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Objective To assess the effects of a multifaceted educational intervention in Norwegian general practice aiming to reduce antibiotic prescription rates for acute respiratory tract infections and to reduce the use of broad spectrum antibiotics.Design Cluster randomised controlled study.Setting Existing continuing medical education groups were recruited and randomised to intervention or control.Participants 79 groups, comprising 382 general practitioners, completed the interventions and data extractions.Interventions The intervention groups had two visits by peer academic detailers, the first presenting the national clinical guidelines for antibiotic use and recent research evidence on acute respiratory tract infections, the second based on feedback reports on each general practitioner’s antibiotic prescribing profile from the preceding year. Regional one day seminars were arranged as a supplement. The control arm received a different intervention targeting prescribing practice for older patients.Main outcome measures Prescription rates and proportion of non-penicillin V antibiotics prescribed at the group level before and after the intervention, compared with corresponding data from the controls.Results In an adjusted, multilevel model, the effect of the intervention on the 39 intervention groups (183 general practitioners) was a reduction (odds ratio 0.72, 95% confidence interval 0.61 to 0.84) in prescribing of antibiotics for acute respiratory tract infections compared with the controls (40 continuing medical education groups with 199 general practitioners). A corresponding reduction was seen in the odds (0.64, 0.49 to 0.82) for prescribing a non-penicillin V antibiotic when an antibiotic was issued. Prescriptions per 1000 listed patients increased from 80.3 to 84.6 in the intervention arm and from 80.9 to 89.0 in the control arm, but this reflects a greater incidence of infections (particularly pneumonia) that needed treating in the intervention arm.Conclusions The intervention led to improved antibiotic prescribing for respiratory tract infections in a representative sample of Norwegian general practitioners, and the courses were feasible to the general practitioners.Trial registration Clinical trials NCT00272155.

Aim: Based on a multidisciplinary review of drug use in nursing home residents, this study aimed to identify the most frequent clinically relevant medication problems and to analyse them according to the drugs involved and types of problems. Methods: Cross sectional study auditing drug use by 1354 residents in 23 nursing homes in Bergen, Norway. Data were collected in 1997. A physician/pharmacist panel performed a comprehensive medication review with regard to indications for drug use and active medical conditions. The drug related problems were subsequently classified according to the drugs involved and types of problems (indication, effectiveness, and safety issues). Results: 2445 potential medication problems were identified in 1036 (76%) residents. Psychoactive drugs accounted for 38% of all problems; antipsychotics were the class most often involved. Multiple psychoactive drug use was considered particularly problematic. Potential medication problems were most frequently classified as risk of adverse drug reactions (26%), inappropriate drug choice for indication (20%), and underuse of beneficial treatment (13%).

ARTIs are frequently treated with antibiotics and often with broader spectrum agents than pcV, which is the recommended first-line antibiotic in the Norwegian guidelines. GPs with a high practice activity are, in general, more liberal with respect to the prescription of antibiotics for ARTIs, and the higher the antibiotic prescription rate, the larger the share of non-pcV agents.

BackgroundMedication-overuse headache (MOH) is common in the general population. We investigated effectiveness of brief intervention (BI) for achieving drug withdrawal in primary care patients with MOH.MethodsThe study was double-blind, pragmatic and cluster-randomised controlled. A total of 25 486 patients (age 18–50) from 50 general practitioners (GPs) were screened for MOH. GPs defined clusters and were randomised to receive BI training (23 GPs) or to continue business as usual (BAU; 27 GPs). The Severity of Dependence Scale was applied as a part of the BI. BI involved feedback about individual risk of MOH and how to reduce overuse. Primary outcome measures were reduction in medication and headache days/month 3 months after the intervention and were assessed by a blinded clinical investigator.Results42% responded to the postal screening questionnaire, and 2.4% screened positive for MOH. A random selection of up to three patients with MOH from each GP were invited (104 patients), 75 patients were randomised and 60 patients included into the study. BI was significantly better than BAU for the primary outcomes (p<0.001). Headache and medication days were reduced by 7.3 and 7.9 (95% CI 3.2 to 11.3 and 3.2 to 12.5) days/month in the BI compared with the BAU group. Chronic headache resolved in 50% of the BI and 6% of the BAU group.ConclusionsThe BI method provides GPs with a simple and effective instrument that reduces medication-overuse and headache frequency in patients with MOH.Trial registration numberNCT01314768.

Aim: To investigate associations between negative life experiences and common illnesses among adolescents. Methods: Cross‐sectional questionnaire study carried out at all lower secondary schools (10 grade) in Oslo, Norway, during 2000 and 2001 (n= 8316 pupils). Different negative life experiences and illnesses were addressed. Results: The participation rate was 88%. Among reported negative life experiences last year were a pressure felt to succeed (62%), death of a close person (26%), exposure to physical violence (22%), bullying at school (15%) and sexual violation (4%). A large number of the pupils had some chronic illness: hay fever (38%), eczema (29%) and asthma (13%). Reported illnesses the previous 12 month were: headache (56%), painful neck or shoulders (35%), sore throat at least three times (15%), lower respiratory tract infection (9%) and mental problems for which help was sought (7%). During the week prior to the survey, 26% of all girls had symptoms of a depressive disorder, while this applied to 10% of all boys. Fifty‐three percent of the boys (29% of the girls) who had depressive symptoms had been exposed to physical violence. Sexually violated boys had a high probability for seeking help for mental problems (OR = 4.9) and for frequent episodes of sore throat (OR = 2.5). Corresponding odds ratios for girls were 1.7 and 2.5, respectively. Conclusion: Common illnesses in adolescence are significantly associated with negative life experiences. In clinical encounters with adolescents not only should the presenting complaints be addressed, but also other common illnesses and relevant background factors such as negative life events.

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BackgroundOlder patients are at particular risk for adverse drug reactions. In older people, interventions targeting potentially inappropriate prescriptions (PIPs) are considered important measures to minimise drug-related harm, especially in the general practice setting where most prescriptions for older patients are issued. AimTo study the effects of a multifaceted educational intervention on GPs' PIPs for older patients. Design and settingThis was a cluster randomised, educational intervention study in Norwegian general practice. Pre-study data were captured from January 2005 MethodEighty continuing medical education (CME) groups (465 GPs) were randomised to receive the educational intervention on GPs' PIPs for older patients (41 CME groups; 256 GPs) or another educational intervention (39 CME groups; 209 GPs); these two groups acted as controls for each other. GPs' prescription data from before and after the intervention were assessed against a list of 13 explicit PIP criteria for patients aged ≥70 years. In the CME groups, trained GPs carried out an educational programme, including an audit, focusing on the 13 criteria and their rationale. ResultsA total of 449 GPs (96.6%) completed the study; 250 in the intervention group and 199 in the control group. After adjusting for baseline differences and clustering effects, a reduction relative to baseline of 10.3% (95% confidence interval = 5.9 to 15.0) PIPs per 100 patients aged ≥70 years was obtained. ConclusionEducational outreach visits with feedback and audit, using GPs as academic detailers in GPs' CME groups, reduced PIPs for older patients aged ≥70 years in general practice.