Background General practice plays a central role in healthcare delivery and holds significant potential to advance sustainability by reducing its environmental footprint and promoting population health. While Denmark has implemented national and regional strategies to enhance sustainability in hospitals and secondary care, comparable initiatives in primary care remain limited, and little is known about general practitioner (GP) views on sustainability in general practice.Aim The aim of the study was to explore GPs’ views on sustainability in general practice.Design and setting Eleven semi-structured interviews were conducted during November and December 2024 with GPs from all regions of Denmark.Method A qualitative individual interview design using interpretative reflexive thematic analysis was used.Results Two main themes were constructed (i) Making sense of sustainability: How GPs perceive sustainability in practice, with the subthemes: Abstract threat, concrete practices, Translating sustainability into clinical language, Financial sustainability as a prerequisite, and When social sustainability feels imposed; and (ii) Between responsibility and reluctance: the GP’s role in a sustainable future, with the subthemes: Waiting for direction and delegation, and Forming sustainability as part of the professional identity. While most participants recognised sustainability as an important topic, they described challenges in transforming it into something manageable that could be incorporated into everyday clinical practice.Conclusion This study underscores the need for more research and policy attention to sustainability in Danish general practice. GPs appear willing to support a sustainability transition in health care, but they require further guidance and knowledge.

BackgroundAntimicrobial resistance (AMR) is a major health challenge in Kyrgyzstan, where acute respiratory tract infections (ARTIs) are common and frequently treated with antibiotics. Although C-reactive protein (CRP) point-of-care testing can support rational prescribing, there is no consensus on safe CRP thresholds for adults. Patient information leaflets (PILs) may further reduce inappropriate antibiotic use by improving understanding of ARTIs and addressing expectations for antibiotics. The 2CARE trial evaluates whether combining PILs with CRP testing can safely reduce antibiotic use among adults with ARTIs in Kyrgyz primary care.Methods2CARE is a multicentre, open-label, individually randomised controlled trial conducted in 15 primary healthcare centres in Kyrgyzstan. Adults aged 18-70 years with acute respiratory symptoms (<14 days) are randomised 1:1 to receive a PIL or no PIL, and independently 1:1:1 to one of three CRP cut-off levels (20, 40, or 60 mg/L), yielding six parallel groups. Primary outcomes are: (1) total antibiotic use within 21 days, and (2) hospital admission within 21 days. Secondary outcomes include baseline antibiotic prescribing, re-consultations, recovery, hospital referral, antiviral use, and mortality. Analyses will follow the intention-to-treat principle, with per-protocol analysis for non-inferiority, using regression models and generalized estimating equations. A total sample of 1,050 participants provides 90% power for both primary comparisons.DiscussionThis trial will generate evidence on the effectiveness of PILs in reducing antibiotic use and establish safe CRP thresholds for adults with ARTIs in a low-resource setting. Findings will inform antimicrobial stewardship policies and guide national CRP implementation in Kyrgyzstan.Trial registrationClinicalTrials.gov Identifier: NCT07261969.

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.

Due to a demographic shift, among others, more general practitioners will be needed in Denmark in the future. In this study, we examine Danish medical trainees’ intention to pursue a career in general practice as they gain firsthand work experience during postgraduate education. The expanded conceptual framework of medical students’ primary care career choice was used in the selection of variables related to the medical trainees’ career intentions and work experience and in the interpretation of the results. The study was a prospectively conducted longitudinal cohort study using cross-sectional time-series data. A questionnaire specific to the Danish context was used for data collection among a national cohort of medical trainees before they entered their first postgraduate training year and again after 15–17 months. Data was analyzed descriptively, and the effect of time on the intention to pursue a career in general practice was assessed using mixed models. Results showed significantly more medical trainees intended to pursue a general practice career at follow-up compared to baseline. Also, the group of medical trainees with that intention included the highest proportion of participants who were parents at follow-up. The intention to pursue a career in general practice was, among others, associated with an interest in regular work hours and the opportunity to work part-time and be self-employed at baseline and follow-up. Applying the conceptual framework to the results suggests that medical trainees already at medical school graduation had gained an authentic and sufficient perception of general practice characteristics and that the shifts in specialty intentions during the follow-up period were driven by changes in personal characteristics.

