Primary Health Care Patients Research Articles

Avoiding anti-inflammatories: a randomised controlled trial testing the effect of an eHealth information package on primary healthcare patient medication knowledge and behaviour in Aotearoa New Zealand

BackgroundPatient medication knowledge and health literacy affect patient safety. Taking angiotensin-converting enzyme inhibitors (ACE-i) or angiotensin II receptor blockers (ARBs), with diuretics and non-steroidal anti-inflammatory medications (NSAIDs) is nephrotoxic. Patients...

Multidisciplinary models of primary health care for patients with chronic non-communicable diseases

Introduction. Chronic non-communicable diseases (CNCD) requires a variety of strategies from different perspectives and at different levels, including individual and country-specific. Comprehensive patient-oriented and proactive approaches play an important role in the provision of multidisciplinary teams of medical care to patients with established CNCD. The purpose of this study is to present the Moscow experience in managing multidisciplinary teams for the treatment of CND patients, using the example of arterial hypertension in the framework of a pilot project in the outpatient clinics of the Troitsk and Novomoskovsky administrative districts (TiNAO; were attached to the territory of Moscow in 2012). Materials and methods. The study was conducted in two stages: at the first, a literature review was carried out, at the second, the stages of launching a pilot project on the management of multidisciplinary teams for the treatment patients with CNCD, using the example of arterial hypertension in the outpatient clinic of TinAO, were developed and discussed. Results. The research analyzes approaches to the use of multidisciplinary teams in the world. Based on the analyzed current regulatory documents, adjustments were made to the foreign model for its possible adaptation to Moscow polyclinics, focusing on proactive dispensary dynamic monitoring. Research limitations. The results of the conducted research are based on operational data from Moscow and can be applied only to the formation of management decisions in Moscow. Conclusion. According to the results of the pilot project testing, an increase in the level of coverage of the attached population with medical care, accessibility of narrow specialists and provision of equal opportunities for obtaining medical care for Muscovites was noted.

Use of herbal medicinal products among patients in primary health care in a Brazilian southeastern city: evidence from the Prover project.

To determine the prevalence and factors associated with herbal medicinal product use among primary healthcare patients in southeastern Brazil. A cross-sectional study combined with documentary research was conducted between August and November 2017, involving interviews with 1,221 adults following dispensing from primary healthcare units. The characterization of herbal medicinal product usage included assessing the prevalence, redundancy, and interaction indicators, as well as identifying sources of recommendation and acquisition. Descriptive statistics were used for variable analysis and logistic regression was used to estimate the factors associated with herbal medicinal product usage, calculating odds ratios at a significance level of 5%. The prevalence of herbal medicinal product usage was 3.8%, with 60% of them prescribed by physicians. Private pharmacies (53%) were the main sources, and Valeriana officinalis (42%) was the most cited plant species and the sole herbal medicinal product on the municipal list. The indicators of redundancy and interactions between concurrently prescribed pharmaceutical and herbal medicinal products were 42.9% and 28.6%, respectively. Herbal medicinal products usage correlated with the female sex (OR= 2.50; 95%CI= 1.11-5.59), non-white race (OR= 0.52; 95%CI= 0.28-0.94), monthly income above 1 minimum wage (OR= 3.48; 95%CI= 1.51-8.01), and self-reported of anxiety, mood disorder or depression (OR= 2.97; 95%CI= 1.55-5.66). Despite the low use of herbal medicinal products, users face a high potential for interactions and therapeutic redundancy. Special attention should be paid to patients taking herbal medicinal products and allopathic medicines concurrently. Women with anxiety, mood disorders, or depression were more likely to use herbal medicinal products, whereas non-white people were 48% less likely to use them, suggesting potential socioeconomic disparities in access.

