International Scientific Conference of Primary Care November 23-24, 2023 Cankarjev dom, Ljubljana, Slovenia CONFERENCE PROCEEDINGS ORGANISED BY: I Colophon Title: Proceedings of the 2nd International Scientific Conference of Primary Care - ISCPC Organised by: Community Health Centre Ljubljana Medical Faculty, Faculty of Medicine of the University of Ljubljana Editorial office: Community Health Centre Ljubljana, Metelkova ulica 9, 1000 Ljubljana, Slovenia. Editor: Prof. Zalika Klemenc Ketiš, M.D., Ph.D. Review by: Assist. prof. Eva Cedilnik Gorup, MD, PhD; Prof. Venija Cerovečki, MD, PhD; Biljana Đukić, MD, PhD; Assist. Prof. Vesna Homar, MD, PhD; Assist. Prof. Vojislav Ivetić, MD, PhD; Assist. Prof. Nena Kopčavar Guček, MD, PhD; Marc Lazarovici, MD, PhD; Assoc. Prof. Zlata Ozvačić Adžić, MD, PhD; Prof. Davorina Petek, MD, PhD; Goranka Petriček, MD, PhD; Prof. Danica Rotar Pavlič, MD, PhD; Prof. Brigita Skela Savič, PhD, M.S., B.S., RN; Aleksander Stepanović, MD, PhD; Prof. Gregor Štiglic, PhD; Assoc. Prof. Ksenija Tušek Bunc, MD, PhD; Assoc. Prof. Erika Zelko, MD, PhD Design and graphic design: Gregor Rogač, Nastja Slak Documentation processing: Cankarjev dom, Prešernova cesta 10, 1000 Ljubljana Web address: https://www.iscpc.si/ File: PDF Publication: November 22, 2023 Publication price: not for sale Published: Ljubljana, November 2023 Copyright © Community Health Centre Ljubljana The content of articles, photos and posters is the responsibility of authors. Kataložni zapis o publikaciji (CIP) pripravili v Narodni in univerzitetni knjižnici v Ljubljani COBISS.SI-ID 172544771 ISBN 978-961-6613-14-9 (PDF) II CONTENTS WELCOME ADDRESS ..................................................................................................................................................IV-V COMMITTEES .................................................................................................................................................................... VI ACKNOWLEDGEMENTS ............................................................................................................................................... VII PROGRAMME .............................................................................................................................................................VIII-IX TABLE OF ARTICLES ....................................................................................................................................................... X PROCEEDINGS ......................................................................................................................................................................1 POSTERS ..............................................................................................................................................................................74 GENERAL INFORMATION ............................................................................................................................................ 122 III WELCOME ADDRESS WELCOME MESSAGE FROM ORGANISATIONAL COMMITTEE Tea Stegne Ignjatovič On behalf of the Organising Committee, I am honoured to welcome you to the 2nd International Scientific Conference of Primary Care, entitled “Interprofessional Teamwork and Quality in Healthcare”. After our first conference, which took place virtually in 2021, we are excited to experience a live conference this year, where we will actually meet and shake hands, learn from each other and exchange good practices for the future through a rich conference programme. Our conference is unique in that it brings together all the professionals involved in primary health care, from doctors, nurses, social workers, physiotherapists, public health professionals to teaching staff, students and key opinion leaders. Our primary goal is to improve primary health care through the use of science, and we strongly believe in teamwork as a way to address the health problems and growing needs of our aging population. To provide quality, safe and patient-oriented care, we need a strong primary health care level and a team of different professionals who together care for the individual with various health problems that arise with age and the pandemic of chronic diseases. The conference will discuss new approaches that are needed to prepare for a future that also faces a global shortage of health workers. Your cooperation is very valuable and we hope you will take advantage of this experience and make your stay in the beautiful Slovenian capital pleasant and leave with a lot of new knowledge. Tea Stegne Ignjatovič IV WELCOME MESSAGE FROM THE SCIENTIFIC COMMITTEE Prof. Zalika Klemenc Ketiš On behalf of the Scientific Committee, I am delighted to welcome you to the International Scientific Conference of Primary Care (ISCPC) in Ljubljana, Slovenia. This year’s conference focused on the theme of “Interprofessional Teamwork and Quality in Health Care.” Primary care is essential to delivering high-quality, accessible, and affordable health care to all. It is also the foundation for effective population health management. The ISCPC conference provides a unique opportunity for primary care clinicians, researchers, policy makers, and other stakeholders to come together to share knowledge, best practices, and innovative approaches to improving primary care. The conference features a variety of plenary sessions, workshops, and poster presentations on a wide range of topics, including: • Interprofessional teamwork: How can we best work together to provide high-quality, patient-centred care? • Quality improvement in primary care: How can we measure and improve the quality of care we provide? • Chronic disease management: How can we best support patients with chronic diseases in managing their health? • Population health management: How can we use data and analytics to improve the health of our communities? • Primary care education and training: How can we ensure that future generations of primary care providers are well-equipped to meet the needs of their patients? The ISCPC conference is an important event for the primary care community. It provides a forum for us to learn from each other, share our successes, and identify opportunities for improvement. I encourage you to participate fully in the conference and to make the most of this opportunity to network with colleagues and learn from experts from around the world. Together, we can make a difference in the lives of our patients and communities! Prof. Zalika Klemenc Ketiš V COMMITTEES ORGANISING COMMITTEE Tea Stegne Ignjatovič (Chair) Robertina Benkovič Urška Godec assist. prof. Nena Kopčavar Guček Renata Milešević Ana Pintar Bojc Anja Poženel Belec Nataša Stojnić Polona Szilvassy Rajka Vignjević Pupovac Uroš Zafošnik SCIENTIFIC COMMITTEE: Prof. Zalika Klemenc Ketiš, Slovenia (Chair) Prof. Venija Cerovečki, Croatia Prof. Mark Lazarevici, Germany Prof. Davorina Petek, Slovenia Prof. Antonija Poplas Susič, Slovenia Dr. Andree Rochfort, Ireland Assoc. Prof. Bohumil Seifert, Czech Republic Assoc. Prof. Brigita Skela Savič. Slovenia Prof. Gregor Štiglic, Slovenia Prof. Dr. Katerina Stavrić, North Macedonia Prof. Sara Willems, Belgium Organised by: The Community Health Centre Ljubljana & The Faculty of Medicine, University of Ljubljana Under Patronage: VENUE Cankarjev dom Cultural and congress centre Prešernova 10 1000 Ljubljana https://www.cd-cc.si/en VI ACKNOWLEDGEMENTS The Organising Committee is deeply appreciative of the sponsorship generously provided by the following companies: Golden sponsor Bronze sponsor Partner Exhibitors Official Coffee Partner VII 2nd International Scientific Conference of Primary Care – ISCPC PROGRAMME CONFERENCE DAY 1 - November 23, 2023 PROCEEDINGS: 8.00–8.45 REGISTRATION & MEET UP 8.45–9.30 Opening Kosovel Hall 9.30–10.00 Mieke Rijken, PhD: Person-centred integrated care for people with multimorbidity: needs, care models and outcomes Moderator: Nena Kopčavar Guček KEYNOTE 10.00–10.15 Discussion 10.15–10.45 BREAK & MEET UP 10.45–11.55 Oral session: Integrated Care 10.45–12.15 Workshops Moderator: Staša Vodička Kosovel Hall E2 Hall 10.45–10.55 Facilitators and Barriers to Scale-up Integrated Care for Hypertension and Type-2-Diabetes WORKSHOP 1: in Slovenia: A Qualitative Study among Stakeholders at Different Levels How to research about integrated Črt Zavrnik (Slovenia), Nataša Stojnić, Majda Mori Lukančič, Matic Mihevc, Tina Virtič, care? Zalika Klemenc-Ketiš, Antonija Poplas-Susič 10.55–11.05 Enhancing Patient-Tailored Home Care through Collaboration between Primary and The workshop will focus on Secondary Care research methodologies that can Natalija Shaurek Aleksandrovska (North Macedonia), Branko Aleksov be used to study integrated primary 11.05–11.15 The use of complementary and alternative medicine among patients in general health care. Participants will be practitioner’s office invited to present their research Mirjana Krepek, Vojislav Ivetić (Slovenia) ideas. They will be asked to develop a methodological plan for the 11.15–11.25 Content Validity and Cognitive Testing in the Development of Motivational Interviewing research, receiving feedback from Self-Assessment Questionnaire the workshop facilitators. Tadeja Hočevar (Slovenia), Tim Anstiss, Danica Rotar Pavlič 11.25–11.35 Knowledge, attitudes, and practices regarding infection control: A survey of nurses in Workshop leader: primary care settings - Kosovo Zalika Klemenc Ketiš Behrije Halilaj-vishi (Kosovo) 11.35–11.45 Prevalence and correlates of anxiety and depression among Slovenian breast cancer survivors in the first 5 years post-treatment during COVID-19: A cross-sectional study Spela Mirosevic (Slovenia), Judith Prins, Nikola Bešić, Simona Borštnar, Marko Popović, Zalika Klemenc-Ketiš 11.45–11.55 Decision-oriented aspects of a university primary care centre: A multidimensional analysis in the context of the Johannes Kepler University Linz Philipp Aigner (Austria) 11.55–13.15 BREAK & MEET UP 13.15–14.15 Prof. Robin Miller: Social Care: the missing piece of the primary care jigsaw? Kosovel Hall Moderator: Tina Virtič Potočnik KEYNOTE 14.15–14.30 Discussion 14.30–15.40 Oral session: Interprofessional Education 14.30–16.00 Workshops Moderator: Špela Miroševič Kosovel Hall E2 Hall 14.30–14.40 Knowledge transfer in multidisciplinary teams in long-term care WORKSHOP 2: Anamarija Kejžar, Patricija Frece, Maša Bizjan (Slovenia) Research proposals in primary 14.40–14.50 Validation of the Slovene version of the STOP-BANG questionnaire in a primary practice care setting Andrej Pangerc (Slovenia), Leja Dolenc Grošelj, Marija Petek Šter The workshop is aimed at PhD 14.50–15.00 Possibilities for further developing of »Careful Assessment« tool in the treatment of patients students in primary healthcare. with medically unexplained conditions They will be asked to present their Eva Svatina Šošić (Slovenia), Vojislav Ivetić research ideas for their doctoral 15.00–15.10 Specialized registered nurses' contribution to the reduction of diabetic complications: a dissertation, present their retrospective study dissertation methodology or Metka Žitnik (Slovenia), Patricija Lunežnik present pilot results. They will get feedback from senior researchers 15.10–15.20 Experiences with Telemedicine and Digital Tools among Primary Health Care Level in primary healthcare. Physicians in Pomurje, Slovenia Staša Vodička (Slovenia), Silvija Prainer Workshop leader: 15.20–15.30 Organizational barriers for knowledge management in interprofessional practice of Davorina Petek healthcare team Anže Jurček (Slovenia) 15.30–15.40 Patient reported indicator surveys (PaRIS): methodological considerations of a field trial in Slovenia Matija Ambrož (Slovenia), Candan Kendir, Zalika Klemenc Ketiš VIII November 23-24, 2023, Ljubljana, Slovenia WWW. .SI 2nd International Scientific Conference of Primary Care – ISCPC 15.40–16.40 POSTER SESSION 1. General Medicine Research Network - Creation of a Framework for the Setup of a General Medicine Research Network in Upper Austria Fabian Bekelaer (Austria) 2. A multidisciplinary approach to the early detection and treatment of multiple myeloma Dragan Gjorgjievski (North Macedonia) 3. Online and Face-to-Face Learning model – our experience from TRANSSIMED Project Elizabeta Kostovska Prilepchanska (North Macedonia) 4. The role and good practices of patronage nursing in primary health care in Slovenia - A case study Tina Krajnc (Slovenia) 5. Burnout in Family Medicine Trainees During Pandemic Jerca Kranjc (Slovenia) 6. A bottom-up cost analysis of telemonitoring in primary care for patients with arterial hypertension and type 2 diabetes: a case of the SCUBY study Mihevc Matic (Slovenia) 7. Portal for patients – new way of electronic communication Gea Novak (Slovenia) 8. The impact of the Covid-19 epidemic on the newly diagnosed patients with arterial hypertension and type 2 diabetes and their management in family medicine clinics of the Maribor region Barbara Pernek (Slovenia) 9. Science day with health education - experiences of health professionals, teachers and students Tanja Podlipnik (Slovenia) 10. Interprofessional collaboration between Community nurses and General practitioners in palliative care: a literature review Jožica Ramšak Pajk (Slovenia) 11. Red Code Protocol and experiential learning with simulations - impact on the survival of patients after sudden cardiac arrest in the Community Health Centre Ljubljana Mateja Škufca Serle (Slovenia) 17.15–18.00 FIELD VISITS (OPTIONAL) Meeting point: next to registration desk in Cankarjev dom at 16.45. Practical visit to Simulation Centre of Ljubljana Community Health Centre with Practical visit to Ljubljana Community Health Centre' demonstration of education with simulation primary care practices A tour of a simulation centre operating at primary level. Participants will be able to A tour of the family medicine practices and visit to the see high fidelity simulations of emergency conditions at primary level (1. Advance diagnostic laboratory, which has the most modern life support, 2. Palliative patient at primary level, 3. Paediatric life support). technology at the primary level. DAY 2 - November 24, 2023 8.00–9.00 REGISTRATION & MEET UP 9.00–9.30 Dr. Andree Rochfort: Patients, Professionals, Primary Care and Planetary Health Kosovel Hall Moderator: Zalika Klemenc Ketiš KEYNOTE 9.30–9.45 Discussion 09.50–11.10 Oral session: Quality & Safety 09.50–11.30 Workshops Moderator: Črt Zavrnik Kosovel Hall E2 Hall 9.50–10.00 Patient Portal and Central Registry of Patient Data: leading accelerators of healthcare WORKSHOP 3: digitalisation in Slovenia Use of simulation in integrated care Živa Rant (Slovenia), Jure Janet, Dalibor Stanimirović 10.00–10.10 How cultural and ethnical characteristics influence the use of primary care services in North The workshop will present the use of Macedonia? simulations in primary healthcare Sashka Janevska (North Macedonia), Katerina Kovachevikj, Elizabeta Kostovska Prilepchanska, education. We will focus on Katarina Stavrikj gamification and the use of the 10.10–10.20 Patient safety culture in the Community Health Centre Ljubljana simulated patient. Participants will Tina Virtič Potočnik (Slovenia), Zalika Klemenc-Ketiš have the opportunity to participate in simulations and give feedback. 10.20–10.30 A Qualitative Study Exploring Facilitators of and Barriers to Interprofessional Collaboration among Healthcare Providers in Primary Healthcare Centers in Qatar Workshop leaders: Alla El-awaisi (Qatar) David Halliwell 10.30–10.40 Quality Assessment of Interprofessional Approach to Elderly Care in Family Medicine in Uroš Zafošnik Slovenia Nino Fijačko Maja Cvetko Gomezelj (Slovenia), Zalika Klemenc-Ketiš 10.40–10.50 How to confront violence in healthcare environment Nena Kopčavar Guček (Slovenia) 10.50–11.00 Examination of employee satisfaction at the health center Zagreb-West Juraj Jug (Croatia), Franka Luetić, Jelena Rakić Matić 11.00–11.10 Preliminary analysis of open data pertaining to the services available through the Health Insurance Institute of Slovenia and provided by family medicine Luka Petravić (Slovenia), Vojislav Ivetić 11.10–12.00 BREAK & MEET UP 12.00–12.30 Assist. Prof. Marit Vassboten Olsen: Simulation-based learning in education Kosovel Hall Moderator: Uroš Zafošnik KEYNOTE 12.30–12.45 Discussion 12.45–13.30 Closing Ceremony IX November 23-24, 2023, Ljubljana, Slovenia WWW. .SI TABLE OF ARTICLES ORAL SESSION: INTEGRATED CARE Enhancing Patient-Tailored Home Care Through Collaboration Between Primary And Secondary Care ................ 2 The Use Of Complementary And Alternative Medicine Among Patients In Family Medicine Office ......................... 5 Knowledge, Attitudes, And Practices Regarding Infection Control: A Survey Of Nurses In Primary Care Settings- Kosovo ............................................................................................................................................................................................. 9 Decision-Oriented Aspects Of A University Primary Care Centre: A Multidimensional Analysis In The Context Of The Johannes Kepler University Linz ............................................................................................................... 14 ORAL SESSION: INTERPROFESSIONAL EDUCATION Knowledge Transfer In Multidisciplinary Teams In Long-Term Care ...................................................................................... 19 Possibilities For Further Developing Of The “Careful Assessment” Tool In The Treatment Of Patients With Medically Unexplained Conditions ......................................................................................................................................................... 23 Specialized Registered Nurses’ Contribution To The Reduction Of Diabetic Complications ........................................... 28 Experiences With Telemedicine And Digital Tools Among Primary Health Care Level Physicians In Pomurje, Slovenia ...................................................................................................................................................................................... 31 ORAL SESSION: QUALITY & SAFETY Patient Portal And Central Registry Of Patient Data: Leading Accelerators Of Healthcare Digitalisation In Slovenia ......................................................................................................................................................................................................... 41 How Cultural And Demographic Characteristics Influence The Use Of Primary Care Services In Village Area In North Macedonia ............................................................................................................................................................ 45 Quality Assessment Of Interprofessional Approach To Elderly Care In Family Medicine In Slovenia ....................... 50 How To Confront Violence In Healthcare ............................................................................................................................................. 54 Examination Of Employee Satisfaction At The Health Center Zagreb-West ......................................................................... 60 Preliminary Analysis Of Open Data Pertaining To The Services Available Through The Health Insurance Institute Of Slovenia And Provided By Family Medicine ............................................................................................................... 65 POSTER SESSION General Medicine Research Network – Creation Of A Framework For The Setup Of A General Medicine Research Network In Upper Austria ....................................................................................................................................................... 70 A Multidisciplinary Approach To The Early Detection And Treatment Of Multiple Myeloma ....................................... 73 Online And Face-To-Face Learning Model – Our Experience From Transsimed Project ................................................ 76 The Role And Good Practices Of Patronage Nursing In Primary Health Care In Slovenia - A Case Study ................ 80 Burnout In Family Medicine Trainees During Pandemic .............................................................................................................. 85 Portal For Patients – New Way Of Electronic Communication .................................................................................................. 90 The Impact Of The Covid-19 Epidemic On The Newly Diagnosed Patients With Arterial Hypertension And Type 2 Diabetes And Their Management In Family Medicine Clinics Of The Maribor Region ............................ 97 Science Day With Health Education - Experiences Of Health Professionals, Teachers And Students .......................102 Interprofessional Collaboration Between Community Nurses And General Practitioners In Palliative Care: A Literature Review .......................................................................................................................................................................................107 Red Code Protocol And Experiential Learning With Simulations – Impact On The Survival Of Patients After Sudden Cardiac Arrest In The Community Health Centre Ljubljana .............................................................................111 X PROCEEDINGS Oral presentations 1 Enhancing Patient-Tailored Home Care through Past medical history: Diabetes, hypertension. No prior analysis was done again and the following results were Collaboration between Primary and Secondary Care surgery. obtained: CRP 220.7; Glycemia 21.2; HbA1c 10.6; WBC 19.0. Medications: Atorvastatin 40 mg (1x1), Follow-up is scheduled again in four days. Perindopril/indapamide 4/1,25 (1x1), Amlodipine 10 (1x1), At the second follow-up the patient is visibly better, the Natalija Shaurek Aleksandrovska MD, MSc1,2; Branko Aleksov MD, Internal Medicine Specialist3 Carvedilol 3,125 (2x1), Gliklazid 60 mg (2x1). weakness has decreased, she is more communicative and more PHO Femili Helt Skopje, R. N. Macedonia1; Center for Family Medicine, Faculty of Medicine, Skopje, R.N. Macedonia2 open to talking about insulin therapy. I did blood biochemical HC Bukuresht, Skopje, R.N. Macedonia3 analyzes again and got the following results: SR 32, CRP 5.3; nsaurek@gmail.com III.RESULTS WBC 20.4; Glycemia 15 mmol/l; Creatinine 113. The next day I arranged an appointment with the specialist at the Diabetes Physical exam: Abstract— Introduction – Primary care doctors are the first Department. After completed consultation and education, the Vitals: Temperature 38°C, heart rate 100/min, respiratory rate instance where patients turn when they have a worsening health I. INTRODUCTION patient was placed on Tresiba insulin therapy once a day. In 22/min, saturation O2 92, blood pressure 140/90, BMI 30. condition. But family doctors are not always able to help their Primary care doctors, including family physicians, are typically the following weeks, the patient had regular glycemic controls patients when their health condition worsens. Sometimes, referral General: The patient is slowed down, lethargic, tachypneic the first healthcare professionals’ patients consult when they and titration of insulin units at the Diabetes Department. to a specialist is not possible due to а lack of an appointment and frightened. She is conversing freely. Despite insulin therapy, she had variations in glycemic values through the “My appointment” application. Therefore, experience health concerns. They are responsible for initial Respiratory: Tachypneic. On auscultation, there was (between 9 and 12mmol/l). White blood cell counts returned to interdisciplinary cooperation is of particular importance in the assessments, diagnoses, and treatment plans. (1) However, bilaterally weakened breathing. normal within the next two weeks. treatment of our patients. there are situations where family doctors may face limitations Cardiovascular: She has regular rate and rhythm with no in addressing these issues, such as the unavailability of murmurs, rubs or gallops. Case description – I present a case of 63-year-old female with specialist appointments. In such cases, interdisciplinary IV.DISCUSSION Initial evaluation severe fatigue and fever. Before her doctor’s visit she performed cooperation and collaboration become essential for providing Laboratory Studies: SR 64; CRP 272.2; WBC 23.8; a PCR test for COVID. It was negative. Past medical history: comprehensive and timely care. Primary care providers are often the first point of contact for Diabetes mellitus, HTA. Glycemia 24.3; Creatinine 133.18. patients when their health condition worsens. The study Primary care doctors are well-positioned to provide preventive Chest X-ray: Reactive left hilar array, diffuse nodular produced by Battersby et al shows that they can educate patients The patient got a referral for lab work and chest X-ray. From the care and manage chronic conditions. Col aborating with conglomerates in the mid-basal parts of both lungs (dense in about managing their health and help them navigate the examination, blood tests and chest X-ray, a diagnosis of specialists allows for early detection and management of the left lung) with a reduction in airiness. All this stated goes healthcare system, reducing the likelihood of emergency Bronchopneumonia was made. She was prescribed an antibiotic in favor of Bronchopneumonia in both lungs. situations. (4) When primary care physicians and specialists and other supportive therapy. On my part, a consultation by conditions, which can prevent the need for emergency care or Diagnosis work closely together, there is a better flow of patient phone was made with an infectious disease specialist who insisted hospitalization. (2) This collaborative approach, often referred Based on the clinical symptoms, laboratory results and X-ray that the patient be hospitalized due to the above-mentioned to as care coordination or integrated care, has been shown to information and medical history. This helps ensure that patients diagnosis of Bronchopneumonia was made. results. After the conversation with the patient and the advice for improve patient outcomes, enhance the efficiency of healthcare receive more comprehensive and seamless care, reducing the Management hospitalization, she refused to be hospitalized. She is a single delivery, and lower healthcare costs. Collaboration can lead to risk of complications that might lead to hospitalization. (5) mother of a child with special needs who cannot take care of more informed decision-making about tests and procedures, Since the patient was in poor health, with comorbidities, and In the Republic of North Macedonia, there is no appointment herself. Therefore, a specialist in internal medicine from the reducing unnecessary healthcare utilization, which can the results obtained were poor, a fellow infectious disease system in primary healthcare. Therefore, the patient can visit Diabetes Department in the Health Center was consulted. After contribute to hospitalizations. (3) specialist from a nearby city hospital was immediately the practice of his family doctor at any time when he/she or taking the anamnesis, I came to the conclusion that the patient contacted by phone. She immediately suggested his/her substitute is on shift. The lack of sufficient health culture did not take her diabetes therapy regularly. She was told to II. MATERIAL AND METHODS hospitalization. The patient was called by phone and told that and education contributes to the fact that patients come for an receive the therapy and to come for a check-up in two days. In the she would need to be hospitalized. Despite her poor health, she examination for a common cold, headache, or even just to next ten days, the patient was called every second day for an Case Presentation refused admission to the hospital because there was no one to examination with the family doctor and at the same time a History on the present illness: А 51-year-old female patient measure blood pressure. During the Covid pandemic, due to the take care of her daughter, who has special needs. consultation with the specialist in internal medicine from the comes for a medical examination early Monday morning. She lack of Covid centers and the mixing of patients, some clinics Due to the complexity of the situation and the poor state of Diabetes Department was made until her medical condition got complains of increased temperature, occasional shortness of started to schedule appointments individually. But not all better. breath and malaise. The symptoms started four days ago. health of the patient, it was decided to treat the patient on an patients respect it. In particular, in my office there is an Before coming for the examination, the patient took two Covid outpatient basis in cooperation with my colleague doctor from appointment system and 60-70% of patients respect it. Conclusion – Interdisciplinary cooperation is of particular tests (rapid and PCR). Both tests were negative. For the past secondary health. In the Health Center where I work, there is a On the other hand, appointments with specialists in secondary importance in the treatment of our patients. In this way, they Diabetes Department where patients go for diabetes treatment. and tertiary healthcare are systemically regulated through the receive the necessary health care, thereby reducing the need to few days, she had been taking Ibuprofen to reduce fever and The colleague from the center was immediately contacted. He My Appointment system. But here we face problems too. Most visit emergency departments. fluids. But her health condition was getting worse. Social History: She denies tobacco, alcohol and illicit drug suggested that the patient be placed on insulin therapy. At the of the time there are no appointments when we need them. This same time, the inflammatory process of the lungs had to be Index Terms—integrated care, primary care, secondary care use. She is a widower, mother of two adult children. Her son is mostly applies to urgent, non-life-threatening health conditions. 30 years old (currently serving a prison sentence), and a treated. Because of this, patients are forced to go to emergency centers. daughter who is 23 years old with combined developmental The patient immediately started receiving the antibiotic Crowds, worries and long waiting times are created there. disabilities with elements of autism. She works in court as a Moxifloxacin a 400 mg (1x1), electrolytes with a higher fluid In the My Term appointment system, there are three types of clerk. intake and vitamin C 1000 1x1. After the conversation with the referrals that are issued to patients. They are a regular referral Allergies: No known medicine, food, or environmental patient regarding diabetes therapy (Tabl Glika (gliklazid) 60 with an appointment, a priority referral for patients who need to allergies. mg 2x1, Tabl Agnis (vildagliptin) 50 mg 2x1) she declared that perform an examination or diagnostic procedure within seven she did not take the one drug (Tabl Agnis 50 mg) at all because days, and an urgent referral that is valid for 24 hours. According it was expensive to buy. Since she was afraid to start insulin to the patient's condition, the family physician decides what therapy immediately because of her poor health, she said she type of referral will be issued. would also buy the second diabetes medicine. A control Secondary healthcare has it shear of problems too. Specialists examination was scheduled for two days. are overbooked with fil ed prescription appointments for At the follow-up examination, the patient is slightly better. On chronic therapy medications and diagnostic procedures that are auscultation, weak breathing persists. A biochemical blood not available to primary care physicians. They do not have 1 2 2 Enhancing Patient-Tailored Home Care through Past medical history: Diabetes, hypertension. No prior analysis was done again and the following results were Collaboration between Primary and Secondary Care surgery. obtained: CRP 220.7; Glycemia 21.2; HbA1c 10.6; WBC 19.0. Medications: Atorvastatin 40 mg (1x1), Follow-up is scheduled again in four days. Perindopril/indapamide 4/1,25 (1x1), Amlodipine 10 (1x1), At the second follow-up the patient is visibly better, the Natalija Shaurek Aleksandrovska MD, MSc1,2; Branko Aleksov MD, Internal Medicine Specialist3 Carvedilol 3,125 (2x1), Gliklazid 60 mg (2x1). weakness has decreased, she is more communicative and more PHO Femili Helt Skopje, R. N. Macedonia1; Center for Family Medicine, Faculty of Medicine, Skopje, R.N. Macedonia2 open to talking about insulin therapy. I did blood biochemical HC Bukuresht, Skopje, R.N. Macedonia3 analyzes again and got the following results: SR 32, CRP 5.3; nsaurek@gmail.com III.RESULTS WBC 20.4; Glycemia 15 mmol/l; Creatinine 113. The next day I arranged an appointment with the specialist at the Diabetes Physical exam: Abstract— Introduction – Primary care doctors are the first Department. After completed consultation and education, the Vitals: Temperature 38°C, heart rate 100/min, respiratory rate instance where patients turn when they have a worsening health I. INTRODUCTION patient was placed on Tresiba insulin therapy once a day. In 22/min, saturation O2 92, blood pressure 140/90, BMI 30. condition. But family doctors are not always able to help their Primary care doctors, including family physicians, are typically the following weeks, the patient had regular glycemic controls patients when their health condition worsens. Sometimes, referral General: The patient is slowed down, lethargic, tachypneic the first healthcare professionals’ patients consult when they and titration of insulin units at the Diabetes Department. to a specialist is not possible due to а lack of an appointment and frightened. She is conversing freely. Despite insulin therapy, she had variations in glycemic values through the “My appointment” application. Therefore, experience health concerns. They are responsible for initial Respiratory: Tachypneic. On auscultation, there was (between 9 and 12mmol/l). White blood cell counts returned to interdisciplinary cooperation is of particular importance in the assessments, diagnoses, and treatment plans. (1) However, bilaterally weakened breathing. normal within the next two weeks. treatment of our patients. there are situations where family doctors may face limitations Cardiovascular: She has regular rate and rhythm with no in addressing these issues, such as the unavailability of murmurs, rubs or gallops. Case description – I present a case of 63-year-old female with specialist appointments. In such cases, interdisciplinary IV.DISCUSSION Initial evaluation severe fatigue and fever. Before her doctor’s visit she performed cooperation and collaboration become essential for providing Laboratory Studies: SR 64; CRP 272.2; WBC 23.8; a PCR test for COVID. It was negative. Past medical history: comprehensive and timely care. Primary care providers are often the first point of contact for Diabetes mellitus, HTA. Glycemia 24.3; Creatinine 133.18. patients when their health condition worsens. The study Primary care doctors are well-positioned to provide preventive Chest X-ray: Reactive left hilar array, diffuse nodular produced by Battersby et al shows that they can educate patients The patient got a referral for lab work and chest X-ray. From the care and manage chronic conditions. Col aborating with conglomerates in the mid-basal parts of both lungs (dense in about managing their health and help them navigate the examination, blood tests and chest X-ray, a diagnosis of specialists allows for early detection and management of the left lung) with a reduction in airiness. All this stated goes healthcare system, reducing the likelihood of emergency Bronchopneumonia was made. She was prescribed an antibiotic in favor of Bronchopneumonia in both lungs. situations. (4) When primary care physicians and specialists and other supportive therapy. On my part, a consultation by conditions, which can prevent the need for emergency care or Diagnosis work closely together, there is a better flow of patient phone was made with an infectious disease specialist who insisted hospitalization. (2) This collaborative approach, often referred Based on the clinical symptoms, laboratory results and X-ray that the patient be hospitalized due to the above-mentioned to as care coordination or integrated care, has been shown to information and medical history. This helps ensure that patients diagnosis of Bronchopneumonia was made. results. After the conversation with the patient and the advice for improve patient outcomes, enhance the efficiency of healthcare receive more comprehensive and seamless care, reducing the Management hospitalization, she refused to be hospitalized. She is a single delivery, and lower healthcare costs. Collaboration can lead to risk of complications that might lead to hospitalization. (5) mother of a child with special needs who cannot take care of more informed decision-making about tests and procedures, Since the patient was in poor health, with comorbidities, and In the Republic of North Macedonia, there is no appointment herself. Therefore, a specialist in internal medicine from the reducing unnecessary healthcare utilization, which can the results obtained were poor, a fellow infectious disease system in primary healthcare. Therefore, the patient can visit Diabetes Department in the Health Center was consulted. After contribute to hospitalizations. (3) specialist from a nearby city hospital was immediately the practice of his family doctor at any time when he/she or taking the anamnesis, I came to the conclusion that the patient contacted by phone. She immediately suggested his/her substitute is on shift. The lack of sufficient health culture did not take her diabetes therapy regularly. She was told to II. MATERIAL AND METHODS hospitalization. The patient was called by phone and told that and education contributes to the fact that patients come for an receive the therapy and to come for a check-up in two days. In the she would need to be hospitalized. Despite her poor health, she examination for a common cold, headache, or even just to next ten days, the patient was called every second day for an Case Presentation refused admission to the hospital because there was no one to examination with the family doctor and at the same time a History on the present illness: А 51-year-old female patient measure blood pressure. During the Covid pandemic, due to the take care of her daughter, who has special needs. consultation with the specialist in internal medicine from the comes for a medical examination early Monday morning. She lack of Covid centers and the mixing of patients, some clinics Due to the complexity of the situation and the poor state of Diabetes Department was made until her medical condition got complains of increased temperature, occasional shortness of started to schedule appointments individually. But not all better. breath and malaise. The symptoms started four days ago. health of the patient, it was decided to treat the patient on an patients respect it. In particular, in my office there is an Before coming for the examination, the patient took two Covid outpatient basis in cooperation with my colleague doctor from appointment system and 60-70% of patients respect it. Conclusion – Interdisciplinary cooperation is of particular tests (rapid and PCR). Both tests were negative. For the past secondary health. In the Health Center where I work, there is a On the other hand, appointments with specialists in secondary importance in the treatment of our patients. In this way, they Diabetes Department where patients go for diabetes treatment. and tertiary healthcare are systemically regulated through the receive the necessary health care, thereby reducing the need to few days, she had been taking Ibuprofen to reduce fever and The colleague from the center was immediately contacted. He My Appointment system. But here we face problems too. Most visit emergency departments. fluids. But her health condition was getting worse. Social History: She denies tobacco, alcohol and illicit drug suggested that the patient be placed on insulin therapy. At the of the time there are no appointments when we need them. This same time, the inflammatory process of the lungs had to be Index Terms—integrated care, primary care, secondary care use. She is a widower, mother of two adult children. Her son is mostly applies to urgent, non-life-threatening health conditions. 30 years old (currently serving a prison sentence), and a treated. Because of this, patients are forced to go to emergency centers. daughter who is 23 years old with combined developmental The patient immediately started receiving the antibiotic Crowds, worries and long waiting times are created there. disabilities with elements of autism. She works in court as a Moxifloxacin a 400 mg (1x1), electrolytes with a higher fluid In the My Term appointment system, there are three types of clerk. intake and vitamin C 1000 1x1. After the conversation with the referrals that are issued to patients. They are a regular referral Allergies: No known medicine, food, or environmental patient regarding diabetes therapy (Tabl Glika (gliklazid) 60 with an appointment, a priority referral for patients who need to allergies. mg 2x1, Tabl Agnis (vildagliptin) 50 mg 2x1) she declared that perform an examination or diagnostic procedure within seven she did not take the one drug (Tabl Agnis 50 mg) at all because days, and an urgent referral that is valid for 24 hours. According it was expensive to buy. Since she was afraid to start insulin to the patient's condition, the family physician decides what therapy immediately because of her poor health, she said she type of referral will be issued. would also buy the second diabetes medicine. A control Secondary healthcare has it shear of problems too. Specialists examination was scheduled for two days. are overbooked with fil ed prescription appointments for At the follow-up examination, the patient is slightly better. On chronic therapy medications and diagnostic procedures that are auscultation, weak breathing persists. A biochemical blood not available to primary care physicians. They do not have 1 2 3 specific appointments for emergency patients. In the last month, V.CONCLUSION The use of complementary and alternative medicine some procedures for prescribing chronic therapy have changed, but not everything has been put into practice yet. Primary care doctors are often the first line of defense for among patients in family medicine office In the presented case, at the time the patient came for an patients, but they may encounter limitations in managing examination, there were no free appointments for x-rays and at worsening health conditions. The importance of the diabetes center. In such situations, some of us primary care Mirjana Krepek 2, Vojislav Ivetić 1,2, interdisciplinary cooperation in healthcare cannot be physicians use personal contacts with specialists to refer the 1 University of Maribor, Faculty of Medicine, Department of Family Medicine, Taborska ulica 8, 2000 Maribor, Slovenia. overstated, as it ensures that patients receive the most patient to the necessary tests and examinations. But should it be 2 appropriate care, even when referrals to specialists may be SAVA MED d.o.o., Cesta k Dravi 8, 2241 Spodnji Duplek, Slovenia. so? Since my practice is located in the Health Center, it was not challenging. Collaboration between primary care and vojislav.ivetic@um.si a problem to contact the colleagues from the secondary secondary care doctors is a critical component of a patient-healthcare at the x-ray and laboratory departments, and then at centered healthcare system. It can lead to better health Abstract— BACKGROUND: The use of complementary and treatment approaches, complementary and alternative, the Diabetes Center. Personal acquaintance and telephone outcomes for patients, reduce the burden on hospitals and alternative medicine has grown significantly in recent years. The constitute a combination of medical and healthcare systems, contact with the infectious disease specialist was also of great purpose of the study was to examine the reasons for using emergency departments, and ultimately result in cost savings methods and products which are not part of conventional help. Since the patient was in a very bad condition, she was complementary and alternative medicine and the related factors. for the healthcare system as a whole. medicine (2, 3). taken to the laboratory and to the x-ray diagnostic department METHODS: The research was based on a questionnaire which According to a study from 2007, CAM is used in the US by with a priority referral. The results were done promptly in less was presented to 690 randomly selected patients between March For this case report to be publicly presented, the patient gave a 1 and July 31, 2017, in two general practitioner’s offices at the 38.3% of adults and 11.8% of children (aged 17 or less) (3). than two hours and the treatment was started immediately. signed informed consent. Community Health Centre dr. Adolf Drolc Maribor. The Women, people with higher education, and people with higher But not every family doctor works in a health center or close to questionnaire covered the fields of official medicine, visiting the income are more common users. The most commonly used it. Our colleagues in rural and suburban areas are facing a REFERENCES healer and self-healing with complementary and alternative method was shown to be natural products (17.7%), followed shortage of secondary care doctors. They are forced to either (1) Starfield, B. (1998). Primary care: Balancing health needs, methods. RESULTS: The questionnaire was completed by 425 by deep breathing techniques (12.7%), meditation (9.4%), deal with seriously ill patients themselves or send them to services, and technology. Oxford University Press. respondents. It was found that (162) 37.8% of the respondents chiropractic (8.8%), massages (8.3%), yoga (6.1%), diets emergency centers. In our healthcare system, the number of had already visited the healer. Most often, complementary and (3.6%), relaxation (2.9%), guided visualization (2.2%), and doctors who have direct contact with col eagues from (2) Bodenheimer, T., & Berry-Mil ett, R. (2009). Care alternative methods were chosen as supplement treatment to homoeopathy (1.8%) (3, 4). Adult Americans most commonly secondary healthcare is very small. management of patients with complex health care needs. The official medicine. The most common health problem that caused use CAM for musculoskeletal problems such as lower back Collaboration between family doctors and col eagues from Synthesis Project. Robert Wood Johnson Foundation. the participants to visit a healer was back pain, and the most common reason for self-healing with complementary and pain, neck and joint pain (3, 4). secondary health care should be at a higher level. Collaborative (3) Sinsky, C., & Colligan, L. (2014). Al ocation of physician alternative methods was cough. Most often, respondents visited In Slovenia, Cvetko T. conducted a survey in 2002 among care promotes evidence-based medicine and shared decision- time in ambulatory practice: A time and motion study in 4 bioenergetic therapist, and most often treated themselves with 716 individuals who had their primary care physician in the making, leading to more appropriate and targeted diagnostic specialties. Annals of Internal Medicine, 160(3), 181-187. herbs. Patients who visited general practitioner more frequently Municipality of Koper (5). She found that within a year, 31% tests and treatments. Saini and colleagues in their study indicate during the year, decided in higher percentages to visit the healer of them used complementary forms of treatment (she avoided that this approach can reduce healthcare costs while (4) Bat ersby, M., Von Korff, M., Schaefer, J., Davis, C., than those who visited general practitioner less frequently. More the term complementary and alternative medicine due to a maintaining or improving patient outcomes and reduce sending Ludman, E., Greene, S. M., & Wagner, E. H. (2002). Twelve than half of the respondents did not or would not tell their doctor evidence-based principles for implementing self-management negative connotation) (5). The following was most commonly patients to emergency centers. (6) about the use of complementary and alternative medicine unless support in primary care. Joint Commission Journal on Quality reported: massages (30.0%), herbs (23.0%), multivitamins The psychological state of the patient was another problem I they would be asked. CONCLUSION: We found out that the and Patient Safety, 28(12), 622-632. (18.0%), energy (14.0%), thermal baths (14.0%), Kozmodisk faced. Despite her poor health, she did not want to be respondents use complementary and alternative medicine, most often as supplement treatment to official medicine. Therefore, it spine massager (12.0%), chiropractic (11.0%), relaxation hospitalized because there was no one to take care of her (5) Starfield, B., Shi, L., & Macinko, J. (2005). Contribution of is very important for general practitioner doctors that we are techniques (8.7%), weight loss programs and diets (7.7%), daughter, who is with special needs. There is no center in primary care to health systems and health. The Milbank aware of the use of complementary and alternative medicine and acupuncture (3.8%), homoeopathy (2.0%), and self-help Macedonia that could take care of such patients 24 hours a day. Quarterly, 83(3), 457-502. that we discuss about it with our patients during consultations in groups (2.9%) (5). There are only day care centers for people with special needs. (6) Saini, V., Garcia-Armesto, S., Klemperer, D., Paris, V., & an open and clear manner. The role of complementary and alternative medicine in The concern for the child and the fear that something would Elshaug, A. G. (2017). Drivers of poor medical care. The national healthcare programs depends on the policy of each happen to her was constantly present during the treatment. The Lancet,390(10090),178-190. Index Terms—complementary medicine, alternative medicine, country, and the statutory regulation of CAM activities stress she had had a large part in the variations in glycemic general practice, family medicine significantly varies among countries (6). Acupuncture is the values despite the use of insulin therapy. only among CAM in Slovenia officially placed on the list of I. INTRODUCTION permitted medical services, thus becoming a part of standard Complementary and alternative medicine includes measures treatment (7). This means it is reimbursed from mandatory and activities based on complementary and alternative health insurance, provided that it is performed by a healthcare medicine systems and methods which are performed in a way professional within public healthcare service (7). that does not harm human health (1). The commonly used The purpose of our study was to examine the reasons as to why abbreviation is CAM. Complementary treatment methods are patients who come to their general practitioner’s office seek used as an addition or supplement to conventional medicine or treatment at a healer and related factors. together with it. They complement conventional treatment but do not replace it. Alternative therapeutic procedures are used II. MATERIAL AND METHODS instead of conventional medicine. The combination of both Subjects 3 4 specific appointments for emergency patients. In the last month, V.CONCLUSION The use of complementary and alternative medicine some procedures for prescribing chronic therapy have changed, but not everything has been put into practice yet. Primary care doctors are often the first line of defense for among patients in family medicine office In the presented case, at the time the patient came for an patients, but they may encounter limitations in managing examination, there were no free appointments for x-rays and at worsening health conditions. The importance of the diabetes center. In such situations, some of us primary care Mirjana Krepek 2, Vojislav Ivetić 1,2, interdisciplinary cooperation in healthcare cannot be physicians use personal contacts with specialists to refer the 1 University of Maribor, Faculty of Medicine, Department of Family Medicine, Taborska ulica 8, 2000 Maribor, Slovenia. overstated, as it ensures that patients receive the most patient to the necessary tests and examinations. But should it be 2 appropriate care, even when referrals to specialists may be SAVA MED d.o.o., Cesta k Dravi 8, 2241 Spodnji Duplek, Slovenia. so? Since my practice is located in the Health Center, it was not challenging. Collaboration between primary care and vojislav.ivetic@um.si a problem to contact the colleagues from the secondary secondary care doctors is a critical component of a patient-healthcare at the x-ray and laboratory departments, and then at centered healthcare system. It can lead to better health Abstract— BACKGROUND: The use of complementary and treatment approaches, complementary and alternative, the Diabetes Center. Personal acquaintance and telephone outcomes for patients, reduce the burden on hospitals and alternative medicine has grown significantly in recent years. The constitute a combination of medical and healthcare systems, contact with the infectious disease specialist was also of great purpose of the study was to examine the reasons for using emergency departments, and ultimately result in cost savings methods and products which are not part of conventional help. Since the patient was in a very bad condition, she was complementary and alternative medicine and the related factors. for the healthcare system as a whole. medicine (2, 3). taken to the laboratory and to the x-ray diagnostic department METHODS: The research was based on a questionnaire which According to a study from 2007, CAM is used in the US by with a priority referral. The results were done promptly in less was presented to 690 randomly selected patients between March For this case report to be publicly presented, the patient gave a 1 and July 31, 2017, in two general practitioner’s offices at the 38.3% of adults and 11.8% of children (aged 17 or less) (3). than two hours and the treatment was started immediately. signed informed consent. Community Health Centre dr. Adolf Drolc Maribor. The Women, people with higher education, and people with higher But not every family doctor works in a health center or close to questionnaire covered the fields of official medicine, visiting the income are more common users. The most commonly used it. Our colleagues in rural and suburban areas are facing a REFERENCES healer and self-healing with complementary and alternative method was shown to be natural products (17.7%), followed shortage of secondary care doctors. They are forced to either (1) Starfield, B. (1998). Primary care: Balancing health needs, methods. RESULTS: The questionnaire was completed by 425 by deep breathing techniques (12.7%), meditation (9.4%), deal with seriously ill patients themselves or send them to services, and technology. Oxford University Press. respondents. It was found that (162) 37.8% of the respondents chiropractic (8.8%), massages (8.3%), yoga (6.1%), diets emergency centers. In our healthcare system, the number of had already visited the healer. Most often, complementary and (3.6%), relaxation (2.9%), guided visualization (2.2%), and doctors who have direct contact with col eagues from (2) Bodenheimer, T., & Berry-Mil ett, R. (2009). Care alternative methods were chosen as supplement treatment to homoeopathy (1.8%) (3, 4). Adult Americans most commonly secondary healthcare is very small. management of patients with complex health care needs. The official medicine. The most common health problem that caused use CAM for musculoskeletal problems such as lower back Collaboration between family doctors and col eagues from Synthesis Project. Robert Wood Johnson Foundation. the participants to visit a healer was back pain, and the most common reason for self-healing with complementary and pain, neck and joint pain (3, 4). secondary health care should be at a higher level. Collaborative (3) Sinsky, C., & Colligan, L. (2014). Al ocation of physician alternative methods was cough. Most often, respondents visited In Slovenia, Cvetko T. conducted a survey in 2002 among care promotes evidence-based medicine and shared decision- time in ambulatory practice: A time and motion study in 4 bioenergetic therapist, and most often treated themselves with 716 individuals who had their primary care physician in the making, leading to more appropriate and targeted diagnostic specialties. Annals of Internal Medicine, 160(3), 181-187. herbs. Patients who visited general practitioner more frequently Municipality of Koper (5). She found that within a year, 31% tests and treatments. Saini and colleagues in their study indicate during the year, decided in higher percentages to visit the healer of them used complementary forms of treatment (she avoided that this approach can reduce healthcare costs while (4) Bat ersby, M., Von Korff, M., Schaefer, J., Davis, C., than those who visited general practitioner less frequently. More the term complementary and alternative medicine due to a maintaining or improving patient outcomes and reduce sending Ludman, E., Greene, S. M., & Wagner, E. H. (2002). Twelve than half of the respondents did not or would not tell their doctor evidence-based principles for implementing self-management negative connotation) (5). The following was most commonly patients to emergency centers. (6) about the use of complementary and alternative medicine unless support in primary care. Joint Commission Journal on Quality reported: massages (30.0%), herbs (23.0%), multivitamins The psychological state of the patient was another problem I they would be asked. CONCLUSION: We found out that the and Patient Safety, 28(12), 622-632. (18.0%), energy (14.0%), thermal baths (14.0%), Kozmodisk faced. Despite her poor health, she did not want to be respondents use complementary and alternative medicine, most often as supplement treatment to official medicine. Therefore, it spine massager (12.0%), chiropractic (11.0%), relaxation hospitalized because there was no one to take care of her (5) Starfield, B., Shi, L., & Macinko, J. (2005). Contribution of is very important for general practitioner doctors that we are techniques (8.7%), weight loss programs and diets (7.7%), daughter, who is with special needs. There is no center in primary care to health systems and health. The Milbank aware of the use of complementary and alternative medicine and acupuncture (3.8%), homoeopathy (2.0%), and self-help Macedonia that could take care of such patients 24 hours a day. Quarterly, 83(3), 457-502. that we discuss about it with our patients during consultations in groups (2.9%) (5). There are only day care centers for people with special needs. (6) Saini, V., Garcia-Armesto, S., Klemperer, D., Paris, V., & an open and clear manner. The role of complementary and alternative medicine in The concern for the child and the fear that something would Elshaug, A. G. (2017). Drivers of poor medical care. The national healthcare programs depends on the policy of each happen to her was constantly present during the treatment. The Lancet,390(10090),178-190. Index Terms—complementary medicine, alternative medicine, country, and the statutory regulation of CAM activities stress she had had a large part in the variations in glycemic general practice, family medicine significantly varies among countries (6). Acupuncture is the values despite the use of insulin therapy. only among CAM in Slovenia officially placed on the list of I. INTRODUCTION permitted medical services, thus becoming a part of standard Complementary and alternative medicine includes measures treatment (7). This means it is reimbursed from mandatory and activities based on complementary and alternative health insurance, provided that it is performed by a healthcare medicine systems and methods which are performed in a way professional within public healthcare service (7). that does not harm human health (1). The commonly used The purpose of our study was to examine the reasons as to why abbreviation is CAM. Complementary treatment methods are patients who come to their general practitioner’s office seek used as an addition or supplement to conventional medicine or treatment at a healer and related factors. together with it. They complement conventional treatment but do not replace it. Alternative therapeutic procedures are used II. MATERIAL AND METHODS instead of conventional medicine. The combination of both Subjects 3 5 The sample included random patients who attended (SD=13.4) years, with male mean age being 45.8 (SD=13.8) problems, weight loss, stress management, menopause, No, because the 145 34.1 51.1 98.2 two selected offices at the Community Health Centre dr. Adolf year, and female 43.7 (SD=13.3) years. The youngest allergies, bloating, frostbite, autoimmune disease, ear infection, physician did not Drolc Maribor between 1 March and 31 March 2017 and were respondent was 20 years old and the oldest 83. 24 (5.6%) did frequent sore throat, for better well-being, finger infection, ask me about the willing to participate in the study. Exclusion criteria in not provide their age. 132 (32.9%) of the respondents had psoriasis, hair loss, anemia, Candida, low pressure, acne, use of any sampling participants were younger than 18 year and older university level education, 122 (28.7%) secondary level indigestion, hormonal problems, leg cramps, prevention, alternative than 80 year of age education, 59 (13.9%) had master’s degree, specialization, or abdominal pain, frequent streptococcal angina, resolving methods. Data collection doctorate, 4 (0.9%) had finished primary school or less, and 24 problems following chemotherapy, obesity, voice loss, eye The data were collected by means of a questionnaire (5.6%) did not provide their level of education. 290 (68.2%) of inflammation, herpes I would not tell 5 1.2 1.8 100.0 we developed based on literature review. A minor part of the the respondents were employed, 61 (14.4%) retired, 37 (8.7%) The results showed a statistically significant association her/him even if subjects completed the questionnaire in the waiting room, unemployed, 12 (2.8%) students, and 25 (5.9%) did not provide between the frequency of visiting the primary care physician they asked. while the others received it to their email address. The their employment status. 298 (70.1%) of the respondents were married or cohabiting, 87 (20.5%) were single, 12 (2.8%) and visiting an alternative medicine healer, χ2(3)=8.31, Total 284 66.8 100.0 questionnaire consisted of 16 questions, and the time needed widowed, and 28 (6.6%) did not provide their marital status. p=0.043. Those who visit their primary care physician more to complete it was 5 to 10 minutes. Data on the gender, age, frequently during the year decide in higher percentages to visit Missing 141 33.2 monthly income, employment status and marital status were It was found that 162 out of 425 (37.8%) respondents had an alternative medicine healer than those who visit their Total 425 100.0 collected. visited an alternative healer compared to 263 out of 425 physician less frequently (Table 1). Questions 1 and 2 related to the use of official (62.2%) who had not. Statistical analysis showed a statistically Table 1: Frequency and percentage display of the association medicine, i.e., the frequency of visits to the personal doctor for significant difference in the covered sample – the number of between the frequency of visiting primary care physician and Question 1 and the frequency of visits to a clinical specialist those who had not visited an alternative haler is statistically visiting an alternative healer IV. DISCUSSION for Question 2. Questions 3, 4, 5 and 6 related to the treatment higher, χ2(1)=24.00, p<0.001. Visit to an Our sample was limited to the patients from two practices at a healer, namely whether they had ever visited one (if the On the average, the respondents mostly agreed (M=4.0 alternative healer at the Community Health Centre dr. Adolf Drolc Maribor. The answer was NO, they continued completing the survey SD=1.3) that they had visited a healer to complement their questionnaire was not standardized but an original prepared questionnaire with Question 7), which healer they had visited, doctor’s treatment. The most important reasons with which the Yes No Total based on the literature. According to the Statistical Office of the the reason for visit, and health issue that had made them seek respondents agreed to the greatest extent (among the reasons Republic of Slovenia, the population of Slovenia at the time of help from a healer. Questions 7 and 8 related to self-treatment listed) were that the healer sees their disease in a more holistic Frequency Less than once f 34 79 113 the survey was 2,064,836; 1,025,125 men and 1,040,770 with CAM, namely whether they had ever self-treated way (M=3.4 SD=1.4), due to adverse effects of pharmaceutical of visiting per year f % 30.1 69.9 100.0 women (8). The ratio between men and women in our sample themselves using any CAM, which method it was, and which products (M=3,1 SD=1,6), and because the healer wants the primary was different, with women being represented in a higher health issue made them use a specific CAM. Question 9 asked patient to be actively involved in the treatment process (M=3.1 care 1 to 3 times per f 95 148 243 number. The mean age of the respondents was 44.4 years, about whether they had notified their primary care physician SD=1,5). The reason with which the respondents on the average physician year which only slightly deviates from the mean age of the Slovenian f % 39.1 60.9 100.0 about using CAM and whether it was linked to a specific disagreed to a greatest extent was that the decision for being population at the time of the survey, which was 43.0 years (8). question asked by the physician about using CAM. Question treated by the healer was not wanting to burden their physician 4 to 8 times per f 25 32 57 In terms of education level, the respondents had higher level 10 listed statements regarding the effectiveness of CAM with their problems (M=1.9 SD=1.3). year of education compared to the Slovenian sample. In the general treatment, price ranges and using CAM in the future. The The most respondents used natural herbs (19.9%), followed f % 43.9 56.1 100.0 Slovenian population, among those above the age of 15, most statements were rated on a scale from 1 to 5 where 1 means “I by dietary supplements (15.5%), treatment with bee products More than 8 f 8 4 12 people have secondary level of education (52.7%), followed by do not agree at all” and 5 “I completely agree”. (11.6%), and alternative exercise (10.8%). times per year primary school level or less in 25.2%, and 22.0% with higher Statistical processing The highest number of the respondents went to see a f % 66.7 33.3 100.0 or university level education (9). Among the respondents, the The characteristics of the sample were specified using bioenergetic therapist (31.5%), followed by massage therapist majority had higher or university education level, 46.8%. The descriptive statistics. For categorical variables (gender, Total f 162 263 425 (15.9%), acupuncture therapist (13,5%) and a homoeopath difference in the education level could be due to the fact that the education level achieved, employment status, marital status), (13.2%). f % 38.1 61.9 100.0 practices are located in the center of Maribor City, which has frequencies and percentages were calculated, and for more educated people compared to the rural areas and towns in continuous variables (age, monthly income), mean values and The most respondents went to see a healer due to lower back Slovenia. standard deviations were calculated. For all variables pain, followed by fatigue and join pain. The following was A half of the respondents would not tell their physician The sample also included a statistically significantly higher measured on the Likert scale, it was assumed that they are reported by the respondents under ‘other’: preparation for about using alternative methods because the physician does not number of those who had not visited an alternative healer, so interval variables, and the parametric tests were used childbirth, anaemia, sudden change in body weight, carpal ask about it. 42.6% reported they told them by themselves, and caution is advised when generalizing the results to the general accordingly. Bivariate statistical tests were used. The SPSS tunnel syndrome, painful breasts, burning tongue, insufferable 1.8% would not tell their physician in any case (Table 2). pain after shingles, hair loss, smoking, stomach problems, Slovenian population. statistical software (IBM Corp., Armonk, NY), version 23, was periodontitis, bladder problems, infertility, diabetes, chronic Table 2: Frequency and percentage display of reporting to the The survey found that 162 (37.8%) respondents had visited used to analyze the data. For interference analyses, the level of sinusitis, impaired immune system, gynaecological problems, primary care physician about using alternative methods an alternative healer. These figures are slightly higher than confidence used was α=0.05. prevention (energy balancing), migraine, allergies, neuropathic f f % Valid f % Cumulative f % those found by Cvetko in 2002 (10), which showed that 30.8% Opinion provided by the Ethics Committee pain, rheumatism, parkinsonism, lymphoma, hormonal of the respondents had visited a healer, and closer to the US The study was approved on 19 September 2015 by the problems, kidney sand, menstrual cramps, epilepsy, psoriasis, Yes, I told 121 28.5 42.6 42.6 survey (38.3%) (4). In England and Australia, the percentage of Republic of Slovenia National Medical Ethics Committee carcinoma, kidney failure, fungal diseases, stress management, him/her by CAM users is even higher, amounting to 44.0% and 44.1%, (application No. 0120-356/2015/2). lung cancer, CIBD, AH, atopic dermatitis, abdominal pain. myself. respectively (10, 11). The differences in the percentages can be The most respondents were being self-treated with Yes, because the 13 3.1 4.6 47.2 likely attributed to the inclusion of different forms of CAM into III. RESULTS alternative methods due to cough, followed by virosis, fatigue, physician asked this group when designing the study. The survey was presented to 690 patients, and 425 (61.6%) headache, nervousness or irritability. The following problems me about the use It was demonstrated that more frequently individuals visit of surveys were completed. There were 288 (67.8%) women were reported by the respondents under ‘other’: burning tongue, of any their primary care physician, in higher percentages they decide and 116 (27.3%) men, and 21 (4.9%) of the respondents did not lung cancer, bladder problems, skin problems, neck pain, alternative to be treated by an alternative medicine healer. Therefore, these answer the question about the gender. The mean age was 44.4 varicose veins, stomach problems, infertility, diabetes, urinary methods. 6 The sample included random patients who attended (SD=13.4) years, with male mean age being 45.8 (SD=13.8) problems, weight loss, stress management, menopause, No, because the 145 34.1 51.1 98.2 two selected offices at the Community Health Centre dr. Adolf year, and female 43.7 (SD=13.3) years. The youngest allergies, bloating, frostbite, autoimmune disease, ear infection, physician did not Drolc Maribor between 1 March and 31 March 2017 and were respondent was 20 years old and the oldest 83. 24 (5.6%) did frequent sore throat, for better well-being, finger infection, ask me about the willing to participate in the study. Exclusion criteria in not provide their age. 132 (32.9%) of the respondents had psoriasis, hair loss, anemia, Candida, low pressure, acne, use of any sampling participants were younger than 18 year and older university level education, 122 (28.7%) secondary level indigestion, hormonal problems, leg cramps, prevention, alternative than 80 year of age education, 59 (13.9%) had master’s degree, specialization, or abdominal pain, frequent streptococcal angina, resolving methods. Data collection doctorate, 4 (0.9%) had finished primary school or less, and 24 problems following chemotherapy, obesity, voice loss, eye The data were collected by means of a questionnaire (5.6%) did not provide their level of education. 290 (68.2%) of inflammation, herpes I would not tell 5 1.2 1.8 100.0 we developed based on literature review. A minor part of the the respondents were employed, 61 (14.4%) retired, 37 (8.7%) The results showed a statistically significant association her/him even if subjects completed the questionnaire in the waiting room, unemployed, 12 (2.8%) students, and 25 (5.9%) did not provide between the frequency of visiting the primary care physician they asked. while the others received it to their email address. The their employment status. 298 (70.1%) of the respondents were married or cohabiting, 87 (20.5%) were single, 12 (2.8%) and visiting an alternative medicine healer, χ2(3)=8.31, Total 284 66.8 100.0 questionnaire consisted of 16 questions, and the time needed widowed, and 28 (6.6%) did not provide their marital status. p=0.043. Those who visit their primary care physician more to complete it was 5 to 10 minutes. Data on the gender, age, frequently during the year decide in higher percentages to visit Missing 141 33.2 monthly income, employment status and marital status were It was found that 162 out of 425 (37.8%) respondents had an alternative medicine healer than those who visit their Total 425 100.0 collected. visited an alternative healer compared to 263 out of 425 physician less frequently (Table 1). Questions 1 and 2 related to the use of official (62.2%) who had not. Statistical analysis showed a statistically Table 1: Frequency and percentage display of the association medicine, i.e., the frequency of visits to the personal doctor for significant difference in the covered sample – the number of between the frequency of visiting primary care physician and Question 1 and the frequency of visits to a clinical specialist those who had not visited an alternative haler is statistically visiting an alternative healer IV. DISCUSSION for Question 2. Questions 3, 4, 5 and 6 related to the treatment higher, χ2(1)=24.00, p<0.001. Visit to an Our sample was limited to the patients from two practices at a healer, namely whether they had ever visited one (if the On the average, the respondents mostly agreed (M=4.0 alternative healer at the Community Health Centre dr. Adolf Drolc Maribor. The answer was NO, they continued completing the survey SD=1.3) that they had visited a healer to complement their questionnaire was not standardized but an original prepared questionnaire with Question 7), which healer they had visited, doctor’s treatment. The most important reasons with which the Yes No Total based on the literature. According to the Statistical Office of the the reason for visit, and health issue that had made them seek respondents agreed to the greatest extent (among the reasons Republic of Slovenia, the population of Slovenia at the time of help from a healer. Questions 7 and 8 related to self-treatment listed) were that the healer sees their disease in a more holistic Frequency Less than once f 34 79 113 the survey was 2,064,836; 1,025,125 men and 1,040,770 with CAM, namely whether they had ever self-treated way (M=3.4 SD=1.4), due to adverse effects of pharmaceutical of visiting per year f % 30.1 69.9 100.0 women (8). The ratio between men and women in our sample themselves using any CAM, which method it was, and which products (M=3,1 SD=1,6), and because the healer wants the primary was different, with women being represented in a higher health issue made them use a specific CAM. Question 9 asked patient to be actively involved in the treatment process (M=3.1 care 1 to 3 times per f 95 148 243 number. The mean age of the respondents was 44.4 years, about whether they had notified their primary care physician SD=1,5). The reason with which the respondents on the average physician year which only slightly deviates from the mean age of the Slovenian f % 39.1 60.9 100.0 about using CAM and whether it was linked to a specific disagreed to a greatest extent was that the decision for being population at the time of the survey, which was 43.0 years (8). question asked by the physician about using CAM. Question treated by the healer was not wanting to burden their physician 4 to 8 times per f 25 32 57 In terms of education level, the respondents had higher level 10 listed statements regarding the effectiveness of CAM with their problems (M=1.9 SD=1.3). year of education compared to the Slovenian sample. In the general treatment, price ranges and using CAM in the future. The The most respondents used natural herbs (19.9%), followed f % 43.9 56.1 100.0 Slovenian population, among those above the age of 15, most statements were rated on a scale from 1 to 5 where 1 means “I by dietary supplements (15.5%), treatment with bee products More than 8 f 8 4 12 people have secondary level of education (52.7%), followed by do not agree at all” and 5 “I completely agree”. (11.6%), and alternative exercise (10.8%). times per year primary school level or less in 25.2%, and 22.0% with higher Statistical processing The highest number of the respondents went to see a f % 66.7 33.3 100.0 or university level education (9). Among the respondents, the The characteristics of the sample were specified using bioenergetic therapist (31.5%), followed by massage therapist majority had higher or university education level, 46.8%. The descriptive statistics. For categorical variables (gender, Total f 162 263 425 (15.9%), acupuncture therapist (13,5%) and a homoeopath difference in the education level could be due to the fact that the education level achieved, employment status, marital status), (13.2%). f % 38.1 61.9 100.0 practices are located in the center of Maribor City, which has frequencies and percentages were calculated, and for more educated people compared to the rural areas and towns in continuous variables (age, monthly income), mean values and The most respondents went to see a healer due to lower back Slovenia. standard deviations were calculated. For all variables pain, followed by fatigue and join pain. The following was A half of the respondents would not tell their physician The sample also included a statistically significantly higher measured on the Likert scale, it was assumed that they are reported by the respondents under ‘other’: preparation for about using alternative methods because the physician does not number of those who had not visited an alternative healer, so interval variables, and the parametric tests were used childbirth, anaemia, sudden change in body weight, carpal ask about it. 42.6% reported they told them by themselves, and caution is advised when generalizing the results to the general accordingly. Bivariate statistical tests were used. The SPSS tunnel syndrome, painful breasts, burning tongue, insufferable 1.8% would not tell their physician in any case (Table 2). pain after shingles, hair loss, smoking, stomach problems, Slovenian population. statistical software (IBM Corp., Armonk, NY), version 23, was periodontitis, bladder problems, infertility, diabetes, chronic Table 2: Frequency and percentage display of reporting to the The survey found that 162 (37.8%) respondents had visited used to analyze the data. For interference analyses, the level of sinusitis, impaired immune system, gynaecological problems, primary care physician about using alternative methods an alternative healer. These figures are slightly higher than confidence used was α=0.05. prevention (energy balancing), migraine, allergies, neuropathic f f % Valid f % Cumulative f % those found by Cvetko in 2002 (10), which showed that 30.8% Opinion provided by the Ethics Committee pain, rheumatism, parkinsonism, lymphoma, hormonal of the respondents had visited a healer, and closer to the US The study was approved on 19 September 2015 by the problems, kidney sand, menstrual cramps, epilepsy, psoriasis, Yes, I told 121 28.5 42.6 42.6 survey (38.3%) (4). In England and Australia, the percentage of Republic of Slovenia National Medical Ethics Committee carcinoma, kidney failure, fungal diseases, stress management, him/her by CAM users is even higher, amounting to 44.0% and 44.1%, (application No. 0120-356/2015/2). lung cancer, CIBD, AH, atopic dermatitis, abdominal pain. myself. respectively (10, 11). The differences in the percentages can be The most respondents were being self-treated with Yes, because the 13 3.1 4.6 47.2 likely attributed to the inclusion of different forms of CAM into III. R this group when designing the study. ESULTS alternative methods due to cough, followed by virosis, fatigue, physician asked The survey was presented to 690 patients, and 425 (61.6%) headache, nervousness or irritability. The following problems me about the use It was demonstrated that more frequently individuals visit of surveys were completed. There were 288 (67.8%) women were reported by the respondents under ‘other’: burning tongue, of any their primary care physician, in higher percentages they decide and 116 (27.3%) men, and 21 (4.9%) of the respondents did not lung cancer, bladder problems, skin problems, neck pain, alternative to be treated by an alternative medicine healer. Therefore, these answer the question about the gender. The mean age was 44.4 varicose veins, stomach problems, infertility, diabetes, urinary methods. 7 are patients who are more active in seeking solutions for their REFERENCES problems, which was also demonstrated by Kersnik J. (12). KNOWLEDGE, ATTITUDES, AND PRACTICES REGARDING INFECTION CONTROL: A 1. Complementary and Alternative Medicine Act 2007. The most commonly visited healer was a bioenergetic Official Gazette of the Republic of Slovenia, Nos. 94/07 and SURVEY OF NURSES IN PRIMARY CARE SETTINGS- KOSOVO therapist (31.5%), followed by massage therapist (15.9%), 87/11 [cited 2023 Sep 28]. Available at: homoeopath (13.2%) and acupuncturist (13.5%). These results http://www.pisrs.si/Pis.web/pregledPredpisa?id=ZAKO4283# ¹Mr.sc.Behrije Halilaj-Vishi Phd.Can, ² Dr.Imri Vishi Phd., ² Dr.Lul Raka Phd. differ from the results of the study conducted by Cvetko T., which ranked massage (30%) first, followed by energy 2. Zaloker A, Zaloker U. Komplementarna in integrativna treatment in 14.0%, while homoeopathy was used just by 2.0% medicina. Zdrav Vestn 2011; 80: 33-8. ¹ General Hospital Ferizaj ,Surgery Department ,Kosovo and acupuncture by 3.8% of respondents (5). An increase in the 3. Complementary and Alternative Medicine. U.S. National ² University of Prishtina ,Nursing Department ,Kosovo use of acupuncture could be due to the fact that it had been Library of Medicine. National Institutes of Health Dec 2011 placed on the list of permitted healthcare services and is [cited 2023 Sep 28]. Available at: 3.Angela Boškin Faculty of Health, Spodnji Plavž 3, 4270 Jesenice, Slovenija reimbursed from mandatory health insurance (provided it is http://www.nlm.nih.gov/medlineplus/complementaryandaltern performed by a healthcare professional within a public ativemedicine.html healthcare service). Homoeopathy is also more accessible, since homoeopathic preparations are available in some 4. The Use of Complementary and Alternative Medicine in pharmacies, together with appropriate counselling about their the United States. National center for complementary and Abstract—: Nurses in primary care are in the frontline and are more infectious microorganisms. The strategies like forming dedicated use. integrative health [cited 2023 Sep 28]. Available at: susceptible to infections while interacting with patients through infection control committees, implementing proper waste handling https://nccih.nih.gov/research/statistics/2007/camsurvey_fs1.h exposure to bodily fluids, infected body parts, blood, and medical and sanitation protocols, and ensuring adherence to occupational On the average, the respondents visited a healer for 2.6 tm materials.. Aim of the Study: This study seeks to evaluate the protection standards can mitigate the avoidable morbidity and (SD=1.3) medical problems. The most common reason was knowledge, attitude, and practices related to standard infection mortality associated with HAIs (Bayleyegn B et.al.,2021). lower back pain, followed by fatigue and join pain. J. Kersnik 5. Cvetko T. Vpliv zdravnika na uporabo dopolnilnih oblik control precautions among healthcare professionals in primary (12) also reports lower back pain as one of the main reasons for zdravljenja, Graduation Thesis. Ljubljana: Chair of Public healthcare (PHC) centers in Kosovo. Subjects and Methods: In this According to the World Health Organization (WHO), infection using CAM. The data are similar to those reported from a study Health; University of Ljubljana; 2003. cross-sectional study, 124 healthcare professionals from Kosovo control is a disciplined approach to preventing infections, aiming to in the US (4), with the most common reason for using CAM 6. Act Amending the Complementary and Alternative PHC centers were included, utilizing an electronic questionnaire for protect those susceptible to infections, both in the community and being problems with musculoskeletal system such as lower Medicine Act, Official Gazette of the Republic of Slovenia, No. data acquisition. Results: A majority of participants were nurses, healthcare settings, particularly those with pre-existing health back pain, and neck and joint pain. possessing high school and Bachelor’s degrees (46.3% and 36.1%, conditions. The fundamental principle of infection prevention and 87/11 [cited 2023 Sep 28]. Available at: respectively), primarily aged over 40 years (59.3%) and boasting control is maintaining proper hygiene [WHO, 2011]. The most common reasons for self-treatment with CAM http://www.mz.gov.si/fileadmin/mz.gov.si/pageuploads/javna more than 10 years of work experience (69.4%). Approximately half were cough and virosis, namely in the form of natural herbs, _razprava_2011/zakon_zdravilci/Zakon_o_zdravilstvu_06041 reported having dedicated rooms for medical waste (50% and A majority of healthcare infections are transmitted by healthcare which is consistent with the data from other studies (4- 1.pdf 46.3%). Participation in infection control training was reported by personnel who neglect proper hand hygiene and fail to change 6,10,11,13). 7. Act of types of medical health activities 2022. Official 74.8%, with around 90% showing a positive attitude towards gloves between patient interactions. Nursing staff, who have more infection control policies and 80% reporting high practice levels. extensive contact with patients and their families, face a heightened We also checked whether the respondents would tell their Gazette of the Republic of Slovenia, Nos. 58/22 [cited 2023 Sep There was a negligible variance in the statements, knowledge, and risk of acquiring and transmitting pathogens (Asodike Maria physician about the past or future use of alternative methods. 28]. Available at: https://www.uradni- attitudes about infection control related to socio-demographic data; et.al.2021). More than a half said they would not tell unless asked by the list.si/_pdf/2022/Ur/u2022058.pdf most participants had work experience, infection control training, physician. J. Kersnik also showed that only 28.9% of patients 8. Population. Statistical Office of the Republic of Slovenia and were older, consistent across all PHC HAIs represent a significant public health issue worldwide, causing talk to their doctor before using CAM and that only 38.2% of [cited 2023 Sep 28]. Available at: centers. Conclusions:Healthcare workers in PHC centers substantial morbidity, mortality, and economic burden due to the patients tell their doctor about their past use of CAM (12). It is http://www.stat.si/statweb/Field/Index/17 demonstrate substantial knowledge and optimal practices regarding extended duration of care and additional costs, particularly in low-therefore important to be aware of CAM use and that patients standard precautions for infection control, with a predominantly and middle-income countries. These infections are prevalent in are asked about its use. 9. Population aged 15 years or more by education. positive attitude. Recommendations include expanding sterilization intensive care units and among neonates [WHO, 2017]. Statistical Office of the Republic of Slovenia. [cited 2023 Sep and waste management spaces in PHC, enhancing training V. CONCLUSION 28]. Available at: programs, and intensifying supervision regarding infection control Infection Prevention and Control (IPC) is a practical, evidence-based http://pxweb.stat.si/pxweb/dialog/SaveShow.asp policies and procedures in PHC settings. Keyword s: Infection clinical and public health specialty focused on safeguarding patients, It was found that respondents use complementary and Control,, Knowledge, Attitude and Practices, Primary Health Care, healthcare workers, and visitors from avoidable infections, including alternative treatment methods. They are eager to help 10. Complementary and alternative medicine use in Health care workers those induced by antimicrobial-resistant pathogens, during themselves with herbs, and most commonly visit a bioenergetic England: results from a national survey. The international healthcare interactions (NSW Health, 2017) . IPC is paramount in therapist. Most forms of CAM are used as a complementary and journal of clinical practice [cited 2023 Sep 28]. Available at: I. INTRODUCTION maintaining the safety and quality of care for every healthcare not replacement method of treatment. http://onlinelibrary.wiley.com/doi/10.1111/j.1742- interaction [WHO, 2022]. 1241.2010.02484.x/full Healthcare professionals (HCPs) are particularly vulnerable to The most common reason for visiting a healer is lower back infections during their interactions with patients, due to exposures to Data from various sources, including the European Centre for pain, followed by fatigue and join pain. Self-treatment with 11. Complementary and alternative medicine use in body fluids, blood, and infected regions, as well as the materials Disease Prevention and Control (ECDC) and the United States CAM is most commonly used for cough and virosis. Australia: a national population-based survey [cited 2023 Sep utilized in patient care (Al-Ahmari et.al.,2021). Healthcare- Centers for Disease Control and Prevention (USCDC), elucidate the 28]. Available at: prevalent issues of HAIs in different healthcare settings [3,4]. The The information that more than a half of the respondents did associated infections (HAIs) are typically acquired during medical https://www.ncbi.nlm.nih.gov/pubmed/17718647 procedures or diagnostic examinations within healthcare settings ongoing COVID-19 pandemic has underscored the importance of not or would not tell their physician about using CAM unless (NSW Health, 2017). Preventing hospital-acquired infections is IPC due to the high transmission rates of SARS-CoV-2 in healthcare specifically asked seems meaningful. It is therefore important 12. Kersnik J. Predictive characteristics of users of crucial in delivering safe, high-quality services in healthcare settings [11,12] (WHO, 2022). for a general practitioner to establish a permanent personal alternative medicine. Schweiz Med Wochenschreib. 2000; 130: facilities by introducing barriers between susceptible hosts and relationship with all of their patients based on mutual trust. 390-4. During consultations, the use of CAM must be discussed openly 13. Ivetić V., Čreslovnik B., Klemenc-Ketiš Z., Kersnik J. and transparently. (2021). Use of complementary and alternative treatment methods among adults in Slovenia. Acta Medico-Biotechnica, 6(1), 51-58. [cited 2023 Sep 28]. Available at: https://doi.org/10.18690/actabiomed.83 8 are patients who are more active in seeking solutions for their REFERENCES problems, which was also demonstrated by Kersnik J. (12). KNOWLEDGE, ATTITUDES, AND PRACTICES REGARDING INFECTION CONTROL: A 1. Complementary and Alternative Medicine Act 2007. The most commonly visited healer was a bioenergetic Official Gazette of the Republic of Slovenia, Nos. 94/07 and SURVEY OF NURSES IN PRIMARY CARE SETTINGS- KOSOVO therapist (31.5%), followed by massage therapist (15.9%), 87/11 [cited 2023 Sep 28]. Available at: homoeopath (13.2%) and acupuncturist (13.5%). These results http://www.pisrs.si/Pis.web/pregledPredpisa?id=ZAKO4283# ¹Mr.sc.Behrije Halilaj-Vishi Phd.Can, ² Dr.Imri Vishi Phd., ² Dr.Lul Raka Phd. differ from the results of the study conducted by Cvetko T., which ranked massage (30%) first, followed by energy 2. Zaloker A, Zaloker U. Komplementarna in integrativna treatment in 14.0%, while homoeopathy was used just by 2.0% medicina. Zdrav Vestn 2011; 80: 33-8. ¹ General Hospital Ferizaj ,Surgery Department ,Kosovo and acupuncture by 3.8% of respondents (5). An increase in the 3. Complementary and Alternative Medicine. U.S. National ² University of Prishtina ,Nursing Department ,Kosovo use of acupuncture could be due to the fact that it had been Library of Medicine. National Institutes of Health Dec 2011 placed on the list of permitted healthcare services and is [cited 2023 Sep 28]. Available at: 3.Angela Boškin Faculty of Health, Spodnji Plavž 3, 4270 Jesenice, Slovenija reimbursed from mandatory health insurance (provided it is http://www.nlm.nih.gov/medlineplus/complementaryandaltern performed by a healthcare professional within a public ativemedicine.html healthcare service). Homoeopathy is also more accessible, since homoeopathic preparations are available in some 4. The Use of Complementary and Alternative Medicine in pharmacies, together with appropriate counselling about their the United States. National center for complementary and Abstract—: Nurses in primary care are in the frontline and are more infectious microorganisms. The strategies like forming dedicated use. integrative health [cited 2023 Sep 28]. Available at: susceptible to infections while interacting with patients through infection control committees, implementing proper waste handling https://nccih.nih.gov/research/statistics/2007/camsurvey_fs1.h exposure to bodily fluids, infected body parts, blood, and medical and sanitation protocols, and ensuring adherence to occupational On the average, the respondents visited a healer for 2.6 tm materials.. Aim of the Study: This study seeks to evaluate the protection standards can mitigate the avoidable morbidity and (SD=1.3) medical problems. The most common reason was knowledge, attitude, and practices related to standard infection mortality associated with HAIs (Bayleyegn B et.al.,2021). lower back pain, followed by fatigue and join pain. J. Kersnik 5. Cvetko T. Vpliv zdravnika na uporabo dopolnilnih oblik control precautions among healthcare professionals in primary (12) also reports lower back pain as one of the main reasons for zdravljenja, Graduation Thesis. Ljubljana: Chair of Public healthcare (PHC) centers in Kosovo. Subjects and Methods: In this According to the World Health Organization (WHO), infection using CAM. The data are similar to those reported from a study Health; University of Ljubljana; 2003. cross-sectional study, 124 healthcare professionals from Kosovo control is a disciplined approach to preventing infections, aiming to in the US (4), with the most common reason for using CAM 6. Act Amending the Complementary and Alternative PHC centers were included, utilizing an electronic questionnaire for protect those susceptible to infections, both in the community and being problems with musculoskeletal system such as lower Medicine Act, Official Gazette of the Republic of Slovenia, No. data acquisition. Results: A majority of participants were nurses, healthcare settings, particularly those with pre-existing health back pain, and neck and joint pain. possessing high school and Bachelor’s degrees (46.3% and 36.1%, conditions. The fundamental principle of infection prevention and 87/11 [cited 2023 Sep 28]. Available at: respectively), primarily aged over 40 years (59.3%) and boasting control is maintaining proper hygiene [WHO, 2011]. The most common reasons for self-treatment with CAM http://www.mz.gov.si/fileadmin/mz.gov.si/pageuploads/javna more than 10 years of work experience (69.4%). Approximately half were cough and virosis, namely in the form of natural herbs, _razprava_2011/zakon_zdravilci/Zakon_o_zdravilstvu_06041 reported having dedicated rooms for medical waste (50% and A majority of healthcare infections are transmitted by healthcare which is consistent with the data from other studies (4- 1.pdf 46.3%). Participation in infection control training was reported by personnel who neglect proper hand hygiene and fail to change 6,10,11,13). 7. Act of types of medical health activities 2022. Official 74.8%, with around 90% showing a positive attitude towards gloves between patient interactions. Nursing staff, who have more infection control policies and 80% reporting high practice levels. extensive contact with patients and their families, face a heightened We also checked whether the respondents would tell their Gazette of the Republic of Slovenia, Nos. 58/22 [cited 2023 Sep There was a negligible variance in the statements, knowledge, and risk of acquiring and transmitting pathogens (Asodike Maria physician about the past or future use of alternative methods. 28]. Available at: https://www.uradni- attitudes about infection control related to socio-demographic data; et.al.2021). More than a half said they would not tell unless asked by the list.si/_pdf/2022/Ur/u2022058.pdf most participants had work experience, infection control training, physician. J. Kersnik also showed that only 28.9% of patients 8. Population. Statistical Office of the Republic of Slovenia and were older, consistent across all PHC HAIs represent a significant public health issue worldwide, causing talk to their doctor before using CAM and that only 38.2% of [cited 2023 Sep 28]. Available at: centers. Conclusions:Healthcare workers in PHC centers substantial morbidity, mortality, and economic burden due to the patients tell their doctor about their past use of CAM (12). It is http://www.stat.si/statweb/Field/Index/17 demonstrate substantial knowledge and optimal practices regarding extended duration of care and additional costs, particularly in low-therefore important to be aware of CAM use and that patients standard precautions for infection control, with a predominantly and middle-income countries. These infections are prevalent in are asked about its use. 9. Population aged 15 years or more by education. positive attitude. Recommendations include expanding sterilization intensive care units and among neonates [WHO, 2017]. Statistical Office of the Republic of Slovenia. [cited 2023 Sep and waste management spaces in PHC, enhancing training V. CONCLUSION 28]. Available at: programs, and intensifying supervision regarding infection control Infection Prevention and Control (IPC) is a practical, evidence-based http://pxweb.stat.si/pxweb/dialog/SaveShow.asp policies and procedures in PHC settings. Keyword s: Infection clinical and public health specialty focused on safeguarding patients, It was found that respondents use complementary and Control,, Knowledge, Attitude and Practices, Primary Health Care, healthcare workers, and visitors from avoidable infections, including alternative treatment methods. They are eager to help 10. Complementary and alternative medicine use in Health care workers those induced by antimicrobial-resistant pathogens, during themselves with herbs, and most commonly visit a bioenergetic England: results from a national survey. The international healthcare interactions (NSW Health, 2017) . IPC is paramount in therapist. Most forms of CAM are used as a complementary and journal of clinical practice [cited 2023 Sep 28]. Available at: I. INTRODUCTION maintaining the safety and quality of care for every healthcare not replacement method of treatment. http://onlinelibrary.wiley.com/doi/10.1111/j.1742- interaction [WHO, 2022]. 1241.2010.02484.x/full Healthcare professionals (HCPs) are particularly vulnerable to The most common reason for visiting a healer is lower back infections during their interactions with patients, due to exposures to Data from various sources, including the European Centre for pain, followed by fatigue and join pain. Self-treatment with 11. Complementary and alternative medicine use in body fluids, blood, and infected regions, as well as the materials Disease Prevention and Control (ECDC) and the United States CAM is most commonly used for cough and virosis. Australia: a national population-based survey [cited 2023 Sep utilized in patient care (Al-Ahmari et.al.,2021). Healthcare- Centers for Disease Control and Prevention (USCDC), elucidate the 28]. Available at: prevalent issues of HAIs in different healthcare settings [3,4]. The The information that more than a half of the respondents did associated infections (HAIs) are typically acquired during medical https://www.ncbi.nlm.nih.gov/pubmed/17718647 procedures or diagnostic examinations within healthcare settings ongoing COVID-19 pandemic has underscored the importance of not or would not tell their physician about using CAM unless (NSW Health, 2017). Preventing hospital-acquired infections is IPC due to the high transmission rates of SARS-CoV-2 in healthcare specifically asked seems meaningful. It is therefore important 12. Kersnik J. Predictive characteristics of users of crucial in delivering safe, high-quality services in healthcare settings [11,12] (WHO, 2022). for a general practitioner to establish a permanent personal alternative medicine. Schweiz Med Wochenschreib. 2000; 130: facilities by introducing barriers between susceptible hosts and relationship with all of their patients based on mutual trust. 390-4. During consultations, the use of CAM must be discussed openly 13. Ivetić V., Čreslovnik B., Klemenc-Ketiš Z., Kersnik J. and transparently. (2021). Use of complementary and alternative treatment methods among adults in Slovenia. Acta Medico-Biotechnica, 6(1), 51-58. [cited 2023 Sep 28]. Available at: https://doi.org/10.18690/actabiomed.83 9 Even with the extensive promotion of standard precautions and the Each section was meticulously designed to extract a nuanced consistently utilize protective goggles during procedures, but a Approximately 62.1% and 52% of participants marked the availability of numerous guidelines, the level of knowledge, understanding of the knowledge, attitudes, practices, and considerable majority, about 83.1%, do adhere to wearing lack of established guidelines in primary healthcare centers attitudes, and the practice of these precautions among healthcare perceived obstacles that healthcare professionals in Kosovo medical gowns during the procedures. Overall, a significant and a dearth of healthcare workers as substantial or extremely professionals is still considerably suboptimal, and the application of PHC centers have regarding standard precautions of infection proportion of participants, 75.6%, demonstrate good practice substantial concerns respectively, with overcrowded these precautions is often underreported (Al-Ahmari et.al.,2021). control. concerning infection control, while 24.4% exhibit poor workplaces being the least concerning obstacles (54.8% and practice, as depicted in Figure 3. 29%). The goal of this study is to scrutinize the knowledge, attitudes, and practices of healthcare professionals operating in primary health care III.RESULT IV. D The statistical analysis emphasizes that the adherence to (PHC) centers in Kosovo in relation to the standard precautions of ISCUSSION apt practices was significantly influenced by the cumulative infection control. This investigation was designed to scrutinize the levels of years of experience in PHC and the attendance of specialized understanding, viewpoints, and application of infection control infection control training sessions.In this chapter, we explain II.M A comprehensive participation of 124 healthcare providers measures among professionals in primary healthcare settings. ATERIAL AND METHODS the results in the light of other research available. We state was achieved in this study. As delineated in Table one, it is The results revealed that a substantial majority, more than what we have discovered and what others have found. evident that a substantial majority of the healthcare two-thirds of the participants, demonstrated profound This study was a cross-sectional examination including 124 professionals (HCP) involved in this study were female, knowledge regarding infection control. healthcare professionals from Primary Health Care (PHC) representing 86.3% of the respondents. Furthermore, a TABLE I.Socio-demographic characteristics of health centers in Kosovo. Data was amassed through an electronic significant proportion, 56.5%, were aged over 40 years. When compared to an earlier study executed in Abha City, care professionals, Kosovo 2023 questionnaire structured into six distinct segments: Kingdom of Saudi Arabia[1], approximately 31.6% of A closer examination of the occupational distribution healthcare providers exhibited deficient knowledge about reveals that the predominant profession among the participants Characteristics Nr % infection control. Nonetheless, a significant 88.2% manifested 1.Socio-Demographic Characteristics- This section gathered was nursing, constituting 73.4% of the contributors. Regarding positive attitudes towards the protocols and policies of Age groups information on gender, age, profession, highest educational background, 47.3% of the participants had infection control, whereas 49.5% showcased suboptimal levels qualification,education, and experience in PHC practice. completed high medical school. Moreover, a considerable <30 years 21 (16.9%) of practice. Various studies from different regions like Abuja, 2.Profile of PHC Centers and Healthcare Professionals-This 66.9% of the participants had acquired over ten years of Nigeria, and Ethiopia, [7,9] have depicted analogous findings, 30‑40 years 33 (26.6%) focused on aspects regarding infection control within primary experience in Primary Health Care (PHC) settings. revealing a disparity in knowledge of standard precautions, health care centers and amongst healthcare professionals. >40 years 70 (56.5%) usage of Personal Protective Equipment (PPE), and adherence 3.Knowledge Regarding Infection Control- Five questions In table two, it is indicated that a modest majority, to standard precautions owing to misconceptions, resource Gender pertained to infection control knowledge and standard approximately 54.8%, reported having a designated room for sterilization purposes. Additionally, 51.6% confirmed the scarcity, and insufficient training opportunities. Male 17 (13.7%) precautions, concentrating on aspects related to sharps and availability of a distinct room specifically for managing needles, application of standard precautions, and diseases In the present research, a predominant proportion of medical waste. Notably, the majority of the participants, Female 107 (86.3 %) transmitted by contaminated needles and sharps. Each correct participants were female (86.3%), with more than half being representing 66.7%, have undergone training in infection above the age of 40 years (56.5%). The majority of Position response was assigned one score, with incorrect or control. participants were nurses (73.4%), and 47.3% had attained high incomplete ones receiving zero. Based on total percentage Physician 0 0% medical school education, with 66.9% boasting over ten years scores, participants were categorized into: Fig.1.Generally, a significant majority of participants, of experience in Primary Health Care (PHC). A considerable Dentist 2 (1.6%) -Those with ≥60% were regarded as having acceptable around 90%, demonstrated substantial knowledge regarding majority declared having separate rooms for sterilization (Good) knowledge. infection control policies and procedures. The statistical Nurse 91 (73.4%) (54.8%) and for medical waste (51.6%), and most have -Those with <60% were seen as having unacceptable (Poor) analysis reveals a noteworthy association between good participated in infection control training (66.7%). Lab technician 18 (14.5%) knowledge. practice and participants’ years of experience in PHC, along Dental assistant 12 (9.7%) 4.Attitude Assessment- Participants’ attitudes were measured with their participation in training programs about infection Generally, an overwhelming 90% of participants displayed control using seven statements about infection control and standard comprehensive knowledge of infection control policies and Qualification precautions, responded to on a five-point Likert scale ranging Table 4. Illustrates the participants' understanding of procedures. The analytical data unveiled a notable association between the adherence to good infection control practices and PhD/MD/equivalent 3 (2.4%) from strongly agree to strongly disagree. After calculating the infection control. A majority, 61.3%, strongly concur that the years spent in PHC, coupled with participation in relevant total attitude score (35 points maximum), participants were standard precautions are instrumental in preventing infection Master 19 (15.3%) training programs. In terms of the participants' insights and categorized as: in primary health care settings. A significant proportion, practices in infection control, a consistent majority recognized Bachelor 43 (34.7%) -Positive attitude for scores ≥60% (>21 points). 35.5%, strongly refute the notion, “There is no necessity to the imperative nature of standard precautions, consistent hand High med school 59 (47.6%) -Negative attitude for scores <60% (less than 21 points). wash or decontaminate hands after making contact with the hygiene, and the employment of PPE to curb infections and -Neutral attitude for scores equal to 60% (21 points). patient’s environment,” and 24.2% hold a neutral stance on hinder the transmission of germs. Experience in PHC 5.Practice Assessment Regarding Infection Control- This this. A substantial 70.2% ardently agree that utilizing gloves <5 years 28 (22.6%) section assessed the practices of healthcare providers using during patient care is a beneficial strategy to curtail the Regarding the execution of infection control measures, a transmission risk of pathogens. Furthermore, a predominant six questions on a five-point scale, ranging from always to majority of participants professed consistently implementing 5‑10 years 13 (10.5%) segment of health workers, 62.9%, emphatically agree that in never. Based on total practice scores (30 points maximum), preventive strategies such as handwashing, and utilizing the absence of standard measures, health care facilities can gloves, face masks, and medical gowns during examinations >10 years 83 (66.9%) participants were categorized into: indeed become infection and disease epidemic sources. and procedures. This denotes that 75.6% of the participants -Good practice for those who achieved ≥70% (21 points or maintained commendable practices in relation to infection more). Table 5. Presents the practices relating to infection control control, whereas 24.4% demonstrated inadequate practices. TABLE II: Profile of primary health care centers and -Poor practice for those who achieved <70% (20 points or among participants. The vast majority of the participants health care professionals regarding infection control less). (96%) consistently wash their hands before examining their Lastly, concerning the impediments to the execution of 6.Perception of Obstacles- Participants rated perceived patients, and a substantial majority (87.1%) always secure the infection control policies and procedures, a significant 64.5% Characteristics Nr (%) obstacles to the proper application of standard precautions needles immediately after use. Similarly, a significant number and about a third (34%) identified the absence of infection Availability of a special room for and infection control as “not important,” “important,” or (70.2%) consistently use gloves during patient examinations, control training as a major or extremely significant hindrance. sterilization in PHC center “very important.” and 82% regularly employ face masks when examining Additionally, inadequate handwashing facilities and scarcity potentially infectious patients. However, only 33.9% of PPE were also deemed to be considerable obstacles. 10 Even with the extensive promotion of standard precautions and the Each section was meticulously designed to extract a nuanced consistently utilize protective goggles during procedures, but a Approximately 62.1% and 52% of participants marked the availability of numerous guidelines, the level of knowledge, understanding of the knowledge, attitudes, practices, and considerable majority, about 83.1%, do adhere to wearing lack of established guidelines in primary healthcare centers attitudes, and the practice of these precautions among healthcare perceived obstacles that healthcare professionals in Kosovo medical gowns during the procedures. Overall, a significant and a dearth of healthcare workers as substantial or extremely professionals is still considerably suboptimal, and the application of PHC centers have regarding standard precautions of infection proportion of participants, 75.6%, demonstrate good practice substantial concerns respectively, with overcrowded these precautions is often underreported (Al-Ahmari et.al.,2021). control. concerning infection control, while 24.4% exhibit poor workplaces being the least concerning obstacles (54.8% and practice, as depicted in Figure 3. 29%). The goal of this study is to scrutinize the knowledge, attitudes, and practices of healthcare professionals operating in primary health care III.RESULT IV. D The statistical analysis emphasizes that the adherence to (PHC) centers in Kosovo in relation to the standard precautions of ISCUSSION apt practices was significantly influenced by the cumulative infection control. This investigation was designed to scrutinize the levels of years of experience in PHC and the attendance of specialized understanding, viewpoints, and application of infection control infection control training sessions.In this chapter, we explain II.M A comprehensive participation of 124 healthcare providers measures among professionals in primary healthcare settings. ATERIAL AND METHODS the results in the light of other research available. We state was achieved in this study. As delineated in Table one, it is The results revealed that a substantial majority, more than what we have discovered and what others have found. evident that a substantial majority of the healthcare two-thirds of the participants, demonstrated profound This study was a cross-sectional examination including 124 professionals (HCP) involved in this study were female, knowledge regarding infection control. healthcare professionals from Primary Health Care (PHC) representing 86.3% of the respondents. Furthermore, a TABLE I.Socio-demographic characteristics of health centers in Kosovo. Data was amassed through an electronic significant proportion, 56.5%, were aged over 40 years. When compared to an earlier study executed in Abha City, care professionals, Kosovo 2023 questionnaire structured into six distinct segments: Kingdom of Saudi Arabia[1], approximately 31.6% of A closer examination of the occupational distribution healthcare providers exhibited deficient knowledge about reveals that the predominant profession among the participants Characteristics Nr % infection control. Nonetheless, a significant 88.2% manifested 1.Socio-Demographic Characteristics- This section gathered was nursing, constituting 73.4% of the contributors. Regarding positive attitudes towards the protocols and policies of Age groups information on gender, age, profession, highest educational background, 47.3% of the participants had infection control, whereas 49.5% showcased suboptimal levels qualification,education, and experience in PHC practice. completed high medical school. Moreover, a considerable <30 years 21 (16.9%) of practice. Various studies from different regions like Abuja, 2.Profile of PHC Centers and Healthcare Professionals-This 66.9% of the participants had acquired over ten years of Nigeria, and Ethiopia, [7,9] have depicted analogous findings, 30‑40 years 33 (26.6%) focused on aspects regarding infection control within primary experience in Primary Health Care (PHC) settings. revealing a disparity in knowledge of standard precautions, health care centers and amongst healthcare professionals. >40 years 70 (56.5%) usage of Personal Protective Equipment (PPE), and adherence 3.Knowledge Regarding Infection Control- Five questions In table two, it is indicated that a modest majority, to standard precautions owing to misconceptions, resource Gender pertained to infection control knowledge and standard approximately 54.8%, reported having a designated room for sterilization purposes. Additionally, 51.6% confirmed the scarcity, and insufficient training opportunities. Male 17 (13.7%) precautions, concentrating on aspects related to sharps and availability of a distinct room specifically for managing needles, application of standard precautions, and diseases In the present research, a predominant proportion of medical waste. Notably, the majority of the participants, Female 107 (86.3 %) transmitted by contaminated needles and sharps. Each correct participants were female (86.3%), with more than half being representing 66.7%, have undergone training in infection above the age of 40 years (56.5%). The majority of Position response was assigned one score, with incorrect or control. participants were nurses (73.4%), and 47.3% had attained high incomplete ones receiving zero. Based on total percentage Physician 0 0% medical school education, with 66.9% boasting over ten years scores, participants were categorized into: Fig.1.Generally, a significant majority of participants, of experience in Primary Health Care (PHC). A considerable Dentist 2 (1.6%) -Those with ≥60% were regarded as having acceptable around 90%, demonstrated substantial knowledge regarding majority declared having separate rooms for sterilization (Good) knowledge. infection control policies and procedures. The statistical Nurse 91 (73.4%) (54.8%) and for medical waste (51.6%), and most have -Those with <60% were seen as having unacceptable (Poor) analysis reveals a noteworthy association between good participated in infection control training (66.7%). Lab technician 18 (14.5%) knowledge. practice and participants’ years of experience in PHC, along Dental assistant 12 (9.7%) 4.Attitude Assessment- Participants’ attitudes were measured with their participation in training programs about infection Generally, an overwhelming 90% of participants displayed control using seven statements about infection control and standard comprehensive knowledge of infection control policies and Qualification precautions, responded to on a five-point Likert scale ranging Table 4. Illustrates the participants' understanding of procedures. The analytical data unveiled a notable association between the adherence to good infection control practices and PhD/MD/equivalent 3 (2.4%) from strongly agree to strongly disagree. After calculating the infection control. A majority, 61.3%, strongly concur that the years spent in PHC, coupled with participation in relevant total attitude score (35 points maximum), participants were standard precautions are instrumental in preventing infection Master 19 (15.3%) training programs. In terms of the participants' insights and categorized as: in primary health care settings. A significant proportion, practices in infection control, a consistent majority recognized Bachelor 43 (34.7%) -Positive attitude for scores ≥60% (>21 points). 35.5%, strongly refute the notion, “There is no necessity to the imperative nature of standard precautions, consistent hand High med school 59 (47.6%) -Negative attitude for scores <60% (less than 21 points). wash or decontaminate hands after making contact with the hygiene, and the employment of PPE to curb infections and -Neutral attitude for scores equal to 60% (21 points). patient’s environment,” and 24.2% hold a neutral stance on hinder the transmission of germs. Experience in PHC 5.Practice Assessment Regarding Infection Control- This this. A substantial 70.2% ardently agree that utilizing gloves <5 years 28 (22.6%) section assessed the practices of healthcare providers using during patient care is a beneficial strategy to curtail the Regarding the execution of infection control measures, a transmission risk of pathogens. Furthermore, a predominant six questions on a five-point scale, ranging from always to majority of participants professed consistently implementing 5‑10 years 13 (10.5%) segment of health workers, 62.9%, emphatically agree that in never. Based on total practice scores (30 points maximum), preventive strategies such as handwashing, and utilizing the absence of standard measures, health care facilities can gloves, face masks, and medical gowns during examinations >10 years 83 (66.9%) participants were categorized into: indeed become infection and disease epidemic sources. and procedures. This denotes that 75.6% of the participants -Good practice for those who achieved ≥70% (21 points or maintained commendable practices in relation to infection more). Table 5. Presents the practices relating to infection control control, whereas 24.4% demonstrated inadequate practices. TABLE II: Profile of primary health care centers and -Poor practice for those who achieved <70% (20 points or among participants. The vast majority of the participants health care professionals regarding infection control less). (96%) consistently wash their hands before examining their Lastly, concerning the impediments to the execution of 6.Perception of Obstacles- Participants rated perceived patients, and a substantial majority (87.1%) always secure the infection control policies and procedures, a significant 64.5% Characteristics Nr (%) obstacles to the proper application of standard precautions needles immediately after use. Similarly, a significant number and about a third (34%) identified the absence of infection Availability of a special room for and infection control as “not important,” “important,” or (70.2%) consistently use gloves during patient examinations, control training as a major or extremely significant hindrance. sterilization in PHC center “very important.” and 82% regularly employ face masks when examining Additionally, inadequate handwashing facilities and scarcity potentially infectious patients. However, only 33.9% of PPE were also deemed to be considerable obstacles. 11 Yes 56 (45.2%) Statement Stro A N D Stron Washing hands 96% 4 Lack of health 11.3% 52.4% 36.3% No 68 (54.8) ngly gree eutr isag gly before examining % care workers agree al ree disagree patients Availability of a special and separate Overcrowded 16.1% 54.8% 29.0% room for medical waste Standard 61.3 3 1 Recapping 87.1 6.5 3.2% 3.2% work place precautions % 7.1% .6% needles % % Yes 64 (51.6) prevent immediately after No 60 (48.4) infection at use REFERENCES health care Having attended a training program on Using gloves 70.2 22. 4.8% 2.4% [1] Al-Ahmari AM, AlKhaldi YM, Al-Asmari BA. Knowledge, infection control facility while examining % 6% attitude and practice about infection control among primary care professionals in Abha City, Kingdom of Saudi Arabia. J Family Yes 82 (66.7) There is no 9.7 9. 2 2 35.5 all patients need to wash or % 7% 4.2 1.0 % Med Prim Care. 2021 Feb;10(2):662-668. doi: 10.4103/jfmpc.jfmpc_1278_20. Epub 2021 Feb 27. PMID: No 41 (33.3) decontaminate % % Using face mask 82.3 12. 4.8% 0.8% while examining % 1 34041058; PMCID: PMC8138372.Veronesi U, Maisonneuve P, Decensi A. Tamoxifen: an enduring star. J Natl Cancer Inst. hands after % touching the possibly infective 2007;99(4):258–260. TABLE III. Knowledge of infection control policies and patient patients [2] Asodike Maria C.1 , Naze Ngozi S.1 , Iwuchukwu Itar1 , procedures among primary care health professionals in environment Wearing goggles 33.9 29. 25.8 4.8% 5.6% Udemba Nkeiruka1 , Obeagu Emmanuel 2 *1 Knowledge, Kosovo 2023 % 8% % attitudes and practices of nurses regarding infection prevention Using 70.2 2 4 0.8% during and control in Imo state university teaching hospital (imsuth), Statements True false gloves while % 3.4% .8% procedures Orlu,Imo state,Nigeria 2021,8(6), 127-134 patient care is a Wearing medical 83.1 6.5 5.6% 4.0% [3] Suetens C, Latour K, Kärki T, Ricchizzi E, Kinross P, Moro ML, Dirty needle and sharp materials 97.6% 2.4 % useful strategy gown during the % % et al. Prevalence of healthcare-associated infections, estimated can transmit disease causing agents for reducing procedures incidence and composite antimicrobial resistance index in acute (TRUE) care hospitals and long-term care facilities: results from two risk of European point prevalence surveys, 2016 to 2017. Standard precautions should be 91.9% 8.1 % transmission of Eurosurveillance: Eur Comm Dis Bul. 2018;23(46). 10. practiced on all patients and microbes [4] HAI and antibiotic use prevalence survey 2021 [website]. Atlanta laboratory specimen serology In absence 62.9 2 4 3 (GA): Centers for Disease Control and Prevention; 2021 irrespective of diagnosis (TRUE) (https://www.cdc.gov/hai/eip/antibiotic-use.html, accessed 3 May of standard % 9.0% .0% .2% 24% Good 2022) When you have a patient who 87.9% 12.1% precautions, Poor [5] Global report on infection prevention and control: executive vomited in dressing room or clinic, health care summary. Geneva: World Health Organization; 2022. Licence: CC 76% the first step in infection control facilities can be BY-NC-SA 3.0 IGO. procedure is to isolate infected area the source of [6] New South Wales Health. Infection prevention and control policy. (TRUE) infection and (NSW PD2017_013). NSW: NSW Health, 2017. disease Figure 3: Practice grades of participants about infection https://www1.health.nsw.gov.au/ Sharp containers are utilized for 84.7% 15.3% epidemics control pds/ActivePDSDocuments/PD2017_013.pdf. (Accessed Dec 2022) used injection needles (TRUE) Table 6.Obstacles against infection control policy and [7] Bayleyegn B, Mehari A, Damtie D, Negash M. Knowledge, Hepatitis B causing agent can be 97.6% 2.4% procedures in health sector Kosovo 2023 Attitude and Practice on Hospital-Acquired Infection Prevention and Associated Factors Among Healthcare Workers at University transmitted with dirty needles and of Gondar Comprehensive Specialized Hospital, Northwest sharps (TRUE) Ethiopia. Infect Drug Resist. 