Scandinavian Journal of Primary Health Care最新文献

Introduction: Multidose drug dispensing (MDD) provides machine-packed, patient-specific dose pouches to improve medication safety and adherence, streamline medication management, and reduce pressure on healthcare systems. Despite the benefits, uptake in Denmark remains lower than in neighbouring countries, even after MDD prescriptions were integrated into the national electronic Shared Medication Record (SMR). This study explores general practitioners' (GPs) and hospital physicians' experiences with MDD following SMR integration.

Methods: A qualitative study was conducted through semi-structured interviews with 15 physicians (8 GPs, 7 hospital physicians) from the Capital Region and the North Region in Denmark between November 2022 and May 2023. Data was analysed using systematic text condensation.

Results: Two main code groups with six subgroups were constructed. "A Multi-layered Burden for Physicians", reflects an experience of an increased workload and added complexity resulting from IT challenges, dosing period calculations, and inconsistent communication with pharmacies. "Finding the Right Fit", highlights uncertainty about which patients and medications are suitable for MDD, together with the differentiated roles of healthcare professionals in managing the MDD system. While some physicians considered MDD beneficial for patients with complex needs, others found it unsuitable for those with fluctuating conditions, especially during hospitalisations.

Conclusion: Although MDD offers potential benefits, its practical implementation is constrained by digital, organisational, and interprofessional challenges. Assessing patient suitability is essential, but rather than excluding patients, the findings suggest reconceptualising MDD as a flexible, adaptable system, capable of meeting individual care needs and responding to changing clinical situations.

Background: Chronic pain remains a leading cause of patient distress in primary care and effective pain management presents an ongoing challenge in patient-clinician interactions. The prescribing of opioids further contributes to communication and shared decision-making disparities between patients and general practitioners. Gaining greater insight into patients' experiences of opioid treatment is valuable as there still is limited knowledge. Patients' perspectives and expectations can provide important contributions to enhance mutual understanding in clinical encounters.

Aim: To explore how patients experience, and what they expect from, pain management consultations regarding opioid use.

Design and setting: A qualitative study with patients in rural Örebro County, Sweden.

Method: Semi-structured interviews were carried out with fifteen chronic pain patients prescribed opioids managed in primary care. The interviews were analyzed using reflexive thematic analysis.

Result: Two main themes were generated to capture patients experience and their expectations concerning pain management and opioids. Prescribing Validation gives insights to what expectations patients have and how they perceive prescriptions. Renewals are interpreted as validation of the pain condition, and dismissals as mistrust. The Battle for the Steering Wheel capture how patients, based on the lived experience of chronic pain, expect and seek to assert their own expertise in consultations but often feel frustrated over being unheard.

Conclusion: While education about the biopsychosocial nature of pain may provide a necessary foundation for communication around reducing opioid use, validation of patient experience is pivotal for building a trusting alliance.

Objective: This study describes patterns of self-management ease and difficulty among older adults with long-term health conditions and the associations with gender, level of education, number of conditions, depression and/or health status.

Materials and methods: Cross-sectional data were collected between 2021-2022 in a municipality in northern Sweden. The survey included demographic and health-related questions. To assess self-management ease or difficulty and symptoms of depression, the Patient Reported Inventory of Self-Management of Chronic Conditions (PRISM-CC) and the Geriatric Depression Scale were used. 516 older adults between 72-73 years of age with long-term health conditions were included. Descriptive statistics and logistic regression were used to describe patterns of self-management ease and difficulty and to examine which factors were associated with self-management difficulty.

Results: Most older adults did not experience self-management difficulty. There were, however, differences between the seven PRISM-CC domains. The Internal domain (managing negative emotions and stress) had the highest percentage (25.39%) of older adults with self-management difficulty. In all domains, there was also a subgroup of individuals (n = 26) that had noticeably lower PRISM-CC scores (more difficulty). A strong association between having depressive symptoms or having poor health status and self-management difficulty was found.

Conclusion: This study highlights the need for regular mental health screenings and individualized self-management support for older adults. Future research should explore intervention strategies that integrate mental health support into self-management programs for individuals with long-term health conditions.

Objective: Primary care plays a central role in diagnosing dementia and coordinating and providing care. This study explores how older people with dementia and their family caregivers experience the process from diagnosis to follow-up in primary care, what support is needed, what works well and what could be improved.

Design: Semi-structured interviews were conducted with four people with dementia and 11 family caregivers in Stockholm, Sweden. Data were analyzed with inductive thematic analysis.

