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Background: In recent decades immigration to Norway from Asia, Africa and Eastern Europe has increased rapidly. The aim of this study was to assess the quality of care for type 2 diabetes mellitus (T2DM) patients from these ethnic minority groups compared with the care received by Norwegians., Methods: In 2006, electronic medical record data were screened at 11 practices (49 GPs; 58857 patients). 1653 T2DM patients cared for in general practice were identified. Ethnicity was defined as self-reported country of birth. Chi-squared tests, one-way ANOVAs, multiple regression, linear mixed effect models and generalized linear mixed models were used., Results: Diabetes was diagnosed at a younger age in patients from the ethnic minority groups (South Asians (SA): mean age 44.9 years, Middle East/North Africa (MENA): 47.2 years, East Asians (EA): 52.0 years, others: 49.0 years) compared with Norwegians (59.7 years, p < 0.001). HbA1c, systolic blood pressure (SBP) and s-cholesterol were measured in >85% of patients in all groups with minor differences between minority groups and Norwegians. A greater proportion of the minority groups were prescribed hypoglycaemic medications compared with Norwegians (>or=79% vs. 72%, p < 0.001). After adjusting for age, gender, diabetes duration, practice and physician unit, HbA1c (geometric mean) for Norwegians was 6.9% compared to 7.3-7.5% in the minority groups (p < 0.05). The proportion with poor glycaemic control (HbA1c > 9%) was higher in minority groups (SA: 19.6%, MENA: 18.9% vs. Norwegians: 5.6%, p < 0.001. No significant ethnic differences were found in the proportions reaching the combined target: HbA1c

Background: The Prescription Peer Academic Detailing (Rx-PAD) project is an educational intervention study aiming at improving GPs' competence in pharmacotherapy. GPs in CME peer groups were randomised to receive a tailored intervention, either to support a safer prescription practice for elderly patients or to improve prescribing of antibiotics to patients with respiratory tract infections. The project was based on the principles of peer group academic detailing, incorporating individual feedback on GPs' prescription patterns. We did a study to explore GPs and tutors' experiences with peer group academic detailing, and to explore GPs' reasons for deviating from recommended prescribing practice., Methods: Data was collected through nine focus group interviews with a total of 39 GPs and 20 tutors. Transcripts from the interviews were analyzed by two researchers according to a procedure for thematic content analysis., Results: A shared understanding of the complex decision-making involved in prescribing in general practice was reported by both GPs and tutors as essential for an open discussion in the CME groups. Tutors experienced that CME groups differed regarding structure and atmosphere, and in some groups it was a challenge to run the scheme as planned. Individual feedback motivated GPs to reflect on and to improve their prescribing practice, though feedback reports could cause distress if the prescribing practice was unfavourable. Explanations for inappropriate prescriptions were lack of knowledge, factors associated with patients, the GP's background, the practice, and other health professionals or health care facilities., Conclusions: GPs and tutors experienced peer group academic detailing as a suitable method to discuss and learn more about pharmacotherapy. An important outcome for GPs was being more reflective about their prescriptions. Disclosure of inappropriate prescribing can cause distress in some doctors, and tutors must be prepared to recognise and manage such reactions.

Background: Guggul, herbal extract from resin of the Commiphora mukul tree, is widely used in Asia as a cholesterol-lowering agent based on Indian Ayurvedic medicine. Its popularity for this use is increasing in the US and Western Europe. Guggulsterones, the presumed bioactive compounds of guggul, may antagonise two nuclear hormone receptors involved in cholesterol metabolism, which is a possible explanation for hypolipidemic effects of these extracts. However, publications of efficacy data on the use of guggul extracts in Western populations are scarce., Objective: To study the efficacy of a guggul-based formulation (short: guggul) on blood lipids in healthy adults with moderately increased cholesterol., Methods: Double-blind, randomised, placebo controlled trial in Norwegian general practice. 43 women and men, age 27-70, with moderately increased cholesterol, randomised to use 2160mg guggul (4 capsules) daily, or placebo for 12 weeks., Outcome Measures: Mean change in total cholesterol, low-density lipoprotein cholesterol (LDL-C), triglycerides, high-density lipoprotein cholesterol (HDL-C) and total cholesterol/HDL-C ratio compared with baseline. Lipids were analysed at baseline, and at 6 and 12 weeks. In addition, unexpected events and adverse effects were recorded., Results: Two dropouts, one withdrawal, and incomplete lab results for six persons left 34 participants to accomplish the trial (18-guggul, 16-placebo) with complete lab test data. After 12 weeks, mean levels of total cholesterol and HDL-C in the active group were significantly reduced compared with the placebo group. However, the mean levels of LDL-C, triglycerides, and total cholesterol/HDL-C ratio between the two groups did not change significantly. Ten guggul users (vs. four in the placebo group) reported side effects: mild gastrointestinal discomfort (n=7), possible thyroid problems (n=2), and generalized skin rash (n=1). The latter resulted in withdrawal from trial., Conclusions: Even if total cholesterol and HDL-C were significantly reduced, the clinical magnitude of this remains obscure. More and larger studies are needed to establish effects and safety of guggul-based formulations in the treatment for hypercholesterolemia.

