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Björkelund C, Saxvik A, Svenningsson I, Petersson EL, Wiegner L, Larsson M, Törnbom K, Wikberg C, Ariai N, Nejati S, Hensing G, Hange D. Rehabilitation cooperation and person-centred dialogue meeting for patients sick-listed for common mental disorders: 12 months follow-up of sick leave days, symptoms of depression, anxiety, stress and work ability - a pragmatic cluster randomised controlled trial from the CO-WORK-CARE project. BMJ Open 2023; 13:e074137. [PMID: 37295824 PMCID: PMC10277141 DOI: 10.1136/bmjopen-2023-074137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023] Open
Abstract
OBJECTIVES To study whether early and enhanced cooperation within the primary care centres (PCC) combined with workplace cooperation via a person-centred employer dialogue meeting can reduce days on sick leave compared with usual care manager contact for patients on sick leave because of common mental disorders (CMD). Secondary aim: to study lapse of CMD symptoms, perceived Work Ability Index (WAI) and quality of life (QoL) during 12 months. DESIGN Pragmatic cluster randomised controlled trial, randomisation at PCC level. SETTING 28 PCCs in Region Västra Götaland, Sweden, with care manager organisation. PARTICIPANTS 30 PCCs were invited, 28 (93%) accepted invitation (14 intervention, 14 control) and recruited 341 patients newly sick-listed because of CMD (n=185 at intervention, n=156 at control PCCs). INTERVENTION Complex intervention consisting of (1) early cooperation among general practitioner (GP), care manager and a rehabilitation coordinator, plus (2) a person-centred dialogue meeting between patient and employer within 3 months. CONTROL GROUP regular contact with care manager. MAIN OUTCOME MEASURES 12 months net and gross number of sick leave days at group level. SECONDARY OUTCOMES 12 months depression, anxiety, stress symptoms, perceived WAI and QoL (EuroQoL-5 Dimensional, EQ-5D). RESULTS No significant differences were found between intervention and control groups concerning days of sick leave (intervention net days of sick leave mean 102.48 (SE 13.76) vs control 96.29 (SE 12.38) p=0.73), return to work (HR 0.881, 95% CI 0.688 to 1.128), or CMD symptoms, WAI or EQ-5D after 12 months. CONCLUSIONS It is not possible to speed up CMD patients' return to work or to reduce sick leave time by early and enhanced coordination among GP, care manager and a rehabilitation coordinator, combined with early workplace contact over and above what 'usual' care manager contact during 3 months provides. TRIAL REGISTRATION NUMBER NCT03250026.
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Affiliation(s)
- Cecilia Björkelund
- Primary Health Care/School of Public Health and Community Medicine/Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Ausra Saxvik
- Primary Health Care/School of Public Health and Community Medicine/Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Irene Svenningsson
- Primary Health Care/School of Public Health and Community Medicine/Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Research and Development Primary Health Care, Region Västra Götaland, Gothenburg, Sweden
| | - Eva-Lisa Petersson
- Primary Health Care/School of Public Health and Community Medicine/Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Research and Development Primary Health Care, Region Västra Götaland, Gothenburg, Sweden
| | - Lilian Wiegner
- Primary Health Care/School of Public Health and Community Medicine/Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Maria Larsson
- Section for rehabilitation and Health, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
| | - Karin Törnbom
- Primary Health Care/School of Public Health and Community Medicine/Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Social Work, University of Gothenburg, Goteborg, Sweden
| | - Carl Wikberg
- Primary Health Care/School of Public Health and Community Medicine/Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Nashmil Ariai
- Primary Health Care/School of Public Health and Community Medicine/Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Shabnam Nejati
- Primary Health Care/School of Public Health and Community Medicine/Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Gunnel Hensing
- School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Dominique Hange
- Primary Health Care/School of Public Health and Community Medicine/Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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af Winklerfelt Hammarberg S, Björkelund C, Nejati S, Magnil M, Hange D, Svenningsson I, Petersson EL, André M, Udo C, Ariai N, Wallin L, Wikberg C, Westman J. Clinical effectiveness of care managers in collaborative primary health care for patients with depression: 12- and 24-month follow-up of a pragmatic cluster randomized controlled trial. BMC Prim Care 2022; 23:198. [PMID: 35945493 PMCID: PMC9361666 DOI: 10.1186/s12875-022-01803-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 07/18/2022] [Indexed: 11/16/2022]
Abstract
Background In previous studies, we investigated the effects of a care manager intervention for patients with depression treated in primary health care. At 6 months, care management improved depressive symptoms, remission, return to work, and adherence to anti-depressive medication more than care as usual. The aim of this study was to compare the long-term effectiveness of care management and usual care for primary care patients with depression on depressive symptoms, remission, quality of life, self-efficacy, confidence in care, and quality of care 12 and 24 months after the start of the intervention. Methods Cluster randomized controlled trial that included 23 primary care centers (11 intervention, 12 control) in the regions of Västra Götaland and Dalarna, Sweden. Patients ≥18 years with newly diagnosed mild to moderate depression (n = 376: 192 intervention, 184 control) were included. Patients at intervention centers co-developed a structured depression care plan with a care manager. Via 6 to 8 telephone contacts over 12 weeks, the care manager followed up symptoms and treatment, encouraged behavioral activation, provided education, and communicated with the patient’s general practitioner as needed. Patients at control centers received usual care. Adjusted mixed model repeated measure analysis was conducted on data gathered at 12 and 24 months on depressive symptoms and remission (MADRS-S); quality of life (EQ5D); and self-efficacy, confidence in care, and quality of care (study-specific questionnaire). Results The intervention group had less severe depressive symptoms than the control group at 12 (P = 0.02) but not 24 months (P = 0.83). They reported higher quality of life at 12 (P = 0.01) but not 24 months (P = 0.88). Differences in remission and self-efficacy were not significant, but patients in the intervention group were more confident that they could get information (53% vs 38%; P = 0.02) and professional emotional support (51% vs 40%; P = 0.05) from the primary care center. Conclusions Patients with depression who had a care manager maintained their 6-month improvements in symptoms at the 12- and 24-month follow-ups. Without a care manager, recovery could take up to 24 months. Patients with care managers also had significantly more confidence in primary care and belief in future support than controls. Trial registration ClinicalTrials.gov identifier: NCT02378272. Submitted 2/2/2015. Posted 4/3/2015. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-022-01803-x.
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Saxvik A, Törnbom K, Petersson EL, Hange D, Nejati S, Björkelund C, Svenningsson I. Experiences of patients with common mental disorders concerning team-based primary care and a person-centered dialogue meeting: An intervention to promote return to work. PLoS One 2022; 17:e0271180. [PMID: 35802679 PMCID: PMC9269955 DOI: 10.1371/journal.pone.0271180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 06/24/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives Common mental disorders in combination with work-related stress are widespread in the western world, not least in Sweden. Various interactive factors, primarily work-related, have impact on the return to work process, for example; a supportive communicative function between the person on sick leave and the employer may facilitate this process. The aim was to investigate experiences of being part of a collaborative care model including a person-centered dialogue meeting with the employer and with a rehabilitation coordinator as the moderator. Methods A qualitative design based on individual interviews with 13 persons diagnosed with common mental disorders who participated in an extensive collaborative care model, called the Co-Work-Care model. Persons were recruited as a heterogeneous sample with respect to age, gender, work background, and time since the intervention. All interviews were analyzed with Systematic Text Condensation. Results Five codes synthesized the results: 1) A feeling of being taken care of, 2) Collaboration within the team was perceived as supportive, 3) An active and sensitive listener, 4) Structure and planning in the dialogue meeting, 5) The person-centered dialogue meeting was supportive and provided increased understanding. Conclusions Participants experienced the close collaborative contact with the care manager and the rehabilitation coordinator as highly valuable for their rehabilitation process. Participants valued a well-structured dialogue meeting that included initial planning and a thorough communication involving the patient, the employer, and coordinator. Further, participants appreciated having an active role during the meeting, also empowering the return to work process.
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Affiliation(s)
- Ausra Saxvik
- Primary Health Care/Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Sweden
| | - Karin Törnbom
- Primary Health Care/Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Sweden
- Department of Social Work, University of Gothenburg, Gothenburg, Sweden
- * E-mail:
| | - Eva-Lisa Petersson
- Primary Health Care/Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Sweden
| | - Dominique Hange
- Primary Health Care/Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Sweden
| | - Shabnam Nejati
- Primary Health Care/Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Sweden
| | - Cecilia Björkelund
- Primary Health Care/Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Sweden
| | - Irene Svenningsson
- Primary Health Care/Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Sweden
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Svenningsson I, Björkelund C, Hange D, Wiegner L, Ariai N, Petersson EL. Symptom patterns in patients newly sick listed for common mental disorders and associations with work-related and socioeconomic factors: a cross-sectional study in Swedish primary care. BMJ Open 2022; 12:e054250. [PMID: 35803640 PMCID: PMC9272126 DOI: 10.1136/bmjopen-2021-054250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The aim was to determine symptom patterns of depression, anxiety and stress-related mental disorders in newly sick listed due to common mental disorders in Swedish primary care patients and to examine associations with sick leave diagnosis, also in relation to socioeconomic, work-related and demographic factors. DESIGN Cross-sectional study. SETTING Primary care in western Sweden. PARTICIPANTS From a randomised controlled trial, patients aged 18-67, seeking primary care and on sick leave due to depression, anxiety and/or mental stress, in total 341 individuals, during 2018-2020. PRIMARY OUTCOME MEASURES Patterns of depressive, anxiety and stress symptoms measured via self-assessment questionnaires (Montgomery Asberg Depression Rating Scale-Self (MADRS-S), General Anxiety Disorder Scale-7 (GAD-7), Karolinska Exhaustion Disorder Scale (KEDS)), sick leave diagnosis, perception of Work Ability Index and job strain via the job strain model. RESULTS A combination of high levels of depressive and stress-related symptoms was more frequent than single symptom clusters among persons with common mental disorders (CMD) on sick leave: 7% of the patients had scores above cut-off for one of the instruments MADRS-S, GAD-7 and KEDS, 12% above cut-off for two and 80% had above cut-off for all three instruments. There was no significant association between low socioeconomic status, high-job strain or working in healthcare/education and having scores above cut-off level for two or more of the instruments. Only perception of own poor work ability showed association with having scores above cut-off level for all three of the assessment instruments of CMD (OR 9.45, 95% CI 2.41 to 37.04). CONCLUSION The diagnosis on the sick certificate is not always congruent with the dominating symptom score level. In patients sick-leaved for CMDs, possible negative factors such as low socioeconomic status, low social support, high-work strain or working in healthcare/education sector did not show significant associations with self-assessment instruments of anxiety, depression and stress. Only patient's perception of own poor work ability was associated with high scores on all three domains. TRIAL REGISTRATION NUMBER NCT03250026.
