Scandinavian Journal of Primary Health Care最新文献

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.

Background: Heart failure (HF) is one of the most common causes of hospitalization and death worldwide. We aimed at identifying variables that can be helpful for early diagnosis of HF in primary care.

Methods: In 2015-16, we included 2007 participants aged ≥ 40 years in the 7th Tromsø study. They underwent echocardiography and other examinations needed for establishing a diagnosis of HF according to European guidelines from 2016. We analyzed associations with HF among the 1863 participants who reported not to have HF. Variables significantly associated with HF were included in multivariable logistic regression analyses. Diagnostic models were further analyzed by ROC curves and areas under curve (AUC) were calculated, optimism corrected by bootstrapping.

Results: The HF prevalence in the age groups 40-64 years, 65-74 years, and ≥ 75 years were 3.5%, 11.7% and 29.4%, respectively. A predictive model based on self-reported hypertension, myocardial infarction, atrial fibrillation, body-mass index and moderate to severe dyspnea had an AUC of 0.813 (95% CI 0.785-0.843). In a significantly stronger model, in which NT-proBNP was included and self-reported atrial fibrillation was replaced by atrial fibrillation on ECG, an AUC of 0.849 (95% CI 0.821-0.880) was reached.

Conclusion: Easily available clinical information may be used both to rule out HF an to identify patients needing further examinations. A direct referral to echocardiography should be considered for elderly patients in primary care with a known cardiovascular disease and severe shortness of breath. With less abundant history and symptoms, ECG and NT-proBNP can guide further investigations.

Background and purpose: Loneliness is a complex public health issue that can lead to increased morbidity, with higher prevalence among older adults. Social prescribing may be one way to ease loneliness. This study aims to explore stakeholders' perceptions of prerequisites for implementing a social prescribing program in a Swedish context.

Method: Reflexive thematic analysis was used to analyse individual semi-structured interviews with eleven stakeholders whose experience were considered relevant for implementing a social prescribing program in the Swedish context. They were selected to provide diverse perspectives related to organisation, position, and geography.

Results: From the analysis three themes were constructed; Where to implement - Necessity to bridge organisational gaps, How to implement - Balancing professional expectations, and For whom to implement - Addressing those with 'real' needs. These themes highlight the perceived prerequisites, including barriers and facilitators, for successful implementation of social prescribing.

Conclusions: The participants' perceptions are suggesting that Sweden has several practical advantages in place for implementing social prescribing, such as robust organisations responsible for citizens' health and well-being and a range of activities available. If organisations can collaborate by prioritizing patients' needs and overcoming organisational divisions and responsibilities, there is potential for successfully implementing social prescribing in Sweden in the future. Nevertheless, implementation may be hampered by limited resources within health care, and challenges to evaluate program effects.

Introduction: In recent years, the increasing availability of instruments and laboratory tests has significantly influenced the diagnostic work in primary healthcare. This study aimed to map the availability of diagnostic equipment and point-of-care tests (POCTs) in Norwegian emergency primary healthcare clinics and examine the demographic and organisational factors influencing their availability.

Methods: This cross-sectional study utilised the National Out-of-Hours Services Registry (NOOHR) survey across all Norwegian emergency primary healthcare clinics in early 2024. Clinic managers provided data on diagnostic equipment and POCTs. Clinics were categorised by population size, hospital proximity, co-location with general practitioner (GP) offices, and total equipment available.

Results: All 167 Norwegian emergency primary healthcare clinics responded. The median number of diagnostic equipment and POCTs was 17 (Interquartile range (IQR) 16-20). Clinics with the most equipment were often smaller, co-located with a GP office, and over 40 km from a hospital. Almost all clinics had a repertoire of CRP, urinary dipstick, haemoglobin, glucose, strep A test, SARS-CoV-2 rapid test, urinary HCG test, pulse oximeter, and ECG. Clinics far from hospitals more frequently had tests like D-dimer and troponin. Of the clinics with troponin tests, 69% had a low-sensitive POCT.

Conclusion: Norwegian emergency primary healthcare clinics are well equipped, especially if co-located with a GP office or far from a hospital. Further research is needed to enlighten how availability influences use and the possible impact on patient trajectories. Clinic leaders should pave the way for sustainable practices and high-value care when deciding their diagnostic equipment and POCTs repertoire.