siljerol

• Heltveit-Olsen, Silje Rebekka; Grude, Nils; Arnljots, Egill Snaebjörnsson; Sundvall, Pär-Daniel; Gunnarsson, Ronny & Kowalczyk, Anna [Vis alle 17 forfattere av denne artikkelen] (2026). Microbiological findings, antibiotic resistance rates and prescription practices for older women with recurrent urinary tract infections: a descriptive study alongside a multinational randomized controlled trial (ImpresU). JAC-Antimicrobial Resistance (JAC-AMR). 8(4). doi: 10.1093/jacamr/dlag121. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Objectives To describe microbiological findings during asymptomatic and symptomatic phases in older women with recurrent urinary tract infections (rUTIs), to evaluate whether antimicrobial resistance patterns of Escherichia coli among methenamine hippurate users differ from untreated controls, and to explore prescription patterns of UTI antibiotics. Methods This was a descriptive study alongside a multinational randomized controlled trial (ImpresU). Women aged ≥70 years with rUTIs were recruited from general practice in Norway, Sweden, Poland and the Netherlands between December 2019 and June 2022. Participants were randomized to methenamine hippurate 1 g or placebo twice daily for 6 months, followed by a 6 month follow-up period. Urinary samples were collected at baseline (asymptomatic) and during acute UTIs. Results We included 281 women. A dominating uropathogen ≥105 cfu/mL was detected in 29% of the baseline urine samples. Of the 178 urinary cultures taken at acute UTIs, 163 (92%) had bacterial growth, of which a minority (10%) were reported as mixed flora. E. coli was most frequently detected both at baseline and in acute UTIs (present in any concentration in 32% versus 60% of urine samples), with highest resistance to amoxicillin (36% versus 43%), trimethoprim (16% versus 22%) and amoxicillin/clavulanate (12% versus 16%). ESBL-producing E. coli at baseline were rare (4.1%). Phylogenetic subgroup B2 was the most frequent E. coli phylotype at baseline (52%). No relevant differences in antimicrobial resistance rates were found between methenamine hippurate users and controls. Narrow-spectrum antibiotics were widely prescribed, and guideline adherence was high. Conclusions Physicians should be aware that 29% of older women with rUTIs in the community may have significant bacterial findings in their urine during asymptomatic phases.

• Skoglund, Ingmarie; Heltveit-Olsen, Silje Rebekka; Brænd, Anja Maria Lyche; Fossum, Guro Haugen; Straand, Jørund & Sundvall, Sofia [Vis alle 8 forfattere av denne artikkelen] (2026). In uncharted territory: managing the COVID-19 pandemic in Swedish regions and municipalities from a primary health care perspective. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 44(1). doi: 10.1080/02813432.2026.2660327. Fulltekst i vitenarkiv Vis sammendrag

  Objective To explore experiences and challenges faced by regional and municipal health care leaders during the COVID-19 pandemic, with a focus on primary health care and care of older adults. Design A longitudinal qualitative study based on two rounds of semi-structured interviews 2–3 months apart. Setting and participants Fifteen health care leaders strategically recruited from regions and municipalities across Sweden. The first interviews took place in November–December 2020, the second in January–March 2021. Results Four themes were identified. The first captured the challenge of navigating uncharted territory during an unprecedented crisis. The second addressed ethical dilemmas arising from public health priorities. The third highlighted the growing significance and evolving role of infection prevention and control. Finally, the fourth illustrated how initially productive and solution-oriented local collaboration and communication gradually gave way to tensions and conflicting responsibilities. Conclusions In the early phases of the pandemic, the Swedish Public Health Agency’s leadership and measures were generally appreciated, although the initial response was widely perceived as slow and insufficient. The high mortality among older adults was regarded as a major failure, raising ethical concerns and exposing tensions in collaboration between actors. Pandemic work was experienced as exhausting yet meaningful, and the field of infection prevention and control gained increased recognition and status. Some distinctive features of Sweden’s pandemic response – such as decentralised decision-making and an emphasis on individual responsibility – may have been shaped by the constitutional prohibition of ministerial rule and the substantial autonomy granted to regional and local authorities.

