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  • 1.
    Ekelin, Elsa
    et al.
    University Health Care Research Center, Region Örebro County, Örebro, Sweden.
    Hansson, Anders
    University Health Care Research Center, Region Örebro County, Örebro, Sweden; Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    The dilemma of repeat weak opioid prescriptions - experiences from swedish GPs2018In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 36, no 2, p. 180-188Article in journal (Refereed)
    Abstract [en]

    Objective: To explore general practitioners' (GP) experiences of dealing with requests for the renewal of weak opioid prescriptions for chronic non-cancer pain conditions.

    Design: Qualitative focus group interviews. Systematic text condensation analysis.

    Setting and subjects: 15 GPs, 4 GP residents and 2 interns at two rural and two urban health centres in central Sweden.

    Main outcome measures: Strategies for handling the dilemma of prescribing weak opioids without seeing the patient.

    Results: After analysing four focus group interviews we found that requests for prescription renewals for weak opioids provoked adverse feelings in the GP regarding the patient, colleagues or the GP's inner self and were experienced as a dilemma. To deal with this, the GP could use passive as well as active strategies. Active strategies, like discussing the dilemma with colleagues and creating common routines regarding the renewal of weak opioids, may improve prescription habits and support physicians who want to do what is medically correct.

    Conclusion: Many GPs feel umcomfortable when prescribing weak opioids without seeing the patient. This qualitative study has identified strategic approaches to deal with that issue.

  • 2.
    Giezeman, Maaike
    et al.
    Örebro University, School of Medical Sciences. Centre for Clinical Research, County Council of Värmland, Karlstad, Sweden.
    Arne, Mats
    Centre for Clinical Research, County Council of Värmland, Karlstad, Sweden; Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden.
    Theander, Kersti
    Centre for Clinical Research, County Council of Värmland, Karlstad, Sweden; Department of Nursing, Faculty of Health Science and Technology, Karlstad University, Karlstad, Sweden.
    Adherence to guidelines in patients with chronic heart failure in primary health care2017In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 35, no 4, p. 336-343Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To describe adherence to international guidelines for chronic heart failure (CHF) management concerning diagnostics, pharmacological treatment and self-care behaviour in primary health care.

    DESIGN: A cross-sectional descriptive study of patients with CHF, using data obtained from medical records and a postal questionnaire.

    SETTING: Three primary health care centres in Sweden.

    SUBJECTS: Patients with a CHF diagnosis registered in their medical record.

    MAIN OUTCOME MEASURES: Adherence to recommended diagnostic tests and pharmacological treatment by the European Society of Cardiology guidelines and self-care behaviour, using the European Heart Failure Self-care Behaviour Scale (EHFScBS-9).

    RESULTS: The 155 participating patients had a mean age of 79 (SD9) years and 89 (57%) were male. An ECG was performed in all participants, 135 (87%) had their NT-proBNP measured, and 127 (82%) had transthoracic echocardiography performed. An inhibitor of the renin angiotensin system (RAS) was prescribed in 120 (78%) patients, however only 45 (29%) in target dose. More men than women were prescribed RAS-inhibition. Beta blockers (BBs) were prescribed in 117 (76%) patients, with 28 (18%) at target dose. Mineralocorticoidreceptor antagonists were prescribed in 54 (35%) patients and daily diuretics in 96 (62%). The recommended combination of RAS-inhibitors and BBs was prescribed to 92 (59%), but only 14 (9%) at target dose. The mean score on the EHFScBS-9 was 29 (SD 6) with the lowest adherence to daily weighing and consulting behaviour.

    CONCLUSION: Adherence to guidelines has improved since prior studies but is still suboptimal particularly with regards to medication dosage. There is also room for improvement in patient education and self-care behaviour.

  • 3.
    Hasselgren, Mikael
    et al.
    Centre for Public Health Research, University of Karlstad, Sweden.
    Arne, M
    Centre for Public Health Research, University of Karlstad, Sweden.
    Lindahl, A
    Centre for Public Health Research, University of Karlstad, Sweden.
    Janson, S
    Centre for Public Health Research, University of Karlstad, Sweden.
    Lundbäck, B
    Respiratory Epidemiology Unit, Department of Occupational Medicine, National Institute for Working Life, Umeå and Solna, Sweden.
    Estimated prevalences of respiratory symptoms, asthma and chronic obstructive pulmonary disease related to detection rate in primary health care2001In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 19, no 1, p. 54-57Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To assess the prevalence of respiratory symptoms, asthma and chronic obstructive pulmonary disease (COPD), and to relate it to an estimated detection rate in primary health care.

