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  • 1.
    Esgard, Veronica Frey
    et al.
    Medpro Clin Noltorp, Sweden; Reg Vastra Gotaland, Sweden.
    Lindman, Ida
    Reg Vastra Gotaland, Sweden; Univ Gothenburg, Sweden.
    Braend, Anja Maria
    Univ Oslo, Norway; Univ Oslo, Norway.
    Fossum, Guro Haugen
    Univ Oslo, Norway; Univ Oslo, Norway.
    Lundberg, Thorbjoern
    Umea Univ, Sweden.
    Moberg, Anna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kärna. Sweden Hlth Ctr Verkstaden, Sweden.
    Nordeman, Lena
    Reg Vastra Gotaland, Sweden; Univ Gothenburg, Sweden.
    Papachristodoulou, Chrysoula
    Hlth Ctr Verkstaden, Sweden.
    Sundvall, Paer-Daniel
    Reg Vastra Gotaland, Sweden; Univ Gothenburg, Sweden; Univ Gothenburg, Sweden.
    Diagnostic methods and written advice for acute otitis media in primary health care2024In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724Article in journal (Refereed)
    Abstract [en]

    Background: Otomicroscopy and pneumatic methods are superior to otoscopy alone in diagnosing acute otitis media (AOM). There is a lack of knowledge regarding the use of different diagnostic methods for AOM in primary health care in Sweden and Norway. Methods: This cross-sectional study included a questionnaire completed by general practitioners (GPs) and specialist trainees (STs/residents/registrars) working in primary care in Sweden and Norway. Multivariable binary logistic regressions were performed to evaluate the use of diagnostic methods and written advice adjusted for educational level, sex and country. Results: Otoscopy was the most frequently used method. Sweden had greater access to the more accurate diagnostic methods. In Norway, the following methods were used to a lesser extent: pneumatic otoscopy, adjusted OR 0.15 (95% CI 0.10-0.23; p < .001), otomicroscopy, adjusted OR 0.013 (95% CI 0.070-0.027; p < .001), pneumatic otomicroscopy, adjusted OR 0.028 (95% CI 0.010-0.078; p < .001) and tympanometry, adjusted OR 0.31 (95% CI 0.21-0.45; p < .001). Written advice was used to a greater extent in Norway, adjusted OR 4.5 (95% CI 3.1-6.7; p < .001). The STs used pneumatic otoscopy and pneumatic otomicroscopy to a lesser extent, adjusted OR 0.65 (95% CI 0.45-0.93; p = .019) and 0.63 (95% CI 0.43-0.92; p = .016). Conclusions: Swedish physicians both used and had greater access to the significantly better diagnostic methods compared with Norwegian physicians while the opposite applied to the use of written information. The GPs used pneumatic otoscopy and pneumatic otomicroscopy to a greater extent than STs. Compared with 2012, the Swedish physicians now more frequently used pneumatic otoscopy.

  • 2.
    Arntsberg, Louise
    et al.
    Halsan 2 Primary Hlth Care Ctr, Sweden.
    Fernberg, Sara
    Aby Primary Hlth Care Ctr, Sweden.
    Berger, Ann-Sofie
    Halsan 2 Primary Hlth Care Ctr, Sweden.
    Hedin, Katarina
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Futurum, Sweden; Lund Univ, Sweden.
    Moberg, Anna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kärna.
    Management and documentation of pneumonia - a comparison of patients consulting primary care and emergency care2024In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724Article in journal (Refereed)
    Abstract [en]

