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Background: Doctors generally enjoy good health, but often refrain from seeking help when they are ill. Self-treatment is widespread, and this can be an inappropriate and risky practice., Material and Method: This is a registry study that compares GPs' own use of the primary and specialist health services in 2018 with a control group consisting of all others in the same age group with the same sex, level of education and health as the GPs. Morbidity in both groups was surveyed with the aid of two validated morbidity indexes in the period 2015-17. Only those who scored zero on both indexes were included., Results: While only 21.7 % of the GPs had sought help from a GP and 3.3 % had attended the emergency department, the corresponding figures for the control group were 61.6 % and 11.8 %. Of the GPs, 17.5 % consulted a contract specialist, compared to 15.5 % of the control group. Measured as a proportion of all specialist consultations, consultations with a psychiatrist constituted 35 % for GPs and 13 % for others. There were small differences in the use of somatic outpatient clinics (25.9 % of GPs and 25.7 % of the control group) and acute admission in somatic hospitals (3.8 % of GPs and 3.3 % of the control group)., Interpretation: This study indicates that GPs receive medical assistance from other than their own GP.

Background: Primary care doctors put diagnostic codes on all reimbursement cards. The objective of this study was to map out the use of non-specific diagnostic codes that can undermine the validity of statistics and disease surveillance., Material and Method: The material consists of data from all electronic reimbursement cards from out-of-hours services in the period 2008-2019. We registered consultations and telephone contacts and the proportion of these that were supplied with diagnostic codes for respiratory infections and three non-specific diagnostic codes., Results: The number of consultations per year increased from 1 402 452 in 2008 to 1 417 395 in 2019, a relative increase of 1 %. The number of telephone contacts per year increased from 286 515 in 2008 to 684 773 in 2019, a relative increase of 139 %. Out-of-hours contacts coded with non-specific diagnoses increased nearly thirteenfold, from 40 280 to 514 715. The use of non-specific diagnoses increased by a factor of 19 for telephone contacts and 2.7 for consultations. The total number of out-of-hours contacts for respiratory infections decreased from 240 037 to 176 909 (a 26 % reduction)., Interpretation: There is a strong tendency for general, non-specific diagnostic codes to replace specific diagnoses of disease on reimbursement cards from out-of-hours services. This undermines the evidence base for statistics and research based on reported ICPC-2 diagnoses, and this is especially of concern when these diagnoses are to be used for monitoring of the COVID-19 pandemic.

Background: There are several examples of inadequate staffing at local emergency medical communication centres (LEMCs) resulting in limited availability and long waits on the telephone. There are no guidelines for population size or the staffing of a LEMC. In the following, we present models of catchment areas and staffing., Material and Method: Traffic intensity on Saturdays and Sundays was based on data on figures for patient contacts at seven LEMCs in 2014 and 2015. We defined the minimum optimal population base as at least 50 % probability of ≥ 10 contacts in the course of a night duty. The Erlang-C formula was used to estimate service level and hence staffing requirements on the basis of population and response-time requirements. We have surveyed the combined staffing requirements of all the LEMCs in Norway., Result: The minimum optimal population base was 29 134. In 2016, 48 of 103 LEMCs were smaller than this. In order to be able to satisfy the response-time requirements in the Norwegian Emergency Medicine Regulations, 112 LEMC night operators and 158 day operators would be necessary for the whole of Norway. A reduction of the response-time requirement from 120 to ten seconds would require 9.8 % more operators at night and 17 % more operators during the day., Interpretation: The models we have presented provide a basis for planning the population base and staffing of LEMCs. Significantly stricter response-time requirements will result in limited need for more personnel.

Background: Poisonings constitute a serious health problem in Norway. The objective of the study was to analyse cases of poisoning reported to out-of-hours services and any changes that may have occurred over a ten-year period., Material and Method: The material consists of reimbursement claims from all doctors on out-of-hours duty in Norway in the period 2006 – 15. Poisonings were defined as ICPC diagnostic codes A84 (poisoning by medical agent), A86 (toxic effect non-medicinal substance) or P16 (acute alcohol abuse)., Results: The contact rate due to poisonings increased from 221 per 100 000 inhabitants in 2006 to 297 per 100 000 inhabitants in 2015. For the age group 1 – 2 years, the contact rate per 100 000 inhabitants dropped from 469 to 223, for the age group 15 – 25 it rose from 523 to 719, and for the age group 53 – 59 it rose from 178 to 339. The highest contact rate was found among women aged 15 – 25 (785 per 100 000 inhabitants). This group also had the highest contact rate caused by poisoning by a medical agent (238 per 100 000 inhabitants). In the age group 15 – 25 years, altogether 63% of the poisonings occurred during the night., Interpretation: The frequency of contact with out-of-hours services because of poisoning is generally increasing, although a strong decline is observed among small children. Adolescents, and young women in particular, stand out in suffering frequent cases of poisoning.

