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1.	Bjerkeli, Pernilla J., et al. (author) Does early identification of high work related stress affect pharmacological treatment of primary care patients?-analysis of Swedish pharmacy dispensing data in a randomised control study 2020 In: Bmc Family Practice. - : Springer Science and Business Media LLC. - 1471-2296. ; 21:1 Journal article (peer-reviewed)abstract Background The study is part of a randomised controlled trial with the overall aim to evaluate if use of the Work Stress Questionnaire (WSQ), combined with feedback at consultation, can be used by healthcare professionals in primary health care to prevent sickness absence. The specific aim of the present study was to investigate whether there were differences in pharmacy dispensing of prescription medications between the intervention group and the control group. Methods The study was a randomized controlled trial. Non-sick-listed employed women and men, aged 18 to 64 years, seeking care at primary health care centres (PHCCs) were eligible participants. The intervention included early identification of work-related stress by the WSQ, general practitioner (GP) training and GP feedback at consultation. Pharmacy dispensing data from the Swedish Prescription Drug Register for a period of 12 months following the intervention was used. Primary outcomes were the number of different medications used, type of medication and number of prescribing clinics. Data was analysed using Mann Whitney U tests and chi-square tests. Results The study population included 271 individuals (132 in the intervention group and 139 in the control group). The number of different medications used per individual did not differ significantly between the control group (median 4.0) and the intervention group (median 4.0, p-value 0.076). The proportion of individuals who collected more than 10 different medications was higher in the control group than in the intervention group (15.8% versus 4.5%, p = 0.002). In addition, the proportion of individuals filling prescriptions issued from more than three different clinics was higher in the control group than in the intervention group (17.3% versus 6.8%, p = 0.007). Conclusion Systematic use of the WSQ combined with training of GPs and feedback at consultation may affect certain aspects of pharmacological treatment in primary health care patients. In this randomised control trial, analysis of pharmacy dispensing data show that patients in the intervention group had less polypharmacy and filled prescriptions issued from a smaller number of different clinics.
2.	Hartman, E. A. R., et al. (author) Decisions on antibiotic prescribing for suspected urinary tract infections in frail older adults: a qualitative study in four European countries 2022 In: Age and ageing. - : Oxford University Press (OUP). - 0002-0729 .- 1468-2834. ; 51:6 Journal article (peer-reviewed)abstract Background a suspected urinary tract infection (UTI) is the most common reason to prescribe antibiotics in a frail older patient. Frequently, antibiotics are prescribed unnecessarily. To increase appropriate antibiotic use for UTIs through antibiotic stewardship interventions, we need to thoroughly understand the factors that contribute to these prescribing decisions. Objectives (1) to obtain insight into factors contributing to antibiotic prescribing for suspected UTIs in frail older adults. (2) To develop an overarching model integrating these factors to guide the development of antibiotic stewardship interventions for UTIs in frail older adults. Methods we conducted an exploratory qualitative study with 61 semi-structured interviews in older adult care settings in Poland, the Netherlands, Norway and Sweden. We interviewed physicians, nursing staff, patients and informal caregivers. Results participants described a chain of decisions by patients, caregivers and/or nursing staff preceding the ultimate decision to prescribe antibiotics by the physician. We identified five themes of influence: (1) the clinical situation and its complexity within the frail older patient, (2) diagnostic factors, such as asymptomatic bacteriuria, (3) knowledge (gaps) and attitude, (4) communication: interprofessional, and with patients and relatives and (5) context and organisation of care, including factors such as availability of antibiotics (over the counter), antibiotic stewardship efforts and factors concerning out-of-hours care. Conclusions decision-making on suspected UTIs in frail older adults is a complex, multifactorial process. Due to the diverse international setting and stakeholder variety, we were able to provide a comprehensive overview of factors to guide the development of antibiotic stewardship interventions.
3.	Skoglund, Ingmarie, 1955, et al. (author) A randomized controlled trial comparing two ways of providing evidence-based drug information to GPs 2013 In: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 31:2, s. 67-72 Journal article (peer-reviewed)abstract Objective. To investigate whether tailored evidence-based drug information (EBDI) to general practitioners (GPs) can change the proportion of ACE inhibitor prescriptions more effectively than EBDI provided as usual three and six months after the intervention.Design. Randomized controlled trial.Setting. GPs in southern Sweden working at primary health care centres (PHCCs) in seven drug and therapeutic committee areas.Intervention. EBDI tailored to motivational interviewing (MI) technique and focused on the benefit aspect was compared with EBDI provided as usual.Subjects. There were 408 GPs in the intervention group and 583 GPs in the control group.Main outcome measures. Change in proportion of ACE inhibitor prescriptions relative to the sum of ACE inhibitors and angiotensin receptor blockers, three and six months after the intervention.Results. The GPs' average proportions of prescribed ACE inhibitors increased in both groups. No statistically significant differences in the change of proportions were found between intervention and control groups. Information was provided to 29% of GPs in both groups.Conclusion. This study could not prove that specially tailored EBDI using MI implements guidelines more effectively than EBDI provided as usual.
