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  • 1.
    Belfrage, Björn
    et al.
    Västra Götaland Primary Health Care, Närhälsan Dals‐Ed Health Center, Ed, Sweden.
    Hansson, Anders
    FoUU‐centrum in Fyrbodal, Research Unit and Section for General Practice, Vänersborg, Sweden.
    Bake, Björn
    Department of Respiratory Medicine and Allergology, Sahlgrenska Academy, University of Gothenburg, , Gothenburg, Sweden.
    Performance and interpretation of spirometry among Swedish hospitals2014Inngår i: Clinical Respiratory Journal, ISSN 1752-6981, E-ISSN 1752-699X, Vol. 10, nr 5, s. 567-573Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background and Aims

    It is unclear to what extent spirometric performance and interpretation is standardized in Sweden. The aim of this study was to find out how spirometry is performed and interpreted in large Swedish hospitals.

    Methods

    In telephone interviews, technicians and physicians working with lung function measurements at 21 large Swedish hospitals were interviewed about routines for spirometry.

    Results

    Answers were obtained from 37 of the 42 departments contacted revealing differences in the spirometric routines. Some departments lack a written method description, and three different prediction equations were used among the departments. Different ways of calculating the forced expiratory volume in 1 s (FEV1)/vital capacity (VC) ratio (FEV%) were found and also differences in performance and interpretation of the reversibility test. When diagnosing chronic obstructive pulmonary disease, none of the departments reported using an individualized diagnostic limit of FEV1/VC based on age, sex and height.

    Conclusion

    There is a need for standardization of performance and interpretation of the spirometry test in Sweden and probably also in other countries.

  • 2.
    Brodersen, John
    et al.
    Section and Research Unit for General Practice, Department of Public Health, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark; Primary Health Care Research Unit, Sorø, Zealand Region Denmark .
    Hansson, Anders
    Örebro universitet, Institutionen för medicinska vetenskaper. The University Health Care Research Center, Region Örebro County, Örebro, Sweden; Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Johansson, Minna
    Research Unit and Section for General Practice, FoUU-centrum Fyrbodal, Vänersborg, Sweden; Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Siersma, Volkert
    Section and Research Unit for General Practice, Department of Public Health, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
    Langenskiöld, Marcus
    Department of Vascular Surgery and Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden; The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
    Pettersson, Monica
    Department of Vascular Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden; Sahlgrenska Academy, University of Gothenburg, Institute of Health and Care Sciences, Gothenburg, Sweden.
    Consequences of screening in abdominal aortic aneurysm: development and dimensionality of a questionnaire2017Inngår i: Journal of patient-reported outcomes, ISSN 2509-8020, Vol. 2, artikkel-id 37Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: In interview studies, men under surveillance for screening-detected abdominal aortic aneurysms have reported ambivalence towards this diagnosis: the knowledge was welcomed together with worries, feelings of anxiety and existential thoughts about life's fragility and mortality due to the diagnosis. Previous surveys about health-related quality of life aspects among men under surveillance for screening-detected aneurysm have all used generic patient-reported outcomes. Therefore, the aim of this study was to extend the core-questionnaire Consequences of Screening for use in abdominal aortic aneurysm screening by testing for comprehension, content coverage, dimensionality, and reliability.

    Methods: In interviews, the suitability, content coverage, and relevance of the core-questionnaire Consequences of Screening were tested on men under surveillance for a screeningdetected abdominal aortic aneurysm. The results were thematically analysed to identify the key consequences of abnormal screening results. Item Response Theory and Classical Test Theory were used to analyse data. Dimensionality, differential item functioning, local response dependency and reliability were established by item analysis, examining the fit between item responses and Rasch models.

    Results: The core-questionnaire Consequences of Screening was found to be relevant for men offered regular follow-up of an asymptomatic screening-detected abdominal aortic aneurysm.Fourteen themes especially relevant for men diagnosed with a screening-detected abdominal aortic aneurysm were extracted from the interviews: 'Uncertainty about the result of the ultra sound examination', 'Change in body perception', 'Guilt', 'Fear and powerlessness', 'Negative experiences from the examination', 'Emotional reactions', 'Change in lifestyle', 'Better not knowing', 'Fear of rupture', 'Sexuality', 'Information', 'Stigmatised', 'Self-blame for smoking', 'Still regretful smoking'. Altogether, 55 new items were generated: 3 were single items and 13 were only relevant for former or current smokers. 51 of the 52 items belonging to a theme were confirmed to fit Rasch models measuring fourteen different constructs. No differential item functioning and only minor local dependency was revealed between some of the 51 items.

