Evolution of sexually transmitted infections cases in the city of Barcelona (2007-2024): profiles by reporting centre

ObjectivePrimary care is the base in many health care systems, and to identify the most registered diagnoses in primary care is a way to identify the overall health care use and needs in society. We estimated the rates of the 30 most common diagnoses in primary health care and their male to female ratio.Research design and methodsThis was a study including inhabitants 18 years and older out of all 2.3 million inhabitants living in Region Stockholm, Sweden. Data on all healthcare appointments from primary care during 2019–2021 were extracted from the Stockholm County Council data warehouse known as VAL. Primary care data were analyzed by underlying population and age. In 2019, only physical visits were available, but during 2021 digital visits were included. For the specific diagnoses, physical and digital visits were merged.ResultsThe five most common diagnoses in primary care were: essential hypertension (I10), myalgia (M79), type 2 diabetes (E11), dorsalgia (M54), and pain in joint (M25). The female-to-male ratios were higher for 27 of the 30 most common diagnoses, for example stress reaction (F43), malaise and fatigue (R53), and headache (R51). Chronic ischaemic heart disease (I25), Type 2 diabetes (E11), and Atrial fibrillation (I48) were more common in men.ConclusionsMost of the common diagnoses in primary care are more often registered in women than in men. The higher presence of diagnoses of pain and mental illness seems to mirror the higher sick leave among women in recent years.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12875-025-02938-3.

The most commonly reported diagnoses in primary care are useful to identify and meet health care needs in society. We estimated the rates of the most common diagnoses in primary health care in total and also by gender. This was a cross-sectional study including all 2.0 million inhabitants living in Stockholm County, Sweden, on 1 January 2009. Data on all health care appointments made in primary care in 2011 and during 2009-11 were extracted from the Stockholm County Council data warehouse VAL (Vårdanalysdatabasen; Stockholm regional health care data warehouse). Primary care data were analysed by underlying population and age. Appropriate specialist open care and inpatient data were used for comparison. The five most common diagnoses in primary care (in 2011) were acute upper respiratory tract infections (6.0% of the population), essential hypertension (5.6%), coughing (2.6%), dorsalgia (2.6%) and acute tonsillitis (2.4%). Female-to-male ratios were higher for 27 of the 30 most common diagnoses, the exceptions being type 2 diabetes, unspecified types of diabetes and multiple wounds. The 30 most common diagnoses in primary care reflect the complexity of disorders cared for in the first line of health care. Knowledge of these patterns is important when aiming at using primary health care resources in a proper way.

To assess the suitability of referral from primary to secondary care in pediatric Otolaryngology. The study was performed in the city of Belo Horizonte, in the state of Minas Gerais, from March 2004 to May 2005. A total of 408 pre-school children referred from primary care to secondary care in the department of Otolaryngology presenting with otitis, tonsillitis, sinusitis, allergic rhinitis, and tonsillar/adenoidal hypertrophy was assessed. The studied variables were: agreement between diagnoses in primary and secondary care; waiting time for doctor's appointment; follow-up, and professional (pediatrician or family physician) that examined children in primary care. Agreement of diagnoses was assessed using kappa statistics. Patients were five years old on average, 214 (52.5%) were boys, mean waiting time for appointment was 3.7 months. Diagnoses in primary and secondary care were respectively: otitis (44%, 49%), tonsillar/adenoidal hypertrophy (22%, 33%), tonsillitis (18%, 23%), sinusitis (13%, 21%), allergic rhinitis (3%, 33%). Agreement analysis of kappa was 0.15 for otitis with effusion, 0.35 for recurrent otitis, 0.04 for tonsillar/adenoidal hypertrophy, 0.43 for tonsillitis, 0.05 for allergic rhinitis, and 0.2 for sinusitis. Diagnoses in primary care referred to secondary care were in agreement when given either by pediatrician or family physician. Unsuitability of referrals from primary to secondary care in otolaryngology was expressed by the long time waiting for appointments and by the low agreement between diagnoses in different level of care for the same patients. Primary health care could be more efficient if professionals were better qualified in Otolaryngology.

