Scandinavian Journal of Primary Health Care最新文献

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.

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: Burnout among General Practitioners (GPs) is a growing concern, with implications for physician well-being, patient care quality, and healthcare system sustainability. However, we lack studies of burnout among GPs in Norway.

Objective(s): To examine the prevalence of burnout among GPs in Norway in 2012, 2018 and 2024 and subsequently identify demographic, health-related, and work-related factors associated with burnout in 2024.

Methods: Data were drawn from the Norwegian Physician Panel, a nationally representative survey conducted in 2012, 2018, and 2024. Response rates exceeded 71% in all waves. Only respondents identifying as GPs were included. Burnout was assessed using the Maslach Burnout Index. Prevalence was reported descriptively. Logistic regression was employed to examine associations between overall burnout, emotional exhaustion, depersonalisation and personal accomplishment and the following independent variables: age, sex, weekly work hours, self-rated health, sick leave, presenteeism, job satisfaction and work-related stress.

Results: Overall burnout increased from 5.8% in 2012 to 17.1% in 2018, reaching 21.8% in 2024. The proportion of GPs with high emotional exhaustion rose from 19.1% to 47.2%, and the proportion with high depersonalization from 2% to 24% over the same period, whereas those reporting low personal accomplishment became relatively fewer, going from 16.4% to 6.3%. In 2024, burnout was significantly associated with low job satisfaction, high work-related stress, and frequent sickness presenteeism.

Conclusion: The prevalence of burnout among Norwegian GPs has increased markedly from 2012 to 2024. Addressing modifiable factors such as work-related stress, job satisfaction, and sickness presenteeism is essential for sustaining physician well-being and maintaining patient care quality.

Background: Out-of-hours primary care (OOH-PC) plays a key role in initial stroke triage, yet the accuracy of telephone assessments by general practitioners (GPs) and their impact on prehospital stroke care remain insufficiently studied.

Aims: To evaluate the sensitivity of stroke and transient ischemic attack (TIA) identification by GPs during OOH-PC telephone triage and examine associations with time from first call to admission, treatment rates, and admission pathways.

Patients and methods: We conducted a retrospective cohort study including patients admitted to stroke centers in the Central Denmark Region (2020-2022) following OOH-PC contact within 48 h. Triage classification was based on GP documentation and compared with final hospital diagnoses. Outcomes included triage sensitivity, intravenous thrombolysis (IVT) rates, and time to admission.

Results: Among 4414 patients, 2738 had a final diagnosis of stroke or TIA, of whom 1728 were triage positive, corresponding to a sensitivity of 63.1% (95% CI, 61.2-64.9). Among patients with acute ischemic stroke (AIS) and symptom onset ≤3 h before OOH-PC contact, 387 of 544 were identified (71.1%, 95% CI, 67.2-74.8). Triage-positive AIS patients had higher IVT rates (adjusted difference: 8.9%, 95% CI, 5.4-12.5) and shorter call-to-admission time. In early-presenting AIS, the adjusted IVT difference was 10.9% (95% CI, 1.4-20.5), and triage-negative patients more often presented with impaired consciousness and visual symptoms.

Conclusions: GPs demonstrated moderate sensitivity in telephone triage of stroke in OOH-PC. Symptom presentation differed between triage groups, suggesting recognition may be influenced by symptom type as well as time from onset.

Background: An updated overview of the antibiotic prescribing pattern in Danish general practice is needed to help inform continued efforts for rational antibiotic prescribing.

Objective: To investigate clinical indications for antibiotic prescriptions issued in general practice in Denmark.

Materials and methods: This register-based study included all redeemed antibiotic prescriptions issued in Danish general practice between 1 January 2023 and 31 December 2023. Data were extracted from 'Antibiotikastatistik', a publicly available register maintained by the Danish Health Data Authority. Descriptive statistics were used to analyze the distribution of the clinical indications. Furthermore, the distribution of the antibiotics prescriptions was analyzed by age across different clinical indication groups, stratified by gender.

Results: A total of 1,916,910 antibiotic prescriptions were issued from Danish general practice in 2023. More than half of these prescriptions were used for treatment of either a respiratory tract infection (28.4%) or a urinary tract infection (26.7%). Throat infection and pneumonia comprised about 70% of indications for treatment of a respiratory tract infection. Prophylactic treatment was mainly used for elderly patients - and most often for urinary tract infections. Some 23.3% of the prescriptions either contained an 'unspecific indication' or had no indication stated.

Conclusions: This study provides a solid overview of indications used for antibiotic prescriptions in Danish general practice. This information might be used for development of future antibiotic stewardship interventions.

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.

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: 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.

Objective: A shortage of healthcare personnel, an aging population and insufficient collaboration between services are highlighted as the greatest challenges in the Norwegian healthcare system. Digital Interaction in Practice (DIP) is a digital collaboration model involving the general practitioner (GP), home care nurses, patient and relatives. The aim is improved coordination and tailored treatment for frail elderly patients with complex needs. The model is developed in close collaboration with healthcare personnel and is being piloted in a large Norwegian municipality.

Methods: This qualitative study included GPs, nurses, and managers in Trondheim municipality, who have actively participated in the development of the DIP model in cooperation with researchers. Focus groups were used to gather experiences of the development and early pilot phase from the views of GPs, nurses and managers. Data were analysed using Braun and Clarks thematic content analysis framework.

Findings: DIP required changes in work practices and allocation of resources, particularly for home care nurses. Furthermore, the participants reported improved interdisciplinary collaboration and viewed DIP as a potential to increase the quality of healthcare services. The workflow chart describing the DIP model was useful but required adaption to local work practices. General practitioners and nurses valued closer collaboration and experienced a more holistic and patient-centred follow-up.

Conclusion: The findings underline the importance of collaboration between GPs, nurses, managers and researchers in the development and local adaptation of the DIP model. Despite some resource challenges and a need for role clarification, DIP may impact resource use in the long term, improve collaboration and coordination among those involved, and achieve more comprehensive, individually tailored patient pathways. Further research on the DIP model's impact is warranted following broader implementation.