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1.
  • Abelsson, Tobias, et al. (author)
  • Quality and availability of information in primary healthcare: the patient perspective
  • 2020
  • In: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 38:1, s. 33-41
  • Journal article (peer-reviewed)abstract
    • Objective: To explore lived experiences of patients communicating with and receiving information from primary health care. Design: Qualitative study analysing transcribed interviews by descriptive content analysis. Setting: Recruitment and interviews took place in southern Sweden in three primary care centres where privacy and undisturbed interview environments was ensured. Subjects: 17 primary care patient informants, 9 men and 8 women aged 31 - 84 years with varying educational levels from primary school to post graduates. Main outcome measures: Thematic categories and subcategories reporting the lived experience of the patients. Results: The analysis yielded three categories and identified as a main theme a feeling of unpredictability based on the emotional aspects of feeling lost and vulnerable when trying to access primary care. The category" Need for easy access" illustrated emotional aspects of importance to patients when contacting primary health care." Need for individual adaptation" described the need to individually adapt health related information." Information exchange" comprised experiences of information evaluation and understanding new information. Conclusions: Patients generally trusted the information received, but experienced a lack of communication, which evoked feelings of unpredictability and abandonment. Experiences of limited access to primary health care and the need for varying degrees of adaptation on the part of the individual were factors of concern for how patients experienced the care.
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2.
  • Agardh, Carl-David, et al. (author)
  • Diabetic control in community care. The use of clinical evaluation and hemoglobin A1
  • 1985
  • In: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 3:1, s. 15-18
  • Journal article (peer-reviewed)abstract
    • Diabetic control was evaluated in 50 consecutive patients attending a community care centre, either by clinical criteria or by determination of glycosylated hemoglobin (HbA1). Two methods used for the determination of HbA1 were found to give similar results, namely ion exchange chromatography and agar gel electrophoresis. On a group basis, good correlation was observed between HbA1 samples analysed prior to and following the elimination of the labile HbA1 fraction. When comparing three treatment modes (diet alone, hypoglycemic agents or insulin), no significant differences in HbA1 levels were noted. Patients considered to have satisfactory and poor control had significantly higher HbA1 levels than those considered to have good control, while no differences were seen between those considered to have satisfactory or poor control. It is concluded that the methods described for the determination of HbA1 yield similar results. Clinical evaluation of diabetic control is reliable in patients classified to have good or poor control. However, in many patients who are considered to have satisfactory control, regular determinations of HbA1 provide valuable additional information.
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4.
  • Agvall, Björn, 1963-, et al. (author)
  • Cost of heart failure in Swedish primary healthcare
  • 2005
  • In: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 23, s. 227-232
  • Journal article (peer-reviewed)abstract
    • Objectives. To calculate the cost for patients with heart failure (HF) in a primary healthcare setting. Design. Retrospective study of all available patient data during a period of one year. Setting. Two healthcare centers in Linköping in the southeastern region of Sweden, covering a population of 19 400 inhabitants. Subjects. A total of 115 patients with a diagnosis of HF. Main outcome measures. The healthcare costs for patients with HF and the healthcare utilization concerning hospital days and visits to doctors and nurses in hospital care and primary healthcare. Results. The mean annual cost for a patient with HF was SEK 37 100. There were no significant differences in cost between gender, age, New York Heart Association functional class, and cardiac function. The distribution of cost was 47% for hospital care, 22% for primary healthcare, 18% for medication, 5% for nursing home, and 6% for examinations. Conclusion. Hospital care accounts for the largest cost but the cost in primary healthcare is larger than previously shown. The total annual cost for patients with HF in Sweden is in the range of SEK 5.0–6.7 billion according to this calculation, which is higher than previously known.Read More: http://informahealthcare.com/doi/abs/10.1080/02813430500197647
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5.
  • Agvall, Björn, 1963-, et al. (author)
  • Patients in primary health care diagnosed and treated as heart failure, with special reference to gender differences
  • 2001
  • In: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 19:1, s. 14-19
  • Journal article (peer-reviewed)abstract
    • Objective - The aim of the present study was to describe patients considered to have had heart failure (HF), or were being treated for HF, in a defined area in primary health care, e.g. diagnostic procedures, aetiologic diseases and management, and to evaluate whether there is a difference between the genders. Design - Descriptive retrospective investigation. Setting - ┼tvidaberg community situated in southeast Sweden, 12 400 inhabitants. Patients - 256 patients treated for symptomatic HF. Main outcome measures - Prevalence, aetiology, diagnostic procedures and management of HF and differences between the genders. Results - The diagnosis of HF was based on an objective evaluation of cardiac function in only 31% of the patients. Ischaemic heart disease (IHD) was the predominant associated disease, followed by hypertension. Therapy included diuretics (84%), angiotensin converting enzyme (ACE) inhibitors (56%) and digoxin (40%). Only 52% had optimal doses of ACE inhibitors. Women had a significantly higher mean age and their diagnoses were based on an objective diagnostic test (echocardiography) in only 20%. Women were prescribed ACE inhibitors to a lesser extent (43%) than men (64%) and with a lower optimal dose (44% versus 56% in men). Conclusion - There is still room for improvement in the management of HF in primary health care, especially in women, where the diagnosis is not generally based on an objective evaluation of cardiac function and where the treatment to a lesser extent than in men includes ACE inhibitors.
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6.
  • Ahlen, G. C., et al. (author)
  • The physician's self-evaluation of the consultation and patient outcome: A longitudinal study
  • 2013
  • In: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 31:1, s. 26-30
  • Journal article (peer-reviewed)abstract
    • Objective. To study whether the physician's evaluation of the consultation correlates to patient outcome one month later concerning symptom relief, sick leave, and drug compliance as perceived by the patient. The study also investigated whether the patient's evaluation of the consultation correlated to patient outcome. Design. A longitudinal study using questionnaires. Setting. A county in south-western Sweden. Subjects. Forty-six physicians and 316 primary care patients aged 16 years or more with a new complaint lasting one week or more were invited. A total of 289 patients completed a questionnaire presented at the consultation; 273 patients were reached in a follow-up telephone interview one month after the consultation. Main outcome measures. The association between each statement in the physician-patient questionnaire (PPQ) from the consultation and the answers obtained from the telephone interview were analysed by either multiple linear or logistic regression analysis. Results. Five out of 10 items in the PPQ were significantly associated with patient outcome. Physician's self-evaluation of the consultation was much more strongly associated with patient outcome than the patient's evaluation. Conclusion. The difference between the physician's and patient's evaluation of the consultation to predict patient outcomes indicates that the physician's self-evaluation of the consultation is of importance.
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7.
  • Ahlforn, K. Crosta, et al. (author)
  • A Swedish version of the Consultation and Relational Empathy (CARE) measure
  • 2017
  • In: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 35:3, s. 286-292
  • Journal article (peer-reviewed)abstract
    • Objective: A validated measure to gather patient feedback on physicians' empathy is not available in Swedish. The objective for this study was to examine the psychometric characteristics of a Swedish version of the Consultation and Relational Empathy (CARE) measure (widely used in English). Design, setting and patients: The CARE measure was translated into Swedish and tested on 554 unselected patients visiting physicians in two primary care clinics in northwestern Stockholm, Sweden. Main outcome measures: Adequate translation, as well as reliability and validity of the Swedish CARE measure. Results: The Swedish CARE measure seemed to demonstrate high acceptability and face validity when consulting a physician. The mean CARE score 41.5 (SD 8.9) over all 10 item was not significantly influenced by seasonality, age or gender. Scores were somewhat negatively distributed, but corrected item-total correlations were high (0.86-0.91) suggesting homogeneity. Internal reliability was very high (Cronbach's alpha 0.975). Factor analysis implied a one-dimensional structure with factor loadings between 0.89 and 0.93. Conclusions: The Swedish CARE measure appears to be psychometrically valid and reliable enough in physicians.
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8.
