What triggers healthcare-seeking behaviour when experiencing a symptom? Results from a population-based survey.

BACKGROUND: The decision process of whether or not to contact the GP is influenced by different factors which have not all been well examined. AIM: The aim of this study was to analyse whether contact to the GP is associated with concern about the symptom, influence on daily activities and symptom burden, such as the total number of symptoms experienced by each person in a general population. DESIGN & SETTING: This Danish nationwide cross-sectional study comprises a random sample of 100 000 people, representative of the adult Danish population ≥20 years. METHOD: Baseline data were collected in a web-based survey conducted from June to December 2012. RESULTS: In total 49 706 (52.5%) individuals answered the questionnaire; 45 483 (91.5%) individuals experienced at least one of 44 predefined symptoms during the 4 weeks preceding the completion of the questionnaire. They reported 268 772 symptom experiences of which 58 370 symptoms (21.7%) resulted in contact with a GP. A high level of concern and influence on daily activities was associated with significantly higher odds for GP contact. A high burden of symptoms was associated with lower odds of contact with the GP. CONCLUSION: Approximately every fifth symptom reported by individuals from the general population leads to GP contact. Influence on daily activities, burden of symptoms, and concern about the symptom were significant factors associated with the decision of whether to contact the GP. No overall association between sex and GP contact was observed.

Do educational meetings and group detailing change adherence to drug formularies in hospitals? A cluster randomized controlled trial.

PURPOSE: The aim of this study was to examine whether educational meetings and group detailing could increase the use of drugs from the ward lists or the drug formulary in hospitals. METHODS: Twelve medical wards from two hospitals were randomized into three groups: control, basic and extended intervention. All wards had a ward list review before interventions. Moreover, the basic intervention consisted of an educational meeting, and the extended intervention included two group detailing sessions. The proportion of drugs used from the ward list or hospital drug formulary (HDF) was the primary outcome. Data (defined daily doses [DDDs], numbers and cost [Euros]) on drugs sold to the wards were retrieved from the two hospitals from 1 July 2011 to 31 August 2012. BASELINE DATA: from July to September 2011, and follow-up data: from June to August 2012. RESULTS: The proportion of formulary drugs used increased for the extended intervention group (0.04, range -0.02 to 0.09) and basic intervention group (0.03, range -0.03 to 0.09) in comparison with a decrease in the control group (-0.01, range -0.03 to -0.02). The interventions did not significantly change odds for selecting drugs from the formulary in comparison with the control group (basic intervention: OR 1.09 [95 % CI 0.81 to 1.46]; extended intervention: OR 1.00 [95 % CI 0.75 to 1.35]). CONCLUSIONS: In this study, educational meetings and group detailing do not significantly improve adherence to ward lists or HDF. The adherence to the formularies at baseline was relatively high, which may explain why the interventions did not have a significant effect.

Quality indicators for treatment of respiratory tract infections? An assessment by Danish general practitioners.

BACKGROUND: In 2008, a set of 41 quality indicators for antibiotic treatment of respiratory tract infections (RTIs) in general practice were developed in an international setting as part of the European project HAPPY AUDIT. OBJECTIVES: To investigate Danish general practitioners' (GPs') assessment of a set of internationally developed quality indicators and to explore if there is an association between the GPs' assessment of the indicators and their practice characteristics as well as their antibiotic prescription pattern. METHODS: A total of 102 Danish GPs were invited to assess the 41 quality indicators. The GPs were categorized into two groups according to their assessment of indicators. Data concerning practice characteristics and antibiotic treatment were obtained during a three-week registration of patients with RTIs and were linked to the GPs' assessments of the indicators. RESULTS: A total of 62 (61%) responded. Quality indicators focusing on the frequency of prescribing of narrow-spectrum penicillin were rated as suitable by more than 80% of the Danish GPs, while quality indicators concerning cephalosporins or quinolones were rated suitable by less than half of the GPs. The antibiotic prescribing pattern differed significantly and the GPs who disagreed on most indicators prescribed more macrolides and less narrow-spectrum penicillin than the GPs who agreed on most indicators. CONCLUSION: Even though an international expert panel agreed on a set of quality indicators for antibiotic treatment of RTIs, only a few of them were rated suitable by the GPs, who are supposed to use them.