1.
Ekman, Björn, et al.
(författare)
Utilization of digital primary care in Sweden : Descriptive analysis of claims data on demographics, socioeconomics, and diagnoses
2019
Ingår i: International Journal of Medical Informatics. - : Elsevier. - 1386-5056 .- 1872-8243. ; 127, s. 134-140
Tidskriftsartikel (refereegranskat) abstract
Objective: As digital technologies for health continue to develop, the ability to provide primary care services to patients with new symptoms will grow. In Sweden, two providers of digital primary care have expanded rapidly over the past years giving rise to a heated debate with clear policy implications. The purpose of the study is to present a descriptive review of digital primary care as currently under development in Sweden.Methods: Descriptive analysis of national coverage data on the utilization of digital care by sex, age, place of residence, socioeconomic status, and most common diagnoses. The data are compared with samples of corresponding data on traditional, office-based primary care, out-of-hours care, and on non-emergency telephone consultations to obtain a comparative analysis of digital care.Results: Digital primary care in Sweden has increased rapidly over the past two years. Currently, more than 30,000 digital consultations are made per month, equivalent to around two percent of all physician-led primary care. Digital care differs in some ways to that of traditional care as users are generally younger and seek for different conditions compared with office-based primary care. Digital care is also similar to traditional care as utilization is higher in metropolitan areas compared with rural areas. Similar to general health care use, there is a negative correlation between use of digital care and socioeconomic status. User profiles by age and sex of digital care are also similar to those of out-of-hours care and non-emergency telephone medical consultations.Conclusions: By providing a detailed description of the development of digital primary care the study contributes to a growing understanding of the contributions that digital technologies can make to health care. Based on current trends digital primary care is likely to continue to increase in frequency over the coming years. As technologies develop and the public becomes more familiar to interacting with medical providers over the Internet also the scope of digital care is likely to expand. As the provision of digital primary care expands across Europe and beyond, policy makers will need to develop regulating capacities to ensure its safe, effective and equitable integration into existing health systems.
2.
3.
Lindahl, Jeanette, et al.
(författare)
The Perceived Support From Light and Color Before and After an Evidence-Based Design Intervention in an Emergency Department Environment: A Quasi-Experimental Study
2023
Ingår i: HERD. - : SAGE Publications. - 2167-5112 .- 1937-5867. ; 16:2, s. 109-124
Tidskriftsartikel (refereegranskat) abstract
Aim: To evaluate patients’ and family members’ perceived support from light and color before, compared with after an evidence-based design (EBD) intervention at an emergency department (ED) using a validated instrument—the Light and Color Questionnaire (LCQ). Background: EDs offer acute care day and night. Thus, a supportive physical environment where light and color is crucial for how the milieu is experienced is vital. Research is limited on how care settings are perceived as supportive by users. Methods: Quasi-experimental evaluation of the refurbishing and remodeling of an ED by an expert group of nurse managers, nursing staff, nursing researchers and architects in south Sweden. LCQ includes dimensions “maximizing awareness and orientation,” “maximizing safety and security,” “supporting functional abilities,” “providing privacy,” “opportunities for personal control” (not for LCQ-Color), and “regulation and quality of stimulation.” LCQ was analyzed and compared in 400 surveys from 100 patients and 100 family members before the intervention and 100 patients and 100 family members after the intervention. Results: The LCQ total score significantly improved after the intervention for both patients and family members. Four of the six dimensions of LCQ Light subscale scores were significantly higher for family members, and three of the six dimensions were significantly higher for patients after the intervention. The LCQ Color subscale score showed significant improvements for all five dimensions for both patients and family members after the intervention. Conclusion: This study showed improved perceived support from light and color in the physical environment for patients and family members after an EBD intervention at an emergency department using a validated instrument—the Light and Color Questionnaire.
4.
Carrasco, Daniel, et al.
