Primary care patients with mild or stable chronic obstructive pulmonary disease need more support in disease management: a secondary analysis of a cluster randomized controlled trial.

Objective: Patient education based on the patient's individual needs and circumstances is known to be associated with positive changes in clinical outcomes in chronic obstructive pulmonary disease (COPD). We aimed to assess the levels of patients' subjective needs for information about COPD before and after their general practitioners had taken part in a COPD education.

Design: A secondary analysis of a cluster randomized controlled trial.

Patient outcomes following GPs' educations about COPD: a cluster randomized controlled trial.

This study aimed to compare patient outcomes following case method learning and traditional lectures as methods for continuing medical education (CME) about chronic obstructive pulmonary disease (COPD) for general practitioners (GPs) in Sweden. In a pragmatic cluster randomized controlled trial, COPD patients (n = 425; case method group n = 209, traditional lectures group n = 216) from 24 primary health care centers replied to questionnaires prior to and 18 months after a 2 × 2-h CME was given to GPs (n = 255). We measured changes in the scores of the Clinical COPD Questionnaire (CCQ), symptoms, needs for disease information, exacerbations, smoking, and use of pulmonary rehabilitation.

A Swedish primary healthcare prevention programme focusing on promotion of physical activity and a healthy lifestyle reduced cardiovascular events and mortality: 22-year follow-up of 5761 study participants and a reference group.

Objective: To evaluate long-term risk of first cardiovascular (CV) events, CV deaths and all-cause deaths in community-dwelling participants of a cardiovascular disease (CVD) prevention programme delivered in a primary care setting.

Methods: Individuals who visited a primary healthcare service in Sollentuna (Sweden) and agreed to participate in the programme between 1988 and 1993 were followed. They had at least one CV risk factor but no prior myocardial infarction and received support to increase physical activity using the programme Physical Activity on Prescription and to adopt health-promoting behaviours including cooking classes, weight reduction, smoking cessation and stress management.

COPD patients need more information about self-management: a cross-sectional study in Swedish primary care.

In Sweden, patients with chronic conditions, such as chronic obstructive pulmonary disease (COPD), often receive education at specialized nurse-led clinics at primary health care centers (PHCCs). Identifying patients' needs for information about COPD is the key to individualized care. This study aimed to assess self-reported needs for information about COPD in primary care patients with either moderate (GOLD 2) or severe (GOLD 3) COPD and identify patient characteristics and exacerbation patterns associated with the findings.

Feasibility of referral to a therapist for assessment of psychiatric problems in primary care - an interview study.

Background: Depression and anxiety disorders are common in primary care. Comorbidities are frequent, and the diagnoses can be difficult. The Mini-International Neuropsychiatric Interview (MINI) can be a support in the clinical examination of patients with complex problems.

Accessing and sharing health information for post-discharge stroke care through a national health information exchange platform - a case study.

Background: Patients and citizens need access to their health information to get a retrospective as well as a prospective view on their care and rehabilitation processes. However, patients' health information is stored in several health information systems and interoperability problems often hamper accessibility. In Sweden a national health information exchange (HIE) platform has been developed that enables information exchange between different health information systems.

Influence of contextual factors on quality of primary care in children with asthma.

Objective: Asthma is a common chronic disease among children, quality assurance is thus important. Adherence to pre-specified quality indicators of practice guidelines could be used to assess the quality of asthma care. The aim was to estimate which contextual factors that had an influence on the primary health care centres (PHCs) adherence to the quality indicators as stated in the practice guidelines.

Effectiveness of traditional lectures and case methods in Swedish general practitioners' continuing medical education about COPD: a cluster randomised controlled trial.

Objectives: To study the effects of continuing medical education (CME) about chronic obstructive pulmonary disease (COPD) for general practitioners (GPs) by comparing two commonly used CME methods with each other and no CME (reference group).

Design: A pragmatic cluster randomised controlled trial with primary healthcare centres (PHCCs) as units of randomisation.

Setting, Participants And Interventions: 24 PHCCs in Stockholm County, Sweden, were randomised into two CME intervention arms: case method learning (CM) (n=12) and traditional lectures (TL) (n=12).

The Mini-International Neuropsychiatric Interview is useful and well accepted as part of the clinical assessment for depression and anxiety in primary care: a mixed-methods study.

Background: Psychiatric complaints are common among primary care patients, with depression and anxiety being the most frequent. Diagnosis of anxiety and depression can be difficult, potentially leading to over- as well as under-diagnosis. The diagnostic process can be facilitated by incorporating structured interviews as part of the assessment.

COPD management by Swedish general practitioners - baseline results of the PRIMAIR study.

Background: Chronic obstructive pulmonary disease (COPD) is a common cause of suffering and death. Evidence-based management of COPD by general practitioners (GPs) is crucial for decreasing the impact of the disease. Efficient strategies include early diagnosis, smoking cessation and multimodal treatment.

