Major scientific achievements of the Centre of Family Medicine.

A survey of more than 600 patients in order to determine the satisfaction with health care has been conducted for the first time in Lithuania.

Out-patient care of patients after stroke. A care programme has been developed and verified, which comprised of active visits of family doctors. In the course of each visit, examination of the patients’ functional independence, cognitive function and emotional disorders was carried out on special scales as well as training of patients. In Vilnius City, 323 patients were involved in this programme.

A study has been carried out on the assessment of the A streptococcus test in upper respiratory airways infection cases. More than 200 patients of Vilnius and Panevėžys Centres of Family Medicine took part in this study. The results of the study have been published in Lithuanian journals of medicine and presented at foreign conferences.

In 2006, Family Medicine Center‘s activities were focused on patient and physician's satisfaction with primary care services and post stroke care in family medicine. The international research project Study of Patient Expectations and Outcomes of Doctor-Patient Interaction was ended. This project investigated physician's satisfaction with main quality indicators of health care services at outpatient level, including physicians of primary and secondary care. Results of study were presented at international conference of family medicine WONCA EUROPE 2006.

Another direction of activities was retrieval questionnaire to assess the quality of life of post stroke patients. In our study we compared the psychometric properties of Geriatric Depression Scale (GDS) and Hospital Anxiety and Depression Scale (HAD) in detecting psychiatric morbidity after stroke. We follow-up during 6 months 251 stroke patients who after the completion of inpatient rehabilitation were discharged home. The patients twice (after discharge and after 6 month) completed the GDS and HAD. Measures were compared in terms of sensitivity and specificity. The distribution, internal consistency, concurrent validity and responsiveness of each measure were examined. No significant differences were found between the GDS and HAD scale in identifying depression. Measures were comparable in terms of specificity and sensitivity. The distribution, internal consistency, concurrent validity were similar in both scales. Spearman correlation coefficient between the GDS and HAD Scale was 0.94 after completion of inpatient rehabilitation and 0.89 after 6 month of our study. The GDS and HAD scale exhibited similar psychometric properties. Study results were presented in international conference of family medicine WONCA EUROPE 2006.

There has not been any research made on BMD decrease with spondyloarthrithies disease in Lithuania. From the scientific point of view taking into account variety of sociodemographic and clinic characteristics, which could be forseen as the right ones while assessing decrease of BMD. This would allow to select patients with this pathology for the BMD research, to choose the right aids of treatment and prophylaxis. As a result this would help to avoid complication, bone fracture. During 2006, different sources of literature under the scientific topics were analysed, questionnaires of having spondyloarthritis and control groups were composed and a permission of the Lithuanian Committee of Bioethics to perform the research procedures was obtained. It was important to determine the decrease of BMD frequency for the patients having spondyloarthrithies (AS,EnA,PsA,ReaA) and to assess the influence of the disease factors on BMD.300-360 patients participated in the research. It is intended to select 160 patients ( 100 males, 60 females) having spondyloarthritis. The age range of patients is from 20 to 65 years. Control groups: 80-100 patients having rheumatoid arthritis and 80 – 100 people not having rheumatic and bone metabolic disease. The Centre of Family Medicine strives to continue the development of optimal and evidence-based procedures and algorithms for the practice of a family doctor, which would be applied in their work by doctors of the primary level all over the country.

The prevalence of cardiovascular risk factors and the control of blood pressure in elderly patients were evaluated in 601 patients: 200 (33%) males and 401 (67%) females with arterial hypertension receiving antihypertensive medication. BP was measured according to WHO recommendations. Cardiovascular risk factors (overweight, hyperlipidemia, diabetes mellitus type 2 (DM2), smoking) were assessed referring to anamnesis and documents. BP of ≤ 140/90 mmHg was found in only 5.8% of patients. Conclusion: BP was insufficiently controlled (p< 0.05); BP in patients with cardiovascular risk factors (hyperlipidemia, DM2, smoking) was not significantly higher (p> 0.05); Patients with overweight or obesity had a higher BP than patients with normal weight (p = 0.002) and the correlation between the BMI and BP was found (Spearman’s correlation coefficient – 0.195 and 0.167, p< 0.05).

The evaluation of prevalence of the main risk factors of cardiovascular diseases (CVD) and their intercorrelations were made in 2 general practice centres and included 300 patients (age between 40 to 66). Screening risk factors were evaluated: smoking, family history of CVD, using of medications (antihypertensive drugs). Anthropometric measurements (height, weight, waist, BMI) were collected. Two blood pressure (BP) readings, electrocardiogram, total cholesterol, high density lipoprotein, low density lipoprotein, triglycerides and glucose results were collected as well. Metabolic syndrome was determined according to AHA/NHLBI 2005 criteria. SCORE table to evaluate CV diseases risk was used.

The results of both studies were presented at the International conference of family medicine Wonca Europe 2007 and they are to be published in the medical journal Gerontologija. (Gerontology) www.gerontologija.lt