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2.
Tidsskr Nor Laegeforen ; 139(13)2019 Sep 24.
Artigo em Norueguês | MEDLINE | ID: mdl-31556521

RESUMO

BACKGROUND: Low back pain is considered to be the most common single cause of sickness absence. In 2010, Sørlandet Hospital Arendal established an interdisciplinary treatment programme through the Faster Return-to-Work scheme, based on the relevant guidelines for patients with low back pain. In this study we present our experiences from six years of the treatment programme. MATERIAL AND METHOD: Patients who were referred to Sørlandet Hospital in Arendal in the period 2011-16 due to long-term symptoms of low back pain were offered interdisciplinary treatment. This included a one-to-one consultation with a doctor, four weeks of group-based low back school, and physiotherapist-led exercise as well as eight weeks of either physiotherapist-led exercise or home exercise. The degree of sick leave and functional level using scores on the Roland-Morris Disability Questionnaire (RMDQ) were reported at the outset and after 4 and 12 weeks. RESULTS: A total of 43 patients in employment completed the treatment programme. The average age was 41.9 years and 52 % were women. Altogether 57 % were on certified sick leave at the outset and the remainder were assessed as being at high risk of going on sick leave. A total of 7.5 % were placed on sick leave during the observation period, while 28.5 % of those on sick leave were declared completely fit. Altogether 52.7 % of the patients had a clinically significant reduction in RMDQ scores (> 3.5 points). INTERPRETATION: The interdisciplinary treatment programme appears to improve function and reduce sickness absent in patients with long-term low back pain. This study has a short follow-up time and no control group; the observations must therefore be interpreted with caution.


Assuntos
Dor Lombar/terapia , Manejo da Dor/métodos , Equipe de Assistência ao Paciente , Adulto , Avaliação da Deficiência , Terapia por Exercício , Feminino , Hospitais Comunitários , Humanos , Masculino , Pessoa de Meia-Idade , Noruega , Educação de Pacientes como Assunto , Modalidades de Fisioterapia , Avaliação de Programas e Projetos de Saúde , Recuperação de Função Fisiológica , Encaminhamento e Consulta , Retorno ao Trabalho , Licença Médica , Inquéritos e Questionários , Resultado do Tratamento
3.
Disabil Rehabil ; : 1-8, 2019 Jan 26.
Artigo em Inglês | MEDLINE | ID: mdl-30688122

RESUMO

AIMS: To obtain more insight into differences in sick leave assessments of workers with subjective health complaints, we studied sick leave assessments among Dutch occupational and insurance physicians, and explored possible determinants for these differences. METHODS: A cross-sectional study was conducted among 50 occupational and 43 insurance physicians in the Netherlands. They all assessed sick leave (complete, partial or no) of nine video case vignettes of workers with subjective health complaints and gave their opinion on the complaints, sick leave and health status. Data were analyzed via a multinomial regression approach, using generalized estimating equations in SPSS. RESULTS: Compared to occupational physicians, complete sick leave was less likely to be assessed by insurance physicians (odds ratio 0.74, 95% confidence interval 0.56-0.97). For occupational physicians, psychological diagnoses, private issues and reduced work ability had more influence on the outcome of the sick leave assessment than for insurance physicians. CONCLUSION: There are differences in sick leave assessments for workers with subjective health complaints between physicians working in the same occupational health system; insurance physicians are stricter in assessing complete sick leave than occupational physicians. These differences may be explained by differences in roles, tasks and perspectives of the physician in occupational health care. Implications for Rehabilitation  Sick leave assessments of workers with subjective health complaints. • The current study showed that there are differences between occupational physicians and insurance physicians in sick leave assessments for workers with subjective health complaints. • These differences may be based on different perspectives, roles and tasks of physicians. • Physicians working in the rehabilitation and occupational health system should be more aware of the impact of these differences on their assessments and advices. • Better communication and collaboration between physicians, and more insight into and clarification of the perspectives may result in more agreement between physicians' sick leave assessment and advice towards workers.

