Scandinavian Journal of Primary Health Care最新文献

Objective: Mental health problems among patients with type 2 diabetes (T2D) and ischemic heart disease (IHD) are common, but often undertreated. General practice is a relevant setting for addressing this complex health condition. However, research suggests that this group of patients often experience problems accessing care. This study aimed to explore how access to mental healthcare in general practice for patients with T2D and/or IHD is facilitated by processes of organizing care.

Design, setting and participants: The study was designed as a qualitative collective case study in four general practices in Central Denmark Region participating in The Healthy Mind Study. Data were collected through ethnographic observations of, and qualitative interviews with patients and healthcare professionals.

Results: We found that when healthcare professionals adapted services to specific patient needs, the patients felt welcome and accepted. Furthermore, finding a balance between letting the patient take responsibility while still providing sufficient support led to patients feeling empowered while still feeling cared for. Organizational prioritization of patients in vulnerable situations created circumstances that enabled healthcare professionals to provide better access to care and better treatment outcomes.

Conclusion: Healthcare professionals in general practice must think about their role in facilitating access to mental healthcare. An important part of this is that general practices prioritize patients in vulnerable situations, for example through specialized services, outreach work, structured staff supervision, and extra time. Recruitment of participants for mental healthcare interventions in general practice may benefit from using informal strategies relying on the patient-provider relationship.

Background: In addition to peripheral neuropathy of various kinds, diabetes can also cause central neuropathy, which among other things can manifest itself as premature cognitive dysfunction, often linked to vascular dysfunction. Although the link between diabetes and cognitive dysfunction was discovered more than 100 years ago and has important clinical implications, this diabetes complication remains relatively unknown. Recent years have seen research that has clarified cerebral insulin resistance and defective insulin signaling as examples of pathogenic factors behind this cognitive impairment in diabetes.

Method: We provide a narrative review of select and contemporary publications with relevance for the interface between diabetes/prediabetes and cognitive function.

Results: Recently published studies show that physical activity can reverse insulin resistance in the brain as well as cognitive impairment and pathological appetite regulation. Pharmacological interventions with, for example, nasal insulin, GLP-1 receptor agonists, SGLT-2 inhibitors, or PPAR-γ agonists have also shown promising results.

Conclusion: Optimization of lifestyle factors (e.g. physical activity), as well as several pharmaceutical agents already in clinical use against diabetes, have shown promising results in improving cognitive function in diabetic patients. An important task for primary health care, where most patients with type 2 diabetes are diagnosed, treated, and followed, is to increase awareness and early detection of cognitive dysfunction in these patients for optimizing risk factor control.

Telemedicine in primary health care is expected to address many of the issues currently challenging service delivery. However, the impact and effect will depend on who will use the new technology.

Objective: The objective of the study was to investigate differences between users and non-users of telemedicine integrated into traditional office-based primary health care.

Methods: Quantitative registry-based population study in two regions in the southeast part of Sweden (n = 73,486), comparing users with non-users of telemedicine across the variables sex, age, socioeconomic status (SES), morbidity and health care seeking behaviour (HSB). Two study periods of six months were used (September 2019-February 2020 for Region Östergötland, and September 2021-February 2022 for Region Kalmar County) to collect user data. A reference period of 36 months (September 2016-August 2019) was used, to collect data on HSB.

Results: Users were more often women under the age of 60 and had higher morbidity (measured as resource utilisation) than non-users (p < .001). In contrast, no statistically significant differences were seen between the two groups regarding SES, measured as Care Need Index (CNI). Regarding HSB, a proxy measure (health record entries) showed more entries for users than non-users.

Conclusions: Our findings suggest that users are more likely to be women and below the age of 60. Likewise, users also tend to have a greater need for health care services compared to non-users, and they seek health care more often compared to non-users. No differences regarding SES were found.

Aim: To investigate the association between Systematic Coronary Risk Evaluation 2 (SCORE2) and subclinical damage in two vascular beds: atherosclerosis in the coronary arteries and aortic arterial stiffness, in a large population-based cohort without cardiovascular disease or diabetes.

Methods: Design: A cross-sectional study based on Swedish CArdio Pulmonary bioImaging Study (SCAPIS) data. Study population: A population-based cohort of 3087 participants aged 50-64.

Outcome: Pulse Wave Velocity (PWV) was measured, and aortic arterial stiffness was defined as PWV≥ 10 m/s. Coronary artery calcium score (CACS) was determined by coronary computed tomography and clinically significant coronary calcification was defined as CACS > 100.

Results: The prevalence of arterial stiffness was 6.6% in the low-moderate SCORE2 risk group, 31.0% in the high-risk group, and 53.3% in the very high-risk group. The prevalence of coronary calcification was 4.5%, 18.5% 23.0%, respectively. There was a modest overlap between arterial stiffness and coronary calcification in all SCORE2 risk groups. When comparing the high SCORE2 risk group with the low-moderate risk group, the Odds ratio (OR) was 6.4, 95% confidence interval (CI 5.1-8.0) for arterial stiffness and 4.8 (CI 3.7-6.3) for coronary calcification. When comparing the very high SCORE2 risk group to the low-moderate group, the OR was 16.2 (CI 11.3-23.1) for arterial stiffness and 6.4 (CI 4.2-9.7) for coronary calcification.

Conclusion: Our study shows that high cardiovascular risk according to SCORE2 is associated with increased arterial stiffness and significant coronary calcification in a population without prevalent cardiovascular disease or diabetes. This knowledge can be useful in primary care, where SCORE2 is frequently used as a risk prediction tool. The modest overlap between arterial stiffness and coronary calcification suggests that CACS and PWV describe different types of vascular damage.

