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A community hospital system covers the entire population of Finland. Yet there is little research on the system beyond routine statistics. More knowledge is needed on the incidence of hospital stays and patient profiles. We investigated the incidence of short-term community hospital stays and the features of care and patients. Prospective observational study. Community hospitals in the catchment area of Kuopio University Hospital in Finland. Short-term (up to one month) community hospital stays of adult residents. The outcome was the incidence rate of short-term community hospital stays according to age, sex and the first underlying diagnoses. A number of 13,482 short-term community hospital stays were analyzed. The patients' mean age was 77 years. The incidence rate of short-term hospital stays was 28.6 stays per 1000 person-years among residents aged <75 years and 419.0 among residents aged ≥75 years. In men aged <75 years, the hospital stay incidence was about 40% higher than in women of the same age but in residents aged ≥75 years incidences did not differ between sexes. The most common diagnostic categories were vascular and respiratory diseases, injuries and mental illnesses. The incidence rate of short-term community hospital stays increased sharply with age and was highest among women aged ≥75 years. Care was required for acute and chronic conditions common in older adults. Community hospitals have a substantial role in hospital care of older adults. Finland has a broad network of community hospitals covering the entire population. More knowledge is needed on incidences and patient profiles of community hospital stays. The incidence of short-term community hospital stays increased sharply with age and was the highest among women aged ≥75 years. Vascular and respiratory diseases accounted for most of the community hospital admissions. Community hospitals play an important role in the care of an aging population. [ABSTRACT FROM AUTHOR]

Prior studies have reported that heart failure typically affects elderly, multimorbid and socioeconomically deprived men. Women with heart failure are generally older, have a higher EF (ejection fraction) and have more heart failure-related symptoms than men. This study explored the disparities in the prevalence of heart failure between men and women in relation to age, multimorbidity level and socioeconomic status of the population in southern Sweden. A register-based, cross-sectional cohort study. Setting and subjects: The inhabitants from 20 years of age onwards (N = 981,383) living in southern Sweden in 2015. Main outcome measure: Prevalence and mean probability of having heart failure in both genders. CNI (Care Need Index) percentiles depend on the socioeconomic status of their listed primary healthcare centres. Men had a higher OR for HF − 1.70 (95% CI 1.65–1.75) - than women. The probability of men having heart failure increased significantly compared to women with advancing age and multimorbidity levels. At all CNI levels, the multimorbid patients had a higher prevalence of heart failure in men than in women. The disparity in the mean probability of heart failure between the most affluent and deprived CNI percentile was more apparent in women compared to men, especially from 80 years. The prevalence of heart failure differs significantly between the genders. Men had an increasing mean probability of heart failure with advancing age and multimorbidity level compared to women. Socioeconomic deprivation was more strongly associated with heart failure in women than in men. The probability of having heart failure differs between the genders in several aspects. Independently of socioeconomic status, men had a higher prevalence of heart failure than women among the multimorbid patients. The mean probability of men having heart failure increased significantly compared to women with advancing age and multimorbidity level. Socioeconomic status was more strongly associated with heart failure in women than in men. [ABSTRACT FROM AUTHOR]

To characterise and explore the development in the number and content of urine samples sent from general practice in the North Denmark Region to the Department of Clinical Microbiology (DCM) at Aalborg University Hospital during a five-year period. A register-based study. General practice. Urine samples received at DCM, Aalborg University Hospital from general practice between 2017 and 2022. Number and content of urine samples. A total of 255,271 urine samples from general practice were received at DCM, with 76.1% being from female patients. Uropathogens were identified in 43.0% of the samples. During the five-year period, a 23.0% increase in the number of urine samples per person (incidence rate ratio (IRR) 1.23, 95% CI 1.21–1.25) was observed. A slight increase in the proportion of positive cultures (risk ratio (RR) 1.03, 95% CI 1.01–1.05) was seen. No notable change in the patient population (age, gender) was observed. Overall, Escherichia coli was the most identified uropathogen (60.4%) followed by Klebsiella spp. (8.7%) and Enterococcus spp. (7.7%). Distribution of the various uropathogens differed slightly depending on patient gender and age, importantly E. coli was less frequently observed in males aged >65 years. During the past five years an increasing amount of urine cultures have been requested at DCM from general practice. Importantly, the cause(s) of this increasing demand needs to be explored further in future studies. Appropriate diagnostics of urinary tract infections can reduce the use of antibiotics in general practice. From 2017 to 2022 a 23% increase per person in requested urine cultures from general practice was observed. A slight increase in positive cultures was found, but no notable change in the patient population (age, gender) was seen. E. coli was the most identified uropathogen independent of gender and age, however, the proportion differed within the various groups. [ABSTRACT FROM AUTHOR]

