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Wiik AB, Doupe MB, Bakken MS, Kittang BR, Jacobsen FF, Førland O. Areas of consensus on unwarranted and warranted transfers between nursing homes and emergency care facilities in Norway: a Delphi study. BMC Health Serv Res 2024; 24:374. [PMID: 38532452 PMCID: PMC10964583 DOI: 10.1186/s12913-024-10879-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 03/19/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Transferring residents from nursing homes (NHs) to emergency care facilities (ECFs) is often questioned as many are terminally ill and have access to onsite care. While some NH to ECF transfers have merit, avoiding other transfers may benefit residents and reduce healthcare system costs and provider burden. Despite many years of research in this area, differentiating warranted (i.e., appropriate) from unwarranted NH to ECF transfers remains challenging. In this article, we report consensus on warranted and unwarranted NH to ECF transfers scenarios. METHODS A Delphi study was used to identify consensus regarding warranted and unwarranted NH to ECF transfers. Delphi participants included nurses (RNs) and medical doctors (MDs) from NHs, out-of-hours primary care clinics (OOHs), and hospital-based emergency departments. A list of 12 scenarios and 11 medical conditions was generated from the existing literature on causes and medical conditions leading to transfers, and pilot tested and refined prior to conducting the study. Three Delphi rounds were conducted, and data were analyzed using descriptive and comparative statistics. RESULTS Seventy-nine experts consented to participate, of whom 56 (71%) completed all three Delphi rounds. Participants reached high or very high consensus on when to not transfer residents, except for scenarios regarding delirium, where only moderate consensus was attained. Conversely, except when pain relieving surgery was required, participants reached low agreement on scenarios depicting warranted NH to ECF transfers. Consensus opinions differ significantly between health professionals, participant gender, and rurality, for seven of the 23 transfer scenarios and medical conditions. CONCLUSIONS Transfers from nursing homes to emergency care facilities can be defined as warranted, discretionary, and unwarranted. These categories are based on the areas of consensus found in this Delphi study and are intended to operationalize the terms warranted and unwarranted transfers between nursing homes and emergency care facilities.
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Affiliation(s)
- Arne Bastian Wiik
- Centre for Care Research, West. Western, Norway University of Applied Sciences, Bergen, Norway.
| | - Malcolm Bray Doupe
- Centre for Care Research, West. Western, Norway University of Applied Sciences, Bergen, Norway
- Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Marit Stordal Bakken
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
| | - Bård Reiakvam Kittang
- University of Bergen, Bergen, Norway
- Department of Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Frode Fadnes Jacobsen
- Centre for Care Research, West. Western, Norway University of Applied Sciences, Bergen, Norway
| | - Oddvar Førland
- Centre for Care Research, West. Western, Norway University of Applied Sciences, Bergen, Norway
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Khan R, Khan A, Mohammed I, Dan F, Cooper V, Charles S, Charles N, Clarke W, Clarke J, Creary D, Chankersingh A. Investigating the leading reasons for primary health care encounters and its implications for health care in Trinidad and Tobago. A systematic review. J Family Med Prim Care 2022; 11:4949-4980. [PMID: 36505547 PMCID: PMC9731049 DOI: 10.4103/jfmpc.jfmpc_1803_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 12/12/2021] [Accepted: 12/16/2021] [Indexed: 12/15/2022] Open
Abstract
This systematic review aims at offering a comparative analysis of the leading reasons for encounters (RFEs) of patients presenting to primary care facilities. A systemic search was carried out using MEDLINE/PUBMED, CINAHL, Google Scholar, LILACS, and PROQUEST to identify the studies relevant to RFEs in primary health care in June 2020. Fifteen studies met the eligibility criteria which included originality, published between 2015 and 2020, listed two to five RFEs at a primary health care facility, and included patients with acute and/or chronic conditions. The mean total RFEs recorded were 6753.07 (Standard deviation = 17446.38, 95% Confidence Interval 6,753.0667 ± 8,829.088 [± 130.74%]). The most common RFE chapters recorded were Respiratory and Digestive chapters. The patients recorded fever as the most frequently reported RFE while cough was ranked as most common. The physicians reported hypertension as the most frequently reported and most common RFE. The most frequently physician and patient reported RFEs to the primary health care are hypertension and fever. Respiratory and Digestive were the most frequently reported chapters. The findings are useful for the proper implementation of services, facilities, and equipment utilized in Trinidad and Tobago primary health care.
