| 1. |
- Kull, Inger, et al.
(författare)
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Astma/KOL-mottagningar i primärvård ger effektivt omhändertagande
- 2008
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Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 105:42, s. 2937-2940
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Tidskriftsartikel (refereegranskat)abstract
- Astma och KOL (kroniskt obstruktiv lungsjukdom) har blivit allt vanligare, och möjligheterna till både korrekt diagnos och förbättrad behandling har ökat under det senaste decenniet, vilket ställer nya krav på hälso- och sjukvården. Korrekt diagnos, adekvat patientutbildning och rökslutarstöd är högt prioriterade åtgärder. Ett strukturerat omhändertagande med en välfungerande astma/KOL-mottagning i primärvården underlättar och förbättrar vården av denna stora patientgrupp. I artikeln föreslås nya kriterier för astma/KOL-mottagningar i primärvård.
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| 2. |
- Arne, Mats, et al.
(författare)
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Availability of pulmonary rehabilitation in primary care for patients with COPD : a cross-sectional study in Sweden
- 2016
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Ingår i: EUROPEAN CLINICAL RESPIRATORY JOURNAL. - : Informa UK Limited. - 2001-8525. ; 3
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Tidskriftsartikel (refereegranskat)abstract
- Background: Pulmonary rehabilitation (PR) is an important, evidence-based component for the management of individuals with chronic obstructive pulmonary disease (COPD). In daily practice, the majority of COPD patients are treated in primary care. However, information about the availability of PR in primary care in Sweden is lacking. The aim was to investigate the availability of rehabilitation resources in primary care settings for patients with COPD in Sweden. Methods: A cross-sectional descriptive design was applied, using web-based questionnaires sent to all primary care centres in four regions, comprising more than half of the 9.6 million inhabitants of Sweden. The main questionnaire included questions about the content and availability of rehabilitation resources for COPD patients. PR was defined as exercise training and one or more of the following activities: education, nutritional intervention, energy conservation techniques or psychosocial support. Results: A total of 381 (55.9%) of the 682 primary care centres answered the main questionnaire. In addition to physicians and nurses, availability of healthcare professionals for rehabilitation in primary care settings was physiotherapists 92.0%, occupational therapists 91.9%, dieticians 83.9% and social workers or psychologists 98.4%. At 23.7% of all centres, PRwas not available toCOPD patients - neither in primary care nor at hospitals. Conclusion: Despite high availability of professionals for rehabilitation in primary care settings, about one-quarter of managers at primary care centres stated that their COPD patients had no access to PR. This indicates a need to structure resources for rehabilitation and to present and communicate the available resources within the healthcare system.
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| 3. |
- Lisspers, Karin, 1954-
(författare)
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Organisation of Asthma in Primary Care, Quality of Life and Sex-related Aspects in Asthma Outcomes
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Objectives: To investigate the organisation of asthma care in primary care and evaluate outcomes for patients attending primary care centres with and without asthma clinics.Other objectives were to study the association between quality of life and asthma control in patients in primary care and to analyse sex differences regarding asthma outcomes related to menopausal status.Material and methods: Cross-sectional surveys and a patient record study.Results: Of all the primary health care centres, 77% had a spirometer and 53% an asthma clinic. At centres with asthma clinics 77% of the patients reported sufficient knowledge of asthma as compared with 65% at centres without asthma clinics (p<0.001). With more time allocated for the nurse, 44% of patients achieved asthma control as compared with 27% at asthma clinics with less time (p<0.003). Patients using short-acting beta-2 agonists more than twice in the last week had clinically significant lower MiniAQLQ scores (5.17 versus 5.91). This finding also held for night awakenings during the previous week (4.42 versus 5.86), courses of oral corticosteroids (5.26 versus 5.64) and reported emergency consultations during the last six months (4.85 versus 5.71). Premenopausal women had significantly lower total MiniAQLQ scores than men in the same age group (5.44 versus 5.89, p<0.001), while no difference was found between postmenopausal women and men of similar ages. The adjusted odds for premenopausal women for asthma exacerbations was 2.0 (95%CI 1.22-3.43) as compared with men in the same age group. No differences were found when comparing postmenopausal women with men of similar ages.Conclusions: Half the primary health care centres had an asthma clinic and the majority had access to a spirometer. Patients at primary health care centres with asthma clinics reported better knowledge of their disease, and asthma control is more often achieved if the nurse is allocated more time. Achieving asthma control is associated with better quality of life in patients in primary care. Premenopausal women had lower quality of life and less often asthma control then men of the same ages, while no corresponding difference was found between postmenopausal women and men of similar ages.
