Scandinavian Journal of Primary Health Care最新文献

Background: Point-of-care (POC) tests, including C-reactive protein (CRP) tests and rapid antigen detection tests (RADT) for group A streptococci (GAS), are widely used in Swedish primary health care (PHC). This study quantifies their use in pharyngotonsillitis and explore their association with antibiotic prescribing.

Material and methods: Retrospective data from 2012-2016 in Region Kronoberg, Sweden, included all PHC visits with a pharyngotonsillitis diagnosis. Patient characteristics, test usage and antibiotic prescriptions were linked by visit date and personal identification number. Descriptive statistics were used for POC test analysis. Logistic regression assessed the association between CRP levels and antibiotic prescribing.

Results: Of 24,237 visits, 68% included RADT and 36% included a CRP test, with 89% of CRP tests performed alongside RADT. CRP testing was more frequent in patients with negative (56%) than positive RADTs (42%) (p < .001). Overall, 66% of RADTs were positive. Median CRP levels were 23 mg/l for positive RADT and 31 mg/l for negative RADT (p < .001). Antibiotics were prescribed for 95% of positive RADTs and 43% of negative RADTs (p < .001). In patients with negative RADTs, CRP testing was associated with higher antibiotic prescribing (57%) compared to no CRP testing (26%) (p < .001). Among these patients, CRP levels were associated with prescribing (aOR 1.032; 95% CI 1.029-1.035; p < .001), with 50% of prescriptions occuring at CRP levels ≤ 20 mg/l.

Conclusion: The use of RADTs and the proportion of positive test were higher than expected, indicating inappropriate use and diagnostic bias. CRP testing, contrary to guidelines, was common and associated with increased antibiotic prescribing.

Background: After COVID-19 infection, long-term impacts on functioning may occur. We studied the functioning of patients with post-COVID-19 condition (PCC) and compared them to controls without PCC.

Methods: This cross-sectional study consisted of 442 patients with PCC referred to rehabilitation at the Helsinki University Hospital (HUS) Outpatient Clinic for the Long-Term Effects of COVID-19, and 198 controls without PCC. Functioning was assessed with a questionnaire including WHODAS 2.0. Patients underwent physical testing including a hand grip strength test (HGST) and a 6-minute walking test (6MWT). Lifestyle was assessed by questionnaire and comorbidities were collected as ICD-10 codes from the HUS Data Lake on the HUS Acamedic platform.

Results: The WHODAS 2.0 average total score was 34 (SD 18) (moderate functional limitation) for patients with PCC and 6 (SD 8) (normal or mild limitation) for the controls. The disability was higher in all aspects of WHODAS 2.0 in patients with PCC. Bivariate binomial and multivariable regression analyses showed that the presence of comorbidities, anxiety, depression, and smoking predicted a WHODAS 2.0 score of 24 (moderate functional limitation) or above in the PCC group. The average 6MWT distance was 435 m (SD 98 m) in patients with PCC and 627 m (SD 70 m) in controls. HGST measurements showed no significant differences from controls.

Conclusions: In conclusion, patients with PCC had significantly reduced functioning based on WHODAS 2.0 scores and the 6MWT results. Comorbidities, anxiety, depression, and smoking were associated with moderate or severe limitations in functioning. Findings support that PCC is multifactorial and requires a holistic approach to rehabilitation.

Objective: To explore the experiences of healthcare and social services professionals and their perceptions of using Certificate for self-care with support (CSS) for preventive self-care for older adults with home care, including the CSS process and collaborations between primary healthcare and social services.

Design: An inductive qualitative study including seven focus group interviews analyzed with reflexive thematic analysis.

Setting and subjects: The study was conducted in the Stockholm Region 2022/23. In total, 23 informants were recruited from four key partners involved in the CSS process: professionals from primary care rehabilitation and primary healthcare, social services officers, and home care staff.

