SwePub
Sök i SwePub databas

  Utökad sökning

Träfflista för sökning "L773:1471 2296 "

Sökning: L773:1471 2296

  • Resultat 1-25 av 148
Sortera/gruppera träfflistan
   
NumreringReferensOmslagsbildHitta
1.
  • Leijon, Matti E., 1970-, et al. (författare)
  • Factors associated with patients self-reported adherence to prescribed physical activity in routine primary health care
  • 2010
  • Ingår i: BMC Family Practice. - London, UK : BioMed Central. - 1471-2296. ; 11:38
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Written prescriptions of physical activity, so‐called physical activity referral (PAR) schemes, have increased in popularity in recent years. Such schemes have mostly been evaluated in terms of efficacy. This study reports on a Swedish PAR scheme implemented in routine primary health care (PHC) measuring patients’ self‐reported adherence to physical activity prescriptions. The aim of this study was to evaluate adherence to physical activity prescriptions issued in everyday PHC at 3 and 12 months and to analyse the different characteristics associated with adherence to these prescriptions.Methods: Prospective prescription data were obtained for 37 of the 42 PHC centres in Östergötland County, Sweden, during 2004. The study population consisted of 3300 patients issued PARs by ordinary PHC staff members. Odds ratios were calculated to identify the factors associated with adherence.Results: The average adherence rate was 56% at 3 months and 50% at 12 months. In the descriptive analyses, higher adherence was associated with increased age, higher activity level at baseline, home‐based activities, prescriptions issued by professional groups other than physicians, and among patients issued PARs due to diabetes, high blood pressure and “other PAR reasons”. In the multiple logistic regression models, higher adherence was associated with higher activity level at baseline, and to prescriptions including home‐based activities, both at 3 and 12 months.Conclusions: Prescriptions from ordinary staff in routine PHC yielded adherence in 50% of the patients in this routine care PAR scheme follow‐up. Patients’ activity level at baseline (being at least somewhat physically inactive) and being issued homebased activities were associated with higher adherence at both 3 and 12 months.
  •  
2.
  • Andersson, Stig J, et al. (författare)
  • General practitioners' conceptions about treatment of depression and factors that may influence their practice in this area. A postal survey
  • 2005
  • Ingår i: BMC Family Practice. - : Springer Science and Business Media LLC. - 1471-2296. ; 6:21
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: The way GPs work does not appear to be adapted to the needs of depressive patients. Therefore we wanted to examine Swedish GPs' conceptions of depressive disorders and their treatment and GPs' ideas of factors that may influence their manner of work with depressive patients. METHODS: A postal questionnaire to a stratified sample of 617 Swedish GPs. RESULTS: Most respondents assumed antidepressive drugs effective and did not assume that psychotherapy can replace drugs in depression treatment though many of them looked at psychotherapy as an essential complement. Nearly all respondents thought that clinical experiences had great importance in decision situations, but patients' own preferences and official clinical guidelines were also regarded as essential. As influences on their work, almost all surveyed GPs regarded experiences from general practice very important, and a majority also emphasised experiences from private life. Courses arranged by pharmaceutical companies were seen as essential sources of knowledge. A majority thought that psychiatrists did not provide sufficient help, while most respondents perceived they were well backed up by colleagues. CONCLUSION: GPs tend to emphasize experiences, both from clinical work and private life, and overlook influences of collegial dealings and ongoing CME as well as the effects of the pharmaceutical companies' marketing activities. Many GPs appear to need more evidence based knowledge about depressive disorders. Interventions to improve depression management have to be supporting and interactive, and should be combined with organisational reforms to improve co-operation with psychiatrists.
  •  
3.
  • Bjerrum, Lars, et al. (författare)
  • Health Alliance for prudent antibiotic prescribing in patients with respiratory tract infections (HAPPY AUDIT) -impact of a non-randomised multifaceted intervention programme
  • 2011
  • Ingår i: BMC Family Practice. - : Springer Science and Business Media LLC. - 1471-2296. ; 12
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Excessive use of antibiotics is worldwide the most important reason for development of antimicrobial resistance. As antibiotic resistance may spread across borders, high prevalence countries may serve as a source of bacterial resistance for countries with a low prevalence. Therefore, bacterial resistance is an important issue with a potential serious impact on all countries. Initiatives have been taken to improve the quality of antibiotic prescribing in primary care, but only few studies have been designed to determine the effectiveness of multifaceted strategies across countries with different practice setting. The aim of this study was to evaluate the impact of a multifaceted intervention targeting general practitioners (GPs) and patients in six countries with different health organization and different prevalence of antibiotic resistance. Methods: GPs from two Nordic countries, two Baltic Countries and two Hispano-American countries registered patients with respiratory tract infections (RTIs) in 2008 and 2009. After first registration they received individual prescriber feedback and they were offered an intervention programme that included training courses, clinical guidelines, posters for waiting rooms, patient brochures and access to point of care tests (Strep A and C-Reactive Protein). Antibiotic prescribing rates were compared before and after the intervention. Results: A total of 440 GPs registered 47011 consultations; 24436 before the intervention (2008) and 22575 after the intervention (2009). After the intervention, the GPs significantly reduced the percentage of consultations resulting in an antibiotic prescription. In patients with lower RTI the GPs in Lithuania reduced the prescribing rate by 42%, in Russia by 25%, in Spain by 25%, and in Argentina by 9%. In patients with upper RTIs, the corresponding reductions in the antibiotic prescribing rates were in Lithania 20%, in Russia 15%, in Spain 9%, and in Argentina 5%. Conclusion: A multifaceted intervention programme targeting GPs and patients and focusing on improving diagnostic procedures in patients with RTIs may lead to a marked reduction in antibiotic prescribing. The pragmatic before-after design used may suffer from some limitations and the reduction in antibiotic prescribing could be influenced by factors not related to the intervention.
