Family practice最新文献

{"title":"Changing the antibiotic prescribing of Australian general practice registrars' for acute respiratory tract infections: a non-randomized controlled trial.","authors":"Alexandria Turner, Mieke L van Driel, Benjamin L Mitchell, Joshua S Davis, Amanda Tapley, Elizabeth Holliday, Jason Dizon, Paul Glasziou, Mina Bakhit, Katie Mulquiney, Andrew Davey, Katie Fisher, Emma J Baillie, Alison Fielding, Dominica Moad, Anthea Dallas, Parker Magin","doi":"10.1093/fampra/cmaf005","DOIUrl":"10.1093/fampra/cmaf005","url":null,"abstract":"<p><strong>Background: </strong>Inappropriate antibiotic prescription for self-limiting respiratory tract infections (RTIs) by general practitioner (GP) registrars (trainees) is less common than by established GPs but still exceeds evidence-based benchmarks. A 2014 face-to-face educational intervention for registrars and supervisors reduced registrars' acute bronchitis antibiotic prescription by 16% (absolute reduction). We aimed to establish the efficacy of an updated registrar/supervisor RTI-management intervention (delivered at distance) on antibiotic prescribing.</p><p><strong>Methods: </strong>A non-randomized trial using a non-equivalent control-group nested within the ReCEnT cohort study. The intervention included online educational modules, registrar and supervisor webinars, and materials for registrar-supervisor in-practice educational sessions, and focussed on acute bronchitis as an exemplar RTI. The theoretical underpinning was the 'capability, opportunity, and motivation' (COM-B) framework. The intervention was delivered to registrars and supervisors of one large educational/training organization annually from mid-2021, with pre-intervention period from 2017, and with postintervention period ending 2023. Two other educational/training organizations served as controls. The primary outcome was antibiotics prescribed for acute bronchitis. Analyses used multivariable logistic regression with predictors of interest: time (before/after intervention), treatment group, and an interaction term for time-by-treatment group, adjusted for potential confounders. The interaction term P-value was used to infer statistical significance of the intervention effect.</p><p><strong>Results: </strong>Of 4612 acute bronchitis presentations, 70% were prescribed antibiotics. There was a 6.9% absolute reduction (adjusted) of prescribing in the intervention-group compared with the control-group. This was not statistically significant (Pinteraction = .22).</p><p><strong>Conclusions: </strong>Failure to find a significant effect on prescribing suggests difficulties with scalability of this (and similar educational) innovations.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":"42 2","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11911915/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143647826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Knowledge, attitudes, and practice of primary care professionals regarding community activities: a descriptive study.","authors":"Diego G Mosteiro-Miguéns, Maruxa Zapata-Cachafeiro, Silvia Novío, Natalia Vieito-Pérez, Tania Alfonso-González, Almudena Rodríguez-Fernández","doi":"10.1093/fampra/cmae056","DOIUrl":"10.1093/fampra/cmae056","url":null,"abstract":"<p><strong>Background: </strong>Promoting health via a community approach is one of the most effective strategies for reducing the current incidence of chronic diseases. Primary care (PC), through the implementation of community activities (CA), has the potential to achieve this goal. Yet the implementation of CA at health centers is not standardized and is often thanks only to the voluntariness of health professionals.</p><p><strong>Objective: </strong>To ascertain the knowledge, attitudes, and practices of PC professionals regarding the implementation of CA.</p><p><strong>Methods: </strong>We carried out a cross-sectional study by circulating a self-administered online questionnaire on CA, across the period December 2022 through June 2023 in Galicia (Spain). All health professionals working in the Galician Health Service PC setting were invited to participate.</p><p><strong>Results: </strong>A total of 521 health professionals participated in the study. They included all types of PC health professionals (physicians, general and specialist nurses -midwives, pediatrics, family and community, mental health- and social workers), including residents in training. Only 14.8% and 12.5% of professionals correctly identified CAs and social prescription (SPr) interventions, respectively. Furthermore, 93.9% recognized that the development of CA in health centers was deficient. Despite this, 76.5% showed a good attitude toward participation in CA.</p><p><strong>Conclusions: </strong>PC professionals find it difficult to identify CA and SPr interventions. Therefore, it is necessary to improve the training of these professionals in the implementation of CA with a view to enhancing population health, reducing the incidence of chronic diseases, and helping lessen the healthcare burden of the health system.