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1.
  • af Winklerfelt Hammarberg, Sandra, et al. (author)
  • Clinical effectiveness of care managers in collaborative primary health care for patients with depression : 12-and 24-month follow-up of a pragmatic cluster randomized controlled trial
  • 2022
  • In: BMC Primary Care. - : Springer Nature. - 2731-4553. ; 23:1
  • Journal article (peer-reviewed)abstract
    • Background In previous studies, we investigated the effects of a care manager intervention for patients with depression treated in primary health care. At 6 months, care management improved depressive symptoms, remission, return to work, and adherence to anti-depressive medication more than care as usual. The aim of this study was to compare the long-term effectiveness of care management and usual care for primary care patients with depression on depressive symptoms, remission, quality of life, self-efficacy, confidence in care, and quality of care 12 and 24 months after the start of the intervention. Methods Cluster randomized controlled trial that included 23 primary care centers (11 intervention, 12 control) in the regions of Vastra Gotaland and Dalarna, Sweden. Patients >= 18 years with newly diagnosed mild to moderate depression (n = 376: 192 intervention, 184 control) were included. Patients at intervention centers co-developed a structured depression care plan with a care manager. Via 6 to 8 telephone contacts over 12 weeks, the care manager followed up symptoms and treatment, encouraged behavioral activation, provided education, and communicated with the patient's general practitioner as needed. Patients at control centers received usual care. Adjusted mixed model repeated measure analysis was conducted on data gathered at 12 and 24 months on depressive symptoms and remission (MADRS-S); quality of life (EQ5D); and self-efficacy, confidence in care, and quality of care (study-specific questionnaire). Results The intervention group had less severe depressive symptoms than the control group at 12 (P = 0.02) but not 24 months (P = 0.83). They reported higher quality of life at 12 (P = 0.01) but not 24 months (P = 0.88). Differences in remission and self-efficacy were not significant, but patients in the intervention group were more confident that they could get information (53% vs 38%; P = 0.02) and professional emotional support (51% vs 40%; P = 0.05) from the primary care center. Conclusions Patients with depression who had a care manager maintained their 6-month improvements in symptoms at the 12- and 24-month follow-ups. Without a care manager, recovery could take up to 24 months. Patients with care managers also had significantly more confidence in primary care and belief in future support than controls.
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  • Augustsson, Pia, 1967, et al. (author)
  • Implementation of care managers for patients with depression: A cross-sectional study in Swedish primary care
  • 2020
  • In: BMJ Open. - : BMJ. - 2044-6055. ; 10:5
  • Journal article (peer-reviewed)abstract
    • Objectives To perform an analysis of collaborative care with a care manager implementation in a primary healthcare setting. The study has a twofold aim: (1) to examine clinicians' and directors' perceptions of implementing collaborative care with a care manager for patients with depression at the primary care centre (PCC), and (2) to identify barriers and facilitators that influenced this implementation. Design A cross-sectional study was performed in 2016-2017 in parallel with a cluster-randomised controlled trial. Setting 36 PCCs in south-west Sweden. Participants PCCs' directors and clinicians. Outcome Data regarding the study's aims were collected by two web-based questionnaires (directors, clinicians). Descriptive statistics and qualitative content analysis were used for analysis. Results Among the 36 PCCs, 461 (59%) clinicians and 36 (100%) directors participated. Fifty-two per cent of clinicians could cooperate with the care manager without problems. Forty per cent regarded to their knowledge of the care manager assignment as insufficient. Around two-thirds perceived that collaborating with the care manager was part of their duty as PCC staff. Almost 90% of the PCCs' directors considered that the assignment of the care manager was clearly designed, around 70% considered the priority of the implementation to be high and around 90% were positive to the implementation. Facilitators consisted of support from colleagues and directors, cooperative skills and positive attitudes. Barriers were high workload, shortage of staff and extensive requirements and demands from healthcare management. Conclusions Our study confirms that the care manager puts collaborative care into practice. Facilitators and barriers of the implementation, such as time, information, soft values and attitudes, financial structure need to be considered when implementing care managers at PCCs. © © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
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  • Björkelund, Cecilia, 1948, et al. (author)
  • Clinical effectiveness of care managers in collaborative care for patients with depression in Swedish primary health care: a pragmatic cluster randomized controlled trial
  • 2018
  • In: Bmc Family Practice. - : Springer Science and Business Media LLC. - 1471-2296. ; 19:1
  • Journal article (peer-reviewed)abstract
    • Background: Depression is one of the leading causes of disability and affects 10-15% of the population. The majority of people with depressive symptoms seek care and are treated in primary care. Evidence internationally for high quality care supports collaborative care with a care manager. Our aim was to study clinical effectiveness of a care manager intervention in management of primary care patients with depression in Sweden. Methods: In a pragmatic cluster randomized controlled trial 23 primary care centers (PCCs), urban and rural, included patients aged >= 18 years with a new (< 1 month) depression diagnosis. Intervention consisted of Care management including continuous contact between care manager and patient, a structured management plan, and behavioral activation, altogether around 6-7 contacts over 12 weeks. Control condition was care as usual (CAU). Outcome measures: Depression symptoms (measured by Mongomery-Asberg depression score-self (MADRS-S) and BDI-II), quality of life (QoL) (EQ-5D), return to work and sick leave, service satisfaction, and antidepressant medication. Data were analyzed with the intention-to-treat principle. Results: One hundred ninety two patients with depression at PCCs with care managers were allocated to the intervention group, and 184 patients at control PCCs were allocated to the control group. Mean depression score measured by MADRS-S was 2.17 lower in the intervention vs. the control group (95% CI [0.56; 3.79], p = 0.009) at 3 months and 2.27 lower (95% CI [0.59; 3.95], p = 0.008) at 6 months; corresponding BDI-II scores were 1.96 lower (95% CI [-0.19; 4.11], p = 0.07) in the intervention vs. control group at 6 months. Remission was significantly higher in the intervention group at 6 months (61% vs. 47%, p = 0.006). QoL showed a steeper increase in the intervention group at 3 months (p = 0.01). During the first 3 months, return to work was significantly higher in the intervention vs. the control group. Patients in the intervention group were more consistently on antidepressant medication than patients in the control group. Conclusions: Care managers for depression treatment have positive effects on depression course, return to work, remission frequency, antidepressant frequency, and quality of life compared to usual care and is valued by the patients.
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  • Björkelund, Cecilia, 1948, et al. (author)
  • [Effects of a care manager organization for care of people with mild-moderate depression in Swedish primary care]. : Vårdsamordnare för depression – effektivt grepp i primärvården - Gav friskare patienter och hälsoekonomiska vinster.
  • 2019
  • In: Lakartidningen. - 1652-7518. ; 116
  • Journal article (other academic/artistic)abstract
    • By strengthening accessibility and continuity and support via a care manager for primary care patients with depression corresponding to 20-30% of a nursing service, patients recovered significantly faster and to a greater extent than in primary care-as-usual. Return to work occurred significantly earlier in the first three months, and net sick leave period was significantly shorter during the following 4-6 months. To introduce a collaborative care organizational change where the care manager is the hub and coordinates care for the patient and makes it possible to adapt the care according to the patient's needs throughout the care process, is thus the individual effort shown to have the greatest efficiency in Swedish primary care to increase the quality of care of depression. This approach, where the clinic and academy work closely and continuously in the development and evaluation phases, makes it possible to rapidly develop new ways of working where consideration is given to the complexity of primary care and the complexity of care needs and care efforts.
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  • Björkelund, Cecilia, 1948, et al. (author)
  • Effects of adding early cooperation and a work-place dialogue meeting to primary care management for sick-listed patients with stress-related disorders: CO-WORK-CARE-Stress - a pragmatic cluster randomised controlled trial.
