| 1. |
- Bendtsen, Preben, et al.
(författare)
-
Referral to an electronic screening and brief alcohol intervention in primary health care in Sweden : Impact of staff referral to the computer
- 2011
-
Ingår i: International Journal of Telemedicine and Applications. - : Hindawi Limited. - 1687-6415 .- 1687-6423. ; 918763
-
Tidskriftsartikel (refereegranskat)abstract
- The aim of this paper was to evaluate whether primary health care staff's referral of patients to perform an electronic screening and brief intervention (e-SBI) for alcohol use had a greater impact on change in alcohol consumption after 3 month, compared to patients who performed the test on their own initiative. Staff-referred responders reported reduced weekly alcohol consumption with an average decrease of 8.4 grams. In contrast, self-referred responders reported an average increase in weekly alcohol consumption of 2.4 grams. Staff-referred responders reported a 49 reduction of average number of heavy episodic drinking (HED) occasions per month. The corresponding reduction for self-referred responders was 62. The differences between staff- and self-referred patient groups in the number who moved from risky drinking to nonrisky drinking at the followup were not statistically significant. Our results indicate that standalone computers with touchscreens that provide e-SBIs for risky drinking have the same effect on drinking behaviour in both staff-referred patients and self-referred patients. Copyright © 2011 Preben Bendtsen et al.
|
|
| 2. |
- Biermann, Olivia, et al.
(författare)
-
Collaboration between non-governmental organizations and public services in health - a qualitative case study from rural Ecuador
- 2016
-
Ingår i: Global Health Action. - : CO-ACTION PUBLISHING. - 1654-9716 .- 1654-9880. ; 9
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Non-governmental organizations (NGOs) have a key role in improving health in low-and middle-income countries. Their work needs to be synergistic, complementary to public services, and rooted in community mobilization and collective action. The study explores how an NGO and its health services are perceived by the population that it serves, and how it can contribute to reducing barriers to care. Design: A qualitative exploratory study was conducted in remote Ecuador, characterized by its widespread poverty and lack of official governance. An international NGO collaborated closely with the public services to deliver preventative and curative health services. Data were collected using focus group discussions and semistructured interviews with purposively sampled community members, healthcare personnel, and community health workers based on their links to the health services. Conventional qualitative content analysis was used, focusing on manifest content. Results: Emerging themes relate to the public private partnership (PPP), the NGO and its services, and community participation. The population perceives the NGO positively, linking it to healthcare improvements. Their priority is to get services, irrespective of the providers structure. The presence of an NGO in the operation may contribute to unrealistic expectations of health services, affecting perceptions of the latter negatively. Conclusions: To avoid unrealistic expectations and dissatisfaction, and to increase and sustain the populations trust in the organization, an NGO should operate in a manner that is as integrated as possible within the existing structure. The NGO should work close to the population it serves, with services anchored in the community. PPP parties should develop a common platform with joint messages to the target population on the providers structure, and regarding partners roles and responsibilities. Interaction between the population and the providers on service content and their expectations is key to positive outcomes of PPP operations.
|
|
| 3. |
- Carlfjord, Siw, 1959-, et al.
(författare)
-
Adoption of a research-based program for neck disorders implemented in primary care physiotherapy : a short- and long-term follow-up survey study
- 2021
-
Ingår i: Physiotherapy Theory and Practice. - : Taylor & Francis. - 0959-3985 .- 1532-5040. ; 37:1, s. 89-98
-
Tidskriftsartikel (refereegranskat)abstract
- Neck disorders are common in primary health care (PHC) physiotherapy. A neck-specific exercise program based on research findings was implemented among physiotherapists in Swedish PHC. The aim of the study was to evaluate the adoption of the program. We invited PHC physiotherapists to an educational session including theoretical information and practical training. Before the educational session the participants (n = 261) completed a baseline questionnaire. After 3 and 12 months, we distributed surveys to identify changes in practice and in confidence regarding diagnosis and treatment. We compared data from 3-months and 12-months follow-up, respectively, with baseline data. Self-reported frequency of most of the included assessment methods was unchanged after 12 months. Frequency of assessment of neck proprioception had increased significantly. Specific neck muscle exercise for treatment of whiplash associated disorders was applied more frequently after 3 and after 12 months than at baseline. Frequency of other treatment methods remained unchanged. Confidence in diagnosis and treatment increased significantly, particularly among women. The program was not adopted as expected, but resulted in increased confidence regarding diagnosis and treatment. The provision of a short educational session seemed not to be sufficient to obtain a sustained change in practice.
|
|
| 4. |
- Carlfjord, Siw, et al.
(författare)
-
Applying the RE-AIM framework to evaluate two implementation strategies used to introduce a tool for lifestyle intervention in Swedish primary health care
- 2012
-
Ingår i: Health Promotion International. - : Oxford University Press. - 0957-4824 .- 1460-2245. ; 27:2, s. 167-176
-
Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to evaluate two implementation strategies for the introduction of a lifestyle intervention tool in primary health care (PHC), applying the RE-AIM framework to assess outcome. A computer-based tool for lifestyle intervention was introduced in PHC. A theory-based, explicit, implementation strategy was used at three centers, and an implicit strategy with a minimum of implementation efforts at three others. After 9 months a questionnaire was sent to staff members (n= 159) and data from a test database and county council registers were collected. The RE-AIM framework was applied to evaluate outcome in terms of reach, effectiveness, adoption and implementation. The response rate for the questionnaire was 73%. Significant differences in outcome were found between the strategies regarding reach, effectiveness and adoption, in favor of the explicit implementation strategy. Regarding the dimension implementation, no differences were found according to the implementation strategy. A theory-based implementation strategy including a testing period before using a new tool in daily practice seemed to be more successful than a strategy in which the tool was introduced and immediately used for patients.
|
|
| 5. |
- Carlfjord, Siw, et al.
(författare)
-
Association Between Frequency of Heavy Episodic Drinking and Self-reported Consequences: A Cross-sectional Study in a Swedish Population
- 2012
-
Ingår i: Alcohol and Alcoholism. - : Oxford University Press (OUP): Policy B. - 0735-0414 .- 1464-3502. ; 47:6, s. 719-724
-
Tidskriftsartikel (refereegranskat)abstract
- Aims: To describe perceived negative consequences (PNCs) of alcohol consumption related to the frequency of heavy episodic drinking (HED) in a Swedish population attending primary health care (PHC). Methods: Data from a computer-based assessment, including questions about alcohol consumption and PNC, were collected from 28 PHC centres in Sweden. The analysis included 4559 responders. Risk ratios concerning PNC for different frequencies of HED were calculated. Results: Engaging in HED once a month for women and two to three times a month for men significantly raised the proportion of individuals reporting PNC, compared with engaging in HED less than once a month. The men reported PNC of alcohol consumption to a higher degree than the women, and in general, the proportion of individuals reporting PNC was associated with the frequency of HED. Conclusion: Engaging in HED once a month for women and two to three times a month for men are critical levels regarding PNC of alcohol consumption. To identify a cut-off value for categorizing individuals as hazardous alcohol consumers due to the frequency of HED, further studies are needed.
|
|
| 6. |
- Carlfjord, Siw, et al.
(författare)
-
Association between organizational climate and perceptions and use of an innovation in Swedish primary health care: a prospective study of an implementation
- 2015
-
Ingår i: BMC Health Services Research. - : BIOMED CENTRAL LTD. - 1472-6963. ; 15:364
-
Tidskriftsartikel (refereegranskat)abstract
- Background: There is a need for new knowledge regarding determinants of a successful implementation of new methods in health care. The role of a receptive context for change to support effective diffusion has been underlined, and could be studied by assessing the organizational climate. The aim of this study was to assess the association between organizational climate when a computer-based lifestyle intervention tool (CLT) was introduced in primary health care (PHC) and the implementation outcome in terms of how the tool was perceived and used after 2 years. Methods: The CLT was offered to 32 PHC units in Sweden, of which 22 units agreed to participate in the study. Before the introduction of the CLT, the creative climate at each participating unit was assessed. After 24 months, a follow-up questionnaire was distributed to the staff to assess how the CLT was perceived and how it was used. A question on the perceived need for the CLT was also included. Results: The units were divided into three groups according to the creative climate: high, medium and low. The main finding was that the units identified as having a positive creative climate demonstrated more frequent use and more positive perceptions regarding the new tool than those with the least positive creative climate. More positive perceptions were seen at both individual and unit levels. Conclusions: According to the results from this study there is an association between organizational climate at baseline and implementation outcome after 2 years when a tool for lifestyle intervention is introduced in PHC in Sweden. Further studies are needed before measurement of organizational climate at baseline can be recommended in order to predict implementation outcome.
|
|
| 7. |
- Carlfjord, Siw, 1959-, et al.
(författare)
-
Asthma and COPD in primary health care, quality according to national guidelines : A cross-sectional and a retrospective study
- 2008
-
Ingår i: BMC Family Practice. - : Springer Science and Business Media LLC. - 1471-2296. ; 9
-
Tidskriftsartikel (refereegranskat)abstract
- Background. In recent decades international and national guidelines have been formulated to ensure that patients suffering from specific diseases receive evidence-based care. In 2004 the National Swedish Board of Health and Welfare (SoS) published guidelines concerning the management of patients with asthma and COPD. The guidelines identify quality indicators that should be fulfilled. The aim of this study was to survey structure and process indicators, according to the asthma and COPD guidelines, in primary health care, and to identify correlations between structure and process quality results. Methods. A cross-sectional study of existing structure by using a questionnaire, and a retrospective study of process quality based on a review of measures documented in asthma and COPD medical records. All 42 primary health care centres in the county council of Östergötland, Sweden, were included. Results. All centres showed high quality regarding structure, although there was a large difference in time reserved for Asthma and COPD Nurse Practice (ACNP). The difference in reserved time was reflected in process quality results. The time needed to reach the highest levels of spirometry and current smoking habit documentation was between 1 and 1 1/2 hours per week per 1000 patients registered at the centre. Less time resulted in fewer patients examined with spirometry, and fewer medical records with smoking habits documented. More time did not result in higher levels, but in more frequent contact with each patient. In the COPD group more time resulted in higher levels of pulse oximetry and weight registration. Conclusion. To provide asthma and COPD patients with high process quality in primary care according to national Swedish guidelines, at least one hour per week per 1000 patients registered at the primary health care centre should be reserved for ACNP. © 2008 Carlfjord and Lindberg, licensee BioMed Central Ltd.
|
|
| 8. |
- Carlfjord, Siw, et al.
