Scandinavian Journal of Primary Health Care最新文献

{"title":"Diagnostic methods and written advice for acute otitis media in primary health care.","authors":"Veronica Frey Esgård, Ida Lindman, Anja Maria Braend, Guro Haugen Fossum, Thorbjörn Lundberg, Anna Moberg, Lena Nordeman, Chrysoula Papachristodoulou, Pär-Daniel Sundvall","doi":"10.1080/02813432.2024.2352444","DOIUrl":"10.1080/02813432.2024.2352444","url":null,"abstract":"<p><strong>Background: </strong>Otomicroscopy and pneumatic methods are superior to otoscopy alone in diagnosing acute otitis media (AOM). There is a lack of knowledge regarding the use of different diagnostic methods for AOM in primary health care in Sweden and Norway.</p><p><strong>Methods: </strong>This cross-sectional study included a questionnaire completed by general practitioners (GPs) and specialist trainees (STs/residents/registrars) working in primary care in Sweden and Norway. Multivariable binary logistic regressions were performed to evaluate the use of diagnostic methods and written advice adjusted for educational level, sex and country.</p><p><strong>Results: </strong>Otoscopy was the most frequently used method. Sweden had greater access to the more accurate diagnostic methods. In Norway, the following methods were used to a lesser extent: pneumatic otoscopy, adjusted OR 0.15 (95% CI 0.10-0.23; <i>p</i> < .001), otomicroscopy, adjusted OR 0.013 (95% CI 0.070-0.027; <i>p</i> < .001), pneumatic otomicroscopy, adjusted OR 0.028 (95% CI 0.010-0.078; <i>p</i> < .001) and tympanometry, adjusted OR 0.31 (95% CI 0.21-0.45; <i>p</i> < .001). Written advice was used to a greater extent in Norway, adjusted OR 4.5 (95% CI 3.1-6.7; <i>p</i> < .001). The STs used pneumatic otoscopy and pneumatic otomicroscopy to a lesser extent, adjusted OR 0.65 (95% CI 0.45-0.93; <i>p</i> = .019) and 0.63 (95% CI 0.43-0.92; <i>p</i> = .016).</p><p><strong>Conclusions: </strong>Swedish physicians both used and had greater access to the significantly better diagnostic methods compared with Norwegian physicians while the opposite applied to the use of written information. The GPs used pneumatic otoscopy and pneumatic otomicroscopy to a greater extent than STs. Compared with 2012, the Swedish physicians now more frequently used pneumatic otoscopy.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"532-537"},"PeriodicalIF":1.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11552276/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140923286","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":"Clinical practice enhanced by interdisciplinary theoretical perspectives.","authors":"Kirsti Malterud, Susanne Reventlow, Ann Dorrit Guassora","doi":"10.1080/02813432.2024.2368852","DOIUrl":"10.1080/02813432.2024.2368852","url":null,"abstract":"<p><strong>Background: </strong>Experience-based knowing in general practice includes advanced interpretation of subjective, complex and particular phenomena in a social context. Enabling different metapositions for reflexivity may provide the accountability needed for such knowing to be recognized as evidence-based practice.</p><p><strong>Objective: </strong>To demonstrate and discuss the potential of substantive theories to enhance interpretation of complex challenges in clinical knowing in general practice.</p><p><strong>Methods: </strong>We present a fictional case to demonstrate how interdisciplinary substantive theories, with a relevant and specific match to concrete questions, can situate the clinical interaction at an accountable platform. A female patient with Parkinson's disease consults her GP complaining that the disease is restraining her life and threatening her future. The GP has some new ideas from Bandura's theory of self-efficacy and introduces the patient to strategies for further action.</p><p><strong>Findings: </strong>The case presents an example of how a relevant substantive theory may offer the GP: 1) a sharper focus for achievement: recognising the issues of fear and identity in chronic, progressive illness, 2) a subsequent position for individualized understanding of adequate strategies: encouraging physical and social activity in a well-known context, and 3) an invitation to consider further possibilities: finding ways to alleviate the burden of fear and progressive decline; engaging in joyful living.</p><p><strong>Implications: </strong>General practice knowledge embraces a diversity of sources with different evidence power. The transparency mediated to clinical practice when supported by relevant substantive theories may contribute to recognition of experience-based knowing as evidence-based practice.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"602-608"},"PeriodicalIF":1.