Biomedical subjects

Rolf Wahlström

Publications and source records attributed to Rolf Wahlström.

9 recordsLinked to original sources

PubMed2006

Quality of interaction between primary health-care providers and patients with type 2 diabetes in Muscat, Oman: an observational study.

BACKGROUND: A good patient-physician interaction is particularly important in chronic diseases like diabetes. There are so far no published data regarding the interaction between the primary health-care providers and patients with type 2 diabetes in Oman, where diabetes is a major and growing health problem. This study aimed at exploring how health-care providers interact with patients with type 2 diabetes at primary health-care level in Muscat, Oman, focusing on the consultation environment, and some aspects of care and information. METHODS: Direct observations of 90 consultations between 23 doctors and 13 diabetes nurses concerned with diabetes management during their consultations with type 2 diabetes patients in six primary health-care centres in the Muscat region, using checklists developed from the National Diabetes Guidelines. Consultations were assessed as optimal if more than 75% of observed aspects were fulfilled and sub-optimal if less than 50% were fulfilled. RESULTS: Overall 52% of the doctors' consultations were not optimal. Some important aspects for a positive consultation environment were fulfilled in only about half of the doctors' consultations: ensuring privacy of consultation (49%), eye contact (49%), good attention (52%), encouraging asking questions (47%), and emphasizing on the patients' understanding of the provided information (52%). The doctors inquired about adverse effects of anti-diabetes drugs in less than 10% of consultations. The quality of the nurses' consultations was sub-optimal in about 75% of 85 consultations regarding aspects of consultation environment, care and information. CONCLUSION: The performance of the primary health-care doctors and diabetes nurses needs to be improved. The role of the diabetes nurses and the teamwork should be enhanced. We suggest a multidisciplinary team approach, training and education to the providers to upgrade their skills regarding communication and care. Barriers to compliance with the guidelines need to be further explored. Improving the work situation mainly for the diabetes nurses and further improvement in the organizational efficiency of diabetes services such as lowering the number of patients in diabetes clinic, are suggested.

Adult↗

PubMed2004

Swedish Council on Technology Assessment in Health Care (SBU). Chapter 7. Sickness absence and psychiatric disorders.

There is limited scientific evidence that women have a higher frequency and incidence of sickness absence due to psychiatric diagnoses. Because of conflicting findings, there is insufficient evidence on gender differences in the duration of sickness absence. Because of conflicting findings, there is also insufficient evidence on the association between age and sickness absence with psychiatric diagnoses. There is insufficient evidence on the association of sickness absence due to psychiatric diagnoses with work-related factors, factors related to family and social networks outside of the job, and psychosocial factors in childhood and adolescence since none of the individual factors were investigated in more than a single study. The results were conflicting (insufficient evidence) in five studies that investigated whether individuals with psychiatric disorders were at greater risk for sickness absence and disability pension, irrespective of the diagnosis on the sickness certificate. The four studies that used alcohol diagnoses to identify alcohol problems found increased sickness absence irrespective of the diagnosis on the certificate (expressed as more sick-leave days or an increased risk for prolonged sickness absence in individuals with alcohol problems). Furthermore, two of the studies found an increased risk for disability pension in women diagnosed with alcohol problems. There is insufficient evidence because of too few studies. The results are conflicting with regard to the association between high alcohol consumption and sickness absence, irrespective of the diagnosis on the certificate (insufficient evidence).

Absenteeism↗

PubMed2004

Swedish Council on Technology Assessment in Health Care (SBU). Chapter 11. Physicians' sick-listing practices.

Physicians' sick-listing practices have been studied to a very limited extent. There is limited scientific evidence that physicians perceive sick-listing duties to be difficult and problematic, regarding both the medical and the insurance-related aspects. There is limited scientific evidence also that quality is often deficient in the sickness certificates issued by physicians. This may affect case management at the local insurance office. There is insufficient scientific evidence to explain the differences in physicians' sick-listing patterns. The effects on patients are also insufficiently studied.

Demography↗

PubMed2004

Knowledge and perceptions of drug quality among drug sellers and consumers in Lao PDR.

