Australian graduating nurses’ knowledge,intentions and beliefs on infection prevention and control: a cross-sectional study

Background

In recent year, national bodies have been actively addressing the increasing concern on the spread of healthcare-associated infections (HAIs). The current study measures the knowledge, intentions and beliefs of third-year Australian nursing students on key infection prevention and control (IPC) concepts.

Methods

A cross-sectional study of final-year undergraduate nursing students from Schools of Nursing at six Australian universities was undertaken. Students were asked to participate in an anonymous survey. The survey explored knowledge of standard precautions and transmission based precautions. In addition intentions and beliefs towards IPC were explored.

Results

349 students from six universities completed the study. 59.8% (95% CI 58.8–60.8%) of questions were answered correctly. Significantly more standard precaution questions were correctly answered than transmission-based precaution questions (p?<?0.001). No association was found between self-reported compliance with IPC activities and gender or age. Certain infection control issues were correlated with the percentage of correctly answered transmission-based precaution questions. The participants were most likely to seek infection control information from an infection control professional.

Conclusion

Knowledge on transmission-based precautions was substandard. As transmission-based precautions are the foundation of IPC for serious organisms and infections, education institutions should reflect on the content and style of educational delivery on this topic.

     

Epilepsy and depression: risk factors for suicide?

Compared to the general population, the suicide rate in epilepsy is 5-fold increased. In particular, patients with temporal lobe epilepsy have a 25-fold increased risk of suicide. Certain psychiatric disorders, including primary mood disorders, also increase the risk for suicide. Among people with epilepsy, psychiatric comorbidity is common, with an elevated rate of Major Depression. A review of the literature about the association between epilepsy, depression and suicide highlights the lack of evaluation of intensity, pervasiveness and characteristics of suicidal ideation in epileptic patients compared with patients with a diagnosis of Major Depression.     

Sick-listed workers’ expectations about and experiences with independent medical evaluation: a qualitative interview study from Norway

Purpose: To reduce the country’s sick leave rate, Norwegian politicians have suggested independent medical evaluations (IMEs) for sick-listed workers. IME was tested in a large, randomized controlled trial in one Norwegian county (Evaluation of IME in Norway, or ‘the NIME trial’). The current study´s aim was to explore sick-listed workers’ expectations about and experiences with participating in an IME.

Material and methods: Nine individual semi-structured telephone interviews were conducted. Our convenience sample included six women and three men, aged 35–59 years, who had diverse medical reasons for being on sick leave. Systematic text condensation was used for analysis.

Results: The participants questioned both the IME purpose and timing, but felt a moral obligation to participate. Inadequate information provided by their general practitioner (GP) to the IME doctor was considered burdensome by several participants. However, most participants appreciated the IME as a positive discussion, even if they did not feel it had any impact on their follow-up or return-to-work process.

Conclusions: According to the sick-listed workers the IMEs were administered too late and disturbed already initiated treatment processes and return to work efforts. Still, the consultation with the IME doctor was rated as a positive encounter, contrary to their expectations. Our results diverge from findings in other countries where experiences with IME consultations have been reported as predominantly negative. These findings, along with additional, upcoming evaluations, will serve as a basis for the Norwegian government’s decision about whether to implement IMEs on a regular basis.

• Key points

• Independent medical evaluations for sick-listed workers has been tested out in a large Norwegian RCT and will be evaluated through qualitative interviews with participating stakeholders and by assessing the effects on RTW and costs/benefits. In this study, we explored sick-listed workers’ expectations about and experiences with participating in an IME.

• ? Participants questioned both the IME purpose and timing, but felt a moral obligation to participate.

• ? Inadequate information provided by their general practitioner (GP) to the IME doctor was considered burdensome by several participants

• ? Sick-listed workers appreciated the IME as a positive discussion, even if they did not feel it had any impact on their follow-up or return-to-work process.

