Introduktion Medicinsk vetenskap och sjukvårdens möjligheter att hjälpa utvecklas ständigt. Sjukvården idag kan i många fall ställa rätt diagnos och ge en effektiv behandling för att bota den som drabbats av ohälsa. Radiologiska undersökningar är ett viktigt hjälpmedel men innebär också risker i form av strålning samt felaktigt resursanvändande. Syfte Syftet med förbättringsarbetet var att skapa en bättre användning av radiologi och följsamhet till medicinska riktlinjer så att patienten får rätt undersökning utifrån sitt behov samt att resur-ser nyttjas mer optimalt. Målsättningen var att öka andelen berättigade undersökningar. Syftet med studien av förbättringsarbetet var att få en förståelse för vilka faktorer som påverkar remittentens val av radiologisk undersökning och därmed berättigandegraden vilka aktiviteter i förbättringsarbetet påverkar berättigandegraden och på vilket sätt Metod Interventioner i form av utbildning och mätningar användes för att höja berättigandegraden. Bedömning av berättigandegraden gjordes av en ST-läkare. En fallstudie med kvalitativ ansats genomfördes och fokusgruppintervju användes för att stu-dera förbättringsarbetet. Resultat Studien visar att berättigandegraden ökar något som ett resultat av de valda interventionerna. Utbildningen på plats gav också upplevda positiva effekter i form av bättre kunskap och lä-rande för deltagare. Analysen visade att osäkerhet som läkare upplever i sitt arbete med patienten kan härledas till kategorierna kunskap och krav. Diskussion/Slutsats Utbildning genomförd av radiologispecialist har visat sig vara framgångsrikt koncept. Mät-ningar som metod för lärande och förändring uppfattades istället som mätning för uppföljning. Förbättrad kunskap kring vilka faktorer som styr läkares val av undersökning har uppnåtts och områden för fortsatt förbättring har identifierats / Introduction Medical science and medical facilities and clinical possibilities to help patients evolve con-stantly. Healthcare today can often make the diagnosis and provide effective treatment to cure the victim of ill health. Radiological surveys are an important tool but also provide risks in the form of radiation, and improper use of resources. Purpose The purpose of the improvement work was to create a better use of radiology and adherence to medical guidelines so that the patient gets the right for increase based on their needs and resources will be used more optimally. The goal was to increase the proportion of eligible studies. The purpose of the study of the improvement was to gain an understanding of what factors affect physicians choice of radiological investigation and thereby provide entitlement degree which activities in the improvement process affects eligibility degree and in what way Method Interventions in the form of education and measurements used to improve eligibility rate. As-sessment of the eligibility rate was made by a resident physician. A case study with a qualitative approach was implemented and focus-group interviews were used to study the improvement process. Results Results indicates that the eligibility rate increased slightly as a result of the selected interven-tions. Education in place, however, gave perceived benefits in terms of improved knowledge and learning for participants. The analysis showed that the uncertainty that physicians experience in their work with pa-tients can be attributed to the categories of knowledge and requirements. Discussion / Conclusion Education conducted by a radiology specialist has is shown to be a successful concept. Meas-urements as a method of learning and change were perceived as measurement for monitoring. Improved knowledge about the determinants of physician choice of survey has been achieved and areas for further improvement are identified.

