A double-blind study of flupenthixol ('Fluanxol') in general practice.

A double-blind crossover trial was carried out in the general practice to compare the effectiveness of flupenthixol and placebo in 43 patients with mild to moderate anxiety/depression states. Patients received either 0.5 mg flupenthixol or identical placebo tablets 2 to 4-times daily for 2 weeks and were then crossed over to the alternative preparation for a further 2 weeks. A simple 5-point rating scale was used to assess patients' symptoms at first visit and at subsequent follow-up. Even though there was a high placebo response, the results showed flupenthixol to be significantly more effective than placebo in relieving symptoms. Few side-effects were reported and were mild in nature.

[A pop-up menu linked to a computerized drug prescribing system. Prescribing pattern's feedback via a simple and quick method]. / Popupmeny kopplad till datoriserad läkemedelsförskrivning. Data om förskrivningsmönster fångas upp enkelt och snabbt.

It takes time for a GP to acquire sufficient experience of a new drug to be able to prescribe competently. This article describes a project studying the use of computerized records to afford a group of GP's swift feedback on recently introduced drugs of special interest. In the south-east of Sweden a network of primary health care centers has been created in two neighboring counties. The pharmacies of the region are also taking part. When new drugs of particular interest are introduced, each participating GP will automatically see a pop-up menu, asking questions pertaining to each computer-assisted prescription. In the pharmacies, patients are given a questionnaire regarding their expectations with respect to the drug. In this way it will be possible to provide the individual GP swift feedback from a large number of colleagues and patients concerning the drug's effectiveness in clinical practice. We have now been studying the COX-2 inhibitors rofecoxib (Vioxx) and celecoxib (Celebrex). Results show that a pop-up menu used in this way provides the general practitioner quick feed-back on prescribing behavior as well as drug effectiveness in clinical practice.

[Incidental screening--a rational basis for integrated prevention of cardiovascular diseases]. / Tillfällig screening--en rationell bas för integrerad hjärt-kärlprevention.

This study at the Lyckeby Primary Health Center, Sweden, demonstrates the feasibility of extended incidental cardiovascular risk-factor screening and intervention. The results indicate that a substantial proportion of the population at risk is detected. After one year 1,008 patients, of a total population of about 7,000 aged between 25 and 59 years, have been screened. Individual advice on non-drug therapies and regular follow-up by a nurse was offered to 41 per cent of these individuals, due to findings of raised blood pressure and/or serum cholesterol.

Opportunistic screening for hypercholesterolaemia with participants selected by the general practitioner. Inclusion and drop-out rate.

The objective of this study was to evaluate a method for opportunistic hypercholesterolaemia screening in primary care. At Lyckeby Primary Health Care Centre in Southern Sweden, where six general practitioners provide care to a population of 15,706 inhabitants, screening of patients aged 25-59 years was integrated with regular case-finding for hypertension. The specific characteristic of the programme was that the general practitioner adjusted, from day to day, the inclusion rate to actual resources. The study evaluated implementation during 3 years; after this time, 27 per cent of the target population was included. The included portion of those who visited the centre was 48% between ages 40 and 59 years, and 20% of those between 25 and 39 years. Compliance with the follow-up protocol differed according to age and risk group. The reattendance rates were better for those aged 40-59 years compared to the younger. It is concluded that opportunistic screening is most feasible in ages 40-59 years, while for younger people traditional population strategies may be preferable. If integrated with regular case-finding and treatment follow-up for hypertension, which are long well established components of general practice, no extra resources are needed for implementation.

Opportunistic screening for hypercholesterolaemia: characterization of two different drop-out groups and status after 2 years.

A total of 507 men and 686 women were opportunistically screened for hypercholesterolaemia and reinvited for a follow-up visit with the nurse after 2 years. Seven-hundred and thirty three (62%) re-attended (group A), while 226 (19%) did not, but saw the nurse at one or more pre-scheduled 6 month check-ups (group B). Two-hundred and thirty-three (20%) did not attend at all (group C). There was no difference between the groups in the number of parallel physician consultations during follow-up. Both groups B and C had higher proportions of smokers than group A. Group C were younger, had lower cholesterol and lower blood pressure (after adjustment for age) than group B, which in turn, had higher cholesterol and blood pressure than group A. The prevalence of hypertension and hypercholesterolaemia declined during the 2 years in group A. Of 189 smokers at baseline, 26 (14%) quit during follow-up. Of the 544 non-smokers, however, 31 (6%) commenced, to out-balance the quitters. Only five of the 43 patients in group A who had a persistent cholesterol of > or = 7.9 mmol/l received medication. It is likely that drop-out from a follow-up programme of this kind is to some extent justified because of the parallel organizations for care.

A comparison of two different team models for treatment of diabetes mellitus in primary care.