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Affiliation(s)
- Irene Svenningsson
- Primary Health Care/School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Research, Education, Development & innovation, Primary Health care, Region Västra Götaland, Vänersborg, Sweden
| | - Cecilia Björkelund
- Primary Health Care/School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Dominique Hange
- Primary Health Care/School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Research, Education, Development & innovation, Primary Health care, Region Västra Götaland, Vänersborg, Sweden
| | - Lilian Wiegner
- Primary Health Care/School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Institute of Stress Medicine, Region Västra Götaland, Gothenburg, Sweden
| | - Nashmil Ariai
- Primary Health Care/School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eva-Lisa Petersson
- Primary Health Care/School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Research, Education, Development & innovation, Primary Health care, Region Västra Götaland, Vänersborg, Sweden
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Petersson EL, Hange D, Udo C, Björkelund C, Svenningsson I. Long-term effect of a care manager on work ability for patients with depression – the PRIM-CARE RCT. Work 2022; 72:601-609. [DOI: 10.3233/wor-205272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND: Collaborative care with a care manager in primary care improves care. OBJECTIVE: To study whether care manager support leads to improved work ability, decreased job strain and reduced time of sick leave among primary care patients with depression. METHODS: A clinical effectiveness study of care managers for depression patients seeking care in primary care was conducted in a RCT 2014 –2016. Patients in the intervention group were assigned a care manager. In the 12-month follow-up, patients with employment (n = 269; intervention n = 142, control n = 127) were studied concerning work ability, job strain and sick leave. RESULTS: An association was shown between reduction of depressive symptoms and improved work ability for the entire group. At 12-month follow-up a statistically significant difference of reduction of depressive symptoms was seen between the groups (MADRS-S: intervention 10.8 vs control 13.1, p = 0.05) as well as increased quality of life (EQ-5D: intervention 0.77 vs control 0.70, p = 0.04). In the intervention group, a concordance was found between the patient’s prediction of return to work and the actual return to work (91%for intervention and 68 %for control group, p = 0.047). CONCLUSIONS: Compared to usual care, the care manager does not seem to further improve perception of work ability, job strain or perception of social support per se among the patients despite a long-term effect on depression symptoms. The lack of a long-term effect regarding these aspects may be due to the fact that care manager support was only provided during the first three months.
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Affiliation(s)
- Eva-Lisa Petersson
- Primary Health Care/Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Gothenburg, Sweden
| | - Dominique Hange
- Primary Health Care/Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Gothenburg, Sweden
| | - Camilla Udo
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
- Center for Clinical Research Dalarna, Uppsala University, Uppsala, Sweden
| | - Cecilia Björkelund
- Primary Health Care/Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Gothenburg, Sweden
| | - Irene Svenningsson
- Primary Health Care/Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Gothenburg, Sweden
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Svenningsson I, Hange D, Udo C, Törnbom K, Björkelund C, Petersson EL. The care manager meeting the patients' unique needs using the care manager model-A qualitative study of experienced care managers. BMC Fam Pract 2021; 22:175. [PMID: 34474682 PMCID: PMC8414763 DOI: 10.1186/s12875-021-01523-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 08/18/2021] [Indexed: 11/10/2022]
Abstract
Background Implementation of a care manager in a collaborative care team in Swedish primary care via a randomized controlled trial showed successful outcome. As four years have elapsed since the implementation of care managers, it is important to gain knowledge about the care managers’ long-term skills and experiences. The purpose was to examine how long-term experienced care managers perceived and experienced their role and how they related to and applied the care manager model. Method Qualitative study with a focus group and interviews with nine nurses who had worked for more than two years as care managers for common mental disorders. The analysis used Systematic Text Condensation. Results Four codes arose from the analysis: Person-centred; Acting outside the comfort zone; Successful, albeit some difficulties; Pride and satisfaction. The care manager model served as a handrail for the care manager, providing a trustful and safe environment. Difficulties sometimes arose in the collaboration with other professionals. Conclusion This study shows that long-term experience of working as a care manager contributed to an in-depth insight and understanding of the care manager model and enabled care managers to be flexible and act outside the comfort zone when providing care and support to the patient. A new concept emerged during the analytical process, i.e. the Anchored Care Manager, which described the special competencies gained through experience. Trial registration NCT02378272 Care Manager—Coordinating Care for Person Centered Management of Depression in Primary Care (PRIM—CARE).
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Affiliation(s)
- Irene Svenningsson
- Primary Health Care/Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. .,Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Sweden.
| | - Dominique Hange
- Primary Health Care/Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Sweden
| | - Camilla Udo
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.,Center for Clinical Research, Dalarna, Sweden
| | - Karin Törnbom
- Primary Health Care/Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Social Work, University of Gothenburg, Gothenburg, Sweden
| | - Cecilia Björkelund
- Primary Health Care/Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Sweden
| | - Eva-Lisa Petersson
- Primary Health Care/Department of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Sweden
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Holst A, Labori F, Björkelund C, Hange D, Svenningsson I, Petersson EL, Westman J, Möller C, Svensson M. Cost-effectiveness of a care manager collaborative care programme for patients with depression in primary care: 12-month economic evaluation of a pragmatic randomised controlled trial. Cost Eff Resour Alloc 2021; 19:52. [PMID: 34404426 PMCID: PMC8369323 DOI: 10.1186/s12962-021-00304-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 07/29/2021] [Indexed: 12/12/2022] Open
Abstract
Objectives To study the cost-effectiveness of a care manager organization for patients with mild to moderate depression in Swedish primary care in a 12-month perspective. Methods Cost-effectiveness analysis of the care manager organization compared to care as usual (CAU) in a pragmatic cluster randomised controlled trial including 192 individuals in the care manager group and 184 in the CAU group. Cost-effectiveness was assessed from a health care and societal perspectives. Costs were assessed in relation to two different health outcome measures: depression free days (DFDs) and quality adjusted life years (QALYs). Results At the 12-month follow-up, patients treated at the intervention Primary Care Centres (PCCs) with a care manager organization had larger health benefits than the group receiving usual care only at control PCCs. Mean QALY per patient was 0.73 (95% CI 0.7; 0.75) in the care manager group compared to 0.70 (95% CI 0.66; 0.73) in the CAU group. Mean DFDs was 203 (95% CI 178; 229) in the care manager group and 155 (95% CI 131; 179) in the CAU group. Further, from a societal perspective, care manager care was associated with a lower cost than care as usual, resulting in a dominant incremental cost-effectiveness ratio (ICER) for both QALYs and DFDs. From a health care perspective care manager care was related to a low cost per QALY (36,500 SEK / €3,379) and DFD (31 SEK/€3). Limitations A limitation is the fact that QALY data was impaired by insufficient EQ-5D data for some patients. Conclusions A care manager organization at the PCC to increase quality of care for patients with mild-moderate depression shows high health benefits, with no decay over time, and high cost-effectiveness both from a health care and a societal perspective. Trial registration details: The trial was registered in ClinicalTrials.com (https://clinicaltrials.gov/ct2/show/NCT02378272) in 02/02/2015 with the registration number NCT02378272. The first patient was enrolled in 11/20/2014. Supplementary Information The online version contains supplementary material available at 10.1186/s12962-021-00304-5.
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Affiliation(s)
- Anna Holst
- Primary Health Care/School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Allmänmedicin, Box 453, 405 30, Gothenburg, Sweden.
| | - Frida Labori
- Health Economics and Policy/School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Cecilia Björkelund
- Primary Health Care/School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Allmänmedicin, Box 453, 405 30, Gothenburg, Sweden
| | - Dominique Hange
- Primary Health Care/School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Allmänmedicin, Box 453, 405 30, Gothenburg, Sweden
| | - Irene Svenningsson
- Primary Health Care/School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Allmänmedicin, Box 453, 405 30, Gothenburg, Sweden.,Region Västra Götaland, Närhälsan Research and Development Primary Health Care, Gothenburg, Sweden
| | - Eva-Lisa Petersson
- Primary Health Care/School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Allmänmedicin, Box 453, 405 30, Gothenburg, Sweden.,Region Västra Götaland, Närhälsan Research and Development Primary Health Care, Gothenburg, Sweden
| | - Jeanette Westman
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Christina Möller
- Primary Health Care Head Office, Närhälsan, Region Västra Götaland, Gothenburg, Sweden
| | - Mikael Svensson
- Health Economics and Policy/School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
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Hange D, Ariai N, Björkelund C, Svenningsson I, Nejati S, Petersson EL, Augustsson P, Skoglund I. Associations between antidepressant therapy, work ability, and sick leave for patients with common mental disorders within a two-year perspective - A longitudinal observational cohort study in Swedish primary care. Heliyon 2021; 7:e07116. [PMID: 34113733 PMCID: PMC8170496 DOI: 10.1016/j.heliyon.2021.e07116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 03/31/2021] [Accepted: 05/17/2021] [Indexed: 11/18/2022] Open
Abstract
Background An increasing number of patients are on sick leave because of common mental disorders (CMD), with or without antidepressant therapy. There is a lack of long-term follow-up studies in the primary care context, where most of the patients are treated. The importance of identifying potential factors associated with work ability for CMD patients is increasingly in focus. Objective To investigate the associations between using antidepressants, sick leave duration, reported work ability and psychological symptoms among patients with CMD during a two-year observation period in the primary care context. Methods Longitudinal observational cohort study at 28 Primary Care Centers in Region Västra Götaland, Sweden, including 182 patients with an employment and on sick leave for CMD. The following outcomes were assessed: work ability measured with WAI, depressive symptoms with MADRS-S, anxiety symptoms with BAI, fatigue symptoms with KEDS, quality of life with EQ-5D, and days of sick leave. The data were compared between the groups that used and did not use antidepressants, during the 24-months observation period. Results Work ability and health-related quality of life increased over time in both groups. A steeper decrease of depressive symptoms, anxiety symptoms as well as an increased health-related quality of life at 3, 6 and 12 months was found in the group without antidepressants, although both groups levelled off at 24 months. In both groups, a higher work ability at baseline was associated with less two-year sick leave. Conclusion Our study indicates that a high work ability at baseline has a strong association with a lower total net and gross sick leave duration during the entire two-year follow-up period for patients with CMD in primary health care, irrespective of use of antidepressants. Using WAI in primary health care could therefore be helpful in predicting return to work. Use of antidepressants during the CMD episode could indicate initially a more pronounced overall symptom pattern, motivating introduction of antidepressants, rather than prolonging the sick leave period.
