| 1. |
- Andersson, Ulrika, et al.
(författare)
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Associations between daily home blood pressure measurements and self-reports of lifestyle and symptoms in primary care: the PERHIT study
- 2024
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Ingår i: SCANDINAVIAN JOURNAL OF PRIMARY HEALTH CARE. - : TAYLOR & FRANCIS LTD. - 0281-3432 .- 1502-7724. ; 42:3, s. 415-423
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Tidskriftsartikel (refereegranskat)abstract
- Objective To explore in a primary care setting the associations between patients' daily self-measured blood pressure (BP) during eight weeks and concurrent self-reported values of wellbeing, lifestyle, symptoms, and medication intake. We also explore these associations for men and women separately. Design and setting The study is a secondary post-hoc analysis of the randomised controlled trial PERson-centeredness in Hypertension management using Information Technology (PERHIT). The trial was conducted in primary health care in four regions in Southern Sweden. Patients Participants (n = 454) in the intervention group in the PERHIT-trial used an interactive web-based system for self-management of hypertension for eight consecutive weeks. Each evening, participants reported in the system their wellbeing, lifestyle, symptoms, and medication adherence as well as their self-measured BP and heart rate. Main outcome measures Association between self-reported BP and 10 self-report lifestyle-related variables. Results Self-reported less stress and higher wellbeing were similarly associated with BP, with 1.0 mmHg lower systolic BP and 0.6/0.4 mmHg lower diastolic BP (p < 0.001). Adherence to medication had the greatest impact on BP levels (5.2/2.6 mmHg, p < 0.001). Restlessness and headache were also significantly associated with BP, but to a lesser extent. Physical activity was only significantly associated with BP levels for men, but not for women. Conclusion In hypertension management, it may be important to identify patients with high-stress levels and low wellbeing. The association between medication intake and BP was obvious, thus stressing the importance of medication adherence for patients with hypertension.
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| 2. |
- Andersson, Ulrika, et al.
(författare)
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Patients and Professionals as Partners in Hypertension Care: Qualitative Substudy of a Randomized Controlled Trial Using an Interactive Web-Based System Via Mobile Phone
- 2021
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Ingår i: Journal of Medical Internet Research. - : JMIR Publications Inc.. - 1438-8871. ; 23:6
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Tidskriftsartikel (refereegranskat)abstract
- Background: The use of technology has the potential to support the patient´s active participation regarding treatment of hypertension. This might lead to changes in the roles of the patient and health care professional and affect the partnership between them. Objective: The aim of this qualitative study was to explore the partnership between patients and health care professionals and the roles of patients and professionals in hypertension management when using an interactive web-based system for self-management of hypertension via the patient’s own mobile phone. Methods: Focus group interviews were conducted with 22 patients and 15 professionals participating in a randomized controlled trial in Sweden aimed at lowering blood pressure (BP) using an interactive web-based system via mobile phones. The interviews were audiorecorded and transcribed and analyzed using thematic analysis. Results: Three themes were identified: the technology, the patient, and the professional. The technology enabled documentation of BP treatment, mainly for sharing knowledge between the patient and the professional. The patients gained increased knowledge of BP values and their relation to daily activities and treatment. They were able to narrate about their BP treatment and take a greater responsibility, inspired by new insights and motivation for lifestyle changes. Based on the patient’s understanding of hypertension, professionals could use the system as an educational tool and some found new ways of communicating BP treatment with patients. Some reservations were raised about using the system, that it might be too time-consuming to function in clinical practice and that too much measuring could result in stress for the patient and an increased workload for the professionals. In addition, not all professionals and patients had adopted the instructions regarding the use of the system, resulting in less realization of its potential. Conclusions: The use of the system led to the patients taking on a more active role in their BP treatment, becoming more of an expert of their BP. When using the system as intended, the professionals experienced it as a useful resource for communication regarding BP and lifestyle. Patients and professionals described a consultation on more equal grounds. The use of technology in hypertension management can promote a constructive and person-centered partnership between patient and professional. However, implementation of a new way of working should bring benefits and not be considered a burden for the professionals. To establish a successful partnership, both the patient and the professional need to be motivated toward a new way of working.
