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The impact of the COVID-19 pandemic on antibiotic prescription rates in out-of-hours primary care - a register-based study in Denmark. COVID-19 大流行对非工作时间初级保健中抗生素处方率的影响--基于丹麦登记册的研究。
IF 1.9 3区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-03-01 Epub Date: 2024-09-30 DOI: 10.1080/02813432.2024.2410331
Emil Krogh, Katrine Bjørnshave Bomholt, Mette Amalie Nebsbjerg, Claus Høstrup Vestergaard, Morten Bondo Christensen, Linda Huibers

Background: Antibiotic prescription rates can be affected by pandemic measures such as lockdowns, social distancing, and remote consultations in general practice. Therefore, such emergency states may negatively affect antimicrobial stewardship, specifically in out-of-hours (OOH) primary care. As contact patterns changed in the COVID-19 pandemic, it would be relevant to explore the impact on antimicrobial stewardship.

Aim: To study the impact of the pandemic on antibiotic prescription rates in OOH primary care, overall and per age group.

Methods: This cross-sectional register-based study used routine data from OOH primary care in the Central Denmark Region. We included all patient contacts in two equivalent time periods: pre-pandemic and pandemic period. The main outcome measure was defined as the number of antibiotic prescriptions per contact (antibiotic prescription rate).

Results: The overall antibiotic prescription rate decreased during the first year of the pandemic compared to the pre-pandemic period (RR = 0.97, 95%CI: 0.96-0.98). Likewise, the rate decreased for clinic consultations (RR = 0.63, 95%CI: 0.62-0.64). However, an increase was seen for telephone consultations (RR = 1.73, 95%CI: 1.70-1.76). The decline in clinic consultations was largest for consultations involving children aged 0-10 years (RR = 0.53, 95%CI: 0.51-0.56).

Conclusion: Antibiotic prescription rates in Danish OOH primary care decreased during the first year of the COVID-19 pandemic, especially for young children. Prescription rates decreased in clinic consultations, whereas the rates increased in telephone consultations. Further research should explore if antibiotic prescription rates have returned to pre-pandemic levels, and if the introduction of video consultations has affected antibiotic prescription patterns in OOH primary care.

背景:抗生素处方率可能会受到大流行措施的影响,例如全科医疗中的封锁、社会疏远和远程会诊。因此,这种紧急状态可能会对抗菌药物管理产生负面影响,特别是在非工作时间(OOH)的初级保健中。由于在 COVID-19 大流行中接触模式发生了变化,因此探讨其对抗菌药物管理的影响将具有现实意义。目的:研究大流行对非全日基层医疗机构抗生素处方率的影响,包括总体影响和各年龄组的影响:这项以登记为基础的横断面研究使用了丹麦中部地区户外初级医疗机构的常规数据。我们纳入了大流行前和大流行期间两个同等时期的所有患者接触者。主要结果指标为每次接触的抗生素处方数量(抗生素处方率):结果:与大流行前相比,大流行第一年的总体抗生素处方率有所下降(RR = 0.97,95%CI:0.96-0.98)。同样,门诊处方率也有所下降(RR = 0.63,95%CI:0.62-0.64)。然而,电话咨询的比率却有所上升(RR = 1.73,95%CI:1.70-1.76)。0-10岁儿童就诊率下降幅度最大(RR = 0.53,95%CI:0.51-0.56):结论:在 COVID-19 大流行的第一年,丹麦门诊初级保健中的抗生素处方率有所下降,尤其是幼儿。门诊咨询中的处方率有所下降,而电话咨询中的处方率有所上升。进一步的研究应探讨抗生素处方率是否已恢复到大流行前的水平,以及视频会诊的引入是否影响了户外初级保健中的抗生素处方模式。
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引用次数: 0
Health determinants among participants in targeted health dialogues offered to all 40-year-old individuals in a metropolitan region of 1.4 million people. 在一个拥有 140 万人口的大都市地区,向所有 40 岁的人提供有针对性的健康对话,参与者的健康决定因素。
IF 1.9 3区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-03-01 Epub Date: 2024-08-01 DOI: 10.1080/02813432.2024.2385547
Emelie Stenman, Beata Borgström Bolmsjö, Anton Grundberg, Kristina Sundquist

Objective: To examine cardiovascular risk factors in 40-year-old participants in the health screening program targeted health dialogues (THDs).

Design: Cross-sectional study.

Setting: 99 Swedish healthcare centers.

Intervention: Metabolic risk factors and health behaviors were assessed. THDs were provided.

Subjects: 1831 (62.3%) THD participants that consented to take part in the research project.

