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  • 1.
    Agvall, Björn
    et al.
    Linköping University, Department of Department of Health and Society, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland.
    Borgquist, Lars
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Foldevi, Mats
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland.
    Dahlström, Ulf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Cost of heart failure in Swedish primary healthcare2005In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 23, p. 227-232Article in journal (Refereed)
    Abstract [en]

    Objectives. To calculate the cost for patients with heart failure (HF) in a primary healthcare setting. Design. Retrospective study of all available patient data during a period of one year. Setting. Two healthcare centers in Linköping in the southeastern region of Sweden, covering a population of 19 400 inhabitants. Subjects. A total of 115 patients with a diagnosis of HF. Main outcome measures. The healthcare costs for patients with HF and the healthcare utilization concerning hospital days and visits to doctors and nurses in hospital care and primary healthcare. Results. The mean annual cost for a patient with HF was SEK 37 100. There were no significant differences in cost between gender, age, New York Heart Association functional class, and cardiac function. The distribution of cost was 47% for hospital care, 22% for primary healthcare, 18% for medication, 5% for nursing home, and 6% for examinations. Conclusion. Hospital care accounts for the largest cost but the cost in primary healthcare is larger than previously shown. The total annual cost for patients with HF in Sweden is in the range of SEK 5.0–6.7 billion according to this calculation, which is higher than previously known.Read More: http://informahealthcare.com/doi/abs/10.1080/02813430500197647

  • 2.
    Agvall, Björn
    et al.
    Linköping University, Department of Department of Health and Society, General Practice. Linköping University, Faculty of Health Sciences.
    Dahlström, Ulf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Patients in primary health care diagnosed and treated as heart failure, with special reference to gender differences2001In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 19, no 1, p. 14-19Article in journal (Refereed)
    Abstract [en]

    Objective - The aim of the present study was to describe patients considered to have had heart failure (HF), or were being treated for HF, in a defined area in primary health care, e.g. diagnostic procedures, aetiologic diseases and management, and to evaluate whether there is a difference between the genders. Design - Descriptive retrospective investigation. Setting - ┼tvidaberg community situated in southeast Sweden, 12 400 inhabitants. Patients - 256 patients treated for symptomatic HF. Main outcome measures - Prevalence, aetiology, diagnostic procedures and management of HF and differences between the genders. Results - The diagnosis of HF was based on an objective evaluation of cardiac function in only 31% of the patients. Ischaemic heart disease (IHD) was the predominant associated disease, followed by hypertension. Therapy included diuretics (84%), angiotensin converting enzyme (ACE) inhibitors (56%) and digoxin (40%). Only 52% had optimal doses of ACE inhibitors. Women had a significantly higher mean age and their diagnoses were based on an objective diagnostic test (echocardiography) in only 20%. Women were prescribed ACE inhibitors to a lesser extent (43%) than men (64%) and with a lower optimal dose (44% versus 56% in men). Conclusion - There is still room for improvement in the management of HF in primary health care, especially in women, where the diagnosis is not generally based on an objective evaluation of cardiac function and where the treatment to a lesser extent than in men includes ACE inhibitors.

  • 3.
    Andén, Annika
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice.
    andersson, s o
    Umeå.
    Rudebeck, Carl-Edvard
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice.
    Concepts underlying outcome measures in studies of consultations in general practice2006In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724Article in journal (Refereed)
  • 4.
    Anskär, Eva
    et al.
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Lindberg, Malou
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Falk, Magnus
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Kärna, Linköping.
    Andersson, Agneta
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Operations management Region Östergötland, Research and Development Unit.
    Legitimacy of work tasks, psychosocial work environment, and time utilization among primary care staff in Sweden2019In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, p. 1-8Article in journal (Refereed)
    Abstract [en]

    Objective: Primary care staff faces a complex work environment including a heavy administrative work load and perceive some work tasks as illegitimate. This study aimed to elucidate associations between the perceived legitimacy of work tasks, the psychosocial work environment, and the utilization of work time among Swedish primary care staff.

    Design and setting: The study was designed as a multicenter study involving all staff categories, i.e. registered nurses, primary care physicians, care administrators, nurse assistants and allied professionals, at eleven primary care centers in Sweden.

    Subjects: Participants completed the Bern Illegitimate Tasks Scale and the Copenhagen Psychosocial Questionnaire. They also recorded time spent on all work tasks, day by day during two separate weeks.

    Main outcome measures and results: More than a quarter (27%) of primary care physicians perceived a high proportion of unnecessary work tasks. After adjusting for profession, age and gender, the perception of having to perform unreasonable work tasks was positively associated with experiencing role conflicts and with the proportion of organization-related administration and service work tasks.

    Conclusion: Across all staff groups, the perception of unreasonable work tasks was more pronounced among staff with a high proportion of non-patient related administration. Also, the perception of having to perform a large amount of illegitimate work tasks affected the psychosocial work environment negatively, which might influence staffs perception of their professional roles. These results illuminate the importance of decision makers to thoroughly consider the distribution and allocation of non-patient related work tasks among staff in primary care.Key pointsWe observed an interaction between perception of having a large proportion of illegitimate work tasks and impaired psychosocial work environment. • More than a quarter of the primary care physicians perceived a high proportion of unnecessary work tasks.• Across all staff groups, performing unreasonable work tasks was associated with an experience of having role conflicts.• Across all staff groups, a perception of performing unreasonable work tasks was associated with the proportion of non-patient related administrative work tasks.

  • 5.
    Barabas, G
    et al.
    Rosenlunds Health Care Centre, Jönköping.
    Mölstad, Sigvard
    Unit of Research and Development in Primary Care, Jönköping.
    No association between elevated post-void residual volume and bacteriuria in residents of nursing homes2005In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 23, no 1, p. 52-56Article in journal (Refereed)
    Abstract [en]

    Objective To evaluate the concept that increased post-void residual urine volume (PVR) is a risk factor for bacteriuria. Design Cross-sectional study. Setting Three nursing homes in Jönköping, southern Sweden. Subjects A total of 147 elderly residents in municipal nursing homes. Main outcome values PVR volumes measured with a portable ultrasonic bladder scan, urine specimen, and questionnaire data on incontinence, immobility, impaired cognition, neurological diseases, and medications. Results Mean age was 86 years and 78% were women. The prevalence of a PVR for the four chosen cut-off values (30, 50, 100, and 150 ml) was 51%, 39%, 20%, and 7%, respectively. The prevalence of bacteriuria was 42%, 46% for women and 28% for men. Elevated PVR was not associated with bacteriuria, incontinence, immobility, impaired cognition or neurological disease (stroke, Parkinson's disease). Conclusion Bacteriuria and elevated PVR are common among elderly residents in nursing homes. The study could not confirm that elevated PVR predisposes to bacteriuria in elderly residents in nursing homes.

  • 6. Bari, Muhammad Rizuanul
    et al.
    Östgren, Carl Johan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, General Practice. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland.
    Rastam, Lennart
    Lindblad, Ulf
    Abdominal obesity and insulin resistance in patients with type 2 diabetes in a Swedish community - Skaraborg Hypertension and Diabetes Project2006In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 24, no 4, p. 211-217Article in journal (Refereed)
    Abstract [en]

    Objective. To explore the association between abdominal obesity and insulin resistance in patients with type 2 diabetes. Design. A cross-sectional observational study. Setting. Primary care in Skara, Sweden. Subjects. A total of 198 men and 186 women with type 2 diabetes who consecutively completed an annual check-up in 1992-1993. Main outcome measures. Abdominal obesity was defined according to criteria for the metabolic syndrome using the waist circumference (WC): > 102 cm for men and > 88 cm for women. Insulin resistance was estimated using the Homeostasis Model Assessment (HOMA), and was dichotomized by the 75th percentile (IR). Results. Abdominal obesity was found in 66 men (33%), and in 106 women (57%). Pearson's correlation coefficients between components of the metabolic syndrome and IR were statistically significant for WC, waist-hip ratio, serum triglycerides, and HDL cholesterol, and were higher for WC (0.40) than for waist-hip ratio (0.23) in both genders (p < 0.001). The association between WC and IR was challenged by successively entering other components of the metabolic syndrome into the model in a logistic regression. In the final model, adjusting for differences in age, systolic blood pressure, HbA1c, serum triglycerides, HDL cholesterol, and microalbuminuria, the association remained statistically significant both in men (OR 8.6, 95% CI 3.0-25.2, p < 0.001), and in women (OR 5.6, 95% CI 1.7-18.1, p = 0.004). Conclusions. WC provides a feasible measure for insulin resistance in the vast majority of subjects with type 2 diabetes. It is convenient and less expensive than direct means and could be used as a proxy for insulin resistance in population studies.

  • 7.
    Bengtsson, Ulrika
    et al.
    University of Gothenburg , Gothenburg , Sweden; .
    Kjellgren, Karin
    University of Gothenburg , Gothenburg , Sweden.
    Hallberg, Inger
    University of Gothenburg , Gothenburg , Sweden.
    Lundin, Mona
    University of Gothenburg , Gothenburg , Sweden.
    Mäkitalo, Åsa
    University of Gothenburg , Gothenburg , Sweden.
    Patient contributions during primary care consultations for hypertension after self-reportingvia a mobile phone self-management support system2018In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 36, no 1, p. 70-79Article in journal (Refereed)
    Abstract [en]

    Objective: This paper reports on how the clinical consultation in primary care is performed under the new premises of patients’ daily self-reporting and self-generation of data. The aim was to explore and describe the structure, topic initiation and patients’ contributions in followup consultations after eight weeks of self-reporting through a mobile phone-based hypertension self-management support system. Design: A qualitative, explorative study design was used, examining 20 audio- (n ¼ 10) and video-recorded (n ¼ 10) follow-up consultations in primary care hypertension management, through interaction analysis. Clinical trials registry: ClinicalTrials.gov NCT01510301. Setting: Four primary health care centers in Sweden. Subjects: Patients with hypertension (n ¼ 20) and their health care professional (n ¼ 7). Results: The consultations comprised three phases: opening, examination and closing. The most common topic was blood pressure (BP) put in relation to self-reported variables, for example, physical activity and stress. Topic initiation was distributed symmetrically between parties and BP talk was lifestyle-centered. The patients’ contributed to the interpretation of BP values by connecting them to specific occasions, providing insights to the link between BP measurements and everyday life activities. Conclusion: Patients’ contribution through interpretations of BP values to specific situations in their own lives brought on consultations where the patient as a person in context became salient. Further, the patients’ and health care professionals’ equal contribution during the consultations showed actively involved patients. The mobile phone-based self-management support system can thus be used to support patient involvement in consultations with a person-centered approach in primary care hypertension management KEY POINTS The clinical consultation is important to provide opportunities for patients to gain understanding of factors affecting high blood pressure, and for health care professionals to motivate and promote changes in life-style. This study shows that self-reporting as base for follow-up consultations in primary care hypertension management can support patients and professionals to equal participation in clinical consultations. Self-reporting combined with increased patient–health care professional interaction during follow-up consultations can support patients in understanding the blood pressure value in relation to their daily life. These findings implicate that the interactive mobile phone self-management support system has potential to support current transformations of patients as recipients of primary care, to being actively involved in their own health.