  •  
4.
  • Bjerrum, Lars, et al. (författare)
  • Health Alliance for Prudent Prescribing, Yield and Use of Antimicrobial Drugs in the Treatment of Respiratory Tract Infections (HAPPY AUDIT)
  • 2010
  • Ingår i: BMC Family Practice. - : Springer Science and Business Media LLC. - 1471-2296. ; 11
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Excessive and inappropriate use of antibiotics is considered to be the most important reason for development of bacterial resistance to antibiotics. As antibiotic resistance may spread across borders, high prevalence countries may serve as a source of bacterial resistance for countries with a low prevalence. Therefore, bacterial resistance is an important issue with a potential serious impact on all countries. The majority of respiratory tract infections (RTIs) are treated in general practice. Most infections are caused by virus and antibiotics are therefore unlikely to have any clinical benefit. Several intervention initiatives have been taken to reduce the inappropriate use of antibiotics in primary health care, but the effectiveness of these interventions is only modest. Only few studies have been designed to determine the effectiveness of multifaceted strategies in countries with different practice setting. The aim of this study is to evaluate the impact of a multifaceted intervention targeting general practitioners (GPs) and patients in six countries with different prevalence of antibiotic resistance: Two Nordic countries (Denmark and Sweden), two Baltic Countries (Lithuania and Kaliningrad-Russia) and two Hispano-American countries (Spain and Argentina). Methods/Design: HAPPY AUDIT was initiated in 2008 and the project is still ongoing. The project includes 15 partners from 9 countries. GPs participating in HAPPY AUDIT will be audited by the Audit Project Odense (APO) method. The APO method will be used at a multinational level involving GPs from six countries with different cultural background and different organisation of primary health care. Research on the effect of the intervention will be performed by analysing audit registrations carried out before and after the intervention. The intervention includes training courses on management of RTIs, dissemination of clinical guidelines with recommendations for diagnosis and treatment, posters for the waiting room, brochures to patients and implementation of point of care tests (Strep A and CRP) to be used in the GPs'surgeries. To ensure public awareness of the risk of resistant bacteria, media campaigns targeting both professionals and the public will be developed and the results will be published and widely disseminated at a Working Conference hosted by the World Association of Family Doctors (WONCA-Europe) at the end of the project period. Discussion: HAPPY AUDIT is an EU-financed project with the aim of contributing to the battle against antibiotic resistance through quality improvement of GPs' diagnosis and treatment of RTIs through development of intervention programmes targeting GPs, parents of young children and healthy adults. It is hypothesized that the use of multifaceted strategies combining active intervention by GPs will be effective in reducing prescribing of unnecessary antibiotics for RTIs and improving the use of appropriate antibiotics in suspected bacterial infections.
  •  
5.
  • Dalemo, Sofia, et al. (författare)
  • Variation in plasma calcium analysis in primary care in Sweden--a multilevel analysis.
  • 2010
  • Ingår i: BMC family practice. - : Springer Science and Business Media LLC. - 1471-2296. ; 11
  • Tidskriftsartikel (refereegranskat)abstract
    • Primary hyperparathyroidism (pHPT) is a common disease that often remains undetected and causes severe disturbance especially in postmenopausal women. Therefore, national recommendations promoting early pHPT detection by plasma calcium (P-Ca) have been issued in Sweden. In this study we aimed to investigate variation of P-Ca analysis between physicians and health care centres (HCCs) in primary care in county of Skaraborg, Sweden.
  •  
6.
