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Darbo tikslas - Įvertinti šeimos gydytojų požiūrį į farmacijos kompanijų medicinos atstovų teikiamą informaciją apie vaistus ir nustatyti, kaip ta informacija pasitelkiama, skiriant vaistus pacientams. Tyrimo metodika. 2008 m. balandžio – gruodžio mėnesiais, buvo apklausti Kauno mieso šeimos gydytojai dirbantys viešosiose ir privačiose įstaigose. Buvo išdalintos 229 anketos, atsakė – 133 respondentai (atsakas – 58, 1 proc.). Anketiniai duomenys analizuoti naudojant statistinę duomenų analizės programą SPSS 13.0. Statistinis duomenų reikšmingumas tikrintas pagal Chi kvadrato kriterijų, laisvės laipsnių skaičių ir statistinį reikšmingumą (p). Hipotezė apie dviejų nepriklausomų imčių vidurkių lygybę buvo tikrinama naudojant Mann – Whitney testą. Rezultatai. Dažniausiai šeimos gydytojai informaciją apie vaistus sužino medicinos atstovų individualių vizitų metu. Efektyviausi būdai informacijai apie vaistus sužinoti yra konferencijos, individualūs medicinos atstovų vizitai, bei specialisto vedamos apvalaus stalo prezentacijos. Lankančių šeimos gydytojus medicinos atstovų profesija dažniausiai yra gydytojai ir farmacininkai. Beveik trys ketvirtadaliai (72,2 proc.) šeimos gydytojų pastebi skirtingų profesijų medicinos atstovų kompetencijos skirtumus ir geriausiai vertina gydytojų bei farmacininkų kompetenciją pateikiant informaciją apie vaistus. Didžioji dalis (71,4 proc.) šeimos gydytojų bendravimą su medicinos atstovais vertina kaip dalykinį, jų nuomone, bendraujant su medicinos... [toliau žr. visą tekstą] / Aim of the study. To evaluate general practitioners view on how pharmaceutical companies present information about medicines and to determine how this information is used by doctors while prescribing them for patients. Methods. The general practitioners, who worked in private and public health centers in Kaunas city, were anonymously questioned from April to December in 2008. In total, 229 questionnaires were distributed, 133 of which were answered and returned back (the response rate was 58%). Statistical analysis of the obtained data was performed using the SPSS v. 13.0 software package. The associations between the variables were tested by Chi squared test. The hypothesis about the differences between means of two independent samples was evaluated using a criterion of Mann-Whitney test. Results. General practitioners most often get information about medicines from personal visits of medical representatives. The most effective ways of finding out the information about medicines are conferences, personal visits of medical representatives and round table meetings lead by specialists. General practitioners were most often visited by medical representatives who have doctor’s or pharmacist‘s qualifications. Almost three quaters (72.2%) of general practitioners have noticed different competence in qualification of medical representatives and those who had doctor‘s or pharmacist‘s qualification were evaluated best in providing the information about medicines. The greater part (71... [to full text]

Introduction Since the 1994 change in power in South Africa, there have been many necessary changes in health legislation (HL), in accordance with the principles enshrined in the Constitution, Such changes have been recognized as being both complex and fraught with stakeholder interests. There is a perception that private family practitioners (FP) generally harbour negative attitudes towards HL that has been brought into effect in recent years. It is also possible that FP, in general, lack knowledge regarding HL. The aim of the study was to assess the knowledge and attitudes of private family practitioners (FP) to health legislation (HL) within a localized geographical area of the eThekweni Metro, KwaZulu-Natal Province. The specific objectives were: To determine family practitioners’ knowledge of health legislation. To determine family practitioners’ attitudes towards health legislation. To assess the correlation between family practitioners’ knowledge and attitudes. To compare the self-reported knowledge of health legislation with the objective assessment of knowledge and attitudes. To establish practitioners’ perceptions of the future of the profession, and of family practice in particular. Methods A cross-sectional descriptive and analytical study was performed, using a pre-tested, validated, structured questionnaire. This instrument was personally hand-delivered to each of a group of private family practitioners practising within a confined geographical area. The sample comprised of 101 family practitioners. Data were analysed using SPSS version 15.0 (SPSS Inc., Chicago, Illinois). Results The study