Background: Traditional methods for dissemination of knowledge, such as lecture-based courses and distribution of guidelines, have shown only modest effect on improving the quality of GPs' prescription practice. We aimed at assessing GPs' own views on various sources of knowledge within pharmacotherapy, and their attitudes to a potentially effective educational method: audit and feedback., Material and Methods: A questionnaire regarding the use of and views on various sources of knowledge concerning pharmacotherapy was sent to GPs in continuing medical education (CME) groups participating in an intervention study on quality improvement of prescription practice., Results: 302 of 479 GPs (63 %) responded. The Norwegian Pharmaceutical Catalogue was the most widely used source of information on drugs. Industry- based sources were generally regarded as less useful and without great influence on prescription practice, but were nevertheless often mentioned as a source of information in specific prescribing situations. The GPs rated CME groups as useful and influential, and 94 % viewed the exposure of own prescription data in the CME group as unproblematic., Interpretation: Audit and feedback in CME groups seems to be a suitable educational method in pharmacotherapy. Industry- based information sources are rated as being of low value, but seem to have influence on prescription practice.

Background: Elderly patients using many medicines are at particular risk of making medication errors after discharge from hospital. This pilot study aims at investigating the feasibility and acceptance of improved written discharge information and home visits (by a pharmacist) to elderly patients who have newly been discharged from a medical department in a hospital., Material and Methods: Patients (70 years and older) who needed at least 5 medicines and were about to be discharged from a medical department in a hospital, were offered home visits by a pharmacist 1, 5 and 26 weeks after discharge. A copy of the medication list was sent to their general practitioner (GP) the day the patient went home. During the home visit, the pharmacist provided information and training and recorded discrepancies between the hospital's medication list and the patients' actual medication use. 57 were invited to participate and 51 accepted the offer. During the 6-month project period, 5 patients died, one moved to a nursing home and one patient dropped out. Patients' and physicians' views on these measures were recorded., Results: 53 discrepancies were disclosed for 29 of 51 patients during the first home visit. 26 discrepancies were disclosed during both the second and third visit; for 15/49 patients during the second and for 14/44 during the third visit. All involved GPs agreed that the medication list should be sent to the patient's GP the day the patient was discharged. Both hospital doctors and GPs regarded home visits by pharmacists to be useful for selected patients., Interpretation: In conclusion, home visits by a pharmacist is feasible, well accepted by doctors and patients and may represent a useful method for reducing medication errors in newly discharged elderly patients. The improved routines for informing the GPs about patients' medication use at discharge were appreciated. A controlled intervention study is needed to substantiate the effects of the measures undertaken in this pilot study.

Background: For many general practitioners (GPs), visits from pharmaceutical representatives (reps) are common settings for receiving updated drug information. We here aim to describe the content and assess the quality of information provided by reps visiting Norwegian GPs., Material and Method: Medical students filled in a questionnaire addressing one pharma rep visit they had experienced during their 6-week general practice period in their fifth year at medical school in Oslo (2001 and 2002)., Results: Students from three classes participated and 144/241 (60 %) of them returned completed questionnaires. The 144 pharma rep meetings addressed 64 different and mostly new drugs, most commonly cardiovascular and pulmonary preparations. The visit was most commonly conducted during a free lunch (90 %) for the entire practice staff (81 %). The representatives offered the GPs free drug samples (41 %), and small presents (44 %). Four of five visits were characterized by incomplete or lacking information about side effects, interactions, contraindications or precautions for using the drug. The students scored their educational benefit from the session on a visual analogue scale from 0 (poor) to 10 (excellent), which revealed a mean score of less than neutral, 4.2., Interpretation: The systematic omittance of important safety information, emphasizes the need for industry unbiased continuing medical drug education in general practice.

Background: To prevent medication errors, community homecare services (CHS) increasingly use multi-dose packaged medicines (MDPM) for their clients. More knowledge is needed on how MDPM affects routines and quality of medication handling in the CHS., Material and Methods: Four CHS districts in a Norwegian community (27 GPs, 121 nurses) participated in the study. Structured questionnaires with some open-ended questions were used during interviews. The questionnaire focused on experience and satisfaction with MDPM as compared to the old system, and on how the MDPM had influenced collaboration between different categories of health personnel., Results: With the MDP-system most nurses and GPs felt that medication control had become easier (CHS 76%, GPs 56%; p = 0.03) and that routines had improved (CHS 84%, GPs 52%; p < 0.001) with the MDP-system. Three of four GPs felt more confident than before about patients receiving the medication they had prescribed (CHS 73%, GPs 78%; p = 0.7). 44% of the GPs felt that they spent more time on prescribing medication with MDPM., Interpretation: MDPM was generally found to improve routines, the quality of medication handling and medication safety. GPs were less content with the arrangement than nurses, probably because they had to collaborate with more CHS districts with different routines for exchanging information. When introducing MDPM in the CHS, explicit and definite orders of responsibility should be established as well as uniform collaboration routines between the GPs, the CHS and the MDPM-providers.

