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Barriers and facilitators for guideline adherence in diagnostic imaging: an explorative study of GPs' and radiologists' perspectives.

https://arctichealth.org/en/permalink/ahliterature298054
Source
BMC Health Serv Res. 2018 07 16; 18(1):556
Publication Type
Journal Article
Date
07-16-2018
Author
Ann Mari Gransjøen
Siri Wiig
Kristin Bakke Lysdahl
Bjørn Morten Hofmann
Author Affiliation
Department of Health sciences in Gjøvik, Norwegian University of Science and Technology in Gjøvik (NTNU), Teknologiveien 22, 2815, Gjøvik, Norway. ann.gransjoen@ntnu.no.
Source
BMC Health Serv Res. 2018 07 16; 18(1):556
Date
07-16-2018
Language
English
Publication Type
Journal Article
Keywords
Adult
Attitude of Health Personnel
Diagnostic Imaging - standards
Female
General Practitioners - standards
Guideline Adherence - standards
Humans
Male
Middle Aged
Norway
Perception
Practice Guidelines as Topic - standards
Practice Patterns, Physicians' - standards
Radiologists - standards
Abstract
Diagnostic imaging has been a part of medicine for the last century. It has been difficult to implement guidelines in this field, and unwarranted imaging has been a frequent problem. Some work has been done to explain these phenomena separately. Identifying the barriers to and facilitators of guideline use has been one strategy. The aim of this study is to offer a more comprehensive explanation of deviations from the guideline by studying the two phenomena together.
Eight general practitioners and 10 radiologists from two counties in Norway agreed to semi-structured interviews. Topics covered in the interviews were knowledge of the guideline, barriers to and facilitators of guideline use, implementation of guidelines and factors that influence unwarranted imaging.
Several barriers to and facilitators of guideline use were identified. Among these are lack of time, pressure from patients, and guidelines being too long, rigid or unclear. Facilitators of guideline use were easy accessibility and having the guidelines adapted to the target group. Some of the factors that influence unwarranted imaging are lack of time, pressure from patients and availability of imaging services.
There are similarities between the perceived barriers for guideline adherence and the perceived factors that influence unwarranted imaging. There may be a few reasons that explains the deviation from guidelines, and the amount of unwarranted imaging.
PubMed ID
30012130 View in PubMed
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Changed terms for drug payment influenced GPs' diagnoses and prescribing practice for inhaled corticosteroids.

https://arctichealth.org/en/permalink/ahliterature114954
Source
Eur J Gen Pract. 2013 Jun;19(2):106-10
Publication Type
Article
Date
Jun-2013
Author
Lene G Dalbak
Sture Rognstad
Hasse Melbye
Jørund Straand
Author Affiliation
Department of General Practice, Institute of Health and Society, University of Oslo, 0318 Oslo, Norway. l.g.dalbak@medisin.uio.no
Source
Eur J Gen Pract. 2013 Jun;19(2):106-10
Date
Jun-2013
Language
English
Publication Type
Article
Keywords
Administration, Inhalation
Aged
Aged, 80 and over
Asthma - diagnosis - drug therapy
Drug Costs
Female
General Practitioners - standards - statistics & numerical data
Glucocorticoids - administration & dosage - economics - therapeutic use
Humans
Male
Middle Aged
Norway
Physician's Practice Patterns - standards - statistics & numerical data
Pulmonary Disease, Chronic Obstructive - diagnosis - drug therapy - physiopathology
Reimbursement Mechanisms
Severity of Illness Index
Spirometry - methods
Abstract
Inhaled glucocorticosteroids (ICS) are first-line anti-inflammatory treatment in asthma, but not in chronic obstructive pulmonary disease (COPD). To restrict ICS use in COPD to cases of severe disease, new terms for reimbursement of drug costs were introduced in Norway in 2006, requiring a diagnosis of COPD to be verified by spirometry.
To describe how GPs' diagnoses and treatment of patients who used ICS before 2006 changed after a reassessment of the patients that included spirometry.
