Experiences of general practitioner continuity among women with chronic fatigue syndrome/myalgic encephalomyelitis: a cross-sectional study

This article is distributed under the terms of the Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver applies to the data made available in this article, unless otherwise stated.Background: Continuity of care is important for patients with chronic illness in need of coordinated healthcare services from multiple providers. Little is known about how patients with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) experience continuity of GP care. This study explores how women with CFS/ME experience GP care across the three dimensions of continuity: informational, management, and relational continuity. Methods: This cross-sectional study uses questionnaire data collected from members of The Norwegian ME Association. Descriptive statistics and logistic regressions were used to estimate experiences of continuity, and associations with age, education, self-rated degree of CFS/ME, duration of the GP relation (GP duration), and number of GP visits for CFS/ME-related issues during the previous year (GP frequency). Results: Almost two-thirds of participants reported positive experiences across all three dimensions of GP continuity of care; 64.4% for informational, 64.1% for management, and 77.2% for relational continuity. Lower educational attainment was associated with more negative experiences of informational continuity (primary school only compared to university educated: odds ratio [OR] 0.12, confidence interval [CI] 0.03–0.49, p = 0.003). Compared to participants aged 40–59 years, those aged 60+ years were significantly less likely to have experienced poor (negative) management continuity (OR 0.25, CI 0.09–0.76, p = 0.014). A GP relationship of three or more years was associated with positive experiences of relational continuity (OR 2.32, CI 1.09–4.95, p = 0.030). Compared to those with moderate CFS/ME, those who graded their CFS/ME as severe or very severe were significantly more likely to have negative experiences of relational continuity (OR 0.38, CI 0.14–0.99, p = 0.047). Conclusions: A large proportion of participants experienced all three aspects of continuity of GP care (especially the relational dimension) positively. Informational and management continuity scores were moderately lower. Our results suggest greater emphasis on information giving, feedback, and better coordination of care to be good strategies for practice improvement for this patient group

Ny ME-veileder innebærer en kursendring i behandlingen av kroniske utmattelsestilstander

Source at https://forskersonen.no/kronikk-me-medisin-og-helse/ny-me-veileder-innebaerer-en-kursendring-i-behandlingen-av-kroniske-utmattelses-tilstander/1936075.National Institute for Health and Care Excellence (NICE) har nylig publisert nye retningslinjer for behandling av langvarige medisinsk uforklarte utmattelsestilstander som myalgisk encefalopati (ME) og kronisk utmattelsessyndrom (CFS). Retningslinjene innebærer en relativt stor kursendring, blant annet er den tidligere vektleggingen av fysisk trening og mentale mestringsstrategier erstattet av råd om tilstrekkelig med hvile. Som forventet ble retningslinjene umiddelbart gjenstand for debatt. Sett i lys av tidligere erfaringer har vi bare sett begynnelsen av den. Debattene om ME og tilgrensede diagnoser er – og har lenge vært – opphetede, polariserte og skyttergravspregede, og forskere opplever det som risikofylt å delta i dem. Hvorfor blir det slik, og hvordan kan vi unngå dette i den debatten som nå må komme? Dette er spørsmål som samfunnsvitenskapelige og humanistiske fag kan gi verdifulle bidrag til. Den utfordrende debatten rundt medisinsk uforklarte fysiske plager henger blant annet sammen med at forskjellige kilder til kunnskap vektlegges ulikt i moderne biomedisin. De ulike kunnskapskildene er rangert i et hierarki: Kunnskap innhentet gjennom vitenskapelig forskning og bruk av medisinsk teknologi blir mest vektlagt. Praksisbasert klinisk kunnskap og pasientenes erfaringsbaserte kunnskap blir minst vektlagt. I forhold til utmattelsestilstandene synes dette å være en treffende beskrivelse. Manglende funn av en biologisk sykdomsmarkør kan tolkes på mange forskjellige måter. Det kan for eksempel tolkes som at sykdommen ikke har en bestemt og avgrenset biologisk markør, eller at vi hittil ikke har klart å identifisere den. Det er i alle fall ingen grunn til å tro at den medisinske kunnskapsutviklingen har nådd et fullkomment stadium. Dersom vi tolker manglende funn av biomarkører som en indikasjon på at sykdommen bør betraktes som en psykisk lidelse, eller kanskje til og med at den er ikke-eksisterende, da er vi på ville veier. Kanskje er det her den viktigste kimen til den opphetede debatten om utmattelsestilstander ligger begravet? I veien videre bør vi tilstrebe økt tillit til og anerkjennelse av de kildene til kunnskap som lett blir oversett i moderne biomedisin: legenes praksisbasert kliniske kunnskap, og den erfaringsbaserte kunnskapen som pasientene selv besitter

