Publications
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Bårdsgjerde, Elise Kvalsund; Kvangarsnes, Marit; Landstad, Bodil Johanne; Hole, Torstein Laurits & Nylenna, Magne
(2024).
A Comprehensive Model for Patient Participation.
In Hole, Torstein Laurits; Kvangarsnes, Marit; Landstad, Bodil Johanne; Bårdsgjerde, Elise Kvalsund & Tippett-Spirtou, Sandra Elizabeth (Ed.),
Towards Sustainable Good Health and Well-being: The Role of Health Literacy.
Springer Publishing Company.
ISSN 9783031618109.
p. 21–46.
doi:
10.1007/978-3-031-61810-9_2.
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Bårdsgjerde, Elise Kvalsund; Landstad, Bodil Johanne; Kvangarsnes, Marit; Nylenna, Magne & Hole, Torstein Laurits
(2024).
Building Health Literacy: Health Professionals’ Experiences in the Myocardial Infarction Pathway.
In Hole, Torstein Laurits; Kvangarsnes, Marit; Landstad, Bodil Johanne; Bårdsgjerde, Elise Kvalsund & Tippett-Spirtou, Sandra Elizabeth (Ed.),
Towards Sustainable Good Health and Well-being: The Role of Health Literacy.
Springer Publishing Company.
ISSN 9783031618109.
p. 119–134.
doi:
10.1007/978-3-031-61810-9_7.
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Kraft, Kristian Bandlien; Hoff, Eivor Hovde; Nylenna, Magne; Moe, Cathrine Fredriksen; Mykletun, Arnstein & Østby, Kristian Amundsen
(2024).
Time is money: general practitioners’ reflections on the fee-for-service system.
BMC Health Services Research.
24(1).
doi:
10.1186/s12913-024-10968-3.
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Background Fee-for-service is a common payment model for remunerating general practitioners (GPs) in OECD countries. In Norway, GPs earn two-thirds of their income through fee-for-service, which is determined by the number of consultations and procedures they register as fees. In general, fee-for-service incentivises many and short consultations and is associated with high service provision. GPs act as gatekeepers for various treatments and interventions, such as addictive drugs, antibiotics, referrals, and sickness certification. This study aims to explore GPs’ reflections on and perceptions of the fee-for-service system, with a specific focus on its potential impact on gatekeeping decisions.<p> <p>Methods We conducted six focus group interviews with 33 GPs in 2022 in Norway. We analysed the data using thematic analysis.<p> <p>Results We identified three main themes related to GPs’ reflections and perceptions of the fee-for-service system. First, the participants were aware of the profitiability of different fees and described potential strategies to increase their income, such as having shorter consultations or performing routine procedures on all patients. Second, the participants acknowledged that the fees might influence GP behaviour. Two perspectives on the fees were present in the discussions: fees as incentives and fees as compensation. The participants reported that financial incentives were not directly decisive in gatekeeping decisions, but that rejecting requests required substantially more time compared to granting them. Consequently, time constraints may contribute to GPs’ decisions to grant patient requests even when the requests are deemed unreasonable. Last, the participants reported challenges with remembering and interpreting fees, especially complex fees. <p>Conclusions GPs are aware of the profitability within the fee-for-service system, believe that fee-for-service may influence their decision-making, and face challenges with remembering and interpreting certain fees. Furthermore, the fee-for-service system can potentially affect GPs’ gatekeeping decisions by incentivising shorter consultations, which may result in increased consultations with inadequate time to reject unnecessary treatments.
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Hoff, Eivor Hovde; Kraft, Kristian Bandlien; Moe, Cathrine Fredriksen; Nylenna, Magne; Østby, Kristian Amundsen & Mykletun, Arnstein
(2024).
The cost of saying no: general practitioners’ gatekeeping role in sickness absence certification.
BMC Public Health.
24(1).
doi:
10.1186/s12889-024-17993-1.
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Background General practitioners (GPs) have an important gatekeeping role in the Norwegian sickness insurance system. This role includes limiting access to paid sick leave when this is not justified according to sick leave criteria. 85% of GPs in Norway operate within a fee-for-service system that incentivises short consultations and high service provision. In this qualitative study, we explore how GPs practise the gatekeeping role in sickness absence certification.<p> <p>Methods Qualitative data was collected through six focus group interviews with 33 GPs, working in practices with a minimum of four practising GPs, in different geographical regions across Norway, including both urban and rural areas. Data was analysed using Braune and Clarke’s thematic analysis approach. <p>Results Our results indicate that GPs’ sick-listing decisions are largely driven by patient demand and preferences for sick leave. GPs reported that they rarely overrule patient requests for sickness absence, including in cases where such requests conflict with the GPs’ opinion of whether sick leave is justified or benefits the patient. The degree of effort made to limit unjustified or non-beneficial sick leave seems to depend on the GPs’ available time and perceived risk of conflict with the patient. GPs generally expressed dissatisfaction with their role as certifiers of sickness absence. <p>Conclusion Our study suggests that GPs’ decisions about sickness certification is largely driven by patient preferences. The GPs’ gatekeeping function is limited to negotiations about grade and duration of absence spells.
