Scandinavian Journal of Primary Health Care最新文献

{"title":"Comparing visual and automated urine dipstick analysis in a general practice population.","authors":"S M L Cox, P Hoitinga, G J Oudhuis, R M Hopstaken, P H M Savelkoul, J W L Cals, E G P M de Bont","doi":"10.1080/02813432.2024.2392776","DOIUrl":"https://doi.org/10.1080/02813432.2024.2392776","url":null,"abstract":"<p><strong>Introduction: </strong>Urinary symptoms constitute the primary reason for female patients to consult their general practitioner. The urinary dipstick test serves as a cornerstone for diagnosing urinary tract infections (UTIs), yet traditional visual interpretation may be subject to variability. Automated devices for dipstick urinalysis are routinely used as alternatives, yet the evidence regarding their accuracy remains limited. Therefore we aimed to compare concordance between visual and automated urinary dipstick interpretation and determine their test characteristics for the prediction of bacteriuria.</p><p><strong>Material and methods: </strong>We conducted a prospective validation study including urine samples originating from adult patients in general practice that were sent to the Maastricht Medical Centre + for urinary culture. Urinary dipstick tests were performed on each sample, which were interpreted visually and automatically. We calculated Cohen's κ and percentage agreement and used 2 × 2 tables to calculate test characteristics.</p><p><strong>Results: </strong>We included 302 urine samples. Visual and automated analysis showed almost perfect agreement (κ = 0.82 and κ = 0.86, respectively) for both nitrite and leukocyte esterase, but moderate agreement for erythrocytes (κ = 0.51). Interpretation of clinically relevant (nitrite and/or leukocyte esterase positive) samples showed almost perfect agreement (κ = 0.88). Urinary dipsticks show similar test characteristics with urinary culture as gold standard, with sensitivities of 0.92 and 0.91 and specificities of 0.37 and 0.41 for visual and automated interpretation respectively.</p><p><strong>Conclusion: </strong>Automated and visual dipstick analysis show near perfect agreement and perform similarly in predicting bacteriuria. However, automated analysis requires maintenance and occasionally measurement errors can occur.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142009285","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 care physicians' experiences of video and online chat consultations: a qualitative descriptive study.","authors":"Kaisa Kujansivu, Elina Tolvanen, Mervi Kautto, Tuomas H Koskela","doi":"10.1080/02813432.2024.2391406","DOIUrl":"https://doi.org/10.1080/02813432.2024.2391406","url":null,"abstract":"<p><strong>Objectives: </strong>To explore the perceptions and views of remote consultations and patient care of primary care physicians (PCPs) who work remotely regularly and have experience performing remote consultations.</p><p><strong>Design: </strong>A qualitative study using thematic analysis.</p><p><strong>Setting: </strong>Four online focus group interviews with 17 PCPs, working with one private health care provider, with public and private primary care patients.</p><p><strong>Subjects: </strong>PCPs who had performed video or online chat consultations with primary care patients for at least 6 months.</p><p><strong>Main outcome measurements: </strong>PCPs' perceptions and views working remotely in online chat and video consultations.</p><p><strong>Results: </strong>Two main themes describing how PCPs perceived remote consultations emerged: 1) remote consultations have an impact on the way physicians work, and 2) remote consultations have an impact on the service system and patients. The subthemes of the first main theme included the physicians' new way of working, impacts on physicians' well-being, and impacts on communication and physician competences. The subthemes for the second main theme were the importance of smoothness of services for the patients, patient suitability, and technical liabilities.</p><p><strong>Conclusion: </strong>Remote consultations provide PCPs with a new way of working that could improve work-life balance. However, it is important to maintain sufficient clinical competence through versatile work. Digital consultations can make contacting healthcare smoother and easier for patients if the patient selection is performed carefully. Online chat seems suitable for singular contacts and simple issues, but remote consultations could be used to sustain continuity of care.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142000627","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":"Between principles and pragmatism - primary healthcare and social services professionals' experiences and perceptions of self-care for older adults with home care: a qualitative study.","authors":"Ing-Mari Dohrn, Åsa von Berens, Christina B Olsson, Elisabeth Rydwik, Elin Jakobsson, Lina Palmlöf","doi":"10.1080/02813432.2024.2389116","DOIUrl":"https://doi.org/10.1080/02813432.2024.2389116","url":null,"abstract":"<p><strong>Objective: </strong>To explore the experiences of healthcare and social services professionals and their perceptions of using Certificate for self-care with support (CSS) for preventive self-care for older adults with home care, including the CSS process and collaborations between primary healthcare and social services.</p><p><strong>Design: </strong>An inductive qualitative study including seven focus group interviews analyzed with reflexive thematic analysis.</p><p><strong>Setting and subjects: </strong>The study was conducted in the Stockholm Region 2022/23. In total, 23 informants were recruited from four key partners involved in the CSS process: professionals from primary care rehabilitation and primary healthcare, social services officers, and home care staff.