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Biomedical subjects

P Lagerløv

Publications and source records attributed to P Lagerløv.

12 recordsLinked to original sources
PubMed2001

Variations in general practitioners' views of asthma management in four European countries.

The aim was to identify differences and similarities in views regarding asthma management among general practitioners in four European countries (Germany, Netherlands, Norway and Sweden), and to explore reasons for suboptimal performance. The results are to be used for the development and tailoring of educational interventions. Semistructured interviews with 20 GPs in each country were conducted and analysed using a phenomenographic approach. The domains of (i) general view of asthma, (ii) the doctor-patient relationship in managing asthma, and (iii) overall management of asthma (treatment goals and evaluation of results) were approached during the interviews. There were different ways of experiencing phenomena related to asthma management both within and between the four countries. Three general views on asthma were found where different perspectives were emphasised: a medical, a 'global' (including community health, social and environmental aspects) and a patient's perspective. Within the medical perspective, only a few German doctors emphasised a psychological aetiology of asthma. The views on the doctor-patient relationship described as 'authoritarian', 'teaching' or 'empowering' occurred similarly in all countries. The majority of the doctors showed confidence in the effectiveness of the pharmaceutical treatment of asthma, some doctors were concerned about limitations, but only in Germany a few doctors were explicitly critical of the values of conventional pharmaceutical treatment. The main treatment goals were either conceived as getting the patient symptom-free (Netherlands, Norway, and Germany) or to control the inflammatory process (Sweden). Several German and some Norwegian doctors expressed the view that patients had to accept the disease and learn how to manage it, while a few German doctors aimed at alternative treatments of asthma. The existence of qualitatively different ways of experiencing asthma management, both in and between countries, calls for consideration when trying to implement general evidence-based treatment guidelines. A variation of approaches in continuing medical education for GPs is needed to address such existing beliefs and conceptions that could sometimes be opposed to the content of educational messages.

Asthma↗
PubMed2001

Structuring prescribing data into traffic-light categories; a tool for evaluating treatment quality in primary care.

BACKGROUND: Prescribing feedback based on aggregated data alone does not give the information needed to improve treatment quality. OBJECTIVES: Our aim was to develop a new method, or tool, of presenting prescribing feedback which, combined with guideline recommendations, makes it possible for doctors to judge their own prescribing as good or bad. METHODS: Asthma was chosen as a disease model, as treatment recommendations are readily available published as national and international guidelines. Four mean daily dosage intervals of inhaled short-acting beta-agonists and four mean daily dosage intervals of inhaled steroids were combined into a 4 x 4 matrix. This matrix of 16 combined dosage boxes was presented to 68 Norwegian GPs participating in peer review groups. As a first step, the GPs in the groups reached consensus on what they considered to be appropriate and inappropriate combined dosage intervals of these drugs based on national guideline recommendations and their joint clinical experience. Accordingly, traffic-light colours, green and red, were assigned to the combined dosage boxes in the matrix. Treatments in boxes difficult to judge were coloured yellow. During a 1-year period prior to the consensus meetings, the dispensed inhaled short-acting beta-agonists and inhaled steroids of each of the doctors' patients were recorded at the local pharmacies. As a second step in developing the new method, the number of patients treated within each of the coloured boxes was presented to the GPs in the peer review groups. These combined presentations provided an overview to the whole group, and individually to each GP, of how many patients were actually given appropriate or inappropriate treatment according to their own agreed upon standard. RESULTS: The GPs categorized 34% of 1122 evaluated patients receiving inhaled short-acting beta-agonists or inhaled steroids as treated inappropriately during the 1-year registration period. Appropriate treatment was given to 47% of the patients, and in 19% of the cases the treatment was difficult to evaluate. CONCLUSIONS: A method has been developed enabling GPs to categorize prescribing information into good (green), bad (red) and difficult to judge (yellow) treatment qualities, based on guideline recommendations and clinical experience. The actual prescribing data for each GP were labelled according to the same colour scheme, thus revealing to each GP his or her own actual prescribing compared with their own treatment standard, yielding information and motivation for quality improvement efforts.

