| 1. |
- Dahle, Nina Edel, et al.
(författare)
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Emoqol- 100 : Development and validation of a single question for low mood in primary care. A retrospective audit.
- 2023
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Ingår i: BJGP OPEN. - : Royal College of General Practitioners. - 2398-3795. ; 7:3
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Tidskriftsartikel (refereegranskat)abstract
- Background: Patients with depression need to be diagnosed and managed effectively in primary care. However, current inventories for case- finding low mood are time- consuming when considering the limited time available during appointments. Aim: To validate the diagnostic accuracy of a single question on the emotional quality of life (Emoqol- 100) as a measure of depression in symptomatic patients. Design & setting: A retrospective clinical audit, validating the Emoqol- 100 compared with the 9- item Patient Health Questionnaire (PHQ- 9) and Burns Depression Scale Today (BDST) in South Auckland, Method: Consecutive patients with suspected low mood, seen over 22 months in a single primary care clinic by one of the authors, were eligible for this retrospective audit (n = 160). The index test was the verbally asked Emoqol- 100: 'How is your emotional quality of life now, with 100 being perfect and 0 being the worst imaginable?' The reference standard was the PHQ- 9 (n = 426 visits) with a cut- off point of >= 10 or BDST (n = 513 visits) with a cut- off point of >= 6. Results: The Emoqol- 100 range 0-20 had a likelihood ratio (LR) of 25.2 for low mood compared with the BDST as the reference standard; and for Emoqol- 100 scores of 21-40, 41-60, 61-80, and 81-100 the LRs were 3.6, 1.7, 0.35, and 0.09, respectively. For the PHQ- 9, these were 10.1, 2.9, 1.3, 0.40, and 0.2, respectively. Any score <= 60 was associated with a low mood. Conclusion: The Emoqol- 100 appears to have high validity, so when it is low (<= 60), it is suggestive of a high PHQ- 9 or BDST score, and a mood issue probably exists. Emoqol- 100 could be helpful for busy primary care professionals and other clinicians.
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| 2. |
- Ellegård, Lina Maria Maria, et al.
(författare)
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Enabling patient-physician continuity in Swedish primary care : the importance of a named GP
- 2024
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Ingår i: BJGP Open. - : Royal College of General Practitioners. - 2398-3795.
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND : Continuity of care is important for patients with chronic conditions. Assigning patients to a named GP may increase continuity. AIM : To examine if patients who were registered with a named GP at the onset of their first chronic disease had higher continuity at subsequent visits than patients who were only registered at a practice. DESIGN & SETTING : Registry-based observational study in Region Skåne, Sweden. The study population included 66,063 patients registered at the same practice at least 1 year before the first chronic condition onset in 2009-2015. METHOD : We compared patients registered with a named GP with patients only registered at a practice over a four-year follow-up period. The primary outcome was the Usual Provider of Care (UPC) index, for all visits and for visits related to the chronic disease. Secondary outcomes were the number of GP, nurse and out-of-hours visits, ED visits, hospital admissions, and mortality. We used linear regression models, adjusted for patient characteristics (using entropy balancing weights) and for practice-level fixed effects. RESULTS : Patients with a named GP at onset had 3-4 percentage points higher UPC, but the difference decreased and was not statistically significant after adjusting for patient and practice characteristics. Patients with a named GP made more visits, though not for the chronic condition. There were no statistically significant differences for the other outcomes. CONCLUSION : Registration with a GP at onset does not imply higher continuity at visits and is not linked to other relevant outcomes for patients diagnosed with their first chronic condition.
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| 3. |
- Ellegård, Lina Maria Maria, et al.
(författare)
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Enabling patient-physician continuity in Swedish primary care : the importance of a named GP
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Ingår i: BJGP open. - 2398-3795.