Caring for Long Covid patients in primary healthcare: a cross-sectional study on general practitioners’ knowledge, perception and experience in Belgium and Malta

BackgroundAt least 10% of Covid-19 recovered individuals experience persistent symptoms (Long Covid). Primary healthcare and general practitioners (GPs) are at the forefront in their care. In this study, GPs’ knowledge, perceptions and experiences with Long Covid, and the definition used in two countries, are investigated to provide insight into GPs’ care for Long Covid patients at a cross-country level.MethodsA cross-sectional study targeted towards GPs was conducted in Belgium and Malta during spring and early summer 2022. An online survey consisting of 15 questions on Long Covid was disseminated. Additionally, country-specific practice and demographic characteristics were collected. Descriptive and logistic regression analyses were performed.ResultsA total of 150 GPs (Belgium = 105; Malta = 45) responded. Female GPs represented 58.0%, median age was 49 years (IQR: 37–61). Concerning GPs’ knowledge and perception on Long Covid, in both countries, most GPs reported insufficient scientific knowledge and information on Long Covid diagnosis and treatment. Access to educational material was limited and an awareness-rising campaign on Long Covid was deemed necessary. Moreover, two out of three GPs stated that Long Covid patients were not well followed up by primary healthcare in mid-2022. For diagnosing Long Covid, 54.7% required a positive Covid-19 test, more often among Belgian GPs than Maltese (64.3% vs. 45.2%, p = 0.036). To assess Long Covid, GPs mainly applied diagnostic criteria by themselves (47.3%) in combination with persistent symptoms (4 weeks to 5 months). Most GPs had experience with Long Covid patients in their practice, regardless of practice type and GPs’ country, sex or age (p = 0.353; p = 0.241; p = 0.194; p = 0.058). Although most GPs (94.7%) stated that Long Covid patients should follow multidisciplinary approach, 48.3% reported providing care for these patients themselves or with GP colleagues and only 29.8% by multidisciplinary cooperation. ConclusionsGPs frequently provide (multidisciplinary) care to Long Covid patients and GPs’ care showed similarities at cross-country level. Although GPs perceive lack of scientific knowledge and educational material on Long Covid, similar diagnostic criteria among GPs were noted. Uniform evidence-based guidelines, scientific support and training for GP across Europe must be a priority to enhance their treatment approach to Long Covid.

Working with Joanne Elphinston Movement Systems® - physiotherapists’ experiences in primary health care. A focus group study

Background JEMS® (Joanne Elphinston Movement Systems) described as a systematic, holistic approach to analyze and create sound foundations for movement, is increasing in popularity among physiotherapists. The aim of this study was to investigate and capture the experiences and narratives of physiotherapists (PTs) using JEMS® for rehabilitation with patients in primary healthcare. Materials and methods In this qualitative description study, we invited 13 PTs to focus group discussions (FGD). Four groups were conducted, three FGD at different locations in Region Västra Götaland, Sweden, and one FGD using Skype. The groups met on one occasion. The FGD method has a qualitative semi-structured research design based on a social constructivist tradition of research. Data were analyzed using the Kreuger method, considering the content of the discussion in a collective understanding of the subject and the interaction taking place among participants. Results Three themes were identified: how the PTs describe their practical and emotional experiences, and how JEMS® has changed their clinical work. Most clearly emerged subjects considering the interaction and communication with the patient, about finding a structure in clinical practice and about the development the informants experience in their role as a physiotherapist and as an individual. Conclusions The FGD was chosen to capture the variety and width of experiences of the PTs using JEMS®. The opportunity for learning and reflecting in the FGDs was appreciated by the PTs. The interaction between the patient and the PT was described as fundamental in establishing foundations for movement. Opportunities to meet and treat patients regardless of functional limitations elaborated and were in that way applicable in primary healthcare where patients seek a physiotherapist for a variety of reasons.

