Scandinavian Journal of Primary Health Care最新文献

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.

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.

Purpose: A trusting relationship between employee and manager is crucial for constructive dialogue regarding work ability. However, employees may sometimes experience collaboration as unpleasant if the dialogue with their manager is not constructive. The aim of the study was to explore how employees on sick leave experience manager involvement in the RTW through a three-party meeting using the Demand and Ability Protocol (DAP) in primary healthcare.

Materials and methods: Data included 20 semi-structured individual interviews with employees diagnosed with common mental disorders or musculoskeletal disorders who had participated in a DAP dialogue. Thematic analysis was used to analyse the data.

Results: Employees wanted to reach out to their manager but had challenges getting the message through about their reduced work ability. During sick leave, the structured DAP held within primary healthcare was experienced as a helpful measure to foster collaboration with the manager. The dialogue helped explore the balance between workplace demands and the employee's capabilities. This enabled both parties to share their view and the rehabilitation coordinator could guide towards potential adaptations. Employees found that the increased mutual understanding fostered by the DAP helped pave the way for ongoing collaboration in the RTW process.

Conclusions: The results underscore the importance of facilitating collaboration between employees and managers before, during, and after sick leave. The DAP can support the development of a trust-based relationship that enables all involved stakeholders to articulate needs, propose measures, and make informed decisions that enhance efforts throughout the RTW process.

Introduction: Semaglutide has gained attention for its efficacy in weight loss. However, little is known about patients' experiences. This study explores patient experiences with using Semaglutide for weight loss (SEMA-WL) in a rural Danish context.

Methods: We conducted semi-structured interviews with nine participants from a rural Danish municipality, recruited from a local clinic. The sample included six women and three men, aged 33-65, who had been prescribed SEMA-WL for at least two months. Data was analysed using systematic text condensation.

Findings: We identified four themes. First, we highlight different experiences of negative perceptions from the local community for using SEMA-WL, often perceived as 'cheating' or as 'an easy way out'. Furthermore, we describe how SEMA-WL is experienced to provide more energy in the participants everyday lives but also viewed as a short-term intervention rather than a permanent solution, assisted by concerns of weight regain. Finally, we show how the participants continuously outweigh the risks of using new medication fearing potential long-term side effects versus living with obesity.

Conclusion: The study highlights the complex social dynamics and personal experiences of using SEMA-WL. While medication offers benefits, it also presents challenges such as social stigma, concerns about long-term effectiveness and side effects, and financial costs. Future research should focus on investigating the experiences of using SEMA-WL in other and more diverse settings as well as the contact and information exchange between patients and healthcare providers.

Background: There is a lack of data on the prevalence of conflicts of interest (COI) declared in systematic reviews over time.

Methods: PubMed was searched for systematic reviews on interventions for chronic obstructive pulmonary disease, type 2 diabetes mellitus, hypertension, dementia, major depression, and osteoarthritis from 2010 and 2019. Selection was conducted by two independent authors, with disagreements resolved in consensus. COI and funding disclosures were extracted. COI were categorised using a specific framework.

Results: 746 systematic reviews were included. One third involved pharmacological interventions. Systematic reviews from China increased from 4% to 21% between 2010 and 2019; Cochrane reviews decreased from 19% to 4%.Systematic reviews presenting a COI statement increased from 79% to 94%. Those with at least one author declaring individual financial COI decreased from 22% to 17% but remained at 22-23% when excluding systematic reviews from China. Almost 1 in 3 systematic reviews on pharmacological interventions and invasive procedures declared individual financial COI for 2019. Individual intellectual COI were declared in 2.5% and other types of COI were very rare.Systematic reviews presenting a funding statement increased from 65% to 81%; industry funding decreased from 6% to 3.4%. Adding industry funding to the prevalence of systematic reviews declaring financial COI only made a marginal difference.

Conclusions: The proportion of systematic reviews on interventions for common diagnoses declaring individual financial COI remained consistent at approximately one in five for both 2010 and 2019, underscoring the need for further research into the implications of this finding.

