Scandinavian Journal of Primary Health Care最新文献

{"title":"The impact on primary care of a large waterborne campylobacter outbreak in Norway: a controlled observational study.","authors":"A Iversen, G Rortveit, K A Wensaas, C O Gulla","doi":"10.1080/02813432.2023.2299116","DOIUrl":"10.1080/02813432.2023.2299116","url":null,"abstract":"<p><strong>Objective: </strong>Document the impact of an outbreak of gastroenteritis on local primary health care services, compared to a control period.</p><p><strong>Design: </strong>Controlled observational study with data from the outbreak and a control period. Data obtained from electronic medical records (EMR) of general practitioners (GPs) and the out-of-hours (OOH) service. Telephone data from the OOH service's telephone records.</p><p><strong>Setting: </strong>Campylobacteriosis outbreak in Askøy municipality, Norway in 2019. Over 2000 individuals were infected.</p><p><strong>Subjects: </strong>Patients in contact with GPs and the OOH service during the outbreak and a control period.</p><p><strong>Main outcome measures: </strong>Patient contacts with GPs and the OOH service during the outbreak and a control period.</p><p><strong>Results: </strong>There was a 36% increase in contacts during the outbreak compared to the control period (4798 vs. 3528), with the OOH service handling 78% of outbreak-related contacts. Telephone advice was the dominant method for managing the increase in contacts to primary care, both in OOH services and daytime general practice (OR 3.73 CI: [3.24-4.28]). Children aged 0-4 years had increased use of primary care during the outbreak (OR 1.51 CI: [1.28-1.78]). GPs referred 25% and OOH services referred 75% of 70 hospitalized cases.</p><p><strong>Conclusion: </strong>The OOH service handled most of the patients during the outbreak, with support from daytime general practice. The outbreak caused a shift towards telephone advice as a means of providing care. Young children significantly increased their use of primary care during the outbreak.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"187-194"},"PeriodicalIF":2.1,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10851797/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139378159","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":"Suitability of issuing sickness certifications in remote consultations during the COVID-19 pandemic. A mixed method study of GPs' experiences.","authors":"Elin Breivik, Eli Kristiansen, Paolo Zanaboni, Monika A Johansen, Nicolas Øyane, Trine Strand Bergmo","doi":"10.1080/02813432.2023.2282587","DOIUrl":"10.1080/02813432.2023.2282587","url":null,"abstract":"<p><strong>Objective: </strong>To explore Norwegian GPs' experiences with and perceived suitability of issuing sickness certifications in remote consultations during the COVID-19 pandemic.</p><p><strong>Design: </strong>We used a mixed methods research design. An online survey with 301 respondents was combined with qualitative interviews with ten GPs.</p><p><strong>Setting: </strong>Norwegian general practice.</p><p><strong>Results: </strong>Most GPs agreed it was difficult to assess a patient's ability to work without physical attendance for a first-time certification in remote consultations. However, extending a certification was considered less problematic. If physical examinations were required, the GPs would ask the patient to come to the office. The most suitable diagnoses for remote certification were respiratory infections and COVID-19-related diagnoses, as well as known chronic and long-term diseases. The GPs emphasized the importance of knowing both the patient and the medical problem. The GP-patient relationship could be affected by remote consultations, and there were mixed views on the impact. Many GPs found it easier to deny a request for a sickness certification in remote consultations. The GPs expressed concern about the societal costs and an increased number of certifications if remote consultations were too easily accessible. The study was conducted during the COVID-19 pandemic, and the findings should be interpreted in that context.</p><p><strong>Conclusions: </strong>Our study shows that issuing sickness certifications in remote consultations were viewed to be suitable for COVID-19 related problems, for patients the GP has met before, for the follow-up of known medical problems, and the extension of sickness certifications. Not meeting the patient face-to-face may affect the GP-patient relationship as well as make the GPs' dual role more challenging.