The emergency department (ED) is a demanding work environment where nurses undertake a variety of clinical and administrative tasks, including medication-related tasks. The integration of a clinical pharmacist into the ED team represents a complex intervention with potential implications for nurses’ distribution of work time, particularly concerning medication-related tasks. This study examined the distribution of work time among ED nurses and assessed the impact of a clinical pharmacist’s presence on this distribution, with an emphasis on medication-related work tasks. A direct observational time and motion study was conducted to evaluate the work time distribution of nurses in three Norwegian EDs, applying the Work Observation Method By Activity Timing (WOMBAT) methodology. Time distributions were measured for non-medication-related tasks, medication-related tasks, standby and movement, both in the absence and presence of a clinical pharmacist in the same ED. A total of 298 h of nursing work time were observed, comprising 138 h without pharmacists present and 160 h with pharmacists present. In the absence of a pharmacist, nurses spent 62.7

Background: Emergency departments (EDs) provide urgent care to diverse patients. Medication-related tasks, crucial for safe diagnosis and treatment, often receive inadequate attention. Clinical pharmacists, experts in medication management, can improve outcomes and reduce costs.Objectives: To investigate how the introduction of clinical pharmacists affects ED junior physicians' work-time distribution, with particular focus on medication-related tasks.Design: A stepped-wedge design was employed, introducing pharmacists across three Norwegian EDs over a 9-month period, with each ED starting at staggered intervals.Methods: Using the Work Observation Method By Activity Timing (WOMBAT) methodology, we observed junior physicians' activities in three EDs. The pharmacists were encouraged to adapt to the ED setting, integrate into the team, and identify ways to apply their expertise effectively. Medication reconciliation became their primary focus. We recorded 251 h of observation in the period without pharmacists present and 287 h in the intervention period, with pharmacists present. The proportion of time spent on different tasks was compared between the two periods.Results: Junior physicians spent 81.0% of their work time on non-medication-related tasks, 11.6% on standby/movement, and 8.7% on medication-related tasks. There was no evidence that the overall time distribution was affected by the intervention. However, in ED2, the proportion of time spent on medication-related documentation was reduced from 6.1% to 2.5%, while standby time increased from 6.1% to 13% with pharmacists present. Face-to-face interactions with pharmacists accounted for less than 2% of the junior physicians' work time in all EDs.Conclusion: In three Norwegian EDs, junior physicians' work time was predominantly spent on non-medication-related tasks, with only 8.7% dedicated to medication-related tasks. The introduction of clinical pharmacists did not significantly impact junior physicians' overall work-time distribution. Further research should investigate pharmacists' impact on ED care quality and efficiency.

Pharmacists in emergency departments (EDs) can alleviate physicians’ workload by handling medication-related tasks and offer valuable contributions in interprofessional teams. We aimed to explore physicians’ experiences working with pharmacists in EDs, and their perspectives on future permanent collaboration. We conducted semi-structured interviews with twenty physicians from two EDs and analyzed the data using thematic analysis. Four main themes emerged, comprising twelve subthemes that highlighted both challenges and motivations. Theme 1: time addressed physicians’ time constraints, and the potential for time reallocation with assistance from pharmacists. Theme 2: various roles of pharmacists focused on the diverse roles of pharmacists who supported patient care and junior physicians, but faced challenges like availability and space constraints. Theme 3: teamwork concerned how pharmacists were trusted, brought valuable insights, and enhanced patient safety, yet there were ambiguous views on responsibility and cultural differences. Theme 4: future perspectives focused on how physicians favored a permanent inclusion of pharmacists in the ED, suggesting that they could independently conduct MedRec. Our findings suggest that pharmacists should be permanently integrated in ED teams. However, there is a need to address challenges related to space and legal regulations to enhance interprofessional collaboration.

