Scandinavian Journal of Primary Health Care最新文献

{"title":"Implementation of lung ultrasonography by general practitioners for lower respiratory tract infections: a feasibility study.","authors":"Félix Amiot, Thomas Delomas, François-Xavier Laborne, Thomas Ecolivet, Richard Macrez, Axel Benhamed","doi":"10.1080/02813432.2024.2343678","DOIUrl":"10.1080/02813432.2024.2343678","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the feasibility of lung ultrasonography (LUS) performed by novice users' general practitioners (GPs) in diagnosing lower respiratory tract infections (LRTIs) in primary health care settings.</p><p><strong>Design: </strong>A prospective interventional multicenter study (December 2019-March 2020).</p><p><strong>Settings and subjects: </strong>Patients aged >3 months, suspected of having LRTI consulting in three different general practices (GPs) (rural, semirural and urban) in France.</p><p><strong>Main outcome measures: </strong>Feasibility of LUS by GPs was assessed by (1) the proportion of patients where LUS was not performed, (2) technical breakdowns, (3) interpretability of images by GPs, (4) examination duration and (5) patient perception and acceptability.</p><p><strong>Results: </strong>A total of 151 patients were recruited, and GPs performed LUS for 111 (73.5%) patients (LUS group). In 99.1% (<i>n</i> = 110) of cases, GPs indicated that they were able to interpret images. The median [IQR] exam duration was 4 [3-5] minutes. LRTI was diagnosed in 70.3% and 60% of patients in the LUS and no-LUS groups, respectively (<i>p</i> = .43). After LUS, GPs changed their diagnosis from 'other' to 'LRTI' in six cases (+5.4%, <i>p</i> < .001), prescribed antibiotics for five patients (+4.5%, <i>p</i> = .164) and complementary chest imaging for 10 patients (+9%, <i>p</i> < .001). Patient stress was reported in 1.8% of cases, 81.7% of patients declared that they better understood the diagnosis, and 82% of patients thought that the GP diagnosis was more reliable after LUS.</p><p><strong>Conclusions: </strong>LUS by GPs using handheld devices is a feasible diagnostic tool in primary health care for LRTI symptoms, demonstrating both effectiveness and positive patient reception.</p><p><strong>Trial registration number: </strong>Clinicaltrial.gov: NCT04602234, 20/10/2020.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"463-470"},"PeriodicalIF":1.9,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11332293/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141066117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring general practice research in Germany: a systematic review of dissertation topics from 1965-2023.","authors":"Nora Sosna, Jost Steinhäuser","doi":"10.1080/02813432.2024.2329213","DOIUrl":"10.1080/02813432.2024.2329213","url":null,"abstract":"<p><strong>Background: </strong>Since its academic inception in the 1960s, Germany's general practice has seen numerous dissertations, many of which are housed in the 'Archive of German language General Practice' (ADAM).</p><p><strong>Aim: </strong>This study aims to provide the first comprehensive overview of dissertation topics from the discipline of general- and family medicine in Germany, establishing a foundation for advancing research.</p><p><strong>Method: </strong>We employed a systematic review approach, examining 801 dissertations from both ADAM and online sources. Each topic was identified, categorized, and finalized through consensus by two independent reviewers.</p><p><strong>Results: </strong>Our analysis encompassed 486 dissertations from ADAM, 176 from the German national library, and 139 from university libraries. A total of 167 unique research topics were identified. The predominant themes included medical education (<i>n</i> = 49), medication orders (<i>n</i> = 39), frequent consultation issues (<i>n</i> = 33), complementary medicine (<i>n</i> = 32), and screening measures (<i>n</i> = 29). The use of qualitative methods was constantly rising, from no qualitative methods used from 1965-1974, up to 22% of dissertations in recent years.</p><p><strong>Conclusion: </strong>The diversity of 167 research topics underscores the vastness and complexity of general practice in Germany. This structured overview is pivotal for facilitating focused and interconnected research endeavors in the field.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"393-398"},"PeriodicalIF":1.9,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11332290/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140132494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Associations between daily home blood pressure measurements and self-reports of lifestyle and symptoms in primary care: the PERHIT study.","authors":"Ulrika Andersson, Peter M Nilsson, Karin Kjellgren, Mikael Ekholm, Patrik Midlöv","doi":"10.1080/02813432.2024.2332745","DOIUrl":"10.1080/02813432.2024.2332745","url":null,"abstract":"<p><strong>Objective: </strong>To explore in a primary care setting the associations between patients' daily self-measured blood pressure (BP) during eight weeks and concurrent self-reported values of wellbeing, lifestyle, symptoms, and medication intake. We also explore these associations for men and women separately.