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Husdal, R., Thors Adolfsson, E., Leksell, J., Eliasson, B., Jansson, S., Jerdén, L., . . . Rosenblad, A. (2019). Associations between quality of work features in primary health care and glycaemic control in people with Type 2 diabetes mellitus: a nationwide survey. Primary Care Diabetes, 13(2), 176-186
Open this publication in new window or tab >>Associations between quality of work features in primary health care and glycaemic control in people with Type 2 diabetes mellitus: a nationwide survey
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2019 (English)In: Primary Care Diabetes, ISSN 1751-9918, E-ISSN 1878-0210, Vol. 13, no 2, p. 176-186Article in journal (Refereed) Published
Abstract [en]

AIMS: To describe and analyse the associations between primary health care centres' (PHCCs') quality of work (QOW) and individual HbA1c levels in people with Type 2 diabetes mellitus (T2DM).

METHODS: This cross-sectional study invited all 1152 Swedish PHCCs to answer a questionnaire addressing QOW conditions. Clinical, socio-economic and comorbidity data for 230,958 people with T2DM were linked to data on QOW conditions for 846 (73.4%) PHCCs.

RESULTS: Of the participants, 56% had controlled (≤52mmol/mol), 31.9% intermediate (53-69mmol/mol), and 12.1% uncontrolled (≥70mmol/mol) HbA1c. An explanatory factor analysis identified seven QOW features. The features having a call-recall system, having individualized treatment plans, PHCCs' results always on the agenda, and having a follow-up strategy combined with taking responsibility of outcomes/results were associated with lower HbA1c levels in the controlled group (all p<0.05). For people with intermediate or uncontrolled HbA1c, having individualized treatment plans was the only QOW feature that was significantly associated with a lower HbA1c level (p<0.05).

CONCLUSIONS: This nationwide study adds important knowledge regarding associations between QOW in real life clinical practice and HbA1c levels. PHCCs' QOW may mainly only benefit people with controlled HbA1c and more effective QOW strategies are needed to support people with uncontrolled HbA1c.

Keywords
Diabetes mellitus, National survey, Primary health care, Quality of health care, Type 2
National Category
Clinical Medicine
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-29099 (URN)10.1016/j.pcd.2018.11.005 (DOI)30545793 (PubMedID)2-s2.0-85057982729 (Scopus ID)
Available from: 2018-12-17 Created: 2018-12-17 Last updated: 2019-03-05Bibliographically approved
Ewertzon, M., Alvariza, A., Winnberg, E., Leksell, J., Andershed, B., Goliath, I., . . . Årestedt, K. (2018). Adaptation and evaluation of the Family Involvement and Alienation questionnaire for use in the care of older people, psychiatric care, palliative care and diabetes care. Journal of Advanced Nursing, 74(8), 1839-1850
Open this publication in new window or tab >>Adaptation and evaluation of the Family Involvement and Alienation questionnaire for use in the care of older people, psychiatric care, palliative care and diabetes care
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2018 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 74, no 8, p. 1839-1850Article in journal (Refereed) Published
Abstract [en]

AIM: To adapt the Family Involvement and Alienation Questionnaire for use in the care of older people, psychiatric care, palliative care and diabetes care and to evaluate its validity and reliability.

BACKGROUND: Involvement in the professional care has proven to be important for family members. However, they have described feelings of alienation in relation to how they experienced the professionals' approach. To explore this issue, a broad instrument that can be used in different care contexts is needed.

DESIGN: A psychometric evaluation study, with a cross-sectional design.

METHOD: The content validity of the Family Involvement and Alienation Questionnaire was evaluated during 2014 by cognitive interviews with 15 family members to adults in different care contexts. Psychometric evaluation was then conducted (2015-2016). A sample of 325 family members participated, 103 of whom in a test-retest evaluation. Both parametric and non-parametric methods were used.

RESULTS: The content validity revealed that the questionnaire was generally understood and considered to be relevant and retrievable by family members in the contexts of the care of older people, psychiatric care, palliative care and diabetes care. Furthermore, the Family Involvement and Alienation Questionnaire (Revised), demonstrated satisfactory psychometric properties in terms of data quality, homogeneity, unidimensionality (factor structure), internal consistency and test-retest reliability.

CONCLUSION: The study provides evidence that the Family Involvement and Alienation Questionnaire (Revised) is reliable and valid for use in further research and in quality assessment in the contexts of the care of older people, psychiatric care, palliative care and diabetes care. 

