Extended prenatal and postnatal home visits in a vulnerable area in Sweden-a pilot study.

OBJECTIVE: Despite close to all-embracing access to child healthcare, health divides exist among children in Sweden. Home visits to families with new-born babies are a cost-effective way to identify and strengthen vulnerable families. An extended postnatal home visiting programme has been implemented in a disadvantaged suburb in Stockholm with positive results. DESIGN: Longitudinal, prospective study and register study from medical records. SETTING: A vulnerable rural area in Sweden. INTERVENTION: A parent advisor from the social services and a midwife performed an extended home visiting programme during the end of pregnancy to mothers of children born between 1 May 2018 and 31 May 2019. During these children's first 15 months, three additional home visits were made by a parent advisor and a child healthcare nurse. The aim of the study is to evaluate the effect of the intervention on the health of the children and the mothers. SUBJECTS: All firstborn children at the study site (N = 30 study, N = 55 control group). MAIN OUTCOME MEASURES: The proportion participating in visits to the child and maternal healthcare services, children being breastfed and receiving childhood vaccinations. RESULTS: There were fewer absentees in the study group during routine check-up visits (93 vs. 84%). More mothers in the study group attended the check-up with the midwives (90 vs. 80%). More children in the study group were breastfed (90 vs. 67%) and received all vaccinations (100 vs. 96%). CONCLUSION: Supplementing the extended home visiting programme with a visit at the end of pregnancy seems to contribute to fewer absentees at routine visits for both mothers and children; furthermore, more children were breastfed and vaccinated compared with the control group.

Evaluation of four additional home visits to all firstborn children by parent advisors and healthcare professionals during the end-of-pregnancy period and early childhood in a vulnerable area showed the following benefits:More children in the study were breastfed and received all vaccinations compared with the control group.There were fewer absentees at the routine check-up visits to the child healthcare centre in the study compared with the control group.More mothers in the study group attended the check-up visits to the midwife 2 months after delivery compared with the controls.

Prevalence of dry mouth in adult patients in primary health care.

OBJECTIVES: To determine the prevalence and severity of dry mouth by age, gender, presence of disease, and medication intake for patients aged 18 years and over, seeking primary health care on the west coast of Sweden (Region of Västra Götaland, VGR). MATERIALS AND METHODS: Cross-sectional study conducted among patients (n = 374, age ≥ 18) visiting primary health care providers (n = 4) in VGR for any medical reasons. Patients were invited to participate by answering a single-item question, 'Have you experienced dry mouth in the last six months?' Patients giving positive answers (n = 163) were asked to fill in the 11-item Xerostomia Inventory (XI) questionnaire to determine the variability and severity of xerostomia. Patients replying 'No' (n = 211) to the single-item question were considered not to have xerostomia and included in the non-xerostomia group. RESULTS: The overall prevalence of xerostomia was 43.6% with a female dominance (61.2%). The prevalence in different age groups among females and males was similar. The number of medications and/or diseases are positively associated with xerostomia. Medication was a significant predictor of the prevalence of xerostomia, regardless of age and gender (p < .001). Patients with five or more medications had the highest prevalence of xerostomia (71.2%). CONCLUSION: Patients seeking primary care on the west coast of Sweden have a high prevalence of xerostomia. Factors associated with xerostomia were female gender and medications and/or diseases. Awareness is required to manage patients with xerostomia in medical and dental care.

Benefits and harms of screening men for abdominal aortic aneurysm in Sweden: a registry-based cohort study.

