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- af Winklerfelt Hammarberg, Sandra, et al.
(författare)
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Clinical effectiveness of care managers in collaborative primary health care for patients with depression : 12-and 24-month follow-up of a pragmatic cluster randomized controlled trial
- 2022
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Ingår i: BMC Primary Care. - : Springer Nature. - 2731-4553. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- Background In previous studies, we investigated the effects of a care manager intervention for patients with depression treated in primary health care. At 6 months, care management improved depressive symptoms, remission, return to work, and adherence to anti-depressive medication more than care as usual. The aim of this study was to compare the long-term effectiveness of care management and usual care for primary care patients with depression on depressive symptoms, remission, quality of life, self-efficacy, confidence in care, and quality of care 12 and 24 months after the start of the intervention. Methods Cluster randomized controlled trial that included 23 primary care centers (11 intervention, 12 control) in the regions of Vastra Gotaland and Dalarna, Sweden. Patients >= 18 years with newly diagnosed mild to moderate depression (n = 376: 192 intervention, 184 control) were included. Patients at intervention centers co-developed a structured depression care plan with a care manager. Via 6 to 8 telephone contacts over 12 weeks, the care manager followed up symptoms and treatment, encouraged behavioral activation, provided education, and communicated with the patient's general practitioner as needed. Patients at control centers received usual care. Adjusted mixed model repeated measure analysis was conducted on data gathered at 12 and 24 months on depressive symptoms and remission (MADRS-S); quality of life (EQ5D); and self-efficacy, confidence in care, and quality of care (study-specific questionnaire). Results The intervention group had less severe depressive symptoms than the control group at 12 (P = 0.02) but not 24 months (P = 0.83). They reported higher quality of life at 12 (P = 0.01) but not 24 months (P = 0.88). Differences in remission and self-efficacy were not significant, but patients in the intervention group were more confident that they could get information (53% vs 38%; P = 0.02) and professional emotional support (51% vs 40%; P = 0.05) from the primary care center. Conclusions Patients with depression who had a care manager maintained their 6-month improvements in symptoms at the 12- and 24-month follow-ups. Without a care manager, recovery could take up to 24 months. Patients with care managers also had significantly more confidence in primary care and belief in future support than controls.
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| 2. |
- Björkelund, Cecilia, 1948, et al.
(författare)
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[Effects of a care manager organization for care of people with mild-moderate depression in Swedish primary care]. : Vårdsamordnare för depression – effektivt grepp i primärvården - Gav friskare patienter och hälsoekonomiska vinster.
- 2019
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Ingår i: Lakartidningen. - 1652-7518. ; 116
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- By strengthening accessibility and continuity and support via a care manager for primary care patients with depression corresponding to 20-30% of a nursing service, patients recovered significantly faster and to a greater extent than in primary care-as-usual. Return to work occurred significantly earlier in the first three months, and net sick leave period was significantly shorter during the following 4-6 months. To introduce a collaborative care organizational change where the care manager is the hub and coordinates care for the patient and makes it possible to adapt the care according to the patient's needs throughout the care process, is thus the individual effort shown to have the greatest efficiency in Swedish primary care to increase the quality of care of depression. This approach, where the clinic and academy work closely and continuously in the development and evaluation phases, makes it possible to rapidly develop new ways of working where consideration is given to the complexity of primary care and the complexity of care needs and care efforts.
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| 6. |
- Holst, Anna, et al.
(författare)
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Cost-effectiveness of a care manager collaborative care programme for patients with depression in primary care : economic evaluation of a pragmatic randomised controlled study
- 2018
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 8:11
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To evaluate the cost-effectiveness of a care manager (CM) programme compared with care as usual (CAU) for treatment of depression at primary care centres (PCCs) from a healthcare as well as societal perspective.Design: Cost-effectiveness analysis.Setting: 23 PCCs in two Swedish regions.Participants: Patients with depression (n=342).Main outcome measures: A cost-effectiveness analysis was applied on a cluster randomised trial at PCC level where patients with depression had 3 months of contact with a CM (11 intervention PCCs, n=163) or CAU (12 control PCCs, n=179), with follow-up 3 and 6 months. Effectiveness measures were based on the number of depression-free days (DFDs) calculated from the Montgomery-angstrom sberg Depression Rating Scale-Self and quality-adjusted life years (QALYs).Results were expressed as the incremental cost-effectiveness ratio: Cost/QALY and Cost/DFD. Sampling uncertainty was assessed based on non-parametric bootstrapping.Results: Health benefits were higher in intervention group compared with CAU group: QALYs (0.357 vs 0.333, p<0.001) and DFD reduction of depressive symptom score (79.43 vs 60.14, p<0.001). The mean costs per patient for the 6-month period were Euro368 (healthcare perspective) and Euro6217 (societal perspective) for the intervention patients and Euro246 (healthcare perspective) and Euro7371 (societal perspective) for the control patients (n.s.). The cost per QALY gained was Euro6773 (healthcare perspective) and from a societal perspective the CM programme was dominant.Discussion: The CM programme was associated with a gain in QALYs as well as in DFD, while also being cost saving compared with CAU from a societal perspective. This result is of high relevance for decision-makers on a national level, but it must be observed that a CM programme for depression implies increased costs at the primary care level.