  • 2024
  • In: Scandinavian journal of primary health care. - 1502-7724. ; , s. 1-15
  • Journal article (peer-reviewed)abstract
    • To investigate whether intensified cooperation between general practitioner (GP), care manager and rehabilitation coordinator (RC) for patients sick-listed for stress-related mental disorder, combined with a person-centred dialogue meeting with employer, could reduce sick-leave days compared with usual care manager contact.Pragmatic cluster-randomised controlled trial, randomisation at primary care centre (PCC) level.PCCs in Region Västra Götaland, Sweden, with care manager organisation.Of 30 invited PCCs, 28 (93%) accepted the invitation and recruited 258 patients newly sick-listed due to stress-related mental disorder (n=142 intervention, n=116 control PCCs).Cooperation between GP, care manager and rehabilitation coordinator from start of illness notification plus a person-centred dialogue meeting between patient and employer within 3months. Regular contact with care manager was continued at the control PCCs.12-months net and gross number of sick-leave days. Secondary outcomes: Symptoms of stress, depression, anxiety; work ability and health related quality of life (EQ-5D) over 12months.There were no significant differences between intervention and control groups after 12months: days on sick-leave (12-months net sick-leave days, intervention, mean = 110.7days (95% confidence interval (CI) 82.6-138.8); control, mean = 99.1days (95% CI 73.9-124.3)), stress, depression, or anxiety symptoms, work ability or EQ-5D. There were no significant differences between intervention and control groups concerning proportion on sick-leave after 3, 6, 12months. At 3months 64.8% were on sick-leave in intervention group vs 54.3% in control group; 6months 38% vs 32.8%, and12 months 16.9% vs 15.5%.Increased cooperation at the PCC between GP, care manager and RC for stress-related mental disorder coupled with an early workplace contact in the form of a person-centred dialogue meeting does not reduce days of sick-leave or speed up rehabilitation.Trial registration: ClinicalTrials.gov Identifier: NCT03250026 https://clinicaltrials.gov/study/NCT03250026?tab=results#publicationsCO-WORK-CAREFirst Posted: August 15, 2017. Recruitment of PCCs: September 2017. Inclusion of patients from December 2017.
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  • Björkelund, Cecilia, 1948, et al. (author)
  • Rehabilitation cooperation and person-centred dialogue meeting for patients sick-listed for common mental disorders: 12 months follow-up of sick leave days, symptoms of depression, anxiety, stress and work ability - a pragmatic cluster randomised controlled trial from the CO-WORK-CARE project.
  • 2023
  • In: BMJ open. - 2044-6055. ; 13:6
  • Journal article (peer-reviewed)abstract
    • To study whether early and enhanced cooperation within the primary care centres (PCC) combined with workplace cooperation via a person-centred employer dialogue meeting can reduce days on sick leave compared with usual care manager contact for patients on sick leave because of common mental disorders (CMD). Secondary aim: to study lapse of CMD symptoms, perceived Work Ability Index (WAI) and quality of life (QoL) during 12 months.Pragmatic cluster randomised controlled trial, randomisation at PCC level.28 PCCs in Region Västra Götaland, Sweden, with care manager organisation.30 PCCs were invited, 28 (93%) accepted invitation (14 intervention, 14 control) and recruited 341 patients newly sick-listed because of CMD (n=185 at intervention, n=156 at control PCCs).Complex intervention consisting of (1) early cooperation among general practitioner (GP), care manager and a rehabilitation coordinator, plus (2) a person-centred dialogue meeting between patient and employer within 3 months.regular contact with care manager.12 months net and gross number of sick leave days at group level.12 months depression, anxiety, stress symptoms, perceived WAI and QoL (EuroQoL-5 Dimensional, EQ-5D).No significant differences were found between intervention and control groups concerning days of sick leave (intervention net days of sick leave mean 102.48 (SE 13.76) vs control 96.29 (SE 12.38) p=0.73), return to work (HR 0.881, 95%CI 0.688 to 1.128), or CMD symptoms, WAI or EQ-5D after 12 months.It is not possible to speed up CMD patients' return to work or to reduce sick leave time by early and enhanced coordination among GP, care manager and a rehabilitation coordinator, combined with early workplace contact over and above what 'usual' care manager contact during 3 months provides.NCT03250026.
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  • Hammarberg, Sandra af Winklerfelt, et al. (author)
  • Care managers can be useful for patients with depression but their role must be clear : a qualitative study of GPs' experiences
  • 2019
  • In: Scandinavian Journal of Primary Health Care. - : TAYLOR & FRANCIS LTD. - 0281-3432 .- 1502-7724. ; 37:3, s. 273-282
  • Journal article (peer-reviewed)abstract
    • Objective: Explore general practitioners' (GPs') views on and experiences of working with care managers for patients treated for depression in primary care settings. Care managers are specially trained health care professionals, often specialist nurses, who coordinate care for patients with chronic diseases. Design: Qualitative content analysis of five focus-group discussions. Setting: Primary health care centers in the Region of Vastra Gotaland and Dalarna County, Sweden. Subjects: 29 GPs. Main outcome measures: GPs' views and experiences of care managers for patients with depression. Results: GPs expressed a broad variety of views and experiences. Care managers could ensure care quality while freeing GPs from case management by providing support for patients and security and relief for GPs and by coordinating patient care. GPs could also express concern about role overlap; specifically, that GPs are already care managers, that too many caregivers disrupt patient contact, and that the roles of care managers and psychotherapists seem to compete. GPs thought care managers should be assigned to patients who need them the most (e.g. patients with life difficulties or severe mental health problems). They also found that transition to a chronic care model required change, including alterations in the way GPs worked and changes that made depression treatment more like treatment for other chronic diseases. Conclusion: GPs have varied experiences of care managers. As a complementary part of the primary health care team, care managers can be useful for patients with depression, but team members' roles must be clear.
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  • 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.
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  • Hange, Dominique, 1963, et al. (author)
  • Experiences of staff members participating in primary care research activities: a qualitative study
  • 2015
  • In: International Journal of General Medicine. - 1178-7074. ; 8, s. 143-8
  • Journal article (peer-reviewed)abstract
    • BACKGROUND: The aim of this paper was to study primary care staff members' experiences and perceptions of participating in a randomized controlled trial concerning Internet therapy. METHODS: Data were collected via five focus groups, each containing four to eight nurses or general practitioners. The systematic text condensation method described by Malterud was used for thematic analysis of meaning and content of data across cases. RESULTS: The informants believed it was important to conduct research within the primary care setting, but it was difficult to combine clinical work and research. They stressed also that there was a need for continuous information and communication between primary care centers and researchers as well as internally at each primary care center. CONCLUSION: Staff members' experiences of participating in a research study were positive, although associated with various difficulties. It is important to include staff members when designing clinical studies; information should be given continuously during the study and communication facilitated between different occupational groups working at the primary care center.
