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  • 1.
    Andersson, Per
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Primärvårdscentrum, Vårdcentralen Ljungsbro.
    Sederholm Lawesson, Sofia
    Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken US. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin.
    Karlsson, Jan-Erik
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten. Dept Internal Med, Sweden.
    Nilsson, Staffan
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Primärvårdscentrum, Vårdcentralen Vikbolandet.
    Thylén, Ingela
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Characteristics of patients with acute myocardial infarction contacting primary healthcare before hospitalisation: a cross-sectional study2018Ingår i: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 19, artikel-id 167Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The characteristics of patients with on-going myocardial infarction (MI) contacting the primary healthcare (PHC) centre before hospitalisation are not well known. Prompt diagnosis is crucial in patients with MI, but many patients delay seeking medical care. The aims of this study was to 1) describe background characteristics, symptoms, actions and delay times in patients contacting the PHC before hospitalisation when falling ill with an acute MI, 2) compare those patients with acute MI patients not contacting the PHC, and 3) explore factors associated with a PHC contact in acute MI patients. Methods: This was a cross-sectional multicentre study, enrolling consecutive patients with MI within 24 hours of admission to hospital from Nov 2012 until Feb 2014. Results: A total of 688 patients with MI, 519 men and 169 women, were included; the mean age was 66 +/- 11 years. One in five people contacted PHC instead of the recommended emergency medical services (EMS), and 94% of these patients experienced cardinal symptoms of an acute MI; i.e., chest pain, and/or radiating pain in the arms, and/or cold sweat. Median delay time from symptom-onset-to-decision-to-seek-care was 2:15 hours in PHC patients and 0:40 hours in non-PHC patients (pamp;lt;0.01). The probability of utilising the PHC before hospitalisation was associated with fluctuating symptoms (OR 1.74), pain intensity (OR 0.90) symptoms during off-hours (OR 0.42), study hospital (OR 3.49 and 2.52, respectively, for two of the county hospitals) and a final STEMI diagnosis (OR 0.58). Conclusions: Ambulance services are still underutilized in acute MI patients. A substantial part of the patients contacts their primary healthcare centre before they are diagnosed with MI, although experiencing cardinal symptoms such as chest pain. There is need for better knowledge in the population about symptoms of MI and adequate pathways to qualified care. Knowledge and awareness amongst primary healthcare professionals on the occurrence of MI patients is imperative.

  • 2.
    André, Malin
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Allmänmedicin. Linköpings universitet, Hälsouniversitetet.
    Andén, Annika
    Linköpings universitet, Institutionen för medicin och hälsa, Allmänmedicin. Linköpings universitet, Hälsouniversitetet.
    Borgquist, Lars
    Linköpings universitet, Institutionen för medicin och hälsa, Allmänmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    Rudebeck, Carl Edvard
    Kalmar County Council, Sweden University of Tromso, Norway .
    GPs decision-making - perceiving the patient as a person or a disease2012Ingår i: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 13, nr 38Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The aim of this study was to analyse the clinical decision making strategies of GPs with regard to the whole range of problems encountered in everyday work. less thanbrgreater than less thanbrgreater thanMethods: A prospective questionnaire study was carried through, where 16 General practitioners in Sweden registered consecutively 378 problems in 366 patients. less thanbrgreater than less thanbrgreater thanResults: 68.3% of the problems were registered as somatic, 5.8% as psychosocial and 25.9% as both somatic and psychosocial. When the problem was characterised as somatic the main emphasis was most often on the symptoms only, and when the problem was psychosocial main emphasis was given to the person. Immediate, inductive, decision-making contrary to gradual, analytical, was used for about half of the problems. Immediate decision-making was less often used when problems were registered as both somatic and psychosocial and focus was on both the symptoms and the person. When immediate decision-making was used the GPs were significantly more often certain of their identification of the problem and significantly more satisfied with their consultation. Rules of thumb in consultations registered as somatic with emphasis on symptoms only did not include any reference to the individual patient. In consultations registered as psychosocial with emphasis on the person, rules of thumb often included reference to the patient as a known person. less thanbrgreater than less thanbrgreater thanConclusions: The decision-making (immediate or gradual) registered by the GPs seemed to have been adjusted on the symptom or on the patient as a person. Our results indicate that the GPs seem to recognise immediately both problems and persons, hence the quintessence of the expert skill of the GP as developed through experience.

  • 3.
    André, Malin
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Department Public Health and Caring Science, Sweden.
    Grondal, Hedvig
    Uppsala University, Sweden.
    Strandberg, Eva-Lena
    Lund University, Sweden; Blekinge County Council, Sweden.
    Brorsson, Annika
    Lund University, Sweden; Skåne Reg, Sweden.
    Hedin, Katarina
    Lund University, Sweden; Kronoberg County Council, Sweden.
    Uncertainty in clinical practice - an interview study with Swedish GPs on patients with sore throat2016Ingår i: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 17, nr 56Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Uncertainty is inevitable in clinical practice in primary care and tolerance for uncertainty and concern for bad outcomes has been shown to vary between physicians. Uncertainty is a factor for inappropriate antibiotic prescribing. Evidence-based guidelines as well as near-patient tests are suggested tools to decrease uncertainty in the management of patients with respiratory tract infections. The aim of this paper was to describe strategies for coping with uncertainty in patients with pharyngotonsillitis in relation to guidelines. Methods: An interview study was conducted among a strategic sample of 25 general practitioners (GPs). Results: All GPs mentioned potential dangerous differential diagnoses and complications. Four strategies for coping with uncertainty were identified, one of which was compliant with guidelines, "Adherence to guidelines", and three were idiosyncratic: "Clinical picture and C-reactive protein (CRP)", "Expanded control", and "Unstructured". The residual uncertainty differed for the different strategies: in the strategy "Adherence to guidelines" and " Clinical picture and CRP" uncertainty was avoided, based either on adherence to guidelines or on the clinical picture and near-patient CRP; in the strategy " Expanded control" uncertainty was balanced based on expanded control; and in the strategy "Unstructured" uncertainty prevailed in spite of redundant examination and anamnesis. Conclusion: The majority of the GPs avoided uncertainty and deemed they had no problems. Their strategies either adhered to guidelines or comprised excessive use of tests. Thus use of guidelines as well as use of more near-patient tests seemed associated to reduced uncertainty, although the later strategy at the expense of compliance to guidelines. A few GPs did not manage to cope with uncertainty or had to put in excessive work to control uncertainty.

  • 4.
    Andén, Annika
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Allmänmedicin. Linköpings universitet, Hälsouniversitetet. Bergnäsets Vårdcentral, Luleå, Sweden .
    Andersson, Sven-Olof
    Umeå University, Sweden.
    Rudebeck, Carl-Edvard
    Kalmar City Council, Sweden.
    To make a difference - how GPs conceive consultation outcomes: A phenomenographic study2009Ingår i: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 10, nr 4Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Outcomes from GPs consultations have been measured mainly with disease specific measures and with patient questionnaires about health, satisfaction, enablement and quality. The aim of this study was to explore GPs conceptions of consultation outcomes.

