DSAM’s publikationsinformation om seneste resultater inden for almenmedicinsk forskning i Danmark.

Association between unmet needs and quality of life of cancer patients: A population-based study

Hansen DG, Larsen PV, Holm LV, Rottmann N, Bergholdt SH, Søndergaard J.


Background . Two conceptually different morbidity outcomes unmet needs and health-related quality of life are used to identify cancer patients in need of clinical attention and to evaluate rehabilitation programmes. The knowledge on the interrelation between unmet needs and health-related quality of life is scarce. This paper studies the hypothesis that patientperceived unmet needs of rehabilitation during the cancer trajectory are associated with decreased quality of life.

Material and methods. Based on registers, a Danish population-based cohort of adult, incident, mixed-site cancer patients diagnosed between 1 October 2007 and 30 September 2008 was established. At 14 months following diagnosis participants completed a questionnaire including health-related quality of life (EORTC QLQ C-30), psychological distress (POMS-SF), and unmet needs with regard to physical, emotional, family-oriented, sexual, work-related, and fi nancial problems. Unmet needs were assessed through six ad hoc questions.

Results. Questionnaires were received from 3439 of 4947 patients, resulting in a response rate of 70%. The three most frequent cancer types were breast (28.4%), prostate (14.6%) and colorectal cancer (15.2%). Overall, 60.1% expressed an unmet need of rehabilitation in at least one area, physical and emotional problems being the most frequent (40.0% and 37.5%). For all scales of the EORTC QLQ C-30 and POMS, signifi cant adjusted mean differences were observed between patients with unmet needs in at least one area and patients with no unmet needs (p-values _ 0.001). These differences were well above levels usually considered clinically relevant. Further, impairment increased with increasing number of areas in which unmet needs were reported.

Discussion. We confi rmed the hypothesis that patient-perceived unmet needs of rehabilitation during the cancer trajectory are associated with decreased quality of  life. This study supports the use of unmet needs questions to identify patients in need of clinical attention. Interventions reducing cancer patients ’ perceived needs of rehabilitation may enhance quality of life.

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The General Practitioner’s Consultation Approaches to Medically Unexplained Symptoms: A Qualitative Study

Hansen HS, Rosendal M, Fink P, Risør MB
ISRN Family Medicine 2013. Article ID 541604. DOI: 10.5402/2013/541604

Undersøgelsens formål var at få indblik i, hvordan praktiserende læger bruger begrebet medicinsk uforklarede symptomer (MUS), og hvordan de håndterer patienter med MUS i den kliniske hverdag. Resultaterne bygger på fokusgruppeinterviews af praktiserende læger. Vi fandt, at konsultationer vedrørende MUS udviklede sig forskelligt omkring den enkelte patient og typisk indbefattede et forløb over flere konsultationer. Konsultationen udmøntede sig typisk på en af tre måder: 1) søgen efter somatisk sygdom, 2) rutinekonsultation eller 3) "at ride på flere heste". Valget af konsultationstype blev påvirket af en række faktorer som fx læge, patient og kontekst. Diagnosen MUS er således indlejret i en kontekst, og den diagnostiske proces er afhængig af konsultationstype.

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Medication effectiveness may not be the major reason for accepting cardiovascular preventive medication: a population-based survey

Harmsen CG, Støvring H, Jarbøl DE, Nexøe J, Gyrd-Hansen D, Nielsen JB, Edwards A, Kristiansen IS.
BMC Med Inform Decis Mak. 2012 Aug 9;12:89. doi: 10.1186/1472-6947-12-89

I undersøgelsen fandt vi at information om forventet effekt synes at have en moderat indflydelse på lægpersoners beslutning om at påbegynde forebyggende medicin, mens faktorer såsom personlig erfaring med hjertekarsygdom forekommer at have en lige så stærk eller endog stærkere indflydelse, hvilket indikerer, at praktiserende læger bør lægge stor vægt på at afdække de årsager, der kan ligge bag deres patienters beslutningsprocesser vedrørende behandling.


Background. Shared decision-making and patients' choice of interventions are areas of increasing importance, not least seen in the light of the fact that chronic conditions are increasing, interventions considered important for public health, and still non-acceptance of especially risk-reducing treatments of cardiovascular diseases (CVD) is prevalent. A better understanding of patients' medication-taking behavior is needed and may be reached by studying the reasons why people accept or decline medication recommendations. The aim of this paper was to identify factors that may influence people's decisions and reasoning for accepting or declining a cardiovascular preventive medication offer.

Methods. From a random sample of 4,000 people aged 40-59 years in a Danish population, 1,169 participants were asked to imagine being at increased risk of cardiovascular disease and being offered a preventive medication. After receiving 'complete' information about effectiveness of the medication they were asked whether they would accept medication. Finally, they were asked about reasons for the decision.

