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  • 1.
    Backman, Christian
    et al.
    School of Medical Sciences, Örebro University, Örebro, Sweden.
    Johansson, Ulf
    University Health Care Research Center, Örebro University Hospital, Örebro, Sweden.
    Hellgren, Mikko
    Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Center.
    Knowledge in and support for standardised cancer care pathways among general practitioners and other physicians in Sweden2021In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 39, no 1, p. 17-22Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate the expertise in and support of the implemented new method of cancer patient pathways (CPPs) among general practitioners (GPs) and other working physicians in Sweden.

    DESIGN: A survey in the form of 10 knowledge-based multiple-choice questions (MCQs) and two general questions about CPPs.

    SETTING: Physicians from two different regions in Sweden answered the survey between December 2018 and January 2019.

    SUBJECTS: GPs in primary care compared to other physicians. 155 participants completed the survey and the response rate was 65%.

    MAIN OUTCOME MEASURES: Physicians' self-estimated knowledge of CPPs in general and opinion of CPPs effect on mortality and morbidity. Their scores on 10 different MCQs. Scores were analysed in subgroups related to the physicians medical specialty and experience.

    RESULTS: A majority of all physicians (63%) felt that they had insufficient knowledge regarding the procedure of CPPs, and the average score from the MCQs was 3.8 out of 10 correct answers. The results showed that GPs performed significantly better than specialists from other disciplines.

    CONCLUSIONS: The low percentage of correctly answered MCQs shows that the information about the entry part of CPPs needs to be improved. The study demonstrates a support for the system with CPPs because the physicians believed in its' positive effects on morbidity and mortality, however, it also reveals a lack of self-estimated knowledge about the system with CPPs.

    Key points

    Cancer patient pathways (CPPs) is a newly implemented method in Sweden that aims to equalize cancer care and reduce the time to diagnosis and treatment.

    • The proficiency of when to initiate an investigation according to a specific CPP seems low. General practitioners (GPs) performed significantly better on knowledge-based questions than other specialists did.
    • Physicians rated their knowledge as insufficient regarding the procedure of CPPs.
    • A clear majority of physicians believed that CPPs promotes a lower mortality and morbidity in cancer.
  • 2.
    Baumbach, Linda
    et al.
    Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
    Ankerst, Donna
    Department of Mathematics and School of Life Sciences, Technical University of Munich, Munich, Germany.
    Roos, Ewa M.
    Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
    Nyberg, Lillemor A.
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Cottrell, Elizabeth
    Primary Care Centre Versus Arthritis, Keele University, Keele, UK.
    Lykkegaard, Jesper
    Department of Public Health, Research Unit for General Practice, University of Southern Denmark, Odense, Denmark.
    Association between received treatment elements and satisfaction with care for patients with knee osteoarthritis seen in general practice in Denmark2021In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 39, no 2, p. 257-264Article in journal (Refereed)
    Abstract [en]

    Objective: While education, exercise, and weight reduction when indicated, are recommended first-line treatments for knee osteoarthritis patients, they remain poorly implemented in favour of pain killer treatment, imaging and referral to surgery. A reason could be that patients are more satisfied with receiving these adjunctive treatment elements. This study aimed to investigate the associations between the received elements of care and the patient's satisfaction with the care for knee osteoarthritis in general practice.

    Design: Cross-sectional study.

    Setting: A Danish general practice.

    Subjects: All consecutive patients >= 30 years of age who consulted the general practitioner (GP) with chronic knee complaints during 18 months and who replied to a mailed questionnaire (n = 136).

    Main outcome measures: The questionnaire addressed patient's knee-related quality of life, and overall satisfaction with care, as well as reception of seven types of information, which are known quality indicators. Information on reception of adjunctive treatment elements was obtained from electronic medical records.

    Results: Patient satisfaction (versus neutrality/dissatisfaction) was positively associated with reception of information on: physical activity and exercise (relative risks [RR] 1.38, 95% bootstrap percentile interval [BPI] 1.02-4.33), and the relationship between weight and osteoarthritis (1.38, 1.01-4.41). No significant associations were found for the five remaining types of information and all the adjunctive treatment elements.

    Conclusion: Providing information as education to patients with knee osteoarthritis as part of the treatment is positively associated with satisfaction with care.

