Biomedical subjects

Jakob Kragstrup

Publications and source records attributed to Jakob Kragstrup.

46 records · Page 3Linked to original sources

PubMed2002

[Secondary prophylaxis in general practice for patients with ischemic heart disease].

INTRODUCTION: We examined the extent to which the Danish College of General Practitioners' guidelines of 1998, "Prevention of ischaemic heart disease in general practice--with special focus on dyslipidaemia", are complied with in the secondary preventive care of patients with ischaemic heart disease. MATERIAL AND METHOD: Twenty-six general practitioners from Ringkjøbing County registered all patients with ischaemic heart disease consecutively over three weeks in May 1999. One hundred and ten patients had suffered acute myocardial infarction, 141 had ischaemic heart disease without acute myocardial infarction. Blood pressure, total cholesterol, and use of cardiovascular drugs were registered. RESULTS: In patients with previous acute myocardial infarction, 66% had had their serum cholesterol measured within the past year; 76% were being treated with acetylsalicylic acid, 46% with beta-blockers, and 27% with lipid-lowering drugs. Of the patients with previous myocardial infarction and a serum cholesterol level > or = 5.0 mmol/l, 33% took lipid-lowering drugs. DISCUSSION: The present study demonstrates that in some areas actual treatment practice does not always comply with the given recommendations. In particular the frequency of cholesterol measuring and treatment with beta-blockers and lipid-lowering drugs show that continued, targeted quality development is required.

Anticholesteremic Agents↗

PubMed2002

Detailed postal feedback about prescribing to asthma patients combined with a guideline statement showed no impact: a randomised controlled trial.

OBJECTIVE: To evaluate the effects of postal feedback with clinically relevant data on general practitioners' prescribing compared with feedback with aggregate data on prescribing patterns of asthma drugs. METHODS: The study was a randomised, controlled trial. The general practitioners (GPs) in the County of Funen, Denmark (292 GPs representing 178 practices) were randomised to one of three groups receiving different forms of prescriber feedback. The first group received detailed and clinically relevant data on asthma drug prescribing patterns and a guideline statement. These data included tables with counts of asthma patients following classification of each individual's consumption of inhaled beta2-agonists and use of inhaled steroids. The second group received aggregate data on asthma drug prescribing patterns and a guideline statement, and the third group received feedback on an unrelated subject and served as control for the other groups. Each GP received prescriber feedback three times within a 6-month period. The last two letters with prescriber feedback had updated information with the purpose of showing changes in prescribing patterns. Effects were followed for a period of 1 year. The main outcome measures were change in fraction of asthmatics treated with inhaled steroids and incidence rate of treatment with inhaled steroids. RESULTS: The three groups had similar baseline characteristics. None of the two types of feedback on prescribing of asthma drugs had a statistically significant impact on GPs' prescribing patterns. CONCLUSION: Mailed prescriber feedback of detailed and clinically relevant data with a guideline statement, without revealing patient identities, has little or no impact on prescribing patterns.

Adolescent↗

PubMed2002

Why has postal prescriber feedback no substantial impact on general practitioners' prescribing practice? A qualitative study.

OBJECTIVE: To better understand the reasons for lack of impact of sending feedback on prescribing pattern to general practitioners (GPs). METHODS: Semi-structured interviews with GPs who had all participated in intervention studies addressing effects of prescriber feedback. Interviews were audiotaped and fully transcribed. Transcripts were studied repeatedly and coded into categories in order to produce meaningful patterns. RESULTS: None of the GPs believed they altered prescribing practice after they received prescriber feedback. Unsolicited prescriber feedback was perceived as violating the GPs' autonomy. The GPs wanted to decide for themselves what data should be sent to them. Aggregated data were difficult to interpret, and GPs did not regard it as a problem that their practice pattern deviated from that of other practices. There was a mistrust of the validity of data, and the GPs wanted to be able to identify the patients with a need for optimised therapy directly from the information provided in the prescriber feedback. In addition they wanted advice on how to optimise therapy. CONCLUSION: Postal prescriber feedback (not revealing the patients' identities) is not effective because it does not motivate GPs to change nor does it address the barriers to change. Prescriber feedback requested by the GPs may be more effective, however, if it includes identities of inappropriately treated patients combined with relevant advice on how to optimise prescribing.