Results. A total of 725 (67%) of 1,082 participants accepted the medication offer. Even quite large effects of medication (up to 8 percentage points absolute risk reduction) had a smaller impact on acceptance to medication than personal experience with cardiovascular disease. Furthermore, increasing age of the participant and living with a partner were significantly associated with acceptance. Some 45% of the respondents accepting justified their choice as being for health reasons, and they were more likely to be women, live alone, have higher income and higher education levels. Among those who did not accept the medication offer, 56% indicated that they would rather prefer to change lifestyle.

Conclusions. Medication effectiveness seems to have a moderate influence on people's decisions to accept preventive medication, while factors such as personal experience with cardiovascular disease may have an equally strong or stronger influence, indicating that practitioners could do well to carefully identify the reasons for their patients' treatment decisions.

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Audit report from Greenland on nurses’ tasks and perceived competency

Nexøe J, Skifte E, Niclasen B, Munck A. 
Rural and Remote Health 12: 1909. (Online) 2012.

Introduction: Despite all efforts, recruitment of healthcare personnel has become increasingly difficult in Greenland as in other remote areas. The aim of this observational study was to describe the extent of health care delivered by nurses in Greenland’s healthcare system. Reasons for encounter, diagnostic procedures, treatments and need for a physician’s assistance, as well as the nurses’ self-perceived competency, were also analysed.
Methods: A total of 42 nurses registered all patient encounters for 10 days in late autumn 2006 in 14 out of 16 healthcare districts in Greenland.
Results:  Nurses treated 1117 encounters (60%) singlehandedly. The nurses felt competent in what they were doing in 1415 encounters (76%). In 525 encounters (31%), a physician’s advice was sought. Either the physician was asked to come or the physician’s advice was obtained by telephone. In four cases the nurses did not feel completely competent, but did not seek advice from the physician on call. Feeling competent did not depend on length of experience in Greenland.
Conclusion:  In Greenland, nurses independently receive, diagnose and treat a substantial number of primary healthcare patients. The nurses take care of the patients and perform a number of clinical and laboratory procedures with great confidence. There has been speculation that part of the difficulty in recruiting doctors and healthcare personnel in remote areas may be due to uneasiness about professional responsibilities and, to some extent, lack of confidence. At least among the registering nurses in this study, this did not seem to be a problem.

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Violence- and alcohol-related acute healthcare visits in Greenland

Jørgen Nexøe, Julie Præst Wilche, Birgit Niclasen, Ann Birkekær Kjeldsen, Christian Færgemann, Anders Munck, Jens Martin Lauritsen.
Scand J Public Health 2012; E-pub ahead of print.


Aims: The aim of this study was to describe emergency admissions in Greenland's healthcare system, and the extent to which admissions were associated with alcohol abuse or violence. Furthermore, we aimed to test whether data on emergencies in Greenland could be registered in a reliable way by simple means. Methods: Registration of all emergencies presented in 15 out of 17 of Greenland's health districts in the period 21 May to 7 June 2010. Results: In the 17-day registration period, 2403 emergencies were registered. In 10% of cases the patients were clinically alcohol intoxicated. When reason for presentation were mental or social problems, attempted suicide, accidents, or violence, 24, 50, 15, and 59% respectively were intoxicated. Alcohol intoxication was statistically significantly more often associated with advanced treatment (e.g. evacuation, hospitalisation, or follow up by doctor or nurse). Conclusions: This study confirms that violence- and alcohol-related emergencies put a considerable strain on Greenland's healthcare system. Due to the short observation period, we have not been able to describe the actual extent of the problem in detail, nor was it possible to estimate whether this problem is more pronounced in Greenland than in other countries, for example Denmark.

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Lack of spirometry use in Danish patients initiating medication targeting obstructive lung disease. Respiratory Medicine 2012;106:1743-8

Koefoed M, Christensen RdP, Søndergaard J, Jarbøl DE. 


Background: Research indicates that a large proportion of patients using medication targeting obstructive lung disease have no history of spirometry testing.

Objective: To investigate the use of spirometry when initiating pulmonary medication targeting obstructive lung disease and to explore possible patient characteristics associated with undergoing spirometry.

Methods: Population-based cohort study. Three Danish National registers were linked enabling a retrieval of data on all primary and secondary healthcare services provided in the time period 2007–2010.

Results: In 2008 a total of 40,969 patients were registered as first time users of pulmonary medication targeting obstructive lung disease. The mean age of the study cohort was 55.6 yrs (SD 18.7). Spirometry test had been performed in 20,262 (49.5%) of the study cohort in the period from 6 months before to 12 months after their first prescription. Just above one third of the cohort, 14,275 (34.8%), had undergone spirometry in the two-month period close to redemption of their first prescription. Women and patients in the oldest age categories were less likely to have spirometry performed.