revealed that private FP possess limited knowledge about HL and have a negative attitude in general towards HL. The mean knowledge score was 55% (standard deviation 12.2%). The mean score for attitudes towards health legislation was 46,3% (standard deviation 4.2%). The correlation coefficient between knowledge and attitudes was 0.244 (p=0.022). Therefore, there was a weak positive, but statistically significant, correlation between knowledge and attitudes. Thus, in general, as knowledge increased, so did attitudes improve and become more positive. The self reported knowledge and attitudes of FPs seemed to show some unexpected though non-statistically significant anomaly, in that FPs who considered themselves “well aware” of certain parts of HL, together with those who were “not aware”, reporting a more negative attitude towards HL than those who considered themselves to be “aware”. FPs’ perceptions of the future of the profession, and of family practice in particular, were generally reported as being reasonable to poor. Financial viability and sustainability of FP, in particular, were reported as being reasonable to poor. The attractiveness of the profession to the youth of today was reported as being poorer than in the past. However, the majority of FP held the perception that medicine as a profession was distinct as it responds to a calling to serve society at large, giving this aspect of the question a ranking of “reasonable to good”. Conclusion and Recommendations The study revealed that this group of FPs attained an overall mean knowledge score of 55% with respect to HL. FPs’ knowledge of HL requires improvement, which can be achieved through effective education and training programmes. Private FPs need to embrace the change process, but also need to be more pro-active in vocalizing their opinions. The Health Ministry and relevant authorities and policymakers need to play a greater role in creating an atmosphere that embraces and facilitates change by involving iii relevant stakeholders. Lastly, it is recommended that this study serve as a template for a broader research project involving larger numbers of participants and a wider geographical area. In addition, an intervention tool should be devised. Such a tool could take the form of a structured education programme on HL, with an associated monitoring and evaluation aspect, which would enable an assessment of the intervention programme in terms of its value and the influence it has on improving knowledge and attitudes. / Thesis (M.Med.Sc.)-University of KwaZulu-Natal, Durban, 2011.

Background: Home visits are part of general practice work in Germany. Within the context of an expanding elderly population and a decreasing number of general practitioner (GPs), open questions regarding the organisation and adequacy of GPs’ care in immobile patients remain. To answer these questions, we will conduct a representative primary data collection concerning contents and organisation of GPs’ home visits in 2014. Because this study will require considerable efforts for documentation and thus substantial involvement by participating GPs, we conducted a pilot study to see whether such a study design was feasible. Methods: We used a mixed methods design with two study arms in a sample of teaching GPs of the University Halle. The quantitative arm evaluates participating GPs and documentation of home visits. The qualitative arm focuses on reasons for non-participation for GPs who declined to take part in the pilot study. Results: Our study confirms previously observed reasons for non-response of GPs in the particular setting of home visits including lack of time and/or interest. In contrast to previous findings, monetary incentives were not crucial for GPs participation. Several factors influenced the documentation rate of home visits and resulted in a discrepancy between the numbers of home visits documented versus those actually conducted. The most frequently reported problem was related to obtaining patient consent, especially when patients were unable to provide informed consent due to cognitive deficits. Conclusions: The results of our feasibility study provide evidence for improvement of the study design and study instruments to effectively conduct a documentation-intensive study of GPs doing home visits. Improvement of instructions and questionnaire regarding time variables and assessment of the need for home visits will be carried out to increase the reliability of future data. One particularly important methodological issue yet to be resolved is how to increase the representativeness of home visit care by including the homebound patient population that is unable to provide informed consent.

