Scandinavian Journal of Primary Health Care最新文献

{"title":"Minimizing unnecessary proBNP blood tests: an evaluation of a pop-up form implementation in general practice.","authors":"Morvarid Sophia Esmaeilzadeh, Anna Elise Engell, Henrik Løvendahl Jørgensen, Bent Struer Lind","doi":"10.1080/02813432.2024.2410984","DOIUrl":"https://doi.org/10.1080/02813432.2024.2410984","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the impact of a compulsory pop-up form on the ordering pattern of proBNP blood tests by general practitioners in the Capital Region of Denmark.</p><p><strong>Design: </strong>A follow-up study comparing the average number of proBNP tests ordered before and after the implementation of an intervention.</p><p><strong>Setting and subjects: </strong>From 2016 to 2021, the average number of proBNP tests increased by over 300%. In March 2022, a compulsory pop-up form was introduced in the electronic request system (WebReq), requiring general practitioners to select one of three indications for ordering proBNP, as recommended by the Danish Society of Cardiology. The study included 528 general practitioners in the Capital Region of Denmark, with data available from January 2020 to 2023, encompassing 83,576 proBNP results from 56,645 patients.</p><p><strong>Main outcome measure: </strong>The average number of proBNP tests ordered per month and the median level of proBNP before and after the intervention.</p><p><strong>Results: </strong>Following the intervention, the average number of proBNP tests per month decreased by 60% over a 22-month follow-up period. The highest reduction was seen among general practitioners who previously ordered the most tests (≥3 per 1000 biochemical tests). In this group, the median proBNP level increased from 12.1 pmol/L before the intervention to 13.5 pmol/L after the intervention (<i>p</i> < 0.0001).</p><p><strong>Conclusions: </strong>This study demonstrates a significant decrease in the number of proBNP requests from general practitioners in the Capital Region of Denmark after the introduction of a pop-up form in the requisition system containing the current guidelines.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"1-7"},"PeriodicalIF":1.9,"publicationDate":"2024-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142366402","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":"https://doi.org/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":"1-8"},"PeriodicalIF":1.9,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","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":"https://doi.org/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":"1-11"},"PeriodicalIF":1.9,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using online health information for unknown symptoms common among young adults: a qualitative analysis of health-related web pages illustrating the need for numeracy skills, the ability to deal with uncertainty, and the risk of ruling out self-care.","authors":"Lisa Viktorsson, Eva Törnvall, Magnus Falk, Pia Yngman-Uhlin","doi":"10.1080/02813432.2024.2408610","DOIUrl":"https://doi.org/10.1080/02813432.2024.2408610","url":null,"abstract":"<p><p>Young adults experiencing unfamiliar symptoms commonly seek health information online. This study's aim was to explore how health information websites express and communicate health information about symptoms common among young adults and guide readers in regard to health, illness, and care. Symptoms commonly searched for by young adults were used as search terms. The resulting data comprised material from 24 web pages and was analyzed using content analysis. The foremost purpose of online health information is to try to narrow down the user's symptoms and then advise the user on what actions to take. This is done by first forming a foundation of knowledge through descriptions and explanations, then specifying the symptom's time, duration, and location, and finally giving advice on whether to self-manage symptoms or seek additional information about them. However, the uncertainty of the diagnosis may rule out self-care. For readers inexperienced with health care, forming a decisive conclusion about diffuse symptoms on the sole basis of online health information could be challenging. The necessity of numeracy skills and the ability to deal with uncertainty are highlighted. There is a discrepancy between health advice given online and readers' accessibility to health care that needs to be addressed in future policy and research.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"1-9"},"PeriodicalIF":1.9,"publicationDate":"2024-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142353095","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":"Diagnostic accuracy of signs and symptoms in acute coronary syndrome and acute myocardial infarction.","authors":"Willem Raat, Lotte Nees, Bert Vaes","doi":"10.1080/02813432.2024.2406266","DOIUrl":"10.1080/02813432.2024.2406266","url":null,"abstract":"<p><strong>Background: </strong>Acute coronary syndrome (ACS) and acute myocardial infarction (AMI) account for a large portion of cardiovascular deaths. Signs and symptoms for these syndromes, such as chest pain, are non-specific and can be caused by a variety of non-cardiac conditions, especially in low-prevalence settings such as general practice. The diagnostic value of these signs and symptoms can be assessed using diagnostic meta-analyses, but the last one dates from 2012.