Motivation and obstacles for weight management among young women - a qualitative study with a public health focus - the Tromsø study: Fit Futures

Source at: https://doi.org/10.1186/s12889-017-4321-9 Background: Due to a worldwide increase in overweight and obesity, weight-management through lifestyle changes has become an important public health issue. Adolescents and young adults comprise a vulnerable group. The transition into adulthood represents a stage in life when establishing good lifestyle habits for the future is important. The aim of this study was to explore motivation and obstacles for weight reduction, weight maintenance and healthy lifestyle choices in young women. Methods: We conducted semi-structured in depth interviews with 12 young women, both overweight and normal weight, recruited from a school-based population survey. By the use of thematic analysis we searched the interview text for relevant meaning units that emerged as topics that illuminated our research questions. Results: A strong motivation for obtaining or keeping normal weight was clearly present among the participants. Independent of weight-group, the participants described increased levels of physical activity, better eating habits and regularity in daily life as desirable changes. Parents were described as important influencers regarding lifestyle habits. Several participants expressed a need for more information about healthy nutrition and eating. Their motivation for physical activity depended on a positive social setting and elements of joy. The participants described the transition into adulthood including moving out of their parents’ home and other structural changes in everyday life, as challenging. It affected their food choices and eating habits and other lifestyle issues. High costs of healthy food and sports activities were frequently mentioned among the obstacles they encountered. Conclusion: The results revealed an obvious motivation for lifestyle changes in individuals and environmental challenges for young women in the relevant stage of their life-course. There seems to be a need for health strategies that strengthens individuals’ capacity to overcome the environmental challenges in the transition to adulthood. This should include reliable and accessible health education/information regarding healthy nutrition, eating habits, food choices and preparation of meals. Structural initiatives such as easier access to affordable healthy food and less expensive opportunities for physical activity and sports should be considered

Modes of Interaction in Naturally Occurring Medical Encounters with General Practitioners: The ´One in a Million´ Study

In this article, we qualitatively explore the manner and style in which medical encounters between patients and general practitioners (GPs) are mutually conducted, as exhibited in situ in 10 consultations sourced from the One in a Million: Primary Care Consultations Archive in England. Our main objectives are to identify interactional modes, to develop a classification of these modes, and to uncover how modes emerge and shift both within and between consultations. Deploying an interactional perspective and a thematic and narrative analysis of consultation transcripts, we identified five distinctive interactional modes: question and answer (Q&A) mode, lecture mode, probabilistic mode, competition mode, and narrative mode. Most modes are GP-led. Mode shifts within consultations generally map on to the chronology of the medical encounter. Patient-led narrative modes are initiated by patients themselves, which demonstrates agency. Our classification of modes derives from complete naturally occurring consultations, covering a wide range of symptoms, and may have general applicability

Geografiske ulikheter i tilbudet av polikliniske tjenester til barn og unge ved norske sykehus - et kulturperspektiv

Nasjonale kartlegginger har påvist til dels store geografiske ulikheter i tilbudet av spesialisthelsetjenester til barn og unge i Norge. Tilbudsulikhetene varierer fra tre til fem ganger for enkelte sykdomskategorier. Disse ulikhetene kan ikke forklares med forskjeller i sykelighet. Helsepolitiske målsettinger om geografisk likeverdige tjenestetilbud til befolkningen tilsier at de geografiske ulikhetene bør reduseres. Hovedmålet med denne artikkelen er å utforske mulige forklaringer på at geografiske ulikheter i tilbud om spesialisttjenester til barn og unge oppstår. Vårt datagrunnlag består av individuelle semistrukturerte dybdeintervjuer med 17 fagansvarlige overleger med prioriteringsansvar og seks kontoransvarlige ved norske barne- og ungdomsavdelinger, fordelt på seks sykehusavdelinger og fire helseregioner. Informantenes utsagn ble tematisk kodet i NVivo og deretter kvalitativt fortolket. Resultatene indikerer at geografiske ulikheter i spesialisttilbud til barn og unge blir skapt i et komplekst samspill av formelle og uformelle strukturer med faktorer av politisk, organisatorisk, ledelsesmessig, medisinskfaglig og kulturell art. Nasjonal likhet er derfor vanskelig å oppnå gjennom formelle strukturer alene. Kulturbygging gjennom faglige nettverk kan sikre legitimitet og faglig forankring. Funksjonsdeling mellom sykehus og andre helsepolitiske virkemidler som er innført for å gi mer effektiv ressursbruk, kan bidra til geografiske ulikheter. Hvilke hensyn som skal veie tyngst, er et normativt spørsmål som ikke bør overses

‘I’d best take out life insurance, then.’ Conceptualisations of risk and uncertainty in primary care consultations, and implications for shared decision-making

