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Year of Publication
2.  Computers and compassion in general practice 
doi:10.3109/02813432.2013.846545
PMCID: PMC3860290  PMID: 24191861
4.  40 years of biannual family medicine research meetings – The European General Practice Research Network (EGPRN) 
Abstract
Objective
To document family medicine research in the 25 EGPRN member countries in 2010.
Design
Semi-structured survey with open-ended questions.
Setting
Academic family medicine in 23 European countries, Israel, and Turkey.
Subjects
25 EGPRN national representatives.
Main outcome measures
Demographics of the general population and family medicine. Assessments, opinions, and suggestions.
Results
EGPRN has represented family medicine for almost half a billion people and > 300 000 general practitioners (GPs). Turkey had the largest number of family medicine departments and highest density of GPs, 2.1/1000 people, Belgium had 1.7, Austria 1.6, and France 1.5. Lowest GP density was reported from Israel 0.17, Greece 0.18, and Slovenia 0.4 GPs per 1000 people. Family medicine research networks were reported by 22 of 25 and undergraduate family medicine research education in 20 of the 25 member countries, and in 10 countries students were required to do research projects. Postgraduate family medicine research was reported by 18 of the member countries. Open-ended responses showed that EGPRN meetings promoted stimulating and interesting research questions such as comparative studies of chronic pain management, sleep disorders, elderly care, healthy lifestyle promotion, mental health, clinical competence, and appropriateness of specialist referrals. Many respondents reported a lack of interest in family medicine research related to poor incentives and low family medicine status in general and among medical students in particular. It was suggested that EGPRN exert political lobbying for family medicine research.
Conclusion
Since 1974, EGPRN organizes biannual conferences that unite and promote primary care practice, clinical research and academic family medicine in 25 member countries.
doi:10.3109/02813432.2013.847594
PMCID: PMC3860292  PMID: 24191874
Europe; family medicine; general practice; research; research network; EGPRN; national representative; membership
5.  What is meant by patient-centredness being value-based? 
Abstract
Objective
To examine whether it is possible to further specify what is meant when we maintain that patient-centredness as a communication skill is a value-based clinical procedure.
Design and main outcome measures
Since a core element in patient-centredness is associated with patients feeling respected, a study regarding encounters where patients felt respected was analysed.
Results
Similarities were found between the core elements of patient-centredness in terms of inviting, listening, and summarizing, and patients feeling respected in terms of listening, having their questions answered, and believing in what they tell their GP.
Conclusion
Even though what is respected cannot be specified, the authors’ analysis indicates that feeling respected is frequently and strongly associated with encounters reflecting core aspects of patient-centredness. In this sense, patient-centredness might be considered value-based. Future research might shed light on what is actually respected: is it the patient's autonomy, integrity, dignity, or honour?
doi:10.3109/02813432.2013.848543
PMCID: PMC3860293  PMID: 24164425
Autonomy; communication skill; general practice; patient-centredness; respectful encounters; Sweden; value-based medicine
6.  Acupuncture for infantile colic: A blinding-validated, randomized controlled multicentre trial in general practice 
Abstract
Objective
Infantile colic is a painful condition in the first months of infancy. Acupuncture is used in Scandinavia as a treatment for infantile colic. A randomized controlled trial was carried out with the aim of testing the hypothesis that acupuncture treatment has a clinically relevant effect for this condition.
Design
A prospective, blinding-validated, randomized controlled multicentre trial in general practice. Research assistants and parents were blinded.
Setting
13 GPs’ offices in Southern Norway.
Intervention
Three days of bilateral needling of the acupuncture point ST36, with no treatment as control.
Subjects
113 patients were recruited; 23 patients were excluded, and 90 randomized; 79 diaries and 84 interviews were analysed.
Main outcome measures
Difference in changes in crying time during the trial period between the intervention and control group.
