Practice variation in surgical procedures and IUD-insertions among general practitioners in Norway – a longitudinal study

Pahle, Andreas; Sørli, Daniel; Kristiansen, Ivar Sønbø; Deraas, Trygve Sigvart; Halvorsen, Peder Andreas

doi:10.1186/s12875-017-0581-9

Cited by 6 publications

(2 citation statements)

References 25 publications

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“…Although long-acting reversible contraceptives are safe and effective and IUDs are important to women’s sexual health [9], nearly one fifth of the GPs in our study did not insert IUDs. This is in accordance with Pahle et al’s registry study; only three out of four GPs in Norway were reimbursed in 2013 for insertion of IUDs [10]. The same study found considerable practice variation in IUD-insertions depending on the GPs gender, with female GPs having higher odds for performing IUD-insertions (OR 6.28, 95% CI 4.70–8.82) than male GPs.…”

Section: Discussionsupporting

confidence: 87%

The when and how of the gynaecological examination: a survey among Norwegian general practitioners

Hjörleifsson

Bjorvatn

Meland

et al. 2019

Scandinavian Journal of Primary Health Care

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Introduction: Little is known about the indications general practitioners (GPs) perceive as relevant for performing gynaecological examinations (GEs), how GPs master the GE and associated procedures, and how they handle the sensitive nature of GEs. Methods: In 2015, 70 medical students at the University of Bergen distributed a questionnaire to all 175 GPs in the practices they visited. The questions covered practical routines related to GEs, insertion of intrauterine device, frequency of GEs in different clinical settings and use of assisting personnel. Statistical analyses included chi-square tests and multiple logistic regressions adjusting for age, gender, specialization and localization. Results: Ninety male and 61 female GPs (87% of invited GPs) responded to the questionnaire. A minority (8%) usually had other staff present during GEs. Compared with female colleagues, male GPs performed bimanual palpation significantly less often in connection with routine Pap smear (AOR 0.3 (95% CI 0.1-0.6)). Twenty-eight percent of the GPs stated that they often/always omitted the GE if the patient was anxious about GE and 35% when the patient asked for referral to a gynaecologist. Omission was more frequent among male GPs. When the GP decided to refer to a gynaecologist based on the patient’s symptoms, more male than female GPs omitted GE (AOR 2.5 (95% CI 1.1-5.4)). Conclusion: Male gender of the GP may be associated with barriers to medical evaluation of pelvic symptoms in women, potentially leading to substandard care. Possibly, however, male GPs’ reluctance to perform the GE may also limit unnecessary bimanual palpation in asymptomatic women.

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Section: Discussionsupporting

confidence: 87%

The when and how of the gynaecological examination: a survey among Norwegian general practitioners

Hjörleifsson

Bjorvatn

Meland

et al. 2019

Scandinavian Journal of Primary Health Care

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“…If women in our study actually were referred to specialized health care for routine testing within The Norwegian Cervical Cancer Screening Programme, our results demonstrate overuse of specialist health care services as cervical screening is supposed to be a primary care undertaking. This reflects a recently observed shift from primary to specialized health care for insertion of intrauterine contraception [ 20 ]. The finding of high numbers of colposcopy, ultrasound, and “complete examinations” in cervical screening appointments adds to this overuse.…”

Section: Discussionmentioning

confidence: 99%

Extent, regional variation and impact of gynecologist payment models in routine pelvic examinations: a nationwide cross-sectional study

et al. 2017

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BackgroundBased on moderate quality evidence, routine pelvic examination is strongly recommended against in asymptomatic women. The aims of this study was to quantify the extent of routine pelvic examinations within specialized health care in Norway, to assess if the use of these services differs across hospital referral regions and to assess if the use of colposcopy and ultrasound differs with gynecologists’ payment models.MethodsNationwide cross-sectional study including all women aged 18 years and older in Norway in the years 2014–16 (2,038,747). Data was extracted from the Norwegian Patient Registry and Statistics Norway. The main outcome measures were 1. The number of appointments per 1000 women with a primary diagnosis of “Encounter for gynecological examination without complaint, suspected or reported diagnosis.” 2. The age-standardized number of these appointments per 1000 women in the 21 different hospital referral regions of Norway. 3. The use of colposcopy and ultrasound in routine pelvic examinations, provided by gynecologists with fixed salaries and gynecologists paid by a fee-for-service model.ResultsAnnually 22.2 out of every 1000 women in Norway had a routine pelvic examination, with variation across regions from 6.6 to 43.9 per 1000. Gynecologists with fixed salaries performed colposcopy in 1.6% and ultrasound in 74.5% of appointments. Corresponding numbers for fee-for-service gynecologists were 49.2% and 96.2%, respectively.ConclusionsRoutine pelvic examinations are widely performed in Norway. The variation across regions is extensive. Our results strongly indicate that fee-for-service payments for gynecologists skyrocket the use of colposcopy and increase the use of ultrasound in pelvic examinations of asymptomatic women.Electronic supplementary materialThe online version of this article (10.1186/s12905-017-0471-2) contains supplementary material, which is available to authorized users.

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Changes in General Practitioners’ consultation frequency over time for patients with hypertension or anxiety/depression symptoms: a 10-year follow-up of the Norwegian HUNT study

et al. 2019

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Background General Practitioners’ (GPs’) workload has been suggested to increase in many countries; how does this impact patient follow-up? Objective To investigate trends in GP consultation patterns for adults according to baseline hypertension and anxiety/depression symptoms and attribution of the GP to trend differences. Methods Prospective cohort study, linking survey data and clinical measurements from the Norwegian HUNT3 study (2006–08) with national administrative data on GP list assignment and consultations with GP services. We grouped participants aged 40–59 years according to sex and their baseline status regarding hypertension and anxiety/depression symptoms. We registered GP consultations in 2007–16 and used general estimation equation models to estimate the level of GP consultations per month per year during follow-up. We used multilevel models with participants nested in their assigned regular GP to calculate GP-level intra-class correlation coefficients, reflecting to what extent patients’ consultation patterns could be attributed to the individual GP. Results In total, 47 550 HUNT3 participants were registered with 102 different GPs in Nord-Trøndelag County, Norway, in 2007. Adjusted for age, we observed an overall increase in GP consultations in 2007–16, particularly in those with a better health status at baseline. About 2% of the variance of patient consultations could be attributed to differences between GPs and 10% to the use of lengthy consultations. Out-of-hours consultations did not change much in the study period 2007–16. Conclusion Increased use of GP consultations, mainly among the healthiest participants, encourage further research into whether these patients displace patients with heavier and more complex needs.

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Practice variation in surgical procedures and IUD-insertions among general practitioners in Norway – a longitudinal study

Cited by 6 publications

References 25 publications

The when and how of the gynaecological examination: a survey among Norwegian general practitioners

The when and how of the gynaecological examination: a survey among Norwegian general practitioners

Extent, regional variation and impact of gynecologist payment models in routine pelvic examinations: a nationwide cross-sectional study

Changes in General Practitioners’ consultation frequency over time for patients with hypertension or anxiety/depression symptoms: a 10-year follow-up of the Norwegian HUNT study

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