[Physicians' assessments of work capacity in patients with SHC: comparison between five European countries]. / Beoordeling van arbeidsongeschiktheid bij SOLK.

OBJECTIVE: Comparing assessments of incapacity to work in patients with subjective health complaints (SHC) by physicians from 5 different European countries. DESIGN: Cross-sectional study. METHOD: General practitioners from Norway (n=56), Sweden (n=29), Denmark (n=41), France (n=46) and occupational and insurance physicians from the Netherlands (n=93) watched and assessed incapacity to work in nine video vignettes of patients with SHC. We subsequently analysed differences between assessments (whether or not there was incapacity to work) by country, with Norway as a reference, as well as differences between general practitioners from the four countries and occupational and insurance physicians using a generalised linear mixed model. RESULTS: Assessments of incapacity to work by physicians from the 5 countries were generally very similar. However, compared to Norwegian general practitioners, Swedish general practitioners (odds ratio (OR) of 0.43 with 95% confidence interval (CI) of 0.23-0.79) and Dutch occupational and insurance physicians (OR of 0.55 with 95% CI of 0.36-0.86) concluded less often that the patients in the videos were unable to work. There were no differences between general practitioners from the other 2 European countries and those from Norway. The Dutch occupational and insurance physicians also concluded less often that there was an incapacity to work compared to all general practitioners from the other 4 European countries (OR of 0.67 with 95% CI of 0.49-0.93). CONCLUSION: There are significant differences between assessments of incapacity to work in patients with SHC between countries and professional groups, but these differences are generally small. Potential explanations for these differences could be found in occupational and insurance medicine specialist training and in the existence of professional guidelines.

Evaluation of individualized quality of life and illness perceptions in low back pain. A patient education cluster randomized controlled trial.

OBJECTIVE: To evaluate the effect of a cognitive patient education intervention compared with usual care on secondary outcomes of individual quality of life and psychological outcomes of illness perceptions and pain catastrophizing in patients with low back pain. METHODS: A pragmatic cluster randomized controlled trial in which 16 general practitioners (GPs) and 20 physiotherapists (PTs) in primary care were randomly assigned to provide either a cognitive patient education intervention or usual treatment. Patients were followed up at 4 weeks and 12 months after treatment. Linear mixed models were used with group, time, type of clinician and interaction effects of group*time as fixed effects. RESULTS: A total of 203 patients provided data at baseline, 86% responded at 4 weeks and 74% at 12 months. For all the outcome measures there was a statistically significant effect of time (p<0.001) and type of clinician (p<0.05) during the follow-up year. There was a significant interaction effect of group×time on illness perceptions (p=0.003), however not for the other outcome measures. CONCLUSION: The cognitive patient education intervention initiated a faster improvement in illness perceptions but not in the other outcomes. PRACTICE IMPLICATIONS: A patient education intervention can be beneficial to improve illness perceptions, however more research is needed.

[Emergency service in Arendal--a new model of intermunicipal emergency service]. / Legevakten i Arendal--en ny modell for interkommunal legevakt.

BACKGROUND: Over the past years there has been increasing debate over the organisation of off-hour primary care emergency services. In March 2000 we established an emergency room serving 80% of the total population of a Norwegian county, Aust-Agder. The most important change introduced was a reduction in house calls. Patients from smaller municipalities now have to come in to the emergency room; previously many consultations were made in the patients' own homes. This organisational model has now been evaluated to see if it made patients less satisfied and whether it was less expensive to run. MATERIAL AND METHODS: 100 patients were interviewed by questionnaire in order to see if there were changes in their satisfaction with the emergency services provided. Costs were studied by collecting data from the social security service and from the participating municipalities before (1999) and after (2000) the reorganisation. RESULTS: The overall impression is that patients have not expressed any dissatisfaction with the new organisational model and that it has cut expenses. We found that the social security service had cost savings of 31% for doctors on call, while the municipalities had an increase in expenditure of 17%. INTERPRETATION: It is possible to establish larger off-hour primary care emergency services without greater inconvenience to the patients. The new model is beneficial for doctors and saves costs for society, though the social security service's savings are somewhat offset by increased expenses on the part of the municipalities.

[General practitioners in hospital]. / Allmennpraktikere i sykehus.

Different models of hospital-primary care collaboration are tried out throughout Norway. It is necessary to look into whether these programmes lead to behavioral changes and, in turn, whether this benefits the patients. In 1995, a general practitioner in Arendal, Norway, initiated a local hospital visiting programme for all general practitioners in the county. The general practitioners were invited to visit one of the departments of the local hospital two weeks every year over a five-year period and thus to get to know all the departments. The aim was to give general practitioners more knowledge of the hospital departments and their doctors, while at the same time giving hospital doctors the opportunity to meet the general practitioners in their catchment area, thus enhancing the collaboration between hospital and primary care through personal contact. One beneficial effect might be quicker access to specialist consultations, as more controls after hospital treatment could be transferred to primary care. This evaluation is based on a survey among hospital departments (12 out of 16 responding) and general practitioners (60 out of 95 responding) who were invited to participate. All respondents wanted the programme to continue. Both hospital doctors and general practitioners were very satisfied with the programme and believed that it would lead to better collaboration between these two levels of our health care system.