    Conclusions: The reliability and the dimensionality of a condition-specific measure with high content validity for men under surveillance for a screening-detected abdominal aortic aneurysm have been demonstrated. This new questionnaire called COS-AAA covers in two parts the psychosocial experience in abdominal aortic aneurysm screening.

  • 3.
    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 GPs2018Inngår i: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 36, nr 2, s. 180-188Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 4.
    Hansson, Anders
    et al.
    Department of Public Health and Community Medicine/Primary Health Care, University of Gothenburg, Gothenburg, Sweden.
    Arvemo, Tobias
    Department of Economics and Informatics, Health and Culture, University West, Trollhättan, Sweden.
    Marklund, Bertil
    Department of Public Health and Community Medicine/Primary Health Care, University of Gothenburg, Gothenburg, Sweden.
    Gedda, Birgitta
    Department of Nursing, Health and Culture, University West, Trollhättan, Sweden.
    Mattsson, Bengt
    Department of Public Health and Community Medicine/Primary Health Care, University of Gothenburg, Gothenburg, Sweden.
    Working together: primary care doctors' and nurses' attitudes to collaboration2010Inngår i: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 38, nr 1, s. 78-85Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Multidisciplinary teamwork is recommended for various disorders and it has been suggested that it is a way to meet the new challenges and demands facing general practitioners (GPs) in modern society. Attempts to introduce the method in primary care have failed partly due to GPs’ unwillingness to participate. The aim of this study was to measure attitudes towards collaboration among GPs and district nurses (DN) and to investigate whether there is a correlation between a positive attitude toward collaboration and high self-esteem in the professional role. Methods: The Jefferson Scale of Attitudes toward Physician Nurse Collaboration and the Professional Self-Description Form (PSDF) was used to study a cohort of 600 GPs and DNs in Västra Götaland region. The purpose was to map differences and correlations of attitude between DNs and GPs, between male and female GPs, and between older and younger DNs and GPs. Results: Four hundred and one answers were received. DNs (mean 51.7) were significantly more positive about collaboration than GPs (mean 49.4). There was no difference between younger and older, male and female GPs. DNs scored higher on the PSDF-scale than GPs. Conclusions: DNs were slightly more positive about collaboration than GPs. A positive attitude towards collaboration did not seem to be a part of the GPs’ professional role to the same extent as it is for DNs. Professional norms seem to have more influence on attitudes than do gender roles. DNs seem more confident in their profession than GPs.

  • 5.
    Hansson, Anders
    et al.
    Research Unit and Section for General Practice, FoUU-centrum i Fyrbodal, Vänersborg, Sweden.
    Brodersen, John
    Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
    Reventlow, Susanne
    Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
    Pettersson, Monica
    Department of Vascular Surgery, Sahlgrenska University Hospital, Gothenburg, sweden; Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Opening Pandora's box: The experiences of having an asymptomatic aortic aneurysm under surveillance2012Inngår i: Health, Risk and Society, ISSN 1369-8575, E-ISSN 1469-8331, Vol. 14, nr 4, s. 341-359Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Abdominal aortic aneurysm (AAA) is a ballooning-out of the aorta that does not normally give any symptoms. Undetected and untreated an aortic aneurysm can rupture, which in most cases is fatal. Mass screening of 65-year old men for the early detection of AAA and, in selected cases, operation seem to reduce mortality due to rupture, although, screening has not reduced the overall mortality in this group. In Västra Götaland, the southwest part of Sweden, screening for AAA amongst 65-year old men started in 2009. There are controversies within the medical community about the benefits and adverse effects of screening. In order to explore men's experiences of being screened and knowing they had an aortic aneurysm, we undertook a qualitative interview study with 15 men who in the screening programme were identified as having an aortic aneurysm and who were to be followed-up with annual ultrasonic examinations for an indeterminate number of years. The interviews were analysed for categories and themes using content analysis. The study found that the men were ambivalent about the knowledge that they had an AAA and about the follow-up monitoring. They appreciated having the knowledge but it was accompanied by worry, feelings of anxiety and existential thoughts about the fragility and finiteness of life. We recommend that before a screening programme is implemented, the psycho-social consequences should be thoroughly investigated. Participants should be given adequate and understandable information about the consequences of screening so that they can make an informed choice whether to participate or not.

