Norwegian Health Care Research Articles

Primary care seeking among adults with chronic neck and low back pain in Norway: A prospective study from the HUNT study linked to Norwegian primary healthcare registry.

To describe the frequency of primary care seeking for neck or back-related conditions among people with chronic neck and low back pain and to develop prediction models of primary care seeking and frequent visits. We included participants of the Trøndelag Health Study (HUNT4, 2017-19) in Norway who self-reported chronic neck and/or low back pain in the preceding year, and extracted data of primary care visits from the Norwegian primary healthcare registry. We investigated a total of 23 potential predictors and used multivariable logistic regression models to predict primary care seeking for neck or back-related conditions and frequent visits by healthcare provider (i.e., the highest quartile of number of visits). Among the 15,352 HUNT4 participants with chronic neck and/or low back pain, 6231 participants (40.6%) sought primary care for neck or back-related conditions (median = 5 visits, IQR 2-15) within 2 years after the study. Participants who consulted physical therapists sought care the most frequently (median = 10 visits, IQR 3-26). Discrimination of the best-fit prediction model of primary care seeking and frequent visits by healthcare provider, assessed by C-statistic, ranged from 0.66-0.76. Participants who made frequent primary care visits in the preceding year were highly likely to continue frequent care seeking in the following 2 years. Around 40% of people seek primary care for chronic neck and low back pain, and frequent care seeking may continue for years. Future studies should investigate strategies to reduce recurrent primary care visits, especially seeking physical therapist care, and promote self-management of chronic pain. People with chronic neck and low back pain who seek physical therapist care had the highest frequency of care seeking, underscoring the significant burden on healthcare systems. The high frequency of visits and associated healthcare expenditures highlight the critical need for effective and valuable primary care for chronic pain management. To mitigate recurrent visits and reduce costs, it is essential to provide patients with evidence-based treatments and self-management interventions.

Knowledge, attitudes, behavior, and self-efficacy related to evidence-based practice among healthcare professionals working in the municipal healthcare service in Norway: a cross-sectional survey

BackgroundPracticing the process of evidence-based practice (EBP) may be challenging for healthcare professionals and may be affected by their EBP knowledge, attitudes, self-efficacy, and behavior. We have some insight into how Norwegian healthcare professionals and students perceive EBP. However, research on the perception of EBP among primary healthcare professionals working in the Norwegian municipal health service is lacking. This study aimed to map EBP knowledge, attitudes, behavior, and self-efficacy among healthcare professionals working with older people in the municipal health service in Norway and to examine associations between how they score and their background characteristics.MethodsA cross-sectional web-based survey was conducted among healthcare professionals in the Norwegian municipal healthcare service. We used the revised Norwegian version of the Evidence-based practice profile questionnaire (EBP2-N) to measure the healthcare professionals’ EBP knowledge, attitudes, behavior, and self-efficacy, operationalized through the five domains of the EBP2-N. We calculated the mean scores for each EBP domain across the total sample and for each subgroup of healthcare professionals. We used a one-way between-groups analysis of variance (ANOVA) to analyze the differences in mean scores between the professions. We also calculated eta-squared values to determine effect size. We used linear regression analyses to examine associations with background variables.ResultsA total of 313 healthcare professionals, including nurses, assistant nurses, physical therapists, occupational therapists, and medical doctors, responded to the survey. The total sample scored the highest on the relevance domain, with a mean domain score of 58.9 (95% CI = 58.1–59.7) on a scale ranging from 14 to 70. The practice domain had the lowest score, with a mean domain score of 22.2 (95% CI = 20.8–21.6) on a scale ranging from 9 to 45. Statistically significant differences in mean scores were found between professions in all domains except the confidence domain. The most considerable differences between professions’ mean scores were found for the relevance and terminology domains, with eta-squared values of 0.13 and 0.19, respectively. The multivariate regression results showed that EBP training was significantly associated with the sum score of the relevance, terminology, and confidence domain. However, EBP training was not associated with the sum score of the practice and sympathy domains.ConclusionsPrimary healthcare professionals in the Norwegian municipal healthcare service hold positive attitudes toward EBP. However, they report a low understanding of research terms, low self-efficacy in performing EBP activities, a lack of perceived compatibility of EBP with professional work, and a low frequency of EBP behavior. Additionally, we observed differences among the included professions in four out of five domains, suggesting that various professions may be unequally prepared for EBP. Finally, our results indicate potential positive outcomes of EBP training. Those who received EBP training exhibited more positive attitudes, a better understanding of common research terms, and higher self-efficacy in performing EBP activities. However, EBP training was not associated with their self-reported EBP behavior.Trial registrationRetrospectively registered (prior to data analysis) in OSF Preregistration. Registration DOI: https://doi.org/10.17605/OSF.IO/428RP.