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11809258/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142497735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patient safety in general practice during COVID-19: a descriptive analysis in 38 countries (PRICOV-19).","authors":"Esther Van Poel, Pierre Vanden Bussche, Claire Collins, Susan Lagaert, Sara Ares-Blanco, Maria Pilar Astier-Pena, Jonila Gabrani, Raquel Gomez Bravo, Kathryn Hoffmann, Zalika Klemenc-Ketis, Christian Mallen, Ana Luisa Neves, Zlata Ožvačić, Victoria Tkachenko, Dorien Zwart, Sara Willems","doi":"10.1093/fampra/cmae059","DOIUrl":"10.1093/fampra/cmae059","url":null,"abstract":"<p><strong>Background: </strong>This article aims to examine patient safety in general practice during COVID-19.</p><p><strong>Methods: </strong>In total, 5489 GP practices from 37 European countries and Israel filled in the online self-reported PRICOV-19 survey between November 2020 and December 2021. The outcome measures include 30 patient safety indicators on structure, process, and outcome.</p><p><strong>Results: </strong>The data showed that structural problems often impeded patient safety during COVID-19, as 58.6% of practices (3209/5479) reported limitations related to their building or infrastructure. Nevertheless, GP practices rapidly changed their processes, including the appointment systems. Implementation proved challenging as, although 76.1% of practices (3751/4932) developed a protocol to answer calls from potential COVID patients, only 34.4% (1252/3643) always used it. The proportion of practices reported having sufficient protected time in general practitioners' schedules to review guidelines remained consistent when comparing the pre-COVID (34.2%,1647/4813) with the COVID period (33.2%,1600/4813). Overall, 42.8% of practices (1966/4590) always informed home care services when patients were diagnosed with COVID-19, while this decreased to 30.1% for other major infectious diseases (1341/4458). Most practices reported at least one incident of delayed care in patients with an urgent condition, most often because the patient did not come to the practice sooner (60.4%, 2561/4237). Moreover, 31.1% of practices (1349/4199) always organized a team discussion when incidents happened. Overall, large variations were found across countries and patient safety indicators.</p><p><strong>Conclusions: </strong>The results demonstrated that European GP practices adopted numerous measures to deliver safe care during COVID-19. However, multilayered interventions are needed to improve infection control and GP practice accessibility in future pandemics.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142544546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determination of subclinical atherosclerosis by total plaque area in patients with diabetes and hypertension.","authors":"Mariana N Carrillo, Hernán A Pérez, Luis L Armando, J David Spence, Sonia E Muñoz, Nestor H Garcia","doi":"10.1093/fampra/cmaf010","DOIUrl":"10.1093/fampra/cmaf010","url":null,"abstract":"<p><strong>Background/objective: </strong>the determination of the carotid total plaque area (TPA) is an indicator of subclinical atherosclerosis and a useful tool in early cardiovascular prevention. Classically, diabetes has been considered the most atherogenic disease, even more so than hypertension, but the incidence of stroke and heart attack is higher in patients with hypertension than in patients with diabetes alone. Therefore, in this study, we compared hypertension and diabetes with regard to the burden of atherosclerosis.</p><p><strong>Methods: </strong>a cross-sectional observational study was carried out on adults (n = 606). Those with a history of a cardiovascular event were excluded.</p><p><strong>Results: </strong>median age was 65 years (IQR 17), 58.6% women. People with diabetes and hypertension had the highest TPA (β exponent: 1.64; 95% CI 1.20-2.26), followed by people with hypertension alone (β exponent: 1.39; 95% CI 1.05-1.86), while people with diabetes alone had no differences (P = .379) with respect to the control group.</p><p><strong>Conclusion: </strong>This cross-sectional study, though limited, emphasizes the need for larger prospective studies to validate the clinical significance of these findings and highlights the importance of routine monitoring of subclinical atherosclerosis in hypertensive patients to assess the effectiveness of preventive therapy.