     

Cardiovascular disease risk factors in a population‐based sample of Norwegian children and adolescents

Objective. The objective of the study was to describe the distribution of cardiovascular disease (CVD) risk factors, and to evaluate the extent of clustering of CVD risk factors in Norwegian children and adolescents. Material and methods. A randomly selected cohort of 9‐year‐olds and 15‐year‐olds from all regions of the country was sampled. Of 2,818 subjects invited to participate, 2,299 accepted, giving an overall participation rate of 82?%. Results. Mean (SD) values for the main risk factors for 9‐year‐old and 15‐year‐old girls and boys were: total cholesterol (TC) (mmol/L) 4.49 (0.73), 4.37 (0.68), 4.19 (0.76) and 3.80 (0.69), respectively; triglycerides (TG) (mmol/L) 0.72 (0.33), 0.63 (0.32), 0.79 (0.32) and 0.82 (0.47), respectively; high density lipoprotein cholesterol (HDL‐c) (mmol/L) 1.70 (0.35), 1.79 (0.40), 1.61 (0.34) and 1.42 (0.30), respectively; systolic blood pressure (mmHg) 102.6 (7.7), 103.3 (7.7), 109.0 (8.8) and 115.3 (9.0), respectively; and homeostasis model assessment score (HOMA) 1.29 (0.83), 1.19 (0.78), 2.10 (1.37) and 2.14 (1.49), respectively. At least five risk factors were found in 11.1 (95?% confidence interval (CI) 8.76 to 13.44) times as many participants as expected. A significant degree of clustering of CVD risk factors was found in 11.4?% (95?% CI, 9.8 to 13.0) of the study population, and these had mean Z scores of 1.24 (0.06) and 1.04 (0.08) for the 9‐year‐olds and 15‐year‐olds, respectively. Conclusion. This study presents national reference data on selected CVD risk factors in children and adolescents.     

Incidence of and risk factors for post–intensive care syndrome among Chinese respiratory intensive care unit patients: A cross-sectional,prospective study

BackgroundPatients transferred from the respiratory intensive care unit (ICU) can experience post–intensive care syndrome (PICS), which comprises cognitive, psychological, and physical disorders that seriously affect the quality of life. Therefore, it was necessary to explore the incidence of and the risk factors for PICS among respiratory ICU patients.ObjectivesThis study evaluated PICS among respiratory ICU patients and explored the risk factors for PICS.MethodsThis cross-sectional, prospective study was performed at one hospital in China. Using convenience sampling, 125 respiratory ICU patients from August 2018 to June 2019 were recruited for the study. The Mini-Mental State Examination, Confusion Assessment Method for the Intensive Care Unit, Hospital Anxiety and Depression Scale, Medical Research Council Scale, activities of daily living scale, Pittsburgh Sleep Quality Index, and the 14-item fatigue scale were used to comprehensively assess the patients' cognitive status, psychological status, and physiological status when entering the ICU and 2 weeks after leaving the ICU. Factors affecting PICS were measured using researcher-created questionnaires of patients’ general information and disease-related information.ResultsFifteen patients were lost to follow-up. Fifty-nine patients had PICS (incidence rate, 53.6%). Logistic regression showed that risk factors for PICS were age, invasive mechanical ventilation, noninvasive ventilator-assisted ventilation, and coronary heart disease (P < 0.05).ConclusionThe PICS incidence was high. Older age, longer invasive mechanical ventilation times, longer noninvasive ventilator times, and coronary heart disease were risk factors for PICS. ICU medical workers in China should pay more attention on PICS, know the risk factors, and implement preventive measures.     

Lactic acidosis and metformin implicated: why better information about risk factors?