Main outcome measures: (1) Prevalence of metabolic risk factors (blood pressure, LDL cholesterol, fasting plasma glucose, BMI, waist-hip ratio) and unhealthy behaviors (tobacco, alcohol, diet, physical activity) by sex, education, and place of birth. (2) Associations between different health behaviors and between the number of unhealthy behaviors and prevalence of metabolic risk factors. (3) THD participation by sociodemographics compared to age-matched controls.

Results: Men had a higher prevalence of all metabolic risk factors, excessive alcohol use and tobacco use than women. Lower educated individuals had a higher prevalence of metabolic risk factors (except for LDL cholesterol) and tobacco use than highly educated. Participants born outside Sweden had a higher prevalence of obesity, high waist-hip ratio, and tobacco use. Participants with 3-4 unhealthy behaviors had significantly higher prevalence of each of the metabolic risk factors except BMI. Women, highly educated and Swedish-born participants were slightly over-represented in the THDs.

Conclusion: Considering the associations between unhealthy behaviors and metabolic risk factors, the THD method, covering lifestyle as well as objective health measures, may be an appropriate method for early identification of individuals at risk for future non-communicable diseases in the whole population with a specific focus on certain groups.

Clinicaltrials.gov: NCT04912739.

目的研究参加健康筛查计划 "目标健康对话"(THDs)的 40 岁参与者的心血管风险因素:设计:横断面研究:干预措施:代谢风险因素和健康行为:干预措施:评估代谢风险因素和健康行为。受试者1,831名(62.3%)同意参与研究项目的THD参与者:(1) 按性别、教育程度和出生地分列的代谢风险因素(血压、低密度脂蛋白胆固醇、空腹血浆葡萄糖、体重指数、腰臀比)和不健康行为(烟草、酒精、饮食、体育锻炼)的发生率。(2)不同健康行为之间的关联,以及不健康行为的数量与代谢风险因素流行率之间的关联。(3) 与年龄匹配的对照组相比,社会人口统计学中的THD参与情况:结果:与女性相比,男性在所有代谢风险因素、过度饮酒和吸烟方面的发生率都更高。与受过高等教育的人相比,受教育程度较低的人代谢风险因素(低密度脂蛋白胆固醇除外)和吸烟的发生率较高。在瑞典以外出生的参与者肥胖、腰臀比高和吸烟的比例较高。有 3-4 种不健康行为的参与者除体重指数(BMI)外,其他代谢风险因素的患病率都明显较高。女性、高学历和瑞典出生的参与者在 THDs 中的比例略高:考虑到不健康行为与代谢风险因素之间的关联,涵盖生活方式和客观健康指标的 THD 方法可能是在整个人群中早期识别未来非传染性疾病风险个体的适当方法,并特别关注某些群体:NCT04912739。
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引用次数: 0
Task shifting for musculoskeletal disorders in Norwegian primary care: a qualitative interview study of general practitioners and specialist musculoskeletal physiotherapists. 挪威基层医疗机构肌肉骨骼疾病的任务转移:对全科医生和肌肉骨骼专科物理治疗师的定性访谈研究。
IF 1.9 3区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-03-01 Epub Date: 2024-08-02 DOI: 10.1080/02813432.2024.2384043
Kenneth Chance-Larsen, Michael Backhouse, Richard Collier, Tobba Sudmann

Objective: To explore the views of general practitioners and physiotherapists on the current model of care for patients with musculoskeletal disorders in Norwegian primary care, and if the English First Contact Practitioner model, where patients have access to multiple professional groups with musculoskeletal health expertise, could inform service development.

Design, setting, and subjects: We analysed interviews with five GPs and 11 physiotherapists and used Lipsky's theories about street-level bureaucracy and Foucault's theories of mechanisms of power and institutional structures to explore task shifting and cooperation between different professions.

Results and interpretation: The empirical material reflected a multi-faceted discourse about skill-mix in primary care, where financial factors, perceptions about competence, and task preferences moderated attitudes to task shifting. Competition and cooperation coexist between the professions, and the seemingly gradual blurring between historical hegemony and new models of care creates both alliances and rivalries. Examples of deviations from the Choosing Wisely principles and evidence-based practice indicate that both general practitioners and physiotherapists balance the roles of patient advocate, gatekeeper, and homo economicus, in a context where task shifting is challenged by established practice. It appears that the management of patients with musculoskeletal disorders is fragmented and to some extent reflects a supply-driven system.

