1.
Hedin, Katarina, et al.
(författare)
Management of patients with sore throats in relation to guidelines : an interview study in Sweden.
2014
Ingår i: Scandinavian Journal of Primary Health Care. - : Taylor & Francis. - 0281-3432 .- 1502-7724. ; 32:4, s. 193-9
Tidskriftsartikel (refereegranskat) abstract
OBJECTIVE: To explore how a group of Swedish general practitioners (GPs) manage patients with a sore throat in relation to current guidelines as expressed in interviews.DESIGN: Qualitative content analysis was used to analyse semi-structured interviews.SETTING: Swedish primary care.SUBJECTS: A strategic sample of 25 GPs.MAIN OUTCOME MEASURES: Perceived management of sore throat patients.RESULTS: It was found that nine of the interviewed GPs were adherent to current guidelines for sore throat and 16 were non-adherent. The two groups differed in terms of guideline knowledge, which was shared within the team for adherent GPs while idiosyncratic knowledge dominated for the non-adherent GPs. Adherent GPs had no or low concerns for bacterial infections and differential diagnosis whilst non-adherent GPs believed that in patients with a sore throat any bacterial infection should be identified and treated with antibiotics. Patient history and examination was mainly targeted by adherent GPs whilst for non-adherent GPs it was often redundant. Non-adherent GPs reported problems getting patients to abstain from antibiotics, whilst no such problems were reported in adherent GPs.CONCLUSION: This interview study of sore throat management in a strategically sampled group of Swedish GPs showed that while two-thirds were non-adherent and had a liberal attitude to antibiotics one-third were guideline adherent with a restricted view on antibiotics. Non-adherent GPs revealed significant knowledge gaps. Adherent GPs had discussed guidelines within the primary care team while non-adherent GPs had not. Guideline implementation thus seemed to be promoted by knowledge shared in team discussions.
2.
Milos, Veronica, et al.
(författare)
Swedish general practitioners attitudes towards treatment guidelines a qualitative study
2014
Ingår i: Bmc Family Practice. - : Springer Science and Business Media LLC. - 1471-2296. ; 15:1
Tidskriftsartikel (refereegranskat) abstract
Background: Drug therapy in primary care is a challenge for general practitioners (GPs) and the prescribing decision is influenced by several factors. GPs obtain drug information in different ways, from evidence-based sources, their own or others? experiences, or interactions with opinion makers, patients or colleagues. The need for objective drug information sources instead of drug industry-provided information has led to the establishment of local drug and therapeutic committees. They annually produce and implement local treatment guidelines in order to promote rational drug use. This study describes Swedish GPs? attitudes towards locally developed evidence-based treatment guidelines. Methods: Three focus group interviews were performed with a total of 17 GPs working at both public and private primary health care centres in Sk?ne in southern Sweden. Transcripts were analysed by conventional content analysis. Codes, categories and themes were derived from data during the analysis. Results: We found two main themes: GP-related influencing factors and External influencing factors. The first theme emerged when we put together four main categories: Expectations and perceptions about existing local guidelines, Knowledge about evidence-based prescribing, Trust in development of guidelines, and Beliefs about adherence to guidelines. The second theme included the categories Patient-related aspects, Drug industry-related aspects, and Health economic aspects. The time-saving aspect, trust in evidence-based market-neutral guidelines and patient safety were described as key motivating factors for adherence. Patient safety was reported to be more important than adherence to guidelines or maintaining a good patient-doctor relationship. Cost containment was perceived both as a motivating factor and a barrier for adherence to guidelines. GPs expressed concerns about difficulties with adherence to guidelines when managing patients with drugs from other prescribers. GPs experienced a lack of time to self-inform and difficulties managing direct-to-consumer drug industry information. Conclusions: Patient safety, trust in development of evidence-based recommendations, the patient-doctor encounter and cost containment were found to be key factors in GPs? prescribing. Future studies should explore the need for transparency in forming and implementing guidelines, which might potentially increase adherence to evidence-based treatment guidelines in primary care.
3.
Gröndal, Hedvig, et al.
