Introduction: To describe the Danish National Health Service Register in relation to research. Content: The register contains data collected for administrative and scientific purposes from health contractors in primary health care. It includes information about citizens, providers, and health services but minimal clinical information. Validity and coverage: The register covers everyone living in Denmark and data is available from 1990. No validity studies have been reported. Because the data is connected to reimbursement the coverage is assumed to be good. Conclusion: The strengths of the register include completeness, size, and long follow-up period. It is useful for research purposes but reservations must be made regarding its validity.

Previous studies addressing determinants of frequent attendance have mainly focused on socio-demographic, psychosocial and medical factors, and few had data on lifestyle and gender-specific factors. This study aims to describe determinants of general practice frequent attendance in Danish adult population, by examining lifestyle, socio-demographic, medical and gender-specific factors. For 54,849 participants of the Danish Diet, Cancer and Health cohort (50–65 year old) we obtained data on visits to general practitioner (GP) from the Danish National Health Service Register at cohort baseline (1993–97), when information on medical conditions and lifestyle, socio-demographic and gender-specific factors was collected by questionnaire. Logistic regression was used to identify determinants of frequent attendance, defined as top 10 % GP users at the year of recruitment into the cohort (baseline) in the period between 1993 and 1997. Frequent attenders accounted for 40 % of all face-to-face GP consultations with a mean 12 visits/year. Women were more likely to be frequent attenders, in crude (Odds ratio: 1.95; 95 % Confidence Interval: 1.85–2.06) and fully adjusted (1.26; 1.09–1.47) model. In a fully adjusted model, strongest determinants of frequent attendance were pre-existing medical conditions, with hypertension (2.58; 2.42–2.75), diabetes (2.24; 1.94–2.59), and mental illness (2.29; 2.09–2.52) more than doubling the odds of being FA. High education (0.63; 0.57–0.69, >4 years higher education vs. no vocational training) and employment (0.61; 0.57–0.65) were inversely associated with frequent attendance. Finally, obesity (1.54; 1.14–2.08), smoking (1.21; 1.12–1.30, current vs. never), physical activity (0.84; 0.80–89), alcohol consumption (0.83; 0.78–0.87 above vs. below recommended level), and hormone therapy in women (1.52; 1.42–1.63) were all significant determinants of frequent attendance. In addition to pre-existing medical conditions, gender, socio-demographic and gender-specific factors, lifestyle (obesity, smoking, exercise and alcohol use) is also an independent determinant of frequent attendance at general practitioner.

This study aims to describe the determinants related to gender differences in the GP utilization in Danish population aged 50-65 years. Cohort-based cross-sectional study. Danish general practice. Totally, 54,849 participants of the Danish Diet, Cancer and Health cohort (50-65 years). The sum of cohort members' face-to-face consultations with general practitioner (GP) at the cohort baseline year (1993-1997). We obtained data on GP visits from the Danish National Health Service Register at the cohort baseline (1993-1997), when information on lifestyle (smoking, body mass index (BMI), alcohol use, physical activity), medical conditions (somatic and mental), employment, education, gravidity, and hormone therapy (HT) use was collected by questionnaire. Women had on average 4.1 and men 2.8 consultations per year. In a crude model, women had 47% higher rate of GP visits than men (incidence rate ratio: 1.47; 95% Confidence Interval: 1.45-1.50), which remained unchanged after adjustment for lifestyle, socio-demographic and medical factors, but attenuated to 18% (1.18; 1.13-1.24) after adjustment for female factors (gravidity and post-menopausal HT. In a fully adjusted model, subjects with hypertension (1.63; 1.59-1.67), mental illness (1.63; 1.61-1.66), diabetes (1.56; 1.47-1.65), angina pectoris (1.28; 1.21-1.34), and unemployed persons (1.19; 1.18-1.21) had highest rates of GP visits. Gravidity and HT use explain a large proportion, but not all of the gender difference in GP utilization. Medical conditions (somatic and mental) and unemployment are the main determinants of GP utilization in men and women, while lifestyle has minor effect. Key points Female gender remained a dominant determinant of GP utilization, after adjustment for lifestyle, socio-demography, medical and gender specific factors, with females consulting their GP 18% more often than males. Female reproductive factors (use of postmenopausal hormone therapy and gravidity) explained a large proportion of the gender variation in use of GP. Strongest determinants for GP use among Danish adults aged 50-65 years were the presence of medical conditions (somatic and mental) and unemployment, while lifestyle factors (e.g., body mass index, alcohol consumption and smoking) had minor effect.