(författare)
-
Computerized lifestyle intervention in routine primary health care : Evaluation of usage on provider and responder levels
- 2009
-
Ingår i: PATIENT EDUCATION AND COUNSELING. - : Elsevier BV. - 0738-3991. ; 75:2, s. 238-243
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim of this study was to evaluate the use of a computerized concept for lifestyle intervention in routine primary health care (PHC). Methods: Nine PHC units were equipped with computers providing a lifestyle test and tailored printed advice regarding alcohol consumption and physical activity. Patients were referred by staff, and performed the test anonymously. Data were collected over a period of I year. Results: During the study period 3065 tests were completed, representing 5.7% of the individuals visiting the PHC units during the period. there were great differences between the units in the number of tests performed and in the proportion of patients referred. One-fifth of the respondents scored for hazardous alcohol consumption, and one-fourth reported low levels of physical activity. The majority of respondents found the test easy to perform, and a majority of those referred to the test found referral positive. Conclusion: The computerized test can be used for screening and intervention regarding lifestyle behaviours in PHC. Responders are positive to the test and to referral. Practice implications: A more widespread implementation of computerized lifestyle tests could be a beneficial complement to face-to-face interventions in PHC.
|
|
| 9. |
- Carlfjord, Siw, et al.
(författare)
-
Experiences from ten years of incident reporting in health care: a qualitative study among department managers and coordinators
- 2018
-
Ingår i: BMC Health Services Research. - : BIOMED CENTRAL LTD. - 1472-6963. ; 18
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Incident reporting (IR) in health care has been advocated as a means to improve patient safety. The purpose of IR is to identify safety hazards and develop interventions to mitigate these hazards in order to reduce harm in health care. Using qualitative methods is a way to reveal how IR is used and perceived in health care practice. The aim of the present study was to explore the experiences of IR from two different perspectives, including heads of departments and IR coordinators, to better understand how they value the practice and their thoughts regarding future application. Methods: Data collection was performed in Ostergotland County, Sweden, where an electronic IR system was implemented in 2004, and the authorities explicitly have advocated IR from that date. A purposive sample of nine heads of departments from three hospitals were interviewed, and two focus group discussions with IR coordinators took place. Data were analysed using qualitative content analysis. Results: Two main themes emerged from the data: "Incident reporting has come to stay" building on the categories entitled perceived advantages, observed changes and value of the IR system, and "Remaining challenges in incident reporting" including the categories entitled need for action, encouraged learning, continuous culture improvement, IR system development and proper use of IR. Conclusions: After 10 years, the practice of IR is widely accepted in the selected setting. IR has helped to put patient safety on the agenda, and a cultural change towards no blame has been observed. The informants suggest an increased focus on action, and further development of the tools for reporting and handling incidents.
|
|
| 10. |
- Carlfjord, Siw, et al.
(författare)
-
Experiences of the implementation of a tool for lifestyle intervention in primary health care: a qualitative study among managers and professional groups
- 2011
-
Ingår i: BMC Health Services Research. - : BioMed Central. - 1472-6963. ; 11:195
-
Tidskriftsartikel (refereegranskat)abstract
- Background:In recent years there has been increasing interest in transferring new knowledge into health care practices, a process often referred to as implementation. The various subcultures that exist among health care workers may be an obstacle in this process. The aim of this study was to explore how professional groups and managers experienced the implementation of a new tool for lifestyle intervention in primary health care (PHC). The computer-based tool was introduced with the intention of facilitating the delivery of preventive services. Methods:Focus group interviews with staff and individual interviews with managers at six PHC units in the southeast of Sweden were performed 9 months after the introduction of the new working tool. Staff interviews were conducted in groups according to profession, and were analysed using manifest content analysis. Experiences and opinions from the different staff groups and from managers were analysed. Results: Implementation preconditions, opinions about the lifestyle test, and opinions about usage were the main areas identified. In each of the groups, managers and professionals, factors related to the existing subcultures seemed to influence their experiences of the implementation. Managers were visionary, GPs were reluctant, nurses were open, and nurse assistants were indifferent. Conclusion: This study indicates that the existing subcultures in PHC influence how the implementation of an innovation is perceived by managers and the different professionals. In PHC, an organization with several subcultures and an established hierarchical structure, an implementation strategy aimed at all groups did not seem to result in a successful uptake of the new method.
|
|
| 11. |
- Carlfjord, Siw, et al.
(författare)
-
Experiences of Working with the Tobacco Issue in the Context of Health Promoting Hospitals and Health Services: A Qualitative Study
- 2011
-
Ingår i: INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH. - : MDPI AG. - 1660-4601. ; 8:2, s. 498-513
-
Tidskriftsartikel (refereegranskat)abstract
- The worldwide Health Promoting Hospital and Health Services (HPH) network was initiated by the World Health Organizations in the late 1980s. The goal of the network is to change the focus of health services from curing patients to also embrace disease prevention and health promotion. In Sweden the network started in 1996, and involves mainly hospitals and primary care. The network members collaborate in task forces, one of which is working on the tobacco issue. There is limited evidence on the value of working within an HPH organization. The aim of this study was to investigate the experiences of members of the Swedish HPH network tobacco task force. Focus group interviews with task force members were analyzed using implementation theory. Three themes, overall experiences of working with tobacco issues, experiences of working with. free from tobacco in connection with surgery., and experiences of work in the HPH tobacco task force, emerged from the interviews. The results show that working with the tobacco issue in the context of health-promoting hospitals and health services met with difficulties involving the following important factors: evidence, context, facilitation and adopter characteristics. Leadership, one contextual factor, at national and local level, seems to be crucial if the work is going to succeed. The tobacco task force of the HPH network is an important facilitator supporting the task.
|
|
| 12. |
- Carlfjord, Siw, et al.
(författare)
-
Five years experience of an annual course on implementation science: an evaluation among course participants
- 2017
-
Ingår i: Implementation Science. - : BIOMED CENTRAL LTD. - 1748-5908. ; 12
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Increasing interest in implementation science has generated a demand for education and training opportunities for researchers and practitioners in the field. However, few implementation science courses have been described or evaluated in the scientific literature. The aim of the present study was to provide a short-and long-term evaluation of the implementation training at Linkoping University, Sweden. Methods: Two data collections were carried out. In connection with the final seminar, a course evaluation form, including six items on satisfaction and suggestions for improvement, was distributed to the course participants, a total of 101 students from 2011 to 2015 (data collection 1), response rate 72%. A questionnaire including six items was distributed by e-mail to the same students in autumn 2016 (data collection 2), response rate 63%. Data from the two data collections were presented descriptively and analysed using the Kirkpatrick model consisting of four levels: reaction, learning, behaviour and results. Results: The students were very positive immediately after course participation, rating high on overall perception of the course and the contents (reaction). The students also rated high on achievement of the course objectives and considered their knowledge in implementation science to be very good and to a high degree due to course participation (learning). Knowledge gained from the course was viewed to be useful (behaviour) and was applied to a considerable extent in research projects and work apart from research activities (results). Conclusions: The evaluation of the doctoral-level implementation science course provided by Linkoping University showed favourable results, both in the short and long term. The adapted version of the Kirkpatrick model was useful because it provided a structure for evaluation of the short-and long-term learning outcomes.
|
|
| 13. |
- Carlfjord, Siw, et al.
(författare)
-
Health care student teams participating in Quality Improvement - A large scale implementation in collaboration between University and County council
- 2013
-
Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- IntroductionIn Health care we always need to improve patient quality and safety. Therefore from an employer’s perspective, it is very important that future employees have knowledge about Quality Improvement (QI) work. Together the Faculty of Health Sciences of Linköping University and the County Council of Östergötland have designed a learning experience where undergraduate students participate and learn about QI work in clinical practice. MethodsOur two organizations started this project together in 2006 with an investigation. Then we begun the work with each semester as a testcycle which were evaluated. After decisions and planning we started in full scale in January 2011. Each semester, about 300 undergraduate students, in interprofessional teams, learn about Quality Improvement in 45 clinical settings, supervised by a tutor and a member of the clinical team. ResultsSince we started the outcome of the project is measured as improvement instudent, staff and patient value. The results have been used to continuously improve the project itself. The satisfaction in the different groups has improved over time. We will show data of this at the presentation. DiscussionThis is an example of large scale implementation in two different organizations. There are also a lot of interests involved, students, tutors, staff, patients and leaders in our two companies.In the workshop experiences from this large scale implementation performed in cooperation between the university and the health care providers will be described. One of the student projects will also be presented. After that we invite to a discussion with the audience regarding the project and to problematize around large scale implementation. Our suggested time table is 45 min for presentation and 45 minutes for questions and discussion.We also plan for more presentations of student projects in poster format to be shown in the lecture hall.
|
|
| 14. |
|
|
| 15. |
- Carlfjord, Siw, et al.
(författare)
-
Introduction of medication review and medication report in Swedish hospital and primary care, using a theory-based implementation strategy
- 2020
-
Ingår i: BMC Health Services Research. - : BMC. - 1472-6963. ; 20:1
-
Forskningsöversikt (refereegranskat)abstract
- BackgroundThe development of routines regarding medication is important to avoid medication-related harm. Medication review and medication reports have earlier been found to be effective, but their implementation is not always successful. The aim of this study was to evaluate the introduction of medication review/medication report in hospital and primary care, in terms of perceptions of the implementation strategy, adoption and sustainability, in one Swedish county.MethodsThe study included 105 clinics. Data was collected from interviews with managers immediately after implementation, survey data and registry data collected five years later. Quantitative data was analysed using non-parametric statistical tests. Open-ended questions were analysed with qualitative methods.ResultsThe implementation activities were found satisfying, and managers were satisfied with their own influence over the process. After five years medication review and medication reports were reported mainly implemented by the managers. Facilitating factors reported were routines, staff influence, dedication, reminders, and a stable workforce, while hindering factors reported were organizational factors, less commitment and flaws in reporting. Registry data showed that performance of medication review was very limited in primary care. In hospital care medication review was registered in about one fifth of the patients, while medication reports, only relevant for hospital care, was registered in half of the patients.ConclusionsThe managers perceptions of the implementation process were mainly positive, and they found the new practices of medication review/medication report implemented. Implementation success, however, was not supported by registry data, showing the need for reliable outcome measures for implementation.
|
|
| 16. |
- Carlfjord, Siw, et al.