BACKGROUND: Large reductions in the incidence of abdominal aortic aneurysm (AAA) and AAA-related mortality mean that results from randomised trials of screening for the disorder might be out-dated. The aim of this study was to estimate the effect of AAA screening in Sweden on disease-specific mortality, incidence, and surgery. METHODS: Individual data on the incidence of AAA, AAA mortality, and surgery for AAA in a cohort of men aged 65 years who were invited to screening between 2006 and 2009, were compared with data from an age-matched contemporaneous cohort of men who were not invited for AAA screening. We also analysed national data for all men aged 40-99 years between Jan 1, 1987, and Dec 31, 2015, to explore background trends. Adjustment for confounding was done by weighting the analyses with a propensity score obtained from a logistic regression model on cohort year, marital status, educational level, income, and whether the patient already had an AAA diagnosis at baseline. Adjustment for differential attrition was also done by weighting the analyses with the inverse probability of still being in the cohort 6 years after screening. Generalised estimating equations were used to adjust the variance for repeated measurement and in response to the weighting. FINDINGS: AAA mortality in Swedish men has decreased from 36 to ten deaths per 100 000 men aged 65-74 years between the early 2000s and 2015. Mortality decreased at similar rates in all Swedish counties, irrespective of whether AAA screening was offered. After 6 years with screening, we found a non-significant reduction in AAA mortality associated with screening (adjusted odds ratio [aOR] 0·76, 95% CI 0·38-1·51), which means that two men (95% CI -3 to 7) avoid death from AAA for every 10 000 men offered screening. Screening was associated with increased odds of AAA diagnosis (aOR 1·52, 95% CI 1·16-1·99; p=0·002) and an increased risk of elective surgery (aOR 1·59, 95% CI 1·20-2·10; p=0·001), such that for every 10 000 men offered screening, 49 men (95% CI 25-73) were likely to be overdiagnosed, 19 of whom (95% CI 1-37) had avoidable surgery that increased their risk of mortality and morbidity. INTERPRETATION: AAA screening in Sweden did not contribute substantially to the large observed reductions in AAA mortality. The reductions were mostly caused by other factors, probably reduced smoking. The small benefit and substantially less favourable benefit-to-harm balance call the continued justification of the intervention into question. FUNDING: Research Unit and Section for General Practice, FoUU-centrum Fyrbodal, Sweden, and the region of Västra Götaland, Sweden.

A national study on collaboration in care planning for patients with complex needs.

INTRODUCTION: The purpose of this study was to investigate inter-organisational collaboration on care planning for patients with complex care needs. Internationally, and in Sweden where the data for this study was collected, difficulties in care planning and transition of patients between the main health care providers, hospitals, municipal care, and primary care are well known. METHOD: A survey of a total population of care managers in hospitals, municipalities, and primary care in Sweden was conducted. The study assessed accessibility, willingness, trustworthiness, and collaboration between health care providers. Data were analysed with descriptive statistics, bivariate, and multivariate regressions. RESULTS: The results indicate that Swedish health care providers show strong self-awareness, but they describe each other's ability to collaborate as weak. Primary care stands out, displaying the highest discrepancy between self-awareness and displayed accessibility, willingness, trustworthiness, and collaboration. CONCLUSION: Inability to collaborate in patient care planning may be due to shortcomings in terms of trust between caregivers in the health care organisation at a national level. Organisations that experience difficulties in collaboration tend to defend themselves with arguments about their own excellence and insufficiency of others.

The Impact of Repeated Assessments by Patients and Professionals: A 4-Year Follow-Up of a Population With Schizophrenia.

The needs of people with schizophrenia are great, and having extensive knowledge of this patient group is crucial for providing the right support. The aim of this study was to investigate, over 4 years, the importance of repeated assessments by patients with schizophrenia and by professionals. Data were collected from evidence-based assessment scales, interviews, and visual self-assessment scales. The data processing used descriptive statistics, correlation and regression analyses. The results showed that the relationships between several of the patients' self-rating assessments were stronger at the 4-year follow-up than at baseline. In parallel, the concordance rate between patient assessments and case manager assessments increased. The conclusions drawn are that through repeated assessments the patients' ability to assess their own situation improved over time and that case managers became better at understanding their patients' situation. This, in turn, provides a safer basis for assessments and further treatment interventions, which may lead to more patients achieving remission, which can lead to less risk for hospitalization and too early death.

Promoting mental health in Swedish preschool-teacher views.