  • 8.
    Broström, Anders
    et al.
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Sunnergren, Ola
    Ryhov County Hospital, Jönköping, Sweden.
    Franzén Årestedt, Kristofer
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Johansson, Peter
    Linköping University, Department of Medical and Health Sciences, Cardiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Ulander, Martin
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Neurophysiology. Linköping University, Faculty of Health Sciences.
    Riegel, Barbara
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences. University of Pennsylvania School of Nursing, Philadelphia, USA.
    Svanborg, Eva
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Neurophysiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology.
    Factors associated with undiagnosed obstructive sleep apnoea in hypertensive primary care patients2012In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 30, no 2, p. 107-113Article in journal (Refereed)
    Abstract [en]

    Objective. In hypertensive primary care patients below 65 years of age, (i) to describe the occurrence of undiagnosed obstructive sleep apnoea (OSA), and (ii) to identify the determinants of moderate/severe OSA. Design. Cross-sectional. Setting. Four primary care health centres in Sweden. Patients. 411 consecutive patients (52% women), mean age 57.9 years (SD 5.9 years), with diagnosed and treated hypertension (BP andgt; 140/90). Main outcome measures. Occurrence of OSA as measured by the apnoea hypopnoea index (AHI). Results. Mild (AHI 5-14.9/h) and moderate/severe (AHI andgt; 15/h) OSA were seen among 29% and 30% of the patients, respectively. Comparing those without OSA with those with mild or moderate/severe OSA, no differences were found in blood pressure, pharmacological treatment (anti-hypertensive, anti-depressive, and hypnotics), sleep, insomnia symptoms, daytime sleepiness, or depressive symptoms. Obesity (BMI andgt; 30 kg/m(2)) was seen in 30% and 68% of the patients with mild and moderate/severe OSA, respectively. Male gender, BMI andgt; 30 kg/m(2), snoring, witnessed apnoeas, and sleep duration andgt; 8 hours were determinants of obstructive sleep apnoea. Conclusion. Previously undiagnosed OSA is common among patients with hypertension in primary care. Obesity, snoring, witnessed apnoeas, long sleep duration, and male gender were the best predictors of OSA, even in the absence of daytime sleepiness and depressive symptoms.

  • 9.
    Bäckman, Karin
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment and Health Economics.
    Carlsson, Per
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment and Health Economics.
    Kentson, M.
    Department of Internal Medicine, Jönköping Hospital, Jönköping, Sweden.
    Hansen, S.
    Department of Internal Medicine, Eksjö Hospital, Eksjö, Sweden.
    Engquist, L.
    Department of Internal Medicine, Värnamo Hospital, Värnamo, Sweden.
    Hallert, C.
    Såpkullen Health Care Centre, Norrköping, Sweden.
    Deep venous thrombosis: A new task for primary health care - A randomised economic study of outpatient and inpatient treatment2004In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 22, no 1, p. 44-49Article in journal (Refereed)
    Abstract [en]

    Objective - A health economic evaluation of two alternative treatment settings, inpatient care and outpatient care, for acute deep venous thrombosis. Design - A randomised multicentre trial in a defined population in regular clinical practice. Setting - Hospitals and related health care centres in the Jönköping county council in Sweden. Interventions - Patients were randomised to either an inpatient strategy (n = 66) or an outpatient strategy (n = 65) using low-molecular-weight heparin, dalteparin, administered subcutaneously once daily and adjusted for body weight. Subjects - Of 224 eligible patients, 131 entered the trial and 124 completed the economic part of the study. Main outcome measures - Direct medical and direct non-medical costs during a 3-month period. Results - Total direct costs were higher for those in the inpatient strategy group, i.e. Swedish Crowns (SEK) 16 400 per patient (Euro 1899) compared to SEK 12 100 per patient (Euro 1405) in the outpatient strategy group (p < 0.001). More patients in the outpatient group received assistance when they returned home. Few patients in either group reported sick leave. There was no difference in total number of days between the two groups. Conclusions - Total direct costs were significantly lower for the outpatient treatment strategy for deep venous thrombosis compared to the inpatient treatment strategy. No significant difference in health impact could be detected. Deep venous thrombosis can to a greater extent than previously be treated in primary care, safely, at a lower cost, and in accordance with patient preferences.

  • 10. Carlsson, L
    et al.
    Håkansson, Annika
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Oncology . Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Oncology UHL.
    Nordenskjöld, Bo
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Oncology . Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Oncology UHL.
    Common cancer-related symptoms among GP patients - Opportunistic screening in primary health care2001In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 19, no 3, p. 199-203Article in journal (Refereed)
    Abstract [en]

    Objective-To study the occurrence of symptoms related to the five most common forms of cancer among patients regularly visiting primary care. To estimate the proportion of symptoms needing GP examination, and the number of tumours thus diagnosed. Design-Patients with some form of non-malignant chronic disease received a letter with information about cancer-related symptoms along with an invitation to regular check-up. The letter described the most common symptoms of breast, colorectal, lung, prostate and skin cancers. Setting-12 health centres in Kalmar County, Sweden. Subjects-5200 patients aged over 40 years. Results-One patient in 13 reported cancer-related symptoms to the GP. Women reported more symptoms than men, and almost half of them had had symptoms at previous check-ups. The GP was able to explain 7 out of 10 patients' symptoms directly. When other symptoms were examined, 8 cancers were diagnosed as well as 6 pre-malignant tumours, corresponding to 3 tumour diagnoses per 1000 check-ups. Conclusion-While attending regular check-ups, patients may not report symptoms which cause anxiety and sometimes indicate serious diseases. It is possible to widen the perspective and link both primary and secondary prevention of certain cancers to the check-up.

  • 11.
    Dannetun, E.
    et al.
    Department of Communicable Disease Control, Landstinget i Östergötland, SE-581 91 Linköping, Sweden, Department of Epidemiology, Swedish Institute for Infectious Disease Control, Solna, Sweden.
    Tegnell, A.
    Communicable Disease Unit, National Board of Health and Welfare, Stockholm, Sweden.
    Hermansson, Göran
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Giesecke, J.
    Department of Epidemiology, Swedish Institute for Infectious Disease Control, Solna, Sweden.
    Parents' reported reasons for avoiding MMR vaccination: A telephone survey2005In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 23, no 3, p. 149-153Article in journal (Refereed)
    Abstract [en]

    Objective. During the second half of the 1990s and the first years of the 2000s a declining coverage for MMR vaccination in two-year-olds was observed in Sweden. The aim was to assess reasons for postponement or non-vaccination. Design. A telephone survey using a structured questionnaire on parents' attitudes regarding their choice to postpone or abstain from vaccinating their child. Setting. The County of Östergötland in Sweden. Subjects. A total of 203 parents of children who had no registered date for MMR vaccination at a Child Health Centre. Main outcome measures. Parental reasons for non-vaccination. Results. In all, 26 of the 203 children had received MMR vaccination but this had not been registered. Of those not vaccinated, 40% of the parents had decided to abstain and 60% to postpone vaccination. Fear of side effects was the most common reason for non-vaccination in both groups. The main source of information was the media followed by the Child Health Centre. Parents with a single child more often postponed vaccination and those who abstained were more likely to have had a discussion with a doctor or nurse about MMR vaccine. Conclusion. Postponers and abstainers may have different reasons for their decision. The role of well-trained healthcare staff in giving advice and an opportunity to discuss MMR vaccination with concerned parents is very important. © 2005 Taylor & Francis.

  • 12.
    Eriksson, B.
    et al.
    Karolinska Inst, Sweden.
    Wandell, P.
    Karolinska Inst, Sweden.
    Dahlström, Ulf
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Nasman, P.
    KTH Royal Inst Technol, Sweden.
    Lund, L. H.
    Karolinska Univ Hosp, Sweden.
    Edner, M.
    Karolinska Inst, Sweden; Karolinska Univ Hosp, Sweden.
    Comorbidities, risk factors and outcomes in patients with heart failure and an ejection fraction of more than or equal to 40% in primary care- and hospital care-based outpatient clinics2018In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 36, no 2, p. 207-215Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of this study is to describe patients with heart failure and an ejection fraction (EF) of more than or equal to 40%, managed in both Primary- and Hospital based outpatient clinks separately with their prognosis, comorbidities and risk factors. Further to compare the heart failure medication in the two groups. Design: We used the prospective Swedish Heart Failure Registry to include 9654 out-patients who had HF and EF amp;gt;= 40%, 1802 patients were registered in primary care and 7852 in hospital care. Descriptive statistical tests were used to analyze base line characteristics in the two groups and multivariate logistic regression analysis to assess mortality rate in the groups separately. Setting: The prospective Swedish Heart Failure Registry. Setting: The prospective Swedish Heart Failure Registry. Subjects: Patients with heart failure and an ejection fraction (EF) of more than or equal to 40%. Main outcome measures: Comorbidities, risk factors and mortality. Results: Mean-age was 77.5 (primary care) and 70.3 years (hospital care) p amp;lt; 0.0001, 46.7 vs. 36.3% women respectively (p amp;lt; 0.0001) and EF amp;gt;= 50% 26.1 vs. 13.4% (p amp;lt; 0.0001). Co-morbidities were common in both groups (97.2% vs. 92.3%), the primary care group having more atrial fibrillation, hypertension, ischemic heart disease and COPD. According to the multivariate logistic regression analysis smoking, COPD and diabetes were the most important independent risk factors in the primary care group and valvular disease in the hospital care group. All-cause mortality during mean follow-up of almost 4 years was 315% in primary care and 27.8% in hospital care. One year-mortality rates were 7.8%, and 7.0% respectively. Conclusion: Any co-morbidity was noted in 97% of the HF-patients with an EF of more than or equal to 40% managed at primary care based out-patient clinics and these patients had partly other independent risk factors than those patients managed in hospital care based outpatients clinics. Our results indicate that more attention should be payed to manage COPD in the primary care group.

