Scandinavian journal of primary health care
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Scand J Prim Health Care · Sep 2016
ReviewQuality assessment of diagnosis and antibiotic treatment of infectious diseases in primary care: a systematic review of quality indicators.
To identify existing quality indicators (QIs) for diagnosis and antibiotic treatment of patients with infectious diseases in primary care. ⋯ The small number of existing QIs predominantly focuses on the choice of antibiotics and is often drug-specific. There is a remarkable lack of diagnostic QIs. Future development of new QIs, especially disease-specific QIs concerning the diagnostic process, is needed. KEY POINTS In order to improve the use of antibiotics in primary care, measurable instruments, such as quality indicators, are needed to assess the quality of care being provided. A total of 11 studies were found, including 130 quality indicators for diagnosis and antibiotic treatment of infectious diseases in primary care. The majority of the identified quality indicators were focusing on the choice of antibiotics and only a few concerned the diagnostic process. All quality indicators were developed by means of a consensus method and were often based on literature studies or guidelines.
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Scand J Prim Health Care · Sep 2016
Intertester reliability of shoulder complaints diagnoses in primary health care.
Shoulder complaints are frequently encountered in general practice, but precise diagnosing is challenging. This study investigated agreement of shoulder complaints diagnoses between clinicians in a primary health care setting. ⋯ Although experienced clinicians showed substantial intertester agreement, precise diagnoses of shoulder complaints in primary health care remain a challenge. The present results call for further research on refined diagnoses of shoulder complaints. Key points Based on medical history and a systematic functional examination by selective tissue tension techniques (STTs), we investigated the agreement of shoulder complaints diagnoses across four primary health care clinicians and 62 patients. • Agreements on diagnoses were generally better than the agreement on individual tests. • Good kappa scores were obtained for the diagnoses glenohumeral capsulitis, rotator cuff tendinopathy, and acromioclavicular lesion. • Further research is necessary to investigate the diagnostic validity of functional shoulder examination by the STTs method.
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Scand J Prim Health Care · Sep 2016
Potentially severe drug-drug interactions among older people and associations in assisted living facilities in Finland: a cross-sectional study.
This study aims to assess potentially severe class D drug-drug interactions (DDDIs) in residents 65 years or older in assisted living facilities with the use of a Swedish and Finnish drug-drug interaction database (SFINX). ⋯ Of the residents in assisted living, 5.9% were exposed to DDDIs associated with the use of a higher number of drugs. Physicians should be trained to find safer alternatives to drugs associated with DDDIs. KEY POINTS Potentially severe, class D drug-drug interactions (DDDIs) have been defined in the SFINX database as clinically relevant drug interactions that should be avoided. • Of the residents in assisted living, 5.9% were exposed to DDDIs that were associated with the use of a higher number of drugs. • The most frequent DDDIs were related to the concomitant use of potassium with amiloride or spironolactone. Carbamazepine and methotrexate were also linked to DDDIs. • No difference in mortality was observed between residents exposed to DDDIs and residents not exposed to DDDIs.
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Scand J Prim Health Care · Sep 2016
The use of a portable three-lead ECG monitor to detect atrial fibrillation in general practice.
Objective: To evaluate how well an inexpensive portable three-lead ECG monitor PEM identified patients with atrial fibrillation (AF) compared to a normal 12-lead ECG. Design: Cross-sectional method comparison study. Setting: From April 2014 to February 2015, we included patients coming to the general practice clinic "Lægerne Sløjfen", Aalborg, Denmark for a routine ECG. ⋯ The PEM device was easy to use and 95.7% of the recordings were technically acceptable for detecting atrial fibrillation. The PEM device has a high sensitivity and specificity in detecting atrial fibrillation compared to a standard 12-lead ECG. Further studies should evaluate the clinical usefulness of the PEM device, e.g. to detect intermittent atrial fibrillation.
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Scand J Prim Health Care · Sep 2016
Follow-up after acute poisoning by substances of abuse: a prospective observational cohort study.
Objective: To chart follow-up of patients after acute poisoning by substances of abuse, register whether patients referred to specialist health services attended, and whether patients contacted a general practitioner (GP) after the poisoning episode. Design: Observational cohort study. Setting: A primary care emergency outpatient clinic in Oslo, Norway. ⋯ Nearly all patients referred to specialist health services attended, indicating the acute poisoning as an opportune moment for intervention. Advising patients to contact their GP was significantly associated with patients consulting the GP, but few patients were so advised. One out of three patients was discharged without follow-up, and there seems to be an unused potential for GP involvement.