Scandinavian Journal of Primary Health Care最新文献

Background: Antibiotic resistance is an increasing global threat, accelerated by both misuse and overuse of antibiotics. Most antibiotics to humans are prescribed in primary care, commonly for respiratory symptoms, and there is a need for research on the usage of and outcomes after antibiotic treatment to counteract antibiotic resistance.

Objective: To evaluate symptom duration, treatment length, and adverse events of antibiotic treatment in children.

Design and setting: Observational study at four out-of-hours services and one paediatric emergency clinic in Norwegian emergency primary care.

Subjects: 266 children aged 0 to 6 years with fever or respiratory symptoms.

Main outcome measures: Duration of symptoms and absenteeism from kindergarten/school, treatment length, and reported adverse events.

Results: There were no differences in duration of symptoms, fever or absenteeism when comparing the groups prescribed (30.8%) and not prescribed (69.2%) antibiotics. This lack of difference remained when analysing the subgroup with otitis media.In the group prescribed antibiotics, 84.5% of parents reported giving antibiotics for 5-7 days, and 50.7% reported no difficulties. Adverse events of antibiotics were reported in 42.3% of the cases, the vast majority being gastrointestinal disturbances.

Conclusion: Children with fever or respiratory symptoms experience similar duration of symptoms and absenteeism regardless of antibiotic treatment. A substantial number of parents reported adverse events when the child received antibiotics. Several parents experienced additional difficulties with the treatment, some ending treatment within day 4.

Trial registration number: NCT02496559; Results.

One of the core principles of providing care in general practice is giving more to those who need it most. We investigate some of the complexities of this ambition in the context of cancer care for patients defined as socially disadvantaged by their general practitioner (GP). We do this by exploring how care is sought, how it is offered, and what expectations patients and GPs carry with them when receiving and providing cancer care in the Danish welfare state. We carried out semi-structured interviews with eight GPs and seven socially disadvantaged cancer patients living with different types and stages of cancer. The interviews focused on needs and challenges in cancer follow-up in general practice and were thematically coded. Drawing on theoretical concepts of morality and Nordic individualism, we point to how one of the main challenges in cancer care and follow-up is to figure out how the doctor-patient relationship should be established, practiced, and maintained. Both GPs and patients stressed the importance of the relationship, but how it should be practiced amidst social norms about being a patient, a citizen and how care-seeking should unfold seems less clear. In conclusion we argue that giving more to those who need it the most is a difficult and ill-defined task that is shaped by the cultural, social, and political expectations of both GPs and patients.

Objective: To explore men's views on the causes and consequences of two common sexual dysfunctions - erectile dysfunction and premature ejaculation - and how this affects physical and mental health as well as social life and intimate or close relations.

Design: A qualitative design with semi-structured interviews using open-ended questions was employed. Individual interviews were conducted, audio recorded and transcribed, and a qualitative content analysis of the text was performed.

Setting: Informants were recruited from an outpatient primary care clinic in Sweden that offers consultation about sexual health to primarily younger men, age 20 years and above.

Subjects: A total of 18 participants were included in the study, ten with erectile dysfunction and eight with premature ejaculation or both.

Main outcome measures: Using the content analysis, different views and strategies of erectile dysfunction and premature ejaculation were presented to illustrate a range of perceptions.

Results: The main theme emerged as 'Striving to understand and deal with the problem', which was divided into four categories: 'Reasons for seeking healthcare', 'Own perceptions/images about the problem and its cause', 'Experienced consequences on sex life' and 'Relationship qualities'.Participants experienced their problems in relation to a partner. Feelings of shame and fear of not being fit for desired sexual practices were common. They thought that underlying physical illness or previous sexual activities could have caused their problems. Decreased sexual desire and low self-esteem were seen as consequences, and participants wished for both medical treatment and counselling as support.

Conclusion: Sexual dysfunction impairs general health and relationships with partners. While counselling is the basic treatment, those who are offered pharmaceutical treatment need follow-up concerning effectiveness and potential concerns.

Background: Demographic changes, the evolvement of modern medicine and new treatments for severe diseases, increase the need for palliative care services. Palliative care includes all patients with life-limiting conditions, irrespective of diagnosis. In Norway, palliative care rests on a decentralised model where patient care can be delivered close to the patient's home, and the Norwegian guideline for palliative care describes a model of care resting on extensive collaboration. Previous research suggests that this guideline is not well implemented among general practitioners (GPs). In this study, we aim to investigate barriers to GPs' participation in palliative care and implementation of the guideline.

Methods: We interviewed 25 GPs in four focus groups guided by a semi-structured interview guide. The interviews were recorded and transcribed verbatim. Data were analysed qualitatively with reflexive thematic analysis.

Results: We identified four main themes as barriers to GPs' participation in palliative care and to implementation of the guideline: (1) different established local cultures and practices of palliative care, (2) discontinuity of the GP-patient relationship, (3) unclear clinical handover and information gaps and (4) a mismatch between the guideline and everyday general practice.

Conclusion: Significant structural and individual barriers to GPs' participation in palliative care exist, which hamper the implementation of the guideline. GPs should be involved as stakeholders when guidelines involving them are created. Introduction of new professionals in primary care needs to be actively managed to avoid inappropriate collaborative practices. Continuity of the GP-patient relationship must be maintained throughout severe illness and at end-of-life.

Objective: To compare management and documentation of vital signs, symptoms and infection severity in pneumonia patients seeking primary care and emergency care without referral.

Design: Medical record review of vital signs, examination findings and severity of pneumonia.

Setting: Primary and emergency care.

Subjects: Two hundred and forty patients diagnosed with pneumonia.