4.	Skoglund, Ingmarie, 1955, et al. (author) GPs' opinions of public and industrial information regarding drugs : a cross-sectional study 2011 In: BMC Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 11, s. 204- Journal article (peer-reviewed)abstract Background: General Practitioners {GP} in Sweden prescribe more than 50% of all prescriptions. Scientific knowledge on the opinions of GPs regarding drug information has been sparse. Such knowledge could be valuable when designing evidence-based drug information to GPs. GPs' opinions on public- and industry-provided drug information are presented in this article. Methods: A cross-sectional study using a questionnaire was answered by 368 GPs at 97 primary-health care centres {PHCC}. The centres were invited to participate by eight out of 29 drug and therapeutic committees {DTCs}. A multilevel model was used to analyse associations between opinions of GPs regarding drug information and whether the GPs worked in public sector or in a private enterprise, their age, sex, and work experience. PHCC and geographical area were included as random effects. Results: About 85% of the GPs perceived they received too much information from the industry, that the quality of public information was high and useful, and that the main task of public authorities was to increase the GPs' knowledge of drugs. Female GPs valued information from public authorities to a much greater extent than male GPs. Out of the GPs, 93% considered the main task of the industry was to promote sales. Differences between the GPs' opinions between PHCCs were generally more visible than differences between areas. Conclusions: Some kind of incentives could be considered for PHCCs that actively reduce drug promotion from the industry. That female GPs valued information from public authorities to a much greater extent than male GPs should be taken into consideration when designing evidence-based drug information from public authorities to make implementation easier.
5.	Af Winklerfelt Hammarberg, Sandra, et al. (author) Outcomes of psychiatric interviews and self-rated symptom scales in people on sick leave for common mental disorders: an observational study. 2022 In: BMJ open. - : BMJ. - 2044-6055. ; 12:6 Journal article (peer-reviewed)abstract To investigate the correspondence between diagnoses on sick leave certificates and diagnoses made in structured psychiatric interviews. Secondary aims were to investigate length of sick leave by diagnoses on sick leave certificates, diagnoses made in structured interviews and symptom severity.Observational study consisting of a secondary analysis of data from a randomised controlled trial and an observational study.The regions of Stockholm and Västra Götaland, Sweden.480 people on sick leave for common mental disorders.Participants were examined with structured psychiatric interviews and self-rated symptom severity scales.(1) Sick leave certificate diagnoses, (2) diagnoses from the Mini International Neuropsychiatric Interview and the Self-rated Stress-Induced Exhaustion Disorder (SED) Instrument (s-ED), (3) symptom severity (Montgomery-Asberg Depression Rating Scale-self-rating version and the Karolinska Exhaustion Disorder Scale) and (4) number of sick leave days.There was little correspondence between diagnoses on sick leave certificates and diagnoses made in structured psychiatric interviews. Many participants on sick leave for SED, anxiety disorder or depression fulfilled criteria for other mental disorders. Most on sick leave for SED (76%) and anxiety disorder (67%) had depression (p=0.041). Length of sick leave did not differ by certificate diagnoses. Participants with SED (s-ED) had longer sick leave than participants without SED (144 vs 84 days; 1.72 (1.37-2.16); p<0.001). More severe symptoms were associated with longer sick leave.Diagnoses on sick leave certificates did not reflect the complex and overlapping nature of the diagnoses found in the structured psychiatric interviews. This finding is relevant to the interpretation of information from health data registers, including studies and guidelines based on these data. A result of clinical interest was that more severe symptoms predicted long-term sick leave better than actual diagnoses.
