Introduction: Assessing work capacity and determining appropriate sick leave is a complex process. Despite the importance of fair and consistent assessments, evidence suggests that evaluations may vary. However, previous studies have been inconclusive and have mainly focused on whether sick leave should be recommended or not. The present study examined the medical reliability and consistency of physicians' assessments of work capacity, as indicated by the reported percentage of reduced work capacity and the recommended length of sick leave.

Methods: A cross-sectional survey was conducted with 142 primary care physicians from four Swedish counties. Participants assessed six anonymised, authentic medical certificates related to mental health and pain-related conditions. For each case, they estimated the degree of reduced work capacity and the recommended sick leave duration, which were combined into a sick leave score. Physician characteristics (e.g. gender, professional status) and perceived managerial support were also measured.

Results: There was considerable variation in sick leave scores, both across physicians and between certificates. Male physicians and those with more years of experience recommended longer sick leave for pain-related cases, while specialists showed less variation in their assessments. Perceived support from frontline managers was associated with lower scores. No significant associations were found for patient involvement.

Conclusions: The findings suggest that sick leave assessments may lack consistency and be influenced by physician-related factors, particularly for pain-related conditions. Stronger support structures, opportunities for knowledge exchange, and clearer guidelines may help reduce unwarranted variation and promote more reliable assessments.

Background: Understanding patients’ perspectives on their medications is important to facilitate collaborative deprescribing and shared decision-making.AimTo explore older patients’ attitudes towards having their medications deprescribed and facilitators for deprescribing in Swedish primary care.

Methods: Swedish primary care patients (≥ 65 years and taking ≥5 medications) responded to an anonymous survey on their attitudes towards deprescribing (June 2022-December 2023).

Results: Out of 101 patients (45% women), 81% were satisfied with their medications (n = 82), 78% would be willing to stop or reduce ≥1 medication if their physician said it was possible (n = 79), and 27% (n = 27) wanted to deprescribe ≥1 medications from their medication lists (with 48 unique medications being mentioned). Side effects associated with the medication was the most commonly stated reason for wanting to deprescribe, mentioned by 52% (14/27 patients). Patients most often wanted to deprescribe blood glucose lowering medications, mentioned by 26% (7/27 patients). Most frequent patient-perceived facilitators for deprescribing were the support from their general practitioner (GP) (68%), a plan for deprescribing (38%), the possibility of restarting the medication if needed (23%), and having an alternative medication (22%).

Conclusions: While most older adults with polypharmacy in Swedish primary care would be willing to deprescribe if suggested by their physician, many did not want to have any medication deprescribed. This difference highlights the need to clarify patients’ preferences when discussing medication changes. Support from the GP was identified as an important facilitator, demonstrating the importance of patient-GP communication and shared decision-making in deprescribing.

Background: In Sweden 70,000 people suffer fragility fractures annually, including 16,000 hip fractures with one-year mortality of up to 25%. Strategies to prevent falls, improve physical function, and enhance bone strength have shown mixed results. Aim: To evaluate the incidence of hip and other fragility fractures following a fracture prevention intervention and assess baseline risk factors for long-term fracture outcomes. Methods: 1,233 rural Swedish women aged 70-100 years in 2002 were followed until 2021 after a primary care-based, non-randomized graded fracture prevention intervention 2002-2004 that included physical activity, fall prevention, and pharmacological treatment tailored to hip fracture risk. Fractures were identified through radiology reports 2002-2021. Results: The most common fractures occurred in the hip with 236 women sustaining 268 hip fractures with highest incidence in women aged 90-94 years. One-year hip fracture mortality was 27%. Hip fractures occurred in 17.7% of the intervention group (77/434) and 19.9% of controls (159/799, p = 0.36). Repeated fragility fractures occurred in 14.1% of the intervention group and 18.6% of controls (OR 0.71; 95% CI 0.53-1.0, p = 0.047), particularly when one fracture involved the hip (OR 0.54 (95% CI 0.31-0.95), p = 0.037). Increasing age (HR 1.8-4.0), height >167 cm (HR 1.6; 95% CI 1.1-2.2), and weight <60 kg (HR 1.5; 95% CI 1.1-2.0) were significant baseline risk factors. Conclusions: We noticed a non-significant reduction in hip fractures after 20 years, yet repeated fractures were less frequent in the intervention group suggesting a potential long-term benefit. Older, taller and lighter women were at greater risk for hip fracture.

