Guro Haugen Fossum

• Skow, Marius; Brænd, Anja Maria; Emilsson, Louise; Høye, Sigurd; Straand, Jørund & Fossum, Guro Haugen (2026). Antibiotic treatment for acute sinusitis and subsequent health care use and work absence: a nationwide registry study from Norway. Family Practice. ISSN 0263-2136. 43(2). doi: 10.1093/fampra/cmag001. Full text in Research Archive Show summary

  Background Acute sinusitis is common in general practice. Although typically self-limiting, antibiotics are frequently prescribed despite guideline recommendations to restrict use. It remains unclear whether antibiotic treatment reduces subsequent health care use or work absence. Objective T o assess how initial treatment with or without antibiotics for acute sinusitis is associated with subsequent health care use and work absence, and to compare phenoxymethylpenicillin (PcV) versus other antibiotics. Methods Nationwide registry-based observational cohort study of adults with acute sinusitis (ICPC-2: R75) diagnosed in Norwegian general practice 2012–2019. We compared GP visits, Ear, Nose, and Throat (ENT) specialist visits, repeat antibiotic prescriptions, and sick leave days in antibiotic-treated and untreated episodes. We estimated adjusted differences in outcomes between groups using linear regression (daily outcomes) and negative binomial regression (weekly counts). Results We included 627 211 episodes from 413 449 patients. Antibiotics were prescribed in 59% of episodes; 53% received PcV. During the index week, antibiotic use was associated with 1.7 fewer GP visits, 0.1 fewer ENT visits, and 25.1 more sick leave days per 100 episodes. Corresponding figures for the following 4 weeks were: 0.9 fewer GP contacts, 10.7 fewer sick leave days, and 0.6 more antibiotic prescriptions. PcV was associated with slightly more GP visits and re-prescribing than other antibiotics. Conclusions Acute sinusitis is followed by a short-term increase in health care use and work absence. Initial antibiotic use was associated with modest short-term differences, but no meaningful reduction in overall follow-up. Findings are consistent with recommendations for restrictive prescribing and narrow-spectrum use when appropriate.

• Skoglund, Ingmarie; Heltveit-Olsen, Silje Rebekka; Brænd, Anja Maria Lyche; Fossum, Guro Haugen; Straand, Jørund & Sundvall, Sofia [Show all 8 contributors for this article] (2026). In uncharted territory: managing the COVID-19 pandemic in Swedish regions and municipalities from a primary health care perspective. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 44(1). doi: 10.1080/02813432.2026.2660327. Full text in Research Archive Show summary

  Objective To explore experiences and challenges faced by regional and municipal health care leaders during the COVID-19 pandemic, with a focus on primary health care and care of older adults. Design A longitudinal qualitative study based on two rounds of semi-structured interviews 2–3 months apart. Setting and participants Fifteen health care leaders strategically recruited from regions and municipalities across Sweden. The first interviews took place in November–December 2020, the second in January–March 2021. Results Four themes were identified. The first captured the challenge of navigating uncharted territory during an unprecedented crisis. The second addressed ethical dilemmas arising from public health priorities. The third highlighted the growing significance and evolving role of infection prevention and control. Finally, the fourth illustrated how initially productive and solution-oriented local collaboration and communication gradually gave way to tensions and conflicting responsibilities. Conclusions In the early phases of the pandemic, the Swedish Public Health Agency’s leadership and measures were generally appreciated, although the initial response was widely perceived as slow and insufficient. The high mortality among older adults was regarded as a major failure, raising ethical concerns and exposing tensions in collaboration between actors. Pandemic work was experienced as exhausting yet meaningful, and the field of infection prevention and control gained increased recognition and status. Some distinctive features of Sweden’s pandemic response – such as decentralised decision-making and an emphasis on individual responsibility – may have been shaped by the constitutional prohibition of ministerial rule and the substantial autonomy granted to regional and local authorities.

• Skonnord, Trygve; Schei, Edvin; Brænd, Anja Maria; Bondevik, Gunnar Tschudi; Fossum, Guro Haugen & Rebnord, Ingrid Keilegavlen [Show all 9 contributors for this article] (2026). Patients' experiences of consultations involving medical students in general practice. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 146. doi: 10.4045/tidsskr.25.0269. Full text in Research Archive Show summary

  Background and aim The aim of the study was to investigate patients' attitudes to and experiences of consultations in general practice where medical students acted as observers or conducted independent consultations. Participants were also asked about the advantages and disadvantages of student involvement. Material and method We conducted a cross-sectional study in which patients completed an online questionnaire in general practitioners' (GPs') waiting rooms, having been invited to participate by medical students in a clinical placement. The results are presented descriptively. Results A total of 2263 out of 5576 (41 %) invited patients participated. Of these, 1287/2263 (57 %) experienced consultations involving students. Of these, 890/1277 (70 %) reported that they valued the experience and 1009/1248 (81 %) agreed that it was a positive experience. Of the 847 patients who clearly recalled a consultation involving a student, 763/837 (91 %) reported feeling safe and 806/846 (95 %) felt they received adequate care. Interpretation Although the vast majority of patients in the study felt well cared for in consultations involving medical students in clinical placement in general practice, special attention should be paid to vulnerable patient groups.