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  • Holst, Anna, et al. (author)
  • Cost-effectiveness of a care manager collaborative care programme for patients with depression in primary care : economic evaluation of a pragmatic randomised controlled study
  • 2018
  • In: BMJ Open. - : BMJ. - 2044-6055. ; 8:11
  • Journal article (peer-reviewed)abstract
    • Objective: To evaluate the cost-effectiveness of a care manager (CM) programme compared with care as usual (CAU) for treatment of depression at primary care centres (PCCs) from a healthcare as well as societal perspective.Design: Cost-effectiveness analysis.Setting: 23 PCCs in two Swedish regions.Participants: Patients with depression (n=342).Main outcome measures: A cost-effectiveness analysis was applied on a cluster randomised trial at PCC level where patients with depression had 3 months of contact with a CM (11 intervention PCCs, n=163) or CAU (12 control PCCs, n=179), with follow-up 3 and 6 months. Effectiveness measures were based on the number of depression-free days (DFDs) calculated from the Montgomery-angstrom sberg Depression Rating Scale-Self and quality-adjusted life years (QALYs).Results were expressed as the incremental cost-effectiveness ratio: Cost/QALY and Cost/DFD. Sampling uncertainty was assessed based on non-parametric bootstrapping.Results: Health benefits were higher in intervention group compared with CAU group: QALYs (0.357 vs 0.333, p<0.001) and DFD reduction of depressive symptom score (79.43 vs 60.14, p<0.001). The mean costs per patient for the 6-month period were Euro368 (healthcare perspective) and Euro6217 (societal perspective) for the intervention patients and Euro246 (healthcare perspective) and Euro7371 (societal perspective) for the control patients (n.s.). The cost per QALY gained was Euro6773 (healthcare perspective) and from a societal perspective the CM programme was dominant.Discussion: The CM programme was associated with a gain in QALYs as well as in DFD, while also being cost saving compared with CAU from a societal perspective. This result is of high relevance for decision-makers on a national level, but it must be observed that a CM programme for depression implies increased costs at the primary care level.
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  • Holst, Anna, et al. (author)
  • Cost-effectiveness of a care manager collaborative care programme for patients with depression in primary care: 12-month economic evaluation of a pragmatic randomised controlled trial
  • 2021
  • In: Cost Effectiveness and Resource Allocation. - : Springer Science and Business Media LLC. - 1478-7547. ; 19
  • Journal article (peer-reviewed)abstract
    • Objectives: To study the cost-effectiveness of a care manager organization for patients with mild to moderate depression in Swedish primary care in a 12-month perspective. Methods: Cost-effectiveness analysis of the care manager organization compared to care as usual (CAU) in a pragmatic cluster randomised controlled trial including 192 individuals in the care manager group and 184 in the CAU group. Cost-effectiveness was assessed from a health care and societal perspectives. Costs were assessed in relation to two different health outcome measures: depression free days (DFDs) and quality adjusted life years (QALYs). Results: At the 12-month follow-up, patients treated at the intervention Primary Care Centres (PCCs) with a care manager organization had larger health benefits than the group receiving usual care only at control PCCs. Mean QALY per patient was 0.73 (95% CI 0.7; 0.75) in the care manager group compared to 0.70 (95% CI 0.66; 0.73) in the CAU group. Mean DFDs was 203 (95% CI 178; 229) in the care manager group and 155 (95% CI 131; 179) in the CAU group. Further, from a societal perspective, care manager care was associated with a lower cost than care as usual, resulting in a dominant incremental cost-effectiveness ratio (ICER) for both QALYs and DFDs. From a health care perspective care manager care was related to a low cost per QALY (36,500 SEK / €3,379) and DFD (31 SEK/€3). Limitations: A limitation is the fact that QALY data was impaired by insufficient EQ-5D data for some patients. Conclusions: A care manager organization at the PCC to increase quality of care for patients with mild-moderate depression shows high health benefits, with no decay over time, and high cost-effectiveness both from a health care and a societal perspective. Trial registration details: The trial was registered in ClinicalTrials.com (https://clinicaltrials.gov/ct2/show/NCT02378272) in 02/02/2015 with the registration number NCT02378272. The first patient was enrolled in 11/20/2014.
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  • Lindh, Magnus, 1960, et al. (author)
  • Clinical Effectiveness of Liraglutide vs Sitagliptin on Glycemic Control and Body Weight in Patients with Type 2 Diabetes: A Retrospective Assessment in Sweden
  • 2016
  • In: Diabetes Therapy. - : Springer Science and Business Media LLC. - 1869-6953 .- 1869-6961. ; 7:2, s. 321-333
  • Journal article (peer-reviewed)abstract
    • Introduction: The aim of the present study was to use real-world data from Swedish primary-care and national registries to understand clinical outcomes in patients with Type 2 diabetes (T2D) treated with liraglutide in clinical practice, and to compare with data from those treated with sitagliptin. Methods: This was a non-interventional, retrospective study conducted between February 2014 and September 2014 using T2D patient data from Swedish primary-care centers and national healthcare registries. The primary objective was to assess the effectiveness of liraglutide in control of glycemia and body weight in clinical practice (stage 1). The secondary objective was to compare the clinical effectiveness of liraglutide with sitagliptin on glycemic control and body weight in clinical practice in a propensity-score-matched population (stage 2). Results: In stage 1 (n = 402), 39.4% of patients treated with liraglutide achieved >= 1.0% (10.9 mmol/mol) reduction in glycated hemoglobin (HbA1c) after 180 days of treatment and 54.9% achieved the target HbA1c of <7.0% (53.0 mmol/mol). Moreover, compared with baseline, 22.5% of patients treated with liraglutide achieved both >= 1.0% reduction in HbA1c and >= 3.0% reduction in body weight. In stage 2, a significantly greater proportion of patients receiving liraglutide (n = 180) than sitagliptin (n = 208) achieved >= 1.0% reduction in HbA1c [52.9% vs 33.5%, respectively (P = 0.0002)]. Mean body-weight loss was also significantly greater in patients receiving liraglutide vs sitagliptin [-3.5 vs -1.3 kg, respectively (P < 0.0001)]. Conclusion: This study provides real-world evidence from Sweden corroborating previous clinical trials that demonstrate greater efficacy of liraglutide over sitagliptin on glycemic control and body-weight reduction in patients with T2D.
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  • Löfgren, Märit, 1977, et al. (author)
  • Promoting health literacy and sense of coherence in primary care patients with long-term impaired work ability-a pilot study.
  • 2022
  • In: Scandinavian journal of primary health care. - : Informa UK Limited. - 1502-7724 .- 0281-3432. ; 40:4, s. 481-490
  • Journal article (peer-reviewed)abstract
    • Evaluate feasibility, partnerships, and study design of intervention to minimise sick leave.The design was a pilot single arm intervention study in primary health care. Outcome measures at follow-ups for each participant were compared with baseline data for the same person.Twenty primary health care patients with recurrent or long-term sick leave or health-related unemployment.Patient education through interactive study groups that met half a day a week for eight subsequent weeks. Groups were led by experienced but not medically trained facilitators. The intervention was designed to improve participant health literacy, sense of coherence, health-related quality of life, and patient involvement in healthcare.Primary outcome was the level of sick leave. Sick leave data were obtained from medical records when available, otherwise patient reported. Secondary outcomes regarding health literacy, sense of coherence, and health-related quality of life were measured with validated questionnaires at baseline and follow-ups.Level of sick leave decreased significantly and participation in work preparatory activities increased during follow-up. Health literacy, sense of coherence (subscale sense of meaningfulness), and health-related quality of life (subscale social functioning) showed statistically significant improvement. Intervention, partnerships, and study design were feasible.An educational programme, conducted in cooperation between primary health care and partners outside the healthcare system, was feasible and showed an impact on sick leave, health literacy, sense of coherence, and health-related quality of life.KEY FINDINGSA pilot study to evaluate an educational programme with study groups conducted in cooperation between primary health care and partners outside the healthcare system showed good feasibility.Sick leave decreased significantly six months after baseline.Health literacy, sense of coherence (subscale sense of meaningfulness), and health-related quality of life (subscale social function) improved significantly 6 months after baseline.
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  • 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.
