| 1. |
- Adolfsson, Eva Thors, et al.
(författare)
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Reporting systems, reporting rates and completeness of data reported from primary healthcare to a Swedish quality register : The National Diabetes Register
- 2011
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Ingår i: International Journal of Medical Informatics. - : Elsevier BV. - 1386-5056 .- 1872-8243. ; 80:9, s. 663-668
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Tidskriftsartikel (refereegranskat)abstract
- Objective:The aims of this paper were to study the reporting rate and completeness of data reported from primary healthcare centres (PHCCs) in Sweden to the Swedish National Diabetes Register (NDR), with a special attention on the relation between these measures and the reporting system used by the PHCCs.Method:A national survey conducted in Swedish primary healthcare covering the year 2006. A questionnaire was used to collect data from 523 PHCCs. Data on 87,099 adult diabetic patients attending these PHCCs and reported to the NDR were obtained from the register. In Sweden, participation in the NDR is voluntary. The data were reported through the Internet, either online using a web-based system or by direct transmission. The main outcome measures were reporting rate and completeness of reported data.Results:Of the 523 PHCCs, almost two-thirds had reported <75% of their diabetic patients to the NDR. The lowest reporting rate was found among the largest PHCCs, while the highest was found among small PHCCs (p < 0.001). Reasons given for not reporting data to the NDR were lack of time and lack of personnel resources. Altogether, 73.1% of the PHCCs reported data to the NDR online using a web-based system, 20.5% used direct transmission and 6.3% used both systems. The PHCCs that reported data through direct transmission systems reported almost 70% of their diabetic patients to the NDR, while PHCCs using web-based systems reported 54% of their diabetic patients to the NDR. Adjusted for other factors, using direct transmission increased the reporting rate by 13.0 percentage points. However, the web-based system contributed to a higher completeness of data than the direct transmission system.Conclusions:A direct transmission system facilitates a high reporting rate to the register at the expense of lower completeness of the reported data.
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| 2. |
- Adolfsson, Eva Thors, et al.
(författare)
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The Swedish National Survey of the Quality and Organization of Diabetes Care in Primary Healthcare—Swed-QOP
- 2010
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Ingår i: Primary Care Diabetes. - : Elsevier BV. - 1751-9918 .- 1878-0210. ; 4:2, s. 91-97
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Tidskriftsartikel (refereegranskat)abstract
- AIM:To describe the quality and organization of diabetes care in primary healthcare in Sweden regarding resources and ways of working.METHOD:A questionnaire was used to collect data from all 921 primary healthcare centres (PHCCs) in Sweden. Of these, 74.3% (n=684) responded to the questionnaire covering list size of the PHCCs, number of diabetic patients, personnel resources and ways of working.RESULTS:The median list size reported from the PHCCs was 9,000 patients, 294 of whom were diabetic patients. The majority (72%) of PHCCs had diabetes-responsible general practitioners (GPs) and almost all (97%) had diabetes specialist nurses (DSNs) with some degree of postgraduate education in diabetes. The PHCCs reported that they used regional/local diabetes guidelines (93%), were engaged in call-recall diabetic reviews by GP(s) (66%) and DSN(s) (89%), checked that patients had participated in the reviews by GP(s) (69%) and DSN(s) (78%), arranged group education programmes (23%) and reported data to a National Diabetes Register (82%).CONCLUSIONS:The presence of diabetes-responsible GP(s) and DSN(s) who use guidelines may contribute to good and equal quality of care. It is, however, necessary to improve the call-recall system and there is an urgent need for all diabetic patients to receive patient education.
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| 3. |
- Adolfsson, Eva Thors, et al.
(författare)
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Type 2 diabetic patients' experiences of two different educational approaches : A qualitative study
- 2008
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Ingår i: International Journal of Nursing Studies. - : Elsevier BV. - 0020-7489 .- 1873-491X. ; 7:45, s. 986-994
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim of the current study was to explore patients' experiences of participating in an empowerment group education programme or receiving individual counselling. Method: In total, 28 patients from seven primary care centres were interviewed. Of these, 14 had received individual counselling and the remaining 14 had also participated in 4-5 empowerment group sessions. The semi-structured interviews were tape-recorded, transcribed verbatim and analysed using qualitative content analysis. Findings: Three main categories crystallized from the interviews: (I) relationships, (II) learning and (III) controlling the disease. The relationships in the individual counselling seemed vertical, characterized by one-way communication with care providers acting as superiors and patients as subordinates. The relationships in the empowerment group appeared to be horizontal, characterized by trust and mutual communication. Those who had received individual counselling talked about learning by compliance-care providers acted as superiors, giving advice they expected the patients to follow. In the empowerment groups the patients talked more about participatory learning, whereby the facilitators and patients shared their knowledge and experiences. Controlling the disease could be labelled external in individual counselling, which made it difficult for patients to take responsibility for and control of their diabetes self-care. On the contrary, the patients in the empowerment group achieved the insight that diabetes is a serious disease but can be influenced, which contributed to their experience of self-control. Conclusions: The current study indicates that vertical relationships, learning by compliance and external control seem to limit patients' ability to take responsibility for their disease, while horizontal relationships, participatory learning and self-control may contribute to strengthening patients' ability to influence and be actively involved in their own care.
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| 4. |
- Annika, Lindh, 1984-, et al.
(författare)
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Description of inhalation technique in patients with COPD in primary care
- 2018
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Ingår i: European Respiratory Journal. - : European Respiratory Society. - 0903-1936 .- 1399-3003. ; 52:Suppl. 62
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: A recent systematic review showed that only about one third of the patients had a correct inhalation technique and the number had not improved the last 40 years¹.Aim: The aim was to describe errors, separated into errors related to devices and errors related to inhalation technique, that occur when patients with COPD inhale medications.Method: In this descriptive study, patients with a COPD diagnosis were recruited from a randomized controlled trial performed 2015-2016 in primary care in four county councils in Sweden. A COPD nurse assessed the inhalation technique using a checklist with errors related to devices and to inhalation technique with possibility to write additional comments.Results: In total, 167 patients using 287 inhalers were assessed, 52% (n = 86) were female, mean age 71 years. A total of 163 errors were noted in the checklist, of which 87 were related to inhalation technique and 76 were related to devices. Except from this the COPD nurse had written comments regarding 53 errors that were not included in the checklist. At least one error (range: 1-7 errors) was made by 46% (n = 76) of the patients.Conclusion: The results show that many patients do not use the device correctly. Both errors related to inhalation technique and related to devices were present. This implies that there is a need to focus on both aspects when teaching patients how to inhale their medication. The checklist used in this study needs to be further improved.
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| 5. |
- Annika, Lindh, 1984-, et al.
(författare)
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Incorrect inhalation technique is common in patients with COPD in primary care
- 2018
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Konferensbidrag (refereegranskat)abstract
- The results show that many patients don’t use the inhaler correctly. Errors related to inhalation technique were twice as common as those related to devices. When teaching patients to use the inhalers it seems like there is a need to focus more on the inhalation technique itself. The checklist used in this study needs to be further improved.
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| 6. |
- Frid, Hanna, et al.