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"7-15"},"PeriodicalIF":2.1,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10851799/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138047806","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":"Effects of an interactive web-based support system via mobile phone on preference-based patient participation in patients living with hypertension - a randomized controlled trial in primary care.","authors":"Hanna Vestala, Marcus Bendtsen, Patrik Midlöv, Karin Kjellgren, Ann Catrine Eldh","doi":"10.1080/02813432.2023.2301567","DOIUrl":"10.1080/02813432.2023.2301567","url":null,"abstract":"<p><strong>Objective: </strong>To estimate the effects of an interactive web-based support system <i>via</i> mobile phone on preference-based patient participation in patients with hypertension treated in primary care (compared with standard hypertensive care only).</p><p><strong>Design: </strong>A parallel group, non-blinded, randomized controlled trial, conducted October 2018-February 2021. Besides standard hypertensive care, the intervention group received eight weeks of support <i>via</i> mobile phone to facilitate self-monitoring and self-management, tentatively providing for augmented patient engagement.</p><p><strong>Setting: </strong>31 primary healthcare centers in Sweden.</p><p><strong>Subjects: </strong>949 patients treated for hypertension.</p><p><strong>Main outcome measures: </strong>The effects on preference-based patient participation, that is, the match between a patient's preferences for and experiences of patient participation in their health and healthcare. This was measured with the 4Ps (Patient Preferences for Patient Participation) tool at baseline, after 8 weeks, and at 12 months. Data were registered electronically and analyzed with multilevel ordinal regression.</p><p><strong>Results: </strong>At baseline, 43-51% had a complete match between their preferences for and experiences of patient participation. There was an indication of a positive effect by a higher match for 'managing treatment myself' at 8-weeks in the intervention group. Such preference-based participation in their health and healthcare was reversed at 12 months, and no further effects of the intervention on preference-based patient participation persisted after 12 months.</p><p><strong>Conclusion: </strong>The interactive web-based support system <i>via</i> mobile phone had a wavering effect on preference-based patient participation. There is a prevailing need to better understand how person-centered patient participation can be facilitated in primary care.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"225-233"},"PeriodicalIF":2.1,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10851821/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139425404","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 the feasibility of an artificial intelligence based clinical decision support system for cutaneous melanoma detection in primary care - a mixed method study.","authors":"Jonatan Helenason, Christoffer Ekström, Magnus Falk, Panagiotis Papachristou","doi":"10.1080/02813432.2023.2283190","DOIUrl":"10.1080/02813432.2023.2283190","url":null,"abstract":"<p><p><b>Objective:</b> Skin examination to detect cutaneous melanomas is commonly performed in primary care. In recent years, clinical decision support systems (CDSS) based on artificial intelligence (AI) have been introduced within several diagnostic fields.<b>Setting:</b> This study employs a variety of qualitative and quantitative methodologies to investigate the feasibility of an AI-based CDSS to detect cutaneous melanoma in primary care.<b>Subjects and Design:</b> Fifteen primary care physicians (PCPs) underwent near-live simulations using the CDSS on a simulated patient, and subsequent individual semi-structured interviews were explored with a hybrid thematic analysis approach. Additionally, twenty-five PCPs performed a reader study (diagnostic assessment on the basis of image interpretation) of 18 dermoscopic images, both with and without help from AI, investigating the value of adding AI support to a PCPs decision. Perceived instrument usability was rated on the System Usability Scale (SUS).<b>Results:</b> From the interviews, the importance of trust in the CDSS emerged as a central concern. Scientific evidence supporting sufficient diagnostic accuracy of the CDSS was expressed as an important factor that could increase trust. Access to AI decision support when evaluating dermoscopic images proved valuable as it formally increased the physician's diagnostic accuracy. A mean SUS score of 84.8, corresponding to 'good' usability, was measured.<b>Conclusion:</b> AI-based CDSS might play an important future role in cutaneous melanoma diagnostics, provided sufficient evidence of diagnostic accuracy and usability supporting its trustworthiness among the users.