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- Neher, Margit, 1959-
(författare)
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Learning Challenges Associated with Evidence-Based Practice in Rheumatology
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Rheumatology is a field of practice that is undergoing many changes, leading to growing demand for rheumatology practitioners to keep up-to-date about the research developments in their field and to implement new findings and recommendations into clinical practice. Research within implementation science has shown that there are numerous barriers to the clinical use of research-based knowledge in health care. Implementation of evidencebased practice (EBP) requires a great deal of learning on the part of practitioners. It is likely that practitioners in rheumatology face similar challenges to those in other clinical fields, but there is a paucity of research concerning the implementation of EBP in rheumatology and the learning required.Aims: The overall aim of the research project was to generate knowledge concerning the learning challenges associated with evidence-based practice in rheumatology.Methods: Qualitative methods were used to explore the use of knowledge sources in rheumatology nursing and the learning opportunities in clinical rheumatology for participants belonging to five professional groups. Quantitative methods sought to examine to what extent evidence-based practice was implemented in clinical rheumatology practice and which individual and organizational factors affected research use. A theory-based study analysed the learning processes associated with achieving an evidence-based practice.Results: Four sources of knowledge were identified for rheumatology nursing practice: interaction with other people in the workplace (peers in particular) and previous knowledge and experience were perceived as preferred sources of knowledge, while written materials and contacts outside the workplace were less privileged. Learning opportunities occurring during daily practice were perceived by participants of all professional groups to consist predominantly of interactions with professional peers in the workplace. Participants perceived a lack of recognized learning opportunities such as continuing professional education and regular participation in rheumatology-specific courses and conferences. Participants also expressed that time for reflection and up-dating knowledge was short in everyday clinical work. The quantitative data showed that while the general interest for EBP was high in rheumatology practice, individual interest and professional self-efficacy related to EBP varied. A longer work-experience in rheumatology, better self-efficacy concerning the use research-based knowledge and more experience from research activities were positively associated with the use of research in practice. The theoretical analysis showed that challenges of implementing evidence-based practice concern not only the acquisition of research-based knowledge and the integration of this knowledge in practice, but also the abandonment of outdated practices.Conclusions: In this thesis, implementation of EBP in rheumatology has been shown to be a complex issue. Social, contextual and individual aspects were found to be involved in the learning processes, the use of knowledge sources and learning opportunities, as well as in the EBP-relevant behaviours that are enacted in clinical rheumatology. The thesis hopes to contribute to a better understanding of the learning challenges in connection with the implementation of EBP in rheumatology practice.
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| 2. |
- Trinks, Anna, 1981-
(författare)
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Alcohol prevention in emergency care : Drinking patterns among patients and the impact of a computerized intervention in a Swedish Emergency department
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this thesis was to generate knowledge about alcohol consumption among patients in a Swedish ED, the reach and effectiveness of a computerized brief intervention delivered in the ED, and factors that are associated with reduced alcohol consumption 6 months after the ED visit.The results from the studies show that alcohol consumption was higher among patients who were injured than patients who were not injured. Injury patients had a higher weekly consumption, drank more frequently and drank higher typical quantities than non-injury patients. Patients who were categorized as acute drinkers had higher weekly alcohol consumption and were more frequently engaged in heavy episodic drinking (HED) than non-acute drinkers.Among the patients who took part in the computerized test, more than 15% stated that they were at the preparation stage or actively motivated to change their alcohol consumption. Of the patients who were categorized as acute drinkers, 34% were at the action or preparation stage.Among patients who were categorized as risky drinkers, 48% became non-risky drinkers at follow-up. The relative change in average weekly consumption among risky drinkers was 30% and the relative change in HED occasions per month was 37% from baseline to follow-up.Motivated to reduce alcohol consumption at baseline, influenced by just visiting the ED, considering the alcohol-related feedback information and impact from a health care provider are independent predictors for reduced alcohol consumption.