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  • Nejati, Shabnam, 1972, et al. (author)
  • How can a care manager at the primary care centre support foreign-born female patients suffering from common mental disorders? – An interview study
  • 2022
  • In: Scandinavian Journal of Caring Sciences. - : Wiley. - 0283-9318 .- 1471-6712. ; 36:2, s. 456-467
  • Journal article (peer-reviewed)abstract
    • Background: Difficulty in communicating can lead to stressful situations both for foreign-born female patients suffering from common mental disorders (CMDs) and for the health care professionals. Aim: The aim of the study was to explore how foreign-born female patients with CMDs experienced their health care encounters and how they perceived a care manager could be a support during their illness, as well as to explore the care managers' perceptions and experiences concerning this group. Methods: A qualitative method with semi-structured interview was chosen. The data were analysed with systematic text condensation. The study was conducted in primary care in western Sweden. Eight Persian-speaking female patients were recruited by the snowball method and participated in the study. Furthermore, nine care managers participated. Results: Foreign-born female patients felt shame and anxiety because of language difficulties, interpreter presence, mental illness, and feelings of dependency. The care managers and the patients felt that physical meetings, access to translated assessment scales and female telephone interpreters, and early and continuous contact and access to health care personnel with a similar cultural background could facilitate communication. Conclusion: In order to facilitate mutual understanding and knowledge, accessibility and continuity of health care are needed to enable foreign-born female patients with CMD to support their own health development. Female interpreters, telephone interpreting, translated scales, and telephone contacts combined with face-to-face visits could facilitate communication.
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  • Nejati, Shabnam, 1972, et al. (author)
  • How can care managers strengthen health literacy among patients with common mental disorders? A qualitative study
  • 2023
  • In: Scandinavian journal of caring sciences. - 1471-6712. ; 37:3
  • Journal article (peer-reviewed)abstract
    • In order for persons with mental illness to be able to promote and preserve their health, sufficient knowledge about health is required. An effective means to improve the health of the patients is to strengthen their health literacy. The aim of this study was to explore how care managers work with health literacy in patients with common mental disorders to help them to better understand and manage their illness.A qualitative study was conducted, using written reports from 25 care managers regarding meetings with patients with common mental disorders in the primary care in a Swedish region. The care managers' reports were coded based on Sörensen's four dimensions for the domain "health care" and analysed deductively through systematic text condensation according to Malterud.The care managers described how they worked strategically and continuously with follow-up and wanted to be responsive to the patients' stories. They confirmed the patients' feelings with the goal of creating increased interaction, thereby involving the patients in their own care. The care managers also worked actively to provide well-balanced care at an early stage. Using various tools such as self-assessment instruments, the care manager started from the patient's basic problem, gave support and discussed strategies based on the patient's condition and situation.The care managers used multifaceted health literacy interventions. They worked in a person-centred, strategic and encouraging manner based on the patient's unique conditions, where sensitivity and adapted information were important aspects. The aim of the interventions was for the patients to become knowledgeable, gain new insights and work independently with their own health.
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21.
  • Petersson, Eva-Lisa, et al. (author)
  • Collaborative care och personcentrerad vård
  • 2020
  • In: Vårdsamordnare vid psykisk ohälsa i primärvården. - Göteborg : Göteborgs universitet. - 9789151960876
  • Book chapter (other academic/artistic)
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22.
  • Petersson, E-L, et al. (author)
  • Examining the description of the concept "treatment as usual" for patients with depression, anxiety and stress-related mental disorders in primary health care research - A systematic review.
  • 2023
  • In: Journal of affective disorders. - : Elsevier BV. - 1573-2517 .- 0165-0327. ; 326, s. 1-10
  • Journal article (peer-reviewed)abstract
    • In randomized controlled trials (RCTs) within medical research, applied interventions are compared to treatment-as-usual (TAU) as the control condition. The aim of the current study was to examine how the concept of TAU is described when used as control condition in RCTs evaluating treatments for depression, anxiety syndromes, and stress-related mental disorders in primary care.A systematic review of RCTs utilizing TAU as control group in the RCT in accordance with PRISMA standards was conducted. We used one multidisciplinary database (Scopus), one database focused on nursing (Cinahl), and one medical database (PubMed). The searches were conducted in November 2021 and May 2022.The included 32 studies comprised of 7803 participants. The content of TAU was classified as follows: 1) Basic descriptions of TAU lacking a detailed account as well as reference to local or national guidelines, 2) Moderate description of TAU including reference to national or local guidelines or a detailed description 3) Advanced description of TAU including references to national guidelines and a detailed description containing five key concepts: early assessment, accessibility, psychological treatment, medication, somatic examination. 18 studies had basic, 11 moderate, and 3 advanced descriptions of TAU.The limitations were that only studies published in English were included.The current study provides an assessment tool with three classification levels for TAU. The description of TAU is still insufficient in RCT studies conducted in primary care, which may affect the interpretation of results. In future research a detailed description of TAU is recommended.
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23.
  • Petersson, Eva-Lisa, et al. (author)
  • Implementeringsprocessen
  • 2020
  • In: Vårdsamordnare vid psykisk ohälsa i primärvården. - Göteborg : Göteborgs universitet. - 9789151960876
  • Book chapter (other academic/artistic)
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24.
  • Petersson, Eva-Lisa, et al. (author)
  • Long-term effect of a care manager on work ability for patients with depression - the PRIM-CARE RCT
  • 2022
  • In: Work. - : IOS Press. - 1051-9815 .- 1875-9270. ; 72:2, s. 601-609
  • Journal article (peer-reviewed)abstract
    • BACKGROUND: Collaborative care with a care manager in primary care improves care. OBJECTIVE: To study whether care manager support leads to improved work ability, decreased job strain and reduced time of sick leave among primary care patients with depression. METHODS: A clinical effectiveness study of care managers for depression patients seeking care in primary care was conducted in a RCT 2014 - 2016. Patients in the intervention group were assigned a care manager. In the 12-month followup, patients with employment (n = 269; intervention n = 142, control n = 127) were studied concerning work ability, job strain and sick leave. RESULTS: An association was shown between reduction of depressive symptoms and improved work ability for the entire group. At 12-month follow-up a statistically significant difference of reduction of depressive symptoms was seen between the groups (MADRS-S: intervention 10.8 vs control 13.1, p = 0.05) as well as increased quality of life (EQ-5D: intervention 0.77 vs control 0.70, p = 0.04). In the intervention group, a concordance was found between the patient's prediction of return to work and the actual return to work (91% for intervention and 68 % for control group, p = 0.047). CONCLUSIONS: Compared to usual care, the care manager does not seem to further improve perception of work ability, job strain or perception of social support per se among the patients despite a long-term effect on depression symptoms. The lack of a long-term effect regarding these aspects may be due to the fact that care manager support was only provided during the first three months.
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25.
  • Petersson, Eva-Lisa, et al. (author)
  • Long-term effect of a care manager on work ability for patients with depression - the PRIM-CARE RCT
  • 2022
  • In: WORK-A JOURNAL OF PREVENTION ASSESSMENT & REHABILITATION. - : IOS Press. - 1051-9815. ; 72:2, s. 601-609
  • Journal article (peer-reviewed)abstract
    • BACKGROUND: Collaborative care with a care manager in primary care improves care. OBJECTIVE: To study whether care manager support leads to improved work ability, decreased job strain and reduced time of sick leave among primary care patients with depression. METHODS: A clinical effectiveness study of care managers for depression patients seeking care in primary care was conducted in a RCT 2014 - 2016. Patients in the intervention group were assigned a care manager. In the 12-month followup, patients with employment (n = 269; intervention n = 142, control n = 127) were studied concerning work ability, job strain and sick leave. RESULTS: An association was shown between reduction of depressive symptoms and improved work ability for the entire group. At 12-month follow-up a statistically significant difference of reduction of depressive symptoms was seen between the groups (MADRS-S: intervention 10.8 vs control 13.1, p = 0.05) as well as increased quality of life (EQ-5D: intervention 0.77 vs control 0.70, p = 0.04). In the intervention group, a concordance was found between the patient's prediction of return to work and the actual return to work (91% for intervention and 68 % for control group, p = 0.047). CONCLUSIONS: Compared to usual care, the care manager does not seem to further improve perception of work ability, job strain or perception of social support per se among the patients despite a long-term effect on depression symptoms. The lack of a long-term effect regarding these aspects may be due to the fact that care manager support was only provided during the first three months.