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Hem, Erlend; Nylenna, Magne & Larsen, Øivind
(2023).
Pasientjournalens mange roller.
Michael.
ISSN 1893-9651.
20,
p. 11–30.
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Kapittel i boka Nylenna M, Hem E. Husom N. red. Pasientjournalen. Michael 2023; 20: Supplement 31.
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Nordfalk, Jenny Maria; Holmøy, Trygve; Thomas, Owen Matthew Truscott; Nylenna, Magne & Gulbrandsen, Pål
(2022).
Training physicians in providing complex information to patients with multiple sclerosis: a randomised controlled trial.
BMJ Open.
12(3).
doi:
10.1136/bmjopen-2021-049817.
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Objective To evaluate the effect of a specific communication training for neurologists on how to provide complex information about treatment options to patients with multiple sclerosis (MS). Design Single-centre, single-blind, randomised controlled trial. Setting One university hospital in Norway. Participants Thirty-four patients with early-stage MS. Intervention A 3-hour training for neurologists on how to provide complex information about MS escalation therapy. Main outcome measures Patient recall rate, measured with a reliable counting system of provided and recalled information about drugs. Secondary outcome measures Number of information units provided by the physicians. Effects on patient involvement through questionnaires. Methods Patients with MS were instructed to imagine a disease development and were randomised and blinded to meet a physician to receive information on escalation therapy, before or after the physician had participated in a 3-hour training on how to provide complex information. Consultations and immediate patient recall interviews were video-recorded and transcribed verbatim. Results Patient recall rate was 0.37 (SD=0.10) pre-intervention and 0.39 (SD=0.10) post-intervention. The effect of the intervention on recall rate predicted with a general linear model covariate was not significant (coefficient parameter 0.07 (SE 0.04, 95% CI (−0.01 to 0.15)), p=0.099). The physicians tended to provide significantly fewer information units after the training, with an average of 91.0 (SD=30.3) pre-intervention and 76.5 (SD=17.4) post-intervention; coefficient parameter −0.09 (SE 0.02, 95% CI (−0.13 to −0.05)), p<0.001. There was a significant negative association between the amount of provided information and the recall rate (coefficient parameter −0.29 (SE 0.05, 95% CI (−0.39 to −0.18)), p<0.001). We found no significant effects on patient involvement using the Control Preference Scale, Collaborate or Four Habits Patient Questionnaire. Conclusion A brief course for physicians on providing complex information reduced the amount of information provided, but did not improve patient recall rate. Trial registration number ISRCTN42739508.
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Clarsen, Benjamin Matthew; Nylenna, Magne; Klitkou, Søren Toksvig; Vollset, Stein Emil; Baravelli, Carl Michael & Bølling, Anette Kocbach
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(2022).
Changes in life expectancy and disease burden in Norway, 1990–2019: an analysis of the Global Burden of Disease Study 2019.
The Lancet Public Health.
ISSN 2468-2667.
7(7),
p. e593–e605.
doi:
10.1016/S2468-2667(22)00092-5.
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Background: Geographical differences in health outcomes are reported in many countries. Norway has led an active policy aiming for regional balance since the 1970s. Using data from the Global Burden of Disease Study (GBD) 2019, we examined regional differences in development and current state of health across Norwegian counties.
Methods: Data for life expectancy, healthy life expectancy (HALE), years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) in Norway and its 11 counties from 1990 to 2019 were extracted from GBD 2019. County-specific contributors to changes in life expectancy were compared. Inequality in disease burden was examined by use of the Gini coefficient.