  • Ekesbo, Rickard, et al. (författare)
  • Lack of adherence to hypertension treatment guidelines among GPs in southern Sweden-A case report- based survey
  • 2012
  • Ingår i: BMC Family Practice. - : Springer Science and Business Media LLC. - 1471-2296. ; 13
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: General practitioners (GPs) often fail to correctly adhere to guidelines for the treatment of hypertension. The reasons for this are unclear, but could be related to lack of knowledge in assessing individual patients' cardiovascular disease risk. Our aim was to investigate how GPs in southern Sweden adhere to clinical guidelines for the treatment of hypertension when major cardiovascular risk factors are taken into consideration. Method: A questionnaire with five genuine cases of hypertension with different cardiovascular risk profiles was sent to a random sample of GPs in southern Sweden (n = 109) in order to investigate the attitude towards blood pressure (BP) treatment when major cardiovascular risk factors were present. Results: In general, GPs who responded tended to focus on the absolute target BP rather than assessing the entire cardiovascular risk factor profile. Thus, cases with the highest risk of cardiovascular disease were not treated accordingly. However, there was also a tendency to overtreat the lowest risk individuals. Furthermore, the BP levels for initiating pharmacological treatment varied widely (systolic BP 140-210 mmHg). ACE inhibitors (70%) were the most common first choice of pharmacological treatment. Conclusion: In this study, GPs in Southern Sweden were suggesting, for different cases, either under- or overtreatment in relation to current guidelines for treatment of hypertension. On reason may be that they failed to correctly assess individual cardiovascular risk factor profiles. Key points: Despite international and national clinical guidelines on the treatment of hypertension, general practitioners often fail to correctly assess the cardiovascular risk for patients in a clinical setting. Most GPs use target blood pressure levels but do not consider other cardiovascular risk factors. Both under- and overtreatment of high and low cardiovascular risk groups were seen in this study.
  •  
7.
  • Hemborg Kristiansson, Mia, et al. (författare)
  • Pain, power and patience - A narrative study of general practitioners' relations with chronic pain patients
  • 2011
  • Ingår i: BMC Family Practice. - : Springer Science and Business Media LLC. - 1471-2296. ; 12
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Chronic pain patients are common in general practice. In this study "chronic pain" is defined as diffuse musculoskeletal pain not due to inflammatory diseases or cancer. Effective patient-physician relations improve treatment results. The relationship between doctors and chronic pain patients is often dysfunctional. Consultation training for physicians and medical students can improve the professional ability to build effective relations, but this demands a thorough understanding of the problems in the relation. Several studies have defined the issues that frequently cause problems, but few have described the process. The aim of this study was to understand and illustrate what GPs' experience in contact with chronic pain patients and what works and does not work in these consultations. Methods: Our theoretical perspective is constructivist, based upon the relativist view that individuals construct realities to understand and navigate the world. Five Swedish General Practitioners (GPs), two male and three female, were interviewed and asked to tell a story about a difficult encounter with a chronic pain patient. Tapes of the interviews were transcribed and analysed using narrative analysis. Three GPs told narratives suited for our analytic tools and these were included in the final results. Results: Each narrative highlights a certain dilemma and a strategy. The dilemmas were: power game; good intentions that fail when a patient is persuaded against her own conviction; persuasion of the unwilling; transferred tiredness; distrust and dissociation from the patient. Professional strategies of listening, encouraging and teamwork were central to handling difficult situations. Conclusions: The narratives show that GP's consultations with chronic pain patients sometimes are characterized by conflicts and difficult situations. They are facilitated by methods such as active listening and teamwork, but still may remain hard to handle. This has not before been studied among Swedish GPs. Narratives based on experience are known to be successful in education and this study suggest how narratives can serve as a training of consultation for medical students, but also in Continuing Professional Development groups for experienced doctors in practice.
  •  
8.
  • Isma, Gabriella, et al. (författare)
  • Childhood overweight and obesity conceived by Child Health Care nurses: a qualitative study.
  • 2012
  • Ingår i: BMC Family Practice. - : Springer Science and Business Media LLC. - 1471-2296. ; 13:57
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Registered Sick Children's Nurses and District Nurses employed at Child Health Care centres are in a position to help prevent childhood overweight and obesity. Prevention of this challenging public health threat could be improved through having a better understanding of how this group of nurses perceives childhood obesity. The aim of this study was to elucidate the conceptions of childhood overweight, including obesity, among nurses working in Child Health Care. Method: A qualitative study using a phenomenographic approach, based on open-ended interviews with 18 Child Health Care nurses (CHC-nurses) strategically selected from 17 Child Health Care Centres in the southern part of Sweden. Results: Four categories of description emerged from the data: Perception of childhood overweight changes, Overweight in younger children a neglected concern, Overweight a delicate issue and Importance of family lifestyle. The participating CHC-nurses conceived overweight in children, primarily obesity in children to be an extensive and serious problem which affects children, families and the surrounding society. Overweight in children was further perceived as a consequence of their parent's lifestyle and their awareness of the problem, which was considered by the CHC-nurses as a sensitive and a provoking issue. It was also perceived that overweight in children is not taken seriously during the pre-school period and that concerns regarding overweight in younger children were mainly about the appearance and not the health of the child. The CHC-nurses perceived that the proportion of overweight children has increased, which Swedish society and the CHC-nurses have adapted to. This adaptation makes it difficult for CHC-nurses to define those children who are overweight. Conclusion: CHC-nurses provide a comprehensive and complex picture of childhood overweight, which includes several difficulties dealing with this issue. Attention to CHC-nurse's conceptions of overweight in children is important since it can affect the parent-nurse relationship and thereby the nurse's, as well as the parent's efforts to influence the children's weight. It is suggested that CHC nurses should work with person centered counseling and empowerment concerning parent to child relations in cases involving overweight.