目的探讨全科医生和物理治疗师对挪威基层医疗机构目前肌肉骨骼疾病患者护理模式的看法,以及英国的 "第一接触医师 "模式(患者可接触到多个具有肌肉骨骼健康专业知识的专业团体)能否为服务发展提供参考:我们分析了对 5 名全科医生和 11 名物理治疗师的访谈,并利用利普斯基关于街道官僚主义的理论以及福柯关于权力机制和制度结构的理论来探讨不同专业之间的任务转移与合作:实证材料反映了关于初级保健中技能组合的多方面讨论,其中财务因素、对能力的看法和任务偏好调节了对任务转移的态度。各专业之间的竞争与合作并存,历史霸权与新的医疗模式之间似乎逐渐模糊,这既造成了联盟,也造成了竞争。偏离 "明智选择 "原则和循证实践的例子表明,在任务转移受到既定实践挑战的情况下,全科医生和物理治疗师都要平衡病人权益维护者、守门人和经济人的角色。对肌肉骨骼疾病患者的管理似乎是分散的,并在一定程度上反映了供应驱动的系统。
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引用次数: 0
Medical practitioners' experiences and considerations when managing sleep medication for adolescents and young adults. 医生在管理青少年睡眠药物时的经验和注意事项。
IF 1.9 3区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-03-01 Epub Date: 2024-09-30 DOI: 10.1080/02813432.2024.2407877
Nanna Maria Andersen, Ásthildur Árnadóttir, Tora Grauers Willadsen, Gritt Overbeck

Introduction: The prevalence of sleep disorders and use of sleep medication, particularly melatonin, are rising among adolescents and young adults (13-24 years). In Denmark, melatonin is approved for use in children with autism and ADHD up to 18 years of age, with other prescriptions being off-label in these age groups. The perspectives of medical practitioners on prescribing sleep medications to this age group remain largely unexplored.

Aim: This study aims to investigate the considerations of general practitioners (GPs) and child and adolescent psychiatrists (psychiatrists) when prescribing and deprescribing sleep medications for 13-24-year-olds.

Methods: We conducted qualitative semi-structured interviews with 10 GPs and six psychiatrists. Data were analyzed using an inductive approach.

Results: Psychiatrists typically prescribed melatonin with the expectation that deprescription would occur in general practice. Despite the universal goal of deprescription, it was hindered by various challenges. GPs identified patient motivation and a clear focus on deprescription as facilitative factors and expressed a need for enhanced emphasis on these aspects in general practice.

Discussion and implications: The findings align with existing prescription trends and literature on factors that promote and inhibit deprescription. The study underscores the complexities of deprescribing sleep medications for adolescents and young adults, suggesting the need for expanded guidelines and enhanced continuing education for GPs.

Conclusions: The research highlights significant discrepancies among medical practitioners regarding the deprescription process of sleep medications for young individuals, complicated by multiple factors. This underscores the need for better guidelines and further studies.

简介在青少年和年轻成年人(13-24 岁)中,睡眠障碍的发病率和睡眠药物(尤其是褪黑素)的使用率都在上升。在丹麦,褪黑素被批准用于 18 岁以下患有自闭症和多动症的儿童,其他处方则不在这些年龄组的标签范围内。本研究旨在调查全科医生(GPs)和儿童青少年精神科医生(psychiatrists)在为 13-24 岁儿童开具和停用睡眠药物处方时的考虑因素:我们对 10 名全科医生和 6 名精神科医生进行了半结构式定性访谈。采用归纳法对数据进行分析:结果:精神科医生通常会开出褪黑素处方,并期望在全科医生处方中会出现褪黑素处方。尽管去处方化是一个普遍目标,但却受到各种挑战的阻碍。全科医生认为患者的动机和对去处方化的明确关注是促进因素,并表示需要在全科实践中加强对这些方面的重视:研究结果与现有的处方趋势以及有关促进和抑制去处方化因素的文献一致。该研究强调了为青少年开具睡眠药物处方的复杂性,表明有必要扩大指南范围并加强对全科医生的继续教育:研究结果表明,在为青少年开具睡眠药物处方的过程中,医疗从业人员之间存在着巨大的差异,这是由多种因素造成的。这凸显了制定更好的指南和开展进一步研究的必要性。
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引用次数: 0
Photo-supported conversations about well-being (BeWellTM) for patients with exhaustion disorders - a controlled clinical intervention study. 针对疲惫障碍患者的照片辅助幸福对话(BeWellTM)--临床干预对照研究。
IF 1.9 3区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-03-01 Epub Date: 2024-11-06 DOI: 10.1080/02813432.2024.2421588
A Birgitta Gunnarsson, Petra Wagman, Ulrica Hörberg, Kristina Holmgren, Sara Holmberg

Introduction: Health-promotion approaches to address stress-related exhaustion disorders, reduce personal suffering, improve coping and participation in everyday life are needed in primary care. The aim of this study was to investigate self-reported health and well-being before and after an intervention focusing on well-being with photo-supported conversations (BeWellTM).

Material and methods: Eighty-one patients (69 women), 20-67 years old, with exhaustion disorders were recruited at Swedish primary health care centres (PHCC) to a controlled clinical study. The intervention group (n = 40) were offered BeWell by therapists in addition to care as usual. Controls (n = 41) received only care as usual. The primary outcome, self-rated symptoms of exhaustion (Karolinska exhaustion disorder scale, KEDS), and secondary outcomes, anxiety and depression, sense of coherence, quality of life, occupational balance, and work ability, were assessed by validated questionnaires. Non-parametric statistical analyses were used to compare data collected directly after the treatment period with baseline measures.

