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Background: Patients with exacerbation of asthma and COPD often need instant treatment, and acute hospitalisation may be necessary. The aim of the study was to determine what sort of contact patients had with doctors, and what sort of treatment they received immediately prior to hospitalisation due to exacerbation., Material and Method: A questionnaire was distributed to patients aged over 18 who were hospitalised because of asthma or COPD exacerbation in Helgeland Hospital and the University Hospital of North Norway, Tromsø, between January 2010 and January 2011. The patients answered questions on the duration of the exacerbation, their contact with doctors and their medical treatment prior to hospitalisation., Results: Data received from 100 of the 122 patients were analysed. The median duration of illness prior to the first contact with a doctor was four days. 52 of the patients had contacted their primary doctor first, 40 contacted A&E first, while eight contacted the hospital directly. The first contact with a doctor resulted in the hospitalisation of 56 patients: 21 (40 %) of those who contacted their primary doctor and 26 (70 %) of those who contacted A&E. 41 patients were hospitalised without being clinically examined by the admitting doctor the same day, 32 after a telephone consultation with their primary doctor or an A&E doctor. Patients aged over 70 were more frequently admitted without a clinical examination, as were patients who had been hospitalised previously., Interpretation: Patients with asthma or COPD exacerbation are often hospitalised directly after a telephone consultation with their primary doctor or an A&E doctor.

Background: The Ministry of Health and Care Services developed an action plan for COPD (chronic obstructive pulmonary disorder) in 2006. General practitioners (GPs) have a central role in this plan and use of spirometry for measurement of lung function is important. We wished to study general practitioners' use of spirometry in the three northern counties of Norway., Material and Method: A questionnaire was sent by post to all the GP offices in the region. Those who did not return the questionnaire were contacted by telephone and the researcher filled in the form based on the conversation. The Norwegian Labour and Welfare Administration provided information about the doctors' use of fee categories., Results: We found that 91 % of the GP offices had a spirometer. Support staff did the spirometric measurements in 66 % of the offices and physicians in the rest. Personnel using spirometry had been trained during the last two years in 86 % of the centres., Interpretation: Spirometry is much used in GP offices and support personnel usually do these measurements. Measures to improve the quality of spirometry should be directed towards both doctors and support staff.

Acute cough may cause considerable distress for patients with upper airway infections, and is a symptom commonly presented to doctors. We wanted to assess the evidence basis for pharmacological treatment of this condition. Predefined terms (MeSH and Emtree) and free text were used to search PubMed and Embase for double-blind randomized trials, reviews and guidelines. Little evidence supports the use of guaifenesine, bromhexine and acetylcysteine for acute cough associated with upper airway infections. Likewise, there is insufficient evidence to decide whether noscapine, codeine and ehylmorphine are beneficial for acute cough on this indication. Well-designed randomized controlled trials with valid outcomes are needed to document possible benefits of treatment. Treatment with codeine or ethylmorphine may be at the expense of adverse effects, abuse or dependence.

Background: We wanted to determine the usefulness of chemical dipstick tests and office culture in diagnosing asymptomatic bacteriuria in pregnant women in general practice., Material and Methods: Dipstick and office urine culture were compared with standard culture results from a microbiology laboratory. The comparison was based on 294 urine samples obtained from pregnant women in a standard general practice setting., Results: Asymptomatic bacteriuria was found in 16 out of 294 urine samples. The sensitivity of dipstick tests was less than 30%. The positive predictive value was 100% for the nitrite test and 40% for office culture., Interpretation: Standard urine culture is the only way to diagnose asymptomatic bacteriuria.

Auscultation of the lungs has been a central element in clinical examination since the early part of the nineteenth century. However, the role of the stethoscope in our diagnostic work-up has more and more been challenged by newer diagnostic equipment. Research carried out over the last 30 years has given us new knowledge about the physical basis of lung sounds and the meaning of the sounds. Electronic stethoscopes and computer-based analysis of digital lung sounds are now available. Lungs auscultation findings should be interpreted with caution and be related to the case history and other clinical findings.

In order to evaluate the usefulness of physical examination of the chest in diagnosing bronchial obstruction, 11 doctors recorded their findings in 692 adult chest patients. Spirometry was carried out after the physical examination. Two categories of patients were selected; patients with known or suspected pulmonary disease (n = 209) and patients who had consulted their doctors for other reasons (n = 483). Bronchial obstruction defined as either FEV1 < 70% predicted or FEV1 < 70% of FVC, was found in 74 of the "pulmonary patients" and 55 of the "non-pulmonary" patients. In the group of patients with bronchial obstruction, a pathological or less certain sign of chest disorder was found in 91% of the "pulmonary" patients, and in 42% of the "non-pulmonary" patients (p < 0.000001). Strenuous respiration was registered in 41% of the "pulmonary" patients with bronchial obstruction, whereas sensitivity was only 2% in the other group. Where there were two or more pathological chest findings, the risk of bronchial obstruction occurring was 66% among the "pulmonary" patients, as opposed to 37% in the "non-pulmonary" group. Physical examination of the chest appeared to be very useful in the detection of bronchial obstruction in patients with pulmonary symptoms, but of limited value in screening for bronchial obstruction.