Results
The blinding validation questions showed a random distribution with p = 0.41 and 0.60, indicating true blinding. We found no statistically significant difference in crying time reduction between acupuncture and control group at any of the measured intervals, nor in the main analysis of differences in changes over time (p = 0.26). There was a tendency in favour of the acupuncture group, with a non-significant total baseline-corrected mean of 13 minutes (95% CI –24 to + 51) difference in crying time between the groups. This was not considered clinically relevant, according to protocol.
Conclusion
This trial of acupuncture treatment for infantile colic showed no statistically significant or clinically relevant effect. With the current evidence, the authors suggest that acupuncture for infantile colic should be restricted to clinical trials.
doi:10.3109/02813432.2013.862915
PMCID: PMC3860294  PMID: 24228748
Acupuncture; acupuncture point; general practice; infantile colic; Norway; randomized controlled trial
7.  Prevalence, characteristics, and management of childhood functional abdominal pain in general practice 
Abstract
Objective
To (i) describe the proportion of children presenting with abdominal pain diagnosed by the GP as functional abdominal pain (GPFAP); (ii) evaluate the association between patient and disease characteristics and GPFAP; (iii) describe diagnostic management by the GP in children presenting with abdominal pain, and (iv) evaluate whether children with GPFAP fulfill diagnostic criteria for functional abdominal pain (FAP) as described in current literature: chronic abdominal pain (CAP) and the Rome III criteria (PRC-III) for abdominal pain-related functional gastrointestinal disorders (FGID).
Design
Cross-sectional study.
Setting
General practices in the Netherlands.
Subjects
305 children aged 4–17 years consulting for abdominal pain.
Main outcome measures
GPFAP, CAP, FGIDs.
Results
89.2% of children were diagnosed with GPFAP. Headaches and bloating were positively associated with GPFAP whereas fever and > 3 red flag symptoms were inversely associated. Additional diagnostic tests were performed in 26.8% of children. Less than 50% of all children with GPFAP fulfilled criteria for CAP and FGIDs; in 47.9% of patients the duration of symptoms at presentation was less than three months.
Conclusions
In almost 90% of children included in this study the GP suspected no organic cause for the abdominal pain. GPs diagnose FAP in children without alarm symptoms and order diagnostic testing in one out of four children presenting with abdominal pain. No difference was found in GPs’ management between children with a diagnosis of GPFAP and other diagnoses. Only about half of the children with a GP diagnosis of FAP fulfilled time-criteria of FAP as defined in the literature.
doi:10.3109/02813432.2013.844405
PMCID: PMC3860295  PMID: 24106821
Abdominal pain; adolescent; child; diagnosis; family practice; general practice; the Netherlands
8.  Partners of cancer patients consult their GPs significantly more often with both somatic and psychosocial problems 
Abstract
Objective
Partners of cancer patients experience psychological distress and impaired physical health around and after the diagnosis of cancer. It is unknown whether these problems are presented to the general practitioner (GP). This study aimed to establish partners’ GP use around the diagnosis of cancer.
Design
Cohort study.
Setting
Primary care.
Subjects
Partners of 3071 patients with breast, prostate, colorectal, or lung cancer were included. Patients were diagnosed in 2001–2009 and were alive at least two years after diagnosis.
Main outcome measures
Number of GP contacts and health problems in partners between six months before and two years after diagnosis.
Results
In the first six months after diagnosis, partners’ GP use was similar to baseline (18 to six months before diagnosis). Between six and 24 months after diagnosis, GP use was increased in partners of patients with breast, prostate, and colorectal cancer, an increase of 31% (p = 0.001), 26% (p = 0.001), and 19% (p = 0.042), respectively. In partners of patients with breast cancer and colorectal cancer, GP use was increased for both somatic and psychosocial symptoms. In partners of prostate cancer patients, an increase was seen in somatic symptoms, whereas in partners of lung cancer patients, GP use was only increased for psychosocial symptoms. “Problems with the illness of the partner” was a frequently recorded reason for contact in the first six months after diagnosis.