Findings: Life expectancy and HALE improved in all Norwegian counties from 1990 to 2019. Improvements in life expectancy and HALE were greatest in the two counties with the lowest values in 1990: Oslo, in which life expectancy and HALE increased from 71·9 years (95% uncertainty interval 71·4-72·4) and 63·0 years (60·5-65·4) in 1990 to 81·3 years (80·0-82·7) and 70·6 years (67·4-73·6) in 2019, respectively; and Troms og Finnmark, in which life expectancy and HALE increased from 71·9 years (71·5-72·4) and 63·5 years (60·9-65·6) in 1990 to 80·3 years (79·4-81·2) and 70·0 years (66·8-72·2) in 2019, respectively. Increased life expectancy was mainly due to reductions in cardiovascular disease, neoplasms, and respiratory infections. No significant differences between the national YLD or DALY rates and the corresponding age-standardised rates were reported in any of the counties in 2019; however, Troms og Finnmark had a higher age-standardised YLL rate than the national rate (8394 per 100 000 [95% UI 7801-8944] vs 7536 per 100 000 [7391-7691]). Low inequality between counties was shown for life expectancy, HALE, all level-1 causes of DALYs, and exposure to level-1 risk factors.
Interpretation: Over the past 30 years, Norway has reduced inequality in disease burden between counties. However, inequalities still exist at a within-county level and along other sociodemographic gradients. Because of insufficient Norwegian primary data, there remains substantial uncertainty associated with regional estimates for non-fatal disease burden and exposure to risk factors.
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Bårdsgjerde, Elise Kvalsund; Kvangarsnes, Marit; Hole, Torstein Laurits; Nylenna, Magne & Landstad, Bodil
(2022).
Physicians’ perceptions of patient participation in the myocardial infarction pathway.
Communication & Medicine. An Interdisciplinary Journal of Healthcare, Ethics and Society.
ISSN 1612-1783.
18(2),
p. 111–125.
doi:
10.1558/cam.20555.
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Myocardial infarction is an acute, frightening and life-threatening condition for patients who are affected. They need plain and simple information about the disease and the treatment, yet patient participation might be challenging in acute situations. Previous studies have shown that patient participation leads to improved patient satisfaction, cooperation with healthcare professionals and better management of the disease. Physicians have a key role in facilitating patient participation in the healthcare services. This study explores physicians’ perceptions of patient participation in the myocardial infarction pathway. In 2018 we interviewed nine experienced physicians in Norway working in different phases of the pathway. Hermeneutics was chosen as the underpinning analytical framework. Four themes illustrated patient participation in the myocardial infarction pathway. Paternalism characterised the acute phase. During hospitalisation the physicians perceived a lack of continuity in physician–patient communication. In the discharge phase, the physicians focused on strengthening health literacy. In the rehabilitation phase, dialogue and shared decision making was central to achieving treatment adherence. We found variations in the level of patient participation along the different phases of the myocardial infarction pathway. Strengthening continuity to ensure patient participation and collaboration between healthcare professionals is essential. The physicians proposed introducing checklists for patient information to enhance interprofessional collaboration and strengthen patient participation.
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Rostadmo, Martine; Strømme, Siri Lunde; Nylenna, Magne; Gulbrandsen, Pål; Hem, Erlend & Skovlund, Eva
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(2021).
How well do doctors understand a scientific article in English when it is not their first language? A randomised controlled trial.
BMJ Open.
11(6),
p. 1–5.
doi:
10.1136/bmjopen-2020-043444.
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Introduction English is the lingua franca of science. How well doctors understand English is therefore crucial for their understanding of scientific articles. However, only 5% of the world’s population have English as their first language. Methods Objectives: To compare doctors’ comprehension of a scientific article when read in their first language (Norwegian) versus their second language (English). Our hypothesis was that doctors reading the article in Norwegian would comprehend the content better than those reading it in English. Design: Parallel group randomised controlled trial. We randomised doctors to read the same clinical review article in either Norwegian or English, before completing a questionnaire about the content of the article. Setting: Conference in primary care medicine in Norway, 2018. Participants: 130 native Norwegian-speaking doctors, 71 women and 59 men. One participant withdrew before responding to the questionnaire and was excluded from the analyses. Interventions: Participants were randomly assigned to read a review article in either Norwegian (n=64) or English (n=66). Reading time was limited to 7 min followed by 7 min to answer a questionnaire. Main outcome measures: Total score on questions related to the article content (potential range −9 to 20). Results Doctors who read the article in Norwegian had a mean total score of 10.40 (SD 3.96) compared with 9.08 (SD 3.47) among doctors who read the article in English, giving a mean difference of 1.32 (95% CI 0.03 to 2.62; p=0.046). Age was independently associated with total score, with decreased comprehension with increasing age. Conclusion The difference in comprehension between the group who read in Norwegian and the group who read in English was statistically significant but modest, suggesting that the language gap in academia is possible to overcome.
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Karlsen, Anniken Th; Sørbø, Marie Flem & Nylenna, Magne
(2020).
Digitale helsetjenester: nye muligheter, nye utfordringer.