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Continuity of care is important for patients with chronic conditions. Assigning patients to a named GP may increase continuity.AIM: To examine if patients who were registered with a named GP at the onset of their first chronic disease had higher continuity at subsequent visits than patients who were only registered at a practice.DESIGN & SETTING: Registry-based observational study in Region Skåne, Sweden. The study population included 66,063 patients registered at the same practice at least 1 year before the first chronic condition onset in 2009-2015.METHOD: We compared patients registered with a named GP with patients only registered at a practice over a four-year follow-up period. The primary outcome was the Usual Provider of Care (UPC) index, for all visits and for visits related to the chronic disease. Secondary outcomes were the number of GP, nurse and out-of-hours visits, ED visits, hospital admissions, and mortality. We used linear regression models, adjusted for patient characteristics (using entropy balancing weights) and for practice-level fixed effects.RESULTS: Patients with a named GP at onset had 3-4 percentage points higher UPC, but the difference decreased and was not statistically significant after adjusting for patient and practice characteristics. Patients with a named GP made more visits, though not for the chronic condition. There were no statistically significant differences for the other outcomes.CONCLUSION: Registration with a GP at onset does not imply higher continuity at visits and is not linked to other relevant outcomes for patients diagnosed with their first chronic condition.
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| 4. |
- Farrell, Karen, et al.
(författare)
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Treatment of Uncomplicated UTI in Males : a Systematic Review of the Literature
- 2021
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Ingår i: BJGP open. - 2398-3795. ; 5:2
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Tidskriftsartikel (refereegranskat)abstract
- Background: Urinary tract infections (UTIs) affect around 20% of the male population in their lifetime. The incidence of UTIs in men in the community is 0.9–2.4 cases per 1000 aged <55 years and 7.7 per 1000 aged ≥85 years. Aim: To evaluate the outcomes of randomised controlled trials (RCTs) comparing the effectiveness of different antimicrobial treatments and durations for uncomplicated UTIs in adult males in outpatient settings. Method: A systematic literature review of RCTs of adult male patients with an uncomplicated UTI treated with oral antimicrobials in any outpatient setting. The outcomes were symptom resolution within 2 weeks of starting treatment, duration until symptom resolution, clinical cure, bacteriological cure, and frequency of adverse events. Results: From the 1052 abstracts screened, three provided sufficient information on outcomes. One study compared trimethoprim-sulfamethoxazole for 14 days (21 males) with 42 days (21 males). Fluoroquinolones were compared in the two other RCTs: lomefloxacin (10 males) with norfloxacin (11 males), and ciprofloxacin for 7 days (19 males) and 14 days (19 males). Combining the results from the three RCTs shows that for 75% males with a UTI (76/101) bacteriological cure was reported at the end of the study. Of the 59 patients receiving a fluoroquinolone, 57 (97%) reported bacteriological and clinical cure within 2 weeks after treatment. Conclusion: The evidence available is insufficient to make any recommendations in relation to type and duration of antimicrobial treatment for male UTIs. Sufficiently powered RCTs are needed to identify best treatment type and duration for male UTIs in primary care.
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| 5. |
- Gjessing, Kristian, 1967-, et al.
(författare)
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Using early childhood infections to predict late childhood antibiotic consumption: a prospective cohort study
- 2020
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Ingår i: BJGP open. - : Royal College of General Practitioners. - 2398-3795. ; 4:5
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Tidskriftsartikel (refereegranskat)abstract
- Background: In the Swedish welfare system, the prescription and price of antibiotics is regulated. Even so, socioeconomic circumstances might affect the consumption of antibiotics for children.Aim: This study aimed to investigate if socioeconomic differences in antibiotic prescriptions could be found for children aged 2–14 years, and to find predictors of antibiotic consumption in children, especially if morbidity or socioeconomic status in childhood may function as predictors.Design & setting: Participants were from All Babies In Southeast Sweden (ABIS), a prospectively followed birth cohort (N = 17 055), born 1997-1999. Pharmaceutical data for a 10-year period, from 2005–2014 were used (the cohort were aged from 5–7, up to 14–16 years). Participation at the 5-year follow-up was 7443 children. All prescriptions from inpatient, outpatient, and primary care were included. National registries and parent reports were used to define socioeconomic data for all participants. Most children’s infections were treated in primary healthcare centres.Method: Parents of included children completed questionnaires about child morbidity at birth and at intervals up to 12 years. Their answers, combined with public records and national registries, were entered into the ABIS database and analysed. The primary outcome measure was the number of antibiotic prescriptions for each participant during a follow-up period between 2005–2014.Results: The most important predictor for antibiotic prescription in later childhood was parent-reported number of antibiotic-treated infections at age 2–5 years (odds ratio (OR) range 1.21 to 2.23, depending on income quintile; P<0.001). In the multivariate analysis, lower income and lower paternal education level were also significantly related to higher antibiotic prescription.Conclusion: Parent-reported antibiotic-treated infection at age 2–5 years predicted antibiotic consumption in later childhood. Swedish doctors are supposed to treat all patients individually and to follow official guidelines regarding antibiotics, to avoid antibiotics resistance. As socioeconomic factors are found to play a role, awareness is important to get unbiased treatment of all children.
