BACKGROUND: Few studies have addressed physicians' home calls in Norway. The aim of this study is to analyse home calls during daytime in Oslo in relation to patients (age, sex, district), diagnoses, request procedures, and clinical outcome. METHODS AND MATERIAL: General practitioners in the City of Oslo emergency medical centre recorded their home calls during three months using a standardised form. RESULTS: Calls to 337 patients (mean age 70, median 77 years; two thirds females; seven to children below two years of age) were recorded. The home calls were requested by relatives (36%), the patients themselves (32%), community care nurses (11%), and nursing homes (7%). The assessments made by the operators of the medical emergency telephone were generally correct. Physicians reported 77% full and 20% partial match between reported and found medical problem. The physicians assessed that 22% of the patients would have been able to go and see a doctor. 39% of all patients were admitted to hospital, 34 % needed ambulance transportation. The admitting GPs received hospital reports only after 27% of admissions. INTERPRETATION: Access to acute home calls by a physician during daytime is a necessary function in an urban public health service.
A journey has been made through Norwegian literature of the last century for the purpose of presenting to the readers of this journal what is to be found of literature describing doctors. The purpose was also to find literary interpretations of the historical evolution of the doctor's role. A characteristic common to all the doctors in the study is that they all suffer from various personal problems such as neuroses, drug abuse, overindulgence in alcohol, family problems, loneliness, maltreatment of children, suicide or murder. A closer study of the description of six local doctors shows small changes in work structure and social relations during the century, but more popular behaviour is found in the portrayal of more modern characters. Good and rich portraits of doctors in Norwegian literature are rare. Those that are found have been created to describe personal or social problems rather than to tell especially what it is like to be a doctor.
Acceptance of guideline recommendations and perceived implementation of coronary heart disease prevention among primary care physicians in five European countries: the Reassessing European Attitudes about Cardiovascular Treatment (REACT) survey.
Division of Primary Care, Public and Occupational Health, Department of Primary Care and General Practice, University of Birmingham, Edgbaston, UK. f.d.r.hobbs@bham.ac.uk
BACKGROUND: Although primary care is the major target of coronary heart disease (CHD) clinical recommendations, little is known of how community physicians view guidelines and their implementation. The REACT survey was designed to assess the views, and perceived implementation, of CHD and lipid treatment guidelines among primary care physicians. METHODS: Semi-structured validated telephone interviews were conducted, in the relevant native tongue, with 754 randomly selected primary care physicians (GPs and family doctors) in five European countries (France, Germany, Italy, Sweden and the UK). RESULTS: Most physicians (89%) agreed with the content of current guidelines and reported use of them (81%). However, only 18% of physicians believed that guidelines were being implemented to a major extent. Key barriers to greater implementation of guidelines were seen as lack of time (38% of all physicians), prescription costs (30%), and patient compliance (17%). Suggestions for ways to improve implementation centred on more education, both for physicians themselves (29%) and patients (25%); promoting, publicizing or increasing guideline availability (23%); simplifying the guidelines (17%); and making them clearer (12%). Physicians perceived diabetes to be the most important risk factor for CHD, followed by hypertension and raised LDL-C. Most physicians (92%) believe their patients do associate high cholesterol levels with CHD. After establishing that a patient is 'at risk' of CHD, physicians reported spending an average of 16.5 minutes discussing risk factors and lifestyle changes or treatment that is required. Factors preventing this included insufficient time (42%), having too many other patients to see (27%) and feeling that patients did not listen or understand anyway (21%). CONCLUSIONS: Primary care physicians need more information and support on the implementation of CHD and cholesterol guideline recommendations. This need is recognized by clinicians.
Physical and occupational therapy are beneficial for persons with chronic arthritis; however, access is problematic. The goal was to examine issues related to access to these services for patients with chronic arthritis.
We used two data sources: 1) questionnaires sent to a random sample of 600 family physicians and to all 85 rheumatologists in the province of Quebec; and 2) interviews of 211 patients with physician-confirmed chronic arthritis recruited from 34 primary care settings in Quebec.
Only 11.5% of family physicians and 31.7% of rheumatologists referred patients with rheumatoid arthritis (RA) to rehabilitation, whereas 60.4% of family doctors referred patients with osteoarthritis. Only 26.1% of patients felt that they required rehabilitation and this was associated with lower self-efficacy (OR: 0.84, 95% CI: 0.72, 0.99) and higher educational level (OR: 2.10, 95% CI: 1.01, 4.36).
Family physicians are less likely to refer patients with RA to therapy. Only about a quarter of patients with chronic arthritis treated in primary care perceived the need for these services. Efforts to improve arthritis care should address education of physicians and patients regarding the benefits of rehabilitation and there should be efforts to increase therapy resources in order to enhance access.
BACKGROUND: In 2002 the Norwegian Board of Health made a survey of the accessibility of general practitioners in Troms county in North Norway. MATERIAL AND METHODS: In a telephone interview one secretary in each surgery informed about telephone response time, planned time for telephone consultations, recorded numbers of urgent consultations, and waiting time to obtain a routine consultation. RESULTS: On average, the planned telephone time was two hours per week. Telephone time was in inverse proportion to the number of patients on the doctor's list. Rural doctors spent twice as much time as urban colleagues on the telephone with their patients. Doctors with lists between 500 and 1500 patients had a higher proportion of urgent consultations compared with doctors with shorter or longer lists. INTERPRETATION: Telephone response time below two minutes and waiting times for routine consultations below 20 days appear to be within acceptable norms. When patient lists are above 1500, doctors' capacity to offer telephone contact and emergency services to their patients seems reduced.
This paper analyses the impact of economic conditions and access to primary health care on health outcomes in Norway. Total mortality rates, grouped into four causes of death, were used as proxies for health, and the number of general practitioners (GPs) at the municipality level was used as the proxy for access to primary health care. Dynamic panel data models that allow for time persistence in mortality rates, incorporate municipal fixed effects, and treat both the number and types of GPs in a district as endogenous were estimated using municipality data from 1986 to 2001. We reject the significant relationship between mortality and the number of GPs per capita found in most previous studies. However, there is a significant effect of the composition of GPs, where an increase in the number of contracted GPs reduces mortality rates when compared with GPs employed directly by the municipality.
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.
