| 1. |
- Drevenhorn, Eva, 1954, et al.
(author)
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A content analysis of patient-centredness in hypertension care after consultation training for nurses .
- 2007
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In: The Internet Journal of Advanced Nursing Practice. - : Internet Scientific Publications. - 1523-6064. ; 8:2
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Journal article (peer-reviewed)abstract
- Lifestyle changes are important when it comes to reducing the risk factors for cardiovascular complications. There is evidence that these changes are more successful if counselling is conducted in a patient-centred way. The purpose was to analyse how nurses used patient-centred counselling with hypertensive patients after video-recorded consultation training. Nineteen nurses from nurse-led clinics in hypertension care at Swedish health centres participated in residential counselling. Two audio-recordings with hypertensive patients in regular practice were made before and after the training and analysed with the emphasis on patient centredness. Weighing up the pros and cons, the identification of beliefs about treatment and negotiations about the reasons for and where to begin behavioural change increased. A slight increase in reflections and pauses was observed. Expansive and provocative questions and the identification of goals or goal-setting were used sparsely. As a result of the training, the nurses gave individually-adapted information more frequently.
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| 2. |
- Bengtsson, Ulrika, et al.
(author)
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Links between blood pressure and life-style factors reported via a mobile phone-based self-management support system
- 2018
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In: Journal of Hypertension. - : Wolters Kluwer. - 0263-6352.
-
Conference paper (other academic/artistic)abstract
- Objective: To explore relationships between patients’ self-monitoring of blood pressure and their concurrent self-reports of medication intake, wellbeing stress, physical activity and symptoms.Design and method: This was a prospective study exploring the eight-week effectiveness of a mobile phone based self-management support system for patients with hypertension. 50 patients undergoing treatment for hypertension, from four primary health care centers situated in urban and suburban communities in Sweden, self-reported through the system once daily during eight weeks.Scientific data: Associations between systolic and diastolic blood pressure and 10 self-report lifestyle-related variables.Results: The single strongest association was found between medication intake and systolic blood pressure, where failure to take medications was associated with an estimated 7.44 mmHg higher systolic blood pressure. To a lesser degree, medication intake was also associated with diastolic blood pressure. Wellbeing and stress were consistently associated with systolic blood pressure and diastolic blood pressure, whereas physical activity was associated with only systolic blood pressure. None of the symptoms dizziness, headache, restlessness, fatigue or palpitations were significantly associated with blood pressure.Conclusions: Blood pressure was associated with patients’ blood pressure management behaviors, eg drug intake and experiences of wellbeing and stress. No association was found between blood pressure and side effects. Enabling persons with hypertension to monitor and track their BP in relation to medication intake, symptoms and life-style variables may be a fruitful way to help them gain first-hand understanding of the importance of adherence and persistence to treatment recommendations.
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| 3. |
- Janson Fagring, Annika, 1949, et al.
(author)
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Depression, anxiety, stress, social interaction and health-related quality of life in men and women with unexplained chest pain
- 2008
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In: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 8:165
-
Journal article (peer-reviewed)abstract
- BACKGROUND: Unexplained chest pain (UCP) is a common reason for emergency hospital admission and generates considerable health-care costs for society. Even though prior research indicates that psychological problems and impaired quality of life are common among UCP patients, there is lack of knowledge comparing UCP patients with a reference group from the general population. The aim of this study was to analyse differences between men and women with UCP and a reference group in terms of psychosocial factors as depression, anxiety, stress, social interaction and health-related quality of life (HRQOL). METHODS: A self-administered questionnaire about psychosocial factors was completed by 127 men and 104 women with acute UCP admitted consecutively to the Emergency Department (ED) or as in-patients on a medical ward. A reference group from the general population, 490 men and 579 women, participants in the INTERGENE study and free of clinical heart disease, were selected. RESULTS: The UCP patients were more likely to be immigrants, have a sedentary lifestyle, report stress at work and have symptoms of depression and trait-anxiety compared with the reference group. After adjustment for differences in age, smoking, hypertension and diabetes, these factors were still significantly more common among patients with UCP. In a stepwise multivariate model with mutual adjustment for psychosocial factors, being an immigrant was associated with a more than twofold risk in both sexes. Stress at work was associated with an almost fourfold increase in risk among men, whereas there was no independent impact for women. In contrast, depression only emerged as an independent risk factor in women. Trait-anxiety and a low level of social interaction were not independently associated with risk in either men or women. Patients with UCP were two to five times more likely to have low scores for HRQOL. CONCLUSION: Both men and women with UCP had higher depression scores than referents, but an independent association was only found in women. Among men, perceived stress at work emerged as the only psychosocial variable significantly associated with UCP.
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| 4. |
- Janson Fagring, Annika, 1949, et al.
(author)
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Twenty-year trends in incidence and 1-year mortality in Swedish patients hospitalised with non-AMI chest pain. Data from 1987-2006 from the Swedish hospital and death registries
- 2010
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In: Heart. - : BMJ Publishing Group. - 1355-6037 .- 1468-201X. ; 96:13, s. 1043-1049
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Journal article (peer-reviewed)abstract
- Objective To study trends for 20 years in incidence and 1-year mortality in hospitalised patients who received a diagnosis of either angina or unexplained chest pain (UCP) in Sweden. Design and setting Register study of all patients aged 25–84 years identified from the Swedish National Hospital Discharge Register who were hospitalised with a first-time diagnosis of UCP or angina pectoris during 1987 to 2006. Participants A total of 378454 patients, 235855 with UCP and 142599 with angina. Main outcome measures 1-Year mortality and standardised mortality ratios (SMRs). Results From the period 1987–1991 to 2002–2006, the observed 1-year mortality rate in men and women with UCP aged 25–74 years decreased from 2.19% to 1.45% and from 1.85% to 0.91%, respectively. SMRs decreased from 1.67 (95% CI 1.39 to 1.95) and 1.63 (1.27 to 2.00) to 1.09 (0.96 to 1.23) and 0.88 (0.75 to 1.00). Corresponding decreases in 1-year mortality for a discharge diagnosis of angina were from 6.50% to 2.49% in men and from 4.80% to 1.68% in women, with SMRs decreasing from 2.69 (2.33–3.05) and 2.59 (2.06–3.12) to 1.09 (0.93–1.25) and 1.05 (0.81–1.29), respectively. Similar changes occurred in patients aged 75–84 years. Only men with UCP aged 75–84 years still retained a slightly increased mortality (SMR 1.14 (1.01–1.28)). Conclusions The prognosis of patients admitted with chest pain in which acute myocardial infarction has been ruled out has improved for the past 20 years, such that the 1-year mortality of these patients is now similar to that in the general population.
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| 5. |
- Jerlock, Margaretha, 1946, et al.
(author)
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Psychosocial profile in men and women with unexplained chest pain
- 2008
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In: J Intern Med. - : Wiley-Blackwell. ; 264:3, s. 265-274
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Journal article (other academic/artistic)abstract
- OBJECTIVE: The aim of this study was to compare men and women with unexplained chest pain (UCP) to a randomly selected population sample free of clinical heart disease with regard to sleep problems, mental strain at work, stress at home, negative life events and health-related quality of life (HRQOL). DESIGN AND SUBJECTS: The study was conducted at a university hospital in Sweden including 231 patients aged 25-69 without any organic cause for chest pain. As a reference group, 1069 participants, were recruited from the INTERGENE population-based study. RESULTS: Patients with UCP had more sleep problems (OR = 1.8, P < 0.0001), were almost three times more worried about stress at work (OR = 2.9, P < 0.0001), or had more stress at home (OR = 2.8, P < 0.0001), and were twice as likely to have negative life events (OR = 2.1, P < 0.0001). Women, but not men, with UCP, had a higher prevalence of cardiovascular risk factors (obesity, smoking, diabetes and hypertension) compared with references. With regard to HRQOL, UCP patients scored significantly lower than references in all dimensions of the SF-36. CONCLUSIONS: In comparison with a healthy reference group, patients with UCP reported more sleep problems, mental strain at work, stress at home and negative life events and had lower health-related quality of life. Aside from immigration the strongest independent psychosocial factors were mental strain at work and negative life events last year in men and stress at home in women.
