Objective: To assess the internal consistency and interpretation of estimates reported in a 30-year cohort study of alcohol consumption and cardiovascular outcomes. Design: Critical commentary with independent recalculation of odds ratios from published aggregate data. Setting: A Swedish occupational cohort study with 30 years of follow-up. Subjects: Published data for 973 male automotive workers. Main outcome measures: Myocardial infarction, stroke, all-cause mortality and survival-time estimates. Results: The published abstract attributes an odds ratio of 0.57 to myocardial infarction, whereas the reported counts yield an odds ratio of 1.41; the 0.57 estimate relates to all-cause mortality. Further concerns include survival-time terminology, numerical inconsistencies across tables and figures, competing-risk methods, multiplicity and residual confounding, including sick-quitter bias. Conclusion: The published record requires correction and reconciliation with the underlying data and statistical analyses. The findings support only exploratory associations and do not establish cardioprotection or a survival benefit from alcohol consumption.
Background In Sweden, general practitioners encounter nearly all children in health visits within the Child Health Services, and these visits have a predetermined agenda according to a national health programme. During the visits, the general practitioner assess the child’s health and development and promote their participation. Earlier research has shown that pictorial support can help capture the child’s attention during health visits, thereby promoting participation. This study aimed to explore general practitioners’ experiences of using pictorial support to promote three-year-olds’ participation in encounters within the Swedish Child Health Services.Methods The study employed a qualitative design, and data were collected through interviews with 20 general practitioners. Deductive content analysis was used when analysing the data.Results The study conveys that general practitioners experience that the pictorial support is a helpful strategy for listening to the child’s views and acting on them. This strategy helps to establish a relationship with the child, promote their participation in the encounter, and conduct an equitable assessment of their health and development in these often complex and challenging encounters.Conclusion The pictorial support used in this study was shown to be a helpful strategy for general practitioners in promoting the child’s participation and facilitating an equitable assessment of their health and development. These results suggest that using pictorial support can help general practitioners consider children’s views and promote their participation in accordance with the Article 12 of the UN Convention on the Rights of the Child.
BACKGROUND:Increased diagnostic testing may contribute to clinically unnecessary healthcare-seeking. AIM:To analyse whether patients exposed to general practitioners (GPs) who frequently use C-reactive protein point-of-care testing (CRP-POCT) have different long-term use of out-of-hours (OOH) primary care services. DESIGN AND SETTING:Register-based time-to-event analysis of OOH primary care in the Central Denmark Region (population 1.3 million). The service functions as gatekeeper to hospital care. The GPs work a limited number of shifts per month. METHODS:All in-person clinic consultations at the OOH clinics from 2014 to 2017 were included. The exposure was the consulted GP's adjusted tendency to perform CRP-POCT relative to peer GPs, based on the latest 50 consultations. Covariates included patient characteristics, GP activity level and experience in OOH care, and time of consultation. Hazard ratios (HRs) for revisiting OOH primary care were estimated. RESULTS:A total of 862,733 consultations were included. The proportion of consultations involving CRP-POCT increased from 12% in 2014 to 19% in 2017. Kaplan-Meier estimates showed that it took 2.5 years before half of the patients had returned for an OOH consultation. The adjusted HR for revisiting was 1.038 (95% CI = 1.023 to 1.054) for patients seen by a GP with twice the average CRP-POCT use or higher, compared with those seen by a GP with average use. CONCLUSION:Being seen by a GP with a high propensity to use CRP-POCT was associated with increased long-term OOH all-cause healthcare-seeking. This may reflect effects of CRP-POCT itself, correlated GP characteristics, or both.