From the shared electronic patient record system in one group practice, patients = 50 years prescribed ICS (including in combination with long-acting beta2-agonists) during the previous year were identified and invited to a tailored consultation including spirometry to assure the quality of diagnosis and treatment. GPs' diagnoses and ICS prescribing patterns after this reassessment were recorded, retrospectively.
Of 164 patients identified, 112 were included. Post-bronchodilator spirometry showed airflow limitation indicating COPD in 55 patients. Of the 57 remaining patients, five had a positive reversibility test. The number of patients diagnosed with asthma increased (from 25 to 62) after the reassessment. A diagnosis of COPD was also more frequently used, whereas fewer patients had other pulmonary diagnoses. ICS was discontinued in 31 patients; 20 with mild to moderate COPD and 11 with normal spirometry.
Altered reimbursement terms for ICS changed GPs' diagnostic practice in a way that made the diagnoses better fit with the treatment given, but over-diagnosis of asthma could not be excluded. Spirometry was useful for identifying ICS overuse.
Notes
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PubMed ID
23560809 View in PubMed
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Characteristics of complaints resulting in disciplinary actions against Danish GPs.

https://arctichealth.org/en/permalink/ahliterature108313
Source
Scand J Prim Health Care. 2013 Sep;31(3):153-7
Publication Type
Article
Date
Sep-2013
Author
Søren Birkeland
Rene Depont Christensen
Niels Damsbo
Jakob Kragstrup
Author Affiliation
Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark. sbirkeland@health.sdu.dk
Source
Scand J Prim Health Care. 2013 Sep;31(3):153-7
Date
Sep-2013
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Child
Child, Preschool
Communication
Denmark
Dissent and Disputes
Employee Discipline - trends
Female
General Practitioners - standards
Humans
Infant
Infant, Newborn
Jurisprudence
Male
Middle Aged
Patient satisfaction
Young Adult
Abstract
The risk of being disciplined in connection with a complaint case causes distress to most general practitioners. The present study examined the characteristics of complaint cases resulting in disciplinary action.
The Danish Patients' Complaints Board's decisions concerning general practice in 2007 were examined. Information on the motives for complaining, as well as patient and general practitioner characteristics, was extracted and the association with case outcome (disciplinary or no disciplinary action) was analysed. Variables included complaint motives, patient gender and age, urgency of illness, cancer diagnosis, healthcare settings (daytime or out-of-hours services), and general practitioner gender and professional seniority.
Cases where the complaint motives involved a wish for placement of responsibility (OR = 2.35, p = 0.01) or a wish for a review of the general practitioner's competence (OR = 1.95, p = 0.02) were associated with increased odds of the general practitioner being disciplined. The odds of discipline decreased when the complaint was motivated by a feeling of being devalued (OR = 0.39, p = 0.02) or a request for an explanation (OR = 0.46, p = 0.01). With regard to patient and general practitioner characteristics, higher general practitioner professional seniority was associated with increased odds of discipline (OR = 1.97 per 20 additional years of professional seniority, p = 0.01). None of the other characteristics was statistically significantly associated with discipline in the multiple logistic regression model.
Complaint motives and professional seniority were associated with decision outcomes. Further research is needed on the impact of professional seniority on performance.
Notes
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PubMed ID
23906082 View in PubMed
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General Practitioners' coronary risk estimates, decisions to start lipid-lowering treatment, gender and length of clinical experience: their interactions in primary prevention.

https://arctichealth.org/en/permalink/ahliterature116866
Source
Prim Health Care Res Dev. 2013 Oct;14(4):394-402
Publication Type
Article
Date
Oct-2013
Author
Federico Vancheri
Lars-Erik Strender
Lars G Backlund
Author Affiliation
Internal Medicine, Ospedale S Elia, Caltanissetta, Sicily, Italy. federico.vancheri@ki.se
Source
Prim Health Care Res Dev. 2013 Oct;14(4):394-402
Date
Oct-2013
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Aged
Coronary Disease - drug therapy - etiology - prevention & control
Cross-Sectional Studies
Decision Making
Female
General Practitioners - standards - statistics & numerical data
Humans
Hypolipidemic Agents - therapeutic use
Linear Models
Logistic Models
Male
Middle Aged
Physician's Practice Patterns - statistics & numerical data
Primary Prevention - methods - statistics & numerical data
Questionnaires
Risk Assessment - methods
Sex Factors
Sweden
Abstract
We investigated whether the risk estimates of General Practitioners (GPs) and their treatment decisions mutually influence each other and whether factors not related to the patient's risk, such as the gender and length in clinical practice, interact.
