Peter Fentz Haastrup

Background and purpose: This study examined lung cancer patients’ diagnostic pathways, focusing on first healthcare contact, general practice events, referral choice, and stage at diagnosis.Patients and methods: General practices in three Danish regions participated in a retrospective survey of medical records for patients diagnosed with lung cancer between March 2019 and February 2021. General practitioners completed a questionnaire on initial contact, symptom presentation, diagnostic events and first referral. Socioeconomic data and tumor stage were retrieved from national registers. Associations between symptom presentation and diagnostic events were analysed.Results: Among 1069 patients, 72% had initial contact in general practice, 22% at a hospital and 5% with out-of-hours care. Of patients starting in general practice (n = 766), 36% presented specific cancer symptoms, 48% non-specific symptoms, 9% both and 7% were asymptomatic. Diagnostic events included hesitation to seek care (10%), declining investigation or non-adherence (4%) and initial management for another disease (33%). Men were more likely to decline investigation or fail to follow-up (odds ratio [OR] 4.32; 95% confidence interval 1.75–10.65). Non-specific symptoms increased the odds of referral for another condition (OR 1.48) or another cancer type (OR 2.99). Most patients were first referred to imaging (48%), whereas 16% entered a cancer care pathway and 18% were acutely hospitalised. Advanced stage was common (80%) and more likely among acutely hospitalised patients (OR 2.68). Interpretation: Most lung cancer patients present first in general practice. Non-specific symptoms are frequent and pose challenges for timely diagnosis.

This case report describes a 69-year-old woman on long-term pantoprazole therapy, initially prescribed for nonspecific upper gastrointestinal symptoms. Despite resistance to discontinuation due to rebound symptoms, a gradual dose reduction combined with patient education and use of antacids led to successful cessation. The case highlights the importance of regular medication review, patient involvement, and awareness of rebound acid hypersecretion in facilitating rational PPI use and deprescribing efforts.

Timely healthcare seeking with colorectal cancer (CRC) symptoms is crucial for treatment options. This study aims to 1. compare CRC symptom reporting and contact to the general practitioner (GP) in the Danish population in 2012 and 2022, 2. analyze the associations between sex, age and GP contact in 2012 and 2022, and 3. explore considerations about GP contact in 2022. Nationwide surveys on symptoms and GP contact in 2012 and 2022 with 100,000 randomly selected adults invited in each. Four CRC symptom categories, GP contact, and six predefined considerations about GP contact were analyzed by descriptive statistics and multivariable logistic regression models. We included 47,423 individuals in 2012, and 28,328 in 2022. Symptom reporting was similar in the two cohorts, whereas GP contact increased significantly. Abdominal pain prompted the highest GP contact in both years (36.1% in 2012; 44.3% in 2022), while changed bowel habits prompted the lowest (20.4% and 24.8%, respectively). Men had lower odds of GP contact than women for most symptom categories, and odds of seeking healthcare increased with age. Among those with no GP contact, half reported either knowing the cause of their symptom or expecting it to resolve on its own. Among those who reported rectal bleeding and no GP contact, 17% described embarrassment. Despite the increased focus on CRC, many individuals with CRC symptoms reported that they knew the cause and expected it to go away on its own, indicating that they might not associate it with serious disease.

Denmark is known for its good population health, largely attributable to its effective healthcare system. This analysis of the Danish primary healthcare system with focus on general practice describes the system's overall structure, function, and financing. Further, it reviews some of the recent developments in organization and decentralization from secondary to primary care. Finally, we discuss some of the key challenges that primary care faces and potential areas for improvement to ensure a sustainable Danish healthcare system of high quality.

Bowel symptoms are common in general practice and though most often benign they can also indicate colorectal cancer where a colonoscopy often is required to rule out malignant disease. Colon capsule endoscopy (CCE) is suggested as a more patient-friendly alternative to colonoscopy but its application in symptomatic patients in general practice needs further investigation. We present a feasibility study of integrating initial triage for CCE into general practice. The technical success of CCE, patient acceptance, and the experiences of general practitioners (GPs) are assessed through qualitative interviews with participating GPs. We were able to recruit some general practices from the area of interest, but inclusion of patients was low. The participating GPs welcomed the concept of CCE as a more patient-friendly procedure and most patients invited by the GP accepted inclusion. Difficulties remembering the project in the diverse everyday of general practice, GP shortage and general time restraints were reported as barriers for patient recruitment by the GPs. Before conducting large-scale implementation studies of CCE, our investigation highlighted critical barriers that need addressing: (1) Time Constraints and GP Shortages: The design of task divisions between sectors should carefully consider time limitations and the scarcity of GPs. (2) Low reinvestigation rates: Minimizing reinvestigation rates is crucial to reduce strain on both patients and healthcare systems.