  • 6.
    Hansson, Anders
    et al.
    Department of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Foldevi, Mats
    Division of Community Medicine/Primary Health Care, Linköping, Sweden.
    Mattsson, Bengt
    Department of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Medical students' attitudes toward collaboration between doctors and nurses: a comparison between two Swedish universities2010Inngår i: Journal of Interprofessional Care, ISSN 1356-1820, E-ISSN 1469-9567, Vol. 24, nr 3, s. 242-250Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The aim of this study was to investigate differences in attitudes towards collaboration between doctors and nurses among medical students in two medical schools: Gothenburg University (GU), which did not offer interprofessional education, and Linköping University (LiU), with a curriculum containing an interprofessional education programme; between male and female students; and between those with previous working experience in medical care and those without. A questionnaire, the Jefferson Scale of Attitudes toward Physician-Nurse Collaboration, was distributed to 314 first year and final year students at GU and LiU: 261 (82%) answers were received. There was no significant difference in attitudes toward collaboration, between first students at GU and LiU, between final year students at the two universities; and between those who had or did not have earlier experience of working in health care. There was a significant difference between male and female students (p = 0.0017) implying a more positive attitude among female students. Females were in majority among final year students (females 80 and males 46) final year, yet, students at both universities did not show a more positive attitude towards collaboration, than did first year students. It was concluded that students who had an interprofessional thread within their medical curriculum did not show different attitudes towards collaboration. The impact of the interprofessional teaching and training programme is discussed and further, especially longitudinal, studies are advocated.

  • 7.
    Hansson, Anders
    et al.
    Department of Public Health and Community Medicine/Primary Health Care, University of Gothenburg, Gothenburg, Sweden.
    Friberg, Febe
    Department of Health Studies, University of Stavanger, Stavanger, Norway; School of Health Sciences, University College of Borås, Borås, Sweden.
    Segesten, Kerstin
    School of Health Sciences, University College of Borås, Borås, Sweden.
    Gedda, Birgitta
    Department of Nursing, Health and Culture, University West, Trollhättan, Sweden.
    Mattsson, Bengt
    Department of Public Health and Community Medicine/Primary Health Care, University of Gothenburg, Gothenburg, Sweden.
    Two sides of the coin - general practitioners' experience of working in multidisciplinary teams.2008Inngår i: Journal of Interprofessional Care, ISSN 1356-1820, E-ISSN 1469-9567, Vol. 22, nr 1, s. 5-16Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Multidisciplinary teamwork, defined as the collaboration between different professional groups to achieve a common purpose, is commonly regarded as a means to meet the complex tasks that medicine has to deal with today. However, many attempts to introduce the method in primary care have failed and this is supposed to be partly due to the fact that general practitioners (GPs) did not participate in the implementation of the method. The aim of this investigation was to get a deeper understanding of their attitude to teamwork by interviewing nine GPs at four Swedish health care centres, where successful teamwork had been ongoing since 1997. Themes and categories in the interviews were identified according to content analysis. Although the attitude in general was in favour of teamwork, four major themes: time-consuming versus time-saving; shared responsibility versus main responsibility; medical expert versus generalist; shared knowledge versus all knowing, could be identified, which all revealed ambivalence towards teamwork among the interviewees. It was concluded that, if teamwork is to be successfully introduced into primary care, the GPs' self-perception has to be taken into consideration as has the prestige and status associated with their traditional role and the benefits of teamwork to the profession of medicine. Apart from time, teamwork requires, professional supervision and doctors need to be trained in this method as early as in medical school.

  • 8.
    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 role2007Inngår i: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 25, nr 2, s. 80-85Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 9.
    Hansson, Anders
    et al.
    Primärvårdens FoUU-enhet i Fyrbodal, Vänersborg, Sverige.
    Marklund, Bertil
    Göteborgs universitet, Göteborg, Sverige.
    ST-läkare vill se praktisk nytta av FoU-kurser [ST-doctors believe scientific courses should relate more to everyday practice]2013Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 110, nr 22, s. 1098-1098Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [sv]

    Enligt Socialstyrelsens målbeskrivning för läkarnas specialistutbildning ska ST-läkaren tillägna sig ett vetenskapligt förhållningssätt.