Objective: Because of the increasing shortage of general practitioners (GPs) in many countries, this study aimed to explore factors related to GP career choice in recent medical graduates. Particular focus was placed on the impact of specific practice-orientated GP courses at different stages of the medical undergraduate curriculum. Design: Observational study. Multivariable binary logistic regression was used to reveal independent associations with career choice. Setting: Leipzig Medical School, Germany. Subjects: 659 graduates (response rate = 64.2%). Main outcome measure: Choice of general practice as a career. Results: Six student-associated variables were found to be independently related to choice of general practice as a career: age, having family or friends in general practice, consideration of a GP career at matriculation, preference for subsequent work in a rural or small-town area, valuing the ability to see a broad spectrum of patients, and valuing long-term doctor – patient relationships. Regarding the curriculum, after adjustment independent associations were found with a specifi c pre-clinical GP elective (OR = 2.6, 95% CI 1.3 – 5.3), a four-week GP clerkship during the clinical study section (OR = 2.6, 95% CI 1.3 – 5.0), and a four-month GP clinical rotation during the final year (OR = 10.7, 95% CI 4.3 – 26.7). It was also found that the work-related values of the female participants were more compatible with those of physicians who opt for a GP career than was the case for their male colleagues. Conclusion: These results support the suggestion that a practice-orientated GP curriculum in both the earlier and later stages of undergraduate medical education raises medical schools’ output of future GPs. The findings are of interest for medical schools (curriculum design, admission criteria), policy-makers, and GPs involved in undergraduate medical education. More research is needed on the effectiveness of specific educational interventions in promoting interest in general practice as a career.

Tiriamojo darbo tikslas. Ištirti stacionarioje sveikatos priežiūros įstaigoje dirbančių slaugytojų sveikatą įtakojančius psichosocialinius rizikos veiksnius ir įvertinti jų valdymo galimybę. Uždaviniai: Nustatyti slaugytojų nuomonę apie psichosocialinių rizikos veiksnius ir jų realų valdymą; Tyrimo metodika. 2011 m. rugpjūčio mėn. atliktas kiekybinis ir kokybinis tyrimas. Apklausti 284 VšĮ Respublikinės Šiaulių ligoninės bendrosios praktikos slaugytojai bei interviu metu apklausti 9 informantai. Rezultatai. Nustatyta nepakankamas apsaugos pirštinių naudojimas (p = 0,000). Daug darbo užduočių, nepriklausančių slaugytojo veiklai (p = 0,002), laiko trūkumas užduotims atlikti (p = 0,008), nepakankamai sudaromos sąlygos profesinei kvalifikacijai kelti ( p = 0,050). Organizavimo veiksniai: naktinis darbas (p = 0,035), nepakankamas darbo užmokestis (p = 0,035). Turinio veiksniai: didelė atsakomybė už atliekamus slaugos veiksmus (p = 0,042), įtakos savo darbui trūkumas (p = 0,027). Darbo santykių veiksniai: bloga skyriaus atmosfera (p = 0,018), nėra bendravimo (p = 0,017), paramos iš skyriaus administracijos trūkumas (p = 0,029), paramos iš įstaigos vadovybės trūkumas (p = 0,000), blogas vadovavimas įstaigai (p = 0,001). Visi šie veiksniai yra statistiškai reikšmingai susiję su slaugytojų amžiumi, jų šeimynine padėtimi, slaugytojų darbo stažu dabartinėje darbo vietoje bei bendru medicininiu darbo stažu. Negatyvus elgesį kasdien ir kas savaitę patirdavo: 2,2 % slaugytojų gaudavo... [toliau žr. visą tekstą] / Aim of study: to investigate the psychosocial risk factors for health among nurses working at in-patient health care setting and evaluate the potential for management of such factors. Objectives: to evaluate the attitudes of nurses towards psychosocial risk factors and actual management of such factors. Material and methods: the qualitative and quantitative study was conducted in August 2011. In total, 284 general practice nurses from Siauliai Hospital were enrolled to study, 9 of them underwent the interview. Results. There were following identified risk factors: insufficient