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Krevers, Barbro
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Broqvist, M., Sandman, L., Garpenby, P. & Krevers, B. (2018). The meaning of severity - do citizenś views correspond to a severity framework based on ethical principles for priority setting?. Health Policy, 122(6), 630-637, Article ID S0168-8510(18)30081-2.
Open this publication in new window or tab >>The meaning of severity - do citizenś views correspond to a severity framework based on ethical principles for priority setting?
2018 (English)In: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 122, no 6, p. 630-637, article id S0168-8510(18)30081-2Article in journal (Refereed) Published
Abstract [en]

The importance for governments of establishing ethical principles and criteria for priority setting in line with social values, has been emphasised. The risk of such criteria not being operationalised and instead replaced by de-contextualised priority-setting tools, has been noted. The aim of this article was to compare whether citizenś views are in line with how a criterion derived from parliamentary-decided ethical principles have been interpreted into a framework for evaluating severity levels, in resource allocation situations in Sweden. Interviews were conducted with 15 citizens and analysed by directed content analysis. The results showed that the multi-factorial aspects that participants considered as relevant for evaluating severity, were similar to those used by professionals in the Severity Framework, but added some refinements on what to consider when taking these aspects into account. Findings of similarities, such as in our study, could have the potential to strengthen the internal legitimacy among professionals, to use such a priority-setting tool, and enable politicians to communicate the justifiability of how severity is decided. The study also disclosed new aspects regarding severity, of which some are ethically disputed, implying that our results also reveal the need for ongoing ethical discussions in publicly-funded healthcare systems.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Citizens views, Directed content analysis, Ethical principles, Priority setting, Severity of ill health, Sweden
National Category
Medical Ethics
Identifiers
urn:nbn:se:liu:diva-147772 (URN)10.1016/j.healthpol.2018.04.005 (DOI)000438479000010 ()29728287 (PubMedID)
Available from: 2018-05-14 Created: 2018-05-14 Last updated: 2018-08-02
Bäckman, K. & Krevers, B. (2017). Prioriteringar över kommunala förvaltningsområden: ett utvecklingsarbete i Motala kommun. Linköping: Linköping University Electronic Press
Open this publication in new window or tab >>Prioriteringar över kommunala förvaltningsområden: ett utvecklingsarbete i Motala kommun
2017 (Swedish)Report (Other academic)
Abstract [sv]

Motala kommun är den första kommunen som på ett systematiskt sätt tagit sig an prioritering och resursfördelning inom alla sina förvaltningsområden med utgångspunkt i de etiska principer och riktlinjer för prioriteringar som gäller för hälso- och sjukvård. Arbetet omfattar utveckling av ett verktyg för prioritering, anpassat till ett kommunalt sammanhang och att använda det i ett systematiskt prioriteringsarbete kombinerat med politiska mål och visioner. Avsikten är att prioriteringsarbetet ska utvecklas till en hållbar rutin, integrerad i befintlig budgetprocess.

Syftet med denna rapport är att beskriva det första skedet i utvecklingsarbetet, med tillhörande arbetsprocesser samt att analysera det utifrån ett förbättringsoch implementeringsperspektiv. Rapporten omfattar åren 2013-2015.

Prioriteringscentrums engagemang i Motala kommun har inneburit att vi genom s k aktionsforskning har studerat utvecklingen av prioriteringsarbetet samtidigt som vi gett stöd till kommunen och deltagit i utvecklingsarbetet av verktyg och processer. Datainsamling har skett genom observationer, dokument, enkäter och olika typer av kontakter.

I Motala kommun har prioriteringsprocessen och dess verktyg utvecklats i nära samarbete med involverade aktörer, de som skulle bli användarna. Prioriteringsarbetet har integrerats i kommunens befintliga ledningssystem och rutiner. Utvecklingen har skett stegvis i små förbättringscykler. På detta sätt har kunskap och lärande byggts upp inom organisationen och arbetet har präglats av långsiktighet.

Motala kommuns utveckling av verktyg och processer för prioritering visar att det är möjligt att vägledas av nationella etiska principer för prioritering inom hälso- och sjukvård och att det går att kombinera dessa med politiska mål och visioner. Det har också varit möjligt att inkludera kommunens alla förvaltningar i prioriteringsarbetet i en öppen, systematisk process som kopplats till ordinarie budgetarbete.