In type II diabetes treated with metformin (Glucophage) lactic acidosis is a rare adverse reaction, fatal in approximately 50 per cent of cases. Metformin is implicated by plasma and intra-erythrocyte levels. An analysis is carried out on available information about this risk for healthcare professionals and for patients. A comparison is made of approved labelling information on Glucophage and its patient leaflets in France and in the USA and an analysis made of the differences. In France, Information given to physicians, pharmacists and patients on the risk of lactic acidosis where Glucophage is implicated must be improved, and on the interest of the metformin plasma level in this case. These are primary points because the issue for the few patients concerned may be fatal. Advice on self-medication may be introduced. The evolution of information provided on these risks depends on the pharmaceutical laboratory, government authorities and healthcare professionals.     

Do general practitioner and patient agree about the risk factors for ischaemic heart disease?

OBJECTIVE: To analyse agreement between patients' and GPs' perceptions of risk factors and overall risk of ischaemic heart disease (IHD). DESIGN: Cross-sectional study based on paired information from patients and GPs. SETTING: Twenty-six GPs in the County of Ringk?bing, Denmark, participating in a medical audit during 3 weeks in May 1999. SUBJECTS: 252 patients with IHD and 1239 without IHD. MAIN OUTCOME MEASURES: GPs and patients were asked about specific risk factors for IHD and their perception of overall risk. Their agreement was evaluated by Kappa statistics. RESULTS: Agreement between GPs and patients varied from 70% to 97%. Disagreement was observed most often for patients with IHD and patients listed with elderly GPs ( > 50 years). Generally, patients perceived the overall risk of IHD lower than their doctors, and for most patients with a perception of low risk the GP estimated the risk as high. CONCLUSIONS: Patients and GPs have different perceptions of the risk of [HD. This may be due to different perceptions of the importance of specific risk factors and different reference frames for risk perception. GPs have an important role in communicating the meaning of risk factors and interventions should be considered to improve risk communication in general practice.     

Cancer patients�� informational needs on health promotion and related factors: a multi-institutional, cross-sectional study in Korea

Background  

As the survival rates of cancer patients increase, health promotion for cancer survivors becomes a more important issue. This study examines whether the informational needs on health promotion by cancer patients is being met and evaluates other factors associated with those informational needs.     

Risk factors for endometrial cancer in Turkish women: Results from a hospital-based case–control study

Purpose of the researchThe aim of this study was to investigate the association between risk factors and endometrial cancer in Turkish women.Methods and sampleIn a hospital-based case-control study conducted in ?stanbul, 285 patients with histologically confirmed endometrial cancer were compared with 1050 controls, admitted to the different departments of the same hospital. Odds ratios (OR) and 95% confidence intervals (CI) were obtained from multivariate logistic regression analysis, fitted by the method of maximum likelihood.Key resultsRisk factors for endometrial cancer were found to be the state of lower education (OR = 2.53, 5% CI: 1.41–4.54), history of hypertension or diabetes (OR = 3.26, 95% CI: 2.21–4.80), (OR = 3.56, 95% CI: 2.02–6.27), lower parity (OR = 3.89, 95% CI: 2.60–5.82), early menarche age (OR = 9.43, 95% CI: 5.35–16.62) and HRT use (OR = 2.66, 5% CI: 1.40–5.06).ConclusionsIn conclusion, our results are supportive of the hypothesis that having a history of chronic disease, lower parity, early menarche and use of HRT were increased-risk factors but negative family history of cancer was decreased-risk factor for endometrial cancer.     

Children’s contact with people with disabilities and their attitudes towards disability: a cross-sectional study

Purpose: To explore the association between children’s self-reported contact with people with disabilities and attitudes towards them, as well the potential mediating influence of anxiety about interacting with people with disabilities and empathy for them. Method: 1881 children, aged 7–16 years, from 20 schools in South West England completed a survey assessing their contact with people with disabilities and their attitudes towards them. Anxiety about interacting with people with disabilities and empathy towards them were examined as potential mediators. Gender, school year, perceived similarity between people with and without disabilities, proportion of children with additional needs at the school and socioeconomic status (SES) were assessed as moderators. A random effects (“multilevel”) regression model was used to test the contact–attitude association and moderation, and path analysis was used to test for mediation. Results: Participants with more self-reported contact reported more positive attitudes towards disability (p?Conclusions: Self-reported contact was observed to be associated with more positive attitudes towards disability, which was partially mediated by empathy and anxiety. Providing opportunities for contact with people with disabilities that reduces anxiety and increases empathy may improve attitudes to disability and merits evaluation in interventions.