Aim: Multimorbidity is a major public health concern. According to previous studies, multimorbidity has been shown to be associated with health-related quality of life (HRQoL). However, existing data concerning high income countries are mainly based on cross-sectional studies. Consequently, longitudinal investigations have been called for. There exist several definitions of multimorbidity in previous population studies, and usually definition is based on self-reported symptoms or diseases or included only few diagnoses. This study aimed to examine how the number of doctor-diagnosed chronic diseases influences HRQoL over time in a population-based setting.

Methods: At 31 and 46 years, participants (n = 3573) of the Northern Finland Birth Cohort 1966 answered 15-Dimensional HRQoL questionnaire (15D). Mean 15D-Scores (varies between 0 and 1) were counted according to the number of 43 chosen chronic diseases. These diseases were found and the definition of multimorbidity was measured by a method using both self-reported doctor-diagnosed and register-based chronic diseases.

Results: In both genders, the mean difference of 15D-Scores increased monotonously in line with the increasing number of new emerging diseases diagnosed for 15 years of follow-up from the age of 31-46 years (p < .05). Furthermore, the more diseases the patient had at the age of 31, the more mean 15D-Scores decreased when having more new emerging diseases at the age of 46.

Conclusions: In general, HRQoL decreased during 15-year follow-up for everyone. Furthermore, decrease in the quality of life is significantly associated with multimorbidity in this longitudinal setting.

This study offers novel insights into parents' experiences of healthcare interactions during weight-related visits. Data were collected through the More and Less Europe study, a randomized controlled trial evaluating a parent support program for children (aged 2-6 years) with overweight or obesity in Sweden, Romania, and Spain to capture parents' experiences of healthcare interactions. Semi-structured interviews were conducted with 45 Swedish parents (71% mothers, 60% with university degree, 51% of migrant background) of 45 children (mean age 7.1 years, SD 1.3, 76% girls) who received standard treatment for overweight or obesity. The interviews were analyzed thematically, identifying two themes: (1) Support or blame, with subthemes Validating family-centeredness, Overly generic advice, and Stigma and the sense of failing; (2) The place and role of the child, with subthemes Neutral, honest, and direct communication, Not for children's ears, and Framing the message with care. While some parents described supportive interactions, others expressed disappointment with generic advice and inadequate support. Some recalled stigmatization, sometimes in the child's presence, raising concerns about the child's well-being. Approaches to preparing children for visits ranged from neutral to direct explanations. Parents expressed contrasting views on children's presence during weight-related discussions: while some felt such discussions would harm their child, others supported children's presence in open and age-appropriate discussion. This study fills a critical gap in obesity management communication by highlighting parental concerns about children's exposure to weight-related discussions. Addressing these concerns is essential to reducing weight stigma in healthcare and protecting children from harmful experiences.

Purpose: This study aimed to investigate the factors associated with blood pressure control in a primary healthcare population with hypertension.

Materials and methods: We used baseline data from a recent Swedish randomized controlled trial where 400 patients diagnosed with hypertension from 10 primary health care centers were included. The participants underwent blood pressure measurements, blood sampling and completed questionnaires on quality of life, physical activities, tobacco- and alcohol use, medication, and comorbidities. Logistic regression analyses were used to estimate odds ratios (OR) and 95% confidence intervals (CI) for factors associated with blood pressure control (<140/90 mmHg).

Results: The mean age of the participants was 69 years. The results showed blood pressure control in 41% of the cases. The factors that had the highest ORs for achieving blood pressure control were previous myocardial infarction (OR 2.44; CI 1.08-5.53), diabetes diagnosis (OR 2.26; CI 1.31-3.88), and use of ≥2 blood pressure medications (OR 1.62; CI 1.07-2.46). Family history of hypertension was negatively associated with blood pressure control (OR 0.29; CI 0.38-0.88) (univariate analyses).

Conclusions: Our study found an association between the use of ≥2 antihypertensive medications and blood pressure control. Despite current treatment guidelines for hypertension, the use of single-drug therapy remains common. By shifting from single drug to combination therapy, focusing on patients with a family history of hypertension and those without comorbidities, the proportion achieving blood pressure control could increase significantly.

Trial registration: ClinicalTrials.gov (NCT04407962).