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26.
  • Petersson, Eva-Lisa, et al. (author)
  • Process evaluation of the CO-WORK-CARE model : Collaboration and a person-centred dialogue meeting for patients with common mental disorder in primary health care
  • 2024
  • In: Scandinavian Journal of Caring Sciences. - 0283-9318 .- 1471-6712.
  • Journal article (peer-reviewed)abstract
    • Rationale: To ensure optimal patient care based on evidence, it is crucial to understand how to implement new methods in practice. However, intervention studies often overlook parts of the implementation process. A comprehensive process evaluation is necessary to understand why interventions succeed or fail in specific contexts and to integrate new knowledge into daily practice. This evaluation examines the full implementation of the Co-Work-Care model in Swedish primary healthcare to identify strengths and weaknesses. Aim: This study aimed to evaluate the process of implementing the CO-WORK-CARE model that focuses on close collaboration and the use of a person-centred dialogue meeting in primary healthcare for patients on sick leave due to common mental disorders. Method: The CO-WORK-CARE model emphasises collaboration among the GP, rehabilitation coordinator and care manager, along with person-centred dialogue meetings involving employers. Following UK Medical Research Council guidelines, we conducted a process evaluation. Data from previous studies were reanalysed. We also analysed field notes and meeting notes using Malterud's qualitative method. Results: The evaluation identified key facilitators for model implementation, including regular visits by facilitators and guidance from the research physician. Peer support meetings also bolstered implementation. However, challenges emerged due to conflicts with existing structures and limitations in person-centred dialogue meetings. Conclusion: Adapting the CO-WORK-CARE model to Swedish primary care is feasible and beneficial, with collaboration among the care manager, rehabilitation coordinator and GP and person-centred dialogue meetings. Thorough preparations, ongoing facilitator and peer support and integrated information enhanced implementation efficiency, despite challenges posed by existing structures. 
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27.
  • Petersson, Eva-Lisa, et al. (author)
  • The experiences of care managers and rehabilitation coordinators of a primary care intervention to promote return to work for patients with common mental disorders: a qualitative study.
  • 2020
  • In: BMC family practice. - : Springer Science and Business Media LLC. - 1471-2296. ; 21:1
  • Journal article (peer-reviewed)abstract
    • In an earlier study, PRIM-CARE RCT, a care manager implementation at the primary care centre showed improved return to work and reduced sick leave for patients with CMD. To further improve return to work, the project Co-Work-Care added a person-centered dialogue meeting between the patient, the employer and the rehabilitation coordinator, preceded by an increased collaboration between care manager, rehabilitation coordinator and GP. In this first qualitative study of the Co-Work-Care project, we explored how care managers and rehabilitation coordinators experienced the Co-Work-Care model. The purpose of this study was to explore care managers' and rehabilitation coordinators' perceptions and experiences of a close collaboration and the use of the person-centred dialogue meeting.From an ongoing RCT with 20 primary care centres, care managers (CMs) (n=13) and rehabilitation coordinators (RCs) (n=12) participated in a qualitative study with focus groups. The study was conducted in the primary health care in a Swedish region. The data was analysed with Systematic Text Condensation by Malterud.Seven codes describing the participants' experiences of the Co-Work-Care model were identified: 1) The importance of collaboration at the primary care centre, 2) Collaboration and division of roles between the RC and the CM, 3) Collaboration with the General practitioner (GP), 4) The person-centred dialogue meeting, 5) Initiating the person-centred dialogue meeting, 6) The person-centred dialogue meeting to improve collaboration with the employer, and 7) The person-centred dialogue meeting to teach about the return to work process.The increased collaboration within the Co-Work-Care model created a common picture and understanding of the patient's situation. The person-centred dialogue meeting in the rehabilitation process became a bridge between the employer and the patient.NCT03250026 (registered August 15, 2017).
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28.
  • Rindner, Lena, 1959, et al. (author)
  • Prognostic factors for future mental, physical and urogenital health and work ability in women, 45-55 years: a six-year prospective longitudinal cohort study.
  • 2020
  • In: BMC women's health. - : Springer Science and Business Media LLC. - 1472-6874. ; 20:1
  • Journal article (peer-reviewed)abstract
    • Impaired health due to stress is a common cause of long-term illness in women aged 45-55years. It is a common cause for visits to primary health care (PHC) and may influence work-ability. The aim of this study was to investigate prognostic factors for future mental, physical and urogenital health as well as work-ability in a population of average women aged 45-55years.This longitudinal cohort study initially assessed 142 women from PHC centers in southwestern Sweden. One houndred and ten accepted participation and were followed for 6years. They were assessed using the self-reported questionnaires: the Menopause Rating Scale (MRS), the Montgomery-Asberg Depression Rating Scale (MADRS-S), the Short-Form Health Survey (SF-36). Descriptive data are presented of health, education, relationships and if they are working. Multicollinearity testing and logistic regression were used to test the explanatory variables.Severity of symptoms in the MRS somatic and urogenital domains decreased while they increased in the psychological and depressive domains. Having tertiary education was associated with decreased overall mental health, vitality and social role functioning. Living with a partner was associated with increased physical role functioning, social role functioning and emotional role functioning.Quality of life seems to be enhanced by a good relationship with the partner, social support and work/life balance. Therefore, to improve women health women should early discuss ways in which these issues can be incorporated as they pursue their academic or career goals. Hence, we emphasize the importance of supporting women to gain increased awareness about a healthy life balance and to have realistic goals in work as well as in their social life.
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29.
  • Samuelson, Sarah, et al. (author)
  • Collaboration for learning : How can it be done? A case study in a tested environment between a company, healthcare professionals and the public in primary care
  • 2021
  • In: INTED2021 Proceedings. - : iated Digital Library.
  • Conference paper (peer-reviewed)abstract
    • Primary care (PC) faces major challenges due to demographic changes, medical and technological advances, increased healthcare costs and higher expectations from well-informed citizens. PC needs to adapt as society changes and in order to meet an increased demand for care, there is a need to be innovative in terms of the services that PC offers. The use of testbeds is becoming more common when introducing new technology into society, but in PC, testbeds are still a fairly new phenomenon. Thus, testbeds are discussed in order to create more effective, efficient and innovative healthcare practices. New health technology has the potential to better satisfy peoples need of healthcare and will eventually change healthcare practice. Testbeds provides opportunities for the healthcare professionals to test new technologies and adopt new work practices which will follow the use of new technologies. Likewise, patients can learn about new technologies and how to use the new care services made possible by the technology. In the testbed, companies can benefit from the knowledge of end users, such as healthcare professionals and patients, as they collaborate to test new technologies and services in real practice. Thus, the testbed has the potential to become an arena for learning between healthcare professionals, patients and companies, collaborating in order to learn and develop healthcare technology based on the need in PC.This paper aims to explore the collaboration between a company, healthcare professionals and the public in a testbed environment in PC, and how collaboration can contribute to learning for all involved. The following research questions guided this study:- What learning arise when a company, healthcare professionals and the public collaborate?- What are the facilitators and barriers for learning in the collaboration between a company, healthcare professionals and the public?The testbed in this study is located on a PC centre in a relatively small municipality with approximately 6600 inhabitants on the west coast of Sweden. The company is a small size company that develops 3D patient information films for healthcare that can be shown on waiting room screens as well as online at patients’ homes. So far, the company has focused on creating films intended for hospital care, such as information about operations and treatments, but now the company want to expand its scope to also include PC. Having limited knowledge about the PC context, the company use the testbed to co-create an information film on fall prevention through collaboration with healthcare professionals and representatives from the target group, namely frail older people. To explore the collaboration when co-creating this film, a case study is conducted. Data is collected by filming and recording collaboration meetings, e-mail conversations, discussion groups and/or individual interviews. We expect this study to provide insights in what learning takes place when companies and end users collaborate on developing healthcare technology and thus contribute with a deeper understanding of “best practices” regarding the collaboration processes in testbeds. In the longer perspective, a well-functioning testbed in PC can potentially contribute with innovative technologies and services that can increase the healthcare's resource efficiency and quality.