BackgroundThere is a growing presence of digital technologies in clinical learning environments. However, there is little research into how such technologies shape embodied teaching and learning for health professional students. This study aims to explore current teaching practices in health disciplines to illuminate how digital technologies are used to facilitate the development of embodied knowledge during student learning of physical examination.MethodsA qualitative interpretive approach was undertaken, sensitised by body pedagogics as a theoretical frame. In-depth interviews with 18 clinical educators across the disciplines of medicine, physiotherapy, midwifery and nursing were held. These interviews explored their current practices for teaching physical examination. The data was analysed using reflexive thematic analysis combined with a 'thinking with theory' approach, in which the theoretical framework of body pedagogics was central to guiding the reflexive and interpretative process.ResultsWe interpreted a framework of five approaches where digital technologies are used to develop bodily knowledge: for sensate knowing; for modelling; for rehearsing; for guiding practice and for providing feedback information.ConclusionFindings suggest that in current teaching practices, digital technology may be used to facilitate multiple essential elements of physical examination instruction. We conceptualised a framework that extends body pedagogics, where we recognise the multiple roles of digital technology for developing bodily knowledge in the context of physical examination.

ObjectiveThe use of dietary supplements (DS) may cause harm through direct and indirect effects. Patients with dementia may be particularly vulnerable. This study aims to explore general practitioners' (GPs') experiences with DS use by these patients, the GPs perceived responsibilities, obstacles in taking on this responsibility, their attitudes toward DS, and suggestions for improvements to safeguard the use of DS in this patient group.DesignQualitative individual interview study conducted February - December 2019. Data were analysed using systematic text condensation.SettingPrimary healthcare clinics in Norway.SubjectsFourteen Norwegian GPs.FindingsNone of the informants were dismissive of patients using DS. They were aware of the possible direct risks and had observed them in patients. Most GPs showed little awareness of potential indirect risks to patients with dementia who use DS. They acknowledged the need for caretaking of these patients. Although there were differences in practice styles, most of the GPs wished to help their patients safeguarding DS use but found it difficult due to the lack of quality assurance of product information. Furthermore, there were no effective ways for the GPs to document DS use in the patients' records. Several suggestions for improvement were given by the GPs, such as increased attention from GPs, inclusion of DS in the prescription software, and stricter regulatory systems for DS from the authorities.ConclusionThe GPs had initially little awareness of this safety risk, but there were differences in practice style and attitudes towards DS. The GPs did not perceive themselves as main responsible for safe use of DS in patient with dementia. The most important reason to disclaim responsibility was lack of information about the products. One suggestion for improvement was better integration of DS in patients' medical record. Currently, little is known about general practitioners (GPs) caretaking of patients with dementia who use dietary supplements (DS). Our study showed that:The GPs in this study showed little awareness of the potential safety risk that DS use may represent for patients with dementia.Several obstacles in the treatment setting and in the regulation of DS make it difficult for the GPs to assume full responsibility for patients with dementia who use DS.Lack of evidence about DS safety and effect adds to professional uncertainty and may cause frustration or reluctance to address the issue.

Learning in medical education encompasses a broad spectrum of learning theories, and an embodiment perspective has recently begun to emerge in continuing professional development (CPD) for health professionals. However, empirical research into the experience of embodiment in learning in CPD is sparse, particularly in the practice of general medicine. In this study, we aimed to explore general practitioners’ (GPs’) learning experiences during CPD from an embodiment perspective, studying the appearance of elements of embodiment—the body, actions, emotions, cognition, and interactions with the surroundings and others—to build an explanatory structure of embodiment in learning. We drew on the concepts of embodied affectivity and mutual incorporation to frame our understanding of embodiment. Four Danish and three Canadian GPs were interviewed to gain insight into specific learning experiences; the interviews and the analysis were inspired by micro-phenomenology, augmented with a complex adaptive systems approach. We constructed an explanatory structure of learning with two entrance points (disharmony and mundanity), an eight-component learning phase, and an ending phase with two exit points (harmony and continuing imbalance). All components of the learning phase—community, pride, validation, rehearsal, do-ability, mind-space, ambiance, and preparing for the future—shared features of embodied affectivity and mutual incorporation and interacted in multi-directional and non-linear ways. We discuss integrating the embodiment perspective into existing learning theories and argue that CPD for GPs would benefit from doing so.