2021 Jan 27;14:259-266. doi: Statements Not Very 10.2147/IDR.S290992. PMID: 33536767; PMCID: PMC7850400 HIV/AIDS causing agent can be 91.9% 8.1% 9% Positive 15% Important Important important [8] World Health Organization & World Bank. (2011). World report transmitted with dirty needles and Negative on disability 2011. World Health Organization. sharps (TRUE) Lack of training 4.0% 64.5% 31.5% https://iris.who.int/handle/10665/44575 76% Neutral on infection control [9] Okechukwu EF, Modreshi C. Knowledge and practice of standard precautions in public health facilities in Abuja, Nigeria. Int J Infect guidelines Control 2012;8:10.3396. doi: 10.3396/ ijic.v8i3.022.12. Figure 2: Attitude grades of participants toward infection Lack of personal 7.3% 55.6% 37.1% [10] Ogoina D, Pondei K, Adetunji B, Chima G, Isichei C, Gidado S. control policy and procedures protection Knowledge, attitude and practice of standard precautions of infection control by hospital workers in two tertiary hospitals in TABLE V.Participants' practices regarding infection equipment Nigeria. J Infect Prev 2015;16:16-22. control policies and procedures in the health sector Kosovo Inadequate hand 4.8% 57.3% 37.9% [11] Yakob E, Lamaro T, Henok A. Knowledge, attitude and practice towards infection control measures among Mizan-Aman General Figure 1.Knowledge 2023 washing facility Hospital workers, South West Ethiopia. J Community Med Health grades of participants about infection control (alcohol Educ 2015;5:1-8. doi: 10.4172/2161-0711.1000370. solutions) Practices Alw Of Som Rar Never [12] Amin T, Al-Wehedy A. Healthcare providers’ knowledge of Lack of 4.0% 62.1% 33.9% standard precautions at the primary healthcare level in Saudi TABLE IV . Attitudes of primary care health professionals ays te etim ely guidelines at Arabia. Infect Dis Health 2009;14:65‑72. towards infection control policies and procedures in the health n es primary health [13] Alice TE, Akhere AD, Ikponwonsa O, Grace E. Knowledge and sector Kosovo 2023 care centers practice of infection control among health workers in a tertiary hospital in Edo state, Nigeria. Direct Res J Health Pharm (DRJHP) 2013;1:20-27. 12 Yes 56 (45.2%) Statement Stro A N D Stron Washing hands 96% 4 Lack of health 11.3% 52.4% 36.3% No 68 (54.8) ngly gree eutr isag gly before examining % care workers agree al ree disagree patients Availability of a special and separate Overcrowded 16.1% 54.8% 29.0% room for medical waste Standard 61.3 3 1 Recapping 87.1 6.5 3.2% 3.2% work place precautions % 7.1% .6% needles % % Yes 64 (51.6) prevent immediately after No 60 (48.4) infection at use REFERENCES health care Having attended a training program on Using gloves 70.2 22. 4.8% 2.4% [1] Al-Ahmari AM, AlKhaldi YM, Al-Asmari BA. Knowledge, infection control facility while examining % 6% attitude and practice about infection control among primary care professionals in Abha City, Kingdom of Saudi Arabia. J Family Yes 82 (66.7) There is no 9.7 9. 2 2 35.5 all patients need to wash or % 7% 4.2 1.0 % Med Prim Care. 2021 Feb;10(2):662-668. doi: 10.4103/jfmpc.jfmpc_1278_20. Epub 2021 Feb 27. PMID: No 41 (33.3) decontaminate % % Using face mask 82.3 12. 4.8% 0.8% while examining % 1 34041058; PMCID: PMC8138372.Veronesi U, Maisonneuve P, Decensi A. Tamoxifen: an enduring star. J Natl Cancer Inst. hands after % touching the possibly infective 2007;99(4):258–260. TABLE III. Knowledge of infection control policies and patient patients [2] Asodike Maria C.1 , Naze Ngozi S.1 , Iwuchukwu Itar1 , procedures among primary care health professionals in environment Wearing goggles 33.9 29. 25.8 4.8% 5.6% Udemba Nkeiruka1 , Obeagu Emmanuel 2 *1 Knowledge, Kosovo 2023 % 8% % attitudes and practices of nurses regarding infection prevention Using 70.2 2 4 0.8% during and control in Imo state university teaching hospital (imsuth), Statements True false gloves while % 3.4% .8% procedures Orlu,Imo state,Nigeria 2021,8(6), 127-134 patient care is a Wearing medical 83.1 6.5 5.6% 4.0% [3] Suetens C, Latour K, Kärki T, Ricchizzi E, Kinross P, Moro ML, Dirty needle and sharp materials 97.6% 2.4 % useful strategy gown during the % % et al. Prevalence of healthcare-associated infections, estimated can transmit disease causing agents for reducing procedures incidence and composite antimicrobial resistance index in acute (TRUE) care hospitals and long-term care facilities: results from two risk of European point prevalence surveys, 2016 to 2017. Standard precautions should be 91.9% 8.1 % transmission of Eurosurveillance: Eur Comm Dis Bul. 2018;23(46). 10. practiced on all patients and microbes [4] HAI and antibiotic use prevalence survey 2021 [website]. Atlanta laboratory specimen serology In absence 62.9 2 4 3 (GA): Centers for Disease Control and Prevention; 2021 irrespective of diagnosis (TRUE) (https://www.cdc.gov/hai/eip/antibiotic-use.html, accessed 3 May of standard % 9.0% .0% .2% 24% Good 2022) When you have a patient who 87.9% 12.1% precautions, Poor [5] Global report on infection prevention and control: executive vomited in dressing room or clinic, health care summary. Geneva: World Health Organization; 2022. Licence: CC 76% the first step in infection control facilities can be BY-NC-SA 3.0 IGO. procedure is to isolate infected area the source of [6] New South Wales Health. Infection prevention and control policy. (TRUE) infection and (NSW PD2017_013). NSW: NSW Health, 2017. disease Figure 3: Practice grades of participants about infection https://www1.health.nsw.gov.au/ Sharp containers are utilized for 84.7% 15.3% epidemics control pds/ActivePDSDocuments/PD2017_013.pdf. (Accessed Dec 2022) used injection needles (TRUE) Table 6.Obstacles against infection control policy and [7] Bayleyegn B, Mehari A, Damtie D, Negash M. Knowledge, Hepatitis B causing agent can be 97.6% 2.4% procedures in health sector Kosovo 2023 Attitude and Practice on Hospital-Acquired Infection Prevention and Associated Factors Among Healthcare Workers at University transmitted with dirty needles and of Gondar Comprehensive Specialized Hospital, Northwest sharps (TRUE) Ethiopia. Infect Drug Resist. 2021 Jan 27;14:259-266. doi: Statements Not Very 10.2147/IDR.S290992. PMID: 33536767; PMCID: PMC7850400 HIV/AIDS causing agent can be 91.9% 8.1% 9% Positive 15% Important Important important [8] World Health Organization & World Bank. (2011). World report transmitted with dirty needles and Negative on disability 2011. World Health Organization. sharps (TRUE) Lack of training 4.0% 64.5% 31.5% https://iris.who.int/handle/10665/44575 76% Neutral on infection control [9] Okechukwu EF, Modreshi C. Knowledge and practice of standard precautions in public health facilities in Abuja, Nigeria. Int J Infect guidelines Control 2012;8:10.3396. doi: 10.3396/ ijic.v8i3.022.12. Figure 2: Attitude grades of participants toward infection Lack of personal 7.3% 55.6% 37.1% [10] Ogoina D, Pondei K, Adetunji B, Chima G, Isichei C, Gidado S. control policy and procedures protection Knowledge, attitude and practice of standard precautions of infection control by hospital workers in two tertiary hospitals in TABLE V.Participants' practices regarding infection equipment Nigeria. J Infect Prev 2015;16:16-22. control policies and procedures in the health sector Kosovo Inadequate hand 4.8% 57.3% 37.9% [11] Yakob E, Lamaro T, Henok A. Knowledge, attitude and practice towards infection control measures among Mizan-Aman General Figure 1.Knowledge 2023 washing facility Hospital workers, South West Ethiopia. J Community Med Health grades of participants about infection control (alcohol Educ 2015;5:1-8. doi: 10.4172/2161-0711.1000370. solutions) Practices Alw Of Som Rar Never [12] Amin T, Al-Wehedy A. Healthcare providers’ knowledge of Lack of 4.0% 62.1% 33.9% standard precautions at the primary healthcare level in Saudi TABLE IV . Attitudes of primary care health professionals ays te etim ely guidelines at Arabia. Infect Dis Health 2009;14:65‑72. towards infection control policies and procedures in the health n es primary health [13] Alice TE, Akhere AD, Ikponwonsa O, Grace E. Knowledge and sector Kosovo 2023 care centers practice of infection control among health workers in a tertiary hospital in Edo state, Nigeria. Direct Res J Health Pharm (DRJHP) 2013;1:20-27. 13 Decision-oriented aspects of a university primary care primary care units which are operational across Austria, none the three dimensions identified earlier, they are included as is organizationally integrated into a university, thus making elements to be discussed in this analysis. centre: A multidimensional analysis in the context of this a pilot project not only for the region of Upper Austria but also for Austria and beyond. [4,6] So, overall, eight conceptually distinct dimensions can be identified as decision-relevant for set ing up a university the Johannes Kepler University Linz After having developed the vision and having secured the primary care centre. (see Fig. 1) According to business general support of relevant stakeholders, such as the Austrian management theory, these can be sub-divided into core and Health Insurance Fund and the Upper Austrian Medical support elements, whereby patient care, practical teaching, Aigner P 1,2, Bekelaer F 1, Rebhandl E 1,3, Zelko E 1 Chamber, the Institute of General Practice is currently and academic research are counted towards the core elements 1 Institute of General Practice, Johannes Kepler University Linz, Austria 2 SOLVE Consulting Managementberatung planning and negotiating matters regarding the since they represent directly value-adding aspects of a GmbH, Vienna, Austria, 3 HAUSARZTMEDIZIN PLUS Gruppenpraxis für Allgemeinmedizin OG, Haslach, Austria implementation of Austria’s first university primary care university primary care centre. The remaining five dimensions philipp.aigner@solve.at centre. Aim of this paper is to support this innovative pilot are classified as support elements because they merely project by providing a scientific basis focusing on decision- represent aid functions which are needed to enable the actual Abstract—The Institute of General Practice of the Johannes predicted to further aggravate significantly over the next oriented aspects from multiple relevant perspectives. services provided to customers. The term customers in this Kepler University Linz is planning to establish Austria’s first decade due to the retirement wave of doctors of the baby context refers to patients, medicine students, and academic university primary care centre – a group practice at the primary boomer generation, the increasing demand for medical care II. MATERIAL AND METHODS researchers, in accordance with the three core elements care level which is organizational y integrated into the due to the aging population, and the shortage of medical The data used in this research was gathered through identified. [8] university. In addition to the provision of regional primary care, graduates pursuing training in the field of general medicine. analyses of literature. For this purpose, the Handbook for Symbolically, a house can be used to portray this concept this pilot project is envisioned to facilitate practical training for [1,2] Founding a Primary Care Unit [7] was used as one of the in a structured, yet il ustrative fashion. Therein, the support medicine students and patient access for academic research in main sources of information and forms the conceptual basis of elements can be depicted as the indispensable foundation on the field of general medicine. Therefore, it can be expected to Beyond direct patient care, the provision of practical this paper’s analyses. This 204-page-long document was simultaneously address several significant challenges faced by teaching to medicine students is considered a challenge as which the core elements are built as the main floor, all under published in its latest edition in August 2023 by the Austrian Austria’s healthcare and education system. Based on literature well. Practical lessons form an integral part of the curriculum the common roof of a university primary care centre. The Federal Ministry of Social Affairs, Health, Care and research, this paper identifies eight conceptually distinct of the human medicine degree but since, in contrast to other visualization of this concept is shown below as Fig. 1. Consumer Protection and was created in col aboration with elements which are decision-relevant for the establishment of the medical specialties, general medicine does not have a university primary care centre and evaluates whether this various subject matter experts including the National Public corresponding department at the university hospital, the endeavour appears to be fundamentally feasible from the Health Institute. Its intended purpose is to provide a structured organization of such training is often laborious and complex. respective perspectives. Additionally, relevant concepts and overview on how to establish a primary care unit, therewith [2,4] success factors are discussed at the level of each of the eight making it a fit ing document to base this paper on, in terms of elements. Patient care, practical teaching, and academic research Another notable challenge in the field of general medicine content and reliability. are identified as the three core elements which represent the is the access to primary patient data for research. Since Methodically, in a first step, conceptually distinct and services directly provided to the university primary care centre’s patients cannot be accessed through a corresponding decision-relevant dimensions of the implementation of a customers – i.e., patients, students, and researchers. department at the university hospital, the Institute of General university primary care centre Additionally, legal structure, organization and management, are identified and defined, Practice of the Johannes Kepler University Linz (“JKU”) has business administration and finance, location and premises as well based on the insight from literature. Those elements are then established a research network including several general as IT infrastructure are identified as the five support elements. conceptionally organized and sub-divided. In order to meet the medicine practices spread over Upper Austria. However, the Figure 1. Visualization of decision-relevant elements. This concept is il ustrated by a figurative house which has a aspiration for multi-perspectivity, in each case, it is researched research collaboration with the network members is relatively foundation composed of the five support elements and a main whether, the integration of a primary care centre into the JKU complex and laborious due to their geographical dispersion In the following paragraphs, for each of the eight elements floor consisting of the three core elements, all under the roof of a appears to be fundamentally feasible from the respective identified, relevant success factors and concepts are identified university primary care unit. After the analysis of each and the need for coordination. [5] perspective. Also, decision-relevant factors and concepts are and discussed. Also, the question whether the establishment of dimension separately, it can be concluded and confirmed that The JKU is located in Linz, capital of the federal state of identified and discussed in the light of the pilot project. a university primary care centre presents itself as the establishment of Austria’s first university primary care centre Upper Austria, and currently offers 310 university places per fundamentally feasible is answered at the level of each in Linz appears to be fundamentally feasible. Due to its year to medicine students through its medical faculty. The III. RESULTS innovative approach, this pilot project can serve as a blueprint element. university’s Institute of General Practice is currently working From the vision and aspired purpose of the university and case study for similar undertakings, in other parts of on the pilot project to establish Austria’s first university primary care centre described in the introduction, it is evident Austria but also beyond. Therefore, further accompanying 1. Patient care primary care centre which is organizationally integrated into that relevant aspects of this undertaking comprise the scientific analyses are recommended. According to the Austrian primary care act, patient- the medical faculty. As such, it is envisioned to unite regional provision of primary care for patients, the facilitation of oriented goals which need to be met by every primary care Index Terms—Austria; Education, Medical, Graduate; General medical care for patients at the primary level with enhanced practical training for medicine students as well as patient centre include primary care close to patients’ homes, good Practice; Health Facility Planning; Primary Health Care opportunities for academic research and practical teaching in access for academic research in the field of general medicine. the discipline of general medicine, thereby tackling the accessibility by public transportation, extended opening hours These three aspects fulfil the criteria of being decision- challenges described above. The term primary care centre is including non-office hours, reachability outside of opening relevant and conceptual y distinct from each other. Therefore, I. INTRODUCTION specified by Austrian federal law and describes a specific form hours in acute cases, integration of telephone- or web-based they are regarded as separate dimensions to be analysed in the services, administration of home visits, guarantee of continuity Austria is facing several challenges in sustainably of group practice at the primary care level. Together with course of this work. The Handbook for Founding a Primary for patients, accessibility for persons with a disability, maintaining the provision of primary health care at the primary care networks, which describe a specific form of Care Unit is structured around five dimensions, each of which measures to mitigate language barriers, availability of required currently high level of quality. Amongst the most crucial collaboration by close-by practices, the corresponding is deemed decision-relevant for setting up a primary care unit medical(-technical) equipment, and participation in challenges is the existing lack of general practitioners which is umbrella term is primary care unit. Of the currently 50 and to each of which a separate chapter is dedicated. Those preventive, screening and integrated healthcare programmes. five dimensions are composed of the legal structure, The services to be provided in particular have to include the organization and management, business administration and provision of primary care to paediatric, elderly, chronically ill, finance, location and premises, and IT infrastructure. Since and multimorbid patients as well as psychosocial healthcare, they meet the criterium of decision-relevance and are drug monitoring, health promotion, and disease prevention. In conceptionally distinct from one another other as well as from a healthcare concept, which must be prepared when 14 Decision-oriented aspects of a university primary care primary care units which are operational across Austria, none the three dimensions identified earlier, they are included as is organizationally integrated into a university, thus making elements to be discussed in this analysis. centre: A multidimensional analysis in the context of this a pilot project not only for the region of Upper Austria but also for Austria and beyond. [4,6] So, overall, eight conceptually distinct dimensions can be identified as decision-relevant for set ing up a university the Johannes Kepler University Linz After having developed the vision and having secured the primary care centre. (see Fig. 1) According to business general support of relevant stakeholders, such as the Austrian management theory, these can be sub-divided into core and Health Insurance Fund and the Upper Austrian Medical support elements, whereby patient care, practical teaching, Aigner P 1,2, Bekelaer F 1, Rebhandl E 1,3, Zelko E 1 Chamber, the Institute of General Practice is currently and academic research are counted towards the core elements 1 Institute of General Practice, Johannes Kepler University Linz, Austria 2 SOLVE Consulting Managementberatung planning and negotiating matters regarding the since they represent directly value-adding aspects of a GmbH, Vienna, Austria, 3 HAUSARZTMEDIZIN PLUS Gruppenpraxis für Allgemeinmedizin OG, Haslach, Austria implementation of Austria’s first university primary care university primary care centre. The remaining five dimensions philipp.aigner@solve.at centre. Aim of this paper is to support this innovative pilot are classified as support elements because they merely project by providing a scientific basis focusing on decision- represent aid functions which are needed to enable the actual Abstract—The Institute of General Practice of the Johannes predicted to further aggravate significantly over the next oriented aspects from multiple relevant perspectives. services provided to customers. The term customers in this Kepler University Linz is planning to establish Austria’s first decade due to the retirement wave of doctors of the baby context refers to patients, medicine students, and academic university primary care centre – a group practice at the primary boomer generation, the increasing demand for medical care II. MATERIAL AND METHODS researchers, in accordance with the three core elements care level which is organizational y integrated into the due to the aging population, and the shortage of medical The data used in this research was gathered through identified. [8] university. In addition to the provision of regional primary care, graduates pursuing training in the field of general medicine. analyses of literature. For this purpose, the Handbook for Symbolically, a house can be used to portray this concept this pilot project is envisioned to facilitate practical training for [1,2] Founding a Primary Care Unit [7] was used as one of the in a structured, yet il ustrative fashion. Therein, the support medicine students and patient access for academic research in main sources of information and forms the conceptual basis of elements can be depicted as the indispensable foundation on the field of general medicine. Therefore, it can be expected to Beyond direct patient care, the provision of practical this paper’s analyses. This 204-page-long document was simultaneously address several significant challenges faced by teaching to medicine students is considered a challenge as which the core elements are built as the main floor, all under published in its latest edition in August 2023 by the Austrian Austria’s healthcare and education system. Based on literature well. Practical lessons form an integral part of the curriculum the common roof of a university primary care centre. The Federal Ministry of Social Affairs, Health, Care and research, this paper identifies eight conceptually distinct of the human medicine degree but since, in contrast to other visualization of this concept is shown below as Fig. 1. Consumer Protection and was created in col aboration with elements which are decision-relevant for the establishment of the medical specialties, general medicine does not have a university primary care centre and evaluates whether this various subject matter experts including the National Public corresponding department at the university hospital, the endeavour appears to be fundamentally feasible from the Health Institute. Its intended purpose is to provide a structured organization of such training is often laborious and complex. respective perspectives. Additionally, relevant concepts and overview on how to establish a primary care unit, therewith [2,4] success factors are discussed at the level of each of the eight making it a fit ing document to base this paper on, in terms of elements. Patient care, practical teaching, and academic research Another notable challenge in the field of general medicine content and reliability. are identified as the three core elements which represent the is the access to primary patient data for research. Since Methodically, in a first step, conceptually distinct and services directly provided to the university primary care centre’s patients cannot be accessed through a corresponding decision-relevant dimensions of the implementation of a customers – i.e., patients, students, and researchers. department at the university hospital, the Institute of General university primary care centre Additionally, legal structure, organization and management, are identified and defined, Practice of the Johannes Kepler University Linz (“JKU”) has business administration and finance, location and premises as well based on the insight from literature. Those elements are then established a research network including several general as IT infrastructure are identified as the five support elements. conceptionally organized and sub-divided. In order to meet the medicine practices spread over Upper Austria. However, the Figure 1. Visualization of decision-relevant elements. This concept is il ustrated by a figurative house which has a aspiration for multi-perspectivity, in each case, it is researched research collaboration with the network members is relatively foundation composed of the five support elements and a main whether, the integration of a primary care centre into the JKU complex and laborious due to their geographical dispersion In the following paragraphs, for each of the eight elements floor consisting of the three core elements, all under the roof of a appears to be fundamentally feasible from the respective identified, relevant success factors and concepts are identified university primary care unit. After the analysis of each and the need for coordination. [5] perspective. Also, decision-relevant factors and concepts are and discussed. Also, the question whether the establishment of dimension separately, it can be concluded and confirmed that The JKU is located in Linz, capital of the federal state of identified and discussed in the light of the pilot project. a university primary care centre presents itself as the establishment of Austria’s first university primary care centre Upper Austria, and currently offers 310 university places per fundamentally feasible is answered at the level of each in Linz appears to be fundamentally feasible. Due to its year to medicine students through its medical faculty. The III. RESULTS innovative approach, this pilot project can serve as a blueprint element. university’s Institute of General Practice is currently working From the vision and aspired purpose of the university and case study for similar undertakings, in other parts of on the pilot project to establish Austria’s first university primary care centre described in the introduction, it is evident Austria but also beyond. Therefore, further accompanying 1. Patient care primary care centre which is organizationally integrated into scientific analyses are recommended. that relevant aspects of this undertaking comprise the According to the Austrian primary care act, patient- the medical faculty. As such, it is envisioned to unite regional provision of primary care for patients, the facilitation of oriented goals which need to be met by every primary care Index Terms—Austria; Education, Medical, Graduate; General medical care for patients at the primary level with enhanced practical training for medicine students as well as patient centre include primary care close to patients’ homes, good Practice; Health Facility Planning; Primary Health Care opportunities for academic research and practical teaching in access for academic research in the field of general medicine. the discipline of general medicine, thereby tackling the accessibility by public transportation, extended opening hours These three aspects fulfil the criteria of being decision- including non-office hours, reachability outside of opening challenges described above. The term primary care centre is relevant and conceptual y distinct from each other. Therefore, I. INTRODUCTION specified by Austrian federal law and describes a specific form hours in acute cases, integration of telephone- or web-based they are regarded as separate dimensions to be analysed in the services, administration of home visits, guarantee of continuity Austria is facing several challenges in sustainably of group practice at the primary care level. Together with course of this work. The Handbook for Founding a Primary for patients, accessibility for persons with a disability, maintaining the provision of primary health care at the primary care networks, which describe a specific form of Care Unit is structured around five dimensions, each of which measures to mitigate language barriers, availability of required currently high level of quality. Amongst the most crucial collaboration by close-by practices, the corresponding is deemed decision-relevant for setting up a primary care unit medical(-technical) equipment, and participation in challenges is the existing lack of general practitioners which is umbrella term is primary care unit. Of the currently 50 and to each of which a separate chapter is dedicated. Those preventive, screening and integrated healthcare programmes. five dimensions are composed of the legal structure, The services to be provided in particular have to include the organization and management, business administration and provision of primary care to paediatric, elderly, chronically ill, finance, location and premises, and IT infrastructure. Since and multimorbid patients as well as psychosocial healthcare, they meet the criterium of decision-relevance and are drug monitoring, health promotion, and disease prevention. In conceptionally distinct from one another other as well as from a healthcare concept, which must be prepared when 15 establishing a primary care centre, those patient-oriented feasibility and advantageousness can be confirmed from this requirement (except for dedicated paediatric practices which equipment, machines, and vehicles, costs for legal, tax, aspects need to be demonstrated and discussed in the light of perspective. can have two paediatricians instead of general practitioners). architectural, and business consulting, notary costs, stamp-the region to be served. [7] Additionally, the core team can comprise paediatricians and duties, and up-front costs for salaries. In order to be able to 4. Legal structure In addition to the patient-oriented aspects listed above, a administrative assistants. In the extended team of a primary pay those costs when due, adequate financing is needed. university primary care centre can contribute to patient care In the Handbook for Founding a Primary Care Unit, the care centre, persons of the following professions can be Capital contributions from the proprietors, loans, and grants by attracting medicine students into the field of general legal form of organization, employment relationships, and integrated: nutritional science, occupational therapy, typically form the long-term side of financing. For the legal medicine, hence securing the next generation of general contracts with external partners are identified as decision-psychology, midwifery, logopaedics, physiotherapy, form of a limited liability company, 35,000 euros are legal y practitioners. This is the case because, on the one hand, work relevant factors from a legal perspective. According to the psychotherapy, social work, massage therapy, medical required as capital contributions which represent the in a group practice is considered favourable by aspiring Austrian primary care act, a primary care centre can be technology, and gynaecology. If a respective necessity can be company’s minimum equity. However, larger capital practitioners. On the other hand, a significant share of founded as either a group practice or an independent proven, a primary care centre manager, with professional contributions may likely be necessary in order to fill the medicine students wishes to work in academia, some of which outpatient clinic. The former must take the legal form of a expertise in business and management, can be hired at the financing gap between the investment costs and the funds could potentially be interested in a career in general medicine limited liability company whereby admissible shareholders are expense of the social insurance to support the founding and acquired through loans and grants. Loans are usually taken out if teaching and research formed an integral part. Overall, the healthcare professionals with a right to work self-employed, operation. Beyond the borders of the own organization, at banks but also loans from other organizations or persons are establishment of a university primary care centre can be such as doctors and certified nurses, who work in the primary cooperations with external partners, such as pharmacies and possible. Grants are non-repayable funds usual y granted by regarded as fundamentally feasible, and even advantageous, care centre full-time. The majority of shares must be held by laboratories, can be set up. The required quantity of persons of public bodies in order to promote desired actions. The most from a patient-oriented perspective. [1,2,3,9] doctors, though. An independent outpatient clinic is subject to the different professions is contingent to the aspired service significant one currently available is funded through the EU’s stricter, more complex regulations since the hospital act portfolio and opening hours, which must add up to at least 47 Resilience and Recovery Fund and reimburses Austrian 2. Practical teaching applies instead of the practitioners’ act; however, with reliefs hours per week on all five workdays also including non-office founders of a primary care centre with 50% of the initial hours in the morning and in the evening. Structural investment costs up to an investment sum of 3,200,000 euros, Practical teaching forms an integral part of the human and exemptions. In this case, the legal form can be chosen organization describes the al ocation of roles and with the specific intention to promote the expansion primary medicine curriculum. Throughout the first five years of their freely but only non-profit healthcare organizations and public responsibilities among the team of the primary care centre, care units in Austria. Operational profit refers to the education, medicine students at JKU take practical seminars institutions can be proprietors. Employment relationships can hence creating a hierarchy. This is typically depicted in an difference between revenues and costs occurred in the organised by the Institute of General Practice in the extent of take the form of salaried employment, independent organigram. Process organization describes the workflow of business operation. Different remuneration models for medical 1 ECTS per semester. In the sixth and final year, students contractors, and management contracts. Depending on the tasks, defining the trigger, the person in charge, the tools, and services provided are available to be chosen from. [6,7,8] complete a clinical-practical rotation of which four weeks are concrete contractual specifications, independent contractors the timeframe, amongst other parameters. Processes can be spent in the field of general medicine. Of the mandatory can either be liable for the delivery of agreed-upon results or divided into management processes, core processes and Considering the high degree of innovation and benefit for twelve weeks of clinical traineeships, which must be done the sheer delivery of work at a reasonable level of effort. support processes and are typical y depicted in a process the public, a university primary care centre might qualify for during the first ten semesters, four weeks are recommended to Factors determining the mix of employment relationships landscape. In the application process, al of the parameters additional grants or supported loans. The provision of practical be spent in the field of general medicine, which is currently include costs, availability of workers, flexibility, and personal discussed in this chapter must be set down in a detailed teaching and academic research can be expected to result in rewarded with a scholarship of 400 euros. Multiple studies preferences. The most significant contract with an external concept and reflected in the light of to the region to be served. increased investment needs due to higher spacing suggest that the exposure of students to general medicine, in partner is the primary care contract which is agreed upon [7,8] requirements and additional equipment. Also, the time spent particular through practical experiences, increases the between the primary care centre and the social insurance, on teaching and research can be expected to result in likelihood of them taking up a career in this field. [2,3,9] within the options depicted by the federal primary care contract framework In the university primary care centre, the cooperation with additional personnel costs and/or loss of revenues. Therefore, . It determines the primary care centre’s the Institute of General Practice should be reflected in the the services provided by the university primary care centre to Through the establishment of a university primary care services and the remuneration from the social insurance. Other organigram and process landscape, showing the involvement the university, and vice versa, need to be remunerated based centre, the complexity and effort of organising practical relevant external contracts comprise a potential rental of members of the institute and defining relevant processes, in on contractual agreements. From a financial perspective, it can teaching can be expected to decrease due to the general y agreement, financing contracts, and supply agreements. [6,7] particular with regard to teaching and research. A designated be confirmed that the founding and operation of a university close col aboration. Additionally, increased patient contact, primary care centre manager could, aside of his or her usual primary care centre appears to be fundamentally feasible. deeper insights into practice work, and new formats might be As a public institution, the Institute of General Practice responsibilities, also act as contact person and interface to the offered to students. Therefore, a university primary care could become proprietor of the university primary care centre university. In order to additionally integrate the two 7. Location and premises centre can be confirmed to be feasible and advantageous from if the legal form of an independent outpatient clinic would be organizations and facilitate cooperation, personnel could be a teaching perspective. chosen. However, in consideration of the respective According to the Handbook for Founding a Primary Care regulations, the Institute of General Practice envisions the deployed in both the Institute of General Practice and the Unit, decision-relevant factors regarding location / premises 3. Academic research form of a group practice. In this case, the ownership of the university primary care centre. For example, a doctor working primarily include the selection of a suitable location and the university primary care centre is independent from the as a lecturer and researcher at the institute could also practice planning of the interior and facilities. The location selection Academic research in the field of general medicine can be institute and the collaboration is solely based on contractual at this primary care centre. Overall, the fundamental process is determined by the regional structural plan for regarded as currently underdeveloped, even though it can agreements and organizational integration, which appears to feasibility can be confirmed from an organizational healthcare and the practice plan which represent public contribute to improved patient care, the attractiveness of the be sufficient. In any case, contractual agreements between the perspective. specifications where practices can be established. Within the field to aspiring practitioners, and the motivation of practising two parties are necessary, stipulating each party’s regulatory specifications, the concrete location can be chosen doctors. The forming of research networks involving several responsibilities, services, and remuneration, particularly with 6. Business administration and finance based on the following regional criteria: demand potential, practices, such as the Norwegian PraksisNett, represent one regard to teaching and research. Considering the legal Decision-relevant aspects in the field of business competition, infrastructure, transport connection, viable way to improve research at the primary care level. Also perspective, the university primary care centre appears to be administration and finance include investments, financing, and agglomeration factors (i.e., regional cooperation partners, such the Institute of General Practice is currently conducting fundamentally feasible. operational profit, according to the Handbook for Founding a as pharmacies and laboratories), staff recruiting potential, research via a network of practices, however with Primary Care Unit. The interplay of those factors must be availability of premises, availability of regional funding, and comparatively high coordination effort. [5,9] 5. Organization and management described and depicted based on projections in a finance plan personal preferences of the founders. The planning of the With the implementation of a university primary care According to the Handbook for Founding a Primary Care which itself forms an integral part of the business plan, giving premises is recommended to be done via room and function centre, access to patients for research purposes at the primary Unit, the team of employees, the service portfolio, and the an overview of the whole business concept. The most programs which are based on detailed guidelines determining care level can be expected to be more easily possible due to structural and process organization are the main decision-important ways of representation of financial information are the quantity, spacing and figuration requirements for different the close col aboration between the university and the practice, relevant factors regarding the organization and management of the cash-flow statement, the income statement, and the areas, such as doctor’s rooms, therapy rooms, waiting rooms, thereby likely reducing coordination effort and enabling a a primary care centre. The primary care act requires each balance sheet. Investment costs with regard to the founding of reception areas, personnel facilities, offices, sanitary facilities, quantitative and qualitative increase in research. Therefore, the practice to have a core team which must consist of two general a primary care centre comprise costs for buying, adapting, utility rooms, and hallways, in the light of the envisioned practitioners and one certified nurse, as a minimum and/or furnishing the premises, costs for the acquisition of service portfolio and projected number of patients. [6,7] 16 establishing a primary care centre, those patient-oriented feasibility and advantageousness can be confirmed from this requirement (except for dedicated paediatric practices which equipment, machines, and vehicles, costs for legal, tax, aspects need to be demonstrated and discussed in the light of perspective. can have two paediatricians instead of general practitioners). architectural, and business consulting, notary costs, stamp-the region to be served. [7] Additionally, the core team can comprise paediatricians and duties, and up-front costs for salaries. In order to be able to 4. Legal structure In addition to the patient-oriented aspects listed above, a administrative assistants. In the extended team of a primary pay those costs when due, adequate financing is needed. university primary care centre can contribute to patient care In the Handbook for Founding a Primary Care Unit, the care centre, persons of the following professions can be Capital contributions from the proprietors, loans, and grants by attracting medicine students into the field of general legal form of organization, employment relationships, and integrated: nutritional science, occupational therapy, typically form the long-term side of financing. For the legal medicine, hence securing the next generation of general contracts with external partners are identified as decision-psychology, midwifery, logopaedics, physiotherapy, form of a limited liability company, 35,000 euros are legal y practitioners. This is the case because, on the one hand, work relevant factors from a legal perspective. According to the psychotherapy, social work, massage therapy, medical required as capital contributions which represent the in a group practice is considered favourable by aspiring Austrian primary care act, a primary care centre can be technology, and gynaecology. If a respective necessity can be company’s minimum equity. However, larger capital practitioners. On the other hand, a significant share of founded as either a group practice or an independent proven, a primary care centre manager, with professional contributions may likely be necessary in order to fill the medicine students wishes to work in academia, some of which outpatient clinic. The former must take the legal form of a expertise in business and management, can be hired at the financing gap between the investment costs and the funds could potentially be interested in a career in general medicine limited liability company whereby admissible shareholders are expense of the social insurance to support the founding and acquired through loans and grants. Loans are usually taken out if teaching and research formed an integral part. Overall, the healthcare professionals with a right to work self-employed, operation. Beyond the borders of the own organization, at banks but also loans from other organizations or persons are establishment of a university primary care centre can be such as doctors and certified nurses, who work in the primary cooperations with external partners, such as pharmacies and possible. Grants are non-repayable funds usual y granted by regarded as fundamentally feasible, and even advantageous, care centre full-time. The majority of shares must be held by laboratories, can be set up. The required quantity of persons of public bodies in order to promote desired actions. The most from a patient-oriented perspective. [1,2,3,9] doctors, though. An independent outpatient clinic is subject to the different professions is contingent to the aspired service significant one currently available is funded through the EU’s stricter, more complex regulations since the hospital act portfolio and opening hours, which must add up to at least 47 Resilience and Recovery Fund and reimburses Austrian 2. Practical teaching applies instead of the practitioners’ act; however, with reliefs hours per week on all five workdays also including non-office founders of a primary care centre with 50% of the initial hours in the morning and in the evening. Structural investment costs up to an investment sum of 3,200,000 euros, Practical teaching forms an integral part of the human and exemptions. In this case, the legal form can be chosen organization describes the al ocation of roles and with the specific intention to promote the expansion primary medicine curriculum. Throughout the first five years of their freely but only non-profit healthcare organizations and public responsibilities among the team of the primary care centre, care units in Austria. Operational profit refers to the education, medicine students at JKU take practical seminars institutions can be proprietors. Employment relationships can hence creating a hierarchy. This is typically depicted in an difference between revenues and costs occurred in the organised by the Institute of General Practice in the extent of take the form of salaried employment, independent organigram. Process organization describes the workflow of business operation. Different remuneration models for medical 1 ECTS per semester. In the sixth and final year, students contractors, and management contracts. Depending on the tasks, defining the trigger, the person in charge, the tools, and services provided are available to be chosen from. [6,7,8] complete a clinical-practical rotation of which four weeks are concrete contractual specifications, independent contractors the timeframe, amongst other parameters. Processes can be spent in the field of general medicine. Of the mandatory can either be liable for the delivery of agreed-upon results or divided into management processes, core processes and Considering the high degree of innovation and benefit for twelve weeks of clinical traineeships, which must be done the sheer delivery of work at a reasonable level of effort. support processes and are typical y depicted in a process the public, a university primary care centre might qualify for during the first ten semesters, four weeks are recommended to Factors determining the mix of employment relationships landscape. In the application process, al of the parameters additional grants or supported loans. The provision of practical be spent in the field of general medicine, which is currently include costs, availability of workers, flexibility, and personal discussed in this chapter must be set down in a detailed teaching and academic research can be expected to result in rewarded with a scholarship of 400 euros. Multiple studies preferences. The most significant contract with an external concept and reflected in the light of to the region to be served. increased investment needs due to higher spacing suggest that the exposure of students to general medicine, in partner is the primary care contract which is agreed upon [7,8] requirements and additional equipment. Also, the time spent particular through practical experiences, increases the between the primary care centre and the social insurance, on teaching and research can be expected to result in likelihood of them taking up a career in this field. [2,3,9] within the options depicted by the federal primary care In the university primary care centre, the cooperation with contract framework additional personnel costs and/or loss of revenues. Therefore, . It determines the primary care centre’s the Institute of General Practice should be reflected in the the services provided by the university primary care centre to Through the establishment of a university primary care services and the remuneration from the social insurance. Other organigram and process landscape, showing the involvement the university, and vice versa, need to be remunerated based centre, the complexity and effort of organising practical relevant external contracts comprise a potential rental of members of the institute and defining relevant processes, in on contractual agreements. From a financial perspective, it can teaching can be expected to decrease due to the general y agreement, financing contracts, and supply agreements. [6,7] particular with regard to teaching and research. A designated be confirmed that the founding and operation of a university close col aboration. Additionally, increased patient contact, primary care centre manager could, aside of his or her usual primary care centre appears to be fundamentally feasible. deeper insights into practice work, and new formats might be As a public institution, the Institute of General Practice responsibilities, also act as contact person and interface to the offered to students. Therefore, a university primary care could become proprietor of the university primary care centre university. In order to additionally integrate the two 7. Location and premises centre can be confirmed to be feasible and advantageous from if the legal form of an independent outpatient clinic would be organizations and facilitate cooperation, personnel could be a teaching perspective. chosen. However, in consideration of the respective According to the Handbook for Founding a Primary Care regulations, the Institute of General Practice envisions the deployed in both the Institute of General Practice and the Unit, decision-relevant factors regarding location / premises 3. Academic research form of a group practice. In this case, the ownership of the university primary care centre. For example, a doctor working primarily include the selection of a suitable location and the university primary care centre is independent from the as a lecturer and researcher at the institute could also practice planning of the interior and facilities. The location selection Academic research in the field of general medicine can be institute and the collaboration is solely based on contractual at this primary care centre. Overall, the fundamental process is determined by the regional structural plan for regarded as currently underdeveloped, even though it can agreements and organizational integration, which appears to feasibility can be confirmed from an organizational healthcare and the practice plan which represent public contribute to improved patient care, the attractiveness of the be sufficient. In any case, contractual agreements between the perspective. specifications where practices can be established. Within the field to aspiring practitioners, and the motivation of practising two parties are necessary, stipulating each party’s regulatory specifications, the concrete location can be chosen doctors. The forming of research networks involving several responsibilities, services, and remuneration, particularly with 6. Business administration and finance based on the following regional criteria: demand potential, practices, such as the Norwegian PraksisNett, represent one regard to teaching and research. Considering the legal Decision-relevant aspects in the field of business competition, infrastructure, transport connection, viable way to improve research at the primary care level. Also perspective, the university primary care centre appears to be administration and finance include investments, financing, and agglomeration factors (i.e., regional cooperation partners, such the Institute of General Practice is currently conducting fundamentally feasible. operational profit, according to the Handbook for Founding a as pharmacies and laboratories), staff recruiting potential, research via a network of practices, however with Primary Care Unit. The interplay of those factors must be availability of premises, availability of regional funding, and comparatively high coordination effort. [5,9] 5. Organization and management described and depicted based on projections in a finance plan personal preferences of the founders. The planning of the With the implementation of a university primary care According to the Handbook for Founding a Primary Care which itself forms an integral part of the business plan, giving premises is recommended to be done via room and function centre, access to patients for research purposes at the primary Unit, the team of employees, the service portfolio, and the an overview of the whole business concept. The most programs which are based on detailed guidelines determining care level can be expected to be more easily possible due to structural and process organization are the main decision-important ways of representation of financial information are the quantity, spacing and figuration requirements for different the close col aboration between the university and the practice, relevant factors regarding the organization and management of the cash-flow statement, the income statement, and the areas, such as doctor’s rooms, therapy rooms, waiting rooms, thereby likely reducing coordination effort and enabling a a primary care centre. The primary care act requires each balance sheet. Investment costs with regard to the founding of reception areas, personnel facilities, offices, sanitary facilities, quantitative and qualitative increase in research. Therefore, the practice to have a core team which must consist of two general a primary care centre comprise costs for buying, adapting, utility rooms, and hallways, in the light of the envisioned practitioners and one certified nurse, as a minimum and/or furnishing the premises, costs for the acquisition of service portfolio and projected number of patients. [6,7] 17 It is to be expected that specific requirements on the feasibility could be fundamental y confirmed, this can be location and premises arise for a university primary care regarded as a validation that the project is likely to be able to Knowledge transfer in multidisciplinary teams in centre. Concretely, its location should be in close proximity to be successfully implemented and operated. Furthermore, due the university premises in order to facilitate the collaboration to its innovative approach, this pilot project can serve as a long-term care on teaching and research. According to the current planning blueprint and case study for similar undertakings, in other status of the pilot project, the establishment in direct proximity parts of Austria but also beyond. Therefore, also, further to the university is likely not feasible due to the already research is recommended. sufficient availability of primary healthcare in this region. However, close-by regions in the town of Linz, which are It is yet to be seen to which degree the university primary Doc. dr. Anamarija Kejžar easily accessible by public transport from the university, are care centre will be able to tackle today’s challenges Patricija Frece undersupplied and hence offer the opportunity to set up a concerning general medicine, such as the sufficient provision Maša Bizjan primary care centre. In the room and function program, the of primary care to patients, the administration of practical presence of students and researchers should be factored in. teaching for medicine students, and the access to patients for Faculty for Social Work UL & MRRC UL This could, for instance, be achieved by planning doctor’s researchers in the field of general medicine. However, positive CS DEOS Notranje Gorice rooms with larger floor space and additional furniture to impacts in those areas are likely to be expected. Further accommodate students. Also, the planning of additional rooms research could substantiate those effects. CS DEOS Horjul designated to seminars for students and research activities may be sensible. It can be concluded that, fundamentally, a ACKNOWLEDGMENT anamarija.kejzar@fsd.uni-lj.si university primary care centre appears to be feasible from the The authors gratefully acknowledge the support of the perspective of its location and premises. Institute of General Practice of the Johannes Kepler Abstract— Care homes possess valuable knowledge regarding which enables us to make the right decisions, as Gamble and University Linz without which this research would not have the care of older individuals and those with dementia, which is Blackwell [3] describe. Tacit knowledge is of great importance 8. IT infrastructure been possible. Also, SOLVE Consulting is cordially thanked becoming increasingly relevant worldwide. The aging population in delivering quality services because it is an essential part of The Handbook for Founding a Primary Care Unit for providing invaluable guidance in the field of healthcare has amplified the demand for care among older people, not only creating relationships with residents, listening to them, and recommends that through the specification of an IT planning through access to their professional experts. in institutions but also within the community. The significance of creating a domestic environment in a care homes. Tacit architecture, the necessary IT components are attributed to knowledge now assumes a new dimension concerning the quality knowledge can be the most important element in promoting the different software solutions which often include several of life. By effectively managing knowledge and facilitating well-being of care homes residents and maintaining the components in one product. The planning but also the REFERENCES knowledge transfer, quality of care can be extended to creation of new knowledge. This qualitative descriptive study explored meaning in residents’ lives. It is internalized in staff attitudes operation of the IT landscape can be regarded as complex and [1] Rechnungshof Österreich (RH). Bericht des Rechnungshofes: experiences of knowledge transfer in multidisciplinary teams in toward residents, in creating livability, in respecting residents’ laborious which is why the involvement of (external) Ärztliche Versorgung im niedergelassenen Bereich. Vienna: RH; 2021. (Reihe Bund; no. 30/2021). care homes. wants and needs, in person-centered care, and in the way staff professionals is usually necessary. [6,7] [2] Blozik E, Erhardt M, Scherer M. Förderung des allgemein- Index Terms—knowledge transfer, long-term care, care homes, feed, care for, and talk to residents. As it creates an important In the context of a university primary care centre, medizinischen Nachwuchses: Initiativen in der universitären new knowledge part of human capital that an organization does not own, it is additional requirements to an IT structure are to be expected. Ausbildung von Medizinstudierenden. Bundesgesundheitsbl. strategically important to enable and foster knowledge transfer Particularly, the collaboration with the Institute of General 2014;57:892-902. I. INTRODUCTION in care homes. Practice, including the administration of practical teaching [3] Stelner-Hofbauer, Melser MC, Holzinger, A. Allgemeinmedizin: The classification of knowledge that we refer to in this paper sessions for students and access for researchers, should be attraktives Arbeitsfeld oder Stiefkind der Medizin?: Einstellungen views knowledge as explicit or tacit II. KNOWLEDGE TRANSFER IN CARE HOMES reflected in the IT landscape which could be achieved by von österreichischen Medizinstudierenden zur Allgemeinmedizin [1]). Explicit knowledge im städtischen und ländlichen Raum. Präv Gesundheitsf. creating interfaces to the university’s IT systems or using typically refers to knowledge that has been expressed in words 2020;15:143-150. Knowledge transfer is a fundemantal aspect of the additional specific software. Overall, the fundamental and numbers. Such knowledge can be shared formally and knowledge management process as it enables sharing, feasibility of a university primary care centre can be [4] Johannes Kepler Universität Linz (JKU) [Internet]. Linz: JKU; systematically in the form of, for example, data, drawings, [cited 2023 Sep 30]. Available from: https://www.jku.at validation, building upon existing knowledge and creation of confirmed from an IT perspective. audio and video tapes, and computer programs [2]. Explicit [5] Kristoffersen ES, Bjorvatn B, Halvorsen A, et al. The Norwegian knowledge in care homes represents documentation and new knowledge. The knowledge ecosystem highlights the Conclusion PraksisNett: a nationwide practice-based research network with a significance of knowledge sharing and collaboration within an novel IT infrastructure. Scand J Prim Healthc. 2022;40(2):217- records (about residents—their medical documentation, According to this research, the fundamental feasibility in 226. biographic stories, and care plans—employees, and different organization. When employees share their expertise and the context of a university primary care centre can be affirmed stakeholders), documented staff meetings and shift handovers, collaborate effectively, an organization’s overall intellectual [6] Plattform Primärversorgung [Internet]. Vienna: Gesundheit in all of the eight perspectives which were identified. For each Österreich GmbH; [cited 2023 Sep 30]. Available from: feedback mechanisms, care homes standards and procedures, capital is strengthened [1,4]. As intellectual capital within an of them, decision-oriented factors and concepts could be https://primaerversorgung.gv.at care homes quality systems, books and training programs, care ecosystem flows and evolves over time, managers should identified and discussed. facilitate the flow of knowledge among individuals, teams, and [7] Deloitte Consulting GmbH. Handbuch zur Gründung einer PVE. homes information technology, and data security and privacy. 2nd ed. Vienna: Bundesministerium für Soziales, Gesundheit, In contrast, tacit knowledge includes insights, intuitions, and departments to maximize the potential of their organization’s IV. DISCUSSION Pflege und Konsumentenschutz; 2023. hunches. This knowledge is difficult to express and formalize intellectual capital. The ecosystem perspective emphasizes that In accordance with the designated aim of this research, the [8] Wilkinson, A, Armstrong SJ, Lounsbury, M, et al. The Oxford and therefore difficult to share. Despite written protocols, the intellectual capital, when managed effectively, leads to findings provide a scientific basis upon which the Johannes handbook of management. Oxford: Oxford University Press; knowledge contained in the implementation of the service is creation of new knowledge, improved services and social 2017. Kepler University’s Institute of General Practice can build its intertwined with the attitude of an individual caregiver to a innovations in care homes. Organizations that nurture their pilot project – the establishment of Austria’s first primary care [9] Haumann H, Flum E, Joos S. Active participation in research and resident. The key to quality care is often in undocumented intellectual capital ecosystem are more likely to adapt to centre which is integrated into a university. Since from all of teaching during post-graduate GP training: perspectives of future general practitioners. Z Evid Fortbild Qual Gesundh wesen. information, including intuition, empathy, and experience, the eight decision-relevant dimensions identified, the 2016;118-199:65-72. 18 It is to be expected that specific requirements on the feasibility could be fundamental y confirmed, this can be location and premises arise for a university primary care regarded as a validation that the project is likely to be able to Knowledge transfer in multidisciplinary teams in centre. Concretely, its location should be in close proximity to be successfully implemented and operated. Furthermore, due the university premises in order to facilitate the collaboration to its innovative approach, this pilot project can serve as a long-term care on teaching and research. According to the current planning blueprint and case study for similar undertakings, in other status of the pilot project, the establishment in direct proximity parts of Austria but also beyond. Therefore, also, further to the university is likely not feasible due to the already research is recommended. sufficient availability of primary healthcare in this region. However, close-by regions in the town of Linz, which are It is yet to be seen to which degree the university primary Doc. dr. Anamarija Kejžar easily accessible by public transport from the university, are care centre will be able to tackle today’s challenges Patricija Frece undersupplied and hence offer the opportunity to set up a concerning general medicine, such as the sufficient provision Maša Bizjan primary care centre. In the room and function program, the of primary care to patients, the administration of practical presence of students and researchers should be factored in. teaching for medicine students, and the access to patients for Faculty for Social Work UL & MRRC UL This could, for instance, be achieved by planning doctor’s researchers in the field of general medicine. However, positive CS DEOS Notranje Gorice rooms with larger floor space and additional furniture to impacts in those areas are likely to be expected. Further accommodate students. Also, the planning of additional rooms research could substantiate those effects. CS DEOS Horjul designated to seminars for students and research activities may be sensible. It can be concluded that, fundamentally, a ACKNOWLEDGMENT anamarija.kejzar@fsd.uni-lj.si university primary care centre appears to be feasible from the The authors gratefully acknowledge the support of the perspective of its location and premises. Institute of General Practice of the Johannes Kepler Abstract— Care homes possess valuable knowledge regarding which enables us to make the right decisions, as Gamble and University Linz without which this research would not have the care of older individuals and those with dementia, which is Blackwell [3] describe. Tacit knowledge is of great importance 8. IT infrastructure been possible. Also, SOLVE Consulting is cordially thanked becoming increasingly relevant worldwide. The aging population in delivering quality services because it is an essential part of The Handbook for Founding a Primary Care Unit for providing invaluable guidance in the field of healthcare has amplified the demand for care among older people, not only creating relationships with residents, listening to them, and recommends that through the specification of an IT planning through access to their professional experts. in institutions but also within the community. The significance of creating a domestic environment in a care homes. Tacit architecture, the necessary IT components are attributed to knowledge now assumes a new dimension concerning the quality knowledge can be the most important element in promoting the different software solutions which often include several of life. By effectively managing knowledge and facilitating well-being of care homes residents and maintaining the components in one product. The planning but also the REFERENCES knowledge transfer, quality of care can be extended to creation of new knowledge. This qualitative descriptive study explored meaning in residents’ lives. It is internalized in staff attitudes operation of the IT landscape can be regarded as complex and [1] Rechnungshof Österreich (RH). Bericht des Rechnungshofes: experiences of knowledge transfer in multidisciplinary teams in toward residents, in creating livability, in respecting residents’ laborious which is why the involvement of (external) Ärztliche Versorgung im niedergelassenen Bereich. Vienna: RH; 2021. (Reihe Bund; no. 30/2021). care homes. wants and needs, in person-centered care, and in the way staff professionals is usually necessary. [6,7] [2] Blozik E, Erhardt M, Scherer M. Förderung des allgemein- Index Terms—knowledge transfer, long-term care, care homes, feed, care for, and talk to residents. As it creates an important In the context of a university primary care centre, medizinischen Nachwuchses: Initiativen in der universitären new knowledge part of human capital that an organization does not own, it is additional requirements to an IT structure are to be expected. Ausbildung von Medizinstudierenden. Bundesgesundheitsbl. strategically important to enable and foster knowledge transfer Particularly, the collaboration with the Institute of General 2014;57:892-902. I. INTRODUCTION in care homes. Practice, including the administration of practical teaching [3] Stelner-Hofbauer, Melser MC, Holzinger, A. Allgemeinmedizin: The classification of knowledge that we refer to in this paper sessions for students and access for researchers, should be attraktives Arbeitsfeld oder Stiefkind der Medizin?: Einstellungen views knowledge as explicit or tacit II. KNOWLEDGE TRANSFER IN CARE HOMES reflected in the IT landscape which could be achieved by von österreichischen Medizinstudierenden zur Allgemeinmedizin [1]). Explicit knowledge im städtischen und ländlichen Raum. Präv Gesundheitsf. creating interfaces to the university’s IT systems or using typically refers to knowledge that has been expressed in words 2020;15:143-150. Knowledge transfer is a fundemantal aspect of the additional specific software. Overall, the fundamental and numbers. Such knowledge can be shared formally and [4] Johannes Kepler Universität Linz (JKU) [Internet]. Linz: JKU; knowledge management process as it enables sharing, feasibility of a university primary care centre can be systematically in the form of, for example, data, drawings, [cited 2023 Sep 30]. Available from: https://www.jku.at validation, building upon existing knowledge and creation of confirmed from an IT perspective. audio and video tapes, and computer programs [2]. Explicit [5] Kristoffersen ES, Bjorvatn B, Halvorsen A, et al. The Norwegian knowledge in care homes represents documentation and new knowledge. The knowledge ecosystem highlights the Conclusion PraksisNett: a nationwide practice-based research network with a significance of knowledge sharing and collaboration within an novel IT infrastructure. Scand J Prim Healthc. 2022;40(2):217- records (about residents—their medical documentation, According to this research, the fundamental feasibility in 226. biographic stories, and care plans—employees, and different organization. When employees share their expertise and the context of a university primary care centre can be affirmed stakeholders), documented staff meetings and shift handovers, collaborate effectively, an organization’s overall intellectual [6] Plattform Primärversorgung [Internet]. Vienna: Gesundheit in all of the eight perspectives which were identified. For each Österreich GmbH; [cited 2023 Sep 30]. Available from: feedback mechanisms, care homes standards and procedures, capital is strengthened [1,4]. As intellectual capital within an of them, decision-oriented factors and concepts could be https://primaerversorgung.gv.at care homes quality systems, books and training programs, care ecosystem flows and evolves over time, managers should identified and discussed. facilitate the flow of knowledge among individuals, teams, and [7] Deloitte Consulting GmbH. Handbuch zur Gründung einer PVE. homes information technology, and data security and privacy. 2nd ed. Vienna: Bundesministerium für Soziales, Gesundheit, In contrast, tacit knowledge includes insights, intuitions, and departments to maximize the potential of their organization’s IV. DISCUSSION Pflege und Konsumentenschutz; 2023. hunches. This knowledge is difficult to express and formalize intellectual capital. The ecosystem perspective emphasizes that In accordance with the designated aim of this research, the [8] Wilkinson, A, Armstrong SJ, Lounsbury, M, et al. The Oxford and therefore difficult to share. Despite written protocols, the intellectual capital, when managed effectively, leads to findings provide a scientific basis upon which the Johannes handbook of management. Oxford: Oxford University Press; knowledge contained in the implementation of the service is creation of new knowledge, improved services and social 2017. Kepler University’s Institute of General Practice can build its intertwined with the attitude of an individual caregiver to a innovations in care homes. Organizations that nurture their pilot project – the establishment of Austria’s first primary care [9] Haumann H, Flum E, Joos S. Active participation in research and resident. The key to quality care is often in undocumented intellectual capital ecosystem are more likely to adapt to centre which is integrated into a university. Since from all of teaching during post-graduate GP training: perspectives of future general practitioners. Z Evid Fortbild Qual Gesundh wesen. information, including intuition, empathy, and experience, the eight decision-relevant dimensions identified, the 2016;118-199:65-72. 19 changing circumstances, innovate, and achieve sustainable 2023 in 2 care homes in Slovenia. The interviews were also gain new knowledge by calling the coordinator, visiting information is also obtained through social media, such as success. transcribed and analyzed by qualitative analysis in a process nurse, or nursing home director. Facebook. Knowledge transfer processes between stakeholders are where units (parts of sentences, sentences, or whole It was pointed out that information is often incomplete and mediated by the interests of the relevant parties [5], so they paragraphs) of analysis were identified first, and then open Informal transfer of knowledge in home care shared "just in time." must be aware of the value that is generated. The results show codes were defined for each part. Qualitative comparative They share their experiences informally at monthly that they have a high interest in sharing knowledge, but there analysis was used to assess the attitudes. We applied the meetings. Some indicated that they meet once a week during a Informal transfer of knowledge in professional team are barriers that affect the transfer of knowledge in care homes. questionnaire from Donate & Sanchez de Pablo on the role of break with colleagues from the same community and share They also communicate via e-mail and one-on-one meetings. The facilitators and barriers to implement knowledge transfer knowledge-oriented leadership in knowledge management what is happening in their area. They also often share information in informal ways, such as in care homes are different and are depending on the type of practices and innovation [6]. Research question was: Some indicated that they also use the social networks over morning coffee or via Facebook. the knowledge transfer. Facebook and WhatsApp for communication. They all Does the way knowledge is transferred within the same home communicate with each other by phone, and occasionally in Various knowledge transfer practices have been introduced differ by unit - a professional team or a home care unit? person. Those who work in the same community occasionally V. DISCUSSION at care homes to encourage the transfer of knowledge between meet informally and share information. generations and to new employees. These include various The results of the qualitative analysis of interviews IV. organizational measures, such as mentoring; working in pairs; RESULTS Formal mechanisms for sharing practices in care home conducted with social workers and members of the professional consistent education in care home; teamwork; daily meetings The members of the professional team indicate that they team point to important findings in our research: during shift changes; and activities to improve communication In the research, we conducted interviews with social care share their experiences during team meetings when it comes to 1. both units emphasize the importance of real-time and create a safe and stimulating work environment (e.g., workers who provide home care and are present in the care interdisciplinary collaboration; in the professional council; communication with leadership (coordinator, nursing adhering to the maxim of respectful communication between home only at the beginning and end of the work shift, and in during lunch; during the day when talking with colleagues supervisor, director) to help make a decision when there is all stakeholders, daily team meetings, and the use of modern their work they are much more independent and left to their directly in the department or during morning coffee or after ambiguity. Being informed about the health status and changes information technology, such as a computer system where all own knowledge and judgment. We were interested in whether work; through internal trainings; written reports; individual among the residents and users of the home care service is also changes and events for each resident are recorded). An the methods of knowledge transfer among social care workers conversations. crucial for successful and safe work in a care home. Meetings important factor in the transfer of knowledge between in the home help unit differ from the methods of knowledge It was pointed out that the proposals should be submitted to are therefore held twice a day at the care home, where they employees and residents is a relationship based on trust and transfer in a professional team, where the members are a the social worker, the head of the center, the mailbox at the provide information about changes and any factors that may mutual respect. If care home include relatives in daily activities physiotherapist, an occupational therapist, a registered nurse reception (the proposals are reviewed by the head), colleagues affect the residents' well-being. and they are regular visitors to care home, a partnership and a social worker. or the head nurse. They are also submitted on the basis of a 2. The frequency of regular meetings is much lower in home relationship can be created between employees and relatives professional report, which is carried out twice a day to provide care - caregivers even mention meeting only once a month. In whereby everyone works hard for the well-being of residents. Formal transfer of knowledge information about changes in the health status of residents or home care, social caregivers are much more on their own in The partnership relationship is based on immediate and clear The social workers meet face-to-face about once a month. other important factors that may affect the well-being of providing all services - in a care home, for example, they have communication between employees and relatives. Relatives All indicate that they communicate with the coordinator residents. nurses as professional help, members of the professional team, expect real-time notifications about any changes in their loved mainly by phone, but also live a few times a month. They Knowledge sharing takes place at meetings, training doctors - on the ground, in the home environment, social one’s health, and they also expect to be heard. After all, they indicate that they receive certain information from the sessions, distribution of professional literature, experiential caregivers are on their own and left to their own knowledge, have taken care of their loved one for many years and know coordinator and important news from the director. All workshops, presentation of reports, assets, and continuing experience and resourcefulness. what contributes to their well-being. information and events are regularly shared with the education. They also acquire knowledge from colleagues, the 3. Information technology is an important tool for coordinator at monthly meetings. Social caregivers say that nursing supervisor, the social worker and internal trainings knowledge transfer. Again, this varies from unit to unit. In the Barriers to the Implementation of Knowledge Transfer in they can share their experiences and bring up their problems at conducted by the center's staff. Information is obtained through care home, staff refer to the computer program as the basic tool care homes are some general, like lack of staff and long-living the monthly meetings. Most indicate that they share their the Internet or exchanges between employees (expert teams, into which all the information about residents' health is entered. society with increasing demand of care homes, as individual to experiences with the coordinator when a particular situation reports, expert councils, individual meetings), information is Since everyone works in the same place, it is much easier to each care home, depending on the organization’s culture and arises. Some call the care home's care manager. Most of them posted on the bulletin board, through the work disk. coordinate spontaneously (in offices, hallways, or on the knowledge management practices: Factors that can hinder the indicate that they also share their experiences with the The members of the expert team unanimously reviewed the phone). However, in the home care unit, a different technology transfer of knowledge in care homes are a lack of staff, which mentoring service at their facility proposals. Sometimes the proposals are considered, sometimes was used. Given the nature of their work, a computer program, contributes to haste, more frequent changes in employees, and The social care workers indicated that they all use cell not, the proposals are considered at the level of the expert team even if available to them, is of little use to them. The social care shallower relationships in a team and with residents and phones in their work. They use them to communicate with the and unanimously adopted, taking into account the impact of workers mainly mention the use of the telephone - where they relatives. Information technology can enable the transfer of coordinator, with each other, with the sponsorship service and decisions on residents. The proposals are reviewed, discussed consult with the coordinator, the head nurse or each other. knowledge, but it may be avoided or used infrequently by older with the relatives of the users. In addition, they also have an and heard by the expert teams. 4. It is not surprising, then, that social care workers are employees. The transfer of knowledge in the knowledge application on their cell phones that they use for work The members of the expert team stated that in their work they much more likely to use informal ways of transferring ecosystem of employees, residents, and relatives can also be (recording hours) and using schedules. All caregivers indicated use computers, telephones, the Internet, the program PRO- knowledge - sharing information, experiences, and ideas after affected by dementia, which is present in almost two-thirds of that they communicate their suggestions to the coordinator, BIT, videos on YouTube and e-mail. They communicate with meetings, during their breaks, through social networks, and by CH residents. Exceptional situations, such as the Covid-19 who then helps to implement the suggestion, adjust it, or each other by phone, reports (transmission of daily phone. pandemic, can also have a negative impact on the transfer of forward it to the director. Some indicate that they feel they can information), weekly meetings (meetings of the expert team). knowledge, as the period of crisis management lasted for a always approach the coordinator or director with their ideas. They also transmit information to each other by phone or call year, with frequent restrictions or bans on resident visits. Most of the users' requests and suggestions are forwarded to when it is urgent and quick transmission is needed. Given the much smaller number of regular meetings, it is the coordinator so that they can review the proposal together. The members of professional team is informed through necessary to find ways to provide quality home care services The social care workers say that they share their knowledge also through the care home, i.e., formally, with timely help, III. computer records and transmission of information in reports, MATERIAL AND METHODS with each other during meetings. Most experiences and and that much of the information is transmitted during team advice, or ideas. It would be useful to introduce at least weekly Qualitative data was obtained with the use of the data gained knowledge are also shared through internal trainings that take meetings. They receive monthly reports on progress and rather than monthly meetings, as meetings are an important way from interviews of 11 caregivers and 5 members of expert place in the organization. Some say they also attend external changes through quality report. They are informed of changes of transferring knowledge. If they have professional dilemmas, team. Semi-structured interviews with them were conducted in trainings where they gain new skills. Some point out that they via e-mail or by the director at team meetings. Much they could always contact the home's nursing supervisor or 20 changing circumstances, innovate, and achieve sustainable 2023 in 2 care homes in Slovenia. The interviews were also gain new knowledge by calling the coordinator, visiting information is also obtained through social media, such as success. transcribed and analyzed by qualitative analysis in a process nurse, or nursing home director. Facebook. Knowledge transfer processes between stakeholders are where units (parts of sentences, sentences, or whole It was pointed out that information is often incomplete and mediated by the interests of the relevant parties [5], so they paragraphs) of analysis were identified first, and then open Informal transfer of knowledge in home care shared "just in time." must be aware of the value that is generated. The results show codes were defined for each part. Qualitative comparative They share their experiences informally at monthly that they have a high interest in sharing knowledge, but there analysis was used to assess the attitudes. We applied the meetings. Some indicated that they meet once a week during a Informal transfer of knowledge in professional team are barriers that affect the transfer of knowledge in care homes. questionnaire from Donate & Sanchez de Pablo on the role of break with colleagues from the same community and share They also communicate via e-mail and one-on-one meetings. The facilitators and barriers to implement knowledge transfer knowledge-oriented leadership in knowledge management what is happening in their area. They also often share information in informal ways, such as in care homes are different and are depending on the type of practices and innovation [6]. Research question was: Some indicated that they also use the social networks over morning coffee or via Facebook. the knowledge transfer. Facebook and WhatsApp for communication. They all Does the way knowledge is transferred within the same home communicate with each other by phone, and occasionally in Various knowledge transfer practices have been introduced differ by unit - a professional team or a home care unit? person. Those who work in the same community occasionally V. DISCUSSION at care homes to encourage the transfer of knowledge between meet informally and share information. generations and to new employees. These include various The results of the qualitative analysis of interviews IV. organizational measures, such as mentoring; working in pairs; RESULTS Formal mechanisms for sharing practices in care home conducted with social workers and members of the professional consistent education in care home; teamwork; daily meetings The members of the professional team indicate that they team point to important findings in our research: during shift changes; and activities to improve communication In the research, we conducted interviews with social care share their experiences during team meetings when it comes to 1. both units emphasize the importance of real-time and create a safe and stimulating work environment (e.g., workers who provide home care and are present in the care interdisciplinary collaboration; in the professional council; communication with leadership (coordinator, nursing adhering to the maxim of respectful communication between home only at the beginning and end of the work shift, and in during lunch; during the day when talking with colleagues supervisor, director) to help make a decision when there is all stakeholders, daily team meetings, and the use of modern their work they are much more independent and left to their directly in the department or during morning coffee or after ambiguity. Being informed about the health status and changes information technology, such as a computer system where all own knowledge and judgment. We were interested in whether work; through internal trainings; written reports; individual among the residents and users of the home care service is also changes and events for each resident are recorded). An the methods of knowledge transfer among social care workers conversations. crucial for successful and safe work in a care home. Meetings important factor in the transfer of knowledge between in the home help unit differ from the methods of knowledge It was pointed out that the proposals should be submitted to are therefore held twice a day at the care home, where they employees and residents is a relationship based on trust and transfer in a professional team, where the members are a the social worker, the head of the center, the mailbox at the provide information about changes and any factors that may mutual respect. If care home include relatives in daily activities physiotherapist, an occupational therapist, a registered nurse reception (the proposals are reviewed by the head), colleagues affect the residents' well-being. and they are regular visitors to care home, a partnership and a social worker. or the head nurse. They are also submitted on the basis of a 2. The frequency of regular meetings is much lower in home relationship can be created between employees and relatives professional report, which is carried out twice a day to provide care - caregivers even mention meeting only once a month. In whereby everyone works hard for the well-being of residents. Formal transfer of knowledge information about changes in the health status of residents or home care, social caregivers are much more on their own in The partnership relationship is based on immediate and clear The social workers meet face-to-face about once a month. other important factors that may affect the well-being of providing all services - in a care home, for example, they have communication between employees and relatives. Relatives All indicate that they communicate with the coordinator residents. nurses as professional help, members of the professional team, expect real-time notifications about any changes in their loved mainly by phone, but also live a few times a month. They Knowledge sharing takes place at meetings, training doctors - on the ground, in the home environment, social one’s health, and they also expect to be heard. After all, they indicate that they receive certain information from the sessions, distribution of professional literature, experiential caregivers are on their own and left to their own knowledge, have taken care of their loved one for many years and know coordinator and important news from the director. All workshops, presentation of reports, assets, and continuing experience and resourcefulness. what contributes to their well-being. information and events are regularly shared with the education. They also acquire knowledge from colleagues, the coordinator at monthly meetings. Social caregivers say that 3. Information technology is an important tool for nursing supervisor, the social worker and internal trainings knowledge transfer. Again, this varies from unit to unit. In the Barriers to the Implementation of Knowledge Transfer in they can share their experiences and bring up their problems at conducted by the center's staff. Information is obtained through care home, staff refer to the computer program as the basic tool care homes are some general, like lack of staff and long-living the monthly meetings. Most indicate that they share their the Internet or exchanges between employees (expert teams, into which all the information about residents' health is entered. society with increasing demand of care homes, as individual to experiences with the coordinator when a particular situation reports, expert councils, individual meetings), information is Since everyone works in the same place, it is much easier to each care home, depending on the organization’s culture and arises. Some call the care home's care manager. Most of them posted on the bulletin board, through the work disk. coordinate spontaneously (in offices, hallways, or on the knowledge management practices: Factors that can hinder the indicate that they also share their experiences with the The members of the expert team unanimously reviewed the phone). However, in the home care unit, a different technology transfer of knowledge in care homes are a lack of staff, which mentoring service at their facility proposals. Sometimes the proposals are considered, sometimes was used. Given the nature of their work, a computer program, contributes to haste, more frequent changes in employees, and The social care workers indicated that they all use cell not, the proposals are considered at the level of the expert team even if available to them, is of little use to them. The social care shallower relationships in a team and with residents and phones in their work. They use them to communicate with the and unanimously adopted, taking into account the impact of workers mainly mention the use of the telephone - where they relatives. Information technology can enable the transfer of coordinator, with each other, with the sponsorship service and decisions on residents. The proposals are reviewed, discussed consult with the coordinator, the head nurse or each other. knowledge, but it may be avoided or used infrequently by older with the relatives of the users. In addition, they also have an and heard by the expert teams. 4. It is not surprising, then, that social care workers are employees. The transfer of knowledge in the knowledge application on their cell phones that they use for work The members of the expert team stated that in their work they much more likely to use informal ways of transferring ecosystem of employees, residents, and relatives can also be (recording hours) and using schedules. All caregivers indicated use computers, telephones, the Internet, the program PRO- knowledge - sharing information, experiences, and ideas after affected by dementia, which is present in almost two-thirds of that they communicate their suggestions to the coordinator, BIT, videos on YouTube and e-mail. They communicate with meetings, during their breaks, through social networks, and by CH residents. Exceptional situations, such as the Covid-19 who then helps to implement the suggestion, adjust it, or each other by phone, reports (transmission of daily phone. pandemic, can also have a negative impact on the transfer of forward it to the director. Some indicate that they feel they can information), weekly meetings (meetings of the expert team). knowledge, as the period of crisis management lasted for a always approach the coordinator or director with their ideas. They also transmit information to each other by phone or call year, with frequent restrictions or bans on resident visits. Most of the users' requests and suggestions are forwarded to when it is urgent and quick transmission is needed. Given the much smaller number of regular meetings, it is the coordinator so that they can review the proposal together. The members of professional team is informed through necessary to find ways to provide quality home care services The social care workers say that they share their knowledge also through the care home, i.e., formally, with timely help, III. computer records and transmission of information in reports, MATERIAL AND METHODS with each other during meetings. Most experiences and and that much of the information is transmitted during team advice, or ideas. It would be useful to introduce at least weekly Qualitative data was obtained with the use of the data gained knowledge are also shared through internal trainings that take meetings. They receive monthly reports on progress and rather than monthly meetings, as meetings are an important way from interviews of 11 caregivers and 5 members of expert place in the organization. Some say they also attend external changes through quality report. They are informed of changes of transferring knowledge. If they have professional dilemmas, team. Semi-structured interviews with them were conducted in trainings where they gain new skills. Some point out that they via e-mail or by the director at team meetings. Much they could always contact the home's nursing supervisor or 21 another professional. There are many possibilities for REFERENCES improvement, such as the inclusion of social care workers in Possibilities for further developing of the "Careful [1] Nonaka, I, Takeuchi, H. The knowledge-creating enterprise: How trainings that take place in care homes or visits by professionals Japanese companies create the dynamics of innovation. 1995. Oxford College in the home environment of care home users. Press. Assessment" tool in the treatment of patients with [2] Becerra-Fernandez, I, Leidner, DE. Knowledge management: An The importance of our findings for future research evolutionary view. 2008. (Vol. 12). ME Sharpe. medically unexplained conditions knowledge transfer in care homes and home care environment [3] Gamble, PR, Blackwell, J. Knowledge management: A state of the art By researching and applying modern management skills, guide. 2001. London: Kogan Page Limited. Eva Svatina Šošić 2, Vojislav Ivetić 1,2, we can contribute significantly to better and continuous [4] Crook, R, Combs, J, Todd, S, Woehr, D, Ketchen, D. Does human capital 1 University of Maribor, Faculty of Medicine, Department of Family Medicine, Taborska ulica 8, 2000 Maribor, information and knowledge transfer, thus improving the quality matter? A meta-analysis of the relationship between human capital and firm of services. In doing so, we can make use of modern performance. 2011. J Appl Psych., 96(3), 443–56. Slovenia. 2 information technologies as well as consultation with SAVA MED d.o.o., Cesta k Dravi 8, 2241 Spodnji Duplek, Slovenia. professionals in the home environment of the users. Like any [5] von Krogh, G, Nonaka, I, Aben, M. Making the most of your company's eva.svatina@gmail.com knowledge: A strategic framework. 2001. Long Range Planning: International study, ours has certain limitations, such as a larger sample size Journal of Strategic Management, 34(4), 421–439. Available from: that could confirm our findings. https://doi.org/10.1016/S0024-6301(01)00059-0 Abstract - Medically unexplained symptoms (MUS) are difficult I. INTRODUCTION to define as a clinical entity. In practice, the most widely used definition is that MUS patients are those who complain of Approximately 20–25% of patients in a family medicine [6] Donate, MJ., Sanchez de Pablo, JD. The role of knowledge-oriented physical symptoms for which no organic or psychiatric cause is practice complain about physical symptoms for which no leadership in knowledge management practices and innovation. 2015. Journal found after numerous investigations. Early identification of cause can be identified – medically unexplained symptoms of Business Research, 68(2), 360-370. patients with MUS is crucial both for the patient and for the (MUS) (1). Most commonly, they report fatigue, dizziness and primary care physician, who is a central player in the long-term general malaise (2). These patients frequently return to their management of such patients. The aim of the qualitative analysis family doctors for appointments and want the doctors to do was to create a paradigmatic model that will be presented as a additional tests and refer them to specialists (3). After years of starting point for a possible redesign of the "Careful Assessment" follow-up, an organic cause for the patient’s problems is found tool and, consequently, for the improvement of the learning only in 10% of cases (4). process for family medicine trainees (FMT), which are linked to the management of patients with MUS in Slovenia. Patients with MUS are commonly a reason for frustration and Methods: Using a nominal group technique, we generated codes dissatisfaction of family doctors, while such patients (answers), subcategories, categories and set priorities. themselves are not satisfied with how they are being treated Subcategories were grouped into categories. Three categories (5). Using a biopsychosocial model, which focuses on the sick were discussed: the advantages of the tool, the disadvantages of person, helps family doctors better understand patients with the tool and possible improvements to the "Careful Assessment" MUS than the biomedical model, which is focused on the tool. disease (6). Doctors also face the challenges of making a Results: The study generated 79 ideas/codes. These were grouped into 12 sub-categories, which in turn were grouped into three diagnosis according to the ICD-10 classification, since they do categories - the advantages of the tool, the disadvantages of the not want to stigmatise patients and thus cause additional tool and suggestions for improvements to the tool. The category problems (7). suggestions for improvement received the highest total number of When managing patients with MUS, doctors often use various votes (82), with five sub-categories. When discussing the category tools and methods. These mostly involve standardised advantages of the "Careful Assessment" tool, most of the questionnaires (2,8), comprehensive psychological theories responses fell into the subcategory of the positive features of the and approaches (9), and qualitative techniques of data tool (enables a systematic approach and holistic treatment, is a collection such as interviews or focus groups (6,10,11). structured tool, etc.). When discussing the category disadvantages Through their results, the above studies aim at standardising of the "Careful Assessment" tool, the most frequent responses were about the negative features of the tool (time-consuming, the MUS identification procedure in primary care patients (12). multiple uses are required, etc.) and the weaknesses of the tool An example of such useful tool is also the "Careful from the patient's point of view (dependence on the sincerity of Assessment" tool based on the "P-P-P" model (predisposing the patient, requires invasion into the patient’s privacy, etc.). In factors, precipitating factors and perpetuating factors) (13). category possible improvements to the "Careful Assessment" According to this model, certain events occurring in a patient’s tool, two subcategories (additional content for predisposing life may influence the disease – they may lay the foundations factors and additional content for perpetuating factors) received for the disease, trigger it or maintain it (13). the most votes. The aim of the qualitative analysis was to create a paradigmatic Conclusion: More research on MUS in primary care is needed to model with main ideas, that will be presented as a starting point improve the consultations with patients and management of the disease. The "Careful Assessment" tool can be of great help in for a possible redesign of the "Careful Assessment" tool and, diagnosing MUS, but it has many drawbacks. This research has consequently, for the improvement of the learning process for provided us with a number of suggestions for improving the tool. family medicine trainees (FMT), which is linked to the management of patients with MUS in Slovenia. Index Terms - Careful Assessment tool; medically unexplained symptoms, family medicine; family medicine trainees; qualitative studies 22 another professional. There are many possibilities for REFERENCES improvement, such as the inclusion of social care workers in Possibilities for further developing of the "Careful [1] Nonaka, I, Takeuchi, H. The knowledge-creating enterprise: How trainings that take place in care homes or visits by professionals Japanese companies create the dynamics of innovation. 1995. Oxford College in the home environment of care home users. Press. Assessment" tool in the treatment of patients with [2] Becerra-Fernandez, I, Leidner, DE. Knowledge management: An The importance of our findings for future research evolutionary view. 2008. (Vol. 12). ME Sharpe. medically unexplained conditions knowledge transfer in care homes and home care environment [3] Gamble, PR, Blackwell, J. Knowledge management: A state of the art By researching and applying modern management skills, guide. 2001. London: Kogan Page Limited. Eva Svatina Šošić 2, Vojislav Ivetić 1,2, we can contribute significantly to better and continuous [4] Crook, R, Combs, J, Todd, S, Woehr, D, Ketchen, D. Does human capital 1 University of Maribor, Faculty of Medicine, Department of Family Medicine, Taborska ulica 8, 2000 Maribor, information and knowledge transfer, thus improving the quality matter? A meta-analysis of the relationship between human capital and firm of services. In doing so, we can make use of modern performance. 2011. J Appl Psych., 96(3), 443–56. Slovenia. 2 information technologies as well as consultation with SAVA MED d.o.o., Cesta k Dravi 8, 2241 Spodnji Duplek, Slovenia. professionals in the home environment of the users. Like any [5] von Krogh, G, Nonaka, I, Aben, M. Making the most of your company's eva.svatina@gmail.com knowledge: A strategic framework. 2001. Long Range Planning: International study, ours has certain limitations, such as a larger sample size Journal of Strategic Management, 34(4), 421–439. Available from: that could confirm our findings. https://doi.org/10.1016/S0024-6301(01)00059-0 Abstract - Medically unexplained symptoms (MUS) are difficult I. INTRODUCTION to define as a clinical entity. In practice, the most widely used definition is that MUS patients are those who complain of Approximately 20–25% of patients in a family medicine [6] Donate, MJ., Sanchez de Pablo, JD. The role of knowledge-oriented physical symptoms for which no organic or psychiatric cause is practice complain about physical symptoms for which no leadership in knowledge management practices and innovation. 2015. Journal found after numerous investigations. Early identification of cause can be identified – medically unexplained symptoms of Business Research, 68(2), 360-370. patients with MUS is crucial both for the patient and for the (MUS) (1). Most commonly, they report fatigue, dizziness and primary care physician, who is a central player in the long-term general malaise (2). These patients frequently return to their management of such patients. The aim of the qualitative analysis family doctors for appointments and want the doctors to do was to create a paradigmatic model that will be presented as a additional tests and refer them to specialists (3). After years of starting point for a possible redesign of the "Careful Assessment" follow-up, an organic cause for the patient’s problems is found tool and, consequently, for the improvement of the learning only in 10% of cases (4). process for family medicine trainees (FMT), which are linked to the management of patients with MUS in Slovenia. Patients with MUS are commonly a reason for frustration and Methods: Using a nominal group technique, we generated codes dissatisfaction of family doctors, while such patients (answers), subcategories, categories and set priorities. themselves are not satisfied with how they are being treated Subcategories were grouped into categories. Three categories (5). Using a biopsychosocial model, which focuses on the sick were discussed: the advantages of the tool, the disadvantages of person, helps family doctors better understand patients with the tool and possible improvements to the "Careful Assessment" MUS than the biomedical model, which is focused on the tool. disease (6). Doctors also face the challenges of making a Results: The study generated 79 ideas/codes. These were grouped into 12 sub-categories, which in turn were grouped into three diagnosis according to the ICD-10 classification, since they do categories - the advantages of the tool, the disadvantages of the not want to stigmatise patients and thus cause additional tool and suggestions for improvements to the tool. The category problems (7). suggestions for improvement received the highest total number of When managing patients with MUS, doctors often use various votes (82), with five sub-categories. When discussing the category tools and methods. These mostly involve standardised advantages of the "Careful Assessment" tool, most of the questionnaires (2,8), comprehensive psychological theories responses fell into the subcategory of the positive features of the and approaches (9), and qualitative techniques of data tool (enables a systematic approach and holistic treatment, is a collection such as interviews or focus groups (6,10,11). structured tool, etc.). When discussing the category disadvantages Through their results, the above studies aim at standardising of the "Careful Assessment" tool, the most frequent responses were about the negative features of the tool (time-consuming, the MUS identification procedure in primary care patients (12). multiple uses are required, etc.) and the weaknesses of the tool An example of such useful tool is also the "Careful from the patient's point of view (dependence on the sincerity of Assessment" tool based on the "P-P-P" model (predisposing the patient, requires invasion into the patient’s privacy, etc.). In factors, precipitating factors and perpetuating factors) (13). category possible improvements to the "Careful Assessment" According to this model, certain events occurring in a patient’s tool, two subcategories (additional content for predisposing life may influence the disease – they may lay the foundations factors and additional content for perpetuating factors) received for the disease, trigger it or maintain it (13). the most votes. The aim of the qualitative analysis was to create a paradigmatic Conclusion: More research on MUS in primary care is needed to model with main ideas, that will be presented as a starting point improve the consultations with patients and management of the disease. The "Careful Assessment" tool can be of great help in for a possible redesign of the "Careful Assessment" tool and, diagnosing MUS, but it has many drawbacks. This research has consequently, for the improvement of the learning process for provided us with a number of suggestions for improving the tool. family medicine trainees (FMT), which is linked to the management of patients with MUS in Slovenia. Index Terms - Careful Assessment tool; medically unexplained symptoms, family medicine; family medicine trainees; qualitative studies 23 II. METHODS smaller groups (3–4 participants each) and had 10 to 15 New, easier approach 20 3 In our qualitative study, the nominal group technique was used. minutes to discuss proposals for improving the tool. Each Tool requires accuracy 47 1 Allows for validation of changes 50 1 This is the type of study that determines the selection, smaller group then prepared a shortlist of the most important Helps to objectivise the condition 52 1 collection and analysis of data during the research process findings. All of the most important findings from the groups Negative features of the "Careful Assessment" tool 28 (14). Manual coding was used, the answers of FMTs were were collected and recorded. If the findings were repeated, It is time-consuming 1 19 analysed, and codes were prepared which could be logically they were numbered. The explanation and interpretation of all Multiple uses are required 26 3 linked and subsequently joined into subcategories and collected ideas followed. The moderator recorded the votes, Too general tool 28 2 categories (higher-level codes) (14). counted them, calculated their rank and prepared a final list. Careful Assessment is not a suitable name 54 1 Not a tool adjusted for several visits 56 1 Participants – We analysed work of the nominal groups, Data analysis – Head of module (V.I.) counted the votes for Not a systematic tool 57 1 which involved FMTs from seven modular groups (modular each finding separately. This resulted in a list of ideas for Poorly structured 61 1 groups No. 17, 18, 19, 20, 21, 22 and 23). There was a total of improving the "Careful Assessment" tool, arranged by the Positive influence on the doctor 22 Better patient understanding 10 5 184 participants. They had undergone training between 2016 number of votes (rank). Based on the frequency of votes (rank), Tool makes us consider MUS 12 5 and 2018 within the Medically Unexplained Symptoms the content was analysed by two independent investigators (V.I Increases doctor satisfaction 14 4 training module (part of the mandatory training within the and E.S.Š.). After each analysis, the investigators met and Helps the doctor to make a diagnosis 19 4 family medicine specialisation). reviewed codes, harmonising them if needed. This increased Improves the doctor-patient relationship 44 2 For the needs of our study, findings of each nominal group the reliability and consistency of the analysis. The aim of the Higher doctor tolerance 49 1 were anonymised so that the identity of any FMT could not be analysis was to develop analytical subcategories, categories Better recognition of psychiatric diseases 51 1 linked to the findings of each nominal group. FMTs were in and theoretical interpretations from the text based on the ideas Weaknesses from the patient’s point of view 21 29.9% male (n=55), 60.9% (n=112) female, and 9.2% (n=17) obtained. In the next phase, the investigators classified and Depends on the patient's sincerity 5 7 did not answer this question. Regarding the location of the combined the obtained ideas (codes) independently of each Lack of patient self-criticism 15 4 practice, they work at, 26.6% (n=49) work in a city, 40.2% other. This part of the analysis resulted in the formation of final Requires invasion into the patient’s privacy 16 4 Patient’s reservations 29 2 (n=74) in a town, 16.8% (n=31) in rural areas, and 16.4% subcategories and categories. Less satisfied patient 43 2 (n=30) did not answer this question. The majority, 76.0% Excessive patient attachment 58 1 (n=140), are employed at a public institution, 17.9% (n=33) at Opinion provided by the Ethics Committee – The Depends on the patient’s cognitive abilities 60 1 a concessionaire (private health practice or private health retrospective study, using already existing data from FMTs Changes regarding predisposition 20 institution with contract with Health Insurance Institute of educational training program (2016-2018) was approved on 3rd Family predisposition/history should be added to susceptibility 6 7 Slovenia which provide compulsory health insurance in of June 2021 by the National Medical Ethics Committee of the Personality type should be added to susceptibility 17 4 Slovenia), 1.6% (n=3) at a private practice without concession, Republic of Slovenia (application No. 0120-210/2021/3). Peer violence should be added to susceptibility 37 2 and 4.5% (n=8) did not answer this question. The average General pool skills should be added to susceptibility 38 2 number of years FMTs spent working in family medicine was III. RESULTS Education should be added to susceptibility 39 2 Traumatic event should be added to susceptibility 72 1 3.3 years (minimum 2 years, maximum 8 years). The FMTs Within seven modular groups, 184 FMTs were divided into 37 Preserving unhealthy relationships should be added to susceptibility 73 1 who took part in the study came from different regions of smaller groups (3–4 participants in each group). Within each School abuse should be added to susceptibility 74 1 Slovenia, which allowed us to obtain a broad sample. group, the FMTs discussed the questions asked and gathered Changes regarding perpetuators 20 ideas. Not enough perpetuators 9 6 Data collection and qualitative methods – As the data There was a total of 79 ideas (codes). They were ranked Dependencies (alcohol, smoking, relationships) should be added to perpetuators 21 3 collection method, the records of FMT findings during their according to the number of votes. The following ideas obtained Chronic somatic diseases/physical disabilities should be added to perpetuators 32 2 work in nominal groups were used. The nominal group Family relationships and work relationships should be added to perpetuators 36 2 the most votes: It is time-consuming, Allows for a systematic technique involves purposeful gathering of participants for Lack of expert help should be added to perpetuators 46 2 approach, It is a structured and useful tool, Allows for a discussion and brainstorming on a specific topic (15,16). Access to unverified information should be added to perpetuators 75 1 comprehensive management, Depends on the patient’s The procedure comprised four phases: generating ideas to Unemployment should be added to perpetuators 76 1 sincerity, Family predisposition should be added to Specialist referrals should be added to perpetuators 77 1 improve the "Careful Assessment" tool, writing these ideas susceptibility, Motivational techniques for behavioural Changes in body weight should be added to perpetuators 78 1 down, explaining and voting on the priority ideas (17). This cognitive change, Prepare a tool for patients, Not enough Lifestyle should be added to perpetuators 79 1 method encourages involvement of all participants, as it perpetuators, Better patient understanding, Add more items for General suggestions to improve the "Careful Assessment" tool 19 enables equal participation (17). Additionally, it is a structured, all three factors … Motivational techniques for behavioural cognitive change 7 7 transparent and repeatable method for synthesising and All answers are shown in Table 1. Add more items for all three factors 11 5 generating ideas (17). Clearer boundary between perpetuators and triggers 30 2 Ideas were generated by encouraging discussion – within their Check the frequency of visits to the practice 66 1 Based on the content analysis and the identified ideas (codes), respective modular groups, the participants were distributed in Include heteroanamnesis 67 1 12 subcategories were formed (Table 1). Add a brief description of family environment 68 1 Limitation regarding cognitive abilities 69 1 Table 1: Subcategories formed based on the ideas (codes) Check the frequency of sick leave 71 1 Improving structural characteristics of the "Careful Assessment" tool 15 SUBCATEGORIES Rank No. of votes Total no. of votes per Prepare a tool for patients 8 7 subcategory Abbreviated version/tool simplification 23 3 Positive features of the "Careful Assessment" tool 37 Change the tool into a 1–10 rating scale/yes*no questionnaire 35 2 Allows for a systematic approach 2 11 Prepare a tool for registered nurses 40 2 Structured and useful tool 3 10 Additional heading: Solution 70 1 Allows for a comprehensive management 4 10 24 II. METHODS smaller groups (3–4 participants each) and had 10 to 15 New, easier approach 20 3 In our qualitative study, the nominal group technique was used. minutes to discuss proposals for improving the tool. Each Tool requires accuracy 47 1 Allows for validation of changes 50 1 This is the type of study that determines the selection, smaller group then prepared a shortlist of the most important Helps to objectivise the condition 52 1 collection and analysis of data during the research process findings. All of the most important findings from the groups Negative features of the "Careful Assessment" tool 28 (14). Manual coding was used, the answers of FMTs were were collected and recorded. If the findings were repeated, It is time-consuming 1 19 analysed, and codes were prepared which could be logically they were numbered. The explanation and interpretation of all Multiple uses are required 26 3 linked and subsequently joined into subcategories and collected ideas followed. The moderator recorded the votes, Too general tool 28 2 categories (higher-level codes) (14). counted them, calculated their rank and prepared a final list. Careful Assessment is not a suitable name 54 1 Not a tool adjusted for several visits 56 1 Participants – We analysed work of the nominal groups, Data analysis – Head of module (V.I.) counted the votes for Not a systematic tool 57 1 which involved FMTs from seven modular groups (modular each finding separately. This resulted in a list of ideas for Poorly structured 61 1 groups No. 17, 18, 19, 20, 21, 22 and 23). There was a total of improving the "Careful Assessment" tool, arranged by the Positive influence on the doctor 22 Better patient understanding 10 5 184 participants. They had undergone training between 2016 number of votes (rank). Based on the frequency of votes (rank), Tool makes us consider MUS 12 5 and 2018 within the Medically Unexplained Symptoms the content was analysed by two independent investigators (V.I Increases doctor satisfaction 14 4 training module (part of the mandatory training within the and E.S.