Results: Demographics and self-rated baseline measures of health and well-being were comparable between the groups, apart from sick leave being more common in the intervention group. Participants in the intervention group reduced their level of exhaustion more than the control group (median difference on KEDS -9.0 vs -4.0, p = .035). However, the size of the KEDS reduction was related to baseline KEDS and, not independently associated with group assignment. Both groups improved regarding secondary outcome measures.

Conclusion: Stress-related symptoms decreased considerably over the treatment period for both groups. The potential benefit of the BeWell, which was intended to facilitate recovery, needs to be further evaluated.

导言:基层医疗机构需要采取促进健康的方法来解决与压力相关的疲惫障碍、减少个人痛苦、提高应对能力和参与日常生活的能力。本研究的目的是通过照片支持对话(BeWellTM)调查干预前后自我报告的健康和幸福感,重点关注幸福感:瑞典初级卫生保健中心(PHCC)招募了 81 名 20-67 岁的疲惫障碍患者(69 名女性)参加一项临床对照研究。干预组(40 人)除了接受常规治疗外,还接受治疗师提供的 BeWell™ 治疗。对照组(n = 41)只接受常规护理。主要结果是疲惫症状自评量表(卡罗林斯卡疲惫障碍量表,KEDS),次要结果是焦虑和抑郁、协调感、生活质量、职业平衡和工作能力,均通过有效问卷进行评估。采用非参数统计分析将治疗期后直接收集的数据与基线测量数据进行比较:结果:除了干预组的病假更常见之外,两组的人口统计学和健康与幸福感的自评基线测量结果相当。干预组的参与者比对照组的参与者更容易减轻疲惫程度(KEDS 的中位数差异为 -9.0 vs -4.0,p = .035)。不过,KEDS 下降的幅度与基线 KEDS 有关,与分组无关。两组患者的次要结果均有所改善:结论:在治疗期间,两组患者的压力相关症状都明显减轻。BeWell™旨在促进康复,其潜在益处有待进一步评估。
{"title":"Photo-supported conversations about well-being (BeWell<sup>TM</sup>) for patients with exhaustion disorders - a controlled clinical intervention study.","authors":"A Birgitta Gunnarsson, Petra Wagman, Ulrica Hörberg, Kristina Holmgren, Sara Holmberg","doi":"10.1080/02813432.2024.2421588","DOIUrl":"10.1080/02813432.2024.2421588","url":null,"abstract":"<p><strong>Introduction: </strong>Health-promotion approaches to address stress-related exhaustion disorders, reduce personal suffering, improve coping and participation in everyday life are needed in primary care. The aim of this study was to investigate self-reported health and well-being before and after an intervention focusing on well-being with photo-supported conversations (BeWell<sup>TM</sup>).</p><p><strong>Material and methods: </strong>Eighty-one patients (69 women), 20-67 years old, with exhaustion disorders were recruited at Swedish primary health care centres (PHCC) to a controlled clinical study. The intervention group (<i>n</i> = 40) were offered BeWell<sup>™</sup> by therapists in addition to care as usual. Controls (<i>n</i> = 41) received only care as usual. The primary outcome, self-rated symptoms of exhaustion (Karolinska exhaustion disorder scale, KEDS), and secondary outcomes, anxiety and depression, sense of coherence, quality of life, occupational balance, and work ability, were assessed by validated questionnaires. Non-parametric statistical analyses were used to compare data collected directly after the treatment period with baseline measures.</p><p><strong>Results: </strong>Demographics and self-rated baseline measures of health and well-being were comparable between the groups, apart from sick leave being more common in the intervention group. Participants in the intervention group reduced their level of exhaustion more than the control group (median difference on KEDS -9.0 vs -4.0, <i>p</i> = .035). However, the size of the KEDS reduction was related to baseline KEDS and, not independently associated with group assignment. Both groups improved regarding secondary outcome measures.</p><p><strong>Conclusion: </strong>Stress-related symptoms decreased considerably over the treatment period for both groups. The potential benefit of the BeWell<sup>™</sup>, which was intended to facilitate recovery, needs to be further evaluated.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"194-204"},"PeriodicalIF":1.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11834767/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142580952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Exploring nurse practitioners' collaboration with general practitioners in Norwegian homecare services: a qualitative study. 探索挪威家庭护理服务中执业护士与全科医生的合作:一项定性研究。
IF 1.9 3区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-03-01 Epub Date: 2024-07-22 DOI: 10.1080/02813432.2024.2381064
Lene Apeness Kjær, Mette Tøien, Linn Hege Førsund

Objective: Nurse practitioners (NPs) have recently been introduced in Norwegian homecare services. The NP role is still in an early implementation phase without standardized role descriptions. NPs are dependent on collaborating with general practitioners (GPs) in the care and treatment of patients. However, little is known about how NPs in Norway experience this collaboration. This study aims to explore how NPs working in homecare services describe their collaborative experiences with GPs, and what influence this collaboration.

