[Preventive examinations for cervix cancer in Denmark. Status in 1995. Plans for 1996].
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Adult↗
Biomedical subjects
F Olesen
Publications and source records attributed to F Olesen.
[Evaluation of trainees' stay in general practice by the young physicians and their tutors].
In 1991 a new reform for postgraduate trainees was introduced in Denmark. Since the reform all young doctors-as a compulsory part of their vocational training-have had to work for six months as general practice trainees, no matter their wishes for future specialization. The reform furthermore led to the general practice trainees being considerably younger than previously-the average length of postgraduate experience before working as a trainee declined from six to seven years to one to two years. In this light an investigation was conducted from August 1992 to July 1993. Seven hundred and fifty-eight questionnaires were sent to general practice trainees and their tutors in Denmark. Ninety-five percent of the questionnaires were returned, thus it was possible to evaluate the new compulsory training in general practice. In conclusion, the main part of the trainees had a positive assessment of the work conditions in general practice. However, a large part of the trainees indicated that their tutor doctors had set aside too short a time for supervision.
Cross-Sectional Studies↗
[It is still beneficial to be a tutor physician].
In 1991 a new reform for postgraduate trainees was introduced in Denmark. As a result of the reform the average postgraduate experience of trainees in general practice declined from six to seven years to one to two years and the training in general practice became compulsory for all. It was expected that these changes would require more supervision of the trainees by their tutor doctors, and some general practitioners no longer wished to receive trainees. In this light an investigation was conducted from August 1992 to July 1993. Questionnaires were sent to tutors who had employed a trainee with less than 25 months of postgraduate experience since 1990. As a precondition questionnaires were only sent to tutors who had also employed trainees before the reform. Two hundred and twenty-eight of the questionnaires were returned. The tutors were asked to compare their assessments of the pre- and post-reform arrangements. According to the answers the young trainees contributed less to the everyday work and they earned the same as or less for the practice than their more experienced predecessors. The tutors were furthermore asked to give a specific assessment of the young trainee working at the moment in general practice. The tutors found sufficient skills in the trainees, they found relief in their workload and a neutral or improved economics due to the trainees In spite of the trainees being less experienced and a need for more supervision and education as compared to the time before the reform, the tutors still agreed that having a trainee in their practice was an overall benefit.
Cross-Sectional Studies↗
[Characterization of "non-attenders" in an organized screening against cancer of cervix uteri].
The aim of the study was to present social and other characteristics of non-attenders in an organized cervical screening programme. It was conducted a case-control study in a cohort. The cohort consists of women in the age group 23-60 years who were invited to the organized cervical screening programme in Aarhus county, Denmark, between 1.10.1990 and 1.4.1994, totalling 133,500 women. The case group included 694 "non-attenders" and the control group 1131 women who had had at least one smear performed during the previous 42 months. The results showed that non-attenders, compared to attenders, had less frequent contact to their general practitioner. The non-attender group did not have an over-representation of markers for special risk of cervical cancer.
Adult↗
[Implementation of research results. Are physicians interested in reference programs?].
In a questionnaire we investigated whether 315 general practitioners (GPs), 79 heads of departments of medicine and 20 heads of departments of neuromedicine were aware of new national guidelines for oral anticoagulation in atrial fibrillation issued by the Danish Society of Internal Medicine. The guidelines were only known to 22% of the GPs, 6% of the neurological consultants and 64% of the medical consultants, but nevertheless only 4-7% of the doctors did not want distribution of guidelines. Fifty-four percent of the GPs and 12% of the specialists preferred the Danish College of General Practitioners to in some way participate in the development of guidelines. Our study suggests that guidelines are met with a positive response, but to obtain optimal use a powerful implementation effort must be recommended.
Anticoagulants↗
A comparative study of prescribing of hormone replacement therapy in USA and Europe.
OBJECTIVES: The use of hormone replacement therapy (HRT) has been shown to vary from one country to another through international studies of sample populations and by comparison of data obtained from comparable national studies. Drawing international prescribing comparisons is very difficult as data sources are few, incomplete and of uncertain accuracy and comparability. As an alternative to direct prescribing information, pharmaceutical sales information indicates medication used. This paper sought to demonstrate international differences in the use of HRT using an economic analysis methodology based on national pharmaceutical sales statistics. METHODS: A recognised economic analysis methodology was used to translate 1991/1992 pharmaceutical sales data into women treatment years of HRT used in each country. From this was calculated the percentage of the female population in each country, eligible for HRT, who would have been taking HRT. RESULTS: The results show a wide variance in the percentage of the eligible female population in each country calculated to have been taking HRT, from <1%-20%. The results indicated that HRT usage fell into three groupings: USA being the greatest user with UK and Scandinavian countries in the middle group and continental Europe having the lowest usage. CONCLUSIONS: National patterns of HRT usage, as calculated by this study, correlate well with those of other studies. Since similar morbidity could be expected as menopause is a naturally occurring event, not a disease, possible reasons for the variance in national prescribing patterns are discussed. The study indicates the need for further research on health beliefs and physicians' and women's attitudes to HRT in different countries to explain the variance in HRT usage, also considering access to healthcare, in particular women's health services. It confirms the validity of using economic analysis of pharmaceutical sales data as a proxy for prescribing data in the arena of prescribing research.
