Over a period of two months in 1988 and 1989 general practitioners in the Norwegian county of Møre and Romsdal recorded all contacts with their patients. Participation was close to 100%. We report data from 10,850 surgery consultations with elderly patients (65 years and older). 60% of the consultations involved female patients, and 58% of the patients were 65-74 years old. New diagnoses were made in one-third of the cases; two-thirds were follow-ups. The most common groups of diagnoses were cardiovascular (28%), musculoskeletal (13%), psychiatric (8%) and respiratory diseases (8%). Almost 10% of all consultations were for hypertension. Drugs were prescribed in 45% of all cases. 27% of all prescriptions were for cardiovascular drugs, and 25% were for drugs for the nervous system. The 20 most common diagnoses made up more than half of the total number of diagnoses. Almost 70% of all prescriptions were for the ten most common therapeutic groups.
Over a period of two months in 1988 and 1989 all general practitioners in the Norwegian county of Møre and Romsdal recorded all contacts with their patients. We report data from 1,384 house calls to elderly patients (65 years and older). House calls made up 11.3% of all face-to-face contacts between general practitioners and elderly patients. 59% of the visits were to female patients, and 60% were to patients 75 years and older. 23% of the house calls took place during weekends, and new diagnoses were made in 58% of the cases. The most common groups of diagnoses were cardiovascular (21%), respiratory (16%), and musculoskeletal diseases (13%). Drugs were prescribed for 42% of the house calls. 28% of all drugs prescribed were for the nervous system, while 26% were antibiotics for systemic use. Most house calls were made because of acute illnesses. Our results suggest that preventive home visits to the elderly are rarely, if ever, performed in general practice.
Despite experiencing a disproportionate burden of acute and chronic health issues, many homeless people face barriers to primary health care. Most studies on health care access among homeless populations have been conducted in the United States, and relatively few are available from countries such as Canada that have a system of universal health insurance. We investigated access to primary health care among a representative sample of homeless adults in Toronto, Canada.
Homeless adults were recruited from shelter and meal programs in downtown Toronto between November 2006 and February 2007. Cross-sectional data were collected on demographic characteristics, health status, health determinants and access to health care. We used multivariable logistic regression analysis to investigate the association between having a family doctor as the usual source of health care (an indicator of access to primary care) and health status, proof of health insurance, and substance use after adjustment for demographic characteristics.
Of the 366 participants included in our study, 156 (43%) reported having a family doctor. After adjustment for potential confounders and covariates, we found that the odds of having a family doctor significantly decreased with every additional year spent homeless in the participant's lifetime (adjusted odds ratio [OR] 0.91, 95% confidence interval [CI] 0.86-0.97). Having a family doctor was significantly associated with being lesbian, gay, bisexual or transgendered (adjusted OR 2.70, 95% CI 1.04-7.00), having a health card (proof of health insurance coverage in the province of Ontario) (adjusted OR 2.80, 95% CI 1.61-4.89) and having a chronic medical condition (adjusted OR 1.91, 95% CI 1.03-3.53).
Less than half of the homeless people in Toronto who participated in our study reported having a family doctor. Not having a family doctor was associated with key indicators of health care access and health status, including increasing duration of homelessness, lack of proof of health insurance coverage and having a chronic medical condition. Increased efforts are needed to address the barriers to appropriate health care and good health that persist in this population despite the provision of health insurance.
OBJECTIVE: To study general practitioners' (GP) assessment of the probability of ischaemic heart disease (IHD) and GP action in daily practice regarding chest pain patients. METHODS: All chest pain patients aged 20-79 years, attending three primary health-care centres in south-east Sweden and assessed by the GP to have high, low or very low probability of IHD, were included consecutively over a two year period. The "GP action in daily practice" was classed as "active decisions" (investigation or treatment) or "wait and see". "IHD" or "not IHD" was settled according to the results of acute hospital investigation or exercise testing/myocardial perfusion scintigraphy. RESULTS: 516 patients were included, 93 high, 145 low and 278 very low probability cases. The outcome was "IHD" in 47%, 9% and 1% respectively. The sensitivity and specificity of the "GP assessment of the probability of IHD" were 72% and 89%. The sensitivity and specificity of the "GP action in daily practice" were 88% and 72%, respectively. The negative predictive value was 98%. CONCLUSION: GP assessment, after clinical evaluation, that the probability of IHD was low did not safely rule out IHD. GP action in daily practice however, indicates that general practice is an appropriate level of care for chest pain patients.
Acupuncture is the complementary treatment most commonly used by general practitioners. This study describes the use of acupuncture among Norwegian general practitioners trained in acupuncture.
By telephone or mail, a questionnaire was presented to 212 general practitioners who had completed training in complementary acupuncture. They were asked to describe the use and effect of acupuncture and their attitude towards acupuncture.
