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Kakovost oskrbe v odnosu na oceno kakovosti vodenja kronične bolezni bolnikov s koronarno boleznijo
Ksenija Tušek-Bunc, Marija Petek Šter, Davorina Petek, 2018, original scientific article

Abstract: Purpose: Patient-centered assessment of chronic illness care is replacing the assessment of satisfaction, which does not cover all dimensions of care. Pa- tient assessments reflect both the qual- ity of chronic illness care and provide feedback to healthcare workers about their work. The study aim was to inves- tigate the patient-centered assessment of coronary heart disease (CHD) pa- tients and its correlation with the care that was delivered. Methods: This cross-sectional study evaluated data obtained from the patient medical records and surveyed patients using the Patient Assessment of Chronic Illness Care (PACIC) ques- tionnaire. A descriptive analysis of the overall and domain-specific responses to the PACIC questionnaire was con- ducted and the association of the results with delivery of care data in the patient records was determined by Pearson's correlation coefficient. Results: The study sample included 768 of 1080 CHD patients (71,1%) at 36 family medicine practices who com- pleted the PACIC questionnaire. The mean age of the re- spondents was 68.3 +- 10.7 years and the overall PACIC score was 3.3 +- 0.9. The highest PACIC scores were deliv- ery system design (3.7), patient activation (3.7), and prob- lem solving (3.6). Follow-up received the lowest score (2.8). Quality of delivered care and PACIC scores were correlated (r = 0.10, p = 0.009). Conclusions: CHD patients highly rated all aspects of chronic care included in the PACIC questionnaire. They were least satisfied with the follow-up and coordination as- pects of chronic care. The process indicators of care were positively correlate with patient assessment of care.
Keywords: coronary heart disease patients, patient's assessment of chronic illness care, quality of care
Published in DKUM: 05.04.2024; Views: 113; Downloads: 2
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The safety of patient management in family medicine in Slovenia during Covid-19 : a crosssectional study
Maja Cvetko Gomezelj, Špela Miroševič, Alina Verdnik Tajki, Ksenija Tušek-Bunc, Esther Van Poel, Sara Willems, Zalika Klemenc-Ketiš, 2023, original scientific article

Abstract: Abstract Background During the Covid-19 pandemic, family medicine practices (FMPs) changed to improve safety against new coronavirus infections for both patients and employees. Protocols for treating patients with suspected Sars-Cov-2 infections were established to protect medical staf and other patients from being infected. However, these protocols also led to increased safety risks, such as delays in treating patients with other medical conditions. This exploratory study aimed to investigate safety risks in treating patients in FMPs during the Covid-19 pandemic and to suggest improvements to prevent Covid-19 in FMPs in Slovenia. Methods A cross-sectional study was rolled out in FMPs in Slovenia as part of the international Pricov-19 study. Data collection on safety management during the Covid-19 pandemic in FMPs in Slovenia took place from November 2020 until January 2021 using a self-administered online survey for FP working in Slovenia. A chi-square test, ANOVA, independent samples t-test or bivariate correlation test was performed to explore associations regarding the safety of patients’ management variables. Results From the 191 participating family physicians (FPs) (15.2% response rate), 54.8% reported having treated patients with fever (not Covid-19) late due to the new protocols at least once, and 54.8% reported patients with urgent conditions having been seen late at least once due to not coming. In the suburbs and rural environments FPs more often reported that at least once patient with a fever (not Covid-19) was seen late due to the protocol (p=0.017) and more often reported that at least once patient with an urgent condition was seen late due to not com‑ ing to their FP (p=0.017). The larger the practice, the more they reported that at least once a patient with fever (not Covid-19) was seen late due to the protocol (p=0.012) and the more they reported at least once a patient with an urgent condition was seen late due to not coming to their FP (p=0.012). Conclusion Covid-19 afected the safety of patient management in FMP in Slovenia. The most common prob‑ lem was foregone care. Therefor, protocols for chronic patient management in the event of epidemics need to be established.
Keywords: Covid-19, family medicine, patient safety, patient management, quality of care, PRICOV-19, primary health care, general practice, timeliness
Published in DKUM: 29.03.2024; Views: 154; Downloads: 10
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Monitoring of quality in health care using indicators : challenges and possible solutions
Mircha Poldrugovac, Tit Albreht, 2017, original scientific article