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| 4. |
- Jones, Rupert C., et al.
(författare)
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Multi-component assessment of chronic obstructive pulmonary disease : an evaluation of the ADO and DOSE indices and the global obstructive lung disease categories in international primary care data sets
- 2016
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Ingår i: npj Primary Care Respiratory Medicine. - London, United Kingdom : Nature Publishing Group. - 2055-1010. ; 26
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Tidskriftsartikel (refereegranskat)abstract
- Suitable tools for assessing the severity of chronic obstructive pulmonary disease (COPD) include multi-component indices and the global initiative for chronic obstructive lung disease (GOLD) categories. The aim of this study was to evaluate the dyspnoea, obstruction, smoking, exacerbation (DOSE) and the age, dyspnoea, obstruction (ADO) indices and GOLD categories as measures of current health status and future outcomes in COPD patients. This was an observational cohort study comprising 5,114 primary care COPD patients across three databases from UK, Sweden and Holland. The associations of DOSE and ADO indices with (i) health status using the Clinical COPD Questionnaire (CCQ) and St George's Respiratory Questionnaire (SGRQ) and COPD Assessment test (CAT) and with (ii) current and future exacerbations, admissions and mortality were assessed in GOLD categories and DOSE and ADO indices. DOSE and ADO indices were significant predictors of future exacerbations: incident rate ratio was 1.52 (95% confidence intervals 1.46-1.57) for DOSE, 1.16 (1.12-1.20) for ADO index and 1.50 (1.33-1.68) and 1.23 (1.10-1.39), respectively, for hospitalisations. Negative binomial regression showed that the DOSE index was a better predictor of future admissions than were its component items. The hazard ratios for mortality were generally higher for ADO index groups than for DOSE index groups. The GOLD categories produced widely differing assessments for future exacerbation risk or for hospitalisation depending on the methods used to calculate them. None of the assessment systems were excellent at predicting future risk in COPD; the DOSE index appears better than the ADO index for predicting many outcomes, but not mortality. The GOLD categories predict future risk inconsistently. The DOSE index and the GOLD categories using exacerbation frequency may be used to identify those at high risk for exacerbations and admissions.
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| 5. |
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| 6. |
- Sundh, Josefin, 1972-, et al.
(författare)
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Change in health status in COPD : a seven-year follow-up cohort study
- 2016
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Ingår i: npj Primary Care Respiratory Medicine. - : Nature Publishing Group. - 2055-1010. ; 26
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Tidskriftsartikel (refereegranskat)abstract
- Health status is a prognostic factor included in the assessment of chronic obstructive pulmonary disease (COPD). The aim of our study was to examine the associations of clinical factors with change in health status over a 7-year follow-up period. In 2005, 970 randomly selected primary and secondary care patients with a COPD diagnosis completed questionnaires including the Clinical COPD Questionnaire (CCQ); and in 2012, 413 completed the CCQ questionnaire again. Linear regression used difference in mean total CCQ score between 2005 and 2012 as the dependent variable. Independent variables were CCQ score at baseline 2005, sex, age, educational level, body mass index (BMI), smoking status, heart disease, diabetes, depression, number of exacerbations in the previous 6 months, dyspnoea (modified Medical Research Council (mMRC)). Health status worsened from mean total CCQ (s.d.) 2.03 (1.26) in 2005 to 2.16 (1.37) in 2012 (P=0.011). In linear regression with adjustment for baseline CCQ; older age, lower education, higher mMRC and BMI below 25 kg/m(2) at baseline were associated with worsened health status in 2012. When sex, age and all statistically significant measures were included simultaneously in the analysis of the main study group, higher mMRC and BMI below 25 kg/m(2) were were associated with deteriorated health status (P<0.0001). A higher level of dyspnoea and lower weight were associated with worse health status in COPD. Strategies for decreasing dyspnoea and awareness of the possible increased risk of worsening disease in under- and normal-weight COPD patients are clinically important.
