Anna-Karin Furhoff

Care by general practitioners and district nurses of patients receiving home nursing: a study from suburban Stockholm

Objectives - To review the care by general practitioners (GPs), district nurses and assistant nurses of patients receiving home nursing. Design - Retrospective data from questionnaires, records and official statistics. Statistical comparisons. Setting - Primary health care from October 1995 to October 1996. Subjects - One-third (158) of all patients receiving home nursing in a suburban area were sampled; 73% (116) participated. All patients of comparable age in one practice served as a control group. Main outcome measures - Number of and reasons for visits and other contacts. Nature of care. Relation between patient problems and care given. Results - Most patients were seen by the nurses two to five times a month. They met their GPs less often than other patients. More measures were undertaken without direct contact between GP and patient. The most common measures concerned medication and the assessment of symptoms. Patients with cognitive problems seemed to get less active GP care. Conclusion - GPs played an active role in the care of patients receiving home nursing even though they seldom met them. Many patients were regularly assessed by the nurses, which might have diminished the need for doctor visits. The care of patients with cognitive problems needs further study.

Rehabilitation of young immigrants in primary care A comparison between two treatment models

OBJECTIVE To evaluate the effect on well-being and sickness certification of interviews and three dialogue sessions concerning ideas about pain in young immigrants suffering from longstanding, benign pain. DESIGN A randomized clinical four-week trial between two treatment groups. SETTING A primary health care centre, Stockholm, Sweden. SUBJECTS 92 persons, 25-45 years of age, on sick leave > 6 weeks. MEASURES Physical and psychiatric examinations and self-ratings of work ability and pain anxiety were made before and after the programme. Sick leave data were studied at three and eight-month follow-ups. RESULTS 45 immigrants, mean age 38 years, mean sick leave 13 months, completed the programme. There were no significant differences in general or diagnostic data between the treatment groups. All had pain. Three-quarters reported pain anxiety. Nearly half had depressive disorders. Only ten persons had self-rated ability for part-time work. After the programme, there were significant differences in favour of the experimental group in number of participants with pain anxiety (p = 0.01), with diagnosed depression (p < 0.05), with self-rated work ability (p = 0.05), and in the number of participants who had returned to work at the eight-month follow-up (p < 0.05). CONCLUSIONS This study indicates that, for young immigrants suffering from long-standing benign pain, a structured dialogue with focus on concepts of pain may reduce pain anxiety and depressive mood, improve self-rated work ability, and increase the prospects of successful rehabilitation back to work.

The medical care of patients with primary care home nursing is complex and influenced by non-medical factors: a comprehensive retrospective study from a suburban area in Sweden

BackgroundThe reduced number of hospital beds and an ageing population have resulted in growing demands for home nursing. We know very little about the comprehensive care of these patients. The objectives were to identify the care, in addition to primary health care, of patients with primary-care home nursing to give a comprehensive view of their care and to investigate how personal, social and functional factors influence the use of specialised medical care.MethodsOne-third (158) of all patients receiving primary-care home nursing in an area were sampled, and 73 % (116) were included. Their care from October 1995 until October 1996 was investigated by sending questionnaires to district nurses and home-help providers and by collecting retrospective data from primary-care records and official statistics. We used non-parametric statistical methods, i.e. medians and minimum – maximum, χ2, and the Mann-Whitney test, since the data were not normally distributed. Conditional logistic regression was used to study whether personal, social or functional factors influenced the chance (expressed as odds ratio) that study patients had made visits to or had received inpatient care from specialised medical care during the study year.Results56 % of the patients had been hospitalised. 73 % had made outpatient visits to specialised medical care. The care took place at 14 different hospitals, and more than 22 specialities were involved, but local care predominated. Almost all patients visited doctors, usually in both primary and specialised medical care. Patients who saw doctors in specialised care had more help from all other categories of care. Patients who received help from their families made more visits to specialised medical care and patients with severe ADL dependence made fewer visits.ConclusionsThe care of patients with primary-care home nursing is complex. Apart from home nursing, all patients also made outpatient visits to doctors, usually in both primary and specialised medical care. Many different caregivers and professions were involved. Reduced functional capacity decreased and help from family members increased the chance of having received outpatient specialised medical care. This raises questions concerning the medical care for patients with both medical and functional problems.