We aimed to assess patient involvement in terms of shared decision-making in general practice from the perspectives of patients with chronic obstructive pulmonary disease (COPD) or type 2 diabetes (T2DM) (or both). A cross-sectional survey using the 9-item Shared Decision-Making Questionnaire (SDM-Q-9) ranging from 0 to 5 (best). Patients diagnosed with either T2DM and/or COPD were asked to focus on their most recent consultation in general practice concerning their T2DM or lung disease. Responders were approached through the Danish Diabetes Association and Danish Lung Association. The sample included 468 responders. Mean scores for the total sample were between 3.3 and 4.2. The overall mean score for all items was 3.7. The highest overall mean score was for patients with T2DM, whereas the lowest overall mean score was for patients having both T2DM and COPD. Furthermore, we observed a slightly lower overall mean score for women compared to men and for those younger than 65 years compared to those aged 65 years or older. Overall, patients are involved in shared decision-making in general practice Minor nuances were found because patients with COPD were less involved in shared decision-making compared to patients with T2DM. Similarly, younger patients and women were less involved than older patients and men. [ABSTRACT FROM AUTHOR]

To explore the needs and opportunities of the general population to communicate their end-of-life care wishes and to investigate what roles are assigned to healthcare providers and family members in end-of-life care discussions. A cross-sectional social survey was carried out in Hungary. Descriptive analysis and analysis of variance were performed. Nationwide survey of the Hungarian general population. The sample (n = 1100) was designed to represent the adult population as per distribution by gender, age and geographical region. Needs and opportunities of the general population to communicate end-of-life care wishes. 72% of participants found it important to discuss their end-of-life care wishes with someone. Six out of ten believed that it was also the GPs' task to talk with the patients about their end-of-life care wishes. An almost equal level of engagement was expected from healthcare providers (80%) -especially physicians (72%)- and family members (75%) in end-of-life conversations. However, only 36% of participants felt that there was someone among their healthcare providers, and 56% of them had a family member or friend with whom they could speak openly about death, dying and preparing for death. Compared to their needs, the general population had fewer opportunities to speak about death, dying and preparing for death. Training programs for healthcare providers, particularly GPs, and public awareness campaigns may support the broader application of advance care planning in Hungary. Current guidelines recommend that GPs initiate advance care planning discussions. However, little is known with whom the general population wish to discuss their end-of-life care preferences and with whom there is an opportunity to do so. An almost equal level of engagement was expected from healthcare providers -especially physicians- and family members in end-of-life conversations. Most of the general population thought that participation in end-of-life discussions was also the GPs' task. The majority of participants reported that there was no one among their healthcare providers and a sizable minority felt that there was no one among their family members or friends with whom they could talk openly about death, dying, and preparing for death. The highest levels of unmet needs regarding end-of-life conversations with healthcare providers were found among those who considered it important to discuss their end-of-life care wishes. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the first point of contact in patients diagnosed with pancreatic cancer, and to study factors associated with the GP's suspicion of cancer, Cancer Patient Pathway (CPP) referral and long diagnostic interval. Cross-sectional study combining register and survey data. Patients with incident pancreatic cancer recorded in the Danish National Patient Register (n = 303). The patient's first point of symptoms presentation, GP's cancer suspicion, CPP referral and diagnostic interval. General practice was the first point of contact for 85.5% of the population. At the first consultation, cancer was suspected in 32.7% and 22.9% were referred to a CPP. The GPs were more likely to suspect cancer or serious illness in patients aged >70 years (prevalence rate ratio (PRR) 1.34, 95% CI 1.09–1.66) and among patients with high comorbidity (PRR 1.23, 95% CI 1.04–1.47). A CPP referral was less likely among patients with low education. The median diagnostic interval was 39 days (interquartile range: 15–72). When the GP initially did not suspect cancer, the likelihood of longer diagnostic interval increased. The majority of patients with pancreatic cancer began their diagnostic route in general practice. Diagnosing pancreatic cancer swiftly in general practice was challenging; the GP did often not initially suspect cancer or refer to a CPP and several of the patient characteristics were associated with the GPs initial suspicion of cancer or CPP referral. Thus, there may be room for improvements in the diagnostics of pancreatic cancer in general practice. Patients with pancreatic cancer have a poor prognosis, as pancreatic cancer is often diagnosed in late stage. The majority of patients with pancreatic cancer began their diagnostic process in general practice. General practitioners (GPs) suspected cancer at the first consultation in one out of three patients with pancreatic cancer; more often in older and comorbid patients. The GPs suspicion of cancer was associated with urgent referral and shorter time to diagnosis. [ABSTRACT FROM AUTHOR]

