Scandinavian Journal of Primary Health Care最新文献

{"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}

{"title":"The impact of COVID-19 pandemic restrictions on general practitioner contacts among patients with common and at-risk diagnoses: a Norwegian registry-based study.","authors":"Jonas Nordvik Dale, Tone Morken, Knut Eirik Eliassen, Jesper Blinkenberg, Guri Rortveit, Valborg Baste","doi":"10.1080/02813432.2025.2491762","DOIUrl":"https://doi.org/10.1080/02813432.2025.2491762","url":null,"abstract":"<p><strong>Background: </strong>Disease prevention strategies during the COVID-19 pandemic could potentially disrupt the continuity of care. Aims: (1) describe changes in contacts with general practitioner (GP) before and during the pandemic, (2) compare consultation rates for common and at-risk diagnoses, and (3) examine the impact of COVID-19 restrictions on monthly consultation rates across patient subgroups.</p><p><strong>Methods: </strong>Register study with data from the Norwegian Registry for Primary Health Care (NRPHC) for the period 1 April 2018 to 30 March 2021. Changes in consultation rate were the main outcome. Twenty-five diagnoses representing common and at-risk for mortality diagnoses were studied. Interrupted time series analyses were applied.</p><p><strong>Results: </strong>Face-to-face consultations decreased from 2935 to 2304 per 1000 inhabitants per year from the pre-pandemic period to the first pandemic year, with an increase in e-consultations from 60 to 846 per 1000 inhabitants per year. Consultations for common diagnoses decreased by 25.6%, whereas those for high-risk diagnoses decreased by 10.7%. In the group of common diagnoses, the decrease in average monthly consultation rates was less among the eldest compared to the youngest age group. A similar decrease was found in the group with multiple morbid conditions compared to single or no morbidity.</p><p><strong>Conclusions: </strong>The pandemic resulted in fewer face-to-face consultations, but there was a substantial rise in electronic consultations. Consultations for at-risk for mortality diagnoses decreased relatively less than for common diagnoses. Consultation rates for older adults and those with multiple decreased less, suggesting that sicker patients continued to visit their GP during the pandemic.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"1-12"},"PeriodicalIF":1.9,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022158","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":"Enhancing primary care quality improvement through national data collection and validation: the primary care quality initiative in Sweden.","authors":"Jörgen Månsson, Malin André, Emil Johansson, Charlotta Malmer Hagstam, Maria C M Eriksson, Susanne Steen, Ulrika Elmroth, Eva Arvidsson","doi":"10.1080/02813432.2025.2490921","DOIUrl":"https://doi.org/10.1080/02813432.2025.2490921","url":null,"abstract":"<p><strong>Objective: </strong>Quality measures in healthcare are crucial for improving outcomes and ensuring patient safety. This study investigated the evolution, implementation, and impact of Primary Care Quality (PCQ). The PCQ aims to facilitate nationwide quality benchmarking, serving as a tool for quality improvement (QI) and research.</p><p><strong>Design/settings: </strong>A descriptive design outlining the development and operationalisation of the PCQ, a national framework for automatic and systematic data collection and feedback.</p><p><strong>Results: </strong>The national PCQ system is a tool for continuous QI in primary care in Sweden. PCQ has achieved extensive adoption, with over 97% of Swedish primary care centres, both private and public driven, utilising the platform for automatic data extraction from patient records and data visualisation. Quality indicators were developed through a structured approach involving primary care professionals, evidence-based clinical practices, and expert contributions from established knowledge organisations, reflecting the breadth of general practice. Data are automatically retrieved from medical records and visualised in real time, with the possibility of benchmarking at an aggregate level and identifying individuals locally at primary care centres. The PCQ has facilitated improvements by enabling quality dialogue among healthcare professionals and supporting continuous local QI. Regionally, the PCQ supports needs assessments and patient safety initiatives. Nationally, it establishes standardised indicators for quality measurement, enabling effective benchmarking and strategic healthcare planning.</p><p><strong>Conclusions: </strong>The implementation of the national PCQ system provided a framework and tool for continuous QI in primary care. The system has influenced national standardization of primary care indicators, with quality improvement results demonstrated regionally and locally through the PCQ.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"1-11"},"PeriodicalIF":1.9,"publicationDate":"2025-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054264","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":"Reorganization of the Danish out-of-hours primary care - a descriptive study.","authors":"Morten Breinholt Søvsø, Janus Laust Thomsen, Erika Frischknecht Christensen, Kasper Karmark Iversen, Fredrik Folke, Christian Backer Mogensen, Annmarie Lassen, Jens Søndergaard, Helle Collatz Christensen, Mette Elkjær, Andreas Søndergaard Heltberg, Ulla Væggemose, Søren Mikkelsen, Lars Bredevang Andersen, Martin Faurholdt Gude, Tine Bennedsen Gehrt, Erik Zakariassen, Linda Huibers","doi":"10.1080/02813432.2025.2490915","DOIUrl":"https://doi.org/10.1080/02813432.2025.2490915","url":null,"abstract":"<p><strong>Background: </strong>Increasing demand for healthcare due to demographic changes and shortage of healthcare professionals challenges the provision of unplanned care. In Denmark, different organizational changes across all regions have been implemented to meet these challenges. This provides great potential for research on the effect of different organizational choices on the use and quality of healthcare. Thus, we aim to provide a comprehensive overview of the current organizational models for acute unplanned out-of-hours primary care (OOHPC) across the five Danish regions, incorporating key contextual factors to characterize these regional systems.