    Methods: Interviews with 17 GPs in groups and individually about consultation outcomes from recently performed consultations were analysed with a phenomenographic research approach.

    Results: The GPs conceived outcomes in four ways: patient outcomes, GPs self-evaluation, relationship building and change of surgery routines.

    Conclusion: Patient outcomes, as conceived by the GPs, were generally congruent with those that had been taken up in outcome studies. Relationship building and change of surgery routines were outcomes in preparation for consultations to come. GPs made self-assessments related to internalized norms, grounded on a perceived collegial professional consensus. Considerations of such different aspects of outcomes can inspire professional development.

  • 5.
    Arvidsson, Eva
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    Andre, Malin
    Uppsala University, Sweden .
    Borgquist, Lars
    Linköpings universitet, Institutionen för medicin och hälsa, Allmänmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    Andersson, David
    Linköpings universitet, Institutionen för ekonomisk och industriell utveckling, Företagsekonomi. Linköpings universitet, Tekniska högskolan.
    Carlsson, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    Setting priorities in primary health care - on whose conditions? A questionnaire study2012Ingår i: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 13, nr 114Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: In Sweden three key criteria are used for priority setting: severity of the health condition; patient benefit; and cost-effectiveness. They are derived from the ethical principles established by the Swedish parliament 1997 but have been used only to a limited extent in primary care. The aim of this study was to describe and analyse: 1) GPs, nurses, and patients prioritising in routine primary care 2) The association between the three key priority setting criteria and the overall priority assigned by the GPs and nurses to individual patients. less thanbrgreater than less thanbrgreater thanMethods: Paired questionnaires were distributed to all patients and the GPs or nurses they had contact with during a 2-week period at four health centres in Sweden. The staff registered the health conditions or health problem, and the planned intervention. Then they estimated the severity of the health condition, the expected patient benefit, and the cost-effectiveness of the planned intervention. Both the staff and the patients reported their overall prioritisation of the patient. In total, 1851 paired questionnaires were collected. less thanbrgreater than less thanbrgreater thanResults: Compared to the medical staff, the patients assigned relatively higher priority to acute/minor conditions than to preventive check-ups for chronic conditions. Severity of the health condition was the priority setting criterion that had the strongest association with the overall priority for the staff as a whole, but for the GPs it was cost-effectiveness. less thanbrgreater than less thanbrgreater thanConclusions: The challenge for primary care providers is to balance the patients demands with medical needs and cost-effectiveness. Transparent priority setting in primary care might contribute to a greater consensus between GPs and nurses on how to use the key priority setting criteria.

  • 6.
    Berman, Anne H.
    et al.
    Stockholm Cty Council, Sweden; Stockholm Ctr Dependency Disorders, Sweden.
    Kolaas, Karoline
    Stockholm Cty Council, Sweden; Gustavsberg Primary Care Clin, Sweden.
    Petersen, Elisabeth
    Stockholm Cty Council, Sweden; Stockholm Ctr Dependency Disorders, Sweden.
    Bendtsen, Preben
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i västra Östergötland, Medicinska specialistkliniken.
    Hedman, Erik
    Stockholm Cty Council, Sweden; Gustavsberg Primary Care Clin, Sweden.
    Linderoth, Catharina
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Müssener, Ulrika
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Sinadinovic, Kristina
    Stockholm Cty Council, Sweden; Stockholm Ctr Dependency Disorders, Sweden.
    Spak, Fredrik
    Chalmers Univ Technol, Sweden.
    Gremyr, Ida
    Univ Gothenburg, Sweden.
    Thurang, Anna
    Stockholm Cty Council, Sweden; Stockholm Ctr Dependency Disorders, Sweden.
    Clinician experiences of healthy lifestyle promotion and perceptions of digital interventions as complementary tools for lifestyle behavior change in primary care2018Ingår i: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 19, artikel-id 139Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Evidence-based practice for healthy lifestyle promotion in primary health care is supported internationally by national policies and guidelines but implementation in routine primary health care has been slow. Referral to digital interventions could lead to a larger proportion of patients accessing structured interventions for healthy lifestyle promotion, but such referral might have unknown implications for clinicians with patients accessing such interventions. This qualitative study aimed to explore the perceptions of clinicians in primary care on healthy lifestyle promotion with or without digital screening and intervention. Methods: Focus group interviews were conducted at 10 primary care clinics in Sweden with clinicians from different health professions. Transcribed interviews were analyzed using content analysis, with inspiration from a phenomenological-hermeneutic method involving naive understanding, structural analysis and comprehensive understanding. Results: Two major themes captured clinicians perceptions on healthy lifestyle promotion: 1) the need for structured professional practice and 2) deficient professional practice as a hinder for implementation. Sub-themes in theme 1 were striving towards professionalism, which for participants meant working in a standardized fashion, with replicable routines regardless of clinic, as well as being able to monitor statistics on individual patient and group levels; and embracing the future with critical optimism, meaning expecting to develop professionally but also being concerned about the consequences of integrating digital tools into primary care, particularly regarding the importance of personal interaction between patient and provider. For theme 2, sub-themes were being in an unmanageable situation, meaning not being able to do what is perceived as best for the patient due to lack of time and resources; and following ones perception, meaning working from a gut feeling, which for our participants also meant deviating from clinical routines. Conclusions: In efforts to increase evidence-based practice and lighten the burden of clinicians in primary care, decision-and policy-makers planning the introduction of digital tools for healthy lifestyle promotion will need to explicitly define their role as complements to face-to-face encounters. Our overriding hope is that this study will contribute to maintaining meaningfulness in the patient-clinician encounter, when digital tools are added to facilitate patient behavior change of unhealthy lifestyle behaviors.

