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Peter Vedsted

Publications and source records attributed to Peter Vedsted.

17 recordsLinked to original sources
PubMed2006

A cluster-randomized trial of the significance of a reminder procedure in a patient evaluation survey in general practice.

OBJECTIVE: . To determine whether adding a reminder procedure to the personal handing out of questionnaires to patients by general practitioners (GPs) in a patient evaluation survey added further information to the study and whether this influenced the results of the evaluations fed back to the GPs. DESIGN: Patient evaluation survey in general practice. STUDY PARTICIPANTS: 6822 patients consulting 60 GPs in a Danish county. GPs were voluntarily participating in a national patient evaluation project. INTERVENTION: We used the EUROPEP instrument for patient evaluation in general practice. It contains 23 items in five dimensions and two additional questions on general satisfaction. GPs were randomized into two groups with and without a reminder procedure. Main outcome measure. Scores in the six assessment dimensions and patient characteristics were compared for the primary and the reminder respondents and between the two randomization groups. In the analyses, we adjusted for the clustering of patients. RESULTS: We found that the use of a reminder procedure increased the response rate. Respondents to a reminder were younger than the primary responding patients and were more critical in their GP assessment. Patient evaluations of the individual GPs were statistically significantly more critical if these reminder responses were included. Absolute differences were too small to have any practical implications. CONCLUSIONS: Adding a reminder procedure to the face-to-face handing out of questionnaires to patients by the GPs increased the response rate significantly but produced no clinically significant differences in the assessment of the GPs.

Adult↗
PubMed2006

Delay in diagnosis of lung cancer in general practice.

BACKGROUND: Lung cancer is a common cancer disease; nevertheless, in Denmark a GP only sees one new case of lung cancer per year. The core symptoms of lung cancer, cough and dyspnoea, are on the other hand very common in general practice. This represents a challenge to the diagnostic process and increases the risk of diagnostic delay. AIM: To explore diagnostic delay in primary health care among patients with lung cancer. DESIGN OF STUDY: A population based observational case series of 84 lung cancer patients' delay. SETTING: The County of Aarhus, Denmark. METHOD: From county-based registers of all histological and cytological tests we identified all patients in the County of Aarhus with lung cancer diagnosed during a 6 month period in 2003. Inclusion was verified by contacting the departments involved in the treatment of lung cancer. Data were based on telephone interviews with patients' GPs. A review of delay was made starting with the first symptom until referral to secondary care. RESULTS: The overall median delay in primary health care was 32.5 days (interquartile interval (IQI) = 12-68 days). One-third of the patients were referred to the diagnostic investigation after their first consultation. Important reasons for delay in primary care were: symptoms not related to the lungs, chest X-ray without suspicion of cancer, comorbidity, waiting times for investigations and lack of explicit follow-up appointment. Prolonged delay was often due to a combination of these factors. CONCLUSION: When diagnosing lung cancer, it is important that GPs are aware of the low sensitivity of chest X-ray. Shorter waiting times for investigations could reduce delay considerably.

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PubMed2005

[The use of Danish day-time general practice. Status and perspectives].

This paper examines the development in the use of Danish general practice in the years 1992 to 2001. The use of general practice increased by 17%. The number of consultations increased by 12%, the number of telephone consultations increased by 25%, and the number of home visits decreased by 18%. The number of Danish citizens increased by 3.6%, but the number of GPs increased by 7.2%. The number of contacts per GP increased by more than 10%. The percentage of citizens attending general practice within a year increased from 80% to 85%. This would have resulted in only a 6% increase, assuming an average attendance rate similar to that of the population. The 50% least frequently attending patients accounted for 18% of all contacts. In comparison, the 10% most frequently attending patients accounted for 33% of all contacts.

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PubMed2005

Social environment and frequent attendance in Danish general practice.