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| 7. |
- Melin, Jeanette, et al.
(författare)
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Entropy-based explanations of serial position and learning effects in ordinal responses to word list tests
- 2023
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Ingår i: Acta IMEKO. - 2221-870X. ; 12:3
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Tidskriftsartikel (refereegranskat)abstract
- Measuring a person’s cognitive abilities, such as memory and learning, is central in many medical conditions to reliably diagnose, treat and monitor disease progression. Common tests typically include tasks of recalling sequences of blocks, digits or words. Recalling a word list is affected by so-called serial position effects (SPE), meaning that words at the beginning or end of the list are more likely to be recalled. In our earlier work, as part of including ordinal and nominal properties in metrology, compensation for ordinality in the raw test scores has been performed with psychometric Rasch measurement theory. Thereafter, SPE have been successfully explained with construct specification equations (CSE) dominated by information theoretical entropy as candidate reference measurement procedures. Here, we present how previous German results for explaining memory difficulty in the immediate recalling (IR, trial 1) task of the Rey’s Auditory Verbal Learning Test (RAVLT) can be replicated with a Swedish cohort (the Gothenburg Mild Cognitive Impairment study, n = 251). This CSE replicability for RAVLT demonstrates comparability across the two cohorts in a kind of inter-laboratory study. Moreover, RAVLT includes repeated trials and learning through practice is expected. How memory task difficulty changes over the eight trials in RAVLT is studied: SPE are not so prominent for the delayed recalling sequences and there is an overall reduction in the task difficulty CSE intercept with trial number, interpreted as an effect of learning. To conclude, the methodology and evidence provided here can be clinically used not only to measure a person’s memory ability but also his or her learning ability, as well as understanding the relationship between learning ability and other cognitive domains.
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| 8. |
- Wallin, Jeanette, et al.
(författare)
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Discrepancy in responses to the surprise question between hemodialysis nurses and physicians, with focus on patient clinical characteristics : A comparative study
- 2023
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Ingår i: Hemodialysis International. - : John Wiley & Sons. - 1492-7535 .- 1542-4758. ; 27:4, s. 454-464
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: The surprise question (SQ) "Would I be surprised if this patient died within the next xx months" can be used by different professions to foresee the need of serious illness conversations in patients approaching end of life. However, little is known about the different perspectives of nurses and physicians in responses to the SQ and factors influencing their appraisals. The aim was to explore nurses' and physicians' responses to the SQ regarding patients on hemodialysis, and to investigate how these answers were associated with patient clinical characteristics. Methods: This comparative cross-sectional study included 361 patients for whom 112 nurses and 15 physicians responded to the SQ regarding 6 and 12 months. Patient characteristics, performance status, and comorbidities were obtained. Cohen's kappa was used to analyze the interrater agreement between nurses and physicians in their responses to the SQ and multivariable logistic regression was applied to reveal the independent association to patient clinical characteristics. Findings: Proportions of nurses and physicians responding to the SQ with "no, not surprised" was similar regarding 6 and 12 months. However, there was a substantial difference concerning which specific patient the nurses and physicians responded "no, not surprised", within 6 (kappa = 0.366, p < 0.001, 95% CI = 0.288-0.474) and 12 months (kappa = 0.379, p < 0.001, 95% CI = 0.281-0.477). There were also differences in the patient clinical characteristics associated with nurses' and physicians' responses to the SQ. Discussion: Nurses and physicians have different perspectives in their appraisal when responding to the SQ for patients on hemodialysis. This may reinforce the need for communication and discussion between nurses and physicians to identify the need of serious illness conversations in patients approaching the end of life, in order to adapt hemodialysis care to patient preferences and needs.
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