Sven-Olof Andersson

Satisfaction is not all – patients' perceptions of outcome of general practice consultations, a qualitative study

BackgroundEvaluation of outcome in general practice can be seen from different viewpoints. In this study we focus on the concepts patients use to describe the outcome of a consultation with a GP.MethodPatients were interviewed within a week after a consultation with a GP. The interviews were made with 20 patients in 5 focus groups and 8 individually. They were analysed with a phenomenographic research approach.ResultsFrom the patients perspective, the outcome of a consultation is about cure or symptom relief, understanding, confirmation, reassurance, change in self-perception and satisfaction.ConclusionGeneral practice consultations are often more important for patients than generally supposed. Understanding is the most basic concept.

Effects of consulting psychiatrist in primary care. 1-year follow-up of diagnosing and treating anxiety and depression.

OBJECTIVE Epidemiological screening of anxiety and depressive disorders in primary care and evaluation of how these patients are identified and treated. Follow-up after 1 year of psychiatric consultation/liaison (C/L) and educational activities. SUBJECTS AND DESIGN In the baseline study 374 unselected and consecutive patients, and in the follow-up study 254 patients (response rate 94.5% and 90.3%, respectively) answered the screening instrument HAD scale (Hospital Anxiety and Depression scale). The HAD results were compared to clinical diagnosis and treatment according to the medical records. Differences after 1 year were analysed. RESULTS At follow-up the prevalence of anxiety had increased from 11.8% to 16.5% (p < 0.05), and of depression from 3.7% to 4.7% (NS) according to HAD. Also, at the follow-up more cases of anxiety disorders were clinically diagnosed--13% vs 8%--as well as an increased number of cases of depressive disorders--7.9% vs 4.0%. The agreement between HAD diagnosis and clinical judgement had increased significantly (p < 0.001) for anxiety disorders from 37% to 70%, and for depression from 20% to 45%. Treatment prevalence had also improved (p < 0.001) at the follow-up for anxiety disorders from 33% to 55% and for depression from 47% to 80%. In total, 4.0% of the baseline and 11.4% of the follow-up population were treated for anxiety and/or depression. CONCLUSIONS Anxiety and depressive disorders are prevalent in primary care. However, only a minority of these patients are identified and treated. Psychiatric consultant support seems to be effective in improving GPs diagnostic and therapeutic skills thus enabling these widespread disorders to be identified at an early stage and properly treated.

Patients frequently consulting general practitioners at a primary health care centre in Sweden — A comparative study

The purpose of this study was to describe the sociodemographic patterns, consultations and the nature of problems of frequent attenders (FAs) at general practitioners at a primary health care centre. The design was a comparative study of FAs (≥5 consultations during 1991) (n = 179) and a contrast group of patients (CPs) matched by age and sex (1-4 consultations during 1991, n = 179). Data from medical records, appointment system, mortality and marital status were recorded. FAs comprised 1.7% of the inhabitants. Boys, middle-aged females, retired males and females and especially very old females were more frequent among FAs than their sections of the population would imply. FAs accounted for 15% and CPs for 4% of the consultations, 6.3 and 1.7 consultations on average, respectively. The average booked time for consultations during 1991 was 140 minutes for FAs and 35 minutes for CPs. Continuity was higher among older than younger FAs. Contacts other than medical consultations comprised a substantial part of the work with FAs, especially among middle-aged and elderly FAs. Problems arising from the musculoskeletal system, psychological and social problems were most common among FAs, often in combination, while chronic diseases such as cardiovascular diseases and diabetes were not crucial for frequent attending. Few FAs consulted as frequently in the preceding years and the following year, as in 1991, but still they accounted for more consultations than CPs during these years. More female FAs than males and CPs were divorced. The study indicates that FAs require a long-term strategy where continuity and accessibility are often important. They might also have profited by more time. However, FAs were a heterogeneous group of patients and follow-up studies and individual studies of FAs would be of interest.

Concepts underlying outcome measures in studies of consultations in general practice

Objective. To give an overview of the concepts used to describe and evaluate the outcome of general practice consultations. Method. A literature study was undertaken. Among 101 articles relevant to the subject 35 were chosen to illustrate the concepts found. Result. The following concepts were found: disease control, patient compliance, efficacy, symptom relief, enablement, general health, and patient satisfaction. The first three concepts encourage objective measurement while the following four concern the patients subjective assessment. Methods naturally linked to the respective concepts are briefly described. Discussion. The concepts reflect very diverse aspects of general practice. Some of the concepts come from other domains of research, while others have been developed within general practice. Disease is not exclusively in focus. The experience, competence, and life situation of the patient are as well dealt with as they should be in accordance with a patient-centred profession. However, the concepts spring from the researchers’ ideas about what is important to patients. The patients’ priorities were not sought.

Is frequent attendance a persistent characteristic of a patient? Repeat studies of attendance pattern at the family practitioner

Objective – To assess the extent of frequent attendance as a persistent characteristic of patients by repeat studies of attendance at a health centre. Design – A follow-up of frequent attenders and compared patients from 1991 among frequent attenders in 1996. Setting – Mariehem health centre in Umeå in northern Sweden providing care for 10 500 and 12 000 inhabitants in 1991 and 1996, respectively. Subjects – Frequent attenders, defined as patients who had at least 5 consultations with physicians during 1 year at the health centre, compared to attenders who had between 1 and 4 consultations in 1991 and 1996. Results – The proportion of people who lived in the area and consulted a doctor at the health centre at least once during 1 year increased from 40.0% in 1991 to 45.2% in 1996. The number of frequent attenders increased from 179 to 303 and they took 15% and 20% of all consultations in 1991 and 1996, respectively. Twenty-five patients (21 females and 4 males) were identified as frequent attenders in both years. Conclusion – With the exception of a small group of patients, mostly females, frequent attendance seems not to be a persistent characteristic of patients.

Waiting Room Time in the Assessment of an Appointment System in Primary Care

Excessive time spent waiting in health care facilities is a nuisance to patients as well as to physicians who then have to see these dissatisfied patients. Most efforts to enhance surgery efficiency have been to optimize physician working hours and patient waiting time has been a minor concern, in particular in countries with a shortage of physicians. At the Vännäs Primary Health Care Centre in northern Sweden, efforts were made to reduce waiting time by making changes in office routines and by introducing a new appointment system. All visits to physicians during two four-week periods (March 1977 and March 1979) were analyzed, with the changes being introduced in the interim. The total time spent waiting by patients, and the patient waiting time in relation to the time scheduled were reduced. A slight increase in physician idle time was also noted. The measures taken to reduce waiting time were effective and contributed to the fulfillment of a postulated aim.

Initiating Change in Primary Care, The Vännäs Project. Its realization and evaluation

It is expected that the development of primary care shall add qualities such as accessibility, continuity and cooperation to the health care system. In Sweden the health care system is mainly based on hospital care, but projects organized outside hospital settings have been tested, the Primary Health Care Center of Vännäs being one of many. This article reports on the aims of the Vännäs Project and the means used to accomplish postulated goals. In a study conducted between 1976 and 1980, we analyzed the interaction of the aims, means and evaluation of the project. The need for a functioning interplay among the three components was emphasized in order to promote sound planning and knowledgeable decisions. A model for development work in primary care is proposed to give stability and structure to thoughts and ideas when changes are being considered. To further primary care, it is necessary to proceed with a clear structure in order to prevent chance and fashion from running the development.