Umeå University's logo

umu.sePublications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Clinical profile of rural community hospital inpatients in Sweden: a register study
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine. (Arcum)ORCID iD: 0000-0002-0350-2132
Umeå University, Faculty of Medicine, Department of Nursing. (Arcum)
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.ORCID iD: 0000-0002-1617-6102
2021 (English)In: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 39, no 1, p. 92-100Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Patients in Sweden's rural community hospitals have not been clinically characterised. We compared characteristics of patients in general practitioner-led community hospitals in northern Sweden with those admitted to general hospitals.

DESIGN: Retrospective register study.

SETTING: Community and general hospitals in Västerbotten and Norrbotten counties, Sweden.

PATIENTS: Patients enrolled at community hospitals and hospitalised in community and general hospitals between 1 January 2010 and 31 December 2014.

OUTCOME MEASURES: Age, sex, number of admissions, main, secondary and total number of diagnoses.

RESULTS: We recorded 16,133 admissions to community hospitals and 60,704 admissions to general hospitals. Mean age was 76.8 and 61.2 years for community and general hospital patients (p < .001). Women were more likely than men to be admitted to a community hospital after age adjustment (odds ratio (OR): 1.11; 95% confidence interval (CI): 1.09-1.17). The most common diagnoses in community hospital were heart failure (6%) and pneumonia (5%). Patients with these diagnoses were more likely to be admitted to a community than a general hospital (OR: 2.36; 95% CI: 2.15-2.59; vs. OR: 3.32: 95% CI: 2.77-3.98, respectively, adjusted for age and sex). In both community and general hospitals, doctors assigned more diagnoses to men than to women (both p<.001).

CONCLUSIONS: Patients at community hospitals were predominantly older and women, while men were assigned more diagnoses. The most common diagnoses were heart failure and pneumonia. Our observed differences should be further explored to define the optimal care for patients in community and general hospitals.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2021. Vol. 39, no 1, p. 92-100
Keywords [en]
Rural health service, geriatrics, health services for the aged, health services research, hospital, inpatient, rural
National Category
Nursing
Identifiers
URN: urn:nbn:se:umu:diva-180124DOI: 10.1080/02813432.2021.1882086ISI: 000617184000001PubMedID: 33569976Scopus ID: 2-s2.0-85100975798OAI: oai:DiVA.org:umu-180124DiVA, id: diva2:1528317
Available from: 2021-02-15 Created: 2021-02-15 Last updated: 2024-02-05Bibliographically approved
In thesis
1. The community hospital model in northern Sweden
Open this publication in new window or tab >>The community hospital model in northern Sweden
2024 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Sjukstugemodellen i norra Sverige
Abstract [en]

Background: Rural community hospitals (CHs) are vital in delivering healthcare services in sparsely populated regions such as northern Sweden. In Sweden these facilities act as primary care units, staffed by general practitioners (GPs), nurses, and other healthcare professionals. They provide hospital beds, emergency care, and basic diagnostics. The CH model, with GPs responsible for hospital care has not been studied earlier in Sweden. 

Aims: This thesis aimed to examine the role and practices of the Swedish rural CH model within the healthcare system and the local community. Furthermore, to investigate the perspectives of rural doctors in Sweden and New Zealand (NZ) working within their respective hospital models. Specific aims: 

To characterise patients admitted to hospitals in Norrbotten and Västerbotten Regions and to compare hospitalisations at rural community hospitals and general hospitals (Study I)

To describe registered care measures carried out in rural community hospitals during episodes of hospital care for patients with heart failure, in comparison with a general hospital (Study II)

To explore rural hospital doctors’ experiences of providing care in rural hospitals in Southern New Zealand (Study III)

To explore rural general practitioners’ experiences of providing care in rural community hospitals in northern Sweden (Study IV) 

Methods and results: Four original papers form the basis of this thesis. In study I, hospital register data from Norr- and Västerbotten Regions were analysed, focusing on hospital admissions of patients enrolled at CHs 2010-2014. We compared CH admissions with general hospital admissions, examining factors such as age, sex, and diagnoses. CH patients were older than those in general hospitals (median age 80 vs. 68 years), and women had a higher likelihood of admission to CHs compared to men. Common diagnoses in the elderly, such as heart failure and pneumonia were more likely admitted to CHs than to general hospitals. Study II utilized hospital register data from Region Västerbotten to describe registered care measures carried out in rural CHs during episodes of hospital care for patients with heart failure 2015-2019, in comparison with a general hospital. CHs showed documentations by fewer individual doctors, more frequent nursing documentation, and fewer blood tests compared to general hospitals. Radiology, including echocardiography, was performed in general hospitals only but in a minority of cases. Documentation by physiotherapists, occupational therapists, and dietitians was limited in both hospital models.

Studies III and IV involved interviews with rural hospital (RH) doctors in New Zealand (NZ), and rural GPs in northern Sweden, respectively, to explore the role of their RH/CH. In both countries, doctors emphasised advantages with proximity and holistic, patient-centred care for elderly, multimorbid, and end-of-life patients. Their RHs/CHs were described to play a central role in rural patients' healthcare journeys, utilizing small, multidisciplinary teams and collaborating with general hospitals and municipal caregivers. Reported challenges for doctors in RHs and CHs included limited resources and inexperience in handling life-threatening, rare cases, and ethical dilemmas unique to rural practice. Despite this, RH doctors considered RH patient safety similar or better than that in general hospitals. CH doctors prompted the idea of expanding the CH model to urban areas. 

Conclusion: We conclude that CHs admit elderly and multimorbid patients elsewhere common in general hospitals. Care for patients with heart failure at CHs showed more nursing notes, greater doctor continuity, and less biomedical examinations. Our results suggest potential for further development in the multidisciplinary care in both hospital models. Rural generalist doctors in Sweden and NZ emphasise the central role of CHs/RHs, their proximity to patients, and their holistic, generalist approach, and they suggest advantages in the RH/CH care for the elderly compared to general hospitals. In Sweden, the importance of relational continuity was stressed, as rural GPs are familiar with their CH patients from primary care. 

Place, publisher, year, edition, pages
Umeå: Umeå University, 2024. p. 73
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 2284
Keywords
Rural health service, health services research, hospital, rural, inpatient, health services for the aged, geriatrics, generalist medicine
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
family medicine; Geriatrics; health services research
Identifiers
urn:nbn:se:umu:diva-220351 (URN)9789180702850 (ISBN)9789180702867 (ISBN)
Public defence
2024-03-01, Triple Helix, Samverkanshuset, Universitetstorget 4, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2024-02-09 Created: 2024-02-05 Last updated: 2024-02-05Bibliographically approved

Open Access in DiVA

fulltext(1183 kB)178 downloads
File information
File name FULLTEXT02.pdfFile size 1183 kBChecksum SHA-512
e49d85361f5a55569c54c976c1c7729cfc80b1e2063fb1ad9332e031e101251a69d6db273b8a6a34106ce6ed480f66ebcae2184ed89a9e592ec5925bae634d36
Type fulltextMimetype application/pdf

Other links

Publisher's full textPubMedScopus

Authority records

Hedman, ManteBoman, KurtBrännström, MargaretaWennberg, Patrik

Search in DiVA

By author/editor
Hedman, ManteBoman, KurtBrännström, MargaretaWennberg, Patrik
By organisation
Family MedicineSection of MedicineDepartment of Nursing
In the same journal
Scandinavian Journal of Primary Health Care
Nursing

Search outside of DiVA

GoogleGoogle Scholar
Total: 189 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

doi
pubmed
urn-nbn

Altmetric score

doi
pubmed
urn-nbn
Total: 357 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf