The aim of patient segmentation is to recognize patients with similar health care needs. The Finnish patient segmentation service Navigator segregates patients into 4 groups, including a self-acting ...group, who presumably manages their everyday life and coordinates their health care. Digital services could support their self-care. Knowledge on self-acting patients’ characteristics is lacking. The study aims are to describe how Navigator assigns patients with diabetes to the 4 groups at nurses’ appointments at a health center, the self-acting patient group’s characteristics compared with other patient groups, and the concordance between the nurse’s evaluation of the patient’s group and the actual group assigned by Navigator (criterion validity). Most patients (259/304, 85.2%) were in the self-acting group. Hypertension, hyperlipidemia, and joint ailments were the most prevalent comorbidities among all patients. Self-acting patients had less ischemic cardiac disease (P=.001), depression or anxiety (P=.03), asthma or chronic obstructive pulmonary disease (P<.001), long-term pain (P<.001), and related medication. Self-acting patients had better self-rated health (P<.001), functional ability (P<.001), health-related quality of life (P<.001), and general well-being (P<.001). All patients considered their skills at using electronic services to be good. The patients in the self-acting group had several comorbidities. However, their functional ability was not yet diminished compared with patients in the other groups. Therefore, to prevent diabetic complications and disabilities, support for patients’ self-management should be emphasized in their integrated care services. Digital services could be involved in the care of patients willing to use them. The study was performed in 1 health center, the participants were volunteers, and most patients were assigned to self-acting patient group. These facts limit the generalizability of our results.
The Patient Enablement Instrument (PEI) is an established patient-reported outcome measure (PROM) that reflects the quality of appointments with general practitioners (GPs). It is a six-item ...questionnaire administered to the patient immediately after a consultation. The aim of this study was to evaluate whether a single-item measure could replace the PEI when measuring patient enablement among Finnish health care centre patients.
Two single-item measures, Q1 and Q2, were chosen for comparison with the PEI. Firstly, a pilot study with questionnaire testing and brief interviews with the respondents were performed in order to assess the content validity of the PEI and the single-item measures. Secondly, a questionnaire study after a single appointment with a GP was carried out in three health care centres in Western Finland in order to evaluate the construct and criterion validity of the single-item measures. A telephone interview was performed 2 weeks after the appointment in order to assess the test-retest reliability of the single-item measures. The sensitivity, specificity, and both positive and negative predictive values of Q1 and Q2 were calculated with different PEI score cut-off points.
Altogether 483 patients with a completed PEI were included in the questionnaire study analyses. Altogether 149 and 175 patients had completed Q1 and Q2, respectively, both in the questionnaire and the telephone interview. The correlations between the PEI and Q1 and Q2 were 0.48 and 0.84, respectively. Both the single-item measures had a high sensitivity and a negative predictive value in relation to patients with lower PEI scores. The reliability coefficients were 0.24 for Q1 and 0.76 for Q2. The test-retest values of Q1, Q2, and the PEI were low.
Q2 seems to be a valid and reliable measure of patient enablement. Q1 seems to be less correlated with the PEI, but it also has a high negative predictive value in relation to low enablement scores.
From previous studies, it is known that the association between fibromyalgia and thyroid autoimmunity diseases exists. On the other hand, it was recently suggested that in many cases thyroid hormone ...treatment might be unnecessary. The aim of our study is to explore the thyroid hormone treatment among primary health care fibromyalgia patients. Our study is cross-sectional and based on fibromyalgia study from the city of Nokia Health Center. Clinical examination was performed to participants, patients filled five questionnaires and information from electronic patient records was gathered. In addition to other parameters, we studied patient's thyroid function levels at the beginning of thyroid hormone treatment.
From those patients participating in the study (n = 103), 34% (n = 33) had thyroid hormone treatment. From those taking thyroid hormone treatment, 48% (n = 16) had information regarding the initial TSH and T4-V levels at the beginning of the treatment. 37% (n = 6) of them had normal thyroid function. Small sample size and data gathered from single health center effects on the generalizability of our findings. However, we suggest further studies to confirm the potential association between fibromyalgia and inappropriate thyroid hormone treatment.
The chief physicians of the Finnish primary healthcare centres (HCs) recognize the value of practice-based research and are motivated to participate in practice-based research network activity if:
* ...The research topics are relevant to their interests and problems encountered at their HC;
* The research activity entails tangible benefits for their HC, such as evidence-based practice and improvement, an increase in professional competence, or an improvement in HC image;
* It is possible to cope with competing priorities and resource limitations.