  • 3.
    Damhus, Christina Sadolin
    et al.
    The Section and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Primary & eHealth Care, Region Zealand, Denmark.
    Siersma, Volkert
    The Section and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
    Hansson, Anders
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Bang, Christine Winther
    The Section and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
    Brodersen, John
    The Section and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Primary & eHealth Care, Region Zealand, Denmark.
    Psychosocial consequences of screening-detected abdominal aortic aneurisms: a cross-sectional study2021In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 39, no 4, p. 459-465Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: In Sweden, an abdominal aortic aneurysm (AAA) screening programme was gradually implemented from 2009 to reduce the incidence of rupture and thereby mortality. AAA screening introduces a variety of unintended, but generally unavoidable, harms, e.g. stress and worry. Such psychosocial consequences have previously only been investigated with generic measures. Therefore, the aim of this study was to describe and compare the psychosocial consequences in men with a screening detected AAA to men with a normal screening result after they participated in the Swedish national AAA-screening programme using a validated psychometric instrument.

    MATERIAL AND METHODS: This study was a cross-sectional survey. Data were originally collected to validate the COS-AAA and has previously been published in details. The Consequences of Screening in Abdominal Aortic Aneurysm (COS-AAA) questionnaire was sent to 250 men with a screening detected AAA and 500 with a normal screening result who were randomly selected from a Swedish population-based screening register.

    RESULTS: In total, 158 (63%) men with a screening detected AAA and 275 (55%) men with a normal screening result completed the COS-AAA. We found that men with a screening detected AAA reported negative psychosocial consequences to a greater extent in 10 of 13 COS-AAA Part 1 scales, all statistically significant except three (behaviour, sleep and negative experiences from examination). For COS-AAA Part 2, there was a statistically significant difference between groups in four of five scales.

    CONCLUSIONS: Men diagnosed with a screening detected AAA, reported more negative psychosocial consequences compared to men with a normal result. Screening for abdominal aorta aneurism (AAA) introduces intended benefits and unintended harms. Adequate measures are necessary to determine the balance between them.Key points:This study applied a condition-specific questionnaire with high content validity and adequate psychometric properties to measure psychosocial consequences in men participating in AAA screening.We found that men with a screening detected AAA reported more negative psychosocial consequences than men with a normal aorta size.The risk of negative psychosocial consequences is important to include in the decision making on whether to participate in screening or not.

  • 4.
    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.

  • 5.
    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.

  • 6.
    Giezeman, Maaike
    et al.
    Örebro University, School of Medical Sciences. Centre for Clinical Research, Region Värmland, Karlstad, Sweden.
    Theander, Kersti
    Centre for Clinical Research, Region Värmland, Karlstad, Sweden.
    Zakrisson, Ann-Britt
    Örebro University, School of Health Sciences. Örebro University Hospital.
    Sundh, Josefin
    Örebro University, School of Medical Sciences. Department of Respiratory Medicine, School of Medical Sciences, Örebro University, Örebro, Sweden.
    Hasselgren, Mikael
    Örebro University, School of Medical Sciences.
    Exploration of the feasibility to combine patients with chronic obstructive pulmonary disease and chronic heart failure in self-management groups with focus on exercise self-efficacy2022In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 40, no 2, p. 208-216Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To compare the level of exercise self-efficacy, symptoms, functional capacity and health status and investigate the association between these variables in patients with chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF). Additionally, to investigate how diagnosis, symptoms and patient characteristics are associated with exercise self-efficacy in these patient groups.

    DESIGN: Cross-sectional study.

    SETTING: Primary care.

    SUBJECTS: Patients (n = 150) with COPD (n = 60), CHF (n = 60) and a double diagnosis (n = 30).

    MAIN OUTCOME MEASURES: Swedish SCI Exercise Self-Efficacy score, modified Medical Research Council Dyspnea score (mMRC), fatigue score, pain severity score, Hospital Anxiety and Depression Scale, functional capacity measured as six-minute walking distance and health status measured by a Visual Analogue Scale.

