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1.	Nymberg, Peter, 1971-, et al. (författare) How do patients experience and use home blood pressure monitoring? A qualitative analysis with UTAUT 2 2024 Ingår i: Scandinavian Journal of Primary Health Care. - Abingdon : Taylor & Francis. - 0281-3432 .- 1502-7724. ; , s. 1-9 Tidskriftsartikel (refereegranskat)abstract Background: hypertension is an important cardiovascular risk factor with potentially harmfulconsequences. home blood pressure monitoring is a promising method for following the effectof hypertension treatment. the use of technology-enabled care and increased patient involvementmight contribute to more effective treatment methods. however, more knowledge is needed toexplain the motivations and consequences of patients engaging in what has been called ‘do-it-yourself healthcare’.Aim: this study aimed to investigate patients’ experiences of home blood pressure monitoringthrough the theoretical frame of the Unified theory of acceptance and Use of technology(UtaUt 2). Methods: the study had a qualitative design, with focus group interviews using theweb-based platform Zoom. the data were analysed using qualitative deductive content analysis,inspired by Graneheim and lundman.Results: the results are presented using the seven theoretical constructs of UtaUt 2: Performanceexpectancy, effort expectancy, social influence, Facilitating conditions, hedonistic Motivation,Price Value and habit. We found one overarching theme ‒ ‘it’s all about the feeling of security’.the patients were influenced by relatives or healthcare personnel and experienced the homemonitoring process as being easy to conduct. the patients emphasised that the quality of theblood pressure monitor was more important than the price. Patients reported home monitoringof blood pressure as a feasible method to follow-up care of their hypertension.Discussion: this study indicates that among motivated patients, home blood pressuremeasurement entails minimal effort, increases security, and leads to better communication aboutblood pressure between healthcare personnel and patients. © 2024 the author(s). Published by informa uK limited, trading as taylor & francis Group
2.	Abelev, Betty, et al. (författare) Long-range angular correlations on the near and away side in p-Pb collisions at root S-NN=5.02 TeV 2013 Ingår i: Physics Letters. Section B: Nuclear, Elementary Particle and High-Energy Physics. - : Elsevier BV. - 0370-2693. ; 719:1-3, s. 29-41 Tidskriftsartikel (refereegranskat)abstract Angular correlations between charged trigger and associated particles are measured by the ALICE detector in p-Pb collisions at a nucleon-nucleon centre-of-mass energy of 5.02 TeV for transverse momentum ranges within 0.5 < P-T,P-assoc < P-T,P-trig < 4 GeV/c. The correlations are measured over two units of pseudorapidity and full azimuthal angle in different intervals of event multiplicity, and expressed as associated yield per trigger particle. Two long-range ridge-like structures, one on the near side and one on the away side, are observed when the per-trigger yield obtained in low-multiplicity events is subtracted from the one in high-multiplicity events. The excess on the near-side is qualitatively similar to that recently reported by the CMS Collaboration, while the excess on the away-side is reported for the first time. The two-ridge structure projected onto azimuthal angle is quantified with the second and third Fourier coefficients as well as by near-side and away-side yields and widths. The yields on the near side and on the away side are equal within the uncertainties for all studied event multiplicity and p(T) bins, and the widths show no significant evolution with event multiplicity or p(T). These findings suggest that the near-side ridge is accompanied by an essentially identical away-side ridge. (c) 2013 CERN. Published by Elsevier B.V. All rights reserved.
3.	Abelev, Betty, et al. (författare) Measurement of prompt J/psi and beauty hadron production cross sections at mid-rapidity in pp collisions at root s=7 TeV 2012 Ingår i: Journal of High Energy Physics. - 1029-8479. ; :11 Tidskriftsartikel (refereegranskat)abstract The ALICE experiment at the LHC has studied J/psi production at mid-rapidity in pp collisions at root s = 7 TeV through its electron pair decay on a data sample corresponding to an integrated luminosity L-int = 5.6 nb(-1). The fraction of J/psi from the decay of long-lived beauty hadrons was determined for J/psi candidates with transverse momentum p(t) > 1,3 GeV/c and rapidity vertical bar y vertical bar < 0.9. The cross section for prompt J/psi mesons, i.e. directly produced J/psi and prompt decays of heavier charmonium states such as the psi(2S) and chi(c) resonances, is sigma(prompt J/psi) (p(t) > 1.3 GeV/c, vertical bar y vertical bar < 0.9) = 8.3 +/- 0.8(stat.) +/- 1.1 (syst.)(-1.4)(+1.5) (syst. pol.) mu b. The cross section for the production of b-hadrons decaying to J/psi with p(t) > 1.3 GeV/c and vertical bar y vertical bar < 0.9 is a sigma(J/psi <- hB) (p(t) > 1.3 GeV/c, vertical bar y vertical bar < 0.9) = 1.46 +/- 0.38 (stat.)(-0.32)(+0.26) (syst.) mu b. The results are compared to QCD model predictions. The shape of the p(t) and y distributions of b-quarks predicted by perturbative QCD model calculations are used to extrapolate the measured cross section to derive the b (b) over bar pair total cross section and d sigma/dy at mid-rapidity.
4.	Abelev, Betty, et al. (författare) Underlying Event measurements in pp collisions at root s=0.9 and 7 TeV with the ALICE experiment at the LHC 2012 Ingår i: Journal of High Energy Physics. - 1029-8479. ; :7 Tidskriftsartikel (refereegranskat)abstract We present measurements of Underlying Event observables in pp collisions at root s = 0 : 9 and 7 TeV. The analysis is performed as a function of the highest charged-particle transverse momentum p(T),L-T in the event. Different regions are defined with respect to the azimuthal direction of the leading (highest transverse momentum) track: Toward, Transverse and Away. The Toward and Away regions collect the fragmentation products of the hardest partonic interaction. The Transverse region is expected to be most sensitive to the Underlying Event activity. The study is performed with charged particles above three different p(T) thresholds: 0.15, 0.5 and 1.0 GeV/c. In the Transverse region we observe an increase in the multiplicity of a factor 2-3 between the lower and higher collision energies, depending on the track p(T) threshold considered. Data are compared to PYTHIA 6.4, PYTHIA 8.1 and PHOJET. On average, all models considered underestimate the multiplicity and summed p(T) in the Transverse region by about 10-30%.
5.	Bolmsjö, Beata Borgström, et al. (författare) Text message-based lifestyle intervention in primary care patients with hypertension : a randomized controlled pilot trial 2020 Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 38:3, s. 300-307 Tidskriftsartikel (refereegranskat)abstract OBJECTIVE: To evaluate the feasibility of a randomized controlled pilot study with lifestyle-promoting text messages as a treatment for hypertension in primary care.DESIGN: Randomized controlled pilot trial.SETTING: Three primary health care centers in southern Sweden.SUBJECTS: Sixty patients aged 40-80 years with hypertension were included.MAIN OUTCOME MEASURES: Feasibility of the pilot study, i.e. recruitment rate, dropout rate and eligibility criteria. Secondary outcomes were change in blood pressure and other cardiovascular risk factors.METHODS: Thirty participants were randomized to the intervention group with four lifestyle-promoting text messages sent every week for six months. The control group received usual care. The baseline and follow-up visits for all 60 patients included measurements of blood pressure, anthropometrics, blood tests and a self-reported questionnaire.RESULTS: All feasibility criteria (recruitment rate (≥55%), dropout rate (≤15%) and eligibility (60 eligible patients during the four-month inclusion period) for the pilot study were fulfilled. This means that a larger study with a similar design may be conducted. After six months, there were no significant improvements in cardiovascular risk factors. However, we found favorable trends for all secondary outcomes in the intervention group as compared to the control group.CONCLUSION: Lifestyle modification in patients with hypertension is important to reduce cardiovascular risk. However, primary healthcare has limited resources to work with modifying lifestyle habits. This is the first pilot study to test the feasibility of text message-based lifestyle intervention in patients with hypertension in Swedish primary healthcare. Whether significant improvement in cardiovascular risk factors may be achieved in a larger study population remains to be evaluated. Key points This pilot randomized controlled trial (RCT) is the first study to evaluate the feasibility of text message-based lifestyle advice to patients with hypertension in Swedish primary healthcare. •All feasibility criteria for the pilot study were fulfilled. This outcome means that a larger study with a similar design may be conducted. •The study was not powered to find significant changes in cardiovascular risk factors. Nevertheless, after six months we found favorable trends for all secondary outcomes in the intervention group compared to control. •If a future larger study can show significant results, this intervention could serve as a useful tool in everyday primary healthcare.