The importance of the nurse's role in the management of patients with type 2 diabetes has long since been emphasized. The aim of this study was to test the hypothesis that a structured organization of type 2 diabetes care, with a diabetes nurse working more independently of the general practitioner, has a significant impact on the patient's self-management and quality of care. The test consisted of 394 registered patients, all with an onset of diabetes mellitus occurring after the age of 34, at two primary health care (PHC) districts in Blekinge county in South Sweden. During one year all consultations for both doctors and nurses were analysed, and a structured telephone survey was carried out involving 364 patients who were 84 years or younger. A comparison between the two PHC centres was made regarding quality of care, frequency of consultation, patients' knowledge of their disease, and patients' self-management. The results showed that organizing care of type 2 diabetes in a structured way encourages better metabolic control in spite of less use of oral medication, and among the patients a greater knowledge of their disease and a more active self-management thus favouring implementation of local guidelines. Also, a difference was found in the patients' choice of contact with doctor or nurse regarding their diabetes and even other causes, which shifted the balance from doctor to nurse. This study provides support for organizing type 2 diabetes care in a structured way to increase the quality of care.

Awareness and treatment of cardiovascular disease risk factors among middle-aged Swedish men and women.

OBJECTIVE: To study awareness and treatment of risk factors for cardiovascular disease in a primary care district where a screening program for hypercholesterolaemia involving one third of the population had been conducted 7 years earlier. DESIGN: A semi-structured telephone survey on four risk factors; blood pressure, serum cholesterol, blood sugar, and smoking habits. SETTING: The study was performed in a defined area in Blekinge county in Sweden. SUBJECTS: A random sample of the general population aged 40-49 years, in total 356 people. MAIN OUTCOME MEASURES: Awareness of individual risk factors, for cardiovascular diseases, on-going medication, and lifestyle changes in order to lower individual risks. RESULTS: A total of 95% had had their blood pressure measured at least once, compared with 69% for serum cholesterol. Twenty-two per cent had at some time been told that they had high blood pressure, and, of these, almost half (44%) received pharmacological treatment. Among the 62 subjects who were informed about hyperlipidaemia only 5% were taking a lipid-reducing drug. Among present smokers, 38% had had at least one quitting episode during the previous 2 years with a median duration of 60 days. CONCLUSION: In a general population there is a difference between blood pressure and cholesterol check-up and medicalization. Screening activities seem to raise the awareness of cardiovascular risk factors in a population, but when evaluating the tendency to change lifestyle the contagious effects of screening activities might be taken into account. Finding quick-relapsing former smokers among current non-smokers may be of importance when planning smoking cessation activities.

Wound management for 287 patients with chronic leg ulcers demands 12 full-time nurses. Leg ulcer epidemiology and care in a well-defined population in southern Sweden.

OBJECTIVE: To study the prevalence, aetiology and treatment of chronic leg and foot ulcers, and to estimate the nurse's time in wound management. DESIGN: A structured questionnaire with 19 questions about chronic ulcers and wound management was sent to all district and community nurses in the county during 1 week in March 1998. A similar questionnaire has been administered regularly since 1986. SETTING: Primary and community care in the county of Blekinge, Sweden, with a population of 1,51,610. PATIENTS: 287 patients with chronic leg and foot ulcers were identified during the week studied. MAIN OUTCOME MEASURES: Prevalence of leg and foot ulcers, ulcer aetiology, treatment of ulcers and wound management time. RESULTS: The estimated prevalence of chronic leg and foot ulcers was 0.19%. Venous ulcers were the most common (38%), of which 87% were treated with some form of compression therapy. Seven percent of the nurse's workload was devoted to ulcer care. During the period 1986 to 1998, ulcers with missing or unknown aetiology decreased from 31% to 6% and ulcers with a duration of more than 2 years from 44% to 27%, while treatment time per ulcer decreased from 2.1 to 1.7 hours/week. CONCLUSION: Monitoring standards for ulcer aetiology through repeated questionnaires seems to ensure more accurate diagnoses. Thorough and detailed information about treatment time documents the workload for wound management.

Medical audit changes physicians' prescribing of antibiotics for respiratory tract infections.

OBJECTIVE: To reduce the prescribing of antibiotics in respiratory tract infections (RTI). DESIGN AND SUBJECTS: The Audit Odense model for registration and quality development was used for RTI. Twenty general practitioners registered their consultations for RTIs during 4 weeks in February-March (n = 1124) and November-December (n = 926) in 1995. Diagnosis, choice of antibiotics and diagnostic tools were registered. In between the two registrations an active intervention took place. Consultations for RTIs among 25 physicians (who had not participated in any intervention or follow-up discussion) served as a control. SETTING: General practice in southern Sweden. OUTCOME MEASURES: Prescribing of antibiotics before and after an intervention. RESULTS: The proportion of patients not receiving an antibiotic increased from the first to the second registration in both groups, in the intervention group from 45 to 55% (p < 0.001) and in the control group from 36 to 40% (p = 0.0298). The reduction was most evident in patients diagnosed with tonsillitis and bronchitis. This was in concordance with an increase in the use of desktop diagnostics (Strep A and CRP). CONCLUSION: These results indicate that it is possible to achieve a change in the utilisation of antibiotics in the treatment of RTIs and that the Audit Project Odense (APO) model could be a valuable tool.