General practitioners as advisers and coordinators in hospitals.
Explore the source record for details and available documents.
Ambulatory Care Information Systems↗
Biomedical subjects
F Olesen
Publications and source records attributed to F Olesen.
[Interpretation of questionnaires. An translation method problem].
For use in a different cultural background, translated questionnaires need to be validated in the new context. International guidelines are needed for such validation, as precision in translation is an important methodological issue. The article consists in a review of the issue and recommended guidelines for the translation and validation of questionnaires, based on the authors' experience and international literature in the field. The authors participate in a European research programme (EU/BIOMED-Europep), set up to develop a questionnaire for exploring patients' priorities and their evaluations of important aspects of general practice.
Data Interpretation, Statistical↗
[How to increase patient compliance? Report and discussion on a Cochrane analysis].
Explore the source record for details and available documents.
Denmark↗
[Screening for Chlamydia trachomatis?].
Explore the source record for details and available documents.
Chlamydia Infections↗
[Self-collected and mailed samples for diagnosis of urogenital Chlamydia trachomatis infection in women].
The study compared urine and vaginal flush samples, collected by women at home by endocervical and urine swabs obtained from their general practitioners, for their efficacy in the diagnosis of Chlamydia trachomatis infection. The study was a multipractice study in 33 general practices. A total of 222 women aged 18-25 years, who attended the general practitioner for a gynaecological examination, were included. Diagnostic tests-eight per woman-were performed by the polymerase chain reaction and the ligase chain reaction. A test was considered true positive if two tests or more were positive The prevalence of infection was 11.2% (23/205). Test sensitivity in samples obtained by general practitioners, samples obtained at home subjected to polymerase chain reaction, and samples obtained at home subjected to ligase chain reaction were 91%, 96%, and 100% respectively. The corresponding specificities were 100%, 92.9% and 99.5%. It is concluded that the diagnostic efficacy of samples obtained at home is as good as tests obtained by the general practitioner.
Adolescent↗
[Prolonged sick-leave: the role of general practitioner].
The aim was to study why long sick leave benefit cases had taken a long time with special focus on the communication between the general practitioner and the social service department. An explorative study was made of the development and communication in 27 consecutive lengthy sick leave cases that had lasted more than 13 weeks, that were discussed at three audit panels with participation of the social worker/officer in charge, the general practitioner and the representatives from the local hospital. The study took place in Aarhus County in 1994. The results were that many of the same problems were found in various cases, such as insufficient certificates, inappropriate use of benefit certificates, waiting times for examinations, treatment and especially rehabilitation. In the more complicated cases, of which there were many, a coordinating person would have helped matters. The GP's were willing to take on this role. The main reasons for lengthy benefit cases were that the illness was medically complicated and of a long duration.
Adult↗
[Use of on-call service by patients with pain in the county of Aarhus].
The aim of the study was to describe the numbers and other characteristics of patients who contacted the general practitioners (GP) out-of-hours on-call service with pain as the most important or major contributing reason for the contact. Data were collected from a questionnaire entered in the GPs' computer system. About 80% of the GPs participated. Over a 14 day period 10,653 contacts were registered, and of these 4718 were analyzed, consisting of 2080 telephone consultations, 1316 consultations and 1322 home visits. The results showed that 30% of the telephone calls, 37% of the consultations and 41% of the home visits concerned a patient with pain problems. Of these contacts concerning pain patients, the physicians estimated that 33% of the consultations and home visits and 55% of the telephone calls were "less necessary" or "unnecessary". It is concluded that pain is a major reason for contacting the GPs' on-call service, and that physicians deem many of these contacts "less necessary" of "unnecessary". Better information to citizens and better education of the physicians might enable some of these contacts to be transferred to normal working hours.
Adolescent↗
[Prescription of strong analgesics in the out-of-hours general practice in the county of Aarhus].
