[The requirement to use the cheapest synonymous preparation--does it work as intended?]. / Ordningen med billigste synonympreparat--virker den etter hensikten?

A retrospective analysis of all prescriptions for hypersensitive drugs was undertaken at a pharmacy serving 20 general practitioners and 17 temporarily employed doctors. The analysis was carried out in 1992 over two three-month periods separated by an interval of five months. The Governmental regulations aimed at promoting use of the "cheapest synonymous drug" apparently had little impact on the doctors' prescriptions. During the 11 months concerned, the prescribed antihypersensitive drugs contained an increasing share of expensive alternatives with no documented ability to reduce cardiovascular morbidity or mortality.

Pharmacy personnel and fever: a study on perception, self-care and information to customers.

To study the fever perception and self-care of pharmacy personnel as well as the information given to customers about the management of fever problems, a random sample of 152 Norwegian pharmacists and 150 pharmacy technicians were interviewed, in 1989, by a national opinion poll company. One-third thought that body temperatures between 39.0 degrees C and 40.5 degrees C could be life-threatening. Of all respondents 24% (33% of technicians, 16% of pharmacists) assumed body temperatures to be rising when sweating accompanied fever. In cases of common cold or influenza accompanied by fever 56% of the personnel would use antipyretics. 7% Of the staff (14% of technicians, 1% of pharmacists) believed penicillin to be effective against viral infections. Antipyretic drug preferences were consistent, but a wide range of perceptions was revealed, in particular with respect to start of antipyretic therapy and seeking medical care for children. Undergraduate and postgraduate education of pharmacy personnel should aim more at satisfying the demand for information of the general public and focus more on the symptomatic treatment of fever and minor illness in general. Pharmacists in charge have a special responsibility in counselling their assistants.

General practitioners and fever: a study on perception, self-care and advice to patients.

To investigate their perception of fever problems, self-care and information given to patients, a random sample of 100 Norwegian general practitioners were interviewed in 1989-1990 by telephone. More than two-thirds of the general practitioners would define fever as a body temperature above 38.0 degrees C. One-third would wait with antipyretic drug therapy for children until the temperature was above 39.5 degrees C. When dealing with fever in their own children, one-third would not follow their own recommendations to parents with febrile children. 43% Had not discussed guidelines for the management of febrile patients with their receptionists. Only 7% had discussed such guidelines with the local pharmacists. Lack of consistency in the information given to patients may result in confusing advice. General practitioners, their receptionists and the local pharmacists should discuss and define guidelines for fever management and information to patients and parents. These should include information about antipyretic therapy and consultation behaviour.

Fever in general practice. II. Reasons for encounter, management and duration of fever conditions.

A sample of 80 direct and 36 telephone encounters for fever was established in 1988 as part of a Norwegian study on fever as a clinical problem in general practice. Reasons for encounter (ICPC) and clinical examinations were recorded along with clinical laboratory tests, treatment, management and follow up (IC-Process-PC). The doctors assessed the diagnostic process by means of visual analogue scale. Duration of the fever conditions was estimated through a postal questionnaire. Patients with direct encounters presented a wide range of reasons for the encounters. Fever was the most frequent single presenting complaint (31%). The general practitioners put major emphasis on the clinical examinations. They prescribed drugs in 68% of the direct encounters. Seventy per cent of the prescriptions were general systemic anti-infectives. Penicillin accounted for 58% of antibiotics. Six (8%) patients were hospitalized, and three (4%) were referred to a specialist. The mean time until complete recovery was 15 days for direct and 19 days for telephone encounters. Fever may be a sign even when it is not a presenting complaint. Major emphasis is probably put on the clinical examination of febrile patients because of the complexity of symptoms and the wide range of diagnoses associated with fever.

Fever in general practice. I. Frequency and diagnoses.