4.
BMC Fam Pract ; 19(1): 133, 2018 07 30.
Artigo em Inglês | MEDLINE | ID: mdl-30060734

RESUMO

BACKGROUND: Entitlement to sickness benefits is a legal process requiring health-related reduced work capacity confirmed by a physician via a sickness certificate. However, there is a knowledge gap concerning physicians' clinical practice of work capacity assessments for patients with common mental disorders (CMD). Physicians claim more knowledge and skills in how to actually do the assessments. The aim of this study was to explore physicians' tacit knowledge of performing assessments of capacity to work and the need for sickness absence in patients with depression and anxiety disorders. METHODS: We performed a qualitative study with open-ended interviews and a short video vignette of a physician and a patient with depression as stimuli. Participating physicians (n = 24) were specialized in general practice, occupational health or psychiatry and experienced in treating patients with depression and anxiety. Interviews were audio-recorded and transcribed verbatim. Inductive content analysis was used as the analytical tool. RESULTS: Five categories were identified. Category 1 identified work capacity assessment as doing a jigsaw puzzle without any master model. The physicians both identified and created the pieces of the puzzle, mainly by facilitating strategies to make the patient a better supplier of essential information. The finished puzzle made up a highly individualized comprehensive picture required for adequate assessment. Categories 2-4 identified the particular essential pieces of information the participants used, relating to the patient's disorder, capacity in the work place and contextual everyday life. For the sickness absence assessment, apart from decreased work capacity, the physicians also took particulars of the work place into account; e.g. could the work place handle an employee with reduced capacity. CONCLUSIONS: Physicians' tacit knowledge of assessing work capacity and the need for sickness absence for patients with CMD was identified as doing a jigsaw puzzle. The physicians became identifiers and creators of the pieces of the puzzle using a broad palette of essential information. Our findings contribute to the knowledge gap on clinical assessment and can be used as an educational tool. Because they are based on the professions' tacit knowledge, acceptance of the model can be expected to be high.


Assuntos
Transtornos de Ansiedade , Transtorno Depressivo , Clínicos Gerais , Medicina do Trabalho , Psiquiatria , Avaliação da Capacidade de Trabalho , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Licença Médica
5.
BMC Fam Pract ; 19(1): 71, 2018 05 22.
Artigo em Inglês | MEDLINE | ID: mdl-29788920

RESUMO

BACKGROUND: Cluster randomized controlled trials are often used in research in primary care but creates challenges regarding biases and confounders. We recently presented a study on low back pain from primary care in Norway with equal effects in the intervention and the control group. In order to understand the specific mechanisms that may produce biases in a cluster randomized trial we conducted a focus group study among the participating health care providers. The aim of this study was to understand how the participating providers themselves influenced on the study and thereby possibly on the results of the cluster randomized controlled trial. METHODS: The providers were invited to share their experiences from their participation in the COPE study, from recruitment of patients to accomplishment of either the intervention or control consultations. Six clinicians from the intervention group and four from the control group took part in the focus group interviews. The group discussions focused on feasibility of the study in primary care and particularly on identifying potential biases and confounders in the study. The audio-recorded interviews were transcribed verbatim and analyzed according to a systematic text condensation. The themes for the analysis emerged from the group discussions. RESULTS: A personal interest for back pain, logistic factors at the clinics and an assessment of the patients' capacity to accomplish the study prior to their recruitment was reported. The providers were allowed to provide additional therapy to the intervention and it turned out that some of these could be regarded as opposed to the messages of the intervention. The providers seemed to select different items from the educational package according to personal beliefs and their perception of the patients' acceptance. CONCLUSION: The study disclosed several potential biases to the COPE study which may have impacted on the study results. Awareness of these is highly important when planning and conducting a cluster randomized controlled trial. Procedures in the recruitment of both providers and patients seem to be key factors and the providers should be aware of their role in a scientific study in order to standardize the provision of the intervention.


Assuntos
Dor Lombar/terapia , Atenção Primária à Saúde/métodos , Adulto , Viés , Análise por Conglomerados , Estudos de Viabilidade , Feminino , Grupos Focais , Pessoal de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Noruega , Seleção de Pacientes
6.
Phys Ther ; 97(12): 1138-1146, 2017 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-29186635

RESUMO

Background: Many interventions for the treatment of low back pain exist, but the mechanisms through which such treatments work are not always clear. This situation is especially true for biopsychosocial interventions that incorporate several different components and methods of delivery. Objective: The study objective was to examine the indirect effects of the Cognitive Patient Education (COPE) intervention via illness perceptions, back pain myths, and pain catastrophizing on disability outcome. Design: This study was a secondary analysis of the COPE randomized controlled trial. Methods: Mediation analysis techniques were employed to examine the indirect effects of the COPE intervention via residualized change (baseline - posttreatment) in the 3 variables hypothesized to be targeted by the COPE intervention on posttreatment disability outcome. Pain intensity at baseline, pain duration, clinician type, and a treatment-mediator interaction term were controlled for in the analysis. Results: Preliminary analyses confirmed that changes in pain catastrophizing and illness perceptions (not back pain myths) were related to both allocation to the intervention arm and posttreatment disability score. The treatment exerted statistically significant indirect effects via changes in illness perceptions and pain catastrophizing on posttreatment disability score (illness perceptions standardized indirect effect = 0.09 [95% CI = 0.03 to 0.16]; pain catastrophizing standardized indirect effect = 0.05 [95% CI = 0.01 to 0.12]). However, the inclusion of an interaction term led to the indirect effects being significantly reduced, with the effects no longer being statistically significant. Limitations: This study presents a secondary analysis of variables not identified a priori as being potentially important treatment targets; other, unmeasured factors could also be important in explaining treatment effects. Conclusions: The finding that small indirect effects of the COPE intervention via changes in illness perceptions and pain catastrophizing on posttreatment disability could be estimated indicates that these variables may be viable treatment targets for biopsychosocial interventions; however, this finding must be viewed in light of the adjusted analyses, which showed that the indirect effects were significantly reduced through the inclusion of a treatment-mediator interaction term.


