Scandinavian Journal of Primary Health Care最新文献

Climate change poses an urgent threat to human health, with thousands of deaths already attributed to extreme heat. In the Nordic countries, where per capita emissions are particularly high, healthcare accounts for 4.2-6.3% of emissions, highlighting the need for immediate action to reduce its climate impact. Evidence supporting sustainable climate solutions in healthcare is steadily growing. Greenhouse gas emissions in general practice can be broadly divided into those arising from clinical activities, such as patient examination, diagnosis, and treatment, and those from non-clinical activities, including clinic operations, energy use, and transportation by staff and patients. In this opinion paper, we discuss and advocate 'Green Care Practices' to minimize greenhouse gas emissions specifically related to clinical activities. We believe that Nordic general practitioners can adopt 'Green Care' to significantly reduce healthcare-related emissions while improving patient outcomes, enhancing efficiency, and promoting environmentally responsible healthcare. Strong primary healthcare, rooted in Nordic values, can support the United Nations Sustainable Development Goals by simultaneously mitigating climate change, reducing inequalities, fostering community stability, and promoting health and well-being. Thus, GPs can ensure sustainability for future generations.

Background: Consultations can be challenging because of patient complexity, affecting care quality. Patient complexity involves factors related to the patient, healthcare professional, organization, and healthcare system. A comprehensive overview of these factors and their significance to healthcare providers is lacking. The aim of this study was to create a literature overview and to examine how the results relate to the experiences of primary care providers.

Methods: The PubMed, Embase and Cochrane databases were searched (2018-2023) to conduct a scoping review. In addition, a focus group was organized with healthcare providers from general practices (a) to discuss the results of the review, and (b) to explore its meaning in daily consultation, based on the real-life patient cases they presented.

Results: The review (171 unique studies) mainly revealed patient-related factors (medical, social and behavioural aspects). Complexity arises when multiple aspects are present and mutually interact. Factors related to the expertise of healthcare professionals, the organization (care coordination) and the system (availability of resources, navigation problems) were also identified. The focus group recognized the factors that influenced patient complexity and their interdependence. They noted a need for support in identifying and treating the patient population in question across disciplines.

Conclusions: A comprehensive overview of factors influencing patient complexity at four different levels (patient, professional, organization, system) is provided. The primary care providers suggested disseminating these results to customize treatment to the needs of patients, which is likely to require coordination across disciplines and integrated care.

Background: In 2015, Norway introduced stricter requirements for organizing primary emergency care. These changes led to new solutions such as municipal emergency outpost satellites, providing inhabitants shorter access to care in resource-limited areas. This study explores patient experiences at emergency outpost satellites staffed by a nurse on site with a general practitioner (GP) available via video consultation.

Methods: A qualitative study was conducted with seven patients, aged 62-82, with complex needs, from four small and medium-sized municipalities in Vestland County, Norway. Data were collected through individual semi-structured interviews, which took place within 6 months of an acute consultation at an emergency outpost satellite. The data were analysed using systematic text condensation (STC).

Results: Patients had both positive and negative experiences with video consultations. They valued short travel distances and quick GP access via video link. Video consultations often replicated several aspects of in-person visits, with nurses playing a crucial role in organizing and ensuring that care was provided effectively. Nurses were key mediators, supporting patients before, during, and after the consultation. However, some patients were dissatisfied with the lack of a physical GP presence, technical issues, and communication challenges.

Conclusions: The participants' experience of communication with the GP and nurse was crucial for the video consultation to be perceived as satisfactory. Participants felt that video consultations reduced travel burdens and provided quick clarification. Nurses played an important mediating role, but poor communication and technical issues made some participants feel unsafe using the emergency outpost satellites.

Background: The One Minute Preceptor model is one of few models proven to be effective in clinical training and validated for teaching clinical reasoning and medical knowledge. It has been introduced to tutors from various health care professions and is considered easy to learn. It is, however, not well-known in Scandinavian primary health care, and studies introducing the model in this context are lacking. Moreover, qualitative studies exploring the views of tutors using the model are also lacking. The aim was therefore to adapt the One Minute Preceptor model to a Swedish context and to explore tutors' experiences of applying it in a primary care setting. A qualitative method with quantitative elements was used.

Methods: A workshop was designed and held in interprofessional groups at various primary health care centres in Region Stockholm. Follow-up interviews were conducted. Data were analysed using qualitative content analysis. Furthermore, pre- and post-surveys were administered.

Results: The results showed that the tutors believed the model to be flexible, and easy to use and adapt, and their self-rated competence increased. Moreover, they believed it could help them give feedback and explore the students' reasoning. This is in line with previous research, but our study contributes by adding the tutor's how perspective on how the model affects these key elements of clinical tutoring.

Conclusions: In conclusion, interprofessional workshops teaching the One Minute Preceptor model are readily held and may be feasible to scale up. Positive outcomes on clinical tutoring are likely; especially on feedback and clinical reasoning, where improvements are needed.

Objective: The multidisciplinary team (MDT) approach in primary care is a relatively recent innovation, developed over the past 15 years. There is limited data on MDTs' effects on Quadruple Aim (QA) goals. The object of this study is to evaluate the implementation of a novel MDT from 2021 to 2023 and its impact on access and continuity of care, compared to an established model. Future research will explore its effects on staff satisfaction, costs, and health outcomes.

Design, setting and patients: This quasi-experimental study compares five intervention health centers with three control centers. It includes all primary care patients from 2021 to 2023, presenting data on access and continuity before and after the intervention.

