Scandinavian Journal of Primary Health Care最新文献

Purpose: This study aimed to assess physicians' perspective of non-specific chronic low back pain (cLBP), focusing on whether they attribute the condition to single or multiple influencing factors. It also explored how these factors are conceptualised and whether physicians' expressed attributions align with the biopsychosocial approach advised in the guidelines for the management of cLBP.

Methods: This exploratory qualitative study used a clinical vignette depicting cLBP and employed a deductive framework analysis. Licensed general practitioners and trainees were asked to identify contributing factors to the patient's cLBP. Five predefined themes, 'Beliefs', 'Previous experiences', 'Emotions', 'Patients behaviour' and 'Contextual factors', were analysed to assess their framing within a biopsychosocial approach.

Results: Seventy-six physicians participated. They used very brief responses when reporting contributing factors to cLBP (median: 11 words). While 71% identified sedentary behaviour as a contributing factor, only 28% mentioned fear of movement and 8% identified the misbeliefs embedded in the vignette. Half of the participants linked the patient's cLBP to multiple factors, yet 38% of those responses were exempt from segments 'less aligned' with a biopsychosocial approach.

Conclusions: Physicians generally provided a multifactorial perspective on cLBP, yet relevant factors such as identifying misbeliefs were often overlooked. Approximately, three-quarters did not mention fear of movement, despite evidence supporting this link. Physicians need to be aware of how their perspective can shape potentially harmful or stigmatizing messages, which may contribute to poorer outcomes for patients with cLBP. Given the methodological limitations, further qualitative research is needed to confirm and expand on these findings.

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.

Objective: There is limited understanding of healthcare consumption among patients seeking care for stress-related exhaustion. This study examines the number of care contacts and treatments received by patients diagnosed with Exhaustion Disorder (ED) in primary care, as well as its association with psychiatric comorbidity, sex, age, location, and the governance of primary care centers (PCCs).

Methods: Data from the Region Västra Götaland healthcare database Vega was analysed including patients diagnosed with ED for the first time during 2018 and 2019, in total of 11,058 patients. Number of care contacts and treatments registered the 12 months before and after the individual date of first time ED diagnosis were compared.

Results: Number of care contacts and treatments and proportion of patients receiving care increased post-ED diagnosis. The variation is large, and patients diagnosed with another psychiatric condition, most often depression or anxiety, in addition to ED received more care. Female patients tended to receive more care. Minor variations were observed with respect to age and PCC population size, while larger differences were identified between municipalities. Public and private PCCs showed a similar pattern for both care contacts and treatments.

Conclusion: Healthcare consumption varies greatly among ED patients seeking primary care. This variation is mostly related to the burden of psychiatric comorbidity and, to a lesser extent, to gender and age. The wide variety of treatments used, along with the gender and age differences observed, warrant further analysis, as these patterns may not align with current evidence for treating patients with ED.

Background: Anxiety is a common problem amongst the population, including patients in general practice. Treatment often relies on medication, but non-pharmacological alternatives may offer safer or more sustainable options, particularly for mild to moderate anxiety. There is a limited overview of which non-pharmacological treatments have been studied or implemented in general practice.

Objectives: This scoping review aims to explore and describe existing evidence on non-pharmacological interventions for anxiety in general practice, providing an overview of available treatment approaches and identifying gaps to inform future research.

Methods: A scoping review was made following the PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines. Data was collected using keywords in several databases (PubMed, CINAHL and APA PsycInfo) and selected based on predefined eligibility criteria.

Results: Three thousand four hundred and twenty-five articles were screened and 64 were assessed. A total of seven peer-reviewed articles were included. Three themes emerged among the interventions. These were digital interventions, step-wise and low-intensity care models, and body-based interventions. The interventions were delivered through various formats, including mobile apps, online platforms and in-person clinics. The studies all targeted patients with mild to moderate anxiety. Despite differences in methodology and populations, the interventions showed a positive effect.

Conclusions: This scoping review highlights that while the evidence is still limited, the non-pharmacological interventions mentioned in this review have shown promise in the treatment of anxiety. Further research is needed to assess the effectiveness, implementation and real-world impact of these approaches in general practice.

Introduction: A negative association between the number of chronic conditions and quality of life (QoL) is well known, but the complexity of this association is not fully understood. This study aimed to 1) examine the association between the number of diagnosis groups, as a measure of multimorbidity, and needs-based QoL, and 2) explore how this association varies across sociodemographic subgroups.

Methods: This cross-sectional study included adults with chronic conditions managed at a general practitioner (GP) who participated in a cluster-randomized trial. The exposure was the number of self-reported diagnosis groups, using an organ-specific definition, and the outcome was needs-based QoL measured using the Multi Morbidity Questionnaire 1 (MMQ1). Multivariable linear regression models were used, and a Minimal Important Difference (MID) for each domain were calculated to assess the clinical relevance.