(författare)
-
Key factors influencing adoption of an innovation in primary health care: a qualitative study based on implementation theory
- 2010
-
Ingår i: BMC Family Practice. - : Springer Science and Business Media LLC. - 1471-2296. ; 11:60
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Bridging the knowledge-to-practice gap in health care is an important issue that has gained interest in recent years. Implementing new methods, guidelines or tools into routine care, however, is a slow and unpredictable process, and the factors that play a role in the change process are not yet fully understood. There is a number of theories concerned with factors predicting successful implementation in various settings, however, this issue is insufficiently studied in primary health care (PHC). The objective of this article was to apply implementation theory to identify key factors influencing the adoption of an innovation being introduced in PHC in Sweden.METHODS: A qualitative study was carried out with staff at six PHC units in Sweden where a computer-based test for lifestyle intervention had been implemented. Two different implementation strategies, implicit or explicit, were used. Sixteen focus group interviews and two individual interviews were performed. In the analysis a theoretical framework based on studies of implementation in health service organizations, was applied to identify key factors influencing adoption.RESULTS: The theoretical framework proved to be relevant for studies in PHC. Adoption was positively influenced by positive expectations at the unit, perceptions of the innovation being compatible with existing routines and perceived advantages. An explicit implementation strategy and positive opinions on change and innovation were also associated with adoption. Organizational changes and staff shortages coinciding with implementation seemed to be obstacles for the adoption process.CONCLUSION: When implementation theory obtained from studies in other areas was applied in PHC it proved to be relevant for this particular setting. Based on our results, factors to be taken into account in the planning of the implementation of a new tool in PHC should include assessment of staff expectations, assessment of the perceived need for the innovation to be implemented, and of its potential compatibility with existing routines. Regarding context, we suggest that implementation concurrent with other major organizational changes should be avoided. The choice of implementation strategy should be given thorough consideration.
|
|
| 17. |
|
|
| 18. |
- Carlfjord, Siw
(författare)
-
Modeller och ramverk
- 2014
-
Ingår i: Implementering av evidensbaserad praktik. - Malmö : Gleerups Utbildning AB. - 9789140684479 ; , s. 115-133
-
Bokkapitel (övrigt vetenskapligt/konstnärligt)
|
|
| 19. |
- Carlfjord, Siw, 1959-, et al.
(författare)
-
Practitioner experiences from the structured implementation of evidence-based practice in primary care physiotherapy : A qualitative study
- 2019
-
Ingår i: Journal of Evaluation In Clinical Practice. - : Wiley-Blackwell Publishing Ltd.. - 1356-1294 .- 1365-2753. ; 25:4, s. 622-629
-
Tidskriftsartikel (refereegranskat)abstract
- RATIONALE, AIMS, AND OBJECTIVES: To provide best available care, the practitioners in primary health care (PHC) must have adequate knowledge about effective interventions. The implementation of such interventions is challenging. A structured implementation strategy developed by researchers at Linköping University, Sweden, was used for the implementation of an evidence-based assessment and treatment programme for patients with subacromial pain among physiotherapists in PHC. To further develop strategies for implementation of evidence-based practices, it was deemed important to study the implementation from the practitioners' perspective. The aim of this study was to explore the practitioners' experiences from the implementation.METHODS: A qualitative design with focus group discussions was applied. The implementation in terms of perceptions of process and outcome was evaluated by focus group discussions with, in total, 16 physiotherapists in the target group. Data were analysed using the method qualitative content analysis.RESULTS: The components of the strategy were viewed positively, and the applicability and evidence base behind the programme were appreciated. The programme was perceived to be adopted, and the practitioners described a changed behaviour and increased confidence in handling patients with subacromial pain. Both patient- and provider-related challenges to the implementation were mentioned.CONCLUSIONS: The practitioners' experiences from the implementation were mainly positive. A strategy with collaboration between academy and practice, and with education and implementation teams as facilitators, resulted in changes in practice. Critical voices concerned interprofessional collaboration and that the programme was focused explicitly on the shoulder, not including other components of physical function.
|
|
| 20. |
- Carlfjord, Siw, et al.
(författare)
-
Primary health care staffs opinions about changing routines in practice: a cross-sectional study
- 2014
-
Ingår i: BMC Family Practice. - : BioMed Central. - 1471-2296. ; 15:2
-
Tidskriftsartikel (refereegranskat)abstract
- Background: In health care organizations, there is a mutual interest from politicians, managers, practitioners and patients that the best available care is provided. Efforts are made to translate new knowledge and evidence-based practices into routine care, but there are a number of obstacles to this translation process. Factors related to the new practice as well as factors related to the implementation process are important, but there is still a knowledge gap regarding how to achieve effective implementation. The aim of the present study was to assess opinions about practice change among staff in primary health care (PHC), focusing on factors related to a new practice and factors related to the implementation process. Methods: A questionnaire was sent to 470 staff members at 22 PHC centres where a new tool for lifestyle intervention had recently been implemented. Thirteen items regarding the characteristics of the new practice and nine items regarding the implementation process were to be judged from not at all important to very important. A factor analysis was performed, and statistical analysis was done using the Kruskal-Wallis nonparametric test. Results: Four factors regarding the characteristics of the new practice were identified. Most important was Objective characteristics, followed by Evidence base, Subjectively judged characteristics and Organizational level characteristics. Two factors were identified regarding the implementation process: Bottom-up strategies were judged most important and Top-down strategies less important. The most important single items regarding characteristics were "easy to use" and "respects patient privacy", and the most important implementation process item was "information about the new practice". Nurses differed most from the other professionals, and judged the factors Evidence base and Organizational level characteristics more important than the others. Staff with more than 10 years experience in their profession judged the Evidence base factor more important than those who were less experienced. Conclusions: To incorporate new practices in PHC, objective characteristics of the new practice and the evidence base should be considered. Use of bottom-up strategies for the implementation process is important. Different opinions according to profession, gender and years in practice should be taken into account when planning the implementation.
|
|
| 21. |
- Carlfjord, Siw, et al.
(författare)
-
Staff perceptions of addressing lifestyle in primary health care : a qualitative evaluation 2 years after the introduction of a lifestyle intervention tool
- 2012
-
Ingår i: BMC Family Practice. - : BioMed Central. - 1471-2296. ; 13:99
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Preventive services and health promotion in terms of lifestyle counselling provided through primary health care (PHC) has the potential to reduce morbidity and mortality in the population. Health professionals in general are positive about and willing to develop a health-promoting and/or preventive role. A number of obstacles hindering PHC staff from addressing lifestyle issues have been identified, and one facilitator is the use of modern technology. When a computer-based tool for lifestyle intervention (CLT) was introduced at a number of PHC units in Sweden, this provided an opportunity to study staff perspectives on the subject. The aim of this study was to explore PHC staffs perceptions of handling lifestyle issues, including the consultation situation as well as the perceived usefulness of the CLT. less thanbrgreater than less thanbrgreater thanMethods: A qualitative study was conducted after the CLT had been in operation for 2 years. Six focus group interviews, one at each participating unit, including a total of 30 staff members with different professions participated. The interviews were designed to capture perceptions of addressing lifestyle issues, and of using the CLT. Interview data were analysed using manifest content analysis. less thanbrgreater than less thanbrgreater thanResults: Two main themes emerged from the interviews: a challenging task and confidence in handling lifestyle issues. The first theme covered the categories responsibilities and emotions, and the second theme covered the categories first contact, existing tools, and role of the CLT. Staff at the units showed commitment to health promotion/prevention, and saw that patients, caregivers, managers and politicians all have responsibilities regarding the issue. They expressed confidence in handling lifestyle-related conditions, but to a lesser extent had routines for general screening of lifestyle habits, and found addressing alcohol the most problematic issue. The CLT, intended to facilitate screening, was viewed as a complement, but was not considered an important tool for health promotion/prevention. less thanbrgreater than less thanbrgreater thanConclusion: Additional resources, for example in terms of manpower, may help to build the structures necessary for the health promotion/prevention task. Committed leaders could enhance the engagement among staff. Cooperation in multi-professional teams seems to be important, and methods or tools perceived by staff as compatible have a potential to be successfully implemented. Economic incentives rewarding quantity rather than quality appear to be frustrating to PHC staff.
|
|
| 22. |
- Carlfjord, Siw, et al.
(författare)
-
Staff perspectives on the use of a computer-based concept for lifestyle intervention implemented in primary health care
- 2010
-
Ingår i: HEALTH EDUCATION JOURNAL. - : Health Education Authority. - 0017-8969 .- 1748-8176. ; 69:3, s. 246-256
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim of this study was to evaluate staff experiences of the use of a computer-based concept for lifestyle testing and tailored advice implemented in routine primary health care (PHC). Design: The design of the study was a cross-sectional, retrospective survey. Setting: The study population consisted of staff at nine PHC units in the county of Ostergotland, Sweden. Method: After a computer-based concept for lifestyle intervention had been in operation for 1 year, a questionnaire was distributed to all staff members. The questions concerned experiences of and attitudes to the concept, and comments on addressing lifestyle issues in PHC. Results: Of the 291 potential respondents, 59 per cent returned the questionnaire. Eighty-five per cent found it positive to refer to the computer-based test, and 93 per cent of those who had read the written advice generated by the computer agreed with the advice provided. Seventy-five per cent thought that the concept could have an effect on a patients lifestyle, and 78 per cent had confidence in the computer-based test. Staff at smaller PHC units had more positive attitudes (p = 0.003) and referred a higher proportion of their patients to the computer-based test than staff at larger units (p = 0.000). Follow-up rates showed no significant differences between the categories. Staff believed that inclusion of more lifestyle areas, e. g. smoking and dietary habits, would make the test more useful. More time, education and the establishment of lifestyle practices were issues suggested in order to enhance the focus on lifestyle factors. Conclusion: Staff members have confidence in the computerized test and consider it a valuable tool. A development towards more lifestyle areas will make it even more useful.
|
|
| 23. |
- Carlfjord, Siw, et al.
(författare)
-
Sustained use of a tool for lifestyle intervention implemented in primary health care : a 2-year follow-up
- 2013
-
Ingår i: Journal of Evaluation In Clinical Practice. - : Wiley-Blackwell. - 1356-1294 .- 1365-2753. ; 19:2, s. 327-334
-
Tidskriftsartikel (refereegranskat)abstract
- Rational, aims and objectives: Sustainability of new methods implemented in health care is one of the most central issues in addressing the gap between research and practice, but is seldom assessed in implementation studies. The aim of this study was to evaluate the implementation of a new tool for lifestyle intervention in primary health care (PHC) 2 years after the introduction, and assess if the implementation strategy used influenced sustainability.Method: A computer-based lifestyle intervention tool (CLT) was introduced at six PHC units in Sweden in 2008, using two implementation strategies: explicit and implicit. The main difference between the strategies was a 4-week test period followed by a decision session, included in the explicit strategy. Evaluations were performed after 6, 9 and 24 months. After 24 months, the RE-AIM framework was applied to assess and compare outcome according to strategy.Results: A more positive outcome regarding Reach, Effectiveness, Adoption and Implementation in the explicit group could be almost completely attributed to one of the units. Maintenance was low and after 24 months, differences according to strategy were negligible.Conclusion: After 24 months the most positive outcomes regarding all RE-AIM dimensions were found in one of the units where the explicit strategy was used. The explicit strategy per se had some effect on the dimension Effectiveness, but was not associated with sustainability overall. Staff at the most successful unit earlier had positive expectations regarding the CLT and found it compatible with existing routines.
