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AbstractBackgroundObjectiveMethodsFindingsImplications\nKEY POINTSExperience-based knowing in general practice includes advanced interpretation of subjective, complex and particular phenomena in a social context. Enabling different metapositions for reflexivity may provide the accountability needed for such knowing to be recognized as evidence-based practice.To demonstrate and discuss the potential of substantive theories to enhance interpretation of complex challenges in clinical knowing in general practice.We present a fictional case to demonstrate how interdisciplinary substantive theories, with a relevant and specific match to concrete questions, can situate the clinical interaction at an accountable platform. A female patient with Parkinson’s disease consults her GP complaining that the disease is restraining her life and threatening her future. The GP has some new ideas from Bandura’s theory of self-efficacy and introduces the patient to strategies for further action.The case presents an example of how a relevant substantive theory may offer the GP: 1) a sharper focus for achievement: recognising the issues of fear and identity in chronic, progressive illness, 2) a subsequent position for individualized understanding of adequate strategies: encouraging physical and social activity in a well-known context, and 3) an invitation to consider further possibilities: finding ways to alleviate the burden of fear and progressive decline; engaging in joyful living.General practice knowledge embraces a diversity of sources with different evidence power. The transparency mediated to clinical practice when supported by relevant substantive theories may contribute to recognition of experience-based knowing as evidence-based practice.Experience-based knowing is an important capacity for interpretation of complex phenomena in general practice, but support for elaboration and analysis of such strategies is limitedInterdisciplinary substantive theories can enable reflexivity and enhance clinical practiceSubstantive theories may offer sharper focus, individualised understanding and recognition of additional possibilitiesA connection to specific theoretical ideas may augment the transparency of experience-based knowing, thus advancing attitudes for evidence-based practiceExperience-based knowing is an important capacity for interpretation of complex phenomena in general practice, but support for elaboration and analysis of such strategies is limitedInterdisciplinary substantive theories can enable reflexivity and enhance clinical practiceSubstantive theories may offer sharper focus, individualised understanding and recognition of additional possibilitiesA connection to specific theoretical ideas may augment the transparency of experience-based knowing, thus advancing attitudes for evidence-based practice [ABSTRACT FROM AUTHOR]

Background: Few family interaction processes are more detrimental to children's health than family conflicts. Conflictual relationships in childhood predict a host of adverse health outcomes across the life course. The current study examines associations between household conflicts and the health of children aged 6–12 years and explores to which extent this may vary by socioeconomic status (SES) and multimorbidity (MM) in the household. Methods: Cross‐sectional study using questionnaire data gathered between 2016 and 2020 as part of the Lolland‐Falster Health Study (LOFUS) combined with routine register data on health care use and socio‐demography from the Danish nationwide administrative databases. The study sample consisted of 1065 children 6–12 years old, who answered LOFUS4 or LOFUS11, from 777 households for which at least one adult answered LOFUS18. Main outcome was children's health complaints, defined as headache, abdominal pain, back pain, and sleep difficulties. Covariates included MM, SES, and conflicts, all three measured at household level. Multivariable logistic regression models were used. Results: Conflicts were negatively associated with children's health. This was most pronounced for general conflicts in the household, with increased complaints of abdominal pain, back pain, and sleep difficulties. The associations varied when we stratified the households according to MM and SES. Significant associations were found within households without MM for abdominal pain, and within households with MM and low SES, and without MM and with high SES for sleep difficulties. While the higher level of abdominal pain for the above indicated households were found for both internal and external conflicts in the household, the higher level in sleep difficulties was mostly driven by internal conflicts. Conclusion: Children reporting frequent health complaints have a higher future health care use compared with children without such complaints. Our results indicate that growing up in a household with a high conflict level might be a predisposing factor. [ABSTRACT FROM AUTHOR]

There is a strong association between social relationships and health. In this article, we ask how a view of social relationships played out in time can help to nuance the role of patients' social networks in their healthcare-seeking behavior. We investigate this link by exploring the dynamics of relatedness in socioeconomically vulnerable young families with a multimorbid parent and their extended networks. Data were generated through repeated semi-structured and open-ended interviews and participant observation. The study found that, for much of their lives, participants experienced life as a series of events that happened to them and were out of their control. This way of being-in-the-world was linked to a consistent pattern of intense and then suddenly discontinued relationships. The relevance for health professionals is that there is a growing trend in healthcare systems worldwide to involve relatives and extended networks in a patient's treatment process. Our findings indicate challenges to this approach and recommend that health professionals are aware that for socioeconomically vulnerable patients with multimorbidity, important relationships can change dramatically, quickly, and repeatedly, over short periods of time. [ABSTRACT FROM AUTHOR]

Objectives Research on successful aging gives limited attention to the role of suffering from multiple chronic conditions (multimorbidity) in combination with notions of masculinity. We address this by bringing into focus how older men with multimorbidity within the Nordic Model welfare system relate to successful aging. The objective is to bring new insights into key elements of how masculinity, multimorbidity and cultural context create alternative individual versions of successful aging. Method The article draws on a long-term fieldwork (18 months) among older men (n=7), who were part of a larger study that also included older women. The fieldwork consisted of 28 interviews with participating men. These data were supplemented by 124 hr of informal chats and observations as well as 32 hr of clinical encounters with health services. Data analysis followed a thematic approach. Results Analysis revealed that older men with multimorbidity understood core components of successful aging, yet did not closely follow them, and instead came up with alternative, gendered interpretations. This process involved three themes centered around independency of: (a) unaided successful aging, (b) vicarious successful aging, and (c) masculine successful aging. Discussion Our study contributes to research on perceptions of successful aging with insights to the role of cultural context, gender and multimorbidity. Living with multimorbidity challenges the ability of the men to positively frame themselves as successfully aging older adults; however, they navigate this dilemma by constructing their own experiences in their own terms of independence. [ABSTRACT FROM AUTHOR]

Background: Getting the right diagnosis is supposed to provide an explanation of a patient's health problem and inform health care decisions. As a core element of clinical reasoning, diagnosis deserves systematic and transparent analysis. Conceptual tools can make doctors become aware of and explore diagnostic knowing. Methods: We demonstrate diagnostic knowing analysed as interpretative and contextualised activity. Our analysis is based on Lonergan's theory of knowing, constituting the cognitive structures as experiencing, understanding, and judging, in a general practice case. Findings: Analysis makes the complexity of diagnostic knowing in this context more transparent, in this case concluding with four diagnostic labels: a corn, constipation, headache and atrial fibrillation. We demonstrate how a medically significant diagnosis does not necessarily evolve deductively from complaints. The opening lines from the patient give ideas of where to look for possible explanations – questions for understanding – rather than diagnostic hypotheses. Such questions emerge from the GP's experiences from meeting the patient, including imaginations and interpretations. When ideas and questions regarding diagnoses have been developed, they may be judged and subjected to reflection. Questioning may also emerge as transitory concerns, not extensively ruled out. Lonergan's theory demonstrated a strong fit with these aspects of diagnostic knowing in general practice. Implications: Analysis demonstrated systematic, transparent approaches to diagnostic knowing, relevant for clinical teaching. We argue that an interpretative understanding of diagnosis can change clinical practice, complementing hypothetico-deductive strategies by recognising additional substantial diagnostic modes and giving access to scholarly reflection. Diagnosis is a core element of clinical reasoning, deserving systematic and transparent analysis beyond hypothetico-deductive reasoning or pattern recognition Diagnostic knowing in general practice is a special instance of all human knowing with subjectivity, interpretation and reflexivity as essential elements Lonergan's theory for knowing based on experiencing, understanding, and judging allowed us to map, decode and recognise advanced acts of clinical reasoning We share our experiences of how these concepts gave us a tool for systematic analysis of the complexities taking place in the GP's office on an ordinary day [ABSTRACT FROM AUTHOR]

