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Biomedical subjects

F Olesen

Publications and source records attributed to F Olesen.

At least 37 records · Page 2Linked to original sources
PubMed2000

[Are out of hours contacts with physicians necessary? Assessment by physicians on call and by patients].

Patients and GPs were asked about necessity and possible prevention of contacts to the out of hour service. 4187 (83.9%) of the GP questionnaires and 1493 (52.3%) of the patient questionnaires were returned. According to the GPs 25% of the contacts were not necessary and 5% were not necessary according to the patients. Patients and GPs agreed that contacts concerning old people were most necessary. GPs assessed contacts concerning children relatively more necessary. Patients assessed contacts concerning middle-aged relatively more necessary. Frequent users were assessed less necessary according to GPs but more necessary according to the users themselves. Many contacts could have been prevented according to both GPs and patients--especially within the first five hours of the service. Concordance between a patient's and a GPs answer was bad (kappa = 0.0-0.2). Concordance between the GPs answering the phone and the GPs examining the patient was only slightly better (kappa = 0.1-0.3).

Adolescent↗
PubMed2000

[How do patients evaluate their general practitioners? Danish results from a European study].

This study aims to assess how patients evaluate the quality of general practice care. With a questionnaire answered by a sample of 1309 (90.9% response) from 36 practices. Patients answered 25 questions relating to their general practice care. Patients were, generally seen, very positive about their general practitioners. "Keeping your records and data confidential" and "providing quick services for urgent health problems" received most positive evaluations, while "waiting time in the waiting room", "being able to speak to the general practitioner on the telephone" and "getting through to the practice on the phone" were assessed most negatively.

Adult↗
PubMed2000

Comparison of patients' preferences and evaluations regarding aspects of general practice care.

BACKGROUND: Although patients' views on health care are perceived to be crucial, insight into the different constructs capturing these views remains limited. OBJECTIVE: The aim of this study was to determine the relationship between patients' preferences and their evaluations of general practice care. METHODS: Patients visiting five rural practices in The Netherlands were asked to complete a questionnaire measuring either their evaluations or their preferences on 44 aspects of general practice care. After at least 3 weeks, those patients who had answered the evaluation questionnaire received the questionnaire measuring their preferences, and vice versa. RESULTS: A total of 449 patients answered both questionnaires (response 70%). The longer the period after the consultation, the lower was the mean percentage of all 44 aspects rated as 'good' in the evaluation questionnaire (P = 0.006) and the higher was the mean percentage of all 44 aspects rated as 'very important' in the preference questionnaire (P = 0.046). The Spearman rank order correlation between the ranking of patients' evaluations and patients' preferences was 0.34, a low although significant correlation (P = 0.024), i.e. the two rank orders do not resemble each other very much. CONCLUSIONS: Patients clearly distinguished their preferences from their evaluations of general practice care. Aspects of general practice care, whether important or not, can be evaluated positively or negatively. Patients' preferences and patients' evaluations are, however, both influenced by the length of the time elapsed since the consultation.

Adolescent↗
PubMed2000

Recurrence of urogenital Chlamydia trachomatis infection evaluated by mailed samples obtained at home: 24 weeks' prospective follow up study.

OBJECTIVES: To evaluate the rate of recurrence of genital Chlamydia trachomatis infection after antibiotic therapy in a population of patients drawn from general practice, and to evaluate whether retesting after antibiotic therapy was advisable and, if so, whether it could be based on a strategy involving samples obtained at home and mailed to the laboratory for analysis. METHODS: Prospective follow up study of 42 patients with genital C trachomatis infection drawn from general practice. Patients at or above the age of 18, with a positive urogenital swab sample obtained by a general practitioner were invited to participate. Follow up testing was based on LCR testing (LCx, Abbott diagnostics) of first void urinary and vaginal flush samples taken by the patients at home and mailed to the laboratory at weeks 2, 4, 8, 12, and 24 after antibiotic therapy. RESULTS: Cumulated incidence of recurrent infection was calculated to 29% (95% CI: 12%-46%) during the 24 weeks of follow up. Previous or present sexually transmitted diseases other than C trachomatis were significantly associated with recurrence (OR 6.1, p = 0.03). 89% of patients tested negative at week 2, and all patients tested negative at some point during the first 4-8 weeks. 84% of the test kits mailed to the patients were returned to the laboratory for analysis. CONCLUSIONS: Recurrence of C trachomatis after antibiotic treatment is a substantial problem. Retesting should be carried out, but not sooner than 12-24 weeks after treatment. Requiring patients to take tests at home appears to be a promising method for retesting.