Keywords
care of older people, diabetes care, family involvement, instrument development, nrsing, palliative care, psychiatric care, psychometric testing, reliability, validity
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-27448 (URN)10.1111/jan.13579 (DOI)29603762 (PubMedID)
Available from: 2018-04-03 Created: 2018-04-03 Last updated: 2018-11-14Bibliographically approved
Julin, B., Willers, C., Leksell, J., Lindgren, P., Muth, K. L., Svensson, A.-M., . . . Dahlström, T. (2018). Association between sociodemographic determinants and health outcomes in individuals with type 2 diabetes in Sweden. Diabetes/Metabolism Research Reviews, 34(4), Article ID e2984.
Open this publication in new window or tab >>Association between sociodemographic determinants and health outcomes in individuals with type 2 diabetes in Sweden
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2018 (English)In: Diabetes/Metabolism Research Reviews, ISSN 1520-7552, E-ISSN 1520-7560, Vol. 34, no 4, p. -9, article id e2984Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Concurrent multifactorial treatment is needed to reduce consequent risks of diabetes, yet most studies investigating the relationship between sociodemographic factors and health outcomes have focused on only one risk factor at a time. Swedish health care is mainly tax-funded, thus providing an environment that should facilitate equal health outcomes in patients, independent of background, socioeconomic status or health profile. This study aimed at investigating the association between several sociodemographic factors and diabetes-related health outcomes represented by HbA1c , systolic blood pressure, LDL cholesterol, predicted 5-year risk of cardiovascular disease as well as statin use.

METHODS: This large retrospective registry-study was based on patient-level data from individuals diagnosed with type 2 diabetes mellitus during 2010-2011 (n = 416,228) in any of seven Swedish regions (~65% of the Swedish population). Health equity in diabetes care was analyzed through multivariate regression analyses on intermediary outcomes (HbA1c , systolic blood pressure, LDL), predicted 5-year risk of cardiovascular disease and process (i.e. statin use) after one-year follow-up, adjusting for several sociodemographic factors.

RESULTS: We observed differences in intermediary risk measures, predicted 5-year risk of cardiovascular disease as well as process dependent on place of birth, sex, age, education and social setting, despite Sweden's articulated vision of equal health care.

CONCLUSIONS: Diabetes patients' health was associated with sociodemographic prerequisites. In addition to demographics (age, sex) and disease history; educational level, marital status and region of birth are important factors to consider when benchmarking health outcomes, e.g. average HbA1c level, between organizational units or between different administrative regions.

Keywords
HbA1c, Type 2 diabetes mellitus, cardiovascular disease, sociodemographics, statin use, systolic blood pressure
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-27115 (URN)10.1002/dmrr.2984 (DOI)000431984700008 ()29377503 (PubMedID)
Available from: 2018-02-06 Created: 2018-02-06 Last updated: 2018-05-23Bibliographically approved
Granström, T., Forsman, H., Brorsson, A. L., Granstam, E. & Leksell, J. (2018). Patients’ experiences before starting anti-VEGF treatment for sight-threatening diabetic macular oedema: A qualitative interview study. Nordic journal of nursing research, 38(1), 11-17
Open this publication in new window or tab >>Patients’ experiences before starting anti-VEGF treatment for sight-threatening diabetic macular oedema: A qualitative interview study
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2018 (English)In: Nordic journal of nursing research, ISSN 2057-1585, E-ISSN 2057-1593, Vol. 38, no 1, p. 11-17Article in journal (Refereed) Published
Abstract [en]

The diabetic complication macular oedema (DME) is a growing problem worldwide because of the increasing number of patients suffering from diabetes mellitus (DM). DME is treated with injections of anti-vascular endothelial growth factor (anti-VEGF) in the eye. This real-world study aimed to describe patients’ experiences before they received their first injection in the eye. Twenty-one men and women aged 49 to 86 years were interviewed. The interviews were analysed using qualitative content analysis. Two categories and an overall theme ‘to be at a crossroads and a crucial phase in life with an uncertain outcome’ were found. The participants expressed thoughts and concerns at different levels, practical concerns about the treatment procedure, and other existential thoughts regarding hope for improved visual acuity or fear of deterioration. Cooperation between eye clinics and diabetes clinics should be strengthened to clarify who is responsible for providing the information and support required by patients.

