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Background: Somatisation is highly prevalent in primary care (present in 25% of visiting patients) but often goes unrecognised. Non-recognition may lead to ineffective treatment, risk of iatrogenic harm, and excessive use of healthcare services. Aim: To examine the effect of training on diagnosis of somatisation in routine clinical practice by general practitioners (GPs). Design of study: Cluster randomised controlled trial, with practices as the randomisation unit. Setting: Twenty-seven general practices (with a total of 43 GPs) in Vejle County, Denmark. Method: Intervention consisted of a multifaceted training programme (the TERM [The Extended Reattribution and Management] model). Patients were enrolled consecutively over a period of 13 working days. Psychiatric morbidity was assessed by means of a screening questionnaire. GPs categorised their diagnoses in another questionnaire. The primary outcome was GP diagnosis of somatisation and agreement with the screening questionnaire. Results: GPs diagnosed somatisation less frequently than had previously been observed, but there was substantial variation between GPs. The difference between groups in the number of diagnoses of somatisation failed to reach the 5% significance (P = 0.094). However, the rate of diagnoses of medically unexplained physical symptoms was twice as high in the intervention group as in the control group (7.7% and 3.9%, respectively, P = 0.007). Examination of the agreement between GPs' diagnoses and the screening questionnaire revealed no significant difference between groups. Conclusion: Brief training increased GPs' awareness of medically unexplained physical symptoms. Diagnostic accuracy according to a screening questionnaire remained unaffected but was difficult to evaluate, as there is no agreement on a gold standard for somatisation in general practice.

Introduktion: Formålet med denne artikel var at belyse patienters vurderinger af ydelser i almen praksis. Metode: Danske resultater fra en international spørgeskemaundersøgelse i ti lande. Seksogtredive praksis blev udvalgt fra hele landet, fordelt efter geografisk beliggenhed samt praksisstørrelse. Fra hver praksis blev 40 voksne patienter konsekutivt inkluderet i undersøgelsen. Spørgeskemaet blev udviklet i en europæisk projektgruppe og omhandlede lægefaglige ydelser, læge-patientforholdet, information og støtte, tilgængelighed samt organisation af ydelser. Resultater: I alt 1.309 (90,9%) besvarede spørgeskemaet. Der var stor tilfredshed med de praktiserende læger. Patienterne vurderede den praktiserende læges evne til at respektere tavshedspligten og hurtig hjælp ved presserende sygdom højest, mens ventetiden i venteværelset, samt at komme til at tale med lægen i telefonen blev vurderet lavest. Ældre patienters (>50 år) vurderinger var mere positive end yngres. Patienter med lavere uddannelse havde mere positive vurderinger end patienter med højere uddannelse. Endelig havde patienter med hyppige kontakter (>5 per år) mere positive vurderinger end patienter med færre kontakter. Der var størst tilfredshed med praktiserende læger i solopraksis. Diskussion: Der var stor tilfredshed med de praktiserende læger, og patienterne vurderede kerneydelserne i almen praksis højest, mens ventetid i forbindelse med kontakt med de praktiserende læger blev vurderet lavest This study aims to assess how patients evaluate the quality of general practice care. With a questionnaire answered by a sample of 1309 (90.9% response) from 36 practices. Patients answered 25 questions relating to their general practice care. Patients were, generally seen, very positive about their general practitioners. "Keeping your records and data confidential" and "providing quick services for urgent health problems" received most positive evaluations, while "waiting time in the waiting room", "being able to speak to the general practitioner on the telephone" and "getting through to the practice on the phone" were assessed most negatively

BACKGROUND AND OBJECTIVES: A governmental reorganization of the after-hours general practice service in Denmark was launched in January 1992. The biggest change was the introduction of mandatory county-wide telephone triage systems staffed by general practitioners. This study assesses the effect of this reorganization on the use of services by frequent attenders (FAs). METHODS: From 1990 to 1994, methods of contact and annual costs per attender were analyzed in an ecological time-trend study based on aggregated administrative data collected from the database of the Public Health Insurance, Aarhus County, Denmark (600,000 inhabitants). The study only included attenders ages 18 and over. FAs were defined as the group that, within each calendar year (12 months), had 4 or more contacts with the after-hours family practice service. RESULTS: FAs made up 9.5% of the attenders and accounted for more than 40% of the contacts and the aggregate costs. The effect of the reorganization was a 12% decrease in the number of attenders, a 16% decrease in the number of contacts, and a 29% decrease in the costs. Reorganization had a significantly bigger effect on FA attendance than on non-FA attendance, and more than half of the overall reduction in use of services could be ascribed to changes in FA behavior. CONCLUSIONS: The reorganization of the after-hours service produced a significant fall in attendance and costs, especially with respect to adult FAs.

Insight into patients’ priorities with respect to health care should complement the views of professionals and policy makers on what is thought to be appropriate health care. To determine the strengths and weaknesses of general practice care from patients’ perspectives written surveys were performed among patients in Denmark, Germany, Israel, Netherlands, Norway, Portugal, Sweden and United Kingdom (n=3540). The potential quality problems identified were spread over the different countries: the low involvement of general practitioners in out-of-hours services in Portugal; the low provision of routine screening in Sweden, Norway and The Netherlands; the lack of a defined patient population in Germany; the lack of a formal gatekeeper role to secondary care in general practice in Germany and Sweden; and the low number of home visits in Sweden.

OBJECTIVE: To demonstrate whether standardization of practice populations by age and sex changes the internal prescription ranking order of a group of practices. DESIGN: Data on the prescribing of cardiovascular drugs in a group of practices were obtained from a county-based database. Information on the age, sex, and numbers of patients per practice was also obtained. The direct standardization method was used to adjust practice populations for age and sex. SETTING: The town of Randers, Aarhus County, Denmark. SUBJECTS: 35 practices, 41 GPs. MAIN OUTCOME MEASURES: Ranking of the 35 practices with respect to number of prescribed daily doses of cardiovascular drugs in crude utilization index and standardized utilization index. The slope of the regression curve of variation between the practices. RESULTS: The change from crude to standardized utilization index gave an entirely new ranking order of the practices. Only four practices did not change ranking position, while four moved more than ten places. The slope between highest and lowest ranked practice did not diminish after standardization. CONCLUSION: Care should be taken when comparing peer prescribing patterns from crude utilization data, and we recommend prior age and sex standardization. Our results are of value in creating a more reliable basis for a debate on variation in prescribing patterns between peers