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Gyllensten, H., Tistad, M., Fridberg, H. & Wallin, L. (2023). Analysis on personnel costs and working time for implementing a more person-centred care approach: a case study with embedded units in a Swedish region. BMJ Open, 13(10), Article ID e073829.
Open this publication in new window or tab >>Analysis on personnel costs and working time for implementing a more person-centred care approach: a case study with embedded units in a Swedish region
2023 (English)In: BMJ Open, E-ISSN 2044-6055, Vol. 13, no 10, article id e073829Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: Our aim was to describe the time and costs used during the implementation of a more person-centred care (PCC) approach as part of ordinary practice.

DESIGN: A case study with embedded units.

SETTING: Region Dalarna, Sweden.

PARTICIPANTS: The Department for Development (DD) staff who provided a central support function in the implementation and six healthcare units: nephrology, two geriatric care and rehabilitation units, two psychiatry units and primary care.

INTERVENTIONS: More PCC.

PRIMARY AND SECONDARY OUTCOME MEASURES: Working days and related salary costs reported by categories indicating costs for implementation strategies, service delivery, and research/development costs.

RESULTS: The healthcare units logged on average 5.5 working days per staff member. In the healthcare units, 6%-57% of the time reported was used for implementation strategies, 40%-90% for service delivery and 2%-12% for research/development. Of the time reported by the DD, 88% was assigned to implementation strategies. Costs associated with reported time indicated 23% of costs for this implementation occurred in the DD. Using the budgeted cost, this proportion increased to 48%. The budget for the DD corresponded to SEK 2.30 per citizen per year and 0.009% of the total healthcare budget of the region.

CONCLUSIONS: The study found that a large part of resources used for this implementation of more PCC occurred in the DD, although at least half of the costs occurred in the healthcare units. Moreover, the cost of providing a central support function corresponds to a tiny proportion of the total health budget.

Keywords
HEALTH ECONOMICS, Health economics, Organisational development, Patient-Centered Care
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:du-47116 (URN)10.1136/bmjopen-2023-073829 (DOI)001085223600007 ()37821128 (PubMedID)2-s2.0-85174642171 (Scopus ID)
Available from: 2023-10-18 Created: 2023-10-18 Last updated: 2023-11-17Bibliographically approved
Nyberg, A., Sondell, A., Lundell, S., Marklund, S., Tistad, M. & Wadell, K. (2023). Experiences of Using an Electronic Health Tool Among Health Care Professionals Involved in Chronic Obstructive Pulmonary Disease Management: Qualitative Analysis.. JMIR Human Factors, 10, Article ID e43269.
Open this publication in new window or tab >>Experiences of Using an Electronic Health Tool Among Health Care Professionals Involved in Chronic Obstructive Pulmonary Disease Management: Qualitative Analysis.
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2023 (English)In: JMIR Human Factors, E-ISSN 2292-9495, Vol. 10, article id e43269Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is one of the most common and deadliest chronic diseases of the 21st century. eHealth tools are seen as a promising way of supporting health care professionals in providing evidence-based COPD care, for example, by reinforcing information and interventions provided to the patients and providing easier access and support to the health care professional themselves. Still, knowledge is scarce on the experience of using eHealth tools from the perspective of the health care professional involved in COPD management.

OBJECTIVE: The study explored the experiences of using an eHealth tool among health care professionals that worked with patients with COPD in their daily clinical practice.

METHODS: This exploratory qualitative study is part of a process evaluation in a parallel group, controlled, pragmatic pilot trial. Semistructured interviews were performed with 10 health care professionals 3 and 12 months after getting access to an eHealth tool, the COPD Web. The COPD Web, developed using cocreation, is an interactive web-based platform that aims to help health care professionals provide health-promoting strategies. Data from the interviews were analyzed using qualitative content analysis with an inductive approach.

RESULTS: The main results reflected health care professionals' experiences in 3 categories: receiving competence support and adjusting practice, improving quality of care, and efforts required for implementation. These categories highlighted that using an eHealth tool such as the COPD Web was experienced to provide knowledge support for health care professionals that led to adaptation and facilitation of working procedures and person-centered care. Taken together, these changes were perceived to improve the quality of care through enhanced patient contact and encouragement of interprofessional collaboration. In addition, health care professionals expressed that patients using the COPD Web were better equipped to tackle their disease and adhered better to provided treatment, increasing their self-management ability. However, structural and external barriers bar the successful implementation of an eHealth tool in daily praxis.