  •  
9.
  • Isma, Gabriella E, et al. (författare)
  • Obstacles to the prevention of overweight and obesity in the context of child health care in Sweden
  • 2013
  • Ingår i: BMC Family Practice. - : BioMed Central. - 1471-2296. ; :14
  • Tidskriftsartikel (refereegranskat)abstract
    • Overweight and obesity in younger children could better be brought in focus through a deeper understanding of how Child Health Care nurses (CHC-nurses) perceive their work with the problems of overweight at the CHC Centers. The aim of this study was to elucidate the CHC-nurses conceptions of their preventive work with childhood overweight and obesity in Child Health Care. A qualitative study, based on open-ended interviews, involving 18 CHC-nurses strategically selected from 17 CHC Centres in the southern part of Sweden using a phenomenographic approach. Two categories of description emerged from the data: (i) Internal obstacles to the CHC- nurses' work with overweight in children and (ii) External obstacles to the management of overweight in children. The CHC-nurses conceived their work with overweight in Child Health Care to be complicated and constrained by several obstacles depending on the nurses' personal priorities, knowledge, responsibility and the absence of resources and cooperation, as well as the lack of uniform guidelines for preventing and managing childhood overweight and further a deficient management organisation. Nurses' attention to monitoring overweight in children, and their initiative for prevention, is based on their conceptions of the obstacles that hinder them in their efforts. An increased awareness of the CHC-nurses conceptions of the priorities, their sense of responsibility and prevention practices is warranted. If measures in this direction are not taken there is a growing risk that overweight children will pass through the CHC without any formal recognition of their situation. There is an indication that the present level of the CHC-nurses' preventive work with childhood overweight has room for improvement in several areas. It is suggested that the specialist education of these health care professionals should be supplemented and that organisation of the management of childhood overweight should be also revised at the primary health care level.
  •  
10.
  • Persson, Gerthi, et al. (författare)
  • Physical activity on prescription (PAP) from the general practitioner's perspective - a qualitative study
  • 2013
  • Ingår i: BMC Family Practice. - : Springer Science and Business Media LLC. - 1471-2296. ; 14
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Physical activity on prescription (PAP) is a successful intervention for increasing physical activity among patients with a sedentary lifestyle. The method seems to be sparsely used by general practitioners (GPs) and there is limited information about GPs' attitudes to counselling using PAP as a tool. The aim of the study was to explore and understand the meaning of prescribing physical activity from the general practitioner's perspective. Methods: Three focus group interviews were conducted with a purposive sample of 15 Swedish GPs in the south of Sweden. Participants were invited to talk about their experience of using PAP. The interviews were transcribed verbatim, analysed using qualitative content analysis. Results: The analysis resulted in four categories: The tradition makes it hard to change attitude, Shared responsibility is necessary, PAP has low status and is regarded with distrust and Lack of procedures and clear guidelines. Traditionally GPs talk with patients about the importance of an increased level of physical activity but they do not prescribe physical activity as a treatment. Physician's education focuses on the use of pharmaceuticals. The responsibility for patients' physical activity level is shared with other health professionals, the patient and society. The GPs express reservations about prescribing physical activity. A heavy workload is a source of frustration. PAP is regarded with distrust and considered to be a task of less value and status. Using a prescription to emphasize an increased level is considered to be redundant and the GPs think it should be administered by someone else in the health care system. Scepticism about the result of the method was also expressed. Conclusions: There is uncertainty about using PAP as a treatment since physicians lack education in non-pharmaceutical methods. The GPs do not regard the written referral as a prioritized task and rather refer to other professionals in the health care system to prescribe PAP. GPs pointed out a need to create routines and arrangements for the method to gain credibility and become everyday practice among GPs.
  •  
11.