  • 7. Bjerrum, L
    et al.
    Munck, A
    Mölstad, S
    Health Alliance for Prudent Prescribing, Yield and Use of Antimicrobial Drugs in the Treatment of Respiratory Tract Infections (HAPPY AUDIT)2010Ingår i: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 11, nr 29Artikel i tidskrift (Refereegranskat)
  • 8.
    Carlfjord, Siw
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Primärvården i centrala länsdelen.
    Festin, Karin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet.
    Primary health care staffs opinions about changing routines in practice: a cross-sectional study2014Ingår i: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 15, nr 2Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: In health care organizations, there is a mutual interest from politicians, managers, practitioners and patients that the best available care is provided. Efforts are made to translate new knowledge and evidence-based practices into routine care, but there are a number of obstacles to this translation process. Factors related to the new practice as well as factors related to the implementation process are important, but there is still a knowledge gap regarding how to achieve effective implementation. The aim of the present study was to assess opinions about practice change among staff in primary health care (PHC), focusing on factors related to a new practice and factors related to the implementation process. Methods: A questionnaire was sent to 470 staff members at 22 PHC centres where a new tool for lifestyle intervention had recently been implemented. Thirteen items regarding the characteristics of the new practice and nine items regarding the implementation process were to be judged from not at all important to very important. A factor analysis was performed, and statistical analysis was done using the Kruskal-Wallis nonparametric test. Results: Four factors regarding the characteristics of the new practice were identified. Most important was Objective characteristics, followed by Evidence base, Subjectively judged characteristics and Organizational level characteristics. Two factors were identified regarding the implementation process: Bottom-up strategies were judged most important and Top-down strategies less important. The most important single items regarding characteristics were "easy to use" and "respects patient privacy", and the most important implementation process item was "information about the new practice". Nurses differed most from the other professionals, and judged the factors Evidence base and Organizational level characteristics more important than the others. Staff with more than 10 years experience in their profession judged the Evidence base factor more important than those who were less experienced. Conclusions: To incorporate new practices in PHC, objective characteristics of the new practice and the evidence base should be considered. Use of bottom-up strategies for the implementation process is important. Different opinions according to profession, gender and years in practice should be taken into account when planning the implementation.

  • 9.
    Carlfjord, Siw
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och hälsa, Socialmedicin och folkhälsovetenskap. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland.
    Lindberg, Malou
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och hälsa, Allmänmedicin. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    Asthma and COPD in primary health care, quality according to national guidelines: A cross-sectional and a retrospective study2008Ingår i: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 9Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background. In recent decades international and national guidelines have been formulated to ensure that patients suffering from specific diseases receive evidence-based care. In 2004 the National Swedish Board of Health and Welfare (SoS) published guidelines concerning the management of patients with asthma and COPD. The guidelines identify quality indicators that should be fulfilled. The aim of this study was to survey structure and process indicators, according to the asthma and COPD guidelines, in primary health care, and to identify correlations between structure and process quality results. Methods. A cross-sectional study of existing structure by using a questionnaire, and a retrospective study of process quality based on a review of measures documented in asthma and COPD medical records. All 42 primary health care centres in the county council of Östergötland, Sweden, were included. Results. All centres showed high quality regarding structure, although there was a large difference in time reserved for Asthma and COPD Nurse Practice (ACNP). The difference in reserved time was reflected in process quality results. The time needed to reach the highest levels of spirometry and current smoking habit documentation was between 1 and 1 1/2 hours per week per 1000 patients registered at the centre. Less time resulted in fewer patients examined with spirometry, and fewer medical records with smoking habits documented. More time did not result in higher levels, but in more frequent contact with each patient. In the COPD group more time resulted in higher levels of pulse oximetry and weight registration. Conclusion. To provide asthma and COPD patients with high process quality in primary care according to national Swedish guidelines, at least one hour per week per 1000 patients registered at the primary health care centre should be reserved for ACNP. © 2008 Carlfjord and Lindberg, licensee BioMed Central Ltd.

  • 10.
    Carlfjord, Siw
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Socialmedicin och folkhälsovetenskap. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Primärvården i centrala länsdelen.
    Lindberg, Malou
    Linköpings universitet, Institutionen för medicin och hälsa, Allmänmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    Andersson, Agneta
    Linköpings universitet, Institutionen för medicin och hälsa, Socialmedicin och folkhälsovetenskap. Linköpings universitet, Hälsouniversitetet.
    Staff perceptions of addressing lifestyle in primary health care: a qualitative evaluation 2 years after the introduction of a lifestyle intervention tool2012Ingår i: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 13, nr 99Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Preventive services and health promotion in terms of lifestyle counselling provided through primary health care (PHC) has the potential to reduce morbidity and mortality in the population. Health professionals in general are positive about and willing to develop a health-promoting and/or preventive role. A number of obstacles hindering PHC staff from addressing lifestyle issues have been identified, and one facilitator is the use of modern technology. When a computer-based tool for lifestyle intervention (CLT) was introduced at a number of PHC units in Sweden, this provided an opportunity to study staff perspectives on the subject. The aim of this study was to explore PHC staffs perceptions of handling lifestyle issues, including the consultation situation as well as the perceived usefulness of the CLT. less thanbrgreater than less thanbrgreater thanMethods: A qualitative study was conducted after the CLT had been in operation for 2 years. Six focus group interviews, one at each participating unit, including a total of 30 staff members with different professions participated. The interviews were designed to capture perceptions of addressing lifestyle issues, and of using the CLT. Interview data were analysed using manifest content analysis. less thanbrgreater than less thanbrgreater thanResults: Two main themes emerged from the interviews: a challenging task and confidence in handling lifestyle issues. The first theme covered the categories responsibilities and emotions, and the second theme covered the categories first contact, existing tools, and role of the CLT. Staff at the units showed commitment to health promotion/prevention, and saw that patients, caregivers, managers and politicians all have responsibilities regarding the issue. They expressed confidence in handling lifestyle-related conditions, but to a lesser extent had routines for general screening of lifestyle habits, and found addressing alcohol the most problematic issue. The CLT, intended to facilitate screening, was viewed as a complement, but was not considered an important tool for health promotion/prevention. less thanbrgreater than less thanbrgreater thanConclusion: Additional resources, for example in terms of manpower, may help to build the structures necessary for the health promotion/prevention task. Committed leaders could enhance the engagement among staff. Cooperation in multi-professional teams seems to be important, and methods or tools perceived by staff as compatible have a potential to be successfully implemented. Economic incentives rewarding quantity rather than quality appear to be frustrating to PHC staff.

  • 11.
    Carlfjord, Siw
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Socialmedicin och folkhälsovetenskap. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Primärvård: Vårdcentraler, Rörelse & Hälsa, LAH, Ungdomsmottagningen.
    Lindberg, Malou
    Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    Bendtsen, Preben
    Linköpings universitet, Institutionen för medicin och hälsa, Socialmedicin och folkhälsovetenskap. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Medicinska specialistkliniken .
    Nilsen, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Socialmedicin och folkhälsovetenskap. Linköpings universitet, Hälsouniversitetet.
    Andersson, Agneta
    Linköpings universitet, Institutionen för medicin och hälsa, Socialmedicin och folkhälsovetenskap. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    Key factors influencing adoption of an innovation in primary health care: a qualitative study based on implementation theory2010Ingår i: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 11, nr 60Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Bridging the knowledge-to-practice gap in health care is an important issue that has gained interest in recent years. Implementing new methods, guidelines or tools into routine care, however, is a slow and unpredictable process, and the factors that play a role in the change process are not yet fully understood. There is a number of theories concerned with factors predicting successful implementation in various settings, however, this issue is insufficiently studied in primary health care (PHC). The objective of this article was to apply implementation theory to identify key factors influencing the adoption of an innovation being introduced in PHC in Sweden.

