Randomised controlled trial of structured personal care of type 2 diabetes mellitus.

OBJECTIVE: To assess the effect of a multifaceted intervention directed at general practitioners on six year mortality, morbidity, and risk factors of patients with newly diagnosed type 2 diabetes. DESIGN: Pragmatic, open, controlled trial with randomisation of practices to structured personal care or routine care; analysis after 6 years. SETTING: 311 Danish practices with 474 general practitioners (243 in intervention group and 231 in comparison group). PARTICIPANTS: 874 (90.1%) of 970 patients aged >/=40 years who had diabetes diagnosed in 1989-91 and survived until six year follow up. INTERVENTION: Regular follow up and individualised goal setting supported by prompting of doctors, clinical guidelines, feedback, and continuing medical education. MAIN OUTCOME MEASURES: Predefined clinical non-fatal outcomes, overall mortality, risk factors, and weight. RESULTS: Predefined non-fatal outcomes and mortality were the same in both groups. The following risk factor levels were lower for intervention patients than for comparison patients (median values): fasting plasma glucose concentration (7.9 v 8.7 mmol/l, P=0.0007), glycated haemoglobin (8.5% v 9.0%, P<0.0001; reference range 5.4-7.4%), systolic blood pressure (145 v 150 mm Hg, P=0.0004), and cholesterol concentration (6.0 v 6.1 mmol/l, P=0.029, adjusted for baseline concentration). Both groups had lost weight since diagnosis (2.6 v 2.0 kg). Metformin was the only drug used more frequently in the intervention group (24% (110/459) v 15% (61/415)). Intervention doctors arranged more follow up consultations, referred fewer patients to diabetes clinics, and set more optimistic goals. CONCLUSIONS: In primary care, individualised goals with educational and surveillance support may for at least six years bring risk factors of patients with type 2 diabetes to a level that has been shown to reduce diabetic complications but without weight gain.

[Individual registration of children in the national health service. New possibilities for epidemiological research in primary health care]. / Eget sygesikringsbevis til børn. Nye muligheder for epidemiologisk forskning i den primaere sundhedssektor.

Since January 1st 1996 all Danish citizens, children included, have been recorded individually in The National Health Service Register (SSR). Services rendered to children are no longer registered with an adult person. This article describes the implementation of this new arrangement. The part of health services to children recorded under an adult personal identification number is getting asymptotically closer to a minimum of about four percent, which is determined by the average time of naming of children. After the introduction of individual registration of children the SSR has improved considerably as a basis for epidemiological studies in Danish primary care.

The Danish National Health Service Register. A tool for primary health care research.

The purpose of the article is to describe the Danish National Health Service Register and its value in primary health care research, using mainly general practice as an example. The Danish National Health Service Register is a data system available for counties and municipalities to manage the National Health Insurance covering primary health care providers. The counties use the register for administrative purposes, especially for the settling of accounts with providers. The register contains data on all citizens, providers, and health care services reimbursed by the health authorities, but holds no data regarding health status. The accuracy and degree of completeness of persons and variables in the National Health Service Register rests on the fact that most primary health care services in Denmark are reimbursed and, therefore, included in the data base. This tie to the economy of both health care authorities and providers is supposed to confer the final register with a high degree of completeness. It is a clear advantage that almost all citizens in Denmark are assigned to only one general practice, and that the attitude towards research is positive among Danish patients and doctors. The register has so far only been used occasionally for research purposes. To take advantage of the register for research purposes within clinical and health services research, however, one must possess not only a detailed knowledge of the Danish society, including the structure of the Danish health care system, but also an intimate acquaintance with rather complex agreement system and the actual interpretation of this.

Accuracy of 1-, 5- and 10-year body weight recall given in a standard questionnaire.

OBJECTIVE: Estimation of the accuracy of 1, 5 and 10 y body weight recall. DESIGN: Comparison of information on body weight history from a patient questionnaire with measured body weights retrieved in general practitioners' records. SUBJECTS: Among 729 newly diagnosed diabetic patients record information on measured body weight was found for 86, 141 and 122 patients recalling their body weight 1,5 and 10 y ago, respectively. Median age was 63.6 y. Median body mass index was 31.1 kg/m2. RESULTS: No average deviation between 1 y body weight recall and the corresponding measured weights is observed, but 5 and 10 y recall underestimates the measured weights by 1.89 kg and 1.98 kg on an average, respectively. On the individual level the agreement is less satisfactory with increasing variability the further back in time you go. The recall does not vary with age and sex and it is independent of weight status, marital status, smoking habits and self-reported health status in this obese group of individuals. CONCLUSIONS: The findings suggest that data from three standard questions may contribute with useful information on near weight history, independent of age, sex and current body weight.