(författare)
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Agreement between different methods of measuring height in elderly patients
- 2013
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Ingår i: Journal of human nutrition and dietetics. - : Wiley. - 0952-3871 .- 1365-277X. ; 26:5, s. 504-511
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundThe present study aimed to examine the agreement between measurements of standing height and self-reported height, height measured with a sliding caliper, and height estimated from either demispan or knee height in elderly patients.MethodsFifty-five patients (mean age 79 years) at a Swedish hospital were included in this observational study. The participants' heights were evaluated as the standing height, self-reported height, height measured in a recumbent position with a sliding caliper, and height estimated from the demispan or knee height.ResultsThe measurements made with a sliding caliper in the recumbent position agreed most closely with the standing height. Ninety-five percent of the individuals' differences from standing height were within an interval of +1.1 to −4.8 cm (limits of agreement). Self-reported height and height estimated from knee height differed relatively strongly from standing height. The limits of agreement were +5.2 to −9.8 cm and +9.4 to −6.2 cm, respectively. The widest distribution of differences was found in the height estimated from the demispan, with limits of agreements from +11.2 to −9.3 cm.ConclusionsWhen measuring the height of patients who find it difficult to stand upright, a sliding caliper should be the method of choice, and the second choice should be self-reported height or the height estimated from knee height. Estimating height from the demispan should be the method of last resort.
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| 7. |
- Gusdal, Annelie K, 1963-
(författare)
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Family caregiving for persons with heart failure : Perspectives of family caregivers, persons with heart failure and registered nurses
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Heart failure is a growing public health problem associated with significant morbidity and mortality. Family support positively affects outcomes for the person with heart failure while also leading to caregiver burden. Registered nurses have a key role in supporting and meeting the needs of family caregivers.The overall aim was to explore the situation and needs of family caregivers to a person with heart failure, and explore requisites and ways of supporting and involving family caregivers in heart failure nursing care.Two interview studies, one web survey study and one intervention study were conducted between 2012 and 2017. A total of 22 family caregivers, eight persons with heart failure and 331 registered nurses participated in the studies.Family caregivers' daily life was characterized by worry, uncertainty and relational incongruence but salutogenic behaviours restored new strength and motivation to care. Family caregivers experienced that their caregiving was taken for granted by health care professionals. Family caregivers expressed a need for a permanent health care contact and more involvement in the planning and implementation of their near one’s health care together with health care professionals. Registered nurses acknowledged family caregivers’ burden, lack of knowledge and relational incongruence. A registered nurse was suggested as a permanent health care contact to improve continuity and security. Registered nurses neither acknowledged family caregivers as a resource nor their need for involvement. Registered nurses working in primary health care centres, in nurse-led heart failure clinics, with district nurse specialization, with education in cardiac nursing care held the most supportive attitudes toward family involvement in heart failure nursing care. Family health conversations via telephone in nurse-led heart failure clinics were found to successfully support and involve families. The conversations enhanced nurse-family relationship and relations within the family. They also provided registered nurses with new, relevant knowledge and understanding about the family as a whole. Family health conversations via telephone were feasible to both families and registered nurses, although fewer and shorter conversations were preferred by registered nurses.This thesis highlights the divergence between family caregivers’ experiences and needs, and registered nurses’ perceptions about family caregivers’ situation and attitudes toward the importance of family involvement. It adds to the knowledge on the importance to acknowledge family caregivers as a resource and to support and involve them in heart failure nursing care. One feasible and successful way is to conduct Family health conversations via telephone in nurse-led heart failure clinics.
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| 8. |
- Gusdal, Annelie K, 1963-, et al.
(författare)
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Family Health Conversations Conductedby Telephone in Heart Failure Nursing Care : A Feasibility Study
- 2018
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Ingår i: Sage Open Nursing. - : SAGE Open. - 2377-9608. ; 4, s. 1-13
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Tidskriftsartikel (refereegranskat)abstract
- Registered nurses (RNs) in heart failure (HF) nursing care have a key role in providing family support, which positively affectsthe outcome for the patient. Telephone interventions conducted by RNs have been reported to be successful in HF nursingcare, but Family Health Conversations (FamHCs) involving the patient and the family, have not previously been tested. Thepurpose of the current study was to explore the experiences and feasibility of nurse-led FamHCs conducted by telephonewith patients and their family caregivers. A single-group intervention study with a pretest–posttest design was conducted inthree regional hospitals that had a nurse-led HF clinic. Five RNs, eight patients, and eight family caregivers participated. ThreeFamHCs were conducted by telephone with each family every 2 weeks. Qualitative and quantitative data were collectedthrough semistructured interviews and questionnaires. FamHCs improved the nurse–family relationships and relationshipswithin the families and provided RNs with new knowledge about the families. FamHCs conducted by telephone wereconsidered to be feasible for both families and RNs, although RNs preferred fewer and shorter FamHCs. The RNs preferredmeeting face-to-face with the families as nonverbal communication between the family members could be missed because oflack of visual input. On the other hand, RNs appreciated to focus entirely on the conversation without the need to performillness-related routine checks. In conclusion, the advantages of FamHCs conducted by telephone outweighed the disadvantages.Visual contact, provided by video telephony, and a shorter version of the tested FamHC would facilitate the use in HFnursing care.
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| 9. |
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| 10. |
- Gusdal, Annelie K, 1963-, et al.
(författare)
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Informal caregivers’ experiences and needs when caring for a relative with heart failure: An interview study
- 2016
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Ingår i: Journal of Cardiovascular Nursing. - : Lippincott Williams & Wilkins. - 0889-4655 .- 1550-5049. ; 31:4, s. 1-8
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Tidskriftsartikel (refereegranskat)abstract
- AbstractBackground: Informal caregivers play an important role for persons with heart failure in strengthening medication adherence, encouraging self-care, and identifying deterioration in health status. Caring for a relative with heart failure can affect informal caregivers' well-being and cause caregiver burden.Objective: The objective of this study was to explore informal caregivers' experiences and needs when caring for a relative with heart failure living in their own home.Methods: The study has a qualitative design with an inductive approach. Interviews were conducted with 14 informal caregivers. Data were analyzed using qualitative content analysis.Results: Two themes emerged: "living in a changed existence" and "struggling and sharing with healthcare." The first theme describes informal caregivers' experiences, needs, and ways of moving forward when living in a changed existence with their relative. Informal caregivers were responsible for the functioning of everyday life, which challenged earlier established roles and lifestyle. They experienced an ever-present uncertainty related to the relative's impending sudden deterioration and to lack of knowledge about the condition. Incongruence was expressed between their own and their relative's understanding and acceptance of the heart failure condition. They also expressed being at peace with their relative and managed to restore new strength and motivation to care. The second theme describes informal caregivers' experiences, needs, and ways in which they handled the healthcare. They felt counted upon but not accounted for, as their care was taken for granted while their need to be seen and acknowledged by healthcare professionals was not met. Informal caregivers experienced an ever-present uncertainty regarding their lack of involvement with healthcare. The lack of involvement with healthcare had a negative impact on the relationship between informal caregivers and their relative due to the mutual loss of important information about changes in medication regimens and the relative's symptoms and well-being. Another cause of negative impact was the lack of opportunity to talk with healthcare professionals about the emotional and relational consequences of heart failure. Healthcare professionals had provided them neither with knowledge on heart failure nor with information on support groups in the municipality. Informal caregivers captured their own mandate through acting as deputies for their relative and claiming their rights of involvement in their relative's healthcare. They also felt confident despite difficult circumstances. The direct access to the medical clinic was a source of relief and they appreciated the contacts with the registered nurses specialized in heart failure. Informal caregivers' own initiatives to participate in meetings were positively received by healthcare professionals.Conclusions: Informal caregivers' daily life involves decisive changes that are experienced as burdensome. They handled their new situations using different strategies to preserve a sense of "self" and of "us." Informal caregivers express a need for more involvement with healthcare professionals, which may facilitate informal caregivers' situation and improve the dyadic congruence in the relation with their relative.
