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Guidelines; from foe to friend? Comparative interviews with GPs in Norway and Denmark
Benedicte Carlsen, Pia K Kjellberg
BMC Health Services Research , 2010, DOI: 10.1186/1472-6963-10-17
Abstract: 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.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.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.It is thoroughly documented that general practitioners (GPs) follow clinical guidelines to varying degrees across practices, regions and countries [1-5] and we also have some knowledge about the GPs' attitudes to guidelines that may explain this variation [6,7]. A systematic review and synthesis of qualitative studies of GPs' attitudes to clinical guidelines found several common themes but no pattern of variation in attitudes between studies from different countries [6]. Reviews have depicted some central themes in GPs' deliberations about following guidelines: Disbelief in evidence, focus on the individual patient (in evidence and practice), reluctance to ration on governments' behalf, the doctor - patient relationship, clinical responsibility (leading to defensive practice or guideline adherence), practicalities (time constraints, competence and equipment), knowledge of
PRIORITY GUIDELINES OF DAIRY BREEDING DEVELOPMENT IN AN AGRARIAN COMPANY Приоритетные направления развития молочного скотоводства в аграрном предприятии  [PDF]
Gayduk V. I.,Shibanihin E. A.
Polythematic Online Scientific Journal of Kuban State Agrarian University , 2012,
Abstract: In the article we have considered and justified: the priority guidelines of dairy breeding development in an agrarian company based on technological processes modernization in branch, the work discipline raise and the merchandising improvement
Attitudes towards and conceptions of digital technologies and media in Danish museums  [cached]
Nanna Holdgaard,Celia Ekelund Simonsen
MedieKultur : Journal of Media and Communication Research , 2011,
Abstract: This paper examines the attitudes and conceptions of digital technologies and media in Danish museum organisations and discusses how the museums understand and prioritise communication compared to formidling (dissemination of knowledge), and to what extent this influences the use of digital technologies and media. The paper argues that digital technologies and media at times are considered digital add-ons to the traditional museum formidling and communication. In order to create a coherent and complete museum experience (both on-site and online), it is necessary to develop integrated and collaborative work processes and structures between the Departments of Formidling and Communication. The paper draws on empirical data and findings from: 1) a mapping of Danish museum organisations in relation to formidling and communication, and 2) expert interviews with four interviewees involved in Danish museum management.
The handling of urinary incontinence in Danish general practices after distribution of guidelines and voiding diary reimbursement: an observational study
Lars Viktrup, Lars M?ller
BMC Family Practice , 2004, DOI: 10.1186/1471-2296-5-13
Abstract: In October 2001, a questionnaire was sent to 243 general practitioners (GPs) in Frederiksborg County following distribution of clinical guidelines in July 1999 (UI in general practice) and September 2001 (UI in female, geriatric, or neurological patients). A policy for a small reimbursement to GPs for use of a fluid intake/voiding diary in the assessment of UI in general practice was implemented in October 2001. Information concerning monthly reimbursement for using a voiding diary, prescribed drugs (presumably used for treating UI), UI consultations in outpatient clinics, and patient reimbursement for pads was obtained from the National Health Service County Registry.Of the 132 (54%) GPs who replied, 87% had read the guidelines distributed 2 years before, but only 47% used them daily. The majority (69%) of the responding GPs had read and appreciated 1–3 other UI