Scandinavian Journal of Primary Health Care最新文献

{"title":"Quality improvement work in general practice; a Norwegian focus group study.","authors":"Torunn Bjerve Eide, Holgeir Skjeie, Sigurd Høye","doi":"10.1080/02813432.2024.2380920","DOIUrl":"10.1080/02813432.2024.2380920","url":null,"abstract":"<p><strong>Background: </strong>Quality improvement work is an essential feature of healthcare services, including general practice. In this study, we aimed to gain more knowledge regarding general practitioners' (GPs) motivation for such work in their practices, as well as what kind of measures were considered motivating and feasible.</p><p><strong>Materials and methods: </strong>We conducted five focus group interviews among Norwegian GPs between November 2021 and November 2022. We included 21 GPs of varying age, gender, experience, and geographic situation. The data were transcribed verbatim and analysed by Systematic Text Condensation, a thematic cross-case analysis.</p><p><strong>Results: </strong>Many GPs had a diverse and imprecise understanding of the term quality improvement, and sound routines in everyday practice were often given as examples of quality improvement measures. There was a universal attitude that quality improvement initiatives should be close to practice, professionally relevant, and sufficiently small to be manageable. The availability of professional communities, either in the GP practices or in continuous medical education groups, was important for motivation. The role of nurses and health secretaries was highlighted as essential to achieve change. Participants commonly described negative reactions to programs that were imposed by external actors without regard for the GPs' perceived needs.</p><p><strong>Conclusion: </strong>GPs were motivated for quality improvement measures provided feasibility within the framework of general practice. Well-functioning professional communities, including involvement of nurses and health-secretaries, were emphasised as requisite for quality improvement. Small scale quality improvement programs suited for the needs of general practice were well received and should be further developed.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"677-685"},"PeriodicalIF":1.9,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11552270/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141752626","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":"Monitoring handgrip strength to motivate lifestyle choices for patients with diabetes type 2 - a pragmatic randomised controlled trial.","authors":"Lena Bornhöft, Susanne Bernhardsson, Lena Nordeman, Anna Grimby-Ekman, Maria Dottori, Maria E H Larsson","doi":"10.1080/02813432.2024.2373298","DOIUrl":"10.1080/02813432.2024.2373298","url":null,"abstract":"<p><strong>Methods: </strong>Measurement of HGS with Jamar dynamometers was added to annual check-ups for patients with T2DM by diabetes nurses in primary care with feedback about normal values for age and sex in the intervention group. The control group had standard check-ups. Change in self-reported PA level was measured with questionnaires.</p><p><strong>Results: </strong>Seven clinics and 334 patients participated. The intervention led to similar effects on PA in both groups. Patients with T2DM had comparable HGS to the general public. Regression analyses showed statistically significantly higher HGS in the intervention group than in the control group at follow-up and no improvement in PA, HbA1c, or waist circumference. Increased HGS was found for older people, men, and people with normal-to-high inclusion HGS, while patients with low inclusion HGS reduced their strength levels.</p><p><strong>Conclusions: </strong>Measuring HGS and giving feedback to patients with T2DM can lead to increased HGS but does not seem to affect general PA level, HbA1c, or waist circumference. People over 65 years, men, and people with normal-to-high HGS were influenced positively by the intervention. Patients with low HGS may need personalised support to increase physical activity and improve function.<b>ClinicalTrials registration:</b> NCT03693521.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"617-632"},"PeriodicalIF":16.4,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11552247/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141498882","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 colorectal cancer patients' diagnostic pathways and general practitioners' assessment of the diagnostic processes: a Danish survey study.","authors":"Dorte E Jarbøl, Sanne Rasmussen, Kirubakaran Balasubramaniam, Jesper Lykkegaard, Linda Juel Ahrenfeldt, Gitte B Lauridsen, Peter Haastrup","doi":"10.1080/02813432.2024.2432376","DOIUrl":"https://doi.org/10.1080/02813432.2024.2432376","url":null,"abstract":"<p><strong>Introduction: </strong>Colorectal cancer (CRC) is among the most common cancers and the prognosis of CRC is highly dependent on stage at diagnosis. Although many cases are diagnosed swiftly, there is still room for improvement.