Development of FastFrail—a rapid frailty screening tool for medical calls: a development study based on cross-sectional data from an urgent care centre in Norway

Article

作者: Sebjørnsen, Isabel ; Gulla, Christine Olsen ; Baste, Valborg ; Advocaat Wigand, Nora ; Ranhoff, Anette Hylen ; Vedvik, Martine Nybakk ; Bakken, Marit Stordal

ObjectiveTo develop a rapid screening tool for the identification of frailty in medical calls and other out-of-hospital acute care services.DesignDevelopment study based on cross-sectional data. A set of potential items were developed based on existing frailty tools and other relevant literature by a panel with geriatric and primary care expertise. The items and the Clinical Frailty Scale (CFS) were administered on a convenience sample of older urgent care patients. Further development of the tool was based on statistical analyses of this data material and final discussions in the panel.SettingUrgent care centre in Norway, data collected between January and August 2022.ParticipantsAll patients ≥70 years were eligible for inclusion, with the exception of patients triaged to the highest urgency level and patients not able to answer questions with no next of kin present.Primary outcomePotential items associated with frailty by CFS, measured by explained variance (adjusted R2values from linear regression analyses).ResultsNine potential items were developed and administered on 200 patients (59% female), of whom 48% were 70–79 years, 38% were 80–89 years and 14% were ≥90 years. The median CFS score was 4 (living with very mild frailty). Receiving help weekly, being homebound and using a walking aid were identified as strong indicators of frailty (adjusted R2values 59%, 48% and 43%, respectively). Together these three factors could explain 74% of the variation in CFS scores.ConclusionsReceiving help weekly, being homebound and using a walking aid are strong indicators of frailty among urgent care patients. We developed a frailty screening tool for medical calls—FastFrail—consisting of three simple, binary questions (yes/no) on these aspects. We hypothesise that FastFrail can supplement traditional symptom-based triage and enable more accurate assessment of older adults calling for acute medical help. We intend to test the tool in clinical practice.

2025-02-07·Family Practice

Variation in general practitioners’ follow-up of depressed patients starting antidepressant medication: a register-based cohort study

Article

作者: Ruths, Sabine ; Haukenes, Inger ; Baste, Valborg ; Smith-Sivertsen, Tone ; Hansen, Anneli B ; Hetlevik, Øystein

AbstractBackgroundGuidelines recommend follow-up within 2 weeks for patients starting medication for depression. Knowledge is lacking about how general practitioners’ (GPs) follow-up varies with patients’ sociodemographic characteristics.ObjectiveTo describe follow-up by GP and specialist in mental healthcare provided to men and women with depression within 3 months of starting drug therapy. Furthermore, to examine whether follow-up varied according to patients’ age and education.MethodsRegistry-based cohort study comprising all patients aged ≥18 years in Norway with a new depression episode in 2014 who started on antidepressants within 12 months from diagnosis. Patients’ age and educational level were the exposures. Outcomes were follow-up by GP and/or mental healthcare specialist, and talking therapy with GP, within 90 days of first prescription. Cox proportional hazard models were used to estimate the likelihood of having follow-up contacts. Log binomial regression analysis was performed to explore the likelihood of having talking therapy with a GP. Time to first contact was illustrated by Kaplan–Meier survival curves.ResultsThe study population comprised 17 000 patients, mean age 45.7 years, 60.6% women. Only 27.8% of the patients were followed up by GP and/or specialist within 2 weeks of the first drug dispensing, 67.1% within 90 days. Older or less educated men and women received less and later contacts than the younger or more highly educated.ConclusionsDifferences in age and educational level were associated with follow-up of depressed patients who started medication. This may indicate unwarranted variation in depression care that GPs should consider when prescribing antidepressants.

2025-01-02·Scandinavian Journal of Primary Health Care

Self-injurious thoughts and behaviours as the reason for contact to Norwegian emergency primary care centres: an observational study

Article

作者: Midtbø, Vivian ; Hunsager, Anita ; Johansen, Ingrid Hjulstad ; Morken, Tone ; Baste, Valborg ; Walby, Fredrik A.

OBJECTIVETo describe and compare contacts regarding self-injurious thoughts and behaviours to other contacts to emergency primary care.DESIGNObservational study.SETTINGA sentinel network of seven emergency primary care centres throughout Norway.SUBJECTSInitial contacts regarding patients 10 years and older during 12 consecutive months (11/2021-10/2022).MAIN OUTCOME MEASURESContacts due to self-injurious thoughts and behaviours.RESULTSSelf-injurious thoughts and behaviours were the reason for contact for 0.6% (n = 478) of initial contacts for patients aged 10 years or older (n = 77 344). When compared to other contacts, self-injurious thoughts and behaviours were associated with female gender, younger age, occurrence during evening and nighttime, higher urgency, and more physician consultations and call-outs. Of contacts about self-injurious thoughts and behaviours, 58.2% were regarding thoughts and 41.8% about behaviours, and in 75.0% a history of similar contacts was recorded. Contacts regarding thoughts often concerned threats (30.6%) and were more often handled by telephone advice than contacts regarding behaviours. Contacts regarding behaviours with suicidal intent were associated with higher urgency and more physician call-outs than contacts regarding non-suicidal behaviours.CONCLUSIONSelf-injurious thoughts and behaviours are rare reasons for contact to emergency primary care but are assessed as more urgent than other contact reasons and trigger more extensive medical help. Many of the patients are known to the service through a history of similar contacts.IMPLICATIONSThe infrequency and severity of these encounters might necessitate training, decision support and procedures to compensate for the health care personnel's limited exposure.

100 项与 National Centre for Emergency Primary Health Care 相关的药物交易

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100 项与 National Centre for Emergency Primary Health Care 相关的转化医学

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