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Biomedical subjects

F Olesen

Publications and source records attributed to F Olesen.

At least 55 records · Page 3Linked to original sources
PubMed1999

Effect of a reorganized after-hours family practice service on frequent attenders.

BACKGROUND AND OBJECTIVES: A governmental reorganization of the after-hours general practice service in Denmark was launched in January 1992. The biggest change was the introduction of mandatory county-wide telephone triage systems staffed by general practitioners. This study assesses the effect of this reorganization on the use of services by frequent attenders (FAs). METHODS: From 1990 to 1994, methods of contact and annual costs per attender were analyzed in an ecological time-trend study based on aggregated administrative data collected from the database of the Public Health Insurance, Aarhus County, Denmark (600,000 inhabitants). The study only included attenders ages 18 and over. FAs were defined as the group that, within each calendar year (12 months), had 4 or more contacts with the after-hours family practice service. RESULTS: FAs made up 9.5% of the attenders and accounted for more than 40% of the contacts and the aggregate costs. The effect of the reorganization was a 12% decrease in the number of attenders, a 16% decrease in the number of contacts, and a 29% decrease in the costs. Reorganization had a significantly bigger effect on FA attendance than on non-FA attendance, and more than half of the overall reduction in use of services could be ascribed to changes in FA behavior. CONCLUSIONS: The reorganization of the after-hours service produced a significant fall in attendance and costs, especially with respect to adult FAs.

Adolescent↗
PubMed1999

Detecting cervical cancer: the European experience.

An effective cervical smear test does not equate to an effective screening programme. A major challenge in Europe has been to formulate efficient, cost-effective, and balanced programmes, and to implement them. Improving participation and follow-up, and reducing the false-positive and false-negative rates are also important factors. This article discusses the process of implementing and maintaining effective screening programmes in European health care systems, comments on common pitfalls of such programmes, and suggests future directions.

Journal Article↗
PubMed1998

[Is the randomized controlled trial overvalued as a basis for clinical decision-making? A review with comments].

The randomized controlled trial (RCT) may have considerable limitations in clinical research. Lacking the possibility of blinding impairs the internal validity of the trials. The external validity is often impaired, as results of RCTs obtained in an ideal situation, may be difficult to generalize to a clinical routine situation. Pragmatic randomized trials move from ideal situations towards routine situations, and by modifying the design it is possible to reduce selection bias due to patient and physician preferences. Quasi-experimental studies have varying degrees of problems with internal validity but are necessary contributions to our knowledge of the effect of treatment in clinical routine situations. Limitations of the usefulness of RCTs as well as pragmatic and quasi-experimental studies in clinical research make it necessary to recognise that different methods complement one another. Research in development of RCTs and new methods in clinical research should be encouraged.

Decision Making↗
PubMed1998

[Somatization in general practice].

Patients with unexplained physical symptoms are very common in primary care. Some patients attribute these symptoms to physical disease (somatizing patients). Somatization can be a symptom of psychiatric disorder, which is found in 1/4 to 1/3 of the patients in a primary care setting. This form of somatization makes diagnosing difficult and is the main reason why psychiatric disorders are underdiagnosed. Simple techniques for diagnosing and treating somatizing patients are available to general practitioners. However, to improve diagnostic sensitivity and treatment, further teaching and development in primary care settings are necessary.

Denmark↗
PubMed1998

[Emergency admissions to a general hospital. Why emergency admission? Is there an alternative?].

A study was conducted where the GPs in a district answered a questionnaire on reasons for hospital admission, divided into the categories: needed hospital investigation, hospital treatment, or needed care and nursing. They judged whether the admission could have been prevented. Finally, a multidisciplinary panel discussed ways to obtain better courses of admission. Of 266 admissions, 40 (15%) were due to a need for care and nursing. Ninety-seven (37%) of the admissions could be replaced by a short one-day stay, and 52 (20%) could have been postponed until the next day if that was possible. The panel discussion showed that municipalities can do more to strengthen the local professional support. It is concluded that the interface between primary care and the hospital should offer better opportunities for one-day admissions or sub-acute admissions, and that municipalities must be more aware of their responsibility for the care of fragile and ill people.

Adult↗
PubMed1998

[Cross-sectional therapeutic programs--an example of a cooperative health care system. A review with comments].

