Ivar Aaraas

Continuity of GP care is related to reduced specialist healthcare use: a cross-sectional survey.

BACKGROUND Continuity of GP care is associated with reduced hospitalisations, but solid documentation of its relationship to use of outpatient specialist services is lacking. AIM To test the association between continuity of GP care and use of inpatient and outpatient specialist services. DESIGN AND SETTING A cross-sectional population-based study with questionnaire data from the sixth Tromsø Study (2007-2008). METHOD Descriptive statistics and two sample t-test were used to estimate specialist healthcare use according to duration of the GP-patient relationship. Logistic regression analysis was used to assess associations between duration and intensity of the GP-patient relationship and use of specialist care. Analyses were adjusted for sex, age, marital status, income, education, and self-rated health, and also stratified by self-rated health and age. RESULTS Of 10,624 eligible GP users, 85% had seen the same GP for >2 years. The probability of visiting outpatient specialist services was significantly lower among these participants compared to those with a shorter GP relationship (odds ratio [OR] = 0.81, 95% confidence interval [95% CI] = 0.71 to 0.92). Similar findings were found for hospitalisations (OR = 0.76, 95% CI = 0.64 to 0.90). Stratified analyses revealed that these associations were not dependent on self-rated health or age. The probability of specialist use increased for the frequent GP users. CONCLUSION Continuity of GP care is associated with reduced use of outpatient specialist services and hospitalisations. Healthcare providers and policymakers who wish to limit use of specialist health care may do well to perform and organise health services in ways that support continuity in general practice.

What professional activities do general practitioners find most meaningful? Cross sectional survey of Norwegian general practitioners.

BackgroundHealth reforms in many countries affect the scope and nature of primary care. General Practitioners (GPs) are expected to spend more time developing public health, preventive health care, coordination of care and teamwork. We aimed to explore which professional activities GPs consider to be meaningful and how they would like to prioritise tasks.MethodsIn a cross sectional online survey 3,270 GPs were invited to consider twenty different activities in general practice. They were asked to rate each of them on a Likert scale anchored from 1 (not meaningful) to 5 (very meaningful). They then selected three activities from the item list on which they would like to spend more time and three activities on which they would like to spend less time. We used multinomial logistic regression to explore associations between the GPs’ preferences for time spent on preventive health care activities and age, gender and practice characteristics.ResultsApproximately 40% (n=1,308) responded. The most meaningful activities were handling common symptoms and complaints (94% scored 4 or 5), chronic somatic diseases (93%), terminal care (80%), chronic psychiatric diseases (77%), risk conditions (76%) and on call emergency services (70%). In terms of priority the same items prevailed except that GPs would like to spend less time on emergency services. Items with low priority were health certificates, practice administration, meetings with local health authorities, medically unexplained symptoms, addiction medicine, follow up of people certified unfit for work, psychosocial problems, preventive health clinics for children and school health services. In multivariate regression models physician and practice characteristics explained no more than 10% of the variability in the GPs’ preferences for time spent on preventive health care services.ConclusionsThe GPs found diagnosis and treatment of diseases most meaningful. Their priorities were partly at odds with those of the health authorities and policy makers.

“Caring for people where they are”: Addressing the double challenge of general practice at the 17th Nordic Congress of General Practice in Tromsø 2011

At the first Nordic Congress of General Practice in Copenhagen in 1979 Christian Borchgrevink, the first professor of general practice in Norway, stated in his key note lecture: Research is important for recruitment and status of our specialist discipline. Through research we raise our critical sense. I believe that general practitioners who organise their curiosity through little or more research will be better doctors in many respects. We think the subsequent 15 congresses, arranged in the five Nordic countries and again in Copenhagen in 2009 [1], have been a manifestation of Borchgrevinks words. When we issue invitations to the 17th Nordic congress in Tromso in June 2011 – for the first time north of the Arctic Circle – we feel proud to belong to this tradition and to be responsible for bringing it a further step towards the future. Our vision for the congress, caring for people where they are, is inspired by life and nature in the northern and rural areas. It refers to the double challenge for all doctors in general practice: to care for people both where they are living, and where they are in their lives.