</p><p><strong>Methods: </strong>Nationwide cross-sectional survey study on OOHPC models in all Danish regions (North, Central, Southern, Capital, and Zealand). Survey questions covered a list of predefined topics created in the author group. One survey was completed per region.</p><p><strong>Results: </strong>OOHPC models differ across regions and time of day. In the North, Central, and Southern regions from 4 PM-11 PM, general practitioner (GP) cooperatives deliver OOHPC (telephone triage, tele- and clinic consultations, and home visits). From 11 PM-8 AM, the regional emergency medical services provide OOHPC in the North (GPs/physicians, paramedics) and Central (physicians, nurses, paramedics) regions. In the Southern region, the administrative responsibility of the OOHPC lies with the emergency department, but GPs provide healthcare aided by paramedics. The Capital, Central (nights), and Zealand regions have nurses and physicians performing telephone triage. All regions provide clinic consultations with physicians. In the Capital region, these consultations are hospital-based. Currently, no OOHPC data is transferred to national registries in four regions during nighttime.</p><p><strong>Conclusion: </strong>Danish OOHPC models differ substantially regarding the use of healthcare professionals for delivering acute unplanned care. All regions still provide gatekeeping, where OOHPC performs a primary evaluation before a possible hospital contact. Delivery of relevant data to registries has decreased substantially with the current models, potentially creating a barrier for nationwide research on OOHPC.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"1-10"},"PeriodicalIF":1.9,"publicationDate":"2025-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143979061","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":"Task shifting from general practitioners to nurses in out-of-hours primary care: an explorative case study of team-based practices.","authors":"Katrine Bjørnshave Bomholt, Anna Mygind, Mette Amalie Nebsbjerg, Morten Bondo Christensen, Linda Huibers, Viola Burau","doi":"10.1080/02813432.2025.2490911","DOIUrl":"https://doi.org/10.1080/02813432.2025.2490911","url":null,"abstract":"<p><strong>Background: </strong>Out-of-hours primary care (OOH-PC) is essential for treating urgent health problems. However, the high demand for these services has increased the workload.</p><p><strong>Objective: </strong>To investigate the interprofessional collaboration in OOH-PC and task shifting from general practitioners (GPs) to nurses, specifically the professional practices and the perceived experiences of GPs and nurses.</p><p><strong>Methods: </strong>This explorative case study was based on observations and interviews, using normalisation process theory as the theoretical framework. Observations were conducted in two OOH-PC clinics in the Central Denmark Region, followed by individual semi-structured interviews with five GPs and six nurses working in these clinics. Data were collected from March to October 2022.</p><p><strong>Results: </strong>GPs and nurses worked together in a team-based workflow based on different roles and skills but joint tasks. The nurses handled patients with injuries and performed diagnostic tests. A team-based workflow with task shifting was supported by familiarity within the team, with nurses performing informal coordination tasks and having formal support like protocols, training, and GP supervision. GPs and nurses appreciated the team-based workflow, as it facilitated efficient resource use and high job satisfaction. However, both groups expressed concerns about the sustainability of OOH-PC clinics.</p><p><strong>Conclusion: </strong>Task shifting from GPs to nurses in OOH-PC is feasible in a team-based workflow, resulting in efficient use of available resources and high job satisfaction. However, task shifting should not aim to replace GPs with nurses. Instead, their roles and skills should be seen as complementary, which calls for task sharing.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"1-13"},"PeriodicalIF":1.9,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143994267","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":"Does point-of-care ultrasound examination by the general practitioner lead to inappropriate care? A follow-up study.","authors":"Camilla Aakjær Andersen, John Brandt Brodersen, Jan Mainz, Janus Laust Thomsen, Ole Graumann, Thomas Løkkegaard, Martin Bach Jensen","doi":"10.1080/02813432.2025.2487095","DOIUrl":"https://doi.org/10.1080/02813432.2025.2487095","url":null,"abstract":"<p><strong>Background: </strong>The use of point-of-care ultrasound (POCUS) in general practice increases, but little is known about potential unintended findings and harms to patients. Information regarding such unwanted effects may be obtained by evaluating the medical records of patients who have been scanned by their general practitioner.</p><p><strong>Objective: </strong>To identify and characterize re-consultations related to POCUS use in general practice, potential misdiagnosis, overdiagnosis, and incidental findings, and to compare potentially troublesome cases to GPs' scanning competence and type of ultrasound device.</p><p><strong>Design and setting: </strong>Professors in general practice with extensive experience in both research and quality assurance in general practice did a blinded review of prospectively collected routine electronic medical record data combined with cross-sectional data collected in relation to POCUS examinations.</p><p><strong>Subjects: </strong>Twenty general practitioners collected data on 564 patients examined with POCUS in primary care.</p><p><strong>Main outcome measures: </strong>International standards for the classification of adverse events and incidental findings were used. First, research assistants identified all re-consultations described in the medical records that were related to the primary health complaint at the index consultation. Second, these re-consultations were classified by the medical experts in terms of seriousness and relation to the POCUS examination performed at the index consultation. In addition, the experts identified possible misdiagnosis, possible overdiagnosis, and incidental findings. Finally, identified cases were discussed in terms of appropriateness and described narratively.