Adolescent↗
PubMed2000

Improving doctors' prescribing behaviour through reflection on guidelines and prescription feedback: a randomised controlled study.

BACKGROUND: It is difficult to put research findings into clinical practice by either guidelines or prescription feedback. AIM: To study the effect on the quality of prescribing by a combined intervention of providing individual feedback and deriving quality criteria using guideline recommendations in peer review groups. METHODS: 199 general practitioners in 32 groups were randomised to participate in peer review meetings related to either asthma or urinary tract infections. The dispensing by the participating doctors of antiasthmatic drugs and antibiotics during the year before the intervention period provided the basis for prescription feedback. The intervention feedback was designed to describe the treatment given in relation to recommendations in the national guidelines. In each group the doctors agreed on quality criteria for their own treatment of the corresponding diseases based on these recommendations. Comparison of their prescription feedback with their own quality criteria gave each doctor the proportion of acceptable and unacceptable treatments. MAIN OUTCOME MEASURE: Difference in the prescribing behaviour between the year before and the year after the intervention. RESULTS: Before intervention the mean proportions of acceptably treated asthma patients in the asthma group and urinary tract infection (control) group were 28% and 27%, respectively. The mean proportion of acceptably treated patients in the asthma group was increased by 6% relative to the control group; this difference was statistically significant. The mean proportions of acceptable treatments of urinary tract infection before intervention in the urinary tract infection group and asthma (control) group were 12% for both groups which increased by 13% in the urinary tract infection group relative to the control group. Relative to the mean pre-intervention values this represented an improvement in treatment of 21% in the asthma group and 108% in the urinary tract infection group. CONCLUSIONS: Deriving quality criteria of prescribing by discussing guideline recommendations gave the doctors a basis for judging their treatment of individual patients as acceptable or unacceptable. Presented with feedback on their own prescribing, they learned what they did right and wrong. This provided a foundation for improvement and the process thus instigated resulted in the doctors providing better quality patient care.

Asthma↗
PubMed2000

Treatment of uncomplicated urinary tract infections: exploring differences in adherence to guidelines between three European countries. Drug Education Project Group.

OBJECTIVE: To evaluate adherence of general practitioners to treatment guidelines regarding urinary tract infections in three European countries and to investigate whether differences in adherence at the prescribing level within and between countries could be explained by general practitioners' knowledge and attitudes, characteristics, or national setting. DESIGN: Prescribing data collected in 1994-1995 were analyzed regarding use of first-choice drugs and duration of treatment, knowledge and attitudes were assessed with a questionnaire, and multiple regression analysis was used to explain differences in prescribing behavior within and between countries. RESULTS: Our study is based on data from 85.6% of the 584 general practitioners who were scheduled to participate in a continuing education program. The mean proportion of responses in agreement with the guidelines regarding first-choice drugs was 0.69 in Sweden, 0.78 in the Netherlands, and 0.79 in Norway; regarding duration of treatment, the mean proportion was 0.56 in Sweden, 0.67 in the Netherlands, and 0.59 in Norway. The proportion of first-choice drugs prescribed for women (18-75 y) was 0.55 in Sweden, 0.83 in the Netherlands, and 1.00 in Norway (patients >16 y). The duration of treatment was 7.6 defined daily doses per prescription in Sweden, 5.9 in the Netherlands, and 6.6 in Norway. Knowledge and attitudes explained 0-17% of the variation in prescribing. Years in practice explained 0-11%, and the general practitioners' gender had no explanatory value. The national setting explained most of the variation between countries. CONCLUSIONS: Differences in prescribing behavior can be explained only to a small extent by deviations from the guidelines in terms of knowledge and attitudes. Between countries, differences in regulation, marketing, and distribution of drugs seem to be of much greater importance.

