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Version 1 publicerades 2023-10-04. Avpublicerad i samband med publicering av version 3. Då hade denna version ladddats ner 2067 gånger.Version 2 innehåll några rättelser, och publicerades 2023-12-05. Avpublicerad i samband med publicering av version 3. Då hade denna version ladddats ner 576 gånger.Version 3 innehåller ytterligare rättelser, publicerad 2024-05-02.

The majority of patients with a distal radius fracture (DRF) are elderly, a group known to experience difficulties with new technology, partly due to a low level of digital literacy. At the beginning of the coronavirus disease 2019 pandemic, during the spring 2020, patients that underwent DRF surgery had regular follow-ups replaced by video calls from their surgeon and physiotherapist. Afterward, patients answered questionnaires regarding health and digital literacy and took part in semistructured interviews regarding the experience of the virtual follow-up. By systemic text condensation, 2 major categories were identified: (1) The video call-new, but surprisingly simple: All but 1 found it easier than expected, and (2) Video calls-the patient's choice: All but 1 patient preferred video calls to physical visits for follow-up. This is the first mixed methods study to assess patients' experiences of digital follow-up after DRF surgery. This study indicates that digital follow-up was highly appreciated, even among patients with low levels of digital literacy. Digital technologies must be made suitable even for patients with inadequate levels of digital literacy.

Background: The growing use of digital primary care consultations has led to concerns about resource use, equity and quality. One of these is how it affects antibiotic prescription. Differences in ease of access for patients and available diagnostic information for the prescribing physicians are reasons to believe prescription rates may be affected. Objectives: We estimated differences in antibiotic prescription between traditional office-based and digital contacts, if these differences varied between groups of diagnoses depending on the availability of information for the prescribing physician, and if differences were associated with socio-demographic patient characteristics. Methods: Using individual level register data for a sample of patients diagnosed with an infection over a two-year period, we estimated differences in prescription between the two types of contacts and applied propensity score techniques to mitigate possible problems with treatment selection bias. Results: The share of antibiotic prescription was 28 (95% CI 27–30, p < 0.001) to 33 (95% CI 29–36, p < 0.001) percentage points lower among digital contacts as compared to office-based contacts. For urinary tract infections, the differences in prescription rates between the two contact types were smaller (34 to 41 percentage points difference) than for throat and skin infections (50 to 60 percentage points difference). For women, rural, older, and people born outside Sweden, digital contacts were associated with higher prescription rates. Conclusions: Antibiotic prescription rates were significantly lower for digital contacts compared with office-based contacts. The findings suggest that digital primary care may be an effective alternative to in-person visits without undue consequences for antibiotic prescription levels, although to varying degree depending on diagnosis.

How do we want to organize health centres? 838Swedish general practitioners’ attitudes to a personal patient list. In Swedish primary care patients are registered at health centres where different professions, such as general practitioners (GPs), nurses, assistant nurses, counsellors, physiotherapists, psychologists and biomedical analysts, work. In an international comparison personal physician continuity is low in Sweden. Several governmental inquiries propose that patients register with one GP or a care team. Do Swedish GPs want a personal patient list and how should this best be realised? A web survey was distributed to the members of the Swedish Union of General Practitioners and was answered by 838 GPs. 91% wanted a personal patient list if reasonably sized, the option to limit their list, and shared responsibility for the list with colleagues or a team. To be able to plan the working day themselves and designated time for collegial dialogue was considered essential for increased efficiency, well-being and reduced risk of patients harm due to their doctor's knowledge gaps., Sverige presterar i internationell jämförelse sämst avseende personlig läkarkontinuitet. Personliga patientlistor kan öka kontinuiteten, men vad tycker svenska allmänläkare? 838 allmänläkare besvarade en webbenkät. 91 procent av svarande under 66 år önskade en personlig patientlista om den är rimligt stor, ca 1 160 personer. Ansvaret för listan bör delas inom ett arbetslag av läkare eller ett team. Tid för kollegial dialog är nödvändig för effektivitet, trivsel och patientsäkerhet. Sverige skulle behöva 11 150 allmänläkare. I dag finns 5 000. Radikala satsningar för rekrytering av läkare till primärvården krävs, liksom övergångslösningar, till exempel listning på andra specialister och på team.