</p><p><strong>Results: </strong>Medical records of 564 patients were reviewed. A low risk of possible misdiagnosis (5.3%), potential overdiagnosis (0.7%), and incidental findings (0.7%) were found. Eleven POCUS-related re-consultations were identified and described.</p><p><strong>Conclusion: </strong>POCUS scanning performed by general practitioners was generally safe, but it can result in unnecessary examinations and potential harm in a few cases. Certain areas, e.g. pelvic scans that included the ovaries, may especially be prone to misdiagnosis.</p><p><strong>Trial registration number: </strong>NCT03375333.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"1-13"},"PeriodicalIF":1.9,"publicationDate":"2025-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022258","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.","authors":"Håkan Hanberger, Anders Ternhag, Enrico Baraldi, Sofia Wagrell, Charlotta Edlund","doi":"10.1080/02813432.2025.2487094","DOIUrl":"10.1080/02813432.2025.2487094","url":null,"abstract":"","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"1-2"},"PeriodicalIF":1.9,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143803993","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":"No longer alone.","authors":"Lottie Sällström Randsalu, Kjerstin Stigmar","doi":"10.1080/02813432.2025.2486145","DOIUrl":"10.1080/02813432.2025.2486145","url":null,"abstract":"<p><strong>Background and purpose: </strong>Absence from work due to illness is common in many western countries and has many negative consequences for both the individual and society. Since 2020 Swedish healthcare regions are required to provide resources to coordinate the rehabilitation process, a complex system involving medical as well as work-related parties, where both the physician and the rehabilitation coordinator play a central role. The aim of this study was to describe how primary care physicians experience the role of and the collaboration with a rehabilitation coordinator.</p><p><strong>Materials and methods: </strong>We used a qualitative design doing semi-structured interviews with primary care physicians (n= 9) in the Skåne healthcare region. The interviews were recorded, transcribed and analyzed using qualitative content analysis.</p><p><strong>Results: </strong>One main category \"An external and internal connecting point that has improved the sick-listing and rehabilitation process\", and four subcategories: \"Provides relief for the individual physician\"; \"Offers practical support at the clinic\"; \"Gives increased sense of security for the patients\" and \"Sufficiently trained, with potential to take further responsibility\", were determined.</p><p><strong>Conclusions: </strong>The study shows that primary care physicians experienced benefits from a close collaboration with a rehabilitation coordinator, feeling less lonely. The rehabilitation coordinator is often regarded as having a central role in insurance medicine related tasks, but an even more active role is desired.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"1-11"},"PeriodicalIF":1.9,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143781022","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 untapped potential for healthcare to support recovery for patients with stress-related exhaustion disorder - creating an experience of generalised safety.","authors":"Susanne Ellbin, Agneta Lindegård, Fredrik Bååthe","doi":"10.1080/02813432.2025.2480869","DOIUrl":"https://doi.org/10.1080/02813432.2025.2480869","url":null,"abstract":"<p><strong>Background: </strong>Exhaustion disorder (ED) is one of the most rapidly increasing causes of sick leave in Sweden. The prolonged recovery time from ED creates a dilemma on both the societal and individual level. How patients experience the encounter with health care is critical for the recovery from ED. The aim of this study was to explore how patients with ED experience the encounter with health care.</p><p><strong>Method: </strong>Data from 23 semi‑structured interviews with ED patients were analysed using content analysis.</p><p><strong>Results: </strong>One of the main findings was that patients want to be listened to and taken seriously in the encounter with health care. However, patients experience that healthcare struggles to meet these expectations. Several informants reported not being listened to, worrying symptoms were overlooked, an individualised care plan was lacking, and patients experienced that they were prematurely dismissed. This created an experience of unsafety, and that could inadvertently maintain the stress response and negatively influence recovery for patients with stress‑related disorders.</p><p><strong>Conclusion: </strong>It is paramount to convey an experience of predictability, despite the fact that patients undergo an unpredictable process related to their ED illness. By combining the traditional load‑recovery theory with the generalised unsafety theory of stress, we can tap into the potential to enhance recovery for patients with ED. We suggest that if the encounter with healthcare provides an experience of generalised safety, the conditions for patients with stress‑related disorders to recover would be distinctly enhanced.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"1-8"},"PeriodicalIF":1.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764969","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":"Supporting parents to inform their adolescent children about their illness in Scandinavian primary health care: opportunities and challenges.","authors":"Charlotte Oja","doi":"10.1080/02813432.2025.2482037","DOIUrl":"https://doi.org/10.1080/02813432.2025.2482037","url":null,"abstract":"","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"1-3"},"PeriodicalIF":1.9,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143693142","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}