Publications by authors named "Ivar J Aaraas"

14 Publications

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Nytt og nyttig for veiledere.

Authors:
Ivar J Aaraas

Tidsskr Nor Laegeforen 2018 01 22;138(2). Epub 2018 Jan 22.

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http://dx.doi.org/10.4045/tidsskr.17.0925DOI Listing
January 2018

'The Senja Doctor': developing joint GP services among rural communities in Northern Norway.

Rural Remote Health 2015 Jul-Sep;15(3):3101. Epub 2015 Aug 21.

National Center of Rural Medicine, University of Tromsø, Tromsø, Norway.

Senja, the second largest island in Norway, encompasses four municipalities. For decades the island has faced serious challenges concerning recruiting and retaining general practitioners (GPs). In 2001 the county medical officer suggested a plan for improvement of GP service based on inter-municipal collaboration. The plan was rejected by the three small and remote municipalities of Senja. In 2007, after further deterioration of the situation, one of the small municipalities initiated a process to establish a joint service. This was very similar to the one previously proposed by the county medical officer. Within the next few years all the municipalities gradually announced their interest in the development of Senjalegen - the Senja Doctor - an inter-municipal GP service. This has resulted in improved continuity of GP care to the population of Senja. In this article we present experiences and discuss effects of creating a robust professional environment securing support and guidance of young doctors. The importance of local involvement and ownership during development of a joint healthcare service is also discussed.
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October 2016

Supply of doctors to a rural region: Occupations of Tromsø medical graduates 1979-2012.

Med Teach 2015 26;37(12):1078-82. Epub 2015 Mar 26.

b University of Oslo , Norway.

Background: The aim of establishing the medical school in Tromsø in 1973 was to improve access to doctors and standards of health care for the previously underprivileged rural population of Northern Norway. In this study we examine how the aim of supplying doctors to the north has been achieved.

Material And Methods: By utilising a cross-sectional design we have analysed 34 classes of Tromsø medical graduates (1979-2012) with regard to occupations in 2013 by the year of graduation and by successive pools of cohorts.

Results: In 2013 altogether 822 of 1611 doctors (51%) were working in Northern Norway. The proportions working in the north for old, intermediate and young cohorts were 37%, 48% and 60%, respectively. Doctors graduating during recent years tended to start their careers in the north to a higher degree than doctors graduating in previous periods. Among doctors from the older classes a relatively large minority have their end-careers in Northern Norway, with a noticeable inclination for long term work in primary care.

Conclusion: Our results support that the first rural oriented medical education model in Europe established in Tromsø 40 years ago is sustainable, achieving its aims.
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http://dx.doi.org/10.3109/0142159X.2015.1009427DOI Listing
September 2016

Continuity of GP care is related to reduced specialist healthcare use: a cross-sectional survey.

Br J Gen Pract 2013 Jul;63(612):482-9

National Centre for Integrated Care and Telemedicine, University Hospital of Northern Norway, Tromsø, Norway.

Background: Continuity of GP care is associated with reduced hospitalisations, but solid documentation of its relationship to use of outpatient specialist services is lacking.

Aim: To test the association between continuity of GP care and use of inpatient and outpatient specialist services.

Design And Setting: A cross-sectional population-based study with questionnaire data from the sixth Tromsø Study (2007-2008).

Method: Descriptive statistics and two sample t-test were used to estimate specialist healthcare use according to duration of the GP-patient relationship. Logistic regression analysis was used to assess associations between duration and intensity of the GP-patient relationship and use of specialist care. Analyses were adjusted for sex, age, marital status, income, education, and self-rated health, and also stratified by self-rated health and age.

Results: Of 10,624 eligible GP users, 85% had seen the same GP for >2 years. The probability of visiting outpatient specialist services was significantly lower among these participants compared to those with a shorter GP relationship (odds ratio [OR] = 0.81, 95% confidence interval [95% CI] = 0.71 to 0.92). Similar findings were found for hospitalisations (OR = 0.76, 95% CI = 0.64 to 0.90). Stratified analyses revealed that these associations were not dependent on self-rated health or age. The probability of specialist use increased for the frequent GP users.

Conclusion: Continuity of GP care is associated with reduced use of outpatient specialist services and hospitalisations. Healthcare providers and policymakers who wish to limit use of specialist health care may do well to perform and organise health services in ways that support continuity in general practice.
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http://dx.doi.org/10.3399/bjgp13X669202DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3693805PMC
July 2013

Remuneration and organization in general practice: do GPs prefer private practice or salaried positions?

