A Swedish programme for dementia diagnostics in primary healthcare.
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ABSTRACT:
SUBMITTER: Jedenius E
PROVIDER: S-EPMC3406641 | biostudies-other | 2008
REPOSITORIES: biostudies-other
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Project description:BACKGROUND:The Swedish Dementia Registry (SveDem) was developed with the aim to improve the quality of diagnostic work-up, treatment and care of patients with dementia disorders in Sweden. METHODS:SveDem is an internet based quality registry where several indicators can be followed over time. It includes information about the diagnostic work-up, medical treatment and community support (www.svedem.se). The patients are diagnosed and followed-up yearly in specialist units, primary care centres or in nursing homes. RESULTS:The database was initiated in May 2007 and covers almost all of Sweden. There were 28 722 patients registered with a mean age of 79.3 years during 2007-2012. Each participating unit obtains continuous online statistics from its own registrations and they can be compared with regional and national data. A report from SveDem is published yearly to inform medical and care professionals as well as political and administrative decision-makers about the current quality of diagnostics, treatment and care of patients with dementia disorders in Sweden. CONCLUSION:SveDem provides knowledge about current dementia care in Sweden and serves as a framework for ensuring the quality of diagnostics, treatment and care across the country. It also reflects changes in quality dementia care over time. Data from SveDem can be used to further develop the national guidelines for dementia and to generate new research hypotheses.
| S-EPMC4335024 | biostudies-literature
Project description:IntroductionVaccination is a fundamental intervention in disease prevention; therefore, the advice and recommendations of health professionals have a major influence on the population's decision to be vaccinated or not. Professionals must have sufficient competencies to carry out their work and recommend vaccination with evidence-based knowledge. The aim is to design and validate a strategy to improve professional competencies in vaccination to positively influence adherence and increase vaccination rates in the population.Methods and analysisTraining will be designed based on evidence and previous studies and piloted with healthcare providers. To test changes in knowledge, a pretest and post-test will be conducted. To test feasibility, a think-aloud method will be used with participants and triangulated with focus groups using SWOT (strengths, weaknesses, opportunities and threats) analysis. Transfer will be measured using the questionnaire 'factors for the indirect evaluation of transfer' and an efficacy questionnaire 1½ months later; for satisfaction, an ad hoc questionnaire will be used. A summative approach will be used for the analysis of the focus groups and descriptive and bivariate statistics for the questionnaires.Ethics and disseminationThis study was approved by the Andalusian Research Ethics Committee, Spain (approval number: 0524-N-20). The results will be made available to the public at journal publications and scientific conferences.
| S-EPMC9196173 | biostudies-literature
Project description:Backgroundthe increasing prevalence of Alzheimer's dementia (AD) has shifted the burden of management towards primary care (PC). Our aim is to compare diagnostic process and management of AD in PC and specialist care (SC).Designcross-sectional study.Subjectsa total of, 9,625 patients diagnosed with AD registered 2011-14 in SveDem, the Swedish Dementia Registry.Methodsdescriptive statistics are shown. Odds ratios are presented for test performance and treatment in PC compared to SC, adjusted for age, sex, Mini-Mental State Examination (MMSE) and number of medication.Resultsa total of, 5,734 (60%) AD patients from SC and 3,891 (40%) from PC. In both, 64% of patients were women. PC patients were older (mean age 81 vs. 76; P < 0.001), had lower MMSE (median 21 vs. 22; P < 0.001) and more likely to receive home care (31% vs. 20%; P < 0.001) or day care (5% vs. 3%; P < 0.001). Fewer diagnostic tests were performed in PC and diagnostic time was shorter. Basic testing was less likely to be complete in PC. The greatest differences were found for neuroimaging (82% in PC vs. 98% in SC) and clock tests (84% vs. 93%). These differences remained statistically significant after adjusting for MMSE and demographic characteristics. PC patients received less antipsychotic medication and more anxiolytics and hypnotics, but there were no significant differences in use of cholinesterase inhibitors between PC and SC.Conclusionprimary and specialist AD patients differ in background characteristics, and this can influence diagnostic work-up and treatment. PC excels in restriction of antipsychotic use. Use of head CT and clock test in PC are areas for improvement in Sweden.
| S-EPMC5859983 | biostudies-literature
Project description:IntroductionThis study examines health-care costs attributed to dementia diseases in the 10 years prior to, during, and 6 years after diagnosis.MethodsUsing administrative register data for people diagnosed with dementia (2010-2016) in southern Sweden (n = 21,184), and a comparison group without dementia, health-care costs over 17 years were examined using longitudinal regression analysis.ResultsAverage annual health-care costs per person were consistently higher before diagnosis in the dementia group (10 years before: Swedish krona (SEK) 2063, P < .005 and 1 year before: SEK8166, P < .005). At diagnosis, health-care costs were more than twice as high (SEK44,410, P < .005). Four to 6 years after diagnosis, there was no significant different in costs compared to comparators.DiscussionExcess health-care cost arise as early as 10 years before a formal diagnosis of dementia, and while there is a spike in cost after diagnosis, health-care costs are no different 4 years after. These findings question currently accepted assumptions on costs of dementia.
