Katarina Hedin | Lund University (original) (raw)
Papers by Katarina Hedin
Scandinavian Journal of Primary Health Care, 2013
Objective . To explore factors and circumstances contributing to prudent antibiotic prescribing f... more Objective . To explore factors and circumstances contributing to prudent antibiotic prescribing for respiratory tract infections in primary care. Design . Two focus groups representing rural and urban areas. A semi-structured interview guide with open-ended questions and an editing analysis style was used. They were examined to identify meaning units that were sorted into categories in an iterative process throughout the analysis. Setting . Primary health care in two counties in southern Sweden. Subjects . Two groups including seven and six general practitioners (GPs) respectively, men and women of different ages with different professional experiences. Main outcome measures . Exploration of categories, determination of themes, construction of models. Results . The decision to prescribe antibiotics takes place in the encounter between GP and patient, initially characterized by harmony or fi ght and the subsequent process by collaboration or negotiation , resulting in agreement , compromise , or disagreement . Several factors infl uence the meeting and contribute to enhancing the conditions for rational prescribing. These conditions are connected to the GP, the relationship, and the setting; organization as well as professional culture. The fi ndings indicate synergies between the factors, and that one factor can sometimes compensate for lack of another. Continuity and mutual trust can make a brief consultation successful, but lack of continuity can eliminate the effects of knowledge and professional skills. Conclusions . The fi ndings emphasize the importance of the encounter between the GP and the patient for prudent antibiotic prescribing. Furthermore, the importance of an appropriate organization of primary care, which promotes continuity and encourages professional autonomy, is demonstrated.
Scandinavian Journal of Primary Health Care, 2014
Objective. To explore how a group of Swedish general practitioners (GPs) manage patients with a s... more Objective. To explore how a group of Swedish general practitioners (GPs) manage patients with a sore throat in relation to current guidelines as expressed in interviews. Design . Qualitative content analysis was used to analyse semi-structured interviews. Setting . Swedish primary care. Subjects. A strategic sample of 25 GPs. Main outcome measures . Perceived management of sore throat patients. Results. It was found that nine of the interviewed GPs were adherent to current guidelines for sore throat and 16 were non-adherent. The two groups differed in terms of guideline knowledge, which was shared within the team for adherent GPs while idiosyncratic knowledge dominated for the non-adherent GPs. Adherent GPs had no or low concerns for bacterial infections and differential diagnosis whilst non-adherent GPs believed that in patients with a sore throat any bacterial infection should be identifi ed and treated with antibiotics. Patient history and examination was mainly targeted by adherent GPs whilst for non-adherent GPs it was often redundant. Non-adherent GPs reported problems getting patients to abstain from antibiotics, whilst no such problems were reported in adherent GPs. Conclusion . This interview study of sore throat management in a strategically sampled group of Swedish GPs showed that while two-thirds were non-adherent and had a liberal attitude to antibiotics one-third were guideline adherent with a restricted view on antibiotics. Non-adherent GPs revealed signifi cant knowledge gaps. Adherent GPs had discussed guidelines within the primary care team while non-adherent GPs had not. Guideline implementation thus seemed to be promoted by knowledge shared in team discussions.
British Journal of General Practice
Respiratory tract infections are the most common reason for antibiotic prescription in Sweden as ... more Respiratory tract infections are the most common reason for antibiotic prescription in Sweden as in other countries. The prescription rates vary markedly in different countries, counties and municipalities. The reasons for these variations in prescription rate are not obvious. To find possible explanations for different antibiotic prescription rates in children. Prospective population based study. All child health clinics in four municipalities in Sweden which, according to official statistics, had high antibiotic prescription rates, and all child health clinics in three municipalities which had low antibiotic prescription rates. During one month, parents recorded all infectious symptoms, physician consultations and antibiotic treatments, from 848 18-month-old children in a log book. The parents also answered a questionnaire about socioeconomic factors and concern about infectious diseases. Antibiotics were prescribed to 11.6% of the children in the high prescription area and 4.7% i...
