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  • 1. Ejeby, Kersti
    et al.
    Savitskij, Ruslan
    Öst, Lars-Göran
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Ekbom, Anders
    Brandt, Lena
    Ramnerö, Jonas
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Åsberg, Marie
    Backlund, Lars G.
    Symptom reduction due to psychosocial interventions is not accompanied by a reduction in sick leave: Results from a randomized controlled trial in primary care2014In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 32, no 2, p. 67-72Article in journal (Refereed)
    Abstract [en]

    Objective. To investigate whether interventions that have positive effects on psychological symptoms and quality of life compared with usual care would also reduce days on sick leave. Design. A randomized controlled trial. Setting. A large primary health care centre in Stockholm, Sweden. Intervention. Patients with common mental disorders were recruited by their GPs and randomized into one of two group interventions that took place in addition to usual care. These group interventions were: (a) group cognitive behavioural therapy (CBT), and (b) group multimodal intervention (MMI). Both types of intervention had previously shown significant effects on quality of life, and MMI had also shown significant effects on psychological symptoms. Patients. Of the 245 randomized patients, 164 were employed and had taken sick leave periods of at least two weeks in length during the study period of two years. They comprised the study group. Main outcome measures. The odds, compared with usual care, for being sick-listed at different times relative to the date of randomization. Results. The mean number of days on sick leave increased steadily in the two years before randomization and decreased in the two years afterwards, showing the same pattern for all three groups. The CBT and MMI interventions did not show the expected lower odds for sick-listing compared with usual care during the two-year follow-up. Conclusion. Reduction in psychological symptoms and increased well-being did not seem to be enough to reduce sickness absence for patients with common mental problems in primary care. The possibility of adding workplace-oriented interventions is discussed.

  • 2.
    Eneroth, Mari
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Work and organizational psychology.
    Gustafsson Sendén, Marie
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Personality, Social and Developmental Psychology.
    Gustafsson, Karin Schenck
    Wall, Maja
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Work and organizational psychology.
    Fridner, Ann
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Work and organizational psychology. Karolinska Institute, Sweden.
    Threats or violence from patients was associated with turnover intention among foreign-born GPs - a comparison of four workplace factors associated with attitudes of wanting to quit one's job as a GP2017In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 35, no 2, p. 208-213Article in journal (Refereed)
    Abstract [en]

    Objective: General practitioners (GPs) are crucial in medical healthcare, but there is currently a shortage of GPs in Sweden and elsewhere. Recruitment of GPs from abroad is essential, but foreign-born physicians face difficulties at work that may be related to turnover intention, i.e. wanting to quit one's job. The study aims to explore the reasons to why foreign-born GPs may intend to quit their job. Design: Survey data were used to compare four work-related factors that can be associated with turnover intentions; patient-related stress, threats or violence from patients, control of work pace, and empowering leadership, among native-born and foreign-born GPs. These work-related factors were subsequently examined in relation to turnover intention among the foreign-born GPs by means of linear hierarchical regression analyses. The questionnaire consisted of items from the QPS Nordic and items constructed by the authors. Setting: A primary care setting in a central area of Sweden. Subjects: Native-born (n = 208) and foreign-born GPs (n = 73). Results: Turnover intention was more common among foreign-born GPs (19.2% compared with 14.9%), as was the experience of threats or violence from patients (22% compared with 3% of the native-born GPs). Threats or violence was also associated with increased turnover intention. Control of work pace and an empowering leadership was associated with reduced turnover intention.