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30.
  • Samuelson, Sarah, et al. (author)
  • Learning in living lab collaboration in primary care : a qualitative study
  • 2023
  • In: Journal of Workplace Learning. - 1366-5626 .- 1758-7859. ; 35:9, s. 218-234
  • Journal article (peer-reviewed)abstract
    • PurposeTo meet future healthcare needs, primary care is undergoing a transformation in which innovations and new ways of working play an important role. However, successful innovations depend on joint learning and rewarding collaborations between healthcare and other stakeholders. This study aims to explore how learning develops when entrepreneurs, healthcare professionals and older people collaborate in a primary care living lab.Design/methodology/approachThe study had an action research design and was conducted at a clinically embedded living lab at a primary care centre on the west coast of Sweden. Data consisted of e-mail conversations, recordings from design meetings and three group interviews with each party (entrepreneurs, healthcare professionals and older people). Data were analysed with inductive qualitative content analysis.FindingsAn overarching theme, “To share each other’s worlds in an arranged space for learning”, was found, followed by three categories, “Prerequisites for learning”, “Strategies to achieve learning” and “To learn from and with each other”. These three categories comprise eight subcategories.Originality/valueThis research contributes to knowledge regarding the need for arranged spaces for learning and innovation in primary care and how collaborative learning can contribute to the development of practice.
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31.
  • Samuelson, Sarah, et al. (author)
  • Standing together at the helm : how employees experience employee-driven innovation in primary car
  • 2024
  • In: BMC Health Services Research. - 1472-6963. ; 24:1
  • Journal article (peer-reviewed)abstract
    • Primary care needs to find strategies to deal with today’s societal challenges and continue to deliver efficient and high-quality care. Employee-driven innovation is increasingly gaining ground as an accessible pathway to developing successful and sustainable organisations. This type of innovation is characterised by employees being engaged in the innovation process, based on a bottom-up approach. This qualitative study explores employees’ experiences of employee-driven innovation at a primary care centre in Sweden. Data are collected by focus group interviews and analysed by inductive qualitative content analysis. The result is presented with the overarching theme “Standing together at the helm” followed by three categories: “Motivating factors for practising employee-driven innovation”, “Challenges in practising employee-driven innovation” and “Benefits of employee-driven innovation”, including nine subcategories. The study found that employee-driven innovation fosters organisational innovation, empowers employees, and enhances adaptability at personal and organisational levels. This enables individual and collective learning, and facilitates the shaping, development, and adaptation of working methods to meet internal and external requirements. However, new employees encountered difficulty grasping the concept of employee-driven innovation and recognising its long-term advantages. Additionally, the demanding and task-focused environment within primary care posed challenges in sustaining efforts in innovation work. The employees also experienced a lack of external support to drive and implement some innovative ideas.
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32.
  • Saxvik, Ausra, et al. (author)
  • Experiences of patients with common mental disorders concerning team-based primary care and a person-centered dialogue meeting: An intervention to promote return to work.
  • 2022
  • In: PloS one. - : Public Library of Science (PLoS). - 1932-6203. ; 17:7
  • Journal article (peer-reviewed)abstract
    • Common mental disorders in combination with work-related stress are widespread in the western world, not least in Sweden. Various interactive factors, primarily work-related, have impact on the return to work process, for example; a supportive communicative function between the person on sick leave and the employer may facilitate this process. The aim was to investigate experiences of being part of a collaborative care model including a person-centered dialogue meeting with the employer and with a rehabilitation coordinator as the moderator.A qualitative design based on individual interviews with 13 persons diagnosed with common mental disorders who participated in an extensive collaborative care model, called the Co-Work-Care model. Persons were recruited as a heterogeneous sample with respect to age, gender, work background, and time since the intervention. All interviews were analyzed with Systematic Text Condensation.Five codes synthesized the results: 1) A feeling of being taken care of, 2) Collaboration within the team was perceived as supportive, 3) An active and sensitive listener, 4) Structure and planning in the dialogue meeting, 5) The person-centered dialogue meeting was supportive and provided increased understanding.Participants experienced the close collaborative contact with the care manager and the rehabilitation coordinator as highly valuable for their rehabilitation process. Participants valued a well-structured dialogue meeting that included initial planning and a thorough communication involving the patient, the employer, and coordinator. Further, participants appreciated having an active role during the meeting, also empowering the return to work process.
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33.
  • Saxvik, Ausra, et al. (author)
  • "Gaining control through close collaboration" - GPs' experiences of a Collaborative Care Model for patients with Common Mental Disorders who need sick leave certification.
  • 2022
  • In: BJGP open. - 2398-3795. ; 6:4
  • Journal article (peer-reviewed)abstract
    • General Practitioners (GPs) are an important part of collaboration around patients with common mental disorders in primary care. To further improve collaboration, the model Co-Work-Care was implemented, which emphasised working more closely with patients through active dialogues among care managers, rehabilitation coordinators and GPs. This enhanced collaborative model also included a person-centred dialogue meeting with patients' employers.To explore GPs' experiences of the Co-Work-Care model - a collaborative care organisation at the primary care centre including a person-centred dialogue meeting in the care of patients with common mental disorders who need sick leave certification.Qualitative individual and group interviews among Swedish GPs with experience of the Co-Work-Care trial where the primary care centre (PCC) was an intervention PCC with the enhanced collaboration model.GPs were sampled purposefully from different Co-Work-Care intervention PCCs in Sweden. Focus group and individual in-depth semi-structured interviews were conducted. All interviews were analysed by Systematic Text Condensation according to Malterud.Three codes describing the GPs' experiences of working in the Co-Work-Care model were identified: 1) A structured work approach, 2) Competency of the care manager and the rehabilitation coordinator, and 3) Gaining control through close collaboration.Overall, GPs experienced that the enhanced collaboration reduced their workload and enabled them to focus on the medical care. Patient care was perceived as safer and more effective. These advantages may result in higher quality in medical and rehabilitation decisions, as well as a more sustainable and less stressful work situation for GPs.
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34.
  • 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.
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35.
  • Svenningsson, Irene, 1957, et al. (author)
  • Anxiety and depression in obese and normal-weight individuals with diabetes type 2: A gender perspective
  • 2012
  • In: Scandinavian Journal of Caring Sciences. - : Wiley. - 1471-6712 .- 0283-9318. ; 26:2, s. 349-354
  • Journal article (peer-reviewed)abstract
    • Background: Obesity is a problem that is increasing worldwide, leading to an increased incidence of type 2 diabetes mellitus (T2DM). Depression is more common among individuals with diabetes, and they are more likely than non-diabetic individuals to experience emotional problems. People with both T2DM and obesity bear an additional emotional burden, which affects their quality of life. Objectives: To describe the prevalence of symptoms of anxiety and depression in groups of obese and normal-weight individuals with T2DM who are undergoing primary care and to investigate possible differences between the groups and between genders. Method: Three hundred and thirty-nine patients with T2DM from nine primary-care centres participated in a cross-sectional study (n = 180 + 159). The response rate was 67%. The Hospital Anxiety and Depression Scale (HADS) and the Beck Depression Inventory – second edition (BDI-II) were employed to estimate the patients’ symptoms of depression and anxiety. Results: An association between T2DM, obesity and depression was observed in both genders. More than one in three women and one in five men with T2DM and obesity exhibited symptoms of anxiety or depression. In the normal-weight group, the females presented more symptoms of anxiety than did their male counterparts. Conclusion: In primary healthcare, the fact that both obese men and women with T2DM are at increased risk of anxiety and depression is an important finding, which must be recognised and considered in the course of primary healthcare consultations. Meeting the unique needs of each individual requires an understanding of both laboratory data and the individual’s emotional status.