Background: Patients dealing with severe mental illnesses (SMI) often face suboptimal clinical outcomes and higher mortality rates due to a range of factors, including undetected physical health conditions. The provision of care for individuals with SMI is frequently disjointed, as they engage with diverse healthcare providers. Despite this fragmentation, primary care, particularly general practitioners (GPs), assumes a pivotal role in the care of SMI patients. Our study aimed to delve into the first-hand experiences of GPs in delivering somatic care to SMI patients, concentrating on the challenges they encounter and the strategies they employ to navigate these difficulties. Methods: We conducted in-depth interviews with fifteen GPs, utilizing a semi-structured interview guide, supplemented by ethnographic observations during clinical consultations in general practice. Through inductive coding, interview transcripts and observational field notes were systematically analysed using interpretative phenomenological analysis (IPA). The findings were then deliberated upon within the author group. Results: GPs revealed that managing the chronic somatic care of SMI patients posed significant challenges. These challenges encompassed the multifaceted needs of patients, their behavior tied to symptoms, a lack of care continuity, and overarching time constraints. To tackle these challenges, the GPs had devised various strategies. However, all participants underscored the critical importance of having adequate time to properly prepare for, conduct, and follow up on consultations. Conclusion: The GPs' interactions with SMI patients brought numerous challenges, although treating these patients were concurrently acknowledged as vital and fulfilling. The findings suggest that increased allocated time in general practice consultations for patients with SMI is important to support the somatic treatment requirements of this patient group. [ABSTRACT FROM AUTHOR]

Using drawings to bridge the communication barriers between adults and children, this article looks at examples of fieldwork with socioeconomically disadvantaged young families in Denmark with a parent who has multiple diagnoses. Studies suggest a link between a disadvantaged socioeconomic childhood and a predisposition to illness and disease in later life and that children of ill parents tend to be ill more often and be lonelier than their peers with healthy parents. These findings are underpinned by other studies showing how children's social relations are vital to how they experience childhood and for their current and future health profile. Based on this knowledge, we wanted to study how children from families without a great deal of resources experience their family life but were faced with the dilemma of how to study this phenomenon. Reflection on these experiences shows that drawing is an effective method to facilitate conversations with children about difficult and taboo issues. The method's strength lies in the way it materializes thoughts and feelings, in the way it generates a sense of "community" between the child and the researcher, which is often challenging in ethnographic research involving children. With their drawings, the children were able to express feelings, sentiments, and experiences that were difficult to articulate in words but not equally difficult to recall as a physical and mental experience or to draw on paper. The drawings illustrated a shared desire among the children who took part in the study for normality, routine, and stability in the family. Please note that we emphasize the importance of including other fieldwork data when interpreting drawings and that it is essential to have a solid contextual understanding of the field. [ABSTRACT FROM AUTHOR]

Quality standards play an increasingly important role in primary care through their inscription in various technologies for improving professional practice. While 'hard' biomedical standards have been the most common and debated, current quality development initiatives increasingly seek to include standards for the 'softer' aspects of care. This article explores the consequences of both kinds of quality standards for chronic care consultations. The article presents findings from an explorative qualitative field study in Danish general practice where a standardized technology for quality development has been introduced. Data from semi-structured interviews and observations among 17 general practitioners were analysed using an iterative analytical approach, which served to identify important variations in the uses and impacts of the technology. The most pronounced impact of the technology was observed among general practitioners who strictly adhered to the procedural standards on the interactional aspects of care. Thus, when allowed to function as an overall frame for consultations, those standards supported adherence to general recommendations regarding which elements to be included in chronic disease consultations. However, at the same time, adherence to those standards was observed to narrow the focus of doctor-patient dialogues and to divert general practitioners' attention from patients' personal concerns. Similar consequences of quality standards have previously been framed as manifestations of an inherent conflict between principles of patient-centredness and formal biomedical quality standards. However, this study suggests that standards on the 'softer' aspects of care may just as well interfere with a clinical approach relying on situated and attentive interactions with patients. [ABSTRACT FROM AUTHOR]

This qualitative study explores the structural barriers to preventive interventions targeting childhood obesity in the Danish health care system. Based on interviews with relevant health care professionals, the paper reports on the problems which are experienced by general practitioners and health visitors and which complicate implementation of the policies of the Danish health authorities. Findings show that the current system is not well equipped to treat early overweight. A gap in primary preventive health care for children at age 3–5, indistinct lines of responsibility, inadequate cooperation, and lack of resources together make it difficult for health care professionals to initiate interventions and reach the children in need of support. By analyzing the policy implementation process in a theoretical framework that discloses the discursive allocation of responsibilities, the study is able to provide a deeper description and analysis of the problem. The study makes it clear how preventive health care for overweight children rests on the negotiation of formal and performed responsibilities among health practitioners within a framework of scarce resources and communication deficit. [ABSTRACT FROM PUBLISHER]

Objective To explore how patients enact presentations of self in consultations dealing with lifestyle in general practice. Methods We conducted a qualitative observational study with thematic, cross-case analysis of video-recorded consultations inspired by discourse analysis. Results Patients presented themselves with an orientation toward responsibility in dialog about lifestyle. They described how they were taking care of themselves and doing their best. In this respect, they demonstrated their achievements as matters of honor. If one lifestyle issue was considered problematic, in some cases patients shifted attention to another, of which they were more proud. In areas where they were not doing well, some patients revealed shame for not acting responsibly. In such cases, patients spoke of themselves in terms of self-deprecation or admitted not living up to expected standards. Conclusion Negotiations of shame and honor, revolving around personal responsibility, are embedded in clinical discourse about lifestyle. Patients take a proactive role in presenting and defending the self against shame. Practice implications GPs should pay more attention to the tacit role of shame in consultations. Failure to do so could lead to distance and hostility while a strategy to acknowledge the impact of shame could help develop and strengthen the doctor–patient relationship. [ABSTRACT FROM AUTHOR]

