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Natvik M, Gjelsvik B, Vangen S, Skjeie H, Brekke M. Women's information needs about menopause: a cross-sectional survey in Norwegian general practice. BJGP Open 2024; 8:BJGPO.2023.0127. [PMID: 37669803 PMCID: PMC11169972 DOI: 10.3399/bjgpo.2023.0127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/28/2023] [Accepted: 09/01/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Research has indicated that providing women with information about menopause can improve their attitudes towards it and symptom experience. Nevertheless, information shared on the menopause is often arbitrary. AIM To examine women's information needs about menopause, and understand if, when, and from whom they want information. DESIGN & SETTING A cross-sectional study was undertaken. A questionnaire survey was distributed to women in the waiting room of 54 general practice clinics in South-Eastern Norway in autumn 2022. METHOD Medical students recruited women in the clinic waiting rooms. A 1-page study-specific questionnaire was used, focusing on need for information about menopause. A multinominal logistic regression model was used to analyse the association between the desire for information and education level, country of birth, and menopausal status. RESULTS A total of 625 women were included, with a mean age of 44.4 years (standard deviation [SD] 8.7). In all, 59% answered that they wanted information about menopause, and 81% of these wanted their GP to inform them, from a median age of 45 years. According to the women, only 10% of GPs had initiated a discussion on the menopause. Higher education was a predictor for wanting information. A main driver of information needs was to help oneself in the present and in the future. In all, 33% did not want information. The main reasons were that they already possessed sufficient information, would take menopause as it comes, were too young, or were already postmenopausal. The sex of the GP did not influence the results. CONCLUSION Most women wanted information about menopause from their GP. The study emphasises the need for GPs to consider prioritising this discussion, and to keep up to date on recommendations and treatment options.
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Affiliation(s)
- Marianne Natvik
- Department of General Practice, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Bjorn Gjelsvik
- Department of General Practice, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Siri Vangen
- Norwegian Research Centre for Women's Health, Oslo University Hospital & Clinical Medicine, University of Oslo, Norway
| | - Holgeir Skjeie
- General Practice Research Unit, University of Oslo, Norway
| | - Mette Brekke
- General Practice Research Unit, University of Oslo, Norway
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Eide TB, van Poel E, Willems S, Jacobsen FF. Changes in work tasks and organization of general practice in Norway during the COVID-19 pandemic: results from a comparative international study. BMC PRIMARY CARE 2023; 24:227. [PMID: 37898780 PMCID: PMC10613352 DOI: 10.1186/s12875-023-02146-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 08/30/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND The COVID-19 pandemic led to huge and rapid changes in general practice in Norway as in the rest of Europe. This paper aims to explore to what extent the COVID-19 pandemic changed the work tasks and organization of Norwegian general practice. MATERIAL AND METHOD We analysed data from the Norwegian part of the international, cross-sectional PRICOV-19 study, collecting data from general practice via an online self-reported questionnaire. We included 130 Norwegian general practices, representing an estimated 520 Norwegian general practitioners (GPs). All Norwegian GPs were invited to participate. In the analyses, we focused on items related to the use of alternatives to face-to-face consultations, changes in the workload, tasks and delegated responsibilities of both the GPs and other personnel in the GP offices, adaptations in routines related to hygiene measures, triage of patients, and how the official rules and recommendations affected the practices. RESULTS There was a large and significant increase in the use of all forms of alternative consultation forms (digital text-based, video- and telephone consultations). The use of several different infection prevention measures were significantly increased, and the provision of hand sanitizer to patients increased from 29.6% pre-pandemic to 95.1% since the pandemic. More than half of the GPs (59.5%) reported that their responsibilities in the practice had increased, and 41% were happy with the task shift. 27% felt that they received adequate support from the government; however, 20% reported that guidelines from the government posed a threat to the well-being of the practice staff. We found no associations with the rurality of the practice location or size of the municipalities. CONCLUSION Norwegian GPs adapted well to the need for increased use of alternatives to face-to-face consultations, and reported a high acceptance of their increased responsibilities. However, only one in four received adequate support from the government, which is an important learning point for similar situations in the future.
