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Carlsen LN, Stefansen S, Ahnfeldt-Mollerup P, Højland Jensen R, Saxhaug Kristoffersen E, Møller Hansen J, Lykkegaard J. Diagnostics and management of headache in general practice. Fam Pract 2024; 41:470-476. [PMID: 36308304 DOI: 10.1093/fampra/cmac121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Headache disorders are globally prevalent and insufficient treatment contribute to low quality of life, increased disability, and socioeconomic costs. However, headache can to a large extent be treated appropriately by general practitioners. OBJECTIVE To explore general practitioners' (GPs') management of patients with headache lasting ≥6 months. METHODS In this retrospective descriptive cross-sectional study based on medical audit, all GPs practicing in Vejle municipality (population 116,992), Denmark, were invited to review their latest 20 patients with headache. Outcome measures were headache diagnostics, treatment, and referrals. Factors associated with referral to neurological treatment were examined by logistic regression. RESULTS Of 26 invited practices, 19 participated reporting on 367 patients with lasting headache (71.4% women; mean-age 48.5 years). One hundred and sixty-one patients had migraine (44%; IQR: 28-60%), 140 (38%; IQR: 25-44%) had tension-type headache; 243 (66%; IQR: 50-79%) used simple analgesics, 147 (40%; IQR: 29-59%) triptans, 37 (10%; IQR: 0-14%) opioids, 93 (25%; IQR: 20-35%) were prescribed preventive medication; 176 (48%; IQR: 48-59%) were referred to neurologist, and 92 (25%; IQR: 10-37%) were referred to CT or MRI scan. Associated factors for referral were >1 headache diagnosis (aOR 1.75 [95% CI: 1.05-2.95]; P = 0.03), post-traumatic headache (aOR 2.53 [95% CI: 1.25-5.38]; P = 0.01), unspecific headache (aOR 2.04 [95% CI: 1.08-3.93]; P = 0.03), and using preventive treatment (aOR 2.75 [95% CI: 1.68-4.57]; P < 0.001). CONCLUSION This study provides insights to how GPs manage patients with long-lasting headache. Focus should be on reducing opioids, increasing preventive treatment, and keeping more patients in primary care.
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Affiliation(s)
- Louise Ninett Carlsen
- Danish Headache Center, Rigshospitalet-Glostrup, University of Copenhagen, Glostrup, Denmark
- Danish Knowledge Center on Headache Disorders, Rigshospitalet-Glostrup, Glostrup, Denmark
| | - Simon Stefansen
- Danish Knowledge Center on Headache Disorders, Rigshospitalet-Glostrup, Glostrup, Denmark
| | - Peder Ahnfeldt-Mollerup
- GP Cluster in Vejle, Vejle, Denmark
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Rigmor Højland Jensen
- Danish Headache Center, Rigshospitalet-Glostrup, University of Copenhagen, Glostrup, Denmark
| | | | - Jakob Møller Hansen
- Danish Knowledge Center on Headache Disorders, Rigshospitalet-Glostrup, Glostrup, Denmark
| | - Jesper Lykkegaard
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
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Haase CB, Bearman M, Brodersen JB, Risor T, Hoeyer K. Data driven or data informed? How general practitioners use data to evaluate their own and colleagues' clinical work in clusters. SOCIOLOGY OF HEALTH & ILLNESS 2024; 46:948-965. [PMID: 38156947 DOI: 10.1111/1467-9566.13743] [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: 03/01/2023] [Accepted: 11/24/2023] [Indexed: 01/03/2024]
Abstract
In contemporary policy discourses, data are presented as key assets for improving health-care quality: policymakers want health care to become 'data driven'. In this article, we focus on a particular example of this ambition, namely a new Danish national quality development program for general practitioners (GPs) where doctors are placed in so-called 'clusters'. In these clusters, GPs are obliged to assess their own and colleagues' clinical quality with data derived from their own clinics-using comparisons, averages and benchmarks. Based on semi-structured interviews with Danish GPs and drawing on Science and Technology Studies, we explore how GPs understand these data, and what makes them trust-or question-a data analysis. The GPs describe how they change clinical practices based on these discussions of data. So, when and how do data for quality assurance come to influence their perceptions of quality? By exploring these issues, we carve out a role for a sociological engagement with evidence in everyday medical practices. In conclusion, we suggest a need to move from the aim of being data driven to one of being data informed.