    Patients may attend either primary or emergency care without referral in Sweden. Guidelines recommend a severity assessment, including assessment of vital signs, to be performed for all patients presenting with suspected pneumonia. Objective To compare management and documentation of vital signs, symptoms and infection severity in pneumonia patients seeking primary care and emergency care without referral. Design Medical record review of vital signs, examination findings and severity of pneumonia. Setting Primary and emergency care. Subjects Two hundred and forty patients diagnosed with pneumonia. Main outcome measures Vital signs, examination findings and severity of pneumonia. Assessments of pneumonia severity according to the reviewers, the traffic light score and CRB-65. Results Respiratory rate, blood pressure, heart rate and oxygen saturation were less often documented in primary care (p < .001). Chest X-ray was performed in 5% of primary care patients vs. 88% of emergency care patients (p < .01). Primary care patients had longer symptom duration, higher oxygen saturation and lower respiratory rate. In total, the reviewers assessed 63% of all pneumonias as mild and 9% as severe. The traffic light scoring model identified 11 patients (9%) in primary care and 53 patients (44%) in emergency care at high risk of severe infection. Conclusions Vital signs were documented less often in primary care than in emergency care. Patients in primary care appear to have a less severe pneumonia, indicating attendance to the correct care level. The traffic light scoring model identified more patients at risk of severe infection than CRB-65, where the parameters were documented to a limited extent.

  • 3.
    Carlsson, Sara
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Medicine Center, Department of Infectious Diseases.
    Hedin, Katarina
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Futurum The Acad Hlth & Care, Sweden; Lund Univ, Sweden.
    Cronberg, Olof
    Lund Univ, Sweden; Vaxjohalsan Primary Healthcare Ctr, Sweden; Reg Kronoberg, Sweden.
    Moberg, Anna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kärna.
    Antibiotic Treatment for Lower Respiratory Tract Infections in Primary Care: A Register-Based Study Examining the Role of Radiographic Imaging2023In: Antibiotics, E-ISSN 2079-6382, Vol. 12, no 7, article id 1165Article in journal (Refereed)
    Abstract [en]

    When imaging (i.e., chest-x-ray or computed tomography) is used to differentiate between acute bronchitis and pneumonia, many patients are being prescribed antibiotics despite the absence of radiographic pneumonia signs. This study of lower respiratory tract infections (LRTIs) with negative chest imaging compares cases where antibiotics were prescribed and not prescribed to find characteristics that could explain the prescription. Data were extracted from the regional electronic medical record system in Kronoberg County, Sweden, for patients aged 18-79 years diagnosed with acute bronchitis or pneumonia and who had any chest radiologic imaging between 2007-2014. Of 696 cases without evidence of pneumonia on imaging, 55% were prescribed antibiotics. Age, sex, and co-morbidity did not differ between those with or without antibiotics. The median level of C-reactive protein was low in both groups but differed significantly (21 vs. 10 mg/L; p < 0.001). Resident physicians prescribed antibiotics more frequently than interns or specialists (p < 0.001). It is unclear what features prompted the antibiotic prescribing in those with negative imaging indicating overuse of antibiotics for LRTIs.

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  • 4.
    Hedin, Katarina
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Lund Univ, Sweden; Futurum, Region Jönköping County, Sweden.
    van der Velden, Alike W.
    Univ Med Ctr Utrecht, Netherlands.
    Hansen, Malene Plejdrup
    Aalborg Univ, Denmark.
    Moberg, Anna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kärna.
    Balan, Anca
    Balan Medfarm SRL, Romania.
    Bruno, Pascale
    Univ Cote Azur, France.
    Coenen, Samuel
    Univ Antwerp, Belgium.
    Johansen, Eskild
    Aalborg Univ, Denmark.
    Kowalczyk, Anna
    Med Univ Lodz, Poland.
    Kurotschka, Peter Konstantin
    Univ Hosp Wurzburg, Germany.
    van der Linde, Sanne R.
    Univ Med Ctr Utrecht, Netherlands.
    Malania, Lile
    Natl Ctr Dis Control & Publ Hlth, Georgia.
    Rohde, Jorn
    Univ Hosp Wurzburg, Germany.
    Verbakel, Jan
    Katholieke Univ Leuven, Belgium; Univ Oxford, England.
    Vornhagen, Heike
    Natl Univ Galway, Ireland.
    Vellinga, Akke
    Univ Coll Dublin, Ireland.
    Initial symptoms and three months follow-up after acute COVID-19 in outpatients: An international prospective cohort study2023In: European Journal of General Practice, ISSN 1381-4788, E-ISSN 1751-1402, Vol. 29, no 3, article id 2154074Article in journal (Refereed)
    Abstract [en]

