Scandinavian Journal of Primary Health Care最新文献

Introduction: Assessing work capacity and determining appropriate sick leave is a complex process. Despite the importance of fair and consistent assessments, evidence suggests that evaluations may vary. However, previous studies have been inconclusive and have mainly focused on whether sick leave should be recommended or not. The present study examined the medical reliability and consistency of physicians' assessments of work capacity, as indicated by the reported percentage of reduced work capacity and the recommended length of sick leave.

Methods: A cross-sectional survey was conducted with 142 primary care physicians from four Swedish counties. Participants assessed six anonymised, authentic medical certificates related to mental health and pain-related conditions. For each case, they estimated the degree of reduced work capacity and the recommended sick leave duration, which were combined into a sick leave score. Physician characteristics (e.g. gender, professional status) and perceived managerial support were also measured.

Results: There was considerable variation in sick leave scores, both across physicians and between certificates. Male physicians and those with more years of experience recommended longer sick leave for pain-related cases, while specialists showed less variation in their assessments. Perceived support from frontline managers was associated with lower scores. No significant associations were found for patient involvement.

Conclusions: The findings suggest that sick leave assessments may lack consistency and be influenced by physician-related factors, particularly for pain-related conditions. Stronger support structures, opportunities for knowledge exchange, and clearer guidelines may help reduce unwarranted variation and promote more reliable assessments.

Objective: In order to reduce unnecessary antibiotic prescribing, diagnostic processes require improvement for children in primary care.

Design: Post hoc analyses of randomised controlled intervention study.

Setting: Eighty general practitioner (GP) practices throughout Latvia.

Intervention: In the first study period, one GP group received combined interventions (access to CRP POCT and GP education), while the second GP group continued usual care (control group). In the second study period, the GP groups were switched - previous control group received combined intervention, but previous intervention group re-established usual care, but the long-term education effect was evaluated in this group.

Subjects: Children with acute infections consulted by a GP.

Main outcome: Impact of combined intervention and long-term education on testing level (CRP, full blood count, Strep A test, influenza test, urinalysis and X-ray) before antibiotic prescribing. Patient- and GPs- related predictors (including practice location and access to laboratory services) of diagnostic testing were also analysed. Secondary outcome was antibiotic prescribing according to the test results.

Results: Diagnostic testing was significantly increased in the combined intervention group versus the usual care group (aOR 11.1, 95% CI 8.0-15.3); however, it was decreased in the long-term education group (26.4%) (aOR 0.5, 95% CI 0.3-0.8). Rural practices and a longer expected time of laboratory results were associated with a more pronounced increase in diagnostic testing in the combined intervention group (aOR 37.6, 95% CI 17.9-79.0; aOR 23.2, 95% CI 14.1-38.0, respectively). It was found that a low CRP value, negative Strep A test or normal X-ray often did not convince GPs to withhold antibiotics.

Conclusion: The availability of CRP POCT and GP education results in a much higher level of diagnostic testing prior to antibiotic prescribing, especially in rural regions. Further improvements in more rational testing and the interpretation of results to guide appropriate antibiotic prescribing are essential.

Trial registration: ISRCTN registry - ISRCTN34931655.

Aims: This study investigates changes in the quality of information in sickness certificates over time, before and after the 2011 national introduction of a revised sickness certificate, and identified factors associated with certificate quality.

Methods: Four experts independently assessed the quality of a total of 783 sickness certificates issued in primary care in 2004, 2009, and 2012. A Global Quality Score (GQS) was constructed by the research group, rating quality on a 10-point scale. The cut-off for high quality was set to GQS >5. The inter-rater reliability of the GQS was tested using Intra-Class Correlation and internal consistency by Pearson correlation coefficients (r). Sickness certificates issued in 2004 and 2009 were merged into one group and compared to sickness certificates in 2012. Logistic binomial regression analyses examined associations between patient-, sick leave-, and physician-related variables and GQS.

Results: The GQS demonstrated moderate to good inter-rater reliability (ICC= 0.79, 95% CI: 0.6-0.9) and good internal consistency. Certificate quality improved significantly (p < 0.001) from 3.6 (SD 1.5) in 2004/2009 to 4.7 (SD 1.2) in 2012. In 2004/2009, mental disorder or an extended length of sick leave was negatively associated with high quality. In 2012, only female sex of the patient was negatively associated with high certificate quality.

Conclusion: While sickness certificate quality was overall low, it improved significantly after the 2011 revision of the sickness certificate. Also, diagnosis, sick leave duration, and patient's sex were factors associated with the quality and varied over time, highlighting the need for further research regarding potential remaining differences in quality of sickness certificates.

Introduction: The antenatal care program is a cornerstone of Norway's national health programs, serving nearly 50 000 women annually. Although usage has risen since the 1980s, with antenatal checkups exceeding recommendations, research on utilization patterns and demography remains limited. Insight is essential for optimizing prenatal care services, containing costs, and avoiding potential overtreatment.

Material and methods: This retrospective descriptive study used registry data from the Control and Payment of Health Reimbursement database, Statistics Norway, and the Norwegian Patient Register, covering 381 092 women giving birth in Norway (2010-2021). Associations were estimated using Poisson regression.

