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  • 1. Bergman, K.
    et al.
    Hedén, L.
    Sundler, A. J.
    Östman, M.
    Hallgren, Jenny
    Unscheduled home consultations by registered nurses may reduce acute clinic visits2024In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 24, no 1Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: To effectively utilize available healthcare resources, integrated care models are recommended. According to such model's, registered nurses have the potential to increase patient access to health care services and alleviate organizational workload. Studies on acute home consultation assessments by registered nurses are sparse. The aim was to describe the reasons and actions for unscheduled same-day face-to-face registered nurse consultation at home offered to patients calling the national telephone helpline for healthcare in Sweden (SHD 1177), according to the integrated Collaborative Health Care model. METHODS: A descriptive cross-sectional study was designed. Data from registered nurses (n = 259) working within the Collaborative Health Care model, who performed unscheduled consultations at home (n = 615) using a data collection tool from 2017 to 2018 were collected. RESULTS: Among the 615 unscheduled home consultations performed by registered nurses, > 50% of the patients were managed at home as their health problems were not deemed as requiring a same-day referral to a clinic when assessed by the registered nurses. The most frequent health problems and reasons for contact were urinary tract problems, followed by medical and surgical conditions. Social factors, including living alone, impacted referral. Those living with a partner received care at home to a greater extent than those who lived alone. CONCLUSION: An integrated model for healthcare involving registered nurses direct assessment, action and accountability seems to be an efficient option for providing integrated care at home and reducing acute clinic visits. © 2024. The Author(s).

  • 2.
    Carlsson, Christina
    et al.
    Department of Oncology, Institute of Clinical Sciences Lund, Lund University, SE - 221 85 Lund, Sweden / Dept. of Research and Development, County Hospital, SE - 301 85 Halmstad, Sweden.
    Nilbert, Mef
    Department of Oncology, Institute of Clinical Sciences Lund, Lund University, SE - 221 85 Lund, Sweden.
    Nilsson, Kerstin
    University of Skövde, School of Life Sciences.
    Supporter or obstructer: experiences from contact person activities among Swedish women with breast cancer2005In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 5, p. 9-Article in journal (Refereed)
    Abstract [en]

    Background: Swedish patient associations for breast cancer patients (PABCPs) offer patients with breast cancer unlimited meetings with a breast cancer survivor, a contact person (CP). We applied the voluntary action perspective in this interview study with members of Swedish PABCPs in order to explore how women with breast cancer experienced their contact with a CP from a PABCP.

    Methods: Audio-taped narratives from 8 women were analysed using Reissman's monitoring and Gee's analysis structure.

    Results: Three themes appeared: 1. Shared experiences give new perspectives on having cancer, 2. Feelings of isolation are a part of the identity of the illness and 3. Relations with others enable self-help. However, the relationship with the CP is sensitive to timing, correct information and understanding.

    Conclusions: CPs act as sounding boards and should optimally have capacity for listening, gives support and act as partner in this conversation. On the other hand, CPs should be aware that their presence and limited general medical knowledge could at times disturb the patient's psychological recovery and strengthen feelings of isolation. Thus, PABCPs must be careful in selecting CPs and offer relevant educational activities related to the themes identified herein.

  • 3.
    Emmesjö, Lina
    et al.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). School of Health and Welfare, Jönköping University, Sweden.
    Gillsjö, Catharina
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). College of Nursing, University of Rhode Island, Kingston, RI, USA.
    Dahl Aslan, Anna K.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR).
    Hallgren, Jenny
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR).
    Patients’ and next of kin’s expectations and experiences of a mobile integrated care model with a home health care physician – a qualitative thematic study2023In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 23, no 1, article id 921Article in journal (Refereed)
    Abstract [en]

    Background

    The organizational principle of remaining at home has offset care from the hospital to the home of the older person where care from formal and informal caregivers is needed. Globally, formal care is often organized to handle singular and sporadic health problems, leading to the need for several health care providers. The need for an integrated care model was therefore recognized by health care authorities in one county in Sweden, who created a cross-organisational integrated care model to meet these challenges. The Mobile integrated care model with a home health care physician (MICM) is a collaboration between regional and municipal health care. Descriptions of patients’ and next of kin’s experiences of integrated care is however lacking, motivating exploration.