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11552296/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141420694","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":"Norwegian general practitioners' and radiologists' perspectives on the referral, justification, and unnecessary imaging-a survey.","authors":"Elin Kjelle, Eivind Richter Andersen, Ingrid Øfsti Brandsæter, Bjørn Morten Hofmann","doi":"10.1080/02813432.2024.2366247","DOIUrl":"10.1080/02813432.2024.2366247","url":null,"abstract":"<p><strong>Aim: </strong>This study aimed to survey general practitioners' (GPs) and radiologists' perspectives on referrals, imaging justification, and unnecessary imaging in Norway.</p><p><strong>Materials and methods: </strong>The survey covered access to imaging, responsibilities, attitudes toward justification assessment, referral process, and demographics using multiple choice questions, statements to report agreement with using the Likert scale and one open question.</p><p><strong>Results: </strong>Forty radiologists and 58 GPs attending national conferences completed a web-based survey, with a 20/15% response rate, respectively. Both radiologists (97%) and GPs (100%) considered avoiding unnecessary examinations essential to their role in the healthcare service. Still, 91% of GPs admitted that they referred to imaging they thought was not helpful, while about 60% of the radiologists agreed that unnecessary imaging was conducted in their workplace. GPs reported pressure from patients and patients having private insurance as the most common reasons for doing unnecessary examinations. In contrast, radiologists reported a lack of clinical information and the inability to discuss patient cases with the GPs as the most common reasons.</p><p><strong>Conclusion: </strong>This study adds to our understanding of radiologists' and GPs' perspectives on unnecessary imaging and referrals. Better guidelines and, even more importantly, better communication between the referrer and the radiologist are needed. Addressing these issues can reduce unnecessary imaging and improve the quality and safety of care.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"574-581"},"PeriodicalIF":1.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11552244/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141451412","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":"Experiences of rehabilitation coordination among people on sick leave with mental health problems.","authors":"Kristin Lork, Louise Danielsson, Maria E H Larsson, Kristina Holmgren","doi":"10.1080/02813432.2024.2361242","DOIUrl":"10.1080/02813432.2024.2361242","url":null,"abstract":"<p><strong>Purpose: </strong>Return to work often requires collaboration between different stakeholders. Rehabilitation coordination is a resource in coordinating efforts during sick leave to facilitate return to work. The purpose of the present study was to describe how people at risk for sick leave or on sick leave with mental health problems experienced rehabilitation coordination.</p><p><strong>Materials and method: </strong>The study had a qualitative approach using qualitative content analysis as described by Graneheim and Lundman. Eleven semi-structured interviews were conducted with persons at risk for sick leave or on sick leave due to mental health problems and with experience of rehabilitation coordination.</p><p><strong>Results: </strong>The participants experience of rehabilitation coordination were described by the overarching theme <i>Building a bridge with many bricks between the person and society</i>. The theme was formed by four categories and eleven subcategories reflecting the complex context of rehabilitation coordination. The categories were <i>Collaboration in a new setting, Unburdened within certain limits, The way back to work is a joint project</i> and <i>Recognising challenges beyond the person.</i></p><p><strong>Conclusions: </strong>People with mental health problems experienced rehabilitation coordination as a meaningful link between healthcare and work. However, rehabilitation coordination needs to be more recognised within healthcare to increase accessibility. It seems important that interventions are directed not only towards the person, but also include the workplace for a sustainable return to work.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"560-573"},"PeriodicalIF":1.