Patient-centered handovers between hospital and primary health care: an assessment of medical records.

Background: Handovers between hospital and primary healthcare possess a risk for patient care. It has been suggested that the exchange of a comprehensive medical record containing both medical and patient-centered aspects of information can support high quality handovers.

Objective: The objective of this study was to explore patient handovers between primary and secondary care by assessing the levels of patient-centeredness of medical records used for communication between care settings and by assessing continuity of patient care.

The key actor: a qualitative study of patient participation in the handover process in Europe.

Background: Patient safety experts have postulated that increasing patient participation in communications during patient handovers will improve the quality of patient transitions, and that this may reduce hospital readmissions. Choosing strategies that enhance patient safety through improved handovers requires better understanding of patient experiences and preferences for participation.

Objective: The aim of this paper is to explore the patients' experiences and perspectives related to the handovers between their primary care providers and the inpatient hospital.

Beliefs and experiences can influence patient participation in handover between primary and secondary care--a qualitative study of patient perspectives.

Background: Communication between healthcare settings at patient transfers between primary and secondary care, 'handover', is a critical and risky process for patients. Patients' views on their roles in these processes are often lacking despite the knowledge that patient participation contributes to enhanced safety and wellbeing.

Objective: This study aims to improve the knowledge and understanding of patients' perspectives about their participation in handover.

Predictors of repeated emergency department visits among persons treated for addiction.

Background/aims: To determine whether frequent emergency department (ED) users who enter specialized treatment programs for alcohol and/or drug problems have any characteristics that predict their future ED use.

Methods: Adult patients (783 alcohol users, 405 illicit drug users) were interviewed. Data from the medical database on utilization of ED and the emergency departments' specific units for addictive diseases (EDAD) 12 months before and 12 months after the interview were linked with patient characteristics in logistic regression models.

Cultural analysis as a perspective for gender-informed alcohol treatment research in a Swedish context.

Aim: An exploratory study to investigate the role of culture in women's drinking at a clinic for women with alcohol problems in a Swedish treatment context.

Methods: A content analysis of the case journal material of 20 consecutive female patients at the EWA clinic (Early treatment of Women with Alcohol addiction) in Stockholm, Sweden, was conducted using an original instrument informed by the field of cultural psychiatry and emerging from recurrent themes in the case journals.

Results: The patients perceived themselves as having a sub-group status.

Is information sharing between the emergency department and primary care useful to the care of frequent emergency department users?

Objectives: To assess whether easy access to medical information of the emergency department's (ED) frequent users would be useful to patient care in the ED and at primary healthcare centres (PHCs), and if resource utilization in the following year would be affected.

Methods: During a 6-month period, frequent users presenting to the ED of Karolinska University Hospital Huddinge, Sweden, were randomized by the electronic database system into an intervention (n=834) or control group (n=965), the definition being three or more visits in 12 months before the index visit. Printout case notes, from the intervention patients' last three visits, were made accessible to the ED physicians and optionally forwarded to the patient's PHC physician.

Length of outpatient addiction treatment and risk of rehospitalization.

Several studies, mainly from the U.S. and usually with selected male samples, show that aftercare is positively related to lower risk of re-addiction or re-treatment.

Waiting for orthopaedic surgery: factors associated with waiting times and patients' opinion.

Objective: To assess waiting times for three groups of orthopaedic patients in Sweden and to identify factors explaining variations in waiting time. Also examined were factors associated with patients' perceptions that waiting times were too long.

Design: Retrospective study.

Short-term treatment for alcohol-related problems: four-session guided self-change versus one session of advice--a randomized, controlled trial.

The aim of this study was to compare two short-term treatments for alcohol-related problems. The study was performed at an outpatient clinic for substance misuse, and subjects (65 men and 28 women) were recruited through advertisements in the local newspaper. The subjects were randomized to either a four-session guided self-change group or a one-session advice group.

Long-term trends in drinking habits among Swedish teenagers: National School Surveys 1971-1999.