Objectives Emergency department (ED) visits remain common among older adults with multiple long-term conditions, many of whom have palliative care needs. However, the ED environment is burdensome for these patients and often misaligned with their goals. This study explores experiences of shortcomings in outpatient care that drive ED use in this population to inform a primary care intervention.Method Qualitative content analysis of free-text responses from a survey of 100 physicians, registered nurses and nurse assistants working across primary care practices, home healthcare, EDs, geriatrics, ambulance services and advanced home healthcare in Stockholm.Results The analysis distinguished one overarching theme: ‘Delayed, fragmented palliative care in primary care settings contributes to ED visits’. This theme comprised two categories: (1) Palliative decision-making in primary care, including subcategories Recognizing palliative care needs and initiating care, and Including patients and families in shared decision-making; and (2) Delivery of palliative care at home, including sub-categories Care planning and symptom management at home, and Ensuring information transfer regarding patients’ preferences. Respondents described how these shortcomings led to crisis-driven ED visits that often conflicted with patients’ wishes to remain and die at home.Conclusion Delayed recognition of palliative care needs and the resulting delay in action are perceived as important drivers of avoidable ED visits in older adults with multiple long-term conditions. Strengthening generalist palliative care in primary care through targeted education, adequate resources, and access to specialist support are potential important components of an intervention aiming to reduce ED use and enable more proactive, person-centred, end‑of‑life care.
Background Living with severe mental illness (SMI) adversely affects quality of life (QoL). The SOFIA program, a coordinated general practice care initiative in Denmark, aimed to improve QoL and reduce mortality through extended general practitioner (GP) consultations, training for GPs and staff, and support in connecting patients with relevant health and social services.Objective To evaluate the impact of the SOFIA intervention on needs-based QoL, self-perceived inequity, and health-related QoL in people with SMI.Design and Setting Cluster-randomised, non-blinded controlled pilot trial conducted in nine Danish general practices between November 2020 and March 2021. Practices were allocated to a coordinated care program (CCP; n = 27), CCP plus a needs-based QoL tool (CCP+; n = 37), or usual care (control; n = 23).Subjects Adults with psychotic disorders, bipolar disorder, or severe depressive disorder.Main Outcome Measures Outcomes were assessed using the Multi-Morbidity Questionnaire (MMQ) and the EQ-5D-5L.Results No statistically significant differences were observed between intervention and control groups in changes in needs-based QoL. Compared with the control group, the CCP+ group showed statistically significant improvements in two self-perceived inequity domains: not being seen and heard and powerlessness. No significant differences were found for the remaining inequity domains or health-related QoL.Conclusion The findings suggest that comprehensive, coordinated GP consultations may help reduce feelings of inequity among people with SMI. Larger pragmatic randomised controlled trials with adequate power and longer follow-up are needed to determine the intervention’s effectiveness on patient-reported outcomes and long-term health.Trial registration The pilot trial protocol registration was dated 05/11/2020, and the registration number is NCT04618250.
INTRODUCTION:The relationship between alcohol consumption and the incidence of myocardial infarction (MI), stroke and all-cause mortality exhibits significant regional variation. OBJECTIVE:This prospective study aimed to investigate this association analyzing data from a cohort of Swedish men aged 45-50 years at baseline, evaluating subgroups over various time intervals, and compiling data on cardiovascular endpoints. METHODS:The Coeur study, conducted between 1993 and 1995, included 973 middle-aged male employees out of a randomly selected sample of 1144 individuals from a Swedish automotive company. Participants were followed for 30 years using national health registers. The accumulated incidence of first-time stroke, first-time MI and all-cause mortality was calculated and adjusted for cardiovascular risk factors. Data analysis employed time-to-event methods (Kaplan-Meier's estimates and hazard ratios) and measures of association (odds ratios and correlation analysis). RESULTS:No statistically significant association was observed between alcohol consumption and stroke (p > 0.05). However, alcohol consumption was associated with lower odds of MI (OR = 0.57, 95% CI: 0.41-0.79) and a slight increase in survival time (HR = 0.997, 95% CI: 0.995-1.000). Alcohol consumers had a median survival advantage of 1.3 years compared to non-consumers. All beverage types showed a negative association with all-cause mortality (total alcohol: OR = 0.57; beer: OR = 0.68, 95% CI: 0.50-0.92; wine: OR = 0.55, 95% CI: 0.41-0.75). Conversely, beer consumption was linked to higher odds of MI (OR = 1.70, 95% CI: 1.05-2.75). CONCLUSIONS:While alcohol consumption in middle-aged men after 30 years follow-up is associated with increased survival time, beer correlates with a higher likelihood of MI.