6.	Calling, Susanna, et al. (författare) Lung function, respiratory symptoms and incident venous thromboembolism during a 44-year follow-up 2023 Ingår i: Thrombosis Update. - Oxford : Elsevier. - 2666-5727. ; 12 Tidskriftsartikel (refereegranskat)abstract Background: Chronic obstructive pulmonary disease (COPD) and infections are risk factors for venous thromboembolism (VTE), but the reasons behind the associations are not fully known. Few studies have investigated whether lung function and respiratory symptoms in individuals without COPD are associated with VTE. Objectives: To study the incidence of VTE in individuals without COPD and other major VTE risk factors, in relation to baseline lung function and respiratory symptoms, through a 44-year follow-up prospective cohort study. Methods: As part of a health screening program, a total of 20,253 men and 7361 women underwent a baseline examination from 1974 to 1992, including a spirometry test and a self-administered questionnaire about respiratory symptoms, e.g., chronic bronchitis, cough, phlegm, and dyspnoea. Lung function was assessed through quartiles of forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC). Through linkage with national registers, all individuals were followed for incidence of VTE. Results: Respiratory symptoms (cough and dyspnoea) at baseline were associated with an increased risk of incident VTE in women after adjustments for age, height, BMI, smoking status, varicose veins, and FEV1/FVC. The adjusted hazard ratio in relation to chronic bronchitis was 1.57 (95% confidence interval 1.17–2.11). Poor lung function was not associated with an increased risk of VTE after adjustments for potential confounders. Conclusion: Women with respiratory symptoms of cough and dyspnoea without COPD have an increased risk of VTE, independent of lung function and major VTE risk factors. Further studies are needed to confirm the association and to study the clinical applicability of the results. © 2023 The Authors
7.	Calling, Susanna, et al. (författare) Trajectories of body mass index and risk for coronary heart disease : A 38-year follow-up study 2021 Ingår i: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 16:10 October 2021 Tidskriftsartikel (refereegranskat)abstract Objective Obesity is a well-known risk factor for coronary heart disease (CHD), but there is little evidence on the effect of long-term trajectories of body mass index (BMI) over the life course. By using repeated assessments, the aim was to study the risk of CHD in adults during 38 years in different trajectories of BMI. Methods A sample of 2129 men and women, aged 20-59 years at baseline, took part in four repeated interviews between 1980 and 2005. Data on BMI, medical history, lifestyle and socioeconomy were collected. Based on the World Health Organization categories of BMI, life course trajectories of stable normal weight, stable overweight, stable obesity, increasing BMI and fluctuating BMI were created. The individuals were followed through national registers for first hospitalization of CHD (389 events) until the end of 2017, and Hazard Ratios (HRs) were calculated, adjusted for age, sex, socioeconomic factors, lifestyle factors and metabolic comorbidities. Results Stable normal weight in all assessments was the reference group. Those who had an increase in BMI from normal weight in the first assessment to overweight or obesity in later assessments had no increased risk of CHD, HR 1.04 (95% CI: 0.70-1.53). The HR for individuals with fluctuating BMI was 1.25 (0.97-1.61), for stable overweight 1.43 (1.03-1.98), for stable obesity 1.50 (0.92-2.55), and for stable overweight or obesity 1.45 (1.07-1.97), after full adjustments. Conclusion Having a stable overweight or obesity throughout adult life was associated with increased CHD risk but changing from normal weight at baseline to overweight or obesity was not associated with increased CHD risk. Prevention of obesity early in life may be particularly important to reduce CHD risk.
8.	Ekman, Björn, et al. (författare) Skala upp den befintliga digitala vården i Sverige 2020 Ingår i: Dagens Medicin. - Stockholm : Bonnier. - 1104-7488. Tidskriftsartikel (populärvet., debatt m.m.)abstract Ge Socialstyrelsen ett nationellt uppdrag att beställa och ersätta vårdgivare av digital vård, föreslår en grupp forskare med anledning av covid-19.
9.	Entezarjou, Artin, et al. (författare) Antibiotic Prescription Rates After eVisits Versus Office Visits in Primary Care : Observational Study 2021 Ingår i: JMIR Medical Informatics. - : JMIR Publications Inc.. - 2291-9694. ; 9:3 Tidskriftsartikel (refereegranskat)abstract BACKGROUND: Direct-to-consumer telemedicine is an increasingly used modality to access primary care. Previous research on assessment using synchronous virtual visits showed mixed results regarding antibiotic prescription rates, and research on assessment using asynchronous chat-based eVisits is lacking.OBJECTIVE: The goal of the research was to investigate if eVisit management of sore throat, other respiratory symptoms, or dysuria leads to higher rates of antibiotic prescription compared with usual management using physical office visits.METHODS: Data from 3847 eVisits and 759 office visits for sore throat, dysuria, or respiratory symptoms were acquired from a large private health care provider in Sweden. Data were analyzed to compare antibiotic prescription rates within 3 days, antibiotic type, and diagnoses made. For a subset of sore throat visits (n=160 eVisits, n=125 office visits), Centor criteria data were manually extracted and validated.RESULTS: Antibiotic prescription rates were lower following eVisits compared with office visits for sore throat (169/798, 21.2%, vs 124/312, 39.7%; P<.001) and respiratory symptoms (27/1724, 1.6%, vs 50/251, 19.9%; P<.001), while no significant differences were noted comparing eVisits to office visits for dysuria (1016/1325, 76.7%, vs 143/196, 73.0%; P=.25). Guideline-recommended antibiotics were prescribed similarly following sore throat eVisits and office visits (163/169, 96.4%, vs 117/124, 94.4%; P=.39). eVisits for respiratory symptoms and dysuria were more often prescribed guideline-recommended antibiotics (26/27, 96.3%, vs 37/50, 74.0%; P=.02 and 1009/1016, 99.3%, vs 135/143, 94.4%; P<.001, respectively). Odds ratios of antibiotic prescription following office visits compared with eVisits after adjusting for age and differences in set diagnoses were 2.94 (95% CI 1.99-4.33), 11.57 (95% CI 5.50-24.32), 1.01 (95% CI 0.66-1.53), for sore throat, respiratory symptoms, and dysuria, respectively.CONCLUSIONS: The use of asynchronous eVisits for the management of sore throat, dysuria, and respiratory symptoms is not associated with an inherent overprescription of antibiotics compared with office visits.TRIAL REGISTRATION: ClinicalTrials.gov NCT03474887; https://clinicaltrials.gov/ct2/show/NCT03474887.
10.	Entezarjou, Artin, et al. (författare) Experiences of digital communication with automated patient interviews and asynchronous chat in Swedish primary care : a qualitative study 2020 Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 10:7, s. 036585-036585 Tidskriftsartikel (refereegranskat)abstract OBJECTIVES: To explore staff experiences of working with a digital communication platform implemented throughout several primary healthcare centres in Sweden.DESIGN: A descriptive qualitative approach using focus group interviews. Qualitative content analysis was used to code, categorise and thematise data.SETTING: Primary healthcare centres across Sweden, in both rural and urban settings.PARTICIPANTS: A total of three mixed focus groups, comprising 19 general practitioners and nurses with experience using a specific digital communication platform.RESULTS: Five categories emerged: 'Fears and Benefits of Digital Communication', 'Altered Practice Workflow', 'Accepting the Digital Society', 'Safe and Secure for Patients' and 'Doesn't Suit Everyone and Everything'. These were abstracted into two comprehensive themes: 'Adjusting to a novel medium of communication' and 'Digitally filtered primary care', describing how staff experienced integrating the software as a useful tool for certain clinical contexts while managing the communication challenges associated with written communication.CONCLUSIONS: Family medicine staff were ambivalent concerning the use of digital communication but, after a period of adjustment, it was seen as a useful communication tool especially when combined with continuity of care. Staff acknowledged limitations regarding use by inappropriate patient populations, information overload and misinterpretation of text by both staff and patients.
11.	Entezarjou, Artin, et al. (författare) Health care utilization following "digi-physical" assessment compared to physical assessment for infectious symptoms in primary care 2022 Ingår i: BMC Primary Care. - : Springer Science and Business Media LLC. - 2731-4553. ; 23 Tidskriftsartikel (refereegranskat)abstract Background: The use of chat-based digital visits (eVisits) to assess infectious symptoms in primary care is rapidly increasing. The "digi-physical" model of care uses eVisits as the first line of assessment while assuming a certain proportion of patients will inevitably need to be further assessed through urgent physical examination within 48 h. It is unclear to what extent this approach can mitigate physical visits compared to assessing patients directly using office visits.Methods: This pre-COVID-19-pandemic observational study followed up "digi-physical" eVisit patients (n = 1188) compared to office visit patients (n = 599) with respiratory or urinary symptoms. Index visits occurred between March 30th 2016 and March 29th 2019. The primary outcome was subsequent physical visits to physicians within two weeks using registry data from Skåne county, Sweden (Region Skånes Vårddatabas, RSVD).Results: No significant differences in subsequent physical visits within two weeks (excluding the first 48 h) were noted following "digi-physical" care compared to office visits (179 (18.0%) vs. 102 (17.6%), P = .854). As part of the "digital-physical" concept, a significantly larger proportion of eVisit patients had a physical visit within 48 h compared to corresponding office visit patients (191 (16.1%) vs. 19 (3.2%), P < .001), with 150 (78.5%) of these eVisit patients recommended some form of follow-up by the eVisit physician.Conclusions: Most eVisit patients (68.9%) with respiratory and urinary symptoms have no subsequent physical visits. Beyond an unavoidable portion of patients requiring urgent physical examination within 48 h, "digi-physical" management of respiratory and urinary symptoms results in comparable subsequent health care utilization compared to office visits. eVisit providers may need to optimize use of resources to minimize the proportion of patients being assessed both digitally and physically within 48 h as part of the "digi-physical" concept.Trial registration: Clinicaltrials.gov identifier: NCT03474887.Supplementary Information: The online version contains supplementary material available at 10.1186/s12875-021-01618-2.
12.	Eriksson, Jon, et al. (författare) Inequity in access to digital public primary healthcare in Sweden: a cross-sectional study of the effects of urbanicity and socioeconomic status on utilization 2024 Ingår i: International Journal for Equity in Health. - 1475-9276. ; 23 Tidskriftsartikel (refereegranskat)abstract BackgroundSocial and geographical inequity in access to primary healthcare is an ongoing concern in Sweden. Digital care can potentially decrease geographical inequity. This study aimed to evaluate how urbanicity affects the utilization of a public digital primary healthcare service - PHC Online.MethodsWe performed an ecological cross-sectional study of 4,482 PHC Online visits grouped by 83 public primary healthcare centers. Multiple linear regression analysis was performed with PHC Online visits per 1,000 registered patients as the dependent variable and urbanicity (municipalities grouped by number of inhabitants), socioeconomic status (Care Need Index), and morbidity (Adjusted Clinical Groups) per primary healthcare center as independent variables.ResultsUtilization of PHC Online was more common among those of a younger age (median 32 years) and among women (65%). Urbanicity did not affect utilization. Lower socioeconomic status and higher morbidity had negative effects on utilization (B -3.289, p = 0.001, B -7.728, p = 0.045).ConclusionsGeographical differences based on urbanicity do not seem to affect the utilization of PHC Online. Further studies are needed to clarify a possible association to geographical barriers in access to primary healthcare, specifically accounting for factors associated with urbanicity and distance to physical clinics, and how age and sex affect such an association. Lower utilization of PHC Online in low socioeconomic status and high morbidity populations raises questions on the effect of digital primary care on equitable access to primary healthcare.