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| 11. |
- Gusdal, Annelie K, et al.
(författare)
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Nurses’ Attitudes toward Family Importance in Heart Failure Care
- 2017
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Ingår i: European Journal of Cardiovascular Nursing. - : Oxford University Press (OUP). - 1474-5151 .- 1873-1953. ; 16:3, s. 256-266
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Tidskriftsartikel (refereegranskat)abstract
- Background: Support from the family positively affects self-management, patient outcomes and the incidence of hospitalizations among patients with heart failure (HF). To involve family members in HF care is thus valuable for the patients. Registered nurses (RNs) frequently meet family members to patients with HF and the quality of these encounters are likely to be influenced by the attitudes RNs hold toward families.Aims: To explore RNs' attitudes toward the importance of families' involvement in HF nursing care and to identify factors that predict the most supportive attitudes.Methods: Cross-sectional, multicentre web-survey study. A sample of 303 RNs from 47 hospitals and 30 primary health care centres (PHCC) completed the instrument Families’ Importance in Nursing Care - Nurses’ Attitudes.Results: Overall, RNs were supportive of families' involvement. Nonetheless, attitudes toward inviting families to actively take part in HF nursing care and involve families in planning of care were less supportive. Factors predicting the most supportive attitudes were to work in a PHCC, a HF clinic, a workplace with a general approach toward families, to have a postgraduate specialization, education in cardiac and or HF nursing care, and a competence to work with families.Conclusions: Experienced RNs in HF nursing care can be encouraged to mentor their younger and less experienced colleagues to strengthen their supportive attitudes toward families. RNs who have designated consultation time with patients and families, as in a nurse-led HF clinic, may have the most favourable condition for implementing a more supportive approach to families.
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| 12. |
- Gusdal, Annelie K, et al.
(författare)
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Registered nurses' perception about the situation of family caregivers to patients with hearth failure - A focus group interwiev study
- 2016
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Ingår i: PLOS ONE. - San Francisco : Public Library of Science (PLoS). - 1932-6203. ; , s. 1-18
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Tidskriftsartikel (refereegranskat)abstract
- IntroductionHeart failure is a growing public health problem associated with poor quality of life and significant morbidity and mortality. The majority of heart failure care is provided by family caregivers, and is associated with caregiver burden and reduced quality of life. Research emphasizes that future nursing interventions should recognize the importance of involving family caregivers to achieve optimal outcomes.AimsThe aims of this study are to explore registered nurses’ perceptions about the situation of family caregivers to patients with heart failure, and registered nurses’ interventions, in order to improve family caregivers’ situation.MethodsThe study has a qualitative design with an inductive approach. Six focus group interviews were held with 23 registered nurses in three hospitals and three primary health care centres. Data were analysed using qualitative content analysis.ResultsTwo content areas were identified by the a priori study aims. Four categories and nine subcategories emerged in the analysis process. The content area “Family caregivers' situation” includes two categories: “To be unburdened” and “To comprehend the heart failure condition and its consequences”. The content area “Interventions to improve family caregivers' situation” includes two categories: “Individualized support and information” and “Bridging contact”.
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| 13. |
- Husdal, Rebecka, et al.
(författare)
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Associations between quality of work features in primary health care and glycaemic control in people with Type 2 diabetes mellitus: A nationwide survey.
- 2019
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Ingår i: Primary care diabetes. - : Elsevier BV. - 1878-0210 .- 1751-9918. ; 13:2, s. 176-186
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Tidskriftsartikel (refereegranskat)abstract
- To describe and analyse the associations between primary health care centres' (PHCCs') quality of work (QOW) and individual HbA1c levels in people with Type 2 diabetes mellitus (T2DM).This cross-sectional study invited all 1152 Swedish PHCCs to answer a questionnaire addressing QOW conditions. Clinical, socio-economic and comorbidity data for 230,958 people with T2DM were linked to data on QOW conditions for 846 (73.4%) PHCCs.Of the participants, 56% had controlled (≤52mmol/mol), 31.9% intermediate (53-69mmol/mol), and 12.1% uncontrolled (≥70mmol/mol) HbA1c. An explanatory factor analysis identified seven QOW features. The features having a call-recall system, having individualized treatment plans, PHCCs' results always on the agenda, and having a follow-up strategy combined with taking responsibility of outcomes/results were associated with lower HbA1c levels in the controlled group (all p<0.05). For people with intermediate or uncontrolled HbA1c, having individualized treatment plans was the only QOW feature that was significantly associated with a lower HbA1c level (p<0.05).This nationwide study adds important knowledge regarding associations between QOW in real life clinical practice and HbA1c levels. PHCCs' QOW may mainly only benefit people with controlled HbA1c and more effective QOW strategies are needed to support people with uncontrolled HbA1c.
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| 14. |
- Husdal, Rebecka, et al.
(författare)
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Diabetes care provided by national standards can improve patients' self‐management skills : A qualitative study of how people with type 2 diabetes perceive primary diabetes care
- 2021
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Ingår i: Health Expectations. - : John Wiley & Sons. - 1369-6513 .- 1369-7625. ; 24:3, s. 1000-1008
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Tidskriftsartikel (refereegranskat)abstract
- Background The increasing incidence of type 2 diabetes mellitus [T2DM] has resulted in extensive research into the characteristics of successful primary diabetes care. Even if self-management support and continuity are increasingly recognized as important, there is still a need for deeper understanding of how patients' experiences of continuity of care coincide with their needs for self-management and/or self-management support.Objective To gain a deeper understanding of how people with T2DM perceive Swedish primary diabetes care and self-management support.Methods This qualitative study used focus groups as the means for data collection. Participants were identified through a purposive sampling method differing in age, sex, diabetes duration and latest registered glycated haemoglobin level. Twenty-eight participants formed five focus groups. Qualitative content analysis was applied to interview transcripts.Results The main theme emerging from the focus group data was that diabetes care provided by national standards improved self-management skills. Two themes that emerged from the analysis were (a) the importance of a clarification of structures and procedures in primary diabetes care and (b) health-care staff 'being there' and providing support enables trust and co-operation to enhance self-management.Conclusions Individual patients' self-management resources are strengthened if the importance of providing relational continuity, management continuity and informational continuity is considered. Patients also need assistance on 'how' self-management activities should be performed.Patient contribution Prior to the study, one pilot focus group was conducted with patients to obtain their perspectives on the content of the planned focus groups; thus, patients were involved in both planning and conduct of the study.