BACKGROUND:Maintaining accessible primary healthcare (PHC) services requires evidence-informed decision-making, especially during health system reforms, which can implicitly or explicitly affect PHC service networks. Following a large-scale administrative reform, Finnish wellbeing services counties are reshaping their local service networks. We investigated the principles guiding PHC service network planning, justifications for service network adjustments, and views on future PHC service provision. METHODS:Publicly available policy documents (n = 31) concerning PHC service networks were systematically identified and extracted from county websites. We followed the READ approach and utilized document analysis with inductive content analysis. RESULTS:Public PHC service network planning focused on travel times and accommodation for external, mainly population-related factors. All counties were also implementing tiered service provision. Service network changes were justified by workforce challenges, particularly in remote areas, and poor condition of premises. Additionally, centralization was argued to enable higher standards of care. Financial aspects were not strongly emphasized. Future PHC centered around digital and mobile care services, which were seen as prerequisites for reducing physical services, while detailed long-term planning was largely absent. CONCLUSIONS:The counties' service network analyses highlighted the complexity of planning and a concurrent balancing act between accessibility, service quality, workforce availability, and physical premises. The strenghtening of acccessibility and availability was emphasized, while the service provision was adapted to the available resources. Our findings can support evidence-informed planning and implementation of health system reforms which affect PHC and provide a basis for further research on PHC service networks and accessibility.
Introduction Psychological safety enables team members to take interpersonal risks without fear of negative consequences. Low psychological safety could be related to psychological distress among primary care physicians, but evidence in this setting remains limited. We assessed anxiety symptoms, perceived stress, psychological safety, and their interrelations in this group.Methods A cross-sectional survey was administered to 231 physicians (63.2% women; 131 general practitioners [GPs] and 100 residents). The survey included the Team Psychological Safety Survey, the two-item Generalized Anxiety Disorder scale, the four-item Perceived Stress Scale, and sociodemographic items. Data were analyzed using hierarchical multiple regression models for anxiety and stress, adjusting for gender, training level, and age. Group comparisons by gender and training level were examined as secondary analyses.Results Of the 231 physicians invited, 111 responded (67.6% women; 62 GPs and 49 residents), yielding a 48% response rate. Among participants, 18.9% screened positive for clinically relevant anxiety symptoms on the GAD-2. Women reported higher levels of anxiety symptoms and lower psychological safety compared with men. Psychological safety was inversely associated with anxiety symptoms and perceived stress, and these associations remained significant after adjusting for demographic factors.Conclusions Low psychological safety is associated with more anxiety symptoms and greater perceived stress among primary care physicians. Compared with men, women reported more anxiety symptoms and lower psychological safety. These findings suggest that perceived psychological safety is a relevant correlate of psychological distress among primary care physicians. Longitudinal and qualitative studies are needed to better understand the relationship between psychological safety and psychological distress, and to explore gender-related differences.
Background High body mass index (BMI) accounts for approximately 7% of total mortality in Sweden and represents a major global public health challenge. In recent years, new anti-obesity medications (AOMs) have been introduced; however, knowledge about how primary care physicians (PCPs) perceive these medications in clinical practice is limited. Understanding PCPs’ perspectives is essential as these medications are expected to play an increasingly important role in obesity care.Aim To explore PCPs’ experiences and perceptions of AOMs, and to identify perceived challenges and opportunities related to their clinical use.Methods A qualitative study was conducted, including 11 in-depth interviews with PCPs working in regional and private primary health care centers in Skåne, Sweden. Data were analyzed using qualitative content analysis.Results The analysis yielded one overarching theme: Negotiating tensions and shifting responsibilities in the transformation of obesity treatment, supported by five categories and 13 sub-categories. AOMs facilitated person-centered discussions about weight management but posed challenges due to limited clinical experience and recent introduction. The multifactorial nature of obesity raised questions regarding clinical responsibility, treatment duration and resource allocation.Conclusions Pharmacological treatment of obesity was perceived as useful for initiating discussions and supporting weight loss. However, PCPs reported challenges related to obesity complexity, lack of consensus on classification and treatment, unclear treatment duration, and economic barriers. Clear guidelines and shared understanding of obesity treatment may reduce uncertainty and provide stronger support for PCPs. Further research incorporating patient perspectives and other Swedish regions can inform national guidelines and enhance the overall understanding of AOMs.