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Affiliation(s)
- Dominique Hange
- Primary Health Care/School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
- Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Sweden
- Corresponding author.
| | - Nashmil Ariai
- Primary Health Care/School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Cecilia Björkelund
- Primary Health Care/School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
- Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Sweden
| | - Irene Svenningsson
- Primary Health Care/School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
- Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Sweden
| | - Shabnam Nejati
- Primary Health Care/School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Eva-Lisa Petersson
- Primary Health Care/School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
- Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Sweden
| | - Pia Augustsson
- Primary Health Care/School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
- Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Sweden
| | - Ingmarie Skoglund
- Primary Health Care/School of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
- Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Sweden
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Petersson EL, Törnbom K, Hange D, Nejati S, Jerlock M, Wikberg C, Björkelund C, Svenningsson I. The experiences of care managers and rehabilitation coordinators of a primary care intervention to promote return to work for patients with common mental disorders: a qualitative study. BMC Fam Pract 2020; 21:272. [PMID: 33339512 PMCID: PMC7749497 DOI: 10.1186/s12875-020-01348-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 12/07/2020] [Indexed: 12/02/2022]
Abstract
Background In an earlier study, PRIM-CARE RCT, a care manager implementation at the primary care centre showed improved return to work and reduced sick leave for patients with CMD. To further improve return to work, the project Co-Work-Care added a person-centered dialogue meeting between the patient, the employer and the rehabilitation coordinator, preceded by an increased collaboration between care manager, rehabilitation coordinator and GP. In this first qualitative study of the Co-Work-Care project, we explored how care managers and rehabilitation coordinators experienced the Co-Work-Care model. The purpose of this study was to explore care managers’ and rehabilitation coordinators’ perceptions and experiences of a close collaboration and the use of the person-centred dialogue meeting. Methods From an ongoing RCT with 20 primary care centres, care managers (CMs) (n = 13) and rehabilitation coordinators (RCs) (n = 12) participated in a qualitative study with focus groups. The study was conducted in the primary health care in a Swedish region. The data was analysed with Systematic Text Condensation by Malterud. Results Seven codes describing the participants’ experiences of the Co-Work-Care model were identified: 1) The importance of collaboration at the primary care centre, 2) Collaboration and division of roles between the RC and the CM, 3) Collaboration with the General practitioner (GP), 4) The person-centred dialogue meeting, 5) Initiating the person-centred dialogue meeting, 6) The person-centred dialogue meeting to improve collaboration with the employer, and 7) The person-centred dialogue meeting to teach about the return to work process. Conclusion The increased collaboration within the Co-Work-Care model created a common picture and understanding of the patient’s situation. The person-centred dialogue meeting in the rehabilitation process became a bridge between the employer and the patient. Trial registration NCT03250026 (registered August 15, 2017). Supplementary Information The online version contains supplementary material available at 10.1186/s12875-020-01348-x.
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Affiliation(s)
- Eva-Lisa Petersson
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Research and Development Primary Health Care, Region Västra Götaland, Göteborg, Sweden
| | - Karin Törnbom
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Social Work, University of Gothenburg, Gothenburg, Sweden
| | - Dominique Hange
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Research and Development Primary Health Care, Region Västra Götaland, Göteborg, Sweden
| | - Shabnam Nejati
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Margareta Jerlock
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Carl Wikberg
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Cecilia Björkelund
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Research and Development Primary Health Care, Region Västra Götaland, Göteborg, Sweden
| | - Irene Svenningsson
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. .,Research and Development Primary Health Care, Region Västra Götaland, Göteborg, Sweden.
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10
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Nejati S, Ariai N, Björkelund C, Skoglund I, Petersson EL, Augustsson P, Hange D, Svenningsson I. Correspondence Between the Neuropsychiatric Interview M.I.N.I. and the BDI-II and MADRS-S Self-Rating Instruments as Diagnostic Tools in Primary Care Patients with Depression. Int J Gen Med 2020; 13:177-183. [PMID: 32523369 PMCID: PMC7234955 DOI: 10.2147/ijgm.s243150] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 03/27/2020] [Indexed: 11/23/2022] Open
Abstract
Objective To investigate the correspondence between the diagnoses received by patients with symptoms of common mental disorder attending primary care, based on the diagnostic instrument International Neuropsychiatric Interview (M.I.N.I.) and the self-assessment instruments such as Beck Depression Inventory (BDI-II) and Montgomery-Asberg Depression Rating Scale - self-rating version (MADRS-S), respectively. Design Data were collected from a prospective observational study, ADAS, between 2014 and 2015. Setting Twenty-eight primary care centers in Region Västra Gotaland, Sweden. Patients A total of 192 patients, 18-60 years of age, on sick leave ≥14 days, with mild/moderate depression, anxiety syndrome, and stress-related mental illness were included. Main Outcome Measures Scores of the assessment instruments (BDI-II and MADRS-S) on inclusion, sensitivity, specificity, positive (PPV) and negative predictive value (NPV) for BDI-II and MADRS-S, respectively, with M.I.N.I used as diagnostic instrument. Results Using M.I.N.I. as gold standard, the BDI-II and MADRS-S showed almost the same sensitivity (86.9% and 87.4%, respectively), but specificity for MADRS-S was doubled compared to BDI-II (36% and 18%, respectively). There was a significant association between MADRS-S and M.I.N.I. (p=0.027). However, the same analysis between BDI and M.I.N.I. was not statistically significant (p= 0.635). NPV and PPV were calculated from assumed prevalences (10% and 75%) and were higher for MADRS-S compared to BDI-II. The PPV differences were between 2% and 7% and NPV differences were between 3% and 19%. Conclusion With M.I.N.I. as gold standard, MADRS-S performs better than BDI-II as a self-assessment tool in the primary care context for depression diagnostics.
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Affiliation(s)
- Shabnam Nejati
- Primary Health Care/School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Nashmil Ariai
- Primary Health Care/School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Cecilia Björkelund
- Primary Health Care/School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Ingmarie Skoglund
- Primary Health Care/School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.,Narhalsan Research and Development Primary Health Care, Region Vastra Gotaland, Gothenburg, Sweden
| | - Eva-Lisa Petersson
- Primary Health Care/School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.,Narhalsan Research and Development Primary Health Care, Region Vastra Gotaland, Gothenburg, Sweden
| | - Pia Augustsson
- Narhalsan Research and Development Primary Health Care, Region Vastra Gotaland, Gothenburg, Sweden
| | - Dominique Hange
- Primary Health Care/School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.,Narhalsan Research and Development Primary Health Care, Region Vastra Gotaland, Gothenburg, Sweden
| | - Irene Svenningsson
- Primary Health Care/School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden.,Narhalsan Research and Development Primary Health Care, Region Vastra Gotaland, Gothenburg, Sweden
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11
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Augustsson P, Holst A, Svenningsson I, Petersson EL, Björkelund C, Björk Brämberg E. Implementation of care managers for patients with depression: a cross-sectional study in Swedish primary care. BMJ Open 2020; 10:e035629. [PMID: 32371517 PMCID: PMC7228530 DOI: 10.1136/bmjopen-2019-035629] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To perform an analysis of collaborative care with a care manager implementation in a primary healthcare setting. The study has a twofold aim: (1) to examine clinicians' and directors' perceptions of implementing collaborative care with a care manager for patients with depression at the primary care centre (PCC), and (2) to identify barriers and facilitators that influenced this implementation. DESIGN A cross-sectional study was performed in 2016-2017 in parallel with a cluster-randomised controlled trial. SETTING 36 PCCs in south-west Sweden. PARTICIPANTS PCCs' directors and clinicians. OUTCOME Data regarding the study's aims were collected by two web-based questionnaires (directors, clinicians). Descriptive statistics and qualitative content analysis were used for analysis. RESULTS Among the 36 PCCs, 461 (59%) clinicians and 36 (100%) directors participated. Fifty-two per cent of clinicians could cooperate with the care manager without problems. Forty per cent regarded to their knowledge of the care manager assignment as insufficient. Around two-thirds perceived that collaborating with the care manager was part of their duty as PCC staff. Almost 90% of the PCCs' directors considered that the assignment of the care manager was clearly designed, around 70% considered the priority of the implementation to be high and around 90% were positive to the implementation. Facilitators consisted of support from colleagues and directors, cooperative skills and positive attitudes. Barriers were high workload, shortage of staff and extensive requirements and demands from healthcare management. CONCLUSIONS Our study confirms that the care manager puts collaborative care into practice. Facilitators and barriers of the implementation, such as time, information, soft values and attitudes, financial structure need to be considered when implementing care managers at PCCs.
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Affiliation(s)
- Pia Augustsson
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Research and Development, Primary Health Care, Region Västra Götaland, Sweden
| | - Anna Holst
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Research and Development, Primary Health Care, Region Västra Götaland, Sweden
| | - Irene Svenningsson
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Research and Development, Primary Health Care, Region Västra Götaland, Sweden
| | - Eva-Lisa Petersson
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Research and Development, Primary Health Care, Region Västra Götaland, Sweden
| | - Cecilia Björkelund
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Research and Development, Primary Health Care, Region Västra Götaland, Sweden
| | - Elisabeth Björk Brämberg
- Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Research and Development, Primary Health Care, Region Västra Götaland, Sweden
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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12
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Björkelund C, Svenningsson I, Westman J, Petersson EL, Hange D, Holst A, Wallin L, Udo C. [Effects of a care manager organization for care of people with mild-moderate depression in Swedish primary care]. Lakartidningen 2019; 116:FSH3. [PMID: 31688945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
By strengthening accessibility and continuity and support via a care manager for primary care patients with depression corresponding to 20-30% of a nursing service, patients recovered significantly faster and to a greater extent than in primary care-as-usual. Return to work occurred significantly earlier in the first three months, and net sick leave period was significantly shorter during the following 4-6 months. To introduce a collaborative care organizational change where the care manager is the hub and coordinates care for the patient and makes it possible to adapt the care according to the patient's needs throughout the care process, is thus the individual effort shown to have the greatest efficiency in Swedish primary care to increase the quality of care of depression. This approach, where the clinic and academy work closely and continuously in the development and evaluation phases, makes it possible to rapidly develop new ways of working where consideration is given to the complexity of primary care and the complexity of care needs and care efforts.
