Scandinavian journal of primary health care
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Scand J Prim Health Care · Dec 2018
Randomized Controlled TrialPoint-of-care CRP matters: normal CRP levels reduce immediate antibiotic prescribing for acutely ill children in primary care: a cluster randomized controlled trial.
Antibiotics are prescribed too often in acutely ill children in primary care. We examined whether a Point-of-Care (POC) C-reactive Protein (CRP) test influences the family physicians' (FP) prescribing rate and adherence to the Evidence Based Medicine (EBM) practice guidelines. ⋯ Normal CRP levels discourage immediate antibiotic prescribing, even when EBM practice guidelines advise differently. Most likely, a normal CRP convinces FPs to withhold antibiotics when guidelines go against their own gut feeling. Future research should focus on whether POC CRP can effectively identify children that benefit from antibiotics more accurately, without increasing the risks of under-prescribing. Key points What is previously known or believed on this topic •Antibiotics are prescribed too often for non-severe conditions. Point-of-care (POC) C-reactive Protein (CRP) testing without guidance does not reduce immediate antibiotic prescribing in acutely ill children in primary care. What this research adds •FPs clearly consider CRP once available: normal CRP levels discourage immediate antibiotic prescribing, even when EBM practice guidelines advise differently. Most likely, a normal CRP convinces FPs to withhold antibiotics when guidelines go against their own gut feeling. •Future research should focus on whether POC CRP can effectively identify children that benefit from antibiotics more accurately, without increasing the risks of under-prescribing.
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Scand J Prim Health Care · Dec 2018
Socioeconomic disparities in physical activity among Swedish women and trends over time - the population study of women in Gothenburg.
To explore secular trends in physical activity in relation to socioeconomic position in middle-aged women, with focus on whether the social gaps have become wider, narrower, or remain unchanged. ⋯ Women in different socioeconomic groups improved their physical activity at work and leisure time to the same extent from 1980 to 2004, indicating that the socioeconomic gap in physical activity is neither increasing nor decreasing. Key Points The gap in physical activity levels between socioeconomic groups seems to have remained stable for middle-aged women the last 25 years. • However, women were more physically active in 2004 at work and during leisure time, independent of socioeconomic position, compared to 1980. • It remains a great challenge to create structures that enable these behaviours for all social groups.
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Scand J Prim Health Care · Dec 2018
Quality assessment in general practice: diagnosis and antibiotic treatment of acute respiratory tract infections.
To investigate areas in need of quality improvement within the diagnostic process and antibiotic treatment of acute respiratory tract infections (RTIs) in Danish general practice by using quality indicators (QIs). ⋯ To improve antibiotic prescribing in general practice it is important to focus on both the diagnostic process and the prescribing patterns. The findings indicate an overuse of antibiotics for acute respiratory tract infections in Danish general practice. Especially the diagnostic process and antibiotic prescribing patterns for acute rhinosinusitis and acute bronchitis could benefit from future quality improvement interventions.
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Scand J Prim Health Care · Dec 2018
Observational StudyTreatment, transport, and primary care involvement when helicopter emergency medical services are inaccessible: a retrospective study.
To examine handling of cancelled helicopter emergency medical services (HEMS) missions with a persisting medical indication. ⋯ Ambulance workers and GPs have an important role when HEMS is unavailable. Our findings indicated good collaboration among the prehospital personnel. Many of the patients were provided minimal or no treatment, and treatment did not differ according to GP involvement. Key Points Knowledge about handling and involvement of prehospital services in cancelled helicopter emergency medical services (HEMS) missions are scarce. Ambulance workers and general practitioners have an important role when HEMS is unavailable Minimal or no treatment was given to a large amount of the patients, regardless of which health personnel who encountered the patient.
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Scand J Prim Health Care · Dec 2018
Creating a safety net for patients with depression in primary care; a qualitative study of care managers' experiences.
The aim of this study was to explore nurses' experiences and perceptions of working as care managers at primary care centers. ⋯ The nurses perceived that working as care managers enabled them to follow and support patients with depression and to maintain close contact during the illness. The care manager function helped to provide continuity in care which is a main task of primary health care. Key Points The care managers described their role as an additional support to the already existing care at the primary care center. • They emphasized that as care managers, they had a person-centered focus and constituted a safety net for patients with depression. • Their role as care managers enabled them to follow and support patients with depression over time, which made their work more meaningful. • Care managers helped to achieve continuity and accessibility to primary health care for patients with depression.