Abstract [en]

Motala municipality is the first municipality which has, systematically, taken on priority setting and resource allocation within all its administrative areas, based on the ethical principles and guidelines for priority settings applicable to health care. The work comprises development of a tool for priority setting, adapted to a municipal context, and using it in systematic setting of priorities combined with political goals and visions. The intention is that the setting of priorities will be developed into a sustainable routine, integrated into the existing budget process.

The purpose of this report is to describe the first stage of the development work with the associated work processes, and to analyse it from an improvement and implementation perspective. The report spans the years 2013-2015.

The involvement of the National Centre for Priority Setting in Health Care in Motala municipality has meant that we, by so called action research, have studied the development of the priority-setting work, while giving support to the municipality and participating in the development of tools and processes. Data collection was undertaken through observations, documents, surveys and contacts of varying kinds.

In Motala municipality the priority setting process and its tools were developed in close collaboration with the actors involved, those who would become the users. Priority setting has been integrated into the municipality’s existing management system and routines. The development has taken place gradually in small improvement cycles. In this way, knowledge and learning was built up within the organisation and the work has been characterised by long-term sustainability.

Motala municipality’s development of tools and processes for priority setting shows that it is possible to be guided by national ethical principles for priority setting within health care, and it is feasible to combine this with political goals and visions. It has also been possible to include all the administrations of the municipality in the setting of priorities, in an open, systematic process linked to regular budgeting.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2017. p. 71
Series
National Center for Priority Setting in Health Care, ISSN 1650-8475 ; 2017:1
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-141165 (URN)
Available from: 2017-09-25 Created: 2017-09-25 Last updated: 2018-04-04Bibliographically approved
Krevers, B. & Bäckman, K. (2016). Development of systematic prioritizations between different welfare sectors - and get it running. In: : . Paper presented at Priorities 2016. Birmingham UK 6-9 September 2016.
Open this publication in new window or tab >>Development of systematic prioritizations between different welfare sectors - and get it running
2016 (English)Conference paper, Oral presentation only (Other academic)
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-136150 (URN)
Conference
Priorities 2016. Birmingham UK 6-9 September 2016
Available from: 2017-03-30 Created: 2017-03-30 Last updated: 2017-04-07Bibliographically approved
Ekdahl, A. W., Alwin, J., Eckerblad, J., Husberg, M., Jaarsma, T., Lindh Mazya, A., . . . Carlsson, P. (2016). Long-Term Evaluation of the Ambulatory Geriatric Assessment: A Frailty Intervention Trial (AGe-FIT): Clinical Outcomes and Total Costs After 36 Months. Journal of the American Medical Directors Association, 17(3), 263-268
Open this publication in new window or tab >>Long-Term Evaluation of the Ambulatory Geriatric Assessment: A Frailty Intervention Trial (AGe-FIT): Clinical Outcomes and Total Costs After 36 Months
Show others...
2016 (English)In: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 17, no 3, p. 263-268Article in journal (Refereed) Published
Abstract [en]

Objective: To compare the effects of care based on comprehensive geriatric assessment (CGA) as a complement to usual care in an outpatient setting with those of usual care alone. The assessment was performed 36 months after study inclusion. Design: Randomized, controlled, assessor-blinded, single-center trial. Setting: A geriatric ambulatory unit in a municipality in the southeast of Sweden. Participants: Community-dwelling individuals aged >= 75 years who had received inpatient hospital care 3 or more times in the past 12 months and had 3 or more concomitant medical diagnoses were eligible for study inclusion. Participants were randomized to the intervention group (IG) or control group (CG). Intervention: Participants in the IG received CGA-based care for 24 to 31 months at the geriatric ambulatory unit in addition to usual care. Outcome measures: Mortality, transfer to nursing home, days in hospital, and total costs of health and social care after 36 months. Results: Mean age (SD) of participants was 82.5 (4.9) years. Participants in the IG (n = 208) lived 69 days longer than did those in the CG (n = 174); 27.9% (n = 58) of participants in the IG and 38.5% (n = 67) in the CG died (hazard ratio 1.49, 95% confidence interval 1.05-2.12, P =.026). The mean number of inpatient days was lower in the IG (15.1 [SD 18.4]) than in the CG (21.0 [SD 25.0], P =.01). Mean overall costs during the 36-month period did not differ between the IG and CG (USD 71,905 [SD 85,560] and USD 65,626 [SD 66,338], P =.43). Conclusions: CGA-based care resulted in longer survival and fewer days in hospital, without significantly higher cost, at 3 years after baseline. These findings add to the evidence of CGAs superiority over usual care in outpatient settings. As CGA-based care leads to important positive outcomes, this method should be used more extensively in the treatment of older people to meet their needs. (c) 2016 AMDA - The Society for Post-Acute and Long-Term Care Medicine.