Assuntos
Terapia Cognitivo-Comportamental , Dor Lombar/terapia , Educação de Pacientes como Assunto , Modalidades de Fisioterapia , Catastrofização , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Dor Lombar/psicologia , Percepção da Dor , Resultado do Tratamento
7.
BMJ Open ; 7(7): e015025, 2017 Jul 21.
Artigo em Inglês | MEDLINE | ID: mdl-28733298

RESUMO

OBJECTIVES: To develop hypotheses about whether there are patient-related factors that influence physicians' decision-making that can explain why some patients with severe subjective health complaints (SHCs) are more likely to be granted sick leave than others. DESIGN: Exploratory cross-sectional. SETTING: Assessments of patient-related factors after watching nine authentic video recordings of patients with severe SHC from a Norwegian general practice. Our previous study showed that three of these nine patients were less likely than the remaining six patients to be granted sick leave by physicians from five European countries. PARTICIPANTS: In total, 10 assessors from Norway, the Netherlands and France. OUTCOMES: The direction in which the assessments may contribute towards the decision to grant a sickness certificate (increasing or decreasing the likelihood of granting sick leave). RESULTS: Physicians consider a wide variety of patient-related factors when assessing sickness certification. The overall assessment of these factors may provide an indication of whether a patient is more likely or less likely to be granted sick leave. Additionally, some single questions (notable functional limitations in the consultation, visible suffering, a clear purpose for sick leave and psychiatric comorbidity) may indicate differences between the two patient groups. CONCLUSIONS: Next to the overall assessment, no notable effect of the complaints on functioning and suffering, a lack of a clear purpose for sick leave and the absence of psychiatric comorbidity may be factors that could help guide the decision to grant sick leave. These hypotheses should be tested and validated in representative samples of professionals involved in sickness certification. This may help to understand the tacit knowledge we believe physicians have when assessing work capacity of patients with severe SHC.


Assuntos
Atitude do Pessoal de Saúde , Tomada de Decisões , Autoavaliação Diagnóstica , Medicina Geral , Padrões de Prática Médica , Licença Médica , Avaliação da Capacidade de Trabalho , Atividades Cotidianas , Adulto , Estudos Transversais , Feminino , França , Clínicos Gerais , Humanos , Masculino , Transtornos Mentais/complicações , Pessoa de Meia-Idade , Motivação , Países Baixos , Noruega , Índice de Gravidade de Doença , Estresse Psicológico
8.
BMC Public Health ; 17(1): 573, 2017 06 14.
Artigo em Inglês | MEDLINE | ID: mdl-28615017

RESUMO

BACKGROUND: It has been discussed whether the relationship between a patient on sick leave and his/her general practitioner (GP) is too close, as this may hinder the GP's objective evaluation of need for sick leave. Independent medical evaluation involves an independent physician consulting the patient. This could lead to new perspectives on sick leave and how to follow-up the patient. METHODS/DESIGN: The current study is a randomized controlled trial in a Norwegian primary care context, involving an effect evaluation, a cost/benefit analysis, and a qualitative evaluation. Independent medical evaluation will be compared to treatment as usual, i.e., the physicians' and social insurance agencies' current management of long-term sick-listed patients. Individuals aged 18-65 years, sick listed by their GP and on full or partial sick leave for the past 6 months in Hordaland county will be included. Exclusion criteria are pregnancy, cancer, dementia or an ICD-10 diagnosis. A total sample of 3800 will be randomly assigned to either independent medical evaluation or treatment as usual. Official register data will be used to measure the primary outcome; change in sickness benefits at 7, 9 and 12 months. Sick listed in other counties will serve as a second control group, if appropriate under the "common trend" assumption. DISCUSSION: The Norwegian effect evaluation of independent medical evaluation after 6 months sick leave is a large randomized controlled trial, and the first of its kind, to evaluate this type of intervention as a means of getting people back to work after long-term sickness absence. TRIAL REGISTRATION: ClinicalTrials.gov NCT02524392 . Registered June 23, 2015.