Adolescent↗
PubMed2000

Asthma management in five European countries: doctors' knowledge, attitudes and prescribing behaviour. Drug Education Project (DEP) group.

The aim of the study was to examine the relationship between guideline recommendations on asthma management, and the performance of doctors in five different European health care contexts. Knowledge, attitudes and prescribing behaviour of doctors recruited to an educational project was investigated. A total of 698 general practitioners from Germany, The Netherlands, Norway and Sweden, and 94 specialists from the Slovak Republic participated. A questionnaire was used to assess their knowledge and attitudes. Antiasthmatic drugs dispensed to their patients reflected their prescribing behaviour. In response to questions on how to treat chronic asthma, most doctors were in agreement with guideline recommendations. In practice, however, the proportion of asthma patients receiving inhaled steroids varied almost twofold, ranging 31% in Germany to 58% in The Netherlands. On questions related to exacerbation of asthma, German and Slovakian doctors often preferred treatment with antibiotics to steroids. They also more often associated yellow-green sputum with bacterial infection. In conclusion, although many doctors in different health care contexts have accepted the recommendations given in guidelines, the proportion of their patients treated accordingly differed. German and Slovakian doctors seem to attach less importance to the inflammatory features of asthma than the doctors from the other three European countries.

Adolescent↗
PubMed1999

GPs' treatment of uncomplicated urinary tract infections--a clinical judgement analysis in four European countries. DEP group. Drug Education Project.

BACKGROUND: Non-adherence to recommendations for treatment of uncomplicated urinary tract infections (UTI) is common, but the reasons are not sufficiently understood. OBJECTIVES: We aimed to assess and compare the influence of specific patient characteristics on GPs' treatment decisions for UTI in four European countries. METHODS: GPs in The Netherlands, Norway, Sweden and Germany were presented 18-26 case vignettes of UTI. Linear regression models were used to determine which patient characteristics predicted non-optimal decisions. RESULTS: Adherence to national recommendations varied both within and between countries, but there were remarkable similarities in the case characteristics predicting non-optimal decisions: a history of UTI and the patient's age were strongly related to prescription of second-choice antibiotics and longer treatment courses. CONCLUSION: In all countries many GPs were reluctant to follow the recommendations in UTI cases that they might perceive as being more complicated.

Adult↗
PubMed1999

Evaluating an educational intervention to improve the treatment of asthma in four European countries. Drug Education Project Group.

In the international Drug Education Project, a new educational program for peer groups of doctors was developed and tested to improve the treatment of asthma patients in The Netherlands, Norway, Sweden, and Slovakia. Individualized feedback on prescribing and the underlying decision strategy was presented and discussed within the group of doctors, in relation to existing guidelines. In a parallel, randomized controlled design the effect on competence and actual prescribing was tested. Results were related to national guidelines. In general, the program improved the doctors' attitudes as well as some of their prescribing behavior. The proportion of patients treated with inhaled corticosteroids significantly improved in The Netherlands (effect size 1.27), and the proportion of oral corticosteroid use for exacerbation treatment increased both in The Netherlands and in Norway (effect sizes 1.99 and 0.87, respectively). Overall attitudes of Dutch and Norwegian doctors also improved significantly (effect sizes 1.06 and 0.87, respectively), as did both knowledge (effect size 1.06) and attitudes (effect size 1.49) concerning exacerbation treatment in Slovakia. In Sweden no significant improvements could be measured. Conclusively, improvements in asthma treatment are possible with an educational program based on self-learning in small peer groups, although effects in one health care setting may not occur in another health care setting. Possible explaining factors may be different attitudes to and experiences with guidelines as well as with continuing medical education programs, and differences in the opportunities for change, including prevailing trends in prescribing behavior.

Adult↗
PubMed1998

The doctor-patient relationship and the management of asthma.

