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Biomedical subjects

Frede Olesen

Publications and source records attributed to Frede Olesen.

At least 55 records · Page 3Linked to original sources
PubMed2004

A new, empirically established hypochondriasis diagnosis.

OBJECTIVE: The narrow ICD-10 and DSM-IV definition of hypochondriasis makes it rarely used yet does not prevent extensive diagnosis overlap. This study identified a distinct hypochondriasis symptom cluster and defined diagnostic criteria. METHOD: Consecutive patients (N=1,785) consulting primary care physicians for new illness were screened for somatization, anxiety, depression, and alcohol abuse. A stratified subgroup of 701 patients were interviewed with the Schedules for Clinical Assessment in Neuropsychiatry and questions addressing common hypochondriasis symptoms. Symptom patterns were analyzed by latent class analysis. RESULTS: Patients fell into three classes based on six symptoms: preoccupation with the idea of harboring an illness or with bodily function, rumination about illness, suggestibility, unrealistic fear of infection, fascination with medical information, and fear of prescribed medication. All symptoms, particularly rumination, were frequent in one of the classes. Classification allowed definition of new diagnostic criteria for hypochondriasis and division of the cases into "mild" and "severe." The weighted prevalence of severe cases was 9.5% versus 5.8% for DSM-IV hypochondriasis. Compared with DSM-IV hypochondriasis, this approach produced less overlap with other somatoform disorders, similar overlap with nonsomatoform psychiatric disorders, and similar assessments by primary care physicians. Severe cases of the new hypochondriasis lasted 2 or more years in 54.3% of the subjects and 1 month or less in 27.2%. CONCLUSIONS: These results suggest that rumination about illness plus at least one of five other symptoms form a distinct diagnostic entity performing better than the current DSM-IV hypochondriasis diagnosis. However, these criteria are preliminary, awaiting cross-validation in other subject groups.

Adult↗
PubMed2003

[Is change of general practitioners more frequent among patients diagnosed with cancer or other serious diseases?].

INTRODUCTION: Change of GP may imply that the patient is dissatisfied with the health service provided. The aim of this study was to investigate whether newly diagnosed cancer patients change their GP more often than other patient groups and the background population. MATERIAL AND METHODS: The investigation was conducted using data on inhabitants from the counties of Aarhus, Vejle and South Jutland. We included 900 Group 1 insured patients, aged 18-75 years, distributed into three groups: 1) frequent cancers, 2) rare cancers and 3) benign, but chronic or severe new diseases. The diagnoses included occurred for the first time at the time of inclusion. Three hundred controls were randomly selected from the regional health care registry in Aarhus. The study period was from March 1 to August 30 1994. A change of GP was defined as a change not caused by the patient's change of residence or the GP's change of practice registration number due to expansion, takeover or split up of practice. RESULTS: In the three disease groups, 28 cases of change of GP were registered with a frequency of 5% (frequent cancers), 2.7% (rare cancers) and 1.7% (benign, but chronic or severe new diseases). The frequency in the background population was 2.7%. None of the differences were statistically significant. DISCUSSION: During the first year following a cancer or chronic disease diagnosis, change of GP is rare, particularly among patients with rare cancers. We reject the hypothesis that change of GP is frequent among newly diagnosed cancer patients.

Adolescent↗
PubMed2003

[Educational outreach visits. Choice of strategy for interviewing general practitioners].

INTRODUCTION: The clinical behaviour of General Practitioners (GPs) can best be influenced by identifying their incitements and barriers in the first place. The purpose of this paper was to describe a model for the outreach visits, in which the purpose was to facilitate and evaluate the desired changes in the clinical behaviour of the GPs. We demonstrate the usefulness and workability of the model as a tool to be used in future implementations. MATERIALS AND METHODS: A total of 41 GPs in the Counties of Aarhus and Vejle participated in the spring of 2000 in an advanced educational programme about how to diagnose and treat patients with functional disorders. All participating GPs received an invitation for a six-month follow-up visit. The purpose of the follow-up visit was to facilitate and evaluate their educational benefits and experience in using psychiatric rating scales. The strategy of the visit was to structure the dialogue with reference to identifying incitements and barriers and to emphasize their strengths, weaknesses, opportunities and threats in connection with the change of their clinical behaviour. RESULTS: Thirty-eight (93%) of the GPs participated in the follow-up outreach visits. The chosen strategy proved to be useful in primary care settings. We identified several areas in which the motivation of the GPs and their possibilities to implement the desired behavioural changes could be strengthened. CONCLUSION: The results suggest that the incitements and barriers of the GPs to change their clinical behaviour can be identified using the strategy described. We suggest that the strategy should form part of the development and evaluation of outreach visits in Denmark.

