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Objective: Patient education based on the patient's individual needs and circumstances is known to be associated with positive changes in clinical outcomes in chronic obstructive pulmonary disease (COPD). We aimed to assess the levels of patients' subjective needs for information about COPD before and after their general practitioners had taken part in a COPD education., Design: A secondary analysis of a cluster randomized controlled trial., Setting: 22 PHCCs in Stockholm, Sweden., Subjects: Randomly selected primary care patients with COPD in GOLD stages 2 and 3 ( n  = 293)., Outcome Measures: Scores in the Lung Information Needs Questionnaire (LINQ) at baseline and 18 months, spirometry results, and self-reported, descriptive patient data., Results: GPs' improved skills in COPD did not affect patients' self-management skills over time. In general, patients' information needs remained great in issues concerning diet, exercise and self-management. However, 43% of the patients reported reduced and 57% increased or unchanged information needs, over time. Reduced information needs were mainly associated with a high level of information needs at baseline (OR = 3.17 [95% CI 1.93-5.23], p  < .01) and establishing contact with a physiotherapist (OR = 2.26 [95% CI 1.05-4.86], p  = .038). Patients in a mild or stable phase of COPD with no recent exacerbations reported greater needs than those with unstable, deteriorated COPD., Conclusion: Patients' information needs are substantial in most areas of self-management of COPD, and seem to covary with the patient's current clinical status. Care providers should thus continuously be vigilant about offering all patients with COPD support and education., Trial Registration: Clinicaltrials.gov, 10 August 2014, Identifier NCT02213809.

Objective: In Sweden, patients with chronic conditions, such as chronic obstructive pulmonary disease (COPD), often receive education at specialized nurse-led clinics at primary health care centers (PHCCs). Identifying patients' needs for information about COPD is the key to individualized care. This study aimed to assess self-reported needs for information about COPD in primary care patients with either moderate (GOLD 2) or severe (GOLD 3) COPD and identify patient characteristics and exacerbation patterns associated with the findings. Design: A cross-sectional study. Setting: Twenty-four PHCCs in Stockholm, Sweden. Subjects: Randomly selected primary care patients with COPD in GOLD stages 2 and 3 ( n  = 542). Main outcome measures: The Lung Information Needs Questionnaire (LINQ) was used to assess perceived information needs. Spirometry results and descriptive, self-reported data on patient factors such as exacerbation history, treatment, smoking, weight/height, comorbidities, health care contacts, education and symptoms were collected. Results: Overall, the greatest reported needs were for information about self-management and diet. GOLD 2 patients (68%) expressed greater needs for information than GOLD 3 patients (32%). We found significant associations between high information needs and patient-related factors such as 'No assigned GP' (OR = 4.32 [95% CI 2.65-7.05]) and 'No contact with COPD nurse in the past 12 months' (OR = 1.83 [95% CI 1.19-2.81]). Conclusion: COPD patients felt they knew too little about self-management of their disease. Low information needs were strongly associated with continuity in patient-GP consultations and moderately associated with contact with a COPD nurse. These associations were strongest in patients with moderate COPD. Key points: As patients with COPD often have multimorbidity, identifying patients' needs for information about COPD is essential to providing individualized patient education and care. In this study of 542 patients from 24 Swedish primary care centers, we found that:Patients with COPD, particularly those with moderate airflow limitation (i.e. GOLD 2) felt they needed more information about COPD than currently provided by health care professionals in primary care.Low information needs were strongly associated with continuity in patient-GP consultations and moderately associated with contact with a COPD nurse. GPs' part in COPD patient education should not be overlooked, as individualized COPD care relies on GPs' expertise in managing patients with multimorbidity.

Background: Chronic obstructive pulmonary disease (COPD) is a common cause of suffering and death. Evidence-based management of COPD by general practitioners (GPs) is crucial for decreasing the impact of the disease. Efficient strategies include early diagnosis, smoking cessation and multimodal treatment., Aim: To describe knowledge about and skills for managing COPD in GPs in Sweden., Methods: Prior to COPD education (the PRIMAIR Study), GPs at primary health care centers (PHCCs) in Stockholm replied to 13 written, patient-case based, multiple choice and free-text questions about COPD. Their knowledge and practical management skills were assessed by assigned points that were analyzed with non-parametric tests., Results: Overall, 250 GPs at 34 PHCCs replied (89% response rate). Total mean score was 9.9 (maximum 26). Scores were highest on 'management of smoking cessation', 'follow-up after exacerbation' and 'diagnostic procedures'. Spirometry was used frequently, although interpretation skills were suboptimal. 'Management of maintenance therapy', 'management of multimorbidity' and 'interprofessional cooperation' had mediocre scores. Scores were unrelated to whether there was a nurse-led asthma/COPD clinic at the PHCC., Conclusions: Swedish GPs' knowledge of COPD and adherence to current guidelines seem insufficient. A nurse-led asthma/COPD clinic at the PHCC does not correlate with sufficient COPD skills in the GPs. The relevance of this study to participants' actual clinical practice and usefulness of easy-to-access clinical guides are interesting topics for future investigation. To identify problem areas, we suggest using questionnaires prior to educational interventions. Key Points General practitioners (GPs) play a crucial role in providing evidence-based care for patients with chronic obstructive pulmonary disease (COPD) who are treated in primary care. Swedish GPs' knowledge about COPD and adherence to current guidelines seem insufficient. Areas in greatest need of improvement are spirometry interpretation, management of maintenance therapy, management of multimorbidity in patients with COPD and interprofessional cooperation.