Place, publisher, year, edition, pages
ELSEVIER SCIENCE INC, 2016
Keywords
Comprehensive Geriatric Assessment; total costs of care; outpatient geriatric care; mortality; hospitalizations
National Category
Clinical Medicine Sociology
Identifiers
urn:nbn:se:liu:diva-126830 (URN)10.1016/j.jamda.2015.12.008 (DOI)000370950000014 ()26805750 (PubMedID)
Note

Funding Agencies|Ostergotland Regional authority in Sweden [LIO-124301]; Linkoping University in Sweden; Stahl Foundation in Sweden [LIO-194541]; Skane Regional authority in Sweden

Available from: 2016-04-07 Created: 2016-04-05 Last updated: 2017-05-03
Engstrand, C., Kvist, J. & Krevers, B. (2016). Patients'€™ perspective on surgical intervention for Dupuytren'€™s disease€: experiences, expectations and appraisal of results. Disability and Rehabilitation, 38(24-26), 2538-2549
Open this publication in new window or tab >>Patients'€™ perspective on surgical intervention for Dupuytren'€™s disease€: experiences, expectations and appraisal of results
2016 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 38, no 24-26, p. 2538-2549Article in journal (Refereed) Published
Abstract [en]

Purpose To explore patients’ perspectives on surgical intervention for Dupuytren’s disease (DD), focusing on patients’ appraisal of results, involving previous experiences, expectations and patient characters.

Method The participants were 21 men, mean age 66 years, scheduled for DD surgery. Qualitative interviews were conducted 2–4 weeks before surgery and 6–8 months after surgery. The model of the Patient Evaluation Process was used as theoretical framework. Data were analyzed using problem-driven content analysis.

Results Five categories are described: previous experiences, expectations before surgery, appraisal of results, expectations of the future and patient character. Previous experiences influenced participants’ expectations, and these were used along with other aspects as references for appraisal of results. Participants’ appraisal of results concerned perceived changes in hand function, care process, competency and organization, and could vary in relation to patient character. The appraisal of results influenced participants’ expectations of future hand function, health and care.

Conclusions Patients’ appraisal of results involved multidimensional reasoning reflecting on hand function, interaction with staff and organizational matters. Thus, it is not enough to evaluate results after DD surgery only by health outcomes as this provides only a limited perspective. Rather, evaluation of results should also cover process and structure aspects of care.

Implications for Rehabilitation

  • To improve health care services, it is important to be aware of the role played by patient’s previous experiences, expectations as well as staff and organizational aspects of care.
  • Knowledge about patients’ experience and view of the results from surgery and rehabilitation should be established by assessment of care effects on health as well as structure and process aspects of care.
  • Evaluation of structure and process aspects of care can be done by using questions about if the patient felt listened to, received clear information and explanations, was included in decision-making, and their view of waiting time or continuity of care.
  • Improving health care services means not only providing the best treatment method available but also developing individualized care by ensuring good interaction with the patient, providing accurate information, and working to improve the structure of the care process.
  • Before treatment, health care providers should have a dialogue with the patient and consider previous experiences and expectations in order to ensure the patient has balanced expectations of the outcome.
Keywords
Care process; hand function; hand surgery; interviews; outcome
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Nursing Physiotherapy
Identifiers
urn:nbn:se:liu:diva-125964 (URN)10.3109/09638288.2015.1137981 (DOI)000385478900020 ()26878688 (PubMedID)
Note

Funding agencies: County Council of Ostergotland, Sweden

Available from: 2016-03-10 Created: 2016-03-10 Last updated: 2017-11-30Bibliographically approved
Ali, L., Krevers, B. & Skarsater, I. (2015). Caring Situation, Health, Self-efficacy, and Stress in Young Informal Carers of Family and Friends with Mental Illness in Sweden. Issues in Mental Health Nursing, 36(6), 407-415
Open this publication in new window or tab >>Caring Situation, Health, Self-efficacy, and Stress in Young Informal Carers of Family and Friends with Mental Illness in Sweden
2015 (English)In: Issues in Mental Health Nursing, ISSN 0161-2840, E-ISSN 1096-4673, Vol. 36, no 6, p. 407-415Article in journal (Refereed) Published
Abstract [en]

This study compared the caring situation, health, self-efficacy, and stress of young (16-25) informal carers (YICs) supporting a family member with mental illness with that of YICs supporting a friend. A sample of 225 carers, assigned to a family group (n = 97) or a friend group (n = 128) completed the questionnaire. It was found that the family group experiences a lower level of support and friends experienced a lower positive value of caring. No other differences in health, general self-efficacy and stress were found. YICs endure different social situations, which is why further study of the needs of YICs, especially those supporting friends, is urgently needed.