    Background: Most studies on long-term follow-up of patients with COVID-19 focused on hospitalised patients. No prospective study with structured follow-up has been performed in non-hospitalised patients with COVID-19. Objectives: To assess long-COVID and post-COVID (WHO definition: symptomatic at least 12 weeks), describe lingering symptoms, their impact on daily activities, and general practice visits and explore risk factors for symptom duration in outpatients. Methods: A prospective study of adult outpatients with confirmed SARS-CoV-2 infection and symptoms consistent with COVID-19 in 11 European countries, recruited during 2020 and 2021 from primary care and the community. Structured follow-up by phone interviews (symptom rating, symptom impact on daily activities and general practice visits) was performed at weeks 2, 4, 8, and 12 by study personnel. Data was analysed descriptively by using correlation matrixes and Cox regression. Results: Of 270 enrolled patients, 52% developed long-COVID and 32% post-COVID-syndrome. When only considering the presence of moderate or (very) severe symptoms at weeks 8 and 12, these percentages were 28% and 18%, respectively. Fatigue was the most often reported symptom during follow-up. The impact of lingering symptoms was most evident in sports and household activities. About half (53%) had at least one general practice contact during follow-up. Obese patients took twice as long to return to usual health (HR: 0.5, 95%CI: 0.3-0.8); no other risk profile could predict lingering symptoms. Conclusion: Long-COVID and post-COVID are also common in outpatients. In 32%, it takes more than 12 weeks to return to usual health.

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  • 5.
    Holmbom, Martin
    et al.
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Urology in Östergötland. Region Östergötland, Medicine Center, Department of Infectious Diseases.
    Andersson, Maria
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Medicine Center, Department of Infectious Diseases.
    Berg, Sören
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart Center, Department of Thoracic and Vascular Surgery.
    Eklund, Dan
    Linköping University, Department of Biomedical and Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Medicine Center, Department of Infectious Diseases.
    Sobczynski, Pernilla
    Linköping University, Department of Biomedical and Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Medicine Center, Department of Infectious Diseases.
    Wilhelms, Daniel
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Clinical Chemistry and Pharmacology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Emergency Medicine in Linköping.
    Moberg, Anna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kärna.
    Fredrikson, Mats
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection. Linköping University, Faculty of Medicine and Health Sciences, Forum Östergötland.
    Balkhed Östholm, Åse
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Medicine Center, Department of Infectious Diseases.
    Hanberger, Håkan
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Medicine Center, Department of Infectious Diseases.
    Prehospital delay is an important risk factor for mortality in community-acquired bloodstream infection (CA-BSI): a matched case–control study2021In: BMJ Open, E-ISSN 2044-6055, Vol. 11, no 11, article id e052582Article in journal (Refereed)
    Abstract [en]

    Objectives The aim of this study was to identify prehospital and early hospital risk factors associated with 30-day mortality in patients with blood culture-confirmed community-acquired bloodstream infection (CA-BSI) in Sweden.

    Methods A retrospective case–control study of 1624 patients with CA-BSI (2015–2016), 195 non-survivors satisfying the inclusion criteria were matched 1:1 with 195 survivors for age, gender and microorganism. All forms of contact with a healthcare provider for symptoms of infection within 7 days prior CA-BSI episode were registered. Logistic regression was used to analyse risk factors for 30-day all-cause mortality.

    Results Of the 390 patients, 61% (115 non-survivors and 121 survivors) sought prehospital contact. The median time from first prehospital contact till hospital admission was 13 hours (6–52) for non-survivors and 7 hours (3–24) for survivors (p<0.01). Several risk factors for 30-day all-cause mortality were identified: prehospital delay OR=1.26 (95% CI: 1.07 to 1.47), p<0.01; severity of illness (Sequential Organ Failure Assessment score) OR=1.60 (95% CI: 1.40 to 1.83), p<0.01; comorbidity score (updated Charlson Index) OR=1.13 (95% CI: 1.05 to 1.22), p<0.01 and inadequate empirical antimicrobial therapy OR=3.92 (95% CI: 1.64 to 9.33), p<0.01. In a multivariable model, prehospital delay >24 hours from first contact remained an important risk factor for 30-day all-cause mortality due to CA-BSI OR=6.17 (95% CI: 2.19 to 17.38), p<0.01.