Background Recruiting and securing primary care physician workforce has been the center of international attention for decades. In Denmark, the number of general practitioners has decreased by 8.5% since 2013. However, a rising population age and increasing prevalence of chronic diseases and multimorbidity place an even greater future need for general practitioners in Denmark. The choice of general practice as specialty has been associated with a range of both intrinsic and extrinsic factors, however, few studies have examined the recruitment potential that lies within medical trainees’ who are undecided about general practice specialization. The aim of this study was, therefore, to explore how medical trainees who are undecided about general practice specialization (GP-positive/undecided) differ from medical trainees who are either committed (GP-committed) or not committed to a general practice career (GP-non-committed) regarding factors related to future work life. Methods The present study concerns baseline findings from a longitudinal survey study. An online questionnaire was e-mailed to a national cohort of medical trainees during their transition from under- to postgraduate education. The associations between orientations towards general practice specialization and work-related factors and potential influencing factors, respectively, were analyzed using uni- and multivariable modified Poisson regression models. Results Of 1,188 invited participants, 461 filled out key study variables concerning specialty preferences and rejections, corresponding to a response rate of 38.8%. We found significant positive associations between GP-positive/undecided orientation and valuing a good work/life balance and the opportunity to organize own working hours when compared to GP-non-committed respondents. Compared to the GP-committed orientations, the GP-positive/undecided orientation was associated with a positive attitude towards technology, working shift hours, and an openness towards several career paths. Across all orientations, undergraduate exposure to the specialties was found to be highly influential on the specialty preferences. Conclusion GP-positive/undecided medical trainees value autonomy over their working hours more than the GP-non-committed, but less than the GP-committed. However, the GP-positive/undecided respondents present more openness to different career opportunities and the use of technology in daily work. We suggest using this knowledge in the planning of recruitment strategies aiming to increase interest in general practice specialization.

PurposeThis paper aims to provide knowledge on medical trainees' considerations about specialisation as they move from undergraduate to postgraduate medical education; especially their interest in general practice compared to other specialities.MethodWe developed and content-validated a questionnaire to examine medical trainees' speciality considerations and conducted a descriptive, cross-sectional study. All medical trainees initiating their internship in Denmark in 2022 (N = 1,188) were invited to participate in the study. Medical specialities were categorised as hospital service specialities, internal medicine specialities, primary care, psychiatry specialities and surgery and emergency specialities. Descriptive statistics were used to describe the cohort and examine the participants' speciality considerations by assigning them to one of the following three orientations: committed, undecided or non-committed to a speciality.ResultsThe response rate was 38.8% (n = 461), and participants' mean age was 27.4 years with a majority of females (68.1%). Nearly 25% of the participants had general practice as speciality preference, and only 13.9% had excluded general practice for future specialisation. Overall, around half of the participants had general practice as a first, second or third preference for specialisation.ConclusionDanish medical trainees show considerable interest in general practice at the time of their transition from undergraduate to postgraduate education. However, to meet future demands on the primary care, further recruitment of general practitioners is still needed. This knowledge of the specialities' recruitment potential will likely be of interest to medical educators and healthcare planners alike.

The presence of digital technologies in clinical learning environments is increasing. However, there is little research into how technologies influence the interplay between touch and the acquisition of physical examination skills by health professional students. In this study, we aimed to explore how digital technologies feature in clinical educators’ accounts of current physical examination teaching in practice. A qualitative interpretive design was used. Data was collected via in-depth interviews with 18 clinical educators from the disciplines of medicine, physiotherapy, midwifery, and nursing to investigate the current perspectives and practices used in teaching physical examination. We interpreted three themes within the data: Polarised perspectives of digital technology use in physical examination teaching, the integration of digital technologies into the teaching of physical examination, and the invisibility of digital technologies in physical examination teaching. Digital technologies have been extensively integrated into the teaching of physical examination. However, the perceptions of the participating clinical educators have not evolved at the same pace. We suggest that clinical educators re-examine their assumptions and attune themselves to the dynamic relationship between hands-on skills and digital tools.