13.	Erlingsdottir, Gudbjörg, et al. (författare) Förbättrade arbets- och patientflöden i primärvården med digitalt Flow : slutrapport 2023 Rapport (övrigt vetenskapligt/konstnärligt)abstract I projektet studeras det digitala verktyget Flow och dess inverkan på personalens arbetsmiljö samt på kostnadseffektiviteten i svensk primärvårdskontext. Flow ger patienten möjlighet till digital kontakt och kommunikation med vårdcentralen samt möjlighet till digital kommunikation mellan olika personalgrupper inom vårdcentralen. Implementeringen av Flow har studerats på tre vårdcentraler: A, B och C. På vårdcentral A har implementeringen gått smidigt och haft en positiv effekt medan den gått mindre bra och inte fått lika positiv effekt på vårdcentral B och C. Detta trots att alla verkar överens om att själva plattformen är lätt att arbete i så kan den således få olika effekt på arbetsbelastningen. För att få en positiv effekt behövs det en rad åtgärder vid införandet och vid själva användandet: en gemensam bild hos både ledning och personal om varför plattformen ska införas att involvera och förankra idén om plattformen hos vårdpersonal redan innan implementeringen; att utbilda all personal i plattformen men också utbilda superanvändare som är villiga att driva implementeringen och villiga att kontinuerligt stötta kollegor i förändringsarbetet; att avsätta tid i schemat för vårdpersonal att utforska, lära sig och använda plattformen; att marknadsföra plattformen gentemot patienterna; att ha regelbundna återkopplingsmöten, i vilka vårdpersonal kan diskutera och ventilera farhågor och förväntningar samt uppmuntra kontinuerlig användning. Vad gäller kostnadsanalysen så förefaller Flow leda till besparingar för vårdgivaren. Vi har också jämfört Flow med två andra digitala system inom vården som vi studerat tidigare. Jämförelserna visar bland annat att även om ett digitalt system upplevs som positivt så skapar det oftast något slags kringarbete för vårdpersonalen när systemet eller data det innehåller ska tas hand om. Vidare kan vi konstatera att digitaliseringen inte ersätter de befintliga arbetsrutinerna helt utan skapar ett parallellt arbetsflöde.
14.	Ethics of Connected and Automated Vehicles : Recommendations on Road Safety, Privacy, Fairness, Explainability and Responsibility 2020 Annan publikation (övrigt vetenskapligt/konstnärligt)abstract This report presents the work of a European Commission Expert Group established to advise on specific ethical issues raised by driverless mobility for road transport. The report aims to promote a safe and responsible transition to connected and automated vehicles (CAVs) by supporting stakeholders in the systematic inclusion of ethical considerations in the development and regulation of CAVs.In the past few years, ethical questions associated with connected and automated vehicles (CAVs) have been the subject of academic and public scrutiny. A common narrative presents the development of CAVs as something that will inevitably benefit society by reducing the number of road fatalities and harmful emissions from transport and by improving the accessibility of mobility services. In contrast, this report applies a Responsible Research and Innovation (RRI) approach to CAVs. This approach recognises the potential of CAV technology to deliver the aforementioned benefits but also recognises that technological progress alone is not sufficient to realise this potential.To deliver the desired results, the future vision for CAVs ought to incorporate a broader set of ethical, legal and societal considerations into the development, deployment and use of CAVs. To this end, this report presents a set of 20 ethical recommendations concerning the future development and use of CAVs. These recommendations are grounded in the fundamental ethical and legal principles laid down in the EU Treaties and in the EU Charter of Fundamental Rights.
15.	Frennert, Susanne, et al. (författare) Digitalt stött patientflöde : hot och/eller möjlighet för att underlätta arbetet beror på ledarskapet och hur arbetet organiseras 2022 Konferensbidrag (refereegranskat)abstract Digital teknik har blivit en stor del av de flestas vardag och arbete. Digitaliseringen sker även inom primärvården och tros kunna öka kvalitet och effektivitet i vården, samt minska kostnaderna(van Gemert-Pijnen, Kip, Kelders, & Sanderman, 2018), men hur påverkar den vårdpersonalens arbete? Primärvården är redan en utsatt sektor på grund av ökat patientflöde, personalflykt och hög sjukfrånvaro (Golay, 2019; Greenhalgh & Papoutsi, 2018). Det är därför av stor vikt att förstå hur olika digitala lösningar påverkar vårdpersonalen och deras arbete. I ett forskningsprojekt följer vi införandet av och arbetet med en digital plattform på vårdcentraler för att studera hur digitalt stött patient- och arbetsflöde påverkar personalens arbetssätt och arbetsbelastning. Genom plattformen kan patienter ta kontakt med vårdcentralen digitalt istället för via telefonsamtal. Kommunikation och patientmöten kan ske synkront eller asynkront i form av digitala (chatt eller video) eller fysiska möten med olika kategorier av vårdpersonal. Plattformen är tänkt att förbättra ledning och organisering av arbetet/patientflödet, minska arbetsbördan och kognitiv belastning, stärka patientens delaktighet samt öka kostnadseffektiviteten – men hur blir det i praktiken?
16.	Frennert, Susanne, et al. (författare) Embedding and Integrating a Digital Patient Management Platform Into Everyday Primary Care Routines : Qualitative Case Study 2022 Ingår i: JMIR Formative Research. - : JMIR Publications. - 2561-326X. ; 6:2 Tidskriftsartikel (refereegranskat)abstract Background: Traditional primary care is characterized by patient consultations via phone and physical visits. However, the current development in Swedish primary care is to blend digital solutions with traditional solutions. This paper addresses this development by examining the normalization of embedding and integrating a digital health care platform into everyday care routines in a primary care clinic. The digital health care platform enables both synchronous (video calls) and asynchronous (chat) communication, as well as self-registration of patient data using automated questions and forms requiring the patient's input.Objective: This study aims to explore the work that health care professionals (HCPs) have to undertake to implement and sustain a digital health care platform as part of their everyday work practice. Methods: HCPs were observed and interviewed to assess their individual and collective engagement and the mechanisms involved in the implementation of the digital platform and its effects on everyday work routines. The normalization process theory (NPT) was used to frame the data analysis.Results: The analysis identified several themes related to the four NPT constructs: coherence, cognitive participation, collective action, and reflexive monitoring. The use of these constructs enabled the analysis to identify ways of supporting implementation. For example, it showed the benefits of having implementation champions and scheduling work hours for HCPs to use the platform. The analysis also revealed a theme of materiality that deviated from the NPT constructs, as NPT gives ontological priority to human actors and social structures.Conclusions: Digital health care platform implementation is a complex process. Our findings provide insights into how individual and collective actions can be supported to embed and integrate a digital platform into everyday care routines. Primary health care organizations need to involve HCPs throughout the implementation process by reorganizing work and providing frequent feedback loops. HCPs are more likely to engage with and commit to changing practices if they perceive the digital platform to be beneficial compared with the current practice. However, they also need resources (eg, time, training, and continuous support) to put the platform into practice. Patient engagement and appraisal are important elements in implementation. Unless patients are willing to use the platform, there is no motivation for HCPs to embed the digital platform into everyday care practice.
17.	Frennert, Susanne, et al. (författare) ‘It increases my ability to influence my ways of working’ : A qualitative study on digitally mediated patient management in primary healthcare 2023 Ingår i: Scandinavian Journal of Caring Sciences. - : John Wiley & Sons. - 0283-9318 .- 1471-6712. ; 37:1, s. 88-105 Tidskriftsartikel (refereegranskat)abstract Background: Digitally mediated primary healthcare is increasingly influencing working conditions, raising questions about how digitally mediated patient management is experienced.Aim: The aim of this study was to generate insights, through the lens of postphenomenology, into how digitally mediated primary healthcare affects the work and working environment, by gathering perspectives from primary healthcare professionals who regularly manage patient errands through a digital platform.Methods: Two rounds of interviews were conducted with a diversified sample of primary healthcare professionals at a primary healthcare centre. The first round of interviews was conducted during the initial phase of the deployment of a digital platform for patient management, with the second round conducted a year later (n = 24). The interview transcripts were analysed using reflexive thematic analysis.Results: Four themes relating to digitally mediated care work were identified: ‘positive feelings towards digitally mediated primary healthcare’, ‘seeing a positive work atmosphere as a prerequisite for change’, ‘experiencing increased control over the pace of workflow’ and ‘reconfiguration of previous problems’.Conclusion and relevance to clinical practice: Building on postphenomenology, our study adds to the understanding of how material and symbolic aspects mutually affect the mediating role of a digital platform for patient management. Thus, the results indicate that the experience of using digitally mediated care processes is conditioned by the discourse towards digitalisation at the workplace and the management's approach to and inclusion of employees in the digital transition of primary healthcare, as well as the usefulness and usability of the digital platform. The findings can inform both practice and policy.
18.	Frennert, Susanne, et al. (författare) Lärdomar från en ”lyckad” implementering av en digital plattform i primärvården 2021 Konferensbidrag (refereegranskat)abstract BakgrundAnvändandet av digitala plattformar ökar inom primärvården. Syftet med den här typen av digitala plattformar är att avståndet ska minska mellan vårdpersonal och patient i tid och rum, vården ska bli mer kontinuerlig och proaktiv samt att resurser allokeras till de delar av vården där de behövs bäst. För att syftet ska nås, behöver dessa plattformar inte bara vara funktionella och användbara, utan de behöver inlemmas i det dagliga arbetet. Tidigare forskning visar att många implementeringar inom primärvården fallerar (Granja, Janssen, & Johansen, 2018). Oftast förklaras den långsamma digitaliseringen inom vården som ett resultat av motstånd bland vårdpersonal och patienter på grund av avsaknad av digitala färdigheter och negativ attityd gentemot teknik (Ali, Zhou, Miller, & Ieromonachou, 2016). Förklaringen speglar ett reduktionistiskt synsätt som saknar förståelse för att implementering av digitala lösningar inom vården, inte är en linjär process utan en komplex process som påverkas av flera faktorer (tekniska, sociala, strukturella, historiska, ekonomiska och politiska), olika aktörer (vårdpersonal, patienter , anhöriga, ledning, politiker), utformningen av tekniska lösningar som ömsesidigt är relaterade och möjliggör viss typ av vård och arbetsförhållanden, samtidigt som de begränsar andra (Nilsen, 2020). SyfteSyftet med vår presentation är att beskriva de lärdomar vi dragit från vad som förefaller vara en framgångsrik implementering av en digital plattform på en vårdcentral. Via plattformen kan patienten digitalt ta kontakt med vårdcentralen och blir dirigerad till antingen fysiska eller digitala vårdmöten, beroende på patientens önskemål och medicinska behov. MetodMaterialet kommer från en pilotstudie och består av 12 semi-strukturerade intervjuer med vårdpersonal samt observationer under utbildningstillfällen av den digitala plattformen och på ett APT. Vårt teoretiska ramverk tar sin utgångspunkt i Normalisation Process Theory (NPT). NPT beskriver det arbete och samspel mellan olika aktörer som krävs, för att normalisera ett nytt arbetssätt och inbegriper fyra mekanismer: samstämmighet; kognitiv medverkan; kollektivt agerande och reflekterande monitorering (Carl May, 2013; C May & Finch, 2009).ResultatPilotstudien visar på en rad åtgärder som förefaller att ha säkerställt normalisering av den digital plattformen på den studerade vårdcentralen: att involvera och förankra idén om det nya arbetssättet/innovationen hos vårdpersonal redan innan implementeringen; att utbilda superanvändare som är villiga att driva implementeringen och villiga att kontinuerligt stötta kollegor i förändringsarbetet; att avsätta tid i schemat för vårdpersonal att utforska, lära sig och använda det nya arbetssättet; att ha regelbundna återkopplingsmöten, i vilka vårdpersonal kan diskutera och ventilera farhågor samt förväntningar.
