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1.  Use of GP services by patients with schizophrenia: a national cross-sectional register-based study 
Reform of health services has given primary care facilities increased responsibility for patients with serious mental disorders (SMD). There has also been a growing awareness of the high somatic morbidity among SMD patients, an obvious challenge for general practitioners (GPs). The aim of this study was to assess the utilisation of GP services by patients with schizophrenia.
The Norwegian list patient system is based on fee-for-service (FFS). For each contact, the GPs send a claim to National Health Insurance detailing the diagnosis, the type of contact, procedures performed, and the personal identifier of the patient. In this study complete GP claims data from 2009 for schizophrenia patients aged 25–60 years were used to assess their utilisation of GP services. Regression models were used to measure the association between patient, GP and practice characteristics, with FFS per patient used as a measure of service utilisation. Data on patients with diabetes (DM) and population means were used for comparison.
The mean annual consultation rate was 5.0 and mean FFS was 2,807 Norwegian Kroner (NOK) for patients diagnosed with schizophrenia. Only 17% had no GP consultation, 26.2% had one or two, 25.3% had three to five, and 16.1% more than five consultations. GPs participated in multidisciplinary meetings for 25.7% of these patients. In schizophrenia patients, co-morbid DM increased the FFS by NOK 1400, obstructive lung disease by NOK 1699, and cardiovascular disease by NOK 863. The FFS for schizophrenia patients who belonged to a GP practice with a high proportion of mental health-related consultations increased by NOK 115 per percent point increase in proportion of consultations. Patients with schizophrenia living in municipalities with < 10,000 inhabitants had a mean increase in FFS of NOK 1048 compared with patients living in municipalities with > 50,000 inhabitants. Diagnostic tests were equally or more frequent used among patients with schizophrenia and comorbid somatic conditions than among similar patients without a SMD.
This study showed that most patients diagnosed with schizophrenia had regular contact with their GP, providing opportunities for the GP to care for both mental and somatic health problems.
PMCID: PMC4339084  PMID: 25884721
Schizophrenia; Mental health; Primary care; General practice; Healthcare services
2.  Personal continuity of care in Norwegian general practice: A national cross-sectional study 
Personal continuity is regarded as a core value in general practice. The aim of this study was to determine the level of personal continuity in Norwegian general practice. An investigation was made of the associations between high levels of personal continuity and patient, general practitioner (GP), and list characteristics.
Cross-sectional register-based study
Norwegian general practice in 2009.
3220 GPs and 3 725 998 patients on the GP lists.
Main outcome measures
The Usual Provider Continuity Index (UPC), which measures the proportion of consultations made by the usual GP, was estimated for patients and aggregated to the GP list level. GPs were grouped into quartiles based on the UPC. Being a GP with a UPC in the two highest quartiles (UPC ≥ 0.80) was the outcome in the statistical analyses.
Poisson regression models were used to estimate relative risks (RR).
The overall UPC was 0.78, increasing gradually from 0.68 in patients < 15 years of age to 0.86 for patients ≥ 60 years of age, and from 0.75 to 0.83 for patients with < 3 annual consultations compared with patients with > 10 consultations. A UPC > 0.80 was associated with longer patient lists and high GP consultation rates. Working in municipalities with < 10 000 residents was negatively associated with a high UPC. The UPC level for GPs was associated with total utilization of GP consultations in the list populations.
Overall, the Norwegian goal of a personal GP has been achieved; however, there are substantial variations between GPs and lower UPCs among young patients and in smaller municipalities.
PMCID: PMC3520415  PMID: 23113798
Clinical practice variation; continuity of care; cross-sectional analysis; general practice; health service research; Norway
3.  Women’s higher likelihood of disability pension: the role of health, family and work. A 5–7 years follow-up of the Hordaland Health Study 
BMC Public Health  2012;12:720.
Women’s higher risk of disability pension compared with men is found in countries with high female work participation and universal welfare schemes. The aim of the study was to examine the extent to which self-perceived health, family situation and work factors explain women’s higher risk of disability pension. We also explored how these factors influenced the gender difference across educational strata.
The population-based Hordaland Health Study (HUSK) was conducted in 1997–99 and included inhabitants born in 1953–57 in Hordaland County, Norway. The current study included 5,959 men and 6,306 women in paid work with valid information on education and self-perceived health. Follow-up data on disability pension, for a period of 5–7 years, was obtained by linking the health survey to a national registry of disability pension. Cox regression analyses were employed.