The purpose of the study is to describe the long-term trends in drinking habits among Swedish students aged 15-16 years. Data were collected from 1971 to 1999, using self-administered questionnaires from nationally representative random cluster samples of school classes, totalling on average 6000 students per year. The highest proportion of alcohol consumers among both boys and girls, about 90%, was seen in the 1970s; this percentage decreased to about 80% in the 1980s and remained at that level through the 1990s.

Repeated use of the emergency department: qualitative study of the patient's perspective.

Objective: To explore what lies behind repeated emergency department (ED) use, from the patients' own perspectives.

Methods: Qualitative study based on in depth interviews with frequent users of the ED at the Huddinge University Hospital, Sweden. Ten adult patients having visited the ED 6-17 times in the previous 12 months were interviewed.

Frequent use of the hospital emergency department is indicative of high use of other health care services.

Study Objective: We sought to determine the proportion of emergency department patients who frequently use the ED and to compare their frequency of use of other health care services at non-ED sites.

Methods: A computerized patient database covering all ambulatory visits and hospital admissions at all care facilities in the county of Stockholm, Sweden, was used. Frequent ED patients were defined as those making 4 or more visits in a 12-month period.

[A survey of "heavy consumers" of emergency care services in Stockholm. Six per cent of the patients accounted for a quarter of emergency consultations].

A small subgroup of patients accounts for a substantial proportion of emergency room (ER) consultations. Of the 479,956 consultations at ER facilities at Stockholm hospitals in 1996, a quarter were accounted for by six per cent of the patients, a subgroup characterised by at least four ER consultations during the year. Some 1,500 patients consulted 12-233 times.

Alcohol consumption and stroke mortality. 20-year follow-up of 15,077 men and women.

Background And Purpose: Since stroke is a principal cause of death in elderly people, we analyzed the association between alcohol and stroke mortality in a cohort of 15,077 middle-aged and older men and women.

Methods: Data on alcohol habits were obtained from a questionnaire in 1967. The subsequent 20 years yielded 769 deaths from stroke, of which 574 were ischemic.

Quality comparisons between privately and publicly managed health care centres in a suburban area of Stockholm, Sweden.

As in many other countries, the health care system in Sweden is currently undergoing rapid changes. Within a framework of public financing, the delivery of health care is to an increasing extent being transferred to various entrepreneurs; private, public or cooperatives. A privately run, but publicly financed, health care centre was evaluated with regard to quality and costs.

The urgency of care need and patient satisfaction at a hospital emergency department.

Satisfaction with the treatment and service at a hospital emergency department (ED) in a Swedish suburban area was generally high according to a questionnaire carried out among 758 patients with a 75 percent response rate. Satisfaction with the ED, however, was significantly lower among patients who were triaged nonurgent than among the immediate and urgent triage patients. This was especially true for younger patients.

High consumers of health care in emergency units: how to improve their quality of care.

Patients with non-urgent complaints and/or who attend frequently account for a substantial portion of the visits to emergency units. These patients usually require other types of care than that provided by a highly specialized emergency department (ED). In this paper we describe the development of ED utilization in the catchment area of Huddinge University Hospital, and the attempts made to improve the quality of care for high consumers of ED care.

Referral of non-urgent cases from an emergency department: patient compliance, satisfaction and attitudes.

A phenomenon of great concern in several Western countries is the number of patients with non-urgent ailments attending the often overloaded hospital emergency departments (EDs). With a view to providing these patients with more appropriate care, they were, in a trial at Huddinge Hospital, Sweden, advised and directed to other care facilities by a specially trained nurse. A survey indicated that 84% of the patients who agreed to a referral followed the advice given.

Frequency of emergency department attendances as a predictor of mortality: nine-year follow-up of a population-based cohort.

Heavy users of the services of emergency departments (EDs) have in previous studies been found to have psychological, social, economic and other difficulties besides their more or less acute medical problems. In order to establish whether mortality is associated with high ED use, a nine-year follow-up study was conducted of a 10 per cent population sample (n = 17,000), selected from the catchment area of Huddinge Hospital, Sweden. ED visits were found to predict nine-year mortality in the cohort.