BMC Infectious Diseases, 2015
Fusobacterium necrophorum is a well-known cause of Lemirre's disease and accumulating evi... more Fusobacterium necrophorum is a well-known cause of Lemirre's disease and accumulating evidence support its pathogenic role in peritonsillar abscess while its role in recurrent and chronic tonsillitis is uncertain. The objective of this study was to assess the prevalence of oropharyngeal colonisation with F. necrophorum and Beta-haemolytic streptococci in a cohort of patients scheduled for tonsillectomy due to recurrent or persistent throat pain, and to evaluate the dynamics of colonisation with repeated sampling during a follow-up time of 6 to 8 months. Fifty-seven (57) patients aged 15-52 years scheduled for tonsillectomy due to chronic/recurrent tonsillitis or recurrent peritonsillar abscess were included. Throat swabs for the detection of F. necrophorum and Beta-haemolytic streptococci and clinical data was collected at inclusion, at the time of surgery and 6 to 8 months after surgery. Statistical analysis was performed using the Chi-square, Fisher's exact and Mc Nemar tests. Fusobacterium necrophorum was found in 28, 30 and 16% of the patients at inclusion, surgery and follow up respectively. The corresponding results for beta-haemolytic streptococci were 5, 9 and 5%. Patients colonised with F. necrophorum at follow-up, after tonsillectomy, were equally relieved from their previous throat pain as non-colonised patients. Looking at individual patients, the culture results for F. necrophorum varied over time, indicating a transient colonisation. Fusobacterium necrophorum was frequently found in throat cultures in this cohort of patients with recurrent or chronic throat pain leading to tonsillectomy. Colonisation was equally frequent in the asymptomatic cohort post-tonsillectomy, indicating that F. necrophorum is not alone causative of the symptoms. In an individual perspective, colonisation with F. necrophorum was transient over time.
BMC family practice, 2015
Excessive antibiotics use increases the risk of resistance. Previous studies have shown that the ... more Excessive antibiotics use increases the risk of resistance. Previous studies have shown that the Centor score combined with Rapid Antigen Detection Test (RADT) for Group A Streptococci can reduce unnecessary antibiotic prescribing in patients with sore throat. According to the former Swedish guidelines RADT was recommended with 2-4 Centor criteria present and antibiotics were recommended if the test was positive. C- reactive protein (CRP) was not recommended for sore throats. Inappropriate use of RADT and CRP has been reported in several studies. From a larger project 16 general practitioners (GPs) who stated management of sore throats not according to the guidelines were identified. Half-hour long semi-structured interviews were conducted. The topics were the management of sore throats and the use of near-patient tests. Qualitative content analysis was used. The use of the near-patient test interplayed with the clinical assessment and the perception that all infections caused by ba...
Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases, 2015
Sore throat is common in primary healthcare. Aetiological studies have focused on the presence of... more Sore throat is common in primary healthcare. Aetiological studies have focused on the presence of a limited number of pathogens. The aim of the present study was to investigate the presence of a wide range of bacteria and viruses, including Fusobacterium necrophorum, in patients with pharyngotonsillitis and in asymptomatic controls. A prospective case control study was performed in primary healthcare in Kronoberg County, Sweden. Patients (n=220) aged 15 to 45 years with a suspected acute pharyngotonsillitis, and controls (n=128), were included. Nasopharyngeal and throat swabs were analysed for β-hemolytic streptococci, F. necrophorum, Mycoplasma pneumoniae, and Chlamydophila pneumoniae, and 13 respiratory viruses. Serum samples were analysed for antibodies to Epstein-Barr virus. The patient history and symptoms, including Centor score, were analysed in relation to pathogens. In 155/220 (70.5%) of the patients, as compared to 26/128 (20.3%) of the controls (p <0.001), at least one...
Scandinavian Journal of Primary Health Care, 2014
Objective. To explore how a group of Swedish general practitioners (GPs) manage patients with a s... more Objective. To explore how a group of Swedish general practitioners (GPs) manage patients with a sore throat in relation to current guidelines as expressed in interviews. Design . Qualitative content analysis was used to analyse semi-structured interviews. Setting . Swedish primary care. Subjects. A strategic sample of 25 GPs. Main outcome measures . Perceived management of sore throat patients. Results. It was found that nine of the interviewed GPs were adherent to current guidelines for sore throat and 16 were non-adherent. The two groups differed in terms of guideline knowledge, which was shared within the team for adherent GPs while idiosyncratic knowledge dominated for the non-adherent GPs. Adherent GPs had no or low concerns for bacterial infections and differential diagnosis whilst non-adherent GPs believed that in patients with a sore throat any bacterial infection should be identifi ed and treated with antibiotics. Patient history and examination was mainly targeted by adherent GPs whilst for non-adherent GPs it was often redundant. Non-adherent GPs reported problems getting patients to abstain from antibiotics, whilst no such problems were reported in adherent GPs. Conclusion . This interview study of sore throat management in a strategically sampled group of Swedish GPs showed that while two-thirds were non-adherent and had a liberal attitude to antibiotics one-third were guideline adherent with a restricted view on antibiotics. Non-adherent GPs revealed signifi cant knowledge gaps. Adherent GPs had discussed guidelines within the primary care team while non-adherent GPs had not. Guideline implementation thus seemed to be promoted by knowledge shared in team discussions.