</p><p><strong>Design and setting: </strong>The study is a secondary post-hoc analysis of the randomised controlled trial PERson-centeredness in Hypertension management using Information Technology (PERHIT). The trial was conducted in primary health care in four regions in Southern Sweden.</p><p><strong>Patients: </strong>Participants (<i>n</i> = 454) in the intervention group in the PERHIT-trial used an interactive web-based system for self-management of hypertension for eight consecutive weeks. Each evening, participants reported in the system their wellbeing, lifestyle, symptoms, and medication adherence as well as their self-measured BP and heart rate.</p><p><strong>Main outcome measures: </strong>Association between self-reported BP and 10 self-report lifestyle-related variables.</p><p><strong>Results: </strong>Self-reported less stress and higher wellbeing were similarly associated with BP, with 1.0 mmHg lower systolic BP and 0.6/0.4 mmHg lower diastolic BP (<i>p</i> < 0.001). Adherence to medication had the greatest impact on BP levels (5.2/2.6 mmHg, <i>p</i> < 0.001). Restlessness and headache were also significantly associated with BP, but to a lesser extent. Physical activity was only significantly associated with BP levels for men, but not for women.</p><p><strong>Conclusion: </strong>In hypertension management, it may be important to identify patients with high-stress levels and low wellbeing. The association between medication intake and BP was obvious, thus stressing the importance of medication adherence for patients with hypertension.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"415-423"},"PeriodicalIF":1.9,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11332292/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140288901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction.","authors":"","doi":"10.1080/02813432.2024.2346386","DOIUrl":"10.1080/02813432.2024.2346386","url":null,"abstract":"","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"493"},"PeriodicalIF":1.9,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11332288/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140877179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pre-hospital management and patient-related factors affecting access to the surgical care of appendicitis - a survey study.","authors":"Kirsi Serenella Lastunen, Ari Kalevi Leppäniemi, Panu Juhani Mentula","doi":"10.1080/02813432.2024.2329214","DOIUrl":"10.1080/02813432.2024.2329214","url":null,"abstract":"<p><strong>Background and aims: </strong>Long pre-hospital delay substantially increases the likelihood of perforated appendicitis. This study aimed to find patient-related factors affecting this delay.</p><p><strong>Methods: </strong>A survey was conducted for patients with acute appendicitis after appendectomy. The participants were asked about their path to the surgical center and socioeconomic status. Variables affecting delays and the rate of complicated appendicitis were analyzed.</p><p><strong>Results: </strong>The study included 510 patients; 157 (31%) had complicated appendicitis with a median prehospital delay of 42 h. In patients with uncomplicated appendicitis, the delay was 21 h, <i>p</i> < .001. Forty-six (29%) patients with complicated appendicitis were not referred to the hospital after the first doctor's visit. The multivariate analysis discovered factors associated with long pre-hospital delay: age 40-64 years (OR 1.63 (95% CI 1.06-2.52); compared to age 18-39), age more than 64 years (OR 2.84 (95% CI 1.18-6.80); compared to age 18-39), loss of appetite (OR 2.86 (95% CI 1.64-4.98)), fever (OR 1.66 (95% CI 1.08-2.57)), non-referral by helpline nurse (OR 2.02 (95% CI 1.15-3.53)) and non-referral at first doctors visit (OR 2.16 (95% CI 1.32-3.53)). Age 40-64 years (OR 2.41 (95% CI 1.50-3.88)), age more than 64 years (OR 8.79 (95% CI 2.19-35.36)), fever (OR 1.83 (95% CI 1.15-2.89)) and non-referral at first doctors visit (OR 1.90 (95% CI 1.14-3.14)) were also risk factors for complicated appendicitis.</p><p><strong>Conclusions: </strong>Advanced age, fever and failure to suspect acute appendicitis in primary care are associated with prolonged pre-hospital delay and complicated appendicitis.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"399-407"},"PeriodicalIF":1.9,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11332302/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140143991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"‘Why do GPs want to come here?’: residents’ intentions to register with new-coming GPs in a disadvantaged neighbourhood in Copenhagen with a GP shortage: a qualitative study","authors":"Stine Dandanell Garn, Sarah Fredsted Villadsen, Charlotte Glümer, Kristina Johansen, Ulla Christensen","doi":"10.1080/02813432.2024.2354361","DOIUrl":"https://doi.org/10.1080/02813432.2024.2354361","url":null,"abstract":"To explore contextual factors influencing residents’ intentions to register with one of the new-coming GPs established as a result of a municipally driven GP coverage intervention in a disadvantage...","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":"183 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141511944","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":"The durability of previous examinations for cancer: Danish nationwide cohort study.","authors":"Jesper Lykkegaard, Jonas Kanstrup Olsen, Sonja Wehberg, Dorte Ejg Jarbøl","doi":"10.1080/02813432.2024.2305942","DOIUrl":"10.1080/02813432.2024.2305942","url":null,"abstract":"<p><strong>Objective: </strong>Patients previously examined for cancer with a negative result may present in general practice with ongoing or new symptoms or signs suggestive of cancer. This paper explores the potential existence of a relatively safe period for cancer occurrence after receiving negative examination results for specific types of cancer, including lung (CT thorax), upper gastrointestinal (gastroscopy), colorectal (colonoscopy), bladder (cystoscopy), and breast (clinical mammography).</p><p><strong>Design: </strong>Register-based time-to-event analyses.</p><p><strong>Setting: </strong>Denmark.</p><p><strong>Subjects: </strong>All 3.3 million citizens aged 30-85 years who on January first, 2017, had not previously been diagnosed with the specific type of cancer were categorized based on the time since their most recent examination.</p><p><strong>Main outcome measures: </strong>Using 1-year follow-up, we calculated the age- and sex-adjusted hazard ratios of being diagnosed with the related cancer, with non-examined individuals as reference. Negative examination results were defined as the absence of a cancer diagnosis within 6 months following the examination.</p><p><strong>Results: </strong>Previous negative examination results were common, also among those diagnosed with cancer during follow-up. For 10 years after a negative colonoscopy the risk of diagnosing a colorectal cancer was nearly halved. However, already 1 year after a clinical mammography and 2 years after a CT thorax the risk of diagnosing the related cancers was significantly higher among those with a previous negative result compared to non-examined individuals.</p><p><strong>Conclusion: </strong>This study did not identify a post-examination period in which the cancer risk, compared to non-examined individuals, was sufficiently low to confidently rule out any of the investigated cancers.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"246-253"},"PeriodicalIF":2.1,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11003324/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139511725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving cardiovascular control in a hypertensive population in primary care. Results from a staff training intervention.","authors":"Rebecka Quester, Staffan Björck, Karin Manhem, Jonatan Nåtman, Susanne Andersson, Per Hjerpe","doi":"10.1080/02813432.2024.2326470","DOIUrl":"10.1080/02813432.2024.2326470","url":null,"abstract":"<p><strong>Objective: </strong>A pilot study to evaluate a staff training intervention implementing a nurse-led hypertension care model.</p><p><strong>Design and setting: </strong>Clinical and laboratory data from all primary care centres (PCCs) in the Swedish region Västra Götaland (VGR), retrieved from regional registers. Intervention started 2018 in 11 PCCs. A total of 190 PCCs served as controls. Change from baseline was assessed 2 years after start of intervention.</p><p><strong>Intervention: </strong>Training of selected personnel, primarily in drug choice, team-based care, measurement techniques, and use of standardized medical treatment protocols.</p><p><strong>Patients: </strong>Hypertensive patients without diabetes or ischemic heart disease were included. The intervention and control groups contained approximately 10,000 and 145,000 individuals, respectively.</p><p><strong>Main outcome measures: </strong>Blood pressure (BP) <140/90 mmHg, LDL-cholesterol (LDL-C) <3.0 mmol/L, BP ending on -0 mmHg (digit preference, an indirect sign of manual measuring technique), choice of antihypertensive drugs, cholesterol lowering therapy and attendance patterns were measured.</p><p><strong>Results: </strong>In the intervention group, the percentage of patients reaching the BP target did not change significantly, 56%-61% (control 50%-52%), non-significant. However, the percentage of patients with LDL-<i>C</i> < 3.0 mmol/L increased from 34%-40% (control 36%-36%), <i>p =</i> .043, and digit preference decreased, 39%-27% (control 41%-35%), <i>p</i> = 0.000. The number of antihypertensive drugs was constant, 1.63 - 1.64 (control 1.62 - 1.62), non-significant, but drug choice changed in line with recommendations.</p><p><strong>Conclusion: </strong>Although this primary care intervention based on staff training failed to improve BP control, it resulted in improved cardiovascular control by improved cholesterol lowering treatment.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"347-354"},"PeriodicalIF":2.1,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11003316/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140060445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adjudications and tinkering with care for socially vulnerable patients with type 2 diabetes in general practice.","authors":"Ann Dorrit Guassora, Nina Tvistholm, Frida Greek Kofod, Sofie A Rogvi, Gitte Wind, Ulla Christensen","doi":"10.1080/02813432.2024.2317825","DOIUrl":"10.1080/02813432.2024.2317825","url":null,"abstract":"<p><strong>Objective: </strong>To analyse the mechanisms at play in the adjudications made by professionals and socially vulnerable patients with type 2 diabetes about their eligibility for care.</p><p><strong>Design, setting and subjects: </strong>The study included 14 patients and 10 health professionals in seven general practice surgeries in deprived areas in Greater Copenhagen. The study data consist of 17 semi-structured interviews with patients and 22 with health professionals immediately after observation of 23 consultations. Our analytical approach was inspired by Systematic Text Condensation and the concept of 'candidacy' for access to health care.</p><p><strong>Results: </strong>Adjudications of patients not being candidates for services were common, but we also found that both patients and health professionals worked to align the services to the needs of the patients. This could include using services differently than was intended by the providers or by changing routines to make it easier for patients to use the services. We discuss these processes as 'tinkering'. This usually implies that the best individual solution for the patient is aimed for, and in this study, the best solution sometimes meant not focusing on diabetes.</p><p><strong>Conclusion: </strong>The study adds to existing knowledge about access to services for socially vulnerable patients by demonstrating that both patients and professionals in general practice engage in tinkering processes to make services work.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"295-303"},"PeriodicalIF":2.1,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11003322/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140028831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of antibiotic treatment for respiratory infections in children an observational study in primary care.","authors":"Linn Karin Tjalvin Alvsåker, Maria Fehn Stensen, Anders Batman Mjelle, Steinar Hunskaar, Ingrid Keilegavlen Rebnord","doi":"10.1080/02813432.2024.2305929","DOIUrl":"10.1080/02813432.2024.2305929","url":null,"abstract":"<p><strong>Background: </strong>Antibiotic resistance is an increasing global threat, accelerated by both misuse and overuse of antibiotics. Most antibiotics to humans are prescribed in primary care, commonly for respiratory symptoms, and there is a need for research on the usage of and outcomes after antibiotic treatment to counteract antibiotic resistance.</p><p><strong>Objective: </strong>To evaluate symptom duration, treatment length, and adverse events of antibiotic treatment in children.</p><p><strong>Design and setting: </strong>Observational study at four out-of-hours services and one paediatric emergency clinic in Norwegian emergency primary care.</p><p><strong>Subjects: </strong>266 children aged 0 to 6 years with fever or respiratory symptoms.</p><p><strong>Main outcome measures: </strong>Duration of symptoms and absenteeism from kindergarten/school, treatment length, and reported adverse events.</p><p><strong>Results: </strong>There were no differences in duration of symptoms, fever or absenteeism when comparing the groups prescribed (30.8%) and not prescribed (69.2%) antibiotics. This lack of difference remained when analysing the subgroup with otitis media.In the group prescribed antibiotics, 84.5% of parents reported giving antibiotics for 5-7 days, and 50.7% reported no difficulties. Adverse events of antibiotics were reported in 42.3% of the cases, the vast majority being gastrointestinal disturbances.</p><p><strong>Conclusion: </strong>Children with fever or respiratory symptoms experience similar duration of symptoms and absenteeism regardless of antibiotic treatment. A substantial number of parents reported adverse events when the child received antibiotics. Several parents experienced additional difficulties with the treatment, some ending treatment within day 4.</p><p><strong>Trial registration number: </strong>NCT02496559; Results.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"237-245"},"PeriodicalIF":2.1,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11003315/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139542643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}