Evaluating the accuracy and adequacy of ChatGPT in responding to queries of diabetes patients in primary healthcare

Evaluating the accuracy and adequacy of ChatGPT in responding to queries of diabetes patients in primary healthcare

Correlation between self-efficacy and health status of Type 2 Diabetes Mellitus patients in primary health care

The health status of Type 2 Diabetes Mellitus (T2DM) patients is observed to decrease simultaneously along with the length of time. Despite the various treatment management offered in primary care, a decrease in health status is also observed among patients in Indonesia as shown by the low self-care ability. Therefore, this research aimed to analyze the relationship between self-efficacy and the health status of patients in primary care in Indonesia to provide evidence for the development of care management interventions for T2DM patients.The research used a descriptive analytical method with a cross-sectional design, including 327 T2DM patients in primary health care selected through cluster random sampling. Data collection used the Indonesian version of the Diabetes Management Self-Efficacy Scale (DMSES) and Short Form 12 (SF-12) questionnaires which had been tested for validity and reliability. The data obtained were analyzed using the Pearson Product Moment test with a significance value of 0.01.The results obtained an r-value of 0.485 with a p-value of 0.00, showing a significant relationship between self-efficacy and health status in T2DM patients (0.00<0.01; CI 99%).In conclusion, this study highlights a significant correlation between self-efficacy and the health status of individuals diagnosed with T2DM. The findings emphasize the pivotal role of self-efficacy in shaping the health outcomes of patients with T2DM.

Assessment of primary health care accessibility and patients’ perception in Madurai district: a geo-medical study

Assessment of primary health care accessibility and patients’ perception in Madurai district: a geo-medical study

Continuity of care and mortality in patients with type 2 diabetes.

How continuity of general practitioner care (GP-CoC) affects mortality in patients with type 2 diabetes (T2D) is unclear. The aim of this study was to examine the effect of having no continuity of care (CoC) and GP-CoC on mortality in primary health care (PHC) patients with T2D. Cohort study in patients aged 60 years or older with T2D within the public PHC of the city of Vantaa, Finland. Inclusion period was between 2002-2011 and follow-up period between 2011-2018. Six groups were formed (no appointments, one appointment and Modified, Modified Continuity Index [MMCI] quartiles). Mortality was measured with standardized mortality ratio (SMR) and adjusted hazard ratio (aHR). GP-CoC was measured with MMCI. Comorbidity status was determined with Charlson comorbidity index (CCI). In total 11,020 patients were included. Mean follow-up time was 7.3 years. SMRs for the six groups (no appointments, one appointment, MMCI quartiles) were 2.46 (95%CI: 2.24-2.71), 3.55 (3.05-4.14), 1.15 (1.06-1.25), 0.97 (0.89-1.06), 0.92 (0.84-1.01) and 1.21 (1.11-1.31), respectively. With continuous MMCI, mortality formed a u-curve. The inflection point was at a MMCI value of 0.65 with corresponding SMR of 0.86. Age and CCI adjusted HR for death between men and women was 1.45 (1.35-1.58). Patients with no CoC had the highest mortality. In patients having care over time, the effect of GP-CoC on mortality was minor and mortality turned to rise with high GP-CoC.

Feasibility and Determinants of Performance for a Tablet-Based Cognitive Assessment Tool in Rural and Urban Southeast Nigeria.

Cognitive assessment is a key component of clinical evaluations for patients with dementia and Alzheimer's disease in primary health care (PHC) settings. The need for well-validated, culturally appropriate, and easy-to-use assessments is especially urgent in low- and middle-income countries (LMICs) that are experiencing rapid growth in their older adult populations. To examine the feasibility and demographic determinants of performance for a tablet-based cognitive assessment tool (TabCAT) battery, which includes subtests for four cognitive domains, among older PHC patients in southeastNigeria. A cross-sectional mixed-method descriptive study evaluating the useability and performance of TabCAT. We enrolled 207 participants (mean age of 64.7±13.5 years; 52% with only primary, 41% secondary, and 7% tertiary education). Most (91%) who initiated the assessment were able to complete it, requiring 10-15 minutes to complete. More years of education was associated with better test scores across all tests (p < 0.001). Living in a rural location was also associated with better performance (p < 0.05). Male compared to female sex did not associate with performance on any of the tests (all ps > 0.05). Tablet-based cognitive assessment was feasible in rural and urban settings of Nigeria. Better performance on cognitive subtests linked to more education and residing in a rural area; however, sex did not predict performance. Digital cognitive assessment tools hold potential for widespread use in healthcare and educational contexts, particularly in regions with varying levels of urbanization and educational access.