BACKGROUND:Medication-related problems are an important cause of emergency department (ED) visits, and medication errors are reported in up to 60% of ED patients. Procedures such as medication reconciliation and medication review can identify and prevent medication-related problems and medication errors. However, this work is often time-consuming. In EDs without pharmacists, medication reconciliation is the physician's responsibility, in addition to the primary assignments of examining and diagnosing the patient. The aim of this study was to identify how much time ED physicians spend on medication-related tasks when no pharmacists are present in the EDs.METHODS:An observational time-and-motion study of physicians in three EDs in Northern Norway was conducted using Work Observation Method by Activity Timing (WOMBAT) to collect and time-stamp data. Observations were conducted in predefined two-hour observation sessions with a 1:1 relationship between observer and participant, during Monday to Friday between 8 am and 8 pm, from November 2020 to October 2021.RESULTS:In total, 386 h of observations were collected during 225 observation sessions. A total of 8.7% of the physicians' work time was spent on medication-related tasks, of which most time was spent on oral communication about medications with other physicians (3.0%) and medication-related documentation (3.2%). Physicians spent 2.2 min per hour on medication reconciliation tasks, which includes retrieving medication-related information directly from the patient, reading/retrieving written medication-related information, and medication-related documentation. Physicians spent 85.6% of the observed time on non-medication-related clinical or administrative tasks, and the remaining time was spent standby or moving between tasks.CONCLUSION:In three Norwegian EDs, physicians spent 8.7% of their work time on medication-related tasks, and 85.6% on other clinical or administrative tasks. Physicians spent 2.2 min per hour on tasks related to medication reconciliation. We worry that patient safety related tasks in the EDs receive little attention. Allocating dedicated resources like pharmacists to contribute with medication-related tasks could benefit both physicians and patients.

People are increasingly able to generate their own health data through new technologies such as wearables and online symptom checkers. However, generating data is one thing, interpreting them another. General practitioners (GPs) are likely to be the first to help with interpretations. Policymakers in the European Union are investing heavily in infrastructures to provide GPs access to patient measurements. But there may be a disconnect between policy ambitions and the everyday practices of GPs. To investigate this, we conducted semi-structured interviews with 23 Danish GPs. According to the GPs, patients relatively rarely bring data to them. GPs mostly remember three types of patient-generated data that patients bring to them for interpretation: heart and sleep measurements from wearables and results from online symptom checkers. However, they also spoke extensively about data work with patient queries concerning measurements from the GPs' own online Patient Reported Outcome system and online access to laboratory results. We juxtapose GP reflections on these five data types and between policy ambitions and everyday practices. These data require substantial recontextualization work before the GPs ascribe them evidential value and act on them. Even when they perceived as actionable, patient-provided data are not approached as measurements, as suggested by policy frameworks. Rather, GPs treat them as analogous to symptoms-that is to say, GPs treat patient-provided data as subjective evidence rather than authoritative measures. Drawing on Science and Technology Studies (STS) literature,we suggest that GPs must be part of the conversation with policy makers and digital entrepreneurs around when and how to integrate patient-generated data into healthcare infrastructures.

In CME/CPD, a significant part of research is about effectiveness. Attention to the development process can be vital to understand how it impacts progress and results. This study aims to explore an innovative process of applying a combined approach using design-based research, collaborative innovation, and program theory to develop CPD about type 2 diabetes for GPs and clinic nurses with a group of interprofessional stakeholders. In particular, the development process of the combined approach and how it impacts the progress and the activities. We applied two qualitative methods. First, we analysed 159 documents from the development process, and second, eight semi-structured key informant interviews. Data were deductively analysed using 15 predefined elements derived from the combined approach combined with open coding analyses. The analysis showed how the combined approach structured the process. And the interviews broadened our understanding of the relationship between the process and the activities. Four additional themes were constructed from the open coding, including surrender to the process. Surrendering was a central part of the interviewees' participation in the process. The combined approach facilitated this unfamiliar experience of surrender. By supporting participants to surrender, the combined approach enabled an expansion of interprofessional collaboration and the development of innovative activities and learning methods in CPD on type 2 diabetes.