Priority Setting in Norwegian Municipal and Health Care Services: A Thematic Analysis of Public Consultation Documents

Priority Setting in Norwegian Municipal and Health Care Services: A Thematic Analysis of Public Consultation Documents

Prehospital seizure management protocols need standardized guidelines. A descriptive study from Norway.

BackgroundPatients with convulsive seizures constitute a significant group in acute neurology. No common European clinical practice guidelines on prehospital seizure management exists, and today most patients are brought to hospital for seizure treatment, with great variation in which prehospital treatment is provided. Only 33% of status epilepticus patients receive a benzodiazepine as first anti-seizure medication (ASM). The aim of this study is to assess the prehospital seizure control protocols in the Emergency Medical Services (EMS) in Norway, and compare these with current evidence for acute management. MethodWe performed a descriptive analysis of the 18 regional EMS protocols in Norway and compared the findings with recent evidence on prehospital treatment. We analysed recommended drug and dosage, route of medication administration, number of additional rescue doses permitted, requirements for registration of type of seizures and seizure duration. ResultsThe protocols vary in terms of preferred medication, administration method, dosage and recommendations regarding first- and second-line therapies. 33 % of protocols explicitly define status epilepticus according to contemporary guidelines, and 16.7 % have an operational definition of when to administer benzodiazepines. All protocols showed variations in dosing and administration instructions and only 28% had a clearly stated first line treatment. ConclusionThere are disparities in the prehospital seizure management protocols within the Norwegian healthcare system, a system comparable to other European countries. To improve seizure management there is a need for standardised guidelines for prehospital treatment.

What influences the use of HR analytics in Human Resource management in Norwegian municipal health care services?

BackgroundThe centrality of human resources in the provision of healthcare suggests that Human Resource (HR) management and the use of Human Resource analytics – use of digital data to better understand, assess, plan and organize the workforce - can play an important role in this. However, data driven decision making in the field of human resource management is lagging, and the appropriation of HR analytics in the healthcare sector is limited.AimThe current study explores the role of HR departments and the adoption of Human Resource analytics in four municipalities in Norway to obtain insights into what influences the use or lack of use of HR analytics.MethodsEmpirical data were generated through qualitative interviews with fourteen individuals working in HR departments, the municipal administration, and the healthcare services. Structurational theory guided the analysis. The findings show that none of the municipalities made extensive use of data to inform decision making related to human resource management or workforce planning.Results and conclusionThree conditions hampered or made irrelevant the use of HR analytics: a decoupling between the services and HR, a weak data-culture, and HR and decision-making processes involving a plurality of stakeholders. However, there were changes underway in all municipalities related to the role of HR and HR analytics.

Legal Regulation, Financial Incentives and Professional Autonomy in the Prioritisation of Norwegian Specialist Health Services.

To study hospital physicians' awareness and perceptions of the legal and financial regulations, and their impact on professional discretion regarding equity in access to treatment and quality of care. A sample of 637 physicians in the Norwegian specialist healthcare services selected from a survey conducted by the Institute for Studies of the Medical Profession. The paper investigates how legal and financial policy instruments affect the application of professional discretion regarding the prioritisation of specialist health services. Descriptive statistics and regressions were conducted for the analyses. Compared with financial incentives, legal regulations (laws, priority rules and guidelines) were assessed to be less negative external interventions in the exercise of medical and professional judgement. The empirical analyses revealed a positive tendency in physicians' assessments of the impact of legal regulations on treatment equity and healthcare quality, but negative attitudes towards financial instruments. The variations revealed are attributable to various structural and epistemic features of the legal-bureaucratic and economic models of administration in this area of the welfare state. Legal and financial regulations are imposed to achieve certain social goals and values. The findings of this study can provide further insight for the health authorities in other countries concerning implementation of such regulations in the specialist healthcare services.