There is no tradition for sharing the responsibility for episodes of care between the primary and secondary sectors in the Danish health care system. Concurrently with increased international experience with shared care programmes, there is also a growing interest in Denmark in cooperation between the sectors. Based on literature research, shared care programmes are presented as a method of ensuring continuity and quality in treatment of chronic diseases. Experiences in the areas of diabetes, asthma, rheumatoid arthritis, and cancer are described. It is concluded that the Danish health care system is well prepared for the implementation of shared care programmes; there are only few sources of payment in the system, and an extensive continuing medical education system ensures that general practitioners can participate in relevant education. The implementation of shared care programmes in Denmark should be followed by scientific evaluation and documentation of the quality of the treatment programmes.

Delivery of Health Care↗
PubMed1998

[Does a computerized price comparison module reduce prescribing costs in general practice?].

The aim was to assess the trends in prescribed defined daily doses (DDD) and drug expenses before and after the introduction of a computerized cost containment module. On January 1993 the module was introduced in 20 practices in Aarhus County that used the computer record system APEX. Two control groups were made. From the Public Health Insurance in Aarhus County (600,000 inhabitants) data were collected during 1992 and 1993. Compared with te controls there were no changes in prescribed DDD, reimbursement for prescribed drugs, and reimbursement per prescribed DDD in the intervention group after the introduction of the module. Cost containment procedures should be more intensive than just giving the doctors a computer-assisted decision aid.

Decision Making, Computer-Assisted↗
PubMed1998

[What do patients expect from the general practitioner? Danish results from a European study].

This study aims to identify and explain which aspects of medical care patients valued and expected from the general practitioner. A questionnaire was given to a sample of 774 patients (86% response rate) from 15 practices. Patients rated the importance and ranked 40 different questions relating to their medical care. Aspects related to technical care were ranked highest. Patients gave low priority to aspects of care related to practice organisation. Enough time during consultations and quick services in case of emergencies got top rank in the study. The study provides information on patients' priorities regarding their general practitioner.

Adolescent↗
PubMed1998

Out of hours service in Denmark: evaluation five years after reform.

OBJECTIVE: Five years after its introduction, to evaluate the 1992 reform in the out of hours service in Denmark. DESIGN: Comparison of data before and after reform. Data were collected from published reports, Danish national health statistics, and the Danish trade union for general practitioners. SETTING: Denmark. MAIN OUTCOME MEASURES: Number of out of hours services; workload of general practitioners; cost of the service; patient satisfaction. RESULTS: Five years after the reform, the percentage of telephone consultations had almost doubled, to 48%. Consultations in doctors' surgeries were relatively unchanged, but home visits were much reduced, to 18%. The percentage of doctors who worked 5 hours or more out of hours per week dropped from about 70% to about 50%. Overall patient satisfaction in 1995 was high (72%). CONCLUSION: The organisation of the out of hours service, with a fully trained general practitioner in a telephone triage function, is working satisfactorily. Many calls that previously would have required home visits are now dealt with by telephone or through consultations. The out of hours workload for general practitioners has decreased considerably.

Denmark↗
PubMed1998

[Consultations in ophthalmological practice. A multi-practice study of referrals to private ophthalmologists in Denmark].

In Denmark the GPs act as gatekeepers for secondary health care services except for ophthalmologists and ear-nose-throat specialists. The aim of this study was to describe consultations and referral patterns to ophthalmologists in private practice in Denmark. Forty-four out of 143 practising ophthalmologists agreed to fill out a short questionnaire on a random sample of their patients. They recorded 1844 consultations. Forty percent of contacts were appointments arranged by the ophthalmologist, 35% were self-referred, 13% were referred by their GP and 12% by others. Cataract, glaucoma and refraction anomalies accounted for 51% of all diagnoses. The distribution of reasons for encounter and diagnoses among self-referred patients and patients referred by their GP does not argue in favour of a change from the present system with free self-referral to a system with gatekeeping by GPs.

Denmark↗
PubMed1998

General practice care and patients' priorities in Europe: an international comparison.