CONCLUSIONS: This study is among the first to explore experiences of using an eHealth tool among health care professionals involved in COPD management. Our novel findings highlight that using an eHealth tool such as the COPD Web may improve the quality of care for patients with COPD (eg, by providing knowledge support for health care professionals and adapting and facilitating working procedures). Our results also indicate that an eHealth tool fosters collaborative interactions between patients and health care professionals, which explains why eHealth is a valuable means of encouraging well-informed and autonomous patients. However, structural and external barriers requiring time, support, and education must be addressed to ensure that an eHealth tool can be successfully implemented in daily praxis.

TRIAL REGISTRATION: ClinicalTrials.gov NCT02696187; https://clinicaltrials.gov/ct2/show/NCT02696187.

Keywords
COPD, care, chronic, clinical, eHealth, electronic, health care professionals, implementation, internet, management, primary care, pulmonary, support, tools, web based
National Category
Nursing
Identifiers
urn:nbn:se:du-45829 (URN)10.2196/43269 (DOI)001017203700027 ()36995743 (PubMedID)2-s2.0-85151911915 (Scopus ID)
Available from: 2023-04-04 Created: 2023-04-04 Last updated: 2023-08-07Bibliographically approved
Hultman, L., Von Koch, L., Schön, U.-K. -., Åkesson, E. & Tistad, M. (2023). Exploring the Sharing and Legitimacy of Experience-Based Knowledge of Living with Acquired Brain Injury in Two Practice Communities. Health & Social Care in the Community, 2023, Article ID 6677161.
Open this publication in new window or tab >>Exploring the Sharing and Legitimacy of Experience-Based Knowledge of Living with Acquired Brain Injury in Two Practice Communities
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2023 (English)In: Health & Social Care in the Community, ISSN 0966-0410, E-ISSN 1365-2524, Vol. 2023, article id 6677161Article in journal (Refereed) Published
Abstract [en]

Background. Involving people with acquired brain injury in service development has the potential to improve service and give experience-based knowledge legitimacy. The objective of this study was to explore experiences of sharing experience-based knowledge of living with acquired brain injury with others, with a particular focus on the conditions for sharing and learning, and the legitimacy of experience-based knowledge. Materials and Methods. Using a single case study design, the processes in two groups that were part of a Swedish supportive network for people with acquired brain injury were explored. One group consisted mainly of people with acquired brain injury who authored a blog and the other group consisted of healthcare staff who produced educational material with the involvement of a person with own experience of acquired brain injury. The data consisted of forty-one collective blogs, fifteen semistructured individual interviews, and ten observations from meetings. The data were analysed by utilizing the community of practice framework and the concepts of legitimate peripheral participation and epistemic injustice. Results. The findings showed that both groups developed learning processes with a focus on everyday rehabilitation as a joint enterprise. Mutual engagement developed from doing activities together and legitimacy in the groups came from engagement in these activities. In the education group, the ambition to involve people with own experience of acquired brain injury was never realized in practice. Hence, experience-based knowledge of living with acquired brain injury never got legitimacy in the group. Conclusions. We conclude that integrating experience-based knowledge from people with own experience of acquired brain injury demands careful and deliberate planning with specific consideration to existing power asymmetries between healthcare professionals and people with own experience. Mitigating epistemic injustice and gaining legitimacy for such knowledge require that people with experience of living with acquired brain injury are recognized as knowledge producers. © 2023 Lill Hultman et al.

Place, publisher, year, edition, pages
Wiley-Hindawi, 2023
National Category
Health Sciences
Identifiers
urn:nbn:se:du-47652 (URN)10.1155/2023/6677161 (DOI)001129218000001 ()2-s2.0-85180606085 (Scopus ID)
Available from: 2024-01-02 Created: 2024-01-02 Last updated: 2024-01-15Bibliographically approved
Goldkuhl, L., Tistad, M., Gyllensten, H. & Berg, M. (2023). Implementing a new birthing room design: a qualitative study with a care provider perspective. BMC Health Services Research, 23(1), Article ID 1122.
Open this publication in new window or tab >>Implementing a new birthing room design: a qualitative study with a care provider perspective
2023 (English)In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 23, no 1, article id 1122Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Research shows that interventions to protect the sensitive physiological process of birth by improving the birthing room design may positively affect perinatal outcomes. It is, however, crucial to understand the mechanisms and contextual elements that influence the outcomes of such complex interventions. Hence, we aimed to explore care providers' experiences of the implementation of a new hospital birthing room designed to be more supportive of women's birth physiology.

