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The personal doctor reform in Sweden: perceived changes in working conditions
Linköping University, Department of Medicine and Care, Nursing Science. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medicine and Care. Linköping University, Faculty of Health Sciences.ORCID iD: 0000-0003-4224-1032
Linköping University, Department of Medicine and Care. Linköping University, Faculty of Health Sciences.
Linköping University, Department of health and environment. Linköping University, Faculty of Health Sciences.
1998 (English)In: Family Practice, ISSN 0263-2136, E-ISSN 1460-2229, Vol. 15, no 3, 192-197 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: In primary care in Sweden, several organizational changes have been implemented during the last decades in order to facilitate a shift from a high proportion of hospital care to a more primary-health-based care. The personal doctor reform has been one of the most important during recent years, for both personnel and patients.

OBJECTIVES: We aimed to compare perceived changes in psychosocial working conditions for GP and district nurses in regions with traditional primary care and regions that have implemented a personal doctor system.

METHODS: A questionnaire was mailed to 566 GPs and 554 district nurses in four selected county councils, two with traditional primary care and two with a personal doctor system. The overall response rate was 83%. A factor analysis of data concerning the experience of the organizational change revealed the following factors: fellowship at work, demands on the individual, influence and control, competence development and stimulation at work.

RESULTS AND CONCLUSIONS: In the group as a whole, there was a general experience of deterioration of working conditions in all aspects except stimulation at work. This tendency was mostly marked in the regions with a personal doctor system. In these regions, GPs and district nurses reported significantly more impairments concerning demands on the individual and competence development. In addition, the district nurses also found themselves less able to exercise influence and control. These changes are neither desirable nor necessary consequences of an organizational development. It is important to follow continuously the personnel's experience in a changing primary health care system.

Place, publisher, year, edition, pages
1998. Vol. 15, no 3, 192-197 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-81078DOI: 10.1093/fampra/15.3.192OAI: oai:DiVA.org:liu-81078DiVA: diva2:550266
Available from: 2012-09-06 Created: 2012-09-06 Last updated: 2017-12-07Bibliographically approved
In thesis
1. Psychosocial working conditions among general practitioners and district nurses: Organisational, professional and gender aspects
Open this publication in new window or tab >>Psychosocial working conditions among general practitioners and district nurses: Organisational, professional and gender aspects
2001 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis focuses on the psychosocial working conditions shared by general practitioners and district nurses in Sweden, in relation to the personal doctor reform and district nurses' right to prescribe drugs.

First, a questionnaire was compiled and developed through a stepwise development phase, including key informant interviews, literature review, and review of other models and questionnaires used with a similar purpose. The questionnaire developed was used in a pilot study with 42 general practitioners and 39 district nurses. The questionnaire with 78 items in different parts, was tested for construct validity through factor analysis, and for reliability through Cronbach's alpha. It was then used in the main study.

One aim was also to compare perceived changes in working conditions between general practitioners and district nurses during different degrees of implementation of a personal doctor system. A sample of 469 general practitioners and 466 district nurses participated. The cross-sectional design makes it difficult to distinguish the possible direct effects of a personal doctor from other regional differences. However, is it important to note that the personnel in a more far-reaching personal doctor system perceived less favourable psychosocial working conditions than personnel in a more traditional primary care system.

Another aim was to investigate gender and professional differences in the shared psychosocial working conditions. Both general practitioners and district nurses were satisfied with the professional content of their work and experienced rather low or moderate levels of strains -and symptoms. However, female general practitioners perceived the most unfavourable working conditions compared with both male colleagues and female district nurses.

The opinions among general practitioners and district nurses, to district nurses' right to prescribe drugs differed in all aspects studied. District nurses were positive and general practitioners negative. To gain a deeper understanding of the different opinions, six focus group interviews was carried out. The resistance to the refonn had turned into silence. General practitioners and district nurses hardly speak to each other about prescribing. The district nurses were uncertain whether the general practitioners trusted them and made up systems for self-control.

The personnel within a more far-reaching personal doctor system perceived less-favourable psychosocial working conditions compared with personnel in more traditional primary care system. Female general practitioners seem to experience the most unfavourable working conditions. compared with both their male counterparts, and female district nurses. District nurses prescribing highlights professional differences. Quantitative and qualitative data complement each other and give more diverse information.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet, 2001. 63 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 669
Keyword
psychosocial working conditions, primary care, general practitioners, district nurses, profession, gender aspects, personal doctor reform, district nurses prescribing
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-27556 (URN)12218 (Local ID)91-7219-962-8 (ISBN)12218 (Archive number)12218 (OAI)
Public defence
2001-05-04, Administrationsbyggnadens aula, Universitetssjukhuset, Linköping, 09:00 (Swedish)
Opponent
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-09-06Bibliographically approved

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Wilhelmsson, SusanFaresjö, TomasFoldevi, MatsÅkerlind, Ingemar

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