Audit report from Greenland on nurses' tasks and perceived competency.

INTRODUCTION: Despite all efforts, recruitment of healthcare personnel has become increasingly difficult in Greenland as in other remote areas. The aim of this observational study was to describe the extent of health care delivered by nurses in Greenland's healthcare system. Reasons for encounter, diagnostic procedures, treatments and need for a physician's assistance, as well as the nurses' self-perceived competency, were also analysed. METHODS: A total of 42 nurses registered all patient encounters for 10 days in late autumn 2006 in 14 out of 16 healthcare districts in Greenland. RESULTS: Nurses treated 1117 encounters (60%) singlehandedly. The nurses felt competent in what they were doing in 1415 encounters (76%). In 525 encounters (31%), a physician's advice was sought. Either the physician was asked to come or the physician's advice was obtained by telephone. In four cases the nurses did not feel completely competent, but did not seek advice from the physician on call. Feeling competent did not depend on length of experience in Greenland. CONCLUSION: In Greenland, nurses independently receive, diagnose and treat a substantial number of primary healthcare patients. The nurses take care of the patients and perform a number of clinical and laboratory procedures with great confidence. There has been speculation that part of the difficulty in recruiting doctors and healthcare personnel in remote areas may be due to uneasiness about professional responsibilities and, to some extent, lack of confidence. At least among the registering nurses in this study, this did not seem to be a problem.

Influence of number needed to treat, costs and outcome on preferences for a preventive drug.

BACKGROUND: The number needed to treat (NNT) has been widely recommended for communicating benefits from risk reductions. It has been claimed that NNT is easily understood and that it has intuitive meaning. There are, however, only few studies of lay people's understanding of NNT. OBJECTIVE: The objective of this study was to explore whether lay people are sensitive to the magnitude of treatment effectiveness as expressed in terms of NNT, and whether the sensitivity is influenced by variation in the type of health outcome, variation in patients' payment for the treatment or variation in the type of side effects. METHODS: In total, 2326 non-institutionalized Danes aged 18-91 years were interviewed face to face and asked whether they would consent to a treatment against a somewhat increased risk of death or heart attack. The respondents were allocated to different levels of effectiveness of treatment expressed as NNT of 10, 100, 200 or 400, different costs and different descriptions of adverse effects. RESULTS: The odds for consenting to therapy were little influenced by the magnitude of NNT, but were greater among married respondents and among those who had side effects presented in terms of headache and constipation. CONCLUSION: In this study, the respondents' choice of treatment was largely insensitive to the magnitude of NNT independently of variations in type of health outcome and costs. NNT may not be easily understood by lay people.

[Influenza vaccinations in Denmark during the season 1999-2000]. / Influenzavaccinationer i Danmark i saesonen 1999-2000.

INTRODUCTION: During the influenza season of 1999-2000, private vaccination clinics in Denmark increasingly offered influenza vaccination in competition with general practitioners (GPs). The clinics arranged group vaccinations in the local community or at workplaces at prices below the standard price. The aim of this study was to assess the actual proportion of people vaccinated, both in the elderly and in the younger population, and to elucidate the effect of marketing by the private vaccination clinics. MATERIAL AND METHOD: In February 2000, a questionnaire about influenza vaccination and general health was posted to 2,144 persons aged 65 or older and 1,717 aged 18-64 years randomly drawn from the Home Office Central Person Register. The questionnaire was completed by 70% in the older group and 66% in the younger group. RESULTS: In Denmark, 47% of the older group and 8% of the younger group were vaccinated against influenza. In the municipality of Copenhagen the acceptance rate was 66% in the older group, compared to 46% in the rest of the country. General practitioners vaccinated 69% of the older group and 66% of the younger group, 24% were vaccinated at a vaccination clinic, and 7% were vaccinated elsewhere. Half the 18-64 year-olds were vaccinated by their own GP, 33% at their workplace, 11% at a vaccination clinic, and 6% elsewhere. DISCUSSION: Based on this study, it is recommended that more effort is made to vaccinate young people in treatment for a chronic illness and the elderly against influenza. Influenza vaccination campaigns aimed at defined target groups could easily be done by general practitioners without establishing a new ad hoc organisation.

Decision on influenza vaccination among the elderly. A questionnaire study based on the Health Belief Model and the Multidimensional Locus of Control Theory.

OBJECTIVE: To create an empirical model, describing factors of importance to the elderly in accepting influenza vaccinations. DESIGN: Epidemiologic study with two coupled questionnaires. In September 1996 a 46-item questionnaire was sent to 2147 elderly people (> or = 65 years). The questionnaire comprised questions about general health, and questions based on the Health Belief Model and the Multidimensional Locus of Control Theory. In February 1997 a postcard questionnaire was sent to the same elderly people asking whether they had been vaccinated against influenza in the past season. SETTING: All Danish counties. SUBJECTS: 2147 persons randomly sampled from the The Civil Registration System. MAIN OUTCOME MEASURE: Factors influencing the rate of influenza vaccine uptake in the elderly. Influenza vaccination rates. RESULTS: In the high-risk group 51% (95% confidence interval: 46-55%) were vaccinated compared to 29% (26-32%) in the low-risk group as regards influenza. By logistic regression the Health Belief Model dimensions "perceived barriers", "perceived benefits" and "perceived severity" were found to be significant predictors of acceptance of influenza vaccinations. CONCLUSIONS: An empirical model based on the Health Belief Model predicting acceptance of influenza vaccinations with a positive predictive value of 91% (87-94%) and a negative predictive value of 86% (83-88%) was obtained.