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Affiliation(s)
- Torunn Bjerve Eide
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Esther van Poel
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Quality and Safety Ghent, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Sara Willems
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Quality and Safety Ghent, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Frode F Jacobsen
- Centre for Care Research West, Western Norway University of Applied Sciences, Bergen, Norway.
- VID Specialized University, Bergen, Norway.
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Larsen SM, Eide TB, Brunborg C, Ramstad K. Daytime contacts and general practitioner consultations, and pain as a reason for encounter in children with cerebral palsy; a Norwegian national registry linkage study. Scand J Prim Health Care 2022; 40:474-480. [PMID: 36633354 PMCID: PMC9848342 DOI: 10.1080/02813432.2022.2144992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
AIM The aim of this study was to compare the prevalence of daytime contacts and consultations, and pain as a reason for encounter (RFE) with a general practitioner (GP), in children with cerebral palsy (CP) (cases) to that of the general paediatric population (controls). METHODS The study linked the Norwegian Directorate of Health's database for the control and reimbursement of health expenses, and the Norwegian Quality and Surveillance Registry for Cerebral Palsy, including children born from 1996 to 2012 in the period 2006 to 2018. All daytime contacts were included. International Classification for Primary Care was applied for RFE. RESULTS Cases accounted for 0.46% of all daytime contacts and 0.27% of all daytime consultations, the latter corresponding with the estimated national prevalence of CP. GPs registered more administrative contact and coded pain as an RFE less frequently in consultations with cases (6%) than with controls (12%). INTERPRETATION Children with CP did not consult GPs more than the general paediatric population did. In consultations, GPs should ask for pain even if the child with CP or parent does not address pain. The local multidisciplinary team should encourage the family to consider consulting a GP if the child is in pain.KEY MESSAGESPrevalence of GP consultations in children with CP is similar to that of children in the general population.GPs perform more administrative work for children with CP than for their other paediatric patients.GPs code pain as an RFE less frequently in consultations with children with CP than in consultations with children in the general population.
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Affiliation(s)
- Selma Mujezinović Larsen
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo and Division of Paediatric and Adolescent Medicine, Rikshospitalet, Oslo University Hospital, Oslo, Norway
- CONTACT Selma Mujezinović Larsen Oslo universitetssykehus HF, Rikshospitalet, Barne- og ungdomsklinikken, Postboks 4950 Nydalen, OsloN-0424, Norway
| | - Torunn Bjerve Eide
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Cathrine Brunborg
- Oslo Center for Statistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Kjersti Ramstad
- Division of Paediatric and Adolescent Medicine, Rikshospitalet, Oslo University Hospital, Oslo, Norway
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Wu F, Wang N, Qu Y. Where does residents' choice of primary medical treatment come from?-A logical analysis based on the perspective of service accessibility and residents' cognition. Front Public Health 2022; 10:949622. [PMID: 36324459 PMCID: PMC9618942 DOI: 10.3389/fpubh.2022.949622] [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: 05/21/2022] [Accepted: 09/15/2022] [Indexed: 01/21/2023] Open
Abstract
The uneven distribution of medical and health resources leads to changes in the choice of patients for medical treatment, which is the key to restrict the reform of medical services in China currently. Taking service accessibility and residents' cognition as the starting point, this study utilized the data from the questionnaire and applied logistic regression and mediation test. By taking service accessibility as an explanatory variable and residents' cognition as an intermediary variable, the study examined the differences between residents' choice of medical treatment at the primary and non-primary levels. Thus, the influencing factors of residents' choice of medical treatment at the primary level were explored. The research statistics came from questionnaires of 1,589 residents in Nanjing, Jiangsu Province, China. The results showed that service accessibility and residents' cognition were significantly correlated with the residents' choice of primary medical treatment. Household registration, age, the signing situation with family doctors, hospital service fees, and distance to the hospital were positively related to residents' choice of primary medical treatment; while the reputation, scale, residents' income, and the reimbursement ratio of residents' medical insurance were negatively correlated with the choice. In addition, residents' cognition played an intermediary effect between service accessibility and the residents' choice of primary medical treatment. The signing situation with family doctors indirectly affected the choice of primary medical treatment through residents' cognition, and residents' cognition masked some negative influence of the reimbursement ratio of residents' medical insurance on the choice of primary medical treatment.