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| 6. |
- Journath, Gunilla, et al.
(author)
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Association of physician's sex with risk factor control in treated hypertensive patients from Swedish primary healthcare.
- 2008
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In: Journal of hypertension. - : Lippincott Williams & Wilkins. - 0263-6352 .- 1473-5598. ; 26:10, s. 2050-6
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Journal article (peer-reviewed)abstract
- OBJECTIVE: To study the association of physician's sex with blood pressure, lipid control, and cardiovascular risk factors in treated hypertensive men and women, stratified for the sex of their physician. METHODS: In a cross-sectional survey of hypertensive patients, 264 primary care physicians (PCPs), 187 men and 77 women from across Sweden, recruited 6537 treated hypertensive patients (48% men) during 2002-2005, consecutively collected from medical records and registered on a web-based form connected to a central database. Patients were included consecutively in the same order as they visited the healthcare centre. RESULTS: Hypertensive women more often reached target systolic/diastolic blood pressure levels (<140/90 mmHg) when treated by female PCPs than when they were treated by male PCPs (32 vs. 24%, P < 0.001). This difference remained when comparing female and male physicians' nondiabetic female patients. Both male and female patients had better control of total cholesterol and low-density lipoprotein cholesterol levels when treated by female PCPs than when treated by male PCPs (total cholesterol <5 mmol/l: women 30 vs. 24%, P < 0.001; men 42 vs. 34%, P < 0.001; low-density lipoprotein cholesterol <3 mmol/l: women 39 vs. 33%, P < 0.01; men 41 vs. 35%, P < 0.05). Female PCPs had a higher proportion of treated hypertensive patients with diabetes than did male PCPs but male PCPs had a higher prevalence of treated hypertensive men with microalbuminuria compared with female PCPs. CONCLUSION: Female physicians appeared more often to reach the treatment goal for blood pressure in female patients and cholesterol levels in all patients than did male physicians.
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| 7. |
- Taft, Charles, 1950, et al.
(author)
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Links between blood pressure and medication intake, well-being, stress, physical activity and symptoms reported via a mobile phone-based self-management support system: a cohort study in primary care
- 2018
-
In: BMJ Open. - : BMJ. - 2044-6055. ; 8:8
-
Journal article (peer-reviewed)abstract
- Objectives To explore relationships between patients’ self-monitoring of blood pressure (BP) and their concurrent self-reports of medication intake, well-being, stress, physical activity and symptoms. Design This study is a secondary analysis of a prospective study exploring the 8-week effectiveness of a mobile phone-based self-management support system for patients with hypertension. Setting Four primary healthcare centres situated in urban and suburban communities in Sweden. Participants 50 patients undergoing treatment for hypertension. Primary and secondary outcome measures Associations between systolic (SBP) and diastolic blood pressure (DBP) and 10 self-report lifestyle-related variables were analysed using linear mixed effects modelling. Results Medication intake, better well-being, less stress and greater physical activity were associated variously with lower same-day SBP and DBP. The single strongest association was found between medication intake and SBP, where failure to take medications was associated with an estimated 7.44mm Hg higher SBP. To a lesser degree, medication intake was also associated with DBP, where DBP was 4.70mm Hg higher in cases where medications were not taken. Well-being and stress were consistently associated with SBP and DBP, whereas physical activity was associated with only SBP. None of the symptoms—dizziness, headache, restlessness, fatigue or palpitations—were significantly associated with BP. Conclusions Our findings that BP was associated with patients’ BP management behaviours and experiences of well-being and stress, but not symptoms suggest that enabling persons with hypertension to monitor and track their BP in relation to medication intake, physical activity, well-being, stress and symptoms may be a fruitful way to help them gain first-hand understanding of the importance of adherence and persistence to treatment recommendations. Trial registration number NCT01510301; Pre-results. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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| 8. |
- Adolfsson, Hans, et al.
(author)
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Betyg i högre utbildning
- 2016
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Reports (other academic/artistic)abstract
- SUHF:s arbetsgrupp för betygsfrågor har varit verksam under perioden 1 mars 2014 – 31 december 2015. Uppdraget har varit att undersöka behovet av betygssystem med fler betygs-steg i högskolan mot bakgrund av den konkurrenssituation som en internationaliserad utbildnings- och arbetsmarknad medför. Uppdraget har också varit att sprida erfarenheter kring flergradiga betygsskalor inkluderande både nationella erfarenheter och exempel från andra europeiska länder. Arbetsgruppen har också uppmanats att föreslå rekommendationer om betygssystem till SUHF:s medlemslärosäten. Arbetsgruppen har främst inhämtat underlag genom intervjuer, en enkät till lärosätena och Ladok-statistik omfattande drygt tre miljoner betygssättningar som renderat godkända betyg över en period av tre år. Resultatet av utredningen visar att svenska lärosäten har en stark tradition av målrelaterad betygssättning som samtliga involverade i utredningen upplever som positiv och viktig att bevara, oavsett antal grader i betygsskalan. Gruppens arbete bekräftar att det finns olika problem med de svenska betygssystemen ur ett internationaliseringsperspektiv. Det går dock inte att säga att det finns någon tydlig samsyn mellan lärosätena om exakt vilka dessa problem är eller hur stora de anses vara. Det är svårt att entydigt koppla problemen till valet av betygsskala. Det finns också andra faktorer för valet av betygsskala som verkar väga minst lika tungt som internationaliseringsperspektivet och som gör att lärosäten inte inför betygsskalor med fler grader. Utredningen visar vidare att flera olika betygssystem används i svensk högskola och heterogeniteten framträder som betydande, såväl mellan lärosäten som inom ett lärosäte. Det finns starka ämnesmässiga traditioner och god argumentation kring enskilda lärosätens val av skala men nationellt saknas det gemensamma ramar för betygssättning, samordning och uppföljning. Huvudsakligen används fortfarande fågradiga betygsskalor i Sverige men 43% av alla betyg sätts numera i betygsskalor med minst tre godkända betygssteg. Ett antal lärosäten har de senaste tio åren gått över till en sjugradig skala för all utbildning eller för viss utbildning som riktar sig till en internationell målgrupp. Under perioden 2011−2014 är A–F-skalan den enda betygsskala som ökat i omfattning medan exempelvis användningen av G–U-skalan minskat med 18,5 %. Att ha en flergradig betygsskala ses som positivt ur flera aspekter: det underlättar internationellt studentutbyte, det kommunicerar tydligare utbildnings-resultaten och är ett bättre instrument för urval för både vidare utbildning och rekrytering på arbetsmarknaden. Flergradiga betyg ställer höga krav på tydliga betygskriterier och genom-tänkta pedagogiska metoder för målrelaterad bedömning. Flera av de problem som rapporten påvisar skulle kunna lösas genom att en gemensam nationell flergradig betygsskala implementerades. I nuläget bedömer arbetsgruppen dock inte att det är realistiskt att rekommendera detta. De svenska lärosätena använder flera olika betygsskalor. De problem fågradiga betyg kan skapa för internationellt studentutbyte verkar upp-vägas av andra värden för många lärosäten. Ett relativt stort antal lärosäten har redan valt att införa en sjugradig betygsskala för utbildning med internationell inriktning. Ett önskemål som lyfts fram i flera enkätsvar och intervjuer är att ett meritvärde eller betyg för hel utbildning, motsvarande grade point average (GPA) införs. GPA upplevs fungera väl för internationell jämförelse. Ladok-statistiken visar på skillnader mellan lärosätena i användningen av betygsskalorna som – åtminstone i avsaknad av fördjupat underlag – ter sig anmärkningsvärt stora. Dessa skillnader bör ses mot bakgrund av att betygssättning är myndighetsutövning och att betyg är ett myndighetsbeslut som studenterna inte kan överklaga. Undersökningen visar på stora skillnader i betygsfördelningen mellan olika betygsskalor även då antalet steg är identiska (5-U respektive AB-U). Det gäller även inom en och samma betygsskala såväl mellan lärosäten som inom lärosäten. Andelen studenter som exempelvis får högsta betyg kan skilja stort. Stickprov inom lärosäten visar på samma variationer i betygssättningen mellan olika kurser. Det finns också en genusskillnad, dock liten. En bättre uppföljning med årlig betygsstatistik kunde införas, dels för alla lärosäten för att ge en nationell överblick och nationella betygsutfall för varje betygsskala, dels för vissa specifika ämnesområden för att kunna jämföra betygsutfall t ex i större utbildningsprogram som ges vid många lärosäten, såsom juristprogrammet, ingenjörsutbildning, lärarutbildning, psykologutbildning, ekonomiutbildning, socionomutbildning. Sådant underlag skulle stimulera till utveckling av examination och bedömning inom högskolan. Arbetsgruppen föreslår därför att.....
