Scandinavian Journal of Primary Health Care最新文献

Objectives: Out-of-hours services (OOHS) worldwide exhibit diverse organisational models, especially within the European Union. This study aims to describe the transformation of OOHS in Region Zealand, Denmark, from a General Practitioner cooperative (GP-OOHS) to a regional organization/service, known as the 1818 Medical Helpline (1818).

Study design: Retrospective cohort study.

Methods: GP-OOHS data (January 2017-October 2023) during the transition from GP-cooperative to Regional Service (October 2022) were analysed. Coded and timestamped services retrieved from the billing system were used to identify patient pathways, defined as services within a 12-hour window. Descriptive statistics were applied.

Results: A total of 2,572,951 patient pathways were recorded, with 2,258,072 under GP-out-of-hours service and 314,879 under the 1818. Overall, patient pathway volumes declined from 412,116 in 2017 to 314,879 in 2022, and admissions fell from 64,555 to 59,967. The median patient age was 35 years. The GP-out-of-hours service had a higher average monthly volume of patient pathways (32,726 vs. 25,940), while 1818 showed a higher proportion of emergency department admissions within 24 h (19.0% vs. 17.6%), the number of admissions fell from 8.2 per 100,000 inhabitants to 7.1 per 100,000 inhabitants. Interrupted time series analysis showed that the previously increasing tendency in ED admissions flattened following the transition. Although the absolute number of children admitted decreased, the proportion of admissions increased due to overall decline in patient pathways. Face-to-face consultations (31.4% vs. 27.1%) and home visits (9.4% vs. 3.4%) were more frequent in GP-out-of-hours service, both being associated with higher admission rates.

Conclusions: OOHS patient pathways declined over the study period and continued to decline following the organizational change. The absolute number of emergency department admissions also decreased, while the relative proportion of admissions increased. These findings indicate a continued decline in OOHS activity and a slight shift toward more acute cases after the reorganisation.

Background and aim: Patients with COPD and concurrent depression and/or anxiety are known to have an increased risk of exacerbations, morbidity, mortality, and deteriorated quality of life. Early detection of depression/anxiety may enable early interventions. The aims of this study were to describe the occurrence of depression and anxiety in primary care patients with COPD in Sweden, and to investigate age and gender differences together with other clinical factors associated with this comorbidity.

Methods: A cross-sectional study was performed on a cohort of patients with doctor's diagnoses of COPD. Patients were randomly selected based on the patients' contact with 98 primary healthcare centers and 13 hospitals in Sweden in 2014. Information about self-reported depression/anxiety, patient characteristics, symptoms, and comorbidity, were collected using patient self-completion questionnaires. Lung function data were extracted from medical records.

Results: Of the 2245 patients recruited, 23% (n = 524) reported depression/anxiety, 29% in women and 16% in men (p <0.001). Factors associated with depression/anxiety were being a woman (OR = 2.06 [95% CI 1.56-2.72]), current smoking (1.83 [1.37-2.43]), comorbid asthma (1.77 [1.32-2.37]), dyspnea (the modified Medical Research Council dyspnea scale ≥2 points) (1.58 [1.17-2.13]) and age <65 years (1.57 [1.17-2.10]). The youngest age groups had the highest proportions of patients with depression/anxiety.

Conclusions: Healthcare professionals need to be particularly aware of depression/anxiety in patients with COPD who are younger, women, current smokers, have comorbid asthma, or dyspnea.

Background: Online symptom checkers are increasingly used for diagnostic support and triage. However, evidence on their performance and evaluations with real-world data remains limited.

Objective: The aim of this study was to evaluate the performance of a digital symptom checker using clinical vignettes derived from real-world cases that had previously been incorrectly triaged.

Methods: A patient-facing, rule-based digital symptom checker used in Swedish primary care was assessed in this study. Vignettes were constructed from cases reported to the Swedish Health and Social Care Inspectorate due to erroneous telephone triage. We hypothesized that the digital symptom checker could provide appropriate triage for these cases. Seven physicians independently simulated patients by entering symptoms in the symptom checker based on each vignette. Triage outcomes were assessed against the Swedish National Triage Guidelines (RGS), evaluating the accuracy and the safety of the triage recommendation.

