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Anticoagulant treatment of patients with chronic atrial fibrillation in primary health care in Sweden--a retrospective study of incidence and quality in a registered population.

https://arctichealth.org/en/permalink/ahliterature51950
Source
Fam Pract. 2004 Dec;21(6):612-6
Publication Type
Article
Date
Dec-2004
Author
Gunnar H Nilsson
Ingela Björholt
Ingvar Krakau
Author Affiliation
Department of Clinical Sciences, Center of Family Medicine, Karolinska Institute, Stockholm, Sweden. gunnar.nilsson@nlpo.sll.se
Source
Fam Pract. 2004 Dec;21(6):612-6
Date
Dec-2004
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Anticoagulants - therapeutic use
Atrial Fibrillation - drug therapy - epidemiology
Chronic Disease
Cohort Studies
Community health centers - standards
Drug Utilization Review
Female
Humans
Incidence
Linear Models
Male
Medical Records Systems, Computerized
Middle Aged
Prevalence
Primary Health Care - standards
Quality of Health Care
Research Support, Non-U.S. Gov't
Sweden - epidemiology
Time Factors
Warfarin - therapeutic use
Abstract
BACKGROUND: The number of patients receiving anticoagulant treatment is increasing. Chronic atrial fibrillation is the most common treatment diagnosis. The literature indicates a variable level of treatment control. Estimates of time within the therapeutic range have been recommended as a measurement of quality. Electronic patient records are providing clinical data that are useful for audits concerning anticoagulant treatment in real-life practice. OBJECTIVE: Our aim was to assess warfarin treatment for chronic atrial fibrillation in primary health care with regard to prevalence, incidence and quality. METHODS: A 2 year retrospective study was carried out of electronic patient records up to April 2002 in primary health care in Stockholm, including 12 primary health care centres with a registered population of 203 407. Main outcome measures were the number of new patients on wafarin treatment for chronic atrial fibrillation, and time within the therapeutic prothrombin range in the first 90 days of treatment using a linear interpolation method. RESULTS: In total, 827 patients were on warfarin treatment for chronic atrial fibrillation, giving a prevalence of 0.41%. Of these, 144 patients (study group) started treatment with warfarin for chronic atrial fibrillation during the study period, giving a yearly incidence of 0.07%. Their mean age was 73.1 years and 61.1% were men. There were 1721 prothrombin monitoring episodes registered in the first 90 days of treatment, on average once a week per patient. The average proportion of time within the therapeutic range was 54.1% (95% confidence interval (CI) 50.1-58.1), and the proportion of therapeutic tests was 50.2% (95% CI 47.8-52.6). CONCLUSIONS: During the first, second and third months of warfarin treatment for chronic atrial fibrillation, patients were outside the therapeutic range time nearly half the time. There was a gender difference favouring men regarding initiation of treatment.
PubMed ID
15465879 View in PubMed
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Asthma and COPD in primary health care, quality according to national guidelines: a cross-sectional and a retrospective study.

https://arctichealth.org/en/permalink/ahliterature85874
Source
BMC Fam Pract. 2008;9:36
Publication Type
Article
Date
2008
Author
Carlfjord Siw
Lindberg Malou
Author Affiliation
Linköping University, Department of Medicine and Health Sciences, SE-581 83 Linköping, Sweden. siw.carlfjord@ihs.liu.se
Source
BMC Fam Pract. 2008;9:36
Date
2008
Language
English
Publication Type
Article
Keywords
Asthma - diagnosis - nursing - therapy
Cross-Sectional Studies
Humans
Medical Records
Models, Theoretical
Practice Guidelines as Topic
Primary Health Care - standards
Process Assessment (Health Care)
Pulmonary Disease, Chronic Obstructive - diagnosis - nursing - therapy
Quality Indicators, Health Care
Questionnaires
Retrospective Studies
Sweden
Time Factors
Abstract
BACKGROUND: In recent decades international and national guidelines have been formulated to ensure that patients suffering from specific diseases receive evidence-based care. In 2004 the National Swedish Board of Health and Welfare (SoS) published guidelines concerning the management of patients with asthma and COPD. The guidelines identify quality indicators that should be fulfilled. The aim of this study was to survey structure and process indicators, according to the asthma and COPD guidelines, in primary health care, and to identify correlations between structure and process quality results. METHODS: A cross-sectional study of existing structure by using a questionnaire, and a retrospective study of process quality based on a review of measures documented in asthma and COPD medical records. All 42 primary health care centres in the county council of Ostergötland, Sweden, were included. RESULTS: All centres showed high quality regarding structure, although there was a large difference in time reserved for Asthma and COPD Nurse Practice (ACNP). The difference in reserved time was reflected in process quality results. The time needed to reach the highest levels of spirometry and current smoking habit documentation was between 1 and 1 1/2 hours per week per 1000 patients registered at the centre. Less time resulted in fewer patients examined with spirometry, and fewer medical records with smoking habits documented. More time did not result in higher levels, but in more frequent contact with each patient. In the COPD group more time resulted in higher levels of pulse oximetry and weight registration. CONCLUSION: To provide asthma and COPD patients with high process quality in primary care according to national Swedish guidelines, at least one hour per week per 1000 patients registered at the primary health care centre should be reserved for ACNP.
PubMed ID
18564436 View in PubMed
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The asthma programme of Finland: an evaluation survey in primary health care.