</p><p><strong>Result: </strong>The analyses resulted in five interconnected themes: 'Guidelines with scope for interpretation,' 'Support for self-care is needed, but complicated in practice,' 'To trust the other professions' competence,' 'There is a transfer of responsibility,' and 'Communication is key.' The overarching theme 'Principles or pragmatism for safe person-centered care,' anchoring the other themes, revealed a common goal of achieving safe and individualized care within available resources, but from two conflicting perspectives: the importance of following the process according to the guidelines or taking a more pragmatic approach.</p><p><strong>Conclusion: </strong>This study highlights the need to establish structures facilitating safe self-care among frail groups, such as older persons dependent on home care. Our findings emphasize that the demarcation between, and responsibilities of, organizations need to be discussed and clarified to offer person-centered support. Comprehensible guidelines and functioning communication channels must be established so that all important perspectives can be heard, not least the patient's.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141913673","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 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":"https://doi.org/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":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health determinants among participants in targeted health dialogues offered to all 40-year-old individuals in a metropolitan region of 1.4 million people.","authors":"Emelie Stenman, Beata Borgström Bolmsjö, Anton Grundberg, Kristina Sundquist","doi":"10.1080/02813432.2024.2385547","DOIUrl":"https://doi.org/10.1080/02813432.2024.2385547","url":null,"abstract":"<p><strong>Objective: </strong>To examine cardiovascular risk factors in 40-year-old participants in the health screening program targeted health dialogues (THDs).</p><p><strong>Design: </strong>Cross-sectional study.</p><p><strong>Setting: </strong>99 Swedish healthcare centers.</p><p><strong>Intervention: </strong>Metabolic risk factors and health behaviors were assessed. THDs were provided.</p><p><strong>Subjects: </strong>1831 (62.3%) THD participants that consented to take part in the research project.</p><p><strong>Main outcome measures: </strong>(1) Prevalence of metabolic risk factors (blood pressure, LDL cholesterol, fasting plasma glucose, BMI, waist-hip ratio) and unhealthy behaviors (tobacco, alcohol, diet, physical activity) by sex, education, and place of birth. (2) Associations between different health behaviors and between the number of unhealthy behaviors and prevalence of metabolic risk factors. (3) THD participation by sociodemographics compared to age-matched controls.</p><p><strong>Results: </strong>Men had a higher prevalence of all metabolic risk factors, excessive alcohol use and tobacco use than women. Lower educated individuals had a higher prevalence of metabolic risk factors (except for LDL cholesterol) and tobacco use than highly educated. Participants born outside Sweden had a higher prevalence of obesity, high waist-hip ratio, and tobacco use. Participants with 3-4 unhealthy behaviors had significantly higher prevalence of each of the metabolic risk factors except BMI. Women, highly educated and Swedish-born participants were slightly over-represented in the THDs.</p><p><strong>Conclusion: </strong>Considering the associations between unhealthy behaviors and metabolic risk factors, the THD method, covering lifestyle as well as objective health measures, may be an appropriate method for early identification of individuals at risk for future non-communicable diseases in the whole population with a specific focus on certain groups.</p><p><strong>Clinicaltrials.gov: </strong>NCT04912739.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141875798","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 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":"https://doi.org/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":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"‘Why do GPs want to come here?’: residents’ intentions to register with new-coming GPs in a disadvantaged neighbourhood in Copenhagen with a GP shortage: a qualitative study","authors":"Stine Dandanell Garn, Sarah Fredsted Villadsen, Charlotte Glümer, Kristina Johansen, Ulla Christensen","doi":"10.1080/02813432.2024.2354361","DOIUrl":"https://doi.org/10.1080/02813432.2024.2354361","url":null,"abstract":"To explore contextual factors influencing residents’ intentions to register with one of the new-coming GPs established as a result of a municipally driven GP coverage intervention in a disadvantage...","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141511944","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":"Improving cardiovascular control in a hypertensive population in primary care. Results from a staff training intervention.","authors":"Rebecka Quester, Staffan Björck, Karin Manhem, Jonatan Nåtman, Susanne Andersson, Per Hjerpe","doi":"10.1080/02813432.2024.2326470","DOIUrl":"10.1080/02813432.2024.2326470","url":null,"abstract":"<p><strong>Objective: </strong>A pilot study to evaluate a staff training intervention implementing a nurse-led hypertension care model.</p><p><strong>Design and setting: </strong>Clinical and laboratory data from all primary care centres (PCCs) in the Swedish region Västra Götaland (VGR), retrieved from regional registers. Intervention started 2018 in 11 PCCs. A total of 190 PCCs served as controls. Change from baseline was assessed 2 years after start of intervention.</p><p><strong>Intervention: </strong>Training of selected personnel, primarily in drug choice, team-based care, measurement techniques, and use of standardized medical treatment protocols.