    RESULTS: Levels of exercise self-efficacy, health status and symptoms were alike for patients with COPD and patients with CHF. Functional capacity was similar after correction for age. Associations with exercise self-efficacy were found for slight dyspnea (mMRC = 1) (R -4.45; 95% CI -8.41- -0.50), moderate dyspnea (mMRC = 2) (-6.60;-10.68- -2.52), severe dyspnea (mMRC ≥ 3) (-9.94; -15.07- -4.80), fatigue (-0.87;-1.41- -0.32), moderate pain (-3.87;-7.52- -0.21) and severe pain (-5.32;-10.13- -0.52), symptoms of depression (-0.98;-1.42- -0.55) and anxiety (-0.65;-0,10- -0.32), after adjustment for diagnosis, sex and age.

    CONCLUSION AND IMPLICATIONS: Patients with COPD or CHF have similar levels of exercise self-efficacy, symptoms, functional capacity and health status. More severe symptoms are associated with lower levels of exercise self-efficacy regardless of diagnosis, sex and age. When forming self-management groups with a focus on exercise self-efficacy, it seems more relevant to consider level of symptoms than the specific diagnosis of COPD or CHF.Key pointsExercise training is an important part of self-management in patients with COPD and chronic heart failure (CHF). High exercise self-efficacy is required for optimal exercise training.Patients with COPD and CHF have similar symptoms and similar levels of exercise self-efficacy, functional capacity and health status.Not the diagnosis, but symptoms of dyspnea, fatigue, pain, depression and anxiety are important factors influencing exercise self-efficacy and need to be addressed.When forming self-management groups with a focus on exercise self-efficacy, it seems more relevant to consider the level of symptoms than the specific diagnosis of COPD or CHF.

  • 7.
    Hansson, Anders
    et al.
    Munkedals Health Care Centre, Munkedal, Sweden.
    Gunnarsson, Ronny
    Department of Public Health and Community Medicine/Primary Health Care, Sahlgrenska Academy, Göteborg University, Göteborg, Sweden.
    Mattsson, Bengt
    Department of Public Health and Community Medicine/Primary Health Care, Sahlgrenska Academy, Göteborg University, Munkedal, Sweden.
    Balancing - an equilibrium act between different positions: an exploratory study on general practitioners' comprehension of their professional role2007In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 25, no 2, p. 80-85Article in journal (Refereed)
    Abstract [en]

    Objective. There is a call to make the duties and working conditions of the GP more transparent. The aim of this study was to explore practising GPs’ personal experiences of their professional role and what they regard to be its salient characteristics. Design. An exploratory and descriptive study was undertaken by interviewing GPs and by performing a focus-group study of experienced GPs. The interviews were transcribed and analysed, and the text was categorized according to content analysis. Setting. The practice of the interviewed GPs. Subjects. Seven GPs in individual interviews and a focus group of experienced GPs. Results. A major theme, Balancing, was identified. It was derived from a number of opposing concepts to which different features were related. “The good shepherd” versus “The medical expert”; “Curing” versus “Caring”; “Short visits” versus “Long consultations”; “The personal doctor” versus “The society's doctor”. In many consultations the GP has to contemplate how to stay in focus between these diverse roles. Conclusion.General practice requires a balance to be achieved between a number of opposing conditions. In their clinical work GPs have to adjust to and integrate alternative perspectives. Problems of recruiting new GPs might be associated with dilemmas in this balancing act.

  • 8.
    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.

  • 9.
    Hellgren, Mikko
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Centre, Örebro University Hospital, Örebro, Sweden.
    Wennberg, Patrik
    Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden.
    Hedin, Katarina
    Futurum, Jönköping, Region Jönköping County, Sweden; Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; Department of Clinical Sciences in Malmö, Family Medicine, Lund University, Malmö, Sweden.
    Jansson, Stefan P. O.
    Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Centre, Örebro University Hospital, Örebro, Sweden; Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Nilsson, Staffan
    Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
    Nilsson, Gunnar
    Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden.
    Wändell, Per
    Department of Neurobiology, Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Huddinge, Sweden.
    Bengtsson Boström, Kristina
    School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.
    Hypertension management in primary health care: a survey in eight regions of Sweden2023In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 41, no 3, p. 343-350Article in journal (Refereed)
    Abstract [en]

    Purpose: To explore hypertension management in primary healthcare (PHC).

    Design: Structured interviews of randomly selected PHC centres (PHCCs) from December 2019 to January 2021.