Summary: The promotion of childhood mental health is an important investment for the future. Many young children spend a large amount of time in preschool, which have unique opportunities to promote mental health at an early stage. The aim of this study was to illuminate teachers' views of what they do in ordinary work to promote mental health among preschool children. This qualitative study had a descriptive and exploratory design and qualitative content analysis was utilized. Six focus group interviews with preschool teachers, concerning families from different cultural, geographical and socioeconomic backgrounds, were conducted in a county in the southwest of Sweden. Both manifest and latent content appeared. Three categories, 'structured world', 'pleasant climate' and 'affirming the child' and 10 subcategories emerged. The latent content of these categories is described under the theme 'creating an atmosphere where each child can flourish in harmony with their environment'. The results show teachers different working approaches with mental health in preschool and together with previous research these results can provide a basis of knowledge for preschool teachers and inspire them to develop and maintain their health-promoting work. In future studies it should be particularly interesting to investigate how the promotive way to work can be transferred to strengthen mental health throughout the school years.

Understanding persons with psychological distress in primary health care.

The purpose of this study was to gain more knowledge and a deeper understanding of experiences of persons living with psychological distress who seek help in primary care. Psychological distress is a state of emotional suffering associated with stressors and demands that are difficult to cope with in daily life. The lack of effective care for and difficulty in identifying psychological distress is frustrating for patients and health professionals alike. The aim was therefore to gain more knowledge about the experience of living with psychological distress. Twelve persons (nine women and three men) aged 23-51 years were interviewed. Analyses were based on a phenomenological hermeneutic method and indicated that psychological distress may be seen as an imbalance (incongruence) between the self and the ideal self, which slowly breaks down a person's self-esteem. This imbalance was described in three dimensions: Struggling to cope with everyday life, Feeling inferior to others and Losing one's grip on life. It seems to be associated with a gradual depletion of existential capacities and lead to dissatisfaction, suffering, poor self-esteem and lack of control. As psychological distress may be a forerunner to mental, physical and emotional exhaustion, there is a need to initiate preventive or early interventions to avoid mental, physical and emotional chaos in such patients. Patients' with psychological distress need to be involved in a person-centred salutogenic dialogue with health professionals to become aware of and strengthen their own capacities to regain health and well-being.

Quality of life, sense of coherence and experiences with three different treatments in patients with psychological distress in primary care: a mixed-methods study.

BACKGROUND: Psychological distress is associated with impaired health-related quality of life (HRQL) and poor sense of coherence (SOC). In a previous study, we found that therapeutic acupuncture (TA) and an integrative treatment that combined TA with person-centred approach in a salutogenic dialogue (IT) alleviated anxiety and depression significantly more than conventional treatment (CT) in primary care patients. Here, we report on secondary analyses regarding the HRQL and SOC from that previous pragmatic randomised controlled trial (RCT). METHOD: Quantitative and qualitative design. One hundred twenty patients were referred for psychological distress. Quantitative analyses were performed at baseline and after 8 weeks of treatment using the SF-36 mental component summary (MCS), physical component summary (PCS) and the Sense of Coherence-13 (SOC) questionnaires. Qualitative manifest content analyses were based on open-ended questions-"Have you experienced any changes since the start of the treatment? Will you describe these changes?" RESULTS: No baseline differences were found. At 8 weeks, both the IT and TA groups had statistically better scores and greater improvement from baseline on the MCS and SOC than the CT group. The effect sizes were large. No significant differences were found between the IT and TA groups or in relation to the PCS. SOC was highly correlated with the MCS but not with the PCS. Dropout rates were low. The experiences of the intervention resulted in four categories: Being heading back; Status quo; Feeling confirmed; and Feeling abandoned, with 13 related subcategories. CONCLUSION: IT and TA seem to improve sense of coherence and mental health status in primary care patients with psychological distress, whereas CT appears to be less beneficial. IT and TA appear to be well-accepted and may serve as useful adjunct treatment modalities to standard primary care. Our results are consistent with much of the previous research in highlighting a strong relationship between SOC and mental health status. The written qualitative data described feeling confirmed and feeling increased self-efficacy, self-care and faith in the future. Those in the CT group, however, described feeling abandoned, missing treatment and experiencing increased emotional and physical problems. More research is needed. TRIAL REGISTRATION: ISRCTN trial number NCT01631500.