Š.). After each analysis, the investigators met and Helps the doctor to make a diagnosis 19 4 family medicine specialisation). reviewed codes, harmonising them if needed. This increased Improves the doctor-patient relationship 44 2 For the needs of our study, findings of each nominal group the reliability and consistency of the analysis. The aim of the Higher doctor tolerance 49 1 were anonymised so that the identity of any FMT could not be analysis was to develop analytical subcategories, categories Better recognition of psychiatric diseases 51 1 linked to the findings of each nominal group. FMTs were in and theoretical interpretations from the text based on the ideas Weaknesses from the patient’s point of view 21 29.9% male (n=55), 60.9% (n=112) female, and 9.2% (n=17) obtained. In the next phase, the investigators classified and Depends on the patient's sincerity 5 7 did not answer this question. Regarding the location of the combined the obtained ideas (codes) independently of each Lack of patient self-criticism 15 4 practice, they work at, 26.6% (n=49) work in a city, 40.2% other. This part of the analysis resulted in the formation of final Requires invasion into the patient’s privacy 16 4 Patient’s reservations 29 2 (n=74) in a town, 16.8% (n=31) in rural areas, and 16.4% subcategories and categories. Less satisfied patient 43 2 (n=30) did not answer this question. The majority, 76.0% Excessive patient attachment 58 1 (n=140), are employed at a public institution, 17.9% (n=33) at Opinion provided by the Ethics Committee – The Depends on the patient’s cognitive abilities 60 1 a concessionaire (private health practice or private health retrospective study, using already existing data from FMTs Changes regarding predisposition 20 institution with contract with Health Insurance Institute of educational training program (2016-2018) was approved on 3rd Family predisposition/history should be added to susceptibility 6 7 Slovenia which provide compulsory health insurance in of June 2021 by the National Medical Ethics Committee of the Personality type should be added to susceptibility 17 4 Slovenia), 1.6% (n=3) at a private practice without concession, Republic of Slovenia (application No. 0120-210/2021/3). Peer violence should be added to susceptibility 37 2 and 4.5% (n=8) did not answer this question. The average General pool skills should be added to susceptibility 38 2 number of years FMTs spent working in family medicine was III. RESULTS Education should be added to susceptibility 39 2 3.3 years (minimum 2 years, maximum 8 years). The FMTs Traumatic event should be added to susceptibility 72 1 Within seven modular groups, 184 FMTs were divided into 37 Preserving unhealthy relationships should be added to susceptibility 73 1 who took part in the study came from different regions of smaller groups (3–4 participants in each group). Within each School abuse should be added to susceptibility 74 1 Slovenia, which allowed us to obtain a broad sample. group, the FMTs discussed the questions asked and gathered Changes regarding perpetuators 20 ideas. Not enough perpetuators 9 6 Data collection and qualitative methods – As the data There was a total of 79 ideas (codes). They were ranked Dependencies (alcohol, smoking, relationships) should be added to perpetuators 21 3 collection method, the records of FMT findings during their according to the number of votes. The following ideas obtained Chronic somatic diseases/physical disabilities should be added to perpetuators 32 2 work in nominal groups were used. The nominal group Family relationships and work relationships should be added to perpetuators 36 2 the most votes: It is time-consuming, Allows for a systematic technique involves purposeful gathering of participants for Lack of expert help should be added to perpetuators 46 2 approach, It is a structured and useful tool, Allows for a discussion and brainstorming on a specific topic (15,16). Access to unverified information should be added to perpetuators 75 1 comprehensive management, Depends on the patient’s The procedure comprised four phases: generating ideas to Unemployment should be added to perpetuators 76 1 sincerity, Family predisposition should be added to Specialist referrals should be added to perpetuators 77 1 improve the "Careful Assessment" tool, writing these ideas susceptibility, Motivational techniques for behavioural Changes in body weight should be added to perpetuators 78 1 down, explaining and voting on the priority ideas (17). This cognitive change, Prepare a tool for patients, Not enough Lifestyle should be added to perpetuators 79 1 method encourages involvement of all participants, as it perpetuators, Better patient understanding, Add more items for General suggestions to improve the "Careful Assessment" tool 19 enables equal participation (17). Additionally, it is a structured, all three factors … Motivational techniques for behavioural cognitive change 7 7 transparent and repeatable method for synthesising and All answers are shown in Table 1. Add more items for all three factors 11 5 generating ideas (17). Clearer boundary between perpetuators and triggers 30 2 Ideas were generated by encouraging discussion – within their Check the frequency of visits to the practice 66 1 Based on the content analysis and the identified ideas (codes), respective modular groups, the participants were distributed in Include heteroanamnesis 67 1 12 subcategories were formed (Table 1). Add a brief description of family environment 68 1 Limitation regarding cognitive abilities 69 1 Table 1: Subcategories formed based on the ideas (codes) Check the frequency of sick leave 71 1 Improving structural characteristics of the "Careful Assessment" tool 15 SUBCATEGORIES Rank No. of votes Total no. of votes per Prepare a tool for patients 8 7 subcategory Abbreviated version/tool simplification 23 3 Positive features of the "Careful Assessment" tool 37 Change the tool into a 1–10 rating scale/yes*no questionnaire 35 2 Allows for a systematic approach 2 11 Prepare a tool for registered nurses 40 2 Structured and useful tool 3 10 Additional heading: Solution 70 1 Allows for a comprehensive management 4 10 25 Positive influence on the patient 15 specialist referrals to additional tests should also be included. (improving structural characteristics of the tool, changes Increases patient satisfaction 13 5 regarding susceptibility, triggers and perpetuators), and Patient activation 24 3 Category: Advantages of the "Careful Assessment" tool – highlighted the advantages of the tool (positive features of the Patient's insight into MUS 25 3 The study found that the tool has a positive influence on the tool, positive influence on the doctor and also the patient) and Conversation as a therapeutic effect 45 2 doctor – the patient is in the centre of attention, conversation weaknesses of the tool (negative features and content-related Patient-centred 48 1 Increases doctor-patient trust 53 1 has a diagnostic and therapeutic effect, doctor-patient trust is disadvantages of the tool, weaknesses from the doctor's point Content-related weaknesses of the "Careful Assessment" tool 11 increased. Other studies also emphasise the importance of a of view and also the patient's point of view). Not knowing what to do with the information obtained 18 4 good doctor-patient relationship for successful treatment of Our findings constitute a good foundation for future studies on No specific instructions when to start using it 42 2 MUS (18). Rasmusen et al. also demonstrated the significance the topic of improving the management of patients with MUS Triggers overlap with perpetuators 55 1 of the biopsychosocial model approach (6). and further development of the "Careful Assessment" tool. Predisposition goes beyond childhood 59 1 Usefulness for one’s own patients only 62 1 A strong emphasis in the category: Weaknesses of the REFERENCES Too general triggers 63 1 "Careful Assessment" tool was on the patient’s point of 1. Burton C. Beyond somatisation: a review of the understanding and Mandatory exclusion diagnostics 64 1 view. The patient's sincerity is essential for a successful use of treatment of medically unexplained physical symptoms (MUPS). Br J Changes regarding triggers 8 the tool, and invasion into the patient’s privacy is significant, Gen Pract. 2003;53:231–239. Newly diagnosed chronic somatic disease should be added to triggers 31 2 2. van Westrienen PE, Pisters MF, Veenhof C, et al. Identification of Way of coping with stress should be added to triggers 32 2 which is often a problem. Salmon et al. conducted a patients with moderate medically unexplained physical symptoms in Parents’ expectations should be added to triggers 33 2 prospective study showing that the patients who wanted primary care with a five years follow-up. BMC Fam Pract. 2019;20:66. Being different should be added to triggers 34 2 emotional support talked more about psychosocial problems, 3. Barsky AJ, Ettner SL, Horsky J, et al. Resource utilization of patients with hypochondriacal health anxiety and somatization. Med Care. Weaknesses from the doctor’s point of view 5 including the psychosocial causes of symptoms and the need 2001;39:705–715. Effectiveness depends on the doctor’s skills 27 2 for psychosocial help (19). On the other hand, the patients who 4. Crimlisk HL, Bhatia K, Cope H, et al. Slater revisited: 6 year follow up Doctor’s decompensation 41 2 wanted an explanation and reassurance themselves proposed to study of patients with medically unexplained motor symptoms. BMJ. Risk of strengthening MUS 65 1 explain the symptoms with physical changes (19). In this 1998;316:582–586. category, the doctor's point of view was also emphasised – the 5. Hodgson P, Smith P, Brown T, et al. Stories from Frequent Attenders: Most ideas (codes) were classified into the subcategory Table 1. A Qualitative Study in Primary Care. Ann Fam Med. 2005;3:318–323. success of treatment depends on the doctor’s skills. Stone also 6. Rasmussen EB, Rø KI. How general practitioners understand and Positive features of the "Careful Assessment" tool, followed by The subcategories that could be logically linked were then showed that negative emotions and lack of diagnostic expertise handle medically unexplained symptoms: a focus group study. BMC Negative features of the "Careful Assessment" tool, Positive combined into categories (higher-level codes). Three prevented the doctors from effectively managing patients with Family Practice. 2018;19:50. influence on the doctor and Weaknesses from the patient’s categories were created: Advantages of the tool, Weaknesses MUS (12). 7. Pohontsch NJ, Zimmermann T, Jonas C, et al. Coding of medically point of view. All subcategories and ideas (codes) are shown in of the tool, and Suggestions for tool improvement (Table 2). unexplained symptoms and somatoform disorders by general practitioners – an exploratory focus group study. BMC Family Advantages of the study – The data collected in our study were Practice. 2018;19:129. Table 2: Categories (higher-level codes) created based on subcategories. analysed using quantitative analysis and nominal group work. 8. den Boeft M, van der Wouden JC, Rydell-Lexmond TR, et al. Identifying patients with medically unexplained physical symptoms in CATEGORY Total no. of votes SUBCATEGORY Total no. of votes The advantage of such a study is a detailed insight into the electronic medical records in primary care: a validation study. BMC per category per subcategory FMTs’ opinion regarding the improvement of the "Careful Fam Pract. 2014;15:109. Improving structural characteristics of the "Careful Assessment" tool 15 Assessment" tool. The study constitutes a foundation for 9. Dwamena FC, Lyles JS, Frankel RM, et al. In their own words: General proposals to improve the "Careful Assessment" tool 19 further studies in the field of MUS diagnostics, and is also qualitative study of high-utilising primary care patients with medically SUGGESTIONS FOR unexplained symptoms. BMC Family Practice. 2009;10:67. IMPROVEMENT 82 Changes regarding susceptibility 20 suitable for use in routine clinical practice. The study involved 10. Ivetić V, Kersnik J, Klemenc-Ketiš Z, et al. Opinions of Slovenian Changes regarding triggers 8 a large sample of participants, allowing us to obtain many new family physicians on medically unexplained symptoms: a qualitative Changes regarding perpetuators 20 ideas. The advantage of the study is also its originality. study. J Int Med Res. 2013;41:705–715. Positive features of the "Careful Assessment" tool 37 ϭϭ ADVANTAGES OF THE Weaknesses of the study – As a weakness of the study, it . Stone L. Managing the consultation with patients with medically unexplained symptoms: a grounded theory study of supervisors and TOOL 74 Positive influence on the doctor 22 should be noted that younger doctors (FMTs) participated, who Positive influence on the patient 15 registrars in general practice. BMC Fam Pract. 2014;15:192. Negative features of the "Careful Assessment" tool 28 are at the beginning of their career and are therefore less 12. Walker EA, Unützer J, Katon WJ. Understanding and caring for the WEAKNESSES OF THE Weaknesses from the doctor’s point of view 5 experienced. It is also difficult to exclude subjectivity of the distressed patient with multiple medically unexplained symptoms. J TOOL 65 Weaknesses from the patient’s point of view Am Board Fam Pract. 1998;11:347–356. 21 participants, especially regarding the methodology of a 13. Flick U, von Kardorff E, Steinke I. A companion to qulitative research. Content-related deficiencies of the "Careful Assessment" tool 11 qualitative study. London: SAGE Publications Ltd; 2003. The study took place in Slovenia, with doctors working within 14. Schreier M. Qualitative content analysis in practice. Los Angeles: The following category received the most votes for ideas have also been confirmed by Lamahewa et. al., who showed the Slovenian healthcare system. Since each country has its SAGE; 2012. (codes): Suggestions for improvement, which was created that women, patients with severe symptom burden, patients own healthcare system, it is difficult to generalise and 15. Elo S, Kyngäs H. The qualitative content analysis process. J Adv Nurs. based on the logical combination of five subcategories (Table with physical abuse in childhood, and those with low income conclude that a similar study conducted in other healthcare 2008;62:107–115. 16. Krippendorf K. Content Analysis: An Introduction to Its Methodology. 2). have poorer prognosis(18). In their study, Dwamena at al. systems would show the same results. Thousand Oaks: SAGE Publications Ltd; 2003. IV. DISCUSSION concluded that almost as a rule, patients with MUS reported a 17. Lamahewa K, Buszewicz M, Walters K, et al. Persistent unexplained current and/or past family dysfunction in their lives(10). Many physical symptoms: a prospective longitudinal cohort study in UK Category: Suggestions for improving the "Careful V. CONCLUSION participants in our study thought that there were not enough primary care. Br J Gen Pract. 2019;69:e246–e253. Assessment" tool – In the "Careful Assessment" tool, 18. Ivetić V, Martinjak Š, Maksuti A. The Careful Assessment Tool for perpetuators (reduced body weight, body weight gain, social The "Careful Assessment" tool is only one of the potential Managing Patients with Medically Unexplained Symptoms - the susceptibility is affected by chronic childhood diseases, withdrawal, and decreased self-confidence) recorded. The approaches to manage patients with MUS. With such and Experience of Slovenian Family Medicine Trainees: a Qualitative childhood abuse and/or neglect, childhood poverty, poor social study showed that dependencies (alcohol, smoking, similar tools and by means of an appropriate therapeutic Study. Zdr Varst. 2022;61:48–54. support. Considering the study, much more factors should be relationships), physical disabilities and chronic somatic approach, we want to change the patient's beliefs, thus 19. Salmon P, Ring A, Humphris GM, et al. Primary Care Consultations included: personality type, family predisposition, peer About Medically Unexplained Symptoms: How Do Patients Indicate diseases, lifestyle, relationships in family and at work, lack of allowing them to better understand the possible causes of their What They Want? J GEN INTERN MED. 2009;24:450–456. violence, school abuse, level of education, traumatic events in expert help, unemployment, access to unverified information, problems and more willingly accept the problems. childhood, maintaining unhealthy relationships. Our findings Our study provided many suggestions for improving the tool 26 Positive influence on the patient 15 specialist referrals to additional tests should also be included. (improving structural characteristics of the tool, changes Increases patient satisfaction 13 5 regarding susceptibility, triggers and perpetuators), and Patient activation 24 3 Category: Advantages of the "Careful Assessment" tool – highlighted the advantages of the tool (positive features of the Patient's insight into MUS 25 3 The study found that the tool has a positive influence on the tool, positive influence on the doctor and also the patient) and Conversation as a therapeutic effect 45 2 doctor – the patient is in the centre of attention, conversation weaknesses of the tool (negative features and content-related Patient-centred 48 1 Increases doctor-patient trust 53 1 has a diagnostic and therapeutic effect, doctor-patient trust is disadvantages of the tool, weaknesses from the doctor's point Content-related weaknesses of the "Careful Assessment" tool 11 increased. Other studies also emphasise the importance of a of view and also the patient's point of view). Not knowing what to do with the information obtained 18 4 good doctor-patient relationship for successful treatment of Our findings constitute a good foundation for future studies on No specific instructions when to start using it 42 2 MUS (18). Rasmusen et al. also demonstrated the significance the topic of improving the management of patients with MUS Triggers overlap with perpetuators 55 1 of the biopsychosocial model approach (6). and further development of the "Careful Assessment" tool. Predisposition goes beyond childhood 59 1 Usefulness for one’s own patients only 62 1 A strong emphasis in the category: Weaknesses of the REFERENCES Too general triggers 63 1 "Careful Assessment" tool was on the patient’s point of 1. Burton C. Beyond somatisation: a review of the understanding and Mandatory exclusion diagnostics 64 1 view. The patient's sincerity is essential for a successful use of treatment of medically unexplained physical symptoms (MUPS). Br J Changes regarding triggers 8 the tool, and invasion into the patient’s privacy is significant, Gen Pract. 2003;53:231–239. Newly diagnosed chronic somatic disease should be added to triggers 31 2 2. van Westrienen PE, Pisters MF, Veenhof C, et al. Identification of Way of coping with stress should be added to triggers 32 2 which is often a problem. Salmon et al. conducted a patients with moderate medically unexplained physical symptoms in Parents’ expectations should be added to triggers 33 2 prospective study showing that the patients who wanted primary care with a five years follow-up. BMC Fam Pract. 2019;20:66. Being different should be added to triggers 34 2 emotional support talked more about psychosocial problems, 3. Barsky AJ, Ettner SL, Horsky J, et al. Resource utilization of patients with hypochondriacal health anxiety and somatization. Med Care. Weaknesses from the doctor’s point of view 5 including the psychosocial causes of symptoms and the need 2001;39:705–715. Effectiveness depends on the doctor’s skills 27 2 for psychosocial help (19). On the other hand, the patients who 4. Crimlisk HL, Bhatia K, Cope H, et al. Slater revisited: 6 year follow up Doctor’s decompensation 41 2 wanted an explanation and reassurance themselves proposed to study of patients with medically unexplained motor symptoms. BMJ. Risk of strengthening MUS 65 1 explain the symptoms with physical changes (19). In this 1998;316:582–586. category, the doctor's point of view was also emphasised – the 5. Hodgson P, Smith P, Brown T, et al. Stories from Frequent Attenders: Most ideas (codes) were classified into the subcategory Table 1. A Qualitative Study in Primary Care. Ann Fam Med. 2005;3:318–323. success of treatment depends on the doctor’s skills. Stone also 6. Rasmussen EB, Rø KI. How general practitioners understand and Positive features of the "Careful Assessment" tool, followed by The subcategories that could be logically linked were then showed that negative emotions and lack of diagnostic expertise handle medically unexplained symptoms: a focus group study. BMC Negative features of the "Careful Assessment" tool, Positive combined into categories (higher-level codes). Three prevented the doctors from effectively managing patients with Family Practice. 2018;19:50. influence on the doctor and Weaknesses from the patient’s categories were created: Advantages of the tool, Weaknesses MUS (12). 7. Pohontsch NJ, Zimmermann T, Jonas C, et al. Coding of medically point of view. All subcategories and ideas (codes) are shown in of the tool, and Suggestions for tool improvement (Table 2). unexplained symptoms and somatoform disorders by general practitioners – an exploratory focus group study. BMC Family Advantages of the study – The data collected in our study were Practice. 2018;19:129. Table 2: Categories (higher-level codes) created based on subcategories. analysed using quantitative analysis and nominal group work. 8. den Boeft M, van der Wouden JC, Rydell-Lexmond TR, et al. Identifying patients with medically unexplained physical symptoms in CATEGORY Total no. of votes SUBCATEGORY Total no. of votes The advantage of such a study is a detailed insight into the electronic medical records in primary care: a validation study. BMC per category per subcategory FMTs’ opinion regarding the improvement of the "Careful Fam Pract. 2014;15:109. Improving structural characteristics of the "Careful Assessment" tool 15 Assessment" tool. The study constitutes a foundation for 9. Dwamena FC, Lyles JS, Frankel RM, et al. In their own words: General proposals to improve the "Careful Assessment" tool 19 further studies in the field of MUS diagnostics, and is also qualitative study of high-utilising primary care patients with medically SUGGESTIONS FOR unexplained symptoms. BMC Family Practice. 2009;10:67. IMPROVEMENT 82 Changes regarding susceptibility 20 suitable for use in routine clinical practice. The study involved 10. Ivetić V, Kersnik J, Klemenc-Ketiš Z, et al. Opinions of Slovenian Changes regarding triggers 8 a large sample of participants, allowing us to obtain many new family physicians on medically unexplained symptoms: a qualitative Changes regarding perpetuators 20 ideas. The advantage of the study is also its originality. study. J Int Med Res. 2013;41:705–715. Positive features of the "Careful Assessment" tool 37 ϭϭ. Stone L. Managing the consultation with patients with medically ADVANTAGES OF THE Weaknesses of the study – As a weakness of the study, it unexplained symptoms: a grounded theory study of supervisors and TOOL 74 Positive influence on the doctor 22 should be noted that younger doctors (FMTs) participated, who Positive influence on the patient 15 registrars in general practice. BMC Fam Pract. 2014;15:192. Negative features of the "Careful Assessment" tool 28 are at the beginning of their career and are therefore less 12. Walker EA, Unützer J, Katon WJ. Understanding and caring for the WEAKNESSES OF THE Weaknesses from the doctor’s point of view 5 experienced. It is also difficult to exclude subjectivity of the distressed patient with multiple medically unexplained symptoms. J TOOL 65 Weaknesses from the patient’s point of view Am Board Fam Pract. 1998;11:347–356. 21 participants, especially regarding the methodology of a 13. Flick U, von Kardorff E, Steinke I. A companion to qulitative research. Content-related deficiencies of the "Careful Assessment" tool 11 qualitative study. London: SAGE Publications Ltd; 2003. The study took place in Slovenia, with doctors working within 14. Schreier M. Qualitative content analysis in practice. Los Angeles: The following category received the most votes for ideas have also been confirmed by Lamahewa et. al., who showed the Slovenian healthcare system. Since each country has its SAGE; 2012. (codes): Suggestions for improvement, which was created that women, patients with severe symptom burden, patients own healthcare system, it is difficult to generalise and 15. Elo S, Kyngäs H. The qualitative content analysis process. J Adv Nurs. based on the logical combination of five subcategories (Table with physical abuse in childhood, and those with low income conclude that a similar study conducted in other healthcare 2008;62:107–115. 16. Krippendorf K. Content Analysis: An Introduction to Its Methodology. 2). have poorer prognosis(18). In their study, Dwamena at al. systems would show the same results. Thousand Oaks: SAGE Publications Ltd; 2003. IV. DISCUSSION concluded that almost as a rule, patients with MUS reported a 17. Lamahewa K, Buszewicz M, Walters K, et al. Persistent unexplained current and/or past family dysfunction in their lives(10). Many physical symptoms: a prospective longitudinal cohort study in UK Category: Suggestions for improving the "Careful V. CONCLUSION participants in our study thought that there were not enough primary care. Br J Gen Pract. 2019;69:e246–e253. Assessment" tool – In the "Careful Assessment" tool, 18. Ivetić V, Martinjak Š, Maksuti A. The Careful Assessment Tool for perpetuators (reduced body weight, body weight gain, social The "Careful Assessment" tool is only one of the potential Managing Patients with Medically Unexplained Symptoms - the susceptibility is affected by chronic childhood diseases, withdrawal, and decreased self-confidence) recorded. The approaches to manage patients with MUS. With such and Experience of Slovenian Family Medicine Trainees: a Qualitative childhood abuse and/or neglect, childhood poverty, poor social study showed that dependencies (alcohol, smoking, similar tools and by means of an appropriate therapeutic Study. Zdr Varst. 2022;61:48–54. support. Considering the study, much more factors should be relationships), physical disabilities and chronic somatic approach, we want to change the patient's beliefs, thus 19. Salmon P, Ring A, Humphris GM, et al. Primary Care Consultations included: personality type, family predisposition, peer About Medically Unexplained Symptoms: How Do Patients Indicate diseases, lifestyle, relationships in family and at work, lack of allowing them to better understand the possible causes of their What They Want? J GEN INTERN MED. 2009;24:450–456. violence, school abuse, level of education, traumatic events in expert help, unemployment, access to unverified information, problems and more willingly accept the problems. childhood, maintaining unhealthy relationships. Our findings Our study provided many suggestions for improving the tool 27 Specialized registered nurses’ contribution to the Limitations considered as the scientific finding of this study since the correlational analysis was not made. Nevertheless, this reduction of diabetic complications The limitation of this study are many biases due to the lack of important data (such as foot examination providers, types of assumption is supported by studies from abroad, where diabetes, ect.). Therefore, the study has weak rigour and can different authors [14, 15] exposed the benefits of foot provide just the assumptions, not the scientific evidence. examinations regarding preventing complications that could result in major amputation. It is necessary to acknowledge the Metka Žitnik, RN, MS III. RESULTS importance of specialized registered nurses' work with diabetic Patricija Lunežnik, RN, MS patients since they provide most foot examinations [13]. metkazitnik@outlook.com Data on amputations above the ankle are a national quality indicator: "1.3.3 Annual incidence of amputation above the ankle in patients with diabetes" [12]. Figure 1 presents the Specialized registered nurses at family practices are Background—Worldwide the number of people with diabetes is In 2011, the Slovenian Ministry of Health started the project important in major amputation prevention because they increasing. In Slovenia, it was estimated that the prevalence of number of cases of amputations of the lower limbs above the of model practices in family medicine [5]. As the result, independently monitor well-managed patients with diabetes diabetes in 2021 was 145.200 people. With the increasing ankle (major amputation) in patients with diabetes per 100.000 specialized registered nurses independently monitor patients [5]. The same service is provided by specialized registered prevalence of diabetes, there is also a rising need to manage and patients with diabetes in the observed calendar years. with well-managed diabetes based on protocols [6]. Nurses' control the disease. In Slovenia, specialized registered nurses at nurses at diabetic practice on secondary level of health care. general practice offices monitor people with well-managed role is also to manage the register of diabetic patients and to Nurses' extended knowledge and expertise detect the first diabetes and accordingly contribute to reducing the frequency of monitor quality indicators [7]. Based on protocol, nurses potential complications of diabetes. The specialized registered complications. One of the common complications of diabetes is search for unmanaged parameters [5], which could result in nurse then provides education about prevention and self-care amputation of the leg above the ankle. Therefore a foot complications. of diabetic foot [11]. The patient is referred to a physician examination and education of patients have been included in the regarding the protocol if necessary. annual check-up of diabetic patients in general practice. We were One of the common complications of diabetes is diabetic interested in whether introducing routine foot examinations in foot, which can result diabetes-related amputation [8]. It would be interesting to look at what happened in 2018, diabetic patients has reduced the prevalence of amputations The prevalence of major amputation (above the ankle) is one as there was a decrease in the number of foot examinations above the ankle. of the quality indicators of chronic care management [4]. and an increase in the number of amputations. The same year, Methods— Retrospectively we analyzed the existing data on In 2011, when the model practices project in family medicine the American Diabetes Association published new dietary amputations above the ankle in diabetic patients and yearly foot started, the prevalence of major amputation due to diabetes guidelines for diabetes [16]. After 2018, we are observing examination frequency in diabetic patients during the period complications was 370,1 per 100.000 patients, who have a slight incrrase, but afterwards a new decrease in amputation 2015–2019. perscribed therapy for diabetes [3]. Preventive foot care is rate. important for reducing the risk of diabetic-related amputation Results— Results clearly show that the number of amputations [9]. Therefore, the foot examination was added as part of the Figure 1: Amputation cases per 100.000 patients with diabetes Most diabetes-related amputations can be prevented by above the ankle is decreasing, when the number of yearly foot protocol for annual check-ups of diabetic patients by in the period 2015–2019. appropriate lifestyle changes, blood sugar management, exams is increasing. specialized registered nurses [10]. A special formular is used Statistical data on yearly foot examination prevalence are regular foot exams, and prompt wound care when needed [1]. Conclusions— Specialized registered nurses play an important for the examination [11], and nurses provide education about collected by the project office of the National Institute of A team-based approach at family practices improved the role in the early detection of complications of diabetes, including foot care [10]. Public Health [13]. Figure 2 presents the prevalence of yearly quality of chronic care management, enabled continuous diabetic foot. Since diabetes is a lifelong disease, the actual foot examinations by specialized registered nurses at family monitoring of patients with diabetes, and patient-centered effectiveness of the work of specialized registered nurses in During the implementation phase of the project of model practices in the observed years. instructions. The opportunity for improving the approach of reducing complications in chronic patients will be observed in the practices in family medicine, diabetologists exposed the team-based diabetes management at the family practice is to future. problem of the high rate of major amputations related to optimize protocols, adjust the quality indicators, and diabetes. This paper was produced because the authors aimed implement improvements [7]. Educating and training Index Terms— amputations, diabetes, foot examination, general to discover whether introducing routine foot examinations in healthcare workers of different profiles about diabetes practice, primary care. diabetic patients has reduced the prevalence of amputations management and preventing its complications can lead to above the ankle. better and more efficient patient outcomes [17]. I. INTRODUCTION II. METHODS Diabetes is one of the most common noncommunicable By reducing complications like major amputation, patients' diseases worldwide [1], and the number of people with A retrospective approach was used to analyse existing data quality of life with diabetes is preserved [18]. Since diabetes is diabetes is increasing [2]. In Slovenia, the estimated obtained from publicly available register of the National a lifelong disease, the actual effectiveness of the work of prevalence of diabetes in 2021 was 145,200 people [3]. Institute of Public Health of Slovenia [12, 13]. Data on specialized registered nurses in reducing complications in The prevalence of diabetes is the number of people diagnosed amputations above the ankle as well as the data on yearly foot chronic patients will be seen in the future. with diabetes in the last 12 months (no matter when the examination frequency in diabetic patients during the period diagnosis was set). In the prevalence of diabetes, the 2015–2019 were analysed. This study proposed a connection REFERENCES prevalence of diabetes type 1 and type 2 are combined [4]. between the increasing number of yearly foot examinations [1] OECD. Health at a Glance 2021: OECD indicators. Paris: OECD With the increasing prevalence of diabetes, there is also a and the decreasing number of amputations among patients with Figure 2: Number of yearly foot examinations by specialized registered Publishing; 2021. rising need to manage and control the disease. diabetes. nurses at family practices in the period 2015–2019. [2] Ministrstvo za zdravje. Vsi za enega! Skupaj za vse nas! [Internet]. 2022 [Cited 2023 Oct 20]. Available from: https://www.obvladajmo IV. DISCUSSION sladkorno.si/wp-content/uploads/2022/12/DPOSB_2020-30_Brosura-01- According to the data from Figure 1 and Figure 2, we can 22_print-za-web.pdf assume that major amputations are decreasing since yearly foot [3] Eržen, I, Zaletel J, Nadrag P. Obvladovanje sladkorne bolezni: ključni exams are increasing. This assumption should not be podatki za leto 2021. Ljubljana: Nacionalni inštitut za javno zdravje; 2022. 28 Specialized registered nurses’ contribution to the Limitations considered as the scientific finding of this study since the correlational analysis was not made. Nevertheless, this reduction of diabetic complications The limitation of this study are many biases due to the lack of important data (such as foot examination providers, types of assumption is supported by studies from abroad, where diabetes, ect.). Therefore, the study has weak rigour and can different authors [14, 15] exposed the benefits of foot provide just the assumptions, not the scientific evidence. examinations regarding preventing complications that could result in major amputation. It is necessary to acknowledge the Metka Žitnik, RN, MS III. RESULTS importance of specialized registered nurses' work with diabetic Patricija Lunežnik, RN, MS patients since they provide most foot examinations [13]. metkazitnik@outlook.com Data on amputations above the ankle are a national quality indicator: "1.3.3 Annual incidence of amputation above the ankle in patients with diabetes" [12]. Figure 1 presents the Specialized registered nurses at family practices are Background—Worldwide the number of people with diabetes is In 2011, the Slovenian Ministry of Health started the project important in major amputation prevention because they increasing. In Slovenia, it was estimated that the prevalence of number of cases of amputations of the lower limbs above the of model practices in family medicine [5]. As the result, independently monitor well-managed patients with diabetes diabetes in 2021 was 145.200 people. With the increasing ankle (major amputation) in patients with diabetes per 100.000 specialized registered nurses independently monitor patients [5]. The same service is provided by specialized registered prevalence of diabetes, there is also a rising need to manage and patients with diabetes in the observed calendar years. with well-managed diabetes based on protocols [6]. Nurses' control the disease. In Slovenia, specialized registered nurses at nurses at diabetic practice on secondary level of health care. general practice offices monitor people with well-managed role is also to manage the register of diabetic patients and to Nurses' extended knowledge and expertise detect the first diabetes and accordingly contribute to reducing the frequency of monitor quality indicators [7]. Based on protocol, nurses potential complications of diabetes. The specialized registered complications. One of the common complications of diabetes is search for unmanaged parameters [5], which could result in nurse then provides education about prevention and self-care amputation of the leg above the ankle. Therefore a foot complications. of diabetic foot [11]. The patient is referred to a physician examination and education of patients have been included in the regarding the protocol if necessary. annual check-up of diabetic patients in general practice. We were One of the common complications of diabetes is diabetic interested in whether introducing routine foot examinations in foot, which can result diabetes-related amputation [8]. It would be interesting to look at what happened in 2018, diabetic patients has reduced the prevalence of amputations The prevalence of major amputation (above the ankle) is one as there was a decrease in the number of foot examinations above the ankle. of the quality indicators of chronic care management [4]. and an increase in the number of amputations. The same year, Methods— Retrospectively we analyzed the existing data on In 2011, when the model practices project in family medicine the American Diabetes Association published new dietary amputations above the ankle in diabetic patients and yearly foot started, the prevalence of major amputation due to diabetes guidelines for diabetes [16]. After 2018, we are observing examination frequency in diabetic patients during the period complications was 370,1 per 100.000 patients, who have a slight incrrase, but afterwards a new decrease in amputation 2015–2019. perscribed therapy for diabetes [3]. Preventive foot care is rate. important for reducing the risk of diabetic-related amputation Results— Results clearly show that the number of amputations [9]. Therefore, the foot examination was added as part of the Figure 1: Amputation cases per 100.000 patients with diabetes Most diabetes-related amputations can be prevented by above the ankle is decreasing, when the number of yearly foot protocol for annual check-ups of diabetic patients by in the period 2015–2019. appropriate lifestyle changes, blood sugar management, exams is increasing. specialized registered nurses [10]. A special formular is used Statistical data on yearly foot examination prevalence are regular foot exams, and prompt wound care when needed [1]. Conclusions— Specialized registered nurses play an important for the examination [11], and nurses provide education about collected by the project office of the National Institute of A team-based approach at family practices improved the role in the early detection of complications of diabetes, including foot care [10]. Public Health [13]. Figure 2 presents the prevalence of yearly quality of chronic care management, enabled continuous diabetic foot. Since diabetes is a lifelong disease, the actual foot examinations by specialized registered nurses at family monitoring of patients with diabetes, and patient-centered effectiveness of the work of specialized registered nurses in During the implementation phase of the project of model practices in the observed years. instructions. The opportunity for improving the approach of reducing complications in chronic patients will be observed in the practices in family medicine, diabetologists exposed the team-based diabetes management at the family practice is to future. problem of the high rate of major amputations related to optimize protocols, adjust the quality indicators, and diabetes. This paper was produced because the authors aimed implement improvements [7]. Educating and training Index Terms— amputations, diabetes, foot examination, general to discover whether introducing routine foot examinations in healthcare workers of different profiles about diabetes practice, primary care. diabetic patients has reduced the prevalence of amputations management and preventing its complications can lead to above the ankle. better and more efficient patient outcomes [17]. I. INTRODUCTION II. METHODS Diabetes is one of the most common noncommunicable By reducing complications like major amputation, patients' diseases worldwide [1], and the number of people with A retrospective approach was used to analyse existing data quality of life with diabetes is preserved [18]. Since diabetes is diabetes is increasing [2]. In Slovenia, the estimated obtained from publicly available register of the National a lifelong disease, the actual effectiveness of the work of prevalence of diabetes in 2021 was 145,200 people [3]. Institute of Public Health of Slovenia [12, 13]. Data on specialized registered nurses in reducing complications in The prevalence of diabetes is the number of people diagnosed amputations above the ankle as well as the data on yearly foot chronic patients will be seen in the future. with diabetes in the last 12 months (no matter when the examination frequency in diabetic patients during the period diagnosis was set). In the prevalence of diabetes, the 2015–2019 were analysed. This study proposed a connection REFERENCES prevalence of diabetes type 1 and type 2 are combined [4]. between the increasing number of yearly foot examinations [1] OECD. Health at a Glance 2021: OECD indicators. Paris: OECD With the increasing prevalence of diabetes, there is also a and the decreasing number of amputations among patients with Figure 2: Number of yearly foot examinations by specialized registered Publishing; 2021. rising need to manage and control the disease. diabetes. nurses at family practices in the period 2015–2019. [2] Ministrstvo za zdravje. Vsi za enega! Skupaj za vse nas! [Internet]. 2022 [Cited 2023 Oct 20]. Available from: https://www.obvladajmo IV. DISCUSSION sladkorno.si/wp-content/uploads/2022/12/DPOSB_2020-30_Brosura-01- According to the data from Figure 1 and Figure 2, we can 22_print-za-web.pdf assume that major amputations are decreasing since yearly foot [3] Eržen, I, Zaletel J, Nadrag P. Obvladovanje sladkorne bolezni: ključni exams are increasing. This assumption should not be podatki za leto 2021. Ljubljana: Nacionalni inštitut za javno zdravje; 2022. 29 [4] Paulin S, Nadrag P, Kelšin N, et al. Ožji nabor kazalnikov za spremljanje Experiences with Telemedicine and Digital Tools obvladovanja sladkorne bolezni v Sloveniji. Ljubljana: Nacionalni inštitut za javno zdravje; 2020. [5] Poplas Susič T, Švab I, Kersnik J. Projekt referenčnih ambulant družinske among Primary Health Care Level Physicians in medicine v Sloveniji. Zdravniški vestnik, 2013; 82:635–647. [6] Medved N, Čuš B, Vračko P, et al. Timska obravnava v referenčnih Pomurje, Slovenia ambulantah družinske medicine [Internet]. 2017 [Cited 2023 Oct 18] Available from: https://www.nijz.si/sites/www.nijz.si/files/ datoteke/clanek_oe_nijz_timska_obravnava_v_radm_04052017.pdf. Original Research [7] Ministrstvo za zdravje. Učinkovitost ambulante družinske medicine za področje nalog diplomirane medicinske sestre [Internet]. 2019 [Cited 2023 Staša Vodička1,2 and Silvija Prainer3 Oct 18]. Available from: https://www.gov.si/assets/ministrstva/MZ/ 1 DOKUMENTI/Organizacija-zdravstvenega-varstva/Mreza/Porocilo-o- Community Health Care Centre Murska Sobota, Murska Sobota, Slovenia ucinkovitosti-ambulant-druzinske-medicine.pdf 2 Faculty of Medicine, University of Maribor, Department of Family Medicine, Maribor, Slovenia 3 [8] Bowling FL, Foley KJ, Boulton AJM. Chapter 14 - Diabetic foot. Community Health Care Centre Gornja Radgona, Gornja Radgona, Slovenia In: Tavakoli M, editor. Diabetic Neuropathy. Exeter: Elsevier; 2022. stasa.vodicka@zd-ms.si p. 223–234. [9] Frykberg RG, Vileikyte L, Boulton AJM, et al. The At-Risk Diabetic Foot: Abstract— Background: In the last decade, and especially in unacceptable way of treating the patient as they did not trust Time to Focus on Prevention. Diabetes Care. 2022;45(10): e144–e145. recent years, we have noticed a rapid development of information digital tools and found the use too difficult. and communication technologies used in healthcare. In the [10] Urbančič Rovan V, Lunder M, Ferjan S, et al. Diabetična noga. In: Pongrac Barlovič D, editor. Slovenske smernice za klinično obravnavo sladkorne reorganization of work due to the Covid-19 pandemic, we quickly Conclusions: Most of the research conducted so far regarding bolezni tipa 2. Ljubljana: Diabetološko združenje Slovenije; 2022. p. 157– accepted and started using telehealth and telemedicine services. telemedicine treatment has focused on the experience and 170. Firstly, the plan for telehealth in the EU was adopted in 2004, satisfaction of patients. They were largely satisfied with the use of since then the European Commission has been encouraging any of the telemedicine modalities (videoconference, telephone [11] Urbančič Rovan V. Diabetična noga. In: Vujičić S, Poljanec Bohnec M, member states to adopt e-health more widely. The result of this is call, asynchronous TM). Innovations and changes bring Žargaj B, editors. Sladkorna bolezen: priročnik za zdravstvene delavce. Ljubljaja: Slovensko osteološko društvo challenges, which is why they are mostly difficult to accept for all ; 2013. p. 331–356. the e-Health project in Slovenia, the goal of which is computerization of Slovenian healthcare. To this date, we have stakeholders. Primary level physicians in Pomurje are mostly in [12] NIJZ podatkovni portal [Internet]. 2023 [Cited 2023 Oct 19]. Available obtained many useful information solutions through this project: favour of its use. However, it should be emphasized that from: https://podatki.nijz.si/pxweb/sl/NIJZ%20podatkovni%20portal/ E-prescription, e-referral, e-consultation, and the Central telemedicine will not completely replace traditional examinations [13] Pisarna za podporo ambulantam družinske medicine. Register kroničnih Register of Patient Data; however, information on physician in the outpatient clinic, but rather complement them. We should bolnikov 2019 [Internet]. 2020 [Cited 2023 Oct 20]. Available from: perspectives about these visits are lacking. embrace the best of both worlds – humanism in medicine and the https://www.gov.si/assets/ministrstva/MZ/DOKUMENTI/Organizacija- use of new technologies to improve health care. It is also necessary zdravstvenega-varstva/Mreza/Porocilo-po-kazalnikih-2019.pdf Methods: We performed a cross-sectional observational study of to take care of adequate technological support, additional [14] Ang GY, Yap CW, Saxen N. Effectiveness of Diabetes Foot Screening in qualitative methodology. The online survey was sent to the e-mail education and appropriate training of health workers, the primary care in preventing lower extremity amputations. Annals of the addresses of all primary physicians in Pomurje according to creation of unified protocols and treatment standards, and a Academy of Medicine of Singapore. 2017; 46:417–423. previous valid list of The Health Insurance Institute of Slovenia solution to the problem of personal data protection. (general or family physicians and paediatricians who work at the [15] Gunes AE, Cimşit M. Can amputation be prevented in diabetic foot? primary level). We used the validated TUQ questionnaire Interdisciplinary approach to diabetic foot: a case report. Undersea and (Telehealth Usability Questionnaire) which we translated and Hyperbaric Medicine. 2017;44(2):157–160. adapted to our conditions. Specialists were asked to forward the Index Terms-- experience, primary health care, physicians, [16] American Diabetes Association. Standards of medical care in diabetes - survey to their residents who are not registered in the specialist’s telemedicine, telehealth, Slovenia 2018. Diabetes Care. 2018; 41:51–s157. database. [17] Ministrstvo za zdravje. Državni program za obvladovanje sladkorne I. INTRODUCTION bolezni 2020-2030: strategija razvoja [Internet]. 2020 [Cited 2023 Oct 18]. Results: Out of 98 mails sent, we have received 104 completed Available from: https://www.gov.si/assets/ministrstva/MZ/ surveys (specialists were instructed to forward the invitation mail WHO's definition of telehealth is the delivery of health care DOKUMENTI/Preventiva-in-skrb-za-zdravje/nenalezljive-bolezni/ to their residents), 77 (74.0%) females and 27 (26.0%) males. 81 services, where distance is a critical factor, by all health care sladkorna-bolezen-2020-2030/dokumenti-z-logotipom/Drzavni-program- (77.9%) were general or family medicine specialists or their professionals using information and communication obvladovanja-sladkorne-bolezni-2020-2030-Strategija-razvoja.pdf residents, 21 (20.2%) paediatrics specialists and their residents, 2 technologies, for the exchange of valid information for [18] Yusof NM, Ahmad AC, Ahmad FS, et al. Quality of life of diabetes (1.9%) were specialist of Occupational medicine. The mean age diagnosis, treatment, and prevention of disease and injuries, amputees following major and minor lower limb amputations. The Medical was 45.912.3 years with a length of service of 18.513.1 years. In research and evaluation, and also for the continuing education journal of Malaysia. 2019;74(1):25–29. general, satisfaction with the use of telemedicine and digital tools is high, which is observed among the younger and older of health care providers, in all the interests of advancing the health of individuals and their communities. (1) Telemedicine physicians. They felt that the system was easy to use and that they could communicate with patients using face-to-face meeting. can be defined as the provision of health services using Those who were not satisfied with the use of telemedical information and telecommunication technologies where one or approaches did not use it. They agreed that it was an more health service providers and the patient are spatially separated. (2, 3) 30 [4] Paulin S, Nadrag P, Kelšin N, et al. Ožji nabor kazalnikov za spremljanje Experiences with Telemedicine and Digital Tools obvladovanja sladkorne bolezni v Sloveniji. Ljubljana: Nacionalni inštitut za javno zdravje; 2020. [5] Poplas Susič T, Švab I, Kersnik J. Projekt referenčnih ambulant družinske among Primary Health Care Level Physicians in medicine v Sloveniji. Zdravniški vestnik, 2013; 82:635–647. [6] Medved N, Čuš B, Vračko P, et al. Timska obravnava v referenčnih Pomurje, Slovenia ambulantah družinske medicine [Internet]. 2017 [Cited 2023 Oct 18] Available from: https://www.nijz.si/sites/www.nijz.si/files/ datoteke/clanek_oe_nijz_timska_obravnava_v_radm_04052017.pdf. Original Research [7] Ministrstvo za zdravje. Učinkovitost ambulante družinske medicine za področje nalog diplomirane medicinske sestre [Internet]. 2019 [Cited 2023 Staša Vodička1,2 and Silvija Prainer3 Oct 18]. Available from: https://www.gov.si/assets/ministrstva/MZ/ 1 DOKUMENTI/Organizacija-zdravstvenega-varstva/Mreza/Porocilo-o- Community Health Care Centre Murska Sobota, Murska Sobota, Slovenia ucinkovitosti-ambulant-druzinske-medicine.pdf 2 Faculty of Medicine, University of Maribor, Department of Family Medicine, Maribor, Slovenia 3 [8] Bowling FL, Foley KJ, Boulton AJM. Chapter 14 - Diabetic foot. Community Health Care Centre Gornja Radgona, Gornja Radgona, Slovenia In: Tavakoli M, editor. Diabetic Neuropathy. Exeter: Elsevier; 2022. stasa.vodicka@zd-ms.si p. 223–234. [9] Frykberg RG, Vileikyte L, Boulton AJM, et al. The At-Risk Diabetic Foot: Abstract— Background: In the last decade, and especially in unacceptable way of treating the patient as they did not trust Time to Focus on Prevention. Diabetes Care. 2022;45(10): e144–e145. recent years, we have noticed a rapid development of information digital tools and found the use too difficult. and communication technologies used in healthcare. In the [10] Urbančič Rovan V, Lunder M, Ferjan S, et al. Diabetična noga. In: Pongrac Barlovič D, editor. Slovenske smernice za klinično obravnavo sladkorne reorganization of work due to the Covid-19 pandemic, we quickly Conclusions: Most of the research conducted so far regarding bolezni tipa 2. Ljubljana: Diabetološko združenje Slovenije; 2022. p. 157– accepted and started using telehealth and telemedicine services. telemedicine treatment has focused on the experience and 170. Firstly, the plan for telehealth in the EU was adopted in 2004, satisfaction of patients. They were largely satisfied with the use of since then the European Commission has been encouraging any of the telemedicine modalities (videoconference, telephone [11] Urbančič Rovan V. Diabetična noga. In: Vujičić S, Poljanec Bohnec M, member states to adopt e-health more widely. The result of this is call, asynchronous TM). Innovations and changes bring Žargaj B, editors. Sladkorna bolezen: priročnik za zdravstvene delavce. Ljubljaja: Slovensko osteološko društvo challenges, which is why they are mostly difficult to accept for all ; 2013. p. 331–356. the e-Health project in Slovenia, the goal of which is computerization of Slovenian healthcare. To this date, we have stakeholders. Primary level physicians in Pomurje are mostly in [12] NIJZ podatkovni portal [Internet]. 2023 [Cited 2023 Oct 19]. Available obtained many useful information solutions through this project: favour of its use. However, it should be emphasized that from: https://podatki.nijz.si/pxweb/sl/NIJZ%20podatkovni%20portal/ E-prescription, e-referral, e-consultation, and the Central telemedicine will not completely replace traditional examinations [13] Pisarna za podporo ambulantam družinske medicine. Register kroničnih Register of Patient Data; however, information on physician in the outpatient clinic, but rather complement them. We should bolnikov 2019 [Internet]. 2020 [Cited 2023 Oct 20]. Available from: perspectives about these visits are lacking. embrace the best of both worlds – humanism in medicine and the https://www.gov.si/assets/ministrstva/MZ/DOKUMENTI/Organizacija- use of new technologies to improve health care. It is also necessary zdravstvenega-varstva/Mreza/Porocilo-po-kazalnikih-2019.pdf Methods: We performed a cross-sectional observational study of to take care of adequate technological support, additional [14] Ang GY, Yap CW, Saxen N. Effectiveness of Diabetes Foot Screening in qualitative methodology. The online survey was sent to the e-mail education and appropriate training of health workers, the primary care in preventing lower extremity amputations. Annals of the addresses of all primary physicians in Pomurje according to creation of unified protocols and treatment standards, and a Academy of Medicine of Singapore. 2017; 46:417–423. previous valid list of The Health Insurance Institute of Slovenia solution to the problem of personal data protection. (general or family physicians and paediatricians who work at the [15] Gunes AE, Cimşit M. Can amputation be prevented in diabetic foot? primary level). We used the validated TUQ questionnaire Interdisciplinary approach to diabetic foot: a case report. Undersea and (Telehealth Usability Questionnaire) which we translated and Hyperbaric Medicine. 2017;44(2):157–160. adapted to our conditions. Specialists were asked to forward the Index Terms-- experience, primary health care, physicians, [16] American Diabetes Association. Standards of medical care in diabetes - survey to their residents who are not registered in the specialist’s telemedicine, telehealth, Slovenia 2018. Diabetes Care. 2018; 41:51–s157. database. [17] Ministrstvo za zdravje. Državni program za obvladovanje sladkorne I. INTRODUCTION bolezni 2020-2030: strategija razvoja [Internet]. 2020 [Cited 2023 Oct 18]. Results: Out of 98 mails sent, we have received 104 completed Available from: https://www.gov.si/assets/ministrstva/MZ/ surveys (specialists were instructed to forward the invitation mail WHO's definition of telehealth is the delivery of health care DOKUMENTI/Preventiva-in-skrb-za-zdravje/nenalezljive-bolezni/ to their residents), 77 (74.0%) females and 27 (26.0%) males. 81 services, where distance is a critical factor, by all health care sladkorna-bolezen-2020-2030/dokumenti-z-logotipom/Drzavni-program- (77.9%) were general or family medicine specialists or their professionals using information and communication obvladovanja-sladkorne-bolezni-2020-2030-Strategija-razvoja.pdf residents, 21 (20.2%) paediatrics specialists and their residents, 2 technologies, for the exchange of valid information for [18] Yusof NM, Ahmad AC, Ahmad FS, et al. Quality of life of diabetes (1.9%) were specialist of Occupational medicine. The mean age diagnosis, treatment, and prevention of disease and injuries, amputees following major and minor lower limb amputations. The Medical was 45.912.3 years with a length of service of 18.513.1 years. In research and evaluation, and also for the continuing education journal of Malaysia. 2019;74(1):25–29. general, satisfaction with the use of telemedicine and digital tools is high, which is observed among the younger and older of health care providers, in all the interests of advancing the health of individuals and their communities. (1) Telemedicine physicians. They felt that the system was easy to use and that they could communicate with patients using face-to-face meeting. can be defined as the provision of health services using Those who were not satisfied with the use of telemedical information and telecommunication technologies where one or approaches did not use it. They agreed that it was an more health service providers and the patient are spatially separated. (2, 3) 31 Telehealth as a professional term has been used since 1990s. only 38% felt comfortable during the consultation with the Slovenia. Its urban center is Murska Sobota, the area is mostly III. RESULTS Telemedicine applications have increased rapidly in many patient. rural. In 2021, this statistical region had the highest average parts of the world during the last decades. Telemonitoring of age of residents, which is 2.3 years higher than the Slovenian Sample demographics chronically ill patients was already introduced in Sweden in Further problems while using virtual tools were concerns that average statistic. The educational structure of the population is 2000 and they computerized clinical decision support systems patients overuse the service, 72% were concerned about less favourable, mainly at the expense of brain drain. Socio- Out of 98 e-mails sent, we received 104 completed surveys to aid telephone triage. In 2010, they evaluated video patients' limited technical knowledge, and 70% claimed that economic indicators point to the poor economic development, (specialists were instructed to forward the invitation mail to consultations between patients and doctors in rural areas. (1,4) patients had limited access to the necessary technology. which lags behind the Slovenian average, and even more so for their residents), 77 (74.0%) females and 27 (26.0%) males. 81 Respondents who successfully included virtual consultations the central Slovenian region, which is the most developed in (77.9%) were general or family medicine specialists or their The first plan for telehealth in the EU was adopted in 2004, in their workflow expressed a higher level of satisfaction. (9) Slovenia. (14) residents, 21 (20.2%) paediatric specialists and their residents, since then the European Commission has been encouraging member states to adopt e-health more widely in Europe. As a In a study carried out at the University of Pittsburgh Medical Table 1: Demographics of Responders result, the e-Health project was established in Slovenia and the Center, it was found that 65% of doctors agree that II. MATERIAL AND METHODS main aim was the computerization of Slovenian healthcare. telemedicine services do not affect their relationship with the N % Survey instrument Nowadays, we have obtained many useful information patient; more than half of them were satisfied with the use of Professional roles solutions through the project: e-prescription, e-referral, e- virtual consultations and agreed that they save time. Doctors Physicians 90 86,5 consultation, and the Central Register of Patient (CRPP). (2,5) and patients agreed that they do not waste so much time driving We used a validated TUQ questionnaire (Telehealth Usability Residents 14 13,5 to medical facilities, this way being more sustainable. Only Questionnaire) (15) on telemedicine use, satisfaction, Speciality Telemedicine services used in primary healthcare in Slovenia 29% of them thought that they could perform a sufficiently experiences and future use, which we translated and adapted to Family medicine specialists 81 77,9 can be classified into three main categories, which are good clinical examination. The final results show that the our conditions. A 21-item 7-point Linkert scale was used with Paediatricians in primary care 21 20,2 combined to achieve the best possible clinical effect. The first majority of respondents confirmed their satisfaction with responses ranging from strongly disagree to strongly agree. is storage and forwarding; the doctor can obtain the data and mandatory virtual education before the COVID-19 epidemic The questionnaire was use for medical physicians who work Occupational medicine specialists 2 1,9 results of examinations from information systems (CRPP) or and that the prior use of the patient's electronic medical record on primary health care level in Pomurje, ranging from the early Sex the patient can provide them to him, e.g. using e-mail or had a positive effect on the rapid adoption of the use of months of Covid-19 pandemic until the present time (from Female 77 74,0 directly from other health service providers with whom it telemedicine. (10) On the other hand, the results of the Swedish February 2020 until March 2023). Male 27 26,0 communicates and coordinates data (e-Consultation). and American (UCLA) studies do not coincide with the claims Total number of responders 104 100 above. Doctors involved are in favour of telemedicine, which Data Collection and statistical analysis The second category is telemonitoring. The measurements are focuses on clinical usefulness. They see the loss of personal made with tested and calibrated devices, analysing the patient's contact with patients as an issue, and the technological We performed a cross-sectional observational study of physiological parameters in the home environment. For infrastructure has not been updated for such needs at the qualitative methodology. The online survey was sent to the e-example, one can monitor the management of chronic diseases primary level of health care. Consequently, they also expressed mail addresses of all primary physicians in Pomurje according 2 (1.9%) were specialist of Occupational medicine. The mean - arterial hypertension and diabetes mellitus type 2. The last worries that these factors will result in harm to the patient and to the then valid list of The Health Insurance Institute of age was 45.912.3 years with a mean length of service of category is a form of communication, whether synchronous will only further increase the workload. (4) In the American Slovenia (general or family physicians and paediatricians who 18.513.1 years. (video or phone call) or asynchronous (e-mail). (2,6,7) study, the results are comparable, but they see the problem that work at the primary level). Specialist physicians were asked to certain vulnerable groups of patients have neither the It was possible to use telemedicine approaches in practice long forward the survey to their residents who are not registered in knowledge nor the necessary technology for this type of care. Survey results before the COVID-19 pandemic, but they were not used to the specialist’s database. They stated that the positive outcome of using video calls is such an extent by healthcare providers at the primary level. (8) that they can see the patient's environment and the conditions Before Covid-19 pandemic there were 36 (34,3%) physicians The outbreak of the COVID-19 pandemic in 2020, which The results of categorical variables were presented in the form they live in. This way, they can see potential safety hazards and that were using telemedical approaches, during Covid-19 resulted in social distancing due to an attempt to limit the of frequencies with the corresponding percentages, and for home support systems. (8) pandemic there were 92 (88,5%) physicians, and after Covid- spread of the virus, greatly accelerated the digitization of numerical variables in the form of mean values with standard 19 pandemic 87 (83,7%) physicians continued using healthcare and the adoption of regulations for the use of deviations. The usefulness of telemedicine was measured During the pandemic, community health centers (CHCs) in telemedical approaches. telemedicine. (4,8) In the recent period, the rapid development using a seven-point Likert scale, all statements were defined as New York State conducted a study on providers' perceptions All of them used or are still using phone calls for of artificial intelligence in primary care and its related clinical numerical variables. A comparison of the utility of of telehealth. Findings suggested that most clinicians agreed communicating with their patients, 5 (4.8%) physicians applications has been causing a lot of concerns. (4) telemedicine between family medicine physicians and that telemedicine has improved patients’ access to medical paediatricians was made using the t-test for independent decided for video calls, 61 (58,7%) physicians communicated Most of the research conducted so far regarding telemedicine care and resulted in fewer patient no-shows. (11) samples because the pairwise analysis included a numerical with their patients using emails, 17 (16,3%) physicians chose treatment has focused on patient perspectives about and a categorical variable with two categories. The usefulness an electronic health record system, 10 (9.6%) physicians used telemedicine visits. Currently, we are less aware how satisfied The present research examines primary health care level of telemedicine in relation to the number of identified patients various applications that work in conjunction with patients' and experienced physicians are with this type of patient care . physicians and their experience with telemedicine and digital was analysed with the Pearson correlation coefficient (all smartphones and 3 (2.7%) physicians decided for various (8) The results show that patient acceptance of telemedicine is tools, as physician acceptance remains vital to telehealth variables included in the analysis were pairs of numerical medical portals for communication (do.zdravnika, Gospodar generally high. Physician attitudes and experiences have been gaining wider and more permanent adoption. Additionally, the type). Statistical analysis was performed using IBM SPSS for zdravja). varied. (4) acceptance of the use of new technologies in medical treatment Microsoft Windows, version 28 (IBM Corp., Armonk, NY). A requires the satisfaction of both doctors and patients. (12,13) value of p<0.05 defined the limit of statistical significance. In a study conducted in Saudi Arabia, 77% of participating physicians were satisfied with the experience of virtual visits. A lot of research has already been done in Slovenia on the topic Telephone calls were used as the main communication tools - of telehealth and telemedicine. Additionally, our study is the 98% of the respondents, with a comfort level of 78%, and 77% first to get an insight into the experiences of doctors at the of the participants also used video consultations; however, primary level of healthcare in the Pomurje region with the use of telemedicine. Pomurje is located in the northeastern part of 32 Telehealth as a professional term has been used since 1990s. only 38% felt comfortable during the consultation with the Slovenia. Its urban center is Murska Sobota, the area is mostly III. RESULTS Telemedicine applications have increased rapidly in many patient. rural. In 2021, this statistical region had the highest average parts of the world during the last decades. Telemonitoring of age of residents, which is 2.3 years higher than the Slovenian Sample demographics chronically ill patients was already introduced in Sweden in Further problems while using virtual tools were concerns that average statistic. The educational structure of the population is 2000 and they computerized clinical decision support systems patients overuse the service, 72% were concerned about less favourable, mainly at the expense of brain drain. Socio- Out of 98 e-mails sent, we received 104 completed surveys to aid telephone triage. In 2010, they evaluated video patients' limited technical knowledge, and 70% claimed that economic indicators point to the poor economic development, (specialists were instructed to forward the invitation mail to consultations between patients and doctors in rural areas. (1,4) patients had limited access to the necessary technology. which lags behind the Slovenian average, and even more so for their residents), 77 (74.0%) females and 27 (26.0%) males. 81 Respondents who successfully included virtual consultations the central Slovenian region, which is the most developed in (77.9%) were general or family medicine specialists or their The first plan for telehealth in the EU was adopted in 2004, in their workflow expressed a higher level of satisfaction. (9) Slovenia. (14) residents, 21 (20.2%) paediatric specialists and their residents, since then the European Commission has been encouraging member states to adopt e-health more widely in Europe. As a In a study carried out at the University of Pittsburgh Medical Table 1: Demographics of Responders result, the e-Health project was established in Slovenia and the Center, it was found that 65% of doctors agree that II. MATERIAL AND METHODS main aim was the computerization of Slovenian healthcare. telemedicine services do not affect their relationship with the N % Survey instrument Nowadays, we have obtained many useful information patient; more than half of them were satisfied with the use of Professional roles solutions through the project: e-prescription, e-referral, e- virtual consultations and agreed that they save time. Doctors Physicians 90 86,5 consultation, and the Central Register of Patient (CRPP). (2,5) and patients agreed that they do not waste so much time driving We used a validated TUQ questionnaire (Telehealth Usability Residents 14 13,5 to medical facilities, this way being more sustainable. Only Questionnaire) (15) on telemedicine use, satisfaction, Speciality Telemedicine services used in primary healthcare in Slovenia 29% of them thought that they could perform a sufficiently experiences and future use, which we translated and adapted to Family medicine specialists 81 77,9 can be classified into three main categories, which are good clinical examination. The final results show that the our conditions. A 21-item 7-point Linkert scale was used with Paediatricians in primary care 21 20,2 combined to achieve the best possible clinical effect. The first majority of respondents confirmed their satisfaction with responses ranging from strongly disagree to strongly agree. is storage and forwarding; the doctor can obtain the data and mandatory virtual education before the COVID-19 epidemic The questionnaire was use for medical physicians who work Occupational medicine specialists 2 1,9 results of examinations from information systems (CRPP) or and that the prior use of the patient's electronic medical record on primary health care level in Pomurje, ranging from the early Sex the patient can provide them to him, e.g. using e-mail or had a positive effect on the rapid adoption of the use of months of Covid-19 pandemic until the present time (from Female 77 74,0 directly from other health service providers with whom it telemedicine. (10) On the other hand, the results of the Swedish February 2020 until March 2023). Male 27 26,0 communicates and coordinates data (e-Consultation). and American (UCLA) studies do not coincide with the claims Total number of responders 104 100 above. Doctors involved are in favour of telemedicine, which Data Collection and statistical analysis The second category is telemonitoring. The measurements are focuses on clinical usefulness. They see the loss of personal made with tested and calibrated devices, analysing the patient's contact with patients as an issue, and the technological We performed a cross-sectional observational study of physiological parameters in the home environment. For infrastructure has not been updated for such needs at the qualitative methodology. The online survey was sent to the e-example, one can monitor the management of chronic diseases primary level of health care. Consequently, they also expressed mail addresses of all primary physicians in Pomurje according 2 (1.9%) were specialist of Occupational medicine. The mean - arterial hypertension and diabetes mellitus type 2. The last worries that these factors will result in harm to the patient and to the then valid list of The Health Insurance Institute of age was 45.912.3 years with a mean length of service of category is a form of communication, whether synchronous will only further increase the workload. (4) In the American Slovenia (general or family physicians and paediatricians who 18.513.1 years. (video or phone call) or asynchronous (e-mail). (2,6,7) study, the results are comparable, but they see the problem that work at the primary level). Specialist physicians were asked to certain vulnerable groups of patients have neither the It was possible to use telemedicine approaches in practice long forward the survey to their residents who are not registered in knowledge nor the necessary technology for this type of care. Survey results before the COVID-19 pandemic, but they were not used to the specialist’s database. They stated that the positive outcome of using video calls is such an extent by healthcare providers at the primary level. (8) that they can see the patient's environment and the conditions Before Covid-19 pandemic there were 36 (34,3%) physicians The outbreak of the COVID-19 pandemic in 2020, which The results of categorical variables were presented in the form they live in. This way, they can see potential safety hazards and that were using telemedical approaches, during Covid-19 resulted in social distancing due to an attempt to limit the of frequencies with the corresponding percentages, and for home support systems. (8) pandemic there were 92 (88,5%) physicians, and after Covid- spread of the virus, greatly accelerated the digitization of numerical variables in the form of mean values with standard 19 pandemic 87 (83,7%) physicians continued using healthcare and the adoption of regulations for the use of deviations. The usefulness of telemedicine was measured During the pandemic, community health centers (CHCs) in telemedical approaches. telemedicine. (4,8) In the recent period, the rapid development using a seven-point Likert scale, all statements were defined as New York State conducted a study on providers' perceptions All of them used or are still using phone calls for of artificial intelligence in primary care and its related clinical numerical variables. A comparison of the utility of of telehealth. Findings suggested that most clinicians agreed communicating with their patients, 5 (4.8%) physicians applications has been causing a lot of concerns. (4) telemedicine between family medicine physicians and that telemedicine has improved patients’ access to medical paediatricians was made using the t-test for independent decided for video calls, 61 (58,7%) physicians communicated Most of the research conducted so far regarding telemedicine care and resulted in fewer patient no-shows. (11) samples because the pairwise analysis included a numerical with their patients using emails, 17 (16,3%) physicians chose treatment has focused on patient perspectives about and a categorical variable with two categories. The usefulness an electronic health record system, 10 (9.6%) physicians used telemedicine visits. Currently, we are less aware how satisfied The present research examines primary health care level of telemedicine in relation to the number of identified patients various applications that work in conjunction with patients' and experienced physicians are with this type of patient care . physicians and their experience with telemedicine and digital was analysed with the Pearson correlation coefficient (all smartphones and 3 (2.7%) physicians decided for various (8) The results show that patient acceptance of telemedicine is tools, as physician acceptance remains vital to telehealth variables included in the analysis were pairs of numerical medical portals for communication (do.zdravnika, Gospodar generally high. Physician attitudes and experiences have been gaining wider and more permanent adoption. Additionally, the type). Statistical analysis was performed using IBM SPSS for zdravja). varied. (4) acceptance of the use of new technologies in medical treatment Microsoft Windows, version 28 (IBM Corp., Armonk, NY). A requires the satisfaction of both doctors and patients. (12,13) value of p<0.05 defined the limit of statistical significance. In a study conducted in Saudi Arabia, 77% of participating physicians were satisfied with the experience of virtual visits. A lot of research has already been done in Slovenia on the topic Telephone calls were used as the main communication tools - of telehealth and telemedicine. Additionally, our study is the 98% of the respondents, with a comfort level of 78%, and 77% first to get an insight into the experiences of doctors at the of the participants also used video consultations; however, primary level of healthcare in the Pomurje region with the use of telemedicine. Pomurje is located in the northeastern part of 33 Figure 1: Proportion of physicians using telemedical approaches before, during and after Covid-19 pandemic. Table 2: Summary Results of 21-item Survey showing Experience with Telemedicine. All Family Paediatrici WƌŽƉŽƌƚŝŽŶŽĨƉŚLJƐŝĐŝĂŶƐƵƐŝŶŐƚĞůĞŵĞĚŝĐĂů responders medicine, ans ĂƉƉƌŽĐŚĞƐ Occupationa (N=104) l medicine (N=21) ϭϬϬ ϴϴ͕ϱ specialists ϴϯ͕ϳ (N=83) ϴϬ MV SD MV SD MV SD t p- ϲϬ value ϯϰ͕ϯ ϰϬ Telehealth improves my patients' access to healthcare services needed. 5,5 1,4 5,5 1,4 5,3 1,4 0,571 0,570 ϮϬ Telehealth saves my patients' time traveling to a hospital or specialist Ϭ clinic. 5,4 1,5 5,4 1,6 5,3 1,3 0,076 0,940 ĞĨŽƌĞŽǀŝĚͲϭϵƉĂŶĚĞŵŝĐ ƵƌŝŶŐŽǀŝĚͲϭϵƉĂŶĚĞŵŝĐ ĨƚĞƌŽǀŝĚͲϭϵƉĂŶĚĞŵŝĐ Telehealth provides for my patients' healthcare need. 5,1 1,5 5,2 1,4 4,7 1,6 1,616 0,109 It was simple to use this system. 4,9 1,8 5,0 1,8 4,5 2,0 1,281 0,203 Figure 2: Proportions of utilization of different kinds of technical modalities in telemedicine. It was easy to learn to use the system. 5,5 1,6 5,7 1,6 5,0 1,9 1,543 0,126 WƌŽƉŽƌƚŝŽŶƐŽĨƵƚŝůŝnjĂƚŝŽŶŽĨĚŝĨĨĞƌĞŶƚŬŝŶĚƐŽĨƚĞĐŶŝĐĂůŵŽĚĂůŝƚŝĞƐŝŶ I believe I could become productive quickly using this system. 5,1 1,9 5,2 1,9 4,6 2,1 1,337 0,184 ƚĞůĞŵĞĚŝĐŝŶĞ The way I interact with this system is pleasant. 4,9 1,6 5,1 1,6 4,1 1,6 2,619 0,010 ϭϮϬ I like using the system. 4,7 1,9 4,9 1,8 3,9 1,9 2,239 0,027 ϭϬϰ The system is simple and easy to understand. 4,9 1,6 4,9 1,6 4,8 1,5 0,270 0,788 ϭϬϬ This system is able to do everything I would want it to be able to do. 3,6 1,7 3,7 1,7 3,2 1,4 1,162 0,248 ϴϬ I can easily talk to the patients using the telehealth system. 4,6 1,8 4,8 1,7 4,1 2,1 1,425 0,157 ϲϭ ϲϬ I can hear the patients clearly using the telehealth system. 4,4 1,6 4,6 1,6 4,0 1,8 1,564 0,121 ϰϬ I felt like patients were able to express myself effectively. 4,1 1,7 4,2 1,7 3,8 1,8 1,011 0,314 ϭϳ Using the telehealth system, I can treat patients as well as if we met in ϮϬ ϭϬ person. 3,6 1,8 3,7 1,8 3,3 1,9 0,862 0,391 ϱ ϯ Ϭ I think the visits provided over the telehealth system are the same as in- WŚŽŶĞĐĂůů sŝĚĞŽĐĂůů ͲŵĂŝů ůĞĐƚƌŽŶŝĐŚĞĂůƚŚ hƐĞŽĨǀĂƌŝŽƵƐ hƐĞŽĨŵĞĚŝĐĂů person visits. 3,3 1,9 3,3 1,9 3,4 1,7 0,251 0,802 ƌĞĐŽƌĚ ĂƉƉůŝĐĂƚŝŽŶƐƚŚĂƚ ƉŽƌƚĂůƐ ŽďƚĂŝŶĚĂƚĂĨƌŽŵƚŚĞ Whenever I made a mistake using the system, I could recover easily and ƉĂƚŝĞŶƚΖƐƉĞƌƐŽŶĂů quickly. 4,6 1,8 4,7 1,7 4,1 1,8 1,434 0,155 ĚŝŐŝƚĂůŵĞƚĞƌƐ The system gave error messages that clearly told me how to fix problems. 3,5 1,7 3,6 1,7 2,9 1,5 1,881 0,063 I feel comfortable communicating with the patients using the telehealth system. 3,2 1,8 3,3 1,8 3,1 1,7 0,250 0,803 Telehealth is an acceptable way to treat my patients. 4,0 1,9 4,0 2,0 4,1 1,9 0,124 0,902 I would use telehealth services again. 4.8 1,9 5,0 1,9 4,4 2,0 1,236 0,219 Overall, I am satisfied with this telehealth system. 4,7 2,0 4,8 1,9 4,1 2,1 1,422 0,158 MV - Mean value of 7-point Linkert scale; SD - Standard deviation, t – t-test for independent samples, p-value - statistically significant difference 34 Figure 1: Proportion of physicians using telemedical approaches before, during and after Covid-19 pandemic. Table 2: Summary Results of 21-item Survey showing Experience with Telemedicine. All Family Paediatrici WƌŽƉŽƌƚŝŽŶŽĨƉŚLJƐŝĐŝĂŶƐƵƐŝŶŐƚĞůĞŵĞĚŝĐĂů responders medicine, ans ĂƉƉƌŽĐŚĞƐ Occupationa (N=104) l medicine (N=21) ϭϬϬ ϴϴ͕ϱ specialists ϴϯ͕ϳ (N=83) ϴϬ MV SD MV SD MV SD t p- ϲϬ value ϯϰ͕ϯ ϰϬ Telehealth improves my patients' access to healthcare services needed. 5,5 1,4 5,5 1,4 5,3 1,4 0,571 0,570 ϮϬ Telehealth saves my patients' time traveling to a hospital or specialist Ϭ clinic. 5,4 1,5 5,4 1,6 5,3 1,3 0,076 0,940 ĞĨŽƌĞŽǀŝĚͲϭϵƉĂŶĚĞŵŝĐ ƵƌŝŶŐŽǀŝĚͲϭϵƉĂŶĚĞŵŝĐ ĨƚĞƌŽǀŝĚͲϭϵƉĂŶĚĞŵŝĐ Telehealth provides for my patients' healthcare need. 5,1 1,5 5,2 1,4 4,7 1,6 1,616 0,109 It was simple to use this system. 4,9 1,8 5,0 1,8 4,5 2,0 1,281 0,203 Figure 2: Proportions of utilization of different kinds of technical modalities in telemedicine. It was easy to learn to use the system. 5,5 1,6 5,7 1,6 5,0 1,9 1,543 0,126 WƌŽƉŽƌƚŝŽŶƐŽĨƵƚŝůŝnjĂƚŝŽŶŽĨĚŝĨĨĞƌĞŶƚŬŝŶĚƐŽĨƚĞĐŶŝĐĂůŵŽĚĂůŝƚŝĞƐŝŶ I believe I could become productive quickly using this system. 5,1 1,9 5,2 1,9 4,6 2,1 1,337 0,184 ƚĞůĞŵĞĚŝĐŝŶĞ The way I interact with this system is pleasant. 4,9 1,6 5,1 1,6 4,1 1,6 2,619 0,010 ϭϮϬ I like using the system. 4,7 1,9 4,9 1,8 3,9 1,9 2,239 0,027 ϭϬϰ The system is simple and easy to understand. 4,9 1,6 4,9 1,6 4,8 1,5 0,270 0,788 ϭϬϬ This system is able to do everything I would want it to be able to do. 3,6 1,7 3,7 1,7 3,2 1,4 1,162 0,248 ϴϬ I can easily talk to the patients using the telehealth system. 4,6 1,8 4,8 1,7 4,1 2,1 1,425 0,157 ϲϭ ϲϬ I can hear the patients clearly using the telehealth system. 4,4 1,6 4,6 1,6 4,0 1,8 1,564 0,121 ϰϬ I felt like patients were able to express myself effectively. 4,1 1,7 4,2 1,7 3,8 1,8 1,011 0,314 ϭϳ Using the telehealth system, I can treat patients as well as if we met in ϮϬ ϭϬ person. 3,6 1,8 3,7 1,8 3,3 1,9 0,862 0,391 ϱ ϯ Ϭ I think the visits provided over the telehealth system are the same as in- WŚŽŶĞĐĂůů sŝĚĞŽĐĂůů ͲŵĂŝů ůĞĐƚƌŽŶŝĐŚĞĂůƚŚ hƐĞŽĨǀĂƌŝŽƵƐ hƐĞŽĨŵĞĚŝĐĂů person visits. 3,3 1,9 3,3 1,9 3,4 1,7 0,251 0,802 ƌĞĐŽƌĚ ĂƉƉůŝĐĂƚŝŽŶƐƚŚĂƚ ƉŽƌƚĂůƐ ŽďƚĂŝŶĚĂƚĂĨƌŽŵƚŚĞ Whenever I made a mistake using the system, I could recover easily and ƉĂƚŝĞŶƚΖƐƉĞƌƐŽŶĂů quickly. 4,6 1,8 4,7 1,7 4,1 1,8 1,434 0,155 ĚŝŐŝƚĂůŵĞƚĞƌƐ The system gave error messages that clearly told me how to fix problems. 3,5 1,7 3,6 1,7 2,9 1,5 1,881 0,063 I feel comfortable communicating with the patients using the telehealth system. 3,2 1,8 3,3 1,8 3,1 1,7 0,250 0,803 Telehealth is an acceptable way to treat my patients. 4,0 1,9 4,0 2,0 4,1 1,9 0,124 0,902 I would use telehealth services again. 4.8 1,9 5,0 1,9 4,4 2,0 1,236 0,219 Overall, I am satisfied with this telehealth system. 4,7 2,0 4,8 1,9 4,1 2,1 1,422 0,158 MV - Mean value of 7-point Linkert scale; SD - Standard deviation, t – t-test for independent samples, p-value - statistically significant difference 35 All five positive weak correlations (r<0.3) were shown, as for ordering. From this point of view, it is interesting that In general, satisfaction with the use of telemedicine and digital not use it, mostly because they did not think it was an physicians with a larger number of patients expressed a 58.7% of participants communicate with their patients via e-tools is enormous. They agree the most by stating that acceptable way of treating the patient as they did not trust statistically significant higher degree of agreement with the mail, while less than 3% of doctors use online medical portals, “Telehealth improves my patients' access to healthcare digital tools and found their use too difficult. next statements: “This system is able to do everything I would which represent a solution to legal restrictions regarding the services needed” and “It was easy to learn to use the system”. want it to be able to do”, “Using the telehealth system, I can protection of personal data. These portals are Gospodar zdravja They felt that “the system was easy to use” and that they could There was a statistically significant difference between family treat patients as well as if we met in person”, “I think the visits and doZdravnika, which enable medical institutions and communicate with patients using face-to-face meetings. They medicine and occupational medicine specialists and provided over the telehealth system are the same as in-person patients to send all types of documents securely electronically, disagreed the most in the following statements: “I feel paediatricians in statements: “The way I interact with this visits”, “I feel comfortable communicating with the patients i.e. manage all administration and securely conduct video comfortable communicating with the patients using the system is pleasant” and “I like using the system”, whereas using the telehealth system” and “Telehealth is an acceptable consultations with a family physician. (17,18). In the Arabic telehealth system” and “I think the visits provided over the family medicine and occupational medicine specialists way to treat my patients”. study, only 2% of doctors used email for communication. (9) telehealth system are the same as in-person visits”. Those who expressed statistically significantly greater agreement than IV. DISCUSSION A Swedish study from 2019 analysed the experience of using were not satisfied with the use of telemedical approaches did paediatricians. an e-consultation platform. Patients with psychological In primary care clinics, telemedicine services are readily problems and those who often need a doctor's advice gained a Table 3: Correlations between the number of patients and statements. available and have been used for a long time. The extent to lot, as they could write a message about their problems outside which they are used depends mainly on the doctor and his of working hours. They observed a reduction in anxiety and r p-value decision for this type of communication. In this study, we thus a reduction in the need for the number of follow-up analysed the experience of doctors at the primary health care examinations. However, with the introduction of the platform, Telehealth improves my patients' access to healthcare services needed. 0,003 0,975 level in Pomurje region in this field. Furthermore, with the the amount of work has increased, thereby reducing overall collected data, we tried to emphasize which technical Telehealth saves my patients' time traveling to a hospital or specialist clinic. 0,095 0,340 efficiency. (19) modalities in telemedicine still have a lot of potential for improvement in the future. Telehealth provides for my patients' healthcare need. 0,084 0,394 In our study, the participants agreed that telehealth improves patients' access to healthcare services and the system was easy It was simple to use this system. -0,031 0,754 During the pandemic, prevention of the spread of SARS-COV- to use. The participants disagreed the most in the following 2 infection was the main facilitator of the rapid adoption and statements: “I feel comfortable communicating with the It was easy to learn to use the system. -0,014 0,888 use of telecommunication and information technologies in all patients using the telehealth system” and “I think the visits primary care clinics. Only 34% of respondents used these provided over the telehealth system are the same as in-person I believe I could become productive quickly using this system. -0,063 0,523 services before the declaration of the pandemic which is visits. Similar results were described in the Pittsburgh study, confirmed by the fact that telemedicine approaches had already where the participants were of the opinion that telemedicine The way I interact with this system is pleasant. -0,015 0,877 been used by 88.5% of participants during the pandemic. This improves access to health care and that working with the percentage remained almost unchanged even after the end of I like using the system. 0,031 0,752 system is simple and they learned it quickly. The majority were the pandemic (83.7%), which indicates the satisfaction of the satisfied with the compulsory, as well as voluntary education majority of stakeholders with these services. Similar results The system is simple and easy to understand. 0,068 0,492 through video content. Only 22% of participating primary care were projected in a survey in the USA, where in 2016 only specialists were of the opinion that video visits are as good as This system is able to do everything I would want it to be able to do. 0,293 0,003 11.8% of family doctors and pediatricians used telemedicine, a regular in-person visit. Differing from our study, they were but after two months of the pandemic in 2020, this proportion satisfied with communication with patients via the medical I can easily talk to the patients using the telehealth system. 0,106 0,283 increased to 91%. (16) platform, and even more 65% of them believed that the provider-patient relationship is unimpaired. (10) I can hear the patients clearly using the telehealth system. 0,113 0,253 All participants in our study (100%) used telephone calls to communicate with patients. These findings support the results I felt like patients were able to express myself effectively. 0,214 0,029 There was a statistically significant difference between family of a study carried out in Saudi Arabia that the telephone call is medicine and occupational medicine specialists and the most frequently used and thus the primary telemedicine Using the telehealth system, I can treat patients as well as if we met in person. 0,294 0,002 pediatricians in the following statements: “The way I interact modality in outpatient clinics, which also increases access to with this system is pleasant” and “I like using the system”, I think the visits provided over the telehealth system are the same as in-person visits. 0,264 0,007 health services in the future. A major difference is in the use of where Family medicine and occupational medicine specialists video calls, as 77% of respondents use them, and in Pomurje expressed statistically significantly greater agreement than Whenever I made a mistake using the system, I could recover easily and quickly. 0,087 0,378 region, the usage is less than 5%. Therefore, we prefer greater pediatricians. Less satisfaction with the use of telemedicine privacy and ease of use offered by a telephone call instead of services among pediatricians probably originates from the fact The system gave error messages that clearly told me how to fix problems. 0,152 0,124 the advantages offered by a video call. The following factors that they also often use telephone calls in Pomurje, where, are: improved patient engagement, the ability to use visual compared to a traditional visit to the outpatient clinic, the I feel comfortable communicating with the patients using the telehealth system. 0,244 0,013 perceptions for clinical examination needs, understanding non- visual and tactile aspects are missing. In this case, doctors only verbal communication and a more comprehensive insight into Telehealth is an acceptable way to treat my patients. 0,229 0,020 have to decide on further action based on the obtained history. the patient's life, including social support, hygiene, and Consequently, it is challenging to fully rely on a history medication adherence. (11) I would use telehealth services again. 0,085 0,392 obtained by a child or a concerned parent. This also helped raise the awareness that children compensate for health Overall, I am satisfied with this telehealth system. 0,120 0,227 As a result, the video call brings a new meaning to traditional problems very well and for a long time, and at the same time, house visit. (8) The legislation in the field of personal data we can get the false feeling that they are still in good health. r - Pearson's correlation coefficient, p-value - statistically significant difference protection in Slovenia prohibits us from providing patients The decompensation is drastically fast. A review of the with medical information, diagnoses, and advice on the literature on this topic suggests that telemedicine services are treatment of medical conditions using an e-mail which is only comparable to face-to-face services (in the general population 36 All five positive weak correlations (r<0.3) were shown, as for ordering. From this point of view, it is interesting that In general, satisfaction with the use of telemedicine and digital not use it, mostly because they did not think it was an physicians with a larger number of patients expressed a 58.7% of participants communicate with their patients via e-tools is enormous. They agree the most by stating that acceptable way of treating the patient as they did not trust statistically significant higher degree of agreement with the mail, while less than 3% of doctors use online medical portals, “Telehealth improves my patients' access to healthcare digital tools and found their use too difficult. next statements: “This system is able to do everything I would which represent a solution to legal restrictions regarding the services needed” and “It was easy to learn to use the system”. want it to be able to do”, “Using the telehealth system, I can protection of personal data. These portals are Gospodar zdravja They felt that “the system was easy to use” and that they could There was a statistically significant difference between family treat patients as well as if we met in person”, “I think the visits and doZdravnika, which enable medical institutions and communicate with patients using face-to-face meetings. They medicine and occupational medicine specialists and provided over the telehealth system are the same as in-person patients to send all types of documents securely electronically, disagreed the most in the following statements: “I feel paediatricians in statements: “The way I interact with this visits”, “I feel comfortable communicating with the patients i.e. manage all administration and securely conduct video comfortable communicating with the patients using the system is pleasant” and “I like using the system”, whereas using the telehealth system” and “Telehealth is an acceptable consultations with a family physician. (17,18). In the Arabic telehealth system” and “I think the visits provided over the family medicine and occupational medicine specialists way to treat my patients”. study, only 2% of doctors used email for communication. (9) telehealth system are the same as in-person visits”. Those who expressed statistically significantly greater agreement than IV. DISCUSSION A Swedish study from 2019 analysed the experience of using were not satisfied with the use of telemedical approaches did paediatricians. an e-consultation platform. Patients with psychological In primary care clinics, telemedicine services are readily problems and those who often need a doctor's advice gained a Table 3: Correlations between the number of patients and statements. available and have been used for a long time. The extent to lot, as they could write a message about their problems outside which they are used depends mainly on the doctor and his of working hours. They observed a reduction in anxiety and r p-value decision for this type of communication. In this study, we thus a reduction in the need for the number of follow-up analysed the experience of doctors at the primary health care examinations. However, with the introduction of the platform, Telehealth improves my patients' access to healthcare services needed. 0,003 0,975 level in Pomurje region in this field. Furthermore, with the the amount of work has increased, thereby reducing overall collected data, we tried to emphasize which technical Telehealth saves my patients' time traveling to a hospital or specialist clinic. 0,095 0,340 efficiency. (19) modalities in telemedicine still have a lot of potential for improvement in the future. Telehealth provides for my patients' healthcare need. 0,084 0,394 In our study, the participants agreed that telehealth improves patients' access to healthcare services and the system was easy It was simple to use this system. -0,031 0,754 During the pandemic, prevention of the spread of SARS-COV- to use. The participants disagreed the most in the following 2 infection was the main facilitator of the rapid adoption and statements: “I feel comfortable communicating with the It was easy to learn to use the system. -0,014 0,888 use of telecommunication and information technologies in all patients using the telehealth system” and “I think the visits primary care clinics. Only 34% of respondents used these provided over the telehealth system are the same as in-person I believe I could become productive quickly using this system. -0,063 0,523 services before the declaration of the pandemic which is visits. Similar results were described in the Pittsburgh study, confirmed by the fact that telemedicine approaches had already where the participants were of the opinion that telemedicine The way I interact with this system is pleasant. -0,015 0,877 been used by 88.5% of participants during the pandemic. This improves access to health care and that working with the percentage remained almost unchanged even after the end of I like using the system. 0,031 0,752 system is simple and they learned it quickly. The majority were the pandemic (83.7%), which indicates the satisfaction of the satisfied with the compulsory, as well as voluntary education majority of stakeholders with these services. Similar results The system is simple and easy to understand. 0,068 0,492 through video content. Only 22% of participating primary care were projected in a survey in the USA, where in 2016 only specialists were of the opinion that video visits are as good as This system is able to do everything I would want it to be able to do. 0,293 0,003 11.8% of family doctors and pediatricians used telemedicine, a regular in-person visit. Differing from our study, they were but after two months of the pandemic in 2020, this proportion satisfied with communication with patients via the medical I can easily talk to the patients using the telehealth system. 0,106 0,283 increased to 91%. (16) platform, and even more 65% of them believed that the provider-patient relationship is unimpaired. (10) I can hear the patients clearly using the telehealth system. 0,113 0,253 All participants in our study (100%) used telephone calls to communicate with patients. These findings support the results I felt like patients were able to express myself effectively. 0,214 0,029 There was a statistically significant difference between family of a study carried out in Saudi Arabia that the telephone call is medicine and occupational medicine specialists and the most frequently used and thus the primary telemedicine Using the telehealth system, I can treat patients as well as if we met in person. 0,294 0,002 pediatricians in the following statements: “The way I interact modality in outpatient clinics, which also increases access to with this system is pleasant” and “I like using the system”, I think the visits provided over the telehealth system are the same as in-person visits. 0,264 0,007 health services in the future. A major difference is in the use of where Family medicine and occupational medicine specialists video calls, as 77% of respondents use them, and in Pomurje expressed statistically significantly greater agreement than Whenever I made a mistake using the system, I could recover easily and quickly. 0,087 0,378 region, the usage is less than 5%. Therefore, we prefer greater pediatricians. Less satisfaction with the use of telemedicine privacy and ease of use offered by a telephone call instead of services among pediatricians probably originates from the fact The system gave error messages that clearly told me how to fix problems. 0,152 0,124 the advantages offered by a video call. The following factors that they also often use telephone calls in Pomurje, where, are: improved patient engagement, the ability to use visual compared to a traditional visit to the outpatient clinic, the I feel comfortable communicating with the patients using the telehealth system. 0,244 0,013 perceptions for clinical examination needs, understanding non- visual and tactile aspects are missing. In this case, doctors only verbal communication and a more comprehensive insight into Telehealth is an acceptable way to treat my patients. 0,229 0,020 have to decide on further action based on the obtained history. the patient's life, including social support, hygiene, and Consequently, it is challenging to fully rely on a history medication adherence. (11) I would use telehealth services again. 0,085 0,392 obtained by a child or a concerned parent. This also helped raise the awareness that children compensate for health Overall, I am satisfied with this telehealth system. 0,120 0,227 As a result, the video call brings a new meaning to traditional problems very well and for a long time, and at the same time, house visit. (8) The legislation in the field of personal data we can get the false feeling that they are still in good health. r - Pearson's correlation coefficient, p-value - statistically significant difference protection in Slovenia prohibits us from providing patients The decompensation is drastically fast. A review of the with medical information, diagnoses, and advice on the literature on this topic suggests that telemedicine services are treatment of medical conditions using an e-mail which is only comparable to face-to-face services (in the general population 37 and in the children treatment). Moreover, clear consensus on telemedicine; even after the end of the pandemic and the lifting 5. eZdravje. Ljubljana 2020: Ministrstvo za zdravje. https://www.jabfm.org/content/34/6/1103.long the benefits of telemedicine approaches in pediatrics has not of restrictive measures, many digital tools remain present in Available online: https://ezdrav.si/ezdravje/ (accessed on 1 September 2023). been reached. The management of chronic health conditions the daily routine of respondents, especially doctors with a (accessed on 1 September 2023). 12. Nguyen M, Waller M, Pandya A, Portnoy J. A with telemedicine approaches has so far shown a lot of larger number of patients are satisfied with this method of 6. Mihevc M, Zavrnik Č, Mori Lukančič M, Virtič T, Review of Patient and Provider Satisfaction with satisfaction and prospects for the future, especially when treatment. For these methods, the doctors must know their Prevolnik Rupel V, Petek Šter M, Klemenc Ketiš Z, Telemedicine. Curr Allergy Asthma Rep. 2020 Sep combined with personal visits. (20) patient well in his biopsychosocial environment and master the Poplas Susič A. Telemonitoring of Elderly with 22;20(11):72. doi: 10.1007/s11882-020-00969-7. skills of other types of communication as well as understand Hypertension and Type 2 Diabetes at the Primary Available online: During the study, we compared satisfaction or the degree of and accept the limitations of these methods of treatment. Given Care Level: Protocol for a Multicentric Randomized https://www.ncbi.nlm.nih.gov/pmc/articles/PMC750 agreement with the statements between doctors working in these assumptions, telemedicine has a great potential to Controlled Pilot Study. Zdr Varst. 2022 Sep 5720/ (accessed on 1 September 2023). clinics with a higher and those with a lower number of improve access to health services - including subspecialty ones 28;61(4):216-223. doi: 10.2478/sjph-2022-0029. 13. Hoff T, Lee D. Physician Satisfaction With identified patients. Statements that showed a statistically - for all doctors and patients, regardless of where they live. Available online: Telehealth: A Systematic Review and Agenda for significant higher level of agreement among doctors with a This is only possible by analysing the existing situation and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC959 Future Research. Quality Management in Health Care larger number of patients are: “This system is able to do constant improvements. 7900/ (accessed on 1 September 2023). 31(3):p 160-169, July/September 2022. doi: everything I would want it to be able to do”, “Using the 7. Kopčavar-Guček N. Tele(družinska)medicina – 10.1097/QMH.0000000000000359 Available online: telehealth system, I can treat patients as well as if we met in Funding Statement zdravljenje na daljavo. In: Klemenc-Ketiš Z (ed.). https://journals.lww.com/qmhcjournal/abstract/2022/ person”, “I think the visits provided over the telehealth system Sodobne infromacijske tehnologije v družinski 07000/physician_satisfaction_with_telehealth__a.9.a are the same as in-person visits”, “I feel comfortable This research received no external funding. medicini.Učno gradivo za 27 učne delavnice za spx# (accessed on 1 September 2023). communicating with the patients using the telehealth system” zdravnike družinske medicine. Ljubljana 2010: 14. Pomurska regija. Statistični urad Republike and “Telehealth is an acceptable way to treat my patients”. Conflicts of interest Združenje zdravnikov družinske medicine; 31-35. Slovenije. Available online: The authors declare that no conflicts of interest exist. Available online: https://www.stat.si/obcine/sl/Region/Index/1 None of the existing studies have attempted to compare this https://dokumen.tips/documents/sodobne- (accessed on 8 September 2023). correlation so far. The results confirm the findings from the Ethical approval informacijske-tehnologije-v-druzinski- 15. University of Pittsburgh School of Health and American study that telemedicine visits are shorter on average medicini.html?page=1 (accessed on 1 September Rehabilitation Sciences Department of Health than in-person visits. (8) In clinics with more identified The research carried no risk of violating ethical principles. 2023). Information ManagementTelehealth Usability patients, time management is much more important than in 8. Gomez T, Anaya YB, Shih KJ, Tarn DM. A Questionnaire. Available online: smaller clinics. At the same time, they must treat and take care REFERENCES Qualitative Study of Primary Care Physicians' https://www.google.com/url?sa=t&rct=j&q=&esrc=s of a larger number of patients, so they are forced to solve Experiences With Telemedicine During COVID-19. &source=web&cd=&ved=2ahUKEwjGt_388ZqBAx simple problems, such as extending prescriptions, control 1. Kruse CS, Krowski N, Rodriguez B, Tran L, Vela J, J Am Board Fam Med. 2021 Feb;34(Suppl):S61-S70. UyiP0HHQhJBmkQFnoECBkQAQ&url=https%3A referrals and other administrative services in the shortest time Brooks M. Telehealth and patient satisfaction: a doi: 10.3122/jabfm.2021.S1.200517. Available %2F%2Fux.hari.pitt.edu%2Fv2%2Fapi%2Fdownloa possible. Furthermore, they can ensure that other patients with systematic review and narrative analysis. BMJ Open. online: d%2FTUQ_English.pdf&usg=AOvVaw1IxL60LUQ more complex problems have fast enough access to a doctor 2017 Aug 3;7(8):e016242. doi: 10.1136/bmjopen- https://www.jabfm.org/content/34/Supplement/S61.l EY3-j5OEQB2qO&opi=89978449 (accessed on 8 and quality treatment. 2017-016242. Available online: ong (accessed on 1 September 2023). September 2023). https://bmjopen.bmj.com/content/7/8/e016242.long 9. Wali R, Shakir M, Jaha A, Alhumaidah R, (accessed on 1 September 2023). 16. North S. Telemedicine in the time of COVID and Strengths and limitations Jamaluddin HA. Primary Care Physician's Perception 2. Verdnik A, Virtič T, Dinevski D. Telemedicinske beyond. J Adolesc Health 2020 Aug;67(2): 145-146. and Satisfaction With Telehealth in the National storitve v družinski medicini. Infor Med Slov. Available online: This was the first study conducted in Pomurje region on Guard Primary Healthcare Centers in Jeddah, Saudi 2021;26(1-2):32–38 Available online: https://doi.org/10.1016/j.jadohealth.2020.05.024 experiences with telemedicine and digital tools among primary Arabia in 2022. Cureus. 2023 Mar 21;15(3):e36480. https://ims.mf.uni- (accessed on 12 September 2023). care physicians. One of the crucial elements during our study doi: 10.7759/cureus.36480. Available online: lj.si/ims_archive/proofreading/26/06.pdf (accessed 17. DoZdravnika – predstavitev. Naklo, 2021: SRC was the large response of the participants and the use of a https://www.ncbi.nlm.nih.gov/pmc/articles/PMC101 on 1 September 2023). Infonet. Available online: validated questionnaire. However, the results of this study 15745/ (accessed on 1 September 2023). 3. Dinevski D, Kelc R, Dugonik B. Video https://dozdravnika.si/predstavitev/ (accessed on 8 cannot be generalized for all primary care physicians in 10. Saiyed S, Nguyen A, Singh R. Physician Perspective communication in telemedicine. In: Graschew G, September 2023). Slovenia because of specific socioeconomic and age and Key Satisfaction Indicators with Rapid Roelofs TA (eds.). Advances in telemedicine: 18. Varna elektronska komunikacija – varni ePosvet. characteristics of Pomurje region. Another interesting point Telehealth Adoption During the Coronavirus Disease technologies, enabling factors and scenarios. Rijeka Ljubljana, 2017: Gospodar zdravja. Available online: would be the number of distance visits made by each individual 2019 Pandemic. Telemed J E Health. 2021 2011: InTech; 211– 232. Available online: https://www.gospodar-zdravja.si/ePosvet-z- and whether they had any training on this topic, and to include Nov;27(11):1225-1234. doi: 10.1089/tmj.2020.0492. https://doi.org/10.5772/13553 (accessed on 1 zdravnikom/ (accessed on 12 September 2023). doctors at the secondary level in the research. This way, we Epub 2021 Jan 29. Available online: September 2023). 19. Eriksson P, Hammar T, Lagrosen S, Nilsson E. would get a complete picture of the current experience with https://www.liebertpub.com/doi/10.1089/tmj.2020.0 4. Glock H, Milos Nymberg V, Borgström Bolmsjö B, Digital consultation in primary healthcare: the effects telemedicine among doctors in Pomurje region. 492?url_ver=Z39.88- Holm J, Calling S, Wolff M, Pikkemaat on access, efficiency and patient safety based on 2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=c M. Attitudes, Barriers, and Concerns Regarding provider experience; a qualitative study. Scand J Prim r_pub++0pubmed (accessed on 1 September 2023). V. C Health Care. 2022 Dec;40(4):498-506. doi: ONCLUSION Telemedicine Among Swedish Primary Care 11. Chang JE, Lindenfeld Z, Albert SL, Massar R, Physicians: A Qualitative Study. Int J Gen Med. 2021 10.1080/02813432.2022.2159200. Available online: Shelley D, Kwok L, Fennelly K, Berry CA. Dec 1;14:9237-9246. doi: 10.2147/IJGM.S334782. https://www.tandfonline.com/doi/citedby/10.1080/0 Telephone vs. Video Visits During COVID-19: The majority of doctors at the primary level in Pomurje have PMID: 34880663; PMCID: PMC8646113. Available 2813432.2022.2159200?scroll=top&needAccess=tru Safety-Net Provider Perspectives. J Am Board Fam some experience with telemedicine, most of them are agree online e&role=tab (accessed on 12 September 2023). Med. 2021 Nov-Dec;34(6):1103-1114. doi: that digital tools increase the accessibility of health services, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC864 20. Shah AC, Badawy SM. Telemedicine in Pediatrics: 10.3122/jabfm.2021.06.210186. Available online: are easy to learn to use, and save patients’ time spent traveling 6113/ (accessed on 1 September 2023). Systematic Review of Randomized Controlled Trials. to institutions. Most of them have a positive view of JMIR Pediatr Parent. 2021 Feb 24;4(1):e22696. doi: 38 and in the children treatment). Moreover, clear consensus on telemedicine; even after the end of the pandemic and the lifting 5. eZdravje. Ljubljana 2020: Ministrstvo za zdravje. https://www.jabfm.org/content/34/6/1103.long the benefits of telemedicine approaches in pediatrics has not of restrictive measures, many digital tools remain present in Available online: https://ezdrav.si/ezdravje/ (accessed on 1 September 2023). been reached. The management of chronic health conditions the daily routine of respondents, especially doctors with a (accessed on 1 September 2023). 12. Nguyen M, Waller M, Pandya A, Portnoy J. A with telemedicine approaches has so far shown a lot of larger number of patients are satisfied with this method of 6. Mihevc M, Zavrnik Č, Mori Lukančič M, Virtič T, Review of Patient and Provider Satisfaction with satisfaction and prospects for the future, especially when treatment. For these methods, the doctors must know their Prevolnik Rupel V, Petek Šter M, Klemenc Ketiš Z, Telemedicine. Curr Allergy Asthma Rep. 2020 Sep combined with personal visits. (20) patient well in his biopsychosocial environment and master the Poplas Susič A. Telemonitoring of Elderly with 22;20(11):72. doi: 10.1007/s11882-020-00969-7. skills of other types of communication as well as understand Hypertension and Type 2 Diabetes at the Primary Available online: During the study, we compared satisfaction or the degree of and accept the limitations of these methods of treatment. Given Care Level: Protocol for a Multicentric Randomized https://www.ncbi.nlm.nih.gov/pmc/articles/PMC750 agreement with the statements between doctors working in these assumptions, telemedicine has a great potential to Controlled Pilot Study. Zdr Varst. 2022 Sep 5720/ (accessed on 1 September 2023). clinics with a higher and those with a lower number of improve access to health services - including subspecialty ones 28;61(4):216-223. doi: 10.2478/sjph-2022-0029. 13. Hoff T, Lee D. Physician Satisfaction With identified patients. Statements that showed a statistically - for all doctors and patients, regardless of where they live. Available online: Telehealth: A Systematic Review and Agenda for significant higher level of agreement among doctors with a This is only possible by analysing the existing situation and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC959 Future Research. Quality Management in Health Care larger number of patients are: “This system is able to do constant improvements. 7900/ (accessed on 1 September 2023). 31(3):p 160-169, July/September 2022. doi: everything I would want it to be able to do”, “Using the 7. Kopčavar-Guček N. Tele(družinska)medicina – 10.1097/QMH.0000000000000359 Available online: telehealth system, I can treat patients as well as if we met in Funding Statement zdravljenje na daljavo. In: Klemenc-Ketiš Z (ed.). https://journals.lww.com/qmhcjournal/abstract/2022/ person”, “I think the visits provided over the telehealth system Sodobne infromacijske tehnologije v družinski 07000/physician_satisfaction_with_telehealth__a.9.a are the same as in-person visits”, “I feel comfortable This research received no external funding. medicini.Učno gradivo za 27 učne delavnice za spx# (accessed on 1 September 2023). communicating with the patients using the telehealth system” zdravnike družinske medicine. Ljubljana 2010: 14. Pomurska regija. Statistični urad Republike and “Telehealth is an acceptable way to treat my patients”. Conflicts of interest Združenje zdravnikov družinske medicine; 31-35. Slovenije. Available online: The authors declare that no conflicts of interest exist. Available online: https://www.stat.si/obcine/sl/Region/Index/1 None of the existing studies have attempted to compare this https://dokumen.tips/documents/sodobne- (accessed on 8 September 2023). correlation so far. The results confirm the findings from the Ethical approval informacijske-tehnologije-v-druzinski- 15. University of Pittsburgh School of Health and American study that telemedicine visits are shorter on average medicini.html?page=1 (accessed on 1 September Rehabilitation Sciences Department of Health than in-person visits. (8) In clinics with more identified The research carried no risk of violating ethical principles. 2023). Information ManagementTelehealth Usability patients, time management is much more important than in 8. Gomez T, Anaya YB, Shih KJ, Tarn DM. A Questionnaire. Available online: smaller clinics. At the same time, they must treat and take care REFERENCES Qualitative Study of Primary Care Physicians' https://www.google.com/url?sa=t&rct=j&q=&esrc=s of a larger number of patients, so they are forced to solve Experiences With Telemedicine During COVID-19. &source=web&cd=&ved=2ahUKEwjGt_388ZqBAx simple problems, such as extending prescriptions, control 1. Kruse CS, Krowski N, Rodriguez B, Tran L, Vela J, J Am Board Fam Med. 2021 Feb;34(Suppl):S61-S70. UyiP0HHQhJBmkQFnoECBkQAQ&url=https%3A referrals and other administrative services in the shortest time Brooks M. Telehealth and patient satisfaction: a doi: 10.3122/jabfm.2021.S1.200517. Available %2F%2Fux.hari.pitt.edu%2Fv2%2Fapi%2Fdownloa possible. Furthermore, they can ensure that other patients with systematic review and narrative analysis. BMJ Open. online: d%2FTUQ_English.pdf&usg=AOvVaw1IxL60LUQ more complex problems have fast enough access to a doctor 2017 Aug 3;7(8):e016242. doi: 10.1136/bmjopen- https://www.jabfm.org/content/34/Supplement/S61.l EY3-j5OEQB2qO&opi=89978449 (accessed on 8 and quality treatment. 2017-016242. Available online: ong (accessed on 1 September 2023). September 2023). https://bmjopen.bmj.com/content/7/8/e016242.long 9. Wali R, Shakir M, Jaha A, Alhumaidah R, (accessed on 1 September 2023). 16. North S. Telemedicine in the time of COVID and Strengths and limitations Jamaluddin HA. Primary Care Physician's Perception 2. Verdnik A, Virtič T, Dinevski D. Telemedicinske beyond. J Adolesc Health 2020 Aug;67(2): 145-146. and Satisfaction With Telehealth in the National storitve v družinski medicini. Infor Med Slov. Available online: This was the first study conducted in Pomurje region on Guard Primary Healthcare Centers in Jeddah, Saudi 2021;26(1-2):32–38 Available online: https://doi.org/10.1016/j.jadohealth.2020.05.024 experiences with telemedicine and digital tools among primary Arabia in 2022. Cureus. 2023 Mar 21;15(3):e36480. https://ims.mf.uni- (accessed on 12 September 2023). care physicians. One of the crucial elements during our study doi: 10.7759/cureus.36480. Available online: lj.si/ims_archive/proofreading/26/06.pdf (accessed 17. DoZdravnika – predstavitev. Naklo, 2021: SRC was the large response of the participants and the use of a https://www.ncbi.nlm.nih.gov/pmc/articles/PMC101 on 1 September 2023). Infonet. Available online: validated questionnaire. However, the results of this study 15745/ (accessed on 1 September 2023). 3. Dinevski D, Kelc R, Dugonik B. Video https://dozdravnika.si/predstavitev/ (accessed on 8 cannot be generalized for all primary care physicians in 10. Saiyed S, Nguyen A, Singh R. Physician Perspective communication in telemedicine. In: Graschew G, September 2023). Slovenia because of specific socioeconomic and age and Key Satisfaction Indicators with Rapid Roelofs TA (eds.). Advances in telemedicine: 18. Varna elektronska komunikacija – varni ePosvet. characteristics of Pomurje region. Another interesting point Telehealth Adoption During the Coronavirus Disease technologies, enabling factors and scenarios. Rijeka Ljubljana, 2017: Gospodar zdravja. Available online: would be the number of distance visits made by each individual 2019 Pandemic. Telemed J E Health. 2021 2011: InTech; 211– 232. Available online: https://www.gospodar-zdravja.si/ePosvet-z- and whether they had any training on this topic, and to include Nov;27(11):1225-1234. doi: 10.1089/tmj.2020.0492. https://doi.org/10.5772/13553 (accessed on 1 zdravnikom/ (accessed on 12 September 2023). doctors at the secondary level in the research. This way, we Epub 2021 Jan 29. Available online: September 2023). 19. Eriksson P, Hammar T, Lagrosen S, Nilsson E. would get a complete picture of the current experience with https://www.liebertpub.com/doi/10.1089/tmj.2020.0 4. Glock H, Milos Nymberg V, Borgström Bolmsjö B, Digital consultation in primary healthcare: the effects telemedicine among doctors in Pomurje region. 492?url_ver=Z39.88- Holm J, Calling S, Wolff M, Pikkemaat on access, efficiency and patient safety based on 2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=c M. Attitudes, Barriers, and Concerns Regarding provider experience; a qualitative study. Scand J Prim r_pub++0pubmed (accessed on 1 September 2023). V. C Health Care. 2022 Dec;40(4):498-506. doi: ONCLUSION Telemedicine Among Swedish Primary Care 11. Chang JE, Lindenfeld Z, Albert SL, Massar R, Physicians: A Qualitative Study. Int J Gen Med. 2021 10.1080/02813432.2022.2159200. Available online: Shelley D, Kwok L, Fennelly K, Berry CA. Dec 1;14:9237-9246. doi: 10.2147/IJGM.S334782. https://www.tandfonline.com/doi/citedby/10.1080/0 Telephone vs. Video Visits During COVID-19: The majority of doctors at the primary level in Pomurje have PMID: 34880663; PMCID: PMC8646113. Available 2813432.2022.2159200?scroll=top&needAccess=tru Safety-Net Provider Perspectives. J Am Board Fam some experience with telemedicine, most of them are agree online e&role=tab (accessed on 12 September 2023). Med. 2021 Nov-Dec;34(6):1103-1114. doi: that digital tools increase the accessibility of health services, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC864 20. Shah AC, Badawy SM. Telemedicine in Pediatrics: 10.3122/jabfm.2021.06.210186. Available online: are easy to learn to use, and save patients’ time spent traveling 6113/ (accessed on 1 September 2023). Systematic Review of Randomized Controlled Trials. to institutions. Most of them have a positive view of JMIR Pediatr Parent. 