  • Rose, Peter W., et al. (författare)
  • Development of a survey instrument to investigate the primary care factors related to differences in cancer diagnosis between international jurisdictions
  • 2014
  • Ingår i: BMC Family Practice. - : BioMed Central. - 1471-2296. ; 15, s. 1-8
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Survival rates following a diagnosis of cancer vary between countries. The International Cancer Benchmarking Partnership (ICBP), a collaboration between six countries with primary care led health services, was set up in 2009 to investigate the causes of these differences. Module 3 of this collaboration hypothesised that an association exists between the readiness of primary care physicians (PCP) to investigate for cancer - the 'threshold' risk level at which they investigate or refer to a specialist for consideration of possible cancer - and survival for that cancer (lung, colorectal and ovarian). We describe the development of an international survey instrument to test this hypothesis. Methods: The work was led by an academic steering group in England. They agreed that an online survey was the most pragmatic way of identifying differences between the jurisdictions. Research questions were identified through clinical experience and expert knowledge of the relevant literature. A survey comprising a set of direct questions and five clinical scenarios was developed to investigate the hypothesis. The survey content was discussed and refined concurrently and repeatedly with international partners. The survey was validated using an iterative process in England. Following validation the survey was adapted to be relevant to the health systems operating in other jurisdictions and translated into Danish, Norwegian and Swedish, and into Canadian and Australian English. Results: This work has produced a survey with face, content and cross cultural validity that will be circulated in all six countries. It could also form a benchmark for similar surveys in countries with similar health care systems. Conclusions: The vignettes could also be used as educational resources. This study is likely to impact on healthcare policy and practice in participating countries.
  •  
12.
  • Strandberg, Eva-Lena, et al. (författare)
  • The meaning of quality work from the general practitioner's perspective: an interview study
  • 2006
  • Ingår i: BMC Family Practice. - : Springer Science and Business Media LLC. - 1471-2296. ; 7:60
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: The quality of health care and its costs have been a subject of considerable attention and lively discussion. Various methods have been introduced to measure, assess, and improve the quality of health care. Many professionals in health care have criticized quality work and its methods as being unsuitable for health care. The aim of the study was to obtain a deeper understanding of the meaning of quality work from the general practitioner's perspective. METHODS: Fourteen general practitioners, seven women and seven men, were interviewed with the aid of a semi-structured interview guide about their experience of quality work. The interviews were tape-recorded and transcribed verbatim. Data collection and analysis were guided by a phenomenological approach intended to capture the essence of the statements. RESULTS: Two fundamentally different ways to view quality work emerged from the statements: A pronounced top-down perspective with elements of control, and an intra-profession or bottom-up perspective. From the top-down perspective, quality work was described as something that infringes professional freedom. From the bottom-up perspective the statements described quality work as a self-evident duty and as a professional attitude to the medical vocation, guided by the principles of medical ethics. Follow-up with a bottom-up approach is best done in internal processes, with the profession itself designing structures and methods based on its own needs. CONCLUSIONS: The study indicates that general practitioners view internal follow-up as a professional obligation but external control as an imposition. This opposition entails a difficulty in achieving systematism in follow-up and quality work in health care. If the statutory standards for systematic quality work are to gain a real foothold, they must be packaged in such a way that general practitioners feel that both perspectives can be reconciled.
  •  
13.
  •  
14.
  • Sundquist, Jan, et al. (författare)
  • Effect of a primary health-care-based controlled trial for cardiorespiratory fitness in refugee women.
  • 2010
  • Ingår i: BMC Family Practice. - : Springer Science and Business Media LLC. - 1471-2296. ; 11
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Refugee women have a high risk of coronary heart disease with low physical activity as one possible mediator. Furthermore, cultural and environmental barriers to increasing physical activity have been demonstrated. The aim of the study was to evaluate the combined effect of an approximate 6-month primary health care- and community-based exercise intervention versus an individual written prescription for exercise on objectively assessed cardiorespiratory fitness in low-active refugee women. METHODS: A controlled clinical trial, named "Support for Increased Physical Activity", was executed among 243 refugee women recruited between November 2006 and April 2008 from two deprived geographic areas in southern Stockholm, Sweden. One geographic area provided the intervention group and the other area the control group. The control group was on a higher activity level at both baseline and follow-up, which was taken into consideration in the analysis by applying statistical models that accounted for this. Relative aerobic capacity and fitness level were assessed as the two main outcome measures. RESULTS: The intervention group increased their relative aerobic capacity and the percentage with an acceptable fitness level (relative aerobic capacity > 23 O2 mlxkgxmin-1) to a greater extent than the control group between baseline and the 6-month follow-up, after adjusting for possible confounders (P = 0.020). CONCLUSIONS: A combined primary health-care and community-based exercise programme (involving non-profit organizations) can be an effective strategy to increase cardiorespiratory fitness among low-active refugee women. TRIAL REGISTRATION: ClinicalTrials.gov ID: NCT00747942.
  •  
15.
  • Vikström, Anna, et al. (författare)
  • Coding of procedures documented by general practitioners in Swedish primary care - an explorative study using two procedure coding systems.