    METHODS: A qualitative study was carried out with staff at six PHC units in Sweden where a computer-based test for lifestyle intervention had been implemented. Two different implementation strategies, implicit or explicit, were used. Sixteen focus group interviews and two individual interviews were performed. In the analysis a theoretical framework based on studies of implementation in health service organizations, was applied to identify key factors influencing adoption.

    RESULTS: The theoretical framework proved to be relevant for studies in PHC. Adoption was positively influenced by positive expectations at the unit, perceptions of the innovation being compatible with existing routines and perceived advantages. An explicit implementation strategy and positive opinions on change and innovation were also associated with adoption. Organizational changes and staff shortages coinciding with implementation seemed to be obstacles for the adoption process.

    CONCLUSION: When implementation theory obtained from studies in other areas was applied in PHC it proved to be relevant for this particular setting. Based on our results, factors to be taken into account in the planning of the implementation of a new tool in PHC should include assessment of staff expectations, assessment of the perceived need for the innovation to be implemented, and of its potential compatibility with existing routines. Regarding context, we suggest that implementation concurrent with other major organizational changes should be avoided. The choice of implementation strategy should be given thorough consideration.

  • 12.
    Grodzinsky, Ewa
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för läkemedelsforskning. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    Walter, Susanna
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Magtarmmedicinska kliniken.
    Viktorsson, Lisa
    Carlsson, Ann-Kristin
    Jones, Michael P.
    Macquarie University, Australia.
    Olsen Faresjö, Ashild
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    More negative self-esteem and inferior coping strategies among patients diagnosed with IBS compared with patients without IBS - a case-control study in primary care2015Ingår i: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 16, nr 6Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    Irritable Bowel Syndrome (IBS) is a chronic, relapsing gastrointestinal disorder,that affects approximately 10% of the general population and the majority are diagnosed  in primary care. IBS has been reported to be associated with altered psychological and cognitive functioning such as mood disturbances, somatization, catastrophizing or altered visceral interoception by negative emotions and stress. The aim was to  investigate the psychosocial constructs of self-esteem and sense of coherence among IBS patients compared to non-IBS patients in primary care.     

    Methods

    A case–control study in primary care setting among IBS patients meeting the ROME III         criteria (n = 140) compared to controls i.e. non-IBS patients (n = 213) without any         present or previous gastrointestinal complaints. The data were collected through self-reportedquestionnaires of psychosocial factors.     

    Results

    IBS-patients reported significantly more negative self-esteem (p < 0.001), lower scores         for positive self-esteem (p < 0.001), and lower sense of coherence (p < 0.001) than the controls. The IBS-cases were also less likely to report ‘good’ health status (p < 0.001) and less likely to report a positive belief in the future (p < 0.001). After controlling for relevant confounding factors in multiple regressions, the elevation  in negative self-esteem among IBS patients remained statistically significant (p =0.02), as did the lower scores for sense of coherence among IBS cases (p = 0.04).     

    Conclusions

    The more frequently reported negative self-esteem and inferior coping strategies among         IBS patients found in this study suggest the possibility that psychological therapies         might be helpful for these patients. However these data do not indicate the causal         direction of the observed associations. More research is therefore warranted to determine whether these psychosocial constructs are more frequent in IBS patients.

  • 13.
    Grondal, Hedvig
    et al.
    Uppsala University, Sweden.
    Hedin, Katarina
    Lund University, Sweden; Regional Kronoberg, Sweden.
    Lena Strandberg, Eva
    Lund University, Sweden; Blekinge County Council, Sweden.
    André, Malin
    Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Uppsala University, Sweden.
    Brorsson, Annika
    Lund University, Sweden; Skåne Reg, Sweden.
    Near-patient tests and the clinical gaze in decision-making of Swedish GPs not following current guidelines for sore throat - a qualitative interview study2015Ingår i: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 16, nr 81Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Excessive antibiotics use increases the risk of resistance. Previous studies have shown that the Centor score combined with Rapid Antigen Detection Test (RADT) for Group A Streptococci can reduce unnecessary antibiotic prescribing in patients with sore throat. According to the former Swedish guidelines RADT was recommended with 2-4 Centor criteria present and antibiotics were recommended if the test was positive. C-reactive protein (CRP) was not recommended for sore throats. Inappropriate use of RADT and CRP has been reported in several studies. Methods: From a larger project 16 general practitioners (GPs) who stated management of sore throats not according to the guidelines were identified. Half-hour long semi-structured interviews were conducted. The topics were the management of sore throats and the use of near-patient tests. Qualitative content analysis was used. Results: The use of the near-patient test interplayed with the clinical assessment and the perception that all infections caused by bacteria should be treated with antibiotics. The GPs expressed a belief that the clinical picture was sufficient for diagnosis in typical cases. RADT was not believed to be relevant since it detects only one bacterium, while CRP was considered as a reliable numerical measure of bacterial infection. Conclusions: Inappropriate use of near-patient test can partly be understood as remnants of outdated knowledge. When new guidelines are introduced the differences between them and the former need to be discussed more explicitly.

  • 14.
    Haasenritter, Joerg
    et al.
    University of Marburg, Germany .
    Aerts, Marc
    University of Louvain, Belgium .
    Boesner, Stefan
    University of Marburg, Germany .
    Buntinx, Frank
    Katholieke University of Leuven, Belgium .
    Burnand, Bernard
    University of Lausanne Hospital, Switzerland .
    Herzig, Lilli
    University of Lausanne, Switzerland .
    Andre Knottnerus, J
    University of Maastricht, Netherlands .
    Minalu, Girma
    University of Louvain, Belgium .
    Nilsson, Staffan
    Linköpings universitet, Institutionen för medicin och hälsa, Allmänmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i östra Östergötland, Vårdcentraler i östra länsdelen.
    Renier, Walter
    Katholieke University of Leuven, Belgium .
    Sox, Carol
    Dartmouth Medical Sch, NH USA .
    Sox, Harold
    Dartmouth Medical Sch, NH USA .
    Donner-Banzhoff, Norbert
    University of Marburg, Germany .
    Coronary heart disease in primary care: accuracy of medical history and physical findings in patients with chest pain - a study protocol for a systematic review with individual patient data2012Ingår i: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 13, nr 81Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Background: Chest pain is a common complaint in primary care, with coronary heart disease (CHD) being the most concerning of many potential causes. Systematic reviews on the sensitivity and specificity of symptoms and signs summarize the evidence about which of them are most useful in making a diagnosis. Previous meta-analyses are dominated by studies of patients referred to specialists. Moreover, as the analysis is typically based on study-level data, the statistical analyses in these reviews are limited while meta-analyses based on individual patient data can provide additional information. Our patient-level meta-analysis has three unique aims. First, we strive to determine the diagnostic accuracy of symptoms and signs for myocardial ischemia in primary care. Second, we investigate associations between study-or patient-level characteristics and measures of diagnostic accuracy. Third, we aim to validate existing clinical prediction rules for diagnosing myocardial ischemia in primary care. This article describes the methods of our study and six prospective studies of primary care patients with chest pain. Later articles will describe the main results. less thanbrgreater than less thanbrgreater thanMethods/Design: We will conduct a systematic review and IPD meta-analysis of studies evaluating the diagnostic accuracy of symptoms and signs for diagnosing coronary heart disease in primary care. We will perform bivariate analyses to determine the sensitivity, specificity and likelihood ratios of individual symptoms and signs and multivariate analyses to explore the diagnostic value of an optimal combination of all symptoms and signs based on all data of all studies. We will validate existing clinical prediction rules from each of the included studies by calculating measures of diagnostic accuracy separately by study. less thanbrgreater than less thanbrgreater thanDiscussion: Our study will face several methodological challenges. First, the number of studies will be limited. Second, the investigators of original studies defined some outcomes and predictors differently. Third, the studies did not collect the same standard clinical data set. Fourth, missing data, varying from partly missing to fully missing, will have to be dealt with. Despite these limitations, we aim to summarize the available evidence regarding the diagnostic accuracy of symptoms and signs for diagnosing CHD in patients presenting with chest pain in primary care. less thanbrgreater than less thanbrgreater thanReview registration: Centre for Reviews and Dissemination (University of York): CRD42011001170