6.	Hange, Dominique, 1963, et al. (author) Associations between antidepressant therapy, work ability, and sick leave for patients with common mental disorders within a two-year perspective A longitudinal observational cohort study in Swedish primary care 2021 In: Heliyon. - : Elsevier BV. - 2405-8440. ; 7:5 Journal article (peer-reviewed)abstract Background: An increasing number of patients are on sick leave because of common mental disorders (CMD), with or without antidepressant therapy. There is a lack of long-term follow-up studies in the primary care context, where most of the patients are treated. The importance of identifying potential factors associated with work ability for CMD patients is increasingly in focus. Objective: To investigate the associations between using antidepressants, sick leave duration, reported work ability and psychological symptoms among patients with CMD during a two-year observation period in the primary care context. Methods: Longitudinal observational cohort study at 28 Primary Care Centers in Region Vastra Gotaland, Sweden, including 182 patients with an employment and on sick leave for CMD. The following outcomes were assessed: work ability measured with WAI, depressive symptoms with MADRS-S, anxiety symptoms with BAI, fatigue symptoms with KEDS, quality of life with EQ-5D, and days of sick leave. The data were compared between the groups that used and did not use antidepressants, during the 24-months observation period. Results: Work ability and health-related quality of life increased over time in both groups. A steeper decrease of depressive symptoms, anxiety symptoms as well as an increased health-related quality of life at 3, 6 and 12 months was found in the group without antidepressants, although both groups levelled off at 24 months. In both groups, a higher work ability at baseline was associated with less two-year sick leave. Conclusion: Our study indicates that a high work ability at baseline has a strong association with a lower total net and gross sick leave duration during the entire two-year follow-up period for patients with CMD in primary health care, irrespective of use of antidepressants. Using WAI in primary health care could therefore be helpful in predicting return to work. Use of antidepressants during the CMD episode could indicate initially a more pronounced overall symptom pattern, motivating introduction of antidepressants, rather than prolonging the sick leave period.
7.	Heltveit-Olsen, S. R., et al. (author) Experiences and management strategies of Norwegian GPs during the COVID-19 pandemic: a longitudinal interview study 2023 In: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 41:1, s. 2-12 Journal article (peer-reviewed)abstract Objective When the COVID-19 pandemic reached Norway, primary health care had to reorganize to ensure safe patient treatment and maintain infection control. General practitioners (GPs) are key health care providers in the municipalities. Our aim was to explore the experiences and management strategies of Norwegian GPs during the COVID-19 pandemic - over time, and in the context of a sudden organizational change. Design Longitudinal qualitative interview study with two interview rounds. The first round of interviews was conducted from September-December 2020, the second round from January-April 2021. In the first interview round, we performed eight semi-structured interviews with GPs from eight municipalities in Norway. In the second round, five of the GPs were re-interviewed. Consecutive interviews were performed 2-4 months apart. To analyze the data, we used thematic analysis. Results The COVID-19 pandemic required GPs to balance several concerns, such as continuity of care and their own professional efforts. Several GPs experienced challenges in the collaboration with the municipality and in relation to defining their own professional position. Guided by The Norwegian Association of General practitioners, The Norwegian College of General Practice and collegial support, they found viable solutions and ended up with a feeling of having adapted to a new normal. Conclusions Although our study demonstrates that the GPs adapted to the changing conditions, the current municipal health care models are not ideal. There is a need for clarification of responsibilities between GPs and the municipality to facilitate a more coordinated future pandemic response.
8.	Heltveit-Olsen, Silje Rebekka, et al. (author) Local management of the COVID-19 pandemic in Norway: a longitudinal interview study of municipality chief medical officers 2024 In: Scandinavian Journal of Primary Health Care. - 0281-3432 .- 1502-7724. ; 41:1, s. 214-224 Journal article (peer-reviewed)abstract Objective: To explore the experiences and views of Norwegian Municipality Chief Medical Officers (MCMOs) on preparedness, collaboration, and organization during the COVID-19 pandemic to gain insight into local crisis management of value for future pandemic responses. Design: Longitudinal qualitative interview study. We conducted semi-structured digital interviews with nine MCMOs working in different municipalities in Norway from September to December 2020. Five MCMOs were re-interviewed from January to April 2021. We used thematic analysis to analyze the data. Results: Through the analysis, three major themes were identified in the material; 1) The view of preparedness changed from being low-priority and dormant to the desire to strengthen preparedness as a permanent measure; 2) The nature of the pandemic forced a change in internal and external communication and collaboration for the MCMOs towards direct dialogue, teamwork and digital networking; 3) The pandemic changed the role and position of the MCMO within the municipal organization. Although most MCMOs were given a leading role in the municipal pandemic response, some MCMOs experienced that they were not positioned to fully exercise their intended role. In our material, de-authorization of the MCMO role seemed to coincide with the increasing size and organizational complexity of the municipality. Conclusions: The Norwegian pandemic response and outcome have been regarded as successful internationally. Although the MCMOs managed to implement flexible and quick responses facilitated by teamwork, dialogue, and joint sensemaking, they also identified several challenges and shortcomings of the Norwegian pandemic preparedness requiring organizational and financial changes to sustain future health system resilience.