The current demand for autism diagnostic services exceeds the ability of the workforce to assess and diagnose children in a timely manner. One solution may be to equip primary care providers (PCPs) with the tools and expertise needed to diagnose autism within their practice. PCPs are often trusted professionals who have many touchpoints with children during early development, in which they can identify early signs of autism. Recent initiatives have focused on bolstering PCPs' diagnostic capabilities; however, no studies have examined how the rates of autism diagnosis in primary care have changed over time. We aimed to evaluate whether autism diagnosis in primary care has changed over time and how diagnosis in primary care relates to a child's age at the time of diagnosis. We found that the likelihood of a child being diagnosed by a PCP decreased by about 2% with every passing year from 2004 to 2019 when accounting for demographic characteristics. In our sample, PCPs diagnosed children approximately 1 year earlier than non-PCPs (e.g., psychologists and psychiatrists). Further research is needed to understand why the proportion of children diagnosed by PCPs decreases over time. However, this decrease suggests more work is needed to get capacity-building initiatives into community primary care practice. Though we must continue to find effective ways to build community PCPs' ability to diagnose autism, the present findings support the crucial role PCPs can play in early autism diagnosis.

Objectives: This study examined whether using electronic reminders leads to an increase in the rate of diagnosis recordings in the electronic health record system following visits to a general practitioner. The impact of electronic reminders was studied in the primary health care of a Finnish city. Methods: This observational quasi-experimental study based on a before-and-after design was carried out by installing an electronic reminder to improve the recording of diagnoses in the computerized electronic health record system. The quantity of the recorded diagnoses was observed before and after the intervention. The effect of this intervention on the distribution of different diagnoses was also studied. Results: Before intervention, 33%–46% of visits (to general practitioners/month) had recorded diagnose in the primary health care units. After 4 years, the recording rate had risen to 87%–95% (p < 0.001). The rate of change in the recording of diagnoses was highest during the first year of intervention and plateaued about 3.5 years after application reminders. In the present study, most of the visits concerned mild respiratory infections, elevated blood pressure, low back pain and type 2 diabetes. Conclusion: An electronic reminder is likely to improve the recording of diagnoses during the visits to general practitioners. The distribution of diagnoses was in line with former reports concerning diagnoses in Finnish primary care.

ObjectivesCancer can be diagnosed in the absence of tumour-related symptoms, but little is known about the frequency and circumstances preceding such diagnoses which occur outside participation in screening programmes. We...

SAT0478 Early inflammatory arthritis detection using a self-administered tool versus general practitioner diagnosis in primary care

Despite the existence of evidence-based guidelines supporting the identification of heart failure (HF) in primary care, the proportion of patients diagnosed in this setting remains low. Understanding variation in patients' routes to diagnosis will better inform HF management. To identify the factors associated with variation in patients' routes to HF diagnosis in primary care. A retrospective cohort study of 13 897 patients diagnosed with HF between 1 January 2010 and 31 March 2013 in English primary care. This study used primary care electronic health records to identify routes to HF diagnosis, defined using the National Institute for Health and Care Excellence (NICE) guidelines, and adherence to the NICE-recommended guidelines. Multilevel logistic regression was used to investigate factors associated with the recommended route to HF diagnosis, and funnel plots were used to visualise variation between practices. Few patients (7%, n = 976) followed the recommended route to HF diagnosis. Adherence to guidelines was significantly associated with younger age (P = 0.001), lower deprivation level (P = 0.007), HF diagnosis source (P<0.001), not having chronic pulmonary disease (P<0.001), receiving further consultation for symptom(s) suggestive of HF (P<0.001), and presenting with breathlessness (P<0.001). Route to diagnosis also varied significantly between GP practices (P<0.001). The significant association of certain patient characteristics with route to HF diagnosis and the variation between GP practices raises concerns about equitable HF management. Further studies should investigate reasons for this variation to improve the diagnosis of HF in primary care. However, these must consider the complexities of a patient group often affected by frailty and multiple comorbidities.