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11552252/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141248481","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 on HbA1c of referral of type 2 diabetes patients to secondary care.","authors":"Kjersti Nøkleby, Anne K Jenum, Esben Selmer Buhl, Tor Claudi, John G Cooper, Signe Flottorp, Karianne F Løvaas, Sverre Sandberg, Tore Julsrud Berg","doi":"10.1080/02813432.2024.2433107","DOIUrl":"https://doi.org/10.1080/02813432.2024.2433107","url":null,"abstract":"<p><strong>Aim: </strong>To study trajectories of HbA1c in type 2 diabetes (T2D) patients referred to diabetes outpatient clinics (DOCs), and to explore characteristics of referrals and patient pathways in patients treated in DOCs.</p><p><strong>Methods: </strong>We retrospectively followed T2D patients from the Norwegian population-based ROSA 4 study to identify persons with T2D who were referred to a DOC. We used latent class trajectory modelling to identify subgroups of patients with similar patterns of HbA1c one year before to one year after the first consultation at a DOC. We performed multinomial regression analyses to identify baseline characteristics associated with group membership.</p><p><strong>Results: </strong>Four hundred and two of 6716 T2D patients started treatment at a DOC, constituting a yearly starting rate of 1.5%. We identified three classes of HbA1c trajectories: (1) stable moderate hyperglycaemia (75%); (2) severe hyperglycaemia with a decline in HbA1c around referral (14%) and (3) severe hyperglycaemia with a decline in HbA1c after starting treatment at the DOC (11%). HbA1c trajectories were associated with diabetes duration RRR 0.92, CI (0.87, 0.97) in class 2 vs. 1 and 0.93 (0.88, 0.98) in class 3 vs. 1. Some differences were found between clinics in rejection rate, processes of care, and duration of follow-up.</p><p><strong>Conclusions: </strong>Norwegian GPs handle most T2D patients themselves. Those with T2D and severe hyperglycaemia had a considerable benefit from being referred to a DOC, though with two separate trajectories: One where HbA1c improved around the time of referral, and another that improved after starting in a DOC.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"1-11"},"PeriodicalIF":1.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771839","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":"Predictive modeling for identification of older adults with high utilization of health and social services.","authors":"Heba Sourkatti, Juha Pajula, Teemu Keski-Kuha, Juha Koivisto, Mika Hilvo, Jaakko Lähteenmäki","doi":"10.1080/02813432.2024.2372297","DOIUrl":"10.1080/02813432.2024.2372297","url":null,"abstract":"<p><strong>Aim: </strong>Machine learning techniques have demonstrated success in predictive modeling across various clinical cases. However, few studies have considered predicting the use of multisectoral health and social services among older adults. This research aims to utilize machine learning models to detect high-risk groups of excessive health and social services utilization at early stage, facilitating the implementation of preventive interventions.</p><p><strong>Methods: </strong>We used pseudonymized data covering a four-year period and including information on a total of 33,374 senior citizens from Southern Finland. The endpoint was defined based on the occurrence of unplanned healthcare visits and the total number of different services used. Input features included individual's basic demographics, health status and past usage of healthcare resources. Logistic regression and eXtreme Gradient Boosting (XGBoost) methods were used for binary classification, with the dataset split into 70% training and 30% testing sets.</p><p><strong>Results: </strong>Subgroup-based results mirrored trends observed in the full cohort, with age and certain health issues, e.g. mental health, emerging as positive predictors for high service utilization. Conversely, hospital stay and urban residence were associated with decreased risk. The models achieved a classification performance (AUC) of 0.61 for the full cohort and varying in the range of 0.55-0.62 for the subgroups.</p><p><strong>Conclusions: </strong>Predictive models offer potential for predicting future high service utilization in the older adult population. Achieving high classification performance remains challenging due to diverse contributing factors. We anticipate that classification performance could be increased by including features based on additional data categories such as socio-economic data.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"609-616"},"PeriodicalIF":1.