2021 Feb 24;4(1):e22696. doi: 39 10.2196/22696. Available online: Patient Portal and Central Registry of Patient Data: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC807 8694/ (accessed on 14 September 2023). leading accelerators of healthcare digitalisation in Slovenia Živa Rant, MSc1, Jure Janet1, assist. prof. Dalibor Stanimirović, PhD2 National Institute of Public Health, Slovenia1, University of Ljubljana, Faculty of Public Administration2 The corresponding author: Ziva.Rant@nijz.si Abstract— Slovenia is one of the most digitally advanced nations broader implications centred around increased social wellin Europe when it comes to healthcare. The previous years have being and economic growth [5]. seen a significant progress in the development and use of the eHealth, which has been led by the National Institute of eHealth applications, particularly during the COVID-19 Public Health (NIPH) since 2015, is one of the key long-term pandemic. The zVEM Patient Portal and the Central Registry of goals of the public sector in Slovenia. Despite certain Patient Data have made the most notable advancements. This challenges, great progress has been made in the field of eHealth paper presents an in-depth analysis of the functionalities and use of the zVEM Patient Portal and the Central Registry of Patient solutions in the last years. The COVID-19 epidemic has in Data, and additionally investigates how the COVID-19 epidemic many ways marked the development of the entire healthcare has affected the development and use of these two eHealth informatics in Slovenia. The paper presents an in-depth analysis solutions. The zVEM Patient Portal provides users with secure of the functionality and use of the zVEM web portal and the and reliable access to eHealth services and personal health data, CRPD in the last years, especially during the COVID-19 which is retrieved from the Central Registry of Patient Data. The epidemic. Today, this is without a doubt the most complex data on use of the zVEM Patient Portal and the Central Registry public information system in Slovenia. The use of the zVEM of Patient Data shows a big jump in 2020 and further exponential and the CRPD has been growing exponentially in the last two growth in 2021. Increased use continues in 2022. years. Although eHealth solutions have undergone unprecedented development in recent years, much effort will Index Terms-- zVEM Patient Portal, Central Registry of Patient have to be made by all stakeholders in the future and additional Data, eHealth, digitalisation, healthcare informatics human and material resources will have to be provided, if we want to maintain progress and perhaps even accelerate the development trend in healthcare informatics in Slovenia. I. I NTRODUCTION II. MATERIAL AND METHODS eHealth is the cornerstone of the healthcare digitalisation initiatives in Slovenia. Slovenia is one of the most digitally This paper presents an in-depth analysis of the functionalities advanced nations in Europe when it comes to healthcare [1]. and use of the zVEM and the CRPD, and additionally The previous years have seen significant progress in the investigates how the COVID-19 epidemic has affected the development and use of the eHealth applications, particularly development and use of the zVEM and the CRPD solutions. during the COVID-19 pandemic. The zVEM Patient Portal This is an extreme example of the development process in the (zVEM) and the Central Registry of Patient Data (CRPD) have field of eHealth solutions in Slovenia, which was highly made the most notable advancements. accelerated during the COVID-19 period, suggesting that the The effective and comprehensive digital transformation of the pandemic was a particular opportunity for rapid advancement Slovenian healthcare system is one of the fundamental changes in the digitalisation domain. The in-depth analysis presented in that should contribute to greater success in dealing with the this paper was based on the case study research methodology numerous challenges facing Slovenia’s healthcare sector. The [6,7], which included an in-depth study of the field and its experiences of developed countries [2,3,4] indicate that critical analysis. successfully implemented projects of digitalising healthcare This article presents an analysis of the functionalities and use have exceptional strategic importance for the further of the zVEM and the CRPD in recent years, especially during development of the healthcare system, and they also point to the COVID-19 pandemic. The analysis performed in this work was based on the case study research methodology and was 40 10.2196/22696. Available online: Patient Portal and Central Registry of Patient Data: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC807 8694/ (accessed on 14 September 2023). leading accelerators of healthcare digitalisation in Slovenia Živa Rant, MSc1, Jure Janet1, assist. prof. Dalibor Stanimirović, PhD2 National Institute of Public Health, Slovenia1, University of Ljubljana, Faculty of Public Administration2 The corresponding author: Ziva.Rant@nijz.si Abstract— Slovenia is one of the most digitally advanced nations broader implications centred around increased social wellin Europe when it comes to healthcare. The previous years have being and economic growth [5]. seen a significant progress in the development and use of the eHealth, which has been led by the National Institute of eHealth applications, particularly during the COVID-19 Public Health (NIPH) since 2015, is one of the key long-term pandemic. The zVEM Patient Portal and the Central Registry of goals of the public sector in Slovenia. Despite certain Patient Data have made the most notable advancements. This challenges, great progress has been made in the field of eHealth paper presents an in-depth analysis of the functionalities and use of the zVEM Patient Portal and the Central Registry of Patient solutions in the last years. The COVID-19 epidemic has in Data, and additionally investigates how the COVID-19 epidemic many ways marked the development of the entire healthcare has affected the development and use of these two eHealth informatics in Slovenia. The paper presents an in-depth analysis solutions. The zVEM Patient Portal provides users with secure of the functionality and use of the zVEM web portal and the and reliable access to eHealth services and personal health data, CRPD in the last years, especially during the COVID-19 which is retrieved from the Central Registry of Patient Data. The epidemic. Today, this is without a doubt the most complex data on use of the zVEM Patient Portal and the Central Registry public information system in Slovenia. The use of the zVEM of Patient Data shows a big jump in 2020 and further exponential and the CRPD has been growing exponentially in the last two growth in 2021. Increased use continues in 2022. years. Although eHealth solutions have undergone unprecedented development in recent years, much effort will Index Terms-- zVEM Patient Portal, Central Registry of Patient have to be made by all stakeholders in the future and additional Data, eHealth, digitalisation, healthcare informatics human and material resources will have to be provided, if we want to maintain progress and perhaps even accelerate the development trend in healthcare informatics in Slovenia. I. I NTRODUCTION II. MATERIAL AND METHODS eHealth is the cornerstone of the healthcare digitalisation initiatives in Slovenia. Slovenia is one of the most digitally This paper presents an in-depth analysis of the functionalities advanced nations in Europe when it comes to healthcare [1]. and use of the zVEM and the CRPD, and additionally The previous years have seen significant progress in the investigates how the COVID-19 epidemic has affected the development and use of the eHealth applications, particularly development and use of the zVEM and the CRPD solutions. during the COVID-19 pandemic. The zVEM Patient Portal This is an extreme example of the development process in the (zVEM) and the Central Registry of Patient Data (CRPD) have field of eHealth solutions in Slovenia, which was highly made the most notable advancements. accelerated during the COVID-19 period, suggesting that the The effective and comprehensive digital transformation of the pandemic was a particular opportunity for rapid advancement Slovenian healthcare system is one of the fundamental changes in the digitalisation domain. The in-depth analysis presented in that should contribute to greater success in dealing with the this paper was based on the case study research methodology numerous challenges facing Slovenia’s healthcare sector. The [6,7], which included an in-depth study of the field and its experiences of developed countries [2,3,4] indicate that critical analysis. successfully implemented projects of digitalising healthcare This article presents an analysis of the functionalities and use have exceptional strategic importance for the further of the zVEM and the CRPD in recent years, especially during development of the healthcare system, and they also point to the COVID-19 pandemic. The analysis performed in this work was based on the case study research methodology and was 41 conducted in the first half of 2023. On one hand, the analysis from the Central Population Register (CRP) and the national included a comprehensive literature review in the field, and Survey and Mapping Administration. Patients themselves can examination of project documentation and technical also express their consent, and can make vaccination bookings specifications for the zVEM and the CRPD. On the other hand, (Fig. 1). it was based on the observations, experience, and professional opinions of experts at the NIJZ who are managing the eHealth system (including the zVEM and the CRPD), along with the actual statistical data on the use of the zVEM and the CRPD from the administrative and business intelligence modules. This paper focuses on the zVEM and CRPD principally because of their usability and importance both for patients and for healthcare workers, and also because of the major progress in the last years. The synthesis of findings from the literature, Figure 3: Growth in the number of visits to the zVEM by year user functionalities from the technical documents, statistical Figure 4. Growth in the number of documents in the CRPD by year. reports and the views of the NIJZ experts, enable the formulation of credible conclusions based on verifiable data zVEM plus (zVEM for healthcare providers) regarding the highlighted research aims. IV. DISCUSSION The zVEM plus portal includes various applications, The zVEM surely delivers significant benefits to all connected to the Slovenian CRPD, which enable the capture of III. RESULTS stakeholders in the Slovenian healthcare system. In addition to Figure 1. Display of data on the zVEM. data and its processing, and the issuing of various reports for the basic benefits of access to eHealth solutions and medical healthcare providers. It is intended for providers that do not use documentation already mentioned, the zVEM is a vital zVEM Patient Portal their own information system for this, such as retirement instrument for patient empowerment and directing public health homes, mobile testing points etc. Some of the most widely In 2021, the number of registered users of the zVEM increased initiatives and communication with the public, especially more than ninefold, reaching 409,900 at the end of 2021. In used applications of zVEM plus include the OKZ app for the The greatest development in terms of the digitalisation of during the critical times (the COVID-19 crisis). From the 2022, the number of registered users is still growing, but at a healthcare in Slovenia in the last years has been observed in the issuing of the Personal medication card and the COVID-19 test patient's point of view, the development and establishment of much slower pace (Fig. 2). zVEM system [8,9]. The zVEM was designed as a linking app for efficient entry of COVID-tests into the database. In the the zVEM is certainly one of the major gains in recent decades. service and the central hub of primary eHealth solutions for future, the system will be upgraded to a more fully-fledged During the epidemic, the zVEM took on an important role in patients, for enabling secure and efficient access to their appointment management and communication system, through informing and raising public awareness. referrals, prescriptions, specialist reports and other documents, which patients will be able to get appointments, ask for The zVEM and the CRPD are constantly being developed and online booking of appointments to secondary services and prescriptions and communicate with their health-care and upgraded, and while this increases their wider usability, it reviewing waiting periods [10]. From the patient's point of providers. The investment was financed by the European also inevitably increases their complexity. In the time of the view, the development and establishment of the zVEM is Union from the European Regional Development Fund as part epidemic all the upgrades needed to be developed and certainly one of the major gains in recent decades. Technically, of the EU-wide response to the COVID-19 pandemic [10]. implemented in the shortest possible time. For some solutions the system was set up in the conclusion of the eHealth project we could use already existing ideas with adjustments, while in November 2015, while its full use, with the possibility of some needed to be done from the scratch. These developments registration, was ensured at the beginning of 2017 [11,9]. The The Central Registry of Patient Data – CRPD would not have been possible without previous work on zVEM provides users with secure and reliable access to their introducing, maintaining and developing the core services of data in the eHealth databases and access to eHealth services. It The data displayed via the zVEM is drawn from the CRPD. the zVEM, the CRPD, and other eHealth solutions. also offers users current content in the area of public health [12]. Today, the CRPD contains a database on patients with The zVEM was put into successful use at the beginning of 2017, permanent or temporary residence in the Republic of Slovenia All this placed great pressure on the insufficient number of and its use experienced a major step forward in 2020 and again and is the most complex public information system in the staff in the area of eHealth. This seriously impacts the eHealth in 2021, with the possibility of printing out the COVID-19 test Figure 2. Growth in the number of registered users of the zVEM by year. country. budget, since upgrading and developing new services requires results and vaccination status, along with the European Digital both initial investment costs and long-term costs for COVID Certificate. The first digital vaccination certificate Sending data to the CRPD is obligatory under the Health Care maintenance and for recruiting new staff members who will could be printed out on 19 March 2021, while the EU Digital The number of unique visits to the zVEM portal also increased Databases Act (ZZPPZ) [13], and thus all healthcare providers ensure the operation of these systems. The COVID-19 epidemic COVID Certificate (EU DCC) could be printed from 24 June exponentially in 2021, reaching 23,975,212 at the end of the are required to use this system. Data is also submitted by clearly illustrated the importance of the eHealth system for the 2021. Since 13 July 2021 the zVEM application has also been year, almost 13 times the number in 2020. The exponential concession holders and private operators without a concession. Slovenian healthcare sector, since it can be asserted without available to mobile phone users, and users have been able to growth is mainly due to the introduction of certificates of Data processing in the CRPD, access to data, exchange of data doubt that without the eHealth system individual segments of download the application for verifying the EU DCC since 5 testing and certificates of vaccination against COVID-19, and for providing medical care and autopsy services, and updating the healthcare service in Slovenia would have collapsed, and a August 2021 [9]. in particular the possibility to print out the EU DCP in July health documentation is regulated by this Act as well [9]. major portion of the system would be seriously crippled and limited in its operations. The greatest harm in such a situation Healthcare providers send out specialist reports, discharge 2021. The high number of visits in 2022 is also recorded in The data on the number of documents in the CRPD shows a big would be suffered by patients. letters and data for the Patient Summary. The databases comparison to 2020, although it is down by a third compared to jump in 2020 and further exponential growth in 2021. At the contained within the eHealth system are used to complete data 2021 (Fig. 3). end of 2021, the number of documents in the CRPD has reached The research results revealed that the COVID-19 epidemic on prescriptions (eRecept), referrals and appointments 129,010,388. The rapid growth continued in 2022, when the had a major impact on the development and use of the zVEM (eNaročanje) and vaccinations (eRCO). Insurance data is number of documents exceeded 182,000,000 (Fig. 4). and the CRPD solutions. During the epidemic, use of the transferred from the national Health Insurance Institute (ZZZS) eHealth system grew in leaps and bounds, and in some areas files. Demographic data is transferred from the Register of increased more than tenfold. Due to the growing requirements Patients and Spatial Units (RPPE), which is regularly updated of users and needs of the system (patient needs, public health 42 conducted in the first half of 2023. On one hand, the analysis from the Central Population Register (CRP) and the national included a comprehensive literature review in the field, and Survey and Mapping Administration. Patients themselves can examination of project documentation and technical also express their consent, and can make vaccination bookings specifications for the zVEM and the CRPD. On the other hand, (Fig. 1). it was based on the observations, experience, and professional opinions of experts at the NIJZ who are managing the eHealth system (including the zVEM and the CRPD), along with the actual statistical data on the use of the zVEM and the CRPD from the administrative and business intelligence modules. This paper focuses on the zVEM and CRPD principally because of their usability and importance both for patients and for healthcare workers, and also because of the major progress in the last years. The synthesis of findings from the literature, Figure 3: Growth in the number of visits to the zVEM by year user functionalities from the technical documents, statistical Figure 4. Growth in the number of documents in the CRPD by year. reports and the views of the NIJZ experts, enable the formulation of credible conclusions based on verifiable data zVEM plus (zVEM for healthcare providers) regarding the highlighted research aims. IV. DISCUSSION The zVEM plus portal includes various applications, The zVEM surely delivers significant benefits to all connected to the Slovenian CRPD, which enable the capture of III. RESULTS stakeholders in the Slovenian healthcare system. In addition to Figure 1. Display of data on the zVEM. data and its processing, and the issuing of various reports for the basic benefits of access to eHealth solutions and medical healthcare providers. It is intended for providers that do not use documentation already mentioned, the zVEM is a vital zVEM Patient Portal their own information system for this, such as retirement instrument for patient empowerment and directing public health homes, mobile testing points etc. Some of the most widely In 2021, the number of registered users of the zVEM increased initiatives and communication with the public, especially more than ninefold, reaching 409,900 at the end of 2021. In used applications of zVEM plus include the OKZ app for the The greatest development in terms of the digitalisation of during the critical times (the COVID-19 crisis). From the 2022, the number of registered users is still growing, but at a healthcare in Slovenia in the last years has been observed in the issuing of the Personal medication card and the COVID-19 test patient's point of view, the development and establishment of much slower pace (Fig. 2). zVEM system [8,9]. The zVEM was designed as a linking app for efficient entry of COVID-tests into the database. In the the zVEM is certainly one of the major gains in recent decades. service and the central hub of primary eHealth solutions for future, the system will be upgraded to a more fully-fledged During the epidemic, the zVEM took on an important role in patients, for enabling secure and efficient access to their appointment management and communication system, through informing and raising public awareness. referrals, prescriptions, specialist reports and other documents, which patients will be able to get appointments, ask for The zVEM and the CRPD are constantly being developed and online booking of appointments to secondary services and prescriptions and communicate with their health-care and upgraded, and while this increases their wider usability, it reviewing waiting periods [10]. From the patient's point of providers. The investment was financed by the European also inevitably increases their complexity. In the time of the view, the development and establishment of the zVEM is Union from the European Regional Development Fund as part epidemic all the upgrades needed to be developed and certainly one of the major gains in recent decades. Technically, of the EU-wide response to the COVID-19 pandemic [10]. implemented in the shortest possible time. For some solutions the system was set up in the conclusion of the eHealth project we could use already existing ideas with adjustments, while in November 2015, while its full use, with the possibility of some needed to be done from the scratch. These developments registration, was ensured at the beginning of 2017 [11,9]. The The Central Registry of Patient Data – CRPD would not have been possible without previous work on zVEM provides users with secure and reliable access to their introducing, maintaining and developing the core services of data in the eHealth databases and access to eHealth services. It The data displayed via the zVEM is drawn from the CRPD. the zVEM, the CRPD, and other eHealth solutions. also offers users current content in the area of public health [12]. Today, the CRPD contains a database on patients with The zVEM was put into successful use at the beginning of 2017, permanent or temporary residence in the Republic of Slovenia All this placed great pressure on the insufficient number of and its use experienced a major step forward in 2020 and again and is the most complex public information system in the staff in the area of eHealth. This seriously impacts the eHealth in 2021, with the possibility of printing out the COVID-19 test Figure 2. Growth in the number of registered users of the zVEM by year. country. budget, since upgrading and developing new services requires results and vaccination status, along with the European Digital both initial investment costs and long-term costs for COVID Certificate. The first digital vaccination certificate Sending data to the CRPD is obligatory under the Health Care maintenance and for recruiting new staff members who will could be printed out on 19 March 2021, while the EU Digital The number of unique visits to the zVEM portal also increased Databases Act (ZZPPZ) [13], and thus all healthcare providers ensure the operation of these systems. The COVID-19 epidemic COVID Certificate (EU DCC) could be printed from 24 June exponentially in 2021, reaching 23,975,212 at the end of the are required to use this system. Data is also submitted by clearly illustrated the importance of the eHealth system for the 2021. Since 13 July 2021 the zVEM application has also been year, almost 13 times the number in 2020. The exponential concession holders and private operators without a concession. Slovenian healthcare sector, since it can be asserted without available to mobile phone users, and users have been able to growth is mainly due to the introduction of certificates of Data processing in the CRPD, access to data, exchange of data doubt that without the eHealth system individual segments of download the application for verifying the EU DCC since 5 testing and certificates of vaccination against COVID-19, and for providing medical care and autopsy services, and updating the healthcare service in Slovenia would have collapsed, and a August 2021 [9]. in particular the possibility to print out the EU DCP in July health documentation is regulated by this Act as well [9]. major portion of the system would be seriously crippled and limited in its operations. The greatest harm in such a situation Healthcare providers send out specialist reports, discharge 2021. The high number of visits in 2022 is also recorded in The data on the number of documents in the CRPD shows a big would be suffered by patients. letters and data for the Patient Summary. The databases comparison to 2020, although it is down by a third compared to jump in 2020 and further exponential growth in 2021. At the contained within the eHealth system are used to complete data 2021 (Fig. 3). end of 2021, the number of documents in the CRPD has reached The research results revealed that the COVID-19 epidemic on prescriptions (eRecept), referrals and appointments 129,010,388. The rapid growth continued in 2022, when the had a major impact on the development and use of the zVEM (eNaročanje) and vaccinations (eRCO). Insurance data is number of documents exceeded 182,000,000 (Fig. 4). and the CRPD solutions. During the epidemic, use of the transferred from the national Health Insurance Institute (ZZZS) eHealth system grew in leaps and bounds, and in some areas files. Demographic data is transferred from the Register of increased more than tenfold. Due to the growing requirements Patients and Spatial Units (RPPE), which is regularly updated of users and needs of the system (patient needs, public health 43 needs, the needs of healthcare providers, the needs of healthcare [6] Yin, R. K. (2018). Case study research and applications : design How cultural and demographic characteristics influence policy), numerous existing features were upgraded, and many and methods (6th ed.). Sage.van Gemert-Pijnen, J. E., Nijland, N., new functionalities were developed. van Limburg, M., Ossebaard, H. C., Kelders, S. M., Eysenbach, G., & Seydel, E. R. (2011). A holistic framework to improve the uptake the use of primary care services in village area in North and impact of eHealth technologies. Journal of medical Internet research, 13(4), e111. V. C Macedonia ONCLUSIONS [7] Kljajić Borštnar, M. (2021). Raziskovanje informacijskih sistemov : učbenik (p. 1 spletni vir (1 datoteka PDF (45 ))). Fakulteta za organizacijske vede. In recent years, Slovenia's eHealth system has undergone https://estudij.um.si/pluginfile.php/676575/mod_resource/content/ Sashka Janevska¹, Katerina Kovachevikj², Elizabeta Kostovska Prilepchanska³, Katarina Stavrikj⁴ significant development, which was accelerated by the 2/U%C4%8Dbenik%20raziskovalna%20metodologija%20Kljaji %C4%87%20Bor%C5%A1tnar%20Mirjana%202021.pdf GPO ,Vita Katerina” Skopje N Macedonia¹; GPO ,Vita Katerina” Skopje N Macedonia²; Commission for evaluation of COVID-19 pandemic. The use of some eHealth applications working ability, Fund for Pension and Disability Insurance of NRM³; Center of Family medicine, Medical Faculty, has increased more than tenfold. [8] Stanimirović, D. (2021). eHealth Patient Portal - becoming an indispensable public health tool in the time of COVID-19. In J. UKIM, Skopje⁴ This in turn has brought up difficulties that have arisen to a Mantas (Ed.), Public Health and Informatics : the future of co- large extent due to the inadequate investment in digitalisation, created eHealth : 31st Medical Informatics in Europe Conference both in terms of HR and infrastructure, and also with regard to (MIE 2021), online 29-31 May 2021 (Issue 281, pp. 880–884). IOS sashkamitovska@yahoo.com Press. developing existing and new systems. There is relatively low level of awareness of the benefits of eHealth, which has been [9] Rant, Ž., Stanimirović, D., & Janet, J. (2022). Functionalities and Abstract quality of care to every patient, regardless of cultural or ethnic use of the zVEM Patient Portal and the Central Registry of Patient background. gradually improving, unfortunately, mainly due to the COVID- Data. 35 Th Bled eConference Digital Restructuring and Human Background: Individual values, beliefs, and behaviors about health 19 pandemic. The system was also very much exposed to the (Re)Action, 65–79. https://doi.org/10.18690/UM.FOV.4.2022.4 and well-being are shaped by various factors such as race, ethnicity, Index Terms—cultural characteristics, ethnicity, islamic patients, poor digital literacy of users, including the most basic use of [10] Janet, J., & Stanimirović, D. (2020). Prenova portala zVEM. In T. nationality, language, gender, socioeconomic status, physical and primary care services computer and telecommunications equipment, as well as Marčun & E. Dornik (Eds.), Digitalni mostovi v zdravstvu : e- mental ability, sexual orientation and occupation. Understanding the computer and information literacy and the use of software Kongres MI’2020 : zbornik prispevkov in povzetkov : Ljubljana, 5. culture, demographic characteristics, religion and providing health november 2020 (pp. 55–59). SDMI. I. INTRODUCTION systems themselves. The digital culture in healthcare care services that are acceptable to Albanian community have institutions needs to be raised, along with the digital [11] Rant, Ž., Stanimirović, D., Tepej Jočić, L., Žlender, A., Gaspari, I., particular challenge. Aim of the study is to describe the cultural, competence of all employees. Digital culture is also important Božič, D., Indihar, S., Beštek, M., Simeunovič, B., Vrečko, A., ethnical and demographic characteristics of the Albanian ethnic In primary care settings, cultural perception and Matetić, V., & Zidarn, J. (2018). Rešitve e-Zdravja. In I. Eržen for the close cohesion of informatics and other areas of work population and their access to health care in a general practice in a competence attitude are imperative as notion of health, illness, (Ed.), 30 let Slovenskega društva za medicinsko informatiko : village near Skopje. Method: Descriptive study based on the data from in organisations, eliminating the traditional divergence. Here, [publikacija ob 30-letnici Slovenskega društva za medicinsko sickness, and care means different to different people [1]. the electronic health register and the manually recorded data in the Individual values, beliefs, and behaviors about health and well-the digital competence of all employees is very important. informatiko] (pp. 184–190). Slovensko društvo za medicinsko informatiko. patients' paper health records of registered patientsin the maternal being are shaped by various factors such as race, ethnicity, The research also implies that the enormous progress that has outpatient clinic aged ≥ 0 months. Results: 4137 patients from nationality, language, gender, socioeconomic status, physical been made in healthcare informatics over the past few years [12] Rant, Ž., Stanimirović, D., & Žlender, A. (2019). Nacionalni Portal zVEM v okviru eZdravja = National portal zVEM within eHealth. Albanian ethnicity registered in the GPs practice from all ages. Two and mental ability, sexual orientation and occupation. The can only be maintained in the future with the successful In P. Šprajc, I. Podbregar, D. Maletič, & M. Radovanović (Eds.), specialists of family medicine from Macedonian ethnicity and 3 knowledge of cultural and ethnical characteristics facilitate promotion of eHealth and significant additional resources. Ekosistem organizacij v dobi digitalizacije [Elektronski vir] : medical nurses from Albanian ethnicity work in the medical teams. healthcare providers to afford improved care and helps to avert Major efforts will be needed, as well as funds, to maintain and konferenčni zbornik = [Ecosystem of organizations in the digital Communication with patients is mostly carried out in the Albanian age : conference proceedings (pp. 873–884). Univerzitetna založba misunderstandings among care provider's staff, patients and continue the truly huge progress made in healthcare language. The birth rate is higher than the Macedonian population. In Univerze. their families. However, similar to ethnicity and culture, informatics in recent years. the past 5 years there is increased emigration of young families in the [13] ZZPPZ. (2021). Zakon o zbirkah podatkov s področja EU countries. Rate of childhood immunization is very high (94%), religion can be an important determinant of health outcomes zdravstvenega varstva (Uradni list RS, št. 65/00, 47/15, 31/18, but the rate of screening programs for chronic diseases is not at a and warrants explicit attention in public health work [2]. The 152/20 – ZZUOOP, 175/20 – ZIUOPDVE, 203/20 – ZIUPOPDVE literature has suggested that different religions may both hinder R satisfactory level (43.3%). Gynecological visits are regular, but use of EFERENCES in 112/21 – ZNUPZ). contraceptives (0.5%) is on low rate with small number of abortions. and enable good health [3]. For example, Ramadan fasting may Among the population there is a very high percentage of smokers pose health risks, while Islamic injunctions against sexual [1] European Commission. (2019). Digital Economy and Society promiscuity and imbibing alcohol, as well as a recommendation (42%) with approximately 3/4 male smokers over 10 years of age. Index (DESI); 2019 Country Report; Slovenia. Patients expect immediate health care for any acute condition against smoking, may promote health [4]. https://ec.europa.eu/newsroom/dae/document.cfm?doc_id=59912 (regardless of the level of urgency), while they often postpone Understanding the culture, religion and providing health [2] Bokolo A. J. (2021). Application of telemedicine and eHealth preventive and control examinations for chronic diseases. Adherence care services that are acceptable to Albanian community with technology for clinical services in response to COVID 19 to the prescribed therapy is at a high level, with the exception of the pandemic. Health and technology, 1–8. Advance online month of Ramadan аnd 1 month after when, due to fasting, some islamic religion have particular challenge. Aim of the study is publication. patients completely stop the therapy. An exceptional problem is to describe the cultural, ethnical and demographic characteristics of the Albanian ethnic population with Islamic [3] Arcury, T. A., Sandberg, J. C., Melius, K. P., Quandt, S. A., Leng, observed in childhood with iron deficiency anemia (27.4%) and poor X., Latulipe, C., Miller, D. P., Jr, Smith, D. A., & Bertoni, A. G. dental health (87%) due the bad eating habits. Conclusion: Cultural, religion and their access to health care in a general practice in a (2020). Older Adult Internet Use and eHealth Literacy. Journal of demographic and ethnical characteristics are important determinants village near Skopje, North Macedonia. applied gerontology : the official journal of the Southern of population health outcomes and need to be recognized by health Gerontological Society, 39(2), 141–150. systems. At the same time, they essentially influence the shaping of https://doi.org/10.1177/0733464818807468 the behavior of individuals towards their own health and the health of [4] Petrova, I., Balyka, O., & Kachan, H. (2020). Digital economy, and the family, outside of the framework of the health system. The goal digital employment appearence. Social and labour relations: theory of culturally competent health care services is to provide the highest and practice, 10(2), 10-20. [5] European Commission. (2018). Communication from the Commission to the European Parliament, the European Council, the Council, the European Economic and Social Committee and the Committee of the Regions on enabling the digital transformation of health and care in the Digital Single Market; empowering citizens and building a healthier society. SWD (2018) 126 final. Brussels. 44 needs, the needs of healthcare providers, the needs of healthcare [6] Yin, R. K. (2018). Case study research and applications : design How cultural and demographic characteristics influence policy), numerous existing features were upgraded, and many and methods (6th ed.). Sage.van Gemert-Pijnen, J. E., Nijland, N., new functionalities were developed. van Limburg, M., Ossebaard, H. C., Kelders, S. M., Eysenbach, G., & Seydel, E. R. (2011). A holistic framework to improve the uptake the use of primary care services in village area in North and impact of eHealth technologies. Journal of medical Internet research, 13(4), e111. V. C Macedonia ONCLUSIONS [7] Kljajić Borštnar, M. (2021). Raziskovanje informacijskih sistemov : učbenik (p. 1 spletni vir (1 datoteka PDF (45 ))). Fakulteta za organizacijske vede. In recent years, Slovenia's eHealth system has undergone https://estudij.um.si/pluginfile.php/676575/mod_resource/content/ Sashka Janevska¹, Katerina Kovachevikj², Elizabeta Kostovska Prilepchanska³, Katarina Stavrikj⁴ significant development, which was accelerated by the 2/U%C4%8Dbenik%20raziskovalna%20metodologija%20Kljaji %C4%87%20Bor%C5%A1tnar%20Mirjana%202021.pdf GPO ,Vita Katerina” Skopje N Macedonia¹; GPO ,Vita Katerina” Skopje N Macedonia²; Commission for evaluation of COVID-19 pandemic. The use of some eHealth applications working ability, Fund for Pension and Disability Insurance of NRM³; Center of Family medicine, Medical Faculty, has increased more than tenfold. [8] Stanimirović, D. (2021). eHealth Patient Portal - becoming an indispensable public health tool in the time of COVID-19. In J. UKIM, Skopje⁴ This in turn has brought up difficulties that have arisen to a Mantas (Ed.), Public Health and Informatics : the future of co- large extent due to the inadequate investment in digitalisation, created eHealth : 31st Medical Informatics in Europe Conference both in terms of HR and infrastructure, and also with regard to (MIE 2021), online 29-31 May 2021 (Issue 281, pp. 880–884). IOS sashkamitovska@yahoo.com Press. developing existing and new systems. There is relatively low level of awareness of the benefits of eHealth, which has been [9] Rant, Ž., Stanimirović, D., & Janet, J. (2022). Functionalities and Abstract quality of care to every patient, regardless of cultural or ethnic use of the zVEM Patient Portal and the Central Registry of Patient background. gradually improving, unfortunately, mainly due to the COVID- Data. 35 Th Bled eConference Digital Restructuring and Human Background: Individual values, beliefs, and behaviors about health 19 pandemic. The system was also very much exposed to the (Re)Action, 65–79. https://doi.org/10.18690/UM.FOV.4.2022.4 and well-being are shaped by various factors such as race, ethnicity, Index Terms—cultural characteristics, ethnicity, islamic patients, poor digital literacy of users, including the most basic use of [10] Janet, J., & Stanimirović, D. (2020). Prenova portala zVEM. In T. nationality, language, gender, socioeconomic status, physical and primary care services computer and telecommunications equipment, as well as Marčun & E. Dornik (Eds.), Digitalni mostovi v zdravstvu : e- mental ability, sexual orientation and occupation. Understanding the computer and information literacy and the use of software Kongres MI’2020 : zbornik prispevkov in povzetkov : Ljubljana, 5. culture, demographic characteristics, religion and providing health november 2020 (pp. 55–59). SDMI. I. INTRODUCTION systems themselves. The digital culture in healthcare care services that are acceptable to Albanian community have institutions needs to be raised, along with the digital [11] Rant, Ž., Stanimirović, D., Tepej Jočić, L., Žlender, A., Gaspari, I., particular challenge. Aim of the study is to describe the cultural, competence of all employees. Digital culture is also important Božič, D., Indihar, S., Beštek, M., Simeunovič, B., Vrečko, A., ethnical and demographic characteristics of the Albanian ethnic In primary care settings, cultural perception and Matetić, V., & Zidarn, J. (2018). Rešitve e-Zdravja. In I. Eržen for the close cohesion of informatics and other areas of work population and their access to health care in a general practice in a competence attitude are imperative as notion of health, illness, (Ed.), 30 let Slovenskega društva za medicinsko informatiko : village near Skopje. Method: Descriptive study based on the data from in organisations, eliminating the traditional divergence. Here, [publikacija ob 30-letnici Slovenskega društva za medicinsko sickness, and care means different to different people [1]. the electronic health register and the manually recorded data in the Individual values, beliefs, and behaviors about health and well-the digital competence of all employees is very important. informatiko] (pp. 184–190). Slovensko društvo za medicinsko informatiko. patients' paper health records of registered patientsin the maternal being are shaped by various factors such as race, ethnicity, The research also implies that the enormous progress that has outpatient clinic aged ≥ 0 months. Results: 4137 patients from nationality, language, gender, socioeconomic status, physical been made in healthcare informatics over the past few years [12] Rant, Ž., Stanimirović, D., & Žlender, A. (2019). Nacionalni Portal zVEM v okviru eZdravja = National portal zVEM within eHealth. Albanian ethnicity registered in the GPs practice from all ages. Two and mental ability, sexual orientation and occupation. The can only be maintained in the future with the successful In P. Šprajc, I. Podbregar, D. Maletič, & M. Radovanović (Eds.), specialists of family medicine from Macedonian ethnicity and 3 knowledge of cultural and ethnical characteristics facilitate promotion of eHealth and significant additional resources. Ekosistem organizacij v dobi digitalizacije [Elektronski vir] : medical nurses from Albanian ethnicity work in the medical teams. healthcare providers to afford improved care and helps to avert Major efforts will be needed, as well as funds, to maintain and konferenčni zbornik = [Ecosystem of organizations in the digital Communication with patients is mostly carried out in the Albanian age : conference proceedings (pp. 873–884). Univerzitetna založba misunderstandings among care provider's staff, patients and continue the truly huge progress made in healthcare language. The birth rate is higher than the Macedonian population. In Univerze. their families. However, similar to ethnicity and culture, informatics in recent years. the past 5 years there is increased emigration of young families in the [13] ZZPPZ. (2021). Zakon o zbirkah podatkov s področja EU countries. Rate of childhood immunization is very high (94%), religion can be an important determinant of health outcomes zdravstvenega varstva (Uradni list RS, št. 65/00, 47/15, 31/18, but the rate of screening programs for chronic diseases is not at a and warrants explicit attention in public health work [2]. The 152/20 – ZZUOOP, 175/20 – ZIUOPDVE, 203/20 – ZIUPOPDVE literature has suggested that different religions may both hinder R satisfactory level (43.3%). Gynecological visits are regular, but use of EFERENCES in 112/21 – ZNUPZ). contraceptives (0.5%) is on low rate with small number of abortions. and enable good health [3]. For example, Ramadan fasting may Among the population there is a very high percentage of smokers pose health risks, while Islamic injunctions against sexual [1] European Commission. (2019). Digital Economy and Society promiscuity and imbibing alcohol, as well as a recommendation (42%) with approximately 3/4 male smokers over 10 years of age. Index (DESI); 2019 Country Report; Slovenia. Patients expect immediate health care for any acute condition against smoking, may promote health [4]. https://ec.europa.eu/newsroom/dae/document.cfm?doc_id=59912 (regardless of the level of urgency), while they often postpone Understanding the culture, religion and providing health [2] Bokolo A. J. (2021). Application of telemedicine and eHealth preventive and control examinations for chronic diseases. Adherence care services that are acceptable to Albanian community with technology for clinical services in response to COVID 19 to the prescribed therapy is at a high level, with the exception of the pandemic. Health and technology, 1–8. Advance online month of Ramadan аnd 1 month after when, due to fasting, some islamic religion have particular challenge. Aim of the study is publication. patients completely stop the therapy. An exceptional problem is to describe the cultural, ethnical and demographic characteristics of the Albanian ethnic population with Islamic [3] Arcury, T. A., Sandberg, J. C., Melius, K. P., Quandt, S. A., Leng, observed in childhood with iron deficiency anemia (27.4%) and poor X., Latulipe, C., Miller, D. P., Jr, Smith, D. A., & Bertoni, A. G. dental health (87%) due the bad eating habits. Conclusion: Cultural, religion and their access to health care in a general practice in a (2020). Older Adult Internet Use and eHealth Literacy. Journal of demographic and ethnical characteristics are important determinants village near Skopje, North Macedonia. applied gerontology : the official journal of the Southern of population health outcomes and need to be recognized by health Gerontological Society, 39(2), 141–150. systems. At the same time, they essentially influence the shaping of https://doi.org/10.1177/0733464818807468 the behavior of individuals towards their own health and the health of [4] Petrova, I., Balyka, O., & Kachan, H. (2020). Digital economy, and the family, outside of the framework of the health system. The goal digital employment appearence. Social and labour relations: theory of culturally competent health care services is to provide the highest and practice, 10(2), 10-20. [5] European Commission. (2018). Communication from the Commission to the European Parliament, the European Council, the Council, the European Economic and Social Committee and the Committee of the Regions on enabling the digital transformation of health and care in the Digital Single Market; empowering citizens and building a healthier society. SWD (2018) 126 final. Brussels. 45 II. MATERIAL AND METHODS not and vil age- town migration in the country. Mostly families failure (CKD) in the Republic of North Macedonia, data were as medical professionals need to value diversity as an integral migrate to: Germany, Austria, Croatia, Slovenia, Switzerland extracted only for these diseases. In the office in 2021, 183 part of our consultation skills [5]. According to the processed Method: In order to obtain data that can be analytically and others. patients with diabetes mel itus were registered, of which 2 data, all patients of Albanian nationality are of the Islam processed, a descriptive study was planned with registered Patients of Albanian nationality get married (100% patients with DM type 1. According to gender distribution, 60 religion. The gender distribution is almost equal, with a slight (32.8%) are male, while 123 (67.2%) are female patients of predominance of female patients at 51.17%. In distribution of patients of Albanian nationality in the maternal outpatient religiously, but not always civilly regulated), at the age of 18-female gender. The prevalence of DM in N Macedonia in 2021 education rate, we can notice a high rate of il iteracy among the clinic aged ≥ 0 months. The doctor’s office is located in a 35 years, average at 23.5 years of age. Married couples in 34% is 135,690 patients, of which 1,091 patients are registered with older population, especially among the female population, and village, 11 km from the capital Skopje, North Macedonia with have 0-2 children, 65% have 3-4 children, while about 1% have DM type 1. According to gender distribution, 59,870 (44.12%) a high rate of secondary vocational education among the patients from 6 surrounding vil ages. Two specialists of family ≥5 children. Infants up to 1 year old are regularly taken for are male patients, while 75,820 (55.88%) ) are female. The younger population. This is due to the existing law on medicine from Macedonian ethnicity and 3 medical nurses scheduled check-ups. The percentage of vaccinated children in prevalence of diabetes in N Macedonia per 100,000 inhabitants compulsory primary and secondary education in N Macedonia from Albanian ethnicity work in the medical teams. 2022 according to the mandatory vaccination calendar is ≈ 94% was 6533.9, i.e. 65.34 per 1000 inhabitants, while the adopted in 1995, according to which a child who does not attend Material: The data were collected directly from the electronic (average value of received vaccines), while the average rate of prevalence of patients registered in the office was 43.39 per primary and secondary school without a justified reason is database of the registered patients of the office and the revaccinated children is ≈ 88%. From 427 registered patients of 1000 inhabitants. subject to monetary and criminal sanctions for the child's manually recorded data in the patients' paper health records, in Albanian nationality aged 0-6 years in 2022, 117 children guardian. Regarding the employment rate, a low employment the period from 19.05.2023 - 01.06.2023. Data collection was (27.4%) were diagnosed with sideropenic anemia. In the same In N Macedonia in 2021, 3576 patients with chronic renal rate of 34% was observed, of which only 6.2% were female conducted on the following characteristics: gender, age, age group, ≈ 87% of children with caries were registered, failure (CKD) were registered. According to gender patients. The total rate of registered employment does not education, employment rate, smoking status, contraceptive rate mostly in the form of circular caries. distribution, 1929 (53.9%) are male, while 1647 (46.1%) are correlate with the actual situation, because most of the patients in women with oral contraceptive therapy, visits for Patients expect immediate health care for any acute female patients. In 2021, 7 patients with CKD were registered work without being registered, ie. in the "gray" economy. The management of chronic conditions, collected prescription condition (regardless of the level of urgency) and very often in the office. According to gender distribution, 4 (57.1%) are low employment rate among female patients is primarily due to drugs for chronic diseases, preventive programs and they seek medical help in emergency centers. In the other side, male patients, while 3 (42.9%) are female. The prevalence of the need to look after the children (the nearest kindergarten is immunization according the regular immunization calendar. they often postpone preventive check – ups and control CKD in NMacedonia per 100,000 inhabitants was 172.2, ie 1.72 per 1,000 inhabitants, while the prevalence of patients 11-16 km away from the place of residence) and to take care of examinations for acute and chronic diseases. Data on performed elderly family members. screening for patients aged 35-65 years for preventive registered in the office was 1.66 per 1,000 inhabitants. All registered patients with CKD in the clinic are on medical In the past 5 years, an increased migration of young families III. RESULTS examination for early detection of diabetes mellitus, kidney diseases and cardiovascular diseases were extracted for the therapy. to EU countries has been registered, but not an increased rural- The following results were obtained by analyzing the period 2017-2019, in order to avoid the impact of the COVID In the office, there is an internal system for scheduling urban migration within the country itself. The most common collected data from the electronic database and manually pandemic on them ( Table I). examinations by phone from 27 March 2023, but on average reason for this migration is of course the higher wages offered written data in the patients' paper records. From 4217 patients, less than 10% of examinations on a daily basis are scheduled. to workers, the higher economic standard and the social 4137 from Albanian, 77 Macedonian and 3 patients from Table I. Screening examination data for Diabetes Mellitus, kidney diseases Most often, the appointment system is used by young mothers protection of the population in the EU member states. But Turkish ethnicity are registered in the GPs practice from ≥ 0 and cardiovascular diseases in period 2017-2019 to schedule an examination for their children. despite the migration, the patients keep their health insurance years. All patients of Albanian nationality are of Islamic Year Planed Showed Invited Showed with us and appear in the lists of active patients and it is difficult religion. Communication between the medical personal and the patients patients patients patients According to the data on completed prescriptions in to calculate the percentage of migration. patients mostly is in the Albanian language. According to the by post- after pharmacies in the period from 2017-2019, a reduced number of Patients of Albanian nationality get married early, which is gender distribution among patients of Albanian nationality, N n (%) mail invitation completed prescriptions can be observed in the quarter of the always religiously regulated, while the civil marriage is 2117 were females, while 2020 were male patients. By year in the post-Ramadan month.( Table II) regulated after several years of entering into a religious one. A distribution of age, the obtained data are given in Figure 1. N n (%) Table II. Completed prescriptions for prescribed medications in small part of the patients do not enter into a civil marriage at all. Figure 1. Distribution of patients by age pharmacies for 2017-2019 2017 484 144(29.7%) 340 19 (5.6%) Due to the above, the number of registered divorces is very smal . According to the obtained data, the largest number of 2018 489 270 (55.2%) 219 2 (0.9%) year I II III IV young families have 3-4 children, while on average in the entire quarter quarter quarter quarter Republic of N Macedonia, families of Macedonian nationality 2019 487 197 (40.5%) 290 8 (2.8%) (%) (%) (%) (%) have 0-2 children. Regarding that, we can directly conclude that the birth rate is higher compared to the population of 2017 94% 63% 75% 91% Macedonian nationality. The rate of immunization according to According to the recorded data in the health record of 2018 96% 61% 82% 93% the mandatory vaccination calendar is very high, compared to female patients, gynecological visits are regular, with a small the official data on vaccination performed in 2022 in N 2019 94% 66% 86% 97% number of abortions. In the office, 927 patients in the Macedonia. The percentage of vaccinated children according to reproductive period aged 15-49 have been registered, 5 of them the mandatory vaccination calendar is ≈ 94%, which is 16.5% use oral contraceptive therapy. Female patients who are not higher than the national average vaccination rate of 75.5% in married, don’t have their own gynecologist and in extremely 2022. This number is explained by the trust in education by IV. DISCUSSION family doctors and patronage nurses and the small influence of According to education, among patients under the age of 50, rare cases visit one and usually consult their family doctor for social media in creating attitudes about vaccination in this >70% have completed secondary school, among patients over their gynecological problems. Young married couples who This study describes the cultural, ethnic and demographic environment. The average rate of revaccinated children is ≈ 50 years of age, >45% have primary school, while female cannot have children are 100% actively treating their infertility. characteristics of patients of Albanian nationality and their 88%, which is 8.8 % higher than the average revaccination rate patients over 65 years of age ≈ 50% have no education. In terms Among patients of Albanian nationality, not a single adoption influence on the use of primary health care services in the for 2022, which is 79.2% at the national level but still it is less of established employment between the ages of 18-65, 1069 are of a child has been registered in the past 16 years. Among the Republic of N Macedonia. The study included 4137 patients of then safe coverage rate which should be over 95%. The reduced unemployed, 369 employed, 3 farmers and 6 foreign insured patients, there is a very high percentage of smokers with 42% Albanian nationality in a village near by capital city Skopje. In percentage of revaccination is explained by the irregular patients. Out of 369 employed patients of Albanian nationality, (≥ 11 years old 1360 of male, and 196 of female patients) and 1 order to overcome the language barrier, the communication controls of children after 1 year of life and the emigration of 302 are male and 67 patients are female. A large proportion of patient registered as alcoholic. between the medical personal and the patients mostly takes families from the country. patients (75%) live in large family communities with ≥ 6 Regarding registered chronic diseases, due to the existence place in the Albanian language. But as the author Kaj J points members. In the past 5 years there is increased emigration of of Registry for Diabetes Mellitus (DM) and chronic renal out in his article, achieving effective communication means Infants up to 1 year of age are regularly taken for a young male patients and their families in the EU countries, but more than overcoming language barriers. Because of that, we scheduled check-up, which is extremely important for 46 II. MATERIAL AND METHODS not and vil age- town migration in the country. Mostly families failure (CKD) in the Republic of North Macedonia, data were as medical professionals need to value diversity as an integral migrate to: Germany, Austria, Croatia, Slovenia, Switzerland extracted only for these diseases. In the office in 2021, 183 part of our consultation skills [5]. According to the processed Method: In order to obtain data that can be analytically and others. patients with diabetes mel itus were registered, of which 2 data, all patients of Albanian nationality are of the Islam processed, a descriptive study was planned with registered Patients of Albanian nationality get married (100% patients with DM type 1. According to gender distribution, 60 religion. The gender distribution is almost equal, with a slight (32.8%) are male, while 123 (67.2%) are female patients of predominance of female patients at 51.17%. In distribution of patients of Albanian nationality in the maternal outpatient religiously, but not always civilly regulated), at the age of 18-female gender. The prevalence of DM in N Macedonia in 2021 education rate, we can notice a high rate of il iteracy among the clinic aged ≥ 0 months. The doctor’s office is located in a 35 years, average at 23.5 years of age. Married couples in 34% is 135,690 patients, of which 1,091 patients are registered with older population, especially among the female population, and village, 11 km from the capital Skopje, North Macedonia with have 0-2 children, 65% have 3-4 children, while about 1% have DM type 1. According to gender distribution, 59,870 (44.12%) a high rate of secondary vocational education among the patients from 6 surrounding vil ages. Two specialists of family ≥5 children. Infants up to 1 year old are regularly taken for are male patients, while 75,820 (55.88%) ) are female. The younger population. This is due to the existing law on medicine from Macedonian ethnicity and 3 medical nurses scheduled check-ups. The percentage of vaccinated children in prevalence of diabetes in N Macedonia per 100,000 inhabitants compulsory primary and secondary education in N Macedonia from Albanian ethnicity work in the medical teams. 2022 according to the mandatory vaccination calendar is ≈ 94% was 6533.9, i.e. 65.34 per 1000 inhabitants, while the adopted in 1995, according to which a child who does not attend Material: The data were collected directly from the electronic (average value of received vaccines), while the average rate of prevalence of patients registered in the office was 43.39 per primary and secondary school without a justified reason is database of the registered patients of the office and the revaccinated children is ≈ 88%. From 427 registered patients of 1000 inhabitants. subject to monetary and criminal sanctions for the child's manually recorded data in the patients' paper health records, in Albanian nationality aged 0-6 years in 2022, 117 children guardian. Regarding the employment rate, a low employment the period from 19.05.2023 - 01.06.2023. Data collection was (27.4%) were diagnosed with sideropenic anemia. In the same In N Macedonia in 2021, 3576 patients with chronic renal rate of 34% was observed, of which only 6.2% were female conducted on the following characteristics: gender, age, age group, ≈ 87% of children with caries were registered, failure (CKD) were registered. According to gender patients. The total rate of registered employment does not education, employment rate, smoking status, contraceptive rate mostly in the form of circular caries. distribution, 1929 (53.9%) are male, while 1647 (46.1%) are correlate with the actual situation, because most of the patients in women with oral contraceptive therapy, visits for Patients expect immediate health care for any acute female patients. In 2021, 7 patients with CKD were registered work without being registered, ie. in the "gray" economy. The management of chronic conditions, collected prescription condition (regardless of the level of urgency) and very often in the office. According to gender distribution, 4 (57.1%) are low employment rate among female patients is primarily due to drugs for chronic diseases, preventive programs and they seek medical help in emergency centers. In the other side, male patients, while 3 (42.9%) are female. The prevalence of the need to look after the children (the nearest kindergarten is immunization according the regular immunization calendar. they often postpone preventive check – ups and control CKD in NMacedonia per 100,000 inhabitants was 172.2, ie 1.72 per 1,000 inhabitants, while the prevalence of patients 11-16 km away from the place of residence) and to take care of examinations for acute and chronic diseases. Data on performed elderly family members. screening for patients aged 35-65 years for preventive registered in the office was 1.66 per 1,000 inhabitants. All registered patients with CKD in the clinic are on medical In the past 5 years, an increased migration of young families III. RESULTS examination for early detection of diabetes mellitus, kidney diseases and cardiovascular diseases were extracted for the therapy. to EU countries has been registered, but not an increased rural- The following results were obtained by analyzing the period 2017-2019, in order to avoid the impact of the COVID In the office, there is an internal system for scheduling urban migration within the country itself. The most common collected data from the electronic database and manually pandemic on them ( Table I). examinations by phone from 27 March 2023, but on average reason for this migration is of course the higher wages offered written data in the patients' paper records. From 4217 patients, less than 10% of examinations on a daily basis are scheduled. to workers, the higher economic standard and the social 4137 from Albanian, 77 Macedonian and 3 patients from Table I. Screening examination data for Diabetes Mellitus, kidney diseases Most often, the appointment system is used by young mothers protection of the population in the EU member states. But Turkish ethnicity are registered in the GPs practice from ≥ 0 and cardiovascular diseases in period 2017-2019 to schedule an examination for their children. despite the migration, the patients keep their health insurance years. All patients of Albanian nationality are of Islamic Year Planed Showed Invited Showed with us and appear in the lists of active patients and it is difficult religion. Communication between the medical personal and the patients patients patients patients According to the data on completed prescriptions in to calculate the percentage of migration. patients mostly is in the Albanian language. According to the by post- after pharmacies in the period from 2017-2019, a reduced number of Patients of Albanian nationality get married early, which is gender distribution among patients of Albanian nationality, N n (%) mail invitation completed prescriptions can be observed in the quarter of the always religiously regulated, while the civil marriage is 2117 were females, while 2020 were male patients. By year in the post-Ramadan month.( Table II) regulated after several years of entering into a religious one. A distribution of age, the obtained data are given in Figure 1. N n (%) Table II. Completed prescriptions for prescribed medications in small part of the patients do not enter into a civil marriage at all. Figure 1. Distribution of patients by age pharmacies for 2017-2019 2017 484 144(29.7%) 340 19 (5.6%) Due to the above, the number of registered divorces is very smal . According to the obtained data, the largest number of 2018 489 270 (55.2%) 219 2 (0.9%) year I II III IV young families have 3-4 children, while on average in the entire quarter quarter quarter quarter Republic of N Macedonia, families of Macedonian nationality 2019 487 197 (40.5%) 290 8 (2.8%) (%) (%) (%) (%) have 0-2 children. Regarding that, we can directly conclude that the birth rate is higher compared to the population of 2017 94% 63% 75% 91% Macedonian nationality. The rate of immunization according to According to the recorded data in the health record of 2018 96% 61% 82% 93% the mandatory vaccination calendar is very high, compared to female patients, gynecological visits are regular, with a small the official data on vaccination performed in 2022 in N 2019 94% 66% 86% 97% number of abortions. In the office, 927 patients in the Macedonia. The percentage of vaccinated children according to reproductive period aged 15-49 have been registered, 5 of them the mandatory vaccination calendar is ≈ 94%, which is 16.5% use oral contraceptive therapy. Female patients who are not higher than the national average vaccination rate of 75.5% in married, don’t have their own gynecologist and in extremely 2022. This number is explained by the trust in education by IV. DISCUSSION family doctors and patronage nurses and the small influence of According to education, among patients under the age of 50, rare cases visit one and usually consult their family doctor for social media in creating attitudes about vaccination in this >70% have completed secondary school, among patients over their gynecological problems. Young married couples who This study describes the cultural, ethnic and demographic environment. The average rate of revaccinated children is ≈ 50 years of age, >45% have primary school, while female cannot have children are 100% actively treating their infertility. characteristics of patients of Albanian nationality and their 88%, which is 8.8 % higher than the average revaccination rate patients over 65 years of age ≈ 50% have no education. In terms Among patients of Albanian nationality, not a single adoption influence on the use of primary health care services in the for 2022, which is 79.2% at the national level but still it is less of established employment between the ages of 18-65, 1069 are of a child has been registered in the past 16 years. Among the Republic of N Macedonia. The study included 4137 patients of then safe coverage rate which should be over 95%. The reduced unemployed, 369 employed, 3 farmers and 6 foreign insured patients, there is a very high percentage of smokers with 42% Albanian nationality in a village near by capital city Skopje. In percentage of revaccination is explained by the irregular patients. Out of 369 employed patients of Albanian nationality, (≥ 11 years old 1360 of male, and 196 of female patients) and 1 order to overcome the language barrier, the communication controls of children after 1 year of life and the emigration of 302 are male and 67 patients are female. A large proportion of patient registered as alcoholic. between the medical personal and the patients mostly takes families from the country. patients (75%) live in large family communities with ≥ 6 Regarding registered chronic diseases, due to the existence place in the Albanian language. But as the author Kaj J points members. In the past 5 years there is increased emigration of of Registry for Diabetes Mellitus (DM) and chronic renal out in his article, achieving effective communication means Infants up to 1 year of age are regularly taken for a young male patients and their families in the EU countries, but more than overcoming language barriers. Because of that, we scheduled check-up, which is extremely important for 47 monitoring the correct growth and development of children at patients (the prevalence of smoking in North Macedonia is 57.9 REFERENCES 6. Alomair N, Alageel S, Davies N, Bailey JV. Factors the first year. An exceptional problem is observed in childhood percent among men and 39.0 percent among women). influencing sexual and reproductive health of Muslim with iron deficiency anemia in almost 1/3 of children aged 0-6 1. Kumar R, Bhat acharya S, Sharma N, Thiyagarajan A. women: a systematic review. Reprod Health. 2020 Mar years. Bad eating habits: use of food from "bags", highly In relation to the presented data from registered patients Cultural competence in family practice and primary 5;17(1):33. doi: 10.1186/s12978-020-0888-1. PMID: processed food, consumption of a large amount of cow's milk, with diabetes mel itus in 2021, a lower prevalence can be care setting. J Family Med Prim Care. 2019 Jan;8(1):1-32138744; PMCID: PMC7059374. snacks and juices, are the most common reasons for the observed in relation to the prevalence of DM in N Macedonia 4. doi: 10.4103/jfmpc.jfmpc_393_18. PMID: development of iron deficiency anemia in children. In children by 33.6%, but with a much higher prevalence in female patients 30911472; PMCID: PMC6396634. 7. DeJong J, Shepard B, Roudi-Fahimi F, Ashford L. of this age, a high percentage of ≈ 87% of caries in milk teeth in relation to male gender. All this is explained by the greater 2. Padela AI, Zaidi D. The Islamic tradition and health Young people’s sexual and reproductive health in the was registered, compared to the data from the Ministry of physical activity that patients have in the rural environment, a inequities: A preliminary conceptual model based on a Middle East and North Africa. Reprod Health. Health for 79.5% of children with caries at the age of 6 in 2018. large part of the male working population are workers in the systematic literature review of Muslim health-care 2007;14(78):8 The predominant form is circular caries, which is associated construction industry, while the majority of the female disparities. Avicenna J Med 2018;8:1-13. 8. Aslam M, Healy MA. Compliance and drug therapy in with long-term use of a bottle with a pacifier, through which population are housewives who maintain their homes and do fasting Moslem patients. J Clin Hosp Pharm. 1986 milk or juice with the addition of sugar is usual y consumed. not have additional physical activity. In relation to the presented 3. Laird LD, de Marrais J, Barnes LL. Portraying Islam Oct;11(5):321-5. doi: 10.1111/j.1365- The poor dental health is also a consequence of the bad eating data from registered patients with CKD in 2021, an almost and Muslims in MEDLINE: A content analysis. Soc 2710.1986.tb00859.x. PMID: 3782478. habits, low dental hygiene and late visits to a dentist. identical prevalence can be observed in relation to the Sci Med 2007;65:2425-39. prevalence of CKD in N Macedonia, with no patient on any 9. Aslam M, Assad A. Drug regimens and fasting during Although there is an appointment system in the office, type of dialysis treatment, which points to timely diagnosis and 4. Al Suwaidi J, Bener A, Suliman A, Hajar R, Salam Ramadan: a survey in Kuwait. Public Health. 1986 which should provide an organized and safer health continuous monitoring of patients with this disease. AM, Numan MT, et al. A population based study of Jan;100(1):49-53. doi: 10.1016/s0033-3506(86)80086- environment for patients, the percentage of patients who use it Ramadan fasting and acute coronary syndromes. Heart 5. PMID: 3749438. is still small. Patients expect immediate health care for any Adherence to the prescribed therapy is at a high level, with 2004;90:695-6. acute condition (regardless of the level of urgency), while they the exception of the month of Ramadan and the month after 5. Kai J (ed.). Valuing diversity: a resource for effective often postpone preventive and control examinations for chronic when the majority of patients change the prescribed daily health care of ethnically diverse communities.London: diseases. The rate of screening programs is not at a satisfactory dosage regimen and some completely stop the therapy. The RCGP, 1999 level. In the following 3 years (2017-2019), out of an average month of fasting has a great impact on the daily life of the Islam of 486 per year, an average of 186 patients (about 38%) showed population, which has a direct impact on adherence to therapy up for an examination, 283 (62%) patients were sent an in this month and the month after and increased percentage of invitation by mail, of which only in an average of 9% complications caused by reducing prescribed doses. Author responded to the invitation for a preventive examination. This Aslaam M in two separate studies [8,9], refers to the great is due to low health education and the need of an examination influence of the month of Ramadan on the change of the only at the moment of feeling sick. prescribed tablet regimen and the compliance of Muslim believers during the 30 religious days. This data should be taken According to the data in the health records, unmarried into account when prescribing therapy, especially in the dosage female patients very rarely visit a gynecologist and usual y regimen and the method of application for chronic, but also for consult their family doctor for their gynecological problems. In acute diseases. this area patients consider that issues related to sexual and reproductive health (SRH) are sensitive subjects and they rarely The study analyzes data from patients from the Albanian discuss for them, even with health workers [6]. On other side ethnic community in a closed village environment, which limits gynecological visits are regular for married patients and they the study and the conclusions drawn in it cannot be generalized visit gynocologists regularly especially during the reproductive for the entire Albanian population in N Macedonia. period. Тhe use of contraceptives is on a low rate which is very similar to the use of oral contraceptive therapy among the female population in North Macedonia. Among the female V. CONCLUSION patients in reproductive period in the office is registered small number of abortions which in correlation with the data on the The study provided comprehensive data that are extremely low level of use of oral contraceptive therapy indicates that important for the improvement of health services in the young families consciously plan the number of children they outpatient clinic, and also provides an opportunity to plan would have. The patients in this region understand the burden future checks in the direction of improving health promotion, of infertility and they accept in-vitro fertilization, only with prevention, diagnosis and management of patients' diseases. material from both spouses. Cultural, ethnical and demographic characteristics are important determinants of population health outcomes and Most Muslims are known to share strong family values and need to be recognized by health systems. At the same time, patriarchal culture, which in certain situations could benefit they essentially influence the shaping of the behavior of young individuals and protect their well-being [7]. According to the Muslim religion, patients do not drink alcohol or use of individuals towards their own health and the health of the drugs which has a positive impact on the health of the family, outside of the framework of the health system. The goal population. Among the population there is a very high of cultural y competent health care services is to provide the percentage of smokers (42%), but lower in comparison with the highest quality of care to every patient, regardless of cultural smoking rate in North Macedonia which is about 48,4% of or ethnic background. Family doctors are the first contact of smokers. Тhere is a big difference in the distribution of smokers patients with the health system and should be properly trained according to genders compared with the country statistics, that to provide health care appropriate to the attitudes, expectations is more than 73,6% of men and less than 10.2 % of the female and needs of different ethnic communities represented in their work environment. 48 monitoring the correct growth and development of children at patients (the prevalence of smoking in North Macedonia is 57.9 REFERENCES 6. Alomair N, Alageel S, Davies N, Bailey JV. Factors the first year. An exceptional problem is observed in childhood percent among men and 39.0 percent among women). influencing sexual and reproductive health of Muslim with iron deficiency anemia in almost 1/3 of children aged 0-6 1. Kumar R, Bhat acharya S, Sharma N, Thiyagarajan A. women: a systematic review. Reprod Health. 2020 Mar years. Bad eating habits: use of food from "bags", highly In relation to the presented data from registered patients Cultural competence in family practice and primary 5;17(1):33. doi: 10.1186/s12978-020-0888-1. PMID: processed food, consumption of a large amount of cow's milk, with diabetes mel itus in 2021, a lower prevalence can be care setting. J Family Med Prim Care. 2019 Jan;8(1):1-32138744; PMCID: PMC7059374. snacks and juices, are the most common reasons for the observed in relation to the prevalence of DM in N Macedonia 4. doi: 10.4103/jfmpc.jfmpc_393_18. PMID: development of iron deficiency anemia in children. In children by 33.6%, but with a much higher prevalence in female patients 30911472; PMCID: PMC6396634. 7. DeJong J, Shepard B, Roudi-Fahimi F, Ashford L. of this age, a high percentage of ≈ 87% of caries in milk teeth in relation to male gender. All this is explained by the greater 2. Padela AI, Zaidi D. The Islamic tradition and health Young people’s sexual and reproductive health in the was registered, compared to the data from the Ministry of physical activity that patients have in the rural environment, a inequities: A preliminary conceptual model based on a Middle East and North Africa. Reprod Health. Health for 79.5% of children with caries at the age of 6 in 2018. large part of the male working population are workers in the systematic literature review of Muslim health-care 2007;14(78):8 The predominant form is circular caries, which is associated construction industry, while the majority of the female disparities. Avicenna J Med 2018;8:1-13. 8. Aslam M, Healy MA. Compliance and drug therapy in with long-term use of a bottle with a pacifier, through which population are housewives who maintain their homes and do fasting Moslem patients. J Clin Hosp Pharm. 1986 milk or juice with the addition of sugar is usual y consumed. not have additional physical activity. In relation to the presented 3. Laird LD, de Marrais J, Barnes LL. Portraying Islam Oct;11(5):321-5. doi: 10.1111/j.1365- The poor dental health is also a consequence of the bad eating data from registered patients with CKD in 2021, an almost and Muslims in MEDLINE: A content analysis. Soc 2710.1986.tb00859.x. PMID: 3782478. habits, low dental hygiene and late visits to a dentist. identical prevalence can be observed in relation to the Sci Med 2007;65:2425-39. prevalence of CKD in N Macedonia, with no patient on any 9. Aslam M, Assad A. Drug regimens and fasting during Although there is an appointment system in the office, type of dialysis treatment, which points to timely diagnosis and 4. Al Suwaidi J, Bener A, Suliman A, Hajar R, Salam Ramadan: a survey in Kuwait. Public Health. 1986 which should provide an organized and safer health continuous monitoring of patients with this disease. AM, Numan MT, et al. A population based study of Jan;100(1):49-53. doi: 10.1016/s0033-3506(86)80086- environment for patients, the percentage of patients who use it Ramadan fasting and acute coronary syndromes. Heart 5. PMID: 3749438. is still small. Patients expect immediate health care for any Adherence to the prescribed therapy is at a high level, with 2004;90:695-6. acute condition (regardless of the level of urgency), while they the exception of the month of Ramadan and the month after 5. Kai J (ed.). Valuing diversity: a resource for effective often postpone preventive and control examinations for chronic when the majority of patients change the prescribed daily health care of ethnically diverse communities.London: diseases. The rate of screening programs is not at a satisfactory dosage regimen and some completely stop the therapy. The RCGP, 1999 level. In the following 3 years (2017-2019), out of an average month of fasting has a great impact on the daily life of the Islam of 486 per year, an average of 186 patients (about 38%) showed population, which has a direct impact on adherence to therapy up for an examination, 283 (62%) patients were sent an in this month and the month after and increased percentage of invitation by mail, of which only in an average of 9% complications caused by reducing prescribed doses. Author responded to the invitation for a preventive examination. This Aslaam M in two separate studies [8,9], refers to the great is due to low health education and the need of an examination influence of the month of Ramadan on the change of the only at the moment of feeling sick. prescribed tablet regimen and the compliance of Muslim believers during the 30 religious days. This data should be taken According to the data in the health records, unmarried into account when prescribing therapy, especially in the dosage female patients very rarely visit a gynecologist and usual y regimen and the method of application for chronic, but also for consult their family doctor for their gynecological problems. In acute diseases. this area patients consider that issues related to sexual and reproductive health (SRH) are sensitive subjects and they rarely The study analyzes data from patients from the Albanian discuss for them, even with health workers [6]. On other side ethnic community in a closed village environment, which limits gynecological visits are regular for married patients and they the study and the conclusions drawn in it cannot be generalized visit gynocologists regularly especially during the reproductive for the entire Albanian population in N Macedonia. period. Тhe use of contraceptives is on a low rate which is very similar to the use of oral contraceptive therapy among the female population in North Macedonia. Among the female V. CONCLUSION patients in reproductive period in the office is registered small number of abortions which in correlation with the data on the The study provided comprehensive data that are extremely low level of use of oral contraceptive therapy indicates that important for the improvement of health services in the young families consciously plan the number of children they outpatient clinic, and also provides an opportunity to plan would have. The patients in this region understand the burden future checks in the direction of improving health promotion, of infertility and they accept in-vitro fertilization, only with prevention, diagnosis and management of patients' diseases. material from both spouses. Cultural, ethnical and demographic characteristics are important determinants of population health outcomes and Most Muslims are known to share strong family values and need to be recognized by health systems. At the same time, patriarchal culture, which in certain situations could benefit they essentially influence the shaping of the behavior of young individuals and protect their well-being [7]. According to the Muslim religion, patients do not drink alcohol or use of individuals towards their own health and the health of the drugs which has a positive impact on the health of the family, outside of the framework of the health system. The goal population. Among the population there is a very high of cultural y competent health care services is to provide the percentage of smokers (42%), but lower in comparison with the highest quality of care to every patient, regardless of cultural smoking rate in North Macedonia which is about 48,4% of or ethnic background. Family doctors are the first contact of smokers. Тhere is a big difference in the distribution of smokers patients with the health system and should be properly trained according to genders compared with the country statistics, that to provide health care appropriate to the attitudes, expectations is more than 73,6% of men and less than 10.2 % of the female and needs of different ethnic communities represented in their work environment. 49 Quality Assessment of Interprofessional Approach to Description of the subjects and methods: score of 7-9. We will classify the indicators into three levels of In the first part of the research a qualitative methodology is used: appropriateness: suitable (median scores between 7 and 9, no Elderly Care in Family Medicine in Slovenia Experts in the field of quality and primary healthcare for adults disagreement), uncertain (median scores between 4 and 6 or any based on their professional background and competences and median with disagreement), unsuitable (median scores between 1 representatives of patient associations will be invited to a focus and 3, no disagreement). We will consider only the quality group discussion on the interprofessional elderly care in a FMC. indicators for the interprofessional approach to elderly care in the Maja Cvetko Gomezelj1, Zalika Klemenc Ketiš 2, 3, 4 The number of focus groups will depend on data saturation. When FMC, which are suitable and tested to prove acceptability, 1Medical Faculty, University of Ljubljana, 2 Ljubljana Community Health Centre, 3 Department of Family Medicine, the data, statements, attitudes of the participants begin to repeat feasibility, reliability, validity and usability [23,24]. Acceptability Medical Faculty, University of Ljubljana, 4 Department of Family Medicine, Medical Faculty, University of Maribor and we no longer get any fresh ideas, we will end the research [19]. will be proven after a pilot study, where we will check with maja.cvetko@gmail.com The discussion will be qualitatively analyzed using the grounded patients and members of the interprofessional team whether the theory method to determine the conceptual framework of the findings from the collected data are acceptable to them. Feasibility interprofessional elderly care in a FMC in Slovenia. The is confirmed by the RAND/UCLA method, the feasibility rating Abstract—In Slovenia and worldwide an interprofessional approach approach, identify areas for improvement, introduce measures and conceptual framework will define the areas and processes that on a scale from 1 to 9 (the higher the rating, the easier the is increasingly used in the elderly care in family medicine clinics with thus enable continuous quality improvement. describe the interprofessional approach to the elderly care in a feasibility) and a pilot study. the aim of improving the quality of patient care. By developing family medicine care in Slovenia, and will be based on theoretical The reliability of the quality indicator will be checked by the quality indicators we will be able to quantitatively assess the quality starting points and practical experience [20]. The created method of internal consistency and expressed by Cronbach alpha of the interprofessional approach, identify place for improvement, I. MATERIAL AND METHODS conceptual framework will serve us as a theoretical starting point coefficient value (for reliability we will take the limit at 0.7 and introduce measures and thus enable continuous quality for the development of the quality indicators of interprofessional indicate the standard error of the calculation). improvement. We will conduct a mixed methods study [13,14]. In the first part, we will use qualitative methods [15] with focus groups and the approach to elderly care in a FMC in Slovenia according to the Validity: Index Terms-- elderly, family medicine, interprofessional, quality method of grounded theory by Glaser and Strauss [16] and the RAND/UCLA method, which is the only systematic method that ◦ the face validity of the indicator will be confirmed by the RAND/UCLA Appropriateness Method [17]. The name of the harmonizes the opinion of experts and scientific evidence [17]. As RAND/UCLA method (suitable). In Europe, an interprofessional approach is increasingly used in ◦ method comes from the names of the inventors - it was developed part of the RAND/UCLA method, we will carry out a systematic content validity will be determined using the RAND/UCLA the elderly care in family medicine clinics with the aim of in cooperation between the non-profit institution RAND (Research review of domestic and foreign literature on the quality indicators method. improving the quality of patient treatment [1-4]. ◦ and Development) and UCLA (University of California Los of the interprofessional approach to the elderly care in the PubMed construct validity will be determined by factor analysis. [21] and Science Direct [22] databases using the search terms ◦ indicators developed according to the RAND/UCLA method There is little evidence in the national and international literature Angeles). In the second part, the research will be quantitative in (interprofessional) AND (family medicine OR general practice have proven predictive validity. that the introduction of an interprofessional approach to the conducting a cross-sectional survey [18]. Fig. 1 demonstrates OR primary care) AND (quality). In the Pub Med database [21], The usefulness of the indicators will be assessed on a scale from 1 treatment of patients at the primary level of adult healthcare has graphic presentation of the methodological part of research. the inclusion criteria for the articles will be free access, human to 9 points as low (1-3 points), medium (4-6 points) or high achieved its purpose of improving treatment and to what extent species, people over 19 years old, English language. The exclusion usefulness (7-9 points). To evaluate the methodological properties [2-7]. The interprofessional approach to the elderly care and other Creation of conceptual framework of criterion for an article will be publication age > 5 years. In the of the developed indicators, we will use the AIRE instrument patients in family medicine clinic (FMC) has so far been interprofessional approach to elderly care in FMC Science direct database [22], the inclusion criteria will be a (Appraisal of Indicators through Research and Evaluation researched primarily qualitatively with the aim of examining what • Focus groups systematic review article and a research article and dealing with Instrument) method, which is a valid and reliable instrument defines it, what are its advantages, what are the encouraging and • Qualitative analysis of the debate using the method the field of medicine, dentistry, nursing and other healthcare specifically based on the assessment of the quality of the quality inhibiting factors in cooperation between interprofessional experts of grounded theory professions. The exclusion criterion for an article will be indicators. It was derived from the AGREE instrument (Appraisal at the primary level, and what is the satisfaction of experts and publication age > 5 years. We will create quality indicators based of Guidelines Through Research and Evaluation instrument), patients with such an approach [5,7-12]. on the systematic literature review and select a range of 8 to 12 which is a widely used standard for assessing the methodological Many questions arise: What is the conceptual framework of Development of quality indicators of the experts who will be asked via e-mail to check the evidence and quality of practice guidelines. The AIRE includes 20 items that interprofessional elderly care in family medicine in Slovenia? What interprofessional approach to elderly care in FMC evaluate the suitability of the first version of the quality indicators. address four quality domains of quality indicators. Each item is a quality interprofessional approach? How to measure the quality • A systematic literature review Suitability will be assessed by numerical scale from 1 to 9, where includes a statement on the quality of the quality indicators and is of an interprofessional approach? What are the peculiarities of the • RAND/UCLA method 1 indicates very low suitability and 9 indicates the highest rated on a four-point numerical scale (from 1 which means no interprofessional elderly care in family medicine care in Slovenia? • AIRE method suitability. The experts will not know about each other and will information or strongly disagree to 4 which means strongly agree). How to measure the quality of the interprofessional approach so • Testing the properties of indicators give their opinions independently of the opinion of others. In the Items from these domains are scored by two independent that the measuring instruments are adapted to the conditions in the next step experts will participate in a joint meeting, where they reviewers and summed across domains. Then a standardized Slovenian healthcare? We will try to answer these questions in a will receive for each quality indicator their own assessment of the domain score is calculated according to the instrument's guidelines scientific way with the consensus of opinions of experts in this appropriateness and frequency distribution of assessments of all using the formula: (all points-minimum possible Evaluation of the quality of the interprofessional field. the experts. This will be the basis for the discussion. After points)/(maximum points-minimum possible points) x 100%. A approach to elderly care in FMC discussion, they will reassess the appropriateness of each quality higher standardized score indicates a higher methodological level After reviewing, analyzing and synthesizing the literature in this • A cross-sectional observational study in FMC in indicator on a numerical scale from 1 to 9. We will assume that the of quality (range 0-100%). Quality indicators have high field we found out that quality indicators have not been developed Slovenia experts agree on the indicator if the number of experts who methodological quality for a domain if they are rated at 50% or yet for an interprofessional approach to elderly care in family evaluate the indicator outside the three-point region (1-3, 4-6, 7- higher, which correlates with "agree" or "strongly agree" [25]. medicine. By developing quality indicators from this area, we will Figure 1: Graphic presentation of the methodological part of 9), which contains the median, is less than or equal to 2 and that be able to quantitatively assess the quality of the interprofessional the research. they do not agree on an indicator if at least 3 experts will rate the In the second part, the research will be quantitative in the form of same indicator with a score of 1-3 and at least 3 experts with a a cross-sectional survey. We will use the developed quality 50 Quality Assessment of Interprofessional Approach to Description of the subjects and methods: score of 7-9. We will classify the indicators into three levels of In the first part of the research a qualitative methodology is used: appropriateness: suitable (median scores between 7 and 9, no Elderly Care in Family Medicine in Slovenia Experts in the field of quality and primary healthcare for adults disagreement), uncertain (median scores between 4 and 6 or any based on their professional background and competences and median with disagreement), unsuitable (median scores between 1 representatives of patient associations will be invited to a focus and 3, no disagreement). We will consider only the quality group discussion on the interprofessional elderly care in a FMC. indicators for the interprofessional approach to elderly care in the Maja Cvetko Gomezelj1, Zalika Klemenc Ketiš 2, 3, 4 The number of focus groups will depend on data saturation. When FMC, which are suitable and tested to prove acceptability, 1Medical Faculty, University of Ljubljana, 2 Ljubljana Community Health Centre, 3 Department of Family Medicine, the data, statements, attitudes of the participants begin to repeat feasibility, reliability, validity and usability [23,24]. Acceptability Medical Faculty, University of Ljubljana, 4 Department of Family Medicine, Medical Faculty, University of Maribor and we no longer get any fresh ideas, we will end the research [19]. will be proven after a pilot study, where we will check with maja.cvetko@gmail.com The discussion will be qualitatively analyzed using the grounded patients and members of the interprofessional team whether the theory method to determine the conceptual framework of the findings from the collected data are acceptable to them. Feasibility interprofessional elderly care in a FMC in Slovenia. The is confirmed by the RAND/UCLA method, the feasibility rating Abstract—In Slovenia and worldwide an interprofessional approach approach, identify areas for improvement, introduce measures and conceptual framework will define the areas and processes that on a scale from 1 to 9 (the higher the rating, the easier the is increasingly used in the elderly care in family medicine clinics with thus enable continuous quality improvement. describe the interprofessional approach to the elderly care in a feasibility) and a pilot study. the aim of improving the quality of patient care. By developing family medicine care in Slovenia, and will be based on theoretical The reliability of the quality indicator will be checked by the quality indicators we will be able to quantitatively assess the quality starting points and practical experience [20]. The created method of internal consistency and expressed by Cronbach alpha of the interprofessional approach, identify place for improvement, I. MATERIAL AND METHODS conceptual framework will serve us as a theoretical starting point coefficient value (for reliability we will take the limit at 0.7 and introduce measures and thus enable continuous quality for the development of the quality indicators of interprofessional indicate the standard error of the calculation). improvement. We will conduct a mixed methods study [13,14]. In the first part, we will use qualitative methods [15] with focus groups and the approach to elderly care in a FMC in Slovenia according to the Validity: Index Terms-- elderly, family medicine, interprofessional, quality method of grounded theory by Glaser and Strauss [16] and the RAND/UCLA method, which is the only systematic method that ◦ the face validity of the indicator will be confirmed by the RAND/UCLA Appropriateness Method [17]. The name of the harmonizes the opinion of experts and scientific evidence [17]. As RAND/UCLA method (suitable). In Europe, an interprofessional approach is increasingly used in method comes from the names of the inventors - it was developed part of the RAND/UCLA method, we will carry out a systematic ◦ content validity will be determined using the RAND/UCLA the elderly care in family medicine clinics with the aim of in cooperation between the non-profit institution RAND (Research review of domestic and foreign literature on the quality indicators method. improving the quality of patient treatment [1-4]. and Development) and UCLA (University of California Los of the interprofessional approach to the elderly care in the PubMed ◦ construct validity will be determined by factor analysis. [21] and Science Direct [22] databases using the search terms ◦ indicators developed according to the RAND/UCLA method There is little evidence in the national and international literature Angeles). In the second part, the research will be quantitative in (interprofessional) AND (family medicine OR general practice have proven predictive validity. that the introduction of an interprofessional approach to the conducting a cross-sectional survey [18]. Fig. 1 demonstrates OR primary care) AND (quality). In the Pub Med database [21], The usefulness of the indicators will be assessed on a scale from 1 treatment of patients at the primary level of adult healthcare has graphic presentation of the methodological part of research. the inclusion criteria for the articles will be free access, human to 9 points as low (1-3 points), medium (4-6 points) or high achieved its purpose of improving treatment and to what extent species, people over 19 years old, English language. The exclusion usefulness (7-9 points). To evaluate the methodological properties [2-7]. The interprofessional approach to the elderly care and other Creation of conceptual framework of criterion for an article will be publication age > 5 years. In the of the developed indicators, we will use the AIRE instrument patients in family medicine clinic (FMC) has so far been interprofessional approach to elderly care in FMC Science direct database [22], the inclusion criteria will be a (Appraisal of Indicators through Research and Evaluation researched primarily qualitatively with the aim of examining what • Focus groups systematic review article and a research article and dealing with Instrument) method, which is a valid and reliable instrument defines it, what are its advantages, what are the encouraging and • Qualitative analysis of the debate using the method the field of medicine, dentistry, nursing and other healthcare specifically based on the assessment of the quality of the quality inhibiting factors in cooperation between interprofessional experts of grounded theory professions. The exclusion criterion for an article will be indicators. It was derived from the AGREE instrument (Appraisal at the primary level, and what is the satisfaction of experts and publication age > 5 years. We will create quality indicators based of Guidelines Through Research and Evaluation instrument), patients with such an approach [5,7-12]. on the systematic literature review and select a range of 8 to 12 which is a widely used standard for assessing the methodological Many questions arise: What is the conceptual framework of Development of quality indicators of the experts who will be asked via e-mail to check the evidence and quality of practice guidelines. The AIRE includes 20 items that interprofessional elderly care in family medicine in Slovenia? What interprofessional approach to elderly care in FMC evaluate the suitability of the first version of the quality indicators. address four quality domains of quality indicators. Each item is a quality interprofessional approach? How to measure the quality • A systematic literature review Suitability will be assessed by numerical scale from 1 to 9, where includes a statement on the quality of the quality indicators and is of an interprofessional approach? What are the peculiarities of the • RAND/UCLA method 1 indicates very low suitability and 9 indicates the highest rated on a four-point numerical scale (from 1 which means no interprofessional elderly care in family medicine care in Slovenia? • AIRE method suitability. The experts will not know about each other and will information or strongly disagree to 4 which means strongly agree). How to measure the quality of the interprofessional approach so • Testing the properties of indicators give their opinions independently of the opinion of others. In the Items from these domains are scored by two independent that the measuring instruments are adapted to the conditions in the next step experts will participate in a joint meeting, where they reviewers and summed across domains. Then a standardized Slovenian healthcare? We will try to answer these questions in a will receive for each quality indicator their own assessment of the domain score is calculated according to the instrument's guidelines scientific way with the consensus of opinions of experts in this appropriateness and frequency distribution of assessments of all using the formula: (all points-minimum possible Evaluation of the quality of the interprofessional field. the experts. This will be the basis for the discussion. After points)/(maximum points-minimum possible points) x 100%. A approach to elderly care in FMC discussion, they will reassess the appropriateness of each quality higher standardized score indicates a higher methodological level After reviewing, analyzing and synthesizing the literature in this • A cross-sectional observational study in FMC in indicator on a numerical scale from 1 to 9. We will assume that the of quality (range 0-100%). Quality indicators have high field we found out that quality indicators have not been developed Slovenia experts agree on the indicator if the number of experts who methodological quality for a domain if they are rated at 50% or yet for an interprofessional approach to elderly care in family evaluate the indicator outside the three-point region (1-3, 4-6, 7- higher, which correlates with "agree" or "strongly agree" [25]. medicine. By developing quality indicators from this area, we will Figure 1: Graphic presentation of the methodological part of 9), which contains the median, is less than or equal to 2 and that be able to quantitatively assess the quality of the interprofessional the research. they do not agree on an indicator if at least 3 experts will rate the In the second part, the research will be quantitative in the form of same indicator with a score of 1-3 and at least 3 experts with a a cross-sectional survey. We will use the developed quality 51 indicators to determine the quality of interprofessional approach we will use the analysis of the distribution of the values of the identified patients/fewer standardized quotients, the doctor has [12] Klemenc-Ketiš Z, Makivić I, Poplas Susič A. The development and to elderly care in family medicine in Slovenia. In the cross- measured variables: frequency distributions, arithmetic mean, more time for in-depth elderly care and consultation with various validation of a new interprofessional team approach evaluation scale. PLoS One. 2018;13(8):e0201385. sectional study on the quality of the interprofessional approach to standard deviation, Chi square test, t-test. For the statistical experts at the primary level healthcare. A general practitioner elderly care in family medicine we will include, according to the analysis of the data on the assessment of the quality of the oversees the holistic elderly care and, as the team leader, decides ]13] Bowers B, Cohen L, Elliot AE, et al. Creating and supporting a mixed system of simple random sampling of the selected FMC and interprofessional approach to elderly care, we will use the on the treatment procedures and referrals of the elderly to the others methods health services research team. Health Services Research. 2013;48:2157-2180. according to the system of sequential sampling, elderly people assessment of the quality of the interprofessional approach to the experts. The quality indicators will show whether and where there living at home aged 65 years or older, who were treated elderly care as independent variable, and the FMC and patient are still opportunities for improvement of interprofessional elderly [14] Korstjens I, Moser A. Practical guidance to qualitative research. Part 6: Longitudinal qualitative and mixed-methods approaches for longitudinal interprofessionally at the primary level who are able to complete characteristics will be the dependent variables. care. The model of development of quality indicators adapted to the and complex health themes in primary care research. Eur J Gen Pract. the questionnaire independently and who have been registered in Slovenian situation will be an original contribution to knowledge 2022;28(1):118-124. a FMC for at least one year. Among the 974 FMC, we will invite and could become an exemplary model for development of quality [15] Korstjens I, Moser A. Series: Practical guidance to qualitative research. a random sample of 100 Slovenian FMC to participate using the II. RESULTS indicators in or other medicine fields in Slovenia and elsewhere. Part 2: Context, research questions and designs. Eur J Gen Pract. 2017 simple random sampling system with the Research randomizer This mixed methods study on quality assessment of Dec;23(1):274-279. computer program [26]. Each participating FMC will include in interprofessional approach to elderly care in family medicine in [16] Adam F, Hlebec V, Kavčič M, et al. Kvalitativno raziskovanje v the research 7 consecutive patients who were treated Slovenia has three main objectives: ACKNOWLEDGMENT interdisciplinarni perspektivi. Ljubljana: Inštitut za razvojne in strateške analize; 2012. interprofessionally, which means that the patient was treated by at Objective 1: To develop quality indicators for the field of The authors gratefully acknowledge the contributions of Špela least three different experts at the primary level. The number of [17] Fitch K, Bernstein SJ, Aguilar MD, et al. The RAND/UCLA interprofessional elderly care in family medicine in Slovenia. Miroševič to the methods of the research. Appropriateness Method user’s manual. Arlington: RAND Corp St seven patients was chosen in order to ensure that the assessment Monica CA; 2001. of the quality of the interprofessional approach to elderly care in Objective 2: To assess the quality of interprofessional approach FMC would not be too long for the participating general to elderly care in Slovenian FMC with the help of developed quality [18] Setia MS. Methodology Series Module 3: Cross-sectional Studies. REFERENCES Indian J Dermatol. 2016;61(3):261-4. practitioner to complete and to obtain a sufficiently large sample indicators for interprofessional treatment. at the same time. To obtain data for quality indicators, general [1] Samuelson M, Tedeschi P, Aarendonk D, et al. Improving [19] Klemenc-Ketiš Z, Švab I, Kersnik J, et al. Raziskovanje v družinski Objective 3: To develop a multivariate model of interprofessional collaboration in primary care: position paper of the medicini, priročnik. 2014. Ljubljana : Katedra za družinsko medicino practitioners will review the medical records of selected interprofessional approach, which will predict the quality of European Forum for Primary Care. Qual Prim Care. 2012;20(4):303-12. Medicinske fakultete consecutive patients who were treated interprofessionally and interprofessional elderly care in Slovenian FMC. [2] Carron T, Rawlinson C, Arditi C, et al. An Overview of Reviews on [20] Matsumura S, Ozaki M, Iwamoto M, et al. Development and Pilot Testing provide us with the data. If the invited FMC refuses to participate, Interprofessional Collaboration in Primary Care: Effectiveness. Int J of Quality Indicators for Primary Care in Japan. JMA J. 2019;2(2):131- we will randomly select and invite a new FMC from the non- After reviewing the literature in this field in the PubMed [21] Integr Care. 202121(2):31. 138. and ScienceDirect [22] databases, we did not find quality indicators invited FMC, and so on until we obtain a sample of at least 700 for interprofessional approach to elderly care in family medicine. [3] Morgan S, Pullon S, McKinlay E. Observation of interprofessional [21] U.S. National Institutes of Health, National Library of Medicine. Pub subjects or invite all FMC in Slovenia to participate. For potential The added scientific value will be the development of quality collaborative practice in primary care teams: An integrative literature Med [Internet]. [cited 2022 Feb 23] Available from: quality indicators that will require patients point of view, patients review. 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Defining and classifying clinical indicators for quality records, we will also collect data about patients referrals improvement. Int J Qual Health Care. 2003;15(6):523-30. (destinations and dates of referrals), characteristics of patients and [5] Donnelly C, Ashcroft R, Mofina A, et al. Measuring the performance of interprofessional primary health care teams: understanding the teams [24] Campbell SM, Braspenning J, Hutchinson A, et al. Research methods characteristics of FMC. We will determine whether there are III. DISCUSSION perspective. Prim Health Care Res Dev. 2019;20:e125. used in developing and applying quality indicators in primary care. Qual factors that are statistically significantly associated with a high- Saf Health Care. 2002;11(4):358-64. The design and implementation of quality indicators is a special [6] Nall RW, Herndon BB, Mramba LK, et al. An Interprofessional Primary quality interprofessional approach to elderly care. We will [25] Joling KJ, van Eenoo L, Vetrano DL, et al. Quality indicators for challenge in the primary health care of adults, as FMC are geo- Care-Based Transition of Care Clinic to Reduce Hospital Readmission. compare the size of the FMC (the criteria will be the number of Am J Med. 2020;133(6):e260-e268. community care for older people: A systematic review. PLoS One. 2018;13(1):e0190298. identified patients, number of standardized quotients graphically scattered, organized differently, with different assess- ͳ [27], [7] Haj-Ali W, Moineddin R, Hutchison B, et al. Role of Interprofessional average number of patient visits in the last 5 working days), the ments of independence in functioning and with progress in medi-primary care teams in preventing avoidable hospitalizations and hospital [26] Research Randomizer. [Internet] [cited: 2022 Jul 2] Available from: http://www.randomizer.org. location of FMC (city municipalities, settlements with more than cine the complexity of treatment at the primary level increases [28]. readmissions in Ontario, Canada: a retrospective cohort study. BMC Health Serv Res. 2020;20:782. 3,000 inhabitants that do not belong to city municipalities or rural The development of quality indicators for an interprofessional ap- [27] Petek Ster M, Svab I, Zivcec Kalan G. Factors related to consultation time: experience in Slovenia. Scand J Prim Health Care. 2008;26(1):29- areas) and distance from the other members of the proach to elderly care will be adapted to the conditions in Slovenian [8] Sørensen M, Stenberg U, Garnweidner-Holme L. A Scoping Review of Facilitators of Multi-Professional Collaboration in Primary Care. Int J 34. interprofessional team (in the same building/in the immediate healthcare system. With the developed quality indicators, we will Integr Care. 2018;18(3):13. [28] Rushforth B., Stokes T, Andrews E. et al. Developing ‘high impact’ vicinity or not), whether it is a private outpatient clinic with be able to quantitatively assess the interprofessional approach to [9] Bollen A, Harrison R, Aslani P, et al. Factors influencing interprofessional guideline-based quality indicators for UK primary care: a multi-stage concession or a FMC in the public health network, the doctor's elderly care in Slovenia. By evaluating the interprofessional ap-collaboration between community pharmacists and general practitioners- consensus process. BMC Fam Pract. 2015;16:156. level of education (specialist or resident in family medicine), years proach, we will be able to discover its shortcomings, which will A systematic review. Health Soc Care Community. 2019;27(4):e189- [29] Dahrouge S, Hogg W, Younger J, et al. Primary Care Physician Panel of work experience as doctor in family medicine and give the interprofessional team the opportunity to improve its per-e212. formance and thus the quality of the interprofessional elderly care. Size and Quality of Care: A Population-Based Study in Ontario, Canada. characteristics of patients (gender, age, location of residence). For Ann Fam Med. 2016;14(1):26-33. We expect that the quality of interprofessional approach to [10] Rawlinson C, Carron T, Cohidon C, et al. An Overview of Reviews on the statistical analysis of the data from the cross-sectional survey, Interprofessional Collaboration in Primary Care: Barriers and elderly care will be related to workload [29]. In FMC with less Facilitators. Int J Integr Care. 2021;21(2):32, 1-15. 1 [11] Tsakitzidis G, Timmermans O, Callewaert N, et al. Outcome Indicators Workload was defined as the number of patients on the physician's the scores of all the patients on the physician's list yielded the number of on Interprofessional Collaboration Interventions for Elderly. Int J Integr list, weighted to take into consideration the age of the patients. The sum of standardized quotients [27]. Care. 2016;16(2):5. 52 indicators to determine the quality of interprofessional approach we will use the analysis of the distribution of the values of the identified patients/fewer standardized quotients, the doctor has [12] Klemenc-Ketiš Z, Makivić I, Poplas Susič A. The development and to elderly care in family medicine in Slovenia. In the cross- measured variables: frequency distributions, arithmetic mean, more time for in-depth elderly care and consultation with various validation of a new interprofessional team approach evaluation scale. PLoS One. 2018;13(8):e0201385. sectional study on the quality of the interprofessional approach to standard deviation, Chi square test, t-test. For the statistical experts at the primary level healthcare. A general practitioner elderly care in family medicine we will include, according to the analysis of the data on the assessment of the quality of the oversees the holistic elderly care and, as the team leader, decides ]13] Bowers B, Cohen L, Elliot AE, et al. Creating and supporting a mixed system of simple random sampling of the selected FMC and interprofessional approach to elderly care, we will use the on the treatment procedures and referrals of the elderly to the others methods health services research team. Health Services Research. 2013;48:2157-2180. according to the system of sequential sampling, elderly people assessment of the quality of the interprofessional approach to the experts. The quality indicators will show whether and where there living at home aged 65 years or older, who were treated elderly care as independent variable, and the FMC and patient are still opportunities for improvement of interprofessional elderly [14] Korstjens I, Moser A. Practical guidance to qualitative research. Part 6: Longitudinal qualitative and mixed-methods approaches for longitudinal interprofessionally at the primary level who are able to complete characteristics will be the dependent variables. care. The model of development of quality indicators adapted to the and complex health themes in primary care research. Eur J Gen Pract. the questionnaire independently and who have been registered in Slovenian situation will be an original contribution to knowledge 2022;28(1):118-124. a FMC for at least one year. Among the 974 FMC, we will invite and could become an exemplary model for development of quality [15] Korstjens I, Moser A. Series: Practical guidance to qualitative research. a random sample of 100 Slovenian FMC to participate using the II. RESULTS indicators in or other medicine fields in Slovenia and elsewhere. Part 2: Context, research questions and designs. Eur J Gen Pract. 2017 simple random sampling system with the Research randomizer This mixed methods study on quality assessment of Dec;23(1):274-279. computer program [26]. Each participating FMC will include in interprofessional approach to elderly care in family medicine in [16] Adam F, Hlebec V, Kavčič M, et al. Kvalitativno raziskovanje v the research 7 consecutive patients who were treated Slovenia has three main objectives: ACKNOWLEDGMENT interdisciplinarni perspektivi. Ljubljana: Inštitut za razvojne in strateške analize; 2012. interprofessionally, which means that the patient was treated by at Objective 1: To develop quality indicators for the field of The authors gratefully acknowledge the contributions of Špela least three different experts at the primary level. The number of [17] Fitch K, Bernstein SJ, Aguilar MD, et al. The RAND/UCLA interprofessional elderly care in family medicine in Slovenia. Miroševič to the methods of the research. Appropriateness Method user’s manual. Arlington: RAND Corp St seven patients was chosen in order to ensure that the assessment Monica CA; 2001. of the quality of the interprofessional approach to elderly care in Objective 2: To assess the quality of interprofessional approach FMC would not be too long for the participating general to elderly care in Slovenian FMC with the help of developed quality [18] Setia MS. Methodology Series Module 3: Cross-sectional Studies. REFERENCES Indian J Dermatol. 2016;61(3):261-4. practitioner to complete and to obtain a sufficiently large sample indicators for interprofessional treatment. at the same time. To obtain data for quality indicators, general [1] Samuelson M, Tedeschi P, Aarendonk D, et al. Improving [19] Klemenc-Ketiš Z, Švab I, Kersnik J, et al. Raziskovanje v družinski Objective 3: To develop a multivariate model of interprofessional collaboration in primary care: position paper of the medicini, priročnik. 2014. Ljubljana : Katedra za družinsko medicino practitioners will review the medical records of selected interprofessional approach, which will predict the quality of European Forum for Primary Care. Qual Prim Care. 2012;20(4):303-12. Medicinske fakultete consecutive patients who were treated interprofessionally and interprofessional elderly care in Slovenian FMC. [2] Carron T, Rawlinson C, Arditi C, et al. An Overview of Reviews on [20] Matsumura S, Ozaki M, Iwamoto M, et al. Development and Pilot Testing provide us with the data. If the invited FMC refuses to participate, Interprofessional Collaboration in Primary Care: Effectiveness. Int J of Quality Indicators for Primary Care in Japan. JMA J. 2019;2(2):131- we will randomly select and invite a new FMC from the non- After reviewing the literature in this field in the PubMed [21] Integr Care. 202121(2):31. 138. and ScienceDirect [22] databases, we did not find quality indicators invited FMC, and so on until we obtain a sample of at least 700 for interprofessional approach to elderly care in family medicine. [3] Morgan S, Pullon S, McKinlay E. Observation of interprofessional [21] U.S. National Institutes of Health, National Library of Medicine. Pub subjects or invite all FMC in Slovenia to participate. For potential The added scientific value will be the development of quality collaborative practice in primary care teams: An integrative literature Med [Internet]. [cited 2022 Feb 23] Available from: quality indicators that will require patients point of view, patients review. Int J Nurs Stud. 2015;52(7):1217-30. https://pubmed.ncbi.nlm.nih.gov. indicators for interprofessional approach to elderly care in a FMC, will also be invited into the research to fill out the questionnaire. adapted to the healthcare system in Slovenia. With quality [4] Lee JK, McCutcheon LRM, Fazel MT, et al. Assessment of [22] Elsevier company. Science direct [Internet]. [cited 2020 Dec 12]. In addition to data on the quality indicators of the interprofessional indicators we will be able to evaluate the quality of Interprofessional Collaborative Practices and Outcomes in Adults With Available from: https://www.sciencedirect.com. Diabetes and Hypertension in Primary Care: A Systematic Review and approach to elderly care in FMC from the patient's medical interprofessional approach to elderly care in FMC in Slovenia. Meta-analysis. JAMA Netw Open. 2021;4(2):e2. [23] Mainz J. Defining and classifying clinical indicators for quality records, we will also collect data about patients referrals improvement. Int J Qual Health Care. 2003;15(6):523-30. (destinations and dates of referrals), characteristics of patients and [5] Donnelly C, Ashcroft R, Mofina A, et al. Measuring the performance of interprofessional primary health care teams: understanding the teams [24] Campbell SM, Braspenning J, Hutchinson A, et al. Research methods characteristics of FMC. We will determine whether there are III. DISCUSSION perspective. Prim Health Care Res Dev. 2019;20:e125. used in developing and applying quality indicators in primary care. Qual factors that are statistically significantly associated with a high- Saf Health Care. 2002;11(4):358-64. [6] Nall RW, Herndon BB, Mramba LK, et al. An Interprofessional Primary quality interprofessional approach to elderly care. We will The design and implementation of quality indicators is a special [25] Joling KJ, van Eenoo L, Vetrano DL, et al. Quality indicators for challenge in the primary health care of adults, as FMC are geo- Care-Based Transition of Care Clinic to Reduce Hospital Readmission. compare the size of the FMC (the criteria will be the number of Am J Med. 2020;133(6):e260-e268. community care for older people: A systematic review. PLoS One. 2018;13(1):e0190298. identified patients, number of standardized quotients graphically scattered, organized differently, with different assess- ͳ [27], [7] Haj-Ali W, Moineddin R, Hutchison B, et al. Role of Interprofessional average number of patient visits in the last 5 working days), the ments of independence in functioning and with progress in medi-primary care teams in preventing avoidable hospitalizations and hospital [26] Research Randomizer. [Internet] [cited: 2022 Jul 2] Available from: http://www.randomizer.org. location of FMC (city municipalities, settlements with more than cine the complexity of treatment at the primary level increases [28]. readmissions in Ontario, Canada: a retrospective cohort study. BMC Health Serv Res. 2020;20:782. 3,000 inhabitants that do not belong to city municipalities or rural The development of quality indicators for an interprofessional ap- [27] Petek Ster M, Svab I, Zivcec Kalan G. Factors related to consultation time: experience in Slovenia. Scand J Prim Health Care. 2008;26(1):29- areas) and distance from the other members of the proach to elderly care will be adapted to the conditions in Slovenian [8] Sørensen M, Stenberg U, Garnweidner-Holme L. A Scoping Review of Facilitators of Multi-Professional Collaboration in Primary Care. Int J 34. interprofessional team (in the same building/in the immediate healthcare system. With the developed quality indicators, we will Integr Care. 2018;18(3):13. vicinity or not), whether it is a private outpatient clinic with be able to quantitatively assess the interprofessional approach to [28] Rushforth B., Stokes T, Andrews E. et al. Developing ‘high impact’ [9] Bollen A, Harrison R, Aslani P, et al. Factors influencing interprofessional guideline-based quality indicators for UK primary care: a multi-stage concession or a FMC in the public health network, the doctor's elderly care in Slovenia. By evaluating the interprofessional ap-collaboration between community pharmacists and general practitioners- consensus process. BMC Fam Pract. 2015;16:156. level of education (specialist or resident in family medicine), years proach, we will be able to discover its shortcomings, which will A systematic review. Health Soc Care Community. 2019;27(4):e189- [29] Dahrouge S, Hogg W, Younger J, et al. Primary Care Physician Panel of work experience as doctor in family medicine and give the interprofessional team the opportunity to improve its per-e212. formance and thus the quality of the interprofessional elderly care. Size and Quality of Care: A Population-Based Study in Ontario, Canada. characteristics of patients (gender, age, location of residence). For Ann Fam Med. 2016;14(1):26-33. We expect that the quality of interprofessional approach to [10] Rawlinson C, Carron T, Cohidon C, et al. An Overview of Reviews on the statistical analysis of the data from the cross-sectional survey, Interprofessional Collaboration in Primary Care: Barriers and elderly care will be related to workload [29]. In FMC with less Facilitators. Int J Integr Care. 2021;21(2):32, 1-15. 1 [11] Tsakitzidis G, Timmermans O, Callewaert N, et al. Outcome Indicators Workload was defined as the number of patients on the physician's the scores of all the patients on the physician's list yielded the number of on Interprofessional Collaboration Interventions for Elderly. Int J Integr list, weighted to take into consideration the age of the patients. The sum of standardized quotients [27]. Care. 2016;16(2):5. 53 How to confront violence in healthcare of various forms of violence are essential for effective reporting of consisted of 33 questions, divided into three parts. The first set violent incidents at work and for taking action [5]. An examination included demographic questions (gender, age, region, occupation, of the accessible databases of the National Institute of Public Health form of healthcare activity, length of service, etc.), the second part Nena Kopčavar Guček (NIJZ) and the Institute for Health Insurance of Slovenia (ZZZS) consisted of set of work habits/characteristics of work (closed and Department of Family Medicine, Medical Faculty, University of Ljubljana and Community Health Center of Ljubljana, does not allow for determination; nor monitoring the frequency of semi-open type of questions, with the possibility of one or more Slovenia workplace violence and its health consequences [7]. The Slovenian answers) and the third the set of perceptions of violence at the nenagucek@gmail.com area is characterized by a high degree of criticism of the healthcare workplace (closed and semi-open type of questions, with the system. Dissatisfaction and the resulting tension is the result of a gap possibility of one or more answers and two tables, where the Abstract— Background: In this paper, an example of needs assessment and building between wishes and possibilities, between promises and reality, respondents are asked to determine the frequency of violence based capacity activity in the form of educating medical staff in their often the result of organizational deficiencies in health care, biased on the stated claims. In the open question, however, the respondents Workplace violence (WPV) encompasses physical violence, own environment as a form of continuous medical education media reports, and personnel and material shortages [8]. described the violent event that they most hurt in his professional harassment, intimidation, and disruptive behavior at the workplace. As an increasingly common phenomenon in the (CME) will be described. life. healthcare environment, it is affecting and involving healthcare Index Terms-- violence, healthcare, working place safety The Slovenian Medical Chamber (SMC) firmly supports the workers, patients, clients and visitors. Only a safe and peaceful principle of zero tolerance towards violence against the medical SAMPLE DESCRIPTION working environment enables the delivery of a high quality, profession. SMC strives for employees, patients, relatives and A purposive sample was used. professional and patient-friendly healthcare. visitors to know, understand and support this policy. In any Medical faculty graduates without additional training (35), trainee Methods: I INTRODUCTION healthcare system, it must be clear to employees, patients and dentists (8), trainees for various specialities, including specialists in relatives that violent behavior will not provide benefits, advantages GP/FM (231), general practitioners without specialization (39), In 2017, a multidisciplinary group was established at the Tragic outcomes and increasing frequency of reports on violent Medical Chamber of Slovenia. In addition to its other activities, incidents suggest the need for raising awareness and raising or advantages, but will lead to legal and administrative specialists (870), dentists without specialization (292), nurses (13), the group of experts also conducts interactive trainings in which competencies of the healthcare workers in this domain. consequences (e.g. interruption of medical care)[7]. These goals nursing technicians participated in the survey (4), administrators (4), a police inspector, a bachelor of laws, a psychiatrist, a registered In its 1996 resolution, the World Health Organization (WHO) were set by the interdisciplinary group "Don't allow violence", others (22), whose occupation was not specified, defined it as nurse, and a family practitioner/specialist of family medicine. defined violence as a major and escalating threat in the world, which was established in 2017 at the SMC. Various experts were "other", who were members of the SMC in 2018. The survey was Following an online research I terms od needs-assessment, an therefore the prevention of violence is presented as a public health included in the group (nursing representatives, lawyers, police completed by 421 men (28.2% of all respondents) and 1051 women, educational modul was prepared. The training is intended for all representative, specialists in traumatology, gynecology, dentistry, representing 70.4% of all respondents, the rest (1.3%) did not healthcare workers. It consists of a 4 hour interactive workshop, priority [1]. Violence causes short-term, long-term and lifelong specify their gender. The average age of all respondents was 46 which is typically conducted in the health setting of the hosting consequences for the individual, as well as for the community, wider psychiatry, family medicine). institution. environment and health systems [2]. years, the average working time 19 years and the average working time in the current job 12 years. The largest number of respondents Results: Compared to the epidemic of chronic diseases, violence is more widespread and preventable, and therefore a greater challenge to II MATERIAL AND METHODS come/work in the Ljubljana region (544 respondents), and the least The results of the research showed that 71.4% of all surveyed global health [1,3]. Although research findings prove that biological With the research, we wanted assess the frequency of violent events in the Zasavje region (18 respondents). health workers were already victims of violence by the patient or and other factors can predispose to violent behavior, violence is compared to violence 10 years ago and to find out the needs of the patient relatives and 31.6% by colleagues. 