Skip header and navigation

Refine By

10 records – page 1 of 1.

Active interprofessional education in a patient based setting increases perceived collaborative and professional competence.

https://arctichealth.org/en/permalink/ahliterature154632
Source
Med Teach. 2009 Feb;31(2):151-7
Publication Type
Article
Date
Feb-2009
Author
Karin Hallin
Anna Kiessling
Annika Waldner
Peter Henriksson
Author Affiliation
Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden.
Source
Med Teach. 2009 Feb;31(2):151-7
Date
Feb-2009
Language
English
Publication Type
Article
Keywords
Consumer Satisfaction
Cooperative Behavior
Education, Medical, Undergraduate
Female
Hospitals
Humans
Interdisciplinary Communication
Male
Professional Competence - standards
Program Evaluation
Questionnaires
Sweden
Teaching - methods
Abstract
Interprofessional competence can be defined as knowledge and understanding of their own and the other team members' professional roles, comprehension of communication and teamwork and collaboration in taking care of patients.
To evaluate whether students perceived that they had achieved interprofessional competence after participating in clinical teamwork training.
Six hundred and sixteen students from four undergraduate educational programs-medicine, nursing, physiotherapy and occupational therapy-participated in an interprofessional course at a clinical education ward. The students filled out pre and post questionnaires (96% response rate).
All student groups increased their perceived interprofessional competence. Occupational therapy and medical students had the greatest achievements. All student groups perceived improved knowledge of the other three professions' work (p = 0.000000) and assessed that the course had contributed to the understanding of the importance of communication and teamwork to patient care (effect size 1.0; p = 0.00002). The medical students had the greatest gain (p = 0.00093). All student groups perceived that the clarity of their own professional role had increased significantly (p = 0.00003). Occupational therapy students had the greatest gain (p = 0.000014).
Active patient based learning by working together in a real ward context seemed to be an effective means to increase collaborative and professional competence.
PubMed ID
18937139 View in PubMed
Less detail

Adherence to guidelines for drug treatment of asthma in children: potential for improvement in Swedish primary care.

https://arctichealth.org/en/permalink/ahliterature122367
Source
Qual Prim Care. 2012;20(2):131-9
Publication Type
Article
Date
2012
Author
Maria Ingemansson
Björn Wettermark
Eva Wikström Jonsson
Maria Bredgard
Marina Jonsson
Gunilla Hedlin
Anna Kiessling
Author Affiliation
Paediatric Department, Astrid Lindgrens Hospital, Karolinska University Hospital, Sweden.
Source
Qual Prim Care. 2012;20(2):131-9
Date
2012
Language
English
Publication Type
Article
Keywords
Adolescent
Anti-Asthmatic Agents - therapeutic use
Asthma - drug therapy
Child
Child, Preschool
Female
Guideline Adherence
Humans
Infant
Male
Physician's Practice Patterns - statistics & numerical data
Primary Health Care
Quality of Health Care
Sweden
Abstract
Adherence to guidelines in general is poor. Because asthma is the most common chronic disease in Swedish children, identifying areas for improvement regarding drug treatment for asthma is crucial.
To explore the utilisation patterns of anti-asthmatic drugs in children with asthma in relation to evidence-based guidelines.
All children visiting 14 primary healthcare centres in Stockholm, Sweden, who had their first prescription of anti-asthmatic agents dispensed between July 2006 and June 2007 were followed over 24 consecutive months. The children (1033 in total) were divided in two age groups: 0-6 years and 7-16 years. The outcome measurements were: the characteristics of the physicians initiating drug treatment; the extent to which the children were initiated on the drugs recommended in the guidelines; and the amount and frequency of drugs dispensed over time and whether the dosage texts on the prescriptions contained adequate information.
In 54% of the older children and 35% of the younger children, only one prescription for anti-asthmatic drugs was dispensed during two years of follow-up following the first prescription. In school-aged children, 50% were initiated on inhaled short-acting bronchodilating beta2-agonists (SABA) in monotherapy. Among preschool children, 64% were initiated on SABA and inhaled corticosteroids in combination. In 41% of the prescriptions dispensed, the indication was stated and in 25% the mechanism of action was stated. Drug therapy was initiated by a general practitioner in 42% of the younger children and 72% of the older children.
There is a need for improvement in adherence to guidelines in important areas. Asthma, especially among children aged 7-16 years, is usually a chronic disease and should, in many cases, be treated with anti-asthmatics counteracting inflammation. However, this was not the case in our study. In addition, the dosage texts written by the physicians did not follow recommendations and may negatively influence patient safety.
PubMed ID
22824566 View in PubMed
Less detail