</p><p><strong>Methods: </strong>We performed a diagnostic meta-analysis in accordance with PRISMA guidelines. We searched PubMed, Embase and CENTRAL from 2006 to 2024. We included studies that assessed the diagnostic accuracy of thirteen different signs and symptoms. We divided patients into two subgroups (AMI and ACS) on which analysis was performed independently.</p><p><strong>Results: </strong>We selected 24 articles for inclusion. Our analysis indicates that signs and symptoms have a limited role in the diagnosis of AMI or ACS. The most useful (highest diagnostic odds ratios, DOR) in the diagnosis of AMI were pain radiating to both arms (DOR 2.95 (95%CI 1.57-5.06)), absence of chest wall tenderness (DOR 3.51 (95%CI 1.64-6.61)), pain radiating to the right arm (DOR 5.17 (95%CI 1.77-11.9)) and sweating (DOR 5.75 (95%CI 2.51-11.4)). For ACS these were pain radiating to the right arm (DOR 3.9 (95%CI 0.7-12.6)) and absence of chest wall tenderness (DOR 7.73 (95%CI 2.19-19.8)).</p><p><strong>Conclusion: </strong>We report the accuracy of thirteen signs and symptoms in the diagnosis of AMI and ACS. These can be useful to calibrate general practitioners' diagnostic assessment of chest pain in primary care settings.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"1-9"},"PeriodicalIF":1.9,"publicationDate":"2024-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142294406","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":"Is general practitioner involvement in the initiation of opioids for chronic non-cancer pain associated with opioid dose and concurrent drug use?","authors":"Trond Høibø, Svetlana Skurtveit, Torgeir Gilje Lid","doi":"10.1080/02813432.2024.2404053","DOIUrl":"https://doi.org/10.1080/02813432.2024.2404053","url":null,"abstract":"<p><p><i>Objective</i> Is the involvement of the regular general practitioner (GP) in the decision to initiate opioid treatment for chronic non-cancer pain (CNCP) associated with two main risk factors for serious adverse events: increased opioid dose and the concomitant use of prescribed benzodiazepines or benzodiazepine-related medications? <i>Design and setting</i> An anonymous web-based survey was conducted in the county of Rogaland, Norway, during the spring of 2021. <i>Subjects</i> GPs who self-reported applying at least once for reimbursement of opioids prescribed to treat CNCP. They were asked to answer the survey based on the last patient for whom they recalled submitting a reimbursement application. <i>Main outcome measures</i> 1) Total opioid dose in daily oral morphine equivalents (OMEQ). 2) Concurrent use of benzodiazepines and/or benzodiazepine-related drugs. <i>Results</i> The daily opioid dose was lower when the surveyed GPs initiated the opioid treatment (36 OMEQ, <i>n</i> = 25), than when others had initiated the treatment (108 OMEQ, <i>n</i> = 31, <i>p</i> = 0.001). For concurrent use of benzodiazepine or benzodiazepine-related drugs, no significant difference was found (33%, <i>n</i> = 9 with GP involvement <i>vs</i>. 47%, <i>n</i> = 16, <i>p</i> = 0.279 with no GP involvement). <i>Conclusions</i> GP involvement in the initiation of opioid medication for CNCP was associated with a lower opioid dose being prescribed. <i>Implications</i> GP involvement in the initiation of opioid prescriptions may facilitate safer prescribing.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"1-4"},"PeriodicalIF":1.9,"publicationDate":"2024-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142294407","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 in- and outpatient health care use of patients with COPD before and after initiation of home care: a registry study from Norway.","authors":"Tron Anders Moger, Jon Helgheim Holte, Olav Amundsen, Silje Bjørnsen Haavaag, Øystein Døhl, Line Kildal Bragstad, Ragnhild Hellesø, Nina Køpke Vøllestad, Trond Tjerbo","doi":"10.1080/02813432.2024.2404056","DOIUrl":"https://doi.org/10.1080/02813432.2024.2404056","url":null,"abstract":"<p><strong>Objective: </strong>Chronic obstructive pulmonary disease (COPD) is a common condition associated with age, multimorbidity and frequently involves the use of health care across levels. Understanding the factors associated with the initiation of long-term care is important when planning the future need for services. We describe healthcare use before and after the reception of any home care. We further studied the associations between healthcare use and first registered home care service and from first registered home care service to nursing home admission or death.