17 % of those surveyed were already victims of physical violence. 48 % were most often the result of their interaction with external factors. In the employees for training. Based on the results of the research, we DESCRIPTION OF RESEARCH AND DATA PROCESSING exposed to violence in the primary care clinic, 35% in the ecological model, violence is conditioned by the interaction of an wanted to create Recommendations for the prevention of violent hospital department and 32 % in the specialist outpatient individual with another individual, family, community and society. incidents and a training plan for employees (measures to prevent The research took place from 12 April 2018 to 16 May 2018 with an clinic.In 57% of health care workers, they want additional In order for a behavior to be defined as violence, it must involve outbreaks of violence). We asked ourselves the following research online survey (1KA). Participation was voluntary. Anonymity was training in the field of prevention, recognition and protection intent, physical force or power and cause consequences [1]. Today, questions: How many respondents have already been victims of guaranteed. In the data analysis, we focused on secondaries, trainee against violence.The workshop has been conducted four times, violence is a global problem that is rapidly expanding. Violence at physical violence? What are the most common causes of violence? three times in the hospital environment and once in a healthcare dentists, specialists, general practitioners without specialization, centre in a small town. More than 100 participants were actively the workplace occurs almost everywhere, the health profession is Which healthcare workplaces are most exposed to violence? How specialists and dentists without specialization. To present the results, contributing to the contents of the workshop by discussing the particularly at risk, where almost a quarter of all violence at the many employees need additional training in the field of prevention, we used descriptive or descriptive statistics. We have also presented vignettes provided by the group as well as discussing their own workplace occurs [4]. According to data from the European Agency recognition and protection against violence? important results in tables. To analyze the association of variables, cases and dilemmas. Their anonymous evaluation sheets reflect for Safety and Health at Work [5] from 2007, the health and social We used the quantitative method of research and the method of we calculated different statistics according to the type of satisfaction with the workshop. sectors are characterized by the highest exposure to violence at the description. The data was collected using a structured measurement scale of the variable. Since both independent variables Conclusion(s): workplace; in the EU 27 the incidence rate was 15% [5]. questionnaire, using the online survey technique. The research was had nominal measurement scales, we calculated Pearson's Chi-Healthcare workers are at high risk of violence worldwide. Between based on professional and scientific literature, the results of research While workplace safety is primarily management's square. We calculated the correlation between the independent responsibility, healthcare workers also play an active role. 8 and 38 percent of healthcare workers experience physical violence in the field of violence against doctors both in our country and variable gender and the dependent variables of questions Q15 Knowledge is pivotal in recognizing and addressing violence. By at some point in their career. Many are exposed to verbal violence. abroad. We took into account our own clinical experience as well as (violence at the workplace), Q16 (forms of violence). enhancing the competencies to prevent, recognize or confront Among the categories of health workers most at risk are nurses and realistic possibilities. based on professional and scientific literature, violence at various educational levels, the workshop described in other personnel directly involved in patient care [6]. the results of research in the field of violence against doctors both in this presentation aims to create safer healthcare settings for Among healthcare workers, some consider workplace violence to be our country and abroad. We took into account our own clinical III RESULTS patients and staff. Only a safe and calm working environment a "conscious occupational risk" or even self-inflicted. Psychological experience as well as realistic possibilities. can guarantee a professional, competent and high-quality Forms of violence healthcare. violence often remains unrecognized, and is often not perceived as violent behavior and is not reported [7]. Knowledge and recognition Physical violence by patients was reported by 17% of doctors [9]. RESEARCH INSTRUMENT DESCRIPTION We used an adapted version of an already tested survey questionnaire [5], which was modified by the members of the expert group, for the sake of comparability of the results. The questionnaire 54 How to confront violence in healthcare of various forms of violence are essential for effective reporting of consisted of 33 questions, divided into three parts. The first set violent incidents at work and for taking action [5]. An examination included demographic questions (gender, age, region, occupation, of the accessible databases of the National Institute of Public Health form of healthcare activity, length of service, etc.), the second part Nena Kopčavar Guček (NIJZ) and the Institute for Health Insurance of Slovenia (ZZZS) consisted of set of work habits/characteristics of work (closed and Department of Family Medicine, Medical Faculty, University of Ljubljana and Community Health Center of Ljubljana, does not allow for determination; nor monitoring the frequency of semi-open type of questions, with the possibility of one or more Slovenia workplace violence and its health consequences [7]. The Slovenian answers) and the third the set of perceptions of violence at the nenagucek@gmail.com area is characterized by a high degree of criticism of the healthcare workplace (closed and semi-open type of questions, with the system. Dissatisfaction and the resulting tension is the result of a gap possibility of one or more answers and two tables, where the Abstract— Background: In this paper, an example of needs assessment and building between wishes and possibilities, between promises and reality, respondents are asked to determine the frequency of violence based capacity activity in the form of educating medical staff in their often the result of organizational deficiencies in health care, biased on the stated claims. In the open question, however, the respondents Workplace violence (WPV) encompasses physical violence, own environment as a form of continuous medical education media reports, and personnel and material shortages [8]. described the violent event that they most hurt in his professional harassment, intimidation, and disruptive behavior at the workplace. As an increasingly common phenomenon in the (CME) will be described. life. healthcare environment, it is affecting and involving healthcare Index Terms-- violence, healthcare, working place safety The Slovenian Medical Chamber (SMC) firmly supports the workers, patients, clients and visitors. Only a safe and peaceful principle of zero tolerance towards violence against the medical SAMPLE DESCRIPTION working environment enables the delivery of a high quality, profession. SMC strives for employees, patients, relatives and A purposive sample was used. professional and patient-friendly healthcare. visitors to know, understand and support this policy. In any Medical faculty graduates without additional training (35), trainee Methods: I INTRODUCTION healthcare system, it must be clear to employees, patients and dentists (8), trainees for various specialities, including specialists in relatives that violent behavior will not provide benefits, advantages GP/FM (231), general practitioners without specialization (39), In 2017, a multidisciplinary group was established at the Tragic outcomes and increasing frequency of reports on violent Medical Chamber of Slovenia. In addition to its other activities, incidents suggest the need for raising awareness and raising or advantages, but will lead to legal and administrative specialists (870), dentists without specialization (292), nurses (13), the group of experts also conducts interactive trainings in which competencies of the healthcare workers in this domain. consequences (e.g. interruption of medical care)[7]. These goals nursing technicians participated in the survey (4), administrators (4), a police inspector, a bachelor of laws, a psychiatrist, a registered In its 1996 resolution, the World Health Organization (WHO) were set by the interdisciplinary group "Don't allow violence", others (22), whose occupation was not specified, defined it as nurse, and a family practitioner/specialist of family medicine. defined violence as a major and escalating threat in the world, which was established in 2017 at the SMC. Various experts were "other", who were members of the SMC in 2018. The survey was Following an online research I terms od needs-assessment, an therefore the prevention of violence is presented as a public health included in the group (nursing representatives, lawyers, police completed by 421 men (28.2% of all respondents) and 1051 women, educational modul was prepared. The training is intended for all representative, specialists in traumatology, gynecology, dentistry, representing 70.4% of all respondents, the rest (1.3%) did not healthcare workers. It consists of a 4 hour interactive workshop, priority [1]. Violence causes short-term, long-term and lifelong specify their gender. The average age of all respondents was 46 which is typically conducted in the health setting of the hosting consequences for the individual, as well as for the community, wider psychiatry, family medicine). institution. environment and health systems [2]. years, the average working time 19 years and the average working time in the current job 12 years. The largest number of respondents Results: Compared to the epidemic of chronic diseases, violence is more widespread and preventable, and therefore a greater challenge to II MATERIAL AND METHODS come/work in the Ljubljana region (544 respondents), and the least The results of the research showed that 71.4% of all surveyed global health [1,3]. Although research findings prove that biological With the research, we wanted assess the frequency of violent events in the Zasavje region (18 respondents). health workers were already victims of violence by the patient or and other factors can predispose to violent behavior, violence is compared to violence 10 years ago and to find out the needs of the patient relatives and 31.6% by colleagues. 17 % of those surveyed were already victims of physical violence. 48 % were most often the result of their interaction with external factors. In the employees for training. Based on the results of the research, we DESCRIPTION OF RESEARCH AND DATA PROCESSING exposed to violence in the primary care clinic, 35% in the ecological model, violence is conditioned by the interaction of an wanted to create Recommendations for the prevention of violent hospital department and 32 % in the specialist outpatient individual with another individual, family, community and society. incidents and a training plan for employees (measures to prevent The research took place from 12 April 2018 to 16 May 2018 with an clinic.In 57% of health care workers, they want additional In order for a behavior to be defined as violence, it must involve outbreaks of violence). We asked ourselves the following research online survey (1KA). Participation was voluntary. Anonymity was training in the field of prevention, recognition and protection intent, physical force or power and cause consequences [1]. Today, questions: How many respondents have already been victims of guaranteed. In the data analysis, we focused on secondaries, trainee against violence.The workshop has been conducted four times, violence is a global problem that is rapidly expanding. Violence at physical violence? What are the most common causes of violence? three times in the hospital environment and once in a healthcare dentists, specialists, general practitioners without specialization, centre in a small town. More than 100 participants were actively the workplace occurs almost everywhere, the health profession is Which healthcare workplaces are most exposed to violence? How specialists and dentists without specialization. To present the results, contributing to the contents of the workshop by discussing the particularly at risk, where almost a quarter of all violence at the many employees need additional training in the field of prevention, we used descriptive or descriptive statistics. We have also presented vignettes provided by the group as well as discussing their own workplace occurs [4]. According to data from the European Agency recognition and protection against violence? important results in tables. To analyze the association of variables, cases and dilemmas. Their anonymous evaluation sheets reflect for Safety and Health at Work [5] from 2007, the health and social We used the quantitative method of research and the method of we calculated different statistics according to the type of satisfaction with the workshop. sectors are characterized by the highest exposure to violence at the description. The data was collected using a structured measurement scale of the variable. Since both independent variables Conclusion(s): workplace; in the EU 27 the incidence rate was 15% [5]. questionnaire, using the online survey technique. The research was had nominal measurement scales, we calculated Pearson's Chi-Healthcare workers are at high risk of violence worldwide. Between based on professional and scientific literature, the results of research While workplace safety is primarily management's square. We calculated the correlation between the independent responsibility, healthcare workers also play an active role. 8 and 38 percent of healthcare workers experience physical violence in the field of violence against doctors both in our country and variable gender and the dependent variables of questions Q15 Knowledge is pivotal in recognizing and addressing violence. By at some point in their career. Many are exposed to verbal violence. abroad. We took into account our own clinical experience as well as (violence at the workplace), Q16 (forms of violence). enhancing the competencies to prevent, recognize or confront Among the categories of health workers most at risk are nurses and realistic possibilities. based on professional and scientific literature, violence at various educational levels, the workshop described in other personnel directly involved in patient care [6]. the results of research in the field of violence against doctors both in this presentation aims to create safer healthcare settings for Among healthcare workers, some consider workplace violence to be our country and abroad. We took into account our own clinical III RESULTS patients and staff. Only a safe and calm working environment a "conscious occupational risk" or even self-inflicted. Psychological experience as well as realistic possibilities. can guarantee a professional, competent and high-quality Forms of violence healthcare. violence often remains unrecognized, and is often not perceived as violent behavior and is not reported [7]. Knowledge and recognition Physical violence by patients was reported by 17% of doctors [9]. RESEARCH INSTRUMENT DESCRIPTION We used an adapted version of an already tested survey questionnaire [5], which was modified by the members of the expert group, for the sake of comparability of the results. The questionnaire 55 Table 1 shows the forms of violence according to On average, respondents estimate that they have been the victim of H0: χ2 = 0 . . There is no association between gender and Q15a- incidence/frequency in the past calendar year an argument 5 to 10 times in the past year. On average, they estimate Q15g in the population. Table 1: Frequency distribution of forms of violence in the previous that they have been the victim of rude, insensitive and disrespectful H1: χ2 > 0 . . There is an association between gender and Q15a- calendar year ( Vir: Raziskava, 2018 (Čebašek-Travnik, 2018)[9] behavior from 5 to 10 times in the past year, the victim of insults, Q15g in the population. cursing and the use of derogatory terms up to 5 times in the past For all variables, the χ2 value is greater than 0. more than from 10 to from 5 to 10 4 to 5 times never year, the victim of harassment and intimidation/bullying (also with The exact characteristic level (p) is less than α = 0.05 only for the Forms of 50 times 50 times times gestures) up to 5 times in the past year and that they have been the variable Q15d - witnessing violence against a co-worker by another violence victim of verbal or written threats, including hate speech or threats co-worker. We reject the null hypothesis for variable Q15d at the N % N % N % N % N % by e-mail, telephone, on social networks up to 5 times in the past 5% level of specificity and accept the alternative hypothesis. At a a. Arguing 72 6,4 % 199 17,6% 237 21,0% 416 36,8% 205 18,2% year. 5% level of specificity, we can claim that there is a connection in the b. Rude and 114 10,4% 256 23,4% 221 20,2% 360 32,9% 143 13,1% population between an individual's gender and his presence in the Analysis of the correlation of dependent variables: forms of event of violence against a co-worker by another co-worker. disrespectful violence - Q16 and independent variables-gender To measure the strength of the connection, we chose the root of behavior Person's coefficient, since both variables have two values each (2x2 c. Threatening 5 0,5% 19 1,9% 40 4,1% 183 18,8% 729 74,7% The assumptions of the chi-square (χ2) test are met for variables table). The value of the Person coefficient (-0.069) indicates a (very) with fists Q16a, Q16b, Q16d, Q16e, Q16g and Q16h (Table 2). low and negative association between the variables. Men are more often witnesses of violence against a colleague by d. Various 10 1,0% 27 2,8% 61 6,4% 207 21,7% 649 68,0% Assumptions: another colleague. disrespectful H0: χ2 = 0 . . There is no association between gender and Q16a- Q16h in the population. gestures H1: χ2 > 0 . . There is an association between gender and Q16a- Other results e. Insults and 49 5,0% 108 11,1% 153 15,7% 381 39,1% 284 29,1% Q16h in the population. cursing For all selected variables, the χ2 value is greater than 0. 48% of the respondents were exposed to violence in the primary f. Metanje 1 0,1% 15 1,6% 48 5,1% 158 16,8% 718 76,4% The exact characteristic level (p) is less than α = 0.05 for variable healthcare clinic, 35% in the ward and 32% in the specialist Q16b (rude and disrespectful behavior) and variable Q16e (insults, healthcare clinic. predmetov cursing). We reject the null hypothesis for variables Q16b and Q16e Regarding solving conflict situations and outbreaks of violence in g. Harassment 13 1,3% 44 4,6% 103 10,7% 337 35,0% 466 48,4% at the 5% level of specificity. With a 5% level of specificity, we can their work environment, 72.4% of doctors and 81.8% of dentists do and claim that there is a connection between gender and the experience not respond to violence or ignore it. Only 28.7% of doctors and intimidating/ of violence in the form of rude and disrespectful behavior in the 11.8% of dentists inform security guards or the police about a bullying population. Also, with a 5% level of characteristic, we can claim that violent incident. there is a connection between gender and the experience of violence The consequences of exposure to violence were post-traumatic stress h. Oral or 13 1,3% 40 4,1% 83 8,6% 360 37,2% 471 48,7% in the form of insults and cursing in the population. disorder (41.6%) and hypersensitivity to stressful events (34.9%). written We chose Cramer's coefficient and Pearson's contingency coefficient 39.8% of doctors exposed to violence felt excessive excitement at the possibility of a recurring event, 7.4% of participants in violent threats to measure the strength of the association. The correlation between the event avoided talking about the violent event. 31.3% of doctors i. Visual/verbal 1 0,1% 10 1,1% 16 1,7% 75 8,0% 831 89,1% gender and variable Q16b is weak (0.099). Likewise with variable and 29.0% of dentists had a sense of hopelessness and the sexual Q16e (0.131). intractability of the situation. Women are more often subjected to violence in the form of rude and harassment disrespectful behavior as well as insults and curses. The most frequently chosen protective measure in a medical j. Physical 1 0,1% 3 0,3% 6 0,6% 58 6,2% 865 92,7% institution or the workplace of the respondents is a form for medical sexual personnel to report on violent patients and/or companions (401 harassment Perpetrators of violence respondents), followed by the constant presence of a security guard in the building (369 respondents). (149 respondents) have options k. Sexual 4 0,4% 6 0,6% 30 3,2% 129 13,8% 769 82,0% The perpetrators of violence are dominated (71.4%) by patients for professional training in cases of violence and legal assistance, harassment and/or their companions, this type of violence is called "client (124 respondents) have options for psychosocial assistance. with obscene initiated violence". 31.6% of violent acts are caused by colleagues. 57% of employees in healthcare would participate in additional language 54.6% of respondents witnessed violence against another healthcare training in the field of prevention, recognition and protection from violence, 16% of respondents would not attend lectures, 28% of l. Hitting, 0 0,0% 0 0,0% 3 0,3% 41 4,4% 888 95,3% worker. 28.9% of respondents witnessed violence against a co- respondents were neutral regarding participation in training [9]. kicking and worker by another co-worker. other forms note) Correlation between dependent variables: workplace Capacity building-CME activities of physical foot violence-Q15 and independent gender variables At the time of this article, the workshop has been conducted four violence times, three times in the hospital environment and once in a e. (Table healthcare center in a small town. The health organizations apply for m. Unauthorised 3 0,3% 12 1,3% 41 4,4% 170 18,1 715 76,0 The assumptions of the chi-square (χ2) test are fulfilled for most of the variables, as all values of the theoretical frequencies are greater the workshop at the SMC. The size of the group is adjusted to the invasion of % % footnot able than 5 (Table 4). interactive methodology of the module, up to 30 participants per privacy T a Assumptions: workshop. More than 100 participants were actively contributing to n. Unauthorised 0 0,0% 4 0,4% 10 1,1% 116 12,4% 809 86,2% e of the contents of the workshop by discussing the vignettes provided by ampl physical and Exa. vodeo recording o. Other 1 0,2% 7 1,4% 5 1,0% 19 3,8% 472 93,7% 56 Table 1 shows the forms of violence according to On average, respondents estimate that they have been the victim of H0: χ2 = 0 . . There is no association between gender and Q15a- incidence/frequency in the past calendar year an argument 5 to 10 times in the past year. On average, they estimate Q15g in the population. Table 1: Frequency distribution of forms of violence in the previous that they have been the victim of rude, insensitive and disrespectful H1: χ2 > 0 . . There is an association between gender and Q15a- calendar year ( Vir: Raziskava, 2018 (Čebašek-Travnik, 2018)[9] behavior from 5 to 10 times in the past year, the victim of insults, Q15g in the population. cursing and the use of derogatory terms up to 5 times in the past For all variables, the χ2 value is greater than 0. more than from 10 to from 5 to 10 4 to 5 times never year, the victim of harassment and intimidation/bullying (also with The exact characteristic level (p) is less than α = 0.05 only for the Forms of 50 times 50 times times gestures) up to 5 times in the past year and that they have been the variable Q15d - witnessing violence against a co-worker by another violence victim of verbal or written threats, including hate speech or threats co-worker. We reject the null hypothesis for variable Q15d at the N % N % N % N % N % by e-mail, telephone, on social networks up to 5 times in the past 5% level of specificity and accept the alternative hypothesis. At a a. Arguing 72 6,4 % 199 17,6% 237 21,0% 416 36,8% 205 18,2% year. 5% level of specificity, we can claim that there is a connection in the b. Rude and 114 10,4% 256 23,4% 221 20,2% 360 32,9% 143 13,1% population between an individual's gender and his presence in the Analysis of the correlation of dependent variables: forms of event of violence against a co-worker by another co-worker. disrespectful violence - Q16 and independent variables-gender To measure the strength of the connection, we chose the root of behavior Person's coefficient, since both variables have two values each (2x2 c. Threatening 5 0,5% 19 1,9% 40 4,1% 183 18,8% 729 74,7% The assumptions of the chi-square (χ2) test are met for variables table). The value of the Person coefficient (-0.069) indicates a (very) with fists Q16a, Q16b, Q16d, Q16e, Q16g and Q16h (Table 2). low and negative association between the variables. Men are more often witnesses of violence against a colleague by d. Various 10 1,0% 27 2,8% 61 6,4% 207 21,7% 649 68,0% Assumptions: another colleague. disrespectful H0: χ2 = 0 . . There is no association between gender and Q16a- Q16h in the population. gestures H1: χ2 > 0 . . There is an association between gender and Q16a- Other results e. Insults and 49 5,0% 108 11,1% 153 15,7% 381 39,1% 284 29,1% Q16h in the population. cursing For all selected variables, the χ2 value is greater than 0. 48% of the respondents were exposed to violence in the primary f. Metanje 1 0,1% 15 1,6% 48 5,1% 158 16,8% 718 76,4% The exact characteristic level (p) is less than α = 0.05 for variable healthcare clinic, 35% in the ward and 32% in the specialist Q16b (rude and disrespectful behavior) and variable Q16e (insults, healthcare clinic. predmetov cursing). We reject the null hypothesis for variables Q16b and Q16e Regarding solving conflict situations and outbreaks of violence in g. Harassment 13 1,3% 44 4,6% 103 10,7% 337 35,0% 466 48,4% at the 5% level of specificity. With a 5% level of specificity, we can their work environment, 72.4% of doctors and 81.8% of dentists do and claim that there is a connection between gender and the experience not respond to violence or ignore it. Only 28.7% of doctors and intimidating/ of violence in the form of rude and disrespectful behavior in the 11.8% of dentists inform security guards or the police about a bullying population. Also, with a 5% level of characteristic, we can claim that violent incident. there is a connection between gender and the experience of violence The consequences of exposure to violence were post-traumatic stress h. Oral or 13 1,3% 40 4,1% 83 8,6% 360 37,2% 471 48,7% in the form of insults and cursing in the population. disorder (41.6%) and hypersensitivity to stressful events (34.9%). written We chose Cramer's coefficient and Pearson's contingency coefficient 39.8% of doctors exposed to violence felt excessive excitement at the possibility of a recurring event, 7.4% of participants in violent threats to measure the strength of the association. The correlation between the event avoided talking about the violent event. 31.3% of doctors i. Visual/verbal 1 0,1% 10 1,1% 16 1,7% 75 8,0% 831 89,1% gender and variable Q16b is weak (0.099). Likewise with variable and 29.0% of dentists had a sense of hopelessness and the sexual Q16e (0.131). intractability of the situation. Women are more often subjected to violence in the form of rude and harassment disrespectful behavior as well as insults and curses. The most frequently chosen protective measure in a medical j. Physical 1 0,1% 3 0,3% 6 0,6% 58 6,2% 865 92,7% institution or the workplace of the respondents is a form for medical sexual personnel to report on violent patients and/or companions (401 harassment Perpetrators of violence respondents), followed by the constant presence of a security guard in the building (369 respondents). (149 respondents) have options k. Sexual 4 0,4% 6 0,6% 30 3,2% 129 13,8% 769 82,0% The perpetrators of violence are dominated (71.4%) by patients for professional training in cases of violence and legal assistance, harassment and/or their companions, this type of violence is called "client (124 respondents) have options for psychosocial assistance. with obscene initiated violence". 31.6% of violent acts are caused by colleagues. 57% of employees in healthcare would participate in additional language 54.6% of respondents witnessed violence against another healthcare training in the field of prevention, recognition and protection from violence, 16% of respondents would not attend lectures, 28% of l. Hitting, 0 0,0% 0 0,0% 3 0,3% 41 4,4% 888 95,3% worker. 28.9% of respondents witnessed violence against a co- respondents were neutral regarding participation in training [9]. kicking and worker by another co-worker. other forms Correlation between dependent variables: workplace Capacity building-CME activities of physical violence-Q15 and independent gender variables At the time of this article, the workshop has been conducted four violence times, three times in the hospital environment and once in a healthcare center in a small town. The health organizations apply for m. Unauthorised 3 0,3% 12 1,3% 41 4,4% 170 18,1 715 76,0 The assumptions of the chi-square (χ2) test are fulfilled for most of the variables, as all values of the theoretical frequencies are greater the workshop at the SMC. The size of the group is adjusted to the invasion of % % than 5 (Table 4). interactive methodology of the module, up to 30 participants per privacy Assumptions: workshop. More than 100 participants were actively contributing to n. Unauthorised 0 0,0% 4 0,4% 10 1,1% 116 12,4% 809 86,2% the contents of the workshop by discussing the vignettes provided by physical and vodeo recording o. Other 1 0,2% 7 1,4% 5 1,0% 19 3,8% 472 93,7% 57 the group as well as discussing their own cases and dilemmas. Their In England, there were 68,683 reported assaults against healthcare anonymous evaluation sheets reflect satisfaction with the workshop. staff between 2013 and 2014. Most of these (69%) occurred in REFERENCES [11] Gascón, S., Martínez-Jarreta, B., González- psychiatric or long-term care facilities. Most of the reported Andrade, JF., Santed, MA., Casalod, J. & Rueda, MA., incidents were caused by patients and/or their families or caregivers [1] Krug, EG., Dahlberg, LL., Mecy, JA., Zwi, AB. & 2009. Aggression Towards Health Care Workers in Spain: IV DISCUSSION [13]. Wilson, A., 2002. The way forward: recommendations for A Multi-facility Study to Evaluate the Distribution of In Slovenia, dissatisfaction, impatience and tension of the healthcare action. In: Krug, EG., Dahlberg, LL., Mecy, JA., Zwi, Growing Violence Among Professionals, Health Facilities Two cross-sectional surveys conducted by the SMC in 2007 and professionals are often transferred to patients and attendants in the AB., Lozano, R, eds. World report on violence and health. and Departments. International Journal of Occupational and Environmental Health, 15(1), pp. 29-35. DOI: 2018 showed that violence against doctors is a serious public health waiting rooms. The distress of patients, relatives and even staff can Geneva (Switzerland): World Health Organization. 10.1179/107735209799449707. problem and that psychological violence is on the rise. The research be a reason for violence. The most common risk factors for showed that women are more often subjected to violence in the form violence are linked to the patient [7]. [2] WHA49.25., 1996. Prevention of violence: a public [12] Claudius, I. A., Desai, S., Davis, E. & Henderson, of rude disrespectful behavior and insults and curses; which raises The research showed that around 70% of violent events in healthcare health priority. Forty-Ninth World Health Assembly Geneva, S., 2017. Case-controlled analysis of patient-based risk concerns given that medicine as nursing is a feminized profession. are perpetrated by patients and their relatives, half as many by 20‒25 May 1996. Hbk Res., Vol. III (3rd ed.), 1.11. Available at: factors for assault in the healhcare workplace. Western The results of physical violence against doctors are comparable over colleagues and as witnesses of violence against a colleague by http://www.who.int/violence_injury_prevention/resources/pu Journal of Emergency Medicine, 18(6), pp. 1153–1158. a 10-year period: in 2007, physical violence by patients was reported another colleague; according to gender definition, men predominate. blications/en/WHA4925_eng.pdf [27.07.2019]. by 22% of doctors, and in 2018 by 17%. The Slovenian healthcare The results warn us of the increase in mobbing, so in the future we [13] National Institute for Health and Care Excellence environment was marked by two murders of doctors by patients, the will have to direct activities and measures to prevent mobbing in the [3] Krug, EG., Dahlberg, LL., Mecy, JA., Zwi, AB. & (NICE), 2015. Short-term management in mental health, murder of a dentist in 2007 and a specialist urologist in 2017. We workplace. Given that life expectancy is increasing, that chronic Wilson, A., 2002. The way forward: recommendations for health and community settings and the royal college of conclude that the level of violence did not decrease in the 10 years non-communicable diseases are on the rise; that healthcare action. In: Krug, EG., Dahlberg, LL., Mecy, JA., Zwi, psychiatrists. . London: The british psychological society between the two surveys. Actions that may have been taken during environment is globally understaffed, we can expect increases in AB., Lozano, R, eds. World report on violence and health. Violence and Aggression. Available at: this time had no measurable results. outbreaks of violence. Perpetrators will be either patients, attendants Geneva (Switzerland): World Health Organization. https://www.nice.org.uk/guidance/ng10/resources/violen Through research, we found that the most exposed to violence are and or even colleagues. ce-and-aggression-shortterm-management-in-mental- health workers in primary health clinics, followed by health workers The research showed (more than 50% of respondents) that there is [4] Nordin, H., 1995. Occupational Injury health-health-and-community-settings-pdf- in the department and specialist health clinics. Research in our no permanent presence of a security guard in medical institutions, Information System. Swedish Board of Occupational 1837264712389 [03.08.2019]. environment shows that the risk of violent incidents is highest in which is one of the most important protective measures. In the USA, Safety and Health. Solna: Fakta om vaold och hot I general emergency medical services and emergency rooms. Doctors emergency department security officers are constantly present, a arbetet. who make house visits and perform field work are particular maximum of 2 companions are present with the patient, each exposed to the risk of violence. With a home visit, the doctor enters emergency department should have an isolation room for agitated [5] European Agency for Safety and Health at Work (EU-OSHA), 2010. Workplace Violence and Harassment: the patient's environment [10]. visitors, which should have video surveillance, there should not be a European Picture. Luxembourg: Publications Office of The results of a Spanish survey involving 1,826 members of the any objects in the room that could be dangerous for (self) harm. In the European Union. medical staff, 3 hospitals, and 22 primary health care institutions Great Britain, information about violent patients is accessible/spread [6] WHO, (b.d.). Violence against health workers. (city, urban environments) show that violence against employees in within the health network, violent patients are denied home visits, Available at: http://www.who.int/violence_injury the health sector is a common phenomenon. Every tenth person has violent patients/victims can be refused care, a personal physician can _prevention/violence/workplace/en/ [03.08.2019]. already been the victim of a physical attack, 5% even more than remove a violent patient from their patient list [8]. once. As a result of physical violence, emergency services are most Among the protective measures against violence in healthcare, less [7] Lovrečič, M., Lovrečič, B. & Uršič Polh, A., 2019. at risk (48%), similar to what our research showed, followed by than 20% of the respondents mentioned the possibility of Priporočila za preprečevanje nasilnih incidentov. psychiatric services (27%). 64% of employees were exposed to "professional training in cases of violence" and "the possibility of Okvirne usmeritve za zaščito zdravništva na delovnem verbal violence (threats, insults, intimidation), of which 34% more legal assistance". Healthcare professionals require additional mestu. Ljubljana: Zdravniška zbornica Slovenije. than once, and 24% repeated verbal violence. Medical technicians training; regarding prevention, recognition and protection from and nurses are the most exposed to physical violence because they violence. We conclude that the guidelines of the expert group [8] Priporočila za preprečevanje nasilnih incidentov, are in most contact with the patient. Doctors are the next most often regarding the planned trainings for employees are justified. 2019. Okvirne usmeritve za zaščito zdravništva na targeted by the perpetrators. Everyone receives insults. Unlike in our delovnem mestu. Zdravniška zbornica Slovenije. Delovna environment, where the targets of violence are mostly health care skupina »Ne dopuščajmo nasilja. Available at: providers, threats are more often directed at those who make ACKNOWLEDGMENT (HEADING 5) https://www.zdravniskazbornica.si/docs/default- decisions, also with the aim of influencing their decisions. The The author gratefully acknowledge the contributions, input source/prepre%C4%8Devanje- nasilja/priporo%C4%8Dila-prepre%C4%8Devanje- research showed no correlation between the frequency of physical and devoted work of all members of the spedial interest group nasilja-zzs-s-cip.pdf?sfvrsn=28883136_10 [27. 07. 2019]. assault and the gender of the staff, and male staff members are more “Don`t allow violence”, and this article actually represents a often targeted than their female colleagues [11]. joint effort of all of us. [9] Čebašek-Travnik, Z., 2018. Rezultati ankete Nasilje In the USA, 13% of healthcare workers reported at least one nad zdravniki. 94. skupščina Zdravniška Zbornica physical assault, and 1.9 physical assaults also result in physical Slovenije: Ljubljana, 14. 06. 2018. injury to employees and, as a result, long-term absenteeism [12]. Our research showed that 17% of respondents had already been [10] Dernovšek, MZ., Lovrečič, M. & Novak-Grubič, victims of physical violence. In Slovenia, we do not have data on V., 2002. Smernice za preprečevanje in obravnavanje absenteeism as a consequence of violence against healthcare nasilnega vedenja duševno motenih oseb v zunaj workers, because workplace violence in the healthcare environment bolnišnični dejavnosti: priročnik VI. Ljubljana: Razširjeni is insufficiently and inadequately documented. strokovni kolegij za psihiatrijo. 58 the group as well as discussing their own cases and dilemmas. Their In England, there were 68,683 reported assaults against healthcare anonymous evaluation sheets reflect satisfaction with the workshop. staff between 2013 and 2014. Most of these (69%) occurred in REFERENCES [11] Gascón, S., Martínez-Jarreta, B., González- psychiatric or long-term care facilities. Most of the reported Andrade, JF., Santed, MA., Casalod, J. & Rueda, MA., incidents were caused by patients and/or their families or caregivers [1] Krug, EG., Dahlberg, LL., Mecy, JA., Zwi, AB. & 2009. Aggression Towards Health Care Workers in Spain: IV DISCUSSION [13]. Wilson, A., 2002. The way forward: recommendations for A Multi-facility Study to Evaluate the Distribution of In Slovenia, dissatisfaction, impatience and tension of the healthcare action. In: Krug, EG., Dahlberg, LL., Mecy, JA., Zwi, Growing Violence Among Professionals, Health Facilities Two cross-sectional surveys conducted by the SMC in 2007 and professionals are often transferred to patients and attendants in the AB., Lozano, R, eds. World report on violence and health. and Departments. International Journal of Occupational and Environmental Health, 15(1), pp. 29-35. DOI: 2018 showed that violence against doctors is a serious public health waiting rooms. The distress of patients, relatives and even staff can Geneva (Switzerland): World Health Organization. 10.1179/107735209799449707. problem and that psychological violence is on the rise. The research be a reason for violence. The most common risk factors for showed that women are more often subjected to violence in the form violence are linked to the patient [7]. [2] WHA49.25., 1996. Prevention of violence: a public [12] Claudius, I. A., Desai, S., Davis, E. & Henderson, of rude disrespectful behavior and insults and curses; which raises The research showed that around 70% of violent events in healthcare health priority. Forty-Ninth World Health Assembly Geneva, S., 2017. Case-controlled analysis of patient-based risk concerns given that medicine as nursing is a feminized profession. are perpetrated by patients and their relatives, half as many by 20‒25 May 1996. Hbk Res., Vol. III (3rd ed.), 1.11. Available at: factors for assault in the healhcare workplace. Western The results of physical violence against doctors are comparable over colleagues and as witnesses of violence against a colleague by http://www.who.int/violence_injury_prevention/resources/pu Journal of Emergency Medicine, 18(6), pp. 1153–1158. a 10-year period: in 2007, physical violence by patients was reported another colleague; according to gender definition, men predominate. blications/en/WHA4925_eng.pdf [27.07.2019]. by 22% of doctors, and in 2018 by 17%. The Slovenian healthcare The results warn us of the increase in mobbing, so in the future we [13] National Institute for Health and Care Excellence environment was marked by two murders of doctors by patients, the will have to direct activities and measures to prevent mobbing in the [3] Krug, EG., Dahlberg, LL., Mecy, JA., Zwi, AB. & (NICE), 2015. Short-term management in mental health, murder of a dentist in 2007 and a specialist urologist in 2017. We workplace. Given that life expectancy is increasing, that chronic Wilson, A., 2002. The way forward: recommendations for health and community settings and the royal college of conclude that the level of violence did not decrease in the 10 years non-communicable diseases are on the rise; that healthcare action. In: Krug, EG., Dahlberg, LL., Mecy, JA., Zwi, psychiatrists. . London: The british psychological society between the two surveys. Actions that may have been taken during environment is globally understaffed, we can expect increases in AB., Lozano, R, eds. World report on violence and health. Violence and Aggression. Available at: this time had no measurable results. outbreaks of violence. Perpetrators will be either patients, attendants Geneva (Switzerland): World Health Organization. https://www.nice.org.uk/guidance/ng10/resources/violen Through research, we found that the most exposed to violence are and or even colleagues. ce-and-aggression-shortterm-management-in-mental- health workers in primary health clinics, followed by health workers The research showed (more than 50% of respondents) that there is [4] Nordin, H., 1995. Occupational Injury health-health-and-community-settings-pdf- in the department and specialist health clinics. Research in our no permanent presence of a security guard in medical institutions, Information System. Swedish Board of Occupational 1837264712389 [03.08.2019]. environment shows that the risk of violent incidents is highest in which is one of the most important protective measures. In the USA, Safety and Health. Solna: Fakta om vaold och hot I general emergency medical services and emergency rooms. Doctors emergency department security officers are constantly present, a arbetet. who make house visits and perform field work are particular maximum of 2 companions are present with the patient, each exposed to the risk of violence. With a home visit, the doctor enters emergency department should have an isolation room for agitated [5] European Agency for Safety and Health at Work (EU-OSHA), 2010. Workplace Violence and Harassment: the patient's environment [10]. visitors, which should have video surveillance, there should not be a European Picture. Luxembourg: Publications Office of The results of a Spanish survey involving 1,826 members of the any objects in the room that could be dangerous for (self) harm. In the European Union. medical staff, 3 hospitals, and 22 primary health care institutions Great Britain, information about violent patients is accessible/spread [6] WHO, (b.d.). Violence against health workers. (city, urban environments) show that violence against employees in within the health network, violent patients are denied home visits, Available at: http://www.who.int/violence_injury the health sector is a common phenomenon. Every tenth person has violent patients/victims can be refused care, a personal physician can _prevention/violence/workplace/en/ [03.08.2019]. already been the victim of a physical attack, 5% even more than remove a violent patient from their patient list [8]. once. As a result of physical violence, emergency services are most Among the protective measures against violence in healthcare, less [7] Lovrečič, M., Lovrečič, B. & Uršič Polh, A., 2019. at risk (48%), similar to what our research showed, followed by than 20% of the respondents mentioned the possibility of Priporočila za preprečevanje nasilnih incidentov. psychiatric services (27%). 64% of employees were exposed to "professional training in cases of violence" and "the possibility of Okvirne usmeritve za zaščito zdravništva na delovnem verbal violence (threats, insults, intimidation), of which 34% more legal assistance". Healthcare professionals require additional mestu. Ljubljana: Zdravniška zbornica Slovenije. than once, and 24% repeated verbal violence. Medical technicians training; regarding prevention, recognition and protection from and nurses are the most exposed to physical violence because they violence. We conclude that the guidelines of the expert group [8] Priporočila za preprečevanje nasilnih incidentov, are in most contact with the patient. Doctors are the next most often regarding the planned trainings for employees are justified. 2019. Okvirne usmeritve za zaščito zdravništva na targeted by the perpetrators. Everyone receives insults. Unlike in our delovnem mestu. Zdravniška zbornica Slovenije. Delovna environment, where the targets of violence are mostly health care skupina »Ne dopuščajmo nasilja. Available at: providers, threats are more often directed at those who make ACKNOWLEDGMENT (HEADING 5) https://www.zdravniskazbornica.si/docs/default- decisions, also with the aim of influencing their decisions. The The author gratefully acknowledge the contributions, input source/prepre%C4%8Devanje- nasilja/priporo%C4%8Dila-prepre%C4%8Devanje- research showed no correlation between the frequency of physical and devoted work of all members of the spedial interest group nasilja-zzs-s-cip.pdf?sfvrsn=28883136_10 [27. 07. 2019]. assault and the gender of the staff, and male staff members are more “Don`t allow violence”, and this article actually represents a often targeted than their female colleagues [11]. joint effort of all of us. [9] Čebašek-Travnik, Z., 2018. Rezultati ankete Nasilje In the USA, 13% of healthcare workers reported at least one nad zdravniki. 94. skupščina Zdravniška Zbornica physical assault, and 1.9 physical assaults also result in physical Slovenije: Ljubljana, 14. 06. 2018. injury to employees and, as a result, long-term absenteeism [12]. Our research showed that 17% of respondents had already been [10] Dernovšek, MZ., Lovrečič, M. & Novak-Grubič, victims of physical violence. In Slovenia, we do not have data on V., 2002. Smernice za preprečevanje in obravnavanje absenteeism as a consequence of violence against healthcare nasilnega vedenja duševno motenih oseb v zunaj workers, because workplace violence in the healthcare environment bolnišnični dejavnosti: priročnik VI. Ljubljana: Razširjeni is insufficiently and inadequately documented. strokovni kolegij za psihiatrijo. 59 Examination of employee satisfaction at the Health employee satisfaction via the Google Forms online tool, which dentistry, health visiting practice, administration and physical consisted of 29 questions. After submission, the form was medicine). After descriptive data processing, the average center Zagreb-West locked and subsequent changes to answers were not possible. values between the observed groups were analyzed by The first part of the survey included five general questions Student's t-test in the Statistica v.12.0 program. related to age, gender, level of education, employment activity III. RESULTS and length of service in the Health Center Zagreb-West, and Juraj Jug1, Franka Luetić1, Jelena Rakić Matić1* the other 24 questions were related to the topic of the research. A total of 27 respondents were male (11.3%), while the rest 1Health center Zagreb-West, Zagreb, Croatia Answers to 12 questions were given on a Likert scale (1 - I am of the descriptive statistics are presented in table 1. Almost a * jelena.rakic.matic@gmail.com not satisfied at all, 2 - I am partially dissatisfied, 3. I am neither third of the respondents had completed only high school, 32 satisfied nor dissatisfied, 4 - I am partially satisfied and 5 I am (13.4%) had completed a master's degree or postgraduate Abstract organization (2.50 vs. 2.93), supervisor's evaluation (3.12 vs. 3.58), completely satisfied) on) and to 2 with a numerical rating (1 – studies, while only two employees had a PhD. The largest utilization of working hours (2.90 vs. 3.88). 5). We did a separate analysis of job satisfaction among the number of employees worked in family medicine (38.5%), INTRODUCTION. The purpose of the research was to identify followed by dentistry (17.6%). 40.6% of employees worked in largest group of employees, health professionals working in problems based on which it will be possible to implement CONCLUSION. Health institutions should develop strategies for the health center for less than 5 years, while 37.7% worked for interventions in order to improve the quality of the working achieving a higher level of employee satisfaction because such family medicine, and all other employees. The table shows the less than 14 years. environment in Health center Zagreb-West, while the purpose of employees are more productive, and their satisfaction affects the results for those activities among which more than 10 the qualitative part was to determine which factors influence quality of services. employees answered the survey questions (family medicine, employee dissatisfaction. Keywords – Health center, Health personnel, Job satisfaction MATERIALS AND METHODS. 239 (47.61 %) out of a total of Table 1. Descriptive statistics of research participants. 502 employees participated in the quantitative research, while 55 I. FM (n = 92) Dentistry Health visiting Administration PM ALL* employees (10.96 %) participated in the qualitative part of the INTRODUCTION (HEADING 1) (n = 42) practice (n = 19) (n = 18) (n = 239) research. Data was collected through an anonymous survey In the healthcare system, employee satisfaction is reflected (n = 26) questionnaire on employee satisfaction via the Google Forms in their behavior at the workplace. It is necessary that the online tool, which consisted of 29 questions. The first part employee is satisfied with their job and work in order to be able Sex included five general questions, and the other 24 questions were to use all of the employee’s potential (1). Job satisfaction Male 11 1 0 3 4 27 related to the research topic. Answers are given using a Likert factors can be divided into two categories, organizational and 11.96% 2.38% 0.00% 15.79% 22.22% 11.30% scale or a numerical rating. Average values between observed personal (2). The first category includes organizational factors Female 81 41 26 16 14 212 groups were analyzed by Student's t-test that include work in general, reward system, organizational 88.04% 97.62% 100.00% 84.21% 77.78% 88.70% structure, relationships with colleagues at work and working RESULTS. A total of 11.3% of respondents were male, the most conditions (2). The second category includes personal factors Age (years) represented were employees aged 31-40, 65 of them (27.2%). that include the unity of personal interests and the job itself, 18 – 30 53 17 6 6 2 97 Almost a third of respondents had completed high school. The largest number of employees worked in family medicine (38.5%). length of service, age of the employee and life satisfaction (2). 57.61% 40.48% 23.08% 31.58% 11.11% 40.59% 40.6% of employees worked in the health center for less than 5 The purpose of the research was to identify problems based 31 – 40 28 16 9 9 7 91 years. The largest number of respondents rated their job on which it will be possible to implement interventions in order 30.43% 38.10% 34.62% 47.37% 38.89% 38.08% satisfaction as 4 (44.4%). 36% of the respondents gave the work to improve the quality of the working environment in Health 41 – 50 3 5 3 3 6 23 organization a rating of 3. A third of the respondents never center Zagreb-West, while the purpose of the qualitative part 3.26% 11.90% 11.54% 15.79% 33.33% 9.62% received feedback from their superiors about the work they was to determine which factors influence employee perform, and the relationship with their superiors was rated 3.45. 51 – 60 4 2 7 1 3 19 dissatisfaction. The efficiency of the administration was rated 2.51. Half of the 4.35% 4.76% 26.92% 5.26% 16.67% 7.95% respondents expressed satisfaction with their colleagues at the > 60 4 2 1 0 0 9 workplace, but two thirds of the respondents experienced II. MATERIAL AND METHODS 4.35% 4.76% 3.85% 0.00% 0.00% 3.77% discrimination at the workplace. Only 8 % of employees are 239 health and non-health workers participated in this completely satisfied with being informed about the situation in the cross-sectional survey out of a total of 502 (47.61 %) who at Length of service in Health Center Zagreb-West health center. Another job would be accepted immediately by 14 the time of the survey from September 18, 2022. until October < 5 35 11 1 2 2 58 % of respondents, and insufficient pay was cited as the main 4, 2022. were employed in the Health Center Zagreb-West. 38.04% 26.19% 3.85% 10.53% 11.11% 24.27% reason for changing jobs (65 %). The largest number of The research is divided into survey (quantitative) part and 5 – 14 22 9 8 8 6 65 employees (85 %) specified a higher salary as a work motivation. 23.91% 21.43% 30.77% 42.11% 33.33% 27.20% A quarter of employees did not attend a professional meeting qualitative part. All 239 employees filled out the questionnaire, during the past year, and 87 % of respondents answered that they while 55 employees (10.96%) participated in the qualitative 15 – 24 12 14 9 5 5 54 wanted the health center to organize professional lectures. 88 % part of the research. All activities of the Health center are 13.04% 33.33% 34.62% 26.32% 27.78% 22.59% of respondents used the institution's internet for information. included (general/family medicine, pediatrics, dentistry, 25 – 34 18 5 6 2 5 49 Employees in family medicine, compared to other employees, patronage, radiology, pharmacy, administration, physical 19.57% 11.90% 23.08% 10.53% 27.78% 20.50% rated the following items with a lower rating: job satisfaction medicine, psychiatry, gynecology, occupational and sports (3.41 vs. 3.97), feeling at the workplace (3.24 vs. 3.78), work > 35 5 3 2 2 0 13 medicine, laboratory diagnostics and internal medicine). Data were collected through an anonymous survey questionnaire on 5.43% 7.14% 7.69% 10.53% 0.00% 5.44% FM = family medicine; PM = physical medicine; *all activities of the Health Center are included The largest number of respondents rated their job feel at your workplace?". However, 14.6% were not satisfied satisfaction with a rating of 4 (44.4%), while a quarter of with the work organization at all, while 25% and 36% of respondents each gave a rating of 5 and a rating of 3. respondents respectively gave the work organization a rating of Respondents gave similar answers to the question "How do you 2 and 3. The same results were recorded for work evaluation. A 60 Examination of employee satisfaction at the Health employee satisfaction via the Google Forms online tool, which dentistry, health visiting practice, administration and physical consisted of 29 questions. After submission, the form was medicine). After descriptive data processing, the average center Zagreb-West locked and subsequent changes to answers were not possible. values between the observed groups were analyzed by The first part of the survey included five general questions Student's t-test in the Statistica v.12.0 program. related to age, gender, level of education, employment activity III. RESULTS and length of service in the Health Center Zagreb-West, and Juraj Jug1, Franka Luetić1, Jelena Rakić Matić1* the other 24 questions were related to the topic of the research. A total of 27 respondents were male (11.3%), while the rest 1Health center Zagreb-West, Zagreb, Croatia Answers to 12 questions were given on a Likert scale (1 - I am of the descriptive statistics are presented in table 1. Almost a * jelena.rakic.matic@gmail.com not satisfied at all, 2 - I am partially dissatisfied, 3. I am neither third of the respondents had completed only high school, 32 satisfied nor dissatisfied, 4 - I am partially satisfied and 5 I am (13.4%) had completed a master's degree or postgraduate Abstract organization (2.50 vs. 2.93), supervisor's evaluation (3.12 vs. 3.58), completely satisfied) on) and to 2 with a numerical rating (1 – studies, while only two employees had a PhD. The largest utilization of working hours (2.90 vs. 3.88). 5). We did a separate analysis of job satisfaction among the number of employees worked in family medicine (38.5%), INTRODUCTION. The purpose of the research was to identify followed by dentistry (17.6%). 40.6% of employees worked in largest group of employees, health professionals working in problems based on which it will be possible to implement CONCLUSION. Health institutions should develop strategies for the health center for less than 5 years, while 37.7% worked for interventions in order to improve the quality of the working achieving a higher level of employee satisfaction because such family medicine, and all other employees. The table shows the less than 14 years. environment in Health center Zagreb-West, while the purpose of employees are more productive, and their satisfaction affects the results for those activities among which more than 10 the qualitative part was to determine which factors influence quality of services. employees answered the survey questions (family medicine, employee dissatisfaction. Keywords – Health center, Health personnel, Job satisfaction MATERIALS AND METHODS. 239 (47.61 %) out of a total of Table 1. Descriptive statistics of research participants. 502 employees participated in the quantitative research, while 55 I. FM (n = 92) Dentistry Health visiting Administration PM ALL* employees (10.96 %) participated in the qualitative part of the INTRODUCTION (HEADING 1) (n = 42) practice (n = 19) (n = 18) (n = 239) research. Data was collected through an anonymous survey In the healthcare system, employee satisfaction is reflected (n = 26) questionnaire on employee satisfaction via the Google Forms in their behavior at the workplace. It is necessary that the online tool, which consisted of 29 questions. The first part employee is satisfied with their job and work in order to be able Sex included five general questions, and the other 24 questions were to use all of the employee’s potential (1). Job satisfaction Male 11 1 0 3 4 27 related to the research topic. Answers are given using a Likert factors can be divided into two categories, organizational and 11.96% 2.38% 0.00% 15.79% 22.22% 11.30% scale or a numerical rating. Average values between observed personal (2). The first category includes organizational factors Female 81 41 26 16 14 212 groups were analyzed by Student's t-test that include work in general, reward system, organizational 88.04% 97.62% 100.00% 84.21% 77.78% 88.70% structure, relationships with colleagues at work and working RESULTS. A total of 11.3% of respondents were male, the most conditions (2). The second category includes personal factors Age (years) represented were employees aged 31-40, 65 of them (27.2%). that include the unity of personal interests and the job itself, 18 – 30 53 17 6 6 2 97 Almost a third of respondents had completed high school. The largest number of employees worked in family medicine (38.5%). length of service, age of the employee and life satisfaction (2). 57.61% 40.48% 23.08% 31.58% 11.11% 40.59% 40.6% of employees worked in the health center for less than 5 The purpose of the research was to identify problems based 31 – 40 28 16 9 9 7 91 years. The largest number of respondents rated their job on which it will be possible to implement interventions in order 30.43% 38.10% 34.62% 47.37% 38.89% 38.08% satisfaction as 4 (44.4%). 36% of the respondents gave the work to improve the quality of the working environment in Health 41 – 50 3 5 3 3 6 23 organization a rating of 3. A third of the respondents never center Zagreb-West, while the purpose of the qualitative part 3.26% 11.90% 11.54% 15.79% 33.33% 9.62% received feedback from their superiors about the work they was to determine which factors influence employee perform, and the relationship with their superiors was rated 3.45. 51 – 60 4 2 7 1 3 19 dissatisfaction. The efficiency of the administration was rated 2.51. Half of the 4.35% 4.76% 26.92% 5.26% 16.67% 7.95% respondents expressed satisfaction with their colleagues at the > 60 4 2 1 0 0 9 workplace, but two thirds of the respondents experienced II. MATERIAL AND METHODS 4.35% 4.76% 3.85% 0.00% 0.00% 3.77% discrimination at the workplace. Only 8 % of employees are 239 health and non-health workers participated in this completely satisfied with being informed about the situation in the cross-sectional survey out of a total of 502 (47.61 %) who at Length of service in Health Center Zagreb-West health center. Another job would be accepted immediately by 14 the time of the survey from September 18, 2022. until October < 5 35 11 1 2 2 58 % of respondents, and insufficient pay was cited as the main 4, 2022. were employed in the Health Center Zagreb-West. 38.04% 26.19% 3.85% 10.53% 11.11% 24.27% reason for changing jobs (65 %). The largest number of The research is divided into survey (quantitative) part and 5 – 14 22 9 8 8 6 65 employees (85 %) specified a higher salary as a work motivation. 23.91% 21.43% 30.77% 42.11% 33.33% 27.20% A quarter of employees did not attend a professional meeting qualitative part. All 239 employees filled out the questionnaire, during the past year, and 87 % of respondents answered that they while 55 employees (10.96%) participated in the qualitative 15 – 24 12 14 9 5 5 54 wanted the health center to organize professional lectures. 88 % part of the research. All activities of the Health center are 13.04% 33.33% 34.62% 26.32% 27.78% 22.59% of respondents used the institution's internet for information. included (general/family medicine, pediatrics, dentistry, 25 – 34 18 5 6 2 5 49 Employees in family medicine, compared to other employees, patronage, radiology, pharmacy, administration, physical 19.57% 11.90% 23.08% 10.53% 27.78% 20.50% rated the following items with a lower rating: job satisfaction medicine, psychiatry, gynecology, occupational and sports (3.41 vs. 3.97), feeling at the workplace (3.24 vs. 3.78), work > 35 5 3 2 2 0 13 medicine, laboratory diagnostics and internal medicine). Data were collected through an anonymous survey questionnaire on 5.43% 7.14% 7.69% 10.53% 0.00% 5.44% FM = family medicine; PM = physical medicine; *all activities of the Health Center are included The largest number of respondents rated their job feel at your workplace?". However, 14.6% were not satisfied satisfaction with a rating of 4 (44.4%), while a quarter of with the work organization at all, while 25% and 36% of respondents each gave a rating of 5 and a rating of 3. respondents respectively gave the work organization a rating of Respondents gave similar answers to the question "How do you 2 and 3. The same results were recorded for work evaluation. A 61 third of the respondents never received feedback from their organized in Health Center. The survey was rated positively by IV. DISCUSSION study. Some of the factors of dissatisfaction are the workload superiors about the quality of the work they perform, and the three quarters of respondents. As the main means of caused by the large number of patients and the overload of relationship with their superiors was rated 3.45. The efficiency information, 88% of respondents used the Health center Job satisfaction describes whether employees are satisfied administrative tasks, which results in a lack of time for of the administration was rated 2.51, but satisfaction with internet, and 75% also learned information orally from and whether their needs at work are met. It is important that the examinations and consultations with patients. One of the factors colleagues at the workplace was really high, with half of the colleagues. Employees in family medicine (N=92, 38.49%) employee has a positive attitude towards the job, considering of dissatisfaction is the exposure of healthcare professionals to respondents being completely satisfied, and 27% partially rated the following items statistically significantly lower than that it is followed by motivation and achievement, which verbal violence by patients or their family members (12). satisfied. The result that as many as two thirds of respondents other employees: job satisfaction (3.41 vs. 3.97), feeling at the contributes to the employee’s satisfaction (3). 239 employees experienced discrimination in the workplace is worrying. In workplace (3.24 vs. 3.78), work organization (2.50 vs. 2.93), participated in the research, of which 27 were male (11.30%), The employees of the Health Center Zagreb-West rated terms of being informed about the situation in the health center, superior's assessment (3.12 vs. 3.58), utilization and schedule and 212 respondents were female (88.70%). According to data their job satisfaction as very good (3.75) with significant respondents mostly gave a neutral answer, while only 8% were of working hours (2.90 vs. 3.88). Doctors in family medicine published in the Croatian Health and Statistical Yearbook for differences between the activities, with the worst ratings given completely satisfied. The average answers to individual were statistically significantly more dissatisfied with their work 2021, the share of women among employed medical doctors by family medicine employees and the administration of the questions according to the related activity are shown in table 2. than other employees (3.41 vs. 3.97; p < 0.001), they felt worse was 63.4%. There is a similar share among Doctor of Dental Health Center. Healthcare institutions should develop strategies 14% of respondents would immediately accept another job, at their workplace (3.24 vs. 3.78, p < 0 .01) and were Medicine, where 67.1% of them are female, while the most to achieve the highest possible level of satisfaction of their while 10% would never. The main reasons for changing jobs significantly more dissatisfied with the organization of work at numerous professional groups within healthcare is made up of employees, because such employees are more productive and are: insufficient pay (65%), employer's lack of concern for the the Health center (2.50 vs. 2.93; p < 0.01). Also, they rated the nurses/technicians, among whom only 13.6% are men (4). efficient, and their satisfaction directly affects the quality of the needs of workers (46%), generally bad working conditions current relationship with superiors within the service (3.12 vs. Almost a third of the respondents had completed high school, provided healthcare services, their availability and efficiency. (26%) and bad interpersonal relations (20%). The largest 3.58; p < 0.05) and satisfaction with the use and distribution of which also corresponds to the data published in the Croatian number of employees would be motivated to work by a higher their working time (2.90 vs. 3.88; p < 0.001) as worse. ). Family Health and Statistical Yearbook for 2021, where it is stated that ACKNOWLEDGMENT salary (85%), the possibility of paid education (54%), better medicine doctors were more often discriminated against than the largest share of employed health workers and associates has None. work organization (48%) and a quality and considerate service other employees of the Health center (2.62 vs. 2.14; p < 0.01). a secondary level of professional education (4). The employees manager (43%). As much as a quarter of the employees had There were no significant differences between the results of the of the Zagreb-West health center rated their satisfaction with never been to any professional meeting or course during the answers to the other questions in the conducted survey between their work as very good (3.75), which is in contrast to research REFERENCES past year, and almost 87% of the respondents answered that family medicine doctors and other employees of the Health conducted in Lithuania, where salary, social status and References are important to the reader; therefore, each they wanted workshops and professional lectures to be center. workload were among the main factors of dissatisfaction with work in primary health care (5). 14.6% of respondents were not citation must be complete and correct. There is no editorial at all satisfied with the work organization, 25% of respondents check on references; therefore, an incomplete or wrong reference will be published unless caught by a reviewer and will Table 2. Mean value of answers to individual questions scored on a Likert scale in the research (1 = I am not satisfied; 5 = I expressed partial satisfaction, while 36% of respondents were detract from the authority and value of the paper. References am very satisfied). neither satisfied nor dissatisfied. In his research conducted in should be readily available publications. FM Dentistry Health visiting Administration PM ALL* 2013, Bogdanović states that, among other things, one of the (n = 92) (n = 42) practice (n = 19) (n = 18) (n = 239) elements that influences the creation of a good organizational [1] Štumerger S. Motivacija i zadovoljstvo zaposlenika u (n = 26) climate is good work organization, and that a bad organizational zdravstvenom sektoru [završni rad]. Varaždin: Sveučilište 1. 3,41 4,14 4,23 3,42 3,83 3,75 climate can result in inadequate achievement of set goals (6). In Sjever; 2018. this research, more than half of the respondents were satisfied 2. 3,24 4,07 3,92 3,16 3,83 3,57 with their relationship with colleagues at the workplace, which [2] Prahin D, Katavić I. Analiza motivacije, zadovoljstva 3. 2,50 2,50 3,21 3,23 2,32 2,77 is of great importance considering that it is known that a good poslom i radnog učinka zaposlenika na primjeru odabranog 4. 2,65 3,10 2,77 2,74 2,67 2,74 and supportive relationship with colleagues is an important poduzeće. Obrazovanje za poduzetništvo. 2021;11:2. 5. 2,08 2,20 2,08 2,31 2,46 2,20 predictor of job satisfaction, especially if it is about employees [3] Bellou V. Organizational culture as a predictor of job 6. 3,12 3,12 3,88 3,69 3,00 3,22 who work in teams (7). satisfaction: the role of gender and age. Career Development 7. 2,35 2,67 2,96 2,37 2,39 2,47 In terms of being informed about the situation in the health Journal. 2010;15:4-19. 8. 4,36 4,40 4,42 3,89 3,72 4,26 center, respondents mostly gave a neutral answer, while only 9. [4] Hrvatski zavod za javno zdravstvo. Hrvatski 1,55 1,31 1,81 2,37 1,78 1,63 8% were completely satisfied. Research conducted in 1985 zdravstveno-statistički ljetopis za 2021. Godinu [Internet]. 10. 2,62 2,10 1,81 1,37 2,72 2,33 shows that the exchange of information in the organization is Available at: https://www.hzjz.hr/hrvatski-zdravstveno-11. 2,74 3,31 2,69 2,95 2,72 2,91 one of the factors that affects employee satisfaction (8). 65% of statisticki-ljetopis/hrvatski-zdravstveno-statisticki-ljetopis-za-12. 2,90 4,19 4,00 3,63 3,39 3,50 respondents cited insufficient salary as the main reason for 2021-tablicni-podaci/. Accessed: 29.09.2023. 13. 2,68 3,17 2,81 2,47 2,94 2,83 changing jobs. The World Health Organization has identified 14. 3,09 3,14 2,77 3,58 2,83 3,14 low wages as one of the causes of fluctation of health personnel [5] Buciuniene I, Blazeviciene A, Bliudziute E. Health care reform and job satisfaction of primary health care FM = family medicine; FPM = physical medicine; *all activities of the Health Center are included (9). Also, many studies show that low wages are one of the main physicians in Lithuania. BMC Fam Pract. 2005;7:6-10. Questions: 1. How satisfied are you with your job? demotivators for employees in the public sector (10,11). 2. How do you feel at your workplace? Although one of the ways to develop human potential is [6] Bogdanović M. Organizacijska klima u hrvatskom 3. How satisfied are you with the organization of work in your institution? education, a quarter of employees have never been to any organizacijskom prostoru: što i kako razvijati? 2013;14. 4. How satisfied are you with the evaluation of the work you perform by your superiors? professional meeting or course during the past year, which 5. How often have you received feedback from your superiors about the quality of the work you do? [7] Bakotić, D. Međuovisnost zadovoljstva na radu 6. How would you rate the current relationship with superiors within the service? could lead to employee demotivation. By carrying out 7. How would you rate the effectiveness of the administration of the Health Center in solving problems from your service? systematic training of employees, their knowledge and skills radnika znanja i organizacijskih performansi [doctoral thesis]. 8. How satisfied are you with the relationship with the colleagues you work with at your workplace? are improved so that they can perform the tasks that are set Split: Sveučilište u Splitu, Ekonomski fakultet Split; 2009. 9. Have you ever been discriminated against by colleagues at work for any reason? before them the best they can. Also, in order for the education 10. Have you ever been discriminated against (for any reason) by patients? [8] Spector PE. Measurement of human service staff to lead to the realization of the goals, certain criteria must be 11. Do you think that your professional potential is well used in your workplace? satisfaction: development of the Job Satisfaction Survey. Am J met by the employees, such as behavior, motivation to learn and 12. How satisfied are you with the utilization and distribution of your working time? Community Psychol. 1985;13:693-713. 13. How satisfied are you with your information and matters concerning the Health Center? the application of what has been learned in practice. A 14. If you were offered a job in another institution similar to your current one, how likely is it that you would accept it? systematic literature review published in 2020 identified factors [9] Manila Philippines: WHO Regional Office for The that contribute to job dissatisfaction among primary care Western Pacific; 2004. World Health Organization. The physicians in Brazil, which are consistent with the results of our 62 third of the respondents never received feedback from their organized in Health Center. The survey was rated positively by IV. DISCUSSION study. Some of the factors of dissatisfaction are the workload superiors about the quality of the work they perform, and the three quarters of respondents. As the main means of caused by the large number of patients and the overload of relationship with their superiors was rated 3.45. The efficiency information, 88% of respondents used the Health center Job satisfaction describes whether employees are satisfied administrative tasks, which results in a lack of time for of the administration was rated 2.51, but satisfaction with internet, and 75% also learned information orally from and whether their needs at work are met. It is important that the examinations and consultations with patients. One of the factors colleagues at the workplace was really high, with half of the colleagues. Employees in family medicine (N=92, 38.49%) employee has a positive attitude towards the job, considering of dissatisfaction is the exposure of healthcare professionals to respondents being completely satisfied, and 27% partially rated the following items statistically significantly lower than that it is followed by motivation and achievement, which verbal violence by patients or their family members (12). satisfied. The result that as many as two thirds of respondents other employees: job satisfaction (3.41 vs. 3.97), feeling at the contributes to the employee’s satisfaction (3). 239 employees experienced discrimination in the workplace is worrying. In workplace (3.24 vs. 3.78), work organization (2.50 vs. 2.93), participated in the research, of which 27 were male (11.30%), The employees of the Health Center Zagreb-West rated terms of being informed about the situation in the health center, superior's assessment (3.12 vs. 3.58), utilization and schedule and 212 respondents were female (88.70%). According to data their job satisfaction as very good (3.75) with significant respondents mostly gave a neutral answer, while only 8% were of working hours (2.90 vs. 3.88). Doctors in family medicine published in the Croatian Health and Statistical Yearbook for differences between the activities, with the worst ratings given completely satisfied. The average answers to individual were statistically significantly more dissatisfied with their work 2021, the share of women among employed medical doctors by family medicine employees and the administration of the questions according to the related activity are shown in table 2. than other employees (3.41 vs. 3.97; p < 0.001), they felt worse was 63.4%. There is a similar share among Doctor of Dental Health Center. Healthcare institutions should develop strategies 14% of respondents would immediately accept another job, at their workplace (3.24 vs. 3.78, p < 0 .01) and were Medicine, where 67.1% of them are female, while the most to achieve the highest possible level of satisfaction of their while 10% would never. The main reasons for changing jobs significantly more dissatisfied with the organization of work at numerous professional groups within healthcare is made up of employees, because such employees are more productive and are: insufficient pay (65%), employer's lack of concern for the the Health center (2.50 vs. 2.93; p < 0.01). Also, they rated the nurses/technicians, among whom only 13.6% are men (4). efficient, and their satisfaction directly affects the quality of the needs of workers (46%), generally bad working conditions current relationship with superiors within the service (3.12 vs. Almost a third of the respondents had completed high school, provided healthcare services, their availability and efficiency. (26%) and bad interpersonal relations (20%). The largest 3.58; p < 0.05) and satisfaction with the use and distribution of which also corresponds to the data published in the Croatian number of employees would be motivated to work by a higher their working time (2.90 vs. 3.88; p < 0.001) as worse. ). Family Health and Statistical Yearbook for 2021, where it is stated that ACKNOWLEDGMENT salary (85%), the possibility of paid education (54%), better medicine doctors were more often discriminated against than the largest share of employed health workers and associates has None. work organization (48%) and a quality and considerate service other employees of the Health center (2.62 vs. 2.14; p < 0.01). a secondary level of professional education (4). The employees manager (43%). As much as a quarter of the employees had There were no significant differences between the results of the of the Zagreb-West health center rated their satisfaction with never been to any professional meeting or course during the answers to the other questions in the conducted survey between their work as very good (3.75), which is in contrast to research REFERENCES past year, and almost 87% of the respondents answered that family medicine doctors and other employees of the Health conducted in Lithuania, where salary, social status and References are important to the reader; therefore, each they wanted workshops and professional lectures to be center. workload were among the main factors of dissatisfaction with work in primary health care (5). 14.6% of respondents were not citation must be complete and correct. There is no editorial at all satisfied with the work organization, 25% of respondents check on references; therefore, an incomplete or wrong reference will be published unless caught by a reviewer and will Table 2. Mean value of answers to individual questions scored on a Likert scale in the research (1 = I am not satisfied; 5 = I expressed partial satisfaction, while 36% of respondents were detract from the authority and value of the paper. References am very satisfied). neither satisfied nor dissatisfied. In his research conducted in should be readily available publications. FM Dentistry Health visiting Administration PM ALL* 2013, Bogdanović states that, among other things, one of the (n = 92) (n = 42) practice (n = 19) (n = 18) (n = 239) elements that influences the creation of a good organizational [1] Štumerger S. Motivacija i zadovoljstvo zaposlenika u (n = 26) climate is good work organization, and that a bad organizational zdravstvenom sektoru [završni rad]. Varaždin: Sveučilište 1. 3,41 4,14 4,23 3,42 3,83 3,75 climate can result in inadequate achievement of set goals (6). In Sjever; 2018. this research, more than half of the respondents were satisfied 2. 3,24 4,07 3,92 3,16 3,83 3,57 with their relationship with colleagues at the workplace, which [2] Prahin D, Katavić I. Analiza motivacije, zadovoljstva 3. 2,50 2,50 3,21 3,23 2,32 2,77 is of great importance considering that it is known that a good poslom i radnog učinka zaposlenika na primjeru odabranog 4. 2,65 3,10 2,77 2,74 2,67 2,74 and supportive relationship with colleagues is an important poduzeće. Obrazovanje za poduzetništvo. 2021;11:2. 5. 2,08 2,20 2,08 2,31 2,46 2,20 predictor of job satisfaction, especially if it is about employees [3] Bellou V. Organizational culture as a predictor of job 6. 3,12 3,12 3,88 3,69 3,00 3,22 who work in teams (7). satisfaction: the role of gender and age. Career Development 7. 2,35 2,67 2,96 2,37 2,39 2,47 In terms of being informed about the situation in the health Journal. 2010;15:4-19. 8. 4,36 4,40 4,42 3,89 3,72 4,26 center, respondents mostly gave a neutral answer, while only 9. [4] Hrvatski zavod za javno zdravstvo. Hrvatski 1,55 1,31 1,81 2,37 1,78 1,63 8% were completely satisfied. Research conducted in 1985 zdravstveno-statistički ljetopis za 2021. Godinu [Internet]. 10. 2,62 2,10 1,81 1,37 2,72 2,33 shows that the exchange of information in the organization is Available at: https://www.hzjz.hr/hrvatski-zdravstveno-11. 2,74 3,31 2,69 2,95 2,72 2,91 one of the factors that affects employee satisfaction (8). 65% of statisticki-ljetopis/hrvatski-zdravstveno-statisticki-ljetopis-za-12. 2,90 4,19 4,00 3,63 3,39 3,50 respondents cited insufficient salary as the main reason for 2021-tablicni-podaci/. Accessed: 29.09.2023. 13. 2,68 3,17 2,81 2,47 2,94 2,83 changing jobs. The World Health Organization has identified 14. 3,09 3,14 2,77 3,58 2,83 3,14 low wages as one of the causes of fluctation of health personnel [5] Buciuniene I, Blazeviciene A, Bliudziute E. Health care reform and job satisfaction of primary health care FM = family medicine; FPM = physical medicine; *all activities of the Health Center are included (9). Also, many studies show that low wages are one of the main physicians in Lithuania. BMC Fam Pract. 2005;7:6-10. Questions: 1. How satisfied are you with your job? demotivators for employees in the public sector (10,11). 2. How do you feel at your workplace? Although one of the ways to develop human potential is [6] Bogdanović M. Organizacijska klima u hrvatskom 3. How satisfied are you with the organization of work in your institution? education, a quarter of employees have never been to any organizacijskom prostoru: što i kako razvijati? 2013;14. 4. How satisfied are you with the evaluation of the work you perform by your superiors? professional meeting or course during the past year, which 5. How often have you received feedback from your superiors about the quality of the work you do? [7] Bakotić, D. Međuovisnost zadovoljstva na radu 6. How would you rate the current relationship with superiors within the service? could lead to employee demotivation. By carrying out 7. How would you rate the effectiveness of the administration of the Health Center in solving problems from your service? systematic training of employees, their knowledge and skills radnika znanja i organizacijskih performansi [doctoral thesis]. 8. How satisfied are you with the relationship with the colleagues you work with at your workplace? are improved so that they can perform the tasks that are set Split: Sveučilište u Splitu, Ekonomski fakultet Split; 2009. 9. Have you ever been discriminated against by colleagues at work for any reason? before them the best they can. Also, in order for the education 10. Have you ever been discriminated against (for any reason) by patients? [8] Spector PE. Measurement of human service staff to lead to the realization of the goals, certain criteria must be 11. Do you think that your professional potential is well used in your workplace? satisfaction: development of the Job Satisfaction Survey. Am J met by the employees, such as behavior, motivation to learn and 12. How satisfied are you with the utilization and distribution of your working time? Community Psychol. 1985;13:693-713. 13. How satisfied are you with your information and matters concerning the Health Center? the application of what has been learned in practice. A 14. If you were offered a job in another institution similar to your current one, how likely is it that you would accept it? systematic literature review published in 2020 identified factors [9] Manila Philippines: WHO Regional Office for The that contribute to job dissatisfaction among primary care Western Pacific; 2004. World Health Organization. The physicians in Brazil, which are consistent with the results of our 63 Migration of Skilled Health Personnel in the Pacific Region: A [11] Chaudhary S, Banerjee A. Correlates of job Preliminary analysis of open data pertaining to the Summary Report. satisfaction in medical officers. Med J Armed Forces India. [10] Dieleman M, Toonen J, Touré H, Martineau T. The 2004;60:329–32. services available through the Health Insurance match between motivation and performance management of [12] Vitali MM, Pires DE, Forte Novatzki EC, Farias JM, health sector workers in Mali. Hum Resour Health. 2006;4:2. Soratto J. Job satisfaction and dissatisfaction in primary health care: an integrative review. Scielo. 2020;29. Institute of Slovenia and provided by family medicine Luka Petravić1, Vojislav Ivetić1,2 1: Medicinska fakulteta, Univerza v Mariboru, Taborska ulica 8, 2000 Maribor, Slovenija; 2: Sava Med d.o.o., Cesta k Dravi 8, 2241 Spodnji Duplek, Slovenija lpetravic@me.com Abstract— BACKGROUND: The Health Insurance Institute of crucial to closely monitor trends and identify comparable databases Slovenia (ZZZS) began publishing service-related data in May 2023, for pairing at the secondary and tertiary levels. following a directive from the Ministry of Health (MoH). The ZZZS website provides easily accessible information about the services Index Terms: Workload, Family Practice, Slovenia, Primary provided by individual doctors, including their names. The user is Health Care, Delivery of Health Care provided relevant information about the doctor's employer, including whether it is a public or private institution. The data provided is I. I useful for studying the public system's operations and identifying NTRODUCTION any errors or anomalies. METHODS: The data for services Healthcare systems possess a substantial volume of data that provided in May 2023 was downloaded and analysed. The published is important for their day-to-day functioning [1]. The data were cross-referenced using the provider's RIZDDZ number publication and re-use of these data have been infrequent. with the daily updated data on ambulatory workload from June 9, Slovenia has recently embraced the concept of open data, 2023, published by ZZZS. The data mentioned earlier were found to seeing its value and potential. As a result, the country has be inaccurate and were improved using alerts from the zdravniki.sledilnik.org portal. Therefore, they currently provide an started the process of releasing its previously inaccessible accurate representation of the current situation. The total number of data to the public, therefore revitalising it and making it services provided by each provider in a given month was determined available to interested parties [2]. It is imperative that by adding up the individual services and then assigning them to the published data adhere to the FAIR data principles, which corresponding provider. RESULTS: A pivot table was created to include the qualities of being Findable, Accessible, identify 307 unique operators, with 15 operators not appearing in Interoperable, and Reusable [3]. both lists. There are 66 public providers, which make up about 72% of the contractual programme in the public system. There are 241 In accordance with a mandate from the Ministry of Health private providers, accounting for about 28% of the contractual (MoH) [4], the Health Insurance Institute of Slovenia (ZZZS) programme. In May 2023, public providers accounted for 69% commenced the publication of data pertaining to primary care (n=646,236) of services in the family medicine system, while private providers contributed 31% (n=291,660). The total number of services in May 2023. The ZZZS website offers readily services provided by public and private providers was 937,896. available information, in a computer-readable format, Three linear correlations were analysed. The initial analysis of the regarding the services provided by individual doctors. This entire sample yielded a R-squared value of .998 and p-value <0.001. information includes their names, provider numbers, the The second analysis of the data from private institutions showed a institutions they are affiliated with, whether these institutions R-Squared value of 0.600 +, with a p < 0.001. The third analysis are publicly or privately owned, and the number of services used data from public providers and showed a strong level of they provide on a daily basis [5]. explanatory power, with a R Squared value of 0.961 with a p-value <0.001. CONCLUSION: Our analysis shows a strong linear correlation between contract size of the program signed and number The data presented in this research has significance in services rendered by family medicine providers. A stronger linear examining the operations of the public system and finding correlation is observed among providers in the public system potential avenues for enhancing the precision of the collected compared to those in the private system. Our study found that data. As it has been proven with the data on primary care private providers generally offer more services than public physicians who accept new patients and those who have providers. However, it is important to acknowledge that the reached their quotas [2]. evaluation framework for assessing services may have inherent flaws when examining the data. Prescribing a prescription and The objective of this research was to analyse the first dataset resuscitating a patient are both assigned a rating of one service. It is disclosed on the services provided and establish connections 64 Migration of Skilled Health Personnel in the Pacific Region: A [11] Chaudhary S, Banerjee A. Correlates of job Preliminary analysis of open data pertaining to the Summary Report. satisfaction in medical officers. Med J Armed Forces India. [10] Dieleman M, Toonen J, Touré H, Martineau T. The 2004;60:329–32. services available through the Health Insurance match between motivation and performance management of [12] Vitali MM, Pires DE, Forte Novatzki EC, Farias JM, health sector workers in Mali. Hum Resour Health. 2006;4:2. Soratto J. Job satisfaction and dissatisfaction in primary health care: an integrative review. Scielo. 2020;29. Institute of Slovenia and provided by family medicine Luka Petravić1, Vojislav Ivetić1,2 1: Medicinska fakulteta, Univerza v Mariboru, Taborska ulica 8, 2000 Maribor, Slovenija; 2: Sava Med d.o.o., Cesta k Dravi 8, 2241 Spodnji Duplek, Slovenija lpetravic@me.com Abstract— BACKGROUND: The Health Insurance Institute of crucial to closely monitor trends and identify comparable databases Slovenia (ZZZS) began publishing service-related data in May 2023, for pairing at the secondary and tertiary levels. following a directive from the Ministry of Health (MoH). The ZZZS website provides easily accessible information about the services Index Terms: Workload, Family Practice, Slovenia, Primary provided by individual doctors, including their names. The user is Health Care, Delivery of Health Care provided relevant information about the doctor's employer, including whether it is a public or private institution. The data provided is I. I useful for studying the public system's operations and identifying NTRODUCTION any errors or anomalies. METHODS: The data for services Healthcare systems possess a substantial volume of data that provided in May 2023 was downloaded and analysed. The published is important for their day-to-day functioning [1]. The data were cross-referenced using the provider's RIZDDZ number publication and re-use of these data have been infrequent. with the daily updated data on ambulatory workload from June 9, Slovenia has recently embraced the concept of open data, 2023, published by ZZZS. The data mentioned earlier were found to seeing its value and potential. As a result, the country has be inaccurate and were improved using alerts from the zdravniki.sledilnik.org portal. Therefore, they currently provide an started the process of releasing its previously inaccessible accurate representation of the current situation. The total number of data to the public, therefore revitalising it and making it services provided by each provider in a given month was determined available to interested parties [2]. It is imperative that by adding up the individual services and then assigning them to the published data adhere to the FAIR data principles, which corresponding provider. RESULTS: A pivot table was created to include the qualities of being Findable, Accessible, identify 307 unique operators, with 15 operators not appearing in Interoperable, and Reusable [3]. both lists. There are 66 public providers, which make up about 72% of the contractual programme in the public system. There are 241 In accordance with a mandate from the Ministry of Health private providers, accounting for about 28% of the contractual (MoH) [4], the Health Insurance Institute of Slovenia (ZZZS) programme. In May 2023, public providers accounted for 69% commenced the publication of data pertaining to primary care (n=646,236) of services in the family medicine system, while private providers contributed 31% (n=291,660). The total number of services in May 2023. The ZZZS website offers readily services provided by public and private providers was 937,896. available information, in a computer-readable format, Three linear correlations were analysed. The initial analysis of the regarding the services provided by individual doctors. This entire sample yielded a R-squared value of .998 and p-value <0.001. information includes their names, provider numbers, the The second analysis of the data from private institutions showed a institutions they are affiliated with, whether these institutions R-Squared value of 0.600 +, with a p < 0.001. The third analysis are publicly or privately owned, and the number of services used data from public providers and showed a strong level of they provide on a daily basis [5]. explanatory power, with a R Squared value of 0.961 with a p-value <0.001. CONCLUSION: Our analysis shows a strong linear correlation between contract size of the program signed and number The data presented in this research has significance in services rendered by family medicine providers. A stronger linear examining the operations of the public system and finding correlation is observed among providers in the public system potential avenues for enhancing the precision of the collected compared to those in the private system. Our study found that data. As it has been proven with the data on primary care private providers generally offer more services than public physicians who accept new patients and those who have providers. However, it is important to acknowledge that the reached their quotas [2]. evaluation framework for assessing services may have inherent flaws when examining the data. Prescribing a prescription and The objective of this research was to analyse the first dataset resuscitating a patient are both assigned a rating of one service. It is disclosed on the services provided and establish connections 65 with the pre-existing publicly available data. Our objective II. RESULTS system-related data. In the future we expect consolidation or A pivot table was created to identify 307 unique institutions, a global list of all the data provided by public institutions with 15 institutions not appearing in both lists. There are 66 leading to the local repositories, a necessary step towards public institutions, which make up about 72 % of the good open data accesibility and findability. contractual programme in the public system. There are 241 private institutions, accounting for about 28 % of the The findings of our study indicate a significant positive linear contractual programme. In May 2023, public providers relationship between the contract size of the programme and accounted for 69 % (n=646,236) of services rendered in the the number of services rendered by family medicine family medicine system, while private providers contributed providers. A nelegibly stronger linear correlation is observed 31 % (n=291,660). The total number of services rendered by among providers in the public system compared to those in public and private providers was 937,896. Three linear the private system. This phenomenon may be attributed to the correlations were analysed, first one being the combined data higher concentration of physicians at public institutions, set without the subgroups. The second and third correlations resulting in a larger patient load and a more balanced (Figure 1) compare two different institution types. The initial distribution of patients among these facilities. Contrastly, analysis of the entire sample yielded a R-squared value of private providers sometimes have a lower physician-to- .998 and a p<0.001. The second analysis of the data from institution ratio, with some privately owned institutions private providers showed a R-Squared value of .600, employing only one doctor. indicating a strong correlation between the variables with p<0.001, providing additional support for the statistical The findings of our research indicate that private providers significance of the results. The third analysis used data from tend to provide a more services compared to their public institutions and showed a R-Squared value of 0.961 governmental counterparts. Nevertheless, it is crucial to with a p-value < 0.001. recognise that the assessment framework used to evaluate services may possess inherent deficiencies when scrutinising III. DISCUSSION the data. Both the act of prescribing a medication and the act The objective of this research was to assess recently opened of resuscitating a patient are classified as services with a data on the services rendered by primary care doctors and rating of one. The current depiction of the work performed provide a novel perspective on the publicly available data [6]. lacks realism and should be revised in order to accurately The utility of this approach has been shown on another open reflect the actual workload. The omission of detailed data set, theprimary health physician capacity data [2]. This explanations on the methodology used for measuring the data analysis not only revealed significant discrepancies in the and the diverse scope included by the concept of "1 unit of official data and real world state, but also presented the service" might result in a significant risk of misinterpretation findings in a manner that prioritises the needs and when being communicated to the general public and the experiences of patients. This hasled to an increased level of development of negative public attitudes [10]. FIGURE 1. CORRELATION BETWEEN NUMBER OF SERVICES RENDERED AND CONTRACTUAL PROGRAMME OF AN INSTITUTION. public scrutiny and has played a significant role in driving the was to ascertain if there are any patterns that can be found in necessary enhancements to the data and improving the It is crucial to closely monitor trends and identify comparable the newly published data set that would allow us to deduce primary source [7]. databases for pairing at the secondary and tertiary levels as the quality of the dataset and compare or differentiate private well. This could offer a good public framework to monitor and public institutions. This is especially important for The use of open data in the future has the potential to the efficacy of forthcoming measures aimed at addressing the improvement of newly opened data sets that have not yet generate significant value by leveraging existing data issue of limited access to primary healthcare [11]. undergone public scrutiny.Material and Methods resources [8]. The European Commission is actively engaged The data for services rendered in May 2023 was downloaded in the pursuit of increasing the availability of government- ACKNOWLEDGMENT and used in analysis [6]. The published data on services generated data via online publication, in accordance with the The authors express their sincere gratitude for the support rendered were cross-referenced using the provider's RIZDDZ current Directive on open data and the re-use of public sector provided by Sava Med d.o.o. in supporting this study, as well number with the daily updated data on ambulatory workload information [8]. Slovenia has developed a website, known as as the valuable insights provided by Znanstveno društvo from June 9, 2023, published by ZZZS. The total number of OPSI, which serves as a platform for the uploading and Sledilnik about health-related open data in Slovenia. We services provided by each provider in a given month was sharing of open data with its residents [9]. The existing would also want to express our gratitude to the ZZZS for their determined by adding up the individual services and then challenge, in facilitating data accessibility across numerous publication of this data and their assistance in facilitating our assigning them to the corresponding provider. The correlation organisations and ministries, lies in the absence of a comprehension of the first dataset release. was calculated using Tableau version 2023.1. R-squared centralised repository for metadata of these datasets. The value gives indicates how much of the variation of a current situation is resulting in increased difficulty in the DATA AVAILIBILITY dependent variable is explained by an independent variable in user's experience of collecting and using this data, albeit it is The data-set used in this manuscript is availible online [6]. a regression model. All of our correlations compared how not rendering it completely unattainable. For instance, ZZZS much does the contractual programme of an institution opts not to use OPSI as a platform for disseminating their REFERENCES predict the number of services rendered. data; instead, they choose to publish the data independently [1] E.J.S. Hovenga and H. Grain, eds., Roadmap to on their own web page. The data pertaining to the public Successful Digital Health Ecosystems: A Global system used in this research were obtained only from the Perspective, Academic Press, an imprint of Elsevier, ZZZS site, which serves as a comprehensive source for health London, United Kingdom, 2022. 66 with the pre-existing publicly available data. Our objective II. RESULTS system-related data. In the future we expect consolidation or A pivot table was created to identify 307 unique institutions, a global list of all the data provided by public institutions with 15 institutions not appearing in both lists. There are 66 leading to the local repositories, a necessary step towards public institutions, which make up about 72 % of the good open data accesibility and findability. contractual programme in the public system. There are 241 private institutions, accounting for about 28 % of the The findings of our study indicate a significant positive linear contractual programme. In May 2023, public providers relationship between the contract size of the programme and accounted for 69 % (n=646,236) of services rendered in the the number of services rendered by family medicine family medicine system, while private providers contributed providers. A nelegibly stronger linear correlation is observed 31 % (n=291,660). The total number of services rendered by among providers in the public system compared to those in public and private providers was 937,896. Three linear the private system. This phenomenon may be attributed to the correlations were analysed, first one being the combined data higher concentration of physicians at public institutions, set without the subgroups. The second and third correlations resulting in a larger patient load and a more balanced (Figure 1) compare two different institution types. The initial distribution of patients among these facilities. Contrastly, analysis of the entire sample yielded a R-squared value of private providers sometimes have a lower physician-to- .998 and a p<0.001. The second analysis of the data from institution ratio, with some privately owned institutions private providers showed a R-Squared value of .600, employing only one doctor. indicating a strong correlation between the variables with p<0.001, providing additional support for the statistical The findings of our research indicate that private providers significance of the results. The third analysis used data from tend to provide a more services compared to their public institutions and showed a R-Squared value of 0.961 governmental counterparts. Nevertheless, it is crucial to with a p-value < 0.001. recognise that the assessment framework used to evaluate services may possess inherent deficiencies when scrutinising III. DISCUSSION the data. Both the act of prescribing a medication and the act The objective of this research was to assess recently opened of resuscitating a patient are classified as services with a data on the services rendered by primary care doctors and rating of one. The current depiction of the work performed provide a novel perspective on the publicly available data [6]. lacks realism and should be revised in order to accurately The utility of this approach has been shown on another open reflect the actual workload. The omission of detailed data set, theprimary health physician capacity data [2]. This explanations on the methodology used for measuring the data analysis not only revealed significant discrepancies in the and the diverse scope included by the concept of "1 unit of official data and real world state, but also presented the service" might result in a significant risk of misinterpretation findings in a manner that prioritises the needs and when being communicated to the general public and the experiences of patients. This hasled to an increased level of development of negative public attitudes [10]. FIGURE 1. CORRELATION BETWEEN NUMBER OF SERVICES RENDERED AND CONTRACTUAL PROGRAMME OF AN INSTITUTION. public scrutiny and has played a significant role in driving the was to ascertain if there are any patterns that can be found in necessary enhancements to the data and improving the It is crucial to closely monitor trends and identify comparable the newly published data set that would allow us to deduce primary source [7]. databases for pairing at the secondary and tertiary levels as the quality of the dataset and compare or differentiate private well. This could offer a good public framework to monitor and public institutions. This is especially important for The use of open data in the future has the potential to the efficacy of forthcoming measures aimed at addressing the improvement of newly opened data sets that have not yet generate significant value by leveraging existing data issue of limited access to primary healthcare [11]. undergone public scrutiny.Material and Methods resources [8]. The European Commission is actively engaged The data for services rendered in May 2023 was downloaded in the pursuit of increasing the availability of government- ACKNOWLEDGMENT and used in analysis [6]. The published data on services generated data via online publication, in accordance with the The authors express their sincere gratitude for the support rendered were cross-referenced using the provider's RIZDDZ current Directive on open data and the re-use of public sector provided by Sava Med d.o.o. in supporting this study, as well number with the daily updated data on ambulatory workload information [8]. Slovenia has developed a website, known as as the valuable insights provided by Znanstveno društvo from June 9, 2023, published by ZZZS. The total number of OPSI, which serves as a platform for the uploading and Sledilnik about health-related open data in Slovenia. We services provided by each provider in a given month was sharing of open data with its residents [9]. The existing would also want to express our gratitude to the ZZZS for their determined by adding up the individual services and then challenge, in facilitating data accessibility across numerous publication of this data and their assistance in facilitating our assigning them to the corresponding provider. The correlation organisations and ministries, lies in the absence of a comprehension of the first dataset release. was calculated using Tableau version 2023.1. R-squared centralised repository for metadata of these datasets. The value gives indicates how much of the variation of a current situation is resulting in increased difficulty in the DATA AVAILIBILITY dependent variable is explained by an independent variable in user's experience of collecting and using this data, albeit it is The data-set used in this manuscript is availible online [6]. a regression model. All of our correlations compared how not rendering it completely unattainable. For instance, ZZZS much does the contractual programme of an institution opts not to use OPSI as a platform for disseminating their REFERENCES predict the number of services rendered. data; instead, they choose to publish the data independently [1] E.J.S. Hovenga and H. Grain, eds., Roadmap to on their own web page. The data pertaining to the public Successful Digital Health Ecosystems: A Global system used in this research were obtained only from the Perspective, Academic Press, an imprint of Elsevier, ZZZS site, which serves as a comprehensive source for health London, United Kingdom, 2022. 67 [2] L. Petravić, M. Brumen, B. Krajnc and A. Srakar, Kaj se the Health Insurance Institute of Slovenia and provided skriva v ozadju zdravniki.sledilnik.org?, 2022, pp. 34– by family medicine, 2023, . 37. [7] M. Z., ZZZS bo podatke o razpoložljivih zdravnikih začel [3] M.D. Wilkinson, M. Dumontier, Ij.J. Aalbersberg, G. posodabljati dnevno, MMC RTV SLO, STA, 2023, . Appleton, M. Axton, A. Baak et al., The FAIR Guiding [8] European Comission, Unlocking the potential of open Principles for scientific data management and data, 2022. stewardship, Sci Data 3 (2016), pp. 160018. [9] Odprti podatki Slovenije. Available at [4] Podatki o izvedenih obravnavah po zdravstvenem https://podatki.gov.si/. delavcu, 2023, . [10] STA, B. U. and L. N., ZZZS objavil število obravnav po [5] Zavod za Zdravstveno Zavarovanje Slovenije, Podatki o zdravnikih. “Podatki so brez konteksta,” 24ur, 2023, . izvedenih obravnavah po zdravstvenem delavcu, [11] STA, B. U. and K. K., Protestniki na ulicah zahtevali družinska medicina, 2023, . enakopravno in vsem dostopno javno zdravstvo, 24ur, . [6] L. Petravić and V. Ivetić, Dataset: Preliminary analysis of open data pertaining to the services available through 68 [2] L. Petravić, M. Brumen, B. Krajnc and A. Srakar, Kaj se the Health Insurance Institute of Slovenia and provided skriva v ozadju zdravniki.sledilnik.org?, 2022, pp. 34– by family medicine, 2023, . 