Conclusions: Many patients initiate medication targeting obstructive pulmonary disease without having airway obstruction confirmed through spirometry. Only one third of the study cohort had a spirometry performed when initiating medication and half had still not undergone spirometry after a year. There should be an increased focus on confirming airway obstruction when initiating medication.

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Associations between reporting of cancer alarm symptoms and socioeconomic and demographic determinants: a population-based, cross-sectional study

Svendsen RP, Paulsen MS, Larsen PV, Hansen BL, Støvring H, Jarbøl DE, Søndergaard J.
BMC Public Health 2012; E-pub ahead of print.


Background: Reporting of symptoms which may signal cancer is the first step in the diagnostic pathway of cancer diseases. Cancer alarm symptoms are common in the general population. Public awareness and knowledge of cancer symptoms are sparse, however, and many people do not seek medical help when having possible cancer symptoms. As social inequality is associated with cancer knowledge, cancer awareness, and information-seeking, our hypothesis is that social inequality may also exist in the general population with respect to reporting of cancer alarm symptoms. The aim of this study was to investigate possible associations between socioeconomic and demographic determinants and reporting of common cancer alarm symptoms.

Methods: A cross-sectional questionnaire survey was performed based on a stratified sample of the Danish general population. A total of 13 777 randomly selected persons aged 20 years and older participated. Our main outcome measures were weighted prevalence estimates of self-reporting one of the following cancer alarm symptoms during the preceding 12 months: a lump in the breast, coughing for more than 6 weeks, seen blood in urine, or seen blood in stool. Logistic regression models were used to calculate unadjusted and adjusted odds ratios with 95% confidence intervals for the associations between each covariate and reporting of cancer alarm symptoms.

Results: A total of 2 098 (15.7%) of the participants reported one or more cancer alarm symptoms within the preceding 12 months.

Women, subjects out of the workforce, and subjects with a cancer diagnosis had statistically significantly higher odds of reporting one or more cancer alarm symptoms. Subjects with older age and subjects living with a partner had lower odds of reporting one or more cancer alarm symptoms. When analysing the four alarm symptoms of cancer separately most tendencies persisted.

Conclusions: Socioeconomic and demographic determinants are associated with self-reporting of common cancer alarm symptoms.

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Unmet needs in cancer rehabilitation during the early cancer trajectory – a nationwide patient survey

Veloso AG, Sperling C, Holm LV, Nicolaisen A, Rottmann N, Thayssen S, Christensen RdP, Knudsen JL, Hansen DG. 


Background. A cancer diagnosis may lead to psychosocial problems and physical symptoms that can be relieved during rehabilitation. The aim of this study was to analyse patient-perceived unmet needs of rehabilitation close to time of diagnosis, i.e. frequencies of unmet needs and the association with sociodemographic characteristics, cancer type and treatment.

Material and methods. All adult residents of Denmark diagnosed with cancer for the fi rst time from 1 May to 31 August 2010 were mailed a patient questionnaire two to fi ve months following diagnosis. The study population was identifi ed by use of national administrative registers. Data on rehabilitation, family situation, education, and cancer treatment were obtained from the questionnaire, while sex, birth year and cancer type were obtained from the Danish National Patient Registry. The association between each type of unmet needs and the variables sex, age, cancer diagnosis, treatment, education, cohabitation status, and children (living at home and away from home) was analysed using multiple logistic regression.

Results. Among the 4346 participants (64.7%) unmet needs were reported with regard to talking to patients in the same situation (24.1%), counselling with a psychologist (21.4%), physical rehabilitation (18.8%), practical help (17.3%), and counselling related to work or education (14.8%). Differences were observed with regard to type of unmet needs, sociodemographic and clinical characteristics, but generally, young age, male sex, low educational level and living alone increased the adjusted odds ratios of unmet needs. Breast cancer and to some extent melanoma cancer decreased the odds.

Conclusion. Unmet needs of rehabilitation are frequent during the early cancer trajectory and sociodemographic and clinical inequalities exist. The results support guideline recommendations of integration of cancer rehabilitation from the beginning of the cancer trajectory. Early interventions tailored to men, patients with low educational level, living alone, or treated with chemotherapy may help counterbalancing social and clinical inequalities in the long run.

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Speciallæge, cand.med. Søren Birkeland har den 26. oktober forsvaret sin ph.d.-afhandling ”Patient complaint cases in general practice”.  Vejledere: Jakob Kragstrup, Niels Damsbo, Mette Hartlev, Peter Bak Mortensen.