Health, 2014
Background and Aim: Respiratory tract infection (RTI) is a common reason for consulting primary h... more Background and Aim: Respiratory tract infection (RTI) is a common reason for consulting primary health care. Antibiotic prescribing for RTIs varies among physicians indicating that national guidelines are not always adhered to. The aim was to study if antibiotic prescribing and use of near-patient tests were different among physicians who complete an audit registration and those who discontinue their participation. Method: A prospective cohort study where physicians participated in an APO (Audit Project Odense) process, making an audit registration for every appointment with a patient who had a respiratory tract infection during 4 weeks in 2008 and 4 weeks in 2009. Between the registrations, a limited educationally oriented intervention was made. 18 Primary Health Care Centres located in three counties in southern of Sweden with 77 primary health care physicians participated. When comparing proportions the Chisquare test was used. Mann Whitney U-test was used when comparing independent groups and Wilcoxon’s signed-rank test was used when comparing dependent groups. Results: Of the 77 physicians, 38 participated only at baseline (group 1) and 39 participated in both registrations (group 2). The overall use of CRP near-patient tests was 37% in group 1 and 28% in group 2 (Chisquare p &amp;lt; 0.001), and the overall use of Strep-A near-patient tests was 31% and 20%, respectively (Chisquare p &amp;lt; 0.001). When the Strep-A near-patient test was negative in pharyngitis/tonsillitis, antibiotics were prescribed to 45% in group 1 and to 12% by group 2 (Chisquare 0.003). Conclusion: In conclusion, this study showed that physicians, who were more inclined to complete audit participation, used near-patient tests and prescribed antibiotics more correctly, according to the national guidelines for respiratory tract infections, than physicians who discontinued the participation. To achieve a rational use of antibiotics, near-patient tests and prescription of antibiotics must be used according to guidelines.
Scandinavian Journal of Primary Health Care, 2006
Objective. To study the effect of an educationally oriented intervention programme, with the reco... more Objective. To study the effect of an educationally oriented intervention programme, with the recommendations from the National Board of Health and Welfare as a base. Design. A prospective intervention study. Setting. Six day-care centres in Växjö, Sweden. Three centres comprised the intervention group and three constituted the control group. Subjects and main outcome measures. The parents and personnel completed a questionnaire on their views concerning information about infectious diseases. During a nine-month period, parents of all children reported every episode of absence, the number of days absent, the cause of absence, and any contact with doctors or prescription of antibiotics. Results. The guidelines were implementable in routine child day-care. Parents found regular information valuable and felt better informed about infectious diseases. Multilevel analyses showed no statistically significant results of the intervention. ''Infection-prone'' children had more sickness absence, doctor's consultations, and antibiotic prescriptions than those not ''infectionprone''. Conclusion. It is possible to implement an educationally oriented intervention programme directed against infectious diseases in child day-care. No significant effect of the intervention was found, which is why a larger intervention study is needed.
Scandinavian Journal of Primary Health Care, 2002
in Primary Care O È stergö tland, Jö nkö ping, Sweden. Conclusion -Bacteriuria is common among el... more in Primary Care O È stergö tland, Jö nkö ping, Sweden. Conclusion -Bacteriuria is common among elderly people living in Scand J Prim Health Care 2002;20:166 -168. ISSN 0281-343 2
Scandinavian Journal of Primary Health Care, 2013
Objective . To explore factors and circumstances contributing to prudent antibiotic prescribing f... more Objective . To explore factors and circumstances contributing to prudent antibiotic prescribing for respiratory tract infections in primary care. Design . Two focus groups representing rural and urban areas. A semi-structured interview guide with open-ended questions and an editing analysis style was used. They were examined to identify meaning units that were sorted into categories in an iterative process throughout the analysis. Setting . Primary health care in two counties in southern Sweden. Subjects . Two groups including seven and six general practitioners (GPs) respectively, men and women of different ages with different professional experiences. Main outcome measures . Exploration of categories, determination of themes, construction of models. Results . The decision to prescribe antibiotics takes place in the encounter between GP and patient, initially characterized by harmony or fi ght and the subsequent process by collaboration or negotiation , resulting in agreement , compromise , or disagreement . Several factors infl uence the meeting and contribute to enhancing the conditions for rational prescribing. These conditions are connected to the GP, the relationship, and the setting; organization as well as professional culture. The fi ndings indicate synergies between the factors, and that one factor can sometimes compensate for lack of another. Continuity and mutual trust can make a brief consultation successful, but lack of continuity can eliminate the effects of knowledge and professional skills. Conclusions . The fi ndings emphasize the importance of the encounter between the GP and the patient for prudent antibiotic prescribing. Furthermore, the importance of an appropriate organization of primary care, which promotes continuity and encourages professional autonomy, is demonstrated.
Primary Health Care Research & Development, 2010
... Archives of Pediatrics and Adolescent Medicine 157, 196–200. Brady, MT 2005: Infectious disea... more ... Archives of Pediatrics and Adolescent Medicine 157, 196–200. Brady, MT 2005: Infectious disease in pediatric out-of-home child care. ... Hedin, K., Cars, H. and Petersson, C. 2000: Färre läkarbesök och mindre antibiotika resultat av begränsad intervention på daghem. ...