Assuntos
Avaliação Médica Independente , Retorno ao Trabalho , Licença Médica , Adolescente , Adulto , Idoso , Análise Custo-Benefício , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Noruega , Atenção Primária à Saúde , Adulto Jovem
9.
Health Qual Life Outcomes ; 15(1): 40, 2017 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-28222741

RESUMO

BACKGROUND: An individualized patient reported outcome (PRO) has recently been recommended within LBP research, but no study has evaluated this instrument with commonly applied PROs. Moreover, the impact of psychological factors has mostly been assessed for disease-specific instruments. The objective of this study was to assess the predictive value of illness perceptions, pain catastrophizing and psychological distress on 12 month outcomes assessed by specific, generic and individualized PROs recommended in low back pain (LBP). METHODS: Secondary analysis of patients with sub-acute or chronic LBP recruited for a cluster randomized controlled trial in primary care who completed a self-administered questionnaire at baseline and 12 months. 12 month scores for the Roland Morris Disability Questionnaire (RMDQ), the EuroQol (EQ-5D), and the Patient Generated Index (PGI) were dependent variables in hierarchical regression analysis. Independent variables included baseline scores for the Brief Illness Perceptions Questionnaire (Brief IPQ), Hopkins Symptom Check List (HSCL-25), Pain Catastrophizing Scale (PCS), health/clinical and sociodemographic variables. RESULTS: Of the 216 eligible patients included, 203 patients responded to the baseline questionnaire and 150 (74%) responded at 12 months. The mean age was 38.3 (SD 10.2) years and 57.6% were female. The Brief IPQ showed a statistically significant variation in the 12-months score of all the PROs, explaining 2.5% in RMDQ, 7.9% in EQ-5D, and 3.6% in PGI. Most of the explained variation for EQ-5D scores related to illness perceptions. The PCS explained 3.7% of the RMDQ and 2.5% in the EQ-5D scores. The HSCL-25 did not make a significant contribution. CONCLUSION: Illness perceptions and pain catastrophizing were associated with 12-month outcomes as assessed by condition-specific, generic and individualized PROs. The Brief IPQ and PCS have relevance to applications in primary care that include interventions designed to enhance psychological aspects of health and where the contribution of such variables to outcomes is of interest. Further studies should assess whether the Brief IPQ perform similarly in LBP populations in other health care settings.


Assuntos
Avaliação da Deficiência , Dor Lombar/psicologia , Medição da Dor/psicologia , Qualidade de Vida/psicologia , Adulto , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Noruega , Medidas de Resultados Relatados pelo Paciente , Valor Preditivo dos Testes , Inquéritos e Questionários
10.
BMJ Open ; 6(7): e011316, 2016 07 14.
Artigo em Inglês | MEDLINE | ID: mdl-27417198

RESUMO

OBJECTIVES: A comparison of appraisals made by general practitioners (GPs) in France and occupational physicians (OPs) and insurance physicians (IPs) in the Netherlands with those made by Scandinavian GPs on work capacity in patients with severe subjective health complaints (SHCs). SETTING: GPs in France and OPs/IPs in the Netherlands gathered to watch nine authentic video recordings from a Norwegian general practice. PARTICIPANTS: 46 GPs in France and 93 OPs/IPs in the Netherlands were invited to a 1-day course on SHC. OUTCOMES: Recommendation of sick leave (full or partial) or no sick leave for each of the patients. RESULTS: Compared with Norwegian GPs, sick leave was less likely to be granted by Swedish GPs (OR 0.51, 95% CI 0.30 to 0.86) and by Dutch OPs/IPs (OR 0.53, 95% CI 0.37 to 0.78). The differences between Swedish and Norwegian GPs were maintained in the adjusted analyses (OR 0.43, 95% CI 0.23 to 0.79). This was also true for the differences between Dutch and Norwegian physicians (OR 0.55, 95% CI 0.36 to 0.86). Overall, compared with the GPs, the Dutch OPs/IPs were less likely to grant sick leave (OR 0.60, 95% CI 0.45 to 0.87). CONCLUSIONS: Swedish GPs and Dutch OPs/IPs were less likely to grant sick leave to patients with severe SHC compared with GPs from Norway, while GPs from Denmark and France were just as likely to grant sick leave as the Norwegian GPs. We suggest that these findings may be due to the guidelines on sick-listing and on patients with severe SHC which exist in Sweden and the Netherlands, respectively. Differences in the working conditions, relationships with patients and training of specialists in occupational medicine may also have affected the results. However, a pattern was observed in which of the patients the physicians in all countries thought should be sick-listed, suggesting that the physicians share tacit knowledge regarding sick leave decision-making in patients with severe SHC.


