Scandinavian Journal of Primary Health Care最新文献

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.

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.

Objective: Task shifting between health care providers is seen as a strategy for combating increased demands in primary healthcare. This study explored the perceptions and experiences of general practitioners (GPs) and nurses regarding vertical task shifting in Norwegian general practice.

Design and methods: We employed a qualitative design. Data were collected through semi-structured interviews with nurses (n = 6) and GPs (n = 5) across six municipalities in Norway. The data were analysed using reflexive thematic analysis.

Results: The analysis resulted in two main themes, each with associated subthemes: 1) Trust plays a pivotal role in task shifting processes; (i) Time is essential for cultivating mutual trust, (ii) Increased knowledge and mutual respect strengthen trust in nurses competencies and responsibilities, and 2) Drivers and barriers to vertical task shifting; (i) Organizational structures influence utilization and perceived value of vertical task shifting, (ii) Choosing to work in interdisciplinary teams despite a lack of funding, (iii) Contextual factors and experience influenced attitudes towards vertical task shifting.

Conclusion: Trust was described as pivotal to the success of vertical task shifting, with time and collaboration facilitating its development. In several cases, the process of task shifting expanded nurses' roles and strengthened interdisciplinary relationships. However, organizational structures and funding significantly influenced the utilization and perception of task shifting. Attitudes toward task shifting varied based on individual and contextual factors.

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: With rapid technological development and new triage systems in primary healthcare, care complexity is increasing, reshaping the landscape of patient safety. Despite their growing integration, little is known about how healthcare professionals safeguard patient safety during triage. Therefore, this study aimed to explore how healthcare professionals manage patient safety during the triage process in digital primary care.

Method: An inductive and explorative research design was employed, using qualitative content analysis to analyse interviews with ten participants. The participants were healthcare professionals experienced with various triage systems.

Results: Three themes were identified: acting as a fine-tuned instrument to avoid mistriage, resolving technical interruptions to prevent triage delays, and mitigating organisational disruptions to ensure adequate assessment. These themes reflected the participants' continuous problem-solving efforts to maintain patient safety throughout the triage process.

Conclusion: The findings suggest that triage systems may be overly simplified, shifting greater responsibility to healthcare professionals, who must interpret system outputs and manage the broader complexities of primary care triage. We argue that triage safety emerges from the interaction between an understanding of the healthcare system's contextual capacity, broad medical knowledge, and the interpersonal skills needed to recognise and respond to each patient's unique situation.

Clinical implications: Clinically, it is essential to define in advance the boundaries and procedures of the triage process, the mode of digital integration, and the system's intended purpose. Specifying these elements helps ensure that the digital tool supports rather than complicates clinical work and helps establish the preconditions necessary for patient safety.

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.