https://arctichealth.org/en/permalink/ahliterature185016
Source
Int J Tuberc Lung Dis. 2003 Jun;7(6):592-8
Publication Type
Article
Date
Jun-2003
Author
M. Erhola
R. Mäkinen
K. Koskela
V. Bergman
T. Klaukka
M. Mäkelä
L. Tirkkonen
M. Kaila
Author Affiliation
Finnish Lung Health Association, Helsinki, Finland.
Source
Int J Tuberc Lung Dis. 2003 Jun;7(6):592-8
Date
Jun-2003
Language
English
Publication Type
Article
Keywords
Asthma - diagnosis - therapy
Clinical Competence - standards - statistics & numerical data
Finland
Health Care Surveys - standards - statistics & numerical data
Humans
Outcome Assessment (Health Care) - standards - statistics & numerical data
Physician's Practice Patterns - standards - statistics & numerical data
Physicians, Family - standards - statistics & numerical data
Practice Guidelines as Topic - standards
Primary Health Care - standards - statistics & numerical data
Program Evaluation - standards - statistics & numerical data
Quality of Health Care - standards - statistics & numerical data
Time Factors
Abstract
To evaluate the basic structures and processes of asthma care 6 years after the launch of the Finnish Asthma Programme. The evaluation will serve as the baseline for the implementation of the evidence-based guidelines for asthma published in 2000.
A descriptive type-2 evaluation (managerial monitoring of a policy implementation), based on operationalised statements of the Asthma Programme.
A co-ordinating doctor for asthma, usually a general practitioner (GP), was interviewed in 248 (91%) health centres; 83% of the health centres have at least one GP nominated as the local asthma co-ordinator and 94% have a nurse. Asthma education for the professionals had been organised in 71% of the health centres in the previous 2 years. First-line treatment consists of an inhaled corticosteroid. Guided self-management is used in 98% of the health centres, but its components were not clear to the doctors.
The basic structure of equipment and organisation for the diagnosis and treatment of asthma has been set up in the primary health care services.
PubMed ID
12797704 View in PubMed
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Delays in assessment of patients with rheumatoid arthritis: variations across Europe.