Family Practice, 2007
Respiratory tract infections (RTI) in children is the most common cause of prescription of antibi... more Respiratory tract infections (RTI) in children is the most common cause of prescription of antibiotics. It is important to describe and analyse non-medical factors in order to develop more rational use of antibiotics. To compare families with high and low concern about infectious illness with regard to social variables, perception of infection proneness and beliefs in antibiotics and to relate the concern for infectious illness to reported morbidity, physician consultations and antibiotic prescriptions for the 18-month-old child in the family. A prospective, population-based survey was performed. During 1 month, all infectious symptoms, physician consultations and antibiotic treatments for 18-month-old children were noted. The 818 families also answered questions about their socio-economic situation, illness perception and concern about infectious illness. High concern about infectious illness was associated with more frequent physicians consultations and more prescriptions of antibiotics. There was no significant difference in reported days with symptoms of RTI, but the parents more often experienced their children with RTI without fever as being ill. The variables of infection proneness in the child, inadequate beliefs in antibiotics and the factor of being the only child were important explanatory factors for concern about infectious illness. High concern about infectious illness is an important determining factor for physician consultations and antibiotic prescription for small children. An adequate consultation, where the doctor deals with the parents&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; worries and gives appropriate information about symptoms and disease, might contribute to less antibiotic prescribing with preserved parental satisfaction.
Family Practice, 2010
Infections are the most commonly reported health problems in children. Younger age and day care o... more Infections are the most commonly reported health problems in children. Younger age and day care outside the home are two factors of importance for infectious morbidity. The influence of siblings on infectious symptoms is not clear. To compare families with one child and families with more than one child in terms of reported infectious symptoms, physician consultations and antibiotic prescriptions. A prospective population-based survey was performed. During 1 month, all infectious symptoms, physician consultations and antibiotic prescriptions for 18-month-old children were noted by the parents. The 789 families also answered questions about socio-economic factors, numbers of siblings in the family and type of day care. No difference in number of symptom days was found between children with and without older siblings. Neither could we find any significance in terms of having older siblings in relation to physician consultations and antibiotic prescriptions. The results of our study indicate that having older siblings not was important in relation to number of symptoms days, physician consultations or antibiotic prescriptions for 18-month-old children in Sweden today. Changes in social activities and attitudes towards antibiotic prescription may explain our different findings as compared with previous Swedish studies and studies from other countries.
Acta Paediatrica, 2008
Aim: To determine if the use of alcohol-based hand-disinfection as a complement to regular hand w... more Aim: To determine if the use of alcohol-based hand-disinfection as a complement to regular hand washing at daycare centers (DCCs) can reduce the childhood rate of absenteeism.
Acta Paediatrica, 2007
Daycare infants have more infectious episodes, see a physician more often, and are prescribed ant... more Daycare infants have more infectious episodes, see a physician more often, and are prescribed antibiotics more often than home care infants. To compare physician consultations and antibiotic prescription in daycare children and home care children taking number of symptom days, sociodemographic factors, concern about infectious illness and antibiotic knowledge into account. For a cohort of Swedish 18-month-old children all infectious symptoms, physician consultation and antibiotic prescriptions were registered during 1 month. 561 infants with daycare outside the home and 278 with daycare at home were included. Of the daycare infants, 23.2% saw a physician and 11.4% were prescribed antibiotics, as compared with 10.8% physician consultations and 5.0% antibiotic prescription for the home care infants. For daycare infants the crude odds ratio for physician consultation were 2.49 (1.63-3.82) and for antibiotic prescription 2.43 (1.34-4.41) compared with home care infants. However, these differences were no longer statistically significant when background data, concern about infectious illness and reported symptoms were taken into account. When background data, concern about infectious illness and reported infectious symptoms were taken into account daycare infants saw a physician and was prescribed antibiotics in the same way as home care infants.
Scandinavian Journal of Primary Health Care, 2006
Objective. To examine infectious symptoms on a daily basis in families with small children and ho... more Objective. To examine infectious symptoms on a daily basis in families with small children and how often these infections cause people to stay at home or seek healthcare. Design. A population-based prospective study. Setting. Child health clinics in seven municipalities in Sweden. Subjects and main outcome measures. All family members of 835 families who came with an 18-month-old child to a child health clinic were asked to register all infectious symptoms in a diary for a month. They were also asked to indicate whether they had stayed at home from day-care or school, whether social insurance had been used, and whether they had contacted healthcare facilities or seen a physician. Results. In total, 7% of the 18-month-old children and 34% of the parents had no symptoms during the winter month. The most common symptom was a runny nose. The 18-month-old children had 1.6 symptom episodes with an average duration of 5.6 days. Of the symptom episodes 13% led to contact with healthcare facilities and 6% to an antibiotic prescription. Of the symptom days 27% required staying at home and in 10% social insurance was claimed. Conclusion. Symptoms of infection among families with small children were common, with a runny nose being the most common. Physician consultations and antibiotic prescriptions were used in a small proportion of the symptom episodes. Social insurance was claimed in about one-third of the days with absence from day-care.
