Slovenia

April 2006

By Janko Kersnik
 

Guidelines
Slovene family medicine society will finally launch translated and adopted Finish EB guidelines in June this year.

National indicators project on management of hypertension
Web based data gathering process on core indicators on management of hypertension based on English protocol: three measurements before the initiation of drug treatment, starting value, disease register, regular of check-ups, mean value of the last three measurements, referral in the case of difficulties in reaching target values. Each participant receives feedback with own results tabulated to the rest of participants.

Practice evaluation – Visotool
Slovene family medicine society is a member of TOPAS collaboration. We decided to use Visotool as a web tool in future practice evaluations in FP.

Teaching QA
One module (i.e. 2 days and 3 week exercise) in vocational training curricula for FP is dedicated to QA. Students have one session on QA during their FP curricula.

Community orientation in FP (http://www.drmed.org/index.php?podkat=25)
Bled course in 2006 (September 19-23) is dedicated to Community orientation in FP. The meeting is aiming at the educators in primary care who are involved in teaching at university or practice level. The aim of the course is to work on a fifth core competence of a FP/GP as adopted by EURACT Educational agenda, which encompasses the ability to reconcile the health needs of individual patients and the health needs of the community in which they work in balance with available resources. TO KNOW the methods for needs assessment of the individual patients and the community and the resources of the community. TO UNDERSTAND the balance between the needs of the patients and the community and resources available.
TO KNOW HOW

• to assess the patients’ social and existential needs
• to assess the community health care needs
• to relate information on social services and structures to the patient
• to communicate with social services and structures outside health care system
• to keep records on collaboration with other services
• to use available evidence to make management decisions in community oriented care.

TO ACCEPT that community orientation is an important aspect of FP/GP care and the limitation of the available resources in designing community programmes.

TO APPRECIATE the coexistence and support of formal and informal support from the community in managing patients’ social and existential problems.

TO VALUE the role of broader teamwork in managing the patients’ social problems and TO VALUE reflection in the community oriented work.

Patient satisfaction
We developed and validated patient evaluation forms for nursery home patients, emergency room patients and for the emergency services patients.

By Janko Kersnik

Slovenia is a small country with population close to 2 million. Slovene family medicine society as part of Medical association is responsible for the CME and quality developments in family practice.

Guidelines
We interviewed 813 family practitioners on the knowledge of hypertension guidelines recommendations. We got 40.2% response rate. The awareness of the guidelines among Slovene general practitioners is modest and comparable to the results of similar studies. The physicians’ acceptance of the guidelines is high and influences their awareness of the guidelines. The guidelines explanatory workshop is an accepted form of continual medical education among general practitioners. There were no other physicians’ characteristics or organizational factors influencing the guideline awareness.

Slovene family medicine society will launch translated and adopted Finish EB guidelines later this year.

National cross-sectional study on the workload and on the management of hypertension in family practices
In a cross-sectional study a random sample of 42 family physicians registered 12596 contacts, including home visits. Only 0.8% of all the contacts held place at the patients’ homes. At each contact, a FP dealt with 1 to 8 different health problems (mean 1.5). In 20.2% of all the contacts, the patients were referred to a clinical specialist. The most frequent action taken was prescription of a drug (in 58%); patients got a mean 1.95 prescriptions per visit. The mean time of the contact was 7.1 minutes. The mean daily frequency of visits was 45.6. Higher workload increases drug prescribing, decreases number of home visits, but doesn’t have impact on referral rate.

First results on the quality of hypertension management in family practices in Slovenia in 2752 patients showed rather poor doctors’ compliance to the guidelines. Only at one quarter of the hypertensive patients doctors followed the proposed set of diagnostic tests for the follow-up, which is however still the same as in the other studies. There was a low yield of non-pharmacological treatments. 85 % of patients on combination therapy with three or more drugs had a diuretic as one of them. Only 15,5 % of patients reached the target values.

Patient satisfaction with family practice in Slovenia between 1998 and 2004
The EUROPEP instrument, consisting of 23 questions was used in 1998 and 2004. In spite of transitional changes the level of patient satisfaction in Slovenia remained nearly at the same level as it used to be before 6 years. On average there is a slight improvement in all but four items. 

- on Slovenian health statistics