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High Blood Cholesterol. Physician and Patient Perspectives.

Troein, Margareta LU (1996)
Abstract (Swedish)
Popular Abstract in Swedish

De vetenskapliga bevisen för att högt blodkolesterol ökar risken för hjärtinfarkt medförde under 80-talet stort intresse för kolesterolsänkning både inom sjukvården och bland allmänheten. Syftet med avhandlingsarbetet var att studera hur läkare och patienter uppfattade och använde kunskaperna om högt blodkolesterol, och hur läkare och receptarier värderade sin egen och den andra yrkesgruppens kompetens i fråga om kolesterolbehandling. Svenska distriktsläkare uppgav att de tillämpade högre blodkolesterolnivåer som gräns för behandling, än vad som angavs i svenska riktlinjer. Läkarna använde oftast riktlinjerna från Socialstyrelsen när de behövde referenslitteratur för beslutsfattande, och de som... (More)
Popular Abstract in Swedish

De vetenskapliga bevisen för att högt blodkolesterol ökar risken för hjärtinfarkt medförde under 80-talet stort intresse för kolesterolsänkning både inom sjukvården och bland allmänheten. Syftet med avhandlingsarbetet var att studera hur läkare och patienter uppfattade och använde kunskaperna om högt blodkolesterol, och hur läkare och receptarier värderade sin egen och den andra yrkesgruppens kompetens i fråga om kolesterolbehandling. Svenska distriktsläkare uppgav att de tillämpade högre blodkolesterolnivåer som gräns för behandling, än vad som angavs i svenska riktlinjer. Läkarna använde oftast riktlinjerna från Socialstyrelsen när de behövde referenslitteratur för beslutsfattande, och de som använde dessa riktlinjer tillämpade lägre kolesterolgränser för behandling än de som inte hänvisade till dem. I en jämförelse med allmänläkare i Minnesota visade sig svenska distriksläkare använda högre gränser än de amerikanska läkarna, och läkemedelsvalet skilde sig också åt. Läkare i Malmö ansåg inte att receptarier var kompetenta att informera patienter om effekter av läkemedelsbehandling för höga blodfetter eller att ge råd om livsstilsförändringar. Av distriktsläkare utvald, tryckt patientinformation om livsstilsförändringar vid högt blodkolesterol innehöll många exempel på faktainformation, men tog sällan upp frågor om att anpassa nya vanor till det dagliga livet. Överhuvudtaget var informationsmaterialet inte anpassat till att människor har olika sätt att tänka och lära sig, och det fanns få exempel på information som underlättade människors egna val. Hos medelålders män, som genomgick en hälsoundersökning, fanns det samband mellan förhållningssätt till hälsa (health beliefs), tidigare sjukhistoria och livsstil. Män med nyupptäckt högt blodkolesterol uttryckte att det var svårt att förstå en hälsorisk, som inte ger några asymtom, och som varken syns på kroppsvikten eller på matvanorna. De ifrågasatte också den ständigt skiftande informationen i massmedia och om effekterna av livsstilsförändringarna var värda besväret. Det finns behov av vidareutveckling av metoderna för information dels till läkare, dels till patienter, för att nya vetenskapliga rön ska kunna få genomslagskraft i läkarens vardagspraktik och i patientens vardagsliv. (Less)
Abstract
Scientific evidence of the causal relationship between high blood cholesterol and risk for coronary heart disease prompted extensive professional and public interest in practical application in the 1980's. Among other things, national guidelines for lipid lowering were published in Sweden in 1988. Mass media covered the topic extensively. The aims of this study were to analyze aspects of physician and patient interpretations and uses of knowledge of hypercholesterolemia and aspects of physician and pharmacist mutual appraisals of competence for treatment of hypercholesterolemia. Swedish family physicians reported applying higher cut-off levels for treatment of hypercholesterolemia than advised in their guidelines. For reference, physicians... (More)
Scientific evidence of the causal relationship between high blood cholesterol and risk for coronary heart disease prompted extensive professional and public interest in practical application in the 1980's. Among other things, national guidelines for lipid lowering were published in Sweden in 1988. Mass media covered the topic extensively. The aims of this study were to analyze aspects of physician and patient interpretations and uses of knowledge of hypercholesterolemia and aspects of physician and pharmacist mutual appraisals of competence for treatment of hypercholesterolemia. Swedish family physicians reported applying higher cut-off levels for treatment of hypercholesterolemia than advised in their guidelines. For reference, physicians mainly used such guidelines, and those who mentioned the guidelines reported applying lower cut-off levels. In comparison with Minnesota family physicians, Swedish physicians applied higher cut-off levels for treatment of hypercholesterolemia, and drug preferences differed. This was partly reflected in differences in national guidelines. Physicians lacked confidence in pharmacists' competence in patient counseling for hypercholesterolemia. Both physicians and pharmacists reported the need for continuing