|
|
| 24. |
- Carlfjord, Siw, 1959-
(författare)
-
The Challenge of Changing Practice : Applying Theory in the Implementation of an Innovation in Swedish Primary Health Care
- 2012
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: The translation of new knowledge, such as research findings, new tools or methods into health care practice has gained increased interest in recent years. Important factors that determine implementation outcome have been identified, and models and checklists to be followed in planning as well as in carrying out an implementation process have been produced. However, there are still knowledge gaps regarding what approach should be used in which setting and for which problems. Primary health care (PHC) in Sweden is an area where there is a paucity of research regarding implementation of new methods into practice. The aim of the thesis was to apply theory in the study of the implementation of an innovation in Swedish PHC, and identify factors that influenced outcome.Methods: The study was performed using a quasi-experimental design, and included six PHC units, two from each one of three county councils in the southeast part of Sweden. A computer-based lifestyle intervention tool (CLT) developed to facilitate addressing lifestyle issues, was introduced at the units. Two different strategies were used for the introduction, both aiming to facilitate the process: a theory-based explicit strategy and an implicit strategy requiring a minimum of effort. Data collection was performed at baseline, and after six, nine and 24 months. Questionnaires were distributed to staff and managers, and data was also collected from the CLT database and county council registers. Implementation outcome was defined as the proportion of eligible patients being referred to the CLT, and was also measured in terms of Reach, Effectiveness, Adoption, Implementation and Maintenance according to the RE-AIM framework. Interviews were performed in order to explore experiences of the implementation process as perceived by staff and managers.Results: A positive organizational climate seemed to promote implementation. Organizational changes or staff shortages coinciding with the implementation process had a negative influence on outcome. The explicit implementation strategy seemed to be more effective than the implicit strategy in the short term, but the differences levelled out over time. The adopters’ perceptions of the implementation seemed to be influenced by the existing professional sub-cultures. Successful implementation was associated with positive expectations, perceptions of the innovation being compatible with existing routines and perceptions of relative advantage.Conclusions: The general conclusion is that when theory was applied in the implementation of a lifestyle intervention tool in Swedish PHC, factors related to the adopters and to the innovation seemed to be more important over time than the strategy used. Staff expectations, perceptions of the innovation’s relative advantage and potential compatibility with existing routines were found to be positively associated with implementation outcome, and other major organizational changes concurrent with implementation seemed to affect the outcome in a negative way. Values, beliefs and behaviour associated with the existing sub-cultures in PHC appeared to influence how the implementation of an innovation was perceived by managers and the different professionals.
|
|
| 25. |
- Carlfjord, Siw, et al.
(författare)
-
The importance of organizational climate and implementation strategy at the introduction of a new working tool in primary health care
- 2010
-
Ingår i: Journal of Evaluation in Clinical Practice. - : Blackwell Publishing Ltd. - 1356-1294. ; 16:6, s. 1326-1332
-
Tidskriftsartikel (refereegranskat)abstract
- Rationale, aims and objectives The transmission of research findings into routine care is a slow and unpredictable process. Important factors predicting receptivity for innovations within organizations have been identified, but there is a need for further research in this area. The aim of this study was to describe contextual factors and evaluate if organizational climate and implementation strategy influenced outcome, when a computer-based concept for lifestyle intervention was introduced in primary health care (PHC). Method The study was conducted using a prospective intervention design. The computer-based concept was implemented at six PHC units. Contextual factors in terms of size, leadership, organizational climate and political environment at the units included in the study were assessed before implementation. Organizational climate was measured using the Creative Climate Questionnaire (CCQ). Two different implementation strategies were used: one explicit strategy, based on Rogers theories about the innovation-decision process, and one implicit strategy. After 6 months, implementation outcome in terms of the proportion of patients who had been referred to the test, was measured. Results The CCQ questionnaire response rates among staff ranged from 67% to 91% at the six units. Organizational climate differed substantially between the units. Managers scored higher on CCQ than staff at the same unit. A combination of high CCQ scores and explicit implementation strategy was associated with a positive implementation outcome. Conclusions Organizational climate varies substantially between different PHC units. High CCQ scores in combination with an explicit implementation strategy predict a positive implementation outcome when a new working tool is introduced in PHC.
|
|
| 26. |
- Danielsson, Marita, 1972-
(författare)
-
Patient Safety - Cultural Perspectives
- 2018
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Shared values, norms and beliefs of relevance for safety in health care can be described in terms of patient safety culture. This concept overlaps with patient safety climate, but culture represents the deeprooted values, norms and beliefs, whereas climate refers to attitudes and more superficial manifestations of culture. There may be numerous subcultures within an organization, including different professional cultures. In recent years, increased attention has been paid to patient safety culture in Sweden, and the patient safety culture/climate in health care is regularly measured based on the assumption that patient safety culture/climate can influence various patient safety outcomes. Aim: The overall aim of the thesis is to contribute to an improved understanding of patient safety culture and subcultures in Swedish health care. Design and methods: The thesis is based on four studies applying different methods. Study 1 was a survey that included 23,781 respondents. Data were analysed with quantitative methods, with primarily descriptive results. Studies 2 and 3 were qualitative studies, involving interviews with a total of 28 registered nurses, 24 nurse assistants and 28 physicians. Interview data were analysed using content analysis. Study 4 evaluated an intervention intended to influence patient safety culture and included data from a questionnaire with both fixed and open-ended questions, which was answered by 200 respondents. Results: A key result from Study 1 was that professional groups differed in terms of their views and statements about patient safety culture/ climate. Registered nurses and nurse assistants in Study 2 were found to have partially overlapping norms, values and beliefs concerning patient safety, which were identified at individual, interpersonal and organizational level. Study 3 found four categories of values and norms among physicians of potential relevance for patient safety. Predominantly positive perceptions were found in Study 4 concerning the Walk Rounds intervention among frontline staff members, local managers and top-level managers who participated in the intervention. However, there were also reflections on disadvantages and some suggestions for improvement. Conclusions: According to the results of the patient safety culture/ climate questionnaire, perceptions about safety culture/climate dimensions contribute more to the rating of overall patient safety than background characteristics (e.g. profession and years of experience). There are differences in the patient safety culture between registered nurses and nurse assistants, which imply that efforts for improved patient safety must be tailored to their respective values, norms and beliefs. Several aspects of physicians’ professional culture may have relevance for patient safety. Expectations of being infallible reduce their willingness to talk about errors they make, thus limiting opportunities for learning from errors. Walk Rounds are perceived to contribute to increased learning concerning patient safety and could potentially have a positive influence on patient safety culture.
|
|
| 27. |
- Danielsson, Marita, et al.
(författare)
-
Patient safety subcultures among registered nurses and nurse assistants in Swedish hospital care : a qualitative study.
- 2014
-
Ingår i: BMC Nursing. - : Springer Science and Business Media LLC. - 1472-6955. ; 13:1, s. 39-
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Patient safety culture emerges from the shared assumptions, values and norms of members of a health care organization, unit, team or other group with regard to practices that directly or indirectly influence patient safety. It has been argued that organizational culture is an amalgamation of many cultures, and that subcultures should be studied to develop a deeper understanding of an organization's culture. The aim of this study was to explore subcultures among registered nurses and nurse assistants in Sweden in terms of their assumptions, values and norms with regard to practices associated with patient safety.METHODS: The study employed an exploratory design using a qualitative method, and was conducted at two hospitals in southeast Sweden. Seven focus group interviews and two individual interviews were conducted with registered nurses and seven focus group interviews and one individual interview were conducted with nurse assistants. Manifest content analysis was used for the analysis.RESULTS: Seven patient safety culture domains (i.e. categories of assumptions, values and norms) that included practices associated with patient safety were found: responsibility, competence, cooperation, communication, work environment, management and routines. The domains corresponded with three system levels: individual, interpersonal and organizational levels. The seven domains consisted of 16 subcategories that expressed different aspects of the registered nurses and assistants nurses' patient safety culture. Half of these subcategories were shared.CONCLUSIONS: Registered nurses and nurse assistants in Sweden differ considerably with regard to patient safety subcultures. The results imply that, in order to improve patient safety culture, efforts must be tailored to both registered nurses' and nurse assistants' patient safety-related assumptions, values and norms. Such efforts must also take into account different system levels. The results of the present study could be useful to facilitate discussions about patient safety within and between different professional groups.
|
|
| 28. |
- Danielsson, Marita, et al.
(författare)
-
Patient safety walk rounds: views of frontline staff members and managers in Sweden
- 2015
-
Ingår i: International Journal of Nursing. - : American research institute for policy development. - 2373-7662 .- 2373-7670. ; 2:2, s. 81-93
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Leadership Walk Rounds (WRs) have been described as a promising intervention to achieve a culture of safety by means of engaging leaders at different levels in patient safety issues. The aim was to investigate WRs carried out in a Swedish county council in terms of advantages, disadvantages and opportunities for improvement, as perceived by the participating frontline staff members, local unit managers and top-level managers.Methods: A cross-sectional study of 19 WRs. Responses from questionnaireswere analysed using qualitative and quantitative methods. Content analysis was used to categorize the findings from open-ended questions regarding advantages, disadvantages and suggestions for improvement.Results: The response rate was 95%. The participants in the WRs were generally very positive about the intervention. They believed that the intervention had several advantages and that WRs could have an impact on patient safety. Few differences between the three personnel categories were found.Conclusions: A WR developed on the basis of descriptions in the literature was perceived to have many advantages according to frontline staff members, local managers and top-level managers who participated in the intervention. WRs are perceived to contribute to increased learning concerning patient safety and to influence the patient safety culture. The overall positive findings are broadly consistent with the predominantly optimistic reports of WRs in the patient safety literature. However, further research is needed to investigate how the potential of the WR can be realized, including evaluationsof the effectiveness of the intervention in terms of various patient safety outcomes.
|
|
| 29. |
- Danielsson, Marita, 1972-, et al.
(författare)
-
The professional culture among physicians in Sweden : potential implications for patient safety
- 2018
-
Ingår i: BMC Health Services Research. - : BioMed Central. - 1472-6963. ; 18:1
-
Tidskriftsartikel (refereegranskat)abstract
- BackgroundPatient safety culture, i.e. a subset of an organization’s culture, has become an important focus of patient safety research. An organization’s culture consists of many cultures, underscoring the importance of studying subcultures. Professional subcultures in health care are potentially important from a patient safety point of view. Physicians have an important role to play in the effort to improve patient safety. The aim was to explore physicians’ shared values and norms of potential relevance for patient safety in Swedish health care.MethodsData were collected through group and individual interviews with 28 physicians in 16 semi-structured interviews, which were recorded and transcribed verbatim before being analysed with an inductive approach.ResultsTwo overarching themes, “the competent physician” and “the integrated yet independent physician”, emerged from the interview data. The former theme consists of the categories Infallible and Responsible, while the latter theme consists of the categories Autonomous and Team player. The two themes and four categories express physicians’ values and norms that create expectations for the physicians’ behaviours that might have relevance for patient safety.ConclusionsPhysicians represent a distinct professional subculture in Swedish health care. Several aspects of physicians’ professional culture may have relevance for patient safety. Expectations of being infallible reduce their willingness to talk about errors they make, thus limiting opportunities for learning from errors. The autonomy of physicians is associated with expectations to act independently, and they use their decisional latitude to determine the extent to which they engage in patient safety. The physicians perceived that organizational barriers make it difficult to live up to expectations to assume responsibility for patient safety. Similarly, expectations to be part of multi-professional teams were deemed difficult to fulfil. It is important to recognize the implications of a multi-faceted perspective on the culture of health care organizations, including physicians’ professional culture, in efforts to improve patient safety.
|
|
| 30. |
- Eckhardt, Martin, 1974-, et al.
