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  • 1.
    André, Malin
    et al.
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    Andén, Annika
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    Borgquist, Lars
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Rudebeck, Carl Edvard
    Kalmar County Council, Sweden University of Tromso, Norway .
    GPs decision-making - perceiving the patient as a person or a disease2012In: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 13, no 38Article in journal (Refereed)
    Abstract [en]

    Background: The aim of this study was to analyse the clinical decision making strategies of GPs with regard to the whole range of problems encountered in everyday work. less thanbrgreater than less thanbrgreater thanMethods: A prospective questionnaire study was carried through, where 16 General practitioners in Sweden registered consecutively 378 problems in 366 patients. less thanbrgreater than less thanbrgreater thanResults: 68.3% of the problems were registered as somatic, 5.8% as psychosocial and 25.9% as both somatic and psychosocial. When the problem was characterised as somatic the main emphasis was most often on the symptoms only, and when the problem was psychosocial main emphasis was given to the person. Immediate, inductive, decision-making contrary to gradual, analytical, was used for about half of the problems. Immediate decision-making was less often used when problems were registered as both somatic and psychosocial and focus was on both the symptoms and the person. When immediate decision-making was used the GPs were significantly more often certain of their identification of the problem and significantly more satisfied with their consultation. Rules of thumb in consultations registered as somatic with emphasis on symptoms only did not include any reference to the individual patient. In consultations registered as psychosocial with emphasis on the person, rules of thumb often included reference to the patient as a known person. less thanbrgreater than less thanbrgreater thanConclusions: The decision-making (immediate or gradual) registered by the GPs seemed to have been adjusted on the symptom or on the patient as a person. Our results indicate that the GPs seem to recognise immediately both problems and persons, hence the quintessence of the expert skill of the GP as developed through experience.

  • 2.
    André, Malin
    et al.
    Linköping University, Department of Medicine and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    Andén, Annika
    Linköping University, Department of Medicine and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    Borgquist, Lars
    Linköping University, Department of Medicine and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    Rudebeck, Carl-Edvard
    Linköping University, Department of Medicine and Health Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Clinical Strategies in General Practice: GPs' Perceptions2009Article in journal (Other academic)
    Abstract [en]

    Background: General practice operates at the point of intersection between health care as a medical-technological and a humanistic enterprise, as manifested through the coherent attention given to both the patient as a person and to the disease.

    Objective: To analyse the problem-solving strategies of GPs with regard to problems encountered and presumed patient outcomes throughout the range of problems and patients encountered in the everyday work of the GP.

    Methods: Sixteen GPs from different areas of Sweden filled out questionnaires concerning 15-30 of their recent consecutive consultations.

    Results: In 94% of the consultations a somatic problem was registered, in 28% of these together with a psychosocial problem. Only a small fraction (5.8%) was registered as psychosocial problems only. In most of the consultations characterised as somatic, the main emphasis was on the symptoms only, whereas emphasis was given only to the person in consultations where the problem was registered as psychosocial. Immediate problem solving was used in about half of the consultations, where the patients were more often considered to be reassured, cope better and to be satisfied. With increasing psychosocial content of the consultations, the GPs registered more dissatisfaction, both for themselves and their patients.

    Limitations: The GPs were not randomly selected and the results are based solely on the GPs perceptions.

    Conclusions: The GPs seemed to adjust their problem solving (immediate or gradual) to the registered problem and furthermore adjust the immediate problem solving, focusing either on the problem or on the patient as a person. This might be regarded as the quintessence of the expert skill of the experienced GP.

  • 3.
    Andén, Annika
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    Outcomes from GPs' Consultations2009Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background and aims. Patients’ consultations with GPs can deal with a wide range of conditions and problems. Generally, consultation outcomes have been considered in evaluations but outcome has a meaning for elaboration of care beyond the graduating role of quality and other evaluation instruments. Knowledge about outcomes is needed for understanding and development. The aim of this thesis was to investigate outcomes of GPs’ consultations as directly experienced by patients and GPs and to investigate connections between clinical strategies and presumed patient outcomes.