Adult↗
PubMed2000

Psychological distress and somatisation as prognostic factors in patients with musculoskeletal illness in general practice.

BACKGROUND: Musculoskeletal illness is a common cause of absenteeism from work, workers' compensation, and disability retirement, and accounts for 9.3% to 17% of patient contacts in general practice. To understand the increase in self-reported musculoskeletal illness and to improve treatment and prevention, it is important to know which factors to target when dealing with these patients. AIM: To investigate whether the prognosis for patients with musculoskeletal illness referred to physiotherapy from general practice can be predicted by the presence of psychological distress and somatisation identified by a general practitioner (GP) and standard questionnaires. METHOD: A multi-practice survey based on questionnaires (index and three-month follow-up). Nine hundred and five consecutive patients referred to physiotherapy from 124 different general practices in Denmark were included. Outcome measures were physical health change, sick leave, patient self-rated improvement, and change in use of medication. RESULTS: Psychological distress and somatisation rated by both GPs and standard questionnaires acted with almost no exception as significant predictors of all four outcome measures. CONCLUSION: Psychological distress and somatisation are important factors when considering preventive initiatives and treatment of patients with musculoskeletal illness in general practice.

Absenteeism↗
PubMed2000

Patients in Europe evaluate general practice care: an international comparison.

BACKGROUND: Patients' evaluations can be used to improve health care and compare general practice in different health systems. AIM: To identify aspects of general practice that are generally evaluated positively by patients and to compare opinions of patients in different European countries on actual care provision. METHOD: An internationally-validated questionnaire was distributed to and completed by patients in 10 European countries. A stratified sample of 36 practices per country, with at least 1080 patients per country, was included. A set of 23 validated questions on evaluations of different aspects of care was used, as well as questions on age, sex, overall health status, and frequency of visiting the GP. RESULTS: The patient sample included 17,391 patients in 10 different countries; the average response rate was 79% (range = 67% to 89%). In general, patients visiting their general practitioner (GP) were very positive about the care provided. For most of the 23 selected aspects of care more than 80% viewed care as good or excellent; in particular, keeping records confidential, GP listening to patients, time during consultations, and quick services in case of urgent problems were evaluated positively. Patients were relatively negative about organisational aspects of care. The evaluations in different countries were largely similar, with some interesting differences; for instance, service and organisational aspects were evaluated more positively in fee-for-service health systems. CONCLUSIONS: Patients in Europe are positive about general practice but improvements in practice management in some countries are requested. More research is needed to study the complex field of differences in expectations and evaluations between countries with different health systems.

Culture↗
PubMed1999

[Detection of Chlamydia trachomatis infection among young people. The effect of home-sampling and mailing the samples].

Genital Chlamydia trachomatis infection is common and treatable, but often asymptomatic. New diagnostic strategies targeting healthy individuals are therefore needed. The 17 high schools in Aarhus County, Denmark, comprising 8909 students, were cluster-randomized into an intervention group which was offered examination by mailing a urine sample (males and females) and a vaginal flush sample (females) directly to the laboratory, and a control group who were offered examination by a physician. Ninety-three percent (867/928) of the sexually experienced female responders underwent examination in the intervention group, compared with 8% (63/833) in the control group (p < 0.001). The corresponding figures for males were 97%, (430/442) and 2% (4/246), respectively (p < 0.001). Also statistically significantly more infected females and males were found in the intervention group (43 females and 11 males in the intervention group vs. five females and one male in the control group). Home sampling improves the diagnosis of C trachomatis infection among apparently healthy young individuals.

Adolescent↗
PubMed1999

[Cross-sectorial cooperation regarding cancer patients in a recently started care program. Ideas and themes based on focus group interviews with general practitioners and oncologists].

This study identified ideas for an improved collaboration between general practitioners and oncologists regarding patients with cancer. A qualitative research-method with focused group interviews was chosen. The results demonstrated that both oncologists and general practitioners would like the general practitioners to take more active part in the total care programme for cancer patients. Some of the needed improvements were more detailed referral letters including description of treatment plans, information about what the patient had been told and general information about the specific cancer disease. Both parts desire bilateral information exchange and a dialogue about the distribution of tasks. Both parts are willing to collaborate but this is at present restricted due to lack of knowledge of each others' working areas and the oncologists' impression that general practitioners need more medical knowledge regarding specific aspects of cancer. A randomized intervention study using ideas from this study may clarify if it is possible to improve the collaboration and thereby the cancer patients' satisfaction with care.