</p><p><strong>Design and subjects: </strong>Patients residing in Oslo or Trondheim at the time of first contact with a COPD primary diagnosis, 2009-2018. Patient data were linked across national and municipal registries, covering healthcare and sociodemographics. The sample consisted of 16,738 individuals.</p><p><strong>Results: </strong>There was a marked increase in inpatient and outpatient hospital contacts in the years prior to and after the reception of any home care. Adjusted for comorbidities and sociodemographics, high numbers of GP consultations, and inpatient and outpatient hospital contacts for respiratory diagnoses were associated with a significantly higher likelihood of receiving home care the next year (hazard odds ratios > 1.3). Following the reception of home care, the type of home care service received (e.g. home nursing or short-term rehabilitation/treatment) was more important than outpatient services in predicting next-year nursing home admission or death.</p><p><strong>Conclusion: </strong>Including data on prior outpatient care when predicting future need for home care is beneficial. A high frequency (top 10%) of yearly GP, in- or outpatient hospital contacts can imply that the patient may be in need of home care in the near future.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"1-11"},"PeriodicalIF":1.9,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142294408","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":"General practitioners’ knowledge and practice in consultations with (potential) torture victims: a qualitative pilot study from Norway","authors":"Abinaya Anpalagan, Hanna Fesseha, Anette Bringedal Houge","doi":"10.1080/02813432.2024.2404054","DOIUrl":"https://doi.org/10.1080/02813432.2024.2404054","url":null,"abstract":"According to the UN Committee Against Torture, all state parties to the Torture Convention have a responsibility to meet the rehabilitation needs of torture victims who have sought asylum within th...","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":"6 1","pages":"1-15"},"PeriodicalIF":2.1,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142255488","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-injurious thoughts and behaviours as the reason for contact to Norwegian emergency primary care centres: an observational study","authors":"Anita Hunsager, Fredrik A. Walby, Vivian Midtbø, Tone Morken, Valborg Baste, Ingrid Hjulstad Johansen","doi":"10.1080/02813432.2024.2400668","DOIUrl":"https://doi.org/10.1080/02813432.2024.2400668","url":null,"abstract":"To describe and compare contacts regarding self-injurious thoughts and behaviours to other contacts to emergency primary care.Observational study.A sentinel network of seven emergency primary care ...","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":"11 1","pages":"1-11"},"PeriodicalIF":2.1,"publicationDate":"2024-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142183486","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":"Exploring general practice staff perspectives on a teaching concept based on instruction videos for diabetic retinopathy screening - an interview study.","authors":"Malene Krogh, Martin Bach Jensen, Morten Sig Ager Jensen, Malene Hentze Hansen, Marie Germund Nielsen, Henrik Vorum, Jette Kolding Kristensen","doi":"10.1080/02813432.2024.2396873","DOIUrl":"https://doi.org/10.1080/02813432.2024.2396873","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this study is to explore general practice staff perspectives regarding a teaching concept based on instructional videos for conducting DR screenings. Furthermore, this study aims to investigate the competencies acquired by the staff through this teaching concept.</p><p><strong>Design and setting: </strong>Qualitative cross-sectional study conducted in general practice clinics in the North Denmark Region.</p><p><strong>Method: </strong>A teaching concept was developed based on instruction videos to teach general practice staff to conduct diabetic retinopathy screenings with automated grading through artificial intelligence. Semi-structured interviews were performed with 16 staff members to investigate their perspectives on the concept and acquired competencies.</p><p><strong>Results: </strong>This study found no substantial resistance to the teaching concept from staff; however, participants' satisfaction with the methods employed in the instruction session, the progression of learning curves, screening competencies, and their acceptance of a known knowledge gap during screenings varied slightly among the participants.</p><p><strong>Conclusion: </strong>This study showed that the teaching concept can be used to teach general practice staff to conduct diabetic retinopathy screenings. Staffs' perspectives on the teaching concept and acquired competencies varied, and this study suggest few adjustments to the concept to accommodate staff's preferences and establish more consistent competencies.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"1-10"},"PeriodicalIF":1.9,"publicationDate":"2024-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142120495","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}