Few published data are available on the quality of diabetic care in Norway. This applies both to general practice and to hospital clinics. We reviewed the notes of 1,876 diabetic patients who were registered with general practitioners in Salten and Rogaland to assess the quality of care with reference to the Norwegian College of General Practitioners' guidelines for diabetic care. 89% of patients were classified as having type-2 diabetes. Hospital clinics were responsible for the care of 93 patients. Analysis of the results showed that during the last 12 months Hb A1c and blood pressure had been measured in 84 and in 86% of those patients under the care of their general practitioner. Some inspection of the foot had been carried out in 45% of the patients, and 37% of the patients had been referred to an ophthalmologist. Guideline targets for glycaemic control had been achieved in 46% of patients younger than 70 years of age (Hb A1c < 7.5%), and in 82% of patients older than 69 years of age (Hb A1c < 9%). Diabetic patients on insulin therapy had the worst glycaemic control. The study shows that the quality of diabetic care is not optimal, examination of the foot, referral for eye examination and glycaemic control of diabetic patients on insulin therapy are examples of areas where improvement is needed.

Correlation between erythrocyte sedimentation rate and C-reactive protein was determined in 239 adult patients in general practice who were suspected of having an infection of the lower respiratory tract. A correlation coefficient of 0.62 (95% CI 0.54-0.69) was found, but there was no association between the results of the two tests when the illness had lasted less than four days. With such a short duration of illness a test for C-reactive protein is to be preferred before erythrocyte sedimentation rate when evaluating lower respiratory tract infections.

We wanted to assess whether routine use of a rapid test for C-reactive protein (CRP) could reduce prescription of antibiotics for adults with possible lower respiratory tract infection. 239 patients were randomized into a CRP group, tested with the rapid test (n = 108) and a control group (n = 121). Before knowing to which group the patient belonged the doctors made a preliminary decision about antibacterial treatment. The C-reactive protein value was then released if the patient belonged to the CRP group, and the therapy could be adjusted in light of the result. Antibacterial courses prescribed during the consultations and in the following three weeks were registered. The clinical course was evaluated by interview after one week and again after three weeks. Antibiotics were prescribed for altogether 56% of the patients in the CRP group and 60% in the control group. The difference was not statistically significant. Prescription of antibiotics was strongly associated with the finding of crackles and wheezes, but not with cough, dyspnoea or chest pain. Slow recovery was associated with high age, absence of fever and a normal value of C-reactive protein. No significant benefit of the CRP test was demonstrated. We discuss whether the doctors made full practical use of the information provided by the test. Bronchial obstruction should probably be considered to be the problem more often in coughing patients with a normal CRP value.

Among 72 adult patients with a diagnosis of acute bronchitis, serological investigation established the presence of an aetiologic agent in 29 (40%). Influenza virus was the most common pathogen. Seven patients had bacterial infection, caused by pneumococci in four patients and Mycoplasma pneumoniae in three. Five of the patients had pneumonia as diagnosed by radiography, and mycoplasmal aetiology was established in one of these. Altogether, 11 patients either had bacterial infection or radiographic pneumonia. Although the doctors' recording of wheezes was strongly associated with prescription of antibiotics (p < 0.0001), wheezes were heard only in two of the 11 patients with pneumonia or bacterial infection, compared with 30 of the 61 patients with viral or unspecified bronchitis. The median value of C-reactive protein (CRP) was 52 mg/l in the 11 patients, significantly higher than < 11 mg/l in the 61 other patients (p < 0.0001). The corresponding values for erythrocyte sedimentation rate were 45 and 14 mm/h (p < 0.0005). The results indicate that certain patients with acute bronchitis should be treated with antibiotics, and that the erythrocyte sedimentation rate and the CRP-test may be useful in detecting which patients this applies to.

In a survey among 3,739 patients belonging to 36 general practices in northern Norway, 33% reported difficult access to their local surgery by telephone. 43% reported difficulty in obtaining access to the doctor once they had obtained contact with the reception. The proportion of patients reporting problems of accessibility by telephone varied greatly, from 5 to 75%. Patients belonging to practices located in towns, with long waiting lists and many doctors, were most dissatisfied with the telephone service. Stable doctor/patient-relationships made direct contact with the doctor easier, while a scheduled time when patients could call the office made direct contact more difficult. We discuss ways to improve accessibility by telephone.

C-reactive protein (CRP) analysis, erythrocyte sedimentation rate and white blood cell count were evaluated as tests in the diagnosis of pneumonia in 84 patients with acute lower respiratory disease. Marked elevated values of CRP were frequently found in pneumonia patients, whereas in most patients with acute asthma, acute exacerbation of chronic obstructive bronchitis and acute bronchitis the values were within the normal range. The combined sensitivities and specificities of the tests were best for CRP, followed by erythrocyte sedimentation rate and white blood cell count.

Among patients consulting general practitioners in northern Norway, 57% had a stable relationship with one doctor, according to answers to a questionnaire. Rather than having a free choice between several doctors, 85% preferred to have a personal doctor. About half the patients wanted the same doctor for the whole family. Even if they had to wait longer for the consultation, 63% would prefer to meet their own doctor. A personal doctor was much less common in northern Norway than in the rest of the country, which could be put down to lower stability in the practices.

Doctors and professional health administrators have been the principal decision-makers and the patients have hardly had any direct influence on the planning and organization of primary health care in Norway. In 1987, in order to draw attention to patient opinions, the Institute of Community Medicine, University of Tromsø, conducted a questionnaire survey among patients attending general practices in North Norway. The question were selected to cover issues in the contemporary debate on the ideology, organization and standards of services of general practitioners. 36 teaching practices in the region were included in the survey. Altogether 3,739 questionnaires were returned, a response rate of over 60%. The respondents reported more than 16,000 consultations during the last year. This paper presents the methods used and the main findings concerning the representativeness of the results and the potential for generalization. Subsequent publications will present detailed results from the study within the framework of patient experiences, preferences and expectations.