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| 6. |
- Hajdarevic, Senada, et al.
(författare)
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Exploring why European primary care physicians sometimes do not think of, or act on, a possible cancer diagnosis : a qualitative study
- 2023
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Ingår i: BJGP Open. - : Royal College of General Practitioners. - 2398-3795. ; 7:4
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Tidskriftsartikel (refereegranskat)abstract
- Background: While primary care physicians (PCPs) play a key role in cancer detection, they can find cancer diagnosis challenging, and some patients have considerable delays between presentation and onward referral.Aim: To explore European PCPs’ experiences and views on cases where they considered that they had been slow to think of, or act on, a possible cancer diagnosis.Design & setting: A multicentre European qualitative study, based on an online survey with open-ended questions, asking PCPs for their narratives about cases when they had missed a diagnosis of cancer.Method: Using maximum variation sampling, PCPs in 23 European countries were asked to describe what happened in a case where they were slow to think of a cancer diagnosis, and for their views on why it happened. Thematic analysis was used to analyse the data.Results: A total of 158 PCPs completed the questionnaire. The main themes were as follows: patients’ descriptions did not suggest cancer; distracting factors reduced PCPs’ cancer suspicions; patients’ hesitancy delayed the diagnosis; system factors not facilitating timely diagnosis; PCPs felt that they had acted wrongly; and problems with communicating adequately.Conclusion: The study identified six overarching themes that need to be addressed. Doing so should reduce morbidity and mortality in the small proportion of patients who have a significant, avoidable delay in their cancer diagnosis. The ‘Swiss cheese’ model of accident causation showed how the themes related to each other.
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| 7. |
- Magnusson, Henrik, 1977-, et al.
(författare)
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Sustainable effect of individualised sun protection advice on sun protection behaviour : a 10-year follow-up of a randomised controlled study in primary care.
- 2019
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Ingår i: BJGP open. - London, United Kingdom : Royal College of General Practitioners. - 2398-3795. ; 3:3
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: In the light of increasing skin cancer incidences worldwide, preventive measures to promote sun protection in individuals with risky sun habits have continued relevance and importance.AIM: To report the long-term effect of individualised sun protection advice given in primary health care (PHC), on sun habits and sun protection behaviour.DESIGN & SETTING: In 2005, 309 PHC patients were enrolled in a randomised controlled study performed in a Swedish PHC setting.METHOD: At baseline, the study participants completed a Likert scale-based questionnaire, mapping sun habits, propensity to increase sun protection, and attitudes towards sun exposure, followed by randomisation into three intervention groups, all receiving individualised sun protection advice: in Group 1 (n = 116) by means of a letter, and in Group 2 (n = 97) and 3 (n = 96) communicated personally by a GP. In Group 3, participants also underwent a skin ultraviolet-sensitivity phototest, with adjusted sun protection advice based on the result. A repeated questionnaire was administered after 3 and 10 years.RESULTS: Statistically significant declines were observed in all groups for sun exposure mean scores over time. When using a cumulative score, according to the Sun Exposure and Protection Index (SEPI), significantly greater decrease in SEPI mean score was observed in Groups 2 and 3 (GP), compared to Group 1 (letter); P<0.01. The addition of a phototest did not enhance the effect of the intervention.CONCLUSION: Individualised sun protection advice mediated verbally by the GP can lead to sustained improvement of sun protective behaviour.
