Health Care Centres In Finland Research Articles

The integration of dermatology experts into primary care to assess and treat patients with skin lesions is cost-effective: A quasi-experimental study.

The management of patients with skin changes can be challenging in primary healthcare; general practitioners (GPs) often lack the expertise to make accurate assessments and treatment decisions. The standard care pathway for skin changes can result in extended treatment times and costs. This study was designed to evaluate the cost-effectiveness of integrating a dermatologist into the primary care setting to assess and treat patients with skin disorders. The primary outcome was the incremental cost-effectiveness ratio (ICER) for each malignant or pre-malignant skin disease found and treated. The secondary outcomes included ICER for any treated skin finding, number needed to excise to find malignant or pre-malignant skin disease, number of hospital referrals required and changes in quality of life (QoL) in the presence and absence of the integration. This was a quasi-experimental cohort study conducted at three primary healthcare centres in Finland. In the two intervention centres, patients with skin findings visited a dermatologist; in the control centre they visited a GP. Cost-effectiveness was assessed using the incremental cost-effectiveness ratio (ICER). QoL was assessed with the PROMIS v1.2, calculative EQ-5D-3L and PROMIS Anxiety 4a instruments. In total, 186 integration and 176 control patients were included. For an additional patient treated for a (pre-)malignant skin disease, the ICER was €852 lower and with any skin disease €381 lower in the integration group than with standard care. Fewer biopsies were required for each malignant or pre-malignant skin disease in the integration group compared to the control group (2.1 and 6.5 per patient; p < 0.001) and lower proportion of patients were referred to hospital (8.1 vs. 17.1%, p < 0.001). Patient QoL did not differ between groups. The integration of dermatological expertise into primary care settings is cost-effective and can streamline the management of patients with skin conditions without worsening their QoL.

User-Initiated Symptom Assessment With an Electronic Symptom Checker: Protocol for a Mixed Methods Validation Study.

The national Omaolo digital social welfare and health care service of Finland provides a symptom checker, Omaolo, which is a medical device (based on Duodecim Clinical Decision Support EBMEDS software) with a CE marking (risk class IIa), manufactured by the government-owned DigiFinland Oy. Users of this service can perform their triage by using the questions in the symptom checker. By completing the symptom checker, the user receives a recommendation for action and a service assessment with appropriate guidance regarding their health problems on the basis of a selected specific symptom in the symptom checker. This allows users to be provided with appropriate health care services, regardless of time and place. This study describes the protocol for the mixed methods validation process of the symptom checker available in Omaolo digital services. This is a mixed methods study using quantitative and qualitative methods, which will be part of the clinical validation process that takes place in primary health care centers in Finland. Each organization provides a space where the study and the nurse triage can be done in order to include an unscreened target population of users. The primary health care units provide walk-in model services, where no prior phone call or contact is required. For the validation of the Omaolo symptom checker, case vignettes will be incorporated to supplement the triage accuracy of rare and acute cases that cannot be tested extensively in real-life settings. Vignettes are produced from a variety of clinical sources, and they test the symptom checker in different triage levels by using 1 standardized patient case example. This study plan underwent an ethics review by the regional permission, which was requested from each organization participating in the research, and an ethics committee statement was requested and granted from Pirkanmaa hospital district's ethics committee, which is in accordance with the University of Tampere's regulations. Of 964 clinical user-filled symptom checker assessments, 877 cases were fully completed with a triage result, and therefore, they met the requirements for clinical validation studies. The goal for sufficient data has been reached for most of the chief symptoms. Data collection was completed in September 2019, and the first feasibility and patient experience results were published by the end of 2020. Case vignettes have been identified and are to be completed before further testing the symptom checker. The analysis and reporting are estimated to be finalized in 2024. The primary goals of this multimethod electronic symptom checker study are to assess safety and to provide crucial information regarding the accuracy and usability of the Omaolo electronic symptom checker. To our knowledge, this will be the first study to include real-life clinical cases along with case vignettes. DERR1-10.2196/41423.