guidelines distributed before the study took place. Eighty-three percent of the responding GPs sometimes or often actively asked their patients about UI, and 92% sometimes or often included a voiding diary in the UI assessment. The available registry data concerning voiding diary reimbursement, prescribed UI drugs, UI consultations in outpatient clinics, and patient reimbursement for pads were insufficient or too variable to determine significant trends.GPs management of UI in a Danish county may be reasonable, but low response rate to the questionnaire and insufficient registry data made it difficult to evaluate the impact of different UI initiatives.Lower urinary tract symptoms, especially urinary incontinence (UI) affect the quality of life in many men and women. UI is defined as the complaint of any involuntary leakage of urine [1]. Stress urinary incontinence (SUI) is defined as the complaint of involuntary leakage on effort or exertion, or on sneezing or coughing, while urge urinary incontinence (UUI) is defined as the complaint of involuntary leakage accompanied by or immediately preceded by urgency
General practitioners' experiences, attitudes, and opinions regarding the pneumococcal vaccination for adults: a qualitative study
Badertscher N, Morell S, Rosemann T, Tandjung R
International Journal of General Medicine , 2012, DOI: http://dx.doi.org/10.2147/IJGM.S38472
Abstract: eral practitioners' experiences, attitudes, and opinions regarding the pneumococcal vaccination for adults: a qualitative study Original Research (862) Total Article Views Authors: Badertscher N, Morell S, Rosemann T, Tandjung R Published Date November 2012 Volume 2012:5 Pages 967 - 974 DOI: http://dx.doi.org/10.2147/IJGM.S38472 Received: 24 September 2012 Accepted: 23 October 2012 Published: 20 November 2012 Nina Badertscher, Seraina Morell, Thomas Rosemann, Ryan Tandjung Institute of General Practice and Health Services Research, University of Zurich, Zurich, Switzerland Introduction: Diseases caused by Streptococcus pneumoniae generate substantial morbidity and mortality. Despite official recommendations to vaccinate everyone over the age of 64, the estimated vaccination rate for this target population is around 2%. In Switzerland, pneumococcal vaccinations are for the most part provided by general practitioners (GPs); in addition, a small number of patients get vaccinated during a hospital stay. We wanted to investigate GPs' attitudes and opinions about the pneumococcal vaccination in primary care and why it is so rarely provided. Methods: For this qualitative study, we conducted semistructured interviews with 20 GPs. Transcriptions of all interviews were analyzed following the technique of qualitative content analysis, supported by the ATLAS.ti software. Results: Most GPs reported that they know pneumococcal vaccination is recommended for several risk groups and elderly patients. As to reasons for the low vaccination rate, GPs mentioned the pneumococcal vaccination had little priority in daily practice, especially in comparison with the importance of other vaccinations, namely influenza. This low level of priority was supported by the fact that the GPs rarely ever experienced a case of a severe pneumococcal disease in their daily work. Furthermore, perceived insufficient evidence resulting from existing epidemiologic data and clinical trials enhanced the little attention given to the pneumococcal vaccination. Conclusion: We found the generally low level of priority given within a consultation, the missing awareness of this subject in daily practice, and the perception of epidemiologic and scientific data as insufficient, as the reasons for the low rate in pneumococcal vaccinations. Efforts to increase the epidemiologic data on the pneumococcal vaccination should be taken. To increase the vaccination rate, it would be necessary to raise the awareness and priority of the pneumococcal vaccination; a feasible way could be the combination of the seasonal flu vaccination campaign with a campaign for pneumococcal vaccination.