Case Method in COPD education for primary care physicians: study protocol for a cluster randomised controlled trial.

Background: Chronic obstructive pulmonary disease (COPD) is a common cause of morbidity and mortality worldwide. It is often undiagnosed and insufficiently managed. Effective forms of continuing medical education (CME) for primary care physicians (PCPs) are necessary to ensure the implementation of guidelines in clinical practice and, thus, improve patients' health.

IntegrIT - Towards Utilizing the Swedish National Health Information Exchange Platform for Clinical Research.

This paper describes how the Swedish national Health Information Exchange platform can be used to facilitate clinical research in the future. Different e-services for different user groups are being developed using a user-centered design approach. The main user groups are study participants, clinical researchers and healthcare professionals.

Post-discharge stroke patients' information needs as input to proposing patient-centred eHealth services.

Background: Despite the potential of eHealth services to revolutionize the way healthcare and prevention is provided many applications developed for patients fail to deliver their promise. Therefore, the aim of this study is to use patient journey mapping to explore post-discharge stroke patients' information needs to propose eHealth services that meet their needs throughout their care and rehabilitation processes.

Methods: Three focus groups with younger (<65 years) and older (> = 65 years) stroke patients were performed.

Time pressured deprioritization of COPD in primary care: a qualitative study.

Objective: To identify factors that hinder discussions regarding chronic obstructive pulmonary disease (COPD) between primary care physicians (PCPs) and their patients in Sweden.

Setting: Primary health care centres (PHCCs) in Stockholm, Sweden.

Subjects: A total of 59 PCPs.

Time Trends in Incidence and Mortality of Acute Myocardial Infarction, and All-Cause Mortality following a Cardiovascular Prevention Program in Sweden.

Background: In 1988, a cardiovascular prevention program which combined an individual and a population-based strategy was launched within primary health-care in Sollentuna, a municipality in Stockholm County. The aim of this study was to investigate time trends in the incidence of and mortality from acute myocardial infarction and all-cause mortality in Sollentuna compared with the rest of Stockholm County during a period of two decades following the implementation of a cardiovascular prevention program.

Materials And Methods: The average population in Sollentuna was 56,589 (49% men) and in Stockholm County (Sollentuna included) 1,795,504 (49% men) during the study period of 1987-2010.

Collaborative interaction points in post-discharge stroke care.

Introduction: Lack of appropriate electronic tools for supporting patient involvement and collaboration with care professionals is a problem in health care.

Methods: Care and rehabilitation processes of post-discharge stroke patients were analysed using the concept of interaction points where patients, next-of-kin and care professionals interact and exchange information. Thirteen interviews with care professionals and five non-participatory observations were performed.

Improving treatment of depression in primary health care: a case study of obstacles to perform a clinical trial designed to implement practice guidelines.

Aim: The aim of this study is to investigate factors contributing to the failure of a randomized clinical trial designed to implement and test clinical practice guidelines for the treatment of depression in primary health care (PHC).

Background: Although the occurrence of depression is increasing globally, many patients with depression do not receive optimal treatment. Clinical practice guidelines for the treatment of depression, which aim to establish evidence-based clinical practice in health care, are often underused and in need of operationalization in and adaptation to clinical praxis.

Clinical cues for detection of people with undiscovered depression in primary health care: a case-control study.

Aim: To identify clinical cues indicative of depression in medical records of cases in primary care with undetected depression.

Background: Depressive disorders are common; the lifetime risk for men and women is 27% and 45%, respectively. Despite effective treatment methods such as antidepressants and cognitive behavioural therapy, depression often remains undiscovered in primary care, with great implications both on the individual and societal level.

Adherence to national guidelines for children with asthma at primary health centres in Sweden: potential for improvement.

Background: Although asthma is the most common chronic paediatric disease in Western Europe, the extent of adherence to guidelines for primary care management of paediatric asthma remains unclear.

Aims: To evaluate adherence to national guidelines for primary care management of children with asthma.

Methods: This survey involved 18 primary healthcare centres in Stockholm, Sweden.

Usage, risk, and benefit of weight-loss drugs in primary care.

Purpose. To investigate the use of the weight-loss drugs rimonabant, sibutramine, and orlistat in primary care and to characterize the patients receiving the drugs. Methods.

A new approach for goal-oriented analysis of healthcare processes.

The development of efficient e-services for patient-centered healthcare requires insight into concrete problems in administrative and clinical work processes as well as an understanding of the strategic goals that should guide these healthcare processes. However, considering both concrete process related problems and high-level strategic goals during process analysis and solution design can be problematic. To address this, we propose a structured approach for analyzing both high- and low-level goals in a healthcare process and relating these to identified problems.

Primary prevention of first-ever stroke in primary health care: a clinical practice study based on medical register data in sweden.

Background. The aim of this study was to investigate whether established risk factors for stroke in patients admitted to health care for first-ever stroke had been detected and treated in primary health care. Methods.