[Epidemiologic study of persons having group 2 insurance in Denmark. 1. Historical development, social and demographic differences between health insurance groups 1 and 2]. / En epidemiologisk undersøgelse af de gruppe 2 sikrede i Danmark. 1. Den historiske udvikling. Sociale og demografiske forskelle imellem sygesikringsgruppe 1 og 2.

The majority of adults in Denmark can choose between the forms of health insurance 1 and 2. Persons insured in Group 2, on payment of a premium, obtain certain perquisites as compared with Group 1, primarily they may consult general practitioners and specialists of their own choice. Since the introduction of the Health Insurance Law in 1976, the number of persons insured in Group 2 has decreased to 3.8% of those insured in 1988. More than 3/4 of these have been insured in Group 2 since 1976. The number of new group 2 insured persons has remained relatively stable at about 3,000 persons per annum. The average age in Group 2 is 58.3 years as compared with 45.0 years in Group 1. 60% live in the region of the capital. The number of economically and socially well established persons in Group 2 is markedly higher than in Group 1, particularly in the higher age groups where the mortality in Group 2 insured persons is considerably lower than in Group 1 insured persons.

[Epidemiologic study of persons having group 2 insurance in Denmark. 2. Utilization of the health services among persons insured in groups 1 and 2]. / En epidemiologisk undersøgelse af de gruppe 2 sikrede i Danmark. 2. Brug af sundhedsvaesenet blandt personer i sygesikringens gruppe 1 og 2.

Persons insured in Group 2 constitute only approximately 4% of the total number of persons insured. In contrast to the approximately 96% of the population insured in Group 1, persons insured in Group 2 are ensured free choice of general practitioner and practising specialists from time to time on payment of partial payment of the doctor's bill. Group 2 insured persons make less use of assistance from the general practitioner than persons in Group 1. On the other hand, persons in Group 2 make much more use of assistance from practising specialists. Persons in Group 2 thus substitute specialist help for help from the general practitioner. This holds particularly true for the specialties gynaecology and medicine. An age-subdivided analysis of the differences between the utilization of hospital services by the two insurance groups shows that persons insured in Group 2 have lower rates of hospitalization and briefer periods of hospitalization than persons insured in Group 1. A review of the utilization of health services by the two health insurance groups supports the theory that persons in insurance Group 2 are, on the whole, relatively healthy persons with a relatively high demand for the level of service of health treatment.

[Epidemiologic study of persons having group 2 insurance in Denmark. 3. A questionnaire study. Attitudes and knowledge of persons insured in group 2 concerning their insurance]. / En epidemiologisk undersøgelse af de gruppe 2 sikrede i Danmark. 3. En spørgeskemaundersøgelse. De gruppe 2 sikredes viden om og syn på sikringsgruppe 2.

A questionnaire investigation among established persons insured in Group 2 and persons who have recently been transferred from Group 1 to Group 2 or vice versa shows that all three groups find that there are considerable advantages in insurance in Group 2. In particular, the right to free choice of general practitioner is emphasized. Under the present arrangement this is associated with geographic and temporal restrictions. In addition, it is regarded as an advantage to be able to change one's doctor (including specialist) from time to time. Approximately 1/3 emphasize that their way through the health system is easier in Group 2 and that they are treated more kindly. The reason for changing from Group 2 to Group 1 was mainly of economical nature. Where a number of persons were concerned, this was associated with retiral. Information about the health of this group also suggest that deterioration in health may also play a part in their choice. Nevertheless, the advantages of Group 2 insurance were not contested. The results of a series of investigations suggest that new Group 2 insured persons are considerably different from the established members of this group. This group consists mainly of young women. The transfer to insurance Group 2 was motivated mainly by definite dissatisfaction and where a number of these were concerned the change was merely temporary. It is concluded that the Group 2 form of health insurance has assumed new perspectives and forms of employment.