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36.
  • Svenningsson, Irene, 1957, et al. (author)
  • Creating a safety net for patients with depression inprimary care: a qualitative study of care managers’ experiences
  • 2018
  • In: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 36:4, s. 355-362
  • Journal article (peer-reviewed)abstract
    • Objective: The aim of this study was to explore nurses’experiences and perceptions of working as care managers at primary care centers.Design: Qualitative, focus group study. Malterud’s method of systematic text condensation was used to analyse the data.Setting: Primary health care in the region of Västra Götaland and region of Dalarna in Sweden.Subjects: Eight nurses were trained during three days including treatment of depression and how to work as care managers. The training was followed by continuous support in the method.Main outcome measures: The nurses’s experiences and perceptions of working as care managers at primary care centers.Results: The care managers described their role as providing additional support to the already existing care at the primary care center, working in teams with a person-centered focus, where they were given the opportunity to follow, support, and constitute a safety net for patients with depression. Further, they perceived that the care manager increased continuity and accessibility to primary care for patients with depression. Conclusion: The nurses perceived that working as care managers enabled them to follow and support patients with depression and to maintain close contact during the illness.  The care manager function helped to provide continuity in care which is a main task of primary health care. 
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37.
  • Svenningsson, Irene, 1957 (author)
  • Diabetes and obesity in primary health care - a condition beyond physiological factors
  • 2011
  • Doctoral thesis (other academic/artistic)abstract
    • Aims: The objectives of this thesis are to illustrate how obese and normal-weight individuals with type 2 diabetes (T2DM) experience their health status and health care interactions and to highlight the diabetes team (doctor, nurse, dietician, physiotherapist) approach to treating obese individuals with T2DM. Methods: Studies I and IV were qualitative interview studies. In study I, the informants were individuals with T2DM and normal weight or obesity. The analysis method was content analysis (n=28). In study IV, interviews were conducted with seven groups and three individual members of a diabetes team. The grounded theory (GT) method was used to analyse the transcribed interviews. Studies II (n = 287) and III (n= 339) were cross-sectional studies. In study II, health-related quality of life (HRQL) was measured with the Short Form 36 (SF 36) and Well-Being Questionnaire (W-BQ12). Attitudes towards disease and treatment were measured with the Diabetes Attitude Scale (DAS) and Diabetes Treatment Satisfaction Questionnaire (DTSQs). In study III, the Hospital Anxiety and Depression Scale (HADS) and the Beck Depression Inventory II (BDI-II) were employed to estimate the subjects’ symptoms of depression and anxiety. The Mann–Whitney U-test was used to examine differences between normal-weight and obese individuals with T2DM and between women and men. Results: The informants felt supported and secure when their care encounters were based on the perspective of the individual. When the encounter was based on the health care perspective, it created feelings of being stuck, defiance, guilt and shame. The health care professionals’ main concerns were to give professional, individualised care and to find the right balance between coaching and caution. T2DM and obesity were associated with decreased HRQL and increased risk of anxiety and depression in both genders. These associations influence health care professional-patient interactions and affect the individual’s coping with his or her illness. General conclusion and implications: Health care professionals in primary health care (PHC) must consider each individual with T2DM’s life situation, including physical, mental, cultural and social dimensions and the differences between the genders. Care plans must focus on the individual’s specific situation. Keywords: Anxiety, depression, diabetes type 2, gender, health care professional, health related quality of life, obesity, patient, primary health care
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38.
  •  
39.
  • Svenningsson, Irene, et al. (author)
  • Health care professionals meeting with individuals with Type 2 diabetes and obesity : Balancing coaching and caution
  • 2011
  • In: International Journal of Qualitative Studies on Health and Well-being. - Oxfordshire : Taylor & Francis. - 1748-2623 .- 1748-2631. ; 6:2
  • Journal article (peer-reviewed)abstract
    • The burden of diabetes and obesity is increasing worldwide, indicating a need to find the best standard for diabetes care. The aim of this study was to generate a theory grounded in empirical data derived from a deeper understanding of health care professionals’ main concerns when they consult with individuals with diabetes and obesity and how they handle these concerns. Tape-recorded interviews were conducted with seven groups and three individual members of a diabetes team in an area of western Sweden. The grounded theory (GT) method was used to analyse the transcribed interviews. A core category, labelled Balancing coaching and caution and three categories (Coaching and supporting, Ambivalence and uncertainty, and Adjusting intentions) emerged. The core category and the three categories formed a substantive theory that explained and illuminated how health care professionals manage their main concern; their ambition to give professional individualised care; and find the right strategy for each individual with diabetes and obesity. The theory generated by this study can improve our understanding of how a lack of workable strategies limits caregivers’ abilities to reach their goals. It also helps identify the factors that contribute to the complexity of meetings between caregivers and individuals with diabetes. © 2011 I. Svenningsson et al.
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40.
  • Svenningsson, Irene, 1957, et al. (author)
  • Process evaluation of a cluster randomised intervention in Swedish primary care: using care managers in collaborative care to improve care quality for patients with depression
  • 2019
  • In: Bmc Family Practice. - : Springer Science and Business Media LLC. - 1471-2296. ; 20
  • Journal article (peer-reviewed)abstract
    • BackgroundThe collaborative care model with a care manager has previously generated beneficial results for patients with depression in terms of decreased burden of depression symptoms. A care manager function has been tested in Sweden in the PRIM-CARE RCT with successful results. The aim of the present study was to evaluate the process of implementing care managers in collaborative care for patients with depression in Swedish primary health care in the PRIM-CARE RCT.MethodsThe study followed UK Medical Research Council guidance for process evaluation.Field notes from the implementation of the PRIM - CARE RCT were used, as well as data collected from five focus group discussions with General Practitioners (n=29) and three focus group discussions with care managers (n=11). Data were analysed with content analysis.ResultsTraining sessions, careful preparation and extensive initial support to the care manager and staff at the Primary Care Centres were important ingredients in the implementation. The close access to facilitators, the recurrent peer support meetings, and the weekly newsletter strengthened the care manager function.ConclusionsA complex intervention adapted to the Swedish primary care context focusing on a care manager function for patients with depression could be performed through a stepwise implementation process. Financial support from the health care regions included in the study helped to reduce the impact of identified barriers. This process evaluation has revealed new and important knowledge for primary care development concerning infrastructure and organization building, knowledge sharing, and facilitating factors and barriers.Trial registrationNCT02378272 Care Manager - Coordinating Care for Person Centered Management of Depression in Primary Care (PRIM - CARE). Registered March 4 2015. Retrospectively registered.
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41.
  • Svenningsson, Irene, 1957, et al. (author)
  • Symptom patterns in patients newly sick listed for common mental disorders and associations with work-related and socioeconomic factors: a cross-sectional study in Swedish primary care.
