Scandinavian Journal of Primary Health Care最新文献

{"title":"Care manager organisation in Swedish primary care centres: impact of sick leave and sick leave duration in patients with common mental disorders. A register-based study.","authors":"Christine Sandheimer, Cecilia Björkelund, Dominique Hange, Christina Möller, Eva-Lisa Petersson, Irene Svenningsson, Gunnel Hensing","doi":"10.1080/02813432.2025.2477150","DOIUrl":"https://doi.org/10.1080/02813432.2025.2477150","url":null,"abstract":"<p><strong>Motivation: </strong>Primary care centres are the first line of mental health service in Sweden responsible for individuals with mild to moderate severe symptoms of common mental disorders (CMD). The aim was to evaluate impact of sick leave and sick leave duration in patients diagnosed with CMD in primary care centres with a care manager organisation during the first and second year after implementation compared to usual care.</p><p><strong>Methods: </strong>Register data on sick leave (mean number of net and gross sick leave days) among patients with CMD was obtained per primary care centre from the national social insurance database MiDAS. Two measures of sick leave were used: <i>impact of sick leave</i> in total patient population with CMD, and <i>sick leave duration</i> among sick listed patients with CMD. Linear mixed-effects regression analysis was performed for cross-sectional differences and longitudinal changes between and within the two groups of primary care centres.</p><p><strong>Results: </strong>Primary care centres with care as usual had a lower proportion of sick listed patients with CMD at both year 1 and 2. Primary care centres with a care manager organisation (CMO) had significantly fewer mean number of sick leave days (net and gross days) among patients with CMD compared to centres with care as usual, indicating a lower impact of sick leave. Sick leave duration among sick listed patients did not show statistically significant differences between the two groups of primary care centres. Both groups of primary care centres increased their sick leave duration significantly from year 1 to year 2, congruent to Sweden as a whole.</p><p><strong>Conclusion: </strong>The aim of this study was to evaluate two measures of sick leave in primary care centres with a care manager organisation compared to care as usual. There were no differences in sick leave duration. Primary care centres with a care manager organisation, designed to increase accessibility and continuity for patients with CMD, seemed to facilitate the primary care centre's possibility to offer enhanced care taking to more patients with CMD with continued lower levels of impact of sick leave compared to care as usual.</p><p><strong>Implementation: </strong>This study evaluated outcomes after implementation of CMO at primary care centres.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"1-9"},"PeriodicalIF":1.9,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625778","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":"A machine learning tool for identifying metastatic colorectal cancer in primary care.","authors":"Eliya Abedi, Marcela Ewing, Elinor Nemlander, Jan Hasselström, Annika Sjövall, Axel C Carlsson, Andreas Rosenblad","doi":"10.1080/02813432.2025.2477155","DOIUrl":"https://doi.org/10.1080/02813432.2025.2477155","url":null,"abstract":"<p><strong>Background: </strong>Detection of colorectal cancer (CRC) is mainly achieved by clinical assessment. As new treatments become available for metastatic CRC (MCRC), it is important to accurately identify these patients.</p><p><strong>Aim: </strong>To develop a predictive model for identifying MCRC in primary health care patients using diagnostic data analysed with machine learning.</p><p><strong>Design and setting: </strong>A case-control study utilising data on primary health care visits for 146 patients >18 years old diagnosed with MCRC in the Västra Götaland Region, Sweden during 2011, and 577 sex-, age, and primary health care centre-matched controls.</p><p><strong>Method: </strong>Stochastic gradient boosting was used to construct a model for predicting the presence of MCRC based on diagnostic codes from primary health care consultations during the year before index (diagnosis) date and number of consultations. Variable importance was estimated using the normalised relative influence (NRI) score. Risks of having MCRC were calculated using odds ratios of marginal effects (OR_ME).</p><p><strong>Results: </strong>The optimal model included 76 variables with non-zero influence, had an area under the curve of 76.5%, a sensitivity of 77.8%, and a specificity of 69.2%. The 10 most important variables had a combined NRI of 61.0%. Number of consultations during the year before index date had the highest NRI at 19.2%, with an OR_ME of 3.3.</p><p><strong>Conclusion: </strong>A machine learning method based on primary health care consultation frequency and diagnoses may be used to identify important variables for predicting presence of MCRC. Both primary health care consultations and associated diagnostic codes need to be taken into consideration.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"1-9"},"PeriodicalIF":1.9,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143625695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patients' experiences with GLP1-RAs - a systematic review.","authors":"Christoffer Kraul Ibsen, Marius Brostrøm Kousgaard, Sofie Olsen, Ann-Kathrin Lindahl Christiansen, Catharina Thiel Sandholdt, Rasmus Rørth, Gritt Overbeck","doi":"10.1080/02813432.2025.2477141","DOIUrl":"https://doi.org/10.1080/02813432.2025.2477141","url":null,"abstract":"<p><strong>Background: </strong>Obesity is a complex condition and a recognized public health challenge. Previous treatment options were associated with high failure rates, but recent trials have shown that significant weight loss can be achieved with GLP1-RAs. However, little is known about the patient's experiences with GLP1-RAs.