The article describes the ordination of opioid analgesics in the out-of-hours general practice service to patients with pain due to an illness lasting for more than two days. The physicians working out-of-hours duty and the patient's GP answered a questionnaire. The research includes 227 contacts. The results showed that the main diagnoses were: migraine/headache (33%), angina pectoris (19%) and back-pain (11%). The physicians estimated 33% of the contacts to be "less necessary" or "unnecessary". In 78% of the cases the GPs "agreed" or "almost agreed" with the deputizing doctors' use of opioids. In most of the cases the patients' usual GPs agreed with the treatment prescribed by the deputizing doctors. There seems to be a disagreement between the GPs and the Danish National Board of Health about the principles concerning the use of opioids.
Analgesics, Opioid↗
Does a computerized price comparison module reduce prescribing costs in general practice?
OBJECTIVE: We aimed to assess the trends in prescribed defined daily doses (DDD) and drug expenses before and after the introduction of a computerized cost containment module into the computer record system of a defined group of GPs. The GPs' expectations for and experiences with the module were examined. METHOD: We performed a controlled follow-up study on antecedent data before and after intervention. A questionnaire was administered to the intervention group at the introduction and 1 year later. Data on prescribing were collected in the database of the Health Insurance Aarhus County, as a normal routine for accounting. The GPs were not aware of the ongoing cost supervision study. Additional cost information software was introduced on 1 January 1993 to 20 practices with 28 GPs. The software assisted the GPs in a semiautomatic way to identify and prescribe the cheapest drugs. The subjects comprised 158 practices including 231 GPs in Aarhus County, Denmark. Questionnaires were sent to the 20 intervention practices. The main outcome measures were prescribed DDD, reimbursement for prescribed drugs, and reimbursement per prescribed DDD quarterly during 1992 and 1993. RESULTS: Compared with the 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. CONCLUSION: Simply giving a random group of GPs computer assistance to choose less expensive drugs did not reduce expenditure per DDD. Cost containment procedures should be more intensive than just giving the doctors a computer-assisted decision aid.
Case-Control Studies↗
Impact of local evidence-based clinical guidelines--a Danish intervention study.
OBJECTIVE: We aimed to evaluate whether a cheap and less labour-intensive regional implementation strategy for guidelines was sufficient to change knowledge and behaviour among GPs. The model studied was the implementation of anticoagulant therapy to prevent stroke in atrial fibrillation. METHOD: The intervention took place in the county of Viborg (149 GPs), Denmark, with the county of Ringkøbing (166 GPs) as control. A local interdisciplinary steering group modified national college-based guidelines, followed by a regional dissemination and implementation strategy. The effect of the intervention was evaluated during a follow-up period by a repeated questionnaire and by monitoring prescriptions for oral anticoagulants in 1993 and 1995 in the Danish National Health Service. RESULTS: Adherence to the guidelines was higher after the intervention but, considering secular trends and baseline differences, the guidelines had no significant effect. The use of oral anticoagulants increased substantially in both counties during the 2-year follow-up period, but the difference in relative change between the counties was negligible. Adherence to the guidelines could not be predicted by any of the reported practice characteristics or attitudes to guidelines. CONCLUSION: Despite solid scientific documentation and regional modification to establish ownership of nationally agreed guidelines, the impact of guidelines on GPs' knowledge and behaviour was disappointing.
Anticoagulants↗
Metaphorically transmitted diseases. How do patients embody medical explanations?
BACKGROUND: The examination was guided by recent theories on metaphors, holding that our conception of the physical world in many ways derives from personal bodily experiences. Such experiences are fundamental to the elaboration of abstract structures of meaning, which, through metaphorical projections, provide a constitutive role in our overall comprehension of the world. It is thus to be assumed that patients will bring their own cluster of metaphors into the consultation room to structure the doctor's explanations. Our study was an attempt to identify some manifestations of this work of structuring and to learn about its consequences for interpersonal communication between patient and doctor. OBJECTIVE: The aim of this study was to examine how, and to what extent patients in a general practice understand pathoanatomical and pathophysiological disturbances as explanations of their illness. METHOD: The empirical basis of the study comprised interviews with a group of patients from a general practice, who were asked to narrate their understanding of medical disturbances. Based on these interviews we identified and classified a number of metaphors they used to describe bodily problems and relations. A deviating mechanical understanding of the body, which we characterize as ethnomechanics, was manifest in all the interviews. This understanding is expanded upon and its significance discussed. Although patients do not feel qualified to understand scientific explanations of their health problems, they do relate to a scientific disease mode of understanding. They do not, however, relate to the fine details and professional implications of this mode. Instead they will associate medical explanations with their pre-established, illness-based system of understanding through imaginative projections. CONCLUSIONS: Doctors need to be aware that patients possess such imaginative and experiential resources to make sense of medical explanations. Attempts to draw patients radically away from these resources may cause confusion and undesired breakdowns in the communication between them and their physician.