[Effect of an influenza vaccination campaign in the municipality of Copenhagen during the 1996-1997 season]. / Effekt af influenzavaccinationskampagnen i Københavns Kommune i saesonen 1996-1997.

In Denmark influenza vaccinations are usually paid for by the patients. In the autumn of 1996 Copenhagen City Council offered free influenza vaccinations to all residents aged 70 years or older. The impact of the campaign was evaluated in a questionnaire study of a random sample of the Danish population aged 70 years or older. In Copenhagen 81% (95% Confidence interval: 67-95%) of the elderly at risk were vaccinated compared to 51% (45-56%) outside Copenhagen. Offering free influenza vaccinations in a mass campaign is an effective way of improving coverage rate. However, no substantial difference was found in cost between the mass campaign and a targeted campaign with free vaccination in general practice.

[Qualitative interview study on acceptance of influenza vaccination among the elderly]. / Kvalitativ interview-undersøgelse om aeldres valg af influenzavaccination.

Nine elderly men and women were interviewed in order to discover factors of importance in accepting influenza vaccinations. The study demonstrated that the fee to be paid by the patients was a considerable barrier to an improvement of the vaccination rate. The elderly informants were all aware that influenza vaccine is available. Some informants expressed uncertainty whether they themselves belonged to the risk groups who should be vaccinated. Sources of information were the general practitioner (GP), relatives, and the mass media. More personal information from the GP to persons at risk was wanted. Influenza vaccination behaviour was found to be consistent with the Health Belief Model. The present organization of influenza vaccinations does not promote a sufficient immunization rate. The threshold for accepting influenza vaccinations appears to be too high for the elderly population.

[Providing patients with their diagnostic test results. A vignette study in general practice]. / Formidling af undersøgelsessvar til patienterne. En vignetundersøgelse i almen praksis.

The communication of results of HIV tests and chest-X-rays because of persistent coughing are of particular interest because potential life-threatening disease may be disclosed. For HIV tests it is recommended that the result is communicated to the patient in the doctor's office face to face. In this questionnaire study based on two simulated case-stories with a 63 year-old man referred to chest-X-rays because of persistent coughing, and a 27 year-old man, who had been living in Africa for some time, now wanting a HIV test performed, we found that only half (53%) of the general practitioners (GP) did communicate HIV test results in the consultation office. X-ray test results were only communicated in the consultation office by 18% of the GPs. Communication of test results which might have serious implications to the patient should preferably not be done by telephone. Patients should be told of potentially serious results in person by their own physician.

Impact of postal invitations and user fee on influenza vaccination rates among the elderly. A randomized controlled trial in general practice.

OBJECTIVE: To examine the impact of postal invitations and user fee on influenza vaccination rates. DESIGN: A controlled randomized trial in 13 general practices. One third of the participating patients received postal invitations to influenza vaccination free of charge. Another third received postal invitations to influenza vaccination on paying the usual fee (US$ 40-60). The last third served as a control group, being vaccinated at their own request and paying the usual fee. SETTING: General practice in the Counties of Funen and Vejle, Denmark. PATIENTS: Five hundred and eighty-five patients aged 65 years or older, recognized by their general practitioner (GP) as being in the risk group for whom influenza vaccination is recommended. MAIN OUTCOME MEASURES: Influenza vaccination rates. RESULTS: In the control group 25% (19-31%, 95% confidence interval) of the patients were vaccinated, compared with 49% (42-56%) in the group who received a postal reminder and paid the usual fee, and 72% (65-78%) in the group invited to be vaccinated free of charge. CONCLUSION: It is suggested that GPs send postal invitations to their elderly patients in the risk groups urgently recommending influenza vaccination. Attention should also be given to offering free influenza vaccination to elderly patients who have recognized indications for vaccination.

[The impact of postal invitations and user fee on influenza vaccination among the elderly. A randomized controlled trial in general practice]. / Betydning af indkaldelse og brugerbetaling for influenzavaccination blandt aeldre. Et randomiseret kontrolleret forsøg i almen praksis.

Influenza epidemics are accompanied by considerable excess morbidity and mortality especially among the elderly and the chronically ill. In the influenza season 1995 a controlled, randomized trial was carried out to examine the impact of postal invitations and user fee on influenza vaccination rates. Five hundred and eighty-five patients aged 65 years or older participated. They were all recognized by their general practitioner (GP) to be in the risk group to whom influenza vaccination is recommended. One third were invited to free influenza vaccination. Another third received postal invitations to influenza vaccination paying the usual fee ($40-$60 US). The last third served as a control group, being vaccinated on their own request and paying the usual fee. In the control group 25% (19-31%, 95% confidence interval) of the patients were vaccinated, compared to 49% (42-56%) in the group which received a postal reminder and paid the usual fee, and 72% (65-78%) in the group invited to be vaccinated free of charge.