(författare)
-
Universal Health Coverage in Marginalized Populations : A Qualitative Evaluation of a Health Reform Implementation in Rural Ecuador
- 2019
-
Ingår i: Inquiry. - : Sage Publications. - 0046-9580 .- 1945-7243. ; 56
-
Tidskriftsartikel (refereegranskat)abstract
- In 2008, Ecuador underwent a major health reform with the aim of universal coverage. Little is known about the implementation of the reform and its perceived effects in rural parts of the country. The aim of this study was to explore the perceived effects of the 2008 health reform implementation, on rural primary health care services and financial access of the rural poor. A qualitative study using focus group discussions was conducted in a rural region in Ecuador, involving health staff, local health committee members, village leaders, and community health workers. Qualitative content analysis focusing on the manifest content was applied. Three categories emerged from the texts: (1) the prereform situation, which was described as difficult in terms of financial access and quality of care; (2) the reform process, which was perceived as top-down and lacking in communication by the involved actors; lack of interest among the population was reported; (3) the effects of the reform, which were mainly perceived as positive. However, testimonies about understaffing, drug shortages, and access problems for those living furthest away from the health units show that the reform has not fully achieved its intended effects. New problems are a challenging health information system and people without genuine care needs overusing the health services. The results indicate that the Ecuadorean reform has improved rural primary health care services. Still, the reform faces challenges that need continued attention to secure its current achievements and advance the health system further.
|
|
| 31. |
- Fritz, Johanna, 1974-
(författare)
-
Implementation of a behavioural medicine approach in physiotherapy : Determinants, clinical behaviours, patient outcomes and the implementation process
- 2020
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Current research shows that a behavioural medicine approach in physiotherapy increases the ability to participate in daily activities and decreases sick leave in patients with persistent musculoskeletal pain. A behavioural medicine approach means that the physiotherapist systematically considers biopsychosocial factors of importance for the patient's activity and participation. Active patient involvement is central, and behaviour change techniques are used. One in seven of the patients in primary health care suffers from persistent musculoskeletal pain. Therefore, primary health care needs to implement a behavioural medicine approach in physiotherapy. However, the implementation of new methods is challenging. It is important to increase the knowledge about how to implement a behavioural medicine approach into physiotherapy clinical practice to make recommended treatment available to more patients with persistent musculoskeletal pain. The overall aim of this thesis was therefore to develop and evaluate methods for supporting the implementation of a behavioural medicine approach in physiotherapy for patients with persistent musculoskeletal pain.In study I, determinants of using a behavioural medicine approach in physiotherapy were identified using a qualitative multiple-case study design. An implementation intervention was developed based on these determinants and on theoretical assumptions regarding behaviour change and learning. The implementation intervention was tested in a quasi-experimental trial for six months and evaluated by focusing on physiotherapists' clinical behaviour changes in study II and the effects on patients' health in study III. In study IV, a process evaluation was conducted with a mixed methods design to explain the impact mechanisms of the implementation intervention. Altogether, 28 physiotherapists, 159 patients and three managers participated in the project.The determinants identified in study I were associated with the physiotherapist, the patient and the workplace. An implementation intervention was developed based on these determinants and on assumptions in the social cognitive theory, the constructivist learning theory, and the Promoting Action on Research Implementation in Health Services (PARIHS) framework. The implementation intervention consisted of outreach visits, peer coaching, educational materials, individual goalsetting, video feedback, self-monitoring in a diary, the stimulation of manager support and an information leaflet for patients. Immediately after the implementation period, the physiotherapists significantly changed their clinical behaviour, but these changes were not sustained. The patients treated by these physiotherapists achieved no further health improvement compared to a control group. Outreach visits, peer coaching, educational material and individual goalsetting were perceived by the physiotherapists as the most useful methods and supported the implementation through multiple learning methods, action planning, processing experiences, synergy effects with self-efficacy beliefs, and extrinsic motivation.In conclusion, this thesis contributes to an increased understanding of the complexity regarding what affects the implementation of a behavioural medicine approach in physiotherapy and the promising methods and their impact mechanisms that support this implementation. A distinction between achieving clinical behaviour changes and sustaining these changes is highlighted. This implies that an implementation intervention needs to support both factors in order for the implementation of a behavioural medicine approach to benefit the patients. The thesis also illustrates how combined theoretical perspectives can inform an implementation intervention in physiotherapy in a useful way.
|
|
| 32. |
- Leijon, Matti, et al.
(författare)
-
Improvement of physical activity by a kiosk-based electronic screening and brief intervention in routine primary health care : Patient-initiated versus staff-referred
- 2011
-
Ingår i: Journal of Medical Internet Research. - : JMIR Publications Inc.. - 1438-8871. ; 13:4, s. e99-
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Interactive behavior change technology (eg, computer programs, Internet websites, and mobile phones) may facilitate the implementation of lifestyle behavior interventions in routine primary health care. Effective, fully automated solutions not involving primary health care staff may offer low-cost support for behavior change. Objectives: We explored the effectiveness of an electronic screening and brief intervention (e-SBI) deployed through a stand-alone information kiosk for promoting physical activity among sedentary patients in routine primary health care. We further tested whether its effectiveness differed between patients performing the e-SBI on their own initiative and those referred to it by primary health care staff. Methods: The e-SBI screens for the physical activity level, motivation to change, attitudes toward performing the test, and physical characteristics and provides tailored feedback supporting behavior change. A total of 7863 patients performed the e-SBI from 2007 through 2009 in routine primary health care in Östergötland County, Sweden. Of these, 2509 were considered not sufficiently physically active, and 311 of these 2509 patients agreed to participate in an optional 3-month follow-up. These 311 patients were included in the analysis and were further divided into two groups based on whether the e-SBI was performed on the patient's own initiative (informed by posters in the waiting room) or if the patient was referred to it by staff. A physical activity score representing the number of days being physically active was compared between baseline e-SBI and the 3-month follow-up. Based on physical activity recommendations, a score of 5 was considered the cutoff for being sufficiently physically active. Results: In all, 137 of 311 patients (44%) were sufficiently physically active at the 3-month follow-up. The proportion becoming sufficiently physically active was 16/55 (29%), 40/101 (40%), and 81/155 (52%) for patients with a physical activity score at baseline of 0, 1 to 2, and 3 to 4, respectively. The patient-initiated group and staff-referred group had similar mean physical activity scores at baseline (2.1, 95% confidence interval [CI] 1.8-2.3, versus 2.3, 95% CI 2.1-2.5) and at follow-up, (4.1, 95% CI 3.4-4.7, vs 4.2, 95% CI 3.7-4.8). Conclusions: Among the sedentary patients in primary health care who participated in the follow-up, the e-SBI appeared effective at promoting short-term improvement of physical activity for about half of them. The results were similar when the e-SBI was patient-initiated or staff-referred. The e-SBI may be a low-cost complement to lifestyle behavior interventions in routine primary health care and could work as a stand-alone technique not requiring the involvment of primary health care staff. © Matti Leijon, Daniel Arvidsson, Per Nilsen, Diana Stark Ekman, Siw Carlfjord, Agneta Andersson, Anne Lie Johansson, Preben Bendtsen.
|
|
| 33. |
- Lindblom, Hanna, 1984-, et al.
(författare)
-
Adoption and use of an injury prevention exercise program in female football: A qualitative study among coaches
- 2018
-
Ingår i: Scandinavian Journal of Medicine and Science in Sports. - : Wiley-VCH Verlagsgesellschaft. - 0905-7188 .- 1600-0838. ; 28:3, s. 1295-1303
-
Tidskriftsartikel (refereegranskat)abstract
- This study focuses on an injury prevention exercise program (IPEP), Knee Control, which has been shown to reduce the incidence of acute knee injury in female adolescent football players. The aim was to explore the factors influencing coaches adoption and use of Knee Control within female football in Sweden. This was a qualitative study involving interviews with 20 strategically selected coaches for female football teams, predominantly adolescent teams. The semi-structured interview guide was influenced by the Health Belief Model, and an ecological perspective was adopted during the interviews. Interviews were analyzed with qualitative content analysis. The results illustrate the different influences that interact on adoption and use of Knee Control by coaches. The coaches described themselves as crucial for Knee Control adoption and use, but external facilitators and barriers such as resources for training, social support from other coaches, clubs and football associations and player buy-in were also described as important. Knee Control characteristics, such as how well the program fit the team, also influenced use of Knee Control. Many coaches modified the program to improve player buy-in and Knee Control fit. Such modifications may risk compromising the preventive effect but may increase feasibility, that is the ease of using Knee Control, and thereby long-term use. These findings may guide the design and delivery of future IPEPs, and improve use of Knee Control, for example, by expanding the program to fit different target groups and supporting coaches and players in the use of Knee Control.
|
|
| 34. |
- Lindblom, Hanna, et al.
(författare)
-
Implementation of a neuromuscular training programme in female adolescent football : 3-year follow-up study after a randomised controlled trial
- 2014
-
Ingår i: British Journal of Sports Medicine. - : B M J Group. - 0306-3674 .- 1473-0480. ; 48:19, s. 1425-1430
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Neuromuscular training (NMT) has been shown to reduce anterior cruciate ligament injury rates in highly structured clinical trials. However, there is a paucity of studies that evaluate implementation of NMT programmes in sports.AIM: To evaluate the implementation of an NMT programme in female adolescent football 3 years after a randomised controlled trial (RCT).METHODS: Cross-sectional follow-up after an RCT using the Reach, Effectiveness, Adoption, Implementation, and Maintenance Sports Setting Matrix (RE-AIM SSM) framework. Questionnaires were sent to the Swedish Football Association (FA), to eight district FAs and coaches (n=303) that participated in the RCT in 2009, and coaches who did not participate in the RCT but were coaching female adolescent football teams during the 2012 season (n=496).RESULTS: Response rates were 100% among the FAs, 57% among trial coaches and 36% among currently active coaches. The reach of the intervention was high, 99% of trial coaches (control group) and 91% of current coaches were familiar with the programme. The adoption rate was 74% among current coaches, but programme modifications were common among coaches. No district FA had formal policies regarding implementation, and 87% of current coaches reported no club routines for programme use. Maintenance was fairly high; 82% of trial coaches from the intervention group and 68% from the control group still used the programme.CONCLUSIONS: Reach and adoption of the programme was high among coaches. However, this study identified low programme fidelity and lack of formal policies for its implementation and use in clubs and district FAs.