  • 13.
    Eriksson, Bjorn
    et al.
    Karolinska Inst, Sweden.
    Wandell, Per
    Karolinska Inst, Sweden.
    Dahlström, Ulf
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Nasman, Per
    KTH Royal Inst Technol, Sweden.
    Lund, Lars H.
    Karolinska Inst, Sweden.
    Edner, Magnus
    Karolinska Inst, Sweden.
    Limited value of NT-proBNP as a prognostic marker of all-cause mortality in patients with heart failure with preserved and mid-range ejection fraction in primary care: A report from the swedish heart failure register2019In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724Article in journal (Refereed)
    Abstract [en]

    Aim: The prognostic value of natriuretic peptides in the management of heart failure (HF) patients with ejection fraction (EF) amp;lt;40% is well established, but is less known for those with EF amp;gt;= 40% managed in primary care (PC). Therefore, the aim of this study is to describe the prognostic significance of plasma NT-proBNP in such patients managed in PC. Subjects: We included 924 HF patients (48% women) with EF amp;gt;= 40% and NT-proBNP registered in the Swedish Heart Failure Registry. Follow-up was 1100 +/- 687 days. Results: One-, three- and five-year mortality rates were 8.1%, 23.9% and 44.7% in patients with EF 40-50% (HFmrEF) and 7.3%, 23.6% and 37.2% in patients with EF amp;gt;= 50% (HFpEF) (p = 0.26). Patients with the highest mean values of NT-proBNP had the highest all-cause mortality but wide standard deviations (SDs). In univariate regression analysis, there was an association only between NT-proBNP quartiles and all-cause mortality. In HFmrEF patients, hazard ratio (HR) was 1.96 (95% CI 1.60-2.39) p amp;lt; 0.0001) and in HFpEF patients, HR was 1.72 (95% CI 1.49-1.98) p amp;lt; 0.0001). In a multivariate Cox proportional hazard regression analysis, adjusted for age, NYHA class, atrial fibrillation and GFR class, this association remained regarding NT-proBNP quartiles [HR 1.83 (95% CI 1.38-2.44), p amp;lt; 0.0001] and [HR 1.48 (95% CI 1.16-1.90), p = 0.0001], HFmrEF and HFpEF, respectively. Conclusion: NT-proBNP has a prognostic value in patients with HF and EF amp;gt;= 40% managed in PC. However, its clinical utility is limited due to high SDs and the fact that it is not independent in this population which is characterized by high age and much comorbidity.

  • 14.
    Falk, Magnus
    et al.
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Primary Health Care Centres. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Magnusson, Henrik
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Sun protection advice mediated by the general practitioner: An effective way to achieve long-term change of behaviour and attitudes related to sun exposure?2011In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 29, no 3, p. 135-143Article in journal (Refereed)
    Abstract [en]

    Objective. To investigate, in primary health care, differentiated levels of prevention directed at skin cancer, and how the propensity of the patients to change sun habits/sun protection behaviour and attitudes towards sunbathing were affected, three years after intervention. Additionally, the impact of the performance of a phototest as a complementary tool for prevention was evaluated. Design. Randomized controlled study. Setting and subjects. During three weeks in February, all patients andgt;= 18 years of age registering at a primary health care centre in southern Sweden were asked to fill in a questionnaire mapping sun exposure habits, attitudes towards sunbathing, and readiness to increase sun protection according to the Transtheoretical Model of Behaviour Change (TTM) (n = 316). They were randomized into three intervention groups, for which sun protection advice was given, in Group 1 by means of a letter, and in Groups 2 and 3 orally during a personal GP consultation. Group 3 also underwent a phototest to demonstrate individual skin UV sensitivity. Main outcome measures. Change of sun habits/sun protection behaviour and attitudes, measured by five-point Likert scale scores and readiness to increase sun protection according to the TTM, three years after intervention, by a repeated questionnaire. Results. In the letter group, almost no improvement in sun protection occurred. In the two doctors consultation groups, significantly increased sun protection was demonstrated for several items, but the difference compared with the letter group was significant only for sunscreen use. The performance of a phototest did not appear to reinforce the impact of intervention. Conclusion. Sun protection advice, mediated personally by the GP during a doctors consultation, can lead to improvement in sun protection over a prolonged time period.

  • 15.
    Hedbäck, Bo
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Nilsson, Peter
    Brandström, Hans
    Lingfors, Hans
    Erhardt, Leif
    Israelsson, Bo
    Sjöberg, Gunilla
    Gender differences in secondary prevention of coronary heart disease: Reasons to worry or not?2003In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 21, no 1, p. 37-42Article in journal (Refereed)
    Abstract [en]

    Objective - To analyse potential gender differences in cardiovascular risk factors and treatment patterns, reflecting clinical practice in secondary prevention. Design - Observational national study during 3 years of patients eligible for secondary prevention of coronary heart disease (CHD). Setting - Fifty-two healthcare districts in Sweden, involving primary health care and hospitals in collaboration, participating in a national quality assurance programme for the prevention of CHD. Subjects - A national sample of male and female patients surviving acute myocardial infarction, or following CABG/PTCA interventions for CHD, controlled at 3-6 months (n=9135) and 12 months (n=4802) of follow-up. The proportion of female patients (25%) did not differ between visits. Main outcome measures - Self-reported data on lifestyle, drug treatment and cardiovascular risk factor levels after consultation in general practice or at hospital policlinics. Results - No major gender differences were recorded in risk factor levels or in cardiovascular drug treatment patterns at 12 months of follow-up. Female patients participated in educational programmes to improve lifestyle to a higher degree than males (52.0 vs 45.1%), but after 1 year were more often (p<0.001) self-reported smokers (11.7 vs 8.4%). Female patients showed higher levels of blood pressure, total cholesterol and HDL cholesterol, but not LDL cholesterol compared to male patients. Conclusions - In general, a gender-equal level of lipid control and access to medical drug treatment has been established for patients in secondary prevention from a national sample in Sweden, followed for 1 year after CHD manifestations and related interventions.

  • 16.
    Hedin, K.
    et al.
    Unit of R and D, Landstinget Kronoberg, Department of Clinical Sciences in Malmö - General Practice/Family Medicine, Lund University, FoU Centrum Box 1223, SE-351 12 Växjö, Sweden.
    Andre, M.
    Centre for Clinical Research, Dalarna, Falun.
    Mölstad, Sigvard
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, General Practice.
    Rodhe, N.
    Centre for Clinical Research, Dalarna, Falun.
    Petersson, C.
    Unit of R and D, Landstinget Kronoberg.
    Infections in families with small children: Use of social insurance and healthcare2006In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 24, no 2, p. 98-103Article in journal (Refereed)
    Abstract [en]

    Objective. To examine infectious symptoms on a daily basis in families with small children and how often these infections cause people to stay at home or seek healthcare. Design. A population-based prospective study. Setting. Child health clinics in seven municipalities in Sweden. Subjects and main outcome measures. All family members of 835 families who came with an 18-month-old child to a child health clinic were asked to register all infectious symptoms in a diary for a month. They were also asked to indicate whether they had stayed at home from day-care or school, whether social insurance had been used, and whether they had contacted healthcare facilities or seen a physician. Results. In total, 7% of the 18-month-old children and 34% of the parents had no symptoms during the winter month. The most common symptom was a runny nose. The 18-month-old children had 1.6 symptom episodes with an average duration of 5.6 days. Of the symptom episodes 13% led to contact with healthcare facilities and 6% to an antibiotic prescription. Of the symptom days 27% required staying at home and in 10% social insurance was claimed. Conclusion. Symptoms of infection among families with small children were common, with a runny nose being the most common. Physician consultations and antibiotic prescriptions were used in a small proportion of the symptom episodes. Social insurance was claimed in about one-third of the days with absence from day-care. © 2006 Taylor & Francis.

