1. Scaling-up an integrated care for patients with non-communicable diseases : an analysis of healthcare barriers and facilitators in Slovenia and BelgiumČrt Zavrnik, Katrien Danhieux, Miriam Hurtado Monarres, Nataša Stojnić, Majda Mori-Lukančič, Monika Martens, Zalika Klemenc-Ketiš, Edwin Wouters, Josefien Van Olmen, Tonka Poplas-Susič, 2021, original scientific article Abstract: Introduction: Although the concept of integrated care for non-communicable diseases was introduced at the primary level to move from disease-centered to patient-centered care, it has only been partially implemented in European countries. The aim of this study was to identify and compare identified facilitators and barriers to scale-up this concept between Slovenia and Belgium.
Methods: This was a qualitative study. Fifteen focus groups and fifty-one semi-structured interviews were conducted with stakeholders at the micro, meso and macro levels. In addition, data from two previously published studies were used for the analysis. Data collection and analysis was initially conducted at country level. Finally, the data was evaluated by a cross-country team to assess similarities and differences between countries.
Results: Four topics were identified in the study: patient-centered care, teamwork, coordination of care and task delegation. Despite the different contexts, true teamwork and patient-centered care are limited in both countries by hierarchies and a very heavily skewed medical approach. The organization of primary healthcare in Slovenia probably facilitates the coordination of care, which is not the case in Belgium. The financing and organization of primary practices in Belgium was identified as a barrier to the implementation of task delegation between health professionals.
Conclusions: This study allowed formulating some important concepts for future healthcare for non-communicable diseases at the level of primary healthcare. The results could provide useful insights for other countries with similar health systems.
Keywords: scale-up, noncommunicable diseases, patientcentered care, primary healthcare, integrated healthcare
Published in DKUM: 22.10.2024; Views: 0; Downloads: 3
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2. Implementation of integrated primary care for patients with diabetes and hypertension : a case from SloveniaZalika Klemenc-Ketiš, Nataša Stojnić, Črt Zavrnik, Nina Ružić Gorenjec, Katrien Danhieux, Majda Mori-Lukančič, Tonka Poplas-Susič, 2021, original scientific article Abstract: Introduction: Research on models of integrated health care for hypertension and diabetes is one of the priority issues in the world. There is a lack of knowledge about how integrated care is implemented in practice. Our study assessed its implementation in six areas: identification of patients, treatment, health education, self-management support, structured collaboration and organisation of care. Methods: This was a mixed methods study based on a triangulation method using quantitative and qualitative data. It took place in different types of primary health care organisations, in one urban and two rural regions of Slovenia. The main instrument for data collection was the Integrated Care Package (ICP) Grid, assessed through four methods: 1) a document analysis (of a current health policy and available protocols; 2) observation of the infrastructure of health centres, organisation of work, patient flow, interaction of patients with health professionals; 3) interview with key informants and 4) review of medical documentation of selected patients. Results: The implementation of the integrated care in Slovenia was assessed with the overall ICP score of 3.7 points (out of 5 possible points). The element Identification was almost fully implemented, while the element Self-management support was weakly implemented. Discussion: The implementation of the integrated care of patients with diabetes and/ or hypertension in Slovenian primary health care organisations achieved high levels of implementation. However, some week points were identified. Conclusion: Integrated care of the chronic patients in Slovenia is already provided at high levels, but the area of self-management support could be improved.
Keywords: delivery of health care, integrated, primary care, self-care
Published in DKUM: 27.08.2024; Views: 105; Downloads: 4
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3. Peer support as part of scaling-up integrated care in patients with type 2 diabetes and arterial hypertension at the primary healthcare level : a study protocolTina Virtič, Matic Mihevc, Črt Zavrnik, Majda Mori-Lukančič, Tonka Poplas-Susič, Zalika Klemenc-Ketiš, 2023, original scientific article Abstract: Introduction: Type 2 diabetes (T2D) and arterial hypertension (AH) are among the greatest challenges facing health systems worldwide and require comprehensive patient-centred care. The key to successful management in chronic patients is self-management support, which was found to be only weakly implemented in Slovenia. The aim of the study is to develop an evidence-based model of peer support for people with T2D and AH at the primary healthcare level in Slovenia, which could represent a potential solution for upgrading integrated care for these patients.
Methods: A prospective interventional, mixed-methods pilot study will begin by recruiting approximately 40 eligible people with T2D and AH through purposive sampling. The participants will receive structured training, led by a specialist nurse, to become trained peer supporters. Each will voluntarily share their knowledge and experience at monthly group meetings with up to 10 people with T2D and AH over a three-month period in the local community. Data will be collected through interviews and focus groups and questionnaires about socio-demographic and clinical data, knowledge about T2D and AH, participants’ quality of life, level of empowerment and acceptability of the intervention.