|
|
| 35. |
- Lindblom, Hanna, 1984-
(författare)
-
Injury Prevention in Youth Football Players : Training Effects and Programme Implementation
- 2019
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background With 17–35% of all 14-year-olds in Sweden being active in football, injuries do occur, most frequently during match play. Based on knowledge of injury mechanisms and risk factors, different injury prevention exercise programmes (IPEPs) have been developed. In this thesis, the Swedish IPEP Knee Control was used as a model for injury preventive training.Aim The overall aim of this thesis was to improve our understanding of the effects of the Knee Control injury prevention exercise programme on sports performance and jump-landing technique, as well as exploring programme implementation and coach experiences of using the programme in youth football.Methods Studies I and IV were cluster-randomised trials focusing on the performance effects of Knee Control. Study I included four teams with 41 female youth football players (mean age 14). The intervention group used Knee Control twice weekly for 11 weeks, whereas the control group teams did their usual training. Knee Control includes six different exercises at four levels of difficulty and with partner exercises and is meant to be used during warm-up at every training session. Performance was tested using a battery of balance, agility, jump and sprint tests at baseline and follow-up at an indoor venue. Study IV had a similar set-up but included two different interventions: Knee Control and a new, further-developed version of the programme, Knee Control+, which were studied during an eight-week intervention involving eight youth football teams, four male, four female (mean age 14), with 77 players. Similar, but not identical, performance tests were used in Study IV, along with drop vertical jumps and tuck jump assessment to assess jump-landing technique.Studies II and III focused on the implementation context. Study II was questionnaire based, using the RE-AIM framework covering the reach, effectiveness, adoption, implementation and maintenance of Knee Control. Coaches for female youth teams (n=352), one representative of the national football association and representatives of eight district football associations responded to web-based questionnaires. Data collection was performed two years after the nation-wide implementation of Knee Control started. Study III was a qualitative study that followed up on the results of Study II. Interviews were conducted with 20 coaches for female football teams and analysed using qualitative content analysis. The interviews focused on factors that affected the adoption and use of Knee Control. All 20 coaches had experience of Knee Control.Results Limited positive effects were seen on jump-landing technique in girls, with the total tuck jump assessment score improving, as well as two separate criteria, the number of jumps accomplished during the 10-second test and additionally an increased knee-flexion angle upon landing from a drop vertical jump. No improvements on the performance tests were found in either Study I or Study IV. Both studies, however, suffered from low player compliance with the IPEPs and as a result low training dosage. No major differences in results were seen between Knee Control and Knee Control+ in Study IV.Study II showed that 91% of the responding coaches were familiar with Knee Control, they perceived the programme to be effective, 74% had started to use it, and it was fairly well maintained over time. However, only one third of the coaches used the programme every week and few used the whole programme. There were no formal policies for programme implementation and use in the district football associations and clubs. Study III showed that the coach was vital for programme use but needed social support, buy-in from players, resources and a feasible programme to facilitate programme adoption and use. When facing challenges with Knee Control implementation and use, the coaches did their best to work around these obstacles; for example, by modifying the programme content or dosage.Conclusions In conclusion, limited positive effects on jump-landing technique were seen in girls, potentially affecting risk factors for injury positively. No clinically meaningful effects from Knee Control or Knee Control+ were seen on performance tests as measured in the studies in either boys or girls. This may be related to the low training dosage. The high programme reach, perceived effectiveness, adoption and fairly high maintenance of Knee Control were positive. The modifications of programme content and/or dosage were concerning but will hopefully decrease with a more user-friendly programme.
|
|
| 36. |
- Lindblom, Hanna, 1984-, et al.
(författare)
-
Limited positive effects on jump-landing technique in girls but not in boys after 8 weeks of injury prevention exercise training in youth football
- 2020
-
Ingår i: Knee Surgery, Sports Traumatology, Arthroscopy. - : Springer Science and Business Media LLC. - 0942-2056 .- 1433-7347. ; 28:2, s. 528-537
-
Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To evaluate changes in jump-landing technique in football-playing boys and girls after 8 weeks of injury prevention training.METHODS: Four boys' and four girls' teams (mean age 14.1 ± 0.8 years) were instructed to use either the original Knee Control injury prevention exercise programme (IPEP) or a further developed IPEP, Knee Control + , at every training session for 8 weeks. Baseline and follow-up testing of jump-landing technique included drop vertical jumps (DVJ), assessed subjectively and with two-dimensional movement analysis, and tuck jump assessment (TJA).RESULTS: Only minor differences in intervention effects were seen between the two IPEPs, and results are therefore presented for both intervention groups combined. At baseline 30% of the boys showed good knee control during the DVJ, normalised knee separation distances of 77-96% (versus hip) and a median of 3 flaws during the TJA. Among girls, 22% showed good knee control, normalised knee separation distances of 67-86% and a median of 4 flaws during the TJA. At follow-up, boys and girls performed significantly more jumps during TJA. No changes in jump-landing technique were seen in boys, whereas girls improved their knee flexion angle at initial contact in the DVJ (mean change + 4.7°, p < 0.001, 95% CI 2.36-6.99, d = 0.7) and their TJA total score (- 1 point, p = 0.045, r = - 0.4).CONCLUSION: The study showed small positive effects on jump-landing technique in girls, but not in boys, after 8 weeks of injury prevention training.LEVEL OF EVIDENCE: Level II.TRIAL REGISTRATION: Clinical Trials gov identifier: NCT03251404.
|
|
| 37. |
- Lindbäck, Yvonne, et al.
(författare)
-
Experiences from pre-surgery physiotherapy and thoughts about future exercise among patients with disc herniation or spinal stenosis: A qualitative study
- 2024
-
Ingår i: MUSCULOSKELETAL SCIENCE AND PRACTICE. - : ELSEVIER. - 2468-7812. ; 69
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Continuous exercising after a physiotherapy intervention for low back pain (LBP) is known to be crucial, but sustaining new habits may be challenging.Aim: To describe patients' pre-and post-surgery experiences after a pre-surgery physiotherapy intervention, and their thoughts about future exercise and self-management.Methods: Individual semi-structured interviews at two time-points were analysed with content analysis. Patients randomised to pre-surgery physiotherapy in an RCT evaluating the intervention, who had participated in >= 12 sessions, were invited. Eighteen patients were interviewed 0-8 months after pre-surgery physiotherapy, and sixteen of those completed a second interview 3-14 months later.Results: Three categories emerged: 1) "Personal experiences from pre-surgery participation", described how participation was perceived as challenging and sometimes stressful, but wellness improved. Cooperation with the physiotherapist was considered crucial and gave confidence. 2) "Attitudes to exercise", described exercise as an action of prevention and rehabilitation that demands motivation. Exercise was perceived to be good for you, physically but also improving mental health and other systems. 3) "Future physical activity -individual re-sponsibility", described the return to former activities and potential challenges for the future. New knowledge was perceived to have changed the prerequisites for exercise and increased security in every-day physical activities.Conclusion: Pre-surgery physiotherapy may enhance self-management through increased confidence, improved knowledge about progression, and awareness about exercise for pain relief, producing a new mindset. Challenges for continuing exercise should be addressed during the intervention. The result can inform supportive strategies for patients to continue with self-management after LBP rehabilitation.
|
|
| 38. |
- Nilsen, Per, et al.
(författare)
-
Implementation of a computerized alcohol advice concept in routine emergency care
- 2009
-
Ingår i: International Emergency Nursing. - : Elsevier BV. - 1755-599X .- 1878-013X. ; 17:2, s. 113-121
-
Tidskriftsartikel (refereegranskat)abstract
- Background: There is a growing body of evidence for computer-generated advice for many health behaviours. This study evaluated the implementation of a computerized concept to provide tailored advice on alcohol in a Swedish emergency department (ED). Aim: The aim was to evaluate the usage of the concept over 12 months: participation rate among the ED population; representativeness of the participants; and participation development over time. Methods: The target population was defined as all patients aged 18-69 years given a card from ED triage staff with a request to conduct a computerized test about their alcohol use. After completing the 5-10-min programme, the patient received a printout, containing personalised alcohol habit feedback, as calculated by the computer from the patients answers. Data for this study were primarily obtained from the computer programme and ED logs. Results: Forty-one percent of the target population completed the computerized test and received tailored alcohol advice. The number of patients who used the concept showed a slight decreasing trend during the first half of the year, leveling off for the second half of the year. Conclusion: A computerized concept for provision of alcohol advice can be implemented in an ED without unrealistic demands on staff and with limited external support to attain sustainability.
|
|
| 39. |
- Peterson, Anna, et al.
(författare)
-
Using education and support strategies to improve the way nurses assess regular and transient pain : A quality improvement study of three hospitals
- 2017
-
Ingår i: Scandinavian Journal of Pain. - : Elsevier. - 1877-8860 .- 1877-8879. ; 16:1, s. 15-21
-
Tidskriftsartikel (refereegranskat)abstract
- Background and aimsSystematic and regular pain assessment has been shown to improve pain management. Well-functioning pain assessments require using strategies informed by well-established theory. This study evaluates documented pain assessments reported in medical records and by patients, including reassessment using a Numeric Rating Scale (NRS) after patients receive rescue medication.MethodsDocumentation surveys (DS) and patient surveys (PS) were performed at baseline (BL), after six months, and after 12 months in 44 in-patient wards at the three hospitals in Östergötland County, Sweden. Nurses and nurse assistants received training on pain assessment and support. The Knowledge to Action Framework guided the implementation of new routines.ResultsAccording to DS pain assessment using NRS, pain assessment increased significantly: from 7% at baseline to 36% at 12 months (p < 0.001). For PS, corresponding numbers were 33% and 50% (p < 0.001). According to the PS, the proportion of patients who received rescue medication and who had been reassessed increased from 73% to 86% (p = 0.003). The use of NRS to document pain assessment after patients received rescue medication increased significantly (4% vs. 17%; p < 0.001).ConclusionsAfter implementing education and support strategies, systematic pain assessment increased, an encouraging finding considering the complex contexts of in-patient facilities. However, the achieved assessment levels and especially reassessments related to rescue medication were clinically unsatisfactory. Future studies should include nursing staff and physicians and increase interactivity such as providing online education support. A discrepancy between documented and reported reassessment in association with given rescue medication might indicate that nurses need better ways to provide pain relief.ImplicationsThe fairly low level of patient-reported pain via NRS and documented use of NRS before and 12 months after the educational programme stresses the need for education on pain management in nursing education. Implementations differing from traditional educational attempts such as interactive implementations might complement educational programmes given at the work place. Standardized routines for pain management that include the possibility for nurses to deliver pain medication within well-defined margins might improve pain management and increase the use of pain assessments. Further research is needed that examines the large discrepancy between patient-reported pain management and documentation in the medical recording system of transient pain.
|
|
| 40. |
- Peterson, Gunnel, 1959-, et al.