In Landstad, Bodil; Kvangarsnes, Marit; Hole, Torstein & Nylenna, Magne (Ed.),
Brukermedvirkning i helsetjenesten - realitet eller retorikk?.
Det norske medicinske Selskab.
ISSN 9788292871805.
p. 155–163.
doi:
https:/www.michaeljournal.no/article/2020/08/Digitale-helsetjenester--nye-muligheter,-nye-utfordringer.
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En aldrende befolkning, økning i kroniske og sammensatte lidelser og økt etterspørsel etter helse- og omsorgstjenester, fordrer nye tjenestetilbud. Mer bruk av datateknologi er åpenbart en del av løsningen. Økt brukermedvirkning er både en driver bak og en konsekvens av mer digitaliserte helsetjenester. Ny teknologi øker mulighetene for egenomsorg, men medfører også økt ansvar for egen utredning og behandling. For noen pasienter oppleves dette som belastende og vanskelig, og som et press til å ta vanskelige valg alene. Også retten til å begrense medvirkningen må ivaretas i den framtidige helsetjenesten.
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Nylenna, Magne
(2020).
Fra lydighet til likeverd - pasientmedvirkning i et historisk og helsepolitisk perspektiv.
In Landstad, Bodil; Kvangarsnes, Marit; Hole, Torstein & Nylenna, Magne (Ed.),
Brukermedvirkning i helsetjenesten - realitet eller retorikk?.
Det norske medicinske Selskab.
ISSN 9788292871805.
p. 15–42.
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I dag er det enighet om at pasientmedvirkning sikrer enkeltpersoners autonomi og rettigheter, og er et middel til kvalitetssikring og utvikling av helsetjenesten. Slik har det ikke alltid vært. Opprinnelig var pasientene passive mottakere av helsehjelp. Prosessen fram mot å etablere aktiv pasientmedvirkning begynte etter den andre verdenskrig. Gjennombruddet kom på 1980- og 1990-tallet. Da endret synet på relasjonen mellom pasient og behandler seg radikalt, og en rekke formelle pasientrettigheter ble innført. I tillegg til endringene på individnivå ble erstatnings- og ombudsordninger, brukerutvalg og andre strukturelle tiltak etablert. Pasienter ble bevisste brukere av helsetjenester med forventninger til tilgjengelighet, valgfrihet og medbestemmelse. De sterkeste drivkreftene for endringene har så langt vært samfunnsutviklingen med demokratisering, internasjonalisering og økt utdanningsnivå i befolkningen. Vil framtidens pasientmedvirkning i høyere grad preges av den teknologiske utvikling?
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Bårdsgjerde, Elise Kvalsund; Landstad, Bodil; Hole, Torstein; Nylenna, Magne; Gjeilo, Kari Hanne & Kvangarsnes, Marit
(2020).
Nurses' perceptions of patient participation in the myocardial infarction pathway.
Nursing Open.
7(5),
p. 1606–1615.
doi:
10.1002/nop2.544.
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Aim To explore nurses' perceptions of patient participation in different phases of the myocardial infarction pathway. Design Qualitative design with a hermeneutical approach. Methods Five focus groups were conducted at two hospitals, one with and one without percutaneous coronary intervention facilities, between February–November 2018. Participants were recruited through purposive sampling. Twenty‐two nurses experienced in cardiac care participated. The analysis had a hermeneutical approach. Results The findings revealed nurses' perceptions of patient participation in different phases of the myocardial infarction pathway. Four themes were identified: (a) variation between paternalism and autonomy in the acute phase; (b) individualization of dialogue and patient participation during treatment; (c) lack of coherence in the pathway hinders patient participation at discharge; and (d) cardiac rehabilitation promotes patients' autonomous decisions in lifestyle changes.
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Rosta, Judith; Aasland, Olaf Gjerløw & Nylenna, Magne
(2019).
Changes in job satisfaction among doctors
in Norway from 2010 to 2017: a study based on repeated surveys.
BMJ Open.
9,
p. 1–11.
doi:
10.1136/bmjopen-2018-027891.