The effects of nurse-led health coaching on health-related quality of life and clinical health outcomes among frequent attenders: A quasi-experimental study

ObjectiveTo evaluate the effects of the nurse-led health coaching on health-related quality of life and clinical health outcomes among frequent attenders in primary healthcare. MethodsA quasi-experimental study design. A total of 110 patients were enrolled in the study. The experimental group (n = 52) received nurse-led health coaching and the control group (n = 58) received the usual care at primary health care centres in Finland. The data were collected before the intervention and 12 months via a questionnaire of health-related quality of life and clinical health outcomes as measured by health-coaching nurses. ResultsThis study found frequent attenders have low health-related quality of life. The nurse-led health coaching showed no differences in health-related quality of life between the experimental and control groups. However, the nurse-led health coaching had statistically significant effects on the blood pressure and health-related quality of life among the experimental participants, especially in emotional role limitation and energy. ConclusionsThis study suggests that nurse-led health coaching may lead to an improvement in the health-related quality of life and blood pressure among frequent attenders. Practice ImplicationsThe health-coaching sessions with own health-coaching nurses and action plans support the frequent attenders´ health promotion goals and implementation.

A systematic-qualitative research for diffusion of innovation in the primary healthcare centers

Purpose – This paper aims to discuss a model for diffusion of innovation among the professionals of primary health-care centers in Finland. The authors answer partially to one of the important questions of the policymakers titled “How primary health-care centers can move toward systems that continuously improve their innovation?”. Design/methodology/approach – A systematic-qualitative framework based on an action research is presented to assess dynamics of diffusion of innovation in the primary health-care centers in Finland. Findings – The authors conceptualize the innovation systems of primary health-care systems by three different diagrams: subsystem diagram, policy structure diagram and causal loop diagram. The investigation reviews innovation process of Finnish professionals (staffs, nurses and doctors) in the frame of a systematic-qualitative analysis. The relationships and consequences of decisions and policies are discussed with a new way of thinking in the health-care sector studies. Originality/value – The implemented systematic-qualitative research in this article is an innovative approach in the innovation studies of the health-care systems.

The smoking habit of a close friend or family member—how deep is the impact? A cross-sectional study

ObjectivesTo assess the risk of becoming a smoker in adulthood associated with parental smoking as well as the smoking of siblings and close friends.DesignA cross-sectional study.Setting4 oral healthcare centres in...

Attitudes Toward Guidelines in Finnish Primary Care Nursing: A Questionnaire Survey

Evidence-based clinical guidelines have attracted international interest as tools for improving the quality of health care. Attitudes toward these guidelines are of great importance because attitudes are proven to be important predictors of guideline use. Attitudes are also believed to be shaped by perceptions of others, which makes the role of organizational implementation interventions interesting. This article describes primary care nurses' attitudes toward guidelines among Finnish primary care nurses and the associations between attitudes, implementation interventions, and guideline use. This study was a cross-sectional survey using postal questionnaires. Participants (N = 409) were primary care nurses working in outpatient services of primary health care centers in Finland. They were selected for the study from two groups of Finnish health centers representing contrasting implementation styles, for example, disseminator and implementer health centers (N = 32). Responses were received from 327 nurses. In general, nurses' attitudes toward guidelines were positive, especially those concerning the reliability and usefulness of guidelines. The utilization of any implementation intervention included in the questionnaire was associated with more positive attitudes. In addition, nurses working in health centers that used an active implementation strategy as opposed to a disseminator strategy also felt that others in their organization rated the guidelines more positively and that guidelines were more easily available. Further, nurses who were familiar or very familiar with the guidelines had more positive attitudes toward them. Attitudes were also associated with self-reported guideline use. The evidence-based guidelines were accepted as a reliable source of advice in patient care in Finnish primary care. It seems that implementation interventions improve attitudes toward guidelines and enhance guideline use. These interventions might also be important from another point of view; they presumably improve familiarity with guidelines, which was also associated with guideline use.

