Perspectives on lifestyle intervention: the views of general practitioners who have taken part in a health promotion study.

AIM: A study was carried out to discover the views of Danish general practitioners on the possibility of intervening in their patients' lifestyles in general and on the obstacles to doing so, based on their experience of participating in a health promotion study. METHOD: A focus group interview was conducted with five general practitioners who had participated in "The Ebeltoft Health Promotion Study" to assess their views on their preventive role. RESULTS: The general practitioners have internalized the view advanced by society and the medical profession that they have an important role to play in preventing lifestyle-related illness. However, they are sceptical about the effectiveness of intervention and have ethical concerns about giving lifestyle advice. They are also somewhat irritated by the fact that patients are chiefly interested in having their health checked, rather than in following up by changing their behaviour. The general practitioners differ in their views as to when, and how actively, they should initiate discussions with individual patients to encourage them to change their lifestyles. CONCLUSIONS: If the medical profession and those responsible for overall health policy wish to make general practitioners change their behaviour towards their patients, it is important that they understand the aims, values, and working conditions of general practitioners that underlie their present attitudes and behaviour.

[Outpatient treatment. What is the evidence?]. / Ambulant behandling. Hvad er der evidens for?

In relation to the development of quality standards for the national quality development study, DGMA, a search was made through the literature on outpatient care. The literature was scanty, but some evidence was found on the following: Continuity of care is a patient demand, and several studies show more effective and less expensive treatment when this is ensured. Two studies show impaired quality of treatment, but quality is not defined either precisely or uniformly. Waiting times dissatisfy patients and perhaps diminish the result of treatment and information. Failure to turn up for appointments affects up to 29 per cent of consultations. Non-attendances could be cut down if patient factors and continuity of care are taken into account. Some outpatient consultations could take place in the general practitioner's surgery, if hospital doctors knew more about their capabilities.

[Accreditation of hospitals. A review of international experiences]. / Akkreditering af hospitaler. En gennemgang af internationale erfaringer.

Internationally, there is solid experience on accreditation. Accreditation in the present paper is described in the form that is used in the three biggest and oldest organisations, The Joint Commission on Accreditation of Healthcare Organization (JCAHO), The Canadian Council on Health Services Accreditation (CCHSA), and The Australian Council on Healthcare (ACHS). Common elements in the organisations are standards, indicators, surveyors, surveys, accreditation report, and end result. The development in the three organisations has been different. However, the establishment of The International Society for Quality in Health Care (ISQua) and The Agenda for Leadership in Programs in Healthcare Accreditation (ALPHA) programme has motivated increasing comparability. The fact that association between accreditation and quality in patient care has not been demonstrated is a weak point. However, standards in the accreditation organisations require the use of clinical guidelines in order to increase the quality of patient care. From the "Health Policy Report 2002" it appears that external assessment in the form of accreditation is going to be a reality in the Danish healthcare sector. Hospitals of all counties and within The Copenhagen Hospital Corporation must undergo accreditation before the year 2006.