Outpatient parenteral antimicrobial therapy (OPAT) using a continuous ambulatory delivery device (CADD) allowing treatment with multiple daily doses: a brief report of a Norwegian experience.

Outpatient parenteral antimicrobial therapy (OPAT) is safe, effective and increasingly available. While OPAT in Norwegian healthcare has been rare, a new continuous ambulatory delivery device (CADD) allowing multiple daily dosing treatments has been innovated making OPAT more accessible. To describe the clinical outcome and safety using CADD in an OPAT setting. Adult patients in need of parenteral antibiotic treatment were offered OPAT and discharged with a programmable digital infusion pump allowing multiple daily dosings. Altogether, 170 patients were included in the study, among which 21% of all patients (36 of 170) were readmitted to hospital while receiving OPAT or within 30 days after end of intravenous antibiotics. None of the 170 patients died due to OPAT and allergies were not noticeable as a problem. We have developed a safe and clinically effective programme offering OPAT in accordance with Norwegian antibiotic treatment guidelines.

Adaptation and validation of the evidence-based practice profile (EBP2) questionnaire in a Norwegian primary healthcare setting

BackgroundAccess to valid and reliable instruments is essential in the field of implementation science, where the measurement of factors associated with healthcare professionals’ uptake of EBP is central. The Norwegian version of the Evidence-based practice profile questionnaire (EBP2-N) measures EBP constructs, such as EBP knowledge, confidence, attitudes, and behavior. Despite its potential utility, the EBP2-N requires further validation before being used in a cross-sectional survey targeting different healthcare professionals in Norwegian primary healthcare. This study assessed the content validity, construct validity, and internal consistency of the EBP2-N among Norwegian primary healthcare professionals.MethodsTo evaluate the content validity of the EBP2-N, we conducted qualitative individual interviews with eight healthcare professionals in primary healthcare from different disciplines. Qualitative data was analyzed using the “text summary” model, followed by panel group discussions, minor linguistic changes, and a pilot test of the revised version. To evaluate construct validity (structural validity) and internal consistency, we used data from a web-based cross-sectional survey among nurses, assistant nurses, physical therapists, occupational therapists, medical doctors, and other professionals (n = 313). Structural validity was tested using a confirmatory factor analysis (CFA) on the original five-factor structure, and Cronbach’s alpha was calculated to assess internal consistency.ResultsThe qualitative interviews with primary healthcare professionals indicated that the content of the EBP2-N was perceived to reflect the constructs intended to be measured by the instrument. However, interviews revealed concerns regarding the formulation of some items, leading to minor linguistic revisions. In addition, several participants expressed that some of the most specific research terms in the terminology domain felt less relevant to them in clinical practice. CFA results exposed partial alignment with the original five-factor model, with the following model fit indices: CFI = 0.749, RMSEA = 0.074, and SRMR = 0.075. Cronbach’s alphas ranged between 0.82 and 0.95 for all domains except for the Sympathy domain (0.69), indicating good internal consistency in four out of five domains.ConclusionThe EBP2-N is a suitable instrument for measuring Norwegian primary healthcare professionals’ EBP knowledge, attitudes, confidence, and behavior. Although EBP2-N seems to be an adequate instrument in its current form, we recommend that future research focuses on further assessing the factor structure, evaluating the relevance of the items, and the number of items needed.RegistrationRetrospectively registered (prior to data analysis) in OSF Preregistration. Registration DOI: https://doi.org/10.17605/OSF.IO/428RP.

Catalysts for change: A qualitative study of middle managers' perception of nursing professional competence in primary healthcare.

This study aims to explore middle managers' perception of nursing professional competence within the Norwegian primary healthcare service, a sector vital for managing complex patient needs. Semi-structured interviews were conducted with four middle managers across different municipalities in Norway. Qualitative content analyses, following Graneheim and Lundman, were used for analysing the transcription of the interviews and the data collected. The qualitative content analysis revealed three main themes: the significance of advanced competence, challenges related to competence development and the necessity for defining advanced competence. The findings indicate that middle managers recognise the importance of advanced nursing competence in providing comprehensive patient care, notwithstanding challenges in manpower and competence enhancement. This research underlines the significance of investing in increased competence and improved management in primary healthcare and offers valuable insights for healthcare policy and practice to enhance patient care.