Conclusion
GP use of partners of cancer patients is increased 6–24 months after diagnosis, but health problems vary between cancer types. GPs should be alert for somatic and psychosocial problems in partners of cancer patients.
doi:10.3109/02813432.2013.861153
PMCID: PMC3860296  PMID: 24299045
Cancer partner; caregiver; general practice; the; Netherlands
9.  Immunochemical faecal occult blood tests in primary care and the risk of delay in the diagnosis of colorectal cancer 
Abstract
Objective
To evaluate the value, risks, and shortcomings of immunochemical faecal occult blood tests (iFOBTs) in the diagnosis of colorectal cancer (CRC) and adenomas with high-grade dysplasia (HGD) in patients initially presenting to primary care.
Design
A retrospective population-based study.
Setting and subjects
All 495 cases of CRC and adenomas with HGD diagnosed in the county of Jämtland, Sweden from 2005 to 2009.
Results
Of 495 patients 323 (65%) initially presented to primary care. IFOBTs were performed in 215 of 323 (67%) patients. The sensitivity of iFOBT for CRC and adenomas with HGD was 88% (83% when patients with a history of rectal bleeding were excluded). Of 34 patients with anaemia found en passant, 10 had negative iFOBTs. Time to diagnosis was longer for patients with negative iFOBTs (p < 0.0005).
Conclusion
IFOBT might be helpful in selecting which patients to refer for colonoscopy. However, iFOBT has a limited sensitivity as a diagnostic test for CRC and adenomas with HGD. Relying only on iFOBT for colonoscopy referral could delay diagnosis, especially for patients with anaemia found en passant.
doi:10.3109/02813432.2013.850205
PMCID: PMC3860297  PMID: 24191847
Colorectal neoplasms; diagnosis; general practice; occult blood; signs and symptoms; Sweden
10.  Barriers and facilitators for general practitioners to engage in advance care planning: A systematic review 
Abstract
Objective
The aim of this systematic review is to identify the perceived factors hindering or facilitating GPs in engaging in advance care planning (ACP) with their patients about care at the end of life.
Design
Studies from 1990 to 2011 were found in four electronic databases (PubMed, CINAHL, EMBASE, PsycINFO); by contacting first authors of included studies and key experts; and searching through relevant journals and reference lists. Studies were screened, graded for quality, and analysed independently by two authors; those reporting the perception by GPs of barriers and facilitators to engagement in ACP were included.
Results
Eight qualitative studies and seven cross-sectional studies were included for data extraction. All barriers and facilitators identified were categorized as GP characteristics, perceived patient factors, or health care system characteristics. Stronger evidence was found for the following barriers: lack of skills to deal with patients’ vague requests, difficulties with defining the right moment, the attitude that it is the patient who should initiate ACP, and fear of depriving patients of hope. Stronger evidence was found for the following facilitators: accumulated skills, the ability to foresee health problems in the future, skills to respond to a patient's initiation of ACP, personal convictions about who to involve in ACP, and a longstanding patient–GP relationship and the home setting.
Conclusion
Initiation of ACP in general practice may be improved by targeting the GPs’ skills, attitudes, and beliefs but changes in health care organization and financing could also contribute.
doi:10.3109/02813432.2013.854590
PMCID: PMC3860298  PMID: 24299046
Advance care planning; barriers; Belgium; facilitators; general practice; general practitioner; systematic review
11.  Sick-leave decisions for patients with severe subjective health complaints presenting in primary care: A cross-sectional study in Norway, Sweden, and Denmark 
Abstract
Objectives
The primary objective of this study was to explore whether general practitioners (GPs) in Norway, Sweden, and Denmark make similar or different decisions regarding sick leave for patients with severe subjective health complaints (SHC). The secondary objective was to investigate if patient diagnoses, the reasons attributed for patient complaints, and GP demographics could explain variations in sick leave decisions.
Design
A cross-sectional study.
Method
Video vignettes of GP consultations with nine different patients.
Subjects
126 GPs in Norway, Sweden, and Denmark.
Setting
Primary care in Norway, Sweden, and Denmark.
Main outcome measure
Sick leave decisions made by GPs.