Scand J Prim Health Care 2012 Dec 10;30(4):229-33. Epub 2012 Oct 10.

National Centre of Rural Medicine, Department of Community Medicine, University of Tromsø, Norway.

Objective: In Norway the default payment option for general practice is a patient list system based on private practice, but other options exist. This study aimed to explore whether general practitioners (GPs) prefer private practice or salaried positions.

Design: Cross-sectional online survey (QuestBack).

Setting: General practice in Norway.

Intervention: Participants were asked whether their current practice was based on (1) private practice in which the GP holds office space, equipment, and employs the staff, (2) private practice in which the GPs hire office space, equipment, or staff from the municipality, (3) salary with bonus arrangements, or (4) salary without bonus arrangement. Furthermore, they were asked which of these options they would prefer if they could choose.

Subjects: GPs in Norway (n = 3270).

Main Outcome Measures: Proportion of GPs who preferred private practice.

Results: Responses were obtained from 1304 GPs (40%). Among these, 75% were currently in private practice, 18% in private practice with some services provided by the municipality, 4% had a fixed salary plus a proportion of service fees, whereas 3% had salary only. Corresponding figures for the preferred option were 52%, 26%, 16%, and 6%, respectively. In multivariate logistic regression analysis, size of municipality, specialty attainment, and number of patients listed were associated with preference for private practice.

Conclusion: The majority of Norwegian GPs had and preferred private practice, but a significant minority would prefer a salaried position. The current private practice based system in Norway seems best suited to the preferences of experienced GPs in urban communities.
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http://dx.doi.org/10.3109/02813432.2012.711191DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3520417PMC
December 2012

[Nurses and social care workers in emergency teams in Norway].

Tidsskr Nor Laegeforen 2011 Jan;131(1):28-31

Bjarkøy legekontor, 9426 Bjarkøy, Norway.

Background: The Norwegian counties Troms and Finnmark are dominated by large areas with widespread habitation and rather long response times for ambulances and doctors. We wished to investigate the extent to which the municipal preparedness in these counties use employees from the municipal nursing and social care services and if these are part of local emergency teams.

Material And Methods: In the autumn of 2008, we sent a questionnaire to the district medical officers and the leaders for municipal nursing and social care services in all 44 municipalities in Troms and Finnmark. The answers were analyzed manually.

Results: 41 municipalities responded. In 34 of these the municipal nurses and social care workers practice emergency medicine procedures. The content in these training sessions is much more comprehensive than that in a typical first aid course. In three of four municipalities ambulance personnel do not participate in this training. In 31 municipalities the inhabitants contact nurses and social care workers directly if they are acutely ill. In only 10 of the municipalities the nurses and social care workers are organized in local teams including a doctor and an ambulance.

Interpretation: In the districts, nursing and social care services are a resource in an emergency medicine context. The potential within these professions can be exploited better and be an important supplement in emergencies. In emergencies, cooperation across disciplines requires a clear organizational and economical structure, local basis and leadership.
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http://dx.doi.org/10.4045/tidsskr.10.0319DOI Listing
January 2011

Examination of final-year medical students in general practice.

Scand J Prim Health Care 2007 Dec;25(4):198-201

ISM, University of Tromsø, Tromsø, Norway.

With general practice recognized as one of three major subjects in the Tromsø medical school curriculum, a matching examination counterpart was needed. The aim was to develop and implement an examination in an authentic general practice setting for final-year medical students. In a general practice surgery, observed by two examiners and one fellow student, the student performs a consultation with a consenting patient who would otherwise have consulted his/her general practitioner (GP). An oral examination follows. It deals with the consultation process, the observed communication between "doctor" and patient, and with clinical problem-solving, taking today's patient as a starting point. The session is closed by discussion of a public-health-related question. Since 2004 the model has been evaluated through questionnaires to students, examiners, and patients, and through a series of review meetings among examiners and students. Examination in general practice using unselected, consenting patients mimics real life to a high degree. It constitutes one important element in a comprehensive assessment process. This is considered to be an acceptable and appropriate way of testing the students before graduation.
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http://dx.doi.org/10.1080/02813430701535660DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3379759PMC
December 2007

Making it Work 2: using a virtual community to focus on rural health issues.

Rural Remote Health 2006 Apr-Jun;6(2):540. Epub 2006 May 2.

Centre for Rural Health, University of Aberdeen, The Green House, Inverness, Scotland.