Quality of life of participants in a mind-body-based self-development course: A descriptive study

Objective: A cross-sectional survey of quality of life of people attending a self-development course involving psychophysiological mind-body medicine (MBM) activities. Design: A questionnaire study using a health-related quality of life (HRQoL) instrument, the SWED-QUAL, with 13 subscales scored 0–100, and questions about utilisation of alternative and standard health care, medication and sick leave. Setting: A training centre for MBM, established 15 years ago. Study group: One hundred and seven eligible course attendants (response rate 88%, age 20–70 years) during the year 2000 assessed their HRQoL just before entering the course. Attendance was self-initiated, without referral. The results on HRQoL were compared with those of control subjects from the general Swedish population. Results: Six of the thirteen HRQoL subscales were strongly and significantly reduced (p < 0.0001) in the study group: Negative affectivity, Role limitation due to emotional health, Positive affectivity, Cognitive functioning, Family functioning and Marital functioning. Long-term sick leave (>6 months) was three times as frequent in the study group as in the general population. Use of psychotropic medication was slightly increased compared to the general population, at least among the younger male participants. The education level was high, health care utilisation was average and body functioning was good. Conclusions: This group of well-educated men and women gave their emotional health an unexpectedly low rating, on a par with that given by people with chronic diseases.

Pain behaviour in young immigrants having chronic pain: an exploratory study in primary care.

Pain behaviour can hamper rehabilitation. The aim of this study was to explore the phenomenon of pain behaviour in an unselected group of immigrant patients on >6 weeks of sick leave before and after a transcultural treatment programme in primary care. Anxiety about pain and pain behaviour—i.e. ≥1.5 points on the University of Alabama in Birmingham (UAB) scale with scores of 0–10—were noted before and after treatment. The sex‐adjusted odds ratios (OR) for pain behaviour, before and after the treatment, were calculated using logistic regression with 95% confidence intervals (95% CIs). Forty‐nine men and 102 women having a mean age of 38 years participated. Their mean sick leave was 46 weeks. All reported psychosocial stress, one‐quarter were depressed and social functioning was generally low. The pain was mostly caused by muscular insertion lesions (entesopathies). The frequency of pain behaviour and anxiety about pain declined after treatment (from 68% to 54% and from 76% to 50% respectively). Duration of full‐time sick leave and among men also decreasing social functioning were correlated with the UAB score. Those who reported persistent anxiety about pain, or men who were depressed, had higher scores. Only persons on full‐time sick leave >1 year had a significant OR for pain behaviour before treatment (OR 3.23; 95% CI 1.17‐8.85, adjusted for sex). After treatment, only persons reporting persistent anxiety about pain showed a significant OR for pain behaviour (OR 3.05; 95% CI 1.49‐6.23, adjusted for sex). In conclusion, pain behaviour was common in this group of immigrant patients ≤45 years of age on long‐term sick leave. Anxiety about pain and full‐time sick leave for more than 1 year significantly predicted pain behaviour.

STARTING INSULIN THERAPY IN ELDERLY NON-INSULIN-DEPENDENT DIABETIC PATIENTS AT A HEALTH CARE CENTRE. METHODOLOGICAL AND ECONOMIC ASPECTS

OBJECTIVE To try to start insulin therapy in elderly non-insulin-dependent diabetes mellitus (NIDDM) patients with secondary failure in primary health care, and compare costs for starting treatment in a health care centre and in a day-care clinic in a hospital. DESIGN Time and costs for start of insulin were calculated. SETTING A health care centre in Stockholm, Sweden. SUBJECTS Fourteen consecutive patients in the health care centre and a control group of 14 patients in the day-care clinic. RESULTS Metabolic control in both groups improved significantly. Total time spent with the district nurse to start insulin treatment was 3 hours during about 7 weeks with a total cost of SEK 1100 in the health care centre. In the day-care clinic patients were admitted 5.6 days with a total cost of SEK 6100-10900. CONCLUSIONS Elderly patients can learn the injection technique and manage insulin therapy, which results in good metabolic control. Insulin treatment can be started in primary health care. With elderly patients it takes time, but it is far more cost-effective in primary health care than at the hospital.