  • Alme, Tomas Nordheim, et al. (author)
  • Chronic fatigue syndromes: real illnesses that people can recover from
  • 2023
  • In: Scandinavian Journal of Primary Health Care. - : TAYLOR & FRANCIS LTD. - 0281-3432 .- 1502-7724. ; 41:4, s. 372-376
  • Journal article (peer-reviewed)abstract
    • The Oslo Chronic Fatigue Consortium consists of researchers and clinicians who question the current narrative that chronic fatigue syndromes, including post-covid conditions, are incurable diseases. Instead, we propose an alternative view, based on research, which offers more hope to patients. Whilst we regard the symptoms of these conditions as real, we propose that they are more likely to reflect the brains response to a range of biological, psychological, and social factors, rather than a specific disease process. Possible causes include persistent activation of the neurobiological stress response, accompanied by associated changes in immunological, hormonal, cognitive and behavioural domains. We further propose that the symptoms are more likely to persist if they are perceived as threatening, and all activities that are perceived to worsen them are avoided. We also question the idea that the best way to cope with the illness is by prolonged rest, social isolation, and sensory deprivation.Instead, we propose that recovery is often possible if patients are helped to adopt a less threatening understanding of their symptoms and are supported in a gradual return to normal activities. Finally, we call for a much more open and constructive dialogue about these conditions. This dialogue should include a wider range of views, including those of patients who have recovered from them.
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10.
  • Andersson, Elin M., et al. (author)
  • Cognitive and emotional reactions to pictorial-based risk communication on subclinical atherosclerosis : a qualitative study within the VIPVIZA trial
  • 2023
  • In: Scandinavian Journal of Primary Health Care. - : Taylor & Francis. - 0281-3432 .- 1502-7724. ; 41:1, s. 69-80
  • Journal article (peer-reviewed)abstract
    • Objectives, setting and subjects: Atherosclerosis screening with ultrasound is non-invasive and can be used as part of risk communication. The potential of personalised and pictorial-based risk communication is assessed in VIPVIZA, a population-based randomised controlled trial that aims at optimising cardiovascular disease (CVD) prevention by investigating the impact of visualisation of subclinical atherosclerosis. The present aim was to explore cognitive and emotional reactions evoked by the intervention as well as attitudes to any implemented life style changes in VIPVIZA participants in the intervention group with improved health status and furthermore to study possible interactions between these factors. Understanding mechanisms of action was central since non-adherence to preventive guidelines are often faced in clinical practice. Design: In-depth interviews with 14 individuals were analysed with qualitative content analysis. Results: Cognitive and emotional processes were highly interlinked and described by the main theme Cognitive and emotional reactions in strong interplay for orchestration of health oriented behavioural change. The informants’ descriptions revealed two distinctly different psychological processes which constituted the two subthemes, Problem-focused coping and Encouragement-driven process. Conclusions: The results highlight that an interaction between emotional reactions and efficacy beliefs is important in facilitating behavioural change. Furthermore, the results underscore the importance of the risk message being perceived as clear, accurate, reliable and also emotionally engaging and thereby show why atherosclerosis screening and pictorial-based risk communication have the potential to contribute to effective CVD prevention strategies and shared decision making in primary care.
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11.
  • Andersson, H. Ingemar, 1950-, et al. (author)
  • Musculoskeletal chronic pain in general practice : studies of health care utilisation in comparison with pain prevalence
  • 1999
  • In: Scandinavian Journal of Primary Health Care. - 0281-3432 .- 1502-7724. ; 17:2, s. 87-92
  • Journal article (peer-reviewed)abstract
    • OBJECTIVE: To study the relations between population prevalence of chronic pain and pain-related diagnoses (musculoskeletal and headaches) in primary health care (PHC) and to examine longitudinal variations in these diagnoses. DESIGN: A population-based mailed survey to catch prevalence data and continuous computerised diagnosis registration in PHC. SETTING: General population in a well-defined Swedish PHC district. SUBJECTS: A random sample of 15% of the population aged 25-74, n = 1101. Annual visitors to district physicians at the health centre. MAIN OUTCOME MEASURES: Rates of pain-related diagnoses in PHC in relation to population prevalence of chronic pain. Comparisons of the number of individuals (annual visiting rates) with pain-related diagnoses 1987-1996. RESULTS: Population pain prevalence and pain-related diagnoses in PHC corresponded as regards the magnitude and distribution of chronic pain by age and partly by pain location. Compared to low-back and widespread pain, neck-shoulder pain and headaches were less frequent in PHC in relation to reported prevalence. From 1987 to 1996 we found an increasing number of individuals seeking primary care with pain-related diagnoses. The increase was mainly assigned to the groups of fibrositis/myalgia and headache. CONCLUSION: Pain-related diagnoses in PHC reflect partly the occurrence of self-reported chronic pain symptoms in the population. The observed increase in visits with pain-related diagnoses in the last 10 years is due to an increased number of individuals with soft-tissue rheumatism and headaches. Future studies will have to elucidate whether these findings are due to an increase in morbidity or changes in care-seeking and social conditions.
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12.
  • Andersson, H. Ingemar, et al. (author)
  • Musculoskeletal chronic pain in general practice : studies of health care utilisation in comparison with pain prevalence
  • 1999
  • In: Scandinavian Journal of Primary Health Care. - : Informa Healthcare. - 0281-3432 .- 1502-7724. ; 17:2, s. 87-92
  • Journal article (peer-reviewed)abstract
    • OBJECTIVE: To study the relations between population prevalence of chronic pain and pain-related diagnoses (musculoskeletal and headaches) in primary health care (PHC) and to examine longitudinal variations in these diagnoses. DESIGN: A population-based mailed survey to catch prevalence data and continuous computerised diagnosis registration in PHC. SETTING: General population in a well-defined Swedish PHC district. SUBJECTS: A random sample of 15% of the population aged 25-74, n = 1101. Annual visitors to district physicians at the health centre. MAIN OUTCOME MEASURES: Rates of pain-related diagnoses in PHC in relation to population prevalence of chronic pain. Comparisons of the number of individuals (annual visiting rates) with pain-related diagnoses 1987-1996. RESULTS: Population pain prevalence and pain-related diagnoses in PHC corresponded as regards the magnitude and distribution of chronic pain by age and partly by pain location. Compared to low-back and widespread pain, neck-shoulder pain and headaches were less frequent in PHC in relation to reported prevalence. From 1987 to 1996 we found an increasing number of individuals seeking primary care with pain-related diagnoses. The increase was mainly assigned to the groups of fibrositis/myalgia and headache. CONCLUSION: Pain-related diagnoses in PHC reflect partly the occurrence of self-reported chronic pain symptoms in the population. The observed increase in visits with pain-related diagnoses in the last 10 years is due to an increased number of individuals with soft-tissue rheumatism and headaches. Future studies will have to elucidate whether these findings are due to an increase in morbidity or changes in care-seeking and social conditions.
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13.
  • Andersson, Helen, 1968, et al. (author)
  • White-coat hypertension detected during opportunistic blood pressure screening in a dental healthcare setting
  • 2021
  • In: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 39:3, s. 348-354
  • Journal article (peer-reviewed)abstract
    • Objective To study white-coat hypertension (WCHT, blood pressure >= 140/90 mmHg in a clinic and normal blood pressure <135/85 mmHg at home), with blood pressure screening of a healthy population during their dental healthcare visit and the associated risk factors. Design A multicentre observational study. Setting A healthy general population at four dental clinics in a region in southern Sweden. Subjects 2025 individuals aged 40-75 years were screened for high blood pressure at their annual regular check-up dental visit. Main outcome measures Frequencies of normal and elevated blood pressure (BP) in dental clinics, with home BP as a reference. According to BP results, the population was divided into three groups: normotension (NT), WCHT and suspected hypertension (HT). Background and life style factors were measured: sex, age, family history of hypertension, body mass index (BMI kg/m(2)), education level, tobacco use, and physical activity level. Results The overall prevalence of WCHT in the study was 17.7%, and the prevalence was 57.2% among those with clinically high blood pressure. Compared with NT, WCHT was associated with male sex (OR 1.56, CI 1.18-2.06), older age group (OR 2.33, CI 1.66-3.26), family history of hypertension (OR 1.61, CI 1.24-2.10), high BMI kg/m(2) (OR 2.36, CI 1.80-3.10), daily snuff use (OR 1.74, CI 1.19-2.53). In comparison with WCHT, HT was associated with male sex (OR 2.16, CI 1.44-3.25), older age group (OR 2.85, CI 1.75-4.65), daily smoking (OR 2.10, CI 1.14-3.85), less daily snuff use (OR 0.59, CI 0.34-0.99). Conclusions The prevalence of WCHT in a healthy population was 17.7%. Regarding cardiovascular risk factors, WCHT seems to be in the middle of NT and HT. Individuals with WCHT can be identified and given lifestyle advice in connection with a dental check-up, but follow-up and assessment of their cardiovascular risk should take place in primary care.