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"51-60"},"PeriodicalIF":2.1,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10851794/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138047804","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":"General practitioners' role in safeguarding patients with dementia in their use of dietary supplements. A qualitative study.","authors":"Hilde Risvoll, Torsten Risør, Kjell H Halvorsen, Marit Waaseth, Trine Stub, Trude Giverhaug, Frauke Musial","doi":"10.1080/02813432.2023.2283182","DOIUrl":"10.1080/02813432.2023.2283182","url":null,"abstract":"<p><strong>Objective: </strong>The use of dietary supplements (DS) may cause harm through direct and indirect effects. Patients with dementia may be particularly vulnerable. This study aims to explore general practitioners' (GPs') experiences with DS use by these patients, the GPs perceived responsibilities, obstacles in taking on this responsibility, their attitudes toward DS, and suggestions for improvements to safeguard the use of DS in this patient group.</p><p><strong>Design: </strong>Qualitative individual interview study conducted February - December 2019. Data were analysed using systematic text condensation.</p><p><strong>Setting: </strong>Primary healthcare clinics in Norway.</p><p><strong>Subjects: </strong>Fourteen Norwegian GPs.</p><p><strong>Findings: </strong>None of the informants were dismissive of patients using DS. They were aware of the possible direct risks and had observed them in patients. Most GPs showed little awareness of potential indirect risks to patients with dementia who use DS. They acknowledged the need for caretaking of these patients. Although there were differences in practice styles, most of the GPs wished to help their patients safeguarding DS use but found it difficult due to the lack of quality assurance of product information. Furthermore, there were no effective ways for the GPs to document DS use in the patients' records. Several suggestions for improvement were given by the GPs, such as increased attention from GPs, inclusion of DS in the prescription software, and stricter regulatory systems for DS from the authorities.</p><p><strong>Conclusion: </strong>The GPs had initially little awareness of this safety risk, but there were differences in practice style and attitudes towards DS. The GPs did not perceive themselves as main responsible for safe use of DS in patient with dementia. The most important reason to disclaim responsibility was lack of information about the products. One suggestion for improvement was better integration of DS in patients' medical record.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"16-28"},"PeriodicalIF":2.1,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10851825/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138047805","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":"What would primary care practitioners do differently after a delayed cancer diagnosis? Learning lessons from their experiences.","authors":"Tuomas H Koskela, Magdalena Esteva, Marcello Mangione, Sara Contreras Martos, Senada Hajdarevic, Cecilia Högberg, Mercè Marzo-Castillejo, Jolanta Sawicka-Powierza, Vija Siliņa, Michael Harris, Davorina Petek","doi":"10.1080/02813432.2023.2296117","DOIUrl":"10.1080/02813432.2023.2296117","url":null,"abstract":"<p><strong>Objective: </strong>Diagnosis of cancer is challenging in primary care due to the low incidence of cancer cases in primary care practice. A prolonged diagnostic interval may be due to doctor, patient or system factors, or may be due to the characteristics of the cancer itself. The objective of this study was to learn from Primary Care Physicians' (PCP) experiences of incidents when they had failed to think of, or act on, a cancer diagnosis.</p><p><strong>Design: </strong>A qualitative, online survey eliciting PCP narratives. Thematic analysis was used to analyse the data.</p><p><strong>Setting and subjects: </strong>A primary care study, with narratives from 159 PCPs in 23 European countries.</p><p><strong>Main outcome measures: </strong>PCPs' narratives on the question 'If you saw this patient with cancer presenting in the same way today, what would you do differently?</p><p><strong>Results: </strong>The main themes identified were: thinking broadly; improvement in communication and clinical management; use of other available resources and 'I wouldn't do anything differently'.</p><p><strong>Conclusion (implications): </strong>To achieve more timely cancer diagnosis, PCPs need to provide a long-term, holistic and active approach with effective communication, and to ensure shared decision-making, follow-up and continuing re-assessment of the patients' clinical conditions.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"123-131"},"PeriodicalIF":2.1,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10851834/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138809139","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":"Importance of continuity of care from a patient perspective - a cross-sectional study in Swedish health care.","authors":"Ebba Cohen, Ida Lindman","doi":"10.1080/02813432.2023.2299119","DOIUrl":"10.1080/02813432.2023.2299119","url":null,"abstract":"<p><strong>Objective: </strong>The primary objective of this study was to evaluate the patients' view on continuity of care (CoC), including preference for a certain general practitioner (GP) and importance and access to a regular general practitioner (RGP).