Attitude of Health Personnel↗

PubMed2002

[Ambulance transportation and prehospital treatment in connection with admission for suspected acute myocardial infarction].

INTRODUCTION: The aim was to describe ambulance transportation and pre-hospital treatment in connection with admission for suspected acute myocardial infarction. MATERIAL AND METHODS: For all patients with suspected acute coronary syndrome who were urgently admitted to the Cardiological Department, Odense University Hospital between 3 August 1998 and 6 December 1998, information about ambulance transportation and pre-hospital treatment was collected through interviews with the patients and study of ambulance records, admission notes, and hospital medical records. In addition, details of the regarding response times were obtained from Falck's emergency service and from nurses' papers. RESULTS: Altogether 279 patients (83%) were transported by ambulance. Half the ambulances arrived at the hospital after 34 minutes (range 11-140 minutes), but every third ambulance took more than 40 minutes to reach the hospital. The pre-hospital treatment of all the patients was: oxygen 69%, nitroglycerin sublingually 46%, nitrous oxide 2%, defibrillation 1.4%, acetylsalicylic acid 9%, morphine injection 8%, and ECG monitoring 57%. CONCLUSION: The study showed that there were quality problems, as every third ambulance took more than 40 minutes to reach the hospital. It also showed that acetylsalicylic acid and morphine were used only to a limited extent in a pre-hospital situation.

Ambulances↗

PubMed2002

High persistence of statin use in a Danish population: compliance study 1993-1998.

AIMS: Several studies have found that compliance with lipid-lowering drug (LLD) treatment is low. However, the results of these studies were based on crude measures of compliance. The aim of this study was to describe compliance with statin treatment by analysing prescription patterns on an individual level in a population-based prescription database over a 6 year period. METHODS: For incident statin users, all prescriptions for statins and drugs indicating cardiovascular disease or diabetes were retrieved from the OPED prescription database covering a population of about 470,000 inhabitants. Treatment was considered discontinued if the interval between two prescriptions exceeded number of tablets prescribed, plus 30 days. Compliance was assessed in terms of persistence and continuity. Persistence was defined as the period from the first prescription date to the date of discontinuation. Continuity was defined as the number of days with treatment (=number of tablets) divided by the total number of days in the period of persistence. RESULTS: 11% of the study cohort only received a single statin prescription. Survival analyses revealed a median persistence of 41 months. Less than 15% of the patients had more than 20% days without therapy within the period of persistence. Patients under 45 years without drug indicators of cardiovascular disease or diabetes presented the lowest compliance. CONCLUSIONS: The study showed good compliance with statin treatment in terms of persistence and continuity. A high percentage of the youngest patients, however, seemed to discontinue treatment before obtaining the full benefit in terms of decreased risk of coronary heart morbidity and mortality.

Adolescent↗

PubMed2002

Methodological problems in comparing audits from the Nordic countries. A critical review of results from audit on Nordic general practitioners' management of patients with psychiatric problems.

In 1998, an audit on psychiatric problems in general practice was conducted in four Nordic countries. Five-hundred-and-sixty general practitioners participated and made registration according to the Audit Project Odense method. This paper describes the methodological problems related to international differences in the organisation of health care, recruitment of general practitioners and the registration of contacts. Nordic differences in this audit gave rise to inspiring discussions at national meetings, but methodological problems remain to be resolved if the results are to prove useful in scientific reporting.

Family Practice↗

PubMed2002

Do general practitioner and patient agree about the risk factors for ischaemic heart disease?

OBJECTIVE: To analyse agreement between patients' and GPs' perceptions of risk factors and overall risk of ischaemic heart disease (IHD). DESIGN: Cross-sectional study based on paired information from patients and GPs. SETTING: Twenty-six GPs in the County of Ringkøbing, Denmark, participating in a medical audit during 3 weeks in May 1999. SUBJECTS: 252 patients with IHD and 1239 without IHD. MAIN OUTCOME MEASURES: GPs and patients were asked about specific risk factors for IHD and their perception of overall risk. Their agreement was evaluated by Kappa statistics. RESULTS: Agreement between GPs and patients varied from 70% to 97%. Disagreement was observed most often for patients with IHD and patients listed with elderly GPs ( > 50 years). Generally, patients perceived the overall risk of IHD lower than their doctors, and for most patients with a perception of low risk the GP estimated the risk as high. CONCLUSIONS: Patients and GPs have different perceptions of the risk of [HD. This may be due to different perceptions of the importance of specific risk factors and different reference frames for risk perception. GPs have an important role in communicating the meaning of risk factors and interventions should be considered to improve risk communication in general practice.