Keywords
anti-VEGF treatment, diabetic macular oedema, qualitative research, visual impairment
National Category
Nursing
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-25211 (URN)10.1177/2057158517709409 (DOI)
Available from: 2017-06-16 Created: 2017-06-16 Last updated: 2018-06-07Bibliographically approved
Husdal, R., Rosenblad, A., Leksell, J., Eliasson, B., Jansson, S., Jerdén, L., . . . Thors Adolfsson, E. (2018). Resources and organisation in primary health care are associated with HbA1c level: a nationwide study of 230958 people with Type 2 diabetes mellitus. Primary Care Diabetes, 12(1), 23-33
Open this publication in new window or tab >>Resources and organisation in primary health care are associated with HbA1c level: a nationwide study of 230958 people with Type 2 diabetes mellitus
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2018 (English)In: Primary Care Diabetes, ISSN 1751-9918, E-ISSN 1878-0210, Vol. 12, no 1, p. 23-33Article in journal (Refereed) Published
Abstract [en]

AIMS: To examine the association between personnel resources and organisational features of primary health care centres (PHCCs) and individual HbA1c level in people with Type 2 diabetes mellitus (T2DM).

METHODS: People with T2DM attending 846 PHCCs (n=230958) were included in this cross-sectional study based on PHCC-level data from a questionnaire sent to PHCCs in 2013 and individual-level clinical data from 2013 for people with T2DM reported in the Swedish National Diabetes Register, linked to individual-level data on socio-economic status and comorbidities. Data were analysed using a generalized estimating equations linear regression models.

RESULTS: After adjusting for PHCC- and individual-level confounding factors, personnel resources associated with lower individual HbA1c level were mean credits of diabetes-specific education among registered nurses (RNs) (-0.02mmol/mol for each additional credit; P<0.001) and length of regular visits to RNs (-0.19mmol/mol for each additional 15min; P<0.001). Organisational features associated with HbA1c level were having a diabetes team (-0.18mmol/mol; P<0.01) and providing group education (-0.20mmol/mol; P<0.01).

CONCLUSIONS: In this large sample, PHCC personnel resources and organisational features were associated with lower HbA1c level in people with T2DM.

Keywords
HbA(1c), Organisation, Personnel resources, Primary health care system, Type 2 diabetes mellitus
National Category
Clinical Medicine
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-26370 (URN)10.1016/j.pcd.2017.09.003 (DOI)000423008800003 ()28964673 (PubMedID)
Available from: 2017-10-03 Created: 2017-10-03 Last updated: 2018-12-20Bibliographically approved
Willers, C., Iderberg, H., Axelsen, M., Dahlström, T., Julin, B., Leksell, J., . . . Lilja, M. (2018). Sociodemographic determinants and health outcome variation in individuals with type 1 diabetes mellitus: A register-based study. PLoS ONE, 13(6), Article ID e0199170.
Open this publication in new window or tab >>Sociodemographic determinants and health outcome variation in individuals with type 1 diabetes mellitus: A register-based study
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2018 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 6, article id e0199170Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Socioeconomic status, origin or demographic attributes shall not determine the quality of healthcare delivery, according to e.g. United Nations and European Union rules. Health equity has been defined as the absence of systematic disparities and unwarranted differences between groups defined by differences in social advantages. A study was performed to investigate whether this was applicable to type 1 diabetes mellitus (T1D) care in a setting with universal, tax-funded healthcare.

METHODS: This retrospective registry-study was based on patient-level data from individuals diagnosed with T1D during 2010-2011 (n = 16,367) in any of seven Swedish county councils (covering ~65% of the Swedish population). Health equity in T1D care was analysed through multivariate regression analyses on absolute HbA1c level at one-year follow-up, one-year change in estimated glomerular filtration rate (eGFR) and one-year change in cardiovascular risk score, using selected sociodemographic dimensions as case-mix factors.

RESULTS: Higher educational level was consistently associated with lower levels of HbA1c, and so was being married. Never married was associated with worse eGFR development, and lower educational level was associated with higher cardiovascular risk. Women had higher HbA1c levels than men, and glucose control was significantly worse in patients below the age of 25.

CONCLUSION: Patients' sociodemographic profile was strongly associated with absolute levels of risk factor control in T1D, but also with an increased annual deterioration in eGFR. Whether these systematic differences stem from patient-related problems or healthcare organisational shortcomings is a matter for further research. The results, though, highlight the need for intensified diabetes management education and secondary prevention directed towards T1D patients, taking sociodemographic characteristics into account.