  • 2012
  • Ingår i: BMC family practice. - : Springer Science and Business Media LLC. - 1471-2296. ; 13:1
  • Tidskriftsartikel (refereegranskat)abstract
    • ABSTRACT: BACKGROUND: Procedures documented by general practitioners in primary care have not been studied in relation to procedure coding systems. We aimed to describe procedures documented by Swedish general practitioners in electronic patient records and to compare them to the Swedish Classification of Health Interventions (KVA) and SNOMED CT. METHODS: Procedures in 200 record entries were identified, coded, assessed in relation to two procedure coding systems and analysed. RESULTS: 417 procedures found in the 200 electronic patient record entries were coded with 36 different Classification of Health Interventions categories and 148 different SNOMED CT concepts. 22.8% of the procedures could not be coded with any Classification of Health Interventions category and 4.3% could not be coded with any SNOMED CT concept. 206 procedure-concept/category pairs were assessed as a complete match in SNOMED CT compared to 10 in the Classification of Health Interventions. CONCLUSIONS: Procedures documented by general practitioners were present in nearly all electronic patient record entries. Almost all procedures could be coded using SNOMED-CT. Classification of Health Interventions covered the procedures to a lesser extent and with a much lower degree of concordance. SNOMED CT is a more flexible terminology system that can be used for different purposes for procedure coding in primary care.
  •  
16.
  • Zielinski, Andrzej, et al. (författare)
  • Differences in referral rates to specialised health care from four primary health care models in Klaipeda, Lithuania
  • 2008
  • Ingår i: BMC Family Practice. - : Springer Science and Business Media LLC. - 1471-2296. ; 9
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Lithuanian primary health care (PHC) is undergoing changes from the systems prevalent under the Soviet Union, which ensured free access to specialised health care. Currently four different PHC models work in parallel, which offers the opportunity to study their respective effect on referral rates. Our aim was to investigate whether there were differences in referrals rates from different Lithuanian PHC models in Klaipeda after adjustment for co-morbidity. Methods: The population listed with 18 PHC practices serving inhabitants in Klaipeda city and region (250 070 inhabitants). Four PHC models: rural state-owned family medicine practices, urban privately owned family medicine practices, state-owned polyclinics and privately owned polyclinics. Information on listed patients and referrals during 2005 from each PHC practice in Klaipeda was obtained from the Lithuanian State Sickness Fund database. The database records included information on age, gender, PHC model, referrals and ICD 10 diagnoses. The Johns Hopkins ACG Case-Mix system was used to study co-morbidity. Referral rates from different PHC models were studied using Poisson regression models. Results: Patients listed with rural state-owned family medicine practices had a significantly lower referral rate to specialised health care than those in the other three PHC models. An increasing co-morbidity level correlated with a higher physician-to self-referral ratio. Conclusion: Family medicine practices located in rural-, but not in urban areas had significantly lower referral rates to specialised health care. It could not be established whether this was due to organisation, training of physicians or financing, but suggests there is room for improving primary health care in urban areas. Patient's place of residence and co-morbidity level were the most important factors for referral rate. We also found that gatekeeping had an effect on the referral pattern with respect to co-morbidity level, so that those with a physician referral were more likely to have had higher co-morbidity.
  •  
17.
  • Arvidsson, Eva, et al. (författare)
  • Priority setting in primary health care - dilemmas and opportunities: a focus group study
  • 2010
  • Ingår i: BMC Family Practice. - : BioMed Central. - 1471-2296. ; 11:71
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Swedish health care authorities use three key criteria to produce national guidelines for local priority setting: severity of the health condition, expected patient benefit, and cost-effectiveness of medical intervention. Priority setting in primary health care (PHC) has significant implications for health costs and outcomes in the health care system. Nevertheless, these guidelines have been implemented to a very limited degree in PHC. The objective of the study was to qualitatively assess how general practitioners (GPs) and nurses perceive the application of the three key priority-setting criteria. Methods: Focus groups were held with GPs and nurses at primary health care centres, where the staff had a short period of experience in using the criteria for prioritising in their daily work. Results: The staff found the three key priority-setting criteria (severity, patient benefit, and cost-effectiveness) to be valuable for priority setting in PHC. However, when the criteria were applied in PHC, three additional dimensions were identified: 1) viewpoint (medical or patients), 2) timeframe (now or later), and 3) evidence level (group or individual). Conclusions: The three key priority-setting criteria were useful. Considering the three additional dimensions might enhance implementation of national guidelines in PHC and is probably a prerequisite for the criteria to be useful in priority setting for individual patients.
  •  
18.
  •  
19.
