Acute admissions to anywhere other than general hospitals are uncommon in Norway, but at Hallingdal sjukestugu, a community hospital in a rural district, this has been practiced for years. This article presents experiences from this practice. Materials and
Hallingdal sjukestugu is a decentralized, specialist healthcare service, under the administration and funding of Ringerike sykehus, the nearest general hospital, which is 170 km away. General practitioners under telephone supervision of the hospital specialists run the inpatient department. Six municipalities with 20,000 inhabitants make use of the community hospital. Statistics were obtained from the patient administration systems and from manual statistics continuously registered in 2009-10.
In 2009-10 the inpatient department, an intermediate care unit with 14 beds, had an average of 605 admissions a year, with a mean length of stay of 6.3 days. There were 455 acute admissions to Hallingdal sjukestugu. Forty per cent of these patients were younger than 67 and 36% were older than 80 years of age. Half were admitted for observation and half for treatment. The main diagnostic groups were infections, injuries and palliative care. Seventeen per cent of the acute admitted patients were later transferred to the general hospital for further work-up or treatment; 70% were discharged to their homes.
The experiences from Hallingdal sjukestugu indicate that it is feasible to give a selected group of patients an alternative to acute admissions to a general hospital.
Health care professionals in several countries are searching for alternatives to acute hospitalization. In Hallingdal, Norway, selected acute patients are admitted to a community hospital. The aim of this study was to analyse whether acute admission to a community hospital as an alternative to a general hospital had any positive or negative health consequences for the patients.
Patients intended for acute admission to the local community hospital were asked to join a randomized controlled trial. One group of the enrolled patients was admitted as planned (group 1, n = 33), while another group was admitted to the general hospital (group 2, n = 27). Health outcomes were measured by the Nottingham Extended Activity of Daily Living Questionnaire and by collection of data concerning specialist and community health care services in a follow-up year.
After one year, no statistical significant differences in the level of daily function was found between group 1 (admissions to the community hospital) and group 2 (admissions to the general hospital). Group 1 had recorded fewer in-patient days at hospitals and nursing homes, as well as lower use of home nursing, than group 2. For outpatient referrals, the trend was the opposite. However, the differences between the two groups were not at a 5% level of statistical significance.
No statistical significant differences at a 5% level were found related to health consequences between the two randomized groups. The study however, indicates a consistent trend of health benefits rather than risk from acute admissions to a community hospital, as compared to the general hospital. Emergency admission and treatment at a lower-level facility than the hospital thus appears to be a feasible solution for a selected group of patients.
ClinicalTrials.gov NCT01069107 . Registered 2 April 2010.
To investigate medical students' self-assessments of their communication skills through medical school related to background factors, curriculum design and perceived medical school stress.
Medical students at all year levels attending Norwegian universities in the spring of 2003 were mailed the Oslo Inventory of Self-reported Communication Skills (OSISCS) developed by the authors. Of the total number of students (N=3055), 60% responded. One school had a traditional curriculum, the other three ran integrated models.
Students assessed their instrumental communication skills to increase linearly year by year, while the relational skills showed a curve-linear trajectory reaching the optimum level half-way into the curriculum. Students attending the traditional school reported lower levels of instrumental skills compared to the students from the integrated schools. In relational skills, a similar difference was maintained half-way into the curriculum, but disappeared towards the end. Perceived medical school stress correlated to the self-reported end point levels of the two types of communication skills.
The trajectories of self-reported instrumental and relational skills indicate significant variations in facilitating mechanisms between curricula, cognitive processing and perceived medical school stress.
Self-reported instrumental and relational communication skills develop differently in medical students over the years according to the type of curriculum.
Curricula should be evaluated for improvement implementations.
Communication training builds on the assumption that understanding of the concepts related to professional communication facilitates the training. We know little about whether students' knowledge of clinical communication skills is affected by their attendance of communication training courses, or to what degree other elements of the clinical training or curriculum design also play a role. The aim of this study was to determine which elements of the curriculum influence acquisition of knowledge regarding clinical communication skills by medical students.
The study design was a cross-sectional survey performed in the four Norwegian medical schools with different curricula, spring 2003. A self-administered questionnaire regarding knowledge of communication skills (an abridged version of van Dalen's paper-and-pencil test) was sent to all students attending the four medical schools. A total of 1801 (59%) students responded with complete questionnaires.
At the end of the 1st year of study, the score on the knowledge test was higher in students at the two schools running communication courses and providing early patient contact (mean 81%) than in the other two medical schools (mean 69-75%, P
Cites: Med Educ. 2002 Feb;36(2):108-911869435
Cites: Med Educ. 2002 Feb;36(2):125-3411869439
Cites: Med Educ. 2002 Feb;36(2):148-5311869442
Cites: Can J Neurol Sci. 2002 Jun;29 Suppl 2:S23-912139082
To test whether young physicians improve their communication skills between graduating from medical school and completing clinical internship, and to explore contributing background and/or internship factors.
Norwegian medical students graduating June 2004 were invited to take part in a videotaped standardized patient interview February 2004. Of the 111 students who originally participated, 62 completed a second interview February 2006. Observed communication skills were assessed with the Arizona Communication Interview Rating Scale (ACIR).
