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Background General practitioners (GPs) diagnose and manage a majority of headache patients seeking health care. With the aim to understand the potential for clinical improvement and educational needs, we performed a study to investigate Norwegian GPs knowledge about headache and its clinical management. Methods We invited GPs from a random sample of 130 Norwegian continuous medical education (CME) groups to respond to an anonymous questionnaire survey. Results 367 GPs responded to the survey (73% of invited CME groups, 7.6% of all GPs in Norway). Mean age was 46 (SD 11) years, with an average of 18 (SD 10) years of clinical experience. In general the national treatment recommendations were followed, while the International Classification of Headache Disorders and other international guidelines were rarely used. Overall, 80% (n = 292) of the GPs suggested adequate prophylactic medication for frequent episodic migraine, while 28% (n = 101) suggested adequate prophylactic medication for chronic tension-type headache (CTTH). Half (52%, n = 191)) of the respondents were aware that different types of acute headache medication can lead to medication-overuse headache (MOH), and 59% (n = 217) knew that prophylactic headache medication does not lead to MOH. GPs often used MRI in the diagnostic work-up. GPs reported that lack of good treatment options was a main barrier to more optimized treatment of headache patients. Conclusion The knowledge of management of CTTH and MOH was moderate compared to migraine among Norwegian GPs.

All Norwegian municipalities have a statutory duty to employ a District Medical Officer as their medical advisor, but they are free to decide where this role should be placed in the municipal hierarchy. The position's contracted working hours, seniority and job content vary between municipalities. We conducted a survey to increase our understanding of how District Medical Officers see their own role.Data were collected by conducting focus group interviews with fifteen District Medical Officers from various municipalities and counties. The data were subjected to thematic qualitative analysis involving systematic text condensation.All the District Medical Officers had advisory roles and many reported limited access to formal decision-making arenas. They typically saw their role as poorly defined and felt a sense of invisibility, but this perception was combined with considerable autonomy. Most of the District Medical Officers reported that they felt caught between demands for advice at two different levels: clinical advice relating to individual cases and general public health advice to local authorities. This sense of being squeezed was more pronounced among District Medical Officers in large municipalities than in small municipalities. Organisational contexts and managerial expectations played a part in creating greater demand for clinical advice. This curbed the development of a public health identity and role.District Medical Officers have a hybrid role as multi-level advisors, and this requires them to adopt several identities. In order to bolster the public health aspect, their role must be made clearer by introducing appropriate expectations and organisational contexts within the municipality.

External inspections constitute a key element of healthcare regulation. Improved quality of care is one of the important goals of inspections but the mechanisms of how inspections might contribute to quality improvement are poorly understood. Drawing on interviews with healthcare professionals and managers and health record data from inspected organizations, we used a realist evaluation approach to explore how twelve inspections of healthcare providers in x= Norway influenced quality improvement. We found that for inspections to contribute to quality improvement, there must be contextual structures present supporting accountability and engaging staff in improvement work. When such structures are present, inspections can contribute to improvement by creating awareness of gaps between desired and current practices, which leads to readiness for change and stimulates intra-organizational reasoning around quality improvement. We discuss our findings using the theory of de- and recoupling, noting how regulators can identify decoupling between intended goals, management systems, practices, and patient outcomes. We further argue that regulators can contribute to a recoupling between these levels by having the capacity to track the providers' clinical performance over time. This will hold the organization accountable for implementing improvement measures and evaluate the effects of the measures on quality of care. publishedVersion

