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Background: GPs’ participation in continuous medical education (CME) is essential for patient care, GPs’ wellbeing, and healthcare expenditure. However, one-quarter of Danish GPs did not use their reimbursement for CME in 2022. Knowledge of barriers for participating in CME is limited. Aim: To analyse the barriers GPs face to participation in CME, and patterns in perceived barriers. Design & setting: A cross-sectional questionnaire study design was used. The study population comprised all 3257 GPs in Denmark who, in May 2023, were registered as entitled to reimbursement for CME. Method: The response rate was n = 1303/3257 (40%). Based on a question about use of CME, the responders were divided into ‘frequent', ‘partial', and ‘seldom’ users. Partial and seldom users answered questions about barriers related to CME (n = 726). The presence of barriers was quantified, and a latent class analysis (LCA) was used to stratify GPs according to their barrier patterns. Results: The most frequent barriers were as follows: too busy (67%); fully booked courses (45%); and no substitute or locum doctor (39%). Based on the LCA, we found three distinctive patterns, clustering around the following: GPs from clinics with no tradition for CME (class 1, 17%); GPs who used time on professional work outside clinic (teaching, organisational work) (class 2, 43%); and GPs who were personally or professionally affected (class 3, 40%). Singled-handed and male GPs were slightly overrepresented among seldom users. Conclusion: We have identified barriers for CME. We found three different profiles of GPs who perceived different patterns of barriers. Identified patterns in barriers should be considered in future CME initiatives.

AbstractBackground The countries of the former Yugoslavia have health and education systems with the same tradition but these have changed over the years. Little is known about how family medicine teaching transitioned from face-to-face to distance education during the COVID-19 pandemic.Objectives to investigate student/teacher experience in transitioning from face-to-face to distance education.Methods A cross-sectional, online survey was conducted among 21 medical schools of the former Yugoslavia between December 2021 and March 2022. Under/postgraduate teachers and students who taught/studied family medicine during the academic year 2020/2021 were invited to participate. Of 31 questions for students and 35 for teachers, all but nine open questions were analysed using descriptive statistics.Results Seventeen of 21 medical schools contributed data involving 117 participants representing all countries of the former Yugoslavia. At the beginning of the pandemic, 30%, 26% and 15% of teachers, students and trainees, respectively, received formal preparation in distance education. Of these, 92% of teachers and 58% of students/trainees felt they were not adequately prepared. Synchronous teaching was the main method used, with a third using hybrid methods. All participants were least confident about online assessment. More than 75% of respondents agreed that lectures could be kept online, not patient consultations or practical skills’ classes.Conclusion Teachers used various old and new methods to provide learning opportunities despite COVID-19 constraints. Effective technology-based strategies are essential to ensure assessment integrity and enhance the learning environment.

AbstractBackground Similar to other countries, Departments of Family Medicine in the former Yugoslavia had to transition from face-to-face to distance education during COVID-19.Objectives To elucidate obstacles and facilitators of the transition from face-to-face to distance education.Methods A cross-sectional, multicentre, qualitative study design was used to analyse nine open-ended questions from an online survey using inductive thematic analysis. The questionnaire was distributed to 21 medical schools, inviting them to involve at least two teachers/students/trainees. Data were collected between December 2021 and March 2022.Results In 17 medical schools, 23 students, 54 trainees and 40 teachers participated. The following themes were identified: facilitators and barriers of transition, innovations for enhancing distance education, convenience of distance education, classical teaching for better communication, the future of distance education, reaching learning outcomes and experience of online assessment. Innovations referred mainly to new online technologies for interactive education and communication. Distance education allowed for greater flexibility in scheduling and self-directed learning; however, participants felt that classical education allowed better communication and practical learning. Teachers believed knowledge-related learning outcomes could be achieved through distance education but not teaching clinical skills. Participants anticipated a future where a combination of teaching methods is used.Conclusion The transition to distance education was made possible thanks to its flexible scheduling, innovative tools and possibility of self-directed learning. However, face-to-face education was considered preferable for fostering interpersonal relations and teaching clinical skills. Educators should strive to strike a balance between innovative approaches and the preservation of personal experiences.

