Scandinavian journal of primary health care
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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
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.
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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.
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Scand J Prim Health Care · Dec 2019
Randomized Controlled Trial Multicenter StudyInforming patients on planned consultation time - a randomised controlled intervention study of consultation time in primary care.
Objective: To investigate whether patients' pre-consultation knowledge of the time frames for the consultation influences the actual consultation time and/or patient and physician related outcomes; satisfaction and enablement. Design: Randomised controlled blinded intervention study. Setting: Four strategically chosen Primary Health Care Centres (PHCC:s) in Kronoberg county in Sweden participated. ⋯ Key pointsPatients prepare before their consultation but to influence its contents and length is difficult. Informing patients on estimated consultation time can influence actual consultation time. Informing patients on planned consultation time has no adverse effects in this study.
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Scand J Prim Health Care · Dec 2019
Multicenter StudyLegitimacy of work tasks, psychosocial work environment, and time utilization among primary care staff in Sweden.
Objective: Primary care staff faces a complex work environment including a heavy administrative work load and perceive some work tasks as illegitimate. This study aimed to elucidate associations between the perceived legitimacy of work tasks, the psychosocial work environment, and the utilization of work time among Swedish primary care staff. Design and setting: The study was designed as a multicenter study involving all staff categories, i.e. registered nurses, primary care physicians, care administrators, nurse assistants and allied professionals, at eleven primary care centers in Sweden. ⋯ Also, the perception of having to perform a large amount of illegitimate work tasks affected the psychosocial work environment negatively, which might influence staffs perception of their professional roles. These results illuminate the importance of decision makers to thoroughly consider the distribution and allocation of non-patient related work tasks among staff in primary care. Key pointsWe observed an interaction between perception of having a large proportion of illegitimate work tasks and impaired psychosocial work environment. • More than a quarter of the primary care physicians perceived a high proportion of unnecessary work tasks.• Across all staff groups, performing unreasonable work tasks was associated with an experience of having role conflicts.• Across all staff groups, a perception of performing unreasonable work tasks was associated with the proportion of non-patient related administrative work tasks.