(författare)
Near-patient tests and the clinical gaze in decision-making of Swedish GPs not following current guidelines for sore throat - a qualitative interview study
2015
Ingår i: BMC Family Practice. - : Springer Science and Business Media LLC. - 1471-2296. ; 16
Tidskriftsartikel (refereegranskat) abstract
Background: Excessive antibiotics use increases the risk of resistance. Previous studies have shown that the Centor score combined with Rapid Antigen Detection Test (RADT) for Group A Streptococci can reduce unnecessary antibiotic prescribing in patients with sore throat. According to the former Swedish guidelines RADT was recommended with 2-4 Centor criteria present and antibiotics were recommended if the test was positive. C-reactive protein (CRP) was not recommended for sore throats. Inappropriate use of RADT and CRP has been reported in several studies. Methods: From a larger project 16 general practitioners (GPs) who stated management of sore throats not according to the guidelines were identified. Half-hour long semi-structured interviews were conducted. The topics were the management of sore throats and the use of near-patient tests. Qualitative content analysis was used. Results: The use of the near-patient test interplayed with the clinical assessment and the perception that all infections caused by bacteria should be treated with antibiotics. The GPs expressed a belief that the clinical picture was sufficient for diagnosis in typical cases. RADT was not believed to be relevant since it detects only one bacterium, while CRP was considered as a reliable numerical measure of bacterial infection. Conclusions: Inappropriate use of near-patient test can partly be understood as remnants of outdated knowledge. When new guidelines are introduced the differences between them and the former need to be discussed more explicitly.
4.
Bjerrum, Lars, et al.
(författare)
Health Alliance for prudent antibiotic prescribing in patients with respiratory tract infections (HAPPY AUDIT) -impact of a non-randomised multifaceted intervention programme
2011
Ingår i: BMC Family Practice. - : Springer Science and Business Media LLC. - 1471-2296. ; 12
Tidskriftsartikel (refereegranskat) abstract
Background: Excessive use of antibiotics is worldwide the most important reason for development of antimicrobial resistance. As antibiotic resistance may spread across borders, high prevalence countries may serve as a source of bacterial resistance for countries with a low prevalence. Therefore, bacterial resistance is an important issue with a potential serious impact on all countries. Initiatives have been taken to improve the quality of antibiotic prescribing in primary care, but only few studies have been designed to determine the effectiveness of multifaceted strategies across countries with different practice setting. The aim of this study was to evaluate the impact of a multifaceted intervention targeting general practitioners (GPs) and patients in six countries with different health organization and different prevalence of antibiotic resistance. Methods: GPs from two Nordic countries, two Baltic Countries and two Hispano-American countries registered patients with respiratory tract infections (RTIs) in 2008 and 2009. After first registration they received individual prescriber feedback and they were offered an intervention programme that included training courses, clinical guidelines, posters for waiting rooms, patient brochures and access to point of care tests (Strep A and C-Reactive Protein). Antibiotic prescribing rates were compared before and after the intervention. Results: A total of 440 GPs registered 47011 consultations; 24436 before the intervention (2008) and 22575 after the intervention (2009). After the intervention, the GPs significantly reduced the percentage of consultations resulting in an antibiotic prescription. In patients with lower RTI the GPs in Lithuania reduced the prescribing rate by 42%, in Russia by 25%, in Spain by 25%, and in Argentina by 9%. In patients with upper RTIs, the corresponding reductions in the antibiotic prescribing rates were in Lithania 20%, in Russia 15%, in Spain 9%, and in Argentina 5%. Conclusion: A multifaceted intervention programme targeting GPs and patients and focusing on improving diagnostic procedures in patients with RTIs may lead to a marked reduction in antibiotic prescribing. The pragmatic before-after design used may suffer from some limitations and the reduction in antibiotic prescribing could be influenced by factors not related to the intervention.
5.
Bjerrum, Lars, et al.
(författare)
Health Alliance for Prudent Prescribing, Yield and Use of Antimicrobial Drugs in the Treatment of Respiratory Tract Infections (HAPPY AUDIT)
2010
Ingår i: BMC Family Practice. - : Springer Science and Business Media LLC. - 1471-2296. ; 11
Tidskriftsartikel (refereegranskat) abstract
Background: Excessive and inappropriate use of antibiotics is considered to be the most important reason for development of bacterial resistance to antibiotics. As antibiotic resistance may spread across borders, high prevalence countries may serve as a source of bacterial resistance for countries with a low prevalence. Therefore, bacterial resistance is an important issue with a potential serious impact on all countries. The majority of respiratory tract infections (RTIs) are treated in general practice. Most infections are caused by virus and antibiotics are therefore unlikely to have any clinical benefit. Several intervention initiatives have been taken to reduce the inappropriate use of antibiotics in primary health care, but the effectiveness of these interventions is only modest. Only few studies have been designed to determine the effectiveness of multifaceted strategies in countries with different practice setting. The aim of this study is to evaluate the impact of a multifaceted intervention targeting general practitioners (GPs) and patients in six countries with different prevalence of antibiotic resistance: Two Nordic countries (Denmark and Sweden), two Baltic Countries (Lithuania and Kaliningrad-Russia) and two Hispano-American countries (Spain and Argentina). Methods/Design: HAPPY AUDIT was initiated in 2008 and the project is still ongoing. The project includes 15 partners from 9 countries. GPs participating in HAPPY AUDIT will be audited by the Audit Project Odense (APO) method. The APO method will be used at a multinational level involving GPs from six countries with different cultural background and different organisation of primary health care. Research on the effect of the intervention will be performed by analysing audit registrations carried out before and after the intervention. The intervention includes training courses on management of RTIs, dissemination of clinical guidelines with recommendations for diagnosis and treatment, posters for the waiting room, brochures to patients and implementation of point of care tests (Strep A and CRP) to be used in the GPs'surgeries. To ensure public awareness of the risk of resistant bacteria, media campaigns targeting both professionals and the public will be developed and the results will be published and widely disseminated at a Working Conference hosted by the World Association of Family Doctors (WONCA-Europe) at the end of the project period. Discussion: HAPPY AUDIT is an EU-financed project with the aim of contributing to the battle against antibiotic resistance through quality improvement of GPs' diagnosis and treatment of RTIs through development of intervention programmes targeting GPs, parents of young children and healthy adults. It is hypothesized that the use of multifaceted strategies combining active intervention by GPs will be effective in reducing prescribing of unnecessary antibiotics for RTIs and improving the use of appropriate antibiotics in suspected bacterial infections.
6.
Caleres, Gabriella, et al.
(författare)
Drugs, distrust and dialogue : - a focus group study with Swedish GPs on discharge summary use in primary care
2018
Ingår i: BMC Family Practice. - : Springer Science and Business Media LLC. - 1471-2296. ; 19:1
Tidskriftsartikel (refereegranskat) abstract
BACKGROUND: Discharge summary with medication report effectively counteracts drug-related problems due to insufficient information transfer in care transitions. The benefits of the discharge summary may be lost if it is not adequately used, and factors affecting optimal use by the GP are of interest. Since the views of Swedish GPs are unexplored, this study aimed to explore and understand GPs experiences, perceptions and feelings regarding the use of the discharge summary with medication report.METHOD: This qualitative study was based on four focus group discussion with 18 GPs and resident physicians in family medicine which were performed in 2016 and 2017. A semi-structured interview guide was used. The interviews were transcribed verbatim and analysed using qualitative content analysis.RESULTS: The analysis resulted in three final main themes: "Importance of the discharge summary", "Role of the GP" and "Create dialogue" with six categories; "Benefits for the GP and perceived benefits for the patient", "GP use of the information", "Significance of different documents", "Spider in the web", "Terminus/End station" and "Improved information transfer in care transitions". Overall, the participants described clear benefits with the discharge summary when accurate although perceived deficiencies were also quite rife.CONCLUSION: The GPs experiences and views of the discharge summary revealed clear benefits regarding mainly medication information, awareness of any plans as well as shared knowledge with the patient. However, perceived deficiencies of the discharge summary affected its use by the GP and enhanced communication was called for.
7.
Persson, Gerthi, et al.
(författare)
Physical activity on prescription (PAP) from the general practitioner's perspective - a qualitative study
2013
Ingår i: BMC Family Practice. - : Springer Science and Business Media LLC. - 1471-2296. ; 14
Tidskriftsartikel (refereegranskat) abstract
Background: Physical activity on prescription (PAP) is a successful intervention for increasing physical activity among patients with a sedentary lifestyle. The method seems to be sparsely used by general practitioners (GPs) and there is limited information about GPs' attitudes to counselling using PAP as a tool. The aim of the study was to explore and understand the meaning of prescribing physical activity from the general practitioner's perspective. Methods: Three focus group interviews were conducted with a purposive sample of 15 Swedish GPs in the south of Sweden. Participants were invited to talk about their experience of using PAP. The interviews were transcribed verbatim, analysed using qualitative content analysis. Results: The analysis resulted in four categories: The tradition makes it hard to change attitude, Shared responsibility is necessary, PAP has low status and is regarded with distrust and Lack of procedures and clear guidelines. Traditionally GPs talk with patients about the importance of an increased level of physical activity but they do not prescribe physical activity as a treatment. Physician's education focuses on the use of pharmaceuticals. The responsibility for patients' physical activity level is shared with other health professionals, the patient and society. The GPs express reservations about prescribing physical activity. A heavy workload is a source of frustration. PAP is regarded with distrust and considered to be a task of less value and status. Using a prescription to emphasize an increased level is considered to be redundant and the GPs think it should be administered by someone else in the health care system. Scepticism about the result of the method was also expressed. Conclusions: There is uncertainty about using PAP as a treatment since physicians lack education in non-pharmaceutical methods. The GPs do not regard the written referral as a prioritized task and rather refer to other professionals in the health care system to prescribe PAP. GPs pointed out a need to create routines and arrangements for the method to gain credibility and become everyday practice among GPs.