General practitioners (GP) differ in views on how to relate to their patients, diagnose asthma and update their knowledge. By understanding the doctors' attitudes within these domains it is possible to design a better information strategy and improve disease management. In order to get insight in the doctors' experiences and ways of thinking regarding asthma, 20 GPs were interviewed. A phenomenographic analysis was applied in describing the doctors' opinions. The doctors' opinions about who was in charge of the asthma management defined four doctor-patient relationships: I will manage it, you will manage it, we will manage it and I do not know whether I will manage it. The GPs differed markedly in how much they trusted the patients' descriptions and the physiological measurements of the disease. Three opinions on how to acquire knowledge were described. Knowledge should be acquired either from experts or from peers. Another belief did not give weight to a defined source but expressed the necessity of using all opportunities at hand. Doctors holding this belief, "the bricoleurs", seemed to be more interested in a "how to do it" than a "why to do it" information. We conclude that strategies for improving asthma management should consider the importance of both patients' accounts and physiological measures, the degree of co-operation between doctors and their patients and eventually the ways and styles of acquiring new knowledge about asthma.

Adult↗
PubMed1995

[Hearing of small children. Satisfactory testing at health centers?].

Of 803 four-year-old children tested, audiometric screening detected ten with secretory otitis media necessitating operation and one child with sensorineural loss of hearing. Control showed audiometer calibrations and noise levels during screening to be within acceptable limits. The anamnestic information ought to be improved by asking direct questions about hearing disabilities at all age levels as part of the screening procedure. The one child with sensorineural hearing loss should have been detected earlier. Perhaps we place too much trust in the methods used to test young childrens' hearing. It may be wise to look more closely into the methods and routines used to screen for hearing defects at one year of age.

Ambulatory Care Facilities↗
PubMed1991

[Breast feeding and smoking--a study at a health center].

361 infants were seen at a total of 605 consultations at a child health centre. The aim was to study the relationship between breast-feeding practice and parental smoking at about six weeks, three months, six months and one year of age. The parents were questioned about breast-feeding, cigarette smoking and cultural origin. At the respective ages 83, 63, 45 and 15% of the infants were breast-fed. The fraction of 58 non-European mothers who breast-fed their children was not significantly lower than in our own culture. None of these mothers smoked, and their children more often had a home environment not involving exposure to tobacco. Compared with infants of non-smoking European women, a significantly lower fraction of children of non-European origin were breast-fed at six months of age, but not at six weeks and three months. Smoking was common in 40% of the mothers when the infant was six months or older. Between six weeks and three months after birth the fraction of smoking mothers increased from 28 to 37%. A significantly lower fraction of smoking mothers than of non-smoking ones breast-fed their infants between the age of three months and one year.

Breast Feeding↗
PubMed1990

[Mastitis in general practice. Is bacteriologic examination useful?].

For a period of 22 months, postpartial women in Oslo were asked to consult one of several specific general practitioners in the event of mastitis. Clinical symptoms, bacteriological findings in breast milk and treatment were recorded in 43 patients. Patients with a favourable (n = 35) and with an unfavourable outcome (n = 8) defined as abscess, relapse and/or relief of symptoms after more than seven days, were compared. Unfavourable outcome was characterized by higher score of clinical symptoms and a higher isolation frequency of Staphylococcus aureus. The occurrence of fever did not differ between the groups. Bacteriological findings in milk from both breasts were compared with the findings from 100 milk donors. Staphylococcus aureus was more frequently isolated in milk from affected breasts than from unaffected and control breasts (17/40 versus 4/40 versus 4/100). Most of the Staphylococcus aureus strains (70%) were betalactamase producers. Coagulase negative staphylococci were a frequent finding in all milk samples, whereas Gram-negative bacteria were frequent only in the controls. The presence of pathogenic bacteria, as well as high bacterial counts, were associated with a higher number of symptoms. However, the predictive value of the bacteriological examination was low. Our study indicates that bacteriological examination of breast milk is justified only in patients with severe, acute symptoms and recurrences when betalactamase producing Staphylococcus aureus are suspected.

Family Practice↗