This study aimed to describe prescription of antibiotics to the elderly population in general practice in Denmark from 2010–2017. This is a national register-based observational study. General practice, Denmark The main outcome measure was prescriptions/1,000 inhabitants/day (PrID) in relation to year, age and sex, indication, and antibiotic agent. In this study, we included inhabitants of Denmark, ≥65 years of age between 01st July 2010–30th June 2017. A total of 5,168,878 prescriptions were included in the study. Antibiotic prescriptions decreased from 2.2 PrID to 1.7 (-26.9%, CI95% [-31.1;-22.4]) PrID during the study. The decrease in PrID was most noticeable among 65–74-year-olds (-25%). The ≥85-year-olds were exposed to twice as many PrID than the 65–74-year-olds, but only accounted for 20% of the total use. Urinary tract infection (UTI) was the most common indication for antibiotic prescription and increased with advancing age. The most commonly prescribed antibiotics were pivmecillinam and phenoxymethylpenicillin. Prescribing with no informative indication was present in one third of all cases. The prescription of antibiotics in the elderly population in general practice decreased from 2010 to 2017. The oldest age group was exposed twice as frequently to antibiotic prescriptions as the 65–74-year-olds. The smallest reduction was observed for the ≥85-year-olds, suggesting targeting interventions at this group. High antibiotic use among elderly is well known and studies indicate mis- and overuse within this population. Our study shows. The prescription rate is decreasing within all age groups of the elderly population. The ≥85-year-olds receive twice as many prescriptions/1000/day as the 65–74-years-olds. [ABSTRACT FROM AUTHOR]

To investigate the association between a recorded procedure code for a medication review and adequate drug treatment management, and to explore factors associated with this code. Cross-sectional study; two primary health care centres, in Region Västra Götaland, Sweden. A total of 302 consecutive patients (≥65 years old, 59% female; median number of drugs: six) requiring a non-urgent consultation with a physician in October–November 2017. Adequate drug treatment management (treatment that did not require any further action), determined in consensus by two specialists in family medicine blinded to the medication review code. Adequate drug treatment management was, overall, less common in those with a recorded medication review over the last year: 63% versus 73% (p = 0.047). This negative association was evident among patients aged 65–74 years: 49% versus 74% (p = 0.003), but absent in those ≥75 years old: 67% versus 70% (p = 0.77). Recommendations from consensus included the search for additional information to be able to make a decision regarding initiation or withdrawal of a drug (n = 53), withdrawal of a drug (n = 41), or ordering a laboratory test (n = 25). Factors associated with a recorded procedure code included age above the remuneration limit of 75 years (odds ratio: 9.8; 95% confidence interval 5.0–19), type 2 diabetes (3.0 (1.5–6.2)), hypertension (2.4 (1.2–4.8)), and depression (2.5 (1.02–6.0)). The presence of a recorded medication review was not positively associated with adequate drug treatment management but was associated with the age limit for remuneration, and some chronic diseases. To improve drug treatment in older people in primary care, a remuneration system linked to recorded medication reviews has been introduced. In this study, fewer patients with than without a recorded medication review (63% versus 73%) had adequate drug treatment management. A recorded medication review was ten times more common in those ≥75 years, that is, the age limit for remuneration. Recorded codes for medication reviews were also common in those with type 2 diabetes, hypertension, and depression. [ABSTRACT FROM AUTHOR]