    DESIGN: A two-staged study with a cross-sectional survey and a clinical validation.

    SETTING: The adult population of Värmland, a county in Sweden.

    SUBJECTS: 4814 persons completed the survey and 206 the confirmative validation study.

    MAIN OUTCOME MEASURES: Prevalence of respiratory symptoms, of asthma and COPD.

    RESULTS: More than 40% reported respiratory symptoms. Wheeze was reported by 8.0%, shortness of breath by 11.4% and sputum production by 14.1%. Smoking was more common among women than among men. The prevalence of asthma was 8.2% and COPD 2.1%. Of persons with asthma, 33% were estimated to be undiagnosed, 67% used medication and nearly 60% attended primary health care services.

    CONCLUSION: Respiratory symptoms as well as asthma were common in this study and equivalent to earlier findings. The difference between the epidemiologically estimated prevalence of asthma and the lower detection rate in primary health care can be explained by at least three factors: persons who did not seek any care, were underdiagnosed or attended other health care providers.

  • 4.
    Hägglund, Doris
    et al.
    Örebro University, Department of Health Sciences.
    Walker-Engström, Marie-Louise
    Larsson, Gregor
    Leppert, Jerzy
    Changes in urinary incontinence and quality of life after four years: a population-based study of women aged 22-50 years2004In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 22, p. 112-117Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES:

    To investigate (a) the incidence and remission rates of female urinary incontinence (UI), (b) changes in type of UI and quality of life (QoL), and (c) whether professional help had been consulted regarding UI.

    DESIGN:

    A 4-year follow-up population-based cohort study.

    SETTING:

    Surahammar, Sweden, a community of 10,500 inhabitants.

    SUBJECTS:

    All 118 incontinent and 130 continent women aged between 22 and 50 years.

    MAIN OUTCOME MEASURES:

    Changes in type of UI were measured using the Detrusor Instability Score (DIS), which was used to distinguish between the stress incontinent and the urge incontinent women. Changes in QoL were measured using the SF-36 Health Survey.

    RESULTS:

    The mean annual incidence and remission rates of UI were the same (4%). The majority of women (83%) reported unchanged UI after 4 years and 77% of these women had stress incontinence. At follow-up, the changes in QoL scores were significantly greater in five out of eight dimensions in the persistently incontinent group compared with the persistently continent group. QoL scores did not change significantly from baseline to the 4-year follow-up within the incidence and remission groups. Three of four women with UI had not sought professional help.

    CONCLUSIONS:

    At 4-year follow-up the type of UI is fairly stable in women below 50 years of age. The QoL decreases in five dimensions, but the clinical relevance of this might be questioned. Most women with UI had not sought professional help.

  • 5.
    Nordin Olsson, Inger
    et al.
    Örebro University, School of Health and Medical Sciences.
    Runnamo, Rebecka
    Family Medicine Research Centre, School of Health and Medical Sciences, Örebro University, Örebro, Sweden; Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Engfeldt, Peter
    Örebro University, School of Health and Medical Sciences.
    Drug treatment in the elderly: an intervention in primary care to enhance prescription quality and quality of life2012In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 30, no 1, p. 3-9Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of the study was to assess the effect on prescription quality and quality of life after intervention with prescription reviews and promotion of patient participation in primary care. Design. A randomized controlled study with three groups: (A) controls, (B) prescription review sent to physician, and (C) as in B and with a current comprehensive medication record sent to the patient. Setting. The municipality of Ö rebro, Sweden (130 000 inhabitants). Intervention. The study focused on the easiest possible intervention to increase prescription quality and thereby increase quality of life. The intervention should be cost-effi cient, focus on colleague-to-colleague advice, and be possible to perform in the primary health care centre without additional resources such as a pharmacist.

    Subjects: 150 patients recently discharged from hospital. Inclusion criteria were: 75 years, fi ve drugs and living in ordinary homes. Main outcome measures. Quality of life (EQ-5D index, EQ VAS) and quality of prescriptions.

    Results: Extreme polypharmacy was common and persistent in all three groups and this was accompanied by an unchanged frequency of drug-risk indicators. There was a low EQ-5D index and EQ VAS in all three groups throughout the study. No statistically signifi cant differences were found anywhere between the groups.

    Conclusion: The intervention seems to have had no effect on quality of prescriptions or quality of life. This underlines the major challenge of fi nding new strategies for improving prescription quality to improve patient outcome measures such as quality of life and reduce the known risks of polypharmacy for the elderly.