Izhodišča: V času epidemije covida-19 v Sloveniji je bilo potrebno celotni teoretični del pouka družinske medicine izvesti po spletu. Metode: Pouk družinske medicine smo prilagodili izvedbi preko videokonferenčnega sistema. Dodali smo aktualne teme o epidemiji, uvedli redne domače naloge, povečali uporabo spletne učilnice in vzpostavili možnost foruma. Uporabili smo nove metode, na primer predavanje z “obrnjeno učilnico”, problemsko usmerjeno učenje s kliničnimi vinjetami in video-posvet o pouku sporazumevanja. Posebej se je obnesla metoda igrifikacije oz. uvedba kviza v pouk. Rezultati: Kakovost, prednosti in nevarnosti spletnega pouka smo ocenili z anketo študentov in mnenjem pedagogov. Študenti so ocenili, da je pouk dobro potekal, sodobne metode so jim ugajale, predlagali pa so več kliničnih primerov in predstavitev najpogostejših stanj v družinski medicini. Spletni pouk so ocenili enako visoko kot klinične vaje. Pedagogi so navedli visoko lastno motivacijo in inovativnost pri spremembi pouka, poudarili prednost časovne prilagodljivosti, po drugi strani pa časovno zahtevnost spletnega poučevanja. V prihodnosti bi lahko s pomočjo spletnega poučevanja določen delež študentov opravljal klinične vaje v domačem okolju, s čimer bi potrebovali manj mentorjev v Ljubljani. Spletno poučevanje ponuja možnost učenja modernih veščin zdravnika družinske medicine (npr. videoposvet), aktivacije študentov (npr. igra vlog) ter omogoči ustvarjanje repozitorija učnih gradiv in sodelovanje gostov iz tujine. Slabost pa je odsotnost osebnega stika s študenti ter neustreznost za učenje kliničnih veščin. Zaključek: Ob takojšnjem prehodu na spletno poučevanje smo preizkusili nove metode pouka, ugotovili nekatere prednosti in pomanjkljivosti. Te izkušnje bodo pomembne za spremembe pouka v naslednjih letih.

Akademska klinična medicina je gibalo razvoja medicinske znanosti in stroke v vsakem sistemu zdravstvenega varstva. To področje medicine v Sloveniji terja boljšo zakonsko ureditev. Prispevek predstavlja stanje na tem področju v Sloveniji in razlog za to, da tako stanje vztraja, ter posledice, ki bodo nastale, če se stanje ne bo spremenilo. Uvodnik zaključujemo s pozivom slovenski stroki in politiki k reševanju tega problema.

Osnovna zdravstvena dejavnost in z njo družinska medicina predstavljata temelj vsakega zdravstvenega sistema. V Sloveniji imamo sistem osnovne zdravstvene dejavnosti, ki je konceptualno priznan kot zelo dober s strani mednarodnih strokovnjakov in organizacij. Ob tem se soočamo z resnimi kritikami in težavami. Prispevek predstavlja pregled izzivov, s katerimi se sooča družinska medicina v Sloveniji zdaj. V devetih točkah so zbrani predlogi ukrepov, ki bi jih bilo potrebno izpolniti, če želimo, da se stanje na področju družinske medicine izboljša.

Abstract Background Croatia and Slovenia were the transit countries on the Balkan route for migrants and refugees from Middle East countries in 2015 and 2016. They had to optimize health care delivery in the special circumstances in refugee camps and transit centres. Little is known about health care provision in border camps where a large number of migrants stay for only couple of hours. Previous studies emphasize that language barriers and cultural differences play a central part in the relationship between health workers and migrants inside the transit zone. The aim of the study was to identify specific characteristics of health care provision experienced by primary healthcare providers in order to prepare solutions on how to organise health care in refugee settings. Methods Twelve thematic interviews were conducted in the middle of the most intense migration movements to the North-West Europe between November and December 2015 with health workers from Croatia and Slovenia. Interview transcripts were read, coded, reviewed, and labelled. We used qualitative content analysis. Results Four themes about the health service provision for refugees at Schengen border were identified. The circumstance when mutual understanding is poor and the consultation not successful, cultural differences represent a central barrier. Participants highlighted that the importance of respecting human dignity is crucial for the provision of basic medical care for migrants in transit. Conclusion Successful overcoming language barriers, respecting cultural differences, humanity, susceptibility to social deprivation and traumatic experiences are the key factors important for organisation of health care in transit centers and camps. This article gives some useful tips for healthcare workers and policy makers who are participating in health services provision for migrants and other refugees. Health workers should be prepared to work in special working conditions with a lack of resources. Their work would require timely planning and reflection on the organization of more transit camps. Trial registration Ethical Committee of the Republic of Slovenia approved the study as a project number 112/02/16.

