Follow-up in general practice of patients treated for precancer of the cervix uteri

It is known that some patients with invasive cancer of the cervix uteri have previously had a positive vaginal cytology, which was not followed up. More recent investigations have also shown that invasive cancer has developed in patients who were treated for premalignant stages of cervical cancer, but who were not followed up adequately. In Denmark, these patients are advised to attend their practitioner for an annual check. The aim of the present study was to find out if 39 women, treated in a hospital for early cervical cancer, did in fact attend their practitioner for adequate follow-up. Fifteen per cent attended less frequently, and 21% more frequently than recommended, while 64% attended as per the schedule. Women who had undergone surgery for the early stages were significantly better attenders. Women over 30 years of age had a similar tendency, but the difference was not significant. It is suggested that, in the interest of more effective follow-up, registration should be computer-controlled.

Referral from general practice to dermatologists

There are many unexplained differences in the rates at which general practitioners make referrals to other medical specialists. We investigated 5,082 referrals from 141 general practitioners to dermatologists in Ringkøbing county in Denmark. As an expression of the referral rate to dermatologists an index of referral to dermatologists was estimated for every general practitioner. The index of referral to dermatologists was the number of referrals to the dermatologists per 1,000 patients per year, including children, standardized for age and sex to the average population in Ringkøbing County. The following six variables were evaluated in relation to the referral index: 1) Distance to the dermatologists, 2) number of doctors per practice, 3) number of consultations per general practitioner per year, 4) number of patients registered, 5) number of consultations per 1,000 patients per year standardized for age and sex, and 6) number of supplementary procedures per consultation. Stepwise multiple linear regression analysis was used. The study showed that the referral index to dermatologists fell both with distance to the dermatologist and with the number of supplementary procedures per consultation. No correlation was found between the referral index and the four other variables studied.

A two-year follow-up of children with urticaria in general practice

A questionnaire was sent in 1984 to 97 children with urticaria, who had previously been seen in Danish general practice during a period of three months in 1982. The questionnaire included questions about provoking factors and the course of the disease. Replies were received from 79 children, 46 of whom had experienced one attack only, and 33 had had several attacks. Fifteen percent of the former and 48% of the latter suggested a variety of provoking agents, which were mainly food and food additives in the recurrent group. Previous infections were not suspected, though 20% had signs or symptoms of infection at the registration in 1982. It is suggested that a first episode of urticaria should be investigated by the practitioner only, with simple questioning and perhaps symptomatic treatment, because the first attack is often the sole one.

Urticaria among Danish children in general practice

During a three month period 186 Danish general practitioners recorded 97 children with urticaria. No significant difference in frequency relating to sex was found. In 88 per cent of the cases the reason for contact was pruritus and exanthema. Patients did not appear to attend the practitioner on account of fear of serious disease. In 15 out of 21 children the disease had persisted for less than 24 months. Ninety-four per cent were questioned about provoking factors, but in only 17% was the aetiology elucidated. Only five patients revisited their general practitioner during a 14 day follow-up period. This confirms that most cases in general practice belong to the acute urticaria type in contrast to cases of urticaria in dermatology out-patient clinics. Seventy-five per cent were treated with drugs, in most cases with antihistamines.