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14.
  • Andersson, Konny, et al. (author)
  • Antibiotic use in Australian and Swedish primary care : a cross-country comparison
  • 2022
  • In: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 40:1, s. 95-103
  • Journal article (peer-reviewed)abstract
    • Objective: Antimicrobial resistance is a growing worldwide problem and is considered to be one of the biggest threats to global health by the World Health Organization. Insights into the determinants of antibiotic prescribing may be gained by comparing the antibiotic usage patterns of Australia and Sweden. Design: Publicly available data on dispensed use of antibiotics in Australia and Sweden between 2006 and 2018. Medicine use was measured using defined daily dose per 1,000 inhabitants per day (DDD/1000/day) and the number of dispensed prescriptions per 1000 inhabitants (prescriptions/1000). Results: The use of antibiotics increased over the study period in Australia by 1.8% and decreased in Sweden by 26.3%. Use was consistently higher in Australia, double that of Sweden in 2018. Penicillin with extended spectrum was the most used class of antibiotics in Australia followed by penicillin with beta lactamase inhibitors. In Sweden, the most used class was beta lactamase-sensitive penicillin and the least used class was penicillin with beta lactamase inhibitors. Conclusion: Antibiotic use in Australia is higher than in Sweden, with a higher proportion of broad-spectrum penicillin, including combinations with beta lactamase inhibitors, and cephalosporins. Factors that may contribute to these differences in antibiotic use include differences in guidelines, the duration of national antimicrobial stewardship programs, and differences in funding mechanisms.Key points Australia has had a consistently higher dispensed use of antibiotics compared to Sweden from 2006 to 2018; and up to twice the use in 2018 •A higher proportion of dispensed antibiotics in Australia were broad-spectrum penicillin, including combinations with beta lactamase inhibitors, and cefalosporins. •The most commonly used class of antibiotics in Australia is penicillin with extended spectrum, compared to beta lactamase sensitive penicillin in Sweden. •Use of macrolides, sulphonamides and trimethoprim, cephalosporins, penicillin with beta lactamase inhibitors and penicillin with extended spectrum was consistently higher in Australia, whereas in Sweden use of fluoroquinolones, lincosamides, beta lactamase-resistant penicillin and beta lactamase sensitive penicillin was higher. •The observed differences could be explained by antibiotic choice recommended in guidelines, prevalence of point-of-care testing, models of primary care funding, the presence and duration of national antimicrobial stewardship programmes, and cultural differences.
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  • Andersson, Susanne, 1957, et al. (author)
  • The association between self-rated health and impaired glucose tolerance in Swedish adults: A cross-sectional study
  • 2013
  • In: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 31:2, s. 111-118
  • Journal article (peer-reviewed)abstract
    • Objective. To investigate gender differences in the association between self-rated health (SRH) and impaired glucose tolerance (IGT) in subjects unaware of their glucose tolerance. Design. A cross-sectional population-based study. Setting. The two municipalities of Vara and Skövde in south-western Sweden. Subjects. A total of 2502 participants (1301 women and 1201 men), aged 30–75, were randomly selected from the population. Main outcome measures. IGT was regarded as the outcome measure and SRH as the main risk factor. Results. The prevalence of IGT was significantly higher in women (11.9%) than in men (10.1%), (p = 0.029), as was the prevalence of low SRH (women: 35.4%; men: 22.1%, p = 0.006). Both men and women with low SRH had a poorer risk factor profile than those with high SRH, and a statistically significant crude association between SRH and IGT was found in both men (OR = 2.8, 95% CI 1.8–4.4) and women (OR = 1.5, 95% CI 1.0–2.2, p = 0.033). However, after controlling for several lifestyle factors and biomedical variables, the association was attenuated and remained statistically significant solely in men (OR = 2.3, 95% CI 1.2–4.3). Conclusion. The gender-specific associations found between SRH and IGT suggest that SRH may be a better indicator of IGT in men than in women. Future studies should evaluate the utility of SRH in comparison with objective health measures as a potential aid to health practitioners when deciding whether to screen for IGT and T2DM.
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19.
  • Andersson, Ulrika, et al. (author)
  • Associations between daily home blood pressure measurements and self-reports of lifestyle and symptoms in primary care: the PERHIT study
  • 2024
  • In: Scandinavian Journal of Primary Health Care. - : TAYLOR & FRANCIS LTD. - 0281-3432 .- 1502-7724.
  • Journal article (peer-reviewed)abstract
    • Objective To explore in a primary care setting the associations between patients' daily self-measured blood pressure (BP) during eight weeks and concurrent self-reported values of wellbeing, lifestyle, symptoms, and medication intake. We also explore these associations for men and women separately. Design and setting The study is a secondary post-hoc analysis of the randomised controlled trial PERson-centeredness in Hypertension management using Information Technology (PERHIT). The trial was conducted in primary health care in four regions in Southern Sweden. Patients Participants (n = 454) in the intervention group in the PERHIT-trial used an interactive web-based system for self-management of hypertension for eight consecutive weeks. Each evening, participants reported in the system their wellbeing, lifestyle, symptoms, and medication adherence as well as their self-measured BP and heart rate. Main outcome measures Association between self-reported BP and 10 self-report lifestyle-related variables. Results Self-reported less stress and higher wellbeing were similarly associated with BP, with 1.0 mmHg lower systolic BP and 0.6/0.4 mmHg lower diastolic BP (p < 0.001). Adherence to medication had the greatest impact on BP levels (5.2/2.6 mmHg, p < 0.001). Restlessness and headache were also significantly associated with BP, but to a lesser extent. Physical activity was only significantly associated with BP levels for men, but not for women. Conclusion In hypertension management, it may be important to identify patients with high-stress levels and low wellbeing. The association between medication intake and BP was obvious, thus stressing the importance of medication adherence for patients with hypertension.
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20.
  • Andersson, Ulrika, et al. (author)
  • Associations between daily home blood pressure measurements and self-reports of lifestyle and symptoms in primary care: the PERHIT study
  • 2024
  • In: SCANDINAVIAN JOURNAL OF PRIMARY HEALTH CARE. - : TAYLOR & FRANCIS LTD. - 0281-3432 .- 1502-7724.
  • Journal article (peer-reviewed)abstract
    • Objective To explore in a primary care setting the associations between patients' daily self-measured blood pressure (BP) during eight weeks and concurrent self-reported values of wellbeing, lifestyle, symptoms, and medication intake. We also explore these associations for men and women separately. Design and setting The study is a secondary post-hoc analysis of the randomised controlled trial PERson-centeredness in Hypertension management using Information Technology (PERHIT). The trial was conducted in primary health care in four regions in Southern Sweden. Patients Participants (n = 454) in the intervention group in the PERHIT-trial used an interactive web-based system for self-management of hypertension for eight consecutive weeks. Each evening, participants reported in the system their wellbeing, lifestyle, symptoms, and medication adherence as well as their self-measured BP and heart rate. Main outcome measures Association between self-reported BP and 10 self-report lifestyle-related variables. Results Self-reported less stress and higher wellbeing were similarly associated with BP, with 1.0 mmHg lower systolic BP and 0.6/0.4 mmHg lower diastolic BP (p < 0.001). Adherence to medication had the greatest impact on BP levels (5.2/2.6 mmHg, p < 0.001). Restlessness and headache were also significantly associated with BP, but to a lesser extent. Physical activity was only significantly associated with BP levels for men, but not for women. Conclusion In hypertension management, it may be important to identify patients with high-stress levels and low wellbeing. The association between medication intake and BP was obvious, thus stressing the importance of medication adherence for patients with hypertension.
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21.
