ABSTRACT
Background: National guidelines are important instruments in reducing inappropriate antibiotic prescriptions. Low adherence to guidelines is an acknowledged problem that needs to be addressed.Method: We evaluated established characteristics for guidelines in the guidelines for lower respiratory tract infection, acute otitis media and pharyngotonsillitis in primary care. We studied how doctors used these guidelines by analysing interviews with 29 general practitioners (GPs) in Sweden.Results: We found important between-guidelines differences, which we believe affects adherence. The GPs reported persistent preconceptions about diagnosis and treatment, which we believe reduces their adherence to the guidelines.Conclusion: To increase adherence, it is important to consider doctors' preconceptions when creating new guidelines.
Subject(s)
Anti-Bacterial Agents/therapeutic use , General Practitioners/psychology , Health Knowledge, Attitudes, Practice , Practice Guidelines as Topic , Respiratory Tract Infections/drug therapy , Adult , Female , Guideline Adherence , Humans , Inappropriate Prescribing/psychology , Male , Middle Aged , Qualitative Research , Respiratory Tract Infections/diagnosis , SwedenABSTRACT
BACKGROUND: To be diagnosed with type 2 diabetes is a challenge for every patient. There are previous studies on patients' experience in general but not addressing the increased cardiovascular risk and multifactorial treatment. The aim of this study was to explore the thoughts, experiences and reactions of newly diagnosed patients with diabetes to this diagnosis and to the risk of developing complications. METHODS: Ten adults (7 men/3 women, aged 50-79) diagnosed with type 2 diabetes within the last 12 months were interviewed at a primary health care center in Sweden. An interview guide was used in the semi-structured interviews that were transcribed verbatim. The analysis was qualitative and inspired by systematic text condensation (Malterud). The text was read several times and meaning units were identified. Related meaning units were sorted into codes and related codes into categories during several meetings between the authors. Finally, the categories were merged and formed themes. RESULTS: We defined three main themes: Reaction to diagnosis, Life changes and Concerns about the future. Most patients reacted to the diagnosis without intensive feelings. Lifestyle changes were mainly accepted but hard to achieve. The patients' major concerns for the future were the consequences for daily life (being able to drive and read) and concerns for relatives rather than anxieties regarding medical issues such as laboratory tests. There were considerable differences in how much patients wanted to know about their future risks. CONCLUSIONS: The results of this study might help to focus doctor-patient communication on issues highlighted by the patients and on the importance of individualizing information and recommendations for each patient.
Subject(s)
Communication , Decision Making , Diabetes Mellitus, Type 2/prevention & control , Health Knowledge, Attitudes, Practice , Healthy Lifestyle , Hypoglycemic Agents/therapeutic use , Aged , Caregivers/psychology , Diabetes Mellitus, Type 2/diagnosis , Diabetes Mellitus, Type 2/psychology , Diet/psychology , Exercise/psychology , Female , Follow-Up Studies , Health Promotion , Humans , Male , Middle Aged , Primary Health Care , Professional-Patient Relations , Prognosis , Qualitative ResearchABSTRACT
A successful model of liaison between the primary and secondary (hospital) levels of health care entails improved co-operation between hospital doctors and general practitioners (GPs). Since its introduction in Denmark in 1991, this approach has been adopted in Sweden and, to a lesser extent, in Norway. Important principles of the model include: 1) both at the primary and secondary level, responsibility for cooperation rests with the physicians themselves; 2) all physicians at both levels are involved; 3) liaison is maintained by selected GPs serving as liaison officers acting in concert under the guidance of a coordinator; 4) liaison officers are responsible for cultivating personal contacts and good relations at hospitals, and promoting interest in and commitment to the system. Evaluation of the model requires both quantitative and qualitative studies. Although few evaluations have been completed, and no definite conclusions can be drawn, the preliminary results of current evaluations in progress in Sweden and Norway are promising, as are the reported experiences of those who use the system. A Nordic ad hoc group has been actively engaged in promoting the quality of primary-secondary health care liaison since 1997.