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Affiliation(s)
- Cecilia Björkelund
- Institute of medicine - Primary Health Care/Public Health and Community Medicine Gothenburg, Sweden Institute of medicine - Primary Health Care Gothenburg, Sweden
| | - Irene Svenningsson
- Goteborgs Universitet - Enehten för allmänmedicin, institutionen för medicin Goteborg, Sweden Goteborgs Universitet - Enehten för allmänmedicin, institutionen för medicin Goteborg, Sweden
| | - Jeanette Westman
- KI - Institutionen för Neurobiologi, Vårdvetenskap och Samhälle (NVS), H1, Sektionen för omvårdnad Stockholm, Sweden KI - Institutionen för Neurobiologi, Vårdvetenskap och Samhälle (NVS), H1, Sektionen för omvårdnad Stockholm, Sweden
| | - Eva-Lisa Petersson
- Goteborgs Universitet - Enheten för allmänmedicin, institutionen för medicin Goteborg, Sweden Goteborgs Universitet - Enheten för allmänmedicin, institutionen för medicin Goteborg, Sweden
| | - Dominique Hange
- Goteborgs Universitet - Enheten för allmänmedicin, institutionen för medicin Goteborg, Sweden Goteborgs Universitet - Enheten för allmänmedicin, institutionen för medicin Goteborg, Sweden
| | - Anna Holst
- Goteborgs Universitet - Enheten för allmänmedicin, institutionen för medicin Goteborg, Sweden Goteborgs Universitet - Enheten för allmänmedicin, institutionen för medicin Goteborg, Sweden
| | - Lars Wallin
- Hogskolan Dalarna Akademin Utbildning Halsa och Samhalle - Falun, Sweden Hogskolan Dalarna Akademin Utbildning Halsa och Samhalle - Falun, Sweden
| | - Camilla Udo
- Hogskolan Dalarna - Falun, Sweden Hogskolan Dalarna - Falun, Sweden
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Hammarberg SAW, Hange D, André M, Udo C, Svenningsson I, Björkelund C, Petersson EL, Westman J. Care managers can be useful for patients with depression but their role must be clear: a qualitative study of GPs' experiences. Scand J Prim Health Care 2019; 37:273-282. [PMID: 31286807 PMCID: PMC6713154 DOI: 10.1080/02813432.2019.1639897] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Objective: Explore general practitioners' (GPs') views on and experiences of working with care managers for patients treated for depression in primary care settings. Care managers are specially trained health care professionals, often specialist nurses, who coordinate care for patients with chronic diseases. Design: Qualitative content analysis of five focus-group discussions. Setting: Primary health care centers in the Region of Västra Götaland and Dalarna County, Sweden. Subjects: 29 GPs. Main outcome measures: GPs' views and experiences of care managers for patients with depression. Results: GPs expressed a broad variety of views and experiences. Care managers could ensure care quality while freeing GPs from case management by providing support for patients and security and relief for GPs and by coordinating patient care. GPs could also express concern about role overlap; specifically, that GPs are already care managers, that too many caregivers disrupt patient contact, and that the roles of care managers and psychotherapists seem to compete. GPs thought care managers should be assigned to patients who need them the most (e.g. patients with life difficulties or severe mental health problems). They also found that transition to a chronic care model required change, including alterations in the way GPs worked and changes that made depression treatment more like treatment for other chronic diseases. Conclusion: GPs have varied experiences of care managers. As a complementary part of the primary health care team, care managers can be useful for patients with depression, but team members' roles must be clear. KEY POINTS A growing number of primary health care centers are introducing care managers for patients with depression, but knowledge about GPs' experiences of this kind of collaborative care is limited. GPs find that care managers provide support for patients and security and relief for GPs. GPs are concerned about potential role overlap and desire greater latitude in deciding which patients can be assigned a care manager. GPs think depression can be treated using a chronic care model that includes care managers but that adjusting to the new way of working will take time.
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Affiliation(s)
- Sandra af Winklerfelt Hammarberg
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden;
- Academic Primary Health Care Centre, Stockholm County Council, Stockholm, Sweden;
- CONTACT Sandra af Winklerfelt Hammarberg Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, Huddinge 141 52, Stockholm, Sweden
| | - Dominique Hange
- Department of Public Health and Community Medicine, Primary Health Care, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden;
| | - Malin André
- Department of Public Health and Caring Sciences – Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden;
| | - Camilla Udo
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden;
- CKF, Center for Clinical Research Dalarna, Falun, Sweden;
| | - Irene Svenningsson
- Department of Public Health and Community Medicine, Primary Health Care, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden;
- Närhälsan Research and Development Primary Health Care, Region Västra Götaland, Gothenburg, Sweden;
| | - Cecilia Björkelund
- Department of Public Health and Community Medicine, Primary Health Care, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden;
| | - Eva-Lisa Petersson
- Department of Public Health and Community Medicine, Primary Health Care, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden;
- Närhälsan Research and Development Primary Health Care, Region Västra Götaland, Gothenburg, Sweden;
| | - Jeanette Westman
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden;
- Academic Primary Health Care Centre, Stockholm County Council, Stockholm, Sweden;
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
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Marczak J, Rembeck G, Petersson EL, Nordeman L. Patient experiences of living with chronic leg ulcers and making the decision to seek professional health-care. J Wound Care 2019; 28:S18-S25. [PMID: 30724122 DOI: 10.12968/jowc.2019.28.sup1.s18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE: The aim of the study was to elucidate how patients experience living with chronic leg ulcers before consulting a health professional, and to determine the reasons behind the decision to visit a health-care centre. METHOD: A qualitative interview study was carried out. There were 11 participants, five men and six women (age range: 27-83 years old). All participants in the study were patients visiting the public primary medical centre in western Sweden for the first time for a chronic leg ulcer. The data was obtained by recorded interviews. Systematic text condensation (STC) by Malterud was applied to the analysis. RESULTS: The analysis identified five main categories of the issues relating to ulcers to their ulcers: convictions, pain, emotions, strategies, and health-care treatment. At first, patients accepted the inconvenience of a leg ulcer. Gradually, they focused more on strategies dealing with the ulcer, and withdrew from their social context, while their fears increased. Many needed support in the decision to seek professional care. CONCLUSION: Despite pain, anxiety, emotional lability, and disappointment, they had strategies to cope with ulcers on their own. A social network seems crucial for the decision to seek professional health care and greater knowledge of leg ulcers, particularly in the elderly population, is needed.
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Affiliation(s)
| | - Gun Rembeck
- Midwife; Department of Public Health and Community Medicine/Primary Health Care, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; and Närhälsan Borås Youth Health Centre Region Västra Götaland, Sweden; and Research and Development Center Södra Älvsborg, Närhälsan Research and Development, Primary Health Care Region Västra Götaland, Sweden
| | - Eva-Lisa Petersson
- Occupational therapist; Närhälsan, Research and Development Primary Health Care Region Västra, Götaland Research, Development Center Gothenburg and South Bohuslän, Sweden; and Department of Primary Health Care/Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lena Nordeman
- Physiotherapist; Research and Development Center Södra Älvsborg, Närhälsan Research and Development, Primary Health Care Region Västra Götaland, Sweden; and University of Gothenburg, Sahlgrenska Academy, Institute of Neuroscience and Physiology, Department of Health and Rehabilitation, Unit of Physiotherapy, Sweden
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15
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Skoglund I, Björkelund C, Svenningsson I, Petersson EL, Augustsson P, Nejati S, Ariai N, Hange D. Influence of antidepressant therapy on sick leave in primary care: ADAS, a comparative observational study. Heliyon 2019; 5:e01101. [PMID: 30627686 PMCID: PMC6321886 DOI: 10.1016/j.heliyon.2018.e01101] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 10/30/2018] [Accepted: 12/24/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Compared to other European countries, Sweden's yearly sick leave expenditures are moderate. Common mental disorders (CMD) are important causes of sick leave, affecting 10-15% of the adult population. A Swedish register based study indicates that antidepressant therapy for patients on long-term sick leave for CMD leads to longer sick leave and higher frequency of non-time-limited sickness compensation as compared to psychotherapy, work oriented rehabilitation, and other therapies. AIM To verify if patients on antidepressant therapy and on long-term sick leave for depression, anxiety and stress-related mental disorders have a longer sick leave than patients treated with other therapies. METHOD Prospective, observational study at 28 primary health care centers in the Region Västra Götaland, Sweden, including 192 patients on sick leave for CMD. Outcome measures were gross and net sick leave days. INTERPRETATION There were no significant differences in sick leave days (gross or net) due to CMD when comparing the patients treated and not treated with antidepressants during the 12 month observation period. The groups differed at baseline only concerning frequency of exhaustion disorder, with a higher frequency of exhaustion disorder in the group without antidepressants. Analysis of other possible factors associated with shorter or longer sick leave only showed associations with the patient's own perception of possibility of returning to work in near and distant future. An important factor associated with longer sick leave was the patient's own perception of possibility of return to present workplace. As CMD are important causes of sick leave and sick leave costs, this factor should be highlighted in future research on the rehabilitation process.