OBJECTIVES:Medication errors are leading causes of hospitalization and death in western countries and WHO encourages health care providers to implement non-dispensing pharmacist services in primary care to improve medication work. However, these services struggle to provide any impact on clinical outcomes. We wanted to explore health care professionals' views on medication work to illuminate determinants of the implementation success. The research was designed to inform and adapt implementation strategies for non-dispensing pharmacist services.DESIGN:Semi-structured interview study with nine healthcare professionals.SETTING:Four Norwegian home care wards.SUBJECTS:Nine healthcare professionals working at different wards within one home care unit.MAIN OUTCOME MEASURES:Determinants of implementation outcomes.RESULTS:Contextual determinants of the implementation process were mainly related to characteristics of the setting such as poorly designed information systems, work overload, and chaotic work environments. The identified barriers question the innovation's appropriateness related to the setting's needs but also provide possibilities for tailoring pharmacist services to local medication work issues. The observable positive effects and the perceived advantage of the pharmacist services are likely to facilitate the implementation process.CONCLUSION:Our study provided information on contextual elements that influence the implementation process of non-dispensing pharmacist services. Awareness of these factors can help develop strategies to help the organization succeed in in achieving program outcomes.

People can express experiences, opinions, and perspectives in stories. In a story, the experiences can be relived and discovered independently of time and place. In medical education, it is a fundamental premise that time progresses, and it is within this temporal space that students learn, acquire competencies, and form identity. It is also within this space that much qualitative research is conducted. However, qualitative examinations at one point in time will result in only a snapshot of a dynamic phenomenon that evolves over time. Existing approaches to qualitative research are often inadequate to accommodate this dynamic development without applying a time- and cost-consuming design such as longitudinal investigations. The purpose of this paper is to present storytelling as a useful research approach to include temporal dimensions in cross-sectional qualitative data collection. We describe the background for the approach, argue for its use, and provide a practical example of storytelling with the use of a fictional character in online focus group discussions to explore a dynamic phenomenon in medical education research. Overall, storytelling offers a narrative approach to qualitative research that allows the researcher to explore phenomena across time and space. The approach has the advantage that it can be used in different formats both oral and written, digital or physical.

Background Emergency department (ED) pharmacists reduce medication errors and improve quality of medication use. Patient perceptions and experiences with ED pharmacists have not been studied. The aim of this study was to explore patients’ perceptions of and experiences with medication-related activities in the ED, with and without an ED pharmacist present. Methods We conducted 24 semistructured individual interviews with patients admitted to one ED in Norway, 12 before and 12 during an intervention, where pharmacists performed medication-related tasks close to patients and in collaboration with ED staff. Interviews were transcribed and analysed applying thematic analysis. Results From our five developed themes, we identified that: (1) Our informants had low awareness and few expectations of the ED pharmacist, both with and without the pharmacist present. However, they were positive to the ED pharmacist. (2) Our informants expressed a variation of trust in the healthcare system, healthcare professionals and electronic systems, though the majority expressed a high level of trust. They believed that their medication list was automatically updated and assumed to get the correct medication. (3) Some informants felt responsible to have an overview of their medication use, while others expressed low interest in taking responsibility regarding their medication. (4) Some informants did not want involvement from healthcare professionals in medication administration, while others expressed no problems with giving up control. (5) Medication information was important for all informants to feel confident in medication use, but the need for information differed. Conclusion Despite being positive to pharmacists, it did not seem important to our informants who performed the medication-related tasks, as long as they received the help they needed. The degree of trust, responsibility, control and information varied among ED patients. These dimensions can be applied by healthcare professionals to tailor medication-related activities to patients’ individual needs.