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J Kragstrup

Publications and source records attributed to J Kragstrup.

At least 19 recordsLinked to original sources
PubMed2000

[Unplanned emergency admission of dying patients. Causes elucidated by focus group interviews with general practitioners].

Research indicates that the major part of terminally ill and dying patients wish to die at home, but in 1993 actually only 24% of Danish cancer patients died at home. The aim of this study was to analyse some barriers the general practitioners meet in the care for dying patients. The focus was unplanned hospitalisation in the final days of the patient's life contrary to home death as planned. The informal carer's lack of resources and insufficient control of symptoms were found to be the immediate reasons for acute hospitalisation. In addition, if the general practitioner did not have a central position in home care, we found a greater risk of unplanned hospitalisation. The conditions for improving home care for the dying are better support for the informal carer, ongoing access to experts in palliation and improved communication overall in the health service.

Caregivers↗
PubMed2000

[Big differences in the frequency of polypharmacy between physicians].

Polypharmacy, the simultaneous use of multiple drugs, is associated with adverse drug reactions, medication errors, and increased risk of hospitalisation. When the number of drugs is five or more (major polypharmacy), a significant risk may be present. We analysed the prevalence of major polypharmacy among listed patients, and identified possible predictors of major polypharmacy related to the practice. Prescription data were retrieved from the Odense Pharmaco-epidemiological Database and the age and sex standardised prevalence rate of major polypharmacy was calculated for each practice (n = 173). Possible predictors of major polypharmacy related to the GPs were analysed by backward stepwise linear multiple regression. A six-fold variation between practices in the prevalence of major polypharmacy was found, i.e. from 16 to 96 per 1000 listed patients (median: 42). Predictors related to the practice structure, workload, clinical work profile, and prescribing profile could explain 56% of the variation.

Adult↗
PubMed2000

Randomised controlled trial of CRP rapid test as a guide to treatment of respiratory infections in general practice.

OBJECTIVE: To assess whether the frequency of antibiotic prescriptions to patients with respiratory infections is reduced when general practitioners (GPs) use a C-reactive protein (CRP) rapid test in support of their clinical assessment, and to study whether using the test will have any effect on the course of disease DESIGN: Randomised controlled trial. SETTING: 35 general practices, County of Funen, Denmark. PATIENTS: 812 patients with respiratory infection. MAIN OUTCOME MEASURES: Frequency of antibiotic prescriptions and morbidity 1 week after the consultation, as stated by the patients. RESULTS: In the CRP group the frequency of antibiotic prescriptions was 43% (179/414) compared with 46% (184/398) in the control group (odds ratio (OR) = 0.9, NS). After 1 week, increased or unchanged morbidity was stated more frequently in the CRP group (12%) than in the control group (8%) (OR = 1.6, p = 0.05). In the control group, the variable having the greatest influence on whether the GP prescribed antibiotics was the patients' general well-being (OR = 2.9, p < 0.0001), whereas in the CRP group the CRP value had the greatest influence (OR = 1.1 per unit increase (mg/l), p < 0.0001). CONCLUSION: Based on the present study, the use of the CRP rapid test in support of a possible antibiotic treatment for respiratory infections in general practice cannot be recommended.

Adolescent↗
PubMed1999

[Polypharmacy estimated by means of a population-based prescription database].

The aim was to investigate estimators of polypharmacy (PP) from a population based prescription database. Data were retrieved from Odense Pharmacoepidemiological Database and contained a 10% random sample (n = 26,977) of drug users in 1994. PP was defined as simultaneous treatment with different drugs, and the duration of treatment was calculated from the date of purchase and the number of defined daily doses prescribed. This estimator was compared with an estimator based on the number of drugs purchased during a three month period. On an average day 8.7% were exposed to minor PP (two to four drugs) and 1.2% to major PP (five or more drugs). Purchase of five or more drugs during a three month period predicted episodes of major PP with a positive predictive value of 80%. Epidemiological measures of multiple drug use can be estimated from a prescription database. Conceptually, an estimator based on the number of simultaneously used drugs is preferable, but the number of drugs purchased during a three month period may be a useful alternative estimator.