[A national questionnaire shows the quality of Swedish medical education. Physicians' perspectives two years after examination].

https://arctichealth.org/en/permalink/ahliterature124988
Source
Lakartidningen. 2012 Feb 29-Mar 13;109(9-10):468-72
Publication Type
Article

Case-based training of evidence-based clinical practice in primary care and decreased mortality in patients with coronary heart disease.

https://arctichealth.org/en/permalink/ahliterature134657
Source
Ann Fam Med. 2011 May-Jun;9(3):211-8
Publication Type
Article
Author
Anna Kiessling
Moira Lewitt
Peter Henriksson
Author Affiliation
Department of Clinical Sciences, Karolinska Institutet, Division of Cardiovascular Medicine, Danderyd Hospital, Stockholm, Sweden. anna.kiessling@ki.se
Source
Ann Fam Med. 2011 May-Jun;9(3):211-8
Language
English
Publication Type
Article
Keywords
Anticholesteremic Agents - therapeutic use
Clinical Competence
Confidence Intervals
Coronary Artery Disease - drug therapy - mortality
Educational Status
Evidence-Based Medicine - methods
Female
General practitioners
Humans
Male
Middle Aged
Primary Health Care - methods
Problem-Based Learning - methods
Quality of Health Care - standards
Statistics as Topic
Sweden
Abstract
We investigated the 10-year mortality rates in a trial that tested a case-based intervention in primary care aimed at reducing the gap between evidence-based goals and clinical practice in patients with coronary heart disease (CHD).
A prospective randomized controlled pragmatic trial was undertaken in a primary care setting. New evidence-based guidelines, with intensified lipid-lowering recommendations in CHD, were mailed to all general practitioners in the region and presented at a lecture in 1995. General practitioners (n = 54) and patients with CHD (n = 88) were assigned according to their primary health care center to 2 balanced groups and randomly allocated to usual care as a control or to an active intervention. General practitioners in the intervention group participated in repeated case-based training during a 2-year period. Patients whose CHD was treated by specialists (n = 167) served as an internal specialist comparison group. Altogether, 255 consecutive patients were included. Cox regression analysis was used to detect any survival benefit of the intervention.
At 10 years, 22% of the patients in the intervention group had died as compared with 44% in the control group (P = .02), with a hazard ratio of 0.45 (95% confidence interval, 0.20-0.95). This difference was mainly due to reduced cardiovascular mortality in the intervention group (P = .01). In addition, the mortality rate of 22% in the intervention group was comparable to the rate of 23% seen in patients treated by a specialist.
Use of case-based training to implement evidence-based practice in primary care was associated with decreased mortality at 10 years in patients with CHD.
Notes
Cites: Arch Intern Med. 2007 Jan 8;167(1):68-7317210880
Cites: Am Heart J. 2007 Jan;153(1):22.e1-817174632
Cites: Evid Rep Technol Assess (Full Rep). 2007 Jan;(149):1-6917764217
Cites: Cochrane Database Syst Rev. 2007;(4):CD00040917943742
Cites: Lancet. 2009 Mar 14;373(9667):929-4019286092
Cites: J Community Health. 2011 Apr;36(2):281-820835777
Cites: Cochrane Database Syst Rev. 2007;(1):CD00012517253445
Cites: Cochrane Database Syst Rev. 2001;(2):CD00303011406063
Cites: BMJ. 2002 Oct 19;325(7369):877-8012386042
Cites: Fam Pract. 2002 Dec;19(6):596-60412429661
Cites: J Am Coll Cardiol. 2004 May 19;43(10):1738-4215145092
Cites: Science. 1981 Jan 30;211(4481):453-87455683
Cites: Lancet. 1994 Nov 19;344(8934):1383-97968073
Cites: BMJ. 1999 May 8;318(7193):1267-910231262
Cites: JAMA. 1999 Sep 1;282(9):867-7410478694
Cites: Lancet. 2005 Jan 1-7;365(9453):82-9315639683
Cites: Int J Technol Assess Health Care. 2005 Spring;21(2):180-615921057
Cites: Acad Med. 2005 Jul;80(7):685-915980087
Cites: Br J Gen Pract. 2005 Jul;55(516):534-816004739
Comment In: Ann Fam Med. 2011 May-Jun;9(3):198-20021555746
PubMed ID
21555748 View in PubMed
Less detail

Cost of lipid lowering in patients with coronary artery disease by case method learning.

