Scandinavian Journal of Primary Health Care最新文献

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.

Objective: Job resources are aspects of work that stimulate development, enhance work engagement and performance, help achieve goals and provide protection from the negative health effects of work demands. Identifying the job resources in GP trainees' work may provide ways to support their wellbeing and future careers in primary care. This study explores how GP trainees perceive their ideal job and identify job resources.

Method: GP trainees attending an orientation course at the University of Eastern Finland were assigned to describe their ideal job. The descriptions were analyzed using abductive qualitative content analysis, where elements of job resources in the Job Demands-Resources (JD-R) model were applied as the theoretical framework.

Results: Continuity of care, patient-centered care, community orientation, and comprehensiveness were key resources in the ideal job of a GP trainee. GP trainees aspired to work as GPs in well-managed clinics that offer opportunities for diverse skill utilization, professional development, collaborative practice, and autonomy in work management. They also prioritized achieving a healthy work-life balance and maintaining a manageable workload.

Conclusion: GP trainees demonstrated a strong commitment to the core values and principles of general practice. This study suggests that it is essential to design jobs that align with these values and offer diverse work tasks, autonomy in work management, opportunities for continuous professional development, and balanced work-life integration. Prioritizing these elements in job design strategies could enhance GPs' occupational well-being and maintain their dedication to primary care throughout their careers.

Climate change poses an urgent threat to human health, with thousands of deaths already attributed to extreme heat. In the Nordic countries, where per capita emissions are particularly high, healthcare accounts for 4.2-6.3% of emissions, highlighting the need for immediate action to reduce its climate impact. Evidence supporting sustainable climate solutions in healthcare is steadily growing. Greenhouse gas emissions in general practice can be broadly divided into those arising from clinical activities, such as patient examination, diagnosis, and treatment, and those from non-clinical activities, including clinic operations, energy use, and transportation by staff and patients. In this opinion paper, we discuss and advocate 'Green Care Practices' to minimize greenhouse gas emissions specifically related to clinical activities. We believe that Nordic general practitioners can adopt 'Green Care' to significantly reduce healthcare-related emissions while improving patient outcomes, enhancing efficiency, and promoting environmentally responsible healthcare. Strong primary healthcare, rooted in Nordic values, can support the United Nations Sustainable Development Goals by simultaneously mitigating climate change, reducing inequalities, fostering community stability, and promoting health and well-being. Thus, GPs can ensure sustainability for future generations.

Background: Consultations can be challenging because of patient complexity, affecting care quality. Patient complexity involves factors related to the patient, healthcare professional, organization, and healthcare system. A comprehensive overview of these factors and their significance to healthcare providers is lacking. The aim of this study was to create a literature overview and to examine how the results relate to the experiences of primary care providers.

Methods: The PubMed, Embase and Cochrane databases were searched (2018-2023) to conduct a scoping review. In addition, a focus group was organized with healthcare providers from general practices (a) to discuss the results of the review, and (b) to explore its meaning in daily consultation, based on the real-life patient cases they presented.

Results: The review (171 unique studies) mainly revealed patient-related factors (medical, social and behavioural aspects). Complexity arises when multiple aspects are present and mutually interact. Factors related to the expertise of healthcare professionals, the organization (care coordination) and the system (availability of resources, navigation problems) were also identified. The focus group recognized the factors that influenced patient complexity and their interdependence. They noted a need for support in identifying and treating the patient population in question across disciplines.

Conclusions: A comprehensive overview of factors influencing patient complexity at four different levels (patient, professional, organization, system) is provided. The primary care providers suggested disseminating these results to customize treatment to the needs of patients, which is likely to require coordination across disciplines and integrated care.