Bakgrunn: Røyking blir fortsatt betraktet som den viktigste forebyggbare årsak til død i ge land. Praktiserende leger er nøkkelpersoner innen tobakksforebygging. Enkel rådgiving, som minimal intervensjon, gitt av allmennleger øker andelen røykfrie pasienter signifikant. Kan en oppsøkende intervensjon gjennomført av en likemann være en egnet metode for å få leger til å ta opp tobakksbruk oftere og på en bedre måte, og kan denne undersøkelsen påvise dette? Hensikt: Hensikten med denne studien er: 1) Vurdere om primærlegene i Agder har endret praksis i perioden 2001-2004 med hensyn til hvor ofte og hvordan de tar opp tobakksbruk med sine pasienter og eventuelle hindringer for dette. 2) Undersøke om oppsøkende intervensjon er en egnet metode for å få leger til å endre praksis ved at de bidrar mer og bedre med individuell røykeintervensjon. Metode: Randomisert kontrollert studie for å undersøke om oppsøkende intervensjon er en egnet metode for å få leger til å endre praksis. Denne studien er sett i lys av en sammenliknende analyse av legenes røykeintervensjon og hindringer for dette i perioden 2001-2004. Resultat: Allmennlegene i Agder har endret praksis i perioden 2001 til 2004. Legene tar oftere opp tobakksbruk uten av pasientene har røykerelaterte symptomer, og det er færre hindringer både for å spørre om røykevaner og for å tilby hjelp til røykeslutt. Studien kan ikke bekrefte at oppsøkende intervensjonen er en egnet metode for å få leger til endre praksis ved at de bidrar mer og bedre med individuell røykeintervensjon. Konklusjon: I perioden 2001-2004 har det vært en signifikant endring i legenes røykeintervensjon og hindringer for dette. Studien kan ikke påvise at legene som fikk opplæringen ”Røykeslutt i praksis” bidrar mer med individuell røykeintervensjon enn kontrollgruppen, og det er heller ikke signifikante forkjeller på hindringer for en slik intervensjon / Background: Cigarette smoking is still considered the leading preventable cause of death in the western world. Physicians constitutes a key personnel in tobacco prevention. Brief advising, such as minimal intervention, performed by general practitioners, GPs, increases the number of smoke free patients significantly. The potential effect of outreach visits performed by a peer educator is a question to be studied. Objective: The objective of this study is: 1) Assesswhether the primary physicians in Agder, during the period 2001 to 2004, have changed their professional practice as tohow often and in which way they discuss smoking habits with their patients and possible barriers to stop them. 2) The study also seeks to determine whether outreach visits constitute an effective method to make GPs change their professional practice by contributing more and better to individual smoking cessation. Method: Randomised controlled study to determine whether outreach visits constitute an effective method to make GPs change their practice. This study is also viewed in the light of a comparative analysis of doctors’ attitude to tobacco prevention over the period 2001-2004. Result: During the period 2001-2004 the GPs in Agder have changed their professional practice. They discuss more frequently tobacco use with patients without smoke-related symptoms, and there are fewer barriers that keep them from asking about smoking habits and from offering assistance with smoking cessation. The effect of outreach visits in improving professional practice cannot be ascertained through this study. Conclusion: During the period 2001-2004 there has been a significant change in the GPs intervention work and fewer barriers to stop them. The GPs who received training through the program “Røykeslutt i praksis” do not contribute to individual smoke intervention any more than the control group. We were unable to detect any significant differences regarding barriers to such intervention / <p>ISBN 91-7997-153-9</p>

Aims: To introduce the concepts “quality assurance”, “rational drug prescribing” and “outreach visits” in general practice in Storstrøm County, Denmark and study the effect of unsolicited mailed feedback and outreach visits on drug prescribing. Methods: The first step was to generate standardised charts displaying the county variations of drug volume prescribing within 13 major drug groups at the second ATC-level. The charts were mailed unsolicited to the 94 general practices in the county. Each practice could identify its position within the county prescribing variation. This procedure was repeated every six months from 1992 to 1998. In 1998 annual outreach visit were offered to general practice and 88 of 94 practices accepted. The awareness of prescribing profiles was monitored during the visits in 1998 and 1999. In 2000 a randomised controlled trial allocating practices into two parallel arms was launched. Effects of two desk guides on rational drug prescribing promoted during outreach visits were evaluated. Results: During the period of mailed feedback, there was a large variation in drug prescribing volumes between practices but little within-practice variation over time. No significant change was detected. Practitioners’ assessment of their own prescribing profiles improved significantly through the outreach visits. The prescribing of antibiotics was significantly affected by the desk guide whereas no effect was detected on the prescribing of non-steroid anti-inflammatory drugs. Conclusions: Semi-annually mailed feedback over a seven-year period had no significant effect on prescribing volumes or variations in prescribing volumes, but some effect on the practitioners’ awareness of their own prescribing profiles. Outreach visits significantly improved the awareness. A randomised controlled trial using outreach visits combined with a simple desk guide affected the prescribing of some antibacterial drugs as intended whereas the similar intervention had no detectable effect on the prescribing of non-steroid anti-inflammatory drugs.