Observational study of selective screening for prediabetes and diabetes in a real-world setting: an interprofessional collaboration method between public dental services and primary health care in Sweden.

OBJECTIVE: Describe a method in a real-world setting to identify persons with undiagnosed prediabetes and type 2 diabetes through an interprofessional collaboration between Public Dental Services and Primary Health Care in Regions Stockholm. DESIGN: A descriptive observational study. SETTING: The study was conducted at seven sites in the region of Stockholm, Sweden. Each collaborating site consisted of a primary health clinic and dental clinic. SUBJECTS: Study participants included adults over 18 years of age who visited the Public Dental Services and did not have a medical history of prediabetes or type 2 diabetes. MAIN OUTCOME MEASURES: Selective screening is conducted in accordance with a risk assessment protocol at the Public Dental Services. In the investigated method, DentDi (Dental and Diabetes), adults diagnosed with caries and/or periodontitis over a cut-off value are referred to the Primary Health Care clinic for screening of prediabetes and type 2 diabetes. RESULTS: DentDi, introduced at seven sites, between the years 2017 and 2020, all of which continue to use the method today. A total of 863 participants from the Public Dental Services were referred to the Primary Health Care. Of those 396 accepted the invitation to undergo screening at the primary health care centre. Twenty-four individuals did not meet the inclusion criteria, resulting in a total of 372 persons being included in the study. Among the 372 participants, 27% (101) had elevated glucose levels, of which 12 were diagnosed with type 2 diabetes and 89 with prediabetes according to the study classification. CONCLUSIONS: DentDi is a feasible method of interprofessional collaboration where each profession contributes with the competence included in everyday clinical practice for early identification of persons with prediabetes and type 2 diabetes with a complete chain of care. The goal is to disseminate this method throughout Stockholm County and even other regions in Sweden.

Type 2 diabetes and poor oral health have a bidirectional association. The number of persons with undetected prediabetes and type 2 diabetes is high and rising globally.Through collaboration between Public Dental Services and Primary Health Care we have developed a feasible and novel method of selectively screening for prediabetes and type 2 diabetes in a real-world setting.By utilizing everyday practice within each discipline, this method has been implemented at seven sites in Region Stockholm.From the original number of 863 participants referred from the Public Dental Services to Primary Health Care 396 attended the medical screening. After excluding 24 participants, a total of 372 participants underwent screening for prediabetes and type 2 diabetes.The results of this study showed that almost 30% who were screened for prediabetes and type 2 diabetes had elevated blood glucose levels.

Making prediabetes visible in primary health care: a qualitative study of health care professionals' perspectives.

BACKGROUND: People with prediabetes are at high risk of developing type 2 diabetes and its complications, such as cardiovascular diseases and premature mortality. Primary prevention and health maintenance are therefore imperative. Evidence has shown that prediabetes can be prevented or delayed with behavioural change, mainly in eating habits and physical activity. Interventions that use a person-centered approach can lead to improvements in self-management, quality of life, and health outcomes. Nevertheless, there is a need for further research that engages healthcare professionals and people with prediabetes in constructing and implementing preventive programs. The purpose of this study is to explore and describe how healthcare professionals perceive prediabetes, the current challenges in its detection and treatment, and what is needed to improve quality of care. METHODS: This qualitative study was conducted in Region Stockholm. A total of 26 primary health care professionals participated in individual interviews: 15 diabetes nurses and/or district nurses, five general practitioners, five dietitians, and one physiotherapist. Interview transcripts were analyzed with qualitative content analysis. RESULTS: The analysis revealed two main themes that emphasize the need to make prediabetes more visible in primary health care. Despite the healthcare professionals' engagement and their motivation to improve prediabetes care, ad hoc practices and the absence of clear screening guidelines and referral pathways made it harder to focus on primary prevention. Supporting professionals in implementing structured care for people with prediabetes might encourage more efficient interprofessional collaboration and contribute to better strategies for promoting behavioural change. CONCLUSIONS: Establishing prediabetes care guidelines, supporting health care professionals´ knowledge and skills in prediabetes care, and implementing interprofessional referral pathways are some steps to enhance prediabetes detection and care precedence in primary health care. These steps could lead to more preventive care and ensure patient safety and health care equity.

Improving the structure of diabetes care in primary care: A pilot study.

