Danish GPs Research Articles

Do physicians' attitudes toward prioritization predict poor-health patients' access to care?

Physicians often face tight resource constraints, meaning they have to make trade-offs between which patients they care for and the amount of care received. Studies show that patients requiring many resources disproportionately suffer a loss of care when resources are constrained. This study uncovers whether physicians' attitudes toward prioritization of healthcare predicts poor-health patients' access to care. We combine unique survey data on Danish GPs' preferred prioritization principle with register data on their patients' contacts in general practice. We consider different types of contacts as the required effort could impact the need for prioritization. Our results show variation in GPs' prioritization principles, where a majority prefers a principle that may lead to an unequal distribution of services. We further find that GPs' attitudes toward prioritization predict some poor-health patients' access to general practice. GPs who state they prefer the principle of prioritizing patients in the poorest health state when resources tightened provide more contacts to poor-health patients. The additional contacts are typically high-effort contacts such as annual status meetings and home visits, but also low-effort contacts such as emails. Our findings indicate inequity in poor-health patients' access to care across general practices.

Barriers for continuous medical education: a cross-sectional questionnaire study among Danish GPs.

GPs' participation in continuous medical education (CME) is essential for patient care, GPs' wellbeing, and healthcare expenditure. However, one-quarter of Danish GPs did not use their reimbursement for CME in 2022. Knowledge of barriers for participating in CME is limited. To analyse the barriers GPs face to participation in CME, and patterns in perceived barriers. A cross-sectional questionnaire study design was used. The study population comprised all 3257 GPs in Denmark who, in May 2023, were registered as entitled to reimbursement for CME. The response rate was n = 1303/3257 (40%). Based on a question about use of CME, the responders were divided into 'frequent', 'partial', and 'seldom' users. Partial and seldom users answered questions about barriers related to CME (n = 726). The presence of barriers was quantified, and a latent class analysis (LCA) was used to stratify GPs according to their barrier patterns. The most frequent barriers were as follows: too busy (67%); fully booked courses (45%); and no substitute or locum doctor (39%). Based on the LCA, we found three distinctive patterns, clustering around the following: GPs from clinics with no tradition for CME (class 1, 17%); GPs who used time on professional work outside clinic (teaching, organisational work) (class 2, 43%); and GPs who were personally or professionally affected (class 3, 40%). Singled-handed and male GPs were slightly overrepresented among seldom users. We have identified barriers for CME. We found three different profiles of GPs who perceived different patterns of barriers. Identified patterns in barriers should be considered in future CME initiatives.

Going the extra mile? General practitioners' upcoding of fees for home visits.

General practitioners' (GPs') income often relies on self-reported activities and performances. They can therefore 'game the system' to maximize their remuneration. We investigate whether Danish GPs game their travel fees for home visits. Combining administrative and geographical data, we measure the difference between GPs' traveled and billed distances. We exploit a rise in the fees for home visits. If there is a link between the rise in fees and upcoding, we interpret this finding as indicative of gaming behavior. We find that upcoding occurs slightly more often than downcoding (16% vs. 13% of visits) for visits that can be both upcoded and downcoded. Using linear probability models with GP fixed effects, we find that the fee rise is associated with a reduction in upcoding of 0.6% of home visits (2.8% for visits where upcoding is feasible) and no change in downcoding. Importantly, we find no statistically significant differences in the reduction in upcoding across distance bands despite large differences in their fee rises. We therefore conclude that there is no causal evidence of GPs gaming their fees.