Background: Values are deeply held views that act as guiding beliefs for individuals and organizations. They state what is important in a profession. The aims of this study were to determine whether European countries have already developed (or are developing) documents on core values in family medicine; to gather the lists of core values already developed in countries; and to gather the opinions of participants on what the core family values in their countries are. Methods: This was a qualitative study. The questionnaire was distributed as an e-survey via email to present and former members of the European Society for Quality and Safety in Family Practice (EQuiP), and other family medicine experts in Europe. The questionnaire included six items concerning core values in family medicine in the respondent's country: the process of defining core values, present core values, the respondents' suggestions for core values, and current challenges of core values. Results: Core values in family medicine were defined or in a process of being defined in several European countries. The most common core values already defined were the doctor-patient relationship, continuity, comprehensiveness and holistic care, community orientation, and professionalism. Some countries expressed the need for an update of the current core values' list. Most respondents felt the core values of their discipline were challenged in today's world. The main values challenged were continuity, patient-centered care/the doctor-patient relationship and comprehensive and holistic care, but also prioritization, equity, and community orientation and cooperation. These were challenged by digital health, workload/lack of family physicians, fragmentation of care, interdisciplinary care, and societal trends and commercial interests. Conclusion: We managed to identify suggestions for core values of family medicine at the European level. There is a clear need to adopt a definition of a value and tailor the discussi

Introduction The ability to provide primary care with the help of a digital platform raises both opportunities and risks. While access to primary care improves, overuse of services and medication may occur. The use of digital care technologies is likely to continue to increase and evidence of its effects, costs and distributional impacts is needed to support policy-making. Since 2016, the number of digital primary care consultations for a range of conditions has increased rapidly in Sweden. This research project aims to investigate health system effects of this development. The overall research question is to what extent such care is a cost-effective and equitable alternative to traditional, in-office primary care in the context of a publicly funded health system with universal access. Three specific areas of investigation are identified: clinical effect; cost and distributional impact. This protocol describes the investigative approach of the project in terms of aims, design, materials, methods and expected results. Methods and analysis The research project adopts a retrospective study design and aims to apply statistical analyses of patient-level register data on key variables from seven regions of Sweden over the years 2017-2018. In addition to data on three common infectious conditions (upper respiratory tract infection; lower urinary tract infection; and skin and soft-tissue infection), information on other healthcare use, socioeconomic status and demography will be collected. Ethics and dissemination This registry-based study has received ethical approval by the Swedish Ethical Review Authority. Use of data will follow the Swedish legislation and practice with regards to consent. The results will be disseminated both to the research community, healthcare decision makers and to the general public.

Published on the occasion of the 25th Anniversary of WONCA Europe, Berlin, December 2020.

The easy access to data from electronic patient records has made using this type of data in pay-for performance systems increasingly common. General practitioners (GPs) throughout Europe oppose this for several reasons. Not all data can be used to derive good quality indicators and quality indicators can’t reflect the broad scope of primary care. Qualities like person-centred care and continuity are particularly difficult to measure. The indicators urge doctors and nurses to spend too much time on the registration and administration of required data. However, quality indicators can be very useful as starting points for discussions about quality in primary care, with the purpose being to initiate, stimulate and support local improvement work. This led to The European Society for Quality and Patient Safety in General Practice (EQuiP) feeling the urge to clarify the different aspects of quality indicators by updating their statement on measuring quality in Primary Care. The statement has been endorsed by the Wonca Europe Council in 2018.

Overloading of the emergency departments in hospitals is, in Sweden, a common problem that is often blamed on lack of access to primary care. We have conducted a cross-sectional study comprising more than 40% of the 347 837 inhabitants of Region Jönköping with access to complete individual data on healthcare consumption, personal doctor continuity, socio-economics, and accessibility data for all of the regions health centres. Individuals with high personal continuity at their own health centre had significantly fewer emergency room visits compared to those with the lowest continuity: for younger adults 55% and for elderly 34% fewer emergency room visits. Access to doctor consultations or to counselling nurses in primary care was not associated with a lower number of emergency room visits. Our results show the importance of personal doctor continuity also for the group of younger adults., Hög personlig läkarkontinuitet i primärvård var förenad med lägre antal läkarbesök på akutmottagningar. Sambandet mellan hög personlig läkarkontinuitet och lägre antal läkarbesök på akutmottagning var störst för gruppen yngre vuxna. God tillgänglighet till läkarbesök på vårdcentral var inte förenad med lägre antal akutmottagningsbesök. God tillgänglighet till telefonrådgivning av sjuksköterska på vårdcentral var inte förenad med lägre antal akutmottagningsbesök.

Background: Quality improvement (QI) is necessary in all healthcare, but quality of healthcare is hard to measure. To use financial incentives to improve care is difficult and may even be harmful. However, conducting QI projects is a well-established way to increase quality in healthcare. Problem: In 2015, there were few QI projects conducted in primary care in the Stockholm Region, Sweden. There was no structured support or way to share the QI projects with other general practitioner (GP) practices. To use financial incentives could increase the number of projects performed and could possibly improve the quality of care. The aim was to increase the number of GP practices performing QI projects in the Stockholm Region through financial incentives. Method: To study QI projects performed during 2016 and 2017 in the Region Stockholm. This was compared with 2015 in Stockholm and with the Region Jönköping in Sweden during 2016 and 2017. Interventions: First, the healthcare administration started to reimburse GP practices for conducting and reporting QI projects in 2016. Second, a 4-hour course in QI was offered. Third, feedback on plans for QI projects was given. The year after the projects were prerformed, they were published online to stimulate sharing and inspiration between the GP practices. Results: For 2016, there were 166 (80%) of the GP practices that presented a QI project and in 2017, 164 (79%) did so. The number of projects in Stockholm increased almost by 100 per years compared with 2015. Conclusion: QI work has increased in Stockholm since 2016, probably because of the financial incentives from the Stockholm Region.