Results: Between Jan 1, 2010, and Dec 31, 2020, the mean number of antenatal checkups increased from 11.1 to 13.0, exceeding guidelines by 5.0. Midwife checkups increased by 2.4, while general practitioner (GP) checkups decreased by 1.1, progressively making midwives the main providers. Compared to women with lower secondary education, highly educated women had 7% more checkups by midwives and 12% fewer with GPs. They also sought GPs less before, during, and after pregnancy (48%, 20%, and 28% less). Women with 16+ checkups (upper quartile) had lower education and 1.6 more GP consultations the year before pregnancy than those with fewer checkups.

Conclusion: From 2010 to 2021, GPs saw a decrease in their role as main providers of antenatal checkups, with midwives now conducting most examinations. The average number of checkups rose by 1.9, not attributable to guideline changes, raising concerns about overutilization among a generally healthy group of women and implications for health system sustainability.

Introduction: Understaffing and dependence on temporary physicians known as locums are common in primary healthcare in Sweden. In this study, we investigate the impact of locum staffing on the quality of antibiotic prescribing for respiratory tract infections. We used two neighbouring cities in northern Sweden with large differences in staffing conditions: Skellefteå, with a 10-fold higher reliance on locum physicians compared to Umeå, which has low locum staffing.

Methods: We used data extracted from patient records for all visits, from the four largest healthcare centres in each of the cities Umeå and Skellefteå, for respiratory tract infections, including the ICD-10 diagnosis code and whether antibiotic treatment was prescribed or not. Data on the contracted hours of locum staff for each healthcare centre were also obtained. Statistical analyses were performed with Spearman correlation, Chi-square and Poisson tests. Logistic regression was used to investigate whether prescribing patterns were affected by the level of relay physicians.

Results: We analysed antibiotic prescriptions for respiratory tract infections based on data from 11,228 patient visits. Regardless of the statistical method used, we found a statistically significant difference, with higher rates of antibiotic prescribing for diagnoses where antibiotics generally are not recommended or where they should be prescribed restrictively. For pneumonia, where antibiotics should normally be prescribed, no difference was seen. The odds of antibiotic prescription for acute upper respiratory tract infection in Skellefteå were 2.5 times higher than in Umeå, with a positive correlation between locum staffing and antibiotic prescriptions for diagnoses where antibiotics should be used restrictively.

Conclusions: Our findings show that a high level of locum staffing and thus insufficient staffing with permanent General practitioners leads to higher rates of inappropriate antibiotic prescribing. This is shown both at the level of individual primary care healthcare centres and at the community level.

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.

Background: Otitis media (OM) in children is a common infection in primary care, contributing to a significant global health and economic burden. In high-income countries, diagnostic inaccuracy leads to over-diagnosis of acute OM (AOM) and over-prescribing of antibiotics, which may contribute to antibiotic resistance.

Aim: To investigate the diagnostic accuracy and the influence of artificial intelligence (AI) in diagnosing OM among primary care physicians and medical students.

Method: A diagnostic accuracy study in which primary care physicians and medical students diagnosed AOM, OM with effusion (OME), and normal eardrums using 21 high-quality digital images, both without and with a fictitious AI support. We estimated the technological impact of the fictitious AI support.

Results: Overall diagnostic accuracy was 64% without, and 75% with AI support. The most experienced physicians reached 69% without, and 80% with AI; the least experienced 61% without, and 73% with AI; medical students reached 64% without, and 74% with AI. Accuracy for AOM was 77% without and 86% with AI, and for OME 46% without and 66% with AI. Mean diagnostic confidence increased significantly with AI support. The technological impact was 1.4. Automation bias was 1.2 overall, 0.9 for the most experienced and 1.2 for the least experienced physicians.

Conclusion: We report modest diagnostic accuracy for OM among primary care physicians and medical students. The fictitious AI support system improved both accuracy and diagnostic confidence and reduced over-diagnosis. The most experienced physicians achieved the highest accuracy, the less experienced were more often misled by the fictitious AI.

Background: High-quality diabetes care should offer personalized treatment and support self-management to reduce complications and maintain quality of life for affected persons. In Malmö, Sweden's third-largest city, primary care treated twice as many individuals with type 2 diabetes (T2D) in 2018 compared to 2011. As the prevalence of T2D increases, healthcare services face increasing challenges.

Objective: To explore experiences of contacts with diabetes care professionals among people living with T2D who are accessing diabetes care in the city of Malmö.

Method: A qualitative inductive design was employed, involving interviews with 21 persons with T2D receiving diabetes care at four primary healthcare centers in Malmö. A semi-structured interview guide was used. Data were analyzed using qualitative content analysis.

Result: The theme 'Seeking room for one's agency' emerged from two categories that illustrate experiences with diabetes care in relation to meeting healthcare needs: 'Importance of connecting with diabetes care professionals' and 'Concerns in navigating diabetes care.' Eight subcategories describe what contact with diabetes care meant for the participants.

Conclusion: The findings highlight opportunities for improving diabetes care to better meet patients' needs. Contacts with diabetes care professionals were perceived as supportive when there was a clear intention to adapt to individual needs and when expectations and communication were transparent. Continuity with general practitioners and educational aspects were identified as unmet healthcare needs. Based on the findings of this study, efforts to a systematic and broad implementation of group-based T2D-education in Malmö are recommended.

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.