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":"42 2","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143656418","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect and implementation of the COVID Box, a remote patient monitoring system for patients with a COVID-19 infection in primary care: a matched cohort study.","authors":"Nicoline E van Hattem, Niels J Mijnsbergen, Hendrikus J A van Os, Bart A Mertens, Just A H Eekhof, Niels H Chavannes, Douwe E Atsma, Tobias N Bonten","doi":"10.1093/fampra/cmae045","DOIUrl":"10.1093/fampra/cmae045","url":null,"abstract":"<p><p>At the onset of the COVID-19 pandemic, the pressure on hospitals increased tremendously. To alleviate this pressure, a remote patient monitoring system called the COVID Box was developed and implemented in primary care. The aim was to assess whether the COVID Box in primary care could reduce emergency department (ED) referrals due to a COVID-19 infection. A matched cohort study was performed between December 2020 and June 2021. Patients with a COVID-19 infection in need of intensive monitoring based on the clinical judgement of their own general practitioner received the COVID Box in primary care combining home monitoring of vital parameters with daily video consultations. The control group was retrospectively matched by propensity score matching. We conducted a subgroup analysis in higher-risk patients with oxygen saturation measurements, considering oxygen saturation as a critical parameter for assessing the risk of a complicated infection. We included 205 patients, of whom 41 patients were monitored with the COVID Box (mean age 70 and 53.7% male) and 164 in the control group (mean age 71.5 and 53% male). No difference was found in ED referrals between the intervention and control groups in our primary analysis. In the subgroup analysis, we found a nonsignificant trend that remote monitoring could reduce the ED referrals. While the overall study found comparable ED referrals between groups, the subgroup analysis suggested a promising prospect in reducing ED referrals due to remote monitoring of higher-risk patients with acute respiratory disease in primary care.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11878381/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142282638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and correlates of alcohol use, mental disorders, and awareness and utilization of support services among healthcare professionals in West Rand District, Gauteng, South Africa: a cross-sectional study.","authors":"Charlotte Mc Magh, Oluwafojimi Fadahun, Joel Msafiri Francis","doi":"10.1093/fampra/cmad094","DOIUrl":"10.1093/fampra/cmad094","url":null,"abstract":"<p><strong>Introduction: </strong>Healthcare professionals (workers) are at an increased risk for developing mental and alcohol use disorders (risky drinking) due to increased psychological distress, long working hours, medical litigation, role conflict, and verbal/physical violence from colleagues and patients. Psychological well-being in healthcare workers is crucial to provide the best quality of care to patients. Current data are limited regarding alcohol abuse (risky drinking) rates and mental health condition among healthcare professionals in South Africa.</p><p><strong>Objectives: </strong>To describe the prevalence and correlates of alcohol use disorder (risky drinking), depression, anxiety, suicidality, and covid anxiety during the coronavirus pandemic in healthcare professionals in West Rand District, Johannesburg, South Africa.</p><p><strong>Methods: </strong>We carried out a cross-sectional study on a sample of healthcare professionals including doctors, nurses, clinical associates, and dentists working in the West Rand District of Gauteng, South Africa, during Covid-19 pandemic. Participants were invited to complete a paper-based questionnaire addressing sociodemographic questions, a set of measures for alcohol use disorder (AUDIT-C), depression (PHQ-2), anxiety (GAD-7), suicidality (PSS-3), covid anxiety (CAS), and awareness and utilization of support services.</p><p><strong>Results: </strong>A total of 330 healthcare professionals (60.9% nurses, 33% doctors, 5.5% other) participated. Females comprised the majority of study participants with 78.8%, and 48.2% of the participants were in the age band 35-64 years. Overall, 20.9% of the healthcare professionals reported risky alcohol use. Females were 73% less likely to report risky alcohol use (AOR = 0.27;95% CI: 0.13-0.54). Prevalence of probable depression was 13.6% and female professionals were 5 times more likely to be classified as having probable depression (AOR = 4.86;95% CI: 1.08-21.90). The grouped prevalence of anxiety ranging from mild to severe was reported at 47.3%, female professionals were 3 times more likely to be classified as having anxiety disorder (AOR = 2.78;95% CI: 1.39-5.57). Furthermore, races other than African had higher rates of anxiety (AOR = 2.54; 95% CI: 1.00-6.42). The prevalence of suicide symptoms was 7.9% and that of covid dysfunctional anxiety 4.8%. Only 5% of participants were involved in an employee wellness program, with 60% expressing interest in joining one.