  • Anell, Anders, et al. (author)
  • Weak association between socioeconomic Care Need Index and primary care visits per registered patient in three Swedish regions
  • 2021
  • In: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 39:3, s. 288-295
  • Journal article (peer-reviewed)abstract
    • OBJECTIVE: The objective was to examine the association between primary care consultations and a Care Need Index (CNI) used to compensate Swedish primary care practices for the extra workload associated with patients with low socioeconomic status.DESIGN: Observational study combining graphical analysis with linear regressions of cross-sectional administrative practice-level data.SETTING: Three Swedish regions, Västra Götaland, Skåne and Östergötland (3.5 million residents). Outcomes were measured in February 2018 and the CNI was computed based on data for 31 December 2017.SUBJECTS: The unit of analysis was the primary care practice (n = 390).MAIN OUTCOME MEASURES: i) Number of GP visits per registered patient; ii) Number of nurse visits per registered patient; iii) Number of morbidity-weighted GP visits per registered patient; iv) Number of morbidity-weighted nurse visits per registered patient.RESULTS: The linear associations between the CNI and GP visits per patient were positive and statistically significant (p<0.01) for both the unweighted and weighted measure in two regions, but the associations were mainly due to 10 practices with very high CNI values. The results for nurse visits varied across regions.CONCLUSIONS: For most levels of the CNI, there was no association with the number of consultations provided. This result may indicate insufficient compensation, weak incentives to spend the money, decisions to spend the money on other things than consultations, or stronger competition for patients among low-CNI practices. The result of this observational study should not be taken as evidence against the possibility that the CNI adjustment of capitation may have affected the socioeconomic equity in GP and nurse visits.Key PointsSwedish primary care practices receive extra compensation for socioeconomically deprived patients but it is unknown how this affects service provision.Practice-level data from three regions years 2017-2018 indicate weak or no relation between the socioeconomic burden and the number of physical consultations per patient.Results are similar when adjusting for patients' morbidity levels, suggesting that the weak gradient was not explained by longer consultations.The exception is that a small number of practices with very high burdens provide more consultations per patient.The results may reflect insufficient compensation, lack of incentives, or funds being spent on other things than consultations.
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  • Anskär, Eva, et al. (author)
  • ‘But there are so many referrals which are totally...only generating workand irritation’ : a qualitative study of physicians’and nurses’experiences ofwork tasks in primary care in Sweden
  • 2022
  • In: Scandinavian Journal of Primary Health Care. - : Taylor & Francis Ltd. - 0281-3432 .- 1502-7724. ; 40:3, s. 350-359
  • Journal article (peer-reviewed)abstract
    • Objective This study explored the perceptions of physicians and nurses in Swedish primary care regarding the legitimacy of their work tasks and the use of their professional competence. Design and setting This qualitative study was based on manifest content analysis. Data were collected with individual semi-structured interviews of physicians and nurses at publicly managed primary care centres in the Region ostergotland, Sweden. To include both large and small primary care centres, we applied strategic sampling. Among 15 primary care centres invited, nine agreed to participate, including four urban, two suburban, and three rural centres. Subjects The study included 11 physicians and 13 nurses from nine primary care centres. Main outcome measures and results The physicians and nurses perceived several of their work tasks as illegitimate. In addition, they experienced work-related difficulties, due to resource shortages, challenging electronic data systems, work inefficiencies, and that there were insufficient cooperation with, and problems drawing the line between, primary care and hospital care responsibilities. However, most found that their individual expertise was appropriately used, overall. Conclusions Strained work situations and illegitimate work tasks may inflate discontentment and lead to negative work stress. Nevertheless, the staff felt that competence was used appropriately in the tasks considered legitimate.
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23.
  • Anskär, Eva, 1957-, et al. (author)
  • Legitimacy of work tasks, psychosocial work environment, and time utilization among primary care staff in Sweden
  • 2019
  • In: Scandinavian Journal of Primary Health Care. - : Taylor & Francis. - 0281-3432 .- 1502-7724. ; 37:4, s. 476-483
  • Journal article (peer-reviewed)abstract
    • Objective: Primary care staff faces a complex work environment including a heavy administrative work load and perceive some work tasks as illegitimate. This study aimed to elucidate associations between the perceived legitimacy of work tasks, the psychosocial work environment, and the utilization of work time among Swedish primary care staff.Design and setting: The study was designed as a multicenter study involving all staff categories, i.e. registered nurses, primary care physicians, care administrators, nurse assistants and allied professionals, at eleven primary care centers in Sweden.Subjects: Participants completed the Bern Illegitimate Tasks Scale and the Copenhagen Psychosocial Questionnaire. They also recorded time spent on all work tasks, day by day during two separate weeks.Main outcome measures and results: More than a quarter (27%) of primary care physicians perceived a high proportion of unnecessary work tasks. After adjusting for profession, age and gender, the perception of having to perform unreasonable work tasks was positively associated with experiencing role conflicts and with the proportion of organization-related administration and service work tasks.Conclusion: Across all staff groups, the perception of unreasonable work tasks was more pronounced among staff with a high proportion of non-patient related administration. Also, the perception of having to perform a large amount of illegitimate work tasks affected the psychosocial work environment negatively, which might influence staffs perception of their professional roles. These results illuminate the importance of decision makers to thoroughly consider the distribution and allocation of non-patient related work tasks among staff in primary care.Key pointsWe observed an interaction between perception of having a large proportion of illegitimate work tasks and impaired psychosocial work environment. • More than a quarter of the primary care physicians perceived a high proportion of unnecessary work tasks.• Across all staff groups, performing unreasonable work tasks was associated with an experience of having role conflicts.• Across all staff groups, a perception of performing unreasonable work tasks was associated with the proportion of non-patient related administrative work tasks.
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24.
  • Areskoug Josefsson, Kristina, 1973-, et al. (author)
  • Workers' experiences of healthy work environment indicators at well-functioning primary care units in Sweden: a qualitative study
  • 2018
  • In: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 36:4, s. 406-414
  • Journal article (peer-reviewed)abstract
    • Objective: Staff experiences of healthy work environment (HWE) indicators at primary care units can assist in understanding why some primary care units function better than others. The aim of the study was to create increased understanding of how workers experienced HWE indicators at well-functioning primary care units. Design: Fifty in-depth interviews with staff at six primary care units in Sweden were analysed with deductive content analysis, revisiting a systematic review of HWE indicators. Results: The study presents additional perspectives on staff experiences of HWE indicators at well-functioning primary care units. The included primary care units (PCU) shared a similar pattern of work environment indicators, with unique solutions and strategies to meet shared challenges. Staff at the included PCUs were encouraged to work to create and sustain a HWE, but each domain (indicator) also provided challenges that the staff and organisation needed to meet. The results suggest that useful approaches for a healthy work environment could be to address issues of organisational virtuousness, employee commitment and joy at work. Conclusions: Both managers and staff are encouraged to actively work not only to create and sustain an HWE but also to promote organisational virtuousness, employee commitment, joy at work and to increase the performance at work, which is of benefit to staff, patients and society.
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25.
  • Ariander, Annaclara, et al. (author)
  • Ethical challenges causing moral distress: nursing home staff's experiences of working during the COVID-19 pandemic
  • 2024
  • In: Scandinavian Journal of Primary Health Care. - : TAYLOR & FRANCIS LTD. - 0281-3432 .- 1502-7724.
  • Journal article (peer-reviewed)abstract
    • ObjectiveTo investigate the experiences of healthcare staff in nursing homes during the COVID-19 pandemic.DesignIndividual interviews. Latent qualitative content analysis.SettingTen nursing homes in Sweden.SubjectsPhysicians, nurses and nurse assistants working in Swedish nursing homes.Main outcome measuresParticipants' experiences of working in nursing homes during the COVID-19 pandemic.ResultsFour manifest categories were found, namely: Balancing restrictions and allocation of scarce resources with care needs; Prioritizing and acting against moral values in advance care planning; Distrust in cooperation and Leadership and staff turnover - a factor for moral distress. The latent theme Experiences of handling ethical challenges caused by the COVID-19 pandemic gave a deeper meaning to the categories.ConclusionDuring the pandemic, nursing home staff encountered ethical challenges that caused moral distress. Moral distress stemmed from not being given adequate conditions to perform their work properly, and thus not being able to give the residents adequate care. Another aspect of moral distress originated from feeling forced to act against their moral values when a course of action was considered to cause discomfort or harm to a resident. Alerting employers and policymakers to the harm and inequality experienced by staff and the difficulty in delivering appropriate care is essential. Making proposals for improvements and developing guidelines together with staff to recognize their role and to develop better guidance for good care is vital in order to support and sustain the nursing home workforce. The COVID-19 pandemic has affected both patients and staff in nursing homes, in Sweden and worldwide.Our study highlights that during the COVID-19 pandemic, nursing home staff encountered several ethical challenges which caused moral distress.Moral distress stemmed from not being given adequate conditions to perform their work, thus not giving the residents appropriate care.Moral distress could also originate from nursing home staff's feeling of being forced to act against their moral values.
