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Background: RGPs (regular general practitioners) are obliged to take on duties in the out-of-hours services in Norway, but they actually perform less than half of this work. We wished to compare remuneration claims for out-of-hours work from RGPs with those from other doctors., Material and Methods: The Norwegian Labour and Welfare administration provided information about all doctors working in the out-of-hours services in Norway in 2006 (4 729 of whom 2 220 were RGPs) and coupled this with the remuneration they had claimed in this period., Results: RGPs had 46.6 % of all patient contacts in the out-of-hours services, but more telephone contacts (57.4 %) and simple/short contacts (50.7 %) than other doctors. Other doctors had most contacts in the largest (59.8 %) and most central (56.7 %) municipalities and used general and unspecific diagnoses more often than the RGPs (12.6 % of all consultations vs. 11.0 %). Older doctors used fewer fees than younger doctors, but otherwise the total number of fees only differed slightly between various groups of doctors. Newly qualified doctors serving their compulsory practice period claimed extra remuneration for long consultations in 41.2 % of the cases, RGPs who are also general practice specialists in 20.2 % of cases, and other doctors in 35.7 % of the consultations. RGPs wrote sick notes more often (7.1 % of consultations) than newly qualified doctors (5.7 %) and other doctors (6.6 %). General practice specialists wrote sick notes most often (7.4 %)., Interpretation: Experienced RGPs and general practice specialists spend less time per patient than other doctors in the out-of-hours services.

Objective: To study the participation of Norwegian regular general practitioners (RGPs) in the out-of-hours system in 2006 and what kind of emergency situations and procedures they experienced in the past 12 months. RGPs' confidence in performing certain emergency procedures was also mapped., Methods: In May 2006 all 3804 RGPs taking part in the RGP scheme in Norway were sent a questionnaire dealing with several aspects of the emergency out-of-hours duty. The RGPs who had participated were asked about 14 pre-selected emergency situations, experiences with different pre-selected emergency procedures and their self-confidence with these in the past 12 months., Results: After two reminders 2913 (78%) answered and 1832 (63%) confirmed they had taken part in emergency out-of-hours services in the past 12 months. 95% of participating RGPs answered questions about emergency situations, 74-78% about emergency procedures. The most common situations were chest pain, psychiatric problems and asthma, experienced by 94%, 92% and 88%, respectively. The number of occasions the doctors had experienced the most frequent emergency procedures (presented as median 25-75% percentiles) were: intravenous medication, three (1-10); oxygen mask, three (1-10); venous access, four (1-10). The doctors reported almost no experiences with other procedures. The doctors reported a high self-confidence in performing the emergency procedures. Male doctors working four or more shifts per month and doctors working in rural areas reported more experiences both in emergency situations and procedures., Conclusion: Approximately two-thirds of RGPs in Norway took part in the out-of-hours service. A wide variety of emergency cases was experienced by the RGPs. Despite this, experiences with most emergency procedures during a 12-month period are low. Regular training is therefore necessary to maintain good skill levels.

Background: Out-of-hours work is often perceived as burdensome and there is an inherent increased risk of making mistakes. The aim of the study was to examine Regular General Practitioners' (RGPs') experiences with and attitudes to out-of-hours work., Material and Methods: A questionnaire was sent to all RGPs in Norway. Participation in out-of-hours work was analysed against characteristics of the physician, list, and municipality., Results: 2,913 RGPs responded (78%). 50% participated fully, 15% partly, and 35% did not participate in out-of-hours work. 28% were formally exempted, and 13% had a regular locum. Women and elderly RGPs participated less, as did RGPs in large and central municipalities. Out-of-hours cooperatives covering several municipalities reduced the amount of work, but did not increase the RGPs' participation rate. List characteristics had little influence on the participation rate. 60% of the RGPs tried to give away most of their duties, 16% wanted more out-of-hours work than their regular duties and 16% of those below 55 years who were still doing out-of-hours work wanted to continue after 55 years. RGPs in small and remote municipalities considered out-of-hours work more challenging, but less remunerating, and more often wanted to move from the municipality., Interpretation: Many RGPs do not participate in out-of-hours work. As Norwegian RGPs constitute an aging cohort, this may become an increasing problem.