Health-related quality of life in psychiatric outpatients: a cross-sectional study of associations with symptoms, diagnoses, and employment status

BackgroundThis cross-sectional study aimed to explore health-related quality of life (HRQoL) in a large heterogeneous patient sample seeking outpatient treatment at a specialist mental health clinic.MethodA sample of 1947 patients with common mental disorders, including depressive-, anxiety-, personality-, hyperkinetic- and trauma-related disorders, completed the EuroQoL 5-Dimension 5-Level (EQ-5D-5L) to assess HRQoL. We investigated clinical and sociodemographic factors associated with the EQ-5D index and the EQ Visual Analogue Scale (VAS) using regression analyses.ResultsThe sample reported lower HRQoL compared with the general population and primary mental health care patients. Sick leave, disability pension, work assessment allowance, and more symptoms of anxiety and depression were associated with lower EQ-5D index and EQ VAS scores. Furthermore, being male, use of pain medication and having disorders related to trauma were associated with reduced EQ-5D index scores, while hyperkinetic disorders were associated with higher EQ-5D index scores.ConclusionHRQoL of psychiatric outpatients is clearly impaired. This study indicated a significant association between employment status, symptom severity, and HRQoL in treatment-seeking outpatients. The findings highlight the importance of assessing HRQoL as part of routine clinical assessment.

Analysis of Risk Factors for the Quality of Health Services in Primary Health Facilities: An Observational Study in North Bengkulu Regency, Indonesia

Primary health care (PHC) is crucial for overall health system performance, particularly in developing nations. However, variations in the quality of PHC services in Indonesia, particularly in North Bengkulu Regency, raise concerns. This study aimed to identify and analyze risk factors associated with suboptimal quality of health services in these facilities. This observational, cross-sectional study was conducted in 20 primary health centers (PHCs) in North Bengkulu Regency. A multi-stage random sampling technique was used to select 400 patients and 80 healthcare providers. Data were collected using validated questionnaires assessing various dimensions of service quality (tangibles, reliability, responsiveness, assurance, and empathy), patient satisfaction, and potential risk factors (socio-demographic, facility-related, and provider-related). Descriptive statistics, bivariate analysis, and multivariate logistic regression were used for data analysis. The study found a significant association between perceived service quality and patient satisfaction. Socio-demographic factors (lower education and income), facility-related factors (inadequate staffing and lack of essential medicines), and provider-related factors (insufficient communication and perceived lack of empathy) were identified as risk factors for lower service quality. The quality of health services in North Bengkulu PHCs is influenced by a complex interplay of patient, facility, and provider factors. Interventions targeting these risk factors, such as community education, capacity building for providers, and improvements in resource allocation, may improve PHC service quality and patient satisfaction in this region.

Health-related word recognition and pronunciation by patients in Gauteng, South Africa in English and native languages.

Low health literacy has been found to affect people's ability to take care of their own health and follow the principles of disease prevention. Incomprehension of health education and healthcare instructions may lead to poor health outcomes. The aim of the study was to describe and compare a sample of primary healthcare patient's ability to recognise and pronounce health-related words in English and in his or her native language. The study was conducted in 12 primary healthcare (PHC) clinics in Gauteng, South Africa. A prospective, quantitative, comparative research design using a survey method was used to assess the ability to recognise and pronounce health-related words of 401 respondents using the REALM-R (SA) tool. Most respondents were 18-29 years (32%) and 30-49 years (53%) old. More than half (54%) of the respondents have completed grade 12 schooling. Adequate English health-related word recognition and pronunciation levels were at 19.5%, while native health-related word recognition and pronunciation levels were far better, ranging between 55.6% and 97.0%. Respondents showed better word recognition and pronunciation of the health-related words in their native language than in English. Providing health information in the patient's native language and on their level of understanding may therefore improve patient health outcomes.Contribution:The study is the first of its kind to determine word recognition and pronunciation of health-related words in English and a native language of South African PHC patients. Knowing this may assist healthcare professionals to give health education and instructions on the patient's level of understanding.