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| 7. |
- Thorn, Jörgen, et al.
(författare)
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Pre-screening av rökare med mini-spirometer leder till förbättrad prediktion av KOL
- 2010
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Ingår i: Svenska läkaresällskapets handlingar: Hygiea. - 0349-1722. ; 119:1, s. 78-78
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- BakgrundTidig diagnos av kroniskt obstruktiv lungsjukdom (KOL), i kombination med rökstopp är viktigt för att förhindra vidare sjukdomsprogress. I primärvården är det önskvärt med lättillgänglig diagnostik för att om möjligt selektera patienter för spirometri. I denna studie undersöks värdet av pre-screening av lungfunktion av patienter i riskzonen för KOL (NCT01013922).MetodPatienter 45 år och äldre, med rökhistorik ≥ 15 paketår inkluderades. Uppgifter kring bl. a. rökvanor och medicinsk historik samlades in. Hälsorelaterad livskvalitet och grad av dyspné undersöktes med frågeformulär (CCQ och MRC-skalan). Lungfunktion (FEV1 och FEV6) mättes initialt med en mini-spirometer, (copd-6, Vitalograph), följt av fullständig standardspirometri inklusive reversibilitetstest (KOL diagnos = FEV1/FVC post-bronkdilatation < 70). Tidsåtgång för spirometri noterades; kostnader beräknas baserat på genomsnittlig sjuksköterskelön. Univariat logistisk regression och ROC (receiver operating characteristic curves) användes.ResultatTotal inkluderades 305 patienter från 21 primärvårdsenheter; 57 % kvinnor, medelålder (standardavvikelse, SD) 61,2 (8,4) år, FEV1/FVC 75,3 (10,2), paketår 30,2 (11,5). KOL diagnostiserades hos 83 patienter (27,2 %). Patienter med KOL hade en genomsnittlig FEV1/FEV6 kvot på 69,0 (9,1), rökare utan KOL 77,7 (9,6). Copd-6 (FEV1/FEV6) kunde med statistisk signifikans prediktera KOL. Sensitivitet och specificitet vid en FEV1/FEV6 cut off på 73,0 var 73,5 % respektive 79,7 %; arean under ROC kurvan var 0,80. Kostnaderna för en copd-6 mätning (tidsåtgång 4,2 minuter) var SEK 19,41, respektive SEK 147 (32,3 minuter) för en standardspirometri. Kostnaden för att detektera en KOL patient, med urval för spirometri baserat endast på ålder och antal paketår, var SEK 542. Genom att pre-selektera individer för spirometri med hjälp av copd-6 kunde kostnaden reduceras till SEK 283. Detta sker dock till priset av att 8,4 % lägre total detektion av KOL patienter till följd av begränsningar vad gäller sensitiviteten hos copd-6. Kön, CCQ eller MRC hade inget prediktivt värde.SammanfattningPre-screening med copd-6 för att selektera patienter med risk för KOL (≥ 45 år; ≥ 15 paketår) före utförande av standardspirometri kunde signifikant prediktera KOL. Användning av copd-6 kan minska kostnaden för att identifiera KOL patienter inom primärvården, men sensitiviteten och specificiteten är i denna studie begränsad.
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| 8. |
- Zakrisson, Ann-Britt, 1955-, et al.
