Scandinavian Journal of Primary Health Care最新文献

Background and purpose: Absence from work due to illness is common in many western countries and has many negative consequences for both the individual and society. Since 2020 Swedish healthcare regions are required to provide resources to coordinate the rehabilitation process, a complex system involving medical as well as work-related parties, where both the physician and the rehabilitation coordinator play a central role. The aim of this study was to describe how primary care physicians experience the role of and the collaboration with a rehabilitation coordinator.

Materials and methods: We used a qualitative design doing semi-structured interviews with primary care physicians (n= 9) in the Skåne healthcare region. The interviews were recorded, transcribed and analyzed using qualitative content analysis.

Results: One main category "An external and internal connecting point that has improved the sick-listing and rehabilitation process", and four subcategories: "Provides relief for the individual physician"; "Offers practical support at the clinic"; "Gives increased sense of security for the patients" and "Sufficiently trained, with potential to take further responsibility", were determined.

Conclusions: The study shows that primary care physicians experienced benefits from a close collaboration with a rehabilitation coordinator, feeling less lonely. The rehabilitation coordinator is often regarded as having a central role in insurance medicine related tasks, but an even more active role is desired.

Background: Exhaustion disorder (ED) is one of the most rapidly increasing causes of sick leave in Sweden. The prolonged recovery time from ED creates a dilemma on both the societal and individual level. How patients experience the encounter with health care is critical for the recovery from ED. The aim of this study was to explore how patients with ED experience the encounter with health care.

Method: Data from 23 semi‑structured interviews with ED patients were analysed using content analysis.

Results: One of the main findings was that patients want to be listened to and taken seriously in the encounter with health care. However, patients experience that healthcare struggles to meet these expectations. Several informants reported not being listened to, worrying symptoms were overlooked, an individualised care plan was lacking, and patients experienced that they were prematurely dismissed. This created an experience of unsafety, and that could inadvertently maintain the stress response and negatively influence recovery for patients with stress‑related disorders.

Conclusion: It is paramount to convey an experience of predictability, despite the fact that patients undergo an unpredictable process related to their ED illness. By combining the traditional load‑recovery theory with the generalised unsafety theory of stress, we can tap into the potential to enhance recovery for patients with ED. We suggest that if the encounter with healthcare provides an experience of generalised safety, the conditions for patients with stress‑related disorders to recover would be distinctly enhanced.

Motivation: Primary care centres are the first line of mental health service in Sweden responsible for individuals with mild to moderate severe symptoms of common mental disorders (CMD). The aim was to evaluate impact of sick leave and sick leave duration in patients diagnosed with CMD in primary care centres with a care manager organisation during the first and second year after implementation compared to usual care.

Methods: Register data on sick leave (mean number of net and gross sick leave days) among patients with CMD was obtained per primary care centre from the national social insurance database MiDAS. Two measures of sick leave were used: impact of sick leave in total patient population with CMD, and sick leave duration among sick listed patients with CMD. Linear mixed-effects regression analysis was performed for cross-sectional differences and longitudinal changes between and within the two groups of primary care centres.

Results: Primary care centres with care as usual had a lower proportion of sick listed patients with CMD at both year 1 and 2. Primary care centres with a care manager organisation (CMO) had significantly fewer mean number of sick leave days (net and gross days) among patients with CMD compared to centres with care as usual, indicating a lower impact of sick leave. Sick leave duration among sick listed patients did not show statistically significant differences between the two groups of primary care centres. Both groups of primary care centres increased their sick leave duration significantly from year 1 to year 2, congruent to Sweden as a whole.

Conclusion: The aim of this study was to evaluate two measures of sick leave in primary care centres with a care manager organisation compared to care as usual. There were no differences in sick leave duration. Primary care centres with a care manager organisation, designed to increase accessibility and continuity for patients with CMD, seemed to facilitate the primary care centre's possibility to offer enhanced care taking to more patients with CMD with continued lower levels of impact of sick leave compared to care as usual.

Implementation: This study evaluated outcomes after implementation of CMO at primary care centres.

Background: Detection of colorectal cancer (CRC) is mainly achieved by clinical assessment. As new treatments become available for metastatic CRC (MCRC), it is important to accurately identify these patients.

Aim: To develop a predictive model for identifying MCRC in primary health care patients using diagnostic data analysed with machine learning.

Design and setting: A case-control study utilising data on primary health care visits for 146 patients >18 years old diagnosed with MCRC in the Västra Götaland Region, Sweden during 2011, and 577 sex-, age, and primary health care centre-matched controls.

Method: Stochastic gradient boosting was used to construct a model for predicting the presence of MCRC based on diagnostic codes from primary health care consultations during the year before index (diagnosis) date and number of consultations. Variable importance was estimated using the normalised relative influence (NRI) score. Risks of having MCRC were calculated using odds ratios of marginal effects (OR_ME).