Telemedicine in primary health care is expected to address many of the issues currently challenging service delivery. However, the impact and effect will depend on who will use the new technology. ObjectiveThe objective of the study was to investigate differences between users and non-users of telemedicine integrated into traditional office-based primary health care. MethodsQuantitative registry-based population study in two regions in the southeast part of Sweden (n = 73,486), comparing users with non-users of telemedicine across the variables sex, age, socioeconomic status (SES), morbidity and health care seeking behaviour (HSB). Two study periods of six months were used (September 2019-February 2020 for Region & Ouml;sterg & ouml;tland, and September 2021-February 2022 for Region Kalmar County) to collect user data. A reference period of 36 months (September 2016-August 2019) was used, to collect data on HSB. ResultsUsers were more often women under the age of 60 and had higher morbidity (measured as resource utilisation) than non-users (p < .001). In contrast, no statistically significant differences were seen between the two groups regarding SES, measured as Care Need Index (CNI). Regarding HSB, a proxy measure (health record entries) showed more entries for users than non-users. ConclusionsOur findings suggest that users are more likely to be women and below the age of 60. Likewise, users also tend to have a greater need for health care services compared to non-users, and they seek health care more often compared to non-users. No differences regarding SES were found.

Objective

The digital transformation of society has significant implications for healthcare. Despite a growing body of research on telemedicine implementation, studies specifically examining chat-based care assessments by primary care nurses remain limited. The aim of the present study was to explore nurses’ work experiences and training needs regarding chat-based care assessments in primary healthcare.

Method

This qualitative exploratory study employed semi-structured in-depth interviews with six nurses trained in telemedicine chat technique. Data were analysed inductively using reflexive thematic analysis.

Results

The findings indicated that chat-based care assessments could lead to prolonged assessment processes, and that nurses needed proficiency in chat techniques and effective communication skills to ensure clarity in conversations and accurate medical history acquisition. Training gaps were noted, particularly in fostering effective patient-professional relationships through brief text exchanges in the chat. The prolonged process had both advantages and disadvantages. Although it was more time-consuming, nurses got better opportunities to consider their responses and consult with colleagues, which was thought to improve the accuracy of medical assessments. Further benefits of chat-based assessments included access to chat history, the ability to share informational links, and opportunities for professional development. Nurses pointed to the need for system improvements, such as auto-anamnesis and auto-triage features, to better support their work in the future.

Conclusion

The study offers valuable insights for healthcare professionals, technology designers, and policymakers regarding the nuances of nurses’ chat-based interactions with patients in primary care settings. The results can inform the development of targeted training programs in chat techniques and communication skills, enhancing the effectiveness of digital consultations and fostering therapeutic relationships with patients. Chat-based assessments offer clear benefits within the care process but also come with challenges.

Objective: Relative one-year cancer survival rates in the Baltic states are lower than the European mean; in the Nordic countries they are higher than the mean. This study investigated the likelihood of General Practitioners (GPs) investigating or referring patients with a low but significant risk of cancer in these two regions, and how this was affected by GP demographics. Design: A survey of GPs using clinical vignettes. Setting: General Practice in Denmark, Estonia, Finland, Latvia, Lithuania, Norway, and Sweden. Subjects: General Practitioners. Outcome measuresA regional comparison of GPs' stated immediate diagnostic actions (whether or not they would perform a key diagnostic test and/or refer to a specialist) for patients with a low but significant risk of cancer (between 1.2 and 3.6%). Results: Of the 427 GPs that completed the questionnaire, those in the Baltic states, and GPs that were more experienced, were more likely to arrange a key diagnostic test and/or refer their patient to a specialist than those in Nordic Countries or who were less experienced (p < 0.001 for both measures). Neither GP sex nor practice location within a country showed a significant association with these measures. Conclusion: While relative one-year cancer survival rates are lower in the Baltic states than in four Nordic countries, we found no evidence that this is due to their GPs' reluctance to take immediate diagnostic action, as GPs in the Baltic states were more likely to investigate and/or refer at the first consultation. Research on patient and secondary care factors is needed to explain the survival differences.