use of hospital gloves (p<0.001), abundance of tasks not related with nursing (p=0.002), lack of time for accomplishing the tasks (p=0.008), and scarce conditions for improvement of professional qualification (p=0.050). Organizational factors: work at night (p=0.035) and low salary (p=0.035). Content-related factors: high responsibility for nursing actions (p=0.042) and lack of influence on own work (p=0.027). Relationships at work: poor internal climate at work (p=0.018), lack of communication (p=0.017), lack of support by department authorities (p=0.029), lack of support by hospital authorities (p<0.001), and poor hospital management (p=0.001). All abovementioned factors were statistically significantly associated with nurses ‘age, family status, work experience in current workplace, and general medical work experience. Daily or weekly negative behaviour towards nurses was reported by 2.2 % in form... [to full text]

La Société Européenne de Cardiologie recommande pour les patients insuffisants cardiaques, en plus de la prise en charge médicamenteuse et interventionnelle, une prise en charge de type « éducation du patient » pour améliorer leur qualité de vie. En France, des programmes multidisciplinaires d’éducation du patient en hôpital ont mesuré leurs effets sur les ré-hospitalisations, la mortalité et le taux de participation des patients aux programmes. Certaines études internationales ont mesuré l’effet de programmes éducatifs délivrés par des équipes hospitalières multidisciplinaires, d’autres ont recruté des patients en soins primaires, mais les programmes étaient conduits par des infirmières ou des assistants des médecins généralistes. Ce type de programme ne reflète pas la situation actuelle en France où la plupart des patients sont suivis en ambulatoires par leurs médecins généralistes. Il semblait nécessaire de connaître plus précisément l'effet de programmes d'éducation du patient délivrés par les médecins généralistes auprès de leurs propres patients. L’objectif principal de l’étude ETIC (Education thérapeutique des patients insuffisants cardiaques) était d’évaluer si un programme d’éducation des patients insuffisants cardiaques délivré par leurs médecins traitants et suivis en médecine générale, améliorait leur qualité de vie. Cette étude interventionnelle, contrôlée, randomisée en grappes, a inclus 241 patients insuffisants cardiaques chroniques suivis par 54 médecins généralistes pendant 19 mois. Les médecins généralistes du groupe intervention ont été sensibilisés pendant 2 jours au programme d’éducation du patient et entrainés à adapter leurs propres objectifs d'éducation aux attentes du patient. Plusieurs séances d'éducation ont été simulées au cours de la formation des médecins. La 1re séance comportait un bilan éducatif explorant le mode de vie et les habitudes alimentaires, l'activité physique, les activités de loisirs, les projets et les ressources des patients. Les patients bénéficiaient de 4 séances d’éducation tous les 3 mois pendant 12 mois puis d’une séance d’éducation de synthèse au 19e mois de suivi. Le critère d’évaluation principal était la qualité de vie mesurée par une échelle de qualité de vie générique, la MOS 36-Item Short Form Health Survey (SF-36), et par une échelle de qualité de vie spécifique de l’insuffisance cardiaque, le Minnesota Living with Heart Failure Questionnaire (MLHFQ). La moyenne d’âge des patients était 74 ans (± 10.5), 62% était des hommes, et leur fraction d’éjection ventriculaire gauche moyenne était de 49.3% ± 14.3%. A la fin du suivi, le score MLHFQ moyen dans les groupes intervention et témoin étaient respectivement 33.4 ± 22.1 versus 27.2 ± 23.3; p = 0.74, intra-cluster coefficient [ICC] = 0.11. A la fin du suivi, la moyenne des scores SF-36 mental et physique dans les groupes intervention et témoin étaient respectivement 58 ± 22.1 versus 58.7 ± 23.9 (p = 0.58, ICC = 0.01) et 52.8 ± 23.8 versus 51.6 ± 25.5 (p = 0.57, ICC = 0.01). Le nombre de patients insuffisants cardiaques à fraction d’éjection conservée (ICFEp) était de 93 (80.9%) dans le groupe intervention et de 94 (74.6%) dans le groupe témoin (p = 0.24). Une étude exploratoire a été réalisée pour décrire les traitements prescrits dans la population de cette étude : évaluation de l’adhésion des médecins généralistes aux recommandations pour les patients à fraction d’éjection réduite (ICFEr) et description des traitements prescrits aux patients ICFEp. Le programme d’éducation du patient délivré dans le cadre de l’étude ETIC, n’a pas fait la preuve d’une amélioration de la qualité de vie des patients. D’autres recherches sont nécessaires pour améliorer la qualité de vie de ces patients. Les stratégies et les méthodes d’éducation restent un champ de recherche à développer. / The European Society of Cardiology guidelines recommend non-pharmacological management to improve patients’ quality of life. In France, patient education programs delivered by hospital multidisciplinary teams in outpatient clinics have been assessed for their impact in patients with heart failure (HF). Some international studies assessed patient education interventions for heart failure patients recruited in the hospital. These programs were delivered by hospital multidisciplinary teams. Others have recruited patients with heart failure in primary care but the patient education programs were delivered by nurses or general practitioner assistants. This does not reflect the situation of the majority of patients in France, most of whom are ambulatory and cared for by general practitioners (GPs). Therefore, more evidence is needed on the effect of patient education programs delivered by GPs. As GPs are the doctors closest to patients, we hypothesized that their patient education could improved the HF patients quality of life. The ETIC (Education thérapeutique des patients insuffisants cardiaques) trial aimed to determine whether a pragmatic education intervention in general practice could improve the quality of life of patients with chronic heart failure (CHF) compared with routine care. This cluster randomised controlled clinical trial included 241 patients with CHF attending 54 general practitioners (GPs) in France and involved 19 months of follow-up. The GPs in the intervention group were trained during an interactive 2-day workshop to provide a patient education program. Several patient education sessions were simulated during the 2-day workshop. Patients had a further four education sessions, at 4, 7, 10 and 13 months, followed by an overview session at 19 months. The primary outcome was patients’ quality of life, as measured by the MOS 36-Item Short Form Health Survey (SF-36), a generic instrument, and the Minnesota Living with Heart Failure Questionnaire (MLHFQ). The mean age of the patients was 74 years (± 10.5), 62% were men and their mean left-ventricular ejection fraction was 49.3% (± 14.3). At the end of the follow-up period, the mean MLHFQ scores in the Intervention and Control Groups were 33.4 ± 22.1 versus 27.2 ± 23.3 (p = 0.74, intra-cluster coefficient [ICC] = 0.11). At the end of the follow-up period, SF-36 mental and physical scores in the Intervention and Control Groups were 58 ± 22.1 versus 58.7 ± 23.9 (p = 0.58, ICC = 0.01) and 52.8 ± 23.8 versus 51.6 ± 25.5 (p = 0.57, ICC = 0.01), respectively. Patients with heart failure with preserved ejection fraction (HFpEF) in the intervention group and in the control group were respectively: 93 (80.9%) and 94 (74.6%) (p = 0.24). A comprehensive data set of this trial was used to assess the prescription behaviour of GPs: GP’s guideline adherence for pharmacotherapy of heart failure with reduced ejection fraction (HFrEF) patients and to describe pharmacotherapy of HFpEF patients. Conclusions Patient education delivered by GPs to elderly patients with stable heart failure in the ETIC program did not demonstrate an improvement in their quality of life compared with routine care. Further research on improving the quality of life of elderly patients with CHF in primary care is needed. Patient education strategies and methods, as well as relevant tools and adapted criteria used to assess them, remain a field of research to develop. This area of investigation will be the following of this work.