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| 9. |
- Aminoff, Ulla Britt, et al.
(author)
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The nurse--a resource in hypertension care.
- 2001
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In: Journal of advanced nursing. - : Wiley. - 0309-2402 .- 1365-2648. ; 35:4, s. 582-9
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Journal article (peer-reviewed)abstract
- AIM OF THE STUDY: To explore the content and structure of communication between patient and nurse at follow-up appointments concerning hypertension. BACKGROUND: Hypertension is a chronic condition and calls for co-operation between health care providers and patients over a long period of time. One important purpose of the follow-up consultations is to transfer knowledge between patients and health care providers in order to empower patients. This is an important determinant of the quality of care. DESIGN/METHODS: The study was based on 20 audio-recordings of actual follow-up appointments and was approved by ethics committees. The consultations took place at four different health care units for hypertensive patients. FINDINGS: The average length of consultations was 18 minutes. In the consultations, patients initiated an average of eight new topics and nurses an average of 20. All nurses talked with patients about life style. Compared with previous studies of follow-ups with physicians, consultations with nurses addressed lifestyle factors and adherence to treatment to a higher degree. It was also observed that patients were more actively involved in interaction with nurses compared with the follow-ups with physicians. CONCLUSIONS: Active patient participation in care is a critical factor in improving adherence to treatment. It would be of value to develop and assess a more patient-centred organization of hypertension care and thereby more individualized hypertension treatment. Nurses may have a pivot role in such care.
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| 10. |
- Andersson, Ulrika, et al.
(author)
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Associations between daily home blood pressure measurements and self-reports of lifestyle and symptoms in primary care: the PERHIT study
- 2024
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In: SCANDINAVIAN JOURNAL OF PRIMARY HEALTH CARE. - : TAYLOR & FRANCIS LTD. - 0281-3432 .- 1502-7724. ; 42:3, s. 415-423
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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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| 11. |
- Andersson, Ulrika, et al.
(author)
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Patients and Professionals as Partners in Hypertension Care: Qualitative Substudy of a Randomized Controlled Trial Using an Interactive Web-Based System Via Mobile Phone
- 2021
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In: Journal of Medical Internet Research. - : JMIR Publications Inc.. - 1438-8871. ; 23:6
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Journal article (peer-reviewed)abstract
- Background: The use of technology has the potential to support the patient´s active participation regarding treatment of hypertension. This might lead to changes in the roles of the patient and health care professional and affect the partnership between them. Objective: The aim of this qualitative study was to explore the partnership between patients and health care professionals and the roles of patients and professionals in hypertension management when using an interactive web-based system for self-management of hypertension via the patient’s own mobile phone. Methods: Focus group interviews were conducted with 22 patients and 15 professionals participating in a randomized controlled trial in Sweden aimed at lowering blood pressure (BP) using an interactive web-based system via mobile phones. The interviews were audiorecorded and transcribed and analyzed using thematic analysis. Results: Three themes were identified: the technology, the patient, and the professional. The technology enabled documentation of BP treatment, mainly for sharing knowledge between the patient and the professional. The patients gained increased knowledge of BP values and their relation to daily activities and treatment. They were able to narrate about their BP treatment and take a greater responsibility, inspired by new insights and motivation for lifestyle changes. Based on the patient’s understanding of hypertension, professionals could use the system as an educational tool and some found new ways of communicating BP treatment with patients. Some reservations were raised about using the system, that it might be too time-consuming to function in clinical practice and that too much measuring could result in stress for the patient and an increased workload for the professionals. In addition, not all professionals and patients had adopted the instructions regarding the use of the system, resulting in less realization of its potential. Conclusions: The use of the system led to the patients taking on a more active role in their BP treatment, becoming more of an expert of their BP. When using the system as intended, the professionals experienced it as a useful resource for communication regarding BP and lifestyle. Patients and professionals described a consultation on more equal grounds. The use of technology in hypertension management can promote a constructive and person-centered partnership between patient and professional. However, implementation of a new way of working should bring benefits and not be considered a burden for the professionals. To establish a successful partnership, both the patient and the professional need to be motivated toward a new way of working.
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| 12. |
- Andersson, Ulrika, et al.
(author)
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PERson-centredness in Hypertension management using Information Technology: a randomized controlled trial in primary care
- 2023
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In: Journal of hypertension. - : LIPPINCOTT WILLIAMS & WILKINS. - 1473-5598 .- 0263-6352. ; 41:2, s. 246-253
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Journal article (peer-reviewed)abstract
- OBJECTIVES: To increase the proportion of individuals with hypertension obtaining a blood pressure (BP) of less than 140/90mmHg by improving the management of hypertension in daily life from a person-centred perspective. METHODS: In this unblinded randomized controlled trial, we tested an interactive web-based self-management system for hypertension. A total of 949 patients with hypertension from 31 primary healthcare centres (PHCCs) in Sweden were randomized 1:1 to either the intervention or usual care group. The intervention included daily measurement - via the participant's mobile phone - of BP and pulse and reports of well being, symptoms, lifestyle, medication intake and side effects for eight consecutive weeks. It also included reminders and optional motivational messages. The primary outcome was the proportion of participants obtaining BP of less than 140/90mmHg at 8 weeks and 12months. Significance was tested by Pearson's chi 2 -test. RESULTS: A total of 862 patients completed the trial, 442 in the intervention group and 420 in the control group. The primary outcome (BP <140/90mmHg) at 8 weeks was achieved by 48.8% in the intervention group and 39.9% in the control group ( P =0.006). At 12months, 47.1% (intervention) and 41.0% (control group) had a BP less than 140/90mmHg ( P =0.071). CONCLUSION: The proportion of participants with a controlled BP of less than 140/90mmHg increased after using the interactive system for self-management of hypertension for 8 weeks compared with usual care. Although the trend continued, there was no significant difference after 12months. The results indicate that the effect of the intervention is significant, but the long-term effect is uncertain. TRIAL REGISTRATION: The study was registered with ClinicalTrials.gov (NCT03554382).