Main outcome measures: Vital signs, examination findings and severity of pneumonia. Assessments of pneumonia severity according to the reviewers, the traffic light score and CRB-65.

Results: Respiratory rate, blood pressure, heart rate and oxygen saturation were less often documented in primary care (p < .001). Chest X-ray was performed in 5% of primary care patients vs. 88% of emergency care patients (p < .01). Primary care patients had longer symptom duration, higher oxygen saturation and lower respiratory rate. In total, the reviewers assessed 63% of all pneumonias as mild and 9% as severe. The traffic light scoring model identified 11 patients (9%) in primary care and 53 patients (44%) in emergency care at high risk of severe infection.

Conclusions: Vital signs were documented less often in primary care than in emergency care. Patients in primary care appear to have a less severe pneumonia, indicating attendance to the correct care level. The traffic light scoring model identified more patients at risk of severe infection than CRB-65, where the parameters were documented to a limited extent.

Headings purpose: Fibromyalgia (FM) is a chronic, nondegenerative disease with important limitations in patients. Its average global prevalence is 1.78%, and women are more affected than men (3:1). Due to the lack of objective diagnostic tools, it is a complex medical condition that is frequently unseen by patients' relatives and doctors, which might nonetheless have a noticeable impact on the patient's entourage.

Material and Methods: This qualitative descriptive study aimed to elicit family members' views on how FM affects their lives. It was conducted in two community health centers (one rural and one urban) from the Sagunto Health Department (Valencia Community, Spain). We included seven focus groups with 41 family members. We analyzed the data gathered with an inductive thematic semantic analysis approach using NVivo 12 software.

Results: We identified four major themes: (1) fibromyalgia as a nosological entity or an invention that is always burdensome; (2) children and spouses as caregivers (or not); (3) adverse effects of fibromyalgia on the couple's sexual life; and (4) harmful consequences of FM on the family economy. The findings showed a negative impact of the disease within the family context. Family members face complex and changing roles and difficulties when living with women with fibromyalgia.

Conclusions: Relatives' better understanding of the disease, greater acceptance of new family roles, and improvement of patients' work conditions are all interventions that may help reduce the negative impact of FM in the family context.

Objective: To investigate the experiences of healthcare staff in nursing homes during the COVID-19 pandemic.

Design: Individual interviews. Latent qualitative content analysis.

Setting: Ten nursing homes in Sweden.

Subjects: Physicians, nurses and nurse assistants working in Swedish nursing homes.

Main outcome measures: Participants' experiences of working in nursing homes during the COVID-19 pandemic.

Results: Four manifest categories were found, namely: Balancing restrictions and allocation of scarce resources with care needs; Prioritizing and acting against moral values in advance care planning; Distrust in cooperation and Leadership and staff turnover - a factor for moral distress. The latent theme Experiences of handling ethical challenges caused by the COVID-19 pandemic gave a deeper meaning to the categories.

Conclusion: During the pandemic, nursing home staff encountered ethical challenges that caused moral distress. Moral distress stemmed from not being given adequate conditions to perform their work properly, and thus not being able to give the residents adequate care. Another aspect of moral distress originated from feeling forced to act against their moral values when a course of action was considered to cause discomfort or harm to a resident. Alerting employers and policymakers to the harm and inequality experienced by staff and the difficulty in delivering appropriate care is essential. Making proposals for improvements and developing guidelines together with staff to recognize their role and to develop better guidance for good care is vital in order to support and sustain the nursing home workforce.

Objective: To investigate if wearing surgical face mask by doctors and nurses during suturing of traumatic wounds has any impact on postoperative infection rate.

Design: Randomized controlled study with masked or unmasked health personnel groups.

Setting: A Norwegian Minor Injury Department.

Subjects: Adult patients with traumatic wounds sutured at the clinic between 7 October 2019 and 28 May 2020.

Main outcome measures: Postoperative infections of sutured wounds.

Results: One hundred and sixty-five patients with 176 wounds were included in the study. Nine out of 88 wounds (10.2%) in the masked group and 11 out of 88 wounds in the unmasked group (12.5%) had a wound infection.

Conclusions: Despite a higher percentage of postoperative infections in the unmasked than in the masked group (12.5% versus 10.2%), the difference was not statistically significant (p = .6). This might imply that the use of facemasks during suture of traumatic wounds in an outpatient setting does not significantly reduce the number of infections. However, due to the covid pandemic, the study had to be prematurely stopped before the planned number of participants had been recruited (n = 594). This increases the risk of type II error.

Objective: When organising healthcare and planning for research to improve healthcare, it is important to include the patients' own perceptions. Therefore, the aim was to explore older patients' views on what is important concerning their current care and possible future interventions in a primary care setting.Design: A qualitative design with individual interviews was used. Analysis through latent content analysis.Setting: Seven Swedish primary care centres.Subjects: Patients (n 30) aged >75 years, connected to elder care teams in primary healthcare.Results: Three categories, consisting of 14 sub-categories in total, were found, namely: Care characterised by easy access, continuity and engaged staff builds security; Everyday life and Plans in late life. The overarching latent theme Person-centred care with easy access, continuity and engaged staff gave a deeper meaning to the content of the categories and sub-categories.Conclusion: It is important to organise primary care for older people through conditions which meet up with their specific needs. Our study highlights the importance of elder care teams facilitating the contact with healthcare, ensuring continuity and creating conditions for a person-centred care. There were variations regarding preferences about training and different views on conversations about end-of-life, which strengthens the need for individualisation and personal knowledge. This study also exemplifies qualitative individual interviews as an approach to reach older people to be part of a study design and give input to an upcoming research intervention, as the interviews contribute with important information of value in the planning of the Swedish intervention trial Secure and Focused Primary Care for Older pEople (SAFE).