(författare)
-
Evaluation of implementation and effectiveness of neck-specific exercise for persistent disability and pain after whiplash injury : study protocol for a randomized controlled study using a hybrid 2 design
- 2022
-
Ingår i: BMC Musculoskeletal Disorders. - London, United Kingdom : BioMed Central (BMC). - 1471-2474. ; 23:1
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Persistent pain and disability in whiplash-associated disorders (WAD) grades II and III are common. In two randomized controlled trials (RCTs) of neck-specific exercises (NSE), we have seen promising results in chronic WAD, with a sustained clinically important reduction in pain and disability. NSE can also be delivered through internet support (NSEIT) and a few visits to a physiotherapist, saving time and cost for both patients and providers. NSE have been shown to have positive effects in other neck pain disorders and we will evaluate the diffusion of the exercises to other patients. The aims of the proposed study are to evaluate an implementation strategy for NSEIT and NSE in primary health care and to evaluate the effectiveness of NSEIT and NSE in clinical practice.METHODS: The proposed study is a prospective cluster-randomized mixed-design study with hybrid 2 trial design. Reg. physiotherapists working in twenty physiotherapy clinics will be included. The primary implementation outcome is proportion of patients with neck pain receiving neck-specific exercise. Secondary outcomes are; physiotherapists attitudes to implementation of evidence-based practice, their self-efficacy and confidence in performing NSEIT/NSE, number of patients visits, and use of additional or other exercises or treatment. To further evaluate the implementation strategy, two qualitative studies will be performed with a sample of the physiotherapists. The primary outcome in the patient effectiveness evaluation is self-reported neck disability according to the Neck Disability Index (NDI). Secondary outcomes are pain intensity in the neck, arm, and head; dizziness; work- and health-related issues; and patient's improvement or deterioration over time. All measurements will be conducted at baseline and at 3 and 12 months. Physiotherapists´ self-efficacy and confidence in diagnosing and treating patients with neck pain will also be evaluated directly after their instruction in NSEIT/NSE.DISCUSSION: This trial will evaluate the implementation strategy in terms of adoption of and adherence to NSEIT and NSE in clinical primary health care, and measure diffusion of the method to other patients. In parallel, the effectiveness of the method will be evaluated. The results may guide physiotherapists and health care providers to sustainable and effective implementation of effective exercise programs.TRIAL REGISTRATION: The randomized trial is registered on ClinicalTrials.gov , NCT05198258 , initial release date January 20, 2022.
|
|
| 41. |
- Pihl, Sofia
(författare)
-
Clinical and methodological aspects on perineal laceration diagnostics at childbirth
- 2019
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Obstetric perineal lacerations are common after vaginal birth. The degree of obstetric perineal laceration is defined by the extent of tissue involved in the laceration. When a perineal laceration has occurred after vaginal delivery, the examination for correct diagnostics is essential before primary suturing. Standard immediate postpartum care is an inspection and palpation of the obstetric perineal laceration. The aim of this thesis was to explore the diagnostics of obstetric perineal lacerations, and to examine how the methods of bidigital perineal palpation and transperineal ultrasound postpartum can contribute to the clinical diagnostic decisions before primary repair. Material and Methods: Study I is a methodological study of transperineal ultrasound of the anovaginal distance. The learning curve and inter-observer agreement of the method is studied between three examiners in an outpatient gynaecological setting. Study II is a prospective observational study of 150 primiparous women with suspected perineal laceration of degree 2-3 immediately after childbirth and the association between bidigital palpation of the perineal height, the anovaginal distance and the final diagnosis of the perineal laceration. Study III is a retrospective observational study with data from the Swedish national Perineal Laceration Registry, studying maternal and obstetric risk factors for internal anal sphincter injury in 3,333 women with external sphincter injury. Study IV is a follow-up study focusing on the implementation strategies and outcome when introducing a new method, (the Diagnostics After DELivery – DADEL concept) for examining perineal lacerations at a maternity ward. The DADEL concept consists of a combination of bidigital palpation of the perineal tissues and transperineal ultrasound in order to determine the degree of perineal lacerations. Results and conclusions: In study I, the method of transperineal ultrasound measurement of anovaginal distance revealed a short learning period and high interobserver agreement. This indicated that the method can be taught and reliably used in further research and clinical practice. In study II, women with external sphincter injury had a shorter anovaginal distance compared to women without this injury. The palpatory perineal thickness was associated with the anovaginal distance. Study III showed that 33% of primiparous women with an external anal sphincter injury also had an internal anal sphincter injury diagnosed immediately after delivery. When the infant was born with a hand or arm beside the head, there was an increased risk for internal anal sphincter injury. Perineal palpatory thickness of less than 10 mm was significantly associated with an internal anal sphincter injury. In the follow-up study of diagnostic methods showed a significantly higher use of bidigital palpation five years after introduction of the DADEL concept. The use of transperineal ultrasound showed no significant change during the same period.
|
|
| 42. |
- Reichenpfader, Ursula, 1969-, et al.
(författare)
-
Embedding hospital-based medication review : The conflictual and developmental potential of a practice
- 2019
-
Ingår i: Journal of Health Organization & Management. - : Emerald Group Publishing Limited. - 1477-7266 .- 1758-7247. ; 33:3, s. 339-352
-
Tidskriftsartikel (refereegranskat)abstract
- Purpose: The purpose of this paper is to explore the embedding of hospital-based medication review attending to the conflictual and developmental nature of practice. Specifically, this paper examines manifestations of contradictions and how they play out in professional practices and local embedding processes.Design/methodology/approach: Using ethnographic methods, this paper employs the activity-theoretic notion of contradictions for analyzing the embedding of medication review. Data from participant observation (in total 290?h over 48 different workdays) and 31 semi-structured interviews with different healthcare professionals in two Swedish hospital-based settings (emergency department, department of surgery) are utilized.Findings: The conflictual and developmental potential related to three interrelated characteristics (contested, fragmented and distributed) of the activity object is shown. The contested nature is illustrated showing different conceptualizations, interests and positions both within and across different professional groups. The fragmented character of medication review is shown by tensions related to the appraisal of the utility of the newly introduced practice. Finally, the distributed character is exemplified through tensions between individual and collective responsibility when engaging in multi-site work. Overall, the need for ongoing ￜrepairￜ work is demonstrated.Originality/value: By using a practice-theoretical approach and ethnographic methods, this paper presents a novel perspective for studying local embedding processes. Following the day-to-day work of frontline clinicians captures the ongoing processes of embedding medication review and highlights the opportunities to learn from contradictions inherent in routine work practices.
|
|
| 43. |
- Reichenpfader, Ursula, 1969-
(författare)
-
Embedding Medication Review in Clinical Practice : Reconceptualising Implementation Using a Practice Theory Perspective
- 2019
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The hospital is a critical setting with respect to medication safety and quality of medication therapy. Medication review, the structured assessment of an individual patient’s medications with the aim of improving therapy, has been advocated as a strategy to reduce medication-related harm. Although programs of medication review have been widely introduced, its implementation has encountered difficulties. While seemingly a rather straightforward concept, processes to identify current medication use and reconcile different medication lists have been complicated by organizational, interprofessional, or technical factors. There is, thus, a need to better understand medication review implementation. However, it is also important to critically consider how the implementation of healthcare interventions is generally understood, and what theoretical or conceptual considerations inform implementation efforts. Studying organizational and social phenomena as they unfold in practice has the potential to shed light on how these everyday activities are generated, how they are adapted over time, and what consequences this has on social and organizational processes.The purpose of this thesis is to develop an alternative perspective on studying the implementation of a healthcare intervention in routine care. More specifically, this thesis aims to theorize the embedding and practicing of medication review in routine hospital work. Theorizing, here, refers to empirically and theoretically exploring phenomena based on cases of local medication review implementation.Drawing on empirical case examples of medication review implementation in southeast Sweden, an ethnographic approach is employed conducting participant observation, informal conversations and semi-structured interviews with different healthcare professionals in two hospital settings, as well as semi-structured interviews with patients from three different hospital settings. A so-called toolkit approach for practice theory is employed, using a range of different practice-theoretical concepts to empirically study practice.The empirical findings point to the centrality of dealing with medication-related problems when conducting and embedding medication review. Both practicing and embedding medication review were shaped by how medication-related problems and potential medication harms were constructed, contested, and negotiated in practice. Practitioners’ everyday actions and practices revealed different meanings attached to the concept of medication-related problem bringing to the fore the contested and conflictual nature of the practice. Also, insight was provided into how practices to embed medication review in routine hospital work unfolded, revealing material-discursive and reflective practices, but also silent modes of legitimizing the ‘non-practicing’ of medication review in a highly structured way.This thesis provides an alternative perspective on studying the implementation of a healthcare intervention and challenges various assumptions underpinning implementation research. Instead, a broadened perspective is suggested directing attention to the practical and situated knowing involved, the local processes of negotiating objectives in practice, as well as to the meaning-making required when practitioners engage with a practice. Finally, there are opportunities to learn from implementation processes, when frontline practitioners involved in embedding medication review are able to reflect on adapting medication review to make routines better fit the local context.
|
|
| 44. |
- Reichenpfader, Ursula, 1969-, et al.
(författare)
-
'In the hospital all is taken care of' : A practice-theoretical approach to understand patients' medication use
- 2020
-
Ingår i: Sociology of Health and Illness. - : Wiley-Blackwell Publishing Inc.. - 0141-9889 .- 1467-9566. ; 42:1, s. 50-64
-
Tidskriftsartikel (refereegranskat)abstract
- Drawing from case examples of medication review implementation in three hospital settings in Sweden, this article examines patients’ medication use. Based on a practice theory approach and utilising data from interviews with patients and participant observation, we reconstruct three practices of everyday medication use centring on accepting, challenging or appropriating medication orders. This article argues that patients’ medication practices are embedded in wider practice arrangements that afford different modes of agency. Reconceptualising patients’ medication use from a practice‐based perspective revealed the meaning‐making, order‐producing and identity‐forming features of these practices. Also, we illustrated how different modes of agency were achieved in patients’ medication practices, suggesting a fluidity of both the meanings attached to and the identities related to medication use. Our findings have practical implications as these practices of medication use can be transformed when altering the arrangements they are embedded in, thus going beyond the clinical encounter.
|
|
| 45. |
- Reichenpfader, Ursula, et al.
(författare)
-
Leadership in evidence-based practice : a systematic review
- 2015
-
Ingår i: Leadership in Health Services. - : Emerald Group Publishing Limited. - 1751-1879 .- 1751-1887. ; 28:4, s. 298-316
-
Tidskriftsartikel (refereegranskat)abstract
- Purpose: We aimed to systematically review published empirical research on leadership as a determinant for the implementation of evidence-based practice (EBP) and to investigate leadership conceptualization and operationalization in this field.Design/methodology/approach: A systematic review with narrative synthesis was conducted. Relevant bibliographic databases and reference lists of pertinent review articles were searched. To be included, a study had to involve empirical research and refer to both leadership and EBP in health care. Study quality was assessed with a structured instrument based on study design.Findings: A total of 17 studies were included. Leadership was mostly viewed as a modifier for implementation success, acting through leadership support. Yet, there was definitional imprecision as well as conceptual inconsistency and studies seemed to inadequately address situational and contextual factors. Although referring to an organizational factor, the concept was mostly analysed at the individual or group level.Research limitations/implications: The concept of leadership in implementation science seems to be not fully developed. It is unclear whether attempts to tap the concept of leadership in available instruments truly capture and measure the full range of the diverse leadership elements at various levels. Research in implementation science would benefit from a better integration of research findings from other disciplinary fields. Once a more mature concept has been established, researchers in implementation science could proceed to further elaborate operationalization and measurement.Originality/value. Although the relevance of leadership in implementation science has been acknowledged, the conceptual base of leadership in this field has received only limited attention.
|
|
| 46. |
- Reichenpfader, Ursula, 1969-, et al.