• Svaland, Malene; Brænd, Anja Maria; Heltveit-Olsen, Silje Rebekka; Rørtveit, Guri; Høye, Sigurd & Straand, Jørund [Show all 7 contributors for this article] (2025). Fear of the Unknown: Pandemic Concerns Among Non-hospitalized COVID-19 Infected or Quarantined Norwegian Adults. Disaster Medicine and Public Health Preparedness. ISSN 1935-7893. 19. doi: 10.1017/dmp.2025.10117. Full text in Research Archive Show summary

  Objective We aimed to explore concerns and feeling of safety among quarantined and non-hospitalized COVID-19 patients. Methods We conducted a qualitative study of free text answers from participants of an online survey. The survey was conducted between March 2020 and June 2021. COVID-19 positive adults in home isolation and adults in quarantine were eligible for participation. 698 participants answered one or more of three open-ended questions about concerns and safety. We analyzed free-text answers using thematic analysis according to Braun and Clarke with an inductive approach. Results Analysis of the free-text answers from all participants identified three main themes: (1) Fear of the unknown, (2) Views on personal care and public health measures, and (3) Concern for the future of a country in crisis. Participants’ feelings revolved around health-related concerns and societal related concerns. They were concerned about their own and other’s health, and possible long-term consequences of COVID-19 infection. Some participants were satisfied with the health care system, others thought follow-ups, testing, vaccination, and information would increase their feeling of safety. Conclusions People quarantined and isolated due to the COVID-19 pandemic had concerns regarding personal health and societal consequences of infection control measures. Health care follow-ups and individualized information would increase participants’ feeling of safety.

• Heltveit-Olsen, Silje Rebekka; Lunde, Lene; Brænd, Anja Maria; Spehar, Ivan; Høye, Sigurd & Skoglund, Ingmarie [Show all 10 contributors for this article] (2024). Local management of the COVID-19 pandemic in Norway: a longitudinal interview study of municipality chief medical officers. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 42(1), p. 214–224. doi: 10.1080/02813432.2023.2301562. Full text in Research Archive Show summary

  Objective - To explore the experiences and views of Norwegian Municipality Chief Medical Officers (MCMOs) on preparedness, collaboration, and organization during the COVID-19 pandemic to gain insight into local crisis management of value for future pandemic responses.<p> <p>Design - Longitudinal qualitative interview study. We conducted semi-structured digital interviews with nine MCMOs working in different municipalities in Norway from September to December 2020. Five MCMOs were re-interviewed from January to April 2021. We used thematic analysis to analyze the data.<p> <p>Results - Through the analysis, three major themes were identified in the material; 1) The view of preparedness changed from being low-priority and dormant to the desire to strengthen preparedness as a permanent measure; 2) The nature of the pandemic forced a change in internal and external communication and collaboration for the MCMOs towards direct dialogue, teamwork and digital networking; 3) The pandemic changed the role and position of the MCMO within the municipal organization. Although most MCMOs were given a leading role in the municipal pandemic response, some MCMOs experienced that they were not positioned to fully exercise their intended role. In our material, de-authorization of the MCMO role seemed to coincide with the increasing size and organizational complexity of the municipality.<p> <p>Conclusions - The Norwegian pandemic response and outcome have been regarded as successful internationally. Although the MCMOs managed to implement flexible and quick responses facilitated by teamwork, dialogue, and joint sensemaking, they also identified several challenges and shortcomings of the Norwegian pandemic preparedness requiring organizational and financial changes to sustain future health system resilience.

• Bjerke, Kristin Nordey; Brænd, Anja Maria & Fossum, Guro Haugen (2024). Parents’ concerns when children get sick during a pandemic: A study of Norwegian online forums. Journal of Pediatric Health Care. ISSN 0891-5245. 38(5), p. 695–702. doi: 10.1016/j.pedhc.2024.05.007. Full text in Research Archive Show summary

  Introduction We aimed to explore the concerns of parents when their children had symptoms of infection during the COVID-19 pandemic. Method Two Norwegian internet forums were searched for parents’ experiences when their children had upper respiratory infection symptoms in 2020–2021. A total of 197 posts were included and analyzed using thematic analysis. Results Parents described COVID-19-related and general worries regarding their children with upper respiratory infection symptoms. The first theme, “It is not ‘just a cold’ during the pandemic,” captures how infection control measures influenced parents’ concerns. The second theme, “Concerns and consequences of fever and cold symptoms,” describes general parental worries. Varying levels of worries regarding health care services, limitations of family life, and concerns for relatives were highlighted. Discussion Knowledge of parents’ concerns about cold symptoms may help primary health care providers target individual patient counseling and provide background information when policymakers develop information material for infection prevention and treatment.

• Esgård, Veronica Frey; Lindman, Ida; Brænd, Anja Maria; Fossum, Guro Haugen; Lundberg, Thorbjörn & Moberg, Anna [Show all 9 contributors for this article] (2024). Diagnostic methods and written advice for acute otitis media in primary health care. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 42(4), p. 532–537. doi: 10.1080/02813432.2024.2352444. Full text in Research Archive Show summary

  Background Otomicroscopy and pneumatic methods are superior to otoscopy alone in diagnosing acute otitis media (AOM). There is a lack of knowledge regarding the use of different diagnostic methods for AOM in primary health care in Sweden and Norway. Methods This cross-sectional study included a questionnaire completed by general practitioners (GPs) and specialist trainees (STs/residents/registrars) working in primary care in Sweden and Norway. Multivariable binary logistic regressions were performed to evaluate the use of diagnostic methods and written advice adjusted for educational level, sex and country. Results Otoscopy was the most frequently used method. Sweden had greater access to the more accurate diagnostic methods. In Norway, the following methods were used to a lesser extent: pneumatic otoscopy, adjusted OR 0.15 (95% CI 0.10–0.23; p < .001), otomicroscopy, adjusted OR 0.013 (95% CI 0.070–0.027; p < .001), pneumatic otomicroscopy, adjusted OR 0.028 (95% CI 0.010–0.078; p < .001) and tympanometry, adjusted OR 0.31 (95% CI 0.21–0.45; p < .001). Written advice was used to a greater extent in Norway, adjusted OR 4.5 (95% CI 3.1–6.7; p < .001). The STs used pneumatic otoscopy and pneumatic otomicroscopy to a lesser extent, adjusted OR 0.65 (95% CI 0.45–0.93; p = .019) and 0.63 (95% CI 0.43–0.92; p = .016). Conclusions Swedish physicians both used and had greater access to the significantly better diagnostic methods compared with Norwegian physicians while the opposite applied to the use of written information. The GPs used pneumatic otoscopy and pneumatic otomicroscopy to a greater extent than STs. Compared with 2012, the Swedish physicians now more frequently used pneumatic otoscopy.

