Scandinavian Journal of Primary Health Care最新文献

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.

Background: Women are disproportionately diagnosed with symptom-based conditions, notably post-COVID condition (PCC). In Sweden, as of February 2022, 2.3% of PCR-verified female COVID-19 cases versus 1.6% of male cases had a PCC diagnosis. Post-viral fatigue syndrome (PVFS) and exhaustion disorder (ED), a common and relevant diagnosis in Sweden, share substantial symptom overlap with PCC.

Aims: To quantify the association between pre-pandemic, symptom-based primary-care visits and subsequent PCC, PVFS, and ED among adult women, adjusting for risk factors for severe COVID-19.

Methods: We conducted a registry-based prospective cohort study of 208,050 women from the Swedish Medical Birth Register, linked to primary-care data and national sociodemographic registers. The exposure was the frequency of visits for predefined symptom-based conditions during 2015-2019. Adjusted odds ratios (ORs) for diagnoses in 2020-2024 were estimated using logistic regression controlling for BMI, education, age, and region of birth.

Results: Across 2,431,182 primary-care physician visits, 19% were symptom-based. Women with >8 such visits had higher odds of all three outcomes: PCC (OR 5.45, 95% CI 4.43-6.71), PVFS (OR 7.71, 95% CI 5.97-9.96), and ED (OR 5.32, 95% CI 4.84-5.85). Pre-pandemic BMI and education were not associated with PCC or PVFS but showed some association with ED. Still, 17% of women with PCC had no recorded symptom-based visits before the pandemic.

Conclusions: Pre-pandemic symptom-based primary-care visits were strongly associated with higher risk of PCC, PVFS, and ED in a dose-dependent way, but modest discrimination underscores heterogeneous individual risk. Patterns suggest other influences alongside biological susceptibility.

Aim: This study aimed to explore how patients with chronic obstructive pulmonary disease (COPD) experience continuity of care through their encounters with a specialised asthma/COPD Registered Nurse in primary care.

Design: An inductive qualitative study using interpretive description.

Methods: Data were collected through semi-structured individual interviews with 13 purposively sampled patients with COPD from four regions in Sweden. The audiotaped interviews were conducted over a 5-month period (September 2024-January 2025) via telephone, transcribed verbatim and analysed using interpretive description.

Results: Three themes describe the results. Meaningful care when encountering a dedicated nurse, which patients describe when encountering the same trusted nurse. Being acknowledged and listened to highlights the patient's appreciation for the nurse's knowledge and competence, both regarding the patient and the disease. Feeling trust in the relationship, a personal but not overly private relationship that fosters trust, which is essential since COPD can be a shameful disease. Some patients haven't shared their diagnosis with loved ones, making the nurse a vital and comforting point of contact.

Conclusion: Patients with COPD value continuity of care with a specialised asthma/COPD Registered Nurse. Trust and a non-judgmental relationship are essential for continuity to be experienced positively. Continuity is more than repeated encounters; it requires quality interactions that empower patients and address the stigma associated with COPD.

Reporting method: Consolidated Criteria for Reporting Qualitative Research guidelines.

Background: Iron deficiency is the most common micronutrient deficiency worldwide, negatively affecting quality of life and health. Young women are at particularly high risk due to increased iron demands during growth, menstrual blood losses, and dietary habits. There are no official guidelines recommending screening for iron deficiency in healthy young women. This study aimed to develop a screening instrument (IRON-5) to predict iron deficiency in this group, with relevance for use in primary care and school health services.

Methods: In 2023, a cross-sectional study was conducted to assess the prevalence of iron deficiency and associated factors in high school girls. A questionnaire assessing dietary habits, menstrual bleeding patterns, iron supplement use, and hormonal contraceptive use was administered. Iron deficiency was defined as serum ferritin <15 µg/L. A post-hoc analysis identified the strongest predictors of iron deficiency and incorporated them into a risk-scoring model.

Results: The final instrument included five predictors: a non-omnivorous diet, heavy menstruation causing discomfort, avoidance of activities due to menstruation, no iron supplementation, and non-use of hormonal contraceptives. A scoring system (0-5) was developed. Using a threshold score of ≥ 3, the model achieved a sensitivity of 74% and specificity of 57% for detecting iron deficiency.

Conclusion: The IRON-5 is a concise and user-friendly screening instrument designed to identify young women at risk of iron deficiency. It demonstrated good sensitivity and may serve as a cost-effective method to prioritize individuals for blood testing. IRON-5 could support identification and prevention strategies in school-based and primary care settings.

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.