During the follow-up period 99 (1.7%) men and 230 (3.6%) women were awarded disability pension, giving a twofold risk of disability pension for women compared with men. Except for a moderate impact of self-perceived health, adjustment for family situation and work factors did not influence the gender difference in risk. Repeating the analyses in strata of education, the gender difference in risk of disability pension among the highly educated was fully explained by self-perceived health and work factors. In the lower strata of education there remained a substantial unexplained gender difference in risk.
In a Norwegian cohort of middle-aged men and women, self-perceived health, family situation and work factors could not explain women’s higher likelihood of disability pension. However, analyses stratified by educational level indicate that mechanisms behind the gender gap in disability pension differ by educational levels. Recognizing the heterogeneity within gender may contribute to a deeper understanding of women’s higher risk of disability pension.
PMCID: PMC3508825  PMID: 22943493
Disability pension; Cohort study; Educational status; Gender; Health; Occupational group; Risk factors
4.  General practitioners' experiences with sickness certification: a comparison of survey data from Sweden and Norway 
BMC Family Practice  2012;13:10.
In most countries with sickness insurance systems, general practitioners (GPs) play a key role in the sickness-absence process. Previous studies have indicated that GPs experience several tasks and situations related to sickness certification consultations as problematic. The fact that the organization of primary health care and social insurance systems differ between countries may influence both GPs' experiences and certification. The aim of the present study was to gain more knowledge of GPs' experiences of sickness certification, by comparing data from Sweden and Norway, regarding frequencies and aspects of sickness certification found to be problematic.
Statistical analyses of cross-sectional survey data of sickness certification by GPs in Sweden and Norway. In Sweden, all GPs were included, with 3949 (60.6%) responding. In Norway, a representative sample of GPs was included, with 221 (66.5%) responding.
Most GPs reported having consultations involving sickness certification at least once a week; 95% of the GPs in Sweden and 99% of the GPs in Norway. A majority found such tasks problematic; 60% of the GPs in Sweden and 53% in Norway. In a logistic regression, having a higher frequency of sickness certification consultations was associated with a higher risk of experiencing them as problematic, in both countries. A higher rate of GPs in Sweden than in Norway reported meeting patients wanting a sickness certification without a medical reason. GPs in Sweden found it more problematic to discuss the advantages and disadvantages of sick leave with patients and to issue a prolongation of a sick-leave period initiated by another physician. GPs in Norway more often worried that patients would go to another physician if they did not issue a certificate, and a higher proportion of Norwegian GPs found it problematic to handle situations where they and their patient disagreed on the need for sick leave.
The study confirms that many GPs experience sickness absence consultations as problematic. However, there were differences between the two countries in GPs' experiences, which may be linked to differences in social security regulations and the organization of GP services. Possible causes and consequences of national differences should be addressed in future studies.
PMCID: PMC3320536  PMID: 22375615
5.  Gender differences in disability after sickness absence with musculoskeletal disorders: five-year prospective study of 37,942 women and 26,307 men 
Gender differences in the prevalence and occupational consequences of musculoskeletal disorders (MSDs) are consistently found in epidemiological studies. The study investigated whether gender differences also exist with respect to chronicity, measured as the rate of transition from sickness absence into permanent disability pension (DP).
Prospective national cohort study in Norway including all cases with a spell of sickness absence > eight weeks during 1997 certified with a MSD, 37,942 women and 26,307 men. The cohort was followed-up for five years with chronicity measured as granting of DP as the endpoint. The effect of gender was estimated in the full sample adjusting for sociodemographic factors and diagnostic distribution. Gender specific analyses were performed with the same explanatory variables. Finally, the gender difference was estimated for nine diagnostic subgroups.
The crude rate of DP was 22% for women and 18% for men. After adjusting for all sociodemographic variables, a slightly higher female risk of DP remained. However, additional adjustment for diagnostic distribution removed the gender difference completely. Having children and working full time decreased the DP risk for both genders, whereas low socioeconomic status increased the risk similarly. There was a different age effect as more women obtained a DP below the age of 50. Increased female risk of chronicity remained for myalgia/fibromyalgia, back disorders and "other/unspecified" after relevant adjustments, whereas men with neck disorders were at higher risk of chronicity.