Assuntos
Atitude do Pessoal de Saúde , Tomada de Decisões , Médicos , Padrões de Prática Médica , Índice de Gravidade de Doença , Licença Médica , Avaliação da Capacidade de Trabalho , Adulto , Comparação Transcultural , Estudos Transversais , Dinamarca , Autoavaliação Diagnóstica , Feminino , França , Medicina Geral , Clínicos Gerais , Humanos , Seguro , Masculino , Pessoa de Meia-Idade , Países Baixos , Noruega , Médicos do Trabalho , Inquéritos e Questionários , Suécia
11.
Med Decis Making ; 36(6): 741-59, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-27053527

RESUMO

BACKGROUND: Self-management-based interventions can lead to improved health outcomes in people with chronic diseases, and multiple patient characteristics are associated with the development of self-management behaviors. Low health literacy (HL) has been implicated in poorer self-management behaviors and increased costs to health services. However, the mechanisms behind this relationship remain unclear. Therefore, the aim of the current review is to assess the association between HL and patient characteristics related to self-management behaviors (i.e., disease-related knowledge, beliefs, and self-efficacy). METHODS: The review comprised 3 phases: 1) database searches, 2) eligibility screening, and 3) study quality assessment and strength of evidence. Inclusion criteria specified that a valid HL screening tool was used, that at least one self-management behavior was assessed, and that patients had a chronic condition. RESULTS: An initial search generated a total of 712 articles, of which 31 studies fulfilled the eligibility criteria. A consistent association was found between low HL and poorer disease-related knowledge in respiratory diseases, diabetes, and multiple disease categories. A significant association between low HL and poorer self-efficacy was reported in cardiovascular diseases, diabetes, human immunodeficiency virus, and multiple disease categories. HL was significantly associated with poorer beliefs in respiratory, musculoskeletal, and cardiovascular diseases. DISCUSSION: The findings from the current review suggest that low HL may affect behaviors necessary for the development of self-management skills. Given that self-management strategies are core components for effective treatment of a range of chronic diseases, low HL poses a considerable health concern. Further research is needed to understand the mediating influence of HL on disease-related knowledge, self-efficacy, and beliefs. From this, HL-sensitive, self-management interventions ought to be devised and implemented.


Assuntos
Doença Crônica/terapia , Gerenciamento Clínico , Alfabetização em Saúde , Autocuidado , Autoeficácia , Humanos
12.
Spine (Phila Pa 1976) ; 41(6): 455-62, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26966970

RESUMO

STUDY DESIGN: A pragmatic cluster randomized controlled trial in primary care. OBJECTIVE: The aim of this study was to estimate the clinical effectiveness and cost-effectiveness of a cognitive-based education program on patients with subacute or chronic low back pain (LBP) in primary care, compared to usual treatment, provided by general practitioners (GP) and physiotherapists (PT). SUMMARY OF BACKGROUND DATA: Patient education has been reported to have a favorable effect on patients with chronic musculoskeletal disorders. In this study, an "Explain Pain" model was adapted to fit into an ordinary clinical setting in Norwegian primary care. METHODS: Sixteen GPs and 20 PTs participated in the study and a total of 216 patients were recruited. The GPs and PTs were randomly assigned to provide either a cognitive patient education or usual treatment. All patients in both groups were provided with four consultations of 30 min with their provider during the study. In the intervention group the patients were educated according to a specific manual written for the purpose of this study. RESULTS: Eighty-one percent responded at 4-week, and 68% at the 12-month follow-up. There was a substantial improvement in function, pain, and sick leave in both groups. After 4 weeks the intervention group scored 0.51 RMDQ points lower than the control group (Beta -0.506 [95% CI -1.76-0.75]). After 12 months the intervention group scored 0.66 RMDQ points higher than the control group (Beta 0.66 [95% CI -0.56-1.88]). There was no significant difference in QALYs in the two treatment groups; the estimated difference was 0.005 (-0.016-0.027) in favor of the intervention. CONCLUSION: This study showed no clinical or health economic benefits as a result of adding a cognitive education program to usual treatment for patients with subacute and chronic LBP. Potential weaknesses such as a long recruiting period and potentially low compliance with the cognitive intervention warrant a careful interpretation of the results.


Assuntos
Análise Custo-Benefício , Dor Lombar/economia , Dor Lombar/terapia , Educação de Pacientes como Assunto/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Adulto , Feminino , Humanos , Dor Lombar/epidemiologia , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto/métodos , Atenção Primária à Saúde/métodos , Licença Médica/estatística & dados numéricos , Adulto Jovem
13.
J Occup Rehabil ; 26(3): 340-9, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-26615412

RESUMO

Purpose The purpose of this study is to test if there is correspondence in stakeholders' assessments of health, work capacity and sickness certification in four workers with comorbid subjective health complaints based on video vignettes. Methods A cross sectional survey among stakeholders (N = 514) in Norway in 2009/2010. Logistic regression and multinomial logistic regression was used to obtain the estimated probability of stakeholders choosing 100 % sick leave, partial sick leave or work and the estimation of odds ratio of stakeholder assessment compared to the other stakeholders for the individual worker. Results The supervisors were less likely to assess poor health and reduced work capacity, and more likely to suggest partial sick leave and full time work compared to the GPs for worker 1. The public was less likely to assess comorbidity and reduced work capacity, and 6 and 12 times more likely to suggest partial sick leave and full time work compared to the GPs for worker 1. Stakeholders generally agreed in their assessments of workers 2 and 3. The public was more likely to assess poor health, comorbidity and reduced work capacity, and the supervisors more likely to assess comorbidity and reduced work capacity, compared to the GPs for worker 4. Compared to the GPs, all other stakeholders were less likely to suggest full time work for this worker. Conclusions Our results seem to suggest that stakeholders have divergent assessments of complaints, health, work capacity, and sickness certification in workers with comorbid subjective health complaints.