Development and validation of the 12-item video consultation self-efficacy scale

Background: Video consultations in healthcare are remote solutions for delivering assessments and treatments to patients. The acceptance and use of video consultations may depend on self-efficacy among healthcare practitioners. Measuring self-efficacy in providing video consultations may identify individuals with insufficient self-efficacy and enable targeted interventions and support. No valid and reliable scale was available for measuring self-efficacy in the Norwegian context. Therefore, our aim was to develop (Study 1) and validate (Study 2) a new research-based video consultation self-efficacy scale for Norwegian practitioners in specialized healthcare. Method: In Study 1, we developed preliminary scale items, based on results from a systematic review. These items were subjected to experts’ opinions in a modified Delphi method-based study. The experts also suggested additional items. These results were then used in developing an initial video consultation self-efficacy scale. In Study 2, this scale was validated in a questionnaire study. Reliability was examined by using item analysis and Cronbach’s alpha (internal consistency). Construct validity was examined by using exploratory factor analysis and Spearman’s correlation (convergent and divergent validity). Results: In Study 1, a total of 56 scale items were considered, and resulted in a preliminary 15-item scale. In Study 2, item analysis and exploratory factor analysis resulted in a unidimensional 12-item video consultation self-efficacy scale. Cronbach’s alpha (internal consistency) was (α) = .974. The Spearman’s correlations showed a moderate positive correlation between the 12-item scale and the Digital Competence Questionnaire, a weak positive correlation between the 12-item scale and the General Self-Efficacy Scale, and a weak positive correlation between the 12-item scale and the WHO-5 Well-Being Index. These results suggest that the scale is a reliable and valid measure for assessing practitioners’ self-efficacy in providing video consultations to patients in specialized healthcare. Implications: We recommend further, more comprehensive, validation of the scale in different contexts in Norwegian specialized healthcare, such as in different clinical specialties and with larger samples. Keywords: development and validation, self-efficacy scale, specialized healthcare, practitioners, video consultation

Stakeholder Perception's of Cybersecurity for Welfare Technology and Remote Care Devices.

In healthcare, there are various stakeholders who hold different understandings of technology. Cybersecurity risks may also be something these stakeholder have varying perceptions of. This papers explores how cybersecurity risks are understood by two key stakeholder groups in the Norwegian healthcare sector related to welfare technology and personal healthcare devices. Two stakeholder groups (healthcare workers and technology vendors) have been interviewed to gather data on this topic. Key findings highlight that there are differences in how risks are perceived, both in terms of likelihood and in consequence. We apply risk perception theory to analyze these findings and provide suggestions for further research within this topic.

Exploring Norwegian homecare healthcare professionals’ perceptions of risk and the link to high-quality care: a qualitative multiple case study

ObjectivesHomecare is a critical component of the ongoing restructuring of healthcare worldwide, given the shift from institution- to home-based care. The homecare evidence base still contains significant gaps: There is...

Contingency and paradoxes in management practices—development plan as a case

Purpose As part of a national plan to govern professional and organizational development in Norwegian specialist healthcare, the country’s hospital clinics are tasked with constructing development plans. Using the development plan as a case, the paper analyzes how managers navigate and legitimize the planning process among central actors and deals with the contingency of decisions in such strategy work.Design/methodology/approach This study applies a qualitative research design using a case study method. The material consists of public documents, observations and single interviews, covering the process of constructing a development plan at the clinical level.Findings The findings suggest that the development plan was shaped through a multilevel translation process consisting of different contending rationalities. At the clinical level, the management had difficulties in legitimizing the process. The underlying tension between top-down and bottom-up steering challenged involvement and made it difficult to manage the contingency of decisions.Practical implications The findings are relevant to public sector managers working on strategy documents and policymakers identifying challenges that might hinder the fulfillment of political intentions.Originality/value This paper draws on a case from Norway; however, the findings are of general interest. The study contributes to the academic discussion on how to consider both the health authorities’ perspective and the organizational perspective to understand the manager’s role in handling the contingency of decisions and managing paradoxes in the decision-making process.

The 2024 revision of the Norwegian standard for the safe practice of anaesthesia.