Result: The analyses resulted in five interconnected themes: 'Guidelines with scope for interpretation,' 'Support for self-care is needed, but complicated in practice,' 'To trust the other professions' competence,' 'There is a transfer of responsibility,' and 'Communication is key.' The overarching theme 'Principles or pragmatism for safe person-centered care,' anchoring the other themes, revealed a common goal of achieving safe and individualized care within available resources, but from two conflicting perspectives: the importance of following the process according to the guidelines or taking a more pragmatic approach.

Conclusion: This study highlights the need to establish structures facilitating safe self-care among frail groups, such as older persons dependent on home care. Our findings emphasize that the demarcation between, and responsibilities of, organizations need to be discussed and clarified to offer person-centered support. Comprehensible guidelines and functioning communication channels must be established so that all important perspectives can be heard, not least the patient's.

Objective: To evaluate the impact of a compulsory pop-up form on the ordering pattern of proBNP blood tests by general practitioners in the Capital Region of Denmark.

Design: A follow-up study comparing the average number of proBNP tests ordered before and after the implementation of an intervention.

Setting and subjects: From 2016 to 2021, the average number of proBNP tests increased by over 300%. In March 2022, a compulsory pop-up form was introduced in the electronic request system (WebReq), requiring general practitioners to select one of three indications for ordering proBNP, as recommended by the Danish Society of Cardiology. The study included 528 general practitioners in the Capital Region of Denmark, with data available from January 2020 to 2023, encompassing 83,576 proBNP results from 56,645 patients.

Main outcome measure: The average number of proBNP tests ordered per month and the median level of proBNP before and after the intervention.

Results: Following the intervention, the average number of proBNP tests per month decreased by 60% over a 22-month follow-up period. The highest reduction was seen among general practitioners who previously ordered the most tests (≥3 per 1000 biochemical tests). In this group, the median proBNP level increased from 12.1 pmol/L before the intervention to 13.5 pmol/L after the intervention (p < 0.0001).

Conclusions: This study demonstrates a significant decrease in the number of proBNP requests from general practitioners in the Capital Region of Denmark after the introduction of a pop-up form in the requisition system containing the current guidelines.

Objective: The aim of this study is to explore general practice staff perspectives regarding a teaching concept based on instructional videos for conducting DR screenings. Furthermore, this study aims to investigate the competencies acquired by the staff through this teaching concept.

Design and setting: Qualitative cross-sectional study conducted in general practice clinics in the North Denmark Region.

Method: A teaching concept was developed based on instruction videos to teach general practice staff to conduct diabetic retinopathy screenings with automated grading through artificial intelligence. Semi-structured interviews were performed with 16 staff members to investigate their perspectives on the concept and acquired competencies.

Results: This study found no substantial resistance to the teaching concept from staff; however, participants' satisfaction with the methods employed in the instruction session, the progression of learning curves, screening competencies, and their acceptance of a known knowledge gap during screenings varied slightly among the participants.

Conclusion: This study showed that the teaching concept can be used to teach general practice staff to conduct diabetic retinopathy screenings. Staffs' perspectives on the teaching concept and acquired competencies varied, and this study suggest few adjustments to the concept to accommodate staff's preferences and establish more consistent competencies.

Young adults experiencing unfamiliar symptoms commonly seek health information online. This study's aim was to explore how health information websites express and communicate health information about symptoms common among young adults and guide readers in regard to health, illness, and care. Symptoms commonly searched for by young adults were used as search terms. The resulting data comprised material from 24 web pages and was analyzed using content analysis. The foremost purpose of online health information is to try to narrow down the user's symptoms and then advise the user on what actions to take. This is done by first forming a foundation of knowledge through descriptions and explanations, then specifying the symptom's time, duration, and location, and finally giving advice on whether to self-manage symptoms or seek additional information about them. However, the uncertainty of the diagnosis may rule out self-care. For readers inexperienced with health care, forming a decisive conclusion about diffuse symptoms on the sole basis of online health information could be challenging. The necessity of numeracy skills and the ability to deal with uncertainty are highlighted. There is a discrepancy between health advice given online and readers' accessibility to health care that needs to be addressed in future policy and research.