Assessment of Distress and Quality of Life: A Comparison of Self-Assessments by Outpatients with a Schizopsychotic Illness and the Clinical Judgment of Nurses.

The aim of this study was to investigate how self-assessments of perceived distress and quality of life in patients with schizopsychotic illness are associated with nurse assessments of symptoms, function and life situation. Data were obtained through interviews that used evidence-based rating and visual analogue self-rating scales. Descriptive statistics, correlation and regression analyses were used to process the data. The results demonstrated that the patient self-ratings did not correlate with the nurse assessments, and the perceived distress was not affected by remission status. The findings indicate that patient self-assessments are not a sufficient basis for decisions regarding appropriate treatment interventions.

Six-month effects of integrative treatment, therapeutic acupuncture and conventional treatment in alleviating psychological distress in primary care patients--follow up from an open, pragmatic randomized controlled trial.

BACKGROUND: To evaluate and compare 6-month effects of 8 weeks of an integrative treatment (IT), therapeutic acupuncture (TA), and conventional treatment (CT) in reducing symptoms of anxiety, depression and in improving health-related quality of life (HRQL) and sense of coherence (SOC) in psychologically distressed primary care patients. METHODS: Patients who had participated in an open, pragmatic randomized controlled trial were followed up six months after treatment. The study sample consisted of 120 adults (40 per treatment arm) aged 20 to 55 years referred from four different primary health care centres in western Sweden for psychological distress. Assessments were made at baseline after eight weeks and after 24 weeks. Anxiety and depression were evaluated with the Hospital Anxiety and Depression scale (HADS), HRQL with the SF-36 Mental Component Summary scores (MCS) and SOC with the Sense of Coherence-13 questionnaire. RESULTS: No baseline differences were found between groups on any outcome variable. At 24 weeks, IT and TA had significantly better values than CT on all variables. All three groups showed significant improvements from baseline on all variables, except HAD depression in CT; however, improvements were significantly greater in IT and TA than in CT. IT and TA did not differ on any outcome variable. Effect sizes were large in IT and TA for all variables and small or moderate in CT. Improvements on all variables seen after 8-weeks of IT and TA remained stable at 24 weeks and the CT group improved on HAD anxiety. CONCLUSIONS: IT and TA seem to be more beneficial than CT in reducing anxiety, depression, and in improving quality of life and sense of coherence after 24 weeks of follow up in patients with psychological distress. More research is needed to confirm these results. TRIAL REGISTRATION: ISRCTN trial number NCT01631500.

Effects of an integrative treatment, therapeutic acupuncture and conventional treatment in alleviating psychological distress in primary care patients--a pragmatic randomized controlled trial.

BACKGROUND: To evaluate and compare effects of an integrative treatment (IT), therapeutic acupuncture (TA), and conventional treatment (CT) in alleviating symptoms of anxiety and depression in psychologically distressed primary care patients. METHODS: An open, pragmatic randomized controlled trial comparing the three treatment regimens at four and eight weeks after treatment. The study sample consisted of 120 adults (40 per treatment arm) aged 20 to 55 years referred from four different primary health care centres in western Sweden for psychological distress. Psychological distress was evaluated at baseline, and after 4 and 8 weeks of treatment using the Hospital Anxiety and Depression scale (HAD). Treatment sessions lasted about 60 minutes in IT and 45 minutes in TA. RESULTS: No baseline differences were found between groups on HAD depression or anxiety. HAD anxiety and depression decreased significantly more in the IT and TA groups than in the CT group both after 4 and 8 weeks of treatment, but not between IT and TA. Improvements in the TA and IT groups were large and clinically significant, whereas CT effects were small and clinically non-significant. CONCLUSIONS: Both IT and TA appear to be beneficial in reducing anxiety and depression in primary care patients referred for psychological distress, whereas CT does not. These results need to be confirmed in larger, longer-term studies addressing potentially confounding design issues in the present study. TRIAL REGISTRATION: ISRCTN trial number NCT01631500.

