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How primary health care physicians make sick listing decisions: the impact of medical factors and functioning.

https://arctichealth.org/en/permalink/ahliterature87362
Source
BMC Fam Pract. 2008;9:3
Publication Type
Article
Date
2008
Author
Norrmén Gunilla
Svärdsudd Kurt
Andersson Dan K G
Author Affiliation
Uppsala University, Department of Public Health and Caring Sciences, Family Medicine and Clinical Epidemiology Section, S-75185 Uppsala, Sweden. gunilla.norrmen@orebroll.se
Source
BMC Fam Pract. 2008;9:3
Date
2008
Language
English
Publication Type
Article
Keywords
Absenteeism
Adult
Attitude of Health Personnel
Cross-Sectional Studies
Decision Making
Educational Status
Employment - statistics & numerical data
Family Practice - methods
Female
Humans
Incidence
Male
Middle Aged
Multivariate Analysis
Physician's Practice Patterns
Primary Health Care - standards - trends
Questionnaires
Regression Analysis
Risk factors
Sick Leave - statistics & numerical data
Sickness Impact Profile
Socioeconomic Factors
Sweden
Work Capacity Evaluation
Abstract
BACKGROUND: The decision to issue sickness certification in Sweden for a patient should be based on the physician's assessment of the reduction of the patient's work capacity due to a disease or injury, not on psychosocial factors, in spite of the fact that they are known as risk factors for sickness absence. The aim of this study was to investigate the influence of medical factors and functioning on sick listing probability. METHODS: Four hundred and seventy-four patient-physician consultations, where sick listing could be an option, in general practice in Orebro county, central Sweden, were documented using physician and patient questionnaires. Information sought was the physicians' assessments of causes and consequences of the patients' complaints, potential to recover, diagnoses and prescriptions on sick leave, and the patients' view of their family and work situation and functioning as well as data on the patients' former and present health situation. The outcome measure was whether or not a sickness certificate was issued. Multivariate analyses were performed. RESULTS: Complaints entirely or mainly somatic as assessed by the physician decreased the risk of sick listing, and complaints resulting in severe limitation of occupational work capacity, as assessed by the patient as well as the physician, increased the risk of sick listing, as did appointments for locomotor complaints. The results for patients with infectious diseases or musculoskeletal diseases were partly similar to those for all diseases. CONCLUSION: The strongest predictors for sickness certification were patient's and GP's assessment of reduced work capacity, with a striking concordance between physician and patient on this assessment. When patient's complaints were judged to be non-somatic the risk of sickness certification was enhanced.
PubMed ID
18208594 View in PubMed
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Physician patient questionnaire to assess physician patient agreement at the consultation.

https://arctichealth.org/en/permalink/ahliterature87456
Source
Fam Pract. 2007 Oct;24(5):498-503
Publication Type
Article
Date
Oct-2007
Author
Ahlén G C
Mattsson B.
Gunnarsson R K
Author Affiliation
Home Care Unit, Primary Health Care, Göteborg, Sweden. gerd.carlsson.ahlen@vgregion.se
Source
Fam Pract. 2007 Oct;24(5):498-503
Date
Oct-2007
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Attitude of Health Personnel
Cross-Sectional Studies
Female
Humans
Male
Middle Aged
Patient satisfaction
Physician-Patient Relations
Primary Health Care - standards - statistics & numerical data
Process Assessment (Health Care)
Questionnaires
Reproducibility of Results
Sweden
Abstract
OBJECTIVE: The primary aim of this study was to validate an instrument of physician-patient agreement in the consultation. A secondary aim was to assess this agreement. METHOD: The setting was a county in the southwest of Sweden with a cross-sectional survey of primary care patients and physicians using separate coded questionnaires. Forty-six physicians and 316 patients aged 16 or more with a new complaint lasting 1 week or more. Thirteen items were evaluated and index of proportional agreement for the dichotomized answers agree (P(pos)) and disagree (P(neg)) was calculated. RESULTS: In 10 of the 13 items, a high level of agreement between physician and patient was seen. Discussion. Index of proportional agreement was useful in finding statements in a questionnaire on agreement for both physicians and patients that could be used for educational purposes and as a check-up for the GP in daily practice.
PubMed ID
17656632 View in PubMed
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An implementation study of the PDRD primary care computerized guidelines.