https://arctichealth.org/en/permalink/ahliterature53151
Source
Int J Technol Assess Health Care. 2005;21(2):180-6
Publication Type
Article
Date
2005
Author
Anna Kiessling
Niklas Zethraeus
Peter Henriksson
Author Affiliation
Karolinska Institute and Danderyd University Hospital, Sweden. anna.kiessling@kids.ki.se
Source
Int J Technol Assess Health Care. 2005;21(2):180-6
Date
2005
Language
English
Publication Type
Article
Keywords
Antilipemic Agents - economics - therapeutic use
Coronary Arteriosclerosis - blood - prevention & control
Education, Medical, Continuing - economics - methods
Family Practice - education
Female
Humans
Lipoproteins, LDL Cholesterol - blood - drug effects
Male
Middle Aged
Practice Guidelines
Primary Health Care
Prospective Studies
Quality of Life
Quality-Adjusted Life Years
Recurrence - prevention & control
Research Support, Non-U.S. Gov't
Sweden
Abstract
OBJECTIVES: This investigation was undertaken to study the costs of a Case Method Learning (CML)-supported lipid-lowering strategy in secondary prevention of coronary artery disease (CAD) in primary care. METHODS: This prospective randomized controlled trial in primary care with an additional external specialist control group in Södertälje, Stockholm County, Sweden, included 255 consecutive patients with CAD. Guidelines were mailed to all general practitioners (GPs; n=54) and presented at a common lecture. GPs who were randomized to the intervention group participated in recurrent CML dialogues at their primary health-care centers during a 2-year period. A locally well-known cardiologist served as a facilitator. Assessment of low-density lipoprotein (LDL) cholesterol was performed at baseline and after 2 years. Analysis according to intention-to-treat-intervention and control groups (n=88)--was based on group affiliation at baseline. The marginal cost of lipid lowering comprised increased cost of lipid-lowering drugs in the intervention group compared with the primary care control group, cost of attendance of the GP's in the intervention group, and cost of time for preparation, travel, and seminars of the facilitator. Costs are as of 2002 with an exchange rate 1 U.S. dollar = 9.5 SEK (Swedish Crowns). RESULTS: Patients in the primary care intervention group had their LDL cholesterol reduced by 0.5 (confidence interval [CI], 0.1-0.9) mmol/L compared with the primary care control group (p
PubMed ID
15921057 View in PubMed
Less detail

Efficacy of case method learning in general practice for secondary prevention in patients with coronary artery disease: randomised controlled study.

https://arctichealth.org/en/permalink/ahliterature53659
Source
BMJ. 2002 Oct 19;325(7369):877-80
Publication Type
Article
Date
Oct-19-2002
Author
Anna Kiessling
Peter Henriksson
Author Affiliation
Centre for Clinical Education, Danderyd University Hospital and Karolinska Institute, SE-182 88 Stockholm, Sweden.
Source
BMJ. 2002 Oct 19;325(7369):877-80
Date
Oct-19-2002
Language
English
Publication Type
Article
Keywords
Confidence Intervals
Coronary Arteriosclerosis - blood - prevention & control
Education, Medical, Continuing
Family Practice - education
Health Knowledge, Attitudes, Practice
Humans
Lipoproteins, LDL Cholesterol - blood
Practice Guidelines
Prospective Studies
Research Support, Non-U.S. Gov't
Sweden
Abstract
OBJECTIVE: To study the efficacy of case method learning, for general practitioners, on patients' lipid concentrations in the secondary prevention of coronary artery disease. DESIGN: Prospective controlled trial. SETTING: Södertälje, Stockholm County, Sweden. PARTICIPANTS: 255 consecutive patients with coronary artery disease. INTERVENTION: Guidelines were mailed to all general practitioners (n=54) and presented at a common lecture. General practitioners who were randomised to the intervention group participated in recurrent case method learning dialogues at their primary healthcare centres during a two year period. A locally well known cardiologist served as a facilitator. MAIN OUTCOME MEASURE: Concentration of low density lipoprotein cholesterol at baseline and after two years. Analysis according to intention to treat (intervention and control groups (n=88)) was based on group affiliation at baseline. RESULTS: Low density lipoprotein cholesterol was reduced by 0.5 mmol/l (95% confidence interval 0.2 to 0.8 mmol/l) (9.3% (2.9% to 15.8%)) from baseline in patients in the intervention group and by 0.5 (0.1 to 0.9) mmol/l compared with controls (P
PubMed ID
12386042 View in PubMed
Less detail

Perceived cognitive function in coronary artery disease--an unrecognised predictor of unemployment.

