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I Krakau

Publications and source records attributed to I Krakau.

72 records · Page 4Linked to original sources
PubMed1992

Key factors in health counselling in the consultation.

To design an effective course in behaviour influence all GPs and general nurses at two health care centres were interviewed concerning procedure and perceived barriers to prevention. The results demonstrated that most doctors and nurses regarded health counselling as important in medical health service. They also maintained that they have time and space for this activity. However, most doctors and nurses were hesitant and/or disappointed concerning their perceived efficacy in affecting people's life habits. The explanation may be that the personnel lack an effective methodology to handle these issues. Few had a more developed educational theory where the starting-point was the patient. Another explanation may be that many doctors and nurses had a non-patient-centred style, which previous studies demonstrate to be less successful in affecting people's behaviour. This was expressed in the notion that the doctor/nurse has to be a model from which the patient can learn the 'right' life habits. It was also expressed in the notion that the reasons why patients do not change behaviour were mostly psychological, but no importance was attached to the role of different values. The results point out the need for education in patient-centred pedagogics.

Adult↗
PubMed1992

Trends in use of health care services in Swedish primary care district. A ten year perspective.

In a study that covered ten years a questionnaire about use of health care facilities was mailed each autumn to 1/60 representative samples of the population in Sollentuna, a Swedish primary care district with three health centres. Primary care was the health care form with the greatest contact area with the population studied. However, the strengthening of district physician resources at one of the three health centres did not, in the long term, lead to more people coming into contact with this form of medical care. It was more common for those who visited a private doctor or school/company doctor also to consult a district physician than vice versa. Similarly, hospital patients visited the health centre to a greater degree than patients of health centres visited hospitals. The only long-term change in the flow of patients that could be registered was a reduction in the number of patients who visited hospital emergency departments. It is concluded that the implementation of an annual survey may be considerably more helpful than more sparse investigations in distinguishing between temporary fluctuations and real changes.

Adolescent↗
PubMed1991

Trends in diagnosis over a 10-year period in a Swedish primary care district.

In a study that covers ten years, the panorama of diagnosis was studied at three health centres in a Swedish primary care district with the aid of an encounter form. Frequencies for the different diagnosis groups varied considerably. In the case of malignant tumours, diseases of the thyroid, other endocrine diseases, symptoms and check-up visits there were more than 3-fold differences in diagnosis frequencies between various years. The results for individual years, therefore, were not representative of diagnosis distribution in the long-term perspective. Both systematic changes and temporary fluctuations occurred during the period. There was no evident lowest common denominator for the six diagnosis groups that increased (benign tumours, diseases of the thyroid and symptoms) or decreased (urinary tract infections, other urogenital diseases and back complaints). Although frequencies for individual diagnosis groups varied sharply from year to year, the diagnosis panorama in its entirety did, however, not change decisively. Permanent district physicians took charge mainly of the chronically ill, while other doctors were more involved with acute illness. It can be concluded that with such a varied diagnosis panorama in primary care it is difficult, based on temporary statistics from individual health centres, to draw general conclusions about the composition of patients. Thus, reliable figures on diagnosis should probably be founded on continuous registration at each clinic rather than on data collected periodically from especially selected reference centres.

Community Health Centers↗
PubMed1991

Quantitative measures of medical activities in relation to diagnosis in primary health care.

In a study that covers three years, the extent of medical activities was analyzed in relation to the sex, age and treatment diagnoses of patients visiting district physicians at three health centres in a Swedish primary care district. All visits were registered with the aid of a specially designed encounter form. The most frequent medical activities were: drug prescriptions, follow-up measures and clinical chemical investigations. Diabetes, other metabolic diseases, malignant tumours and cardiovascular disease were the diagnosis groups associated with the most activities, while traumas, middle ear infections and check-up visits were associated with the least. In the case of both men and women, the number of activities per visit increased in proportion to age. The present study indicates that quantitative measures of medical activities, combined with diagnoses or other patient characteristics as sex and age, can be employed in clearly quantifying the content of consultations in primary health care.

Adolescent↗
PubMed1991

Severity of illness and diagnoses in a Swedish general practice population.

All general practitioners at three Swedish health centres continuously assessed their patients' degree of functional deficiency on a 1-5 scale over a period of 5 1/2 years. They also registered diagnoses and certain other medical measures. Around 85% were judged to be ill to some degree, but few were seriously ill. There were small differences in functional capacity between men and women of different ages: both benign, self-limiting complaints and severe illnesses could be associated with considerable problems, while many patients with severe diseases had little discomfort. There was also a considerable discrepancy between functional impairment and work capacity. Using a combination of functional assessment with routine registration of diagnoses seems to be a useful method of obtaining a modulated, distinct picture of the types of patient encountering the general practitioner. However, further development work within the field is needed.

