Views on primary prevention of cardiovascular disease - an interview study with Swedish GPs

Background: General practitioners (GPs) have gradually become more involved in the prevention of cardiovascular disease (CVD), both through more frequent prescribing of pharmaceuticals and by giving advice regarding lifestyle factors. Most general practitioners are now faced with decisions about pharmaceutical or non-pharmaceutical treatment for primary prevention every day. The aim of this study was to explore, structure and describe the views on primary prevention of cardiovascular disease in clinical practice among Swedish GPs. Methods: Individual interviews were conducted with 21 GPs in southern Sweden. The interview transcripts were analysed using a qualitative approach, inspired by phenomenography. Results: Two main categories of description emerged during the analysis. One was the degree of reliance on research data regarding the predictability of real risk and the opportunities for primary prevention of CVD. The other was the allocation of responsibility between the patient and the doctor. The GPs showed different views, from being convinced of an actual and predictable risk for the individual to strongly doubting it; from relying firmly on protection from disease by pharmaceutical treatment to strongly questioning its effectiveness in individual cases; and from reliance on prevention of disease by non-pharmaceutical interventions to a total lack of reliance on such measures. Conclusions: The GPs' different views, regarding the rationale for and practical management of primary prevention of CVD, can be interpreted as a reflection of the complexity of patient counselling in primary prevention in clinical practice. The findings have implications for development and implementation of standard treatment guidelines, regarding long-time primary preventive treatment

Antibiotic prescribing in outpatients: a 1-week diagnosis-prescribing study in 5 counties in Sweden

A diagnosis-antibiotic prescribing study initiated by the Swedish Strategic Programme for the Rational Use of Antimicrobial Agents and Surveillance of Resistance was performed in 5 counties in Sweden (total 1,290,000 inhabitants) during 1 week in November 2000. The aims of the study were to analyse diagnoses and antibiotics prescribed for outpatients and to appraise the feasibility of the data collection method. Physicians in primary care and departments of ENT, paediatrics and infectious diseases completed a questionnaire for each patient with an infectious disease complaint, including information about age, sex, diagnosis, diagnostic methods used and treatment. When an antibiotic was prescribed, the type and duration of treatment were noted. A total of 7, 071 forms were returned, of which 7,029 included information on diagnosis; infections of the respiratory tract, urinary tract and the skin or soft tissues were responsible for 70%, 14% and 10% of the visits, respectively. Antibiotics were prescribed in 59% of all cases and phenoxymethylpenicillin was the most commonly prescribed antibiotic. Of the forms returned, 94% emanated from primary care centres. In conclusion, this study provides information on the treatment pattern associated with various diagnoses and the pattern of use of various antibiotics. Such a study is relatively simple to perform and entails only a small extra workload for the participants

Jag vill, men hur? Ett utforskande av den kreativa processen.

I want to, but how? My work is a research of the creative process. I have asked myself how ideas take form and how materials can become bearers of ideas. The work has been treated as an action rather than an object. The result shows my research and my interpretation: the process and result are the same

Management of urinary tract infections in primary care: A repeated 1-week diagnosis-prescribing study in five counties in Sweden in 2000 and 2002

A diagnosis-antibiotic prescribing study was performed in 5 counties in Sweden during 1week in November in the y 2000 and 2002, respectively. As part of the study, the characteristics and clinical management of patients who received diagnoses of urinary tract infections (UTIs) ( n = 1564) in primary care, were analysed. 85% of the visits were by women, and 74% of all consultations were diagnosed as lower UTIs. One or more diagnostic tests were performed in 98% of the women with suspected lower or recurrent UTIs and 95% were prescribed an antibiotic. The most commonly prescribed antibiotics for lower UTIs were trimethoprim followed by pivmecillinam and a quinolone. The study indicated a change in antibiotic prescribing with improved adherence to the national recommendations. There was an increase of prescribed nitrofurantoin and a decrease of prescribed quinolones to women with lower UTIs between the studied y. Furthermore, 3-d treatment with trimethoprim increased although the prescribed duration was mostly 7 d. In contrast to the guidelines, few urine cultures were performed. The study highlights the necessity of updating the guidelines for the management of lower UTIs in general practice

Use of a pilot drug information centre

Introduction: Provision of access to drug information by prescribers and other health care professionals is important in pharmacotherapy. At the time of this study there was very scanty literature in this area from Africa. Objective: To assess use of a pilot drug information centre (DIC) which was set up in a department of Pharmacology and Therapeutics in a university teaching hospital in Uganda. Methods: This was a situational analysis with a prospective study design. The pilot DIC was established and its use over an eleven-month period was assessed. The received queries were evaluated for source of the query, reason for the query and type of query. Results: During the 11 months 297 queries were received, 72.3% of which were from public hospitals. Most werefrom prescribing doctors (54.2%). Majority were on drug-drug interaction (41.2%), followed by therapy (23.2%). Out of 197 specific drug requests, 65.5% were on antiretroviral. Conclusion: We found that healthcare professionals were enthusiastically using the drug information centre. It is, therefore, necessary and feasible to establish a DIC in Uganda that will enable these professionals to readily access drug information