Results
“Psychological” diagnoses in Sweden were related to lower odds ratio (OR) of granting sick leave than in Norway (OR = 0.07; 95% CI = 0.01–0.83) Assessments of patient health, the risk of deterioration, and their ability to work predicted sick leave decisions. Specialists in general medicine grant significantly fewer sick leaves than non-specialists.
Conclusion
Sick-leave decisions made by GPs in the three countries were relatively similar. However, Swedish GPs were more reluctant to grant sick leave for patients with “psychological” diagnoses. Assessments regarding health-related factors were more important than diagnoses in sick-leave decisions. Specialist training may be of importance for sick-leave decisions.
doi:10.3109/02813432.2013.844412
PMCID: PMC3860299  PMID: 24164371
Diagnosis; family practice; general practice; medically unexplained symptoms; Norway; primary health care; sick leave; somatoform disorder
12.  Different recommendations for empiric first-choice antibiotic treatment of uncomplicated urinary tract infections in Europe 
Abstract
Objective
Uncomplicated urinary tract infection (uUTI) is a common reason for antibiotic treatment in primary health care. Due to the increasing prevalence of antibiotic-resistant uropathogens it is crucial to use the most appropriate antibiotics for first-choice empiric treatment of uUTI. Particularly, it is important to avoid antibiotics associated with a high rate of antimicrobial resistance. This study compares national recommendations from six European countries, investigating recommendations for first-choice antibiotic therapy of uUTI.
Setting
General practice in six European countries.
Method
Searches were undertaken on PubMed, the Cochrane Library databases, Google, and Google Scholar. Recommendations from different geographical regions in Europe were investigated: Northern Europe (Denmark, Sweden), Western Europe (Scotland), Central Europe (Germany), Southern Europe (Spain), and Eastern Europe (Croatia).
Results
The six countries recommended seven different antibiotics. Five countries recommended more than one antibiotic as first-choice treatment. Half of the countries recommended antibiotics associated with a high rate (> 10–20%) of resistant E. coli. All countries recommended at least one antibiotic associated with a low (< 5%) resistance rate.
Discussion
The differences in first-choice treatment of uUTI could not be explained by differences in local bacterial aetiology or by different patterns of antimicrobial resistance. Despite resistance rates exceeding 10–20%, sulphamethizole, trimethoprim. or fluoroquinolones were recommended in half of the countries.
Conclusion
Within the European countries there are considerable differences in recommendations for empiric first-choice antibiotic treatment of uUTI. In order to reduce the increasing antimicrobial resistance in Europe, it is important to agree on the most appropriate antibiotics for empiric treatment of uUTI.
doi:10.3109/02813432.2013.844410
PMCID: PMC3860300  PMID: 24102498
Antibiotics; antimicrobial resistance; Denmark; general practice; primary health care; recommendations; uncomplicated urinary tract infection
13.  Challenges in managing elderly people with diabetes in primary care settings in Norway 
Abstract
Objective
To explore the experiences and clinical challenges that nurses and nursing assistants face when providing high-quality diabetes-specific management and care for elderly people with diabetes in primary care settings.
Design
Focus-group interviews.
Subjects and setting
Sixteen health care professionals: 12 registered nurses and four nursing assistants from nursing homes (10), district nursing service (5), and a service unit (1) were recruited by municipal managers who had local knowledge and knew the workforce. All the participants were women aged 32–59 years with clinical experience ranging from 1.5 to 38 years.
Results
Content analysis revealed a discrepancy between the level of expertise which the participants described as important to delivering high-quality care and their capacity to deliver such care. The discrepancy was due to lack of availability and access to current information, limited ongoing support, lack of cohesion among health care professionals, and limited confidence and autonomy. Challenges to delivering high-quality care included complex, difficult patient situations and lack of confidence to make decisions founded on evidence-based guidelines.
