Ny kunnskap i allmennmedisin - presentasjon av sammendragene fra forskningsdagen på Nidaroskongressen 2015.

Ny kunnskap i allmennmedisin Presentasjon av sammendragene fra forskningsdagen på Nidaroskongressen 2015. . REOi G ERT AV ELIN OLAUG RDSVD LD• Avdelingfor allmennmedisin, Instituttfor helse og samfunn, Universitetet i Oslo På forskningsdagen på Nidaroskongressen 2015 ble det presentert mennmedisin». Elin Høien Bergene fikk mange spennende foredrag fra forskning i norsk allmennmedisin. AMFF-prisen for presentasjonen «Strate. gies to give children bad tasting medici.Prosjektene spente fra innvandreres bruk forskningsprisene -AFU-prisen som går nes». av legevakt til allmennlegers erfaringer til relativt ferske forskere, og AMFF-pri.Mer om de to prisbelønte prosjektene og med kliniske retningslinjer. I tillegg pre.sen som går til forskere på PhD-nivå. I år den øvrige forskningen som ble presentert senterte Bente Mjølstad sin doktorgrad. var det Inger Lyngstad som mottok AFU.på Nidaroskongressen 2015, kan du lese i De som deltok med frie foredrag kon.prisen for sin presentasjon «Uønskede sammendragene som vi presenterer i dette kurrerte om de to allmennmedisinske hendelser og pasientskader i norsk all-nummeret av Utposten. General practitioners still commonly prescribe benzodiazepines, z-hypnotics and opioid analgesics for elderly patients without face-to-face contacts. The prescription peer academic detailing (rx-pad} study. ANNE CATHRINE SUNDSETH1 , SVEIN GJELSTAD1 , JØRUND STRAAND1 , ELIN D. RDSVDLD1 1 Deportment of General Proctice/Fomily Medicine, Institute of Health and society, University of Oslo, Oslo, Norway. BACKGROUNO Elderly people are at particular risk of side effects from use of benzodiazepines, z-hyp.notics and opioid-analgesics (BZO-drugs) in terms of dependency, oversedation, falls and fractures. Still, many elderly use these drugs. National guidelines recommend that the general practitioners (GPs) should see the patients for both initial and repeat prescriptions of BZO-drugs, and prescri.bing of small quantum packages and low doses should be preferred. Furthermore, the treatment should aim for short-term or intermittent use. The extent to which cur.rent practice complies with these recom.mendations is not known. PURPOSE To describe and assess Norwegian GPs' prescription patterns of BZO-drugs to el.derly patients. MATERIAL AND METHODS Contact-and prescription data from 148 Norwegian GPs for patients 1 70 years of age during an eight-months period in 2009. The patient-doctor contacts were categori.zed as direct (face-to-face office-consulta.tions and home-visits) and indirect (via third party, phone or mail) contacts. Expla.natory variables were characteristics lin.ked to the GPs, their practices, patients and the drugs prescribed. RESULTS Z-hypnotics were most commonly prescri.bed, both during indirect and direct doctor.patient contacts. More than 60 per cent of prescriptions of BZO-drugs to elderly pati.ents were issued during indirect GP-patient contacts, two thirds were for packages of 50 tablets or more. Prescribing during indirect contacts was associated with relatively low over all practice activity and a high number of listed older patients. CONCLUSIONS Norwegian GP's BZO-drug prescribing to el.derly patients still conflict with repeated na.tional guidelines as the ordinations most fre.quently take place duringindirect GP-patient contacts and typically are issued as relatively large quantum packages by each prescripti.on. The prescription patterns further indica.te that BZO-drugs commonly are prescribed as long term therapy, and not for short-tenn.ar intermittent use as recommended. li:• UTPOSTEN 3 • 2016 ABSTRACTS Uønskete hendelser og pasientskader i norsk allmennmedisin? INGER LYNGSTAD1, ELLEN T. DELIKÅS2, BJØRNAR NYEN3 1, Ringerike medisinske senter, Hønefoss, 2 Akershus universitetssykehus HF. 3 Porsgrunn kommune BAKGRUNN Det har vært arbeidet lite systematisk med pasientsikkerhet i norsk allmennmedisin, i fastlegeordningen og primærhelsetjenes.ten for øvrig. Det er ingen meldeplikt for uønskete hendelser og