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| 13. |
- Andersson, Ulrika, et al.
(author)
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PERSON-CENTREDNESS IN HYPERTENSION MANAGEMENT USING INFORMATION TECHNOLOGY (PERHIT) : A RANDOMISED CONTROLLED TRIAL IN PRIMARY HEALTH CARE
- 2022
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In: Journal of Hypertension. - : Ovid Technologies (Wolters Kluwer Health). - 1473-5598 .- 0263-6352. ; 40, s. 197-197
-
Conference paper (other academic/artistic)abstract
- OBJECTIVE: Few studies address results from use of new technology and patient participation in hypertension management. The PERHIT Study is a multicentre randomised controlled trial with the aim to evaluate the effects of a person-centred approach using a web-based, interactive self-management system through the patient´s own mobile phone on blood-pressure and well-being. Primary aim is the degree of achieved blood pressure (BP) control after eight weeks and one year. In addition, person-centeredness, usefulness, daily life activities in relation to BP values, awareness of risk and health care costs are studied. DESIGN AND METHOD: The PERHIT study was performed in four regions in southern Sweden. Following inclusion, more than 900 patients from 31 primary health care centres were randomised to two groups. In the intervention group (INT), patients were provided with a web-based self-management support system including a home-BP monitor. For eight consecutive weeks, they measured BP and performed self-reports regarding well-being, symptoms, lifestyle, medication intake and side effects every evening via their mobile phone. They could also receive motivational messages and reminders throughout the intervention period. Both patients and professionals had access to graphic feedback of reported values through a secure web portal. Patients in the control (CON) group received standard treatment as usual. RESULTS: The primary outcome (BP < 140/90 mmHg) was achieved by 48.5% and 47.1% in the INT, and by 40.4% and 40.9% in the CON group after 8 weeks (p = 0.016) and 12 months (p = 0.067), respectively. Both patients and professionals experienced the system as a useful resource for communication regarding BP and lifestyle. They described that it could be used to support a constructive and person-centred partnership between patients and professionals. CONCLUSIONS: Blood pressure control was significantly better after eight weeks, but not after one year, following an intervention based on use of mobile phones, feedback and interaction between patients and primary care professionals compared to standard care. The system can be a tool toward a new way of working and help patients reach a controlled BP and play a role in a more person-centred and individually adapted hypertension management.
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| 14. |
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| 15. |
- Andersson, Ulrika, et al.
(author)
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Variability in home blood pressure and its association with renal function and pulse pressure in patients with treated hypertension in primary care
- 2023
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In: Journal of Human Hypertension. - : SPRINGERNATURE. - 0950-9240 .- 1476-5527.
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Journal article (peer-reviewed)abstract
- Blood pressure variability (BPV) represents a cardiovascular risk factor, regardless of mean level of blood pressure (BP). In this post-hoc analysis from the PERson-centredness in Hypertension management using Information Technology (PERHIT) study, we aimed to explore BPV in daily home measurements in hypertensive patients from primary care, to identify factors associated with high BPV and to investigate whether estimated glomerular filtration rate (eGFR) and pulse pressure, as markers of target organ damage (TOD), are associated with BPV. For eight consecutive weeks, 454 participants reported their daily BP and heart rate in their mobile phone, along with reports of lifestyle and hypertension-related factors. Systolic BP (SBP) values were used to calculate BPV with coefficient of variation (CV) as primary estimate. Background characteristics and self-reports were tested between fifths of CV in a linear regression model, adjusted for age and sex. Associations between BPV and eGFR and pulse pressure were tested with linear and logistic regression models. Higher home BPV was associated with higher age, BP, heart rate, and smoking. BPV was lower for participants with low alcohol consumption and treatment with calcium channel blockers. There was a significant association between BPV and pulse pressure (P = 0.015), and between BPV and eGFR (P = 0.049). Participants with high BPV reported more dizziness and palpitations. In conclusion, pulse pressure and eGFR were significantly associated with home BPV. Older age, high BP, heart rate, and smoking were associated with high BPV, but treatment with calcium channel blockers and low alcohol consumption was associated with low BPV. Trial registration: The study was registered with ClinicalTrials.gov [NCT03554382].
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| 16. |
- Aronsson, Patrik, 1983, et al.
(author)
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The understanding of core pharmacological concepts among health care students in their final semester
- 2015
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In: BMC Medical Education. - : Springer Science and Business Media LLC. - 1472-6920. ; 15 (1)
-
Journal article (peer-reviewed)abstract
- Abstract Background: The overall aim of the study was to explore health care students ́ understanding of core concepts in pharmacology. Method: An interview study was conducted among twelve students in their final semester of the medical program (n = 4), the nursing program (n = 4), and the specialist nursing program in primary health care (n = 4) from two Swedish universities. The participants were individually presented with two pharmacological clinically relevant written patient cases, which they were to analyze and propose a solution to. Participants were allowed to use the Swedish national drug formulary. Immediately thereafter the students were interviewed about their assessments. The interviews were audio-recorded and transcribed verbatim. A thematic analysis was used to identify units of meaning in each interview. The units were organized into three clusters: pharmacodynamics, pharmacokinetics, and drug interactions. Subsequent procedure consisted of scoring the quality of students ́ understanding of core concepts. Non-parametric statistics were employed. Results: The study participants were in general able to define pharmacological concepts, but showed less ability to discuss the meaning of the concepts in depth and to implement these in a clinical context. The participants found it easier to grasp concepts related to pharmacodynamics than pharmacokinetics and drug interactions. Conclusion: These results indicate that education aiming to prepare future health care professionals for understanding of more complex pharmacological reasoning and decision-making needs to be more focused and effective.
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| 17. |
- Bengtsson, Ulrika, et al.
(author)
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Aspects of hypertension - a multi-perspective approach on the way towards adherence and self-management
- 2012
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In: Fifth Geneva conference on person-centerd medicine.
-
Conference paper (other academic/artistic)abstract
- Hypertension is a long lasting condition for which a poor adherence to therapy becomes a substantial threat to the individual and public health. Major efforts have been made to explore reasons for poor adherence but few successful interventions have been designed. There is a need for effective strategies tailored for the unique needs of persons with hypertension. We set out to explore and describe relevant aspects of hypertension and hypertension treatment, from the perspective of persons with hypertension and health care providers. Focus group interviews were performed with 12 persons with hypertension and 15 health care providers and analysed according to thematic analysis. Persons with hypertension perceived trust, relationship to providers, well-being and prevention of complications as important aspects of hypertension care. Further they sought to understand the interplay between symptoms and variation of blood pressure. The providers emphasised accessibility, clear and consistent counselling, prevention of complications and educational efforts but doubted patients’ ability to be participating partners in care. The study presents aspects that persons with hypertension and health care providers deem important in hypertension self-management. Our findings provide input for future outcome measures and may increase the understanding of hypertension and treatment from a person-centred perspective.
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| 18. |
- Bengtsson, Ulrika, et al.
