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Patientens tillit till den prehospitala vårdkedjan: Ändamålsenlig vårdnivå för patienter med primärvårdsbehov
2017 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aim: The overall aim of the thesis is to investigate whether a new care-model can be introduced – in which patients with primary care needs and not in need of hospital emergency department care can be referred directly to a healthcare centre – and respond to the patient’s need of trust and patient safety.  

Methods: The four sub studies employ different methods: three are quantitative with varying approaches and one is qualitative. Sub study I is a retrospective explorative register study aimed to identify characteristics and frequency. Sub study II is an instrument development study aimed to measure patient trust. Sub study III is a randomized controlled trial, which compared the level of patient trust and patient-safety among low-priority ambulance patients who were randomized into two groups: the experimental group (care at the healthcare centre) and the control group (traditional care at Emergency department). Finally, sub study IV is a hermeneutic lifeworld study based on interviews with patients who participated in the new care model.  

Main results: Sixteen percent of the patients to whom an ambulance was allocated could have received care at a healthcare centre instead of an emergency department. They were slightly younger and healthier as regards their histories, but were found at all priority levels and with almost all symptom codes. Patient trust in care did not differ regardless of whether they were cared for at a healthcare centre or at the emergency department. However, 59 patients of 188 overall (31%) fulfilled one or more of the given criteria for potentially reduced patient safety. The phenomenon of trust does not automatically involve medical care. However, attention to the patient’s lifeworld in a professional caring relationship enables the patient to trust the caregiver and the healthcare environment. It is clear that the “voice of lifeworld” enables the patient to feel trust. 

Conclusion: One in six patients allotted an ambulance may get taken to primary care instead of the hospital emergency department. These patients are found at all priority levels and in most of the symptom codes.  An instrument has been developed that measures patient trust in the prehospital chain of care (Study I). The instrument has proved to be useful in this patient group and is based on two dimensions: Credibility and Accessibility (Study II). Patients’ trust in the prehospital care chain proved to be high and bore no relation to where they received care. Patient safety, on the other hand, appeared to be limited in view of the fact that an excessive proportion of patients were exposed to potential patient safety risks (Study III). Communication that appeals to a patient's lifeworld increases the opportunities for understanding and participation. In all, lifeworld communication creates trust in care at the right level of care as well as in care relationships and the healthcare environment (Study IV). 

Place, publisher, year, edition, pages
Borås: Högskolan i Borås, 2017.
Series
Skrifter från Högskolan i Borås, ISSN 0280-381X ; 81
Keyword [en]
Ambulance care, Caring relationship, Hermeneutics, Lifeworld, Patient safety, Patient trust, Primary care, Randomized Controlled Trial
National Category
Nursing
Research subject
Människan i vården
Identifiers
URN: urn:nbn:se:hb:diva-12194ISBN: 978-91-88269-49-2 (print)ISBN: 978-91-88269-50-8 (electronic)OAI: oai:DiVA.org:hb-12194DiVA: diva2:1104875
Available from: 2017-09-20 Created: 2017-06-02 Last updated: 2017-09-22Bibliographically approved
List of papers
1. Swedish emergency medical services' identification of potential candidates for primary healthcare: Retrospective patient record study.
Open this publication in new window or tab >>Swedish emergency medical services' identification of potential candidates for primary healthcare: Retrospective patient record study.
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2015 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 33, no 4, 311-317 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: To investigate patients who called the emergency medical services (EMS) for primary healthcare (PHC) problems.

DESIGN: A retrospective and exploratory patient record study from an EMS perspective, comparing two groups: those who were potential candidates for PHC and those who were not. All data were gathered from EMS and hospital records.

SETTINGS: The study was completed at the EMS and five hospital areas in the western region of Sweden.

SUBJECTS: The patients (n = 3001) who called the EMS in 2011. Data were missing for 10%.

MAIN OUTCOME MEASURES: The frequency and the clinical characteristics of the patients who called the EMS and were actually potential candidates for PHC.

RESULTS: Of a total of 2703 patients, a group of 426 (16%) were assessed as potential candidates for PHC and could thus be treated at a level of care other than the emergency department. Patients who were classified as suitable for PHC were found at all priority levels and within all symptom groups, but were younger and healthier than the other group.

CONCLUSION: Numerous patients seeking help from the EMS do not end up at the most appropriate level in the healthcare system.

IMPLICATIONS: In the EMS, guidelines are needed to enable pre-hospital emergency nurses to assess and triage patients to the most appropriate level of healthcare. Key points Patients calling the emergency medical services do not always end up at an appropriate level of healthcare. In total, 16% of patients were identified by the Swedish emergency medical services as potential candidates for primary healthcare. These patients were younger and healthier than those needing care at the emergency department. They were found at all priority levels and within all symptom groups.

Keyword
Emergency Medical Services, Primary Healthcare, Triage, Exploratory, Assessment, Prehospital Emergency Nurse
National Category
Medical and Health Sciences
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-5412 (URN)10.3109/02813432.2015.1114347 (DOI)26635215 (PubMedID)
Projects
Vård på rätt vårdnivå
Funder
Länsförsäkringar AB
Available from: 2015-12-18 Created: 2015-12-18 Last updated: 2017-12-01Bibliographically approved
2. Use of the Medical emergency services by patients with suspected acte primary healthcare problems: Developing av questionnaire measure patient trust in healthcare
Open this publication in new window or tab >>Use of the Medical emergency services by patients with suspected acte primary healthcare problems: Developing av questionnaire measure patient trust in healthcare
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2016 (English)In: European Journal for Person Centered Healthcare, ISSN 2052-5648, E-ISSN 2052-5656, Vol. 4, no 3, 444-452 p.Article in journal (Refereed) Accepted
Abstract [en]

Rationale aims and objectives: The objective of this study was to develop a questionnaire measuring the level of trust and its constituents in patients calling the Emergency Medicak Services (EMS) for suspected acute primary healthcare problems. The questionnaire is called the Patient Trust Questionnaire (PTQ). The following frontline service providers were involved: 1) The Dispatch Centre, 2) the Emergency Medical Services and 3) the recieving unit (the Emergency Department/Healthcare Centre)

Method: Cross-sectional data were collected repeately and redundant items were discarded using a step-by-step approach. Based on litterature review, the PTQ was developed in line with the folowing 4-step procedure: 1) item construction, 2) a face-to-face evaluation of separate items, 3) an emerical pre-evaluation targeting each separate frontline service provider and 4) an emperical full-scale evaluation. The inclusion criteria for participating were that the patient must be 18 years of age or older and suspected having a suspected acute primary care problem when calling the EMS. In the finale full-scale evaluation of the questionnaire, 427 patients were included.

Results: A set of 8 items with good phsycometric properties remained through the developing procedure. Two constituents of trust emerged (labelled credibility and accessibility), witch were robust across all fronline service providers.

Conclusion: A new measuring instrument has been developed for this particular healthcare chain, for patients with suspected acute primary care problem calling the EMS. Althought not yet validated, the PTQ is a potentially usefull tool in future healthcare research with reference to the concept of patient trust.

Keyword
Acute primary healthcare, emergency department, emergency medical services, healthcare centre, patient dependence, patient vulerability, patient misstrust, patient trust, person-centered healthcare, questinnaire
National Category
Medical and Health Sciences
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-11739 (URN)10.5750/ejpch.v4i3.1120 (DOI)
Projects
VRV projektet
Funder
Länsförsäkringar AB
Available from: 2017-01-10 Created: 2017-01-10 Last updated: 2017-11-29Bibliographically approved

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