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| 15. |
- Husdal, Rebecka
(författare)
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Key Features for Successful Swedish Primary Diabetes Care – Reality or Fiction? : Nationwide studies of longitudinal follow-up, HbA1c levels and all-cause mortality in an organizational context
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aims To extend knowledge about the changes in Swedish primary diabetes care from 2006 to 2013 and investigate associations of personnel resources, organizational features and quality-of-work conditions of primary health-care centres (PHCCs) with individual HbA1c levels and all-cause mortality in people with type 2 diabetes mellitus (T2DM).Methods Information about organizational features, personnel resources and quality-of-work conditions were collected from responses of PHCC managers to the Swedish National Survey of the Quality and Organisation of Diabetes Care in Primary HealthCare (Swed-QOP) questionnaire. The longitudinal cross-sectional study included 74.3% and 76.4% of PHCCs in 2006 and 2013, respectively. Individual clinical data for 230,958 people with T2DM obtained from the Swedish National Diabetes Register were linked to the data from the Swed-QOP questionnaire. Individual data were linked to socio-economic and comorbidity data. All-cause mortality was followed up for a median of 4.2 years for 187,570 people with T2DM.Results The longitudinal follow-up study showed a decreased median PHCC list size but an increased median number of people with T2DM. The mean European Credit Transfer and Accumulation System (ECTS) credits in diabetes-specific education for registered nurses (RNs) increased. The number of PHCCs providing group education programs and involving the patient in goal setting remained low (I). PHCCs having diabetes teams and group education programs were associated with decreased HbA1c levels. Using call-recall system to general practitioners (GPs) was associated with increased HbA1c levels (II). Seven quality-of-work features were identified, of which Individualized treatment was associated with decreased HbA1c levels in people with controlled (≤ 52 mmol/mol), intermediate (53–69 mmol/mol) and uncontrolled (≥ 70 mmol/mol) HbA1c (III). GP staffing was associated with a decreased risk of early death and the mean ECTS credits in diabetes-specific and pedagogical education of RNs was associated with a decreased risk of early death in people aged ≥ 55 years and in men, respectively (IV).Conclusion This thesis adds to previous work on significant but less pronounced key features for successful organization of primary diabetes care, and indicates that the complexity of diabetes disease makes it difficult to identify success factors applicable to all people living with T2DM.
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| 16. |
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| 17. |
- Husdal, Rebecka, et al.
(författare)
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Resource allocation and organisational features in Swedish primary diabetes care : Changes from 2006 to 2013
- 2017
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Ingår i: Primary Care Diabetes. - : Elsevier. - 1751-9918 .- 1878-0210. ; 11:1, s. 20-28
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Tidskriftsartikel (refereegranskat)abstract
- Aims: To compare the resource allocation and organisational features in Swedish primary diabetes care for patients with type 2 diabetes mellitus (T2DM) between 2006 and 2013.Methods: Using a repeated cross-sectional study design, questionnaires covering personnel resources and organisational features for patients with T2DM in 2006 and 2013 were sent to all Swedish primary health care centres (PHCCs) during the following year. In total, 684 (74.3%) PHCCs responded in 2006 and 880 (76.4%) in 2013.Results: Compared with 2006, the median list size had decreased in 2013 (p<0.001), whereas the median number of listed patients with T2DM had increased (p<0.001). Time devoted to patients with T2DM and diabetes-specific education levels for registered nurses (RNs) had increased, and more PHCCs had in-house psychologists (all p<0.001). The use of follow-up systems and medical check-ups had increased (all p<0.05). Individual counselling was more often based on patients' needs, while arrangement of group-based education remained low. Patient participation in setting treatment targets mainly remained low.Conclusions: Even though the diabetes-specific educational level among RNs increased, the arrangement of group-based education and patient participation in setting treatment targets remained low. These results are of concern and should be prioritised as key features in the care of patients with T2DM. (C) 2016 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.
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| 18. |
- Husdal, Rebecka, et al.
(författare)
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Resources and organisation in primary health care are associated with HbA(1c) level : A nationwide study of 230 958 people with Type 2 diabetes mellitus
- 2018
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Ingår i: Primary Care Diabetes. - : Elsevier. - 1751-9918 .- 1878-0210. ; 12:1, s. 23-33
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Tidskriftsartikel (refereegranskat)abstract
- Aims: To examine the association between personnel resources and organisational features of primary health care centres (PHCCs) and individual HbAic level in people with Type 2 diabetes mellitus (T2DM).Methods: People with T2DM attending 846 PHCCs (n =230 958) were included in this crosssectional study based on PHCC-level data from a questionnaire sent to PHCCs in 2013 and individual-level clinical data from 2013 for people with T2DM reported in the Swedish National Diabetes Register, linked to individual-level data on socio-economic status and comorbidities. Data were analysed using a generalized estimating equations linear regression models.Results: After adjusting for PHCC- and individual-level confounding factors, personnel resources associated with lower individual HbAi, level were mean credits of diabetes specific education among registered nurses (RNs) (-0.02 mmol/mol for each additional credit; P < 0.001) and length of regular visits to RNs (-0.19 mmol/mol for each additional 15 min; P < 0.001). Organisational features associated with HbAie level were having a diabetes team (-0.18 mmol/mol; P <0.01) and providing group education (-0.20 mmol/mol; P < 0.01).Conclusions: In this large sample, PHCC personnel resources and organisational features were associated with lower HbA(1c), level in people with T2DM.
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| 19. |
- Husdal, Rebecka
(författare)
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The organisation of diabetes care for persons with type 2 diabetes mellitus : A nationwide cross-sectional study in Swedish primary health care
- 2017
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim To extend the current knowledge about changes in Swedish diabetes care from 2006 to 2013 (Paper I), and to investigate the association between personnel resources and organisational features of primary health care centres (PHCCs) and the individual level of glycated haemoglobin (HbA1c) among persons with type 2 diabetes mellitus (T2DM) (Paper II).Methods The longitudinal cross-sectional study described in Paper I included a total of 684 (74.3%) of eligible 921 PHCCs in 2006 and 880 (76.4%) of eligible 1152 PHCCs in 2013. The Swedish National Survey of the Quality and Organisation of Diabetes Care in Primary Healthcare (Swed-QOP) questionnaire was sent to PHCC managers in 2007 and 2014. In Paper II, persons with T2DM (n = 230 958) attending 846 PHCCs were included. The PHCC-level data for 2013 were obtained from the Swed-QOP questionnaire and the individual-level data for 2013 were obtained from the National Diabetes Register. These data were linked to national registers containing individual-level data on socio-economic status and comorbidities.Results From 2006 to 2013, the median list size of PHCCs decreased while the median number of persons with T2DM at the PHCC increased (all P < 0.001). The median number of whole time equivalent registered nurses (RNs) per 500 persons with T2DM increased from 0.64 in 2006 to 0.79 in 2013 (P < 0.001). Compared with 2006, 30% percentage points more PHCCs (17.0% in 2006 and 47.5% in 2013) had an RN with at least 16 European Credit Transfer and Accumulation System (ECTS) credits in diabetes-specific education in 2013 (P < 0.001). Access to an in-house psychologist increased from 25.9% in 2006 to 47.1% in 2013 (P < 0.001). No change was found regarding in-house access to dietitians, chiropodists, social workers or physiotherapists. Observed changes in the organisational features of PHCCs from 2006 to 2013 included increased frequency of medical check-ups, use of call–recall systems and use of systems for checking that persons with T2DM participated in annual visits to general practitioners (GPs) and RNs (all P < 0.05). Providing group education remained scarce in both years (Paper I). After adjusting for several important confounders, personnel resources associated with decreasing individual HbA1c levels were the number of ECTS credits in diabetes-specific education among RNs (P < 0.001) and the duration of regular visits to RNs (P < 0.001). However, the opposite effect (i.e., increased HbA1c levels) was found for the duration of visits to GPs (P < 0.001). Organisational features associated with decreased individual HbA1c levels were PHCCs having a diabetes team (P < 0.01) and providing group education (P < 0.01) (Paper II).Conclusions The findings presented in this thesis add important knowledge on evaluating changes in diabetes care in Sweden. Some findings can be interpreted as initiatives to focus on increasing the time RNs devote to caring for persons with T2DM, and in ensuring RNs undergo diabetes-specific education. Furthermore, factors such as diabetes-specific education, diabetes teams and group education were associated with lower individual HbA1c levels. These findings could stimulate decision-makers to prioritise these factors for offering high-quality, equitable care to persons with diabetes.
