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Biomedical subjects

J Eskerud

Publications and source records attributed to J Eskerud.

13 recordsLinked to original sources
PubMed1997

Why are some doctors high-prescribers of benzodiazepines and minor opiates? A qualitative study of GPs in Norway.

BACKGROUND: Registration studies have shown great variations in prescribing volume and prescribing patterns of benzodiazepines (BZDs) and minor opiates among GPs. OBJECTIVES: We aimed to form a basis for hypotheses and build theories about prescribing, in order to investigate how high-prescribing doctors can legitimize their own prescribing pattern. METHODS: A qualitative interview study of doctors with previously known high, medium and low prescribing volumes was performed. The interpretation focused on the doctors' self-explanations and how they influence their daily decision of prescribing. RESULTS AND CONCLUSIONS: It was a striking feature that many of the attitudes towards the drugs were common both within and between the three groups of prescribers. All doctors regarded the task of prescribing as difficult, and the great majority strongly advocated restriction in prescribing. In order to cope with daily practice and to live with high prescribing volumes, doctors make use of effective working strategies. These strategies, of ascribing responsibility to the previous doctor, to patient autonomy and responsibility, to the patient's age and to concomitant diseases, are described in this study. An allocation of responsibility to other persons or circumstances delimits the doctors' professional discretion in this matter. Striking differences between prescriber groups were not found in the analysis, but when all small tendencies in all steps of the decision-making process were added, a clear trend was revealed.

Adult↗
PubMed1996

[Physicians' view on drug therapy for hypertension. A questionnaire in the county of Hordaland].

A questionnaire survey was conducted in Hordaland county to discover opinions on drug therapy for uncomplicated hypertensives with no other risk factors. The response rate was 66%; 179 general practitioners and 31 hospital doctors. The doctors were well informed about the documentation of the clinical benefit of various drugs. As regards the minimum blood pressure that was considered as warranting drug treatment, the majority of the doctors followed the recently issued national guidelines. For young patients the first choice drugs were beta-blockers (27%), ACE-inhibitors (25%) or calcium-blockers (20%). For older patients 65% of the doctors preferred diuretics or beta-blockers. The majority (80%) based their choice of drug primarily on documentation of clinical value or absence of side effects. The doctors underestimated the cost of the newer antihypertensive drugs.

Adult↗
PubMed1994

[Control of prescriptions of B-preparations. A registry study of B-preparations in Oslo and Akershus].

In two Norwegian counties all prescriptions for benzodiazepines and analgesics containing codeine were registered over a two month period and the records were subsequently transferred to a database. 93,000 prescriptions were registered, equivalent to this 2.8 millions DDD. The registration showed great variation, both in the doctors' volume of prescribing and their prescribing patterns. 30 doctors of the total of 4,000 were responsible for 13% of the total volume prescribed. We propose that the doctors with unacceptable prescribing rates should be offered a special education program provided by the Norwegian Medical Association. The computer routines of the pharmacies appear to be inadequate for registration and research purposes. In 2% of all the prescriptions the doctors name could not be identified. Thus it seems warranted to use the doctors' identity number on prescriptions for these drugs. A reduction of the number of tablets in the largest packages dispensed should be considered by the authorities. For effective quality control of prescribing, better understanding is needed of the differences in doctors' prescribing patterns.

Benzodiazepines↗
PubMed1994

[Communication in emergency health services].

When the new national radio and telecommunications system for acute medical services is established in 1995, 25 years will have passed since publication of the first White Paper on the issue. By following the process of this reform as it has evolved it is possible to point out how various government bodies and professional groups have stimulated or hindered the process to suit their individual motives and needs. In addition to active involvement by enthusiastic professionals and government agencies, the approval and implementation of such a reform requires the support of other institutions, other professional groups, the media and politicians.

Emergency Medical Services↗
PubMed1993

[Diagnosis of migraine in general practice].