Objective: To identify factors that hinder discussions regarding chronic obstructive pulmonary disease (COPD) between primary care physicians (PCPs) and their patients in Sweden., Setting: Primary health care centres (PHCCs) in Stockholm, Sweden., Subjects: A total of 59 PCPs., Design: Semi-structured individual and focus-group interviews between 2012 and 2014. Data were analysed inspired by grounded theory methods (GTM)., Results: Time-pressured patient-doctor consultations lead to deprioritization of COPD. During unscheduled visits, deprioritization resulted from focusing only on acute health concerns, while during routine care visits, COPD was deprioritized in multi-morbid patients. The reasons PCPs gave for deprioritizing COPD are: "Not becoming aware of COPD", "Not becoming concerned due to clinical features", "Insufficient local routines for COPD care", "Negative personal attitudes and views about COPD", "Managing diagnoses one at a time", and "Perceiving a patient's motivation as low''., Conclusions: De-prioritization of COPD was discovered during PCP consultations and several factors were identified associated with time constraints and multi-morbidity. A holistic consultation approach is suggested, plus extended consultation time for multi-morbid patients, and better documentation and local routines., Key Points: Under-diagnosis and insufficient management of chronic obstructive pulmonary disease (COPD) are common in primary health care. A patient-doctor consultation offers a key opportunity to identify and provide COPD care. Time pressure, due to either high number of patients or multi-morbidity, leads to omission or deprioritization of COPD during consultation. Deprioritization occurs due to lack of awareness, concern, and local routines, negative personal views, non-holistic consultation approach, and low patient motivation. Better local routines, extended consultation time, and a holistic approach are needed when managing multi-morbid patients with COPD.

Objective: To study possible social predictors for reduction of hyperlipidaemia in subjects offered lifestyle intervention in primary health care after an opportunistic screening., Setting: Primary health care in Sollentuna, Sweden., Design: Follow-up study of changes in high lipid levels in men and women aged 20-60 years participating in a voluntary screening and cardiovascular prevention programme., Subjects and Main Outcome Measures: A total of 1904 individuals had a follow-up visit registered after a mean of 466 days. Men and women with raised lipid levels (serum cholesterol = 6.5 mmol/l, and/or triglycerides = 2.3 mmol/l) at baseline were compared with normolipidaemic participants. Data on social characteristics such as education, occupation, marital status, and income were collected from national censuses. Associations between socioeconomic factors and changes in lipid levels were studied., Results: Men and women with hyperlipidaemia were generally (p < 0.001) older (men 6-8 years, women 8-10 years) and less educated than normolipidaemic subjects. Significant predictors for reducing hypercholesterolaemia were younger age, OR 0.97 (0.95-1.00) for increasing age, and longer education, OR 0.47 (0.24-0.91) for low education (<9 years). Foreign-born subjects were more likely to achieve a high success rate in reducing hypercholesterolaemia, OR 3.43 (1.00-11.8), than the Swedish-born. No significant predictors were detected for reduction of high triglyceride levels., Conclusion: A successful reduction of high cholesterol levels was associated with younger age and longer education in a primary health care-based programme for cardiovascular prevention.

Objective: To study the feasibility of a cardiovascular prevention programme., Design: Opportunistic screening for cardiovascular risk factors. Advice and treatment to reduce identified cardiovascular risk factors. Individually designed follow-up., Setting: Primary health care in Sollentuna (51,000 inhabitants), Sweden., Subjects: Visitors to health care centres., Main Outcome Measures: Feasibility and effectiveness to reduce identified cardiovascular risk factors., Results: During 4 years 5622 persons, of whom 4655 (83%) were in the age group 20-60 years, participated in the programme. The prevalences of risk factors as smoking, overweight, hypertension, hypercholesterolaemia and hypertriglyceridaemia were high. At follow-up investigations, mean S-cholesterol levels were reduced by 7% among men and 10% among women. S-triglycerides were reduced by 24% and 42%, respectively. Diastolic blood pressures were reduced in men from 95 to 90 mmHg and in women from 94 to 88 mmHg. However, no effects on weight were noted and due to a low follow-up rate meaningful analysis of smoking habits was not possible., Conclusion: A programme for cardiovascular screening and prevention can be integrated in the primary health care system. Prevalent cardiovascular risk factors like hypercholesterolaemia, hypertriglyceridaemia and high blood pressure were significantly reduced after intervention.