The quantitative assessment of the absolute risk of developing coronary heart disease (CHD) and the decision to start treatment with lipid-lowering drugs are crucial tasks in the primary prevention of CHD.
Nine clinical vignettes, four rated high-risk and five rated low-risk according to the Framingham equation, were mailed to three groups of 90 randomly selected GPs in Stockholm. One group (R) was asked to estimate the risk of CHD within 10 years on a visual analogue scale. A second group (R1D) was asked to estimate the risk and to specify whether they would recommend a pharmacological lipid-lowering treatment. A third group (D) only to indicate whether they would recommend treatment.
Response rate ranged from 42.2% to 45.6%. The median risk estimates were higher in the R group than in the R1D group (difference not statistically significant). R1D group showed higher proportions of correct decisions to start treatment compared with the R group (86.2% versus 77.5%, P50.19). More correct decisions were made by female doctors (OR 1.77, 95% CI 1.19-2.61, P50.004) and by less experienced doctors (OR 0.97, 95% CI 0.95-0.99, P50.016).
The task of making CHD risk estimates and the task of making decisions whether to start lipid-lowering treatment do not seem to influence each other. The gender of physicians and the length of clinical experience seem to affect treatment decisions. Female GPs and less experienced GPs are more likely to make correct decisions. However, the relatively low response rate to the questionnaires may limit the generalizability of these results.
PubMed ID
23351666 View in PubMed
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General practitioners' use of ICPC diagnoses and their correspondence with patient record notes.

https://arctichealth.org/en/permalink/ahliterature308514
Source
Tidsskr Nor Laegeforen. 2019 Oct 22; 139(15):
Publication Type
Journal Article
Date
Oct-22-2019
Author
Geir Lindquist Sporaland
Gunnar Mouland
Bjørn Bratland
Ellen Rygh
Harald Reiso
Source
Tidsskr Nor Laegeforen. 2019 Oct 22; 139(15):
Date
Oct-22-2019
Language
Norwegian
English
Publication Type
Journal Article
Keywords
General Practitioners - standards
Humans
International Classification of Diseases
Medical Records - standards
Norway
Office Visits
Practice Patterns, Physicians' - standards
Primary Health Care - classification
Referral and Consultation - classification
Abstract
The quality of the general practitioners' setting of diagnoses using codes from the International Classification for Primary Care (ICPC) is important, because these codes are used for purposes of quality development, research and public health statistics. It is uncertain, however, to what extent these diagnoses present a correct picture of the content of and reasons for the consultations and the prevalence of illness in the population. The objective of this study was to identify the extent to which the general practitioners' use of diagnostic codes correlates with the content of the patient record notes.
A total of 23 general practitioners from five different medical centres in Agder county participated in the study. The patient record notes from all patient contacts over two working days in 2013 were reviewed by two experienced general practitioners who assessed the degree of correspondence between the content of the patient record notes and the concomitant ICPC diagnostic codes.
A total of 1 819 patient contact were assessed, and for 1 591 of these (87.5 %) it was possible to assess the correspondence between the patient record notes and the diagnosis. We found good correspondence for 693 (85.3 %) consultations and 321 (69.9 %) simple contacts with issuance of a prescription. For simple contacts with no issuance of a prescription there was good correspondence for 213 (83.9 %), although 144 of a total of 398 (36.2 %) could not be assessed because the patient record notes were absent, too brief or imprecise.
The diagnoses made during consultations corresponded well with the patient record notes examined in this study. The results may indicate that caution should be exercised in including simple contacts in the data on diagnoses in public statistics. The findings should be followed up in larger-scale and more representative national studies.
