Due to copyright issues, an electronic copy of the thesis must be ordered from the faculty. For the faculty to have time to process the order, the order must be received by the faculty at the latest 2 days before the public defence. Orders received later than 2 days before the defence will not be processed. After the public defence, please address any inquiries regarding the thesis to the candidate.
Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Associate Professor Hilde Philips, University of Antwerp, Belgium
- Second opponent: Director Anette Fosse, UiT - Arctic University of Norway,
- Third member and chair of the evaluation committee: Professor II Stig Tore Bogstrand, University of Oslo
Chair of the Defence
Professor emeritus Gunnar Aksel Bjune, University of Oslo
Principal Supervisor
Associate Professor Sigurd Høye, University of Oslo
Summary
The thesis aimed to explore how respiratory tract infections are assessed and handled in out-of-hours clinics by telephone triage nurses and doctors and to assess the effect of an educational intervention for telephone triage nurses. Data from medical records, focus group interviews and electronic compensation claims were used.
Antibiotic prescribing increased during busy sessions in out-of-hours clinics, and 34 % of all patients with respiratory tract infections were treated with antibiotics despite these conditions’ non-urgent and self-limiting nature.
The study found that telephone triage nurses are ambivalent gatekeepers to out-of-hours clinics. They prefer the term service provider to describe their role. The nurses search for consensus with callers through negotiations and strategies and perceive that triage scales are inferior to their clinical skills when assessing callers with respiratory tract infections. Telephone triage nurses describe how structural factors, like the doctors’ fee-for-service plan, largely determine how the population use the out-of-hours clinics.
The educational intervention did not influence the number of consultations for respiratory tract infections in out-of-hours clinics. The proportion of respiratory tract infections diagnosed out-of-hours during three winter months was 22.4 %, corresponding to 13.7 % for list-holding GPs.
Doctors in out-of-hours clinics need working conditions that facilitate appropriate antibiotic prescribing, such as fixed salaries. Municipalities should consider fixed salaries for all their doctors. Telephone triage nurses must have clinical skills, triage scales, and enough time to assess callers with respiratory tract infections. Leaders of out-of-hours GP cooperatives should facilitate discussions between the local nurses and doctors, aiming for common attitudes and practices on handling respiratory tract infections within their entities.
Additional information
Contact the research support staff.