Abstract: A number of stakeholders identified the need to revise the national set of quality indicators. The objectives of monitoring quality indicators that were determined in 2010 for the most part were not accomplished. Key reasons include: insufficient communication between stakeholders after the indicator set was introduced, insufficient definition of human and financial resources necessary for indicators' monitoring, lack of a thorough ICT structure that could support indicators' monitoring and weak leadership for these activities. A new performance indicators' set requires a clear identification of the objectives to be pursued and consequently of the theoretical framework for the indicators. Mostly it is necessary in addition to the identification of the challenges so far, to also recognize what are the possibilities to strengthen this area in the future.
Keywords: quality, health care, health promotion, efficiency
Published in DKUM: 09.10.2018; Views: 1111; Downloads: 108
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Social capital in rural communities in the Netherlands
Frans Thissen, 2009, original scientific article

Abstract: The quality of life in Dutch rural communities is high in comparison with urban communities in the Netherlands because of the residential quality of villages, the mobility of the inhabitants and the strong commitment by the inhabitants to the local society. However, today’s Dutch villages bear no resemblance to the traditional village and neither is social capital self-evident nowadays. This article presents evidence from two projects. It summarizes some results of a national survey organised within the framework of the research programme entitled ‘The Social State of the Countryside’, as carried out by the Social and Cultural Planning Office of The Netherlands (SCP) and a project in one of the most rural parts of the Netherlands (Zeeland). In the Zeeland villages, social capital is analysed from the point of view of the relationship between quality of life, social cohesion and local community care in small villages.
Keywords: transformation of rural communities, civil society, social capital, quality of life, social vitality, social cohesion, community care
Published in DKUM: 19.03.2018; Views: 1470; Downloads: 105
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Quality registers in professional health care educations : knowledge gaps and proposed actions
Annika Nordin, Torie Palm Ernsäter, Bo Bergman, 2014, original scientific article

Abstract: Background and purpose: The use of quality registers has increased rapidly in Sweden and they are identified as beneficial for health care competitiveness. A quality register is a structured gathering of patient information, to improve health care. However, the introduction of quality registers in health care organisations presupposes that employees know how to use them in quality improvement. Disconnections, or knowledge gaps, concerning quality registers hamper the possibilities to take advantage of them. Taking departure in professional health care educations, the purpose with the paper is to identify and explore knowledge gaps concerning quality registers. A second purpose is to propose actions to bridge the gaps. Methodology/Approach: In 2012 50 semi-structured telephone interviews were completed and the material analysed in the search for knowledge gaps. Results: Five knowledge gaps were found. Some professional health care educations teach improvement knowledge, but they have difficulties integrating quality registers as a resource in teaching. Quality registers do not sufficiently cooperate with professional health care educations and county councils do not generally include learning of quality registers in clinical placements/practicums. Conclusion: Professional health care educations need forums where they can collaborate with others to jointly explore how learning of quality registers can be integrated. There are promising approaches.
Keywords: quality registers, quality improvement, health care
Published in DKUM: 22.01.2018; Views: 1067; Downloads: 137
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Factors impacting on the activation and approach times of helicopter emergency medical services in four Alpine countries
Iztok Tomazin, Miljana Vegnuti, John Ellerton, Oliver Reisten, Guenther Sumann, Janko Kersnik, 2012, original scientific article