Objective: An inter-municipal out-of-hours (OOH) district covers several municipalities with one centralized casualty clinic. These OOH districts are large geographical areas with long driving times to the casualty clinic. Remote OOH units were established in two OOH districts in Norway, to secure better access to the OOH service. Patients were offered video consultations with nurse-led appointments at the remote OOH units. The aim was to investigate contact rates and distribution of consultation types before and after the remote units were established. Design. An observational study with pre- and post-data collected from municipalities with and without (controls) remote OOH units.

Setting: Two OOH districts, Førde and Molde, with five and four remote OOH units, respectively.

Subjects: Inhabitants contacting the Local Emergency Communications Centers (LEMCs) in the two areas.

Results: In municipalities that established remote OOH units the contact rates to the LEMCs decreased by 15% in Førde and 16% in the Molde OOH districts in 2021, compared with 2019. Control municipalities had an increased rate of 7% and 2%, respectively. Consultation rates decreased by 16% and 12% in municipalities with remote OOH units in Førde and Molde, respectively. In 2021, 7% of contacts from municipalities with remote OOH units in Førde OOH district and 3% in Molde OOH district ended in a consultation at a remote OOH unit. In the Molde OOH district, where the traditional casualty clinic was replaced with remote OOH units, home visits and callouts decreased by 76% and 86% from 2019 to 2021.

Conclusion: Establishing remote OOH units could have decreased contact and consultation rates in both districts. Most contacts were handled with actions other than a remote OOH unit encounter with video consultation. There was a large reduction of home visits and callouts in the Molde OOH district in 2021, compared with 2019.

Background: General practitioners (GPs) who supervise medical students during clinical placements are valuable resources for medical universities. However, several countries struggle with recruiting supervisors. More knowledge about GPs' attitudes and factors that motivate them to be supervisors, is essential for developing targeted recruitment strategies and effective follow-up by universities.

Objective: We aimed to investigate GPs' attitudes to and motivation for supervising medical students in clinical placements.

Methods: A web-based questionnaire was sent to all GPs in Norway in February 2022. Both active supervisors' and non-supervisors' responses were collected. Attitudes were reported as scores on a five-point Likert scale in response to 21 statements, while motivation was reported by highlighting the most important motivational factors among 15 items. Descriptive statistics were used to rank the statements and motivation factors. Independent sample t-test and ANOVA were used to analyse differences in mean scores across subgroups.

Results: We received 1466 responses (29%), of whom 498 (34%) were active supervisors. Results revealed positive attitudes towards supervising medical students in clinical placements, even among non-supervisors. Statements about the supervisor role and its importance regarding recruitment, professional stimulation and clinical teaching competence, were scored high. Many agreed that supervising students increased their workload. 'Recruitment contribution' was the most selected motivation item.

Conclusion: Recruitment contribution, professional development, workday variation and the feeling of fulfilment contribute to GPs' motivation to supervise. The results indicate a promising future for recruiting clinical supervisors.

Aims: The aim of this study was to describe the prevalence, associations, and reasons for the use of complementary and alternative medicine (CAM) in Sweden, as well as to further explore possible self-perceived outcomes including adverse effects as well as the sources of information used.

Methods: Data were collected by a cross-sectional survey, administered by computer assisted telephone interviews, in June 2020 (n = 500), during the first three months of the COVID-19 pandemic. The survey was a modified version of the International Questionnaire to measure use of Complementary and Alternative Medicine (I-CAM-Q) instrument.

Results: 63.6% of respondents reported use of CAM. The most common reasons for use were to improve general well-being and/or to treat long-term illness or its symptoms. Very few used CAM to prevent or treat COVID-19. The most used CAMs were natural remedies and dietary supplements (50%), followed by self-help practices (33.2%) and consultation of CAM providers (13%). Women, those of older age (40+), and living in larger cities were more likely to use CAMs compared to the entire sample. Household income or level of education did not predict CAM use. Few adverse effects were reported. The main sources for information were media and the Internet followed by family and friends.

Conclusions: This study contributes with updated knowledge about Swedish citizens' use of CAM. The results are important to inform health care policy about patterns of CAM use among Swedish citizens.