• Skonnord, Trygve; Brænd, Anja Maria & Fossum, Guro Haugen (2024). Pasienterfaringer med fastlegetjenesten under covid-19-pandemien – en tverrsnittsstudie. Tidsskrift for velferdsforskning. ISSN 0809-2052. 27(1), p. 1–11. doi: 10.18261/tfv.27.1.3. Full text in Research Archive Show summary

  Bakgrunn: Pasientenes legesøkningsatferd under covid-19-pandemien er lite studert. Formålet med studien var å undersøke norske pasienters erfaringer med fastlegenes tilgjengelighet og endringer i legesøkning og egenomsorg under pandemien. Materiale og metode: I denne tverrsnittsstudien delte medisinstudenter ut spørreskjemaer til pasienter på fastlegers venterom høsten 2021. Vi mottok 639 anonyme svar. Resultater: 78% av deltakerne opplevde tilgjengeligheten til fastlegekontoret som før, mens 74% oppgav egen terskel til å ta kontakt som uendret. 16% utsatte kontakt med helsetjenesten for sine plager, hvorav halvparten opplevde negative konsekvenser. Konklusjon: Selv om erfaringene fra covid-19-pandemien er at fastlegetjenesten i stor grad var omstillingsdyktig og leverte tilpassede tjenester, er det rom for å gi tydeligere informasjon om tilgjengelighet til fastlegetjenesten ved framtidige pandemier.

• Skow, Marius; Fossum, Guro Haugen; Høye, Sigurd; Straand, Jørund; Emilsson, Louise & Brænd, Anja Maria (2023). Antibiotic treatment of respiratory tract infections in adults in Norwegian general practice. JAC-Antimicrobial Resistance (JAC-AMR). 5(1). doi: 10.1093/jacamr/dlac135. Full text in Research Archive Show summary

  Objectives To analyse the prevalence of respiratory tract infection (RTI) episodes with and without antibiotic prescriptions in adult patients in Norwegian general practice during the period 2012–2019. Methods Observational study linking data from the Norwegian Control and Payment for Health Reimbursements Database and the Norwegian Prescription Database. Episodes of acute RTIs in patients aged 18 years or older were identified and linked to antibiotic prescriptions dispensed within 7 days after diagnosis. We analysed annual infection rates and antibiotic prescription rates and antibiotics prescribed for the different RTI conditions. Results RTI episode rate per 1000 inhabitants was 312 in 2012 and 277 in 2019, but showed no linear trend of change during the study period (P = 0.205). Antibiotic prescription rate decreased from 37% of RTI episodes in 2012 to 23% in 2019 (P < 0.001). The reduction in prescribing was most pronounced for episodes coded with ICPC-2 symptom diagnoses, as well as upper RTIs, influenza, acute bronchitis and sinusitis. Prescriptions for phenoxymethylpenicillin decreased from 178 746 in 2012 to 143 095 in 2019, but increased as proportion of total antibiotic prescriptions from 40% in 2012 to 53% in 2019 (P < 0.001). Conclusions This study demonstrates stable RTI episode rates and reduced antibiotic prescription rates for RTIs for adults in Norwegian general practice 2012–2019. We also observed a shift towards relatively more use of phenoxymethylpenicillin and less broad-spectrum antibiotics. These changes are in line with the aims of the Norwegian strategy against antibiotic resistance.

• Fossum, Guro Haugen; Brænd, Anja Maria; Heltveit-Olsen, Silje Rebekka; Rørtveit, Guri; Høye, Sigurd & Straand, Jørund (2023). Symptoms, symptom severity, and contact with primary health care among nonhospitalized COVID-19 patients: a Norwegian web-based survey. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 41(4), p. 427–434. doi: 10.1080/02813432.2023.2266477. Full text in Research Archive Show summary

  Objective Dependent on clinical setting, geography and timing during the pandemic, variable symptoms of COVID-19 have been reported. Our aim was to describe self-reported symptom intensity and contact with primary health care among nonhospitalized COVID-19 patients. Design Web-based survey. Setting Norway between March 2020 and July 2021. Subjects Adults in home isolation. Main outcome measures Participants reported possible COVID-19 symptoms, duration of symptoms, score of symptom severity (Likert scale 0–3), risk factors, comorbidity, and questions regarding follow-up and information from primary health care. Results Of 477 participants, 379 (79%) had PCR-confirmed COVID-19, 324 (68%) were females, and 90% were younger than 60 years. Most common symptoms were “fatigue and/or muscle ache” (80%), nasal symptoms (79%), and headache (73%). The mean severity of symptoms was generally low. Symptoms with the highest mean scores were “fatigue and/or muscle ache” (1.51, SD 1.02) and headache (1.27 (SD 1.00). Mean scores for severity ranged from 0.28 (nausea) to 1.51 (fatigue and/or muscle ache). Women reported higher symptom scores than men. For “affected sense of smell and/or taste”, patients either reported a high symptom score (24%) or no affliction at all (49%). A third of the participants (32%) were followed-up by primary care health personnel, and almost 40% had sought or received information about COVID-19 from general practitioners. Conclusion The mean severity of symptoms among nonhospitalized adult COVID-19 patients was generally low. We found large variations in the occurrence and severity of symptoms between patients.

