Scandinavian journal of primary health care
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Scand J Prim Health Care · Dec 2019
Multicenter StudyCOPD patients need more information about self-management: a cross-sectional study in Swedish primary care.
Objective: In Sweden, patients with chronic conditions, such as chronic obstructive pulmonary disease (COPD), often receive education at specialized nurse-led clinics at primary health care centers (PHCCs). Identifying patients' needs for information about COPD is the key to individualized care. This study aimed to assess self-reported needs for information about COPD in primary care patients with either moderate (GOLD 2) or severe (GOLD 3) COPD and identify patient characteristics and exacerbation patterns associated with the findings. ⋯ GOLD 2) felt they needed more information about COPD than currently provided by health care professionals in primary care. Low information needs were strongly associated with continuity in patient-GP consultations and moderately associated with contact with a COPD nurse. GPs' part in COPD patient education should not be overlooked, as individualized COPD care relies on GPs' expertise in managing patients with multimorbidity.
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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.
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Scand J Prim Health Care · Dec 2019
Limited value of NT-proBNP as a prognostic marker of all-cause mortality in patients with heart failure with preserved and mid-range ejection fraction in primary care: A report from the swedish heart failure register.
Aim: The prognostic value of natriuretic peptides in the management of heart failure (HF) patients with ejection fraction (EF) <40% is well established, but is less known for those with EF ≥40% managed in primary care (PC). Therefore, the aim of this study is to describe the prognostic significance of plasma NT-proBNP in such patients managed in PC. Subjects: We included 924 HF patients (48% women) with EF ≥40% and NT-proBNP registered in the Swedish Heart Failure Registry. ⋯ We show that high NT-proBNP predicts increased all-cause mortality in HFpEF-patients managed in primary care. The clinical use is however limited due to large standard deviations, many co-morbidities and high age. Many of these co-morbidities contribute to all-cause mortality and management of these patients should also focus on these co-morbidities.
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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.
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Scand J Prim Health Care · Dec 2019
The ecology of medical care: access points to the health care system in Austria and other developed countries.
Objective: This study aimed to analyze the Austrian health care system using the ecology of care model. Our secondary aim was to compare data from Austria with those available from other countries. Design: 3508 interviews employing a 30-item questionnaire related to the utilization of the health care system including demographic factors were conducted. ⋯ Key pointsIn Austria and similarly organized countries, there appears to be high utilization of health care in general, as well as with particular utilization of specialists and hospitalizations. The high utilization of all levels of care in Austria may be the result of competition, lack of a clear demarcation line between the primary and secondary level of care, and the presence of universal health coverage. Pathways between primary and secondary care should be strengthened as previous studies have shown that comparable countries lack the health benefits of strong primary care and its function for health care coordination.