Primarni nivo zdravstvenega varstva predstavlja vstopno mesto v zdravstveni sistem in od njega je v veliki meri odvisna kakovost in stroškovna vzdržnost zdravstvenega sistema. Raziskovanje je gonilo strokovnega razvoja v skrbi za čim boljšo kakovost oskrbe pacientov. Družinska medicina (DM) v Sloveniji predstavlja največjo specialnost na primarnem nivoju zdravstvenega varstva, ki je na področju raziskovanja v zadnjih desetletjih dosegla velike uspehe. V preglednem prispevku bodo prikazane značilnosti raziskovanja v družinski medicini, predstavljena vključenost raziskovanja v različne nivoje izobraževalnega procesa in delo v praksi ter nakazani izzivi, ki družinsko medicino kot znanstveno in raziskovalno vedo čakajo v prihodnje.

General Practice/Family Medicine (GP/FM) is a key discipline within primary health care and so by extension for the whole health care system. An essential condition for effective GP/FM care is a work force that is highly qualified. As society is changing rapidly, a revision of the GP/FM definition is ongoing, in addition to a recent movement of identifying related core values. In this paper, we want to give an overview on how these new paths and perspectives are currently reflected in GP/FM teaching and training. We selected four core values that fit in with possible future visions: person-centered care, continuity of care, cooperation in care, and community-oriented care. By a narrative review, we observed that GP/FM education toward core values is often built around overarching topics. Teaching and learning take place in specific contexts, most of all through placements within communities, primary care settings, or hospital wards. Mixed teaching- and training methods are used combining knowledge, skills, and attitude. Furthermore, collaboration with other health professionals and peers is stressed, in addition to the importance of role models, a holistic focus and the involvement of patients. Since these core values are important within GP/FM and rather few studies on the educational aspects and learning tools were found we advocate encouraging each other more to share good practices, certainly the innovative ones specifically related to GP/FM.

Background: Values are deeply held views that act as guiding beliefs for individuals and organizations. They state what is important in a profession. The aims of this study were to determine whether European countries have already developed (or are developing) documents on core values in family medicine; to gather the lists of core values already developed in countries; and to gather the opinions of participants on what the core family values in their countries are.Methods: This was a qualitative study. The questionnaire was distributed as an e-survey via email to present and former members of the European Society for Quality and Safety in Family Practice (EQuiP), and other family medicine experts in Europe. The questionnaire included six items concerning core values in family medicine in the respondent's country: the process of defining core values, present core values, the respondents' suggestions for core values, and current challenges of core values.Results: Core values in family medicine were defined or in a process of being defined in several European countries. The most common core values already defined were the doctor-patient relationship, continuity, comprehensiveness and holistic care, community orientation, and professionalism. Some countries expressed the need for an update of the current core values' list. Most respondents felt the core values of their discipline were challenged in today's world. The main values challenged were continuity, patient-centered care/the doctor-patient relationship and comprehensive and holistic care, but also prioritization, equity, and community orientation and cooperation. These were challenged by digital health, workload/lack of family physicians, fragmentation of care, interdisciplinary care, and societal trends and commercial interests.Conclusion: We managed to identify suggestions for core values of family medicine at the European level. There is a clear need to adopt a definition of a value and tailor the discussion and actions on the family medicine core values accordingly. There is also a need to identify the core values of family medicine in European countries. This could strengthen the profession, promote its development and research, improve education, and help European countries to advocate for the profession.