De-implementation strategy to reduce unnecessary antibiotic prescriptions for ambulatory HIV-infected patients with upper respiratory tract infections in Mozambique: a study protocol of a cluster randomized controlled trial

BackgroundAntibiotics are globally overprescribed for the treatment of upper respiratory tract infections (URTI), especially in persons living with HIV. However, most URTIs are caused by viruses, and antibiotics are not indicated. De-implementation is perceived as an important area of research that can lead to reductions in unnecessary, wasteful, or harmful practices, such as excessive or inappropriate antibiotic use for URTI, through the employment of evidence-based interventions to reduce these practices. Research into strategies that lead to successful de-implementation of unnecessary antibiotic prescriptions within the primary health care setting is limited in Mozambique. In this study, we propose a protocol designed to evaluate the use of a clinical decision support algorithm (CDSA) for promoting the de-implementation of unnecessary antibiotic prescriptions for URTI among ambulatory HIV-infected adult patients in primary healthcare settings.MethodsThis study is a multicenter, two-arm, cluster randomized controlled trial, involving six primary health care facilities in Maputo and Matola municipalities in Mozambique, guided by an innovative implementation science framework, the Dynamic Adaption Process. In total, 380 HIV-infected patients with URTI symptoms will be enrolled, with 190 patients assigned to both the intervention and control arms. For intervention sites, the CDSAs will be posted on either the exam room wall or on the clinician´s exam room desk for ease of reference during clinical visits. Our sample size is powered to detect a reduction in antibiotic use by 15%. We will evaluate the effectiveness and implementation outcomes and examine the effect of multi-level (sites and patients) factors in promoting the de-implementation of unnecessary antibiotic prescriptions. The effectiveness and implementation of our antibiotic de-implementation strategy are the primary outcomes, whereas the clinical endpoints are the secondary outcomes.DiscussionThis research will provide evidence on the effectiveness of the use of the CDSA in promoting the de-implementation of unnecessary antibiotic prescribing in treating acute URTI, among ambulatory HIV-infected patients. Findings will bring evidence for the need to scale up strategies for the de-implementation of unnecessary antibiotic prescription practices in additional healthcare sites within the country.Trial registrationISRCTN, ISRCTN88272350. Registered 16 May 2024, https://www.isrctn.com/ISRCTN88272350

An Assessment of Health Behaviours in Primary Care Patients: A Cross-Sectional Study.

A healthy lifestyle is a key determinant of health, especially for people with chronic diseases such as diabetes or hypertension. The health behaviours which contribute to a healthy lifestyle include the following: regular physical activity, preventive examinations, maintaining a proper diet and avoiding the consumption of alcohol or cigarettes. They have a significant impact on the disease process, controlling symptoms and preventing complications. The aim of this study was to examine the health behaviours related to diet, physical activity and prevention among Polish primary health care patients and to identify predictors of health behaviours. For this reason, the standardized Health Behaviour Scale (HBS) questionnaire was used. The study was conducted among 269 patients (including 61.71% women) in primary health care facilities. The mean age of participants was 52.89 years (±17.76). The mean HBS score was 36.93 ± 9.66. A statistically significant association was found between HBS scores and such sociodemographic variables as education (p = 0.0061, r = 0.17), body mass index (p = 0.0018, r = -0.20, β = -0.36) and self-assessed economic status (p = 0.0094, r = 0.16). Women's health behaviours as measured by HBS were significantly better than men's (p < 0.001, β = -6.82). A special focus should be given to the groups manifesting poorer health behaviours (e.g., men, older people and persons with low socioeconomic status) by offering them tailored health-promoting interventions.