O.2.1-8 Who are suitable targets for a social prescribing intervention addressing physical activity? A survey-based study including viewpoints from general practitioners

Abstract Purpose Social prescribing has been suggested as an inter-sectoral intervention to increase physical activity. In the intervention, healthcare professionals refer patients or citizens to a link worker who is assisting them to locate peer-based activities in their local community. The present study investigated which groups of physically inactive adults the Danish general practitioners reported as relevant target groups for a social prescribing intervention to increase the level of physical activity. Methods The study design was a descriptive survey-based study. Danish general practitioners completed an online survey. On 10-point interval scales, they rated the suitability of referring 25 selected target groups of physically inactive adults (18+) with medical conditions or health-threatening behaviour to a social prescribing intervention to increase their level of physical activity. A score of 0 referred to not suitable at all, whereas a score of 10 indicated highly suitable. Using non-parametric statistics, target groups were considered eligible for an intervention if the 25th percentile had a score of 8 or above indicating that 75% of the GPs reported a score of 8 or above. Results A total of 52 general practitioners completed the survey. Of these, 75% reported a score of 8 or above to Danes with metabolic syndrome (median=10; 25th percentile=9), overweight (median=10; 25th percentile=9), diabetes (median=10; 25th percentile=8), and low back pain (median=9; 25th percentile=8) indicating these to be target groups of social prescribing to increase the level of physical activity. GPs considered the following groups less suitable for an intervention: persons with eating disorders (median=4; 25th percentile=2), migraine (median=5; 25th percentile=3), and women during postpartum (median=6; 25th percentile=3). Data from open-ended questions added nuances to the ratings and suggested citizens struggling with loneliness to be a new target group for social prescribing. Conclusions A majority of the responding Danish GPs identified persons with metabolic syndrome, overweight, diabetes, and low back pain as being target groups suited for a social prescribing intervention to increase the level of physical activity. These results are interesting since several approaches to impede the level of physical inactivity exist, and political and organizational efforts have become subject of the recent attention.

Are Drug Safety Advisories Compatible with Physicians’ Information Behaviour?

Physicians critically depend on up-to-date risk information when prescribing drugs, but they typically have little time to navigate the vast information. In the European Union, Direct to Healthcare Professional Communications (DHPC) letters are distributed to physicians to mitigate drug risks that emerge after market approval, but the letters show low impact. This study characterises general practitioners’ (GPs) information behaviour regarding drug safety and assesses the compatibility of DHPCs with the identified information behaviour. We conducted 17 semi-structured interviews and four follow-up interviews with Danish GPs about safety concerns and analysed them using Wilson’s model of information behaviour. We found that GPs primarily use an online drug monograph for point-of-care information needs and a newsletter from the authorities for clinical management strategies. They generally did not consider DHPCs a useful source of information. GPs argued that numerous sources contained the same information as the DHPC and believed these to be superior in terms of convenience, clinical relevance, and quality of evidence. A new digital mode of DHPC delivery from a public authority may improve the general adoption but also generated new problems. Overall, this suggests that DHPCs in their current form are not very compatible with information behaviour of GPs.

General Practitioners' Experiences of Professional Uncertainties Emerging from the Introduction of Video Consultations in General Practice: Qualitative Study.

BackgroundUncertainties are omnipresent in health care, but little is known about general practitioners’ (GPs) professional uncertainties concerning digital consultations. This is problematic, as many countries have undergone an extensive digital transformation.ObjectiveThe aim of this study was to explore the professional uncertainties that emerged among Danish GPs with the introduction of video consultations.MethodsWe conducted qualitative interviews with 15 Danish GPs during the beginning of the COVID-19 pandemic in 2020. The interviews were analyzed using an abductive approach.ResultsWe identified 3 categories of uncertainty: integrity, setting, and interaction. Respectively, these 3 categories of uncertainty refer to (1) uncertainties related to how technology may impede the provision of health care; (2) uncertainties related to the potentials of video technology; and (3) uncertainties related to how the video consultation technology affects interactions with patients.ConclusionsThe uncertainties experienced by Danish GPs appear to be a typical reaction to the introduction of new technology. Embedding video consultation technology into GPs’ working routines will take time, and GPs do not necessarily feel intuitively capable of transferring their abilities, such as being good and socially present for video-mediated consultations. The heterogeneity of professional uncertainties experienced among the GPs suggests that they are the product of individual GP-technology relationships—not of the technology in itself. Consequently, we cannot expect that uncertainties can be remedied by changing or precluding new technology.