The Norwegian standard for the safe practice of anaesthesia was first published in 1991, and revised in 1994, 1998, 2005, 2010 and 2016 respectively. The 1998 version was published in English for the first time in Acta Anaesthesiologica Scandinavica in 2002. It must be noted that this is a national standard, reflecting the specific opportunities and challenges in a Norwegian setting, which may be different from other countries in some respects. A feature of the Norwegian healthcare system is the availability, on a national basis, of specifically highly trained and qualified nurse anaesthetists. Another feature is the geography, with parts of the population living in remote areas. These may be served by small, local emergency hospitals. Emergency transport of patients to larger hospitals is not always achievable when weather conditions are rough. These features and challenges were considered important when designing a balanced and consensus-based national standard for the safe practice of anaesthesia, across Norwegian clinical settings. In this article, we present the 2024 revision of the document. This article presents a direct translation of the complete document from the Norwegian original.

Digital leadership: Norwegian healthcare managers' attitudes towards using digital tools.

Health services are undergoing digitalization and applying new digital tools. These changes may provide healthcare managers with opportunities to exercise digital leadership. However, managers' attitudes may influence the extent to which they demonstrate digital leadership. This study explores the attitudes of Norwegian healthcare managers towards: (1) digital tools and change and (2) to what extent digital tools are applicable to various tasks of managers. Cross-sectional study including 154 managers in hospitals and municipal health services in a Norwegian county. The questionnaire was about management and digital tools, and the data was analyzed by descriptive statistics, correlations, and content analysis. The healthcare managers perceived that digital tools facilitated a positive change in organizational work processes aligned with values and goals. Digital tools supported administrative tasks such as gaining control over responsibilities. However, 76 managers stated that certain tasks, including interactions with employees (e.g. performance appraisals and sick leave follow-up) and the building of an organizational culture, should not be performed using digital tools or using them only to a limited extent; for these tasks, they preferred in-person meetings. Norwegian healthcare managers' attitudes toward digital tools are generally positive, but there are areas where they find the tools less suitable. The results provide new insights into healthcare by indicating that many managers may have positive attitudes toward digital tools. However, digital leadership may not be applicable equally in all areas of healthcare managers' work. This raises the question of whether digital leadership can or should be exercised uniformly in every area of health services.

Norwegian perspectives on health care for people with intellectual and developmental disabilities

AbstractThe Norwegian health care system is built on individual rights and the principles of universal access, decentralization, and free choice of provider. Norway has universal health coverage, funded primarily by general taxes and by payroll contributions shared by employers and employees. Local authorities at the municipal level organize and finance primary health care services according to local demand and within national frameworks. Habilitation services are offered both in the primary health care and as a part of the specialist health services. They offer both inpatient and outpatient services for people with intellectual/developmental disabilities (IDD). National guidelines, known as Good health and care services for people with IDD, have recently (2021) been launched after various reports over the years of serious breaches and challenges in the health and care services provided to people with IDD.

Health professionals’ experience and perceived obstacles with managing patients’ medication information in Norway: cross-sectional survey

BackgroundAccess to correct and up to date medication information is crucial for effective patient treatment. However, persistent discrepancies exist. This study examines the experiences and challenges health professionals encounter while utilizing current digital solutions in the Norwegian healthcare system to manage patients' medication information.MethodsA cross-sectional descriptive analysis using quantitative survey data was conducted to investigate how health professionals managed patients’ medication information. Content analysis was used to analyze free-text responses concerning challenges they encountered when transferring medication information and to identify factors deemed necessary for implementing the Shared Medication List in Norway.ResultsA total of 262 doctors and 244 nurses responded to the survey. A higher percentage of doctors (72.2%) expressed concerns regarding obtaining accurate and updated medication lists than nurses (42.9%), particularly for patients with polypharmacy (35.3%) or transitioning between primary and specialist care services (27.6%). The patient's verbal information was the main source for hospital doctors (17%) to obtain an overview of the patient’s medication usage, while general practitioners (19%) and nurses (working in both primary and specialist care services, 28% and 27% respectively) predominantly relied on electronic prescriptions. Doctors, in particular general practitioners, reported carrying excessive responsibilities in coordinating with other health actors (84.8%) and managing patients' medication information. The vast majority of both doctors (84.4%) and nurses (82.0%) were in favor of a Shared Medication List. However, about a third of doctors (36.3%) and nurses (29.8%) expressed the need for a more balanced responsibility in updating and managing patients' medication information, while ensuring compatibility with existing digital systems.ConclusionsFragmented resources for medication information and unclear responsibilities were prevalent concerns among both professional groups. Doctors voiced more concern than nurses about the accuracy of patients’ medication list. While both groups are positive about a shared medication list, successful implementation requires proactive training initiatives and clearer role clarification.