• Implications for Rehabilitation

• Children who reported greater levels of contact with people with disabilities had more positive attitudes towards disability.

• Anxiety about interacting with people with disabilities and empathy towards them partially mediated the contact–attitude associations.

• Providing opportunities for contact with people with disabilities, reducing anxiety and increasing empathy may improve children’s attitudes to disability.

     

Nursing students’ attitudes and experiences with mental illness: A cross-sectional study

Almost half (46%) of people will experience a mental health issue in their lifetime and all nurses need mental health knowledge and skills regardless of their area of specialization. Little is known, however, about student attitudes toward people with mental illness on entry to pre-registration nursing programs. The aims were to investigate Australian pre-registration nursing students’ attitudes toward, and prior experience with, people with mental illness on program commencement. This cross-sectional study used the Community Attitudes Toward Mental Illness (CAMI) scale with pre-registration nursing students, and questions on students’ prior experience with mental illness (self, family, friends). There were n = 311 (271 female/40 male) first year, first semester Bachelor of Nursing students at a national Australian university. Students reported prior experience with mental illness with family (49.5%/n = 154) and friends (61.4%/n = 191). Self-reported (36.3% /n = 113) mental illness, particularly anxiety and depression, significantly exceeded national averages. Most students held accepting attitudes toward people with mental illness, except for perceptions of dangerousness. This study provides new findings on nursing student attitudes and experience with people with mental illness on program entry. The high self-reported prevalence of anxiety and depression at program entry indicates a pressing need for early intervention and mental wellbeing strategies for students from commencement of their tertiary education. Fear-reducing education which challenges perceptions of dangerousness in relation to people with mental illness, and supportive mental health clinical placements during their program, may help improve students’ attitudes and reduce fear and mental health stigma.     

An examination of gender stereotypes,ambivalent sexism,and dating violence as potential predictors of nursing students’ beliefs about intimate partner violence: A cross-sectional correlational study

AimThis study aimed to examine the role of the feminine or masculine gender stereotypes, ambivalent sexism and dating violence to predict nursing students’ beliefs about intimate partner violence.BackgroundAlthough there has been a growing interest in understanding the sociocultural contexts and the factors of the intimate partner violence, there is a serious lack of empirical research on different dimensions of this problem among nursing students.DesignA cross-sectional correlational design was used.MethodsThe data were collected from a sample of 520 university students from three nursing schools in Istanbul, Turkey. Participants were selected through convenience sampling. Data were collected with the sociodemographic form, the Beliefs About Wife Beating Scale, the Ambivalent Sexism Inventory, the revised Conflict Tactics Scale, and the Bem Sex Role Inventory.ResultsResults revealed that male participants were more prone to justify wife beating and believe that battered women benefitted from beating. Based on the results of the study, in addition to sex, region of birth, representing feminine or masculine gender stereotypes, hostile sexism, psychological aggression and having an injury due to experiencing violence in the latest relationship were the important predictors of nursing students’ beliefs about intimate partner violence.ConclusionsNursing curricula should include courses to enhance students’ awareness towards violence against women, sexism and gender equality. More, universities should provide counseling services for nursing students who experienced violence.     