METHODS: This qualitative study reports on the implementation of the new birthing room, which was evaluated in the Room4Birth randomised controlled trial in Sweden. Individual interviews were undertaken with care providers, including assistant nurses, midwives, obstetricians, and managers (n = 21). A content analysis of interview data was conducted and mapped into the three domains of the Normalisation Process Theory coding manual: implementation context, mechanism, and outcome.

RESULTS: The implementation of the new room challenged the prevailing biomedical paradigm within the labour ward context and raised the care providers' awareness about the complex interplay between birth physiology and the environment. This awareness had the potential to encourage care providers to be more emotionally present, rather than to focus on monitoring practices. The new room also evoked a sense of insecurity due to its unfamiliar design, which acted as a barrier to integrating the room as a well-functioning part of everyday care practice.

CONCLUSION: Our findings highlight the disparity that existed between what care providers considered valuable for women during childbirth and their own requirements from the built environment based on their professional responsibilities. This identified disparity emphasises the importance of hospital birthing rooms (i) supporting women's emotions and birth physiology and (ii) being standardised to meet care providers' requirements for a functional work environment.

TRIAL REGISTRATION: ClinicalTrials.gov: NCT03948815, 14/05/2019.

Keywords
Birth environment design, Birthing room, Care provider, Childbirth, Complex interventions, Implementation science, Maternal health services, Normalisation process theory, Qualitative research
National Category
Nursing
Identifiers
urn:nbn:se:du-47147 (URN)10.1186/s12913-023-10051-3 (DOI)001145792800005 ()37858103 (PubMedID)2-s2.0-85174517964 (Scopus ID)
Available from: 2023-10-24 Created: 2023-10-24 Last updated: 2024-02-22Bibliographically approved
Lindblom, S., Ytterberg, C., Flink, M., Carlsson, A. C., Stenberg, U., Tistad, M., . . . Laska, A. C. (2023). The Use of Teach Back at Hospital Discharge to Support Self-Management of Prescribed Medication for Secondary Prevention after Stroke-Findings from A Feasibility Study. Healthcare, 11(3), Article ID 391.
Open this publication in new window or tab >>The Use of Teach Back at Hospital Discharge to Support Self-Management of Prescribed Medication for Secondary Prevention after Stroke-Findings from A Feasibility Study
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2023 (English)In: Healthcare, E-ISSN 2227-9032, Vol. 11, no 3, article id 391Article in journal (Refereed) Published
Abstract [en]

The study aimed to investigate whether a structured discharge letter and the use of the person-centred communication method Teach Back for sharing information at hospital discharge could support perceived understanding and knowledge of and adherence to prescribed medication for secondary prevention after stroke. Data from a feasibility study of a codesigned care transition support for people with stroke was used. Patients who at discharge received both a structured discharge letter and participated in the person-centred communication method Teach Back (n = 17) were compared with patients receiving standard discharge procedures (n = 21). Questionnaires were used to compare the groups regarding perceived understanding of information about medical treatment, knowledge of information about medical treatment and medication adherence at 1 week and 3 months. There was a statistically significant difference in perceived understanding of information about medical treatment (p > 0.01) between the groups in favour of those who participated in Teach Back at the discharge encounter. No differences between groups were found regarding understanding health information about medical treatment and medication adherence. The results indicate that the use of Teach Back at the discharge encounter positively impacts perceived understanding of information about medical treatment in people with stroke. However, considering the nonrandomised study design and the small sample size, a large-scale trial is needed.