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26.
  • Arne, Mats, 1954-, et al. (author)
  • Physical activity and quality of life in subjects with chronic disease : chronic obstructive pulmonary disease compared with rheumatoid arthritis and diabetes mellitus
  • 2009
  • In: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 27:3, s. 141-147
  • Journal article (peer-reviewed)abstract
    • OBJECTIVE: Chronic diseases interfere with the life situation of the affected person in different ways. The aim was to compare the burden of disease in three chronic diseases - chronic obstructive pulmonary disease (COPD), rheumatoid arthritis (RA), diabetes mellitus (DM) - and in healthy subjects, with a particular interest in physical activity, quality of life, and psychological health. DESIGN: Cross-sectional, observational study. SETTING AND SUBJECTS: Postal survey questionnaire to a stratified, random population of 68 460 subjects aged 18-84 years in Sweden. The subjects included were 40-84 years old (n = 43 589) and data were analysed for COPD (n = 526), RA (n = 1120), DM (n = 2149) and healthy subjects (n = 6960). RESULT: Some 84% of subjects with COPD, 74% (RA), 72% (DM), and 60% in healthy subjects (p < 0.001, COPD versus RA, DM, and healthy subjects) had a physical activity level considered too low to maintain good health according to guidelines. Quality of life (EuroQol five-dimension questionnaire, EQ-5D) was lower in COPD and RA than in DM. Anxiety/depression was more common in subjects with COPD (53%) than in those with RA (48%) and DM (35%) (p < 0.001, COPD versus RA and DM), whereas mobility problems were more common in RA (55%) than COPD (48%) and DM (36%) (p < 0.001, RA versus COPD and DM). All differences between groups remained significant after adjusting for age, sex, and socioeconomic background factors. CONCLUSION: Subjects with chronic diseases had a low level of physical activity, most evident in subjects with COPD. COPD and RA had a higher negative impact on quality of life than DM. Our results indicate that increased attention regarding physical inactivity in subjects with chronic diseases is needed to minimize the burden of disease.
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27.
  • Arntsberg, Louise, et al. (author)
  • Management and documentation of pneumonia–a comparison of patients consulting primary care and emergency care
  • 2024
  • In: Scandinavian Journal of Primary Health Care. - : TAYLOR & FRANCIS LTD. - 0281-3432 .- 1502-7724.
  • Journal article (peer-reviewed)abstract
    • Patients may attend either primary or emergency care without referral in Sweden. Guidelines recommend a severity assessment, including assessment of vital signs, to be performed for all patients presenting with suspected pneumonia. Objective: To compare management and documentation of vital signs, symptoms and infection severity in pneumonia patients seeking primary care and emergency care without referral. Design: Medical record review of vital signs, examination findings and severity of pneumonia. Setting: Primary and emergency care. Subjects: Two hundred and forty patients diagnosed with pneumonia. Main outcome measures: Vital signs, examination findings and severity of pneumonia. Assessments of pneumonia severity according to the reviewers, the traffic light score and CRB-65. Results: Respiratory rate, blood pressure, heart rate and oxygen saturation were less often documented in primary care (p < .001). Chest X-ray was performed in 5% of primary care patients vs. 88% of emergency care patients (p < .01). Primary care patients had longer symptom duration, higher oxygen saturation and lower respiratory rate. In total, the reviewers assessed 63% of all pneumonias as mild and 9% as severe. The traffic light scoring model identified 11 patients (9%) in primary care and 53 patients (44%) in emergency care at high risk of severe infection. Conclusions: Vital signs were documented less often in primary care than in emergency care. Patients in primary care appear to have a less severe pneumonia, indicating attendance to the correct care level. The traffic light scoring model identified more patients at risk of severe infection than CRB-65, where the parameters were documented to a limited extent.
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28.
  • Arvidsson, Eva, et al. (author)
  • Primary care patients' attitudes to priority setting in Sweden
  • 2009
  • In: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 27:2, s. 123-128
  • Journal article (peer-reviewed)abstract
    • Objective. To analyse attitudes to priority setting among patients in Swedish primary healthcare. Design. A questionnaire was given to patients comprising statements on attitudes towards prioritizing, on the role of politicians and healthcare staff in prioritizing, and on patient satisfaction with the outcome of their contact with primary healthcare (PHC). Settings. Four healthcare centres in Sweden, chosen through purposive sampling. Participants. All the patients in contact with the health centres during a two-week period in 2004 (2517 questionnaires, 72% returned). Main outcomes. Patient attitudes to priority setting and satisfaction with the outcome of their contact. Results. More than 75% of the patients agreed with statements like Public health services should always provide the best possible care, irrespective of cost. Almost three-quarters of the patients wanted healthcare staff rather than politicians to make decisions on priority setting. Younger patients and males were more positive towards priority setting and they also had a more positive view of the role of politicians. Less than 10% of the patients experienced some kind of economic rationing but the majority of these patients were satisfied with their contact with primary care. Conclusions. Primary care patient opinions concerning priority setting are a challenge for both politicians and GPs. The fact that males and younger patients are less negative to prioritizing may pave the way for a future dialogue between politicians and the general public.
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29.
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30.
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31.
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32.
  • Backman, Christian, et al. (author)
  • Knowledge in and support for standardised cancer care pathways among general practitioners and other physicians in Sweden
  • 2021
  • In: Scandinavian Journal of Primary Health Care. - : Taylor & Francis. - 0281-3432 .- 1502-7724. ; 39:1, s. 17-22
  • Journal article (peer-reviewed)abstract
    • OBJECTIVE: To investigate the expertise in and support of the implemented new method of cancer patient pathways (CPPs) among general practitioners (GPs) and other working physicians in Sweden.DESIGN: A survey in the form of 10 knowledge-based multiple-choice questions (MCQs) and two general questions about CPPs.SETTING: Physicians from two different regions in Sweden answered the survey between December 2018 and January 2019.SUBJECTS: GPs in primary care compared to other physicians. 155 participants completed the survey and the response rate was 65%.MAIN OUTCOME MEASURES: Physicians' self-estimated knowledge of CPPs in general and opinion of CPPs effect on mortality and morbidity. Their scores on 10 different MCQs. Scores were analysed in subgroups related to the physicians medical specialty and experience.RESULTS: A majority of all physicians (63%) felt that they had insufficient knowledge regarding the procedure of CPPs, and the average score from the MCQs was 3.8 out of 10 correct answers. The results showed that GPs performed significantly better than specialists from other disciplines.CONCLUSIONS: The low percentage of correctly answered MCQs shows that the information about the entry part of CPPs needs to be improved. The study demonstrates a support for the system with CPPs because the physicians believed in its' positive effects on morbidity and mortality, however, it also reveals a lack of self-estimated knowledge about the system with CPPs.Key pointsCancer patient pathways (CPPs) is a newly implemented method in Sweden that aims to equalize cancer care and reduce the time to diagnosis and treatment.The proficiency of when to initiate an investigation according to a specific CPP seems low. General practitioners (GPs) performed significantly better on knowledge-based questions than other specialists did.Physicians rated their knowledge as insufficient regarding the procedure of CPPs.A clear majority of physicians believed that CPPs promotes a lower mortality and morbidity in cancer.
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33.
  • Barabas, G, et al. (author)
  • No association between elevated post-void residual volume and bacteriuria in residents of nursing homes
  • 2005
  • In: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 23:1, s. 52-56
  • Journal article (peer-reviewed)abstract
    • Objective To evaluate the concept that increased post-void residual urine volume (PVR) is a risk factor for bacteriuria. Design Cross-sectional study. Setting Three nursing homes in Jönköping, southern Sweden. Subjects A total of 147 elderly residents in municipal nursing homes. Main outcome values PVR volumes measured with a portable ultrasonic bladder scan, urine specimen, and questionnaire data on incontinence, immobility, impaired cognition, neurological diseases, and medications. Results Mean age was 86 years and 78% were women. The prevalence of a PVR for the four chosen cut-off values (30, 50, 100, and 150 ml) was 51%, 39%, 20%, and 7%, respectively. The prevalence of bacteriuria was 42%, 46% for women and 28% for men. Elevated PVR was not associated with bacteriuria, incontinence, immobility, impaired cognition or neurological disease (stroke, Parkinson's disease). Conclusion Bacteriuria and elevated PVR are common among elderly residents in nursing homes. The study could not confirm that elevated PVR predisposes to bacteriuria in elderly residents in nursing homes.
