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Burnout is characterized by emotional exhaustion, depersonalization and reduced personal accomplishment. In agreement with international studies, Danish figures have revealed an increase in prevalence of severe burnout from 2.8% in 2004 to 5.3% in 2012. There is only little research on the consequences for the burned-out general practitioner (GP) and his patients as well as on appropriate intervention strategies. Even though burnout appears to be caused by a combination of personality factors and environmental conditions, the literature has one-sidedly focused on the resilience of the individual GP.

Every year one fourth of the young Danish population is tested for urogenital Chlamydia trachomatis--mostly as part of opportunistic testing. The rationale is that asymptomatic infections may reduce reproductive capacity in women and that screening may reduce the burden of disease in the population. Systematic reviews documented lack of conclusive evidence for reproductive complications after asymptomatic infections and lack of evidence concerning the effect of screening on long-term sequelae. Routine opportunistic testing should be replaced by research protocols aiming to evaluate the effect of such interventions.

Introduction: Patients' experiences constitute a significant part of the quality assessment of general practice care. The aim of the present study was to examine the patients' assessment of their general practitioners (GPs) and to determine to which extent the assessments were associated with patient characteristics., Material and Methods: A survey among patients registered with the participating GPs assessing 23 aspects of the GP-patient relationship, medical care, information and support, organisation of care and accessibility. Analyses of associations between the assessments and patient characteristics., Results: The most positively assessed aspect was confidentiality in the GPs' record keeping followed by aspects of empathy and precision, while the poorest evaluations were given to GP and practice availability by phone and amount of waiting time in the waiting room. Elderly patients, frequent attenders, patients who had a long history with the GP and patients with a good self-rated health were those who were most satisfied in general. The significance of patient gender and educational level was more complex. Patients suffering from chronic heart, endocrine or cancer diseases were more satisfied than patients without a chronic condition., Conclusion: Our results may be used for ongoing adjustment of care to the needs of groups of patients - while keeping in mind the individual patient's needs.

Introduction: The aim of the present study was to examine to which extent the patients' assessment of their general practitioner was associated which the gender and age of the physician., Material and Methods: A survey among patients registered with the GPs assessing 23 aspects of the GP-patient relationship, medical care, information and support, organisation of care and accessibility. Analyses of associations between the assessments and the gender and age of the physicians., Results: A total of 703 doctors participated in the study. Assessments from 56,652 patients were included in the analyses (response rate 73.1%). We found that patients perceived male physicians as more accessible than their female colleagues. The younger doctors were assessed more positively than their older colleagues on certain aspects, but the numeric differences between the groups were minor., Conclusion: Female general practitioners may benefit from paying more attention to the accessibility aspect. Older physicians may benefit from emphasizing their patients' need for participation, information and a sense of continuity.

Introduction: This study aimed to examine if and how the patients' assessment of their general practitioner (GP) was associated with the organization of the practice, the number of listed patients and the number of staff members., Material and Methods: A survey among patients registered with the participating GPs assessing 23 aspects of the GP-patient relationship, medical care, information and support, organisation of care and accessibility. Analysis of the associations between the assessments and practice characteristics was performed., Results: A total of 703 GPs partook in the study. Assessments from 56,652 patients were included in the analyses (response rate 67.6%). Solo practicing GPs, GPs with a short list of patients and GPs with a large staff were assessed more positively than their colleagues in other types of practices, GPs with many listed patients and GPs with a small staff., Conclusion: The study showed a complex association between the patient-experienced accessibility of general practice care and the number of listed patients and practice staff. Patients experienced the best accessibility in practices with few listed patients and in practices with a large staff. GPs in single-handed practices had far more positive assessments of accessibility than did GPs in partnership practices, especially availability by phone and waiting time prior to an appointment. Differences in patient list and staff between practices could not explain this finding.

Care coordination is a superordinate term for terms related to the optimization of care for people suffering from chronic diseases and cancer. In this article, we present Danish terms for "disease management programme" and "case management" among others, and effects are summarized. The central Danish terms explored are "forløbskoordinering", "forløbsprogram", "forløbskoordinator", and "tovholder".