  • 17.
    Hedin, Katarina
    et al.
    Lund University, Sweden; Kronoberg County Council, Sweden.
    Lena Strandberg, Eva
    Lund University, Sweden; Blekinge County Council, Sweden.
    Grondal, Hedvig
    Uppsala University, Sweden.
    Brorsson, Annika
    Lund University, Sweden; Centre Primary Health Care Research, Sweden.
    Thulesius, Hans
    Lund University, Sweden; Kronoberg County Council, Sweden.
    André, Malin
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Department of Public Health and Caring Sciences Family Medicine and Preventive Medicine, Uppsala University, Sweden .
    Management of patients with sore throats in relation to guidelines: An interview study in Sweden2014In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 32, no 4, p. 193-199Article in journal (Refereed)
    Abstract [en]

    Objective. To explore how a group of Swedish general practitioners (GPs) manage patients with a sore throat in relation to current guidelines as expressed in interviews. Design. Qualitative content analysis was used to analyse semi-structured interviews. Setting. Swedish primary care. Subjects. A strategic sample of 25 GPs. Main outcome measures. Perceived management of sore throat patients. Results. It was found that nine of the interviewed GPs were adherent to current guidelines for sore throat and 16 were non-adherent. The two groups differed in terms of guideline knowledge, which was shared within the team for adherent GPs while idiosyncratic knowledge dominated for the non-adherent GPs. Adherent GPs had no or low concerns for bacterial infections and differential diagnosis whilst non-adherent GPs believed that in patients with a sore throat any bacterial infection should be identified and treated with antibiotics. Patient history and examination was mainly targeted by adherent GPs whilst for non-adherent GPs it was often redundant. Non-adherent GPs reported problems getting patients to abstain from antibiotics, whilst no such problems were reported in adherent GPs. Conclusion. This interview study of sore throat management in a strategically sampled group of Swedish GPs showed that while two-thirds were non-adherent and had a liberal attitude to antibiotics one-third were guideline adherent with a restricted view on antibiotics. Non-adherent GPs revealed significant knowledge gaps. Adherent GPs had discussed guidelines within the primary care team while non-adherent GPs had not. Guideline implementation thus seemed to be promoted by knowledge shared in team discussions.

  • 18.
    Hultberg, Josabeth
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Åby.
    Rudebeck, Carl-Edvard
    Kalmar County Council, Sweden; University of Tromso, Norway.
    Patient participation in decision-making about cardiovascular preventive drugs - resistance as agency2017In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 35, no 3, p. 231-239Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of the study was to describe and explore patient agency through resistance in decision-making about cardiovascular preventive drugs in primary care. Design: Six general practitioners from the southeast of Sweden audiorecorded 80 consultations. From these, 28 consultations with proposals from GPs for cardiovascular preventive drug treatments were chosen for theme-oriented discourse analysis. Results: The study shows how patients participate in decision-making about cardiovascular preventive drug treatments through resistance in response to treatment proposals. Passive modes of resistance were withheld responses and minimal unmarked acknowledgements. Active modes were to ask questions, contest the address of an inclusive we, present an identity as a non-drugtaker, disclose non-adherence to drug treatments, and to present counterproposals. The active forms were also found in anticipation to treatment proposals from the GPs. Patients and GPs sometimes displayed mutual renouncement of responsibility for decision-making. The decision-making process appeared to expand both beyond a particular phase in the consultations and beyond the single consultation. Conclusions: The recognition of active and passive resistance from patients as one way of exerting agency may prove valuable when working for patient participation in clinical practice, education and research about patient-doctor communication about cardiovascular preventive medication. We propose particular attentiveness to patient agency through anticipatory resistance, patients disclosures of non-adherence and presentations of themselves as non-drugtakers. The expansion of the decision-making process beyond single encounters points to the importance of continuity of care.

  • 19.
    Kastbom, Lisa
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Ljungsbro.
    Milberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in East Östergötland, Department of Advanced Home Care in Norrköping.
    Karlsson, Marit
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Advanced Home Care in Linköping.
    We have no crystal ball-advance care planning at nursing homes from the perspective of nurses and physicians2019In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate clinicians perspectives on the factors that shape the process of advance care planning in a nursing home context. Design: Interviews. Latent qualitative content analysis. Setting: Nine nursing homes in Sweden. Subjects: 14 physicians and 11 nurses working at nursing homes. Main outcome measures: Participants views on advance care planning (ACP) at nursing homes. Results: The analysis of the interviews resulted in four manifest categories: Exploration of preferences and views, e.g. exploring patient wishes regarding end-of-life issues and restrictions in care at an early stage, and sensitivity to patients readiness to discuss end-of-life issues; Integration of preferences and views, e.g. integration of patients preferences and staffs and family members views; Decision amp; documentation of the ACP, e.g. clear documentation in patients medical records that are up-to-date and available for staff caring for the patient, and Implementation amp; re-evaluation of the ACP, e.g. nurse following up after ACP-appointment to confirm the content of the documented ACP. The latent theme, Establishing beneficence - defending oneself against tacit accusations of maleficence, emerged as a deeper meaning of all the four (manifest) parts of the ACP-process Conclusion: This study stresses the importance of involving patients, family members, and the team in the work with advance care planning in nursing homes. In addition, clear medical record documentation and proficiency in end-of-life communication related to advance care planning for physicians as well as nurses may also be factors that significantly shape advance care planning in a nursing home context.

  • 20. Kristjansson, I
    et al.
    Ardal, B
    onsson, JS
    Sigurdsson, JA
    Foldevi, Mats
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice.
    Björkstén, B
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Barn.
    Adverse reactions to food and food allergy in young children in Iceland and Sweden.  1999In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 17, p. 30-34Article in journal (Refereed)
  • 21.
    Lagerström, Folke
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, General Practice.
    Fredlund, H.
    Dept. of Clin. Microbiol./Immunol., Örebro University Hospital, Sweden.
    Holmberg, H.
    Department of Infectious Diseases, Örebro University Hospital, Sweden.
    Sputum specimens can be obtained from patients with community-acquired pneumonia in primary care2004In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 22, no 2, p. 83-86Article in journal (Refereed)
    Abstract [en]

    Objective - To improve the aetiological diagnosis in community-acquired pneumonia (CAP) increased efforts were made to obtain expectorated sputum specimens from patients with CAP. Design - A prospective, clinical study. Patients were encouraged to cough spontaneously and to expectorate a sputum specimen. If unsuccessful, they were asked to inhale nebulized hypertonic saline to induce secretion and cough. Setting - One primary health care centre in Örebro, Sweden. Subjects - Patients attending the Health Centre with acute symptoms of CAP. Main outcome measures - Availability and quality of sputum specimen from patients with CAP in primary care. Results - 177 patients were included, 63% were women and the mean age was 51years. 28% were smokers and 46% showed infiltrates on chest X-ray. Sputum specimens were obtained from 125 patients. Fifty-nine were expectorated spontaneously and 66 were induced. Ninety-one of the specimens were found to be acceptable, whereas 34 were discarded. Potential pathogens were found in 57% of the 91 specimens. Conclusion - Acceptable sputum specimens can be obtained with some effort from approximately half of the patients in primary care. Sputum culture might improve the knowledge of the bacterial aetiology of CAP in selected patients and in epidemiological studies.

  • 22.
    Leijon, Matti E.
    et al.
    Center for Primary Health Care Research, Lund University .
    Faskunger, Johan
    Swedish National Institute of Public Health.
    Bendtsen, Preben
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Health Care. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Department of Medical Specialist.
    Festin, Karin
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Who is not adhering to physical activity referrals, and why?2011In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 29, no 4, p. 234-240Article in journal (Refereed)
    Abstract [en]

    Objective. To analyse patients self-reported reasons for not adhering to physical activity referrals (PARs). Design and setting. Data on 1358 patients who did not adhere to PARs were collected at 38 primary health care (PHC) centres in Sweden. Intervention. PHC providers issued formal physical activity prescriptions for home-based activities or referrals for facility-based activities. Subjects. Ordinary PHC patients whom regular staff believed would benefit from increased physical activity. Main outcome measure: Reasons for non-adherence to PARs: "sickness", "pain", "low motivation", "no time", "economic factors", and "other". Results. Sickness and pain were the most common motives for non-adherence among older patients. The youngest patients blamed economic factors and lack of time more frequently than those in the oldest age group. Economic factors was a more common reason for non-adherence among those referred for facility-based activities compared with those prescribed home-based activities. Low motivation was a more frequent cause of non-adherence among those prescribed home-based activities compared with those referred for facility-based activities. Furthermore, lack of time was a more common reason for non-adherence among patients issued with PARs due to high blood pressure than other patients, while low motivation was a more common reason among patients issued with PARs because of a BMI of greater than 25. Conclusion. The reasons for non-adherence differ between patients prescribed home-based activities and referred for facility-based activities, as well as between patients with different specific characteristics. The information obtained may be valuable not only for the professionals working in PHC, but also for those who work to develop PARs for use in different contexts.

  • 23.
    Lindström, Kjell
    et al.
    Primary Health Care Centre of Habo, Göteborg University, Göteborg, Sweden.
    Berg, Lars
    Primary Health Care Centre of Tibro, Göteborg University, Göteborg, Sweden.
    Rylander, Bo
    Primary Health Care Centre of Tibro, Göteborg University, Göteborg, Sweden.
    Hagman, Anders
    Medical Departments of Falköping, Göteborg University, Göteborg, Sweden.
    Olsson, Lave
    Medical Departments of Skövde Hospitals, Göteborg University, Göteborg, Sweden.
    Bengtsson, Calle
    Department of Primary Health Care, Göteborg University, Göteborg, Sweden.
    A model for quality assessment in primary health care using the tracer condition technique with insulin treated diabetes as one of the tracers1997In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 15, no 2, p. 92-96Article in journal (Refereed)
    Abstract [en]

    Objective-To find a method for quality assessment in primary health care and to apply this method on a defined disease.

    Design-General practitioners and hospital doctors worked out a programme for evaluating the quality of outpatient care of patients with insulin treated diabetes as one of five tracers. An expert committee comprising experienced general practitioners and hospital doctors compared two health centres with one outpatient medical department Data were collected during a defined period combined with a one-year retrospective view, official statistics on medical care, and a questionnaire completed by the patients.

    Setting-Two primary health care centres and one outpatient medical department in southwestern Sweden.

    Patients-243 insulin treated diabetic patients attending the hospital and 87 insulin treated patients attending the health centres.

    Main results-There were no difficulties for the expert panel to agree on which indicators were to be studied. The expert panel concluded that there was no difference between the quality of the two levels of care studied.

    Conclusions-Medical audit was a useful method for evaluating medical quality. Co-operation between hospital doctors and general practitioners was of great value for evaluation of the quality of primary health care.