    Setting: Seventy-six PHCCs in eight regions of Sweden.

    Main outcome measures: Staffing and organization of hypertension care. Methods of measuring blood pressure (BP), laboratory tests, registration of co-morbidities and lifestyle advice at diagnosis and follow-up.

    Results: The management of hypertension varied among PHCCs. At diagnosis, most PHCCs (75%) used the sitting position at measurements, and only 13% routinely measured standing BP. One in three (33%) PHCCs never used home BP measurements and 25% only used manual measurements. The frequencies of laboratory analyses at diagnosis were similar in the PHCCs. At follow-up, fewer analyses were performed and the tests of lipids and microalbuminuria decreased from 95% to 45% (p < 0.001) and 61% to 43% (p = 0.001), respectively. Only one out of 76 PHCCs did not measure kidney function at routine follow-ups. Lifestyle, physical activity, food habits, smoking and alcohol use were assessed in ≥96% of patients at diagnosis. At follow-up, however, there were fewer assessments. Half of the PHCCs reported dedicated teams for hypertension, 82% of which were managed by nurses. There was a great inequality in the number of patients per tenured GP in the PHCCs (median 2500; range 1300-11300) patients.

    Conclusions: The management of hypertension varies in many respects between PHCCs in Sweden. This might lead to inequity in the care of patients with hypertension.

    KEY POINTS: Hypertension is mainly handled in primary healthcare (PHC), and this study shows important dissimilarities in organization and clinical management. Several variants in techniques and measurements of blood pressure were found between PHC centres. Lifestyle, clinical and laboratory assessments decreased at follow-ups compared to at diagnosis, specifically for lipids, microalbuminuria and electrocardiograms. Nearly half of the PHC centres reported that they had dedicated hypertension teams.

  • 10.
    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.

  • 11.
    Högberg, Cecilia
    et al.
    Department of Public Health and Clinical Medicine, Unit of Research, Education and Development Östersund, Umeå University, Umeå, Sweden.
    Cronberg, Olof
    Department of Clinical Sciences, Lund University, Lund, Malmö; Department of R & D, Region Kronoberg, Växjö, Sweden.
    Thulesius, Hans
    Department of Clinical Sciences, Lund University, Lund, Malmö; Department of R & D, Region Kronoberg, Växjö, Sweden; Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden.
    Lilja, Mikael
    Department of Public Health and Clinical Medicine, Unit of Research, Education and Development Östersund, Umeå University, Umeå, Sweden.
    Jansson, Stefan P. O.
    Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Centre, School of Medical Sciences, Örebro University, Örebro, Sweden; Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Gunnarsson, Ulf
    Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden.
    Use of faecal immunochemical tests common in patients with suspected colorectal cancer but unrelated to travel distance to secondary care: a population-based study from Swedish primary care2022In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 40, no 4, p. 459-465Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Evidence is increasing for the use of faecal immunochemical tests (FITs) for occult blood as diagnostic tools when colorectal cancer can be suspected. FITs have been used for this purpose in Swedish primary care since around 2005 despite absence of supporting guidelines. To our knowledge, the extent of this use has not been studied.

    OBJECTIVE: To investigate the use of FITs as diagnostic tools, and if the use was related to patient age, sex and travel time from primary care to diagnostic facilities in secondary care.

    DESIGN: Population-based retrospective study using data from electronic health records.

    SETTING AND SUBJECTS: Patients ≥18 years that provided FITs in primary care in five Swedish health care regions during 2015. Driving times from their primary care centres to secondary care were calculated.

    MAIN OUTCOME MEASURES: The proportion of patients that provided FITs was calculated for each region, different age intervals and grouped driving times.

    RESULTS: 18,913 patients provided FITs. The proportion of listed patients in the five regions that provided FITs increased with age: 0.86-1.2% for ages <65 years, 3.6-4.1% for ages 65-79 years and 3.8-6.1% for ages ≥80 years. Differences between the regions were small. There was no overall correlation between the proportion of patients that provided FITs and driving time to secondary care.