Objective: To develop a short and easily used self-report measure of Type A behaviour (Simplified Type A Questionnaire = STAQ) and to examine its capacity to predict Type A behaviour as assessed by more time-consuming measures., Design: A Videotaped Structured Interview (VSI) and a self-report measure, previously validated in Sweden, were used as comparison instruments to the STAQ., Setting: Primary health care., Patients: 206 (81 men and 125 women) aged 17-75 years attending a health centre during one year., Main Outcome Measures: The reliability, measured by Cronbach's alpha and split-half correlation. The specificity and sensitivity of the STAQ. The correlaiton between the STAQ and the two other diagnostic measures., Results: The reliability of the STAQ was 0.70 and 0.75, respectively. The specificity was 83% and the sensitivity 75%. The correlation between the STAQ and the VSI was 0.45. The correlation between the STAQ and the previously validated self-report was 0.61., Conclusions: The STAQ has good psychometric properties and, in comparison with other diagnostic measurement instruments in medical service, it has an acceptable discrimination capacity.

Objective: To integrate prevention of cardiovascular disease within the primary health care., Design: A prevention programme which combines population and individual high-risk strategy., Setting: The Primary Health Care in Sollentuna, Stockholm, Sweden., Main Outcome Measure: Characteristics of, and risk factor prevalence among, persons registered in the prevention programme., Results: During the first year more than 2000 persons, representing every tenth visitor and 6% of the population aged 15-60 years, were registered in the prevention programme. 90% were < or = 60 years and 62% were women. A large proportion (70%) had risk factors that required advice, treatment, and follow up. 24% of the men and 27% of the women were smokers, 68% and 62% respectively, had serum cholesterol > or = 5.2 mmol/l, and 33% and 22% had a diastolic blood pressure > or = 90 mmHg., Conclusion: The present study implies that it is possible to integrate a large scale prevention programme in the existing primary health care organization. The prevalence of risk factors in those who enter the prevention programme is high, which places great demands for treatment and follow up.

In a study that covered ten years a questionnaire about use of health care facilities was mailed each autumn to 1/60 representative samples of the population in Sollentuna, a Swedish primary care district with three health centres. Primary care was the health care form with the greatest contact area with the population studied. However, the strengthening of district physician resources at one of the three health centres did not, in the long term, lead to more people coming into contact with this form of medical care. It was more common for those who visited a private doctor or school/company doctor also to consult a district physician than vice versa. Similarly, hospital patients visited the health centre to a greater degree than patients of health centres visited hospitals. The only long-term change in the flow of patients that could be registered was a reduction in the number of patients who visited hospital emergency departments. It is concluded that the implementation of an annual survey may be considerably more helpful than more sparse investigations in distinguishing between temporary fluctuations and real changes.

In a study that covered ten years a questionnaire about perceived health and use of health care services was mailed each autumn to 1/60 representative samples of the population in Sollentuna, a Swedish primary care district. The majority of respondents thought that their health was good, and only a small minority reported themselves as quite, or very sick. Those assessments were stable during the ten year period. The tendency to visit the health services increased with the degree of severity of the illness. This increase was most marked in the case of visits to emergency departments and visits by appointment at hospitals, and least in the case of visits to private doctors and company/school physicians, while visits to doctors at health centres and to district nurses occupied an intermediate position. Thus, by including a simple question about perceived health in a questionnaire designed to measure use of health care services, important information about the relations between use of health services and health conditions could be obtained.

In a study that covers ten years, a questionnaire about use of health care facilities and satisfaction with care was mailed out each autumn to 1/60 representative samples of the population in Sollentuna, a Swedish primary care district with three health centres. An open-ended question concerning "what is good and what is bad in the health service today" was used to measure the respondents' attitudes. The health centres attracted most comment and were considered on the whole to function better in terms of service and care than the hospitals. The latter were heavily criticized for long queues and poor availability. The continuity, however, was considered fairly poor in both the primary care and the hospitals. The few comments on private practitioners were almost without exception positive. The attributes of (all types of) care to which the respondents attached the greatest importance were closely connected with the orientation and objectives which have been stated internationally for primary care, viz. availability, continuity, quality/safety, primary responsibility, and co-ordination. Improvement of resources and reorganization in small health care teams at one of the three health centres prompted a significant increase of positive attitudes to primary care.