</p><p><strong>Aim: </strong>We aimed to explore CRC diagnostic pathways, encompassing (1) place of initial contact; (2) associations with symptom presentations, sex, and age with events in the diagnostic process and initial referrals and (3) the general practitioner's (GP's) evaluation of the diagnostic processes.</p><p><strong>Methods: </strong>All GPs in North-, Central-, and Southern Denmark were invited to fill in questionnaires for their listed patients diagnosed with cancer during the past two years.</p><p><strong>Results: </strong>Among 1,032 recorded CRC patients, 65% had their initial contact in general practice, 5% within the out-of hours service, 10% in the hospital, and 20% were diagnosed based on screening. A total of 27% of CRC patients over 40 who initially presented in general practice were treated or referred on suspicion of another disease first, and 9% were reported to have had hesitated in seeking medical attention. Some 37% presented solely non-specific symptoms, increasing the odds of the GP advising watchful waiting (OR 2.48; 95% CI 1.06-5.81), treating or referring on the suspicion of another illness first (OR 2.57; 95% CI 1.76-3.75), wait due to normal findings (OR 2.11; 95% CI 1.16-3.85), or referring to diagnostic imaging (OR 3.07; 95% CI 1.63-5.79). The GPs assessed nearly one fifth of the diagnostic processes as poor.</p><p><strong>Conclusion: </strong>Most CRC patients are diagnosed with initial presentation in general practice. Having non-specific symptoms is common and challenges timely diagnosis.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"1-10"},"PeriodicalIF":1.9,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142716623","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 encounters with young unaccompanied refugees: a qualitative study among general practitioners and physicians in migrant health clinics in Norway and Denmark.","authors":"Gjertrud Moe, Bente Prytz Mjølstad, Linn Okkenhaug Getz, Morten Sodemann, Borgunn Ytterhus","doi":"10.1080/02813432.2024.2428364","DOIUrl":"https://doi.org/10.1080/02813432.2024.2428364","url":null,"abstract":"<p><strong>Objective: </strong>This study examines the experiences of clinical encounters with young unaccompanied refugees in Norway and Denmark among both general practitioners (GPs) and physicians in migrant health clinics (MHC physicians), and it identifies important aspects that should be taken into consideration for improving the quality of healthcare for these patients.</p><p><strong>Methodology: </strong>Ten individual in-depth interviews with physicians in Norway and Denmark were conducted and analysed using interpretative phenomenology. Axel Honneth's theory of recognition was our theoretical lens.</p><p><strong>Results: </strong>The physicians described these patients as vulnerable individuals. They adopted a variety of approaches in their encounters with young unaccompanied refugees spanning from a 'holistic' to an 'instrumental' approach. Those who described an instrumental approach focused on understanding and categorising symptoms from a biomedical perspective, while those describing a holistic approach considered 'the whole person' within their everyday context. Those with a more holistic approach also expressed the importance of interdisciplinary collaboration and defined work-divide. Relationships of trust between physicians and the young unaccompanied refugees were shown to be an important facilitator for adequate healthcare, but this required availability, continuity, and dialogue.</p><p><strong>Conclusion: </strong>Our results highlight how physicians' encounters with vulnerable young refugees actualize previously documented contrasts between holistic and instrumental approaches in clinical work. We argue that recognition in healthcare is conditional on physicians taking a holistic approach. This approach can help build relationships of trust and can support interdisciplinary collaboration. Moreover, such an approach can facilitate the essential components of Honneth's theory of recognition, namely social esteem and emotional support. Barriers to greater interdisciplinary collaboration in healthcare services need to be addressed at the system level.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"1-11"},"PeriodicalIF":1.9,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142682316","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 participants' characteristics and self-assessed readiness to conduct clinical trials in general practice - baseline analysis of the RaPHaeL practice-based research network.","authors":"Alexander Bauer, Larissa Virnau, Eric Sven Kroeber, Heidrun Lingner, Markus Bleckwenn, Thomas Frese, Kathleen Denny, Annett Braesigk, Tobias Deutsch","doi":"10.1080/02813432.2024.2427272","DOIUrl":"https://doi.org/10.1080/02813432.2024.2427272","url":null,"abstract":"<p><strong>Background: </strong>Primary care is integral to healthcare systems extending beyond traditional illness management to include preventive care, chronic disease management, and health promotion. Practice-based research networks (PBRNs) have emerged as essential infrastructures for conducting clinical research in primary care. This study explores the establishment of the 'Research-Practices Halle-Leipzig' (RaPHaeL) PBRN in Germany, evaluating the characteristics and research readiness of participating practices.