pasientskader i pri.mærhelsetjenesten. En britisk oversiktsar.tikkel fra 201 r viser at det sannsynligvis forekommer pasientskade ved en til pro.sent av konsultasjoner i primærhelsetje.nesten og at internasjonal erfaring viser at halvparten av skadene som oppstår i helse.tjenesten sannsynligvis kan unngås. Formålet med min undersøkelse var å studere metoden «Primary Care Triggertool» for måling av pasientskader i en norsk fastlegepraksis og vurdere om meto.den kan brukes i forbedringsarbeid i pri.mærhelsetjenesten. MATERIALE OG METODE Trigger tool metoden er en retrospektiv gransking av et tilfeldig utvalg av pasient.journaler, hvor det benyttes definerte kri.terier til å finne fram til journaler som do-kumenterer mulige pasientskader. Pasientsikkerhetsprogrammet brukes me.toden Global Trigger Tool ved alle landets helseforetak for å kartlegge forekomst av pasientskader. Primary Care Trigger Tool er utviklet i England og ble publisert i 2009 av National Health Service. Jeg inkluderte alle de 57 pasientene over 70 år fra min fastlegeliste i perioden 2011.2012. Resultater og konklusjon ble presentert muntlig på Nidaroskongressen. Strategies to give medicines to children who refuse -a qualitative study of parental online discussion forums ELIN HØIEN BERGENE'·', TORSTEIN BAADE RØ3 • 4 , ASLAK STEINSBEKK1 1 Oeportment of Public Heo/th ond General Proctice, Norwegian University of Science ond Technology, Trondheim, Norway,• 2 Central Norway Phormocy Trust, Trondheim, Norway• 3 Oeportment of Cancer Reseorch ond Mo/ecu/or Medicine, Norwegian University of Science ond Technology, Trondheim, Norway• 4 Deportment of Pediotrics, St. Olov's Hospital, Trondheim University Hospital, Norway AIM fied with threads from an English langua.wards or threats, changing the medicines' The aim of this study was to describe stra.ge forum. palatability, or diverting the child's atten.tegies parents use when giving medicines tion. 3) Forced administration -restraining to children who refuse to take them. RESULTS the child and forcing it to swallow the Parents chose different ways to give medi.medicine. MATERIAL AND METHOOS cines to children who resisted, depending A qualitative study of parents' postings on on the children's age and development and CONCLUSION discussion forums. Google was used to the parents' attitude towards medication Parents use a variety of strategies to give identify threads from a Scandinavian in.and child rearing. The findings were cate.medicines to children who resist. Health ternet forum where parents discussed gi.gorized into three main strategies: r) Hid.professionals should be aware of parents' ving medicines to resisting children. The den administration -in food or while the need for advice, but that there is no ane threads were analyzed using systematic child was sleeping or distracted, 2) Open size fit all approach on how to give bad tas.text condensation. The analysis was veri-administration -by negotiation with re-ting medicines to children. Gp's attitudes towards participating in emergency medicine: a qualitative study MAGNUS HJDRTDAHL1 , PEDER HALVORSEN', METTE BECH RISØR' IGeneraf Practice Reseorch Unit, University of Tromsø, The Arctic University of Norway BACKGROUNO RESULTS te on a regular basis was seen as vital to Whether general pract1t10ners (GPs) The GPs felt that their role had changed maintain their skills. should accompany the ambulance to pre.during the last decades, resulting in less ex.The GPs had difficulties explaining how hospital call outs is a matter of controver.perience and more uncertainty. Also the to decide whether to participate in call sy. We aimed to gain insight into GPs' atti.Emergency Medical Technician teams outs. Decisions were perceived as difficult tudes towards participating in call outs. (EMT) had evolved and they now function due to insufficient information. GPs wor. without a physician. king in casualty clinics located dose to MATERIAL AND METHOOS The GPs wanted to participate in call EMT stations reported more participation.Focus group interviews with GPs at four outs since this improved patient care