Scandinavian journal of primary health care
-
Scand J Prim Health Care · Dec 2019
Erroneous computer-based interpretations of atrial fibrillation and atrial flutter in a Swedish primary health care setting.
Objective: To describe the incidence of incorrect computerized ECG interpretations of atrial fibrillation or atrial flutter in a Swedish primary care population, the rate of correction of computer misinterpretations, and the consequences of misdiagnosis. Design: Retrospective expert re-analysis of ECGs with a computer-suggested diagnosis of atrial fibrillation or atrial flutter. Setting: Primary health care in Region Kronoberg, Sweden. ⋯ In a Swedish primary care setting, computer-based ECG interpretations of atrial fibrillation or atrial flutter were incorrect in 89 of 988 (9.0%) consecutive cases. Incorrect computer diagnoses of atrial fibrillation or atrial flutter were not corrected by the primary-care physician in 47% of cases. In 12 of the cases with an incorrect computer rhythm diagnosis, misdiagnosed atrial fibrillation or flutter led to inappropriate treatment with anticoagulant therapy.
-
Scand J Prim Health Care · Dec 2019
A tailored e-learning gives long-term changes in determinants of GPs' benzodiazepines prescribing: a pretest-posttest study with self-report assessments.
Objective: Despite guidelines and campaigns, general practitioners (GPs) continue to overprescribe benzodiazepines (BZDs). New approaches to improve prescribing are needed. Using behavior change techniques and tailoring interventions to user characteristics are vital to promote behavior change. ⋯ Key PointsA tailored e-intervention resulted in significant and long term changes in previously identified determinants of prescribing BZDs. The e-module resulted in a positive impact on GPs' readiness to adhere to BZD prescribing guidance and the way they experience psychosocial consultations. Tailoring an e-intervention to target group characteristics appears to be successful in promoting behavioral change in experienced GPs.
-
Scand J Prim Health Care · Dec 2019
Observational StudyFractures diagnosed in primary care - a five-year retrospective observational study from a Norwegian rural municipality with a ski resort.
Objective: The aim of this study was to characterize fractures recorded at a Norwegian primary care centre near a ski resort. Design: A retrospective five-year observational study in the period 2010-2014. Setting: A primary care centre equipped with an x-ray machine and located near a ski resort in a small rural municipality of 931 inhabitants in Norway. ⋯ More than 60% had fractures in the wrist, collarbone, shin or ankle. More than half of the patients with a fracture were males and below 20 years old. Most fractures were ski-related.
-
Scand J Prim Health Care · Dec 2019
Observational StudyVariations in older people's use of general practitioner consultations and the relationship with mortality rate in Vantaa, Finland in 2003-2014.
Objective: It is generally expected that the growth of the older population will lead to an increase in the use of health care services. The aim was to examine the changes in the number of visits made to general practitioners (GP) by the older age groups, and whether such changes were associated with changes in mortality rates. Design and setting: A register-based observational study in a Finnish city where a significant increase in the older population took place from 2003 to 2014. ⋯ The amount of GP visits of 65+ decreased in primary health care, especially in the youngest groups. However, in the oldest age groups (85+), the use of GPs remained unchanged regardless of changes in service supply. As the rate of GP visits among the population of 65+ declined, the positive trend in the mortality rate ceased.
-
Scand J Prim Health Care · Dec 2019
Diagnostic knowing in general practice: interpretative action and reflexivity.
Background: Getting the right diagnosis is supposed to provide an explanation of a patient's health problem and inform health care decisions. As a core element of clinical reasoning, diagnosis deserves systematic and transparent analysis. Conceptual tools can make doctors become aware of and explore diagnostic knowing. ⋯ Implications: Analysis demonstrated systematic, transparent approaches to diagnostic knowing, relevant for clinical teaching. We argue that an interpretative understanding of diagnosis can change clinical practice, complementing hypothetico-deductive strategies by recognising additional substantial diagnostic modes and giving access to scholarly reflection. Key PointsDiagnosis is a core element of clinical reasoning, deserving systematic and transparent analysis beyond hypothetico-deductive reasoning or pattern recognitionDiagnostic knowing in general practice is a special instance of all human knowing with subjectivity, interpretation and reflexivity as essential elementsLonergan's theory for knowing based on experiencing, understanding, and judging allowed us to map, decode and recognise advanced acts of clinical reasoning We share our experiences of how these concepts gave us a tool for systematic analysis of the complexities taking place in the GP's office on an ordinary day.