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Berge SD, Brekke M, Meland E, Mildestvedt T. How do general practitioners handle couple relationship problems in consultations? A focus group study. Fam Pract 2022; 39:913-919. [PMID: 35179196 PMCID: PMC9508873 DOI: 10.1093/fampra/cmac010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Couple relationship problems are common and associated with health problems. The aim of this study was to explore general practitioners' (GPs') experiences, expectations, and educational needs when dealing with couple relationship problems in consultations. METHODS We conducted an exploratory qualitative study by carrying out 3 semistructured focus group interviews with 18 GPs. We used systematic text condensation for the analyses. RESULTS Participants shared their experiences of handling couple relationship problems in consultations. Three main themes emerged: (i) pragmatic case-finding: golden opportunities to reveal patients' couple relationship problems; (ii) conceptual and role confusion; (iii) professional competence and personal experience. While issues in relationships could serve as an explanation for relevant clinical problems, some GPs questioned whether relationship issues are strictly medical. All participants had engaged in individual supportive therapy, but none saw themselves as therapists. The interviews revealed that an individual supportive focus might lead to a consolidation of 1 partner's view, rather than challenging their position. Long-term doctor-patient relationships made it easier to talk about these issues. CONCLUSIONS This study revealed several paradoxes. GPs are confident in offering individual supportive therapy for couple relationship issues but should be aware of substantial pitfalls such as side-taking and constraining change. Despite dealing with relationship problems, GPs do not see themselves as therapists. They use professional and personal experience but would benefit from increasing their skills in cognitive restructuring promoting behavioural flexibility facing relationship problems.
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Affiliation(s)
- Siri D Berge
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Mette Brekke
- General Practice Research Unit, Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Eivind Meland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Thomas Mildestvedt
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Skyrud KD, Hernæs KH, Telle KE, Magnusson K. Impacts of mild COVID-19 on elevated use of primary and specialist health care services: A nationwide register study from Norway. PLoS One 2021; 16:e0257926. [PMID: 34624023 PMCID: PMC8500442 DOI: 10.1371/journal.pone.0257926] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/13/2021] [Indexed: 12/29/2022] Open
Abstract
AIM To explore the temporal impact of mild COVID-19 on need for primary and specialist health care services. METHODS In all adults (≥20 years) tested for SARS-CoV-2 in Norway March 1st 2020 to February 1st 2021 (N = 1 401 922), we contrasted the monthly all-cause health care use before and up to 6 months after the test (% relative difference), for patients with a positive test for SARS-CoV-2 (non-hospitalization, i.e. mild COVID-19) and patients with a negative test (no COVID-19). RESULTS We found a substantial short-term elevation in primary care use in all age groups, with men generally having a higher relative increase (men 20-44 years: 522%, 95%CI = 509-535, 45-69 years: 439%, 95%CI = 426-452, ≥70 years: 199%, 95%CI = 180-218) than women (20-44 years: 342, 95%CI = 334-350, 45-69 years = 375, 95%CI = 365-385, ≥70 years: 156%, 95%CI = 141-171) at 1 month following positive test. At 2 months, this sex difference was less pronounced, with a (20-44 years: 21%, 95%CI = 13-29, 45-69 years = 38%, 95%CI = 30-46, ≥70 years: 15%, 95%CI = 3-28) increase in primary care use for men, and a (20-44 years: 30%, 95%CI = 24-36, 45-69 years = 57%, 95%CI = 50-64, ≥70 years: 14%, 95%CI = 4-24) increase for women. At 3 months after test, only women aged 45-70 years still had an increased primary care use (14%, 95%CI = 7-20). The increase was due to respiratory- and general/unspecified conditions. We observed no long-term (4-6 months) elevation in primary care use, and no elevation in specialist care use. CONCLUSION Mild COVID-19 gives an elevated need for primary care that vanishes 2-3 months after positive test. Middle-aged women had the most prolonged increased primary care use.