</p><p><strong>Conclusion: </strong>Alcohol use (risky drinking) and mental disorders were common among healthcare professionals in West Rand District, Johannesburg, South Africa. There is overall poor awareness and use of support structures highlighting urgent need for interventions. Future studies could also explore in-depth the drivers of mental disorders and lack of utilization of the available service and strategies to deliver alcohol and mental disorder screening, brief intervention, and","PeriodicalId":12209,"journal":{"name":"Family practice","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11954498/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10253211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is use of a long-term proton pump inhibitor or histamine-2 receptor antagonist a risk factor for iron-deficiency anaemia in Taiwan? A neglected clinical drug-drug interaction.","authors":"Yi-Ting Wu, Ya-Ting Lu, Chao-Yu Chu, Horng-Jiun Chao, Li-Na Kuo, Kuei-Ju Cheng, Hsiang-Yin Chen","doi":"10.1093/fampra/cmad090","DOIUrl":"10.1093/fampra/cmad090","url":null,"abstract":"<p><strong>Background: </strong>Proton pump inhibitors (PPIs) and histamine-2 receptor (H2) antagonists change the gastric pH and reduce the intestinal absorption of nonheme iron. Case reports and case-control studies have demonstrated that absorption of iron is affected by gastric acidity, but the clinical importance of these drug-drug interactions has remained uncertain.</p><p><strong>Objectives: </strong>The present case-control study employed 2 million longitudinal claims in 2011-2018 in the Taiwan National Health Insurance Research Database to investigate the impact of PPIs/H2 antagonists on the occurrence of iron-deficiency anaemia (IDA).</p><p><strong>Methods: </strong>The present study retrospectively compared exposure to PPIs/H2 antagonists for 1 year among 5,326 cases with IDA and 21,304 matched controls. The postdiagnosis prescribing pattern was also calculated to understand current practice.</p><p><strong>Results: </strong>Long-term (≥2 month) use of PPIs/H2 antagonists resulted in a higher risk of developing IDA than noncontinuous use/nonuse of those drugs (adjusted odds ratio [aOR] = 2.36, 95% confidence interval [CI] = 1.94-2.86, P < 0.001). There were significant changes in the postdiagnosis prescribing patterns of PPIs/H2 antagonists. The risk of developing IDA remained significant in the female subgroup (aOR = 2.16, 95% CI = 1.73-2.70, P < 0.001) and was even more prominent in those aged ≥ 50 years (aOR = 2.68, 95% CI = 1.94-3.70, P < 0.05).</p><p><strong>Conclusions: </strong>This study found that long-term use of PPIs/H2 antagonists increased the risk of developing IDA, and there was strong evidence of prescription pattern adjustments postdiagnosis. Physicians and pharmacists should be aware of this risk when patients are expected to take or have been taking PPIs/H2 antagonists for the long term.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41109081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"General practice utilisation by Australian cancer patients in the last year of life.","authors":"Matthew P Grant, Damien McCarthy, Chris Kearney, Anna Collins, Vijaya Sundararajan, Joel J Rhee, Jennifer A M Philip, Jon D Emery","doi":"10.1093/fampra/cmae062","DOIUrl":"10.1093/fampra/cmae062","url":null,"abstract":"<p><strong>Objectives: </strong>General practice plays a key role in end-of-life care, yet the extent of this remains largely unknown due to a lack of detailed clinical data. This study aims to describe the care provided by General Practitioners (GPs) for people with cancer in their last year of life.</p><p><strong>Methods: </strong>Retrospective cohort study using linked routine primary care and death certificate data in Victoria, Australia. Patients were included who died from cancer between 2008 and 2017.</p><p><strong>Results: </strong>In total 7025 cancer patients were included, mean age of 74.8 yrs. 95% of patients visited their GP in the last 6 months of life, with a median of 11 general practice contacts in this period. 72% of patients visited their GP in the second-last month prior to death, and 74% in the last month of life. The majority of patients (58%) were prescribed opioids, 19% anticipatory medications, 24% received a home visit, and a small proportion had imaging (6%) in the last month and pathology (6%) in the last fortnight. Patients in regional areas had more contact with general practices in the last year of life compared to metropolitan patients (median metropolitan = 16, inner regional = 25, and outer regional = 23, P < .001). The use of GP services did not differ by cancer type.</p><p><strong>Conclusions: </strong>GP's play a central role in end-of-life care provision for cancer patients, which intensifies in the last months of life. There is room for improvement, with a proportion having little or no engagement, and low rates of home visits and anticipatory medication prescribing.