Scandinavian Journal of Primary Health Care最新文献

{"title":"Detection of heart failure in a general population not aware of having the disease.","authors":"Michelle Tuv Pettersen, Henrik Schirmer, Juan Carlos Aviles Solis, Mark Spigt, Hasse Melbye","doi":"10.1080/02813432.2025.2503447","DOIUrl":"https://doi.org/10.1080/02813432.2025.2503447","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"1-11"},"PeriodicalIF":1.9,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144080075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Experiences of patients with complex needs at municipal emergency outpost satellites.","authors":"Trude Østerbø, Gro Hovland, Siri Ytrehus, Dagrun Kyrkjebø, Erik Zakariassen, Ole T Kleiven","doi":"10.1080/02813432.2025.2502095","DOIUrl":"https://doi.org/10.1080/02813432.2025.2502095","url":null,"abstract":"<p><strong>Background: </strong>In 2015, Norway introduced stricter requirements for organizing primary emergency care. These changes led to new solutions such as municipal emergency outpost satellites, providing inhabitants shorter access to care in resource-limited areas. This study explores patient experiences at emergency outpost satellites staffed by a nurse on site with a general practitioner (GP) available <i>via</i> video consultation.</p><p><strong>Methods: </strong>A qualitative study was conducted with seven patients, aged 62-82, with complex needs, from four small and medium-sized municipalities in Vestland County, Norway. Data were collected through individual semi-structured interviews, which took place within 6 months of an acute consultation at an emergency outpost satellite. The data were analysed using systematic text condensation (STC).</p><p><strong>Results: </strong>Patients had both positive and negative experiences with video consultations. They valued short travel distances and quick GP access <i>via</i> video link. Video consultations often replicated several aspects of in-person visits, with nurses playing a crucial role in organizing and ensuring that care was provided effectively. Nurses were key mediators, supporting patients before, during, and after the consultation. However, some patients were dissatisfied with the lack of a physical GP presence, technical issues, and communication challenges.</p><p><strong>Conclusions: </strong>The participants' experience of communication with the GP and nurse was crucial for the video consultation to be perceived as satisfactory. Participants felt that video consultations reduced travel burdens and provided quick clarification. Nurses played an important mediating role, but poor communication and technical issues made some participants feel unsafe using the emergency outpost satellites.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"1-12"},"PeriodicalIF":1.9,"publicationDate":"2025-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144033531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving access, mixed continuity: effects of multidisciplinary teams on primary health-care in Finland - a quasi-experimental study.","authors":"Elisa Jokelin, Laura Piirainen, Erja Mustonen, Paulus Torkki","doi":"10.1080/02813432.2025.2502658","DOIUrl":"https://doi.org/10.1080/02813432.2025.2502658","url":null,"abstract":"<p><strong>Objective: </strong>The multidisciplinary team (MDT) approach in primary care is a relatively recent innovation, developed over the past 15 years. There is limited data on MDTs' effects on Quadruple Aim (QA) goals. The object of this study is to evaluate the implementation of a novel MDT from 2021 to 2023 and its impact on access and continuity of care, compared to an established model. Future research will explore its effects on staff satisfaction, costs, and health outcomes.</p><p><strong>Design, setting and patients: </strong>This quasi-experimental study compares five intervention health centers with three control centers. It includes all primary care patients from 2021 to 2023, presenting data on access and continuity before and after the intervention.</p><p><strong>Intervention: </strong>Nurse-only consultations were replaced with a multidisciplinary nurse-physician model to address issues during initial contact more effectively. Nurses also took on the role of case managers, enhancing relational continuity. Lean daily visual management with continuous improvement, strategic goal setting, and coaching leadership style were implemented.</p><p><strong>Main outcome measures: </strong>Access was measured using the 'third available appointment' (T3) metric, and continuity with the COC-index, both for physicians only.</p><p><strong>Results: </strong>Access improved at all intervention centers, with T3 reduced from 90 to 1.125-4.75 days, while controls remained at 90 days. COC improved at three intervention centers but declined at two, with declines also observed at control centers.</p><p><strong>Conclusion: </strong>The novel MDT enhanced primary care access compared to the traditional model. However, relying solely on T3 may be insufficient for evaluating effectiveness. Mixed results in continuity underscore the need for further investigation.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"1-14"},"PeriodicalIF":1.9,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patients' perspectives regarding antibiotic treatment for acute sinusitis in Norwegian general practice. A qualitative interview study.","authors":"Jorunn Thaulow, Torunn Bjerve Eide, Sigurd Høye, Holgeir Skjeie","doi":"10.1080/02813432.2025.2498510","DOIUrl":"https://doi.org/10.1080/02813432.2025.2498510","url":null,"abstract":"<p><strong>Background: </strong>The prescription rate for antibiotics for acute sinusitis in primary care remains high, despite evidence showing their limited effectiveness. GPs frequently encounter patient demands for antibiotics, which can influence their decision-making process.