COPD health care in Sweden – A study in primary and secondary care

Tilling, Björn; Ekström, Thommy; Jørgensen, Leif; Johansson, Gunnar; Larsson, Kjell

doi:10.1016/j.rmed.2009.10.007

Cited by 27 publications

(36 citation statements)

References 19 publications

(11 reference statements)

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“…According to national criteria for asthma/COPD receptions in primary care [39], a level corresponding to 10 weeks of university supplementary training about asthma and COPD for a COPD nurse is an acceptable level. Two third of the nurses in our study did not reach even half that level and similar results were found in a study covering the whole Sweden [48]. In the subcategory Driving spirit carries COPD care the COPD nurses was described to be main responsible for the spirometry tests, that is required to confirm a COPD diagnosis [1].…”

Section: Discussionsupporting

confidence: 60%

“…Meanwhile, earlier Swedish surveys [23, 24, 48] have reported high availability of professionals for rehabilitation in primary care. Access to patient education in groups was low in our study, while earlier studies [23, 24] showed that nearly half of the centres had access to PR-programmes in primary care, while a quarter sent their patients to hospital-based PR-programs [23].…”

Section: Discussionmentioning

confidence: 99%

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Building COPD care on shaky ground: a mixed methods study from Swedish primary care professional perspective

Lundell

Tistad

Rehn

et al. 2017

BMC Health Serv Res

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BackgroundChronic obstructive pulmonary disease (COPD) is a public health problem. Interprofessional collaboration and health promotion interventions such as exercise training, education, and behaviour change are cost effective, have a good effect on health status, and are recommended in COPD treatment guidelines. There is a gap between the guidelines and the healthcare available to people with COPD.The aim of this study was to increase the understanding of what shapes the provision of primary care services to people with COPD and what healthcare is offered to them from the perspective of healthcare professionals and managers.MethodsThe study was conducted in primary care in a Swedish county council during January to June 2015. A qualitatively driven mixed methods design was applied. Qualitative and quantitative findings were merged into a joint analysis. Interviews for the qualitative component were performed with healthcare professionals (n = 14) from two primary care centres and analysed with qualitative content analysis. Two questionnaires were used for the quantitative component; one was answered by senior managers or COPD nurses at primary care centres (n = 26) in the county council and the other was answered by healthcare professionals (n = 18) at two primary care centres. The questionnaire data were analysed with descriptive statistics.ResultsThe analysis gave rise to the overarching theme building COPD care on shaky ground. This represents professionals driven to build a supportive COPD care on ‘shaky’ organisational ground in a fragmented and non-compliant healthcare organisation. The shaky ground is further represented by uninformed patients with a complex disease, which is surrounded with shame. The professionals are autonomous and pragmatic, used to taking responsibility for their work, and with limited involvement of the management. They wish to provide high quality COPD care with interprofessional collaboration, but they lack competence and are hindered by inadequate routines and lack of resources.ConclusionsThere is a gap between COPD treatment guidelines and the healthcare that is provided in primary care. To facilitate implementation of the guidelines several actions are needed, such as further training for professionals, additional resources, and improved organisational structure for interprofessional collaboration and patient education.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-017-2393-y) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 60%

Section: Discussionmentioning

confidence: 99%

Building COPD care on shaky ground: a mixed methods study from Swedish primary care professional perspective

Lundell

Tistad

Rehn

et al. 2017

BMC Health Serv Res

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“…The corresponding rates in non-COPD subjects in the same studies were 33% and 13%, respectively. [35,39] A survey of COPD patients in secondary care (2007) showed that 23% were still smokers [40] compared to national estimates of around 16% (2005) in the whole population (>45 years of age) [37].…”

Section: Methodological Considerationsmentioning

confidence: 99%

Incidence of stroke and stroke subtypes in chronic obstructive pulmonary disease

et al. 2015

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Incidence of stroke and stroke subtypes in chronic obstructive pulmonary disease.Söderholm, Martin; Inghammar, Malin; Hedblad, Bo; Egesten, Arne; Engström, Gunnar Link to publication Citation for published version (APA): Söderholm, M., Inghammar, M., Hedblad, B., Egesten, A., & Engström, G. (2016). Incidence of stroke and stroke subtypes in chronic obstructive pulmonary disease. European Journal of Epidemiology, 31(2), 159-168. DOI: 10.1007/s10654-015-0113-7 General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.• Users may download and print one copy of any publication from the public portal for the purpose of private study or research.• You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal Take down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim. ABSTRACT BackgroundIt is uncertain whether the incidence of stroke is increased in patients with chronic obstructive pulmonary disease (COPD), and whether COPD is associated with all subtypes of stroke (i.e. ischemic stroke, intracerebral haemorrhage and subarachnoid haemorrhage). We evaluated the association between COPD and incidence of stroke in a nation-wide cohort study. MethodsAll individuals between 40 and 84 years of age, hospitalised for COPD between 1987and 2003 in Sweden were identified in the Swedish hospital discharge register. For each COPD patient (n=103,419), one reference individual was randomly selected from the general population matched for year of birth, sex and county of residence.After excluding subjects with prior stroke, incidence rates during 10 years follow-up were calculated. Hazard ratios (HR) for stroke comparing COPD patients with reference subjects were estimated using Cox regression adjusting for demographics and comorbidities. ResultsIncidence of all-cause stroke (n events=17,402) was significantly increased in COPD patients compared to reference individuals ConclusionsIncidences of all stroke subtypes are increased in COPD, especially during the first years after COPD diagnosis. The association was independent of several comorbidities, although residual confounding from smoking and hypertension cannot be excluded. A global evaluation of stroke risk factors seems warranted in patients with COPD.

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“…11 Most PC centers in Sweden have spirometers and specialized asthma/COPD nurses who provide customized care. 10 Annual societal costs of COPD in Sweden in 2010 were estimated at €1.5 billion, and similar to the picture globally, indirect costs were higher than direct costs of the disease, accounting for 65% and 35% of the total costs, respectively. 12 It is important to better understand the economic burden of COPD in Sweden regarding direct and indirect cost drivers, particularly how these costs differ between patients with/without COPD.…”

mentioning

confidence: 80%

“…3 A majority of patients with COPD in Sweden are managed in PC. 10 During an acute exacerbation, patients present at their primary health care center or at the hospital emergency department. 11 Most PC centers in Sweden have spirometers and specialized asthma/COPD nurses who provide customized care.…”

mentioning

confidence: 99%