Intervention: Nurse-only consultations were replaced with a multidisciplinary nurse-physician model to address issues during initial contact more effectively. Nurses also took on the role of case managers, enhancing relational continuity. Lean daily visual management with continuous improvement, strategic goal setting, and coaching leadership style were implemented.

Main outcome measures: Access was measured using the 'third available appointment' (T3) metric, and continuity with the COC-index, both for physicians only.

Results: Access improved at all intervention centers, with T3 reduced from 90 to 1.125-4.75 days, while controls remained at 90 days. COC improved at three intervention centers but declined at two, with declines also observed at control centers.

Conclusion: The novel MDT enhanced primary care access compared to the traditional model. However, relying solely on T3 may be insufficient for evaluating effectiveness. Mixed results in continuity underscore the need for further investigation.

Background: Increasing numbers of scabies cases have been reported in Europe and around the world in recent years. Scabies is more common in children and adolescents than in adults.

Objectives: To characterise patient profiles and treatment strategies of scabies over time at the dermatology clinic of Oulu University Hospital (OUH), Finland.

Methods: The OUH database was searched using diagnostic codes, and all patients diagnosed with scabies in the OUH dermatology unit between 1996 and 2022 were included in the study. The retrieved patient records were reviewed for demographic and clinical data.

Results: The study included the records of 662 patients. 'Suspected scabies' was given as reason for referral to a specialist care in only 21.5% of cases. Time between a symptom onset and the referral to the dermatology unit was significantly longer in adults and adolescents than in small children (p < 0.001), and was longer than six months in one-fifth of adults. Symptomatic sites varied between age groups: compared with small children, adults more commonly (p < 0.001) presented with symptoms in the genital-gluteal area, whereas symptoms were located on the head and 'foot and ankles' more often in young children than other age groups (p < 0001 for all comparisons).

Conclusions: Diagnosis was markedly delayed in many patients, especially adults. Unspecified, pruritic skin symptoms should lead to a suspicion of scabies, and when a diagnosis is unclear, the patient should be referred to a dermatologist as quickly as possible. This would both help patients and prevent further spread of the infestation.

Objective: To explore the experiences of orthopedic surgeons and general practitioners (GPs) in providing pain management, focusing on opioid prescribing practices and follow-up care for trauma patients following orthopedic injuries.

Methods: Four semi-structured focus group interviews were conducted among 18 physicians, two among GPs and two among orthopedic trauma surgeons. Each group consisted of either specialist candidates or experienced specialists. The interviews explored experiences with follow-up care for orthopedic trauma patients, pain management, including opioid use and tapering, and were thematically analyzed.

Results: Four main themes were identified: (1) Navigating post-discharge pain management, where GPs experienced problematic transfer of treatment responsibility and lack of opioid taper plans from the specialist health service. (2) A knowledge gap in pain management, with GPs reporting insufficient knowledge about opioid treatment, and orthopedic residents describing lacking systematic training in this area during specialization. (3) Changes in opioid prescribing practices over time, which had led to a self-perceived shift from liberal to restrictive prescription attitudes. (4) Unrealistic expectations of pain relief among patients were perceived by GPs and orthopedic surgeons throughout recovery.

Conclusions and implications: Our findings reveal a knowledge gap in pain management, suggesting a need for enhanced education and training for GPs, both in specialization and specialist, and for orthopedic residents. This is crucial to meet the needs of trauma patients with severe orthopedic injuries and long-term pain. GPs need access to advisory support from the specialist healthcare system. These resources, including follow-up during challenging recovery phases, must be accessible to enhance patients care.

Objective: To evaluate the effect of the LEARN-to-COPE intervention on sick leave, symptoms, and coping.

Design and setting: Cluster-randomized controlled trial including 40 primary care centers (PCCs) in Region Västra Götaland, Sweden. Randomization at the PCC level. Effect of the intervention was compared to Care-as-Usual (CAU). Follow-up was conducted using registry sick leave data, validated questionnaires, and patient-reported data.

Subjects: Primary healthcare patients with recurrent or long-term sick leave or health-related unemployment from included PCCs (n = 243).

Intervention: Patient education was conducted via interactive study groups, which convened for half a day every week over eight consecutive weeks. Implementation was centralized in close collaboration with educational associations. The purpose of the intervention was to strengthen participants' sense of coherence and health literacy, with the aim of enhancing their work ability and health.

Main outcome measures: The primary outcome measure was change in scheduled activity, derived from data on sick leave (obtained from the Swedish Social Insurance Agency) and participation in work-oriented rehabilitation (self-reported occupational status). Secondary outcomes (symptoms and coping) were measured with validated questionnaires at baseline and follow-ups after 3, 6, and 12 months.

Results: Included participants suffered from anxiety, depression, exhaustion, and pain and had poor health-related quality of life. After 12 months, there was no significant change in scheduled activity, sense of coherence, symptoms, or health-related quality of life, but a statistically significant positive change in health literacy and self-efficacy was found in the intervention group.

Conclusion: Considering participants' pronounced burden of symptoms, the focus should be on improving the sick leave process as a whole, rather than seeking quick remedies for patients' complex health issues. Centralized implementation of the intervention was a promising concept that deserves further evaluation.

Trial registration number: Clinicaltrials.gov NCT04254367.

Denmark is known for its good population health, largely attributable to its effective healthcare system. This analysis of the Danish primary healthcare system with focus on general practice describes the system's overall structure, function, and financing. Further, it reviews some of the recent developments in organization and decentralization from secondary to primary care. Finally, we discuss some of the key challenges that primary care faces and potential areas for improvement to ensure a sustainable Danish healthcare system of high quality.