Background: Most patients that commit suicide consult their GPs before their death. This topic is often surrounded by secrecy and associated with guilt and shame. There is a lack of knowledge about support for GPs after patient suicide. Objectives: To identify the widest range of Slovenian GPs’ problems and needs in connection with patient suicide, and, based on the findings of the study, to prepare ways to assist GPs after patient suicide. Methods: Semi-structured interviews were held with GPs that had experienced a patient’s suicide during their professional career until saturation was reached. The interview guide was piloted. Twenty-two in-depth interviews were carried out between April 2012 and February 2013. Transcripts were coded and thematically analysed using qualitative content analysis. Results: Participating GPs suggested possible forms of support, most frequently individual consultation with a psychologist or a psychiatrist, in person, by phone, or via e-mail. Balint groups, group consultations and various workshops on suicide or depression would be a preferable form of support. Some GPs perceived critical incident review as an attempt to blame them, whereas others saw it as an opportunity for support. A group of peers that could discuss professional dilemmas in which more experienced GPs would help younger GPs would be helpful. Conclusion: Slovenian GPs did not have any formal support system at the time of the research, but they would appreciate such a possibility.

Introduction: Slovenia has a high level of alcohol consumption. Comparisons of the alcohol drinking habits of the Roma and non-Roma population have yielded conflicting results. The aim of this research was to compare alcohol consumption habits between Roma and non-Roma in a sample population in Northeastern Slovenia. Methods: We conducted a cross-sectional study in which we included 100 representatives of Roma and 100 representatives of non-Roma population, aged 18 to 65 years. The questionnaire used included demographic data (gender, age, marital status, education, and employment) and the AUDIT (Alcohol Use Disorders Identification Test) questionnaire. Two logistic regression models (teetotallers/drinkers and non-hazardous drinkers/other drinkers) were used for the comparison of drinking habits. Results: Roma scored lower on overall AUDIT score (4.51) than non-Roma (4.56). Roma and non-Roma differ significantly regarding teetotallers (39.0% vs. 16.0%) and non-hazardous drinkers (38.0% vs. 64.0%). Ethnicity was identified to have a statistically significant impact on the studied drinking behaviour: teetotallers (p < 0.001) and non-hazardous drinkers (p = 0.015). Discussion and conclusion: Our aim was to look at the differences between the two groups rather than obtain representative data on the population. Our research also casts a doubt on whether the AUDIT scale is suitable for measuring alcohol abuse.

The paper describes experiences in the development of an international textbook of family medicine. The process of its development has started in Slovenia, where the Slovenian authors have written a textbook, adhering strictly to the European definition of family medicine and its core competencies. The format and the approach were also adopted by Croatian authors, who have used most of the material from the Slovenian book, but have modified some of the chapters according to the situation in the country and have added some of their own. This activity has created an opportunity for a truly international collaboration in the area of education of family medicine, with a creation of an international consortium, which would be responsible for the core content of the book and local adaptations of the book according to the specificities and needs of different countries. Conclusion. This innovative approach in the development of teaching material may be interesting for a variety of smaller countries in Europe and worldwide.

Objective. The European Academy of Teachers in General Practice / Family Medicine (EURACT) has developed an educational agenda, the key document for teaching family medicine in Europe. The aim of our study was to find out how final year medical students at the beginning of their family medicine clerkship understand the discipline of family medicine. Methods. The attitudes toward family medicine were paraphrased and developed into a 164-item questionnaire, which was administered to 335 final-year medical students at the beginning of their clerkship. Using combinatorial optimization with genetic algorithms we selected 30 items which yielded the highest Cronbach alpha reliability coefficient. Finally, we performed a factor analysis to find which dimensions of family medicine were recognised by the students and compared them with the domains defined in the EURACT definition. Results. The 30-item questionnaire had a Cronbach alpha reliability coefficient of 0.919. The differences between male and female students were not very significant (p=0.061). With the factor analysis we recognised seven factors, belonging to three out of six domains of the EURACT educational agenda: primary care management, personcenteredness and comprehensive approach. Conclusion. Final-year medical students at the beginning of their family medicine clerkship understand some of the dimensions of family medicine rather well, but they are not aware of some important competences of family doctors. There is a necessity to teach students about specific problem solving skills and the importance of balance between the health needs of an individual patient and the community.

