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Asthma nurse practice in primary health care: quality, costs and outcome
Linköping University, Department of Department of Health and Society, General Practice. Linköping University, Faculty of Health Sciences.
2001 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The primary aim of the present work was to document and analyse whether it is beneficial to patients and to the health care sector to organise asthma care in primary health care is  the form of asthma nurse practices (ANPs). During the past decade ANPs have been established in primary health care in the county of Östergatland, Sweden. The prevalence of asthma is increasing in the industrialised world, and this focuses attention on the efficacy and quality of asthma care.

The methods, data collection and measurements that were used can be summarised as follows. The studies included: (i) a prospective intervention study (ANP concept) with pre- and post- test comparisons, objective measurements and patient questionnaires; (ii) further development of a patient questionnaire, validation of items by structured followHup telephone interviews using predetermined criteria; (iii) comparison of quality and cost in two different approaches to providing asthma care within primary health care, traditional care and care given at a primary health care centre with an ANP, by combining a retrospective review of documentation in patient records using a special form and a prospective approach using a patient questionnaire; (iv) semi-structured interviews with asthma patients to obtain their view of asthma care and clarify factors of importance for compliance with prescribed medication.

The evaluation demonstrated that on the group level, primary health care centres with ANPs resulted in better disease control, fewer asthma symptoms, and better patient experienced knowledge and self-management outcomes. The results also showed fewer emergency visits, better documentation of asthma management and better asthma quality outcomes. It was also found that health care costs were lower with the ANP than with traditional asthma care in primary health care. The patients expressed important aspects of the care as the need for security, including regular asthma check-ups, easy access to care, continuity in the care, competence ofthe health care staff, and information and knowledge about asthma. Increasing age, female gender, long duration of the disease, the attitude of the staff, and whether patients felt they had obtained information and education about asthma were all factors of importance for compliance with prescribed medication.

The main conclusion of the thesis was that the ANP concept seems to improve asthma care in primary health care and resulted in economic advantages for the health care sector.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet , 2001. , 69 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 695
Keyword [en]
asthma, asthma care, primary health care, family practice, nursing, quality, costs, consensus programs, guidelines
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-27512Local ID: 12168ISBN: 91-7219-989-X (print)OAI: oai:DiVA.org:liu-27512DiVA: diva2:248064
Public defence
2001-11-09, Administrationsbyggnadens aula, Universitetssjukhuset, Linköping, 09:00 (Swedish)
Opponent
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-11-09Bibliographically approved
List of papers
1. Asthma nurse practice: a resource-effective approach in asthma management
Open this publication in new window or tab >>Asthma nurse practice: a resource-effective approach in asthma management
1999 (English)In: Respiratory Medicine, ISSN 0954-6111, E-ISSN 1532-3064, Vol. 93, no 8, 584-588 p.Article in journal (Refereed) Published
Abstract [en]

The objective of this study was to evaluate the efficacy of an Asthma Nurse Practice (ANP) in primary health care.

A 12-month (September 1994–August 1995) open, prospective intervention study with pre- and post-test comparisons was performed on patients with asthma treated at a primary care centre in Sweden.

Sixty-three patients with mild or moderate asthma participated and medication, structured follow-up and education in self-management at an ANP were assessed over a 12-month period.

The main outcome measures assessed were pulmonary function, eosinophil cationic protein (ECP) in serum, respiratory symptoms, patient knowledge of asthma and emergency visits.

ANP in primary health care increased patient knowledge of asthma and medication. The number of patients with nocturnal symptoms decreased significantly. Pulmonary function was improved: vital capacity (VC) 98–106, forced expiratory volume in 1 sec (FEV1) 93–100 and peak expiratory flow (PEF) 98–115% of predicted (P<0·001). Variation in PEF fell from 21 to 12% (P<0·001). ECP was significantly reduced. Visits to the emergency room were 60% fewer during the year of intervention (P<0·01).