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11552250/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141493238","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":"Changes in location and number of nurse consultations as the supply of general practitioners decreases in primary health care: six-year register-based follow-up cohort study in the city of Vantaa, Finland.","authors":"Aina Enckell, Merja K Laine, Hanna-Maria Roitto, Marko Raina, Timo Kauppila","doi":"10.1080/02813432.2024.2375548","DOIUrl":"10.1080/02813432.2024.2375548","url":null,"abstract":"<p><strong>Objective: </strong>To investigate whether the location and the number of nurse consultations have changed in response to the continuously decreasing number of GP consultations in the fourth-largest city in Finland. It has been suggested that nurse consultations are replacing GP consultations.</p><p><strong>Design: </strong>A retrospective register-based follow-up cohort study.</p><p><strong>Setting: </strong>Public primary health care in the City of Vantaa, Finland.</p><p><strong>Subjects: </strong>All documented face-to-face office-hour consultations with practical and registered nurses, and consultations with practical and registered nurse in the emergency department of Vantaa primary health care between 1 January 2009 and 31 December, 2014.</p><p><strong>Main outcome measures: </strong>Change in the number of consultations with practical and registered nurses between 2009 and 2014 in primary health care both during office-hours and in the emergency department.</p><p><strong>Results: </strong>Over the follow-up period, the monthly median number of practical nurse consultations in the emergency department per 1000 inhabitants increased from 1.6 (interquartile range [IQR] 1.3-1.7) to 10.5 (10.3-12.2) (<i>p</i> < 0.001) and registered nurse consultations from a median of 3.6 (3.0-4.0) to 14.5 (13.0-16.6) (<i>p</i> < 0.001). However, there was no significant change in the median monthly number of office-hour consultations with practical or registered nurses.</p><p><strong>Conclusions: </strong>It appears that in primary health care, medical consultations have shifted from GPs to nurses with lower education levels, and from care during office-hours to emergency care.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"643-649"},"PeriodicalIF":1.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11552289/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141555451","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":"Physicians' intentions to use digital tools - a comparative survey, before and after the COVID-19 pandemic, in Southern Sweden.","authors":"Sofia Olofsson, Fredric Karlsson, Miriam Pikkemaat, Björn Ekman, Mattias Rööst, Hans Thulesius, Veronica Milos Nymberg","doi":"10.1080/02813432.2024.2346133","DOIUrl":"10.1080/02813432.2024.2346133","url":null,"abstract":"<p><strong>Objectives: </strong>To describe changes in Swedish primary care physicians' use of, attitudes and intentions toward digital tools in patient care between 2019 and 2022.</p><p><strong>Design: </strong>A survey using a validated questionnaire measuring physician's intentions to use digital tools based on the theory of planned behavior.</p><p><strong>Setting: </strong>Sample of primary health care centers in southern Sweden.</p><p><strong>Subjects: </strong>Primary care physicians.</p><p><strong>Main outcome measures: </strong>Self-reported use and intentions to use, digital tools including digital consultations by text or video, chronic disease monitoring and artificial intelligence (AI) and the associations between attitudes, subjective norms, perceived behavioral control and behavioral intentions to use digital tools, in 2019 compared to 2022.</p><p><strong>Results: </strong>In both 2019 (<i>n</i> = 198) and 2022 (<i>n</i> = 93), physicians reported high intentions to use digital tools. Self-reported use of video was slightly higher in 2022 (<i>p</i> = .03). No other changes were seen in the self-reported use or behavioral intentions to use digital tools.</p><p><strong>Conclusion: </strong>The slow adoption of patient-related digital tools in Swedish primary health care does not seem to be explained by a low intention to use them among physicians. Future research on implementation of digital tools should include a focus on contextual factors such as organizational, technical and cultural barriers.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"497-514"},"PeriodicalIF":1.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11552288/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140865852","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":"Reflections of nurses and primary healthcare managers on integrating hospital at home into public primary healthcare services: a Norwegian focus group study.","authors":"Lillian Karlsen, Bente Prytz Mjølstad, Bjarte Bye Løfaldli, Anne-Sofie Helvik","doi":"10.1080/02813432.2024.2373310","DOIUrl":"10.1080/02813432.2024.2373310","url":null,"abstract":"<p><strong>Background: </strong>Hospital at home (HaH) is an innovative approach to healthcare delivery that brings specialized services to patients' homes. HaH services are typically available in urban areas where hospitals can easily reach nearby patients. An integrated care model that utilizes the public primary healthcare system may extend HaH services to include patients residing further away from hospitals. However, there is limited evidence of primary healthcare employees' views on integrating HaH care into primary healthcare services. This study aimed to explore the reflections of primary healthcare employees on integrating HaH care into primary healthcare services.