In most developing countries, including the Lao People's Democratic Republic (PDR), high prevalence of low quality drugs has been reported. The aim of this study was to explore knowledge and perceptions regarding drug quality among drug sellers and consumers, in Savannakhet province, Lao PDR. Quantitative and qualitative methods were used. Fifty-nine drug sellers and 278 exit customers were interviewed. Eight focus group discussions with drug sellers and community members were conducted. There was inadequate scientific drug knowledge among drug sellers. Only a few customers were aware of the existence of low quality drugs. Only one drug seller knew what constitutes a good quality drug according to the given criteria, and only two drug sellers knew the correct temperature for drug storage. Forty-four per cent had correct knowledge on drug labelling and 73% could read the expiry date. Fifty-eight per cent stated that they bought some drugs from unauthorized sources. Both drug sellers and consumers also elaborated on a local definition of drug quality. They determined drug quality by its perceived efficacy in the sense that a drug is good if it takes the disease away. They also trusted the responsible authorities not to provide them with low quality drugs. A majority of the consumers (73%) did not worry about the quality of the drugs, their greatest problem being financial constraints. People living in urban districts had significantly more knowledge on aspects of drug quality than those living in rural and remote areas. The limitations in scientific knowledge among drug sellers and the low awareness among consumers may contribute to the continued existence of low quality drugs. Government interventions through training of drug sellers and drug information for lay people are suggested.

Adolescent↗

PubMed2003

Effectiveness of feedback for improving case management of malaria, diarrhoea and pneumonia--a randomized controlled trial at provincial hospitals in Lao PDR.

BACKGROUND: Standard Treatment Guidelines were introduced to all prescribers at provincial hospitals in Lao PDR and treatment indicators were developed within the National Drug Policy programme to monitor compliance. OBJECTIVES: To evaluate the effects of an educational intervention to improve treatment practices of malaria, diarrhoea and pneumonia. METHODS: Randomized controlled trial with prescribers at 24 departments at eight provincial hospitals, matched into four pairs. The three departments of internal medicine, paediatrics and out-patients in each pair were randomized into intervention or control group. The 6-month intervention was conducted by members of the Drug and Therapeutics Committees, and comprised monthly audit sessions in the form of outcome feedback using indicator scores on recorded treatment of malaria, diarrhoea and pneumonia. We measured treatment indicator scores 6 months after the end of the intervention compared with baseline. RESULTS: The aggregated mean scores for all diseases, and for malaria and diarrhoea, improved significantly. For pneumonia, improvement was seen in both the intervention and control groups. Record keeping was improved for all three diseases. For malaria, there were improvements in recording patients' history, and in frequency of microscope testing; for diarrhoea, regarding weight measurements, palpation of the fontanel for children under 2 years, and reduction of irrational use of anti-diarrhoeals and antibiotics; for pneumonia, in recording respiratory count, and reducing irrational use of anti-histamines and anti-cough medications. CONCLUSIONS: Audit-feedback systems to improve quality of care are feasible and effective also in hospital settings in low-income countries.

Case Management↗

PubMed2002

The value of clinical judgement analysis for improving the quality of doctors' prescribing decisions.

BACKGROUND: Many initiatives are taken to improve prescribing decisions. Educational strategies for doctors have been effective in at least 50% of cases. Some reflection on one's own performance seems to be a common feature of the most effective strategies. So far, such reflections have mainly focused on the observed outcomes of the doctors' decisions, i.e. on what doctors do in practice. Studies in other fields have shown that another form of feedback based on the analysis of judgements may be useful as well. OBJECTIVES: The objectives of the study were to discuss the principles underlying clinical judgement analysis, give examples of its use in the medical context, and discuss its potential for improving prescribing decisions. RESULTS: Clinical judgement analysis can look behind the outcome of a decision to the underlying decision process. Carefully constructed or selected case material is required for this analysis. Combining feedback on outcomes with feedback based on clinical judgement analysis offers doctors insight both in what they do, and why or when they do it. It may reveal determinants of decision making which are not available through unaided introspection. Interventions using this combination of feedback for improving doctors' prescribing behaviour have been (partly) successful in 4 cases and unsuccessful in one case. CONCLUSIONS: Clinical judgement analysis gives doctors a structured reflection on the decision-making policy, and can help them to improve their future decisions. It may be especially useful for groups of doctors who try to work towards a consensus policy. The approach is not very helpful when simple decision rules are appropriate.

Clinical Competence↗

PubMed2002

Upper respiratory tract infections in general practice: diagnosis, antibiotic prescribing, duration of symptoms and use of diagnostic tests.

