Učinak programirane intervencije liječnika obiteljske medicine na stavove pacijenata prema preventivnim aktivnostima i na čimbenike rizika za cerebrovaskularne bolesti

doctoral thesis

• Title (english): The effects of the programmed intervention of familly medicine doctors on the patients' attitudes towards preventive activities and the risk factors for cerebbrovascular diseases
• Author: Jasna Vučak; VIAF: 305542768
• Mentor: Milica Katić (mentor)
• Committee member: nije dostupno (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; Zagreb
• Defense date and country: 2013-12-23, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Public Health and Health Care
• Universal decimal classification (UDC): 61 - Medical sciences

Abstract

Cilj istraživanja je bio ispitati promjene stavova i ponašanja pacijenata nakon
sustavne i planirane intervencije liječnika obiteljske medicine te učinkovitost u prevenciji rizičnih čimbenika za cerebrovaskularna oboljenja u osoba životne dobi 40 i više godina u skrbi liječnika obiteljske medicine.
Istraživanje je provedeno u sklopu projekta „Učinkovitost intervencije liječnika obiteljske medicine u prevenciji kardiovaskularnih oboljenja“ ( Cardiovascular risk and intervention sudy in Croatia – familiy medicine – CRISIC-fm) koji je prijavljen u međunarodnu bazu randomiziranih kontroliranih studija (ISRCTN31857696). U prvoj fazi istraživanja (presječni krak) uključeno je 59 liječnika koji su randomizirani u intervencijsku i kontrolnu skupinu. Ispitanici intervencijske skupine su bili podvrgnuti sistematiziranoj i programiranoj intervenciji dok su kontrolnoj skupini liječnici nastavili pružati uobičajenu skrb. Svi ispitanici iz obih skupina su bili prospektivno praćeni a nakon 24 mjeseca od inicijalne posjete identičnim postupcima retestirani, kako bi se utvrdio ishod intervencije u obje skupine.
U CRISIC-fm studiji na početku istraživanja bilo je uključeno 2485 ispitanika (946 muškaraca i 1537 žena) prosječne dobi 61(±10.8) godina. Od navedenih 2485 ispitanika uključenih u studiju njih 1374 je bilo u intervencijskoj, a 1111 u kontrolnoj skupini.
U intervencijskoj je grupi došlo do promjene u gotovo svim stavovima na način da su nepušenje , vrijednosti kolesterola, GUK-a, arterijskog tlaka , testova na PAPU i mamografija nakon intervencije vrednovane kao važne i ta promjena je na razini statističke značajnosti od P<0,001. Ocjena važnosti prehrane i adekvatne

konzumacije alkohola je pozitivno promijenjena na razini značajnosti od P= 0,01 dok je ocjena značajnosti tjelesne aktivnosti promijenjena na graničnoj razini statističke značajnosti (P=0,05). Navedene promjene u stavovima su pratile i ciljane promjene sistoličkog, dijastoličkog tlaka, WHR, vrijednosti ukupnog kolesterola, LDL kolesterola, GUK-a natašte, triglicerida te HDL kolesterola.
Rezultati našeg istraživanja pokazuju kako programiranim sustavnim pristupom liječnika obiteljske medicine pacijenti mijenjaju svoje stavove o značaju pojedinih oblika ponašanja te da isto tako mijenjaju svoje navike i ponašanje. Te se promjene mogu objektivizirati promjenama u mjerljivim parametrima. Navedene promjene u ponašanju nisu rezultirale niti u promjenama vezanim na kvalitetu života niti su imale utjecaja na ukupni rizik za moždani udar mjeren postojećim procjenskim tablicama.

Abstract (english)

The aim of the research was to examine the changes in attitudes and behaviors of the patients after the systematic and planned intervention pf the family medicine doctors and efficiency in prevention of risk factors in cerebrovascular diseases in person of 40 years of age and older under the care of family medicine doctors.
The research was conducted as a part of the project called “The effectiveness of the family medicine doctors in prevention of cardiovascular diseases” (Cardiovascular risk and intervention study in Croatia – family medicine – CRISIC – fm) which was included in the international database of the randomized control studies (ISRCTN31857696). The first phase of the research (cross–sectional) included 59 doctors randomized in intervention and control groups. The subjects of the intervention group underwent the systematized and programmed intervention while the control group continued with the usual care. All the subjects in both groups were prospectively monitored and 24 months after the initial visit were retested using identical methods to ascertain the outcome of intervention in both groups.
The CRISTIC – fm study initially included 2485 subjects (946 males and 1537 females) with the average age of 61 (±10.8).

The intervention group changed most of its attitudes stating that not smoking, cholesterol level, blood glucose, artery blood pressure, Pap–tests and mammography were very important holding the statistic significance level of P<0,001. The assessment of diet relevance as well as adequate alcohol assumption was changed for the better with the statistic significance level of P=0,01. The assessment of relevance of physical activity was changed to the borderline level of the statistic significance level (P=0,05). Previously mentioned changes in attitude followed the aimed changes in systolic and diastolic blood pressures, WHR, total cholesterol level, LDL – cholesterol, blood glucose while starving, triglyceride and HDL cholesterol.
The results of our research showed that with programmed systematic approach of family medicine doctors the patients change their attitudes regarding the importance of certain modes of behavior and also change their habits and behavior. Those changes can be objectified by changes in measurable parameters. Previously mentioned changes in behavior did not result in changes regarding the quality of life neither did they have influence on total risk for stroke measured by current assessment tables.

• Keywords: medicina
• Keywords (english): medicine
• Language: croatian
• URN:NBN: urn:nbn:hr:105:340612
• Study programme: Title: Biomedicine and Health Sciences; Study programme type: university; Study level: postgraduate; Academic / professional title: doktor/doktorica znanosti, područje biomedicine i zdravstva (doktor/doktorica znanosti, područje biomedicine i zdravstva)
• Type of resource: Text
• Extent: 147 str.
• File origin: Born digital
• Access conditions: Open access
• Created on: 2023-05-05 07:48:23