8.
Rööst, Mattias, et al.
(författare)
Reliability and applicability of the Patient Enablement Instrument (PEI) in a Swedish general practice setting
2015
Ingår i: BMC Family Practice. - : Springer Science and Business Media LLC. - 1471-2296. ; 16:1
Tidskriftsartikel (refereegranskat) abstract
Background: The Patient Enablement Instrument (PEI), which has been used to evaluate core ingredients in primary care consultations, has been proposed as a means of moving beyond patient satisfaction evaluations. The aim of the present study was to examine the reliability and applicability of the PEI to the Swedish context. Methods: The original PEI was translated to Swedish and included in a questionnaire that was given to consecutively scheduled patients in four primary care settings. Respondents completed identical questionnaires immediately after a consultation, as well as two days and two weeks later. The analysis focused on internal reliability, test-retest reliability and internal construct validity. Results: Mean PEI scores declined significantly between baseline (3.48, SD 3.21) and the first follow-up questionnaire (3.06, SD 3.37). All three questionnaires showed high internal consistency (Cronbach's alpha >0.85). Test-retest showed moderate agreement for all questions when comparing baseline and the first follow-up (kappa 0.54-0.65) and greater consistency between the two follow-up questionnaires (kappa 0.65-0.75). A large proportion of respondents characterized at least one of the questions as irrelevant (39%). Conclusions: The Swedish version of the PEI instrument has high internal consistency and moderate to good reliability. It can be used in research but is not recommended as a measure of quality of care. The instrument could benefit from further development and validity testing.
9.
Strandberg, Eva-Lena, et al.
(författare)
Can the APO method be used for measuring soft data?: A pilot study.
2011
Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 29:4, s. 241-246
Tidskriftsartikel (refereegranskat) abstract
Objectives. The aims were to develop auditing according to the APO (Audit Project Odense) method for measuring soft data, exemplified by a holistic view, and to test the instrument. Design. A descriptive study of the development of an APO chart and a test registration. Setting. Primary health care, Blekinge County, Sweden. Subjects. Ten general practitioners (GPs) were invited to transform categories of the concept of a holistic view obtained in an earlier study, into 30 variables on an APO registration chart. The participants chose to study different kinds of knowledge as aspects of holistic care. Main outcome measure. An APO registration chart and test of the instrument. Results. After three meetings the group had drawn up an APO registration chart supplemented with Likert scales. A pilot audit was performed. Eight doctors registered 255 consultations. In assessment of the patients' problems, factual medical knowledge was important in 83% of the cases, familiarity in 53%, and a capacity for judgement in 36%. In decision-making factual medical knowledge was used in 88% and capacity for judgement in 58%. A holistic view was necessary for the outcome in 43% and valuable in 25%. The GPs used the Likert scales in a majority of the cases. Conclusions. In this first step in developing an instrument, the results indicate that the APO method could be an alternative for studying what happens in the consultation, and the occurrence of an abstract phenomenon such as the use of different kinds of knowledge as part of a holistic view.
10.
Strandberg, Eva-Lena, et al.
(författare)
"I'm Dr Jekyll and Mr Hyde": Are GPs' antibiotic prescribing patterns contextually dependent? A qualitative focus group study.
2013
Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 31:3, s. 158-165
Tidskriftsartikel (refereegranskat) abstract
Abstract Objective. To explore factors and circumstances contributing to prudent antibiotic prescribing for respiratory tract infections in primary care. Design. Two focus groups representing rural and urban areas. A semi-structured interview guide with open-ended questions and an editing analysis style was used. They were examined to identify meaning units that were sorted into categories in an iterative process throughout the analysis. Setting. Primary health care in two counties in southern Sweden. Subjects. Two groups including seven and six general practitioners (GPs) respectively, men and women of different ages with different professional experiences. Main outcome measures. Exploration of categories, determination of themes, construction of models. Results. The decision to prescribe antibiotics takes place in the encounter between GP and patient, initially characterized by harmony or fight and the subsequent process by collaboration or negotiation, resulting in agreement, compromise, or disagreement. Several factors influence the meeting and contribute to enhancing the conditions for rational prescribing. These conditions are connected to the GP, the relationship, and the setting; organization as well as professional culture. The findings indicate synergies between the factors, and that one factor can sometimes compensate for lack of another. Continuity and mutual trust can make a brief consultation successful, but lack of continuity can eliminate the effects of knowledge and professional skills. Conclusions. The findings emphasize the importance of the encounter between the GP and the patient for prudent antibiotic prescribing. Furthermore, the importance of an appropriate organization of primary care, which promotes continuity and encourages professional autonomy, is demonstrated.
