Scandinavian journal of primary health care
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Scand J Prim Health Care · Sep 2021
Testing for coeliac disease rarely leads to a diagnosis: a population-based study.
Coeliac disease (CD) has an estimated prevalence of ∼1% in Europe with a significant gap between undiagnosed and diagnosed CD. Active case finding may help to bridge this gap yet the diagnostic yield of such active case finding in general practice by serological testing is unknown. ⋯ The number of diagnosed CD patients in the Netherlands is substantially higher than previously reported. This suggests that the gap between diagnosed and undiagnosed patients is lower than generally assumed. This may explain that despite a high frequency of gluten-related consultations in general practice the diagnostic yield of case finding by serological testing is low.Key pointsThe diagnostic approach of GPs regarding CD and the diagnostic yield is largely unknownCase finding in a primary health care practice has a low yield of 1.6%CD testing was mostly prompted by consultation for gastrointestinal symptomsThere is a heterogeneity in types of serological test performed in primary care.
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Scand J Prim Health Care · Sep 2021
Observational StudyWeak association between socioeconomic Care Need Index and primary care visits per registered patient in three Swedish regions.
The objective was to examine the association between primary care consultations and a Care Need Index (CNI) used to compensate Swedish primary care practices for the extra workload associated with patients with low socioeconomic status. ⋯ For most levels of the CNI, there was no association with the number of consultations provided. This result may indicate insufficient compensation, weak incentives to spend the money, decisions to spend the money on other things than consultations, or stronger competition for patients among low-CNI practices. The result of this observational study should not be taken as evidence against the possibility that the CNI adjustment of capitation may have affected the socioeconomic equity in GP and nurse visits.Key PointsSwedish primary care practices receive extra compensation for socioeconomically deprived patients but it is unknown how this affects service provision.Practice-level data from three regions years 2017-2018 indicate weak or no relation between the socioeconomic burden and the number of physical consultations per patient.Results are similar when adjusting for patients' morbidity levels, suggesting that the weak gradient was not explained by longer consultations.The exception is that a small number of practices with very high burdens provide more consultations per patient.The results may reflect insufficient compensation, lack of incentives, or funds being spent on other things than consultations.
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Scand J Prim Health Care · Sep 2021
Awareness of parental illness: a grounded theory of upholding family equilibrium in parents on long-term sick-leave in primary health care.
To understand the main concern of chronically ill parents and how they resolve this concern in relation to their children. ⋯ Parents on long-term sick leave in primary health care can need assistance to facilitate the awareness context of themselves and their child.Implications: Clinicians can identify the current awareness context of their patient and help their patient towards increased understanding of their illness; their child's needs and the parental capacities needed to reveal the illness and its impacts.Key PointsChildren are affected when parents are ill; they wish for information on their parent's illness. Effective interventions are available in settings other than primary health care and possibilities seen by GPs and families in Scandinavian primary health care have been previously described. There is a knowledge gap in how parents view themselves and their parenting when ill in primary health care. An analysis grounded in interviews was needed to generate a hypothesis (theory) of parental concerns and behaviours.This theory proposes that an important concern of chronically ill parents is to sustain family equilibrium, which they attempt to do by upholding family relationships.Specific upholding behaviours include masking, resisting, colluding, and revealing. In response, children will engage in mirroring behaviours. Which paired behaviours are enacted will depend upon the respective levels of comprehension of parent and child regarding the illness and on the child's need for parenting. In their interactions, parent and child create one of six awareness contexts.Identifying the current awareness context in the family about chronic parental illness provides clinicians with a conceptual tool to better support those families locked in suspicious or conflicted awareness contexts.
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Scand J Prim Health Care · Sep 2021
Roles and responsibilities in substance use prevention in the school setting: views among Finnish school personnel representatives.
This study explores the views of Finnish school personnel representatives regarding substance use prevention responsibilities. ⋯ The findings highlight a need to develop structures and role clarity among school personnel, which can advance further development of intra-school and inter-sectoral collaboration in primary substance use prevention and mental health promotion. In the Finnish context, the successful implementation of relevant legislation, which some school representatives view as unclear or contravening, could be further supported.Key pointsViews regarding responsibilities in primary substance use prevention in the school setting have been less researched in the Nordic countries:The importance of inter-sectoral and intra-school collaboration is emphasized among school personnel representatives, including the role of the homesPrimary prevention and mental health promotion responsibilities are viewed as less clear than secondary and tertiary prevention responsibilitiesStructural guidelines concerning e.g. confidentiality aspects and curriculum features can both support and challenge school representatives in their roles.
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Scand J Prim Health Care · Sep 2021
Good communication was valued as more important than accessibility according to 707 Nordic primary care patients: a report from the QUALICOPC study.
To explore Nordic patients' ranking of the importance of different aspects of general practice. ⋯ Organisational framework for general practice must allow for acceptable communication quality as well as availability.Key pointsIn order to identify relevant service areas for quality improvement in primary care, we aimed to increase knowledge of patient ranked importance of different dimensions of care.Nordic primary care patients valued good communication and involvement in decisions higher than accessibility to care.A singular focus on the access of care when developing services may not be in accordance with patient preferences.