https://arctichealth.org/en/permalink/ahliterature132389
Source
Ann Rheum Dis. 2011 Oct;70(10):1822-5
Publication Type
Article
Date
Oct-2011
Author
Karim Raza
Rebecca Stack
Kanta Kumar
Andrew Filer
Jacqueline Detert
Hans Bastian
Gerd R Burmester
Prodromos Sidiropoulos
Eleni Kteniadaki
Argyro Repa
Tore Saxne
Carl Turesson
Herman Mann
Jiri Vencovsky
Anca Catrina
Aikaterini Chatzidionysiou
Aase Hensvold
Solbritt Rantapää-Dahlqvist
Alexa Binder
Klaus Machold
Brygida Kwiakowska
Adrian Ciurea
Giorgio Tamborrini
Diego Kyburz
Christopher D Buckley
Author Affiliation
Rheumatology Research Group, MRC Centre for Immune Regulation, Institute for Biomedical Research, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK. k.raza@bham.ac.uk
Source
Ann Rheum Dis. 2011 Oct;70(10):1822-5
Date
Oct-2011
Language
English
Publication Type
Article
Keywords
Adult
Aged
Arthritis, Rheumatoid - diagnosis
Delayed Diagnosis - statistics & numerical data
Europe
Female
Humans
Male
Middle Aged
Patient Acceptance of Health Care - statistics & numerical data
Primary Health Care - standards - statistics & numerical data
Referral and Consultation - standards - statistics & numerical data
Time Factors
Abstract
The first 3 months after symptom onset represent an important therapeutic window for rheumatoid arthritis (RA). This study investigates the extent and causes of delay in assessment of patients with RA in eight European countries.
Data on the following levels of delay were collected from 10 centres (Berlin, Birmingham, Heraklion, Lund, Prague, Stockholm, Umeå, Vienna, Warsaw and Zurich): (1) from onset of RA symptoms to request to see healthcare professional (HCP); (2) from request to see HCP to assessment by that HCP; (3) from initial assessment by HCP to referral to rheumatologist; and (4) from referral to rheumatologist to assessment by that rheumatologist.
Data were collected from 482 patients with RA. The median delay across the 10 centres from symptom onset to assessment by the rheumatologist was 24 weeks, with the percentage of patients seen within 12 weeks of symptom onset ranging from 8% to 42%. There were important differences in the levels underlying the total delays at individual centres.
This research highlights the contribution of patients, professionals and health systems to treatment delay for patients with RA in Europe. Although some centres have strengths in minimising certain types of delay, interventions are required in all centres to ensure timely treatment for patients.
PubMed ID
21821867 View in PubMed
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Determinants of adherence to recommendations for depressed elderly patients in primary care: a multi-methods study.

https://arctichealth.org/en/permalink/ahliterature263164
Source
Scand J Prim Health Care. 2014 Dec;32(4):170-9
Publication Type
Article
Date
Dec-2014
Author
Eivind Aakhus
Andrew D Oxman
Signe A Flottorp
Source
Scand J Prim Health Care. 2014 Dec;32(4):170-9
Date
Dec-2014
Language
English
Publication Type
Article
Keywords
Aged
Data Collection
Delivery of Health Care - standards
Depressive Disorder - therapy
Evaluation Studies as Topic
Female
Guideline Adherence
Health Priorities
Humans
Information Dissemination
Interviews as Topic
Male
Norway
Practice Guidelines as Topic
Primary Health Care - standards
Time Factors
Abstract
It is logical that tailoring implementation strategies to address identified determinants of adherence to clinical practice guidelines should improve adherence. This study aimed to identify and prioritize determinants of adherence to six recommendations for elderly patients with depression.
Group and individual interviews and a survey were conducted in Norway.
Individual and group interviews with healthcare professionals and patients, and a mailed survey of healthcare professionals. A generic checklist of determinants of practice was used to categorize suggested determinants.
Physicians and nurses from primary and specialist care, psychologists, researchers, and patients.
Determinants of adherence to recommendations for depressed elderly patients in primary care.
A total of 352 determinants were identified, of which 99 were prioritized. The most frequently identified factors had to do with dissemination of guidelines, general practitioners' time constraints, the low prioritization of elderly patients with depression, and the patients' or relatives' wish for medication. Approximately three-quarters of the determinants were from three of the seven domains in the generic checklist: individual healthcare professional factors, patient factors, and incentives and resources. The survey did not provide useful information due to a low response rate and a lack of responses to open-ended questions.
The list of prioritized determinants can inform the design of interventions to implement recommendations for elderly patients with depression. The importance of the determinants that were identified may vary across communities, practices. and patients. Interventions that address important determinants are necessary to improve practice.
Notes
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PubMed ID
25431340 View in PubMed
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The effect of specialist care within the first year on subsequent outcomes in 24,232 adults with new-onset diabetes mellitus: population-based cohort study.

https://arctichealth.org/en/permalink/ahliterature165145
Source
Qual Saf Health Care. 2007 Feb;16(1):6-11
Publication Type
Article
Date
Feb-2007
Author
F A McAlister
S R Majumdar
D T Eurich
J A Johnson
Author Affiliation
Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
Source
Qual Saf Health Care. 2007 Feb;16(1):6-11
Date
Feb-2007
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Ambulatory Care - standards
Cause of Death
Cohort Studies
Diabetes Mellitus, Type 2 - diagnosis - mortality - therapy
Endocrinology - standards
Female
Humans
Internal Medicine - standards
Male
Middle Aged
Primary Health Care - standards
Process Assessment (Health Care)
Proportional Hazards Models
Referral and Consultation
Risk assessment
Saskatchewan - epidemiology
Time Factors
Abstract
Although specialty care has been shown to improve short-term outcomes in patients hospitalised with acute medical conditions, its effect on patients with chronic conditions treated in the ambulatory care setting is less clear.
To examine whether specialty care (ie, consultative care provided by an endocrinologist or a general internist in concert with a patient's primary care doctor) within the first year of diagnosis is associated with improved outcomes after the first year for adults with diabetes mellitus treated as outpatients.
Population-based cohort study using linked administrative data.
The province of Saskatchewan, Canada.
24 232 adults newly diagnosed with diabetes mellitus between 1991 and 2001.
The primary outcome was all-cause mortality. Analyses used multivariate Cox proportional hazards models with time-dependent covariates, propensity scores and case mix variables (demographic, disease severity and comorbidities). In addition, restriction analyses examined the effect of specialist care in low-risk subgroups.
The median age of patients was 61 years, and over a mean follow-up of 4.9 years 2932 (12%) died. Patients receiving specialty care were younger, had a greater burden of comorbidities, and visited doctors more often before and after their diabetes diagnosis (all p
Notes
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Comment In: Qual Saf Health Care. 2007 Feb;16(1):3-517301193
PubMed ID
17301194 View in PubMed
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Impact of medical students' descriptive evaluations on long-term course development.

https://arctichealth.org/en/permalink/ahliterature82350
Source
BMC Med Educ. 2006;6:24
Publication Type
Article
Date
2006
Author
Wahlqvist Mats
Skott Annika
Björkelund Cecilia
Dahlgren Gösta
Lonka Kirsti
Mattsson Bengt
Author Affiliation
Department of Primary Health Care, The Sahlgrenska Academy, Göteborg University, Sweden. mats.wahlqvist@allmed.gu.se
Source
BMC Med Educ. 2006;6:24
Date
2006
Language
English
Publication Type
Article
Keywords
Adult
Attitude of Health Personnel
Clinical Competence
Curriculum - trends
Education, Medical, Undergraduate - trends
Faculty, Medical
Feedback
Female
Humans
Learning
Male
Medical History Taking - standards
Physical Examination - standards
Primary Health Care - standards
Program Evaluation - methods
Students, Medical - psychology
Sweden
Time Factors
Abstract
BACKGROUND: In medical education, feedback from students is helpful in course evaluation. However, the impact of medical students' feedback on long-term course development is seldom reported. In this project we studied the correspondence between medical students' descriptive evaluations and key features of course development over five years. METHODS: Qualitative content analysis was used. The context was consultation skills courses in the middle of the Göteborg undergraduate curriculum during five years. An analysis of 158 students' descriptive evaluations was brought together with an analysis of key features of course development; learning objectives, course records, protocols from teachers' evaluations and field notes. Credibility of data was tested by two colleagues and by presenting themes at seminars and conferences. Authors' experiences of evaluating the course over many years were also used. RESULTS: A corresponding pattern was found in students' descriptive evaluations and key features of course development, indicating the impact of students' open-ended feed-back. Support to facilitators and a curriculum reform also contributed. Students' descriptive feedback was both initiating and validating longitudinal course implementation. During five years, students' descriptive evaluations and teachers' course records were crucial sources in a learner-centred knowledge-building process of course development. CONCLUSION: Students' descriptive evaluations and course records can be seen as important instruments in developing both courses and students' learning. Continuity and endurance in the evaluation process must be emphasized for achieving relevant and useful results.
PubMed ID
16638146 View in PubMed
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Individually tailored treatment targeting motor behavior, cognition, and disability: 2 experimental single-case studies of patients with recurrent and persistent musculoskeletal pain in primary health care.

https://arctichealth.org/en/permalink/ahliterature70551
Source
Phys Ther. 2005 Oct;85(10):1061-77
Publication Type
Article
Date
Oct-2005
Author
Pernilla Asenlöf
Eva Denison
Per Lindberg
Author Affiliation
Department of Public Health and Caring Sciences/Section of Caring Sciences, Uppsala University, Uppsala Science Park, S-751 85 Uppsala, Sweden. pernilla.asenlof@pubcare.uu.se
Source
Phys Ther. 2005 Oct;85(10):1061-77
Date
Oct-2005
Language
English
Publication Type
Article
Keywords
Disability Evaluation
Female
Humans
Middle Aged
Motor Activity
Musculoskeletal Diseases - etiology - rehabilitation
Pain - etiology - rehabilitation
Pain Measurement - methods
Patient compliance
Patient Education - methods
Patient satisfaction
Physical Therapy Modalities - standards
Primary Health Care - standards
Questionnaires
Reproducibility of Results
Research Support, Non-U.S. Gov't
Sweden
Time Factors
Treatment Outcome
Abstract
BACKGROUND AND PURPOSE: This article introduces an individually tailored intervention targeting motor behavior, cognition, and disability in patients managed by physical therapists in primary health care. Effects on self-rated disability, pain intensity, and pain control are described. SUBJECTS: Two women with recurrent or persistent disabling musculoskeletal pain were selected. METHODS: Two experimental single-subject A(1)-B-C-A(2) studies with multiple baselines across situations were used. Principal outcome data were collected daily with patient-specific continuous measures for 3 weeks before intervention, continuously during intervention, and for 2 weeks during each of the 1-, 4-, 6-, and 12-month follow-up examinations. RESULTS: Disability and pain intensity decreased, and pain control increased in both subjects. The results were maintained at the follow-up examinations. DISCUSSION AND CONCLUSION: Positive outcomes of the intervention were reported from 2 subjects with recurrent and persistent disabling pain. Procedures for systematic tailoring of treatment to behavioral goals and individual patient characteristics are available as a result of the successful application. The results need to be replicated in future clinical controlled group studies.
PubMed ID
16180955 View in PubMed
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Medical home implementation and trends in diabetes quality measures for AN/AI primary care patients.

https://arctichealth.org/en/permalink/ahliterature268830
Source
Prim Care Diabetes. 2015 Apr;9(2):120-6
Publication Type
Article
Date
Apr-2015
Author
Julia J Smith
Janet M Johnston
Vanessa Y Hiratsuka
Denise A Dillard
Steve Tierney
David L Driscoll
Source
Prim Care Diabetes. 2015 Apr;9(2):120-6
Date
Apr-2015
Language
English
Publication Type
Article
Keywords
Alaska - epidemiology
Biomarkers - blood
Diabetes Mellitus, Type 2 - blood - diagnosis - ethnology - therapy
Emergency Service, Hospital - trends
Health Resources - standards - trends
Hemoglobin A, Glycosylated - metabolism
Humans
Incidence
Indians, North American
Length of Stay - trends
Patient Admission - trends
Patient-Centered Care - standards - trends
Predictive value of tests
Primary Health Care - standards - trends
Program Evaluation
Quality Improvement - standards - trends
Quality Indicators, Health Care - standards - trends
Time Factors
United States
United States Indian Health Service - standards - trends
Abstract
Patient-centered medical home (PCMH) principles including provider continuity, coordination of care, and advanced access align with healthcare needs of patients with Type II diabetes mellitus (DM-II). We investigate changes in trend for DM-II quality indicators after PCMH implementation at Southcentral Foundation, a tribal health organization in Alaska.
Monthly rates of DM-II incidence, hemoglobin A1c (HbA1c) measurements, and service utilization were calculated from electronic health records from 1996 to 2009. We performed interrupted time series analysis to estimate changes in trend.
Rates of new DM-II diagnoses were stable prior to (p=0.349) and increased after implementation (p
PubMed ID
25095763 View in PubMed
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14 records – page 1 of 2.