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Affiliation(s)
| | - Kjersti Helene Hernæs
- Norwegian Institute of Public Health, Cluster for Health Services Research, Oslo, Norway
| | - Kjetil Elias Telle
- Norwegian Institute of Public Health, Cluster for Health Services Research, Oslo, Norway
| | - Karin Magnusson
- Norwegian Institute of Public Health, Cluster for Health Services Research, Oslo, Norway
- Faculty of Medicine, Department of Clinical Sciences Lund, Orthopaedics, Clinical Epidemiology Unit, Lund University, Lund, Sweden
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Kjeldsberg M, Tschudi-Madsen H, Mdala I, Bruusgaard D, Natvig B. Patients in general practice share a common pattern of symptoms that is partly independent of the diagnosis. Scand J Prim Health Care 2021; 39:184-193. [PMID: 33905284 PMCID: PMC8293972 DOI: 10.1080/02813432.2021.1913886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To describe self-reported symptoms among patients in general practice and to explore the relationships between symptoms experienced by patients and diagnoses given by general practitioners. DESIGN Doctor-patient questionnaires focusing on patients' self-reported symptoms during the past 7 days and the doctors' diagnoses. SETTING General practices in urban and suburban areas in Southeast Norway. SUBJECTS Forty-seven general practitioners who included 866 patients aged ≥18 years on a random day in practice. RESULTS The most frequently reported symptoms were tiredness (46%), lower back pain (43%), neck pain (41%), headache (39%), shoulder pain (36%), and sleep problems (35%). Women had a significantly higher prevalence than men for 16 of 38 symptoms (p < 0.05). The mean number of symptoms was 7.5 (range, 0-32; women, 8.1; men, 6.5, p < 0.05). Regression analysis showed that patients who received a social security grant had 59% more symptoms than those who were employed and that people with asthenia and depression/anxiety had 44% and 23% more symptoms, respectively than those with all other diagnoses. The patterns of symptoms reported showed similar patterns across the five most prevalent diagnoses. CONCLUSIONS Patients in general practice report a number of symptoms and share a common pattern of symptoms, which appear to be partly independent of the diagnoses given. These findings suggest that symptoms are not necessarily an indication of disease.KEY POINTSPatients consulting general practitioners have a high number of self-reported symptoms.The most frequent symptoms are tiredness, lower back pain, neck pain, headache, shoulder pain, and sleep problems.Patients diagnosed with asthenia and depression/anxiety report the highest number of symptoms.Selected diagnoses show similar patterns in symptom distribution.Symptoms are not necessarily an indication of disease.
