1. Academic general practice/family medicine in times of COVID-19 - Perspective of WONCA EuropeAdam Windak, Thomas Frese, Eva Hummers-Pradier, Zalika Klemenc-Ketiš, Sonia Tsukagoshi, Josep Vilaseca, Shlomo Vinker, Mehmet Ungan, 2020, izvirni znanstveni članek Opis: COVID-19 outbreak has significantly changed all aspects of general practice in Europe. This art-icle focuses on the academic challenges for the discipline, mainly in the field of education,research, and quality assurance. The efforts of the European Region of the World Organisationof National Colleges, Academies, and Academic Associations of General Practitioners/FamilyPhysicians (WONCA Europe) to support academic sustainability of the discipline in the time ofpandemic are presented. Medical education was affected by the pandemic, threatening both itsproductivity and quality. Emerging new educational methods might be promising, but theresults of their rapid implementation remain uncertain. A relatively small number of publicationsrelated to COVID-19 and general practice is available in the medical literature. There is a short-age of original data from general practice settings. This contrasts with the crucial role of GPs infighting a pandemic. COVID-19 outbreak has opened widely new research areas, which shouldbe explored by GPs. Maintaining the quality of care and safety of all patients during the COVID-19 pandemic is the utmost priority. Many of them suffer from poor access or inadequate man-agement of their problems. Rapid implementation of telemedicine brought both threats andopportunities. The COVID-19 pandemic also challenged doctors' safety and well-being. Theseaspects will require discussion and remedy to prevent deterioration of the quality of primarycare. WONCA Europe is making a multi-faceted effort to support GPs in difficult times of thepandemic. It is ready to support future efforts to uphold the integrity of family medicine as anacademic discipline. Ključne besede: infectious diseases, quality of care, public health, community medicine, health care organisation, management, medical education Objavljeno v DKUM: 07.01.2025; Ogledov: 0; Prenosov: 4
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2. Safety culture and the positive association of being a primary care training practice during COVID-19 : the results of the multi-country European PRICOV-19 studyBianca Silva, Zlata Ožvačić Adžić, Pierre Vanden Bussche, Esther Van Poel, Bohumil Seifert, Cindy Heaster, Claire Collins, Canan Tuz Yilmaz, Felicity Knights, Zalika Klemenc-Ketiš, 2022, izvirni znanstveni članek Opis: The day-to-day work of primary care (PC) was substantially changed by the COVID-19 pandemic. Teaching practices needed to adapt both clinical work and teaching in a way that enabled the teaching process to continue, while maintaining safe and high-quality care. Our study aims to investigate the effect of being a training practice on a number of different outcomes related to the safety culture of PC practices. PRICOV-19 is a multi-country cross-sectional study that researches how PC practices were organized in 38 countries during the pandemic. Data was collected from November 2020 to December 2021. We categorized practices into training and non-training and selected outcomes relating to safety culture: safe practice management, community outreach, professional well-being and adherence to protocols. Mixed-effects regression models were built to analyze the effect of being a training practice for each of the outcomes, while controlling for relevant confounders. Of the participating practices, 2886 (56%) were non-training practices and 2272 (44%) were training practices. Being a training practice was significantly associated with a lower risk for adverse mental health events (OR: 0.83; CI: 0.70-0.99), a higher number of safety measures related to patient flow (Beta: 0.17; CI: 0.07-0.28), a higher number of safety incidents reported (RR: 1.12; CI: 1.06-1.19) and more protected time for meetings (Beta: 0.08; CI: 0.01-0.15). No significant associations were found for outreach initiatives, availability of triage information, use of a phone protocol or infection prevention measures and equipment availability. Training practices were found to have a stronger safety culture than non-training practices. These results have important policy implications, since involving more PC practices in education may be an effective way to improve quality and safety in general practice. Ključne besede: safety culture, patient safety, quality of care, primary health care, COVID-19, medical education, vocational training, PRICOV-19, infectious disease, multi-country, general practice Objavljeno v DKUM: 04.07.2024; Ogledov: 128; Prenosov: 17
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3. The safety of patient management in family medicine in Slovenia during Covid-19 : a crosssectional studyMaja Cvetko Gomezelj, Špela Miroševič, Alina Verdnik Tajki, Ksenija Tušek-Bunc, Esther Van Poel, Sara Willems, Zalika Klemenc-Ketiš, 2023, izvirni znanstveni članek Opis: 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. Ključne besede: Covid-19, family medicine, patient safety, patient management, quality of care, PRICOV-19, primary health care, general practice, timeliness Objavljeno v DKUM: 29.03.2024; Ogledov: 249; Prenosov: 18
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4. Monitoring of quality in health care using indicators : challenges and possible solutionsMircha Poldrugovac, Tit Albreht, 2017, izvirni znanstveni članek Opis: 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. Ključne besede: quality, health care, health promotion, efficiency Objavljeno v DKUM: 09.10.2018; Ogledov: 1196; Prenosov: 114
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5. Quality registers in professional health care educations : knowledge gaps and proposed actionsAnnika Nordin, Torie Palm Ernsäter, Bo Bergman, 2014, izvirni znanstveni članek Opis: 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. Ključne besede: quality registers, quality improvement, health care Objavljeno v DKUM: 22.01.2018; Ogledov: 1171; Prenosov: 155
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6. Factors impacting on the activation and approach times of helicopter emergency medical services in four Alpine countriesIztok Tomazin, Miljana Vegnuti, John Ellerton, Oliver Reisten, Guenther Sumann, Janko Kersnik, 2012, izvirni znanstveni članek Opis: 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. Ključne besede: emergency medical services, air ambulances, emergency helicopters, quality of health care, activation and approach time Objavljeno v DKUM: 29.06.2017; Ogledov: 1654; Prenosov: 319
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7. The safety attitudes questionnaire - ambulatory version : psychometric properties of the Slovenian version for the out-of-hours primary care settingZalika Klemenc-Ketiš, Matjaž Maletič, Vesna Stropnik, Ellen Tveter Deilkås, Dag Hofoss, Gunnar Tschudi Bondevik, 2017, izvirni znanstveni članek Opis: 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. Ključne besede: patient safety, quality assurance, health care Objavljeno v DKUM: 28.06.2017; Ogledov: 2048; Prenosov: 199
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8. The role of the psychosocial dimension in the improvement of quality of care : a systematic reviewIrena Makivić, Janko Kersnik, Zalika Klemenc-Ketiš, 2016, pregledni znanstveni članek Opis: 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. Ključne besede: general practice, social problems, psychosocial care, quality of health care, reviews Objavljeno v DKUM: 05.04.2017; Ogledov: 1089; Prenosov: 221
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9. Discrete event simulation of administrative and medical processesRobert Leskovar, Rok Accetto, Alenka Baggia, Zlatko Lazarevič, Goran Vukovič, Peter Požun, 2011, pregledni znanstveni članek Opis: 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. Ključne besede: health care, discrete event simulation, quality of service Objavljeno v DKUM: 27.03.2017; Ogledov: 1355; Prenosov: 162
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