BACKGROUND: A lack of social support is associated with increased morbidity and mortality and a decreased effect of prevention. Frequent attenders to primary care are characterised by poorer social conditions than other patients in general practice, but we do not know whether this is due to social inequalities in health or whether social factors in themselves determine the use of general practice. AIM: To examine if social factors are associated with frequent attendance in general practice after adjusting for physical and psychological health variables. DESIGN OF STUDY: Population-based cross-sectional survey. SETTING: Two hundred and twenty GPs in 132 practices in the county of Aarhus, Denmark, and the listed adult population (aged 20-64 years). METHOD: A sample of frequent attenders and infrequent attenders was drawn. The study included only those resident in the county and who had consulted a GP during the period November 1997-October 1998. A questionnaire about physical, psychological and social factors was sent to the patients. The associations between social factors and frequent attendance were adjusted for physical and psychological health and tendency towards somatisation. RESULTS: A total of 1423 (73.7%) frequent attenders and 1103 (74.9%) infrequent attenders responded. Male frequent attendance was associated, with statistical significance, with living alone and being without work or on a disability pension. Among women, lack of professional education or being without work tended to increase the likelihood of frequent attendance. CONCLUSION: This study shows that for men, social factors may in themselves determine the use of general practice. None of the investigated social factors seemed to restrict the use of general practice.

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PubMed2004

Drug prescription for adult frequent attenders in Danish general practice: a population-based study.

PURPOSE: To analyse the association between daytime frequent attendance in general practice and drug use, i.e. type of drug used and prevalence of polypharmacy. METHODS: A population-based cross-sectional study of individual face-to-face contacts with 179 Danish general practices (320 general practitioners, GPs) in the county of Northern Jutland, Denmark and the drug use of the 371 897 inhabitants aged 20 and over. Data on contacts and reimbursed drugs were obtained during the year of 1997 from the Health Insurance Registry. Frequent attenders (FAs) were defined as the 10% most FAs in 12 months. We measured the prevalence difference (PD) and the prevalence ratio (PR) of drug use and polypharmacy (drugs from five or more ATC groups) among FAs. RESULTS: FAs received prescriptions in 95% of the cases and utilised 27% of all prescribed drugs. Compared with the 50% least attending patients, the highest absolute prevalence of drug use among FAs was found for antibiotics (PD: 22.6-34.5), strong analgesics and psychotropics (PD: 16.0-38.5) and cardiovascular (PD: 4.2-46.2), musculoskeletal (PD: 16.3-29) and gastrointestinal drugs (PD: 10.8-39.9). The FAs had an increased PR for receiving a drug (1.1-1.6) and their polypharmacy PD was high (4.0-46.3). The association between frequent attendance and the prevalence of polypharmacy was strong (PR = 6.7-36.7). CONCLUSIONS: Frequent attendance in general practice is strongly associated with drug use and polypharmacy. FAs account for a high proportion of the prescription workload, and some disease groups are very common among FAs.

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PubMed2004

Physical, mental and social factors associated with frequent attendance in Danish general practice. A population-based cross-sectional study.

Knowledge of which factors are prompting patients to seek primary care is important to the ongoing effort to improve management in general, and management of frequent attenders (FAs) in particular. We conducted a cross-sectional population-based study with the aim at examining associations between physical, mental and social factors and frequent attendance in general practice. We collected questionnaire and registry data in the County of Aarhus (630,000 inhabitants), Denmark. Half of the county general practices (132 practices, 220 GPs) were selected randomly. FAs were defined as the top 10% attenders over the past 12 months. A questionnaire including SF-36 and questions about physical and mental health and social conditions was sent to age and gender stratified samples of FAs and non-FAs from these practices. Impairments (SF-36) associated with frequent attendance were physical in 54-71% (prevalence difference (PD): 16-33%, adjusted prevalence ratio (adj. PR): 1.1-1.7), mental in 58-70% (PD: 17-25%, adj. PR:1.1-1.4) and social in 40-59% (PD: 13-28%, adj. PR:0.9-1.5). Among FAs, 46-88% had used three or more different drugs (PD: 26-39%, adj. PR:1.5-2.3) and 27-41% had been referred one or more times to outpatient specialists (PD: 4-19%, adj. PR:1.2-2.5). Although our data cannot determine the direction of causality, they clearly demonstrate that FAs carry a large burden of physical, mental and social impairments which underpins the complexity and heterogeneity of the problems which they present. The results make clear that biopsychosocial management is a core issue in FA management in general practice.