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To assess job satisfaction for different categories of Norwegian doctors from 2010 to 2016–2017.Cross-sectional surveys in 2010, 2012, 2014 and 2016–2017 of partly overlapping samples.Norway from 2010 to 2016–2017.Doctors working in different job positions (hospital doctors, general practitioners (GPs), private practice specialists, doctors in academia). Response rates were 67% (1014/1520) in 2010, 71% (1279/1792) in 2012, 75% (1158/1545) in 2014 and 73% (1604/2195) in 2016–2017. The same 548 doctors responded at all four points in time.Main outcome measureJob Satisfaction Scale (JSS), a 10-item widely used instrument, with scores ranging from 1 (low satisfaction) to 7 (high satisfaction) for each item, and an unweighted mean total sum score.General Linear Modelling, controlling for gender and age, and paired t-tests.For all doctors, the mean scores of JSS decreased significantly from 5.52 (95% CI 5.42 to 5.61) in 2010 to 5.30 (5.22 to 5.38) in 2016–2017. The decrease was significant for GPs (5.54, 5.43 to 5.65 vs 5.17, 5.07 to 5.28) and hospital doctors (5.14, 5.07 to 5.21 vs 5.00, 4.94 to 5.06). Private practice specialists were most satisfied, followed by GPs and hospital doctors. The difference between the GPs and the private practice specialists increased over time.From 2010 to 2016–2017 job satisfaction for Norwegian doctors decreased, but it was still at a relatively high level. Several healthcare reforms and regulations over the last decade and changes in the professional culture may explain some of the reduced satisfaction.
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Nylenna, Magne & Larsen, Øivind
(2019).
Folkehelseinstituttet nå - og før.
Michael.
ISSN 1893-9651.
16(1),
p. 36–52.
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Folkehelseinstituttet har endret seg i tråd med utviklingen i samfunn, helse og helsetjeneste. Statens institutt for folkehelsen var opprinnelig et nasjonalt sentrallaboratorium med særlig vekt på arbeid med datidens mange og farlige smittsomme sykdommer. Etter Den andre verdenskrig ble infeksjonsovervåkning og miljømedisin stadig viktigere arbeidsområder. Med desentraliseringen av den diagnostiske laboratorievirksomheten i mikrobiologi og virologi fikk instituttet nye funksjoner. Fra 1980-årene ble forebyggende helsearbeid i videre forstand inkludert. Senere fusjoner og omorganiseringer har utvidet samfunnsoppdraget ytterligere. Med etableringen av Nasjonalt folkehelseinstitutt i 2002 ble det nasjonale ansvaret for sentrale helseregistre og biobanker formalisert, og arbeidet med psykisk helse styrket. Etter den seneste omorganiseringen i 2016 skal Folkehelseinstituttet i tillegg til sin spesielle rolle som rådgiver i smittevernarbeidet, også være kunnskapsleverandør til hele helse- og omsorgstjenesten.
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Larsen, Øivind & Nylenna, Magne
(2019).
Folkehelseinsituttet i dag - hvordan ble det slik?
Michael.
ISSN 1893-9651.
16(1),
p. 53–163.
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Transkribert og redigert referat fra et aktørseminar 1. oktober 2018, der sentrale personer ved Folkehelseinstituttet i Oslo så tilbake på instituttets nære historie.
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Larsen, Øivind; Ridderström, Gunnar & Nylenna, Magne
(2019).
Helsefremmende stedsplanlegging.
Michael.
ISSN 1893-9651.
p. 33–40.
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Det finnes mye god kunnskap om sammenhengen mellom stedsplanlegging og beboernes og brukernes helse på kort og lang sikt, blant annet innenfor fag som samfunnsmedisin, samfunnsgeografi, sosiologi og psykologi. Det er både generell kunnskap og kunnskaper om hvordan omgivelser fungerer og oppleves på det stedet det gjelder. Ofte kan det gå tungt å få omsatt slik kunnskap i praksis i planleggingsprosessene. I kommuner som forplikter seg i henhold til FNs bærekraftsmål, vil helseaspektet kunne komme tydeligere fram og få større gjennomslag.
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Nordfalk, Jenny Maria; Gulbrandsen, Pål; Gerwing, Jennifer; Nylenna, Magne & Menichetti, Julia
(2019).
Development of a measurement system for complex oral information transfer in medical consultations.
BMC Medical Research Methodology.
19.
doi:
10.1186/s12874-019-0788-7.
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Background Information exchange between physician and patient is crucial to achieve patient involvement, shared decision making and treatment adherence. No reliable method exists for measuring how much information physicians provide in a complex, unscripted medical conversation, nor how much of this information patients recall. This study aims to fill this gap by developing a measurement system designed to compare complex orally provided information to patient recall. Methods The development of the complex information transfer measurement system required nine methodological steps. Core activities were data collection, definition of information units and the first draft of a codebook, refinement through independent coding and consensus, and reliability testing. Videotapes of physician-patient consultations based on a standardized scenario and post-consultation interviews with patients constituted the data. The codebook was developed from verbatim transcriptions of the videotapes. Inter-rater reliability was calculated using a random selection of 10% of the statements in the transcriptions. Results Thirtyfour transcriptions of visits and interviews were collected. We developed a set of rules for defining a single unit of information, defined detailed criteria for exclusion and inclusion of relevant units of information, and outlined systematic counting procedures. In the refinement phase, we established a system for comparing the information provided by the physician with what the patient recalled. While linguistic and conceptual issues arose during the process, coders still achieved good inter-rater reliability, with intra-class correlation for patient recall: 0.723, and for doctors: 0.761. A full codebook is available as an appendix. Conclusions A measurement system specifically aimed at quantifying complex unscripted information exchange may be a useful addition to the tools for evaluating the results of health communication training and randomized controlled trials.