Supply of doctors to a rural region: Occupations of Tromsø medical graduates 1979–2012

Abstract Background: The aim of establishing the medical school in Tromsø in 1973 was to improve access to doctors and standards of health care for the previously underprivileged rural population of Northern Norway. In this study we examine how the aim of supplying doctors to the north has been achieved. Material and methods: By utilising a cross-sectional design we have analysed 34 classes of Tromsø medical graduates (1979–2012) with regard to occupations in 2013 by the year of graduation and by successive pools of cohorts. Results: In 2013 altogether 822 of 1611 doctors (51%) were working in Northern Norway. The proportions working in the north for old, intermediate and young cohorts were 37%, 48% and 60%, respectively. Doctors graduating during recent years tended to start their careers in the north to a higher degree than doctors graduating in previous periods. Among doctors from the older classes a relatively large minority have their end-careers in Northern Norway, with a noticeable inclination for long term work in primary care. Conclusion: Our results support that the first rural oriented medical education model in Europe established in Tromsø 40 years ago is sustainable, achieving its aims.

Nytt og nyttig for veiledere

Denne boken er en «klassiker» blant norske bøker om helseog sosialfaglig veiledning. Første utgave kom i 1979. Forfatterens begrunnelse for enda en ny revidert utgave, den femte i rekken, er en stadig økning av relevant forskningsbasert kunnskap om omsorgssvikt, traumer, stress og sykdomsskapende utviklingstrekk i vårt moderne samfunn. Avstanden mellom praksis og den kunnskap som er tilgjengelig, er lang og økende. Alle utdanninger som har helsefremmende, relasjonsbasert arbeid som et primært siktemål, trenger stadig fornyelse og oppdatert kunnskap for å møte personer og familier som søker hjelp, på en faglig etisk forsvarlig måte. For å lykkes med dette er det en økende erkjennelse av behovet for veiledet praksis i utdanningen av alt helseog sosialpersonell, inkludert leger og pedagoger.

Utdanner Universitetet i Tromsø – Norges arktiske universitet leger til å arbeide i distrikter?

BACKGROUND When Storting (the Norwegian Parliament) resolved in 1968 to build the University of Tromsø, the purpose of the study model was to promote recruitment and a stable GP density throughout North Norway. We wanted to shed light on the degree to which GPs and doctors in health trusts who were graduates of the University of Tromsø work in rural and central municipalities, and at university hospitals and other hospitals respectively. MATERIAL AND METHOD We used de-identified data covering 406 GPs and 909 doctors in health trusts who had graduated from the University of Tromsø in the period 1979 – 2012. RESULTS A larger share of GPs educated at the University of Tromsø (30 %) worked in rural municipalities compared with all GPs in Norway (19 %). GPs educated at the University of Tromsø staffed 57 % of the positions in central municipalities and 34 % of the positions in rural municipalities in North Norway. A larger share of doctors in health trusts (64 %) educated at the University of Tromsø worked at a university hospital compared with all doctors in health trusts in Norway (56 % worked at a university hospital). Over half (53 %) of the doctors at the University Hospital of North Norway were graduates of the University of Tromsø. In Nordland and Finnmark, the corresponding percentage at health trusts varied between 14 and 28 %. INTERPRETATION Our data suggest that medical studies at the University of Tromsø make a considerable contribution to GP density in rural communities and to solid recruitment to the University Hospital of North Norway.