37. [7] M. Z., ZZZS bo podatke o razpoložljivih zdravnikih začel [3] M.D. Wilkinson, M. Dumontier, Ij.J. Aalbersberg, G. posodabljati dnevno, MMC RTV SLO, STA, 2023, . Appleton, M. Axton, A. Baak et al., The FAIR Guiding [8] European Comission, Unlocking the potential of open Principles for scientific data management and data, 2022. stewardship, Sci Data 3 (2016), pp. 160018. [9] Odprti podatki Slovenije. Available at [4] Podatki o izvedenih obravnavah po zdravstvenem https://podatki.gov.si/. delavcu, 2023, . [10] STA, B. U. and L. N., ZZZS objavil število obravnav po [5] Zavod za Zdravstveno Zavarovanje Slovenije, Podatki o zdravnikih. “Podatki so brez konteksta,” 24ur, 2023, . izvedenih obravnavah po zdravstvenem delavcu, [11] STA, B. U. and K. K., Protestniki na ulicah zahtevali družinska medicina, 2023, . enakopravno in vsem dostopno javno zdravstvo, 24ur, . [6] L. Petravić and V. Ivetić, Dataset: Preliminary analysis of open data pertaining to the services available through PROCEEDINGS Posters 69 General Medicine Research Network – III. RESULTS projects, but the number of stakeholders and research projects, as well as the legal, technical and operational factors to be taken Creation of a Framework for the Setup of a General Medicine In this section, we will briefly present the results of the expert interviews conducted and the framework derived from into account, impose additional complexity. In this sense, especially the general practitioners emphasized the need for Research Network in Upper Austria these findings, as well as its application on the example of the "General Medicine Research Network Upper Austria". clear, well documented and communicated processes as a key to ensure efficient workflows and minimal disruption of Interview findings everyday practice operations. Fabian Bekelaer MSc.1, Prof. Dr. Erwin Rebhandl1, Prof. Dr. Erika Zelko1 In a previous study of the Institute of General Practice of the Enabling functions. In contrast to the core processes, the 1Institute of General Practice, JKU Linz, Austria JKU, 650 general practitioners were asked about their attitude enabling functions cover the overarching topics such as fabian.bekelaer@jku.at towards research by means of a questionnaire. There it was governance and coordination, finance/funding, legal issues as shown that more than a quarter of the general practitioners (105 well as systems and infrastructure and therefore serve to operate Abstract — As an independent discipline, general medicine has a recommendations of the relevant stakeholders and outline its out of 416 GPs who answered) expressed their willingness to the network and its core processes as smoothly as possible. comprehensible need for independent research that takes into application on the example of the “General Medicine Research contribute to research. This impression also emerged during our account the epidemiological and methodological specificities of Network Upper Austria”. interviews where we tried to elicit the general practitioners’ The results of our interviews indicate that for general primary care. However, despite the need for comprehensive expectations and recommendations regarding a potential practitioners, good organization and communication within the research, a common problem encountered is the lack of research Based on the preceding considerations the following network in more detail. Examples of motivation to participate network and minimal disruption of practice operations are of infrastructure that adequately facilitates such research. With this research questions can be derived: in the research network included gaining evidence with eminent importance. For this reason, the enabling function project we want to close this gap, which is why we conducted practical relevance and feedback on the general practitioners’ “Governance and Coordination” was created. In the example of several expert interviews with relevant stakeholders on their ▪ What are the expectations and requirements of general own work. Among others, good communication within the our project “General Medicine Research Network Upper expectations and recommendations regarding the setup of such a practitioners regarding the development of a research Austria”, the Institute of General Practice of the JKU is network. Based on the insights gathered, we derived the network? network, minimal disruption of practice operations, timely responsible for the organization of the network, the “Research Network Framework” that consists of core processes ▪ What requirements and recommendations from other feedback of research results, and involvement in the planning administration of systems and infrastructure, the planning and and enabling functions and allows to implement and operate such disciplines need to be considered? of research projects were mentioned as prerequisites for a coordination of research projects and the planning and a network as smoothly as possible. Each element of the ▪ What are the main elements of a framework for the functioning network. organization of joint exchanges between the parties involved in framework is presented in terms of content and its application is setup of a research network in the field of general The second part of interviews was held with various experts the network. outlined on the example of the project “General Medicine medicine that need to be identified and worked on? from different disciplines, which we hoped would provide Research Network Upper Austria”. By applying the framework ▪ What tools and processes need to be established to insights into the prerequisites and recommendations regarding The next enabling function is called “Systems and to our own project, we were able to quickly build up our network achieve the most efficient workflow and collaboration the development of the network. Within the prospective Infrastructure” and deals with all issues related to a common with numerous general practitioners and launch a first project within the network? workflow and collaboration platform which was cited as a key with extensive data collection. administrative team of the Institute of General Practice, the ▪ What kind of enabling functions are needed for the element by several parties. Concerning our project “General successful implementation and operation of such a desire for clear responsibilities as well as clear processes within Medicine Research Network Upper Austria”, we are currently Index Terms – General Medicine, General Practice, Primary network? the research projects was expressed above all. Furthermore, the in the process of developing this platform that allows the Care, Research Infrastructure, Research Network establishment of a common platform as a workflow and collaboration tool was mentioned as important by both the participating general practitioners to inform themselves about II. M general practitioners and the institute staff. The technical planned and ongoing research projects, the required data and I. I ATERIAL AND METHODS NTRODUCTION feasibility of such a platform was confirmed by our IT expert, further parameters. Moreover, completed projects and their As an independent discipline, general medicine has a In consideration of the need for research infrastructure on the however, the processing and storage of the collected data were results and recommendations for implementation in the comprehensible need for independent research that takes into one hand and the lack of a standardized framework for the identified as the main issues to be clarified. In accordance with practical setting can be viewed. The platform will also offer the account the epidemiological and methodological specificities of implementation on the other hand, we conducted several non-that, the legal advisor interviewed also highlighted the opportunity to briefly present one's own research ideas which primary care. Only in the primary care setting can studies be standardized, open interviews with various stakeholders who, importance of compliance with existing data protection motivates general practitioners to question their own interests conducted that include multimorbid patients and nursing home in our view, are crucial for the successful implementation of a guidelines and the associated careful preparation of the required and challenges in their daily work and further accommodates residents, consider low-prevalence decisions, and test the research network in the field of general medicine in general and data, for example the anonymization of patient data. This issue the general practitioners' desire for early involvement in the effectiveness of new interventions in everyday life. General for our specific project “General Medicine Research Network was also addressed several times by the general practitioners planning of future project ideas. medical research is therefore essential for the advancement of Upper Austria” in particular. In the first part of interviews, we interviewed. Regarding the cooperation between the Institute Two further enabling functions of the framework are called the discipline and thus for the continuous improvement of asked the general practitioners who planned to participate in the and the participating general practitioners the development of “Finance/Funding” and “Legal issues” and comprise securing general medical care. network about their expectations, requirements, and memoranda of understanding with the rights and obligations of funding of the network as well as forming a legal basis for the However, despite the need for comprehensive research in recommendations in setting up the network. In the second part both parties was further recommended as prerequisite. collaboration between the parties involved. With regard to the general medicine outlined above, a common problem of interviews, we held discussions with IT experts, legal Form findings to framework to application financing of the network, it became apparent that sufficient encountered is the lack of research infrastructure that advisors, potential funders and sponsors of the project, as well financial resources must be available for setting up the platform adequately facilitates such research. Furthermore, there is a lack as stakeholders from the JKU Linz and the planned team of Based on the findings from the interviews presented above, or compensating the general practitioners. For this reason, the of concrete procedural models that outline the establishment of organizers and research coordinators of the Institute of General we created the “Research Network Framework” which is JKU Linz granted a budget of 100,000 euros over a period of 5 such a research infrastructure and enable it to be carried out as Practice. By doing so, we hoped to address overarching topics divided into two main parts, i.e. research core processes and years. In addition, the Austrian Health Insurance Fund is efficiently as possible. With this project we want to close this for the development of a sustainable network structure. enabling or supporting functions (see Figure 1). supporting the project with a grant of 15,000 euros for the gap and develop a framework which enables the development Research core processes. The core processes include all research coordination. From a legal point of view, the of a research network based on the requirements and elements of a comprehensive research project, ranging from cooperation of the Institute of General Practice and the general research planning, the development of a specific participating general practitioners within the “General research objective, the choice of a suitable survey method, data Medicine Research Network Upper Austria” will be governed collection, processing and analysis, to the interpretation and by memoranda of understanding which have been presentation of the research results and their dissemination to recommended and prepared by the legal department of the JKU the participating general practitioners. In this sense, the Linz. In addition, all questions regarding data protection and individual steps do not differ greatly from other research 70 General Medicine Research Network – III. RESULTS projects, but the number of stakeholders and research projects, as well as the legal, technical and operational factors to be taken Creation of a Framework for the Setup of a General Medicine In this section, we will briefly present the results of the expert interviews conducted and the framework derived from into account, impose additional complexity. In this sense, especially the general practitioners emphasized the need for Research Network in Upper Austria these findings, as well as its application on the example of the "General Medicine Research Network Upper Austria". clear, well documented and communicated processes as a key to ensure efficient workflows and minimal disruption of Interview findings everyday practice operations. Fabian Bekelaer MSc.1, Prof. Dr. Erwin Rebhandl1, Prof. Dr. Erika Zelko1 In a previous study of the Institute of General Practice of the Enabling functions. In contrast to the core processes, the 1Institute of General Practice, JKU Linz, Austria JKU, 650 general practitioners were asked about their attitude enabling functions cover the overarching topics such as fabian.bekelaer@jku.at towards research by means of a questionnaire. There it was governance and coordination, finance/funding, legal issues as shown that more than a quarter of the general practitioners (105 well as systems and infrastructure and therefore serve to operate Abstract — As an independent discipline, general medicine has a recommendations of the relevant stakeholders and outline its out of 416 GPs who answered) expressed their willingness to the network and its core processes as smoothly as possible. comprehensible need for independent research that takes into application on the example of the “General Medicine Research contribute to research. This impression also emerged during our account the epidemiological and methodological specificities of Network Upper Austria”. interviews where we tried to elicit the general practitioners’ The results of our interviews indicate that for general primary care. However, despite the need for comprehensive expectations and recommendations regarding a potential practitioners, good organization and communication within the research, a common problem encountered is the lack of research Based on the preceding considerations the following network in more detail. Examples of motivation to participate network and minimal disruption of practice operations are of infrastructure that adequately facilitates such research. With this research questions can be derived: in the research network included gaining evidence with eminent importance. For this reason, the enabling function project we want to close this gap, which is why we conducted practical relevance and feedback on the general practitioners’ “Governance and Coordination” was created. In the example of several expert interviews with relevant stakeholders on their ▪ What are the expectations and requirements of general own work. Among others, good communication within the our project “General Medicine Research Network Upper expectations and recommendations regarding the setup of such a practitioners regarding the development of a research Austria”, the Institute of General Practice of the JKU is network. Based on the insights gathered, we derived the network? network, minimal disruption of practice operations, timely responsible for the organization of the network, the “Research Network Framework” that consists of core processes ▪ What requirements and recommendations from other feedback of research results, and involvement in the planning administration of systems and infrastructure, the planning and and enabling functions and allows to implement and operate such disciplines need to be considered? of research projects were mentioned as prerequisites for a coordination of research projects and the planning and a network as smoothly as possible. Each element of the ▪ What are the main elements of a framework for the functioning network. organization of joint exchanges between the parties involved in framework is presented in terms of content and its application is setup of a research network in the field of general The second part of interviews was held with various experts the network. outlined on the example of the project “General Medicine medicine that need to be identified and worked on? from different disciplines, which we hoped would provide Research Network Upper Austria”. By applying the framework ▪ What tools and processes need to be established to insights into the prerequisites and recommendations regarding The next enabling function is called “Systems and to our own project, we were able to quickly build up our network achieve the most efficient workflow and collaboration the development of the network. Within the prospective Infrastructure” and deals with all issues related to a common with numerous general practitioners and launch a first project within the network? workflow and collaboration platform which was cited as a key with extensive data collection. administrative team of the Institute of General Practice, the ▪ What kind of enabling functions are needed for the element by several parties. Concerning our project “General successful implementation and operation of such a desire for clear responsibilities as well as clear processes within Medicine Research Network Upper Austria”, we are currently Index Terms – General Medicine, General Practice, Primary network? the research projects was expressed above all. Furthermore, the in the process of developing this platform that allows the Care, Research Infrastructure, Research Network establishment of a common platform as a workflow and collaboration tool was mentioned as important by both the participating general practitioners to inform themselves about II. M general practitioners and the institute staff. The technical planned and ongoing research projects, the required data and I. I ATERIAL AND METHODS NTRODUCTION feasibility of such a platform was confirmed by our IT expert, further parameters. Moreover, completed projects and their As an independent discipline, general medicine has a In consideration of the need for research infrastructure on the however, the processing and storage of the collected data were results and recommendations for implementation in the comprehensible need for independent research that takes into one hand and the lack of a standardized framework for the identified as the main issues to be clarified. In accordance with practical setting can be viewed. The platform will also offer the account the epidemiological and methodological specificities of implementation on the other hand, we conducted several non-that, the legal advisor interviewed also highlighted the opportunity to briefly present one's own research ideas which primary care. Only in the primary care setting can studies be standardized, open interviews with various stakeholders who, importance of compliance with existing data protection motivates general practitioners to question their own interests conducted that include multimorbid patients and nursing home in our view, are crucial for the successful implementation of a guidelines and the associated careful preparation of the required and challenges in their daily work and further accommodates residents, consider low-prevalence decisions, and test the research network in the field of general medicine in general and data, for example the anonymization of patient data. This issue the general practitioners' desire for early involvement in the effectiveness of new interventions in everyday life. General for our specific project “General Medicine Research Network was also addressed several times by the general practitioners planning of future project ideas. medical research is therefore essential for the advancement of Upper Austria” in particular. In the first part of interviews, we interviewed. Regarding the cooperation between the Institute Two further enabling functions of the framework are called the discipline and thus for the continuous improvement of asked the general practitioners who planned to participate in the and the participating general practitioners the development of “Finance/Funding” and “Legal issues” and comprise securing general medical care. network about their expectations, requirements, and memoranda of understanding with the rights and obligations of funding of the network as well as forming a legal basis for the recommendations in setting up the network. In the second part However, despite the need for comprehensive research in both parties was further recommended as prerequisite. collaboration between the parties involved. With regard to the general medicine outlined above, a common problem of interviews, we held discussions with IT experts, legal Form findings to framework to application financing of the network, it became apparent that sufficient encountered is the lack of research infrastructure that advisors, potential funders and sponsors of the project, as well financial resources must be available for setting up the platform adequately facilitates such research. Furthermore, there is a lack as stakeholders from the JKU Linz and the planned team of Based on the findings from the interviews presented above, or compensating the general practitioners. For this reason, the of concrete procedural models that outline the establishment of organizers and research coordinators of the Institute of General we created the “Research Network Framework” which is JKU Linz granted a budget of 100,000 euros over a period of 5 such a research infrastructure and enable it to be carried out as Practice. By doing so, we hoped to address overarching topics divided into two main parts, i.e. research core processes and years. In addition, the Austrian Health Insurance Fund is efficiently as possible. With this project we want to close this for the development of a sustainable network structure. enabling or supporting functions (see Figure 1). supporting the project with a grant of 15,000 euros for the gap and develop a framework which enables the development Research core processes. The core processes include all research coordination. From a legal point of view, the of a research network based on the requirements and elements of a comprehensive research project, ranging from cooperation of the Institute of General Practice and the general research planning, the development of a specific participating general practitioners within the “General Medicine Research Network Upper Austria” will be governed research objective, the choice of a suitable survey method, data collection, processing and analysis, to the interpretation and by memoranda of understanding which have been presentation of the research results and their dissemination to recommended and prepared by the legal department of the JKU the participating general practitioners. In this sense, the Linz. In addition, all questions regarding data protection and individual steps do not differ greatly from other research 71 compliance to existing guidelines are also addressed in this IV. DISCUSSION A multidisciplinary approach to the early detection and function. As demonstrated above, the need for general medical research is urgent. However, the lack of appropriate research treatment of multiple myeloma infrastructure is evident throughout. Furthermore, there is a lack of concrete frameworks in literature and practice on how to Dragan Gjorgjievski successfully implement such a network efficiently. With this PZU Svetlana A.Stojkova project we wanted to close this gap and developed a framework E-mail address: dragan_gjorgjievski@yahoo.com which enables the setup of a research network based on the requirements and recommendations of relevant stakeholders. Abstract-Multiple myeloma is a malignant disease characterized blood cells. Rather than make helpful antibodies, the cancer The application of our framework on the example of the project by an uncontrolled accumulation of clonal plasma cells in the cells make proteins that don't work right. This leads to "General Medicine Research Network Upper Austria" shows bone marrow, a high concentration of monoclonal complications of multiple myeloma. [1] the significance and positive effects of a standardized and immunoglobulins in the serum or urine, and lytic bone lesions. structured approach. To date, 20 general practitioners could Multiple myeloma occurs with a frequency of 3 cases per 100,000 People with multiple myeloma may experience a number of already be recruited for the research network and a first research inhabitants and represents 2- 3% of all malignant diseases and different symptoms and signs. For people with myeloma who project with more than 800 collected data sets could be about 15% of all hematological malignancies. Early recognition have no symptoms, their cancer may be discovered by a blood conducted. For the coming years, we plan to expand the by family physicians of symptoms suggestive of multiple myeloma or urine test that is performed for a different reason, such as for network to the whole of Upper Austria. and an interdisciplinary approach between family physicians, an annual physical exam. [2] Figure 1. Research Network Framework and hematologists is very significant in early initiation of multiple myeloma treatment. METHODS: The medical documentation of The term “CRAB” is to describe the most common signs of a patient was analyzed, showing the role of the family doctor in multiple myeloma. This acronym stands for calcium levels (C), early recognition of the symptoms of multiple myeloma, but also renal failure R), anemia (A) and bone pain. (B)[3] the importance of cooperation with the hematologist for a better Myeloma may weaken and degrade bones, leading to outcome and early treatment of the patient. RESULTS: A 77- calcium entering the bloodstream (a condition known as year-old married father of one son comes to the examination with enlarged neck lymph nodes, sore throat and headache. Pharynx hypercalcemia). This condition may lead to symptoms hyperemic without purulent patches on the tonsils with swelling including nausea, thirst, reduced appetite, confusion or of the neck lymph nodes on both sides. Pulmonary vesicular constipation. [4]Renal failure describes lack of function in the breathing without accompanying sounds. The patient is referred kidneys. Because myeloma cells release high levels of proteins, for laboratory tests, a pcr test for covid and a throat swab. kidney damage may result. [4] If myeloma cells come into Leukocytosis (15,000) and elevated sedimentation and isolated contact with healthy bone marrow (where blood cells develop), S.aureus from the throat were detected. At the control the body may not make enough red blood cells, leading to examination on the seventh day, the patient no longer feels pain anemia. Anemia may cause fatigue, weakness, fast heartbeat, in the throat or difficulty swallowing, it was agreed to do a control shortness of breath and other symptoms. [3] Because myeloma laboratory, but the patient did not do it. One month later, he may damage the bones, pain may result, particularly in the spine comes to the examination because of pain in the spine that lasts and ribs. [4]Symptoms of myeloma may be similar to many for almost 10 days and spreads to the leg, but malaise and other conditions. This can make it difficult to diagnose. Because pronounced weakness have appeared in the last days. The patient of this, several tests are required. These may include: urine test, is referred for an X-ray of the LS rbet as well as laboratory blood test, x-rays, bone marrow biopsy. After MM is analyzes Due to leukopenia, anemia and the presence of general confirmed, additional tests are used to check for the presence of weakness and pain in the spine, the patient was referred to the impaired kidney function, anemia, thickening of the blood, and Hematology Clinic for further investigation and treatment. other complications of multiple myeloma.[5]Blood and urine CONCLUSION: Multiple myeloma is an insidious disease and tests for monoclonal protein — An abnormal protein produced therefore needs a good history examination and early diagnosis and treatment that would lead to a better outcome for the patient. by the plasma cells, called a monoclonal (M) protein (sometimes called a "paraprotein"), can be found in the blood Key worlds: family doctor, myeloma, hematologist or urine of almost all patients with MM, which helps establish the diagnosis. M proteins serve no useful function, and may be Introduction responsible for increases in the thickness of the blood, kidney damage, or bleeding problems.[5] In some patients, "free light Multiple myeloma is a cancer that forms in a type of white chains" (FLCs), which represent a small portion of the blood cell called a plasma cell. Healthy plasma cells help fight paraprotein, are secreted either in addition to the M protein or infections by making proteins called antibodies. by itself. These can be measured by an assay called the free light chain assay.[5] The assay measures the two types of free light Antibodies find and attack germs. [1]In multiple myeloma, chains, kappa and lambda, which are made by plasma cells, and cancerous plasma cells build up in bone marrow. The bone provides a ratio of the two.[5]However, it is important to marrow is the soft matter inside bones where blood cells are remember that not everyone with a monoclonal protein has made. In the bone marrow, the cancer cells crowd out healthy MM. The diagnosis also requires one or more abnormalities 72 compliance to existing guidelines are also addressed in this IV. DISCUSSION A multidisciplinary approach to the early detection and function. As demonstrated above, the need for general medical research is urgent. However, the lack of appropriate research treatment of multiple myeloma infrastructure is evident throughout. Furthermore, there is a lack of concrete frameworks in literature and practice on how to Dragan Gjorgjievski successfully implement such a network efficiently. With this PZU Svetlana A.Stojkova project we wanted to close this gap and developed a framework E-mail address: dragan_gjorgjievski@yahoo.com which enables the setup of a research network based on the requirements and recommendations of relevant stakeholders. Abstract-Multiple myeloma is a malignant disease characterized blood cells. Rather than make helpful antibodies, the cancer The application of our framework on the example of the project by an uncontrolled accumulation of clonal plasma cells in the cells make proteins that don't work right. This leads to "General Medicine Research Network Upper Austria" shows bone marrow, a high concentration of monoclonal complications of multiple myeloma. [1] the significance and positive effects of a standardized and immunoglobulins in the serum or urine, and lytic bone lesions. structured approach. To date, 20 general practitioners could Multiple myeloma occurs with a frequency of 3 cases per 100,000 People with multiple myeloma may experience a number of already be recruited for the research network and a first research inhabitants and represents 2- 3% of all malignant diseases and different symptoms and signs. For people with myeloma who project with more than 800 collected data sets could be about 15% of all hematological malignancies. Early recognition have no symptoms, their cancer may be discovered by a blood conducted. For the coming years, we plan to expand the by family physicians of symptoms suggestive of multiple myeloma or urine test that is performed for a different reason, such as for network to the whole of Upper Austria. and an interdisciplinary approach between family physicians, an annual physical exam. [2] Figure 1. Research Network Framework and hematologists is very significant in early initiation of multiple myeloma treatment. METHODS: The medical documentation of The term “CRAB” is to describe the most common signs of a patient was analyzed, showing the role of the family doctor in multiple myeloma. This acronym stands for calcium levels (C), early recognition of the symptoms of multiple myeloma, but also renal failure R), anemia (A) and bone pain. (B)[3] the importance of cooperation with the hematologist for a better Myeloma may weaken and degrade bones, leading to outcome and early treatment of the patient. RESULTS: A 77- calcium entering the bloodstream (a condition known as year-old married father of one son comes to the examination with enlarged neck lymph nodes, sore throat and headache. Pharynx hypercalcemia). This condition may lead to symptoms hyperemic without purulent patches on the tonsils with swelling including nausea, thirst, reduced appetite, confusion or of the neck lymph nodes on both sides. Pulmonary vesicular constipation. [4]Renal failure describes lack of function in the breathing without accompanying sounds. The patient is referred kidneys. Because myeloma cells release high levels of proteins, for laboratory tests, a pcr test for covid and a throat swab. kidney damage may result. [4] If myeloma cells come into Leukocytosis (15,000) and elevated sedimentation and isolated contact with healthy bone marrow (where blood cells develop), S.aureus from the throat were detected. At the control the body may not make enough red blood cells, leading to examination on the seventh day, the patient no longer feels pain anemia. Anemia may cause fatigue, weakness, fast heartbeat, in the throat or difficulty swallowing, it was agreed to do a control shortness of breath and other symptoms. [3] Because myeloma laboratory, but the patient did not do it. One month later, he may damage the bones, pain may result, particularly in the spine comes to the examination because of pain in the spine that lasts and ribs. [4]Symptoms of myeloma may be similar to many for almost 10 days and spreads to the leg, but malaise and other conditions. This can make it difficult to diagnose. Because pronounced weakness have appeared in the last days. The patient of this, several tests are required. These may include: urine test, is referred for an X-ray of the LS rbet as well as laboratory blood test, x-rays, bone marrow biopsy. After MM is analyzes Due to leukopenia, anemia and the presence of general confirmed, additional tests are used to check for the presence of weakness and pain in the spine, the patient was referred to the impaired kidney function, anemia, thickening of the blood, and Hematology Clinic for further investigation and treatment. other complications of multiple myeloma.[5]Blood and urine CONCLUSION: Multiple myeloma is an insidious disease and tests for monoclonal protein — An abnormal protein produced therefore needs a good history examination and early diagnosis and treatment that would lead to a better outcome for the patient. by the plasma cells, called a monoclonal (M) protein (sometimes called a "paraprotein"), can be found in the blood Key worlds: family doctor, myeloma, hematologist or urine of almost all patients with MM, which helps establish the diagnosis. M proteins serve no useful function, and may be Introduction responsible for increases in the thickness of the blood, kidney damage, or bleeding problems.[5] In some patients, "free light Multiple myeloma is a cancer that forms in a type of white chains" (FLCs), which represent a small portion of the blood cell called a plasma cell. Healthy plasma cells help fight paraprotein, are secreted either in addition to the M protein or infections by making proteins called antibodies. by itself. These can be measured by an assay called the free light chain assay.[5] The assay measures the two types of free light Antibodies find and attack germs. [1]In multiple myeloma, chains, kappa and lambda, which are made by plasma cells, and cancerous plasma cells build up in bone marrow. The bone provides a ratio of the two.[5]However, it is important to marrow is the soft matter inside bones where blood cells are remember that not everyone with a monoclonal protein has made. In the bone marrow, the cancer cells crowd out healthy MM. The diagnosis also requires one or more abnormalities 73 such as anemia, bone lesions, kidney failure, and high calcium II . DISCUSSION levels in the blood. In most individuals with MM, a bone marrow aspiration and biopsy shows that plasma cells comprise an abnormally high percentage of bone marrow cells (more than Various case reports have been made of myeloma patients 10 percent). worldwide. Something that can be noticed is that fatigue and It may be necessary to collect samples from different areas general weakness dominate in all cases, while the rest of the because MM can affect the marrow of some bones but not symptoms are individual. It is precisely because of the general others. [5]Specialized tests performed on the bone marrow symptoms that patients with multiple myeloma are detected sample may reveal genetic or chromosomal abnormalities of the very late, and therefore the outcome of treatment is fatal in the plasma cells in people with MM. The results of these tests are majority of cases. Multiple myeloma is an insidious disease helpful for predicting the response to treatment and survival. and therefore needs a good history examination and early About 80 percent of patients with MM have bone changes on diagnosis and treatment that would lead to a better outcome for imaging at the time of diagnosis. [5] These can include distinct, the patient. round (lytic) areas of bone erosion; generalized thinning of the Material and Methods bones; and/or fractures. [5]The bones most commonly involved The medical documentation of a patient was analyzed, REFERENCES are the vertebrae, the ribs, the pelvic bones, and the bones of the showing the role of the family doctor in early recognition of the thigh and upper arm. [5] Imaging tests are done at the time of symptoms of multiple myeloma, but also the importance of [1] Multiple myeloma - Symptoms and causes Available diagnosis to look for bone changes. cooperation with the hematologist for a better outcome and from:https://www.mayoclinic.org/diseases- This may include low-dose whole body computed early treatment of the patient. conditions/multiple-myeloma/diagnosis-treatment/drc- tomography (CT), combined positron emission tomography I RESULTS 20353383 (PET)/CT, or magnetic resonance imaging (MRI). [5] Case report: A 77-year-old married father of one son comes [2] Multiple Myeloma: Symptoms and Signs Available The diagnosis of MM requires the following:[5] 1.A bone to the examination with enlarged neck lymph nodes, sore throat from:https://www.cancer.net/cancertypes/multiplemyeloma/sy marrow aspirate or biopsy showing that at least 10 percent of and headache. Pharynx hyperemic without purulent patches on mptoms-and-signs the cells are plasma cells or the presence of a plasma cell tumor the tonsils with swelling of the neck lymph nodes on both sides. [3] What is Multiple Myeloma? Symptoms, Causes, & (called a plasmacytoma), plus at least one of the following two Pulmonary vesicular breathing without accompanying sounds. Prognosis https://themmrf.org/multiple-myeloma/ features. 2. Evidence of damage to the body as a result of the The patient is referred for laboratory tests, a pcr test for covid plasma cell growth, such as severe bone damage, kidney failure, and a throat swab. Leukocytosis (15,000) and elevated [4].Multiple myeloma symptoms anemia, or high calcium in the blood, and/or 3. Detection of one sedimentation and isolated S.Aureus from the throat were https://www.cancercenter.com/cancertypes/multiplemyeloma/ of the following findings: ≥60 percent plasma cells in the bone detected. It was prescribe antibiotic for 7 days. At the control symptoms marrow; serum free light chain ratio of 100 or more (provided examination on the seventh day, the patient no longer feels pain [5]. Multiple myeloma symptoms, diagnosis, and staging involved FLC level is at least 100 mg/L); or MRI showing more in the throat or difficulty swallowing, it was agreed to do a than one lesion (involving bone or bone marrow). Multiple control laboratory, but the patient did not do it. One month later, https://www.uptodate.com/contents/multiple-myeloma-myeloma treatment isn't always needed right away. If the he comes to the examination because of pain in the spine that symptoms-diagnosis-and-stagingbeyond-the-basics multiple myeloma is slow growing and isn't causing symptoms, lasts for almost 10 days and spreads to the leg, but malaise and close watching might be the first step. For people with multiple [6] Cardiac Considerations for Modern Multiple Myeloma pronounced weakness have appeared in the last days. The myeloma who need treatment, there are a number of ways to Therapies patient is referred for an X-ray of the LS rbet as well as help control the disease.(1) Standard treatment is induction laboratory analyzes. https://www.acc.org/latest-in- chemotherapy with a combination of a proteasome inhibitor cardiology/articles/2016/07/07/14/59/cardiacconsiderations- (e.g.,bortezomib or carfilzomib), immunomodulatory agent X-ray show Disc herniation at L4-L5 and L5-S1, with for-modern-multiple-myeloma-therapies (e.g., thalidomide, lenalidomide, or pomalidomide), and dorsal reduction of disc spaces and bridged osteophytes glucocorticosteroid (dexamethasone). The most common initial Spondylolisthesis of the facet joints at the L2-L3 level Kyphosis therapy choices are bortezomib + lenalidomide + deviation in the thoracolumbar part of the spine, with a bridged dexamethasone or cyclophosphamide + bortezomib + osteophyte. Laboratory test shows: Le 2.2, Hb 97 G/L SE 64 dexamethasone. [6]Induction therapy is given 4-6 cycles ER 2.79 *10 Crea 173.64 umol/L. Due to leukopenia, anemia followed by autologous hematopoietic cell transplantation. and the presence of general weakness and pain in the spine, the [6]Thereafter, many patients receive post-transplant therapy patient was referred to the Hematology Clinic for further (also called consolidation or maintenance therapy). In patients investigation and treatment. In the hematology clinic not eligible for autologous hematopoietic cell transplantation, a investigation was done. The results are as follow a bone marrow prolonged course of initial chemotherapy with a doublet puncture proved the presence of more than 10% of plasma cells. (bortezomib + dexamethasone or lenalidomide + Laboratory analyzes with a low level of erythrocytes and dexamethasone) or triplet (bortezomib + lenalidomide + leukocytes and with elevated calcium and with elevated dexamethasone or cyclophosphamide + bortezomib + sedimentation as well as elevated degradation products. dexamethasone) is typically administered (Figure 1). [6] Electrophoresis with the presence of monoclonal proteins. A Figure 1 diagnosis of Multiple Myeloma was made. Open history in a day hospital for further treatment. 74 such as anemia, bone lesions, kidney failure, and high calcium II . DISCUSSION levels in the blood. In most individuals with MM, a bone marrow aspiration and biopsy shows that plasma cells comprise an abnormally high percentage of bone marrow cells (more than Various case reports have been made of myeloma patients 10 percent). worldwide. Something that can be noticed is that fatigue and It may be necessary to collect samples from different areas general weakness dominate in all cases, while the rest of the because MM can affect the marrow of some bones but not symptoms are individual. It is precisely because of the general others. [5]Specialized tests performed on the bone marrow symptoms that patients with multiple myeloma are detected sample may reveal genetic or chromosomal abnormalities of the very late, and therefore the outcome of treatment is fatal in the plasma cells in people with MM. The results of these tests are majority of cases. Multiple myeloma is an insidious disease helpful for predicting the response to treatment and survival. and therefore needs a good history examination and early About 80 percent of patients with MM have bone changes on diagnosis and treatment that would lead to a better outcome for imaging at the time of diagnosis. [5] These can include distinct, the patient. round (lytic) areas of bone erosion; generalized thinning of the Material and Methods bones; and/or fractures. [5]The bones most commonly involved The medical documentation of a patient was analyzed, REFERENCES are the vertebrae, the ribs, the pelvic bones, and the bones of the showing the role of the family doctor in early recognition of the thigh and upper arm. [5] Imaging tests are done at the time of symptoms of multiple myeloma, but also the importance of [1] Multiple myeloma - Symptoms and causes Available diagnosis to look for bone changes. cooperation with the hematologist for a better outcome and from:https://www.mayoclinic.org/diseases- This may include low-dose whole body computed early treatment of the patient. conditions/multiple-myeloma/diagnosis-treatment/drc- tomography (CT), combined positron emission tomography 20353383 I RESULTS (PET)/CT, or magnetic resonance imaging (MRI). [5] [2] Multiple Myeloma: Symptoms and Signs Available Case report: A 77-year-old married father of one son comes The diagnosis of MM requires the following:[5] 1.A bone from:https://www.cancer.net/cancertypes/multiplemyeloma/sy to the examination with enlarged neck lymph nodes, sore throat marrow aspirate or biopsy showing that at least 10 percent of mptoms-and-signs and headache. Pharynx hyperemic without purulent patches on the cells are plasma cells or the presence of a plasma cell tumor the tonsils with swelling of the neck lymph nodes on both sides. [3] What is Multiple Myeloma? Symptoms, Causes, & (called a plasmacytoma), plus at least one of the following two Pulmonary vesicular breathing without accompanying sounds. Prognosis https://themmrf.org/multiple-myeloma/ features. 2. Evidence of damage to the body as a result of the The patient is referred for laboratory tests, a pcr test for covid plasma cell growth, such as severe bone damage, kidney failure, and a throat swab. Leukocytosis (15,000) and elevated [4].Multiple myeloma symptoms anemia, or high calcium in the blood, and/or 3. Detection of one sedimentation and isolated S.Aureus from the throat were https://www.cancercenter.com/cancertypes/multiplemyeloma/ of the following findings: ≥60 percent plasma cells in the bone detected. It was prescribe antibiotic for 7 days. At the control symptoms marrow; serum free light chain ratio of 100 or more (provided examination on the seventh day, the patient no longer feels pain [5]. Multiple myeloma symptoms, diagnosis, and staging involved FLC level is at least 100 mg/L); or MRI showing more in the throat or difficulty swallowing, it was agreed to do a than one lesion (involving bone or bone marrow). Multiple control laboratory, but the patient did not do it. One month later, https://www.uptodate.com/contents/multiple-myeloma-myeloma treatment isn't always needed right away. If the he comes to the examination because of pain in the spine that symptoms-diagnosis-and-stagingbeyond-the-basics multiple myeloma is slow growing and isn't causing symptoms, lasts for almost 10 days and spreads to the leg, but malaise and [6] Cardiac Considerations for Modern Multiple Myeloma close watching might be the first step. For people with multiple pronounced weakness have appeared in the last days. The Therapies myeloma who need treatment, there are a number of ways to patient is referred for an X-ray of the LS rbet as well as help control the disease.(1) Standard treatment is induction laboratory analyzes. https://www.acc.org/latest-in- chemotherapy with a combination of a proteasome inhibitor cardiology/articles/2016/07/07/14/59/cardiacconsiderations- (e.g.,bortezomib or carfilzomib), immunomodulatory agent X-ray show Disc herniation at L4-L5 and L5-S1, with for-modern-multiple-myeloma-therapies (e.g., thalidomide, lenalidomide, or pomalidomide), and dorsal reduction of disc spaces and bridged osteophytes glucocorticosteroid (dexamethasone). The most common initial Spondylolisthesis of the facet joints at the L2-L3 level Kyphosis therapy choices are bortezomib + lenalidomide + deviation in the thoracolumbar part of the spine, with a bridged dexamethasone or cyclophosphamide + bortezomib + osteophyte. Laboratory test shows: Le 2.2, Hb 97 G/L SE 64 dexamethasone. [6]Induction therapy is given 4-6 cycles ER 2.79 *10 Crea 173.64 umol/L. Due to leukopenia, anemia followed by autologous hematopoietic cell transplantation. and the presence of general weakness and pain in the spine, the [6]Thereafter, many patients receive post-transplant therapy patient was referred to the Hematology Clinic for further (also called consolidation or maintenance therapy). In patients investigation and treatment. In the hematology clinic not eligible for autologous hematopoietic cell transplantation, a investigation was done. The results are as follow a bone marrow prolonged course of initial chemotherapy with a doublet puncture proved the presence of more than 10% of plasma cells. (bortezomib + dexamethasone or lenalidomide + Laboratory analyzes with a low level of erythrocytes and dexamethasone) or triplet (bortezomib + lenalidomide + leukocytes and with elevated calcium and with elevated dexamethasone or cyclophosphamide + bortezomib + sedimentation as well as elevated degradation products. dexamethasone) is typically administered (Figure 1). [6] Electrophoresis with the presence of monoclonal proteins. A Figure 1 diagnosis of Multiple Myeloma was made. Open history in a day hospital for further treatment. 75 Online and Face-to-Face Learning model – our medical education contexts, e-learning appears to be at least as Table I. Opinion of the instructors from N.Macedonia on effective as traditional instructor-led methods such as lectures. hybrid education of TRANSSIMED project experience from TRANSSIMED Project Students do not see e-learning as replacing traditional instructor-led training but as a complement to it, forming part Question Preferences n (%) of a blended-learning strategy2. But in adults, this model of Do you think - Learning theory 9 Elizabeta Kostovska Prilepchanska¹,Katarina Stavrikj¹,Katerina Kovachevikj², Sashka Janevska² learning has found a suitable application, even in medical hybrid education is (100%) - Learning practical skills Center of Family medicine, Medical Faculty- UKIM, Skopje¹ GPO ,,Vita Katerina” Skopje N Macedonia² education. Many Universities and academic institutions have suitable for adopted and continue to practice hybrid model of education (choose multiple 7 (78%) - Learning communication beti_prikos@yahoo.com even COVID-19 pandemic has finished. Blended learning is a answers) skills 7 (78%) new approach to improving the quality of medical education. - Case report 5 (55%) Abstract— Background: The COVID-19 pandemic has changed Conclusion: Considering the length of training, our experience Acceptance of blended learning plays an important role in its several segments of human life and it has also changed the face of was positive and this hybrid model provided more benefits and effective implementation. 3] TRANSIMED project, as part of - Performance 8 (89%) education. Both traditional and online medium of education have highlights both face-to-face and online education for future the ERASMUS+ programs has the main objective to establish Please choose - Time saving 7 (78%) their pros and cons. Many universities and academic institutions education. a competency-based, sustainable system of simulation-based which of the have adopted and continue to practice hybrid model of education - Saving funds 9 vocational training in primary health care in three countries following do you even COVID-19 pandemic has finished. TRANSIMED project, as Index Terms-- face-to-face education, online education, hybrid think are (100%) - Education tailored to the part of the ERASMUS+ programs has the main objective to education, opinions. (Slovenia, Croatia and N. Macedonia). To achieve the main advantages of the participant 5 (55%) establish a competency-based, sustainable system of simulation- objectives of the Project, combination model of e-learning – hybrid education model - Possibility of preliminary 7 (78%) based vocational training in primary health care in three online and face to face was used by the main leader of the preparation countries (Slovenia, Croatia and N. Macedonia). To achieve the project- SIM Centre-Community Health Centre Ljubljana. 6 (67%) main objectives of the Project, combination model of learning – - Greater availability of I. INTRODUCTION online and face to face was used by the main leader of the project- materials and other resources SIM Centre-Community Health Centre Ljubljana. Two groups The COVID-19 pandemic has changed several segments of 7 (78%) II. M - Determination of ATERIAL AND METHODS of instructors, basic and advanced, from the partner countries human life and it has also changed the face of education. Both knowledge through testing and 7 (78%) had finished this training. Aim: to investigate instructor’s traditional and online medium of education have their pros and In order to obtain objective feedback on the achieved hybrid evaluation opinions regarding hybrid model of education: online and face- cons. Students are more aware of self-efficacy, self-awareness, education, an online survey was conducted with a 8 (89%) - Interactivity to-face. Method: More than 20 modules were implemented for self-paced learning, creating a flexible learning environment, questionnaire that covered: demographic characteristics, 7 (78%) - Learning clinical skills both levels of instructors. Most of them were processed on line, and allowing for an interactive and safe way to learn digitally previous experience with online education, experience with with physical presence but some of them were realized as a part of the trainings in the when reflecting upon hybrid and blended learning. Another hybrid education, advantages and disadvantages of online and SIM Centre together with the practical part that included strength that should be emphasized is how hybrid and blended - Possibility of faster hybrid education and a opened question about their opinion for working in a group with high fidelity mannequins according to adaptation in the education learning may increase accessibility for those with physical and process pre-developed scenarios. The education took place over the the role of hybrid model in medical education. The mental disabilities, in addition to those who are audibly course of 15 days, of which 9 days were online and 6 days were questionnaire was filled out by all 9 participants who impaired. Incorporating storytelling with hybrid and blended Please state - Insufficient time to learn 0 (0%) realized in SIM Centre in Ljubljana for advance instructors and completed training through a hybrid model for project which of the the material learning will enhance not only the relationship between the 5 (55%) 6 on line and 5 days face to face education for basic instructors. TRANSSIMED, in the period from March-June 2023. following do you think are - Poor technical After completing the training, instructors continue to work at educator and learner by creating a more interactive 4 (44%) disadvantages of performance of education national level developing cultural y adapted educational environment, but will also increase the student knowledge and the hybrid learning - Inadequate interaction 3 (33%) programs for education with simulation for medical teams in retention of the content. model? with the educator and the primary health care level and establishing a sustainable system of III. R 3 (33%) Depending upon the professor delivering the content and the ESULTS participants education with simulations to improve patient safety, which is the student absorbing the content, hybrid and blended learning can Feedback was received from all instructors aged 34 to 54 main goal of the project TRANSSIMED. Results: Feedback - Inappropriate modules pose a potential weakness within an online learning experience. years (6 women and 3 men), all specialists in family medicine received from 9 instructors that finished hybrid education. With This can also allow for all parties involved becoming with work experience between 9 and 21 years as a family doctor - Inadequate assessment on line education, there was no need for longer absence from complacent if the online course is not fully structured or was more than positive, ranking 5 from 0 to 5 (Table I). All of Please, from 1 All 9 instructors rated the 9 work, which was of great importance for the instructors who them have previously experience with on line education and 6 to 5, express your education in TRANSSIMED (100%) works as family doctors. The space flexibility followed by interactive. When teaching in an online environment another of them were involved in online education as educators at our satisfaction with with the highest rating-5 familiarity with digital technology, working in a small group with potential weakness is there is no way of gauging body language faculty. Instructors believe that the hybrid education is suitable the hybrid constant interaction, excellent access to materials on an on-line with students. Hybrid and blended learning certainly has its fair for learning theoretical knowledge (100%), communication and education method platform, respecting a time frame and a planned time for share of potential chal enges such as: technology could be in the practical skil s (78%), improving performance (89%), but it completing tasks were also very significant benefits of this compromised, computer compatibility, individual learners TRANSSIMED project education. At the end of each day, evaluation of knowledge with integrity may be questionable, adjusting from the traditional should be considered whether to use it as a complex model for a test was organized. While negative opinions regard technical classroom to an online learning landscape, online software case report (55%). Main advantages are saving funds, and problems, the long working day, less time for the family and for options are costly, and so forth.1] effective learning of clinical skills with physical presence rest. Perceived benefits of face-to-face education include close followed with time saving, possible preliminary preparation, contact with teachers, socialization, and interactions, as well as In pandemic conditions, it started with the implementation interactivity and faster adaptation in the education process. As IV. DISCUSSION participant’s active participation, while the major perceived of online education at all levels of the education system as a main disadvantages was mentioned poor technical performance As part of the TRANSSIMED project, in the period March- disadvantage was the material cost. Positive perceptions about unique and applicable way of education, and the duration of the of education and inadequate interaction with educator during June 2023, 9 instructors - 5 advance and 4 basic, attended hybrid education are often linked to combining the benefits of pandemic situation made it possible to choose both the good online education. hybrid education model for acquiring competencies through the face-to-face and online education. and the less good aspects of this type of education. In diverse simulation method. 27 modules were implemented for advanced instructors, and 14 for Basic. Most of them were processed on line, but some of them were realized as a part of the trainings in the SIM Centre in Ljubljana together with the practical part that included working in a group with high fidelity mannequins according to pre-developed scenarios. The 76 Online and Face-to-Face Learning model – our medical education contexts, e-learning appears to be at least as Table I. Opinion of the instructors from N.Macedonia on effective as traditional instructor-led methods such as lectures. hybrid education of TRANSSIMED project experience from TRANSSIMED Project Students do not see e-learning as replacing traditional instructor-led training but as a complement to it, forming part Question Preferences n (%) of a blended-learning strategy2. But in adults, this model of Do you think - Learning theory 9 Elizabeta Kostovska Prilepchanska¹,Katarina Stavrikj¹,Katerina Kovachevikj², Sashka Janevska² learning has found a suitable application, even in medical hybrid education is (100%) - Learning practical skills Center of Family medicine, Medical Faculty- UKIM, Skopje¹ GPO ,,Vita Katerina” Skopje N Macedonia² education. Many Universities and academic institutions have suitable for adopted and continue to practice hybrid model of education (choose multiple 7 (78%) - Learning communication beti_prikos@yahoo.com even COVID-19 pandemic has finished. Blended learning is a answers) skills 7 (78%) new approach to improving the quality of medical education. - Case report 5 (55%) Abstract— Background: The COVID-19 pandemic has changed Conclusion: Considering the length of training, our experience Acceptance of blended learning plays an important role in its several segments of human life and it has also changed the face of was positive and this hybrid model provided more benefits and effective implementation. 3] TRANSIMED project, as part of - Performance 8 (89%) education. Both traditional and online medium of education have highlights both face-to-face and online education for future the ERASMUS+ programs has the main objective to establish Please choose - Time saving 7 (78%) their pros and cons. Many universities and academic institutions education. a competency-based, sustainable system of simulation-based which of the have adopted and continue to practice hybrid model of education - Saving funds 9 vocational training in primary health care in three countries following do you even COVID-19 pandemic has finished. TRANSIMED project, as Index Terms-- face-to-face education, online education, hybrid think are (100%) - Education tailored to the part of the ERASMUS+ programs has the main objective to education, opinions. (Slovenia, Croatia and N. Macedonia). To achieve the main advantages of the participant 5 (55%) establish a competency-based, sustainable system of simulation- objectives of the Project, combination model of e-learning – hybrid education model - Possibility of preliminary 7 (78%) based vocational training in primary health care in three online and face to face was used by the main leader of the preparation countries (Slovenia, Croatia and N. Macedonia). To achieve the project- SIM Centre-Community Health Centre Ljubljana. 6 (67%) main objectives of the Project, combination model of learning – - Greater availability of I. INTRODUCTION online and face to face was used by the main leader of the project- materials and other resources SIM Centre-Community Health Centre Ljubljana. Two groups The COVID-19 pandemic has changed several segments of 7 (78%) II. M - Determination of ATERIAL AND METHODS of instructors, basic and advanced, from the partner countries human life and it has also changed the face of education. Both knowledge through testing and 7 (78%) had finished this training. Aim: to investigate instructor’s traditional and online medium of education have their pros and In order to obtain objective feedback on the achieved hybrid evaluation opinions regarding hybrid model of education: online and face- cons. Students are more aware of self-efficacy, self-awareness, education, an online survey was conducted with a 8 (89%) - Interactivity to-face. Method: More than 20 modules were implemented for self-paced learning, creating a flexible learning environment, questionnaire that covered: demographic characteristics, 7 (78%) - Learning clinical skills both levels of instructors. Most of them were processed on line, and allowing for an interactive and safe way to learn digitally previous experience with online education, experience with with physical presence but some of them were realized as a part of the trainings in the when reflecting upon hybrid and blended learning. Another hybrid education, advantages and disadvantages of online and SIM Centre together with the practical part that included strength that should be emphasized is how hybrid and blended - Possibility of faster hybrid education and a opened question about their opinion for working in a group with high fidelity mannequins according to adaptation in the education learning may increase accessibility for those with physical and process pre-developed scenarios. The education took place over the the role of hybrid model in medical education. The mental disabilities, in addition to those who are audibly course of 15 days, of which 9 days were online and 6 days were questionnaire was filled out by all 9 participants who impaired. Incorporating storytelling with hybrid and blended Please state - Insufficient time to learn 0 (0%) realized in SIM Centre in Ljubljana for advance instructors and completed training through a hybrid model for project which of the the material learning will enhance not only the relationship between the 5 (55%) 6 on line and 5 days face to face education for basic instructors. TRANSSIMED, in the period from March-June 2023. following do you think are - Poor technical After completing the training, instructors continue to work at educator and learner by creating a more interactive 4 (44%) disadvantages of performance of education national level developing cultural y adapted educational environment, but will also increase the student knowledge and the hybrid learning - Inadequate interaction 3 (33%) programs for education with simulation for medical teams in retention of the content. model? with the educator and the primary health care level and establishing a sustainable system of III. R 3 (33%) Depending upon the professor delivering the content and the ESULTS participants education with simulations to improve patient safety, which is the student absorbing the content, hybrid and blended learning can Feedback was received from all instructors aged 34 to 54 main goal of the project TRANSSIMED. Results: Feedback - Inappropriate modules pose a potential weakness within an online learning experience. years (6 women and 3 men), all specialists in family medicine received from 9 instructors that finished hybrid education. With This can also allow for all parties involved becoming with work experience between 9 and 21 years as a family doctor - Inadequate assessment on line education, there was no need for longer absence from complacent if the online course is not fully structured or was more than positive, ranking 5 from 0 to 5 (Table I). All of Please, from 1 All 9 instructors rated the 9 work, which was of great importance for the instructors who them have previously experience with on line education and 6 to 5, express your education in TRANSSIMED (100%) works as family doctors. The space flexibility followed by interactive. When teaching in an online environment another of them were involved in online education as educators at our satisfaction with with the highest rating-5 familiarity with digital technology, working in a small group with potential weakness is there is no way of gauging body language faculty. Instructors believe that the hybrid education is suitable the hybrid constant interaction, excellent access to materials on an on-line with students. Hybrid and blended learning certainly has its fair for learning theoretical knowledge (100%), communication and education method platform, respecting a time frame and a planned time for share of potential chal enges such as: technology could be in the completing tasks were also very significant benefits of this compromised, computer compatibility, individual learners practical skil s (78%), improving performance (89%), but it TRANSSIMED project education. At the end of each day, evaluation of knowledge with integrity may be questionable, adjusting from the traditional should be considered whether to use it as a complex model for a test was organized. While negative opinions regard technical classroom to an online learning landscape, online software case report (55%). Main advantages are saving funds, and problems, the long working day, less time for the family and for options are costly, and so forth.1] effective learning of clinical skills with physical presence rest. Perceived benefits of face-to-face education include close followed with time saving, possible preliminary preparation, contact with teachers, socialization, and interactions, as well as In pandemic conditions, it started with the implementation interactivity and faster adaptation in the education process. As IV. DISCUSSION participant’s active participation, while the major perceived of online education at all levels of the education system as a main disadvantages was mentioned poor technical performance As part of the TRANSSIMED project, in the period March- disadvantage was the material cost. Positive perceptions about unique and applicable way of education, and the duration of the of education and inadequate interaction with educator during June 2023, 9 instructors - 5 advance and 4 basic, attended hybrid education are often linked to combining the benefits of pandemic situation made it possible to choose both the good online education. hybrid education model for acquiring competencies through the face-to-face and online education. and the less good aspects of this type of education. In diverse simulation method. 27 modules were implemented for advanced instructors, and 14 for Basic. Most of them were processed on line, but some of them were realized as a part of the trainings in the SIM Centre in Ljubljana together with the practical part that included working in a group with high fidelity mannequins according to pre-developed scenarios. The 77 education took place over the course of 15 days, of which 9 days performance, inadequate interaction between the educator and doi:10.1186/s12909-020-02302-2 . PMID: 33066768; PMCID: 7. were online and 6 days were realized in SIM Centre in the group, inadequate modules and inadequate testing stand out. PMC7565754 8. Nikolopoulou, K. (2022). Face-To-Face, Online and Hybrid Ljubljana for advance instructors and 6 on line and 5 days face Nikolopoulou also find positive perceptions of the Greek 5. Garden AL, Le Fevre DM, Waddington HL, Weller JM. Debriefing Education: University Students’ Opinions and Preferences. Journal to face education for basic instructors. students about hybrid education which are often linked to after Simulation-Based Non-Technical Skill Training in Healthcare: of Digital Educational Technology, 2(2), ep2206. A Systematic Review of Effective Practice. Anaesthesia and https://doi.org/10.30935/jdet/12384 Online education is mostly reserved for the theoretical part combining the benefits of face-to-face and online education. Intensive Care. 2015;43(3):300-308. 9. Powell, A., Watson, J., Staley, P., Patrick, S., Horn, M., Fetzer, L., of education, which implies concise interactive lectures that Students’ preferences for their future education highlight both doi:10.1177/0310057X1504300303 Hibbard, L., Oglesby, J., &Verma, S. (2015). Blending learning: 6. Zalika Klemenc-Ketis, Uroš Zafošnik & Antonija Poplas The evolution of online and face-to-face education from Singh et al. ended with an assessment. The next day, the lecture started with face-to-face and hybrid education.6] Susič (2020) An innovative approach to educating primary health 29 2008–2015. iNACOL, The International Association for K-12 an evaluation of what was learned from the previous day and a Regarding the possibility of using the hybrid model in care teams about medical emergencies, Education for Primary Online Learning. https://files.eric.ed.gov/fulltext/ED560788.pdf comment on the homework. The participants themselves gave medical education, several answers were given in favor of a Care, 31:1, 44-47, DOI: 10.1080/14739879.2019.1691471 feedback on what they had done and learned, and the facilitators more economical education that saves time and resources, in gave directions to the module itself through an intensive one-on-one education, but also for a group of participants with interactive discussion. For the next day, the contents that will different places of residence, mastering the new skil s and be processed as well as the materials that could be searched for protocols, renewal of knowledge and practical performance of an easier and better mastering of the education were announced. appropriate interventions, trainings in al medical fields and in On-line games were also used in which the teams shared their al levels of medical education. And that's exactly why blended thoughts and upgraded their knowledge. learning is a new approach to improving the quality of medical Most of this face-to-face education was aimed at mastering education. 3] practical skills in a simulation center but also for repeating Prior evidence suggests that students who complete course some highlights or upgrading for the next module. On a highly work using blended/hybrid modality (combination of in-person realistic mannequin, through the simulation on an already and online instruction) excel when compared to peers who may prepared scenario for saving a life-threatening patient, the have access to only one form of instruction. Blended/hybrid instructors were educated by practicing debriefing and learning offers a creative option to faculty and academic leaders feedback. Non-technical skills training in healthcare frequently so they can make information available to students even outside uses high-fidelity simulation followed by a facilitated of the four wal s of the classroom. This helps in optimizing and discussion known as debriefing. 4] maximizing productivity of individual students during in- This hybrid model of education with simulation was a person sessions. 7] unique experience for the instructors from Macedonia who for the first time had the opportunity to be educated in a SIM center for primary health care teams. They have long working V. CONCLUSION experience as family doctors and are the patient's first contact with the health system even when it comes to managing Considering the length of training, our experience was positive emergency situations. These situations require updated and this hybrid model provided more benefits and highlights knowledge, communication skil s, trained staff and adequate both face-to-face and online education for future education. equipment and organization, so therefore the need for such a And in that direction all 9 instructors rated the education in specific education in the SIM Center was recognized. 5] TRANSSIMED with the highest rating-5. Students’ opinions-preferences regarding hybrid model of The TRANSSIMED project, under the Erasmus + program, education – online and face-to-face, have implications for enabled excellent education of instructors through modules further practices and/or policies. Limitations: The sample we implemented with a hybrid model of education. had at this education makes it difficult to extrapolate the With the first part of the hybrid model, which included results. Exploring participant’s opinions-preferences on hybrid online education, several positive aspects stand out, such as less model of education will be an ongoing research issue. After the absenteeism from work, which was of great importance for the pandemic and the forced full application of online education, instructors who works as family doctors. The space flexibility the way is paved for more widespread implementation of the followed by commotion in pursuing education is also hybrid-blended learning mode in education. mentioned as positive benefits. Inadequate handling of technique as well as lack of emotions in education are singled out as shortcomings of the highest rank, but the need for equipment and inadequate handling of technique as well as lack of interaction are also perceived. Similar strengths were REFERENCES detected in the Singh’s study. 1] 1. Singh, J., Steele, K., & Singh, L. (2021). Combining the Best of Online and Face-to-Face Learning: Hybrid and Blended Learning The greatest advantage of the hybrid model of education is Approach for COVID-19, Post Vaccine, & Post-Pandemic the saving of funds followed by the faster adaptation in the World. Journal of Educational Technology Systems, 50(2), 140– educational process and the possibility of prior preparation as 171. https://doi.org/10.1177/00472395211047865 2. well as the practice of practical skills with predetermined 3. Ruiz JG, Mintzer MJ, Leipzig RM. The impact of E-learning in knowledge and verification through testing. The possibility of medical education. Acad Med. 2006 Mar;81(3):207-12. interaction, saving time and the possibility to adapt education doi:10.1097/00001888-200603000-00002 . PMID: 16501260. to the measure of the participants stand out as an advantage. 4. Azizi SM, Roozbahani N, Khatony A. Factors affecting the From a disadvantage perspective, possible poor technical acceptance of blended learning in medical education: application of UTAUT2 model. BMC Med Educ. 2020 Oct 16;20(1):367. 78 education took place over the course of 15 days, of which 9 days performance, inadequate interaction between the educator and doi:10.1186/s12909-020-02302-2 . PMID: 33066768; PMCID: 7. were online and 6 days were realized in SIM Centre in the group, inadequate modules and inadequate testing stand out. PMC7565754 8. Nikolopoulou, K. (2022). Face-To-Face, Online and Hybrid Ljubljana for advance instructors and 6 on line and 5 days face Nikolopoulou also find positive perceptions of the Greek 5. Garden AL, Le Fevre DM, Waddington HL, Weller JM. Debriefing Education: University Students’ Opinions and Preferences. Journal to face education for basic instructors. students about hybrid education which are often linked to after Simulation-Based Non-Technical Skill Training in Healthcare: of Digital Educational Technology, 2(2), ep2206. A Systematic Review of Effective Practice. Anaesthesia and https://doi.org/10.30935/jdet/12384 Online education is mostly reserved for the theoretical part combining the benefits of face-to-face and online education. Intensive Care. 2015;43(3):300-308. 9. Powell, A., Watson, J., Staley, P., Patrick, S., Horn, M., Fetzer, L., of education, which implies concise interactive lectures that Students’ preferences for their future education highlight both doi:10.1177/0310057X1504300303 Hibbard, L., Oglesby, J., &Verma, S. (2015). Blending learning: 6. Zalika Klemenc-Ketis, Uroš Zafošnik & Antonija Poplas The evolution of online and face-to-face education from Singh et al. ended with an assessment. The next day, the lecture started with face-to-face and hybrid education.6] Susič (2020) An innovative approach to educating primary health 29 2008–2015. iNACOL, The International Association for K-12 an evaluation of what was learned from the previous day and a Regarding the possibility of using the hybrid model in care teams about medical emergencies, Education for Primary Online Learning. https://files.eric.ed.gov/fulltext/ED560788.pdf comment on the homework. The participants themselves gave medical education, several answers were given in favor of a Care, 31:1, 44-47, DOI: 10.1080/14739879.2019.1691471 feedback on what they had done and learned, and the facilitators more economical education that saves time and resources, in gave directions to the module itself through an intensive one-on-one education, but also for a group of participants with interactive discussion. For the next day, the contents that will different places of residence, mastering the new skil s and be processed as well as the materials that could be searched for protocols, renewal of knowledge and practical performance of an easier and better mastering of the education were announced. appropriate interventions, trainings in al medical fields and in On-line games were also used in which the teams shared their al levels of medical education. And that's exactly why blended thoughts and upgraded their knowledge. learning is a new approach to improving the quality of medical Most of this face-to-face education was aimed at mastering education. 3] practical skills in a simulation center but also for repeating Prior evidence suggests that students who complete course some highlights or upgrading for the next module. On a highly work using blended/hybrid modality (combination of in-person realistic mannequin, through the simulation on an already and online instruction) excel when compared to peers who may prepared scenario for saving a life-threatening patient, the have access to only one form of instruction. Blended/hybrid instructors were educated by practicing debriefing and learning offers a creative option to faculty and academic leaders feedback. Non-technical skills training in healthcare frequently so they can make information available to students even outside uses high-fidelity simulation followed by a facilitated of the four wal s of the classroom. This helps in optimizing and discussion known as debriefing. 4] maximizing productivity of individual students during in- This hybrid model of education with simulation was a person sessions. 7] unique experience for the instructors from Macedonia who for the first time had the opportunity to be educated in a SIM center for primary health care teams. They have long working V. CONCLUSION experience as family doctors and are the patient's first contact with the health system even when it comes to managing Considering the length of training, our experience was positive emergency situations. These situations require updated and this hybrid model provided more benefits and highlights knowledge, communication skil s, trained staff and adequate both face-to-face and online education for future education. equipment and organization, so therefore the need for such a And in that direction all 9 instructors rated the education in specific education in the SIM Center was recognized. 5] TRANSSIMED with the highest rating-5. Students’ opinions-preferences regarding hybrid model of The TRANSSIMED project, under the Erasmus + program, education – online and face-to-face, have implications for enabled excellent education of instructors through modules further practices and/or policies. Limitations: The sample we implemented with a hybrid model of education. had at this education makes it difficult to extrapolate the With the first part of the hybrid model, which included results. Exploring participant’s opinions-preferences on hybrid online education, several positive aspects stand out, such as less model of education will be an ongoing research issue. After the absenteeism from work, which was of great importance for the pandemic and the forced full application of online education, instructors who works as family doctors. The space flexibility the way is paved for more widespread implementation of the followed by commotion in pursuing education is also hybrid-blended learning mode in education. mentioned as positive benefits. Inadequate handling of technique as well as lack of emotions in education are singled out as shortcomings of the highest rank, but the need for equipment and inadequate handling of technique as well as lack of interaction are also perceived. Similar strengths were REFERENCES detected in the Singh’s study. 1] 1. Singh, J., Steele, K., & Singh, L. (2021). Combining the Best of Online and Face-to-Face Learning: Hybrid and Blended Learning The greatest advantage of the hybrid model of education is Approach for COVID-19, Post Vaccine, & Post-Pandemic the saving of funds followed by the faster adaptation in the World. Journal of Educational Technology Systems, 50(2), 140– educational process and the possibility of prior preparation as 171. https://doi.org/10.1177/00472395211047865 2. well as the practice of practical skills with predetermined 3. Ruiz JG, Mintzer MJ, Leipzig RM. The impact of E-learning in knowledge and verification through testing. The possibility of medical education. Acad Med. 2006 Mar;81(3):207-12. interaction, saving time and the possibility to adapt education doi:10.1097/00001888-200603000-00002 . PMID: 16501260. to the measure of the participants stand out as an advantage. 4. Azizi SM, Roozbahani N, Khatony A. Factors affecting the From a disadvantage perspective, possible poor technical acceptance of blended learning in medical education: application of UTAUT2 model. BMC Med Educ. 2020 Oct 16;20(1):367. 79 The role and good practices of patronage nursing in nurse in the patronage care is to achieve the well-being of the As can be seen from the above data, the main actors in the individual, the family and the community through services of patronage care are registered nurses, registered health primary health care in Slovenia - A case study a preventive, curative and social nature. professionals and, in some cases, a senior nurse. In some organisational units, however, there are also health technician A registered nurse in the patronage care is a family nurse working in the area of patronage care. The differences between TNA KRAJNC dipl. med. ses. whose work reflects an understanding of the practice context these two profiles in the patronage care are exclusively in the and cultural characteristics necessary for the service user and competences they have in carrying out health education tina.kolenko@gmail.com their families to receive care that is evidence-based, of high interventions. quality and in line with their values and beliefs (McCormack, Abstract: 2018). She cares for the individual and their family from before The activity of private duty nursing can be carried out within Keywords: patronage care, registred nurse, individual, family birth until their death. The individual's family is accompanied health care institutions or as an independent concession, but in INTRODUCTION: Patronage care is a specialised area of and local community by registered nurse in patronage care at the mourning this case the registered nurse in patronage care must be nursing that deals with the holistic care of the individual, their ceremony. (Ramšak Pajk et al., 2016) She is the home health integrated into the public health network and must take over family and the local community in which they reside, in all INTRODUCTION care provider and coordinator of all forms of home support and all areas of activity (Železnik et al., 2011). periods of health and illness. In Slovenia, patronage care is an the link between the individual and her/his personal doctor. important part of the primary health care network. It is "Health 2020" (World Health Organization 2013), which is the In Tabel 1, you can see the number of teams in the patronage essential that the work of the registered nurse in the patronage starting point for health policy in 53 European countries, Coordinate the work: care sector from 2013 to 2020, separately by level of education care is primarily carried out in the individual's home and in presents as common goals: to radically improve the health and - with services in the health centre, and in total. the local community. At the same time, she is also the well-being of populations, reduce health inequalities, - with your chosen personal doctor (adult healthcare, coordinator of all the forms of support needed in the home by strengthen public health and ensure people-centred health healthcare for pre-school, school children and young people, both the individual and the family. A registered nurse in systems. It calls for a radical change in health policy to foster women's healthcare) THE CONTENT OF PATRONAGE VISITS patronage care is a family nurse. She cares for the individual the development of primary health care based on prevention - other health teams (ambulance of specialist at primary level - and their family from before birth until death. She or he and management of disease and on convergence towards anticoagulant ambulance , ambulanfe for diabetic, etc.) Based on the legal definitions of individual and family accompanies the family during the mourning period. In this integrated, individualised and patient- and family-centred care. - with secondary and tertiary level services (hospitals, treatments in the context of health care, they can be divided article, we would like to give a brief overview of the area and In this context, the importance and dynamism of the roles of rehabilitation centres, spas, etc.) into preventive and curative treatments. Preventive treatments organisation of the work in the patronage care. METHODS: In health care providers is increasingly being highlighted. As - with other services and organisations outside the health care are defined in the Regulations for the Provision of Preventive the preparation of this article, we have used a variety of Barrett et al (2016) note, many concepts and definitions have system that can contribute in any way to the optimal solution Health Care at Primary Level (hereafter referred to as the literature that addresses the holistic health care of the been developed about the provision of nursing care in the of the individual's and family's situation (Home Care Services, Regulations), which were issued in 1998 on the basis of the individual at primary level in its various forms. This includes community and in the patient's home, which in Slovenia refer Red Cross, Social Work Centres, local community, Senior Health Care and Health Insurance Act and the Act on Health both preventive and curative treatments, which also include the to as 'patronage care'. Dickson et al (2013) present seven key Citizens' Homes, etc.) (Železnik et al. 2011). Care Activity. However, in practice it is often impossible to area of work of patronage care. In addition, we have also elements of community nursing: meeting community health strictly distinguish between preventive and curative care. included some statistics from the monitoring of the number of needs, working directly with people, a public health approach, Because in the vast majority of curative treatments in the field, consultations in the patronage care before and during the service coordination, supporting self-care, interdisciplinary STAFF WORKING IN RESIDENTIAL CARE in addition to the provision of a range of health care services COVID-19 epidemic. RESULTS: From the literature review collaboration and continuity of care. ordered by a doctor, many preventive measures are hidden, and the regular monitoring of the number of visits over the The working standard is 2500 individuals per single registered In Slovenia, patronage care is an important part of primary which are aimed at preventing the disease and its consequences years, it can be seen that the quantity and severity of nurse in patronage care and 5000 individuals per single health health care, which differs from other primary health care (Ramšak Pajk et al., 2016). consultations is changing and increasing from year to year, due technician (HT), provided that the network is filled with activities in that it is primarily carried out in the patient's home, to the irreversible ageing of the population in the field areas, registered nurses. in the local community, in the field and also in the health The Regulations (1998), which have undergone many and the reduction of the length of stay in hospitals hospital centre. It is a polyvalent primary health care activity and is In 2021, the document Staffing Standards and Norms in revisions over the years, stipulate that preventive care in beds. Comparing the data on the number of attendances before therefore a specialised area of nursing in its own right. It deals patronage care includes: Nursing and Midwifery Care was published under the auspices and during the COVID-19 epidemic also shows an increase in with the individual, the family and the local community in a of the Health and Midwifery Care Chamber - the Association - Family health education the volume of attendance due to changes in the system of specific field area during periods of health and illness. The of Professional Associations of Nurses, Midwives and Health - Health education in the local community attendances at the primary health care level. CONCLUSION: provider in the patronage care is a registered nurse in the Technicians of Slovenia (the Chamber - the Association). In daily work patronage care face a variety of challenges that - An antenatal visit to a pregnant woman patronage care (RN) or a community nurse (CN), who However, these are not yet in force. The chapter on preventive require to continuously adapt tha work and approaches - Attending a newborn and infant identifies care needs, plans and implements interventions, and care provides for the recruitment of registered nurse in according to the needs of individuals, their families and the evaluates the objectives achieved. She advises on healthy - patronage care according to the following scheme: Patronage visit to a mother after childbirth local community in which they are involved. By successfully lifestyles and points out risk criteria that may endanger the - Patronage visit to a child in the 2nd and 3rd year of overcoming a wide range of challenges, the registered nurse health of the individual, his/her family and the local - URBAN ENVIRONMENT: 2200 individuals or 1 registered age continuously improves her professionalism and innovation. In community (Železnik et al., 2011). Due to the emerging nurse in patronage care per 1200 treatments - Patronage visits to risk groups (patients with active this way, she helps to create the best possible conditions for the demographic changes, the role of the registered nurse in the - SEMIRURAL ENVIRONMENT: 2000 individuals or 1 tuberculosis, muscular and neuromuscular disorders, individual to stay as long as possible in his or her home patronage care is constantly being upgraded and adapted registered nurse in patronage care per 1090 treatments tetra and paraplegia, multiple sclerosis, cerebral environment, despite various obstacles. according to the needs of the population and the development - RURAL ENVIRONMENT: 1,800 individualss or 1 palsy, intellectual disabilities, disabilities, chronic of long-term care services. The global goal of the registered registered nurse in patronage care employee for every 980 illness and over 65 years of age) treatments - Consultative patronage visit to non-responders in - And 0.2 nursing technicians for every registered nurse in patronage care, which equates to 1 helath technician (HT) for prevention programmes (SVIT, ZORA, DORA) every 5 registered nurse in patronage care. 80 The role and good practices of patronage nursing in nurse in the patronage care is to achieve the well-being of the As can be seen from the above data, the main actors in the individual, the family and the community through services of patronage care are registered nurses, registered health primary health care in Slovenia - A case study a preventive, curative and social nature. professionals and, in some cases, a senior nurse. In some organisational units, however, there are also health technician A registered nurse in the patronage care is a family nurse working in the area of patronage care. The differences between TNA KRAJNC dipl. med. ses. whose work reflects an understanding of the practice context these two profiles in the patronage care are exclusively in the and cultural characteristics necessary for the service user and competences they have in carrying out health education tina.kolenko@gmail.com their families to receive care that is evidence-based, of high interventions. quality and in line with their values and beliefs (McCormack, Abstract: 2018). She cares for the individual and their family from before The activity of private duty nursing can be carried out within Keywords: patronage care, registred nurse, individual, family birth until their death. The individual's family is accompanied health care institutions or as an independent concession, but in INTRODUCTION: Patronage care is a specialised area of and local community by registered nurse in patronage care at the mourning this case the registered nurse in patronage care must be nursing that deals with the holistic care of the individual, their ceremony. (Ramšak Pajk et al., 2016) She is the home health integrated into the public health network and must take over family and the local community in which they reside, in all INTRODUCTION care provider and coordinator of all forms of home support and all areas of activity (Železnik et al., 2011). periods of health and illness. In Slovenia, patronage care is an the link between the individual and her/his personal doctor. important part of the primary health care network. It is "Health 2020" (World Health Organization 2013), which is the In Tabel 1, you can see the number of teams in the patronage essential that the work of the registered nurse in the patronage starting point for health policy in 53 European countries, Coordinate the work: care sector from 2013 to 2020, separately by level of education care is primarily carried out in the individual's home and in presents as common goals: to radically improve the health and - with services in the health centre, and in total. the local community. At the same time, she is also the well-being of populations, reduce health inequalities, - with your chosen personal doctor (adult healthcare, coordinator of all the forms of support needed in the home by strengthen public health and ensure people-centred health healthcare for pre-school, school children and young people, both the individual and the family. A registered nurse in systems. It calls for a radical change in health policy to foster women's healthcare) THE CONTENT OF PATRONAGE VISITS patronage care is a family nurse. She cares for the individual the development of primary health care based on prevention - other health teams (ambulance of specialist at primary level - and their family from before birth until death. She or he and management of disease and on convergence towards anticoagulant ambulance , ambulanfe for diabetic, etc.) Based on the legal definitions of individual and family accompanies the family during the mourning period. In this integrated, individualised and patient- and family-centred care. - with secondary and tertiary level services (hospitals, treatments in the context of health care, they can be divided article, we would like to give a brief overview of the area and In this context, the importance and dynamism of the roles of rehabilitation centres, spas, etc.) into preventive and curative treatments. Preventive treatments organisation of the work in the patronage care. METHODS: In health care providers is increasingly being highlighted. As - with other services and organisations outside the health care are defined in the Regulations for the Provision of Preventive the preparation of this article, we have used a variety of Barrett et al (2016) note, many concepts and definitions have system that can contribute in any way to the optimal solution Health Care at Primary Level (hereafter referred to as the literature that addresses the holistic health care of the been developed about the provision of nursing care in the of the individual's and family's situation (Home Care Services, Regulations), which were issued in 1998 on the basis of the individual at primary level in its various forms. This includes community and in the patient's home, which in Slovenia refer Red Cross, Social Work Centres, local community, Senior Health Care and Health Insurance Act and the Act on Health both preventive and curative treatments, which also include the to as 'patronage care'. Dickson et al (2013) present seven key Citizens' Homes, etc.) (Železnik et al. 2011). Care Activity. However, in practice it is often impossible to area of work of patronage care. In addition, we have also elements of community nursing: meeting community health strictly distinguish between preventive and curative care. included some statistics from the monitoring of the number of needs, working directly with people, a public health approach, Because in the vast majority of curative treatments in the field, consultations in the patronage care before and during the service coordination, supporting self-care, interdisciplinary STAFF WORKING IN RESIDENTIAL CARE in addition to the provision of a range of health care services COVID-19 epidemic. RESULTS: From the literature review collaboration and continuity of care. ordered by a doctor, many preventive measures are hidden, and the regular monitoring of the number of visits over the The working standard is 2500 individuals per single registered In Slovenia, patronage care is an important part of primary which are aimed at preventing the disease and its consequences years, it can be seen that the quantity and severity of nurse in patronage care and 5000 individuals per single health health care, which differs from other primary health care (Ramšak Pajk et al., 2016). consultations is changing and increasing from year to year, due technician (HT), provided that the network is filled with activities in that it is primarily carried out in the patient's home, to the irreversible ageing of the population in the field areas, registered nurses. in the local community, in the field and also in the health The Regulations (1998), which have undergone many and the reduction of the length of stay in hospitals hospital centre. It is a polyvalent primary health care activity and is In 2021, the document Staffing Standards and Norms in revisions over the years, stipulate that preventive care in beds. Comparing the data on the number of attendances before therefore a specialised area of nursing in its own right. It deals patronage care includes: Nursing and Midwifery Care was published under the auspices and during the COVID-19 epidemic also shows an increase in with the individual, the family and the local community in a of the Health and Midwifery Care Chamber - the Association - Family health education the volume of attendance due to changes in the system of specific field area during periods of health and illness. The of Professional Associations of Nurses, Midwives and Health - Health education in the local community attendances at the primary health care level. CONCLUSION: provider in the patronage care is a registered nurse in the Technicians of Slovenia (the Chamber - the Association). In daily work patronage care face a variety of challenges that - An antenatal visit to a pregnant woman patronage care (RN) or a community nurse (CN), who However, these are not yet in force. The chapter on preventive require to continuously adapt tha work and approaches - Attending a newborn and infant identifies care needs, plans and implements interventions, and care provides for the recruitment of registered nurse in according to the needs of individuals, their families and the evaluates the objectives achieved. She advises on healthy - patronage care according to the following scheme: Patronage visit to a mother after childbirth local community in which they are involved. By successfully lifestyles and points out risk criteria that may endanger the - Patronage visit to a child in the 2nd and 3rd year of overcoming a wide range of challenges, the registered nurse health of the individual, his/her family and the local - URBAN ENVIRONMENT: 2200 individuals or 1 registered age continuously improves her professionalism and innovation. In community (Železnik et al., 2011). Due to the emerging nurse in patronage care per 1200 treatments - Patronage visits to risk groups (patients with active this way, she helps to create the best possible conditions for the demographic changes, the role of the registered nurse in the - SEMIRURAL ENVIRONMENT: 2000 individuals or 1 tuberculosis, muscular and neuromuscular disorders, individual to stay as long as possible in his or her home patronage care is constantly being upgraded and adapted registered nurse in patronage care per 1090 treatments tetra and paraplegia, multiple sclerosis, cerebral environment, despite various obstacles. according to the needs of the population and the development - RURAL ENVIRONMENT: 1,800 individualss or 1 palsy, intellectual disabilities, disabilities, chronic of long-term care services. The global goal of the registered registered nurse in patronage care employee for every 980 illness and over 65 years of age) treatments - Consultative patronage visit to non-responders in - And 0.2 nursing technicians for every registered nurse in patronage care, which equates to 1 helath technician (HT) for prevention programmes (SVIT, ZORA, DORA) every 5 registered nurse in patronage care. 81 Tabel 1:Number of teams contracted by National health Insurance Year 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 Fund in Slovenia. Year: 2013 2014 2015 2016 2017 2018 2019 2020 Appoint 1.141.657 1.140.302 1.148.462 1.186.774 1.207.608 1.197.204 1.192.627 1.212.633 1.184.649 1.239.415 ments / RN 707,31 715,93 719,03 725,83 740,98 750,41 783,50 822,99 example HT 140,98 140,91 129,03 122,93 110,99 99,65 87,50 80,81 Total: 848,29 856,84 848,06 848,76 851,97 850,06 871 903,80 Tabel 2: Number of appointments/exeples per year from2012 to The chart above shows the growth in the number of patronage 2021. protective equipment. Because of the different weather The most common procedures and interventions in the doctor care appointments, which are divided into preventive and who require more complex and longer treatment, and thus an conditions (wind, rain, sun, hot, cold), it proved to be a ordered care are: curative treatments. Statistically speaking, in 2012, was increase in the number of curative visits. Both of these facts, challenge to consistently follow the instructions for the correct 80.82% of curative treatments and 19.18% of preventive - Monitoring vital signs and health status in the patient in turn, lead to the need to adapt daily work and approach to fitting and removal of all the necessary protective equipment treatments were carried out in the patronage care in Slovenia. the needs of individuals and their families. More complex at home needed to come into contact with a sick individual when In 2021, the proportion of curative treatments was already treatments require continuous education on the new medical- working in the field. - Administering medicines to a patient at home 86.62%, while the proportion of preventive treatments was technical procedures and approaches that are being developed - Wound care (acute and chronic) only 13.38%. In 2020 and 2021, the implementation of on a daily basis. Therefore, a major challenge in the patronage The Table 2 shows the number of services provided in the area - Catheterisation in a woman in the home environment preventive treatments was adapted to epidemiological care is to achieve greater autonomy in work (Ramšak Pajk et of patronage care before and during the COVID-19 epidemic. - Application of the klistir at home measures. In particular, visits to pregnant women, children, al.,2016). - Nursing care for a patient with a stoma newborns and infants were carried out without interruption, Over the 10-year period from 2012 to 2022, the number of employees in patronage care has increased by 8.8%, while the - Nursing care of the patient with nasogastric tube and while other preventive visits, the omission of which could have The strengths of registered nurses in patronage care are their number of visits has increased by 8.6%. Compared to 2012, the feeding stomas negative consequences for patients' health, were carried out to exceptional knowledge of the community, where they perceive number of visits per employee has remained almost the same - Collection, preparation and transport of biological a lesser extent. social and health problems in conjunction with the local community and other stakeholders, find appropriate solutions. according to the data (0.2% increase). In 2021, despite the samples for laboratory tests In this way, they can help to create the conditions for the reduced functioning of the health system due to the COVID- - Nursing care for a patient on continuous oxygen THE CHALLENGES OF WORKING IN PATRONAGE individual to stay as long as possible in the home environment, 19 epidemic, there is a 2.8% increase in the number of visits therapy at home CARE despite age, illness and handicaps (Ramšak Pajk et al. 2016). per employee compared to 2020. Also in 2021, there is a record - Palliative care in the home environment number of visits per 1,000 inhabitants, which is attributable to - Various other procedures and interventions as part of Registered nurses in patronage care face many challenges in In 2020 and 2021, the implementation of the patronage health the reduced functioning and reduced access to other providers nursing care activities (peritoneal dialysis, vascular their work. The population is ageing at an unstoppable rate, service was clearly affected by the COVID-19 epidemic. Due in the health care system (Health Statistical Yearbook of catheter care, pleural drainage care, elastomeric pain leading to specific nursing and care needs for elderly patients. to the epidemiological measures, both preventive and curative Slovenia 2021). pump application, infusion application, etc.) And hospital bed lengths are getting shorter. This is leading to activities were curtailed. Only those patronage treatments were an increase in the number of patients in the home environment Literature: carried out, the omission of which could have had negative consequences on the patient's health (Statistical Yearbook of McCormack, B., 2018. The need to prioritize the person in Health Statistics of Slovenia 2021). nursing and healthcare: considering Healthfulness'. Obzornik zdravstvene nege, 52(4), pp. 220−224. Retrieved from: https:/ doi.org/10.14528/snr.2018.52.4.2955 PATRONAGE CARE DURING A COVID EPIDEMIC - 19 1200000 Barrett, A., Terry, D.R., Le, Q. & Hoang, H., 2016. Factors s 1000000 Over the last three years, healthcare at all levels has been influencing community nursing roles and health service 992460 1018497 1073592 922717 particularly challenged by the COVID-19 epidemic, which has provision in rural areas: a review of literature. Contemporary aring 800000 posed an additional challenge for the patronage care. The Nurse, 52(1), pp. 119–135. he registered nurses in patronage care were often the first to enter Retrieved from: 600000 of the homes of families with sick individuals. There has also https:/ doi.org/10.1080/10376178.2016.1198234 er 400000 been an increase in the number of attendances per registered nurse in the patronage care due to increases in the number of Dickson, C.A.W. & Coulter Smith, M.A., 2013. Time for Numb 200000 work orders issued by ambulance of chosen personal doctor. 218940 change in community nursing: a critique of the 194314 The Association of Nurses and Health Care Technicians in 0 174130 165823 implementation of the review of nursing in the community Patronage Care, which operates under the auspices of the 2012 2015 2018 2021 Chamber of Nurses and Health Care Technicians of the across NHS Scotland. Journal of Nursing Management, Year Federation, has prepared guidelines to help registered nurses in 21(2), pp. 339–350. Preventive treatments Curate's treatments patronage care to carry out patronage visits during the Retrieved from: https:/ doi.org/10.1111/j.1365-epidemic. 2834.2012.01382.x Diagram 1: Number of patronage preventive and curative appointments from 2012 to 2021 The relationship of trust between the individual, their family on the one hand, and the registered nurse on the other, has been Garber L., 2012. Comunity health nursing: A partnership of the most challenging at this time. Many times it appeared that Care. Nursing42(1) pp.19,20, January 2012. Avalible at: individuals had concealed the fact that they themselves were https:/ journals.lww.com/nursing/fulltext/2012/01001/commu ill or had close contact with someone who was ill. One of the nity_health_nursing a_partnership_of_care.7.aspx challenges during the epidemic was the correct use of 82 Tabel 1:Number of teams contracted by National health Insurance Year 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 Fund in Slovenia. Year: 2013 2014 2015 2016 2017 2018 2019 2020 Appoint 1.141.657 1.140.302 1.148.462 1.186.774 1.207.608 1.197.204 1.192.627 1.212.633 1.184.649 1.239.415 ments / RN 707,31 715,93 719,03 725,83 740,98 750,41 783,50 822,99 example HT 140,98 140,91 129,03 122,93 110,99 99,65 87,50 80,81 Total: 848,29 856,84 848,06 848,76 851,97 850,06 871 903,80 Tabel 2: Number of appointments/exeples per year from2012 to The chart above shows the growth in the number of patronage 2021. protective equipment. Because of the different weather The most common procedures and interventions in the doctor care appointments, which are divided into preventive and who require more complex and longer treatment, and thus an conditions (wind, rain, sun, hot, cold), it proved to be a ordered care are: curative treatments. Statistically speaking, in 2012, was increase in the number of curative visits. Both of these facts, challenge to consistently follow the instructions for the correct 80.82% of curative treatments and 19.18% of preventive - Monitoring vital signs and health status in the patient in turn, lead to the need to adapt daily work and approach to fitting and removal of all the necessary protective equipment treatments were carried out in the patronage care in Slovenia. the needs of individuals and their families. More complex at home needed to come into contact with a sick individual when In 2021, the proportion of curative treatments was already treatments require continuous education on the new medical- working in the field. - Administering medicines to a patient at home 86.62%, while the proportion of preventive treatments was technical procedures and approaches that are being developed - Wound care (acute and chronic) only 13.38%. In 2020 and 2021, the implementation of on a daily basis. Therefore, a major challenge in the patronage The Table 2 shows the number of services provided in the area - Catheterisation in a woman in the home environment preventive treatments was adapted to epidemiological care is to achieve greater autonomy in work (Ramšak Pajk et of patronage care before and during the COVID-19 epidemic. - Application of the klistir at home measures. In particular, visits to pregnant women, children, al.,2016). - Nursing care for a patient with a stoma newborns and infants were carried out without interruption, Over the 10-year period from 2012 to 2022, the number of employees in patronage care has increased by 8.8%, while the - Nursing care of the patient with nasogastric tube and while other preventive visits, the omission of which could have The strengths of registered nurses in patronage care are their number of visits has increased by 8.6%. Compared to 2012, the feeding stomas negative consequences for patients' health, were carried out to exceptional knowledge of the community, where they perceive number of visits per employee has remained almost the same - Collection, preparation and transport of biological a lesser extent. social and health problems in conjunction with the local community and other stakeholders, find appropriate solutions. according to the data (0.2% increase). In 2021, despite the samples for laboratory tests In this way, they can help to create the conditions for the reduced functioning of the health system due to the COVID- - Nursing care for a patient on continuous oxygen THE CHALLENGES OF WORKING IN PATRONAGE individual to stay as long as possible in the home environment, 19 epidemic, there is a 2.8% increase in the number of visits therapy at home CARE despite age, illness and handicaps (Ramšak Pajk et al. 2016). per employee compared to 2020. Also in 2021, there is a record - Palliative care in the home environment number of visits per 1,000 inhabitants, which is attributable to - Various other procedures and interventions as part of Registered nurses in patronage care face many challenges in In 2020 and 2021, the implementation of the patronage health the reduced functioning and reduced access to other providers nursing care activities (peritoneal dialysis, vascular their work. The population is ageing at an unstoppable rate, service was clearly affected by the COVID-19 epidemic. Due in the health care system (Health Statistical Yearbook of catheter care, pleural drainage care, elastomeric pain leading to specific nursing and care needs for elderly patients. to the epidemiological measures, both preventive and curative Slovenia 2021). pump application, infusion application, etc.) And hospital bed lengths are getting shorter. This is leading to activities were curtailed. Only those patronage treatments were an increase in the number of patients in the home environment Literature: carried out, the omission of which could have had negative consequences on the patient's health (Statistical Yearbook of McCormack, B., 2018. The need to prioritize the person in Health Statistics of Slovenia 2021). nursing and healthcare: considering Healthfulness'. Obzornik zdravstvene nege, 52(4), pp. 220−224. Retrieved from: https:/ doi.org/10.14528/snr.2018.52.4.2955 PATRONAGE CARE DURING A COVID EPIDEMIC - 19 1200000 Barrett, A., Terry, D.R., Le, Q. & Hoang, H., 2016. Factors s 1000000 Over the last three years, healthcare at all levels has been influencing community nursing roles and health service 992460 1018497 1073592 922717 particularly challenged by the COVID-19 epidemic, which has provision in rural areas: a review of literature. Contemporary aring 800000 posed an additional challenge for the patronage care. The Nurse, 52(1), pp. 119–135. he registered nurses in patronage care were often the first to enter Retrieved from: 600000 of the homes of families with sick individuals. There has also https:/ doi.org/10.1080/10376178.2016.1198234 er 400000 been an increase in the number of attendances per registered nurse in the patronage care due to increases in the number of Dickson, C.A.W. & Coulter Smith, M.A., 2013. Time for Numb 200000 work orders issued by ambulance of chosen personal doctor. 218940 change in community nursing: a critique of the 194314 The Association of Nurses and Health Care Technicians in 0 174130 165823 implementation of the review of nursing in the community Patronage Care, which operates under the auspices of the 2012 2015 2018 2021 Chamber of Nurses and Health Care Technicians of the across NHS Scotland. Journal of Nursing Management, Year Federation, has prepared guidelines to help registered nurses in 21(2), pp. 339–350. Preventive treatments Curate's treatments patronage care to carry out patronage visits during the Retrieved from: https:/ doi.org/10.1111/j.1365-epidemic. 2834.2012.01382.x Diagram 1: Number of patronage preventive and curative appointments from 2012 to 2021 The relationship of trust between the individual, their family on the one hand, and the registered nurse on the other, has been Garber L., 2012. Comunity health nursing: A partnership of the most challenging at this time. Many times it appeared that Care. Nursing42(1) pp.19,20, January 2012. Avalible at: individuals had concealed the fact that they themselves were https:/ journals.lww.com/nursing/fulltext/2012/01001/commu ill or had close contact with someone who was ill. One of the nity_health_nursing a_partnership_of_care.7.aspx challenges during the epidemic was the correct use of 83 Navodilo za izvajanje, beleženje in obračunavanje storitev v babiške nege Slovenije - Zveza strokovnih društev Burnout in Family Medicine Trainees During Pandemic patronažnem varstvu. Ljubljana 2021: Nacionalni inštitut za medicinskih sester, babic in zdravstvenih tehnikov Slovenije, javnozdravje. Retrieved from: https://nijz.si/sistem- Sekcija medicinskih sester in zdravstvenih tehnikov v zdravstvenega-varstva/patronazno-varstvo/navodilo-za- patronažni dejavnosti. Jerca Kranjc, dr.med., prof. dr. Polona Selič-Zupančič, univ. dipl. psih., izvajanje-belezenje-in-obracunavanje-storitev-v- ZD Ilirska Bistrica, Katedra za družinsko medicine MF UL, Katedra za psihologijo, MF UM patronaznem-varstvu/ Šušteršič, O., Horvat, M., Cibic, D., Peternelj, A. & Brložnik, jerca.kranjc@gmail.com M., 2006. Patronažno varstvo in patronažna zdravstvena Planirano število timov, Retrieved from: nega: nadgradnja in prilagajanje novim izzivom. Obzornik zdravstvene nege, 40(4), pp. 245–252. Abstract to increased workload, but was most likely related to inadequate https://partner.zzzs.si/wps/portal/portali/aizv/zdravstvene_sto Available at: Background protective equipment (p=0.020), fear of becoming infected ritve/podatki_o_dostopnosti_do_zdravstvenih_storitev/planir http:/ www.obzornikzdravstvenenege.si/2006.40.4.247 During the pandemic, burnout was shown worldwide to be (p=0.005), fear of transmitting infections to family members ano_stevilo_timov associated primarily with increased workload, inadequate (p=0.033) and parenthood (p=0.027). Zakon o dolgotrajni oskrbi /ZDOsk/ (2023). Uradni list RS, protective equipment, fear of infection and transmission of Factors associated with non-burnout were not having been Podatki o obveznem zdravstvenem zavarovanju št. 1/2023 (za št.84 (2. 8. 2023). Retrieved from: https://www.uradni-infection to others. The aim of the study was to determine the vaccinated (p=0.005) and not having children (p=0.026); further obdobje januar – december 2022) list.si/1/objava.jsp?sop=2021-01-3898 prevalence of the individual burnout dimensions, i.e. emotional research is advisable to assess and interpret these characteristics. Retrieved from: exhaustion (EE), depersonalisation (D) and low personal https://www.zzzs.si/?id=126&detail=B6B2EDB6AA2FE0A4 Zakon o zdravstvenem varstvu in zdravstvenem zavarovanju accomplishment (PA), as well as the overall prevalence of burnout Conclusions C12589750038F0F7 /ZZVZZ/ (2006). Uradni list RS, št. 72 (23. 6. 2006). (MBITOT) in family medicine trainees and to identify factors The prevalence of burnout among family medicine trainees was associated with burnout. In addition, the study aimed to compare higher during the pandemic than in 2012. Given the factors Retrieved from: Podatki o obveznem zdravstvenem zavarovanju št. 1/2022 (za burnout prevalence during the pandemic with another Slovenian associated with higher burnout scores, it is reasonable to assume http:/ pisrs.si/Pis.web/pregledPredpisa?id=ZAKO213 obdobje januar – december 2021) study where burnout prevalence among family medicine trainees that pandemic-related anxiety and systemic unpreparedness acted Retrieved from: was 18.3%, EE 45.9%, D 43.1% and PA 45.9%. as additional burnout factors. https:/ www.zzzs.si/?id=126&detail=722C8E0042FD79E3C1 Zakon o zdravstveni dejavnosti /ZZDej/ (2005). Uradni list 25880C002D9BC2 RS, št. 23 (26. 1. 2005). Methods Index terms: Burnout, family medicine trainees, emotional Retrieved from: https://www.uradni- The study was quantitative and cross-sectional. Data were exhaustion, depersonalisation, personal accomplishment Podatki o obveznem zdravstvenem zavarovanju št. 1/2021 (za list.si/1/objava.jsp?sop=2006-01-3075 collected using an anonymous online questionnaire sent to the e- obdobje januar - december 2020) mail addresses of 230 family medicine trainees who were I. INTRODUCTION Retrieved Zdravstveni statistični letopis Slovenije 2019 (pp. 5-2-20) registered on the list of family medicine trainees at the Medical from:https:/ www.zzzs.si/?id=126&detail=EEA740FAA9B82 Retrieved from: https://nijz.si/publikacije/zdravstveni- Chamber of Slovenia at the time of the study, between 19.4. and Burnout is known as a psychological syndrome described by 916C12586950027607C statisticni-letopis-2019/ 15.7.2021. The questionnaire contained socio-demographic data, three components: emotional exhaustion (EE), depersonalisation questions on workload, protective equipment, fear of infection (D) and reduced personal accomplishment (PA), which occur as a Podatki o obveznem zdravstvenem zavarovanju št. 1/2020 (za Zdravstveni statistični letopis Slovenije 2020 (pp. 5-2-16) transmission and the Maslach Burnout Questionnaire (MBI). Data sustained response to chronic stressors at work [1]. It usually obdobje januar - december 2019) Retrieved from: https://nijz.si/publikacije/zdravstveni- were statistically analysed. using bivariate tests and multivariable occurs after at least one year in a particular position, as stressors Retrieved statisticni-letopis-2020/ regression modelling. then begin to accumulate, leading to cynicism and a decline in the from:https:/ www.zzzs.si/?id=126&detail=A75EFD124C28F individual's effectiveness [1-3]. 0F5C125852D003173B8 Zdravstveni statistični letopis Slovenije 2021 (pp. 5-2-16) Results Retrieved from: https://nijz.si/publikacije/zdravstveni- The 102 participants (44.5% response rate) were 30.5 ± 2.5 years It is more common in age groups over 30 or 40, in single men Podatki o obveznem zdravstvenem zavarovanju št. 1/2019 (za statisticni-letopis-2021/ old and 81.4% were women. The mean duration of specialisation and in people with higher levels of education [1]. It occurs more obdobje januar - december 2018) was 3.9 ± 2.0 years. Most of the participants were married or in a often in people who have difficulty adapting to change, who trust Retrieved Zupančič, V., Ljubič, A., Milavec Kapun, M. & Štemberger partnership (79.4%), more than half of them had children (53.9%) others more than themselves, who have lower self-esteem and who from:https:/ www.zzzs.si/?id=126&detail=B89B12B5BB33C Kolnik, T., 2018. Raziskovanje na področju patronažne and 54.9% worked in cities. Half of them (52.9%) examined an tend to deal passively with stressful events [1,4], or in people who 665C12583BE0030FADA zdravstvene nege v Sloveniji v obdobju od 2007 do 2016: average of 40-60 patients per day and 27.5% examined 60-80 are overly committed to their work and want to achieve more than pregled literature. Obzornik zdravstvene nege, 52(4), pp. patients per day. Most (79.2%) worked in COVID-19 clinics and their colleagues, for example [2]. Podatki o obveznem zdravstvenem zavarovanju št. 1/2018 (za 264−281. Retrieved from: were vaccinated (76.5%); one third (35.3%) worked there up to 5 obdobje januar - december 2017) https:/ doi.org/10.14528/snr.2018.52.4.211 Burnout is associated with suboptimal patient care and an hours per week and 15.7% worked more than 10 hours per week. Retrieved from: increased risk of medical errors. Doctors experienced lower The overall prevalence of burnout (MBITOT) was 48.6 %. The https:/ www.zzzs.si/?id=126&detail=D70E0EEA6111389AC Železnik, D., Horvat, M., Panikvar Žlahtič, K., Filej, B. in productivity, lower job satisfaction, strained relationships with highest prevalence was 50.0% for EE (p=0.843), 51.0% for D 1258257003A3B70 Vidmar, I. 2011. Aktivnosti zdravstvene nege v patronažnem colleagues and an increased likelihood of leaving their jobs. The (p=0.427), 70.6% for PA (p < 0.001) and 37.3% for all three varstvu. Ljubljana: Zbornica zdravstvene in babiške nege risk of alcohol or drug abuse and suicidal tendencies also increased combined (p=0.001), which could be attributed to pandemic- Pravilnik za izvajanje preventivnega zdravstvenega varstva Slovenije Zveza društev medicinskih sester, babic in [5-7]. related conditions. Only 21.6% of trainees were not burnt out in na primarni ravni. (2023). Uradni list RS, št. 93 (31.8.2023). zdravstvenih tehnikov Slovenije. any dimension – less than in 2012 (29.4%), but the difference Retrieved from: In the Slovenian context, burnout in family medicine trainees proved not to be significant (p=0.193). Bivariate, it was not related http://www.pisrs.si/Pis.web/pregledPredpisa?id=NAVO59 World Health Organization, 2013. Health 2020: A European was comparable to another study. A 2018 study that focused on policy framework supporting action across government and Ramšak Pajk J., Ljubič A., (Eds.), 2016. Priporočila society for health and well-being. Copenhagen. obravnave pacientov v patronažnem varstvu za diplomirane Available at: medicinske sestre. Ljubljana: Zbornica zdravstvene in http://www.euro.who.int/ data/assets/pdf_file/0006/199536/ Health2020-Short.pdf?ua=1 84 Navodilo za izvajanje, beleženje in obračunavanje storitev v babiške nege Slovenije - Zveza strokovnih društev Burnout in Family Medicine Trainees During Pandemic patronažnem varstvu. Ljubljana 2021: Nacionalni inštitut za medicinskih sester, babic in zdravstvenih tehnikov Slovenije, javnozdravje. Retrieved from: https://nijz.si/sistem- Sekcija medicinskih sester in zdravstvenih tehnikov v zdravstvenega-varstva/patronazno-varstvo/navodilo-za- patronažni dejavnosti. Jerca Kranjc, dr.med., prof. dr. Polona Selič-Zupančič, univ. dipl. psih., izvajanje-belezenje-in-obracunavanje-storitev-v- ZD Ilirska Bistrica, Katedra za družinsko medicine MF UL, Katedra za psihologijo, MF UM patronaznem-varstvu/ Šušteršič, O., Horvat, M., Cibic, D., Peternelj, A. & Brložnik, jerca.kranjc@gmail.com M., 2006. Patronažno varstvo in patronažna zdravstvena Planirano število timov, Retrieved from: nega: nadgradnja in prilagajanje novim izzivom. Obzornik zdravstvene nege, 40(4), pp. 245–252. Abstract to increased workload, but was most likely related to inadequate https://partner.zzzs.si/wps/portal/portali/aizv/zdravstvene_sto Available at: Background protective equipment (p=0.020), fear of becoming infected ritve/podatki_o_dostopnosti_do_zdravstvenih_storitev/planir http:/ www.obzornikzdravstvenenege.si/2006.40.4.247 During the pandemic, burnout was shown worldwide to be (p=0.005), fear of transmitting infections to family members ano_stevilo_timov associated primarily with increased workload, inadequate (p=0.033) and parenthood (p=0.027). Zakon o dolgotrajni oskrbi /ZDOsk/ (2023). Uradni list RS, protective equipment, fear of infection and transmission of Factors associated with non-burnout were not having been Podatki o obveznem zdravstvenem zavarovanju št. 1/2023 (za št.84 (2. 8. 2023). Retrieved from: https://www.uradni-infection to others. The aim of the study was to determine the vaccinated (p=0.005) and not having children (p=0.026); further obdobje januar – december 2022) list.si/1/objava.jsp?sop=2021-01-3898 prevalence of the individual burnout dimensions, i.e. emotional research is advisable to assess and interpret these characteristics. Retrieved from: exhaustion (EE), depersonalisation (D) and low personal https://www.zzzs.si/?id=126&detail=B6B2EDB6AA2FE0A4 Zakon o zdravstvenem varstvu in zdravstvenem zavarovanju accomplishment (PA), as well as the overall prevalence of burnout Conclusions C12589750038F0F7 /ZZVZZ/ (2006). Uradni list RS, št. 72 (23. 6. 2006). (MBITOT) in family medicine trainees and to identify factors The prevalence of burnout among family medicine trainees was associated with burnout. In addition, the study aimed to compare higher during the pandemic than in 2012. Given the factors Retrieved from: Podatki o obveznem zdravstvenem zavarovanju št. 1/2022 (za burnout prevalence during the pandemic with another Slovenian associated with higher burnout scores, it is reasonable to assume http:/ pisrs.si/Pis.web/pregledPredpisa?id=ZAKO213 obdobje januar – december 2021) study where burnout prevalence among family medicine trainees that pandemic-related anxiety and systemic unpreparedness acted Retrieved from: was 18.3%, EE 45.9%, D 43.1% and PA 45.9%. as additional burnout factors. https:/ www.zzzs.si/?id=126&detail=722C8E0042FD79E3C1 Zakon o zdravstveni dejavnosti /ZZDej/ (2005). Uradni list 25880C002D9BC2 RS, št. 23 (26. 1. 2005). Methods Index terms: Burnout, family medicine trainees, emotional Retrieved from: https://www.uradni- The study was quantitative and cross-sectional. Data were exhaustion, depersonalisation, personal accomplishment Podatki o obveznem zdravstvenem zavarovanju št. 1/2021 (za list.si/1/objava.jsp?sop=2006-01-3075 collected using an anonymous online questionnaire sent to the e- obdobje januar - december 2020) mail addresses of 230 family medicine trainees who were I. INTRODUCTION Retrieved Zdravstveni statistični letopis Slovenije 2019 (pp. 5-2-20) registered on the list of family medicine trainees at the Medical from:https:/ www.zzzs.si/?id=126&detail=EEA740FAA9B82 Retrieved from: https://nijz.si/publikacije/zdravstveni- Chamber of Slovenia at the time of the study, between 19.4. and Burnout is known as a psychological syndrome described by 916C12586950027607C statisticni-letopis-2019/ 15.7.2021. The questionnaire contained socio-demographic data, three components: emotional exhaustion (EE), depersonalisation questions on workload, protective equipment, fear of infection (D) and reduced personal accomplishment (PA), which occur as a Podatki o obveznem zdravstvenem zavarovanju št. 1/2020 (za Zdravstveni statistični letopis Slovenije 2020 (pp. 5-2-16) transmission and the Maslach Burnout Questionnaire (MBI). Data sustained response to chronic stressors at work [1]. It usually obdobje januar - december 2019) Retrieved from: https://nijz.si/publikacije/zdravstveni- were statistically analysed. using bivariate tests and multivariable occurs after at least one year in a particular position, as stressors Retrieved statisticni-letopis-2020/ regression modelling. then begin to accumulate, leading to cynicism and a decline in the from:https:/ www.zzzs.si/?id=126&detail=A75EFD124C28F individual's effectiveness [1-3]. 0F5C125852D003173B8 Zdravstveni statistični letopis Slovenije 2021 (pp. 5-2-16) Results Retrieved from: https://nijz.si/publikacije/zdravstveni- The 102 participants (44.5% response rate) were 30.5 ± 2.5 years It is more common in age groups over 30 or 40, in single men Podatki o obveznem zdravstvenem zavarovanju št. 1/2019 (za statisticni-letopis-2021/ old and 81.4% were women. The mean duration of specialisation and in people with higher levels of education [1]. It occurs more obdobje januar - december 2018) was 3.9 ± 2.0 years. Most of the participants were married or in a often in people who have difficulty adapting to change, who trust Retrieved Zupančič, V., Ljubič, A., Milavec Kapun, M. & Štemberger partnership (79.4%), more than half of them had children (53.9%) others more than themselves, who have lower self-esteem and who from:https:/ www.zzzs.si/?id=126&detail=B89B12B5BB33C Kolnik, T., 2018. Raziskovanje na področju patronažne and 54.9% worked in cities. Half of them (52.9%) examined an tend to deal passively with stressful events [1,4], or in people who 665C12583BE0030FADA zdravstvene nege v Sloveniji v obdobju od 2007 do 2016: average of 40-60 patients per day and 27.5% examined 60-80 are overly committed to their work and want to achieve more than pregled literature. Obzornik zdravstvene nege, 52(4), pp. patients per day. Most (79.2%) worked in COVID-19 clinics and their colleagues, for example [2]. Podatki o obveznem zdravstvenem zavarovanju št. 1/2018 (za 264−281. Retrieved from: were vaccinated (76.5%); one third (35.3%) worked there up to 5 obdobje januar - december 2017) https:/ doi.org/10.14528/snr.2018.52.4.211 Burnout is associated with suboptimal patient care and an hours per week and 15.7% worked more than 10 hours per week. Retrieved from: increased risk of medical errors. Doctors experienced lower The overall prevalence of burnout (MBITOT) was 48.6 %. The https:/ www.zzzs.si/?id=126&detail=D70E0EEA6111389AC Železnik, D., Horvat, M., Panikvar Žlahtič, K., Filej, B. in productivity, lower job satisfaction, strained relationships with highest prevalence was 50.0% for EE (p=0.843), 51.0% for D 1258257003A3B70 Vidmar, I. 2011. Aktivnosti zdravstvene nege v patronažnem colleagues and an increased likelihood of leaving their jobs. The (p=0.427), 70.6% for PA (p < 0.001) and 37.3% for all three varstvu. Ljubljana: Zbornica zdravstvene in babiške nege risk of alcohol or drug abuse and suicidal tendencies also increased combined (p=0.001), which could be attributed to pandemic- Pravilnik za izvajanje preventivnega zdravstvenega varstva Slovenije Zveza društev medicinskih sester, babic in [5-7]. related conditions. Only 21.6% of trainees were not burnt out in na primarni ravni. (2023). Uradni list RS, št. 93 (31.8.2023). zdravstvenih tehnikov Slovenije. any dimension – less than in 2012 (29.4%), but the difference Retrieved from: In the Slovenian context, burnout in family medicine trainees proved not to be significant (p=0.193). Bivariate, it was not related http://www.pisrs.si/Pis.web/pregledPredpisa?id=NAVO59 World Health Organization, 2013. Health 2020: A European was comparable to another study. A 2018 study that focused on policy framework supporting action across government and Ramšak Pajk J., Ljubič A., (Eds.), 2016. Priporočila society for health and well-being. Copenhagen. obravnave pacientov v patronažnem varstvu za diplomirane Available at: medicinske sestre. Ljubljana: Zbornica zdravstvene in http://www.euro.who.int/ data/assets/pdf_file/0006/199536/ Health2020-Short.pdf?ua=1 85 burnout and empathy in family medicine trainees and specialists The study was a quantitative study of a cross-sectional nature. showed an even lower percentage of individuals who were not Data were collected using an anonymous online questionnaire sent TABLE II. BIVARIATE RELATIONSHIP BETWEEN OBSERVED FACTORS AND BURNOUT MBITOT affected by burnout than the 2012 reference study [8]. Burnout to the email addresses of family medicine trainees. 