Purpose: To describe optometric practitioners and their encountering patients., Methods: All members of the Norwegian Association of Optometrists working in the community (n = 761) were invited to participate in a questionnaire survey; questionnaire responders (n = 508) were asked to take part in a practice registration. Data collection was carried out between November 2004 and May 2005 using a questionnaire and a practice registration form., Results: Five hundred and eight optometrists responded to the questionnaire; of these 212 participated in the practice registration, in which 4052 patient encounters were recorded. All optometrists reported taking patient history in the areas of vision and ocular health; 55% asked questions about general health for all patients. More than 80% collaborated with general practitioners and ophthalmologists. The patient encounters were with 1699 men and 2216 women; 60% of patients were aged 45 years or older. Patients reported a history of ocular disease and other conditions of relevance for ocular health in 12% and 17% of encounters, respectively. One per cent had low vision [best corrected visual acuity (BCVA) < 0.33] and 2% were visually impaired (BCVA < 0.5). Ophthalmoscopy was performed for 88% of patients; dilated fundus examinations were carried out for 2%; clinical findings of cataract were reported for 11%; and retinopathy was suspected in 3%. Six per cent of patients were referred to a general practitioner or ophthalmologist., Conclusion: Optometrists generally collaborate with general practitioners and ophthalmologists. They take history, investigate and assess patients with ocular problems. A significant number of patients had primary or secondary ocular disease. This illustrates the role of optometrists as healthcare workers.

Background: In an elderly, community based population we aimed at investigating antihypertensive and lipid lowering medication use in relation to own and familiar cardiovascular morbidity and diabetes mellitus, as well as to lifestyle factors and general health. We also examined levels of blood pressure in untreated and treated residents, to investigate factors correlating with blood pressure control., Methods: A health survey carried out in 1997-9 in the county of Hordaland, Norway included a self-administered questionnaire mailed to 4,338 persons born in 1925-7. Drug use the day prior to filling in the questionnaire was reported. A health check-up was carried out, where their systolic and diastolic blood pressure (SBP and DBP), body mass index (BMI), and serum-cholesterol level were recorded., Results: One third of respondents used one or more antihypertensive drugs, while 13% of men and women were treated with a statin. Diabetes mellitus, own or relatives'cardiovascular disease, having quit smoking, physical inactivity, and overweight correlated with antihypertensive treatment. Mean blood pressure was lower in respondents not on treatment. Among those on treatment, 38% of men and 29% of women had reached a target BP-level of lower than 140/90 mm Hg. Own cardiovascular disease and a low BMI correlated with good BP-control., Conclusion: One third of 70-74 year old individuals living in the community used one or more antihypertensive drugs. Only around one third of those treated had reached a target BP-level of less than 140/90 mm Hg. Own cardiovascular disease and a low BMI correlated with good BP-control.

Background: A school is generally acknowledged to be a key setting for promoting pupils' health and well-being., Methods: Data from a cross-sectional questionnaire study conducted with all 10th grade pupils in 46 public schools. Depressive symptoms was defined by a positive score on Hopkin's Symptom Check List-10 (HSCL-10). Two composite variables expressing risk were established: (i) presence of negative factors (PNF), consisting of self-reported pressure to succeed, sexual violation, and exposure to bullying and violence; and (ii) absence of positive factors (APF), comprising respondents' self-reported physical activity, educational aspirations, and family's valuing their opinions., Results: Out of 7505 pupils, complete data were obtained for 6207. The prevalence of symptoms of depression varied greatly among different schools (boys, from 0 to 19%; girls, from 3.3 to 39%). The PNF varied from 12.3 to 45.5% for boys, and from 4.2 to 38.8% for girls. Corresponding figures for APF were 2.4-23.1% for boys and 4.3-37.5% for girls. Among boys, we found significant associations between PNF and symptoms of depression, odds ratio (95% CI) 4.5 (3.5-5.8), and between APF and depressive symptoms, 3.1 (2.3-4.1). For girls, corresponding odds ratios were 3.5 (2.9-4.2) and 2.1 (1.7-2.6), respectively., Conclusions: The proportion of pupils with depressive symptoms varies greatly among Oslo public schools. This variation is associated with features of the pupils' social context.