Introduction: The use of psychometric tests is increasing in Danish general practice. The instruments are usually paper-based, but a few electronic instruments are now available, including the electronic Common Mental Disorder Questionnaire (e-CMDQ). The aim of the present study is to evaluate the applicability of the e-CMDQ in daily clinical work, the validity of data obtained, indications for use and the GP-perceived benefit of test results., Material and Methods: Twenty GPs were invited to test the e-CMDQ during the period from 1 January 2005 to 31 December 2005. They received a fee for using the instrument, equivalent to that received for using other validated psychiatric rating scales., Results: Eleven GPs participated and included a total of 125 (average 11.4, range 2-36) patients during the test period. The average time spent on completing the e-CMDQ was 5.6 minutes. Data were almost complete with 4,499 out of 4,500 possible patient responses. The instrument was mainly used on suspicion of psychiatric morbidity, when problems had lasted for more than two weeks, when patients presented with multiple physical symptoms, and for test follow-up. The separate rating scales performed well: Cronbach's alpha 0.69-0.92 and Loevinger coefficients 0.30-0.91. The GPs considered the test results to be useful in 89 percent of the cases., Conclusion: The use of the e-CMDQ was associated with low time consumption, high data quality, sufficient construct validity and high user satisfaction. The instrument was only partly implemented and therefore barriers amenable to change should be brought into focus.

Palliative homecare has been a primary care task for a long time. The introduction of palliative specialist teams has given patients with severe symptoms the possibility of getting qualified help, but has also resulted in a general tendency to exclude primary care from palliative care. Barriers to providing shared care are the organization of palliative care and the working culture of health professionals. Increased focus on shared care research is needed in order to optimise palliative home care.

Introduction: The aim of the study was to assess the level of job satisfaction among Danish general practitioners (GPs)., Materials and Methods: A questionnaire on job satisfaction and sociodemography was sent to all 458 registered GPs in the County of Aarhus, Denmark., Results: A total of 379 (83.5%) GPs participated. Danish GPs have a high level of job satisfaction. They were most satisfied with colleagues and fellow workers, amount of responsibility and freedom to choose their own method of working, and they were least satisfied with remuneration and hours of work. Longer working hours were associated with lower job satisfaction. Furthermore, GPs with low job satisfaction wanted to retire earlier. There was no association between job satisfaction and the number of practice staff. One in every twenty (6%) GPs would not repeat the same career choice again. Apart from their remuneration, Danish GPs' job satisfaction was higher than that of their Norwegian and British colleagues., Conclusion: Overall job satisfaction among Danish GPs was high, also compared with foreign countries. Low job satisfaction was associated with wanting to retire early, implying that a high level of job satisfaction is important for GP retention. Shorter working hour was associated with higher job satisfaction.

Introduction: In 2004, The Danish National Board of Health introduced new guidelines for prenatal screening and diagnosis. Subsequently, all pregnant women in Denmark have been offered a maternal serum screening and a nuchal translucency measurement (NTM). The results are combined to a single risk estimate of carrying a Down syndrome child. All pregnant women are also offered a late second trimester scan for fetal abnormalities. Pregnant woman should be fully informed to enable them to make an informed choice. We explored the role of information in the pregnant women's understanding and decision-making for the NTM., Materials and Methods: 26 consenting pregnant women were interviewed after their first visit to their GP and again after the late ultrasound scan. Our results are mainly based on the first interviews and the 24 participants who chose to have a NTM., Results: The pregnant women consider a fetal scan as an attractive routine procedure during pregnancy. Apart from the information about prenatal examinations given by the GP, the pregnant women do not subsequently seek further information. The most important motives for wanting to have the NTM are 1) assurance, 2) choice, 3) expectations of the scan being a happy event, and 4) the idea that the examinations are approved by the Danish health care system., Discussion: The decision to have a NTM is motivated by expectations that exceed the specific medical aim of the examination and the content of the information provided. The pregnant women believe in a link between knowledge and anxiety, and therefore do not wish to "know too much". Our results show that the pregnant woman's conception of the information provided and her motives for having a NTM are based on strategies and rationales that hinder an informed choice.

More than two thirds of carcinomas of the uterine cervix are caused by human papilloma virus (HPV) types 16 and 18, and 90% of all genital warts are caused by HPV 6 and 11. In June 2006, the US Food and Drug Administration accepted the first prophylactic HPV vaccine against HPV 6, 11, 16 and 18 to be offered to girls and young women. This new vaccine is also now available in Denmark. Questions concerning economics, ethics, organization, and vaccine monitoring need to be discussed in connection with the establishment of a vaccine program. In addition, information to the general population as well as to health care providers and decision-makers should have been given a high priority.