Results: A total of 69 unique vignettes yielded 483 individual trials. After excluding 93 trials due to significant deviations from the original vignette description (adding or omitting symptoms), 390 trials were included in the primary analysis. The symptom checker achieved 91% accuracy (95% CI 88-94%) and 94% safety (95% CI 91-96%).

Conclusions: The symptom checker demonstrated high accuracy and safety when triaging a subset of vignettes based on real-world cases that had been previously erroneously triaged. This study also highlights the difficulties of using vignettes when evaluating symptom checkers. To our knowledge, this is the first study to evaluate such systems using vignettes based on actual patient cases with known triage errors.

Background: Around 95% of all websites selling medicines globally are illegal and contribute to the spread of substandard and falsified medicines. Hence, it is important to identify legal pharmacies when accessing medicines online. During 2022-2024, 250 million prescriptions were legally dispensed in Sweden, and 69% were prescribed in primary care. Pharmacists and general practitioners are key healthcare professionals who can guide people to safe online purchases. The overall aim was to describe Swedes' online purchasing habits for medicines.

Methods: We used a cross-sectional design and collected information from the general population through an annual digital questionnaire for three years in a row, 2022-2024. In total, 6006 respondents, 18-79 years old, were included.

Results: Fifty-two percent had bought medicines online in the last year. Most respondents, 91%, did not recognise the common EU logo mandatory for authorised online pharmacies. People buying over-the-counter medicines online were significantly younger than those buying prescription-only medicines online. Female gender and higher level of education were associated with more online purchases of medicines. Most respondents' purchasing habits were not influenced by external factors. Reasons for increased online purchases were, for example, that it helps planning regarding access to treatment.

Conclusions: Half of the study participants have used online pharmacies, but fewer than 10% know how to identify a safe online pharmacy, i.e. many are at risk for fraud. Increasing this knowledge by informing those who prefer online purchases has the possibility to use the advantages and avoid the risks associated with online purchases of medicines.

Purpose: To examine the association between uncomplicated urinary tract infections and subsequent type 2 diabetes (T2D) diagnosis in women. Materials and methods: We included 1,840,044 women without previously diagnosed type 2 diabetes (T2D) or redeemed antidiabetic drugs. Results and conclusions: During the 12-year study period, women with uncomplicated urinary tract infections (cystitis and pyelonephritis), diagnosed within two years before T2D, did not have higher subsequent risks of T2D compared to those without urinary tract infections.

Introduction: Understaffing and dependence on temporary physicians known as locums are common in primary healthcare in Sweden. In this study, we investigate the impact of locum staffing on the quality of antibiotic prescribing for respiratory tract infections. We used two neighbouring cities in northern Sweden with large differences in staffing conditions: Skellefteå, with a 10-fold higher reliance on locum physicians compared to Umeå, which has low locum staffing.

Methods: We used data extracted from patient records for all visits, from the four largest healthcare centres in each of the cities Umeå and Skellefteå, for respiratory tract infections, including the ICD-10 diagnosis code and whether antibiotic treatment was prescribed or not. Data on the contracted hours of locum staff for each healthcare centre were also obtained. Statistical analyses were performed with Spearman correlation, Chi-square and Poisson tests. Logistic regression was used to investigate whether prescribing patterns were affected by the level of relay physicians.

Results: We analysed antibiotic prescriptions for respiratory tract infections based on data from 11,228 patient visits. Regardless of the statistical method used, we found a statistically significant difference, with higher rates of antibiotic prescribing for diagnoses where antibiotics generally are not recommended or where they should be prescribed restrictively. For pneumonia, where antibiotics should normally be prescribed, no difference was seen. The odds of antibiotic prescription for acute upper respiratory tract infection in Skellefteå were 2.5 times higher than in Umeå, with a positive correlation between locum staffing and antibiotic prescriptions for diagnoses where antibiotics should be used restrictively.

Conclusions: Our findings show that a high level of locum staffing and thus insufficient staffing with permanent General practitioners leads to higher rates of inappropriate antibiotic prescribing. This is shown both at the level of individual primary care healthcare centres and at the community level.

Introduction: Assessing work capacity and determining appropriate sick leave is a complex process. Despite the importance of fair and consistent assessments, evidence suggests that evaluations may vary. However, previous studies have been inconclusive and have mainly focused on whether sick leave should be recommended or not. The present study examined the medical reliability and consistency of physicians' assessments of work capacity, as indicated by the reported percentage of reduced work capacity and the recommended length of sick leave.

