Scandinavian Journal of Primary Health Care最新文献

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).

Background: Timely healthcare seeking with colorectal cancer (CRC) symptoms is crucial for treatment options. This study aims to 1. compare CRC symptom reporting and contact to the general practitioner (GP) in the Danish population in 2012 and 2022, 2. analyze the associations between sex, age and GP contact in 2012 and 2022, and 3. explore considerations about GP contact in 2022.

Methods: Nationwide surveys on symptoms and GP contact in 2012 and 2022 with 100,000 randomly selected adults invited in each. Four CRC symptom categories, GP contact, and six predefined considerations about GP contact were analyzed by descriptive statistics and multivariable logistic regression models.

Results: We included 47,423 individuals in 2012, and 28,328 in 2022. Symptom reporting was similar in the two cohorts, whereas GP contact increased significantly. Abdominal pain prompted the highest GP contact in both years (36.1% in 2012; 44.3% in 2022), while changed bowel habits prompted the lowest (20.4% and 24.8%, respectively). Men had lower odds of GP contact than women for most symptom categories, and odds of seeking healthcare increased with age. Among those with no GP contact, half reported either knowing the cause of their symptom or expecting it to resolve on its own. Among those who reported rectal bleeding and no GP contact, 17% described embarrassment.

Conclusion: Despite the increased focus on CRC, many individuals with CRC symptoms reported that they knew the cause and expected it to go away on its own, indicating that they might not associate it with serious disease.

Objective: Explore treatment trajectories over a two-year follow-up among patients with musculoskeletal disorders (MSDs) in Norway and investigate the associations with education and country of origin.

Design: Register-based cohort study.

Settings: Data were obtained from three national registers, the Norwegian Control and Payment of Health Reimbursements Database (KUHR), the Norwegian Patient Registry (NPR) and Statistics Norway (SSB).

Subjects: Patients diagnosed with MSDs in 2015 in primary healthcare according to the International Classification of Primary Care, second edition (ICPC-2).

Main outcome measures: Treatment trajectory classes of healthcare use over a 2-years follow-up were generated using group-based multi-trajectory modelling, for all patients registered with MSDs and three common diagnoses: spine pain, osteoarthritis and fibromyalgia.

Results: From the analysis, four treatment trajectory classes of healthcare use were identified for MSD patients overall; low (75%), stable (10%), descending (9%) and high use (5%). The pattern was almost similar for the three diagnostic groups. High use was primarily caused by consistent high use of physiotherapy. For MSD patients overall, low education increased the probability of being in the low and stable use classes, while high education increased the probability of being in the descending use class. Patients with Norway as country of origin, were less likely to be in the class with low use and more likely to be in the class with descending use.

Conclusion: Using nationwide register data and group-based multi-trajectory modelling show that about 75% of all patients with MSD, consulting primary healthcare in Norway, were classified as low users of healthcare services and 5% were classified as high users. Overall, both education and country of origin were associated with the treatment trajectory classes. However, high use was not associated with neither education nor country of origin.

Background: The majority of individuals in Sweden with type 2 diabetes have their sole health care provider in primary health care. Metformin treatment often causes gastrointestinal side-effects. Our aim was to construct and validate a questionnaire assessing gastrointestinal symptoms before and after starting metformin treatment for type 2 diabetes.

Methods: In the Interaction Between Metformin and Microbiota (MEMO) study, 54 participants rated six gastrointestinal symptoms at baseline and after 2 months of metformin treatment in a questionnaire (measured change, i.e. the difference between assessments at these two time points), as well as direct assessment of perceived change in symptoms after 2 months in a separate validation questionnaire (reported change, i.e. how participants themselves have perceived the change between the same two time points). Spearman's ρ was calculated and reported with its 95% CI.

Results: The agreement between reported and measured change of symptoms, measured as Spearman's ρ, was above 0.4 for 4 out of 6 symptoms (poor appetite 0.60 [95% CI 0.39-0.75], loose stool or diarrhea 0.58 [95% CI 0.37-0.74], flatulence 0.45 [95% CI 0.21-0.64], and abdominal pain 0.45 [95% CI 0.20-0.65]). The agreement was lower for nausea and vomiting, although these were numerically above 75% in agreement, likely due to few symptomatic participants overall.

Conclusion: For common side-effect symptoms associated with metformin treatment, our study shows that symptom change measured as the difference between assessments at two different time-points was in overall agreement, validating the usability of the constructed questionnaire for metformin side-effects.

Objective: In primary health care in southern Sweden, interprofessional medication reviews are conducted, to a limited extent, for patients living independently, with the purpose of optimising their pharmacological treatment. These medication reviews have identified and addressed many important issues regarding the patients' medication. However, there is limited knowledge regarding the participating physicians' perspectives on the work. Gaining a better understanding of the physicians' perspectives could contribute to the optimisation of the interprofessional medication review model used in primary health care. This study aimed to explore physicians' perceptions and experiences of interprofessional medication reviews in primary health care for patients who live independently.