(author)
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Developing an interactive mobile phone self-report system for self-management of hypertension. Part 1: Patient and professional perspectives
- 2014
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In: Blood Pressure. - : Informa UK Limited. - 0803-7051 .- 1651-1999. ; 23:5, s. 288-295
-
Journal article (peer-reviewed)abstract
- Low adherence remains a struggle in hypertension management, despite improvement efforts. Presuming that increased patient participation is a possible approach, we collaborated with patients and healthcare professionals to design a self-report system to support self-management. The study aimed to explore and describe relevant aspects of hypertension and hypertension treatment, for use in the development of an interactive mobile phone self-report system. It further aimed to suggest which clinical measures, lifestyle measures, symptoms and side-effects of treatment would be meaningful to include in such a system. Five focus group interviews were performed with 15 patients and 12 healthcare professionals, and data was analysed using thematic analysis. Patients suggested trust, a good relationship with caregivers, and well-being as important aspects of hypertension self-management. Furthermore, they regarded blood pressure, dizziness, stress, headache and tiredness as important outcomes to include. Patients sought to understand interconnections between symptoms and variations in blood pressure, whilst healthcare professionals doubted patients’ ability to do so. Healthcare professionals emphasized accessibility, clear and consistent counselling, complication prevention and educational efforts. The study presents aspects of importance for follow-up to understand the interplay between blood pressure and daily life experiences for patients with hypertension. Read More: http://informahealthcare.com.ezproxy.ub.gu.se/doi/abs/10.3109/08037051.2014.883203
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| 19. |
- Bengtsson, Ulrika, et al.
(author)
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Developing an interactive mobile phone self-report system for self-management of hypertension. Part 2 : Content validity and usability
- 2014
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In: Blood Pressure. - : Informa UK Limited. - 0803-7051 .- 1651-1999. ; 23:5, s. 296-306
-
Journal article (peer-reviewed)abstract
- Self-management support tools using technology may improve adherence to hypertension treatment. There is a need for user-friendly tools facilitating patients' understanding of the interconnections between blood pressure, wellbeing and lifestyle. This study aimed to examine comprehension, comprehensiveness and relevance of items, and further to evaluate the usability and reliability of an interactive hypertension-specifi c mobile phone self-report system. Areas important in supporting self-management and candidate items were derived from five focus group interviews with patients and healthcare professionals (n = 27), supplemented by a literature review. Items and response formats were drafted to meet specifications for mobile phone administration and were integrated into a mobile phone data-capture system. Content validity and usability were assessed iteratively in four rounds of cognitive interviews with patients (n = 21) and healthcare professionals (n = 4). Reliability was examined using a test-retest. Focus group analyses yielded six areas covered by 16 items. The cognitive interviews showed satisfactory item comprehension, relevance and coverage; however, one item was added. The mobile phone self-report system was reliable and perceived easy to use. The mobile phone self-report system appears efficiently to capture information relevant in patients' self-management of hypertension. Future studies need to evaluate the effectiveness of this tool in improving self-management of hypertension in clinical practice.
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| 20. |
- Bengtsson, Ulrika, et al.
(author)
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Development of a mobile phone self-report system for persons with hypertension: focus group interviews with patients and providers
- 2013
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In: Kardiovaskulära Vårmötet 2013.
-
Conference paper (peer-reviewed)abstract
- Ulrika Bengtsson, Lena Ring, Inger Hallberg, Karin Kjellgren Background: Hypertension is a risk factor for cardiovascular disease for which poor adherence to therapy becomes a substantial threat to health. Major efforts have been made to explore reasons for poor adherence but few successful interventions have been designed. There is a need for effective strategies tailored for the unique needs of persons with hypertension. We set out to explore and describe relevant aspects of hypertension and hypertension treatment, from the perspective of persons with hypertension and health care providers. Methods: Focus group interviews were performed with 15 persons with hypertension and 12 health care providers and analysed according to thematic analysis. Results: Persons with hypertension perceived trust, relationship to providers, well-being and prevention of complications as important aspects of hypertension care. Further they sought to understand the interplay between symptoms and variation of blood pressure. The providers emphasised accessibility, clear and consistent counselling, prevention of complications and educational efforts but doubted patients’ ability to be participating partners in care. Conclusion: The study presents aspects that persons with hypertension and health care providers deem important in hypertension self-management. Our finding provides input for future outcome measures, such as self-reports, and may serve as a foundation for the development of a self-report system for persons with hypertension. It may further increase the understanding of hypertension and treatment, from a person-centred perspective.
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| 21. |
- Bengtsson, Ulrika, et al.
(author)
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Development of a mobile phone self-report system for persons with hypertension: focus group interviews with patients and providers
- 2013
-
In: HPH 21 st International Conference on Health Promoting Hospitals and Health Services.
-
Conference paper (peer-reviewed)abstract
- Introduction: Hypertension is a risk factor for cardiovascular disease for which poor adherence to therapy becomes a substantial threat to health. Major efforts have been made to explore reasons for poor adherence but few successful interventions have been designed. There is a need for effective strategies designed to facilitate an increased understanding for the complexity of hypertension and treatment by strengthening of patient participation as well as patient empowerment. Purpose / Methods: The aim of this study was to explore and describe relevant aspects of hypertension and hypertension treatment, from the perspective of persons with hypertension and health care providers. Focus group interviews were performed with 15 persons with hypertension and 12 health care providers and analysed according to thematic analysis. Results: Persons with hypertension perceived trust, relationship to providers, well-being and prevention of complications as important aspects of hypertension care. Further they sought to understand the interplay between symptoms and variation of blood pressure. The providers emphasised accessibility, clear and consistent counselling, prevention of complications and educational efforts but doubted patients’ ability to be participating partners in care. Conclusion: The study presents aspects that persons with hypertension and health care providers deem important in hypertension management. Our finding provides input for future outcome measures, such as self-reports and may serve as a foundation for the development of a self-report system for persons with hypertension. They may further facilitate patient empowerment by increasing the understanding of hypertension and its’ treatment, from a person-centred perspective.
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| 22. |
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| 23. |
- Bengtsson, Ulrika, et al.
(author)
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Improved Blood Pressure Control Using an Interactive Mobile Phone Support System
- 2016
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In: The Journal of Clinical Hypertension. - : Wiley. - 1524-6175 .- 1751-7176. ; 18:2, s. 101-108
-
Journal article (peer-reviewed)abstract
- This explorative, longitudinal study evaluated the effect of the daily use of a mobile phone-based self-management support system for hypertension in reducing blood pressure (BP) among 50 primary care patients with hypertension over 8 weeks. The self-management system comprises modules for (1) self-reports of BP, pulse, lifestyle, symptoms, and well-being; (2) delivery of reminders and encouragements; and (3) graphical feedback of self-reports. Daily use of the support system significantly reduced BP (systolic BP 7 mm Hg, diastolic BP 4.9 mm Hg) between baseline and week 8, with daily improvements leveling off as the study progressed. Three homogenous subsets of patients were identified who, despite different initial BP levels, showed similar decreases in BP during the study, indicating that patients benefited irrespective of baseline BP. In showing significant reductions in BP, our results suggest that the self-management support system may be a useful tool in clinical practice to help patients self-manage their hypertension.
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| 24. |
- Bengtsson, Ulrika, et al.
(author)
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Patient contributions during primary care consultations for hypertension after self-reporting via a mobile phone self-management support system.