</p><p><strong>Patients: </strong>Hypertensive patients without diabetes or ischemic heart disease were included. The intervention and control groups contained approximately 10,000 and 145,000 individuals, respectively.</p><p><strong>Main outcome measures: </strong>Blood pressure (BP) <140/90 mmHg, LDL-cholesterol (LDL-C) <3.0 mmol/L, BP ending on -0 mmHg (digit preference, an indirect sign of manual measuring technique), choice of antihypertensive drugs, cholesterol lowering therapy and attendance patterns were measured.</p><p><strong>Results: </strong>In the intervention group, the percentage of patients reaching the BP target did not change significantly, 56%-61% (control 50%-52%), non-significant. However, the percentage of patients with LDL-<i>C</i> < 3.0 mmol/L increased from 34%-40% (control 36%-36%), <i>p =</i> .043, and digit preference decreased, 39%-27% (control 41%-35%), <i>p</i> = 0.000. The number of antihypertensive drugs was constant, 1.63 - 1.64 (control 1.62 - 1.62), non-significant, but drug choice changed in line with recommendations.</p><p><strong>Conclusion: </strong>Although this primary care intervention based on staff training failed to improve BP control, it resulted in improved cardiovascular control by improved cholesterol lowering treatment.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11003316/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140060445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The durability of previous examinations for cancer: Danish nationwide cohort study.","authors":"Jesper Lykkegaard, Jonas Kanstrup Olsen, Sonja Wehberg, Dorte Ejg Jarbøl","doi":"10.1080/02813432.2024.2305942","DOIUrl":"10.1080/02813432.2024.2305942","url":null,"abstract":"<p><strong>Objective: </strong>Patients previously examined for cancer with a negative result may present in general practice with ongoing or new symptoms or signs suggestive of cancer. This paper explores the potential existence of a relatively safe period for cancer occurrence after receiving negative examination results for specific types of cancer, including lung (CT thorax), upper gastrointestinal (gastroscopy), colorectal (colonoscopy), bladder (cystoscopy), and breast (clinical mammography).</p><p><strong>Design: </strong>Register-based time-to-event analyses.</p><p><strong>Setting: </strong>Denmark.</p><p><strong>Subjects: </strong>All 3.3 million citizens aged 30-85 years who on January first, 2017, had not previously been diagnosed with the specific type of cancer were categorized based on the time since their most recent examination.</p><p><strong>Main outcome measures: </strong>Using 1-year follow-up, we calculated the age- and sex-adjusted hazard ratios of being diagnosed with the related cancer, with non-examined individuals as reference. Negative examination results were defined as the absence of a cancer diagnosis within 6 months following the examination.</p><p><strong>Results: </strong>Previous negative examination results were common, also among those diagnosed with cancer during follow-up. For 10 years after a negative colonoscopy the risk of diagnosing a colorectal cancer was nearly halved. However, already 1 year after a clinical mammography and 2 years after a CT thorax the risk of diagnosing the related cancers was significantly higher among those with a previous negative result compared to non-examined individuals.</p><p><strong>Conclusion: </strong>This study did not identify a post-examination period in which the cancer risk, compared to non-examined individuals, was sufficiently low to confidently rule out any of the investigated cancers.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11003324/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139511725","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":"Adjudications and tinkering with care for socially vulnerable patients with type 2 diabetes in general practice.","authors":"Ann Dorrit Guassora, Nina Tvistholm, Frida Greek Kofod, Sofie A Rogvi, Gitte Wind, Ulla Christensen","doi":"10.1080/02813432.2024.2317825","DOIUrl":"10.1080/02813432.2024.2317825","url":null,"abstract":"<p><strong>Objective: </strong>To analyse the mechanisms at play in the adjudications made by professionals and socially vulnerable patients with type 2 diabetes about their eligibility for care.</p><p><strong>Design, setting and subjects: </strong>The study included 14 patients and 10 health professionals in seven general practice surgeries in deprived areas in Greater Copenhagen. The study data consist of 17 semi-structured interviews with patients and 22 with health professionals immediately after observation of 23 consultations. Our analytical approach was inspired by Systematic Text Condensation and the concept of 'candidacy' for access to health care.</p><p><strong>Results: </strong>Adjudications of patients not being candidates for services were common, but we also found that both patients and health professionals worked to align the services to the needs of the patients. This could include using services differently than was intended by the providers or by changing routines to make it easier for patients to use the services. We discuss these processes as 'tinkering'. This usually implies that the best individual solution for the patient is aimed for, and in this study, the best solution sometimes meant not focusing on diabetes.</p><p><strong>Conclusion: </strong>The study adds to existing knowledge about access to services for socially vulnerable patients by demonstrating that both patients and professionals in general practice engage in tinkering processes to make services work.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11003322/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140028831","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}