    Conclusion Prehospital delay and inappropriate empirical antibiotic therapy were found to be important risk factors for 30-day all-cause mortality associated with CA-BSI. Increased awareness and earlier detection of BSI in prehospital and early hospital care is critical for rapid initiation of adequate management and antibiotic treatment.All data relevant to the study are included in the article or uploaded as supplemental information.

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  • 6.
    Moberg, Anna
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kärna, Linköping.
    Cronberg, Olof
    Växjöhälsan Primary Healthcare Center and Department of Research and Development, Region Kronoberg, Växjö, Sweden; Department of Clinical Sciences in Malmö, Family Medicine, Lund University, Malmö, Sweden .
    Falk, Magnus
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kärna, Linköping.
    Hedin, Katarina
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Department of Clinical Sciences Malmö, Family Medicine, Lund University, Malmö, Sweden; GP, Futurum, Region Jönköping County .
    Change in the use of diagnostic tests in the management of lower respiratory tract infections: a register-based study in primary care2020In: BJGP Open, ISSN 2398-3795, Vol. 4, no 1Article in journal (Refereed)
    Abstract [en]

    Background Differentiating between pneumonia and acute bronchitis is often difficult in primary care. There is no consensus regarding clinical decision rules for pneumonia, and guidelines differ between countries. Use of diagnostic tests and change of management over time is not known.

    Aim To calculate the proportion of diagnostic tests in the management of lower respiratory tract infections (LRTIs) in a low antibiotic prescribing country, and to evaluate if the use and prescription pattern has changed over time.

    Design & setting A register-based study on data from electronic health records from January 2006 to December 2014 in the Kronoberg county of south east Sweden.

    Method Data regarding use of C-reactive protein (CRP), chest x-rays (CXRs), microbiological tests, and antibiotic prescriptions were assessed for patients aged 18–79 years, with the diagnosis pneumonia, acute bronchitis, or cough.

    Results A total of 54 229 sickness episodes were analysed. Use of CRP increased during the study period from 61.3% to 77.5% for patients with pneumonia (P<0.001), and from 53.4% to 65.7% for patients with acute bronchitis (P<0.001). Use of CXR increased for patients with acute bronchitis from 3.1% to 5.1% (P<0.001). Use of microbiological tests increased for patients with pneumonia, from 1.8% to 5.1% (P<0.001). The antibiotic prescription rate decreased from 18.6 to 8.2 per 1000 inhabitants per year for patients with acute bronchitis, but did not change for patients with pneumonia.

    Conclusion Use of CRP and microbiological tests in the diagnostics of LRTIs increased despite the fact that the incidence of pneumonia and acute bronchitis was stable.

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  • 7.
    Moberg, Anna
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kärna.
    Ravell Jensen, Anna
    Linköping University, Department of Health, Medicine and Caring Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kungsgatan.
    Paues, Jakob
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Medicine Center, Department of Infectious Diseases.
    Falk, Magnus
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kärna.
    C-reactive protein influences the doctors degree of suspicion of pneumonia in primary care: a prospective observational study2020In: European Journal of General Practice, ISSN 1381-4788, E-ISSN 1751-1402, Vol. 26, no 1, p. 210-216Article in journal (Refereed)
    Abstract [en]

    Background In primary care, the diagnosis of pneumonia is often based on history and clinical examination alone. However, a previous study showed that the general practitioners degree of suspicion correlates well with findings on chest X-ray, when the C-reactive protein (CRP) value is known. Objectives The present study aimed to investigate to what extent the physicians degree of suspicion is affected by the CRP level when community-acquired pneumonia is suspected in primary care. Methods A prospective observational study was conducted at five primary health care centres in Sweden between October 2015 and December 2017. Adult patients (n = 266) consulting their health care centre with symptoms of lower respiratory tract infection, where the physician suspected pneumonia, were included consecutively. Anamnestic information and findings from clinical examination were documented in a case report form. All patients were tested for CRP. The physicians rated their degree of suspicion as unsure, quite sure, and sure before and after the CRP result. Results The degree of suspicion of pneumonia changed in 69% of the cases; most often to a lower degree (40%). In 28% of the cases, there was no longer any suspicion of pneumonia after CRP. Conclusion Our results indicate that CRP testing highly influences the physicians degree of suspicion of pneumonia in primary care and that it seems to be of most value when not sure of the diagnosis.