A diagnosis/antibiotic prescribing study was performed in 5 counties in Sweden for 1 week in November 2000. As part of this study, the characteristics and clinical management of patients with upper respiratory tract infections (n = 2899) in primary care were analyzed. Almost half of the patients were aged < 15 y and one-fifth of the patients consulted out of hours. Of all patients seeking primary care for upper respiratory tract infections, 56.0% were prescribed an antibiotic. Almost all patients who were given the diagnoses streptococcal tonsillitis, acute otitis media or acute sinusitis were prescribed antibiotics, compared to 10% of patients with common cold or acute pharyngitis. The most frequently prescribed antibiotic was penicillin V (79.2%) and this was even more pronounced out of hours, when the diagnoses otitis media and streptococcal tonsillitis were more frequently used. In patients with common cold and acute pharyngitis, the percentage who received antibiotics increased with increasing length of symptoms and increasing CRP levels. In patients with acute pharyngitis or streptococcal tonsillitis, antibiotics were prescribed less frequently provided streptococcal tests were performed. The management of patients with upper respiratory tract infections in general practice seems to be in good agreement with current Swedish guidelines. However, the study indicates some areas for improvement. The diagnosis of acute sinusitis seems to have been overestimated and used only to justify antibiotic treatment.

Acute Disease↗

PubMed2002

Variations in asthma treatment in five European countries--judgement analysis of case simulations.

OBJECTIVE: The aim of this study was to explore and compare treatment decisions and the influence of specific patient characteristics on asthma management in five European countries, and to relate this to existing guidelines. METHODS: Using the technique of clinical judgement analysis, doctors in The Netherlands, Norway, Germany, Sweden and the Slovak Republic (40-100 doctors per country) were presented with sets of written simulated cases on asthma treatment. Patient characteristics were varied to determine their influence on the doctors' decisions. Decisions indicating over- and under-prescribing in relation to a gold standard derived from guidelines were also determined. RESULTS: Doctors in The Netherlands prescribed more oral steroid courses and fewer antibiotics than doctors in Norway and Sweden, whereas doctors in Germany and the Slovak Republic prescribed the least oral steroids and the most antibiotics. Partially, this variation could be explained by differences in the underlying propensity to prescribe, but differences in the use of patient characteristics also contributed to the variation. Norwegian doctors were most inclined to increase the maintenance treatment of inhaled corticosteroids, which could best be explained by their relatively high focus on the patient's peak expiratory flow value. Compared with the gold standard, there was 25-56% under-prescribing of oral steroids, and 21-45% over-prescribing of antibiotics. CONCLUSIONS: The variation in treatment of asthma patients between doctors in different countries may, in part, be attributed to variations in the underlying propensity to prescribe, and in part to different use of clinical patient characteristics. These findings can be used in tailoring educational programmes to improve treatment practices.

Adrenal Cortex Hormones↗

PubMed1997

Changing Primary Care Doctors' Conceptions - A Qualitative Approach to Evaluating an Intervention.

Objective: To describe conceptions of the management of hyperlipidaemia and assess changes in conceptions after an educational intervention.- Setting and subjects: Primary care in Sweden. Twenty doctors at community health centres.- Methods: Within an educational experiment evaluating the effects of 'group detailing' by community pharmacists at 67 health centres, a selected sample of doctors were interviewed on two occasions, one and a half year apart, regarding their views on atherosclerotic cardiovascular disease and hyperlipidaemia. Half of the doctors had, in between the interviews, participated in four educational group sessions, where information was presented and discussed regarding the national recommendations on the management of hyperlipidaemia. Applying a phenomenographic approach, the variation of conceptions was described regarding six domains: general attitude to cardiovascular disease, risk factors, prevention of ischaemic heart disease, role of blood lipids, treatment of hyperlipidaemia, and screening for hypercholesterolaemia.- Outcome measures: Descriptions of categories of conceptions and changes of conceptions to ones in line with the treatment guidelines for individual doctors and for the two groups of doctors.- Results: There was a variation of conceptions in all six domains in both groups of doctors. The doctors' conceptions in the intervention group changed significantly to ones in line with the treatment recommendations (p < 0.01), which was not the case in the control group. A significant number of doctors in the intervention group changed at least one of the six conceptions to ones in concordance with the recommendations (p = 0.011). Although doctors in the control group also changed conceptions, this change was not statistically significant.- Conclusions: The doctors' conceptions changed significantly after 'group detailing' on management of hyperlipidaemia. Qualitative changes of conceptions may be used as outcome measures when evaluating the impact of an information activity directed at health care professionals.

Journal Article↗