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- André, Malin, 1949-, et al.
(författare)
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Diagnosis-prescribing surveys in 2000, 2002 and 2005 in Swedish general practice : Consultations, diagnosis, diagnostics and treatment choices
- 2008
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Ingår i: Scandinavian Journal of Infectious Diseases. - : Informa UK Limited. - 0036-5548 .- 1651-1980. ; 40:8, s. 648-654
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study is to present diagnostic patterns, diagnostics used and antibiotic treatment in relation to guidelines in 3 repeated diagnosis-prescription studies conducted simultaneously in general practice in 5 Swedish counties, during 1 week in November 2000, 2002 and 2005. General practitioners (GPs) at the participating health centres were asked to complete a form for all patients with symptoms of an infectious disease. During the studied periods a total of 15,371 consultations was registered. Consultations with GPs diagnosed as respiratory tract infection (RTI), especially consultations for sore throat, decreased considerably between y 2000 and 2005. The percentage of patients allocated an RTI diagnosis and prescribed an antibiotic declined significantly from 54% to 49% and the decline was most pronounced among children. Penicillin V remained the dominant antibiotic prescribed throughout the study periods. For lower urinary tract infections there was a significant change in choice of prescribed antibiotics with an increase for pivmecillinam and nitrofurantoin and a decrease for trimethoprim, in accordance with recommendations. The results indicate a quite close adherence to current guidelines, with changes in the pattern of consultations as well as in the management of infectious diseases in general practice in Sweden.
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- André, Malin, 1949-, et al.
(författare)
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The management of infections in children in general practice in Sweden. : a repeated 1-week diagnosis-prescribing study in 5 counties in 2000 and 2002.
- 2005
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Ingår i: The Journal of Infectious Diseases. - : Informa UK Limited. - 0022-1899 .- 0036-5548 .- 1651-1980. ; 37:11-12, s. 863-869
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Tidskriftsartikel (refereegranskat)abstract
- A diagnosis-prescribing study was performed in 5 Swedish counties during 1 week in November in 2000 and repeated in 2002. The aim of the present study was to analyse data for children 0-15y of age who consulted a general practitioner with symptoms of an infection. During the 2 weeks studied, 4049 children were consulted. Respiratory tract infections (RTI) were the predominant diagnoses, above all among the youngest children, while the proportion of urinary tract infections and skin infections increased with increasing age. Between the y 2000 and 2002, the proportion of children allocated the diagnosis streptococcal tonsillitis and pneumonia decreased (p<0.01 and p<0.001, respectively) while the proportion of common cold increased (p<0.001). Antibiotic prescribing decreased from 55% to 48% (p<0.001) for respiratory infections between the years studied. The only significant changes in type of antibiotics prescribed were the increase of isoxazolylpenicillins (p<0.001) used for skin infection and the decrease of macrolides (p=0.001). A diagnostic test was used in more than half of the consultations. Of children allocated a RTI diagnosis, 36% were prescribed antibiotics when a C-reactive protein test was performed compared to 58% in those not tested. Further studies are needed in general practice to determine the optimal use of near-patient tests in children with RTI.
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- André, Malin, et al.
(författare)
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The Use of CRP Tests in Patients with Respiratory Tract Infections in Primary Care in Sweden Can Be Questioned
- 2004
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Ingår i: Scandinavian Journal of Infectious Diseases. - : Informa UK Limited. - 0036-5548 .- 1651-1980. ; 36:3, s. 192-197
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Tidskriftsartikel (refereegranskat)abstract
- A diagnosis-antibiotic prescribing study was performed in 5 counties in Sweden during 1 week in November in 2000 and 2002 respectively. As a part of the study, the use and results of C-reactive protein (CRP) tests in relation to duration of symptoms and antibiotic prescribing in 6778 patients assigned a diagnosis of respiratory tract infections were analysed. In almost half (42%) of the patients, a CRP test was performed. The majority of CRP tests (69%) were performed in patients assigned diagnosis upper respiratory tract infection, where the test is not recommended. Overall, there was a minor decrease in antibiotic prescribing when CRP was used (41%), in comparison to 44% of the patients where no CRP was performed (p<0.01). Patients assigned diagnoses implying a bacterial aetiology were prescribed antibiotics irrespective of result of CRP or length of symptoms before consultation. For patients assigned viral diagnoses, antibiotic prescribing increased with increasing duration of symptoms and increasing value of CRP. The use of CRP decreased antibiotic prescribing in patients assigned to viral diagnoses and with longstanding symptoms (p<0.001). However, 59% of the patients assigned viral diagnoses with CRP≥25 received antibiotics, which seems to indicate a misinterpretation of CRP and a non-optimal use of antibiotics.
