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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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Characteristics of health care organizations associated with learning and development: lessons from a pilot study.

https://arctichealth.org/en/permalink/ahliterature147787
Source
Qual Manag Health Care. 2009 Oct-Dec;18(4):285-94
Publication Type
Article
Author
Monica Nyström
Author Affiliation
Medical Management Centre, Department of Learning, Informatics, Management & Ethics, Karolinska Institutet, Stockholm, Sweden. monica.nystrom@ki.se
Source
Qual Manag Health Care. 2009 Oct-Dec;18(4):285-94
Language
English
Publication Type
Article
Keywords
Delivery of Health Care - standards
Humans
Interviews as Topic
Organizational Culture
Organizational Innovation
Pilot Projects
Primary Health Care - standards
Quality Indicators, Health Care
Sweden
Total Quality Management
Abstract
Characteristics of health care organizations associated with an ability to learn from experiences and to develop and manage change were explored in this study. Understanding of these characteristics is necessary to identify factors influencing success in learning from the past and achieving future health care quality objectives. A literature review of the quality improvement, strategic organizational development and change management, organizational learning, and microsystems fields identified 20 organizational characteristics, grouped under (a) organizational systems, (b) key actors, and (c) change management processes. Qualitative methods, using interviews, focus group reports, and archival records, were applied to find associations between identified characteristics and 6 Swedish health care units externally evaluated as delivering high-quality care. Strong support for a characteristic was defined as units having more than 4 sources describing the characteristic as an important success factor. Eighteen characteristics had strong support from at least 2 units. The strongest evidence was found for the following: (i) key actors have long-term commitment, provide support, and make sense of ambiguous situations; (ii) organizational systems encourage employee commitment, participation, and involvement; and (iii) change management processes are employed systematically. Based on the results, a new model of "characteristics associated with learning and development in health care organizations" is proposed.
PubMed ID
19851236 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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Did changing primary care delivery models change performance? A population based study using health administrative data.

https://arctichealth.org/en/permalink/ahliterature133982
Source
BMC Fam Pract. 2011;12:44
Publication Type
Article
Date
2011
Author
R Liisa Jaakkimainen
Jan Barnsley
Julie Klein-Geltink
Alexander Kopp
Richard H Glazier
Author Affiliation
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. liisa.jaakkimainen@ices.on.ca
Source
BMC Fam Pract. 2011;12:44
Date
2011
Language
English
Publication Type
Article
Keywords
Adult
Aged
Cross-Sectional Studies
Delivery of Health Care - standards
Female
Humans
Male
Middle Aged
Models, Theoretical
Ontario
Primary Health Care - standards
Quality of Health Care
Young Adult
Abstract
Primary care reform in Ontario, Canada started with the introduction of new enrollment models, the two largest of which are Family Health Networks (FHNs), a capitation-based model, and Family Health Groups (FHGs), a blended fee-for-service model. The purpose of this study was to evaluate differences in performance between FHNs and FHGs and to compare performance before and after physicians joined these new primary care groups.
This study used Ontario administrative claims data to compare performance measures in FHGs and FHNs. The study population included physicians who belonged to a FHN or FHG for at least two years. Patients were included in the analyses if they enrolled with a physician in the two years after the physician joined a FHN or FHG, and also if they saw the physician in a two year period prior to the physician joining a FHN or FHG. Performance was derived from the administrative data, and included measures of preventive screening for cancer (breast, cervical, colorectal) and chronic disease management (diabetes, heart failure, asthma).
Performance measures did not vary consistently between models. In some cases, performance approached current benchmarks (Pap smears, mammograms). In other cases it was improving in relation to previous measures (colorectal cancer screening). There were no changes in screening for cervical cancer or breast cancer after joining either a FHN or FHG. Colorectal cancer screening increased in both FHNs and FHGs. After enrolling in either a FHG or a FHN, prescribing performance measures for diabetes care improved. However, annual eye examinations decreased for younger people with diabetes after joining a FHG or FHN. There were no changes in performance measures for heart failure management or asthma care after enrolling in either a FHG or FHN.
Some improvements in preventive screening and diabetes management which were seen amongst people after they enrolled may be attributed to incentive payments offered to physicians within FHGs and FHNs. However, these primary care delivery models need to be compared with other delivery models and fee for service practices in order to describe more specifically what aspects of model delivery and incentives affect care.
Notes
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PubMed ID
21639883 View in PubMed
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District nurses' perceptions of osteoporosis management: a qualitative study.