    Methods. First, concepts describing outcomes from patients’ and GPs’ viewpoints were developed from interviews in groups and individually. Secondly, based on this, questionnaires about the consultation outcomes were formulated. Then, patients and GPs answered questionnaires regarding the same recent consultation. The numbers of the different outcomes were counted and the experiences of outcomes from the same consultations were compared. Finally, another questionnaire including both the GP outcome questions and questions about the clinical situation and decisions made was answered by GPs.

    Results. Concepts describing consultation outcomes were brought forward. Cure/symptom relief, reassurance, patient understanding and satisfaction were used by both patients and GPs to describe outcome of consultations. Only patients described as outcomes a confirmation of their ideas and a change in self-perception. GPs, but not patients, described the patient outcomes in terms of check-up and coping. Besides this, GPs also described other outcomes that concerned relationship-building, a change of surgery routines and self-evaluation. Selfevaluation was related to a perceived collegial consensus about right and wrong. The concordance between GPs and patients assessing the same consultations was high for satisfaction, intermediate for patient understanding and low for belief in cure/symptom relief. Clinical strategies were linked to outcomes. Immediate problem solving was registered in about half the consultations. When immediate problem solving was registered the patients were supposed to be more reassured, satisfied and coped better than after gradual problem solving. With increasing psychosocial content of the consultation the GPs registered more dissatisfaction both for themselves and their patients.

    Conclusions. Change in self- perception was a prominent patient outcome. GPs’ self-evaluations ought to have the inherent possibility to serve as a basis for development of general practice.

    The entire map of the encountered outcome concepts can serve as a basis for further research and development. The mapping of concepts can be of help when prioritising. Knowledge about the total picture of consultation outcomes can help the GP to understand the patients’ worlds better. It can also contribute to a realistic picture of possible consultation outcomes. The GPs seemed to adjust their problem solving (immediate or gradual) to the registered problem and furthermore adjust the immediate problem solving, focusing either on the problem or on the patient as a person.

    List of papers
    1. Satisfaction is not all: patients' perceptions of outcome of general practice consultations, a qualitative study
    Open this publication in new window or tab >>Satisfaction is not all: patients' perceptions of outcome of general practice consultations, a qualitative study
    2005 (English)In: BMC family practice, ISSN 1471-2296, Vol. 6, no 43Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND: Evaluation of outcome in general practice can be seen from different viewpoints. In this study we focus on the concepts patients use to describe the outcome of a consultation with a GP.

    METHOD: Patients were interviewed within a week after a consultation with a GP. The interviews were made with 20 patients in 5 focus groups and 8 individually. They were analysed with a phenomenographic research approach.

    RESULTS: From the patient's perspective, the outcome of a consultation is about cure or symptom relief, understanding, confirmation, reassurance, change in self-perception and satisfaction.

    CONCLUSION: General practice consultations are often more important for patients than generally supposed. Understanding is the most basic concept.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-18478 (URN)10.1186/1471-2296-6-43 (DOI)16242048 (PubMedID)
    Note
    Original Publication: Annika Andén, Sven-Olof Andersson and Carl-Edvard Rudebeck, Satisfaction is not all: patients' perceptions of outcome of general practice consultations, a qualitative study, 2005, BMC family practice, (6), 43. http://dx.doi.org/10.1186/1471-2296-6-43 Licensee: BioMed Central http://www.biomedcentral.com/ Available from: 2009-05-28 Created: 2009-05-28 Last updated: 2009-10-30Bibliographically approved
    2. To make a difference - how GPs conceive consultation outcomes: A phenomenographic study
    Open this publication in new window or tab >>To make a difference - how GPs conceive consultation outcomes: A phenomenographic study
    2009 (English)In: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 10, no 4Article in journal (Refereed) Published
    Abstract [en]

    Background: Outcomes from GPs consultations have been measured mainly with disease specific measures and with patient questionnaires about health, satisfaction, enablement and quality. The aim of this study was to explore GPs conceptions of consultation outcomes.

    Methods: Interviews with 17 GPs in groups and individually about consultation outcomes from recently performed consultations were analysed with a phenomenographic research approach.

    Results: The GPs conceived outcomes in four ways: patient outcomes, GPs self-evaluation, relationship building and change of surgery routines.