Design: The study had a qualitative descriptive design, applying individual, semi structured interviews to generate data from five Norwegian nurse practitioners working in homecare services. Data were analyzed using systematic text condensation.

Findings: The NPs had varied experiences regarding the collaboration with GPs. NPs stated their role as unclear, lacking standards and job descriptions. The NPs experienced that some GPs were uncertain about the NPs competence, which inhibited collaboration and restricted the NPs utilization of their full capability.NPs experienced a higher degree of collaboration with GPs they knew, and they indicated that trust was the key to facilitate collaboration. The NPs also noted the challenges of establishing relationships with GPs due to the lack of formal meetings and the physical separation of their workplaces.

Conclusion: Interpersonal dynamics, organizational structures and systemic frameworks influenced the collaboration between GPs and NPs in homecare services. Trust was identified as an important prerequisite for collaboration.

目的:挪威的家庭护理服务最近引入了执业护士(NP)。护士的角色仍处于早期实施阶段,没有标准化的角色描述。在护理和治疗病人的过程中,护士必须与全科医生(GP)合作。然而,人们对挪威的全科医生如何体验这种合作却知之甚少。本研究旨在探讨在家庭护理服务机构工作的护师如何描述他们与全科医生的合作经历,以及影响这种合作的因素:本研究采用定性描述设计,通过对五名在家庭护理服务机构工作的挪威执业护士进行半结构化的个别访谈来获取数据。研究结果:护士们在与医生合作方面的经验各不相同:结果:执业护士在与全科医生合作方面的经验各不相同。护士们认为自己的角色不明确,缺乏标准和工作描述。非全科医生体验到,一些全科医生不确定非全科医生的能力,这阻碍了合作,限制了非全科医生充分发挥其能力。非全科医生与他们认识的全科医生的合作程度较高,他们表示信任是促进合作的关键。由于缺乏正式会议和工作地点的实际分离,护士在与全科医生建立关系方面也面临挑战:人际动态、组织结构和系统框架影响了全科医生和护士在家庭护理服务中的合作。信任被认为是合作的重要前提。
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引用次数: 0
Primary care physicians' experiences of video and online chat consultations: a qualitative descriptive study. 初级保健医生对视频和在线聊天咨询的体验:一项定性描述性研究。
IF 1.9 3区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-03-01 Epub Date: 2024-08-18 DOI: 10.1080/02813432.2024.2391406
Kaisa Kujansivu, Elina Tolvanen, Mervi Kautto, Tuomas H Koskela

Objectives: To explore the perceptions and views of remote consultations and patient care of primary care physicians (PCPs) who work remotely regularly and have experience performing remote consultations.

Design: A qualitative study using thematic analysis.

Setting: Four online focus group interviews with 17 PCPs, working with one private health care provider, with public and private primary care patients.

Subjects: PCPs who had performed video or online chat consultations with primary care patients for at least 6 months.

Main outcome measurements: PCPs' perceptions and views working remotely in online chat and video consultations.

Results: Two main themes describing how PCPs perceived remote consultations emerged: 1) remote consultations have an impact on the way physicians work, and 2) remote consultations have an impact on the service system and patients. The subthemes of the first main theme included the physicians' new way of working, impacts on physicians' well-being, and impacts on communication and physician competences. The subthemes for the second main theme were the importance of smoothness of services for the patients, patient suitability, and technical liabilities.

Conclusion: Remote consultations provide PCPs with a new way of working that could improve work-life balance. However, it is important to maintain sufficient clinical competence through versatile work. Digital consultations can make contacting healthcare smoother and easier for patients if the patient selection is performed carefully. Online chat seems suitable for singular contacts and simple issues, but remote consultations could be used to sustain continuity of care.