Scandinavian Journal of Primary Health Care, 2013
Objective . To explore factors and circumstances contributing to prudent antibiotic prescribing f... more Objective . To explore factors and circumstances contributing to prudent antibiotic prescribing for respiratory tract infections in primary care. Design . Two focus groups representing rural and urban areas. A semi-structured interview guide with open-ended questions and an editing analysis style was used. They were examined to identify meaning units that were sorted into categories in an iterative process throughout the analysis. Setting . Primary health care in two counties in southern Sweden. Subjects . Two groups including seven and six general practitioners (GPs) respectively, men and women of different ages with different professional experiences. Main outcome measures . Exploration of categories, determination of themes, construction of models. Results . The decision to prescribe antibiotics takes place in the encounter between GP and patient, initially characterized by harmony or fi ght and the subsequent process by collaboration or negotiation , resulting in agreement , compromise , or disagreement . Several factors infl uence the meeting and contribute to enhancing the conditions for rational prescribing. These conditions are connected to the GP, the relationship, and the setting; organization as well as professional culture. The fi ndings indicate synergies between the factors, and that one factor can sometimes compensate for lack of another. Continuity and mutual trust can make a brief consultation successful, but lack of continuity can eliminate the effects of knowledge and professional skills. Conclusions . The fi ndings emphasize the importance of the encounter between the GP and the patient for prudent antibiotic prescribing. Furthermore, the importance of an appropriate organization of primary care, which promotes continuity and encourages professional autonomy, is demonstrated.
Scandinavian Journal of Primary Health Care, 2014
Objective. To explore how a group of Swedish general practitioners (GPs) manage patients with a s... more Objective. To explore how a group of Swedish general practitioners (GPs) manage patients with a sore throat in relation to current guidelines as expressed in interviews. Design . Qualitative content analysis was used to analyse semi-structured interviews. Setting . Swedish primary care. Subjects. A strategic sample of 25 GPs. Main outcome measures . Perceived management of sore throat patients. Results. It was found that nine of the interviewed GPs were adherent to current guidelines for sore throat and 16 were non-adherent. The two groups differed in terms of guideline knowledge, which was shared within the team for adherent GPs while idiosyncratic knowledge dominated for the non-adherent GPs. Adherent GPs had no or low concerns for bacterial infections and differential diagnosis whilst non-adherent GPs believed that in patients with a sore throat any bacterial infection should be identifi ed and treated with antibiotics. Patient history and examination was mainly targeted by adherent GPs whilst for non-adherent GPs it was often redundant. Non-adherent GPs reported problems getting patients to abstain from antibiotics, whilst no such problems were reported in adherent GPs. Conclusion . This interview study of sore throat management in a strategically sampled group of Swedish GPs showed that while two-thirds were non-adherent and had a liberal attitude to antibiotics one-third were guideline adherent with a restricted view on antibiotics. Non-adherent GPs revealed signifi cant knowledge gaps. Adherent GPs had discussed guidelines within the primary care team while non-adherent GPs had not. Guideline implementation thus seemed to be promoted by knowledge shared in team discussions.
British Journal of General Practice
Respiratory tract infections are the most common reason for antibiotic prescription in Sweden as ... more Respiratory tract infections are the most common reason for antibiotic prescription in Sweden as in other countries. The prescription rates vary markedly in different countries, counties and municipalities. The reasons for these variations in prescription rate are not obvious. To find possible explanations for different antibiotic prescription rates in children. Prospective population based study. All child health clinics in four municipalities in Sweden which, according to official statistics, had high antibiotic prescription rates, and all child health clinics in three municipalities which had low antibiotic prescription rates. During one month, parents recorded all infectious symptoms, physician consultations and antibiotic treatments, from 848 18-month-old children in a log book. The parents also answered a questionnaire about socioeconomic factors and concern about infectious diseases. Antibiotics were prescribed to 11.6% of the children in the high prescription area and 4.7% i...
BMC Infectious Diseases, 2015
Fusobacterium necrophorum is a well-known cause of Lemirre's disease and accumulating evi... more Fusobacterium necrophorum is a well-known cause of Lemirre's disease and accumulating evidence support its pathogenic role in peritonsillar abscess while its role in recurrent and chronic tonsillitis is uncertain. The objective of this study was to assess the prevalence of oropharyngeal colonisation with F. necrophorum and Beta-haemolytic streptococci in a cohort of patients scheduled for tonsillectomy due to recurrent or persistent throat pain, and to evaluate the dynamics of colonisation with repeated sampling during a follow-up time of 6 to 8 months. Fifty-seven (57) patients aged 15-52 years scheduled for tonsillectomy due to chronic/recurrent tonsillitis or recurrent peritonsillar abscess were included. Throat swabs for the detection of F. necrophorum and Beta-haemolytic streptococci and clinical data was collected at inclusion, at the time of surgery and 6 to 8 months after surgery. Statistical analysis was performed using the Chi-square, Fisher's exact and Mc Nemar tests. Fusobacterium necrophorum was found in 28, 30 and 16% of the patients at inclusion, surgery and follow up respectively. The corresponding results for beta-haemolytic streptococci were 5, 9 and 5%. Patients colonised with F. necrophorum at follow-up, after tonsillectomy, were equally relieved from their previous throat pain as non-colonised patients. Looking at individual patients, the culture results for F. necrophorum varied over time, indicating a transient colonisation. Fusobacterium necrophorum was frequently found in throat cultures in this cohort of patients with recurrent or chronic throat pain leading to tonsillectomy. Colonisation was equally frequent in the asymptomatic cohort post-tonsillectomy, indicating that F. necrophorum is not alone causative of the symptoms. In an individual perspective, colonisation with F. necrophorum was transient over time.