https://arctichealth.org/en/permalink/ahliterature204085
Source
Scand J Prim Health Care. 1998 Sep;16(3):149-53
Publication Type
Article
Date
Sep-1998
Author
J. Jousimaa
I. Kunnamo
M. Mäkelä
Author Affiliation
University of Kuopio, Department of Community Health and General Practice, Finland.
Source
Scand J Prim Health Care. 1998 Sep;16(3):149-53
Date
Sep-1998
Language
English
Publication Type
Article
Keywords
Adult
Attitude of Health Personnel
Computer User Training
Databases, Factual
Decision Support Systems, Clinical
Family Practice - education - standards
Female
Finland
Follow-Up Studies
Guideline Adherence
Humans
Male
Middle Aged
Practice Guidelines as Topic
Primary Health Care - standards
Questionnaires
Reference Books
Therapy, Computer-Assisted - organization & administration
Abstract
To study the implementation of electronic guidelines designed for general practitioners (GPs).
A descriptive 3-year follow-up study.
All new subscribers to Physician's Desk Reference and Database (PDRD) in 1992.
Locations of computers, where PDRD software was installed for the first time in 1992.
Expectations of the program and changes in attitudes towards it, getting started with the system, frequency and continuity of use and estimated usefulness of the program.
The guidelines were expected to enhance diagnostic accuracy (60% of subscribers), save time (45%), and reduce costs (11%). After 1 year's use, the opinions of the users on these topics had become slightly more positive. Technical problems delayed starting to use the program in 27%. After 1 year 72% were using the program at least weekly. Using frequency was associated with having the computer in the office. The subscribers who renewed their subscription after one year often became regular users.
The study provides insight into the implementation phase of computer-based guidelines in a population of early adopters. Technical support was essential to overcome the barriers associated with computer technology. The perceived need for information was independent of the age and experience of the physicians.
PubMed ID
9800227 View in PubMed
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Physicians' patterns of using a computerized collection of guidelines for primary care.

https://arctichealth.org/en/permalink/ahliterature204222
Source
Int J Technol Assess Health Care. 1998;14(3):484-93
Publication Type
Article
Date
1998
Author
J. Jousimaa
I. Kunnamo
M. Mäkelä
Author Affiliation
University of Kuopio.
Source
Int J Technol Assess Health Care. 1998;14(3):484-93
Date
1998
Language
English
Publication Type
Article
Keywords
Adult
Databases, Factual - utilization
Decision Support Systems, Clinical - statistics & numerical data - utilization
Female
Finland
Guideline Adherence
Health Services Research
Humans
Information Services
Male
Practice Guidelines as Topic
Primary Health Care - standards - statistics & numerical data
Questionnaires
Abstract
Physician's Desk Reference and Database is a Finnish collection of computerized primary care guidelines. The program has been in clinical use since 1989. For this study, a function producing a log file of all searches was added to the program. Two hundred twenty-seven users returned log files that contained 15,267 searches. The users made 3.12 (range 1-10.4) searches per day. The average time needed to find and read an article was 4.9 minutes. Sufficient facts were found in 71% of the searches. Dermatology was the most popular field of interest, followed by infectious diseases and cardiology.
PubMed ID
9780535 View in PubMed
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Use of and attitudes toward current care guidelines among primary and secondary care nurses in Finland.