</p><p><strong>Methods: </strong>A cross-sectional survey (MORNING II) was conducted among all general practitioners (GPs) joining the RaPHaeL PBRN, assessing socio-demographic characteristics, practice infrastructure, and research readiness. After a descriptive analysis, we compared data with a previous study (MORNING) to examine potential differences between PBRN participants and non-participants. We developed a research readiness score (RRS) to quantify practices' ability to perform clinical research subtasks.</p><p><strong>Results: </strong>The response rate was 97.1% and our participants were often male, involved in undergraduate education, generally interested in research or had previous research experiences. However, they differed widely in age and size, staff structure, and patient demographics of their practices. Initially, around two-thirds of the practices were not sufficiently prepared to conduct clinical trials (self-assessed feasibility of relevant subtasks). If further research and documentation tasks are required, patient recruitment estimations are lower than for patient identification and information.</p><p><strong>Conclusion: </strong>This study highlights the variability in research readiness among GP practices and shows the need for targeted training. By systematically assessing and enhancing research capabilities of participating GPs, PBRNs can facilitate high-quality clinical research in primary care to improve patient outcomes and healthcare delivery.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"1-11"},"PeriodicalIF":1.9,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142626334","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":"Validation of point-of-care tests used at in-home assessments among older adults in primary care.","authors":"Siri Aas Smedemark, Ditte Beck Jepsen, Karen Andersen-Ranberg, Mads Nybo","doi":"10.1080/02813432.2024.2426162","DOIUrl":"https://doi.org/10.1080/02813432.2024.2426162","url":null,"abstract":"<p><strong>Background: </strong>Diagnosing acute disease in older adults is challenged by vague and atypical symptoms. Point-of-care tests (POCTs) at home may improve diagnostics and clinical decision-making. We compared various POCT devices to routine testing in acutely ill older adults to assess their clinical reliability.</p><p><strong>Methods: </strong>We enrolled participants aged 65+ years requiring acute in-home assessment with signs of acute conditions. Venous and capillary blood samples were collected and analysed on-site using POCT, while identical samples were transported and analysed in a routine laboratory. Agreement between POCT and laboratory testing was assessed using scatter plots with linear regression, Pearson's correlation coefficient (PCC), limits of agreement, and Bland-Altman plots. Misclassification rates were calculated based on clinically meaningful cut-offs to assess POCT's clinical reliability.</p><p><strong>Results: </strong>We included 100 participants with a mean age of 81.6 (±8.4 SD) years. Strong correlation was found between POCT and routine measurements (PCC: 0.76-0.94 for capillary samples and 0.85-0.98 for venous samples). Venous samples showed higher PCC than capillary, except for neutrophils (0.93 for capillary, 0.89 for venous). Misclassification occurred in capillary samples for haemoglobin (10/62) and total WBC (6/50), while in venous samples, misclassification was observed for haemoglobin (4/54), total WBC (4/50), K⁺ (5/47), urea (5/47), and creatinine (3/42). No misclassification was observed for Na⁺.</p><p><strong>Conclusion: </strong>POCT provides acceptable, clinically reliable measurements in acutely ill older adults, potentially enhancing diagnostics and treatments during in-home assessment. Venous blood testing is preferable due to a lower misclassification rate, but capillary blood remains a pragmatic alternative, despite higher variation and inaccuracy.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"1-10"},"PeriodicalIF":1.9,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142626335","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":"District nurses experiences in providing terminal care in rural and more urban districts. A qualitative study from the Faroe Islands.","authors":"Elsa J D Johannesen, Helle Timm, Ása Róin","doi":"10.1080/02813432.2024.2329207","DOIUrl":"10.1080/02813432.2024.2329207","url":null,"abstract":"<p><strong>Objective: </strong>To explore district nurses' experiences in providing terminal care to patients and their families until death in a private home setting.</p><p><strong>Design, setting and subjects: </strong>Qualitative study. Data derived from focus group discussions with primary nurses in The Faroe Islands.