  • 24.
    Lindström, Kjell
    et al.
    Unit of Research and Development in Primary Care, Jönköping, Sweden.
    Ekedahl, Anders
    Department of Research and Development, National Corporation of Swedish Pharmacies.
    Carlsten, Anders
    Department of Research and Development, National Corporation of Swedish Pharmacies.
    Mårtensson, Jan
    Unit of Research and Development in Primary Care, Jönköping, Sweden and Department of Nursing Science, School of Health Sciences, Jönköping, Sweden.
    Mölstad, Sigvard
    Linköping University, Department of Department of Health and Society, General Practice. Linköping University, Faculty of Health Sciences.
    Can selective serotonin inhibitor drugs in elderly patients in nursing homes be reduced?2007In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 25, no 1, p. 3-8Article in journal (Refereed)
    Abstract [en]

    Objective. To investigate whether treatment with selective serotonin reuptake inhibitors (SSRIs) could be withdrawn for elderly residents who had been on treatment for at least one year and to evaluate a method for systematic drug review.

    Design. Open, prospective, interventional study.

    Setting. Four counties in Sweden. Subjects. Elderly residents at 19 nursing homes, with ongoing treatment with SSRIs for more than one year.

    Main outcome measures. Clinical evaluation, registration of drugs used and rating with Montgomery–Åsberg Depression Rating Scale (MADRS). A semi-structured telephone interview with 15 participating physicians and 19 nurses.

    Results. About one-third of all 822 residents in the nursing homes had ongoing antidepressant treatment, predominantly with SSRIs; 75% of them had been treated with SSRIs for at least one year and 119 (60%) of these were considered eligible for the study. The intervention was judged successful in 52% of these residents of whom 88% had a MADRS rating of less than 20 points. The GPs and the nurses experienced the method as practicable.

    Conclusions. Withdrawal of SSRI treatment was successful in the majority of cases. The MADRS may be a valuable addition to clinical evaluation when deciding whether to end or continue SSRI treatment.

  • 25.
    Lindström, Kjell
    et al.
    Linköping University, Department of Department of Health and Society, General Practice. Linköping University, Faculty of Health Sciences.
    Engström, Sven
    Linköping University, Department of Department of Health and Society, General Practice. Linköping University, Faculty of Health Sciences.
    Bengtsson, Calle
    Department of Primary Health Care, Göteborg University, Göteborg, Sweden.
    Borgquist, Lars
    Linköping University, Department of Department of Health and Society, General Practice. Linköping University, Faculty of Health Sciences.
    Determinants of hospitalisation rates: does primary health care play a role?2003In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 21, no 1, p. 15-20Article in journal (Refereed)
    Abstract [en]

    Objective - To analyse the influence of rates of general practitioner visits on rates of hospitalisations.

    Design  - Ecological cross-sectional study of factors influencing hospitalisation rates. Aggregated data on primary care centre area level.

    Setting - The county of Östergötland, Sweden, with 3 hospital districts and 41 primary health care centres, and the hospital district of Jönköping in the county of Jönköping, Sweden, with 11 primary health care centres.

    Outcome measure - Hospitalisation rates.

    Results  - Age and rates of outpatient hospital visits were the most important factors explaining the variation in rates of hospitalisations between the primary health care centre areas. Hospital districts, socioeconomic factors and rates of GP visits also influenced the rates of hospitalisations.

    Conclusion - When evaluating the influence of primary health care on the rates of hospitalisations, both socioeconomic factors and health care structure must be taken into consideration. Doing this, the rates of GP visits correlated negatively with the rates of hospitalisations.

  • 26.
    Lindström, Kjell
    et al.
    The Primary Health Care Centre of Habo, Sweden.
    Hagman, Anders
    Medical Department, Falköping Hospital, Sweden.
    Bengtsson, Calle
    Department of Primary Health Care, Gothenburg University, Sweden.
    Medical audit used for estimation of optimum level of outpatient care1995In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 13, no 3, p. 175-181Article in journal (Refereed)
    Abstract [en]

    Objective - To create a model for determining the optimum level of outpatient medical care and to determine this level.

    Design - Expert committees were established comprising one or two hospital physicians and two general practitioners who checked medical records for all outpatient visits to doctors made by a defined population during a defined period of time. the determination of optimum level was made blindly by each member of the expert committee.

    Setting and participants - the study comprised all visits to physicians during 10 weeks, in total more than 4000, made by the people in a Swedish community, of which 2084 were randomized.

    Results - Total agreement between the members of the committee was initially reached for 84% of the visits and, after a common discussion between the committee members, for 99%. A general practitioner was considered to be the optimum level of care for 76% of the patients in the total series, in the upper ages (above 80) for about 85%.

    Conclusion - This method seemed suitable for determining the optimum level of care in a population and may be of value when planning for an optimum health care service. Based on the results from our study it seems reasonable to assume that general practitioners whose training corresponds to that of Swedish ones are competent to treat about 75% of all consultations.

  • 27.
    Linnarsson, Rolf
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Medical audit based on computer-stored patient records exemplified with an audit of hypertenstion care1993In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 11, p. 74-80Article in journal (Refereed)
  • 28.
    Moberg, A. B.
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Primary Health Care in Central County. Kärna Vårdcent, Linkoping, Sweden.
    Taleus, U.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Primary Health Care in Central County. Ljungsbro Vårdcent, Sweden.
    Garvin, Peter
    Linköping University, Department of Medical and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care. Linköping University, Faculty of Medicine and Health Sciences.
    Fransson, Sven Göran
    Region Östergötland, Center for Diagnostics, Department of Radiology in Linköping. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences.
    Falk, Magnus
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Community-acquired pneumonia in primary care: clinical assessment and the usability of chest radiography2016In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 34, no 1, p. 21-27Article in journal (Refereed)
    Abstract [en]

    Objectives: To investigate the diagnostic value of different clinical and laboratory findings in pneumonia and to explore the association between the doctors degree of suspicion and chest X-ray (CXR) result and to evaluate whether or not CXR should be used routinely in primary care, when available. Design: A three-year prospective study was conducted between September 2011 and December 2014. Setting: Two primary care settings in Linkoping, Sweden. Subjects: A total of 103 adult patients with suspected pneumonia in primary care. Main outcome measures: The physicians recorded results of a standardized medical physical examination, including laboratory results, and rated their suspicion into three degrees. The outcome of the diagnostic variables and the degree of suspicion was compared with the result of CXR. Results: Radiographic pneumonia was reported in 45% of patients. When the physicians were sure of the diagnosis radiographic pneumonia was found in 88% of cases (p&lt;0.001), when quite sure the frequency of positive CXR was 45%, and when not sure 28%. Elevated levels of C-reactive protein (CRP)50mg/L were associated with the presence of radiographic pneumonia when the diagnosis was suspected (p&lt;0.001). Conclusion: This study indicates that CXR can be useful if the physician is not sure of the diagnosis, but when sure one can rely on ones judgement without ordering CXR.

  • 29.
    Månsson, Jörgen
    et al.
    Primary Health Care Centre Husläkarna i Kungsbacka.
    Marklund, Bertil
    Primary Health Care Research and Development Unit County Council Halland.
    Carlsson, Per
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment.
    Costs in primary care of investigating symptoms suspicious of cancer in a defined population2006In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 24, p. 243-250Article in journal (Refereed)
  • 30.
    Neumark, Thomas
    et al.
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    Brudin, Lars
    Linköping University, Department of Medical and Health Sciences, Clinical Physiology. Linköping University, Faculty of Health Sciences.
    Engström, Sven
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Central County Primary Health Care. Unit of Research and Development in Primary Care, Jönköping, Sweden.
    Mölstad, Sigvard
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    Trends in number of consultations and antibiotic prescriptions for respiratory tract infections between 1999 and 2005 in primary healthcare in Kalmar County, Southern Sweden2009In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 27, no 1, p. 18-24Article in journal (Refereed)
    Abstract [en]

    Background: Respiratory tract infections (RTIs) comprise the most common indication for consulting a general practitioner and obtaining an antibiotic prescription.

    Objective: To study changes in the number of visits, diagnoses, and antibiotic prescriptions for RTI in primary healthcare during the period 1999-2005.

    Design: A retrospective, descriptive, population-based study of electronic patient records.

    Setting: County of Kalmar in southeastern Sweden.

    Patients: Patients visiting primary healthcare units in Kalmar County for an RTI between 1 July 1999 and 31 December 2005. Main outcome measures. RTI diagnoses, antibiotic prescriptions, age groups.

    Results: A total of 240 447 visits for RTI made between 1999 and 2005 were analysed. The yearly consultation rates for the diagnoses acute tonsillitis and AOM decreased by 12% and 10%, respectively (p = 0.001). Of all patients consulting for an RTI diagnosis, 45% received antibiotics. Of all prescribed antibiotics, 60% were for phenoxymethylpenicillin (PcV) and 18% doxycycline. Amoxicillin or amoxicillin + clavulanic acid was prescribed to a lesser extent. The proportion of patients obtaining an antibiotic prescription was almost constant over time (44-46%). The prescriptions of doxycycline showed increasing values (NS). The prescriptions of remaining antibiotics decreased significantly especially for patients up to middle age.

    Conclusion: This large population study, comprising more than six years of observations, showed the number of primary healthcare patients receiving an RTI diagnosis decreased during the period 1999-2005, but the proportion of patients receiving an antibiotic prescription remained the same. The large seasonal variations indicate a need for further interventions to decrease antibiotic use for RTIs.