Adult↗

PubMed2002

Ageing may have limited impact on future costs of primary care providers.

OBJECTIVE: To project the future costs of primary care providers in Denmark, taking into account high costs in the last year of life. DESIGN: Observational study and modelling. SETTING: Primary health care providers (doctors, dentists, physiotherapists, etc.), but not nursing homes and home help services. METHODS: The Danish population for the years 1995-2020 was projected on the basis of the current population using the cohort-component method. Average costs of use of various types of primary care providers were estimated from a 19.2% random sample of the 1995 population. Future costs were then projected using the population projection and age- and sex-specific average costs for survivors and non-survivors. RESULTS: The population was projected to increase by 8.2%, while the estimated increase was 36.1% for people aged over 50 years. Future costs of primary care providers were projected to increase by 8.2%, i.e. proportionally to the population increase. CONCLUSIONS: The results of the study indicate that demographic changes will Influence future costs of primary care providers through an increasing population size, but not because of ageing. This conclusion is independent of whether high costs in the last year of life are accounted for or not.

Adolescent↗

PubMed2002

Perception of risk information. Similarities and differences between Danish and Polish general practitioners.

OBJECTIVE: The objective of the study was to gain better insight into how general practitioners (GPs) perceive risk reduction and the way this perception may be influenced by healthcare environment. DESIGN: Questionnaires with clinical episodes were sent to Danish and Polish GPs, who were randomised into four groups, each receiving the same case story with differently phrased information about risk reduction achieved through medical treatment. The GPs were asked whether they would recommend medical treatment, knowing the case story and expected risk reduction. SUBJECTS: Danish and Polish GPs. RESULTS: A greater proportion of Polish GPs than Danish GPs would definitely or probably recommend treatment (93% versus 72%; p < 0.001). Both groups of doctors were more inclined to recommend treatment when the achievable benefits were presented in terms of relative risk reduction rather than absolute risk reduction or number needed to treat. CONCLUSION: Neither information on number needed to treat nor relative risk reduction alone provides doctors with all the information they need to recommend treatment or prevention to their patients. The present study showed that the professional handling of risk information is affected by differences produced by healthcare cultures.

Adult↗

PubMed2002

Danish GPs' perception of disease risk and benefit of prevention.

BACKGROUND: Uncertainty and risk are central issues in relation to health and health care services. Healthy individuals do not necessarily fall ill, despite the presence of risk factors. It has been documented that doctors, health service administrators and patients are more inclined to choose interventions against risk factors when information about the effects is presented in terms of relative risk reductions rather than absolute risk reductions. OBJECTIVES: The objective of the study was to gain better insight into how GPs perceive risk of disease, and how this perception is influenced by the way the risk is presented, e.g. whether changes in risk are presented in absolute or relative terms. METHODS: Questionnaires with clinical episodes were sent to 1500 Danish GPs. The GPs were randomized into four groups of 375, who all received the same case story with information about risk reduction achieved through medical treatment phrased in terms of either relative risk reduction, absolute risk reduction, number needed to treat or all of the aforementioned terms of risk reduction. The GPs were asked whether they would recommend medical treatment as primary prevention, knowing the case story and expected risk reduction. RESULTS: The GPs' attitude towards recommending medical treatment was dependent on the phrasing of risk reductions. Seventy-two per cent of doctors who received all information on risk reductions would definitely or probably recommend medication, while 91% would recommend medication if information only about relative risk reduction was given, and 63% would recommend medication if information was given in terms of absolute risk reduction or number needed to treat. CONCLUSION: In order to advise patients in a rational way, in addition to knowledge of the patients' preferences, doctors need to take into account all available measures of risk reductions.

Attitude of Health Personnel↗