Scandinavian Journal of Primary Health Care最新文献

Background: Chronic pain remains a leading cause of patient distress in primary care and effective pain management presents an ongoing challenge in patient-clinician interactions. The prescribing of opioids further contributes to communication and shared decision-making disparities between patients and general practitioners. Gaining greater insight into patients' experiences of opioid treatment is valuable as there still is limited knowledge. Patients' perspectives and expectations can provide important contributions to enhance mutual understanding in clinical encounters.

Aim: To explore how patients experience, and what they expect from, pain management consultations regarding opioid use.

Design and setting: A qualitative study with patients in rural Örebro County, Sweden.

Method: Semi-structured interviews were carried out with fifteen chronic pain patients prescribed opioids managed in primary care. The interviews were analyzed using reflexive thematic analysis.

Result: Two main themes were generated to capture patients experience and their expectations concerning pain management and opioids. Prescribing Validation gives insights to what expectations patients have and how they perceive prescriptions. Renewals are interpreted as validation of the pain condition, and dismissals as mistrust. The Battle for the Steering Wheel capture how patients, based on the lived experience of chronic pain, expect and seek to assert their own expertise in consultations but often feel frustrated over being unheard.

Conclusion: While education about the biopsychosocial nature of pain may provide a necessary foundation for communication around reducing opioid use, validation of patient experience is pivotal for building a trusting alliance.

Background: Effective collaboration between general practitioners (GPs) and specialized mental health services is essential to ensure high-quality care for patients with depression. However, achieving such collaboration remains a challenge across healthcare systems internationally. This study aimed to investigate Norwegian GPs' perceptions of their collaboration with the two main components of specialized mental health services - community mental health centers and psychiatric contract specialists. We further examined factors associated with GPs' perceptions of well-functioning collaboration and assessed how their knowledge of prioritization regulations was related to these perceptions.

Methods: A questionnaire among Norwegian GPs, part of a biennial survey among physicians working in Norway capturing information of different elements of collaboration between GPs and mental health specialists and knowledge about prioritization criteria.

Results: Half of the GPs reported collaboration be well-functioning, largely independent of organizational model. A shared understanding of the patient's problems and clear definition of roles had the highest association with well-functioning collaboration. Experiencing a clear distribution of responsibilities and tasks and active communication was associated with perceived well-functioning collaboration. GPs' knowledge about the prioritization criteria was positively associated with a perceived well-functioning collaboration.

Our findings reveal unclarities regarding the distribution of responsibilities and tasks and very little interactive communication between GPs and mental health specialists in both organizational models, which were affecting the GPs' perceptions of collaboration negatively.

Conclusions: Enhanced clarity regarding the roles and responsibilities, more communication about the patient during concurrent treatment, and improved knowledge about specialized mental health prioritization criteria could facilitate and improve the collaboration.

Objective: A shortage of healthcare personnel, an aging population and insufficient collaboration between services are highlighted as the greatest challenges in the Norwegian healthcare system. Digital Interaction in Practice (DIP) is a digital collaboration model involving the general practitioner (GP), home care nurses, patient and relatives. The aim is improved coordination and tailored treatment for frail elderly patients with complex needs. The model is developed in close collaboration with healthcare personnel and is being piloted in a large Norwegian municipality.

Methods: This qualitative study included GPs, nurses, and managers in Trondheim municipality, who have actively participated in the development of the DIP model in cooperation with researchers. Focus groups were used to gather experiences of the development and early pilot phase from the views of GPs, nurses and managers. Data were analysed using Braun and Clarks thematic content analysis framework.

Findings: DIP required changes in work practices and allocation of resources, particularly for home care nurses. Furthermore, the participants reported improved interdisciplinary collaboration and viewed DIP as a potential to increase the quality of healthcare services. The workflow chart describing the DIP model was useful but required adaption to local work practices. General practitioners and nurses valued closer collaboration and experienced a more holistic and patient-centred follow-up.

Conclusion: The findings underline the importance of collaboration between GPs, nurses, managers and researchers in the development and local adaptation of the DIP model. Despite some resource challenges and a need for role clarification, DIP may impact resource use in the long term, improve collaboration and coordination among those involved, and achieve more comprehensive, individually tailored patient pathways. Further research on the DIP model's impact is warranted following broader implementation.