https://arctichealth.org/en/permalink/ahliterature272307
Source
Osteoporos Int. 2015 Jul;26(7):1911-8
Publication Type
Article
Date
Jul-2015
Author
A. Claesson
E. Toth-Pal
P. Piispanen
H. Salminen
Source
Osteoporos Int. 2015 Jul;26(7):1911-8
Date
Jul-2015
Language
English
Publication Type
Article
Keywords
Accidental Falls - prevention & control
Attitude of Health Personnel
Bone Density Conservation Agents - adverse effects - therapeutic use
Clinical Competence
Clinical Nursing Research - methods
Community Health Services - standards
Delivery of Health Care - standards
Disease Management
Focus Groups
Humans
Interprofessional Relations
Nurses, Community Health - psychology
Osteoporosis - diagnosis - therapy
Osteoporotic Fractures - etiology - prevention & control
Patient Care Team - organization & administration
Primary Health Care - standards
Qualitative Research
Risk Assessment - methods - standards
Sweden
Abstract
Underdiagnosis of osteoporosis is common. This study investigated Swedish district nurses' perceptions of osteoporosis management. They perceived the condition as having low priority, and the consequences of this perception were insufficient awareness of the condition and perceptions of bone-specific medication as unsafe. They perceived, though, competency when working with fall prevention.
Undertreatment of patients with osteoporosis is common. Sweden's medical care strategy dictates prioritisation of various conditions; while guidelines exist, osteoporosis is not prioritised. The aim of this study was to investigate district nurses' perceptions of osteoporosis management within Sweden's primary health care system.
Four semi-structured focus group interviews were conducted with 13 female district nurses. The interviews were analysed using thematic analysis.
The overall theme was perceiving osteoporosis management as ambiguous. The themes were perceiving barriers and perceiving opportunities. These subthemes were linked to perceiving barriers: (i) insufficient procedures, lack of time and not aware of the condition; (ii) insufficient knowledge about diagnosis and about fracture risk assessment tools; (iii) low priority condition and unclear responsibility for osteoporosis management; and (iv) bone-specific medication was sometimes perceived to be unsafe. These subthemes were linked to perceiving opportunities: (i) professional competency when discussing fall prevention in home visit programs, (ii) willingness to learn more about osteoporosis management, (iii) collaboration with other professionals and (iv) willingness to identify individuals at high risk of fracture.
Osteoporosis was reported, by the district nurses, to be a low-priority condition with consequences being unawareness of the condition, insufficient knowledge about bone-specific medications, fracture risk assessment tools and procedures. These may be some of the explanations for the undertreatment of osteoporosis. At the same time, the district nurses described competency performing the home visits, which emerged as an optimal opportunity to discuss fall prevention and to introduce FRAX with the aim to identify individuals at high risk of fracture.
PubMed ID
25792490 View in PubMed
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Effect of a community oriented problem based learning curriculum on quality of primary care delivered by graduates: historical cohort comparison study.

https://arctichealth.org/en/permalink/ahliterature172328
Source
BMJ. 2005 Oct 29;331(7523):1002
Publication Type
Article
Date
Oct-29-2005
Author
Robyn Tamblyn
Michal Abrahamowicz
Dale Dauphinee
Nadyne Girard
Gillian Bartlett
Paul Grand'Maison
Carlos Brailovsky
Author Affiliation
McGill University, Montreal, QC, Canada H3A 1A3. robyn.tamblyn@mcgill.ca
Source
BMJ. 2005 Oct 29;331(7523):1002
Date
Oct-29-2005
Language
English
Publication Type
Article
Keywords
Aged
Clinical Competence - standards
Community Medicine - education
Continuity of Patient Care
Curriculum
Delivery of Health Care - standards
Education, Medical, Graduate - methods
Female
Humans
Mammography - utilization
Physician's Practice Patterns - standards
Primary Health Care - standards
Problem-Based Learning - methods
Quebec
Referral and Consultation - statistics & numerical data
Abstract
To assess whether the transition from a traditional curriculum to a community oriented problem based learning curriculum at Sherbrooke University is associated with the expected improvements in preventive care and continuity of care without a decline in diagnosis and management of disease.
Historical cohort comparison study.
Sherbrooke University and three traditional medical schools in Quebec, Canada.
751 doctors from four graduation cohorts (1988-91); three before the transition to community based problem based learning (n = 600) and one after the transition (n = 151).
Annual performance in preventive care (mammography screening rate), continuity of care, diagnosis (difference in prescribing rates for specific diseases and relief of symptoms), and management (prescribing rate for contraindicated drugs) assessed using provincial health databases for the first 4-7 years of practice.
After transition to a community oriented problem based learning curriculum, graduates of Sherbrooke University showed a statistically significant improvement in mammography screening rates (55 more women screened per 1000, 95% confidence interval 10.6 to 99.3) and continuity of care (3.3% more visits coordinated by the doctor, 0.9% to 5.8%) compared with graduates of a traditional medical curriculum. Indicators of diagnostic and management performance did not show the hypothesised decline. Sherbrooke graduates showed a significant fourfold increase in disease specific prescribing rates compared with prescribing for symptom relief after the transition.
Transition to a community oriented problem based learning curriculum was associated with significant improvements in preventive care and continuity of care and an improvement in indicators of diagnostic performance.
Notes
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Comment In: BMJ. 2005 Oct 29;331(7523):977-816254276
PubMed ID
16239292 View in PubMed
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21 records – page 1 of 3.