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34.
  • Bari, Muhammad Rizuanul, et al. (author)
  • Abdominal obesity and insulin resistance in patients with type 2 diabetes in a Swedish community - Skaraborg Hypertension and Diabetes Project
  • 2006
  • In: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 24:4, s. 211-217
  • Journal article (peer-reviewed)abstract
    • Objective. To explore the association between abdominal obesity and insulin resistance in patients with type 2 diabetes. Design. A cross-sectional observational study. Setting. Primary care in Skara, Sweden. Subjects. A total of 198 men and 186 women with type 2 diabetes who consecutively completed an annual check-up in 1992-1993. Main outcome measures. Abdominal obesity was defined according to criteria for the metabolic syndrome using the waist circumference (WC): > 102 cm for men and > 88 cm for women. Insulin resistance was estimated using the Homeostasis Model Assessment (HOMA), and was dichotomized by the 75th percentile (IR). Results. Abdominal obesity was found in 66 men (33%), and in 106 women (57%). Pearson's correlation coefficients between components of the metabolic syndrome and IR were statistically significant for WC, waist-hip ratio, serum triglycerides, and HDL cholesterol, and were higher for WC (0.40) than for waist-hip ratio (0.23) in both genders (p < 0.001). The association between WC and IR was challenged by successively entering other components of the metabolic syndrome into the model in a logistic regression. In the final model, adjusting for differences in age, systolic blood pressure, HbA1c, serum triglycerides, HDL cholesterol, and microalbuminuria, the association remained statistically significant both in men (OR 8.6, 95% CI 3.0-25.2, p < 0.001), and in women (OR 5.6, 95% CI 1.7-18.1, p = 0.004). Conclusions. WC provides a feasible measure for insulin resistance in the vast majority of subjects with type 2 diabetes. It is convenient and less expensive than direct means and could be used as a proxy for insulin resistance in population studies.
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35.
  • Baumbach, Linda, et al. (author)
  • Association between received treatment elements and satisfaction with care for patients with knee osteoarthritis seen in general practice in Denmark
  • 2021
  • In: Scandinavian Journal of Primary Health Care. - : Taylor & Francis. - 0281-3432 .- 1502-7724. ; 39:2, s. 257-264
  • Journal article (peer-reviewed)abstract
    • Objective: While education, exercise, and weight reduction when indicated, are recommended first-line treatments for knee osteoarthritis patients, they remain poorly implemented in favour of pain killer treatment, imaging and referral to surgery. A reason could be that patients are more satisfied with receiving these adjunctive treatment elements. This study aimed to investigate the associations between the received elements of care and the patient's satisfaction with the care for knee osteoarthritis in general practice.Design: Cross-sectional study.Setting: A Danish general practice.Subjects: All consecutive patients >= 30 years of age who consulted the general practitioner (GP) with chronic knee complaints during 18 months and who replied to a mailed questionnaire (n = 136).Main outcome measures: The questionnaire addressed patient's knee-related quality of life, and overall satisfaction with care, as well as reception of seven types of information, which are known quality indicators. Information on reception of adjunctive treatment elements was obtained from electronic medical records.Results: Patient satisfaction (versus neutrality/dissatisfaction) was positively associated with reception of information on: physical activity and exercise (relative risks [RR] 1.38, 95% bootstrap percentile interval [BPI] 1.02-4.33), and the relationship between weight and osteoarthritis (1.38, 1.01-4.41). No significant associations were found for the five remaining types of information and all the adjunctive treatment elements.Conclusion: Providing information as education to patients with knee osteoarthritis as part of the treatment is positively associated with satisfaction with care.
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36.
  • Beck, Simon, et al. (author)
  • Implementing advance care planning in Swedish healthcare settings–a qualitative study of professionals’ experiences
  • 2023
  • In: Scandinavian Journal of Primary Health Care. - : Taylor and Francis Ltd.. - 0281-3432 .- 1502-7724. ; 41:1, s. 23-32
  • Journal article (peer-reviewed)abstract
    • Background: Advance care planning (ACP) is a process involving conversations about values and preferences regarding future care at the end-of-life. ACP has led to positive outcomes, both in relation to quality of life and with increased use of palliative care, less life-sustaining treatment and fewer hospital admissions. Sweden has yet to embrace the practice systematically, but scattered initiatives exist.Aim: To study implementation of a routine for ACP in NH settings in Sweden by exploring healthcare professionals’ experiences of engaging in ACP following this implementation.Methods: The study followed a qualitative inductive design with convenience and snowball sampling. Semi-structured group and individual interviews with registered healthcare professionals were analysed using qualitative content analysis.Findings: Organisational support for sustainable ACP implementation was found to be essential. This included sufficient training, facilitation, collaboration and uniform work routines across providers and professionals. Engaging in ACP conversations following the implemented routine was found to be a process of preparing, being, talking, deciding and sharing.Conclusions: Successful implementation of ACP in NHs requires a carefully planned implementation strategy. ACP in NHs tend to be medically focused at the expense of residents’ psychosocial care-planning needs. Widespread uptake of ACP in Sweden could be useful in the national effort to adopt more person-centred care in Swedish healthcare.KEY POINTS While advance care planning has been implemented in many other countries, Sweden lacks a national strategy on advance care planning and Swedish healthcare settings have yet to systematically implement this practice. • This study is the first to report on professionals’ experiences of engaging in sustainable advance care planning, following top-down implementation of the practice in one Swedish region. • Successful implementation of advance care planning in nursing homes requires a system-level approach, and shortcomings of the implementation process are highlighted.
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37.
  • Bengtsson, Anna, 1973-, et al. (author)
  • Increased knowledge makes a difference!–general practitioners’ experiences of pictorial information about subclinical atherosclerosis for primary prevention: an interview study from the VIPVIZA trial
  • 2021
  • In: Scandinavian Journal of Primary Health Care. - : Taylor & Francis. - 0281-3432 .- 1502-7724. ; 39:1, s. 77-84
  • Journal article (peer-reviewed)abstract
    • Objectives: To explore how pictorial information on subclinical atherosclerosis affects GPs’ perception of patient cardiovascular disease (CVD) risk, their communication with patients, and GPs’ attitude to the treatment of CVD risk factors.Design, setting and subjects: Fifteen individual interviews were conducted between March 2014 and December 2016, with GPs who had received pictorial information regarding their patients’ subclinical atherosclerosis. The pictorial information was also received by the patients together with written information regarding atherosclerosis and CVD risk prior to the appointment with their GP. The interviews were recorded, transcribed and analyzed using qualitative content analysis.Results: Three categories were identified in the analysis. Increased knowledge makes a difference: When patients had more in-depth knowledge regarding atherosclerosis, the consultation became more patient-centered and moved towards shared decision making. This is real, not just a number: GPs described their risk assessment and the patient’s risk perception as more accurate with pictorial information about subclinical atherosclerosis. How to deal with the result–A passive to active approach: Some GPs acted promptly on the pictorial information while others took no action.Conclusion and implications: Pictorial information regarding patients’ subclinical atherosclerosis affected GPs’ assessment of CVD risk. The communication shifted towards shared decision-making although the GPs’ attitude to the result and treatment of CVD risk factors varied. Informing patients about examination results, both in writing and pictures, prior to a consultation can facilitate shared decision making and enhance preventive measures.Trial registration: https://clinicaltrials.gov/ct2/show/NCT01849575.KEY POINTS: Providing pictorial information about carotid ultrasound results and information regarding atherosclerosis to GPs and patients affects primary prevention:Informing patients about examination results prior to a consultation can be useful in clinical practice to enhance preventive measuresGPs experienced that increased patient knowledge resulted in a more patient-centered consultation and improved shared decision-makingGPs described their risk assessment and patients’ risk perception as more accurate with pictorial information about subclinical atherosclerosis.
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38.
  • Bengtsson, Ulrika, et al. (author)
  • Patient contributions during primary care consultations for hypertension after self-reporting via a mobile phone self-management support system.