| S-EPMC10078636 | biostudies-literature
Project description:Implementation of interventions concerning prevention and health promotion in health care has faced particular challenges resulting in a low frequency and quality of these services. In November 2011, the Swedish National Board of Health and Welfare released national clinical practice guidelines to counteract patients' unhealthy lifestyle habits. Drawing on the results of a previous study as a point of departure, the aim of this two-year follow up was to assess the progress of work with lifestyle interventions in primary healthcare as well as the uptake and usage of the new guidelines on lifestyle interventions in clinical practice.Longitudinal study among health professionals with survey at baseline and 2 years later. Development over time and differences between professional groups were calculated with Pearson chi-square test.Eighteen percent of the physicians reported to use the clinical practice guidelines, compared to 58% of the nurses. Nurses were also more likely to consider them as a support in their work than physicians did. Over time, health professionals usage of methods to change patients' tobacco habits and hazardous use of alcohol had increased, and the nurses worked to a higher extent than before with all four lifestyles. Knowledge on methods for lifestyle change was generally high; however, there was room for improvement concerning methods on alcohol, unhealthy eating and counselling. Forty-one percent reported to possess thorough knowledge of counselling skills.Even if the uptake and usage of the CPGs on lifestyle interventions so far is low, the participants reported more frequent counselling on patients' lifestyle changes concerning use of tobacco and hazardous use of alcohol. However, these findings should be evaluated acknowledging the possibility of selection bias in favour of health promotion and lifestyle guidance, and the loss of one study site in the follow up. Furthermore, this study indicates important differences in physicians and nurses' attitudes to and use of the guidelines, where the nurses reported working to a higher extent with all four lifestyles compared to the first study. These findings suggest further investigations on the implementation process in clinical practice, and the physicians' uptake and use of the CPGs.
| S-EPMC5880081 | biostudies-other
Project description:Cryptosporidium parvum is a common pathogen in preweaned calves but in Sweden Cryptosporidium bovis, which is considered apathogenic, is the most common species in this age group and it has been identified in diarrhoeal samples, indicating that it could be a cause of diarrhoea. In routine diagnostic procedures, infection is determined by microscopy, which is not sufficient to differentiate these species. We investigated whether routine Cryptosporidium diagnostic procedures need improvement to include species determination. The relation of Cryptosporidium spp. and subtype with the clinical picture and other pathogens was also investigated. A total of 782 diarrhoeal calf samples were analysed and Cryptosporidium infection was diagnosed in 198 samples. Cryptosporidium parvum was identified in 178, C. bovis in six and mixed C. bovis/C. parvum in seven samples. Twenty-seven C. parvum subtypes were identified, of which 16 were newly described. Except for three herds, only one subtype per herd was identified. Cryptosporidium parvum-positive calves were younger than C. bovis-positive calves and most C. parvum infections were seen at 1-3 weeks of age. Oocyst counts were higher in C. parvum samples. Yellow faecal colour was associated with C. parvum infection. Watery faeces had no greater association with C. parvum infection, but C. parvum subtype family IIa was more common than subtype family IId in watery faecal samples. No other pathogens were detected in the six C. bovis-infected calves, indicating a pathogenic potential. Our results show that species determination does not need to be included in routine Cryptosporidium diagnostic procedures in order to estimate the clinical relevance of infection in diarrhoeal calves. The maximum age when analysis for clinical cryptosporidiosis is performed can be lowered to 6 weeks of age. However, the indicated pathogenic potential of C. bovis warrants further attention.
| S-EPMC7094644 | biostudies-literature
Project description:Key stakeholders' involvement is crucial to the sustainability of quality point-of-care (POC) diagnostics services in low-and-middle income countries. The aim of this study was to explore key stakeholder perceptions on the implementation of POC diagnostics in rural primary healthcare (PHC) clinics in South Africa. We conducted a qualitative study encompassing in-depth interviews with multiple key stakeholders of POC diagnostic services for rural and resource-limited PHC clinics. Interviews were digitally recorded and transcribed verbatim prior to thematic content analysis. Thematic content analysis was conducted using themes guided by the World Health Organisation (WHO) quality-ASSURED (Affordable, Sensitive, Specific, User friendly, Rapid and to enable treatment at first visit and Robust, Equipment free and Delivered to those who need it) criteria for POC diagnostic services in resource-limited settings. 11 key stakeholders participated in the study. All stakeholders perceived the main advantage of POC diagnostics as enabling access to healthcare for rural patients. Stakeholders perceived the current POC diagnostic services to have an ability to meet patients' needs, but recommended further improvement of the following areas: research on cost-effectiveness; improved quality management systems; development of affordable POC diagnostic and clinic-based monitoring and evaluation. Key stakeholders of POC diagnostics in rural PHC clinics in South Africa highlighted the need to assess affordability and ensure quality assurance of current services before adopting new POC diagnostics and scaling up current POC diagnostics.