Anxiety and depression in obese and normal-weight individuals with diabetes type 2: a gender perspective.

BACKGROUND: Obesity is a problem that is increasing worldwide, leading to an increased incidence of type 2 diabetes mellitus (T2DM). Depression is more common among individuals with diabetes, and they are more likely than non-diabetic individuals to experience emotional problems. People with both T2DM and obesity bear an additional emotional burden, which affects their quality of life. OBJECTIVES: To describe the prevalence of symptoms of anxiety and depression in groups of obese and normal-weight individuals with T2DM who are undergoing primary care and to investigate possible differences between the groups and between genders. METHOD: Three hundred and thirty-nine patients with T2DM from nine primary-care centres participated in a cross-sectional study (n = 180 + 159). The response rate was 67%. The Hospital Anxiety and Depression Scale (HADS) and the Beck Depression Inventory - second edition (BDI-II) were employed to estimate the patients' symptoms of depression and anxiety. RESULTS: An association between T2DM, obesity and depression was observed in both genders. More than one in three women and one in five men with T2DM and obesity exhibited symptoms of anxiety or depression. In the normal-weight group, the females presented more symptoms of anxiety than did their male counterparts. CONCLUSION: In primary healthcare, the fact that both obese men and women with T2DM are at increased risk of anxiety and depression is an important finding, which must be recognised and considered in the course of primary healthcare consultations. Meeting the unique needs of each individual requires an understanding of both laboratory data and the individual's emotional status.

"Difficult" dental patients: a grounded theory study of dental staff's experiences.

INTRODUCTION: The "difficult" patient is a well-known and potentially negative character in various care contexts. OBJECTIVES: This study aimed to generate a conceptual framework explaining the main concerns about "difficult" dental patients, and obtain a deeper understanding of their characteristics, how they affect the dental staff and how the staff think and act in order to manage these patients. METHODS: Ten interviews were conducted with professional dental caregivers, including dentists, dental hygienists, and dental nurses. The audio-recorded interviews were transcribed and analyzed in accordance with the principles of grounded theory. RESULTS: The main concern regarding "difficult" dental patients generated a framework of seven descriptive interrelated lower-level categories grounded in the data, subsumed in the core category "balancing subjective difficulties". The informants perceived the possession of "showing interaction difficulties" and "having bio-psycho-social complexity", as characteristic features of "difficult" patients, who could further adversely affect the dental staff by "evoking negative emotions and behaviors", "hampering self-esteem and job satisfaction", and "impairing life and health in general". To manage the dental care of these patients, the staff used strategies aimed at "activating internal and external resources" and "creating adaptive treatment relations" with patients. CONCLUSIONS: The dental staff's meaning of the phenomenon of "difficult" dental patients points to specific characteristics, effects, and handling strategies. The core category captures the contradictory dynamics of characteristics and affects as these concepts seem interrelated to the caregivers' handling capacity. The dental staff's possibility of handling the main concern through balancing subjective difficulties depends on contextual conditions regarding time, to bring the patient and/or oneself at the center of attention. This indicates a need for further research regarding dental interactions and studies generalizing the outlook on "difficult" dental patients.

Type 2 diabetes: perceptions of quality of life and attitudes towards diabetes from a gender perspective.