To illustrate the views of chief physicians in Finnish primary healthcare health centres (HCs) on the existing research capacity of their centres, their attitudes to practice-based research network activity, and research topics of interest to them.
A cross-sectional survey study.
Finnish HCs.
Chief physicians in Finnish HCs.
We used a questionnaire that included five-point Likert scales and multiple choice and open-ended questions to identify the chief physician's profile, the HC content, the attitudes of chief physicians towards engagement in research, research topics of interest to them, and factors that may influence their motivation. Descriptive methods were used for the analysis of the quantitative data, while the qualitative data were processed using inductive thematic analysis.
There was a relatively good representation of all hospital districts. One-third of HCs had at least one person doing research, and 61% of chief physicians would support research in their setting. Their stimulus for research was primarily testing new therapies, protocols, and care processes, as well as effectiveness and healthcare improvement. The expected benefits that motivate engagement in Practice-based research networks (PBRNs) are evidence-based practice and raised professional capacity and profile of the HC.
Chief physicians regard research as an elementary part of the development of primary care practices and health policy. Their motivation to engage in PBRN activity is determined by the relevance of the research to their interests and the management of competing priorities and resource limitations.
General practitioners (GPs) should regularly review patients' medications and, if necessary, deprescribe, as inappropriate polypharmacy may harm patients' health. However, deprescribing can be ...challenging for physicians. This study investigates GPs' deprescribing decisions in 31 countries.
In this case vignette study, GPs were invited to participate in an online survey containing three clinical cases of oldest-old multimorbid patients with potentially inappropriate polypharmacy. Patients differed in terms of dependency in activities of daily living (ADL) and were presented with and without history of cardiovascular disease (CVD). For each case, we asked GPs if they would deprescribe in their usual practice. We calculated proportions of GPs who reported they would deprescribe and performed a multilevel logistic regression to examine the association between history of CVD and level of dependency on GPs' deprescribing decisions.
Of 3,175 invited GPs, 54% responded (N = 1,706). The mean age was 50 years and 60% of respondents were female. Despite differences across GP characteristics, such as age (with older GPs being more likely to take deprescribing decisions), and across countries, overall more than 80% of GPs reported they would deprescribe the dosage of at least one medication in oldest-old patients (> 80 years) with polypharmacy irrespective of history of CVD. The odds of deprescribing was higher in patients with a higher level of dependency in ADL (OR =1.5, 95%CI 1.25 to 1.80) and absence of CVD (OR =3.04, 95%CI 2.58 to 3.57).
The majority of GPs in this study were willing to deprescribe one or more medications in oldest-old multimorbid patients with polypharmacy. Willingness was higher in patients with increased dependency in ADL and lower in patients with CVD.
Common colds are the most frequently encountered disease worldwide and the most frequent reason for self-care. According to the cross-sectional European Common Colds study (COCO), patients use as ...many as 12 items on average for self-care. Little is known about the influence of discomfort and knowledge on self-care for common colds.
To understand the influence of patients' discomfort during a cold and their knowledge about the self-limited disease course on the use of self-care measures.
This COCO analysis included 2,204 patients from 22 European primary care sites in 12 countries. Each site surveyed 120 consecutive adults with a 27-item questionnaire asking about patients' self-care, subjective discomfort during a cold (discomfort: yes/no), and knowledge about the self-limited course (yes/no). Country-specific medians of the number of self-care items served as a cut-off to define high and low self-care use. Four groups were stratified based on discomfort (yes/no) and knowledge (yes/no).
Participants' mean age was 46.5 years, 61.7% were female; 36.3% lacked knowledge; 70.6% reported discomfort. The group has discomfort/no knowledge exhibited the highest mean item use (13.3), followed by has discomfort/has knowledge (11.9), no discomfort/no knowledge (11.1), and no discomfort/has knowledge (8.8). High use was associated with discomfort (OR 1.8; CI 1.5-2.2), female gender (OR 1.7; 1.4-2.0), chronic pain/arthritis (OR 1.6; 1.2-2.1), more years of education (OR 1.3; 1.1-1.6), age <48 years (OR 1.3; 1.0-1.5), and lack of knowledge (OR 1.2; 1.0-1.4).
Counseling on common colds should address patients' discomfort and soothing measures in addition to providing information on the natural disease course.