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Affiliation(s)
- Mona Kjeldsberg
- General Practice Research Unit (AFE), Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
- CONTACT Mona Kjeldsberg General Practice Research Unit (AFE), Department of General Practice, Institute of Health and Society, University of Oslo, P.O. Box 1130, Blindern, OsloN-0318, Norway
| | - Hedda Tschudi-Madsen
- General Practice Research Unit (AFE), Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Ibrahimu Mdala
- General Practice Research Unit (AFE), Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Dag Bruusgaard
- General Practice Research Unit (AFE), Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Bård Natvig
- General Practice Research Unit (AFE), Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
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Berge SD, Meland E, Brekke M, Bondevik GT, Thuen F, Mildestvedt T. Couple relationship problems-a task for the general practitioner? A cross-sectional survey from Norway. Fam Pract 2021; 38:115-120. [PMID: 32968779 PMCID: PMC8006763 DOI: 10.1093/fampra/cmaa093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND A healthy couple relationship is a predictor of good health. There is a lack of knowledge about what role family and couples counselling should have in general practice. OBJECTIVES To identify the prevalence of patients who have talked, or want to talk, with their general practitioner (GP) about their couple relationship, to investigate what characterizes these patients and to explore whether they believe that couple relationship problems should be dealt with in general practice. METHODS We conducted a cross-sectional survey in 70 general practices in Norway during spring 2019. A questionnaire was answered by 2178 consecutive patients (response rate 75%) in GP waiting rooms. Data were examined using frequencies and linear and logistic regression models. RESULTS We included 2097 responses. Mean age was 49.0 years and 61.3% were women. One in four (25.0%) had already talked with their GP about couple relationship problems, while one in three (33.5%) wanted to talk with their GP about their couple relationship problems. These patients more frequently had experience of divorce, poor self-rated health, an opinion that their couple relationship had a significant impact on their health and lower couple relationship quality when adjusted for age, sex, present marital status and children living at home. We found that 46.4% of patients believed that GPs should be interested in their couple relationship problems. CONCLUSION Relationship problems are frequently addressed in general practice. GPs should be prepared to discuss this issue to facilitate help for couples earlier than they might otherwise expect.
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Affiliation(s)
- Siri Dalsmo Berge
- Department of Global Public Health and Primary Care, University of Bergen, Bergen
| | - Eivind Meland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen
| | - Mette Brekke
- General Practice Research Unit, Institute of Health and Society, University of Oslo, Oslo
| | - Gunnar Tschudi Bondevik
- Department of Global Public Health and Primary Care, University of Bergen, Bergen.,National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen
| | - Frode Thuen
- Centre for Evidence-Based Practice, Western Norway University of Applied Sciences, Bergen, Norway
| | - Thomas Mildestvedt
- Department of Global Public Health and Primary Care, University of Bergen, Bergen
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Iversen HH, Holmboe O, Bjertnaes O. Patient-reported experiences with general practitioners: a randomised study of mail and web-based approaches following a national survey. BMJ Open 2020; 10:e036533. [PMID: 33051230 PMCID: PMC7554501 DOI: 10.1136/bmjopen-2019-036533] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The standard data-collection procedure in the Norwegian national patient experience survey programme is post-discharge mail surveys, which include a pen-and-paper questionnaire with the option to answer electronically. A purely electronic protocol has not previously been explored in Norway. The aim of this study was to compare response rates, background characteristics, data quality and main study results for a survey of patient experiences with general practitioners (GPs) administered by the standard mail data-collection procedure and a web-based approach. DESIGN Cross-sectional survey. SETTING GP offices in Norway. PARTICIPANTS The sample consisted of 6999 patients aged 16 years and older registered with a GP in November 2018. INTERVENTION Based on a three-stage sampling design, 6999 patients of GPs aged 16 or older were randomised to one of two survey administration protocols: Group A, who were mailed an invitation with both a pen-and-paper including an electronic response option (n=4999) and Group B, who received an email invitation with electronic response option (n=2000). MAIN OUTCOME MEASURES Response rates, background characteristics, data quality and main study results. RESULTS The response rate was markedly higher for the mail survey (42.6%) than for the web-based survey (18.3%). A few of the background variables differed significantly between the two groups, but the data quality and patient-reported experiences were similar. CONCLUSIONS Web-based surveys are faster and less expensive than standard mail surveys, but their low response rates and coverage problems threaten their usefulness and legitimacy. Initiatives to increase response rates for web-based data collection and strategies for tailoring data collection to different groups should be key elements in future research.
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Affiliation(s)
| | - Olaf Holmboe
- Division of Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Oyvind Bjertnaes
- Division of Health Services, Norwegian Institute of Public Health, Oslo, Norway
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