Introduction: Polypharmacy is a common concern, especially in the older population. In some countries more that 50% of all individuals over 60 receive five or more drugs, most often due to multimorbidity and increased longevity. However, polypharmacy is associated with multiple adverse events, and more medication may not always be the answer. The terms “appropriate” and “inappropriate” are often used to distinguish between “much” and “too much” medications in relation to polypharmacy in research and practice, but no explicit definition exists to describe what these terms encompass. The aim of this review is to unfold the different understandings of and perspectives on (in)appropriate polypharmacy and suggest a framework for further research and practice. Method: A scoping review was conducted using the framework of Arksey and O’Malley and Levac et al. Pubmed, Embase, PsycINFO, CINAHL, Cochrane database, Scopus and Web of Science were searched for references in English, Danish, Norwegian and Swedish using the search string “Polypharmacy” AND “Appropriate” OR “Inappropriate”. Data was extracted on author information, aims and objectives, methodology, study population and setting, country of origin, main findings and implications, and all text including the words “appropriate,” “inappropriate,” and “polypharmacy.” Qualitative meaning condensation analysis was used and data charted using descriptive and thematic analysis. Results: Of 3982 references, a total of 92 references were included in the review. Most references were from 2016-2021, from fields related to medicine or pharmacy, and occurred within primary and secondary healthcare settings. Based on the qualitative analysis, a framework were assembled consisting of Context, three domains (Standardization, Practices and Values & Concerns) and Patient Perspective. Conclusion: Inappropriate polypharmacy is a concept loaded by its heterogeneity and the usefulness of a single definition is doubtful. Instead, the framework suggested in this article representing different dimensions of inappropriate polypharmacy may serve as an initial strategy for focusing research and practice on polypharmacy in old age.

To quantify the association between obesity and somatic hospital costs and number of overall somatic hospital contacts--number of inpatient admissions, number of outpatient visits, and number of emergency department visits--based on anthropometric measurements of waist circumference (WC) and information from The National Patient Registry and The Danish Case-Mix System (DRG). The study population consisted of two sub-samples from the Inter99 study at Research Centre for Prevention and Health in 1999-2001. One sub-sample used WC as an indicator for obesity (n = 5,151), whereas the other used BMI as an indicator for obesity (n = 4,048). Using WC, obesity was defined as WC > 102 cm for men and > 88 cm for women. Normal weight was defined as circumference < 94 cm for men and < 80 cm for women. Using BMI, obesity was defined as BMI > 30 kg/m2, whereas individuals with BMI = 18.5-24.9 kg/m2 were defined as normal weight. Individuals with BMI < 18.5 kg/m2 were excluded from both sub-samples. We undertook a 3-year retrospective study of the relationship between obesity and use of hospital resources. Data on hospital contacts and costs were obtained from The National Patient Registry and DRG. Analyses were performed using two-part models and Poisson regression. Outcome variables were costs and hospital contacts. This study has demonstrated that obese individuals have a greater use of hospital services and greater hospital costs compared with normal weight individuals. When using WC as an indicator for obesity, mean hospital costs were 33.8% greater among obese women and 45.3% greater among obese men in a 3-year period but the differences were not significant. When using BMI to measure obesity, obese men had significantly greater costs (57.5%) than normal weight men. Furthermore, obese men and women (indicated by WC) had an increased number of hospital contacts compared with normal weight individuals (rate ratio 1.32, 95% CI 1.21-1.43 for men and 1.20, 95% CI 1.11-1.28 for women) including inpatient admissions, outpatient visits, and emergency department visits. The same trends were seen when obesity was indicated by BMI.

Background: People with multimorbidity, defined as the co-existence of two or more chronic conditions in an individual, often suffer from pain and functional limitations caused by musculoskeletal disorders and the chronic conditions. In chiropractic practice, two thirds of patients are treated for low back pain (LBP). It is unknown to what extent LBP is accompanied with chronic conditions in chiropractic practice. The objective was to determine the prevalence of multimorbidity among patients with LBP in chiropractric practice and to investigate if multimorbidity affects pain intensity, self-rated health, physical and mental health. Finally, to explore if individuals with multimorbidity have a different recovery for the LBP. Methods: Patients presenting with a new episode of LBP were recruited from 10 chiropractic clinics in 2016–2018. Patient-reported data concerning socio-demographics, self-rated health, pain intensity, history of LBP, mental health and chronic conditions were collected at baseline. The prevalence of multimorbidity was determined. To evaluate differences in recovery from the LBP, we estimated changes in the Roland Morris Disability Questionnaire (RMDQ) score and use of pain medication at baseline, 2 weeks, 3 months and 12 months. The analyses were adjusted using regression models. Results: 2083 patients were included at baseline and 71%, 68% and 64% responded to follow-up questionnaires at 2 weeks, 3 and 12 months. 1024 (49%) participants reported to have at least one chronic condition and 421 (20%) had multimorbidity (≥ 2 chronic conditions). The presence of multimorbidity was associated with increased odds of poor self-rated health (OR 2.13), physical fitness (OR 1.79), poor muscular strength (OR 1.52), poor endurance (OR 1.51), and poor balance (OR 1.33). Patients with high LBP intensity combined with multimorbidity showed a poorer recovery than patients without chronic diseases (mean difference in RMDQ score 3.53 at 12 months follow-up). More patients with multimorbidity used pain medication for LBP at 12 months follow-up compared to those without chronic disease (OR 2.36). Conclusions: Chiropractors should be aware that patients with LBP may suffer from multimorbidity with poor general health. Patients with multimorbidity also have poorer recovery from LBP than people without chronic disease and clinical follow-up may be indicated.