  • 31.
    Neumark, Thomas
    et al.
    Linköping University, Department of Department of Health and Society, General Practice. Linköping University, Faculty of Health Sciences. Lindsdal Primary Health Centre, Kalmar, Sweden.
    Mölstad, Sigvard
    Linköping University, Department of Department of Health and Society, General Practice. Linköping University, Faculty of Health Sciences. Unit of Research and Development in Primary care, Jönköping.
    Rosén, Christer
    Department of Oto-Rhino-Laryngology, Kalmar County Hospital, Kalmar.
    Persson, Lars-Göran
    Unit of Research and Development in Primary care, Jönköping.
    Törngren, Annika
    Department of Oto-Rhino-Laryngology, Kalmar County Hospital, Kalmar.
    Brudin, Lars
    Linköping University, Department of Medicine and Care, Clinical Physiology. Linköping University, Faculty of Health Sciences.
    Eliasson, Ingvar
    Department of Clinical Microbiology and Immunology, Lund University Hospital, Lund, Sweden.
    Evaluation of phenoxymethylpenicillin treatment of acute otitis media in children aged 2-162007In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 25, no 3, p. 166-171Article in journal (Refereed)
    Abstract [en]

    Objective. To study the clinical recovery from acute otitis media (AOM) in children, 2-16 years of age, managed with or without treatment with phenoxymethylpenicillin (PcV).

    Design. An open, prospective randomized trial. Children aged between 2 and 16 years, presenting with one- or double-sided AOM (without perforation) with symptom duration of less than four days, were included. The children were randomized to PcV for five days or to no primary antibiotic treatment. A health score and compliance were registered on a daily basis for seven days. Setting. A total of 32 health centres and 72 GPs in south-east Sweden.

    Subjects. Children aged 2-16 presenting with earache. Main outcome measures. Recovery time, symptom duration, frequency of complications (up to three months) and consumption of healthcare services independent of treatment with or without antibiotics.

    Results. A total of 179 patients carried out the trial, 92 were randomized to PcV, 87 to no primary antibiotic treatment. The median recovery time was four days in both groups. Patients who received PcV had less pain (p <0.001) and used fewer analgesics. There were no significant differences in the number of middle-ear effusions or perforations at the final control after three months. Children randomized to PcV treatment consulted less (p <0.001) during the first seven days.

    Conclusions. Our investigation supports that PcV treatment of AOM does not affect the recovery time or complication rates. PcV provided some symptomatic benefit in the treatment of AOM in otherwise healthy children, aged 2-16 years.

  • 32.
    Nilsen, Per
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science.
    Aalto, Mauri
    National Health Institute, Finland.
    Bendtsen, Preben
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Acute Internal Medicine.
    Seppä, Kaija
    Tampere University Hospital, Finland.
    Effectivness of strategies to implement brief alcohol intervention in primary healthcare2006In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, no 24Article in journal (Refereed)
  • 33.
    Nilsson, Gunnar
    et al.
    Allmänmedicin Karolinska Institutet.
    Åhlfeldt, Hans
    Linköping University, The Institute of Technology. Linköping University, Department of Biomedical Engineering, Medical Informatics.
    Strender, L-E
    Allmänmedicin Karolinska Institutet.
    Textual content, health problems and diagnostic codes in electronic patient records in general practice2003In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 21, no 1, p. 33-36Article in journal (Refereed)
    Abstract [en]

    Objective - To investigate textual content, health problems and diagnostic codes in everyday electronic patient records. Design - Retrospective and observational database study. Setting - Primary health care in Stockholm. Subjects - Twenty randomly selected general practitioners with 20 records each. Main outcome measures - The frequency of use of problem-oriented medical records. The number of words, problems and diagnostic codes. The completeness and correctness of the diagnostic codes. Results - About 14.5% of 400 studied records were problem-oriented. The mean number of words per record was 99.4, and the mean number of problems managed per record was 1.2. On average, there were 1.1 diagnostic codes per record and this differed widely among GPs and also among the electronic patient record systems. The mean number of codes per problem was 0.9, and the proportion of correct codes was 97.4%. Conclusions - The electronic patient records in general practice in Stockholm have an extensive textual content. A vast majority of the problems are coded and the completeness and correctness of diagnostic codes are high. It seems that problem-oriented electronic patient record systems enforce coding activities. It is feasible to establish a database of diagnostic data for research and health care planning based on electronic patient records.

  • 34.
    Nilsson, Staffan
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in East Östergötland, Primary Health Care in Norrköping.
    Andersson, Agneta
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Janzon, Magnus
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.
    Karlsson, Jan-Erik
    County Hospital Ryhov, Sweden.
    Levin, Lars-Åke
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Cost consequences of point-of-care troponin T testing in a Swedish primary health care setting2014In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 32, no 4, p. 241-247Article in journal (Refereed)
    Abstract [en]

    Objective. To evaluate the safety and cost-effectiveness of point-of-care troponin T testing (POCT-TnT) for the management of patients with chest pain in primary care. Design. Prospective observational study with follow-up. Setting. Three primary health care (PHC) centres using POCT-TnT and four PHC centres not using POCT-TnT in south-east Sweden. Patients. All patients greater than= 35 years of age, contacting one of the PHC centres for chest pain, dyspnoea on exertion, unexplained weakness and/or fatigue, with no other probable cause than cardiac, were included. Symptoms must have commenced or worsened during the previous seven days. Main outcome measures. Emergency referral rates, diagnoses of acute myocardial infarction (AMI) or unstable angina (UA), and costs were collected for 30 days after the patient sought care at the PHC centre. Results. A total of 196 patients with chest pain were included: 128 in PHC centres with POCT-TnT and 68 in PHC centres without POCT-TnT. Fewer patients from the PHC centres with POCT-TnT (n = 32, 25%) were emergently referred to hospital than from centres without POCT-TnT (n = 29, 43%; p = 0.011). Eight patients (6.2%) from PHC centres with POCT-TnT were diagnosed with AMI or UA compared with six patients (8.8%) from centres without POCT-TnT (p = 0.565). Two patients with AMI or UA were classified as missed cases from PHC centres with POCT-TnT and there were no missed cases from PHC centres without POCT-TnT. SKr290 000 was saved per missed case of AMI or UA. Conclusion. The use of POCT-TnT in primary care may be cost saving but at the expense of missed cases.

  • 35.
    Nordin Olsson, Inger
    et al.
    University of Örebro.
    Runnamo, Rebecka
    Linköping University, Faculty of Health Sciences.
    Engfeldt, Peter
    University of Örebro.
    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 Orebro, 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-efficient, 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: andgt;= 75 years, andgt;= five 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 significant 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 finding 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.

  • 36.
    Petersson, Ulla
    et al.
    Linköping University, Department of Medicine and Health Sciences, Primary Care . Linköping University, Faculty of Health Sciences.
    Kjellström, Thomas
    2Department of Internal Medicine, Helsingborg Hospital, Sweden.
    Thyroid function tests, serum lipids and gender interrelations in a middle-aged population2001In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 19, no 3, p. 183-185Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To study the value of screening for thyroid function in a screening program for hyperlipidaemia.

    DESIGN: A screening study in primary health care.

    SETTING: All individuals in a defined rural area, Söderåkra, Sweden, aged 40-59 years were invited to a screening programme at the local primary health care centre.

    PARTICIPANTS: 782 individuals were invited for screening. Blood samples were obtained from 88% of the invited males and from 92% of the females.

    MAIN OUTCOME MEASURES: Thyroid function tests (thyroid stimulating hormone (TSH) and free T4), serum lipids (total-cholesterol, HDL-cholesterol, LDL-cholesterol and s-triglycerides), b-glucose and body anthropometry (body mass index and waist to hip circumference) were measured.

    RESULTS: 0.57% of males and 1.13% of females showed evidence of hypothyroidism as defined by a TSH value greater than 3.75 mU/l of those with s-cholesterol concentration above 7 mmol/l. In addition, higher TSH values in females were associated with higher s-cholesterol, s-LDL-cholesterol and s-triglycerides.

    CONCLUSION: It seems appropriate to screen for hypothyroidism in females with s-cholesterol above 7.0 mmol/l.

  • 37.
    Reigo, Tomas
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics. Linköping University, Faculty of Health Sciences.
    Timpka, Toomas
    Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Tropp, Hans
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics. Linköping University, Faculty of Health Sciences.
    The epidemiology of back pain in vocational age groups1999In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 17, no 1, p. 17-21Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To investigate the prevalence of back pain in a general population aged between 20 and 59 years.

    POPULATION: A representative sample of 2000 individuals from Ostergotland County, Sweden (population 400,000).

    STUDY DESIGN: Cross-sectional study using a questionnaire including the pain drawing.

    RESULTS: The observed point prevalence was 28% (95% confidence interval 26-31%). The adjusted prevalence taking into account the non-responders was 23% (21-25%). Lumbar pain with radiation was reported by 40%, while 4% had only cervical pain with radiation. Twelve per cent were on sick-leave due to back pain. Activity of daily life was affected mainly in the group of men aged 40-59 and only in household tasks. The back problems did not affect social activity.

    CONCLUSIONS: The prevalence of back problems in the vocational ages was found to be 23%. Only small parts of a pain population are on sick-leave or have changed working tasks because of back problems. The distribution of pain in most cases is combined with radiation to extremities and not isolated to a single region. The combination of different localisations shows the pain problem to be more than just a "low back" problem.

  • 38.
    Reigo, Tomas
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Orthopaedics. Linköping University, Department of Department of Health and Society, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Tropp, Hans
    Department of Orthopaedic Surgery, Norrköping Hospital, Sweden.
    Timpka, Toomas
    Linköping University, Department of Medical and Health Sciences, Division of Preventive and Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Clinical findings in a population with back pain: Relation to one-year outcome and long-term sick leave2000In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 18, no 4, p. 208-214Article in journal (Refereed)
    Abstract [en]

    Objective - To investigate whether physical examination findings can be used in predicting recovery from back pain and new episodes of sick leave.

    Design - One-year prospective study of a single cohort.

    Settings - Semi-rural Swedish county.

    Population - A cross-section of a general population with back pain (207 women, 176 men) between 20 and 59 years of age.

    Main outcome measures - Cumulative incidence of sick leave due to back pain, cumulative incidence of sick leave due to back pain > 30 days, incidence of recovery from back pain.

    Results - For recovery from pain, the absence of tenderness in the trapezius muscle (OR 0.33, CI 0.1-0.5) was predictive. New sick leave was predicted by tenderness in the trapezius muscle (OR 2.67, CI 1.5-4.9), and had a tendency to be associated with a flattened lumbar lordosis and a restricted cervical range of motion. For long-term sick leave, the same findings and also observation of scoliosis (OR 3.44, CI 1.1-10.5) were predictive.