PubMed ID
31642635 View in PubMed
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General practitioners' use of sickness certification guidelines in Sweden at introduction and four years later: a survey study.

https://arctichealth.org/en/permalink/ahliterature296018
Source
Int J Qual Health Care. 2018 Jul 01; 30(6):429-436
Publication Type
Journal Article
Date
Jul-01-2018
Author
Catharina Gustavsson
Elin Hinas
Therese Ljungquist
Kristina Alexanderson
Author Affiliation
Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
Source
Int J Qual Health Care. 2018 Jul 01; 30(6):429-436
Date
Jul-01-2018
Language
English
Publication Type
Journal Article
Keywords
Adult
Aged
Cross-Sectional Studies
Female
General Practitioners - standards
Guidelines as Topic
Humans
Male
Middle Aged
Physician-Patient Relations
Sick Leave
Surveys and Questionnaires
Sweden
Work Capacity Evaluation
Abstract
National sickness certification guidelines were introduced in Sweden in 2007, comprising both overarching and diagnoses-specific recommendations. This study aimed to investigate how general practitioners (GP) used and perceived the usefulness of these guidelines in the sickness certification process close after introduction and 4 years later.
Two nationwide cross-sectional surveys in 2008 and 2012.
Swedish healthcare.
Physicians working in primary healthcare and having sickness certification consultations at least a few times per year (n = 4214 in 2008, and n = 4067 in 2012).
Frequency of use and perceived usefulness of the sickness certification guidelines.
Most GPs used the guidelines at least a few times per year (in 2008 74.6%; in 2012 85.2%). In 2008, 44.1% reported a need to develop competence in using the guidelines, compared with 23.3% in 2012. Of those using the guidelines, 36.7% in 2008 and 44.6% in 2012 reported it problematic to write sickness certificates in accordance with the guidelines. Most GPs (89.2% in 2008 and 88.8% in 2012) valued the guidelines beneficial to ensure quality in sickness certification consultations. A larger proportion in 2012 compared with 2008 reported that the guidelines facilitated contacts with patients (61.2%, respectively, 55.6%), as well as with other stakeholders.
The guidelines were perceived as useful and beneficial to ensure high quality in sickness certification consultations, and facilitated contacts with patients as well as other stakeholders. In 2012, still one-fourth reported a need to develop more competence in using the sickness certification guidelines.
PubMed ID
29590398 View in PubMed
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Guideline adherence of antithrombotic treatment initiated by general practitioners in patients with nonvalvular atrial fibrillation: a Danish survey.

https://arctichealth.org/en/permalink/ahliterature113927
Source
Clin Cardiol. 2013 Jul;36(7):427-32
Publication Type
Article
Date
Jul-2013
Author
Axel Brandes
Mikkel Overgaard
Liane Plauborg
Christian Dehlendorff
Frede Lyck
Jørgen Peulicke
Søren Vinther Poulsen
Steen Husted
Author Affiliation
Department of Cardiology, Odense University Hospital, Odense, Denmark. axel.brandes@rsyd.dk
Source
Clin Cardiol. 2013 Jul;36(7):427-32
Date
Jul-2013
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Anticoagulants - therapeutic use
Atrial Fibrillation - complications - diagnosis - drug therapy
Chi-Square Distribution
Cross-Sectional Studies
Denmark
Drug Utilization Review
Female
Fibrinolytic Agents - therapeutic use
General Practitioners - standards
Guideline Adherence - standards
Health Care Surveys
Humans
Male
Middle Aged
Physician's Practice Patterns - standards
Platelet Aggregation Inhibitors - therapeutic use
Practice Guidelines as Topic - standards
Primary Health Care - standards
Prospective Studies
Risk assessment
Risk factors
Stroke - etiology - prevention & control
Abstract
The aim of this prospective survey was to describe the demographics, stroke risk profile, and the guideline adherence of antithrombotic treatment in a Danish primary care population of patients with nonvalvular atrial fibrillation (AF).