OBJECTIVE: To compare obese and normal-weight people with type 2 diabetes (T2DM), with a focus on their attitudes towards the disease, quality of life (QoL) and treatment from a gender perspective. METHODS: Two hundred and eighty-seven people with T2DM participated in a cross-sectional study. Health-related quality of life (HRQL) data from the Medical Outcomes Short Form Study 36 (SF 36), Well-Being Questionnaire (W-BQ12), Diabetes Attitude Scale (DAS) and Diabetes Treatment Satisfaction Questionnaire (DTSQs) were used. The results are presented descriptively. The Mann-Whitney U-test was conducted to examine differences between normal-weight and obese diabetics and between women and men. RESULTS: The results of this study show that there was a gender difference in the perception of QoL; obese females with diabetes experienced more limitations in daily life due to physical and emotional problems than obese males with diabetes. Obese men had reduced physical and vitality scores compared to normal-weight individuals. Compared to normal-weight females with diabetes, obese women had lower vitality scores, more body pain and more severe physical impacts. The negative emotional impact for obese females with diabetes was also demonstrated by the results of the W-BQ12 questionnaire. Obese females with diabetes felt that the disease was more overwhelming and difficult to handle in comparison to obese males with diabetes. There was no difference between the groups in terms of how they experienced treatment. CONCLUSION: There was a gender difference in the perceptions of QoL of people with T2DM. There was also a difference between the QoL of obese and normal-weight people with T2DM, as the obese may suffer from underlying depression. Further investigations are needed for health professionals to be able to meet the unique needs of each specific diabetic group.

Patient care encounters with the MCHL: a questionnaire study.

BACKGROUND: Both internationally and nationally, the medical care help line (MCHL) is a growing operation within the healthcare field. In Sweden, approximately 5 million calls per year are processed. The service is managed by specially trained nurses. AIM: To describe how patients' sex, age, education level and care level influenced their perceptions of care encounters with the MCHL. METHODOLOGICAL DESIGN AND INSTRUMENT: A questionnaire was designed through the operationalisation of terms based on a previous interview study with MCHL callers. It was distributed to 858 callers in a region of southwest Sweden. The questionnaire was comprised of 14 visual analogue scales (VAS). Validity and reliability were determined to be acceptable by a pilot study and factor analyses. RESULTS: Response frequency n = 517 (60.4 %). Three factors, interaction, service and product, emerged to describe high satisfaction with the MCHL from different perspectives. The items 'friendliness', 'respect', 'confirmation', 'accessibility' and 'simplicity' scored highest, whereas the 'joint decision-making', 'composure' and 'time' items had the lowest values. CONCLUSIONS AND RELEVANCE TO CLINICAL NURSING: A new questionnaire with acceptable validity and reliability was created on the basis of an interview study examining patient encounters with the MCHL. The new questionnaire may provide useful support in the education of MCHL nurses and other nurses in telephone triage. It can also be used for quality development and as a basis for further research on telephone nursing.

Working together--primary care doctors' and nurses' attitudes to collaboration.

BACKGROUND: Multidisciplinary teamwork is recommended for various disorders and it has been suggested that it is a way to meet the new challenges and demands facing general practitioners (GPs) in modern society. Attempts to introduce the method in primary care have failed partly due to GPs' unwillingness to participate. The aim of this study was to measure attitudes towards collaboration among GPs and district nurses (DN) and to investigate whether there is a correlation between a positive attitude toward collaboration and high self-esteem in the professional role. METHODS: The Jefferson Scale of Attitudes toward Physician Nurse Collaboration and the Professional Self-Description Form (PSDF) was used to study a cohort of 600 GPs and DNs in Västra Götaland region. The purpose was to map differences and correlations of attitude between DNs and GPs, between male and female GPs, and between older and younger DNs and GPs. RESULTS: Four hundred and one answers were received. DNs (mean 51.7) were significantly more positive about collaboration than GPs (mean 49.4). There was no difference between younger and older, male and female GPs. DNs scored higher on the PSDF-scale than GPs. CONCLUSIONS: DNs were slightly more positive about collaboration than GPs. A positive attitude towards collaboration did not seem to be a part of the GPs' professional role to the same extent as it is for DNs. Professional norms seem to have more influence on attitudes than do gender roles. DNs seem more confident in their profession than GPs.

What makes the everyday life of Swedish adolescent girls less stressful: a qualitative analysis.