Network of vascular diseases, death and biochemical characteristics in a set of 4,197 patients with type 1 diabetes (The FinnDiane Study)

BackgroundCardiovascular disease is the main cause of premature death in patients with type 1 diabetes. Patients with diabetic kidney disease have an increased risk of heart attack or stroke. Accurate knowledge of the complex inter-dependencies between the risk factors is critical for pinpointing the best targets for research and treatment. Therefore, the aim of this study was to describe the association patterns between clinical and biochemical features of diabetic complications.MethodsMedical records and serum and urine samples of 4,197 patients with type 1 diabetes were collected from health care centers in Finland. At baseline, the mean diabetes duration was 22 years, 52% were male, 23% had kidney disease (urine albumin excretion over 300 mg/24 h or end-stage renal disease) and 8% had a history of macrovascular events. All-cause mortality was evaluated after an average of 6.5 years of follow-up (25,714 patient years). The dataset comprised 28 clinical and 25 biochemical variables that were regarded as the nodes of a network to assess their mutual relationships.ResultsThe networks contained cliques that were densely inter-connected (r > 0.6), including cliques for high-density lipoprotein (HDL) markers, for triglycerides and cholesterol, for urinary excretion and for indices of body mass. The links between the cliques showed biologically relevant interactions: an inverse relationship between HDL cholesterol and the triglyceride clique (r < -0.3, P < 10-16), a connection between triglycerides and body mass via C-reactive protein (r > 0.3, P < 10-16) and intermediate-density cholesterol as the connector between lipoprotein metabolism and albuminuria (r > 0.3, P < 10-16). Aging and macrovascular disease were linked to death via working ability and retinopathy. Diabetic kidney disease, serum creatinine and potassium, retinopathy and blood pressure were inter-connected. Blood pressure correlations indicated accelerated vascular aging in individuals with kidney disease (P < 0.001).ConclusionThe complex pattern of links between diverse characteristics and the lack of a single dominant factor suggests a need for multifactorial and multidisciplinary paradigms for the research, treatment and prevention of diabetic complications.

Cost-effectiveness of implementing national guidelines in the treatment of acute otitis media in children

Acute otitis media (AOM) is one of the most common diseases of childhood, representing a major disease burden on the society. New evidence-based guidelines for AOM, focusing on children under 7 years of age, were introduced in Finland in 1999. The aim of this study was to evaluate the cost-effectiveness of implementing those guidelines in Finland. A 5-year prospective trial was conducted in thirty community primary healthcare centers in Finland. All AOM patients between 0 and 6 years of age visiting the study health centers for the first time, for this episode of illness, during 1 week in November 1998 (n = 579) and November 2002 (n = 369) were included in this study. The outcome measure was the percentage of symptom-free patients. The mean direct cost of an AOM episode per patient stayed almost the same after implementing the guidelines, euro152 in 1998 and euro150 in 2002. After implementing the guidelines, the percentage of symptom-free patients was 10 percentage points higher than before the guidelines. The treatment after the implementation of the guidelines, thus, was a dominant strategy. Implementing the guidelines to the treatment of AOM in children was associated with extra health benefits at slightly lower direct costs and, thus, is a dominant strategy. The focus of this study was on the short-term effects of the treatment; including long-term effects in the analysis might affect the results.

Modifying Antibiotic Prescribing in Primary Care

a result of inactive empirical antibiotic therapy as well as increasing economic costs for the community. Data on the association between the appropriateness of empirical antibiotic therapy and paitent outcomes is sparse for primary health care, compared with data from hospital settings, but anecdotal experience indicates that poor early antibiotic choice may be associated with progression of infection leading to hospitalization. In view of the above concerns, it appears reasonable that efforts be expended to improve the adequacy of antibiotic prescribing in the primary care setting. In this issue of Clinical Infectious Diseases, Rautakorpi et al. [7] describe a remarkable effort to improve antibiotic use in the Finnish primary health care setting. It has long been known that antibiotic prescribing is taken seriously in Scandinavia; indeed, almost one-third of all primary health care centers in Finland expressed a willingness to participate in this study. A multifaceted intervention was initiated over a 2-year period, primarily targeting physicians, although the authors hint at enhanced education for patients. One physician from each participating health care center spent 6.5 days in a “train the trainer” program. Their primary goal was to improve compliance among their colleagues with antibiotic prescribing guidelines for 6 common infections—otitis media, sinusitis, pharyngitis, acute bronchitis, bacterial skin infections, and urinary tract infections. Feedback on the study results, which acted as an important stimulus for ongoing adherence, was given to the physicians once a year. The intervention was successful on some, but not all, counts. There were significant improvements in compliance with first-line antibiotic treatment recommendations for sinusitis (from 35% to 51%; ), acute bronchitis (from 4% to P ! .001 9%; ), and urinary tract infec