We hypothesized that a significant proportion of patients with nonvalvular AF do not receive guideline-adherent antithrombotic treatment in primary care.
We performed a cross-sectional survey of antithrombotic treatment using data of AF patients from general practices.
Sixty-four general practitioners enrolled 1743 patients with a mean age of 74.8?±?11.2 years. The mean CHADS2 and CHA2 DS2 -VASc scores were 1.9?±?1.3 and 3.5?±?1.8, respectively. Of the patients, 12.4% and 4.04%, respectively, were at truly low risk, with a CHADS2 and CHA2 DS2 -VASc score 0 (P
PubMed ID
23670894 View in PubMed
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High diagnostic value of general practitioners' presumptive diagnosis for pyelonephritis, meningitis and pancreatitis.

https://arctichealth.org/en/permalink/ahliterature276572
Source
Dan Med J. 2016 Jan;63(1):A5181
Publication Type
Article
Date
Jan-2016
Author
Srishamanthi Sriskandarajah
Rasmus Carter-Storch
Ulrik Frydkjær-Olsen
Christian Backer Mogensen
Source
Dan Med J. 2016 Jan;63(1):A5181
Date
Jan-2016
Language
English
Publication Type
Article
Keywords
Continuity of Patient Care - organization & administration - standards
Denmark
Early Diagnosis
Emergency Service, Hospital - statistics & numerical data
Female
General Practice - methods - statistics & numerical data
General Practitioners - standards
Humans
Likelihood Functions
Male
Meningitis - diagnosis
Middle Aged
Pancreatitis - diagnosis
Predictive value of tests
Pyelonephritis - diagnosis
Referral and Consultation - organization & administration - statistics & numerical data
Sensitivity and specificity
Abstract
In Denmark, patients referred from the general practitioner (GP) to the emergency department (ED) can be referred with either specific symptoms or with a presumptive diagnosis. The aim of the present study was to evaluate the diagnostic accuracy for various presumptive diagnoses made by the GP in a population acutely referred to an ED.
This was a retrospective cohort study of all registered acute referrals for admission to Kolding ED in 2010. Eight presumptive diagnoses were selected for further studies: meningitis, acute coronary syndrome (ACS), pulmonary embolism, pneumonia, pancreatitis, deep venous thrombosis (DVT), pyelonephritis and intestinal obstruction. The presumptive diagnoses were compared with the final diagnosis on discharge. Sensitivity, specificity, predictive values and likelihood ratios were calculated.
A total of 8,841 patients were enrolled. The highest and lowest sensitivities were seen for DVT (90%) and meningitis (36%), respectively; and the highest and lowest values for specificity were observed for meningitis (99%) and ACS (30%), respectively. The positive predictive value had a wide range with the lowest value for ACS (9%) and the highest for pneumonia (59%). For pyelonephritis, meningitis and pancreatitis, the likelihood ratio of a positive test was above 10. The likelihood ratio of a negative test was above 0.1 for all diagnoses.
Patients referred with the presumptive diagnoses pyelonephritis, meningitis and pancreatitis had a high likelihood of having the disease in question. It is important not to discard any of the included presumptive diagnoses even if the GPs fail to suggest them on admission.
none.
PubMed ID
26726904 View in PubMed
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"I'm Dr Jekyll and Mr Hyde": are GPs' antibiotic prescribing patterns contextually dependent? A qualitative focus group study.

https://arctichealth.org/en/permalink/ahliterature108072
Source
Scand J Prim Health Care. 2013 Sep;31(3):158-65
Publication Type
Article
Date
Sep-2013
Author
Eva Lena Strandberg
Annika Brorsson
Charlotta Hagstam
Margareta Troein
Katarina Hedin
Author Affiliation
Department of Clinical Sciences, Lund University, Malmö, Sweden. eva-lena.strandberg@med.lu.se
Source
Scand J Prim Health Care. 2013 Sep;31(3):158-65
Date
Sep-2013
Language
English
Publication Type
Article
Keywords
Adult
Anti-Bacterial Agents - therapeutic use
Female
Focus Groups
General Practitioners - standards
Humans
Male
Physician's Practice Patterns
Physician-Patient Relations
Primary Health Care
Professional Autonomy
Qualitative Research
Referral and Consultation
Respiratory Tract Infections - drug therapy
Sweden
Young Adult
Abstract
To explore factors and circumstances contributing to prudent antibiotic prescribing for respiratory tract infections in primary care.