目的探讨经常远程工作并有远程会诊经验的初级保健医生(PCP)对远程会诊和患者护理的看法和观点:设计:采用主题分析法进行定性研究:对 17 名初级保健医生进行了四次在线焦点小组访谈,他们与一家私营医疗机构合作,为公立和私立初级保健机构的患者提供服务:与初级保健患者进行视频或在线聊天咨询至少 6 个月的初级保健医生:主要结果测量:初级保健医生对远程在线聊天和视频咨询工作的看法和观点:描述初级保健医生如何看待远程会诊的两个主题是:1)远程会诊对医生的工作方式有影响;2)远程会诊对服务系统和患者有影响。第一个主题的次主题包括医生的新工作方式、对医生福祉的影响以及对沟通和医生能力的影响。第二大主题的次主题包括:为患者提供顺畅服务的重要性、患者的适宜性和技术责任:远程会诊为初级保健医生提供了一种新的工作方式,可以改善工作与生活的平衡。然而,通过多功能工作保持足够的临床能力非常重要。如果能谨慎选择患者,数字会诊能让患者更顺利、更轻松地接触医疗服务。在线聊天似乎适用于单一联系和简单问题,但远程会诊可用于保持护理的连续性。
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引用次数: 0
General practice variation in peptic ulcer prophylaxis: a nationwide register-based study. 全科医生在消化性溃疡预防方面的差异:一项基于全国登记册的研究。
IF 1.9 3区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-03-01 Epub Date: 2024-08-30 DOI: 10.1080/02813432.2024.2396871
Peter Fentz Haastrup, Jane Møller Hansen, Jens Søndergaard, Dorte Ejg Jarbøl

Background: Incidence of peptic ulcer bleeding can be substantially reduced by prophylactic use of proton pump inhibitors (PPIs) in patients at risk, but use of PPI varies among risk patients, and substantial under-prescribing may exist. The variation in prophylactic prescribing among general practices remains unknown.

Methods: A nationwide register-based cross-sectional study analyzing the proportion of patients at risk of ulcer bleeding receiving PPI treatment within Danish general practices. Using logistic regression, we analyze associations between general practice characteristics and prophylactic treatment among patients at risk of ulcer bleeding listed with the general practice.

Results: In most general practices, less than 40% of the patients at increased risk of ulcer bleeding were covered by PPI. Geographical variation was present, where practice location outside the capital area was associated with higher odds of PPI coverage among their risk patients. Partnership practices with GPs with a mean age ≥65 years or with only female GPs were associated with higher odds of providing prophylaxis among their risk patients compared to practices with a mean GP age <45 years or with only male GPs. Similar associations were not found for single-handed practices.

Conclusions: A significant under-prescribing of ulcer prophylaxis is common across all general practice characteristics, and only few associations with practice characteristics were present. Most efforts to rationalize PPI prescribing have aimed at reducing overprescribing but the findings point to under-prescribing as a problem as well. Development of new methods to assist GPs in identifying individuals at risk of ulcer complications is needed.

背景:对高危患者预防性使用质子泵抑制剂(PPI)可大大降低消化性溃疡出血的发生率,但不同高危患者使用 PPI 的情况各不相同,可能存在大量处方不足的情况。全科医生之间预防性处方的差异仍是未知数:一项基于全国登记的横断面研究分析了丹麦全科诊所中接受 PPI 治疗的溃疡出血高危患者的比例。我们使用逻辑回归分析了全科医生的特征与在全科医生处登记的有溃疡出血风险的患者中接受预防性治疗之间的关联:在大多数全科诊所中,溃疡出血风险增加的患者中只有不到 40% 接受了 PPI 治疗。地域差异是存在的,位于首都以外地区的诊所对高危患者进行 PPI 治疗的几率更高。全科医生平均年龄≥65岁或只有女性全科医生的合作诊所与全科医生平均年龄结论的诊所相比,为高危患者提供预防性治疗的几率更高:溃疡预防性治疗处方严重不足的现象在所有全科医生诊所中都很普遍,而与诊所特征相关的因素却很少。使 PPI 处方合理化的大多数努力都旨在减少过量处方,但研究结果表明处方不足也是一个问题。需要开发新的方法来帮助全科医生识别有溃疡并发症风险的人群。
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引用次数: 0
Diagnostic accuracy of signs and symptoms in acute coronary syndrome and acute myocardial infarction. 急性冠状动脉综合征和急性心肌梗死症状和体征的诊断准确性。
IF 1.9 3区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-03-01 Epub Date: 2024-09-22 DOI: 10.1080/02813432.2024.2406266
Willem Raat, Lotte Nees, Bert Vaes

Background: Acute coronary syndrome (ACS) and acute myocardial infarction (AMI) account for a large portion of cardiovascular deaths. Signs and symptoms for these syndromes, such as chest pain, are non-specific and can be caused by a variety of non-cardiac conditions, especially in low-prevalence settings such as general practice. The diagnostic value of these signs and symptoms can be assessed using diagnostic meta-analyses, but the last one dates from 2012.

Methods: We performed a diagnostic meta-analysis in accordance with PRISMA guidelines. We searched PubMed, Embase and CENTRAL from 2006 to 2024. We included studies that assessed the diagnostic accuracy of thirteen different signs and symptoms. We divided patients into two subgroups (AMI and ACS) on which analysis was performed independently.