The level of communication skills increased significantly during the period for participants overall; and for females but not males. General social skills reached significantly higher levels than specific professional skills, both types of skill improving during the study. Independent predictors were working in local hospitals, learning atmosphere and low stress. At school completion, 50% reached a level defined as 'advanced beginner'. Towards the end of the internship, 58% reached 'capable' and 27% 'competent' levels of communication skills.
Female physicians improved most in communication skills, the gender difference being multivariate mediated through low stress levels and learning atmosphere. The findings support the division of communication skills into general social and specific professional skills.
The relatively low proportion of young physicians, especially males, developing the capability to practise independently at internship completion indicates a need for more effective training in communication skills, during both medical school and internship.
Medicine management in primary health care involves several participants: the prescribing physicians, various health care personnel involved in drug administration and patients with varying degrees of will and competence to be compliant. Many things can go wrong in this process, resulting in medication errors. This qualitative survey focuses on how information is transferred within primary healthcare and how prescription and administration of medicines are documented.
A random selection of GPs and medical secretaries in nine regular GP practices and a strategic selection of community nurses, personnel in nursing homes and emergency clinics and in hospital departments at the University Hospital of Northern Norway were interviewed in a semi-structured way during the spring of 2005. Observations were undertaken in both nursing homes and units for community nurses. Observations were logged, interviews taped, transcribed and the total material analysed.
Necessary information on medication was not easily accessible to health care personnel in charge of patient care. Obtaining the information was time-consuming and the quality was variable and perceived as unreliable. Five out of nine GPs regarded a pharmacy prescription to be sufficient information to community nurses regarding alterations in patient medication. GPs seldom signed prescriptions in the nurses' medication chart. Patient medication information was not present when needed. Community nurses on night duty therefore often did not know what drugs they were handing out during their home visits. Discharge notes from the hospitals were often delayed, they were not sent to community nurses and just three out of nine GPs updated their medication summaries when receiving such information.
There is a need for improved communication and handling of information related to patient medication in primary health care. Patients in an ambulatory setting, who are not in charge of their own medication, are especially vulnerable to failure.
We examine the conditions for trust relationships between patients and physicians. A trust relationship is not normally negotiated explicitly, but we wanted to discuss it with both patients and physicians. We therefore relied on a combination of interviews and observations. Sixteen patients and 8 family physicians in Norway participated in the study. We found that trust relationships were negotiated implicitly. Physicians were authorized by patients to exercise their judgment as medical doctors to varying degrees. We called this phenomenon the patient's mandate of trust to the physician. A mandate of trust limited to specific complaints was adequate for many medical procedures, but more open mandates of trust seemed necessary to ensure effective and humane treatment for patients with more complex and diffuse illnesses. More open mandates of trust were given if the physician showed an early interest in the patient, was sensitive, gave time, built alliances, or bracketed normal behavior.
BACKGROUND: This study investigates the assumption that the Norwegian population's use of Internet health services has an impact on health related attitudes and behaviour. MATERIAL AND METHODS: In 2000 and 2001, 1,006 and 1,018 subjects were randomly selected from the general population in Norway and interviewed over the telephone. In 2001, a web-based questionnaire was presented to 600 of a 2,800 member Internet panel who reported having used the Internet for health purposes; 79% responded. RESULTS: The proportion of Norwegians who use the Internet for health purposes increased from 19% in 2000 to 31% in 2001. The proportion of those wishing to use e-mail in interaction with their doctor increased from 30% to 45%. Based on information from the Internet, 33% of users in 2001 have asked their doctor specific questions; 11% have suggested a diagnosis, 21% have altered their diet and/or lifestyle; 10% have started with health products or programmes without consulting their doctor. 13% have experienced anxiety, while 48% have experienced relief. INTERPRETATION: Norwegians' use of the Internet appears to supplement rather than replace ordinary health services. Health personnel will need to respond to Internet-generated expectations and behaviour.
BACKGROUND: Nearly half of the Norwegian population claim that they would like to use the internet to communicate with their general practitioner. A web-based system complying with Norway's strict statutory requirements for the processing of personal data was developed and tested in an effort to assess the implications of this mode of communication. MATERIAL AND METHOD: The system was tested for one year in a group practice with six doctors. 200 patients were recruited and randomized into intervention and control groups. Data was collected through questionnaires, interviews and system logs. RESULTS: The 48 patients who used the system sent on average 3.3 messages, the six doctors sent between nine and 65 messages each. Traditional inquiries (visits, telephones) to the doctor averaged 3.2 and 4.5 for the intervention and control group respectively. 41% of the messages were inquiries about health issues, 22% were about renewals of prescriptions and sick leave notes, while 13% were requests for an appointment. Patients and doctors were both positive to this mode of communication. Patients who did not use the service said that they expected to use it in the future. INTERPRETATION: Electronic communication appears to replace some consultations and telephone inquiries. The study gives reason to expect that communication between patients and general practitioners over the internet will be more important in the future.
The introduction of information and communication technology (ICT) into the patient-doctor relationship represents a significant change in modern health care. Communication via computers-e-mediated communication-is affecting the context of patient-doctor interaction, touching core elements of the relationship. Based on data from a qualitative study conducted among Norwegian patients who had used ICT to communicate with their doctors, the authors argue that patients' use of ICT and the element of trust in the patient-doctor relationship influence each other. Furthermore, they contend that patients' constructions of trust in this relationship can be understood in light of basic mechanisms in modern society. The study sheds light on some potential concerns and benefits as communication technology increasingly is integrated into the patient-doctor relationship.