Disability,caregiver’s dependency and patterns of access to rehabilitation care: results from a national representative study in Peru

Purpose: To determine the prevalence of disability in Peru, explore dependency on caregiver’s assistance and assess access to rehabilitation care. Method: Data from Disability National Survey (ENEDIS), including urban and rural areas, were analyzed. Disability was defined as a permanent limitation on movement, vision, communication, hearing, learning/remembering or social relationships. Dependency was defined as the self-reported need for a caregiver to help with daily activities; and access to rehabilitation care was defined as the self-report of any therapy for disabilities. Estimates and projections were calculated using sample strata, primary sampling units and population weights, and prevalence ratios (PRs) and 95%CI were reported. Results: From 798?308 people screened, 37?524 (5.1%; 95%CI 4.9--5.2%) had at least one disability. A total of 37?117 were included in further analysis, mean age 57.8 (SD?±?24.1) years, 52.1% women. Dependency was self-reported by 14?980 (40.5%; 95%CI: 39.2–41.9%) individuals with disabilities. A family member, usually female, was identified as a caregiver in 94.3% (95%CI: 93.3–95.3%) of dependent participants. Only 2881 (10.7%; 95%CI: 9.7–11.9%) of people with disabilities reported access to rehabilitation care. Major inequality patterns of disability burden versus access to rehabilitation care were observed by age and education level. Older age groups had higher disability burden yet lower chances of access to rehabilitation care. Conversely, the higher the education level, the lesser the overall disability burden but also the higher chances of reporting receiving care. Private healthcare insurance doubled the probability of having access to rehabilitation compared with those without insurance. Conclusions: Approximately 1.6 million Peruvians have at least one disability, and 40% of them require assistance with daily activities. Informal caregiving, likely female and relative-provided, is highly common. Rehabilitation care access is low and inequitable. Our results signal a major need to implement strategies to guarantee the highest standard of health care for people with disabilities.

• Implications for Rehabilitation

• Major inequality patterns in terms of burden of disability versus access to rehabilitation care were observed: those groups who concentrate more disability reported receiving less rehabilitation care.

• Caregiving is mostly informal and provided by a direct relative, mainly a woman, who resigned to their usual activities in order to help care for the person with disability. As a result, there is a need to develop appropriate support and training for caregivers.

• Access to care services in Peru is low and inequitable, but especially for people with disabilities: they experience greater barriers when accessing healthcare services even in the case of having health insurance.

     

Clinicians’ attitudes towards escalation and management of deteriorating patients: A cross-sectional study

BackgroundInternationally, rapid response systems have been implemented to recognise and categorise hospital patients at risk of deterioration. Whilst rapid response systems have been implemented with a varying amount of success, there remains ongoing concern about the lack of improvement in the escalation, and management of the deteriorating patient. It also remains unclear why some clinicians fail to escalate concerns for the deteriorating patient.ObjectiveThe objective of this study was to explore clinicians’ attitudes towards the escalation, and management of the deteriorating patient.MethodsA cross-sectional online survey of conveniently sampled clinicians from the acute care sector in a regional health district in Australia was conducted. The Clinicians’ Attitudes towards Responding and Escalating care of Deteriorating patients scale, was used to explore attitudes towards the escalation and management of the deteriorating patient.ResultsSurvey responses were received from medical officers (n = 43), nurses (n = 677), allied health clinicians (n = 60), and students (n = 57). Years of experience was significantly associated with more confidence responding to deteriorating patients (p < .001) and significantly less fears about escalating care (p < .001). Nurses (M = 4.16, SD = .57) and students (M = 4.11, SD = .55) in general had significantly greater positive beliefs that the rapid response system would support them to respond to the deteriorating patient than allied health (M = 3.67, SD = .64) and medical (M = 3.87, SD = .54) clinicians, whilst nurses and medical clinicians had significantly less fear about escalating care and greater confidence in responding to deteriorating patients than allied health clinicians and healthcare students (p < .001).ConclusionNurses and medical officers have less fear to escalate care and greater confidence responding to the deteriorating patient than allied health clinicians and students. Whilst the majority of participants had positive perceptions towards the rapid response system, those with less experience lacked the confidence to escalate care and respond to the deteriorating patient.     