Databases, Factual↗
PubMed1999

[A screening test for depression in general practice. The COOP/WONCA chart].

Depressed patients in general practice may be difficult to identify. Questionnaires may be used for screening but some of the existing instruments are difficult to use and have only to a limited degree been introduced in general practice. In this study 798 patients' answers to the COOP/WONCA chart "Feelings" were compared to GPs' diagnosis according to ICD-10 criteria for depressive single episode (F32). At cut-off2/3 (slight/moderate problems) the chart had a sensitivity of 89% (76-100%) and specificity of 75% (72-78%). The predictive value of a positive test was not higher than 33% for any cut-off point and the predictive value of a negative test never less than 98%. A two-phased diagnostic strategy with the COOP/WONCA chart as step one is suggested as a possible and relatively simple way to optimize recognition of depressive patients in general practice.

Denmark↗
PubMed1999

[General practitioners want continuing education. Audit registrations among 369 physicians in Copenhagen].

The purpose of the study was to evaluate general practitioners' (GPs') interest in CME. A medical audit comprising 369 GPs in three counties was conducted in 1996. During 28,550 consultations the participating GPs recorded clinical subject, handling of the consultation, problems in the consultation and perceived need for training in relation to the consultation. The interest in CME varied from GP to GP and from one clinical subject to another. Desire for CME was expressed in relation to 16% of the consultations, most frequently in relation to psychiatry, community medicine and musculoskeletal diseases. Theoretical courses were the learning style most often preferred, especially for subjects requiring biomedical knowledge. Newer educational methods were also listed. Organisers of CME for general practitioners should be aware of the wide range of needs and wishes for CME among general practitioners.

Clinical Competence↗
PubMed1999

How well do patient and general practitioner agree about the content of consultations?

OBJECTIVE: To analyse agreement between patients' and general practitioners' perception of content of consultations. DESIGN: Cross-sectional study based on paired questionnaires answered by patients and general practitioners (GPs). SETTING: General practices in the County of Funen, Denmark. SUBJECTS: All 291 GPs in the County were invited to join the investigation, and 137 accepted. All patients who consulted the participating GPs in a 3 day period were included in the investigation. The GPs registered 6021 patients, of whom 3578 (59%) returned the completed questionnaire. MAIN OUTCOME MEASURES: GPs and patients were asked about the urgency of the consultation, number of problems presented, duration of consultation, and quality of communication. The GPs' and patients' answers were matched, and variables of agreement were made. Patients were furthermore asked about their satisfaction with the consultation. RESULTS AND CONCLUSION: Agreement for the four matched answers varied from 69% to 83%. Disagreement was observed more often in consultations where the patient's self-evaluated health was poor, the patient was female, had a chronic disease, expected a prescription or felt that the GP had little knowledge of his/her life circumstances. Agreement concerning urgency, number of problems and quality of communication was associated with a higher degree of patient satisfaction.

Adult↗
PubMed1999

Decision on influenza vaccination among the elderly. A questionnaire study based on the Health Belief Model and the Multidimensional Locus of Control Theory.

OBJECTIVE: To create an empirical model, describing factors of importance to the elderly in accepting influenza vaccinations. DESIGN: Epidemiologic study with two coupled questionnaires. In September 1996 a 46-item questionnaire was sent to 2147 elderly people (> or = 65 years). The questionnaire comprised questions about general health, and questions based on the Health Belief Model and the Multidimensional Locus of Control Theory. In February 1997 a postcard questionnaire was sent to the same elderly people asking whether they had been vaccinated against influenza in the past season. SETTING: All Danish counties. SUBJECTS: 2147 persons randomly sampled from the The Civil Registration System. MAIN OUTCOME MEASURE: Factors influencing the rate of influenza vaccine uptake in the elderly. Influenza vaccination rates. RESULTS: In the high-risk group 51% (95% confidence interval: 46-55%) were vaccinated compared to 29% (26-32%) in the low-risk group as regards influenza. By logistic regression the Health Belief Model dimensions "perceived barriers", "perceived benefits" and "perceived severity" were found to be significant predictors of acceptance of influenza vaccinations. CONCLUSIONS: An empirical model based on the Health Belief Model predicting acceptance of influenza vaccinations with a positive predictive value of 91% (87-94%) and a negative predictive value of 86% (83-88%) was obtained.

