Diagnosis of patients with raised serum calcium level in primary care, Sweden

Dalemo, Sofia; Hjerpe, Per; Bengtsson, Kristina Boström

doi:10.1080/02813430600784443

Cited by 17 publications

(18 citation statements)

References 16 publications

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“…Overall 5,8% of the inhabitants underwent a P-Ca analysis, which is comparable with an earlier study from Skaraborg (6,1%) [6] and two-fold compared with a study from primary care in southern Stockholm [19] Female patients and patients with previous P-Ca analysis were more likely to have a P-Ca analysis, which could be explained by women's greater risk of pHPT and recurrent check-ups of patients with chronic diseases.…”

Section: Discussionsupporting

confidence: 88%

“…Even though previous studies indicate that the frequency of P-Ca analyses differs between health care centres (HCC) [6] the understanding of the relative importance of the different levels (patients, physicians, HCCs) for these differences is limited. However, in a study from New Zealand where a defined clinical situation was presented to GPs, it was shown that inherent characteristics of the physicians more than the patients clinical situation determined which laboratory tests were ordered [7].…”

Section: Introductionmentioning

confidence: 99%

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Variation in plasma calcium analysis in primary care in Sweden - a multilevel analysis

et al. 2010

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BackgroundPrimary hyperparathyroidism (pHPT) is a common disease that often remains undetected and causes severe disturbance especially in postmenopausal women. Therefore, national recommendations promoting early pHPT detection by plasma calcium (P-Ca) have been issued in Sweden. In this study we aimed to investigate variation of P-Ca analysis between physicians and health care centres (HCCs) in primary care in county of Skaraborg, Sweden.MethodsIn this cross sectional study of patients' records during 2005 we analysed records from 154 629 patients attending 457 physicians at 24 HCCs. We used multilevel logistic regression analysis (MLRA) and adjusted for patient, physician and HCC characteristics. Differences were expressed as median odds ratio (MOR).ResultsThere was a substantial variation in number of P-Ca analyses between both HCCs (MORHCC 1.65 [1.44-2.07]) and physicians (MORphysician 1.95 [1.85-2.08]). The odds for a P-Ca analysis were lower for male patients (OR 0.80 [0.77-0.83]) and increased with the number of diagnoses (OR 25.8 [23.5-28.5]). Sex of the physician had no influence on P-Ca test ordering (OR 0.93 [0.78-1.09]). Physicians under education ordered most P-Ca analyses (OR 1.69 [1.35-2.24]) and locum least (OR 0.73 [0.57-0.94]). More of the variance was attributed to the physician level than the HCC level. Different mix of patients did not explain this variance between physicians. Theoretically, if a patient were able to change both GP and HCC, the odds of a P-Ca analysis would in median increase by 2.45. Including characteristics of the patients, physicians and HCCs in the MLRA model did not explain the variance.ConclusionsThe physician level was more important than the HCC level for the variation in P-Ca analysis, but further exploration of unidentified contextual factors is crucial for future monitoring of practice variation.

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Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Variation in plasma calcium analysis in primary care in Sweden - a multilevel analysis

et al. 2010

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“…Medical records of all patients with elevated calcium concentrations between 1995–2000 have been studied previously [12], Figure 1. At baseline, 1995–2000, an elevated calcium concentration was defined as ≥2.56 mmol/l in at least one test.…”

Section: Methodsmentioning

confidence: 99%

Quality of life and health care consumption in primary care patients with elevated serum calcium concentrations in - a prospective, case control, study

et al. 2014

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BackgroundPatients with elevated calcium concentrations have an increased morbidity due to various underlying illnesses. However, there is a lack of studies of quality of life and health care consumption in patients with hypercalcaemia per se. The study aims to investigate quality of life and health care consumption, as measured by, sick leave, drug prescriptions and the number of visits and admissions to health care centres and hospitals, in primary care patients with elevated calcium concentrations.MethodsA prospective, case control, study in primary care centre, in Sweden. Patients with elevated, (n = 127, 28 men), and normal calcium concentrations, (n = 254, 56 men), mean age 61.4 year, were recruited in the study and followed during 10 years. Eighty-six percent of those alive at the time of follow up participated in a follow up visit. The study participants completed a quality of life survey, SF-36, which also were compared with the Swedish SF-36 national normative database.ResultsPatients with elevated calcium concentrations had significantly lower quality of life both compared with the control group (patients with normal calcium concentrations) and compared with age and gender-matched reference material from the Swedish SF-36 national normative database. The group with elevated calcium concentrations had significantly more hospitalisations (p = 0.017), subsequently cancer diagnoses (p < 0.003), sick leave (p = 0.007) and medication (p = 0.002) compared with patients with normal calcium concentrations. Men with elevated calcium concentrations had more contacts with the psychosocial team (p = 0.02) at the health care centre.ConclusionsElevated calcium concentrations are associated with significantly reduced quality of life and increased health care consumption and should therefore be an important warning flag that should alert the physician to further investigate and care for the patient. This is the first study in this field and the results need to be confirmed in further studies.

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“…In a previous study we showed that no underlying cause was found in 55% of the patients with elevated calcium concentrations in primary care [3]. As the calcium concentration is often included in primary care routine analyses, more knowledge is needed concerning the effects of increased calcium concentrations on morbidity and mortality.…”

Section: Introductionmentioning

confidence: 99%

Long-term follow-up of patients with elevated serum calcium concentrations in Swedish primary care

Dalemo

Eggertsen

Hjerpe

et al. 2013

Scandinavian Journal of Primary Health Care

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ObjectiveTo follow up patients with elevated calcium concentrations after 10 years.DesignLongitudinal, using medical records, questionnaires, and clinical investigation.SettingPrimary care in Tibro, Sweden, 2008–2010.Subjects127 patents with elevated calcium concentrations and 254 patients with normal calcium concentrations from the local community, attending the health care centre.Main outcome measuresDiagnoses and mortality in patients with elevated calcium concentrations in 1995–2000, compared with patients with normal calcium concentrations and the background population.ResultsThe proportion of patients for whom no underlying cause was detected decreased from 55% at baseline to 12% at follow-up. Primary hyperparathyroidism was most common in women, 23% at baseline and 36% at follow-up, and the cancer prevalence increased from 5% to 12% in patients with elevated calcium concentration. Mortality tended to be higher in men with elevated calcium concentrations compared with men with normal calcium concentrations, and was significantly higher than in the background population (SMR 2.3, 95% CI 1.3–3.8). Cancer mortality was significantly increased in men (p = 0.039). Low calcium concentrations were also associated with higher mortality (p = 0.004), compared with patients with normal calcium concentrations.ConclusionThis study underscores the importance of investigating patients with increased calcium concentrations suggesting that most of these patients – 88% in our study – will turn out to have an underlying disease associated with hypercalcaemia during a 10-year follow-up period. Elevated calcium concentrations had a different disease pattern in men and women, with men showing increased cancer mortality in this study.

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Diagnosis of patients with raised serum calcium level in primary care, Sweden

Cited by 17 publications

References 16 publications

Variation in plasma calcium analysis in primary care in Sweden - a multilevel analysis

Variation in plasma calcium analysis in primary care in Sweden - a multilevel analysis

Quality of life and health care consumption in primary care patients with elevated serum calcium concentrations in - a prospective, case control, study

Long-term follow-up of patients with elevated serum calcium concentrations in Swedish primary care

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