To study white-coat hypertension (WCHT, blood pressure ≥140/90 mmHg in a clinic and normal blood pressure <135/85 mmHg at home), with blood pressure screening of a healthy population during their dental healthcare visit and the associated risk factors. A multicentre observational study. A healthy general population at four dental clinics in a region in southern Sweden. 2025 individuals aged 40–75 years were screened for high blood pressure at their annual regular check-up dental visit. Frequencies of normal and elevated blood pressure (BP) in dental clinics, with home BP as a reference. According to BP results, the population was divided into three groups: normotension (NT), WCHT and suspected hypertension (HT). Background and life style factors were measured: sex, age, family history of hypertension, body mass index (BMI kg/m2), education level, tobacco use, and physical activity level. The overall prevalence of WCHT in the study was 17.7%, and the prevalence was 57.2% among those with clinically high blood pressure. Compared with NT, WCHT was associated with male sex (OR 1.56, CI 1.18–2.06), older age group (OR 2.33, CI 1.66–3.26), family history of hypertension (OR 1.61, CI 1.24–2.10), high BMI kg/m2 (OR 2.36, CI 1.80–3.10), daily snuff use (OR 1.74, CI 1.19–2.53). In comparison with WCHT, HT was associated with male sex (OR 2.16, CI 1.44–3.25), older age group (OR 2.85, CI 1.75–4.65), daily smoking (OR 2.10, CI 1.14–3.85), less daily snuff use (OR 0.59, CI 0.34–0.99). The prevalence of WCHT in a healthy population was 17.7%. Regarding cardiovascular risk factors, WCHT seems to be in the middle of NT and HT. Individuals with WCHT can be identified and given lifestyle advice in connection with a dental check-up, but follow-up and assessment of their cardiovascular risk should take place in primary care. Screening in dental practice can detect white-coat hypertension (WCHT) (17.7%) and suspected hypertension (HT) (12.4%). Individuals with WCHT have more cardiovascular risk factors than normotensive individuals. Individuals with WCHT could be given lifestyle advice in dental clinics according to current guidelines. [ABSTRACT FROM AUTHOR]