Perceptions and attitudes of clinicians in Spain toward clinical practice guidelines and grading systems: a protocol for a qualitative study and a national survey
Anna Kotzeva, Ivan Solà, José Carrasco, Petra del Campo, Francisco Gracia, Enrique Calderón, Idoia de Gaminde, Maria Estrada, Flora Martínez, Carola Orrego, Rafael Rotaeche, Flavia Salcedo, Paola Velázquez, Pablo Alonso-Coello
BMC Health Services Research , 2010, DOI: 10.1186/1472-6963-10-328
Abstract: A mixed-method design combining qualitative and quantitative research techniques will evaluate general practitioners (GPs) and hospital-based specialists in Spain with the objective of exploring attitudes and perceptions about CPGs and evidence grading systems. The project will consist of two phases: during the first phase, group discussions will be carried out to gain insight into perceptions and attitudes of the participants, and during the second phase, this information will be completed by means of a survey, reaching a greater number of clinicians. We will explore these issues in GPs and hospital-based practitioners, with or without previous experience in guideline development.Our study will identify and gain insight into the perceived problems and barriers of Spanish practitioners in relation to guideline knowledge and use. The study will also explore beliefs and attitudes of clinicians towards CPGs and evidence grading systems used to rate the quality of the evidence and the strength of recommendations. Our results will provide guidance to healthcare researchers and healthcare decision makers to improve the use of guidelines in Spain and elsewhere.Clinical practice guidelines (CPGs) are designed to support decision-making processes in patient care and are classically defined as "systematically developed statements to assist practitioners' and patients' decisions about appropriate healthcare for specific circumstances" [1]. While there is some evidence that CPGs improve outcomes when they are appropriately implemented, [2,3] there are numerous factors which influence their acceptability and use by healthcare providers [4].Some of the major barriers to guideline adherence can be related to practitioner, patient, organisational or guideline factors, [5-7] although practitioners appear to be a key factor. Aspects such as knowledge, perceptions of and attitudes toward CPGs in general, are professional-related. Other factors that affect the success of guideline impl
General practitioners' experiences, attitudes, and opinions regarding the pneumococcal vaccination for adults: a qualitative study  [cached]
Badertscher N,Morell S,Rosemann T,Tandjung R
International Journal of General Medicine , 2012,
Abstract: Nina Badertscher, Seraina Morell, Thomas Rosemann, Ryan TandjungInstitute of General Practice and Health Services Research, University of Zurich, Zurich, SwitzerlandIntroduction: Diseases caused by Streptococcus pneumoniae generate substantial morbidity and mortality. Despite official recommendations to vaccinate everyone over the age of 64, the estimated vaccination rate for this target population is around 2%. In Switzerland, pneumococcal vaccinations are for the most part provided by general practitioners (GPs); in addition, a small number of patients get vaccinated during a hospital stay. We wanted to investigate GPs' attitudes and opinions about the pneumococcal vaccination in primary care and why it is so rarely provided.Methods: For this qualitative study, we conducted semistructured interviews with 20 GPs. Transcriptions of all interviews were analyzed following the technique of qualitative content analysis, supported by the ATLAS.ti software.Results: Most GPs reported that they know pneumococcal vaccination is recommended for several risk groups and elderly patients. As to reasons for the low vaccination rate, GPs mentioned the pneumococcal vaccination had little priority in daily practice, especially in comparison with the importance of other vaccinations, namely influenza. This low level of priority was supported by the fact that the GPs rarely ever experienced a case of a severe pneumococcal disease in their daily work. Furthermore, perceived insufficient evidence resulting from existing epidemiologic data and clinical trials enhanced the little attention given to the pneumococcal vaccination.Conclusion: We found the generally low level of priority given within a consultation, the missing awareness of this subject in daily practice, and the perception of epidemiologic and scientific data as insufficient, as the reasons for the low rate in pneumococcal vaccinations. Efforts to increase the epidemiologic data on the pneumococcal vaccination should be taken. To increase the vaccination rate, it would be necessary to raise the awareness and priority of the pneumococcal vaccination; a feasible way could be the combination of the seasonal flu vaccination campaign with a campaign for pneumococcal vaccination.Keywords: prevention, Swiss primary care, barriers and facilitators, Streptococcus pneumoniae
Priority setting in health care: Attitudes of physicians and patients  [PDF]
Jeannette Winkelhage, Margrit Schreier, Adele Diederich
Health (Health) , 2013, DOI: 10.4236/health.2013.54094
Abstract:

Background: The opinion of physicians clearly counts in prioritizing health care, but there is little information on the rationales underlying treatment decisions and whether these rationales are accepted by patients. Objective: To compare physicians and patients regarding their understanding and use of therapeutic benefit and treatment costs as criteria for prioritizing health care. Methods: Seven physicians and twelve patients were purposefully selected to yield a heterogeneous sample. Participants were interviewed face-to-face, following a semi-structured topic guide comprising three scenarios that focused on interventions with low or unproven therapeutic benefit and high costs, respectively. For data analysis we used qualitative content analysis. Results: We found that patients and physicians differed in their understanding of therapeutic benefit, their expectations of what medicine can do and their use of costs as criteria for prioritizing health care. Physicians were less likely to assess a certain intervention as effec tive, and they less often accepted upper funding limits in health care. Unlike the physicians, patients raised non-medical aspects in decision making such as the patient’s consent and social inequalities. Conclusions: The revealed differences point toward the necessity to strengthen the doctor-patient communication, to improve information for patients about the possibilities and limits of health care and to gain a deeper understanding of their attitudes, wishes and concerns to reach an agreement by physicians and patients on the treatment to be implemented.