Prescribing antibiotics: Factors driving decision-making in general practice. A discrete choice experiment

BackgroundAntimicrobial resistance is a threat to human health. We need to strive for a rational use of antibiotics to reduce the selection of resistant bacteria. Most antibiotics are prescribed in general practice, but little is known about factors influencing general practitioners’ (GPs) decision-making when prescribing antibiotics. AimTo 1) assess the importance of factors that influence decisions by GPs to prescribe antibiotics for acute respiratory tract infections (RTIs) and 2) identify segments of GPs influenced differently when deciding to prescribe antibiotics. MethodsA questionnaire survey including a discrete choice experiment was conducted. Danish GPs were asked to indicate whether they would prescribe antibiotics in six hypothetical choice sets with six variables: whether the GP is behind schedule, patient's temperature, patient's general condition, lung auscultation findings, C-reactive protein (CRP) level, and whether the patient expects antibiotics. Error component and latent class models were estimated and the probabilities of prescribing in different scenarios were calculated. ResultsThe questionnaire was distributed to every Danish GP (n = 3,336); 1,152 (35%) responded. Results showed that GPs were influenced by (in prioritised order): CRP level (Relative importance (RI) 0.54), patient's general condition (RI 0.20), crackles at auscultation (RI 0.15), and fever (RI 0.10). Being behind schedule and patient expectations had no significant impact on antibiotic prescription at the aggregate level. The latent class analysis identified five classes of GPs: generalists, CRP-guided, general condition-guided, reluctant prescribers, and stethoscopy-guided. For all classes, CRP was the most important driver, while GPs were heterogeneously affected by other drivers. ConclusionThe most important factor affecting Danish GPs’ decision to prescribe antibiotics at the aggregate level, in subgroups of GPs, and across latent classes was the CRP value. Hence, the use of CRP testing is an important factor to consider in order to promote rational antibiotic use in the battle against antimicrobial resistance.

Prescribing antibiotics: the use of diagnostic tests in general practice. A register-based study

Objective To assess (i) the pattern of antibiotic prescribing in Danish general practice, (ii) the use of diagnostic tests [point-of-care (POC) and tests analysed at the hospital laboratory (laboratory tests)], and (iii) the frequency of diagnostic testing in relation to antibiotic prescriptions. Design Retrospective cross-sectional register-based study. Setting General practice in a geographical area of Denmark covering 455,956 inhabitants. Subjects We studied redeemed antibiotic prescriptions and performed diagnostic tests in general practice from 2013 to 2017 among inhabitants in nine selected municipalities. Main outcome measures Frequency of antibiotic courses. Frequency and type of diagnostic testing performed in relation to types of antibiotics. Results A total of 783,252 antibiotic courses were redeemed from general practice with an overall decrease of 19% during 2013–2017. Diagnostic testing increased by 6% during this period. POC tests comprised the majority of performed diagnostic tests (83%) with C-reactive protein (CRP) as the most frequently used test. A 27% increase in the use of laboratory tests was observed. Tests were performed in relation to 43% of all antibiotic courses; most in relation to prescriptions for sulphonamide and trimethoprim (57%) and rarely when prescribing tetracyclines (10%). Conflicting with national guidelines, Danish GPs prescribed fluoroquinolones without performing any kind of diagnostic testing in 48% of the cases. Conclusions This study provides an overview of the use of diagnostic tests in relation to antibiotics and creates basis for further research into the variability between types of antibiotics. The study indicates that there is room for improvement to use diagnostic tests as an aid to promote prudent antibiotic use. KEY POINTS Diagnostic tests (point-of-care or tests analysed at the hospital laboratory), can increase diagnostic certainty and lead to a reduction in antibiotic use in general practice. A decrease in antibiotic courses in general practice in Denmark was observed during 2013–2017, while the use of diagnostic tests increased. A diagnostic test was performed in relation to 43% of antibiotic courses. Only 52% of prescribed fluoroquinolones was related to a diagnostic test, conflicting with national guidelines.