and rural or remote casualty clinics in Norway the community appreciated it. Due to am.CONCLUSION were analysed using thematic analysis as bulances being absent for extended peri.The GP's role in emergency medicine has . described by Braun and Clarke. ods of time, GPs sometimes must handle changed, but is still important in the local call outs alone. Consequently, being on-si-community. I UTPOSTEN 3 • 2016 Mfl ABSTRACTS General practitioners' experiences with multiple clinical guidelines: a qualitative study from Norway BJARNE AUSTAD1 ·2, IRENE HETLEVIK', BENTE PRYTZ MJ0LSTAD2 ·3, ANNE-SOFIE HELVIK2 ·4 1 Sjøsiden Legesenter, Trondheim • 2 Allmennmedisinsk forskningsenhet, Institutt for samfunnsmedisin, NTNU, Trondheim• 3 Saksvik Legesenter; Hundhamaren• 4 Avdeling for øre-Nese-Hals, St Olavs Hospital, Trondheim BACKGROUNO It is well known that general practitioners (GPs) often do not adhere to clinical guide.lines, but reasons for this seem complex and difficult to understand. Limited rese.arch focuses on the total amount of clini.cal guidelines as they appear in general practice. The aim of this study was to getin-depth information by exploring Norwe.gian GPs' experiences and reflections on the use of multiple clinical guidelines in their daily work. METHOOS A qualitative focus group study based on a purposeful sample of 25 Norwegian GPs within four preexisting groups. The GPs' work experience varied from recent gra.duates up to 35 (mean 9.6) years. The inter.views were analyzed with systematic text condensation which is a phenomenologi.cal approach. RESULTS r) The GPs considered clinical guidelines to be necessary and to provide quality and safety in their clinical practice. 2) However,they found it difficult to adhere to them due to guideline overload, guidelines that were inaccessible and overly large, and be.cause of a mismatch between guidelines and patients' needs. Adherence was especi.ally difficult in multimorbid patients whe.re several guidelines were expected to be applied at the same time. 3) The discrepan.cy between judging guidelines as necessa.ry but difficult to adhere to, created dilem.mas for the practitioners. The GPs handled these by using their clinical judgement and by putting a greater focus on the pati.ents' complaints and quality oflife than on adhering to guidelines. CONCLUSIONS The GPs provided compelling reasons for low adherence to clinical guidelines despi.te considering them to be necessary. This challenge the idea that quality of care in general practice is largely synonymous with adherence to guidelines for singledise ases. The impact of sex and age on the performance of FINDRISC. The HUNT DE-PLAN Study in Norway 35 4 ANNE J0LLE1 , KRISTIAN MIDTHJELL1 , JOSTEIN HDLMEN1 , JAAKKD TUDMILEHTD2 ·, SVEN MAGNUS CARLSEN4 ·, JONATHAN SHAW6 , BJØRN .. ÅSVDL0 1 . 1 HUNT Reseorch Centre, Deportment of Public Heolth ond Gener./ Proctice, Foculty of Medicine, Norwegian University of Science ond Technology, Levanger, Norway.• 2 Oeportment for C/inico/ Neurosciences ond Preventive Medicine, oonube University Kre ms, Austria. • 3 University of Helsinki. • 4 oeportment of Endocrino/ogy, St Olavs Hospital, Trondheim University Hospital, Trondheim, Norway• 5 Unit for App/ied Clinico/ Reseorch, Institute for Cancer Reseorch ond Mo/ecu/or Medicine, Norwegian University of Science ond Technology, Trondheim, Norway• 6 Boker /Dl, Heart ond Diabetes Institute, Melbourne, Australia INTROOUCTION FINDRISC (1 15) among 47,694 adults in the for any form of IGM. The PPV for IGM was The Finnish Diabetes Risk Score (FIN.HUNT3 Survey (2006-08). Among 2,559 lower in women (3 r.2 per cent) than in DRISC) is recommended as a screening participants who participated in oral glu.men (40.4 per cent), and increased from tool for diabetes risk. However, there is cose tolerance testing, we estimated the 19.r per cent at age 20-39 to 55.5 per cent at lack of well-powered studies examining PPV of elevated FINDRISC for identifying age 1 80 years. the performance of FINDRISC by sex and unknown prevalent diabetes and other age. forms ofIGM. CONCLUSION FINDRISC