Assuntos
Transtornos Psicofisiológicos/diagnóstico , Licença Médica/estatística & dados numéricos , Avaliação da Capacidade de Trabalho , Adulto , Comorbidade , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Noruega/epidemiologia , Transtornos Psicofisiológicos/epidemiologia , Transtornos Psicofisiológicos/fisiopatologia , Transtornos Psicofisiológicos/psicologia , Licença Médica/economia
14.
Scand J Prim Health Care ; 33(1): 40-6, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25602364

RESUMO

OBJECTIVES: To explore general practitioners' (GPs') specific negotiation strategies regarding sick-leave issues with patients suffering from subjective health complaints. DESIGN: Focus-group study. SETTING: Nine focus-group interviews in three cities in different regions of Norway. PARTICIPANTS: 48 GPs (31 men, 17 women; age 32-65), participating in a course dealing with diagnostic practice and assessment of sickness certificates related to patients with subjective health complaints. RESULTS: The GPs identified some specific strategies that they claimed to apply when dealing with the question of sick leave for patients with subjective health complaints. The first step would be to build an alliance with the patient by complying with the wish for sick leave, and at the same time searching for information to acquire the patient's perspective. This position would become the basis for the main goal: motivating the patient for a rapid return to work by pointing out the positive effects of staying at work, making legal and moral arguments, and warning against long-term sick leave. Additional solutions might also be applied, such as involving other stakeholders in this process to provide alternatives to sick leave. CONCLUSIONS AND IMPLICATIONS: GPs seem to have a conscious approach to negotiations of sickness certification, as they report applying specific strategies to limit the duration of sick leave due to subjective health complaints. This give-and-take way of handling sick-leave negotiations has been suggested by others to enhance return to work, and should be further encouraged. However, specific effectiveness of this strategy is yet to be proven, and further investigation into the actual dealings between doctor and patients in these complex encounters is needed.


Assuntos
Clínicos Gerais , Motivação , Negociação , Relações Médico-Paciente , Padrões de Prática Médica , Retorno ao Trabalho , Licença Médica , Adulto , Idoso , Atitude do Pessoal de Saúde , Medicina de Família e Comunidade , Feminino , Grupos Focais , Humanos , Masculino , Pessoa de Meia-Idade , Noruega
15.
J Rehabil Med ; 46(8): 781-7, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25117176

RESUMO

OBJECTIVE: To evaluate the reliability and validity of the improved version of the Patient Generated Index (PGI) in patients with low back pain. METHODS: The PGI was administered to 90 patients attending care in 1 of 6 institutions in Norway and evaluated for reliability and validity. The questionnaire was given out to 61 patients for re-test purposes. RESULTS: The PGI was completed correctly by 80 (88.9%) patients and, of the 61 patients responding to the re-test, 50 (82.0%) completed both surveys correctly. PGI scores were approximately normally distributed, with a median of 40 (range 80), where 100 is the best possible quality of life. There were no floor or ceiling effects. The 5 most frequently listed areas affecting quality of life were pain, sleep, stiffness, socializing and housework. The test-retest intraclass correlation coefficient was 0.73. The smallest detectable changes for individual and group purposes were 32.8 and 4.6, respectively. The correlations between PGI scores and other instrument scores followed a priori hypotheses of low to moderate correlations. DISCUSSION: The PGI has evidence for reliability and validity in Norwegian patients with low back pain at the group level and may be considered for application in intervention studies when a comprehensive evaluation of quality of life is important. However, the smallest detectable change, of approximately 30 points, may be considered too large for individual purposes in clinical applications.


Assuntos
Atividades Cotidianas/psicologia , Dor Lombar/psicologia , Qualidade de Vida , Perfil de Impacto da Doença , Feminino , Humanos , Dor Lombar/fisiopatologia , Masculino , Pessoa de Meia-Idade , Noruega , Reprodutibilidade dos Testes , Inquéritos e Questionários
16.
BMC Fam Pract ; 15: 107, 2014 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-24885524