    Det är oklart vad målet innebär och hur det ska tolkas, vilket speglas i de olika specialistföreningarnas olika anvisningar och kursernas olika utformning.

    De traditionella FoU-kurser som erbjuds har inte alltid motsvarat ST-läkarnas förväntningar.

    Två fokusgruppsintervjuer med ST-läkare från olika specialiteter visar att ST-läkare anser att det är viktigt att tillägna sig ett vetenskapligt kritiskt tänkande för att kunna granska sina egna behandlingsmetoder och be­möta patienternas frågor.

  • 10.
    Hansson, Anders
    et al.
    Academy of Sahlgrenska, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Svensson, Ann
    School of Business, Economics and IT, University West, Sweden.
    Ahlström, Britt Hedman
    Department of Health Science, Section for Health Promotion and Care Sciences, University West, Sweden.
    Larsson, Lena G.
    Academy of Sahlgrenska, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Forsman, Berit
    Department of Health Sciences, Section for Nursing, Graduate Level, University West, Trollhättan, Sweden.
    Alsén, Pia
    Department of Health Sciences, Section for Nursing, Graduate Level, University West, Trollhättan, Sweden.
    Flawed communications: Health professionals' experience of collaboration in the care of frail elderly patients2018Inngår i: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 46, nr 7, s. 680-689Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aims: Frail elderly patients who have multiple illnesses do not fare well in modern health care systems, mainly due to a lack of care planning and flawed communication between health professionals in different care organisations. This is especially noticeable when patients are discharged from hospital. The aim of this study was to explore health care professionals' experience of obstacles and opportunities for collaboration.

    Methods: Health professionals were invited to participate in three focus groups, each consisting of a hospital physician, a primary care physician, a hospital nurse, a primary care nurse, a municipal home care nurse or an assistant officer, a physical or occupational therapist and a patient or a family member representative. These individual people were then asked to discuss the obstacles and opportunities for communication between themselves and with the patients and their relatives when presented with the case report of a fictitious patient. Content analysis was used to identify categories.

    Results: Several obstacles were identified for effective communication and care planning: insufficient communication with patients and relatives; delayed collaboration between care-givers; the lack of an adequate responsible person for care planning; and resources not being distributed according to the actual needs of patients. The absence of an overarching responsibility for the patient, beyond organisational borders, was a recurring theme. These obstacles could also be seen as opportunities.

    Conclusions: Obstacles for collaboration were found on three levels: societal, organisational and individual. As health care professionals are well aware of the problems and also see solutions, management for health care should support employees' own initiatives for changes that are of benefit in the care of frail elderly patients with multiple illnesses.

  • 11.
    Johansson, Minna
    et al.
    Department of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Research Unit and Section for General Practice, FoUU-centrum Fyrbodal, Vänersborg, Sweden.
    Hansson, Anders
    Department of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Research Unit and Section for General Practice, FoUU-centrum Fyrbodal, Vänersborg, Sweden.
    Brodersen, John
    Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
    Estimating overdiagnosis in screening for abdominal aortic aneurysm: could a change in smoking habits and lowered aortic diameter tip the balance of screening towards harm?2015Inngår i: BMJ-BRITISH MEDICAL JOURNAL, E-ISSN 1756-1833, Vol. 350, artikkel-id h825Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Clinical context—Abdominal aortic aneurysms (AAAs) are often asymptomatic until they rupture, when the death rate is greater than 80%. If diagnosed before rupture, AAA can be treated with surgery, which has a mortality of 4-5% Diagnostic change— Sweden, the UK, and the US have initiated screening programmes for AAA. There are also proposals to change the aortic diameter for diagnosis from ≥30 mm to 25 mm Rationale for change—Early diagnosis by screening allows the opportunity of surgery to prevent ruptures Leap of faith—Detecting asymptomatic aneurysms will reduce AAA mortality and morbidity Impact on prevalence—Our estimates indicate that screening almost doubles AAA prevalence, but most AAAs are small and at low risk of rupture. Changing the definition of an AAA from 30 mm to 25 mm would double prevalence again Evidence of overdiagnosis—We estimate that if 10 000 men are invited to screening, 46 AAA deaths can be prevented over 13-15 years but 176 would have an AAA ≥30 mm detected that remained asymptomatic after 13 years. A recent drop in AAA prevalence reduces the benefits of screening and worsens the benefit:harm ratio Harms of overdiagnosis—Asymptomatic men are labelled at risk of a life threatening condition for which they will be under lifelong surveillance. Of 10 000 men invited to AAA screening, 37 (95% confidence interval 15 to 60) overdiagnosed men had unnecessary preventive surgery, of whom 1.6 (1.4 to 1.7) died Limitations—Figures for exact calculations of overdiagnosis are not available and unlikely to emerge. The psychosocial consequences of living with a screen detected AAA are inadequately investigated. Cost effectiveness data on screening are inconclusive Conclusion— Screening programmes have changed the meaning of an AAA diagnosis from a life threatening condition to a risk factor. AAA screening programmes should be revisited because of reduced benefits in modern populations and because data suggest considerable harm

