Guidelines; from foe to friend? Comparative interviews with GPs in Norway and Denmark

<p>Abstract</p> <p>Background</p> <p>GPs follow clinical guidelines to varying degrees across practices, regions and countries, but a review study of GPs' attitudes to guidelines found no systematic variation in attitudes between studies from different countries. However, earlier qualitative studies on this topic are not necessarily comparable. Hence, there is a lack of empirical comparative studies of GP's attitudes to following clinical guidelines. In this study we reproduce a Norwegian focus group study of GPs' general attitudes to national clinical guidelines in Denmark and conduct a comparative analysis of the findings.</p> <p>Methods</p> <p>A strategic sample of GP's in Norway (27 GPs) and Denmark (18 GPs) was interviewed about their attitudes to guidelines, and the interviews coded and compared for common themes and differences.</p> <p>Results</p> <p>Similarities dominated the comparative material, but the analysis also revealed notable differences in attitudes between Norwegian and the Danish GPs. The most important difference was related to GP's attitudes to clinical guidelines that incorporated economic evaluations. While the Norwegian GPs were sceptical to guidelines that incorporated economic evaluation, the Danish GPs regarded these guidelines as important and legitimate. We suggest that the differences could be explained by the history of guideline development in Norway and Denmark respectively. Whereas government guidelines for rationing services were only newly introduced in Norway, they have been used in Denmark for many years.</p> <p>Conclusion</p> <p>Comparative qualitative studies of GPs attitudes to clinical guidelines may reveal cross-national differences relating to the varying histories of guideline development. Further studies are needed to explore this hypothesis.</p

Urinary incontinence in the elderly: attitudes and experiences of general practitioners. A focus group study.

Contains fulltext : 50429.pdf (publisher's version ) (Open Access)OBJECTIVE: To assess general practitioners' (GPs') attitudes to urinary incontinence in elderly patients and their experiences in the application of the Dutch College of General Practitioners' guideline in daily practice. DESIGN: Two existed groups of six GPs working in villages and seven GPs working in urban practices. METHOD: Two focus-group discussions with recording of discussions and transcription. Transcripts were analysed by two independent researchers. RESULTS: During the discussions three main themes of attitudes came forward: (1) therapeutic nihilism of GPs and low motivation of patients, (2): GPs experienced lack of time because of difficulties in explaining the therapy and because of impaired mobility of older patients, (3) because of the complexity of the problem and co-morbidity, GPs as well as patients were reluctant to treat the UI. The most remarkable findings in the application of the guideline were: (1) because of the barriers mentioned above, physical examination did not take place in spite of GPs' conviction as to the benefit of it; (2) GPs' knowledge of treatment options in the elderly with UI is substandard. CONCLUSION: Several patient (comorbidity, impaired mobility, low motivation, and acceptance of the problem) and GP factors (therapeutic nihilism, lack of time and knowledge) interfere with good management of UI in the elderly

The association between blood pressure and whole blood methylmercury in a cross-sectional study among Inuit in Greenland

<p>Abstract</p> <p>Background</p> <p>The Inuit in Greenland have a high average consumption of marine species and are highly exposed to methylmercury, which in other studies has been related to hypertension. Data on the relation between methylmercury and hypertension is limited, especially in populations subjected to a high exposure of methylmercury. We examined the relation between whole blood mercury and blood pressure (BP) in Inuit in Greenland.</p> <p>Methods</p> <p>A cross-sectional population-based study among adult Inuit in Greenland was performed in 2005–2009. Information on socio-demography, lifestyle, BP, blood samples and clinical measurements was obtained – the latter after overnight fasting. BP was measured according to standardized guidelines. Whole blood mercury concentration was used as a marker of exposure. The analyses were restricted to Inuit aged 30–69 years with four Greenlandic grandparents (N = 1,861). Multivariate regression analyses with inclusion of confounders were done separately for men and women with the omission of participants receiving anti-hypertensive drugs, except for logistic regression analyses of the relation between mercury and presence of hypertension (yes/no).</p> <p>Results</p> <p>The mean whole blood mercury level was 20.5 μg/L among men and 14.7 μg/L among women. In multivariate analyses adjusted for confounders, diastolic BP decreased with increasing mercury concentration. In men diastolic BP decreased significantly for each four-fold increase in mercury concentration (Beta = −0.04, standard error = 0.01, p = 0.001), while no relation between mercury and diastolic BP was found among women. For systolic BP, a similar non-statistically significant result was seen only for men (Beta = −0.02, standard error = 0.01, p = 0.06). A relation between mercury and hypertension was only found in men; the odds ratio for hypertension was 0.99 (95% CI: 0.98-0.99). No relation between quintiles of mercury and hypertension was found. The relationship between mercury and BP parameters may be non-linear: In analyses of quintiles of mercury the overall effect of mercury on BP parameters was only statistically significant for diastolic BP among men (Wald test, p = 0.01), however pairwise comparisons showed that some quintiles were not statistically different. This result is supported by LOESS modelling.</p> <p>Conclusions</p> <p>No adverse associations between whole blood mercury and blood pressure were found. With increasing whole blood mercury concentrations, diastolic BP and the risk of hypertension decreased among men in the study: this may be explained by confounding by exercise or unknown factors.</p