19.	Frennert, Susanne, et al. (författare) Materiality and digitalisation : Observations on eHealth solutions for care 2022 Konferensbidrag (refereegranskat)abstract This presentation brings light on how the materialityof three eHealth solutions affects care and carework. We conducted 92 semi-structured interviewswith healthcare workers from the south of Sweden.The analysis of the data was interpretive with focuson the participants’ experiences. By exploring thelived experiences of the participants, we found thatall the three solutions (1) changed the boundariesbetween patients and colleagues; (2) enabledaugmented information- and knowledge processes;and (3) reconfigured professional control.
20.	Frennert, Susanne, et al. (författare) Materiality and digitalisation : observations on eHealth solutions for care 2022 Konferensbidrag (refereegranskat)abstract This presentation brings light on how the materiality of three eHealth solutions affects care and care work. We conducted 92 semi-structured interviews with healthcare workers from the south of Sweden. The analysis of the data was interpretive with focus on the participants’ experiences. By exploring the lived experiences of the participants, we found that all the three solutions (1) changed the boundaries between patients and colleagues; (2) enabled augmented information- and knowledge processes; and (3) reconfigured professional control.
21.	Frennert, Susanne, et al. (författare) Materiality and the mediating roles of eHealth : a qualitative study and comparison of three cases 2022 Ingår i: Digital Health. - London : Sage Publications. - 2055-2076. ; 8 Tidskriftsartikel (refereegranskat)abstract Against the backdrop of eHealth solutions increasingly becoming a part of healthcare professionals’ ways of doing care work, this paper questions how the solutions mediate the experience of healthcare professionals when deployed. We undertook a qualitative study of three eHealth solutions, conducting qualitative interviews with a diverse sample of 102 healthcare professionals from different care settings across the south of Sweden. Materiality and postphenomenology serve as analytic tools for achieving an understanding of the mediating roles of eHealth solutions. The analysis emphasises the mediating roles consisting of interrelated paradoxes: (1) changing and perpetuating boundaries between patients and professional groups, (2) (dis)enabling augmented information and knowledge processes and (3) reconfiguring professional control over work. This contribution provides critical insights into materiality as a category of analysis in studies on the deployment of eHealth solutions, as these technologies have both intended and unintended consequences for care work. Our study identified general positive consequences of all three solutions, such as the increased feeling of closeness to patients and colleagues over time and space; increased ‘understanding’ of patients through patient-generated data; and increased autonomy, due to the fact that asynchronous communication makes it possible to decide when and which patient to attend to. We also identified general unintended consequences of the solutions, such as maintenance of power relations maintained due to organisational structures and professional relations, disabled information and knowledge processes due to the lack of non-verbal clues, reduced professional autonomy due to technical scripts determining what data is collected and how it is categorised, and uneven workload due to the dependency on patient input and compliance.
22.	Frennert, Susanne, et al. (författare) Successful Implementation and Integration of a Digital Healthcare Platform Supporting Patient- and Workflow in a Swedish Primary Healthcare Center 2021 Ingår i: ; , s. 33-34 Konferensbidrag (refereegranskat)abstract This abstract is based on a pilot study from an ongoing project focusing the implementation of a digital platform offering support for both the patient- and workflow at a primary healthcare center in Western Sweden. The overarching aim of the project is to follow the introduction and adaptation (normalization) of the platform in primary healthcare centers to study how digital support of the patient- and workflow affects the healthcare professionals (HCP) working routines and workload. Through the platform, patients can make contact with the primary healthcare center digitally instead of through phone calls. Communication can take place synchronously or asynchronously and patient meetings digitally (through chat or video) or physically. Through the platform patients are directed to different categories of HCPs, depending on symptoms. We will present the findings of how the organization and leadership was prepared for the introduction of the platform and how the HCPs are prepared, trained and affected by the implementation. The primary healthcare center’s motive for implementing the platform was to increase patient accessibility and experience, enhance resource utilization, and to decrease workload for HCPs (primarily the nurses).Past research shows that implementations of this type of digital platforms are a complex process, involving a wide range of actors who translate means, actions, and objectives into care practices in different ways (Damschroder et al., 2009) not always rendering the expected effects (Cajander, Larusdottir, & Hedström, 2020). Also, early research on digital implementations in healthcare has been accused of being rich in data but “information poor” (Nilsen, 2020). However, several theoretical tools to comprehend and illuminate implementation failures or successes have been developed (Damschroder et al., 2009; C May & Finch, 2009; C. R. May et al., 2011; Nilsen, 2020; Tabak, Khoong, Chambers, & Brownson, 2012). One such explanatory framework is the Normalization Process Theory (NPT) (C May & Finch, 2009). NPT identifies and explains important mechanisms that promote or inhibit an implementation process. It allows a systematic exploration of how and why (or not) a digital healthcare platform becomes normalized and sustained in healthcare practice. NPT “characterizes and explains implementation processes as interactions between ‘emergent expressions of agency (i.e., the things that people do to make something happen, and the ways that they work with different components of a complex intervention to do so); and as ‘dynamic elements of context’ (the social-structural and social-cognitive resources that people draw on to realize that agency)” (Carl May, 2013, p. 1). We use NPT and its constructs as an explanatory framework for analyzing the empirical findings from the pilot study. MethodMethods of inquiry included semi-structured interviews (N=12) and observations during training sessions with the HCPs (2), as well as at a formal workplace meeting (1). The interviews were conducted with four nurses, three doctors, two managers, one psychologist, and one rehabilitation coordinator from the same healthcare center. We also interviewed one of the main initiators and developers of the platform. NPT has inspired the framing of the interviews as well as the data analysis.FindingsThe findings suggest that the digital platform has been successfully implemented and integrated into the everyday care routines at the primary healthcare center. In specific, it has positively affected the patient- and workflow as well as the HCP’s working conditions. The findings also point at the importance of preparation on the organizational and leadership level before platform implementation. In the presentation, we will elaborate further on how the platform becomes successfully embedded and integrated by using the NPT constructs of coherence, cognitive participation, collective actions, and reflexive monitoring as an analytical lens.
23.	Glock, Hanna, et al. (författare) Attitudes, Barriers, and Concerns Regarding Telemedicine Among Swedish Primary Care Physicians : A Qualitative Study 2021 Ingår i: International Journal of General Medicine. - 1178-7074. ; 14, s. 9237-9246 Tidskriftsartikel (refereegranskat)abstract PURPOSE: The primary care physician's traditional patient contacts are challenged by the rapidly accelerating digital transformation. In a quantitative survey analysis based on the theory of planned behavior, we found high behavioral intention to use telemedicine among Swedish primary care physicians, but low reported use. The aim of this study was to further examine the physicians' experiences regarding telemedicine, with a focus on possible explanations for the gap between intention and use, through analysis of the free-text comments supplied in the survey.MATERIAL AND METHODS: The material was collected through a web-based survey which was sent out to physicians at 160 primary health care centers in southern Sweden from May to August 2019. The survey covered four areas: general experiences of telemedicine, digital contacts, chronic disease monitoring with digital tools, and artificial intelligence. A total of 100 physicians submitted one or more free-text comments. These were analyzed using qualitative content analysis with an inductive approach.RESULTS: The primary care physicians expressed attitudes towards telemedicine that focused on clinical usefulness. Barriers to use were the loss of personal contact with patients and a deficient technological infrastructure. The major concerns were that these factors would result in patient harm and an increased workload. The connection between intention and use postulated by the theory of planned behavior was not applicable in this context, as external factors in the form of availability and clinical usefulness of the specific technology were major impediments to use despite a generally positive attitude.CONCLUSION: All telemedicine tools must be evaluated regarding clinical usefulness, patient safety, and effects on staff workload, and end users should be included in this process. Utmost consideration is needed regarding how to retain the benefits of personal contact between patient and provider when digital solutions are introduced.
24.	Glock, Hanna, et al. (författare) ‘In the end, I’m the one who has to do the job’ : Participant experience of a lifestyle intervention for patients with hypertension 2023 Ingår i: Scandinavian Journal of Primary Health Care. - 0281-3432. ; 41:4, s. 457-468 Tidskriftsartikel (refereegranskat)abstract Objective: Cardiovascular disease can be prevented through lifestyle changes, but such changes are often hard to attain. Text message interventions with lifestyle advice have shown small but promising effects. Our objective was to explore participant experience of a text message lifestyle intervention for patients with hypertension, and implications for future lifestyle interventions. Design and subjects: Fourteen participants were purposefully selected for telephone interviews after completion of a text message lifestyle intervention. A semi-structured interview guide with open-ended questions was used. Interviews were recorded and transcribed verbatim. The material was analyzed through systematic text condensation as described by Malterud, a data-driven analysis style that includes deductive elements. Setting: Primary care in three regions in southern Sweden. Results: The analysis resulted in three themes. ‘Blood pressure and lifestyle, how seriously to take it?’ revealed a remaining need for knowledge regarding to what extent lifestyle affects risk for cardiovascular disease. ‘The text messages–a useful reminder in need of tailoring’ described that the design of the intervention was satisfactory, but suggested improvements through increased individualization. Finally, ‘Water off a duck’s back or a kick in the pants–when does behavior change?’ showed how some participants responded to the push to change while others did not, supplying material for further analysis in a framework of behavioral change theory. Conclusion: A key to adoption was advice that was applicable in daily life. Timing in relation to a diagnosis of hypertension or other motivational factors, and tailoring to prior knowledge, habits, and limitations could increase effectiveness.