- 2018
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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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| 25. |
- Berg, Katarina, 1959-
(author)
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Patients’ perspectives on recovery from day surgery
- 2012
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Doctoral thesis (other academic/artistic)abstract
- A large number of elective surgical patients in Sweden and elsewhere have their surgical procedure performed in a day surgery context. The surgical care event, with its postoperative surveillance, is brief at the surgery unit and patients are discharged home with the intention that they should manage postoperative recovery mainly themselves. However, several patients attest to being in an exposed situation when assuming responsibility for recovery at home. The overall aim of this thesis was to attain comprehensive knowledge of postoperative recovery following day surgery from a patient perspective.A questionnaire, the Post-discharge Surgical Recovery scale, was translated into Swedish and evaluated regarding its psychometric properties in a Swedish context. A sample of 607 day surgery patients who had undergone orthopaedic, general or gynaecological surgery self-rated their recovery at postoperative Days 1, 7 and 14 using the Post-discharge Surgical Recovery scale and the Quality of Recovery-23. Health-related quality of life was assessed before and 30 days after the surgical procedure, using the EQ-5D. In a second sample, 31 patients were interviewed in their homes regarding their recovery after day surgery. The interviews were conducted on postoperative Days 11-37, and focused on the meaning of recovery, self-care and perceptions of recovery. Data were explored by means of a phenomenographic analysis.The Post-discharge Surgical Recovery scale showed satisfactory psychometric properties when used among Swedish day surgery patients. Following discharge, recovery included both physical and emotional perspectives. Recovery varied, and influencing factors were found to be type of surgery, age, perceived health and emotional status on the first postoperative day. Orthopaedic patients had a more protracted recovery process compared to general surgery and gynaecological patients, along with more postoperative pain and lower health-related quality of life. Patients perceived that postoperative recovery comprised different internal and external factors and a large amount of responsibility regarding their recovery and surgical outcome. To be prepared for recovery at home, patients wanted knowledge and understanding about the normal range of recovery following their specific surgical procedure, and needed support from different sources in their surroundings.This thesis provides insight into day surgery patients’ postoperative situation. Based on the studies, individualized and well thought-out support appears favourable in order to have confident and well prepared patients at home. In contrast to smooth and easy patient care at the surgery unit, the postoperative phase seems to be a weak link in the day surgical continuity of patient care. Postoperative care needs to be further improved to increase quality and patients’ overall satisfaction with the day surgical experience. Attention should be paid to patients’ physical and emotional resources and needs.
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| 26. |
- Berg, Katarina, et al.
(author)
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Postoperative recovery and its association with health-related quality of life among day surgery patients
-
Other publication (other academic/artistic)abstract
- Background: Day surgery holds advantages for both the patient and the health care organization. However, recovery beyond the first postoperative week and following different types of surgery has not been explored to any greater degree. The current aims were to prospectively describe postoperative recovery and health-related quality of life among different groups of day surgery patients and to explore the association between postoperative recovery and health-related quality of life 30 days after discharge. A consecutive sample of 607 adult day surgery patients undergoing orthopaedic, gynaecological or general surgery was included. Postoperative recovery was assessed on days 1, 7 and 14 using the Swedish Post-discharge Surgery Recovery scale and the Quality of Recovery-23 scale. The EQ-5D was used to assess health-related quality of life preoperatively and 30 days following discharge. A repeated measure ANOVA was conducted to evaluate postoperative recovery from day 1 to day 14 and between different surgical groups. Hierarchical multiple linear regression models were used to explore the association between postoperative recovery and health-related quality of life.Results: Postoperative recovery improved from day 1 to 14 in all surgical groups (p<0.001). The orthopaedic patients had lower postoperative recovery on day 14 compared to the general and the gynaecological patients (p<0.001). Health-related quality of life was lower among orthopaedic patients (p<0.001), even if significant improvements over time were seen in all groups. Recovery on day 7 was associated with health-related quality of life 30 days after the day surgery (p<0.05).Conclusion: Particularly orthopaedic day surgical patients seem to favour a closer follow-up in order to support recovery and thereby also positively influence health-related quality of life.
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| 27. |
- Berg, Katarina, et al.
(author)
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Postoperative recovery and its association with health-related quality of life among day surgery patients.
- 2012
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In: BMC Nursing. - : Springer Science and Business Media LLC. - 1472-6955. ; 11:1, s. Article ID: 24-
-
Journal article (peer-reviewed)abstract
- BACKGROUND: Day surgery holds advantages for both the patient and the health care organization. However, recovery beyond the first postoperative week and following different types of surgery has not been explored to any greater degree. The current aims were to prospectively describe postoperative recovery and health-related quality of life among different groups of day surgery patients and to explore the association between postoperative recovery and health-related quality of life 30 days after discharge.METHODS: A consecutive sample of 607 adult day surgery patients undergoing orthopaedic, gynaecological or general surgery was included. Postoperative recovery was assessed on days 1, 7 and 14 using the Swedish Post-discharge Surgery Recovery scale and the Quality of Recovery-23 scale. The EQ-5D was used to assess health-related quality of life preoperatively and 30 days following discharge. A repeated measure ANOVA was conducted to evaluate postoperative recovery from day 1 to day 14 and between different surgical groups. Hierarchical multiple linear regression models were used to explore the association between postoperative recovery and health-related quality of life.RESULTS: Postoperative recovery improved from day 1 to 14 in all surgical groups (p<0.001). The orthopaedic patients had lower postoperative recovery on day 14 compared to the general and the gynaecological patients (p<0.001). Health-related quality of life was lower among orthopaedic patients (p<0.001), even if significant improvements over time were seen in all groups. Recovery on day 7 was associated with health-related quality of life 30 days after the day surgery (p<0.05).CONCLUSION: Particularly orthopaedic day surgical patients seem to favour a closer follow-up in order to support recovery and thereby also positively influence health-related quality of life.
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| 28. |
- Berg, Katarina, et al.
(author)
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Postoperative recovery from the perspective of day surgery patients : A phenomenographic study
- 2013
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In: International Journal of Nursing Studies. - : Elsevier. - 0020-7489 .- 1873-491X. ; 50:12, s. 1630-1638
-
Journal article (peer-reviewed)abstract
- Background: Today, many patients undergo surgical procedures in a day surgery setting. The shift from inpatient care to care at the patient’s own home following discharge places various demands on patients and their families during the recovery process. There is a need for knowledge of how the postoperative recovery process is perceived, as research indicates a lack of support for patients managing recovery at home.Objectives: To explore day surgery patients’ perceptions of postoperative recovery.Design: A qualitative design with a phenomenographic approach was used.Methods and settings: Semi-structured interviews with 31 patients undergoing an orthopaedic, general or urologic day surgical procedure were carried out face-to-face at the patients’ homes, 11-37 days post-discharge. Patients were recruited from two day surgery settings: one private unit and one unit associated with a local county hospital.Results: The patients perceived postoperative recovery as comprising internal and external prerequisites and implied changes in ordinary life with varying levels of support. The organization at the day surgery unit, with its advantages and disadvantages, was perceived as having an impact on the subsequent recovery trajectory. The results are demonstrated in three descriptive categories: ‘Conditions for recovery at home’, The rollback to ordinary life’ and ‘Being a cog in a flow of care’.Conclusions: Postoperative recovery following day surgery implies, from the patients’ perspective, a migration from being a recipient of care at the day surgery unit to playing an active role, with extensive responsibility at home. To manage self-care confidently, postdischarge patients require knowledge and understanding of what constitutes the normal range in recovery following their specific surgical procedure.
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| 29. |
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| 30. |
- Berglund, Helene, 1957, et al.
(author)
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Care planning at home: a way to increase the influence of older people?