    Conclusion - There are subgroups with back pain predisposed to development of more persistent symptoms and a higher risk for sick-listing.

  • 39.
    Rodhe, Nils
    et al.
    FoU Jönköping .
    Englund, Lars
    Uppsala univ .
    Mölstad, Sigvard
    Unit of Research and Development in Primary Care, Jönköping.
    Samuelsson, Eva
    Umeå univ .
    Bacteriuria is associated with urge urinary incontinence in older women2008In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 26, no 1, p. 35-39Article in journal (Refereed)
    Abstract [en]

    Objective To evaluate the concept that increased post-void residual urine volume (PVR) is a risk factor for bacteriuria. Design Cross-sectional study. Setting Three nursing homes in Jönköping, southern Sweden. Subjects A total of 147 elderly residents in municipal nursing homes. Main outcome values PVR volumes measured with a portable ultrasonic bladder scan, urine specimen, and questionnaire data on incontinence, immobility, impaired cognition, neurological diseases, and medications. Results Mean age was 86 years and 78% were women. The prevalence of a PVR for the four chosen cut-off values (30, 50, 100, and 150 ml) was 51%, 39%, 20%, and 7%, respectively. The prevalence of bacteriuria was 42%, 46% for women and 28% for men. Elevated PVR was not associated with bacteriuria, incontinence, immobility, impaired cognition or neurological disease (stroke, Parkinson's disease). Conclusion Bacteriuria and elevated PVR are common among elderly residents in nursing homes. The study could not confirm that elevated PVR predisposes to bacteriuria in elderly residents in nursing homes.

  • 40.
    Scheike, Morten
    et al.
    Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
    Nilsson, Staffan
    Linköping University, Department of Department of Health and Society, General Practice. Linköping University, Faculty of Health Sciences.
    Nylander, Eva
    Linköping University, Department of Clinical and Experimental Medicine, Plastic Surgery, Hand Surgery and Burns. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
    Exercise testing and myocardial perfusion scintigraphy in primary care patients with chest pain of new onset2007In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 25, no 2, p. 117-122Article in journal (Refereed)
    Abstract [en]

    Objective: To analyse the outcome of exercise testing and myocardial perfusion scintigraphy (MPS) in primary care patients with chest pain of new onset.

    Design: Prospective, observational. Patients aged 20-79 years, consulting due to chest pain of new onset, were enrolled consecutively.

    Setting: Three primary care health centres in south-eastern Sweden.

    Patients: 191 patients where the possibility of stable ischaemic heart disease (IHD) could not be excluded by clinical examination alone.

    Main outcome measures: Exercise test results, when equivocal completed by MPS.

    Results: Exercise testing revealed IHD in 14 (7%) and no IHD in 134 (70%) of the cases. In 43 (23%) the exercise test results were equivocal. Thirty-nine of these patients underwent MPS, which showed IHD in 19 and no IHD in 20 cases. Among previously diagnosed cardiovascular disease and risk factors only atrial fibrillation in the male group showed a significant correlation to the outcome IHD.

    Conclusion: Exercise testing and MPS are both useful when investigating chest pain patients in primary care.

  • 41.
    Segernäs Kvitting, Anna
    et al.
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Primary Health Care in Central County.
    Wimo, Anders
    Karolinska Institute, Sweden .
    Johansson, Maria
    Linköping University, Department of Clinical and Experimental Medicine, Geriatric. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Geriatric Medicine in Linköping.
    Marcusson, Jan
    Linköping University, Department of Clinical and Experimental Medicine, Geriatric. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Geriatric Medicine in Linköping.
    A Quick Test of Cognitive Speed (AQT): Usefulness in dementia evaluations in primary care2013In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 31, no 1, p. 13-19Article in journal (Refereed)
    Abstract [en]

    Objective. To validate A Quick Test of Cognitive Speed (AQT) as an instrument in diagnostic dementia evaluations against final clinical diagnosis and compare AQT with the Mini-Mental State Examination (MMSE) and Clock Drawing Test (CDT) in primary care. Design. Primary health care cohort survey. Setting. Four primary health care centres and a geriatric memory clinic in Sweden. Patients. 81 patients (age 65 and above) were included: 52 with cognitive symptoms and 29 presumed cognitively healthy. None of the patients had a previous documented dementia diagnosis. All patients performed MMSE, CDT, and AQT at the primary health care clinic and were referred for extensive neuropsychological testing at a memory clinic. AQT was validated against final clinical diagnosis determined by a geriatric specialist and a neuropsychologist. Main outcome measures. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), likelihood ratios, correlation data, and receiver operating characteristic (ROC). Results. For MMSE, sensitivity and specificity was 0.587 and 0.909; CDT 0.261 and 0.879; and AQT 0.783 and 0.667, respectively. For the combination of MMSE and CDT, sensitivity and specificity was 0.696 and 0.788, for MMSE and AQT 0.913 and 0.636. The ROC curve for AQT showed an area under curve (AUC) of 0.773. Conclusion. Our results suggest AQT is a usable test for dementia assessments in primary care. Sensitivity for AQT is superior to CDT, equivalent to MMSE, and comparable to the combination MMSE and CDT. MMSE in combination with AQT improves sensitivity. Because AQT is user-friendly and quickly administered, it could be applicable for primary care settings.

  • 42.
    Sondergaard, Elisabeth
    et al.
    University of Copenhagen, Denmark; University of Copenhagen, Denmark.
    Grauers Willadsen, Tora
    University of Copenhagen, Denmark; University of Copenhagen, Denmark.
    Dorrit Guassora, Ann
    University of Copenhagen, Denmark; University of Copenhagen, Denmark.
    Vestergaard, Mogens
    University of Aarhus, Denmark; University of Aarhus, Denmark.
    Olafia Tomasdottir, Margret
    University of Iceland, Iceland.
    Borgquist, Lars
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Holmberg-Marttila, Doris
    Pirkanmaa Hospital Dist, Finland.
    De Fine Olivarius, Niels
    University of Copenhagen, Denmark; University of Copenhagen, Denmark.
    Reventlow, Susanne
    University of Copenhagen, Denmark; University of Copenhagen, Denmark.
    Problems and challenges in relation to the treatment of patients with multimorbidity: General practitioners views and attitudes2015In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 33, no 2, p. 121-126Article in journal (Refereed)
    Abstract [en]

    Objective. To explore views and attitudes among general practitioners (GPs) and researchers in the field of general practice towards problems and challenges related to treatment of patients with multimorbidity. Setting. A workshop entitled Patients with multimorbidity in general practice held during the Nordic Congress of General Practice in Tampere, Finland, 2013. Subjects. A total of 180 GPs and researchers. Design. Data for this summary report originate from audio-recorded, transcribed verbatim plenary discussions as well as 76 short questionnaires answered by attendees during the workshop. The data were analysed using framework analysis. Results. (i) Complex care pathways and clinical guidelines developed for single diseases were identified as very challenging when handling patients with multimorbidity; (ii) insufficient cooperation between the professionals involved in the care of multimorbid patients underlined the GPs impression of a fragmented health care system; (iii) GPs found it challenging to establish a good dialogue and prioritize problems with patients within the timeframe of a normal consultation; (iv) the future role of the GP was discussed in relation to diminishing health inequality, and current payment systems were criticized for not matching the treatment patterns of patients with multimorbidity. Conclusion. The participants supported the development of a future research strategy to improve the treatment of patients with multimorbidity. Four main areas were identified, which need to be investigated further to improve care for this steadily growing patient group.

  • 43.
    Stratelis, Georgios
    et al.
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Primary Health Care in Motala.
    Fransson, Sven Göran
    Linköping University, Department of Medical and Health Sciences, Radiology. Linköping University, Faculty of Health Sciences.
    Schmekel, Birgitta
    Linköping University, Department of Medical and Health Sciences, Clinical Physiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Clinical Physiology.
    Jakobsson, Per
    Linköping University, Department of Medical and Health Sciences, Pulmonary Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Respiratory Medicine UHL.
    Mölstad, Sigvard
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    High prevalence of emphysema and its association with BMI: A study of smokers with normal spirometry2008In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 26, no 4, p. 241-247Article in journal (Refereed)
    Abstract [en]

    Objectives: To evaluate to what extent emphysema was evident, as identified by High Resolution Computed Tomography (HRCT), in smokers with normal lung function and to relate age, gender, smoking history, and body mass index (BMI) to the HRCT results. A secondary aim was to study to what extent emphysema was present in smokers with lower normal values of lung function defined as FEV1/FVC ratio percentage of predicted value (89-93% of predicted value for males and 90-93% for females) or FEF50 60% of predicted compared with smokers without this definition.

    Methods: Fifty-nine smokers, with a mean age of 53 years and with normal lung function, were examined with HRCT.

    Results: Emphysema evidenced visually by HRCT was present in 43% of the subjects. Using a 0-5 grade scale (0=normal finding; 5=emphysema in most slices), the degree of emphysema was almost exclusively 3-4. The type of emphysema was distributed as centrilobular emphysema predominant in 43.5%, paraseptal emphysema predominant in 43.5%, and as an equal mixture of these types in 13%. The presence of emphysema did not differ between the group of smokers with lower normal values of lung function and the rest of the smokers. Smokers with emphysema had significantly lower BMI than those devoid of emphysema, 24 and 27 respectively (p0.0011).

    Conclusion: There was a high occurrence of visual emphysema in middle-aged smokers with normal lung function. The densitometric quantitative analysis method is inadequate for detecting mild emphysema. High prevalence of emphysema was associated with low BMI.