• Forthun, Ingeborg; Rørtveit, Guri; Fossum, Guro Haugen; Jørgensen, Pål; Halvorsen, Peder Andreas & Nilsen, Stein [Show all 9 contributors for this article] (2023). Søvnforstyrrelser og forskrivning av hypnotika i allmennpraksis – en PraksisNett-studie. SØVN. ISSN 1891-5493. p. 11–15. Full text in Research Archive Show summary

  Søvnforstyrrelser er svært utbredt i befolkningen. Insomni er den vanligste søvnforstyrrelsen med en forekomst på omkring 10-20 %. Forekomsten ser ut til å være økende i befolkningen. Blant pasienter på venterommet hos norske fastleger er forekomsten så høy som rundt 50 % ifølge to tidligere studier. Insomni utgjør en risikofaktor for utvikling av psykiske lidelser og er identifisert som en mulig kausal årsaksfaktor for en rekke negative helseutfall. Selv om sovemedisiner kun er anbefalt ved akutte søvnplager, er forskrivning av sovemedisiner også for langvarige plager svært vanlig. Medikamentgruppen hypnotika inkluderer benzodiazepiner, benzodiazepinlignende sovemidler (z preparater) og melatoninpreparater. I klinisk praksis benyttes av og til også andre preparater enn hypnotika mot søvnproblemer, inkludert antidepressiva, antihistaminer og antipsykotika.

• Skow, Marius Andre Hybbestad; Fossum, Guro Haugen; Høye, Sigurd; Straand, Jørund; Brænd, Anja Maria & Emilsson, Louise (2023). Hospitalizations and severe complications following acute sinusitis in general practice: a registry-based cohort study. Journal of Antimicrobial Chemotherapy. ISSN 0305-7453. 78(9), p. 2217–2227. doi: 10.1093/jac/dkad227. Full text in Research Archive Show summary

  Objectives To investigate complication rates of acute sinusitis in general practice, and whether antibiotic prescribing had an impact on complication rate. Methods All adult patients diagnosed with sinusitis in Norwegian general practice between 1 July 2012 and 30 June 2019 were included. GP consultation data from the Norwegian Control and Payment for Health Reimbursements Database were linked with antibiotic prescriptions (Norwegian Prescription Database) and hospital admissions (Norwegian Patient Registry). Main outcomes were sinusitis-related hospitalizations and severe complications within 30 days. Logistic regression was used to estimate associations between antibiotic prescriptions, prespecified risk factors, individual GP prescribing quintile, and outcomes. Results A total of 711 069 episodes of acute sinusitis in 415 781 patients were identified. During the study period, both annual episode rate (from 30.2 to 21.2 per 1000 inhabitants) and antibiotic prescription rate (63.3% to 46.5%; P < 0.001) decreased. Yearly hospitalization rate was stable at 10.0 cases per 10 000 sinusitis episodes and the corresponding rate of severe complications was 3.2, with no yearly change (P = 0.765). Antibiotic prescribing was associated with increased risk of hospitalization [adjusted OR 1.8 (95% CI 1.5–2.1)] but not with severe complications. Individual GP prescribing quintile was not associated with any of the outcomes, whereas risk factors such as previous drug abuse, or head injury, skull surgery or malformations, and being immunocompromised were significantly associated with increased risk of both outcomes. Conclusions Severe complications of acute sinusitis were rare and no protective effect of high prescribing practice among GPs was found. Recommendations to further reduce antibiotic prescribing are generally encouraged, except for high-risk groups.

• Kristoffersen, Espen Saxhaug; Bjorvatn, Bjørn; Halvorsen, Peder Andreas; Nilsen, Stein; Fossum, Guro Haugen & Fors, Egil Andreas [Show all 12 contributors for this article] (2022). The Norwegian PraksisNett: a nationwide practice-based research network with a novel IT infrastructure. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 40(2), p. 217–226. doi: 10.1080/02813432.2022.2073966. Full text in Research Archive Show summary

  Clinical research in primary care is relatively scarce. Practice-based research networks (PBRNs) are research infrastructures to overcome hurdles associated with conducting studies in primary care. In Norway, almost all 5.4 million inhabitants have access to a general practitioner (GP) through a patient-list system. This gives opportunity for a PBRN with reliable information about the general population. The aim of the current paper is to describe the establishment, organization and function of PraksisNett (the Norwegian Primary Care Research Network). Materials and Methods We describe the development, funding and logistics of PraksisNett as a nationwide PBRN. Results PraksisNett received funding from the Research Council of Norway for an establishment period of five years (2018–2022). It is comprised of two parts; a human infrastructure (employees, including academic GPs) organized as four regional nodes and a coordinating node and an IT infrastructure comprised by the Snow system in conjunction with the Medrave M4 system. The core of the infrastructure is the 92 general practices that are contractually linked to PraksisNett. These include 492 GPs, serving almost 520,000 patients. Practices were recruited during 2019–2020 and comprise a representative mix of rural and urban settings spread throughout all regions of Norway. Conclusion Norway has established a nationwide PBRN to reduce hurdles for conducting clinical studies in primary care. Improved infrastructure for clinical studies in primary care is expected to increase the attractiveness for studies on the management of disorders and diseases in primary care and facilitate international research collaboration. This will benefit both patients, GPs and society in terms of improved quality of care.