Family medicine is a discipline that has only recently joined the academic arena. Because of this, the academic contribution of this discipline to universities has not been clarified yet. On the other hand, the medical schools suffer from well-known challenges, that havebeen largely known in the discussions about the crisis of academicmedicine. The article explores the possibilities of mutual cooperationbetween family medicine and the universities. In order to profit fromthe qualities of academic medicine and family medicine, a partnershipbetween the two needs to be established. It should be built on acceptance of differences and adaptation of family medicine to the rules of the academia, which should be done without sacrificing its principles. The author describes three potential scenarios how family medicine can be introduced in the undergraduate curriculum: a) as a subject at the end of the curriculum, b) as collaboration in early patient contact and teaching clinical skills and c) as part of the integrated curriculum. The author concludes that both family medicine and the medical school have a lot to benefit from mutual cooperation. This requires compromises that are not always easy.

Background: Family practice in Slovenia is provided by state-employed family physicians as well as concessionaires. However, both work under a contract withthe National Health Insurance Institute. This study focuses on comparing patients’ experiences with Slovenian concessionaires and state- employed physicians. Methods: We performed analyses using survey data from a cross-sectional study on patient experiences, which took place from September 2011 to April 2012 as a part of the international QUALICOPC study. The Slovenian branch of this study included 1,962 patients visiting family practices. Patients were classified into two groups regarding the registered status of their family physician. They completed the questionnaires immediately after visiting their family physicians. Data used in the analyses included 76variables:18socio-economic and 58variableslinked to the patient's experience. Results:The analyses showed few differences between concessionaires and state-employed family physicians. In comparison to patients of state-employed family physicians, patients of concessionaires were less likely to make an appointment for a visit (19.8% vs. 29.2%), were generally more frequent visitors (43.7% vs. 50.7%), and more often felt that opening hours are too restricted (25.7 % vs. 31.9%). Patients of concessionaires believed more often that in general, doctors can be trusted (40.1% vs.47.1 %). A smaller percentage of patients of concessionaires felt that their physician had the capacity to deal with personal problems as well as provide medical care (61.9% vs. 54.7%). Conclusions: There are few differences in patients’ experiences of state-employed family physicians and concessionaires. Slovenian patients have a generally positive experience with family practice services regardless of the family physicians’ status. Plans for organizational change of the health sector should include patients’ perceptions of services.

No abstract available.

Background: Primary health care has undergone great changes as a consequence of demographic changes, growing patients’ awareness and organizational changes in the healthcare system. Declining interest in family medicine specialization further worsens the situation. In the period of lack of GPs and their overloading, it is necessary to include a diploma graduate nurse in the team of GPs and to define competencies and activities in such a way that encourage more active approach to the patients, meeting the indicators of quality.The purpose of the article is to describe the project of model practice in Slovenia and to present some results.Methods: A model practice introduces a new concept in the areas of human resource standards (to existing team, a diploma graduate nurse is included on a part-time basis); work competences (use of protocols for the treatment of chronic patients, extended and well-defined preventive screenings, establishing registers of chronic patients and assessing quality by means of quality indicators) and work management (redistribution of workload ).Results: Due to great interest of general practitioners, a total of 271 model practices were introduced in 2011 and 2012. MPs have been distributed evenly through different regions inSlovenia. Registers of patients with chronic diseases (COPD, asthma and diabetes) have been established and during the preventive screening, on average 2 patients with a chronic disease and 15 patients with risk factors have been detected. Patients are treated actively according to their needs rather than their preferences.Conclusions: The project of MPs enables a high quality and cost effectiveness of patients’ treatment in family medicine. With a gradual introducing of new MPs, a well planed and monitored patients’ care will be implemented in the practice. In a long run, disburdening of a secondary care level and more rational consumption of drugs are expected

