Skrb za bolesnike s akutnim respiratornim infekcijama u obiteljskoj medicini

master's thesis

• Title (english): Family medicine care for patients with acute respiratory infections
• Author: Domagoj Jelić
• Mentor: Goranka Petriček (mentor)
• Committee member: Zlata Ožvačić Adžić (predsjednik povjerenstva)
• Committee member: Venija Cerovečki Nekić (član povjerenstva)
• Committee member: Goranka Petriček (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Family Medicine); Zagreb
• Defense date and country: 2020-07-17, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Public Health and Health Care; Family Medicine

Abstract

Sukladno podacima Svjetske zdravstvene organizacije prevalencija respiratornih bolesti iznosi i do 15% u svjetskoj populaciji, od kojih, kao uzrok smrti ARI zauzimaju 3. mjesto. Ordinacije primarne zdravstvene zaštite (PZZ) prvi su kontakt bolesnika te predstavljaju čuvare ulaza (engl. gate keeper) u zdravstveni sustav zemlje (u Hrvatskoj te velikom broju zemalja Europe). Očekuje se da se u ordinacijama opće/obiteljske medicine riješi i do 85% svih zdravstvenih problema, što upućuje na raznolikost i kompleksnost dijagnostičkih odluka s kojima se liječnici opće/obiteljske medicine susreću u svakodnevnom radu. Sukladno podacima literature, trećina svih dolazaka u ordinacije PZZ je zbog respiratornih poteškoća koje uključuju većinom sinusitis, kašalj, faringitis, pneumonije i druge. Infekcije gornjih respiratornih putova imaju veliki ekonomski učinak na društvo obzirom da utječu na radnu sposobnost te dovode do izbivanja sa posla i iz škole. Nadalje, najčešći razlog propisivanja antibiotika u ordinacijama opće/obiteljske medicine u Hrvatskoj su upravo ARI. Jedan od važnih javnozdravstvenih problema u svijetu predstavlja i porast antimikrobne rezistencije (AMR) na lijekove koja je povezana sa povećanom potrošnjom antibiotika. Pretjerano propisivanje antimikrobne terapije povezuje sa više čimbenika koji uključuju nedostatnu educiranost liječnika, manjak adekvatnih dijagnostičkih postupaka na razini PZZ kao i nedostatak točno određenih smjernica za postupanje pri ovim stanjima. Poteškoći adekvatnog dijagnosticiranja ARI pridonose i prenapučenost zdravstvenog sustava te kratkoća trajanja konzultacije. Istraživanja upućuju da se rutinskom upotrebom dodatnih dijagnostičkih testova (kao što su brzi testovi za CRP ili STREP A testovi) u slučaju dijagnostičke nesigurnosti može smanjiti i propisivanje antibiotika uz uštedu sredstava i osiguranje dodatnog vremena za zbrinjavanje ostalih stanja. Edukacija pacijenata bilo javnozdravstvenim kampanjama bilo individualnim konzultacijama o uzrocima, tijeku i liječenju ARI pridonosi pravilnom provođenju simptomatske terapije te smanjenju očekivanja/pritiska na liječnike da propišu antibiotike u liječenju ovih stanja.

Abstract (english)

According to the World Health Organization, the prevalence of respiratory diseases is up to 15% in the world's population, of which, as a cause of death, ARIs rank 3rd. Primary health care (PHC) clinics are the first contact of patients and represent gate keepers in the health system of the country (in Croatia and many European countries). It is expected that up to 85% of all health problems will be solved in general/family medicine practices, which indicates the diversity and complexity of diagnostic decisions that general practitioners/family physicians encounter in their daily work. According to the literature, one third of all visits to PHC clinics are due to respiratory difficulties, which mostly include sinusitis, cough, pharyngitis, pneumonia and others. Upper respiratory tract infections have a major economic impact on society as they affect work ability and lead to absences from work and school. Furthermore, the most common reason for prescribing antibiotics in general practice/family medicine in Croatia is ARI. One of the important public health problems in the world is the increase in antimicrobial resistance (AMR) to drugs, which is associated with increased consumption of antibiotics. Excessive prescribing of antimicrobial therapy is associated with several factors that include insufficient education of physicians, lack of adequate diagnostic procedures on PHC level as well as lack of well-defined guidelines for dealing with these conditions. Difficulties in adequately diagnosing ARI are also due to the overcrowding of the health care system and insufficient consultation duration to make a diagnosis. Research suggests that routine use of additional diagnostic tests (such as rapid tests for CRP or STREP A tests) in the event of diagnostic uncertainty may reduce antibiotic prescribing while saving resources and providing additional time to treat other conditions. Educating patients through either public health campaigns or individual consultations on the causes, course and treatment of ARI contributes to the proper implementation of symptomatic therapy and reduces the expectation/pressure on physicians to prescribe antibiotics in the treatment of these conditions.

• Keywords: akutne respiratorne infekcije (ARI); obiteljska medicina; liječnik obiteljske medicine; antimikrobna rezistencija (AMR); dijagnostika
• Keywords (english): acute respiratory infections (ARI); family medicine; family physicians; antimicrobial resistance (AMR); diagnosti
• Language: croatian
• URN:NBN: urn:nbn:hr:105:486606
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2021-08-24 09:09:29