Scandinavian journal of primary health care
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Scand J Prim Health Care · Dec 2021
Prescribing antibiotics: the use of diagnostic tests in general practice. A register-based study.
To assess (i) the pattern of antibiotic prescribing in Danish general practice, (ii) the use of diagnostic tests [point-of-care (POC) and tests analysed at the hospital laboratory (laboratory tests)], and (iii) the frequency of diagnostic testing in relation to antibiotic prescriptions. ⋯ This study provides an overview of the use of diagnostic tests in relation to antibiotics and creates basis for further research into the variability between types of antibiotics. The study indicates that there is room for improvement to use diagnostic tests as an aid to promote prudent antibiotic use.KEY POINTSDiagnostic tests (point-of-care or tests analysed at the hospital laboratory), can increase diagnostic certainty and lead to a reduction in antibiotic use in general practice.A decrease in antibiotic courses in general practice in Denmark was observed during 2013-2017, while the use of diagnostic tests increased.A diagnostic test was performed in relation to 43% of antibiotic courses.Only 52% of prescribed fluoroquinolones was related to a diagnostic test, conflicting with national guidelines.
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Scand J Prim Health Care · Dec 2021
Psychosocial consequences of screening-detected abdominal aortic aneurisms: a cross-sectional study.
In Sweden, an abdominal aortic aneurysm (AAA) screening programme was gradually implemented from 2009 to reduce the incidence of rupture and thereby mortality. AAA screening introduces a variety of unintended, but generally unavoidable, harms, e.g. stress and worry. Such psychosocial consequences have previously only been investigated with generic measures. Therefore, the aim of this study was to describe and compare the psychosocial consequences in men with a screening detected AAA to men with a normal screening result after they participated in the Swedish national AAA-screening programme using a validated psychometric instrument. ⋯ Men diagnosed with a screening detected AAA, reported more negative psychosocial consequences compared to men with a normal result. Screening for abdominal aorta aneurism (AAA) introduces intended benefits and unintended harms. Adequate measures are necessary to determine the balance between them.Key points:This study applied a condition-specific questionnaire with high content validity and adequate psychometric properties to measure psychosocial consequences in men participating in AAA screening.We found that men with a screening detected AAA reported more negative psychosocial consequences than men with a normal aorta size.The risk of negative psychosocial consequences is important to include in the decision making on whether to participate in screening or not.
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Scand J Prim Health Care · Dec 2021
'Never change a winning team': GPs' perspectives on discontinuation of long-term antidepressants.
Long-term antidepressant use, much longer than recommended by guidelines, can harm patients and generate unnecessary costs. Most antidepressants are prescribed by general practitioners (GPs) but it remains unclear why they do not discontinue long-term use. ⋯ Discontinuation of long-term antidepressants is a difficult and uncertain process for GPs, especially in the absence of a facilitating life-event or patient demand. The absence of a compelling need for discontinuation and fear of relapse of symptoms in a stable patient are important barriers for GPs when considering discontinuation. In order to increase GPs' motivation to discontinue long-term antidepressants, more emphasis on the futility of the actual effect and on potential harms related to long-term use is needed.KEY POINTSCurrent awareness:Long-term antidepressant use, much longer than recommended by guidelines, can harm patients and generate unnecessary costs.Main statements: • Discontinuation of long-term antidepressants is a difficult and uncertain process for GPs. • More emphasis on the futility of the actual effect of antidepressants and on potential harms related to long-term use is needed.
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Scand J Prim Health Care · Dec 2021
General practitioners' experiences with children and adolescents with functional gastro-intestinal disorders: a qualitative study in Norway.
Objective: Functional gastrointestinal disorders (FGIDs) are common in children and adolescents. During 2016 and 2019, we investigated the experiences among parents of children with FGIDs and interviewed their children and adolescents during 2020. The aim of the present study was to explore the experiences among general practitioners (GPs) who treat this patient group. ⋯ Conclusions: The GPs' biopsychosocial focus and long-term follow-up care are essential in treating children and adolescents with FGIDs and their parents. KEY POINTSCurrent awarenessAbdominal pain is a common symptom in children and adolescents, for which an organic cause is seldom found. Main statementsGPs feel competent to treat children and adolescents who have functional gastro-intestinal disorders (FGIDs) without referring them to hospital or specialists. • A main task for GPs is to inform children, adolescents, and their parents that FGIDs are not a serious organic disease and that everyday life should continue.