Background: Several earlier studies have shown that doctors in local out-of-hours emergency primary health care participate in call-outs to varying degrees. It is the out-of-hours doctor who decides whether to respond with a call-out. We wished to study the assessments that form the basis of this decision., Material and Method: We interviewed the out-of-hours doctors in the county of Hordaland who had been alerted about an emergency incident on the health radio network during an evening or night shift, apart from at weekends. The interview period lasted from July to October 2012 and was linked directly to specific alarm calls., Results: There were 252 relevant incidents, 72 of which were investigated. A total of 47 of the 95 doctors contacted were interviewed (49%). The doctor responded with a call-out in 65 % of the incidents. Normally it was the content of the message about the patient's medical condition that was critical for the doctor's decision to respond with a call-out, while it was most often practical aspects that meant that she/he did not respond in this way. When the doctor responded with a call-out, and later assessed the call-out as necessary, the patient's need for medical expertise was the most important reason given., Interpretation: In the incidents studied, the decision on whether or not to respond with a call-out was based on a balanced consideration of the patient's needs and what was practically possible for the doctor. The out-of-hours doctors experienced a need for medical expertise in many emergency medical situations.

Background: It has been documented from a number of out-of-hours primary health care services that the utilisation of the services declines with increasing travel distances. In this study we have investigated the correlation between travel distances and the use of out-of-hours medical services for all Norwegian municipalities that provide such services at a single permanent casualty clinic round the clock. In addition, we have sought to reveal any differences in consultation rates between municipalities that maintain single-municipality or inter-municipal out-of-hours services, as well as between municipalities in which the casualty clinics are co-located with a hospital or located separately., Material and Method: Information on the types of out-of-hours services existing in 2011 was retrieved from the Norwegian Emergency Primary Health Care Registry, and 315 municipalities with single permanent casualty clinic premises were included. Rates for various types of utilisation of these clinics were calculated on the basis of statistics generated from reimbursement claims., Results: The number of medical consultations and house calls per inhabitant fell by 48 % and 55 % respectively when average travel distance increased from 0 to 50 kilometres. The use of telephone/letter contact was not significantly associated with distances. Single-municipality casualty clinics located outside hospitals had the highest consultation rate for out-of-hours medical services when adjusted for distance., Interpretation: This supports previous findings to the fact that distance is a crucial factor for the utilisation of out-of-hours medical services. Establishing inter-municipal casualty clinics and co-locating them with hospitals may contribute to a lower rate of use of out-of-hours medical services.

Background: Geographical factors have an impact on the utilisation of out-of-hours services. In this study we have investigated the travel distance to out-of-hours casualty clinics in Norwegian municipalities in 2011 and the number of municipalities covered by the proposed recommendations for secondary on-call arrangements due to long distances., Material and Method: We estimated the average maximum travel times and distances in Norwegian municipalities using a postcode-based method. Separate analyses were performed for municipalities with a single, permanently located casualty clinic. Altogether 417 out of 430 municipalities were included. We present the median value of the maximum travel times and distances for the included municipalities., Results: The median maximum average travel distance for the municipalities was 19 km. The median maximum average travel time was 22 minutes. In 40 of the municipalities (10 %) the median maximum average travel time exceeded 60 minutes, and in 97 municipalities (23 %) the median maximum average travel time exceeded 40 minutes. The population of these groups comprised 2 % and 5 % of the country's total population respectively. For municipalities with permanent emergency facilities(N = 316), the median average flight time 16 minutes and median average distance 13 km.., Interpretation: In many municipalities, the inhabitants have a long average journey to out-of-hours emergency health services, but seen as a whole, the inhabitants of these municipalities account for a very small proportion of the Norwegian population. The results indicate that the proposed recommendations for secondary on-call duty based on long distances apply to only a small number of inhabitants. The recommendations should therefore be adjusted and reformulated to become more relevant.