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Affiliation(s)
- Ingmarie Skoglund
- Department of Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
- The Research and Development Department, Södra Älvsborg, Sven Eriksonsplatsen 4, 503 38 Borås, Sweden
| | - Cecilia Björkelund
- Department of Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Irene Svenningsson
- Department of Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
- Region Västra Götaland, Närhälsan Research and Development Primary Health Care, Sweden
| | - Eva-Lisa Petersson
- Department of Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
- Region Västra Götaland, Närhälsan Research and Development Primary Health Care, Sweden
| | - Pia Augustsson
- Department of Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
- Region Västra Götaland, Närhälsan Research and Development Primary Health Care, Sweden
| | - Shabnam Nejati
- Department of Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
- Region Västra Götaland, Närhälsan Research and Development Primary Health Care, Sweden
| | - Nashmil Ariai
- Department of Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
- Region Västra Götaland, Närhälsan Research and Development Primary Health Care, Sweden
| | - Dominique Hange
- Department of Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden
- Region Västra Götaland, Närhälsan Research and Development Primary Health Care, Sweden
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Svenningsson I, Udo C, Westman J, Nejati S, Hange D, Björkelund C, Petersson EL. Creating a safety net for patients with depression in primary care; a qualitative study of care managers' experiences. Scand J Prim Health Care 2018; 36:355-362. [PMID: 30314415 PMCID: PMC6381518 DOI: 10.1080/02813432.2018.1529018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE The aim of this study was to explore nurses' experiences and perceptions of working as care managers at primary care centers. DESIGN Qualitative, focus group study. Systematic text condensation was used to analyze the data. SETTING Primary health care in the region of Västra Götaland and region of Dalarna in Sweden. SUBJECTS Eight nurses were trained during three days including treatment of depression and how to work as care managers. The training was followed by continuous support. MAIN OUTCOME MEASURES The nurses' experiences and perceptions of working as care managers at primary care centers. RESULTS The care managers described their role as providing additional support to the already existing care at the primary care center, working in teams with a person-centered focus, where they were given the opportunity to follow, support, and constitute a safety net for patients with depression. Further, they perceived that the care manager increased continuity and accessibility to primary care for patients with depression. CONCLUSION The nurses perceived that working as care managers enabled them to follow and support patients with depression and to maintain close contact during the illness. The care manager function helped to provide continuity in care which is a main task of primary health care. Key Points The care managers described their role as an additional support to the already existing care at the primary care center. • They emphasized that as care managers, they had a person-centered focus and constituted a safety net for patients with depression. • Their role as care managers enabled them to follow and support patients with depression over time, which made their work more meaningful. • Care managers helped to achieve continuity and accessibility to primary health care for patients with depression.
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Affiliation(s)
- Irene Svenningsson
- Department of Primary Health Care, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden;
- Primary Health Care, Närhälsan Research and Development, Region Västra Götaland, Sweden;
- CONTACT Irene Svenningsson Department of Primary Health Care, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, SwedenPrimary Health Care, Närhälsan Research and Development, Region Västra Götaland, Sweden
| | - Camilla Udo
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden;
- Centre for Clinical Research, Dalarna, Sweden;
| | - Jeanette Westman
- Division of Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Shabnam Nejati
- Department of Primary Health Care, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden;
| | - Dominique Hange
- Department of Primary Health Care, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden;
| | - Cecilia Björkelund
- Department of Primary Health Care, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden;
| | - Eva-Lisa Petersson
- Department of Primary Health Care, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden;
- Primary Health Care, Närhälsan Research and Development, Region Västra Götaland, Sweden;
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Holst A, Ginter A, Björkelund C, Hange D, Petersson EL, Svenningsson I, Westman J, André M, Wikberg C, Wallin L, Möller C, Svensson M. Cost-effectiveness of a care manager collaborative care programme for patients with depression in primary care: economic evaluation of a pragmatic randomised controlled study. BMJ Open 2018; 8:e024741. [PMID: 30420353 PMCID: PMC6252772 DOI: 10.1136/bmjopen-2018-024741] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To evaluate the cost-effectiveness of a care manager (CM) programme compared with care as usual (CAU) for treatment of depression at primary care centres (PCCs) from a healthcare as well as societal perspective. DESIGN Cost-effectiveness analysis. SETTING 23 PCCs in two Swedish regions. PARTICIPANTS Patients with depression (n=342). MAIN OUTCOME MEASURES A cost-effectiveness analysis was applied on a cluster randomised trial at PCC level where patients with depression had 3 months of contact with a CM (11 intervention PCCs, n=163) or CAU (12 control PCCs, n=179), with follow-up 3 and 6 months. Effectiveness measures were based on the number of depression-free days (DFDs) calculated from the Montgomery-Åsberg Depression Rating Scale-Self and quality-adjusted life years (QALYs). Results were expressed as the incremental cost-effectiveness ratio: ∆Cost/∆QALY and ∆Cost/∆DFD. Sampling uncertainty was assessed based on non-parametric bootstrapping. RESULTS Health benefits were higher in intervention group compared with CAU group: QALYs (0.357 vs 0.333, p<0.001) and DFD reduction of depressive symptom score (79.43 vs 60.14, p<0.001). The mean costs per patient for the 6-month period were €368 (healthcare perspective) and €6217 (societal perspective) for the intervention patients and €246 (healthcare perspective) and €7371 (societal perspective) for the control patients (n.s.). The cost per QALY gained was €6773 (healthcare perspective) and from a societal perspective the CM programme was dominant. DISCUSSION The CM programme was associated with a gain in QALYs as well as in DFD, while also being cost saving compared with CAU from a societal perspective. This result is of high relevance for decision-makers on a national level, but it must be observed that a CM programme for depression implies increased costs at the primary care level. TRIAL REGISTRATION NUMBER NCT02378272; Results.
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Affiliation(s)
- Anna Holst
- Department of Public Health and Community Medicine/Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Annika Ginter
- Department of Public Health and Community Medicine/Health Metrics, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Cecilia Björkelund
- Department of Public Health and Community Medicine/Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Dominique Hange
- Department of Public Health and Community Medicine/Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eva-Lisa Petersson
- Department of Public Health and Community Medicine/Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Närhälsan Research and Development Primary Health Care, Region Västra Götaland, Gothenburg, Sweden
| | - Irene Svenningsson
- Department of Public Health and Community Medicine/Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Närhälsan Research and Development Primary Health Care, Region Västra Götaland, Gothenburg, Sweden
| | - Jeanette Westman
- Division of Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Malin André
- Department of Public Health and Caring Sciences-Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
| | - Carl Wikberg
- Department of Public Health and Community Medicine/Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lars Wallin
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
- Department of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Christina Möller
- Primary Health Care Head Office, Närhälsan, Region Västra Götaland, Hisings Backa, Sweden
| | - Mikael Svensson
- Department of Public Health and Community Medicine/Health Metrics, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Skoglund I, Petersson EL, Hange D. A bridge over troubled water? A qualitative study of primary care patients' experiences of a rehabilitation program. J Multidiscip Healthc 2018; 11:457-466. [PMID: 30254453 PMCID: PMC6141123 DOI: 10.2147/jmdh.s166866] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose The aim of this study was to explore how patients on sick leave experienced and perceived the early collaboration work model (ECM) for rehabilitation. Patients and methods Data were collected via focus group discussions and individual interviews with 15 patients on sick leave, at nine primary health care centers. The systematic text condensation method described by Malterud was used for thematic analysis of meaning and content of data across cases. Results The participants perceived that sharing experiences with others in a similar situation was restorative. They described the importance of coordination in the program as well as the efforts of the rehabilitation coordinator, who helped with daily structure and support in the beginning as well as encouragement throughout the sick leave period. Some participants felt ashamed of being on sick leave and of being outside the community. Conclusion ECM with a rehabilitation coordinator who could share responsibility with the patient during the entire sick leave period was perceived to be of support during rehabilitation.
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Affiliation(s)
- Ingmarie Skoglund
- Närhälsan Research and Development Primary Health Care, Region Västra Götaland, Sweden, .,Department of Public Health and Community Medicine/Primary Health Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,
| | - Eva-Lisa Petersson
- Närhälsan Research and Development Primary Health Care, Region Västra Götaland, Sweden, .,Department of Public Health and Community Medicine/Primary Health Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,
| | - Dominique Hange
- Närhälsan Research and Development Primary Health Care, Region Västra Götaland, Sweden, .,Department of Public Health and Community Medicine/Primary Health Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,
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Björkelund C, Svenningsson I, Hange D, Udo C, Petersson EL, Ariai N, Nejati S, Wessman C, Wikberg C, André M, Wallin L, Westman J. Clinical effectiveness of care managers in collaborative care for patients with depression in Swedish primary health care: a pragmatic cluster randomized controlled trial. BMC Fam Pract 2018; 19:28. [PMID: 29426288 PMCID: PMC5807835 DOI: 10.1186/s12875-018-0711-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 01/24/2018] [Indexed: 11/10/2022]
Abstract
Background Depression is one of the leading causes of disability and affects 10-15% of the population. The majority of people with depressive symptoms seek care and are treated in primary care. Evidence internationally for high quality care supports collaborative care with a care manager. Our aim was to study clinical effectiveness of a care manager intervention in management of primary care patients with depression in Sweden. Methods In a pragmatic cluster randomized controlled trial 23 primary care centers (PCCs), urban and rural, included patients aged ≥ 18 years with a new (< 1 month) depression diagnosis. Intervention consisted of Care management including continuous contact between care manager and patient, a structured management plan, and behavioral activation, altogether around 6-7 contacts over 12 weeks. Control condition was care as usual (CAU). Outcome measures: Depression symptoms (measured by Mongomery-Asberg depression score-self (MADRS-S) and BDI-II), quality of life (QoL) (EQ-5D), return to work and sick leave, service satisfaction, and antidepressant medication. Data were analyzed with the intention-to-treat principle. Results One hundred ninety two patients with depression at PCCs with care managers were allocated to the intervention group, and 184 patients at control PCCs were allocated to the control group. Mean depression score measured by MADRS-S was 2.17 lower in the intervention vs. the control group (95% CI [0.56; 3.79], p = 0.009) at 3 months and 2.27 lower (95% CI [0.59; 3.95], p = 0.008) at 6 months; corresponding BDI-II scores were 1.96 lower (95% CI [− 0.19; 4.11], p = 0.07) in the intervention vs. control group at 6 months. Remission was significantly higher in the intervention group at 6 months (61% vs. 47%, p = 0.006). QoL showed a steeper increase in the intervention group at 3 months (p = 0.01). During the first 3 months, return to work was significantly higher in the intervention vs. the control group. Patients in the intervention group were more consistently on antidepressant medication than patients in the control group. Conclusions Care managers for depression treatment have positive effects on depression course, return to work, remission frequency, antidepressant frequency, and quality of life compared to usual care and is valued by the patients. Trial registration Identifier: NCT02378272. February 2, 2015. Retrospectively registered.