Fibromyalgia is a functional syndrome. Despite recent findings, there is still considerable uncertainty about its diagnostic process.
This study aimed to explore patients' experiences with ...fibromyalgia during the diagnostic process in primary health care. Moreover, we tried to determine how diagnostic consultation could be improved.
This study is based on data from patients with fibromyalgia in a primary health care study conducted in Nokia, Finland. Patients with fibromyalgia were identified from electronic medical records. Focus-group participants with fibromyalgia diagnoses were selected using a purposive sampling method to gather a maximum variation sample. Qualitative thematic analysis was used for the coded data from four focus-group discussions in 2018. A description of the coding tree was provided and researchers organised the codes. Finally, all researchers identified themes from the data.
The main unifying entities were the uncertainty and contradictions fibromyalgia patients faced on several occasions. Physicians sometimes offered other diagnoses - like depression - as an explanation for the symptoms, or used repetitive tests to eliminate other possible diagnoses. Furthermore, patients expressed their wishes for a holistic, empathetic, and up-to-date approach to their symptoms.
In our interviews, a good doctor-patient relationship and continuity of care were necessary, as were the physician's attitude and knowledge of fibromyalgia. Our findings also suggest avoiding repeated or unnecessary rule-out tests and the overdiagnosis of psychiatric disorders is necessary.
The national Omaolo digital social welfare and health care service of Finland provides a symptom checker, Omaolo, which is a medical device (based on Duodecim Clinical Decision Support EBMEDS ...software) with a CE marking (risk class IIa), manufactured by the government-owned DigiFinland Oy. Users of this service can perform their triage by using the questions in the symptom checker. By completing the symptom checker, the user receives a recommendation for action and a service assessment with appropriate guidance regarding their health problems on the basis of a selected specific symptom in the symptom checker. This allows users to be provided with appropriate health care services, regardless of time and place.
This study describes the protocol for the mixed methods validation process of the symptom checker available in Omaolo digital services.
This is a mixed methods study using quantitative and qualitative methods, which will be part of the clinical validation process that takes place in primary health care centers in Finland. Each organization provides a space where the study and the nurse triage can be done in order to include an unscreened target population of users. The primary health care units provide walk-in model services, where no prior phone call or contact is required. For the validation of the Omaolo symptom checker, case vignettes will be incorporated to supplement the triage accuracy of rare and acute cases that cannot be tested extensively in real-life settings. Vignettes are produced from a variety of clinical sources, and they test the symptom checker in different triage levels by using 1 standardized patient case example.
This study plan underwent an ethics review by the regional permission, which was requested from each organization participating in the research, and an ethics committee statement was requested and granted from Pirkanmaa hospital district's ethics committee, which is in accordance with the University of Tampere's regulations. Of 964 clinical user-filled symptom checker assessments, 877 cases were fully completed with a triage result, and therefore, they met the requirements for clinical validation studies. The goal for sufficient data has been reached for most of the chief symptoms. Data collection was completed in September 2019, and the first feasibility and patient experience results were published by the end of 2020. Case vignettes have been identified and are to be completed before further testing the symptom checker. The analysis and reporting are estimated to be finalized in 2024.
The primary goals of this multimethod electronic symptom checker study are to assess safety and to provide crucial information regarding the accuracy and usability of the Omaolo electronic symptom checker. To our knowledge, this will be the first study to include real-life clinical cases along with case vignettes.
DERR1-10.2196/41423.
Diagnosis of cancer is challenging in primary care due to the low incidence of cancer cases in primary care practice. A prolonged diagnostic interval may be due to doctor, patient or system factors, ...or may be due to the characteristics of the cancer itself. The objective of this study was to learn from Primary Care Physicians' (PCP) experiences of incidents when they had failed to think of, or act on, a cancer diagnosis.
A qualitative, online survey eliciting PCP narratives. Thematic analysis was used to analyse the data.
A primary care study, with narratives from 159 PCPs in 23 European countries.
PCPs' narratives on the question 'If you saw this patient with cancer presenting in the same way today, what would you do differently?
The main themes identified were: thinking broadly; improvement in communication and clinical management; use of other available resources and 'I wouldn't do anything differently'.
To achieve more timely cancer diagnosis, PCPs need to provide a long-term, holistic and active approach with effective communication, and to ensure shared decision-making, follow-up and continuing re-assessment of the patients' clinical conditions.
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