BMC family practice, 2015
Excessive antibiotics use increases the risk of resistance. Previous studies have shown that the ... more Excessive antibiotics use increases the risk of resistance. Previous studies have shown that the Centor score combined with Rapid Antigen Detection Test (RADT) for Group A Streptococci can reduce unnecessary antibiotic prescribing in patients with sore throat. According to the former Swedish guidelines RADT was recommended with 2-4 Centor criteria present and antibiotics were recommended if the test was positive. C- reactive protein (CRP) was not recommended for sore throats. Inappropriate use of RADT and CRP has been reported in several studies. From a larger project 16 general practitioners (GPs) who stated management of sore throats not according to the guidelines were identified. Half-hour long semi-structured interviews were conducted. The topics were the management of sore throats and the use of near-patient tests. Qualitative content analysis was used. The use of the near-patient test interplayed with the clinical assessment and the perception that all infections caused by ba...
Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases, 2015
Sore throat is common in primary healthcare. Aetiological studies have focused on the presence of... more Sore throat is common in primary healthcare. Aetiological studies have focused on the presence of a limited number of pathogens. The aim of the present study was to investigate the presence of a wide range of bacteria and viruses, including Fusobacterium necrophorum, in patients with pharyngotonsillitis and in asymptomatic controls. A prospective case control study was performed in primary healthcare in Kronoberg County, Sweden. Patients (n=220) aged 15 to 45 years with a suspected acute pharyngotonsillitis, and controls (n=128), were included. Nasopharyngeal and throat swabs were analysed for β-hemolytic streptococci, F. necrophorum, Mycoplasma pneumoniae, and Chlamydophila pneumoniae, and 13 respiratory viruses. Serum samples were analysed for antibodies to Epstein-Barr virus. The patient history and symptoms, including Centor score, were analysed in relation to pathogens. In 155/220 (70.5%) of the patients, as compared to 26/128 (20.3%) of the controls (p <0.001), at least one...
Scandinavian Journal of Primary Health Care, 2014
Objective. To explore how a group of Swedish general practitioners (GPs) manage patients with a s... more Objective. To explore how a group of Swedish general practitioners (GPs) manage patients with a sore throat in relation to current guidelines as expressed in interviews. Design . Qualitative content analysis was used to analyse semi-structured interviews. Setting . Swedish primary care. Subjects. A strategic sample of 25 GPs. Main outcome measures . Perceived management of sore throat patients. Results. It was found that nine of the interviewed GPs were adherent to current guidelines for sore throat and 16 were non-adherent. The two groups differed in terms of guideline knowledge, which was shared within the team for adherent GPs while idiosyncratic knowledge dominated for the non-adherent GPs. Adherent GPs had no or low concerns for bacterial infections and differential diagnosis whilst non-adherent GPs believed that in patients with a sore throat any bacterial infection should be identifi ed and treated with antibiotics. Patient history and examination was mainly targeted by adherent GPs whilst for non-adherent GPs it was often redundant. Non-adherent GPs reported problems getting patients to abstain from antibiotics, whilst no such problems were reported in adherent GPs. Conclusion . This interview study of sore throat management in a strategically sampled group of Swedish GPs showed that while two-thirds were non-adherent and had a liberal attitude to antibiotics one-third were guideline adherent with a restricted view on antibiotics. Non-adherent GPs revealed signifi cant knowledge gaps. Adherent GPs had discussed guidelines within the primary care team while non-adherent GPs had not. Guideline implementation thus seemed to be promoted by knowledge shared in team discussions.