  • 3. Jedenius, Erik
    et al.
    Johnell, Kristina
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Fastbom, Johan
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Strömqvist, Jan
    Winblad, Bengt
    Andreasen, Niels
    Dementia management programme in a community setting and the use of psychotropic drugs in the elderly population2011In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 29, no 3, p. 181-186Article in journal (Refereed)
    Abstract [en]

    Background and objective. The number of elderly persons in society is increasing, placing additional demands on the public health system. Extensive use of drugs is common in the elderly, and in patients with dementia this further increases their vulnerability. Since 1998 the municipality of Kalmar, Sweden, has worked with a dementia management programme that focuses on early intervention in order to identify the patient's help needs at an early stage. An important part of the programme aims at optimizing pharmacological treatment. The objective of the present study is to evaluate whether the dementia programme had a secondary effect on the use of psychotropic medication in the elderly population in general. Design and setting. A retrospective, drug utilization study analysing the use of selected drug categories by the elderly (75 years and older) in the Kalmar municipality compared with the whole of Sweden. Results and conclusions. The results suggest that the dementia programme contributed to an improvement in psychotropic drug use in the elderly as a secondary effect. Furthermore, the implementation of this programme did not require allocation of extra funding.

  • 4. Johansson-Pajala, Rose-Marie
    et al.
    Jorsäter Blomgren, Kerstin
    Bastholm-Rahmner, Pia
    Fastbom, Johan
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Martin, Lene
    Nurses in municipal care of the elderly act as pharmacovigilant intermediaries: a qualitative study of medication management2016In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 34, no 1, p. 37-45Article in journal (Refereed)
    Abstract [en]

    Objective: To explore registered nurses' experience of medication management in municipal care of the elderly in Sweden, with a focus on their pharmacovigilant activities. Design: A qualitative approach using focus-group discussions was chosen in order to provide in-depth information. Data were analysed by qualitative content analysis. Setting: Five focus groups in five different long-term care settings in two regions in Sweden. Subject: A total of 21 registered nurses (RNs), four men and 17 women, aged 27-65 years, with 4-34 years of nursing experience. Results: The findings reveal that RNs in municipal long-term care settings can be regarded as vigilant intermediaries in the patients' drug treatments. They continuously control the work of staff and physicians and mediate between them, and also compensate for existing shortcomings, both organizational and in the work of health care professionals. RNs depend on other health care professionals to be able to monitor drug treatments and ensure medication safety. They assume expanded responsibilities, sometimes exceeding their formal competence, and try to cover for deficiencies in competence, experience, accessibility, and responsibility-taking. Conclusion: The RNs play a central but also complex role as vigilant intermediaries in the medication monitoring process, including the issue of responsibility. Improving RNs' possibility to monitor their patients' drug treatments would enable them to prevent adverse drug events in their daily practice. New strategies are justified to facilitate RNs' pharmacovigilant activities.

  • 5. Ödesjö, H.
    et al.
    Anell, A.
    Boman, A.
    Fastbom, Johan
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Franzén, S.
    Thorn, J.
    Björck, S.
    Pay for performance associated with increased volume of medication reviews but not with less inappropriate use of medications among the elderly - an observational study2017In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 35, no 3, p. 271-278Article in journal (Refereed)
    Abstract [en]

    Objective: A pay for performance programme was introduced in 2009 by a Swedish county with 1.6 million inhabitants. A process measure with payment linked to coding for medication reviews among the elderly was adopted. We assessed the association with inappropriate medication for five years after baseline.

    Design and setting: Observational study that compared medication for elderly patients enrolled at primary care units that coded for a high or low volume of medication reviews.

    Patients: 144,222 individuals at 196 primary care centres, age 75 or older.

    Main outcome measures: Percentage of patients receiving inappropriate drugs or polypharmacy during five years at primary care units with various levels of reported medication reviews.

    Results: The proportion of patients with a registered medication review had increased from 3.2% to 44.1% after five years. The high-coding units performed better for most indicators but had already done so at baseline. Primary care units with the lowest payment for coding for medication reviews improved just as well in terms of inappropriate drugs as units with the highest payment - from 13.0 to 8.5%, compared to 11.6 to 7.4% and from 13.6 to 7.2% vs 11.8 to 6.5% for polypharmacy.

    Conclusions: Payment linked to coding for medication reviews was associated with an increase in the percentage of patients for whom a medication review had been registered. However, the impact of payment on quality improvement is uncertain, given that units with the lowest payment for medication reviews improved equally well as units with the highest payment.

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