Expected results: The study will provide an evidence-based model for integrating peer support into the local community. It is expected that the intervention will prove feasible and acceptable with educational, psychosocial and behavioural benefits.
Conclusion: Peer support through empowerment of people with T2D and AH, family members and other informal caregivers in the local community could scale-up the integrated care continuum and contribute to sustainability of the healthcare system.
Keywords: diabetes type 2, arterial hypertension, peer support, self-management, integrated primary, healthcare
Published in DKUM: 17.07.2024; Views: 103; Downloads: 4
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4. Telemonitoring of elderly with hypertension and type 2 diabetes at the primary care level : protocol for a multicentric randomized controlled pilot studyMatic Mihevc, Črt Zavrnik, Majda Mori-Lukančič, Tina Virtič, Valentina Prevolnik Rupel, Marija Petek Šter, Zalika Klemenc-Ketiš, Tonka Poplas-Susič, 2022, original scientific article Abstract: Introduction: Arterial hypertension (AH) and type 2 diabetes (T2D) represent a significant burden for the public health system, with an exceptionally high prevalence in patients aged ≥65 years. This study aims to test the acceptability, clinical effectiveness, and cost-effectiveness of telemonitoring in elderly patients with AH and T2D at the primary care level.
Methods: A m ulti-centre, prospective, randomized, controlled t rial w ill be conducted. Patients a ged ≥ 65 y ears with AH and T2D will be randomized in a 1:1 proportion to a mHealth intervention or standard care group. Patients in the intervention group will measure their blood pressure (BP) twice weekly and blood glucose (BG) once monthly. The readings will be synchronously transmitted via a mobile application to the telemonitoring platform, where they will be reviewed by a general practitioner who will indicate changes in measurement regimen or carry out a teleconsultation. The primary endpoint will be a change in systolic BP (SBP) and glycated haemoglobin (HbA1c) relative to standard care up to 12 months after inclusion. Secondary endpoints will be a change in other observed clinical variables, quality-of-life indexes, and costs.
Expected results: Telemonitoring will be an acceptable method of care associated with significant reductions in SBP and HbA1c levels and an increase in quality-of-life indexes in the intervention group. However, the cost-effectiveness threshold (incremental cost-effectiveness ratio below €25,000/quality-adjusted life year) might not be reached.
Conclusion: This study will provide new evidence for scaling up telemonitoring network at the primary care level and modifying telemonitoring protocols to achieve the best clinical and cost-effective outcomes.
Keywords: mobile health, telemonitoring, blood pressure, blood glucose, HbA1c, aged, primary health care, costs
Published in DKUM: 27.06.2024; Views: 178; Downloads: 8
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5. Process evaluation of the scale-up of integrated diabetes and hypertension care in Belgium, Cambodia and Slovenia (the SCUBY Project) : a study protocolMonika Martens, Edwin Wouters, Josefien Van Olmen, Zalika Klemenc-Ketiš, Srean Chhim, Savina Chham, Verle Buffel, Katrien Danhieux, Nataša Stojnić, Črt Zavrnik, Tonka Poplas-Susič, Win Van Damme, Por Ir, Roy Remmen, Grace Marie V Ku, Kerstin Klipstein-Grobusch, Daniel Boateng, 2022, original scientific article Abstract: Introduction Integrated care interventions for type 2 diabetes (T2D) and hypertension (HT) are effective, yet challenges exist with regard to their implementation and scale-up. The ‘SCale-Up diaBetes and hYpertension care’ (SCUBY) Project aims to facilitate the scale-up of integrated care for T2D and HT through the co-creation and implementation of contextualised scale-up roadmaps in Belgium, Cambodia and Slovenia. We hereby describe the plan for the process and scale-up evaluation of the SCUBY Project. The specific goals of the process and scale-up evaluation are to (1) analyse how, and to what extent, the roadmap has been implemented, (2) assess how the differing contexts can influence the implementation process of the scale-up strategies and (3) assess the progress of the scale-up.
Methods and analysis A comprehensive framework was developed to include process and scale-up evaluation embedded in implementation science theory. Key implementation outcomes include acceptability, feasibility, relevance, adaptation, adoption and cost of roadmap activities. A diverse range of predominantly qualitative tools—including a policy dialogue reporting form, a stakeholder follow-up interview and survey, project diaries and policy mapping—were developed to assess how stakeholders perceive the scale-up implementation process and adaptations to the roadmap. The role of context is considered relevant, and barriers and facilitators to scale-up will be continuously assessed.
