The patients in this dataset had an average of 4.2 disease diagnoses and 0.8 symptom diagnoses. Many had disease in multiple organ systems or multiple diseases in each organ system. Substance abuse, smoking and many of these diagnoses are all significantly associated with reduced health and longevity. The patients in this study seem to have more somatic morbidity than those in two previous studies (11, 12).
The current study did not include a control group. A literature search was therefore conducted to identify findings from previous studies. The proportion of patients with asthma/COPD is 50 % higher in this dataset than in the HUNT 3 dataset (18). A study from Nord-Trøndelag county (19), which performed echocardiography in 1296 individuals (mean age 49 years), found that 30 (2.3 %) had cardiovascular disease that could affect heart function. The frequency of pathology appears to be considerably higher in the current study.
The self-reported health complaints (structured questionnaires) show that many patients put up with diseases, ailments and chronic pain without contacting their GP. In the HUNT 3 study, 83 % of participants said they had consulted their GP in the last year (18), while 62 patients (41 %) in our dataset had contacted their GP because of physical ailments in the last six months.
Eighty-three per cent of our patients used tobacco or snus daily, while in the Nord-Trøndelag Health Study (HUNT 3, 2006 – 08), 16 – 25 % were daily smokers or snus users, with the proportion increasing slightly with age (18).
Twelve per cent of patients stated directly that they had little contact with their GP. A large proportion of those who either declined to answer, had no contact with their GP or who had just changed GP also indicated that they had little contact, but did not want this to be recorded.
Several user surveys have shown a high degree of satisfaction with the GP scheme (20). The substance abusers in this study do not seem to be equally satisfied. There may be several reasons for this, including frequent changes of GP, limited ability to pay fees, poor attendance of appointments, complex presentations that require extensive time to investigate, restriction of access to habit-forming substances by the GP, and fear of stigmatisation.
A number of GPs see substance abusers as troublesome – associating them with disturbances in the waiting room, attendance outside of scheduled appointments and poor compliance with treatment programmes. Before implementation of the GP scheme, and again in 2013, doubts were raised about whether the GP scheme was truly the best option for substance abusers (21, 22). However, from our data we cannot say how many of the patients' illnesses and ailments their GPs were aware of.