Pre-registration nursing students’ perceptions and experience of intentional rounding: A cross-sectional study

This paper examines pre-registration nursing students’ perceptions of the practice of intentional rounding and perceived benefits for nurses and patients.Intentional rounding was developed to ensure nursing staff regularly check on patients to ensure that all care needs are met. It has been linked to a reduction in falls and call bell use, and an increase in patient safety. No previous studies have examined pre-registration nursing students’ role in the practice of intentional rounding during clinical placements nor the perceptions of rounding practices, important from a future workforce perspective.A cross-sectional multisite study was undertaken, and pre-registration nursing students completed the Nurses’ Perceptions of Patient Rounding Scale between August 2017– June 2018, distributed using online education platforms and email. Strobe reporting guidelines were used to report findings.Participants perceived positive benefits in intentional rounding for nurses and patients. Mixed opinions surrounded the sufficiency of education received around the intervention. Previous nursing experience was linked to opposing opinions of intentional rounding, depending on education levels.Participants had a positive perception of intentional rounding practices overall. Education surrounding intentional rounding needs to be consistent, and introduced before students are expected to actively participate in the practice of rounding on clinical placement.     

The global burden of headache in children and adolescents – developing a questionnaire and methodology for a global study

Background

Burden of headache has been assessed in adults in countries worldwide, and is high, but data for children and adolescents are sparse. The objectives of this study were o develop a questionnaire and methodology for the global estimation of burden of headache in children and adolescents, to test these in use and to present preliminary data.

Methods

We designed structured questionnaires for mediated-group self-administration in schools by children aged 6-11 years and adolescents aged 12-17 years. In two pilot studies, we offered the questionnaires to pupils in Vienna and Istanbul. We performed face-to-face interviews in a randomly selected subsample of 199 pupils to validate the headache diagnostic questions.

Results

Data were collected from 1,202 pupils (mean 13.9 ± 2.4 years; 621 female, 581 male). The participation rate was 81.1% in Istanbul, 67.2% in Vienna. The questionnaire proved acceptable: ≤5% of participants disagreed partially or totally with its length, comprehensibility or simplicity. The sensitivity, specificity, positive and negative predictive values ranged between 0.71 and 0.76 for migraine and between 0.61 and 0.85 for tension-type headache (TTH). Cronbach’s alpha was 0.83. The 1-year prevalence of headache was 89.3%, of migraine 39.3% and of TTH 37.9%. The prevalence of headache on ≥15 days/month was 4.5%. One fifth (20.7%) of pupils with headache lost ≥1 day of school during the preceding 4 weeks and nearly half (48.8%) reported ≥1 day when they could not do activities they had wanted to. The vast majority of pupils with headache experienced difficulties in coping with headache and in concentrating during headache. Quality of life was poorer in pupils with headache than in those without.

Conclusion

These pilot studies demonstrate the usefulness of the questionnaires and feasibility of the methodology for assessing the global burden of headache in children and adolescents, and predict substantial impact of headache in these age groups.     

Epidemiology of sepsis in Germany: results from a national prospective multicenter study

Objective To determine the prevalence and mortality of ICU patients with severe sepsis in Germany, with consideration of hospital size. Design Prospective, observational, cross-sectional 1-day point-prevalence study. Setting 454 ICUs from a representative nationwide sample of 310 hospitals stratified by size. Data were collected via 1-day on-site audits by trained external study physicians. Visits were randomly distributed over 1 year (2003). Patients Inflammatory response of all ICU patients was assessed using the ACCP/SCCM consensus conference criteria. Patients with severe sepsis were followed up after 3 months for hospital mortality and length of ICU stay. Measurements and results Main outcome measures were prevalence and mortality. A total of 3,877 patients were screened. Prevalence was 12.4% (95% CI, 10.9–13.8%) for sepsis and 11.0% (95% CI, 9.7–12.2%) for severe sepsis including septic shock. The ICU and hospital mortality of patients with severe sepsis was 48.4 and 55.2%, respectively, without significant differences between hospital size. Prevalence and mean length of ICU stay of patients with severe sepsis were significantly higher in larger hospitals and universities (≤ 200 beds: 6% and 11.5 days, universities: 19% and 19.2 days, respectively). Conclusions The expected number of newly diagnosed cases with severe sepsis in Germany amounts to 76–110 per 100,000 adult inhabitants. To allow better comparison between countries, future epidemiological studies should use standardized study methodologies with respect to sepsis definitions, hospital size, and daily and monthly variability. The named authors wrote this article on behalf of the German Competence Network Sepsis (SepNet) C. Engel and F. M. Brunkhorst contributed equally to this work     