    Conclusion: Patient outcomes, as conceived by the GPs, were generally congruent with those that had been taken up in outcome studies. Relationship building and change of surgery routines were outcomes in preparation for consultations to come. GPs made self-assessments related to internalized norms, grounded on a perceived collegial professional consensus. Considerations of such different aspects of outcomes can inspire professional development.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-16883 (URN)10.1186/1471-2296-10-4 (DOI)
    Available from: 2009-02-22 Created: 2009-02-20 Last updated: 2017-12-13Bibliographically approved
    3. What happened? GPs' perceptions of consultation outcomes and a comparison with the experiences of their patients
    Open this publication in new window or tab >>What happened? GPs' perceptions of consultation outcomes and a comparison with the experiences of their patients
    2010 (English)In: European Journal of General Practice, ISSN 1381-4788, E-ISSN 1751-1402, Vol. 16, no 2, p. 80-84Article in journal (Other academic) Published
    Abstract [en]

    Objective: To investigate GPs’ perceptions of consultation outcomes and to investigate the associations between these and outcomes perceived by the patients. Design: 25 GPs and 10 patients for each GP filled in a questionnaire about the outcome of the same consultation. The questions in the questionnaires were formulated from concepts found in preceding qualitative studies. Their answers were analysed and compared. Setting: GPs and patients from 16 group practices in Norrbotten, Sweden. Results: The GPs had the apprehension that their consultations would lead to cure/symptom relief in half of their consultations. They believed that their patients were satisfied up to 90% and that up to 75% had been reassured, understood more or could cope better. The GPs were satisfied themselves with up to 95% of the consultations, they enhanced their relationship to their patient up to 70%. Their affirmative concordance with their patients was high regarding satisfaction, intermediate regarding patient reassurance and patient understanding and lowest regarding cure/symptom relief.

    Conclusion: The GPs’ were lacking in their ability to assess the patients’ increased understanding and the concordance between their own and the patients’ expectation of cure/symptom relief was low.

    Keywords
    Family Practice, Outcome, Outcome Assessment, Consultation, General Practitioner
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-18480 (URN)10.3109/13814780903528587 (DOI)20100110 (PubMedID)
    Available from: 2009-05-28 Created: 2009-05-28 Last updated: 2017-12-13Bibliographically approved
    4. Clinical Strategies in General Practice: GPs' Perceptions
    Open this publication in new window or tab >>Clinical Strategies in General Practice: GPs' Perceptions
    2009 (English)Article in journal (Other academic) Submitted
    Abstract [en]

    Background: General practice operates at the point of intersection between health care as a medical-technological and a humanistic enterprise, as manifested through the coherent attention given to both the patient as a person and to the disease.

    Objective: To analyse the problem-solving strategies of GPs with regard to problems encountered and presumed patient outcomes throughout the range of problems and patients encountered in the everyday work of the GP.

    Methods: Sixteen GPs from different areas of Sweden filled out questionnaires concerning 15-30 of their recent consecutive consultations.

    Results: In 94% of the consultations a somatic problem was registered, in 28% of these together with a psychosocial problem. Only a small fraction (5.8%) was registered as psychosocial problems only. In most of the consultations characterised as somatic, the main emphasis was on the symptoms only, whereas emphasis was given only to the person in consultations where the problem was registered as psychosocial. Immediate problem solving was used in about half of the consultations, where the patients were more often considered to be reassured, cope better and to be satisfied. With increasing psychosocial content of the consultations, the GPs registered more dissatisfaction, both for themselves and their patients.

    Limitations: The GPs were not randomly selected and the results are based solely on the GPs perceptions.

    Conclusions: The GPs seemed to adjust their problem solving (immediate or gradual) to the registered problem and furthermore adjust the immediate problem solving, focusing either on the problem or on the patient as a person. This might be regarded as the quintessence of the expert skill of the experienced GP.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-18481 (URN)
    Available from: 2009-05-28 Created: 2009-05-28 Last updated: 2009-08-17Bibliographically approved
  • 4.
    Andén, Annika
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice.
    andersson, s o
    Umeå.
    Rudebeck, Carl-Edvard
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice.
    Concepts underlying outcome measures in studies of consultations in general practice2006In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724Article in journal (Refereed)
  • 5.
    Andén, Annika
    et al.
    Linköping University, Department of Medicine and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    Andersson, Sven-Olof
    Department of Public Health and Clinical Medicine, Family Medicine, University of Umeå, SE-90185, Umeå, Sweden.
    Rudebeck, Carl-Edvard
    Kalmar County Council, Vårdcentralen Esplanaden, SE-59330 Västervik, Sweden.
    Satisfaction is not all: patients' perceptions of outcome of general practice consultations, a qualitative study2005In: BMC family practice, ISSN 1471-2296, Vol. 6, no 43Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Evaluation of outcome in general practice can be seen from different viewpoints. In this study we focus on the concepts patients use to describe the outcome of a consultation with a GP.