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Affiliation(s)
- Raveed Khan
- Public Health and Primary Care Unit, Department of Paraclinical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago,The School of Medicine, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago,Address for correspondence: Dr. Raveed Khan, Public Health and Primary Care Unit, Department of Paraclinical Sciences, The School of Medicine, Faculty of Medical Sciences, The University of the West Indies, St. Augustine - 00000, Trinidad and Tobago. E-mail:
| | - Adam Khan
- The School of Medicine, Faculty of Medicine and Health Sciences, Royal College of Surgeons, Dublin, Ireland
| | - Ishmail Mohammed
- The School of Medicine, Faculty of Medicine and Health Sciences, Royal College of Surgeons, Dublin, Ireland
| | - Farhaana Dan
- The School of Medicine, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Valtio Cooper
- The School of Medicine, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Sherise Charles
- The School of Medicine, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Nkese Charles
- The School of Medicine, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Whitney Clarke
- The School of Medicine, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Jeniece Clarke
- The School of Medicine, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Devonia Creary
- The School of Medicine, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
| | - Ashley Chankersingh
- The School of Medicine, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
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Moth G, Christensen MB, Christensen HC, Carlsen AH, Riddervold IS, Huibers L. Age-related differences in motives for contacting out-of-hours primary care: a cross-sectional questionnaire study in Denmark. Scand J Prim Health Care 2020; 38:272-280. [PMID: 32700648 PMCID: PMC7470132 DOI: 10.1080/02813432.2020.1794160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Demands for out-of-hours primary care (OOH-PC) services are increasing. Many citizens call because of non-urgent health problems. Nevertheless, the patients' motives for requesting medical help outside office hours remains an understudied area. This study aimed to examine motives for calling OOH-PC services in various age groups. DESIGN Cross-sectional paper based questionnaire study conducted during two weeks in 2015. SETTING The OOH-PC services in two Danish regions. SUBJECTS Randomly selected patients calling the two healthcare services and accepting to participate in the study received a questionnaire on patient characteristics, health problems, and 26 pre-defined motives based on the Andersen Behavioural Model. Multivariate regression analyses were conducted for various age groups to calculate the probability of each motive to be a significant factor for the decision to call. RESULTS A total of 1,871 patients were included in the study; half were parents of children aged 0-12 years. Young adults (18 to 39 years) differed significantly from other age groups as they more often stated perceived barriers and benefits such as "Own GP no time available soon enough" and "Need for quick help because of work". CONCLUSION Young adults more often perceive barriers and benefits, which may suggest af difference in expectations regarding the purpose of out-of-hours services and accessibility. Further research is needed to address this issue and further explore the potential gap between the citizens' expectations to the OOH-PC services and the prevailing health policies. Key points The out-of-hours primary healthcare services are increasingly contacted for non-urgent problems, but little is known about the citizens' motives for calling. Age is associated with differences in the perceived importance of various motives for calling out-of-hours care. Young adults are more often than other age groups motivated to call due to logistical issues, such as their job.