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| 20. |
- Isaksson, Sofia Sterner, et al.
(författare)
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Effects of nutrition education using a food-based approach, carbohydrate counting or routine care in type 1 diabetes: 12 months prospective randomized trial
- 2021
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Ingår i: Bmj Open Diabetes Research & Care. - : BMJ. - 2052-4897. ; 9:1
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Tidskriftsartikel (refereegranskat)abstract
- Introduction Evidence on the effects of structured nutrition education is weak in adults with type 1 diabetes mellitus (T1D) with moderately impaired glycemic control. Objective was to compare the effects of different types of nutrition education programs on glycemic control, cardiovascular risk factors, quality of life, diet quality and food choices in T1D. Research design and methods A 12 months randomized controlled study conducted at nine diabetes specialist centers with three parallel arms: (i) a food-based approach (FBA) including foods with low glycemic index or (ii) carbohydrate counting (CC) according to today's standard practice or (iii) individual sessions according to routine care (RC). The primary end point was difference in glycated hemoglobin A1c (HbA1c) between groups at 12 months. Results 159 patients were randomized (FBA: 51; CC: 52; RC: 55). Mean (SD) age 48.6 (12.0) years, 57.9% females and mean (SD) HbA1c level 63.9 (7.9) mmol/mol, 8% (0.7%). After 3 months, HbA1c improved in both FBA and CC compared with RC. However, there were no significant differences at 12 months in HbA1c; FBA versus RC (-0.4 mmol/mol (1.3), 0.04% (0.1%)), CC versus RC (-0.8 mmol/mol (1.2), 0.1% (0.1%)), FBA versus CC (0.4 mmol/mol (0.3), 0.04% (0.01%)). At 12 months, intake of legumes, nuts and vegetables was improved in FBA versus CC and RC. FBA also reported higher intake of monounsaturated and polyunsaturated fats compared with RC, and dietary fiber, monounsaturated and polyunsaturated fats compared with CC (all p values <0.05). There were no differences in blood pressure levels, lipids, body weight or quality of life. Conclusions Nutrition education using an FBA, CC or RC is equivalent in terms of HbA1c and cardiovascular risk factors in persons with T1D with moderately impaired glycemic control. An FBA had benefits regarding food choices compared with CC and RC.
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| 21. |
- Lostelius, Petra, et al.
(författare)
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An electronic patient-reported outcome created based on my needs is worth using : an explorative qualitative study investigating young people's opinions for a health assessment tool
- 2022
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Ingår i: Journal of Patient-Reported Outcomes. - : Springer Nature. - 2509-8020. ; 6:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundYoung people in different healthcare settings are positive about using electronic patient-reported outcomes (ePROs), which are meant to increase the effectiveness and safety of interventions from the patient's perspective. Sweden offers free healthcare to young people aged 12-25 years at 275 youth health clinics (YHCs), whose goals are to strengthen young people and promote sexual, physical, and mental health. YHCs need effective ways to identify the overall picture of young people's health and health-related problems. To our knowledge, there is no ePRO for YHCs that provides an overview of young people's health from several health perspectives. The aim of this study was to explore young people's view on content and design of an ePRO to provide an overview of their health and health related problems when visiting a YHC, and their opinion on what healthcare needs to consider when using the ePRO. This was an explorative qualitative study. The participants were included from five YHCs, in different socioeconomic areas in central Sweden. Fifteen participants were included: 10 girls, three boys, and two non-binary participants with an age range of 16-22 years. Data were collected using a semi-structured interview guide and individual interviews, and inductive content analysis was performed.ResultsOne main theme, "ePRO created based on my needs is worth using" and two sub-themes, "Appealing content and design" and "Trusting healthcare", emerged. The participants wanted that an ePRO should include overall questions about mental-, physical-, and sexual health and social support. Participants also believed the ePRO must disclose the risks of self-harm or suicide. The participants noted the importance of emotional and digital security when using the ePRO and having a confidential conversation with a healthcare provider. To share health information means to trust to gain health.ConclusionsThe study participants' views on content and design can form the basis for designing an ePRO for young people. Their thoughts on safety and treatment in healthcare can be considered in the development process. This study is the starting point for developing an ePRO for young people at YHCs.
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| 22. |
- Lostelius, Petra, et al.
(författare)
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Identification of health-related problems in youth : a mixed methods feasibility study evaluating the Youth Health Report System
- 2024
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Ingår i: BMC Medical Informatics and Decision Making. - : BioMed Central Ltd. - 1472-6947. ; 24:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Because poor health in youth risk affecting their entry in adulthood, improved methods for their early identification are needed. Health and welfare technology is widely accepted by youth populations, presenting a potential method for identifying their health problems. However, healthcare technology must be evidence-based. Specifically, feasibility studies contribute valuable information prior to more complex effects-based research. The current study assessed the process, resource, management, and scientific feasibility of the Youth Health Report System prototype, developed within a youth health clinic context in advance of an intervention study. Methods: This mixed-methods feasibility study was conducted in a clinical setting. The process, resource, management, and scientific feasibility of the Youth Health Report System were investigated, as recommended in the literature. Participants were youth aged 16–23 years old, attending a youth health clinic, and healthcare professionals from three clinics. The youth participants used their smart phones to respond to Youth Health Report System health questions and healthcare professionals used their computer to access the results and for registration system entries. Qualitative data were collected from interviews with healthcare professionals, which were described with thematic analysis. Youth participants’ quantitative Youth Health Report System data were analyzed for descriptive statistics. Results: Feasibility analysis of qualitative data from interviews with 11 healthcare professionals resulted in three themes: We expected it could be hard; Information and routines helped but time was an issue; and The electronic case report form was valuable in the health assessment. Qualitative data were collected from the Youth Health Report System. A total of 54 youth participants completed the evaluation questionnaire, and healthcare professionals retrieved information from, and made post-appointment system entries. Quantitative results revealed few missing items and acceptable data variability. An assessment template of merged qualitative and quantitative data guided a consensus discussion among the researchers, resulting in acceptable feasibility. Conclusions: The process-, resource-, management-, and scientific feasibility aspects were acceptable, with some modifications, strengthening the potential for a successful Youth Health Report System intervention study.
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| 23. |
- Lostelius, Vikman Lostelius, et al.