Background: Norwegian emergency medical services are used with frequency, often in relation to conditions that could wait until the next day to be handled by the patient's regular GP (RGP). We investigated whether there are characteristics of particular GPs that may help explain why patients on their list use the emergency medical services., Material and Methods: We used data from the billing cards for 2008 from all emergency doctors, linked to information from the Regular GP database and Statistics Norway, for a total of 4,097 RGPs. For each RGP we estimated a contact rate: The total number of contacts reported for their list patients (identified by their personal ID numbers), divided by the length of the RGP's list. This rate was subsequently analysed with regard to characteristics of the RGP (bivariate analyses and multiple logistic regression)., Results: The average contact rate amounted to 27.4 contacts per 100 list patients, with significant variation between the RGPs (the 25th percentile was 17.8 contacts and the 75th percentile 33.1). Patients of male RGPs, young RGPs and immigrant RGPs used the emergency medical services more frequently than patients of female RGPs, older RGPs and Norwegian RGPs. Patients from long lists, single-doctor practices and open lists used the emergency medical services less frequently than patients from short lists, group practices and closed lists. The contact rate was higher in rural municipalities than in urban areas., Interpretation: The large variations in the use of emergency medical services indicate that more RGPs should take measures to improve accessibility for emergency calls during the daytime.

Background: Approximately half of all accident and emergency medical (A&E) services are provided by regular general practitioners (RGPs). We wished to find out which RGPs staff the A&E services., Material and Method: The material comprises billing cards from all A&E doctors in 2008, linked to information from Statistics Norway and the Regular GP database. We estimated the proportion of various RGPs who staff the A&E roster and how many patient contacts they had while on duty. The same variables describing the RGPs were used in a multivariate logistic regression analysis, in which the dependent variable was whether the RGPs were on the emergency service roster or not., Results: Altogether 53% of the RGPs were on the emergency service roster, and accounted for 47% of all patient contacts. The RGPs were older than other emergency doctors (44 years as opposed to 34 years), and included a smaller proportion of women (33% as opposed to 44%). Immigrants accounted for 23% of the RGPs and 21% of the other emergency doctors. Women RGPs were on A&E duty less frequently than their male counterparts in all age groups, and they also had fewer patient contacts (206 and 374). The participation rate decreased in proportion to the doctors' age, increasing list length and increasing centrality. Immigrant RGPs with a short time of residence in Norway had the highest frequency of on-call duty (81%)., Interpretation: The number of women RGPs is increasing, and it is therefore likely that the frequency of on-call duty among RGPs will decrease further. However, the immigrants are providing a significant contribution to maintaining the A&E scheme.

Background: The use of medication for ADHD has increased significantly since the 1990 s. The objective of this study was to establish the prescription rate for such drugs in Norway, and to examine which doctors prescribe them., Material and Method: Data relating to all ADHD medication collected in the period 2004-08 was obtained from the Norwegian Prescription Database and linked to the GP database., Results: The number of people who collected at least one prescription annually for ADHD medication increased over the period, while the number of new drug users remained stable. In 2008, 3.6 % of the boys and 1.2 % of the girls aged 11-15 collected their prescriptions. Of the people who collected their prescriptions for the first time in 2005, 53 % continued to collect prescriptions every year throughout the period 2006-08. In 2008, extended-release methylphenidate constituted 51 % of the prescription volume for adults and 83 % for children and young people. GPs prescribed 17 % of the total volume collected in 2004 and 48 % in 2008., Interpretation: During childhood and the teenage years there are substantial differences between the sexes when it comes to the prescription pick-up rate for ADHD medication. This may suggest that girls who suffer from ADHD go through large parts of their statutory education before they are diagnosed and receive treatment. GPs play an important role in the treatment of ADHD.

Background: In April 2009 the World Health Organization (WHO) declared that spreading of a new influenza A(H1N1) virus had reached epidemic proportions, and on June 11, 2009 they declared that the world was in fact facing a pandemic. In Norway the influenza pandemic was the cause of much activity from health authorities and all levels of the health services. This report concerns pandemic-related work within clinical and community medicine in a municipality in western Norway., Material and Methods: All contacts between the general practitioners (GPs) and patients with influenza-like disease in Austevoll municipality were recorded for the second half of 2009. The lead public health nurse recorded vaccination activity systematically. Absence from secondary school in the municipality was recorded and the Medical Health Officer recorded all pandemic-related activities., Results: 141 patients living in the municipality (3.2 % of the population) contacted the GP for influenza-like disease. Most cases occurred during weeks 43-47. A large majority of the encounters with the GP during these weeks were with patients below 20 years of age, whereas the age distribution was much more diverse at other points in time. Absence from secondary school was also highest in weeks 43-47. 54 % of the municipality's inhabitants were vaccinated. At the end of the main wave of the epidemic, vaccination coverage had reached 28 %. The Medical Health Officer had a large workload, especially during the main wave., Interpretation: The influenza epidemic in 2009 hit Austevoll municipality in weeks 43-47. Mass vaccination was started too late to have a major influence on the epidemic. Systematic mapping of the epidemic on a municipal level is a useful supplement to the national surveillance.