Increasingly, medical choices involve deciding whether to look for evidence of undetected, asymptomatic conditions, or increased risk of future conditions (i.e. screening). Those who screen at sufficiently high risk face decisions about interventions to prevent or postpone the onset of possible, but not certain, future symptomatic conditions. Other preventive decisions include whether or not to accept population-based intervention, such as vaccination. Using decision trees, we model the normative structures and associated uncertainties that underlie five medical decision situations, each of which involves assessing the probabilistic hypothesis that a person has, or will in the future have, a given symptomatic condition. The probability estimate that results from assessment becomes an input into predicting treatment benefit, with the probability of benefit decreasing as that of the symptomatic condition decreases. The five situations identified in this paper involve assessing: (1) a symptomatic patient; (2) an asymptomatic individual for an undetected condition; (3) an individual for risk of a future condition; (4) an individual for multiple risks simultaneously (shotgun assessment); and (5) an individual for a population-based intervention. Analysis of these situations facilitates examination of intuitive probabilistic reasoning. Drawing on evidence in related literature, we discuss some implications of decision-makers imposing the wrong structure or probabilistic reasoning when making medical choices. In particular, we discuss (1) overestimation of expected benefit due to systematic underestimation of uncertainty in a given decision; (2) overconfidence in probabilistic test results; and (3) failure to understand the implications of cumulative probabilities when ‘shot-gun’ testing. [ABSTRACT FROM PUBLISHER]

General practitioners (GPs) treat more than 90% of common mental disorders. Their approaches to psychological interventions have been little studied and their process of understanding patients remains unexplored. This qualitative interview and observation study aimed to explore Danish GPs' approaches to emotional problems and mental disorders in 'talking therapy' and in routine consultations. Different typical approaches were identified and could be described using the concept of mentalisation. Some participants used a basic reflective approach but no well-described method. Others were satisfied with the biomedical professional identity and did not engage in patients' emotional problems. The individual participant's approach in talking therapy was mirrored in routine consultations. Training a mentalising or reflective stance might promote more uniform therapeutic approaches to patients' emotional problems. [ABSTRACT FROM AUTHOR]

Objectives. Parents of sick children frequently visit their general practitioners (GPs). The aim was to explore parents' interpretation of their child's incipient signs and symptoms when falling ill and their subsequent unsatisfactory experience with the GP in order to make suggestions for improvements in the medical encounter. Design. Semi-structured interviews. Setting and subjects. Twenty strategically selected families with a child from a birth cohort in Frederiksborg County, Denmark were interviewed. Results. Parents wanted to consult their GP at the right time, i.e. neither too early nor too late. Well-educated parents experienced a discrepancy between their knowledge about their child, the information they had sought about the illness and the consultation with the GP, when they were dismissed with phrases such as ''it will disappear'' or ''it is just a virus''. The parents went along with the GP's advice if the child only occasionally became sick. However, parents of children with recurrent illnesses seemed very frustrated. During the course of several consultations with their GP, they started to question the GP's competence as the child did not regain health. Conclusions. Parents want to be acknowledged as competent collaborators. The GP's failure to acknowledge the parents' knowledge of their child's current illness, and the parents' attempt to identify what is wrong with the child and make the child feel better before the encounter may have consequences for the GP's credibility. It is therefore recommended that parents of children with recurrent illnesses receive extra attention and information. [ABSTRACT FROM AUTHOR]

General practitioners (GPs) treat more than 90 per cent of patients with mental disease. Time restriction is often seen as a hindrance to their engagement in psychological treatment. This study aimed to explore GPs' experiences of time when delivering 'talking therapy' and to analyse how time influenced the treatment of emotional problems in routine consultations. A qualitative approach was chosen, the data consisted of interviews with 14 GPs and observation of consecutive consultations in four of the participants' practices. Analysis was made by Interpretative Phenomenological Analysis. Eleven participants delivered talking therapy, five (therapeutically minded participants) often. Three aspects of time emerged: (1) the chronological time of the schedule; (2) the inner time with another rhythm and flow of thought; (3) the longitudinal time where meeting repeatedly for short consultations promoted a trusting relationship where problems were disclosed gradually and a narrative was created. With therapeutic participants the same aspects of time could be identified in routine consultations. Stress and a heavy workload counteracted the perception of inner time. Theories of time and narrative from psychotherapeutic thinking could be applied, form links to the unconscious and the narrative time and could possibly be made more explicit in general practice. Awareness of the different time aspects is necessary for improving the treatment of mental health in primary care. Political and organizational willingness to secure the necessary working conditions is, however, equally important for optimal treatment. [ABSTRACT FROM AUTHOR]

Objective. To explore elderly women's physical activity in relation to their perception of the risk of osteoporosis. Design. Qualitative study using in-depth interviews. Setting. Informants were purposely selected from a Danish population-based, age-specific cohort study conducted in the county of Copenhagen with people born in 1936. Subjects. Women in their sixties. Results. Women who perceived a current risk of osteoporosis tended to reduce their physical activity in an attempt to reduce the risk of bone damage. This behaviour was related to the imagined fragility of the bones (the risk inside the body), and the actual situations (the risk outside the body), including places and activities. Knowledge of a reduced bone mass reinforced the women's uncertainty about what their bones could endure. Experiences managing physical activity without injury resulted in reinterpretations of their risk of bone fractures and increased physical activity. Conclusions. Perceived risk of osteoporosis may lead to decreased physical activity and hence actually increase the risk. When informing individuals about health risk people's images and imaginations of the actual risk have to be acknowledged. When a bone scan is being considered, explicit advice encouraging physical activity - especially the weight-bearing kind - should be stressed. [ABSTRACT FROM AUTHOR]

Aims : To explore elderly Danish women's ideas about osteoporosis and the possible threat to health. The authors discuss the issue of risk interpretations in itself, using osteoporosis as a case. Methods : A qualitative study based on material from focus‐group discussions. Twenty‐two 60‐ to 61‐year‐old healthy women were selected on the basis of questionnaire answers. Analysis was based on a meaning‐centred approach. Results : Comprehension of osteoporosis was mainly based on images representing various dimensions of osteoporosis. The women drew on experiences with relatives, friends, and health information. Physical appearance seemed to be the most common way of assessing those who had osteoporosis or who might have it in the future. Women's ideas about osteoporosis were influenced by two main, parallel stereotypes of knowledge based on models of ageing with bodily decay and the threat of a preventable disease. They seemed to vacillate, often integrating elements from both models in their comprehension. The scenarios for women with or liable to develop osteoporosis as a disease appeared to be founded on worst‐case scenarios. Conclusion : It is suggested that health professionals pay greater attention to people's models and images of risk conditions and carefully decide which images they wish to promote. Health education regarding osteoporosis comprises an ethical obligation to avert the construction of the more extreme and anxiety‐producing prototypes. This is especially important when informing individuals about risk and prevention and when decisions on screenings and other medical examinations are made. [ABSTRACT FROM AUTHOR]

Abstract: The imaging technology of bone scans allows visualization of the bone structure, and determination of a numerical value. Both these are subjected to professional interpretation according to medical (epidemiological) evidence to estimate the individual''s risk of fractures. But when bodily experience is challenged by a visual diagnosis, what effect does this have on an individual? The aim of this study was to explore women''s bodily experiences after a bone scan and to analyse how the scan affects women''s self-awareness, sense of bodily identity and integrity. We interviewed 16 Danish women (aged 61–63) who had had a bone scan for osteoporosis. The analysis was based on Merleau-Ponty''s perspective of perception as an embodied experience in which bodily experience is understood to be the existential ground of culture and self. Women appeared to take the scan literally and planned their lives accordingly. They appeared to believe that the ‘pictures’ revealed some truth in themselves. The information supplied by the scan fostered a new body image. The women interpreted the scan result (a mark on a curve) to mean bodily fragility which they incorporated into their bodily perception. The embodiment of this new body image produced new symptom interpretations and preventive actions, including caution. The result of the bone scan and its cultural interpretation triggered a reconstruction of the body self as weak with reduced capacity. Women''s interpretation of the bone scan reorganized their lived space and time, and their relations with others and themselves. Technological information about osteoporosis appeared to leave most affected women more uncertain and restricted rather than empowered. The findings raise some fundamental questions concerning the use of medical technology for the prevention of asymptomatic disorders. [Copyright &y& Elsevier]