• Svaland, Malene; Brænd, Anja Maria; Heltveit-Olsen, Silje Rebekka; Rørtveit, Guri; Høye, Sigurd & Straand, Jørund [Vis alle 7 forfattere av denne artikkelen] (2025). Fear of the Unknown: Pandemic Concerns Among Non-hospitalized COVID-19 Infected or Quarantined Norwegian Adults. Disaster Medicine and Public Health Preparedness. ISSN 1935-7893. 19. doi: 10.1017/dmp.2025.10117. Fulltekst i vitenarkiv Vis sammendrag

  Objective We aimed to explore concerns and feeling of safety among quarantined and non-hospitalized COVID-19 patients. Methods We conducted a qualitative study of free text answers from participants of an online survey. The survey was conducted between March 2020 and June 2021. COVID-19 positive adults in home isolation and adults in quarantine were eligible for participation. 698 participants answered one or more of three open-ended questions about concerns and safety. We analyzed free-text answers using thematic analysis according to Braun and Clarke with an inductive approach. Results Analysis of the free-text answers from all participants identified three main themes: (1) Fear of the unknown, (2) Views on personal care and public health measures, and (3) Concern for the future of a country in crisis. Participants’ feelings revolved around health-related concerns and societal related concerns. They were concerned about their own and other’s health, and possible long-term consequences of COVID-19 infection. Some participants were satisfied with the health care system, others thought follow-ups, testing, vaccination, and information would increase their feeling of safety. Conclusions People quarantined and isolated due to the COVID-19 pandemic had concerns regarding personal health and societal consequences of infection control measures. Health care follow-ups and individualized information would increase participants’ feeling of safety.

• Heltveit-Olsen, Silje Rebekka; Arnljots, Egill Snaebjörnsson; Sundvall, Pär-Daniel; Gunnarsson, Ronny; Kowalczyk, Anna & Godycki-Cwirko, Maciej [Vis alle 16 forfattere av denne artikkelen] (2025). Methenamine hippurate as prophylaxis for recurrent urinary tract infections in older women - a triple-blind, randomised, placebo-controlled, phase IV trial (ImpresU). Clinical Microbiology and Infection (CMI). ISSN 1198-743X. 31(11), s. 1873–1879. doi: 10.1016/j.cmi.2025.07.006. Fulltekst i vitenarkiv Vis sammendrag

  Objectives This study aims to investigate the preventive effect of the antiseptic methenamine hippurate on recurrent urinary tract infections (rUTIs) in older women. Methods Triple-blind, randomised, placebo-controlled phase IV trial with a 6-month treatment period and a 6-month follow-up. Women ≥70 years with rUTIs were recruited from general practice in Norway, Sweden, Poland, and The Netherlands. Recruitment started in December 2019, with follow-up completed at the end of June 2023. Participants were randomly assigned to methenamine hippurate 1g × 2 or placebo 1 tablet × 2 for 6 months. The primary outcome was the number of antibiotic treatments for urinary tract infections (UTIs) during the treatment period. Secondary outcomes included the number of antibiotic treatments for UTIs during the follow-up period, UTI symptom severity and episode duration. Differences in complications were measured as safety outcomes. Results Of 289 recruited women, 281 (97%) were included in the main analysis (140 in the methenamine hippurate group, 141 in the placebo group). During the treatment period, the methenamine hippurate group had a lower incidence of antibiotic treatments for UTIs than the placebo group, with an incidence rate ratio of 0.75 (95% CI: 0.57–1.0, p 0.049). In the follow-up period, the ratio was reversed: the methenamine hippurate group had a higher incidence of antibiotic treatments for UTIs than the placebo group, with an incidence rate ratio of 1.7 (95% CI:1.3–2.3, p<0.001). There were no important differences in UTI symptom severity/duration or complications between the groups. Discussion Methenamine hippurate reduces the frequency of rUTIs in older women with a point estimate of a 25% reduction, suggesting advantages over low-dose antibiotic prophylaxis because of its low potential for selection for antimicrobial resistance and mild side effects. However, discontinuation after 6-month treatment duration seems to increase the risk of UTI relapses, and physicians should be aware of this risk when initiating or discontinuing treatment.