Keywords
care transitions, communication, health literacy, medication adherence, patient discharge, rehabilitation
National Category
Nursing
Identifiers
urn:nbn:se:du-45448 (URN)10.3390/healthcare11030391 (DOI)000930309100001 ()36766966 (PubMedID)2-s2.0-85147829871 (Scopus ID)
Available from: 2023-02-14 Created: 2023-02-14 Last updated: 2023-03-23Bibliographically approved
Tistad, M., Bergström, A., Elf, M., Eriksson, L., Gustavsson, C., Göras, C., . . . Wallin, L. (2023). Training and support for the role of facilitator in implementation of innovations in health and community care: a scoping review protocol.. Systematic Reviews, 12(1), Article ID 15.
Open this publication in new window or tab >>Training and support for the role of facilitator in implementation of innovations in health and community care: a scoping review protocol.
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2023 (English)In: Systematic Reviews, E-ISSN 2046-4053, Vol. 12, no 1, article id 15Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Implementing and sustaining innovations in clinical practice, such as evidence-based practices, programmes, and policies, is frequently described as challenging. Facilitation as a strategy for supporting implementation requires a facilitator, i.e. an individual with a designated role to support the implementation process. A growing number of studies report that facilitation can help tackle the challenges in implementation efforts. To optimise the potential contribution of facilitation as a strategy to improve the implementation of new practices, there is a need to enhance understanding about what training and support is required for individuals in the facilitator role. The objective of this scoping review is to map how facilitators have been trained for, and supported in, the facilitator role in implementation studies in health and community care. Specifically, the review aims to examine what is reported on training and support of facilitators in terms of learning outcomes, content, dose, mode of delivery, learning activities, and qualifications of the trainers and how the facilitators perceive training and support.

METHODS: This scoping review will follow the guidance of the Joanna Briggs Institute and the PRISMA Extension for Scoping Review checklist. We will include articles in which (a) facilitation is deployed as an implementation strategy, with identified facilitator roles targeting staff and managers, to support the implementation of specified innovations in health or community care, and (b) training and/or support of facilitators is reported. We will exclude articles where facilitation is directed to education or training in specific clinical procedures or if facilitation supports the implementation of general quality improvement systems. All types of peer-reviewed studies and study protocols published in English will be included. A systematic search will be performed in MEDLINE (Ovid), Embase (embase.com), Web of Science Core Collection, and CINAHL (Ebsco).

DISCUSSION: The proposed scoping review will provide a systematic mapping of the literature on the training and support of implementation facilitators and contribute useful knowledge within the field of implementation science to inform future facilitation initiatives.

SYSTEMATIC REVIEW REGISTRATION: Registered at Open Science Framework (registration https://doi.org/10.17605/OSF.IO/M6NPQ ).

Keywords
Community care, Evidence-based practice, Facilitation, Facilitator, Healthcare services, Implementation science, Supervision, Support, Training, i-PARIHS
National Category
Nursing
Identifiers
urn:nbn:se:du-45393 (URN)10.1186/s13643-023-02172-x (DOI)000924318500001 ()36721192 (PubMedID)2-s2.0-85147186976 (Scopus ID)
Available from: 2023-02-07 Created: 2023-02-07 Last updated: 2023-03-02Bibliographically approved
Tistad, M., Wallin, L. & Carlström, E. (2022). A comparison of three organisational levels in one health care region in Sweden implementing person-centred care: coupled, decoupled or recoupled in a complex organisation. BMC Health Services Research, 22(1), Article ID 196.
Open this publication in new window or tab >>A comparison of three organisational levels in one health care region in Sweden implementing person-centred care: coupled, decoupled or recoupled in a complex organisation
2022 (English)In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 22, no 1, article id 196Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Establishing more substantial patient involvement in the health care has become fundamental to Western health care services. Person-centred care (PCC) has been developed as a way of working that involve the patients and family members. However, the implementation of PCC in clinical practice has proven to be challenging. The aim of this study was to explore the congruence of managers' perceptions and understanding of various aspects of PCC across three organisational levels in one health care region in Sweden in terms of coupling, decoupling and recoupling.

METHODS: A policy on increased patient participation in health care was adopted in one health care region in Sweden. This policy was embodied in the form of PCC and a support strategy for the implementation was put in place. Participants representing three organisational levels (senders: politicians, n = 3; messengers: senior management, n = 7; and receivers: middle- and frontline managers, n = 13) were interviewed and documents collected. A deductive qualitative content analysis was performed and findings from the three organisational levels compared.

RESULTS: Descriptions of PCC at all the three organisational levels included health care provided in partnership between provider and patient. However, messengers and receivers also included aspects of how work was organised as part of the concept. Representatives at all levels expected high-quality care while reducing health care costs as an outcome, however, messengers and receivers also anticipated improvements in the work environment and reduced staff turnover. Strategies to support implementation included continuation and enhancement of existing routines that were considered person-centred and development of new ones. A need to make PCC less 'fuzzy' and ambiguous and instead communicate a more tangible care process was described. Representatives among messengers and receivers also suggested that no actions were needed because the practice was already considered person-centred.