25.	Jansåker, Filip, et al. (författare) Neighborhood deprivation and coronary heart disease in patients with bipolar disorder 2022 Ingår i: Scientific Reports. - : Springer Science and Business Media LLC. - 2045-2322. ; 12:1 Tidskriftsartikel (refereegranskat)abstract The aim was to study the potential effect of neighborhood deprivation on incident and fatal coronary heart disease (CHD) in patients with bipolar disorder. This was a nationwide cohort study which included all adults aged 30 years or older with bipolar disorder (n = 61,114) in Sweden (1997–2017). The association between neighborhood deprivation and the outcomes was explored using Cox regression analysis, with hazard ratios (HRs) and 95% confidence intervals (CIs). Patients with bipolar disorder living in neighborhoods with high or moderate levels of deprivation were compared with those living in neighborhoods with low deprivation scores. There was an association between level of neighborhood deprivation and incident and fatal CHD among patients with bipolar disorder. The HRs were 1.24 (95% CI 1.07–1.44) for men and 1.31 (1.13–1.51) for women for incident CHD among patients with bipolar disorder living in high deprivation neighborhoods compared to those from low deprivation neighborhoods, after adjustments for potential confounders. The corresponding HR for fatal CHD were 1.35 (1.22–1.49) in men and 1.30 (1.19–1.41) in women living in high deprivation neighborhoods. Increased incident and fatal CHD among patients with bipolar disorder living in deprived neighborhoods raises important clinical and public health concerns.
26.	Jansåker, Filip, et al. (författare) The effect of sociodemographic factors, parity and cervical cancer on antibiotic treatment for uncomplicated cystitis in women : A nationwide cohort study 2021 Ingår i: Antibiotics. - : MDPI AG. - 2079-6382. ; 10:11 Tidskriftsartikel (refereegranskat)abstract Background: Uncomplicated cystitis is one of the most common reasons for antibiotic treatment in otherwise healthy women. Nationwide studies on antibiotic treatment for this infection and in relation to factors beyond the infection itself have hitherto not been available. Methods: This was a nationwide open cohort study consisting of 352,507 women aged 15–50 years with uncomplicated cystitis (2006–2018). The outcome was a redeemed antibiotic prescription within five days from the cystitis diagnosis. Logistic regression models were used to examine the relationship between the outcome and the predictor variables. Results: This study identified 192,065 redeemed treatments (54.5%). Several sociodemographic variables were associated with antibiotic treatment. For example, women with the lowest income had an odds ratio (OR) of 1.26 (95% CI 1.23–1.28) compared to those with the highest income. History of cervical cancer and high parity were also associated with lower treatment rates. Conclusion: This study presents novel factors beyond the infection which seem to affect the antibiotic treatment for uncomplicated cystitis in women. Future studies to investigate possible mechanisms are warranted in order to properly use our findings. This may help healthcare workers and planners to provide a more equal treatment plan for this common infection, which may reduce misuse of antibiotics, decrease costs and improve efforts against antibiotic resistance.
27.	Marjadi, Brahmaputra, et al. (författare) Diversity Audit of Medical School Examination Questions Ingår i: Teaching and Learning in Medicine. - 1040-1334. Tidskriftsartikel (refereegranskat)abstract Phenomenon: This article reports the under-researched presentation of demographic, social, and economic diversity in medical school examination questions. Approach: The present study audited 3,566 pre-clinical and clinical multiple-choice and short answer examination questions in the same year (2018) from three medical schools in two continents to review the diversity of patients portrayed. The audit was based on an extension of Critical Race Theory beyond race and ethnicity to include pertinent social determinants of health. Findings: Patients were presented in 1,537 (43.1%) of the audited examination questions. Apart from age (89.4%) and binary genders (93.9%), other diversity characteristics were rarely portrayed (ethnicity 7.2%, relationship status 1.9%, sexual identity 1.1%, socio-economic status 0.5%, geographic residence 0.1%, disability 0.1%), or not at all (non-binary genders; residency status; religion/spirituality). Insights: While presenting excessive and unnecessary patient characteristics in examination questions should be avoided, the absence of many diversity aspects may reduce examination authenticity and defeat the teaching of diversity in medicine. Medical schools should consider a routine audit and reasonable improvement of the diversity features of patients in examination questions to support teaching and learning activities addressing patients’ diversity.
28.	Milos Nymberg, Veronica, et al. (författare) HEAD-MIP–(HEAlth Dialogues for patients with Mental Illness in Primary care)—a feasibility study 2023 Ingår i: Pilot and Feasibility Studies. - London : BioMed Central (BMC). - 2055-5784. ; 9 Tidskriftsartikel (refereegranskat)abstract Background: Patients with mental illness have an increased risk of cardiovascular morbidity and mortality compared to the rest of the population, which is partly related to unhealthy lifestyle habits. To individualise lifestyle counselling in primary care, the Swedish-developed Health Dialogue (HD) can be used as an educative tool at recurrent measurement points with the goal to improve non-healthy lifestyle habits. HD has not been aimed specifically at patients with mental illness, and the effect of a systematic approach with repeated HDs in patients with mental illness in primary care has not been previously studied. The aim of this pilot study was to assess the feasibility of the study design for a larger-scale cohort study using repeated HDs focused on the improvement of lifestyle habits in patients seeking primary care due to anxiety, depression, sleeping problems or stress-related symptoms. Methods: Patients were recruited after a visit to a Primary Health Care Center due to mental illness between October 2019 until November 2021 and received a Health Dialogue, including an assessment of cardiovascular risk factors through a Health Curve. Specific feasibility objectives measured were dropout rate, time to follow-up, and risk improvement rate for different lifestyle changes. Results: A total of 64 patients were recruited and 29 (45%) attended a second HD, with a mean follow-up time of 15 months. All participants had at least one elevated cardiovascular risk level on the Health Curve for the assessed lifestyles. Risk level improvement rate was good except for tobacco use. Conclusion: Despite a higher dropout rate than expected, we suggest that the proposed methodology for a full cohort study within general practice of patients with mental illness in primary care is both acceptable to practice and feasible. © 2023, BioMed Central Ltd., part of Springer Nature.
29.	Milos Nymberg, Veronica, et al. (författare) How do clinical supervisors and managers in Swedish primary care perceive their opportunities to meet the learning needs of medical students? 2022 Ingår i: Advances in Medical Education and Practice. - 1179-7258. ; 13, s. 521-533 Tidskriftsartikel (refereegranskat)abstract Introduction: Primary health care centers (PHCCs) in Sweden are struggling to maintain a balance between increasing demands of service and supervision and learning activities for a growing number of students. We sought a deeper understanding of primary care physicians and managers behavioral intention towards supervising, and their perceptions of the structural preconditions and support needed.Methods: The study combines two theoretical approaches, the Theory of Planned Behavior (TPB) and Social Practice Theory. A questionnaire with 22 items including an open-ended question was designed to collect quantitative and qualitative data and sent to clinical supervisors and managers at PHCCs in Southern Sweden. The aim was to map a) participants' behavioral intention and perceived capacity to act to improve supervision and b) their perceptions of structural prerequisites and support needed to sustain and develop clinical supervision practice.Results: A total of 181 questionnaires were returned, with a total response rate of 60.7%. Behavior predictors (attitudes, subjective norms, and perceived behavioral control) were positively correlated to behavioral intention towards supervising and building supervising competence. Three themes emerged from the content analysis of the qualitative data: "Time and distribution", "Improved communication and support systems" and "Elimination of structural barriers.".Discussion: The manager and supervisor reports suggest that the intentions and capacity of individuals (individuals' agency) is not a strong barrier to high-quality supervising and teaching in PHCC. Organizational preconditions for sustaining and developing supervision practice exist, and structural barriers for exercising agency could be eliminated according to PHCC managers and supervisors. However, a conclusion of our study from a practice theory perspective is that how and to what degree primary care physicians engage in supervision and competence building is determined by how the workplace - and the medical school - afford participation in supervision-related workplace activities. Improved communication between medical school, managers and supervising physicians and on-site faculty development integrated in daily clinical work were described as important facilitators of a favorable supervision and learning environment.