AimsTo explore the association between soluble neuropilin-1 (sNRP-1) and depression in patients with newly diagnosed type 2 diabetes (T2D). Materials and MethodsMulticentre, cross-sectional study including adults with serologically confirmed newly diagnosed T2D. Included variables: sex, sNPR-1 (low sNRP-1 was defined as _226 ng/mL), psychometrically assessed depression and anxiety, antidepressants, BMI, haemoglobin A1c, C-peptide and pre-existing cardiovascular disease. Multiple regression analyses were performed with depression and low sNRP-1 as dependent variables. ResultsThe study comprised 837 participants (18-94 years, younger patients _60 years 38%). Depressed patients (n = 119) compared to non-depressed (n = 718) had a higher prevalence of anxiety (64% vs. 14%), antidepressants (36% vs. 14%), low sNRP-1 (45% vs. 22%) (all p _ 0.001); physical inactivity (42% vs. 29%, p = 0.006); smoking (20% vs. 12%, p = 0.018); and higher BMI (p = 0.002). Independently associated with depression (n = 736) were anxiety (adjusted odds ratio (AOR) 11.7, p _ 0.001), low sNRP-1 (AOR 3.3, p _ 0.001), BMI (per kg/m2) (AOR 1.1, p = 0.016) and physical inactivity (AOR 1.8, p = 0.018). In younger patients (n = 288), independently associated with low sNRP-1 were depression (AOR 3.3, p _ 0.001), myocardial infarction (AOR 3.8, p = 0.039) and younger age (per year) (AOR 0.97, p = 0.043). In older patients (n = 521), independently associated with low sNRP-1 were depression (AOR 3.1, p _ 0.001), and younger age (0.97, p = 0.030). ResultsThe study comprised 837 participants (18-94 years, younger patients _60 years 38%). Depressed patients (n = 119) compared to non-depressed (n = 718) had a higher prevalence of anxiety (64% vs. 14%), antidepressants (36% vs. 14%), low sNRP-1 (45% vs. 22%) (all p _ 0.001); physical inactivity (42% vs. 29%, p = 0.006); smoking (20% vs. 12%, p = 0.018); and higher BMI (p = 0.002). Independently associated with depression (n = 736) were anxiety (adjusted odds ratio (AOR) 11.7, p _ 0.001), low sNRP-1 (AOR 3.3, p _ 0.001), BMI (per kg/m2) (AOR 1.1, p = 0.016) and physical inactivity (AOR 1.8, p = 0.018). In younger patients (n = 288), independently associated with low sNRP-1 were depression (AOR 3.3, p _ 0.001), myocardial infarction (AOR 3.8, p = 0.039) and younger age (per year) (AOR 0.97, p = 0.043). In older patients (n = 521), independently associated with low sNRP-1 were depression (AOR 3.1, p _ 0.001), and younger age (0.97, p = 0.030). ConclusionsLow sNRP-1 (_226 ng/mL) was associated with depression in all patients with newly diagnosed T2D. In younger patients (_60 years), depression, pre-existing myocardial infarction and younger age were associated with low sNRP-1. In older patients, only depression and younger age were associated with low sNRP-1.

IMPORTANCE The successful implementation of artificial intelligence (AI) in health care depends on its acceptance by key stakeholders, particularly patients, who are the primary beneficiaries of AI-driven outcomes. OBJECTIVES To survey hospital patients to investigate their trust, concerns, and preferences toward the use of AI in health care and diagnostics and to assess the sociodemographic factors associated with patient attitudes.

DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study developed and implemented an anonymous quantitative survey between February 1 and November 1, 2023, using a nonprobability sample at 74 hospitals in 43 countries. Participants included hospital patients 18 years of age or older who agreed with voluntary participation in the survey presented in 1 of 26 languages. EXPOSURE Information sheets and paper surveys handed out by hospital staff and posted in conspicuous hospital locations.

MAIN OUTCOMES AND MEASURES The primary outcome was participant responses to a 26-item instrument containing a general data section (8 items) and 3 dimensions (trust in AI, AI and diagnosis, preferences and concerns toward AI) with 6 items each. Subgroup analyses used cumulative link mixed and binary mixed-effects models.