Aged↗
PubMed1999

Randomized controlled trial of the effect of medical audit on AIDS prevention in general practice.

OBJECTIVE: We aimed to evaluate the effect of a medical audit on AIDS prevention in general practice. METHODS: We conducted a prospective randomized controlled study performed as 'lagged intervention'. At the time of comparison, the intervention group had completed 6 months of audit including a primary activity registration, feedback of own data and a meeting with colleagues and experts, and had received brief summaries of the meetings and reminders about the project (a full 'audit circle'). The participants were from general practices in Copenhagen and the Counties of Funen and Vejle, Denmark. One hundred and thirty-three GPs completed the project. The main outcome measures were the number of consultations involving AIDS prevention and the number of talks about AIDS initiated by the GP, and some elements of the content were registered on a chart. RESULTS: No statistically significant difference was observed in the frequency of consultations involving AIDS prevention between the intervention group (1.2% of consultations) and the control group (1.4%). Furthermore, no significant differences were observed regarding the content of these consultations or regarding the fraction of such consultations initiated by the GPs. CONCLUSIONS: Medical audit had no observed effect on AIDS prevention in general practice.

Acquired Immunodeficiency Syndrome↗
PubMed1999

Polypharmacy in general practice: differences between practitioners.

BACKGROUND: Polypharmacy, the simultaneous use of multiple drugs, is associated with adverse drug reactions, medication errors, and increased risk of hospitalization. When the number of concurrently used drugs totals five or more (major polypharmacy), a significant risk may be present. AIM: To analyse the interpractice variation in the prevalence of major polypharmacy among listed patients, and to identify possible predictors of major polypharmacy related to the practice. METHOD: Prescription data were retrieved from the Odense Pharmacoepidemiological Database, and individuals subject to major polypharmacy were identified. The age- and sex-standardized prevalence rate of major polypharmacy was calculated for each practice in the County of Funen in Denmark (n = 173), using the distribution of age and sex of the background population as a reference. The practice characteristics were retrieved from the Regional Health Insurance System. Possible predictors of major polypharmacy related to the general practitioners (GPs) were analysed using backward stepwise linear multiple regression. RESULTS: A six-fold variation between the practices in the prevalence of major polypharmacy was found (16 to 96 per 1000 listed patients; median = 42). Predictors related to the practice structure, workload, clinical work profile, and prescribing profile could explain 56% of the variation. CONCLUSION: A substantial part of the variation in major polypharmacy between practices can be explained by predictors related to practice.

Adult↗
PubMed1998

[The effect of a reference program and a media campaign on the prevention of AIDS in general practice].

The objective of the study was to evaluate the effect of a reference programme and a mass media campaign about prevention of HIV. A "before-after" study including three measurements was carried out. Before, immediately after, and six months after the intervention the GPs completed questionnaires, and prospectively registered consultations involving the prevention of HIV. Immediately after the intervention the median number of consultations dealing with HIV was significantly higher (three as compared to two during ten working days). The rise in activity was due to a higher number of consultations initiated by the patients. The conclusion was that the reference programme did not cause a significant change in the GPs' behaviour. However, the mass media campaign resulted in a temporary increase in the number of patients who took the initiative to talk about HIV with their GPs.

Acquired Immunodeficiency Syndrome↗
PubMed1998

[Effect of an influenza vaccination campaign in the municipality of Copenhagen during the 1996-1997 season].

In Denmark influenza vaccinations are usually paid for by the patients. In the autumn of 1996 Copenhagen City Council offered free influenza vaccinations to all residents aged 70 years or older. The impact of the campaign was evaluated in a questionnaire study of a random sample of the Danish population aged 70 years or older. In Copenhagen 81% (95% Confidence interval: 67-95%) of the elderly at risk were vaccinated compared to 51% (45-56%) outside Copenhagen. Offering free influenza vaccinations in a mass campaign is an effective way of improving coverage rate. However, no substantial difference was found in cost between the mass campaign and a targeted campaign with free vaccination in general practice.

