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Objective To examine the occurrence of and types of defensive medicine (DM), and the reasons for practicing DM in general practice. Design Prospective survey registration of consecutive consultations regarding defensive medicine defined as: Actions that are not professionally well founded but are carried out due to demands and pressure. The GPs registered the degree of defensiveness, the type(s) of defensive action(s) and the reason(s) for acting defensively. Setting Danish general practice. Subjects A total of 26 GPs registered a total of 1,758 consultations. Main outcome measures Defensive medical actions. Results Defensive actions were performed in 12% (210/1749) of all consultations. A fifth (46/210) of the defensive actions were characterised by the GPs as ‘moderately’ or ‘highly’ defensive. Frequent types of defensive actions were: blood tests, point-of-care-tests (POCTs) and referrals. Common reasons for defensive actions were: Influence from patients, 37% (78/210), concerns of overlooking severe disease, 32% (67/210) and influence from patient relatives, 12% (25/210). Conclusion Danish GPs registered self-perceived defensive actions in a prospective survey. DM was carried out in one out of eight consultations, most often due to patient influence. The most frequent defensive actions were blood tests, POCTs and referrals.

Objective: To assess general practitioners’ (GPs’) information-seeking behaviour and perceived importance of sources of scientific medical information and to investigate associations with GP characteristics. Design: A national cross-sectional survey was distributed electronically in December 2013. Setting: Danish general practice. Subjects: A population of 3440 GPs (corresponding to approximately 96% of all Danish GPs). Main outcome measures: GPs’ use and perceived importance of information sources. Multilevel mixed-effects logit models were used to investigate associations with GP characteristics after adjusting for relevant covariates. Results: A total of 1580 GPs (46.4%) responded to the questionnaire. GPs’ information-seeking behaviour is associated with gender, age and practice form. Single-handed GPs use their colleagues as an information source significantly less than GPs working in partnership practices and they do not use other sources more frequently. Compared with their younger colleagues, GPs aged above 44 years are less likely to seek information from colleagues, guidelines and websites, but more likely to seek information from medical journals. Male and female GPs seek information equally frequently. However, whereas male GPs are more likely than female GPs to find that pharmaceutical sales representative and non-refundable CME meetings are important, they are less likely to find that colleagues, refundable CME meetings, guidelines and websites are important. Conclusion: Results from this study indicate that GP characteristics should be taken into consideration when disseminating scientific medical information, to ensure that patients receive medically updated, high-quality care.KEY POINTS Research indicates that information-seeking behaviour is associated with GP characteristics. Further insights could provide opportunities for targeting information dissemination strategies. Single-handed GPs seek information from colleagues less frequently than GPs in partnerships and do not use other sources more frequently. GPs aged above 44 years do not seek information as frequently as their younger colleagues and prefer other information sources. Male and female GPs seek information equally frequently, but do not consider information sources equally important in keeping medically updated.

Background Pregnancy vulnerability contributes to poor perinatal mental health. Proper cross-sectoral collaboration may mitigate perinatal mental health problems. General practitioners (GPs) often face barriers when assessing pregnancy vulnerability, but little is known about GPs’ perceived barriers to the cross-sectoral collaboration on vulnerable pregnant women.Objective To explore GPs’ barriers to cross-sectoral collaboration on pregnant women with vulnerabilities, and how barriers are associated with the organization of antenatal care (ANC) and general practice characteristics.Design, setting and subjects A cross-sectional questionnaire study among Danish GPs (n = 3465).Main outcome measures Descriptive statistics according to the Theoretical Domains Framework describes the barriers to collaboration. Analytical statistics with ordered logistic regression models demonstrate associations between selected barriers (the main outcome measures) and organization of ANC, GP and practice, characteristics.Results A total of 760 GPs (22%) participated. Perceived GP barriers to collaboration were lacking knowledge of ANC levels relevant to vulnerable pregnant women, insufficient information on vulnerability indicators from collaborating parties, heavy workload and insufficient remuneration for collaborative meetings. Being young were associated with insufficient GP knowledge of ANC levels. Old age was associated with less likelihood of experiencing heavy workload as a barrier.Conclusions Barriers to collaboration on vulnerable pregnant women were associated with some GP-organizational characteristics including low experience in collaborating with partners in ANC, and GP characteristics, such as age. Reducing general practice workload, e.g. by reorganizing priority areas, releasing more time to vulnerable patients, and improving cross-sectoral information sharing on vulnerability might improve collaboration on vulnerable pregnant women.

Objective To assess (i) the pattern of antibiotic prescribing in Danish general practice, (ii) the use of diagnostic tests [point-of-care (POC) and tests analysed at the hospital laboratory (laboratory tests)], and (iii) the frequency of diagnostic testing in relation to antibiotic prescriptions. Design Retrospective cross-sectional register-based study. Setting General practice in a geographical area of Denmark covering 455,956 inhabitants. Subjects We studied redeemed antibiotic prescriptions and performed diagnostic tests in general practice from 2013 to 2017 among inhabitants in nine selected municipalities. Main outcome measures Frequency of antibiotic courses. Frequency and type of diagnostic testing performed in relation to types of antibiotics. Results A total of 783,252 antibiotic courses were redeemed from general practice with an overall decrease of 19% during 2013–2017. Diagnostic testing increased by 6% during this period. POC tests comprised the majority of performed diagnostic tests (83%) with C-reactive protein (CRP) as the most frequently used test. A 27% increase in the use of laboratory tests was observed. Tests were performed in relation to 43% of all antibiotic courses; most in relation to prescriptions for sulphonamide and trimethoprim (57%) and rarely when prescribing tetracyclines (10%). Conflicting with national guidelines, Danish GPs prescribed fluoroquinolones without performing any kind of diagnostic testing in 48% of the cases. Conclusions This study provides an overview of the use of diagnostic tests in relation to antibiotics and creates basis for further research into the variability between types of antibiotics. The study indicates that there is room for improvement to use diagnostic tests as an aid to promote prudent antibiotic use.KEY POINTS Diagnostic tests (point-of-care or tests analysed at the hospital laboratory), can increase diagnostic certainty and lead to a reduction in antibiotic use in general practice. A decrease in antibiotic courses in general practice in Denmark was observed during 2013–2017, while the use of diagnostic tests increased. A diagnostic test was performed in relation to 43% of antibiotic courses. Only 52% of prescribed fluoroquinolones was related to a diagnostic test, conflicting with national guidelines.