Oralizations in e-mail consultations: A study of general practitioners’ use of non-verbal cues in written doctor–patient communication

It is well-known that non-verbal cues are essential in doctor–patient communication. As doctor–patient communication is turning increasingly digital and written, it becomes relevant to explore the role of non-verbal cues in such communication genres. One more recent genre is the doctor–patient e-mail consultation. Research has found that while patients like e-mail consultations, they also miss facial expressions, eye contact, etc. In this study, we explored the different ways in which Danish GPs use non-verbal cues in e-mail consultations. We analysed 633 e-mail consultations written by 22 GPs. We applied the concept oforalization, which includes the use of emoticons and non-standard use of grammar and spatial arrangement. We found that the dominant types of oralizations were non-corrected spelling errors and lack of attention to capitalization. Overall, GPs used a limited number of other non-verbal cues. We discuss how these findings relate to norms of formality and professional context.

Physical activity through social prescribing: An interview-based study of Danish general practitioners' opinions.

Previous research suggested that regular physical activity (PA) is beneficial in both prevention and treatment of physical and mental conditions. Danish general practitioners' (GPs) have an ideal position to motivate inactive patients to increase their PA. Social prescribing (SP) enables GPs and other healthcare professionals in primary care to link patients to community-based activities of support provided by the community and the voluntary sector. This interview-based study aimed to explore viewpoints among Danish GPs regarding the advantages and disadvantages of applying SP to promote PA. The GPs were recruited through snowball sampling. Semi-structured interviews with nine Danish GPs were held via telephone or via Skype video conference. All interviews were audio-recorded and transcribed. Data were managed using the program NVivo 12 and analysed using the Framework Method procedure for analysis. The findings highlighted the need for tools to support GPs in providing an overview of patient-tailored options for PA in the local community. Advantages of applying SP to promote PA were related to the social aspect, the non-medical approach to a healthier lifestyle and the GPs' opportunity to signpost patients to PA in their local community. A supporting link-worker facilitating a bridge between general practice and community-based activities was identified as a pivotal component, specifically among patients with complex needs. Disadvantages of applying SP to promote PA were related to patients' expectations to general practice, stigmatising attitudes of society and lack of financial resources in patients. This study is the first to explore SP to promote PA in a Danish context. There is a need for an easy-to-use tool to support GPs in providing specific PA counselling. On this basis, SP appears as a promising tool for GPs to promote PA.

Defensive medicine in Danish general practice. Types of defensive actions and reasons for practicing defensively

Objective To examine the occurrence of and types of defensive medicine (DM), and the reasons for practicing DM in general practice. Design Prospective survey registration of consecutive consultations regarding defensive medicine defined as: Actions that are not professionally well founded but are carried out due to demands and pressure. The GPs registered the degree of defensiveness, the type(s) of defensive action(s) and the reason(s) for acting defensively. Setting Danish general practice. Subjects A total of 26 GPs registered a total of 1,758 consultations. Main outcome measures Defensive medical actions. Results Defensive actions were performed in 12% (210/1749) of all consultations. A fifth (46/210) of the defensive actions were characterised by the GPs as ‘moderately’ or ‘highly’ defensive. Frequent types of defensive actions were: blood tests, point-of-care-tests (POCTs) and referrals. Common reasons for defensive actions were: Influence from patients, 37% (78/210), concerns of overlooking severe disease, 32% (67/210) and influence from patient relatives, 12% (25/210). Conclusion Danish GPs registered self-perceived defensive actions in a prospective survey. DM was carried out in one out of eight consultations, most often due to patient influence. The most frequent defensive actions were blood tests, POCTs and referrals.

GP preferences for discussing statin deprescribing: a discrete choice experiment.