9.	Hoste, M. E., et al. (author) The experiences of patients ill with COVID-19-like symptoms and the role of testing for SARS-CoV-2 in supporting them: A qualitative study in eight European countries during the first wave of the pandemic 2023 In: European Journal of General Practice. - 1381-4788. ; 29:2 Journal article (peer-reviewed)abstract BackgroundAccess to testing during the first wave of the COVID-19 pandemic was limited, impacting patients with COVID-19-like symptoms. Current qualitative studies have been limited to one country or were conducted outside Europe.ObjectivesTo explore - in eight European countries - the experiences of patients consulting in primary care with COVID-19-like symptoms during the first wave of the pandemic.MethodsSixty-six semi-structured interviews, informed by a topic guide, were conducted by telephone or in person between April and July 2020. Patients with COVID-19-like symptoms were purposively recruited in primary care sites in eight countries and sampled based on age, gender, and symptom presentation. Deductive and inductive thematic analysis techniques were used to develop a framework representing data across settings. Data adequacy was attained by collecting rich data.ResultsSeven themes were identified, which described the experiences of patients consulting. Two themes are reported in this manuscript describing the role of COVID-19 testing in this experience. Patients described significant distress due to their symptoms, especially those at higher risk of complications from COVID-19, and those with severe symptoms. Patients wanted access to testing to identify the cause of their illness and minimise the burden of managing uncertainty. Some patients testing positive for COVID-19 assumed they would be immune from future infection.ConclusionPatients experiencing novel and severe symptoms, particularly those with comorbidities, experienced a significant emotional and psychological burden due to concerns about COVID-19. Testing provided reassurance over health status and helped patients identify which guidance to follow. Testing positive for SARS-CoV-2 led to some patients thinking they were immune from future infection, thus influencing subsequent behaviour.
10.	Hällås, E., et al. (author) “That’s probably how you would want care to be” - experiences of sick leave teams at a health center, a mixed method study 2023 In: BMC Primary Care. - 2731-4553. ; 24:1 Journal article (peer-reviewed)abstract Background: The health center where this study was performed the management wanted to test whether a sick leave team provided the physicians with better conditions for the task of assessing sick leave. The goals were to ensure the quality of the assessment of patients with sick leave needs and to improve the work environment. The aim of this study was to take part in the staff's experiences of having access to and working in sick leave teams and how the working method affected the number of sick leave patients and sick leave pattern. Methods: A mixture of qualitative and quantitative methods. Two focus groups were conducted with a total of 11 participants. The head of the health center formed the focus groups, which consisted of 6 doctors, 3 district nurses, 1 rehab coordinator and 1 psychologist. Aggregated sick leave data for full-time and part-time sick leave of more than 90, 180 and 360days, respectively, were obtained and compiled at project start and end, and from the corresponding period 18months before project start. Results: The introduction of sick leave teams with physicians and rehabilitation coordinator for patients who turn to the health center for mental illness and / or musculoskeletal problems emerged three main categories from the analysis of the focus group discussions: working environment, clear roles and in-depth competence. The total number of people who were on sick leave more than 365days decreased by 27% between start and the end of the project, and the proportion of women increased by 11%. Conclusions: The study shows that the complex task of sick leave can be perceived as positive by physicians with the support of teamwork. The working method is similar to that applied in occupational health care, where the physician is not alone with this task. This can also be a way to make primary care a more attractive workplace.
11.	Jonasson, Grethe, 1945, et al. (author) The rise and fall of the alveolar process: Dependency of teeth and metabolic aspects 2018 In: Archives of Oral Biology. - : Elsevier BV. - 0003-9969 .- 1879-1506. ; 96, s. 195-200 Research review (peer-reviewed)abstract © 2018 The Authors The alveolar bone has a unique capacity to follow the teeth's movements. It is formed around erupting teeth and their periodontal ligaments: the more the teeth have erupted, the larger the alveolar process. Throughout life the teeth erupt and migrate in an occlusal and mesial direction to compensate for attrition, an evolutionary trait. After tooth extraction, the alveolar process is resorbed to varying degrees. The mandibular alveolar bone mirrors skeletal bone condition. Due to fast bone turnover (which is the fastest in the whole skeleton), low bone mass and increased fracture risk may first be seen here. If a periapical radiograph of the mandibular premolars shows a dense trabeculation with well-mineralized trabeculae and small intertrabecular spaces, it is a reliable sign of normal skeletal bone density (BMD) and low skeletal fracture risk, whereas a sparse trabecular pattern indicates osteopenia and high fracture risk. The bone turnover rate in the mandible is twice that of the maxilla, and may, hypothetically, play a role in the development of osteonecrosis of the jaw (ONJ), which has been found mainly in the mandibular alveolar process?
