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- Adamiak, Grazyna Teresa, 1956-
(författare)
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Påverkan av organisatoriska och miljömässiga faktorer på tillgänglighet till akutsjukvården
- 2004
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The settings investigated were departments of internal medicine (IM), orthopaedics and surgery in acute care hospitals in Sweden. The objective was to identify exogenous and endogenous determinants of accessibility of health care. Both qualitative and quantitative analysis of utilisation was performed on national and regional level of data aggregation. The study proposes that accessibility to acute health services is influenced by exogenous factors, partly outside the control of health care professionals, such as season, physical proximity and overall supply. Organisational properties such as availability of inpatient beds, hospital and physician specialisation and the degree of system integration between provides of emergency care have effects on the quality of care. The novel finding is the strong association between acute readmissions and remaining inpatient utilisation indicating effects of bed supply on global use within IM. These conclusions follow:§ structural changes on system level work as a method of prioritisation between patient groups by changes in criteria of accessibility;§ the natural and organisational environments determine waiting times in EDs in hospitals by fluctuations of demand;§ geographical accessibility coincides with the supply in terms of over- or underutilisation mirrored in the outcome of medical care;§ effective access is determined by the divide of resources between inpatient and outpatient care and the total supply of inpatient care;§ increasing demands on inpatient care in IM may be derived from deficiencies in the care of chronically ill, elderly patients;§ transition of information and communication among care givers and patients varies in efficiency depending on vehicles for coordination and system integration;§ the level of training of the admitting physician has effects on effective accessibility to inpatient care.There are conflicts between accessibility, efficiency and appropriateness of settings calling for attention to capacity to benefit in addition to needs as priority criteria.
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- Backlund, L.B., et al.
(författare)
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Early detection of diabetic retinopathy by mobile retinal photography service working in partnership with primary health care teams
- 1998
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Ingår i: Diabetic Medicine. - 0742-3071 .- 1464-5491. ; 15:S3, s. S32-S37
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Tidskriftsartikel (refereegranskat)abstract
- Community-wide fundus photography was organized for early detection of diabetic retinopathy (DR) by mobile teams. High-quality three-field Kodachrome fundus photography, performed according to the London Protocol through dilated pupils was offered free of charge to primary care; images were taken in the community and assessed centrally. Data are presented from the first 80 primary health care centres (PHCCs) participating, serving 990 000 (about 60 %) of inhabitants in Stockholm County. Beginning in 1990, 6863 diabetes patients were invited by PHCCs; 5490 (80 %) attended. We reached 77 % of persons with known diabetes; only 37 % had had their eyes examined during the preceding 2 years. For 97 % of patients, images were assessable. DR was present in 34 % of patients (non-proliferative DR not requiring further assessment 29 %, non-proliferative DR requiring further assessment 1.1 %, proliferative DR 0.5 % and macular involvement 3.6 %). Re-examination after 2 years was offered to 64 %; follow-up photography after 1 year to 24 %. Fluorescein angiography and/or photocoagulation treatment was performed in 3.6 %. This method of early diagnosis is feasible, acceptable, and reached twice as many patients as did the usual referral-based system of care. We now plan to extend this service to cover the whole county.
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- Bastholm Rahmner, Pia, et al.
(författare)
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"Limit work to here and now" : A focus group study on how emergency physicians view their work in relation to patients' drug treatment
- 2008
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Ingår i: International Journal of Qualitative Studies on Helath and Well-being. - : Informa UK Limited. - 1748-2623 .- 1748-2631. ; 3:3, s. 155-164
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Tidskriftsartikel (refereegranskat)abstract
- Patients come to the emergency department (ED) with complex medication and some patients present symptoms of adverse drug effects. Drug treatment is a complex process for physicians to handle. The aim of this study was to explore how a group of ED physicians view their work in relation to patients’ drug treatment. Three semi-structured focus group discussions with 12 physicians in an ED in Sweden were conducted and analysed thematically. The core theme was ‘‘limit work to here and now’’. Three descriptive themes were identified in relation to the main theme; (1) focussing to cope with work; (2) decision making on limited patient-specific information; and (3) actively seeking learning moments. The findings show that the physicians actively seek learning moments in work. Signing their own notes in the computerized medical record is a way of getting feedback on the treatment they have initiated and it was seen as a large part of their clinical education. If we want to support the physicians with new technology for safer drug treatment, such as a computerized drug prescribing support system, the support system should be adapted to the different learning styles and needs.
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| 7. |
- Bastholm Rahmner, Pia, et al.