Place, publisher, year, edition, pages
TAYLOR and FRANCIS INC, 2015
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-121924 (URN)10.3109/01612840.2014.1002644 (DOI)000361335200004 ()26241566 (PubMedID)
Note

Funding Agencies|Vardal Institute; Swedish Institute for Health Science, Lund, Sweden; Swedish Institute for Health Science, Gothenburg, Sweden; Vinnvard

Available from: 2015-10-13 Created: 2015-10-12 Last updated: 2017-12-01
Ekdahl, A. W., Wirehn, A.-B., Alwin, J., Jaarsma, T., Unosson, M., Husberg, M., . . . Carlsson, P. (2015). Costs and Effects of an Ambulatory Geriatric Unit (the AGe-FIT Study): A Randomized Controlled Trial. Journal of the American Medical Directors Association, 16(6), 497-503
Open this publication in new window or tab >>Costs and Effects of an Ambulatory Geriatric Unit (the AGe-FIT Study): A Randomized Controlled Trial
Show others...
2015 (English)In: Journal of the American Medical Directors Association, ISSN 1538-9375, Vol. 16, no 6, p. 497-503Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To examine costs and effects of care based on comprehensive geriatric assessment (CGA) provided by an ambulatory geriatric care unit (AGU) in addition to usual care.

DESIGN: Assessor-blinded, single-center randomized controlled trial.

SETTING: AGU in an acute hospital in southeastern Sweden.

PARTICIPANTS: Community-dwelling individuals aged 75 years or older who had received inpatient hospital care 3 or more times in the past 12 months and had 3 or more concomitant medical diagnoses were eligible for study inclusion and randomized to the intervention group (IG; n = 208) or control group (CG; n = 174). Mean age (SD) was 82.5 (4.9) years.

INTERVENTION: Participants in the IG received CGA-based care at the AGU in addition to usual care.

OUTCOME MEASURES: The primary outcome was number of hospitalizations. Secondary outcomes were days in hospital and nursing home, mortality, cost of public health and social care, participant' sense of security in care, and health-related quality of life (HRQoL).

RESULTS: Baseline characteristics did not differ between groups. The number of hospitalizations did not differ between the IG (2.1) and CG (2.4), but the number of inpatient days was lower in the IG (11.1 vs 15.2; P = .035). The IG showed trends of reduced mortality (hazard ratio 1.51; 95% confidence interval [CI] 0.988-2.310; P = .057) and an increased sense of security in care interaction. No difference in HRQoL was observed. Costs for the IG and CG were 33,371£ (39,947£) and 30,490£ (31,568£; P = .432).

CONCLUSIONS AND RELEVANCE: This study of CGA-based care was performed in an ambulatory care setting, in contrast to the greater part of studies of the effects of CGA, which have been conducted in hospital settings. This study confirms the superiority of this type of care to elderly people in terms of days in hospital and sense of security in care interaction and that a shift to more accessible care for older people with multimorbidity is possible without increasing costs. This study can aid the planning of future interventions for older people.

TRIAL REGISTRATION: clinicaltrials.gov identifier: NCT01446757.

Place, publisher, year, edition, pages
Elsevier, 2015
Keywords
Comprehensive geriatric assessment; ambulatory geriatric care; costs; hospitalization; multimorbidity; randomized controlled trial; security
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-118967 (URN)10.1016/j.jamda.2015.01.074 (DOI)000355134100009 ()25703450 (PubMedID)
Available from: 2015-06-05 Created: 2015-06-05 Last updated: 2016-04-24
Engstrand, C., Krevers, B. & Kvist, J. (2015). Factors affecting functional recovery after surgery and hand therapy in patients with Dupuytren's disease. Journal of Hand Therapy, 28(3), 255-260
Open this publication in new window or tab >>Factors affecting functional recovery after surgery and hand therapy in patients with Dupuytren's disease
2015 (English)In: Journal of Hand Therapy, ISSN 0894-1130, E-ISSN 1545-004X, Vol. 28, no 3, p. 255-260Article in journal (Refereed) Published
Abstract [en]