</p><p><strong>Objectives: </strong>This paper systematically reviews research on patients' experience with GLP1-RAs.</p><p><strong>Methods: </strong>A literature search in PubMed, PsycINFO, Embase and Sociological Abstracts included studies on adults' experiences with GLP1-RAs, regardless of methodology. Exclusions of studies: mental illness, pregnancy, former bariatric surgery, PCOS. Study quality and transparency were assessed according to design, using thematic analysis for synthesis.</p><p><strong>Results: </strong>Nine studies, selected from 7,607 records, encompassed three qualitative studies (semi-structured interviews), three RCTs, two narrative reviews and one survey study. The analysis identified five key themes: (1) Patients are willing to accept adverse events, like gastrointestinal disorders, for successful weight loss, (2) Patients experience improved physical functioning, well-being, and active daily living as a result of weight loss, (3) Patients express diverse opinions and skills regarding the medication's usability, (4) Patients believe that the medication improves their ability to manage sweet cravings, (5) Gender seems to affect patients' experiences with the medication, with females reporting more benefits than males.</p><p><strong>Conclusion: </strong>Despite a huge demand and usage of GLP1-RAs, qualitative research on patients' experiences is scarce. Further studies are crucial for understanding short and long-term patient experiences.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"1-10"},"PeriodicalIF":1.9,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143606330","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":"Primary health care in Ukraine is a cornerstone in both health reform and response to the full-scale invasion.","authors":"Jens Wilkens, Michael Harris, Pavlo Kolesnyk","doi":"10.1080/02813432.2025.2477787","DOIUrl":"https://doi.org/10.1080/02813432.2025.2477787","url":null,"abstract":"","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"1-3"},"PeriodicalIF":1.9,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143606288","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":"Struggling in no-man's land between childhood and adulthood - a phenomenological-hermeneutical video-observation study exploring adolescent males' encounters with general practitioners.","authors":"Johanna Haraldsson, Linus Johnsson, Per Kristiansson, Ylva Tindberg, Lena Nordgren","doi":"10.1080/02813432.2025.2475507","DOIUrl":"https://doi.org/10.1080/02813432.2025.2475507","url":null,"abstract":"<p><strong>Objective: </strong>Many adolescent males report negative experiences of consultations with general practitioners (GPs), which contrasts with the importance of patient-centredness that GPs themselves emphasise. A better understanding of this discrepancy might facilitate improvements. The aim was to explore and describe adolescent males' encounters with GPs in Swedish primary healthcare centres using a lifeworld perspective.</p><p><strong>Design: </strong>Qualitative lifeworld-based study. Video-recorded observations were analysed using a phenomenological-hermeneutical method.</p><p><strong>Setting: </strong>Two primary healthcare centres in mid-Sweden.</p><p><strong>Subjects: </strong>Nine males aged 15 to 19, video-recorded during their encounters with GPs in March through May 2022.</p><p><strong>Findings: </strong>Adolescent males navigate between being children in need of parental support and men who can take initiative and responsibility. They face cognitive, emotional, and relational demands, the complexity of which renders them particularly vulnerable. When feeling exposed and not knowing what to expect, they struggle to make themselves understood, and to understand what the GP is saying and what is happening. The difficulties that they have disclosed to the GP in trust need to be recognised and carefully acted upon. Thus the GP must respond appropriately to this complex mix of vulnerabilities to prevent feelings of disappointment or of having exposed themselves in vain.</p><p><strong>Conclusion: </strong>The complexity of encounters with adolescent males imposes great demands on GPs to identify and adapt to their individual needs. A proper ethical response involves helping them navigate the challenges of the consultation while also respecting them as persons and meeting their age-dependent needs.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"1-13"},"PeriodicalIF":1.9,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586492","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":"Self-reported sleep disturbance and inappropriate z-hypnotic use among older adults in general practice.","authors":"C Lundqvist, T B Simonsen, T G Siddiqui","doi":"10.1080/02813432.2025.2475300","DOIUrl":"https://doi.org/10.1080/02813432.2025.2475300","url":null,"abstract":"<p><strong>Background: </strong>Sleep disorders such as insomnia may occur in old age, potentially leading to z-hypnotic use. However, few studies have explored older adults' self-reported sleep concerns in relation to z-hypnotic use. We aim to examine this relationship.