  • 2018
  • In: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 36:1, s. 70-79
  • Journal article (peer-reviewed)abstract
    • This paper reports on how the clinical consultation in primary care is performed under the new premises of patients’ daily self-reporting and self-generation of data. The aim was to explore and describe the structure, topic initiation and patients’ contributions in follow-up consultations after eight weeks of self-reporting through a mobile phone-based hypertension self-management support system. A qualitative, explorative study design was used, examining 20 audio- (n=10) and video-recorded (n=10) follow-up consultations in primary care hypertension management, through interaction analysis. Clinical trials registry: ClinicalTrials.gov NCT01510301. The consultations comprised three phases: opening, examination and closing. The most common topic was blood pressure (BP) put in relation to self-reported variables, for example, physical activity and stress. Topic initiation was distributed symmetrically between parties and BP talk was lifestyle-centered. The patients’ contributed to the interpretation of BP values by connecting them to specific occasions, providing insights to the link between BP measurements and everyday life activities. Patients’ contribution through interpretations of BP values to specific situations in their own lives brought on consultations where the patient as a person in context became salient. Further, the patients’ and health care professionals’ equal contribution during the consultations showed actively involved patients. The mobile phone-based self-management support system can thus be used to support patient involvement in consultations with a person-centered approach in primary care hypertension management
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39.
  • Bennet, Louise, et al. (author)
  • Diastolic dysfunction is associated with sedentary leisure time physical activity and smoking in females only
  • 2010
  • In: SCANDINAVIAN JOURNAL OF PRIMARY HEALTH CARE. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 28:3, s. 172-178
  • Journal article (peer-reviewed)abstract
    • Objectives. Left ventricular diastolic dysfunction with preserved systolic function (DD-PSF) is associated with an increased risk of morbidity and mortality. Population-based surveys studying the associations between DD-PSF and lifestyle-associated risk factors, such as leisure time physical activity (LTPA) and smoking, are scarce. Thus, the aims were to explore the associations between DD-PSF and LTPA and smoking, employing optimal echocardiographic techniques. Design. Cross-sectional study conducted from 2001 to 2003. Setting.The study was conducted in a random sample of a rural Swedish population. Subjects. Men and women of 30–75 years of age were consecutively invited for conventional echocardiography and tissue velocity imaging (n = 1149). Structured questionnaires and physical examinations were conducted using standardized methods. Main outcome measures. DD-PSF was defined according to the European Society of Cardiology criteria excluding subjects with ejection fraction < 45%, or a self-reported history of heart failure. Results. Complete information was available in 500 men and 538 women. In a multivariate model, DD-PSF was independently associated with sedentary LTPA and smoking in females; sedentary LTPA odds ratio (OR) 2.91, 95% confidence interval (CI) 1.02 to 8.27, and smoking OR 3.42, 95% CI 1.35 to 8.64. The probability of identifying DD-PSF in females with a sedentary LTPA was 37% and increased to 80% if they also had hypertension and were obese. Conclusions. Sedentary LTPA and smoking are independently associated with DD-PSF in females. Identification of a sedentary lifestyle in females increases the probability of diagnosing DD-PSF.
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40.
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41.
  • Bergström, Erik, et al. (author)
  • School injuries. Epidemiology and clinical features of 307 cases registered at hospital during one school year.
  • 1991
  • In: Scandinavian Journal of Primary Health Care. - 0281-3432 .- 1502-7724. ; 9:3, s. 209-16
  • Journal article (peer-reviewed)abstract
    • Injuries at school were studied for one school year in 57 primary and three secondary schools (13,733 students, aged 7-19 years) at Umeå in northern Sweden. The injury rate was 22/1000 student years. There was a wide variation in injury rate between different schools. The boy/girl ratio was 1.1/1. Physical education was the dominating activity at the time of injury for the older students and play in the school yard for the younger. The majority of the students had a minor injury, but 17% had a fracture. The injured students did not seem to have more somatic, psychological or social problems than students in general. Fewer competitive sports and ball games and more adult supervision and organized activities during breaks are suggestions to reduce injuries at school. A hospital-based injury registration system is well fitted for serving as a base for analysing school injuries.
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42.
  • Berkhout, Maria (Marjo) Johanna, 1976, et al. (author)
  • Hypertension treatment in the oldest-old: focus group interviews with Swedish general practitioners.
  • 2022
  • In: Scandinavian journal of primary health care. - : Informa UK Limited. - 1502-7724 .- 0281-3432. ; 40:3, s. 395-404
  • Journal article (peer-reviewed)abstract
    • This study explored the considerations and experiences of Swedish General Practitioners (GPs) of hypertension treatment in patients 80years and above.Qualitative design with focus group interviews. Data were analysed by qualitative content analysis.Primary health care centres (PHCCs), both rural and urban, in the Region of Västra Götaland, Sweden.GPs and GP trainees working at PHCCs in 2019 and 2020. Five focus group interviews with 24 physicians were performed.Considerations and experiences of hypertension treatment in the oldest-old.Eighteen GPs and six GP trainees participated in the study. The latent content was formulated in a theme: 'The physician's decision-making in the treatment of hypertension in the oldest-old implies the inclusion of both medical and humanistic considerations.' The manifest content constituted three main categories: 'The patient characteristics' included medical condition, behavioural factors and daily life. 'The physician's role' described the GP as a professional and her/his experienced support. 'The treatment decision' considered these categories and involved risk-benefit balancing and communication. For the future, the participants proposed better guidelines for the oldest-old multimorbid patients, increased teamwork, continuous cooperation with nurses and better cooperation with hospital physicians.Hypertension care for the oldest-old was experienced as complicated by GPs, due to the need of balancing medical and humanistic considerations. The GP's clinical experience and the received support were of importance when making the treatment decision based on risk-benefit balancing and communication with the patient.Key pointsGPs experienced the task of caring for the oldest-old patients with hypertension as complicated.Patient factors like multimorbidity, polypharmacy, behavioural factors and the patient's condition of daily life were identified.Clinical experience and the experienced support at the PHCC were discussed as important for the GPs' treatment decision.Treatment decisions for the oldest-old patients with hypertension were based on risk-benefit balancing and communication with the patients.
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43.
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44.
  • Bjork, J., et al. (author)
  • Personal responsibility for health? A phenomenographic analysis of general practitioners' conceptions
  • 2021
  • In: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 39:3, s. 322-331
  • Journal article (peer-reviewed)abstract
    • Objective To analyse and describe general practitioners' perceptions of the notion of a 'personal responsibility for health'. Design Interview study, phenomenographic analysis. Setting Swedish primary health care. Subjects General Practitioners (GPs). Main outcome measures Using the phenomenographic method, the different views of the phenomenon (here: personal responsibility for health) were presented in an outcome space to illustrate the range of perceptions. Results The participants found the notion of personal responsibility for health relevant to their practice. There was a wide range of perceptions regarding the origins of this responsibility, which was seen as coming from within yourself; from your relationships to specific others; and/or from your relationship with the generalized other. Furthermore, the expressions of this responsibility were perceived as including owning your health problem; not offloading all responsibility onto the GP; taking active measures to keep and improve health; and/or accepting help in health. The GP was described as playing a key role in shaping and defining the patient's responsibility for his/her health. Some aspects of personal responsibility for health roused strong emotions in the participants, especially situations where the patient was seen as offloading all responsibility onto the GP. Conclusion The notion of personal responsibility for health is relevant to GPs. However, it is open to a broad range of interpretations and modulated by the patient-physician interaction. This may make it unsuitable for usage in health care priority settings. More research is mandated to further investigate how physicians work with patient responsibility, and how this affects the patient-physician relationship and the physician's own well-being.
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45.