Conclusion
Participants lacked confidence and autonomy to manage elderly people with diabetes in municipal care settings. Lack of information, support, and professional cohesion made the role challenging.
doi:10.3109/02813432.2013.854445
PMCID: PMC3860301  PMID: 24205973
Chronic illness; diabetes; elderly people; focus groups; general practice; home-based services; Norway; nursing homes; qualitative research
14.  Long-term follow-up of patients with elevated serum calcium concentrations in Swedish primary care 
Abstract
Objective
To follow up patients with elevated calcium concentrations after 10 years.
Design
Longitudinal, using medical records, questionnaires, and clinical investigation.
Setting
Primary care in Tibro, Sweden, 2008–2010.
Subjects
127 patents with elevated calcium concentrations and 254 patients with normal calcium concentrations from the local community, attending the health care centre.
Main outcome measures
Diagnoses and mortality in patients with elevated calcium concentrations in 1995–2000, compared with patients with normal calcium concentrations and the background population.
Results
The proportion of patients for whom no underlying cause was detected decreased from 55% at baseline to 12% at follow-up. Primary hyperparathyroidism was most common in women, 23% at baseline and 36% at follow-up, and the cancer prevalence increased from 5% to 12% in patients with elevated calcium concentration. Mortality tended to be higher in men with elevated calcium concentrations compared with men with normal calcium concentrations, and was significantly higher than in the background population (SMR 2.3, 95% CI 1.3–3.8). Cancer mortality was significantly increased in men (p = 0.039). Low calcium concentrations were also associated with higher mortality (p = 0.004), compared with patients with normal calcium concentrations.
Conclusion
This study underscores the importance of investigating patients with increased calcium concentrations suggesting that most of these patients – 88% in our study – will turn out to have an underlying disease associated with hypercalcaemia during a 10-year follow-up period. Elevated calcium concentrations had a different disease pattern in men and women, with men showing increased cancer mortality in this study.
doi:10.3109/02813432.2013.861152
PMCID: PMC3860302  PMID: 24299047
Gender; general practice; hypercalcaemia; mortality; longitudinal studies; primary care; primary hyperparathyroidism; Sweden
15.  Letter to the Editor 
doi:10.3109/02813432.2013.846579
PMCID: PMC3860303  PMID: 24164391
16.  Response to the Letter to the Editor 
doi:10.3109/02813432.2013.846999
PMCID: PMC3860304  PMID: 24164406
17.  2012 and 2013 Peer Review Panel 
doi:10.3109/02813432.2013.847137
PMCID: PMC3860305
18.  Developing Danish general practice 
doi:10.3109/02813432.2013.815989
PMCID: PMC3750431  PMID: 23909283
19.  Calle Bengtsson in memoriam 
doi:10.3109/02813432.2013.814977
PMCID: PMC3750432  PMID: 23886011
20.  Low prevalence of irritable bowel syndrome in primary health care in four Swedish counties 
Abstract
Objective
Few large-scale studies have examined the prevalence of irritable bowel syndrome (IBS) and the number of visits among IBS patients in a primary health care setting. The aim of this study was to assess the prevalence of IBS in primary health care in four Swedish counties. Another aim was to study the number of visits among the IBS patients.
Design
A register-based study.
Setting
A primary health care database with information on patients from 71 primary health care centres in the Swedish counties of Stockholm, Uppsala, Värmland, and Gotland.
Subjects
The primary health care database contains individual-level data for 919 954 patients for the period 2001–2007.
Main outcome measures
Prevalence of IBS diagnosis.
Results
10 987 patients had a diagnosis of IBS, which corresponds to a prevalence of 1.2%. IBS was most common in the 25–44 years age group (37% of IBS patients); 71% of IBS patients were female, and 81% of IBS patients visited their GP six or more times, compared with 46% of non-IBS patients. However, 95% of the IBS patients visited their GP three times or fewer for IBS.