Objective: Hypertension care requires considerable resources from primary healthcare, and efficient work models are desirable both to improve treatment outcome and to ease staff workload. This study's objective was to describe how healthcare staff experienced the implementation of a new nurse-led work model for hypertension care.

Methods: Qualitative content analysis was used for data analysis. Digitally conducted interviews with 14 physicians, nurses and managers from six of the eleven primary healthcare centres participating in an intervention to improve hypertension care in the Västra Götaland region. The intervention included training of healthcare professionals in a new nurse-led team work model using standardized protocols for treatment and follow-up.

Results: The intervention was appreciated, even requested, by both nurses, physicians and managers. The clearly defined division of tasks in the team provided structure, safety, and eased the workload. Treatment was streamlined and the work was perceived as more professional and stimulating. However, implementation of the new work model, including task shift, required close cooperation between nurses and physicians, trust and dedication. Implementation failed if the staff turnover was high, or if management support lacked. Personal qualities, judgement, experience and learning by cooperating with each other, were highlighted as important additional factors for competence and professionally performed hypertension care.

Conclusion: Healthcare can benefit from this intervention, but manager support and involvement of both nurses and physicians are crucial factors for successful implementation. Structured protocols cannot replace experience and personal qualities but provide appreciated support and increased safety.

Background: A gradual transition from cytology-based screening to Human Papillomavirus (HPV) testing within the cervical cancer screening program has resulted in new routines for follow-up, and new challenges for communication of abnormal test results. General practitioners (GPs) have an important role in the screening program, as they are the primary performers of the screening test, they communicate test results to patients and refer them to a specialist if necessary.

Objective: The study explores what consequences the introduction of HPV testing in the cervical cancer screening programme has for GPs' professional practice and communication with patients.

Design, setting and subjects: Qualitative focus group study including 32 GPs in Central Norway who conduct screening tests within the cervical cancer screening programme.

Results: The overall concern of the GPs was to communicate abnormal test results in a way that ensured appropriate follow-up, without causing unnecessary worry. Staying updated on revised screening guidelines and maintaining their role as medical experts when communicating results to patients could be challenging. GPs shared the responsibility for follow-up after an abnormal result between themselves, the women, and the screening programme. Reciprocal familiarity between GP and patient guided decisions about what and how to communicate, and how to balance the shared responsibility. GPs used their professional judgement to assess patients' informational needs and tailored information accordingly.

Conclusion: GPs manage the challenges of communicating abnormal screening results by sharing responsibility and using their professional judgement. Strengthening support and communication tools may enhance their role in the screening programme.

Background: Heart failure (HF) is one of the most common causes of hospitalization and death worldwide. We aimed at identifying variables that can be helpful for early diagnosis of HF in primary care.

Methods: In 2015-16, we included 2007 participants aged ≥ 40 years in the 7th Tromsø study. They underwent echocardiography and other examinations needed for establishing a diagnosis of HF according to European guidelines from 2016. We analyzed associations with HF among the 1863 participants who reported not to have HF. Variables significantly associated with HF were included in multivariable logistic regression analyses. Diagnostic models were further analyzed by ROC curves and areas under curve (AUC) were calculated, optimism corrected by bootstrapping.

Results: The HF prevalence in the age groups 40-64 years, 65-74 years, and ≥ 75 years were 3.5%, 11.7% and 29.4%, respectively. A predictive model based on self-reported hypertension, myocardial infarction, atrial fibrillation, body-mass index and moderate to severe dyspnea had an AUC of 0.813 (95% CI 0.785-0.843). In a significantly stronger model, in which NT-proBNP was included and self-reported atrial fibrillation was replaced by atrial fibrillation on ECG, an AUC of 0.849 (95% CI 0.821-0.880) was reached.

Conclusion: Easily available clinical information may be used both to rule out HF an to identify patients needing further examinations. A direct referral to echocardiography should be considered for elderly patients in primary care with a known cardiovascular disease and severe shortness of breath. With less abundant history and symptoms, ECG and NT-proBNP can guide further investigations.

Aims: To examine the separate associations of glycemic control and chronic kidney disease with hospitalization days over one year in patients with type 2 diabetes (T2D).

