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Almost the entire Danish population is registered with a GP for primary health care, which is tax-financed and free at the point of use. GPs are private entrepreneurs regulated through collective agreements between the Danish regions and the organisation of GPs. 5 Patients need referrals from their GPs to consult hospital specialists and to access municipal educational self-care support. Consequently, GPs in Denmark act as gatekeepers to other health services and play a key role in chronic care, which is organised through disease management programmes (DMPs).
- Table 1. An example of how GPs are expected to stratify patients with type 2 diabetes, determining the level of chronic care 6
Disease regulation Well Poor Self-care High General practice General practice
Specialist careLow General practice
Self-care supportGeneral practice
Specialist care
Self-care support - Table 2. Personal and demographic details of the GPs who participated in the study, n = 12
Median age, years (range) 56 (37–69) Sex, n Male 6 Female 6 Time in practice, years (range) 16 (1–41) Practice size
1 GP 6 2 GPs 6 Practice location Village, <5000 inhabitants 3 Town, ≥5000 inhabitants 9 Distance from practice to hospital ≤30 minutes' drive, n (range) 5 (2–27) >30 minutes' drive, n (range) 7 (35–51) - Table 3. Profile of the patient cases that informed discussion in the GP interviews, n = 36
Age, years
Mean 62.5 Range 37–81 Sex, n (%)
Male 21 (58) Female 15 (42) Chronic conditions, n (%) Diabetes 36 (100) Heart disease 18 (50) Mental disorder 16 (44) Obesity 14 (39) Addiction (alcohol or cannabis) 9 (25) Musculoskeletal disorders 8 (22) Respiratory disease 4 (11) Peter is a middle-aged man with schizophrenia and periodic alcohol misuse, who is overweight. He also suffers from type 2 diabetes, heart failure, and chronic obstructive pulmonary disease. His GP had tried to refer Peter to hospital several times, but Peter often cancels or leaves the hospital because he cannot cope in the large hospital setting. The GP finds that Peter has an unbearable feeling of insecurity which is related to his psychiatric disorder. Therefore, the GP manages Peter’s chronic conditions, although she does not see this as the best solution for Peter. They are in weekly contact and Peter gets appointments at very short notice, because he has so many diseases to deal with and his conditions easily exacerbate.
John is a retired manual worker in his early seventies who has diabetes and possibly dementia, but he refuses further medical examination. He often shows up at the GP’s surgery without an appointment. The GP has talked frequently to John and his wife about improving disease regulation through diet and exercise, but John has not managed to change his habits. Recently, John’s wife has been diagnosed with cancer and cannot support John as much as before. John lives in the countryside and he disagrees with his wife’s suggestion of moving to the nearby town, although he is at risk of losing his driver’s licence.
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