Deprescribing (planned, supervised discontinuation) of statins may be considered in some older persons. This should be carefully discussed between patients and GPs. We examined GPs' preferences for discussing statin deprescribing by conducting a discrete choice experiment (DCE) sent to a stratified random sample of 500 Danish GPs. Attributes were discussion topics (goals of therapy, evidence on statin use in older persons, adverse effects, uncertainty), and levels were the depth of the discussion topics (none, brief, detailed). We used mixed logistic regression for analysis. A total of 90 GPs (mean age 48, 54% female, mean 11 years in practice) completed the DCE. There was substantial variability in which topics GPs felt were most important to discuss; however, GPs generally preferred a brief discussion of topics to detailed ones. The most important discussion topic appeared to be goals of therapy. GPs felt a brief discussion of evidence was important but not a detailed one, while adverse effects and uncertainty were felt to be less important to discuss. GPs prefer brief discussions on a range of topics when discussing statin deprescribing but have differing views on which topics are most important. For deprescribing communication tools to be useful to GPs in clinical practice, they may need to focus on brief coverage of the range of relevant topics. Future work should evaluate patient preferences, and opportunities for education and training for GPs on deprescribing communication.

Danish GPs' Experiences When Managing Patients Presenting to General Practice with Symptoms of Acute Lower Respiratory Tract Infections: A Qualitative Study.

One of the most common indications for antibiotic prescribing in general practice is acute lower respiratory tract infections (LRTI). This study aimed to explore general practitioners’ (GPs’) considerations and experiences when managing patients with symptoms of an acute LRTI. Individual semi-structured interviews were conducted with seven GPs in the North Denmark Region from January to March 2020. Data were analysed by means of systematic text condensation. The analysis revealed four themes: (1) practicalities of assessing patients with LRTI, (2) assessment of the patient, (3) treatment decisions, and (4) patient expectations. The GPs described having developed individual diagnostic strategies and routines when managing patients with symptoms of an acute LRTI. However, a general assessment of the patient was essential to all the GPs and the diagnosis was seldom based on a single symptom or finding. Most GPs described having great faith in abnormal lung auscultation. The use of C-reactive protein testing served several purposes, such as deciding on the severity of the infection, prescribing antibiotics or not, and as a communicative tool. Diagnostic uncertainty is a driver of antibiotic use and clinical practice might benefit from the development of clinical prediction rules for diagnosing pneumonia.

Home sweet home: GPs' response to an increase in the fee size for home visits.

In many health care systems GPs receive fees for their services. Policymakers may use the size of these fees to try to incentivise GPs to provide more care. However, evidence is mixed on whether and how GPs respond to an increase in the fee size. This study investigates how GPs respond to an average increase of 150% in the fee for a high-effort and infrequent service such as a home visit due to patients' illness. We consider Danish GPs' provision of these visits to enlisted patients living outside of nursing homes. Using linear regressions with general practice fixed effects and a rich number of control variables, we estimate the association between GPs' provision of these home visits and the fee rise. On average, we find no association between the fee rise and GPs' provision of home visits. However, we find that GPs who previously provided the fewest home visits to eligible patients increase their provision by 13% after the fee rise compared to other GPs. This increase in visits is driven by more patients receiving multiple visits after the fee rise. We conclude that a fee rise may not yield a strong response in GPs' provision of high-effort and infrequent services such as home visits.

Not just an information-delivery tool. An ethnographic study exploring Danish GPs’ perspectives on and experiences with the relational potential of email consultation

Objective To explore GPs’ perspectives on and daily experiences with the relational potential of email consultations. Design Qualitative study with data from participant observation and semi-structured interviews Setting General practice setting in Denmark Subjects Practice personnel from four clinics were observed and 16 GPs (seven women and nine men, between 35 and 70 years of age) interviewed. Field notes and interview data were analysed using an inductive thematic analysis approach. Main outcome measures Main themes and subthemes reporting GPs’ perspectives on and experiences with the relational potential of email consultations. Results The analyses showed that due to perceived interpretational shortcomings, the GPs generally experienced email consultation as unsuitable for communication about relational, socio-emotional and sensitive matters. In doctor–patient relationships founded on mutual knowledge and trust, the email consultation was however used as a supportive communication channel, as a way for the patient to express emotions and affect and for the GP to proactively show interest and compassion towards the patient. Conclusion Email consultations were highly context-variant. Within continuing relationships and in conjunction with face-to-face consultations, email consultation was used for supportive communication holding the potential for maintaining, strengthening and/or dissolving the GP-patient relationship. Therefore, email consultation is not simply an information-delivery tool but also holds more explicit relational potentials. KEY POINTS Overall, the GPs perceived email consultation as unsuitable for non-medical, relationship-oriented purposes. Nonetheless, the GPs experienced that email consultations oftentimes comprised communication about relational and socio-emotional issues. Knowledge of the patient was a vital factor for the GP’s comfort in and acceptability of relational functions of email consultation. Email consultation is not simply an information-delivery tool as it holds the potential for maintaining, strengthening and/or dissolving the GP-patient relationship.