Introduction: Despite various formal limitations, an increasing number of opioid users, especially those stabilised in substitution therapy, travel abroad, away from their permanent residence to neighbouring and remote countries on other continents. Drug users are particularly at risk to get infected with hepatitis A, B, C and HIV during travelling.The main objectives of the study were to identify and determine the frequency of potential travel-related risk behaviour, such as illicit drug use, sharing of injecting equipment, unprotected sex, involvement in criminal activities and the extent of risk in illicit drug users, included in the programmes of the Centers for Prevention and Treatment of Drug Addiction in Slovenia.Methods: The study was carried out in two phases. The first phase included semi-structured interviews conducted in a group of drug users willing to participate in the study. Based on the analysis of transcripts and additional data, the original questionnaire Risky behaviour of illicit drug users during travels was developed and filled in anonymously and on a voluntary basis at the network of Centres for Prevention and Treatment of Drug Addiction. Univariate analysis between independent and dependent factors was conducted based on chi-square test and t-test for independent factors. Multivariate analysis of the impact of independent factors on the dependent factor was conducted based on binary logistic regression.Results: The questionnaire was filled out anonymously and voluntarily by 776 individuals in 14 Slovene centres for prevention and treatment of drug addiction. The results confirmed the first hypothesis that drug users travelling away from their permanent residence are more likely to share their injecting equipment, and engage in unprotected sex and in drug-related crime, and the second hypothesis stating that illegal drug users included in the substitution treatment programmes, who regularly use drugs at home, more often use drugs while travelling than individuals included in the substitution treatment programmes, who never use drugs at home. The hypothesis that illegal drug users who travel abroad more often stop their substitution therapy than those who stay at home was not proven true.Conclusion: The results of quantitative analysis showed a low prevalence of travel-related risk behaviours, including the sharing of injecting equipment, and engaging in unprotected sex and drug-related crime.

Communicating with patients is a basic skill of a family doctor. It includes taking the history while following the patient’s feelings and expectations and explaining the intended tests and treatment. Good communication between the doctor and the patient enables maintaining their long-term quality relationship based on trust. Such a relationship significantly contributes to the quality of medical care of the patient and brings satisfaction not only to the patient but also to the entire medical staff involved in the treatment. Communication skills can be learned. But teaching such communication in the classic medical education has long been neglected. The Department of Family medicine at the Medical Faculty of Ljubljana has contributed considerably to some changes in this area. Results of several researches have shown that changes in learning communication skills cannot be made by simply learning from books or attending lectures. Therefore, the Department of Family medicine has been enabling their students to improve their skills of communication through different forms of practical work for 15 years. The purpose of this article is to present 15 years of experience in teaching communication especially with the help of video at the Department of Family Medicine at the Medical Faculty of Ljubljana.

Background: This study explored how adequately the additive and mediational models could explain the relationships between personality traits and coping behavior in predicting burnout syndrome in professional soldiers of the Slovene Army. The additive model suggests that personality and coping are independent, unique contributors to maladjustment outcomes. The mediational model, on the other hand, suggests that personality factors predispose people to use particular coping strategies that tend to be less effective for adjustment. Methods: A total of 390 soldiers (87 % response rate) completed the Eysenck Personality Questionnaire, the Ways of Coping Questionnaire and the Maslach Burnout Inventory. Results: The structural equation modeling confirmed an adequate fit only of the additive model. As hypothesized, emotional exhaustion was positively associated with neuroticism and emotionoriented coping. Depersonalization was positively associated with psychoticism, and personal accomplishment was positively associated with extraversion and problem-oriented coping, and inversely with neuroticism and emotion-oriented coping. Conclusions: To reduce burnout in the Slovenian Army, it may be of great benefit to provide training of effective stress-coping mechanisms, and create peer support groups among soldiers. Such intervention should be especially beneficial for soldiers with a vulnerable personality structure (high neuroticism and psychoticism and low extraversion).

In the academic year 2009/2010 the Faculty of Medicine in Ljubljana launched a new curriculum in medicine and dental medicine. It consists of a unified masters’ programme, prepared along the lines of the Bologna process. Its aims include continuous learning, integration of subjects, unification of the teaching process, introduction of electives, active role of students, implementation of more modern teaching methods and contact with patients and practice already from the beginning of the study. The article describes the process of implementation, main characteristics of the curriculum and first experiences. The first results show that the changes were successful. Nevertheless, the authors point out that the curriculum reform is a long-term process that is not limited only to the modifications of the timetable, but influences a range of other activities of the medical faculty.