Of the 111 physicians who replied (53%), 67 (60%) used acupuncture in their clinical practice. 78% had acupuncture courses of less than four weeks' duration only. 52% stated that acupuncture was the preferred treatment in more than 5% of their patients. About 70-80% used acupuncture as a supplement to conventional treatment. Acupuncture was commonly used in patients with musculoskeletal pain (93%), migraine (66%), and headache (63%), less often in patients with nausea, allergy, anxiety, sleep disturbances and gastrointestinal disorders. Improvement was reported in approximately three out of four patients. Lack of time was regarded as the major limitation to the use of acupuncture.
Many general practitioners trained in complementary acupuncture use acupuncture as an integrated part of their clinical practice.
Psychopathology is the main risk factor for adolescent suicide but several studies have shown that only a small proportion of suicide victims receive mental health care during the months preceding their suicide. The goal of this study is to describe the utilization of medical services by Quebec adolescent suicide victims during the year preceding their suicide.
All suicides of persons aged 19 or less that occurred during a five-year period were retrieved from the Quebec Coroner's database. Corresponding medical services utilization data were retrieved from the Quebec physician payment database (RAMQ) and the Quebec hospitalization database (MED-ECHO). Data were analyzed in terms of types and intensity of medical services (physical or psychiatric), types of providers (general practitioners, psychiatrists, and other medical specialists), and timing of interventions relative to the date of suicide.
78% of all Quebec adolescent suicide victims utilized medical services during the year before their suicide. However, only 12% of all victims received medical attention for psychiatric problems, and only 9.9% met with a psychiatrist during that same period of time. General practitioners and non-psychiatric medical specialists provided medical attention for psychiatric problems to only 5.6% and 0.7% of those future suicide victims with whom they met in outpatient settings, and the intensity of their interventions was low.
These results suggest that the level of recognition and treatment of psychopathology in Quebec adolescents who later commit suicide is low, despite the fact that a large proportion of them meet with physicians during the year preceding their suicide. This suggests that information and training programs pertaining to adolescent suicide and psychopathology should be implemented for GPs and non-psychiatric medical specialists as well.
To determine family physicians' availability to their general practice patients after hours and to explore the characteristics and determinants of after-hours services.
Secondary analysis of the 2001 National Family Physician Workforce Survey.
Canadian family physicians and general practitioners currently in practice (n = 10,553).
Provision of after-hours care, defined as providing care to all practice patients outside of normal office hours.
Sixty-two percent of Canadian family physicians reported providing after-hours service. The lowest rates were found in Quebec (34%) and the highest in Alberta and Saskatchewan (88%). Respondents practising in academic and community clinics, offering selective medical services (emergency care, palliative care, housecalls, after-hours care), or living outside of Ontario or Quebec were more likely to provide after-hours care. Women physicians, those practising in walk-in clinics, or physicians primarily paid by fee-for-service were less likely to do so. Urban versus rural location, organization of practice (solo or group), age of physician, country of graduation, and physician satisfaction were not found to significantly affect the likelihood of providing after-hours services.
Knowledge of these factors can be used to inform policy development for after-hours service arrangements, which is particularly relevant today, given provincial governments' interests in exploring alternative payment plans and primary care reform options.
Cites: Can Fam Physician. 1997 Jul;43:1235-99241461
Anxiety and depression in Swedish primary care has rarely been studied. A national sample of 131 primary care physicians and their 1,348 patients during one day in September 2001 responded to questionnaires on somatic disease, social conditions, treatments, and symptoms of anxiety and depression. A total of 23% of the patients had generalized anxiety and/or depression with or without receiving treatment, i.e. the most common category following musculoskeletal conditions. The appointment was caused by anxiety in 7.1% of the patients, depression in 8.5%, and insomnia in 11%. This group of patients did not deviate much in terms of somatic and social conditions, except being younger. Doctors were confident in diagnosing and treating them. Five key questions can be used in primary care to screen for these common psychiatric conditions.
Comment In: Lakartidningen. 2003 Jun 5;100(23):2080-212833748
Comment In: Lakartidningen. 2003 Mar 27;100(13):116912705167
The objective of this study is to describe patients who had treatment for hypersensitivity illnesses by general practitioners (GPs) or classical homeopaths (CHs) and the patients' self-reported effectiveness of the treatment received. The data stems from an exploratory retrospective study amongst 88 Danish patients (response rate 58%) suffering from hypersensitivity illnesses, who chose treatment from one of six GPs or one of 10 CHs who participated in the project. The patients themselves selected their treatment. The GPs or the CHs considered that the patient's treatment was complete or that the patient was in a situation of current 'maintenance treatment'. The patients' primary reason for consulting the GP or the CH was that they were suffering from hypersensitivity illnesses. No significant difference was found between the two groups of patients in relation to age, education and duration of hypersensitivity symptoms. The CH patients were more likely to be employed in teaching, research, health care or the social sector compared to GP patients. The two groups of patients were similar in respect of their health at the start of the treatment, 57% of the patients who consulted a CH experienced an improvement of their state of health compared to 24% of the GP patients. Both groups of patients experienced an improvement of their psychological health after treatment. Logistic regression analysis showed that the GP or CH was the only significant effect variable. The results are based on the patients' retrospective, self-reported effectiveness of the treatments.