In conclusion, patients attending an Asthma Nurse Practice, comprising a structured programme for asthma management, improve their knowledge and asthma control.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-26739 (URN)10.1016/S0954-6111(99)90159-2 (DOI)11334 (Local ID)11334 (Archive number)11334 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
2. Patient questionnaires in primary health care: Validation of items used in asthma care
Open this publication in new window or tab >>Patient questionnaires in primary health care: Validation of items used in asthma care
2000 (English)In: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 12, no 1, 19-24 p.Article in journal (Refereed) Published
Abstract [en]

Objective.To evaluate each item in a patient questionnaire for the purpose of investigating whether the validity of each item is acceptable.

Design.The questionnaire was completed by the patients at an ordinary follow-up visit for their asthma, and within 1 week a nurse interviewed them by telephone with the aim of analysing the validity of each item through the use of predetermined criteria.

Settings.Patients with asthma in primary health care settings in Sweden.

Study participants.Fifty-one patients were consecutively included from three different primary health care units.

Results.Nine of 13 items had an acceptable validity. The four items that were not found to have acceptable validity were developed further.

Conclusion.Evaluating each item in a questionnaire by means of interviews with the specific patient population is a useful method of assuring that the intention of the patient questionnaire has been met.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-26743 (URN)10.1093/intqhc/12.1.19 (DOI)11338 (Local ID)11338 (Archive number)11338 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
3. Asthma nurse practice improves outcomes and reduces costs in primary health care
Open this publication in new window or tab >>Asthma nurse practice improves outcomes and reduces costs in primary health care
Show others...
2002 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 16, no 1, 73-78 p.Article in journal (Refereed) Published
Abstract [en]

Objective. The aim of this study was to elucidate the care of patients with asthma in primary health care from medical, patient self-management, health, quality of live, and health economic perspectives.

Methods. Asthma nurse practice (ANP), an alternative asthma self-management strategy, was compared with traditional asthma care in primary health care in southern Sweden regarding medical history, lifestyle, self-management, symptoms caused by asthma, effects on sick leave, state of health, quality of life and health care costs. The first part of the investigation comprised a retrospective study of a randomly selected sample of patient records of asthmatics (n=152). The second part, lasting 3 months, was prospective and included consecutive patients visits (n=347).

Results. The ANP approach showed better results in most of the evaluated outcomes such as asthma quality documentation and self-management and the number of asthma symptoms was significantly lower. From a health economic perspective the results were encouraging with respect to ANP.

Conclusion. This alternative asthma strategy, ANP, improved asthma care in primary health care and resulted in economic advantages in the health care sector. However the result may only be generalized to other practices working with asthma nurses in the same way.

National Category
Social Sciences
Identifiers
urn:nbn:se:liu:diva-28307 (URN)10.1046/j.1471-6712.2002.00054.x (DOI)13438 (Local ID)13438 (Archive number)13438 (OAI)
Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2017-12-13Bibliographically approved
4. Asthma care and factors affecting medication compliance: the patient's point of view
Open this publication in new window or tab >>Asthma care and factors affecting medication compliance: the patient's point of view
2001 (English)In: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 13, no 5, 375-383 p.Article in journal (Refereed) Published
Abstract [en]

Objective. To identify important factors that can influence patient compliance with prescribed medication and to elucidate aspects of asthma care from the patient's point of view.

Design. Field investigation; the interviewer used a semi‐structured questionnaire.

Setting. Patients with asthma in primary health care settings in Sweden.

Study participants. A sample of 77 patients was randomly selected from 11 primary health care centres in southern Sweden; 63 of these patients participated in the study.

Conclusion. The factors of importance for self‐reported compliance with prescribed medication were age, gender, duration of the disease, the attitude of the staff and information/education about asthma. The patients expressed important aspects of care, and these are in accordance with how an asthma nurse practice functions in Sweden.

Keyword
asthma, compliance, interview, patient opinions
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-49116 (URN)10.1093/intqhc/13.5.375 (DOI)
Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2017-12-12Bibliographically approved

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