The national strategy for treatment of chronic diseases - including MS - and changes in the Swedish welfare system, call for analyses of the use of, and patient satisfaction with, care in a long-term perspective. The aim was therefore to explore the use of care and the predictive value of personal factors, disease-specific factors and functioning on the use of care and to explore patient satisfaction with care in a 10-year perspective.
Information regarding personal factors, disease-specific factors, functioning and satisfaction with care was collected by home-visits; use of care was collected from the Stockholm County Council computerised register.
Data from 121 people with MS (PwMS) was collected. Primary care accounted for the majority of all care. Neurology and Rehabilitation Departments together accounted for two-thirds of all hospital outpatient care. Rehabilitation Departments accounted for one-third of the total number of inpatient days. Lower coping capacity, impaired manual dexterity and activity of daily living dependency at baseline, together with progress in MS disability predicted a higher use of care. Overall, patient satisfaction with care was stable over time.
The extensive use of care offers challenges to care coordination. Implementation of person-centred care could be a strategy to increase efficacy/outcome of care.
Persistent somatization patients put a serious burden on the health care system with multiple admissions, tests, surgeries, and medications. This study reports on factors relevant to the health-seeking behavior of somatizing patients and aspects of the health care system that facilitate their overutilization of health resources. Individuals (age 17-49 years) from the general population of two Danish municipalities with at least 10 general admissions during an 8-year period were studied comparing persistent somatizers with other high utilizers of medical admissions. Results are reported on geographical mobility, change in family doctors, route and distribution of admissions by time of day or week, discharges against medical advice, physical disease overlooked, and distribution of admissions to specialties. Although the health-seeking behavior of persistent somatizers may in part explain their overutilization of health care resources, such overutilization could be reduced and much suffering avoided if physicians displayed the same enthusiasm in diagnosing somatization as in ruling out organic pathology.
Comment In: Gen Hosp Psychiatry. 1993 Jul;15(4):208-108344509
The relationship between life satisfaction and alexithymia was studied in a sample of 229 patients as a part of a naturalistic follow-up study of depression in Finnish primary health care. The measures were the abbreviated Life Satisfaction Scale and the 20-item Toronto Alexithymia Scale. Depression was assessed by telephone with the short form of the Composite International Diagnostic Interview. Of all subjects, 19.2% were alexithymic, and 9.2% were depressed. Alexithymia was negatively associated with life satisfaction even when depression and other confounding factors were controlled for. Alexithymia is a risk factor for life dissatisfaction in primary-care patients.
Information on arthritis and other musculoskeletal disorders among Aboriginal people is sparse. Survey data show that arthritis and rheumatism are among the most commonly reported chronic conditions and their prevalence is higher than among non-Aboriginal people.
To describe the burden of arthritis among Aboriginal people in northern Canada and demonstrate the public health significance and social impact of the disease.
Using cross-sectional data from more than 29 000 Aboriginal people aged 15 years and over who participated in the Aboriginal Peoples Survey 2006, we assessed regional differences in the prevalence of arthritis and its association with other risk factors, co-morbidity and health care use.
The prevalence of arthritis in the three northern territories ("North") is 12.7% compared to 20.1% in the provinces ("South") and is higher among females than males in both the North and South. The prevalence among Inuit is lower than among other Aboriginal groups. Individuals with arthritis are more likely to smoke, be obese, have concurrent chronic diseases, and are less likely to be employed. Aboriginal people with arthritis utilized the health care system more often than those without the disease.
Aboriginal-specific findings on arthritis and other chronic diseases as well as recognition of regional differences between North and South will enhance program planning and help identify new priorities in health promotion.
Researchers in health care often use ecological data from population aggregates of different sizes. This paper deals with a fundamental methodological issue relating to the use of such data. This study investigates the question of whether, in doing analyses involving different areas, the estimating equations should be weighted by the populations of those areas. It is argued that the correct answer to that question turns on some deep epistemological issues that have been little considered in the public health literature.
To illustrate the issue, an example is presented that estimates entitlements to primary physician visits in Manitoba, Canada based on age/gender and socioeconomic status using both population weighted and unweighted regression analyses.
The entire population of the province furnish the data. Primary care visits to physicians based on administrative data, demographics and a measure of socioeconomic status (SERI), based on census data, constitute the measures.
Significant differences between weighted and unweighted analyses are shown to emerge, with the weighted analyses biasing entitlements towards the more populous and advantaged population.
The authors endorse the position that, in certain problems, data analyses involving population aggregates unweighted by population size are more appropriate and normatively justifiable than are analyses weighted by population. In particular, when the aggregated units make sense, theoretically, as units, it is more appropriate to carry out the analyses without weighting by the size of the units. Unweighted analyses yield more valid estimations.
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Mental stress is common in the general population. Mounting evidence suggests that mental stress is associated with multimorbidity, suboptimal care and increased mortality. Delivering healthcare in a biopsychosocial context is key for general practitioners (GPs), but it remains unclear how persons with high levels of perceived stress are managed in primary care. We aimed to describe the association between perceived stress and primary care services by focusing on mental health-related activities and markers of elective/acute care while accounting for mental-physical multimorbidity.
Population-based cohort study.
Primary healthcare in Denmark.
118?410 participants from the Danish National Health Survey 2010 followed for 1?year. Information on perceived stress and lifestyle was obtained from a survey questionnaire. Information on multimorbidity was obtained from health registers.