Background Knee osteoarthritis (OA) is a prevalent condition and public health concern. Guidelines recommend non-surgical treatments - such as education, exercise and weight management - as core elements of OA management; however, uptake remains low. General practitioners (GPs) play a crucial role in delivery, yet little is known about how GPs navigate OA treatments in the Scandinavian context.Aim To explore Danish GPs' perceptions and experiences of knee OA management, focusing on treatments and referral, and to identify key barriers and facilitators to delivering guideline-recommended treatments.Methods Twelve semi-structured online interviews were conducted with GPs and GP trainees. Participants were recruited through a combination of convenience and self-selection sampling. Data were analyzed inductively using thematic analysis.Results Four themes were identified: (1) knowledge and practice extend beyond guidelines, (2) non-surgical treatments are limited and inconsistently provided, (3) conceptual and relational tensions are negotiated and (4) fostering patient motivation is challenging.Conclusion GPs displayed generally up-to-date knowledge of core non-surgical treatments, although familiarity with referral criteria was more variable. They held positive attitudes toward exercise and physiotherapy-led treatment, but experienced limited active dissemination of guidelines. Structural barriers, including fragmented pathways and uneven municipal services limited delivery of non-surgical treatments. Weight loss was viewed as effective in relieving joint pain but an unsustainable treatment focus, highlighting the need for a feasible, weight-inclusive approach to weight management. Strengthening cross-sector coordination, developing and implementing multidisciplinary OA services as well as clarifying where responsibility for fostering patient motivation should be placed, may enhance delivery of non-surgical care.
Background To improve care for community-dwelling older individuals, Swedish primary care has implemented nurse-led elderly care units targeting this group.Aim To explore how primary care nurses working in elderly care units view their role regarding medication safety and gain their perspectives on the work model.Methods This was a qualitative focus group study with 14 strategically sampled primary care nurses working at elderly care units. Data were collected through three focus groups and two individual interviews between September 2024 and June 2025, audio-recorded and transcribed verbatim. Content analysis was applied, and the person-centred nursing framework was used to interpret the results. Triangulation and reflexivity were pursued, and an audit trail was maintained to ensure trustworthiness.Results Five categories emerged (1), diverse conditions for elderly care units (2), preventing and managing drug-related problems (3), bridging the gap - a vital function for medication safety (4), the comprehensive geriatric perspective, and (5) perceptions of the nurse's role.Conclusion This study found that nurses in elderly care units recognize their potentially significant role in medication safety. Their comprehensive geriatric perspective enables them to impede or intervene on drug-related problems, compensate for fragmented care and resolve issues as a central coordinator. However, the absence of guidelines leads to inconsistent and inequitable care, insights important for further development of the work model.
BACKGROUND:Continuity of care is key for high-quality primary care, associated with improved health outcomes, reduced mortality and more efficient use of resources. Achieving relational continuity is challenging in systems with high provider choice and fragmented care-seeking. Sweden exemplifies this tension, combining broad access to primary care and low GP continuity. AIM:To examine how individual characteristics (age, morbidity, socioeconomic status and migration background) and primary care center (PCC) features (ownership, size, physician turnover, patient mix and location) are associated with relational continuity and to contrast within-PCC continuity with total continuity systemwide. DESIGN AND SETTING:Retrospective cohort study using linked administrative register data covering all in-person physician contacts in primary care for 1.4 million residents in Region Skåne, Sweden. METHOD:Continuity of Care Index (CoCI) was measured using all primary care physician visits over 36-months. Linear regression models estimated associations between individual and PCC characteristics and continuity, adjusting for individual- and PCC-level covariates. RESULTS:The characteristics most strongly associated with higher continuity were low physician turnover, older age, chronic conditions, smaller PCC size and private ownership. Individuals with higher education, higher income and foreign background had lower total continuity. Differences in continuity were more strongly associated with PCC characteristics than with patient characteristics. CONCLUSION:Relational continuity in Swedish primary care is associated primarily with organizational factors, particularly physician turnover and practice size. Fragmented care-seeking among specific groups, especially individuals born outside the Nordic countries, contributes to lower total continuity but does not reflect weaker patient-provider relationships within PCCs.