identified more women than AIMS RESULTS men as high-risk individuals for diabetes. To estimate, by sex and age, the prevalence The prevalence of elevated FINDRISC was FINDRISC had a high PPV for detectingof elevated FINDRISC and the positive pre.12.r per cent in women and 9.6 per cent in prevalent IGM, and the PPV was higher in dictive value (PPV) of FINDRISC for identi.men, and increased from r.5 per cent at age men than women and in older than youn.fying impaired glucose metabolism (IGM) 20-39 to 25.r per cent at age 70-79 years. ger individuals. Our data indicate that the in a general Norwegian population. The PPVs of elevated FINDRISC were 9.8 impact of sex and age on diabetes risk is per cent for diabetes, 16.9 per cent for im.not adequately captured byFINDRISC, and METHOOS paired glucose tolerance, 8.2 per cent for that refinements to it might improve dia.We estimated the prevalence of elevated impaired fasting glucose, and 34.9 per cent betes prediction. Knowing patients as persons. A theory-driven qualitative study of the relevance of person-related knowledge in primary health care MJØLSTAD, BENTE PRYTZ • Allmennmedisinsk forskningsennet lnstitutt forsomfunnsmedisin, NTNU BAKGRUNN Fastleger følger pasienter over tid og har sinsk relevant, blir den sjelden overført til mulighet til å bli kjent med deres personli.annet helsepersonell når pasienter henvi.ge bakgrunn (biografi) og livssituasjon. ses. Prosjektet utforsker hva allmennlegers Selv om slik kunnskap kan være medi-personrelaterte kunnskap består av og be- 11•• UTPOSTEN 3 • 20161 tydningen av å overføre og vektlegge slik kunnskap når pasienter skal rehabiliteres. MATERIALE OG METODE Fokusgruppeintervjuer med to grupper all.mennleger (senior og junior) og en interven.sjonsstudie på et sykehjem hvor nipasienter,respektive fastleger og helsepersonell deltok. I intervensjonstudien ble det gjort telefonin.tervju av fastlegen og dybdeintervju av pasi.enten for å få informasjon om pasienten som ABSTRACTS Use of emergency care services by immigrants-a survey of walk-in patients who attended the Oslo Accident and Emergency Outpatient Clinic 2 SVEN El RIK RUUD1 ·, RUTH AGA3 , BÅRD NATVI G1 , PER HJDRTDAH L 1 I IOepartment of General Practice, Institute of Health and society, University of Oslo, Norway• 2 oepartment of Emergency General Proctice, City of Oslo Heo/th Agency, Oslo, Norway• 3 Section for Orthopoedic Emergency, Oslo University Hospital, Norway BACKGROUNO The Oslo Accident and Emergency Outpatient Clinic (OAEOC) experienced a 5-6 per cent an.nual increase in patient visits between 2005 and 2orr, which was significantly higher than the 2-3 per cent annual increase among regis.tered Oslo residents. This study explored immi.grant walk-in patients' use of both the general emergency and trauma clinics of the OAEOC, and their self-reported affiliationwith the regu.lar general practitioners (RGP) scheme. MATERIAL AND METHOOS A cross-sectional survey of walk-in patients attending the OAEOC during two weeks in September 2009. We analysed demographicdata, patients'self-reported number of OAE.OC and RGP consultations during the prece.ding 12 months and self-reported affiliation with the RGP scheme. The first approach used Poisson regressionmodels to study visit frequency. The second approach compared the proportions of first-and second-generati.on immigrants and those from the four most frequently represented countries (Sweden,Pakistan, Somalia and Poland) among the pa.tient population, with their respective pro.portions within the general Oslo population. RESULTS The analysis included 3,864 patients: 1,821 attended the general emergency clinic and 2,043 the trauma clinic. Both first-and se.cond-generation immigrants reported a sig.nificantly higher OAEOC visit frequencycompared with Norwegians. Norwegians, re.presenting 73 per cent of the city population,accounted for 6 5 per cent of OAEOC visits. In contrast, first-and second-generation immi.grants made up 27 per cent of the city popu.lation but accounted for 35 per cent of OAE.OC visits. This proportional increase in use was primarily