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Eiring, Øystein; Brurberg, Kjetil Gundro; Nytrøen, Kari & Nylenna, Magne
(2018).
Rapid methods including network meta-analysis to produce evidence in clinical decision support: A decision analysis.
Systematic Reviews.
7(168).
doi:
10.1186/s13643-018-0829-z.
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Background Conducting systematic reviews is time-consuming but crucial to construct evidence-based patient decision aids, clinical practice guidelines and decision analyses. New methods might enable developers to produce a knowledge base more rapidly. However, trading off scientific rigour for speed when creating a knowledge base is controversial, and the consequences are insufficiently known. We developed and applied faster methods including systematic reviews and network meta-analyses, assessed their feasibility and compared them to a gold standard approach. We also assessed the feasibility of using decision analysis to perform this comparison. Methods Long-term treatment in bipolar disorder was our testing field. We developed two new methods: an empirically based, rapid network meta-analysis (NMA) and an expert NMA, and conducted a patient survey. We applied these methods to collect effect estimates for evidence-based treatments on outcomes important to patients. The relative importance of outcomes was obtained from patients using a stated preference method. We used multi-criteria decision analysis to compare a gold standard NMA with the rapid NMA in terms of the ability of the gold standard NMA to change the ranking and expected values of treatments for individual patients. Results Using rapid methods, it was feasible to identify evidence addressing outcomes important to patients. We found that replacing effect estimates from our rapid NMA with estimates from the gold standard NMA resulted in relatively small changes in the ranking and expected value of treatments. The rapid method sufficed to estimate the effects of nine out of ten options. To produce a ranking of treatments accurate for more than 95% of patients, it was necessary to supplement systematic with rapid methods and to use relative importance weights in the analysis. Integrating estimates of the outcome “treatment burden” had a larger impact on rankings than replacing rapid with gold standard methods. Using patients’ importance weights only modestly affected results. Conclusions The transfer of knowledge to practice could benefit from faster systematic reviewing methods. The results in this preliminary assessment suggest that an improved rapid NMA approach might replace gold standard NMAs. Decision analysis could be used to compare evidence summarisation methods.
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Bårdsgjerde, Elise Kvalsund; Kvangarsnes, Marit; Landstad, Bodil; Nylenna, Magne & Hole, Torstein
(2018).
Patients’ narratives of their participation in the myocardial infarction pathway.
Journal of Advanced Nursing.
ISSN 0309-2402.
75(5),
p. 1063–1073.
doi:
10.1111/jan.13931.
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Aim To explore how patients in areas without local percutaneous coronary intervention (PCI) facilities experience patient participation in different phases of the myocardial infarction pathway. Background Acute treatment of myocardial infarction often involves PCI. In Norway, this treatment is centralized at certain hospitals; thus, patients often require long‐distance transportation and experience frequent hospital transfers. Short hospital stays, transfers between hospitals and the patient's emotional state pose challenges to promoting patient participation. Design A qualitative design with a narrative approach. Methods Participants were recruited through purposive sampling. Eight men and two women were interviewed in 2016. Findings Four themes related to the patients' experiences at the beginning, middle and end of the pathway were identified: (a) Lack of verbal communication in the acute phase; (b) trust in healthcare professionals and treatment; (c) lack of participation and coordination at discharge; and (d) shared decision‐making in rehabilitation. The findings showed how the patients moved from a low level of patient participation in the acute phase to a high level of patient participation in the rehabilitation phase. Conclusion This is the first study to explore patient participation in different phases of the myocardial infarction pathway. We argue that individual plans for information and patient participation are important to improve patient involvement in an earlier stage of the pathway. Further research from a healthcare professional perspective can be valuable to understand this topic. Impact This study gives new insight that can be valuable for healthcare professionals in implementing patient participation throughout the pathway.
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Larsen, Øivind & Nylenna, Magne
(2017).
Frederik Holst som redaktør.
Michael.
ISSN 1893-9651.
14(4),
p. 324–342.