National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-28108 (URN)10.1371/journal.pone.0199170 (DOI)000436793500006 ()29958293 (PubMedID)2-s2.0-85049256847 (Scopus ID)
Available from: 2018-07-04 Created: 2018-07-04 Last updated: 2018-07-19Bibliographically approved
Johansson, K., Österberg, S. A., Leksell, J. & Berglund, M. (2018). Supporting patients learning to live with diabetes: a phenomenological study. British Journal of Nursing, 27(12), 697-704
Open this publication in new window or tab >>Supporting patients learning to live with diabetes: a phenomenological study
2018 (English)In: British Journal of Nursing, ISSN 0966-0461, E-ISSN 2052-2819, Vol. 27, no 12, p. 697-704Article in journal (Refereed) Published
Abstract [en]

This article describes a study of the phenomenon of supporting patients who are learning to live with diabetes, from a diabetes specialist nurse (DSN) perspective. Guided by principles of reflective lifeworld research, data from six interviews (four in groups and two individual) with 16 DSNs were analysed. The results show that, in order to support learning, DSNs use a self-critical approach with the insight that they should not take over responsibility for their patients' diabetes. The DSNs support, encourage and challenge the patients to self-reflect and take responsibility based on patients' own goals and needs. To provide support, DSNs need to assume a tactful, critically challenging approach, dare to confront patients' fears and other emotions and have the insight to know that the responsibility for learning and integration of the condition lies with the patient. To be able to support patients in this way, it is necessary that the DSN is mentored and supported in this role.

Keywords
Diabetes, Diabetes specialist nurse, Lifeworld, Patient support, Phenomenology, Reflection, Sweden
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-28107 (URN)10.12968/bjon.2018.27.12.697 (DOI)29953270 (PubMedID)2-s2.0-85049237778 (Scopus ID)
Available from: 2018-07-04 Created: 2018-07-04 Last updated: 2018-07-16Bibliographically approved
Svedbo Engström, M., Leksell, J., Johansson, U.-B., Eeg-Olofsson, K., Borg, S., Palaszewski, B. & Gudbjörnsdottir, S. (2017). A disease-specific questionnaire for measuring patient-reported outcomes and experiences in the Swedish National Diabetes Register: Development and evaluation of content validity, face validity, and test-retest reliability.. Patient Education and Counseling, 101(1), 139-146
Open this publication in new window or tab >>A disease-specific questionnaire for measuring patient-reported outcomes and experiences in the Swedish National Diabetes Register: Development and evaluation of content validity, face validity, and test-retest reliability.
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2017 (English)In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 101, no 1, p. 139-146Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To describe the development and evaluation of the content and face validity and test-retest reliability of a disease-specific questionnaire that measures patient-reported outcomes and experiences for the Swedish National Diabetes Register for adult patients who have type 1 or type 2 diabetes.

METHODS: In this methodological study, a questionnaire was developed over four phases using an iterative process. Expert reviews and cognitive interviews were conducted to evaluate content and face validity, and a postal survey was administered to evaluate test-retest reliability.

RESULTS: The expert reviews and cognitive interviews found the disease-specific questionnaire to be understandable, with relevant content and value for diabetes care. An item-level content validity index ranged from 0.6-1.0 and a scale content validity/average ranged from 0.7-1.0. The fourth version, with 33 items, two main parts and seven dimensions, was answered by 972 adults with type 1 and type 2 diabetes (response rate 61%). Weighted Kappa values ranged from 0.31-0.78 for type 1 diabetes and 0.27-0.74 for type 2 diabetes.

CONCLUSIONS: This study describes the initial development of a disease-specific questionnaire in conjunction with the NDR. Content and face validity were confirmed and test-retest reliability was satisfactory.

PRACTICE IMPLICATIONS: With the development of this questionnaire, the NDR becomes a clinical tool that contributes to further understanding the perspectives of adult individuals with diabetes.