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- André, Malin, et al.
(författare)
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Upper respiratory tract infections in general practice: diagnosis, antibiotic prescribing, duration of symptoms and use of diagnostic tests
- 2002
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Ingår i: Scandinavian Journal of Infectious Diseases. - : Taylor & Francis. - 2374-4235 .- 0036-5548 .- 1651-1980. ; 34, s. 880-
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Tidskriftsartikel (refereegranskat)abstract
- A diagnosis/antibiotic prescribing study was performed in 5 counties in Sweden for 1 week in November 2000. As part of this study, the characteristics and clinical management of patients with upper respiratory tract infections (n = 2899) in primary care were analyzed. Almost half of the patients were aged < 15 y and one-fifth of the patients consulted out of hours. Of all patients seeking primary care for upper respiratory tract infections, 56.0% were prescribed an antibiotic. Almost all patients who were given the diagnoses streptococcal tonsillitis, acute otitis media or acute sinusitis were prescribed antibiotics, compared to 10% of patients with common cold or acute pharyngitis. The most frequently prescribed antibiotic was penicillin V (79.2%) and this was even more pronounced out of hours, when the diagnoses otitis media and streptococcal tonsillitis were more frequently used. In patients with common cold and acute pharyngitis, the percentage who received antibiotics increased with increasing length of symptoms and increasing CRP levels. In patients with acute pharyngitis or streptococcal tonsillitis, antibiotics were prescribed less frequently provided streptococcal tests were performed. The management of patients with upper respiratory tract infections in general practice seems to be in good agreement with current Swedish guidelines. However, the study indicates some areas for improvement. The diagnosis of acute sinusitis seems to have been overestimated and used only to justify antibiotic treatment.
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- Björkegren, Karin
(författare)
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Studies on Vitamin B12 and Folate Deficiency Markers in the Elderly : A Population-based Study
- 2003
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aims of this study were to document the levels of cobalamin, folate, methylmalonic acid (MMA) and total homocysteine (tHcy) in serum and their relations to symptoms, clinical findings, and other factors in order to improve the possibilities of detecting early deficiency of vitamin B12 or folate, and to study the effects of cobalamin and folic acid treatment over a three-year period. The study population consisted of a 20% random sample of persons 70 years or older living in Älvkarleby in mid-Sweden. They were invited to a survey and 224 (88.4%) persons responded. Data were obtained by questionnaire, laboratory investigations and physical examination for the period 1993 – 1999. In a multivariate analysis performed at baseline, serum MMA and tHcy were significantly and independently correlated to age, serum cobalamin, and creatinine levels, and tHcy also to sex and serum folate. Neither serum cobalamin, folate, MMA nor tHcy had any significant correlation to haemoglobin or mean red cell volume. Almost half of the study population had signs of low tissue levels of vitamin B12 or folate. Among those who took multivitamin preparations, the proportion was much lower, 25%. Among traditional symptoms and clinical findings that have been linked to vitamin B12 or folate tissue deficiency, only changes in the tongue mucosa and mouth angle stomatitis were significantly associated with abnormal serum folate and tHcy levels. Traditional symptoms of vitamin deficiency may appear later in the course. 69 persons who had laboratory indications of early or overt tissue deficiency of vitamin B12 or folate and who had no ongoing vitamin treatment were given cobalamin for six months. Those whose MMA or tHcy levels did not normalise were given folic acid in addition to cobalamin. After further treatment for three months, all persons but one had normal levels. The laboratory effect still remained after three years of treatment. There was a tendency towards improvement of vibration sense, especially in the long nerve paths, and improvement of neurological symptoms and oral mucosa findings. Conclusion: A substantial proportion of elderly persons have laboratory signs of incipient tissue deficiency of vitamin B12 and folate. Treatment normalises lab parameters and some symptoms.