</p><p><strong>Aim: </strong>This study aimed to explore the help-seeking and expectations of patients experiencing symptoms of acute sinusitis, with a particular focus on their desire for antibiotics. We sought to understand why patients seek their GP for sinusitis, what kind of treatment they hope to receive, and how they perceive their influence on the GP's treatment decision.</p><p><strong>Methods: </strong>We conducted 12 semi-structured interviews with patients who had consulted their GP for acute sinusitis from various regions across Norway. The qualitative analysis was performed using systematic text condensation.</p><p><strong>Results: </strong>We developed 3 main themes:1. 'Pain and exhaustion'- Patients primarily consulted their GP for acute sinusitis seeking medication to alleviate pain and accelerate recovery.2. 'I trust the GP, but mainly myself'- While patients expressed trust in their GPs, they also had clear expectations of receiving the specific treatment they sought. 3. 'Antibiotics works'- Most patients associated medication with antibiotics and believed they were effective against sinusitis.</p><p><strong>Conclusion: </strong>Patients with sinusitis primarily visited their GP to seek relief from pain and to obtain medication that they believe could speed up recovery, which often meant antibiotics. These findings suggest a continuing need for measures targeting both doctors and patients to align treatment expectations, improve adherence to clinical guidelines, and adjust patient expectations. Better pain management of sinusitis should be emphasized.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"1-9"},"PeriodicalIF":1.9,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144033544","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mapping the ideal job: insights into job resources of general practitioner trainees.","authors":"Outi Öhman, Nina Tusa, Tiina Ahonen, Taina Hintsa, Pekka Mäntyselkä","doi":"10.1080/02813432.2025.2501071","DOIUrl":"https://doi.org/10.1080/02813432.2025.2501071","url":null,"abstract":"<p><strong>Objective: </strong>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.</p><p><strong>Method: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"1-11"},"PeriodicalIF":1.9,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144028187","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mapping motivational factors for continuous medical education: insights from general practitioners with varying levels of participating in CME.","authors":"Helle Ibsen, Linda Juel Ahrenfeldt, Jens Søndergaard, Igor Švab, Niels Kristian Kjær","doi":"10.1080/02813432.2025.2498508","DOIUrl":"https://doi.org/10.1080/02813432.2025.2498508","url":null,"abstract":"<p><strong>Background: </strong>General practitioners' (GPs) participation in continuous medical education (CME) is crucial for patient care, GPs' well-being and healthcare costs. Despite this, 25% of Danish GPs did not participate in CME in 2022. It is vital to understand motivational factors for engaging in CME.</p><p><strong>Aim: </strong>To analyze motivation for CME and differences in motivational factors among GPs with different levels of participating.</p><p><strong>Design and setting: </strong>A cross-sectional questionnaire informed from qualitative interviews was conducted among all 3257 GPs in Denmark in May 2023.</p><p><strong>Method: </strong>The response rate was 40%. Responders were categorized as 'frequent', 'partial' and 'infrequent' CME users. We employed descriptive statistics and logistic regression analysis to quantify predefined motivational factors. Free text comments were analyzed using systematic text condensation. We used self-determination theory as a framework in the interpretation.</p><p><strong>Results: </strong>Most reported motivational factors were 'relevant medical update' (98%) and 'topics of interest' (96%). Financial incentives had a minor impact across all groups. Infrequent users were less easy to motivate and were more likely to state controlled motivational factors, e.g. a duty. Frequent and partial users of CME reported more autonomous motivation, i.e. personal development, collegial togetherness and professional well-being.</p><p><strong>Conclusions: </strong>Relevant medical updates that enhance perceived competence in patient care are crucial for all GPs. Infrequent users seem less motivated by avoiding burnout, collegial togetherness and well-being.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"1-9"},"PeriodicalIF":1.9,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054256","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Innovation and testing in general practitioners' practice - the challenging path from idea to new practice.","authors":"Tore Norendal Braathen, Toril Thorvaldsen Dale, Randi Brendbekken, Irene Øyeflaten","doi":"10.1080/02813432.2025.2498513","DOIUrl":"https://doi.org/10.1080/02813432.2025.2498513","url":null,"abstract":"<p><strong>Aims: </strong>General practitioners (GPs) need tools and working methods to deal with sick listed patients' multifaceted needs as well as to collaborate with stakeholders such as the employer or the social welfare counsellor. This study explored GPs' experiences when testing the mapping and dialogue tool ISIVET in sick leave follow-up.</p><p><strong>Methods: </strong>Individual interviews with seven GPs in salaried positions testing ISIVET in sick leave follow-up in a Norwegian municipality. Data were transcribed verbatim and analysed using systematic text condensation.</p><p><strong>Results: </strong>Five categories of experiences were identified: 1) positive perceptions of ISIVET in terms of visualizing the complexity of health and work conditions, 2) procedures and collection of research data made it difficult to test the tool, 3) unclear ownership and anchoring, 4) difficulties with experimentation in demanding working days and 5) close follow-up during training followed by a lack of sharing experiences.