AIM: The aim of this pilot study was to determine whether glycemic control can be improved in patients with type 2 diabetes by implementing a workshop model to improve the structure of diabetes care at primary health care centers (PHCCs). METHODS: The intervention consisted of 4 workshops at 12 PHCCs with HbA1c >70 mmol/mol (high HbA1c). Each PHCC could choose how many workshops they wished to attend and was to be represented by the manager, a diabetes nurse, and a GP. Participants analyzed the structure of diabetes care at their PHCC and developed an action plan to improve it. The percentage of patients with high HbA1c at baseline, 12, and 24 months was collected. Qualitative content analysis was also conducted. RESULTS: All PHCCs reduced the percentage of patients with high HbA1c 12 months after the intervention, but not all maintained the reduction at 24 months. Participants experienced structuring diabetes care as central to reducing the percentage of patients with high HbA1c. Pillars of structured diabetes care included establishing routines, working in teams, and having and implementing an action plan. CONCLUSIONS: Working with the structure of diabetes care improved care structure and had a positive impact on HbA1c. To sustain the positive impact, PHCCs had to set long-term goals and regularly evaluate performance.

Impact of an educational intervention for district nurses about preparedness to encounter women exposed to intimate partner violence.

AIM: To evaluate the impact of an educational intervention on the preparedness of district nurses at primary healthcare centres to encounter women exposed to intimate partner violence. METHODOLOGICAL DESIGN: An observational quasi-experimental study. Participants were divided into an intervention group (n = 117) and a control group (n = 204), both from the eastern part of Sweden. A group of nurses from across Sweden (the 'national group,' n = 217) was also recruited. The Violence Against Women Health Care Provider Survey was used pre- and 1 year postintervention to measure the intervention's impact. This survey, which measured preparedness, included eight factors: practitioner preparedness, self-confidence, lack of control, comfort following disclosure, professional support, practice pressures, abuse inquiry and consequences of asking. anova, the paired Wilcoxon test, the Mann-Whitney U test and the Kruskal-Wallis test were used to analyse the data. FINDINGS: Pre-intervention preparedness was equal in all three groups. In the intervention group, preparedness related to the factor practitioner lack of control increased (p = 0.003), but a comparison of change between the intervention and control groups showed no significant intervention effect (p = 0.069). CONCLUSIONS: The results indicate that the intervention had a low impact on district nurses' preparedness. The educational intervention must be adjusted; a main focus of changes should be the addition of continuing postintervention supervision and support.

To ask, or not to ask: the hesitation process described by district nurses encountering women exposed to intimate partner violence.

AIMS AND OBJECTIVES: To improve the understanding of district nurses' experiences of encountering women exposed to intimate partner violence. BACKGROUND: Intimate partner violence is a public health issue that influences all aspects of affected women's lives; it is thus of great relevance to identify intimate partner violence. District nurses in primary health care in Sweden encounter women of all ages and are therefore in a unique position to identify intimate partner violence and provide nursing care. However, studies indicate that several barriers have kept nurses from identifying intimate partner violence. Consequently deeper understanding of district nurses' encounters with women exposed to intimate partner violence is needed. DESIGN: A qualitative study using grounded theory method. METHODS: Interviews with 11 district nurses in primary health care in Sweden. RESULTS: The hesitation process is central in these encounters. Several barriers to asking and factors that facilitated asking impacted the hesitation process. Under the influence of these factors, district nurses moved from being unaware that identifying intimate partner violence was their professional responsibility, to becoming ambivalent about asking, to starting to prepare themselves to ask about intimate partner violence. The presence of factors that facilitated asking finally made district nurses feel prepared, and then they decided to ask women about intimate partner violence. CONCLUSIONS: The concept of managing the hesitation process could be used to be incorporated in continuing education and training. Barriers and facilitators concerning organisational factors found in this study may be specific to the Swedish health care system, but the concept of the hesitation process is applicable in similar contexts and perhaps to other issues about which it is difficult to ask. RELEVANCE TO CLINICAL PRACTICE: This study illuminates the importance of a supportive work environment in reducing district nurses' hesitation to ask about intimate partner violence and to propose continuing education, training and supervision for district nurses regarding intimate partner violence.

Consultations between Immigrant Patients, Their Interpreters, and Their General Practitioners: Are They Real Meetings or Just Encounters? A Qualitative Study in Primary Health Care.