Does accreditation affect the job satisfaction of general practitioners? A combined panel data survey and cluster randomised field experiment

A critical question for policy makers in health care is whether external interventions have unintended consequences such as lowering professionals’ job satisfaction. We investigate whether a non-monetary incentive, in the form of mandatory accreditation, affects the job satisfaction of Danish GPs. Accreditation of general practice in Denmark was introduced as a cluster randomised stepwise implementation from 2016 to 2018. We measure job satisfaction at three time points: before the randomisation took place, one year into the accreditation process and two years into the accreditation process. We use a balanced panel of GPs who have completed all three waves of the survey (n = 846) and estimate a series of random and mixed effects ordered logit models. Despite many GPs having negative attitudes towards accreditation, we find no evidence of accreditation affecting GP job satisfaction. However, there are negative associations between job satisfaction and perceiving accreditation as a tool for external control. Policy makers are therefore encouraged to carefully inform about new interventions and identify barriers to diminish pre-existing negative perceptions about the incentive.

Exploring how GPs discuss statin deprescribing with older people: a qualitative study.

BackgroundGiven uncertainty surrounding benefits and harms, shifts in patient health status, and changing patient goals and preferences, statin deprescribing may be considered in some older people. This decision should be carefully discussed between GPs and patients.AimTo explore how GPs discuss deprescribing of statins with their older patients.Design & settingA qualitative study was undertaken using face-to-face, semi-structured interviews with Danish GPs from the regions of Southern Demark and Zealand.MethodThe GP participants belonged to group practices and were identified from personal networks and snowballing. The interviews lasted approximately 30 minutes and were conducted in English. They were analysed using systematic text condensation.ResultsA total of 11 GPs were interviewed and three themes were identified. (1) Reason for initiating a discussion: statin deprescribing mainly came up when GPs reviewed medication lists. There were differences between GPs regarding when or if they brought up deprescribing. (2) Discussion topics: GPs often discussed their interpretation of evidence surrounding statin use in older people. There were differences in how and if GPs discussed patient preferences. GPs viewed uncertainty and life expectancy as difficult to discuss. (3) Depth of discussion: the perceived level of patient engagement, and clinical context, could influence the extent of discussion.ConclusionGPs identified a range of topics that could be discussed with patients surrounding statin deprescribing. The depth and content of discussions varied according to the situation, and between GPs. Challenges may exist in communicating around certain topics, such as uncertainty and life expectancy. Further understanding of how to best communicate around challenging topics, and development of structured frameworks, may help facilitate statin deprescribing discussions. Identifying what patients think is important to discuss would provide necessary insight to promote quality discussions and shared understanding of the decision.

Influence of patient multimorbidity on GP burnout: a survey and register-based study in Danish general practice.