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  • 8. Order onlineBuy this publication >>
    Moberg, Anna
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kärna.
    Diagnosing pneumonia in primary care: Aspects of the value of clinical and laboratory findings and the use of chest X-ray2020Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    It is important to identify patients with pneumonia because it is potentially a serious disease, often of bacterial origin, that should be treated with antibiotics. It is equally important to identify those with acute bronchitis, a self-limiting disease, that should not be treated with antibiotics. Because bacterial resistance is increasing, over-prescribing of antibiotics should be avoided. However, it is sometimes difficult to differentiate between the two diagnoses, and guidelines concerning the assessment do not conform.  

    The general aim of this thesis was to investigate if diagnostics of pneumonia in primary care can be improved and whether this could contribute to reduced prescription of antibiotics.  

    As a first step, different anamnestic, clinical and laboratory findings and the doctor’s degree of suspicion of pneumonia in primary care were compared with chest X-ray (CXR) findings. The doctor’s degree of suspicion of pneumonia was shown to be a good predictor. When the physician was sure of the diagnosis, the likelihood for radiographic pneumonia was high and when quite sure, CXR was positive in less than half of the cases.  

    To further improve the diagnostics of pneumonia, and thus reduce antibiotic prescriptions, patients were referred for CXR when the physician was unsure or quite sure of a pneumonia diagnosis. The intervention did not result in any decrease in antibiotic prescriptions compared with a control group. However, it emerged that the physicians did not fully trust the CXR outcome, but prescribed antibiotics even when the results were negative.  

    To gain insight into the contribution of C-reactive protein (CRP) levels to the degree of suspicion, physicians were asked to estimate their degree of suspicion of pneumonia before and after CRP testing. CRP affected the degree of suspicion to a great extent, and most often resulted in a lowered degree of suspicion and thereby in the clinical decision of dismissing the diagnosis of pneumonia.  

    The use of different diagnostic tests and prescription of antibiotics in the assessment of acute bronchitis and pneumonia over time was evaluated in a register-based study. The study showed that the use of diagnostic tests for both diagnoses has increased, and that there has been a reduction in antibiotic prescriptions for acute bronchitis.  

    In conclusion, the doctor’s degree of suspicion of pneumonia seems to be a good predictor of the condition. When the physician is sure of the diagnosis, no further investigation is needed, and antibiotics can be prescribed on reliable grounds. CRP testing affects the degree of suspicion and is most valuable when unsure of the diagnosis where it can be helpful to exclude pneumonia. In contrast, more extensive use of CXR does not contribute to a decrease in antibiotic prescriptions in the diagnostics of pneumonia.

    List of papers
    1. Community-acquired pneumonia in primary care: clinical assessment and the usability of chest radiography
    Open this publication in new window or tab >>Community-acquired pneumonia in primary care: clinical assessment and the usability of chest radiography
    Show others...
    2016 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 34, no 1, p. 21-27Article in journal (Refereed) Published
    Abstract [en]