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Frederik Holst (1791–1871) var en av de første redaktører for vitenskapelige tidsskrifter i Norge. Han var lege, og en av de ansvarlige for det medisinske innholdet i Magazin for Naturvidenskaberne i 1824 og 1825. Han grunnla og redigerte Norges første medisinsk-vitenskapelige tidsskrift Eyr (1826–1837), og ble valgt som redaktør da storsatsingen Norsk Magazin for Lægevidenskaben startet opp i 1840. Holst formet hvordan et norsk medisinsk fagtidsskrift skulle være. Hans allsidige virke som professor, forfatter og samfunnsbygger sørget for at 1800-tallets medisinske tidsskrifter fikk en tydelig vinkling mot samfunnet omkring.
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Nylenna, Magne & Larsen, Øivind
(2017).
Frederik Holst - professor, publisist og pioner.
Michael.
ISSN 1893-9651.
14(4),
p. 259–271.
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Legen Frederik Holst (1791–1871) var i 1817 den første som forsvarte en doktorgrad i Norge, uansett fagfelt. Som professor i farmakologi, toksikologi og hygiene ved Det kongelige Frederiks Universitet i Christiania var han med på å utdanne de første kullene av leger som ble uteksaminert i Norge. Ved sin virksomhet som tidsskriftutgiver, redaktør og forfatter påvirket han flere generasjoner av leger. Gjennom sitt arbeid med medisinallovgivning og helsetjenesteorganisering har han bidratt til å forme norsk helsevesen. Sporene etter «Norges første samfunnsmedisiner» kan følges helt fram til våre dager.
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Eiring, Øystein; Nytrøen, Kari; Kienlin, Simone Maria; Khodambashi, Soudabeh & Nylenna, Magne
(2017).
The development and feasibility of a personal health-optimization system for people with bipolar disorder.
BMC Medical Informatics and Decision Making.
17.
doi:
10.1186/s12911-017-0481-x.
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Background People with bipolar disorder often experience ill health and have considerably reduced life expectancies. Suboptimal treatment is common and includes a lack of effective medicines, overtreatment, and non-adherence to medical interventions and lifestyle measures. E- and m-health applications support patients in optimizing their treatment but often exhibit conceptual and technical shortcomings. The objective of this work was to develop and test the usability of a system targeting suboptimal treatment and compare the service to other genres and strategies. Methods Based on the frameworks of shared decision-making, multi-criteria decision analysis, and single-subject research design, we interviewed potential users, reviewed research and current approaches, and created a first version using a rapid prototyping framework. We then iteratively improved and expanded the service based on formative usability testing with patients, healthcare providers, and laypeople from Norway, the UK, and Ukraine. The evidence-based health-optimization system was developed using systematic methods. The System Usability Scale and a questionnaire were administered in formative and summative tests. A comparison of the system to current standards for clinical practice guidelines and patient decision aids was performed. Results Seventy-eight potential users identified 82 issues. Driven by user feedback, the limited first version was developed into a more comprehensive system. The current version encompasses 21 integrated core features, supporting 6 health-optimization strategies. One crucial feature enables patients and clinicians to explore the likely value of treatments based on mathematical integration of self-reported and research data and the patient’s preferences. The mean ± SD (median) system usability score of the patient-oriented subsystem was 71 ± 18 (73). The mean ± SD (median) system usability score in the summative usability testing was 78 ± 18 (75), well above the norm score of 68. Feedback from the questionnaire was generally positive. Eighteen out of 23 components in the system are not required in international standards for patient decision aids and clinical practice guidelines.
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Nylenna, Magne
(2025).
Allmennmedisinsk forskning må styrkes!
Michael.
ISSN 1893-9651.
22,
p. 317–321.
doi:
10.5617/michael.12758.
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Kunnskapsproduksjon er nødvendig for all framtidsrettet helsetjeneste. I motsetning til sykehusene har ikke kommunehelsetjenesten noen forskningsforpliktelse. Motivasjonen og rammebetingelsene mangler også. Skal primærhelsetjenesten i Norge opprettholde sin kvalitet og sitt renommé, må den bebudede helsereformen sikre en reell styrking av allmennmedisinsk forskning. Allmennleger må stimuleres til nysgjerrighet og få tilgang til forskningslitteratur.
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Frich, Jan C; Nylenna, Magne; Telle, Kjetil Elias; Flottorp, Signe Agnes & Røttingen, John-Arne
(2025).
The Norwegian Harkness-experience 2010–2025.
In Frich, Jan C & Nylenna, Magne (Ed.),
The Harkness fellowship – the Norwegian experience.
Michael.
ISSN 9788292871706.
p. 10–20.
doi:
10.56175/Michael.12577.
