Burnout seems to be a common problem in FDs across Europe and is associated with personal and workload indicators, and especially job satisfaction, intention to change job and the (ab)use of alcohol, tobacco and medication. The study questionnaire appears to be a valid tool to measure burnout in FDs. Recommendations for employment conditions of FDs and future research are made, and suggestions for improving the instrument are listed.

Theme: 'Reducing the risk of chronic diseases in general practice/family medicine'

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Background: Some symptoms are recognised as red flags for cancer, causing the General Practitioner (GP) to refer the patient for investigation without delay. However, many early symptoms of cancer are vague and unspecific, and in these cases, a delay in referral risks a diagnosis of cancer that is too late. Empowering GPs in their management of patients that may have cancer is likely to lead to more timely cancer diagnoses. Aim: To identify the factors that affect European GPs’ empowerment in making an early diagnosis of cancer. Methods: This was a Delphi study involving GPs in 20 European countries. We presented GPs with 52 statements representing factors that could empower GPs to increase the number of early cancer diagnoses. Over three Delphi rounds, we asked GPs to indicate the clinical relevance of each statement on a Likert scale. The final list of statements indicated those that were considered by consensus to be the most relevant. Results: In total, 53 GPs from 20 European countries completed the Delphi process, out of the 68 GPs who completed round one. Twelve statements satisfied the pre-defined criteria for relevance. Five of the statements related to screening and four to the primary/secondary care interface. The other selected statements concerned information technology (IT) and GPs’ working conditions. Statements relating to training, skills and working efficiency were not considered priority areas. Conclusion: GPs consider that system factors relating to screening, the primary-secondary care interface, IT and their working conditions are key to enhancing their empowerment in patients that could have cancer. These findings provide the basis for seeking actions and policies that will support GPs in their efforts to achieve timely cancer diagnosis.

ith increasing life expectancy accumulates and chronic morbidity, data for this tendency is in the national and international health institutions in developed countries. Health authorities are making significant efforts to put into effect various initiatives over the past two decades, for organizing of effective medical monitoring of chron- A AB BS S T TR RA AC CT T O Ob bj je ec ct ti iv ve e: : With increasing life expectancy increases and chronic morbidity. Health authorities are making efforts to put into effect initiatives for organizing of effective medical monitoring of chronically ill patients. In Bulgaria, the chronically ill are tracked according to rules on a national level. The goal that we had set in this study was to understand the disease management process, emphasizing the involvement of the patient, as well as the quality of life. In addition we studied the experience of other countries undergoing reforms in the strategies and approaches for dealing with chronic diseases. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : We used a qualitative method of researchfocus groups that include different medical specialists. R Re es su ul lt ts s: : In the discussions was considered the possibility for the patient to be a part of the team, but generally such a setting is not typical for our country. As a whole, the discussion regarding the concept of quality of life was tied for time and a relatively small number of topics were formulated in this regard. The role of the GP and the creation of multidisciplinary teams, cooperation between departments as a prerequisite for improving the quality of life of chronically ill patients were also discussed. C Co on nc cl lu us si io on n: : Patient satisfaction is directly related to the active involvement and responsibility for their own health.K Ke ey y W Wo or rd ds s: : Public health; chronic disease; patients Ö ÖZ ZE ET T A Am ma aç ç: : Beklenen ömrün uzaması ile birlikte kronik hastalıklar da artmaktadır. Sağlık uzmanları kronik hastaların etkili tıbbi takiplerini organize etmek için girişimlerde bulunup, çaba harcamaktadırlar. Bulgaristan'da kronik hastalar ulusal düzeyde konulan kurallara göre izleniyorlar. Çalışmamızın amacı, bu hastalıkların tedavi süreçlerini araştırmak, hastaya ilişkin yönleri üze-rinde durmak ve böylece olabildiğince yaşam kalitesini artırmaktır. Ek olarak, diğer ülkelerdeki bu alandaki yenilikleri ve reform stratejilerini incelemeyi amaçladık. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Farklı tıp alanlarındaki uzmanları içeren araştırma odaklı grupların kalitatif yöntemini kullandık. B Bu ul lg gu ul la ar r: : Tartışmalarda hastayı ekibin bir üyesi olarak ele aldık, fakat bu durum bizim ülkemize özgü değil-dir. Bütün olarak tartışmada, yaşam kalitesini artırmaya yönelik sayıları az da olsa fikirlere yoğun-laşıldı. Genel sağlık hizmeti veren pratisyen doktorun multidisipliner ekipteki rolü ve bu hastaların yaşam kalitesini artırmak üzere departmanlar arasında işbirliği sağlaması üzerinde duruldu. S So on nu uç ç...

In Bulgaria, the patient is entitled to palliative care in case of incurable disease with an unfavourable prognosis. Palliative care is provided by the family doctor/GP and institutions. Literature on palliative care providing is scarce. The objective of the study was to investigate the opinion of general practitioners, medical students, and other medical specialists working in institutions on palliative care. Method. We have developed a structured questionnaire. Descriptive statistics have been calculated for all items. Differences between groups have been compared using u-criterion. Level of significance was < 0.05. Data has been analyzed using SPSS v. 16. Results. A total of 518 respondents completed the survey. Lack of appropriate organisation and financing has been pointed out by all participants. The GP's role in palliative care providing has been described as a contradictory one. The criteria on the basis of which the patients are eligible for palliative care have been arranged in the same way by all respondents, but GPs chose the longest temporal indicator. Quality assessment has not been applied. 2/3 of respondents demanded palliative care training. Conclusion. On the whole, the investigated groups differed to some extent in their opinion on palliative care both on conceptual and practical levels.

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