Ethics and dissemination Ethical approval has been obtained from the Institutional Review Board (ref. 1323/19) at the Institute of Tropical Medicine (Antwerp, Belgium). The SCUBY Project presents a comprehensive framework to guide the process and scale-up evaluation of complex interventions in different health systems. We describe how implementation outcomes, mechanisms of impact and scale-up outcomes can be a basis to monitor adaptations through a co-creation process and to guide other scale-up interventions making use of knowledge translation and co-creation activities.
Keywords: diabetes and hypertension care, Belgium, Cambodia, Slovenia
Published in DKUM: 27.06.2024; Views: 139; Downloads: 8
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6. Perceptions of the primary health care team about the implementation of integrated care of patients with type 2 diabetes and hypertension in Slovenia : qualitative studyNataša Stojnić, Zalika Klemenc-Ketiš, Majda Mori-Lukančič, Črt Zavrnik, Tonka Poplas-Susič, 2023, original scientific article Abstract: Background
Integrated care involves good coordination, networking, and communication within health care services and externally between providers and patients or informal caregivers. It affects the quality of services, is more cost-effective, and contributes to greater satisfaction among individuals and providers of integrated care. In our study, we examined the implementation and understanding of integrated care from the perspective of providers - the health care team - and gained insights into the current situation.
Methods
Eight focus groups were conducted with health care teams, involving a total of 48 health care professionals, including family physicians, registered nurses, practice nurses, community nurses, and registered nurses working in a health education center. Prior to conducting the focus groups, a thematic guide was developed based on the literature and contextual knowledge with the main themes of the integrated care package. The analysis was conducted using the NVivo program.
Results
We identified 12 main themes with 49 subthemes. Health care professionals highlighted good accessibility and the method of diagnostic screening integrated with preventive examinations as positive aspects of the current system of integrated care in Slovenia. They mentioned the good cooperation within the team, with the involvement of registered nurses and community nurses being a particular advantage. Complaints were made about the high workload and the lack of workforce. They feel that patients do not take the disease seriously enough and that patients as teachers could be useful.
Conclusion
Primary care teams described the importance of implementing integrated care for diabetes and hypertension patients at four levels: Patient, community, care providers, and state. Primary care teams also recognized the importance of including more professionals from different health care settings on their team.
Keywords: integrated health care system, type-2-diabetes, Hypertension, Health care team, interdisciplinary primary care, qualitative research
Published in DKUM: 19.04.2024; Views: 250; Downloads: 11
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7. Odnos žensk do personaliziranih kozmetičnih izdelkov in njihove uporabeKarin Zavrnik, 2022, master's thesis Abstract: Ljudje smo si med seboj različni po določenih lastnostih, prav tako se med seboj razlikujemo po različnih tipih kože. Vsak posameznik ima specifične karakteristike in potrebe po negi svoje kože, zato je še posebej pomembno prepoznati lasten tip kože. V kozmetični industriji se je tako porodila ideja o individualizirani obravnavi in negi kože posameznika. To je sprožilo razvoj personaliziranih kozmetičnih izdelkov, ki so v današnjem času pritegnili veliko pozornosti. Personaliziran kozmetični izdelek opredelimo kot izdelek, ki je prilagojen značilnostim posameznikove kože in/ali njegovim željam ter potrebam. Namenjeni so za uporabo zunanjih delov človeškega telesa z namenom, da jih očistimo, odišavimo, spremenimo videz, nudimo zaščito ter vzdržujemo ali korigiramo telesne vonjave. Personalizirani kozmetični izdelki omogočajo personalizirano nego kože, saj kupcu nudijo izdelek, ki vsebuje natančno izbrane sestavine. Te bodo na njegovo kožo učinkovito delovale in tako hitreje dosegle želen rezultat, ki jih drugi kozmetični izdelki morebiti ne bi. V magistrski nalogi smo želeli raziskati, kako se odnos žensk do personaliziranih kozmetičnih izdelkov razlikuje glede na njihove demografske dejavnike, kot so starost, osebni mesečni dohodek in dokončana stopnja izobrazbe. Prav tako smo z raziskavo želeli ugotoviti, kaj vpliva na odločitev, da se bo posameznik odločil za uporabo personaliziranega kozmetičnega izdelka.