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he Harkness Fellowships, offered by The Commonwealth Fund, provide midcareer professionals from selected countries—including Norway—with a year-long opportunity to conduct health policy research in the U.S. The program aims to develop international leaders by fostering comparative research and collaboration across health systems. Fellows are placed at leading U.S. institutions, engage with mentors, participate in seminars, site visits, and policy briefings, and present their findings at a final seminar. Since Norway joined the program in 2010, 14 Norwegian fellows have completed the program, supported by the Norwegian Knowledge Centre for Health Services, the Norwegian Institute of Public Health and the Research Council of Norway.
The Norwegian fellows have explored a wide range of topics including equity, overdiagnosis, telemedicine, and care for chronic conditions. They report that the program fosters both professional and personal development, new research collaborations, and lasting networks. Their contributions have enriched Norwegian health services research and policy through publications, policy advice, and policy and practice innovation. The program is considered a valuable source of international perspective and leadership development for improving health care systems.
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Hem, Erlend; Gjesdal, Knut Tjøl; TranebjÆrg, lisbeth & Nylenna, Magne
(2024).
Historien om Jervell og Lange-Nielsens syndrom.
Tidsskrift for Den norske legeforening (Tidsskriftet).
ISSN 0029-2001.
144(15).
doi:
10.4045/tidsskr.24.0412.
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Larsen, Øivind & Nylenna, Magne
(2023).
Infeksjonssykdommenes historie - verktøy og speil.
Michael.
ISSN 1893-9651.
20(3),
p. 275–282.
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Lederartikkel til Michael 2023; 20: hefte 3 Infeksjonshistorie. Dette er et temanummer som viser til verdien av å studere smittsomme sykdommers utbredelse og historie.
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Nylenna, Magne & Hem, Erlend
(2021).
Begreper og betegnelser i helsespråket.
Michael.
ISSN 1893-9651.
18,
p. 14–25.
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Larsen, Øivind; Hem, Erlend & Nylenna, Magne
(2021).
Tidsskriftet Michael - en programerklæring.
Michael.
ISSN 1893-9651.
18(1),
p. 7–11.
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Bårdsgjerde, Elise Kvalsund; Kvangarsnes, Marit; Hole, Torstein; Nylenna, Magne & Landstad, Bodil
(2021).
Physicians' perceptions of patient participation in the myocardial infarction pathway.
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Landstad, Bodil; Kvangarsnes, Marit; Hole, Torstein & Nylenna, Magne
(2020).
Brukermedvirkning i helsetjenesten - realitet og retorikk.
In Landstad, Bodil; Kvangarsnes, Marit; Hole, Torstein & Nylenna, Magne (Ed.),
Brukermedvirkning i helsetjenesten - realitet eller retorikk?.
Det norske medicinske Selskab.
ISSN 9788292871805.
p. 7–13.
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Nylenna, Magne & Hem, Erlend
(2020).
Hva kan forskning om 1800-tallsepidemier lære oss i dag?
Michael.
ISSN 1893-9651.
17,
p. 615–620.
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Larsen, Øivind & Nylenna, Magne
(2019).
Folkehelseinstituttet opplevd innenfra.
Michael.
ISSN 1893-9651.
16(1),
p. 7–9.
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Lederartikkel i Michaels spesialnummer (2019; 16: hefte 1) om Folkehelseinstituttets historie.
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Bårdsgjerde, Elise Kvalsund; Kvangarsnes, Marit; Landstad, Bodil; Nylenna, Magne & Hole, Torstein
(2019).
Pasienter erfarer mangler i informasjon og oppfølging etter hjerteinfarkt.
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Bårdsgjerde, Elise Kvalsund; Kvangarsnes, Marit; Landstad, Bodil; Nylenna, Magne & Hole, Torstein
(2019).
Medvirkning ved hjerteinfarkt i pasientforløpet.
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Bårdsgjerde, Elise Kvalsund; Kvangarsnes, Marit; Landstad, Bodil; Nylenna, Magne & Hole, Torstein
(2019).
Pasientfortellinger om pasientmedvirkning ved hjerteinfarkt.
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Nylenna, Magne & Westin, Steinar
(2018).
The good medical paper: What do editors and reviewers look for? Peer review as a process for quality improvement.
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Bårdsgjerde, Elise Kvalsund; Kvangarsnes, Marit; Nylenna, Magne & Hole, Torstein
(2018).
Pasienterfaringer ved hjerteinfarkt - variasjon i oppfølgingen.
136(303),
p. 16–16.
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Published
Apr. 13, 2011 2:45 PM
- Last modified
May 27, 2011 4:22 PM