RESULTS In total, 13 806 patients participated, including 8951 (64.8%) in the Global North and 4855 (35.2%) in the Global South. Their median (IQR) age was 48(34-62) years, and 6973 (50.5%) were male. The survey results indicated a predominantly favorable general view of AI in health care, with 57.6% of respondents (7775 of 13 502) expressing a positive attitude. However, attitudes exhibited notable variation based on demographic characteristics, health status, and technological literacy. Female respondents (3511 of 6318 [55.6%]) exhibited fewer positive attitudes toward AI use in medicine than male respondents (4057 of 6864 [59.1%]), and participants with poorer health status exhibited fewer positive attitudes toward AI use in medicine (eg, 58 of 199 [29.2%] with rather negative views) than patients with very good health (eg, 134 of 2538 [5.3%] with rather negative views). Conversely, higher levels of AI knowledge and frequent use of technology devices were associated with more positive attitudes. Notably, fewer than half of the participants expressed positive attitudes regarding all items pertaining to trust in AI. The lowest level of trust was observed for the accuracy of AI in providing information regarding treatment responses (5637 of 13 480 respondents [41.8%] trusted AI). Patients preferred explainable AI (8816 of 12 563 [70.2%]) and physician-led decision-making (9222 of 12 652 [72.9%]), even if it meant slightly compromised accuracy.

CONCLUSIONS AND RELEVANCE In this cross-sectional study of patient attitudes toward AI use in health care across 6 continents, findings indicated that tailored AI implementation strategies should take patient demographics, health status, and preferences for explainable AI and physician oversight into account.

Importance: General practitioners (GPs) sometimes initiate a treatment despite not expecting it to improve patients' symptoms by any physiological mechanism. These essentially placebo treatments are ethically controversial, and their frequency is unclear. They involve risks for patients, but to estimate these, more data are needed. Objective To develop a more precise overview of the rate at which GPs prescribe essentially placebo treatments.

Design, Setting, and Participants: This cross-sectional survey study included currently practicing GPs from 20 European countries and Israel who responded to online questionnaires. The online questionnaires were taken between December 12, 2019, and August 4, 2021, and analyzed on April 28, 2022. Respondents were contacted by national representatives, either through personal networks (convenience sampling) or an existing database (volunteer sampling).

Main Outcomes and Measures: The main outcome was the rate of essentially placebo prescriptions, given as the rate per week and the proportion of consultations. Secondary outcomes were the associations between this rate and GP background characteristics (gender, age, education about placebos, years of experience, patients seen, and working hours per week).

Results: A total of 952 practicing GPs responded (453 of 745 [61%] female; mean [SD] age of 48.02 [11.95] years), and 669 answered all questions. Overall, 689 of 818 respondents (84%) indicated they had prescribed an essentially placebo treatment at least once. Overall, the median (IQR) rate of essentially placebo prescriptions was 0.5 (0.1 to 2.0) per week or 0.67% (0.06% to 2.50%) of consultations. The prescription rate was higher in men (beta = 1.94 [95% CI, 0.58 to 3.29]; P = .005), those with more work experience (beta = 0.12 [95% CI, 0.06 to 0.18]; P < .001), and those who work fewer hours per week (beta = -0.08 [95% CI, -0.13 to -0.03]; P = .001).

Conclusions and Relevance: In this survey study of GPs across 21 countries, essentially placebo prescriptions featured in a small minority of consultations, but they nevertheless occurred regularly for most GPs. Rates varied only slightly by GP background characteristics. This suggests that essentially placebo prescriptions were common at a population level, which poses risks for the patient-GP relationship and creates medical risks for patients. Future research should further investigate the decision-making process behind these prescriptions and their effects on patients.

This study reports the results of a university course aimed at exploring and improving cooperation in healthcare with both cancer survivors, loved ones and healthcare professionals as students.

Central to the course was the understanding of and moving between each other's perspectives. Operating within a framework inspired by problem-based learning (PBL), small groups consisting of at least one cancer survivor, one loved one and one healthcare professional, collaboratively created scenarios based on their personal experiences. The students developed, elaborated, and identified problems and potential solutions. The pedagogical framing illustrated an empowering process of defining and elaborating a problem of their combined concerns, using their different knowledge. Although cooperation presented challenges, most students were able to explore and appreciate each other's perspectives when provided with a safe environment. Our experiences highlight the importance of both contextual safety and personal development as key factors in addressing power imbalances in healthcare.