Two focus groups representing rural and urban areas. A semi-structured interview guide with open-ended questions and an editing analysis style was used. They were examined to identify meaning units that were sorted into categories in an iterative process throughout the analysis.
Primary health care in two counties in southern Sweden.
Two groups including seven and six general practitioners (GPs) respectively, men and women of different ages with different professional experiences.
Exploration of categories, determination of themes, construction of models.
The decision to prescribe antibiotics takes place in the encounter between GP and patient, initially characterized by harmony or fight and the subsequent process by collaboration or negotiation, resulting in agreement, compromise, or disagreement. Several factors influence the meeting and contribute to enhancing the conditions for rational prescribing. These conditions are connected to the GP, the relationship, and the setting; organization as well as professional culture. The findings indicate synergies between the factors, and that one factor can sometimes compensate for lack of another. Continuity and mutual trust can make a brief consultation successful, but lack of continuity can eliminate the effects of knowledge and professional skills.
The findings emphasize the importance of the encounter between the GP and the patient for prudent antibiotic prescribing. Furthermore, the importance of an appropriate organization of primary care, which promotes continuity and encourages professional autonomy, is demonstrated.
Notes
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PubMed ID
23941086 View in PubMed
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Point-of-care testing with CRP in primary care: a registry-based observational study from Norway.

https://arctichealth.org/en/permalink/ahliterature275201
Source
BMC Fam Pract. 2015;16:170
Publication Type
Article
Date
2015
Author
Ingrid K Rebnord
Steinar Hunskaar
Sturla Gjesdal
Øystein Hetlevik
Source
BMC Fam Pract. 2015;16:170
Date
2015
Language
English
Publication Type
Article
Keywords
Adult
After-Hours Care - methods
Cross-Sectional Studies
Family Practice - organization & administration
Female
General Practitioners - standards
Humans
Male
Middle Aged
Norway
Point-of-Care Testing - organization & administration
Primary Health Care - methods
Registries
Retrospective Studies
Abstract
Norwegian primary health care is maintained on the regular general practitioners (RGPs), GP's contracted to the municipalities in a list patient system, working at daytime and at out-of-hours services (OOH services). Respiratory disease is most prevalent during OOH services, and in more than 50 % of the consultations, a CRP test is performed. Children in particular have a high consultation rate, and the CRP test is frequently conducted, but the contributing factors behind its frequent use are not known. This study compares the RGPs rate of CRP use at daytime and OOH in consultations with children and how this rate is influenced by characteristics of the RGPs.
A cross-sectional register study was conducted based on all (N?=?2,552,600) electronic compensation claims from consultations with children?=?5 year during the period 2009-2011 from primary health care. Consultation rates and CRP use were estimated and analysed using descriptive methods. Being among the 20% of RGPs with the highest rate of CRP use at daytime or OOH was an outcome measure in regression analyses using RGP-, and RGP list characteristics as explanatory variables.
One third of all RGPs work regularly in OOH services, and they use CRP 1.42 times more frequently in consultations with children in OOH services than in daytime services even when the distribution of diagnosis according to ICPC-2 chapters is similar. Not being approved specialist, have a large number at their patient-lists but relatively few children on their list and a large number of consultations with children were significantly associated with frequent use of CRP in daytime services. The predictors for frequent CRP use in OOH services were being a young doctor, having many consultations with children during OOH and a frequent use of CRP in daytime services.
The increase in the frequency of CRP test use from daytime to OOH occurs in general for RGPs and for all most used diagnoses. The RGPs who use the CRP test most frequently in their daytime practice have the highest rate of CRP in OOH services.
Notes
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PubMed ID
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