observed in the general emer.gency clinic (42 per cent of visits). Their pro- Should pulse oximetry be included in GPs' assessment of patients with obstructive tung disease? LENE G DALBAK 1 · 2 , J0 RUND STRAAN D2 , HASSE M ELBYE1 I l General Practice Research Unit, oepartment of community Medicine, University of Tromsø, Norway• 2 Oeportment of General Proctice, Institute of Heolth ond Society, University of Oslo, Norway OBJECTIVE To explore associations between decreased pulse oximetry values (SpO2) and clinical,laboratory, and demographic variables in general practice patients diagnosed with asthma or chronic obstructive pulmonarydisease (COPD) including COPD and asthma in combination. DESIGN/SETTING A cross-sectional study in seven Norwegi.an general practices, of patients aged 40 years or more diagnosed by their general practitioner (GP) with asthma or COPD. The patients were examined during a sta.ble phase of their disease. Patients diagno.sed with COPD (including COPD/asthma in combination) and those diagnosed with asthma only, were analyzed separately. MAIN OUTCOME MEASURES Decreased SpO2 values (,;;95 per cent and ,;;92 per cent). RESULTS Of 372 included patients (mean age 61.5 ye.ars, 62 percentfemales), 82 (22.opercent) had SpO2,;; 95 per cent among which r r had SpO2 ,;; 92 per cent. In both asthma and COPD pati.ents, SpO2 ,;;95 per cent was significantly as.sociated with reduced lung function (spiro.metry), a diagnosis of coronary heart disease,and older age (;,,65 years). Haemoglobin abo.ve normal was associated with SpO2 ,;;95 per cent in the COPD group. These associations were confirmed by multivariable logistic re.gression, where FEV1 per cent predicted ,,;;50 was the strongest predictor of SpO2 ,;;95 per cent (OR 6.8, 95 per cent CI 2.8-16.4). CONCLUSION Pulse oximetry represents a diagnostic ad.junct in assessing the severity of obstructi.ve pulmonary disease. Decreased pulse oximetry values in asthma and/or COPD patients during stable phases should prompt the GPs to consider revising diag.nosis and treatment and to look for co.morbidity. person. Det ble laget biografiske journalno.tat til bruk under oppholdet. Både fastlege og pasient vurderte hva som var vesentlig å vektlegge i rehabiliteringsprosessen. RESULTAT Allmennlegene i fokusgruppene hevdet å ha personrelatert kunnskap om sine pasi.enter og vektla den som viktig; senior leger i større grad enn juniorer (artikkel I). Inter.vensjonsstudien viste at allmennlegene faktisk hadde begrenset kunnskap om sine pasienter som personer selv ved langvarigelege-pasient relasjoner (artikkel II). Til tross for institusjonens intensjon om å individu.alisere behandlingen, var tilnærmingen i stor grad standardisert og tok i liten grad hensyn til allmennlegenes anbefalinger og pasientenes individuelle ønsker. DISKUSJON Avhandlingen belyser behovet for en mer portional use of the trauma clinic (29 per cent) was similar to their proportion in the city. Among first-generation immigrants only 7 r per cent were affiliated with the RGP system, in contrast to 96 per cent of Norwegi.ans. Similar finding were obtained when im.migrants were grouped by nationality. Com.pared to Norwegians, immigrants from Sweden, Pakistan and Somalia reportedusing the OAEOC significantly more often. Immigrants from Sweden, Poland and Soma.lia were over-represented at both clinics. The least frequent RGP affiliation was among im.migrants from Sweden (32 per cent) and Po.land (65 per cent). CONCLUSIONS In Norway, immigrant subgroups use emer.gency health care services in different ways.Understanding these patterns of health.seeking behaviour may be important when designing emergency health services. fleksibel og person-senteret tilnærming til pasienter. Ulike tilnærminger til hvordan personen kan gjeninnføres i medisinen diskuteres, herunder en humanistisk og en teknologisk variant av persontilpasset me.disin, foruten narrativt basert medisin. DISPUTAS: 03.09.2015-Ph.d i samfunnsmedisin VEILEDERE: Professor Irene Hetlevik dr.med., Professor Anna Luise Kirkengen dr.med,Professor Linn Getz ph.d. I UTPOSTEN 3 • 2016 ill