    Method

    A qualitative thematic study. Data collection was done before the patients met the MICM physician, and again six months later.

    Results

    The participants expected a sense of relief when admitted to MICM, and hoped for shared responsibility, building a personal contact and continuity but experienced lack of information about what MICM was. At the follow-up interview, participants described having an easier daily life. The increased access to the health care personnel (HCP) allowed participants to let go of responsibility, and created a sense of safety through the personalised contact and continuity. However, some felt ignored and that the personnel teamed up against the patient. The MICM structure was experienced as hierarchical, which influenced the possibility to participate. However, the home visits opened up the possibility for shared decision making.

    Conclusion

    Participants had an expectation of receiving safe and coherent health care, to share responsibility, personal contact and continuity. After six months, the participants expressed that MICM had provided an easier daily life. The direct access to HCP reduced their responsibility and they had created a personalised contact with the HCP and that the individual HCP mattered to them, which could be perceived as in line with the goals in the shift to local health care. The MICM was experienced as a hierarchic structure with impact on participation, indicating that all dimensions of person-centred care were not fulfilled.

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  • 4.
    Kjellström, Sofia
    et al.
    The Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Sweden.
    Sarre, Sophie
    Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King’s College London, UK.
    Masterson, Daniel
    The Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Sweden.
    The complexity of leadership in coproduction practices: a guiding framework based on a systematic literature review2024In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 24, no 1, article id 219Article, review/survey (Refereed)
    Abstract [en]

    Background: As coproduction in public services increases, understanding the role of leadership in this context is essential to the tasks of establishing relational partnerships and addressing power differentials among groups. The aims of this review are to explore models of coproduction leadership and the processes involved in leading coproduction as well as, based on that exploration, to develop a guiding framework for coproduction practices.

    Methods: A systematic review that synthesizes the evidence reported by 73 papers related to coproduction of health and welfare.

    Results: Despite the fact that models of coleadership and collective leadership exhibit a better fit with the relational character of coproduction, the majority of the articles included in this review employed a leader-centric underlying theory. The practice of coproduction leadership is a complex activity pertaining to interactions among people, encompassing nine essential practices: initiating, power-sharing, training, supporting, establishing trust, communicating, networking, orchestration, and implementation.

    Conclusions: This paper proposes a novel framework for coproduction leadership practices based on a systematic review of the literature and a set of reflective questions. This framework aims to help coproduction leaders and participants understand the complexity, diversity, and flexibility of coproduction leadership and to challenge and enhance their capacity to collaborate effectively.

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  • 5.
    Lautamatti, Emmi
    et al.
    Faculty of Medicine and Health Technology, Tampere University, Finland ; The Wellbeing Services County of Pirkanmaa, Tampere, Finland.
    Mattila, Kari J.
    Faculty of Medicine and Health Technology, Tampere University, Finland.
    Suominen, Sakari
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Public Health, University of Turku, Finland ; The Wellbeing Services County of Southwest Finland, Research Centre, Turku, Finland.
    Sillanmäki, Lauri
    The Wellbeing Services County of Southwest Finland, Research Centre, Turku, Finland ; University of Turku, Finland ; Department of Public Health, University of Helsinki, Finland.
    Sumanen, Markku
    Faculty of Medicine and Health Technology, Tampere University, Finland.
    A named General Practitioner (GP) is associated with an increase of hospital days in a single predictor analysis: a follow-up of 15 years2023In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 23, no 1, article id 1178Article in journal (Refereed)
    Abstract [en]