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PubMed2004

Variation in proportion of frequent attenders between Danish general practices.

AIM: The authors examined the inter-practice variation in the proportion of adult frequent attenders and whether practice factors may explain some of this variation. METHODS: A population-based cross-sectional study was performed on the basis of registers including 262 active general practices and their 419,072 registered adults aged 20 and over in the County of Aarhus, Denmark (630,000 inhabitants) from November 1997 to October 1998. The number of face-to-face daytime contacts with general practitioners was counted for each individual on the basis of data drawn from the files of the National Health Service. Frequent attenders were defined as the 10% most frequent attenders in the county over 12 months for each sex, and four age groups. Both the crude and standardized proportions of frequent attenders in each practice were calculated. Associations between practice factors and the frequent attender proportions were assessed from the squared partial correlation coefficients. RESULTS: The proportion of frequent attenders ranged from 1.9 to 26.2% (factor 13.8) (standardized: 1.6 to 27.8% (factor 17.4)) with 10th to 90th percentiles of 4.4 to 12.9% (factor 2.9) (standardized: 4.3 to 13.2% (factor 3.1)). A low standardized proportion of frequent attenders was statistically significantly associated with a high degree of urbanization, a large number of registered individuals per GP and female GP (multiple R(2) > 0.16 for all practices and 0.22 for solo practices). CONCLUSIONS: Variation in the proportion of frequent attenders was considerable between practices and about one-fifth of this variation could be explained by practice factors.

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PubMed2002

[Frequent attenders in general practice. Who are they and how are they managed?].

INTRODUCTION: Frequent attenders (FAs) account for a large number of the consultations and a large part of the workload in general practice. We need knowledge about the way general practitioners (GPs) characterise this group of patients and about their proposals for clinical management. This study aims to describe the types of FAs seen in general practice and their proposed management. MATERIAL AND METHODS: Six randomly sampled CME groups in Aarhus County were offered a meeting about frequent attendance in general practice, and five groups with a total of 89 GPs accepted. FAs were defined as the top 10% patients attending during 12 months. One week before the meeting, each GP received an introduction to the meeting and the names of two FAs listed with the practice. Through exploratory focus group interviews, supplemented by a small group-based CME method, the GPs were asked to discuss FA characteristics and to make proposals for clinical management. A total of 59 (66.3%) participated in the five meetings. RESULTS: Eight FA types consistently emerged from the discussions, and the GPs suggested 12 possible ways of managing them. These aspects involved communicative, organisational (planning), and biopsychosocial skills. DISCUSSION: The variety of types shows that FAs are not solely the so-called difficult patients, but a diverse group demanding many different aspects of care. Hence, the GPs are in a key position demanding specific skills to manage these patients.

Communication↗
PubMed2002

[The postgraduate training of general practitioners in communication and counseling. A questionnaire survey in the county of Aarhus].

INTRODUCTION: The study aimed to describe the postgraduate training of the general practitioners (GPs) in communication and psychiatric counselling. MATERIAL AND METHODS: GPs in Aarhus County, Denmark, received a mailed questionnaire about psychiatric hospital training, participation in courses and Balint groups (psychiatric supervision), and their need for further training. RESULTS AND DISCUSSION: The questionnaire was returned by 320 (74.4%) GPs. Almost all GPs had received some kind of postgraduate training although to a very varying extent. Almost half had taken courses of more than three days' duration, and half were members of a psychiatric supervision group. Two-thirds of the GPs thought they needed further training. The need was independent of the GP's evaluation of his/her own psychiatric education.

Communication↗
PubMed2002

Patient and GP agreement on aspects of general practice care.