RESUMO

BACKGROUND: Further research on effective interventions for patients with peristent Medically Unexplained Physical Symptoms (MUPS) in general practice is needed. Prevalence estimates of such patients are conflicting, and other descriptive knowledge is needed for development and evaluation of effective future interventions. In this study, we aimed to estimate the consultation prevalence of patients with persistent MUPS in general practice, including patients' characteristics and symptom pattern, employment status and use of social benefits, and the general practitioners' (GPs) management strategy. METHOD: During a four-week period the participating Norwegian GPs (n=84) registered all consultations with patients who met a strict definition of MUPS (>3 months duration and function loss), using a questionnaire with simple tick-off questions. Analyses were performed with descriptive statistics for all variables and split analysis on gender and age. RESULTS: The GPs registered 526 patients among their total of 17 688 consultations, giving a consultation prevalence of persistent MUPS of 3%. The mean age of patients was 46 years, and 399 (76%) were women. The most frequent group of symptoms was musculoskeletal problems, followed by asthenia/fatigue. There was no significant gender difference in symptom pattern. Almost half of the patients were currently working (45%), significantly more men. The major GP management strategy was supportive counseling. CONCLUSION: A consultation prevalence rate of 3% implies that patients with persistent MUPS are common in general practice. Our study disclosed heterogeneity among the patients such as differences in employment status, which emphasizes the importance of personalized focus rather than unsubstantiated stereotyping of "MUPS patients" as a group.


Assuntos
Medicina Geral , Transtornos Somatoformes/diagnóstico , Transtornos Somatoformes/terapia , Aconselhamento , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Noruega , Relações Médico-Paciente , Inquéritos e Questionários
17.
Scand J Prim Health Care ; 31(4): 227-34, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24164371

RESUMO

OBJECTIVES: The primary objective of this study was to explore whether general practitioners (GPs) in Norway, Sweden, and Denmark make similar or different decisions regarding sick leave for patients with severe subjective health complaints (SHC). The secondary objective was to investigate if patient diagnoses, the reasons attributed for patient complaints, and GP demographics could explain variations in sick leave decisions. DESIGN: A cross-sectional study. METHOD: Video vignettes of GP consultations with nine different patients. SUBJECTS: 126 GPs in Norway, Sweden, and Denmark. SETTING: Primary care in Norway, Sweden, and Denmark. MAIN OUTCOME MEASURE: Sick leave decisions made by GPs. RESULTS: "Psychological" diagnoses in Sweden were related to lower odds ratio (OR) of granting sick leave than in Norway (OR = 0.07; 95% CI = 0.01-0.83) Assessments of patient health, the risk of deterioration, and their ability to work predicted sick leave decisions. Specialists in general medicine grant significantly fewer sick leaves than non-specialists. CONCLUSION: Sick-leave decisions made by GPs in the three countries were relatively similar. However, Swedish GPs were more reluctant to grant sick leave for patients with "psychological" diagnoses. Assessments regarding health-related factors were more important than diagnoses in sick-leave decisions. Specialist training may be of importance for sick-leave decisions.


Assuntos
Clínicos Gerais/psicologia , Padrões de Prática Médica/estatística & dados numéricos , Atenção Primária à Saúde , Licença Médica/estatística & dados numéricos , Avaliação da Capacidade de Trabalho , Adulto , Estudos Transversais , Tomada de Decisões , Dinamarca , Autoavaliação Diagnóstica , Feminino , Clínicos Gerais/estatística & dados numéricos , Humanos , Masculino , Transtornos Mentais/diagnóstico , Pessoa de Meia-Idade , Noruega , Índice de Gravidade de Doença , Suécia
18.
Scand J Prim Health Care ; 31(2): 95-100, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23659708

RESUMO

PURPOSE: Medically unexplained physical symptoms (MUPS) form a major cause of sickness absence. The purpose of this study was to explore factors which may influence further marginalization among patients with MUPS on long-term sickness absence. METHODS: Two focus-group discussions were conducted with a purposive sample of 12 participants, six men and six women, aged 24-59 years. Their average duration of sickness absence was 10.5 months. Participants were invited to share stories about experiences from the process leading to the ongoing sickness absence, with a focus on the causes being medically unexplained. Systematic text condensation was applied for analysis. Inspired by theories of marginalization and coping, the authors searched for knowledge of how patients' positive resources can be mobilized to counteract processes of marginality. RESULTS: Analysis revealed how invisible symptoms and lack of objective findings were perceived as an additional burden to the sickness absence itself. Factors that could counteract further marginalization were a supportive social network, positive coping strategies such as keeping to the daily schedule and physical activity, and positive attention and confidence from professionals. CONCLUSIONS: Confidence from both personal and professional contacts is crucial. GPs have an important and appreciated role in this aspect.