Aged↗
Characteristics of subgroups of attenders and non-attenders in an organised screening programme for cervical cancer.
OBJECTIVE: Several studies have compared attenders and non-attenders in organised cervical screening programmes but few have analysed subgroups of attenders and non-attenders. This study presents social and other characteristics of such subgroups. SETTING: Aarhus County, Denmark. METHODS: A case-control study in a cohort of 133,500 women, aged 23-60, included in the programme from 1 October 1990 to 1 April 1994. The participation rate was 75%, and those taking part comprised women with opportunistic screening or who had had a smear owing to symptoms in the previous three years ("active" attenders), and women who were invited for screening because they had not been otherwise tested ("passive" attenders). "Passive" (n = 708) and "active" attenders (n = 692) were compared. Women who had never had a smear test ("never" attenders, n = 287) were then compared with "ever" attenders (n = 1215)-that is, women who had not had a smear test during the previous 42 months, but had had at least one previous test. Data were collected by mailed questionnaires. RESULTS: The response rate was 81% and 53% for attenders and non-attenders, respectively. After correction for age, there was no difference between the "active" and "passive" attenders for cancer risk factors (smoking, age of first intercourse, number of sexual partners, and social group), or in the degree of responsibility for close relatives, but "active" attenders seemed to have more frequent contact with their general practitioner. "Never" attenders had less frequent contact with their general practitioner than "ever" attenders. They were more often living alone and nullipara, but had no overrepresentation of cancer risk factors. CONCLUSIONS: Increased effect cannot be obtained by focusing on the described groups, but by increasing the participation rate. "Never" attenders do not belong to a special risk group.
Adult↗
Identifying patients for research in general practice.
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Clinical Trials as Topic↗
Change in ranking order of prescribing patterns by age and sex standardization of the practice population--audit may be misleading.
OBJECTIVE: To demonstrate whether standardization of practice populations by age and sex changes the internal prescription ranking order of a group of practices. DESIGN: Data on the prescribing of cardiovascular drugs in a group of practices were obtained from a county-based database. Information on the age, sex, and numbers of patients per practice was also obtained. The direct standardization method was used to adjust practice populations for age and sex. SETTING: The town of Randers, Aarhus County, Denmark. SUBJECTS: 35 practices, 41 GPs. MAIN OUTCOME MEASURES: Ranking of the 35 practices with respect to number of prescribed daily doses of cardiovascular drugs in crude utilization index and standardized utilization index. The slope of the regression curve of variation between the practices. RESULTS: The change from crude to standardized utilization index gave an entirely new ranking order of the practices. Only four practices did not change ranking position, while four moved more than ten places. The slope between highest and lowest ranked practice did not diminish after standardization. CONCLUSION: Care should be taken when comparing peer prescribing patterns from crude utilization data, and we recommend prior age and sex standardization. Our results are of value in creating a more reliable basis for a debate on variation in prescribing patterns between peers.
Adult↗
[Does learning new knowledge and discarding old knowledge go too slowly?].
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Clinical Competence↗
Physicians' responses to patient vignettes: are they valid?
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Clinical Competence↗
[Registration in medical journals of prescriptions for strong analgesics prescribed by general practitioners].
The use of strong analgesics was continuously registered in 90 patients throughout 12 months via the public health authorities, who are responsible for the control of prescription of strong analgesics. After the 12 months, questionnaires were sent to the prescribing doctors about the treatment during that period. Twenty-five patients were excluded mainly due to incomplete data and non-responding GPs. Analysis of validity of the GPs' registration, with the public health authorities' registration used as the reference standard, showed 90% (95% confidence limits (CL):68-99%) agreement concerning continuing treatment with strong analgesics and 98% (CL:88-100%) regarding GPs' registration of patients not being treated with strong analgesics. In all, misclassification occurred in 5% (CL:1-13%) of the patients. Our study suggests that the GPs' information about prescriptions of strong analgesics is valid, and that it can be used in research.
Analgesics↗
[Health profile of farmers--a study from Djursland].
The aim of the study was to describe the pattern of illness and the incidence of diseases in a population of Danish full-time farmers. All members of the Farmers Association in Djursland, Jutland, Denmark, (n = 1309), were asked to complete a questionnaire. Of these, 896 (68.4%) accepted, of whom 610 were full-time farmers. The pattern of illness is described by the incidence of chronic disease, the incidence of specific disease, and the incidence of typical symptoms within the last 14 days. Furthermore, the incidence of work-related accidents and the use of medicine were registered. The data were compared with results from a similar investigation in the general Danish population. The incidence of disease in the locomotive and the respiratory system is higher among farmers. In contrast, the incidence of psychiatric and cardiovascular disease as well as insomnia appeared lower. In conclusion full-time farmers have an increased risk of suffering from certain diseases.
Adolescent↗
Implementation of guidelines on stroke prevention.