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Affiliation(s)
- Cecilia Björkelund
- Department of Primary Health Care, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. .,Department of Primary Health Care, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Box 454, 40530, Göteborg, Sweden.
| | - Irene Svenningsson
- Department of Primary Health Care, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Dominique Hange
- Department of Primary Health Care, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Camilla Udo
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
| | - Eva-Lisa Petersson
- Department of Primary Health Care, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Närhälsan Research and Development Primary Health Care, Gothenburg, Sweden
| | - Nashmil Ariai
- Department of Primary Health Care, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Shabnam Nejati
- Department of Primary Health Care, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Catrin Wessman
- Health Metrics Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Carl Wikberg
- Department of Primary Health Care, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Malin André
- Department of Public Health and Caring Sciences - Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
| | - Lars Wallin
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.,Department of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Jeanette Westman
- Division of Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
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20
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Eriksson MCM, Kivi M, Hange D, Petersson EL, Ariai N, Häggblad P, Ågren H, Spak F, Lindblad U, Johansson B, Björkelund C. Long-term effects of Internet-delivered cognitive behavioral therapy for depression in primary care - the PRIM-NET controlled trial. Scand J Prim Health Care 2017; 35:126-136. [PMID: 28585868 PMCID: PMC5499312 DOI: 10.1080/02813432.2017.1333299] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Internet-delivered cognitive behavioral therapy (ICBT) is recommended as an efficient treatment alternative for depression in primary care. However, only few previous studies have been conducted at primary care centers (PCCs). We evaluated long-term effects of ICBT treatment for depression compared to treatment as usual (TAU) in primary care settings. DESIGN Randomized controlled trial. SETTING Patients were enrolled at16 PCCs in south-west Sweden. PARTICIPANTS Patients attending PCCs and diagnosed with depression (n = 90). INTERVENTIONS Patients were assessed by a primary care psychologist/psychotherapist and randomized to ICBT or TAU. The ICBT included an ICBT program consisting of seven modules and weekly therapist e-mail or telephone support during the 3-month treatment period. MAIN OUTCOME MEASURES Questionnaires on depressive symptoms (BDI-II), quality of life (EQ-5D) and psychological distress (GHQ-12) were administered at baseline, with follow-ups at 3, 6 and 12 months. Antidepressants and sedatives use, sick leave and PCC contacts were registered. RESULTS Intra-individual change in depressive symptoms did not differ between the ICBT group and the TAU group during the treatment period or across the follow-up periods. At 3-month follow-up, significantly fewer patients in ICBT were on antidepressants. However, the difference leveled out at later follow-ups. There were no differences between the groups concerning psychological distress, sick leave or quality of life, except for a larger improvement in quality of life in the TAU group during the 0- to 6-month period. CONCLUSIONS ICBT with weekly minimal therapist support in primary care can be equally effective as TAU among depressed patients also over a 12-month period. CLINICAL TRIAL REGISTRATION The trial was registered in the Swedish Registry, researchweb.org, ID number 30511.
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Affiliation(s)
- Maria C. M. Eriksson
- Department of Primary Health Care/Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- CONTACT Maria C. M. Eriksson Department of Primary Health Care, University of Gothenburg, Box 454, 405 30 Gothenburg, Sweden
| | - Marie Kivi
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Dominique Hange
- Department of Primary Health Care/Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eva-Lisa Petersson
- Department of Primary Health Care/Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Gothenburg, Sweden
| | - Nashmil Ariai
- Department of Primary Health Care/Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Hans Ågren
- Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Fredrik Spak
- Department of Epidemiology and Social Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Ulf Lindblad
- Department of Primary Health Care/Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Boo Johansson
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Cecilia Björkelund
- Department of Primary Health Care/Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Hange D, Ariai N, Kivi M, Eriksson MC, Nejati S, Petersson EL. The impact of internet-based cognitive behavior therapy on work ability in patients with depression - a randomized controlled study. Int J Gen Med 2017; 10:151-159. [PMID: 28579817 PMCID: PMC5446974 DOI: 10.2147/ijgm.s129710] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Objectives The aim of this randomized controlled trial (RCT) was to investigate the effects of internet-based cognitive behavior therapy (ICBT) treatment for depression compared to treatment-as-usual (TAU) on improving work ability and quality of life in patients with mild-to-moderate depression. We also examined whether patients treated with ICBT returned to work more rapidly, that is, had fewer days of sick leave, than patients treated with TAU. Design This study is based on material from the PRIM-NET RCT that took place between 2010 and 2013. Setting Primary care centers in Region Vastra Gotaland, Sweden, population about 1.6 million. Patients A total of 77 patients with depression randomized to either ICBT (46 patients) or TAU (31 patients). Mean age of participants was 35.8 years, and 67.5% were women. Main outcome measures Work ability was measured with the Work Ability Index, depressive symptoms with Montgomery Asberg Depression Rating Scale – self-rating version (MADRS-S), quality of life with EuroQoL-5D (EQ-5D), and number of sick leave days. Results Both groups showed an association between improved work ability and reduction of depressive symptoms and between improved work ability and better quality of life. ICBT could not be shown to improve work ability more than TAU among patients with mild-to-moderate depression. There were no differences between the groups concerning number of patients with sick leave or number of sick leave days. Conclusion Our study indicates that a high level of work ability has an association with high health-related quality of life in patients with mild-to-moderate depression, whether they are treated with ICBT or TAU. ICBT has previously been found to be cost-effective and can be seen as a good alternative to TAU. In addition to the ICBT, an intervention oriented toward the work place might improve work ability and reduce the number of sick leave days among patients with depression.
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Affiliation(s)
- Dominique Hange
- Department of Public Health and Community Medicine/Primary Health Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Nashmil Ariai
- Department of Public Health and Community Medicine/Primary Health Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Marie Kivi
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Maria Cm Eriksson
- Department of Public Health and Community Medicine/Primary Health Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Shabnam Nejati
- Department of Public Health and Community Medicine/Primary Health Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eva-Lisa Petersson
- Department of Public Health and Community Medicine/Primary Health Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Narhalsan Research and Development Primary Health Care, Region Vastra Gotaland, Gothenburg, Sweden
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Holst A, Nejati S, Björkelund C, Eriksson MCM, Hange D, Kivi M, Wikberg C, Petersson EL. Patients' experiences of a computerised self-help program for treating depression - a qualitative study of Internet mediated cognitive behavioural therapy in primary care. Scand J Prim Health Care 2017; 35:46-53. [PMID: 28277055 PMCID: PMC5361419 DOI: 10.1080/02813432.2017.1288813] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE The objective of this study was to explore primary care patients' experiences of Internet mediated cognitive behavioural therapy (iCBT) depression treatment. DESIGN Qualitative study. Data were collected from focus group discussions and individual interviews. SETTING Primary care. METHOD Data were analysed by systematic text condensation by Malterud. SUBJECTS Thirteen patients having received iCBT for depression within the PRIM-NET study. MAIN OUTCOME MEASURES Analysis presented different aspects of patients' experiences of iCBT. RESULTS The informants described a need for face-to-face meetings with a therapist. A therapist who performed check-ups and supported the iCBT process seemed important. iCBT implies that a responsibility for the treatment is taken by the patient, and some patients felt left alone, while others felt well and secure. This was a way to work in privacy and freedom with a smoothly working technology although there was a lack of confidence and a feeling of risk regarding iCBT. CONCLUSION iCBT is an attractive alternative to some patients with depression in primary care, but not to all. An individual treatment design seems to be preferred, and elements of iCBT could be included as a complement when treating depression in primary care. Such a procedure could relieve the overall treatment burden of depression. Key points Internet mediated cognitive behavioural therapy (iCBT) can be effective in treating depression in primary care, but patients' experiences of iCBT are rarely studied • Most patients express a need for human contact, real-time interaction, dialogue and guidance when treated for depression. • The patient's opportunity to influence the practical circumstances about iCBT is a success factor, though this freedom brings a large responsibility upon the receiver. • An individual treatment design seems to be crucial, and elements of iCBT could be included as a complement to face-to-face meetings.
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Affiliation(s)
- Anna Holst
- Department of Primary Health Care/Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- CONTACT Anna Holst Department of Primary Health Care/Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, PO Box 454, SE 405 30 Gothenburg, Sweden
| | - Shabnam Nejati
- Department of Primary Health Care/Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Cecilia Björkelund
- Department of Primary Health Care/Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Maria C. M. Eriksson
- Department of Primary Health Care/Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Dominique Hange
- Department of Primary Health Care/Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Marie Kivi
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Carl Wikberg
- Department of Primary Health Care/Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eva-Lisa Petersson
- Department of Primary Health Care/Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Närhälsan Research and Development Primary Health Care, Region Västra Götaland, Gothenburg, Sweden
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Wikberg C, Pettersson A, Westman J, Björkelund C, Petersson EL. Patients' perspectives on the use of the Montgomery-Asberg depression rating scale self-assessment version in primary care. Scand J Prim Health Care 2016; 34:434-442. [PMID: 27804312 PMCID: PMC5217279 DOI: 10.1080/02813432.2016.1248635] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE The aim of the current study was to better understand how patients with depression perceive the use of MADRS-S in primary care consultations with GPs. DESIGN Qualitative study. Focus group discussion and analysis through Systematic Text Condensation. SETTING Primary Health Care, Region Västra Götaland, Sweden. SUBJECTS Nine patients with mild/moderate depression who participated in a RCT evaluating the effects of regular use of the Montgomery-Åsberg Depression Self-assessment scale (MADRS-S) during the GP consultations. MAIN OUTCOME MEASURE Patients' experiences and perceptions of the use of MADRS-S in primary care. RESULTS Three categories emerged from the analysis: (I) confirmation; MADRS-S shows that I have depression and how serious it is, (II) centeredness; the most important thing is for the GP to listen to and take me seriously and (III) clarification; MADRS-S helps me understand why I need treatment for depression. CONCLUSION Use of MADRS-S was perceived as a confirmation for the patients that they had depression and how serious it was. MADRS-S showed the patients something black on white that describes and confirms the diagnosis. The informants emphasized the importance of patient-centeredness; of being listened to and to be taken seriously during the consultation. Use of self-assessment scales such as MADRS-S could find its place, but needs to adjust to the multifaceted environment that primary care provides. Key Points Patients with depression in primary care perceive that the use of a self-assessment scale in the consultation purposefully can contribute in several ways. The scale contributes to Confirmation: MADRS-S shows that I have depression and how serious it is. Centeredness: The most important thing is for the GP to listen to and take me seriously. Clarification: MADRS-S helps me understand why I need treatment for depression.