</p><p><strong>Methods: </strong>We conducted a cross-sectional study using a web-based questionnaire to assess sleep disturbances and medication use (z-hypnotics, benzodiazepines, and opioid analgesics) among 5,194 older adults through 21 GPs in southeast Norway. The main outcome, inappropriate z-hypnotic use, was defined as self-reported use for ≥4 weeks at ≥ three times per week. We used descriptive statistics and exploratory logistic regression mixed-effects models for data analysis.</p><p><strong>Results: </strong>Among the 687 patients included in the study, 22% (<i>N</i> = 153) reported sleep disturbances. Of these, 84% (<i>N</i> = 575) did not use z-hypnotics, while 16% (<i>N</i> = 112) used z-hypnotics, 63% (<i>N</i> = 71) of these used them inappropriately. (≥4 weeks, ≥ three times per week). Patients with sleep disturbances (OR: 12.1, CI: 6.77 - 21.6, <i>p</i> < 0.001), trouble falling or staying asleep (OR: 14.6, CI: 5.04-42.0, <i>p</i> < 0.001), and multiple reasons for disturbances (pain, overthinking, or a family death) (OR: 3.58, CI: 1.85-6.93, <i>p</i> < 0.001) had higher odds of inappropriate z-hypnotic use compared to those with no or occasional disturbances. Men had lower odds (OR: 0.54, CI: 0.30-0.97, <i>p</i> = 0.039) than women. GP prescribing was not associated with inappropriate use, but men had lower odds (OR: 0.34, CI: 0.14-0.84, <i>p</i> = 0.020) when prescribed by male GPs compared to women prescribed by female GPs.</p><p><strong>Conclusion: </strong>A high proportion of patients used z-hypnotics inappropriately. This inappropriate use was associated with experienced sleep disturbances, particularly trouble falling asleep, trouble staying asleep, and multiple reasons for sleep disturbances. The prescribing GP was not significantly associated with inappropriate use.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"1-8"},"PeriodicalIF":1.9,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586491","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 the COVID-19 pandemic on antibiotic prescription rates in out-of-hours primary care - a register-based study in Denmark.","authors":"Emil Krogh, Katrine Bjørnshave Bomholt, Mette Amalie Nebsbjerg, Claus Høstrup Vestergaard, Morten Bondo Christensen, Linda Huibers","doi":"10.1080/02813432.2024.2410331","DOIUrl":"10.1080/02813432.2024.2410331","url":null,"abstract":"<p><strong>Background: </strong>Antibiotic prescription rates can be affected by pandemic measures such as lockdowns, social distancing, and remote consultations in general practice. Therefore, such emergency states may negatively affect antimicrobial stewardship, specifically in out-of-hours (OOH) primary care. As contact patterns changed in the COVID-19 pandemic, it would be relevant to explore the impact on antimicrobial stewardship.</p><p><strong>Aim: </strong>To study the impact of the pandemic on antibiotic prescription rates in OOH primary care, overall and per age group.</p><p><strong>Methods: </strong>This cross-sectional register-based study used routine data from OOH primary care in the Central Denmark Region. We included all patient contacts in two equivalent time periods: pre-pandemic and pandemic period. The main outcome measure was defined as the number of antibiotic prescriptions per contact (antibiotic prescription rate).</p><p><strong>Results: </strong>The overall antibiotic prescription rate decreased during the first year of the pandemic compared to the pre-pandemic period (RR = 0.97, 95%CI: 0.96-0.98). Likewise, the rate decreased for clinic consultations (RR = 0.63, 95%CI: 0.62-0.64). However, an increase was seen for telephone consultations (RR = 1.73, 95%CI: 1.70-1.76). The decline in clinic consultations was largest for consultations involving children aged 0-10 years (RR = 0.53, 95%CI: 0.51-0.56).</p><p><strong>Conclusion: </strong>Antibiotic prescription rates in Danish OOH primary care decreased during the first year of the COVID-19 pandemic, especially for young children. Prescription rates decreased in clinic consultations, whereas the rates increased in telephone consultations. Further research should explore if antibiotic prescription rates have returned to pre-pandemic levels, and if the introduction of video consultations has affected antibiotic prescription patterns in OOH primary care.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"140-147"},"PeriodicalIF":1.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11834801/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142353094","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":"Medical practitioners' experiences and considerations when managing sleep medication for adolescents and young adults.","authors":"Nanna Maria Andersen, Ásthildur Árnadóttir, Tora Grauers Willadsen, Gritt Overbeck","doi":"10.1080/02813432.2024.2407877","DOIUrl":"10.1080/02813432.2024.2407877","url":null,"abstract":"<p><strong>Introduction: </strong>The prevalence of sleep disorders and use of sleep medication, particularly melatonin, are rising among adolescents and young adults (13-24 years). In Denmark, melatonin is approved for use in children with autism and ADHD up to 18 years of age, with other prescriptions being off-label in these age groups. The perspectives of medical practitioners on prescribing sleep medications to this age group remain largely unexplored.</p><p><strong>Aim: </strong>This study aims to investigate the considerations of general practitioners (GPs) and child and adolescent psychiatrists (psychiatrists) when prescribing and deprescribing sleep medications for 13-24-year-olds.</p><p><strong>Methods: </strong>We conducted qualitative semi-structured interviews with 10 GPs and six psychiatrists. Data were analyzed using an inductive approach.