12.	Nejati, Shabnam, 1972, et al. (author) Correspondence Between the Neuropsychiatric Interview M.I.N.I. and the BDI-II and MADRS-S Self-Rating Instruments as Diagnostic Tools in Primary Care Patients with Depression 2020 In: International Journal of General Medicine. - 1178-7074. ; 13, s. 177-183 Journal article (peer-reviewed)abstract Objective: To investigate the correspondence between the diagnoses received by patients with symptoms of common mental disorder attending primary care, based on the diagnostic instrument International Neuropsychiatric Interview (M.I.N.I.) and the self-assessment instruments such as Beck Depression Inventory (BDI-II) and Montgomery-Asberg Depression Rating Scale - self-rating version (MADRS-S), respectively. Design: Data were collected from a prospective observational study, ADAS, between 2014 and 2015. Setting: Twenty-eight primary care centers in Region Vastra Gotaland, Sweden. Patients: A total of 192 patients, 18-60 years of age, on sick leave >= 14 days, with mild/moderate depression, anxiety syndrome, and stress-related mental illness were included. Main Outcome Measures: Scores of the assessment instruments (BDI-II and MADRS-S) on inclusion, sensitivity, specificity, positive (PPV) and negative predictive value (NPV) for BDI-II and MADRS-S, respectively, with M.I.N.I used as diagnostic instrument. Results: Using M.I.N.I. as gold standard, the BDI-II and MADRS-S showed almost the same sensitivity (86.9% and 87.4%, respectively), but specificity for MADRS-S was doubled compared to BDI-II (36% and 18%, respectively). There was a significant association between MADRS-S and M.I.N.I. (p=0.027). However, the same analysis between BDI and M.I.N.I. was not statistically significant (p=0.635). NPV and PPV were calculated from assumed prevalences (10% and 75%) and were higher for MADRS-S compared to BDI-II. The PPV differences were between 2% and 7% and NPV differences were between 3% and 19%. Conclusion: With M.I.N.I. as gold standard, MADRS-S performs better than BDI-II as a self-assessment tool in the primary care context for depression diagnostics.
13.	Nissling, Linnea, 1991, et al. (author) Primary Care Peer-Supported Internet-Mediated Psychological Treatment for Adults With Anxiety Disorders: Mixed Methods Study. 2020 In: JMIR formative research. - : JMIR Publications Inc.. - 2561-326X. ; 4:8 Journal article (peer-reviewed)abstract The effect of internet-delivered cognitive behavioral therapy (iCBT) on anxiety in adults is well-known. However, patient dropouts and poor adherence to treatment are common. Feelings of belonging and empowerment from the treatment might be key to the completion of iCBT. Peer support workers are people with a personal experience of mental health problems, trained to provide professional support to people who require mental health care.This study aims to assess patient experiences; the feasibility, safety, and acceptability; and preliminary effectiveness on anxiety and depression, empowerment, and adherence to treatment in an 8-week peer-supported iCBT program for patients with anxiety disorders treated in primary care.This was a single-arm mixed methods feasibility study. Participants were patients referred to a central unit for iCBT in primary care. Quantitative data were collected pre-, post-, and 3 months postintervention. Qualitative data were collected through semistructured interviews.A total of 9 participants completed the quantitative outcome assessment. Statistically significant improvements were observed in perceived empowerment at a 3-month follow-up, and significant decreases in anxiety, depression, and psychological distress at the end of the treatment were maintained at a 3-month follow-up. In total, 8 of the 9 patients showed improvement in the severity of their symptoms of anxiety. Adherence to treatment was good among the participants. No serious adverse events were reported. Eight participants were enrolled in the qualitative analysis. The qualitative results showed 3 main themes: (1) real contact in an online world, (2) empowering experiences, and (3) being behind the wheel. Qualitative results largely emphasized the personal relationship and supported the acceptability of adding peer support to iCBT.Peer support in digital treatment seems to be a safe and acceptable intervention. The preliminary results suggest the effectiveness of peer support on patient empowerment, anxiety, depression, psychological distress, and adherence to treatment. The results indicate the need for future studies to evaluate the effect of adding peer support to iCBT in larger randomized controlled trials.