https://arctichealth.org/en/permalink/ahliterature134623
Source
Clin Nurs Res. 2011 Aug;20(3):310-25
Publication Type
Article
Date
Aug-2011
Author
Risto Kuronen
Piia Jallinoja
Kristiina Patja
Author Affiliation
Joint Authority for Päijät-Häme Social and Health Care, Sykekatu, Lahti, Finland. risto.kuronen@fimnet.fi
Source
Clin Nurs Res. 2011 Aug;20(3):310-25
Date
Aug-2011
Language
English
Publication Type
Article
Keywords
Adult
Attitude of Health Personnel
Female
Finland
Follow-Up Studies
Guideline Adherence - statistics & numerical data
Humans
Hypertension - nursing
Male
Middle Aged
Nursing Evaluation Research
Nursing Staff, Hospital - education - psychology
Practice Guidelines as Topic
Primary Health Care - standards
Progressive Patient Care - standards
Abstract
Attitudes toward, familiarity with, and use of clinical guidelines in general and the national Hypertension Guideline were studied. A questionnaire study was conducted before and after an educational program (VALTIT) among primary and secondary care nurses in Päijät-Häme, Finland. The program included centralized training sessions and interactive local workshops. Prior to the program, a majority of nurses had a positive attitude toward guidelines but used guidelines seldom. Primary care nurses were better aware of the Hypertension Guideline than secondary care nurses, but the guideline was poorly used by both groups. At the follow-up, familiarity with the Hypertension Guideline and use of guidelines increased among primary care nurses. In future, primary care nurses will have a more autonomous role in patient care and should participate in clinical guideline development and related research. Our study has shown they are a potential target of such interventions.
PubMed ID
21558484 View in PubMed
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[Dissatisfied primary care patients in vulnerable areas goes to the hospital emergency department].

https://arctichealth.org/en/permalink/ahliterature104159
Source
Lakartidningen. 2014 May 27-Jun 10;111(22-23):1012-3
Publication Type
Article

Primary health care ICD--a tool for general practice research.

https://arctichealth.org/en/permalink/ahliterature197094
Source
Int J Health Plann Manage. 2000 Apr-Jun;15(2):133-48
Publication Type
Article
Author
H. Pärnänen
E. Kumpusalo
J. Takala
Author Affiliation
Kuopio University, Department of Public Health and General Practice, Finland.
Source
Int J Health Plann Manage. 2000 Apr-Jun;15(2):133-48
Language
English
Publication Type
Article
Keywords
Adult
Child
Clinical Competence
Data Collection
Diagnosis, Differential
Diagnosis-Related Groups - classification
Disease - classification
Family Practice - standards - statistics & numerical data
Female
Finland - epidemiology
Humans
Insurance, Health
Male
Medical Records - classification
Physician's Practice Patterns
Population Surveillance
Primary Health Care - standards - utilization
Referral and Consultation - statistics & numerical data
Abstract
The International Classification of Diseases (ICD) has become the only diagnostic classification system of international standard that allows reliable comparisons of epidemiological data between countries, parts of a country, levels of health care systems, or different periods of time. However, for primary health care purposes it is too specific to describe problems relevant to the work of general practitioners (GPs). Tools are thus needed to 'compress' data in primary health care for educational, administrative and research purposes. The objective of this paper was to introduce a diagnosis coding system that can be used in primary health care settings for these purposes. Principal diagnoses, as assessed by medical doctors, were collected from 20,648 patient visits. After primary coding, according to the ICD on a five-digit scale, the diagnoses were grouped into larger entities, which reduced the number of diagnoses to one eighth of the original number. The ten most common original five-digit diagnoses accounted for one quarter of all consultations, whereas the ten most common diagnoses counted for one half of all consultations after compressing the data into new categories. Analysing epidemiological data in the records of primary health care by the ICD offers benefits because of the latter's wide use. These are discussed below.
PubMed ID
11009947 View in PubMed
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Detection of tongue cancer in primary care.