    Objectives: To investigate the diagnostic value of different clinical and laboratory findings in pneumonia and to explore the association between the doctors degree of suspicion and chest X-ray (CXR) result and to evaluate whether or not CXR should be used routinely in primary care, when available. Design: A three-year prospective study was conducted between September 2011 and December 2014. Setting: Two primary care settings in Linkoping, Sweden. Subjects: A total of 103 adult patients with suspected pneumonia in primary care. Main outcome measures: The physicians recorded results of a standardized medical physical examination, including laboratory results, and rated their suspicion into three degrees. The outcome of the diagnostic variables and the degree of suspicion was compared with the result of CXR. Results: Radiographic pneumonia was reported in 45% of patients. When the physicians were sure of the diagnosis radiographic pneumonia was found in 88% of cases (p&lt;0.001), when quite sure the frequency of positive CXR was 45%, and when not sure 28%. Elevated levels of C-reactive protein (CRP)50mg/L were associated with the presence of radiographic pneumonia when the diagnosis was suspected (p&lt;0.001). Conclusion: This study indicates that CXR can be useful if the physician is not sure of the diagnosis, but when sure one can rely on ones judgement without ordering CXR.

    Place, publisher, year, edition, pages
    TAYLOR & FRANCIS LTD, 2016
    Keywords
    Chest radiography; clinical assessment; community-acquired pneumonia; C-reactive protein; general practice; primary care; Sweden
    National Category
    Basic Medicine
    Identifiers
    urn:nbn:se:liu:diva-127062 (URN)10.3109/02813432.2015.1132889 (DOI)000372023200005 ()26849394 (PubMedID)
    Note

    Funding Agencies|County Council of ostergotland

    Available from: 2016-04-13 Created: 2016-04-13 Last updated: 2020-10-02
    2. Use of chest X-ray in the assessment of community acquired pneumonia in primary care - an intervention study
    Open this publication in new window or tab >>Use of chest X-ray in the assessment of community acquired pneumonia in primary care - an intervention study
    Show others...
    2020 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 38, no 3, p. 323-329Article in journal (Refereed) Published
    Abstract [en]

    Objectives The aim of this study was to explore if consequent use of chest X-ray (CXR), when the physician is not sure of the diagnosis of pneumonia after clinical examination and CRP-testing, favors a more restrictive prescribing of antibiotics. Design This was an intervention study conducted between September 2015 and December 2017. Setting Two intervention primary health care centers (PHCCs) and three control PHCCs in the southeast of Sweden. Intervention All patients were referred for CXR when the physician s suspicion of pneumonia was unsure, or quite sure after CRP-testing. Control units managed patients according to their usual routine after clinical examination and CRP-testing. Subjects A total of 104 patients were included in the intervention group and 81 patients in the control group. The inclusion criteria of the study were clinically suspected pneumonia in patients &gt;= 18 years, with respiratory symptoms for more than 24 h. Main outcome measure:Antibiotic prescribing rate. Results In the intervention group, 85% were referred for CXR and 69% were prescribed antibiotics, as compared to 26% and 77% in the control group. The difference in antibiotic prescribing rate was not statistically significant, unadjusted OR 0.68 [0.35-1.3] and adjusted OR 1.1 [CI 0.43-3.0]. A total of 24% of patients with negative CXR were prescribed antibiotics. Conclusion This study could not prove that use of CXR when the physician was not sure of the diagnosis of pneumonia results in lowered antibiotic prescribing rate in primary care. In cases of negative findings on CXR the physicians do not seem to rely on the outcome when it comes to antibiotic prescribing.

    Place, publisher, year, edition, pages
    Taylor & Francis, 2020
    Keywords
    Family practice; pneumonia; chest X-ray; antibiotics; general practice; intervention; primary care
    National Category
    General Practice
    Identifiers
    urn:nbn:se:liu:diva-168549 (URN)10.1080/02813432.2020.1794404 (DOI)000551614000001 ()32705941 (PubMedID)2-s2.0-85088535684 (Scopus ID)
    Available from: 2020-08-26 Created: 2020-08-26 Last updated: 2021-05-04Bibliographically approved
    3. Change in the use of diagnostic tests in the management of lower respiratory tract infections: a register-based study in primary care
    Open this publication in new window or tab >>Change in the use of diagnostic tests in the management of lower respiratory tract infections: a register-based study in primary care
    2020 (English)In: BJGP Open, ISSN 2398-3795, Vol. 4, no 1Article in journal (Refereed) Published
    Abstract [en]

    Background Differentiating between pneumonia and acute bronchitis is often difficult in primary care. There is no consensus regarding clinical decision rules for pneumonia, and guidelines differ between countries. Use of diagnostic tests and change of management over time is not known.