Clinical Competence↗
PubMed1999

CME in primary care: the way forward.

The paper aims to describe the context for future continuing medical education (CME) in primary care. CME must develop the doctor's ability to look at diseases from a scientifically-based biomedical, psychological, and social perspective. It is a challenge for CME to bridge the gap between scientific evidence, and doctors' knowledge, attitude, and performance, but awareness on how to do this is scarce. CME must be better integrated with quality development, especially with the use of clinical guidelines. This is impeded by insufficient scientific evidence on the impact, advantages, and disadvantages of different CME methods, and by insufficient outcome measures of the effect of CME. Teaching the teachers should also be improved. It is concluded that the time is ripe for a scientific-based development in the conduction of CME. This may be done by establishing national research centres for CME, working together in an international network.

Certification↗
PubMed1999

Patients' priorities with respect to general practice care: an international comparison. European Task Force on Patient Evaluations of General Practice (EUROPEP).

BACKGROUND AND OBJECTIVES: Improving the sensitivity of general practice to patients' needs demands a good understanding of patients' expectations and priorities in care provision. Insight into differences in expectations of patients in different cultures and health care systems may support decision-making on desirable models for care provision in general practice. An international study was conducted to determine priorities of patients in general practice care: which views do patients in different countries have in common and which views differ? METHODS: Written surveys in general practices in the UK, Norway, Sweden, Denmark, The Netherlands, Germany, Portugal and Israel were performed. Samples of patients from at least 12 practices per country, stratified according to area and type of practice, were included. Patients rated the importance of 38 different aspects of general practice care, selected on the basis of literature analysis, qualitative studies and consensus discussions. Rankings between countries were compared. RESULTS: A total number of 3540 patients (response rate on average 55%) completed the questionnaire. Patients in different countries had many opinions in common. Aspects that got the highest ranking were: getting enough time during the consultation; quick services in case of emergencies; confidentiality of information on patients; telling patients all they want to know about their illness; making patients feel free to talk about their problems; GPs going to courses regularly; and offering preventive services. However, differences between opinions of patients in different countries were also found for some of the selected aspects. A confounding effect of patients' characteristics may have played a role in these differences. DISCUSSION: The study provides information on what patients expect of and value in general practice care. It shows that patients in different cultures and health care systems may have different views on some aspects of care, but most of all that they have many views in common, particularly as far as doctor-patient communication and accessibility of services are concerned.

Adult↗
PubMed1999

Long-term prognosis of acute low back pain in patients seen in general practice: a 1-year prospective follow-up study.

OBJECTIVES: We aimed to examine the prognosis of acute low back pain (LBP) in patients in general practice and to identify prognostic factors associated with the long-term prognosis based on information immediately available to the GP. METHOD: We conducted a prospective cohort study in general practice in Denmark. The patients were those aged 18-60 years consulting their GP due to an episode of LBP lasting less than 2 weeks. The GPs collected data regarding 34 exposure variables, including their global assessment of the likelihood of chronic LBP. Outcome variables were collected from the patients after 1, 6 and 12 months. The outcome measures were days on sick leave, and functional or complete recovery from LBP. RESULTS: In total, 503 (96%) patients were followed during the whole study period. Fifty per cent of the patients on sick leave returned to work within 8 days; after 1 year, only 2% remained on sick leave. At the 1-year follow-up, 45% of the patients continued to complain of LBP. Logistic regression analyses showed that the factors most significantly associated with poor long-term LBP outcome were (i) severity of LBP at inclusion, (ii) assessments by the GP of susceptibility to develop chronic LBP and (iii) a history of LBP having caused previous sick leave. CONCLUSIONS: LBP in general practice has a good prognosis with regard to sick leave, but a high proportion of patients continue to complain of LBP. We were not able to identify objective measures that strongly predict the prognosis of the individual LBP patient. The overall assessment by the GPs seems to be the most important predictor associated with the long-term outcome.

Acute Disease↗
PubMed1999

Frequent attenders in out-of-hours general practice care: attendance prognosis.