(författare)
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Development and usability evaluation of an electronic health report form to assess health in young people : a mixed-methods approach
- 2023
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Ingår i: BMC Medical Informatics and Decision Making. - : BioMed Central Ltd. - 1472-6947. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Electronic Patient-Reported Outcomes (ePROs) have potential to improve health outcomes and healthcare. The development of health-technology applications, such as ePROs, should include the potential users and be theoretically grounded. Swedish Youth Health Clinics (YHCs) offer primarily sexual and psychological healthcare for young people aged 12 to 25 years old. Young people in healthcare settings are considered a vulnerable group. The development of a collection of Patient-Reported Outcomes (PROs) in an Electronic Health Report Form (eHRF) for identifying health and health-related problems in young people, was preceded by a qualitative interview study, exploring young people’s views on using an eHRF at YHCs and which questions about health an eHRF should contain. The aim of the current study was to develop and evaluate the usability of an eHRF prototype for identifying health and health-related problems in young people visiting YHCs. Methods: This study used a participatory design. During the development, an expert panel consisting of eight researchers and one Information Technology worker, participated. A wide literature search was performed to find PROs to construct an eHRF prototype to cover health areas. A mixed methods usability evaluation included 14 participants (young people, healthcare professionals, and an expert panel). Results: The development resulted in an eHRF prototype, containing ten reliable and valid health questionnaires addressing mental-, physical-, and sexual health and social support, a self-efficacy question, and background questions, in total 74 items. The interviews in the usability evaluation resulted in three categories describing the usability of the eHRF: ‘Captures the overall health of young people but needs clarification’, ‘Fun, easy, and optional and will keep young people’s interest’, and ‘Potential contribution to improve the health consultation’. The quantitative results support the usability of the eHRF for YHCs. Conclusions: The participatory approach contributed to development of the eHRF prototype to cover health areas adapted for the target population. The usability evaluation showed that the eHRF was usable and had the potential for self-reflection and contributions to cooperation between young people and healthcare professionals during the health consultation.
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| 24. |
- Söderström, Lisa, 1982-, et al.
(författare)
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Dietary advice and oral nutritional supplements do not increase survival in older malnourished adults : a multicentre randomised controlled trial
- 2020
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Ingår i: Upsala Journal of Medical Sciences. - : Uppsala Medical Society. - 0300-9734 .- 2000-1967. ; 125:3, s. 240-249
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Forskningsöversikt (refereegranskat)abstract
- Objectives: The study aimed to investigate the effect on survival after 6 months of treatment involving individual dietary advice and oral nutritional supplements in older malnourished adults after discharge from hospital. Methods: This multicentre randomised controlled trial included 671 patients aged 65 years who were malnourished or at risk of malnutrition when admitted to hospital between 2010 and 2014, and followed up after 8.2 years (median 4.1 years). Patients were randomised to receive dietary advice or oral nutritional supplements, separate or in combination, or routine care. The intervention started at discharge from the hospital and continued for 6 months, with survival being the main outcome measure. Results: During the follow-up period 398 (59.3%) participants died. At follow-up, the survival rates were 36.9% for dietary advice, 42.4% for oral nutritional supplements, 40.2% for dietary advice combined with oral nutritional supplements, and 43.3% for the control group (log-rank test p = 0.762). After stratifying the participants according to nutritional status, survival still did not differ significantly between the treatment arms (log-rank test p = 0.480 and p = 0.298 for the 506 participants at risk of malnutrition and the 165 malnourished participants, respectively). Conclusions: Oral nutritional supplements with or without dietary advice, or dietary advice alone, do not improve the survival of malnourished older adults. These results do not support the routine use of supplements in older malnourished adults, provided that survival is the aim of the treatment.
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| 25. |
- Söderström, Lisa, 1982-, et al.
(författare)
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Malnutrition is associated with increased mortality in older adults regardless of the cause of death
- 2017
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Ingår i: British Journal of Nutrition. - : Cambridge University Press. - 0007-1145 .- 1475-2662. ; 117:4, s. 532-540
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Tidskriftsartikel (refereegranskat)abstract
- Malnutrition predicts preterm death, but whether this is valid irrespective of the cause of death is unknown. The aim of the present study was to determine whether malnutrition is associated with cause-specific mortality in older adults. This cohort study was conducted in Sweden and included 1767 individuals aged >= 65 years admitted to hospital in 2008-2009. On the basis of the Mini Nutritional Assessment instrument, nutritional risk was assessed as well nourished (score 24-30), at risk of malnutrition (score 17-23.5) or malnourished (score < 17). Cause of death was classified according to the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, into twenty different causes of death. Data were analysed using Cox proportional hazards regression models. At baseline, 55.1% were at risk of malnutrition, and 9.4% of the participants were malnourished. During a median follow-up of 5.1 years, 839 participants (47.5%) died. The multiple Cox regression model identified significant associations (hazard ratio (HR)) between malnutrition and risk of malnutrition, respectively, and death due to neoplasms (HR 2.43 and 1.32); mental or behavioural disorders (HR 5.73 and 5.44); diseases of the nervous (HR 4.39 and 2.08), circulatory (HR 1.95 and 1.57) or respiratory system (HR 2.19 and 1.49); and symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (HR 2.23 and 1.43). Malnutrition and risk of malnutrition are associated with increased mortality regardless of the cause of death, which emphasises the need for nutritional screening to identify older adults who may require nutritional support in order to avoid preterm death.
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| 26. |
- Söderström, Lisa, 1982-, et al.
(författare)
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Mealtime habits and meal provision are associated with malnutrition among elderly patients admitted to hospital
- 2013
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Ingår i: Clinical Nutrition. - : Elsevier. - 0261-5614 .- 1532-1983. ; 32:2, s. 281-288
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Tidskriftsartikel (refereegranskat)abstract
- Background & aims: Large-scale studies performed in hospitals with the validated Mini Nutritional Assessment tool (MNA) are scarce. However, factors associated with malnutrition are important for identifying individuals at risk. The aims of the present study were to estimate the prevalence of malnutrition and to examine the association between mealtime habits, meal provision, and malnutrition among elderly patients admitted to hospital.Methods: This cross-sectional study included patients aged ≥ 65 years admitted to internal medicine, surgical or orthopaedic wards. The MNA was used for their nutritional assessment, and factors potentially associated with malnutrition were recorded.Results: Of 1771 patients (mean age 78 years), 35.5% were well-nourished, 55.1% were at risk of malnutrition and 9.4% were malnourished. Overnight fasts exceeding 11 hours, fewer than four eating episodes a day, and not cooking independently were associated with both malnutrition and risk of malnutrition.Conclusions: The risk of malnutrition was high among elderly patients admitted to hospital, whereas the proportion with fully developed malnutrition was lower than expected. A long overnight fast, few eating episodes, and not cooking independently were associated with an increased risk of malnutrition. Knowledge of these factors when providing care to the elderly may assist health-care professionals to prevent malnutrition.
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| 27. |
- Söderström, Lisa, 1982-
(författare)
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Nutritional Screening of Older Adults : Risk Factors for and Consequences of Malnutrition
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aims The overall aim of this thesis was to extend current knowledge about the prevalence of malnutrition, to identify possible risk factors for development of malnutrition, and to describe the consequences of malnutrition in relation to all-cause and cause-specific mortality among older adults admitted to hospital.Methods The prevalence of malnutrition was estimated in a cohort of 1771 older adults (≥65 years) who were admitted to a Swedish hospital during 2008–2009 (15 months) and screened for malnutrition using the Mini Nutritional Assessment (MNA) instrument. Possible risk factors for malnutrition were recorded during the hospital stay (Study I). Dietary intake 10 years earlier (in 1997) was collected for 725 of these older adults (Study II). All-cause (Study III) and cause-specific (Study IV) mortality were followed up after medians of 3.5 and 5.1 years, respectively, for 1767 of the participants.Results The prevalence of malnutrition was 9.4% while 55.1% were at risk of malnutrition. Risk factors for malnutrition was an overnight fast >11 hours, <4 eating episodes a day, and not cooking independently. In middle-aged and older adults with a body mass index <25 kg/m2 in 1997, the risk of malnutrition increased for each additional percentage point of energy from total, saturated and monounsaturated fat at follow-up after 10 years. Malnourished older adults had almost four times higher risk of death during follow-up, while those at risk of malnutrition had a 56% higher risk, compared to well-nourished. Furthermore, well-nourished older adults had consistently lower risk of death, regardless of the cause of death.Conclusions Only 35.5% of older adults admitted to hospital were well-nourished. The identified risk factors could be used in interventions aimed at preventing malnutrition. Normal-weight and underweight middle-aged and older adults should consider limiting the intake of total fat and/or improve the quality of the fat in the diet in order to decrease the risk of becoming malnourished later in life. Malnutrition and risk of malnutrition were associated with increased overall and cause-specific mortality. These relationships emphasize the need for nutritional screening to identify individuals who may require nutritional support in order to avoid preterm death.