Results: We selected 24 articles for inclusion. Our analysis indicates that signs and symptoms have a limited role in the diagnosis of AMI or ACS. The most useful (highest diagnostic odds ratios, DOR) in the diagnosis of AMI were pain radiating to both arms (DOR 2.95 (95%CI 1.57-5.06)), absence of chest wall tenderness (DOR 3.51 (95%CI 1.64-6.61)), pain radiating to the right arm (DOR 5.17 (95%CI 1.77-11.9)) and sweating (DOR 5.75 (95%CI 2.51-11.4)). For ACS these were pain radiating to the right arm (DOR 3.9 (95%CI 0.7-12.6)) and absence of chest wall tenderness (DOR 7.73 (95%CI 2.19-19.8)).

Conclusion: We report the accuracy of thirteen signs and symptoms in the diagnosis of AMI and ACS. These can be useful to calibrate general practitioners' diagnostic assessment of chest pain in primary care settings.

背景:急性冠状动脉综合征(ACS)和急性心肌梗死(AMI)占心血管死亡的很大一部分。这些综合征的体征和症状(如胸痛)是非特异性的,可由多种非心脏病引起,尤其是在全科医生等发病率较低的环境中。这些体征和症状的诊断价值可通过诊断荟萃分析进行评估,但最近一次荟萃分析是在 2012 年:我们根据 PRISMA 指南进行了诊断荟萃分析。我们检索了 2006 年至 2024 年的 PubMed、Embase 和 CENTRAL。我们纳入了对 13 种不同体征和症状的诊断准确性进行评估的研究。我们将患者分为两个亚组(AMI 和 ACS),分别进行分析:我们选择了 24 篇文章纳入研究。我们的分析表明,体征和症状在急性心肌梗死或急性心肌梗死的诊断中作用有限。对诊断急性心肌梗死最有用(诊断几率比最高,DOR)的体征是向两臂放射的疼痛(DOR 2.95 (95%CI 1.57-5.06))、无胸壁压痛(DOR 3.51 (95%CI 1.64-6.61))、向右臂放射的疼痛(DOR 5.17 (95%CI 1.77-11.9))和出汗(DOR 5.75 (95%CI 2.51-11.4))。对于 ACS,这些指标是放射至右臂的疼痛(DOR 3.9 (95%CI 0.7-12.6))和无胸壁压痛(DOR 7.73 (95%CI 2.19-19.8)):我们报告了十三种体征和症状在诊断急性心肌梗死和急性心肌梗死中的准确性。结论:我们报告了 13 种体征和症状在诊断急性心肌梗死和急性心肌梗死时的准确性,这些体征和症状可用于校准全科医生在初级医疗环境中对胸痛的诊断评估。
{"title":"Diagnostic accuracy of signs and symptoms in acute coronary syndrome and acute myocardial infarction.","authors":"Willem Raat, Lotte Nees, Bert Vaes","doi":"10.1080/02813432.2024.2406266","DOIUrl":"10.1080/02813432.2024.2406266","url":null,"abstract":"<p><strong>Background: </strong>Acute coronary syndrome (ACS) and acute myocardial infarction (AMI) account for a large portion of cardiovascular deaths. Signs and symptoms for these syndromes, such as chest pain, are non-specific and can be caused by a variety of non-cardiac conditions, especially in low-prevalence settings such as general practice. The diagnostic value of these signs and symptoms can be assessed using diagnostic meta-analyses, but the last one dates from 2012.</p><p><strong>Methods: </strong>We performed a diagnostic meta-analysis in accordance with PRISMA guidelines. We searched PubMed, Embase and CENTRAL from 2006 to 2024. We included studies that assessed the diagnostic accuracy of thirteen different signs and symptoms. We divided patients into two subgroups (AMI and ACS) on which analysis was performed independently.</p><p><strong>Results: </strong>We selected 24 articles for inclusion. Our analysis indicates that signs and symptoms have a limited role in the diagnosis of AMI or ACS. The most useful (highest diagnostic odds ratios, DOR) in the diagnosis of AMI were pain radiating to both arms (DOR 2.95 (95%CI 1.57-5.06)), absence of chest wall tenderness (DOR 3.51 (95%CI 1.64-6.61)), pain radiating to the right arm (DOR 5.17 (95%CI 1.77-11.9)) and sweating (DOR 5.75 (95%CI 2.51-11.4)). For ACS these were pain radiating to the right arm (DOR 3.9 (95%CI 0.7-12.6)) and absence of chest wall tenderness (DOR 7.73 (95%CI 2.19-19.8)).</p><p><strong>Conclusion: </strong>We report the accuracy of thirteen signs and symptoms in the diagnosis of AMI and ACS. These can be useful to calibrate general practitioners' diagnostic assessment of chest pain in primary care settings.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"111-119"},"PeriodicalIF":1.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11834805/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142294406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The incidence and prevalence of Dupuytren's disease in primary care: results from a text mining approach on registration data. 杜普伊特伦氏病在初级保健中的发病率和流行率:对登记数据进行文本挖掘的结果。
IF 1.9 3区 医学 Q3 HEALTH CARE SCIENCES & SERVICES Pub Date : 2025-03-01 Epub Date: 2024-10-18 DOI: 10.1080/02813432.2024.2416678
Roel J M van Straalen, Michiel R de Boer, Francine Vos, Paul M N Werker, Dieuwke C Broekstra