To describe antibiotic prescriptions in out-of-hour (OOH) service in primary care setting in Iceland and to study the indications for prescriptions. A population based retrospective study, using electronic data from the OOH registration system. OOH primary care setting in Reykjavik capital area in Iceland. All patients that received a prescription for oral antibiotic drug at an OOH service in Reykjavik capital area over a one-year period. Number of oral antibiotic prescriptions and diagnosis connected to the prescriptions according to age and sex. There were 75,582 contacts with the OOH primary care of which 25,059 contacts resulted in prescription of an oral antibiotic (33%). The most common antibiotic prescribed in total, and for the diagnosis studied, was amoxicillin with clavulanic acid. It was most often prescribed for acute otitis media. Of those diagnosed with otitis media 50% were treated with amoxicillin with clavulanic acid and 40% of those diagnosed with pneumonia received that treatment. The second most prescribed antibiotic was amoxicillin. Most often it was prescribed for sinusitis, in 47% of cases with that diagnosis. Antibiotics are often prescribed in OOH primary care in Iceland and a substantial number of the patients diagnosed in OOH primary care with acute otitis media or pneumonia are prescribed broad-spectrum antibiotics. Antibiotic prescription rate is high and broad-spectrum drugs often prescribed in OOH primary care service in Iceland. The results should encourage general practitioners in Iceland to review antibiotic prescriptions in OOH service. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to describe and characterize the prescription of antibiotics for urinary tract infection (UTI) in general practice in Denmark and to evaluate compliance with current recommendations. Design: National registry-based study Setting: Danish general practice Patients: 267.539 patients who redeemed a prescription for antibiotics with the clinical indication UTI at community pharmacies between July 1st 2012 and June 31st 2013. Main outcome measures: Antibiotics prescribed for 1) acute lower UTI, 2) acute upper UTI and 3) recurrent UTI presented as amount of prescriptions, number of treatments per 1000 inhabitants per day (TID) and defined daily doses per 1000 inhabitants per day (DID). Results: A total of 507.532 prescriptions were issued to 267.539 patients during the one year study period, representing 2.35 DID. Acute lower UTI was the most common reason for prescription of antibiotics (89.5%) followed by recurrent UTI (8.4%). The majority of the prescriptions were issued to people above 60 year old (57.6%). Pivmecillinam was the most commonly prescribed antibiotic in acute lower (45.8%) and acute upper (63.3%) UTI. Trimethroprim was the most commonly prescribed antibiotic in recurrent UTI (45.9%). Prescription of quinolones increased with increasing patient-age (p = <.0001). Conclusion: Compliance with current Danish recommendations was moderately high. Pivmecillinam is the first line antibiotic for the management of acute lower and upper UTI, and trimethroprim is the first line option of recurrent UTI. A high proportion of the antibiotic prescriptions were issued in the elderly population including a relatively high prescription rate of quinolones. Key points: Urinary tract infection (UTI) is a common cause for prescription of antibiotics in general practice Poor compliance in general practice with recommendations for first-line treatment of UTI may increase antibiotic resistance Danish general practitioners are generally compliant with national and regional guidelines for antibiotic treatment of UTI There is high use of antibiotics in the elderly population including a worrisome high use of broad-spectrum antibiotics, such as Quinolones. [ABSTRACT FROM AUTHOR]

Objective: We investigated the association between socioeconomic factors and the attainment of treatment goals and pharmacotherapy in patients with type 2 diabetes in Denmark. Design: A cross-sectional population study. Setting: The municipality of Naestved, Denmark. Subjects: We studied 907 patients with type 2 diabetes identified from a random sample of 21,205 Danish citizens. Main outcome measures: The proportion of patients who were not achieving goals for diabetes care based on their HbA1c, LDL-cholesterol, blood pressure, and lifestyle, and the proportion of patients who were treated with antihypertensive and cholesterol- and glucose-lowering medication. Methods: We investigated the association of the socioeconomic factors such as age, gender, education, occupation, income, and civil status and attainment of treatment goals and pharmacotherapy in logistic regression analyses. We investigated effect modification of cardiovascular disease and kidney disease. Results: Middle age (40–65 years), low education level (i.e. basic schooling), and low household income (i.e. less than 21,400 € per year) were associated with nonattainment of goals for diabetes care. The association of socioeconomic factors with attainment of individual treatment goals varied. Patients with low socioeconomic status were more often obese, physically inactive, smoking, and had elevated blood pressure. Socioeconomic factors were not associated with treatment goals for hyperglycemia. Socioeconomic factors were inconsistently associated with pharmacotherapy. There was no difference in contacts to general practitioners according to SES. Conclusions: In a country with free access to health care, the socioeconomic factors such as middle age, low education, and low income were associated with nonattainment of goals for diabetes care. Middle age, low education, and low income were associated with nonattainment of goals for diabetes care, especially for lifestyle goals. Patients with low socioeconomic status were more often obese, physically inactive, smoking, and had elevated blood pressure. Association of socioeconomic factors with pharmacotherapy was inconsistent. [ABSTRACT FROM AUTHOR]