</p><p><strong>Design: </strong>Cross-sectional study.</p><p><strong>Setting: </strong>Primary care center in Halland County, in the western part of Sweden.</p><p><strong>Subjects: </strong>Patients ≥18 years old and having at least one appointment at the primary care center during October-December 2022.</p><p><strong>Main outcome measures: </strong>Preference for a certain GP and importance of and accessibility for an RGP.</p><p><strong>Results: </strong>The study included 404 patients. Importance of having an RGP was considered by 86% of the patients. Preference for a certain GP was thought by 73% of the patients, and when asked as a bivariate question, 69% considered having an RGP. Both the importance of an RGP and preference for a certain GP were more often considered by patients ≥65 years (<i>p</i> < .0001). Regarding accessibility, 67% of the patients reported having access to their RGP 'always/most of the time or a lot of the time' and 62% reported seeing their RGP at last visit.</p><p><strong>Conclusions: </strong>In conclusion, this study showed that the majority of patients value CoC in terms of importance of having an RGP. Older patients were more likely to have a preference for a certain GP. Two-third of the patients succeeded in seeing their RGP always or a lot of the time. The results in this study provide evidence that CoC is important for most patients, regardless of age and gender.Key pointsPrevious studies have showed that continuity of care (CoC) is important regarding mortality and morbidity. In primary care, there is a current debate regarding CoC, accessibility and the strive for CoC. This study showed that the majority of patients, regardless of age and gender, value CoC and consider it being important. However, there was a statistically significant difference regarding age, where patients above 65 years old thought it was more important to have a regular general practitioner and more often had a preference for a certain GP.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"195-200"},"PeriodicalIF":2.1,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10851828/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139378157","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":"The burden of persistent symptom diagnoses in primary care patients: a cross-sectional study.","authors":"Asma Chaabouni, Juul Houwen, Georg Grewer, Martin Liebau, Reinier Akkermans, Kees van Boven, Iris Walraven, Henk Schers, Tim Olde Hartman","doi":"10.1080/02813432.2023.2293930","DOIUrl":"10.1080/02813432.2023.2293930","url":null,"abstract":"<p><strong>Introduction: </strong>The burden of symptoms is a subjective experience of distress. Little is known on the burden of feeling unwell in patients with persistent symptom diagnoses. The aim of this study was to assess the burden in primary care patients with persistent symptom diagnoses compared to other primary care patients.</p><p><strong>Methods: </strong>A cross-sectional study was performed in which an online survey was sent to random samples of 889 patients with persistent symptom diagnoses (>1 year) and 443 other primary care patients after a transactional identification in a Dutch primary care data registry. Validated questionnaires were used to assess the severity of symptoms (PHQ-15), Symptom Intensity and Symptom Interference questionnaires, depression (PHQ-9), anxiety (GAD-7), quality of life (SF-12 and EQ-5D-5L)) and social functioning (SPF-ILs).</p><p><strong>Results: </strong>Overall, 243 patients completed the survey: 178 (73.3%) patients in the persistent symptom diagnoses group and 65 (26.7%) patients in the control group. In the persistent group, 65 (36.5%) patients did not have persistent symptom(s) anymore according to the survey response. Patients who still had persistent symptom diagnoses (<i>n</i> = 113, 63.5%) reported significantly more severe somatic symptoms (mean difference = 3.6, [95% CI: 0.24, 4.41]), depression (mean difference = 3.0 [95% CI: 1.24, 3.61]) and anxiety (mean difference = 2.3 [95% CI: 0.28, 3.10]) and significantly lower physical functioning (mean difference = - 6.8 [95% CI: -8.96, -3.92]).</p><p><strong>Conclusion: </strong>Patients with persistent symptom diagnoses suffer from high levels of symptoms burden. The burden in patient with persistent symptoms should not be underestimated as awareness of this burden may enhance person-centered care.