Aims: A study was undertaken to explore how menopausal women are affected by awareness of potential risk of osteoporosis. Methods: A qualitative interview study, including analysis of in-depth interviews with 17 women who independently gave views on risk, out of 24 women interviewed about their menopausal symptoms. The women were selected on the basis of a survey including 1261 women chosen at random, to cover a broad spectrum of Danish women, their menopausal experiences, and contact with the healthcare system. The study was part of a larger project targeting menopause. Results: Awareness of osteoporosis risk caused a feeling of uncertainty and worry in some women. Only women reacting in this way seemed to act in order to prevent future fractures. The affected women were puzzled to realize that risk-reducing medication could introduce new hazards. Most of the women had heard about osteoporosis related to menopause as culturally embedded knowledge. Conclusions: Making individual women uncertain and worried must be considered a potentially serious side effect of health promotion. The findings raise the question of whether introducing healthy people to the threat of future diseases is ethically justifiable. As hormonal treatment is no longer recommended for long-term use, it is suggested that the strong link between osteoporosis and menopause should be toned down when counselling menopausal women. [ABSTRACT FROM AUTHOR]

Objective -- To explore women's needs and wants when seeing the GP in relation to menopausal issues. Design -- A qualitative interview study. Setting and subjects -- The study was part of a larger project, targeting menopause. It included in-depth interviews of 24 women aged 52-53 years who came from all over Denmark. The women showed a great variety of menopausal experience of symptoms and treatment. Main outcome measures -- An acquaintance with the women's agendas when seeing the GP about menopausal issues. Results and conclusion -- Women consulting their GPs either wanted to discuss treatment for menopausal symptoms, to have an examination for diseases or to get a risk assessment. Their needs for medication or examination were satisfied but several women wanted more information, especially about the pros and cons of hormone therapy (HT). Risk assessment, if not requested, indicated problems, with some women feeling uncomfortable if the GPs started a discussion about HT and osteoporosis, if they only wanted an examination to be reassured that everything was normal. The authors' findings indicate that GPs encounter a subtle balance in considering the question of risk information to menopausal women who do not request it. [ABSTRACT FROM AUTHOR]

The language of risk has many meanings, and in this article we demonstrate a discrepancy between individually perceived risk and the medical understanding of risk as understood and communicated by general practitioners (GPs). Risk is experienced and interpreted by people in a cultural context, i.e. the same objective risk can be perceived in many different ways and given a different meaning in daily life. GPs' evaluation of risk is made on the basis of our epidemiological knowledge, the medical culture of risk perception and the GP's personal experience and interpretation. The theoretical focus in the article is a synthesis of two theories: patient-centred general practice and theory based in anthropology about risk as culturally and socially constructed. We use empirical data from a qualitative study to illuminate the discussion. [ABSTRACT FROM AUTHOR]

AbstractObjectiveDesign and methodsSubjectsResultsConclusionTo explore how the parents of children with atopic dermatitis and allergic diseases such as food allergy, allergic rhinoconjunctivitis, and asthma experience interactions with the Danish healthcare system over time.A qualitative design with individual in-depth interviews. The analysis was inspired by Systematic Text Condensation.Eleven parents of children with atopic dermatitis and allergic diseases who received treatment at hospitals in the Capital Region of Denmark. The families had experiences of cross-sectoral patient care.Despite having the same diseases, the children’s care pathways were very different. Mapping demonstrated the intricacy of care pathways for this group of children. We identified three aspects that impacted interaction with healthcare: responsibility, tasks, and roles. The families experienced care when the distribution of tasks and responsibilities associated with treatment and system navigation were consistent with both their expectations and their actual experiences. At the same time, families frequently experienced limited collaboration between healthcare professionals resulting in perceived fragmented care and an extended role for parents as care coordinators. Families felt cared for when healthcare professionals knew both their biomedical and biographical circumstances, and adjusted the level of support and care in accordance with the families’ particular needs, expectations, and evolving competences.We suggest that a possible pathway to improve care may be through a partnership approach as part of family-centered care, with general practitioners having a key role in helping to articulate the individual needs and expectations of each family. [ABSTRACT FROM AUTHOR]

Following the COVID-19 pandemic, Denmark introduced repeated lock-downs of society, including outreach services and visits from social workers for people living with mental illnesses. Based on ethnographic fieldwork, in this article we explore how people with mental illness react to and manage their lives amid COVID-19 mitigations, focusing on how they experience and negotiate vulnerability at personal and community level. We argue, that the subjective management of restrictions implicated in their personal lives notions of risk, vulnerability and agency, and shows a diversity and heterogeneity of responses to the pandemic that allowed the mentally ill to perform good citizenship. [ABSTRACT FROM AUTHOR]

The article offers information on the Nordic Congress to be held in May 2009 in Copenhagen, Denmark.

Using drawings to bridge the communication barriers between adults and children, this article looks at examples of fieldwork with socioeconomically disadvantaged young families in Denmark with a parent who has multiple diagnoses. Studies suggest a link between a disadvantaged socioeconomic childhood and a predisposition to illness and disease in later life and that children of ill parents tend to be ill more often and be lonelier than their peers with healthy parents. These findings are underpinned by other studies showing how children's social relations are vital to how they experience childhood and for their current and future health profile. Based on this knowledge, we wanted to study how children from families without a great deal of resources experience their family life but were faced with the dilemma of how to study this phenomenon. Reflection on these experiences shows that drawing is an effective method to facilitate conversations with children about difficult and taboo issues. The method's strength lies in the way it materializes thoughts and feelings, in the way it generates a sense of "community" between the child and the researcher, which is often challenging in ethnographic research involving children. With their drawings, the children were able to express feelings, sentiments, and experiences that were difficult to articulate in words but not equally difficult to recall as a physical and mental experience or to draw on paper. The drawings illustrated a shared desire among the children who took part in the study for normality, routine, and stability in the family. Please note that we emphasize the importance of including other fieldwork data when interpreting drawings and that it is essential to have a solid contextual understanding of the field. [ABSTRACT FROM AUTHOR]