Results: The study included 31,753 patients. Significant, linear, associations were found between the number of diagnosis groups and needs-based QoL. Age, education, occupation, and living alone were identified as effect modifiers. The strongest associations were observed among participants aged 40-59 years, those with lower educational levels, the unemployed, and those living alone.

Conclusion: A cumulative burden of multimorbidity was identified as increasing number of diagnoses was associated with lower needs-based QoL. Socioeconomically and socially vulnerable groups may experience greater impacts on their QoL and may benefit from additional support or more personalized care approaches. These findings highlight the importance of a bio-psycho-social approach when caring for patients with chronic disease and multimorbidity in general practice.

Introduction: The prevalence of hypertension (HT) increases with age. Uncertainty remains about how to treat the oldest patients, who often suffer from multimorbidity.

Aim: We explored which factors influence general practitioners' (GPs') and GP trainees' treatment of hypertension among the oldest-old.

Methods: GPs and GP trainees in Sweden were invited to fill out an online survey through announcements in newsletters and closed social media groups.

Results: Of the 577 questionnaires that were initiated, 397 were completed (69%). The respondents stated that acceptable blood pressure ranges were 115-152/61-93 mmHg. Regarding factors influencing choices of HT treatment, all respondents considered patient's living conditions more important than medical factors, more so by female (80%) than by male physicians (71%, p = 0.049), and more by respondents less experienced in primary health care (PHC) (83%) compared to more experienced (74%, p = 0.043). Lifestyle recommendations, except dietary advice, were frequently offered (80.4%-91.4%). All respondents identified co-morbidity and cardiovascular risk factors as important for treatment decisions. Respondents with more PHC experience considered HT treatment guidelines more useful than those with less experience (p = 0.012). Improved cooperation with other caregivers and a common medication list were prioritised more by female than male respondents.

Conclusions: Both medical factors and living conditions were important for GPs and GP trainees in making HT treatment decisions for the oldest-old. Female and less experienced respondents prioritised living conditions. Organisational changes in HT care for the oldest-old were more important to female respondents.

Background: Perinatal depressive symptoms affect one in 10 parents. However, there is a lack of knowledge on issues related to early and appropriate support for depressive parents. The study investigated what kind of support depressive parents need and receive prenatally from health professionals and whether the received support moderates the association between prenatal depressive symptoms and postpartum mental health.

Methods: The FinChildren survey for parents of babies aged 3-6 months (8977 mothers, 5825 fathers) was conducted in 2020. Parents evaluated their current mental health at the time and prenatal depressive symptoms and support needed (e.g. parenthood, mood, fear of childbirth) retrospectively.

Results: Prenatal depressive symptoms (mothers 29.0%, fathers 12.7%) were associated with the need for all types of support, and inadequate support was associated with poorer postpartum mental health for all parents. For prenatal depressive parents, prenatal support for mood, and for prenatally depressive fathers, support in the case of fear of childbirth were important elements in reducing postpartum depressive symptoms or mental strain.

Limitations: The study design was retrospective and cross-sectional. A screening tool was used to identify prenatal depressive symptoms without a clinically relevant cut-off point.

Conclusions: Prenatally depressive parents' support needs do not only concern mental health. Unmet support needs during pregnancy were highly predictive for postpartum depressive symptoms or mental strain. Adequate support for prenatal mood and in the case of paternal fear of childbirth is important, but further research is needed on the most relevant combinations of support issues and practices to support depressive parents.

Background: The Danish primary care sector is responsible for the majority of antibiotic prescriptions, with upper respiratory tract infections, particularly acute rhinosinusitis (ARS), being a key contributor. This study explored the decision-making process regarding antibiotic use for ARS among general practitioners (GPs) and doctors in training working in general practice.

Methods: Nine semi-structured interviews were conducted with 10 doctors. Interviews were audio-recorded, transcribed verbatim and analyzed using systematic text condensation.

Results: Four key themes were developed: (1) 'It all starts before the consultation': staff-led triage shaping ARS care, (2) two diagnostic worlds: experienced intuition vs. rule-bound caution, (3) C-reactive protein (CRP) in the crossfire: guide, reassurance or irrelevant in antibiotic decision-making and (4) 'Sometimes it's a negotiation': managing patient expectations without losing stewardship. Although diagnosing ARS was often straightforward, distinguishing bacterial from viral infections proved difficult. C-reactive protein testing was common, but its reliability was questioned. Antibiotic prescribing decisions were influenced by patient history, comorbidities and risk factors. While antibiotics were rarely considered necessary initially, patient expectations and doctor-patient relationships sometimes influenced prescribing.

Conclusions: This study illustrates the complexity of diagnosing and managing ARS, shaped by clinical uncertainty, competing priorities and non-clinical pressures. Variation in doctor involvement, diagnostic practices and CRP thresholds reveals the challenges of standardization. Training, guidelines and patient education are valued but may not ensure optimal antibiotic use. Diagnostic decisions are relational, negotiated and context-specific, influenced by public health concerns, patient needs and workflow demands. Without acknowledging this complexity, antibiotic stewardship efforts could potentially fall short.