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Affiliation(s)
- Christoffer Bjerre Haase
- Department of Public Health, Section for Health Services Research, University of Copenhagen, Copenhagen, Denmark
- Centre for Research in Assessment and Digital Learning (CRADLE), Deakin University, Melbourne, Victoria, Australia
- Department of Public Health, Centre of General Practice, University of Copenhagen, Copenhagen, Denmark
| | - Margaret Bearman
- Centre for Research in Assessment and Digital Learning (CRADLE), Deakin University, Melbourne, Victoria, Australia
| | - John Brandt Brodersen
- Department of Public Health, Centre of General Practice, University of Copenhagen, Copenhagen, Denmark
- Research Unit for General Practice, Region Zealand, Denmark
- Research Unit for General Practice, UiT The Arctic University of Norway, Tromsø, Norway
| | - Torsten Risor
- Department of Public Health, Centre of General Practice, University of Copenhagen, Copenhagen, Denmark
- Section for General Practice, Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Klaus Hoeyer
- Department of Public Health, Section for Health Services Research, University of Copenhagen, Copenhagen, Denmark
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Jønsson ABR, Martiny FHJ, Søndergaard MK, Brodersen JB, Due TD, Nielsen MH, Bakkedal C, Bardram JE, Bissenbakker K, Christensen I, Doherty K, Kjellberg P, Mercer SW, Reventlow S, Rozing MP, Møller A. Introducing extended consultations for patients with severe mental illness in general practice: Results from the SOFIA feasibility study. BMC PRIMARY CARE 2023; 24:206. [PMID: 37798651 PMCID: PMC10552249 DOI: 10.1186/s12875-023-02152-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 09/05/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND People with a severe mental illness (SMI) have shorter life expectancy and poorer quality of life compared to the general population. Most years lost are due to cardiovascular disease, respiratory disease, and various types of cancer. We co-designed an intervention to mitigate this health problem with key stakeholders in the area, which centred on an extended consultations for people with SMI in general practice. This study aimed to1) investigate general practitioners' (GPs) experience of the feasibility of introducing extended consultations for patients with SMI, 2) assess the clinical content of extended consultations and how these were experienced by patients, and 3) investigate the feasibility of identification, eligibility screening, and recruitment of patients with SMI. METHODS The study was a one-armed feasibility study. We planned that seven general practices in northern Denmark would introduce extended consultations with their patients with SMI for 6 months. Patients with SMI were identified using practice medical records and screened for eligibility by the patients' GP. Data were collected using case report forms filled out by practice personnel and via qualitative methods, including observations of consultations, individual semi-structured interviews, a focus group with GPs, and informal conversations with patients and general practice staff. RESULTS Five general practices employing seven GPs participated in the study, which was terminated 3 ½ month ahead of schedule due to the COVID-19 pandemic. General practices attempted to contact 57 patients with SMI. Of these, 38 patients (67%) attended an extended consultation, which led to changes in the somatic health care plan for 82% of patients. Conduct of the extended consultations varied between GPs and diverged from the intended conduct. Nonetheless, GPs found the extended consultations feasible and, in most cases, beneficial for the patient group. In interviews, most patients recounted the extended consultation as beneficial. DISCUSSION Our findings suggest that it is feasible to introduce extended consultations for patients with SMI in general practice, which were also found to be well-suited for eliciting patients' values and preferences. Larger studies with a longer follow-up period could help to assess the long-term effects and the best implementation strategies of these consultations.