Background: More than half of all antibiotic prescriptions in general practice are issued for respiratory tract infections (RTIs), despite convincing evidence that many of these infections are caused by viruses. Frequent misuse of antimicrobial agents is of great global health concern, as we face an emerging worldwide threat of bacterial antibiotic resistance. There is an increasing need to identify determinants and patterns of antibiotic prescribing, in order to identify where clinical practice can be improved., Methods/design: Approximately 80 peer continuing medical education (CME) groups in southern Norway will be recruited to a cluster randomized trial. Participating groups will be randomized either to an intervention- or a control group. A multifaceted intervention has been tailored, where key components are educational outreach visits to the CME-groups, work-shops, audit and feedback. Prescription Peer Academic Detailers (Rx-PADs), who are trained GPs, will conduct the educational outreach visits. During these visits, evidence-based recommendations of antibiotic prescriptions for RTIs will be presented and software will be handed out for installation in participants PCs, enabling collection of prescription data. These data will subsequently be linked to corresponding data from the Norwegian Prescription Database (NorPD). Individual feedback reports will be sent all participating GPs during and one year after the intervention. Main outcomes are baseline proportion of inappropriate antibiotic prescriptions for RTIs and change in prescription patterns compared to baseline one year after the initiation of the tailored pedagogic intervention., Discussion: Improvement of prescription patterns in medical practice is a challenging task. A thorough evaluation of guidelines for antibiotic treatment in RTIs may impose important benefits, whereas inappropriate prescribing entails substantial costs, as well as undesirable consequences like development of antibiotic resistance. Our hypothesis is that an educational intervention program will be effective in improving prescription patterns by reducing the total number of antibiotic prescriptions, as well as reducing the amount of broad-spectrum antibiotics, with special emphasis on macrolides.

Background: Age-related alterations in metabolism and excretion of medications increase the risk of adverse drug events in the elderly. Inappropriate polypharmacy and prescription practice entails increased burdens of impaired quality of life and drug related morbidity and mortality. The main objective of this trial is to evaluate effects of a tailored educational intervention towards general practitioners (GPs) aimed at supporting the implementation of a safer drug prescribing practice for elderly patients > or = 70 years., Methods/design: Approximately 80 peer continuing medical education (CME) groups (about 600 GPs) in southern Norway will be recruited to a cluster randomized trial. Participating groups will be randomized either to an intervention- or a control group. The control group will not receive any intervention towards prescription patterns in elderly, but will be the target of an educational intervention for prescription of antibiotics for respiratory tract infections. A multifaceted intervention has been tailored, where key components are educational outreach visits to the CME-groups, work-shops, audit and feedback. Prescription Peer Academic Detailers (Rx-PADs), who are trained GPs, will conduct the educational outreach visits. During these visits, a set of quality indicators (QIs), i.e. explicit recommendations for safer prescribing for elderly patients, will be presented and discussed. Software will be handed out for installation in participants' practice computers to enable extraction of pre-defined prescription data. These data will subsequently be linked to corresponding data from the Norwegian Prescription Database (NorPD). Individual feedback reports will be sent all participating GPs during and one year after the intervention. Feedback reports will include QI-scores on individual- and group levels, before and after the intervention. The main outcome of this trial is the change in proportions of inappropriate prescriptions (QIs) for elderly patients > or = 70 years following intervention, compared to baseline levels., Discussion: Improvement of prescription patterns in medical practice is a challenging task. Evidence suggests that a thorough evaluation of diagnostic indications for drug treatment in the elderly and/or a reduction of potentially inappropriate drugs may impose significant clinical benefits. Our hypothesis is that an educational intervention program will be effective in improving prescribing patterns for elderly patients in GP settings.

Background: The withdrawal of rofecoxib (Vioxx) from the global market because of adverse cardiovascular effects affected many patients and created a lot of publicity., Material and Methods: 287 patients from four general practices who had received prescriptions for rofecoxib in 2004 were identified from the medical records of their general practitioner (GP) and mailed a questionnaire addressing their reactions and their expectations of their GP in this respect., Results: 140 out of 287 patients returned the questionnaire. More than half were scared by the media frenzy about the withdrawal. 15% had received information from their GP after the withdrawal, whereas 70% wanted this kind of information. 42% had received prescriptions for rofecoxib, even if the patients could not confirm the presence of the diagnostic criteria., Interpretation: The media frenzy gave rise to concern among patients, who want their GP to be more active in informing them about their use of unsafe medication. Better routines and data tools are needed for GPs to better identify and inform patients when needed.

Background: To examine the level and patterns of self-reported medication use (prescription and non-prescription drugs) among 70-74 year old individuals living in the community, and to explore self-reported indications for use, and factors possibly predictive of drug use., Methods: A health survey carried out in 1997-99 in the county of Hordaland (Western Norway) in the setting of a population study. A self-administered questionnaire was mailed to 4338 persons born in 1925-27, and a health check-up was offered. Drug use the previous day was reported (point prevalence). 3341 (77.0%) persons who responded, comprise the material for the analyses., Results: Between one third (males) and one quarter (females) did not take any drug the previous day. Mean number of drugs among users was 2.8 (men and women). 32% used three or more drugs and 11.5% five or more. Hypertension and other cardiovascular problems were by far the most common reasons for drug use, followed by respiratory, musculoskeletal and mental health problems. Self-reported poor health, a high Body Mass Index (BMI), and being an ex-smoker (but not currently a smoker) correlated with increasing number of drugs taken., Conclusion: Among 70-74-year old individuals living in the community no use of medication was more common than major polypharmacy (5+ drugs). Persons who had fallen ill and were put on regular medication, probably tended to quit smoking, while those who remained healthy, continued to smoke.