  • 15.
    Keurhorst, M.
    et al.
    Radboud University of Nijmegen, Netherlands; Saxion University of Appl Science, Netherlands.
    Heinen, M.
    Radboud University of Nijmegen, Netherlands.
    Colom, J.
    Govt Catalonia, Spain.
    Linderoth, Catharina
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Müssener, Ulrika
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Okulicz-Kozaryn, K.
    State Agency Prevent Alcohol Related Problems, Poland.
    Palacio-Vieira, J.
    Govt Catalonia, Spain.
    Segura, L.
    Govt Catalonia, Spain.
    Silfversparre, F.
    University of Gothenburg, Sweden.
    Slodownik, L.
    State Agency Prevent Alcohol Related Problems, Poland.
    Sorribes, E.
    Govt Catalonia, Spain.
    Laurant, M.
    Radboud University of Nijmegen, Netherlands; HAN University of Appl Science, Netherlands.
    Wensing, M.
    Radboud University of Nijmegen, Netherlands.
    Strategies in primary healthcare to implement early identification of risky alcohol consumption: why do they work or not? A qualitative evaluation of the ODHIN study2016Ingår i: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 17, nr 70Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Screening and brief interventions (SBI) in primary healthcare are cost-effective in risky drinkers, yet they are not offered to all eligible patients. This qualitative study aimed to provide more insight into the factors and mechanisms of why, how, for whom and under what circumstances implementation strategies work or do not work in increasing SBI. Methods: Semi-structured interviews were conducted between February and July 2014 with 40 GPs and 28 nurses in Catalonia, the Netherlands, Poland, and Sweden. Participants were purposefully selected from the European Optimising Delivery of Healthcare Interventions (ODHIN) trial. This randomised controlled trial evaluated the influence of training and support, financial reimbursement and an internet-based method of delivering advice on SBI. Amongst them were 38 providers with a high screening performance and 30 with a low screening performance from different allocation groups. Realist evaluation was combined with the Tailored Implementation for Chronic Diseases framework for identification of implementation determinants to guide the interviews and analysis. Transcripts were analysed thematically with the diagram affinity method. Results: Training and support motivated SBI by improved knowledge, skills and prioritisation. Continuous provision, sufficient time to learn intervention techniques and to tailor to individual experienced barriers, seemed important Tamp;S conditions. Catalan and Polish professionals perceived financial reimbursement to be an additional stimulating factor as well, as effects on SBI were smoothened by personnel levels and salary levels. Structural payment for preventive services rather than a temporary project based payment, might have increased the effects of financial reimbursement. Implementing e-BI seem to require more guidance than was delivered in ODHIN. Despite the allocation, important preconditions for SBI routine seemed frequent exposure of this topic in media and guidelines, SBI facilitating information systems, and having SBI in protocol-led care. Hence, the second order analysis revealed that the applied implementation strategies have high potential on the micro professional level and meso-organisational level, however due to influences from the macro-level such as societal and political culture the effects risks to get nullified. Conclusions: Essential determinants perceived for the implementation of SBI routines were identified, in particular for training and support and financial reimbursement. However, focusing only on the primary healthcare setting seems insufficient and a more integrated SBI culture, together with meso- and macro-focused implementation process is requested.

  • 16.
    Kärner, Anita
    et al.
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Nilsson, Staffan
    Linköpings universitet, Institutionen för medicin och hälsa, Allmänmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i östra Östergötland, Vårdcentraler i östra länsdelen.
    Jaarsma, Tiny
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Andersson, Agneta
    Linköpings universitet, Institutionen för medicin och hälsa, Socialmedicin och folkhälsovetenskap. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    Wiréhn, Ann-Britt
    Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    Wodlin, Peter
    Östergötlands Läns Landsting, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Hjelmfors, Lisa
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Tingström, Pia
    Linköpings universitet, Institutionen för medicin och hälsa, Omvårdnad. Linköpings universitet, Hälsouniversitetet.
    The effect of problem-based learning in patient education after an event of CORONARY heart disease - a randomised study in PRIMARY health care: design and methodology of the COR-PRIM study2012Ingår i: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 13, nr 110Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    Even though there is convincing evidence that self-care, such as regular exercise         and/or stopping smoking, alters the outcomes after an event of coronary heart disease         (CHD), risk factors remain. Outcomes can improve if core components of secondary prevention         programmes are structurally and pedagogically applied using adult learning principles         e.g. problem-based learning (PBL). Until now, most education programs for patients         with CHD have not been based on such principles. The basic aim is to discover whether         PBL provided in primary health care (PHC) has long-term effects on empowerment and         self-care after an event of CHD.     

    Methods/Design

    A randomised controlled study is planned for patients with CHD. The primary outcome         is empowerment to reach self-care goals. Data collection will be performed at baseline         at hospital and after one, three and five years in PHC using quantitative and qualitative         methodologies involving questionnaires, medical assessments, interviews, diaries and         observations. Randomisation of 165 patients will take place when they are stable in         their cardiac condition and have optimised cardiac medication that has not substantially         changed during the last month. All patients will receive conventional care from their         general practitioner and other care providers. The intervention consists of a patient         education program in PHC by trained district nurses (tutors) who will apply PBL to         groups of 6–9 patients meeting on 13 occasions for two hours over one year. Patients         in the control group will not attend a PBL group but will receive home-sent patient         information on 11 occasions during the year.     