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| 3. |
- Öhrn, Annica, 1960-
(författare)
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Measures of Patient Safety : Studies of Swedish Reporting Systems and Evaluation of an Intervention Aimed at Improved Patient Safety Culture
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Unsafe health care delivery results in millions of patients suffering from injuries or death worldwide. A Swedish study estimated the prevalence of preventable adverse events as high as 8.6% in hospital care, which demonstrates that patient safety is no less a problem in Sweden than elsewhere. Reporting of adverse events has become an integral part of patient safety work. The aim of reporting is to identify patient safety problems and provide background data and information for efforts to improve patient safety. However, adverse events in health care can be captured and measured using different methods and stored in disparate systems that are not fully integrated. This makes it difficult to obtain a complete coherent picture of the frequency and nature of various types of adverse events. Another difficulty is to distinguish between adverse events and accepted complications of medical care.The overall aim of this thesis is to generate knowledge for improved understanding of how patient safety can be measured in terms of reporting adverse events and improved by targeting patient safety culture with an intervention implemented in a Swedish county council. Three research questions have been derived from the aim: (1) To what extent can analysis of patient claims contribute to an understanding of the magnitude of the patient safety problem? (2) To what extent do data captured from different reporting systems in Sweden differ? (3) To what extent can a structured intervention that fosters learning on patient safety issues and encourages leadership commitment improve the patient safety culture in a Swedish county council from a five-year perspective?The research is based on studies of three national reporting systems: Lex Maria to the National Board of Health and Welfare; patient claims to the County Councils´ Mutual Insurance Company; and medical data reported to the National Swedish Spine Register (Swespine). Data have also been assembled as part of an evaluation within the Patient Safety Dialogue intervention.This thesis indicates that different Swedish reporting systems provide disparate views and have many discrepancies regarding data quality and coverage of adverse events. Patient claims seem to be an important source of information that can complement information from incident reporting systems and quality registries in health care to provide an understanding of the magnitude of the patient safety problem.The research also shows that a structured intervention that fosters learning on patient safety issues and encourages leadership commitment can improve the culture of patient safety. However, a longer period of time and focused efforts might be required to achieve improvements across all departments within a Swedish county council.
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| 4. |
- Bernhardsson, Susanne, 1958-
(författare)
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Advancing evidence-based practice in primary care physiotherapy : Guideline implementation, clinical practice, and patient preferences
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Research on physiotherapy treatment interventions has increased dramatically in the past 25 years and it is a challenge to transfer research findings into clinical practice, so that patients benefit from effective treatment. Development of clinical practice guidelines is a potentially useful strategy to implement research evidence into practice. However, the impact of guideline implementation in Swedish primary care physiotherapy is unknown. To achieve evidence-based practice (EBP), research evidence should be integrated with clinical expertise and patient preferences, but knowledge is limited about these factors in Swedish primary care physiotherapy.The overall aim of this thesis was to increase understanding of factors of importance for the implementation of EBP in Swedish primary care physiotherapy. Specific aims were: to translate and adapt a questionnaire for the measurement of EBP and guidelines; to investigate physiotherapists’ attitudes, knowledge and behaviour related to EBP and guidelines; to examine clinical practice patterns; to evaluate the effects of a tailored guideline implementation strategy; and to explore patients’ preferences for physiotherapy.The thesis comprises four studies (A-D), reported in five papers. In Study A, a questionnaire for the measurement of EBP and guidelines was translated, cross-culturally adapted, and tested for validity (n=10) and reliability (n=42). Study B was a cross-sectional study in which this questionnaire was used to survey primary care physiotherapists in the county council Region Västra Götaland (n=271). In Study C, a strategy for the implementation of guidelines was developed and evaluated, using the same questionnaire (n=271 at baseline, n=256 at follow-up), in a prospective controlled trial. The strategy was based on an implementation model, was tailored to address the determinants of guideline use identified in Study B, and comprised