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Affiliation(s)
- Carl Wikberg
- Department of Public Health and Community Medicine, Section of Primary Health Care, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
- Närhälsan Research and Development Primary Health Care, Region Västra Götaland, Sweden
- CONTACT Carl Wikberg Department of Public Health and Community Medicine/Primary Health Care, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Agneta Pettersson
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm
- Swedish Council on Health Technology Assessment (SBU), Stockholm
| | - Jeanette Westman
- Centre for Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Cecilia Björkelund
- Department of Public Health and Community Medicine, Section of Primary Health Care, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Eva-Lisa Petersson
- Department of Public Health and Community Medicine, Section of Primary Health Care, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
- Närhälsan Research and Development Primary Health Care, Region Västra Götaland, Sweden
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Jörgensdotter Wegnelius C, Petersson EL. Cultural Background and Societal Influence on Coping Strategies for Physical Activity Among Immigrant Women. J Transcult Nurs 2016; 29:54-63. [PMID: 27815551 DOI: 10.1177/1043659616676317] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE The aim of the study was to examine, from an intersectional perspective, how immigrant women with prolonged illness experience the conditions for physical activity. METHOD Focus groups were used. Twenty-two women from primary care representing 14 countries were included. Systematic text condensation was applied for analysis. RESULTS Five conditions were identified: Dual cultures to relate to, Isolation an invisible danger, Keys to physical activity, Physical activity for whom, The power to decide the agenda. DISCUSSION AND CONCLUSION This study shows the importance of raising the intersectional perspective for immigrant women's possibilities to perform physical activity. Immigrant women's vulnerability to power relations and their adjustment to society's expectations are significant considerations to be aware of. IMPLICATIONS FOR PRACTICE Our findings emphasize the significance of collaborating in biomedical and psychosocial issues, considering that the obstacles are more comprehensive than society assumes regarding prior knowledge, isolation, and cultural rules.
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Wikberg C, Nejati S, Larsson MEH, Petersson EL, Westman J, Ariai N, Kivi M, Eriksson M, Eggertsen R, Hange D, Baigi A, Björkelund C. Comparison Between the Montgomery-Asberg Depression Rating Scale-Self and the Beck Depression Inventory II in Primary Care. Prim Care Companion CNS Disord 2015; 17:14m01758. [PMID: 26644958 DOI: 10.4088/pcc.14m01758] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 03/09/2015] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE The Montgomery-Asberg Depression Rating Scale-Self (MADRS-S) and the Beck Depression Inventory II (BDI-II) are commonly used self-assessment instruments for screening and diagnosis of depression. The BDI-II has 21 items and the MADRS-S has 9 items. These instruments have been tested with psychiatric inpatients but not in outpatient primary care, where most patients with symptoms of depression initially seek treatment. The purpose of this study was to compare these 2 instruments in the primary care setting. METHOD Data were collected from 2 primary care randomized controlled trials that were performed from 2010 to 2013 in Sweden: the Primary Care Self-Assessment MADRS-S Study and Primary Care Internet-Based Cognitive Behavioral Therapy Study. There were 146 patients (73 patients each from both trials) who had newly diagnosed mild or moderate depression (per DSM-IV recommendations) and who had assessment with both the MADRS-S and BDI-II at primary care centers. Comparability and reliability of the instruments were estimated by Pearson product moment correlation and Cronbach α. RESULTS A good correlation was observed between the 2 instruments: 0.66 and 0.62 in the 2 study cohorts. The reliability within the 2 study cohorts was good for both MADRS-S (Cronbach α: 0.76 for both cohorts) and BDI-II items (Cronbach α: 0.88 and 0.85). CONCLUSIONS The 2 instruments showed good comparability and reliability for low, middle, and high total depression scores. The MADRS-S may be used as a rapid, easily administered, and inexpensive tool in primary care and has results comparable to the BDI-II in all domains.
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Affiliation(s)
- Carl Wikberg
- Department of Primary Health Care, Institute of Medicine (Drs Petersson, Eggertsen, Hange, Baigi, and Björkelund; Mr Wikberg; and Mss Nejati, Ariai, and Eriksson), Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology (Dr Larsson), and Department of Psychology (Ms Kivi), University of Gothenburg, Gothenburg, Sweden; Närhälsan Research and Development Primary Health Care, Region Västra Götaland, Gothenburg, Sweden (Drs Larsson and Petersson); and Department of Neurobiology, Care Sciences and Society, Center for Family Medicine, Karolinska Institutet, Stockholm, Sweden (Dr Westman)
| | - Shabnam Nejati
- Department of Primary Health Care, Institute of Medicine (Drs Petersson, Eggertsen, Hange, Baigi, and Björkelund; Mr Wikberg; and Mss Nejati, Ariai, and Eriksson), Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology (Dr Larsson), and Department of Psychology (Ms Kivi), University of Gothenburg, Gothenburg, Sweden; Närhälsan Research and Development Primary Health Care, Region Västra Götaland, Gothenburg, Sweden (Drs Larsson and Petersson); and Department of Neurobiology, Care Sciences and Society, Center for Family Medicine, Karolinska Institutet, Stockholm, Sweden (Dr Westman)
| | - Maria E H Larsson
- Department of Primary Health Care, Institute of Medicine (Drs Petersson, Eggertsen, Hange, Baigi, and Björkelund; Mr Wikberg; and Mss Nejati, Ariai, and Eriksson), Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology (Dr Larsson), and Department of Psychology (Ms Kivi), University of Gothenburg, Gothenburg, Sweden; Närhälsan Research and Development Primary Health Care, Region Västra Götaland, Gothenburg, Sweden (Drs Larsson and Petersson); and Department of Neurobiology, Care Sciences and Society, Center for Family Medicine, Karolinska Institutet, Stockholm, Sweden (Dr Westman)
| | - Eva-Lisa Petersson
- Department of Primary Health Care, Institute of Medicine (Drs Petersson, Eggertsen, Hange, Baigi, and Björkelund; Mr Wikberg; and Mss Nejati, Ariai, and Eriksson), Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology (Dr Larsson), and Department of Psychology (Ms Kivi), University of Gothenburg, Gothenburg, Sweden; Närhälsan Research and Development Primary Health Care, Region Västra Götaland, Gothenburg, Sweden (Drs Larsson and Petersson); and Department of Neurobiology, Care Sciences and Society, Center for Family Medicine, Karolinska Institutet, Stockholm, Sweden (Dr Westman)
| | - Jeanette Westman
- Department of Primary Health Care, Institute of Medicine (Drs Petersson, Eggertsen, Hange, Baigi, and Björkelund; Mr Wikberg; and Mss Nejati, Ariai, and Eriksson), Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology (Dr Larsson), and Department of Psychology (Ms Kivi), University of Gothenburg, Gothenburg, Sweden; Närhälsan Research and Development Primary Health Care, Region Västra Götaland, Gothenburg, Sweden (Drs Larsson and Petersson); and Department of Neurobiology, Care Sciences and Society, Center for Family Medicine, Karolinska Institutet, Stockholm, Sweden (Dr Westman)
| | - Nashmil Ariai
- Department of Primary Health Care, Institute of Medicine (Drs Petersson, Eggertsen, Hange, Baigi, and Björkelund; Mr Wikberg; and Mss Nejati, Ariai, and Eriksson), Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology (Dr Larsson), and Department of Psychology (Ms Kivi), University of Gothenburg, Gothenburg, Sweden; Närhälsan Research and Development Primary Health Care, Region Västra Götaland, Gothenburg, Sweden (Drs Larsson and Petersson); and Department of Neurobiology, Care Sciences and Society, Center for Family Medicine, Karolinska Institutet, Stockholm, Sweden (Dr Westman)
| | - Marie Kivi
- Department of Primary Health Care, Institute of Medicine (Drs Petersson, Eggertsen, Hange, Baigi, and Björkelund; Mr Wikberg; and Mss Nejati, Ariai, and Eriksson), Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology (Dr Larsson), and Department of Psychology (Ms Kivi), University of Gothenburg, Gothenburg, Sweden; Närhälsan Research and Development Primary Health Care, Region Västra Götaland, Gothenburg, Sweden (Drs Larsson and Petersson); and Department of Neurobiology, Care Sciences and Society, Center for Family Medicine, Karolinska Institutet, Stockholm, Sweden (Dr Westman)
| | - Maria Eriksson
- Department of Primary Health Care, Institute of Medicine (Drs Petersson, Eggertsen, Hange, Baigi, and Björkelund; Mr Wikberg; and Mss Nejati, Ariai, and Eriksson), Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology (Dr Larsson), and Department of Psychology (Ms Kivi), University of Gothenburg, Gothenburg, Sweden; Närhälsan Research and Development Primary Health Care, Region Västra Götaland, Gothenburg, Sweden (Drs Larsson and Petersson); and Department of Neurobiology, Care Sciences and Society, Center for Family Medicine, Karolinska Institutet, Stockholm, Sweden (Dr Westman)
| | - Robert Eggertsen
- Department of Primary Health Care, Institute of Medicine (Drs Petersson, Eggertsen, Hange, Baigi, and Björkelund; Mr Wikberg; and Mss Nejati, Ariai, and Eriksson), Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology (Dr Larsson), and Department of Psychology (Ms Kivi), University of Gothenburg, Gothenburg, Sweden; Närhälsan Research and Development Primary Health Care, Region Västra Götaland, Gothenburg, Sweden (Drs Larsson and Petersson); and Department of Neurobiology, Care Sciences and Society, Center for Family Medicine, Karolinska Institutet, Stockholm, Sweden (Dr Westman)
| | - Dominique Hange
- Department of Primary Health Care, Institute of Medicine (Drs Petersson, Eggertsen, Hange, Baigi, and Björkelund; Mr Wikberg; and Mss Nejati, Ariai, and Eriksson), Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology (Dr Larsson), and Department of Psychology (Ms Kivi), University of Gothenburg, Gothenburg, Sweden; Närhälsan Research and Development Primary Health Care, Region Västra Götaland, Gothenburg, Sweden (Drs Larsson and Petersson); and Department of Neurobiology, Care Sciences and Society, Center for Family Medicine, Karolinska Institutet, Stockholm, Sweden (Dr Westman)
| | - Amir Baigi
- Department of Primary Health Care, Institute of Medicine (Drs Petersson, Eggertsen, Hange, Baigi, and Björkelund; Mr Wikberg; and Mss Nejati, Ariai, and Eriksson), Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology (Dr Larsson), and Department of Psychology (Ms Kivi), University of Gothenburg, Gothenburg, Sweden; Närhälsan Research and Development Primary Health Care, Region Västra Götaland, Gothenburg, Sweden (Drs Larsson and Petersson); and Department of Neurobiology, Care Sciences and Society, Center for Family Medicine, Karolinska Institutet, Stockholm, Sweden (Dr Westman)
| | - Cecilia Björkelund
- Department of Primary Health Care, Institute of Medicine (Drs Petersson, Eggertsen, Hange, Baigi, and Björkelund; Mr Wikberg; and Mss Nejati, Ariai, and Eriksson), Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology (Dr Larsson), and Department of Psychology (Ms Kivi), University of Gothenburg, Gothenburg, Sweden; Närhälsan Research and Development Primary Health Care, Region Västra Götaland, Gothenburg, Sweden (Drs Larsson and Petersson); and Department of Neurobiology, Care Sciences and Society, Center for Family Medicine, Karolinska Institutet, Stockholm, Sweden (Dr Westman)
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Hange D, Björkelund C, Svenningsson I, Kivi M, Eriksson MC, Petersson EL. Experiences of staff members participating in primary care research activities: a qualitative study. Int J Gen Med 2015; 8:143-8. [PMID: 25926753 PMCID: PMC4403682 DOI: 10.2147/ijgm.s78847] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background The aim of this paper was to study primary care staff members’ experiences and perceptions of participating in a randomized controlled trial concerning Internet therapy. Methods Data were collected via five focus groups, each containing four to eight nurses or general practitioners. The systematic text condensation method described by Malterud was used for thematic analysis of meaning and content of data across cases. Results The informants believed it was important to conduct research within the primary care setting, but it was difficult to combine clinical work and research. They stressed also that there was a need for continuous information and communication between primary care centers and researchers as well as internally at each primary care center. Conclusion Staff members’ experiences of participating in a research study were positive, although associated with various difficulties. It is important to include staff members when designing clinical studies; information should be given continuously during the study and communication facilitated between different occupational groups working at the primary care center.
