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5 Practice variation revisited – the contribution of primary care
  1. Eivind Meland1,
  2. Hans Johan Breidablik2
  1. 1University of Bergen, Bergen, Norway
  2. 2Helse Førde, Førde, Norway


Practice variation is often explained as originating from supply-driven services in hospitals and secondary care. This presentation will have studies from primary care as its point of departure.

I will present results related to PSA-testing, tonsillectomy, referral to psychiatric specialist care, use of specialist care, variation in diagnostic labelling, and use of resources at the primary care level. I will discuss the concept of unwanted or unexplained variation and identify factors that can explain the variation. Factors related to sociodemographics and morbidity are known and accepted as source of explained variation. Our research has also examined how resource allocation in health care in the municipalities contributes to practice variation. Relative inequality at the municipality level contributes to psychiatric morbidity and explains variation.

Finally, I will discuss the phenomenon of overdiagnosis in a historical perspective. I start with Michael Balint and the post-second-world-war psychosocial turn in medicine. The family was the important unity in this era. It was taken over by the risk society era where the individual was the focus of medical interest. Balint acknowledged ‘infantile regression’ as a common human experience of suffering. How can we promote his concept of ‘maturation’ in our current society to enable realistic expectations to health care?.

Objectives Present research from primary health care in Norway with focus on practice variation.

Method Oral presentation of own research.

Results Practice variation is evident also at the primary care level. Some of the variation is random and unexplained. However, we find some factors at the primary care level that can explain practice variacion.

Conclusions Practice variation is mostly unexplained. Diseases are not objective phenomena, but seem also to originate as a product of the doctor-patient interaction. ’Maturation’ - is that a responsibility for the clinician?.

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