• Heltveit-Olsen, Silje Rebekka; Lunde, Lene; Brænd, Anja Maria Lyche; Spehar, Ivan; Høye, Sigurd & Skoglund, Ingmarie [Show all 10 contributors for this article] (2022). Experiences and management strategies of Norwegian GPs during the COVID-19 pandemic: a longitudinal interview study. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. doi: 10.1080/02813432.2022.2142796. Full text in Research Archive Show summary

  Objective: When the COVID-19 pandemic reached Norway, primary health care had to reorganize to ensure safe patient treatment and maintain infection control. General practitioners (GPs) are key health care providers in the municipalities. Our aim was to explore the experiences and management strategies of Norwegian GPs during the COVID-19 pandemic - over time, and in the context of a sudden organizational change.<p> <p>Design: Longitudinal qualitative interview study with two interview rounds. The first round of interviews was conducted from September–December 2020, the second round from January–April 2021. In the first interview round, we performed eight semi-structured interviews with GPs from eight municipalities in Norway. In the second round, five of the GPs were re-interviewed. Consecutive interviews were performed 2–4 months apart. To analyze the data, we used thematic analysis. <p>Results: The COVID-19 pandemic required GPs to balance several concerns, such as continuity of care and their own professional efforts. Several GPs experienced challenges in the collaboration with the municipality and in relation to defining their own professional position. Guided by The Norwegian Association of General practitioners, The Norwegian College of General Practice and collegial support, they found viable solutions and ended up with a feeling of having adapted to a new normal. <p>Conclusions: Although our study demonstrates that the GPs adapted to the changing conditions, the current municipal health care models are not ideal. There is a need for clarification of responsibilities between GPs and the municipality to facilitate a more coordinated future pandemic response.

• Fossum, Guro Haugen; Gjelstad, Svein; Kvaerner, Kari Jorunn & Lindbæk, Morten (2018). Prescribing antibiotics when the stakes are higher — do GPs prescribe less when patients are pregnant? A retrospective observational study. British Journal of General Practice Open. 2(2), p. 1–12. doi: 10.3399/bjgpopen18X101505. Full text in Research Archive Show summary

  Background Most oral antibiotics are prescribed by GPs, and they are therefore the most important influencers with regard to improving antibiotic prescription patterns. Although GPs’ prescription patterns in general are well-studied, little is known about antibiotic prescription patterns in pregnancy. Aim To study GPs’ antibiotic prescriptions in respiratory tract infections (RTIs) during pregnancy, and assess differences, if any, between pregnant and non-pregnant patients. Design & setting Retrospective observational study combining prescription data from the Norwegian Peer Academic Detailing (Rx-PAD) study database, pregnancy data from the Norwegian birth registry, and pharmacy dispension data from the Norwegian Prescription Database (NorPD). Method Records of patient contacts with 458 GPs, between December 2004 and February 2007, were screened for RTI episodes. Similar diagnoses were grouped together, as were similar antibiotics. Episodes were categorised according to whether the patient was pregnant or not, and included women aged 16–46 years. Logistic regression models were used to assess odds ratios (ORs), and calculated relative risks (cRRs) were produced. The authors also adjusted for clustering at various levels. Results Overall prescription rate for RTI episodes was 30.8% (n = 96 830). The cohort was reduced to include only episodes with women pregnant in the study period (n = 18 890). The antibiotic prescription rate in pregnancy was 25.9% versus 34.2% in the time before and after pregnancy (cRR = 0.66 [95% confidence intervals {CI} = 0.68 to 0.81]). During pregnancy, 83.0% of the antibiotic prescriptions were picked up at a pharmacy, compared to an 86.6% filling rate in non-pregnant patients. The difference was not significant when adjusting for clustering at the patient level. Conclusion Norwegian GPs prescribe fewer antibiotics overall when patients are pregnant and, when they do prescribe, choose more narrow spectrum antibiotics for RTIs. This indicates a possible lower target rate for GP prescriptions to females. A low antibiotic dispension rate during pregnancy may represent a discussion topic in the consultation setting, to address possible reasons and avoid under-treatment.

• Fossum, Guro Haugen; Lindbæk, Morten; Gjelstad, Svein & Kvaerner, Kari Jorunn (2018). Relationship between Maternal and First Year of Life Dispensations of Antibiotics and Antiasthmatics. Antibiotics. 7(3). doi: 10.3390/antibiotics7030084. Full text in Research Archive Show summary

  Antibiotics are the most frequent prescription drugs used by pregnant women. Our objective was to investigate if the dispensation of antibiotics and antiasthmatics in children less than 1 year of age is associated with prenatal antibiotic exposure. A secondary aim was to explore the incidence of dispensed antibiotics in pregnancy and dispensed antibiotics and antiasthmatics in children. We conducted an observational study using the Peer Academic Detailing study database to select patients eligible for match in the Medical Birth Registry of Norway, a total of 7747 mother-and-child pairs. Details on antibiotic and antiasthmatic pharmacy dispensations were obtained from the Norwegian Prescription Database. One quarter (1948 of 7747) of the mothers in the study had been dispensed antibiotics during pregnancy. In their first year of life, 17% (1289) of the children had had an antibiotic dispensation, 23% (1747) an antiasthmatic dispensation, and 8% (619) of the children had had both. We found a significant association between dispensed antibiotics in pregnancy and dispensed antibiotics to the child during their first year of life; OR = 1.16 (95% CI: 1.002–1.351). The association was stronger when the mothers were dispensed antibiotics at all, independent of the pregnancy period; OR = 1.60 (95% CI: 1.32–1.94). We conclude that the probability for dispensation of antibiotics was increased in children when mothers were dispensed antibiotics, independent of pregnancy. Diagnostic challenges in the very young and parental doctor-seeking behavior may, at least in part, contribute to the association between dispensations in mothers and children below the age of one year.