Materials and methods: A cross-sectional study using retrospective data on T2D patients in Region Halland, Sweden, during 2020. Data from the Region Halland database included hospitalizations, emergency visits, primary care encounters, glycemic control, estimated glomerular filtration rate (eGFR), comorbidities, pharmacotherapy and healthcare encounters. Negative binomial regression was used to assess associations with healthcare utilization.

Results: A total of 12,689 patients participated, with an average age of 66.0 years (67.1 years for women and 65.2 years for men, p = 0.010). Higher glycated hemoglobin (HbA1c) and elevated blood glucose levels were associated with increased hospitalization days. Relative risks (RRs) for hospitalization days were higher for HbA1c 52-70 mmol/mol (RR 1.08, 95% CI 1.01-1.15) and >70 mmol/mol (RR 1.24, 95% CI 1.12-1.37). Elevated blood glucose levels ≥7.8 mmol/L had an RR of 1.17 (95% CI 1.04-1.32), while <7.8 mmol/L had an RR of 0.85 (95% CI 0.76-0.96). Patients with an eGFR between 30 and 60 mL/min had a RR of hospitalization of 1.35 (95% CI 1.26-1.44) compared to those with an eGFR >60 mL/min. For patients with an eGFR <30 mL/min, the RR of hospitalization was 3.36 (95% CI 3.00-3.77).

Conclusions: Both poor glycemic control and decreased kidney function were associated with higher hospitalization rates in T2D patients. These findings emphasize the need for effective management of glycemic control and renal function to reduce the healthcare burden in this patient population.

Background and purpose: Loneliness is a complex public health issue that can lead to increased morbidity, with higher prevalence among older adults. Social prescribing may be one way to ease loneliness. This study aims to explore stakeholders' perceptions of prerequisites for implementing a social prescribing program in a Swedish context.

Method: Reflexive thematic analysis was used to analyse individual semi-structured interviews with eleven stakeholders whose experience were considered relevant for implementing a social prescribing program in the Swedish context. They were selected to provide diverse perspectives related to organisation, position, and geography.

Results: From the analysis three themes were constructed; Where to implement - Necessity to bridge organisational gaps, How to implement - Balancing professional expectations, and For whom to implement - Addressing those with 'real' needs. These themes highlight the perceived prerequisites, including barriers and facilitators, for successful implementation of social prescribing.

Conclusions: The participants' perceptions are suggesting that Sweden has several practical advantages in place for implementing social prescribing, such as robust organisations responsible for citizens' health and well-being and a range of activities available. If organisations can collaborate by prioritizing patients' needs and overcoming organisational divisions and responsibilities, there is potential for successfully implementing social prescribing in Sweden in the future. Nevertheless, implementation may be hampered by limited resources within health care, and challenges to evaluate program effects.

Introduction: In recent years, the increasing availability of instruments and laboratory tests has significantly influenced the diagnostic work in primary healthcare. This study aimed to map the availability of diagnostic equipment and point-of-care tests (POCTs) in Norwegian emergency primary healthcare clinics and examine the demographic and organisational factors influencing their availability.

Methods: This cross-sectional study utilised the National Out-of-Hours Services Registry (NOOHR) survey across all Norwegian emergency primary healthcare clinics in early 2024. Clinic managers provided data on diagnostic equipment and POCTs. Clinics were categorised by population size, hospital proximity, co-location with general practitioner (GP) offices, and total equipment available.

Results: All 167 Norwegian emergency primary healthcare clinics responded. The median number of diagnostic equipment and POCTs was 17 (Interquartile range (IQR) 16-20). Clinics with the most equipment were often smaller, co-located with a GP office, and over 40 km from a hospital. Almost all clinics had a repertoire of CRP, urinary dipstick, haemoglobin, glucose, strep A test, SARS-CoV-2 rapid test, urinary HCG test, pulse oximeter, and ECG. Clinics far from hospitals more frequently had tests like D-dimer and troponin. Of the clinics with troponin tests, 69% had a low-sensitive POCT.

Conclusion: Norwegian emergency primary healthcare clinics are well equipped, especially if co-located with a GP office or far from a hospital. Further research is needed to enlighten how availability influences use and the possible impact on patient trajectories. Clinic leaders should pave the way for sustainable practices and high-value care when deciding their diagnostic equipment and POCTs repertoire.