(författare)
-
Medi(c)ation work in the emergency department : Making standardized practice work
- 2018
-
Ingår i: Professions & Professionalism. - : OsloMet - Oslo Metropolitan University. - 1893-1049. ; 8:2
-
Tidskriftsartikel (refereegranskat)abstract
- Medication review, the systematic examination of an individual patient’s medicines in order to improve medication therapy, has been advocated as an important patient safety measure. Despite widespread use, little is known about how medication review is conducted when implemented in routine health care. Drawing from an ethnographic case study in a Swedish emergency department and using a practice-based approach, we examine how medication review is practically accomplished and how knowledge is mobilized in everyday practice. We show how physicians construct and negotiate medication safety through situated practices and thereby generate knowledge through mundane activities. We illustrate the centrality of practitioners’ collective reflexive work when co-constructing meaning and argue here that practitioners’ local adaptations can serve as important prerequisites to make “standardized” practice function in everyday work. Organizations need to build a practical capacity to support practitioners’ work-based learning in messy and time-pressured health care settings.
|
|
| 47. |
- Reichenpfader, Ursula, et al.
(författare)
-
Our surgeons want this to be short and simple: practices of in-hospital medication review as coordinated sociomaterial actions
- 2018
-
Ingår i: Studies in Continuing Education. - : ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD. - 0158-037X .- 1470-126X. ; 40:3, s. 323-336
-
Tidskriftsartikel (refereegranskat)abstract
- Medication review, a systematic assessment of a patients medicines by a health care professional, is intended to prevent medication-related harms. A critical element of medication review concerns whether medication review is conducted in a coordinated way. This article draws from a case example of implementing medication review in two surgical wards of a Swedish regional hospital and aims to analyse how medication review is being accomplished with respect to the coordination of its actions. Using a practice-based ethnographic approach, we present several coordination mechanisms by illustrating how practices are connected to materials involved in medication review. Also, we show how common orientations, ends, and understandings expressed in different medication review practices contribute to the coordination of the practices. In conclusion, this article highlights the complexity of establishing and sustaining medication review as a coordinated practice in routine health care. By closely examining sociomaterial connections, this article sheds new light on the neglected issue of artefacts and arrangements in constituting and transforming a highly complex medication practice.
|
|
| 48. |
- Ridelberg, Mikaela, 1982-, et al.
(författare)
-
Landstingens och regionernas patientsäkerhetsberättelser : Systematisk sammanställning och jämförande analys av uppgifter inrapporterade från vårdgivare i Sverige för åren 2010, 2011 och 2012
- 2014
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Sverige fick en ny patientsäkerhetslag 2011 (PSL 2010:659) i syfte att göra vården säkrare. Bland annat ställer lagen krav på att vårdgivare sammanställer en Patientsäkerhetsberättelse (PSB) årligen. Förra året gjordes en första granskning av de PSB som skrevs för år 2010 samt 2011. Uppdraget var att beskriva och jämföra innehållet från landstingens och regionernas PSB för verksamhetsåren 2010 och 2011 utifrån perspektiven struktur, process och resultat. För detta ändamål utarbetades en utvärderingsmodell som använ des i arbetet.Denna rapport bygger på den tidigare utarbetad e och testad e modell en och avser att ge en bild av patientsäkerhetsarbetet inom svensk hälso- och sjukvård med utgångspunkt i de PSB som vårdgivarna har sammanställt för år 2012 samt att göra en jämförelse med innehållet i tidigare PSB. Analysen har gjorts med kvantitativ innehållsanalys.Granskningen visar att 2012 års PSB har högre täckningsgrad av variabler i jämförelse med 2010 och 2011. Resultatet visar att många variabler har tagits med i redovisningen men att det ibland inte är tydligt beskrivet vad som har gjorts eller vilka strukturer redovisningen faktiskt syftar på. Det är även tydligt att landstingen har haft vägledning av de grundläggande och prestationsbaserade krav som SKL haft uppställda för 2012 år s patientsäkerhetsarbete utifrån överenskommelsen med regeringen, vilket även framkom i 2011 års PSB.Av sammanlagt 5 2 undersökta patientsäkerhetsvariabler inom struktur (n=18 ), process (n=25) och resultat (n=9) som beskrivs fullständigt eller delvis i PSB år 2012, har olika landsting/regioner redovisat olika många möjliga variabler, med ett högsta värde av 44 av 52 och lägsta 28 av 5 2.Konceptet PSB är unikt internationellt sett och ger en god bild av hur man arbetar med patientsäkerhetsfrågor i landstingen/regionerna, men det finns också en utvecklingspotential. Vi bedömer att PSB i dagsläget inte riktigt håller måttet för att utöva myndighetstillsyn då det fortfarande kan vara svårt att få en tydlig bild av vad som faktiskt görs inom olika landsting/regioner. PSB har blivit mer informativa 2012 än tidigare år men saknar enhetlighet vad gäller rapporterade variabler och rapporterade resultatmått. Ytterligare utveckling av SKL:s mall skulle kunna underlätta landstingens arbete med att sammanställa PSB och förbättra förutsättningarna för jämförelser mellan landsting/regioner och över tid
|
|
| 49. |
- Ridelberg, Mikaela, 1982-, et al.
(författare)
-
Patient safety work in Sweden: quantitative and qualitative analysis of annual patient safety reports.
- 2016
-
Ingår i: BMC Health Services Research. - : BioMed Central. - 1472-6963. ; 16:98, s. 1-9
-
Tidskriftsartikel (refereegranskat)abstract
- BackgroundThere is widespread recognition of the problem of unsafe care and extensive efforts have been made over the last 15 years to improve patient safety. In Sweden, a new patient safety law obliges the 21 county councils to assemble a yearly patient safety report (PSR). The aim of this study was to describe the patient safety work carried out in Sweden by analysing the PSRs with regard to the structure, process and result elements reported, and to investigate the perceived usefulness of the PSRs as a tool to achieve improved patient safety.MethodsThe study was based on two sources of data: patient safety reports obtained from county councils in Sweden published in 2014 and a survey of health care practitioners with strategic positions in patient safety work, acting as key informants for their county councils. Answers to open-ended questions were analysed using conventional content analysis.ResultsA total of 14 structure elements, 31 process elements and 23 outcome elements were identified. The most frequently reported structure elements were groups devoted to working with antibiotics issues and electronic incident reporting systems. The PSRs were perceived to provide a structure for patient safety work, enhance the focus on patient safety and contribute to learning about patient safety.ConclusionPatient safety work carried out in Sweden, as described in annual PSRs, features a wide range of structure, process and result elements. According to health care practitioners with strategic positions in the county councils’ patient safety work, the PSRs are perceived as useful at various system levels.
|
|
| 50. |
- Roback, Kerstin, 1953-, et al.
(författare)
-
Fyra år med patientsäkerhetsberättelsen : sammanställning och jämförande analys av uppgifter inrapporterade från vårdgivare i Sverige 2010-2013
- 2015
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Sverige fick en ny patientsäkerhetslag 2011 i syfte att göra vården säkrare. I denna ingår att alla vårdgivare årligen ska ställa samman en patientsäkerhetsberättelse (PSB) med början för verksamhetsåret 2010. PSB har nu skrivits för fjärde året i rad. Syftet med denna rapport är att utifrån innehållet i landstingens/regionernas PSB ge en bild av patientsäkerhetsarbetet inom svensk hälso- och sjukvård, under de fyra år som PSB har sammanställts. Granskning en är dels en granskning av innehållet i 2013 års PSB men också en sammanfattning av utvecklingen av patientsäkerhetsarbetet under verksamhetsåren 2010 till 2013, så som det beskrivs i PSB:erna. Innehållet har analyserats utifrån perspektiven struktur, process och resultat och jämförelser har gjorts över tid och mellan olika landsting/regioner. Liknande granskningar har tidigare gjorts vid två tillfällen och analyserna bygger på en tidigare utarbetad och testad modell i de tidigare granskningarna av landstingens/ regionernas PSB. En tydlig utveckling har skett över åren, både vad gäller beskrivningarna av patientsäkerhetsarbetet och vilka områden och resultat man vill lyfta fram. Granskningen visar att landstingen/regionerna har haft vägledning av de grundläggande och prestations - baserade krav som funnits för patientsäkerhetsarbetet i den överenskommelse som träffats mellan staten och SKL. Man har också följt SKL:s mall för att skriva PSB. Detta har dock inte lett till någon större samstämmighet i vad som verkligen rapporteras utan har mer varit en likriktning av rapporternas struktur. M ånga variabler som tagits med i redovisningen beskrivs dessutom i ganska vaga ordalag. Överlag har standarden dock ökat och många PSB är innehållsrika och ger en bra översikt över hur patientsäkerhetsarbetet bedrivs och vad som återstår att göra. Jämfört med tidigare år har PSB 2013 fokuserat mer på resultat och egenkontroll. Tidigare berätta de man att man mäter och registrerar olika saker. Nu anger man också resultat från de olika mätningarna i en högre grad. Vidare har ledningens roll för att höja säkerheten börjat uppmärksamma, även om många också påpekar att ansvaret för att bedriva en säker vård i slutändan ligger hos enskilda medarbetare. Av sammanlagt 62 undersökta patientsäkerhetsvariabler som ingått i den landstingsvisa jämförelsen 2013 har täckningsgraden i snitt varit 67 %. Motsvarande, sett över hela tidsspannet 2010 - 2013, är 63 %. Landsting en/regionerna har redovisat olika stor andel av de undersökta variablerna, med en högsta andel på 75 % för Östergötland, räknat som ett genomsnitt över de fyra åren. Skillnaderna mellan landstingen/regionerna är dock inte stora och drygt hälften (11 st.) har ett resultat över 65 %. Ett fåtal mer blygsamma resultat har uppmätts där en slentrianmässig rapportering förekommer och där den relevant a information en är sparsam. Detta kan tyda på att man inte har integrerat PSB:n som ett instrument i patientsäkerhetsarbetet, utan har andra medel för att skapa struktur och översikt över arbetet. De allra flesta har dock sammanställt informativa och välstrukturerade rapporter. Mot bakgrund av den utveckling som skett av PSB:n, under en relativt kort tid, kan man förmoda att den kommer att fortsätta utvecklas i en pågående dynamisk process i många landsting/regioner och med tiden få en allt viktigare roll i arbetet för att åstadkomma en säkrare vård.
|
|