Looking to the future: adolescents with cerebral palsy talk about their aspirations – a narrative study

Purpose: To explore the future hopes and aspirations of adolescents with cerebral palsy (CP) with a particular focus on their reflections on engagement in leisure activities. Method: This qualitative study used narrative inquiry methodology. Ten adolescents, aged 14–16 years with CP and Manual Ability Classification System levels ranging from I–IV, were purposively sampled from a longitudinal study of leisure participation. Data were gathered during two face–face interviews conducted approximately 1 month apart. Between interviews, photographs were taken by the adolescents to represent their visions of their future aspirations. In accordance with narrative inquiry methodology, the results were presented as individual stories constructed by the researcher. These narratives were subsequently analysed to produce themes representing the participants’ reflections on their future. Results: Three themes were developed: (i) Keeping close relationships, (ii) Choosing a future life of one’s own, (iii) Leisure in the years ahead. All the adolescents had aspirations for education, work, leisure and living situation. Conclusion: This study highlights the value of seeking information from adolescents with CP and suggests clinicians be aware of, and work to support their expectations for future study, employment and recreational engagement.

Implications for Rehabilitation

• To our knowledge, this is the first recent study to describe the aspirations of adolescents with cerebral palsy. The study findings reinforce the value of seeking information directly from the adolescents themselves.

• These adolescents with cerebral palsy had clear aspirations for future education, work, fun, friendship and travel. Although these aspirations seem common to us all, recent research into adult outcomes suggests adolescents with cerebral palsy will need focused support to attain their goals.

• The results highlight the need for educational and health professionals to be future-focused, to take a lifespan perspective, when working with adolescents with childhood disability.

     

Cancer patients’ use of primary care out-of-hours services: a cross-sectional study in Norway

Objective: To investigate how cancer patients in Norway use primary care out-of-hours (OOH) services and describe different contact types and procedures.

Design: A retrospective cross-sectional registry study using a billing registry data source.

Setting: Norwegian primary care OOH services in 2014.

Subjects: All patients’ contacts in OOH services in 2014. Cancer patients were identified by ICPC-2 diagnosis.

Main outcome measures: Frequency of cancer patients’ contacts with OOH services, contact types, diagnoses, procedures, and socio-demographic characteristics.

Results: In total, 5752 cancer patients had 20,220 contacts (1% of all) in OOH services. Half of the contacts were cancer related. Cancer in the digestive (22.9%) and respiratory (18.0%) systems were most frequent; and infection/fever (21.8%) and pain (13.6%) most frequent additional diagnoses. A total of 4170 patients had at least one cancer-related direct contact; of these, 64.5% had only one contact during the year. Cancer patients had more home visits and more physicians’ contact with municipal nursing services than other patients, but fewer consultations (p?p?Conclusion: There was no indication of overuse of OOH services by cancer patients in Norway, which could indicate good quality of cancer care in general.

• KEY POINTS

• Many are concerned about unnecessary use of emergency medical services for non-urgent conditions.

• ??There was no indication of overuse of out-of-hours services by cancer patients in Norway.

• ??Cancer patients had relatively more home visits, physician’s contact with the municipal nursing service, and weekend contacts than other patients.

• ??Cancer patients in the least central municipalities had relatively more contacts with out-of-hours services than those in more central municipalities.