  • 6.
    Shebehe, Jacques
    et al.
    The University Healthcare Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Hansson, Anders
    Örebro University, School of Medical Sciences. The University Healthcare Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Academy of Sahlgrenska, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    High hospital readmission rates for patients aged ≥65 years associated with low socioeconomic status in a Swedish region: a cross-sectional study in primary care2018In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 36, no 3, p. 300-307Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: There is a presumption that hospital readmission rates amongst persons aged ≥65 years are mainly dependent on the quality of care. In this study, our primary aim was to explore the association between 30-day hospital readmission for patients aged ≥65 years and socioeconomic characteristics of the studied population. A secondary aim was to explore the association between self-reported lack of strategies for working with older patients at primary health care centres and early readmission.

    DESIGN: A cross-sectional ecological study and an online questionnaire sent to the heads of the primary health care centres. We performed correlation and regression analyses.

    SETTING AND SUBJECTS: Register data of 283,063 patients in 29 primary health care centres in the Region Örebro County (Sweden) in 2014.

    MAIN OUTCOME MEASURE: Thirty-day hospital readmission rates for patients aged ≥65 years. Covariates were socioeconomic characteristics among patients registered at the primary health care centre and eldercare workload.

    RESULTS: Early hospital readmission was found to be associated with low socioeconomic status of the studied population: proportion foreign-born (r = 0.74; p < 0.001), proportion unemployed (r = 0.73; p < 0.001), Care Need Index (r = 0.74; p < 0.001), sick leave rate (r = 0.51; p < 0.01) and average income (r = -0.40; p = 0.03). The proportion of unemployed alone could explain up to 71.4% of the variability in hospital readmission (p < 0.001). Primary health care centres reporting lack of strategies to prevent readmissions in older patients did not have higher hospital readmission rates than those reporting they had such strategies.

    CONCLUSION: Primary health care centres localized in neighbourhoods with low socioeconomic status had higher rates of hospital readmission for patients aged ≥65. Interventions aimed at reducing hospital readmissions for older patients should also consider socioeconomic disparities.

    Key Points

    • In Sweden, hospital readmission within 30 days among patients aged ≥65 has been used as a measure of quality of primary care for the elderly.
    • However, in our study, elderly 30-day readmission was associated with low neighbourhood socioeconomic status.
    • A simple survey in one Swedish region showed that the primary health care centres that lacked active strategies for working with aged patients did not have higher hospital readmission rates than those that reported having strategies.
    • Interventions aimed at reducing elderly hospital readmissions should therefore also consider the socioeconomic disparities in the elderly.
  • 7.
    Skoglund, Ingmarie
    et al.
    Department of Public Health and Community Medicine/Primary Health Care, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden; Research and Development Unit, Primary Health Care and Dental Care, Southern Älvsborg County, Region Västra Götaland, Vänersborg, Sweden.
    Björkelund, Cecilia
    Department of Public Health and Community Medicine/Primary Health Care, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Petzold, Max
    Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Gunnarsson, Ronny
    Cairns Clinical School, School of Medicine and Dentistry, James Cook University, Douglas QLD, Australia.
    Möller, Margareta
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Health Care Sciences, Örebro University Hospital, Region Örebro County, Örebro, Sweden.
    A randomized controlled trial comparing two ways of providing evidence-based drug information to GPs2013In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 31, no 2, p. 67-72Article in journal (Refereed)
    Abstract [en]

    Objective. To investigate whether tailored evidence-based drug information (EBDI) to general practitioners (GPs) can change the proportion of ACE inhibitor prescriptions more effectively than EBDI provided as usual three and six months after the intervention.

    Design. Randomized controlled trial.

    Setting. GPs in southern Sweden working at primary health care centres (PHCCs) in seven drug and therapeutic committee areas.

    Intervention. EBDI tailored to motivational interviewing (MI) technique and focused on the benefit aspect was compared with EBDI provided as usual.

    Subjects. There were 408 GPs in the intervention group and 583 GPs in the control group.

    Main outcome measures. Change in proportion of ACE inhibitor prescriptions relative to the sum of ACE inhibitors and angiotensin receptor blockers, three and six months after the intervention.

    Results. The GPs' average proportions of prescribed ACE inhibitors increased in both groups. No statistically significant differences in the change of proportions were found between intervention and control groups. Information was provided to 29% of GPs in both groups.

    Conclusion. This study could not prove that specially tailored EBDI using MI implements guidelines more effectively than EBDI provided as usual.

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