Ph.d.-afhandlingen “Patientklagesager i almen praksis” udgår fra Institut for Sundhedstjenesteforskning (Forskningsenheden for Almen Praksis) ved Syddansk Universitet. Afhandlingen bygger på en undersøgelse af hvem der får patientklagesager og hvad der kendetegner patientklagesager som ender med en påtale. Undersøgelsen tager sit udgangspunkt i registeroplysninger, samt et års klagesagsafgørelser (2007) fra ”Sundhedsvæsenets Patientklagenævn” (nu: ”Sundhedsvæsenets Disciplinærnævn”).

Undersøgelsen, som udelukkende omfattede alment praktiserende læger, viste at travle læger med mange kontakter oftere fik klager. Læger, som havde praktiseret i mange år, var også mere udsat for at få en klage, og i forbindelse med klagesagernes afgørelse fik de oftere en påtale. Desuden resulterede klagesagerne oftere i påtale når klager havde fokus på den praktiserende læges ansvar og formåen medens påtale var sjældnere, når klagen var begrundet i et ønske om forklaring af behandlingsforløbet, eller klager havde følt sig talt ned til. Hvis den praktiserende læge var indklaget sammen med andre, var forekomsten af påtaler mindre, medens påtale omvendt optrådte hyppigere ved længere sagsforløb.

Afhandlingen problematiserer betydningen af kommunikation, travlhed og det at have praktiseret over længere tid. Den belyser tillige faktorer af kritisk betydning i forbindelse med selve klagesagsprocessen.

Afhandlingen er skrevet af Søren Fryd Birkeland som er uddannet praktiserende læge og jurist.

Cand.med. Malene Plejdrup Hansen har den 12. oktober forsvaret sin ph.d.-afhandling ”Qualityindicators for diagnosis and treatment of respiratory tract infections in general practice”.  Vejledere: Lars Bjerrum, Dorte Jarbøl, Bente Gahrn-Hansen, René dePont Christensen.

Ph.d.-afhandlingen“Quality indicators for diagnosis and treatment of respiratory tract infections in general practice. Development, assessment and application” er udarbejdet af Malene Plejdrup Hansen og udgår fra Forskningsenheden for Almen Praksis i Odense, Syddansk Universitet.

Ved en Delphi undersøgelse blev i alt 41 kvalitetsindikatorer for diagnostik og behandling af luftvejsinfektioner vurderet relevante af et internationalt ekspertpanel. Efterfølgende blev danske alment praktiserende læger inviteret til at vurdere kvalitetsindikatorsættet, og de fandt kun få af indikatorerne for anvendelige. Denne viden er vigtig, da en forudsætning for en vellykket implementering af kvalitetsforbedrings redskaber, såsom kvalitetsindikatorer, forudsætter, at lægerne finder kvalitetsindikatorerne relevante og brugbare i deres dagligdag.

Otte af kvalitetsindikatorerne blev afslutningsvis applikeret på audit data for at undersøge kvaliteten af antibiotisk behandling af akut mellemørebetændelse i almen praksis i seks forskellige lande. Til trods for at mange guidelines i dag anbefaler tilbageholdenhed med antibiotisk behandling i de fleste tilfælde af akut mellemørebetændelse, fandt vi, at størstedelen af patienterne blev behandlet med antibiotika i både Argentina, Spanien, Kaliningrad, Litauen, Sverige og Danmark.

Praktiserende læge Jesper Lykkegaard har den 18. januar forsvaret sin ph.d.-afhandling ”COPD hospitalisations in Denmark 2002-2009: Factors influencing the incidence, prevalence, and lifetime risk”. Vejledere: Jens Søndergaard, Morten Andersen, Jakob Kragstrup, Henrik Støvring.

Ph.d.-forsvar ved Thomas Mukais med titlen ”Using information and communication technology in general practice cancer pathways”

Forsvaret finder sted fredag den 22. marts 2013 kl. 14-16 i Samfundsmedicinsk Auditorium (lokale 101), bygning 1262, Bartholins Allé 4, 8000 Aarhus C.

Offentlig forsvarshandling i forbindelse med erhvervelse af ph.d.-graden ved cand.med. Maja Skov Paulsen

Emne: ”Hypertension in general practice: Treatment, socioecomic factors and comorbidities”
Tid: Torsdag, den 28. februar 2013 kl. 14.00
Sted: Store Auditorium, J.B. Winsløws Vej 15, 1., 5000 Odense C

Professor Thomas Kahan, Hjärtkliniken, Danderyds sjukhus, Sverige
Lektor Martin Bach Jensen, Institut for Folkesundhed - Almen Medicin, Aarhus Universitet
Lektor Bente M. Nørgaard, Klinisk Epidemiologi, Klinisk Institut, Syddansk Universitet (formand)

Hovedansvarlig vejleder:
Professor Jens Søndergaard, Almen Praksis, Institut for Sundhedstjenesteforskning, Syddansk Universitet

DSAM, Stockholmsgade 55, 2100 København Ø

Telefon: 7070 7431 E-mail: dsam@dsam.dk