30.	Milos Nymberg, Veronica, et al. (författare) Lifestyle and cardiovascular risk factors in a Swedish primary care population with self-reported psychiatric symptoms 2024 Ingår i: Preventive Medicine Reports. - Amsterdam : Elsevier. - 2211-3355. ; 37 Tidskriftsartikel (refereegranskat)abstract ObjectiveIndividuals with psychiatric illness suffer from poorer physical health compared with the general population and have a higher risk of developing cardiovascular and metabolic diseases. This cross-sectional study aims to describe the prevalence of lifestyle and cardiovascular risk factors and the association with self-reported psychiatric symptoms in a population of 40-year-old individuals screened with targeted Health Dialogues in southern Sweden.MethodsAll 40-year-old individuals registered at 99 primary healthcare centers in southern Sweden were invited to participate. Self-reported lifestyle habits on a web questionnaire, anthropometric measurements, blood pressure, and blood tests were collected. The Health Dialogue resulted in a risk level assessment for different lifestyle habits and a meeting with a trained coach.ResultsA total of 1831 individuals completed a Health Dialogue between 1st January 2021 and 30th June 2022. There were more individuals with high-risk levels for several lifestyle habits in the group with self-reported psychiatric illness compared with the rest of the study population. The analysis showed that physical inactivity, unhealthy diet, high-risk alcohol intake, tobacco use, psychosocial strain, higher BMI, and waist-hip ratio were associated with increased levels of psychiatric symptoms after adjustment for sex and socioeconomic factors.ConclusionUnhealthy lifestyle habits were associated with self-reported psychiatric symptoms in 40-year-old individuals assessed with targeted Health Dialogues in a primary care context. Organized screening might contribute to early detection of modifiable risk factors for cardiovascular disease. Individuals with psychiatric symptoms should be prioritized for screening of unhealthy lifestyle behaviors. © 2023 The Author(s)
31.	Milos Nymberg, Veronica, et al. (författare) Trends in Remote Health Care Consumption in Sweden : Comparison Before and During the First Wave of the COVID-19 Pandemic 2022 Ingår i: JMIR Human Factors. - : JMIR Publications Inc.. - 2292-9495. ; 9:1 Tidskriftsartikel (refereegranskat)abstract Background: Remote assessment of respiratory tract infections (RTIs) has been a controversial topic during the fast development of private telemedicine providers in Swedish primary health care. The possibility to unburden the traditional care has been put against a questionable quality of care as well as risks of increased utilization and costs. The COVID-19 pandemic has contributed to a changed management of patient care to decrease viral spread, with an expected shift in contact types from in-person to remote ones. Objective: The main aim of this study was to compare health care consumption and type of contacts (in-person or remote) for RTIs before and during the COVID-19 pandemic. The second aim was to study whether the number of follow-up contacts after an index contact for RTIs changed during the study period, and whether the number of follow-up contacts differed if the index contact was in-person or remote. A third aim was to study whether the pattern of follow-up contacts differed depending on whether the index contact was with a traditional or a private telemedicine provider. Methods: The study design was an observational retrospective analysis with a description of all index contacts and follow-up contacts with physicians in primary care and emergency rooms in a Swedish region (Skane) for RTIs including patients of all ages and comparison for the same periods in 2018, 2019, and 2020. Results: Compared with 2018 and 2019, there were fewer index contacts for RTIs per 1000 inhabitants in 2020. By contrast, the number of follow-up contacts, both per 1000 inhabitants and per index contact, was higher in 2020. The composition of both index and follow-up contacts changed as the share of remote contacts, in particular for traditional care providers, increased. Conclusions: During the COVID-19 pandemic in 2020, fewer index contacts for RTIs but more follow-up contacts were conducted, compared with 2018-2019. The share of both index and follow-up contacts that were conducted remotely increased. Further studies are needed to study the reasons behind the increase in remote contacts, and if it will last after the pandemic, and more clinical guidelines for remote assessments of RTI are warranted.
32.	Milos, Veronica (författare) Drug therapy - a challenge in primary care. 2014 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract Introduction: Drug therapy in primary care is a broad field, with two areas previously identified as particularly challenging: treatment of the elderly and prescription of antibiotics against uncomplicated upper respiratory tract infections (URTIs). General practitioners’ (GPs’) attitudes and adherence to evidence-based treatment guidelines might be influenced by different interventions and need to be studied. Objectives: 1. To study different intervention models that might influence GPs’ adherence to treatment guidelines. 2. To describe GPs’ attitudes towards locally developed treatment guidelines. Methods: (Paper I) Systematic medication reviews by pharmacists were performed in a randomised controlled study of 369 elderly patients living in the community or nursing homes, who were using the multi-dose drug dispensing (MDD) system. Drug lists were assessed before and after the intervention with a focus on potentially inappropriate medications (PIMs). (Paper II) A retrospective analysis of medication lists was conducted in the same patient sample, with a focus on fall risk-increasing drugs (FRIDs), orthostatic drugs (ODs) and falls. (Paper III) A randomised controlled study was performed using two questionnaire-based behaviour change interventions aimed at reducing prescription of antibiotics against URTIs in primary care. (Paper IV) A qualitative study was performed using focus group interviews to assess GPs’ attitudes towards evidence-based local treatment guidelines. Results: Papers I and II: Systematic medication reviews by pharmacists reduced the number of patients taking PIMs and the total number of drugs these patients were taking, but not the number of patients taking more than three psychotropic drugs. A significant proportion (87%) of the study sample was taking FRIDs and ODs. Numbers of FRIDs were associated with the total number of drugs and with severe falls. There was no association between numbers of ODs and occurrence of severe falls. Paper III: There was a significant decrease in the antibiotic prescribing rate in one of the two intervention groups compared to the control group in patients 0-6 years, but no differences between the groups in patients of all ages. Paper IV: Trust in evidence-based recommendations and patient safety were found to be key factors in prescribing, as was the patient-doctor encounter, with emphasis on informing the patient. The GPs all experienced a lack of time to self-inform, difficulties managing patients with multiple prescribers and direct-to-consumer drug industry information. Cost containment was perceived as both a barrier and a motivator for adherence to guidelines. Conclusion: Multi-professional assessment of patient’s drug list and questionnaire-based behaviour change interventions might be feasible methods to improve quality of drug treatment in primary care and need to be studied further. GPs found trust in evidence-based guidelines and patient safety to be essential in drug prescribing.
33.	Milos, Veronica, et al. (författare) Fall risk-increasing drugs and falls: a cross-sectional study among elderly patients in primary care 2014 Ingår i: BMC Geriatrics. - : Springer Science and Business Media LLC. - 1471-2318. ; 14 Tidskriftsartikel (refereegranskat)abstract Background: Falls are the most common cause of injuries and hospital admissions in the elderly. The Swedish National Board of Health and Welfare has created a list of drugs considered to increase the fall risk (FRIDs) and drugs that might cause/worsen orthostatism (ODs). This cross-sectional study was aimed to assess FRIDs and their correlation with falls in a sample of 369 community-dwelling and nursing home patients aged >= 75 years and who were using a multi-dose drug dispensing system. Methods: Data were collected from the patients' electronic medication lists. Retrospective data on reported falls during the previous three months and severe falls during the previous 12 months were collected. Primary outcome measures were incidence of falls as well as numbers of FRIDs and ODs in fallers and non-fallers. Results: The studied sample had a high incidence of both reported falls (29%) and severe falls (17%). Patients were dispensed a mean of 2.2 (SD 1.5) FRIDs and 2.0 (SD 1.6) ODs. Fallers used on average more FRIDs. Severe falls were more common in nursing homes patients. More women than men experienced severe falls. There were positive associations between number of FRIDs and the total number of drugs (p < 0.01), severe falls (p < 0.01) and female sex (p = 0.03). There were also associations between number of ODs and both total number of drugs (p < 0.01) and being community dwelling (p = 0.02). No association was found between number of ODs and severe falls. Antidepressants and anxiolytics were the most frequently dispensed FRIDs. Conclusions: Fallers had a higher number of FRIDs. Numbers of FRIDs and ODs were correlated with the total number of drugs dispensed. Interventions to reduce falls in the elderly by focusing on reducing the total number of drugs and withdrawal of psychotropic medications might improve the quality and safety of drug treatment in primary care.
34.	Milos, Veronica, et al. (författare) Improving the Quality of Pharmacotherapy in Elderly Primary Care Patients Through Medication Reviews: A Randomised Controlled Study 2013 Ingår i: Drugs & Aging. - : Springer Science and Business Media LLC. - 1170-229X .- 1179-1969. ; 30:4, s. 235-246 Tidskriftsartikel (refereegranskat)abstract Background Polypharmacy in the Swedish elderly population is currently a prioritised area of research Objective This study aimed to assess a structured model for pharmacist-led medication reviews in Methods This study was a randomised controlled clinical trial performed in a group of patients aged >= Results A total of 369 patients were included: 182 in the intervention group and 187 in the control Conclusions Medication reviews involving pharmacists in primary health care appear to be a feasible
35.	Milos, Veronica, et al. (författare) Samordning sjukvård--apotek krävs för bra IT-beslutsstöd. Patientsäkerhet viktig faktor, visar pilotstudie från primärvård i Skåne. 2011 Ingår i: Läkartidningen. - 0023-7205. ; 108:48, s. 2506-2507 Tidskriftsartikel (refereegranskat)
36.	Milos, Veronica, et al. (författare) Swedish general practitioners attitudes towards treatment guidelines a qualitative study 2014 Ingår i: Bmc Family Practice. - : Springer Science and Business Media LLC. - 1471-2296. ; 15:1 Tidskriftsartikel (refereegranskat)abstract Background: Drug therapy in primary care is a challenge for general practitioners (GPs) and the prescribing decision is influenced by several factors. GPs obtain drug information in different ways, from evidence-based sources, their own or others? experiences, or interactions with opinion makers, patients or colleagues. The need for objective drug information sources instead of drug industry-provided information has led to the establishment of local drug and therapeutic committees. They annually produce and implement local treatment guidelines in order to promote rational drug use. This study describes Swedish GPs? attitudes towards locally developed evidence-based treatment guidelines. Methods: Three focus group interviews were performed with a total of 17 GPs working at both public and private primary health care centres in Sk?ne in southern Sweden. Transcripts were analysed by conventional content analysis. Codes, categories and themes were derived from data during the analysis. Results: We found two main themes: GP-related influencing factors and External influencing factors. The first theme emerged when we put together four main categories: Expectations and perceptions about existing local guidelines, Knowledge about evidence-based prescribing, Trust in development of guidelines, and Beliefs about adherence to guidelines. The second theme included the categories Patient-related aspects, Drug industry-related aspects, and Health economic aspects. The time-saving aspect, trust in evidence-based market-neutral guidelines and patient safety were described as key motivating factors for adherence. Patient safety was reported to be more important than adherence to guidelines or maintaining a good patient-doctor relationship. Cost containment was perceived both as a motivating factor and a barrier for adherence to guidelines. GPs expressed concerns about difficulties with adherence to guidelines when managing patients with drugs from other prescribers. GPs experienced a lack of time to self-inform and difficulties managing direct-to-consumer drug industry information. Conclusions: Patient safety, trust in development of evidence-based recommendations, the patient-doctor encounter and cost containment were found to be key factors in GPs? prescribing. Future studies should explore the need for transparency in forming and implementing guidelines, which might potentially increase adherence to evidence-based treatment guidelines in primary care.