Conclusion and implications
The prevalence of IBS was low among Swedish primary health care patients. This might suggest that IBS patients are insufficiently diagnosed in Swedish primary health care.
doi:10.3109/02813432.2013.811949
PMCID: PMC3750433  PMID: 23906034
Epidemiology; gender; general practice; irritable bowel syndrome; prevalence; primary health care; Sweden
21.  Presenting the improved possibility for staying well might be better than talking about change in risk: Use of the Non-Occurrence Probability Increase (NOPI) 
Abstract
Objective
Talking about risk with patients is problematic since the individual's risk is not addressed and is usually very low. This study aimed to see how fact presentation influenced the decision-making process for general practitioners concerning treatment for the prevention of cardiovascular disease. Rather than looking at the risk of becoming ill, often presented as high figures of relative risk reduction (RRR), it could be useful to present the probability of staying well, i.e. from the concept of non-occurrence probability (NOP) and non-occurrence probability increase (NOPI) – simply a single measure of change in NOP.
Design
General practitioners (GPs) had personal response keypads to answer two questions, presented differently, concerning whether they would allow themselves to be treated or not be treated for the risk of cardiovascular death.
Setting and subjects
Five audiences consisting of general practitioners attending lectures.
Results
When the question was presented as RRR, 68% and 86%, respectively, of the physicians responded that they would take the decision to treat. When presented as the concept of NOPI the figures were reduced to 18% and 16%, respectively (p < 10–6).
Implications
Developing tools to explain treatment effect is crucial to enhancing health care quality. Since NOPI is one potential way of presenting prevention of risk we encourage future research to evaluate the NOPI concept compared with RRR and absolute risk reduction (ARR).
doi:10.3109/02813432.2013.811951
PMCID: PMC3750434  PMID: 23889596
Cardiovascular diseases; drug therapy; general practice; patient compliance; patient education; probability; risk assessment; Sweden
22.  Early multidisciplinary assessment was associated with longer periods of sick leave: A randomized controlled trial in a primary health care centre 
Abstract
Objective
To study the effects on sick leave from an early multidisciplinary assessment at a primary health care centre.
Design
Randomized controlled trial.
Setting
Patients who saw GPs at a primary health care centre in mid-Sweden and asked for a sickness certificate for psychiatric or musculoskeletal diagnoses were invited to participate. Patients included were sick-listed for less than four weeks; 33 patients were randomized either to an assessment within a week by a physiotherapist, a psychotherapist, and an occupational therapist or to “standard care”. The therapists used methods and tools they normally use in their clinical work.
Main outcome measure
Proportion of patients still sick-listed three months after randomization, total and net days on sick leave, and proportion who were on part-time sick leave.
Results
At follow-up after three months, in contrast to the pre-trial hypothesis, there was a trend toward a higher proportion of patients still sick-listed in the intervention group (7/18) as compared with the control group (3/15). The intervention group also had significantly longer sick-listing periods (mean 58 days) than the control group (mean 36 days) (p = 0.038). The proportion of patients who were part time sick-listed was significantly higher in the intervention group (10/18) than in the control group (2/15) (p = 0.027).
Conclusions
In this study an early multidisciplinary assessment was associated with longer periods on sick leave and more individuals on part-time sick leave.
doi:10.3109/02813432.2013.811943
PMCID: PMC3750435  PMID: 23909930
General practice; GP; multidisciplinary; primary health care; randomized controlled trial; rehabilitation; sick leave; sickness certification; Sweden
23.  Second cancers after childhood cancer – GPs beware! 
Abstract
Background
One of the long-term effects in childhood cancer survivors (CCS) is the development of second cancers. In a cohort of CCS, this study describes how second cancers were presented, the way they were diagnosed, and the knowledge CCS had about their increased risk to develop a second cancer.
Patients and methods
Selected participants were all adult five-year CCS (n = 1275) who were treated at the University Medical Center Groningen since 1965. Of these, 84 (6.6%) had developed a second cancer, of which 27 had died. The 57 survivors were asked to participate in a telephone interview.
Results
Of the 57 CCS, 35 (61%) participated. Together they had developed 45 second cancers. Most participants (97%) were seen at the long-term follow-up clinic. Of all second cancers, 89% caused symptoms. Of all second cancers, the majority (56%) were first presented at the general practitioner's (GP's) office and 20% at follow-up testing. Of these CCS, only 28% were aware of their increased risk of developing a second cancer.
