Scandinavian journal of primary health care
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Scand J Prim Health Care · Sep 1985
Why do our patients see us? A study of reasons for encounter in general practice.
The patients' reasons for encounter were recorded in 10 278 personal doctor-patient contacts in nine Norwegian municipalities over a two-month period, and were classified according to a simplified version of the WHO "Reason for Encounter Classification". A two-dimensional classification system was used where each reason was classified according to the location and type of problem. Symptoms and complaints made up 64.9% of all encounters. ⋯ Psychological and social reasons were rather infrequent 3.1% and 0.3%. Compared with the frequencies of psychiatric and social diagnoses recorded in general practice, this indicates a discrepancy between the patient's own opinion of problems and the doctor's interpretations. Females had a significantly higher contact rate than males, mainly due to problems related to the genital system, inclusive of the breast.
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Scand J Prim Health Care · Sep 1985
Problems in intervention and evaluation. A case report of a community-based rehabilitation and activation programme for the elderly and disabled.
A rehabilitation and activation programme for elderly and disabled home nursing patients and home help clients was launched in Posio, Finland, in 1979. The evaluation of the controlled intervention programme took two years. ⋯ The difficulties of this evaluative study were many, one problem being the low quality of outcome measures. To carry out interdisciplinary evaluative studies, the following recommendations are proposed, based on the experiences of this study: the staff in charge should have previous experience of research; an outside researcher is recommended; the connected study should not be overemphasized, in order to avoid extra pressures on the workers; the time needed to develop the routines for collecting data and writing reports should be estimated in advance and divided between the collaborators; information should be collected by many methods; possible difficulties should be anticipated; besides a local organizing body, a separate, independent and interdisciplinary supervisory team is important; any intervention should be based on the interest of several instances.
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This study attempts to search for early indicators of the need for referral to permanent institutional care of the chronically ill and disabled already receiving home nursing and/or home help. The study population covered 218 home nursing patients and home help clients. ⋯ Four groups of factors were studied in order to search for the early indicators: age, sex, health including functional status and housing conditions. Referral to permanent institutional care was found to be related to old age (75+ years) disorientation to weekday and year, inability to wash oneself and diagnosed dementia senilis.
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Based on a review of the literature it can be said that a main obstacle to a rational approach to prevention and health promotion in the elderly, seems to be on the one side our lack of knowledge of what constitutes effective intervention, and on the other a feeling of great urgency--which may easily lead us astray. More basic information on factors influencing the individual rate of organ decline is needed, and controlled clinical trials of the effectiveness of different approaches to intervention are required. In the present state of things there is no need for therapeutic nihilism--important conditions causing distress and disability in old age are amenable to preventive action.
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Scand J Prim Health Care · Sep 1984
Early rehabilitation at home of elderly patients with hip fractures and consumption of resources in primary care.
From 1976 onwards an active rehabilitation programme has been applied to elderly patients with fresh hip fractures at the Department of Orthopaedics in Lund in Southern Sweden. This involves early mobilisation in the hospital (internal fixation and immediate weight-bearing) and at home, rehabilitation in cooperation with primary health care personnel from the time of the patient's admission. The purposes of this investigation were to evaluate the effect of this programme in primary care and to assess the consumption of resources for rehabilitation at home of patients with cervical or trochanteric hip fractures. ⋯ Patients with cervical fractures consumed less resources for rehabilitation than patients with trochanteric fractures. The total cost per patient was ten times higher for care at a convalescent-home than for rehabilitation at home through primary care. Early at home rehabilitation of elderly patients with hip fractures gives good results at a minimal cost and is thus of advantage both to the patient and to the community.