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Udgivelsesdato: september

Der tales i disse år meget om patientforløb, shared care og en bedre kronikerindsats. I den forbindelse tales der om, at praksis foruden bevarelse af sit reaktive arbejde med diagnostik og behandling skal øge sit proaktive arbejde. Denne artikel beskriver tankerne bag en øget proaktiv indsats, og den diskuterer, hvilke ideologiske afklaringer og hvilke praktiske konsekvenser det vil have for almen praksis, hvis vi skal være centrale aktører i en proaktiv forebyggelsesindsats for mennesker med kroniske lidelser og sygdomme.

Udgivelsesdato: 26. september

Udgivelsesdato: 25. februar

OBJECTIVE: This study explores former cancer patients' psychosocial rehabilitation needs after hospital discharge.METHOD: Three focus-group interviews with 15 patients.RESULTS: Five main areas were identified: (1) Need for continuous support and information about rehabilitation opportunities; (2) Support to the family; (3) Psychological help also addressing fear of relapse of cancer; (4) Needs for social support; (5) Needs pertaining to how friends and acquaintances relate to the patients.CONCLUSION: Each of these aspects should be carefully considered for each patient, preferably by one assigned healthcare provider. Fear of cancer relapse prevails among the patients, the family and the social network and it is important in relation to psychosocial rehabilitation.

Udgivelsesdato: Oktober

Konferencen: ECCO 14 - The European cancer Conference, Barcelona, Spanien, 23.

Background: Few randomized controlled trials have been conducted on the benefits of using informationtechnology to support the cancer patient pathway. The relatively low incidence and the complexity of cancer pathways make it difficult for the general practitioner to advise the patient satisfactorily. This may lead to diagnostic delay, delay in treatment, lack of continuity and seamless pathways and low patient satisfaction.Objective: Our aim is to clarify to which degree clinical information support systems can provide GPs and Our aim is to clarify to which degree clinical information support systems can provide GPs and patients with on-time and updated information about agreed care pathways and to examine the effect on delay, use of and adherence to guidelines and doctor and patient satisfaction.Subjects and Methods: We intend to conduct two randomized controlled trials to measure the effect of inserting URL links based on the ICD10 codes of the discharge letter. The cohort will consist of about 2000 patients enrolled in a mammography screening programme in two of five Danish regions.In the second study, we plan to enroll about 12000 cancer patients to measure the effect using an electronic questionnaire compared to using a paper questionnaire to create an extended data and feedback system. Results: Different outcome measures will be analyzed: Use of health care services, clinical satisfaction, patient experienced continuity, use of further tests and adherence to guidelines.

Udgivelsesdato: December

Background: Denmark has the highest morbidity and mortality from cancer in Western Europe, and studies suggest that Danish cancer patients are diagnosed at a later stage than patients in the other Nordic countries. To address this issue a Danish hospital has introduced fast track diagnosis of cancer and expanded services to the general practitioners. Objective: To investigate the diagnostic delay of cancer, patient and provider satisfaction and health economic aspects in two Danish regions with special emphasis on the possible benefits of fast track diagnosis. Methods: The study will be designed as a cross-sectional study with the construction of a clinical database of all incident cancers in two Danish regions within a year (12,000 patients). Data will be collected from general practitioners, patients and national registers. In the first part of the analysis the general variation in diagnostic delay will be described in uni- and multivariate analysis models based on three types of delay (patient, doctors and system delay) and stratified by diagnosis. The second part of the analysis will focus on the possible benefits from fast track diagnosis in terms of reduced diagnostic delay, patient satisfaction and economic benefits. Perspectives: The study will provide important information on the actual diagnostic delay in the two Danish regions and identify differences in the diagnostic delay between the hospitals in the regions.

Udgivelsesdato: januar

Udgivelsesdato: 21. maj

Udgivelsesdato: 29 oktober

PhD day (abstract p18.04 i programbogen).

14th Nordic Congress of General Practice, Stockholm Socialmedicinsk tidsskrift 2005:91

http://www.dssnet.dk/content/Et%20fælles%20sundhedsvæsen.pdf

BACKGROUND. Palliative care for cancer patients is an important part of a GP's work. Although every GP is frequently involved in care for terminally ill cancer patients, only little is known about how these palliative efforts are perceived by the patients and their families, a knowledge that is vital to further improve palliative care in the primary sector.AIM. The aim of the study was to analyse the quality of palliative home care with focus on the GP's role based on evaluations by relatives of recently deceased cancer patients and professionals from both the primary and secondary health care sectors.METHOD. A number of focus group interviews were conducted with three types of subgroups: 1) Bereaved relatives, 2) GPs and 3) Various health-care-professionals, namely community nurses, hospital physicians and GPs. The interviews were transcribed and analysed according to a phenomenological approach.RESULTS. The analyses revealed several key areas, e.g.: 1) How to take, give and maintain professional responsibility for palliative home care. 2) A need for transparent communication both among primary care professionals and among professionals across the primary/secondary interface. 3) The primary sector needs easy access to specialist advise, supervision and empowerment. 4) Better and easier communication pathways are important, both within the primary sector and across the sectors to improve accessibility.CONCLUSION. Our study shows a need for improvements in palliative home care and provides important knowledge about how these improvements are achieved.The GPs want closer supervision and improved shared care. They want to be key persons in palliative home care, but to fill this role it is vital that they take or are given the responsibility in a very transparent way, i.e.: A way that is transparent, both to themselves, the patients and the relatives and to the other healthcare professionals involved.

Udgivelsesdato: september

Udgivelsesdato: 3. april

Udgivelsesdato: November

14th Nordic Congress of General Practice, Stockholm (Socialmedicinsk tidsskrift 2005:84.)

BACKGROUND: A lack of social support is associated with increased morbidity and mortality and a decreased effect of prevention. Frequent attenders to primary care are characterised by poorer social conditions than other patients in general practice, but we do not know whether this is due to social inequalities in health or whether social factors in themselves determine the use of general practice. AIM: To examine if social factors are associated with frequent attendance in general practice after adjusting for physical and psychological health variables. DESIGN OF STUDY: Population-based cross-sectional survey. SETTING: Two hundred and twenty GPs in 132 practices in the county of Aarhus, Denmark, and the listed adult population (aged 20-64 years). METHOD: A sample of frequent attenders and infrequent attenders was drawn. The study included only those resident in the county and who had consulted a GP during the period November 1997-October 1998. A questionnaire about physical, psychological and social factors was sent to the patients. The associations between social factors and frequent attendance were adjusted for physical and psychological health and tendency towards somatisation. RESULTS: A total of 1423 (73.7%) frequent attenders and 1103 (74.9%) infrequent attenders responded. Male frequent attendance was associated, with statistical significance, with living alone and being without work or on a disability pension. Among women, lack of professional education or being without work tended to increase the likelihood of frequent attendance. CONCLUSION: This study shows that for men, social factors may in themselves determine the use of general practice. None of the investigated social factors seemed to restrict the use of general practice. Udgivelsesdato: 2005-Jul