1. 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, izvirni znanstveni članek Opis: 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.
Ključne besede: mobile health, telemonitoring, blood pressure, blood glucose, HbA1c, aged, primary health care, costs
Objavljeno v DKUM: 27.06.2024; Ogledov: 178; Prenosov: 9
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2. Stališča zdravnikov družinske medicine in njihovih bolnikov do izvajanja 24-urnega neinvazivnega merjenja krvnega tlaka v ambulanti družinske medicineMarija Petek Šter, Janko Kersnik, 2009, izvirni znanstveni članek Opis: Purpose: Ambulatory blood pressure monitoring (ABPM) is increasingly being used in general practice, but there is a lack of information about the attitudes of general practitioners and their patients about the use of ABPM inprimary care in Europe. Methods: Cross sectional survey performed on consecutive patients with uncontrolled hypertension treated by at least two different antihypertensive drugs and referred for ABPM in 38 general practicesin Slovenia. Patients and physicians completed a questionnaire about their satisfaction with, attitudes about and acceptance of ABPM in general practice; the latter two were assessed using 5 point Likert scales. Results: We obtained complete data for 185 patients; 95 female (51.4%) and 90 (48.6%) male, aged 37 to 79 years (mean 59.5, SD 9.5 years). 106 (67.3 %) patients were completely satisfied with the instructions given before ABPM. Patients found ABPM an acceptable method of blood pressure control. They believed that ABMP helped to reach better blood pressure control (Likert scale: 4.46, SD 1.03) and valued having access to ABPM in general practice (Likert scale: 4.65, SD 1.01). General practitioners strongly believed that ABPM was acceptable to patients, improved patient and physician interest in blood pressure control, improved compliance with treatment and reduced prescription of antihypertensive drugs. They recognised ABPM as being most valuable in cases of patients with suspected white-coat hypertension (Likert scale: 4.79, SD 0.49). Conclusions: Patients and general practitioners find ABPM to be an acceptable method for investigating blood pressure. Patients value being able to access ABPM in general practice rather than in a specialist setting.
Ključne besede: arterijska hipertenzija, 24-NMKT, stališča, sprejem, družinska medicina
Objavljeno v DKUM: 19.04.2024; Ogledov: 165; Prenosov: 5
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3. Kakovost oskrbe v odnosu na oceno kakovosti vodenja kronične bolezni bolnikov s koronarno boleznijoKsenija Tušek-Bunc, Marija Petek Šter, Davorina Petek, 2018, izvirni znanstveni članek Opis: 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.
Ključne besede: coronary heart disease patients, patient's assessment of chronic illness care, quality of care
Objavljeno v DKUM: 05.04.2024; Ogledov: 199; Prenosov: 9
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4. Vpliv 24-urnega neinvazivnega merjenja krvnega tlaka na obravnavo bolnikov z arterijsko hipertenzijo v družinski mediciniMarija Petek Šter, Janko Kersnik, 2009, izvirni znanstveni članek Opis: Izhodišča: Podatki, pridobljeni s pomočjo 24-urnega neinvazivnega merjenja krvnega tlaka (24- NMKT), so pomembno dopolnilo k ambulantnim meritvam krvnega tlaka v diagnostiki hipertenzije in spremljanju zdravljenja. Namen raziskave je bil ugotoviti, kako izvedba 24-NMKT vpliva na obravnavo bolnikov z arterijsko hipertenzijo v družinski medicini.
Preiskovanci in metode: V raziskavo je bilo v 38 ambulantah družinske medicine vključenih 339 zaporednih bolnikov z arterijsko hipertenzijo, ki kljub kombinacijskemu zdravljenju niso dosegali ciljnih vrednosti. Bolniki so bili naključno razdeljeni v testno skupino, pri kateri smo izvedli 24-NMKT, ter kontrolno skupino, pri kateri preiskave nismo izvedli. Po 12 tednih smo ocenjevali učinek 24-NMKT na nadaljnje zdravljenje arterijske hipertenzije.
Rezultati: Analizirali smo podatke za 339 bolnikov: 160 v testni in 179 v kontrolni skupini, ki so bili stari od 34 do 80 let (v povprečju 61,4 leta, SD 9,8 let) s povprečnim sistoličnim 159,2 (SD 12,5) mm Hg ter diastoličnim krvnim tlakom 92,1 (SD 8,7) mm Hg. Pri 45 (28,1 %) bolnikih smo z 24-NMKT ugotovili doseganje ciljnih vrednosti krvnega tlaka. Verjetnost za urejen krvni tlak je bila večja pri ženskah – razmerje obetov (OR) 5.445 (95-odstotni interval zaupanja 2,16–13,76) – ter pri bolnikih z nižjo vrednostjo srednjega arterijskega tlaka na osnovi ambulantnih meritev krvnega tlaka – OR = 0.931 (95-odstotni interval zaupanja 0,84–0,97). Izvedba 24-NMKT ni vplivala na število s hipertenzijo povezanih obiskov v ambulanti (1,6 v testni, 1,7 v kontrolni skupini, p = 0,306), so bili pa bolniki v testni skupini redkeje izpostavljeni spreminjanju antihipertenzivnega zdravljenja (v testni v 52,5 %, v kontrolni v 66,5 %, p = 0,009).
Zaključki: Učinek bele halje je pogosto prisoten pri bolnikih z arterijsko hipertenzijo, zdravljenih s kombinirano antihipertenzivno terapijo. 24-NMKT ne vpliva na pogostost obiskov v ambulanti, zmanjša pa verjetnost za spreminjanje antihipertenzivne terapije.
Ključne besede: arterijska hipertenzija, ambulanta družinske medicine, 24-urno neinvazivno merjenje krvnega tlaka, spremljanje, zdravljenje z zdravili
Objavljeno v DKUM: 27.03.2017; Ogledov: 1830; Prenosov: 137
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