The international literature shows that primary care is well placed to address mental health problems in young people, but that primary care professionals experience a range of challenges in this regard. In Denmark, young adults who have complex psychosocial problems, and who are not in education or work, cause political and academic concern. They are also in regular contact with their general practitioners, the Danish municipalities and psychiatric services. However, little is known about general practitioners' perspectives on caring for this vulnerable group of patients. In this article, we investigate how general practitioners' care work is shaped by the bureaucratic management of care in a complex infrastructure network comprising the general practitioners, psychiatry, the municipalities and the young adults. The analysis is based on interviews and focus groups with general practitioners, psychiatric nurses and social workers. We employ Tronto's concept of care and the concept of boundary work as a theoretical framework. We argue that general practitioners strive to provide care, but they are challenged by the following: contested diagnostic interpretations and the bureaucratic significance of diagnoses for the provision of care from psychiatry and the municipalities, systemic issues with handling intertwined social and mental health problems, and the young adults' difficulties with accessing and receiving available care. [ABSTRACT FROM AUTHOR]

An increasing number of young adults in Denmark experience difficulties in completing their education and holding down a job. Many of these young adults have psychosocial problems and common mental disorders. To retain public income support they must attend education and work-directed activities, known as 'activation programmes'. Based on ethnographic fieldwork, this study presents an analysis of how one such programme unfolds in practice and how the participants engaged with the activities and negotiated the underlying rationales. We argue that the activities involved in the programme constitute 'biographical techniques' that entail a configuration of the participants as being responsible for their own biographies and having the capability to solve their problems themselves. The participants challenged this configuration of subjectivity by recounting complex or immediate problems that could not be solved through biographical techniques and by refusing to deal with their life stories as a way of configuring their futures. Biographical techniques limited the possibilities for grappling with the complexity of the participants' problems. We conclude that the participants are therefore subjected to biographical coercion because forms of subjectivity other than biographical subjectivity are disregarded. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the feasibility and fidelity of implementing and assessing the SOFIA coordinated care program aimed at lowering mortality and increasing quality of life in patients with severe mental illness by improving somatic health care in general practice. Design: A cluster-randomised, non-blinded controlled pilot trial. Setting: General Practice in Denmark. Intervention: The SOFIA coordinated care program comprised extended structured consultations carried out by the GP, group-based training of GPs and staff, and a handbook with information on signposting patients to relevant municipal, health, and social initiatives. Patients: Persons aged 18 years or older with a diagnosis of psychotic, bipolar, or severe depressive disorder. Main outcome measures: We collected quantitative data on the delivery, recruitment and retention rates of practices and patients, and response rates of questionnaires MMQ and EQ-5D-5 L. Results: From November 2020 to March 2021, nine practices were enrolled and assigned in a 2:1 ratio to the intervention group (n = 6) or control group (n = 3). Intervention group practices included 64 patients and Control practices included 23. The extended consultations were delivered with a high level of fidelity in the general practices; however, thresholds for collecting outcome measures, and recruitment of practices and patients were not reached. Conclusion: Our findings suggest that delivering the coordinated care program in a fully powered trial in primary care is likely feasible. However, the recruitment methodology requires improvement to ensure sufficient recruitment and minimize selective inclusion. Trial registration: The date of pilot trial protocol registration was 05/11/2020, and the registration number is NCT04618250. [ABSTRACT FROM AUTHOR]

Keywords: delabeling; drug allergy; drug provocation test; penicillin allergy; penicillin allergy labels EN delabeling drug allergy drug provocation test penicillin allergy penicillin allergy labels 969 973 5 09/05/23 20230901 NES 230901 Key messages Correct penicillin allergy labels are crucial for patient safety and correct patient management. Twenty-nine patients with a disproved allergy still had an incorrect penicillin allergy label in the hospital EMR, and of those, 16 (55.1%) also had an incorrect penicillin allergy label in primary care. The primary aim of this study was to investigate the degree of match/mismatch between penicillin allergy labels in hospital and primary care EMR systems in patients who had undergone penicillin allergy investigation in a hospital allergy clinic. Among patients with a disproved allergy, 93 patients (21.4%) still had an incorrect penicillin allergy label in primary care (79 GP clinics). [Extracted from the article]

Despite patient-centered communication has been recognized in medical education for decades, it has been reported that medical students detach from the patient during medical school and that their empathy declines. In addition, poor communication with doctors has been shown as one of the most common problems in patient complaints, which indicate that patient-centered communication training needs to be developed further. Therefore, many educational initiatives engage patients' experiences but there is no explicit understanding about how patients contribute to the process of educating medical students. The context for this study is a learning situation in which medical students have communication training with patients with chronic conditions in a simulation lab. This provides opportunity to investigate what medical students learn from patients and how they learn it. This qualitative study involves four focus groups with each 3–7 participants, 2 paired interviews and 8 individual semi-structured interviews (30–90 min) with 32 medical students, who had attended the communication course. The interviews were recorded, transcribed and thematic analysis was applied inductively and organized into four main themes. Learning from patients provided medical students opportunities to 1) see the world through the patients' eyes, 2) understand the diversity of patients' needs, and 3) recognize the importance of matching patients' and doctors' perspectives. Consequently, 4) students expressed challenges in interacting with the patients when performing the role as 'medical expert'. Difficulty empathizing became visible in the students' interaction with patients. The patients' authentic contributions provided the students with unique opportunities to engage with their own emotions and capacity for empathy. However, for students to benefit from this affective practical training, they need guidance to balance professional and personal aspects in encounters. Perhaps there is a need to introduce the 'doctor as person' in medical education. [ABSTRACT FROM AUTHOR]

Touch is a fundamental sense and the most unexplored of the five senses, despite its significance for everything we do in relation to ourselves and others. Studies have shown that touch generates trust, care and comfort and is essential for constituting the body. Based on ethnographic fieldwork, this study explores the absence and presence of touch in interactions between people with mental illness and professionals, in health care encounters with general practitioners, neurologists and physiotherapists, as well as masseurs. We found that touch and physical examination of patients with mental illness is absent in health care encounters, leaving the patients with feelings of being out of place, misunderstood, less socially approved and less worthy of trust. Drawing on Honneth and Guenther, we conclude that touch and being touched is an essential dimension of recognition—both of the patients' bodily sensations and symptoms and of them as human beings, detached from the psychiatric label—as well as contributing to the constitution of self and personhood. These findings confirm that touch works as an existential hinge that affirms a connection between the patient, the body and others and gives a sense of time, space and existence. [ABSTRACT FROM AUTHOR]

Aim: To investigate approaches among healthcare providers (HCPs) that support or hinder person‐centredness in group‐based diabetes education programmes targeting persons with type 2 diabetes. Methods: Ethnographic fieldwork in a municipal and a hospital setting in Denmark. The two programmes included 21 participants and 10 HCPs and were observed over 5 weeks. Additionally, 10 in‐depth semi‐structured interviews were conducted with patients (n = 7) and HCPs (n = 3). Data were analysed using systematic text condensation. Results: Hindering approaches included a teacher‐centred focus on delivering disease‐specific information. Communication was dialog based, but HCPs primarily asked closed‐ended questions with one correct answer. Additional hindering approaches included ignoring participants with suboptimal health behaviours and a tendency to moralize that resulted in feelings of guilt among participants. Supporting approaches included letting participants set the agenda using broad, open‐ended questions. Discussion: Healthcare providers are often socialized into a biomedical approach and trained to be experts. However, person‐centredness involves redefined roles and responsibilities. Applying person‐centredness in practice requires continuous training and supervision, but HCPs often have minimum support for developing person‐centred communication skills. Techniques based on motivational communication, psychosocial methods and facilitating group processes are effective person‐centred approaches in a group context. Conclusion: Teacher‐centredness undermined person‐centredness because HCPs primarily delivered disease‐specific recommendations, leading to biomedical information overload for participants. [ABSTRACT FROM AUTHOR]