• Heltveit-Olsen, Silje Rebekka; Lunde, Lene; Brænd, Anja Maria; Spehar, Ivan; Høye, Sigurd & Skoglund, Ingmarie [Vis alle 10 forfattere av denne artikkelen] (2024). Local management of the COVID-19 pandemic in Norway: a longitudinal interview study of municipality chief medical officers. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 42(1), s. 214–224. doi: 10.1080/02813432.2023.2301562. Fulltekst i vitenarkiv Vis sammendrag

  Objective - To explore the experiences and views of Norwegian Municipality Chief Medical Officers (MCMOs) on preparedness, collaboration, and organization during the COVID-19 pandemic to gain insight into local crisis management of value for future pandemic responses.<p> <p>Design - Longitudinal qualitative interview study. We conducted semi-structured digital interviews with nine MCMOs working in different municipalities in Norway from September to December 2020. Five MCMOs were re-interviewed from January to April 2021. We used thematic analysis to analyze the data.<p> <p>Results - Through the analysis, three major themes were identified in the material; 1) The view of preparedness changed from being low-priority and dormant to the desire to strengthen preparedness as a permanent measure; 2) The nature of the pandemic forced a change in internal and external communication and collaboration for the MCMOs towards direct dialogue, teamwork and digital networking; 3) The pandemic changed the role and position of the MCMO within the municipal organization. Although most MCMOs were given a leading role in the municipal pandemic response, some MCMOs experienced that they were not positioned to fully exercise their intended role. In our material, de-authorization of the MCMO role seemed to coincide with the increasing size and organizational complexity of the municipality.<p> <p>Conclusions - The Norwegian pandemic response and outcome have been regarded as successful internationally. Although the MCMOs managed to implement flexible and quick responses facilitated by teamwork, dialogue, and joint sensemaking, they also identified several challenges and shortcomings of the Norwegian pandemic preparedness requiring organizational and financial changes to sustain future health system resilience.

• Hartman, Esther; Groen, Wim; Heltveit-Olsen, Silje Rebekka; Lindbæk, Morten; Høye, Sigurd & Lithén, Sara Sofia [Vis alle 17 forfattere av denne artikkelen] (2024). Implementation of a tailored multifaceted antibiotic stewardship intervention to improve antibiotic prescribing for urinary tract infections in frail older adults (ImpresU) in four European countries: a process evaluation alongside a pragmatic cluster randomized controlled trial. Trials. 25(1). doi: 10.1186/s13063-024-08545-4. Fulltekst i vitenarkiv Vis sammendrag

  Background We previously performed a pragmatic cluster randomized controlled trial (RCT) in general practices and older adult care organizations in Poland, the Netherlands, Norway, and Sweden. We found that a multifaceted antibiotic stewardship intervention (ASI) substantially reduced antibiotic use for suspected urinary tract infections (UTIs) in frail older adults compared with usual care. We aimed to evaluate the implementation process of the ASI to provide recommendations for clinical practice. Methods We conducted a process evaluation alongside the cluster RCT. The ASI consisted of a decision-tool and a toolbox, which were implemented using a participatory-action-research (PAR) approach with sessions for education and evaluation. We documented the implementation process of the intervention and administered a questionnaire to health care professionals (HCPs) from participating organizations in the intervention and usual care clusters. We evaluated the multiple components of the intervention and its implementation following a structured framework. Results The questionnaire was completed by 254 HCPs from the 38 participating clusters. All components were largely delivered according to plan and evaluated as useful. The decision-tool and toolbox materials were reported to facilitate decision-making on UTIs. Regarding the PAR approach, educational sessions focusing on the distinction between UTIs and asymptomatic bacteriuria were held in all 19 intervention clusters. In 17 out of these 19 clusters, evaluation sessions took place, which were reported to help remind HCPs to implement the ASI. During both sessions, HCPs valued the reflection that took place and the resulting awareness of their behavior. It allowed them to explore implementation barriers and to tailor their local implementation process to overcome these. For example, HCPs organized extra educational sessions or revised local policies to incorporate the use of the decision-tool. Various HCPs took key roles in implementation. Staff changes and the COVID-19 pandemic were important contextual barriers. Conclusions We found each component of the multifaceted ASI and its implementation to have added value in the process to improve antibiotic prescribing for suspected UTIs in a heterogeneous older adult care setting. We recommend using a multifaceted, multidisciplinary approach that enables HCPs to reflect on their current practice and accordingly tailor local implementation. Trial registration ClinicalTrials.gov NCT03970356. Registered on May 31, 2019.