    Background: Continuity of care constitutes the basis of primary health care services and is associated with decreased hospitalization. In Finland, accessibility to primary care and increased use of hospital services are recognized challenges for the health care system. Objectives: The aim of the study was to determine whether having a named GP is associated with hospital service use. Methods: The data are part of the Health and Social Support study (HeSSup) based on a random Finnish working-age population sample. The cohort of the study comprised participants of postal surveys in 1998 (n = 25,898) who returned follow-up questionnaires both in 2003 and 2012 (n = 11,924). Background characteristics were inquired in the questionnaires, and hospitalization was derived from national registries (Hilmo-register). Results: A named GP was reported both in 2003 and 2012 only by 34.3% of the participants. The association between hospital days and a named GP was linearly rising and statistically significant in a single predictor model. The strongest associations with hospital use were with health-related factors, and the association with a named GP was no longer significant in multinomial analysis. Conclusion: A named GP is associated with an increased use of hospital days, but in a multinomial analysis the association disappeared. Health related factors showed the strongest association with hospital days. From the perspective of the on-going Finnish health and social services reform, continuity of care should be emphasized. 

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  • 6.
    Lautamatti, Emmi
    et al.
    Faculty of Medicine and Health Technology, Tampere University, Finland ; Centre for General Practice, Pirkanmaa Hospital District, Tampere, Finland.
    Mattila, Kari
    Faculty of Medicine and Health Technology, Tampere University, Finland.
    Suominen, Sakari
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Department of Public Health and Clinical Research Centre, University of Turku, Turku University Hospital, Finland.
    Sillanmäki, Lauri
    Turku University Hospital and University of Turku, Finland ; Department of Public Health, University of Helsinki, Finland.
    Sumanen, Markku
    Faculty of Medicine and Health Technology, Tampere University, Finland.
    A named GP increases self-reported access to health care services2022In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 22, no 1, article id 1262Article in journal (Refereed)
    Abstract [en]

    Background: Continuity of care strengthens health promotion and decreases mortality, although the mechanisms of these effects are still unclear. In recent decades, continuity of care and accessibility of health care services have both decreased in Finland. Objectives: The aim of the study was to investigate whether a named and assigned GP representing continuity of care is associated with the use of primary and hospital health care services and to create knowledge on the state of continuity of care in a changing health care system in Finland. Methods: The data are part of the Health and Social Support (HeSSup) mail survey based on a random Finnish working age population sample of 64,797 individuals drawn in 1998 and follow-up surveys in 2003 and 2012. The response rate in 1998 was 40% (n = 25,898). Continuity of care was derived from the 2003 and 2012 data sets, other variables from the 2012 survey (n = 11,924). The principal outcome variables were primary health care and hospital service use reported by participants. The association of the explanatory variables (gender, age, education, reported chronic diseases, health status, smoking, obesity, NYHA class of any functional limitation, depressive mood and continuity of care) with the outcome variables was analysed by binomial logistic regression analysis. Results: A named and assigned GP was independently and significantly associated with more frequent use of primary and hospital care in the adjusted logistic regression analysis (ORs 1.53 (95% CI 1.35–1.72) and 1.19 (95% CI 1.08–1.32), p < 0.001). Conclusion: A named GPs is associated with an increased use of primary care and hospital services. A named GP assures access to health care services especially to the chronically ill population. The results depict the state of continuity of care in Finland. All benefits of continuity of care are not enabled although it still assures treatment of population in the most vulnerable position. 

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  • 7.
    Nygren, Mikaela
    et al.
    Department of Medical and Health Sciences, Division of Health Care Analysis, Linköping University, Sweden.
    Roback, Kerstin
    Linköping University, Sweden.
    Öhrn, Annica
    Linköping University, Sweden.
    Rutberg, Hans
    Linköping University, Sweden.
    Rahmqvist, Mikael
    Linköping University, Sweden.
    Nilsen, Per
    Linköping University, Sweden.
    Factors influencing patient safety in Sweden: perceptions of patient safety officers in the county councils2013In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 13, no 1, article id 52Article in journal (Refereed)
    Abstract [en]

    Background: National, regional and local activities to improve patient safety in Sweden have increased over the last decade. There are high ambitions for improved patient safety in Sweden. This study surveyed health care professionals who held key positions in their county council’s patient safety work to investigate their perceptions of the conditions for this work, factors they believe have been most important in reaching the current level of patient safety and factors they believe would be most important for achieving improved patient safety in the future.