Objective:To chart follow-up of patients after acute poisoning by substances of abuse, register whether patients referred to specialist health services attended, and whether patients contacted a general practitioner (GP) after the poisoning episode. Design:Observational cohort study. Setting:A primary care emergency outpatient clinic in Oslo, Norway. Subjects:Patients ≥12 years treated for acute poisoning by substances of abuse were included consecutively from October 2011 to September 2012. Main outcome measures:Follow-up initiated at discharge, proportion of cases in which referred patients attended within three months, and proportion of cases in which the patient consulted a GP the first month following discharge. Results:There were 2343 episodes of acute poisoning by substances of abuse. In 391 (17%) cases the patient was hospitalised, including 49 (2%) in psychiatric wards. In 235 (10%) cases the patient was referred to specialist health services, in 91 (4%) advised to see their GP, in 82 (3%) to contact social services, in 74 (3%) allotted place in a homeless shelter, and in 93 (4%) other follow-up was initiated. In 1096 (47%) cases, the patient was discharged without follow-up, and in a further 324 (14%), the patient self-discharged. When referred to specialist health services, in 200/235 (85%) cases the patient attended within three months. Among all discharges, in 527/1952 (27%) cases the patient consulted a GP within one month. When advised to see their GP, in 45/91 (49%) cases the patient did. Conclusion:Attendance was high for follow-up initiated after acute poisoning by substances of abuse.KEY POINTSDespite poor long-term prognosis, patients treated for acute poisoning by substances of abuse are frequently not referred to follow-up.Nearly all patients referred to specialist health services attended, indicating the acute poisoning as an opportune moment for intervention.Advising patients to contact their GP was significantly associated with patients consulting the GP, but few patients were so advised.One out of three patients was discharged without follow-up, and there seems to be an unused potential for GP involvement. [ABSTRACT FROM PUBLISHER]

Objective:To characterize dropouts from type-2 diabetes (T2D) care in communal primary health care. Design:An observational study. Setting:In a Finnish city, patients with T2D who had not contacted the public primary health care system during the past 12 months were identified with a computer based search and contacted by a trained diabetes nurse. Subjects:Dropouts from T2D treatment. Main outcome measures:Demographic factors, laboratory parameters, examinations, medications, and comorbidities. Results:Of the patients with T2D, 10% (n = 356) were dropouts and 60% of them were men. Median HbA1cwas 6.5 (QR for 25% and 75%: 6.0, 7.7) %, (45 [42,61] mmol/mol). Of the dropouts, 14% had HbA1c ≥ 9.0% (75 mmol/mol), and these patients were younger than the other dropouts (mean age 54.4 [SD 10.8] years vs. 60.6 [9.4] years,p < 0.001). Median low-density lipoprotein (LDL) cholesterol level was 2.8 (QR 2.1, 3.4) mmol/l. Median systolic blood pressure (BP) was 142 (QR 130, 160) mm Hg. Median diastolic BP was 86 (78, 94) mm Hg. Of the dropouts, 83% had comorbidities and 62% were prescribed metformin as a treatment. Conclusions:Ten percent of T2D patients were dropouts of whom those with a poor glycaemic control were younger than the other dropouts. BP and LDL cholesterol concentrations were non-optimal among the majority of the dropouts. Metformin was prescribed less frequently to the dropouts than is usual for T2D patients. The comorbidities were equally common among the dropouts as among the other T2D patients.KEY POINTS  Which kinds of patients are dropouts from type-2 diabetes care is not known.• One-tenth of the patients with T2D were dropouts and they generally had good glycaemic control.• Blood pressure and LDL cholesterol concentrations were non-optimal among the majority of the dropouts.• Fourteen percent of these dropouts had HbA1c > 9% (75 mmol/mol) and they were more often younger than the other dropouts. [ABSTRACT FROM PUBLISHER]