- 2012
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In: International Journal of Integrated Care. - : Igitur, Utrecht Publishing & Archiving Services. - 1568-4156. ; 12:September
-
Journal article (peer-reviewed)abstract
- Introduction: Care-planning meetings represent a common method of needs assessment and decision-making practices in elderly care. Older people's influence is an important and required aspect of these practices. This study's objective was to describe and analyse older people's influence on care-planning meetings at home and in hospital. Methods: Ten care-planning meetings were audio-recorded in the older people's homes and nine were recorded in hospital. The study is part of a project including a comprehensive continuum-of-care model. A qualitative content analysis was performed. Results: Care-planning meetings at home appeared to enable older people's involvement in the discussions. Fewer people participated in the meetings at home and there was less parallel talking. Unrelated to the place of the care-planning meeting, the older people were able to influence concerns relating to the amount of care/service and the choice of provider. However, they were not able to influence the way the help should be provided or organised. Conclusion: Planning care at home indicated an increase in involvement on the part of the older people, but this does not appear to be enough to obtain any real influence. Our findings call for attention to be paid to older people's opportunities to receive care and services according to their individual needs and their potential for influencing their day-to-day provision of care and service.
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| 31. |
- Berglund, Helene, 1957, et al.
(author)
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Effects of a continuum of care intervention on frail older persons' life satisfaction: a randomized controlled study
- 2015
-
In: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 24:7-8, s. 1079-1090
-
Journal article (peer-reviewed)abstract
- Aims and objectives The aim of this study was to analyse effects of a comprehensive continuum of care (intervention group) on frail older persons’ life satisfaction, as compared to those receiving usual care (control group). The intervention included geriatric assessment, case management, interprofessional collaboration, support for relatives and organising of care-planning meetings in older persons’ own homes. Background Improvements in older persons’ subjective well-being have been shown in studies including care planning and coordination by a case manager. However, effects of more complex continuum of care interventions on frail older persons’ life satisfaction are not well explored. Design Randomised controlled study. Methods The validated LiSat-11 scale was used in face-to-face interviews to assess older persons’ life satisfaction at baseline and at three, six and 12 months after the baseline. The odds ratio for improving or maintaining satisfaction was compared for intervention and control groups from baseline to three-month, three- to six-month as well as six- to 12-month follow-ups. Results Older persons who received the intervention were more likely to improve or maintain satisfaction than those who received usual care, between 6 and 12 month follow-ups, for satisfaction regarding functional capacity, psychological health and financial situation. Conclusions A comprehensive continuum of care intervention comprising several components had a positive effect on frail older persons’ satisfaction with functional capacity, psychological health and financial situation. Relevance to clinical practice Frail older persons represent a great proportion of the persons in need of support from the health care system. Health care professionals need to consider continuum of care interventions’ impact on life satisfaction. As life satisfaction is an essential part of older persons’ well-being, we propose that policy makers and managers promote comprehensive continuum of care solutions.
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| 32. |
- Berglund, Helene, 1957, et al.
(author)
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Older people's views of quality of care: a randomised controlled study of continuum of care
- 2013
-
In: Journal of Clinical Nursing. - : Wiley-Blackwell. - 0962-1067 .- 1365-2702. ; 22:19-20, s. 2934-2944
-
Journal article (peer-reviewed)abstract
- Aims and objectives To analyse frail older peoples views of quality of care when receiving a comprehensive continuum of care intervention, compared with those of people receiving the usual care (control group). The intervention included early geriatric assessment, case management, interprofessional collaboration, support for relatives and organising of care-planning meetings in older peoples own homes. less thanbrgreater than less thanbrgreater thanBackground Prior studies indicate that tailored/individualised care planning conducted by a case manager/coordinator often led to greater satisfaction with care planning among older people. However, there is no obvious evidence of any effects of continuum of care interventions on older peoples views of quality of care. less thanbrgreater than less thanbrgreater thanDesign Randomised controlled study. less thanbrgreater than less thanbrgreater thanMethods Items based on a validated questionnaire were used in face-to-face interviews to assess older peoples views of quality of care at three, six and 12months after baseline. less thanbrgreater than less thanbrgreater thanResults Older people receiving a comprehensive continuum of care intervention perceived higher quality of care on items about care planning (p0005), compared with those receiving the usual care. In addition, they had increased knowledge of whom to contact about care/service, after three and 12months (pandlt;003). less thanbrgreater than less thanbrgreater thanConclusions The study gives evidence of the advantages of a combination of components such as organising care-planning meetings in older peoples own homes, case management and interprofessional teamwork. less thanbrgreater than less thanbrgreater thanRelevance to clinical practice The results have implications for policymakers, managers and professionals in the area of health and social care for older people to meet individual needs of frail older people.
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| 33. |
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| 34. |
- Berglund, Helene, 1957, et al.
(author)
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Organizing integrated care for older persons: Strategies in Sweden during the past decade
- 2015
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In: Journal of Health Organisation & Management. - : Emerald Group Publishing Limited. - 1477-7266 .- 1758-7247. ; 29:1, s. 128-151
-
Journal article (peer-reviewed)abstract
- Purpose – The purpose of this paper is to describe and analyse ways of organizing integrated care for older persons in Sweden during the past decade. Design/methodology/approach – The data consist of 62 cases of development work, described in official reports. A meta-analysis of cases was performed, including content analysis of each case. A theoretical framework comprising different forms of integration (co-ordination, contracting, co-operation and collaboration) was applied. Findings – Co-operation was common and collaboration, including multiprofessional teamwork, was rare in the cases. Contracting can be questioned as being a form of integration, and the introduction of consumer choice models appeared problematic in inter-organization integration. Goals stated in the cases concerned steering and designing care, rather than outcome specifications for older persons. Explicit goals to improve integration in itself could imply that the organizations adapt to strong normative expectations in society. Trends over the decade comprised development of local health care systems, introduction of consumer choice models and contracting out. Research limitations/implications – Most cases were projects, but others comprised evaluations of regular organization of integrated care. These evaluations were often written normatively, but constituted the conditions for practice and were important study contributions. Practical implications – Guiding clinical practice to be aware of importance of setting follow-up goals.