| S-EPMC5373012 | biostudies-literature
Project description:BACKGROUND:Work stress is an increasing burden in society. Identifying early symptoms of work stress in primary healthcare (PHC) could result in earlier and better-targeted care. The Work Stress Questionnaire (WSQ) was developed in PHC for this task. We aimed to evaluate whether the use of the WSQ, in combination with physicians' feedback, resulted in differences in healthcare visits and treatment compared to treatment as usual (TAU) in patients reporting high stress. Our hypothesis was that patients receiving the intervention would generate more visits to rehabilitation providers during follow-up compared to TAU. METHODS:A two-armed randomised controlled trial was conducted at seven primary healthcare centres (PHCCs) in Region Västra Götaland, Sweden. One group received the WSQ intervention, and the controls received TAU. Employed, not sick-listed persons aged 18-64?years who sought care for mental or physical health complaints at the PHCCs participated. Register data on healthcare visits and treatments 12?months prior to inclusion and 12?months after were obtained and analysed with Fisher's exact test together with questionnaire data (WSQ and background features). RESULTS:A total of 271 participants were included in the study, 132 intervention and 139 controls. Visits to psychologists/psychotherapists were higher among intervention participants with high stress (20%, n?=?87) during follow-up compared to corresponding controls (7%, n?=?97) (p?<?0.05). Collaborative care measures were more common among the stressed intervention participants (23%) post-inclusion compared to the stressed controls (11%) (p?<?0.05). The amount of received cognitive behavioural therapy (CBT) was higher among the stressed intervention group (16%) than among controls (10%) during follow-up. CONCLUSIONS:The intervention group that used the WSQ with physicians' feedback had an increased number of rehabilitative measures and treatment more in line with established guidelines compared to treatment as usual. Findings of the study indicate that the WSQ can assist in identifying work stress in primary healthcare and contribute to physicians' recommendations of suitable rehabilitative measures at an earlier stage compared to treatment as usual. TRIAL REGISTRATION:ClinicalTrials.gov. Identifier: NCT02480855 . Registered 20 May 2015.
| S-EPMC7339485 | biostudies-literature
Project description:IntroductionDementia is on the rise in Canada and globally. Ensuring accessibility to diagnosis, treatment and management throughout the course of the disease is a very significant problem worldwide. In order to provide comprehensive care to patients and their caregivers, enhancing primary care-based dementia care is seen as the way forward. In many Canadian provinces various collaborative care models (collCMs) anchored in primary care to improve dementia care have been developed and implemented. The overall objective of our research programme is to identify key factors for the successful implementation of collCMs, and to facilitate dissemination and scale-up of dementia best practices.Methods and analysisWe will use a convergent mixed-methods design. An observational study using chart review (2014-2016) and questionnaires (2014-2018; repeated in 2020) will measure application of guidelines and implementation of collCMs. This study will be complemented with a qualitative descriptive study using interviews (2017-2020) conducted in parallel. Quantitative and qualitative results will be further integrated using a matrix representing sites and findings. An integrated knowledge exchange strategy will ensure uptake by principal stakeholders throughout the research.Ethics and disseminationOur study has been approved by all relevant ethics committees. Our dissemination plan follows an integrated knowledge transfer strategy using provincial, national and international councils. We will present the results individually to the clinical sites and then to these councils. Our research will be the first provincial and cross jurisdictional evaluation of primary care models for patients living with dementia, providing evidence on the ongoing debate on the respective role of clinicians in primary care and specialists in caring for patients with dementia.
| S-EPMC7232631 | biostudies-literature
Project description:ObjectiveWe aimed to investigate the differences in clinical characteristics and pharmacological treatment associated with the presence of diabetes in a large cohort of patients with dementia.Research design and methodsA cross-sectional registry-based study was conducted using data from the Swedish Dementia Registry (SveDem). Data on dementia diagnosis, dementia type, and demographic determinants were extracted from SveDem. Data from the Swedish Patient Register and Prescribed Drug Register were combined for the diagnosis of diabetes. Data on antidiabetic, dementia, cardiovascular, and psychotropic medications were extracted from the Swedish Prescribed Drug Register. Logistic regression was used to determine whether the variables were associated with diabetes after adjustment for confounders. In total, 29,630 patients were included in the study, and 4,881 (16.5%) of them received a diagnosis of diabetes.ResultsIn the fully adjusted model, diabetes was associated with lower age at dementia diagnosis (odds ratio [OR] 0.97 [99% CI 0.97-0.98]), male sex (1.41 [1.27-1.55]), vascular dementia (1.17 [1.01-1.36]), and mixed dementia (1.21 [1.06-1.39]). Dementia with Lewy bodies (0.64 [0.44-0.94]), Parkinson disease dementia (0.46 [0.28-0.75]), and treatment with antidepressants (0.85 [0.77-0.95]) were less common among patients with diabetes. Patients with diabetes who had Alzheimer disease obtained significantly less treatment with cholinesterase inhibitors (0.78 [0.63-0.95]) and memantine (0.68 [0.54-0.85]).ConclusionsPatients with diabetes were younger at dementia diagnosis and obtained less dementia medication for Alzheimer disease, suggesting less optimal dementia treatment. Future research should evaluate survival and differences in metabolic profile in patients with diabetes and different dementia disorders.
| S-EPMC5566285 | biostudies-literature