BACKGROUND:Previous studies have shown an association between dementia and diabetes. This study focused on examining whether insulin resistance is a risk factor for mild cognitive impairment (MCI). We also evaluated whether common cardiovascular risk factors or depressive symptoms modify the risk of MCI along with insulin resistance and compared the health-related quality of life (HRQoL) with or without MCI. METHODS:The participants were followed from 57 to 69 years of age and divided into two groups, MCI and non-MCI, according to their Consortium to Establish a Registry for Alzheimer's Disease (CERAD) total score at the follow-up. The changes in Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) and fasting insulin level during the follow-up were determined. Smoking, alcohol consumption, physical activity, depressive symptoms, and HRQoL were obtained by questionnaire. Body weight, height, blood pressure, and low-density lipoprotein (LDL) cholesterol were measured at baseline and follow-up. Adjustments were made for baseline cognitive performance, professional education and physical activity. RESULTS:Greater increases in HOMA-IR (OR 2.20, 95% CI 1.05-4.62) and fasting insulin (OR 3.49, 95% CI 1.48-8.23) increased the risk of MCI. Lower cognitive performance at baseline (OR 6.33; 95% CI 3.27-12.29), lower level of education (OR 3.94, 95% CI 1.76-8.81) and lower level of physical activity (OR 2.44, 95% CI 1.06-5.65) also increased the risk of MCI at follow-up. There was a greater decline in health-related quality of life among the MCI group. CONCLUSION:Insulin resistance is a risk factor for MCI and MCI causes worsening of HRQoL during aging.
BACKGROUND/AIM:Sarcopenia screening in primary care is limited by time and workload. The aim of this study was to investigate the relationship between SARC-F (Strength, Assistance with walking, Rise from a chair, Climb stairs, and Falls)-defined sarcopenia risk and routine laboratory parameters in primary care. Additionally, the study aimed to determine the prevalence of sarcopenia risk, as defined by the SARC-F, in the study population. MATERIALS AND METHODS:Data were collected from individuals aged 65 and older (n = 396) registered at two family health centers in İzmir who had complete SARC-F and laboratory data. Sarcopenia risk was defined as a SARC-F score of 4 or higher. Demographic, clinical, and routine laboratory data were obtained from electronic records. Multivariate logistic regression, Pearson chi-square test, and Mann-Whitney U test were used for statistical analysis. A p-value <0.05 was considered statistically significant. RESULTS:The study included 396 individuals with an average age of 70 ± 6.3 years, of whom 55.1% were female. Sarcopenia risk was present in 16.9% of participants (20.6% in women and 12.3% in men). Multiple logistic regression analyses showed that increased age (OR = 1.250, 95% CI = 1.177-1.327), female sex (OR = 2.284, 95% CI = 1.057-4.934), higher BMI (body mass index) (OR = 1.106, 95% Cl = 1.026-1.193), lower ferritin (OR = 0.992, 95% Cl = 0.985-1.000), and lower albumin (OR = 0.777, 95% Cl = 0.693-0.871) levels were associated with an increased risk of sarcopenia. CONCLUSION:The results of our study indicate that the risk of sarcopenia can be quite a common clinical condition in primary care. When increased clinical demands and limited time hinder the use of tests such as SARC-F, routine laboratory tests may help identify individuals at risk of sarcopenia.