OBJECTIVE: We aimed to describe the use of out-of-hours service and analyse attendance prognosis for frequent attenders and other groups of attenders, and to present a concept describing frequent attendance over time. METHODS: All adult attenders in 1990 were included in a 4-year follow-up study. Frequent attenders (FAs) were defined as those 10% among the attenders who most frequently used the out-of-hours service during a calendar year (12 months). This gave an intersection point of four or more contacts for frequent attenders. Three more groups were defined according to whether they had one, two or three contacts per year. The setting was out-of-hours general practice in Aarhus County, Denmark. Data were collected from the database of the Public Health Insurance, Aarhus County. The county had approximately 600,000 inhabitants, of whom 465,000 were aged 18 years and over. The subjects were 101,321 individuals aged 18 years and over who contacted the out-of-hours service in 1990. Outcome measures were attendance per year, age and sex. RESULTS: FAs made 42% of the out-of-hours contacts in 1990, and 33% of those who were FAs in 1990 were also FAs in 1991. Among the 1990 FAs, 67% contacted the out-of-hours service at least once in 1991, 25% contacted the service at least once in each of the following 4 years and 7% remained FAs in the following 4 years. The probability of being an FA rose with the duration of previous frequent attendance. Age above 50 years significantly predicted future status as an FA. Females made up two-thirds of FAs, but sex did not predict future frequent attendance. CONCLUSION: Frequent attendance could be regarded as a short-lived phenomenon. On the other hand, FAs were the most stable attenders of all groups of attenders over the years. Older FAs had the highest probability of remaining FAs.

Adolescent↗
PubMed1999

Diffusion of new drugs in Danish general practice.

OBJECTIVES: There is a large variation in implementing research findings in clinical practice. We examined whether the concept of early or late adopters is universal for the diffusion of all new drugs, and whether it is associated with non-scientific factors in general practice. METHODS: We identified all prescriptions for five new drugs from the population-based prescription database in North Jutland County, Denmark (490000 inhabitants) from 1993 to 1996, and calculated the period from release of the drugs to the issuing of the first prescription by each GP. Logistic regression was performed to predict early or late prescribing from physician characteristics, practice activity and the number of prescriptions, adjusted for age and sex. RESULTS: The distributions of the diffusion time of the drugs by 95 solo practitioners were asymmetrical, with a long upper tail representing the late prescribers. The shape and slope of the diffusion curve were highly drug dependent. There was poor agreement of the three adopter categories (early, intermediate and late prescribers) between the five drugs (kappa < 0.35), but being a late prescriber was the most consistent condition. Late prescribing of tramadol, compared with intermediate prescribing, was associated with female physicians (odds ratio (OR) 5.7; 95% CI 1.5-21.3), smaller list size (OR 0.1; 95% CI 0.0-0.8), a strong general restrictive attitude to pharmacotherapy (OR 0.07; 95% CI 0.01-0.68) and a tendency to lower diagnostic activity per patient (OR 0.4; 95% CI 0.1-1.9). CONCLUSIONS: The slope and shape of the diffusion curve are both dependent on physician and drug characteristics, but late prescribers share some common characteristics.

Age Distribution↗
PubMed1999

Impact of menstrual cycle on the diagnostic performance of LCR, TMA, and PCE for detection of Chlamydia trachomatis in home obtained and mailed vaginal flush and urine samples.

OBJECTIVES: To assess the impact of the menstrual cycle on the diagnostic performance of various assays for detection of Chlamydia trachomatis in home obtained and mailed vaginal flush and urine specimens. METHODS: A ligase chain reaction assay (LCR; Abbott Laboratories), a transcription mediated amplification assay (TMA; Gen-Probe), and an enzyme amplified immunoassay (PCE; Dako Diagnostics) were evaluated for their validity in detecting C trachomatis in vaginal flush, first void urine, and midstream urine specimens obtained by female high school students at home and mailed directly to the diagnostic laboratory. RESULTS: C trachomatis was detected in 45 of 889 females (5.1%). The vaginal flush material was positive by TMA and LCR in 84% and 82% of the chlamydia positive females, respectively. First void urine was positive by TMA in 73% and by LCR in 49% of the cases. Midstream urine was positive by TMA and LCR in 69% and 42% of the females, respectively. On a pool of first void and midstream urine, PCE detected 49% of the chlamydia positive females. The overall prevalence of C trachomatis increased with increasing time after the last menstrual bleeding. In urine samples, but not vaginal flush specimens, obtained 3 weeks after the last menstrual bleeding, the sensitivities of TMA, LCR, and PCE decreased markedly suggesting that inhibitors to the assays are excreted in the urine but not in vaginal secretions at this time. CONCLUSION: Vaginal flush samples are superior to urines for detection of chlamydia infections in females. In screening of young asymptomatic females, samples should be obtained in the latter part of the menstrual cycle.

Adolescent↗