Brief intervention protocol by telephone delivered by nurses to patients with harmful alcohol use in primary health care: A feasibility trial

AimThe aim of this study is to examine the feasibility of a brief intervention protocol by telephone performed by nurses in primary health care facilities. MethodsA nonrandomized single-arm feasibility study was performed. The proposed intervention of this study is the Brief Intervention carried out by the nurse delivered by telephone, synchronously with alcohol users. The brief intervention is a motivational approach based on the FRAMES model, with its components being: Feedback, Responsibility, Advice, Menu of options, Empathy and Self-efficacy. To assess the feasibility of the protocol, we evaluated the procedure for enrolling participants, the acceptability of the protocol to participants, the satisfaction of the participants, convenience and treatment continuity. The quantitative data analysis was carried out in the R software, using descriptive statistics, categorical variables were reported by frequencies and percentages. For continuous variables, medians, means, standard deviations and range values were computed. ResultsWe followed the participants (n = 165) from baseline (T0) until 3 months (T1) and 6 months (T2) after the brief intervention. The partial effect suggests a reduction in alcohol consumption, and statistically significant differences were observed from baseline before the BI, with a decrease of 0.66 points in AUDIT scores at T1. Among the patients who completed the 3-month follow-up, 48 % reported a positive experience of receiving the brief intervention by the nurses, and 44 % reported a decrease in alcohol consumption. ConclusionsBrief intervention delivered by telephone was considered feasible and acceptable by primary health care patients, and they perceived improvement in their alcohol consumption after receiving the BI performed by nurses.

EUFOREUM Berlin 2023: Optimizing care for type 2 inflammatory diseases from clinic to AI: A pediatric focus.

The European Forum for Research and Education in Allergy and Airways diseases (EUFOREA) organized its bi-annual forum EUFOREUM in Berlin in November 2023. The aim of EUFOREUM 2023 was to highlight pediatric action plans for prevention and optimizing care for type 2 inflammatory conditions starting in childhood, with a focus on early-stage diagnosis, ensuring neither under- nor overdiagnosis, optimal care, and suggestions for improvement of care. EUFOREA is an international not-for-profit organization forming an alliance of all stakeholders dedicated to reducing the prevalence and burden of chronic respiratory diseases through the implementation of optimal patient care via educational, research, and advocacy activities. The inclusive and multidisciplinary approach of EUFOREA was reflected in the keynote lectures and faculty of the virtual EUFOREUM 2023 (www.euforea.eu/euforeum) coming from the pediatric, allergology, pulmonology, ENT, dermatology, primary health care fields and patients around the central theme of type 2 inflammation. As most type 2 inflammatory conditions may start in childhood or adolescence, and most children have type 2 inflammation when suffering from a respiratory or skin disease, the moment has come to raise the bar of ambitions of care, including prevention, remission and disease modification at an early stage. The current report provides a comprehensive overview of key statements by the faculty of the EUFOREUM 2023 and the ambitions of EUFOREA allowing all stakeholders in the respiratory field to be updated and ready to join forces in Europe and beyond.

Symptomatic diagnoses in primary care: an observational cohort study.