Women with MSDs had a moderately increased risk of chronicity compared to men, when including MSDs with a traumatic background. Possible explanations are lower income, a higher proportion belonging to diagnostic subgroups with poor prognosis, and a younger age of chronicity among women. When all sociodemographic and diagnostic variables were adjusted for, no gender difference remained, except for some diagnostic subgroups.
PMCID: PMC3046931  PMID: 21299856
6.  Norwegian GPs' participation in multidisciplinary meetings: A register-based study from 2007 
An increasing number of patients with chronic disorders and a more complex health service demand greater interdisciplinary collaboration in Primary Health Care. The aim of this study was therefore to identify factors related to general practitioners (GPs), their list populations and practice municipalities associated with a high rate of GP participation in multidisciplinary meetings (MDMs).
A national cross-sectional register-based study of Norwegian general practice was conducted, including data on all GPs in the Regular GP Scheme in 2007 (N = 3179). GPs were grouped into quartiles based on the annual number of MDMs per patient on their list, and the groups were compared using one-way analysis of variance. Binary logistic regression was used to analyse associations between high rates of participation and characteristics of the GP, their list population and practice municipality.
On average, GPs attended 30 MDMs per year. The majority of the meetings concerned patients in the age groups 20-59 years. Psychological disorders were the motivation for 53% of the meetings. In a multivariate logistic regression model, the following characteristics predicted a high rate of MDM attendance: younger age of the GP, with an OR of 1.6 (95% CI 1.2-2.1) for GPs < 45 years, a short patient list, with an OR of 4.9 (3.2-7.5) for list sizes below 800 compared to lists ≥ 1600, higher proportion of psychological diagnosis in consultations (OR3.4 (2.6-4.4)) and a high MDM proportion with elderly patients (OR 4.1 (3.3-5.4)). Practising in municipalities with less than 10,000 inhabitants (OR 3.7 (2.8-4.9)) and a high proportion of disability pensioners (OR 1.6 (1.2-2.2)) or patients receiving social assistance (OR 2.2 (1.7-2.8)) also predicted high rates of meetings.
Psychological problems including substance addiction gave grounds for the majority of MDMs. GPs with a high proportion of consultations with such problems also participated more frequently in MDMs. List size was negatively associated with the rate of MDMs, while a more disadvantaged list population was positively associated. Working in smaller organisational units seemed to facilitate cooperation between different professionals. There may be a generation shift towards more frequent participation in interdisciplinary work among younger GPs.
PMCID: PMC2999607  PMID: 21078187
7.  Occupational disability caused by dizziness and vertigo: a register-based prospective study 
Despite the magnitude of dizziness/vertigo in primary health care, prospective studies are scarce, and few studies have focused on vocational consequences. Using the International Classification of Primary Health Care (ICPC), GPs have two alternative diagnoses, H82 (vertiginous syndrome) and N17 (vertigo/dizziness), when issuing sickness certificates to these patients.
To assess the incidence of dizziness/vertigo in long-term sickness absence and to identify sociodemographic and diagnostic predictors for transition into disability pension.
Design of study
Register-based prospective study, 5-year follow-up.
All individuals in Norway eligible for sickness absence in 1997 (registered employed or unemployed).
The risk of disability pension was assessed with Cox proportional hazards analysis, with medical and sociodemographic information as independent variables, stratified for sex.
Six-hundred and ninety-four women and 326 men were included. Dizziness/vertigo made up 0.9% of long-term sickness absence among women and 0.7% among men. Among both women and men, 41% was certified with H82 and 59% with N17: 23% of women and 24% of men obtained a disability pension. Age was the strongest predictor for obtaining a disability pension. Subjects with only basic education had an almost doubled risk of obtaining a disability pension compared to the highest educational group. Women with H82 had significantly higher risk for obtaining a disability pension than those with N17. The difference increased after adjustment for sociodemographic variables. Sex had no effect when all other variables were controlled for.
Dizziness/vertigo is an infrequent cause of certified sickness absence, but long-term sickness absentees with dizziness/vertigo have a considerable risk of obtaining a disability pension in the future.
PMCID: PMC2529199  PMID: 18801279
disability insurance; dizziness; health insurance; risk factors; sick leave; vertigo

Results 1-7 (7)