Attitude of Health Personnel↗
PubMed2003

Value of self-reportable screening criteria to identify asymptomatic individuals in the general population for urogential Chlamydia trachomatis infection screening.

Submission of samples from the home allows screening for Chlamydia trachomatis without preceding professional assessment of clinical risk factors. Therefore, a validation of self-reportable information for use as selective screening criteria is needed. We asked a total of 1175 women and 1033 men who participated in an in-home sampling screening study to provide information on behavior and sociodemographic characteristics. In a multivariate model, selective screening criteria were developed on the basis of information from a random part of the tested population (development group), and the validity was assessed for the remaining part of the tested population (validation group). To find all infections, 95% of the subjects had to be screened, and screening 63% of them would have detected 86% of infections. Low predictive values were found when selective screening criteria from other studies were assessed. Selective screening by means of in-home sampling strategies among men and women aged 21-23 years cannot be recommended in the area studied.

Adult↗
PubMed2003

Patient characteristics as predictors of primary health care preferences: a systematic literature analysis.

OBJECTIVE: To identify associations between various cultural and demographic factors and patients' primary health care preferences. SEARCH STRATEGY: Searches were performed in MEDLINE (1966-December 2000), PsycINFO (1977-May 2001) and Sociological Abstracts (1963-December 2000). Identified papers were checked for more papers. INCLUSION CRITERIA: Studies with a focus on primary health care or health care in general, asking patients about preferences with regard to health care, reporting quantitative results and examining the relations between specific patient characteristics and patient preferences. DATA EXTRACTION AND SYNTHESIS: Data were extracted from studies using a scoring form to register what methods were used, which patient characteristics were analysed and which patient characteristics significantly influenced patients' preferences with regard to different aspects of health care (P < 0.05). MAIN RESULTS: A total of 145 studies were included with 2276 comparisons between subgroups of patients. Of all the comparisons, 607 (27%) showed a significant association between patient characteristics and preferences with regard to primary health care. Age and economic status significantly related to patient preferences in 38 and 33% of the comparisons, respectively. Education, health status, family situation, sex, and utilization of health care related significantly to patient preferences in less than 25% of the comparisons. CONCLUSIONS: This review of the literature showed patient characteristics to be an important determinant of preferences regarding many aspects of primary health care defined as general practice care or health care, in general. All of the patient characteristics examined here showed at least some significant associations with preferences for primary health care.

Age Factors↗
PubMed2003

General practitioner assessment of structured oncological information accompanying newly referred cancer patients.

OBJECTIVE: To investigate general practitioner (GP) assessment of a structured oncology information pack sent to GPs when newly referred patients had visited a department of oncology for the first time, and to compare their assessment of this material with their assessment of traditional information provided by the department. DESIGN: Randomised, unblinded clinical trial. SETTING: Patients and GPs in the catchment area of a regional oncology department. SUBJECTS/PATIENTS: 248 cancer patients and their 199 GPs. MAIN OUTCOME MEASURES: GP assessment of the quality of the information material received for each patient. RESULTS: 88.3% of the 248 questionnaires were returned. The structured information pack improved GP knowledge of oncology; GPs found themselves better equipped to support and counsel patients during the course of their illness, and practitioner satisfaction with the department rose. CONCLUSION: Intervention, though reasonably simple, inexpensive and not particularly time-consuming, improved cooperation between the specialist department and the GP. While this is a small step in the right direction, the need remains for new initiatives and further studies into how to improve cooperation and communication between the primary and secondary healthcare sectors.

Catchment Area, Health↗
PubMed2003

A framework for clinical general practice and for research and teaching in the discipline.