230 active All MBI rates were higher among those with longer service time, a greater trainees who had worked during the pandemic were invited to TOT p n=102 Low Medium High number of patients per day, doctors in rural areas and those with participate. Data collection took place from 19 April 2021 to 15 (%) n (%) n (%) n (%) chronic diseases [9]. July 2021. Gender 0.600* Before the pandemic, burnout among residents was known to The questionnaire consisted of questions on socio-demographic Male 19 (18.6) 5 (26.3) 7 (18.4) 7 (15.6) be related to the burden of responsibility [10,11]. lack of sleep, data, questions on work and workload, adequacy of protective Female 83 (81.4) 14 (73.7) 31 (81.6) 38 (84.4) lower salaries [10], insomnia, working more than 60 hours per equipment and fear of transmission of infection, and the Maslach Residency in family medicine (in week, poor access to supervising specialists and inadequate Burnout Inventory (MBI) [3] – Slovenian version. years) 3.9 ± 2.0 3.5 ± 1.8 3.6 ± 2.0 4.4 ± 2.1 0.119# collegial support [12]. Marital status 0.215* Statistical analysis was conducted using IBM SPSS 28 for Single 21 (20.6) 6 (31.6) 9 (23.7) 6 (13.3) During the COVID-19 pandemic, work-related stress increased. Microsoft Windows (IBM Corp., Armonk, NY). Results of Married/partnership 81 (79.4) 13 (68.4) 29 (76.3) 39 (86.7) Stress increased due to inadequate protective equipment, fear of categorical variables were presented as frequency and percentage, Having children 0.027* infection, transmission to the home environment and patients [13- whereas continuous variables were presented as mean ± standard Yes 55 (53.9) 8 (42.1) 16 (42.1) 31 (68.9) 16], workers had to make difficult decisions (who to treat) and had deviation. Bivariate statistical methods included chi-square test No 47 (46.1) 11 (57.9) 22 (57.9) 14 (31.1) less time for themselves or their families [15,17]. and one-way analysis of variance. The influence of independent Work location 0.745* variables on overall burnout was conducted using ordinal logistic Town 56 (54.9) 11 (57.9) 19 (50.0) 26 (57.8) Residents exposed to SARS-CoV-2 patients had a higher regression. A significance level of p < 0.05 determined the In rural area 46 (45.1) 8 (42.1) 19 (50.0) 19 (42.2) prevalence of stress compared to those who were not exposed, and threshold for statistical significance. Inadequate protective equipment 2.5±1.2 2.0±1.2 2.5±1.0 2.8±1.2 0.050# women were more prone to depression than men, while unmarried Fear of transmitting infection to family individuals were more prone to depression [18]. On the other hand, III. RESULTS members 3.8±1.0 3.3±1.4 3.8±0.8 4.0±1.0 0.033# the data show that burnout was higher in regular departments due to insufficient education about protective equipment [19]. There The survey was completed by a total of 102 of the invited Fear of getting infected 3.0±1.2 2.2±1.1 3.3±1.0 3.1±1.3 0.005# was also a higher risk of developing depression, anxiety and (response rate 44.5%) of family medicine trainees. How many times per month did you 0.535* insomnia [20]. work in the emergency department? The mean scores for burnout according to the MBI [4] scales were I did not perform shifts 17 (16.7) 4 (21.1) 7 (18.4) 6 (13.3) as follows: EE: 26.5 ± 10.6; D: 10.8 ± 4.6; and PA: 29.1 ± 6.5. The II. MATERIAL AND METHODS results in Table 1 show that 45 (48.6%) respondents reported high 1-2 times per month 40 (39.2) 4 (21.1) 15 (39.5) 21 (46.7) 3 times per month 26 (25.5) 6 (31.6) 11 (28.9) 9 (20.0) The aim of this study was to investigate the prevalence of levels of MBITOT. Regarding the individual dimensions, 51 4 times per month or more 19 (18.6) 5 (28.9) 5 (13.2) 9 (20.0) burnout among internal medicine residents during the COVID-19 (50.0%) reported high EE, 52 (51.0%) reported high D and 72 Average number of patients per day in 0.112* pandemic (from March 2020 to the completion of the survey on 15 (70.6%) reported low PA. The prevalence of a high level of your clinic? July 2021) and to identify associated factors. It was hypothesised burnout in all three dimensions of the MBI was present in 37.3% up to 40 daily 20 (19.6) 5 (26.3) 8 (21.1) 7 (15.6) that the EE, D and PA prevalence of burnout and the overall of cases, while 21.6% did not report a high level of burnout in any 40-60 daily 54 (52.9) 8 (42.1) 25 (65.8) 21 (46.7) prevalence of burnout (MBI MBI dimension. Compared to the 2012 study [8], only PA and TOT) would be at least 5% higher than 60-80 daily 28 (27.5) 6 (31.6) 5 (13.2) 17 (37.8) those reported in a reference study of burnout in trainees [8]. In high burnout level were statistically significant in all dimensions How many hours per week did you addition, increased workload, inadequate protective equipment (p < 0.001 and p=0.001), EE (p=0.843), D (p=0.427), no high work in a COVID-19 clinic? 0.252* and fear of infection were expected to be associated with burnout. burnout level (p=0.193). I did not work in a COVID-19 clinic 21 (20.6) 6 (31.6) 4 (10.5) 11 (24.4) up to 5 hours per week 36 (35.3) 7 (36.8) 11 (28.9) 18 (40.0) between 5 and 10 hours per week 29 (28.4) 4 (21.1) 15 (39.5) 10 (22.2) TABLE I. PREVALENCE OF EE, D AND PA (N=102) more than 10 hours per week 16 (15.7) 2 (10.5) 8 (21.1) 6 (13.3) EE D PA MBI Have you been vaccinated? 0.608* TOT n (%) n (%) n (%) n (%) yes 78 (76.5) 13 (68.4) 29 (76.3) 36 (80.0) High 51 (50.0) 52 (51.0) 8 (7.8) 45 (486) no 24 (23.5) 6 (31.6) 9 (23.7) 9 (20.0) Medium 26 (25.5) 39 (38.2) 22 (21.6) 38 (31.9) * chi-square test, # one-way analysis of variance Low 25 (24.5) 11 (10.8) 72 (70.6) 19 (19.5) Multivariable ordinal logistic regression results showed that reported lower burnout (OR=0.18; 95% CI=0.05-0.59; higher ratings of inadequate protective equipment increased the p=0.005). The independent variables explained 31.9 % of the The results of the bivariate analysis examining the relationship burnout was found to be statistically significantly associated with risk of burnout (OR=1.64; 95% CI=1.08-2.48; p=0.020). original variance of the dependent variable, overall burnout between the observed factors and overall burnout, as shown in parenting (p=0.027), fear of personal infection (p=0.005) and fear Doctors without children reported lower burnout (OR=0.27; (Nagelkerke R2=0.319). Table 2, revealed statistically significant associations. High of transmitting infection to family members (p=0.033). 95% CI=0.09-0.85; p=0.026), and unvaccinated doctors 86 burnout and empathy in family medicine trainees and specialists The study was a quantitative study of a cross-sectional nature. showed an even lower percentage of individuals who were not Data were collected using an anonymous online questionnaire sent TABLE II. BIVARIATE RELATIONSHIP BETWEEN OBSERVED FACTORS AND BURNOUT MBITOT affected by burnout than the 2012 reference study [8]. Burnout to the email addresses of family medicine trainees. 230 active All MBI rates were higher among those with longer service time, a greater trainees who had worked during the pandemic were invited to TOT p n=102 Low Medium High number of patients per day, doctors in rural areas and those with participate. Data collection took place from 19 April 2021 to 15 (%) n (%) n (%) n (%) chronic diseases [9]. July 2021. Gender 0.600* Before the pandemic, burnout among residents was known to The questionnaire consisted of questions on socio-demographic Male 19 (18.6) 5 (26.3) 7 (18.4) 7 (15.6) be related to the burden of responsibility [10,11]. lack of sleep, data, questions on work and workload, adequacy of protective Female 83 (81.4) 14 (73.7) 31 (81.6) 38 (84.4) lower salaries [10], insomnia, working more than 60 hours per equipment and fear of transmission of infection, and the Maslach Residency in family medicine (in week, poor access to supervising specialists and inadequate Burnout Inventory (MBI) [3] – Slovenian version. years) 3.9 ± 2.0 3.5 ± 1.8 3.6 ± 2.0 4.4 ± 2.1 0.119# collegial support [12]. Marital status 0.215* Statistical analysis was conducted using IBM SPSS 28 for Single 21 (20.6) 6 (31.6) 9 (23.7) 6 (13.3) During the COVID-19 pandemic, work-related stress increased. Microsoft Windows (IBM Corp., Armonk, NY). Results of Married/partnership 81 (79.4) 13 (68.4) 29 (76.3) 39 (86.7) Stress increased due to inadequate protective equipment, fear of categorical variables were presented as frequency and percentage, Having children 0.027* infection, transmission to the home environment and patients [13- whereas continuous variables were presented as mean ± standard Yes 55 (53.9) 8 (42.1) 16 (42.1) 31 (68.9) 16], workers had to make difficult decisions (who to treat) and had deviation. Bivariate statistical methods included chi-square test No 47 (46.1) 11 (57.9) 22 (57.9) 14 (31.1) less time for themselves or their families [15,17]. and one-way analysis of variance. The influence of independent Work location 0.745* variables on overall burnout was conducted using ordinal logistic Town 56 (54.9) 11 (57.9) 19 (50.0) 26 (57.8) Residents exposed to SARS-CoV-2 patients had a higher regression. A significance level of p < 0.05 determined the In rural area 46 (45.1) 8 (42.1) 19 (50.0) 19 (42.2) prevalence of stress compared to those who were not exposed, and threshold for statistical significance. Inadequate protective equipment 2.5±1.2 2.0±1.2 2.5±1.0 2.8±1.2 0.050# women were more prone to depression than men, while unmarried Fear of transmitting infection to family individuals were more prone to depression [18]. On the other hand, III. RESULTS members 3.8±1.0 3.3±1.4 3.8±0.8 4.0±1.0 0.033# the data show that burnout was higher in regular departments due to insufficient education about protective equipment [19]. There The survey was completed by a total of 102 of the invited Fear of getting infected 3.0±1.2 2.2±1.1 3.3±1.0 3.1±1.3 0.005# was also a higher risk of developing depression, anxiety and (response rate 44.5%) of family medicine trainees. How many times per month did you 0.535* insomnia [20]. work in the emergency department? The mean scores for burnout according to the MBI [4] scales were I did not perform shifts 17 (16.7) 4 (21.1) 7 (18.4) 6 (13.3) as follows: EE: 26.5 ± 10.6; D: 10.8 ± 4.6; and PA: 29.1 ± 6.5. The II. MATERIAL AND METHODS results in Table 1 show that 45 (48.6%) respondents reported high 1-2 times per month 40 (39.2) 4 (21.1) 15 (39.5) 21 (46.7) 3 times per month 26 (25.5) 6 (31.6) 11 (28.9) 9 (20.0) The aim of this study was to investigate the prevalence of levels of MBITOT. Regarding the individual dimensions, 51 4 times per month or more 19 (18.6) 5 (28.9) 5 (13.2) 9 (20.0) burnout among internal medicine residents during the COVID-19 (50.0%) reported high EE, 52 (51.0%) reported high D and 72 Average number of patients per day in 0.112* pandemic (from March 2020 to the completion of the survey on 15 (70.6%) reported low PA. The prevalence of a high level of your clinic? July 2021) and to identify associated factors. It was hypothesised burnout in all three dimensions of the MBI was present in 37.3% up to 40 daily 20 (19.6) 5 (26.3) 8 (21.1) 7 (15.6) that the EE, D and PA prevalence of burnout and the overall of cases, while 21.6% did not report a high level of burnout in any 40-60 daily 54 (52.9) 8 (42.1) 25 (65.8) 21 (46.7) prevalence of burnout (MBI MBI dimension. Compared to the 2012 study [8], only PA and TOT) would be at least 5% higher than 60-80 daily 28 (27.5) 6 (31.6) 5 (13.2) 17 (37.8) those reported in a reference study of burnout in trainees [8]. In high burnout level were statistically significant in all dimensions How many hours per week did you addition, increased workload, inadequate protective equipment (p < 0.001 and p=0.001), EE (p=0.843), D (p=0.427), no high work in a COVID-19 clinic? 0.252* and fear of infection were expected to be associated with burnout. burnout level (p=0.193). I did not work in a COVID-19 clinic 21 (20.6) 6 (31.6) 4 (10.5) 11 (24.4) up to 5 hours per week 36 (35.3) 7 (36.8) 11 (28.9) 18 (40.0) between 5 and 10 hours per week 29 (28.4) 4 (21.1) 15 (39.5) 10 (22.2) TABLE I. PREVALENCE OF EE, D AND PA (N=102) more than 10 hours per week 16 (15.7) 2 (10.5) 8 (21.1) 6 (13.3) EE D PA MBI Have you been vaccinated? 0.608* TOT n (%) n (%) n (%) n (%) yes 78 (76.5) 13 (68.4) 29 (76.3) 36 (80.0) High 51 (50.0) 52 (51.0) 8 (7.8) 45 (486) no 24 (23.5) 6 (31.6) 9 (23.7) 9 (20.0) Medium 26 (25.5) 39 (38.2) 22 (21.6) 38 (31.9) * chi-square test, # one-way analysis of variance Low 25 (24.5) 11 (10.8) 72 (70.6) 19 (19.5) Multivariable ordinal logistic regression results showed that reported lower burnout (OR=0.18; 95% CI=0.05-0.59; higher ratings of inadequate protective equipment increased the p=0.005). The independent variables explained 31.9 % of the The results of the bivariate analysis examining the relationship burnout was found to be statistically significantly associated with risk of burnout (OR=1.64; 95% CI=1.08-2.48; p=0.020). original variance of the dependent variable, overall burnout between the observed factors and overall burnout, as shown in parenting (p=0.027), fear of personal infection (p=0.005) and fear Doctors without children reported lower burnout (OR=0.27; (Nagelkerke R2=0.319). Table 2, revealed statistically significant associations. High of transmitting infection to family members (p=0.033). 95% CI=0.09-0.85; p=0.026), and unvaccinated doctors 87 IV. DISCUSSION in 2012 [12]. The workload has also changed in terms of the respondent fatigue. The low response rate might have [11] Davis C, Krishnasamy M, Morgan Z, et al. Academic Achievement, number of shifts per month. More trainees were now involved influenced the final results, especially when comparing the Professionalism, and Burnout in Family Medicine Residents. Family The prevalence of burnout (MBI Medicine. 2021;53(6):423-32. TOT) in the study was 48.6% in shifts in the emergency department (Table 2). More of them frequency of EE and D, which was higher but did not exceed and 37.6% in all three dimensions, respectively (Table 1). participated in shifts three times per month and fewer in shifts the predefined difference of 5% compared to the study by Selič [12] Geng H, Tan F, Deng Y, et al. High rate of burnout among residents four times per month (Table 2). However, unlike in the 2012 et al. [8]. Comparing these results with the 2012 study by Selič et al. under standardized residency training in a tertiary teaching hospital of study [11], a greater number of shifts was not associated with middle China: Results from a cross-sectional survey. Medicine there were 19.3% more people with burnout. There were also burnout. Increased workload (more patient visits and more With each new doctor experiencing burnout, the risk of sick (Baltimore). 2020;99(27): e20901. more people experiencing high levels of burnout in all three shifts) was not associated with burnout (Table 2), as suggested leave increases and consequently the workload is shifted to a dimensions, but statistically significant differences of 5% were by other global studies [1,4,8,10]. This could be due to youth smaller and smaller group of colleagues, which subsequently [13] Firew T, Sano ED, Lee JW, et al. Protecting the front line: a cross- only observed in the case of low PA. EE and D only slightly sectional survey analysis of the occupational factors contributing to (30.5 ± 2.5 years) and the initial enthusiasm of young doctors, increases the level of burnout [1,10]. Given the very high rate healthcare workers’ infection and psychological distress during the exceeded the predicted 5%. In addition, fewer respondents who have not been exposed to various stresses for so long and of burnout among GP trainees and the current state of the COVID-19 pandemic in the USA. BMJ open. 2020;10(10):e042752. reported no burnout compared to previous studies [8]. may be better able to compensate for them. In comparison, healthcare system, it is crucial to regulate conditions at the primary level to create a safer and healthier future for all – [14] de Wit K, Mercuri M, Wallner C, et al. Canadian emergency physician Compared to the pre-pandemic meta-analysis, which older and more experienced doctors were more vulnerable to workers and patients alike. psychological distress and burnout during the first 10 weeks of COVID- included trainees from different disciplines, 12.9 % more EE in the 2018 study [9]. On the other hand, almost half of the 19: A mixed‐methods study. Journal of the American College of people were affected by burnout [10]. Before the pandemic, the respondents in this study were affected by burnout, which is Emergency Physicians Open. 2020;1(5):1030-8 . V. ACKNOWLEDGMENT burnout rate among family medicine trainees in the United still a high percentage and can be related to Maslach's findings [15] Bradley M, Chahar P. Burnout of healthcare providers during COVID- States was 36.8 %, but this study only considered EE and D, that young people at the beginning of their career may be more We sincerely thank the statistician Alojz Tapajner for the 19. Cleveland Clinic journal of medicine. 2020. which makes a direct comparison with our results difficult, as a vulnerable to burnout due to lack of experience [1]. If such a statistical analysis. significant proportion of burnout was attributed to the low PA high percentage of burnout is already present in our studied [16] Shanafelt T, Ripp J, Trockel M. Understanding and addressing sources [11]. The only case with higher burnout rates before the group due to other reasons, it is reasonable to assume that the REFERENCES of anxiety among health care professionals during the COVID-19 pandemic was found in China, where at least 71.05 % were burnout percentage will be even higher in a few years due to pandemic. Jama. 2020;323(21):2133-4. affected by burnout [12]. In our study, the percentage was increased workload – it increases after passing the residency [1] Maslach C, Schaufeli WB, Leiter MP. Job burnout. Annual review of [17] Morgantini LA, Naha U, Wang H, et al. Factors contributing to closest to this in the low category PA (Table 1). Among the exam along with higher levels of responsibility [9], and given psychology. 2001;52(1):397-422. healthcare professional burnout during the COVID-19 pandemic: A studies conducted during the pandemic, 2.3 % fewer trainees of the current state of the country and projections for the future, rapid turnaround global survey. PloS one. 2020;15(9):e0238217. different disciplines suffered from burnout in the United States there will be fewer doctors per patient in the coming years, [2] Jan, Freudenberger HJ. Staff burn‐out. Journal of social issues. 1974;30(1):159-65. than in our study [18]. Compared to the Romanian studies, leading to an even higher workload for those who remain. [18] Kannampallil TG, Goss CW, Evanoff BA, et al. Exposure to COVID-19 fewer trainees suffered from burnout in our study, which could patients increases physician trainee stress and burnout. PloS one. Factors associated with burnout during the pandemic were [3] Maslach C, Jackson SE. The measurement of experienced burnout. 2020;15(8):e0237301. be due to better organisation of the health service [19]. inadequate protective equipment, fear of infection and fear of Journal of organizational behavior. 1981;2(2):99-113. [19] Dimitriu MC, Pantea-Stoian A, Smaranda AC, et al. Burnout syndrome Compared to the Slovenian burnout studies from 2012 and transmitting infection to family members (Table 2), which has [4] Wiederhold BK, Cipresso P, Pizzioli D, et al. Intervention for physician in Romanian medical residents in time of the COVID-19 pandemic. 2018, participants in this study had fewer children (Table 2). also been demonstrated in other studies [13-16]. Working in a burnout: a systematic review. Open Medicine. 2018;13(1):253-63. Medical hypotheses. 2020;144:109972. However, compared to previous studies, participants without COVID-19 clinic was not statistically associated with burnout children reported lower burnout rates, while participants with (Table 2) and is consistent with the Romanian study where [5] West CP, Dyrbye LN, Shanafelt TD. Physician burnout: contributors, [20] Lai J, Ma S, Wang Y, et al. Factors associated with mental health consequences and solutions. Journal of internal medicine. outcomes among health care workers exposed to coronavirus disease children reported higher burnout rates (Table 2) [8,9]. The burnout rates were lower in COVID-19 clinics compared to 2018;283(6):516-29. 2019. JAMA network open. 2020;3(3):e203976-. association that single people would experience more burnout regular departments. In the COVID-19 clinics, clear treatment [1] was also not statistically significant (Table 2). Women were pathways and protocols were quickly established for patients, [6] Stehman CR, Testo Z, Gershaw RS, et al. Burnout, drop out, suicide: [21] Nacionalni inštitut za javno zdravje, Cepljenje proti covidu-19 - za more numerous in the study and experienced more burnout whereas this was more difficult to achieve in regular physician loss in emergency medicine, part I. Western Journal of splošno javnost. (Cited 2022 Dec 4) Available from https://www.nijz.si/sl/cepljenje-covid. (Table 2), similar to a pre-pandemic study [11]. However, this departments and clinics, especially with COVID-19 positive Emergency Medicine. 2019;20(3):485-94. result was not statistically significant (Table 2). Statistically patient influx. COVID-19 Clinics also received more [7] Lacy BE, Chan JL. Physician burnout: the hidden health care crisis. significant differences in the highest burnout scores between appropriate equipment earlier and staff were more familiar with Clinical Gastroenterology and Hepatology. 2018;16(3):311-7. trainees from urban and rural areas were not found, in contrast the correct use of personal protective equipment [19]. to a 2018 study where EE higher scores were observed among The influence of vaccination has not been observed in other [8] Selič P, Ignjatovič TS, Ketiš ZK. Burnout among Slovenian family doctors from rural areas [9]. medicine trainees: a cross-sectional study. Slovenian Medical Journal. studies; in this study, non-vaccinated trainees reported lower 2012;81(3):218–24. One factor contributing to the higher burnout rate compared burnout. This could be due to the personal characteristics of the to the 2012 study could be the higher number of patients treated individuals. Those who took a clear and firm stance, in this case [9] Penšek L, Selič P. Empathy and burnout in Slovenian family medicine doctors: the first presentation of Jefferson scale of empathy results. daily. As many as 18 % of the respondents treated 60-80 against vaccination, may have been more decisive and Slovenian Journal of Public Health. 2018;57(3):155-65. patients per day (Table 2). This could be due to a difference in confident in their decisions. They may have been more counting "short visits", which may have already resulted in a protective, taking more time for themselves and therefore less [10] Rodrigues H, Cobucci R, Oliveira A, et al. Burnout syndrome among higher patient load per day in 2012 [11]. However, it is prone to burnout [1,4,8,10]. medical residents: A systematic review and meta-analysis. PloS one. noteworthy that the trend towards a higher daily patient load is 2018;13(11): e0206840. The results of this study should be interpreted with caution also observed in the interim study, where 9.2 % more due to the low response rate, which could already indicate respondents reported seeing more than 60 patients per day than burnout, saturation with work in the clinics or simply 88 IV. DISCUSSION in 2012 [12]. The workload has also changed in terms of the respondent fatigue. The low response rate might have [11] Davis C, Krishnasamy M, Morgan Z, et al. Academic Achievement, number of shifts per month. More trainees were now involved influenced the final results, especially when comparing the Professionalism, and Burnout in Family Medicine Residents. Family The prevalence of burnout (MBI Medicine. 2021;53(6):423-32. TOT) in the study was 48.6% in shifts in the emergency department (Table 2). More of them frequency of EE and D, which was higher but did not exceed and 37.6% in all three dimensions, respectively (Table 1). participated in shifts three times per month and fewer in shifts the predefined difference of 5% compared to the study by Selič [12] Geng H, Tan F, Deng Y, et al. High rate of burnout among residents four times per month (Table 2). However, unlike in the 2012 et al. [8]. Comparing these results with the 2012 study by Selič et al. under standardized residency training in a tertiary teaching hospital of study [11], a greater number of shifts was not associated with middle China: Results from a cross-sectional survey. Medicine there were 19.3% more people with burnout. There were also burnout. Increased workload (more patient visits and more With each new doctor experiencing burnout, the risk of sick (Baltimore). 2020;99(27): e20901. more people experiencing high levels of burnout in all three shifts) was not associated with burnout (Table 2), as suggested leave increases and consequently the workload is shifted to a dimensions, but statistically significant differences of 5% were by other global studies [1,4,8,10]. This could be due to youth smaller and smaller group of colleagues, which subsequently [13] Firew T, Sano ED, Lee JW, et al. Protecting the front line: a cross- only observed in the case of low PA. EE and D only slightly sectional survey analysis of the occupational factors contributing to (30.5 ± 2.5 years) and the initial enthusiasm of young doctors, increases the level of burnout [1,10]. Given the very high rate healthcare workers’ infection and psychological distress during the exceeded the predicted 5%. In addition, fewer respondents who have not been exposed to various stresses for so long and of burnout among GP trainees and the current state of the COVID-19 pandemic in the USA. BMJ open. 2020;10(10):e042752. reported no burnout compared to previous studies [8]. may be better able to compensate for them. In comparison, healthcare system, it is crucial to regulate conditions at the primary level to create a safer and healthier future for all – [14] de Wit K, Mercuri M, Wallner C, et al. Canadian emergency physician Compared to the pre-pandemic meta-analysis, which older and more experienced doctors were more vulnerable to psychological distress and burnout during the first 10 weeks of COVID- workers and patients alike. included trainees from different disciplines, 12.9 % more EE in the 2018 study [9]. On the other hand, almost half of the 19: A mixed‐methods study. Journal of the American College of people were affected by burnout [10]. Before the pandemic, the respondents in this study were affected by burnout, which is Emergency Physicians Open. 2020;1(5):1030-8 . V. ACKNOWLEDGMENT burnout rate among family medicine trainees in the United still a high percentage and can be related to Maslach's findings [15] Bradley M, Chahar P. Burnout of healthcare providers during COVID- States was 36.8 %, but this study only considered EE and D, that young people at the beginning of their career may be more We sincerely thank the statistician Alojz Tapajner for the 19. Cleveland Clinic journal of medicine. 2020. which makes a direct comparison with our results difficult, as a vulnerable to burnout due to lack of experience [1]. If such a statistical analysis. significant proportion of burnout was attributed to the low PA high percentage of burnout is already present in our studied [16] Shanafelt T, Ripp J, Trockel M. Understanding and addressing sources [11]. The only case with higher burnout rates before the group due to other reasons, it is reasonable to assume that the REFERENCES of anxiety among health care professionals during the COVID-19 pandemic was found in China, where at least 71.05 % were burnout percentage will be even higher in a few years due to pandemic. Jama. 2020;323(21):2133-4. affected by burnout [12]. In our study, the percentage was increased workload – it increases after passing the residency [1] Maslach C, Schaufeli WB, Leiter MP. Job burnout. Annual review of [17] Morgantini LA, Naha U, Wang H, et al. Factors contributing to closest to this in the low category PA (Table 1). Among the exam along with higher levels of responsibility [9], and given psychology. 2001;52(1):397-422. healthcare professional burnout during the COVID-19 pandemic: A studies conducted during the pandemic, 2.3 % fewer trainees of the current state of the country and projections for the future, rapid turnaround global survey. PloS one. 2020;15(9):e0238217. different disciplines suffered from burnout in the United States there will be fewer doctors per patient in the coming years, [2] Jan, Freudenberger HJ. Staff burn‐out. Journal of social issues. 1974;30(1):159-65. than in our study [18]. Compared to the Romanian studies, leading to an even higher workload for those who remain. [18] Kannampallil TG, Goss CW, Evanoff BA, et al. Exposure to COVID-19 fewer trainees suffered from burnout in our study, which could patients increases physician trainee stress and burnout. PloS one. Factors associated with burnout during the pandemic were [3] Maslach C, Jackson SE. The measurement of experienced burnout. 2020;15(8):e0237301. be due to better organisation of the health service [19]. inadequate protective equipment, fear of infection and fear of Journal of organizational behavior. 1981;2(2):99-113. [19] Dimitriu MC, Pantea-Stoian A, Smaranda AC, et al. Burnout syndrome Compared to the Slovenian burnout studies from 2012 and transmitting infection to family members (Table 2), which has [4] Wiederhold BK, Cipresso P, Pizzioli D, et al. Intervention for physician in Romanian medical residents in time of the COVID-19 pandemic. 2018, participants in this study had fewer children (Table 2). also been demonstrated in other studies [13-16]. Working in a burnout: a systematic review. Open Medicine. 2018;13(1):253-63. Medical hypotheses. 2020;144:109972. However, compared to previous studies, participants without COVID-19 clinic was not statistically associated with burnout children reported lower burnout rates, while participants with (Table 2) and is consistent with the Romanian study where [5] West CP, Dyrbye LN, Shanafelt TD. Physician burnout: contributors, [20] Lai J, Ma S, Wang Y, et al. Factors associated with mental health consequences and solutions. Journal of internal medicine. outcomes among health care workers exposed to coronavirus disease children reported higher burnout rates (Table 2) [8,9]. The burnout rates were lower in COVID-19 clinics compared to 2018;283(6):516-29. 2019. JAMA network open. 2020;3(3):e203976-. association that single people would experience more burnout regular departments. In the COVID-19 clinics, clear treatment [1] was also not statistically significant (Table 2). Women were pathways and protocols were quickly established for patients, [6] Stehman CR, Testo Z, Gershaw RS, et al. Burnout, drop out, suicide: [21] Nacionalni inštitut za javno zdravje, Cepljenje proti covidu-19 - za more numerous in the study and experienced more burnout whereas this was more difficult to achieve in regular physician loss in emergency medicine, part I. Western Journal of splošno javnost. (Cited 2022 Dec 4) Available from https://www.nijz.si/sl/cepljenje-covid. (Table 2), similar to a pre-pandemic study [11]. However, this departments and clinics, especially with COVID-19 positive Emergency Medicine. 2019;20(3):485-94. result was not statistically significant (Table 2). Statistically patient influx. COVID-19 Clinics also received more [7] Lacy BE, Chan JL. Physician burnout: the hidden health care crisis. significant differences in the highest burnout scores between appropriate equipment earlier and staff were more familiar with Clinical Gastroenterology and Hepatology. 2018;16(3):311-7. trainees from urban and rural areas were not found, in contrast the correct use of personal protective equipment [19]. to a 2018 study where EE higher scores were observed among The influence of vaccination has not been observed in other [8] Selič P, Ignjatovič TS, Ketiš ZK. Burnout among Slovenian family doctors from rural areas [9]. medicine trainees: a cross-sectional study. Slovenian Medical Journal. studies; in this study, non-vaccinated trainees reported lower 2012;81(3):218–24. One factor contributing to the higher burnout rate compared burnout. This could be due to the personal characteristics of the to the 2012 study could be the higher number of patients treated individuals. Those who took a clear and firm stance, in this case [9] Penšek L, Selič P. Empathy and burnout in Slovenian family medicine doctors: the first presentation of Jefferson scale of empathy results. daily. As many as 18 % of the respondents treated 60-80 against vaccination, may have been more decisive and Slovenian Journal of Public Health. 2018;57(3):155-65. patients per day (Table 2). This could be due to a difference in confident in their decisions. They may have been more counting "short visits", which may have already resulted in a protective, taking more time for themselves and therefore less [10] Rodrigues H, Cobucci R, Oliveira A, et al. Burnout syndrome among higher patient load per day in 2012 [11]. However, it is prone to burnout [1,4,8,10]. medical residents: A systematic review and meta-analysis. PloS one. noteworthy that the trend towards a higher daily patient load is 2018;13(11): e0206840. The results of this study should be interpreted with caution also observed in the interim study, where 9.2 % more due to the low response rate, which could already indicate respondents reported seeing more than 60 patients per day than burnout, saturation with work in the clinics or simply 89 Portal for patients – new way of electronic II. MATERIAL AND METHODS 1st level - Unfinished - Type of study: This was a quantitative study. primary school 3 4 communication 2nd level - Finished - Participants: We conducted an online survey, that was primary school 16 1.9 accessible to all patients of Community Health Center of Ljubljana, that have already registered and have been using the 3rd level – Lower Secondary education 16 1.9 tool »Portal for patients«. The survey was conducted between March and May 2023. We received 837 fully completed (2-year program) questionnaires by patients. Gea Novak, MD1¹, Prof. Dr. Zalika Klemenc Ketiš, MD² 4th level – Upper Community Health Center Ljubljana¹ ², Department of Family Medicine, Faculty of Medicine, University of Ljubljana² - Data collection: The survey was anonymous. Secondary education 75 9 (3-year program) gea.novak@zd-lj.si¹, zalika.klemenc-ketis@zd-lj.si² The first 3 questions were about age, gender and level of education. 5th level – High school (4-year program) 212 25.3 Then there were 13 questions regarding user satisfaction with »Portal for patients«. This set of questions was composed in a way 6th level 1 – Post- Abstract — Background: In Slovenia, like in many other countries, I. INTRODUCTION that the participants had to answer with one of the options: secondary non-tertiary 92 11 family medicine specialists/general practitioners (GPs) are usually education the first contact of a patient with a doctor. GPs help with numerous Good organization of work in health care is a prerequisite for 1 – I do not agree at all. problems that patients have and represent a connection by referrals patients to receive adequate health care. Besides that, patients 6th level 2 – Short-cycle with specialists of secondary and/or tertiary level. Because they appreciate good accessibility to a doctor, involving patients in 2 – I do not agree. tertiary education 106 12.7 conduct many consultations daily, also by increasing demands (aging treatment and sufficient time for consultation with a doctor [1]. 3 – I cannot define myself. population, insufficient number of doctors in Slovenia), it is 7th level – Bachelor's or Communication between doctors and patients is the central sometimes hard for a patient to come into a contact with his/her equivalent level 237 28.3 driving force in formation of a relationship between the doctor and 4 – I agree. family medicine doctor. Also, e-mail communication is not in line with the patient, and the relationship itself is key to ensuring quality 8th level – Master's or GDPR. To improve and provide a safer communication option, a new 5 – I totally agree. online tool has been implemented in Community Health Center treatment [2]. equivalent level 80 9.6 Ljubljana, called »Portal for patients«. The purpose of this study was The last question was open type. We asked the participants if Performance and quality of work in a family medicine office to assess user satisfaction with it. they want to share something else with us. does not depend only on doctor’s professional knowledge and Cronbach’s Alpha of the questionnaire was 0.915. Mean of the sum skills. The following organizational elements are also important: - Statistical analysis: score was 58.9 ± 22.5 points. Methods: Quantitative study was conducted between March and May Participants agreed the most with the item “For using the Portal I 2023 using an anonymous internet survey about Portal for patients location, size, equipment and arrangement of the clinic, quality We calculated the sum score from all items. We used a Baker do not need help, for example of a family member or a friend.”, and that was put on the Portal, allowing anyone using the Portal to access and flawlessness of medical equipment, coordinated and well- & Hearnshaw equation [(∑items 1±i) × 100/(5 × i)] × 1.25±25) it. Altogether 837 patients successfully completed the survey. Between organized teamwork. Effective internal organization of health the least with the item “The people who care for me and affect me, to range the scale's score from 0 to 100 [4]. ∑items 1±i represents them, there was 325 men and 505 women, with mean age of 49,8 years. centers and clinics have been proven to improve the quality of want me to use the Portal” (Table 2). medical care [3]. the sum of the scores of i items; 5 represents the maximum score Results: T-analysis of answers showed that more than a half of users points of each item; and i represents the number of items. The Table 2: Average response to individual question are satisfied with the program, do not have technical issues, and General practitioners (family medicine specialists) in Slovenia other numbers are needed for mathematical purposes in order to found it easy to learn to use the program. In average they do not think conduct many consultations daily. Aging population and range the scale's score from 0 to 100. Mean Standard that the responsiveness or communication with the family medicine insufficient number of doctors in the country represent a challenge. Deviation office has improved with the introduction of the Portal, nor that the Therefore, patients sometimes find it hard to encounter their family For each factor, we also calculated the Cronbach's alpha. 1. The people who care for me use of the Portal contributes to the quality of medical treatment in medicine doctor. For bivariate analyses, we used independent t-test and Pearsin and affect me, want me to use the 2.88 1.31 primary care. Computer software is useful to family medicine offices in all correlations. Portal. Conclusions: Portal for patients is a new tool of electronic segments of the organization of patient care (ordering a 2. My nurse and family medicine communication between family medicine offices and their users consultation or examination, prescribing electronic recipes and doctor encouraged me to use the 3.14 1.38 (patients). It is generally well received among patients but according referrals, managing the patient’s sick leave and other III. RESULTS Portal. to our survey, people believe that it needs some technical administration activities and documentation). But e-mail improvements. It can also only replace e-mail, while patients want to communication is not in line with GDPR (General Data Protection There were 837 respondents in a sample, out of which 505 (60.8%) 3. Learning to use the Portal was still be able to communicate with family medicine office by phone, Regulation). were women (Table 1). The mean age of the sample was 49.8 ± easy for me. 3.62 1.28 regular mail and in person. 15.0 years. Because of all stated above, a new online tool has been Table 1: Gender and level of education 4. I have no technical problems Index Terms – communication, general practitioners, family medicine implemented in Community Health Center Ljubljana, called using the Portal. 3.52 1.32 office, patient, Portal for patients. »Portal for patients«. The purpose of this study was to present this Frequency Valid percent new technology and assess user satisfaction with it. 5. I know how to access the Men 325 39.2 Portal. 4.12 0.93 Women 505 60.8 6. Using the Portal has become a habit for me. 3.51 1.31 90 Portal for patients – new way of electronic II. MATERIAL AND METHODS 1st level - Unfinished - Type of study: This was a quantitative study. primary school 3 4 communication 2nd level - Finished - Participants: We conducted an online survey, that was primary school 16 1.9 accessible to all patients of Community Health Center of Ljubljana, that have already registered and have been using the 3rd level – Lower Secondary education 16 1.9 tool »Portal for patients«. The survey was conducted between March and May 2023. We received 837 fully completed (2-year program) questionnaires by patients. Gea Novak, MD1¹, Prof. Dr. Zalika Klemenc Ketiš, MD² 4th level – Upper Community Health Center Ljubljana¹ ², Department of Family Medicine, Faculty of Medicine, University of Ljubljana² - Data collection: The survey was anonymous. Secondary education 75 9 (3-year program) gea.novak@zd-lj.si¹, zalika.klemenc-ketis@zd-lj.si² The first 3 questions were about age, gender and level of education. 5th level – High school (4-year program) 212 25.3 Then there were 13 questions regarding user satisfaction with »Portal for patients«. This set of questions was composed in a way 6th level 1 – Post- Abstract — Background: In Slovenia, like in many other countries, I. INTRODUCTION that the participants had to answer with one of the options: secondary non-tertiary 92 11 family medicine specialists/general practitioners (GPs) are usually education the first contact of a patient with a doctor. GPs help with numerous Good organization of work in health care is a prerequisite for 1 – I do not agree at all. problems that patients have and represent a connection by referrals patients to receive adequate health care. Besides that, patients 6th level 2 – Short-cycle with specialists of secondary and/or tertiary level. Because they appreciate good accessibility to a doctor, involving patients in 2 – I do not agree. tertiary education 106 12.7 conduct many consultations daily, also by increasing demands (aging treatment and sufficient time for consultation with a doctor [1]. 3 – I cannot define myself. population, insufficient number of doctors in Slovenia), it is 7th level – Bachelor's or Communication between doctors and patients is the central sometimes hard for a patient to come into a contact with his/her equivalent level 237 28.3 driving force in formation of a relationship between the doctor and 4 – I agree. family medicine doctor. Also, e-mail communication is not in line with the patient, and the relationship itself is key to ensuring quality 8th level – Master's or GDPR. To improve and provide a safer communication option, a new 5 – I totally agree. online tool has been implemented in Community Health Center treatment [2]. equivalent level 80 9.6 Ljubljana, called »Portal for patients«. The purpose of this study was The last question was open type. We asked the participants if Performance and quality of work in a family medicine office to assess user satisfaction with it. they want to share something else with us. does not depend only on doctor’s professional knowledge and Cronbach’s Alpha of the questionnaire was 0.915. Mean of the sum skills. The following organizational elements are also important: - Statistical analysis: score was 58.9 ± 22.5 points. Methods: Quantitative study was conducted between March and May Participants agreed the most with the item “For using the Portal I 2023 using an anonymous internet survey about Portal for patients location, size, equipment and arrangement of the clinic, quality We calculated the sum score from all items. We used a Baker do not need help, for example of a family member or a friend.”, and that was put on the Portal, allowing anyone using the Portal to access and flawlessness of medical equipment, coordinated and well- & Hearnshaw equation [(∑items 1±i) × 100/(5 × i)] × 1.25±25) it. Altogether 837 patients successfully completed the survey. Between organized teamwork. Effective internal organization of health the least with the item “The people who care for me and affect me, to range the scale's score from 0 to 100 [4]. ∑items 1±i represents them, there was 325 men and 505 women, with mean age of 49,8 years. centers and clinics have been proven to improve the quality of want me to use the Portal” (Table 2). medical care [3]. the sum of the scores of i items; 5 represents the maximum score Results: T-analysis of answers showed that more than a half of users points of each item; and i represents the number of items. The Table 2: Average response to individual question are satisfied with the program, do not have technical issues, and General practitioners (family medicine specialists) in Slovenia other numbers are needed for mathematical purposes in order to found it easy to learn to use the program. In average they do not think conduct many consultations daily. Aging population and range the scale's score from 0 to 100. Mean Standard that the responsiveness or communication with the family medicine insufficient number of doctors in the country represent a challenge. Deviation office has improved with the introduction of the Portal, nor that the Therefore, patients sometimes find it hard to encounter their family For each factor, we also calculated the Cronbach's alpha. 1. The people who care for me use of the Portal contributes to the quality of medical treatment in medicine doctor. For bivariate analyses, we used independent t-test and Pearsin and affect me, want me to use the 2.88 1.31 primary care. Computer software is useful to family medicine offices in all correlations. Portal. Conclusions: Portal for patients is a new tool of electronic segments of the organization of patient care (ordering a 2. My nurse and family medicine communication between family medicine offices and their users consultation or examination, prescribing electronic recipes and doctor encouraged me to use the 3.14 1.38 (patients). It is generally well received among patients but according referrals, managing the patient’s sick leave and other III. RESULTS Portal. to our survey, people believe that it needs some technical administration activities and documentation). But e-mail improvements. It can also only replace e-mail, while patients want to communication is not in line with GDPR (General Data Protection There were 837 respondents in a sample, out of which 505 (60.8%) 3. Learning to use the Portal was still be able to communicate with family medicine office by phone, Regulation). were women (Table 1). The mean age of the sample was 49.8 ± easy for me. 3.62 1.28 regular mail and in person. 15.0 years. Because of all stated above, a new online tool has been Table 1: Gender and level of education 4. I have no technical problems Index Terms – communication, general practitioners, family medicine implemented in Community Health Center Ljubljana, called using the Portal. 3.52 1.32 office, patient, Portal for patients. »Portal for patients«. The purpose of this study was to present this Frequency Valid percent new technology and assess user satisfaction with it. 5. I know how to access the Men 325 39.2 Portal. 4.12 0.93 Women 505 60.8 6. Using the Portal has become a habit for me. 3.51 1.31 91 7. For contacting family medicine contributes to Responsiveness office, I like to use the Portal the quality of and finished high Responsiveness finished most (rather than the phone, e- 3.14 1.47 medical communication school: 3.4 ± and Bachelor's or mail). treatment. with family 1.2 vs. other: 3.3 0.001 communication Master's -2.8 0.006 3.1 ± 1.3 with family level: 2.7 ± 1.3 8. For using the Portal I do not I would medicine office have improved. medicine office vs. other: 3.2 ± need help, for example of a family 4.15 1.16 recommend have improved. 1.2 member or a friend. using the Portal 3.3 ± 1.3 vs. 3.1 ± 1.3 2.4 0.02 I am satisfied finished high school: 3.4 ± 9. Responsiveness and to my friends with Portal for 2.5 0.01 finished communication with family 3.15 1.26 and family. patients. 1.2 vs. other: 3.1 ± 1.3 Bachelor's or medicine office have improved. Using the Portal I am satisfied with Portal for Master's -3.5 < 0.001 10. I am satisfied with Portal for allows me to be 3.2 ± 1.2 vs. I have a feeling patients. level: 2.7 ± 1.3 patients. 3.19 1.29 more involved that using the vs. other: 3.2 ± in my own 3.0 ± 1.3 2.9 0.003 Portal finished high school: 3.1 ± 1.3 11. I have a feeling that using the medical care. contributes to 1.2 vs. other: 2.1 0.04 Portal contributes to quality of 2.95 1.24 quality of 2.9 ± 1.3 medical treatment. medical I have a feeling finished treatment. that using the 12. I would recommend using the Portal Bachelor's or Portal to my friends and family. 3.18 1.34 I would contributes to Master's -3.2 0.002 recommend finished high quality of level: 2.5 ± 1.3 13. Using the Portal allows me to Table 4: Differences regarding education using the Portal school: 3.3 ± 2.0 0.05 medical vs. other: 3.0 ± be more involved in my own 3.07 1.26 to my friends 1.3 vs. other: treatment. 1.2 medical care. Item Mean t-test p-value and family. 3.1 ± 1.3 For using the Portal I do not finished I would finished need help, for primary Using the Portal Bachelor's or finished high recommend example of a school: 2.5 ± -4.8 < 0.001 allows me to be Master's Table 3: Differences regarding gender school: 3.3 ± using the Portal -2.3 0.02 family member 1.5 vs. other: more involved level: 2.8 ± 1.4 1.2 vs. other: 3.9 < 0.001 to my friends or a friend. 4.2 ± 1.1 in my own vs. other: 3.2 ± Item Mean (male 3.0 ± 1.3 and family. vs. female) t-test p-value medical care. 1.3 The people who finished The people who care for me and secondary care for me and affect me, want education: 3.1 2.2 0.03 Using the Portal finished affect me, want 3.0 ± 1.3 vs. me to use the ± 1.2 vs. other: finished allows me to be Bachelor's or me to use the 2.8 ± 1.3 2.1 0.04 Portal. 2.8 ± 1.3 I know how to tertiary more involved Master's -3.6 < 0.001 Portal. level: 2.6 ± 1.3 finished access the education: 4.2 2.4 0.02 in my own Portal. ± 0.8 vs. other: vs. other: 3.1 ± I have no I know how to secondary medical care. 4.0 ± 1.0 1.2 technical 3.7 ± 1.3 vs. access the education: 3.8 -2.5 0.02 problems using 3.4 ± 1.3 2.4 0.02 Portal. ± 1.1 vs. other: the Portal. 4.2 ± 0.9 For using the Using the Portal For using the finished finished Portal I do not has become a 3.6 ± 1.3 vs. Portal I do not tertiary secondary need help, for Table 5: Differences regarding age habit for me. 3.4 ± 1.3 2.0 0.05 need help, for example of a education: 4.3 3.8 <,001 example of a education: 3.7 -3.3 0.001 ± 1.0 vs. other: Item Pearson For contacting family member family member ± 1.5 vs. other: 4.0 ± 1.3 coefficient p-value family medicine or a friend. or a friend. 4.2 ± 1.1 office, I like to The people who use the Portal 3.4 ± 1.4 vs. For contacting For contacting care for me and the most (rather 3.0 ±1.5 3.6 < 0.01 family medicine finished affect me, want 0.138 < 0.001 finished high family medicine than the phone, office, I like to Bachelor's or me to use the school: 3.4 ± office, I like to e-mail). use the Portal 2.7 0.01 use the Portal Master's -2.0 0.05 Portal. the most (rather 1.4 vs. other: the most (rather level: 2.8 ± 1.5 I have a feeling Learning to use 3.1 ± 1.3 vs. than the phone, 3.1 ± 1.5 than the phone, vs. other: 3.2 ± that using the the Portal was -0.182 < 0.001 2.9 ± 1.2 2.8 0.01 e-mail). e-mail). 1.5 Portal easy for me. 92 7. For contacting family medicine contributes to Responsiveness office, I like to use the Portal the quality of and finished high Responsiveness finished most (rather than the phone, e- 3.14 1.47 medical communication school: 3.4 ± and Bachelor's or mail). treatment. with family 1.2 vs. other: 3.3 0.001 communication Master's -2.8 0.006 3.1 ± 1.3 with family level: 2.7 ± 1.3 8. For using the Portal I do not I would medicine office have improved. medicine office vs. other: 3.2 ± need help, for example of a family 4.15 1.16 recommend have improved. 1.2 member or a friend. using the Portal 3.3 ± 1.3 vs. 3.1 ± 1.3 2.4 0.02 I am satisfied finished high school: 3.4 ± 9. Responsiveness and to my friends with Portal for 2.5 0.01 finished communication with family 3.15 1.26 and family. patients. 1.2 vs. other: 3.1 ± 1.3 Bachelor's or medicine office have improved. Using the Portal I am satisfied with Portal for Master's -3.5 < 0.001 10. I am satisfied with Portal for allows me to be 3.2 ± 1.2 vs. I have a feeling patients. level: 2.7 ± 1.3 patients. 3.19 1.29 more involved that using the vs. other: 3.2 ± in my own 3.0 ± 1.3 2.9 0.003 Portal finished high school: 3.1 ± 1.3 11. I have a feeling that using the medical care. contributes to 1.2 vs. other: 2.1 0.04 Portal contributes to quality of 2.95 1.24 quality of 2.9 ± 1.3 medical treatment. medical I have a feeling finished treatment. that using the 12. I would recommend using the Portal Bachelor's or Portal to my friends and family. 3.18 1.34 I would contributes to Master's -3.2 0.002 recommend finished high quality of level: 2.5 ± 1.3 13. Using the Portal allows me to Table 4: Differences regarding education using the Portal school: 3.3 ± 2.0 0.05 medical vs. other: 3.0 ± be more involved in my own 3.07 1.26 to my friends 1.3 vs. other: treatment. 1.2 medical care. Item Mean t-test p-value and family. 3.1 ± 1.3 For using the Portal I do not finished I would finished need help, for primary Using the Portal Bachelor's or finished high recommend example of a school: 2.5 ± -4.8 < 0.001 allows me to be Master's Table 3: Differences regarding gender school: 3.3 ± using the Portal -2.3 0.02 family member 1.5 vs. other: more involved level: 2.8 ± 1.4 1.2 vs. other: 3.9 < 0.001 to my friends or a friend. 4.2 ± 1.1 in my own vs. other: 3.2 ± Item Mean (male 3.0 ± 1.3 and family. vs. female) t-test p-value medical care. 1.3 The people who finished The people who care for me and secondary care for me and affect me, want education: 3.1 2.2 0.03 Using the Portal finished affect me, want 3.0 ± 1.3 vs. me to use the ± 1.2 vs. other: finished allows me to be Bachelor's or me to use the 2.8 ± 1.3 2.1 0.04 Portal. 2.8 ± 1.3 I know how to tertiary more involved Master's -3.6 < 0.001 Portal. level: 2.6 ± 1.3 finished access the education: 4.2 2.4 0.02 in my own Portal. ± 0.8 vs. other: vs. other: 3.1 ± I have no I know how to secondary medical care. 4.0 ± 1.0 1.2 technical 3.7 ± 1.3 vs. access the education: 3.8 -2.5 0.02 problems using 3.4 ± 1.3 2.4 0.02 Portal. ± 1.1 vs. other: the Portal. 4.2 ± 0.9 For using the Using the Portal For using the finished finished Portal I do not has become a 3.6 ± 1.3 vs. Portal I do not tertiary secondary need help, for Table 5: Differences regarding age habit for me. 3.4 ± 1.3 2.0 0.05 need help, for example of a education: 4.3 3.8 <,001 example of a education: 3.7 -3.3 0.001 ± 1.0 vs. other: Item Pearson For contacting family member family member ± 1.5 vs. other: 4.0 ± 1.3 coefficient p-value family medicine or a friend. or a friend. 4.2 ± 1.1 office, I like to The people who use the Portal 3.4 ± 1.4 vs. For contacting For contacting care for me and the most (rather 3.0 ±1.5 3.6 < 0.01 family medicine finished affect me, want 0.138 < 0.001 finished high family medicine than the phone, office, I like to Bachelor's or me to use the school: 3.4 ± office, I like to e-mail). use the Portal 2.7 0.01 use the Portal Master's -2.0 0.05 Portal. the most (rather 1.4 vs. other: the most (rather level: 2.8 ± 1.5 I have a feeling Learning to use 3.1 ± 1.3 vs. than the phone, 3.1 ± 1.5 than the phone, vs. other: 3.2 ± that using the the Portal was -0.182 < 0.001 2.9 ± 1.2 2.8 0.01 e-mail). e-mail). 1.5 Portal easy for me. 93 I have no doctor's office doesn't work, I couldn't write a message. Also the The Portal is a safer communication option than regular e-mail medical care, are more satisfied and would recommend the technical appearance of the application (look and feel) is rather clumsy and in view of compliance with EU general data protection regulation Portal to their friends and family. problems using -0.087 0.01 obsolete. Responsiveness of nurse and doctor on the other hand (GDPR). Registration to Portal is possible in two ways: - Those with Bachelor’s or Master's or equivalent level of the Portal. is more than satisfactory.” registration using SIGEN-CA and SIGOV-Ca certificates and SI- education were in 6 out of 13 questions less satisfied with I know how to - “We need improvements also in telephone contact. Some seniors PASS directly on the Portal (https://portal.zd-lj.si/register) or new technology than everyone else. They don’t believe that access the Portal. -0.125 < 0.001 do not have a computer or they don't know how to use it.” registration with personal identification at the clinic - the medical responsiveness and communication with family medicine staff adds the patient to the system and sends two registration office has improved nor that it allows them to be more For using the - “Access to health care has improved by using the Portal in my codes (one by e-mail, the other by text message on mobile phone); involved in their own medical care. Portal I do not opinion. Good system.” which are valid for 24 hours. The patient can also authorize need help, for another person if he does not have his own email address and There have been some statistically important differences in example of a -0.295 < 0.001 - “The idea of Portal itself is excellent. The execution is on low mobile phone number. In this case, the authorized person answers regarding age of the participants as well, and those family member or technical and user level. From a programmer's point of view, I completes the registration process, and the authorizer signs the answers are represented in Table 5. In answers with positive a friend. think that you are capable of much better.” Pearson coefficient, the older the participants age, more positive - “Thank you.” authorization [5]. they evaluated the Portal (in questions about whether the medical I am satisfied with Portal for 0.576 < 0.001 - “I made the decision myself for using the Portal and I also As the technology is new (it has been implemented at the end staff recommended the Portal to them, if they are satisfied with the patients. encourage others to use it. I hope I can take care of myself as long of the year 2022), we wanted to access user satisfaction with the Portal, if they have a feeling that using it contributes to quality of as possible. As for claims that the use of the Portal contributes to help of an internet survey. medical treatment, if they would recommend using it to their I have a feeling a better medical treatment: it truly does provide a faster contact friends and family and if it allows them to be more involved in that using the Examining the answers of 837 participants of our survey, we with the doctor, but still, as a representative of the old generation, their own medical care). And on the contrary; in those questions Portal contributes found that the Portal is generally well received among patients. In I prefer personal contact with my doctor. Kind greetings!” with negative Pearson coefficient, the older the participants age, to quality of 0.503 < 0.001 11 out of 13 questions, the answers were more positive (scoring less satisfied they are with the Portal (questions about learning medical - “No Portal will ever and in no way compensate the direct contact higher than 3 out of 5 points). That means more than a half of how to use the Portal, technical problems, accessing the Portal and treatment. between patients and doctors. At least until (I hope never) AI will participants stated that medical staff encouraged them to use the the need for help using it). not be on higher mental and emotional level of development from Portal, that learning to do so was easy for them, that they had no I would homo sapiens.” technical problems, know how to access the Portal, it has even While reading the comments participants wrote in open recommend using become a habit for them and they do not need help, for example of question at the end of the survey, one thing was clear: people think the Portal to my 0.588 < 0.001 - “I have no comments. I am glad you introduced the Portal for a family member or a friend for using it. They also in larger that Portal for patients can only replace e-mail, they want to still friends and patients.” family. proportion think that responsiveness and communication with be able to communicate with family medicine office by phone and, - “The portal is a great thing for bureaucratic matters that have to family medicine offices have improved, are satisfied with Portal of course, in person. Using the be done, but by no means can replace a visit to the doctor when for patients, would recommend using it to their friends and family Portal allows me this is necessary. I was helping older family members to use it - and believe using it allows them to be more involved in their own Of course this tool, like other computer and mobile to be more they just needed encouragement and a little practice and now they medical care. applications, may be hard for the older generation to use and involved in my 0.514 < 0.001 are grateful, because contact like this is sometimes easier. I understand, but they can hopefully get help from their close ones own medical support the Portal and above all, centralization of medical Only in 2 out of 13 questions the answers were more negative; and if not, continue to use telephone as the first communication care. documentation in electronic form.” less than a half of participants believe that people who care for tool. them and affect them, want them to use the Portal and think that - “All changes are initially unpopular, but eventually you get used As some of the participants of the survey stated, some technical to it and you see that it is really great (no waiting in line, no using the Portal contributes to quality of medical treatment. improvements would be welcome, for example simplifying the In the last, open type question, we received many comments, waiting on the phone). You can see your file, past medications, In 7 out of 13 questions we found statistically important access. But then the safety of personal information would be in short and long, some positive and welcoming to the new software, ongoing therapy, conversations are possible, responsiveness of difference in answers between gender of participants. In all of question. while others were negative and critical. Here are some examples of doctors and nurses is faster. I must also say that I had a very those, the men answered more positively and welcoming to new the patient’s comments: responsive doctor and nurse even before the introduction of the technology than women. Portal for patients is a useful tool, but it does not in any case - “It is necessary to eliminate character limit in messages. Writing Portal. I believe that for older generation it is more difficult to use substitute to a patients visit at the doctor in person. It just messages should work non-stop, even when the doctor is absent. the Portal, but hopefully they can get help from their children, Statistical analysis also showed some differences in answers simplifies and fastens the contact with family medicine office, and When another doctor substitutes, the messages should be grandchildren, neighbors and in any case the family medicine regarding to the levels of education of participants: makes it easier to set an appointment. It is useful for getting quick transferred directly to his office.” office is still available to them by telephone. Best regards.” - Participants with finished primary school need more help information and advice, as well as managing administrative matters, such as writing electronic recipes, referral letters to - “We were practically forced into using the Portal, but it did prove for using the Portal compared to everyone else. control examinations by other specialists, ending sick leaves and to be good novelty. I would like an easier access to Portal IV. D - Those with finished secondary education find it harder to ISCUSSION so on. (without simultaneous e-mail use). As the Portal allows sending access the Portal and in comparison to everyone else need only 1 message until the doctor answers, this should be clearly It has been noticed that many patients in Slovenia find it more help with it. In further systematic improvements it will remain important to visible (it would be even better if you could send more messages, difficult to get in touch with their GPs. To fasten the accessibility - Those with finished high school to a greater extent find the right balance between the capacity of family medicine sometimes the need for this appears later).” of family medicine offices, a new online tool has been compared to all others believe that communication has offices and the actual needs of patients on the other hand. All improved, that the Portal contributes to quality of medical available communication options need to be used, but the choice - “Authentication of access to the Portal is not user friendly (when implemented in Community Health Center Ljubljana, called requesting for access it requires sending additional codes by text »Portal for patients«. treatment and allows them to be more involved in their own of each primarily depending on individual patient’s needs. message and e-mail every time). During the time when the 94 I have no doctor's office doesn't work, I couldn't write a message. Also the The Portal is a safer communication option than regular e-mail medical care, are more satisfied and would recommend the technical appearance of the application (look and feel) is rather clumsy and in view of compliance with EU general data protection regulation Portal to their friends and family. problems using -0.087 0.01 obsolete. Responsiveness of nurse and doctor on the other hand (GDPR). Registration to Portal is possible in two ways: - Those with Bachelor’s or Master's or equivalent level of the Portal. is more than satisfactory.” registration using SIGEN-CA and SIGOV-Ca certificates and SI- education were in 6 out of 13 questions less satisfied with I know how to - “We need improvements also in telephone contact. Some seniors PASS directly on the Portal (https://portal.zd-lj.si/register) or new technology than everyone else. They don’t believe that access the Portal. -0.125 < 0.001 do not have a computer or they don't know how to use it.” registration with personal identification at the clinic - the medical responsiveness and communication with family medicine staff adds the patient to the system and sends two registration office has improved nor that it allows them to be more For using the - “Access to health care has improved by using the Portal in my codes (one by e-mail, the other by text message on mobile phone); involved in their own medical care. Portal I do not opinion. Good system.” which are valid for 24 hours. The patient can also authorize need help, for another person if he does not have his own email address and There have been some statistically important differences in example of a -0.295 < 0.001 - “The idea of Portal itself is excellent. The execution is on low mobile phone number. In this case, the authorized person answers regarding age of the participants as well, and those family member or technical and user level. From a programmer's point of view, I completes the registration process, and the authorizer signs the answers are represented in Table 5. In answers with positive a friend. think that you are capable of much better.” Pearson coefficient, the older the participants age, more positive - “Thank you.” authorization [5]. they evaluated the Portal (in questions about whether the medical I am satisfied with Portal for 0.576 < 0.001 - “I made the decision myself for using the Portal and I also As the technology is new (it has been implemented at the end staff recommended the Portal to them, if they are satisfied with the patients. encourage others to use it. I hope I can take care of myself as long of the year 2022), we wanted to access user satisfaction with the Portal, if they have a feeling that using it contributes to quality of as possible. As for claims that the use of the Portal contributes to help of an internet survey. medical treatment, if they would recommend using it to their I have a feeling a better medical treatment: it truly does provide a faster contact friends and family and if it allows them to be more involved in that using the Examining the answers of 837 participants of our survey, we with the doctor, but still, as a representative of the old generation, their own medical care). And on the contrary; in those questions Portal contributes found that the Portal is generally well received among patients. In I prefer personal contact with my doctor. Kind greetings!” with negative Pearson coefficient, the older the participants age, to quality of 0.503 < 0.001 11 out of 13 questions, the answers were more positive (scoring less satisfied they are with the Portal (questions about learning medical - “No Portal will ever and in no way compensate the direct contact higher than 3 out of 5 points). That means more than a half of how to use the Portal, technical problems, accessing the Portal and treatment. between patients and doctors. At least until (I hope never) AI will participants stated that medical staff encouraged them to use the not be on higher mental and emotional level of development from Portal, that learning to do so was easy for them, that they had no the need for help using it). I would homo sapiens.” technical problems, know how to access the Portal, it has even While reading the comments participants wrote in open recommend using become a habit for them and they do not need help, for example of question at the end of the survey, one thing was clear: people think the Portal to my 0.588 < 0.001 - “I have no comments. I am glad you introduced the Portal for a family member or a friend for using it. They also in larger that Portal for patients can only replace e-mail, they want to still friends and patients.” family. proportion think that responsiveness and communication with be able to communicate with family medicine office by phone and, - “The portal is a great thing for bureaucratic matters that have to family medicine offices have improved, are satisfied with Portal of course, in person. Using the be done, but by no means can replace a visit to the doctor when for patients, would recommend using it to their friends and family Portal allows me this is necessary. I was helping older family members to use it - and believe using it allows them to be more involved in their own Of course this tool, like other computer and mobile to be more they just needed encouragement and a little practice and now they medical care. applications, may be hard for the older generation to use and involved in my 0.514 < 0.001 are grateful, because contact like this is sometimes easier. I understand, but they can hopefully get help from their close ones own medical support the Portal and above all, centralization of medical Only in 2 out of 13 questions the answers were more negative; and if not, continue to use telephone as the first communication care. documentation in electronic form.” less than a half of participants believe that people who care for tool. them and affect them, want them to use the Portal and think that - “All changes are initially unpopular, but eventually you get used As some of the participants of the survey stated, some technical to it and you see that it is really great (no waiting in line, no using the Portal contributes to quality of medical treatment. improvements would be welcome, for example simplifying the In the last, open type question, we received many comments, waiting on the phone). You can see your file, past medications, In 7 out of 13 questions we found statistically important access. But then the safety of personal information would be in short and long, some positive and welcoming to the new software, ongoing therapy, conversations are possible, responsiveness of difference in answers between gender of participants. In all of question. while others were negative and critical. Here are some examples of doctors and nurses is faster. I must also say that I had a very the patient’s comments: those, the men answered more positively and welcoming to new responsive doctor and nurse even before the introduction of the technology than women. Portal for patients is a useful tool, but it does not in any case - “It is necessary to eliminate character limit in messages. Writing Portal. I believe that for older generation it is more difficult to use substitute to a patients visit at the doctor in person. It just messages should work non-stop, even when the doctor is absent. the Portal, but hopefully they can get help from their children, Statistical analysis also showed some differences in answers simplifies and fastens the contact with family medicine office, and When another doctor substitutes, the messages should be grandchildren, neighbors and in any case the family medicine regarding to the levels of education of participants: makes it easier to set an appointment. It is useful for getting quick transferred directly to his office.” office is still available to them by telephone. Best regards.” - Participants with finished primary school need more help information and advice, as well as managing administrative matters, such as writing electronic recipes, referral letters to - “We were practically forced into using the Portal, but it did prove for using the Portal compared to everyone else. control examinations by other specialists, ending sick leaves and to be good novelty. I would like an easier access to Portal IV. D - Those with finished secondary education find it harder to ISCUSSION so on. (without simultaneous e-mail use). As the Portal allows sending access the Portal and in comparison to everyone else need only 1 message until the doctor answers, this should be clearly It has been noticed that many patients in Slovenia find it more help with it. In further systematic improvements it will remain important to visible (it would be even better if you could send more messages, difficult to get in touch with their GPs. To fasten the accessibility - Those with finished high school to a greater extent find the right balance between the capacity of family medicine sometimes the need for this appears later).” of family medicine offices, a new online tool has been compared to all others believe that communication has offices and the actual needs of patients on the other hand. All - “Authentication of access to the Portal is not user friendly (when implemented in Community Health Center Ljubljana, called improved, that the Portal contributes to quality of medical available communication options need to be used, but the choice requesting for access it requires sending additional codes by text »Portal for patients«. treatment and allows them to be more involved in their own of each primarily depending on individual patient’s needs. message and e-mail every time). During the time when the 95 V. CONCLUSSION [2] Ha JF, Longnecker N. Doctor-patient communication: a review. Ochsner J. 2010: p 38-43. The impact of the covid-19 epidemic on the newly [3] Švab I., Rotar Pavlič D. Družinska medicina. Združenje Portal for patients is a new tool of electronic communication zdravnikov družinske medicine – SZD. Iljaž R., Kert S., Vatovec-diagnosed patients with arterial hypertension and between family medicine offices and their users (patients). It is Progar I., Cvetko T. 2012: p 124-134. generally well received among patients but according to our survey, people believe that it needs some technical improvements. [4] Baker R, Hearnshaw H. A method for surveying patient type 2 diabetes and their management in family It can also only replace e-mail, while patients want to still be able satisfaction audit protocol PS1. Leicester: Eli Lilly National to communicate with family medicine office by phone, regular Cinical Audit Centre; 1996. medicine clinics of the Maribor region mail and in person. [5] zd-lj.si [Internet]. Ljubljana; [cited 2023 Sept 23]. Available from: https://www.zd- lj.si/zdlj/index.php?option=com_content&view=article&id=998:p Barbara Pernek3, dr.med,, spec. druž. med. REFERENCES ortal-za-paciente-nov-nacin-elektronske-komunikacije-z- doc. dr. Vojislav Ivetić1,2., spec. druž. med. ambulanto-4&catid=260&Itemid=2877&lang=sl 1: Medicinska fakulteta, Univerza v Mariboru, Taborska ulica 8, 2000 Maribor, Slovenija; 2: Sava Med d.o.o., Cesta k [1] Švab I., Rotar Pavlič D. Družinska medicina. Združenje zdravnikov družinske medicine – SZD. Drešček M., Iljaž R. 2012: Dravi 8, 2241 Spodnji Duplek, Slovenija 3: ZD dr. Adolfa Drolca, Maribor, Ulica Talcev 9, 2000 Maribor, Slovenija p 146-154. barbara.pernek@zd-mb.si Abstract I. INTRODUCTION Background The aim of this study is to find out whether COVID-19 Prevention epidemic measures have affected the number of newly The word prevention comes from the Latin word "praevenire" diagnosed patients with arterial hypertension and type 2 (prea - before and venire - comes) and means to prevent an diabetes in the general population. event (disease, accident) before it even happens by taking Methods correct and timely action(1). A study of data from two family medicine clinics within the Prevention in healthcare deals with health protection, disease ZD dr. Adolfa Drolca Maribor (ZP Rače) and two private prevention and timely detection and treatment of diseases. family medicine clinics (SAVA MED d.o.o. and MEDIKUS We know four types of prevention(2): d.o.o.) in Sp. Duplek were carried out. The study included all • primary prevention patients with newly diagnosed arterial hypertension (MKB The aim of primary prevention is to improve the state of health DG: I10) or type 2 diabetes (MKB DG E11.) in the period and prevent the onset of disease. It includes a healthy between 2018 and 2021. The data was obtained through the population with a very low risk of developing diseases, which health information system ProMedica and by inspecting the we want to further educate about the risk factors for the electronic medical record files of the mentioned clinics. development of various diseases or to protect against the Results development of diseases (e.g. mandatory vaccination program, The results for RA Rače and RA Duplek show 57 (167.6%) smoking prevention, salt iodization). more newly diagnosed cases of arterial hypertension and 43 • secondary prevention (134,4%) more newly diagnosed cases of type 2 diabetes in the The goal of secondary prevention is the detection of preclinical period before the epidemic compared to the period during the stages of the disease, their diagnosis and early treatment. It epidemic. The increase in the number of newly diagnosed covers healthy people with a high risk of developing the cases is therefore statistically significant. The percentage of disease (smokers, overweight people). first follow-up health check-ups of patients with newly • tertiary prevention diagnosed arterial hypertension in 2018/19 was 53.8 vs. 52.9 The aim of tertiary prevention is to prevent the progression of during the epidemic and newly diagnosed type 2 diabetes was the disease (treatment, monitoring). It focuses on the 62,7 vs. 53,1. In these cases the difference was not statistical y psychological, physical and social rehabilitation of patients. It significant. tries to prevent complications of the disease and preserves Conclusion impaired abilities and establishes optimal functioning. In the years 2020 and 2021 there were considerably fewer • quaternary prevention newly diagnosed patients. The patients who were diagnosed The goal of quaternary prevention is measures that protect with a chronic non-communicable disease, nevertheless individuals (healthy individuals or patients) from medical received treatment in accordance with medical care guidelines. interventions that could cause more harm than good(3,4). Index Terms-- preventive health care, arterial hypertension, type In the Republic of Slovenia, we have had a program of primary 2 diabetes, COVID-19, family medicine. prevention of cardiovascular diseases since 2000, which was 96 V. CONCLUSSION [2] Ha JF, Longnecker N. Doctor-patient communication: a review. Ochsner J. 2010: p 38-43. The impact of the covid-19 epidemic on the newly [3] Švab I., Rotar Pavlič D. Družinska medicina. Združenje Portal for patients is a new tool of electronic communication zdravnikov družinske medicine – SZD. Iljaž R., Kert S., Vatovec-diagnosed patients with arterial hypertension and between family medicine offices and their users (patients). It is Progar I., Cvetko T. 2012: p 124-134. generally well received among patients but according to our survey, people believe that it needs some technical improvements. [4] Baker R, Hearnshaw H. A method for surveying patient type 2 diabetes and their management in family It can also only replace e-mail, while patients want to still be able satisfaction audit protocol PS1. Leicester: Eli Lilly National to communicate with family medicine office by phone, regular Cinical Audit Centre; 1996. medicine clinics of the Maribor region mail and in person. [5] zd-lj.si [Internet]. Ljubljana; [cited 2023 Sept 23]. Available from: https://www.zd- lj.si/zdlj/index.php?option=com_content&view=article&id=998:p Barbara Pernek3, dr.med,, spec. druž. med. REFERENCES ortal-za-paciente-nov-nacin-elektronske-komunikacije-z- doc. dr. Vojislav Ivetić1,2., spec. druž. med. ambulanto-4&catid=260&Itemid=2877&lang=sl 1: Medicinska fakulteta, Univerza v Mariboru, Taborska ulica 8, 2000 Maribor, Slovenija; 2: Sava Med d.o.o., Cesta k [1] Švab I., Rotar Pavlič D. Družinska medicina. Združenje zdravnikov družinske medicine – SZD. Drešček M., Iljaž R. 2012: Dravi 8, 2241 Spodnji Duplek, Slovenija 3: ZD dr. Adolfa Drolca, Maribor, Ulica Talcev 9, 2000 Maribor, Slovenija p 146-154. barbara.pernek@zd-mb.si Abstract I. INTRODUCTION Background The aim of this study is to find out whether COVID-19 Prevention epidemic measures have affected the number of newly The word prevention comes from the Latin word "praevenire" diagnosed patients with arterial hypertension and type 2 (prea - before and venire - comes) and means to prevent an diabetes in the general population. event (disease, accident) before it even happens by taking Methods correct and timely action(1). A study of data from two family medicine clinics within the Prevention in healthcare deals with health protection, disease ZD dr. Adolfa Drolca Maribor (ZP Rače) and two private prevention and timely detection and treatment of diseases. family medicine clinics (SAVA MED d.o.o. and MEDIKUS We know four types of prevention(2): d.o.o.) in Sp. Duplek were carried out. The study included all • primary prevention patients with newly diagnosed arterial hypertension (MKB The aim of primary prevention is to improve the state of health DG: I10) or type 2 diabetes (MKB DG E11.) in the period and prevent the onset of disease. It includes a healthy between 2018 and 2021. The data was obtained through the population with a very low risk of developing diseases, which health information system ProMedica and by inspecting the we want to further educate about the risk factors for the electronic medical record files of the mentioned clinics. development of various diseases or to protect against the Results development of diseases (e.g. mandatory vaccination program, The results for RA Rače and RA Duplek show 57 (167.6%) smoking prevention, salt iodization). more newly diagnosed cases of arterial hypertension and 43 • secondary prevention (134,4%) more newly diagnosed cases of type 2 diabetes in the The goal of secondary prevention is the detection of preclinical period before the epidemic compared to the period during the stages of the disease, their diagnosis and early treatment. It epidemic. The increase in the number of newly diagnosed covers healthy people with a high risk of developing the cases is therefore statistically significant. The percentage of disease (smokers, overweight people). first follow-up health check-ups of patients with newly • tertiary prevention diagnosed arterial hypertension in 2018/19 was 53.8 vs. 52.9 The aim of tertiary prevention is to prevent the progression of during the epidemic and newly diagnosed type 2 diabetes was the disease (treatment, monitoring). It focuses on the 62,7 vs. 53,1. In these cases the difference was not statistical y psychological, physical and social rehabilitation of patients. It significant. tries to prevent complications of the disease and preserves Conclusion impaired abilities and establishes optimal functioning. In the years 2020 and 2021 there were considerably fewer • quaternary prevention newly diagnosed patients. The patients who were diagnosed The goal of quaternary prevention is measures that protect with a chronic non-communicable disease, nevertheless individuals (healthy individuals or patients) from medical received treatment in accordance with medical care guidelines. interventions that could cause more harm than good(3,4). Index Terms-- preventive health care, arterial hypertension, type In the Republic of Slovenia, we have had a program of primary 2 diabetes, COVID-19, family medicine. prevention of cardiovascular diseases since 2000, which was 97 initially implemented as part of the CINDI program(5). In • patients with already known and treated cardiovascular In the second part of the research, we examined the electronic 2020/21 18 (52,9) 16 (47,1) 34 (100,0) 2011, at the level of family medicine clinics, the project of disease. medical records of patients who were diagnosed with the Fisher's exact test did not show a statistically significant reference clinics began to be implemented, the purpose of Treatment of DM2 includes lifestyle changes (weight loss, disease between 2018 and 2021 to see if they had a check-up difference regarding the proportion of control first which is primary and secondary prevention of the most dietary measures, regular exercise, restriction of alcohol intake at the referral clinic within six months of the diagnosis. examinations of arterial hypertension between the two periods common chronic non-communicable diseases (CNC)(6). A and smoking cessation). It has also been shown that a very Patients in whom AH or DM2 was detected before 2018 or (p=1.000). registered nurse works in the referral outpatient clinic, and her important factor in the successful treatment of diabetes is after 2021 were not included in the study. Table 3: Control first inspection after detection of DM2 in work is aimed at screening the defined adult population and patient education about the nature and causes of the Data collection and description of variables 2018/19 and 2020/21 monitoring well-managed patients with a stable, well-managed disease(15). The goal of DM2 treatment is to reduce blood The patients were divided into two groups, namely those in First control examination Total newly chronic disease(6). glucose to a value of Hb1Ac <7 in the long term and thereby whom the disease was detected during the years 2018-2019 after detection of DM type 2 discovered Arterial hypertension prevent microvascular complications of the disease. Higher and those in whom the disease was detected during the years Period da ne n (%) AH is an important risk factor for cardiovascular diseases. average values of Hb1Ac are allowed in elderly patients and in 2020-2021. Each group was then further divided into two n (%) n (%) Lifestyle factors (physical inactivity, risky drinking of patients with a shorter life expectancy, as in these patients it is subgroups, those who had a follow-up examination at the 2018/19 47 (62,7) 28 (37,3) 75 (100,0) alcoholic beverages, salting of food, obesity) and heredity play assumed that a more intensive therapy would result in a higher reference clinic within half a year after the diagnosis and those 2020/21 17 (53,1) 15 (46,9) 32 (100,0) a role in its development. In more than 90% of patients with cost of treatment and at the same time worsen the quality of who did not. The time interval of observation in both cases was Fisher's exact test showed no statistically significant difference AH, the cause of the disease is unknown, and therefore we life(16). the same. Some control examinations (of those patients who in the proportion of control first DM2 examinations between speak of essential AH(7). In 10% of patients, we are talking The epidemic of COVID 19 had the disease detected towards the end of 2021) were also the two periods (p=0.394). about secondary AH, where the cause of AH is known In order to prevent the spread of the Coronavirus disease 2019 carried out in the first half of 2022, when there is officially no (diseases of the thyroid, adrenal glands, kidneys, as a result of (COVID 19), general measures have been taken all over the longer an epidemic, but all preventive measures remain taking certain medications)(7) and it is treated by treating the world (care for hand hygiene, wearing a surgical mask indoors recommended in healthcare. underlying cause. and social distance of at least 1.5m). All non-essential services Statistical analysis IV. DISCUSSION A screening test for AH is blood pressure measurement. We were closed, public events were cancelled, gatherings of Categorical variables were presented as numbers and It turned out that in the period before the COVID-19 epidemic, speak of AH when the patient has several consecutive blood people were prohibited. percentages. Covariate variables were presented with mean 57 and 167.6% more cases of AH than during the epidemic pressure measurements above 140/90 mmHg(8). During the first wave of the epidemic, the implementation of values and standard deviation. In the first hypothesis, the were diagnosed. Also, in the period before the COVID-19 The diagnosis of AH (I10) is made when the blood pressure is preventive programs was interrupted several times in Slovenia. binomial test was used to analyze the statistically significant epidemic, 43 and 43 134.4% more DM2 cases than during the elevated during at least two visits to the family medicine clinic All preventive activities were abandoned only during the first difference in the prevalence of the research and control groups. epidemic were diagnosed. or when the average of the elevated blood pressure values interruption, and during the following interruptions, the scope Binomial test and Fisher's exact test were used to compare A 2011 World Health Organization survey found that measured at home in the morning and in the evening for seven of preventive services was reduced mainly due to the categorical variables in the second hypothesis. The limit of the approximately 55 million people die each year, with 2/3 of the consecutive days. redeployment of personnel due to additional activities that statistical characteristic was determined by a value of p < 0.05. deaths being caused by non-communicable chronic diseases, Treatment includes lifestyle changes (dietary measures, were necessary to contain the spread of infections (taking The results were processed using Microsoft Excel 2016 MSO. including cardiovascular disease, diabetes, lung disease and regular exercise, maintaining a suitable body weight, limiting swabs, vaccinations, setting up cal centers, etc. .) cancer(18). Considering that in 2020-2021 we had a reduced the intake of alcoholic beverages and stopping smoking), Research ethics prevention program and consequently less detection of chronic regular blood and urine laboratory tests, ECG measurement The purpose of the research was to determine the impact of the The research was approved by the Medical Ethics Commission non-communicable diseases, in the coming years we can and, if necessary, the introduction of a suitable COVID-19 epidemic (in 2020 and 2021) on the number of of the Republic of Slovenia (Decision No. 0120-128/2022/3, expect more people in whom AH and DM2 wil be detected in antihypertensive drug(9). Most antihypertensive drugs lower newly diagnosed AH and DM2 patients and what their further April 21, 2022). later stages, as a result, complications of the disease will also mean systolic pressure by 10-15%(10). management was in the family medicine clinics of the Maribor be associated more often . The appropriate treatment must be selected individually for region. Preventive measures implemented at the national level must be each patient, depending on the level of AH at the time of III. RESULTS cost-effective or have a significant impact on the quality of life. diagnosis and its associated diseases. Table 1: Newly diagnosed chronic diseases in 2018/19 and The most cost-effective interventions are usually those aimed Type 2 diabetes II. MATERIAL AND METHODS 2020/21 at higher-risk populations. In screening, efficiency also The term diabetes refers to a group of different diseases that Type of research and place of implementation depends on frequency (more frequent screening brings greater have in common an excessively high level of glucose in the A quantitative retrospective study was conducted. Data from Chronic disease Period 2018/19 2020/21 benefits, but is less financially efficient)(19). blood. The diseases differ according to their pathophysiology the medical records of two family medicine clinics of the Arterial hypertension 91 34 In 2014, it was estimated that by 2023, the number of non- and are divided into type 1 diabetes, type 2 diabetes, Medical Center dr. Adolfa Drolca Maribor (ZP Rače), and data Sladkorna bolezen 75 32 communicable chronic diseases in the USA will grow by 42%, gestational diabetes and secondary diabetes. The most from two family medicine clinics of private providers (SAVA The binomial test showed that the number of newly diagnosed which will cost the country 4.2 billion US dollars due to the common type of diabetes is type 2 diabetes (DM2), which MED d.o.o. and MEDIKUS d.o.o., Sp. Duplek). AH cases was statistically significantly higher before the increased volume of patient treatment and reduced economic accounts for approximately 90% of all diabetes(11). A sample epidemic (p<0.001). Also, in the period before the COVID-19 activity of the population(20). A 2017 Monte Carlo study The DM2 screening test is a measurement of fasting blood Data were collected from ZP Rače, within two clinics of the epidemic, 43 and 43 134.4% more DM2 cases than during the showed that early detection and treatment of AH has the glucose in people with known risk factors for DM2 (12). Medical Center Dr. Adolfa Drolca Maribor and data from the epidemic. The binomial test showed that the number of newly greatest annual financial savings(21). The diagnosis of DM2 (E11.9) is made on the basis of medical records of two private family medicine clinics (SAVA diagnosed DM2 cases was statistically significantly higher On the other hand, the American Diabetes Association has measured fasting blood glucose or by OGTT in persons with MED d.o.o. and MEDIKUS d.o.o.) from Spodnji Duplek. before the epidemic (p<0.001). estimated that the costs of medical care for patients with borderline basal glycemia(13): All patients who were newly diagnosed with AH (MKB DG: Table 2: First Control examination after detection of AH diabetes are twice as high as for people without diabetes, In order to be included in the screening program for DM2 in I10) or DM2 (MKB DG: E11.9) in the years 2018-2021 were in 2018/19 and 2020/21 mainly due to patient backlogs, reduced productivity due to the the referral clinic, an individual must meet certain criteria(14). included. Sample data were obtained using the ProMedica consequences of the disease, and premature mortality(22). Inclusion criteria: health information system from the annual reports of the works First control examination Total newly In Slovenia, the direct medical costs of diabetes in 2012 were • defined persons over 30 years of age. for an individual referral clinic and reviews the electronic Period after detection of AH discovered estimated at EUR 114.3 million, of which 35% were Exclusion criteria: medical records of the aforementioned family medicine da ne n (%) medicines, 14% medical devices, 14% hospital treatment and • patients with already known and treated diabetes, clinics. n (%) n (%) 13% care in social institutions. Other costs of treatment and • patients with already known and treated arterial hypertension, 2018/19 49 (53,8) 42 (46,2) 91 (100,0) management of the disease, including visits to the doctor at the 98 initially implemented as part of the CINDI program(5). In • patients with already known and treated cardiovascular In the second part of the research, we examined the electronic 2020/21 18 (52,9) 16 (47,1) 34 (100,0) 2011, at the level of family medicine clinics, the project of disease. medical records of patients who were diagnosed with the Fisher's exact test did not show a statistically significant reference clinics began to be implemented, the purpose of Treatment of DM2 includes lifestyle changes (weight loss, disease between 2018 and 2021 to see if they had a check-up difference regarding the proportion of control first which is primary and secondary prevention of the most dietary measures, regular exercise, restriction of alcohol intake at the referral clinic within six months of the diagnosis. examinations of arterial hypertension between the two periods common chronic non-communicable diseases (CNC)(6). A and smoking cessation). It has also been shown that a very Patients in whom AH or DM2 was detected before 2018 or (p=1.000). registered nurse works in the referral outpatient clinic, and her important factor in the successful treatment of diabetes is after 2021 were not included in the study. Table 3: Control first inspection after detection of DM2 in work is aimed at screening the defined adult population and patient education about the nature and causes of the Data collection and description of variables 2018/19 and 2020/21 monitoring well-managed patients with a stable, well-managed disease(15). The goal of DM2 treatment is to reduce blood The patients were divided into two groups, namely those in First control examination Total newly chronic disease(6). glucose to a value of Hb1Ac <7 in the long term and thereby whom the disease was detected during the years 2018-2019 after detection of DM type 2 discovered Arterial hypertension prevent microvascular complications of the disease. Higher and those in whom the disease was detected during the years Period da ne n (%) AH is an important risk factor for cardiovascular diseases. average values of Hb1Ac are allowed in elderly patients and in 2020-2021. Each group was then further divided into two n (%) n (%) Lifestyle factors (physical inactivity, risky drinking of patients with a shorter life expectancy, as in these patients it is subgroups, those who had a follow-up examination at the 2018/19 47 (62,7) 28 (37,3) 75 (100,0) alcoholic beverages, salting of food, obesity) and heredity play assumed that a more intensive therapy would result in a higher reference clinic within half a year after the diagnosis and those 2020/21 17 (53,1) 15 (46,9) 32 (100,0) a role in its development. In more than 90% of patients with cost of treatment and at the same time worsen the quality of who did not. The time interval of observation in both cases was Fisher's exact test showed no statistically significant difference AH, the cause of the disease is unknown, and therefore we life(16). the same. Some control examinations (of those patients who in the proportion of control first DM2 examinations between speak of essential AH(7). In 10% of patients, we are talking The epidemic of COVID 19 had the disease detected towards the end of 2021) were also the two periods (p=0.394). about secondary AH, where the cause of AH is known In order to prevent the spread of the Coronavirus disease 2019 carried out in the first half of 2022, when there is officially no (diseases of the thyroid, adrenal glands, kidneys, as a result of (COVID 19), general measures have been taken all over the longer an epidemic, but all preventive measures remain taking certain medications)(7) and it is treated by treating the world (care for hand hygiene, wearing a surgical mask indoors recommended in healthcare. underlying cause. and social distance of at least 1.5m). All non-essential services Statistical analysis IV. DISCUSSION A screening test for AH is blood pressure measurement. We were closed, public events were cancelled, gatherings of Categorical variables were presented as numbers and It turned out that in the period before the COVID-19 epidemic, speak of AH when the patient has several consecutive blood people were prohibited. percentages. Covariate variables were presented with mean 57 and 167.6% more cases of AH than during the epidemic pressure measurements above 140/90 mmHg(8). During the first wave of the epidemic, the implementation of values and standard deviation. In the first hypothesis, the were diagnosed. Also, in the period before the COVID-19 The diagnosis of AH (I10) is made when the blood pressure is preventive programs was interrupted several times in Slovenia. binomial test was used to analyze the statistically significant epidemic, 43 and 43 134.4% more DM2 cases than during the elevated during at least two visits to the family medicine clinic All preventive activities were abandoned only during the first difference in the prevalence of the research and control groups. epidemic were diagnosed. or when the average of the elevated blood pressure values interruption, and during the following interruptions, the scope Binomial test and Fisher's exact test were used to compare A 2011 World Health Organization survey found that measured at home in the morning and in the evening for seven of preventive services was reduced mainly due to the categorical variables in the second hypothesis. The limit of the approximately 55 million people die each year, with 2/3 of the consecutive days. redeployment of personnel due to additional activities that statistical characteristic was determined by a value of p < 0.05. deaths being caused by non-communicable chronic diseases, Treatment includes lifestyle changes (dietary measures, were necessary to contain the spread of infections (taking The results were processed using Microsoft Excel 2016 MSO. including cardiovascular disease, diabetes, lung disease and regular exercise, maintaining a suitable body weight, limiting swabs, vaccinations, setting up cal centers, etc. .) cancer(18). Considering that in 2020-2021 we had a reduced the intake of alcoholic beverages and stopping smoking), Research ethics prevention program and consequently less detection of chronic regular blood and urine laboratory tests, ECG measurement The purpose of the research was to determine the impact of the The research was approved by the Medical Ethics Commission non-communicable diseases, in the coming years we can and, if necessary, the introduction of a suitable COVID-19 epidemic (in 2020 and 2021) on the number of of the Republic of Slovenia (Decision No. 0120-128/2022/3, expect more people in whom AH and DM2 wil be detected in antihypertensive drug(9). Most antihypertensive drugs lower newly diagnosed AH and DM2 patients and what their further April 21, 2022). later stages, as a result, complications of the disease will also mean systolic pressure by 10-15%(10). management was in the family medicine clinics of the Maribor be associated more often . The appropriate treatment must be selected individually for region. Preventive measures implemented at the national level must be each patient, depending on the level of AH at the time of III. RESULTS cost-effective or have a significant impact on the quality of life. diagnosis and its associated diseases. Table 1: Newly diagnosed chronic diseases in 2018/19 and The most cost-effective interventions are usually those aimed Type 2 diabetes II. MATERIAL AND METHODS 2020/21 at higher-risk populations. In screening, efficiency also The term diabetes refers to a group of different diseases that Type of research and place of implementation depends on frequency (more frequent screening brings greater have in common an excessively high level of glucose in the A quantitative retrospective study was conducted. Data from Chronic disease Period 2018/19 2020/21 benefits, but is less financially efficient)(19). blood. The diseases differ according to their pathophysiology the medical records of two family medicine clinics of the Arterial hypertension 91 34 In 2014, it was estimated that by 2023, the number of non- and are divided into type 1 diabetes, type 2 diabetes, Medical Center dr. Adolfa Drolca Maribor (ZP Rače), and data Sladkorna bolezen 75 32 communicable chronic diseases in the USA will grow by 42%, gestational diabetes and secondary diabetes. The most from two family medicine clinics of private providers (SAVA The binomial test showed that the number of newly diagnosed which will cost the country 4.2 billion US dollars due to the common type of diabetes is type 2 diabetes (DM2), which MED d.o.o. and MEDIKUS d.o.o., Sp. Duplek). AH cases was statistically significantly higher before the increased volume of patient treatment and reduced economic accounts for approximately 90% of all diabetes(11). A sample epidemic (p<0.001). Also, in the period before the COVID-19 activity of the population(20). A 2017 Monte Carlo study The DM2 screening test is a measurement of fasting blood Data were collected from ZP Rače, within two clinics of the epidemic, 43 and 43 134.4% more DM2 cases than during the showed that early detection and treatment of AH has the glucose in people with known risk factors for DM2 (12). Medical Center Dr. Adolfa Drolca Maribor and data from the epidemic. The binomial test showed that the number of newly greatest annual financial savings(21). The diagnosis of DM2 (E11.9) is made on the basis of medical records of two private family medicine clinics (SAVA diagnosed DM2 cases was statistically significantly higher On the other hand, the American Diabetes Association has measured fasting blood glucose or by OGTT in persons with MED d.o.o. and MEDIKUS d.o.o.) from Spodnji Duplek. before the epidemic (p<0.001). estimated that the costs of medical care for patients with borderline basal glycemia(13): All patients who were newly diagnosed with AH (MKB DG: Table 2: First Control examination after detection of AH diabetes are twice as high as for people without diabetes, In order to be included in the screening program for DM2 in I10) or DM2 (MKB DG: E11.9) in the years 2018-2021 were in 2018/19 and 2020/21 mainly due to patient backlogs, reduced productivity due to the the referral clinic, an individual must meet certain criteria(14). included. Sample data were obtained using the ProMedica consequences of the disease, and premature mortality(22). Inclusion criteria: health information system from the annual reports of the works First control examination Total newly In Slovenia, the direct medical costs of diabetes in 2012 were • defined persons over 30 years of age. for an individual referral clinic and reviews the electronic Period after detection of AH discovered estimated at EUR 114.3 million, of which 35% were Exclusion criteria: medical records of the aforementioned family medicine da ne n (%) medicines, 14% medical devices, 14% hospital treatment and • patients with already known and treated diabetes, clinics. n (%) n (%) 13% care in social institutions. Other costs of treatment and • patients with already known and treated arterial hypertension, 2018/19 49 (53,8) 42 (46,2) 91 (100,0) management of the disease, including visits to the doctor at the 99 primary and secondary level, accounted for around 25% of the lower socioeconomic status also increased the probability of a [6] Referenčna ambulanta [cited 2022 Jan 15]. Available from: https://www.who.int/news-room/fact-sheets/detail/the-top-10- annual costs(23). worse course of the disease(26). http://www.referencna-ambulanta.si/ causes-of-death In addition to the direct costs, the indirect costs of the disease In 2020, Mexican researchers who investigated the connection [7] Petek Šter M, Bulc M, Accetto R, Petek D, Salobir B. Žontar T, [19] Cohen J. "The cost savings and cost-effectiveness of clinical are also added, which include the financial consequences of between undetected DM2, a confirmed diagnosis of DM2 and Škorič S, Jovanovič E. Protokol vodenja arterijske hipertenzije in preventative [sic] care. Robert Wood Johnson Foundation". The lost productivity due to morbidity and mortality. In this same the course of the COVID infection suggested that HbA1c ukrepanje ob njenih poslabšanjih/zapletih (2017) – modifikacija Synthesis Project. Robert Wood Johnson Foundation . Research Synthesis report No.18, September 2009. research, the estimated indirect costs amounted to EUR 5.5 should also be checked in the drawn blood sample of every protokola 2013. million, of which the patient stock was EUR 2.3 million and patient admitted to the hospital due to SARS-CoV2 infection. [8] Accetto R, Salobir B, Brguljan Hitij J, Dolenc P. Slovenske [20] Does Preventive Care Save Money? Health Economics and the smernice za obravnavo hipertenzije 2013. Zdrav Vestn 2014; 83: Presidential Candidates [cited 2022 Oct 25]. Available from: the lost future income was EUR 3.2 million. Due to the lack of In this way, we would discover many people who have DM2 727–58. https://pubmed.ncbi.nlm.nih.gov/18272889/ DOI: data on disability and premature retirements as a result of but do not yet have a confirmed diagnosis, and this would be [9] Initial Treatment of Hypertension [cited 2022 Oct 28]. Available 10.1056/NEJMp0708558 PMID: 18272889 diabetes, it was not possible to estimate this cost completely useful mainly because of easier prediction of the course of from: https://pubmed.ncbi.nlm.nih.gov/12584370/ DOI: [21] A Monte Carlo simulation approach for estimatih the health and accurately, so the estimate of indirect costs is also significantly infection with SARS-CoV2(27). 10.1056/NEJMcp010357 PMID: 12584370 economic impact of interventions provided at a student-run clinic underestimated(23). The number of all examinations in 2020-2021 was reduced, but [10] Materson BJ, Reda DJ, Cushman WC, et al. Single-drug therapy for [cited 2022 Oct 25]. Available from: In 2020, there were 118,215 recipients of glucose-lowering those patients who were diagnosed with a new chronic non-hypertension in men: a comparison of six antihypertensive agents https://ui.adsabs.harvard.edu/abs/2017PLoSO..1289718A/abstra with placebo. N Engl J Med 1993;328: 914-21. [Erratum, N Engl J ct/DOI: 10.1371/journal.pone.0189718 drugs in Slovenia, which is 1.6% (1,841 people) more than in communicable disease during this time were still treated Med 1994;330: 1689.] 2019 or as much as 41% (34,570 people) more than in 2008. according to the guidelines on the monitoring of their disease. [22] Economic costs of diabetes in the U.S. in 2012 [28.10.2022]. [11] Slovenske smernice za klinično obravnavo sladkorne bolezni tipa 2 Dosegljivo na: https://pubmed.ncbi.nlm.nih.gov/23468086/ DOI: They calculated that there are about 20% of such people whose Screening of the general population was significantly less in pri odraslih osebah, Diabetološko združenje Slovenije, Združenje 10.2337/dc12-2625 PMID: 23468086 diabetes is not detected and about 15% of those who are treated 2020 and 2021. endokrinologov Slovenije [cited 2022 Jan 18]. Available from: [23] Ekonomsko breme sladkorne bolezni v Sloveniji 2012 [cited 2022 non-pharmacologically. If we add the estimate to the actual A similar study was conducted in the United Kingdom (UK) in https://endodiab.si/priporocila/smernice-za-vodenje-sladkorne-bolezni/ Nov 30]. Available from: https://www.nijz.si/sl/ekonomsko- number of patients with diabetes, there are around 173,846 2021, where 15 million patients were monitored between breme-sladkorne-bolezni-v-sloveniji-2012-0 people with diabetes or 8.3% of the population (24). March 1, 2020 and December 10, 2020, during the strictest [12] Slovenske smernice za klinično obravnavo sladkorne bolezni tipa 2 pri odraslih osebah. Diabetološko združenje Slovenije, Združenje [24] Obvladovanje sladkorne bolezni v letu 2020 [cited 2022 Nov 30]. In 2021, SARS-CoV2 infection was also added to the narrower COVID measures. They compared the incidence of DM2 in the endokrinologov Slovenije, Klinični oddelek za endokrinologijo, Available from: set of indicators for monitoring the management of diabetes in UK, the frequency of HbA1c measurements and the mortality diabetes in presnovne bolezni, Interna klinika UKC Ljubljana. https://www.nijz.si/sites/www.nijz.si/files/datoteke/prva_objava Slovenia. According to data for 2020, more than one quarter of of patients due to DM2. It turned out that in April 2020, from Ljubljana, 2015. _sb_2020.pdf those who died from COVID-19 (the main cause of death) the expected 40 newly diagnosed patients/100,000 inhabitants, [13] Bulc M, Zaletel J. Obvladovanje sladkorne bolezni tip 2 v [25] EuroPrevent 2018: Report from the European Congress on received diabetes medication in the year before the date of the actual number of newly diagnosed patients fell to družinski medicini [cited 2022 Jan 20]. Available from: Preventive Cardiology 19-21 April, 2018, in Ljubljana, Slovenia http://www.referencna-ambulanta [cited 2022 Nov 30]. Available from: death(24). 12/100,000 inhabitants. In the following months, the number https://pubmed.ncbi.nlm.nih.gov/30428032/ DOI: Impact of the COVID-19 epidemic on the management of of newly diagnosed patients increased again, but by the end of [14] Bulc M, Zaletel, Protokol odkrivanja in vodenja sladkorne bolezni tipa 2 [cited 2022 Jan 18]. Available from: 10.1093/eurheartj/ehy665 PMID: 30428032 patients with arterial hypertension and diabetes the year it had not reached the average compared to previous http://www.referencna-ambulanta.si/ [26] Diabetes and COVID-19 [cited 2022 Dec 01]. Available from: The primary goal of treatment for AH and DM2 is to prevent years. At the same time, the mortality of patients with DM2 [15] Computer-based diabetes self-management interventions for adults https://www.cdc.gov/diabetes/library/reports/reportcard/diabetes- the occurrence of cardiovascular diseases and prevent increased by twofold(28). with type 2 diabetes mellitus [cited 2022 Oct 28]. Available from: and-covid19.html premature mortality, so early detection and prevention of the DM2 develops over several years, the development of the https://pubmed.ncbi.nlm.nih.gov/23543567/DOI: [27] Impact of undiagnosed type 2 diabetes and pre-diabetes on severity disease is even more important. disease depends on many factors, so it is unlikely that a change 10.1002/14651858.CD008776.pub2 PMID: 23543567 and mortality for SARS-CoV-2 infection [cited 2022 Dec 01]. The treatment of non-communicable chronic diseases includes, in lifestyle during a pandemic will affect the incidence of DM2 [16] Initial management of hyperglycemia in adults with type 2 Available from: https://drc.bmj.com/content/9/1/e002026 in addition to medication, lifestyle changes, weight loss, in the general population. Assuming incidence remains the diabetes mellitus [cited 2022 Oct 28]. Available from: [28] Impact of COVID-19 on diagnoses, monitoring, and mortality in dietary measures, etc., which primarily requires motivation. same, around 60,000 patients with DM2 were missed or later https://www.uptodate.com/contents/initial-management-of-people with type 2 diabetes in the UK [cited 2022 Dec 01]. hyperglycemia-in-adults-with-type-2-diabetes-mellitus Available from: People can gain part of their motivation by regularly detected in the UK alone between March and December 2020 https://www.thelancet.com/journals/landia/article/PIIS2213- monitoring their health status and its improvement. This is according to this survey(28). This figure could be even higher [17] Koronavirus, ključne informacije [cited 2022 Mar 10]. Available from:https://www.nijz.si/sl/koronavirus-2019-ncov 8587(21)00116-9/fulltext achieved, among other things, through regular check-ups in the in the coming years due to the general deterioration of the DOI:https://doi.org/10.1016/S2213-8587(21)00116-9 general medicine clinic or in the reference clinic. Therefore, quality of life during the pandemic (increase in body weight [18] The top 10 causes of death [cited 2022 Oct 25]. Available from: follow-up examinations are almost as important to the general due to limited movement, poorer nutrition, increased drinking health of the population as early detection of the disease. In of alcoholic beverages and the impact on the quality of sleep 2018, at the Congress of the European Association for and psychological stress brought by the feeling of being Preventive Cardiology EuroPrevent, in which Slovenia also threatened during the pandemic ). participated, the results of the EuroAspire survey were presented, which shows that many coronary patients also have diabetes. A glucose stress test was performed on patients REFERENCES hospitalized for heart attack and the proportion of patients with [1] Govc Eržen J, Petek Šter M, Priročnik za zdravnike družinske DM2 was shown to increase by 2x. In our area, 53% of patients medicine; Izvajanje integrirane preventive kroničnih nenalezljivih bolezni v referenčnih ambulantah družinske medicine, Ljubljana, who have suffered a heart attack also have DM2. Coronary 2017. patients with diabetes, however, have up to four times higher [2] Levels of Disease Prevention. Centers for Disease Control and risk of recurrent cardiovascular complications. In such Prevention, Atlanta, 2007. patients, therefore, an even more intensive control of the [3] Martins C. et al. Eur J Gen Pract 2017 Dec;24(1):106-111. regulation of AH and DM2 is needed (25). Early research in the US from January to May 2020 also [4] WONCA International Dictionary for General/Family Practice, 2003. showed that patients diagnosed with AH or DM2 or those who had the disease but were undetected were about six times more [5] CINDI v Sloveniji [cited 2022 Jan 15]. Available from: http://cindi- likely to be hospitalized with SARS-CoV2 and 12 times more slovenija.net/index.php?option=com_content&task=view&id=16 likely to die. In addition, older age, other chronic diseases and 7&Itemid=84 100 primary and secondary level, accounted for around 25% of the lower socioeconomic status also increased the probability of a [6] Referenčna ambulanta [cited 2022 Jan 15]. Available from: https://www.who.int/news-room/fact-sheets/detail/the-top-10- annual costs(23). worse course of the disease(26). http://www.referencna-ambulanta.si/ causes-of-death In addition to the direct costs, the indirect costs of the disease In 2020, Mexican researchers who investigated the connection [7] Petek Šter M, Bulc M, Accetto R, Petek D, Salobir B. Žontar T, [19] Cohen J. "The cost savings and cost-effectiveness of clinical are also added, which include the financial consequences of between undetected DM2, a confirmed diagnosis of DM2 and Škorič S, Jovanovič E. Protokol vodenja arterijske hipertenzije in preventative [sic] care. Robert Wood Johnson Foundation". The lost productivity due to morbidity and mortality. In this same the course of the COVID infection suggested that HbA1c ukrepanje ob njenih poslabšanjih/zapletih (2017) – modifikacija Synthesis Project. Robert Wood Johnson Foundation . Research Synthesis report No.18, September 2009. research, the estimated indirect costs amounted to EUR 5.5 should also be checked in the drawn blood sample of every protokola 2013. million, of which the patient stock was EUR 2.3 million and patient admitted to the hospital due to SARS-CoV2 infection. [8] Accetto R, Salobir B, Brguljan Hitij J, Dolenc P. Slovenske [20] Does Preventive Care Save Money? Health Economics and the smernice za obravnavo hipertenzije 2013. Zdrav Vestn 2014; 83: Presidential Candidates [cited 2022 Oct 25]. Available from: the lost future income was EUR 3.2 million. Due to the lack of In this way, we would discover many people who have DM2 727–58. https://pubmed.ncbi.nlm.nih.gov/18272889/ DOI: data on disability and premature retirements as a result of but do not yet have a confirmed diagnosis, and this would be [9] Initial Treatment of Hypertension [cited 2022 Oct 28]. Available 10.1056/NEJMp0708558 PMID: 18272889 diabetes, it was not possible to estimate this cost completely useful mainly because of easier prediction of the course of from: https://pubmed.ncbi.nlm.nih.gov/12584370/ DOI: [21] A Monte Carlo simulation approach for estimatih the health and accurately, so the estimate of indirect costs is also significantly infection with SARS-CoV2(27). 10.1056/NEJMcp010357 PMID: 12584370 economic impact of interventions provided at a student-run clinic underestimated(23). The number of all examinations in 2020-2021 was reduced, but [10] Materson BJ, Reda DJ, Cushman WC, et al. Single-drug therapy for [cited 2022 Oct 25]. Available from: In 2020, there were 118,215 recipients of glucose-lowering those patients who were diagnosed with a new chronic non-hypertension in men: a comparison of six antihypertensive agents https://ui.adsabs.harvard.edu/abs/2017PLoSO..1289718A/abstra with placebo. N Engl J Med 1993;328: 914-21. [Erratum, N Engl J ct/DOI: 10.1371/journal.pone.0189718 drugs in Slovenia, which is 1.6% (1,841 people) more than in communicable disease during this time were still treated Med 1994;330: 1689.] 2019 or as much as 41% (34,570 people) more than in 2008. according to the guidelines on the monitoring of their disease. [22] Economic costs of diabetes in the U.S. in 2012 [28.10.2022]. [11] Slovenske smernice za klinično obravnavo sladkorne bolezni tipa 2 Dosegljivo na: https://pubmed.ncbi.nlm.nih.gov/23468086/ DOI: They calculated that there are about 20% of such people whose Screening of the general population was significantly less in pri odraslih osebah, Diabetološko združenje Slovenije, Združenje 10.2337/dc12-2625 PMID: 23468086 diabetes is not detected and about 15% of those who are treated 2020 and 2021. endokrinologov Slovenije [cited 2022 Jan 18]. Available from: [23] Ekonomsko breme sladkorne bolezni v Sloveniji 2012 [cited 2022 non-pharmacologically. If we add the estimate to the actual A similar study was conducted in the United Kingdom (UK) in https://endodiab.si/priporocila/smernice-za-vodenje-sladkorne-bolezni/ Nov 30]. Available from: https://www.nijz.si/sl/ekonomsko- number of patients with diabetes, there are around 173,846 2021, where 15 million patients were monitored between breme-sladkorne-bolezni-v-sloveniji-2012-0 people with diabetes or 8.3% of the population (24). March 1, 2020 and December 10, 2020, during the strictest [12] Slovenske smernice za klinično obravnavo sladkorne bolezni tipa 2 pri odraslih osebah. Diabetološko združenje Slovenije, Združenje [24] Obvladovanje sladkorne bolezni v letu 2020 [cited 2022 Nov 30]. In 2021, SARS-CoV2 infection was also added to the narrower COVID measures. They compared the incidence of DM2 in the endokrinologov Slovenije, Klinični oddelek za endokrinologijo, Available from: set of indicators for monitoring the management of diabetes in UK, the frequency of HbA1c measurements and the mortality diabetes in presnovne bolezni, Interna klinika UKC Ljubljana. https://www.nijz.si/sites/www.nijz.si/files/datoteke/prva_objava Slovenia. According to data for 2020, more than one quarter of of patients due to DM2. It turned out that in April 2020, from Ljubljana, 2015. _sb_2020.pdf those who died from COVID-19 (the main cause of death) the expected 40 newly diagnosed patients/100,000 inhabitants, [13] Bulc M, Zaletel J. Obvladovanje sladkorne bolezni tip 2 v [25] EuroPrevent 2018: Report from the European Congress on received diabetes medication in the year before the date of the actual number of newly diagnosed patients fell to družinski medicini [cited 2022 Jan 20]. Available from: Preventive Cardiology 19-21 April, 2018, in Ljubljana, Slovenia http://www.referencna-ambulanta [cited 2022 Nov 30]. Available from: death(24). 