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Background: Little is known about variations in the provision of chronic care services in primary care.Aim: To describe the frequency of chronic care services provided by GPs and analyse the extent of non-random variation in service provision.Design and Setting: Nationwide cohort study undertaken in Denmark using data from 2016.Method: Information on chronic care services was obtained from national health registers, including annual chronic care consultations, chronic care procedures, outreach home visits, and talk therapy. The associations between services provided, patient morbidity, and socioeconomic factors were estimated. Service variations were analysed, and excess variation related to practice-specific factors was estimated while accounting for random variation.Results: Chronic care provision was associated with increasing patient age, increasing number of long-term conditions, and indicators of low socioeconomic status. Variation across practices ranged from 1.4 to 128 times more than expected after adjusting for differences in patient population and random variation. Variation related to practice-specific factors was present for all the chronic care services that were investigated. Older patients with lower socioeconomic status and multimorbidity were clustered in practices with low propensity to provide certain chronic care services.Conclusion: Chronic care was provided to patients typically in need of health care, that is, older adults, those with multimorbidity, and those with low socioeconomic status, but service provision varied more than expected across practices. GPs provided slightly fewer chronic care services than expected in practices where many patients with multimorbidity and low socioeconomic status were clustered, suggesting inverse care law mechanisms. [ABSTRACT FROM AUTHOR]

Background: Guideline-adherent oral anticoagulant treatment (OAC) in atrial fibrillation (AF) remains a challenge. In Denmark, most patients with AF are treated in general practice. Nevertheless, determinants of OAC prescription in primary care are poorly understood., Aim: To investigate variation in OAC adherence between general practice clinics and identify clinic characteristics associated with a lower propensity to prescribe OAC., Design & Setting: Nationwide register-based cohort study including prevalent and incident patients with AF and CHA 2 DS 2 -VASc score≥2 ( n =165,731) listed with Danish general practice clinics ( n =1666) in 2021., Method: The main outcome was OAC adherence assessed as proportion of days covered. We used clinic OAC propensity to evaluate variation. OAC propensity was quantified as ratios between observed and expected adherence. Expected adherence was estimated based on the composition of the clinic patient populations. Sampled reference populations were constructed to account for random variation. Linear regression models examined associations between OAC propensity and clinic characteristics., Results: The proportion of days covered with OAC in the AF-population was 78%. OAC propensity in clinics in the 90 th percentile was 20% higher compared to clinics in the 10 th percentile, however this difference was reduced to 3% when accounting for random variation. Modest associations were observed between clinic characteristics and OAC propensity. The most significant difference was in the correlation between geographic location and OAC propensity, showing an 8% gap between top- and bottom-performing regions., Conclusion: The study suggests persistent underutilisation of OAC in AF patients and little variation in OAC prescription patterns across general practice clinics., (Copyright © 2024, The Authors.)

Background: Somatisation is highly prevalent in primary care (present in 25% of visiting patients) but often goes unrecognised. Non-recognition may lead to ineffective treatment, risk of iatrogenic harm, and excessive use of healthcare services., Aim: To examine the effect of training on diagnosis of somatisation in routine clinical practice by general practitioners (GPs)., Design of Study: Cluster randomised controlled trial, with practices as the randomisation unit., Setting: Twenty-seven general practices (with a total of 43 GPs) in Vejle County, Denmark., Method: Intervention consisted of a multifaceted training programme (the TERM [The Extended Reattribution and Management] model). Patients were enrolled consecutively over a period of 13 working days. Psychiatric morbidity was assessed by means of a screening questionnaire. GPs categorised their diagnoses in another questionnaire. The primary outcome was GP diagnosis of somatisation and agreement with the screening questionnaire., Results: GPs diagnosed somatisation less frequently than had previously been observed, but there was substantial variation between GPs. The difference between groups in the number of diagnoses of somatisation failed to reach the 5% significance (P = 0.094). However, the rate of diagnoses of medically unexplained physical symptoms was twice as high in the intervention group as in the control group (7.7% and 3.9%, respectively, P = 0.007). Examination of the agreement between GPs' diagnoses and the screening questionnaire revealed no significant difference between groups., Conclusion: Brief training increased GPs' awareness of medically unexplained physical symptoms. Diagnostic accuracy according to a screening questionnaire remained unaffected but was difficult to evaluate, as there is no agreement on a gold standard for somatisation in general practice.

On the basis of structured interviews with 146 parents, this study describes why and when parents of acutely ill children seek the out-of-hours service, what actions they might have taken beforehand, and their expectations as to the outcome of the consultation. A total of 46% of the parents did not consider their child's condition to be serious, but 12% throught that their child was very ill. Parents sought medical advice because of what they perceived to be a lack of control of the condition (49%), fear of a serious disease (17%), and for symptom relief (34%). All except three parents expected there to be an examination of their child, and 79% expected an explanation or a diagnosis. Only 13% spontaneously mentioned that they expected a prescription. It is clinical and communicative skills that prevail in promoting successful consultations in this setting.