    Aim To calculate the proportion of diagnostic tests in the management of lower respiratory tract infections (LRTIs) in a low antibiotic prescribing country, and to evaluate if the use and prescription pattern has changed over time.

    Design & setting A register-based study on data from electronic health records from January 2006 to December 2014 in the Kronoberg county of south east Sweden.

    Method Data regarding use of C-reactive protein (CRP), chest x-rays (CXRs), microbiological tests, and antibiotic prescriptions were assessed for patients aged 18–79 years, with the diagnosis pneumonia, acute bronchitis, or cough.

    Results A total of 54 229 sickness episodes were analysed. Use of CRP increased during the study period from 61.3% to 77.5% for patients with pneumonia (P<0.001), and from 53.4% to 65.7% for patients with acute bronchitis (P<0.001). Use of CXR increased for patients with acute bronchitis from 3.1% to 5.1% (P<0.001). Use of microbiological tests increased for patients with pneumonia, from 1.8% to 5.1% (P<0.001). The antibiotic prescription rate decreased from 18.6 to 8.2 per 1000 inhabitants per year for patients with acute bronchitis, but did not change for patients with pneumonia.

    Conclusion Use of CRP and microbiological tests in the diagnostics of LRTIs increased despite the fact that the incidence of pneumonia and acute bronchitis was stable.

    Place, publisher, year, edition, pages
    London, United Kingdom: Royal College of General Practitioners, 2020
    Keywords
    community-acquired pneumonia, Primary care, management, C-reactive protein, chest X-ray, antibiotics, anti-bacterial agents
    National Category
    Infectious Medicine
    Identifiers
    urn:nbn:se:liu:diva-170219 (URN)10.3399/bjgpopen20X101015 (DOI)2-s2.0-85087083720 (Scopus ID)
    Note

    Forskningsfinansiär: Medical Research Council of Southeast Sweden (reference number: FORSS-931097)

    Available from: 2020-10-02 Created: 2020-10-02 Last updated: 2020-10-20Bibliographically approved
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  • 9.
    Moberg, Anna
    et al.
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kärna.
    Kling, Moa
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kungsgatan.
    Paues, Jakob
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Medicine Center, Department of Infectious Diseases.
    Fransson, Sven Göran
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Diagnostics and Specialist Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Radiology in Linköping.
    Falk, Magnus
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kärna.
    Use of chest X-ray in the assessment of community acquired pneumonia in primary care - an intervention study2020In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 38, no 3, p. 323-329Article in journal (Refereed)
    Abstract [en]

    Objectives The aim of this study was to explore if consequent use of chest X-ray (CXR), when the physician is not sure of the diagnosis of pneumonia after clinical examination and CRP-testing, favors a more restrictive prescribing of antibiotics. Design This was an intervention study conducted between September 2015 and December 2017. Setting Two intervention primary health care centers (PHCCs) and three control PHCCs in the southeast of Sweden. Intervention All patients were referred for CXR when the physician s suspicion of pneumonia was unsure, or quite sure after CRP-testing. Control units managed patients according to their usual routine after clinical examination and CRP-testing. Subjects A total of 104 patients were included in the intervention group and 81 patients in the control group. The inclusion criteria of the study were clinically suspected pneumonia in patients &gt;= 18 years, with respiratory symptoms for more than 24 h. Main outcome measure:Antibiotic prescribing rate. Results In the intervention group, 85% were referred for CXR and 69% were prescribed antibiotics, as compared to 26% and 77% in the control group. The difference in antibiotic prescribing rate was not statistically significant, unadjusted OR 0.68 [0.35-1.3] and adjusted OR 1.1 [CI 0.43-3.0]. A total of 24% of patients with negative CXR were prescribed antibiotics. Conclusion This study could not prove that use of CXR when the physician was not sure of the diagnosis of pneumonia results in lowered antibiotic prescribing rate in primary care. In cases of negative findings on CXR the physicians do not seem to rely on the outcome when it comes to antibiotic prescribing.

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