(författare)
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Physicians perceptions of possibilities and obstacles prior to implementing a computerised drug prescribing support system
- 2004
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Ingår i: International journal of health care quality assurance incorporating leadership in helath services. - : Emerald. - 1366-0756 .- 2051-3135. ; 17:4, s. 173-179
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Tidskriftsartikel (refereegranskat)abstract
- Seeks to identify physicians' perceptions of possibilities and obstacles prior to implementing a computerised drug prescribing support system. Details a descriptive, qualitative study, with semi-structured individual interviews of 21 physicians in the Accident and Emergency Department of South Stockholm General Hospital. Identifies four descriptive categories for possibilities and obstacles. Concludes that gaining access to patient drug history enables physicians to carry out work in a professional way – a need the computerised prescription support system was not developed for and thus cannot fulfil. Alerts and producer-independent drug information are valuable in reducing workload. However, technical prerequisites form the base for a successful implementation. Time must be given to adapt to new ways of working.
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| 8. |
- Bastholm Rahmner, Pia, et al.
(författare)
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Variations in understanding the drug-prescribing process : a qualitative study among Swedish GPs
- 2009
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Ingår i: Family Practice. - : Oxford University Press (OUP). - 0263-2136 .- 1460-2229. ; 26:2, s. 121-127
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: A majority of doctor-patient meetings result in the patient getting a prescription. This underlines the need for a high-quality prescription process. While studies have been made on single therapeutic drug groups, a complete study of the physicians' general thought process that comprises the prescription of all drugs still remains to be made. OBJECTIVE: To identify variations in ways of understanding drug prescribing among GPs. METHODS: A descriptive qualitative study was conducted with 20 Swedish physicians. Informants were recruited purposively and their understandings about prescribing were studied in semi-structured interviews. Data were analysed using a phenomenographic approach. RESULTS: Five categories were identified as follows: (A) GP prescribed safe, reliable and well-documented drugs for obvious complaints; (B) GP sought to convince the patient of the most effective drug treatment; (C) GP chose the best drug treatment taking into consideration the patient's entire life situation; (D) GP used clinical judgement and close follow-up to minimize unnecessary drug prescribing and (E) GP prescribed drugs which are cheap for society and environmentally friendly. The categories are interrelated, but have different foci: the biomedical, the patient and the society. Each GP had more than one view but none included all five. The findings also indicate that complexity increases when a drug is prescribed for primary or secondary prevention. CONCLUSIONS: GPs understand prescribing differently despite similar external circumstances. The most significant factor to influence prescribing behaviour was the physician's patient relation approach. GPs may need to reflect on difficulties they face while prescribing to enhance their understandings.
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| 9. |
- Bastholm Rahmner, Pia, et al.
(författare)
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Whose job is it anyway? : Swedish general practitioners' perception of their responsibility for the patient's drug list.
- 2010
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Ingår i: Annals of Family Medicine. - : Annals of Family Medicine. - 1544-1709 .- 1544-1717. ; 8:1, s. 40-46
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE Information about the patient's current drug list is a prerequisite for safe drug prescribing. The aim of this study was to explore general practitioners' (GPs) understandings of who is responsible for the patient's drug list so that drugs prescribed by different physicians do not interact negatively or even cause harm. The study also sought to clarify how this responsibility was managed. METHODS We conducted a descriptive qualitative study among 20 Swedish physicians. We recruited the informants purposively and captured their view on responsibility by semistructured interviews. Data were analyzed using a phenomenographic approach. RESULTS We found variation in understandings about who is responsible for the patient's drug list and, in particular, how the GPs use different strategies to manage this responsibility. Five categories emerged: (1) imposed responsibility, (2) responsible for own prescriptions, (3) responsible for all drugs, (4) different but shared responsibility, and (5) patient responsible for transferring drug information. The relation between categories is illustrated in an outcome space, which displays how the GPs reason in relation to managing drug lists. CONCLUSIONS The understanding of the GP's responsibility for the patient's drug list varied, which may be a threat to safe patient care. We propose that GPs are made aware of variations in understanding responsibility so that health care quality can be improved.
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- Boll, Madeleine, et al.
(författare)
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Variations in how physiotherapists understand their work on organizational and societal levels
- 2011
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Ingår i: Physiotherapy Research International. - : Wiley. - 1358-2267 .- 1471-2865. ; 16:2, s. 101-108
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Tidskriftsartikel (refereegranskat)abstract
- Background and Purpose. Many physiotherapists have moved from treating persons on individual and group levels to working in different service positions on organizational and societal levels within healthcare organizations. The present study has investigated how physiotherapists working on those levels understand their job. The aim of the study was to describe variations in physiotherapists' understanding of their work on organizational and societal levels within healthcare organizations. The research question was: how do physiotherapists understand their work on organizational and societal levels? Method. A phenomenographic approach was chosen. Physiotherapists working in different positions on organizational and societal levels were interviewed. Results. Among our 21 informants we found three logically interrelated categories: 'exploring and performing an assignment', 'interactive learning and balancing support' and 'moving within a continually changing structure'. These three categories of descriptions formed an outcome space of ways of understanding work on organizational and societal levels within healthcare organizations. Conclusions. The findings in this study can be used as tools in professional discussions on how ways of understanding work have an impact on how work is performed and how change is achieved.
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