This paper uses three typical case stories from general practice to demonstrate that a GP simultaneously considers four dimensions when making a diagnosis and planning subsequent treatment of a patient in the consultation: (i). a biomedical dimension; (ii). a culture and context dimension; (iii). a medico-psychological dimension; and (iv). a network and social dimension. By taking this diagnostic and therapeutic approach, the GP adds value to the total performance of the health care system. It is demonstrated that a GP needs theoretical, research-based knowledge and skills within all four dimensions, and that it is necessary for a GP to work together with both medical and non-medical disciplines when defining the research and teaching agenda. It is stressed that consultation and communication skills are important tools for any doctor, and the value of continuity of care is discussed. Finally, the implications of the diagnostic approach with respect to planning research and teaching programmes are discussed, and the need for a better balance is stressed.

Clinical Competence↗
PubMed2003

Continuity of care: an essential element of modern general practice?

For a variety of reasons, GPs are working more and more with unfamiliar patients. The proposed new British GP contract stipulates that in future patients will register with a practice, rather than with a named GP and a recent new definition of general practice did not mention continuing care. There has been persistent confusion about the definition of continuity of care. Evidence for the benefit of patients usually seeing the same doctor is still limited. In this paper we describe some discrete elements of continuity, emphasize the importance of interpersonal continuity and suggest how this may work. The contributions of informational continuity (especially good records) and of excellent consulting skills are put in context. We conclude that further evidence is needed to demonstrate the added value of interpersonal continuity in general practice and that this needs a clear theoretical basis. We propose that such a theory will define the concept of multi-dimensional diagnosis as the key strength of our discipline and that continuity, especially interpersonal continuity, is an important factor in achieving this economically and in a way which satisfies both patients and professionals.

Continuity of Patient Care↗
PubMed2003

The FIP study: a randomised, controlled trial of screening and recognition of psychiatric disorders.

BACKGROUND: Research on questionnaires as screening tools for psychiatric disorders has yielded conflicting results. AIM: To examine the effect of a routinely administered questionnaire on recognition of common psychiatric disorders in general practice. DESIGN OF STUDY: Randomised controlled trial. SETTING: Twenty-eight general practices in Aarhus County, Denmark. METHOD: Thirty-eight general practitioners (GPs) and 1785 consecutive patients, aged 18-65 years old, presenting with a new health problem, participated. Before consultation, patients were screened using a brief screening questionnaire (SQ) including somatisation, anxiety, depression, and alcohol abuse scales. Patients were randomised to one of two groups: 900 questionnaires were disclosed and scored by the GPs, 885 were blinded. A stratified subsample of 701 patients was interviewed after the consultation using a standardised psychiatric research interview (SCAN). RESULTS: Overall the GPs' recognition rates were 14% (95% confidence interval [CI] = -2 to 30) better for depression and 35% (95% CI = 2 to 68) better for alcohol problems when SQs were disclosed. Recognition rates for anxiety improved 8% (95% CI = -9 to 26) overall. In the case of somatoform disorders, disclosure showed no effect overall. Among those with high SQ scores, however, disclosure increased recognition rates on any mental disorder evaluated. CONCLUSION: This study demonstrated limited usefulness for routine screening for common psychiatric disorders. However, findings suggest that the SQ may be useful for case-finding among a subgroup of patients with high SQ scores.

Adolescent↗
PubMed2003

Diagnosis of somatisation: effect of an educational intervention in a cluster randomised controlled trial.

BACKGROUND: Somatisation is highly prevalent in primary care (present in 25% of visiting patients) but often goes unrecognised. Non-recognition may lead to ineffective treatment, risk of iatrogenic harm, and excessive use of healthcare services. AIM: To examine the effect of training on diagnosis of somatisation in routine clinical practice by general practitioners (GPs). DESIGN OF STUDY: Cluster randomised controlled trial, with practices as the randomisation unit. SETTING: Twenty-seven general practices (with a total of 43 GPs) in Vejle County, Denmark. METHOD: Intervention consisted of a multifaceted training programme (the TERM [The Extended Reattribution and Management] model). Patients were enrolled consecutively over a period of 13 working days. Psychiatric morbidity was assessed by means of a screening questionnaire. GPs categorised their diagnoses in another questionnaire. The primary outcome was GP diagnosis of somatisation and agreement with the screening questionnaire. RESULTS: GPs diagnosed somatisation less frequently than had previously been observed, but there was substantial variation between GPs. The difference between groups in the number of diagnoses of somatisation failed to reach the 5% significance (P = 0.094). However, the rate of diagnoses of medically unexplained physical symptoms was twice as high in the intervention group as in the control group (7.7% and 3.9%, respectively, P = 0.007). Examination of the agreement between GPs' diagnoses and the screening questionnaire revealed no significant difference between groups. CONCLUSION: Brief training increased GPs' awareness of medically unexplained physical symptoms. Diagnostic accuracy according to a screening questionnaire remained unaffected but was difficult to evaluate, as there is no agreement on a gold standard for somatisation in general practice.