Aged↗
PubMed1998

[Antabus treatment in general practice. A pharmaco-epidemiological study of prescription patterns based on a prescription database].

Denmark has a long tradition for the use of alcohol-aversive drugs in the treatment of alcoholism, most commonly disulfiram (Antabuse). The purpose of this study was to examine the prescription patterns for disulfiram in Danish general practice on an individual level. By means of a prescription database we analysed 150,787 prescriptions on reimbursed medicine to persons who had redeemed prescriptions for alcohol-aversive drugs during the period 1.1.1993 to 31.12.1995 in the County of Funen. Prevalence of disulfiram treatment was 12 per 10,000 inhabitants, three-year prevalence 75 per 10,000 inhabitants and incidence 21 per 10,000 inhabitants per year. Eighty-seven percent of treatments were stopped at (or before) the expiration of one prescription, and relapse was frequent (46%).

Adult↗
PubMed1998

[Role of Danish general practitioners in the prevention of AIDS].

The study describes Danish general practitioners' perception of their own role and their actual behaviour in the prevention of HIV/AIDS. Data collection was carried out by questionnaire and prospective registration of consultations dealing with HIV/AIDS during a two-week period. The results showed that most of the GPs (94%) were of the opinion that GPs should play a central part in the prevention of HIV, and 90% thought that the GP should take the initiative to talk about HIV. The median number of consultations dealing with HIV was two during ten working days (range 0-18), and more than half the GPs (56%) had not themselves initiated a conversation concerning the problem. The conclusion of the study is that there was discrepancy between the GPs' vision of their role in HIV prevention and activities in practice. It is recommended that initiatives are taken to strengthen the GPs' role in AIDS prevention.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Polypharmacy: correlations with sex, age and drug regimen. A prescription database study.

OBJECTIVE: To analyse the occurrence of multiple drug use (polypharmacy, PP) in the population and to identify individuals particularly prone to PP. METHODS: Data were derived from the Odense Pharmacoepidemiological Database (OPED) and covered all subsidised prescriptions during 1994 presented by inhabitants in the county of Funen (n = 466567). The number of individuals concurrently using two to four drugs (minor PP) and five or more drugs (major PP) was calculated on a random day in 1994. Drugs were classified according to the Anatomical Therapeutical Chemical (ATC) classification index. The main therapeutic class (second level of the ATC code) was used as an indicator for the type of health problem. A stepwise backwards logistic regression was used to identify predictors of major PP. Odds ratios were calculated for different drug classes, and the age and sex of all drug users. RESULTS: On a random day, 8.3% of the population were exposed to minor PP and 1.2% to major PP. The prevalence of PP increased with age, and from the age of 70 years, two thirds of all drug users were PP users. Drug use was 50% more prevalent among women than men, but over the age of 70, the sexes did not differ in the prevalence of major PP. Many different drug combinations were found, and among major PP users (n = 5443), two thirds had their own unique drug regimen, different from all other drug users. Cardiovascular drugs and analgesics were often involved in PP among the elderly, while asthma drugs, psychotropic drugs and anti-ulcer drugs were predominant among young individuals exposed to PP. The odds ratio (OR) for major PP was substantially increased for individuals treated for cardiovascular diseases (OR, 4.5), anaemia (OR, 4.1) and respiratory diseases (OR, 3.6). CONCLUSIONS: PP is widespread in the population. Clinicians and organisers who are responsible for quality assurance programmes should intensify their surveillance of the groups most prone to PP (the elderly and those using analgesics or drugs for cardiovascular disease, anaemia, asthma and diabetes).

Adolescent↗
PubMed1997

[Age at menarche and first sexual intercourse. A cross-sectional study of 17-year old Danish women].

The age at menarche and first intercourse was analyzed from data obtained from a questionnaire sent to 1500 17 year-old randomly selected Danish women (76% responded). The average age at menarche was 13.37 years (SD: 1.24). The median age at the time of the first intercourse was 16.6 years. Late sexual debut was observed for girls who were relatively old at menarche and for those with a higher level of education. Apparently the age at menarche and at first sexual intercourse has not changed significantly in recent years.

Adolescent↗