CONCLUSION: The findings indicated that congruence between organisational levels existed in some aspects, suggesting coupling between policy and practice. However, also incongruences were identified that might be due to the fuzziness of definitions and the application of PCC in practice, and the difficulty in assessing the level of patient-centredness in clinical practice.

Keywords
Health policy, Implementation, Person-centred care, Spread, Sweden
National Category
Nursing
Identifiers
urn:nbn:se:du-39654 (URN)10.1186/s12913-022-07548-8 (DOI)000756260300009 ()35164765 (PubMedID)2-s2.0-85124621717 (Scopus ID)
Projects
Implementing person-centred care: process evaluation of strategies, leadership and health economy using process evaluation, IMPROVE
Available from: 2022-02-22 Created: 2022-02-22 Last updated: 2023-04-14Bibliographically approved
Andersson, P., Tistad, M., Eriksson, Å., Enebrink, P. & Sturidsson, K. (2022). Implementation and evaluation of Illness Management and Recovery (IMR) in mandated forensic psychiatric care – Study protocol for a multicenter cluster randomized trial. Contemporary Clinical Trials Communications, 27, 100907-100907, Article ID 100907.
Open this publication in new window or tab >>Implementation and evaluation of Illness Management and Recovery (IMR) in mandated forensic psychiatric care – Study protocol for a multicenter cluster randomized trial
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2022 (English)In: Contemporary Clinical Trials Communications, E-ISSN 2451-8654, Vol. 27, p. 100907-100907, article id 100907Article in journal (Refereed) Published
Abstract [en]

Introduction: Forensic mental health care is hampered by lack of evidence-based treatments. The Swedish forensic mental health population consists of patients suffering from severe illnesses such as schizophrenia and bipolar disorders, similar to populations in international studies. Illness Management and Recovery (IMR) is an intervention for patients with serious mental illness, based on psychoeducational, cognitive-behavioral and motivational components. The purpose is to strengthen participants’ illness management skills and recovery. Objective: To test effectiveness of IMR within forensic mental health by comparing it to treatment as usual. Method: This is a cluster-randomized controlled trial. Patients in forensic mental health inpatient units are randomized to an active (IMR) or a control condition (treatment as usual). Clustering of patients is based on ward-units where inpatients are admitted. Patients in the active condition receive two group and one individual IMR sessions per week. The treatment phase is estimated to last nine months. Outcomes include illness related disability, illness management skills, sense of recovery, hope, mental health and security related problems. Outcomes are measured at baseline, four months into treatment, at treatment completion and at three months follow-up. Staff experiences of implementing IMR will be explored by a self-report measure and semi-structured interview based on Normalization Process Theory. Ethics and dissemination: The study is approved by the Swedish Ethical Review Authority (Registration No. 2020–02046). Participation will be voluntary based on written informed consent. Results will be disseminated through peer-reviewed articles and conferences. The study is registered in the US registry of clinical trials (NCT04695132). 

Keywords
Forensic mental health; Illness management and recovery; Offender rehabilitation; Schizophrenia spectrum disorder
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:du-41596 (URN)10.1016/j.conctc.2022.100907 (DOI)000795154300006 ()35499065 (PubMedID)2-s2.0-85128142859 (Scopus ID)
Available from: 2022-06-14 Created: 2022-06-14 Last updated: 2023-03-17Bibliographically approved
Fridberg, H., Wallin, L. & Tistad, M. (2022). Operationalisation of person-centred care in a real-world setting: a case study with six embedded units. BMC Health Services Research, 22(1), Article ID 1160.
Open this publication in new window or tab >>Operationalisation of person-centred care in a real-world setting: a case study with six embedded units
2022 (English)In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 22, no 1, article id 1160Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Although person-centred care (PCC) is growing globally in popularity it is often vague and lacks conceptual clarity and definition. The ambiguity stretches from PCC's underlying philosophical principles and definitions of the concept to how it is operationalised and practised on the ground by health care professionals. We explore how the PCC model by the Gothenburg University Centre for Person-centred Care (GPCC) was operationalised in a real-world setting by using a set of recommendations by Fixsen and others that define and structure the core components of innovations in four distinct but interrelated components: philosophical principles and values, contextual factors, structural elements and core practices. Thus, this study aimed to increase knowledge about core practices in PCC in six health care units in real-world circumstances.