Qualitative methodology is gaining increasing attention and esteem in medical research, with general practice research taking a lead. With these methods, human and social interaction and meaning can be explored and shared by systematic interpretation of text from talk, observation or video. Qualitative studies are often included in Ph.D. theses from general practice in Scandinavia. Still, the Ph.D. programs across nations and institutions offer only limited training in qualitative methods. In this opinion article, we draw upon our observations and experiences, unpacking and reflecting upon values and challenges at stake when qualitative studies are included in Ph.D. theses. Hypotheses to explain these observations are presented, followed by suggestions for standards of evaluation and improvement of Ph.D. programs. The authors conclude that multimethod Ph.D. theses should be encouraged in general practice research, in order to offer future researchers an appropriate toolbox. [ABSTRACT FROM AUTHOR]

Background: Many elderly people wish to die at home but end up dying at the hospital. If the patient wishes to die at home, palliative care provided by General Practitioners (GPs) may increase the chance of dying at home, however, there is a lack of knowledge on how GPs should provide palliative care. We aimed to identify roles, tasks and approaches of GPs enabling palliative care, by exploring the experiences of GPs, other healthcare professionals, patients, and relatives through a systematic review of the qualitative literature. Methods: We searched PubMed, EMBASE, PsycINFO, Web of Science, and CINAHL in March 2022. Thematic analysis was used for synthesizing the results. Results: Four thousand five hundred sixty three unique records were retrieved, and 12 studies were included for review. Of these, ten were interview or focus group studies and two were survey studies with additional open-ended questions. Only qualitative findings from the studies were used in synthesizing the results. Thematic analysis produced four main themes describing the roles, tasks and approaches of GPs enabling palliative care to increase the chance for patients to die at home. GPs can support patients in the final phases of life by applying a holistic, patient-centred, and proactive approach to palliative care and by having sufficient education and training. Furthermore, the palliative care consultation should include symptom management, handling psychosocial and spiritual needs, maintaining a fragile balance, and proper communication with the patient. Lastly, GPs must address several palliative care elements surrounding the consultation including initiating the palliative care, being available, being the team coordinator/collaborator, providing continuous care and having sufficient knowledge about the patient. Conclusions: The roles, tasks and approaches of the GPs enabling palliative care include being aware of elements in the palliative care consultation and elements surrounding the consultation and by having sufficient education and training and a broad, proactive, and patient-centred approach. [ABSTRACT FROM AUTHOR]

Objective:Little is known about how strategies of retaining patients are acted out by general practitioners (GPs) in the clinical encounter. With this study, we apply Grimens’ (2009) analytical connection between trust and power to explore how trust and power appear in preventive health checks from the GPs’ perspectives, and in what way trust and power affect and/or challenge strategies towards retaining patients without formal education. Design:Data in this study were obtained through semi-structured interviews with GPs participating in an intervention project, as well as observations of clinical encounters. Results:From the empirical data, we identified three dimensions of respect: respect for the patient’s autonomy, respect for professional authority and respect as a mutual exchange. A balance of respect influenced trust in the relationship between GP and patients and the transfer of power in the encounter. The GPs articulated that a balance was needed in preventive health checks in order to establish trust and thus retain the patient in the clinic. One way this balance of respect was carried out was with the use of humour. Conclusions:To retain patients without formal education in the clinical encounter, the GPs balanced trust and power executed through three dimensions of respect. In this study, retaining patients was equivalent to maintaining a trusting relationship. A strategic use of the three dimensions of respect was applied to balance trust and power and thus build or maintain a trusting relationship with patients.KEY POINTS  Little is known about how strategies for retaining patients are acted out by GPs in preventive health checks. •  Retaining patients requires a balance of trust and power, which is executed through three dimensions of respect by the GPs. •  Challenges of recruiting and retaining patients in public health initiatives might be associated with the balance of respect. [ABSTRACT FROM PUBLISHER]

Presents reply to comments by Kristiansen et al. on the problems implicit in risk communication. Issue related to difference in perceptions towards dealing with risk; Effectiveness of quoting numbers and percentages regarding diagnosis to patients; Responsibilities of general practitioners in communicating risk information.

Objective.The aim of this study is to analyse the interaction between patients and GPs in preventive consultations with an emphasis on how patients answer GPs’ questions about lifestyle, and the conditions these answers impose on the process of establishing agreement about lifestyle as a problem or not.Design.Six general practitioners (GPs) video-recorded 15 annual preventive consultations. From these, 32 excerpts of discussions about lifestyle were analysed using conversation analysis (CA).Results.GPs used an interview format to assess risk in patients’ lifestyles. In some cases patients adhered to this format and answered the GPs’ questions, but in many cases patients gave what we have termed “anticipatory answers”. These answers indicate that the patients anticipate a response from their GPs that would highlight problems with their lifestyle. Typically, in an anticipatory answer, patients bypass the interview format to give their own evaluation of their lifestyle and GPs accept this evaluation. In cases of “no-problem” answers from patients, GPs usually encouraged patients by adding support for current habits.Conclusion.Patients anticipated that GPs might assess their lifestyles as problematic and they incorporated this possibility into their responses. They thereby controlled the definition of their lifestyle as a problem or not. GPs generally did not use the information provided in these answers as a resource for further discussion, but rather relied on standard interview procedures. Staying within the patients’ frame of reference and using the patients’ anticipatory answers might provide GPs with a better point of departure for discussion regarding lifestyle. [ABSTRACT FROM PUBLISHER]