education, including skills for patient counseling. Printed patient education material concerning treatment of hypercholesterolemia, selected by physicians, contained many examples of plain facts, but rarely addressed the practical implementation of new habits in everyday life. In general, the information was not related to individual orientation of knowledge and social life-styles, and did not give a foundation for the patient to judge the information individually. Middle-aged urban men, invited to a screening for risk factors for coronary heart disease, demonstrated correlations between health beliefs, previous health related experiences and risk behavior. Men with recently discovered hypercholesterolemia expressed difficulties in understanding the condition as it is non-symptomatic, and can not be identified by body weight or dietary habits. They also questioned the information in media, since it changed frequently, and whether the benefits of life-style changes would be worthwhile. In conclusion, new educational methods are required to improve the dissemination and implementation of scientific achievement in physicians' everyday practice and patients' everyday life. (Less)
Please use this url to cite or link to this publication:
author
opponent
  • Associate Professor Mattsson, Bengt, Department of Family Medicine, University of Umeå, Norrland's University Hospital, S-901 89 UMEÅ, Sweden
organization
publishing date
type
Thesis
publication status
published
subject
keywords
qualitative method, practice guideline, pharmacist, life-style, information, hypercholesterolemia, health education, health belief, framework, family physician, family medicine, Cholesterol, counseling, screening, Social medicine, Socialmedicin, samhällsmedicin
pages
143 pages
publisher
Department of Community Medicine, Malmö University Hospital
defense location
Aulan, Medicinskt Forskningscentrum, Malmö University Hospital, Malmö
defense date
1996-04-25 13:15
external identifiers
  • Other:ISRN: LUMEDW/MESO--1015--SE
ISBN
91-628-1980-1
language
English
LU publication?
yes
id
eb9b17e2-d1a3-4707-9ec1-5661825dd353 (old id 28283)
date added to LUP
2007-06-11 11:29:35
date last changed
2016-09-19 08:45:14
@misc{eb9b17e2-d1a3-4707-9ec1-5661825dd353,
  abstract     = {Scientific evidence of the causal relationship between high blood cholesterol and risk for coronary heart disease prompted extensive professional and public interest in practical application in the 1980's. Among other things, national guidelines for lipid lowering were published in Sweden in 1988. Mass media covered the topic extensively. The aims of this study were to analyze aspects of physician and patient interpretations and uses of knowledge of hypercholesterolemia and aspects of physician and pharmacist mutual appraisals of competence for treatment of hypercholesterolemia. Swedish family physicians reported applying higher cut-off levels for treatment of hypercholesterolemia than advised in their guidelines. For reference, physicians mainly used such guidelines, and those who mentioned the guidelines reported applying lower cut-off levels. In comparison with Minnesota family physicians, Swedish physicians applied higher cut-off levels for treatment of hypercholesterolemia, and drug preferences differed. This was partly reflected in differences in national guidelines. Physicians lacked confidence in pharmacists' competence in patient counseling for hypercholesterolemia. Both physicians and pharmacists reported the need for continuing education, including skills for patient counseling. Printed patient education material concerning treatment of hypercholesterolemia, selected by physicians, contained many examples of plain facts, but rarely addressed the practical implementation of new habits in everyday life. In general, the information was not related to individual orientation of knowledge and social life-styles, and did not give a foundation for the patient to judge the information individually. Middle-aged urban men, invited to a screening for risk factors for coronary heart disease, demonstrated correlations between health beliefs, previous health related experiences and risk behavior. Men with recently discovered hypercholesterolemia expressed difficulties in understanding the condition as it is non-symptomatic, and can not be identified by body weight or dietary habits. They also questioned the information in media, since it changed frequently, and whether the benefits of life-style changes would be worthwhile. In conclusion, new educational methods are required to improve the dissemination and implementation of scientific achievement in physicians' everyday practice and patients' everyday life.},
  author       = {Troein, Margareta},
  isbn         = {91-628-1980-1},
  keyword      = {qualitative method,practice guideline,pharmacist,life-style,information,hypercholesterolemia,health education,health belief,framework,family physician,family medicine,Cholesterol,counseling,screening,Social medicine,Socialmedicin,samhällsmedicin},
  language     = {eng},
  pages        = {143},
  publisher    = {ARRAY(0x83d00e0)},
  title        = {High Blood Cholesterol. Physician and Patient Perspectives.},
  year         = {1996},
}