The mean age of the respondents was 46 (± 8) years, the mean length of the period during which they had worked in primary health care was 18 (± 9) years and the mean size of the list was 1800 (± 513) patients. Of the respondents 55% worked in urban areas, 40% in rural areas, and 5% worked in both areas. The majority of the doctors (92%) were female. The age and sex distribution of the respondents and non-respondents did not differ significantly.
Individual versus family registration in patient lists
A total of 90 (62%) FDs were of the opinion that it was good to have the same FD for the whole family, 31 (21%) responded that it was preferable that every family member chooses a FD on the basis of personal preference and 25 (17%) thought that children should have a primary health care physician other than adults of the same family. Of the FDs, 119 (82%) responded that most patients were registered in their lists by families.
The degree of involvement of FDs in family matters
Of the respondents 15 (10%) were of the opinion that FDs should deal only with the health problems of concrete patients without involvement of family members, 94 (65%) responded that, besides managing the health problems of patients, FDs should communicate and cooperate with family members, and 36 (25%) thought that apart from the previously mentioned issues, FDs should deal with the family members' emotional and relationship problems.
FDs' belief about the necessity for awareness of different family matters
Over 70% of Estonian FDs agreed that in the case of all patients, it is necessary to be aware of drug addiction in the family, diseases of family members, living conditions and alcohol abuse in the family, while the remainder believed that they should be aware of these issues on certain occasions. Of the respondents, over a third thought that the FD should always be aware of relationships in the family and 12% thought that the FD should always be aware of leisure activities of their patients. However, between 60 to 75% believed that FDs should be aware of these issues in certain occasions (Figure ). Very few FDs responded that patients had never actively sought FDs to discuss family relations (4 out of 143) or health risks in the family (5 out of 145), while 44 (30%) of the respondents stated that patients commonly addressed them to discuss family relations, and 34 (23%) reported that it was common to discuss the health risks associated with the familial diseases.
Percentage distribution of the FDs' answers to the question: "Is it necessary to be aware of the following issues related to their patients' families?"
Preparedness for management of family-related issues
The respondents valued highly their preparedness to counsel for harmful habits: 104 (71%) of the respondents felt that their preparedness was adequate. Regarding the other issues, less than half of the respondents considered their training adequate (Table ).
FDs' self-assessment of their preparedness for management of different family related issues
FDs' self-assessement of the ability to manage different problems (substance abuse, relationship problems) in family
Altogether 142 FDs responded to the question about their ability to reduce the use of harmful substances (alcohol, tobacco, drugs) in families. One hundred (70%) of the respondents reported that this was within the scope of their ability, while the majority (n = 71) stated that the methods used were advice and counselling, but also referral to specialists, use of specific medications and suggestions regarding appropriate reading material. However, 16 FDs admitted that the efficacy of their work in this field was low.
Nearly one-third of the respondents (30%) estimated that they were not able to reduce the use of harmful substances in their patients' families. The analysis of the open-ended questions identifed some key problems:
• Low motivation of patients.
• Socio-economic reasons for substance abuse.
• Limited time for consultation.
• Inadequate preparedness for management of these issues.
One hundred and forty-three FDs responded to the question about their influence on relationship problems in their patients' families, 83 (58%) of them were of the opinion that they were able to modify these problems. In most cases, FDs used advice and counselling (n = 52), but they also cooperated with specialists as the psychotherapist, family therapist, psychiatrist or social worker. Of the family doctors 60 (42%) thought that they were not able to influence the patients' relationship problems. In the analysis of the open questions, the doctors identified several key problems:
• Limited time.
• Lack of special training.
• Patients do not address FDs with their problem.
• Patients themselves deny the existence of the problem.
• These are the patients' private issues in which physicians could not intervene.
The FDs who were sure that they were able to modify the patients' harmful habits as well as family relationships were more likely to estimate their preparedness for the management of these issues as adequate. Among the doctors who reported that their preparedness for counselling for lifestyle issues was adequate, 76% (n = 76) believed that they were able to treat harmful habits, versus 57% (n = 24) of those who reported that their preparedness for such issues was not adequate (p < 0.05); in the case of relationship problems, the respective percentages were 41% (n = 34) versus 9% (n = 5) (p < 0.0001). There were found no other significant determinants among the sociodemographic or work related factors.