The main objective of this study is to gain knowledge about interactional factors that support and obstruct mutual risk-assessments and shared decision-making (SDM) in clinical consultations. Through a narrative analysis of verbatim tran- scripts of 28 naturally occurring consultations performed in English National Health Service practices, we explore the ways in which patients and general practitioners conceptualise, construct and negotiate risks related to diagnostic tests and medical treatments. Consultations were sampled from a corpus of 212 consultation transcripts from the One in a Million: Primary care consultations archive on the basis that they contained the word ‘risk(s)’. Most sampled cases relate to cardiovascular conditions and cancer. Drawing on a social constructionist perspective and the relational theory of risk, we found that while GPs talked about mathematical-probabilistic population risk, patients expressed their own experiences of possible future dangers, conceptualised through words like ‘worried’, ‘scared’ and ‘concerned’. Risk objects, defined here as entities to which harmful consequences are conceptually attached, were constructed differently by patients and GPs, especially in relation to cardiovascular risks. Their different rationalities sometimes obstructed any form of mutual risk-assessments. The relational theory of risk proved to be a useful theoretical frame for exploring layers and configurations of risk constructions among patients and clinicians, and for capturing interactional factors that support and obstruct mutual risk-assessments and SDM. For patients to be able to engage in genuine dialogues and make informed decisions about their care, it is paramount for patients and doctors to co-construct patients’ health-risks during clinical encounters

Continuity of GP care is associated with lower use of complementary and alternative medical providers: a population-based cross-sectional survey

BACKGROUND: Continuity of general practitioner (GP) care is associated with reduced use of emergency departments, hospitalisation, and outpatient specialist services. Evidence about the relationship between continuity and use of complementary and alternative medical (CAM) providers has so far been lacking. The aim of this study was to test the association between continuity of GP care and the use of CAM providers. METHODS: We used questionnaire data from the sixth Tromsø Study, conducted in 2007–8. Using descriptive statistical methods, we estimated the proportion using a CAM provider among adults (30–87 years) who had visited a GP during the last 12 months. By means of logistic regressions, we studied the association between the duration of the GP-patient relationship and the use of CAM providers. Analyses were adjusted for the frequency of GP visits, gender, age, marital status, income, education, and self-rated health and other proxies for health care needs. RESULTS: Of 9,743 eligible GP users, 85.1% had seen the same GP for more than two years, 83.7% among women and 86.9% among men. The probability of visiting a CAM provider was lower among those with a GP relationship of more than 2 years compared to those with a shorter GP relationship (odds ratio [OR] 0.81, 95% confidence interval [CI] 0.68-0.96). Other factors associated with CAM use were female gender, poor health, low age and high income. There was no association with education. CONCLUSIONS: Continuity of GP care as measured by the duration of the GP-patient relationship was associated with lower use of CAM providers. Together with previous studies this suggests that continuity of GP care may contribute to health care delivery from fewer providers

Samfunn og sykdom. Bokanmeldelse av "Medicinsk sociologi: sociale faktorers betydning for befolkningens helbred", redigert av Rikke Lund, Charlotte Juul Nilsson, Ulla Christensen og Lars Iversen.

Source at https://www.michaeljournal.no/article/2022/02/Samfunn-og-sykdom.Denne reviderte artikkelsamlingen har som hovedtema sammenhengen mellom samfunn og sykdom, spesielt hvordan sosiale og samfunnsmessige forhold har betydning for folks helse, med utgangspunkt i «socialepidemiologiske metoder» (s. 14). Boken inneholder i alt 10 kapitler, samt innledning og stikkordsregister, og den er rikt illustrert med figurer og tabeller i fargetrykk. Forfatterne kommer fra ulike fagdisipliner, men de fleste har medisinsk fagbakgrunn. Alle faggrupper innenfor medisin og helse er definert som målgruppe

Vitenskap og verdier i moderne medisin: Idealer og realiteter

Dette essayet inneholder en kritisk drøfting av for estillingen om medisinsk praksis som en kunnskapsbasert og verdinøytral virksomhet. Perspektivet er sosiologisk og historisk, og til dels også kjønnet. Utgangspunktet for drøftingen er to case , ett fra somatikken og ett fra psykiatrien. Fra somatikken; de såkalte medically unexplained physical symptoms (MUPS); fra psykiatrien; karaktertrekkdiagnosene. I en ganske lang opptakt til drøftingen introduseres konteksten de to casene inngår og oppstår i, og da primært noen tanker omkring noen viktige endringer i klinisk tenkning og beslutningstaking som kom i kjølvannet av medisinens vitenskapeliggjøring (som er så gjennomgripende at de kan kalles et paradigmeskifte)