(författare)
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Improved quality of care by using the PRISMS form to support self-management in patients with COPD : A Randomized Controlled Trial
- 2020
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Ingår i: Journal of Clinical Nursing. - : Blackwell Science Ltd.. - 0962-1067 .- 1365-2702. ; 29:13-14, s. 2410-2419
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Tidskriftsartikel (refereegranskat)abstract
- AIMS AND OBJECTIVE: To investigate the effects on the quality of care of the Patient Report Informing Self-Management Support (PRISMS) form compared with usual care among patients with Chronic Obstructive Pulmonary Disease (COPD) consulting a COPD nurse in primary health care.BACKGROUND: Patients with COPD experience symptoms affecting their everyday lives and there is a need for interventions in self-management support. The delivery of chronic care in an organized, structured, and planned manner can lead to more productive relationships between professionals and patients.DESIGN: A multicentre randomised controlled trial with a post-test design, according to the CONSORT checklist, in one intervention group (n=94) and one control group (n=108).METHODS: In addition to usual care, the intervention group (n=94) completed the PRISMS form to indicate areas where they wanted self-management support before the consultation with the COPD nurse. This form comprises 17 items that patients with COPD commonly experience as problems. The control group received usual care (n=108). The primary outcome was patients' satisfaction with quality of care, assessed using the Quality from the Patient's Perspective (QPP) questionnaire. Means and (SD) are presented where applicable. Differences between the intervention and control group were analysed with Student's t-test for independent groups for interval data, and the Mann-Whitney U-test for ordinal data.RESULTS: Participants in the intervention group were more satisfied with the QPP domains "personal attention", regarding both "Perceived reality" (p=0.021) and "Subjective Importance" (p=0.012). The PRISMS form revealed "Shortness of breath" as the most commonly experienced problem and the issue most desired to discuss.CONCLUSION: The PRISMS form improved patient satisfaction with quality of care regarding personal attention, which is an important factor in patient participation and improving relationships and communication.RELEVANCE TO CLINICAL PRACTICE: The PRISMS form can be a useful tool in improving person-centred care when delivering self-management support.
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| 9. |
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| 10. |
- Ställberg, Björn, et al.
(författare)
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Management, morbidity and mortality of COPD during an 11-year period : an observational retrospective epidemiological register study in Sweden (PATHOS)
- 2014
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Ingår i: Primary Care Respiratory Journal. - : Springer Science and Business Media LLC. - 1471-4418 .- 1475-1534. ; 23:1, s. 38-45
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Chronic obstructive pulmonary disease (COPD) is one of the most common causes of mortality and a major contributor to morbidity. Longitudinal clinical practice data yielding information on the characteristics of the disease, its natural course, and management are limited.AIMS: To investigate and describe the COPD population from a nationwide perspective during an 11-year period (1999-2009) with a focus on management, co-morbidity, and mortality.NETHODS: This observational retrospective epidemiological study linked electronic medical records data from patients with COPD in primary care to mandatory Swedish hospital, drug and Cause of Death registry data from 1999 to 2009 (PATHOS).RESULTS: A total of 21,361 patients with a COPD diagnosis were included (mean age 68.0 years, 53% females). The proportion of patients diagnosed in primary care increased from 59% in 1999 to 81% in 2009 and the mean age at diagnosis decreased from 73 to 66 years. The number of exacerbations decreased from 3.0 to 1.3 and COPD-related hospitalisations decreased from 1.02 to 0.20 per patient per year. Prescriptions of long-acting muscarinic antagonists and fixed combinations of inhaled corticosteroid/long-acting β2-agonist inhalers increased from 0% to 36% and 37%, respectively. The most common co-morbidities were hypertension, heart failure, ischaemic heart disease, and diabetes. Overall life expectancy was 8.3±6.8 years shorter in patients with COPD than in the general population, and all- cause mortality was 3.5 times higher.CONCLUSIONS: Management of COPD in Sweden has improved during the 11-year study period. Despite this, patients with COPD have a substantially reduced life expectancy than the general population.
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