    Discussion

    We expect that the 1-year PBL-patient education will improve patients’ beliefs, self-efficacy         and empowerment to achieve self-care goals significantly more than one year of standardised         home-sent patient information. The assumption is that PBL will reduce cardiovascular         events in the long-term and will also be cost-effective compared to controls. Further,         the knowledge obtained from this study may contribute to improving patients’ ability         to handle self-care, and furthermore, may reduce the number of patients having subsequent         CHD events in Sweden.

  • 17.
    Kärner Köhler, Anita
    et al.
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten.
    Tingström, Pia
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten.
    Jaarsma, Tiny
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten.
    Nilsson, Staffan
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Primärvårdscentrum, Vårdcentralen Vikbolandet.
    Patient empowerment and general self-efficacy in patients with coronary heart disease: a cross-sectional study2018Ingår i: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 19, artikel-id 76Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    In managing a life with coronary heart disease and the possibility of planning and following a rehabilitation plan, patients’ empowerment and self-efficacy are considered important. However, currently there is limited data on levels of empowerment among patients with coronary heart disease, and demographic and clinical characteristics associated with patient empowerment are not known.

    The purpose of this study was to assess the level of patient empowerment and general self-efficacy in patients six to 12 months after the cardiac event. We also aimed to explore the relationship between patient empowerment, general self-efficacy and other related factors such as quality of life and demographic variables.

    Methods

    A sample of 157 cardiac patients (78% male; age 68 ± 8.5 years) was recruited from a Swedish hospital. Patient empowerment was assessed using the SWE-CES-10. Additional data was collected on general self-efficacy and well-being (EQ5D and Ladder of Life). Demographic and clinical variables were collected from medical records and interviews.

    Results

    The mean levels of patient empowerment and general self-efficacy on a 0–4 scale were 3.69 (±0.54) and 3.13 (±0.52) respectively, and the relationship between patient empowerment and general self-efficacy was weak (r = 0.38). In a simple linear regression, patient empowerment and general self-efficacy were significantly correlated with marital status, current self-rated health and future well-being. Multiple linear regressions on patient empowerment (Model 1) and general self-efficacy (Model 2) showed an independent significant association between patient empowerment and current self-rated health. General self-efficacy was not independently associated with any of the variables.

    Conclusions

    Patients with a diagnosis of coronary heart disease reported high levels of empowerment and general self-efficacy at six to 12 months after the event. Clinical and demographic variables were not independently associated with empowerment or low general self-efficacy. Patient empowerment and general self-efficacy were not mutually interchangeable, and therefore both need to be measured when planning for secondary prevention in primary health care.

  • 18.
    Leijon, Matti E.
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Socialmedicin och folkhälsovetenskap. Linköpings universitet, Hälsouniversitetet. Center for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden.
    Bendtsen, Preben
    Linköpings universitet, Institutionen för medicin och hälsa, Socialmedicin och folkhälsovetenskap. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Medicinska specialistkliniken .
    Ståhle, Agneta
    Department of Neurobiology, Health Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden.
    Ekberg, Kerstin
    Linköpings universitet, Institutionen för medicin och hälsa, Arbetslivsinriktad rehabilitering. Linköpings universitet, HELIX Vinn Excellence Centre. Linköpings universitet, Hälsouniversitetet.
    Festin, Karin
    Linköpings universitet, Institutionen för medicin och hälsa, Socialmedicin och folkhälsovetenskap. Linköpings universitet, Hälsouniversitetet.
    Nilsen, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Socialmedicin och folkhälsovetenskap. Linköpings universitet, Hälsouniversitetet.
    Factors associated with patients self-reported adherence to prescribed physical activity in routine primary health care2010Ingår i: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 11, nr 38Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Written prescriptions of physical activity, so‐called physical activity referral (PAR) schemes, have increased in popularity in recent years. Such schemes have mostly been evaluated in terms of efficacy. This study reports on a Swedish PAR scheme implemented in routine primary health care (PHC) measuring patients’ self‐reported adherence to physical activity prescriptions. The aim of this study was to evaluate adherence to physical activity prescriptions issued in everyday PHC at 3 and 12 months and to analyse the different characteristics associated with adherence to these prescriptions.

    Methods: Prospective prescription data were obtained for 37 of the 42 PHC centres in Östergötland County, Sweden, during 2004. The study population consisted of 3300 patients issued PARs by ordinary PHC staff members. Odds ratios were calculated to identify the factors associated with adherence.

    Results: The average adherence rate was 56% at 3 months and 50% at 12 months. In the descriptive analyses, higher adherence was associated with increased age, higher activity level at baseline, home‐based activities, prescriptions issued by professional groups other than physicians, and among patients issued PARs due to diabetes, high blood pressure and “other PAR reasons”. In the multiple logistic regression models, higher adherence was associated with higher activity level at baseline, and to prescriptions including home‐based activities, both at 3 and 12 months.

    Conclusions: Prescriptions from ordinary staff in routine PHC yielded adherence in 50% of the patients in this routine care PAR scheme follow‐up. Patients’ activity level at baseline (being at least somewhat physically inactive) and being issued homebased activities were associated with higher adherence at both 3 and 12 months.