Adult↗
PubMed2002

[Illness perception in general practice--in relation to patients with somatization disorder].

In this paper different perceptions of disease and illness in general practice and possible implications of these perceptions for the GP's clinical work are described and discussed. The focus is on patients with medically unexplained symptoms and on the question whether the illness perception of the GP to some extent can explain the often inappropriate treatment of these patients.

Adaptation, Psychological↗
PubMed2002

[Patients' evaluations as quality measurements in general practice].

Patients' evaluations have several functions as quality measurements: A general judgement of the quality of the health care system and a direct assessment of defined aspects of service and care. In this article the concept of patient satisfaction and the application of patients' evaluations on quality improvement in the health care system is discussed. Despite many attempts to formulate an explanatory theory about the matter, a useful theoretical basis for the concept of satisfaction is still missing. This does not imply the exclusion of patients' evaluation of the health system, and it is discussed why and in which areas of quality improvement patients should be involved and how their evaluations should be interpreted. Studies including patients' evaluations are referred to and discussed.

Family Practice↗
PubMed2002

[Frequent attenders in general practice. Who are they and how are they managed?].

INTRODUCTION: Frequent attenders (FAs) account for a large number of the consultations and a large part of the workload in general practice. We need knowledge about the way general practitioners (GPs) characterise this group of patients and about their proposals for clinical management. This study aims to describe the types of FAs seen in general practice and their proposed management. MATERIAL AND METHODS: Six randomly sampled CME groups in Aarhus County were offered a meeting about frequent attendance in general practice, and five groups with a total of 89 GPs accepted. FAs were defined as the top 10% patients attending during 12 months. One week before the meeting, each GP received an introduction to the meeting and the names of two FAs listed with the practice. Through exploratory focus group interviews, supplemented by a small group-based CME method, the GPs were asked to discuss FA characteristics and to make proposals for clinical management. A total of 59 (66.3%) participated in the five meetings. RESULTS: Eight FA types consistently emerged from the discussions, and the GPs suggested 12 possible ways of managing them. These aspects involved communicative, organisational (planning), and biopsychosocial skills. DISCUSSION: The variety of types shows that FAs are not solely the so-called difficult patients, but a diverse group demanding many different aspects of care. Hence, the GPs are in a key position demanding specific skills to manage these patients.

Communication↗
PubMed2002

[Continuing medical education of general practitioners. A prospective study from the Aarhus county].

INTRODUCTION: Danish general practitioners' (GPs') participation in continuing medical education (CME) has often been the subject of debate, but actually very little is known about the extent and the contents of the activities. MATERIAL AND METHODS: One hundred and sixty-one Danish GPs participated in this one-year prospective study by collecting data on their own CME activities. RESULTS: We received 9980 data registration sheets. Over a period of 8.4 months, an average Danish GP spent 67 hours on traditional CME, equivalent to about 96 hours per year, and 12 hours on small group-based CME per year, i.e. a total of 108 hours per year. In addition, he or she spent 90 hours per year reading books, journals, etc. Thus, the time spent on CME totalled more than 200 hours per year. Most of the CME courses were held outside surgery hours. DISCUSSION: We conclude that the GPs in Aarhus County participate in a large number of CME activities--even more than expected by their own organisation.

Adult↗
PubMed2002

[The postgraduate training of general practitioners in communication and counseling. A questionnaire survey in the county of Aarhus].

INTRODUCTION: The study aimed to describe the postgraduate training of the general practitioners (GPs) in communication and psychiatric counselling. MATERIAL AND METHODS: GPs in Aarhus County, Denmark, received a mailed questionnaire about psychiatric hospital training, participation in courses and Balint groups (psychiatric supervision), and their need for further training. RESULTS AND DISCUSSION: The questionnaire was returned by 320 (74.4%) GPs. Almost all GPs had received some kind of postgraduate training although to a very varying extent. Almost half had taken courses of more than three days' duration, and half were members of a psychiatric supervision group. Two-thirds of the GPs thought they needed further training. The need was independent of the GP's evaluation of his/her own psychiatric education.

Communication↗