BackgroundA leadership development programme (The Health Leadership School) was launched in 2018 for junior doctors and medical students in Norway.ObjectiveTo study participants’ experiences and self-assessed learning outcomes, and if there were any differences in outcome among participants who met face-to-face versus and those who had to complete half of the programme in a virtual classroom due to the COVID-19 pandemic.MethodsParticipants who completed The Health Leadership School in 2018–2020 were invited to respond to a web-based questionnaire.ResultsA total of 33 (83%) out of 40 participants responded. The majority of respondents (97%) somewhat agreed or strongly agreed that they had gained knowledge and skills they did not learn in medical school. Respondents reported a high learning outcome for most competency domains, and there was no difference in outcome when comparing scores of those who met face-to-face versus and those who had to complete half of the programme in a virtual classroom. Among participants who participated in virtual classroom sessions due to the COVID-19 pandemic, the majority agreed that the programme could be run as a combination of face-to-face and virtual sessions.ConclusionThis brief report suggests that leadership development programmes for junior doctors and medical students can be run in-part using virtual classroom sessions, but that face-to-face sessions are important to foster relational and teamwork skills.

BAKGRUNN Alle kommuner er lovpålagt å ha en kommunelege som medisinskfaglig rådgiver, men bestemmer selv organiseringen av rollen. Stillingsstørrelse, plassering og innhold varierer mellom ulike kommuner. Vi gjorde en studie for å få økt kunnskap om hvordan kommuneoverleger opplever sin egen rolle. MATERIALE OG METODE Det ble samlet data fra fokusgruppeintervjuer med 15 kommuneoverleger fra ulike kommuner og fylker. Dataene ble gjenstand for tematisk kvalitativ analyse med bruk av systematisk tekstkondensering. RESULTATER Alle kommuneoverlegene var i rådgiverfunksjoner, og mange oppga liten tilgang på formelle beslutningsarenaer. Deres opplevelse var preget av rolleuklarhet og usynlighet, men også stor grad av autonomi. De fleste kommuneoverlegene ga uttrykk for å stå i skvis mellom behovene for rådgivning på to ulike nivåer: klinisk rådgivning i enkeltsaker og overordnet samfunnsmedisinsk rådgivning til ledelsen i kommunen. Opplevelsen var tydeligere hos kommuneoverleger i større kommuner enn i små. Organisatorisk ramme og forventninger fra ledelsen bidro til overvekt av etterspørsel etter klinisk rådgivning. Dette begrenset utviklingen av en samfunnsmedisinsk identitet og rolleutøvelse. FORTOLKNING Kommuneoverleger står i en hybridrolle som rådgivere på ulike nivåer som krever ulike identiteter. For å styrke den samfunnsmedisinske utøvelsen må rollen tydeliggjøres gjennom organisatoriske rammer og forventninger i kommunen.

Background Huntington’s disease (HD) is a progressive genetic neurodegenerative disease accompanied by mental and neurocognitive disabilities, which requires long-term and comprehensive treatment and care. Information on the health and economic burden of HD is scarce, but essential for conducting health economic analyses, in light of the prospect of new therapies for HD. In this study, we aim to identify values for Health-Related Quality of Life (HRQoL), describe service utilization and costs, and their associations with clinical and socio-demographic variables across all phases of HD. Methods A cross-sectional study including 86 patients across all phases of HD. Values of HRQoL were calculated based on EQ-5D-3L index scores. Additionally, health care and societal costs were estimated based on service utilization collected using the Client Service Receipt Inventory (CSRI) and data from the patients’ interviews. Total societal costs included costs of primary and secondary health care services, informal care and productivity loss of the patients. Multiple regression analyses were used to investigate associations between socio-demographic and clinical variables on HRQoL and costs. Results HRQoL values declined, while total costs increased across disease severity. Total six-month healthcare costs and total societal costs were € 18,538 and € 66,789 respectively. Healthcare and societal costs doubled from early to middle phase, and tripled from middle to advanced disease phase. Main six-month cost components for the three disease phases were informal care costs (€ 30,605) accounting for approximately half the total societal costs, and costs due to production loss (€ 18,907) being slightly higher than the total healthcare costs. Disease severity and gender were found to have the strongest effect on both values of HRQoL and costs. Conclusions Reported values of HRQoL and costs including costs for production loss may be used in modelling the cost-effectiveness of treatment for HD. Our results highlight the crucial role the informal caregivers play in the care provided to HD patients in all disease phases. Future research should focus on the estimation of productivity loss among informal caregivers.