    Methods: The study population consisted of 218 health care professionals holding strategic positions in patient safety work in Swedish county councils. Using a questionnaire, the following topics were analysed in this study: profession/occupation; number of years involved in a designated task on patient safety issues; knowledge/overview of the county council’s patient safety work; ability to influence this work; conditions for this work; and the importance of various factors for current and future levels of patient safety.

    Results: The response rate to the questionnaire was 79%. The conditions that had the highest number of responses in complete agreement were “patients’ involvement is important for patient safety” and “patient safety work has good support from the county council’s management”. Factors that were considered most important for achieving the current level of patient safety were root cause and risk analyses, incident reporting and the Swedish Patient Safety Law. An organizational culture that encourages reporting and avoids blame was considered most important for improved patient safety in the future, closely followed by improved communication between health care practitioners and patients.

    Conclusion: Health care professionals with important positions in the Swedish county councils’ patient safety work believe that conditions for this work are somewhat constrained. They attribute the current levels of patient safety to a broad range of factors and believe that many different solutions can contribute to enhanced patient safety in the future, suggesting that this work must be multifactorial.

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  • 8.
    Ridelberg, Mikaela
    et al.
    Department of Medical and Health Sciences, Division of Health Care Analysis, Linköping University, Sweden.
    Roback, Kerstin
    Department of Medical and Health Sciences, Division of Health Care Analysis, Linköping University, Sweden.
    Nilsen, Per
    Department of Medical and Health Sciences, Division of Community Medicine, Linköping University, Sweden.
    Carlfjord, Siw
    Department of Medical and Health Sciences, Division of Community Medicine, Linköping University, Sweden.
    Patient safety work in Sweden: quantitative and qualitative analysis of annual patient safety reports2016In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 16, no 1, article id 98Article in journal (Refereed)
    Abstract [en]

    Background: There is widespread recognition of the problem of unsafe care and extensive efforts have been made over the last 15 years to improve patient safety. In Sweden, a new patient safety law obliges the 21 county councils to assemble a yearly patient safety report (PSR). The aim of this study was to describe the patient safety work carried out in Sweden by analysing the PSRs with regard to the structure, process and result elements reported, and to investigate the perceived usefulness of the PSRs as a tool to achieve improved patient safety.

    Methods: The study was based on two sources of data: patient safety reports obtained from county councils in Sweden published in 2014 and a survey of health care practitioners with strategic positions in patient safety work, acting as key informants for their county councils. Answers to open-ended questions were analysed using conventional content analysis.

    Results: A total of 14 structure elements, 31 process elements and 23 outcome elements were identified. The most frequently reported structure elements were groups devoted to working with antibiotics issues and electronic incident reporting systems. The PSRs were perceived to provide a structure for patient safety work, enhance the focus on patient safety and contribute to learning about patient safety.

    Conclusion: Patient safety work carried out in Sweden, as described in annual PSRs, features a wide range of structure, process and result elements. According to health care practitioners with strategic positions in the county councils' patient safety work, the PSRs are perceived as useful at various system levels.