Abstract: Background: The outcome of severely injured or ill patients can be time dependent. Short activation and approach times for emergency medical service (EMS) units are widely recognized to be important quality indicators. The use of a helicopter emergency medical service (HEMS) can significantly shorten rescue missions especially in mountainous areas. We aimed to analyze the HEMS characteristics that influence the activation and approach times. Methods: In a multi-centre retrospective study, we analyzed 6121 rescue missions from nineHEMS bases situated in mountainous regions of four European countries. Results: We found large differences in mean activation and approach times among HEMS bases. The shortest mean activation time was 2.9 minutes; the longest 17.0 minutes. The shortest mean approach time was 10.4 minutes; the longest 45.0 minutes. Short times are linked (p < 0.001) to the following conditions: helicopter operator is not state owned; HEMS is integrated in EMS; all crew members are at the same location; doctors come from state or private health institutions; organization performing HEMS is privately owned; helicopters are only for HEMS; operation area is around 10.000 km2; HEMS activation is by a dispatching centre of regional government who is in charge of making decisions; there is only one intermediator in the emergency call; helicopter is equipped with hoist or fixed line; HEMS has more than one base with helicopters, and one team per base; closest neighboring base is 90 km away; HEMS is about 20 years old and has more than 650 missions per year; and modern helicopters are used. Conclusions: An improvement in HEMS activation and approach times is possible. We found 17 factors associated with shorter times.
Keywords: emergency medical services, air ambulances, emergency helicopters, quality of health care, activation and approach time
Published in DKUM: 29.06.2017; Views: 1554; Downloads: 308
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The safety attitudes questionnaire - ambulatory version : psychometric properties of the Slovenian version for the out-of-hours primary care setting
Zalika Klemenc-Ketiš, Matjaž Maletič, Vesna Stropnik, Ellen Tveter Deilkås, Dag Hofoss, Gunnar Tschudi Bondevik, 2017, original scientific article

Abstract: Background: Several tools have been developed to measure safety attitudes of health care providers, out of which the Safety Attitudes Questionnaire (SAQ) is regarded as one of the most appropriate ones. In 2007, it was adapted to outpatient (primary health care) settings and in 2014 it was tested in out-of-hours health care settings in Norway. The purpose of this study was to translate the English version of the SAQ-Ambulatory Version (SAQ-AV) to Slovenian language; to test its reliability; and to explore its factor structure. Methods: This was a cross-sectional study that took place in Slovenian out-of-hours primary care clinics in March- May 2015 as a part of an international study entitled Patient Safety Culture in European Out-of-hours services. The questionnaire consisted of the Slovenian version of the SAQ-AV. The link to the questionnaire was emailed to health care workers in the out-of-hours clinics. A total of 438 participants were invited. We performed exploratory factor analysis. Results: Out of 438 invited participants, 250 answered the questionnaire (response rate 57.1%). Exploratory factor analysis put forward five factors: 1) Perceptions of management, 2) Job satisfaction, 3) Safety climate, 4) Teamwork climate, and 5) Communication. Cronbach's alpha of the whole SAQ-AV was 0.922. Cronbach's alpha of the five factors ranged from 0.587 to 0.791. Mean total score of the SAQ-AV was 56.6 +- 16.0 points. The factor with the highest average score was Teamwork climate and the factor with the lowest average was Job satisfaction. Conclusions: Based on the results in our study, we cannot state that the SAQ-AV is a reliable tool for measuring safety culture in the Slovenian out-of-hours care setting. Our study also showed that there might be other safety culture factors in out-of-hours care not recognised before. We therefore recommend larger studies aiming to identify an alternative factor structure.
Keywords: patient safety, quality assurance, health care
Published in DKUM: 28.06.2017; Views: 1856; Downloads: 174
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The role of the psychosocial dimension in the improvement of quality of care : a systematic review
Irena Makivić, Janko Kersnik, Zalika Klemenc-Ketiš, 2016, review article