37.	Milos, Veronica, et al. (författare) The coordination health care - pharmacy is needed for good IT support. Patient safety is an important factor according to a pilot study from primary health care in Scania : Samordning sjukvård-apotek krävs för bra IT-beslutsstöd. Patientsäkerhet viktig faktor, visar pilotstudie från primärvård i Skåne 2011 Ingår i: Läkartidningen. - 0023-7205. ; 108:48, s. 2506-7 Tidskriftsartikel (refereegranskat)abstract In English: Optimization of drug prescribing is a highly prioritized area and there is a need for electronic decision support for prescribers. The prescribing decision is multifaceted and general practitioners see patient safety and time saving as the biggest advantages. Until guidelines can be included in the electronic journals, it is necessary to find effective tools to motivate the doctors to use electronic instruments to increase the adherence to treatment guidelines. A closer examination of physician attitudes is needed. Just as important is the challenge to improve the IT communication between the different stakeholders, primary health care and pharmacy for a safer drug use in primary health care.
38.	Milos, Veronica, et al. (författare) Theory-based interventions to reduce prescription of antibiotics-A randomized controlled trial in Sweden 2013 Ingår i: Family Practice. - : Oxford University Press (OUP). - 0263-2136 .- 1460-2229. ; 30:6, s. 634-640 Tidskriftsartikel (refereegranskat)abstract Background.: Upper respiratory tract infections (URTIs) are the most common reason for consulting a GP and for receiving an antibiotic prescription, although evidence shows poor benefit but rather increasing antibiotic resistance. Interventions addressing physicians have to take into consideration the complexity of prescribing behaviour. Objective.: To study whether interventions based on behavioural theories can reduce the prescribing of antibiotics against URTIs in primary care. Setting and subjects.: GPs at 19 public primary health care centres in southern Sweden. Methods.: We performed a randomized controlled study using two behavioural theory-based interventions, the persuasive communication intervention (PCI) and the graded task intervention (GTI), which emerged from social cognitive theory and operant learning theory. GPs were randomized to a control group or one of two intervention groups (PCI and GTI). Main outcome measures.: Changes in the rate of prescription of antibiotics against URTIs in primary care patients of all ages and in patients aged 0-6 years. Results.: No significant differences were seen in the prescription rates before and after the interventions when patients of all ages were analysed together. However, for patients aged 0-6 years, there was a significant lower prescription rate in the PCI group (P = 0.037), but not the GTI group, after intervention. Conclusion.: Theory-based interventions have limited impact on reducing the prescription of antibiotics against URTIs in primary care. Future studies are needed to draw firm conclusions about their effects. © The Author 2013. Published by Oxford University Press. All rights reserved.
39.	Modig, Sara, et al. (författare) Assessment of medication discrepancies with point prevalence measurement : how accurate are the medication lists for Swedish patients? 2022 Ingår i: Drugs and Therapy Perspectives. - : Springer Science and Business Media LLC. - 1172-0360 .- 1179-1977. ; 38:4, s. 185-193 Tidskriftsartikel (refereegranskat)abstract Background: Medication discrepancies are common, potentially harmful and may result from poor medication information across medical records. Our aim was to describe current medication discrepancy rates, types and severity in hospital, primary and specialized outpatient care in Sweden, as well as comparing these with previous measurements. Methods: Participants visiting health care in Skåne in November 2020 were randomly selected to include 100 adult patients each in public and private primary health care centers, hospitals and outpatient care. Within 2 weeks after a health care visit or hospital admission, a pharmacist medication reconciliation was performed to identify any discrepancies. Two general practitioners assessed their potential to cause harm. Descriptive and comparative statistics were used. Results: In total, 405 patients (mean age 61.6 years, median 6.5 medications) were included in the analysis. The majority (72%) of the included patients had ≥1 medication list discrepancy. Total number of discrepancies was 1038 (average 2.6 per patient), with a significantly higher discrepancy rate (4.5) noted in specialized outpatient care (p < 0.001). Overall, unintentional addition (44%) or omission (39%) of drug were most frequent. Out of all discrepancies, 20.7% were rated to have moderate (18.2%) or high (2.5%) potential risk of harm. Cardiovascular, nervous system and antidiabetic medications were more often involved in potentially harmful discrepancies. When compared with previous measurements, the proportion of accurate medication lists significantly improved in primary care compared to 2018 (34% vs 20%, p = 0.0011), as well as a decrease in overall discrepancy rate (p = 0.0029). Conclusion: Medication discrepancies were in general abundant despite a recent health care visit, both in hospital care and primary care, with the highest number in specialized outpatient care. A considerable share was classified as potentially harmful thus implying a major threat to medication safety.
40.	Nymberg, Peter, 1971-, et al. (författare) Association between changed self-rated health and the risk of venous thromboembolism in Malmö Preventive Program : a cohort study 2024 Ingår i: Journal of Thrombosis and Thrombolysis. - New York : Springer-Verlag New York. - 0929-5305 .- 1573-742X. ; 57:3, s. 497-502 Tidskriftsartikel (refereegranskat)abstract Poor self-rated health (SRH) is associated with incident arterial cardiovascular disease in both sexes. Studies on the association between SRH and incident venous thromboembolism (VTE) show divergent results in women and no association in men. This study focuses on the association between change in SRH and incident VTE in a cohort of 11,558 men and 6682 women who underwent a baseline examination and assessment of SRH between 1974 and 1992 and a re-examination in 2002–2006. To investigate if changes in SRH over time affect the risk of incident VTE in men and women. During a follow-up time from the re-examination of more than 16 years, there was a lower risk for incident VTE among women if SRH changed from poor at baseline to very good/excellent (HR 0.46, 95% CI 0.28; 0.74) at the re-examination. Stable good SRH (good to very good/excellent at the re-examination, HR 0.60, 95% CI 0.42; 0.89), or change from good SRH at baseline into poor/fair at the re-examination (HR 0.68, 95% CI 0.51; 0.90) were all significantly associated with a reduced risk for VTE. All comparisons were done with the group with stable poor SRH. This pattern was not found among men. Regardless of a decreased or increased SRH during life, having an SRH of very good/excellent at any time point seems to be associated with a decreased risk of VTE among women. © 2024, The Author(s).
41.	Nymberg, Peter, 1971-, et al. (författare) Association between self-rated health and venous thromboembolism in Malmö Preventive Program: A cohort study 2022 Ingår i: Preventive Medicine. - : Elsevier BV. - 0091-7435 .- 1096-0260. ; 159 Tidskriftsartikel (refereegranskat)abstract Introduction: Venous thromboembolism (VTE) and cardiovascular disease (CVD) share some risk factors such as smoking, obesity, and dietary habits. Poor self-rated health (SRH) has been shown to be a predictor of arterial CVD and mortality for both men and women. The association between SRH and VTE has only been investigated in one previous Swedish study with a cohort that just contained women. This Swedish study did not show any significant associations between poor SRH and VTE in women. Methods: A cohort of 22,444 men and 10,902 women in the Malmö Preventive Program was followed for a period of 44 years. All participants in the baseline screening with measurements including SRH were traced in national registers. Data on VTE events were collected from national hospital registries. Cox proportional regression analysis was used to calculate the association between SRH and time to VTE. Results: During a follow-up time of 44.31 years, a total of 2612 individuals were affected by VTE. Good SRH was associated with a lower risk for VTE in women both in the univariate model (HR = 0.75, CI = 0.65–0.85) and after adjustments for age, smoking, BMI and varicose veins (HR = 0.81, CI 0.70–0.93). SRH was not a predictor for VTE in men, neither in the unadjusted (HR = 1.05, CI 0.90–1.13) nor in the fully adjusted model (HR = 1.00, CI = 0.88–1.14). Conclusion: In this cohort study, SRH was associated with VTE in women but not among men. The association was significant even when adjusting for well-known risk factors such as varicose veins, BMI and smoking. © 2022 The Authors
42.	Nymberg, Veronica Milos, et al. (författare) ‘Having to learn this so late in our lives…’ Swedish elderly patients’ beliefs, experiences, attitudes and expectations of e-health in primary health care 2019 Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 37:1, s. 41-52 Tidskriftsartikel (refereegranskat)abstract Objective: The elderly are an increasing group and large consumers of care in Sweden. Development of mobile information technology shows promising results of interventions for prevention and treatment of chronic diseases. Exploring the elderly patients’ beliefs, attitudes, experiences and expectations of e-health services helps us understand the factors that influence adherence to such tools in primary care. Material and methods: We conducted focus group interviews with 15 patients from three primary health care centers (PHCCs) in Southern Sweden. Data were analysed with thematic content analysis with codes and categories emerged from data during analysis. Results: We found one comprehensive theme: ‘The elderly’s ambivalence towards e-health: reluctant curiosity, a wish to join and need for information and learning support’. Eight categories emerged from the text during analysis: ‘E-health–a solution for a non-existing problem?’, ‘The elderly’s experiences of e-health’, ‘Lack of will, skills, self-trust or mistrust in the new technology’, ‘Organizational barriers’, ‘Wanting and needing to move forward’, ‘Concerns to be addressed for making e-health a good solution’, ‘Potential advantages with e-health versus ordinary health care’ and ‘Need for speed, access and correct comprehensive information’. Conclusions: Elderly patients in Sweden described feelings of ambivalence towards e-health, raising concerns as accessibility to health care, mistrust in poor IT systems or impaired abilities to cope with technology. They also expressed a wish and need to move forward albeit with reluctant curiosity. Successful implementation of e-health interventions should be tailored to target different attitudes and needs with a strong focus on information and support for the elderly.Key points Exploring the elderly patients’ beliefs, experiences, attitudes and expectations of the fast developing e-health services helps us understand the factors that influence adherence to such tools in primary care. Elderly patients in Sweden reported ambivalence and different experiences and attitudes towards e-health, raising concerns as accessibility to health care, costs and mistrust in poor IT systems or impaired abilities to cope with technology. They also expressed a wish and need to move forward albeit with reluctant curiosity. Successful implementation of e-health interventions should be tailored to target different attitudes and needs with a strong focus on information and support for the elderly.