Health, 2014
Background and Aim: Respiratory tract infection (RTI) is a common reason for consulting primary h... more Background and Aim: Respiratory tract infection (RTI) is a common reason for consulting primary health care. Antibiotic prescribing for RTIs varies among physicians indicating that national guidelines are not always adhered to. The aim was to study if antibiotic prescribing and use of near-patient tests were different among physicians who complete an audit registration and those who discontinue their participation. Method: A prospective cohort study where physicians participated in an APO (Audit Project Odense) process, making an audit registration for every appointment with a patient who had a respiratory tract infection during 4 weeks in 2008 and 4 weeks in 2009. Between the registrations, a limited educationally oriented intervention was made. 18 Primary Health Care Centres located in three counties in southern of Sweden with 77 primary health care physicians participated. When comparing proportions the Chisquare test was used. Mann Whitney U-test was used when comparing independent groups and Wilcoxon’s signed-rank test was used when comparing dependent groups. Results: Of the 77 physicians, 38 participated only at baseline (group 1) and 39 participated in both registrations (group 2). The overall use of CRP near-patient tests was 37% in group 1 and 28% in group 2 (Chisquare p &amp;lt; 0.001), and the overall use of Strep-A near-patient tests was 31% and 20%, respectively (Chisquare p &amp;lt; 0.001). When the Strep-A near-patient test was negative in pharyngitis/tonsillitis, antibiotics were prescribed to 45% in group 1 and to 12% by group 2 (Chisquare 0.003). Conclusion: In conclusion, this study showed that physicians, who were more inclined to complete audit participation, used near-patient tests and prescribed antibiotics more correctly, according to the national guidelines for respiratory tract infections, than physicians who discontinued the participation. To achieve a rational use of antibiotics, near-patient tests and prescription of antibiotics must be used according to guidelines.
Scandinavian Journal of Primary Health Care, 2006
Objective. To study the effect of an educationally oriented intervention programme, with the reco... more Objective. To study the effect of an educationally oriented intervention programme, with the recommendations from the National Board of Health and Welfare as a base. Design. A prospective intervention study. Setting. Six day-care centres in Växjö, Sweden. Three centres comprised the intervention group and three constituted the control group. Subjects and main outcome measures. The parents and personnel completed a questionnaire on their views concerning information about infectious diseases. During a nine-month period, parents of all children reported every episode of absence, the number of days absent, the cause of absence, and any contact with doctors or prescription of antibiotics. Results. The guidelines were implementable in routine child day-care. Parents found regular information valuable and felt better informed about infectious diseases. Multilevel analyses showed no statistically significant results of the intervention. ''Infection-prone'' children had more sickness absence, doctor's consultations, and antibiotic prescriptions than those not ''infectionprone''. Conclusion. It is possible to implement an educationally oriented intervention programme directed against infectious diseases in child day-care. No significant effect of the intervention was found, which is why a larger intervention study is needed.
Scandinavian Journal of Primary Health Care, 2002
in Primary Care O È stergö tland, Jö nkö ping, Sweden. Conclusion -Bacteriuria is common among el... more in Primary Care O È stergö tland, Jö nkö ping, Sweden. Conclusion -Bacteriuria is common among elderly people living in Scand J Prim Health Care 2002;20:166 -168. ISSN 0281-343 2
Scandinavian Journal of Primary Health Care, 2013
Objective . To explore factors and circumstances contributing to prudent antibiotic prescribing f... more Objective . To explore factors and circumstances contributing to prudent antibiotic prescribing for respiratory tract infections in primary care. Design . Two focus groups representing rural and urban areas. A semi-structured interview guide with open-ended questions and an editing analysis style was used. They were examined to identify meaning units that were sorted into categories in an iterative process throughout the analysis. Setting . Primary health care in two counties in southern Sweden. Subjects . Two groups including seven and six general practitioners (GPs) respectively, men and women of different ages with different professional experiences. Main outcome measures . Exploration of categories, determination of themes, construction of models. Results . The decision to prescribe antibiotics takes place in the encounter between GP and patient, initially characterized by harmony or fi ght and the subsequent process by collaboration or negotiation , resulting in agreement , compromise , or disagreement . Several factors infl uence the meeting and contribute to enhancing the conditions for rational prescribing. These conditions are connected to the GP, the relationship, and the setting; organization as well as professional culture. The fi ndings indicate synergies between the factors, and that one factor can sometimes compensate for lack of another. Continuity and mutual trust can make a brief consultation successful, but lack of continuity can eliminate the effects of knowledge and professional skills. Conclusions . The fi ndings emphasize the importance of the encounter between the GP and the patient for prudent antibiotic prescribing. Furthermore, the importance of an appropriate organization of primary care, which promotes continuity and encourages professional autonomy, is demonstrated.
Primary Health Care Research & Development, 2010
... Archives of Pediatrics and Adolescent Medicine 157, 196–200. Brady, MT 2005: Infectious disea... more ... Archives of Pediatrics and Adolescent Medicine 157, 196–200. Brady, MT 2005: Infectious disease in pediatric out-of-home child care. ... Hedin, K., Cars, H. and Petersson, C. 2000: Färre läkarbesök och mindre antibiotika resultat av begränsad intervention på daghem. ...