Abstract: The aim of our systematic review was to analyse the published literature on the psychosocial dimension of care in family medicine and its relationship with quality of care. We wanted to find out whether there is any evidence on the psychosocial approach in (family) medicine. The recommended bio-psycho-social approach, besides the biomedical model of illness, takes into account several co-influencing psychological, sociological and existential factors. An online search of nine different databases used Boolean operators and the following selection criteria: the paper contained information on the holistic approach, quality indicators, family medicine, patient-centred care and/or the bio-psycho-social model of treatment. We retrieved 743 papers, of which 36 fulfilled our inclusion criteria. Including the psychosocial dimension in patient management has been found to be useful in the prevention and treatment of physical and psychiatric illness, resulting in improved social functioning and patient satisfaction, reduced health care disparities, and reduced annual medical care charges. The themes of patient-centred, behavioural or psychosocial medicine were quite well presented in several papers. We could not find any conclusive evidence of the impact of a holistic biopsycho-social-approach. Weak and variable definitions of psychosocial dimensions, a low number of welldesigned intervention studies, and low numbers of included patients limited our conclusions.
Keywords: general practice, social problems, psychosocial care, quality of health care, reviews
Published in DKUM: 05.04.2017; Views: 1029; Downloads: 179
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Self-reported chronic conditions in student population in Slovenia
Zalika Klemenc-Ketiš, Žiga Hladnik, Danica Rotar-Pavlič, Mieke Post, Janko Kersnik, 2010, original scientific article

Abstract: Purpose/Objective: The aims of this study were (1) to determine the prevalence of chronic diseases in a student population in Slovenia, (2) to determine the effects of chronic diseases on the use of health services. Methods: A cross-sectional web-survey among university students in Ljubljana and Maribor, Slovenia took place in March and April 2008. Data were analyzed using SPSS version 13.0 (SPSS Inc, Chicago, IL, USA),and chi-square test, t-test and binary logistic regression analysis were performed. Results: The prevalence of chronic diseases in the student population was 40.3 %. The most common chronic diseases were allergies (excluding hay fever) (14.9 %), hay fever (11.4 %), followed by skin diseases (9.2 %) and anxiety (5.3 %). Both high blood pressure and asthma had a higher prevalence in men than in women (p < 0.001 and p = 0.023, respectively). Students with chronic conditions less often thought that they can influence their own health by self-treatment, experienced stress in the previous week, more likely visited or contacted his/her personal doctor in the past year, more likely purchased medications for self-treatment from a pharmacist in the past year, were more aware of the facts that self-treatment may hide the symptoms and signs of illness to such extent that the doctor may not be able to recognize it or overlook it completely. Conclusion: A greater awareness of the prevalence and impact of chronic diseases in students is warranted and the existing interventions should be changed in order to achieve a better life quality of university students.
Keywords: students, chronic disease, prevalence, self-care, quality of life
Published in DKUM: 28.03.2017; Views: 1282; Downloads: 82
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Discrete event simulation of administrative and medical processes
Robert Leskovar, Rok Accetto, Alenka Baggia, Zlatko Lazarevič, Goran Vukovič, Peter Požun, 2011, review article

Abstract: Background: Medical processes are often obstructed by administrative ones. The main issue in administrative processes is uneven workload resulting in an increased possibility of human errors. The system approach assures that medical and administrative processes are integrated. According to research reports and best practices, discrete event simulation is a proper method to implement the system approach. Methods: A detailed analysis of the administrative processes was performed using interviews, UML diagrams and flowcharts. Based on the data gathered from the information system and measurements on the site, the distribution of patient arrivals and service times were modelled. The aim of discrete event simulation models was to replicate the behaviour of the existing system (separate administration) and to simulate the changes proposed (joint administration). Results: Average utilizations of administrative personnel in 100 simulation runs for specific clinical departments are: 83.8 % at the Department of Rheumatology, 61.9 % at the Department of Hypertension, and 47.2 % at the Veteransć Medical Unit. Should joint administration be applied, the average utilization of administrative personnel would be 74.3%. Conclusions: Discrete event simulation proved that joint administration would contribute to a more even workload distribution among administrative personnel, higher quality of service and easier human resource management. The presented approach can be efficiently applied to large-scale systems e.g. organizational changes of processes in Specialist Outpatient Clinics.
Keywords: health care, discrete event simulation, quality of service
Published in DKUM: 27.03.2017; Views: 1288; Downloads: 150
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