Objective: To identify and describe the core characteristics and the spread of quality circles in primary healthcare in European countries. Design: An online survey was conducted among European Society for Quality and Safety in Family Practice (EQuiP) delegates. To allow comparison with earlier results, a similar survey as in a study from 2000 was used. Setting: Primary Health Care in European countries. Subjects: General practitioners, delegated experts of the European Society for Quality and Safety in Family Practice (EQuiP). Main outcome measures: (1) Attendance in quality circles (2) their objectives (3) methods of quality improvement quality circles use (4) facilitator’s role and training (5) role of institutions (6) supporting material and data sources quality circles use. Results: 76% of the delegates responded, representing 24 of 25 countries. In 13 countries, more than 10% of general practitioners participated in quality circles, compared with eight countries in 2000. The focus of quality circles moved from continuous medical education to quality improvement. Currently, quality circles groups use case-based discussions, educational materials and local opinion leaders in addition to audit and feedback. Some national institutions provide training for facilitators and data support for quality circle groups. Conclusion: The use of quality circles has increased in European countries with a shift in focus from continuous medical education to quality improvement. Well-trained facilitators are important, as is the use of varying didactic methods and quality improvement tools. Qualitative inquiry is necessary to examine why QCs thrive or fail in different countries and systems. KEY POINTS Countries with already established quality circle movements increased their participation rate and extended their range of quality circle activities The focus of quality circles has moved from CME/CPD to quality improvement Well-trained facilitators are important, as is the use of

Quality indicators can be very useful as a starting point for quality improvement work. However, using quality indicators for pay for performance, seems to have mainly negative consequences. In order to clarify this EQuiP updated their policy paper on quality indicators, which was recently endorsed by Wonca Europe. The positive side of indicators, using them for quality improvement, is exemplified by ”Primary Care Quality”, a Swedish system for quality improvement in primary care. In this workshop, a brief background to EQuiP’s policy paper is presented. Thereafter ”Primary Care Quality” is introduced. Together, the participants will discuss different use of quality indicators with focus on How the Position paper can be applied in their context How indicators for quality improvement can help quality improvement (by testing ”cases” from Swedish health care centres). Finally, we summarize our experience of working with quality indicators and discuss what we can do to facilitate the positive use of them.

HUVUDBUDSKAP Hög personlig läkarkontinuitet i primärvård var förenad med lägre antal läkarbesök på akutmottagningar. Sambandet mellan hög personlig läkarkontinuitet och lägre antal läkarbesök på akutmottagning var störst för gruppen yngre vuxna. God tillgänglighet till läkarbesök på vårdcentral var inte förenad med lägre antal akutmottagningsbesök. God tillgänglighet till telefonrådgivning av sjuksköterska på vårdcentral var inte förenad med lägre antal akutmottagningsbesök., Personal physician continuity in primary care associated with fewer emergency room visits Overloading of the emergency departments in hospitals is, in Sweden, a common problem that is often blamed on lack of access to primary care. We have conducted a cross-sectional study comprising more than 40% of the 347 837 inhabitants of Region Jönköping with access to complete individual data on healthcare consumption, personal doctor continuity, socio-economics, and accessibility data for all of the region’s health centres. Individuals with high personal continuity at their own health centre had significantly fewer emergency room visits compared to those with the lowest continuity: for younger adults 55% and for elderly 34% fewer emergency room visits. Access to doctor consultations or to counselling nurses in primary care was not associated with a lower number of emergency room visits. Our results show the importance of personal doctor continuity also for the group of younger adults.

Primary health centres (PHCs) nowadays have access to data feed-back through different sources. However, while some HCSs are constantly running improvement projects others don’t use feed-back data. A national system for the audit and feed-back, Primary Care Quality, is now introduced in Sweden. Increased knowledge aboutthe reasons behind the different use of audit and feed-back data at different PHCs would be helpful help to improve conditions for use of data for quality improvement. Focus group interviews were conducted with staff and management teams at primary care centres in Sweden during. Data was analysed using qualitative content analysis. Preliminary results are three main themes that describes different approaches to quality improvement in daily practice. Each theme represents a quality improvement strategy with specifik characteristics. The three themes can be described on an axis from simple to complicated to complex.