• Heltveit-Olsen, Silje Rebekka; Gopinathan, Unni; Blix, Hege Salvesen; Elstrøm, Petter & Høye, Sigurd (2024). Effect of methenamine hippurate shortage on antibiotic prescribing for urinary tract infections in Norway - an interrupted time series analysis. Journal of Antimicrobial Chemotherapy. ISSN 0305-7453. 79(5), s. 1109–1117. doi: 10.1093/jac/dkae078. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Background Despite a lack of conclusive evidence of effect, methenamine hippurate is widely prescribed as preventive treatment for recurrent urinary tract infections (UTIs) in Norway. A national discontinuation of methenamine hippurate treatment due to a 4-month drug shortage in 2019 presented an opportunity to evaluate its preventive effect on UTIs among regular users. Objective To estimate the impact of the methenamine hippurate drug shortage on prescription frequency of UTI antibiotics. Methods Data from The Norwegian Prescription Database was analysed using an interrupted time series design. The time series consisted of 56 time periods of 14 days. The model included two naturally occurring interruptions: (i) the methenamine hippurate drug shortage, and (ii) reintroduction of the drug. The study population were 18 345 women ≥50 years receiving ≥2 prescriptions of methenamine hippurate in the study period before the shortage. Main outcome measure was number of prescriptions of UTI antibiotics per 1000 methenamine hippurate users. Prescription rates of antibiotics for respiratory tract infections were analysed to assess external events affecting antibiotic prescribing patterns. Results We found a significant increase of 2.41 prescriptions per 1000 methenamine hippurate users per 14-day period during the drug shortage (95%CI 1.39, 3.43, P &amp;lt; 0.001), followed by a significant reduction of −2.64 prescriptions after reintroduction (95%CI −3.66, −1.63, P &amp;lt; 0.001). Conclusions During the methenamine hippurate drug shortage, we found a significant increase in prescribing trend for UTI antibiotics followed by a significant decrease in prescribing trend after reintroduction. This change in trend seems to reflect a preventive effect of the drug on recurrent UTIs.

• Hartman, Esther; Pol, Alma C. Van De; Heltveit-Olsen, Silje Rebekka; Lindbæk, Morten; Høye, Sigurd & Lithén, Sara Sofia [Vis alle 18 forfattere av denne artikkelen] (2023). Effect of a multifaceted antibiotic stewardship intervention to improve antibiotic prescribing for suspected urinary tract infections in frail older adults (ImpresU): pragmatic cluster randomised controlled trial in four European countries. The BMJ. doi: 10.1136/bmj-2022-072319. Fulltekst i vitenarkiv Vis sammendrag