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- Ljungberg, Christina, 1978-, et al.
(författare)
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Primary care and hospital doctors’ experiences of prescribing information transfer using a shared electronic patient medical record system
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Rationale, aim and objective Uppsala county council has implemented a shared electronic patient medical record (e-PMR) system between primary and secondary care. Uppsala is one of the first counties in Sweden to implement such a system, and has the largest number of affiliated health care users with a shared e-PMR. The aim of this study was to investigate primary care and hospital doctors’ experiences of using the shared e-PMR, regarding information about individual patients’ drug therapies between the health care levels.Method Semi-structured focus groups were conducted. Four groups were held with hospital and four with primary care doctors. Data were analysed from an interpretivist perspective, aiming at capturing the physicians’ perspective. They were coded, categorised and similar categories grouped into themes. The constant comparative method was used; all new data were compared to earlier data and earlier analyses, and categories were formed and reformed throughout the analysis. After analysis of the data from the separate groups, a mixed focus group was held with doctors from both primary care and hospital, in which the earlier findings were discussed, to explore variations in the data. The analysis was informed by the Data-Information-Knowledge-Wisdom hierarchy, where a differentiation is made between raw facts (data) and their conversion into, for example, a useful form for a particular context (knowledge).Results The shared e-PMR was perceived as having many advantages, especially as all information was available electronically, which was convenient and time saving. The large amount of information, however, made it difficult to handle. The sought-after knowledge could be hard to retrieve in an information overload. Information about a patient’s drug therapy was not always collected in the medication list; additional information could be found in the e-PMR-notes, given by the patient or in the list of the patient’s automated medication dispensing service. Doctors did not summarize information as often, instead cross-referencing information that could be found elsewhere in the e-PMR.Conclusions The information in the e-PMR needs to be structured in a comprehensible way to facilitate reading and knowledge production. It is not just about providing information, the knowledge needs to be communicated in a good way to the next care-giver.
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- Ljungberg, Christina, 1978-, et al.
(författare)
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Responsibility for a patient’s drug therapy : perspectives of primary care and hospital doctors
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Background: Health care provision is complex, with many actors, bringing difficulties in ensuring the responsibility for different health care providers is clear. Perceived lack of responsibility for a patient between primary and hospital care can lead to non-compliance with drug guidelines. The aim of this study was to investigate hospital and primary care doctors’ views of responsibility for patients’ drug therapy.Methods: Four audio-recorded focus groups were held with hospital doctors and four with primary care doctors. Fourteen hospital and 27 primary care doctors participated. The data were transcribed and analysed from an interpretivist perspective, to capture the physicians’ perspectives. Data were coded and categorised and similar categories grouped into themes. A mixed focus group was then held with 14 doctors from both primary care and hospital, who had participated in earlier focus groups. This allowed doctors from both settings to discuss the findings from the separate groups and to explore variations in the data.Results: Taking responsibility for the patient’s drug therapy was seen as being discharged when the doctors reviewed the patient’s drugs and updated the list of medications in the medical record. Nobody said they had the overall responsibility for the individual patient’s drug therapy. Secondary care doctors often only took responsibility for drugs within their own clinical area. Primary care doctors found it difficult to take overall responsibility, especially for highly specialized treatments, even though they described themselves as having a more comprehensive perspective of the patient’s drugs than the hospital doctors. Barriers to taking responsibility for both sectors included time constrains, lack of information regarding prescribing decisions by other doctors, highly specialized or expensive drugs and lack of economic incentives. Doctors from different health care levels did not routinely meet, informally or formally, and, at the time of the study, had no clear channels for communication between them. Conclusions: Taking responsibility to review the patient’s list of medications was perceived as important, but was described as difficult in daily practice.
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