Among primary health care patients, it is sometimes impossible to assign a definitive diagnosis for the patient's reported or observed symptoms. Therefore, symptomatic diagnoses are often used. The aim of the present study was to examine the proportion of symptomatic diagnoses among primary health care patients. We also explored which symptomatic diagnoses were most frequently recorded as well as their age and gender distribution. This is a register-based study in the public primary health care of the city of Vantaa, Finland. Diagnoses were entered according to the 10th revision of the International Classification of Diseases (ICD-10). The data consisted of every diagnosis entered into the electronic health record between January first 2016 and December 31st 2018. Both absolute numbers and relative proportions of various symptomatic diagnosis recordings (chapter 'R') were reported. Of all the recorded diagnoses (N=503,001), the proportion of R-diagnoses was 13.5% (N=67,905). Diagnoses of symptoms and signs involving the digestive system and abdomen (R10-19) (4.1% of all; n=18,550), the circulatory and respiratory systems (R00-09) (3.9%; n=17,426), general symptoms and signs (R50-69) (3.4%; n=15,165), and the skin and subcutaneous tissue (R20-23) (2.2%; n=9,812) were the most prevalent. Age was also a major factor determining how the symptomatic diagnoses were distributed between women and men. Overall, the symptomatic diagnoses were more common among women than men (14.1% and 12.4%, respectively). The major symptomatic diagnosis categories, including symptoms and signs involving the digestive system and abdomen, the skin and the subcutaneous tissue, and general symptoms and signs, were more predominant among women, while symptoms and signs involving the circulatory and respiratory systems were more common among men. A symptomatic diagnosis code was recorded in about one eighth of the GP appointments, although there were significant sex differences in the prevalence within and between diagnosis groups.

The estimated 10-year risk of first-onset cardiovascular disease in Swedish-born and non-Swedish-born primary healthcare patients

BackgroundSCORE2 has been introduced as an updated risk assessment tool for calculating the 10-year risk of first-onset cardiovascular disease (CVD). However, it does not account for ethnicity or socioeconomic status, known to affect CVD risk. This study investigated and compared SCORE2 estimates in Swedish-born and non-Swedish-born primary healthcare patients. The second aim was to examine if several risk factors could explain differences in CVD risk between the groups.MethodsThis was an observational, cross-sectional study. Data were obtained from the 4D Diabetes Project study, providing a total of 444 participants aged between 40 and 69 years. All participants had complete risk variable data necessary for the SCORE2 tool and no history of previous CVD. Descriptive analysis was conducted to compare distributions of risk factors between Swedes and immigrants and odds ratios of risk factors amongst these two groups in correlation to elevated CVD risk were calculated using logistic regression.ResultsSwedish-born patients showed a significantly higher risk of elevated CVD risk estimates (≥ 2.5% CVD risk increase for individuals < 50 years, respectively, ≥ 5% for individuals aged 51–69) than the non-Swedish-born population, even after adjustment for educational level (OR = 1.61, 95% CI 1.08–2.39). Weekly alcohol consumption implicated a risk of being classified as high risk of CVD risk, regardless of country of birth (OR = 1.93 CI 1.25-3.00). However, Swedes accounted for most of the alcohol consumption (62.6% vs. 19.6%). No other explanatory variable showed significance in association with elevated CVD risk.ConclusionsSwedish-born patients were found to be at higher risk of an increased 10-year CVD risk. The association of alcohol consumption with elevated CVD risk needs to be further studied in longitudinal studies in representative populations, notably among Sweden’s diverse ethnic groups.

Primary Healthcare Case Management Nurses and Assistance Provided to Chronic Patients: A Narrative Review.

Population aging is causing increases in the numbers of chronic diseases, with the consequent need for changes in health systems to better assist patients with chronic conditions. A narrative review was conducted in this study with the objective of analysing the scientific evidence on the care and assistance provided by Case Management Nurses (CMNs) to chronic patients in primary healthcare. A total of 15 articles published in English, Spanish, and Portuguese were selected in the following databases: PubMed, Embase, Cochrane Library, Scopus, Dialnet, Cinahl, and Web of Science. In total, 46.6% of the studies showed the assistance provided by CMNs for chronic pathologies. Most of the articles selected (80%) considered that the assistance offered by case management nurses in relation to chronic diseases is effective, enabling cost reductions, which supposes benefits at the economic and political levels. It was concluded that CMNs have proven to be efficient in caring for people with chronic diseases, improving the quality of life of these people and their caregivers; therefore, they have a fundamental role in the PHC.