several components including an educational seminar. Study D was an exploratory qualitative study of patients with musculoskeletal disorders (n=20), using qualitative content analysis.The validity and reliability of the questionnaire was found to be satisfactory. Most physiotherapists have a positive regard for EBP and guidelines, although these attitudes are not fully reflected in the reported use of guidelines. The most important determinants of guideline use were considering guidelines important to facilitate practice and knowing how to integrate patient preferences with guidelines. The tailored, multi-component guideline implementation significantly affected awareness of, knowledge of, and access to guidelines. Use of guidelines was significantly affected among those who attended an implementation seminar. Clinical practice for common musculoskeletal conditions included interventions supported by evidence of various strengths as well as interventions with insufficient research evidence. The most frequently reported interventions were advice and exercise therapy. The interviewed patients expressed trust and confidence in the professionalism of physiotherapists and in the therapists’ ability to choose appropriate treatment, rendering treatment preferences subordinate. This trust seemed to foster active engagement in their physiotherapy.In conclusion: The adapted questionnaire can be used to reliably measure EBP in physiotherapy. The positive attitudes found do not necessarily translate to guideline use, due to several perceived barriers. The tailored guideline implementation strategy used can be effective to reduce barriers and contribute to increased use of guidelines. The clinical practice patterns identified suggest that physiotherapists rely both on research evidence and their clinical expertise when choosing treatment methods. Patients’ trust in their physiotherapist’s competence and preference for active engagement in their therapy need to be embraced by the clinician and, together with the therapist’s clinical expertise, integrated with guideline use in the clinical decision making. Further research is needed on how the EBP components and different knowledge sources can be integrated in physiotherapy practice, as well as on implementation effects on patient outcomes.
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| 5. |
- Holmqvist, Marika, 1959-
(författare)
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Addressing Alcohol : Alcohol Prevention in Swedish Primary and Maternity Health Care and Occupational Health Services
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Alcohol consumption in Sweden has reached its highest levels of the past 100 years in the wake of the country’s entry into the European Union in 1995. Increased alcohol prevention efforts in Swedish health care settings have been given high priority by the authorities. The Swedish parliament’s national action plan up to 2010 emphasises that public health must be protected by achieving reductions in alcohol consumption and limiting the negative physical, psychological, and social effects of alcohol.This thesis aims to investigate various aspects related to the current alcoholpreventive activity in 2006 among health care professionals in three important health care settings: primary health care (PHC), occupational health services (OHS), and maternity health care (MHC). The thesis includes four studies based on a total population mail questionnaire survey.Results from the studies show that alcohol issues in both PHC and OHS were addressed less frequently than all other lifestyle issues, i.e. smoking, physical activity, overweight, and stress. Important barriers to alcohol-preventive activity in these settings were perceived lack of time, scepticism regarding the effectiveness of addressing the issue of alcohol, fear of potentially negative patient responses, uncertainty about how to ask, uncertainty about how to give advice regarding alcohol, and uncertainty concerning where to refer the patient.OHS professionals generally considered themselves more skilful than their PHC counterparts in achieving change in patients’ alcohol habits and more knowledgeable about providing advice to patients with risky alcohol consumption. The overall frequency of initiating discussions about alcohol with patients in PHC and OHS was positively associated with self-assessed skills, knowledge, and education for all professional categories.Slightly more than one-third of the MHC midwives used a questionnaire to assess the woman’s alcohol intake before the pregnancy; AUDIT was the most commonly used questionnaire. Their perceived knowledge concerning alcohol and pregnancy matters was generally high, but the midwives considered themselves less proficient at detecting pregnant women with risky alcohol consumption before the pregnancy.MHC midwives had participated in more continuing professional education in handling risky drinking than all other categories investigated. PHC nurses was the category that had the highest proportion of professionals who lacked education in handling risky drinking. Professionals in PHC, OHS, and MHC to a large extent believed that provision of more knowledge about counselling techniques to use when alcohol-related symptoms are evident could facilitate increased alcohol intervention activity.