Between 21 and 23 September 2005, over 200 delegates from eight countries gathered in Tromsö, within the Arctic Circle, to discuss challenges and solutions to rural health issues. This conference was a sequel to a previous event entitled 'Making it Work', held in Scotland in 2003, in which it was identified that service delivery in remote and rural areas needed to be innovative to ensure equity. A major aim of this event was to move the debate forward to describe specific examples of practice that could be adopted in participating countries. The delegates included clinicians, managers and administrators, senior policymakers and educationalists, elected local and national politicians, patients and their representatives. In order to focus debate, the organisers provided an outline of a virtual remote community ('Hope'), including some geographic and demographic information, together with four case studies of individual health problems faced by residents of the community. During the introductory session, a short film was shown featuring the 'residents' of this community, introducing delegates to the specific problems they faced. Throughout the conference, delegates were asked to reflect back to how any recommendations made might apply to the citizens of Hope. The clinical scenarios presented included: (1) a 37 year old pregnant woman in labour during adverse weather conditions; (2) a 17 year old island resident with acute psychosis who attempts suicide; (3) an 80 year old woman living alone who suffers a stroke; and (4) a family of four with a complex range of chronic health issues including smoking, alcoholism, diabetes, teenage pregnancy, asthma and depression on a background of deprivation and unemployment. Parallel discussions and workshops focussed on a number of key themes linked to the examples highlighted in the 'Hope' scenario. These included: maternity services; mental health; chronic disease management; health improvement and illness prevention; supporting healthy rural communities; and education for rural health staff. This approach to targeting discussion is valuable in rural health conferences where the participants may be from diverse backgrounds and the issues discussed are multi-faceted.
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July 2006

[Examination in general practice at the University in Tromso].

Tidsskr Nor Laegeforen 2005 Aug;125(16):2221-3

Institutt for samfunnsmedisin, Universitetet i Tromsø, 9037 Tromsø.

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August 2005

[Access to general practitioners in a county in Troms].

Tidsskr Nor Laegeforen 2005 Aug;125(16):2210-2

Tromsø kommune, Rådhuset, 9299 Tromsø.

Background: In 2002 the Norwegian Board of Health made a survey of the accessibility of general practitioners in Troms county in North Norway.

Material And Methods: In a telephone interview one secretary in each surgery informed about telephone response time, planned time for telephone consultations, recorded numbers of urgent consultations, and waiting time to obtain a routine consultation.

Results: On average, the planned telephone time was two hours per week. Telephone time was in inverse proportion to the number of patients on the doctor's list. Rural doctors spent twice as much time as urban colleagues on the telephone with their patients. Doctors with lists between 500 and 1500 patients had a higher proportion of urgent consultations compared with doctors with shorter or longer lists.

Interpretation: Telephone response time below two minutes and waiting times for routine consultations below 20 days appear to be within acceptable norms. When patient lists are above 1500, doctors' capacity to offer telephone contact and emergency services to their patients seems reduced.
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August 2005

[Norwegian and Australian physicians' attitudes to adverse events].

Tidsskr Nor Laegeforen 2005 Aug;125(16):2204-6

Institutt for samfunnsmedisin, Universitet i Tromsø, 9037 Tromsø.

Background: As "second victims", doctors may find it difficult to meet patients and relatives with an open and regretting mind after adverse incidents.

Material And Methods: In a series of six workshops 103 doctors, 46 from Australia and 57 from Norway, were included. Initially the participants completed a questionnaire about possible reactions after serious adverse events, experiences with formal complaints and legal charges, and an option to describe a personally experienced adverse event. This was followed by an interactive educational session, where prevention and management of adverse events were discussed. A descriptive analysis based on a combination of questionnaire data and notes from the discussions has been performed.

Result And Interpretation: The questionnaire responses showed that Australian and Norwegian doctors mainly did agree about the most appropriate ways of responding after a serious adverse event. Subsequent discussions showed that certain issues were recurrently and similarly discussed among the participants through all the workshops. Although the majority principally did agree on an open approach, an underlying sceptical attitude emerged, partially connected to experiences of being thoughtlessly blamed by colleagues in the wisdom of hindsight. The study outlines a strategy to raise doctors' understanding of the importance of openness in order to reinforce trust in relation to all involved parties--patient, relatives, colleagues and self--after adverse events.
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August 2005

Reactions to adverse events among Australian and Norwegian doctors.

Aust Fam Physician 2004 Dec;33(12):1045-6

University of Tromsø, Norway.

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December 2004

[Sabbatical "down under"].

Tidsskr Nor Laegeforen 2002 Oct;122(24):2384-5

Psykiatrisk avdeling Asgård Universitetssykehuset Nord-Norge 9291 Tromsø.

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October 2002
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