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11809245/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142617230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of a multifaceted intervention programme on antibiotic prescribing and dispensing in four patient-centred settings in five European countries. The HAPPY PATIENT project.","authors":"Ana García-Sangenís, Jesper Lykkegaard, Malene Plejdrup Hansen, Beatriz González López-Valcárcel, Fabiana Raynal, Laura Vallejo-Torres, Lars Bjerrum, Athina Chalkidou, Jette Nygaard Jensen, Ingrid Rebnord, Bent Håkan Lindberg, Katja Taxis, Maarten Lambert, Ruta Radzeviciene, Lina Jaruseviciene, Pia Touboul Lundgren, Pascale Bruno, Vanessa Lesage, Anna Kowalczyk, Maciej Godycki-Cwirko, Christos Lionis, Maria-Nefeli Karkana, Marilena Anastasaki, Matilde Bøgelund Hansen, Jonas Kanstrup Olsen, Jens Søndergaard, Daniela Modena, Stella Mally, Laura Álvarez, Carl Llor","doi":"10.1093/fampra/cmae064","DOIUrl":"10.1093/fampra/cmae064","url":null,"abstract":"<p><strong>Background: </strong>The primary cause of antimicrobial resistance is excessive and non-indicated antibiotic use.</p><p><strong>Aim: </strong>To evaluate the impact of a multifaceted intervention aimed at various healthcare professionals (HCPs) on antibiotic prescribing and dispensing for common infections.</p><p><strong>Design and setting: </strong>Before-and-after study set in general practice, out-of-hours services, nursing homes, and community pharmacies in France, Greece, Lithuania, Poland, and Spain.</p><p><strong>Methods: </strong>Following the Audit Project Odense method, HCPs from these four settings self-registered encounters with patients related to antibiotic prescribing and dispensing before and after an intervention (February-April 2022 and February-April 2023). Prior to the second registration, the HCPs undertook a multifaceted intervention, which included reviewing and discussing feedback on the first registration's results, enhancing communication skills, and providing communication tools. Indicators to identify potentially unnecessary prescriptions and non-first-line antibiotic choices were developed, and the results of the two registrations were compared.</p><p><strong>Results: </strong>A total of 345 HCPs registered 10 744 infections in the first registration period and 10 207 infections in the second period. In general practice, participants showed a significant 9.8% reduction in unnecessary antibiotic prescriptions in the second period, whereas limited or no effect was observed in out-of-hours services and nursing homes (0.8% reduction and 4.5% increase, respectively). Pharmacies demonstrated an 18% increase in safety checks, and correct advice in pharmacies rose by 17%.</p><p><strong>Conclusion: </strong>External factors like COVID-19, antibiotic shortages, and a streptococcal epidemic impacted the intervention's benefits. Despite this, the intervention successfully improved antibiotic use in both settings.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11809241/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142617231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"School absence policy and healthcare use: a difference-in-difference cohort analysis.","authors":"Kirsti Wahlberg, Kristine Pape, Bjarne Austad, Andreas Asheim, Kjartan S Anthun, Johan H Bjørngaard, Gunnhild Å Vie","doi":"10.1093/fampra/cmae042","DOIUrl":"10.1093/fampra/cmae042","url":null,"abstract":"<p><strong>Background: </strong>A national policy in Norway demanding certificates for medical absences in upper secondary school was implemented in 2016, leading to an increase in general practitioner (GP) visits in this age group.</p><p><strong>Objectives: </strong>To assess the policy's effect on the use of primary and specialist healthcare.</p><p><strong>Methods: </strong>A cohort study following all Norwegian youth aged 14-21 in the years 2010-2019 using a difference-in-differences approach comparing exposed cohorts expected to attend upper secondary school after the policy change in 2016 with previous unexposed cohorts. Data were collected from national registries.</p><p><strong>Results: </strong>The absence policy led to the increased number of contacts with GPs for exposed cohorts during all exposed years, with estimated incidence rate ratios (IRRs) in the range from 1.14 (95% confidence intervals [CI] 1.11-1.18) to 1.25 (95% CI 1.21-1.30). Consultations for respiratory tract infections increased during exposed years. However, there was no conclusive policy-related difference in mental health consultations with GPs. In specialist healthcare we did not find conclusive evidence of an effect of absence policy on the risk of any contact per school year, but there was a slightly increased risk of contacts with ear-nose-throat specialist services.</p><p><strong>Conclusions: </strong>We found an increase in general practice contacts attributable to the school absence policy. Apart from a possible increase in ear-nose-throat contacts, increased GP attention did not increase specialized healthcare.</p>","PeriodicalId":12209,"journal":{"name":"Family practice","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11879198/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142143048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}