  • Andén, Annika, et al. (författare)
  • To make a difference - how GPs conceive consultation outcomes : A phenomenographic study
  • 2009
  • Ingår i: BMC Family Practice. - London : Springer Science and Business Media LLC. - 1471-2296. ; 10:4
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Outcomes from GPs consultations have been measured mainly with disease specific measures and with patient questionnaires about health, satisfaction, enablement and quality. The aim of this study was to explore GPs conceptions of consultation outcomes.Methods: Interviews with 17 GPs in groups and individually about consultation outcomes from recently performed consultations were analysed with a phenomenographic research approach.Results: The GPs conceived outcomes in four ways: patient outcomes, GPs self-evaluation, relationship building and change of surgery routines.Conclusion: Patient outcomes, as conceived by the GPs, were generally congruent with those that had been taken up in outcome studies. Relationship building and change of surgery routines were outcomes in preparation for consultations to come. GPs made self-assessments related to internalized norms, grounded on a perceived collegial professional consensus. Considerations of such different aspects of outcomes can inspire professional development.
  •  
20.
  •  
21.
  • André, Malin, et al. (författare)
  • GPs decision-making - perceiving the patient as a person or a disease
  • 2012
  • Ingår i: BMC Family Practice. - : BioMed Central. - 1471-2296. ; 13:38
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: The aim of this study was to analyse the clinical decision making strategies of GPs with regard to the whole range of problems encountered in everyday work. less thanbrgreater than less thanbrgreater thanMethods: A prospective questionnaire study was carried through, where 16 General practitioners in Sweden registered consecutively 378 problems in 366 patients. less thanbrgreater than less thanbrgreater thanResults: 68.3% of the problems were registered as somatic, 5.8% as psychosocial and 25.9% as both somatic and psychosocial. When the problem was characterised as somatic the main emphasis was most often on the symptoms only, and when the problem was psychosocial main emphasis was given to the person. Immediate, inductive, decision-making contrary to gradual, analytical, was used for about half of the problems. Immediate decision-making was less often used when problems were registered as both somatic and psychosocial and focus was on both the symptoms and the person. When immediate decision-making was used the GPs were significantly more often certain of their identification of the problem and significantly more satisfied with their consultation. Rules of thumb in consultations registered as somatic with emphasis on symptoms only did not include any reference to the individual patient. In consultations registered as psychosocial with emphasis on the person, rules of thumb often included reference to the patient as a known person. less thanbrgreater than less thanbrgreater thanConclusions: The decision-making (immediate or gradual) registered by the GPs seemed to have been adjusted on the symptom or on the patient as a person. Our results indicate that the GPs seem to recognise immediately both problems and persons, hence the quintessence of the expert skill of the GP as developed through experience.
  •  
22.
  • Arvidsson, Eva, et al. (författare)
  • Setting priorities in primary health care - on whose conditions? A questionnaire study
  • 2012
  • Ingår i: BMC Family Practice. - : BioMed Central. - 1471-2296. ; 13:114
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: In Sweden three key criteria are used for priority setting: severity of the health condition; patient benefit; and cost-effectiveness. They are derived from the ethical principles established by the Swedish parliament 1997 but have been used only to a limited extent in primary care. The aim of this study was to describe and analyse: 1) GPs, nurses, and patients prioritising in routine primary care 2) The association between the three key priority setting criteria and the overall priority assigned by the GPs and nurses to individual patients. less thanbrgreater than less thanbrgreater thanMethods: Paired questionnaires were distributed to all patients and the GPs or nurses they had contact with during a 2-week period at four health centres in Sweden. The staff registered the health conditions or health problem, and the planned intervention. Then they estimated the severity of the health condition, the expected patient benefit, and the cost-effectiveness of the planned intervention. Both the staff and the patients reported their overall prioritisation of the patient. In total, 1851 paired questionnaires were collected. less thanbrgreater than less thanbrgreater thanResults: Compared to the medical staff, the patients assigned relatively higher priority to acute/minor conditions than to preventive check-ups for chronic conditions. Severity of the health condition was the priority setting criterion that had the strongest association with the overall priority for the staff as a whole, but for the GPs it was cost-effectiveness. less thanbrgreater than less thanbrgreater thanConclusions: The challenge for primary care providers is to balance the patients demands with medical needs and cost-effectiveness. Transparent priority setting in primary care might contribute to a greater consensus between GPs and nurses on how to use the key priority setting criteria.
  •  
23.
  •  
24.
  •  
25.