  • 12. Pettersson, Monica
    et al.
    Hansson, Anders
    Research Unit, , Region Örebro County, Örebro, Sweden.
    Brodersen, John
    Research Unit, Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
    Kumlien, Christine
    Department of Caring Science, Malmö University, Malmö, Sweden.
    Experiences of the screening process and the diagnosis abdominal aortic aneurysm among 65-year-old men from invitation to a 1-year surveillance.2017Inngår i: Journal of Vascular Nursing, ISSN 1062-0303, E-ISSN 1532-6578, Vol. 35, nr 2, s. 70-77, artikkel-id S1062-0303(16)30112-1Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The prevalence of abdominal aortic aneurysm (AAA) is reported to be 2.2%-8% among men >65 years. During recent years, screening programs have been developed to detect AAA, prevent ruptures, and thereby saving lives. Therefore, most men with the diagnosis are monitored conservatively with regular reviews. The objective of the study was to describe how men diagnosed with abdominal aortic aneurysm <55 mm discovered by screening experience the process and diagnosis from invitation to 1 year after screening. A total of eleven 65-year-old men were included in three focus groups performed in a University Hospital in Sweden. These were qualitatively analyzed using manifest and latent content analysis. The experience of the screening process and having an abdominal aortic aneurysm in a long-term perspective revealed three categories: "trusting the health care system," emphasizing the need for continual follow-ups to ensure feelings of security; "the importance size," meaning that the measure was abstract and hard to understand; and "coping with the knowledge of abdominal aortic aneurysm," denoting how everyday life was based mostly on beliefs, since a majority lacked understanding about the meaning of the condition. The men want regular surveillance and surrendered to the health care system, but simultaneously experienced a lack of support thereof. Knowing the size of the aorta was important. The men expressed insecurity about how lifestyle might influence the abdominal aortic aneurysm and what they could do to improve their health condition. This highlights the importance of communicating knowledge about the abdominal aortic aneurysm to promote men's feelings of security and giving space to discuss the size of the aneurysm and lifestyle changes.

  • 13.
    Shebehe, Jacques
    et al.
    The University Healthcare Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Hansson, Anders
    Örebro universitet, Institutionen för medicinska vetenskaper. 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 care2018Inngår i: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 36, nr 3, s. 300-307Artikkel i tidsskrift (Fagfellevurdert)
    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.
  • 14.
    Vallo Hult, Helena
    et al.
    University West, Sweden; NU Hospital Group, Sweden.
    Hansson, Anders
    University Health Care Research Center.
    Svensson, Lars
    University West, Sweden.
    Gellerstedt, Martin
    University West, Sweden.
    Flipped healthcare for better or worse2019Inngår i: Health Informatics Journal, ISSN 1460-4582, E-ISSN 1741-2811, Vol. 25, nr 3, s. 587-597Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The medical profession is highly specialized, demanding continuous learning, while also undergoing rapid development in the rise of data-driven healthcare. Based on clinical scenarios, this study explores how resident physicians view their roles and practices in relation to informed patients and patient-centric digital technologies. The paper illustrates how the new role of patients alters physicians' work and use of data to learn and update their professional practice. It suggests new possibilities for developing collegial competence and using patient experiences more systematically. Drawing on the notion of flipped healthcare, we argue that there is a need for new professional competencies in everyday data work, along with a change in attitudes, newly defined roles, and better ways to identify and develop reliable online sources. Finally, the role of patients, not only as consumers but also producers of healthcare, is a rather formidable and complex cultural change to be addressed.

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