  • 2022
  • In: BMJ open. - : BMJ. - 2044-6055. ; 12:7
  • Journal article (peer-reviewed)abstract
    • The aim was to determine symptom patterns of depression, anxiety and stress-related mental disorders in newly sick listed due to common mental disorders in Swedish primary care patients and to examine associations with sick leave diagnosis, also in relation to socioeconomic, work-related and demographic factors.Cross-sectional study.Primary care in western Sweden.From a randomised controlled trial, patients aged 18-67, seeking primary care and on sick leave due to depression, anxiety and/or mental stress, in total 341 individuals, during 2018-2020.Patterns of depressive, anxiety and stress symptoms measured via self-assessment questionnaires (Montgomery Asberg Depression Rating Scale-Self (MADRS-S), General Anxiety Disorder Scale-7 (GAD-7), Karolinska Exhaustion Disorder Scale (KEDS)), sick leave diagnosis, perception of Work Ability Index and job strain via the job strain model.A combination of high levels of depressive and stress-related symptoms was more frequent than single symptom clusters among persons with common mental disorders (CMD) on sick leave: 7% of the patients had scores above cut-off for one of the instruments MADRS-S, GAD-7 and KEDS, 12% above cut-off for two and 80% had above cut-off for all three instruments. There was no significant association between low socioeconomic status, high-job strain or working in healthcare/education and having scores above cut-off level for two or more of the instruments. Only perception of own poor work ability showed association with having scores above cut-off level for all three of the assessment instruments of CMD (OR 9.45, 95% CI 2.41 to 37.04).The diagnosis on the sick certificate is not always congruent with the dominating symptom score level. In patients sick-leaved for CMDs, possible negative factors such as low socioeconomic status, low social support, high-work strain or working in healthcare/education sector did not show significant associations with self-assessment instruments of anxiety, depression and stress. Only patient's perception of own poor work ability was associated with high scores on all three domains.NCT03250026.
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42.
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43.
  • Svenningsson, Irene, et al. (author)
  • Vårdsamordnarfunktionen i praktiken
  • 2020
  • In: Vårdsamordnare vid psykisk ohälsa i primärvården. - Göteborg : Göteborgs universitet. - 9789151960876
  • Book chapter (other academic/artistic)
  •  
44.
  • Svensson, A., et al. (author)
  • Healthcare professionals learning when implementing a digital artefact identifying patients' cognitive impairment
  • 2023
  • In: JOURNAL OF WORKPLACE LEARNING. - 1366-5626. ; 35:6
  • Journal article (peer-reviewed)abstract
    • PurposeThis paper presents findings from a qualitative study of healthcare professionals' practice, where learning is taking place when a digital artefact is implemented for identification of patients' cognitive impairment. The use of digital artefacts is increasing in various workplaces, to include professionals in healthcare. This paper aims to explore the following research question: How is the professional learning unfolding in patient-based work when a digital artefact transforms the practice? Design/methodology/approachVarious data collection methods are used for this study, consisting of dialogue meetings, interviews and a reference-group meeting. Thematic analysis is used to inductively bring forth the themes of the collected data. FindingsProfessionals' knowledge and experience are of vital importance in learning and changing work practices. Together with their ability to reflect on changes, their knowledge and experience constitute the prefiguration when the introduction of a digital application brings about indeterminacy in the work practice. Originality/valueThis paper makes a contribution to practice-based research as it consolidates previous research and identifies professionals knowledge and learning in a healthcare context. This can be used to further explore and advance the field, as well as to establish the evidence-based importance of transforming practices based on implementation of digital artefacts.
  •  
45.
  • Svensson, Ann, 1962-, et al. (author)
  • Healthcare professionals learning when implementing a digital artefact identifying patients’ cognitive impairment
  • 2023
  • In: Journal of Workplace Learning. - 1366-5626 .- 1758-7859. ; 35:6, s. 490-505
  • Journal article (peer-reviewed)abstract
    • PurposeThis paper presents findings from a qualitative study of healthcare professionals’ practice, where learning is taking place when a digital artefact is implemented for identification of patients’ cognitive impairment. The use of digital artefacts is increasing in various workplaces, to include professionals in healthcare. This paper aims to explore the following research question: How is the professional learning unfolding in patient-based work when a digital artefact transforms the practice?Design/methodology/approachVarious data collection methods are used for this study, consisting of dialogue meetings, interviews and a reference-group meeting. Thematic analysis is used to inductively bring forth the themes of the collected data.FindingsProfessionals’ knowledge and experience are of vital importance in learning and changing work practices. Together with their ability to reflect on changes, their knowledge and experience constitute the prefiguration when the introduction of a digital application brings about indeterminacy in the work practice.Originality/valueThis paper makes a contribution to practice-based research as it consolidates previous research and identifies professionals knowledge and learning in a healthcare context. This can be used to further explore and advance the field, as well as to establish the evidence-based importance of transforming practices based on implementation of digital artefacts.
  •  
46.
  • Toskas, Konstantinos, et al. (author)
  • PRC2-mediated repression is essential to maintain identity and function of differentiated dopaminergic and serotonergic neurons
  • 2022
  • In: Science Advances. - : American Association for the Advancement of Science (AAAS). - 2375-2548. ; 8:34
  • Journal article (peer-reviewed)abstract
    • How neurons can maintain cellular identity over an entire life span remains largely unknown. Here, we show that maintenance of identity in differentiated dopaminergic and serotonergic neurons is critically reliant on the Polycomb repressive complex 2 (PRC2). Deletion of the obligate PRC2 component, Eed, in these neurons resulted in global loss of H3K27me3, followed by a gradual activation of genes harboring both H3K27me3 and H3K9me3 modifications. Notably, H3K9me3 was lost at these PRC2 targets before gene activation. Neuronal survival was not compromised; instead, there was a reduction in subtype-specific gene expression and a progressive impairment of dopaminergic and serotonergic neuronal function, leading to behavioral deficits characteristic of Parkinson's disease and anxiety. Single-cell analysis revealed subtype-specific vulnerability to loss of PRC2 repression in dopamine neurons of the substantia nigra. Our study reveals that a PRC2-dependent nonpermissive chromatin state is essential to maintain the subtype identity and function of dopaminergic and serotonergic neurons.
  •  
47.
  • Udo, Camilla, et al. (author)
  • An interview study of the care manager function : Opening the door to continuity of care for patients with depression in primary care
  • 2019
  • In: Nursing Open. - : Wiley. - 2054-1058. ; 6:3, s. 974-982
  • Journal article (peer-reviewed)abstract
    • Aim: To explore experiences among patients with depression of contact with a care manager at a primary care centre.Design: A qualitative explorative study.Methods: During spring and summer 2016, 20 individual face-to-face interviews were conducted with patients with experience of care manager contact. The material was analysed using systematic text condensation.Results: The participants described that having contact with a care manager was a support in their recovery process. Care became more available, and the structured continuous contact and the care manager's availability contributed to a trusting relationship. Having someone to share their burden with was a relief. However, it was described as negative when the care manager was perceived as inflexible and not open to issues that the participants felt a need to discuss. For the care manager contact to be successful, there is a need for flexibility and individually tailored contact.
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48.
  • Wiegner, Lilian, et al. (author)
  • Newly educated care managers' experiences of providing care for persons with stress-related mental disorders in the clinical primary care context.
  • 2019
  • In: PloS one. - : Public Library of Science (PLoS). - 1932-6203. ; 14:11
  • Journal article (peer-reviewed)abstract
    • Our aim was to explore how the care managers put the complex care manager task into practice and how they perceived their task, which was to facilitate effective, person-centred treatment for stress-related disorder concordant with evidence-based guidelines in primary care.This was a qualitative study using examination reports from the course for care managers. Systematic text condensation according to Malterud was used for the analysis.Primary health care centres.Twenty-eight newly educated care managers in primary health care participated in the study. The median age was 50 (31-68) years. Twenty-seven were women and one was a man. Twenty-one were employed as nurses and seven as counsellors.The informants perceived the role as care manager as meaningful but at times complicated. To participate in teams and to work closely with the general practitioner was experienced as important. The co-ordinating function was emphasised as especially important, as well as the increased continuity in care. The dual role as care manager and counsellor was sometimes experienced as problematic.The informants took advantage of the knowledge they had attained during the course. They perceived themselves as being a bridge between patients and other professionals. The result of having dual roles at the primary health care centre unexpectedly revealed difficulties for some professionals. The nurses seemed more familiar with the new way of working.
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