Background: Prompted by the H1N1 influenza epidemic in autumn 2009, Norwegian health authorities launched a campaign for better hygiene. We wanted to investigate whether there was any change in the out-of-hours contact rate for infectious diseases during this campaign., Material and Methods: The material consisted of remuneration claims from all doctors doing out-of-hours work during the years 2006-2009. The contact rates for nine diagnoses of infectious illness in autumn 2009 were compared with a corresponding mean from the years 2006-2008., Results: The contact rate for influenza was ten times higher in autumn 2009 than in the three preceding years. During the same period there was a significant reduction in conjunctivitis (contact rate ratio 0.74), otitis (0.73), sinusitis (0.70), throat infections (0.79), pneumonia (0.70) and intestinal infections (0.82). There were small changes in the contact rates for acute upper respiratory tract infections and urinary tract infections, but in December there was also a clear reduction in acute upper respiratory tract infections (0.61)., Interpretation: The reduced contact rates for infectious diseases may be ascribed to an effect of the campaign, but other factors may also have contributed to this result.

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.

Background: Effectivization of the Norwegian out-of-hours primary care medical services has probably rendered the services less available to residents in nursing homes in many places. In Bergen, an out-of-hours medical service especially dedicated to residents in retirement and nursing homes and people with special needs living at home, was established in March 2006. We wanted to assess this medical service after its first year of activity., Material and Methods: Data were prospectively recorded on when the services were used and characteristics of the users . Information about the institutions was also recorded., Results: 926 patients used the services during the first year; more than half of them received sick calls. Pneumonias and urinary tract infections were the most common diagnoses. A high level of doctor staffing at the nursing homes did not lead to decreased use. Neither the total number of beds nor the number of short - time beds in the nursing homes had a significant influence on the use of this service., Interpretation: This targeted out-of-hours service was used less than expected during its first year. The nursing homes' use of this service is determined by factors other than the number of beds and doctor staffing.

Background: All Norwegian municipalities have prepared local emergency plans, but the usefulness of such plans has not been evaluated. The aim was to investigate how such an electronic plan is used in emergency situations in one of these municipalities (Askøy), with focus on quality work and the function of the local emergency medical communication centre(LEMC)., Material and Methods: During 20 months all events that activated the emergency plan were registered and evaluated, either by evaluation meetings or otherwise. A structured questionnaire was sent to all participants in the local emergency services before and after the registrations., Results: Ten emergency events were registered during the project period; 38 topics worked well, 52 topics had potential for improvement and 16 were deviations from the plan. Examples of evaluated topics are raising alarm and giving feedback within the services, use of nationwide radio communication system, on-site cooperation and use of the plan. In retrospect mapping of events showed that more situations could have led to activation of the plan. The questionnaire revealed that 70 % of respondents meant the cooperation was good or very good, both before and after the registrations. There were few changes in the answers before and after the project period., Interpretation: An electronic emergency-preparedness plan used in emergency medical communication centres is a suitable tool in quality work and can be a valuable tool for evaluation of emergency situations.

Background: The ambulance service in Norway has gone through a pronounced upgrading of skills and professionalization during the last 10 years. The purpose of this survey was to obtain knowledge on how the ambulance personnel perceive their own professional competence and their relationship to other occupational groups with whom they cooperate., Material and Method: A questionnaire was sent to 300 persons who received authorization as ambulance personnel between 2002 - 2005. Questions were included on evaluation of inter-professional cooperation, professional appreciation and competence in practical handling of patients., Results: The response rate was 52 %. The ambulance personnel regarded the most problematic relationships and situations to be with nurses and regular general practioners in the out-of-hours services and with doctors in connection with emergencies at accident sites. 78 % of the ambulance personnel claimed that their own occupational group has the highest competence in the practical handling of patients with acute illness and injuries outside of hospitals. Nevertheless, only 19 % of them felt that occupational groups with who they cooperate appreciate their competence., Interpretation: Ambulance personnel have strong confidence in their own occupational group's competence in practical handling of patients. Strengthened formal competence combined with increased possibilities for initial medical treatment in the ambulances, may have contributed to an expanded role for ambulance personnel within pre-hospital emergency care. Smooth cooperation between regular general practitioners and ambulance personnel requires that both parties increase their understanding of the other group's procedures and roles.