OBJECTIVE: The aim of the present study was to compare patient and GP priorities for general practice care. METHODS: A questionnaire survey was carried out in general practice in Denmark which included 900 consecutive patients aged over 18 years from 15 practices collected in 1995, and 919 randomly sampled GPs in 1999. The postal questionnaire, developed by the EUROPEP group, contained 40 questions about eight aspects of primary care. Participants were asked to state their priorities for each question ranging from "not at all important" to "most important". A reminder questionnaire was sent to non-responders after 2 weeks. Top priority percentages ("very/most important") were calculated for each question as were differences between participant groups. RESULTS: Questionnaires were answered by 771 (85.7%) patients and 584 (64.2%) GPs. Their priorities were highly correlated (r = 0.754, P < 0.001). Patients gave higher priority than GPs to availability and accessibility of the practice and seeing the same GP. The GP should be capable of providing information on illness, investigations and treatments and patient associations, and should know the patient's history and be regularly updated through courses. CONCLUSIONS: Patient and GP priorities for primary care were highly correlated. The higher priority awarded by patients than by GPs to specific aspects of primary care should be acknowledged when organizing and developing general practice.

Adult↗
PubMed2002

Patient satisfaction with availability of general practice: an international comparison.

OBJECTIVE: To identify associations between the characteristics of general practitioners and practices, and patients' evaluations of the availability of general practice. DESIGN: Written surveys completed by patients. SETTING: General practice care in nine European countries: Denmark, Germany, The Netherlands, Norway, UK, Belgium (Flanders and Wallonia), Switzerland, Slovenia and Spain. STUDY PARTICIPANTS: 15996 adult patients consecutively visiting the general practitioner (response rates per country varied between 47 and 89%). MAIN MEASURES: The Europep instrument to assess patients' evaluations of five aspects of the availability of general practice care: (1) getting an appointment, (2) getting through on the phone, (3) being able to speak to the practitioner on the telephone, (4) waiting time in the waiting room, and (5) providing quick services for urgent health problems. Each general practitioner recorded age, sex, number of years in the practice, number of practitioners and other care providers in the practice, and urbanization level of the practice. RESULTS: Patients' more positive evaluations were associated with fewer general practitioners in the practice, except for quick services for urgent health problems (range of conditional overall odds ratios, 1.69-2.02). In addition, a number of significant unconditional overall odds ratios were found, particularly those related to the number of general practitioners' working hours and the number of care providers in the practice. None of the associations was found consistently in all countries. CONCLUSION: Patients favour small practices and full-time general practitioners, which contradicts developments in general practice in many countries. Policy makers should consider how the tensions between patients' views and organizational developments can be solved.

Adult↗
PubMed2002

Special status consultation for frequent attenders. Who are the candidates?

BACKGROUND: The need to optimize frequent attender (FA) care and to economize on scarce resources in primary care has given rise to calls for intervention. However, precise knowledge of the specifics of this need is scarce, as is knowledge of how best to orchestrate intervention vis-à-vis particular FA groups. The aim of the study was to analyse the need for a special FA status consultation and to analyse if such need springs from physical, mental or social factors among FAs. METHOD: Half of the 270 general practices in the County of Aarhus, Denmark, were randomly allocated to the study group (in total 132 practices; 220 general practitioners (GPs)). From these practices age- and gender-stratified samples of FAs were drawn. FAs were defined as the top 10 per cent attenders in 12 months. Questionnaires were used to elicit FA and GP attitudes to the introduction of a status consultation and to obtain GPs' evaluation of their FAs' physical, mental and social status. The special FA consultation was introduced as a reimbursed half-hour consultation where the FA and the GP could discuss the patient's current and future care status. RESULTS: Over three-quarters of the FAs would accept the offer to have the status consultation, and the GPs would recommend it for one-fourth of their FAs. The expressed need was highly associated with an expected positive effect on health (prevalence ratio (PR) for GPs: 11.7 (8.9-15.5), PR for FAs: 1.6 (1.5-1.8)) and a decrease in attendance (PR for FAs: 1.4 (1.3-1.5)). The GPs quoted physical, mental and social indications for the consultation. The FAs who had high levels of functional symptoms were most likely to accept the consultation. CONCLUSIONS: There was an expressed need for an FA status consultation, which may lead to a positive effect on health and attendance. The GPs pointed to physical, mental and social indicators for a special FA consultation.

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