  • Björk Javanshiri, Amanda, et al. (author)
  • Follow-up and screening for type-2 diabetes mellitus in women with previous gestational diabetes in primary care
  • 2023
  • In: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 41:1, s. 98-103
  • Journal article (peer-reviewed)abstract
    • ObjectiveGestational diabetes mellitus (GDM) is an established risk factor for developing type 2 diabetes mellitus (T2DM) that is possible to prevent by systematic follow-up and preventive measures. The aim of this study was to examine whether women with previous GDM were offered follow-up in primary care, according to Swedish national guidelines.DesignRetrospective review of electronic medical records.SettingPrimary care in southern Sweden, Skåne county.SubjectsWomen who received a GDM diagnosis in 2018 at the Endocrinology department, Skåne University Hospital in Lund. The study population consisted of a total number of 161 patients, whereof 83 patients were included.Main outcome measuresWhether primary care offered follow-up for T2DM after GDM and if any communication took place between secondary and primary care. Furthermore, it was examined whether the quality of the follow-up was in accordance with the national guidelines.ResultsOf the study population, a total of 29% (n = 24) had been followed-up by primary care. In 55% (n = 46) of the cases, there was no communication between secondary and primary care. Plasma glucose was checked in all (n = 20) cases where follow-up could be evaluated. Conversations about lifestyle habits took place in 70% (n = 14) of the cases. Weight and risk factors for cardiovascular disease were controlled in less than half (n = 9) of the patients. Lifestyle advice was offered in two cases and in 24% (n = 20) of the cases an annual check-up was planned.ConclusionsThe follow-up of women with previous GDM in primary care in southern Sweden was lacking in seven out of 10 cases and showed great potential for improvement.Key PointsGestational diabetes is an established risk factor for developing type 2 diabetes.Earlier research has recognized that risk reduction is possible by systematic follow-up and preventive measures, but the extent of follow-up in primary care in southern Sweden remains unknown.This study demonstrates a lack of follow-up according to national guidelines for women with previous gestational diabetes in primary care in southern Sweden.There is great potential to improve the care of these patients with relatively simple means.
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46.
  • Björkelund, Cecilia, 1948, et al. (author)
  • Calle Bengtsson in memoriam
  • 2013
  • In: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 31:3
  • Journal article (other academic/artistic)
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47.
  • Björkelund, Cecilia, 1948, et al. (author)
  • Secular trends in cardiovascular risk factors with a 36-year perspective: observations from 38- and 50-year-olds in the Population Study of women in Gothenburg
  • 2008
  • In: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 1502-7724 .- 0281-3432. ; 26:3, s. 140-6
  • Journal article (peer-reviewed)abstract
    • Department of Public Health and Community Medicine/Primary Health Care, The Sahlgrenska Academy, University of Gothenburg, Sweden. cecilia.bjorkelund@allmed.gu.se OBJECTIVES: To study secular trends in cardiovascular risk factors in four different cohorts of women examined in 1968-1969, 1980-1981, 1992-1993 and 2004-2005. DESIGN: Comparison of four representative cohorts of 38- and 50-year-old women over a period of 36 years. SETTING: Gothenburg, Sweden with approximately 450,000 inhabitants. SUBJECTS: Four representative samples of 38- and 50-year-old women were invited to free health examinations (participation rate 59-90%, n =1901). MAIN OUTCOME MEASURES: Body mass index (BMI), systolic and diastolic blood pressure (SBP, DBP), leisure time exercise, use of antihypertensive medication, smoking, levels of haemoglobin, b-glucose, s-cholesterol, s-triglycerides and HDL-cholesterol. RESULTS: There was no significant difference in mean BMI from 1968-1969 versus 2004-2005. Mean leisure time exercise was significantly higher in later born cohorts; in 1968, around 15% were physically active compared with 40% in 2004. SBP and DBP, mean s-cholesterol and s-triglyceride levels were significantly lower in both 38- and 50-year-old cohorts in 2004-2005 versus 1968-1969. HDL-cholesterol (not measured until 1992-1993), showed a significantly higher mean level in 2004-2005. Reduction of risk factors was apparent in women with a high as well as low level of physical activity. Smoking declined most in women with high levels of physical activity. CONCLUSIONS: Several cardiovascular risk factors related to lifestyle have improved in middle-aged women from the 1960s until today. Most of the positive trends are observed in women with both low and high physical activity.
  •  
48.
  • Björkelund, Cecilia, 1948, et al. (author)
  • Using patient-centred consultation when screening for depression in elderly patients: A comparative pilot study
  • 2011
  • In: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 29:1, s. 51-56
  • Journal article (peer-reviewed)abstract
    • Objective. Using validated screening instruments to detect depressive symptoms in the elderly has been recommended. The aim of this study was to compare a patient-centred consultation model with the PRIME-MD screening questionnaire, using the MADRS-S as reference for detecting depressive symptoms in an elderly primary care population. Design. Comparative study. Setting. Primary care, Sweden. Subjects. During an 11-month period 302 consecutive patients aged 60 and over attending a primary care centre were screened with the PRIME- MD and the Montgomery-Asberg Depression Rating Scale-Self-rated version (MADRS-S) instrument. The results were unknown to the GPs who used a structured, patientcentred consultation model comprising seven open-ended “key questions”. Main outcome measures. Sensitivity, specifi city, positive predictive values (PPV), and negative predictive values (NPV) were calculated for the PRIME-MD screening questionnaire and the patient-centred consultation model using MADRS-S as reference for possible depression at two cut-off levels with 15% prevalence. Results. Sensitivity was lower for the consultation model than the PRIME-MD screening questionnaire: 78% and 98%, respectively. The GPs failed to identify every fi fth patient using the lower cut-off (MADRS-S 13) but the number of required diagnostic interviews decreased by almost 50%: 85 versus 162, respectively. PPV was 43% and 28%, respectively. Both instruments showed high sensitivity (93%) using the higher cut-off (MADRS-S 20) and had high NPV: 95% and 99%, respectively. Conclusions. The fi ndings suggest that the consultation screening procedure might be as useful in everyday practice as the PRIME-MD screening questionnaire. Both screening procedures may also be useful for ruling out depressive symptoms.
  •  
49.
  • Björkman, Ingeborg, et al. (author)
  • Awareness of antibiotic resistance and antibiotic prescribing in UTI treatment : A qualitative study among primary care physicians in Sweden
  • 2013
  • In: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 31:1, s. 50-55
  • Journal article (peer-reviewed)abstract
    • ObjectivesTo improve education and information for general practitioners in relation to rational antibiotic prescribing for urinary tract infection (UTI), it is important to be aware of GPs' views of resistance and how it influences their choice of UTI treatment. The aim of this study was to explore variations in views of resistance and UTI treatment decisions among general practitioners (GPs) in a county in Sweden.DesignQualitative, semi-structured interviews were analysed with a phenomenographic approach and content analysis.SettingPrimary care in Kronoberg, a county in southern Sweden.SubjectsA purposeful sample of 20 GPs from 15 of 25 health centres in the county.Main outcome measures.The variation of perceptions of antibiotic resistance in UTI treatment. How UTIs were treated according to the GPs.ResultsThree different ways of viewing resistance in UTI treatment were identified. These were: (A) No problem, I have never seen resistance, (B) The problem is bigger somewhere else, and (C) The development of antibiotic resistance is serious and we must be careful. Moreover, GPs' perceptions of antibiotic resistance were mirrored in how they reported their treatment of UTIs in practice.ConclusionThere was a hierarchal scale of how GPs viewed resistance as an issue in UTI treatment. Only GPs who expressed concerns about resistance followed prescribing guidelines completely. This offers valuable insights into the planning and most likely the outcome of awareness or educational activities aimed at changed antibiotic prescribing behaviour.
  •  
50.
  • Björndell, Cajsa, et al. (author)
  • Physicians' experiences of video consultation with patients at a public virtual primary care clinic: a qualitative interview study
  • 2021
  • In: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 39:1, s. 67-76
  • Journal article (peer-reviewed)abstract
    • Objective To describe physicians' experiences of video consultation with new patients visiting a publicly owned virtual primary care clinic. Design In this qualitative study, data were collected from semi-structured individual interviews and analysed by systematic text condensation. Setting A publicly owned virtual primary care clinic in Region Vastra Gotaland, Sweden. Subjects Ten primary care physicians working at the clinic. Results Connecting with a patient over video could be either straightforward or deficient, depending on communication and the patient's condition. Clinical experience, communication skills, and involving patients throughout the consultation and examination were crucial for assessments over video where patients were guided to perform self-examination. The flexibility of work and the regulated assignment online were positive for the physicians' work situation and wellbeing. Providing video consultation within the same organisation as the patient's regular health centre was considered to facilitate patient care and safety. Video consultation was considered suitable for some diagnoses and for some patients not able to reach a primary healthcare centre, though doubts were expressed about the healthcare and social benefits of this virtual care service. Conclusion For the physicians, video consultation induced changes in the basis for assessment of primary care patients. The limitations on informational exchange demanded an extended form of patient involvement founded upon consultation skills, clinical experience and new skills for virtual examination. Combining virtual care with traditional general practice has the potential to reduce the workload for the individual physician and ensure medical competence in virtual primary care. Video consultation experienced suitable in some situations, but easy access to it expressed problematic in terms of medical prioritisation in healthcare.
  •  
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