BACKGROUND By 2015, mental illness will become the greatest healthcare burden in the world. Within the community, people with depression are most often treated by family doctors. Treatment for depression also includes psychiatric specialists, with varying cooperation between the primary care provider and the psychiatrist. This study’s goal was to define cooperation between family doctors and psychiatric specialists when treating patients with depression.METHODS In 2009 six focus groups were held that included general practitioners. The data were analyzed using qualitative methods. Results: Seventeen topics and related categories were developed for the study. One of these related to the cooperation between primary care providers and psychiatric specialists. Family doctors see psychiatrists as responsible for working with more challenging patients and as intermediaries in evaluating sick leave and assessing ability to work. Psychiatrists offer family doctors support in the education process and in terms of supervision. Numerous factors influence referral from primary to secondary level, including patients’ and doctors’ personal characteristics.CONCLUSIONSAchieving the goals of treating patients with depression requires not only expertise, organization at the primary care level, and a method of communication between patients and doctors, but also cooperation between primary care providers and psychiatric specialists. This ought to take place in compliance with professional criteria and not as a result of the patient’s condition and pressure from the patient. Representatives of both specializations should establish ways to work together and clarify the issue of information exchange and (in)appropriate referrals for obtaining opinions regarding sick leave and disability-based retirement.

Background: In this research the alcohol policy stakeholders’ opinion on the implementation of activities of alcohol policy in Slovenia in five years after the adoption of the Act Restricting the Use of Alcohol was studied. The hypothesis that stakeholders will attribute the highest score to the implementation of activities on Drinking and Driving and Education and communication was tested.

Little is known about the risk of progression to hazardous alcohol use in people currently drinking at safe limits. We aimed to develop a prediction model (predictAL) for the development of hazardous drinking in safe drinkers.A prospective cohort study of adult general practice attendees in six European countries and Chile followed up over 6 months. We recruited 10,045 attendees between April 2003 to February 2005. 6193 European and 2462 Chilean attendees recorded AUDIT scores below 8 in men and 5 in women at recruitment and were used in modelling risk. 38 risk factors were measured to construct a risk model for the development of hazardous drinking using stepwise logistic regression. The model was corrected for over fitting and tested in an external population. The main outcome was hazardous drinking defined by an AUDIT score ≥8 in men and ≥5 in women.69.0% of attendees were recruited, of whom 89.5% participated again after six months. The risk factors in the final predictAL model were sex, age, country, baseline AUDIT score, panic syndrome and lifetime alcohol problem. The predictAL model's average c-index across all six European countries was 0.839 (95% CI 0.805, 0.873). The Hedge's g effect size for the difference in log odds of predicted probability between safe drinkers in Europe who subsequently developed hazardous alcohol use and those who did not was 1.38 (95% CI 1.25, 1.51). External validation of the algorithm in Chilean safe drinkers resulted in a c-index of 0.781 (95% CI 0.717, 0.846) and Hedge's g of 0.68 (95% CI 0.57, 0.78).The predictAL risk model for development of hazardous consumption in safe drinkers compares favourably with risk algorithms for disorders in other medical settings and can be a useful first step in prevention of alcohol misuse.

No abstract available.

BACKGROUND It is known that the consequences of stigmatization towards people with severe mentalillness reflect themselves in a lack of self-esteem and consequently in low level of initiativesto improve one’s status in the community. The burden of stigma may cause denial of participation in the stigmatized group. So far, there were few studies to compare the mentally illpatients’ perception of the »other« mentally ill with the perception of future professionals inmental health services. METHODS We have compared stigmatizing attitudes of students with attitudes of patients with severemental illness. RESULTS The patients expressed higher stigmatization scores towards people with severe mentalillness than the students. CONCLUSIONS Negative attitudes of patients with severe mental illness towards their own group presenta serious problem. Actions are needed to improve their identification and reduce theperceived need for exclusion from their group