Methods: A cross-sectional survey was conducted with 142 primary care physicians from four Swedish counties. Participants assessed six anonymised, authentic medical certificates related to mental health and pain-related conditions. For each case, they estimated the degree of reduced work capacity and the recommended sick leave duration, which were combined into a sick leave score. Physician characteristics (e.g. gender, professional status) and perceived managerial support were also measured.

Results: There was considerable variation in sick leave scores, both across physicians and between certificates. Male physicians and those with more years of experience recommended longer sick leave for pain-related cases, while specialists showed less variation in their assessments. Perceived support from frontline managers was associated with lower scores. No significant associations were found for patient involvement.

Conclusions: The findings suggest that sick leave assessments may lack consistency and be influenced by physician-related factors, particularly for pain-related conditions. Stronger support structures, opportunities for knowledge exchange, and clearer guidelines may help reduce unwarranted variation and promote more reliable assessments.

Background: Screening and brief interventions (SBIs) for alcohol use are effective but challenging to implement in primary care settings. Universal screening is resource-intensive and may not align with general practitioners' (GPs) perceived professional role. Pragmatic case finding (PCF), which integrates alcohol discussions into clinically relevant contexts, may provide a feasible alternative to traditional SBI.

Aim: This study aimed to assess the feasibility and acceptability of tailored, theory-based educational outreach visits (EOVs) to embed PCF in primary care, explore its influence on professional practice in addressing alcohol, and examine changes in determinants of GP behaviour pre- and post-implementation.

Design and setting: Four EOVs were delivered in GP clinics in Stavanger and Oslo, Norway, involving 37 GPs and 22 support staff, to enhance GPs' ability to manage alcohol-related health problems.

Method: A mixed-methods feasibility study comprising semi-structured group interviews and quantitative surveys. Group interviews explored GPs' experiences, while the Determinants of Implementation Behaviour Questionnaire (DIBQ) assessed changes in knowledge, skills and intentions. Qualitative data were thematically analysed. Quantitative data were analysed using descriptive statistics.

Results: GPs (n = 10) perceived the EOVs as feasible and acceptable, preferring in-person over remote delivery. Key themes included greater awareness of alcohol's health impacts, sustaining awareness of hidden cases, reducing stigma through normalised discussions, and balancing motivation with the challenge of changing entrenched habits. Survey findings (n = 19) showed a gradual, positive shift in GPs' knowledge, skills, and goals to discuss alcohol.

Conclusion: The EOVs were feasible and acceptable for embedding PCF in primary care. They may strengthen GPs' capacity to address alcohol in routine consultations, but further research is needed to assess fidelity, sustainability, and patient-level outcomes.

Trial registration number: ClinicalTrials.gov ID: NCT04725552.

Background: During the COVID-19 pandemic, the use of macrolides, specifically azithromycin, for respiratory tract infections (RTIs) in primary care increased in several countries. In Norway, antibiotic treatment of COVID-19 was never recommended.

Objectives: To investigate the antibiotic treatment for RTIs in Norwegian primary care, comparing pre-pandemic and pandemic periods.

Methods: We defined RTI episodes and antibiotic treatment using several national registries including demographic and residency data from Statistics Norway, reimbursement claims from the Norwegian Registry for Primary Health Care, antibiotic dispensing from the Norwegian Prescription Database, and deaths from the Norwegian Cause of Death Registry, for the years 2018-2021.

Results: Approximately 80% of the 4 904 376 total RTI episodes during the study period were handled exclusively in daytime general practice (DGP). Use of electronic consultations for RTI episodes increased from less than 1% to more than 50%. Throughout the study period, most RTI episodes were handled without antibiotic use. The antibiotic treatment rate for RTI episodes dropped during the pandemic, relative risk (RR) 0.52, 95% confidence interval (CI) 0.52-0.52, compared to pre-pandemic. Over half of all antibiotic treatments for RTIs were phenoxymethylpenicillin, and the distribution of antibiotic types was relatively stable during the study period, except for some temporary changes in the initial months of the pandemic. DGP handled most of the influx of RTIs during the first month of the COVID-19 pandemic in primary care, without increasing antibiotic use.

Conclusions: DGP handled most of the influx of RTIs during the initial phase of the COVID-19 pandemic in primary care. During the pandemic antibiotic treatment for RTIs was reduced, and the distribution of antibiotic types barely changed.