  • Björk, Anne, et al. (författare)
  • Evaluation of sun holiday, diet habits, origin and other factors as determinants of vitamin D status in Swedish primary health care patients : a cross-sectional study with regression analysis of ethnic Swedish and immigrant women
  • 2013
  • Ingår i: BMC Family Practice. - : Springer Science and Business Media LLC. - 1471-2296. ; 14, s. 129-
  • Tidskriftsartikel (refereegranskat)abstract
    • BackgroundDeterminants of vitamin D status measured as 25-OH-vitamin D in blood are exposure to sunlight and intake of vitamin D through food and supplements. It is unclear how large the contributions are from these determinants in Swedish primary care patients, considering the low radiation of UVB in Sweden and the fortification of some foods. Asian and African immigrants in Norway and Denmark have been found to have very low levels, but it is not clear whether the same applies to Swedish patients. The purpose of our study was to identify contributors to vitamin D status in Swedish women attending a primary health care centre at latitude 60°N in Sweden.MethodsIn this cross-sectional, observational study, 61 female patients were consecutively recruited between January and March 2009, irrespective of reason for attending the clinic. The women were interviewed about their sun habits, smoking, education and food intake at a personal appointment and blood samples were drawn for measurements of vitamin D and calcium concentrations.ResultsPlasma concentration of 25-OH-vitamin D below 25 nmol/L was found in 61% (19/31) of immigrant and 7% (2/30) of native women. Multivariate analysis showed that reported sun holiday of one week during the last year at latitude below 40°N with the purpose of sun-bathing and native origin, were significantly, independently and positively associated with 25-OH-vitamin D concentrations in plasma with the strongest association for sun holiday during the past year.ConclusionsVitamin D deficiency was common among the women in the present study, with sun holiday and origin as main determinants of 25-OH-vitamin D concentrations in plasma. Given a negative effect on health this would imply needs for vitamin D treatment particularly in women with immigrant background who have moved from lower to higher latitudes.Keywords: Vitamin D; Sun habits; Immigrant; Women; Primary health care
  •  
Skapa referenser, mejla, bekava och länka
  • Resultat 1-25 av 148
Typ av publikation
tidskriftsartikel (145)
forskningsöversikt (3)
Typ av innehåll
refereegranskat (148)
Författare/redaktör
Andre, Malin (8)
Midlöv, Patrik (7)
Björkelund, Cecilia, ... (6)
Nilsen, Per (4)
Petersson, Eva-Lisa (4)
Halling, Anders (4)
visa fler...
Samuelsson, Eva (4)
Nilsson, Gunnar (4)
Borgquist, Lars (4)
Bendtsen, Preben (4)
Hedenrud, Tove, 1967 (4)
Andersson, Agneta (3)
Nilsson, Staffan (3)
Svenningsson, Irene, ... (3)
Wikberg, Carl (3)
Westman, J (3)
Ahlström, Gerd (3)
Eggertsen, Robert, 1 ... (3)
Hensing, Gunnel, 195 ... (3)
Nilsson, Gunnar H. (3)
Holmgren, Kristina, ... (3)
Hedin, Katarina (3)
Furhoff, AK (3)
Bramhagen, Ann-Cathr ... (3)
Ekblad, Solvig (2)
Eriksson, I (2)
Fors, Uno (2)
Kristiansson, Per (2)
Wahlström, Rolf (2)
Håkansson, Anders (2)
Pettersson, A (2)
Lilja, Mikael (2)
Nejati, Shabnam, 197 ... (2)
Hange, Dominique, 19 ... (2)
Udo, Camilla (2)
Wallin, Lars (2)
Rudebeck, Carl Edvar ... (2)
Östman, Margareta (2)
Carlsson, Per (2)
Hammarström, Anne (2)
Sandelowsky, Hanna (2)
Sundquist, Jan (2)
Lindblad, Ulf, 1950 (2)
Johansson, SE (2)
Lenander, Cecilia (2)
Thulesius, Hans (2)
Müssener, Ulrika (2)
Salminen, Helena (2)
Andén, Annika (2)
Nilsson, Staffan, 19 ... (2)
visa färre...
Lärosäte
Karolinska Institutet (46)
Lunds universitet (38)
Göteborgs universitet (32)
Linköpings universitet (31)
Uppsala universitet (25)
Umeå universitet (14)
visa fler...
Stockholms universitet (5)
Malmö universitet (5)
Linnéuniversitetet (5)
Högskolan Dalarna (4)
Högskolan i Gävle (3)
Örebro universitet (3)
Högskolan i Halmstad (2)
Mälardalens universitet (2)
Mittuniversitetet (2)
Högskolan i Skövde (2)
Högskolan Väst (1)
Jönköping University (1)
Chalmers tekniska högskola (1)
Marie Cederschiöld högskola (1)
VTI - Statens väg- och transportforskningsinstitut (1)
visa färre...
Språk
Engelska (148)
Forskningsämne (UKÄ/SCB)
Medicin och hälsovetenskap (106)
Samhällsvetenskap (6)
Teknik (1)

År

Kungliga biblioteket hanterar dina personuppgifter i enlighet med EU:s dataskyddsförordning (2018), GDPR. Läs mer om hur det funkar här.
Så här hanterar KB dina uppgifter vid användning av denna tjänst.

 
pil uppåt Stäng

Kopiera och spara länken för att återkomma till aktuell vy