Because of the difficulties inherent in diagnosis in primary care, it is inevitable that diagnostic errors will occur. However, despite the important consequences associated with diagnostic errors and their estimated high prevalence, teaching and research on diagnostic error is a neglected area. To ascertain the key learning points from GPs' experiences of diagnostic errors and approaches to clinical decision making associated with these. Secondary analysis of 36 qualitative interviews with GPs in Oxfordshire, UK. Two datasets of semi-structured interviews were combined. Questions focused on GPs' experiences of diagnosis and diagnostic errors (or near misses) in routine primary care and out of hours. Interviews were audiorecorded, transcribed verbatim, and analysed thematically. Learning points include GPs' reliance on 'pattern recognition' and the failure of this strategy to identify atypical presentations; the importance of considering all potentially serious conditions using a 'restricted rule out' approach; and identifying and acting on a sense of unease. Strategies to help manage uncertainty in primary care were also discussed. Learning from previous examples of diagnostic errors is essential if these events are to be reduced in the future and this should be incorporated into GP training. At a practice level, learning points from experiences of diagnostic errors should be discussed more frequently; and more should be done to integrate these lessons nationally to understand and characterise diagnostic errors.

Evidence for the use of B-type natriuretic peptides for screening asymptomatic populations and for diagnosis in primary care

BackgroundDelayed diagnosis in primary care is a common, harmful and costly patient safety incident. Its measurement and monitoring are underdeveloped and underutilised. We created and implemented a novel approach to identify problems leading to and solutions for delayed diagnosis in primary care.MethodsWe developed a novel priority-setting method for patient safety problems and solutions called PRIORITIZE. We invited more than 500 NW London clinicians via an open-ended questionnaire to identify three main problems and solutions relating to delayed diagnosis in primary care. 113 clinicians submitted their suggestions which were thematically grouped and synthesized into a composite list of 33 distinct problems and 27 solutions. A random group of 75 clinicians from the initial cohort scored these and an overall ranking was derived. The agreement between the clinicians’ scores was presented using the Average Expert Agreement.ResultsThe top ranked problems were poor communication between secondary and primary care and the inverse care law, i.e. a mismatch between patients’ medical needs and healthcare supply. The highest ranked solutions included: a more rigorous system of communicating abnormal results of investigations to patients, direct hotlines to specialists for GPs to discuss patient problems and better training of primary care clinicians in relevant areas. A priority highlighted throughout the findings is a need to improve communication between clinicians as well as with patients. The highest ranked suggestions had the highest consensus between experts.ConclusionsThe novel method we have developed is highly feasible, informative and scalable, and merits wider exploration with a view of becoming part of a routine pro-active and preventative system for patient safety assessment. Clinicians proposed a range of concrete suggestions with an emphasis on improving communication among clinicians and with patients and better GP training. In their view, delayed diagnosis can be largely prevented with interventions requiring relatively minor investment. Rankings of identified problems and solutions can serve as an aid to policy makers and commissioners of care in prioritization of scarce healthcare resources.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-016-0530-z) contains supplementary material, which is available to authorized users.