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| 35. |
- Bos (Sparén), Elisabeth, 1958-
(author)
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A good learning environment for nursing students in primary health care
- 2014
-
Doctoral thesis (other academic/artistic)abstract
- Background: Clinical learning is a key part for developing nursingursing education. Previous studies concentrated on hospitals as placement sites. Research results reported in this dissertation identify factors that encourage good learning environments in primary health care (PHC) placements.Aims and methods: The overall aim of the present research was to identify factors that promote good clinical learning environments in PHC settings. Clinical learning environment was investigated from students 'and supervisors' perspectives and their perceptions of the clinical part of nursing education in PHC settings. The present research implemented three quantitative studies (I, II, III) and one qualitative study (IV). In study I investigated district nurses’ (DNs’) student supervision experiences in PHC units before and after implementation of a new supervision model; 98 of 133 DNs (74%) responded to a questionnaire before and 84 (65%) respondes after implementation. In study II validated the Clinical Learning Environment, Supervision, and Nurse Teacher (CLES+T) scale. In study III investigated students’ motivation, total satisfaction, and experience of professional role models associated with dimensions in clinical learning environments. In studies II and III collected data from undergraduate nursing students (n=356) using the CLES+T scale. In study IV interviewed six focus groups with 24 supervisors (DNs); these data provided understanding of student supervision in PHC units.Results: Study I revealed significant need for a new supervision model in PHC units. Supervisors had difficulties staying updated on changes in nursing curricula and experienced insufficient support from universities. They felt that they had to set aside time from their regular duties and get permission from unit managers to supervise students. The supervisors felt confident in the supervisory role, but few had formal educational and academic credentials. After the new supervision model implementation, several supervisors were more satisfied with the supervision organization. The model implementation resulted in improvements within PHC units. Study II confirmed good internal reliability in the CLES+T scale and demonstrated that the five-factor model within the scale is the best-fit model. Supervisory relationship was the most important factor and it strongly correlated with these factors: (i) pedagogical atmosphere and (ii) premises of nursing. Supervisory relationship was moderately correlated with the role of the nurse teacher, and leadership style correlated with PHC units. Study III revealed a statistically significant association between (i) students’ motivation, total satisfaction, and experiences of professional role models and (ii) five dimensions of clinical learning environments. The satisfaction factor had a statistically significant association (effect size was high) with the dimensions; this clearly indicated that students experienced satisfaction. Supervisory relationship and pedagogical atmosphere particularly influenced students’ satisfaction and motivation. Study IV revealed three themes related to supervisors’ experiences during student supervision in PHC units: abandonment, ambivalence, and sharing the holistic approach. Supervisors felt abandoned by their managers, colleagues, and nurse teachers rom universities. They were proud to be DNs and willing to share experiences with students – yet torn between being students’ supervisors and patients’ nurses.Conclusion: This dissertation reports six main factors for good learning environments in PHC units. Supervisors must be prepared and engaged, and students must be motivated. A close, reflective supervisory relationship is one of the most important factors for learning in PHC units. Successful supervision requires clear structure and organization. Adequate support and resources from PHC units are needed for supervisors. Collaboration and liaison between universities and PHC units are needed to link theoretical and practical parts of nurse education. PHC-unit circumstances contribute to holistic nursing care, which is an important factor for student learning. Furthermore, the CLES+T scale was shown to be a reliable tool to use for evaluating PHC settings as clinical learning environment.
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| 36. |
- Brink, Eva, 1952, et al.
(author)
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General self-efficacy and health-related quality of life after myocardial infarction
- 2012
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In: Psychology, Health & Medicine. - : Routledge. - 1354-8506 .- 1465-3966. ; 17:3
-
Journal article (peer-reviewed)abstract
- Fatigue after myocardial infarction (MI) has been found to be distressing. A person's self-efficacy will influence his/her health behavior and plays an active role in tackling illness consequences. This study investigated associations between fatigue, disturbed sleep, general self-efficacy, and health-related quality of life (HRQoL) in a sample of 145 respondents admitted to hospital for MI two years earlier. The aim was to identify the predictive value of general self-efficacy and to elucidate mediating factors between self-efficacy and HRQoL. General self-efficacy measured four months after MI was positively related to HRQoL after two years. In tests of indirect effects, fatigue meditated the effects between self-efficacy and the physical and the mental dimension of HRQoL, respectively. The indirect effect of disturbed sleep went through that of fatigue. To conclude, patients who suffer from post-MI fatigue may need support aimed at helping them increase their self-efficacy as well as helping them adapt to sleep hygiene principles and cope with fatigue, both of which will have positive influences on HRQoL.
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| 37. |
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| 38. |
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| 39. |
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| 40. |
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| 41. |
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| 42. |
- Drevenhorn, Eva, 1954, et al.
(author)
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Assessment of hypertensive patients' self-care agency after counseling training of nurses
- 2015
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In: Journal of the American Association of Nurse Practitioners. - : Ovid Technologies (Wolters Kluwer Health). - 2327-6886 .- 2327-6924. ; 27:11, s. 624-630
-
Journal article (peer-reviewed)abstract
- PurposeThe aim of the study was to assess hypertensive patients' self-care agency and any correlation with the patient's lifestyle changes and the nurse's degree of patient centeredness after counseling training. Data sourcesNurses in the intervention group (IG; n = 19) working at nurse-led clinics at health centers were trained in patient centeredness (motivational interviewing) and the stages of change model and included 137 patients. Nurses in the control group (CG; n = 14) included 51 patients. The Exercise of Self-Care Agency (ESCA) instrument was used. There was a significant difference from baseline to the 2-year follow-up in the ESCA score (IG, p = .0001). An increase in ESCA score was correlated with an increased level of physical activity after 2 years (IG, p = .0001; CG, p = .040). ConclusionsThe counseling training gave an increase in the patients' self-care agency scores, which was significantly correlated with increased physical activity. Implications for practiceIn clinical practice it is important for nurses to be patient centered in their counseling to affect patients' self-care agency in a positive direction.
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| 43. |
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| 44. |
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| 45. |
- Drevenhorn, Eva, et al.
(author)
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Consultation training of nurses for cardiovascular prevention - A randomized study of 2 years duration
- 2012
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In: Blood Pressure. - : Informa Healthcare. - 0803-7051 .- 1651-1999. ; 21:5, s. 293-299
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Journal article (peer-reviewed)abstract
- The aim of this study was to increase patients adherence to the treatment of hypertension through the consultation training of nurses. Thirty-three nurses were included in the study. In the intervention group (IG), 19 nurses took part in a 3-day residential training course on the Stages of Change model, Motivational Interviewing and guidelines for cardiovascular prevention, and recruited 153 patients. Sixteen nurses in the control group (CG) recruited 59 patients. A decrease in systolic and diastolic blood pressure and total cholesterol was noticed in both groups over the 2 years. Heart rate (p = 0.027), body mass index (p = 0.019), weight (p = 0.0001), waist (p = 0.041), low-density lipoprotein-cholesterol (p = 0.0001), the waist-hip ratio (p = 0.024), and perceived stress (p = 0.001) decreased to any great extent only in the IG. After 2 years, 52.6% of the patients in the IG (p = 0.13) reached the target of andlt;= 140/90 mmHg in blood pressure compared with 39.2% in the CG. For self-reported physical activity, there was a significant (p = 0.021) difference between the groups. The beneficial effects of the consultation training on patients weight parameters, physical activity, perceived stress and the proportion of patients who achieved blood pressure control emphasize consultation training and the use of behavioural models in motivating patients to adhere to treatment.
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| 46. |
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| 47. |
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| 48. |
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| 49. |
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| 50. |
- Drevenhorn, E., et al.
(author)
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Counselling on lifestyle factors in hypertension care after training on the stages of change model
- 2007
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In: European Journal of Cardiovascular Nursing. - : Sage Publications. - 1474-5151 .- 1873-1953. ; :6, s. 46-53
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Journal article (peer-reviewed)abstract
- BACKGROUND:In assisting the nurse's counselling on lifestyle changes in hypertension care a behaviour model can be used.AIM:To analyse the effects of nurses' training on the use of the stages of change model when counselling hypertensive patients to perform lifestyle changes.METHODS:As part of a randomised, controlled trial, 19 nurses belonging to the intervention group took part in video-recorded consultation training with simulated patients. To evaluate the training, the nurses audio-recorded their consultations with two patients before and after the intervention. Analysis focused on the areas of non-pharmacological treatment and the nurses' attention to the patients' readiness for change.RESULTS:Patient participation in the consultations increased after the training. The importance of non-pharmacological treatment was mentioned more frequently for all areas of lifestyle behaviour, exercise, smoking, alcohol consumption, food and stress, and the nurses acquired a more distinct structure for their consultations. The mean length of the recorded consultations increased from 18 min to 20.5 min. All the criteria for fulfillment of attention to patient's readiness to change were met in nine consultations before the training and in seven after it. After the training, attention was paid to support more frequently than before in the action and maintenance stages and a great deal of information was provided.
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