  • 19.
    Lionis, Christos
    et al.
    University of Crete, Greece .
    Petelos, Elena
    University of Crete, Greece .
    Shea, Sue
    University of Crete, Greece .
    Bagiartaki, Georgia
    University of Crete, Greece .
    Tsiligianni, Ioanna G.
    University of Crete, Greece .
    Kamekis, Apostolos
    University of Crete, Greece .
    Tsiantou, Vasiliki
    National School Public Heatlh, Greece .
    Papadakaki, Maria
    University of Crete, Greece .
    Tatsioni, Athina
    University of Ioannina, Greece .
    Moschandreas, Joanna
    University of Crete, Greece .
    Saridaki, Aristoula
    University of Crete, Greece .
    Bertsias, Antonios
    University of Crete, Greece University of Crete, Greece .
    Faresjö, Tomas
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet.
    Olsen Faresjö, Åshild
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet.
    Martinez, Luc
    University of Paris 06, France EPAR Team, France .
    Agius, Dominic
    Mediterranean Institute Primary Care, Malta .
    Uncu, Yesim
    Turkish Assoc Family Phys TAHUD, Turkey .
    Samoutis, George
    University of Nicosia, Cyprus .
    Vlcek, Jiri
    Charles University of Prague, Czech Republic .
    Abasaeed, Abobakr
    Charles University of Prague, Czech Republic .
    Merkouris, Bodossakis
    Greek Assoc Gen Practitioners, Greece .
    Irrational prescribing of over-the-counter (OTC) medicines in general practice: testing the feasibility of an educational intervention among physicians in five European countries2014Ingår i: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 15, nr 34Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Irrational prescribing of over-the-counter (OTC) medicines in general practice is common in Southern Europe. Recent findings from a research project funded by the European Commission (FP7), the "OTC SOCIOMED", conducted in seven European countries, indicate that physicians in countries in the Mediterranean Europe region prescribe medicines to a higher degree in comparison to physicians in other participating European countries. In light of these findings, a feasibility study has been designed to explore the acceptance of a pilot educational intervention targeting physicians in general practice in various settings in the Mediterranean Europe region. Methods: This feasibility study utilized an educational intervention was designed using the Theory of Planned Behaviour (TPB). It took place in geographically-defined primary care areas in Cyprus, France, Greece, Malta, and Turkey. General Practitioners (GPs) were recruited in each country and randomly assigned into two study groups in each of the participating countries. The intervention included a one-day intensive training programme, a poster presentation, and regular visits of trained professionals to the workplaces of participants. Reminder messages and email messages were, also, sent to participants over a 4-week period. A pre- and post-test evaluation study design with quantitative and qualitative data was employed. The primary outcome of this feasibility pilot intervention was to reduce GPs intention to provide medicines following the educational intervention, and its secondary outcomes included a reduction of prescribed medicines following the intervention, as well as an assessment of its practicality and acceptance by the participating GPs. Results: Median intention scores in the intervention groups were reduced, following the educational intervention, in comparison to the control group. Descriptive analysis of related questions indicated a high overall acceptance and perceived practicality of the intervention programme by GPs, with median scores above 5 on a 7-point Likert scale. Conclusions: Evidence from this intervention will estimate the parameters required to design a larger study aimed at assessing the effectiveness of such educational interventions. In addition, it could also help inform health policy makers and decision makers regarding the management of behavioural changes in the prescribing patterns of physicians in Mediterranean Europe, particularly in Southern European countries.

  • 20.
    Nilsson, Staffan
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i östra Östergötland, Primärvården i östra länsdelen.
    Järemo, Petter
    Region Östergötland, Närsjukvården i östra Östergötland, Medicinkliniken ViN.
    Non-coronary chest pain does not affect long-term mortality: a prospective, observational study using a matched population control2016Ingår i: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 17, artikel-id 159Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Chest pain assumed to be of non-coronary origin (NCCP) may be linked to enhanced mortality due to coronary heart disease (CHD). The aim of this study was to follow NCCP patients, as defined in primary care, with respect to mortality and long-term morbidity of CHD. We further examined if NCCP associates with risk factors for CHD.

    Methods: Patients consulting general practitioners (GPs) in 1998–2000 in three primary care centers in the southeast Sweden for chest pain regarded as NCCP were compared with controls matched for age, gender and residential area. Causes of death were gathered from registry data and death certificates. In 2005 a postal questionnaire was distributed to the survivors to collect demographic and clinical data. If participants had CHD diagnosed by a physician prior to inclusion they were excluded.

    Results: Patients with NCCP (n = 382) and population controls (n = 746) did not differ with respect to mortality and incidence of CHD. The NCCP group reported more ongoing chest pain (OR 3.34 95 % CI 2.41–4.62), they more often had elevated blood pressure (OR 1.86 95 % CI 1.32–2.60), consumed more β-blockers (p < 0.001), aspirin (p = 0.013), thiazides (p = 0.004) and long-acting nitrates (p = 0.002). They further had more remedies for acid-related disorders (p = 0.014) and obstructive pulmonary disease (p < 0.001).

    Conclusions: The study suggests that individuals with chest pain judged by GPs to be NCCP do not develop CHD more frequently than population controls. It is evident that NCCP often lasts for many years and that the condition associates with hypertension.

  • 21. Olsson, Erik
    et al.
    Narvselius, Eleonora
    Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Samhälle, mångfald, Identitet (SMI).
    Cultural Identifications, Political representations ad national Project(s) on the Symbolic Arena of the Orange Revolution2007Ingår i: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 7, nr 2, s. 29-54Artikel i tidskrift (Refereegranskat)
    Abstract [en]

       

  • 22.
    Roel, Eduardo
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Allmänmedicin.
    Faresjö, Åshild
    Zetterström, Olle
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för molekylär och klinisk medicin, Allergicentrum. Östergötlands Läns Landsting, Medicincentrum, Allergicentrum US.
    Trell, Erik
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Allmänmedicin.
    Faresjö, Tomas
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Allmänmedicin.
    Clinically diagnosed childhood asthma and follow-up of symptoms in a Swedish case control study2005Ingår i: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 6Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Childhood asthma has risen dramatically not only in the western societies and now forms a major and still increasing public health problem. The aims of this study were to follow up at the age of ten the patterns of asthma symptoms and associations among children with a clinically diagnosed asthma in a sizeable urban-rural community and to in compare them with demographic controls using a standardised questionnaire. Methods: In a defined region in Sweden with a population of about 150 000 inhabitants, all children (n = 2 104) born in 1990 were recorded. At the age of seven all primary care and hospital records of the 1 752 children still living in the community were examined, and a group of children (n = 191) was defined with a well-documented and medically confirmed asthma diagnosis. At the age of ten, 86 % of these cases (n = 158) and controls (n = 171) completed an ISAAC questionnaire concerning asthma history, symptoms and related conditions. Results: Different types of asthma symptoms were highly and significantly over-represented in the cases. Reported asthma heredity was significantly higher among the cases. No significant difference in reported allergic rhinitis or eczema as a child was found between cases and controls. No significant difference concerning social factors or environmental exposure was found between case and controls. Among the control group 4.7 % of the parents reported that their child actually had asthma. These are likely to be new asthma cases between the age of seven and ten and give an estimated asthma prevalence rate at the age of ten of 15.1 % in the studied cohort. Conclusion: A combination of medical verified asthma diagnosis through medical records and the use of self-reported symptom through the ISAAC questionnaire seem to be valid and reliable measures to follow-up childhood asthma in the local community. The asthma prevalence at the age of ten in the studied birth cohort is considerably higher than previous reports for Sweden. Both the high prevalence figure and allowing the three-year lag phase for further settling of events in the community point at the complementary roles of both hospital and primary care in the comprehensive coverage and control of childhood asthma in the community. © 2005 Roel et al, licensee BioMed Central Ltd.