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"112-122"},"PeriodicalIF":2.1,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10851811/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139378158","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":"Insulin initiation in patients with type 2 diabetes is often delayed, but access to a diabetes nurse may help-insights from Norwegian general practice.","authors":"Ibrahimu Mdala, Kjersti Nøkleby, Tore Julsrud Berg, John Cooper, Sverre Sandberg, Karianne Fjeld Løvaas, Tor Claudi, Anne Karen Jenum, Esben Selmer Buhl","doi":"10.1080/02813432.2023.2296118","DOIUrl":"10.1080/02813432.2023.2296118","url":null,"abstract":"<p><p><b>Objective</b>: We opted to study how support staff operational capacity and diabetes competences may impact the timeliness of basal insulin-initiation in general practice patients with type 2 diabetes (T2D).<b>Design/Setting/Outcomes:</b> This was an observational and retrospective study on Norwegian primary care patients with T2D included from the ROSA4-dataset. Exposures were (1) support staff size, (2) staff size relative to number of GPs, (3) clinic access to a diabetes nurse and (4) share of staff with diabetes course (1 and 2 both relate to staff operational capacity, whereas 3 and 4 are both indicatory of staff diabetes competences). Outcomes were 'timely basal insulin-initiation' (primary) and 'attainment of HbA_1c<7%' after insulin start-up (secondary). Associations were analyzed using multiple linear regression, and directed acyclic graphs guided statistical adjustments.<b>Subjects:</b> Insulin naïve patients with 'timely' (<i>N</i> = 294), 'postponed' (<i>N</i> = 219) or 'no need of' (<i>N</i> = 3,781) basal insulin-initiation, respectively.<b>Results:</b> HbA_1c [median (IQR)] increased to 8.8% (IQR, 8.0, 10.2) prior to basal insulin-initiation, which reduced HbA_1c to 7.3 (6.8-8.1) % by which only 35% of the subjects reached HbA_1c <7%. Adjusted risk of 'timely basal insulin-initiation' was more than twofold higher if access to a diabetes nurse (OR = 2.40, [95%CI, 1.68, 3.43]), but related only vaguely to staff size (OR = 1.01, [95%CI, 1.00, 1.03]). No other staff factors related significantly to neither the primary nor the secondary outcome.<b>Conclusion:</b> In Norwegian general practice, insulin initiation in people with T2D may be affected by therapeutic inertia but access to a diabetes nurse may help facilitating more timely insulin start-up.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"132-143"},"PeriodicalIF":2.1,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10851798/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138809138","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":"Local management of the COVID-19 pandemic in Norway: a longitudinal interview study of municipality chief medical officers.","authors":"Silje Rebekka Heltveit-Olsen, Lene Lunde, Anja Maria Brænd, Ivan Spehar, Sigurd Høye, Ingmarie Skoglund, Pär-Daniel Sundvall, Guro Haugen Fossum, Jørund Straand, Mette Bech Risør","doi":"10.1080/02813432.2023.2301562","DOIUrl":"10.1080/02813432.2023.2301562","url":null,"abstract":"<p><strong>Objective: </strong>To explore the experiences and views of Norwegian Municipality Chief Medical Officers (MCMOs) on preparedness, collaboration, and organization during the COVID-19 pandemic to gain insight into local crisis management of value for future pandemic responses.</p><p><strong>Design: </strong>Longitudinal qualitative interview study. We conducted semi-structured digital interviews with nine MCMOs working in different municipalities in Norway from September to December 2020. Five MCMOs were re-interviewed from January to April 2021. We used thematic analysis to analyze the data.</p><p><strong>Results: </strong>Through the analysis, three major themes were identified in the material; 1) The view of preparedness changed from being low-priority and dormant to the desire to strengthen preparedness as a permanent measure; 2) The nature of the pandemic forced a change in internal and external communication and collaboration for the MCMOs towards direct dialogue, teamwork and digital networking; 3) The pandemic changed the role and position of the MCMO within the municipal organization. Although most MCMOs were given a leading role in the municipal pandemic response, some MCMOs experienced that they were not positioned to fully exercise their intended role. In our material, de-authorization of the MCMO role seemed to coincide with the increasing size and organizational complexity of the municipality.</p><p><strong>Conclusions: </strong>The Norwegian pandemic response and outcome have been regarded as successful internationally. Although the MCMOs managed to implement flexible and quick responses facilitated by teamwork, dialogue, and joint sensemaking, they also identified several challenges and shortcomings of the Norwegian pandemic preparedness requiring organizational and financial changes to sustain future health system resilience.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"214-224"},"PeriodicalIF":2.1,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10851791/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139425405","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}