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  • 9.
    Simonsen, Nina
    et al.
    Folkhälsan Research Center, Helsinki, Finland / Department of Public Health, University of Helsinki, Helsinki, Finland.
    Koponen, Anne M.
    Folkhälsan Research Center, Helsinki, Finland / Department of Public Health, University of Helsinki, Helsinki, Finland.
    Suominen, Sakari
    University of Skövde, School of Health and Education. University of Skövde, Health and Education. Department of Public Health, University of Turku, Turku, Finland.
    Patients' assessment of chronic illness care: a validation study among patients with type 2 diabetes in Finland2018In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 18, article id 412Article in journal (Refereed)
    Abstract [en]

    Background: To meet the challenges of the rising prevalence of chronic diseases, such as type 2 diabetes, new approaches to healthcare delivery have been initiated; among these the influential Chronic Care Model (CCM). Valid instruments are needed to evaluate the public health impact of these frameworks in different countries. The Patient Assessment of Chronic Illness Care (PACIC) is a 20-item quality of care measure that, from the perspective of the patient, measures the extent to which care is congruent with the CCM. The aim of this study was to evaluate the psychometric properties of the Finnish translation of the PACIC questionnaire, in terms of validity and reliability, in a large register-based sample of patients with type 2 diabetes.

    Method: The PACIC items were translated into Finnish in a standardized forward-backward procedure, followed by a cross-sectional survey among patients with type 2 diabetes (response rate 56%; n = 2866). We assessed the Finnish version of the PACIC scale for the following psychometric properties: content validity, internal consistency reliability, convergent and construct validity. We also present descriptive data on total scale as well as predetermined subscale levels.

    Results: The item-response on the PACIC scale was high with only small numbers of missing data (0.5-1.1%). Ceiling effects were low (0.3-5.3%) whereas floor effects were over 20% for two of the predetermined subscales (problem solving and follow-up/coordination). The total PACIC scale showed a reasonable distribution and excellent internal consistency (alpha 0.94) while the internal consistency of the subscales were at least acceptable (0.74-0.86). The principal component analysis identified a two-or three-factor solution instead of the proposed five-dimensional. In other respects, the PACIC scale showed the hypothesized relationships with quality of care and outcome measures, thus demonstrating convergent and construct validity.

    Conclusion: A Finnish version of the PACIC scale is now validated in the primary care setting among patients with type 2 diabetes. The findings suggest comparable psychometric properties of the Finnish scale as of the original English instrument and earlier translations, and reasonable levels of validity and reliability.

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  • 10.
    Snögren, Maria
    et al.
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR). Research School of Health and Welfare, Jönköping University, Sweden.
    Ek, Kristina
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR).
    Browall, Maria
    Department of Nursing, School of Health and Welfare, Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Sweden ; Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden.
    Eriksson, Irene
    University of Skövde, School of Health Sciences. University of Skövde, Digital Health Research (DHEAR).
    Lindmark, Ulrika
    Department of Health Sciences, Karlstad University, Sweden.
    Impacts on oral health attitude and knowledge after completing a digital training module among Swedish healthcare professionals working with older adults2024In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 24, no 1, article id 174Article in journal (Refereed)
    Abstract [en]

    Oral health care is essential, and digital training may influence healthcare professionals’ attitudes to and knowledge of oral health. The aim, therefore, was to evaluate the impact on attitudes to and knowledge of oral health after using a digital training module among Swedish healthcare professionals working within a municipality-run healthcare service for older adults. A secondary aim was to explore the healthcare professionals’ experiences of using the digital module. The study comprised a survey of healthcare professionals (registered nurses (RNs), assistant nurses, and care assistants) caring for older adults in a municipality in Sweden. Pre-post-tests were conducted to evaluate the outcomes for attitudes to and knowledge of oral health and of their experiences of completing the digital training module in oral health. These were statistically explored by comparing differences between the pre-post-tests, while the open-ended questions were analysed with qualitative content analysis. The findings of this study indicate that healthcare professionals had similar perceptions of their attitudes to and knowledge of oral health both before and after the digital training module in oral health. The study also indicates that healthcare professionals experienced that it is easier to perform practical oral health care after completing the digital training. The results also show that healthcare professionals value oral health knowledge and that the digital training module was easy to use and to disseminate knowledge throughout the municipality. The findings have implications for developing, implementing, and promoting healthcare professionals’ attitudes to and knowledge of oral health and in using a digital training module in combination with practical exercises in oral health in municipality health care.

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