</p><p><strong>Results: </strong>Four themes were identified: 'Challenges in providing terminal care', 'The importance of supporting families', 'Collaborative challenges in terminal care' and 'Differences between rural districts and urban districts'. The nurses felt that terminal care could be exhausting, but they also felt the task rewarding. Involving the family was experienced as a prerequisite for making home death possible. Good collaboration with the local GPs was crucial, and support from a palliative care team was experienced as helpful. They pointed out that changes of GP and the limited services from the palliative care team were challenging. Structural and economic conditions differed between urban and rural districts, which meant that the rural districts needed to make private arrangements regarding care during night hours, while the urban districts had care services around the clock.</p><p><strong>Conclusion: </strong>Our findings underline the complexity of terminal care. The nurses felt exhausted yet rewarded from being able to fulfil a patient's wish to die at home. Experience and intuition guided their practice. They emphasised that good collaboration with the GPs, the palliative care team and the families was important. Establishing an outgoing function for the palliative care team to support the nurses and the families would increase the scope for home deaths. Working conditions differed between rural and urban districts.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"367-377"},"PeriodicalIF":1.9,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11332285/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140132493","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 of adding early cooperation and a work-place dialogue meeting to primary care management for sick-listed patients with stress-related disorders: CO-WORK-CARE-Stress - a pragmatic cluster randomised controlled trial.","authors":"C Björkelund, E-L Petersson, I Svenningsson, A Saxvik, L Wiegner, G Hensing, I H Jonsdottir, M Larsson, C Wikberg, N Ariai, S Nejati, D Hange","doi":"10.1080/02813432.2024.2329212","DOIUrl":"10.1080/02813432.2024.2329212","url":null,"abstract":"<p><strong>Objectives: </strong>To investigate whether intensified cooperation between general practitioner (GP), care manager and rehabilitation coordinator (RC) for patients sick-listed for stress-related mental disorder, combined with a person-centred dialogue meeting with employer, could reduce sick-leave days compared with usual care manager contact.</p><p><strong>Design: </strong>Pragmatic cluster-randomised controlled trial, randomisation at primary care centre (PCC) level.</p><p><strong>Setting: </strong>PCCs in Region Västra Götaland, Sweden, with care manager organisation.</p><p><strong>Participants: </strong>Of 30 invited PCCs, 28 (93%) accepted the invitation and recruited 258 patients newly sick-listed due to stress-related mental disorder (<i>n</i> = 142 intervention, <i>n</i> = 116 control PCCs).</p><p><strong>Intervention: </strong>Cooperation between GP, care manager and rehabilitation coordinator from start of illness notification plus a person-centred dialogue meeting between patient and employer within 3 months. Regular contact with care manager was continued at the control PCCs.</p><p><strong>Main outcome measures: </strong>12-months net and gross number of sick-leave days. Secondary outcomes: Symptoms of stress, depression, anxiety; work ability and health related quality of life (EQ-5D) over 12 months.</p><p><strong>Results: </strong>There were no significant differences between intervention and control groups after 12 months: days on sick-leave (12-months net sick-leave days, intervention, mean = 110.7 days (95% confidence interval (CI) 82.6 - 138.8); control, mean = 99.1 days (95% CI 73.9 - 124.3)), stress, depression, or anxiety symptoms, work ability or EQ-5D. There were no significant differences between intervention and control groups concerning proportion on sick-leave after 3, 6, 12 months. At 3 months 64.8% were on sick-leave in intervention group vs 54.3% in control group; 6 months 38% vs 32.8%, and12 months 16.9% vs 15.5%.</p><p><strong>Conclusion: </strong>Increased cooperation at the PCC between GP, care manager and RC for stress-related mental disorder coupled with an early workplace contact in the form of a person-centred dialogue meeting does not reduce days of sick-leave or speed up rehabilitation.<b>Trial registration:</b> ClinicalTrials.gov Identifier: NCT03250026 https://clinicaltrials.gov/study/NCT03250026?tab=results#publicationsCO-WORK-CAREFirst Posted: August 15, 2017. Recruitment of PCCs: September 2017. Inclusion of patients from December 2017.</p>","PeriodicalId":21521,"journal":{"name":"Scandinavian Journal of Primary Health Care","volume":" ","pages":"378-392"},"PeriodicalIF":1.9,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11332284/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140332029","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}