    METHOD: Patients were interviewed within a week after a consultation with a GP. The interviews were made with 20 patients in 5 focus groups and 8 individually. They were analysed with a phenomenographic research approach.

    RESULTS: From the patient's perspective, the outcome of a consultation is about cure or symptom relief, understanding, confirmation, reassurance, change in self-perception and satisfaction.

    CONCLUSION: General practice consultations are often more important for patients than generally supposed. Understanding is the most basic concept.

  • 6.
    Andén, Annika
    et al.
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Bergnäsets Vårdcentral, Luleå, Sweden .
    Andersson, Sven-Olof
    Umeå University, Sweden.
    Rudebeck, Carl-Edvard
    Kalmar City Council, Sweden.
    To make a difference - how GPs conceive consultation outcomes: A phenomenographic study2009In: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 10, no 4Article in journal (Refereed)
    Abstract [en]

    Background: Outcomes from GPs consultations have been measured mainly with disease specific measures and with patient questionnaires about health, satisfaction, enablement and quality. The aim of this study was to explore GPs conceptions of consultation outcomes.

    Methods: Interviews with 17 GPs in groups and individually about consultation outcomes from recently performed consultations were analysed with a phenomenographic research approach.

    Results: The GPs conceived outcomes in four ways: patient outcomes, GPs self-evaluation, relationship building and change of surgery routines.

    Conclusion: Patient outcomes, as conceived by the GPs, were generally congruent with those that had been taken up in outcome studies. Relationship building and change of surgery routines were outcomes in preparation for consultations to come. GPs made self-assessments related to internalized norms, grounded on a perceived collegial professional consensus. Considerations of such different aspects of outcomes can inspire professional development.

  • 7.
    Andén, Annika
    et al.
    Linköping University, Department of Medicine and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    André, Malin
    Centre for Clinical Research, Falun.
    Rudebeck, Carl-Edvard
    Kalmar County Council, Esplananden Health Care Centre, Västervik.
    What happened? GPs' perceptions of consultation outcomes and a comparison with the experiences of their patients2010In: European Journal of General Practice, ISSN 1381-4788, E-ISSN 1751-1402, Vol. 16, no 2, p. 80-84Article in journal (Other academic)
    Abstract [en]

    Objective: To investigate GPs’ perceptions of consultation outcomes and to investigate the associations between these and outcomes perceived by the patients. Design: 25 GPs and 10 patients for each GP filled in a questionnaire about the outcome of the same consultation. The questions in the questionnaires were formulated from concepts found in preceding qualitative studies. Their answers were analysed and compared. Setting: GPs and patients from 16 group practices in Norrbotten, Sweden. Results: The GPs had the apprehension that their consultations would lead to cure/symptom relief in half of their consultations. They believed that their patients were satisfied up to 90% and that up to 75% had been reassured, understood more or could cope better. The GPs were satisfied themselves with up to 95% of the consultations, they enhanced their relationship to their patient up to 70%. Their affirmative concordance with their patients was high regarding satisfaction, intermediate regarding patient reassurance and patient understanding and lowest regarding cure/symptom relief.

    Conclusion: The GPs’ were lacking in their ability to assess the patients’ increased understanding and the concordance between their own and the patients’ expectation of cure/symptom relief was low.

  • 8.
    Andén, Annika
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, General Practice.
    Wiborgh, Meta
    Bergnäsets VC .
    Långa sjukdskrivningar i Luleå, en studie av sjukskrivningar vid en vårdcentral2008In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 5, p. 369-375Article in journal (Other academic)
    Abstract [sv]

       

1 - 8 of 8
CiteExportLink to result list
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Cite
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  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • oxford
  • Other style
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Language
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  • en-GB
  • en-US
  • fi-FI
  • nn-NO
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