Background: With the introduction of the list patient system, it has been suggested that routine examination of children should be transferred to the general practitioners (GPs). The aim of this study was to find out how the users of the public child health centres view the relationship between the child health centre and the GPs, and to find out whether parents would like their GPs to perform the routine examinations., Material and Methods: A questionnaire was given to parents in a small Norwegian town who attended the child health centre during spring and summer 2003 and to the town's GPs. Replies were received from 189 parents and from 14 out of 18 GPs., Results: 29% of the parents would prefer to have their GP perform the routine examinations, 48% preferred not to and 23% did not express an opinion. Among the GPs, the corresponding figures were 57%, 29% and 14%. 93% of the GPs felt the need for closer cooperation between GP and child health centre., Interpretation: The parents thought that having their GPs perform the routine examinations was less important than the contact with the health visitor and other parents. The GPs wanted closer cooperation between child health centre and GP. We recommend local trials in which the GPs perform the routine examinations of children on their list, at the child health centre.

Purpose: To analyze associations among the negative life experiences and health-care-seeking of adolescents during the 12 months before the study., Methods: Cross-sectional questionnaire study among 10th-year students at all secondary schools in Oslo., Results: In 2000 and in 2001, 7329 (88%) of Oslo's 8316 secondary-school students responded to the questionnaire. Some contacts with primary health care during the previous year were reported by 71% of respondents, and 6% had seen a mental health practitioner (psychologist or psychiatrist). Health care utilization was not correlated with the family's financial situation as reported by the student (boys = 1019; girls = 1258), or with a parent's unemployment (boys = 253; girls = 325). The 2112 boys (59% of all) and 2378 girls (64%) who reported feeling strong pressure from others to succeed, had more contacts with all primary health care services. Girls, but not boys, who reported being bullied by others reported more psychologist or psychiatrist visits than did their nonbullied peers. Exposure to physical violence was associated with a significant increase in visits to the School Health Service, family physician, and emergency medical service, and was related to more than doubling the probability of visiting a mental health practitioner. Being sexually violated during the previous year increased the likelihood of boys visiting mental health practitioner more than four times (odds ratio [OR] 4.6; 95% confidence interval [CI] 1.7-12.2); and visiting School Health Service by nearly four times, (OR 3.7; 95% CI 1.0-13.5)., Conclusion: Variation in adolescent health care seeking can, by and large, be predicted by negative life experiences.

Background: Antipsychotic drugs are widely used for behavioural and psychological symptoms of dementia. We discuss the evidence for this treatment and implications for clinical practice., Method: Literature search on Medline was supplemented by clinical guidelines and drug reports., Results and Interpretation: Treatment with antipsychotic drugs for behavioural symptoms has limited effectiveness; the documentation is generally weaker for older than for newer drugs. Conventional antipsychotics give important risks of adverse events, while the newer antipsychotics imply increased risk of cerebrovascular events; hence, monitoring of effect and adverse events is imperative. Standardised methods for assessing behavioural symptoms, e.g. the Neuropsychiatric Inventory, are suitable for follow up. Controlled trials indicate that withdrawal is a feasible method for assessing actual drug effect and the need for continued treatment. Withdrawal attempts should therefore be conducted regularly for all patients taking antipsychotics for behavioural and psychological symptoms of dementia.

Aim: To explore possible risk-reducing factors associated with the incidence of common illnesses and use of healthcare services among adolescents., Methods: Cross-sectional questionnaire study conducted in all Oslo schools among all 15- and 16-y-olds in 2000 and 2001. The adolescent population was divided into a low-risk (LR) and a high-risk (HR) group, and into quartiles, based on a sum score of different negative life experiences. The groups were compared with respect to potential risk-reducing factors., Results: 88% of the 8316 pupils filled in the questionnaires. The difference between the LR and HR groups was largest for the possible risk-reducing factor "my family values my opinion" (LR group = 92%; HR group = 82%), and "I manage to solve serious problems myself" (LR = 91%; HR = 86%). The family valuing the adolescents' opinions was the risk-reducing factor most often associated with lower incidences of illness and healthcare utilization. Among the adolescents at highest risk, less depression was strongly related to positive relationships with friends, boys: odds ratio = 0.1 (CI 95%: 0.0-0.7); and girls: 0.2 (0.1-0.5). Adolescents reporting that they managed their own problems had about half the risk of depression., Conclusion: Good relations with family and friends, and a feeling of managing one's own life, are significantly related to lower rates of illness, in particular depression, and less healthcare-seeking behaviour. The risk-reducing effects increase with increasing risk. Healthcare workers therefore need to pay more attention to HR patients.