Objective. In Sweden, about 19% of residents have a foreign background. Previous studies reported immigrant patients experience communication difficulties despite the presence of interpreters during consultations. The objective of this study was to gain insights into the participants' perceptions and reflections of the triangular meeting by means of in-depth interviews with immigrant patients, interpreters, and general practitioners (GPs). Method. A total of 29 participants-10 patients, 9 interpreters, and 10 GPs-participated in face-to-face interviews. Content analysis was used to process the interview material. Results. Six themes were generated and arranged under two subject areas: the interpretation process (the means of interpreting and means of informing) and the meeting itself (individual tailored approaches, consultation time, the patient's feelings, and the role of family members). Conclusion. This paper highlights feelings including frustration and insecurity when interpretation and relationships are suboptimal. Strategies for immigrant patients, interpreters, and GPs for getting a successful consultation may be needed. To transform the triangular meeting from an encounter to a real meeting, our results indicate a need for professional interpreters, for GPs to use a patient-tailored approach, and sufficient consultation time. Practice Implications. Use of professional interpreters is recommended, as is developing cultural competence.

Cross-cultural adaptation of an intimate partner violence questionnaire.

The aim of this study was to describe the translation and the cross-cultural adaptation process of questionnaire about intimate partner violence (IPV). IPV is a serious threat to women's health. There is a need for instruments to measure the results of educational interventions. The Violence Against Women Health Care Provider Survey was found suitable for translation and adaptation to the Swedish cultural context. A five-step process according to Guillemin et al. was followed: (a) translation by independent translators, (b) back translation of each translation independently from each other, (c) committee review with multidisciplinary members produces the final version, and (d) pretesting to ensure equivalence between source and final version, and (e) weighting scores. The Swedish version consisted of the same number of items as the original. The results indicated that the questionnaire can be used in Sweden to measure the effectiveness of IPV training programs.

Nurses' preparedness to care for women exposed to Intimate Partner Violence: a quantitative study in primary health care.

BACKGROUND: Intimate partner violence (IPV) has a deep impact on women's health. Nurses working in primary health care need to be prepared to identify victims and offer appropriate interventions, since IPV is often seen in primary health care. The aim of the study was to assess nurses' preparedness to identify and provide nursing care to women exposed to IPV who attend primary health care. METHOD: Data was collected using a questionnaire to nurses at the primary health care centres. The response rate was 69.3%. Logistic regression analysis was used to test relationships among variables. RESULTS: Shortcomings were found regarding preparedness among nurses. They lacked organisational support e.g. guidelines, collaboration with others and knowledge regarding the extensiveness of IPV. Only half of them always asked women about violence and mostly when a woman was physically injured. They felt difficulties to know how to ask and if they identified violence they mostly offered the women a doctor's appointment. Feeling prepared was connected to obtaining knowledge by themselves and also to identifying women exposed to IPV. CONCLUSION: The majority of the nurses were found to be quiet unprepared to provide nursing care to women exposed to IPV. Consequences might be treatment of symptoms but unidentified abuse and more and unnecessary suffering for these women. Improvements are needed on both at the level of the organisation and individual.

A description of some aspects of the triangular meeting between immigrant patients, their interpreters and GPs in primary health care in Stockholm, Sweden.

BACKGROUND: Little is known about what immigrant patients, interpreters and GPs who have participated in the same consultation experience during these consultations or their reflections about these experiences. Previous studies have focused on the patient's, the interpreter's or the GP's perspective or a combination of two perspectives. OBJECTIVES: The first aim was to describe some aspects of each of the three perspectives in the triangular meeting between immigrant patients, interpreters and GPs, including their experiences, reflections and interactions during the consultation in primary health care. The second aim was to analyse patients' satisfaction with the consultation; whether satisfaction is influenced by respect for patients' culture, personality and wishes; and whether interpreters or GPs experience any ethical conflicts during the consultation. METHODS: Using questionnaires, all three categories were asked about their opinions regarding the communication, their experiences and reflections during the consultation and the patient's satisfaction. The interpreters and GPs were asked about ethical conflicts. RESULTS: Of the 182 respondents, 52 were patients, 65 GPs and 65 interpreters. A matched group of answers from patients, GPs and interpreters was present in 40 consultations. Eighteen of the patients experienced language difficulties. Twenty-six experienced respect for their culture; 32, respect for their personality; and 33, respect for their wishes. Ethical conflicts were rare. All three categories reported that the majority of patients were satisfied with the consultation. CONCLUSIONS: Professional interpreters are important for both a correct verbal and a cultural interpretation. Patient-centred communication is of key importance to a successful consultation.