[Care for the elderly--elderly persons needing care should select residential community carefully].
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Biomedical subjects
Publications and source records attributed to H K Otterstad.
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During the last five years, the prescription of tranquillizers has been reduced by 26% in Vestfold County compared with 19% in the country as a whole. This is probably a result of two initiatives: a common strategy to reduce prescription in the county, and monitoring prescription rate of the individual general practitioners. We examined the prescription of diazepam 5 mg tablets and found a reduction of more than 30% from 1989 to 1995. The reduction was greatest among the younger age groups and decreased with increasing age. The most probable reason for this pattern is a more restrictive attitude among general practitioners towards using diazepam to treat the young and middle-aged. The results for 1995 show that women still receive about 60% more diazepam than men, and women aged 70-79 years receive 117% more than women aged 40-49 years.
The accessibility by phone of 35 general practitioners during consulting hours was tested systematically in 1989 and 1991. During this period the accessibility of the doctors was reduced from 74 to 62%. Only 3% of the doctors comply with the set standard of 90%. The main reason for the results are too few telephone lines to each practice. The norm should be at least two ingoing and two outgoing lines per practice.
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In Vestfold county the system of emergency care under the primary health service covers 130 hours per week distributed between six regions. The coverage is uneven, and is lower in densely populated areas where the hospitals are located and doctors are many. The organization of the emergency care varies. The largest regions have an emergency out-patient unit. In the smaller regions the doctors visit the home. The use of the emergency care provided by the primary health service was about 0.3 contacts per inhabitant per year, regardless of coverage, and correlated with opening hours. 39% of the general practitioners were reluctant to do emergency work outside normal consulting hours.
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In this survey, 600 respondents over the age of 25 chosen at random from two districts in the city of Bergen were asked about their own and their families' pattern of use of health services, particularly their use of physicians. 87% of the adults and 80% of the children reported having a "family doctor". The ties to these physicians were weak, however, since only 34% of the respondents said they would contact their family doctor if taken ill during normal consulting hours. Consequently, the term "family physician" seems to be used somewhat inaccurately in Norwegian health care.
The accessibility by phone of 35 general practitioners during consulting hours was tested systematically. The doctor was accessible in the case of 74% of all calls, no answer was obtained in 15%, and in 11% the office was inaccessible due to the use of an automatic telephone answerer. In the authors' opinion the standard should be 90% accessibility by phone for general practitioners in primary health care. This standard was met by 20% of the doctors.
A study carried out in the county of Vestfold in the spring of 1989 clearly showed how cooperation between doctor and nurse influenced the level and quality of care provided by doctors to patients nursed at home. Good cooperation coincided with high quality health services, and ensured rational use of resources in relation to the patients' needs. The study showed that the quality and frequency of cooperation between doctor and nurse are of utmost importance for the service given to the patients.
A study was carried out in the county of Vestfold in the spring of 1989 to establish the quality and quantity of the medical services for patients nursed at home. The study showed that doctors in rural districts provide better service than doctors in the towns. This difference is particularly noticeable in the case of patients who are acutely ill. The study also showed that patient-doctor contacts are seldom for patients nursed at home, with an average frequency of one every eight weeks for consulting-room consultations and one every 15 weeks for visits to the home.