconventional schema score than all other study years (p<0.001). There were no statistically significant differences among 3 cohorts of 2nd year medical students, demonstrating the absence of cohort or point-of-measurement effects. Longitudinal study of 3 cohorts demonstrated that students regressed from Postconventional to Maintaining Norms schema-based reasoning after entering the clinical part of the curriculum. Interpretation Our study demonstrated direct causative relationship between the regression in moral reasoning development and clinical teaching during medical curriculum. The reasons may include hierarchical organization of clinical practice, specific nature of moral dilemmas faced by medical students, and hidden medical curriculum.
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Affiliation(s)
- Darko Hren
- University of Split Faculty of Philosophy, Split, Croatia.
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Prescription of benzodiazepines in Slovenian family medicine: a qualitative study. Wien Klin Wochenschr 2010; 122:474-8. [PMID: 20658195 DOI: 10.1007/s00508-010-1413-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2009] [Accepted: 07/05/2010] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Previous quantitative research showed large variations in prescribing volume and prescribing patterns of benzodiazepines among Slovenian family physicians. We performed a qualitative interview study to investigate how high-prescribing family physicians explain their own prescription. METHODS Five family physicians with benzodiazepine prescriptions in volumes larger than 4000 defined daily doses per month and five who prescribed volumes smaller than 2000 defined daily doses per month, selected randomly from the representative sample of Slovenian family physicians, were interviewed. Physicians' self-explanations about their daily decisions regarding benzodiazepine prescribing, patients' and practice characteristics and their attitudes towards patients were analysed. RESULTS Family physicians were reporting about patients' needs and their demands, co-morbidity of older patients, previous good experience with benzodiazepines, concerns about decreasing dosage or discontinuation of benzodiazepines, high workload and time constraints, limited access to mental health workers and insufficient education and training. CONCLUSION Family physicians consider the task of initiating, withdrawing or reducing benzodiazepines as demanding due to complexity of psychosocial problems, co-morbidity, workload, time-consumingness, need to master counselling skills, demands of their patients, particularly the long-term ones and due to low access to mental health services. The majority of family physicians agreed with restrictions in their prescription based on the guidelines.
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HÖGlund AT, Eriksson S, Helgesson G. The role of guidelines in ethical competence-building: perceptions among research nurses and physicians. ACTA ACUST UNITED AC 2010. [DOI: 10.1258/ce.2009.009047] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim of the present study was to describe and explore the perception of ethical guidelines and their role in ethical competence-building among Swedish physicians and research nurses. Twelve informants were interviewed in depth. The results demonstrated that the informants had a critical attitude towards ethical guidelines and claimed to make little use of them in practical moral judgements. Ethical competence was seen primarily as character-building, related to virtues such as being empathic, honest and loyal to patients. Ethical competence was assumed to be learned through good examples, role models and practical experience, while ethical guidelines were not perceived as valuable in this process. In order to improve the staff's familiarity with and the usability of ethical guidelines, the workplace needs to provide opportunities for ethical dialogues. In such discussions, argumentation can improve, virtues can be developed and guidelines can be usefully invoked.
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Affiliation(s)
- Anna T HÖGlund
- Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics, Uppsala University, SE-751 22 Uppsala, Sweden
| | - Stefan Eriksson
- Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics, Uppsala University, SE-751 22 Uppsala, Sweden
| | - Gert Helgesson
- Stockholm Centre for Healthcare Ethics, LIME, Karolinska Institutet, Stockholm, Sweden
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