Introduction: Although delirium is a reversible cerebral syndrome, the effect of treatment of the elderly is unsatisfactory, involving prolonged hospitalizations and increased risk of relapse and mortality. The purpose of this study was to evaluate whether hospitalization for delirium (severe delirium) diagnosed by ICD-10 criteria predicts increased morbidity, utilization of health services and mortality., Materials and Methods: Delirious inpatients (n = 26) discharged after treatment in an old-age psychiatric university clinic were studied for nine years. In a register-based design, the above-mentioned parameters of the delirium cohort were compared with a group of controls (n = 116)., Results: There was a trend to increased mortality in the delirium cohort. Compared with the controls, the delirium cohort had a significantly increased incidence of disorders of vital organs, serious psychiatric disorders, particularly depression, increased use of hospital psychiatry and general practitioner's out-of-hours service, but less use of office-hour services. The incidence of delirium in the cohorts was low. In the delirium cohort, there was no significantly increased use of services or the number of diagnoses in somatic hospitals., Conclusion: Increased somatic and psychiatric morbidity and a trend to increased mortality indicate a serious prognosis after severe delirium in the elderly. It is noteworthy that the delirium cohort had increased use of GPs' out-of-hours services but less use of office-hour services.

Introduction: The aim of this study was to determine whether there is a nihilistic attitude towards diagnosing lung cancer among Danish general practitioners (GPs) and to obtain the GPs' evaluation of the present approach to lung cancer diagnosis., Materials and Methods: A questionnaire was sent to 1,186 randomly selected GPs. Most of the questions addressed the possibilities of improving primary prevention, GPs' attitudes towards diagnosing lung cancer, their opinions about waiting times and their clinical practice., Results: A total of 848 (71%) completed the questionnaire. Only 12% agreed with the statement that the prognosis for lung cancer is so unfavourable that there is no hurry to diagnose the disease, while 22% agreed to the statement that diagnostic delay rarely means anything for the prognosis. About half of the GPs found the diagnostic period too long. There were, however, wide variations among the different counties in Denmark. The majority of GPs followed the recommendations of the Danish Lung Cancer Group for diagnosing lung cancer, especially the elderly GPs, who were also more inclined to make follow-up appointments after lung infections. More than one in every four practitioners was reluctant to use the word "cancer" in referrals to hospitals or for investigation., Conclusion: The study showed that Danish GPs do not have a nihilistic attitude towards diagnosing lung cancer and that elderly practitioners are more careful about diagnosing lung cancer. GPs' satisfaction with waiting times varies widely among the different counties in Denmark. Many practitioners were reluctant to use the word "cancer" in referrals.

This paper examines the development in the use of Danish general practice in the years 1992 to 2001. The use of general practice increased by 17%. The number of consultations increased by 12%, the number of telephone consultations increased by 25%, and the number of home visits decreased by 18%. The number of Danish citizens increased by 3.6%, but the number of GPs increased by 7.2%. The number of contacts per GP increased by more than 10%. The percentage of citizens attending general practice within a year increased from 80% to 85%. This would have resulted in only a 6% increase, assuming an average attendance rate similar to that of the population. The 50% least frequently attending patients accounted for 18% of all contacts. In comparison, the 10% most frequently attending patients accounted for 33% of all contacts.

The narrow ICD-10 and DSM-IV definition of hypochondriasis makes it a rarely used diagnosis. Based on a latent class analysis of the symptoms exhibited by 701 patients (ages 18-65) in general practice, a new and more valid hypochondriasis diagnosis was defined in this study. The main symptom is "obsessive rumination about illnesses", and the patient must also have at least one of five other symptoms. The prevalence was 9.5 for both genders. There was a good agreement between the diagnoses made during the psychiatric interview and the physicians' assessments.

Introduction: Change of GP may imply that the patient is dissatisfied with the health service provided. The aim of this study was to investigate whether newly diagnosed cancer patients change their GP more often than other patient groups and the background population., Material and Methods: The investigation was conducted using data on inhabitants from the counties of Aarhus, Vejle and South Jutland. We included 900 Group 1 insured patients, aged 18-75 years, distributed into three groups: 1) frequent cancers, 2) rare cancers and 3) benign, but chronic or severe new diseases. The diagnoses included occurred for the first time at the time of inclusion. Three hundred controls were randomly selected from the regional health care registry in Aarhus. The study period was from March 1 to August 30 1994. A change of GP was defined as a change not caused by the patient's change of residence or the GP's change of practice registration number due to expansion, takeover or split up of practice., Results: In the three disease groups, 28 cases of change of GP were registered with a frequency of 5% (frequent cancers), 2.7% (rare cancers) and 1.7% (benign, but chronic or severe new diseases). The frequency in the background population was 2.7%. None of the differences were statistically significant., Discussion: During the first year following a cancer or chronic disease diagnosis, change of GP is rare, particularly among patients with rare cancers. We reject the hypothesis that change of GP is frequent among newly diagnosed cancer patients.