Results: Four themes were identified: Seamless assessment - from primary care to memory clinic, describes the transition from primary care to memory clinics, where empathy and professionalism are crucial to prevent feelings of failure. After diagnosis - a no man's land, highlights a communication gap between memory clinics and primary care that leaves informants feeling abandoned and causes emotional distress and isolation. Follow-up in a deficient primary care, underscores the importance of having 'a single point of entry' for coordinated support and a primary care provider with expertise in dementia. Embracing life with the diagnosis, emphasizes the need for guidance from a dedicated dementia team to manage progression.

Conclusion: People with dementia and their caregivers felt that primary care often failed to meet their needs due to limited accessibility, poor coordination, and a lack of dementia-specific expertise. Strengthening the role of general practitioners, introducing liaison nurses, and enhancing collaboration with municipal services could improve continuity, navigation, and support. These findings underscore the need for Swedish health care policy to promote sustainable, person-centered dementia care models within primary care.

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.

Background: Persistent fatigue is a transdiagnostic symptom that is present in many different medical conditions and diagnoses and is a common reason for seeking health care. Despite a lack of consensus on how to understand and treat persistent fatigue, a subset of patients recover. The experiences of patients who recovered from persistent fatigue have important implications for future research and rehabilitation interventions. Purpose: This study aimed to further improve the understanding of the recovery process for people who have improved function and regained health following three health conditions characterized by persistent fatigue (CFS/ME, Post Covid-19 Condition and Exhaustion Disorder), and to develop a comprehensive model of the recovery process. Methods: Fourteen former patients shared their stories about their recovery during videotaped interviews. Narrative analysis was used to explore participants' experiences of the recovery process, focusing on decisive events. Results: Recovering from persistent fatigue could be understood as a nonlinear stepwise learning process with a marked turning point. This turning point involved finding hope and a new understanding of their fatigue condition, which in turn provided the patient with guidance on what measures to take. Discussion: We discuss the results in relation to previous research as well as their clinical implications. A new understanding of the symptoms seems to be central to recovery from persistent fatigue, but it is not sufficient in itself. Health care needs to provide explanatory models that fuel hope and agency, as well as individualized interventions, to enable the recovery process.

Objective: Hypertension care requires considerable resources from primary healthcare, and efficient work models are desirable both to improve treatment outcome and to ease staff workload. This study's objective was to describe how healthcare staff experienced the implementation of a new nurse-led work model for hypertension care.

Methods: Qualitative content analysis was used for data analysis. Digitally conducted interviews with 14 physicians, nurses and managers from six of the eleven primary healthcare centres participating in an intervention to improve hypertension care in the Västra Götaland region. The intervention included training of healthcare professionals in a new nurse-led team work model using standardized protocols for treatment and follow-up.

Results: The intervention was appreciated, even requested, by both nurses, physicians and managers. The clearly defined division of tasks in the team provided structure, safety, and eased the workload. Treatment was streamlined and the work was perceived as more professional and stimulating. However, implementation of the new work model, including task shift, required close cooperation between nurses and physicians, trust and dedication. Implementation failed if the staff turnover was high, or if management support lacked. Personal qualities, judgement, experience and learning by cooperating with each other, were highlighted as important additional factors for competence and professionally performed hypertension care.

Conclusion: Healthcare can benefit from this intervention, but manager support and involvement of both nurses and physicians are crucial factors for successful implementation. Structured protocols cannot replace experience and personal qualities but provide appreciated support and increased safety.

Background: A gradual transition from cytology-based screening to Human Papillomavirus (HPV) testing within the cervical cancer screening program has resulted in new routines for follow-up, and new challenges for communication of abnormal test results. General practitioners (GPs) have an important role in the screening program, as they are the primary performers of the screening test, they communicate test results to patients and refer them to a specialist if necessary.

Objective: The study explores what consequences the introduction of HPV testing in the cervical cancer screening programme has for GPs' professional practice and communication with patients.

Design, setting and subjects: Qualitative focus group study including 32 GPs in Central Norway who conduct screening tests within the cervical cancer screening programme.

Results: The overall concern of the GPs was to communicate abnormal test results in a way that ensured appropriate follow-up, without causing unnecessary worry. Staying updated on revised screening guidelines and maintaining their role as medical experts when communicating results to patients could be challenging. GPs shared the responsibility for follow-up after an abnormal result between themselves, the women, and the screening programme. Reciprocal familiarity between GP and patient guided decisions about what and how to communicate, and how to balance the shared responsibility. GPs used their professional judgement to assess patients' informational needs and tailored information accordingly.

Conclusion: GPs manage the challenges of communicating abnormal screening results by sharing responsibility and using their professional judgement. Strengthening support and communication tools may enhance their role in the screening programme.