General daytime consultations, out-of-hours services, mental health-related services and chronic care services in primary care obtained from health registers.
Perceived stress levels were associated with primary care activity in a dose-response relation when adjusted for underlying conditions, lifestyle and socioeconomic factors. In the highest stress quintile, 6.8% attended GP talk therapy (highest vs lowest quintile, adjusted incidence rate ratios (IRR): 4.96, 95%?CI 4.20 to 5.86), 3.3% consulted a psychologist (IRR: 6.49, 95%?CI 4.90 to 8.58), 21.5% redeemed an antidepressant prescription (IRR: 4.62, 95%?CI 4.03 to 5.31), 23.8% attended annual chronic care consultations (IRR: 1.22, 95%?CI 1.16 to 1.29) and 26.1% used out-of-hours services (IRR: 1.47, 95%?CI 1.51 to 1.68). For those with multimorbidity, stress was associated with more out-of-hours services, but not with more chronic care services.
Persons with high stress levels generally had higher use of primary healthcare, 4-6 times higher use of mental health-related services (most often in the form of psychotropic drug prescriptions), but less timely use of chronic care services.
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The objective of this study was to evaluate the efficacy of an Asthma Nurse Practice (ANP) in primary health care. A 12-month (September 1994-August 1995) open, prospective intervention study with pre- and post-test comparisons was performed on patients with asthma treated at a primary care centre in Sweden. Sixty-three patients with mild or moderate asthma participated and medication, structured follow-up and education in self-management at an ANP were assessed over a 12-month period. The main outcome measures assessed were pulmonary function, eosinophil cationic protein (ECP) in serum, respiratory symptoms, patient knowledge of asthma and emergency visits. ANP in primary health care increased patient knowledge of asthma and medication. The number of patients with nocturnal symptoms decreased significantly. Pulmonary function was improved: vital capacity (VC) 98-106, forced expiratory volume in 1 sec (FEV1) 93-100 and peak expiratory flow (PEF) 98-115% of predicted (P
AIMS AND OBJECTIVES. The aim of this study was to describe characteristics in burn injuries in children (zero to six years old), consulting primary care and hospital-based care in Malmö, Sweden. Burn-injured children consulting the University Hospital or the 21 Health Centres, during year 1998 and year 2002, were included. BACKGROUND. Epidemiological studies of burns in children have mostly been hospital-based and the cases that never reached the hospital have been excluded. DESIGN. The study had a retroperspective design with data collected from medical records. METHODS. Chi-squared test was used to analyse differences in nominal data and cross tables were used to analyse the proportions between the characteristics of the injuries and sex, age and nationality. RESULTS. The burn-injured children were 148 and 80% of those were scalds, caused by hot liquid (71%) or hot food (29%). The greatest number was boys between one and two years old. Children to foreign born parents were more frequently affected and the extent of the injuries often larger. Almost all the accidents (96%) occurred in home environment, while a family member was next to the child. The Health Centres received more often children affected on hand/arm and by causes like hot food than the University Hospital. CONCLUSIONS. Our data demonstrate the importance of developing a programme for the prevention of paediatric scalds with education of family members to be aware of the danger. With present study the knowledge about the occurrence of injuries in scald accidents in children has become deeper. This knowledge may contribute to more individual adept child accident prevention programme, to use in the child health care.
To investigate how cancer patients in Norway use primary care out-of-hours (OOH) services and describe different contact types and procedures.
A retrospective cross-sectional registry study using a billing registry data source.
Norwegian primary care OOH services in 2014.
All patients' contacts in OOH services in 2014. Cancer patients were identified by ICPC-2 diagnosis.
Frequency of cancer patients' contacts with OOH services, contact types, diagnoses, procedures, and socio-demographic characteristics.
In total, 5752 cancer patients had 20,220 contacts (1% of all) in OOH services. Half of the contacts were cancer related. Cancer in the digestive (22.9%) and respiratory (18.0%) systems were most frequent; and infection/fever (21.8%) and pain (13.6%) most frequent additional diagnoses. A total of 4170 patients had at least one cancer-related direct contact; of these, 64.5% had only one contact during the year. Cancer patients had more home visits and more physicians' contact with municipal nursing services than other patients, but fewer consultations (p?
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OBJECTIVES: To review the care by general practitioners (GPs), district nurses and assistant nurses of patients receiving home nursing. DESIGN: Retrospective data from questionnaires, records and official statistics. Statistical comparisons. SETTING: Primary health care from October 1995 to October 1996. SUBJECTS: One-third (158) of all patients receiving home nursing in a suburban area were sampled; 73% (116) participated. All patients of comparable age in one practice served as a control group. MAIN OUTCOME MEASURES: Number of and reasons for visits and other contacts. Nature of care. Relation between patient problems and care given. RESULTS: Most patients were seen by the nurses two to five times a month. They met their GPs less often than other patients. More measures were undertaken without direct contact between GP and patient. The most common measures concerned medication and the assessment of symptoms. Patients with cognitive problems seemed to get less active GP care. CONCLUSION: GPs played an active role in the care of patients receiving home nursing even though they seldom met them. Many patients were regularly assessed by the nurses, which might have diminished the need for doctor visits. The care of patients with cognitive problems needs further study.