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Affiliation(s)
- A B R Jønsson
- The Section of General Practice and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Center for Health and Society, Department of People and Technology, Roskilde University, Roskilde, Denmark
- Department of Community Medicine, The Arctic University of Norway, Tromsø, Norway
| | - F H J Martiny
- The Section of General Practice and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
- Center for Social Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.
| | - M K Søndergaard
- The Research Unit for General Practice, University of Southern Denmark, Odense, Denmark
| | - J B Brodersen
- The Section of General Practice and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Community Medicine, The Arctic University of Norway, Tromsø, Norway
- Primary Health Care, Region Zealand, Denmark
| | - T D Due
- The Section of General Practice and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - M H Nielsen
- The Section of General Practice and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - C Bakkedal
- The Section of General Practice and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - J E Bardram
- Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - K Bissenbakker
- The Section of General Practice and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - I Christensen
- The Danish Centre for Social Science Research, Copenhagen, Denmark
| | - K Doherty
- Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - P Kjellberg
- The Danish Centre for Social Science Research, Copenhagen, Denmark
| | - S W Mercer
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, Denmark
| | - S Reventlow
- The Section of General Practice and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - M P Rozing
- The Section of General Practice and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - A Møller
- The Section of General Practice and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Rosenbæk F, Riisgaard H, Nielsen JB, Wehberg S, Waldorff FB, Pedersen LB, Søndergaard J. GPs' prescription patterns, experience, and attitudes towards medicinal cannabis-a nationwide survey at the early stage of the Danish test scheme. BMC PRIMARY CARE 2023; 24:17. [PMID: 36650442 PMCID: PMC9843989 DOI: 10.1186/s12875-023-01971-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 01/04/2023] [Indexed: 01/18/2023]
Abstract
BACKGROUND On 1 January 2018 a four-year test scheme concerning use of medicinal cannabis (MC) was enacted. It has recently been extended for four more years by the Danish Parliament permitting all Danish physicians to prescribe MC to their patients. Previous studies have shown that general practitioners (GPs) have varying prescription experience, little knowledge, and mixed attitudes about MC. However, the present evidence is still limited, and no studies exist about Danish GPs' prescription experience, knowledge, and attitudes towards MC. Therefore, our aim was to examine Danish GPs' prescription experience, knowledge, and attitudes towards MC. METHODS A national online survey-based study addressing Danish GPs was performed from September 2018 to July 2019. We performed separate multivariable logistic regression analyses including GPs' prescription experience, knowledge, and attitudes towards MC as outcome variables. RESULTS A total of 427 (38.4%) of 1112 GPs completed the questionnaire. Of these, 37 (8.7%) had experience in prescribing MC. The majority had little or no knowledge about MC (80.6%) as well as a negative view on prescription of MC (71.4%) to patients. Factors associated with prescribing MC to patients were: Single-handed practices (OR = 1.6, 95% CI 1.1;1.8) and perception of having quite some knowledge about MC (OR = 4.8, 95% CI 2.2;10.4). Factors associated with having quite some knowledge about MC were: having a positive attitude towards prescribing MC (OR = 5.2, 95% CI 1.9;14.0), being male (OR = 1.7, 95% CI 1.4;1.8), and being at least 60 years of age (OR = 2.8, 95% CI 1.3;6.0). Factors associated with having a positive attitude towards prescribing MC were: having quite some knowledge about MC (OR = 5.2, 95% CI 2.2;12.5) and GPs being male (OR = 1.7, 95% CI 1.1;1.9). CONCLUSION In this first study on prescription experience, knowledge, and attitudes about MC among Danish GPs, conducted one year after the Danish test scheme was enacted, we find a very low proportion of prescribers, little knowledge, and an overall negative attitude towards MC. Among the prescribing GPs, four in ten have little to no knowledge and a negative attitude towards MC. We stress that prescribing patterns, knowledge, and attitudes may change throughout the remaining time of the test scheme.
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Affiliation(s)
- F Rosenbæk
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, Odense C, 5000, Denmark.
| | - H Riisgaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, Odense C, 5000, Denmark
| | - J B Nielsen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, Odense C, 5000, Denmark
| | - S Wehberg
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, Odense C, 5000, Denmark
| | - F B Waldorff
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, Odense C, 5000, Denmark
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - L B Pedersen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, Odense C, 5000, Denmark
- Department of Public Health, DaCHE - Danish Centre for Health Economics, University of Southern Denmark, Winsløws Vej 9B, Odense C, 5000, Denmark
| | - J Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, J.B. Winsløws Vej 9A, Odense C, 5000, Denmark
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