Background and Aims: The use of psychotropic drugs in nursing homes is generally considered to be inappropriately high. The aim of the present survey was to compare psychotropic drug use in nursing homes (NHs) in 1985 relative to 1996/97, and to explore predictors for this drug use., Methods: Cross-sectional study. Mental capacity was assessed by means of the Clinical Dementia Rating scale (CDR), and behavior registered by trained nurses. Scheduled, daily use of psychotropic drugs among long-term care residents in 1985 (N=1247) and 1996/97 (N=1035) was recorded. Bivariate analyses and logistic regression analyses were applied to establish predictors for psychoactive drug use., Results: From 1985 to 1996/97, the proportion of residents using any psychotropic drug increased from 52 to 57%. Antipsychotic drug use decreased from 33 to 22%, while anxiolytics increased from 11 to 16%, hypnotics from 11 to 14%, and antidepressants from 12 to 31%. Psychotropic drug use was predominantly associated with behavioral symptoms and not with mental impairment. Concurrent use of two or more psychotropic drugs increased from 23 to 32% of all psychotropic users., Conclusions: During the study period, a substantial decline in the use of antipsychotics was observed, but a generally increased overall use of psychotropic drugs, particularly antidepressants. Psychotropic drug treatment was mainly associated with behavioral symptoms.

Background: Frail elderly outpatients often receive medicines from community nurses. There is little knowledge of how general practitioners (GPs) and nurses update and coordinate their medication lists for their shared patients., Material and Methods: Lists of regular medication for 90 randomly selected shared patients from GPs as well as community nurses were assessed with respect to agreement. An agreement score was calculated for number of medicines and for each drug: total daily dosage and dose regimen. Routines for updating medication lists were addressed in a questionnaire to GPs and community nurses., Results: For three out of four patients, discrepancies were found between physicians' and nurses' lists of regular medication. 52% of the discrepancies were in relation to cardiovascular drugs and psychotropic drugs. Only 41% of the GPs reported explicit routines for updating their medication lists., Interpretation: The GPs' lack of knowledge of what their patients actually receive may contribute to medication errors and adverse drug reactions.

Background: Few studies have addressed physicians' home calls in Norway. The aim of this study is to analyse home calls during daytime in Oslo in relation to patients (age, sex, district), diagnoses, request procedures, and clinical outcome., Methods and Material: General practitioners in the City of Oslo emergency medical centre recorded their home calls during three months using a standardised form., Results: Calls to 337 patients (mean age 70, median 77 years; two thirds females; seven to children below two years of age) were recorded. The home calls were requested by relatives (36%), the patients themselves (32%), community care nurses (11%), and nursing homes (7%). The assessments made by the operators of the medical emergency telephone were generally correct. Physicians reported 77% full and 20% partial match between reported and found medical problem. The physicians assessed that 22% of the patients would have been able to go and see a doctor. 39% of all patients were admitted to hospital, 34 % needed ambulance transportation. The admitting GPs received hospital reports only after 27% of admissions., Interpretation: Access to acute home calls by a physician during daytime is a necessary function in an urban public health service.

Background: In a part of Oslo, Norway, the community care services use multi-dose packed medicines for some of their clients. We wanted to investigate whether this improved quality as compared to manually dispensed medicines., Material and Methods: We included 20 patients who received multi-dose packaged medicines, and 33 patients in two other districts who received manually dispensed medicines, and recorded disagreements between what daily medicines the general practitioner had prescribed and those that were dispensed by the community care service or the multi-dose packager., Results: The 53 patients received a total of 324 daily medicines. Disagreements were found in 23% of all daily medicines, involving 58% of patients. In addition, deficiencies in the information on medication were found in 6% of all daily doses. For patients who received multi-dose packaged medicines, disagreements were found in relation to 21 % of the drugs. For patients who received manually dispensed medicines, disagreements were found in 17% and 33% of the medicines lists in the two districts., Interpretation: The disagreements found between the medication prescribed by doctors and what was dispensed were unacceptable regardless of dispensing method (manual or automatic). It is important to clarify who should be responsible for maintaining accurate records for patients who receive community care.