  • 44.
    Stratelis, Georgios
    et al.
    Linköping University, Department of Medicine and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, West County Primary Health Care.
    Mölstad, Sigvard
    Linköping University, Department of Medicine and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    Jakobsson, Per
    Linköping University, Department of Medicine and Health Sciences, Pulmonary Medicine . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Respiratory Medicine UHL.
    Zetterström, Olle
    Linköping University, Department of Clinical and Experimental Medicine, Allergy Centre . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Allergy Centre.
    The impact of repeated spirometry and smoking cessation advice on smokers with mild COPD2006In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 24, no 3, p. 133-139Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Smoking cessation is the most important therapeutic intervention in patients with chronic obstructive pulmonary diseases (COPD) and the health benefits are immediate and substantial. Major efforts have been made to develop methods with high smoking cessation rates.

    OBJECTIVES: To study whether a combination of spirometry and brief smoking cessation advice to smokers with COPD, annually for three years, increased their smoking cessation rate in comparison with groups of smokers with normal lung function.

    METHOD: Prospective, randomized study in primary care. Smoking cessation rates were compared between smokers with COPD followed-up yearly over a period of three years and smokers with normal lung function followed-up yearly for three years or followed-up only once after three years.

    RESULTS: The point-prevalence abstinence rate and prolonged abstinence rate at 6 and 12 months increased yearly and in smokers with COPD at year 3 was 29%, 28%, and 25%, respectively. The abstinence rates were significantly higher in smokers with COPD than in smokers with normal lung function. Smoking cessation rates among smokers with normal lung function did not increase with increasing number of follow-ups.

    CONCLUSION: Smokers diagnosed with COPD stopped smoking significantly more often than those with normal lung function.

  • 45.
    Sydsjö, Gunilla
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Monfils-Gustavsson, Wiktor
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    DeKeyser, Nicholas
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Claesson, Ing-Marie
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Sydsjö, Adam
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Josefsson, Ann
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Effects of a weight-gain restriction programme for obese pregnant women on sickness absence and pregnancy benefits2013In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 31, no 2, p. 106-110Article in journal (Refereed)
    Abstract [en]

    Objective. To evaluate the effect of a weight-gain restriction programme for obese pregnant women on sickness absence days and pregnancy benefit days during pregnancy and postpartum.

    Design. A prospective, controlled intervention study. The Swedish Social Security Agency's records were utilized to compile sickness absence and pregnancy benefit information.

    Setting. Antenatal care clinics in the south-east of Sweden.

    Subjects. One hundred fifty-five obese pregnant women who participated in a weight restriction program with weekly structured motivational and behavioural talks combined with aqua-aerobics during pregnancy. A total of 193 obese pregnant women with no intervention served as controls.

    Main outcome measures. Sickness absence benefits and pregnancy benefits expressed as a percentage.

    Results. On average women in the intervention group had 76.68 total full days of sickness absence benefit compared with 53.09days in the control group. Total full days of pregnancy benefits were 39.66% days and 41.41% for the intervention and control groups respectively. For the women who were on sick leave there were no differences between the groups in the amount of days taken.

    Conclusions. Given the complexity of factors that have an influence on sickness absence leave, it is possible that programmes that do not address the influence of social aspects and attitudes towards sickness absence have limited effect.

  • 46.
    Sydsjö, Gunilla
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Sydsjö, Adam
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    No association found between sickness absence and duration of pregnancy benefit2005In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 23, no 3, p. 178-183Article in journal (Refereed)
    Abstract [en]

    Objective. Issuing sickness absence certifications is a time-consuming part of GPs' and obstetricians' work in antenatal care. The aim was to study whether a social benefit, the Pregnancy benefit, introduced in Sweden in 1980 and especially targeted at pregnant women working in arduous occupations, had any demonstrable effect on sickness absence among employed pregnant women. Design. Data from delivered women's medical and social security records were collected for 7459 consecutively delivered women in 1978, 1986, 1992, and 1997. Setting. Two delivery wards in southern Sweden. Main outcomes measures. The mean number of days of leave provided by the Pregnancy benefit increased by 8 days up to 1986, and by an additional 6 days between 1986 and 1997, making the total increase 14 days. The mean number of days of sickness absence increased by 19 days between 1978 and 1986, but fell by 24 days between 1986 and 1997. All occupational groups studied behaved in the same way. Results. No direct correlation was found between sickness absence and the number of days of the Pregnancy benefit that were used. Instead, changes in sickness absence among pregnant women were similar to changes in sickness absence among all persons insured, both men and women. Conclusions. Increasing costs of social security insurance among pregnant women are more probably coupled to levels in the social security insurance, as pregnant women seem more inclined to apply for a sickness absence certificate during periods when the economic compensation practically equals their salary. © 2005 Taylor & Francis.

  • 47.
    Tengblad, Anders
    et al.
    Linköping University, Department of Department of Health and Society, General Practice. Linköping University, Faculty of Health Sciences.
    Grodzinsky, Ewa
    Linköping University, Department of Department of Health and Society, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Lindström, Kjell
    Unit of Research and Development in Primary Care, County of Jönköping, Sweden.
    Mölstad, Sigvard
    Linköping University, Department of Medicine and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    Borgquist, Lars
    Linköping University, Department of Department of Health and Society, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Östgren, Carl Johan
    Linköping University, Department of Department of Health and Society, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, West County Primary Health Care.
    Self-monitoring of blood glucose and glycaemic control in type 2 diabetes2007In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 25, no 3, p. 140-146Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Previous studies have shown inconsistent results with regard to whether or not self-monitoring of blood glucose (SMBG) is related to better glycaemic control in type 2 diabetes. The aim of this study was to explore the use of SMBG and its association with glycaemic control in patients with type 2 diabetes in primary care.

    DESIGN: A cross-sectional observational study was conducted in 2003 at 18 primary health care centres in Sweden, in which all known patients with diabetes were surveyed. The study included 6495 patients with type 2 diabetes. A sample of 896 patients was selected for further exploration of data from medical records. A telephone interview was performed with all patients in this group using SMBG (533 patients).

    RESULTS: There were no differences in HbA1c levels between users (6.9%) and non-users (6.8%) of SMBG in patients treated with insulin or in patients treated with oral agents (6.3% in both groups). In patients treated with diet only, users of SMBG had higher levels of HbA1c compared with non-users (5.5% vs. 5.4%, p =0.002). Comparing medical records between users and non-users of SMBG showed no differences in diabetes-related complications in any treatment category group.

    CONCLUSION: The use of SMBG was not associated with improved glycaemic control in any therapy category of patients with type 2 diabetes in primary care. The absence of difference in glycaemic control between users and non-users of SMBG could not be explained by differences in comorbidity between users and non-users of SMBG.

  • 48.
    Wilhelmsson, Susan
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Foldevi, Mats
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, General Practice.
    Åkerlind, Ingemar
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, National Centre for Work and Rehabilitation.
    Faresjö, T
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Welfare and Care (IVV), Science in Nursing.
    Unfavourable working conditions for female GPs. A comparison between Swedish general practitiners and district nurses2002In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 20, p. 74-78Article in journal (Refereed)
  • 49.
    Zielinski, Andrzej
    et al.
    Blekinge Centre Competence, Sweden .
    Borgquist, Lars
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Halling, Anders
    University of Southern Denmark, Denmark .
    Distance to hospital and socioeconomic status influence secondary health care use2013In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 31, no 2, p. 83-88Article in journal (Refereed)
    Abstract [en]

    Objective. The aim of this study was to investigate how distance to hospital and socioeconomic status (SES) influence the use of secondary health care (SHC) when taking comorbidity into account. Design and setting. A register-based study in Ostergotland County. Subjects. The adult population of Ostergotland County. Main outcome measures. Odds of SHC use in the population and rates of SHC use by patients were studied after taking into account comorbidity level assigned using the Adjusted Clinical Groups (ACG) Case-Mix System. The baseline for analysis of SES was individuals with the lowest education level (level 1) and the lowest income (1st quartile). Results. The study showed both positive and negative association between SES and use of SHC. The risk of incurring SHC costs was 12% higher for individuals with education level 1. Individuals with income in the 2nd quartile had a 4% higher risk of incurring SHC costs but a 17% lower risk of emergency department visits. Individuals with income in the 4th quartile had 9% lower risk of hospitalization. The risk of using SHC services for the population was not associated with distance to hospital. Patients living over 40 km from hospital and patients with higher SES had lower use of SHC services. Conclusions. It was found that distance to hospital and SES influence SHC use after adjusting for comorbidity level, age, and gender. These results suggest that GPs and health care managers should pay a higher degree of attention to this when planning primary care services in order to minimize the potentially redundant use of SHC.

  • 50.
    Ólafsdóttir, María
    et al.
    Linköping University, Department of Department of Health and Society, General Practice. Linköping University, Faculty of Health Sciences.
    Foldevi, Mats
    Linköping University, Department of Department of Health and Society, General Practice. Linköping University, Faculty of Health Sciences.
    Marcusson, Jan
    Linköping University, Department of Neuroscience and Locomotion, Geriatrics. Linköping University, Faculty of Health Sciences.
    Dementia in Primary Care: Why the Low Detection Rate?2001In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 19, no 3, p. 194-198Article in journal (Refereed)
    Abstract [en]

    Objective - The aim of the present study was to find reasons for the low detection rate of dementia in primary care. Another aim was to investigate the attitudes and knowledge on dementia among Swedish general practitioners (GPs).

    Design - Two-hundred-and-twenty-eight postal questionnaires were distributed to GPs in the county of Östergötland. Setting - Primary care in Sweden.

    Main outcome measures - The opinions of GPs on dementia management in primary care.

    Results - The response rate was 67%. GPs showed a good knowledge of dementia diseases but underestimated the occurrence of dementia. They presented a positive attitude towards managing patients with dementia and considered that existing drug therapy justified an active search for patients with dementia in primary care, but they believed the efficacy of the drugs to be limited. Assessing the social environment of patients and organising social support were regarded as the most difficult tasks in the management of demented patients.

    Conclusion - The study indicates that the main obstacles are a lack of resources and a sceptical attitude to the benefits of drug treatment. Co-operation between the community services, specialist clinics and the primary care team should be improved.

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