(författare)
Primary care physicians' knowledge and attitudes about obesity, adherence to treatment guidelines and association with confidence to treat obesity : a Swedish survey study
2022
Ingår i: BMC Primary Care. - : BioMed Central (BMC). - 2731-4553. ; 23:1
Tidskriftsartikel (refereegranskat) abstract
Background Obesity is a chronic disease with increasing prevalence. We aimed to explore primary care physicians' knowledge and attitudes about obesity and how knowledge and attitudes are associated with confidence and adherence to obesity guidelines and barriers to obesity treatment. Methods A questionnaire survey was sent by e-mail to 1642 primary care physicians in four regions in Sweden. The survey focused on the physicians' knowledge, attitudes towards obesity, confidence in obesity management, adherence to obesity guidelines and barriers to optimal care. We created different statistical indices for knowledge, attitudes and adherence. To analyse the correlation between these indices, we used linear regression analyses. Results Replies from 235 primary care physicians yielded a response rate of 14.3%. Most physicians answered correctly that obesity is a disease (91%), that obesity regulation sits in the hypothalamus (70%) and that obesity is due to disorders of appetite regulation (69%). However, 44% of the physicians thought that the most effective weight reduction method for severe obesity was lifestyle changes; 47% believed that obesity is due to lack of self-control, 14% mentioned lack of motivation and 22% stated laziness. Although 97% believed that physicians can help individuals with obesity and 56% suggested that obesity treatment should be prioritised, 87% of the physicians expressed that losing weight is the patients' responsibility. There was a positive association between higher knowledge and better adherence to obesity guidelines (B = 0.07, CI 0.02-0.12, p-value = 0.005) and feeling confident to suggest medication (p < 0.001) or bariatric surgery (p = 0.002). While 99% of the physicians felt confident to discuss lifestyle changes, 67% and 81% were confident to suggest medication or bariatric surgery, respectively. Respondents perceived that the greatest barrier in obesity management was lack of time (69%) and resources (49%). Conclusion There was a positive association between Swedish primary care physicians' knowledge and adherence to obesity guidelines and being more confident to suggest obesity treatment. Yet, many physicians had an ambivalent attitude towards obesity management.
5.
Hedin, Katarina, et al.
(författare)
Management of patients with sore throats in relation to guidelines : an interview study in Sweden.
2014
Ingår i: Scandinavian Journal of Primary Health Care. - : Taylor & Francis. - 0281-3432 .- 1502-7724. ; 32:4, s. 193-9
Tidskriftsartikel (refereegranskat) abstract
OBJECTIVE: To explore how a group of Swedish general practitioners (GPs) manage patients with a sore throat in relation to current guidelines as expressed in interviews.DESIGN: Qualitative content analysis was used to analyse semi-structured interviews.SETTING: Swedish primary care.SUBJECTS: A strategic sample of 25 GPs.MAIN OUTCOME MEASURES: Perceived management of sore throat patients.RESULTS: It was found that nine of the interviewed GPs were adherent to current guidelines for sore throat and 16 were non-adherent. The two groups differed in terms of guideline knowledge, which was shared within the team for adherent GPs while idiosyncratic knowledge dominated for the non-adherent GPs. Adherent GPs had no or low concerns for bacterial infections and differential diagnosis whilst non-adherent GPs believed that in patients with a sore throat any bacterial infection should be identified and treated with antibiotics. Patient history and examination was mainly targeted by adherent GPs whilst for non-adherent GPs it was often redundant. Non-adherent GPs reported problems getting patients to abstain from antibiotics, whilst no such problems were reported in adherent GPs.CONCLUSION: This interview study of sore throat management in a strategically sampled group of Swedish GPs showed that while two-thirds were non-adherent and had a liberal attitude to antibiotics one-third were guideline adherent with a restricted view on antibiotics. Non-adherent GPs revealed significant knowledge gaps. Adherent GPs had discussed guidelines within the primary care team while non-adherent GPs had not. Guideline implementation thus seemed to be promoted by knowledge shared in team discussions.
6.
Petrazzuoli, Ferdinando, et al.