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| 3. |
- Andersson, Ulrika, et al.
(författare)
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PERson-centredness in Hypertension management using Information Technology: a randomized controlled trial in primary care
- 2023
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Ingår i: Journal of hypertension. - : LIPPINCOTT WILLIAMS & WILKINS. - 1473-5598 .- 0263-6352. ; 41:2, s. 246-253
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To increase the proportion of individuals with hypertension obtaining a blood pressure (BP) of less than 140/90mmHg by improving the management of hypertension in daily life from a person-centred perspective. METHODS: In this unblinded randomized controlled trial, we tested an interactive web-based self-management system for hypertension. A total of 949 patients with hypertension from 31 primary healthcare centres (PHCCs) in Sweden were randomized 1:1 to either the intervention or usual care group. The intervention included daily measurement - via the participant's mobile phone - of BP and pulse and reports of well being, symptoms, lifestyle, medication intake and side effects for eight consecutive weeks. It also included reminders and optional motivational messages. The primary outcome was the proportion of participants obtaining BP of less than 140/90mmHg at 8 weeks and 12months. Significance was tested by Pearson's chi 2 -test. RESULTS: A total of 862 patients completed the trial, 442 in the intervention group and 420 in the control group. The primary outcome (BP <140/90mmHg) at 8 weeks was achieved by 48.8% in the intervention group and 39.9% in the control group ( P =0.006). At 12months, 47.1% (intervention) and 41.0% (control group) had a BP less than 140/90mmHg ( P =0.071). CONCLUSION: The proportion of participants with a controlled BP of less than 140/90mmHg increased after using the interactive system for self-management of hypertension for 8 weeks compared with usual care. Although the trend continued, there was no significant difference after 12months. The results indicate that the effect of the intervention is significant, but the long-term effect is uncertain. TRIAL REGISTRATION: The study was registered with ClinicalTrials.gov (NCT03554382).
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| 4. |
- Aronsson, Patrik, 1983, et al.
(författare)
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The understanding of core pharmacological concepts among health care students in their final semester
- 2015
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Ingår i: BMC Medical Education. - : Springer Science and Business Media LLC. - 1472-6920. ; 15 (1)
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Background: The overall aim of the study was to explore health care students ́ understanding of core concepts in pharmacology. Method: An interview study was conducted among twelve students in their final semester of the medical program (n = 4), the nursing program (n = 4), and the specialist nursing program in primary health care (n = 4) from two Swedish universities. The participants were individually presented with two pharmacological clinically relevant written patient cases, which they were to analyze and propose a solution to. Participants were allowed to use the Swedish national drug formulary. Immediately thereafter the students were interviewed about their assessments. The interviews were audio-recorded and transcribed verbatim. A thematic analysis was used to identify units of meaning in each interview. The units were organized into three clusters: pharmacodynamics, pharmacokinetics, and drug interactions. Subsequent procedure consisted of scoring the quality of students ́ understanding of core concepts. Non-parametric statistics were employed. Results: The study participants were in general able to define pharmacological concepts, but showed less ability to discuss the meaning of the concepts in depth and to implement these in a clinical context. The participants found it easier to grasp concepts related to pharmacodynamics than pharmacokinetics and drug interactions. Conclusion: These results indicate that education aiming to prepare future health care professionals for understanding of more complex pharmacological reasoning and decision-making needs to be more focused and effective.
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| 5. |
- Bengtsson, Ulrika, et al.