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Affiliation(s)
- Grete Moth
- Research Unit for General Practice, Aarhus, Denmark
- CONTACT Grete Moth Research Unit for General Practice, Aarhus, Denmark
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Haraldseide LM, Sortland LS, Hunskaar S, Morken T. Contact characteristics and factors associated with the degree of urgency among older people in emergency primary health care: a cross-sectional study. BMC Health Serv Res 2020; 20:345. [PMID: 32321500 PMCID: PMC7178956 DOI: 10.1186/s12913-020-05219-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 04/13/2020] [Indexed: 01/06/2024] Open
Abstract
Background As the proportion of older people increases, so will the consumption of health services. The aim of this study was to describe the contact characteristics among older people and to identify factors associated with the degree of urgency at the Norwegian out-of-hours (OOH) emergency primary health care services. Methods Inhabitants aged ≥70 years who contacted the OOH service during 2014–2017 in seven OOH districts in Norway were included. We investigated the variables sex, age, time of contact, mode of contact, ICPC-2 based reason for encounter (RFE), priority degree and initial response. We also performed frequency analyses, rate calculations and a log-binomial regression. Results A total of 38,293 contacts were registered. The contact rate/1000 inhabitants/year was three times higher in the oldest age group (≥90 years) compared to the youngest age group (70–74 years). Direct attendance accounted for 8.4% of the contacts and 32.8% were telephone contacts from health professionals. The most frequent RFE chapter used was “A General and unspecified” (21.0%) which also showed an increasing rate with higher age. 6.0% of the contacts resulted in a home visit from a doctor. Variables significantly associated with urgent priority degree were RFEs regarding cardiovascular (Relative risk (RR) 1.85; CI 1.74–1.96), neurological (RR 1.55; CI 1.36–1.77), respiratory (RR 1.40; CI 1.30–1.51) and digestive (RR 1.22; CI 1.10–1.34) issues. In addition, telephone calls from health professionals (RR 1.21; CI 1.12–1.31), direct attendance (RR 1.13; CI 1.04–1.22), contacts on weekdays (RR 1.13; CI 1.06–1.20) and contacts from men (RR 1.13; CI 1.09–1.17) were significantly associated with urgent priority degree. Conclusions This study provides important information about the Norwegian older inhabitants’ contact with the OOH emergency primary health care services. There are a wide variety of RFEs, and the contact rate is high and increases with higher age. Telephone contact is most common. The OOH staff frequently identify older people as having “general and unspecified” reasons for encounters. OOH nursing staff would benefit from having screening tools and enhanced geriatric training to best support this vulnerable group when these individuals call the OOH service.
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Affiliation(s)
- Lisa Marie Haraldseide
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Kalfarveien 31, NO-5018, Bergen, Norway.
| | - Linn Solveig Sortland
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Kalfarveien 31, NO-5018, Bergen, Norway
| | - Steinar Hunskaar
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Kalfarveien 31, NO-5018, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Tone Morken
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Kalfarveien 31, NO-5018, Bergen, Norway
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Foster H, Moffat KR, Burns N, Gannon M, Macdonald S, O'Donnell CA. What do we know about demand, use and outcomes in primary care out-of-hours services? A systematic scoping review of international literature. BMJ Open 2020; 10:e033481. [PMID: 31959608 PMCID: PMC7045150 DOI: 10.1136/bmjopen-2019-033481] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE To synthesise international evidence for demand, use and outcomes of primary care out-of-hours health services (OOHS). DESIGN Systematic scoping review. DATA SOURCES CINAHL; Medline; PsyARTICLES; PsycINFO; SocINDEX; and Embase from 1995 to 2019. STUDY SELECTION English language studies in UK or similar international settings, focused on services in or directly impacting primary care. RESULTS 105 studies included: 54% from mainland Europe/Republic of Ireland; 37% from UK. Most focused on general practitioner-led out-of-hours cooperatives. Evidence for increasing patient demand over time was weak due to data heterogeneity, infrequent reporting of population denominators and little adjustment for population sociodemographics. There was consistent evidence of higher OOHS use in the evening compared with overnight, at weekends and by certain groups (children aged <5, adults aged >65, women, those from socioeconomically deprived areas, with chronic diseases or mental health problems). Contact with OOHS was driven by problems perceived as urgent by patients. Respiratory, musculoskeletal, skin and abdominal symptoms were the most common reasons for contact in adults; fever and gastrointestinal symptoms were the most common in the under-5s. Frequent users of daytime services were also frequent OOHS users; difficulty accessing daytime services was also associated with OOHS use. There is some evidence to suggest that OOHS colocated in emergency departments (ED) can reduce demand in EDs. CONCLUSIONS Policy changes have impacted on OOHS over the past two decades. While there are generalisable lessons, a lack of comparable data makes it difficult to judge how demand has changed over time. Agreement on collection of OOHS data would allow robust comparisons within and across countries and across new models of care. Future developments in OOHS should also pay more attention to the relationship with daytime primary care and other services. PROSPERO REGISTRATION NUMBER CRD42015029741.