Introduction: The clinical behaviour of General Practitioners (GPs) can best be influenced by identifying their incitements and barriers in the first place. The purpose of this paper was to describe a model for the outreach visits, in which the purpose was to facilitate and evaluate the desired changes in the clinical behaviour of the GPs. We demonstrate the usefulness and workability of the model as a tool to be used in future implementations., Materials and Methods: A total of 41 GPs in the Counties of Aarhus and Vejle participated in the spring of 2000 in an advanced educational programme about how to diagnose and treat patients with functional disorders. All participating GPs received an invitation for a six-month follow-up visit. The purpose of the follow-up visit was to facilitate and evaluate their educational benefits and experience in using psychiatric rating scales. The strategy of the visit was to structure the dialogue with reference to identifying incitements and barriers and to emphasize their strengths, weaknesses, opportunities and threats in connection with the change of their clinical behaviour., Results: Thirty-eight (93%) of the GPs participated in the follow-up outreach visits. The chosen strategy proved to be useful in primary care settings. We identified several areas in which the motivation of the GPs and their possibilities to implement the desired behavioural changes could be strengthened., Conclusion: The results suggest that the incitements and barriers of the GPs to change their clinical behaviour can be identified using the strategy described. We suggest that the strategy should form part of the development and evaluation of outreach visits in Denmark.

Patients' evaluations have several functions as quality measurements: A general judgement of the quality of the health care system and a direct assessment of defined aspects of service and care. In this article the concept of patient satisfaction and the application of patients' evaluations on quality improvement in the health care system is discussed. Despite many attempts to formulate an explanatory theory about the matter, a useful theoretical basis for the concept of satisfaction is still missing. This does not imply the exclusion of patients' evaluation of the health system, and it is discussed why and in which areas of quality improvement patients should be involved and how their evaluations should be interpreted. Studies including patients' evaluations are referred to and discussed.

In this paper different perceptions of disease and illness in general practice and possible implications of these perceptions for the GP's clinical work are described and discussed. The focus is on patients with medically unexplained symptoms and on the question whether the illness perception of the GP to some extent can explain the often inappropriate treatment of these patients.

Introduction: Frequent attenders (FAs) account for a large number of the consultations and a large part of the workload in general practice. We need knowledge about the way general practitioners (GPs) characterise this group of patients and about their proposals for clinical management. This study aims to describe the types of FAs seen in general practice and their proposed management., Material and Methods: Six randomly sampled CME groups in Aarhus County were offered a meeting about frequent attendance in general practice, and five groups with a total of 89 GPs accepted. FAs were defined as the top 10% patients attending during 12 months. One week before the meeting, each GP received an introduction to the meeting and the names of two FAs listed with the practice. Through exploratory focus group interviews, supplemented by a small group-based CME method, the GPs were asked to discuss FA characteristics and to make proposals for clinical management. A total of 59 (66.3%) participated in the five meetings., Results: Eight FA types consistently emerged from the discussions, and the GPs suggested 12 possible ways of managing them. These aspects involved communicative, organisational (planning), and biopsychosocial skills., Discussion: The variety of types shows that FAs are not solely the so-called difficult patients, but a diverse group demanding many different aspects of care. Hence, the GPs are in a key position demanding specific skills to manage these patients.

Introduction: Danish general practitioners' (GPs') participation in continuing medical education (CME) has often been the subject of debate, but actually very little is known about the extent and the contents of the activities., Material and Methods: One hundred and sixty-one Danish GPs participated in this one-year prospective study by collecting data on their own CME activities., Results: We received 9980 data registration sheets. Over a period of 8.4 months, an average Danish GP spent 67 hours on traditional CME, equivalent to about 96 hours per year, and 12 hours on small group-based CME per year, i.e. a total of 108 hours per year. In addition, he or she spent 90 hours per year reading books, journals, etc. Thus, the time spent on CME totalled more than 200 hours per year. Most of the CME courses were held outside surgery hours., Discussion: We conclude that the GPs in Aarhus County participate in a large number of CME activities--even more than expected by their own organisation.

Introduction: The study aimed to describe the postgraduate training of the general practitioners (GPs) in communication and psychiatric counselling., Material and Methods: GPs in Aarhus County, Denmark, received a mailed questionnaire about psychiatric hospital training, participation in courses and Balint groups (psychiatric supervision), and their need for further training., Results and Discussion: The questionnaire was returned by 320 (74.4%) GPs. Almost all GPs had received some kind of postgraduate training although to a very varying extent. Almost half had taken courses of more than three days' duration, and half were members of a psychiatric supervision group. Two-thirds of the GPs thought they needed further training. The need was independent of the GP's evaluation of his/her own psychiatric education.