Background: The focus of research and management of Dupuytren's disease (DD) is shifting from relieving symptoms in the later stages of disease towards the prevention of contractures. Treatment services might likewise shift towards primary care. Studying characteristics of DD patients who seek medical care for the first time, may identify a symptomatic target group for early DD treatments. We present the first study that estimates the incidence and prevalence of DD in primary care by applying a text-mining algorithm to registration data.

Methods: This is a population-based cohort study using electronic health records from Dutch general practices involved in a regional research network. Descriptive statistics were used to describe sex, age, comorbidities and lifestyle factors, the latter two were identified via International Classification of Primary Care (ICPC) codes. Incidence rate was calculated as number of patients with a first contact for DD/1000 person years for the years 2017-2021, point prevalence as the percentage of patients with a contact for DD in 2021. DD contacts were identified using a text-mining algorithm.

Results: The incidence ranged between 1.41 and 1.72/1000 person years and the overall prevalence was 1.99%. Incidence and prevalence are higher among males and increase with age, peaking between 61 and 80 years.

Conclusions: Our results of prevalence and incidence of DD in primary care give an insight into the relevant population of patients with symptomatic DD that might be the future target group for potential disease controlling treatments.

背景:杜普伊特伦氏病(Dupuytren's disease,DD)的研究和管理重点正从缓解疾病后期的症状转向预防挛缩。治疗服务也同样可能转向初级保健。研究首次就医的 DD 患者的特征,可以为早期 DD 治疗确定有症状的目标群体。我们提交了第一份研究报告,该报告通过对登记数据应用文本挖掘算法,估算了基层医疗机构中 DD 的发病率和流行率:这是一项基于人群的队列研究,使用的是参与地区研究网络的荷兰全科医生的电子健康记录。描述性统计用于描述性别、年龄、合并症和生活方式因素,后两者通过国际初级保健分类(ICPC)代码确定。发病率按 2017-2021 年首次接触 DD 的患者人数/1000 人年计算,点流行率按 2021 年接触过 DD 的患者百分比计算。DD接触者是通过文本挖掘算法确定的:发病率介于 1.41 和 1.72/1000 人年之间,总患病率为 1.99%。男性的发病率和患病率较高,并随着年龄的增长而增加,在 61 至 80 岁之间达到高峰:我们对初级保健中 DD 的流行率和发病率进行的调查结果显示,有症状的 DD 患者可能是未来潜在疾病控制治疗的目标群体。
{"title":"The incidence and prevalence of Dupuytren's disease in primary care: results from a text mining approach on registration data.","authors":"Roel J M van Straalen, Michiel R de Boer, Francine Vos, Paul M N Werker, Dieuwke C Broekstra","doi":"10.1080/02813432.2024.2416678","DOIUrl":"10.1080/02813432.2024.2416678","url":null,"abstract":"<p><strong>Background: </strong>The focus of research and management of Dupuytren's disease (DD) is shifting from relieving symptoms in the later stages of disease towards the prevention of contractures. Treatment services might likewise shift towards primary care. Studying characteristics of DD patients who seek medical care for the first time, may identify a symptomatic target group for early DD treatments. We present the first study that estimates the incidence and prevalence of DD in primary care by applying a text-mining algorithm to registration data.</p><p><strong>Methods: </strong>This is a population-based cohort study using electronic health records from Dutch general practices involved in a regional research network. Descriptive statistics were used to describe sex, age, comorbidities and lifestyle factors, the latter two were identified <i>via</i> International Classification of Primary Care (ICPC) codes. Incidence rate was calculated as number of patients with a first contact for DD/1000 person years for the years 2017-2021, point prevalence as the percentage of patients with a contact for DD in 2021. DD contacts were identified using a text-mining algorithm.</p><p><strong>Results: </strong>The incidence ranged between 1.41 and 1.72/1000 person years and the overall prevalence was 1.99%. Incidence and prevalence are higher among males and increase with age, peaking between 61 and 80 years.</p><p><strong>Conclusions: </strong>Our results of prevalence and incidence of DD in primary care give an insight into the relevant population of patients with symptomatic DD that might be the future target group for potential disease controlling treatments.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"173-180"},"PeriodicalIF":1.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11834792/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142473794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Scandinavian Journal of Primary Health Care
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