(författare)
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Developing an interactive mobile phone self-report system for self-management of hypertension. Part 1: Patient and professional perspectives
- 2014
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Ingår i: Blood Pressure. - : Informa UK Limited. - 0803-7051 .- 1651-1999. ; 23:5, s. 288-295
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Tidskriftsartikel (refereegranskat)abstract
- Low adherence remains a struggle in hypertension management, despite improvement efforts. Presuming that increased patient participation is a possible approach, we collaborated with patients and healthcare professionals to design a self-report system to support self-management. The study aimed to explore and describe relevant aspects of hypertension and hypertension treatment, for use in the development of an interactive mobile phone self-report system. It further aimed to suggest which clinical measures, lifestyle measures, symptoms and side-effects of treatment would be meaningful to include in such a system. Five focus group interviews were performed with 15 patients and 12 healthcare professionals, and data was analysed using thematic analysis. Patients suggested trust, a good relationship with caregivers, and well-being as important aspects of hypertension self-management. Furthermore, they regarded blood pressure, dizziness, stress, headache and tiredness as important outcomes to include. Patients sought to understand interconnections between symptoms and variations in blood pressure, whilst healthcare professionals doubted patients’ ability to do so. Healthcare professionals emphasized accessibility, clear and consistent counselling, complication prevention and educational efforts. The study presents aspects of importance for follow-up to understand the interplay between blood pressure and daily life experiences for patients with hypertension. Read More: http://informahealthcare.com.ezproxy.ub.gu.se/doi/abs/10.3109/08037051.2014.883203
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| 6. |
- Bengtsson, Ulrika, et al.
(författare)
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Improved Blood Pressure Control Using an Interactive Mobile Phone Support System
- 2016
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Ingår i: The Journal of Clinical Hypertension. - : Wiley. - 1524-6175 .- 1751-7176. ; 18:2, s. 101-108
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Tidskriftsartikel (refereegranskat)abstract
- This explorative, longitudinal study evaluated the effect of the daily use of a mobile phone-based self-management support system for hypertension in reducing blood pressure (BP) among 50 primary care patients with hypertension over 8 weeks. The self-management system comprises modules for (1) self-reports of BP, pulse, lifestyle, symptoms, and well-being; (2) delivery of reminders and encouragements; and (3) graphical feedback of self-reports. Daily use of the support system significantly reduced BP (systolic BP 7 mm Hg, diastolic BP 4.9 mm Hg) between baseline and week 8, with daily improvements leveling off as the study progressed. Three homogenous subsets of patients were identified who, despite different initial BP levels, showed similar decreases in BP during the study, indicating that patients benefited irrespective of baseline BP. In showing significant reductions in BP, our results suggest that the self-management support system may be a useful tool in clinical practice to help patients self-manage their hypertension.
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| 7. |
- Bengtsson, Ulrika, et al.
(författare)
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Patient contributions during primary care consultations for hypertension after self-reporting via a mobile phone self-management support system.
- 2018
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 36:1, s. 70-79
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Tidskriftsartikel (refereegranskat)abstract
- This paper reports on how the clinical consultation in primary care is performed under the new premises of patients’ daily self-reporting and self-generation of data. The aim was to explore and describe the structure, topic initiation and patients’ contributions in follow-up consultations after eight weeks of self-reporting through a mobile phone-based hypertension self-management support system. A qualitative, explorative study design was used, examining 20 audio- (n=10) and video-recorded (n=10) follow-up consultations in primary care hypertension management, through interaction analysis. Clinical trials registry: ClinicalTrials.gov NCT01510301. The consultations comprised three phases: opening, examination and closing. The most common topic was blood pressure (BP) put in relation to self-reported variables, for example, physical activity and stress. Topic initiation was distributed symmetrically between parties and BP talk was lifestyle-centered. The patients’ contributed to the interpretation of BP values by connecting them to specific occasions, providing insights to the link between BP measurements and everyday life activities. Patients’ contribution through interpretations of BP values to specific situations in their own lives brought on consultations where the patient as a person in context became salient. Further, the patients’ and health care professionals’ equal contribution during the consultations showed actively involved patients. The mobile phone-based self-management support system can thus be used to support patient involvement in consultations with a person-centered approach in primary care hypertension management
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| 8. |
- Berglund, Helene, 1957, et al.
(författare)
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Care planning at home: a way to increase the influence of older people?