Background: Norwegian regular general practitioners (RGPs) are required to participate in out-of-hours duty. The aim of this study was to determine their actual participation rate., Material and Methods: Information was collected from the RGP Database, the Municipality Database and from physicians' bills to the National Insurance in 2004. The material consists of 3,751 RGPs and 2,317 other physicians claiming reimbursement for out-of-hours work., Results: RGPs received 51.8% of the total reimbursement for out-of-hours work, and 35.6% of them did not have any such income. Male RGPs received almost twice as much reimbursement for out-of-hours duty as their female colleagues, and there was a strong tendency for older RGPs to receive less. Among all physicians, young men were those who generally worked most frequently out-of-hours. RGPs' reimbursement dropped with poorer coverage of doctors, increasing list size, if their list was full or overcrowded, and with increasing size and central localization of the municipality., Interpretation: A large proportion of RGPs do not work out-of-hours in emergency services.

Background: We wanted to chart telephone accessibility in 100 randomly selected general practices in Norway and to define a standard against which others could compare themselves., Material and Methods: During one week, the telephone company recorded all calls to each practice and how many were answered, unanswered, or blocked. Mean waiting time for answer and mean conversation time were also registered. Each practice received a report, comparing its own results to those of other practices. An accessibility index was calculated by dividing the percentage of answered calls with mean holding time on the line (waiting time plus conversation time). Background variables about the practices were collected by questionnaires., Results: There were 266 calls (95 % confidence interval 219 - 312) per week per 1000 patients on the list. 66 % (61 - 71) were answered. Mean waiting time was 25 seconds (20 - 30), conversation time 119 seconds (111 - 127). It is estimated that 7.0 calls (6.4 - 7.5) are answered per patient on a list per year. The accessibility index showed large variations, mostly independent of background variables., Interpretation: Compared with earlier registrations, telephone accessibility has improved despite a strong increase in traffic. Structural aspects of the practices do not explain the variation in telephone accessibility; interest and attitudes are probably just as important.

Background: The most heavily discussed subject on Eyr, the Norwegian mailing list for general practitioners, has been the introduction of a general practice list system (GPLS)., Material and Methods: All messages in the GPLS debate were recorded from its start in August 1996 up until the GPLS was introduced nationwide in June 2001., Results: During this period, 243 different persons posted 2,153 messages about the GPLS, 232 of the participants were physicians, 203 of them GPs. Mean age was 46 years; males were strongly overrepresented (87%). 80% of the participants posted ten or fewer messages, 10% posted 11-20 messages, and 10% posted more than 20 messages. GPs sent most of their messages in the evenings, academics and public health officers sent most of their messages during work hours. Mean length of the messages was 179 words, 72% were responses to earlier messages. Most of the messages were neutral regarding the GPLS, 207 (9.6%) were negative, and 181 (8.4%) positive. Academics, public health officers, and participants in a GPLS trial were heavily overrepresented with positive messages., Interpretation: It is concluded that this debate has been fairly balanced. Participation greatly exceeded what would have been possible in traditional media.

Background: GPs have a particular responsibility to limit the occurrence of polypharmacy and adverse drug reactions, and to discontinue unnecessary drug therapy., Objective: The aim of the present study was to measure the extent to which patients and physicians agree upon information communicated in a consultation when a drug is withdrawn., Methods: A total of 272 Norwegian GPs and 272 patients filled in questionnaires after a consultation in which a long-term drug therapy had been discontinued. Their answers were compared and the agreement measured by kappa statistics., Results: There was 100% concordance between physicians and patients as to what drug had been discontinued. Most of the drugs (72%) were cardiovascular. There was fair agreement as to whether the drug was to be stopped abruptly or gradually withdrawn (kappa 0.61) and whether a follow-up appointment had been scheduled (kappa 0.41). Physicians were not able to judge patients' satisfaction accurately (kappa 0.20). Most patients (73%) were satisfied or very satisfied with the decision to withdraw the drug, and many commented that good communication and close follow-up is a prerequisite for successful withdrawal of long-term drug treatment., Conclusions: Discontinuation of drug treatment was welcomed by most patients. Physicians and patients agreed completely as to what drug was to be discontinued, and fairly well about other factual aspects, but physicians were not able to judge patients' satisfaction accurately.