https://arctichealth.org/en/permalink/ahliterature53111
Source
Qual Life Res. 2005 Aug;14(6):1481-8
Publication Type
Article
Date
Aug-2005
Author
Anna Kiessling
Peter Henriksson
Author Affiliation
Centre for Clinical Education, Karolinska Institute at Danderyd University Hospital, Stockholm, Sweden. Anna.Kiessling@kids.ki.se
Source
Qual Life Res. 2005 Aug;14(6):1481-8
Date
Aug-2005
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Cognition
Coronary Arteriosclerosis - physiopathology - psychology
Female
Hospitalization
Humans
Male
Middle Aged
Prospective Studies
Quality of Life
Questionnaires
Research Support, Non-U.S. Gov't
Retirement - psychology - statistics & numerical data
Sick Leave - statistics & numerical data
Sickness Impact Profile
Sweden
Unemployment - psychology - statistics & numerical data
Abstract
OBJECTIVE: We aimed to assess whether perceived cognitive function influences employment and return to work in patients with coronary artery disease (CAD). DESIGN: Prospective longitudinal cohort study. SETTING: Health care system of Södertälje, Stockholm County, Sweden. PATIENTS: We included consecutive unselected patients less than 65 years of age with CAD and followed them during 2 years. MAIN OUTCOME MEASURES: Gainful employment and return to work in patients with CAD. RESULTS: We found that perceived cognitive function predicts both prevalence of unemployment [OR 2.06 (95% CI: 1.36-3.13); p = 0.0006] and early retirement and sick leave due to coronary artery disease [OR 1.59 (95% CI: 1.12-2.25)] both at baseline and 2 years later. Furthermore, perceived cognitive function predicted return to work after an acute coronary event [OR 2.28 (95% CI: 1.08-4.84)]. Covariates such as age, sex, prevalence and degree of angina (CCS grade), cardiovascular risk factors and events did not change the predictive power. CONCLUSIONS: Perceived cognitive function is a hitherto unrecognised independent predictor of unemployment, sick leave and return to work in patients with coronary artery disease. Perceived cognitive function adds a new perspective on ability to gainful employment in patients with CAD. The findings might have significance both to individual care and to society.
PubMed ID
16110928 View in PubMed
Less detail

Perceived cognitive function is a major determinant of health related quality of life in a non-selected population of patients with coronary artery disease--a principal components analysis.

https://arctichealth.org/en/permalink/ahliterature53225
Source
Qual Life Res. 2004 Dec;13(10):1621-31
Publication Type
Article
Date
Dec-2004
Author
Anna Kiessling
Peter Henriksson
Author Affiliation
Centre for Clinical Education, Karolinska Institute at Danderyd University Hospital, Stockholm, Sweden. angust@ki.se
Source
Qual Life Res. 2004 Dec;13(10):1621-31
Date
Dec-2004
Language
English
Publication Type
Article
Keywords
Aged
Analysis of Variance
Cognition - physiology
Coronary Disease - physiopathology - psychology
Cross-Sectional Studies
Female
Humans
Likelihood Functions
Male
Middle Aged
Quality of Life
Questionnaires
Reproducibility of Results
Research Support, Non-U.S. Gov't
Sweden
Abstract
OBJECTIVE: To assess health related quality of life (HRQL) and explore its underlying structure in a non-selected population of patients with coronary artery disease (CAD). DESIGN, SETTING AND SUBJECTS: HRQL was estimated by the disease specific Cardiac Health Profile (CHP) questionnaire and the EuroQol-VAS (EQ) in 253 consecutive unselected CAD patients in Södertälje, Stockholm County, Sweden. Explorative factor analysis was used to identify independent dimensions of HRQL. Current angina was ranked according to Canadian Cardiovascular Society Classification (CCS). RESULTS: Four independent principal factors representing perceived cognitive, physical, social and emotional functions underlying the patients' HRQL were found. Identical factors were recognized with an alternate technique. The major factor--explaining 43 % of HRQL--was perceived cognitive function reflecting ability to concentrate, activity drive, memory and problem solving. Cognitive function correlated to EQ but not to CCS. Perceived physical function/general health explained 9% of HRQL and was as expected related both to EQ and CCS. Total CHP scores differed significantly to those of healthy controls. CONCLUSIONS: Perceived cognitive function seems to be a major determinant of HRQL in CAD patients. This, in addition to earlier reports of possible prognostic information of reduced cognitive function, would prompt us to propose that HRQL assessments should include questions aimed to assess cognitive function.
PubMed ID
15651534 View in PubMed
Less detail