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| 28. |
- Söderström, Lisa, 1982-
(författare)
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Nutritional status among older people : Risk factors and consequences of malnutrition
- 2013
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Despite the high frequency and serious consequences of protein–energy malnutrition, prevention and treatment of malnutrition do not currently receive appropriate attention. Increased awareness of the importance of nutritional screening among older people is needed. The overall aim of this thesis was to extend our current knowledge about malnutrition and the consequences of a poor nutritional status in relation to preterm death, and to identify possible risk factors for developing malnutrition among older people. The aim of Paper I was to estimate the prevalence of malnutrition and to examine the associations between mealtime habits, meal provision, and malnutrition among older people admitted to a Swedish hospital. The aim of Paper II was to examine whether nutritional status, defined according to the three categories in the full Mini Nutritional Assessment (MNA) instrument, is an independent predictor of preterm death in older people.The baseline survey was a cross-sectional study of 1771 patients aged ³65 years who were admitted to hospital. Nutritional status was assessed using the MNA instrument, and possible risk factors associated with malnutrition were recorded during the hospital stay (Paper I). Overall survival was followed up after 35–50 months in a cohort study of 1767 participants (Paper II).Of the 1771 participants, 35.5% were well-nourished, 55.1% were at risk of malnutrition, and 9.4% were malnourished at baseline. An overnight fast >11 hours was associated with risk of malnutrition (odds ratio (OR) 1.46; 95% confidence interval (CI) 1.14–1.87) and being malnourished (OR 1.67; 95% CI 1.04–2.69). Fewer than four eating episodes a day was associated with both risk of malnutrition (OR 1.88, 95% CI 1.52–2.32) and being malnourished (OR 3.10; 95% CI 2.14–4.49). Not cooking independently was also associated with both risk of malnutrition (OR 1.9; 95% CI 1.30–2.93) and being malnourished (OR 5.04; 95% CI 2.95–8.61). At the 50-month follow-up, the survival rates were 75.2% for well-nourished participants, 60.0% for those at risk of malnutrition, and 33.7% for malnourished participants. After adjusting for confounders, the hazard ratios (95% CI) for all-cause mortality were 1.56 (1.18–2.07) in the group at risk of malnutrition and 3.71 (2.28–6.04) in the malnourished group. Nutritional status defined according to the three categories in the full MNA independently predicted preterm death in people aged 65 years and older.This thesis provides additional knowledge of the current nutritional situation among older people admitted to hospital. The high prevalence and serious consequences of malnutrition demonstrated in this thesis underline the importance of screening and taking actions to counteract malnutrition among older people. The data showing that the length of overnight fasting and number of eating episodes per day are possible risk factors for malnutrition are consistent with the current nutritional recommendations. This knowledge may stimulate care providers to decrease the length of overnight fasting and increase the number of eating episodes per day among older people at risk of malnutrition.
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| 29. |
- Söderström, Lisa, 1982-, et al.
(författare)
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Nutritional status predicts preterm death in older people : a prospective cohort study
- 2014
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Ingår i: Clinical Nutrition. - : Elsevier BV. - 0261-5614 .- 1532-1983. ; 33:2, s. 354-359
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Tidskriftsartikel (refereegranskat)abstract
- Background & aims: There is an association between malnutrition and mortality. However, it is uncertain whether this association is independent of confounders. The aim of the present study was to examine whether nutritional status, defined according to the three categories in the full Mini Nutritional Assessment (MNA) instrument, is an independent predictor of preterm death in people 65 years and older. Methods: This prospective cohort study included individuals aged >= 65 years who were admitted to hospital between March 2008 and May 2009 and followed-up after 50 months (n = 1767). Nutritional status was assessed with the MNA, and possible risk factors associated with malnutrition were recorded during participants hospital stay. Main outcome measure was overall survival. Results: Based on the MNA definitions, 628 (35.5%) were well-nourished, 973 (55.1%) were at risk of malnutrition, and 166 (9.4%) of the participants were malnourished at baseline. During the follow-up period 655 (37.1%) participants died. At follow-up, the survival rates were 75.2% for well-nourished participants, 60.0% for those at risk of malnutrition, and 33.7% for malnourished participants (p < 0.001). After adjusting for confounders the hazard ratios (95% CI) for all-cause mortality were 1.56 (1.18-2.07) in the group at risk of malnutrition and 3.71 (2.28-6.04) in the malnourished group. Conclusions: Nutritional status defined according to the three categories in the full MNA independently predicts preterm death in people aged 65 years and older. These findings are clinically important and emphasise the usefulness of the MNA for screening of nutritional status.
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| 30. |
- Thors Adolfsson, Eva, et al.
(författare)
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Does patient education facilitate diabetic patients’ possibilities to reach national treatment targets? : A national survey in Swedish primary health care
- 2009
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Ingår i: Scandinavian Journal of Primary Health Care. - : Taylor & Francis. - 0281-3432 .- 1502-7724. ; 27:2, s. 91-96
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveTo describe how patient education is arranged in Swedish primary healthcare (PHC) and to assess whether the type of patient education and individual goal setting have an impact on diabetic patients’ possibilities of reaching national treatment targets.DesignA Swedish national survey.SettingSwedish PHC.SubjectsData from 485 primary healthcare centres (PHCCs) and 91 637 diabetic patients reported by the PHCCs to the National Diabetes Register in 2006.Main outcome measuresDescription of how patient education is arranged, HbA1c, body mass index, cholesterol, blood pressure, and physical activity.ResultsOf the PHCCs that reported how they performed the individual counselling, 50% reported checklist-driven counselling and 8% individualized counselling based on patients’ needs. A total of 105 PHCCs reported that they arranged group education. Of these, 67% used pre-planned programmes and 9% individualized the programme to the patients’ needs. The majority of PHCCs (96%) reported that they set individual goals (HbA1c, blood pressure, lipids, and lifestyle). A minority of the PHCCs (27%) reported that the patients were involved in the final decision concerning their goals. Individual goal-setting facilitated patients’ possibilities of reaching treatment targets. Goal-setting, list size of PHCCs, and personnel resources explained a variance of 2.1–5.7%. Neither individual counselling (checklist-driven or individualized to patients’ needs) nor group education had an impact on patients’ possibilities of reaching the targets.ConclusionThe current study indicates that improvement is needed in patient education in PHC to facilitate diabetic patients’ possibilities of reaching national treatment targets.
