Biomedical subjects

Pekka Larivaara

Publications and source records attributed to Pekka Larivaara.

6 recordsLinked to original sources

PubMed2006

Patient-nurse-doctor interaction in general practice teleconsultations--a qualitative analysis.

We analysed the interaction in doctor-nurse-patient teleconsultations in primary care. A qualitative analysis was performed of 30 primary care teleconsultations in northeastern Finland. The male doctor was the same in all consultations. One of the trained nurses appeared in 27 consultations. The analysis followed the methodological principles of the grounded theory approach. The interaction in the doctor-nurse-patient triad was complex. The doctor had to concentrate on many things at the same time and undivided attention to the patient was not always possible. The nurse assumed an active role and was a facilitator of the interaction, an advocate for the patient, a secretary for the doctor and a mediator of the doctor's therapeutic influence. The patients frequently turned to the nurse for information. The role of interpersonal dynamics in telemedical encounters is important. Both the doctor and the nurse need to learn new skills to perform teleconsultations jointly.

Adult↗

PubMed2006

Nurses learning family-oriented interprofessional collaboration.

OBJECTIVES: A two-year family-oriented interprofessional education programme for professionals working in the field of primary services (e.g. health care, social welfare, school, day care) was started in the Province of Oulu, Finland in 2000. The programme aimed to provide the participants (n = 76) with skills to work with families in interprofessional collaboration. The study investigated the views and working methods of all the 14 nurses who participated in the course. STUDY DESIGN: Qualitative study employing the content analysis method. METHODS: The data were collected by using open-ended questions at the beginning and at the end of the education and analysed with the method of content analysis. RESULTS: Initially, the nurses were aware of the significance and the premises of family-oriented interprofessional collaboration, but seldom implemented them in practice. At the end of the programme, their working methods had changed from expert- to client- and family-oriented direction. They began to appreciate interprofessional collaboration and found that client- and family-oriented working methods supported families' own resources. CONCLUSIONS: In order to change the theoretical framework and practical working methods of the professionals a sufficiently long process of education is needed where the interprofessional collaboration is put into practice already during the education. Even though this education programme was developed and implemented for professionals working in the primary social and health care services in the Northern Finland, we believe that it is applicable to the teaching of interprofessional collaboration in different settings in different countries.

Education, Continuing↗

PubMed2004

Differences in brief interventions on excessive drinking and smoking by primary care physicians: qualitative study.

BACKGROUND: Brief interventions by primary care physicians have been shown to be effective in reducing both smoking and excessive drinking. However, physicians seem to target smoking more often than drinking. We aimed to explore this difference in health promotion practises for finding ways to improve alcohol interventions in primary health centres. METHODS: Qualitative semistructured interviews of 35 physicians in four health centres in Finland, and triangulation by audit of notes made by these doctors concerning alcohol drinking and smoking in medical records (n = 1200) of randomly selected 20-60 years old patients, who had visited their physician at least once in a 12-month study period. RESULTS: On the basis of the interviews, there were five main differences in preventive work between issues of alcohol use and smoking: recognition, perceived importance as a health risk factor, intervention tools available, stigmatising label, and expectations about the effectiveness of counselling. In 106 (8.8%) of medical records, there was a mention of smoking, and in 82 (6.8%) of alcohol use (P < 0,0001). Quantity of alcohol consumption was described obscurely. When one of the visits was made for hypertension, diabetes, dyspepsia, general health check or heart arrhythmias, smoking was recorded more often than alcohol consumption. CONCLUSIONS: Tobacco use was mentioned more often in medical records than alcohol drinking. Physicians were more comfortable in undertaking a preventive approach for smoking than for alcohol use. The factors contributing to this difference must be considered in any attempts to improve implementation of secondary prevention of alcohol misuse.

Adult↗

PubMed2004

Towards interprofessional family-oriented teamwork in primary services: the evaluation of an education programme.

A 2-year interprofessional family-oriented training programme for professionals working in the field of primary services (e.g. health care, social welfare, schools, day care) started in Oulu Province, Finland, in 2000. It aimed to provide the trainees with skills to work with families in interprofessional teams, to support them to cope better and to encourage them to develop new models for helping clients. Seventy-six trainees from 13 professions participated. This paper describes the structure, methods and the content of the programme and evaluates its success. Material was content analysed from participants' evaluations at the end of the programme and discussion during a focus group in which three trainees and three trainers participated. During the programme trainees' working methods moved from being detached experts towards client and family-orientation. Job satisfaction also improved. They began to appreciate interprofessional teamwork and found that client and family-oriented working methods supported families in using their own resources in solving problems. The study indicated that the sufficiently long process of education where the interprofessional collaboration has been put in practice already during the education is needed to change the theoretical framework and practical working methods of the trainees.

Education, Professional↗

PubMed2003

Factors influencing inquiry about patients' alcohol consumption by primary health care physicians: qualitative semi-structured interview study.

BACKGROUND: Early recognition of and intervention in risky alcohol consumption has been shown to be an effective way to reduce the harm. However, primary care physicians are still not screening for and intervening sufficiently in their patients' alcohol misuse. OBJECTIVE: The purpose of this study was to explore factors having an effect on primary health care physicians inquiring about patients' alcohol consumption. METHOD: A qualitative study of primary care physicians' experiences and views based on tape recorded semi-structured interviews was carried out on all physicians (n = 35) working at four health centres in Eastern Finland. RESULTS: Seven main categories were identified that either prevent or promote discussion about alcohol consumption: the sensitive nature of alcohol drinking; the reason for consultation; awareness of a patient's alcohol problem; patient factors; availability of intervention tools; expectations of effectiveness of interventions; and lack of time. CONCLUSIONS: There still exist many barriers to initiating discussions about alcohol in the consultation room. Changing the frame of reference of the concept of alcohol drinking from an addictive disease to a general lifestyle risk factor could overcome many of these barriers.

Adult↗

PubMed2002

Evaluation of a family-oriented continuing medical education course for general practitioners.

OBJECTIVE: To explore the long-term effects of a 2-year Family Systems Medicine course. Fifteen experienced GPs participated in the training programme. SETTING: Continuing Education Centre, University of Tampere, Department of Public Health Science and General Practice, University of Oulu, Finland. METHODS: The participants assessed the development of their professional skills on the Doherty-Baird scale and filled in 2 questionnaires. The material obtained from the application form and 2 questionnaires was analysed using the grounded theory method. RESULTS: The reasons for taking part in the course seemed to be the constant increase in the workload, problems caused by the demands for change and adaptation, stress and exhaustion. Furthermore, 10 health centres out of 15 had adopted the population-based practice, which requires different working methods compared to the old routines. Some trainees reported that their family-centred working methods improved during the course. A year after the end of the training, all of the GPs who had participated were using such methods in their daily practice. Half of the participants felt that they had also improved the functioning of their working group by making it more family-oriented. The significance of multi-professional collaboration was one of the most important insights during the course. CONCLUSION: The 2-year family-oriented training programme provided GPs with systemic thinking and with new skills, including the ability to work with families. The programme raised awareness of the need for multi-professional collaboration in the primary care settings.

Adult↗