Nurses and social care workers in emergency teams in Norway

BACKGROUND The Norwegian counties Troms and Finnmark are dominated by large areas with widespread habitation and rather long response times for ambulances and doctors. We wished to investigate the extent to which the municipal preparedness in these counties use employees from the municipal nursing and social care services and if these are part of local emergency teams. MATERIAL AND METHODS In the autumn of 2008, we sent a questionnaire to the district medical officers and the leaders for municipal nursing and social care services in all 44 municipalities in Troms and Finnmark. The answers were analyzed manually. RESULTS 41 municipalities responded. In 34 of these the municipal nurses and social care workers practice emergency medicine procedures. The content in these training sessions is much more comprehensive than that in a typical first aid course. In three of four municipalities ambulance personnel do not participate in this training. In 31 municipalities the inhabitants contact nurses and social care workers directly if they are acutely ill. In only 10 of the municipalities the nurses and social care workers are organized in local teams including a doctor and an ambulance. INTERPRETATION In the districts, nursing and social care services are a resource in an emergency medicine context. The potential within these professions can be exploited better and be an important supplement in emergencies. In emergencies, cooperation across disciplines requires a clear organizational and economical structure, local basis and leadership.

The cheerful buzzing of Nordic voices

After years of preparation, we were excited to welcome our colleagues to the 17th Nordic Congress of General Practice in Tromso 14–17 June 2011. 371 Danes, 297 Norwegians, 245 Swedes, 59 Finns, 9 Icelanders and 51 participants from other countries, altogether 1033 persons, were awaited. As Tromso has no big venue, the congress had to be shared between two neighbouring hotels, quayside in the city centre. In the sunny spring weather, this location felt perfect. The summing and humming of many tongues, mingling and networking out in the open, accompanied by seagulls, was for us the signature tune of the congress. This engaged participation started many months earlier with early registrations and a large number of submitted abstracts. To our knowledge, the whole scientific programme took place as planned. Choosing between the many interesting parallel sessions was not easy. In many of the contributions we could recognize a reference to our vision for the congress: ‘Caring for people where they are’. We also had an idea of a relation between the scientific and the cultural programme, which materialized beyond our expectations. The opening with songs of Mari Boine and the premiere of a film about professor Anders Forsdahl connected the audience to the people living in the High North, but also had a universal appeal. Which were the highlights of the congress? More than half of the participants responded to our QuestBack evaluation. The highest scores were given to the congress surroundings, the opening ceremony, and the overall opinion of the congress. The plenary speakers were also highly ranked. Our interpretation is that the blending of it all was successful: The place, the people, the programme and what happened in-between. We hope that the congress in this meaning was an inspiration for our daily work as doctors, researchers and leaders. The high attendance from young participants at this congress felt like a promise that ‘The Diamonds of General Practice’ will shine on. This congress followed up on themes from Copenhagen 2009, like the relation between human biology and human biography. We also drew on their idea of long coffee breaks to allow discussions to continue informally. Tampere has to find their own way, but we learned some lessons. Both oral presentations and posters were well visited. They are important meeting places for the young, and should have been given more space in the programme and better locations. We took some risks by organizing a large conference in a city without optimal facilities. On a rainy day, the premises would have been cramped. Transmitting plenary sessions between two conference halls was done for the first and probably last time. And we dared to take urban people out for the most rustic and chaotic conference dinner ever. Anyway, the music was swinging and midnight sun shining; thanks for trusting us and see you all for tango in Tampere 2013!

Examination of final-year medical students in general practice.

With general practice recognized as one of three major subjects in the Tromsø medical school curriculum, a matching examination counterpart was needed. The aim was to develop and implement an examination in an authentic general practice setting for final-year medical students. In a general practice surgery, observed by two examiners and one fellow student, the student performs a consultation with a consenting patient who would otherwise have consulted his/her general practitioner (GP). An oral examination follows. It deals with the consultation process, the observed communication between “doctor” and patient, and with clinical problem-solving, taking todays patient as a starting point. The session is closed by discussion of a public-health-related question. Since 2004 the model has been evaluated through questionnaires to students, examiners, and patients, and through a series of review meetings among examiners and students. Examination in general practice using unselected, consenting patients mimics real life to a high degree. It constitutes one important element in a comprehensive assessment process. This is considered to be an acceptable and appropriate way of testing the students before graduation.