The aim of the present paper was to study the implementation of new medical knowledge. We investigated whether Danish doctors have implemented new national guidelines for oral anticoagulation of atrial fibrillation. An anonymous questionnaire with six standardized case stories was sent to 315 general practitioners in the county of Viborg and Ringkøbing, 79 heads of departments of medicine and cardiology, and 20 heads of departments of neuromedicine across the country. The answers showed that the Danish doctors recommended anticoagulant therapy only to a low extent for this group of patients despite the guidelines and the scientific evidence. The reasons for not choosing anticoagulant therapy were lack of knowledge concerning risk of stroke associated with the disease, worries about the disadvantages of the treatment, and lack of knowledge of its benefits. It is concluded that despite solid scientific documentation and an intensive implementation process of guidelines, issued by well-known respected colleagues in a small homogeneous country as Denmark (5 million inhabitants), knowledge of new research findings varies greatly and is generally limited. To obtain optimal use of new research findings, a powerful implementation effort must be recommended and the study reveals a need for a closer link between research and post-graduate education.
Aged↗
[On-duty medical service regulation in Norway, Sweden, Finland and Denmark].
Out of hours services are under discussion in the Nordic countries, and their organisations in Norway, Sweden, Finland and Denmark are compared in the article. Only in Denmark all such services are free of charge. In Denmark and in most parts of Norway, the patient must first phone a call-in service manned by a physician who acts as receptionist cum dispatcher. House calls are very rarely made in Sweden and Finland but account for approximately 20 percent of the out of hours workload in Norway and Denmark.
Denmark↗
Patients with urinary tract infection: proposed management strategies of general practitioners, microbiologists and urologists.
BACKGROUND: It is difficult to implement change in general practice. It is not known how best to conduct effective continuing medical education in general practice. General practitioners' criteria for good clinical practice vary and it is unknown whether systematic education by hospital specialists could be expected to reduce variation between general practitioners. AIM: A study was undertaken to describe general practitioners', microbiologists' and urologists' strategies for diagnosis, treatment, and follow up of female patients with symptoms of urinary tract infection, a common reason for consultation in general practice. The findings of the study were to be used as a base upon which to discuss the advantages and disadvantages of using hospital specialists as a resource in general practitioners' peer group based continuing medical education. METHOD: Three vignettes together with several proposals for diagnosis, treatment and follow up were presented in a questionnaire to general practitioners, microbiologists and urologists in Denmark. The case histories concerned three female patients (aged 10, 30 and 60 years) who consulted their general practitioner for advice. The female patients were otherwise healthy and well known to the practice. General practitioners', microbiologists' and urologists' recommendations for good clinical practice were compared. RESULTS: A total of 154 general practitioners (77%), 45 microbiologists (51%) and 54 urologists (61%) who were eligible for the study responded to the questionnaire. There was considerable variation in the management strategies proposed by doctors within each specialty and between the specialties. Microbiologists and urologists were more likely to suggest treating the 30-year-old woman by giving advice and a prescription by telephone compared with their general practitioner colleagues. Conversely, the microbiologists and urologists were more likely to suggest asking the 10- and 60-year-old patients to attend the clinic for examination compared with the general practitioners. The general practitioners reported asking the patients to return for follow up more commonly than the hospital specialists. CONCLUSION: Large variation in suggested strategies for diagnosis, treatment and follow up was shown both within and between specialties. Continuing medical education of general practitioners based on small peer group discussions using hospital specialists as a group resource would not necessarily reduce variation in clinical practice between general practitioners. A need for evidence-based rather than consensus-directed guidelines would be needed in order to reduce variation in clinical practice between doctors.
Adult↗
Out of hours service: the Danish solution examined.
In Denmark the provision of out of hours care by general practitioners came under increasing pressure in the 1980s because of growing demand for services by the public and increasing complaints from rural doctors about their heavy workload and disproportionately low remuneration in comparison with urban doctors. As a result, the out of hours service was reformed at the start of 1992: locally negotiated rota systems were replaced with county based services. Each county now has a coordination centre, where all patients' calls are received by a team of doctors. The doctors may give a telephone consultation, advise the patient to attend one of the emergency clinics strategically placed about the county, or arrange for a home visit. Doctors on home visiting duty are located at bases throughout the county and keep in touch with the coordination centre with mobile telephones. Graded fees mean that doctors are encouraged to give telephone consultations rather than arrange for clinic consultations or home visits. The reforms have reduced doctors' out of hours workload and the number of home visits made and have proved acceptable to patients, doctors, and administrators.
Aged↗
[Status of preventive screening for uterine cervix cancer in Denmark in 1994].
In 1986 The National Board of Health published guidelines for cervical cancer screening in Denmark. These guidelines recommend organized screening with personal invitations every three years to women in the age group 23-59 years, and in the years to come also invitation of women aged 60-74 years. We studied the organization of cervical cancer screening in Danish counties at the beginning of 1994. Organized screening programmes are running in 15 out of the 16 "counties" (this include the municipalities of København and Frederiksberg). Four counties completely follow the national guidelines. Eight counties follow these guidelines in general, but they do not invite women above the age of 60 years. In total, 72% of women aged 25-74 years are at present invited for cervical cancer screening in Denmark.
Adult↗