• Fossum, Guro Haugen; Lie, Agnes Kathrine; Jebsen, Peter Wilhelm; Sandlie, Lars Eriks & Mork, Jon (2017). Human papillomavirus in oropharyngeal squamous cell carcinoma in South-Eastern Norway: prevalence, genotype, and survival. European Archives of Oto-Rhino-Laryngology. ISSN 0937-4477. 274(11), p. 4003–4010. doi: 10.1007/s00405-017-4748-8. Full text in Research Archive
• Denstad, Silje Eilertsen; Aasen, Silja; Østrem, Anette; Bakkeheim, Vivi; Fossum, Guro Haugen & Moen, Mette Haase (2017). Hysterektomi ved St. Olavs hospital 1989-2014. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 137(16). doi: 10.4045/tidsskr.16.0260. Full text in Research Archive Show summary

  BAKGRUNN Hysterektomi er en av de vanligste gynekologiske operasjonene. Operasjonsmetodene har endret seg de siste decenniene. Nye utredningsmuligheter og alternative behandlingsmetoder har kommet til. Hensikten med denne studien er å beskrive utviklingen av hysterektomi utført på benign indikasjon ved St. Olavs hospital i perioden 1989–2014. MATERIALE OG METODE Totalt 903 pasienter er inkludert fra årgangene 1989, 1994, 1999, 2004, 2010 og 2014. Journalopplysninger om demografi, preoperativ utredning og behandling, operasjonsindikasjon, operasjonsmetode, operasjonstid, komplikasjoner, liggetid og sykmeldingsperiode er registrert retrospektivt ved gjennomgang av pasientjournaler. RESULTATER Fra 1989 til 2014 ble preoperativ diagnostikk ved abrasio redusert fra 68 % til 4 %, mens pipellemetoden økte fra 8 % til 68 %. Ultralydundersøkelse ble i 2014 utført hos 97 %. Hysterektomier utført med laparotomi ble redusert fra 107 i 1989 til 37 per 100 000 kvinner i 2014, mens vaginale og laparoskopiske hysterektomier til sammen økte i samme periode fra tre til 81 per 100 000 kvinner. I 2014 ble nesten halvparten av hysterektomiene utført med robotassistert laparoskopi. Parallelt med overgangen fra laparotomi til mindre invasive metoder ble det registrert mindre blødning og kortere ligge- og sykmeldingstid. FORTOLKNING Operasjonsmetoder for hysterektomier har gått fra åpen laparotomi til mindre invasive metoder som vaginal og laparoskopisk kirurgi. Robotassistert laparoskopisk hysterektomi er nå den vanligste operasjonsmetoden. Mindre invasive inngrep er gunstig for pasientsikkerhet og rekonvalesens.

• Fossum, Guro Haugen; Lindbæk, Morten; Gjelstad, Svein; Dalen, Ingvild & Kvaerner, Kari Jorunn (2013). Are children carrying the burden of broad-spectrum antibiotics in general practice? Prescription pattern for paediatric outpatients with respiratory tract infections in Norway. BMJ Open. 3(1). doi: 10.1136/bmjopen-2012-002285. Full text in Research Archive

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• Høye, Sigurd; Fossum, Guro Haugen & Emilsson, Louise (2026). Acute sinusitis – quo vadis? Full text in Research Archive Show summary

  Acute sinusitis (AS) is a frequent reason for primary care visits and has historically been a major cause of unnecessary antibiotic prescribing, contributing significantly to antimicrobial resistance (AMR). This symposium presents findings from the Norwegian BASIC (Better treatment for Acute Sinusitis In primary health Care) project, which addresses AMR and promotes sustainability by tackling diagnostic uncertainty, evaluating treatment alternatives, and studying patient and prescriber expectations. The central theme is the shifting landscape of AS management: while Norway has succeeded in substantially reducing antibiotic use, clinical decision-making remains complex, driven by patient-reported symptoms rather than clear guidelines. Aim of the symposium The overarching purpose of this symposium is to contribute to an improved understanding and management of acute sinusitis (AS) in Nordic general practice. The symposium will provide clinically useful information by presenting the newest evidence regarding appropriate AS management, thereby enhancing patient care. For the academic audience, the symposium offers academically valuable insights by detailing the innovative research methodology utilized in the BASIC project. Titles of Presentations included in the symposium Sinusitis – a vanishing entity? Introduction, 5 min. Sigurd Høye, associate professor and head of The Antibiotic Centre for Primary care, Department of General Practice, University of Oslo 'Antibiotics Works': Patient and GP experiences and expectations 5 min. Sigurd Høye, associate professor and head of The Antibiotic Centre for Primary care, Department of General Practice, University of Oslo Less antibiotics – more complications? 15 min. Louise Emilsson, associate professor, Department of General Practice, University of Oslo If not antibiotics – what then? 15 min Guro Haugen Fossum, researcher and head of research group, Department of General Practice, University of Oslo

• Renaa, Therese; Fossum, Guro Haugen; Høye, Sigurd; Skow, Marius & Emilsson, Louise (2026). Rate of otitis complications with lower antibiotic prescribing to preschool children in general practice. Nordic Congress of General Practice : Abstracts. Full text in Research Archive Show summary