14.	Skoglund, Ingmarie, 1955, et al. (author) A bridge over troubled water? A qualitative study of primary care patients' experiences of a rehabilitation program 2018 In: Journal of Multidisciplinary Healthcare. - : Informa UK Limited. - 1178-2390. ; 11, s. 457-466 Journal article (peer-reviewed)abstract Purpose: The aim of this study was to explore how patients on sick leave experienced and perceived the early collaboration work model (ECM) for rehabilitation. Patients and methods: Data were collected via focus group discussions and individual interviews with 15 patients on sick leave, at nine primary health care centers. The systematic text condensation method described by Malterud was used for thematic analysis of meaning and content of data across cases. Results: The participants perceived that sharing experiences with others in a similar situation was restorative. They described the importance of coordination in the program as well as the efforts of the rehabilitation coordinator, who helped with daily structure and support in the beginning as well as encouragement throughout the sick leave period. Some participants felt ashamed of being on sick leave and of being outside the community. Conclusion: ECM with a rehabilitation coordinator who could share responsibility with the patient during the entire sick leave period was perceived to be of support during rehabilitation.
15.	Skoglund, Ingmarie, 1955, et al. (author) GPs' thoughts on prescribing medication and evidence-based knowledge: the benefit aspect is a strong motivator. A descriptive focus group study. 2007 In: Scandinavian journal of primary health care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 25:2, s. 98-104 Journal article (peer-reviewed)abstract OBJECTIVE: To describe GPs' thoughts of prescribing medication and evidence-based knowledge (EBM) concerning drug therapy. DESIGN: Tape-recorded focus-group interviews transcribed verbatim and analysed using qualitative methods. SETTING: GPs from the south-eastern part of Västra Götaland, Sweden. SUBJECTS: A total of 16 GPs out of 178 from the south-eastern part of the region strategically chosen to represent urban and rural, male and female, long and short GP experience. METHODS: Transcripts were analysed using a descriptive qualitative method. RESULTS: The categories were: benefits, time and space, and expert knowledge. The benefit was a merge of positive elements, all aspects of the GPs' tasks. Time and space were limitations for GPs' tasks. EBM as a constituent of expert knowledge should be more customer adjusted to be able to be used in practice. Benefit was the most important category, existing in every decision-making situation for the GP. The core category was prompt and pragmatic benefit, which was the utmost benefit. CONCLUSION: GPs' thoughts on evidence-based medicine and prescribing medication were highly related to reflecting on benefit and results. The interviews indicated that prompt and pragmatic benefit is important for comprehending their thoughts.
16.	Skoglund, Ingmarie, 1955, et al. (author) Influence of antidepressant therapy on sick leave in primary care: ADAS, a comparative observational study. 2019 In: Heliyon. - : Elsevier BV. - 2405-8440. ; 5:1 Journal article (peer-reviewed)abstract Compared to other European countries, Sweden's yearly sick leave expenditures are moderate. Common mental disorders (CMD) are important causes of sick leave, affecting 10-15% of the adult population. A Swedish register based study indicates that antidepressant therapy for patients on long-term sick leave for CMD leads to longer sick leave and higher frequency of non-time-limited sickness compensation as compared to psychotherapy, work oriented rehabilitation, and other therapies.To verify if patients on antidepressant therapy and on long-term sick leave for depression, anxiety and stress-related mental disorders have a longer sick leave than patients treated with other therapies.Prospective, observational study at 28 primary health care centers in the Region Västra Götaland, Sweden, including 192 patients on sick leave for CMD. Outcome measures were gross and net sick leave days.There were no significant differences in sick leave days (gross or net) due to CMD when comparing the patients treated and not treated with antidepressants during the 12 month observation period. The groups differed at baseline only concerning frequency of exhaustion disorder, with a higher frequency of exhaustion disorder in the group without antidepressants. Analysis of other possible factors associated with shorter or longer sick leave only showed associations with the patient's own perception of possibility of returning to work in near and distant future. An important factor associated with longer sick leave was the patient's own perception of possibility of return to present workplace. As CMD are important causes of sick leave and sick leave costs, this factor should be highlighted in future research on the rehabilitation process.