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| 31. |
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| 32. |
- Thors Adolfsson, Eva, 1957-
(författare)
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Patient Education for People with Type 2 Diabetes in Primary Health Care
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The general aim of this thesis was to evaluate different aspects of patient education for people with type 2 diabetes in Swedish primary health care. The evaluation was conducted in a primary health care setting in central Sweden and in Swedish primary health care in its entirety. Seven centres in central Sweden had implemented the empowerment programme for patients with type 2 diabetes. Data on 16 care providers’ views on implementing the programme were collected in focus-group interviews. The effect and the patients’ experiences of the programme were evaluated in a randomized controlled trial (RCT) (n=101) and in individual interviews (n=28). In the RCT, 50 patients were assigned to the programme and 51 patients to routine diabetes care. The patients answered a 27-item questionnaire and BMI and HbA1c were measured, before the intervention and at one-year follow-up. Further, data from 485 primary health care centres with 91,637 diabetic patients were collected to evaluate patient education in Swedish primary health care in its entirety. The care providers experienced conflicting roles in changing from expert to facilitator in the empowerment programme. The programme improved patients’ confidence in diabetes knowledge and contributed to their experience of self-control, while patients in the routine diabetes care experienced external control. Of the 485 centres, 50% reported having checklist-driven individual counselling and 8% that they individualized the counselling based upon patients’ needs. Most centres (>90%) set individual goals, but only one-third involved patients in the final decisions regarding their goals. Setting individual goals was found to have an impact on patients’ possibilities to reach national treatment targets. In conclusion, the implementation of empowerment in patient education demands support to care providers in order to influence patients’ self-care. Furthermore, patients need to reflect upon necessary self-care changes and also set individual goals to facilitate the reaching of national treatment targets.
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| 33. |
- Thors Adolfsson, Eva, et al.
(författare)
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Patient education in type 2 diabetes : A randomized controlled 1-year follow-up study
- 2007
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Ingår i: Diabetes Research and Clinical Practice. - : Elsevier BV. - 0168-8227 .- 1872-8227. ; 76:3, s. 341-350
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the present study was to evaluate the impact of empowerment group education on type 2 diabetes patients’ confidence in diabetes knowledge, self-efficacy, satisfaction with daily life, BMI and glycaemic control compared with the impact of routine diabetes care on the same factors at a 1-year follow-up. In this randomized controlled trial, conducted at 7 primary care centres in central Sweden, 101 patients were randomly assigned either to empowerment group education (intervention group) or to routine diabetes care (control group). Out of these, 42 patients in the intervention group and 46 in the control group completed the 1-year follow-up. Before the intervention and at the 1-year follow-up, the patients answered a 27-item questionnaire, and weight, BMI and HbA1c were measured. The questionnaire comprised three domains: confidence in diabetes knowledge, self-efficacy and satisfaction with daily life. At 1-year follow-up, the level of confidence in diabetes knowledge was significantly higher in the intervention group than in the control group (p<0.05). No significant differences were found in self-efficacy, satisfaction with daily life, BMI and HbA1c between the intervention and control group. The empowerment group education did improve patients’ confidence in diabetes knowledge with maintained glycaemic control despite the progressive nature of the disease.
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| 34. |
- Vikman Lostelius, Petra, 1972-
(författare)
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Development of a digital Health Report System : From exploration of need to identification of health-related problems in young people
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction While foremost mental health and psychosomatic symptoms are increasing in young people, little is known about the health in young people visiting Youth Health Clinics (YHC). Also, there is no unified health survey used to collect overall health data from young people nationally at YHCs.Aims To develop a health- and welfare technology tool to identify and increase knowledge about health-related problems in young people visiting YHCs.Methods The structured development of a health and welfare technology tool, the Health Report System (studies I to III) had a consultative level participatory approach. Study I was qualitative and contained interviews with young people on content and design for a digital questionnaire. Studies II and III had mixed methods design and included young people, healthcare professionals, and a researcher expert panel. Qualitative data came from interviews and quantitative data from questionnaires. The studies evaluated usability and feasibility. Study IV was quantitative and used data from the evaluation questionnaire, exploring the mediated association of variables on mental well-being, using a set of regression analyses.Results Study I: Young people (n=15) were positive to use a health and welfare technology tool if it was in accordance with their needs. It should give an overview of mental-, physical-, and sexual health and social support. The results should be discussed with healthcare professionals during a health assessment. Study II: The researchers used guidelines to develop the Health Report System and included ten validated and reliable health questionnaires. The usability of the Health Report System was evaluated by young people (n=4), YHC healthcare professionals (n=3), and an expert panel (n=7). The converged qualitative and quantitative data showed that the Health Report System was very usable for YHCs. Study III: The qualitative results from healthcare professionals’ interviews (n=11) and quantitative questionnaire results from young people (n=54) were merged. Using a matrix for assessment of feasibility, the researcher's consensus decision, was that progression and use of the Health Report System in an intervention study was feasible. Study IV: Results from young people’s (n=223) health data showed statistical significance for the mediating effect of social functioning between the sense of mastery and mental well-being. Conclusion This thesis presents that the Health Report System has the potential to identify health-related problems in young people, strengthen the health communication between young people and healthcare professionals, and influence the YHC organization.
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| 35. |
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| 36. |
- Zakrisson, Ann-Britt, 1955-, et al.
(författare)
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Improved quality of care by using the PRISMS form to support self-management in patients with COPD : A Randomized Controlled Trial
- 2020
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Ingår i: Journal of Clinical Nursing. - : Blackwell Science Ltd.. - 0962-1067 .- 1365-2702. ; 29:13-14, s. 2410-2419
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Tidskriftsartikel (refereegranskat)abstract
- AIMS AND OBJECTIVE: To investigate the effects on the quality of care of the Patient Report Informing Self-Management Support (PRISMS) form compared with usual care among patients with Chronic Obstructive Pulmonary Disease (COPD) consulting a COPD nurse in primary health care.BACKGROUND: Patients with COPD experience symptoms affecting their everyday lives and there is a need for interventions in self-management support. The delivery of chronic care in an organized, structured, and planned manner can lead to more productive relationships between professionals and patients.DESIGN: A multicentre randomised controlled trial with a post-test design, according to the CONSORT checklist, in one intervention group (n=94) and one control group (n=108).METHODS: In addition to usual care, the intervention group (n=94) completed the PRISMS form to indicate areas where they wanted self-management support before the consultation with the COPD nurse. This form comprises 17 items that patients with COPD commonly experience as problems. The control group received usual care (n=108). The primary outcome was patients' satisfaction with quality of care, assessed using the Quality from the Patient's Perspective (QPP) questionnaire. Means and (SD) are presented where applicable. Differences between the intervention and control group were analysed with Student's t-test for independent groups for interval data, and the Mann-Whitney U-test for ordinal data.RESULTS: Participants in the intervention group were more satisfied with the QPP domains "personal attention", regarding both "Perceived reality" (p=0.021) and "Subjective Importance" (p=0.012). The PRISMS form revealed "Shortness of breath" as the most commonly experienced problem and the issue most desired to discuss.CONCLUSION: The PRISMS form improved patient satisfaction with quality of care regarding personal attention, which is an important factor in patient participation and improving relationships and communication.RELEVANCE TO CLINICAL PRACTICE: The PRISMS form can be a useful tool in improving person-centred care when delivering self-management support.
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