Attitude to Health↗
Do general practitioners want guidelines? Attitudes toward a county-based and a national college-based approach.
OBJECTIVE: We carried out two studies (a and b) to assess general practitioners' attitudes towards a) regionally developed guidelines and b) guidelines developed by the Danish College of General Practitioners. DESIGN: a) A randomized study among all GPs in Aarhus county comparing their attitudes towards guidelines in general and towards regional multidisciplinary developed guidelines on Pap-testing for cervical cancer, and b) a survey among all Danish GPs on attitudes towards earlier submitted guidelines for diabetes Type 2. SETTING: GPs in Aarhus county and in all Denmark. SUBJECTS: a) Questionnaires sent to 370 doctors in Aarhus county, and b) to 3471 GPs in all Denmark. MAIN OUTCOME MEASURES: a) Attitudes to the known Pap guidelines compared with general attitudes. Themes in question were acceptance of guidelines, acceptance of multidisciplinary involvement, especially from the administrative staff, perceived effect on the consultation and the quality of care. In study b) remembrance of receiving, having read and used previous guidelines. Wishes with respect to future updates. RESULTS: a) GPs were very positive towards the Pap guidelines they knew, and only few resisted. The number of positive answers was significantly fewer when doctors were asked about guidelines in general. b) There was an overwhelmingly positive attitude towards guidelines from the College on diabetes care and other topics relevant to GP work. CONCLUSION: Danish GPs reported a very positive attitude towards the presented well-known guidelines on Pap testing and diabetes Type 2, and a fairly positive attitude towards hypothetical questions on guidelines in general.
Attitude of Health Personnel↗
Organizing, storing, and analysing qualitative research information in a computer database.
OBJECTIVE: To describe a method to handle data in qualitative research. DESIGN: Description of the data handling process in a personal computer database. SETTING: The method was used in a Danish qualitative study with more than 100 interviews on quality of care. OUTCOME MEASURES: The author's own description and assessment of the system. RESULTS: Storing information in a database makes it possible to store and retrieve information from qualitative research divided in themes and subthemes. The themes and subthemes are based on an interview guide and the succeeding development of theory and new themes. The comprehensive sorting systems in a database enable the researcher to keep an overview of his data while analysing and reporting. CONCLUSION: Storing, analysing, and retrieving data from qualitative research demands careful planning. A computer database may be a good help in this process if the researcher will not use more complex and comprehensive software for his analysis.
Denmark↗
[Symptoms of urinary tract infections in general practice. A comparison of diagnostic criteria and treatment among general practitioners, microbiologists and urologists].
General practitioners' criteria for good clinical practice vary, and it is unknown whether systematic education by specialists could be expected to reduce variation. The aim of this was to describe general practitioners', microbiologists' and urologists' criteria for diagnosis, treatment, and follow-up of women with symptoms of urinary tract infection. Based on these examples, advantages and disadvantages of using specialists as consultants in GPs' peer-group-based CME (continued medical education) are discussed. Three short case vignettes were presented in a questionnaire to GPs, microbiologists and urologists with prechosen choice of diagnostic, treatment, and follow-up strategy. A total of 154 (77%) GPs, 45 (51%) microbiologists, and 54 (61%) urologists answered the questionnaires. There was considerable variation in proposed strategy both within each specialty and between the specialties. Microbiologists, and to some extent urologists, would more often than the GPs treat a 30-year-old woman via telephone advice and prescription, while they more often tended to ask a 10- and 60-year-old woman to come to the clinic for examination. The GPs, more than the other doctor groups, would ask the patients to return for follow-up. Continuous medical education of GPs based on small-group peer discussions and with specialists as consultants in the groups cannot be expected to lead to less variation in choice of medical strategy.