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Affiliation(s)
- Hamish Foster
- General Practice and Primary Care, University of Glasgow, Glasgow, UK
| | - Keith R Moffat
- General Practice and Primary Care, University of Glasgow, Glasgow, UK
| | - Nicola Burns
- General Practice and Primary Care, University of Glasgow, Glasgow, UK
| | - Maria Gannon
- General Practice and Primary Care, University of Glasgow, Glasgow, UK
| | - Sara Macdonald
- General Practice and Primary Care, University of Glasgow, Glasgow, UK
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Seeger I, Kreienmeyer L, Hoffmann F, Freitag MH. Cross-sectional study in an out-of-hours primary care centre in northwestern Germany - patient characteristics and the urgency of their treatment. BMC FAMILY PRACTICE 2019; 20:41. [PMID: 30836946 PMCID: PMC6399868 DOI: 10.1186/s12875-019-0929-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 02/26/2019] [Indexed: 11/20/2022]
Abstract
Background Due to the increasing number of non-urgent visits to emergency departments, it is becoming increasingly important to also investigate emergency care in out-of-hours (OOH) primary care. The aim of this study was to provide an insight into the care structures of an OOH primary care centre, to evaluate the reasons for encounter (RFE) and to assess the urgency of the treatment from the physicians´ point of view. Methods In the summer of 2017, we conducted a cross-sectional study over four weeks in the OOH primary care centre of Oldenburg, a city in Lower Saxony with about 160,000 inhabitants. We collected socio-demographic data, RFE and the duration of the complaints. The International Classification for Primary Care 2nd Edition (ICPC-2) was used to categorize symptoms. The attending physicians supplemented information on further treatment (including hospitalization) and the urgency of consultation in the OOH primary care centre. Results A total of 892 of the 1098 OOH patients which were visiting the OOH primary care centre took part in the study (participation: 81.2%). More than half of the patients were between 18 and 39 years old. A quarter of all RFE named by study participants were in the ICPC-2 category “skin”. More than 60% of patients had the symptoms for more than two days before visiting the OOH primary care centre. In 34.5% of all cases no medication was prescribed and one in six patients received further diagnostic tests such as urinalysis and blood tests (15.8%). From the physicians’ point of view, 26.3% of all study participants could have been treated by the family doctor during the regular consultation hours. Conclusion The study shows that in the OOH primary care centre about a quarter of all patients could have waited until regular consultation hours. Mostly young patients used the easily accessible and free care in the OOH primary care centre. Further studies are necessary to better understand the individual reasons of patients to use the OOH primary care centre.
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Affiliation(s)
- Insa Seeger
- Department for Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, D-26111, Oldenburg, Germany.