Methods: We conducted a qualitative study based on semi-structured discussions in four focus groups with a total of 24 participating primary care physicians. The discussions were transcribed verbatim, condensed, coded and categorised using content analysis.

Results: Through our analysis, we identified four categories: obstacles and facilitators, interprofessional collaboration with the pharmacist, the physician's responsibility and value-adding aspects. An underlying theme, a value-creating intervention with logistical barriers, emerged from the latent material.

Conclusion: Physicians expressed a consistently positive view of medication reviews for independently living patients, highlighting their value for patient safety, clinical decision-making, and learning. However, practical barriers, such as time constraints and unclear routines, were seen as key obstacles to implementation. These findings reflect the dual nature of medication reviews as a value-creating intervention with logistical challenges, which need to be addressed to support broader integration in primary care.

Background: Effective collaboration between general practitioners (GPs) and specialized mental health services is essential to ensure high-quality care for patients with depression. However, achieving such collaboration remains a challenge across healthcare systems internationally. This study aimed to investigate Norwegian GPs' perceptions of their collaboration with the two main components of specialized mental health services - community mental health centers and psychiatric contract specialists. We further examined factors associated with GPs' perceptions of well-functioning collaboration and assessed how their knowledge of prioritization regulations was related to these perceptions.

Methods: A questionnaire among Norwegian GPs, part of a biennial survey among physicians working in Norway capturing information of different elements of collaboration between GPs and mental health specialists and knowledge about prioritization criteria.

Results: Half of the GPs reported collaboration be well-functioning, largely independent of organizational model. A shared understanding of the patient's problems and clear definition of roles had the highest association with well-functioning collaboration. Experiencing a clear distribution of responsibilities and tasks and active communication was associated with perceived well-functioning collaboration. GPs' knowledge about the prioritization criteria was positively associated with a perceived well-functioning collaboration.

Our findings reveal unclarities regarding the distribution of responsibilities and tasks and very little interactive communication between GPs and mental health specialists in both organizational models, which were affecting the GPs' perceptions of collaboration negatively.

Conclusions: Enhanced clarity regarding the roles and responsibilities, more communication about the patient during concurrent treatment, and improved knowledge about specialized mental health prioritization criteria could facilitate and improve the collaboration.

Background: Understanding patients' perspectives on their medications is important to facilitate collaborative deprescribing and shared decision-making.

Aim: To explore older patients' attitudes towards having their medications deprescribed and facilitators for deprescribing in Swedish primary care.

Methods: Swedish primary care patients (≥ 65 years and taking ≥5 medications) responded to an anonymous survey on their attitudes towards deprescribing (June 2022-December 2023).

Results: Out of 101 patients (45% women), 81% were satisfied with their medications (n = 82), 78% would be willing to stop or reduce ≥1 medication if their physician said it was possible (n = 79), and 27% (n = 27) wanted to deprescribe ≥1 medications from their medication lists (with 48 unique medications being mentioned). Side effects associated with the medication was the most commonly stated reason for wanting to deprescribe, mentioned by 52% (14/27 patients). Patients most often wanted to deprescribe blood glucose lowering medications, mentioned by 26% (7/27 patients). Most frequent patient-perceived facilitators for deprescribing were the support from their general practitioner (GP) (68%), a plan for deprescribing (38%), the possibility of restarting the medication if needed (23%), and having an alternative medication (22%).

Conclusions: While most older adults with polypharmacy in Swedish primary care would be willing to deprescribe if suggested by their physician, many did not want to have any medication deprescribed. This difference highlights the need to clarify patients' preferences when discussing medication changes. Support from the GP was identified as an important facilitator, demonstrating the importance of patient-GP communication and shared decision-making in deprescribing.

Background: In Denmark, transgender and nonbinary (TNB) individuals must consult their General Practitioner (GP) to access gender-affirming healthcare (GAHC). TNB individuals report unmet health needs and higher incidences of mental health challenges compared to cisgender peers. Cultural safety, involving a 'safe space,' could reduce healthcare inequities.

Objectives: This study aims to identify the factors, according to TNB individuals in Denmark, that create, maintain, and disrupt a 'safe space' in general practice.

Method: Twelve semi-structured qualitative interviews with TNB individuals aged 20 to 43 were conducted, transcribed verbatim, and analysed using Systematic Text Condensation.

Main findings: Participants felt unsafe with GPs due to negative experiences related to being transgender, leading to healthcare avoidance. They valued GPs who respected chosen names, showed interest in transgender care, and were upfront about limitations. A significant issue was lack of GP knowledge on transgender healthcare, often requiring participants to educate their GPs. Participants emphasised the need for doctors to avoid assumptions about patients based on gender identity. Participants did not believe that a 'safe space' can be realised but wish for a 'safer space'.

Conclusion: Trans individuals feel unsafe when consulting their GP due to past and present negative experiences, which leads to healthcare avoidance. A 'safer space' encompasses; respecting chosen names, showing an interest in transgender care, listening and meeting patients on their terms. The study highlights the importance of educating GPs on respectful interactions, suggesting that adopting the concept of a 'safer space' as a medical term could improve healthcare for TNB individuals.