Scandinavian Journal of Primary Health Care最新文献

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.

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.

Background: Primary health care is in the unique position of being a first level of support and care to individuals with mental health problems. The focus in this service is on diagnosis, medical treatment, and symptom reduction. However, to access it is perceived as challenging by both patients and providers. An increased understanding of the lived experience of encountering primary health care may be beneficial for the delivery of a tailored mental health service to patients.

Aim: To explore the lived experience of encounters with primary health care of a person with mental health problems.

Methods: Eleven in-depth interviews were conducted online between October 2022 and April 2023. A descriptive phenomenology study in accordance with Giorgi was used to analyze the material.

Results: The essence of the lived experience of being a patient with MHP was a desire to be embraced by health professionals, which was the general construction based on four themes, To come from a place of loneliness and vulnerability, To sense mental health was viewed as problematic, To not be in control and To feel safe.

Conclusions: The lived experience of being a patient with mental health problems was described as everyday challenges due to their mental health. They never knew whether the support was there for them as patients when encountering primary health care. Acknowledging patients as experts on their life situation is the core element in person-centered care. It is therefore crucial for further research to include patients' experiential knowledge to inform clinical practice and to improve clinical outcomes.

Aim: To (1) explore perceived access to general practice, relationship with the general practitioner (GP) and previous experiences with general practice among the Danish population and (2) analyse the associations with sex, age, chronic disease and health literacy.

Methods: A cross-sectional nationwide survey study among 100,000 randomly selected adults aged 20 years or above. Questionnaire data comprised items covering the perceived access to, relationship and previous experiences with GP contacts, chronic disease and health literacy. Data were linked to register data. Descriptive statistics and multivariable logistic regression models were applied.

Results: A total of 27,713 (30%) individuals were included. More than a third reported difficulties with talking to the GP secretary (35%) and with getting an appointment with their preferred doctor (44%). Some 80% reported high confidence in the GP, whereas previous negative experiences and insufficient consultation time were reported by 33% and 46%, respectively. Females and individuals with health literacy challenges in terms of being less able to actively engage with healthcare professionals were more likely to report difficulties with access to and previous negative experiences with general practice. Individuals with higher age, chronic disease(s) and health literacy challenges in terms of feeling less understood and supported, and less ability to actively engage with healthcare providers were less confident in their GP.

Conclusions: This study highlights difficulties related to accessing general practice and previous negative experiences among different population groups. Since some individuals are more likely to encounter these challenges, differentiating healthcare services may promote greater equity in health.

Introduction: Irritable bowel syndrome (IBS) is a common condition that should be diagnosed using the Rome criteria and limited laboratory testing. The aim of this retrospective, medical record-based study was to evaluate the adherence of Swedish primary health care practitioners to diagnostic guidelines for IBS.

Methods: Using the electronic patient register in primary care, we identified 1943 new IBS cases in patients aged 18-65 between January 2015 and December 2019 in Region Örebro County. A random sample of 400 patients was selected and their medical records were scrutinized to evaluate diagnostic methods.

Results: Of the 309 eligible medical records, only 36.2% of patients met the Rome III or IV criteria. The criteria were explicitly documented in 4.9% of cases, and subclassification was noted in 5.5%. There were no significant differences in diagnostic practices between GPs and other physicians. Only 9.4% were diagnosed without laboratory testing, although 69.9% did not undergo all recommended tests according to local guidelines. Rectoscopy was performed in 14.2%, while 9.7% and 5.8% of patients were referred for colonoscopy or CT, respectively, with significantly higher referral rates in patients over 40 years. Men were more frequently referred for colonoscopy while other diagnostic procedures showed no significant sex differences.

Conclusions: Adherence to IBS diagnostic guidelines in Swedish primary care seems to be limited among both GPs and non-GPs. The documented use of Rome criteria is minimal, and guideline-compliant laboratory testing is insufficient. Increased awareness and structured implementation of IBS diagnostic criteria are warranted.

Background: Chronic insomnia is commonly treated with hypnotics. However, the treatment of choice is cognitive behavioral therapy for insomnia (CBTi). We investigated whether a self-help book based on CBTi is effective in reducing hypnotic use and improving sleep.

Methods: Patients who had received a prescription from their GP for z-hypnotics (zopiclone or zolpidem) in the last 6 months were recruited through PraksisNett, an infrastructure within General Practice, for a randomized controlled trial comparing written materials in form of a sheet of sleep hygiene advice and a self-help book. The participants completed an online questionnaire about hypnotic use, insomnia symptoms, sleep duration, anxiety and depression before the intervention and at 4-5 months follow-up.

Results: In total, 125 patients (response rate 72.7%) completed the follow-up questionnaire. Interaction analyses indicated effects favoring the self-help book for hypnotic use and anxiety. The book reduced the proportion using hypnotics daily from 25.4% to 18.6%, while the proportion increased from 21.2% to 22.7% in the sleep hygiene group. The proportion reporting anxiety was reduced from 32.1% to 23.2% in the self-help book group, while it increased from 27.0% to 31.7% in the sleep hygiene group. Insomnia symptoms were lowered in both intervention groups, whereas depression remained unchanged.

Conclusion: This study indicated that the self-help book was an effective low-threshold treatment option that seems to reduce hypnotic use and at the same time improve sleep and mental health. The patients who received sleep hygiene advice also reported some positive effects, but daily hypnotic use and anxiety increased.

Background: In Sweden 70,000 people suffer fragility fractures annually, including 16,000 hip fractures with one-year mortality of up to 25%. Strategies to prevent falls, improve physical function, and enhance bone strength have shown mixed results.

Aim: To evaluate the incidence of hip and other fragility fractures following a fracture prevention intervention and assess baseline risk factors for long-term fracture outcomes.

Methods: 1,233 rural Swedish women aged 70-100 years in 2002 were followed until 2021 after a primary care-based, non-randomized graded fracture prevention intervention 2002-2004 that included physical activity, fall prevention, and pharmacological treatment tailored to hip fracture risk. Fractures were identified through radiology reports 2002-2021.

Results: The most common fractures occurred in the hip with 236 women sustaining 268 hip fractures with highest incidence in women aged 90-94 years. One-year hip fracture mortality was 27%. Hip fractures occurred in 17.7% of the intervention group (77/434) and 19.9% of controls (159/799, p = 0.36). Repeated fragility fractures occurred in 14.1% of the intervention group and 18.6% of controls (OR 0.71; 95% CI 0.53-1.0, p = 0.047), particularly when one fracture involved the hip (OR 0.54 (95% CI 0.31-0.95), p = 0.037). Increasing age (HR 1.8-4.0), height >167 cm (HR 1.6; 95% CI 1.1-2.2), and weight <60 kg (HR 1.5; 95% CI 1.1-2.0) were significant baseline risk factors.

Conclusions: We noticed a non-significant reduction in hip fractures after 20 years, yet repeated fractures were less frequent in the intervention group suggesting a potential long-term benefit. Older, taller and lighter women were at greater risk for hip fracture.