Scandinavian journal of primary health care
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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
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
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
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.
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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.