  Introduction Antibiotic prescribing for otitis decreased in Norway from 2012 to 2019. Diagnosing otitis in young children is challenging, and the consistently high antibiotic prescription rate indicates a low threshold for antibiotic treatment in general practice, likely driven by diagnostic uncertainty and concern for complications. Aim To investigate if the rate of severe complications increases when fewer children with otitis are treated with antibiotics. Methods Registry study based on population data combined from four different health registries: KUHR (The Norwegian control and reimbursement registry), SSB (Norwegian statistics), NPR (The National Patient Registry), and NorPD (the Norwegian prescription registry). Multivariate logistic regressions tested associations of antibiotic treatment for otitis with hospitalization and severe complications, adjusted for demographic factors, underlying illness, health care access and the general practitioners (GP’s) prescription patterns. Severe complications included sinus venous thrombosis, mastoiditis, pneumonia, meningitis and sepsis. Results Preliminary results indicated that of 269,003 otitis episodes, only 300 resulted in a severe complication, 0.1%. Pneumonia and mastoiditis were the most common severe complications. The rate of severe complications changed minimally from 2012 (9/10 000 episodes) to 2019 (11/10 000 episodes), while the antibiotic prescription rate decreased by 21%. Asthma (OR 2.05 CI 1.54 – 2.75) and Down syndrome/craniofacial anomaly (OR 2,63 CI 1.08 – 6.40) gave the highest OR for severe complications among pre-existing conditions. The risk of complications was the same for children treated by low-prescribing GPs as high-prescribing GP’s. Conclusions and clinical implication Severe complications of otitis are rare. There was observed no increase in the rate of complications with lower antibiotic prescription.

• Brænd, Anja Maria; Fossum, Guro Haugen; Romøren, Maria; Eliassen, Knut Eirik Ringheim; Werner, Erik Lønnmark & Skonnord, Trygve (2026). Patient experiences with student consultations in Norwegian general practice: a questionnaire study. Full text in Research Archive
• Skonnord, Trygve; Schei, Edvin; Brænd, Anja Maria; Bondevik, Gunnar Tschudi; Fossum, Guro Haugen & Rebnord, Ingrid Keilegavlen [Show all 9 contributors for this article] (2025). Patients’ experiences of meeting a medical student. A cross-sectional study from general practitioners’ waiting rooms. Full text in Research Archive
• Halvorsen, Peder Andreas; Fossum, Guro Haugen; Koskela, Tuomas & Tolvanen, Elina (2025). Involving Primary Care Patients in Clinical Research: The Pivotal Role of Practice-Based Research Networks (PBRNs). Full text in Research Archive
• Fossum, Guro Haugen (2025). The Norwegian Primary Care Research Network (Praksisnett) Possibilities with industry initiated clinical trials. Full text in Research Archive
• Skonnord, Trygve; Fossum, Guro Haugen; Romøren, Maria; Eliassen, Knut Eirik Ringheim; Werner, Erik Lønnmark & Brænd, Anja Maria (2025). The experience of meeting a medical student at the GP's office. Full text in Research Archive
• Skow, Marius; Emilsson, Louise; Høye, Sigurd; Straand, Jørund; Brænd, Anja Maria & Fossum, Guro Haugen (2024). BIHULEBETENNELSE I ALLMENNPRAKSIS: PÅVIRKER ANTIBIOTIKA RISIKOEN FOR LANGVARIGE OG KOMPLISERTE PASIENTFORLØP? Full text in Research Archive Show summary

  Bakgrunn: Akutt bihulebetennelse er en vanlig tilstand i allmennpraksis, hvor antibiotika ofte foreskrives, til tross for økende dokumentasjon som viser at ukompliserte tilfeller sjelden har nytte av slik behandling. Risikoen for alvorlige komplikasjoner er lav, og tidligere studier fra norsk allmennpraksis har ikke vist noen vesentlig beskyttende effekt av antibiotika når det gjelder å forhindre sykehusinnleggelser eller alvorlige komplikasjoner etter akutt bihulebetennelse. Denne studien fokuserer på såkalte milde komplikasjoner av akutt bihulebetennelse, med vekt på antall konsultasjoner i allmennpraksis, bruk av spesialisthelsetjenester, sykefravær og antibiotikabruk. Målet med studien er å undersøke forekomsten av forlengede og kompliserte pasientforløp ved akutt bihulebetennelse som behandles utenfor sykehus, og å sammenligne utfallet blant pasienter som behandles med antibiotika, med de som ikke gjør det. Metode: Ved å koble data fra flere nasjonale helseregistre, analyserer vi episoder av akutt bihulebetennelse hos voksne pasienter diagnostisert i allmennpraksis i perioden 2012–2019. For hver episode samler vi inn opplysninger om antibiotikaresepter, legekonsultasjoner, sykemeldinger og kontakter hos øre-nese-hals-spesialister og poliklinikker. Vi bruker en «difference-in-difference»-metode for å sammenligne utfallet av episoder behandlet med og uten antibiotika, ved å undersøke forekomsten av de ulike utfallsmålene i 12 uker etter en akutt bihulebetennelsesepisode, sammenlignet med 12 uker før episoden. Resultater: Vår kohort består over 600 000 episoder av akutt bihulebetennelse. Analysene er ikke ferdige på tidspunktet for innsending av sammendraget, men foreløpige resultater vil bli presentert på møtet. Konklusjoner: Konklusjonene er foreløpig ikke klare og vil bli trukket basert på den endelige analysen av våre data.