Stress is a widespread phenomenon in society today, not least among children and adolescents. Stress-related ill-health has increased in this population and affects girls to a greater extent than boys. Against this background, it is important to acquire knowledge about measures that prevent stress, especially in girls. The aim of this study was therefore to illuminate adolescent girls' experiences and reflections about what makes everyday life less stressful. An explorative design, qualitative content analysis, was used. In-depth interviews were conducted with fifteen 17-year-old girls. The analysis comprised both manifest and latent content and revealed the girls' own experiences of and reflections about what makes everyday life less stressful. Three categories, 'Enjoyment and Recovery', 'Trust' and 'Insight and Influence', and nine subcategories emerged. The latent content of these categories is described by the theme 'access to sources of strength'. It is essential that persons in the girls' surroundings are aware of all sources that provide the strength to resist and prevent stress in everyday life. A climate has to be created in all arenas of the girls' everyday life in which they can access these sources of strength. Utilizing the girls' experiences and views about what needs to be done is the first step towards a preventive and promotive mode of working on their own circumstances and wishes. This approach is consistent with the Ottawa Charter for Health Promotion, which emphasizes the importance of involving the target group.

Community pharmacy and primary health care in Sweden - at a crossroads.

The overall goal of Swedish health care is good health and equitable care for the whole population. The responsibility for health is shared by the central government, the regions, and the municipalities. Primary care accounts for approximately 20 percent of all expenditures on health care. About 16% of all physicians work in primary health. The regions have also employed a large number of clinical pharmacists, usually hospital-based, but many perform a variety of different primary care services, the most common of which is patient medication reviews. Swedish primary health care is at a crossroads facing extensive challenges, due to changes in demography and demanding financial conditions. These changes necessitate large transformations in health services and delivery. Current Government inquiries have primarily focused on two ways to meet the challenges; a shift towards more local care requiring a transfer of resources from hospital care, and a further development of structured digi-physical care, that is both digital ("online doctors") and physical accessibility of care. While primary care at present is undergoing processes of change, community pharmacy has done so during the past decade since the re-regulation of the Swedish pharmacy market. A monopoly was replaced by a competitive system, where five pharmacy chains now share most of the market, a competition that has made community pharmacy very commercialized. A number of different, promising primary care services are being offered, but they are usually delivered on a small scale due to a lack of remuneration and philosophy of providers. Priority is given to sales and fast dispensing of prescriptions, often with a minimum of counseling. Reflecting primary health care, community pharmacy in Sweden is at a crossroads but currently has a golden opportunity to choose a route of collaboration with primary health care in its current transformation into more local and digi-physical care. A major challenge is that primary health care inquires, strategic plans, and national policy documents usually do not include community pharmacy as a partner. Hence, community pharmacy have to be proactive and seize this chance of changes in primary health policy and organization in order to become an important link in the chain of health care delivery, or there is a significant risk that it will predominantly remain a retail business.

Callers' perceptions of receiving advice via a medical care help line.

BACKGROUND: Telephone consultations with specially trained nurses are becoming an increasingly common form of care. AIM: To describe patients' perceptions of receiving advice via a medical care help line. RESULTS: The patients perceived the help line as a professional, reliable and easily accessible asset in everyday life, that self-care is promoted through personal advice and that the help line is a partner with whom one can discuss reflections and feelings. It is also a kind of 'back up'. The advice service is perceived as satisfactory when the nurse is calm, friendly, confirming and shows respect. Compliance and acceptance are enhanced when patients feel involved in the decision-making process. The fact that the service is easily accessible is perceived as simple and time saving. CONCLUSIONS: Seen from the patient's perspective, the telephone contact with the help line is a simple, easily accessible and secure alternative that is appreciated and used. Caring encounters gave rise to feelings, influenced by the agreement between one's own needs and expectations, the encounter between human beings and the care provided. More in-depth studies is needed focusing on the patient's perspective and characterizes of the caring encounter over the telephone. RELEVANCE TO CLINICAL NURSING: Improved understanding of the patient's perspective on the care provided leads to increased staff satisfaction and motivation. Care encounters over the phone are common today for nurses and their well-being at work is beneficial for both themselves and the care they provide and thereby for the patients.