12/100,000 inhabitants. In the following months, the number https://pubmed.ncbi.nlm.nih.gov/30428032/ DOI: Impact of the COVID-19 epidemic on the management of of newly diagnosed patients increased again, but by the end of [14] Bulc M, Zaletel, Protokol odkrivanja in vodenja sladkorne bolezni tipa 2 [cited 2022 Jan 18]. Available from: 10.1093/eurheartj/ehy665 PMID: 30428032 patients with arterial hypertension and diabetes the year it had not reached the average compared to previous http://www.referencna-ambulanta.si/ [26] Diabetes and COVID-19 [cited 2022 Dec 01]. Available from: The primary goal of treatment for AH and DM2 is to prevent years. At the same time, the mortality of patients with DM2 [15] Computer-based diabetes self-management interventions for adults https://www.cdc.gov/diabetes/library/reports/reportcard/diabetes- the occurrence of cardiovascular diseases and prevent increased by twofold(28). with type 2 diabetes mellitus [cited 2022 Oct 28]. Available from: and-covid19.html premature mortality, so early detection and prevention of the DM2 develops over several years, the development of the https://pubmed.ncbi.nlm.nih.gov/23543567/DOI: [27] Impact of undiagnosed type 2 diabetes and pre-diabetes on severity disease is even more important. disease depends on many factors, so it is unlikely that a change 10.1002/14651858.CD008776.pub2 PMID: 23543567 and mortality for SARS-CoV-2 infection [cited 2022 Dec 01]. The treatment of non-communicable chronic diseases includes, in lifestyle during a pandemic will affect the incidence of DM2 [16] Initial management of hyperglycemia in adults with type 2 Available from: https://drc.bmj.com/content/9/1/e002026 in addition to medication, lifestyle changes, weight loss, in the general population. Assuming incidence remains the diabetes mellitus [cited 2022 Oct 28]. Available from: [28] Impact of COVID-19 on diagnoses, monitoring, and mortality in dietary measures, etc., which primarily requires motivation. same, around 60,000 patients with DM2 were missed or later https://www.uptodate.com/contents/initial-management-of-people with type 2 diabetes in the UK [cited 2022 Dec 01]. hyperglycemia-in-adults-with-type-2-diabetes-mellitus Available from: People can gain part of their motivation by regularly detected in the UK alone between March and December 2020 https://www.thelancet.com/journals/landia/article/PIIS2213- monitoring their health status and its improvement. This is according to this survey(28). This figure could be even higher [17] Koronavirus, ključne informacije [cited 2022 Mar 10]. Available from:https://www.nijz.si/sl/koronavirus-2019-ncov 8587(21)00116-9/fulltext achieved, among other things, through regular check-ups in the in the coming years due to the general deterioration of the DOI:https://doi.org/10.1016/S2213-8587(21)00116-9 general medicine clinic or in the reference clinic. Therefore, quality of life during the pandemic (increase in body weight [18] The top 10 causes of death [cited 2022 Oct 25]. Available from: follow-up examinations are almost as important to the general due to limited movement, poorer nutrition, increased drinking health of the population as early detection of the disease. In of alcoholic beverages and the impact on the quality of sleep 2018, at the Congress of the European Association for and psychological stress brought by the feeling of being Preventive Cardiology EuroPrevent, in which Slovenia also threatened during the pandemic ). participated, the results of the EuroAspire survey were presented, which shows that many coronary patients also have diabetes. A glucose stress test was performed on patients REFERENCES hospitalized for heart attack and the proportion of patients with [1] Govc Eržen J, Petek Šter M, Priročnik za zdravnike družinske DM2 was shown to increase by 2x. In our area, 53% of patients medicine; Izvajanje integrirane preventive kroničnih nenalezljivih bolezni v referenčnih ambulantah družinske medicine, Ljubljana, who have suffered a heart attack also have DM2. Coronary 2017. patients with diabetes, however, have up to four times higher [2] Levels of Disease Prevention. Centers for Disease Control and risk of recurrent cardiovascular complications. In such Prevention, Atlanta, 2007. patients, therefore, an even more intensive control of the [3] Martins C. et al. Eur J Gen Pract 2017 Dec;24(1):106-111. regulation of AH and DM2 is needed (25). Early research in the US from January to May 2020 also [4] WONCA International Dictionary for General/Family Practice, 2003. showed that patients diagnosed with AH or DM2 or those who had the disease but were undetected were about six times more [5] CINDI v Sloveniji [cited 2022 Jan 15]. Available from: http://cindi- likely to be hospitalized with SARS-CoV2 and 12 times more slovenija.net/index.php?option=com_content&task=view&id=16 likely to die. In addition, older age, other chronic diseases and 7&Itemid=84 101 Science day with health education - experiences of In the Health Promotion Centre at the Kranj Health Centre, as during the health education content delivery and the part of health education for children and adolescents, providers comprehensibility of the content. health professionals, teachers and students enter and organise science days with various additional topics in addition to the regular health education workshops. The most II. MATERIAL AND METHODS common topics are basic resuscitation procedures, stopping The research was based on a quantitative non-experimental Jana Lavtižar, Tanja Podlipnik bleeding and removing foreign objects from the respiratory descriptive method of work. In the theoretical part, we used the Health Center Kranj tract, social networking, exercise, mental health, sleep and nutrition. method of reviewing the relevant domestic and foreign podlipnik.tanja@gmail.com literature. PubMed, Science Direct, Research Gate and For several years now, providers of health education for CINAHL were used for the literature search. Keywords used Abstract— The school environment is key to providing children in Slovenia is to teach about healthy lifestyles. In doing so, they children and adolescents have been confronted with the for the literature search were: health education for children and and adolescents with the knowledge and skills to lead a healthy make a significant contribution to improving the healthy problem of excessive use of information and communication adolescents, exercise for children and adolescents, social lifestyle. Members of the multidisciplinary team of the Health lifestyles of children and adolescents or to reducing the technologies by children and adolescents in primary schools. A networks, healthy eating. Promotion Centre or the Health Education Centre working in emergence and further development of risky behaviours. It survey (1) was carried out in four primary schools among fifth-health centres play an important role in introducing these links with educational institutions and enters classrooms to grade pupils to determine the timing and type of ICT use. The We asked the following research questions: important topics. Children and adolescents are interested in empower children and adolescents to adopt healthy lifestyles results show that students use ICT for an average of 147 personal development and health as they grow up. Health Which health education topics are most interesting for (9). minutes per day. 85% of 15-18 year olds use social networks. education programme providers (workshops and lectures) are There is a clear difference in use, between genders, with boys students? seen as trustworthy among children and adolescents. With a Health education for children and adolescents abroad is not the using it more often than girls. The health system should professional approach and interesting content, they can ensure same as in Slovenia. In several European countries, including What is the engagement of pupils during the delivery of health emphasise the development of safe use of social networks and that children and adolescents develop the skills they need to grow Spain, Finland, Norway and England, the school system is education content? provide effective mental health support to those who need it up healthy and lead a healthy lifestyle. A descriptive quantitative organised in such a way that educational institutions employ a Similar to research abroad, new "online" risky behaviours and What is the students' understanding of the health education method of empirical research was carried out. The sample was school nurse to educate children and adolescents about healthy signs of new forms of addiction are emerging in Slovenia (4). content given ? purposive. Questionnaires were distributed to students, teachers lifestyles and prevention of risky behaviours, and to implement Children and adolescents need restrictions on their use, but and health education providers in April and May 2023. Students interventions to achieve better health (10) In foreign countries, In the empirical part, the data were collected using a unfortunately not all of them do. Excessive use results in found the most engaging health education content to be the school nurse has multiple roles and is employed in an questionnaire addressed to the pupils, the teachers of the 'Instagram' (PV = 4.4, SO = 0.96) and the least engaging health inappropriate behaviour of children and adolescents, violence primary schools where the health education day was held and education content to be 'Stop the Bleed' (PV = 3.7, SO = 1.14). The educational establishment and covers the entire health when access to ICT is restricted, lack of exercise leading to the health education providers. In the questionnaire, the pupils practitioners considered that students showed excellent interest education for one or more educational establishments. obesity, and reduced development of communication skills (3). rated the comprehensibility of the health education content in the topics presented (PV = 4.7), as did teachers (PV = 4.4; SO Health-related habits and behaviours developed in childhood Physical activity is one of the most important protective factors presented, the interestingness of the health education content = 0.5). The topic 'Instagram' was the most comprehensible to are with us throughout our lives, so it is important to instil a for adolescents' mental and physical health (9). Physical and the health education content presented using a Likert scale students (PV = 4.8; SO = 0.51), while the topic on stopping healthy lifestyle in childhood, as the introduction and activity is one of the most effective ways to manage stress. It is bleeding was the least comprehensible (PV = 4.2; SO = 0.91). (from 1-fair to 5-excellent). The teacher questionnaire also maintenance of healthy lifestyle habits is the best preventive important that young people, who are highly exposed to Health education and prevention are important during included a Likert scale (from 1-fail to 5-excellent), where behaviour against the onset of many diseases and illnesses (9). adolescence and help children and adolescents to foster healthy stressful situations during their education, are aware of this. It teachers rated the theme of the science day, the organisation lifestyles, including in the school environment. The topics are Despite the fact that adolescence is a privileged period and would be advisable to further motivate young people, equip and information, and the participation of the pupils, and we engaging for pupils, presented in a way that motivates children is generally known as a "disease-free" period, it is nevertheless them with practical and theoretical knowledge and provide were also interested in the time or duration of the science day. and adolescents to participate. Growing up is a period when characterised by certain problematic transformations and them with quality conditions for physical activity also in the When interviewing health education providers, we were also children and adolescents acquire new experiences and, transitions. Due to the gradual transition to sexual maturity, study environment (13). One study (15) found that more than interested in the organisation and space of the science day, consequently, experience hardships along with them. Therefore, teenagers during this period can be more or less confused, half of the adolescents surveyed are physically inactive. The their self-assessment of the preparation and presentation of the it is important to regularly provide health education content that which is why Health Education is a compulsory subject in age and gender of adolescents do not play a significant role in health education content, with respondents rating themselves helps children to cope with personal adversity in order to obtain Finland. This course is mainly aimed at talking about growing this. The need to raise young people's awareness of the professional, quality information. This will help children to grow from 1-fair to 5-fair. In the second part, a Likert scale was used up, sexuality, and they have a digital learning environment, e- prevention of risk factors for chronic non-communicable up in a healthy way and to foster a healthy lifestyle, which is the to assess the level of agreement on the activities in each class books and videos that are aimed at both health education diseases is growing every day (15). Adolescents who are active foundation for maintaining a healthy lifestyle in adulthood. (from 1-do not agree at all to 5-agree completely). teachers and students (16). in sport may be exposed to more stress due to frequent training sessions, environmental expectations and lack of free time. All I. I A purposive, non-random sample was used. 220 questionnaires NTRODUCTION In Slovenia, health education topics for children and of these factors can also potentially increase their susceptibility adolescents include: healthy habits, personal hygiene, healthy to the onset of mental health problems (11). were distributed to pupils, 15 to teachers and 10 to In Slovenia, the health education provider for children and lifestyles, injury prevention, addiction, growing up, positive practitioners. 161 pupils, 9 teachers and 10 health education adolescents is a registered nurse working at the primary health self-image and stress, interpersonal relationships, education for Kostanjevec et al. (6) found that eighth-graders have providers were included in the survey. care level. The National Institute of Public Health (8) develops healthy sexuality, relationships with the body in terms of cancer satisfactory eating habits, which are associated with regular the basic range of topics, while other topical topics are prepared The survey was carried out in April and May 2023 in a primary prevention, and basic CPR procedures using AEDs, among consumption of at least three meals a day, breakfast, fruit and by the staff of the Health Promotion Centres or Health school. Statistical analysis of data processing was carried out others (14). It also highlights the need to standardise the dairy products. Less satisfactory is the consumption of Education Centres themselves. On average, a registered nurse using Microsoft Excel 2016. Descriptive statistics methods delivery of activities, to ensure equal availability and vegetables and fish, sweet and salty snacks, sugary drinks and who is a health education provider enters each classroom at were used to process the data, calculating frequencies, accessibility for all children and adolescents, and to integrate fried foods. The authors found that pupils were familiar with least once during the school year. The role of the registered percentages and mean values for each variable. different professional teams to ensure that health education has healthy foods and dishes and with the basic principles of nurse in Health Promotion Centres or Health Education Centres the best possible preventive effect (14). healthy eating. However, although they have sufficient knowledge about healthy food and eating, they are less attentive III. RESULTS to ensuring that the food they eat is healthy (6). Which health education topics are most interesting for The aim of the study was to find out which health education students? content is most interesting for students, their engagement TABLE 1: INTERESTINGNESS OF HEALTH EDUCATION CONTENT ACCORDING TO STUDENTS 102 Science day with health education - experiences of In the Health Promotion Centre at the Kranj Health Centre, as during the health education content delivery and the part of health education for children and adolescents, providers comprehensibility of the content. health professionals, teachers and students enter and organise science days with various additional topics in addition to the regular health education workshops. The most II. MATERIAL AND METHODS common topics are basic resuscitation procedures, stopping The research was based on a quantitative non-experimental Jana Lavtižar, Tanja Podlipnik bleeding and removing foreign objects from the respiratory descriptive method of work. In the theoretical part, we used the Health Center Kranj tract, social networking, exercise, mental health, sleep and nutrition. method of reviewing the relevant domestic and foreign podlipnik.tanja@gmail.com literature. PubMed, Science Direct, Research Gate and For several years now, providers of health education for CINAHL were used for the literature search. Keywords used Abstract— The school environment is key to providing children in Slovenia is to teach about healthy lifestyles. In doing so, they children and adolescents have been confronted with the for the literature search were: health education for children and and adolescents with the knowledge and skills to lead a healthy make a significant contribution to improving the healthy problem of excessive use of information and communication adolescents, exercise for children and adolescents, social lifestyle. Members of the multidisciplinary team of the Health lifestyles of children and adolescents or to reducing the technologies by children and adolescents in primary schools. A networks, healthy eating. Promotion Centre or the Health Education Centre working in emergence and further development of risky behaviours. It survey (1) was carried out in four primary schools among fifth-health centres play an important role in introducing these links with educational institutions and enters classrooms to grade pupils to determine the timing and type of ICT use. The We asked the following research questions: important topics. Children and adolescents are interested in empower children and adolescents to adopt healthy lifestyles results show that students use ICT for an average of 147 personal development and health as they grow up. Health Which health education topics are most interesting for (9). minutes per day. 85% of 15-18 year olds use social networks. education programme providers (workshops and lectures) are There is a clear difference in use, between genders, with boys students? seen as trustworthy among children and adolescents. With a Health education for children and adolescents abroad is not the using it more often than girls. The health system should professional approach and interesting content, they can ensure same as in Slovenia. In several European countries, including What is the engagement of pupils during the delivery of health emphasise the development of safe use of social networks and that children and adolescents develop the skills they need to grow Spain, Finland, Norway and England, the school system is education content? provide effective mental health support to those who need it up healthy and lead a healthy lifestyle. A descriptive quantitative organised in such a way that educational institutions employ a Similar to research abroad, new "online" risky behaviours and What is the students' understanding of the health education method of empirical research was carried out. The sample was school nurse to educate children and adolescents about healthy signs of new forms of addiction are emerging in Slovenia (4). content given ? purposive. Questionnaires were distributed to students, teachers lifestyles and prevention of risky behaviours, and to implement Children and adolescents need restrictions on their use, but and health education providers in April and May 2023. Students interventions to achieve better health (10) In foreign countries, In the empirical part, the data were collected using a unfortunately not all of them do. Excessive use results in found the most engaging health education content to be the school nurse has multiple roles and is employed in an questionnaire addressed to the pupils, the teachers of the 'Instagram' (PV = 4.4, SO = 0.96) and the least engaging health inappropriate behaviour of children and adolescents, violence primary schools where the health education day was held and education content to be 'Stop the Bleed' (PV = 3.7, SO = 1.14). The educational establishment and covers the entire health when access to ICT is restricted, lack of exercise leading to the health education providers. In the questionnaire, the pupils practitioners considered that students showed excellent interest education for one or more educational establishments. obesity, and reduced development of communication skills (3). rated the comprehensibility of the health education content in the topics presented (PV = 4.7), as did teachers (PV = 4.4; SO Health-related habits and behaviours developed in childhood Physical activity is one of the most important protective factors presented, the interestingness of the health education content = 0.5). The topic 'Instagram' was the most comprehensible to are with us throughout our lives, so it is important to instil a for adolescents' mental and physical health (9). Physical and the health education content presented using a Likert scale students (PV = 4.8; SO = 0.51), while the topic on stopping healthy lifestyle in childhood, as the introduction and activity is one of the most effective ways to manage stress. It is bleeding was the least comprehensible (PV = 4.2; SO = 0.91). (from 1-fair to 5-excellent). The teacher questionnaire also maintenance of healthy lifestyle habits is the best preventive important that young people, who are highly exposed to Health education and prevention are important during included a Likert scale (from 1-fail to 5-excellent), where behaviour against the onset of many diseases and illnesses (9). adolescence and help children and adolescents to foster healthy stressful situations during their education, are aware of this. It teachers rated the theme of the science day, the organisation lifestyles, including in the school environment. The topics are Despite the fact that adolescence is a privileged period and would be advisable to further motivate young people, equip and information, and the participation of the pupils, and we engaging for pupils, presented in a way that motivates children is generally known as a "disease-free" period, it is nevertheless them with practical and theoretical knowledge and provide were also interested in the time or duration of the science day. and adolescents to participate. Growing up is a period when characterised by certain problematic transformations and them with quality conditions for physical activity also in the When interviewing health education providers, we were also children and adolescents acquire new experiences and, transitions. Due to the gradual transition to sexual maturity, study environment (13). One study (15) found that more than interested in the organisation and space of the science day, consequently, experience hardships along with them. Therefore, teenagers during this period can be more or less confused, half of the adolescents surveyed are physically inactive. The their self-assessment of the preparation and presentation of the it is important to regularly provide health education content that which is why Health Education is a compulsory subject in age and gender of adolescents do not play a significant role in health education content, with respondents rating themselves helps children to cope with personal adversity in order to obtain Finland. This course is mainly aimed at talking about growing this. The need to raise young people's awareness of the professional, quality information. This will help children to grow from 1-fair to 5-fair. In the second part, a Likert scale was used up, sexuality, and they have a digital learning environment, e- prevention of risk factors for chronic non-communicable up in a healthy way and to foster a healthy lifestyle, which is the to assess the level of agreement on the activities in each class books and videos that are aimed at both health education diseases is growing every day (15). Adolescents who are active foundation for maintaining a healthy lifestyle in adulthood. (from 1-do not agree at all to 5-agree completely). teachers and students (16). in sport may be exposed to more stress due to frequent training sessions, environmental expectations and lack of free time. All I. INTRODUCTION In Slovenia, health education topics for children and of these factors can also potentially increase their susceptibility A purposive, non-random sample was used. 220 questionnaires adolescents include: healthy habits, personal hygiene, healthy to the onset of mental health problems (11). were distributed to pupils, 15 to teachers and 10 to In Slovenia, the health education provider for children and lifestyles, injury prevention, addiction, growing up, positive practitioners. 161 pupils, 9 teachers and 10 health education adolescents is a registered nurse working at the primary health self-image and stress, interpersonal relationships, education for Kostanjevec et al. (6) found that eighth-graders have providers were included in the survey. care level. The National Institute of Public Health (8) develops healthy sexuality, relationships with the body in terms of cancer satisfactory eating habits, which are associated with regular the basic range of topics, while other topical topics are prepared The survey was carried out in April and May 2023 in a primary prevention, and basic CPR procedures using AEDs, among consumption of at least three meals a day, breakfast, fruit and by the staff of the Health Promotion Centres or Health school. Statistical analysis of data processing was carried out others (14). It also highlights the need to standardise the dairy products. Less satisfactory is the consumption of Education Centres themselves. On average, a registered nurse using Microsoft Excel 2016. Descriptive statistics methods delivery of activities, to ensure equal availability and vegetables and fish, sweet and salty snacks, sugary drinks and who is a health education provider enters each classroom at were used to process the data, calculating frequencies, accessibility for all children and adolescents, and to integrate fried foods. The authors found that pupils were familiar with least once during the school year. The role of the registered percentages and mean values for each variable. different professional teams to ensure that health education has healthy foods and dishes and with the basic principles of nurse in Health Promotion Centres or Health Education Centres the best possible preventive effect (14). healthy eating. However, although they have sufficient knowledge about healthy food and eating, they are less attentive III. RESULTS to ensuring that the food they eat is healthy (6). Which health education topics are most interesting for The aim of the study was to find out which health education students? content is most interesting for students, their engagement TABLE 1: INTERESTINGNESS OF HEALTH EDUCATION CONTENT ACCORDING TO STUDENTS 103 TABLE 3: STUDENTS' SELF-ASSESSMENT OF PARTICIPATION DURING mentioned there, besides referring to his findings, also some as a mandatory part of the health education curriculum already Contents n AV SD HEALTH EDUCATION DELIVERY COMPARED TO TEACHERS' AND foreign literature; sure (see introduction)The virtual world is an in primary schools. Research shows that adolescents PROVIDERS' ASSESSMENT OF PARTICIPATION Basic 161 4,5 0,85 additional source of information for adolescents about outperform adults in all areas of TPO (12). Contents n AV SD resuscitation themselves, the changes that are happening to them, a source of Health education and prevention are important during Teachers 9 4,4 0,5 information about self-image formation, also about the search Stopping 161 3,5 1,25 for a sexual identity; the virtual world is also a source of adolescence and help children and adolescents to foster healthy bleeding Health 10 4,7 0,49 information for adolescents about themselves, the changes that lifestyles, including in the school environment. The topics are education engaging for pupils, presented in a way that motivates children New fashion 161 4,3 0,96 are happening to them, a source of information about the providers and adolescents to participate. Growing up is a period when icon - formation of a self-image, also about the search for a sexual children and adolescents acquire new experiences and, screens Students 161 4,15 1,01 identity. Through the Internet, they seek and experiment with contacts, while at the same time maintaining existing contacts consequently, experience hardships along with them. Therefore, it is important to regularly provide health education Instagram 161 4,5 0,76 Legend: n = sample size; AV = arrange value; SD = standard deviation; with their "real" peers. Excessive control or restriction of online Scale: 1-inadequate, 2-insufficient, 3-good, 4-good, 5-excellent contact will only lead to rebellion on the part of the teenager content that also helps children to cope with personal adversity, Positive self- 161 4,3 0,86 and a loss of valuable, confidential contact. It is precisely in order to obtain professional, quality information. This will image, stress Teachers generally rate student participation with a mean score help children to grow up in a healthy way and to foster healthy of AV = 4.4 (SD = 0.5), and health educators with a mean score because of these considerations that it is necessary to explain to lifestyles, which will form the basis for maintaining healthy Moving 161 3,4 1,27 of 4.7 (SD= 0.49) (Table 3) children and adolescents how the use of information and lifestyles in adulthood. around communication technologies can affect their physical and mental health (4). In the secJond research question, we asked Legend: n = sample size; AV = arrange value; SD = standard deviation; the teachers present during the lectures, the providers of health REFERENCES Scale: 1-inadequate, 2-insufficient, 3-good, 4-good, 5-excellent What is the students' understanding of the health education content given ? education and the students themselves about their self- assessment of their participation in the health education content. Table 1 shows how students rated the interestingness of the Teachers gave excellent evaluations of the pupils' participation. [1] BAJC, Aljaž, TOMŠIČ, Žiga, KAJZAR, Jure, JEREB,et al. The health education content provided. They rated "Basic CPR" TABLE 4: ASSESSMENT OF THE HEALTH EDUCATION CONTENT However, students gave the highest participation score for the impact of social media on the children mental health. V: PETELIN, Ana (ur.), et al. Zdravje otrok in mladostnikov = Health of children (AV = 4.5, SD = 0.85) and "Instagram" (AV = 4.5, SD = 0.76) UNDERSTOOD content on 'Instagram', which we attribute to the topicality of and adolescents : [proceedings], Zdravje otrok in mladostnikov, as the most interesting content, and "Moving" (AV = 4.3, SD = Contents n AV SD the content, as most adolescents have contact with social znanstvena in strokovna konferenca z mednarodno udeležbo, 1.27) as the least interesting content. networks. The lowest engagement score was for the content on Basic 161 4,6 0,75 Portorož, 20. september 2019. Koper: University of Primorska stopping bleeding (PV = 3.7). We need to be aware that, Press. 2019; 9-15. resuscitation What is the engagement of pupils during the delivery of health especially for teenagers, contact with blood is more likely to education content? Stopping 161 4,2 0,91 cause discomfort and, some might say, stigma, so we attribute the lowest average score for the content on stopping bleeding to [2] Bozjak, B. & Pogorevc, N. Psychoactive substances (Drugs) and bleeding this fact. One of the most common non-chemical addictions addiction. In. Attitudes to the Body, Handbook for Health Education Providers in Primary Health Care. Ljubljana: National TABLE 2: STUDENTS' SELF-ASSESSMENT OF THEIR PARTICIPATION IN New fashion 161 4,6 0,71 among young people today is internet addiction. Adolescents Institute of Public Health; 2020. pp.95-140. HEALTH EDUCATION icon - develop an emotional attachment to online friends and activities [3] Demšar, T. The use of information and communication screens they create on their computer screens. Internet addiction also technologies by fifth grade students; 2019. Contents n AV SD Instagram 161 4,8 0,51 affects other areas of a young person's life, in personal, family, Basic 161 4,3 1,08 financial and professional spheres. Internet addiction also resuscitation Positive self- 161 4,3 0,95 affects adolescents' relationships with each other, their family [4] Jeriček Klanšček, H., Zupanič, T., Roškar, M., et al. New "online" image, stress environment, friends and work environment (2). challenges in adolescent health in Slovenia; 2019. Stopping 161 3,7 1,14 [5] Livk, M. How to reach the goal: Every child knows BLS. In. Vajd, bleeding Moving 161 4,3 0,97 In the third research question, students were asked how they R., Zelinka , M. (eds.). Emergency medicine 2023 selected topics; around understood the health education content. The most understood 2023. pp. 62-71. New fashion 161 4,2 0,97 content was again about Instagram and screens, which again icon - Legend: n = sample size; AV = arrange value; SD = standard deviation; Scale: 1-inadequate, 2-insufficient, 3-good, 4-good, 5-excellent can be attributed to the topicality of the topic among screens adolescents. Understanding of the topic of basic resuscitation procedures was also rated as excellent. The Kranj Health Instagram 161 4,4 0,96 [6] Kostanjevec, S., Juriševič M., Torkar, G. Eating habits and at itudes Table 4 shows the extent to which students understood the Promotion Centre has established good cooperation with towards healthy eating among eighth-grade students; 2019. Positive self- 161 4,3 0,95 health education content. The most understood topic was educational institutions and set up a system for teaching TPO [7] Kranjc; P. Mass education of primary schoolchildren in basic image, stress "Instagram" (AV = 4.8, SD = 0.51), while the least understood over the years. In 2014, a new algorithm was created with the resuscitation procedures using an automated external defibrillator; Kranj Emergency Medical Unit, according to which lay TPO is 2017. Moving 161 4,0 1,00 was the topic on stopping bleeding (AV = 4.2, SD = 0.91). taught. It is the "5 Fingers" algorithm, which was also presented around [8] National Institute of Public Health [Internet]. Health education IV. DISCUSSION at one of the previous Emergency Medicine Congresses. This for children and adolescents (schoolchildren). [cited 2023 Sep 23]. Avaliable from: https://www.nijz.si/sl/vzgoja-za-zdravje-za- Legend: n = sample size; AV = arrange value; SD = standard deviation; algorithm is used by 58% of the respondents. Of course, we also In the survey, we wanted to find out which health education otroke-in-mladostnike-solarje. Scale: 1-inadequate, 2-insufficient, 3-good, 4-good, 5-excellent use it when teaching lay people. The experience is excellent as content was most interesting to students, how engaged they it is easy to understand and remember (5). Primary school Table 2 shows the students' self-assessment of their were during the health education content and whether the children who had previously undergone mass education in TPO participation during the health education content. They content was comprehensible to students. using an automatic defibrillator had satisfactory knowledge and [9] National Institute of Public Health (NIJZ) [Internet]. Health perceived that they participated the most during the health Statistical Yearbook 2015. National Institute of Public Health, skills to perform TPO and use an AED. Primary school students 2017. [cited 2023 Sep 23]. Available from: education content "Instagram" (AV = 4.4; SD = 0.96) and the The study found that the health education content that was most interesting to students was the basic resuscitation are one of the highly motivated and receptive groups of http://www.nijz.si/sites/www.nijz.si/files/publikacijedatoteke/zdra least during the health education content "Stop bleeding" (AV vstvenistatisticniletopis_2015_3.pdf procedures, both the lecture and the practical part, and the individuals, and they also disseminate this knowledge to the = 3.7; SD = 1.14). content on Instagram. One more thing about TPO - they can use wider local community, including adults (7). Early education of [10] Papler, L., Milavec Kapun, M., Kvas, A. Children's health care in as a source a reference to a paper published by Matjaž, he has children about TPO is very important and should be introduced the hands of teachers instead of school nurses. In A. Kvas & K. Kacjan Žgajnar (Eds.), 10th Student Conference of Health 104 TABLE 3: STUDENTS' SELF-ASSESSMENT OF PARTICIPATION DURING mentioned there, besides referring to his findings, also some as a mandatory part of the health education curriculum already Contents n AV SD HEALTH EDUCATION DELIVERY COMPARED TO TEACHERS' AND foreign literature; sure (see introduction)The virtual world is an in primary schools. Research shows that adolescents PROVIDERS' ASSESSMENT OF PARTICIPATION Basic 161 4,5 0,85 additional source of information for adolescents about outperform adults in all areas of TPO (12). Contents n AV SD resuscitation themselves, the changes that are happening to them, a source of Health education and prevention are important during Teachers 9 4,4 0,5 information about self-image formation, also about the search Stopping 161 3,5 1,25 for a sexual identity; the virtual world is also a source of adolescence and help children and adolescents to foster healthy bleeding Health 10 4,7 0,49 information for adolescents about themselves, the changes that lifestyles, including in the school environment. The topics are education engaging for pupils, presented in a way that motivates children New fashion 161 4,3 0,96 are happening to them, a source of information about the providers and adolescents to participate. Growing up is a period when icon - formation of a self-image, also about the search for a sexual children and adolescents acquire new experiences and, screens Students 161 4,15 1,01 identity. Through the Internet, they seek and experiment with contacts, while at the same time maintaining existing contacts consequently, experience hardships along with them. Therefore, it is important to regularly provide health education Instagram 161 4,5 0,76 Legend: n = sample size; AV = arrange value; SD = standard deviation; with their "real" peers. Excessive control or restriction of online Scale: 1-inadequate, 2-insufficient, 3-good, 4-good, 5-excellent contact will only lead to rebellion on the part of the teenager content that also helps children to cope with personal adversity, Positive self- 161 4,3 0,86 and a loss of valuable, confidential contact. It is precisely in order to obtain professional, quality information. This will image, stress Teachers generally rate student participation with a mean score help children to grow up in a healthy way and to foster healthy of AV = 4.4 (SD = 0.5), and health educators with a mean score because of these considerations that it is necessary to explain to lifestyles, which will form the basis for maintaining healthy Moving 161 3,4 1,27 of 4.7 (SD= 0.49) (Table 3) children and adolescents how the use of information and lifestyles in adulthood. around communication technologies can affect their physical and mental health (4). In the secJond research question, we asked Legend: n = sample size; AV = arrange value; SD = standard deviation; the teachers present during the lectures, the providers of health REFERENCES Scale: 1-inadequate, 2-insufficient, 3-good, 4-good, 5-excellent What is the students' understanding of the health education content given ? education and the students themselves about their self- assessment of their participation in the health education content. Table 1 shows how students rated the interestingness of the Teachers gave excellent evaluations of the pupils' participation. [1] BAJC, Aljaž, TOMŠIČ, Žiga, KAJZAR, Jure, JEREB,et al. The health education content provided. They rated "Basic CPR" TABLE 4: ASSESSMENT OF THE HEALTH EDUCATION CONTENT However, students gave the highest participation score for the impact of social media on the children mental health. V: PETELIN, Ana (ur.), et al. Zdravje otrok in mladostnikov = Health of children (AV = 4.5, SD = 0.85) and "Instagram" (AV = 4.5, SD = 0.76) UNDERSTOOD content on 'Instagram', which we attribute to the topicality of and adolescents : [proceedings], Zdravje otrok in mladostnikov, as the most interesting content, and "Moving" (AV = 4.3, SD = Contents n AV SD the content, as most adolescents have contact with social znanstvena in strokovna konferenca z mednarodno udeležbo, 1.27) as the least interesting content. networks. The lowest engagement score was for the content on Basic 161 4,6 0,75 Portorož, 20. september 2019. Koper: University of Primorska stopping bleeding (PV = 3.7). We need to be aware that, Press. 2019; 9-15. resuscitation What is the engagement of pupils during the delivery of health especially for teenagers, contact with blood is more likely to education content? Stopping 161 4,2 0,91 cause discomfort and, some might say, stigma, so we attribute the lowest average score for the content on stopping bleeding to [2] Bozjak, B. & Pogorevc, N. Psychoactive substances (Drugs) and bleeding this fact. One of the most common non-chemical addictions addiction. In. Attitudes to the Body, Handbook for Health Education Providers in Primary Health Care. Ljubljana: National TABLE 2: STUDENTS' SELF-ASSESSMENT OF THEIR PARTICIPATION IN New fashion 161 4,6 0,71 among young people today is internet addiction. Adolescents Institute of Public Health; 2020. pp.95-140. HEALTH EDUCATION icon - develop an emotional attachment to online friends and activities [3] Demšar, T. The use of information and communication screens they create on their computer screens. Internet addiction also technologies by fifth grade students; 2019. Contents n AV SD Instagram 161 4,8 0,51 affects other areas of a young person's life, in personal, family, Basic 161 4,3 1,08 financial and professional spheres. Internet addiction also resuscitation Positive self- 161 4,3 0,95 affects adolescents' relationships with each other, their family [4] Jeriček Klanšček, H., Zupanič, T., Roškar, M., et al. New "online" image, stress environment, friends and work environment (2). challenges in adolescent health in Slovenia; 2019. Stopping 161 3,7 1,14 [5] Livk, M. How to reach the goal: Every child knows BLS. In. Vajd, bleeding Moving 161 4,3 0,97 In the third research question, students were asked how they R., Zelinka , M. (eds.). Emergency medicine 2023 selected topics; around understood the health education content. The most understood 2023. pp. 62-71. New fashion 161 4,2 0,97 content was again about Instagram and screens, which again icon - Legend: n = sample size; AV = arrange value; SD = standard deviation; Scale: 1-inadequate, 2-insufficient, 3-good, 4-good, 5-excellent can be attributed to the topicality of the topic among screens adolescents. Understanding of the topic of basic resuscitation procedures was also rated as excellent. The Kranj Health Instagram 161 4,4 0,96 [6] Kostanjevec, S., Juriševič M., Torkar, G. Eating habits and at itudes Table 4 shows the extent to which students understood the Promotion Centre has established good cooperation with towards healthy eating among eighth-grade students; 2019. Positive self- 161 4,3 0,95 health education content. The most understood topic was educational institutions and set up a system for teaching TPO [7] Kranjc; P. Mass education of primary schoolchildren in basic image, stress "Instagram" (AV = 4.8, SD = 0.51), while the least understood over the years. In 2014, a new algorithm was created with the resuscitation procedures using an automated external defibrillator; Kranj Emergency Medical Unit, according to which lay TPO is 2017. Moving 161 4,0 1,00 was the topic on stopping bleeding (AV = 4.2, SD = 0.91). taught. It is the "5 Fingers" algorithm, which was also presented around [8] National Institute of Public Health [Internet]. Health education IV. DISCUSSION at one of the previous Emergency Medicine Congresses. This for children and adolescents (schoolchildren). [cited 2023 Sep 23]. Avaliable from: https://www.nijz.si/sl/vzgoja-za-zdravje-za- Legend: n = sample size; AV = arrange value; SD = standard deviation; algorithm is used by 58% of the respondents. Of course, we also In the survey, we wanted to find out which health education otroke-in-mladostnike-solarje. Scale: 1-inadequate, 2-insufficient, 3-good, 4-good, 5-excellent use it when teaching lay people. The experience is excellent as content was most interesting to students, how engaged they it is easy to understand and remember (5). Primary school Table 2 shows the students' self-assessment of their were during the health education content and whether the children who had previously undergone mass education in TPO participation during the health education content. They content was comprehensible to students. using an automatic defibrillator had satisfactory knowledge and [9] National Institute of Public Health (NIJZ) [Internet]. Health perceived that they participated the most during the health Statistical Yearbook 2015. National Institute of Public Health, skills to perform TPO and use an AED. Primary school students 2017. [cited 2023 Sep 23]. Available from: education content "Instagram" (AV = 4.4; SD = 0.96) and the The study found that the health education content that was most interesting to students was the basic resuscitation are one of the highly motivated and receptive groups of http://www.nijz.si/sites/www.nijz.si/files/publikacijedatoteke/zdra least during the health education content "Stop bleeding" (AV vstvenistatisticniletopis_2015_3.pdf procedures, both the lecture and the practical part, and the individuals, and they also disseminate this knowledge to the = 3.7; SD = 1.14). content on Instagram. One more thing about TPO - they can use wider local community, including adults (7). Early education of [10] Papler, L., Milavec Kapun, M., Kvas, A. Children's health care in as a source a reference to a paper published by Matjaž, he has children about TPO is very important and should be introduced the hands of teachers instead of school nurses. In A. Kvas & K. Kacjan Žgajnar (Eds.), 10th Student Conference of Health 105 Sciences with International Participation "Public Health": [13] Potočnik, D. & Povšnar, E. Physical activity and stress Interprofessional collaboration between community proceedings of peer-reviewed papers. University of Ljubljana, management in nursing students; 2019. Faculty of Health Sciences; 2018. pp. 357-366. [14] Pucelj V, Peternel L, Drglin Z et al. Together for Health - For better [11] Perko, U. , Černelič Bizjak, M. Selected mental disorders among health and reduction of health inequalities in children and nurses and General practitioners in palliative care: a sport active and inactive adolescents; 2019. adolescents: a health education programme for children and adolescents ( 0 to 19 years ). Ljubljana: National Institute of Public [12] Pivač, S., Skela Savič, B., Gradišek, P., et al. The importance of Health; 2016. pp. 5-29. literature review educating children about basic resuscitation procedures using an automated external defibrillator for children's prosocial and social [15] Terbovc, A. Adolescents and physical activity; 2019. behaviour: a systematic review of the literature. In: K. Pesjak, ed. 11th International Scientific Conference: Interprofessional [16] Toumi, J. Life course health developmnet (LCHD) and adolescents 1Jožica Ramšak Pajk, 2Fiona Murphy, 1Brigita Skela Savič integration at different levels of healthcare: trends, needs and health; 2019. 1 Faculty of Health Care Angela Boškin, Jesenice challenges. Bled, 7 June 2018. Jesenice: Angela Boškin Faculty of 2 Emeritus Professor, University of Limerick, Ireland Health; 2018. pp. 270-278. jramsakpajk@fzab.si Abstract— Pal iative care in the home environment is becoming European Association for Palliative Care EAPC [4] and [3] an increasingly necessary service in view of the demographic emphasize the importance of basic palliative care in the context structure of the population and the complex treatment of chronic of primary health care. Palliative care requires diseases. The primary palliative care team consist of a community interprofessional collaboration of various health professionals nurse and the family medicine physician. Their good cooperation is an important factor of high-quality palliative care at home. The based on partnership, integration and teamwork. Collaboration aim of this review is to discuss the role of community nurses in between family physicians and nurses is a decisive element of palliative care provision in primary care settings with a particular the quality of palliative care at the primary level [5]. Findings focus on interprofessional cooperation in palliative care teams. from a review study Reeves et al [6] showed that changes designed to improve interprofessional collaboration can A rapid review of the existing professional and scientific literature slightly improve practice performance compared to usual care. was used. The total number of retrieved literature was 410, of End-of-life care with a primary-level team allows people to die which 11 were included in the final analysis. We used the at home [7] which is not possible without the help of family PRISMA diagram and the COREQ checklist to ensure the quality of the included sources. caregivers, primary-level health workers (GPs and community nurses) and others, such as social workers and home care The effective provision of palliative care requires workers. A qualitative study Oosterveld et al. [8] from the interprofessional col aboration between community nurses and patient's perspective on quality palliative care at home, general practitioners in primary health care. Their role includes emphasizes the importance of collaboration between doctors cooperation, communication and coordination. Some barriers to and nurses in outpatient care and highlights person-centered effective interprofessional col aboration have been identified, care, a clear protocol and the correct transfer of information which include a lack of explicit description of each other's roles between palliative care providers. If there is poor and tasks and a lack of organizational support. Finally, effective communication between professionals and other services and interprofessional collaboration has a major impact on the provision of optimal pal iative care and needed to be explored in role confusion, patients may not receive optimal care. the future. Community nurses maybe ideal y placed to implement and coordinate palliative care in primary care [9]. Index Terms-- community nursing care, palliative team, primary This review article delves into the multifaceted role of health care. community nurses in primary care pal iative care set ings, with a particular emphasis on promoting interprofessional I. INTRODUCTION (HEADING 1) communication and cooperation within palliative care teams. . Palliative care aims to improve the quality of life of patients and their families facing the problems associated with life- II. MATERIAL AND METHODS threatening illness (World Health Organization [WHO], 2020). The WHO [1] palliative care atlas indicates that almost 80% of A rapid literature review of existing professional and scientific basic palliative care is provided by community nurses and literature was used. We searched the bibliographic databases, General practitioners and effective interprofessional PubMed, Wiley, CINAHL, Cochrane from March to May collaboration plays a decisive role [2]. Given that there are 2023. We used the combination of following keywords: limited specialist palliative services for the care of patients at community nurse/district nurse; palliative care; the end of life, it is necessary to develop and provide palliative interprofessional collaboration; primary health care. Inclusion care within primary care [3]. criteria were: publications in the last 10 years, quantitative, qualitative research and literature review, freely available text of the article, relevance to the researched topic. For quality 106 Sciences with International Participation "Public Health": [13] Potočnik, D. & Povšnar, E. Physical activity and stress Interprofessional collaboration between community proceedings of peer-reviewed papers. University of Ljubljana, management in nursing students; 2019. Faculty of Health Sciences; 2018. pp. 357-366. [14] Pucelj V, Peternel L, Drglin Z et al. Together for Health - For better [11] Perko, U. , Černelič Bizjak, M. Selected mental disorders among health and reduction of health inequalities in children and nurses and General practitioners in palliative care: a sport active and inactive adolescents; 2019. adolescents: a health education programme for children and adolescents ( 0 to 19 years ). Ljubljana: National Institute of Public [12] Pivač, S., Skela Savič, B., Gradišek, P., et al. The importance of Health; 2016. pp. 5-29. literature review educating children about basic resuscitation procedures using an automated external defibrillator for children's prosocial and social [15] Terbovc, A. Adolescents and physical activity; 2019. behaviour: a systematic review of the literature. In: K. Pesjak, ed. 11th International Scientific Conference: Interprofessional [16] Toumi, J. Life course health developmnet (LCHD) and adolescents 1Jožica Ramšak Pajk, 2Fiona Murphy, 1Brigita Skela Savič integration at different levels of healthcare: trends, needs and health; 2019. 1 Faculty of Health Care Angela Boškin, Jesenice challenges. Bled, 7 June 2018. Jesenice: Angela Boškin Faculty of 2 Emeritus Professor, University of Limerick, Ireland Health; 2018. pp. 270-278. jramsakpajk@fzab.si Abstract— Pal iative care in the home environment is becoming European Association for Palliative Care EAPC [4] and [3] an increasingly necessary service in view of the demographic emphasize the importance of basic palliative care in the context structure of the population and the complex treatment of chronic of primary health care. Palliative care requires diseases. The primary palliative care team consist of a community interprofessional collaboration of various health professionals nurse and the family medicine physician. Their good cooperation is an important factor of high-quality palliative care at home. The based on partnership, integration and teamwork. Collaboration aim of this review is to discuss the role of community nurses in between family physicians and nurses is a decisive element of palliative care provision in primary care settings with a particular the quality of palliative care at the primary level [5]. Findings focus on interprofessional cooperation in palliative care teams. from a review study Reeves et al [6] showed that changes designed to improve interprofessional collaboration can A rapid review of the existing professional and scientific literature slightly improve practice performance compared to usual care. was used. The total number of retrieved literature was 410, of End-of-life care with a primary-level team allows people to die which 11 were included in the final analysis. We used the at home [7] which is not possible without the help of family PRISMA diagram and the COREQ checklist to ensure the quality of the included sources. caregivers, primary-level health workers (GPs and community nurses) and others, such as social workers and home care The effective provision of palliative care requires workers. A qualitative study Oosterveld et al. [8] from the interprofessional col aboration between community nurses and patient's perspective on quality palliative care at home, general practitioners in primary health care. Their role includes emphasizes the importance of collaboration between doctors cooperation, communication and coordination. Some barriers to and nurses in outpatient care and highlights person-centered effective interprofessional col aboration have been identified, care, a clear protocol and the correct transfer of information which include a lack of explicit description of each other's roles between palliative care providers. If there is poor and tasks and a lack of organizational support. Finally, effective communication between professionals and other services and interprofessional collaboration has a major impact on the provision of optimal pal iative care and needed to be explored in role confusion, patients may not receive optimal care. the future. Community nurses maybe ideal y placed to implement and coordinate palliative care in primary care [9]. Index Terms-- community nursing care, palliative team, primary This review article delves into the multifaceted role of health care. community nurses in primary care pal iative care set ings, with a particular emphasis on promoting interprofessional I. INTRODUCTION (HEADING 1) communication and cooperation within palliative care teams. . Palliative care aims to improve the quality of life of patients and their families facing the problems associated with life- II. MATERIAL AND METHODS threatening illness (World Health Organization [WHO], 2020). The WHO [1] palliative care atlas indicates that almost 80% of A rapid literature review of existing professional and scientific basic palliative care is provided by community nurses and literature was used. We searched the bibliographic databases, General practitioners and effective interprofessional PubMed, Wiley, CINAHL, Cochrane from March to May collaboration plays a decisive role [2]. Given that there are 2023. We used the combination of following keywords: limited specialist palliative services for the care of patients at community nurse/district nurse; palliative care; the end of life, it is necessary to develop and provide palliative interprofessional collaboration; primary health care. Inclusion care within primary care [3]. criteria were: publications in the last 10 years, quantitative, qualitative research and literature review, freely available text of the article, relevance to the researched topic. For quality 107 assessment, the hierarchy of evidence Polit and Beck [10] was Role clarification Negotiations around interprofessional conflict were oriented community & public health nursing. 2016; 2(2): doi:10.4172/2471- used. To assess the quality of included qualitative research, the In home care nursing, community nurses are often more more toward determining professional status than considering 9846.1000124 COREQ (Consolidated criteria for reporting qualitative independent [14]. For community nurse it is crucial that their patients’ needs [17]. [6] Reeves S, Xyrichis A, Zwarenstein M. Teamwork, collabora-tion, research) 32 item checklist tool was used [11]. The Canadian rolles are accepted and recognized by patients and by the GP Interprofessional collaboration is very demanding and can be coordination, and networking: Why we need to distinguish between different types of interprofessional practice. Journal of interprofessional health collaborative framework [12] was [15]. the cause of many conflicts regarding the performance of tasks Interprofessional Care. 2017;32(1): 1–3. utilized as a theoretical framework to identify the concept of Complex care situations require a higher number of health or in relationships [5]. doi:10.1080/13561820.2017.1400150 interprofessional cooperation according to the 6 domains of the professionals working together. This collaboration requires Communication strategies, shared decision-making and [7] Cai J, Zhang L, Guerriere D, Coyte P.C. Congruence between framework. precise role profiles and trust in each other’s competency [15, respect for others' opinions reduce the occurrence of conflicts preferred and actual place of death for those in receipt of home- 22]. [23]. based palliative care. Journal of palliative medicine. 2020; 23(11). III. RESULTS The findings show that a palliative care key person is important [8] Oosterveld-Vlug MG, Custers B, Hofstede J. et al. What are for continuous pal iative care. The two most frequently essential elements of high-quality palliative care at home? An The total number of obtained literatures was 410, with 11 IV. DISCUSSION represented, in terms of position and function, were the interview study among patients and relatives faced with advanced included in the final analysis. The PRISMA diagram is used to cancer. BMC Palliative care. 2019;18(96). community nurse and the general practitioner [16]. The framework that was used, can offer some direction to https://doi.org/10.11186/s12904-019-0485-7 schematically display the review process [13]. achieve inter-professional cooperation to deliver palliative The search gave 590 articles. After duplicates were removed, [9] Sekse RJT, Hunskar I, Ellingsen S. The nurse’s role in palliative Patient/family centered care care in community settings in Slovenia. We try to argued some care: A qualitative meta-synthesis. J Clin Nurs. 2018; 27: 21-38. 410 articles were screened. 72 articles were then retrieved in Nurses and GP emphasized that a shared definition of goals, domains as important. There is still work to be conducted in a https://doi.org/10.1111/jocn.13912 full text assessed. The final number of articles left was 11 (Fig. cooperative tasks and responsibilities by development of comprehensive understanding of an interprofessional 1). The majority of the studies come from Northern and Central [10] Polit DF, Beck CT. Essentials of Nursing Research: Appraising cooperative team work, would help improve patient care [17]. cooperation in a basic palliative team in the primary health Evidence for Nursing Practice. 9th ed. Philadelphia: Lippincot Europe. From study design the qualitative methods dominated. Organizational changes are needed to ensure that people care. Williams & Wilkins. 2018. There are included 7 articles with qualitative studies 1 receive quality palliative care, other health services in their There is one of the most prevalent stereotypes among [11] Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting quantitative research and 3 systematic literature review. own homes and that are involved in care planning [18]. physicians that they see themselves as “leaders” and “decision- qualitative research (COREQ): a 32-item checklist for interviews Clear responsibility regarding communication with the patient makers” whereas other health-care professionals are considered and focus groups. International Journal for Quality in Health Care. to be “team players” [2]. The hierarchical relationships that 2007;19(6): 349-357. n Aditional records and family [19]. Records identified continue to characterize col aboration between nursing and [12] Canadian interprofessional health collaborative (CIHC). A national through database identified through other icatio interfrofessional competency framework. University of British searching (n=585) ) sources (n=5) medicine often result in poor communication as well as Team functioning unresolved conflicts within professional groups [17, 23]. Columbia, Vancouver Canada. 2010. Available at: https://phabc.org/wp-content/uploads/2015/07/CIHC-National- Identif Effective and well-functioning teamwork can also act as a Therefore, for successful cooperation within the team, the source of support to individual nurses [14]. Interprofessional-Competency-Framework.pdf professional identity of al team members must be built [17]. Records after removing By becoming familiar with each other, team members can start [13] Moher D, Liberati A, Tetzlaff J. et al. 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(n=360) (n=277) Collaborative leadership increased, as wel as the understanding of their roles in the team, https://doi.org/10.1111/hsc.13910 Professionalization strategies for nursing and the economic and as a result, patient care improved. Josi et al. [15] also [15] Josi R, Bianchi M, Brandt S.K. Advanced practice nurses in ility transformations of the health care system are two important emphasize, that the role clarification is crucial for efficient primary care in Switzerland: an analysis of interprofessional Full-text article interprofessional col aboration. collaboration. BMC Nursing, 2020;19(1): 112. Eligib factors contributing to the persistent problems in assessed for eligibility Full-text articles excluded (n=72) interprofessional cooperation [17]. (n=83) [16] Hasson F, Betts M, Shannon C, Fee A. Roles and responibilities of Interprofessional cooperation and this kind of education is the community palliative care key worker: a scoping review. 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Health care teams interprofessional domain which all of them are essential to Early identification of patients according the palliative care, Association for Palliative Care. 2009. Available at: as complex adaptive systems: understanding team behavior through https://www.eapcnet.eu/Portals/0/adam/Content/LmgAajW9M0O demonstrate interprofessional collaboration. The domains are: digital documentation, IT communication, the possibility of team members perception of interpersonal interaction. BMC Health s7VYZs0ZXCQ/Text/White%20Paper%20on%20standards%20a Service Research. 2018;18: 570. https://doi.org/10.1186/s12913- role clarification, patient/family centered care, team viewing the patient documentation on all levels of health care nd%20norms%20for%20hospice%20and%20palliative%20care% 018-3392-3 ) func tioning, collaborative leadership, interprofessional [22]. 20in%20Europe.pdf [21] Mertens F, De Gendt A, Deveugele M. et al. Interprofessional communication and interprofessional conflict. [5] Alvarado V, Liebig B. Inter-Professional collaboration between collaboration within fluid teams: Community nurses experiences Interprofessional conflict family doctors and nurses at the end of life. Challenges of with palliative home care . J Clin Nurse . 2019; 28: 3680-3690. community-based palliative care in Switzerland. Journal of https://doi.org/10.1111/jocn.14969. 108 assessment, the hierarchy of evidence Polit and Beck [10] was Role clarification Negotiations around interprofessional conflict were oriented community & public health nursing. 2016; 2(2): doi:10.4172/2471- used. To assess the quality of included qualitative research, the In home care nursing, community nurses are often more more toward determining professional status than considering 9846.1000124 COREQ (Consolidated criteria for reporting qualitative independent [14]. For community nurse it is crucial that their patients’ needs [17]. [6] Reeves S, Xyrichis A, Zwarenstein M. Teamwork, collabora-tion, research) 32 item checklist tool was used [11]. The Canadian rolles are accepted and recognized by patients and by the GP Interprofessional collaboration is very demanding and can be coordination, and networking: Why we need to distinguish between different types of interprofessional practice. Journal of interprofessional health collaborative framework [12] was [15]. the cause of many conflicts regarding the performance of tasks Interprofessional Care. 2017;32(1): 1–3. utilized as a theoretical framework to identify the concept of Complex care situations require a higher number of health or in relationships [5]. doi:10.1080/13561820.2017.1400150 interprofessional cooperation according to the 6 domains of the professionals working together. This collaboration requires Communication strategies, shared decision-making and [7] Cai J, Zhang L, Guerriere D, Coyte P.C. Congruence between framework. precise role profiles and trust in each other’s competency [15, respect for others' opinions reduce the occurrence of conflicts preferred and actual place of death for those in receipt of home- 22]. [23]. based palliative care. Journal of palliative medicine. 2020; 23(11). III. RESULTS The findings show that a palliative care key person is important [8] Oosterveld-Vlug MG, Custers B, Hofstede J. et al. What are for continuous pal iative care. The two most frequently essential elements of high-quality palliative care at home? An The total number of obtained literatures was 410, with 11 IV. DISCUSSION represented, in terms of position and function, were the interview study among patients and relatives faced with advanced included in the final analysis. The PRISMA diagram is used to cancer. BMC Palliative care. 2019;18(96). community nurse and the general practitioner [16]. The framework that was used, can offer some direction to https://doi.org/10.11186/s12904-019-0485-7 schematically display the review process [13]. achieve inter-professional cooperation to deliver palliative The search gave 590 articles. After duplicates were removed, [9] Sekse RJT, Hunskar I, Ellingsen S. The nurse’s role in palliative Patient/family centered care care in community settings in Slovenia. We try to argued some care: A qualitative meta-synthesis. J Clin Nurs. 2018; 27: 21-38. 410 articles were screened. 72 articles were then retrieved in Nurses and GP emphasized that a shared definition of goals, domains as important. There is still work to be conducted in a https://doi.org/10.1111/jocn.13912 full text assessed. The final number of articles left was 11 (Fig. cooperative tasks and responsibilities by development of comprehensive understanding of an interprofessional 1). The majority of the studies come from Northern and Central [10] Polit DF, Beck CT. Essentials of Nursing Research: Appraising cooperative team work, would help improve patient care [17]. cooperation in a basic palliative team in the primary health Evidence for Nursing Practice. 9th ed. Philadelphia: Lippincot Europe. From study design the qualitative methods dominated. Organizational changes are needed to ensure that people care. Williams & Wilkins. 2018. There are included 7 articles with qualitative studies 1 receive quality palliative care, other health services in their There is one of the most prevalent stereotypes among [11] Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting quantitative research and 3 systematic literature review. own homes and that are involved in care planning [18]. physicians that they see themselves as “leaders” and “decision- qualitative research (COREQ): a 32-item checklist for interviews Clear responsibility regarding communication with the patient makers” whereas other health-care professionals are considered and focus groups. International Journal for Quality in Health Care. to be “team players” [2]. The hierarchical relationships that 2007;19(6): 349-357. n Aditional records and family [19]. Records identified continue to characterize col aboration between nursing and [12] Canadian interprofessional health collaborative (CIHC). A national through database identified through other icatio interfrofessional competency framework. University of British searching (n=585) ) sources (n=5) medicine often result in poor communication as well as Team functioning unresolved conflicts within professional groups [17, 23]. Columbia, Vancouver Canada. 2010. Available at: https://phabc.org/wp-content/uploads/2015/07/CIHC-National- Identif Effective and well-functioning teamwork can also act as a Therefore, for successful cooperation within the team, the source of support to individual nurses [14]. Interprofessional-Competency-Framework.pdf professional identity of al team members must be built [17]. Records after removing By becoming familiar with each other, team members can start [13] Moher D, Liberati A, Tetzlaff J. et al. Preferred Reporting Items for duplicates (n=410) Greater emphasis should therefore be given to strategies that to share experiences and information, build relationship and Systematic Reviews and Meta-Analyses: The PRISMA Statement. N= 482 would reduce this difference in cooperation, namely strategies ing PLoS Med. 2009; 6(7): 1-6. trust and create shared goals and coherence [14]. ean to promote the equality of both professional groups [24]. [14] Larsson R, Erlingsdóttir G, Persson J, Rydenfält C. Teamwork in Scr Knowledge of one's own tasks and tasks of other services [19]. Mitchell et al. [22] found out that after interprofessional home care nursing: A scoping literature review. Health & Social Records screened Records excluded education, the competence and autonomy of health workers Care in the Community. 2022;30: 3309–3327. (n=360) (n=277) Collaborative leadership increased, as wel as the understanding of their roles in the team, https://doi.org/10.1111/hsc.13910 Professionalization strategies for nursing and the economic and as a result, patient care improved. Josi et al. [15] also [15] Josi R, Bianchi M, Brandt S.K. Advanced practice nurses in ility transformations of the health care system are two important emphasize, that the role clarification is crucial for efficient primary care in Switzerland: an analysis of interprofessional Full-text article interprofessional col aboration. collaboration. BMC Nursing, 2020;19(1): 112. Eligib factors contributing to the persistent problems in assessed for eligibility Full-text articles excluded (n=72) interprofessional cooperation [17]. (n=83) [16] Hasson F, Betts M, Shannon C, Fee A. Roles and responibilities of Interprofessional cooperation and this kind of education is the community palliative care key worker: a scoping review. 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Based on the literature review and It emphasizes the importance of open communication, European association for palliative care (EAPC): A delphi study. palliative care: a qualitative study of interprofessional collaboration synthesis of sources, we want to put our findings in relation to informal meetings and conversations about current affairs and Palliative medicine, 2022; 26(4): 680-697. in Norway. BMC Health Services Research, 22 pp.314 the 6 domains of the Canadian framework. the patient's treatment plan, and the possibility of consultation [4] EAPC, White Paper on standards and norms for hospice and https://doi.org/10.1186/s12913-022-07713-z. The framework presents a constellation of 6 interconnecting [21]. palliative care in Europe: Recommendations from the European [20] Pype P, Mertens F, Helewaut F, Krystallidou D. Health care teams interprofessional domain which all of them are essential to Early identification of patients according the palliative care, Association for Palliative Care. 2009. Available at: as complex adaptive systems: understanding team behavior through https://www.eapcnet.eu/Portals/0/adam/Content/LmgAajW9M0O demonstrate interprofessional collaboration. The domains are: digital documentation, IT communication, the possibility of team members perception of interpersonal interaction. BMC Health s7VYZs0ZXCQ/Text/White%20Paper%20on%20standards%20a Service Research. 2018;18: 570. https://doi.org/10.1186/s12913- role clarification, patient/family centered care, team viewing the patient documentation on all levels of health care nd%20norms%20for%20hospice%20and%20palliative%20care% 018-3392-3 ) func tioning, collaborative leadership, interprofessional [22]. 20in%20Europe.pdf [21] Mertens F, De Gendt A, Deveugele M. et al. Interprofessional communication and interprofessional conflict. [5] Alvarado V, Liebig B. Inter-Professional collaboration between collaboration within fluid teams: Community nurses experiences Interprofessional conflict family doctors and nurses at the end of life. Challenges of with palliative home care . J Clin Nurse . 2019; 28: 3680-3690. community-based palliative care in Switzerland. Journal of https://doi.org/10.1111/jocn.14969. 109 [22] Mitchell S, Loew J, Milington-Sanders C, Dale J. Providing end of collaboration and integration in primary care. BMJ Open. 2022; Red Code Protocol and experiential learning with life care in general practice: findings of a national GP questionnaire 12(10) doi:10.1136/bmjopen-2022-062111. survey. British journal of general practice. 2016; 66(650): 647-53. doi: 10.3399/bjgp16X686113. [24] Huq JL, Reay T, Chreim S. Protecting the paradox of interprofessional collaboration. Organization Studies. simulations – impact on the survival of patients after [23] Sirimsi MM, De Loof H. Van den Broeck K. et al. Scoping review 2017;38(3/4): 513–538. to identify strategies and interventions improving interprofessional sudden cardiac arrest in the Community Health Centre Ljubljana Mateja Škufca Sterle Emergency Department Ljubljana, Community Health Center Ljubljana, Slovenia Faculty of Medicine, University of Ljubljana, Slovenia E-mail: mateja.skufca@gmail.com Abstract—Medical teams in primary care deal with a large that emergencies within primary care offices are rare but still number of patients on a daily basis, including occasionally occur regularly [1]. In 2022, Melzel et al [1] found in Germany endangered patients and those who experience sudden cardiac that emergency situations in primary care offices occur on arrest. Since these situations are relatively rare, they often cause average once a month, more frequently in rural areas than in significant stress for medical teams in primary care who may not urban settings. The most common emergencies were acute feel competent to handle such cases. To address this issue, the Red coronary syndrome, heart arrhythmias, and breathing Code Protocol for activating the medical team in case of difficulties. During the observed one-year period, emergencies was established at the Ljubljana Community Health cardiopulmonary resuscitation was performed in 13.9% of Centre in early 2014. The teams are adequately equipped and continuously trained in the Simulation centre of the health centre. primary care offices [1]. A Canadian study showed that two After the implementation of the Red Code Protocol, all patients percent of all emergency calls originated from primary care who suffered sudden cardiac arrest at the health center were offices due to various emergency situations [2]. appropriately resuscitated. In addition to effective basic life Resuscitation in the case of sudden cardiac arrest within or support procedures, an automatic defibrillator was used in the in the immediate vicinity of a primary medical facility should majority of cases before the arrival of the emergency medical be more successful due to the presence of medical personnel team. The survival rate of patients with sudden cardiac arrest at and appropriate equipment. But the rarity of such situations the Ljubljana Community Health Centre significantly increased after the implementation of the Red Code Protocol compared to makes it difficult for primary care workers to remain up-to-date the previous period. The continuous experiential learning of and competent in providing life support [3]. The most frequent medical teams in Ljubljana Community Health Centre units reason mentioned by primary care physicians as a barrier to not through simulations, along with the establishment of the Red acting appropriately in an emergency situation was a lack of Code Protocol, achieved its purpose: better patient care and practical skills [4]. increased patient survival after sudden cardiac arrest at the However, it is the responsibility of every healthcare worker Community Health Centre Ljubljana. to know how to respond appropriately and care for an Index Terms—Community Health Centre Ljubljana, Red Code emergency patient. This is especially true for primary health Protocol, cardiac arrest, resuscitation care workers, who are the first contact with a patient seeking help in a health centre. As a response to the educational needs of more than 1500 employees about managing emergency situations (including I. INTRODUCTION sudden cardiac arrest), Ljubljana Community Health Centre Medical teams in primary health care deal with many (CHC) established a Simulation Centre (SIM Centre) in 2014 patients every day, among whom are occasionally also vitally [5]. One of the first projects of the SIM Centre was to create a endangered patients or patients who experience sudden cardiac protocol for the activation of a medical team in the event of an death. In these cases, proper and rapid initial patient care is emergency in the CHC Ljubljana (Red Code Protocol) [6]. critical. Teams continuously learn and renew their knowledge with the help of experiential learning with simulations in the SIM Little literature exists on emergencies and sudden cardiac Centre. There they can not only acquire knowledge and skills, arrests within primary care offices. International literature on but also learn how to cope with difficult patients, dangerous the frequency and types of emergencies is scarce, indicating situations and unexpected events. Learning through simulations 110 [22] Mitchell S, Loew J, Milington-Sanders C, Dale J. Providing end of collaboration and integration in primary care. BMJ Open. 2022; Red Code Protocol and experiential learning with life care in general practice: findings of a national GP questionnaire 12(10) doi:10.1136/bmjopen-2022-062111. survey. British journal of general practice. 2016; 66(650): 647-53. doi: 10.3399/bjgp16X686113. [24] Huq JL, Reay T, Chreim S. Protecting the paradox of interprofessional collaboration. Organization Studies. simulations – impact on the survival of patients after [23] Sirimsi MM, De Loof H. Van den Broeck K. et al. Scoping review 2017;38(3/4): 513–538. to identify strategies and interventions improving interprofessional sudden cardiac arrest in the Community Health Centre Ljubljana Mateja Škufca Sterle Emergency Department Ljubljana, Community Health Center Ljubljana, Slovenia Faculty of Medicine, University of Ljubljana, Slovenia E-mail: mateja.skufca@gmail.com Abstract—Medical teams in primary care deal with a large that emergencies within primary care offices are rare but still number of patients on a daily basis, including occasionally occur regularly [1]. In 2022, Melzel et al [1] found in Germany endangered patients and those who experience sudden cardiac that emergency situations in primary care offices occur on arrest. Since these situations are relatively rare, they often cause average once a month, more frequently in rural areas than in significant stress for medical teams in primary care who may not urban settings. The most common emergencies were acute feel competent to handle such cases. To address this issue, the Red coronary syndrome, heart arrhythmias, and breathing Code Protocol for activating the medical team in case of difficulties. During the observed one-year period, emergencies was established at the Ljubljana Community Health cardiopulmonary resuscitation was performed in 13.9% of Centre in early 2014. The teams are adequately equipped and continuously trained in the Simulation centre of the health centre. primary care offices [1]. A Canadian study showed that two After the implementation of the Red Code Protocol, all patients percent of all emergency calls originated from primary care who suffered sudden cardiac arrest at the health center were offices due to various emergency situations [2]. appropriately resuscitated. In addition to effective basic life Resuscitation in the case of sudden cardiac arrest within or support procedures, an automatic defibrillator was used in the in the immediate vicinity of a primary medical facility should majority of cases before the arrival of the emergency medical be more successful due to the presence of medical personnel team. The survival rate of patients with sudden cardiac arrest at and appropriate equipment. But the rarity of such situations the Ljubljana Community Health Centre significantly increased after the implementation of the Red Code Protocol compared to makes it difficult for primary care workers to remain up-to-date the previous period. The continuous experiential learning of and competent in providing life support [3]. The most frequent medical teams in Ljubljana Community Health Centre units reason mentioned by primary care physicians as a barrier to not through simulations, along with the establishment of the Red acting appropriately in an emergency situation was a lack of Code Protocol, achieved its purpose: better patient care and practical skills [4]. increased patient survival after sudden cardiac arrest at the However, it is the responsibility of every healthcare worker Community Health Centre Ljubljana. to know how to respond appropriately and care for an Index Terms— emergency patient. This is especially true for primary health Community Health Centre Ljubljana, Red Code Protocol, cardiac arrest, resuscitation care workers, who are the first contact with a patient seeking help in a health centre. As a response to the educational needs of more than 1500 employees about managing emergency situations (including I. INTRODUCTION sudden cardiac arrest), Ljubljana Community Health Centre Medical teams in primary health care deal with many (CHC) established a Simulation Centre (SIM Centre) in 2014 patients every day, among whom are occasionally also vitally [5]. One of the first projects of the SIM Centre was to create a endangered patients or patients who experience sudden cardiac protocol for the activation of a medical team in the event of an death. In these cases, proper and rapid initial patient care is emergency in the CHC Ljubljana (Red Code Protocol) [6]. critical. Teams continuously learn and renew their knowledge with the help of experiential learning with simulations in the SIM Little literature exists on emergencies and sudden cardiac Centre. There they can not only acquire knowledge and skills, arrests within primary care offices. International literature on but also learn how to cope with difficult patients, dangerous the frequency and types of emergencies is scarce, indicating situations and unexpected events. Learning through simulations 111 is enhanced with In-situ simulations in real clinical from the hospital and neurological outcome of patients at significantly more often used an AED (92.9% vs 26.3%; environment [5]. discharge (Cerebral Performance Category – CPC). p<0,001) and performed early defibrillation (71.4% vs 21.1%; The aim of the study is to determine whether the outcome Statistical analysis: The study population was divided into p=0,004) before the arrival of the EMT (Table II). The first IV. DISCUSSION of patients who experience sudden cardiac arrest at the CHC two groups: the BEFORE group (period 2001-2013) and the recorded cardiac rhythm was significantly more frequently Primary care workers deal with many patients every day, Ljubljana has improved after the introduction of the Red Code AFTER group (period 2014-2022). Non-continuous data were shockable in the AFTER group compared to the BEFORE among whom are occasionally also vitally endangered patients. Protocol and implementation of continuous education of staff presented as counts (percentages), and the Chi-square test was group (Table II). Wide range of symptoms and rarity of emergency situations, at the SIM Centre. used to compare non-continuous data. Continuous data were especially of sudden cardiac arrest, makes it difficult for primary care workers to remain up-to-date and competent in summarized as the mean (±SD) and compared using Student’s t -test for independent samples. The computer program IBM TABLE II: Resuscitation characteristics and response time of the EMT managing these patients. II. M SPSS Statistics, version 29.0.0 (IBM Corporation, Armonnk, BEFORE AFTER Statistics ATERIAL AND METHODS The fact that sudden cardiac arrest is a rare event at the NY, USA) was used for statistical analysis. A significance level group group primary healthcare level is evident from the data that, in the last p<0.05 was considered statistically significant. p 22 years, there have been 36 cases of sudden cardiac arrest in Study design: A retrospective analysis of resuscitations in (n=19) (n=14) or in the immediate vicinity Ljubljana CHC. This averages out the units of the Ljubljana CHC was performed in the period to 1.6 cases of sudden cardiac arrest per year in the largest from January 1, 2001, to December 31, 2022. The study was Response 6.42±2.4 6.93±2.5 p=0.564 primary healthcare institution in Slovenia, which has over 1500 observational and causal-comparative in nature. The research III. RESULTS time of EMT protocol received approval by Medical Ethics Committee (no. In the period 2001-2022 there were 36 resuscitations in the (min) employees. It is clear that a significant portion of healthcare 0120-228/2023/5). CHC Ljubljana. 22 resuscitations took place in the period workers at the primary level will not witness or be in a situation Using AED, 5 (26.3%) 13 (92.9%) p<0.001 to perform resuscitation on a patient in their workplace Study setting: Ljubljana CHC is the largest healthcare before the establishment of the Red Code Protocol (2001-2013) n (%) throughout their careers. institution at the primary level in Slovenia. In its current (BEFORE group) and 14 after the establishment (2014-2022) The first 4 (21.1%) 9 (64.3%) p=0.012 organization, it has eight organizational units with over 1,500 (AFTER group). Three patients experienced cardiac arrest in Research has shown that simulations, as an educational recorded healthcare and other employees. Ljubljana CHC provides the presence of the EMT in the period before the establishment technique, result in an increase in perceived competence and of the Red Code Protocol, so these patients were not included rhythm confidence in the ability of primary care workers to respond to healthcare services for the Municipality of Ljubljana and, in in the study. shockable, n an emergency [7]. All professionals who are not employed in certain activities, also for the broader area of neighboring (%) an emergency department require education for treating municipalities (emergency medical services). The number of Demographic characteristics of patients in both groups are patients in life-threatening situation in a safe and controlled patient visits across all units of ZDL on an annual basis exceeds listed in Table I. The two groups did not significantly differ in Performed 4 (21.1%) 10 (71.4%) p=0.004 environment. There they can acquire the necessary knowledge 2,000,000. average age; however, there was a statistically significant defibrillation, higher proportion of males in the AFTER group compared to n (%) and practical skills. In addition to that they also learn how to Study population: The study included all patients who the BEFORE group. cope with dangerous situations, difficult patients and underwent cardiopulmonary resuscitation in the units of the unexpected events, as well as working as a team leader or a CHC Ljubljana or in their immediate vicinity in the period from team member [5]. Education with simulations for healthcare January 1, 2001, to December 31, 2022. All resuscitations workers represents an opportunity to gain additional knowledge TABLE I: Demographic characteristics of patients in both groups before the establishment of the Red Code Protocol in the ROSC before the arrival of the EMT was achieved more and skills without harming the patient. This is how they will be beginning of 2014 were classified as BEFORE group and they BEFORE AFTER Statistics often in the second period compared to the first period (28.6% prepared and trained to act correctly in rare but urgent include resuscitations from the period of 2001 to 2013. group group vs 5.3%) (Table III). In the second period compared to the first situations, which can determine the final outcome for the Resuscitations performed after the establishment of the Red P period, ROSC was achieved more often (64.3% vs 52.6%; patient. Code Protocol were classified as AFTER group and include (n=19) (n=14) p>0,05), significantly more patients were discharged from the resuscitations performed in the period of 2014 to 2022. As a response to the educational needs of more than 1500 Male, n (%) 7 (36.8%) 12 (85.7%) p=0.005 hospital (57.1% vs 21.1%; p=0,033) and more patients had a good neurological outcome (57.1% vs 10.5%) (Table III). employees, Ljubljana CHC established a Simulation Centre in Data collection: The study utilized data obtained from Average age 62.7±22.2 59.4±22.0 p=0.668 the beginning of the year 2014. Healthcare and non-healthcare emergency intervention records of the Ljubljana CHC, (years) workers are trained there in managing emergency situations by NMP3000Web of the Ljubljana Dispatch Centre, ambulatory TABLE III: Outcomes after sudden cardiac arrest using realistic simulations. records of University Medical Centre (UKC) Ljubljana emergency department and discharge summaries from hospital One of the first projects of the SIM Centre was the In both groups, medical causes of sudden cardiac arrest BEFORE AFTER Statistics wards where treated patients were admitted. Patients for whom establishment of the Red Code Protocol. The Red Code predominated. In the period after the implementation of the Red group group p medical documentation could not be obtained were excluded Protocol is the activation of the emergency response team for Code protocol, all cardiac arrests due to medical causes were (period (period from the study. Patients who experienced sudden cardiac arrest urgent situations in the Ljubljana CHC unit or its immediate recorded. Before the implementation of the Red Code protocol, 2001-2013) 2014-2022) in Ljubljana CHC units in the presence of an emergency vicinity, which acts quickly and efficiently in case of an medical causes also prevailed, with the exception of a cardiac medical team (EMT) were also excluded from the study. ROSC before 1 (5.3%) 4 (28.6%) p=0.065 emergency. The goal is to ensure a safe environment for the arrest caused by trauma (homicide of a healthcare worker and the arrival of patient in all Ljubljana CHC units by managing acute Primary outcome: The primary aim of the study was to suicide attempt by the perpetrator within the premises of the EMT, n (%) emergencies with a trained team in the shortest possible time. compare resuscitations performed by the medical teams in Ljubljana Health Centre). In the event of an acute deterioration in the patient's condition, primary health care before and after the establishment of the ROSC, n (%) 10 (52.6%) 9 (64.3%) p=0.503 The performance of basic life support (BLS) procedures did the on-duty team begins patient care and continues it until the Red Code Protocol where we observed the performance of not differ between the groups, as BLS procedures, with the Discharged 4 (21.1%) 8 (57.1%) p=0.033 arrival of the EMT. In the case of a sudden cardiac arrest, this resuscitation procedures, the use of automatic defibrillator exception of one patient in the group before the implementation from the shortens the time to the initiation of BLS and early (AED) and early defibrillation by health workers before the of the Red Code Protocol, were conducted in all patients (see hospital, n defibrillation, which has been proven to increase the patient's arrival of the EMT. Table II). There was also no significant difference in response (%) chances of survival [8]. Secondary outcome: The secondary aim was to assess the times of the EMT between the groups (Table II). CPC 1 or 2 at 2 (10.5%) 8 (57.1%) p=0.04 The on-duty team consists of two members, a doctor, and a impact of the establishment of the Red Code Protocol on the In the second period – after the establishment of the Red discharge, n nurse. They are equipped with a resuscitation bag containing all return of spontaneous circulation (ROSC), discharge of patients Code Protocol, compared to the first period, healthcare workers (%) the necessary equipment for providing initial managing emergency situations and an AED. The phone number to reach 112 is enhanced with In-situ simulations in real clinical from the hospital and neurological outcome of patients at significantly more often used an AED (92.9% vs 26.3%; environment [5]. discharge (Cerebral Performance Category – CPC). p<0,001) and performed early defibrillation (71.4% vs 21.1%; The aim of the study is to determine whether the outcome Statistical analysis: The study population was divided into p=0,004) before the arrival of the EMT (Table II). The first IV. DISCUSSION of patients who experience sudden cardiac arrest at the CHC two groups: the BEFORE group (period 2001-2013) and the recorded cardiac rhythm was significantly more frequently Primary care workers deal with many patients every day, Ljubljana has improved after the introduction of the Red Code AFTER group (period 2014-2022). Non-continuous data were shockable in the AFTER group compared to the BEFORE among whom are occasionally also vitally endangered patients. Protocol and implementation of continuous education of staff presented as counts (percentages), and the Chi-square test was group (Table II). Wide range of symptoms and rarity of emergency situations, at the SIM Centre. used to compare non-continuous data. Continuous data were especially of sudden cardiac arrest, makes it difficult for primary care workers to remain up-to-date and competent in summarized as the mean (±SD) and compared using Student’s t-test for independent samples. The computer program IBM TABLE II: Resuscitation characteristics and response time of the EMT managing these patients. II. M SPSS Statistics, version 29.0.0 (IBM Corporation, Armonnk, BEFORE AFTER Statistics ATERIAL AND METHODS The fact that sudden cardiac arrest is a rare event at the NY, USA) was used for statistical analysis. A significance level group group primary healthcare level is evident from the data that, in the last p<0.05 was considered statistically significant. p 22 years, there have been 36 cases of sudden cardiac arrest in Study design: A retrospective analysis of resuscitations in (n=19) (n=14) or in the immediate vicinity Ljubljana CHC. This averages out the units of the Ljubljana CHC was performed in the period to 1.6 cases of sudden cardiac arrest per year in the largest from January 1, 2001, to December 31, 2022. The study was Response 6.42±2.4 6.93±2.5 p=0.564 primary healthcare institution in Slovenia, which has over 1500 observational and causal-comparative in nature. The research III. RESULTS time of EMT protocol received approval by Medical Ethics Committee (no. In the period 2001-2022 there were 36 resuscitations in the (min) employees. It is clear that a significant portion of healthcare 0120-228/2023/5). CHC Ljubljana. 22 resuscitations took place in the period workers at the primary level will not witness or be in a situation Using AED, 5 (26.3%) 13 (92.9%) p<0.001 to perform resuscitation on a patient in their workplace Study setting: Ljubljana CHC is the largest healthcare before the establishment of the Red Code Protocol (2001-2013) n (%) throughout their careers. institution at the primary level in Slovenia. In its current (BEFORE group) and 14 after the establishment (2014-2022) The first 4 (21.1%) 9 (64.3%) p=0.012 organization, it has eight organizational units with over 1,500 (AFTER group). Three patients experienced cardiac arrest in Research has shown that simulations, as an educational recorded healthcare and other employees. Ljubljana CHC provides the presence of the EMT in the period before the establishment technique, result in an increase in perceived competence and of the Red Code Protocol, so these patients were not included rhythm confidence in the ability of primary care workers to respond to healthcare services for the Municipality of Ljubljana and, in in the study. shockable, n an emergency [7]. All professionals who are not employed in certain activities, also for the broader area of neighboring (%) an emergency department require education for treating municipalities (emergency medical services). The number of Demographic characteristics of patients in both groups are patients in life-threatening situation in a safe and controlled patient visits across all units of ZDL on an annual basis exceeds listed in Table I. The two groups did not significantly differ in Performed 4 (21.1%) 10 (71.4%) p=0.004 environment. There they can acquire the necessary knowledge 2,000,000. average age; however, there was a statistically significant defibrillation, higher proportion of males in the AFTER group compared to n (%) and practical skills. In addition to that they also learn how to Study population: The study included all patients who the BEFORE group. cope with dangerous situations, difficult patients and underwent cardiopulmonary resuscitation in the units of the unexpected events, as well as working as a team leader or a CHC Ljubljana or in their immediate vicinity in the period from team member [5]. Education with simulations for healthcare January 1, 2001, to December 31, 2022. All resuscitations workers represents an opportunity to gain additional knowledge TABLE I: Demographic characteristics of patients in both groups before the establishment of the Red Code Protocol in the ROSC before the arrival of the EMT was achieved more and skills without harming the patient. This is how they will be beginning of 2014 were classified as BEFORE group and they BEFORE AFTER Statistics often in the second period compared to the first period (28.6% prepared and trained to act correctly in rare but urgent include resuscitations from the period of 2001 to 2013. group group vs 5.3%) (Table III). In the second period compared to the first situations, which can determine the final outcome for the Resuscitations performed after the establishment of the Red P period, ROSC was achieved more often (64.3% vs 52.6%; patient. Code Protocol were classified as AFTER group and include (n=19) (n=14) p>0,05), significantly more patients were discharged from the As a response to the educational needs of more than 1500 resuscitations performed in the period of 2014 to 2022. Male, n (%) 7 (36.8%) 12 (85.7%) p=0.005 hospital (57.1% vs 21.1%; p=0,033) and more patients had a good neurological outcome (57.1% vs 10.5%) (Table III). employees, Ljubljana CHC established a Simulation Centre in Data collection: The study utilized data obtained from Average age 62.7±22.2 59.4±22.0 p=0.668 the beginning of the year 2014. Healthcare and non-healthcare emergency intervention records of the Ljubljana CHC, (years) workers are trained there in managing emergency situations by NMP3000Web of the Ljubljana Dispatch Centre, ambulatory using realistic simulations. TABLE III: Outcomes after sudden cardiac arrest records of University Medical Centre (UKC) Ljubljana One of the first projects of the SIM Centre was the emergency department and discharge summaries from hospital In both groups, medical causes of sudden cardiac arrest BEFORE AFTER Statistics establishment of the Red Code Protocol. The Red Code wards where treated patients were admitted. Patients for whom predominated. In the period after the implementation of the Red group group p Protocol is the activation of the emergency response team for medical documentation could not be obtained were excluded Code protocol, all cardiac arrests due to medical causes were (period (period urgent situations in the Ljubljana CHC unit or its immediate from the study. Patients who experienced sudden cardiac arrest recorded. Before the implementation of the Red Code protocol, 2001-2013) 2014-2022) vicinity, which acts quickly and efficiently in case of an in Ljubljana CHC units in the presence of an emergency medical causes also prevailed, with the exception of a cardiac emergency. The goal is to ensure a safe environment for the medical team (EMT) were also excluded from the study. ROSC before 1 (5.3%) 4 (28.6%) p=0.065 arrest caused by trauma (homicide of a healthcare worker and the arrival of patient in all Ljubljana CHC units by managing acute Primary outcome: The primary aim of the study was to suicide attempt by the perpetrator within the premises of the EMT, n (%) emergencies with a trained team in the shortest possible time. compare resuscitations performed by the medical teams in Ljubljana Health Centre). In the event of an acute deterioration in the patient's condition, primary health care before and after the establishment of the ROSC, n (%) 10 (52.6%) 9 (64.3%) p=0.503 The performance of basic life support (BLS) procedures did the on-duty team begins patient care and continues it until the Red Code Protocol where we observed the performance of not differ between the groups, as BLS procedures, with the Discharged 4 (21.1%) 8 (57.1%) p=0.033 arrival of the EMT. In the case of a sudden cardiac arrest, this resuscitation procedures, the use of automatic defibrillator exception of one patient in the group before the implementation from the shortens the time to the initiation of BLS and early (AED) and early defibrillation by health workers before the of the Red Code Protocol, were conducted in all patients (see hospital, n defibrillation, which has been proven to increase the patient's arrival of the EMT. Table II). There was also no significant difference in response (%) chances of survival [8]. Secondary outcome: The secondary aim was to assess the times of the EMT between the groups (Table II). CPC 1 or 2 at 2 (10.5%) 8 (57.1%) p=0.04 The on-duty team consists of two members, a doctor, and a impact of the establishment of the Red Code Protocol on the In the second period – after the establishment of the Red discharge, n nurse. They are equipped with a resuscitation bag containing all return of spontaneous circulation (ROSC), discharge of patients Code Protocol, compared to the first period, healthcare workers (%) the necessary equipment for providing initial managing emergency situations and an AED. The phone number to reach 113 the team is known to all the staff in the unit and is exclusively In addition to BLS, which was administered to almost all sectional study in northwestern Germany. Eur J Gen Pract. [6] Zafošnik U, Škufca Sterle M. Reception and treatment of used for activating the team. patients in both groups, an AED was used in almost all patients 2022;28(1):209-216. emergency patients in the Health Centre Ljubljana-Red Code. In: Vajd R, Gričar M, editors. 21st International Symposium on The team must respond to the call immediately and be with after 2014. Consequently, more shockable rhythms were [2] Liddy C, Dreise H, Gaboury I. Frequency of in-office emergencies Emergency Medicine; 2012 Jun 19-21; Portorož, Slovenia: in primary care. Canadian Fam Physician. 2009;55(10):1004- the patient within two minutes. recorded, and defibrillation was performed before the arrival of Slovenian Society for Emergency Medicine; 2014. p. 289-292. the EMT in many cases. Survival of patients in the AFTER 1005.e54. [7] Monachino A, Caraher C, Ginsberg J, et al. Medical emergencies All teams refresh their knowledge once a year at the SIM group was significantly higher compared to the BEFORE [3] Ramanayake RP, Ranasingha S, Lakmini S. Management of in the primary care setting: An evidence based practice approach Centre, and once a year, in-situ simulations are conducted in group. emergencies in general practice: role of general practitioners. J using simulation to improve readiness. J Pediatr Nurs. 2019;49:72- each unit. In situ simulations are a type of simulation delivered Family Med Prim Care. 2014;3(4):305-308. 78. in a real clinical environment. Participants are situated in their However, this improvement cannot be solely attributed to [4] Cernuda Martinez JA, Castro Delgado R, Arcos Gonzales P. Self- [8] Sirikul W, Piankusol C, Wittayachamnankul B, et al. A actual workplace and use their medical equipment during the the establishment of the Red Code Protocol. Over the last 22 perceived limitations and difficulties by Primary Health Care retrospective multi-centre cohort study: Pre-hospital survival simulation. In situ simulations provide an exceptional years, we have witnessed significant advances in medical Physicians to assist emergencies. Medicine (Baltimore). factors of out-of-hospital cardiac arrest (OHCA) patients in 2018;97(52):e13819. opportunity to identify latent safety threats and enhance team science, both in the prehospital management of cardiac arrest Thailand. Resusc Plus. 2022;9:100196. collaboration [9]. and in hospital treatment. [5] Klemenc-Ketis Z, Zafošnik U, Poplas Susič A. An innovative [9] Yajamanyam PK, Sohi D. In situ simulation as a quality approach to educating primary health care about medical improvement initiative. Arch Dis Child Educ Pract Ed. Such organized team within a primary healthcare institution The fact remains that rapid and professional care of patients emergencies. Educ Prim Care. 2020;31(1):44-47. 2015;100(3):162-163 for responding to emergency situations significantly contributes experiencing cardiac arrest at Ljubljana CHC has increased the to prompt and professional intervention, which is of paramount chances of survival for many patients. Numerous studies indeed importance for a patient experiencing sudden cardiac arrest. confirm the connection between immediate resuscitation and early defibrillation in the case of shockable rhythms and the With the research, we aimed to determine whether the care survival of patients after cardiac arrest. of patients who experienced sudden cardiac arrest improved after the establishment of the protocol. We also aimed to This study also has limitations. The first and most investigate whether there was an increase in the survival rate of significant limitation is the small sample size of patients who patients who experienced sudden cardiac arrest at the Ljubljana experience sudden cardiac arrest at the Ljubljana CHC every CHC after the implementation of continuous education for year. This is the reason why, for some results, we cannot draw healthcare workers and the establishment of the Red Code conclusions with prescribed certainty due to the small sample Protocol, compared to the period before. size. In both periods, healthcare workers performed BLS on all The second limitation is the fact that increased patient patients who experienced sudden cardiac arrest at Ljubljana survival after the implementation of Red Code Protocol at the CHC. The only exception was one intervention in the period Ljubljana CHC cannot be solely attributed to the establishment before the establishment of the Red Code Protocol, which of the protocol. However, since it is proven that immediate BLS involved a healthcare worker homicide at the Ljubljana CHC procedures and early defibrillation increase the chances of premises. The nurse who witnessed the murder of a healthcare survival, it is clear that the protocol implementation has worker and the subsequent cardiac arrest was unable to provide contributed to better outcomes for patients experiencing sudden medical help due to an extremely stressful situation. cardiac arrest at the Ljubljana CHC. Unlike BLS, the key difference was the use of AED and early defibrillation. In the AFTER group, an AED was used in V. almost all patients, with the exception of one intervention CONCLUSION involving an infant where the priority was to clear the airway, establish an open airway, and provide artificial ventilation. In the period after the establishment of the Red Code Protocol Therefore, the AED was significantly more frequently used in the AFTER group. The earlier rhythm analysis with an AED in the Community Health Centre Ljubljana, medical workers before the arrival of the EMT is the reason why the proportion used AED in most cases of resuscitation and performed early of patients with an initially recorded shockable rhythm was defibrillation more often before the arrival of the EMS team. significantly higher in the AFTER group, while the average The survival of patients after resuscitation in the Community response times of the EMT did not significantly differ in both Health Centre Ljubljana after the establishment of the Red groups. Code Protocol is significantly higher than in the period before. The continuous experiential learning of medical teams in ROSC before the arrival of EMT was several times higher Ljubljana Health Centre units through simulations and the in the AFTER group compared to the BEFORE group, but the establishment of the Red Code Protocol achieved its purpose – sample size was too small for statistical inference. better management and increased patient survival after sudden Statistically significant, there was a higher survival rate of cardiac arrest in CHC Ljubljana. patients until discharge from the hospital in the AFTER group. The proportion of patients in the AFTER group who had a good neurological outcome (CPC 1 or 2) at hospital discharge was almost six times higher compared to the BEFORE group, but here, too, the sample size was too small for statistical inference. REFERENCES We can conclude that after the establishment of the Red Code Protocol, the management of patients who experienced [1] Melzel M, Hoffmann F, Freitag MH, et al. Frequency and sudden cardiac arrest at Ljubljana CHC significantly improved. management of emergencies in primary care offices: A cross- 114 the team is known to all the staff in the unit and is exclusively In addition to BLS, which was administered to almost all sectional study in northwestern Germany. Eur J Gen Pract. [6] Zafošnik U, Škufca Sterle M. Reception and treatment of used for activating the team. patients in both groups, an AED was used in almost all patients 2022;28(1):209-216. emergency patients in the Health Centre Ljubljana-Red Code. In: Vajd R, Gričar M, editors. 21st International Symposium on The team must respond to the call immediately and be with after 2014. Consequently, more shockable rhythms were [2] Liddy C, Dreise H, Gaboury I. Frequency of in-office emergencies Emergency Medicine; 2012 Jun 19-21; Portorož, Slovenia: in primary care. Canadian Fam Physician. 2009;55(10):1004- the patient within two minutes. recorded, and defibrillation was performed before the arrival of Slovenian Society for Emergency Medicine; 2014. p. 289-292. the EMT in many cases. Survival of patients in the AFTER 1005.e54. [7] Monachino A, Caraher C, Ginsberg J, et al. Medical emergencies All teams refresh their knowledge once a year at the SIM group was significantly higher compared to the BEFORE [3] Ramanayake RP, Ranasingha S, Lakmini S. Management of in the primary care setting: An evidence based practice approach Centre, and once a year, in-situ simulations are conducted in group. emergencies in general practice: role of general practitioners. J using simulation to improve readiness. J Pediatr Nurs. 2019;49:72- each unit. In situ simulations are a type of simulation delivered Family Med Prim Care. 2014;3(4):305-308. 78. in a real clinical environment. Participants are situated in their However, this improvement cannot be solely attributed to [4] Cernuda Martinez JA, Castro Delgado R, Arcos Gonzales P. Self- [8] Sirikul W, Piankusol C, Wittayachamnankul B, et al. A actual workplace and use their medical equipment during the the establishment of the Red Code Protocol. Over the last 22 perceived limitations and difficulties by Primary Health Care retrospective multi-centre cohort study: Pre-hospital survival simulation. In situ simulations provide an exceptional years, we have witnessed significant advances in medical Physicians to assist emergencies. Medicine (Baltimore). factors of out-of-hospital cardiac arrest (OHCA) patients in 2018;97(52):e13819. opportunity to identify latent safety threats and enhance team science, both in the prehospital management of cardiac arrest Thailand. Resusc Plus. 2022;9:100196. collaboration [9]. and in hospital treatment. [5] Klemenc-Ketis Z, Zafošnik U, Poplas Susič A. An innovative [9] Yajamanyam PK, Sohi D. In situ simulation as a quality approach to educating primary health care about medical improvement initiative. Arch Dis Child Educ Pract Ed. Such organized team within a primary healthcare institution The fact remains that rapid and professional care of patients emergencies. Educ Prim Care. 2020;31(1):44-47. 2015;100(3):162-163 for responding to emergency situations significantly contributes experiencing cardiac arrest at Ljubljana CHC has increased the to prompt and professional intervention, which is of paramount chances of survival for many patients. Numerous studies indeed importance for a patient experiencing sudden cardiac arrest. confirm the connection between immediate resuscitation and early defibrillation in the case of shockable rhythms and the With the research, we aimed to determine whether the care survival of patients after cardiac arrest. of patients who experienced sudden cardiac arrest improved after the establishment of the protocol. We also aimed to This study also has limitations. The first and most investigate whether there was an increase in the survival rate of significant limitation is the small sample size of patients who patients who experienced sudden cardiac arrest at the Ljubljana experience sudden cardiac arrest at the Ljubljana CHC every CHC after the implementation of continuous education for year. This is the reason why, for some results, we cannot draw healthcare workers and the establishment of the Red Code conclusions with prescribed certainty due to the small sample Protocol, compared to the period before. size. In both periods, healthcare workers performed BLS on all The second limitation is the fact that increased patient patients who experienced sudden cardiac arrest at Ljubljana survival after the implementation of Red Code Protocol at the CHC. The only exception was one intervention in the period Ljubljana CHC cannot be solely attributed to the establishment before the establishment of the Red Code Protocol, which of the protocol. However, since it is proven that immediate BLS involved a healthcare worker homicide at the Ljubljana CHC procedures and early defibrillation increase the chances of premises. The nurse who witnessed the murder of a healthcare survival, it is clear that the protocol implementation has worker and the subsequent cardiac arrest was unable to provide contributed to better outcomes for patients experiencing sudden medical help due to an extremely stressful situation. cardiac arrest at the Ljubljana CHC. Unlike BLS, the key difference was the use of AED and early defibrillation. In the AFTER group, an AED was used in almost all patients, with the exception of one intervention V. CONCLUSION involving an infant where the priority was to clear the airway, establish an open airway, and provide artificial ventilation. In the period after the establishment of the Red Code Protocol Therefore, the AED was significantly more frequently used in the AFTER group. The earlier rhythm analysis with an AED in the Community Health Centre Ljubljana, medical workers before the arrival of the EMT is the reason why the proportion used AED in most cases of resuscitation and performed early of patients with an initially recorded shockable rhythm was defibrillation more often before the arrival of the EMS team. significantly higher in the AFTER group, while the average The survival of patients after resuscitation in the Community response times of the EMT did not significantly differ in both Health Centre Ljubljana after the establishment of the Red groups. Code Protocol is significantly higher than in the period before. The continuous experiential learning of medical teams in ROSC before the arrival of EMT was several times higher Ljubljana Health Centre units through simulations and the in the AFTER group compared to the BEFORE group, but the establishment of the Red Code Protocol achieved its purpose – sample size was too small for statistical inference. better management and increased patient survival after sudden Statistically significant, there was a higher survival rate of cardiac arrest in CHC Ljubljana. patients until discharge from the hospital in the AFTER group. The proportion of patients in the AFTER group who had a good neurological outcome (CPC 1 or 2) at hospital discharge was almost six times higher compared to the BEFORE group, but here, too, the sample size was too small for statistical inference. REFERENCES We can conclude that after the establishment of the Red Code Protocol, the management of patients who experienced [1] Melzel M, Hoffmann F, Freitag MH, et al. Frequency and sudden cardiac arrest at Ljubljana CHC significantly improved. management of emergencies in primary care offices: A cross- 115 INDEX OF AUTHORS Aigner P. .............................................................................................................................................................................14 Aleksandrovska N.S. .......................................................................................................................................................2 Aleksov B. ............................................................................................................................................................................2 Bekelaer F. ...................................................................................................................................................................14, 70 Bizjan M. .............................................................................................................................................................................19 Cvetko Gomezelj M. ...................................................................................................................................................... 50 Frece P. ................................................................................................................................................................................19 Gjorgjievski D. .................................................................................................................................................................. 73 Halilaj-Vishi B.Vojislav I. ...............................................................................................................................................9 Janet J. ...............................................................................................................................................................................41 Janevska S. ................................................................................................................................................................45, 76 Jug J. .................................................................................................................................................................................. 60 Kejžar A. .............................................................................................................................................................................19 Klemenc-Ketiš Z. ......................................................................................................................................................50, 90 Kopčavar Guček N. ........................................................................................................................................................ 54 Kostovska Prilepchanska E. ................................................................................................................................45, 76 Kovachevikj K. ..........................................................................................................................................................45, 76 Krajnc T. ............................................................................................................................................................................ 80 Kranjc J. ............................................................................................................................................................................ 85 Krepek M. .............................................................................................................................................................................5 Lavtižar J. ........................................................................................................................................................................102 Luetić F. .............................................................................................................................................................................. 60 Lunežnik P. ....................................................................................................................................................................... 28 Murphy F. .........................................................................................................................................................................107 Novak G. ............................................................................................................................................................................ 90 Petravić L. ......................................................................................................................................................................... 65 Pernek B. ........................................................................................................................................................................... 97 Podlipnik T. .....................................................................................................................................................................102 Prainer S. ............................................................................................................................................................................31 Raka L. ...................................................................................................................................................................................9 Rakić Matić J. .................................................................................................................................................................. 60 Ramšak Pajk J. ..............................................................................................................................................................107 Rant Ž. .................................................................................................................................................................................41 Rebhandl E. ................................................................................................................................................................14, 70 Selič-Zupančič P. ............................................................................................................................................................ 85 Skela Savič B. .................................................................................................................................................................107 Stavrikj K. ...................................................................................................................................................................45, 76 Svatina Šošić E. .............................................................................................................................................................. 23 Škufca Sterle M. ..............................................................................................................................................................111 Vishi I. ...................................................................................................................................................................................9 Vodička S. ..........................................................................................................................................................................31 Vojislav I. ..........................................................................................................................................................5, 23, 65, 97 Zelko E..........................................................................................................................................................................14, 70 Žitnik M. ............................................................................................................................................................................ 28 116 GENERAL INFORMATION SOCIAL PROGRAMME Conference Dinner 23 November 2023 at 20.00 Price: 80EUR As Aperitivo Restaurant Dress code: Business casual GENERAL INFORMATION Internet Wireless internet connection is available at Cankarjev dom. The name of the network is CD_GUEST. No login or password is needed. Conference Identification Badge A conference identification badge will be included in the conference material provided upon registration. There will be no admittance to the Scientific Sessions without the conference badge. Attendance Certificate A certificate of attendance will be issued to all registered participants after the Congress upon submission of EACMME feedback survey. Photos for ISCPC Use ISCPC attendance implies your consent to be photographed or otherwise recorded for use on the ISCPC website or news publications. Please note that no scientific presentations will be recorded. CREDIT POINTS “The 2nd International Scientific Conference of Primary Care - ISCPC, Ljubljana, Slovenia, 23/11/2023-24/11/2023 has been accredited by the European Accreditation Council for Continuing Medical Education (EACCME®) with 8 European CME credits (ECMEC®s). Each medical specialist should claim only those hours of credit that he/she actually spent in the educational activity.” Each participant can only receive the number of credits he/she is entitled to according to his/her actual participation at the event once he/she has completed the feedback form. Cf. criteria 9 and 23 of UEMS 2016.20. Zdravniška Zbornice Slovenije je konferenco ISCPC akreditirala s 8 kreditnimi točkami. For Credit Points accredidation porpouse your attendance will be monitored. 117 Orotracheal intubation Chest compressions Carotid pulse check External defibrillation Invasive ventilation IDEAL TRAINING TEAM & IV SITE CPR PAIR ATLAS WITH REALITi 360 • Lightweight, wireless and fully mobile, Atlas and REALITi 360 support effortless in-situ training • REALITi 360 simulates a wide variety of premium branded patient monitors, defibrillators, and ventilator screens • No real devices and no additional connectors are required to deliver training, saving you money and the need to source real patient monitors and defibrillators from in/outside the hospital • Owing to its intuitive design, Atlas can be used straight out of the box • The functional and robust design of Atlas boasts minimal to no maintenance Atlas is fully integrated with REALITi 360. The combination of Atlas and REALITi 360 offers a complete solution for AHA/ERC compliant ALS trainings. 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IO SITE AIRWAY MANAGEMENT MORE INFORMATION AVAILABLE ONLINE AT 3BSCIENTIFIC.COM 3B Scientific Europe Kft. • Taneszközgyártó és Forgalmazó Kft • Kozma u. 9/B • H-1108 Budapest • Hungary Phone: +36 1 431 09 14 • Fax: +36 1 262 33 93 • eu3bs@3bscientific.com • 3bscientific.com 119