Background: Availability of equipment for diagnostics and treatment in out-of-hours services in Norway is not documented and no guidelines exist on requirements for the various types of equipment (including drugs) needed. A knowledge basis on status and needs should be established so minimum requirements can be developed., Material and Methods: The National Centre for Emergency Primary Health Care sent a questionnaire on availability of diagnostic equipment, laboratory tests, medication and quality assurance systems to all 261 municipal out-of-hours services in Norway in February 2006., Results: 223/261 (86 %) of the services responded. 150 used the same office as a day-time practice, 59 had their own office and 14 were localised in a hospital/ emergency care unit. Services located in GP surgeries with a daytime-practice had a wider range of equipment, laboratory tests and medicines. Physicians on duty in the out-of-hours services with shared facilities did much of the laboratory work, but the quality control was done by the personnel at daytime. 27 % of the independent services did not have external control of their laboratory work (they were not members of the Norwegian Quality Improvement of Primary Care Laboratories). GPs were trained on acute medical situations more than once a year in 52 % of all the out-of-hours-services, but for only 40 % in the independent services. Other personnel were trained more than once a year in 74 % of the independent services., Interpretation: Availability of equipment and laboratory test repertoire for GPs on duty at out-of-hours services seems to depend on whether the services are shared with GP surgeries and also used at daytime, and the distance to ambulance, hospital and pharmacy. Lack of routines for laboratory work and low training frequency in acute medical procedures may lead to poor quality of the analyses and lower competence than needed.

Background: Certain aspects (frequency and management) of medical emergencies in Norwegian communities are not adequately documented. Previous studies indicate an annual case incidence rate of about 10 per 1000 inhabitants. This article presents results of a recording of medical emergencies (during a 2-year period) in the Norwegian island community Austevoll (4400 citizens) south of Bergen (without a mainland connection)., Material and Methods: Data on a variety of aspects were recorded on medical emergencies, defined as incidents where the doctor found it necessary to take immediate action. Data on these occurrences were recorded into questionnaires by all doctors and ambulance personnel in Austevoll in the period 1 October 2005 to 30 September 2007., Results: 236 medical emergencies were documented. This corresponds to 27 incidents per 1000 inhabitants per year. 84 % of the emergencies were acute illnesses and 16 % were accidents. The emergencies occurred in the patients' home or other dwelling in 71 % of the cases. In Austevoll, the doctor is the first personnel category to reach to the patient in 52 % of cases., Interpretation: This study estimates a higher incidence of medical emergencies than previous records. A likely reason is that the municipal medical services have been the point of observation in our study, while previous studies have counted incidents recorded in the emergency medical communication centres.

Background: A comprehensive study of medical emergency situations in a rural community in Norway has been undertaken for the first time. Some results from this study are presented; i.e. data on events (types and management) that occur in medical emergency situations., Material and Methods: Austevoll is an island community in western Norway, with about 4400 inhabitants. Data on all events in medical emergency situations were recorded during two years. The following information was recorded: degree of urgency at the time of the emergency call and at patient examination (as assessed by the doctor), treatment measures and the relationship between doctors' and ambulance personnel's assessments., Results: 236 medical emergency events were recorded. The doctors downgraded the seriousness of the event (from emergency call to actual examination of the patient) in 43 % of cases, while the event was upgraded in 11 %. For alarms dispatched from the emergency medical communication centres, the doctors downgraded the evaluation of seriousness in the time span alarm-examination in 67 % of cases, while the ambulance personnel downgraded seriousness in 85 %. Home dwelling was the initial location of treatment in 63 % of patients. The procedures performed most frequently were: venous cannulation, airway handling (including administration of oxygen), ECG-recording and/or monitoring of cardiac rhythm, and parenteral administration of drugs., Interpretation: For emergency medicine work general practitioners should focus on training fundamental practical skills. The doctors and the ambulance personnel have complementary roles in handling of medical emergency events. Ability of obtaining an adequate overall view of the patient's condition is an important aspect of the doctor's role.

Background: The Norwegian Air Ambulance Foundation started a first responder defibrillator program in cooperation with the Norwegian Ministry of Health and Care Services in 2002. By January 2007, 250 half-automatic defibrillators had been made available in 200 municipalities and 250 users had been trained. The aim of the study was to identify defibrillator users' motivation, self-assessed competence and their experience with the referring physician., Material and Method: In autumn 2005, a structured questionnaire was sent to 490 providers (a 50% random selection of all 980) who attended the first responder defibrillator program and course in 2002/2003. The response rate was 70% (307/439)., Results: 33% of the providers had not received a formal delegation certificate from a doctor. A majority (75%) of providers had not met the actual doctor and could therefore not tell if they were involved in the program. Almost everyone (99%) meant that they personally and that the first responder group as a whole (98%) would manage the job. For the 120 (39%) users who had been in a real-life situation corresponding numbers were 93% and 90%. Real-life situations had a positive effect on motivation for 71 (59%) of the first responders., Interpretation: This study indicates that for most doctors delegation of responsibility was a formality without any professional content. The first responders were self-confident and motivated.