To (1) examine considerations before and experiences with GP contact during the first COronaVIrus Disease 2019 (COVID-19) lockdown among Danish citizens; (2) analyse the associations with sex, age, chronic disease, and socioeconomic factors; and (3) explore changes in healthcare-seeking behaviour post-pandemic. A total of 100,000 Danes aged 20 years or older, randomly selected in the general population, were invited to participate in a survey examining considerations and experiences with healthcare seeking during the first COVID-19 lockdown. Data were collected in spring 2022 and linked to register data on socioeconomic factors. Descriptive statistics and multivariable logistic regression models were applied. Of the 27,369 eligible individuals, 18% reported a need to contact their GP. Being worried about burdening the healthcare system was most frequently reported (45%), followed by being in doubt about acceptable contact reasons (33%), and concern about infection (24%). Although 44% of those who needed to contact their GP found the digital solutions advantageous, individuals frequently found it difficult to discuss symptoms by telehealth (29%) and that they were examined less thoroughly. Generally, women, younger people, and individuals with lower socioeconomic status were more likely to be worried and report difficulties with contact to general practice. Some 86% of the respondents reported no changes in healthcare-seeking behaviour post-pandemic. The results may assist in the organisation of healthcare in case of future lockdowns. Yet, the COVID-19 pandemic has only slightly affected the healthcare-seeking behaviour in the Danish general population.

Colorectal cancer (CRC) is among the most common cancers and the prognosis of CRC is highly dependent on stage at diagnosis. Although many cases are diagnosed swiftly, there is still room for improvement. We aimed to explore CRC diagnostic pathways, encompassing (1) place of initial contact; (2) associations with symptom presentations, sex, and age with events in the diagnostic process and initial referrals and (3) the general practitioner's (GP's) evaluation of the diagnostic processes. All GPs in North-, Central-, and Southern Denmark were invited to fill in questionnaires for their listed patients diagnosed with cancer during the past two years. Among 1,032 recorded CRC patients, 65% had their initial contact in general practice, 5% within the out-of hours service, 10% in the hospital, and 20% were diagnosed based on screening. A total of 27% of CRC patients over 40 who initially presented in general practice were treated or referred on suspicion of another disease first, and 9% were reported to have had hesitated in seeking medical attention. Some 37% presented solely non-specific symptoms, increasing the odds of the GP advising watchful waiting (OR 2.48; 95% CI 1.06-5.81), treating or referring on the suspicion of another illness first (OR 2.57; 95% CI 1.76-3.75), wait due to normal findings (OR 2.11; 95% CI 1.16-3.85), or referring to diagnostic imaging (OR 3.07; 95% CI 1.63-5.79). The GPs assessed nearly one fifth of the diagnostic processes as poor. Most CRC patients are diagnosed with initial presentation in general practice. Having non-specific symptoms is common and challenges timely diagnosis.

Incidence of peptic ulcer bleeding can be substantially reduced by prophylactic use of proton pump inhibitors (PPIs) in patients at risk, but use of PPI varies among risk patients, and substantial under-prescribing may exist. The variation in prophylactic prescribing among general practices remains unknown. A nationwide register-based cross-sectional study analyzing the proportion of patients at risk of ulcer bleeding receiving PPI treatment within Danish general practices. Using logistic regression, we analyze associations between general practice characteristics and prophylactic treatment among patients at risk of ulcer bleeding listed with the general practice. In most general practices, less than 40% of the patients at increased risk of ulcer bleeding were covered by PPI. Geographical variation was present, where practice location outside the capital area was associated with higher odds of PPI coverage among their risk patients. Partnership practices with GPs with a mean age ≥65 years or with only female GPs were associated with higher odds of providing prophylaxis among their risk patients compared to practices with a mean GP age <45 years or with only male GPs. Similar associations were not found for single-handed practices. A significant under-prescribing of ulcer prophylaxis is common across all general practice characteristics, and only few associations with practice characteristics were present. Most efforts to rationalize PPI prescribing have aimed at reducing overprescribing but the findings point to under-prescribing as a problem as well. Development of new methods to assist GPs in identifying individuals at risk of ulcer complications is needed.