In 1836, a system of district physicians was established in Norway. In addition to providing individual medical services, the district physicians supervised other health care providers and looked after vulnerable groups of patients. They were also chairmen of the local boards of health, and were supposed to engage in anything that might improve local health conditions. The first district physicians were given responsibility for enormous areas, and would rarely get in close contact with the people in their districts. When the districts were divided into smaller units, they came closer to the local people, but they had to struggle hard for recognition. Over the years, however, they succeeded by means of health information and increasingly effective medical remedies. In the late 1950s, local health services were in a deep crisis, but towards the end of the 1960s new and radical political trends initiated a revitalisation. Primary health care became increasingly popular among young doctors, and a large number of new positions were established. However, in 1984, at the height of this boom, the government chose to close down the district physician service.

Objective: To describe general practitioners' (GPs) prescribing patterns for antibiotics and to compare them with therapeutic guidelines., Design: Cross-sectional, observational study., Setting: In the Norwegian county Møre & Romsdal the GPs recorded all contacts with patients and prescriptions during two months., Subjects: 69,843 contacts with 56,758 prescriptions, of which 7905 were for systemic antibiotics., Main Outcome Measures: Prescriptions in relation to diagnosis, kind of consultation, and patients' age and sex., Results: 61% of all antibiotic prescriptions were for females, 26% were issued during indirect contacts, and 14% were repeat prescriptions. Phenoxymethylpenicillin was prescribed most frequently (32%), followed by co-trimoxazole (19%), tetracyclines (18%), erythromycin (16%), and penicillins with extended spectrum (6%). Urinary tract infection was the most frequent diagnosis for antibiotic prescribing (24%), followed by acute bronchitis (13%), ear infections (9%), upper respiratory tract infections (8%), and acute tonsillitis (8.2%). A regression analysis showed that first-time consultations for tonsillitis and otitis, but not for acute bronchitis and pneumonia, patient age 13-64 years, female physician, urban practice location, and a fixed. GP salary were associated with the prescribing of phenoxymethylpenicillin in contrast to other antibiotics., Conclusion: Antibiotics are often prescribed for viral infections (e.g., acute bronchitis). Broad spectrum antibiotics are often prescribed for diagnoses where penicillin is recommended as first choice. The issue of antibiotic misuse should be addressed more explicitly in general practice.

Over a period of two months in 1988 and 1989 all general practitioners in the Norwegian county of Møre and Romsdal recorded all contacts with their patients. We report data from 1,384 house calls to elderly patients (65 years and older). House calls made up 11.3% of all face-to-face contacts between general practitioners and elderly patients. 59% of the visits were to female patients, and 60% were to patients 75 years and older. 23% of the house calls took place during weekends, and new diagnoses were made in 58% of the cases. The most common groups of diagnoses were cardiovascular (21%), respiratory (16%), and musculoskeletal diseases (13%). Drugs were prescribed for 42% of the house calls. 28% of all drugs prescribed were for the nervous system, while 26% were antibiotics for systemic use. Most house calls were made because of acute illnesses. Our results suggest that preventive home visits to the elderly are rarely, if ever, performed in general practice.

Over a period of two months in 1988 and 1989 general practitioners in the Norwegian county of Møre and Romsdal recorded all contacts with their patients. Participation was close to 100%. We report data from 10,850 surgery consultations with elderly patients (65 years and older). 60% of the consultations involved female patients, and 58% of the patients were 65-74 years old. New diagnoses were made in one-third of the cases; two-thirds were follow-ups. The most common groups of diagnoses were cardiovascular (28%), musculoskeletal (13%), psychiatric (8%) and respiratory diseases (8%). Almost 10% of all consultations were for hypertension. Drugs were prescribed in 45% of all cases. 27% of all prescriptions were for cardiovascular drugs, and 25% were for drugs for the nervous system. The 20 most common diagnoses made up more than half of the total number of diagnoses. Almost 70% of all prescriptions were for the ten most common therapeutic groups.

In 1988 and 1989 all general practitioners (GPs) in Møre & Romsdal recorded all encounters with patients over a period of two months. The participation rate was close to 100% and a total of 90,458 encounters were recorded. Of all encounters 61% involved female patients. Female GPs had more female patients than their male colleagues (71% versus 59%). The discrepancy was most pronounced for sex-specific diagnoses. Home visits accounted for 9% of all direct encounters, an increase from the 5-6% reported in the 1970s. 37% of all contacts occurred by phone or messenger. The diagnostic distribution compares well with Olav Rutle's findings in 1978. Cardiovascular diseases, however, seem to have become less prominent since that time. The most frequent ICPC diagnoses were musculoskeletal (17%), respiratory (14%), cardiovascular (12%), and psychiatric (12%). Respiratory diseases dominated among children, musculoskeletal diseases among adults, and cardiovascular diseases among the elderly.