The quality of GP consultation in two different salary systemsA Finnish experience

Objective – To compare the quality of consultations between two Finnish employment contract systems: the capitation-based contract (CB) and the time-based contract (TB). Design – Cross-sectional study based on paired questionnaires answered by patients and general practitioners (GPs). Setting and subjects – 81 GPs with their patients from four health care centres in Finland, 2191 encounters. Main outcome measures – Both patients’ and GPs’ opinions on the role of personal doctor, medico-professional quality, quality of communication, consultation conditions, economic quality (= number of examinations and treatments), and duration of consultation. Results – Patients were more satisfied than the doctors with the quality of consultations. We found no differences between the groups in the patients’ opinions on the quality. The GPs in the CB group rated their work quality higher than the GPs in the TB group. The patients’ and the GPs’ understanding of the GP as a personal doctor varied so that the patients considered their GP as their personal doctor more often than the GPs in question. Conclusions – The GPs with a capitation-based contract evaluated the quality of their work higher than other GPs. Patient satisfaction was not dependent on the GP's contract.

Development of a scale to assess the compliance of hypertensive patients

The purpose of this paper is to describe the development of the “Compliance of Hypertensive Patients” scale (=CHPS), and assessment of its reliability and validity. Previous scales incorporate only activity in health regimens as indicators of hypertensive patients’ compliance. The “Compliance of Hypertensive Patients” scale was developed to incorporate other indicators of compliance also, such as intention, responsibility and collaboration. Data were collected from a convenience sample of 103 patients, in five health care centres in Finland. Dimensionality was explored using principal component analysis and internal consistency was estimated according to a standard item analysis approach and Theta coefficient. Validity was assessed using face validity, content validity and criterion-related validity (through the use of concurrent validity). The data supported five subscales, labelled: lifestyle, intention, attitude, responsibility and smoking. Inter-item correlations ranged from 0.24 to 0.61 and corrected item-total correlations from 0.32 to 0.67, across subscales. The Theta coefficient demonstrated good internal consistency. This scale forms a useful starting point in the development of a reliable and valid tool to assess compliance of hypertensive patients, based on several indicators.

Treatment of depressive patients in general practice: The effects of a short training course in the practice orientation of general practitioners

The objective of this study was to assess the changes after a short training course in the practice orientation of general practitioners (GPs) in diagnosing and treating patients with depression. A controlled intervention study design was used, with pre- and post-intervention measurements. The intervention was conducted in four health care centers in Finland. One health care center functioned as the control. The intervention was a 3-day training course, targeted at all the staff of the intervention health care centers. It included lectures on depression and practice in small groups, focusing especially on patient-caregiver relationships and interaction. Both in the intervention and in the control health care centers all patients were screened for depression during 1 week before and 4 months after the training. The agreement on the patients' depressive status was measured by comparing the patients' Beck Depression Inventory (BDI) scores with the GPs' assessments. Practice orientation was evaluated from descriptions given by the treating GPs. In the intervention health care centers 18% (210 of 1154) of the patients in the pretest phase and 17% (132 of 799) in the posttest phase were indicated as depressed by the BDI. Contrary to expectations, the GPs' originally low sensitivity (in comparison with the BDI) in detecting depression decreased even somewhat more after the training course (17.1%/11.4%). However, the practice changed slightly from being symptom-oriented toward being patient- or even family-oriented in the intervention health care centers.