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| 8. |
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| 9. |
- Moberg, Anna B, et al.
(författare)
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Change in the use of diagnostic tests in the management of lower respiratory tract infections: a register-based study in primary care
- 2020
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Ingår i: BJGP open. - : Royal College of General Practitioners. - 2398-3795. ; 4:1
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Tidskriftsartikel (refereegranskat)abstract
- Background Differentiating between pneumonia and acute bronchitis is often difficult in primary care. There is no consensus regarding clinical decision rules for pneumonia, and guidelines differ between countries. Use of diagnostic tests and change of management over time is not known. Aim To calculate the proportion of diagnostic tests in the management of lower respiratory tract infections (LRTIs) in a low antibiotic prescribing country, and to evaluate if the use and prescription pattern has changed over time. Design & setting A register-based study on data from electronic health records from January 2006 to December 2014 in the Kronoberg county of south east Sweden. Method Data regarding use of C-reactive protein (CRP), chest x-rays (CXRs), microbiological tests, and antibiotic prescriptions were assessed for patients aged 18–79 years, with the diagnosis pneumonia, acute bronchitis, or cough. Results A total of 54 229 sickness episodes were analysed. Use of CRP increased during the study period from 61.3% to 77.5% for patients with pneumonia (P<0.001), and from 53.4% to 65.7% for patients with acute bronchitis (P<0.001). Use of CXR increased for patients with acute bronchitis from 3.1% to 5.1% (P<0.001). Use of microbiological tests increased for patients with pneumonia, from 1.8% to 5.1% (P<0.001). The antibiotic prescription rate decreased from 18.6 to 8.2 per 1000 inhabitants per year for patients with acute bronchitis, but did not change for patients with pneumonia. Conclusion Use of CRP and microbiological tests in the diagnostics of LRTIs increased despite the fact that the incidence of pneumonia and acute bronchitis was stable.
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| 10. |
- Moberg, Anna, 1976-, et al.
(författare)
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Change in the use of diagnostic tests in the management of lower respiratory tract infections : a register-based study in primary care
- 2020
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Ingår i: BJGP Open. - London, United Kingdom : Royal College of General Practitioners. - 2398-3795. ; 4:1
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Tidskriftsartikel (refereegranskat)abstract
- Background Differentiating between pneumonia and acute bronchitis is often difficult in primary care. There is no consensus regarding clinical decision rules for pneumonia, and guidelines differ between countries. Use of diagnostic tests and change of management over time is not known.Aim To calculate the proportion of diagnostic tests in the management of lower respiratory tract infections (LRTIs) in a low antibiotic prescribing country, and to evaluate if the use and prescription pattern has changed over time.Design & setting A register-based study on data from electronic health records from January 2006 to December 2014 in the Kronoberg county of south east Sweden.Method Data regarding use of C-reactive protein (CRP), chest x-rays (CXRs), microbiological tests, and antibiotic prescriptions were assessed for patients aged 18–79 years, with the diagnosis pneumonia, acute bronchitis, or cough.Results A total of 54 229 sickness episodes were analysed. Use of CRP increased during the study period from 61.3% to 77.5% for patients with pneumonia (P<0.001), and from 53.4% to 65.7% for patients with acute bronchitis (P<0.001). Use of CXR increased for patients with acute bronchitis from 3.1% to 5.1% (P<0.001). Use of microbiological tests increased for patients with pneumonia, from 1.8% to 5.1% (P<0.001). The antibiotic prescription rate decreased from 18.6 to 8.2 per 1000 inhabitants per year for patients with acute bronchitis, but did not change for patients with pneumonia.Conclusion Use of CRP and microbiological tests in the diagnostics of LRTIs increased despite the fact that the incidence of pneumonia and acute bronchitis was stable.
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