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Objective: To investigate whether one additional educational session about inhaler use, delivered to patients with COPD in primary healthcare, could affect the patients' skills in inhaler use. Specifically, to study the effects on errors related to handling the device, to inhalation technique, and to both. Methods: This nonrandomized controlled clinical trial included 64 patients who used devices and made errors. COPD nurses assessed inhaler use using a checklist and educated patients. Intervention group received one additional educational session after two weeks. Results: At baseline, patients in the IG had more devices (n = 2,1) compared to patients in the CG (n = 1,6) (p = 0.003). No other statistically significant differences were seen at baseline. At follow-up, intervention group showed a lower proportion of patients who made errors related to handling the device (p = 0.006). No differences were seen in the other categories. Conclusion: One additional educational session in inhaler use for patients with COPD was effective in reducing the proportion of patients making errors related to handling of their devices. Practice implications: Categorization of errors might help healthcare professionals to assess the suitability of patients' devices, tailor patient education, and thus improve patient health.

Aims and objective To investigate the effects on the quality of care of the Patient Report Informing Self-Management Support (PRISMS) form compared with usual care among patients with chronic obstructive pulmonary disease (COPD) consulting a COPD nurse in primary health care. Background Patients with COPD experience symptoms affecting their everyday lives, and there is a need for interventions in self-management support. The delivery of chronic care in an organised, structured and planned manner can lead to more productive relationships between professionals and patients. Design A multicentre randomised controlled trial with a post-test design, according to the CONSORT checklist, in one intervention group (n = 94) and one control group (n = 108). Methods In addition to usual care, the intervention group (n = 94) completed the PRISMS form to indicate areas where they wanted self-management support before the consultation with the COPD nurse. This form comprises 17 items that patients with COPD commonly experience as problems. The control group received usual care (n = 108). The primary outcome was patients' satisfaction with quality of care, assessed using the Quality from the Patient's Perspective (QPP) questionnaire. Means and (SD) are presented where applicable. Differences between the intervention and control group were analysed with Student's t test for independent groups for interval data, and the Mann-Whitney U test for ordinal data. Results Participants in the intervention group were more satisfied with the QPP domains "personal attention," regarding both "perceived reality" (p = .021) and "subjective importance" (p = .012). The PRISMS form revealed "shortness of breath" as the most commonly experienced problem and the issue most desired to discuss. Conclusion The PRISMS form improved patient satisfaction with quality of care regarding personal attention, which is an important factor in patient participation and improving relationships and communication. Relevance to clinical practice The PRISMS form can be a useful tool in improving person-centred care when delivering self-management support. Register id 192691 at http://www.researchweb.org/is/en/sverige/project/192691.

Lena Lundh,1,2 Kjell Larsson,3 Anders Lindén,4,5 Scott Montgomery,6– 8 Lena Palmberg,3 Hanna Sandelowsky1,2,7 1Academic Primary Health Care Centre, Stockholm County Council, Stockholm, Sweden; 2Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden; 3Division of Integrative Toxicology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; 4Division for Lung and Airway Research, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; 5Karolinska Severe COPD Center, Department of Respiratory Medicine and Allergy, Karolinska University Hospital Solna, Stockholm, Sweden; 6Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden; 7Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; 8Department of Epidemiology and Public Health, University College London, London, UKCorrespondence: Hanna Sandelowsky, Karolinska Institutet, Department of Medicine, Division of Clinical Epidemiology, Stockholm, SE-171 76, Sweden, Tel +46738902565, Email hanna.sandelowsky@ki.seBackground: To facilitate effective personalized medicine, primary health care needs better methods of assessing and monitoring chronic obstructive pulmonary disease (COPD).Aim: This cohort study aims to investigate how biomarkers relate to clinical characteristics and COPD patients’ subjective needs over time.Methods: Patients (n=750) in different COPD severity according to the GOLD criteria and age- and sex-matched controls (n=750) will be recruited over a period of 5 years from 15 primary health care centers in Region Stockholm, Sweden, and followed for 10 years in the first instance. Data on patients’ subjective needs will be collected via telephone/email, data on clinical/physiological variables (eg, symptoms, exacerbations, comorbidities, medications, smoking habits, lung function) from existing databases that are based on medical records, and data on biomarkers via repeated blood sampling. Quantitative and qualitative methods will be used. Initial results are expected after 2 years (feasibility test), and a larger body of evidence after 5 years.Discussion: The study is expected to provide definitive and clinically useful scientific evidence about how biomarkers relate to clinical variables and patients’ subjective needs. This new evidence will facilitate accurate, and personalized COPD management by the use of valid biomarkers. It will provide useful tools for primary care professionals and may facilitate optimal self-management.Keywords: airway inflammation, COPD, biomarkers, cohort, patients’ needs, personalized medicine, primary care

Introduction: To lose a person close suddenly, during childhood or adolescence, can be devastating. Many children or adolescents experienced the 2004 Indonesian tsunami when they were between 10- and 15-years-old. This study, from Stockholm, Sweden, describes the long-term effects of loss, eight- or nine-years post disaster, in young adulthood. Method: A mixed-method approach was used including statistical analyses (n = 210) and interpretative phenomenological analysis (IPA). Results: It was shown that there was a significant difference between bereaved (n=34) and nonbereaved (n = 176) respondents concerning, psychological distress, posttraumatic stress symptoms, and self-rated health. Three themes were found by using the IPA approach (n=9): Living in traumas, carrying heavy baggage, and living with change. Conclusion: The respondents described personal feelings of grief that are not expressed in their outward appearance or behavior in their daily living. When meeting young adults that have lost someone close in childhood or adolescence, this is important to have in mind. Funding: Kempe Carlgrenska fonden