Background: In 2018, an amendment to the Danish Health Care Act was passed making it a requirement for patients not proficient in Danish to pay for interpretation services in health care settings. Thereafter there has been a drastic decline in the use of professional interpreters, especially in general practice. We aimed to investigate the experiences of general practitioners (GPs) in establishing an understanding with these patients in consultations, without the presence of a professional interpreter. Methods: The study was qualitative, based on semi-structured interviews with nine purposively selected GPs. Analysis was by interpretative phenomenological analysis. Results: The GPs said that after the amendment was passed, the patients chose to almost exclusively use family members or friends as ad hoc interpreters, or they attended consultations with no interpreter present at all. The GPs experienced that the use of family interpreters caused specific problems, due to both their relationship with the patient and their lack of professional interpretation skills. If no mediator was present the GPs perceived the establishment of understanding as extremely challenging. This was particularly the case if patients had chronic conditions, mental or psychosocial problems or if cultural barriers were present. According to the GPs, the challenges were not exclusively restricted to a lack of language translation, but could also involve intertwined cultural barriers or social problems. The impairment in mutual understanding had different consequences, and led to poorer treatment at many levels in health care. The lack of access to a professional interpreter also presented the GP with ethical and legal dilemmas. Conclusions: The GPs experienced that the changes in interpretation provision for patients in health care had led to professional interpretation being almost absent from general practice settings for patients subject to the fee. This led to several communication challenges, insufficient understanding in consultations, and poorer treatment of these, often very vulnerable, patients. The situation could, however, also involve the risk of epistemic injustice. The GPs experienced the situation as very unsatisfactory; it both comprised their ability to exercise their professionalism and their ethical obligations and restricted their legal rights. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives This study aimed to evaluate the relative effectiveness of electronic and postal reminders for increasing adherence to the quality assurance programme for the international normalized ratio ( INR) point-of-care testing ( POCT) device in primary care. Methods All 213 family practices that use the Elective Laboratory of the Capital Region, Denmark, and regularly conduct INR POCT were randomly allocated into two similarly sized groups. During the 4-month intervention, these practices were sent either computer reminders ( Com Rem) or computer-generated postal reminders ( Postal) if they did not perform a split test to check the quality of their INR POCT for each calendar month. The adherence of the practices was tracked during the subsequent 8 months subdivided into two 4-month periods both without intervention. Outcomes were measures of split test procedure adherence. Results Both interventions were associated with an increase in adherence to the split test procedure - a factor 6.00 [95% confidence interval (CI) 4.46-7.72] and 8.22 [95% CI 5.87-11.52] for ComRem and Postal, respectively - but there is no evidence that one of the interventions was more effective than the other. In the Com Rem group, the expected number of split tests (out of four) was 2.54 (95% CI 2.33-2.76) versus 2.44 (95% CI 2.24-2.65) in the Postal group, P = 0.14. There was a slight decrease in adherence over the two follow-ups, but neither intervention was better than the other in achieving a lasting improvement in adherence. Conclusion Computer reminders are as efficient as postal reminders in increasing adherence to a quality assurance programme for the INR POCT device in primary care. [ABSTRACT FROM AUTHOR]

Background: Computer reminders are increasingly being applied in efforts to improve quality and patient safety. However, research is still needed to establish the effectiveness of different kinds of reminders in various settings. This study aimed to evaluate the effectiveness of computer reminders for improving adherence to a quality assessment scheme for point-of-care testing in general practice. Method: The study was conducted as a randomized controlled crossover trial among general practices in the Capital Region of Denmark. The intervention consisted of sending computer reminders (ComRem) to practices not adhering to the guideline recommendations of split testing for hemoglobin and glucose. Practices were randomly allocated into two groups. During the first follow-up period, one of the groups received the ComRem intervention together with the general implementation activities (GIA), while the other group only received the GIA. For the second follow-up period, the intervention was switched between the two groups. Outcomes were measured as split test procedure adherence. Results: A total of 142 practices were randomly allocated to the early intervention group and 144 practices to the late intervention group (the control group in the first follow-up period). In the first intervention period, the mean number of split tests performed in the group receiving ComRem group increased from 1.22 to 3.76 (out of eight possible tests) while the mean number of split tests increased from 1.11 to 2.35 in the group targeted by GIA only (p = 0.0059). After the crossover, a similar effect of reminders was observed. Furthermore, the developments in outcome measures over time showed a strong effect of computer reminders beyond the intervention periods. Conclusion: There was a significant effect of computer reminders on adherence to the quality assessment scheme for point-of-care testing. Thus, computer reminders seem to be useful for supporting the implementation of relatively simple procedures for quality and safety. [ABSTRACT FROM AUTHOR]

Background: Although General Practitioners (GPs) are uniquely placed to identify children with emotional, social, and behavioural problems, they succeed in identifying only a small number of them. The aim of this article is to explore the strategies, methods, and tools employed by GPs in the assessment of the preschool child's emotional, mental, social, and behavioural health. We look at how GPs address parental care of the child in general and in situations where GPs have a particular awareness of the child. Method: Twenty-eight Danish GPs were purposively selected to take part in a qualitative study which combined focus-group discussions, observation of child consultations, and individual interviews with GPs. Results: Analysis of the data suggests that GPs have developed a set of methods, and strategies to assess the preschool child and parental care of the child. They look beyond paying narrow attention to the physical health of the child and they have expanded their practice to include the relations and interactions in the consultation room. The physical examination of the child continues to play a central role in doctor-child communication. Conclusion: The participating GPs' strategies helped them to assess the wellbeing of the preschool child but they often find it difficult to share their impressions with parents. [ABSTRACT FROM AUTHOR]

Abdominal aortic aneurysm (AAA) is a ballooning-out of the aorta that does not normally give any symptoms. Undetected and untreated an aortic aneurysm can rupture, which in most cases is fatal. Mass screening of 65-year old men for the early detection of AAA and, in selected cases, operation seem to reduce mortality due to rupture, although, screening has not reduced the overall mortality in this group. In Västra Götaland, the southwest part of Sweden, screening for AAA amongst 65-year old men started in 2009. There are controversies within the medical community about the benefits and adverse effects of screening. In order to explore men's experiences of being screened and knowing they had an aortic aneurysm, we undertook a qualitative interview study with 15 men who in the screening programme were identified as having an aortic aneurysm and who were to be followed-up with annual ultrasonic examinations for an indeterminate number of years. The interviews were analysed for categories and themes using content analysis. The study found that the men were ambivalent about the knowledge that they had an AAA and about the follow-up monitoring. They appreciated having the knowledge but it was accompanied by worry, feelings of anxiety and existential thoughts about the fragility and finiteness of life. We recommend that before a screening programme is implemented, the psycho-social consequences should be thoroughly investigated. Participants should be given adequate and understandable information about the consequences of screening so that they can make an informed choice whether to participate or not. [ABSTRACT FROM PUBLISHER]

Objectives. Some parents with a sick infant contact a doctor, while others do not. The reasons underlying such parental decisions have not been thoroughly studied. The purpose of this study was to explore how the actual symptoms in the infant were associated with parent-rated illness, illness severity, and the probability of the parents contacting a doctor. Design. A retrospective questionnaire and a prospective diary study covering 14 months of the participating infants'' lives. Setting and subjects. The 194 participating infants were followed for three months prospectively from the age of 11 to 14 months using diary cards, and retrospectively from birth until the age of 11 months by a questionnaire. Results. During the three months of the diary card prospective follow-up, the infants had symptoms on average every second day, and the vast majority (92%) had 10 or more days with at least one symptom; 38% of the infants were reported to have had five or more symptoms for more than five days. Fever, earache, and vomiting were the symptoms most likely to cause parents to rate their infant as ill. Earache was the symptom that triggered doctor contact most immediately. The parent-rated illness severity was strongly related to the tendency to contact a doctor. However, this association was markedly weaker when adjustment was made for the infant not eating normally, having a cough, or running a fever. Conclusion. Specific symptoms such as fever, earache, and vomiting were strongly associated with the probability of parents rating the infant as ill. An earache would cause the parents to contact a doctor. Fever and vomiting were other symptoms triggering doctor contacts. First, these symptoms could cause the parents to want a doctor's expert evaluation of the infant's illness; second, the parents could expect medication to be necessary; or third, it could just be difficult for the parents to handle the ill infant. [ABSTRACT FROM AUTHOR]