Practice guidelines in the context of primary care, learning and usability in the physicians' decision-making process--a qualitative study.

https://arctichealth.org/en/permalink/ahliterature261321
Source
BMC Fam Pract. 2014;15:141
Publication Type
Article
Date
2014
Author
Maria Ingemansson
Pia Bastholm-Rahmner
Anna Kiessling
Source
BMC Fam Pract. 2014;15:141
Date
2014
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
Decision Making
Feedback
Female
Focus Groups
General practitioners
Guideline Adherence
Humans
Learning
Male
Physician's Practice Patterns
Practice Guidelines as Topic
Primary Health Care - methods
Qualitative Research
Sweden
Abstract
Decision-making is central for general practitioners (GP). Practice guidelines are important tools in this process but implementation of them in the complex context of primary care is a challenge. The purpose of this study was to explore how GPs approach, learn from and use practice guidelines in their day-to-day decision-making process in primary care.
A qualitative approach using focus-group interviews was chosen in order to provide in-depth information. The participants were 22 GPs with a median of seven years of experience in primary care, representing seven primary healthcare centres in Stockholm, Sweden in 2011. The interviews focused on how the GPs use guidelines in their decision-making, factors that influence their decision how to approach these guidelines, and how they could encourage the learning process in routine practice.Data were analysed by qualitative content analysis. Meaning units were condensed and grouped in categories. After interpreting the content in the categories, themes were created.
Three themes were conceptualized. The first theme emphasized to use guidelines by interactive contextualized dialogues. The categories underpinning this theme: 1. Feedback by peer-learning 2. Feedback by collaboration, mutual learning, and equality between specialties, identified important ways to achieve this learning dialogue. Confidence was central in the second theme, learning that establishes confidence to provide high quality care. Three aspects of confidence were identified in the categories of this theme: 1. Confidence by confirmation, 2. Confidence by reliability and 3. Confidence by evaluation of own results. In the third theme, learning by use of relevant evidence in the decision-making process, we identified two categories: 1. Design and lay-out visualizing the evidence 2. Accessibility adapted to the clinical decision-making process as prerequisites for using the practice guidelines.
Decision-making in primary care is a dual process that involves use of intuitive and analytic thinking in a balanced way in order to provide high quality care. Key aspects of effective learning in this clinical decision-making process were: contextualized dialogue, which was based on the GPs' own experiences, feedback on own results and easy access to short guidelines perceived as trustworthy.
Notes
Cites: Health Policy. 2013 Nov;113(1-2):180-723910731
Cites: BMC Health Serv Res. 2013;13:42924148207
Cites: Acad Med. 2014 Feb;89(2):285-9124362387
Cites: Acad Med. 2014 Feb;89(2):197-20024362398
Cites: PLoS One. 2014;9(2):e8606524505253
Cites: JAMA. 1999 Oct 20;282(15):1458-6510535437
Cites: BMJ. 2000 Jan 1;320(7226):50-210617534
Cites: Nurse Educ Today. 2004 Feb;24(2):105-1214769454
Cites: Health Technol Assess. 2004 Feb;8(6):iii-iv, 1-7214960256
Cites: BMJ. 1995 Jul 15;311(6998):182-47613435
Cites: Fam Pract. 1998 Apr;15(2):105-119613476
Cites: BMJ. 1998 Aug 15;317(7156):465-89703533
Cites: CMAJ. 1999 Sep 7;161(5):519-2310497607
Cites: Med Educ. 2005 Apr;39(4):418-2715813765
Cites: Br J Gen Pract. 2007 Dec;57(545):971-818252073
Cites: Cochrane Database Syst Rev. 2009;(2):CD00303019370580
Cites: Healthc Q. 2009;12 Spec No Patient:e171-619667765
Cites: Adv Health Sci Educ Theory Pract. 2009 Sep;14 Suppl 1:27-3519669918
Cites: BMC Health Serv Res. 2010;10:1720078891
Cites: BMC Fam Pract. 2010;11:6020731817
Cites: Ann Fam Med. 2011 May-Jun;9(3):198-20021555746
Cites: Med Teach. 2011;33(11):887-9221711217
Cites: Acad Med. 2012 Feb;87(2):135-822273611
Cites: Acad Med. 2012 Feb;87(2):149-5622189886
Cites: Acad Med. 2013 Jun;88(6):788-9423619072
Cites: J Health Organ Manag. 2013;27(2):266-7223802402
PubMed ID
25143046 View in PubMed
Less detail

10 records – page 1 of 1.