| | - Laura Kreienmeyer
- Department for Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, D-26111, Oldenburg, Germany
| | - Falk Hoffmann
- Department for Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, D-26111, Oldenburg, Germany
| | - Michael H Freitag
- Department for Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, D-26111, Oldenburg, Germany
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Stegink S, Elliott AM, Burton C. Statistical complexity of reasons for encounter in high users of out of hours primary care: analysis of a national service. BMC Health Serv Res 2019; 19:108. [PMID: 30736776 PMCID: PMC6368808 DOI: 10.1186/s12913-019-3938-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 01/30/2019] [Indexed: 11/10/2022] Open
Abstract
Background Managing demand for urgent and unscheduled care is a major problem for health services globally. A particular issue is that some patients appear to make heavy use of services, including primary care out of hours. We hypothesised that greater variation (statistical complexity) in reasons for attending primary care out of hours services may be a useful marker of patients at high risk of ongoing heavy service use. Methods We analysed an anonymised dataset of contacts with the primary care out of hours care for Scotland in 2011. This contained 120,395 contacts from 13,981 high-using patients who made 5 or more contacts during a calendar year. We allocated the stated reason for each encounter into one of 14 categories. For each patient we calculated measures of statistical complexity of reasons for encounter including the count of different categories, Herfindahl index and statistical entropy of either the categories themselves, or the category transitions. We examined the association of these measures of statistical complexity with patient and healthcare use characteristics. Results The high users comprised 2.4% of adults using the service and accounted for 15% of all contacts. Statistical complexity (as entropy of categories) increased with number of contacts but was not substantially influenced by either patient age or sex. This lack of association with age was unexpected as with increasing multi-morbidity one would expect greater variability in reason for encounter. Between 5 and 10 consultations, higher entropy was associated with a reduced likelihood of further consultations. In contrast, the occurrence of one or more contacts for a mental health problem was associated with increased likelihood of further consultations. Conclusion Complexity of reason for encounter can be estimated in an out of hours primary care setting. Similar levels of statistical complexity are seen in younger and older adults (suggesting that it is more to do with consultation behaviour than morbidity) but it is not a predictor of ongoing high use of urgent care. Electronic supplementary material The online version of this article (10.1186/s12913-019-3938-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sarah Stegink
- Medical School, University of Aberdeen, Aberdeen, UK
| | - Alison M Elliott
- Abertay University, Dundee, UK.,Institute for Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Christopher Burton
- Institute for Applied Health Sciences, University of Aberdeen, Aberdeen, UK. .,Academic Unit of Primary Medical Care, University of Sheffield, Samuel Fox House, Northern General Hospital, Sheffield, S5 7AU, UK.
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Midtbø V, Raknes G, Hunskaar S. Telephone counselling by nurses in Norwegian primary care out-of-hours services: a cross-sectional study. BMC FAMILY PRACTICE 2017; 18:84. [PMID: 28874124 PMCID: PMC5586064 DOI: 10.1186/s12875-017-0651-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 08/09/2017] [Indexed: 11/29/2022]
Abstract
Background The primary care out-of-hours (OOH) services in Norway are characterized by high contact rates by telephone. The telephone contacts are handled by local emergency medical communication centres (LEMCs), mainly staffed by registered nurses. When assessment by a medical doctor is not required, the nurse often handles the contact solely by nurse telephone counselling. Little is known about this group of contacts. Thus, the aim of this study was to investigate characteristics of encounters with the OOH services that are handled solely by nurse telephone counselling. Methods Nurses recorded ICPC-2 reason for encounter (RFE) codes and patient characteristics of all patients who contacted six primary care OOH services in Norway during 2014. Descriptive statistics and frequency analyses were applied. Results Of all telephone contacts (n = 61,441), 23% were handled solely by nurse counselling. Fever was the RFE most frequently handled (7.3% of all nurse advice), followed by abdominal pain, cough, ear pain and general symptoms. Among the youngest patients, 32% of the total telephone contacts were resolved by nurse advice compared with 17% in the oldest age group. At night, 31% of the total telephone contacts were resolved solely by nurse advice compared with 21% during the day shift and 23% in the evening. The share of nurse advice was higher on weekdays compared to weekends (mean share 25% versus 20% respectively). Conclusion This study shows that nurses make a significant contribution to patient management in the Norwegian OOH services. The findings indicate which conditions nurses should be able to handle by telephone, which has implications for training and routines in the LEMCs. There is the potential for more nurse involvement in several of the RFEs with a currently low share of nurse counselling. Electronic supplementary material The online version of this article (doi:10.1186/s12875-017-0651-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Vivian Midtbø
- National Centre for Emergency Primary Health Care, Uni Research Health, Box 7810, NO 5020, Bergen, Norway.
| | - Guttorm Raknes
- National Centre for Emergency Primary Health Care, Uni Research Health, Box 7810, NO 5020, Bergen, Norway.,Regional Medicines Information & Pharmacovigilance Centre (RELIS), University Hospital of North Norway, Box 79, NO 9038, Tromsø, Norway.,Raknes Research, Myrdalskogen 243, NO 5117, Ulset, Norway
| | - Steinar Hunskaar
- National Centre for Emergency Primary Health Care, Uni Research Health, Box 7810, NO 5020, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Box 7804, NO 5018, Bergen, Norway
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