Niels Bentzen

Self-care within a model for demand for medical care

Self-care is interpreted from a health economic point of view. Various approaches are presented. It is stressed that the decision-oriented approach used by other health service researchers is an integral part of the economic approach to the topic as is the idea of a continuum of care, from self-care to professional care. A new approach is taken to the modeling of self-care, in that self-care becomes part of a four-part demand for care model. This makes it possible to model the demand for care for three different groups separately: 1--persons with zero episodes; 2--persons with pure illness episodes and illness episodes with self-care; 3--persons with episodes involving professional care or professional care combined with self-care. Another contribution is due to the so-called episodic approach to the demand for care. The natural counting units are illness and treatment episodes, i.e. instead of counting for instance number of times a general practitioner is consulted we ought to count the number of episodes involving professional care, self-care or both types of care. The episodic approach seems to be well suited for work with self-care. The empirical part is based on a unique Danish panel study using health diaries returned weekly. Data from 27 of the 52 reporting weeks are used, involving more than 14,000 episodes distributed across about 2800 persons belonging to about 1000 households. The use of health diaries seems to be very well suited to the study of self-care in that less salient events and activities than professional care are picked up far better in prospective health diary studies than in retrospective questionnaire based surveys. Descriptive and regression (logistic and ordinary) results are presented.

Medical Audit - The APO-Method in General Practice

(1993). Medical Audit - The APO-Method in General Practice. Scandinavian Journal of Primary Health Care: Vol. 11, No. sup1, pp. 13-18.

Selection and Cross-Cultural Adaptation of Health Outcome Measures

In evaluating health care there is often a need to go beyond simple measures of health like morbidity and mortality, and look at changes in patients’ quantity as well as quality of life. An ever-growing number of instruments are available. The article focuses on issues related to the selection of instruments for the assessment of health status and health outcome. The aim is to provide the reader with a series of questions to be considered in choosing and using an instrument or adapting one for use in a particular culture. The theoretical concept of health and its relevant components must be assessed. The researcher must furthermore assess the purpose of measuring health, conceptual underpinning of the chosen health measure, from whose perspective the assessment should be made, target population, setting in which the instrument is to be administered, and type of instrument (e.g. a generic versus an illness-specific instrument) and its psychometric properties as well as practical requirements in administeri...

Current health as a general health indicator. II: Evaluation of reliability and validity.

OBJECTIVE To examine whether a Current Health scale produces reliable and valid measures of self perceived health status. DESIGN Examination of reliability, based on internal consistency (Cronbachs alpha coefficient). Examination of validity focusing on convergent and discriminant validity. SUBJECTS 2263 male and female heads of households who participated in The Danish Health Study 1982-83. The survey used items pertaining to health status from Rands Health Insurance Study. RESULTS The scale has acceptable properties and is preferable to a single item measure of general health status. It can be used in general practice.

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.