43.	Nymberg, Veronica Milos, et al. (författare) The impact of medication reviews conducted in primary care on hospital admissions and mortality : An observational follow-up of a randomized controlled trial 2021 Ingår i: Drug, Healthcare and Patient Safety. - 1179-1365. ; 13, s. 1-9 Tidskriftsartikel (refereegranskat)abstract Background: Drug-related problems among the elderly population are common and increasing. Multi-professional medication reviews (MR) have arisen as a method to optimize drug therapy for frail elderly patients. Research has not yet been able to show conclusive evidence of the effect of MRs on mortality or hospital admissions. Aim: The aim of this study was to assess the impact of MRs’ on hospital admissions and mortality after six and 12 months in a frail population of 369 patients in primary care in a cohort from a randomized controlled study. Methods: Patients were blindly randomized to an intervention group (receiving MRs) and a control group (receiving usual care). Descriptive data on mortality and hospital admissions at six and 12 months were collected. Survival analysis was performed for time to death and time to the first hospital admission within 12 months. Results: An observational follow-up was performed in a cohort of 369 patients, previously randomized to an intervention group (182) and a control group (187). Most of the patients (75%) were females and lived in nursing homes. At six months, 50 patients of the baseline population (27%) in the control group had been admitted to hospital at least once, compared to 40 patients (21%) in the intervention group. At 12 months, the percentage had increased to 70 (37%) in the control group compared to 53 (29%) in the intervention group. Compared to usual care, we found that MRs reduced the risk of hospital admissions within 12 months by 42% (HR = 0.58, 95% CI 0.37–0.92, p=0.021), but found no difference in mortality (HR = 1.12, 95% CI 0.78–1.61, p=0.551) between the groups. Conclusion: We suggest that MRs should be recommended in the care of frail elderly patients with expected benefits on delayed hospital admissions. The study is registered at ClinicalTrials.gov, registration number NCT04040855, Unique Protocol ID 2018/8.
44.	Olofsson, Sofia, et al. (författare) Physicians’ intentions to use digital tools–a comparative survey, before and after the COVID-19 pandemic, in Southern Sweden 2024 Ingår i: Scandinavian Journal of Primary Health Care. - 0281-3432. Tidskriftsartikel (refereegranskat)abstract Objectives: To describe changes in Swedish primary care physicians’ use of, attitudes and intentions toward digital tools in patient care between 2019 and 2022. Design: A survey using a validated questionnaire measuring physician’s intentions to use digital tools based on the theory of planned behavior. Setting: Sample of primary health care centers in southern Sweden. Subjects: Primary care physicians. Main outcome measures: Self-reported use and intentions to use, digital tools including digital consultations by text or video, chronic disease monitoring and artificial intelligence (AI) and the associations between attitudes, subjective norms, perceived behavioral control and behavioral intentions to use digital tools, in 2019 compared to 2022. Results: In both 2019 (n = 198) and 2022 (n = 93), physicians reported high intentions to use digital tools. Self-reported use of video was slightly higher in 2022 (p =.03). No other changes were seen in the self-reported use or behavioral intentions to use digital tools. Conclusion: The slow adoption of patient-related digital tools in Swedish primary health care does not seem to be explained by a low intention to use them among physicians. Future research on implementation of digital tools should include a focus on contextual factors such as organizational, technical and cultural barriers.
45.	Pikkemaat, Miriam, et al. (författare) HEAD-MIP - HEAlth Dialogue for patients with Mental Illness in Primary care 2022 Konferensbidrag (refereegranskat)abstract BackgroundPatients with mental illness have an increased risk of cardiovascular morbidity and mortality. Targeted health conversations can identify individuals at risk and then offer help reducing the risk of disease and complications. The Swedish-developed Health Dialogue is a health conversation including a pedagogical tool to visualize the parts of the patient's lifestyle that might benefit most from improvements. Its use in primary health care has shown improvement of lifestyle habits as well as reduced mortality. Despite a higher expected benefit for patients with mental illness, the Health Dialogue is not aimed specifically or tested for this patient group.MethodsPatients > 18 years old seeking primary care for mental illness (depression, anxiety, sleep disorders, or stress-related problems) were included. A trained nurse performed a Health Dialogue with the patients, including both questionnaires of lifestyle habits, stress, mental illness, and measurements of body mass index, blood pressure, blood glucose, and cholesterol. Individually tailored advice based on the risk profile was provided.ResultsAll participants had at least one lifestyle area with an increased risk level. There were over 20% of the patients who had abnormal fasting glucose values, elevated blood pressure, or cholesterol levels. Three-quarters were overweight or obese. More than 40% had the highest risk level for Waist-Hip-Ratio and high-risk levels in the physical inactivity lifestyle area. Compared to an ongoing population screening of 40-year-olds, we found higher proportions of overweight or obesity, physical inactivity, and elevated blood pressure or glucose values.ConclusionOur results with a large proportion of unhealthy lifestyle habits in patients with mental illness in primary care show the importance of interventions in this patient group with potentially positive effects on improved mental wellbeing and decreased metabolic and cardiovascular risk. Studying a larger cohort with long-term follow-up is highly motivated.
46.	Pikkemaat, Miriam, et al. (författare) Structured assessment of modifiable lifestyle habits among patients with mental illnesses in primary care 2022 Ingår i: Scientific Reports. - London : Nature Publishing Group. - 2045-2322. ; 12 Tidskriftsartikel (refereegranskat)abstract Patients with mental illness have an increased risk of cardiovascular morbidity. The Swedish-developed Health Dialogue is a pedagogical tool to individualize lifestyle counselling, used in specific age-groups to improve lifestyle habits and decrease mortality, but not tested specifically for patients with mental illness. Patients > 18 years old seeking primary care due to symptoms related to mental illness and diagnosed with depression, sleeping disorders, stress and anxiety, were included. A nurse-led health dialogue was conducted, focusing on lifestyle habits, anthropometric measurements, and blood samples, resulting in tailored advice regarding the individual’s risk profile. All 64 participants had lifestyle areas with increased risk level. Approximately 20% had elevated fasting glucose, blood pressure or cholesterol levels, and over 40% had highest risk level in Waist–Hip-Ratio. 30% were overweight, or physical inactive. The results suggest the need of a larger cohort study with long-term follow up, to establish potentially positive effects on wellbeing, and decreased cardiovascular risk in patients with mental illness. © 2022, The Author(s).
47.	Pikkemaat, Miriam, et al. (författare) Swedish Primary Care Physicians' Intentions to Use Telemedicine : A Survey Using a New Questionnaire - Physician Attitudes and Intentions to Use Telemedicine (PAIT) 2021 Ingår i: International Journal of General Medicine. - : Dove Medical Press. - 1178-7074. ; 14, s. 3445-3455 Tidskriftsartikel (refereegranskat)abstract Background: Research on intentions to use telemedicine in primary care is sparse. This survey study explored primary care physicians' intentions to use telemedicine by using a newly developed questionnaire: Physician Attitudes and Intentions to use Telemedicine. Methods: An anonymous web-survey with questions focusing on theory-based predictors of behavioral intentions such as Attitudes, Subjective norms and Perceived behavioral control was designed, validated, and sent to all primary care physicians at 160 primary health care centers in southern Sweden from May to August 2019. The questionnaire had 29 subject items (including 49 multiple-choice sub-items). Main outcome measures were intentions to use three domains of telemedicine and correlation between theory-based predictors and behavioral intentions for using telemedicine. Results: The survey was validated by an expert group, amended, and then tested and retested. A majority of the 198 physicians who returned the web-surveys reported that they did not use e-mails (68%), nor video consultations (78%), chat (81%), or text messages (86%) in their everyday patient work. Yet, most physicians described a positive intention to use telemedicine in patient care for all three studied domains with Attitudes and Perceived behavioral control being significant predictors (p<0.01) for Intentions to use digital contacts (R-2 = 0.54), chronic disease monitoring with digital tools (R-2 = 0.47) and artificial intelligence (R-2 = 0.54). A structural validation of a preliminary instrument - Physician Attitudes and Intention to use Telemedicine (PAIT) - containing 28 sub-items was done by exploratory factor analysis with acceptable explanatory, reliability and sampling adequacy measures. Five factors emerged with Eigenvalues between 1.6 and 11.1 explaining 72% of the variance. Total Cronbach's alpha was 0.91 and Kaiser-Meyer-Olkirk 0.79. Conclusion: Before the covid-19 pandemic, Swedish primary care physicians reported a low use yet high behavioral intention to use telemedicine in a study where we developed the preliminary instrument Physician Attitudes and Intention to use Telemedicine. Perceived behavioral control had the largest predictive value of behavioral intention to use telemedicine. Thus, interventions aiming to increase the use of digital tools in primary care should possibly focus on empowering physicians' self-efficacy towards using them.
48.	Rockler Meurling, Carl, et al. (författare) Telemedicine in Swedish primary health care - a web-based survey exploring patient satisfaction 2023 Ingår i: BMC Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 23:1 Tidskriftsartikel (refereegranskat)abstract Background: Direct-to-consumer telemedicine (TM), with patients having access to a physician via video or text chat, has gradually been introduced into Swedish primary care during the last two decades. Earlier studies have concluded that patients were generally satisfied with TM and the satisfaction rate was consistently above 80% and comparable with in-person visits. Despite the number of studies looking at user experience, studies assessing what factors influence patient satisfaction are lacking. To further develop digital care, it is important to explore the patients’ opinions of this relatively new phenomenon. The primary aim of this study was to explore patient opinions regarding satisfaction with TM-provided care, based on different age groups, sex, symptoms, and which type of health care professional they were assessed by. Methods: The study was a quantitative web survey performed in 2020–2021 in which 688 patients using a TM provider in Southern Sweden responded. The results were analysed using Chi-2 test with the main outputs; satisfaction level and percentage that would use TM for similar symptoms in the future. Results: The results from the survey population show that patients that were assessed by a doctor were more likely to intend to use TM in the future and were more satisfied with the visit than patients assessed by a nurse. Our results also show that patients older than 70 years of age were less likely to use TM again compared to the total population. Conclusion: This study shows that patient satisfaction with TM varied depending on the patient’s age. The older patients were less satisfied than their younger equivalents. For patient satisfaction to be high, it was also crucial which health care provider the patient had been assessed by. The patients were more satisfied when assessed by a doctor than by a nurse. In addition, the study shows that patient satisfaction with TM was generally comparable to traditional care.

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