Background: The Personal Crisis Support Team at Bergen Accident and Emergency Department offers open access interventions for individuals that have experienced a psychosocial crisis. The aim of the study was to investigate contacts to the personal crisis support team, causes of contact and referrals., Material and Methods: All contacts in 2006 were included in the study. Variables such as patients' gender, age, cause of contact, number of consultations and to whom the patients were referred were recorded from the medical records., Results: The Personal Crisis Support Team handled 2090 contacts and received 901 patients; 602 of whom were women. Nearly every third patient (n = 186) were between 19-30 years old. The patients presented with many different causes of contact, but the majority (n = 590) came due to psychosocial crises, such as unexpected life events or worries about own children. 267 patients presented with symptoms of possible mental disorders. Most patients were further referred to various public or private health services., Interpretation: The Personal Crisis Support Team at Bergen Accident and Emergency Department was approached by patients of all ages with various psychosocial crises. This support team is an example of community-based early intervention after crisis.

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: Out-of-hours services in Norway have not been systematically assessed and no national statistics exist. This article reports a pilot study of requests to three casualty clinics and the activities related to these requests., Material and Methods: All requests to the three clinics, day and night for four weeks in the spring of 2006, were recorded. Variables and definitions were discussed with all participating personnel before start. A coordinator at each casualty clinic was responsible for ensuring data quality and sending data to the study centre weekly., Results: 5,041 requests were recorded. Contact rates per 1,000 inhabitants ranged from 29 to 84. In two casualty clinics a large majority of the contacts were given the priority grade "not urgent". In one casualty clinic the rate "acute" was more than twice the rate in the two others. The rate of consultation with GPs differed, but the rate of home visits and acute response by ambulance and GP was low in all the casualty clinics., Interpretation: Large differences were identified regarding several factors affecting requests to casualty clinics in Norway. This pilot study supports the need for a larger and more representative study.

Background: The organization of out-of-hours primary health care services in Norway is currently changing from municipal-based to larger inter-municipal co-operations with regular employees and improved competence. The Norwegian Medical Association and others have encouraged the establishment of larger out-of-hours primary health care units that include all municipalities and regular GPs and serve the entire population. More data are needed to study the situation for out-of-hours services in Norway., Material and Methods: The National Centre for Emergency Primary Health Care sent questionnaires to all 433 municipalities in Norway the autumn of 2005 to study how the out-of-hours primary health services are organized., Results: Out-of-hours primary health services is an inter-municipality endeavour in two-thirds of Norwegian municipalities and one third of the remaining municipalities have plans to start such co-operation. Regular GPs participate in out-of-hours services to a varying degree. In half of the municipalities all regular GPs participate in out-of-hours duty. Participation decreases with increasing numbers of inhabitants and regular GPs in the municalities. We found a distinct variation in the number of phone calls per inhabitant to municipal out-of-hours services. Due to geographical factors, there are also variations in patient transport time and availability of ambulances to the out-of-hours offices., Interpretation: We observed distinct variations in the organization of the out-of-hours emergency primary health services in Norway. Some of these differences are due to differences in population density and geographical factors.

Background: Limited data are available on casualty clinic facilities and localisation, inter-municipal co-operation and routines for out-of-hours services in the 433 Norwegian municipalities. The National centre for emergency primary health care collected data on these issues from October 2005 until February 2006., Method: Questionnaires concerning organisation of the out-of-hours services, casualty clinic facilities, locations and routines were sent to every Norwegian municipality., Results: 282 of the 433 municipalities are in charge of out-of-hours services in 262 districts in the evenings and 230 districts during nights and weekends. There is inter-municipal cooperation in 100 of the districts. Most out-of-hours services are located in one casualty clinic in the host municipality and have the same locations as GP surgeries and laboratories. Most clinics offered the same services, but some routines were different. About half of the casualty clinics had a system for training of doctors and other health personnel. Half of the doctors on duty were available on the emergency communications system (radio). User assessments were collected, telephone calls documented and discrepancies reported to a varying degree, and medical histories were not consistently sent to regular GPs., Interpretation: Inter-municipal co-operations are most common in areas with a high population density, i.e. in southern and eastern parts of Norway. Varying routines in out-of-hours service districts indicate that several municipalities do not fulfil all the obligations in regulations from the Ministry of health and care services in Norway.

Earth rays are claimed to cause several types of illness and shielding against earth rays to have a therapeutic effect. There have been many reports in the media of the dangers of earth rays and the usefulness of protective shielding. As with several other alternative therapies, the theory of earth rays and its effects is incompatible with modern medicine, chemistry and physical science. We have earlier shown that earth rays can not be consistently detected, and that children sleeping on earth rays are no more ill than other children are. Recently, a randomised, controlled trial has convincingly though hardly surprisingly shown no effect of TX-disc shielding against earth rays. TX-discs are of plastic with rings of copper. Eighty patients with longstanding muscular-skeletal complaints were enrolled. Patients were, after a few weeks, substantially better (20-40%) whether they had received real TX-discs or not. The concept of earth rays lacks any scientific verification. We advocate prudence in taking success stories, whether published or from one's own clinical experience, as proof of any treatment's effectiveness before having it confirmed by research.