Although fever is a common symptom, few studies have broadly addressed this as a clinical problem in general practice. The aims of this study were to determine the frequency of fever among general practice patients in two rural municipalities in Norway, the diagnoses (according to ICHPPC-2-def.) of conditions causing fever, and the receptionist's role in the management of these problems. All the general practitioners and their receptionists within the study area participated. During 4 weeks throughout 1988 all individuals attending their general practitioner had their body temperature measured with an electronic thermometer (orally > or = 7 years, rectally < 7 years). Fever was defined as an oral body temperature > or = 37.5 degrees C (rectally > or = 38.0 degrees C in those < 7 years). All telephone applications, including telephone encounters for fever, were recorded. Fever was detected in 80 (5%) of a total of 1610 direct encounters: 36% of those below 7 years of age (n = 70) were febrile. One-third of the total encounters for fever were telephone encounters (n = 36), of which 30% were managed by the receptionists. A wide range of diagnoses were made, most of which were associated with infectious diseases. The distribution of the diagnoses of primary care patients with fever is different from those admitted to hospital for fever of unknown origin. General practitioners and their receptionists should consider fever a diagnostic challenge, especially when the patient is handled over the telephone.

[How do people perceive fever and what is done for it?]. / Hvordan oppfatter mennesker feber og hva gjør de?

The perception of fever has changed throughout history. Fever is a common symptom, and nowadays antipyretics are widely used. However, our knowledge of layman's perception of fever and self-care is rather limited. Unfounded parental concern of fever in children ("fever phobia") has not been found in Nordic studies. However, the findings indicate a need for more definite and consistent information on fever and fever management, including self-medication. This is a joint challenge to primary health care workers and local pharmacists.

Fever: management and self-medication. Results from a Norwegian population study.

A representative sample of the Norwegian population was interviewed in 1988 as part of a monthly national opinion poll to investigate lay management and self-medication of fever. Six hundred and nineteen women and 592 men over the age of 15 were interviewed in their homes. Approximately one-fifth reported inappropriate measuring of body temperature. A variety of management and self-medication was found. In cases of common cold or influenza with fever, 35% would use antipyretics. Forty per cent would start to use antipyretics at a temperature below 39.0 degrees C. Forty-four per cent did not know any antipyretic brand names at all. The results indicate a need for more definite and consistent information to make fever management and self-medication more rational. Such information should be discussed and given by general practitioners, nurses at child welfare centers and pharmacists.

Fever: knowledge, perception and attitudes. Results from a Norwegian population study.

To investigate the layman's knowledge, perception and attitudes regarding normal body temperature, fever, infections and the effect of penicillin on virus infections a representative sample of the Norwegian population (619 women and 592 men over the age of 15) was interviewed in 1988 as part of a monthly national opinion poll. One-third thought body temperatures up to 40.5 degrees C to be life-threatening, but the results do not justify the application of the term 'fever phobia' as described in other studies based on non-representative samples. More respondents were afraid of viral infections (48%) than bacterial infections (9%), which may be due to the media focus upon the HIV/AIDS epidemic. Thirty-five per cent believed penicillin to be effective against virus infections. Educational programmes on fever should also include information about virus infections and their treatment.

Some arguments on early hospital admission and treatment of suspected meningococcal disease cases.

Arguments are presented which indicate or show that: (1) Diagnostic precision and severity level of systemic meningococcal disease (MCd) both seem to rise exponentially with the developmental stage of the disease at referral. Lowering of the clinical admission threshold improves early coverage of vaguely suspected cases and should probably be implemented in Norway. (2) Fear that cell wall active bactericidal antibiotics could trigger important endotoxin release may cause unnecessary treatment delays. (3) Although risk of death due to meningococcal septicemia is the main indication for early treatment of MCd, the risk of sequelae may also become a major cause for very early treatment of MCd. (4) Treatment delays for MCd cases could have been substantially reduced by implementing reasonable guidelines. (5) In the relations between the public and the health service both organizational and psychological factors are operating. (6) Increased awareness among professionals and lay people of some key symptoms and signs may facilitate earlier diagnosis of MCd. (7) Earlier treatment of meningococcal disease is now feasible and does seldom preclude the possibility of etiological diagnosis. (8) More relevant studies and information on the early phases and rapid management of MCd are highly desirable. Rapid diagnosis and treatment of MCd are very important to reduce death, sequelae and community costs and should be more advocated in training of health personnel and in public information.