(författare)
Unburdening dementia a basic social process grounded theory - based on a primary care physician survey from 25 countries
2020
Ingår i: Scandinavian Journal of Primary Health Care. - : Taylor & Francis Group. - 0281-3432 .- 1502-7724. ; 38:3, s. 253-264
Tidskriftsartikel (refereegranskat) abstract
Objective To explore dementia management from a primary care physician perspective. Design One-page seven-item multiple choice questionnaire; free text space for every item; final narrative question of a dementia case story. Inductive explorative grounded theory analysis. Derived results in cluster analyses. Appropriateness of dementia drugs assessed by tertiary care specialist. Setting Twenty-five European General Practice Research Network member countries. Subjects Four hundred and forty-five key informant primary care physician respondents of which 106 presented 155 case stories. Main outcome measures Processes and typologies of dementia management. Proportion of case stories with drug treatment and treatment according to guidelines. Results Unburdeningdementia - a basic social process - explained physicians' dementia management according to a grounded theory analysis using both qualitative and quantitative data. Unburdening starts withRecognizingthe dementia burden byBurden IdentificationandBurden Assessmentfollowed byBurden Relief. Drugs to relieve the dementia burden were reported for 130 of 155 patients; acetylcholinesterase inhibitors or memantine treatment in 89 of 155 patients - 60% appropriate according to guidelines and 40% outside of guidelines. More Central and Northern primary care physicians were allowed to prescribe, and more were engaged in dementia management than Eastern and Mediterranean physicians according to cluster analyses. Physicians typically identified and assessed the dementia burden and then tried to relieve it, commonly by drug prescriptions, but also by community health and home help services, mentioned in more than half of the case stories. Conclusions Primary care physician dementia management was explained by anUnburdeningprocess with the goal to relieve the dementia burden, mainly by drugs often prescribed outside of guideline indications. Implications:Unique data about dementia management by European primary care physicians to inform appropriate stakeholders.
7.
Pikkemaat, Miriam, et al.
(författare)
Swedish Primary Care Physicians' Intentions to Use Telemedicine : A Survey Using a New Questionnaire - Physician Attitudes and Intentions to Use Telemedicine (PAIT)
2021
Ingår i: International Journal of General Medicine. - : Dove Medical Press. - 1178-7074. ; 14, s. 3445-3455
Tidskriftsartikel (refereegranskat) abstract
Background: Research on intentions to use telemedicine in primary care is sparse. This survey study explored primary care physicians' intentions to use telemedicine by using a newly developed questionnaire: Physician Attitudes and Intentions to use Telemedicine. Methods: An anonymous web-survey with questions focusing on theory-based predictors of behavioral intentions such as Attitudes, Subjective norms and Perceived behavioral control was designed, validated, and sent to all primary care physicians at 160 primary health care centers in southern Sweden from May to August 2019. The questionnaire had 29 subject items (including 49 multiple-choice sub-items). Main outcome measures were intentions to use three domains of telemedicine and correlation between theory-based predictors and behavioral intentions for using telemedicine. Results: The survey was validated by an expert group, amended, and then tested and retested. A majority of the 198 physicians who returned the web-surveys reported that they did not use e-mails (68%), nor video consultations (78%), chat (81%), or text messages (86%) in their everyday patient work. Yet, most physicians described a positive intention to use telemedicine in patient care for all three studied domains with Attitudes and Perceived behavioral control being significant predictors (p<0.01) for Intentions to use digital contacts (R-2 = 0.54), chronic disease monitoring with digital tools (R-2 = 0.47) and artificial intelligence (R-2 = 0.54). A structural validation of a preliminary instrument - Physician Attitudes and Intention to use Telemedicine (PAIT) - containing 28 sub-items was done by exploratory factor analysis with acceptable explanatory, reliability and sampling adequacy measures. Five factors emerged with Eigenvalues between 1.6 and 11.1 explaining 72% of the variance. Total Cronbach's alpha was 0.91 and Kaiser-Meyer-Olkirk 0.79. Conclusion: Before the covid-19 pandemic, Swedish primary care physicians reported a low use yet high behavioral intention to use telemedicine in a study where we developed the preliminary instrument Physician Attitudes and Intention to use Telemedicine. Perceived behavioral control had the largest predictive value of behavioral intention to use telemedicine. Thus, interventions aiming to increase the use of digital tools in primary care should possibly focus on empowering physicians' self-efficacy towards using them.
8.
Lindahl, Jeanette, et al.