Results: The optimal model included 76 variables with non-zero influence, had an area under the curve of 76.5%, a sensitivity of 77.8%, and a specificity of 69.2%. The 10 most important variables had a combined NRI of 61.0%. Number of consultations during the year before index date had the highest NRI at 19.2%, with an OR_ME of 3.3.

Conclusion: A machine learning method based on primary health care consultation frequency and diagnoses may be used to identify important variables for predicting presence of MCRC. Both primary health care consultations and associated diagnostic codes need to be taken into consideration.

Background: Obesity is a complex condition and a recognized public health challenge. Previous treatment options were associated with high failure rates, but recent trials have shown that significant weight loss can be achieved with GLP1-RAs. However, little is known about the patient's experiences with GLP1-RAs.

Objectives: This paper systematically reviews research on patients' experience with GLP1-RAs.

Methods: A literature search in PubMed, PsycINFO, Embase and Sociological Abstracts included studies on adults' experiences with GLP1-RAs, regardless of methodology. Exclusions of studies: mental illness, pregnancy, former bariatric surgery, PCOS. Study quality and transparency were assessed according to design, using thematic analysis for synthesis.

Results: Nine studies, selected from 7,607 records, encompassed three qualitative studies (semi-structured interviews), three RCTs, two narrative reviews and one survey study. The analysis identified five key themes: (1) Patients are willing to accept adverse events, like gastrointestinal disorders, for successful weight loss, (2) Patients experience improved physical functioning, well-being, and active daily living as a result of weight loss, (3) Patients express diverse opinions and skills regarding the medication's usability, (4) Patients believe that the medication improves their ability to manage sweet cravings, (5) Gender seems to affect patients' experiences with the medication, with females reporting more benefits than males.

Conclusion: Despite a huge demand and usage of GLP1-RAs, qualitative research on patients' experiences is scarce. Further studies are crucial for understanding short and long-term patient experiences.

Objective: Many adolescent males report negative experiences of consultations with general practitioners (GPs), which contrasts with the importance of patient-centredness that GPs themselves emphasise. A better understanding of this discrepancy might facilitate improvements. The aim was to explore and describe adolescent males' encounters with GPs in Swedish primary healthcare centres using a lifeworld perspective.

Design: Qualitative lifeworld-based study. Video-recorded observations were analysed using a phenomenological-hermeneutical method.

Setting: Two primary healthcare centres in mid-Sweden.

Subjects: Nine males aged 15 to 19, video-recorded during their encounters with GPs in March through May 2022.

Findings: Adolescent males navigate between being children in need of parental support and men who can take initiative and responsibility. They face cognitive, emotional, and relational demands, the complexity of which renders them particularly vulnerable. When feeling exposed and not knowing what to expect, they struggle to make themselves understood, and to understand what the GP is saying and what is happening. The difficulties that they have disclosed to the GP in trust need to be recognised and carefully acted upon. Thus the GP must respond appropriately to this complex mix of vulnerabilities to prevent feelings of disappointment or of having exposed themselves in vain.

Conclusion: The complexity of encounters with adolescent males imposes great demands on GPs to identify and adapt to their individual needs. A proper ethical response involves helping them navigate the challenges of the consultation while also respecting them as persons and meeting their age-dependent needs.

Background: Sleep disorders such as insomnia may occur in old age, potentially leading to z-hypnotic use. However, few studies have explored older adults' self-reported sleep concerns in relation to z-hypnotic use. We aim to examine this relationship.

Methods: We conducted a cross-sectional study using a web-based questionnaire to assess sleep disturbances and medication use (z-hypnotics, benzodiazepines, and opioid analgesics) among 5,194 older adults through 21 GPs in southeast Norway. The main outcome, inappropriate z-hypnotic use, was defined as self-reported use for ≥4 weeks at ≥ three times per week. We used descriptive statistics and exploratory logistic regression mixed-effects models for data analysis.

Results: Among the 687 patients included in the study, 22% (N = 153) reported sleep disturbances. Of these, 84% (N = 575) did not use z-hypnotics, while 16% (N = 112) used z-hypnotics, 63% (N = 71) of these used them inappropriately. (≥4 weeks, ≥ three times per week). Patients with sleep disturbances (OR: 12.1, CI: 6.77 - 21.6, p < 0.001), trouble falling or staying asleep (OR: 14.6, CI: 5.04-42.0, p < 0.001), and multiple reasons for disturbances (pain, overthinking, or a family death) (OR: 3.58, CI: 1.85-6.93, p < 0.001) had higher odds of inappropriate z-hypnotic use compared to those with no or occasional disturbances. Men had lower odds (OR: 0.54, CI: 0.30-0.97, p = 0.039) than women. GP prescribing was not associated with inappropriate use, but men had lower odds (OR: 0.34, CI: 0.14-0.84, p = 0.020) when prescribed by male GPs compared to women prescribed by female GPs.

Conclusion: A high proportion of patients used z-hypnotics inappropriately. This inappropriate use was associated with experienced sleep disturbances, particularly trouble falling asleep, trouble staying asleep, and multiple reasons for sleep disturbances. The prescribing GP was not significantly associated with inappropriate use.