Denmark↗
[Vaginal smears on clinical indication in a county with systematized screening].
In Denmark PAP-smear screening is performed by the GPs. The objective of this study is to report the proportion af smears taken on clinical indication over an eight week period in the county of Aarhus, and to obtain a precise reason for making a PAP-smear on clinical indication. Some 27% of all smears taken were on clinical indication. Some 55% of these smears were due to a follow-up on previous PAP-smears, while tests due to subjective symptoms account for the major part of the remaining tests. Testing the target group outside the screening programme is discouraged, but some 43% of tests on indication are not due to follow-up of previous smears. Further studies of the consequences of such testing are recommended.
Adult↗
[Methaphors and understanding of diseases].
In the recent two decades it has been argued that our language and sense of reality is radically structured by metaphors. Metaphors are not just figurative expressions of existing similarities, but can create such similarities. Certain metaphors (root metaphors) may convey new world views and thus underpin new theoretical formations. The article goes through a series of metaphorical descriptions of illness, and elaborates on the importance of metaphors for medical communication and language-use. The significance of the metaphors for communication between physician and patient is lined out, and it is described how the use and subsequent rendering of metaphors from two different structures of understanding may lead to serious misapprehension.
Anecdotes as Topic↗
Diagnosis of urogenital Chlamydia trachomatis infection in women based on mailed samples obtained at home: multipractice comparative study.
OBJECTIVE: To compare urine and vaginal flush samples collected by women at home with endocervical and urethral swabs obtained by general practitioners for their efficacy in the diagnosis of urogenital Chlamydia trachomatis infection. DESIGN: Multipractice comparative study. SETTING: 33 general practices and a central department of clinical microbiology in Aarhus County, Denmark. SUBJECTS: 222 women aged 18-25 years who for any reason had a gynaecological examination. INTERVENTIONS: Endocervical and urethral swabs were obtained by the women's general practitioners. The same women when at home then collected a first void urine sample, a midstream urine sample, and a vaginal flush sample (using a vaginal pipette) and mailed them to the laboratory. MAIN OUTCOME MEASURES: C trachomatis defected by the polymerase chain reaction and the ligase chain reaction. Eight tests for C trachomatis were performed for every woman. When two of the eight yielded positive results the patient was considered infected. RESULTS: The overall prevalence of C trachomatis infection was 11.2% (23/205 women). Test sensitivities in samples obtained by general practitioners, samples obtained at home subjected to polymerase chain reaction, and samples obtained at home subjected to ligase chain reaction were 91%, 96%, and 100% respectively. The corresponding specificities were 100%, 92.9%, and 99.5%. CONCLUSIONS: The diagnostic efficacy of samples obtained by women at home and mailed to the laboratory was as good as for samples obtained by a general practitioner when using the ligase chain reaction. This may have important implications for the practicability of screening for this common, often asymptomatic, and treatable infection.
Adolescent↗
[Patients' attitudes towards and satisfaction with interns in general practice. Practicing interns and patient satisfaction].
The aim of this study was to evaluate the Danish vocational training scheme from a patient's point of view. This was especially interesting as all young doctors have six months vocational training in general practice after finishing university. During April 1993 junior doctors in twelve general practices in the county of Aarhus, Denmark, distributed a total of 574 questionnaires to consecutive patients after a consultation. The questionnaire was anonymously returned to the research unit. Four hundred and five patients answered the questionnaire. Ninety-three percent were fairly or very satisfied with the consultation, and 87% were sure or fairly sure that they would attend a trainee again. Eighty-five percent said that the trainee was as easy to communicate with as their own doctor. However, 36% said that attending a trainee was their only chance of seeing a doctor on the day preferred, and 47% did not feel fully informed about the trainee system. The data was analyzed with respect to sex, age, and disease related factors, and only minor differences were found. The survey shows that Danish patients were very positive about the GP trainee system, especially compared to previous investigations from other countries. However patients were not sufficiently informed about the aim and contents of the trainee system.
Attitude↗