Attitudes and Perceptions about Clinical Guidelines: A Qualitative Study with Spanish Physicians  [PDF]
Ivan Solà, José Miguel Carrasco, Petra Díaz del Campo, Javier Gracia, Carola Orrego, Flora Martínez, Anna Kotzeva, Imma Guillamón, Enrique Calderón, Idoia de Gaminde, Arturo Louro, Rafael Rotaeche, Flavia Salcedo, Paola Velázquez, Pablo Alonso-Coello
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0086065
Abstract: Background Clinical guidelines (CGs) are popular for healthcare decision making but their acceptability and use by healthcare providers is influenced by numerous factors. Some of these factors are professional-related, such as knowledge and perceptions of and attitudes toward CGs in general. The aim of our study was to evaluate attitudes and perceptions of Spanish physicians towards CGs. Methods We coordinated six discussion groups with a total of 46 physicians. The participants were drawn from 12 medical specialties from both specialized and primary care. We recorded the sessions and transcribed the content verbatim. We analyzed the data using an approach based on the grounded theory. Results We identified two main constructs that defined the physicians' perceptions towards guidelines: knowledge and usefulness. “Knowledge” defined the theoretical meanings of guidelines, while “Usefulness” referred to the pragmatic approach to guidelines. These constructs were interrelated through a series of categories such as confidence, usability, accessibility, dissemination and formats. Conclusions In our study, the constructs that impacted most on physician's attitudes to clinical guidelines were knowledge and usefulness. The tension between the theoretical and the pragmatic constructs determined the attitudes and how physicians use guidelines. Groups developing guidelines should ask relevant clinical questions and develop implementable and context specific recommendations. Developers should be explicit and consistent in the development and presentation of recommendations.
Types of treatment collaboration between conventional and alternative practitioners – results from a research project at a Danish MS hospital
Lasse Skovgaard,Niels Haahr,Liv Bjerre,Laila Launs?
International Journal of Integrated Care , 2010,
Abstract: Introduction: More than 50% of the People with Multiple Sclerosis (PwMS) in Denmark use alternative treatment. Most of them combine alternative and conventional treatment, but PwMS often find that there is no dialogue, coordination or synergy between the parallel courses of treatment offered. For this reason the Danish Multiple Sclerosis Society conducted a research project to develop and examine different models for collaboration between conventional and alternative treatment providers. Materials and methods: Empirical material consist of individual interviews with practitioners, a group interview with practitioners, a group interview with professional staff at the Danish MS hospital that provided the organisational framework for the project, interviews with patients as well as written responses from participating treatment providers in connection with practitioner-researcher seminars held. Results: Collaboration between researchers and the treatment team resulted in the development examination of several models which describe the strengths and weaknesses of various types of collaboration. The models also show that the various types of collaboration place different requirements on the degree of 1) mutual acknowledgement and understanding among practitioners, 2) flexibility and resources in the organizational framework, and 3) patients' activities and own efforts, respectively. Perspectives: The relationship between integration and pluralism can contribute to a fruitful discussion in regards to the value of treatment collaboration. In addition to the many positive perspectives the characterise integration of different treatment modalities the project points to the importance of not overlooking the opportunities, values and potential inherent in a pluralistic ideal in the form of patients' own active efforts and the dynamism that can arise when the patient becomes a co-informant, co-coordinator and/or co-integrator.
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