Background: The introduction of acid suppressant, cytoprotective and prokinetic drugs represented major progress in the treatment of acid-related diseases. In Norway, these drugs were reimbursed by the National Insurance System (NIS) from 1986. However, even if the distribution of the various diagnostic indications for prescribing were lacking, this reimbursement was stopped in 1995. The aim of this study was to describe prescriptions for presumed licensed diagnostic indications of these drugs for a defined population, and analyse them with regard to patients characteristics, verified (endoscopic) diagnoses, and therapeutic guidelines., Material and Methods: All prescriptions issued in 1994 to inhabitants of Lindesnes and Mandal Municipalities (17,105 inhabitants) were retrospectively retrieved from the pharmacies and the NIS. The medical records of the local endoscopy units and roentgen laboratories were subsequently searched for information on diagnostic procedures and final diagnosis leading to the prescriptions for these patients., Results: A total number of 1,128 prescriptions (87,905 DDDs) were issued to 441 patients (3% of the population at risk; mean age 63 years; 55% men), and more commonly for the elderly (for 11% of those aged 80 years or more). Diagnostic procedures were documented for 93% of the patients (upper endoscopy in 404, 92%). Diagnostic indications for prescribing were reflux oesophagitis (48%), duodenal ulcer (24%), gastric ulcer (13%), and dyspepsia with normal endoscopic findings (12%). The drugs issued were H2-receptor antagonists (59%), proton pump inhibitors (31%), and cisapride (10%). 8% of the patients were long-term users of an NSAID. Of the 441 patients, drug treatment was issued to 38 with normal endoscopic findings and to 31 patients in whom we could not document examination by endoscopy or X-ray., Interpretation: This study supports that the prevalence of dyspeptic complaints calling for drug treatment increases with patient age. With minor exceptions we found that the prescribing practice for the different diagnoses is in accordance with established therapeutic guidelines.

Background: Even if benzodiazepines are recommended for short-term use, they are prescribed for years. Doctors often feel uncomfortable about this., Material and Methods: In this audit the prescription of benzodiazepines by one general practitioner was studied on the basis of the medical records, a mailed questionnaire to patients, and special benzodiazepine consultations which included diagnostic assessment. 17 long-term benzodiazepine users were given a follow-up which included general information, personal advice and alternative treatment aimed at discontinuing their use of benzodiazepines., Results: 76 out of 754 patients had received prescriptions for a benzodiazepine during the previous three years. The questionnaire was completed by 63 patients. The results revealed that the treatment had originally been initiated by a general practitioner in 78% of the cases, most commonly for anxiety (40%), sleeping difficulties (23%), or depression (10%). Their doctor had previously suggested benzodiazepine withdrawal in 46% of the patients. One third were long-term users. 46% of these had used this medication more than ten years; 90% suffered from chronic illness. After 17 months, 47% of the patients had stopped using benzodiazepines while another 29% used significantly less than before., Interpretation: A broad and individually tailored intervention towards patients in general practice may be a useful tool in reducing long-term use of benzodiazepines.

Background: The global pandemic of antibiotic resistance is causing considerable concern, and a major reason for the growing world-wide resistance problem is the overuse of anti-infective drugs, especially the use of broad spectrum antibiotics. This is still a relatively minor problem in most of the Nordic countries where the consumption of antibiotics is less than half of that reported from southern Europe and the United States of America (USA)., Aim: To describe the resistance pattern among common respiratory tract pathogens in Norwegian general practice, the national consumption of antibiotics, and GPs' prescription patterns for respiratory tract infections. To offer some suggestions as to why Norway has maintained a favourable situation regarding resistant microbes during the past 10 years., Methods: An analysis of the prescription patterns in Norwegian general practice., Results: There is a low total prescription volume of antibiotics compared with other countries. Penicillin V is the most commonly used antibiotic for the most common airway diseases in general practice in Norway., Conclusion: Although there is a low prevalence of antibiotic resistance in Norway, there is still a great potential for reducing the unnecessary antibiotic prescribing for the most common respiratory illnesses.

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.

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.

Objective: To describe general practitioners' (GPs) prescribing patterns during direct contacts (DC) vs. indirect contacts (IC) with respect to the patients (age and sex), diagnoses, and drugs., Design: Descriptive study., Setting: In the Norwegian county Møre & Romsdal, the GPs recorded all contacts with patients and prescriptions during two months., Subjects: 69843 contacts with patients (42202 DC; 24983 IC) during which 56758 prescriptions were issued., Main Outcome Measures: Prescriptions (drugs, strength of tablets, amount prescribed, initial/repeat). Diagnoses for prescribing., Results: 72 drugs were prescribed per 100 DC; 93 per 100 IC. The drugs prescribed most frequently during DC were CNS-drugs (19%), antibiotics (18%), and respiratory drugs (14%); and during IC, CNS-drugs (34%), cardiovascular (16%), and respiratory drugs (12%). More prescriptions during IC were repeat (IC, 79%; DC, 37%). 57% of all CNS-drugs were issued during IC (90% of which were repeat prescriptions). 25% of the antibiotics were issued during IC (70% of which were initial prescriptions)., Conclusion: The GPs' prescribing patterns during DC and IC are different, which probably reflects that different health problems are handled during DC and IC. Prescription studies should address both settings. Our findings raise concern about the medical foundation for antibiotic and psychotropic prescribing during IC.