Absenteeism↗
PubMed1991

Satisfaction with health care in a Swedish primary care district. A ten year's perspective.

In a study that covers ten years, a questionnaire about use of health care facilities and satisfaction with care was mailed out each autumn to 1/60 representative samples of the population in Sollentuna, a Swedish primary care district with three health centres. An open-ended question concerning "what is good and what is bad in the health service today" was used to measure the respondents' attitudes. The health centres attracted most comment and were considered on the whole to function better in terms of service and care than the hospitals. The latter were heavily criticized for long queues and poor availability. The continuity, however, was considered fairly poor in both the primary care and the hospitals. The few comments on private practitioners were almost without exception positive. The attributes of (all types of) care to which the respondents attached the greatest importance were closely connected with the orientation and objectives which have been stated internationally for primary care, viz. availability, continuity, quality/safety, primary responsibility, and co-ordination. Improvement of resources and reorganization in small health care teams at one of the three health centres prompted a significant increase of positive attitudes to primary care.

Adolescent↗
PubMed1991

Perception of health and use of health care services in a Swedish primary care district. A ten year's perspective.

In a study that covered ten years a questionnaire about perceived health and use of health care services was mailed each autumn to 1/60 representative samples of the population in Sollentuna, a Swedish primary care district. The majority of respondents thought that their health was good, and only a small minority reported themselves as quite, or very sick. Those assessments were stable during the ten year period. The tendency to visit the health services increased with the degree of severity of the illness. This increase was most marked in the case of visits to emergency departments and visits by appointment at hospitals, and least in the case of visits to private doctors and company/school physicians, while visits to doctors at health centres and to district nurses occupied an intermediate position. Thus, by including a simple question about perceived health in a questionnaire designed to measure use of health care services, important information about the relations between use of health services and health conditions could be obtained.

Adolescent↗
PubMed1990

Impact of day care on dementia patients--costs, well-being and relatives' views.

Forty-seven patients in psychogeriatric day centre were analysed regarding use of resources, costs and well-being. The level of well-being was based on interviews with staff and relatives and related to the economic outcome--a cost utility analysis. A 6 month period prior to day care was compared with the first 6 months in such care. The use of resources at home increased by 20% while the use of institutional care was reduced by 22%. Fifty-three percent of the patients improved in their well-being after participation in day care. When the cost of utility analysis was applied, the cost for a well-year was 4293 pounds.

Aged↗
PubMedDate not supplied

Cost-effectiveness analysis of day care for patients with dementia disorders.

In a cost-effectiveness analysis, the costs of 55 demented patients in day care (DC) and 45 patients on a waiting list were related to the effects on indices measuring quality of life. Based on one year's study, the costs per patient per day, was USD 55 for the DC-group and USD 63 for the controls (p > 0.05). Both groups deteriorated in the indices during the study year. The trend was that DC was both cheaper and better in the indices, and some of the underlying variables for the used indices also showed significantly better results in favour of DC. However, since the changes between the groups were not significant regarding the basic question at issue, it cannot be stated that DC is more cost-effective than a care organisation without DC. Different interpretations of the results are presented.

Aged↗
PubMedDate not supplied

Feedback on prescribing rate combined with problem-oriented pharmacotherapy education as a model to improve prescribing behaviour among general practitioners.

OBJECTIVE: To develop a working model with which prescribing behaviour among general practitioners might be influenced. DESIGN: Intervention based on feedback on prescribing rates and problem-oriented educational outreach visits, using educational material and local opinion leaders. Randomised study with three parallel intervention groups of general practitioners, which also served as controls for each other. The pharmacotherapeutic fields chosen were hypertension, peptic ulcer/dyspepsia and depression. Prescription data were retrieved from the electronic patient records for periods of 1 year before and after the intervention. SETTING: Six health care centres and three continuing medical education groups in Stockholm. SUBJECTS: Forty general practitioners. MAIN OUTCOME MEASURES: Drug prescribing rates and patterns before and after the intervention. RESULTS: In the hypertension field, desired trends in fractional prescribing (favouring diuretics and beta blocking agents) were recorded, with a significant (P < 0.05) effect on prescriptions for agents acting on the renin-angiotensin system, despite a pre-existing prescribing behaviour already much in line with the goals. In the peptic ulcer/dyspepsia field, desired trends were recorded for both types of therapies addressed. The fractional prescribing rates for proton-pump inhibitors decreased from 61.0% to 52.6% in the intervention arm and increased from 68.1% to 76.0% in the control arm (not significant due to low power). The depression group focused on better general attention to the disease and only minor changes were registered. CONCLUSION: Feedback of individual prescribing rates, combined with problem-oriented educational outreach visits, is a promising model for the improvement of prescribing behaviour. Data from the electronic patient record were feasible for feedback on prescribing rates.

Education, Medical, Continuing↗