Objectives: To evaluate general practitioners' (GPs') ability to perform focused lung ultrasound (FLUS) following a training program and assess FLUS feasibility in general practice. Also, to describe FLUS findings and evaluate GPs' ability to interpret these in adults with acute lower respiratory tract infection (LRTI) when pneumonia is suspected and assess GPs' perception of FLUS impact.

Methods: Nine GPs, using point-of-care ultrasound, completed a FLUS training program. Adults (≥ 18 years) with acute cough (< 28 days) and at least one other symptom of acute LRTI, where the GP suspected pneumonia, were subsequently included. All patients received FLUS. The GPs reported FLUS findings, feasibility, and perception of FLUS impact. Recorded FLUS videos from all patients were reviewed by two specialists (Specialist Reference). The specialists assessed FLUS image quality. Agreements between the GPs and the Specialist Reference on FLUS findings were used to evaluate GPs' ability to interpret FLUS.

Results: Of 91 patients included, FLUS image quality was acceptable or higher in 84 patients (92.4%). FLUS proved feasible with only two scans not completed. The GPs reported FLUS pathological findings in 51.7% of patients in 78% agreement with the Specialist Reference and Cohen's kappa 0.56. Focal B-lines represented the most frequent pathological findings. The GPs perceived that FLUS impacted change in tentative diagnosis and/or plans for treatment and/or visitation in 29 (32.0%) of patients.

Conclusion: After the training, the GPs performed FLUS well. Interpretation of FLUS pathology presence was of moderate agreement. The GPs perceived that FLUS had impact on patient management.

Trial registration number: ClinicalTrials.gov NCT04711031.

Introduction: Knee pain increases the risk of developing chronic widespread pain (CWP) and knee osteoarthritis (KOA). The prevalence of CWP and KOA has increased, and there is a need for early prevention. Therefore, the aim was to examine the associations of health-related quality of life (HRQoL) and lifestyle habits with chronic pain at a two-year follow-up in individuals with knee pain.

Methods: A two-year longitudinal cohort study including 251 individuals aged 30-60 years reporting knee pain at baseline. HRQoL was measured via the Short-Form General Health Survey (SF-36), and lifestyle habits included questions on overweight, physical activity, diet, alcohol and tobacco use. Pain was assessed with a pain mannequin. Differences in health status and lifestyle habits over time in groups with unchanged no chronic pain (NCP), transitioned to less and more pain, and unchanged CWP were analysed using Wilcoxon's, McNemar's and Friedman's tests. Multinominal regression analysis was performed to study associations with reporting chronic pain at follow-up.

Results: Reporting better HRQoL across various SF-36 concepts and normal weight at baseline was associated with reporting NCP after two years. A few changes were made regarding HRQoL and lifestyle habits over the course of two years, but an increase in general health was associated with transitioning to less pain.

Conclusions: During primary care visits for knee pain with a combination of overweight or lower HRQoL, individuals should receive comprehensive attention to prevent the development of CWP. Future studies should investigate the associations further.

Introduction: Polypharmacy is widespread. The demographic shift toward older patients receiving multiple medications increases risk and drug-related problems in these patients.

Objective: To investigate patient perspectives on polypharmacy and the experienced effects of medication reviews by pharmacists in general practice.

Methods: Twenty-two semi-structured interviews with patients with polypharmacy (>5 medications) from 6 different general practice clinics in the North Denmark region. The interviewees were from the intervention arm of a randomized clinical trial and had received a medication review with a pharmacist in addition to the usual annual check-up in general practice. Participants were interviewed at baseline (no later than 2 weeks after the medication review) and again at follow-up (6 months after the medication review). The interviews were transcribed verbatim and thematically analyzed with an inductive approach.

Results: The patients' narratives show that they face many difficulties in their everyday lives, making it hard for them to live up to society's ideal of what it is to live a healthy life. The interviewees were generally positive toward the intervention and felt comfortable having a pharmacist conduct the medication review in their usual general practice clinic. Some interviewees gained more insight into their medication from the review.

Conclusion: Patient narratives give a comprehensive understanding of the challenges of polypharmacy. Having pharmacists conduct medication reviews in general practice could ensure more time and focus on patients and their medication management. The combined knowledge of physicians, nurses, and pharmacists regarding thorough polypharmacy management is recommended.

Aim: To (1) examine considerations before and experiences with GP contact during the first COronaVIrus Disease 2019 (COVID-19) lockdown among Danish citizens; (2) analyse the associations with sex, age, chronic disease, and socioeconomic factors; and (3) explore changes in healthcare-seeking behaviour post-pandemic.

Method: A total of 100,000 Danes aged 20 years or older, randomly selected in the general population, were invited to participate in a survey examining considerations and experiences with healthcare seeking during the first COVID-19 lockdown. Data were collected in spring 2022 and linked to register data on socioeconomic factors. Descriptive statistics and multivariable logistic regression models were applied.

Results: Of the 27,369 eligible individuals, 18% reported a need to contact their GP. Being worried about burdening the healthcare system was most frequently reported (45%), followed by being in doubt about acceptable contact reasons (33%), and concern about infection (24%). Although 44% of those who needed to contact their GP found the digital solutions advantageous, individuals frequently found it difficult to discuss symptoms by telehealth (29%) and that they were examined less thoroughly. Generally, women, younger people, and individuals with lower socioeconomic status were more likely to be worried and report difficulties with contact to general practice. Some 86% of the respondents reported no changes in healthcare-seeking behaviour post-pandemic.

Conclusion: The results may assist in the organisation of healthcare in case of future lockdowns. Yet, the COVID-19 pandemic has only slightly affected the healthcare-seeking behaviour in the Danish general population.

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.