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  • 1.
    Wiitavaara, Birgitta
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Fahlström, Martin
    Institutionen för klinisk vetenskap, Umeå universitet.
    Djupsjöbacka, Mats
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Prevalence, diagnostics, and management of musculoskeletal disorders in primary health care in Sweden: an investigation of 2000 randomly selected patient records2017In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 23, no 2, p. 325-332Article in journal (Refereed)
    Abstract [en]

    Background. To improve the care of patients suffering from musculoskeletal disorders (MSD) further knowledge regarding the prevalence, diagnostics and management of different MSD in primary care is required. Thus the aims of this study were: -to investigate the prevalence of patients seeking care due to different MSD at primary health care centres (PHCs); -to chart different factors as symptoms, diagnosis, and actions prescribed for patients that visited the PHCs due to MSD; and -to make comparisons regarding differences due to gender, age, and rural or urban PHC.

    Methods. 2000 patient records for patients in working age were randomly selected equally distributed on one rural and one urban PHC. A 3-year period was reviewed retrospectively. For all patient records age, sex, occupation, occupational activity, date of visit, if it was a new or re-visit, cause to the visit, and diagnosis related to the visit were registered. For visits due to MSD the location of the patients symptoms, which symptoms were described in the patient record, the type of those symptoms, which actions were prescribed to resolve the patients problems, and also sickleave prior to and after the visit, were registered. Data was analysed using cross tabulation, multidimensional Chi-square (Pearson), and a probability level of p < .05.

    Results. The prevalence of MSD was high, almost 60 % of the patients had some sort of MSD symptoms, either at the day for visit or the reviewed 3 year period, and a bit higher among women than men. Upper and lower limb problems were most common. Symptoms were most prevalent in the young and middle age-groups. The patients got a variety of different diagnoses, and between 13-35 % of the patients did not receive a MSD-diagnose despite having MSD-symptoms. There was a great variation in how the cases were handled. Medication and sick leave certificates were most common while work-related rehabilitation was less common. Conclusion. The present study points out some weaknesses regarding diagnostics and management of MSD in primary care. Further studies to compare the results regarding diagnoses for musculoskeletal symptoms and measures taken to solve the patients’ problems would be of interest.

  • 2.
    Wijk, Katarina
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research. Uppsala university; Region Gävleborg.
    Åberg Jönsson, Fredrik
    Region Gävleborg.
    Lindberg, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science. Uppsala university; Region Gävleborg.
    Perceived enabling factors and barriers for the implementation of improvements in health care in order to achieve patient‐centred care: A case report from Sweden2019In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753Article in journal (Refereed)
    Abstract [en]

    Rationale, aim, and objectives

    More knowledge is needed regarding the complex factors and perceptions that enable the implementation of change in health care. The study aimed to examine the enabling factors and barriers encountered in the implementation of improvements in health care in order to achieve patient‐centred care (PCC) and to study if there was a correlation in the extent the improvements were perceived to be implemented and the preconditions that were considered to affect them.

    Methods

    Using a mixed method design, data were gathered via a questionnaire and individual interviews with health care personnel, clinic managers, and first‐line managers. The data collection and analyses were based on the framework for Promoting Action on Research Implementation in Health Services (PARiHS). Correlations between PCC improvements and preconditions for improvements were performed.

    Results

    A high level of involvement, knowledge, and adequate resources were considered important to achieve an implementation of PCC with joint responsibility. Leadership and management need to be explicit and promote continuous follow‐up and feedback. Preconditions for improvement had a linear correlation with the perceived level of implementation. Knowledge‐related preconditions had greatest impact on implementation.

    Conclusions

    The PARiHS framework was appropriate to use since the three components of evidence, context, and facilitation present different important preconditions in the implementation process. Evidence was the highest rated contributor since evidence‐based practices in health care are necessary. It is vital that the important role of the context and facilitators is acknowledged in the implementation process to enable a successful implementation of change. There is a need to incorporate a clear strategy involving all levels in the organization. Furthermore, leaders play an important role in the implementation by facilitating communication and support and by having trust in facilitators and health care personnel. The results are applicable to other interventions implementing change in health care.

  • 3.
    Wijk, Katarina
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research. Centre for Research and Development, Region Gävleborg/Uppsala University, Gävle, Sweden; Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Åberg Jönsson, Fredrik
    Centre for Research and Development, Region Gävleborg/Uppsala University, Gävle, Sweden.
    Lindberg, Maria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Caring Science, Caring Science. Centre for Research and Development, Region Gävleborg/Uppsala University, Gävle, Sweden; Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Perceived enabling factors and barriers for the implementation of improvements in health care in order to achieve patient-centred care: A case report from Sweden2019In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753Article in journal (Refereed)
    Abstract [en]

    Abstract Rationale, aim, and objectives More knowledge is needed regarding the complex factors and perceptions that enable the implementation of change in health care. The study aimed to examine the enabling factors and barriers encountered in the implementation of improvements in health care in order to achieve patient-centred care (PCC) and to study if there was a correlation in the extent the improvements were perceived to be implemented and the preconditions that were considered to affect them. Methods Using a mixed method design, data were gathered via a questionnaire and individual interviews with health care personnel, clinic managers, and first-line managers. The data collection and analyses were based on the framework for Promoting Action on Research Implementation in Health Services (PARiHS). Correlations between PCC improvements and preconditions for improvements were performed. Results A high level of involvement, knowledge, and adequate resources were considered important to achieve an implementation of PCC with joint responsibility. Leadership and management need to be explicit and promote continuous follow-up and feedback. Preconditions for improvement had a linear correlation with the perceived level of implementation. Knowledge-related preconditions had greatest impact on implementation. Conclusions The PARiHS framework was appropriate to use since the three components of evidence, context, and facilitation present different important preconditions in the implementation process. Evidence was the highest rated contributor since evidence-based practices in health care are necessary. It is vital that the important role of the context and facilitators is acknowledged in the implementation process to enable a successful implementation of change. There is a need to incorporate a clear strategy involving all levels in the organization. Furthermore, leaders play an important role in the implementation by facilitating communication and support and by having trust in facilitators and health care personnel. The results are applicable to other interventions implementing change in health care.

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