  • 23.
    Strandberg, Eva Lena
    et al.
    Lund University, Sweden; Blekinge County Council, Sweden.
    Brorsson, Annika
    Lund University, Sweden; Centre Primary Health Care Research, Sweden.
    André, Malin
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Uppsala University, Sweden.
    Gröndal, Hedvig
    Uppsala University, Sweden.
    Molstad, Sigvard
    Lund University, Sweden.
    Hedin, Katarina
    Lund University, Sweden; Regional Kronoberg, Sweden.
    Interacting factors associated with Low antibiotic prescribing for respiratory tract infections in primary health care - a mixed methods study in Sweden2016Ingår i: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 17, nr 78Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Prescribing of antibiotics for common infections varies widely, and there is no medical explanation. Systematic reviews have highlighted factors that may influence antibiotic prescribing and that this is a complex process. It is unclear how factors interact and how the primary care organization affects diagnostic procedures and antibiotic prescribing. Therefore, we sought to explore and understand interactions between factors influencing antibiotic prescribing for respiratory tract infections in primary care. Methods: Our mixed methods design was guided by the Triangulation Design Model according to Creswell. Quantitative and qualitative data were collected in parallel. Quantitative data were collected by prescription statistics, questionnaires to patients, and general practitioners audit registrations. Qualitative data were collected through observations and semi-structured interviews. Results: From the analysis of the data from the different sources an overall theme emerged: A common practice in the primary health care centre is crucial for low antibiotic prescribing in line with guidelines. Several factors contribute to a common practice, such as promoting management and leadership, internalized guidelines including inter-professional discussions, the general practitioners diagnostic process, nurse triage, and patient expectation. These factors were closely related and influenced each other. The results showed that knowledge must be internalized and guidelines need to be normative for the group as well as for every individual. Conclusions: Low prescribing is associated with adapted and transformed guidelines within all staff, not only general practitioners. Nurses triage and self-care advice played an important role. Encouragement from the management level stimulated inter-professional discussions about antibiotic prescribing. Informal opinion moulders talking about antibiotic prescribing was supported by the managers. Finally, continuous professional development activities were encouraged for up-to-date knowledge.

  • 24. Strandberg, Eva Lena
    et al.
    Ovhed, Ingvar
    Borgquist, Lars
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Allmänmedicin. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    Wilhelmsson, Susan
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Hälsouniversitetet.
    The perceived meaning of a (w)holistic view among general practitioners and district nurses in Swedish primary care: a qualitative study2007Ingår i: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296Artikel i tidskrift (Refereegranskat)
  • 25.
    Thomas, Kristin
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin.
    Krevers, Barbro
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Hälsouniversitetet.
    Bendtsen, Preben
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Medicinska specialistkliniken .
    Long-term impact of a real-world coordinated lifestyle promotion initiative in primary care: a quasi-experimental cross-sectional study2014Ingår i: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 15, nr 201Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Integration of lifestyle promotion in routine primary care has been suboptimal. Coordinated care models (e.g. screening, brief advice and referral to in-house specialized staff) could facilitate lifestyle promotion practice; they have been shown to increase the quality of services and reduce costs in other areas of care. This study evaluates the long-term impact of a coordinated lifestyle promotion intervention with a multidisciplinary team approach in a primary care setting. Methods: A quasi-experimental, cross-sectional design was used to compare three intervention centres using a coordinated care model and three control centres using a traditional model of lifestyle promotion care. Outcomes were inspired by using the RE-AIM framework: reach, the proportion of patients receiving lifestyle promotion; effectiveness, self-reported attitudes and competency among staff; adoption, proportion of staff reporting daily practice of lifestyle promotion and referral; and implementation, of the coordinated care model. The impact was investigated after 3 and 5 years. Data collection involved a patient questionnaire (intervention, n = 433-497; control, n = 455-497), a staff questionnaire (intervention, n = 77-76; control, n = 43-56) and structured interviews with managers (n = 8). The X-2 test or Fisher exact test with adjustment for clustering by centre was used for the analysis. Problem-driven content analysis was used to analyse the interview data. Results: The findings were consistent over time. Intervention centres did not show higher rates for reach of patients or adoption among staff at the 3- or 5-year follow-up. Some conceptual differences between intervention and control staff remained over time in that the intervention staff were more positive on two of eight effectiveness outcomes (one attitude and one competency item) compared with control staff. The Lifestyle team protocol, which included structural opportunities for coordinated care, was implemented at all intervention centres. Lifestyle teams were perceived to have an important role at the centres in driving the lifestyle promotion work forward and being a forum for knowledge exchange. However, resources to refer patients to specialized staff were used inconsistently. Conclusions: The Lifestyle teams may have offered opportunities for lifestyle promotion practice and contributed to enabling conditions at centre level but had limited impact on lifestyle promotion practices.

  • 26.
    Vikström, Anna
    et al.
    Department of Neurobiology, Care Sciences and Society, Center for Family and Community Medicine, Karolinska Institutet, Huddinge, Sweden.
    Hägglund, Maria
    Department of Learning, Informatics, Management and Ethics, Health Informatics Centre-(HIC), Karolinska Institutet, Stockholm, Sweden.
    Nyström, Mikael
    Linköpings universitet, Institutionen för medicinsk teknik, Medicinsk informatik. Linköpings universitet, Tekniska högskolan.
    Strender, Lars-Erik
    Department of Neurobiology, Care Sciences and Society, Center for Family and Community Medicine, Karolinska Institutet, Huddinge, Sweden.
    Koch, Sabine
    Department of Learning, Informatics, Management and Ethics, Health Informatics Centre-(HIC), Karolinska Institutet, Stockholm, Sweden.
    Hjerpe, Per
    R&D Centre, Skaraborg PC, Skövde; Social Epidemiology, Department of Clinical Sciences, Faculty of Medicine, Lund University, Sweden.
    Lindblad, Ulf
    Department of Public Health and Community Medicine/Primary Health Care, the Sahlgrenska Academy at the University of Gothenburg, Sweden.
    Nilsson, Gunnar H
    Department of Neurobiology, Care Sciences and Society, Center for Family and Community Medicine, Karolinska Institutet, Huddinge, Sweden.
    Coding of procedures documented by general practitioners in Swedish primary care-an explorative study using two procedure coding systems2012Ingår i: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 13, nr 2Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background

    Procedures documented by general practitioners in primary care have not been studied in relation to procedure coding systems. We aimed to describe procedures documented by Swedish general practitioners in electronic patient records and to compare them to the Swedish Classification of Health Interventions (KVÅ) and SNOMED CT.

    Methods

    Procedures in 200 record entries were identified, coded, assessed in relation to two procedure coding systems and analysed.

    Results

    417 procedures found in the 200 electronic patient record entries were coded with 36 different Classification of Health Interventions categories and 148 different SNOMED CT concepts. 22.8% of the procedures could not be coded with any Classification of Health Interventions category and 4.3% could not be coded with any SNOMED CT concept. 206 procedure-concept/category pairs were assessed as a complete match in SNOMED CT compared to 10 in the Classification of Health Interventions.

    Conclusions

    Procedures documented by general practitioners were present in nearly all electronic patient record entries. Almost all procedures could be coded using SNOMED CT.

    Classification of Health Interventions covered the procedures to a lesser extent and with a much lower degree of concordance. SNOMED CT is a more flexible terminology system that can be used for different purposes for procedure coding in primary care.

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