Aim: The present study aimed to describe the experience of district nurses (DNs) in using a clinical decision support system (CDSS) and the safe medication assessment (SMA) tool during patient visits to elderly care units at primary health care centres. Background: In Swedish primary health care, general practitioners (GPs) prescribe and have the responsibility to regularly review older adults’ medications, while DN (nurses specialised in primary health care) play an important role in assessing older adults’ ability to manage their medications, detecting potential drug-related problems and communicating with patients and GPs about such problems. In a previous feasibility study, we found that DNs who use a combination of a CDSS and the SMA tool identified numerous potentially harmful or dangerous factors and took a number of nursing care actions to improve the safety and quality of patients’ medication use. In telephone interviews, patients indicated that they were positive towards the assessment and interventions. Methods: Individual interviews with seven DNs who worked at six different primary health care centres in Region Stockholm were carried out in 2018. In 2019, an additional group interview was conducted with two of the seven DNs so they could discuss and comment on preliminary findings. Qualitative content analysis was used to analyse the interview transcripts. Findings: Using the tools, the DNs could have a natural conversation about medication use with older adults. They could get a clear picture of the older adults’ medication use and thus obtain information that could facilitate collaboration with GPs about this important component of health care for older adults. However, for the tools to be used in clinical practice, some barriers would have to be overcome, such as the time-consuming nature of using the tools and the lack of established routines for interprofessional collaboration regarding medication discussions.

The Trying To Quit smoking questionnaire (TTQ), was developed to measure pressure-filled mental states, use of destructive pressure-relief strategies and ambivalent thoughts about quitting smoking among patients with COPD. The aim of this study was to evaluate whether the TTQ (available in an extended and in a reduced version) can be used to predict smoking cessation outcomes in smokers with COPD. As higher TTQ scores indicate higher degree of psychological distress, we hypothesised that TTQ scores at baseline would be negatively correlated with the probability of making a quit attempt, reducing the intensity of smoking and achieving complete abstinence during the 3 months. Smokers with COPD were recruited during planned or unplanned visits to primary healthcare centres, and 109 completed the TTQ at baseline and 85% participated in the follow-up after 3 months. Logistic regression was used to measure the association between the original (19 items) and the brief (14 item) version of TTQ scores and three outcomes: making at least one quit attempt, reducing the intensity of smoking and achieving complete abstinence. In a primary analysis among all the participants higher total score in the original version of TTQ was significantly associated with a lower probability of quit attempts. In a secondary analysis of subgroups of patients classified according to their readiness to quit, high TTQ scores at baseline were associated with lower probability of complete abstinence among patients not ready to quit (adjusted odds ratio (OR)=0.72; 95% confidence interval (CI)=0.53–0.99). Among patients ready to quit, high score on pressure-filled mental states was associated with lower probability of quit attempts (OR=0.78; 95% CI=0.66–0.94) but with higher probability of reduced smoking (OR=1.32; 95% CI=1.05–1.66). Ambivalent thoughts were associated with lower probability of all outcomes, but estimates were not statistically significant. Destructive coping strategies were inconsistently associated with the outcomes. TTQ in its original version and two of its subscales predicted smoking cessation outcomes in the anticipated direction. Therefore, this instrument may be useful in tailoring smoking cessation counselling for patients with COPD.

To investigate why some patients with chronic obstructive pulmonary disease (COPD) have difficulty quitting smoking and to develop a theoretical model that describes their perspectives on these difficulties.Grounded theory method was used from the selection of participants to the analyses of semi-structured interviews with 14 patients with COPD. Four additional interviews were conducted to ensure relevance.The analysis resulted in a theoretical model that illustrates the process of 'Patients with COPD trying to quit smoking'. The model illuminates factors related to the decision to try to quit smoking, including pressure-filled mental states and constructive or destructive pressure-relief strategies. The constructive strategies lead either to success in quitting or to continuing to try to quit. The destructive strategies can lead to losing hope and becoming resigned to continuing to smoke.The theoretical model 'Patients trying to quit smoking' contributes to a better understanding of the pressure-filled mental states and destructive strategies experienced by some patients with COPD in the process of trying to quit. This better understanding can help nurses individualise counselling. Moreover, patients' own awareness of these states and strategies may facilitate their efforts to quit. The information in the model can also be used as a supplement to methods such as motivational interviewing (MI).

Care of patients with chronic obstructive pulmonary disease in primary health care Aim. This paper is a report of a study of nurses' perceptions of caring for patients with chronic obstructive pulmonary disease. Background. Chronic obstructive pulmonary disease is a global health problem and the number of patients being treated with this disease in primary healthcare settings is increasing. This places new demands on the nurses involved. Method. A phenomenographic approach was adopted, using a purposive sample. Data were generated between February and May 2003 from 20 interviews with district nurses and general nurses who cared for patients in primary healthcare settings with chronic obstructive pulmonary disease. Findings. In most cases, nurses cared for older people with moderate to severe chronic obstructive pulmonary disease. They described this care from two overall orientations: task and individual. The nurses' perceptions of the care of these patients were described as creating commitment and participation by establishing a good relationship with patients and supporting them in their personal care, educating patients by supplying information and knowledge in various ways, co-operation by co-operating with or referring to other caregivers, and arranging and implementing clinical examinations and treatments. Conclusion. The type of care depended on who the patient met: either a task-oriented nurse or an individual-oriented nurse. Therefore, nursing programmes should pay special attention to the support and guidance of new and inexperienced and task-oriented nurses. Healthcare planners should take into consideration the need for individualized care when organizing care and allocating resources for chronically ill people.