An estimated 50–70% of symptomatic patients with Alzheimer’s Disease and Related Dementias (ADRD) go unrecognized or are misdiagnosed in primary care, delaying access to supportive services, financial and residential planning, clinical trials, and potentially disease-modifying therapies. One key barrier to timely diagnosis is low educational attainment (e.g., not finishing high school), which is associated with both increased ADRD risk and higher rates of comorbidities. Blood-based biomarkers (BBMs) offer a promising, less invasive, and cost-effective tool to improve diagnosis in primary care. However, individuals with low educational attainment are underrepresented in BBM validation studies, raising concerns about their applicability to diverse populations. ADDPCP, an NIA-funded study, evaluates the accuracy and impact of ADRD diagnosis in primary care across California using clinical tools and BBMs. This presentation reviews the development and validation of educational materials to support BBM decision-making for low-literacy populations. Informed by prior PET amyloid disclosure protocols, we co-developed multi-modal pre-and post-test counseling materials using evidence-based health communication strategies and the Lexile Framework for Reading. These materials—narrated presentations and take-home brochures with pictorial aids—explain the purpose of BBM testing, the risks and benefits of learning results, and the limitations of the information provided. We are in the process of assessing their clarity and relevance through cognitive interviews with 12 matched participants naïve to the study.

About one in every three US adults is estimated to have insomnia disorder. Consequences of untreated insomnia disorder are debilitating and costly, and primary care providers (PCPs) are uniquely positioned to detect and treat insomnia, thus preventing its adverse outcomes. The goal of this study was to explore the utility of analyzing electronic medical record data to identify patterns in diagnosis and management of insomnia disorder by PCPs. This was a cross-sectional descriptive study. Numbers of medical records containing at least one insomnia disorder diagnosis code, one insomnia-related medication, or both were tabulated. Prevalence and odds ratios (ORs) were determined. Insomnia disorder diagnoses were present in 9.4% of the records; 7.4% contained insomnia-related medication(s), and only 3.9% contained both. Diagnoses and medications were higher among women than men (ORs up to 2.87, depending on age range) and in general and increased with age. The prevalence of insomnia disorder diagnoses in primary care medical records falls below expectation for the population of interest, and less than half of patients with an insomnia disorder diagnosis are prescribed an insomnia-related medication. Electronic medical records provide an efficient window into insomnia disorder diagnosis and management patterns in the primary care setting. Primary care providers may be missing opportunities to detect and treat insomnia disorder as a way of improving overall patient outcomes. Electronic medical record systems may require modification to facilitate more accurate data extraction.

Backgrounddatabases of electronic health records are powerful tools for dementia research, but data can be influenced by incomplete recording. We examined whether people with dementia recorded in a specialist database (from a mental health and dementia care service) differ from those recorded in primary care.Methodsa retrospective cohort study of the population covered by Lambeth DataNet (primary care electronic records) between 2007 and 2019. Documentation of dementia diagnosis in primary care coded data and linked records in a specialist database (Clinical Records Interactive Search) were compared.Results3,859 people had dementia documented in primary care codes and 4,266 in the specialist database, with 2,886/5,239 (55%) documented in both sources. Overall, 55% were labelled as having Alzheimer’s dementia and 29% were prescribed dementia medication, but these proportions were significantly higher in those documented in both sources. The cohort identified from the specialist database were less likely to live in a care home (prevalence ratio 0.73, 95% confidence interval 0.63–0.85), have multimorbidity (0.87, 0.77–0.98) or consult frequently (0.91, 0.88–0.95) than those identified through primary care codes, although mortality did not differ (0.98, 0.91–1.06).Discussionthere is under-recording of dementia diagnoses in both primary care and specialist databases. This has implications for clinical care and for generalizability of research. Our results suggest that using a mental health database may under-represent those patients who have more frailty, reflecting differential referral to mental health services, and demonstrating how the patient pathways are an important consideration when undertaking database studies.

Primary care is in a unique position to teach the broad spectrum of differential diagnoses. We developed and piloted a new elective seminar ‘Differential Diagnosis in Primary Care’. With the help of simulation patients, training models, interactive small group work, and short lectures we addressed common complaints presented in the daily routine of primary care like vertigo, dyspnoea, chest or abdominal pain. We put a special focus on the diagnostic accuracy of history and physical examination. The final examination was conducted as an objective structured clinical examination.