• Fossum, Guro Haugen & Halvorsen, Peder Andreas (2024). Using information technology to facilitate research in a practice-based research network - the story of PraksisNett. Full text in Research Archive
• Fossum, Guro Haugen (2024). BASIC - A randomized controlled trial testing topical treatment with chloramphenicol eye drops. Full text in Research Archive
• Skow, Marius Andre Hybbestad; Brænd, Anja Maria; Emilsson, Louise; Høye, Sigurd; Straand, Jørund & Fossum, Guro Haugen (2024). Complicated courses of sinusitis in general practice in an era of antibiotic stewardship. Full text in Research Archive
• Bellika, Johan Gustav; Bjorvatn, Bjørn; Halvorsen, Peder Andreas; Jørgensen, Pål; Emberland, Knut Erik & Fossum, Guro Haugen [Show all 7 contributors for this article] (2024). Personvernet som fundament for fremtidens digitale helsevesen. Full text in Research Archive
• Skow, Marius; Emilsson, Louise; Straand, Jørund; Høye, Sigurd & Fossum, Guro Haugen (2024). Complicated courses of sinusitis in general practice in an era of antibiotic stewardship. Full text in Research Archive
• Heltveit-Olsen, Silje Rebekka; Fossum, Guro Haugen & Engelsen, Thea Cecilie (2024). Pandemien endret kommuneoverlegens rolle. [Internet]. Forskning.no. Full text in Research Archive
• Renaa, Therese; Emilsson, Louise; Skow, Marius; Høye, Sigurd & Fossum, Guro Haugen (2023). Antibiotic prescriptions to preschool children with respiratory tract infections in Norwegian primary health care 2012-2019. Full text in Research Archive
• Skow, Marius; Fossum, Guro Haugen; Høye, Sigurd; Straand, Jørund; Brænd, Anja Maria & Emilsson, Louise (2023). Luftveisinfeksjoner og antibiotikaforskrivning i allmennpraksis. Full text in Research Archive
• Fossum, Guro Haugen & Halvorsen, Peder Andreas (2023). Using information technology to facilitate research in a practice-based research network - the story of PraksisNett. Full text in Research Archive
• Fossum, Guro Haugen & Halvorsen, Peder Andreas (2023). PraksisNett - et forskningsnettverk i primærhelsetjenesten. Full text in Research Archive
• Fossum, Guro Haugen; Brænd, Anja Maria Lyche; Heltveit-Olsen, Silje Rebekka; Høye, Sigurd; Rørtveit, Guri & Straand, Jørund (2022). CovidNor - The Patient Study. Full text in Research Archive
• Svaland, Malene; Brænd, Anja Maria Lyche & Fossum, Guro Haugen (2022). CovidNor - The Patient Study. Full text in Research Archive
• Fors, Egil Andreas; Rørtveit, Guri; Bellika, Johan Gustav; Nilsen, Stein; Fossum, Guro Haugen & Bjorvatn, Bjørn (2022). Practice-based research networks: A small step for a GP, but a giant leap for primary care research. Full text in Research Archive
• Heltveit-Olsen, Silje Rebekka; Lunde, Lene; Brænd, Anja Maria; Spehar, Ivan; Høye, Sigurd & Skoglund, Ingmarie [Show all 10 contributors for this article] (2022). Experiences and management strategies of Norwegian GPs during the COVID-19 pandemic: A longitudinal interview study. Full text in Research Archive
• Skonnord, Trygve; Brænd, Anja Maria & Fossum, Guro Haugen (2022). Patient experiences from the COVID-19 pandemic regarding health care seeking, self-care, concern for disease, and delayed diagnosis and treatment; a cross-sectional study in general practice. Full text in Research Archive
• Skow, Marius; Fossum, Guro Haugen; Høye, Sigurd; Straand, Jørund; Emilsson, Louise & Brænd, Anja Maria (2022). Antibiotic treatment of adult patients with respiratory tract infections in Norwegian general practice: A nationwide registry-based study. Full text in Research Archive
• Fossum, Guro Haugen; Heltveit-Olsen, Silje Rebekka & Høye, Sigurd (2020). Experiences of patients and primary health care professionals during the COVID-19 epidemic in Norway. Full text in Research Archive
• Fossum, Guro Haugen (2019). Infeksjoner og antibiotikabruk hos gravide og hos småbarn. Full text in Research Archive
• Fossum, Guro Haugen (2019). RESPIRATORY TRACT INFECTIONS AND PRESCRIPTION DRUGS IN MOTHER AND CHILD - A STUDY FROM NORWEGIAN GENERAL PRACTICE. Full text in Research Archive
• Fossum, Guro Haugen; Brænd, Anja Maria; Høye, Sigurd & Minge, Christina (2019). European Treatment Guidelines for Otitis, Sinusitis and Tonsillitis in Primary Care. Full text in Research Archive
• Fossum, Guro Haugen (2018). Relationship between maternal antibiotic prescriptions and antibiotic and antiasthmatic prescriptions in children younger than one year. Full text in Research Archive
• Fossum, Guro Haugen & Hjortdal, Per (2013). Streptokokkhalsinfeksjon og skarlagensfeber, Nasjonale retningslinjer for antibiotikabruk i primærhelsetjenesten. Helsedirektoratet. ISSN 9788280812711. p. 73–78. Full text in Research Archive
• Fossum, Guro Haugen (2013). Antibiotika til barn -et spørsmål om smak og behag. Utposten. ISSN 0800-5680. 2, p. 6–7. Full text in Research Archive
• Fossum, Guro Haugen (2019). RESPIRATORY TRACT INFECTIONS AND PRESCRIPTION DRUGS IN MOTHER AND CHILD - A STUDY FROM NORWEGIAN GENERAL PRACTICE. Universitetet i Oslo. Full text in Research Archive

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