Background: There is little systematized knowledge about drug use and its association to occupation. We studied how drug use varied between different occupational groups, with particular emphasis on those that impair awareness and psychomotor performance., Material and Methods: Study data stemmed from the Hordaland county health survey (Norway) performed in 1997 - 99. 34,249 persons 40 - 49 years of age were included in the study and 66 % responded. The participants were classified into 10 different occupational categories according to national standards. Information about drug use and occupation was analysed and corrected for age and gender., Results: 21.1 % of working men and 36.1 % of working women reported that they had used at least one registered drug the day before they answered the questionnaire. The pattern of drug use varied between occupational groups. Individuals with a military occupation had the lowest rate of use (12.8 %), while employees within sales, service and care reported the highest one (35.7 %). The variation between groups in terms of drugs that impair awareness and psychomotor performance, was small and non significant, Interpretation: Drug use varied between occupational groups, even after control for age and gender. This may either be due to differences between the occupations, to differences between the individuals who choose certain occupations, or a combination of the two. The main conclusion is, however, that the study uncovered no association between hazardous or unfortunate drug use and any single kind of occupation.

Background: The aim of this study was to assess the predictability in the processing of complaints from patients against general practitioners. We also wanted to identify medical issues and situations prone to elicit complaints and possible reactions., Material and Methods: This study includes cases received by the Norwegian Board of Health from county governors during two years (n = 107). One half of the cases consists of complaints that were remitted due to the complainants' objection to county governors' rejections. The other half is cases remitted when county governors assumed that the GP should be given a reaction. In the medico-legal assessment of the cases it was checked whether the guidelines for such cases had been observed., Results: The guidelines had been observed in all but two cases. The relation between indefensible action and insufficient clinical judgment is highly significant (p < 0.001). This also holds for the relation between reactions following an on call-situation and the general practitioner not having Norwegian as his or hers first language. The handling of female patients leads to significantly less reactions than those of male patients. The county governors' assessments coincided to a limited degree with the assessments made by the Norwegian Board of Health., Interpretations: The assessments of complaints made against GPs are coherent and predictable and may be a source of learning from mistakes. The relation between reaction following an on call-situation and the GP not having Norwegian as his/hers first language should elicit actions on several levels. The lack of conformity between the county governors and the Norwegian Board of Health in assessing these cases indicates that a two-step processing is not appropriate.

Background: We wanted to investigate to what extent Norwegian general practitioners (GPs) working within a patient list system have patients who they are legally incompetent to treat, what services they offer these patients, and what attitudes a representative sample of the GPs has towards situations where one is asked to offer services to such patients., Material and Methods: A questionnaire was sent to 622 randomly chosen GPs. We registered sex, age, list size, size of the local community and health region for every practice. For eight hypothetical situations, we recorded whether the doctor clearly, probably or hardly would offer services., Results: About one quarter of the doctors had their spouses and own children below 18 on their list. Many had secretaries or colleagues on the list. From 18% to 31% of the doctors confirmed that they have prescribed reimbursable prescription drugs to one such patient. There were great variations in views on legal competence to treat in these hypothetical situations., Interpretation: GPs encounter problems of legal competence to treat. Many were of the view that a pragmatic approach is needed in day-to-day general practice. GPs should be aware of their own practice and aware of both legal competence problems and other challenges induced by having family, close friends and co-workers on the list.

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: A list patient system was established in Norway in June 2001. Among general practitioners (GPs) there were much concern about workload according to list length, and about uneven distribution of workload among GPs., Material and Methods: In February 2003 a questionnaire about working hours, waiting time for appointments and job satisfaction was sent to all GPs in Bergen., Results: 160 out of 185 (85%) GPs replied. Working hours were closely related to list length, waiting time was not. 79% had a waiting time of less than eight "days in practice". 46% rated their job satisfaction within the list system as "good/very good", 37% were moderately satisfied. We found lower scores among GPs with long waiting time and a full list. No relevant differences between male and female GPs were found., Interpretation: GPs adjust their working hours in order to cope with waiting time. Job satisfaction is lower when the GP has a waiting time of more than three weeks and a full list, factors that could indicate a heavy workload.