</p><p><strong>Results: </strong>Psychiatrists typically prescribed melatonin with the expectation that deprescription would occur in general practice. Despite the universal goal of deprescription, it was hindered by various challenges. GPs identified patient motivation and a clear focus on deprescription as facilitative factors and expressed a need for enhanced emphasis on these aspects in general practice.</p><p><strong>Discussion and implications: </strong>The findings align with existing prescription trends and literature on factors that promote and inhibit deprescription. The study underscores the complexities of deprescribing sleep medications for adolescents and young adults, suggesting the need for expanded guidelines and enhanced continuing education for GPs.</p><p><strong>Conclusions: </strong>The research highlights significant discrepancies among medical practitioners regarding the deprescription process of sleep medications for young individuals, complicated by multiple factors. This underscores the need for better guidelines and further studies.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"120-130"},"PeriodicalIF":1.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11834797/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142353023","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 nurse practitioners' collaboration with general practitioners in Norwegian homecare services: a qualitative study.","authors":"Lene Apeness Kjær, Mette Tøien, Linn Hege Førsund","doi":"10.1080/02813432.2024.2381064","DOIUrl":"10.1080/02813432.2024.2381064","url":null,"abstract":"<p><strong>Objective: </strong>Nurse practitioners (NPs) have recently been introduced in Norwegian homecare services. The NP role is still in an early implementation phase without standardized role descriptions. NPs are dependent on collaborating with general practitioners (GPs) in the care and treatment of patients. However, little is known about how NPs in Norway experience this collaboration. This study aims to explore how NPs working in homecare services describe their collaborative experiences with GPs, and what influence this collaboration.</p><p><strong>Design: </strong>The study had a qualitative descriptive design, applying individual, semi structured interviews to generate data from five Norwegian nurse practitioners working in homecare services. Data were analyzed using systematic text condensation.</p><p><strong>Findings: </strong>The NPs had varied experiences regarding the collaboration with GPs. NPs stated their role as unclear, lacking standards and job descriptions. The NPs experienced that some GPs were uncertain about the NPs competence, which inhibited collaboration and restricted the NPs utilization of their full capability.NPs experienced a higher degree of collaboration with GPs they knew, and they indicated that trust was the key to facilitate collaboration. The NPs also noted the challenges of establishing relationships with GPs due to the lack of formal meetings and the physical separation of their workplaces.</p><p><strong>Conclusion: </strong>Interpersonal dynamics, organizational structures and systemic frameworks influenced the collaboration between GPs and NPs in homecare services. Trust was identified as an important prerequisite for collaboration.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"3-12"},"PeriodicalIF":1.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11834775/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141734994","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":"Task shifting for musculoskeletal disorders in Norwegian primary care: a qualitative interview study of general practitioners and specialist musculoskeletal physiotherapists.","authors":"Kenneth Chance-Larsen, Michael Backhouse, Richard Collier, Tobba Sudmann","doi":"10.1080/02813432.2024.2384043","DOIUrl":"10.1080/02813432.2024.2384043","url":null,"abstract":"<p><strong>Objective: </strong>To explore the views of general practitioners and physiotherapists on the current model of care for patients with musculoskeletal disorders in Norwegian primary care, and if the English First Contact Practitioner model, where patients have access to multiple professional groups with musculoskeletal health expertise, could inform service development.</p><p><strong>Design, setting, and subjects: </strong>We analysed interviews with five GPs and 11 physiotherapists and used Lipsky's theories about street-level bureaucracy and Foucault's theories of mechanisms of power and institutional structures to explore task shifting and cooperation between different professions.</p><p><strong>Results and interpretation: </strong>The empirical material reflected a multi-faceted discourse about skill-mix in primary care, where financial factors, perceptions about competence, and task preferences moderated attitudes to task shifting. Competition and cooperation coexist between the professions, and the seemingly gradual blurring between historical hegemony and new models of care creates both alliances and rivalries. Examples of deviations from the Choosing Wisely principles and evidence-based practice indicate that both general practitioners and physiotherapists balance the roles of patient advocate, gatekeeper, and <i>homo economicus</i>, in a context where task shifting is challenged by established practice. It appears that the management of patients with musculoskeletal disorders is fragmented and to some extent reflects a supply-driven system.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"13-23"},"PeriodicalIF":1.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11834803/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141875799","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}