Family Practice, 2007
Respiratory tract infections (RTI) in children is the most common cause of prescription of antibi... more Respiratory tract infections (RTI) in children is the most common cause of prescription of antibiotics. It is important to describe and analyse non-medical factors in order to develop more rational use of antibiotics. To compare families with high and low concern about infectious illness with regard to social variables, perception of infection proneness and beliefs in antibiotics and to relate the concern for infectious illness to reported morbidity, physician consultations and antibiotic prescriptions for the 18-month-old child in the family. A prospective, population-based survey was performed. During 1 month, all infectious symptoms, physician consultations and antibiotic treatments for 18-month-old children were noted. The 818 families also answered questions about their socio-economic situation, illness perception and concern about infectious illness. High concern about infectious illness was associated with more frequent physicians consultations and more prescriptions of antibiotics. There was no significant difference in reported days with symptoms of RTI, but the parents more often experienced their children with RTI without fever as being ill. The variables of infection proneness in the child, inadequate beliefs in antibiotics and the factor of being the only child were important explanatory factors for concern about infectious illness. High concern about infectious illness is an important determining factor for physician consultations and antibiotic prescription for small children. An adequate consultation, where the doctor deals with the parents&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; worries and gives appropriate information about symptoms and disease, might contribute to less antibiotic prescribing with preserved parental satisfaction.
Family Practice, 2010
Infections are the most commonly reported health problems in children. Younger age and day care o... more Infections are the most commonly reported health problems in children. Younger age and day care outside the home are two factors of importance for infectious morbidity. The influence of siblings on infectious symptoms is not clear. To compare families with one child and families with more than one child in terms of reported infectious symptoms, physician consultations and antibiotic prescriptions. A prospective population-based survey was performed. During 1 month, all infectious symptoms, physician consultations and antibiotic prescriptions for 18-month-old children were noted by the parents. The 789 families also answered questions about socio-economic factors, numbers of siblings in the family and type of day care. No difference in number of symptom days was found between children with and without older siblings. Neither could we find any significance in terms of having older siblings in relation to physician consultations and antibiotic prescriptions. The results of our study indicate that having older siblings not was important in relation to number of symptoms days, physician consultations or antibiotic prescriptions for 18-month-old children in Sweden today. Changes in social activities and attitudes towards antibiotic prescription may explain our different findings as compared with previous Swedish studies and studies from other countries.
Acta Paediatrica, 2008
Aim: To determine if the use of alcohol-based hand-disinfection as a complement to regular hand w... more Aim: To determine if the use of alcohol-based hand-disinfection as a complement to regular hand washing at daycare centers (DCCs) can reduce the childhood rate of absenteeism.
Acta Paediatrica, 2007
Daycare infants have more infectious episodes, see a physician more often, and are prescribed ant... more Daycare infants have more infectious episodes, see a physician more often, and are prescribed antibiotics more often than home care infants. To compare physician consultations and antibiotic prescription in daycare children and home care children taking number of symptom days, sociodemographic factors, concern about infectious illness and antibiotic knowledge into account. For a cohort of Swedish 18-month-old children all infectious symptoms, physician consultation and antibiotic prescriptions were registered during 1 month. 561 infants with daycare outside the home and 278 with daycare at home were included. Of the daycare infants, 23.2% saw a physician and 11.4% were prescribed antibiotics, as compared with 10.8% physician consultations and 5.0% antibiotic prescription for the home care infants. For daycare infants the crude odds ratio for physician consultation were 2.49 (1.63-3.82) and for antibiotic prescription 2.43 (1.34-4.41) compared with home care infants. However, these differences were no longer statistically significant when background data, concern about infectious illness and reported symptoms were taken into account. When background data, concern about infectious illness and reported infectious symptoms were taken into account daycare infants saw a physician and was prescribed antibiotics in the same way as home care infants.
Scandinavian Journal of Primary Health Care, 2006
Objective. To examine infectious symptoms on a daily basis in families with small children and ho... more Objective. To examine infectious symptoms on a daily basis in families with small children and how often these infections cause people to stay at home or seek healthcare. Design. A population-based prospective study. Setting. Child health clinics in seven municipalities in Sweden. Subjects and main outcome measures. All family members of 835 families who came with an 18-month-old child to a child health clinic were asked to register all infectious symptoms in a diary for a month. They were also asked to indicate whether they had stayed at home from day-care or school, whether social insurance had been used, and whether they had contacted healthcare facilities or seen a physician. Results. In total, 7% of the 18-month-old children and 34% of the parents had no symptoms during the winter month. The most common symptom was a runny nose. The 18-month-old children had 1.6 symptom episodes with an average duration of 5.6 days. Of the symptom episodes 13% led to contact with healthcare facilities and 6% to an antibiotic prescription. Of the symptom days 27% required staying at home and in 10% social insurance was claimed. Conclusion. Symptoms of infection among families with small children were common, with a runny nose being the most common. Physician consultations and antibiotic prescriptions were used in a small proportion of the symptom episodes. Social insurance was claimed in about one-third of the days with absence from day-care.