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Affiliation(s)
- Dominique Hange
- Department of Primary Health Care/Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Cecilia Björkelund
- Department of Primary Health Care/Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Irene Svenningsson
- Närhälsan Research and Development Primary Health Care, Region Västra Götaland, University of Gothenburg, Gothenburg, Sweden
| | - Marie Kivi
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - Maria C Eriksson
- Department of Primary Health Care/Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eva-Lisa Petersson
- Department of Primary Health Care/Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden ; Närhälsan Research and Development Primary Health Care, Region Västra Götaland, University of Gothenburg, Gothenburg, Sweden
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Danielsson L, Papoulias I, Petersson EL, Carlsson J, Waern M. Exercise or basic body awareness therapy as add-on treatment for major depression: a controlled study. J Affect Disord 2014; 168:98-106. [PMID: 25043321 DOI: 10.1016/j.jad.2014.06.049] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 06/27/2014] [Accepted: 06/28/2014] [Indexed: 12/28/2022]
Abstract
BACKGROUND While physical exercise as adjunctive treatment for major depression has received considerable attention in recent years, the evidence is conflicting. This study evaluates the effects of two different add-on treatments: exercise and basic body awareness therapy. METHODS Randomized controlled trial with two intervention groups and one control, including 62 adults on antidepressant medication, who fulfilled criteria for current major depression as determined by the Mini International Neuropsychiatric Interview. Interventions (10 weeks) were aerobic exercise or basic body awareness therapy (BBAT), compared to a single consultation with advice on physical activity. Primary outcome was depression severity, rated by a blinded assessor using the Montgomery Asberg Rating Scale (MADRS). Secondary outcomes were global function, cardiovascular fitness, self-rated depression, anxiety and body awareness. RESULTS Improvements in MADRS score (mean change=-10.3, 95% CI (-13.5 to -7.1), p=0.038) and cardiovascular fitness (mean change=2.4ml oxygen/kg/min, 95% CI (1.5 to 3.3), p=0.017) were observed in the exercise group. Per-protocol analysis confirmed the effects of exercise, and indicated that BBAT has an effect on self-rated depression. LIMITATIONS The small sample size and the challenge of missing data. Participants׳ positive expectations regarding the exercise intervention need to be considered. CONCLUSIONS Exercise in a physical therapy setting seems to have effect on depression severity and fitness, in major depression. Our findings suggest that physical therapy can be a viable clinical strategy to inspire and guide persons with major depression to exercise. More research is needed to clarify the effects of basic body awareness therapy.
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Affiliation(s)
- Louise Danielsson
- Institute of Neuroscience and Physiology, Department of Clinical Neurosciences and Rehabilitation, Sahlgrenska Academy, University of Gothenburg, Box 455, 405 30 Gothenburg, Sweden; University of Gothenburg Centre for Person-Centred Care (GPCC), Sweden.
| | | | - Eva-Lisa Petersson
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; Närhälsan Research and Development Primary Health Care, Region Västra Götaland, Gothenburg, Sweden
| | - Jane Carlsson
- Institute of Neuroscience and Physiology, Department of Clinical Neurosciences and Rehabilitation, Sahlgrenska Academy, University of Gothenburg, Box 455, 405 30 Gothenburg, Sweden; University of Gothenburg Centre for Person-Centred Care (GPCC), Sweden
| | - Margda Waern
- Institute of Neuroscience and Physiology, Department of Clinical Neurosciences and Rehabilitation, Sahlgrenska Academy, University of Gothenburg, Box 455, 405 30 Gothenburg, Sweden; Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Sweden
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Kivi M, Eriksson MCM, Hange D, Petersson EL, Vernmark K, Johansson B, Björkelund C. Internet-based therapy for mild to moderate depression in Swedish primary care: short term results from the PRIM-NET randomized controlled trial. Cogn Behav Ther 2014; 43:289-98. [PMID: 24911260 PMCID: PMC4260664 DOI: 10.1080/16506073.2014.921834] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Depression presents a serious condition for the individual and a major challenge to health care and society. Internet-based cognitive behavior therapy (ICBT) is a treatment option supported in several trials, but there is as yet a lack of effective studies of ICBT in "real world" primary care settings. We examined whether ICBT differed from treatment-as-usual (TAU) in reducing depressive symptoms after 3 months. TAU comprised of visits to general practitioner, registered nurse, antidepressant drugs, waiting list for, or psychotherapy, or combinations of these alternatives. Patients, aged ≥ 18 years, who tentatively met criteria for mild to moderate depression at 16 primary care centers in the south-western region of Sweden were recruited and then assessed in a diagnostic interview. A total of 90 patients were randomized to either TAU or ICBT. The ICBT treatment included interactive elements online, a workbook, a CD with mindfulness and acceptance exercises, and minimal therapist contact. The treatment period lasted for 12 weeks after which both groups were assessed. The main outcome measure was Beck Depression Inventory-II (BDI-II). Additional measures were Montgomery Åsberg Depression Rating Scale - self rating version (MADRS-S) and Beck Anxiety Inventory (BAI). The analyses revealed no significant difference between the two groups at post treatment, neither on BDI-II, MADRS-S, nor BAI. Twenty patients (56%) in the ICBT treatment completed all seven modules. Our findings suggest that ICBT may be successfully delivered in primary care and that the effectiveness, after 3 months, is at par with TAU.
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Affiliation(s)
- Marie Kivi
- a Department of Psychology , University of Gothenburg , Gothenburg , Sweden
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Abstract
BACKGROUND To improve the detection, diagnosis and follow-up of depression in primary care patients, it has been proposed that GPs should employ assessment instruments as a complement to the consultation. However, most GPs do not use such instruments routinely. OBJECTIVE To explore perceptions of Swedish GPs on the use of instruments in the medical consultation. METHODS Twenty-seven GPs discussed in five focus groups that were digitally recorded, transcribed verbatim and analysed by systematic text condensation. RESULTS Six code groups emerged from the focus group discussions: (i) a perceived pressure from authorities and psychiatry to report depression scores; (ii) the scores were considered to be of limited value for the GP but could help the patient by facilitating sick leave compensation and hospitalization; (iii) instruments hampered the dialogue with the patient and non-verbal information was lost; (iv) the reliability of questionnaires was questioned; (v) instruments were seen as not fitting into primary care and GPs were uncertain how to use them and (vi) the main advantage of instruments was to promote communication with specific categories of patients. CONCLUSIONS Using instruments to obtain a quantitative score of depression was of no benefit to the GPs. Given the weak evidence for the clinical relevance of many instruments, there is little reason to introduce them into practice. However, the instruments can facilitate communication with external actors and specific groups of patients.
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Affiliation(s)
- Agneta Pettersson
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm
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Abstract
PURPOSE The aim was to explore experiences of capacity to work in persons working while depressed and anxious in order to identify the essence of the phenomenon capacity to work. METHOD Four focus groups were conducted with 17 participants employed within the regular job market. Illness experiences ranged from symptoms to clinical diagnoses. A phenomenological approach was employed. RESULTS The phenomenon of capacity to work was distinguished by nine constituents related to task, time, context and social interactions. The phenomenon encompassed a lost familiarity with one's ordinary work performance, the use of a working facade and adoption of new time-consuming work practices. Feelings of exposure in interpersonal encounters, disruption of work place order, lost "refueling" and a trade-off of between work capacity and leisure-time activities was also identified. The reduced capacity was pointed out as invisible, this invisibility was considered troublesome. CONCLUSIONS A complex and comprehensive concept emerged, not earlier described in work capacity studies. Rehabilitation processes would benefit from deeper knowledge of the individual's capacity to work in order to make efficient adjustments at work. Results can have particular relevance both in clinical and occupational health practice, as well as in the workplaces, in supporting re-entering workers after sickness absence. Implications for Rehabilitation The reduced capacity to work due to depression and anxiety is not always understandable or observable for others, therefore, the rehabilitation process would benefit from increased knowledge and understanding of the difficulties afflicted individuals experience at work. Identifying tasks that contribute to "refueling" at work might enhance the success of the rehabilitation. Rehabilitation programs could be tailored to better address the inabilities that impact on the capacity to work when depressed and anxious.
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Affiliation(s)
- Monica Bertilsson
- Institute of Medicine/Social Medicine, The Sahlgrenska Academy at University of Gothenburg, University of Gothenburg , Gothenburg , Sweden
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