</p><p><strong>Conclusions: </strong>Despite positive GP perceptions of ISIVET in sick leave follow-up, the testing 'failed' due to difficulties during the testing overshadowing the benefits. This was primarily due to poor technological and practical adaptions of the use of the tool in a busy GP's working day. Secondly, a weak local anchoring with lack of follow-up and sharing of experiences, influenced the use of ISIVET negatively. If further testing of ISIVET in primary care is carried out, it would be necessary to simplify and adapt the use of the tool extensively. Given the positive perceptions of ISIVET, one could consider new adaptions and further testing according to these experiences.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"1-9"},"PeriodicalIF":1.9,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144011923","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter to the editor regarding 'does point-of-care ultrasound examination by the general practitioner lead to inappropriate care? A follow-up study'.","authors":"Zachary Boivin","doi":"10.1080/02813432.2025.2499172","DOIUrl":"https://doi.org/10.1080/02813432.2025.2499172","url":null,"abstract":"","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"1-2"},"PeriodicalIF":1.9,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144011924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multimorbidity and health related quality of life in midlife - a longitudinal study from Northern Finland Birth Cohort 1966.","authors":"Oili Junttila, Paula Pesonen, Markku Timonen, Juha Auvinen","doi":"10.1080/02813432.2025.2492296","DOIUrl":"https://doi.org/10.1080/02813432.2025.2492296","url":null,"abstract":"<p><strong>Aim: </strong>Multimorbidity is a major public health concern. According to previous studies, multimorbidity has been shown to be associated with health-related quality of life (HRQoL). However, existing data concerning high income countries are mainly based on cross-sectional studies. Consequently, longitudinal investigations have been called for. There exist several definitions of multimorbidity in previous population studies, and usually definition is based on self-reported symptoms or diseases or included only few diagnoses. This study aimed to examine how the number of doctor-diagnosed chronic diseases influences HRQoL over time in a population-based setting.</p><p><strong>Methods: </strong>At 31 and 46 years, participants (<i>n</i> = 3573) of the Northern Finland Birth Cohort 1966 answered 15-Dimensional HRQoL questionnaire (15D). Mean 15D-Scores (varies between 0 and 1) were counted according to the number of 43 chosen chronic diseases. These diseases were found and the definition of multimorbidity was measured by a method using both self-reported doctor-diagnosed and register-based chronic diseases.</p><p><strong>Results: </strong>In both genders, the mean difference of 15D-Scores increased monotonously in line with the increasing number of new emerging diseases diagnosed for 15 years of follow-up from the age of 31-46 years (<i>p</i> < .05). Furthermore, the more diseases the patient had at the age of 31, the more mean 15D-Scores decreased when having more new emerging diseases at the age of 46.</p><p><strong>Conclusions: </strong>In general, HRQoL decreased during 15-year follow-up for everyone. Furthermore, decrease in the quality of life is significantly associated with multimorbidity in this longitudinal setting.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"1-12"},"PeriodicalIF":1.9,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of dietary supplements by individuals with dementia - the caregivers' perspective.","authors":"Hilde Risvoll, Marit Waaseth, Kjell H Halvorsen, Trude Giverhaug, Frauke Musial","doi":"10.1080/02813432.2025.2496829","DOIUrl":"https://doi.org/10.1080/02813432.2025.2496829","url":null,"abstract":"<p><strong>Introduction: </strong>Due to their cognitive challenges, individuals with dementia, often rely on their caregivers for support with activities of daily living. Many of them use dietary supplements (DS) but are at risk of overdosing on DS due to forgetfulness. Moreover, DS may cause adverse events or interactions with prescription drugs (PD). This study aimed to explore the role of caregivers in managing DS use and to identify potential risks associated with its administration.</p><p><strong>Methods: </strong>A cross-sectional survey among caregivers of individuals with dementia recruited from dementia organisations in North-Norway.</p><p><strong>Results: </strong>Out of 163 caregivers invited to participate, 104 (64%) participated. Of those, 59 reported that the individual under their care used DS. Twenty-seven caregivers had assisted in DS administration. Eleven expressed concerns around the DS use, and 17 reported that the individual with dementia had previously made mistakes in its administration. Several caregivers did not know whether the individual with dementia used DS nor had difficulties taking DS correctly. Additionally, only 45 were aware that DS use could potentially be harmful. Regarding securing safe use of DS in this patient group, the respondents ranked general practitioners to be most responsible. Nearly 50% of those who had sought advice from health care professionals regarding DS use, were not satisfied with the response. A small sample size and heterogeneous study group must be taken into account when interpreting the results.</p><p><strong>Conclusion: </strong>Caregivers were often involved in individuals with dementia's DS use and expressed a willingness to assume responsibility for ensuring safer use. However, several respondents were unaware of the general safety concerns related to DS use. Furthermore, communication with health care professionals regarding DS use, often failed to met the needs of these patients and their caregiver. Collectively, these conditions may impose a risk to individuals with dementia.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"1-12"},"PeriodicalIF":1.9,"publicationDate":"2025-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144064558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}