BackgroundPatient multimorbidity and GP burnout are increasing problems in primary care and are potentially related.AimTo examine whether patient multimorbidity was associated with GP burnout in a Danish primary care setting.Design and settingQuestionnaire data from 1676 Danish GPs and register data on their patients.MethodGPs completed the Maslach Burnout Inventory. Patients listed in a national registry with ≥2 chronic physical diseases from a list of 10 were classified with multimorbidity. For each practice, crude and sex- and age-standardised rates of multimorbidity were calculated, the latter computed as a weighted average with the weights taken from a reference population (5 646 976 Danish citizens). Data were analysed with logistic regression and adjusted analyses included GPs’ age and sex, number of GPs in practice, and socioeconomic deprivation among patients as covariates.ResultsA high crude rate of patient multimorbidity increased GPs’ likelihood of burnout (odds ratio [OR] 1.79, 95% confidence interval [CI] = 1.13 to 2.82), and when adjusting for covariates the association remained significant when comparing GPs in the third highest quartile of the multimorbidity rate against GPs in the lowest quartile (OR 1.64, 95% CI = 1.02 to 2.64). The sex- and age-standardised patient multimorbidity rate was not associated with GPs’ likelihood of burnout.ConclusionA high crude rate of patient physical multimorbidity increased the likelihood of burnout among GPs. The sex- and age-standardised rate of multimorbidity was not related to GPs’ likelihood of burnout. Thus, the absolute amount of multimorbidity, and not the relative, affects the GP’s burnout risk. GPs with high numbers of patients with complex needs should be supported to prevent suboptimal care and GP burnout.

Danish GPs’ and practice nurses’ management of acute sore throat and adherence to guidelines

Sore throat is a frequent presentation of acute respiratory tract infections in general practice. Though these infections are often harmless and self-limiting, antibiotics are frequently prescribed. In Denmark, practice nurses manage an increasing part of patients with acute minor illnesses. We aimed (i) to investigate Danish practice nurses' and GPs' management of patients presenting with a sore throat and (ii) to explore to what extent management is according to current Danish guidelines. A cross-sectional study was conducted during winter 2017, involving GPs and practice nurses in Danish general practices. Patients with a sore throat were registered according to the Audit Project Odense method. A total of 44 practices participated with the registration of 1503 patients presenting with a sore throat. Most patients had a strep A test performed, especially when managed by a practice nurse (84.6% versus 61.8%, χ2 = 90.1, P < 0.05). In total, 40.6% of performed strep A tests were not according to guideline recommendations. Antibiotics were prescribed for about one-third of patients, regardless whether managed by a practice nurse or a GP (χ2 = 0.33, P = 0.57). However, 32.4% of these prescriptions were not in line with Danish guidelines. Patients with acute sore throat were managed similarly by GPs and practice nurses, apart from a higher use of strep A tests in patients seen by practice nurses. Importantly, this study demonstrated that there is still room for improvement of the management of these patients in Danish general practice.

Variation in general practitioners’ information-seeking behaviour – a cross-sectional study on the influence of gender, age and practice form

Objective: To assess general practitioners’ (GPs’) information-seeking behaviour and perceived importance of sources of scientific medical information and to investigate associations with GP characteristics.Design: A national cross-sectional survey was distributed electronically in December 2013.Setting: Danish general practice.Subjects: A population of 3440 GPs (corresponding to approximately 96% of all Danish GPs).Main outcome measures: GPs’ use and perceived importance of information sources. Multilevel mixed-effects logit models were used to investigate associations with GP characteristics after adjusting for relevant covariates.Results: A total of 1580 GPs (46.4%) responded to the questionnaire. GPs’ information-seeking behaviour is associated with gender, age and practice form. Single-handed GPs use their colleagues as an information source significantly less than GPs working in partnership practices and they do not use other sources more frequently. Compared with their younger colleagues, GPs aged above 44 years are less likely to seek information from colleagues, guidelines and websites, but more likely to seek information from medical journals. Male and female GPs seek information equally frequently. However, whereas male GPs are more likely than female GPs to find that pharmaceutical sales representative and non-refundable CME meetings are important, they are less likely to find that colleagues, refundable CME meetings, guidelines and websites are important.Conclusion: Results from this study indicate that GP characteristics should be taken into consideration when disseminating scientific medical information, to ensure that patients receive medically updated, high-quality care.KEY POINTSResearch indicates that information-seeking behaviour is associated with GP characteristics. Further insights could provide opportunities for targeting information dissemination strategies.Single-handed GPs seek information from colleagues less frequently than GPs in partnerships and do not use other sources more frequently.GPs aged above 44 years do not seek information as frequently as their younger colleagues and prefer other information sources.Male and female GPs seek information equally frequently, but do not consider information sources equally important in keeping medically updated.