    CONCLUSION: FITs were used extensively in Swedish primary care with a higher use in older age groups. There was no tendency towards a higher use of FITs at primary care centres with longer driving times to secondary care.Key PointsEvidence is increasing for the use of faecal immunochemical tests (FITs) as diagnostic tools when colorectal cancer can be suspected. We investigated the use of FITs in Sweden.FITs were used extensively in primary care especially in older age groups.There were small differences in the use of FITs between five studied health care regions.There was no tendency towards a higher use of FITs at primary care centres with longer driving times to diagnostic facilities in secondary care.

  • 12.
    Nilsing Strid, Emma
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Center.
    Wallin, Lars
    School of Health and Welfare, Dalarna University, Falun, Sweden.
    Nilsagård, Ylva
    Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Center.
    Exploring expectations and readiness for healthy lifestyle promotion in Swedish primary health care: a qualitative analysis of managers, facilitators, and professionals2024In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Prior to a multifaceted implementation strategy for a healthy lifestyle-promoting practice the expectations of primary health care managers, appointed internal facilitators and health care professionals on supporting change was explored.

    DESIGN: This study had an explorative qualitative design using data gathered from individual interviews and focus groups. Qualitative content analysis with a deductive category development was applied using the Consolidated Framework for Implementation Research.

    SETTING AND PARTICIPANTS: The study was conducted in a primary care setting in central Sweden as a part of the Act in Time research project. Prior to a multifaceted implementation strategy, we held 16 individual interviews with managers and appointed facilitators and five focus groups with 26 health care professionals.

    RESULTS: Managers, facilitators, and professionals held similar expectations, where their expressed need for support corresponded to three constructs: Readiness for implementation, Implementation climate, and Engaging. Our findings indicate the need for strong leadership engagement to focus on how the healthy lifestyle-promoting practice can be anchored among the professionals. Managers at all levels should communicate the vision and goals, enable facilitators and professionals to improve their competencies, build inter-professional teams, and jointly plan the new practice.

    CONCLUSION: To change to a healthy lifestyle promoting practice professionals request support from their managers, who in turn need support from the middle and top managers. The requested support includes helping to prioritise health promotion and enabling the primary care centres to build competence and take ownership of the implementation.

    TRIAL REGISTRATION: ClinicalTrials.gov NCT04799860.

  • 13.
    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.

  • 14.
    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.
  • 15.
    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.

  • 16.
    Westerling, Ulrika
    et al.
    Örebro University, School of Health Sciences. University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Kumla Primary Health Care Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Hellgren, Mikko
    Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Kumla Primary Health Care Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Hermansson, Liselotte
    Örebro University, School of Health Sciences. University Health Care Research Center.
    Nilsing Strid, Emma
    Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Center.
    In safe hands: a qualitative study on older adults' experiences of a tailored primary health care unit2022In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 40, no 2, p. 271-280Article in journal (Refereed)
    Abstract [en]

    Objective: Today's health care system faces challenges in meeting the needs of older people with multimorbidity. To better cope with these needs, tailored primary health care with geriatric competence and person-centred care has been suggested. The aim of this study was to explore older patients' experiences of a tailored primary health care unit.

    Design: This was a qualitative study using semi-structured individual interviews and qualitative content analysis.

    Setting and patients: Nineteen patients were recruited from a tailored PHC unit for people aged 75 years or older in a region in central Sweden.

    Methods: The interview data were analysed using inductive category development.

    Results: In the analysis, the theme In safe hands when in need of primary health care emerged. The interviewees expressed a desire to participate in their own care. Easy access, enough consultation time and a calm environment, along with the PHC professionals' welcoming and attentive approach enhanced their feeling of being in safe hands. PHC professionals were perceived as having geriatric knowledge and taking responsibility for the care of older patients. Although the interviewees experienced that they received attention for their health conditions, a need for a more preventive approach to care emerged.

    Conclusion: Older patients highly appreciated their tailored PHC unit and they emphasised that it was an improvement compared to the ordinary PHC centre. This study provides insights into older patients' experiences, which may be helpful in the ongoing process of improving care for older patients in PHC.

    • Older patients attending a tailored Primary health care (PHC) unit felt acknowledged, unlike in the ordinary PHC centre, which facilitated their participation in their care.
    • The calm environment, specialist geriatric competence and ample patient contact time enabled them to feel secure and taken care of.
    • Older patients expressed a need for an incorporation of social services and health promotion visits at the tailored PHC unit.
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