[General practioners and patients' general life problems]. / Korleis møter allmennlegane pasientanes livsproblem?

BACKGROUND: Many contact general practitioners (GPs) about non-medical problems in their lives; a situation which may be frustrating for GPs. MATERIAL AND METHODS: Semi-structured in-depth interviews with six Norwegian GPs by e-mail. The interviews were analysed according to a discourse analysis of which role the GPs considered they had, whether they saw themselves as therapists and how they perceived the personal strain related to working in general medicine. RESULTS: The majority of GPs did not distinguish clearly between somatic and more general life-related problems. Nevertheless, they defined medical problems as quite strictly somatic and saw themselves mainly as experts in somatic medicine. They described themselves more as spiritual advisers (pastor-like) than as psychotherapists. Some meant that their work had given them more self- confidence and made them more tolerant, but many said they felt helpless in their role as doctors. INTERPRETATION: GPs are doctors for all people. They have to relate to healthy and sick individuals with various medical and general life problems, and often experience a discrepancy between their medical competence and the challenges they meet.

[Treatment of opiate-dependent patients in a general practice]. / Opioidbehandling av rusmiddelavhengige i en allmennpraksis.

BACKGROUND: A method for receival and follow-up of opioid-dependent patients in a general practice is described, and the results of an observational study of 146 such patients presented. MATERIAL AND METHODS: Opioid-dependent patients, who injected illegal opioids and had been treated with opioids by the first author from 01.08.97 to 01.08.06, were included in the study. Their medical records were examined; and mortality rates, treatment status and income status as of 01.08.06 recorded. The patients were also interviewed by telephone. RESULTS AND INTERPRETATION: Mortality rates were low during opioid treatment; both when the regular general practitioner (RGP) was the only treatment provider (0.5% annual mortality) and when the patient in addition participated in a methadone support program (1.3%). No deaths by overdose were registered during RGP-supervised opioid prescription. Without opioid treatment, mortality was 5.1%. 97 % of the patients were followed up in some way at the time of observation. Opioid treatment had been prescribed by a RGP for more than one period to more than half the patients after specialist treatment had failed. Urine tests show a relatively low fraction of illegal opioid use (18% positive tests) during opioid treatment by a RGP. Patients became more financially independent, i.e. a smaller fraction of their income came from social security during the treatment period, indicating that the care given to these patients may have positive effects over time. In conclusion, RGPs may have an important role both in receival and follow-up of this patient group. This study has shown that stabilising patients with opioids prescribed by an interested and engaged RGP may have contributed positively to the treatment and rehabilitation of the patients and did not lead to dangerous situations.

The GPs' Experiences Questionnaire (GPEQ): reliability and validity following a national survey to assess GPs' views of district psychiatric services.

BACKGROUND: The measurement of patient and professional views of quality are important components in the evaluation of health care delivery. OBJECTIVE: To describe the development and evaluation of the GPs' Experiences Questionnaire (GPEQ) for assessing the quality of community mental health clinics in Norway. DESIGN: Literature review, GP interviews, pre-testing of questionnaire items and a cross-sectional national survey. SETTING: Postal survey of GPs in Norway evaluating 73 community mental health clinics in the five health regions in Norway during spring of 2006. SUBJECTS: Three thousand four hundred and sixty-three GPs were sent a postal questionnaire with the GPEQ and were asked to assess their community mental health clinic responsible for general adult psychiatric services. RESULTS: Two thousand one hundred and thirty (61.5%) GPs returned a completed questionnaire. Low levels of missing data suggest that the questionnaire is acceptable. Factor analysis identified five scales: workforce situation (four items), discharge letter (three items), competence (four items), guidance (three items) and emergency situations (two items). All scales met the criterion of 0.7 for Cronbach's alpha and test-retest correlations were 0.72-0.87. The results of validity testing were as hypothesized with scale scores significantly related to knowledge of the community mental health clinic, overall satisfaction, negative experiences with the clinic, waiting time and acceptance of referrals. CONCLUSIONS: The GPEQ is a self-administered questionnaire that includes the most important aspects of the GPs' experience of quality at community mental health clinics. All scales have good evidence for internal consistency, test-retest reliability and validity.