Keywords
Development, Patient-reported outcome, Type 1 diabetes, Type 2 diabetes, Validity
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-25651 (URN)10.1016/j.pec.2017.07.016 (DOI)28736071 (PubMedID)
Available from: 2017-07-31 Created: 2017-07-31 Last updated: 2018-02-09Bibliographically approved
Brorsson, A. L., Lindholm Olinder, A., Viklund, G., Granström, T. & Leksell, J. (2017). Adolescents’ perceptions of participation in group education using the Guided Self-Determination-Young method: a qualitative study. BMJ Open Diabetes Research & Care, 5(1), Article ID e000432.
Open this publication in new window or tab >>Adolescents’ perceptions of participation in group education using the Guided Self-Determination-Young method: a qualitative study
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2017 (English)In: BMJ Open Diabetes Research & Care, ISSN 2052-4897, Vol. 5, no 1, article id e000432Article in journal (Refereed) Published
Abstract [en]

Objective Guided Self-Determination (GSD) is a person-centered communication and reflection method. Education in groups may have a greater impact than the content of the education, and constructive communication between parents and adolescents has been shown to be of importance. The purpose of this study was to describe adolescents’ perceptions of participation in group education with the Guided Self-Determination-Young (GSD-Y) method, together with parents, in connection with the introduction of continuous subcutaneous insulin infusion.

Research design and methods In the present qualitative interview study, 13 adolescents with type 1 diabetes were included after completing a GSD-Y group education program in connection with the introduction of continuous subcutaneous insulin infusion at three hospitals located in central Sweden. The adolescents were interviewed individually, and qualitative content analysis was applied to the interview transcripts.

Results Two categories that emerged from the analysis were the importance of context and growing in power through the group process. An overarching theme that emerged from the interviews was the importance of expert and referent power in growing awareness of the importance of self-management as well as mitigating the loneliness of diabetes.

Conclusions GSD-Y has, in various ways, mitigated experiences of loneliness and contributed to conscious reflection about self-management in the group (referent power) together with the group leader (expert power). Overall, this highlights the benefits of group education, and the GSD method emphasizes the person-centered approach.

Keywords
adolescent, patient education, qualitatve research, type 1 diabetes
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-26578 (URN)29225894 (PubMedID)
Funder
Swedish Diabetes Association
Note

Open Access APC beslut 28/2017

Available from: 2017-11-21 Created: 2017-11-21 Last updated: 2018-09-11Bibliographically approved
Husdal, R., Rosenblad, A., Leksell, J., Eliasson, B., Jansson, S., Jerdén, L., . . . Thors Adolfsson, E. (2017). Resource allocation and organisational features in Swedish primary diabetes care: changes from 2006 to 2013. Primary Care Diabetes, 11(1), 20-28
Open this publication in new window or tab >>Resource allocation and organisational features in Swedish primary diabetes care: changes from 2006 to 2013
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2017 (English)In: Primary Care Diabetes, ISSN 1751-9918, E-ISSN 1878-0210, Vol. 11, no 1, p. 20-28Article in journal (Refereed) Published
Abstract [en]

AIMS: To compare the resource allocation and organisational features in Swedish primary diabetes care for patients with type 2 diabetes mellitus (T2DM) between 2006 and 2013.

METHODS: Using a repeated cross-sectional study design, questionnaires covering personnel resources and organisational features for patients with T2DM in 2006 and 2013 were sent to all Swedish primary health care centres (PHCCs) during the following year. In total, 684 (74.3%) PHCCs responded in 2006 and 880 (76.4%) in 2013.

RESULTS: Compared with 2006, the median list size had decreased in 2013 (p<0.001), whereas the median number of listed patients with T2DM had increased (p<0.001). Time devoted to patients with T2DM and diabetes-specific education levels for registered nurses (RNs) had increased, and more PHCCs had in-house psychologists (all p<0.001). The use of follow-up systems and medical check-ups had increased (all p<0.05). Individual counselling was more often based on patients' needs, while arrangement of group-based education remained low. Patient participation in setting treatment targets mainly remained low.

CONCLUSIONS: Even though the diabetes-specific educational level among RNs increased, the arrangement of group-based education and patient participation in setting treatment targets remained low. These results are of concern and should be prioritised as key features in the care of patients with T2DM.

Keywords
Organisational features; Primary diabetes care; Repeated cross-sectional survey; Resource allocation; Type 2 diabetes mellitus
National Category
Health Sciences
Research subject
Health and Welfare, Egenvård, hälsa och självanklagelse hos personer med diabetesrelaterad blindhet
Identifiers
urn:nbn:se:du-22701 (URN)10.1016/j.pcd.2016.08.002 (DOI)000392679200003 ()27578488 (PubMedID)
Available from: 2016-08-15 Created: 2016-08-15 Last updated: 2017-11-28Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-8682-2045

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