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Patients suffering from COPD are often treated with a substantial number of medications due to multimorbidity. The combination of multimorbidity and polypharmacy can make the treatment of individuals with COPD difficult. Although guidelines in recent years have focused on the reduction of inappropriate medication, there is still room for improvement. This review suggests an increased focus on smoking cessation and physical activity in terms of the use of social prescribing to prevent polypharmacy and thereby improve sustainability in patients with COPD., (Published under Open Access CC-BY-NC-BD 4.0. https://creativecommons.org/licenses/by-nc-nd/4.0/.)

This review describes the current Danish guidelines for inhaled asthma treatment. Monotherapy with short-acting beta-agonists (SABA) taken when needed is no longer recommended in asthma therapy for adults due to safety concerns. The recommended first-line treatment is now inhaled corticosteroids (ICS) taken with formoterol or ICS taken with SABA. The choice of inhaler can have a significant impact on compliance and symptom control, and an individualized approach is therefore needed. Biological treatment may be an alternative to oral corticosteroids in selected patient groups.

Patients with personality disorders are common. They often have co-morbid mental and physical illnesses, poor quality of life, and severe social impairment. Yet, these disorders of personality are often undiagnosed. A detailed and carefully taken history and, at best, a structured interview are important for a valid diagnosis, description of dysfunctional traits and for the assessment of severity. An initial psychotherapeutic case formulation is important to enhance alliance and adherence. In case of psychiatric co-morbidities, depending on their severity, they should be treated first.

Changes in vaginal discharge are often caused by imbalance in the vaginal microflora, and laboratory testing is usually of little use, as most microbes detected are commensals. In-office diagnosis in general practice using wet mount microscopy and Amsel criteria is helpful and often sufficient to ensure correct diagnosis and treatment. Laboratory testing of vaginal discharge should only be performed, if sexually transmitted disease is suspected, if there is treatment failure or inconclusive wet mount prior to gynaecological surgery, and in pregnant women with recurrent miscarriage or preterm birth.

In 2014, Institute for Human Rights published the report "Equal access to healthcare - an analysis of general practitioners' meeting with patients from ethnic minorities". General practice may contribute to equal access to healthcare for this group of patients. This is, however, a challenge for general practitioners, and they cannot resolve this alone. We recommend that more research is performed in this topic, that general practice focuses on these challenges, that more knowledge is provided, and that the cooperation between general practice, local municipalities, regions and the secondary sector is optimized.

Patients with complex chronic pain conditions are often difficult to treat with analgesia alone. Psychosocial intervention is needed to help them gain control and find an appropriate level of activity. This article summarizes the possibilities of psychosocial treatment of pain patients at the general practitioners and in specialist units of multidisciplinary pain treatment. The theoretical frame used is cognitive behavioural therapy. In practice, psychoeducation, mindfulness, and relaxation exercises are introduced to the patients to help them with daily life activity and work.

19% of the grown-up Danish population suffer from a chronic pain condition. Most patients are treated by general practi-tioners (GPs), and only a smaller group need specialist treatment. This article goes through the pharmacological possibilities available with a special focus on treatment by GPs. For chronic pain as fibromyalgia and low back pain non-steroidal anti-inflammatory drugs and paracetamol are not recommended on a regular basis. The main pharmacological treatment is tricyclic antidepressants and gabapentinoids. If opioids are needed, long acting drugs are preferred.

Introduction: Christmas is a unique time for family occasions - unfortunately the number of divorces increase in the months after Christmas. In this study, we examined the relationship between medical speciality, length of relationship, risk of divorce and if belief in Santa impacted on these outcomes., Material and Methods: A questionnaire was developed from the lived experiences of the authors and distributed to doctors of any speciality through links (SurveyXact) in emails, text messages and Facebook from June 28 2016 to August 1 2016. Multivariate regression models were used to analyze the results., Results: A total of 1,100 completed questionnaires were included in the analyses. The divorce rate among respondents was 12%. Compared to the speciality "general practice" all other specialities had higher divorce rates. The highest risk of divorce was reported by physicians specialized in psychiatry (odds ratio 2.13 (95% confidence interval: 1.03-4.43)). Belief in Santa was associated with a slightly increased risk of divorce in all medical specialities, with the exception of psychiatry. General practitioners also exhibited the longest duration of relationships compared to peers in other medical specialities., Conclusion: Being a general practitioner was associated with a low risk of divorce and significantly longer relationships than in other medical specialities. Belief in Santa in regard to divorce only seemed to be beneficial for psychiatrists. So please participate in the joy of Christmas but do not rely on Santa - go shop your own presents for the family., Funding: none., Trial Registration: not relevant.

Project Palliation in the Odsherred Municipality is concerned with testing of a cooperation model between Lynghuset, general practice and Pain Centre, Holbæk Hospital. The purpose was to improve the palliative care to people suffering from life-threatening diseases through development of interdisciplinary and cross-sectorial cooperation. The model has shown to contribute to improvements but it also leaves room for further qualification.

A Cochrane review has recently challenged the benefit of health checks. Included studies, screening procedures and treatments were however very heterogeneous and did not fulfil present days standards and most studies were done outside primary care. This review concentrates on research from health checks in Danish general practices focusing on early detection and treatment of risk factors for cardiovascular disease and diabetes. The authors recommend Danish general practitioners to offer opportunistic screening and treatment of people with diabetes and people at risk for cardiovascular disease. Future research questions are highlighted.