Insight into patients' priorities with respect to health care should complement the views of professionals and policy makers on what is thought to be appropriate health care. To determine the strengths and weaknesses of general practice care from patients' perspectives written surveys were performed among patients in Denmark, Germany, Israel, Netherlands, Norway, Portugal, Sweden and United Kingdom (n = 3540). The potential quality problems identified were spread over the different countries: the low involvement of general practitioners in out-of-hours services in Portugal; the low provision of routine screening in Sweden, Norway and The Netherlands; the lack of a defined patient population in Germany; the lack of a formal gatekeeper role to secondary care in general practice in Germany and Sweden; and the low number of home visits in Sweden.

Europe↗
PubMed1998

A systematic review of the literature on patient priorities for general practice care. Part 1: Description of the research domain.

To make health care more responsive to patient needs, insight into patient priorities is needed. A systematic literature review, using electronic and manual searches, was made of studies on patient priorities with regard to primary health care. Data-extraction was performed by two researchers, followed by systematic analyses of study features. 57 studies were included. The aspects of care and methods used showed a wide variation. Aspects most often included were "informativeness", "humaneness" and "competence/accuracy". Based on an analysis of 19 studies, the following aspects were seen by patients as most important in more than 50% of the studies that included them: "humaneness", "competence/accuracy", "patients' involvement in decisions", "time for care", "other aspects of availability/accessibility", "informativeness", "exploring patients' needs", "other aspects of relation and communication" and "availability of special services".

Adult↗
PubMed1998

Women's knowledge of and attitude towards organized cervical smear screening.

OBJECTIVE: To describe women's barriers to cervical screening by asking about their experience with and knowledge of smear tests and by examining the women's contact and relationship with their GP. SETTING: Questionnaires sent to women in Aarhus County, Denmark. METHODS: A case control study in a cohort. The cohort, 133,500 women, represents women aged 23-60 years who were invited to the organized cervical screening program between 1.10.90 and 1.4.94. A case group, non-attenders (n=694), who had not had a smear within the previous 42 months, and a control group, attenders (n=1131), who had at least one smear test within the previous 42 months, were compared with each other. Predictor variables in the two groups were analyzed by univariate and multivariate (logistic regression) analysis. RESULTS: Non-attenders more often had insufficient contact with the GP (having a bad relationship, feeling of not receiving sufficient information) and associated a gynecological examination with more psychological unpleasantness. Most non-attenders (65.5%) and attenders (88.5%) intended to attend next time they were invited for cervical screening, and resistance to mass screening on principle did not seem to have great influence on the number of non-attenders. Both non-attenders and attenders had poor knowledge of the smear test. No significant difference was found concerning the characteristics of the general practice used by non-attenders and attenders. CONCLUSIONS: The main barriers to regular cervical screening are insufficient contact with the GP and psychological unpleasantness associated with the gynecological examination. Resistance to cervical screening on principle does not seem to have a great influence on attendance.

Adult↗
PubMed1998

Urogenital Chlamydia trachomatis infections in general practice: diagnosis, treatment, follow-up and contact tracing.

BACKGROUND: Patients with urogenital Chlamydia trachomatis infection are frequently seen in general practice. It is, therefore, important to assess GPs' management of these patients in order to ensure adequate control of the disease. OBJECTIVE: We aimed to evaluate the GPs' routines in diagnosis, medical treatment, follow-up and contact tracing according to knowledge/attitude (criteria) and actual performance. METHODS: The study comprised the 388 GPs in the County of Aarhus. Two questionnaires were used. The first questionnaire was mailed to each of 252 GPs who had attended a patient with urogenital C. trachomatis infection 4 weeks previously. Each GP was asked about his/her actual performance for that particular patient. In order to elucidate the GPs' criteria, the second questionnaire was mailed to each of the 388 GPs in the County of Aarhus, asking about their usual intended routines (criteria) for managing urogenital C. trachomatis infections. The questionnaires covered the same topics. RESULTS: Great variations among the GPs' management of urogenital C. trachomatis infection according to sampling-site, medical treatment, follow-up and contact tracing were found. Furthermore, a discrepancy between criteria and actual performance for obtaining an urethral swab-sample in women and for contact tracing of previous partners were demonstrated. The GPs stated that they had intended to obtain more urethral swab-samples and do more contact tracing than they actually did. CONCLUSIONS: We conclude that increasing the collection of urethral samples from women combined with greater emphasis on contact tracing procedures might limit the prevalence of the infection. In order to achieve this, continuous medical education and auditing procedures on urogenital chlamydial infections may be helpful.

Anti-Bacterial Agents↗