Information sharing between the dental healthcare and child welfare services regarding child maltreatment-A repeated cross-sectional study in Norway.

Little is known about dental healthcare workers reported suspected child maltreatment to and received inquiry from the child welfare services (CWS). Assess time lag differences in public dental healthcare workers' information sharing with CWS and identify sociodemographic and attitudinal covariates of information sharing with CWS in 2014 and 2019. In 2014 and 2019, a national census of 1542 and 1791 Norwegian dental health care workers, respectively, were invited to participate in an electronic survey. Of them, 1200 (77.8%) and 1270 (70.9%) replied to the questionnaires. Time trends of reported child maltreatment and received inquiries were estimated and adjusted for sociodemographics, attitudes, trust, and collaborative routines in logistic regression analyses. The likelihood of reported child maltreatment to and received inquiry from CWS was higher in 2019 than in 2014 (OR 1.4 [95% CI 1.2-1.7] and OR 1.1 [95% CI 0.9-1.4]). Significant associations occurred with sociodemographic characteristics, attitudes, and collaborative routines. The likelihood of receiving inquiry about whether being employed long versus short term was higher in 2019 than in 2014. Information sharing between dental healthcare workers and CWS improved across time and might promote beneficial outcomes.

Etiske perspektiver i behandling av spiseforstyrrelser

This article aims to show how the use of systematic ethical considerations can illuminate important dilemmas in the treatment of eating disorders in children and adolescents in Norwegian mental health care. In a fictional clinical case, a six-step model for ethical reflection is used to examine the role of parents in family-based treatment (FBT) or, more precisely, how the explicit responsibility given to parents in FBT may lead to doubts about their ability as caregivers, and whether a recommendation for hospitalisation should in such cases be equated with the therapist’s duty to notify the child welfare service. By conducting a consistent and methodical review of relevant aspects of these ethical problems, the analysis offers a concrete, systematic way in which to clarify the ethical challenges, uncover underlying values and explore new perspectives and solutions in the treatment of eating disorders in children and adolescents. Furthermore, it suggests important areas of development in evidence-based practice and cross-sectoral cooperation in the field of eating disorders. Keywords: Family-based treatment, eating disorder, parents, care, ethical analysis, evidence-based practice

The Work and Social Adjustment Scale (WSAS): An investigation of reliability, validity, and associations with clinical characteristics in psychiatric outpatients.

This study, the first to assess the reliability and validity of the Work and Social Assessment Scale (WSAS) in Norwegian routine mental health care, examines differences in functional impairment based on sick leave status, psychiatric diagnosis, and sex. Including 3573 individuals from community mental health services (n1 = 1157) and a psychiatric outpatient clinic (n2 = 2416), exploratory factor analysis (EFA) on subsample 1 and confirmatory factor analysis (CFA) on subsample 2 were utilized to replicate the identified factor structure. EFA supported a one-factor model, replicated by the CFA, with high internal consistency (α = .82, ω = .81). Patients on sick leave reported greater impairments in all aspects of functioning, except for relationships, with the largest effect size observed in the reported ability to work (d = .39). Psychiatric outpatients with major depressive disorder were associated with difficulties in home management, private leisure activities, and forming close relationships. Patients with attention-deficit/hyperactivity disorder reported less impairment than those with other disorders. Patients with personality disorders reported more relationship difficulties than those with PTSD, ADHD, and anxiety. No differences were found in the perceived ability to work between diagnoses. Women had a higher impairment in private leisure activities, whereas men reported more impairment in relationships. The demonstrated reliability and validity suggest that WSAS is a valuable assessment tool in Norwegian routine mental health care. Variations in functional impairment across sick leave status, sex, and psychiatric diagnoses highlight the importance of integrating routine assessments of functional impairment into mental health care practices. Future research should combine WSAS with register data to allow for a broader understanding of treatment effectiveness, emphasizing improvements in functional outcomes alongside symptom alleviation.