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Artikkelbilde
Lungelegene Bernt Aarli (t.v.) og Bjarte Nore ved Haukeland universitetssjukehus har fått programmeringshjelp fra IT-ingeniør Kjell Garatun-Tjeldstø i Codelab. Foto: Klaus Meyer

Kolskalkulator skal hjelpe allmennlegene

Lungeleger i Bergen opplevde at fastleger droppet å bruke nye, kompliserte kolsretningslinjer. Derfor utviklet de nettsiden «kolskalkulatoren».

Publisert: 2015-01-23 — 13.30 (Oppdatert: 2015-05-08 — 14.28)
Denne artikkelen er over seks år gammel.

I 2011 kom nye internasjonale kols-retningslinjer, og året etter kom nasjonale retningslinjer som i stor grad bygger på Global Initiative for Chronic Obstructive Lung Disease (GOLD). De norske retningslinjene som legene skal forholde seg til er på hele 173 sider. Flere eksperter mener veilederen har blitt for komplisert for fastleger å håndtere, slik Dagens Medisin tidligere har skrevet.

Ifølge de nye retningslinjene skal ikke legen lenger bare måle pasientens lungefunksjon, men også ta hensyn til pasientens plager. Dette skal gjøres gjennom å registrere antall forverringer og rangere symptomer etter standardiserte skjemaer for deretter å dele pasientene inn i fire ulike behandlingsgrupper.

– Vi tenkte dette både ville komplisere oppfølging og bli mer tidkrevende for allmennpraktikerne, og var i tvil om de nye retningslinjene ville bli fulgt. Mitt inntrykk er at de ikke brukes og har til gode å se et journalnotat skrevet av en annen lege hvor pasienten plasseres i behandlingsgruppe basert på retningslinjene, sier overlege Bernt Aarli ved lungeavdelingen på Haukeland universitetssjukehus.

Nettside gir medisinråd
Sammen med kollega Bjarte Nore ønsket han derfor å lage et dataprogram som skulle gjøre dette enklere for fastlegene. Resultatet, nettsiden kolskalkulator.no, ble lansert i september i år. En to minutter lang instruksjonsvideo viser hvordan kolskalkulatoren kan brukes til å stille diagnose og gi riktig behandling i løpet av fem enkle steg.

Ved mistanke om kols gjøres først spirometri, deretter registreres ulike opplysninger om pasienten på nettsiden. Resultatet angir om kols-diagnose er sannsynlig, og plasserer pasienten i riktig behandlingsgruppe. Kalkulatoren foreslår deretter medisiner, før en oppsummering kan klippes inn i pasientjournalen.

– Virker oppgitte
Aarli og Nore fikk hjelp fra Innovasjon Norge til å utvikle kalkulatoren, som er industriavhengig. De er nå i ferd med å inngå en avtale som vil gjøre at kalkulatoren blir tilgjengelig gjennom Norsk Elektronisk Legemiddelhåndbok (NEL) neste år. Målet er å nå flest mulig leger.

– Allmennpraktikere virker oppgitt over omfanget av retningslinjer generelt, og mange liker ikke kols-retningslinjene. Men så lenge dette er de gjeldende retningslinjene, må vi forholde oss til dem. Alle vi har snakket med er positive til et verktøy som kan gjøre hverdagen lettere, sier Aarli.

– Kan ikke erstatte skjønn
Ifølge Aarli har kalkulatoren vært benyttet cirka 1085 ganger siden 1. september. Legene vet ikke om utregningene er gjort på fiktive eller reelle pasienter.

– Hvilke ulemper er forbundet med å basere seg på et slikt automatisk verktøy?

– En lege står alltid ansvarlig for diagnose og behandling, og man kan aldri stole blindt på automatiske diagnoseverktøy. Kalkulatoren tar høyde for om pasienten er norsk, europeisk eller fra andre verdensdeler. Men det er mange ting som potensielt kan gå galt; for eksempel kan faktorer som ekstrem fedme og tidligere operasjoner påvirke lungevolumet, uten at det er kols. En maskin kan aldri erstatte klinisk skjønn, men kalkulatoren gir en god guide til hva retningslinjene sier om behandlingsvalg, understreker lungelegen. 

Lungelegen opplyser at kalkulatoren foreløpig har ikke generert noen inntekter for oppfinnerne, men at de ser på inntjeningsmuligheter for å kunne holde tjenesten ved like i fremtiden.

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  • Driss 17.12.2015 16.17.54

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Here, the blackboard-paper-pencil-workbook setup is only supplementary to the many hands-on, interactive materials available and better suited for young beginners. The 1000+ library books and school supplies there for the children to use and keep in order are part of the tuition fee, so are the daily snacks served – an added convenience to parents. This house-turned-kindergarten doesn’t boast many rooms, just avenues for social growth and academic achievement. You cannot expect to see a building, large offices or school buses only progress. But, if these are what you’re looking for, then you’ve come to the right place to scout!*KIDSCHOOL – A Child Development Center for 2 bd to 6 year olds is located at 84 Dr. Lazcano Street in Quezon City. It is in the residential “Scout” Area with wide tree-lined roads. The main roads Tomas Morato and Roces Avenue make it accessible even to public transportation.Yours,Marielle Irene D. Rodriguez0919-4441422

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