17.	Skoglund, Ingmarie, 1955, et al. (author) Lycka och frustration i professionell svenska för utrikesfödda läkare 2021 In: Högskolepedagogisk konferens, HKG2021, 23 november, Göteborgs universitet. Conference paper (other academic/artistic)
18.	Skoglund, Ingmarie, 1955 (author) Prescribing drugs in primary health care - Thoughts, information strategy and outcome 2012 Doctoral thesis (other academic/artistic)abstract Aims: General aim; to investigate whether tailored evidence-based drug information provided to general practitioners can be implemented more effectively than evidence-based drug information provided as usual. Specific aims; to describe general practitioners’ (GPs) thoughts on prescribing medication and evidence-based drug information: to explore GPs’ attitudes on drug information: to investigate whether tailored evidence-based drug information can influence these attitudes differently or the prescribing behaviour more effectively than drug information provided as usual.Methods: Focus-group interviews with a descriptive qualitative approach (I), a cross sectional survey using an attitude questionnaire analysed in a multilevel mode and by multiple logistic regression (II), and a randomised controlled study (RCTs, III and IV) were used. In the two latter medical information officers (MIOs) providing drug information to GPs were matched pair-wise and randomised into intervention or control groups. The GPs were cluster randomised by their MIOs. The intervention MIOs were trained to provide evidence-based drug information tailored with motivational interviewing and to focus on the benefit aspect. The control MIOs provided evidence-based drug information as usual. Data was collected by an attitude questionnaire (III), analysed by the Mann-Whitney test and intention-to-treat. Prescriptions for antihypertensive drugs were collected (IV). The change in proportion of ACE inhibitor prescriptions relative to the sum of ACE inhibitors and Angiotensin II receptor blockers, during 0–3 and 4–6 months after the intervention, was analysed with multiple linear regression, by intention-to-treat and per protocol.Results: GPs thoughts on prescribing medication and on evidence-based medicine dealt much with benefit. The core category ‘prompt and pragmatic benefit’ was the utmost benefit (I). A majority of the GPs perceived the information from the industry as too excessive; that the main task of the industry was to promote sales. The quality of public information was regarded as high and useful. Female GPs valued public information to a much greater extent than did male GPs (II). The changes in attitudes to drug information did not differ between the two groups (III). Information was given to 29% of GPs in both groups (IV). The GPs’ average change in proportion of prescribed ACE inhibitors increased in both groups after the intervention. General conclusions and implications: GPs’ thoughts on evidence-based drug information and prescribing medication relates predominantly to ‘prompt and pragmatic benefit’; delivered immediately, useful and handy. Female GPs valued public drug information much more than male GPs did, which might be useful to know in future implementation. GPs’ attitudes on drug information did not differ between the groups after the intervention. Neither did the change in proportion of prescribed ACE inhibitors differ. This indicates no benefit in using tailored evidence-based drug information compared to drug information provided as usual.
19.	Sundvall, Pär-Daniel, et al. (author) Rational antibiotic prescribing in primary care: qualitative study of opportunities and obstacles 2020 In: BJGP Open. - 2398-3795. ; 4:4 Journal article (peer-reviewed)abstract Background: The Swedish strategic programme against antibiotic resistance (Strama) has worked towards rational use of antibiotics, and Swedish antibiotic prescribing is low. Aim: To explore how opportunities and obstacles for rational antibiotic prescribing were perceived by primary health care centres (PHCCs). Design & setting: A qualitative study of 50 randomly selected reports from approximately 200 PHCCs in 2013 and 2016 in Region Västra Götaland, Sweden. Method: One assigned GP at each PHCC reported yearly in an open-ended questionnaire on how the PHCC worked to improve antibiotic prescribing. The report included several antibiotic-related tasks and a summary of reflective meetings with the doctors, the head of the PHCC, and, preferably, also the nurses. The reports were qualitatively analysed using Malterud’s systematic text condensation (STC). Results: ‘Everyone wants to do right, but sometimes you do not know what’s right or wrong.’ Knowledge about diagnosis and treatment of infectious diseases was highlighted. Knowledge and skills had to be internalised by the clinician in order to bring about behavioural change. This could be achieved through reflective, collegial dialogues where consensus often was found. Structural factors at the PHCC could provide good conditions for ‘doing right’, but could also constitute obstacles. Teamwork involving all personnel was important to achieve rational antibiotic prescribing. Conclusion: Enablers for rational antibiotic prescribing were knowledge, reflective collegial dialogues, a well organised workplace, and a collaborating team. Obstacles were lack of knowledge, insufficient staffing, perceived lack of time, and overuse of laboratory tests. Patients’ attitudes and expectations could be both.