Professional, knowledge-based institutions have a particular form of organization and culture that makes special demands on the strategic planning supervised by research administrators and managers. A model for dynamic strategic planning based on a pragmatic utilization of the multitude of strategy models was used in a small university-affiliated research unit. Working with the strategic planning was well received by the staff and the research managers gained a good basis for decisions about the future. Key inferences can be drawn from the involvement of staff in strategic planning in a professional organization: 1) the strategic concepts used must be adapted to the specific situation and the specific institution on a continuous basis so the staff accepts the necessity and meaningfulness of strategic planning; 2) the creativity of academic staff members is best expressed throughout the process by repeated written re-formulations of the vision, strategy and action plan of the institution; 3) strategic planning is most meaningful for those who are involved in it, but only the most interested staff members should be involved in the most time-consuming part of the process; and 4) the lemniscatic development method used can help to engage the staff in strategic planning, increasing the legitimacy of the strategy determined for the organization. [ABSTRACT FROM AUTHOR]

Objective . To explore situations in which parents with an ill child consult a physician and to identify trigger factors for consultation. Design and settings . Qualitative interviews with parents of young children. Parents were asked to describe the situation in which the decision to contact the physician was made. Subjects . A total of 20 families selected from a birth cohort from Frederiksborg County. The cohort numbered 194 of 389 children born between 1 and 28 February 2001. The cohort was followed prospectively from the age of 9 to 12 months by diary (January–April), and retrospectively from birth to the age of 9 months by questionnaire. Families were chosen on the basis of information provided in a questionnaire, diary illness pattern and a telephone conversation. Results . Nine trigger factors associated with physician contacts were identified. Parents’ answers demonstrated how their feelings and logical reasoning while caring for an ill child led them to consult the physician. The main reasons for consultation were children's protracted or aggravated symptoms. Parents initially tried to handle the situation but when unsuccessful information and advice was sought by consulting a physician. Conclusions . Parents consult the physician when they feel overtaxed, afraid, or inadequately prepared to care for their ill child. They considered seriously whether to consult a physician or not. [ABSTRACT FROM AUTHOR]

Objective: To explore what and how medical students learn from patients with chronic conditions in the context of communication skills training.Methods: Semi-structured interviews and focus groups with 32 medical students. Interviews were recorded, transcribed, analyzed inductively and organized into four main narrative themes.Results: Learning from patients provided medical students opportunities to see the world through the patients' eyes, understand the diversity of patients' needs, and recognize the importance of matching patients' and doctors' perspectives. Consequently, students expressed emotional responses on challenges in interactions with the patients related to performing the role as 'medical expert'. Difficulty empathizing became visible in the students' interaction with patients.Conclusion: The patients' authentic contributions provided the students with unique opportunities to engage with their own emotions and capacity for empathy. However, for students to benefit from this affective practical training, they need guidance to balance professional and personal aspects in encounters. There is a need to introduce the 'doctor as person' in medical education.Practice Implications: Patients with chronic conditions strengthen students' learning of empathy as part of transformative learning. Doing so with patients is a challenging way of learning. Thus, faculty and educators must provide explicit guidance for students to benefit. [ABSTRACT FROM AUTHOR]

Introduction: Globally, acute lower respiratory infections are the leading cause of mortality among children under 5 years. Following World Health Organization primary care guidelines, pneumonia is diagnosed based on cough/difficult breathing and fast breathing. We aimed to describe the practices of healthcare workers in primary care health facilities in Uganda in the management of young children with respiratory symptoms especially regarding asthma as opposed to pneumonia.Methods: Health workers were observed during clinical consultations with children 1-59 months of age presenting with cough and/or difficult breathing at recruitment. Afterward, an exit interview with the caregiver was conducted. Health center availability of clinical guidelines, equipment and supplies for management of children with respiratory symptoms was assessed systematically.Results: A total of 218 consultations with 50 health workers at six health centers were included. Median consultation time was 4 min. Health workers asked history relevant to distinguishing asthma from pneumonia in 16% of consultations. The respiratory rate was counted in 10%. Antibiotics were prescribed to 32% of all the children and to 39% of children diagnosed with pneumonia. Caregivers reported being informed of findings and possible diagnosis in 5% of cases. Medicine and equipment needed for diagnosing and treating asthma were generally unavailable.Conclusion: Clinical practices among Ugandan health workers in primary care are insufficient to distinguish between main causes of respiratory symptoms, especially asthma as opposed to pneumonia, in children under five. Irrational use of antibiotics is widespread. Clear communication with caregivers is lacking. This could be due to lack of relevant competencies, medicines, time and supplies.Lay Summary: Globally, the most frequent cause of death for children under five is infections in the lower airways. The World Health Organization recommends that in local health clinics this is defined as cough/difficult breathing and fast breathing. This article focuses on the practices of local health workers in Uganda and how they in practice diagnose and treat children under five with these symptoms. In addition, we try to estimate how much the caregivers of the children understand from the consultation. This is done by observing the healthcare workers (HCWs) and by interviewing the caregivers. In general, we found that the consultations were too short, that too few of the health workers looked for important signs for lower airways disease such as fast breathing and that antibiotics were prescribed in too many of the consultations. Also, the length and quality of the consultations and the supplies at the local health clinics were not sufficient to diagnose and treat asthma, which can often be mistaken for an infection. We believe that it is an important problem that too few children with asthma are being diagnosed correctly and that antibiotics are being prescribed too frequently, the latter being an important cause of antibiotic resistance. Relevant action must be taken to improve this. [ABSTRACT FROM AUTHOR]

Background: Training is a common and cost-effective way of trying to improve quality of care in low- and middle-income countries but studies of contextual factors for the successful translation of increased knowledge into clinical change are lacking, especially in primary care. The purpose of this study was to assess the impact of contextual factors on the effect of training rural healthcare workers in Kyrgyzstan and Vietnam on their knowledge and clinical performance in managing pediatric patients with respiratory symptoms.Methods: Primary care health workers in Kyrgyzstan and Vietnam underwent a one-day training session on asthma in children under five. The effect of training was measured on knowledge and clinical performance using a validated questionnaire, and by direct clinical observations.Results: Eighty-one healthcare workers participated in the training. Their knowledge increased by 1.1 Cohen's d (CI: 0.7 to 1.4) in Kyrgyzstan where baseline performance was lower and 1.5 Cohen's d (CI: 0.5 to 2.5) in Vietnam. Consultations were performed by different types of health care workers in Kyrgyzstan and there was a 79.1% (CI 73.9 to 84.3%) increase in consultations where at least one core symptom of respiratory illness was asked. Only medical doctors participated in Vietnam, where the increase was 25.0% (CI 15.1 to 34.9%). Clinical examination improved significantly after training in Kyrgyzstan. In Vietnam, the number of actions performed generally declined. The most pronounced difference in contextual factors was consultation time, which was median 15 min in Kyrgyzstan and 2 min in Vietnam.Discussion and Conclusion: The effects on knowledge of training primary care health workers in lower middle-income countries in diagnosis and management of asthma in children under five only translated into changes in clinical performance where consultation time allowed for changes to clinical practice, emphasizing the importance of considering contextual factors in order to succeed in behavioral change after training. [ABSTRACT FROM AUTHOR]