Study design: Prospective cohort study. Introduction: The evidence of the relationship between functional recovery and impairment after surgery and hand therapy are inconsistent. Purpose of the study: To explore factors that were most related to functional recovery as measured by DASH in patients with Dupuytrens disease. Methods: Eighty-one patients undergoing surgery and hand therapy were consecutively recruited. Functional recovery was measured by the Disability of the Arm, Shoulder and Hand (DASH) questionnaire. Explanatory variables: range of motion of the finger joints, five questions regarding safety and social issues of hand function, and health-related quality of life (Euroqol). Results: The three variables "need to take special precautions", "avoid using the hand in social context", and health-related quality of life (EQ-5D index) explained 62.1% of the variance in DASH, where the first variable had the greatest relative effect. Discussion: Safety and social issues of hand function and quality of life had an evident association with functional recovery. Level of evidence: IV.

Place, publisher, year, edition, pages
Elsevier, 2015
Keywords
Dupuytrens contracture; Emotional function; Range of motion; Recovery of function; Quality of life
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-121325 (URN)10.1016/j.jht.2014.11.006 (DOI)000359329100005 ()25998546 (PubMedID)
Note

Funding Agencies|Medical Research Council of southeast Sweden [FORSS-72231]; County Council of Ostergotland, Sweden [LIO-77311]

Available from: 2015-09-14 Created: 2015-09-14 Last updated: 2017-12-04
Krevers, B., Broqvist, M. & Bäckman, K. (2015). Frågor till medborgare om öppenhet, prioriteringsprocess och beslutsfattare avseende prioritering och ransonering: En artikelöversikt. Linköping: Linköping University Electronic Press
Open this publication in new window or tab >>Frågor till medborgare om öppenhet, prioriteringsprocess och beslutsfattare avseende prioritering och ransonering: En artikelöversikt
2015 (Swedish)Report (Other academic)
Abstract [sv]

Vårt syfte med denna rapport är att öka kunskapen om vad medborgare tillfrågats om i forskningsstudier avseende prioritering och ransonering inom hälso- och sjukvård. Avsikten är också att belysa studiernas syfte och tillvägagångssätt för att genom det få information om i vilken grad det finns tillförlitlig, överförbar och generaliserbar kunskap om vad medborgare tänker, anser och vill i dessa frågor. En sådan översikt kan visa på eventuella kunskapsluckor och därigenom belysa behov av framtida studier.

Vi utgick från en metod för översiktsstudier och utvecklade sökord, granskningsstruktur och inklusions- och exklusionskriterier. I sökningen användes en kombination av sökord i tre databaser för internationella vetenskapliga tidskrifter. I granskning av artiklarna kategoriserades de utifrån vad medborgare hade blivit tillfrågad om, åtta frågeområden kunde identifieras.

Denna rapport bygger på ett delresultat och omfattar artiklar inom tre frågeområden: öppenhet, prioriteringsprocesser och beslutsfattare. Av dem handlar fyra studier om öppenhet, tre om prioriteringsprocessen och nitton om beslutsfattare. De kommer från nio olika länder, varav de flesta från Europa, och är publicerade från 1993 till 2013. Studierna baseras på både kvalitativ och kvantitativa metoder av olika slag.

Sammantaget gav vår artikelöversikt relativt få artiklar inom de tre frågeområden som ingår i rapporten och det finns även en del metodbrister i dessa studier t.ex. i urval och frågornas precisering. Det råder därmed osäkerhet om vad medborgare tänker, anser och vill när det gäller öppenhet, prioriteringsprocesser och beslutsfattare. Några exempel på kunskapsbrister som vår artikelöversikt pekar på är att kunskapen om svenska medborgares syn på dessa tre frågeområden är bristfällig och kunskap om hur medborgarnas åsikter förändras över tid saknas. Det råder även brist på kunskap om det finns skillnader mellan medborgare från olika länder inklusive Sverige, och deras syn på dessa tre frågeområden om prioritering och ransonering samt om deras syn skiljer sig åt i relation till välfärdssystem, demokratiska system, auktoritetskultur, grad av tillit, trygghet, etc.