20.	Wanat, M., et al. (author) Patients’ and clinicians’ perspectives on the primary care consultations for acute respiratory infections during the first wave of the COVID-19 pandemic: an eight-country qualitative study in Europe 2022 In: BJGP Open. - 2398-3795. ; 6:2 Journal article (peer-reviewed)abstract Background: The impact of the COVID-19 pandemic on patients’ and clinicians’ perceptions of healthcare-seeking behaviour and delivery of care is unclear. The pandemic accelerated the use of remote care, and understanding its benefits and drawbacks may inform its implementation during current and future healthcare emergencies. Aim: To explore patients’ and primary care professionals’ (PCPs) experiences of primary care delivery in the first wave of the pandemic. Design & setting: Qualitative study using semi-structured interviews in primary care in eight European countries (England, Ireland, Belgium, the Netherlands, Greece, Poland, Sweden, and Germany). Method: A total of 146 interviews were conducted with 80 PCPs and 66 patients consulting for respiratory tract infection (RTI) symptoms, in eight European countries. Data were collected between April and July 2020, and analysed using thematic analysis. Results: It was found that patients accepted telemedicine when PCPs spent time to understand and address their concerns, but a minority preferred in-person consultations. PCPs felt that remote consultations created emotional distance between themselves and patients, and they reported having to manage diverse COVID-19-related medical and social concerns. Conclusion: Remote consultations for RTI symptoms may be acceptable long term if both groups are happy to use this format, but it is important that PCPs take time to address patients’ concerns and provide safety-netting advice.
21.	Wanat, M., et al. (author) Supporting Primary Care Professionals to Stay in Work During the COVID-19 Pandemic: Views on Personal Risk and Access to Testing During the First Wave of Pandemic in Europe 2021 In: Frontiers in Medicine. - : Frontiers Media SA. - 2296-858X. ; 8 Journal article (peer-reviewed)abstract Background: Minimising primary care professionals' (PCPs) risk of SARS-CoV-2 infection is crucial to ensure their safety as well as functioning health care system. PCPs' perspectives on the support they needed in the early stages of a public health crisis can inform future preparedness. Aim: To understand PCPs' experiences of providing care during the COVID-19 pandemic, with focus on personal risk from COVID-19 and testing. Design and Setting: Qualitative study using semi-structured interviews with PCPs in England, Belgium, the Netherlands, Ireland, Germany, Poland, Greece and Sweden, between April and July 2020. Method: Interviews were analysed using a combination of inductive and deductive thematic analysis techniques. Results: Eighty interviews were conducted, showing that PCPs tried to make sense of their risk of both contracting and severity of COVID-19 by assessing individual risk factors and perceived effectiveness of Personal Protective Equipment (PPE). They had limited access to PPE yet continued providing care as their "duty." Some PCPs felt that they were put in high-risk situations when patients or colleagues were not flagging symptoms of COVID-19. Not having access to testing in the initial stages of the pandemic was somewhat accepted but when available, was valued. Conclusion: Access to adequate PPE and testing, as well as training for staff and education for patients about the importance of ensuring staff safety is crucial. Given PCPs' varied response in how they appraised personal risk and their tolerance for working, PCPs may benefit from the autonomy in deciding how they want to work during health emergencies.
22.	Wanat, M., et al. (author) Transformation of primary care during the COVID-19 pandemic: experiences of healthcare professionals in eight European countries 2021 In: British Journal of General Practice. - : Royal College of General Practitioners. - 0960-1643 .- 1478-5242. ; 71:709 Journal article (peer-reviewed)abstract Background I'm Tian/care has a crucial role in responding to the COVID-19 pandemic as the first point of patient care and gatekeeper to secondary care. Qualitative studies exploring the experiences of healthcare professionals during the COVID-19 pandemic have mainly focused on secondary care. Aim To gain an understanding of the experiences of European primary care professionals (PCPs) working during the first peak of the COVID-19 pandemic. Design and setting An exploratory qualitative study, using semi structured interviews in primary care in England, Belgium, the Netherlands. Ireland. Germany, Poland, Greece, and Sweden, between April and July 7020. Method Interviews were audiorecorded, transcribed, and analysed using a combination of inductive and deductive thematic analysis techniques. Results Fighty interviews were conducted with PCPs. PCPs had to make their own decisions on how to rapidly transform services in relation to COVID-19 and non-COVID-19 care. Despite being overwhelmed with guidance. they often lacked access to practical training. Consequently. PCPs turned to their colleagues for moral support and information to try to quickly adjust to new ways of working, including remote care. arid to deal with uncertainty. Conclusion PCPs rapidly transformed primary care delivery despite a number of challenges. Representation of primary care at policy level and engagement with local primary care champions are needed to facilitate easy and coordinated access to practical information on how to adapt services, ongoing training, and access to appropriate mental health support services for PCPs. Preservation of autonomy and responsiveness of primary care are critical to preserve the ability for rapid transformation in any future crisis of care delivery.

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