</p><p><strong>Methods: </strong>Ten focus group interviews were conducted with homecare nurses and managers of primary healthcare services in five municipalities in Mid-Norway. Reflexive thematic analysis was used to analyze the data.</p><p><strong>Results: </strong>The analysis resulted in three key themes regarding the integration of HaH care into primary healthcare. Participants discussed how they capture the distinctiveness of HaH care within the primary healthcare landscape. Moreover, they identified that the introduction of HaH care reveals opportunities to address challenges. Lastly, the study uncovered a strong primary healthcare commitment and a sense of professional pride among the participants. This resilience and dedication among primary healthcare employees appeared as an incentive to make the integration of HaH work.</p><p><strong>Conclusions: </strong>This study offers valuable insights into integrating HaH into primary healthcare services, highlighting opportunities to address challenges. The resilience and dedication of primary healthcare employees underscore their commitment to adapting to and thriving with HaH care. To establish a sustainable HaH care model, it is important to address geographical limitations, consider the strain on providers, maintain robust relationships, enhance funding, and formalize decision-making processes.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"633-642"},"PeriodicalIF":1.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11552280/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141493239","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":"Gatekeeping and referral of patients holding private health insurance: a survey among general practitioners in Norway.","authors":"Jørgen Breivold, Karin Isaksson Rø, Stein Nilsen, Merethe Kristine Kousgaard Andersen, Jørgen Nexøe, Stefán Hjörleifsson","doi":"10.1080/02813432.2024.2380923","DOIUrl":"10.1080/02813432.2024.2380923","url":null,"abstract":"<p><strong>Objective: </strong>Private health insurance is becoming more common in Norway. The aim of this study was to investigate GPs' opinions on private health insurance, and their experiences from consultations where health insurance can affect decisions about referring.</p><p><strong>Design: </strong>A web based cross-sectional survey.</p><p><strong>Setting: </strong>Norwegian general practice.</p><p><strong>Subjects: </strong>All GPs in Norway were in 2019 invited to participate in an online survey.</p><p><strong>Main outcome measures: </strong>The GPs' opinions and experiences regarding health insurance were reported as proportions. Multiple logistic regression was used to test associations between how frequently GPs refer patients without further considerations and variables concerning their characteristics, opinions, and experiences.</p><p><strong>Results: </strong>Of 1,309 GPs (response rate 27%), 93% stated that private health insurance raises the risk of overtreatment and 90% considered such insurance to contribute to inequality in health. Frequently being pressured to refer in the absence of a medical indication was reported by 42%. Moreover, 28% often or always chose to refer patients without further consideration, and this was associated with perceptions of pressure with an adjusted odds ratio (AOR) of 3.80, 95% confidence interval (CI) 2.73-5.29, and unpleasant reactions from patients following refusals (AOR 1.63, 95% CI 1.14-2.33).</p><p><strong>Conclusion: </strong>Although most participating GPs associated private health insurance with overtreatment and inequality in health, more than one in four choose to refer without further consideration. GPs' experience of pressure to refer and negative reactions from patients when they consider referrals not to be medically indicated, raises the risk of medical overuse for patients holding private health insurance.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"695-703"},"PeriodicalIF":1.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11552242/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141749057","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}