Objectives: To investigate the prevailing management of female urinary incontinence by Norwegian general practitioners (GPs), and to compare information given by the patients with information in their medical records., Design: Incontinent women who had received reimbursement for incontinence aids or drugs were identified by the local Insurance Offices, and a random sample was interviewed about what examinations and treatments they had received. Similar information was later collected from their GPs., Setting: The Bergen area, Norway., Subjects: Forty-eight GPs and 82 patients., Main Outcome Measures: Actions taken according to the patients and their medical records. Kappa statistics were used to evaluate the strength of agreement., Results: The GPs had done a gynaecological examination in 54%, a leakage provocation test in 12%, and a urinalysis in 73% of the patients. Thirty-two per cent of the women had been instructed in pelvic floor exercises and 13% in bladder training. The GPs had prescribed oestrogens for 48% of the older women (> 59 years), anticholinergics for 29% of those with urge or mixed incontinence. Overall Kappa between the two data sources was 0.37., Conclusion: GPs' incontinence management can be improved, especially regarding gynaecological examination, pelvic floor exercises, and the prescription of oestrogens. Retrospective chart data or patient interviews are unreliable data sources.

Background and Objectives: Patient vignettes are often used for investigating the performance of physicians. The purpose of this study was to assess the criterion validity of vignettes., Methods: A random sample of incontinent women were interviewed, and vignettes depicting their cases were later presented to their own physicians. Questionnaires sent to the physicians included open questions about what drug treatment the doctor would give and a checklist (cueing items) for indicating other possible actions. Analysis compared actions taken with vignette patients and actual actions taken with the real patients., Results: Thirty-two general practitioners and 32 patients were included in the study. When cueing items were provided, the physicians claimed more actions with vignettes than were actually performed. Mean difference was 1.9 actions per case (95% confidence interval 1.3 to 2.4). No such difference was found for the open question. When cues were provided, the likelihood ratio for reporting a vignette action in comparison with actually performing the action with a similar real patient was 2.8 (2.2 to 3.5), and Kappa .39. When no cues were provided, the likelihood ratio was 5.1 (2.6 to 10), and Kappa .45. Total number of actions with vignettes and real patients correlated significantly (r = .65, P < .001)., Conclusions: Responses to vignettes with cueing items overestimate real performance. The agreement may be better when no cues are offered. The method may have acceptable validity for group comparisons.

Six case histories concerning female urinary incontinence were mailed to 191 randomly selected general practitioners (GPs) in Norway, of whom 139 (73%) replied. Great variations in suggested investigations and treatment were found between individual doctors. Four explanatory variables were examined: doctors' sex, years since graduation, urban/rural location, and GP specialization. GP specialists treated fewer patients adequately than non-specialists. Experienced female doctors instructed more patients in pelvic floor exercises, prescribed more oestrogens, referred more patients, and also indicated the possibility of surgery more frequently than their colleagues. Nevertheless, patient management is largely independent of a doctor's sex and age, practice location, and GP specialization.

The investigators set out to find out how Norwegian general practitioners (GPs) manage women suffering from urinary incontinence by using responses to a questionnaire containing six typical case histories. Questionnaires were sent to 191 GPs, of whom 139 (73%) replied. In 93% of all case histories the GPs responded that they would conduct some kind of investigation or treatment. Gynaecological examination and microscopy of the urine were the most frequent investigations stated. Drugs were prescribed in 41% of cases, mainly following appropriate indications. Instruction in pelvic floor exercises was predominant for the younger patients, while old patients were prescribed incontinence pads. Thus it seems that the therapeutic ambitions of the practitioner are reduced as the patients get older. Bladder training was only stipulated in 14% of cases. Adequate treatment is defined as relevant drugs and exercises in combination with pads, or referral. According to this definition 46% of the patients were treated adequately, 28% by the GPs themselves. Twenty five percent of the patients were referred to a gynaecologist.