Background: Blood pressure control is sub-optimal all over the world. The aim of the study was to find out about the quality of the blood pressure control in Slovenia.Patients and method: Randomly selected general practitioners fulfilled a questionnaire for each of the 20 conse cutive attenders with arterial hypertension. We collected data for 980 patients with arterial hypertension, who attended their general practitioners in September 2006. Data about blood pressure control was taken from the medical record; we took into account the last two blood pressure measurements in the office before the visit in which we selected the study sample.Results: In the sample of 980 patients there were 47.4 % male and 52.6 % female, who were from 20 to 97 years old (average 62.3 years, SD 11.9 years). The target blood pressure was reached in 388 (40.1 %) patients with hypertension. 927 (94.6 %) patients were given an advice on non-pharmacological measures. In 986 (98.8 %) patients antihypertensive drugs were prescribed. 668 (68.2 %) patients took a combined antihypertensive treatment. The most frequently prescribed drug classes were blockers of renin-angiotensine system in 843 (86.0 %) patients, 225 (23.2 %) patients took blockers of renin-angiotensine receptors. In 527 (53.8 %) patients antihypertensive treatment was changed during the treatment. Physicians performed at least one measure to improve blood pressure control in 430 (74.3 %) patients with uncontrolled hypertension; changes in drug treatment were made in 252 (43.5 %) patients.Conclusions: More frequent advice on non-pharmacological measures, more intensive drug treatment and adaptation of treatment to patients lead to better blood pressure control.

Background: The aim of this research was to find out, whether arteriolar changes, found during an eye examination, predict high risk of a cardiovascular event, independently from the cardiovascular risk factors using the coronary risk tables.Methods: The cross-sectional study involved 100 patients: 50 consecutive patients with arterial hypertension and 50 consecutive attenders without arterial hypertension. Excluding criteria were: age younger than 40 and older than 70, diabetes, cataract or usage of eye-drops for lowering high ocular pressure. Retinal examination was performed using the method of direct ophthalmoscopy at dilated pupil. The considered retinal changes were: generalized arteriolar narrowing, focal arteriolar narrowing, arteriovenous nicking and widened light reflex, but we were also looking for the presence of retinopathy (hemorrhages, exudates, optic disc swelling). The cardiovascular risk was calculated using tables of coronary risk. A risk of 20% or more in the next 10 years was considered as high risk for a cardiovascular event.Results: The mean age of participants was 53.5 years (SD 7.6 years). 17 (17%) participants had high coronary risk (i.e. equal or higher than 20%, according to the tables of coronary risk). Retinal changes were present in 54 (54%) participants, and were more common in the group of hypertensive patients (p = 0.001). In the univariate analysis all four types of microvascular changes were associated with at least 20% coronary risk, but in multivariate analysis two types of retinal changes, arteriovenous nicking (OR = 9.136, 95% CI from 1.696 to 49.216) and focal arteriolar narrowing (OR = 5.885, 95% CI from 1.204 to 28.758), were associated with high cardiovascular risk.Conclusions: Microvascular changes are common among middle aged people attending general practice. The presence of any retinal changes, but especially focal arteriolar narrowing and arteriovenous nicking, predicts high cardiovascular risk. If these results are ever confirmed on a larger sample, the eye-ground examination could be an additional method of cardiovascular risk assessment in a general practitioner’s office.

Background. Quality of physician’s work is getting more and more important element being assessed both by laic and professional world. A profession of physician is certainly one of the most exactly regulated jobs in a legal way. But this fact alone cannot automatically ensure a proper and needed quality. In Slovenia, this is a relatively new element when comparing a steady practice of taking operational directives and algorythms. There is no head organisation or body that would be appointed for adopting regulations from the field, implementing them into practice, controlling their operation and supplementing them accordingly. That leads towards a dispersion, inclusion of many subjects and relatively substantial funding. Unfortunately, outcomes do not match efforts involved. The purpose of this article is to present institutions, legislation and regulations related to the physician work quality in Slovenia.Conclusions. Profession of physician is currently the most regulated profession from a legal point of view. Violation of regulations usually has consequences for both physician and patient. By adopting the appropriate criteria, quality can be defined, monitored and improved. Using certain mechanisms, there is a possibility to detect deviations and differences in order to eliminate them.