Objective:This study aims to describe the determinants related to gender differences in the GP utilization in Danish population aged 50–65 years. Design:Cohort-based cross-sectional study. Setting:Danish general practice. Subjects:Totally, 54,849 participants of the Danish Diet, Cancer and Health cohort (50–65 years). Main outcome measures:The sum of cohort members’ face-to-face consultations with general practitioner (GP) at the cohort baseline year (1993–1997). We obtained data on GP visits from the Danish National Health Service Register at the cohort baseline (1993–1997), when information on lifestyle (smoking, body mass index (BMI), alcohol use, physical activity), medical conditions (somatic and mental), employment, education, gravidity, and hormone therapy (HT) use was collected by questionnaire. Results:Women had on average 4.1 and men 2.8 consultations per year. In a crude model, women had 47% higher rate of GP visits than men (incidence rate ratio: 1.47; 95% Confidence Interval: 1.45–1.50), which remained unchanged after adjustment for lifestyle, socio-demographic and medical factors, but attenuated to 18% (1.18; 1.13–1.24) after adjustment for female factors (gravidity and post-menopausal HT. In a fully adjusted model, subjects with hypertension (1.63; 1.59–1.67), mental illness (1.63; 1.61–1.66), diabetes (1.56; 1.47–1.65), angina pectoris (1.28; 1.21–1.34), and unemployed persons (1.19; 1.18–1.21) had highest rates of GP visits. Conclusions:Gravidity and HT use explain a large proportion, but not all of the gender difference in GP utilization. Medical conditions (somatic and mental) and unemployment are the main determinants of GP utilization in men and women, while lifestyle has minor effect.Key pointsFemale gender remained a dominant determinant of GP utilization, after adjustment for lifestyle, socio-demography, medical and gender specific factors, with females consulting their GP 18% more often than males.Female reproductive factors (use of postmenopausal hormone therapy and gravidity) explained a large proportion of the gender variation in use of GP.Strongest determinants for GP use among Danish adults aged 50–65 years were the presence of medical conditions (somatic and mental) and unemployment, while lifestyle factors (e.g., body mass index, alcohol consumption and smoking) had minor effect. [ABSTRACT FROM PUBLISHER]

Objective. To study coping differences between young and experienced GPs in primary care who experience medical errors and uncertainty. Design. Questionnaire-based survey (self-assessment) conducted in 2011. Setting. Finnish primary practice offices in Southern Finland. Subjects. Finnish GPs engaged in primary health care from two different respondent groups: young (working experience ≤ 5years, n = 85) and experienced (working experience > 5 years, n = 80). Main outcome measures. Outcome measures included experiences and attitudes expressed by the included participants towards medical errors and tolerance of uncertainty, their coping strategies, and factors that may influence (positively or negatively) sources of errors. Results. In total, 165/244 GPs responded (response rate: 68%). Young GPs expressed significantly more often fear of committing a medical error (70.2% vs. 48.1%, p = 0.004) and admitted more often than experienced GPs that they had committed a medical error during the past year (83.5% vs. 68.8%, p = 0.026). Young GPs were less prone to apologize to a patient for an error (44.7% vs. 65.0%, p = 0.009) and found, more often than their more experienced colleagues, on-site consultations and electronic databases useful for avoiding mistakes. Conclusion. Experienced GPs seem to better tolerate uncertainty and also seem to fear medical errors less than their young colleagues. Young and more experienced GPs use different coping strategies for dealing with medical errors. Implications. When GPs become more experienced, they seem to get better at coping with medical errors. Means to support these skills should be studied in future research. [ABSTRACT FROM AUTHOR]

Objective. To study the associations between active choice of primary care provider and healthcare utilization, multimorbidity, age, and sex, comparing data from primary care and all healthcare in a Swedish population. Design. Descriptive cross-sectional study using descriptive analyses including t-test, correlations, and logistic regression modelling in four separate models. Setting and subjects. The population (151 731) and all healthcare in Blekinge in 2007. Main outcome measure. Actively or passively listed in primary care, registered on 31 December 2007. Results. Number of consultations (OR 1.31, 95% CI 1.30-1.32), multimorbidity level (OR 1.69, 95% CI 1.67-1.70), age (OR 1.03, 95% CI 1.03-1.03), and sex (OR for men 0.67, 95% CI 0.65-0.68) were all associated with registered active listing in primary care. Active listing was more strongly associated with number of consultations and multimorbidity level using primary care data (OR 2.11, 95% CI 2.08-2.15 and OR 2.14, 95% CI 2.11-2.17, respectively) than using data from all healthcare. Number of consultations and multimorbidity level were correlated and had similar associations with active listing in primary care. Modelling number of consultations, multimorbidity level, age, and sex gave four separate models with about 70% explanatory power for active listing in primary care. Combining number of consultations and multimorbidity did not improve the models. Conclusions. Number of consultations and multimorbidity level were associated with active listing in primary care. These factors were also associated with each other differently in primary care than in all healthcare. More complex models including non-health-related individual characteristics and healthcare-related factors are needed to increase explanatory power. [ABSTRACT FROM AUTHOR]