Objective: To compare general practitioners' (GPs) prescribing patterns of benzodiazepine hypnotics with current recommendations., Design: Observational, cross-sectional study., Setting: The Norwegian county Møre and Romsdal., Subjects: 3452 prescriptions for benzodiazepine hypnotics prescribed by GPs for patients aged 20 years and older during two months., Main Outcome Measures: Prescriptions (strength of tablets, amount prescribed given in Defined and Prescribed Daily Doses: DDDs and PDDs, directions for use); initial or repeat, patients (age, sex); kind of GP-patient contact during prescribing., Results: 68.4% of the prescriptions for benzodiazepine hypnotics were for women; 52.7% were for patients aged 65 or older (65+); 59.9% were issued during indirect contacts; 81.9% were repeat prescriptions. The amount of drug per prescription increased with patients' age: 65+ received on average 69.9 DDDs (76.9 PDDs) per prescription compared with 34.4 DDDs (37.1 PDDs) for young adults (20-29 years). About four of five prescriptions were for the "strong" (i.e. 1 tablet = 1 DDD) sleeping pills irrespective of patients' age and type of prescription (initial or repeat). Written directions for use were: "to be taken daily" in 55.1%, and "only if required" in 38.0% of the prescriptions. Written information on duration of "cure" was only found in one case., Conclusions: GPs' prescribing patterns are not in accordance with recommended dosage and duration of treatment; this pattern is most pronounced for elderly patients.

Objective: To examine general practitioners' (GPs) prescribing patterns of diuretics with respect to indications, drugs and doses to reveal possible needs for prescribing audits., Design: Observational, cross-sectional study., Setting: The Norwegian county Møre & Romsdal., Subjects: 1896 prescriptions for diuretics prescribed by GPs during two months., Main Outcome Measures: Prescriptions (drugs, strength of tablets, volume prescribed, directions for use). Diagnoses for prescribing., Results: Furosemide was prescribed most frequently (48.7%) followed by the compound diuretic of hydrochlorothiazide and amiloride (26.4%), thiazides and related drugs (13.0%), and spironolactone (5.8%). Diuretics were mainly prescribed for hypertension (48.4%), congestive heart failure (35.6%), and oedemas (e.g. orthostatic) (6.1%). The patients' mean age was 69.2 years; two of three were females. When thiazides and related drugs were prescribed for hypertension, we found that the daily dose was excessive in 37.2% of the cases. In congestive heart failure, furosemide was prescribed in about four of five cases, while bumetanide was prescribed in 1.5% of the cases., Conclusion: Our findings indicate that GPs need more knowledge about low-dose diuretic therapy in hypertension, about different diuretic regimens in heart failure, and about non drug treatment for orthostatic oedema. Clinical pharmacology regarding diuretics should be given priority in the vocational training and continuing education for GPs.

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.

The barber-surgeons' guild in Bergen was founded on 17 January 1597. For nearly 250 years this was the only "medical association" in Norway. The guild disappeared with the death of its latest master, Christian Wilhelm Wisbech (1740-1822). However, only nine years later his son, Christian Wisbech (1801-69), founded the Medical Association in Bergen. The barber-surgeons were craftsmen who got their education by apprenticeship. They were the medical practitioners of their times. Their empirical knowledge was more in touch with real life than was the medicine taught by the professors. This paper describes the barber-surgeons' education and work, including their conflicts with other craftsmen and doctors. During the 18th century the barber-surgeons' education was improved, and eventually was given full academic status.

The first Norwegian medical school was founded in 1814. Niels Berner Sørenssen (1774-1857), one of three professors, was responsible for teaching pathology and therapy, and for clinical education. Together with his student and successor, Andreas Christian Conradi (1809-68), he made his mark on Norwegian physicians for a period of 50 years. A few years ago a small handwritten book by a medical student, dated 1828, turned up in a second-hand market. This book, which contains notes from Professor Sørenssen's lectures on therapy, demonstrates that his teaching was heavily influenced by the speculative theories of John Brown (1735-88). Similar influence is traceable in the annual reports from Norwegian physicians during the second half of the 19th century. Sørenssen urged his students to thoroughly investigate the medical history and make a detailed clinical examination, and his attitude to therapy was careful, almost reluctant. This personal clinical attitude was probably more important than the theoretical foundation upon which he based his lectures.

The aim of this study was to elaborate, implement and evaluate a strategy for discontinuation of long-term diuretic treatment in elderly patients in general practice. Thirty-three patients were enrolled for a supervised step-down and withdrawal of diuretics. After withdrawal, the patients were followed up for 6 months or until diuretic treatment was re-established. Withdrawal was successful according to the protocol in 18 cases. Diuretic withdrawal failed and the treatment was re-established in 15 cases, four of which were sudden cardiovascular events. Most withdrawal failures were identified by routine examinations through the follow-up programmes, thus they had few consequences for the patients. This demonstrates that careful follow-up is essential after diuretic withdrawal. Our findings support the view that a large proportion of elderly patients on diuretics may not need such treatment.