Introduction Chat-based digital clinics have become an increasingly important gateway to primary healthcare in many countries. This exploratory study describes the socio-demographic characteristics of digital clinic users, examines patterns of digital clinic use among potentially vulnerable population groups, and compares the medical reasons for chat-based digital clinic contacts with those of traditional primary care.Material and methods We conducted an observational register-based study using nationwide data covering digital and traditional contacts to public and private primary care clinics in Finland from January 2022 to February 2025. Using a rich linked dataset, we examined several potentially vulnerable socioeconomic subgroups, including individuals aged 80 and above, those with multimorbidity, the unemployed, and members of the lowest income quintile. The study population comprised 1,599,588 individuals residing in eight wellbeing services counties in Finland.Results Public digital clinic users appeared to be younger, more often women, and more often live in urban areas, and have a lower prevalence of chronic illnesses compared with users of traditional public primary care. Potentially vulnerable patient groups also used digital services, although they used traditional services more. Medical reasons for digital clinic contacts were often relatively simple, but individuals with chronic illnesses also used digital services to address their care needs.Discussion We observed differences in the characteristics of users of digital and traditional primary healthcare services. We generated hypotheses for future research on equity in digital healthcare access. Further research is needed to evaluate whether improving access to digital services for vulnerable groups could support health equity.
INTRODUCTION:The increasing prevalence of long-term use of proton pump inhibitors (PPIs) could reflect inappropriate prescribing. Deprescribing PPIs may lead to rebound hyperacidity and subsequent reinitiation of therapy. Education on rational PPI therapy is relevant for general practitioners (GPs). METHODS:We evaluated a Norwegian academic detailing (AD) campaign aimed at promoting rational therapy with PPIs among GPs. Electronic questionnaires were distributed before and after AD visits conducted between August 2024 and July 2025. Respondents rated their agreement with five statements assessing specific knowledge, and two statements assessing general knowledge and skills, related to PPI therapy. A seven-point Likert scale (1 = strongly disagree, 7 = strongly agree) was used to measure self-perceived learning outcomes. RESULTS:Of 1,018 GPs visited, 138 (14%) completed both questionnaires. The median positive change on the Likert scale was two points for both specific knowledge and general knowledge and skills. Seventy-four percent of GPs reported a 2-4 point improvement in specific knowledge, while 64% reported a similar improvement in general knowledge and skills. Three additional statements regarding the impact of the AD visit were included in the post-visit questionnaire. The statement 'The AD visit answered all my questions regarding PPI therapy' received a median rating of 7. 'The AD visit has changed my practice with PPI' received a median rating of 6, and 'The AD visit has confirmed my practice with PPI' received a median rating of 5. No significant differences were observed between Norwegian health regions in the ratings of statements related to rational prescribing of PPIs or the AD visit. CONCLUSIONS:AD addressing rational therapy with PPIs was associated with a positive self-perceived learning outcome among GPs who completed both questionnaires.
Background The Health Assessment Tool (HAT) is a validated instrument designed to comprehensively assess the health of older adults. This study examinedthe feasibility and acceptability of implementing the HAT in Swedish primary care, while exploring older patients’ needs and professional perspectives, drawing on experiences from a multicenter prospective validation study.Methods A qualitative design was employed using reflexive thematic analysis. Data were collected through semi-structured interviews with patients and healthcare managers, and a focus group discussion with healthcare staff familiarized with the HAT in six Swedish primary care centers. Analysis followed Braun and Clarke’s six-phase thematic approach, integrating inductive and deductive reasoning.Results The analysis constructed one overarching theme: ‘For the needs left waiting, the HAT is a feasible bridge to holistic care of older adults’, supported by two main themes: ‘Voices of aging, unmet needs unveiled’ and ‘The HAT: a dependable compass for decision making in the care of older people’. Findings revealed challenges for older adults, including rapid health decline, loss of independence, loneliness, and gaps in primary care. The HAT was positively received for its comprehensive, person-centered approach, despite some concerns regarding time required for its assessment.Conclusions The HAT was perceived as feasible and acceptable by older patients and healthcare providers, with the potential to transform care of older adults through proactive, holistic assessments. Its use may foster collaboration between health and social care professionals, a key prerequisite for meeting the complex needs of older people. Future research should evaluate a HAT-based model to support its integration into routine primary care.