Background: The purpose of this study was to explore the attitudes of patients seeking emergency care, with special emphasis on the role of the recently introduced list patient system., Material and Method: During a twelve-day period in January 2003, patients seeking emergency care in Bergen, Norway were asked to fill in a questionnaire that explored whether they knew the name of the physician on whose list they were, their assessment of the accessibility of this physician, whether they had tried to contact him or her prior to coming in for emergency care, why they had contacted emergency care, and if they were willing to wait one or several days for a consultation if they were certain to get an appointment with their own physician., Results: 1504 questionnaires were analyzed (72% of the study population). Most patients knew the name of their physician (84%) and were reasonably satisfied with his or her accessibility. Nevertheless, three in four patients had not tried to contact their physician prior to coming in to the emergency centre. Half of them were willing to wait until the next day to see their personal physician., Interpretation: There is a considerable potential for change of patient behaviour in primary care emergencies.

Background and Objective: General practitioners diagnose and treat benign and malignant skin tumours. We have performed a retrospective study of all skin neoplasms diagnosed in a general practice., Material and Methods: Information on all skin neoplasms presented in one general practice in 1990-1999 were obtained by retrospective search of notes from 41,601 consultations (electronic files) and a handsearch of the paper-based archives., Results: A total of 568 skin tumours had been diagnosed, i.e. 1.37 tumours per 100 consultations. 60% of the patients were women, median age was 49 years. Nevi, seborrheic keratoses and dermatofibromas were the most frequent diagnoses. 26 malignant skin lesions had been diagnosed, among them 19 basal cell carcinomas and three malignant melanomas. All skin cancers were taken care of at the first consultation, by excision, referral, or an early new appointment for further evaluation., Interpretation: Skin tumours are frequently diagnosed and treated in general practice.

On the basis of a clinical presentation of a woman with atrial fibrillation and diabetes mellitus, this article examines how medical evidence can be combined with patient preferences in the analysis of clinical choice. Such choices tend to be analysed and discussed without due consideration for patient or public values. It is argued that such an analysis is incomplete until the patient's preferences are incorporated into the model. This is also a way of implementing patient-centred medicine. We discuss how decision theory can be used to clarify clinical choices, sometimes with surprising results for the physician. How to handle situations when the patient's preferences are in conflict with the physician's judgement, is also discussed. It is concluded that good clinical practice must be based on evidence, but it should also take into account the patient's values in choices with uncertain outcomes.

Medical studies on violence towards women have usually focused on domestic violence. Less attention has been devoted to other kinds of violence towards women regardless of cause. During a 12-month period in 1994-95 all victims of assault were recorded at Bergen Accident and Emergency Department. The attending physician completed a questionnaire on violence exploring where, when and how the assault happened, the use of weapons, whether the patient and perpetrator or both were under the influence of alcohol, and whether the patient intended to press legal charges. Patient characteristics and medical information were also recorded. 24% of the assaulted victims were females (241 of a total of 994). 131 of the females were victims of domestic violence, while 102 were injured in public places. Women injured in public places tended to be younger and more likely to be under the influence of alcohol than those injured by domestic violence. There were no significant differences in patterns of ICPC-diagnoses between the two groups, though the number of admissions to hospitals and referrals to specialists was higher in the group subjected to domestic violence.

Uncomplicated acute cystitis, defined as acute lower urinary tract infection in an otherwise healthy, non-pregnant, adult woman, is the most frequent form of urinary tract infection managed in general practice. The current views on diagnosis and treatment are reviewed. Using clinical epidemiological concepts we focus on the importance of the medical history, but urinalysis can be regarded as an aid in the process of differential diagnosis. Most patients will be cured by a three-day oral course of antibiotic treatment. Longer duration of treatment gives no increase in the rate of cure, and a higher rate of side-effects. Several antibiotics may be used, and from an ecological point of view we encourage a varied prescription policy. No follow-up is needed unless the symptoms persist or reappear soon after treatment.

The incidence and prevalence of violence in a society are usually estimated on the basis of police and court records. A public health approach to this problem is uncommon. We examined all assault victims who attended the Accident and Emergency Department, in Bergen, Norway during a 12 month period in 1994-95. The attending physician filled in a questionnaire on violence as a part of the medical history. The questionnaire included questions on when, where and how the violence occurred, possible influence of alcohol on both victim and perpetrator, and whether or not the patient intended to press legal charges. We also recorded information on diagnosis, treatment, admission to hospital and referral to specialists, and on the personal characteristics of the assault victim (gender, age, domicile, work record). 994 assault victims were identified, 241 females and 753 males. The mean age of the males was 28 years and of the females 33 years. The majority of the assaults took place at night and at weekends, and under influence of alcohol. Weapons were rarely used and physical injuries were usually slight. A majority of the patients did not want to press legal charges.