Background/purpose The sick-listing process is often perceived uncertain and unclear by both patients and staff. To improve the process, a framework for structured assessment of rehabilitation and sick-listing (STARS) has been developed in the South-Eastern Healthcare Region in Sweden. STARS consists of seven methodological tools supporting healthcare professionals in sick-listing and rehabilitation. The purpose of this study was to investigate how primary healthcare staff clinically involved in the sick leave process experience working according to STARS.Method We used a qualitative design conducting focus group discussions (n = 7) with healthcare staff (n = 37). Eligible participants were physicians, rehabilitation coordinators and other healthcare professionals working clinically with patients. The focus group conversations were analyzed with thematic content analysis according to Braun and Clarke. The study was registered in clinicaltrials.gov (number NCT05655962).Result The participants’ experience of working according to STARS were described by the overarching theme ‘STARS as an enabling structure’ formed by three themes and eight subthemes. The themes were ‘Clearer roles and responsibilities through the RECO function’, ‘Moving from individual work to teamwork’ and ‘A more active and personalized rehabilitation and sick-listing process’.Conclusion The findings suggest that implementing the STARS framework may provide a supportive structure for a uniform and consistent way of working across primary healthcare centers. By clarifying RECOs’ roles and strengthening interprofessional collaboration, the framework may support a more patient-centered approach across services.
Purpose: Clinical features of COPD and asthma overlap, complicating differential diagnosis. This study investigated the prevalence of comorbid asthma in COPD patients and its association with patient-related outcomes.Materials and methods: Patients with a doctor’s diagnosis of COPD were randomly selected in two cohorts 2005 (n = 1060) and 2014 (n = 1671), from primary and secondary care in Sweden. Data were collected from medical records and patient questionnaires at baseline and at follow-up (2012 and 2022, respectively). Questionnaires included data on exacerbations. Symptoms were assessed using the clinical COPD questionnaire (CCQ). Comorbid asthma was identified through medical records. Ten-year mortality data were obtained from national registers. Logistic and linear regression assessed associations with patient-reported outcomes; Cox regression was applied for mortality analyses.Results: Comorbid asthma was found in 22% of the 2005 cohort and 9% of the 2014 cohort (p < .001). In both cohorts, it was associated with an increased risk of exacerbations: OR (95% CI) 1.58 (1.07–2.32), p = .02, and 2.20 (1.38–3.52), p < .001, respectively. No associations were found between comorbid asthma and worsening of health status (CCQ). Mortality risk did not differ in the 2005 cohort, HR (95% CI) 0.92 (0.71–1.18), but was lower in the 2014 cohort, HR (95% CI) 0.67 (0.49–0.93), p = .02.Conclusion: Comorbid asthma in COPD has changed from 22 to 9%, potentially due to improved diagnostics. Comorbid asthma remains clinically relevant due to its association with an increased exacerbation risk.
Background The Patient Experiences Questionnaire for Out-of-Hours Care (PEQ-OHC) is used in local and national surveys of primary care but has not been evaluated for measurement properties since 2010. This study assessed aspects of validity, reliability, and internal consistency alongside the EQ-5D-5L.Methods The PEQ-OHC and EQ-5D-5L were part of an electronic survey of 1,765 OHC patients recruited nationally across Norway 4–8 weeks following care. At 7–12 days, respondents received a retest questionnaire. Testing followed the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist for patient-reported instruments.Results The 509 (29%) respondents had a median (IQR) age of 55 (38–66) years and 54% were female. Confirmatory factor analysis showed evidence for structural validity including PEQ-OHC scales of doctor contact, nurse contact, organisation and telephone contact (Comparative Fit/Tuckey Lewis Index = 0.97, Standardised Root Mean Residuals = 0.05). Together with a new scale of video contact, Cronbach’s alpha ranged from 0.79–0.98; only organisation fell below 0.90. Test-retest weighted kappa was generally of a high to excellent level for PEQ-OHC items (0.59–0.86) and EQ-5D dimensions (0.76–0.85). Intraclass correlation coefficients ranged from 0.74–0.83 for PEQ-OHC scale scores; EQ-5D-5L index = 0.91, EQ VAS = 0.81. Over 75% of results followed hypotheses, in comparisons of instrument scores with variables relating to experiences, health and services use.Conclusion Evidence for reliability and validity further supports application of the PEQ-OHC in national and local quality measurement. The EQ-5D-5L also performed well and can be used alongside the PEQ-OHC to assess and adjust for case-mix across OHC centres.
Background Eating disorders are severe conditions associated with high morbidity, mortality and socioeconomic burden. Primary care physicians are central in their early detection and treatment, but clinicians have been found to have limited knowledge and even negative attitudes toward eating disorder patients. Most studies have focused on anorexia nervosa (AN) and bulimia nervosa (BN), while less is known about attitudes toward binge eating disorder (BED) and avoidant/restrictive food intake disorder (ARFID).Aim To examine primary care physicians’ attitudes toward eating disorders and assess whether education and clinical experience predict comfort in management and willingness to work with affected patients.Methods A cross-sectional survey was conducted among primary care physicians (n = 191) attending a mandatory seminar. Attitudes toward AN, BN, BED and ARFID were assessed using Likert-type items based on prior research. Ordinal logistic regression analyses examined associations between education, experience and selected attitudes.Results Overall attitudes were similar across diagnoses. Only 14–21% reported enjoying working with eating disorder patients. Education was consistently associated with greater comfort in management and enjoyment of working with these patients, whereas clinical experience was more strongly associated with comfort in management than with enjoyment. Familiarity with ARFID was low, reflected in reduced response rate (14.6%).Conclusions Attitudes toward eating disorders were broadly similar across diagnoses, but positive attitudes toward working with affected patients were uncommon. Education was consistently associated with more favorable attitudes and greater confidence in management, highlighting the potential value of continuing professional education and support for eating disorder care in primary care.