Andra kunskapsbrister gäller vilka faktorer som kan ha betydelse för medborgares syn när det gäller dessa tre frågeområden samt vad sådana faktorer i så fall skulle få för konsekvenser t.ex. för hur frågor ska ställas till medborgare, hur beslut beskrivs, hur beslutsprocesser ska gå till och öppenheten kring beslut.

Det saknas även kunskap om involvering av medborgare verkligen leder till det som ofta framhålls som motiv för att involvera dem t.ex. bättre beslut, ökad legitimitet i beslut och större acceptans och tillit hos medborgare och/eller att de uppskattar detta som en demokratisk handling. Det saknas också kunskap om och problematisering av hur medborgares åsikter ska vägas mot andra gruppers synpunkter t.ex. i relation till politiker som är utsedda genom demokratiska val.

Dessa kunskapsbrister kan vara utgångspunkter för framtida intressanta och viktiga studier där medborgare tillfrågas om hur de ser på öppenhet,prioriteringsprocesser och beslutsfattare. Det kan ge betydelsefull kunskap om vilken roll medborgare och andra aktörer kan och bör ha i relation till prioritering och ransonering, vilka aktiviteter som bör genomföras och vilka konsekvenser det kan ge.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2015. p. 48
Series
National Center for Priority Setting in Health Care, ISSN 1650-8475 ; 2015:2
Keywords
Health care sector, Health priorities, Prioritering inom sjukvården, Sverige, Kronobergs län
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-122487 (URN)
Available from: 2015-11-04 Created: 2015-11-04 Last updated: 2016-11-03Bibliographically approved
Andersson, K., Krevers, B. & Bendtsen, P. (2015). Implementing healthy lifestyle promotion in primary care: a quasi-experimental cross-sectional study evaluating a team initiative. BMC Health Services Research, 15(31)
Open this publication in new window or tab >>Implementing healthy lifestyle promotion in primary care: a quasi-experimental cross-sectional study evaluating a team initiative
2015 (English)In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 15, no 31Article in journal (Refereed) Published
Abstract [en]

Background:

Non-communicable diseases are a leading cause of death and can largely be prevented by healthy lifestyles. Health care organizations are encouraged to integrate healthy lifestyle promotion in routine care. This study evaluates the impact of a team initiative on healthy lifestyle promotion in primary care.

Methods: A quasi-experimental, cross-sectional design compared three intervention centres that had implemented lifestyle teams with three control centres that used a traditional model of care. Outcomes were defined using the RE-AIM framework: reach, the proportion of patients receiving lifestyle promotion; effectiveness, self-reported attitudes and competency among staff; adoption, proportion of staff reporting regular practice of lifestyle promotion; implementation, fidelity to the original lifestyle team protocol. Data collection methods included a patient questionnaire (n = 888), a staff questionnaire (n = 120) and structured interviews with all practice managers and, where applicable, team managers (n = 8). The chi square test and problem-driven content analysis was used to analyse the questionnaire and interview data, respectively.

Results:Reach: patients at control centres (48%, n = 211) received lifestyle promotion significantly more often compared with patients at intervention centres (41%, n = 169). Effectiveness: intervention staff was significantly more positive towards the effectiveness of lifestyle promotion, shared competency and how lifestyle promotion was prioritized at their centre. Adoption: 47% of staff at intervention centres and 58% at control centres reported that they asked patients about their lifestyle on a daily basis. Implementation: all intervention centres had implemented multi-professional teams and team managers and held regular meetings but struggled to implement in-house referral structures for lifestyle promotion, which was used consistently among staff.

Conclusions:Intervention centres did not show higher rates than control centres on reach of patients or adoption among staff at this stage. All intervention centres struggled to implement working referral structures for lifestyle promotion. Intervention centres were more positive on effectiveness outcomes, attitudes and competency among staff, however. Thus, lifestyle teams may facilitate lifestyle promotion practice in terms of increased responsiveness among staff, illustrated by positive attitudes and perceptions of shared competency. More research is needed on lifestyle promotion referral structures in primary care regarding their configuration and implementation.

Place, publisher, year, edition, pages
BioMed Central, 2015
Keywords
Healthy lifestyle promotion; Primary care; Implementation fidelity; Coordination of care; RE-AIM framework
National Category
General Practice
Identifiers
urn:nbn:se:liu:diva-114581 (URN)10.1186/s12913-015-0688-4 (DOI)000348819200002 ()25608734 (PubMedID)
Note

Funding Agencies|Ostergotland County Council; Linkoping University

Available from: 2015-02-27 Created: 2015-02-26 Last updated: 2018-08-14
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