- 2012
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Ingår i: International Journal of Integrated Care. - : Igitur, Utrecht Publishing & Archiving Services. - 1568-4156. ; 12:September
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Care-planning meetings represent a common method of needs assessment and decision-making practices in elderly care. Older people's influence is an important and required aspect of these practices. This study's objective was to describe and analyse older people's influence on care-planning meetings at home and in hospital. Methods: Ten care-planning meetings were audio-recorded in the older people's homes and nine were recorded in hospital. The study is part of a project including a comprehensive continuum-of-care model. A qualitative content analysis was performed. Results: Care-planning meetings at home appeared to enable older people's involvement in the discussions. Fewer people participated in the meetings at home and there was less parallel talking. Unrelated to the place of the care-planning meeting, the older people were able to influence concerns relating to the amount of care/service and the choice of provider. However, they were not able to influence the way the help should be provided or organised. Conclusion: Planning care at home indicated an increase in involvement on the part of the older people, but this does not appear to be enough to obtain any real influence. Our findings call for attention to be paid to older people's opportunities to receive care and services according to their individual needs and their potential for influencing their day-to-day provision of care and service.
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| 9. |
- Berglund, Helene, 1957, et al.
(författare)
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Effects of a continuum of care intervention on frail older persons' life satisfaction: a randomized controlled study
- 2015
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Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 24:7-8, s. 1079-1090
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Tidskriftsartikel (refereegranskat)abstract
- Aims and objectives The aim of this study was to analyse effects of a comprehensive continuum of care (intervention group) on frail older persons’ life satisfaction, as compared to those receiving usual care (control group). The intervention included geriatric assessment, case management, interprofessional collaboration, support for relatives and organising of care-planning meetings in older persons’ own homes. Background Improvements in older persons’ subjective well-being have been shown in studies including care planning and coordination by a case manager. However, effects of more complex continuum of care interventions on frail older persons’ life satisfaction are not well explored. Design Randomised controlled study. Methods The validated LiSat-11 scale was used in face-to-face interviews to assess older persons’ life satisfaction at baseline and at three, six and 12 months after the baseline. The odds ratio for improving or maintaining satisfaction was compared for intervention and control groups from baseline to three-month, three- to six-month as well as six- to 12-month follow-ups. Results Older persons who received the intervention were more likely to improve or maintain satisfaction than those who received usual care, between 6 and 12 month follow-ups, for satisfaction regarding functional capacity, psychological health and financial situation. Conclusions A comprehensive continuum of care intervention comprising several components had a positive effect on frail older persons’ satisfaction with functional capacity, psychological health and financial situation. Relevance to clinical practice Frail older persons represent a great proportion of the persons in need of support from the health care system. Health care professionals need to consider continuum of care interventions’ impact on life satisfaction. As life satisfaction is an essential part of older persons’ well-being, we propose that policy makers and managers promote comprehensive continuum of care solutions.
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| 10. |
- Berglund, Helene, 1957, et al.
(författare)
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Organizing integrated care for older persons: Strategies in Sweden during the past decade
- 2015
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Ingår i: Journal of Health Organisation & Management. - : Emerald Group Publishing Limited. - 1477-7266 .- 1758-7247. ; 29:1, s. 128-151
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Tidskriftsartikel (refereegranskat)abstract
- Purpose – The purpose of this paper is to describe and analyse ways of organizing integrated care for older persons in Sweden during the past decade. Design/methodology/approach – The data consist of 62 cases of development work, described in official reports. A meta-analysis of cases was performed, including content analysis of each case. A theoretical framework comprising different forms of integration (co-ordination, contracting, co-operation and collaboration) was applied. Findings – Co-operation was common and collaboration, including multiprofessional teamwork, was rare in the cases. Contracting can be questioned as being a form of integration, and the introduction of consumer choice models appeared problematic in inter-organization integration. Goals stated in the cases concerned steering and designing care, rather than outcome specifications for older persons. Explicit goals to improve integration in itself could imply that the organizations adapt to strong normative expectations in society. Trends over the decade comprised development of local health care systems, introduction of consumer choice models and contracting out. Research limitations/implications – Most cases were projects, but others comprised evaluations of regular organization of integrated care. These evaluations were often written normatively, but constituted the conditions for practice and were important study contributions. Practical implications – Guiding clinical practice to be aware of importance of setting follow-up goals.
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