METHODS: A case study with six embedded health care units was conducted from 2016 to 2019. We collected data from three sources: interviews (n = 12) with change agents, activity logs and written documents. Data were triangulated, and core practices were identified and deductively coded to the PCC model's structural elements: initiating, working and safeguarding the partnership with patients.

RESULTS: We identified operationalisations of PCC in line with the three structural elements in the GPCC model at all included health care units. A range of both similarities and dissimilarities between units were identified, including the level of detail in describing PCC practices, when these practices were conducted and by whom at the workplace. The recommendations for describing the core components of PCC also helped us identify how some operationalisations of PCC seemed more driven by contextual factors, including a new regulation for planning and documenting care across health care specialities.

CONCLUSIONS: Our findings show how PCC is operationalised in different health care units in a real-world setting based on change agents' understanding of the concept and their unique context. Increased knowledge of PCC and its philosophical principles and values, contextual factors, structural elements and core practices, is necessary to build a common understanding of the PCC-concept. Such knowledge is essential when PCC is operationalised as part of implementation efforts in health care.

Keywords
Case study, Core components, Implementation, Operationalisation, Person-centred care
National Category
Nursing
Identifiers
urn:nbn:se:du-42742 (URN)10.1186/s12913-022-08516-y (DOI)000855171800006 ()36104690 (PubMedID)2-s2.0-85137927170 (Scopus ID)
Available from: 2022-09-22 Created: 2022-09-22 Last updated: 2023-03-17Bibliographically approved
Sedelius, H., Tistad, M., Bergsten, U., Dehlin, M., Iggman, D., Wallin, L. & Svärd, A. (2022). Professionals' perspectives on existing practice and conditions for nurse-led gout care based on treatment recommendations: a qualitative study in primary healthcare. BMC Primary Care, 23(1), Article ID 71.
Open this publication in new window or tab >>Professionals' perspectives on existing practice and conditions for nurse-led gout care based on treatment recommendations: a qualitative study in primary healthcare
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2022 (English)In: BMC Primary Care, ISSN 2731-4553, Vol. 23, no 1, article id 71Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Gout affects nearly 2 % of the population and is associated with repeated painful flares of arthritis. Preventive urate-lowering therapy is widely available, but only one third of patients receive adequate treatment. Lack of knowledge among healthcare professionals and patients within primary healthcare are implicated as partial explanations for this undertreatment. Nurse-led care has proved to be an effective model when treating patients with gout, but there is a need for more knowledge about factors that can be expected to influence the future implementation of such care. The aim of this study was to describe factors influencing existing gout care in primary healthcare and the conditions for a future implementation of nurse-led gout care based on national treatment recommendations.

METHODS: In this qualitative study, focus group discussions with 56 nurses and physicians and individual interviews with eight managers were conducted at nine primary healthcare units in central Sweden. A deductive qualitative content analysis based on the main constructs of the framework Integrated Promoting Action on Research Implementation in Health Services was followed by an inductive analysis within the frames of the main constructs: innovation, recipients and context.

RESULTS: Gout-related contacts with primary healthcare was described as being patient initiated, diagnostics was in some respects complex and nurse-led care was experienced as a favourable primary healthcare model in general (innovation). Gout was seen as a low-priority condition with acute flares and there was inadequate knowledge of gout, including preventive treatment (recipients). Primary healthcare was perceived as having a holistic but fragmented responsibility for gout care, recommendations against keeping waiting lists complicated follow-up appointments and a need for motivation and support when introducing new practices was emphasised (context).

CONCLUSION: In this study, investigating the perspective of professionals, several factors were found to influence existing gout care. It will be crucial to target these factors in the development of a future implementation strategy.

Keywords
Experiences, Gout, I-PARIHS, Implementation, Nurse-led care, Personnel experiences, Primary healthcare
National Category
Nursing
Identifiers
urn:nbn:se:du-41348 (URN)10.1186/s12875-022-01677-z (DOI)000781351100001 ()35392809 (PubMedID)2-s2.0-85127893206 (Scopus ID)
Available from: 2022-05-02 Created: 2022-05-02 Last updated: 2023-03-17Bibliographically approved
Projects
SveNN: Svenskt Nätverk för Normalization Process Theory-relaterad implementeringsforskning
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-0581-2895

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