https://arctichealth.org/en/permalink/ahliterature19990
Source
Br J Gen Pract. 2001 Feb;51(463):106-11
Publication Type
Article
Date
Feb-2001
Author
S. Kantola
K. Jokinen
K. Hyrynkangas
P. Mäntyselkä
O P Alho
Author Affiliation
Department of Oral and Maxillofacial Surgery, Oulu University Hospital, PO Box 5281, FIN-90014 University of Oulu, Finland. saara.kari@oulu.fi
Source
Br J Gen Pract. 2001 Feb;51(463):106-11
Date
Feb-2001
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Female
Finland - epidemiology
Humans
Male
Middle Aged
Prevalence
Primary Health Care - standards
Prognosis
Tongue Neoplasms - diagnosis - epidemiology
Abstract
BACKGROUND: The incidence of tongue cancer is increasing, and survival has not improved since the majority of patients present at an advanced stage. Patient delay has remained the same over the years and is difficult to influence. Much less is known about the delay in diagnosis caused by physicians and dentists. AIM: To investigate the detection of tongue cancer in primary care in Northern Finland and to examine the consultation prevalence of oral symptoms in primary care in Finland. STUDY: Analysis of data from medical records of tongue cancer patients kept between 1 January 1974 and 31 December 1994 for the general health insurance scheme. SETTING: The two northernmost provinces of Finland (population of 700,000). METHOD: Data were collected on demographic and clinical variables and on the first medical visit on 75 tongue cancer patients. In addition, primary care physicians recorded all patient visits during four weeks in 25 health centres randomly selected throughout Finland in 1996. RESULTS: At the initial visit, the tongue cancer patient was correctly referred for further examinations in 49 (65%) cases. In 12 (16%) of cases the patient was not referred but was scheduled for a follow-up visit, and was neither referred nor followed-up in 14 (19%). When compared with the referred patients the median professional delay was somewhat longer for the unreferred patients but increased dramatically if no follow-up was arranged (0.6 months [range = 0.1-2.4] versus 1.2 [range = 0.3-2.2] versus 5.2 [range = 0.7-18.2], P
PubMed ID
11217621 View in PubMed
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Determinants of primary medical practice in adult cancer prevention.

https://arctichealth.org/en/permalink/ahliterature237290
Source
Med Care. 1986 Mar;24(3):216-24
Publication Type
Article
Date
Mar-1986
Author
R N Battista
J I Williams
L A MacFarlane
Source
Med Care. 1986 Mar;24(3):216-24
Date
Mar-1986
Language
English
Publication Type
Article
Keywords
Adult
Breast Neoplasms - prevention & control
Colonic Neoplasms - prevention & control
Data Collection
Education, Medical, Continuing
Factor Analysis, Statistical
Female
Humans
Lung Neoplasms - prevention & control
Male
Neoplasms - prevention & control
Physicians, Family
Primary Health Care - standards
Professional Practice
Quebec
Rectal Neoplasms - prevention & control
Smoking - prevention & control
Uterine Cervical Neoplasms - prevention & control
Abstract
The authors conducted a study of primary care physicians in the province of Quebec to ascertain their patterns of preventive practice with respect to cancer in four anatomic sites: breast, cervix, colon-rectum, and lung. They further explored the data set to elicit the determinants of the patterns of preventive practice. Scales were constructed encompassing practice behaviors for each type of cancer, continuing education intensity, knowledge, and belief. The content of these scales was delineated through factor analysis and their reliability assessed using Cronbach's alpha. Other variables were also considered in the conceptual model. Bivariate analysis and multivariate techniques were used. The models tested contained many significant interaction terms. A limited number of the first-order interactions was explored for each of the dependent variables. Different patterns emerged for each cancer type. Mode of reimbursement, continuing education, gender of physician, provider-related barriers to prevention, and knowledge were found to be the major predictors of prevention scores for the cancers studied, but their relative importance varied according to each cancer. The importance of better understanding the determinants of physician behaviors is emphasized and the existence of several possible explanatory models suggested.
PubMed ID
3951264 View in PubMed
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213 records – page 1 of 22.