195 patients with headache were examined by general practitioners and neurologists, and their diagnoses were compared. The general practitioners diagnosed migraine in 116 cases, the neurologists in 144 cases, and in 104 cases their diagnoses agreed. Thus, migraine can be difficult to diagnose, and this study indicates underdiagnosis of this common condition by general practitioners. This may result in overuse of analgesics and alternative therapies, and too little prescription of specific migraine medication. Greater familiarity with the diagnostic criteria of the International Headache Society should make it easier to arrive at a correct migraine diagnosis.

Adolescent↗
PubMed1993

[Access to family practitioners by telephone. A practical example of quality assurance].

A record of telephone calls in a Norwegian town (Molde) in 1987 showed that fewer inquiries were answered by general practitioners and their receptionists than by personnel in any other profession or trade. The general practitioners and the receptionists agreed on measures to improve accessibility, and more records of telephone calls were made. The measures and the process are described. At local level, a record of calls which differentiates between those answered by the providers of primary care and those answered by automatic machines seems to be a simple and useful means of quality assurance which we encourage others to apply.

Family Practice↗
PubMed1993

[Complaints about primary care physicians].

The most serious complaints against general practitioners are investigated and dealt with by the Directorate of Health. A systematic review of 100 cases of complaint from 1983 up to 21 May 1992 showed that 57 of them concerned an urgent need of medical assistance and deputizing service. One-quarter of the complaints concerned telephone consultations. Incorrect diagnosis was the most frequent reason for the complaint. More than half of the cases referred to acute somatic diseases and accidents. The results will be used jointly by the Directorate of Health and the Norwegian Medical Association to improve practice.

Diagnostic Errors↗
PubMed1993

[Diagnosis of migraine in general practice].

195 patients with headache were examined by general practitioners and neurologists, and their diagnoses were compared. The general practitioners diagnosed migraine in 116 cases, the neurologists in 144 cases, and in 104 cases their diagnoses agreed. Thus, migraine can be difficult to diagnose, and this study indicates underdiagnosis of this common condition by general practitioners. This may result in overuse of analgesics and alternative therapies, and too little prescription of specific migraine medication. Greater familiarity with the diagnostic criteria of the International Headache Society should make it easier to arrive at a correct migraine diagnosis.

Adolescent↗
PubMed1992

[Standards as basis for medical audit].

Medical audit usually implies evaluation of medical practice in order to control whether certain standards are complied with. Research on decision making has disclosed, however, that standards for clinical problem solving are not always easy to establish. It has been difficult to influence doctors to adhere to standards defined by experts. We therefore propose that medical audit should focus more on education than on control. If standards are to be used, the doctors participating in medical audit projects should also help to define the standards. We suggest the following procedure for medical audit projects: observe practice--reflect on it--identify changes--formulate standards--implement changes--evaluate changes--give feedback to the group about the outcome. Standards defined by experts working remote from medical practice, must be replaced by standards based on practical knowledge acquired by doctors with common experience.

Decision Making↗
PubMed1992

[Antibiotic prevention of bacterial endocarditis].

Bacterial endocarditis is a serious condition with high lethality. The authors review the etiology of the disease and conditions and procedures associated with increased risk, and give recommendations on choice and dosage of effective antibiotics. Most cases of endocarditis are caused by gram-positive cocci of the genera Streptococcus, Enterococcus or Staphylococcus. The number of cases caused by staphylococci has increased in recent decades. Risk of acquiring endocarditis is higher, for example, in patients with prosthetic cardiac valves and in patients with a previous history of endocarditis. Interventions associated with increased risk include various procedures in the mouth, throat and upper airways, since this is where the bacteria most often causing endocarditis are to be found. A single oral dose of amoxycillin is recommended for standard prophylaxis, and ampicillin in combination with an aminoglycoside for parenteral use. In cases of penicillin allergy, a single oral dose of clindamycin is recommended in patients at risk of bacteriemia from the respiratory tract, with trimetoprim as an alternative for genito-urinary and gastrointestinal procedures. Vancomycin or vancomycin plus aminoglycoside is recommended as a parenteral regimen in cases of penicillin allergy.

Anti-Bacterial Agents↗