Aim. This study investigates which leadership styles can be identified among general practice lead physicians and how they are associated with and predicted by staff and context characteristics like profession, gender, age, work experience, and team size. Method/material. In a cross-sectional study self-administered questionnaires were distributed to staff physicians (42% females) and support staff (98% females) at 101 primary health care centres in North Norway. A total of 127 and 222, respectively, responded (response rate 59%). Items were ranked on Likert scales (range 1-5). Results. Analysis revealed three significantly different styles (mean scores/Cronbach's alpha): change style (3.36/0.898), task style (3.17/0.885), and relation style (2.88/0.900). The lead physicians were perceived as practising change style the most and relation style the least. Males experienced significantly more of all three styles. Support staff scored lowest for all styles. Age was negatively correlated with relation style and change style, while work experience was negatively correlated with change style. No significant association was found between styles and team size. Conclusion. Leadership in rural general practice can be identified in terms of task, relation, and change styles. Change style is the most perceived style. Males seem to be most attentive to leadership styles. However, within the staff physician group, there is less difference between genders. Support staff scores lowest for all styles; this might indicate either less need for leadership or dissatisfaction with leadership. Age and work experience seem to reduce employees' attention to relation and change styles, indicating that maturity reduces needs for these leadership styles. Due to growing demands for leaders to take care of efficiency and change in general practice, more young female physicians, and more diverse staff groups, these findings may be useful to understand leadership and leadership training for general practice. [ABSTRACT FROM AUTHOR]

Objective. Few large-scale studies have examined the prevalence of irritable bowel syndrome (IBS) and the number of visits among IBS patients in a primary health care setting. The aim of this study was to assess the prevalence of IBS in primary health care in four Swedish counties. Another aim was to study the number of visits among the IBS patients. Design. A register-based study. Setting. A primary health care database with information on patients from 71 primary health care centres in the Swedish counties of Stockholm, Uppsala, Värmland, and Gotland. Subjects. The primary health care database contains individual-level data for 919 954 patients for the period 2001-2007. Main outcome measures. Prevalence of IBS diagnosis. Results. 10 987 patients had a diagnosis of IBS, which corresponds to a prevalence of 1.2%. IBS was most common in the 25-44 years age group (37% of IBS patients); 71% of IBS patients were female, and 81% of IBS patients visited their GP six or more times, compared with 46% of non-IBS patients. However, 95% of the IBS patients visited their GP three times or fewer for IBS. Conclusion and implications. The prevalence of IBS was low among Swedish primary health care patients. This might suggest that IBS patients are insufficiently diagnosed in Swedish primary health care. [ABSTRACT FROM AUTHOR]

Objective. Several studies indicate that ethnicity may be a strong predictor of poor self-rated health (SRH). The aims of the present study were to investigate whether there was an association between ethnicity and poor SRH in subjects with type 2 diabetes and to determine if the association remained after adjusting for possible confounders such as age, gender employment, marital status, and education. Design. A cross-sectional study based on a patient population in the town of Södertälje. An unconditional logistic regression was performed to estimate the odds ratios (ORs) and 95% confidence intervals (95% CIs). Setting. Four primary health care centers. Subjects. A total of 354 individuals were included: Assyrian/Syrian-born (n = 173) and Swedish-born (n = 181). Results. The odds ratio for rating poor SRH for Assyrian/Syrian subjects with type 2 diabetes was 4.5 times higher (95% CI = 2.7-7.5) than for Swedish patients in a crude model. After adjusting for possible confounders, unemployed/retired people had 5.4 times higher odds for reporting poor SRH than employees (OR = 5.4; 95% CI = 2.3-12.5). Women had 1.8 times higher odds (95% CI = 1.0-3.0) for reporting poor SRH than men. In the final model poor SRH among Assyrians/Syrians decreased but still remained significant (OR=3.7; 95% CI = 2.5-6.6). Conclusions. The findings in this study are important for planning primary health care services. They highlight the crucial importance of being aware of the subjective health status of immigrants fleeing from war in the Middle East and resettling in Sweden. [ABSTRACT FROM AUTHOR]