Outi Kanste

The attitudes of multiprofessional teams to telehealth adoption in northern Finland health centres

A telehealth network was established between seven health centres, the local university and the university hospital in the Oulu Arc Subregion in a rural area of northern Finland. During the period 2004–2007, the videophone network was used for different types of teleconsultation (orthopaedics, psychiatry, diabetes, rehabilitation), continuing education and various patient care and administrative meetings. Qualitative research with observation and interviews with 30 professionals (physicians, nurses, psychiatric nurses, physiotherapists) was carried out in early 2007 to find out health-care professionals attitudes toward telehealth and to see how the attitudes were connected to telehealth usage. Overall, the attitudes were more positive than negative, ranging from negative to enthusiastically positive. Diversity of attitudes occurred in relation to time, situation, profession, health centre and telehealth application. Ten different types of telehealth adopters were recognized: enthusiastic user, positive user, critical user, hesitant user, positive participant, hesitant participant, critical participant, neutral participant, negative participant and positive non-participant. Telehealth was especially well accepted in continuing education and in diabetes teleconsultations. The study showed that a negative attitude was not a definite barrier to telehealth adoption, but it did require additional attention from project workers and managers. Project staff and managers need to take into account the diverse attitudes of health professionals, because different people require different actions to adopt telehealth in their work.

The compatibility of telehealth with health-care delivery.

There is no clear understanding about the concept of technology adoption in the health-care environment. Compatibility is one of the factors affecting telehealth adoption. We investigated the key factors of telehealths compatibility with health centre activities. Qualitative research was carried out in 2007–2009, with 55 interviews in seven health centres and in one special care hospital. The people interviewed were physicians, nurses and physiotherapists. After analysing the interview material, we concluded that compatibility has three aspects: individual, process and organizational compatibility. Individual compatibility was manifested in four different ways: from the viewpoints of professionals, patients, communication and cooperation. Three aspects of process compatibility were introduced: scheduling, resources and complexity of processes. Modest organizing efforts with telehealth and even a lack of interest can be expressions of organizational compatibility. Functional and user-friendly technology is a basic precondition for telehealth compatibility. With thorough organizing, most of the compatibility challenges can be solved.

The effects of a counselling intervention on lifestyle change in people at risk of cardiovascular disease

Background: The study assessed the effects of a counselling intervention on lifestyle changes in certain-aged people at risk of cardiovascular disease. Design and methods: This was an intervention study at baseline and six- and 12-month follow-ups. The participants were 40 years old (n= 53 at baseline, n=33 at six months and n=34 at 12 months). The main outcomes were cardiovascular health parameters, such as weight, BMI, waist circumference, blood pressure, cholesterol (total, high density lipoprotein, low density lipoprotein), blood glucose, and self-assessed and reported lifestyle and adherence to lifestyle changes. The counselling intervention was Internet-based and carried out via Skype or face-to-face in small groups (on average, six participants). Results: There were statistically significant differences between the baseline and the 12-month follow-up with respect to the consumption of fat and snacks. Some positive cardiovascular health improvements were detected between baseline and six months, but not as clearly between baseline and 12 months. The participants reported having a healthier diet at 12 months than at baseline. At 12 months, BMI measurements indicated that all participants were overweight (mean BMI 29.8), but according to the self-assessed data, only 25% considered themselves to be so. Conclusions: Changes in lifestyle were detected as a result of the intervention. These lifestyle changes may improve cardiovascular health in the long term. Discrepancies were found between the measured indicators of cardiovascular health and information obtained from questionnaires and diary records. In order to achieve sustainable lifestyle changes, long-term support is required.

Prevalence of anxiety disorders among Finnish primary care high utilizers and validation of Finnish translation of GAD-7 and GAD-2 screening tools

Abstract Objective. To analyse the prevalence of GAD and other anxiety disorders, as well as sensitivity and specificity of GAD-7 among high utilizers of health care. Setting. Four municipal health centres in Northern Finland. Subjects. A psychiatric interview was conducted for 150 high utilizers of health care. Main outcome measures. Prevalence of GAD as well as sensitivity and specificity of GAD-7. Results. The prevalence of GAD was 4% in this study group of Finnish high utilizers of health care. The sensitivity of GAD-7 was 100.0% (95% CI 54.1–100.0) and the specificity of GAD-7 was 82.6% (95% CI 75.4–88.4) with a cut-off point of 7 or more. Conclusion. GAD is rather common among high utilizers of primary care, although the prevalence of 4% is lower than that previously reported. GAD-7 is a valid and useful tool for detecting GAD among primary health care patients.

Adherence to health regimens among frequent attenders of Finnish healthcare.

Objectives The aim of the study was to describe adherence to health regimens and the factors associated with it among adult frequent attenders (FAs). Design This was a cross-sectional study. The study sample consisted of 462 healthcare FAs in 7 municipal health centres in northern Finland. An FA is a person who has had 8 or more outpatient visits to a GP (in a health centre) or 4 or more outpatient visits to a university hospital during 1 year. The main outcome was self-reported adherence to health regimens. Results Of the FAs, 82% adhered well to their health regimens. Carrying out self-care, medical care and feeling responsible for self-care were the most significant predictors to good adherence in all models. No significant differences in adherence were found in male and female subjects, age groups or educational levels. Support from healthcare providers and support from relatives were not significant predictors of good adherence. Conclusion FAs in Finland adhere well to health regimens and exceptionally well to medication. Variables that predict the best adherence of FAs to health regimens are carrying out self-care, receiving medical care and feeling responsible for self-care.Objectives The aim of the study was to describe adherence to health regimens and the factors associated with it among adult frequent attenders (FAs). Design This was a cross-sectional study. The study sample consisted of 462 healthcare FAs in 7 municipal health centres in northern Finland. An FA is a person who has had 8 or more outpatient visits to a GP (in a health centre) or 4 or more outpatient visits to a university hospital during 1 year. The main outcome was self-reported adherence to health regimens. Results Of the FAs, 82% adhered well to their health regimens. Carrying out self-care, medical care and feeling responsible for self-care were the most significant predictors to good adherence in all models. No significant differences in adherence were found in male and female subjects, age groups or educational levels. Support from healthcare providers and support from relatives were not significant predictors of good adherence. Conclusion FAs in Finland adhere well to health regimens and exceptionally well to medication. Variables that predict the best adherence of FAs to health regimens are carrying out self-care, receiving medical care and feeling responsible for self-care.Objectives The aim of the study was to describe adherence to health regimens and the factors associated with it among adult frequent attenders (FAs). Design This was a cross-sectional study. The study sample consisted of 462 healthcare FAs in 7 municipal health centres in northern Finland. An FA is a person who has had 8 or more outpatient visits to a GP (in a health centre) or 4 or more outpatient visits to a university hospital during 1 year. The main outcome was self-reported adherence to health regimens. Results Of the FAs, 82% adhered well to their health regimens. Carrying out self-care, medical care and feeling responsible for self-care were the most significant predictors to good adherence in all models. No significant differences in adherence were found in male and female subjects, age groups or educational levels. Support from healthcare providers and support from relatives were not significant predictors of good adherence. Conclusion FAs in Finland adhere well to health regimens and exceptionally well to medication. Variables that predict the best adherence of FAs to health regimens are carrying out self-care, receiving medical care and feeling responsible for self-care.