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| 6. |
- Leijon, Matti, 1970-
(författare)
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Activating People : Physical activity in the general population and referral schemes among primary health care patients in a Swedish county
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In this thesis the need for physical activity interventions is investigated in a general adult population, the characteristics of physical activity referral (PAR) scheme recipients and referral practitioners, and the effectiveness of PAR in a routine primary health-care (PHC) setting in the county of Östergötland, Sweden. The thesis consists of four papers: three papers are based on a quantitative, uncontrolled prospective PAR study and one paper is based on a population survey in the county of Östergötland, Sweden.In 2006, only one in four of the adult population, aged 18–84 years, in Östergötland was considered sufficiently active to meet the Swedish national public health recommendations, stated as “30 minutes of moderate physical activity a day”. More than one-third (37%) reported that they hade no intentions to change their physical activity levels, while 36% had thought about change, and 27% were determined to change. Although the individuals felt a large responsibility for their own physical activity, they also believed that this responsibility is partly shared by health-care providers. Among those who wanted to increase their physical activity level, almost one in seven of the total population and one in four among those reporting poor general health, with a BMI over 30 and those who were inactive reported that they wanted support to bring about this change. More than half of them wanted this support from their health-care provider.During 2004 and 2005, a total of 6300 patients received PARs as part of the Östergötland PAR scheme. Two-thirds of the patients were female and half of the patients were 45–64 years old. The PAR scheme reached a relatively high proportion of physically inactive people. PARrelated statistics, including the numbers of referrals made at individual PHC centres and by different professional categories, showed large differences in prescribing activities, both by patient categories, and by prescribing professionals, indicating great potential for further improvements of this scheme in the future.Half of the patients (51%) who received PARs were recommended home-based activities, such as walking. Patient follow-up showed that an increase in self-reported physical activity level was achieved by 52% of the patients at the 12-month follow-up. The proportion of inactive patients decreased from 33% at baseline to 20% at 12 months. The proportion of patients who were physically active on a regular basis increased from 22% at baseline to 32% at 12 months. Neither patient age, diagnosis/PAR reason nor the profession of the prescriber were associated with differences in effectiveness. Low activity levels at baseline and homebased activities were significantly associated with increased physical activity at 12 months. Half of the patients (50%) achieved adherence to PARs at the 12-month follow-up, with adherence assessed by simply asking the patients about their adherence to prescribed activity. Patients’ activity levels at baseline (being at least somewhat physically active) and being issued home-based activities were significantly associated with higher adherence at 12 months.
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| 7. |
- Petersson, Lena, 1968-, et al.
(författare)
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Challenges to implementing artificial intelligence in healthcare : a qualitative interview study with healthcare leaders in Sweden
- 2022
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Ingår i: BMC Health Services Research. - London : BioMed Central (BMC). - 1472-6963. ; 22
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Tidskriftsartikel (refereegranskat)abstract
- Background: Artificial intelligence (AI) for healthcare presents potential solutions to some of the challenges faced by health systems around the world. However, it is well established in implementation and innovation research that novel technologies are often resisted by healthcare leaders, which contributes to their slow and variable uptake. Although research on various stakeholders’ perspectives on AI implementation has been undertaken, very few studies have investigated leaders’ perspectives on the issue of AI implementation in healthcare. It is essential to understand the perspectives of healthcare leaders, because they have a key role in the implementation process of new technologies in healthcare. The aim of this study was to explore challenges perceived by leaders in a regional Swedish healthcare setting concerning the implementation of AI in healthcare.Methods: The study takes an explorative qualitative approach. Individual, semi-structured interviews were conducted from October 2020 to May 2021 with 26 healthcare leaders. The analysis was performed using qualitative content analysis, with an inductive approach.Results: The analysis yielded three categories, representing three types of challenge perceived to be linked with the implementation of AI in healthcare: 1) Conditions external to the healthcare system; 2) Capacity for strategic change management; 3) Transformation of healthcare professions and healthcare practice.Conclusions: In conclusion, healthcare leaders highlighted several implementation challenges in relation to AI within and beyond the healthcare system in general and their organisations in particular. The challenges comprised conditions external to the healthcare system, internal capacity for strategic change management, along with transformation of healthcare professions and healthcare practice. The results point to the need to develop implementation strategies across healthcare organisations to address challenges to AI-specific capacity building. Laws and policies are needed to regulate the design and execution of effective AI implementation strategies. There is a need to invest time and resources in implementation processes, with collaboration across healthcare, county councils, and industry partnerships. © The Author(s) 2022.
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