Rezultati so pokazali, da se odnos žensk do personaliziranih kozmetičnih izdelkov razlikuje glede na starost žensk. Razlikuje se med skupinami žensk, rojenimi med letoma 1965 in 1983, in tistimi, ki so se rodile v letih od 1984 do 2002. Prav tako se odnos razlikuje med ženskami, ki so se rodile med letoma 1946–1964 in 1984–2002. Statistično značilne razlike v odnosu žensk do uporabe personaliziranih kozmetičnih izdelkov obstajajo tudi glede na njihov osebni mesečni dohodek in zaključeno stopnjo izobrazbe. Značilne razlike obstajajo tudi med skupinami žensk, katerih stopnja izobrazbe je magisterij, in tistimi, ki so dokončale osnovno šolo. Prav tako pa tudi med tistimi, ki imajo opravljen magisterij, in tistimi, ki imajo zaključeno višjo ali visoko šolo. Analiza pomembnosti posameznih dejavnikov, kot so učinkovito delovanje, ugodna cena, videz embalaže, posebno izbrane kozmetične sestavine za izbran tip kože in personalizirana embalaža izdelka, je pokazala, da je ženskam najpomembnejši dejavnik za odločitev o uporabi personaliziranih kozmetičnih izdelkov njihovo učinkovito delovanje.
Keywords: odnos žensk, personalizacija, personalizirani kozmetični izdelki
Published in DKUM: 21.02.2023; Views: 620; Downloads: 95
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8. Cenitev in dejavniki vrednosti nepremičnin ter dejavniki lastnih pričakovanj potencialnih kupcev stanovanjskih nepremičnin v mestni občini mariborBratko Zavrnik, 2017, master's thesis Abstract: Magistrsko delo obravnava značilnosti stanovanjskih nepremičnin v primerjavi z drugimi produkti na prostem trgu, načine njihovega vrednotenja in dejavnike, ki so za kupce pomembni pri odločitvah o njihovem nakupu. V teoretičnem delu so predstavljeni definicija, pojem lastništva, značilnosti, lastnosti in vrste nepremičnin. Predstavljene so tudi značilnosti in zakonitosti trga nepremičnin ter postopki vrednotenja. V empiričnem delu je na vzorcu opravljena raziskava treh sklopov lastnih pričakovanj potencialnih kupcev nepremičnin v Mestni občini Maribor: fizičnih dejavnikov, dejavnikov bivalnega okolja in socioekonomskih dejavnikov. Rezultati raziskave kažejo, da so za kupce najpomembnejši lokacija, dobre prometne povezave in občutek varnosti.
Keywords: nepremičnine, stanovanjske nepremičnine, trg nepremičnin, cenitev nepremičnin, Mestna občina Maribor, dejavniki lastnih pričakovanj potencialnih kupcev nepremičnin
Published in DKUM: 08.03.2018; Views: 1561; Downloads: 190
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9. PROBLEMATIKA HITREGA UPOKOJEVANJA V SLOVENSKEM GOSPODARSTVUJure Zavrnik, 2012, undergraduate thesis Abstract: Upokojitev predstavlja zadnjo večjo prelomnico v človekovem življenju. Simbolno ponazarja prehod v obdobje umiritve in počitka po, z raznimi aktivnostmi in dejavnostmi zapolnjenim, aktivnem življenju posameznika. V tem obdobju ljudje počno stvari, ki so jim v veselje, vendar za njih prej niso imeli časa ali energije. Kdaj se bo pri komu začelo to obdobje, je odvisno od posameznika – od njegovega fizičnega in psihičnega počutja, kakor tudi od materialnih zmožnosti.
Problem se pojavi, če ljudje občutijo težnjo po upokojitvi zaradi nezadovoljstva na svojem delovnem mestu. Zaradi tega gospodarstvo izgublja zaposlene, ki predstavljajo danes njegov največji potencial in vrednost. Namesto, da bi se v gospodarstvu trudili prepoznati sposobnosti svojih zaposlenih, jih spodbujati in vlagati v njihov razvoj, se nanje še vedno gleda kot strošek, kot nujno zlo, ki ga je potrebno oklestiti. S tem seminarjem smo skozi analizo problematike prišli do zaključka, da tiči del vzroka za krizo, v kateri se je znašlo naše gospodarstvo, v neprimernem ravnanju z zaposlenimi.
Podjetja bodo morala čim prej spremeniti svoj odnos do zaposlenih in povečati motiviranje ter vlaganje v njihov razvoj, saj bodo le tako dosegla večjo inovativnost, ki je ključ za boljšo konkurenčnost. Svoje bo seveda k reševanju problematike morala prispevati država in prvi znaki, da se intenzivno pripravljajo ukrepi in reforme na področju trga dela, pokojninske zakonodaje ter zdravstvenega sistema, so spodbudni.
Keywords: upokojevanje, hitro upokojevanje, motiviranje, konkurenčnost, pokojninska reforma, pokojninska zakonodaja
Published in DKUM: 11.12.2012; Views: 1277; Downloads: 87
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