Objectives This study investigated the diagnostic accuracy of AI-assisted diabetic retinopathy screening in primary care, using ophthalmologist-led screening as the reference standard.Methods Patients with type 2 diabetes attending routine appointments at 10 primary care clinics underwent AI-assisted screening, followed by re-screening at an ophthalmology clinic. The quality of fundus images captured in primary care was independently assessed, and diagnostic accuracy was evaluated by comparing AI-assisted results with ophthalmologist results, including sensitivity, specificity, PPV, NPV, and AUC. Two analyses were conducted: one including all images and one excluding those of poor quality.Results Among 183 patients (336 images), 18.6% of images were classified as poor quality. When all images were included, the AI-assisted screening achieved a sensitivity of 73.7%, specificity of 90.2%, PPV of 31.1%, NPV of 98.3%, and AUC of 0.82. Excluding poor-quality images improved sensitivity to 80.0%, NPV to 98.7%, and AUC to 0.84. Additional ocular findings unrelated to diabetic retinopathy were observed in 96 patients, including confirmed or non-specific signs of glaucoma, cataract, age-macular degeneration, benign nevus and reduced visual acuity.Conclusion AI-assisted screening in primary care shows potential for clinical application, but further validation in larger populations and improvements in image quality are needed before clinical implementation.
BACKGROUND:In general practice, symptom diagnoses are commonly used when patients seek care for symptoms in which no specific disease or disorder can be diagnosed. These diagnoses are prevalent, yet little is known about how they evolve or how General Practitioners (GPs) manage them in daily practice. AIM:To explore the course of symptom diagnoses and compare GPs' management strategies, both for symptom diagnoses that persisted for more than a year or changed into disease diagnoses. METHODS:A retrospective longitudinal cohort study was conducted using the Dutch Family Medicine Network (FaMe-Net) database. We included all episodes of care in which the diagnosis recorded at the first consultation was coded as a symptom diagnosis between 2008 and 2021. The course of each EoC was analyzed, comparing management strategies, such as GP contacts, interventions, referrals, and medication use, between symptom diagnoses that persisted and those that changed into disease diagnoses. Referrals to primary healthcare workers include referrals to nurses, social workers and therapists such as physiotherapists and occupational therapists. RESULTS:Out of the 12,532 EoC that started as symptom diagnoses, 9.4% changed into a disease diagnosis within a median of 22 days [2-239], 85.8% resolved within one year, and 4.3% persisted as symptom diagnoses. Within the course of the first year of care, a significantly higher number of management strategies were found for EoC that changed into a disease diagnosis. Referrals to primary healthcare workers were lower for EoC that changed into disease diagnoses (OR = 0.80, 95% CI [0.74, 0.87], p < 0.001). CONCLUSION:Symptom diagnoses are more likely to resolve within a year, and only a few will persist or change into disease diagnoses. GPs can rapidly diagnose diseases. Our findings highlight the importance of reassurance in patient care when discussing the prognosis of symptom diagnoses, as most of these symptoms tend to resolve.
Introduction Hypothyroidism is a prevalent endocrine disorder predominantly managed in primary care. Improper treatment can lead to significant clinical and public health consequences. Despite the availability of clear clinical guidelines, over- and undertreatment frequently occur. The aim was to explore and map indications of over- and undertreatment of hypothyroidism in a primary care setting.Methods We conducted a scoping review guided by Arksey and O’Malley. The search was conducted in PubMed, Embase, CINAHL, Scopus, and the Cochrane Library. We included peer-reviewed studies exploring over- and undertreatment of hypothyroidism in primary care and included both registry/audit and survey studies. Data were extracted across four structured stages, capturing study characteristics and treatment-related outcomes. Data on indications were compared across studies to identify recurring patterns.Results Nineteen studies were included. The findings show that the majority of studies with larger study populations report a moderate prevalence of over- and undertreatment. Overtreatment was associated with early initiation of therapy, absence of confirmatory testing, and suppressed TSH levels during follow-up. Undertreatment was linked to incomplete diagnostic evaluation, delayed treatment initiation, and inadequate follow-up. Survey studies reported similar patterns of inappropriate management but higher adherence to clinical guidelines.Conclusion This scoping review found consistent evidence of both over- and undertreatment of hypothyroidism in primary care. A discrepancy between clinicians’ reported intentions and observed practice suggests the need to attend to behavioural and organisational factors, and to provide greater support for individualised decision-making to improve care.