Assuntos
Absenteísmo , Licença Médica , Marginalização Social , Transtornos Somatoformes/psicologia , Atividades Cotidianas/psicologia , Adaptação Psicológica , Adulto , Feminino , Grupos Focais , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Marginalização Social/psicologia , Adulto Jovem
19.
Eur J Gen Pract ; 19(3): 158-61, 2013 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-23514138

RESUMO

BACKGROUND: Guidelines suggest a review of hypnotic prescriptions every four weeks for zopiclone, zolpidem and zaleplon ('Z-drugs'). The lack of face-to-face consultation between the physician and the patient increases the potential of misuse and resultant dependence. OBJECTIVES: To determine the proportion of long-term hypnotic Z-drug prescription issued without face-to-face consultation, and factors associated with such practice. METHOD: Audit based on an extract of data from the French health insurance database in two French departments. Long-term Z-drug prescriptions by general practitioners (GPs) were analysed over a one-year period, regardless of the association of the prescription with a reimbursed consultation. Main factors considered were patient characteristics (gender, age, socioeconomic status, suffering from a chronic disease) and physician characteristics (gender, age, location of the practice, patient list size). RESULTS: Overall, 67 256 long-term Z-drug prescriptions were reviewed. Of these, 23 107 (34.4%) were not associated with a consultation. Only 17% (95%CI: 16-18%) of long-term hypnotic consumers attended a consultation on all the dates noted on the prescription. Z-drug prescriptions were more likely to be prescribed in a consultation if the patient had a chronic illness (P < 0.0001), a low socioeconomic status (P < 0.0001), was less than 45 or over 65 years old (P < 0.0001), or visited a psychiatrist during the same year (P < 0.0001). Having a longer patient list or practising in a rural area were physician characteristics associated with non-adherent Z-drug prescription (P < 0.0001). CONCLUSION: Prescribing Z-drug hypnotics without a face-to-face consultation was frequent, especially in middle-aged patients without co-morbidity who were not seen by a psychiatrist.


Assuntos
Medicina de Família e Comunidade/estatística & dados numéricos , Hipnóticos e Sedativos/administração & dosagem , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/estatística & dados numéricos , Acetamidas/administração & dosagem , Acetamidas/efeitos adversos , Acetamidas/uso terapêutico , Adolescente , Adulto , Idoso , Compostos Azabicíclicos/administração & dosagem , Compostos Azabicíclicos/efeitos adversos , Compostos Azabicíclicos/uso terapêutico , Estudos de Coortes , Bases de Dados Factuais , Medicina de Família e Comunidade/normas , Feminino , França , Fidelidade a Diretrizes , Humanos , Hipnóticos e Sedativos/efeitos adversos , Hipnóticos e Sedativos/uso terapêutico , Masculino , Pessoa de Meia-Idade , Piperazinas/administração & dosagem , Piperazinas/efeitos adversos , Piperazinas/uso terapêutico , Padrões de Prática Médica/normas , Piridinas/administração & dosagem , Piridinas/efeitos adversos , Piridinas/uso terapêutico , Pirimidinas/administração & dosagem , Pirimidinas/efeitos adversos , Pirimidinas/uso terapêutico , Estudos Retrospectivos , Fatores de Tempo , Adulto Jovem , Zolpidem
20.
Tidsskr Nor Laegeforen ; 132(21): 2388-90, 2012 Nov 12.
Artigo em Inglês, Norueguês | MEDLINE | ID: mdl-23160588

RESUMO

BACKGROUND: In 2001, we undertook a survey among general practitioners in Aust-Agder county to describe how patients with spinal problems were examined and treated by GPs. We have now conducted a new survey among the regular GPs in the same county. MATERIAL AND METHOD: All regular GPs in Aust-Agder county received an invitation to participate in the study. The doctors were asked to continuously register over two weeks all patients who visited the doctor and gave spinal problems as their main reason, and to describe all measures that were implemented after the consultation. RESULTS: Of the 87 practising regular GPs, 53% responded. In total, the doctors had received 5,822 patients during the period of study, whereof 3% had reported spinal problems. The examination and treatment provided to these patients were on the whole unchanged since 2001. Only 41% of the doctors reported to cooperate regularly with a physiotherapist, and 11% with a chiropractor, a reduction from 73% and 35% respectively in 2001. The doctors reported co-morbidity in 37% of the patients. Patients were referred for diagnostic imaging with equal frequency as in 2001, although skeletal x-ray and CT had mainly been replaced by MRI. INTERPRETATION: The doctors in this sample treat patients with spinal problems in approximately the same way as the doctors in the 2001 survey, but cooperate less frequently with physiotherapists and chiropractors, and MRI has become the primary alternative when diagnostic imaging is requisitioned.


Assuntos
Dor Lombar , Médicos de Atenção Primária , Padrões de Prática Médica/tendências , Gerenciamento Clínico , Humanos , Relações Interprofissionais , Dor Lombar/diagnóstico , Dor Lombar/terapia , Imagem por Ressonância Magnética/estatística & dados numéricos , Manipulação Quiroprática/estatística & dados numéricos , Noruega , Modalidades de Fisioterapia/estatística & dados numéricos , Atenção Primária à Saúde/tendências , Radiografia/estatística & dados numéricos , Encaminhamento e Consulta/tendências , Inquéritos e Questionários
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