Conclusions
It is important to inform CCS continuously regarding their increased risk, as a relatively small percentage are aware of this. Since most of these patients first reported their symptoms to the GP, all GPs should be aware of this increased risk, in particular because this concerns cancer at a younger age than normally expected. A survivor care plan might be an effective way of communication with both CCS and GPs.
doi:10.3109/02813432.2013.824152
PMCID: PMC3750436  PMID: 23906108
Childhood cancer survivors; general practice; general practitioner; long-term follow-up; second cancers; The Netherlands
24.  Characteristics of complaints resulting in disciplinary actions against Danish GPs 
Abstract
Objective
The risk of being disciplined in connection with a complaint case causes distress to most general practitioners. The present study examined the characteristics of complaint cases resulting in disciplinary action.
Material and methods
The Danish Patients’ Complaints Board's decisions concerning general practice in 2007 were examined. Information on the motives for complaining, as well as patient and general practitioner characteristics, was extracted and the association with case outcome (disciplinary or no disciplinary action) was analysed. Variables included complaint motives, patient gender and age, urgency of illness, cancer diagnosis, healthcare settings (daytime or out-of-hours services), and general practitioner gender and professional seniority.
Results
Cases where the complaint motives involved a wish for placement of responsibility (OR = 2.35, p = 0.01) or a wish for a review of the general practitioner's competence (OR = 1.95, p = 0.02) were associated with increased odds of the general practitioner being disciplined. The odds of discipline decreased when the complaint was motivated by a feeling of being devalued (OR = 0.39, p = 0.02) or a request for an explanation (OR = 0.46, p = 0.01). With regard to patient and general practitioner characteristics, higher general practitioner professional seniority was associated with increased odds of discipline (OR = 1.97 per 20 additional years of professional seniority, p = 0.01). None of the other characteristics was statistically significantly associated with discipline in the multiple logistic regression model.
Conclusion
Complaint motives and professional seniority were associated with decision outcomes. Further research is needed on the impact of professional seniority on performance.
doi:10.3109/02813432.2013.823768
PMCID: PMC3750437  PMID: 23906082
Communication; Denmark; general practice; ICPC-2; jurisprudence; patient complaints
25.  “I'm Dr Jekyll and Mr Hyde”: Are GPs’ antibiotic prescribing patterns contextually dependent? A qualitative focus group study 
Abstract
Objective
To explore factors and circumstances contributing to prudent antibiotic prescribing for respiratory tract infections in primary care.
Design
Two focus groups representing rural and urban areas. A semi-structured interview guide with open-ended questions and an editing analysis style was used. They were examined to identify meaning units that were sorted into categories in an iterative process throughout the analysis.
Setting
Primary health care in two counties in southern Sweden.
Subjects
Two groups including seven and six general practitioners (GPs) respectively, men and women of different ages with different professional experiences.
Main outcome measures
Exploration of categories, determination of themes, construction of models.
Results
The decision to prescribe antibiotics takes place in the encounter between GP and patient, initially characterized by harmony or fight and the subsequent process by collaboration or negotiation, resulting in agreement, compromise, or disagreement. Several factors influence the meeting and contribute to enhancing the conditions for rational prescribing. These conditions are connected to the GP, the relationship, and the setting; organization as well as professional culture. The findings indicate synergies between the factors, and that one factor can sometimes compensate for lack of another. Continuity and mutual trust can make a brief consultation successful, but lack of continuity can eliminate the effects of knowledge and professional skills.
Conclusions
The findings emphasize the importance of the encounter between the GP and the patient for prudent antibiotic prescribing. Furthermore, the importance of an appropriate organization of primary care, which promotes continuity and encourages professional autonomy, is demonstrated.
doi:10.3109/02813432.2013.824156
PMCID: PMC3750438  PMID: 23941086
Antibiotic prescribing; consultation; doctor–patient relationship; general practice; primary health care; respiratory tract infections; Sweden

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