The purpose of this study was to measure and evaluate GPs' practices, perceptions, and beliefs with regard to chronic childhood asthma management and to identify GPs' attitudes towards practice guidelines in particular the SACAWG (South African Childhood Asthma Work Group) guideline (Motala et al., 2000). In 2001 a single period cross-sectional survey was conducted among 300 GPs in the Nelson Mandela Metropole (NMM) which comprised the Port Elizabeth, Uitenhage, and Despatch regions. GPs in clinical practice in the NMM were identified from the register of the Health Professions Council (HPC) CD-ROM (2000). The register contains names and professional information on all physicians in South Africa who have completed or in the process of completing requirements to practice medicine. GPs meeting the following criteria were identified: (1) primary self-designated practice specialty of general practice; (2) practice location in Port Elizabeth, Uitenhage, and Despatch areas; and (3) engaged in direct patient care. The HPC register contained listings for 300 GPs that matched the study criteria. Data were collected by means of a structured self-administered questionnaire. Questionnaires with a return envelope were mailed to the GPs' practices. Questionnaires were returned by 89 of the 300 eligible NMM GPs, reflecting a 29,7 % response rate. A 43-item Chronic Childhood Asthma Management questionnaire was developed and validated to assess the delivery of asthma care by GPs in the NMM. Forty-four per cent of the respondents reported performing spirometry on patients with newly diagnosed asthma as part of their initial evaluation. For patients with moderate persistent asthma prescribing of inhaled corticosteroids (ICSs) varied by patient age, with 57,4% of physicians routinely prescribing them for patients < 5 years, compared with 76,5% of physicians prescribing them for patients 5 years. Awareness of the SACAWG guidelines among these GPs was high, with 76,8% reporting that they have heard of the guidelines, and 59,4% reporting having read them. 14,5 per cent of the GPs reported developing written treatment plans for patients with moderate or severe asthma. To achieve the best results with their asthma patients, 68,1% of the physicians reported that patient compliance was imperative, 49,3% reported education as the most important, pharmacotherapy / good products was reported as most important by 29,0% of the group, environmental control was cited by 18,8% of the GPs. Several aspects of the SACAWG guidelines appear to have been incorporated into clinical practice by GPs in the NMM, whereas other recommendations do not appear to have been readily adopted. This information suggests areas for intervention to improve primary care for asthma in the NMM.

As the occurrence of obesity increases amongst young people, so increases the risk of more people suffering from heart failure as early as during middle age. The aim is to describe the life experiences of middle aged persons living with chronic heart failure. The literature study is based on twelve published, qualitative, and scientifically proved articles derived from MedLine and Cinahl using queries representing the subject, as well as from manual searching in ScienceDirect and LIBRIS. These articles have been analyzed from a life world perspective. Four main themes and four sub themes were identified from the articles' results. The main themes are "The social life", "Quality of life", "Body failing", and "the Economical impact of chronic heart failure". These represent the main areas where the patients feel the greatest loss due to their condition. The discussion reveals the importance of informing the patients of the common prevalence of the feelings described in this study. Also, the nurse should function as a coach for self-care with continuous follow-ups. The result of this study will hopefully increase the understanding of the heart diseased patients' life situations. / I takt med att förekomsten av kraftig övervikt ökar bland unga, ökar även risken för att fler personer drabbas av hjärtsvikt redan i medelåldern. Syftet är att utifrån befintlig forskning beskriva medelålders personers upplevelser av hur det är att leva med kronisk hjärtsvikt. Litteraturstudien baseras på 12 publicerade, kvalitativa och vetenskapliga artiklar efter sökning i MedLine och Cinahl med specifika sökord som representerade ämnet. Manuella sökningar utfördes i ScienceDirect och LIBRIS. Artiklarna har analyserats utifrån ett livsvärldsperspektiv. Ur artiklarnas resultat identifierades fyra teman och sex subteman. Huvudteman är ”Det sociala livet”, ”Livskvalitet”, ”Kroppen sviker” och ”Ekonomiska aspekter”. Huvudteman skildrar patienternas upplevdelser av att leva med kronisk hjärtsvikt. I diskussionen framkommer att det är viktigt för en patient med kronisk hjärtsvikt att få bekräftat att upplevda känslor är vanligt förekommande. Vidare bör sjuksköterskan fungera som en vägledare för egenvård med kontinuerliga uppföljningar. Förhoppningen är att resultatet från denna studie ska öka förståelsen för hjärtsjuka patienter inom ramen för hälso- och sjukvård.