(författare)
Psychometric evaluation of the Swedish language Person-centred Climate Questionnaire - family version
2015
Ingår i: Scandinavian Journal of Caring Sciences. - Hoboken, NJ : Wiley. - 1471-6712 .- 0283-9318. ; 29:4, s. 859-864
Tidskriftsartikel (refereegranskat) abstract
Background: In a holistic view of care, the family is important for the patient as well as for the staff and integration of family members in health care is a growing trend. Yet, family participation in the care is sparsely investigated and valid assessment instruments are needed. Setting: Data were collected from 200 family members participating in an intervention study at an emergency department (ED) in Sweden. Method: The Person-centred Climate Questionnaire Family (PCQ-F) is a measure for how family members perceive the psychosocial climate. PCQ-F is a self-report instrument that contains 17 items assessing safety, every-dayness and hospitality - three subscale dimensions that mirror the Swedish patient version of the questionnaire, the PCQ-P. Aim: The aim of this study was to evaluate the psychometric properties of the Swedish version of the PCQ-F in an ED context. Results: The psychometric properties of the PCQ-F were evaluated using statistical estimates of validity and reliability and showed high content validity and internal consistency. Cronbach's Alpha was >0.7 and item-total correlations were >0.3 and <0.7. Conclusion: In terms of psychometrics, the findings in this study indicate that the PCQ-F can be used with satisfactory validity and reliability to explore to what degree family members perceive ED settings as being person-centred, safe, welcoming and hospitable within an everyday and decorated physical environment. As the PCQ already exists in a valid and reliable patient (PCQ-P) and staff (PCQ-S) version, this new family member version is a significant addition to the literature as it enables further comparative studies of how diverse care settings are perceived by different stakeholders.
9.
Sandén, Ulrika, et al.
(författare)
Breaking the patientification process - through co-creation of care, using old arctic survival knowledge
2021
Ingår i: International Journal of Qualitative Studies on Health and Well-being. - : Informa UK Limited. - 1748-2631 .- 1748-2623. ; 16:1
Tidskriftsartikel (refereegranskat) abstract
Purpose: Cancer research and connected innovation processes often lack a major component; patient participation. We revisit three studies (a-c) in order to explore how Momentary contentment theory may be used to improve patient participation and psychosocial health.Method: We revisited data from the initial (a) classic grounded theory study on Momentary contentment, based on four years of observation and 14 interviews. It explains a way of dealing with life close to death and morbidity. In the imminence of danger the studied culture resembles the context of cancer patients. The two following studies used focus group interviews with (b) 19 cancer patients and (c) 17 relatives of cancer patients in southern Sweden.Results: We suggest a process where cancer patients are taught to be submissive and that the support they receive from health providers may be counterproductive to contentment; a patientification process. We present alternative ways for people to handle issues such as hope, waiting, knowledge gaps and healthcare navigation while living with cancer. We introduce an alternative to patientification and passive patients where active patients create their own safety and truly participates in their care. Conclusions: We propose clinical studies to introduce such a shift from patentification to co-creation of care.
10.
Sandgren, Anna, et al.
(författare)
Striving for emotional survival in palliative cancer nursing
2006
Ingår i: Qualitative Health Research. - : Sage Publications. - 1049-7323 .- 1552-7557. ; 16:1, s. 79-96
Tidskriftsartikel (refereegranskat) abstract
In this grounded theory study, the authors analyze interviews and participant observation data related to palliative cancer nursing in hospitals. Striving for Emotional Survival emerged as the pattern of behavior through which nurses deal with their main concern, the risk of being emotionally overloaded by their work. It involved three main strategies: Emotional Shielding through Professional Shielding or Cold Shielding; Emotional Processing through Chatting, Confirmation Seeking, Self-Reflecting, or Ruminating; and Emotional Postponing through Storing or Stashing. Emotional Competence is a property of Striving for Emotional Survival that explains more or less adequate ways of dealing with emotional overload. The theory Striving for Emotional Survival can be useful in the nurses' daily work and provides a comprehensive framework for understanding how nurses deal with emotional difficulties. The authors suggest that health care organizations encourage self-care, prioritize time to talk, and offer counseling to nursing staff with emotionally difficult working conditions.