Multimorbidity, especially co-morbidity between mental and somatic disorders, represents a growing challenge in general practice. The solution is hardly evermore sophisticated guidelines. The practitioner must improve on basing the clinical assessment of the patient on specific functional ability and need of rehabilitation. This requires allocation of time to handle more than one problem at a time and a close cooperation of treatment between physician, patient and staff. This article points to patient education and involvement of relatives, the use of problem-solving techniques, collaborative care and use of telemedicine tools as possible solutions.

Improving the vulnerable hospital discharge process among older people has been in focus for decades. The economic impact and ease of measurement of all-cause hospital readmission rates have questioned whether they are reducible. This review aimed to identify the efficiency of follow-up home visits after hospital discharge by district nurses in coordination with general practice. Six settings in Denmark have been evaluated in different controlled designs. Results are inconsistent and inconclusive due to selection bias and methods chosen. Targeting and management organisation need further research.

Chronic obstructive pulmonary disease (COPD) is substantially underdiagnosed and under treated. The present review paper discusses the possibilities of early diagnosis by means of spirometry in the setting of Danish general practice. It is concluded that case finding of undiagnosed COPD is feasible by applying opportunistic spirometry in patients with relevant exposures and relevant respiratory symptoms. The potential barriers of this approach and possible solutions are discussed.

Prolonged bleeding or spotting and pain are the most common reasons for women to request early removal of intrauterine device (IUD). We wanted to investigate which parameters influenced the removal of IUDs among women in general practice and to see if there was a difference between copper-releasing IUDs and levonorgestrel-releasing IUDs. In general the women were satisfied with both types of IUDs. More women with copper-releasing IUDs had an early removal because of complaints than women with levonorgestrel-releasing IUDs.

Suboptimal treatment with oral anticoagulation therapy of atrial fibrillation is well-documented. The use of clinical guidelines and databases in general practice can improve adherence to the guidelines stipulated by the Danish Society of Cardiology. However, guidelines should be updated continuously, and in approximately 20% of our patients the application of oral anticoagulation therapy turned out to be problematic, even though they had a high thromboembolic risk score.

The aim of the study was to evaluate the impact of general practitioners (GPs) follow-up of unvaccinated girls in the Danish Human Papillomavirus catch-up vaccination programme. Telephone interviews were conducted with the GPs to explore their follow-up procedure. The girls were divided into two groups: 1) girls contacted by their GP and 2) girls not contacted by their GP. Ten months later 61% of the girls, who had been contacted, had started vaccination in the follow-up group compared to 53% of girls, who had not been contacted (p < 0.02). Follow-up by GPs increased the likelihood of subsequent vaccination in a group of unvaccinated girls.

Though colorectal cancer is one of the most common cancers in Denmark, there is a serious lack of knowledge in general practice about symptom presentation. The prevalence and the positive predictive value of the so-called alarm symptoms are vague, and screening will only detect a small number of cancers per year. In the future, general practice will still play an important role in the diagnosis of colorectal cancer; therefore, knowledge about how the disease presents in general practice is urgently needed, and intervention studies on how to optimize early diagnosis should be encouraged.

The antimicrobial consumption in primary health care has increased notably during the latest decade. The increase has predominantly been among broad-spectrum antimicrobial agents. Denmark is no longer among the European countries with the lowest consumption. The reasons for these changes are not fully explained, but increased dosage for each treated patient and more patients treated have played an important role. To some extent, the consumption meets with relevant quality indicators for antibiotic prescribing, but the use of resistance inducing antibiotics needs to be limited according to guidelines.

Introduction: It is a well-known phenomenon that there is a lack of information about patients' medicines at their admittance to hospital. By using data from the electronic medicine profile (PEM) the extra information is to be evaluated and compared to normal procedure for collecting medicine information., Material and Methods: This cross-section investigation involves patients admitted with acute hip fractures at Amager Hospital, Copenhagen. After registration of the patients' medication history extra information was extracted from PEM with the consent of the patient. Information from medication history, patient, general practitioner, and PEM was compared in order to reach an overall view of the patients' current medicine status., Results: Sixty-three patients participated; 58 gave consent. The average age was 80 years, and the patients used on average five medicaments each, totalling 323 out of which PEM stated the use of 99, which were not supplied by other sources. Out of 39 patients 2.5 lacked medicaments. 55% of these medicaments were estimated to be of significant clinical importance for further treatment. Two patients could have been exposed to a potential lethal occurrence had information from PEM not been applied. Every third drug that PEM added belonged to the Anatomical Therapeutic Chemical-systemets group N, which has the indication for the nervous system, including pain and depression., Conclusion: Information from PEM helps improve medication history. The possibility of wrong medication especially in the form of insufficient medication and interaction due to lack of information on the patients' current medicine is minimised through the use of PEM.

About 85% of cancer patients present with symptoms to general practice. The health care system should be organised in a way that GPs are able to refer patients to timely and early cancer diagnosis. The GP works in an area where symptoms most often are benign and cancer is rare. Only a minority of the symptoms in the population are presented to the GP. The GP must refer many of these knowing that generally the positive predictive value is 2-10%. To be able to ensure the best primary cancer diagnostic pathway we need much more research on symptoms, use of diagnostics and the way to organise this in a health care system where every third citizen will get cancer.