  Objective To evaluate whether antibiotic prescribing for suspected urinary tract infections in frail older adults can be reduced through a multifaceted antibiotic stewardship intervention. Design Pragmatic, parallel, cluster randomised controlled trial, with a five month baseline period and a seven month follow-up period. Setting 38 clusters consisting of one or more general practices (n=43) and older adult care organisations (n=43) in Poland, the Netherlands, Norway, and Sweden, from September 2019 to June 2021. Participants 1041 frail older adults aged 70 or older (Poland 325, the Netherlands 233, Norway 276, Sweden 207), contributing 411 person years to the follow-up period. Intervention Healthcare professionals received a multifaceted antibiotic stewardship intervention consisting of a decision tool for appropriate antibiotic use, supported by a toolbox with educational materials. A participatory-action-research approach was used for implementation, with sessions for education, evaluation, and local tailoring of the intervention. The control group provided care as usual. Main outcome measures The primary outcome was the number of antibiotic prescriptions for suspected urinary tract infections per person year. Secondary outcomes included the incidence of complications, all cause hospital referrals, all cause hospital admissions, all cause mortality within 21 days after suspected urinary tract infections, and all cause mortality. Results The numbers of antibiotic prescriptions for suspected urinary tract infections in the follow-up period were 54 prescriptions in 202 person years (0.27 per person year) in the intervention group and 121 prescriptions in 209 person years (0.58 per person year) in the usual care group. Participants in the intervention group had a lower rate of receiving an antibiotic prescription for a suspected urinary tract infection compared with participants in the usual care group, with a rate ratio of 0.42 (95% confidence interval 0.26 to 0.68). No differences between intervention and control group were observed in the incidence of complications (<0.01 v 0.05 per person year), hospital referrals (<0.01 v 0.05), admissions to hospital (0.01 v 0.05), and mortality (0 v 0.01) within 21 days after suspected urinary tract infections, nor in all cause mortality (0.26 v 0.26). Conclusions Implementation of a multifaceted antibiotic stewardship intervention safely reduced antibiotic prescribing for suspected urinary tract infections in frail older adults.

• Fossum, Guro Haugen; Brænd, Anja Maria; Heltveit-Olsen, Silje Rebekka; Rørtveit, Guri; Høye, Sigurd & Straand, Jørund (2023). Symptoms, symptom severity, and contact with primary health care among nonhospitalized COVID-19 patients: a Norwegian web-based survey. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 41(4), s. 427–434. doi: 10.1080/02813432.2023.2266477. Fulltekst i vitenarkiv Vis sammendrag

  Objective Dependent on clinical setting, geography and timing during the pandemic, variable symptoms of COVID-19 have been reported. Our aim was to describe self-reported symptom intensity and contact with primary health care among nonhospitalized COVID-19 patients. Design Web-based survey. Setting Norway between March 2020 and July 2021. Subjects Adults in home isolation. Main outcome measures Participants reported possible COVID-19 symptoms, duration of symptoms, score of symptom severity (Likert scale 0–3), risk factors, comorbidity, and questions regarding follow-up and information from primary health care. Results Of 477 participants, 379 (79%) had PCR-confirmed COVID-19, 324 (68%) were females, and 90% were younger than 60 years. Most common symptoms were “fatigue and/or muscle ache” (80%), nasal symptoms (79%), and headache (73%). The mean severity of symptoms was generally low. Symptoms with the highest mean scores were “fatigue and/or muscle ache” (1.51, SD 1.02) and headache (1.27 (SD 1.00). Mean scores for severity ranged from 0.28 (nausea) to 1.51 (fatigue and/or muscle ache). Women reported higher symptom scores than men. For “affected sense of smell and/or taste”, patients either reported a high symptom score (24%) or no affliction at all (49%). A third of the participants (32%) were followed-up by primary care health personnel, and almost 40% had sought or received information about COVID-19 from general practitioners. Conclusion The mean severity of symptoms among nonhospitalized adult COVID-19 patients was generally low. We found large variations in the occurrence and severity of symptoms between patients.

• Heltveit-Olsen, Silje Rebekka; Lunde, Lene; Brænd, Anja Maria Lyche; Spehar, Ivan; Høye, Sigurd & Skoglund, Ingmarie [Vis alle 10 forfattere av denne artikkelen] (2022). Experiences and management strategies of Norwegian GPs during the COVID-19 pandemic: a longitudinal interview study. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. doi: 10.1080/02813432.2022.2142796. Fulltekst i vitenarkiv Vis sammendrag

  Objective: When the COVID-19 pandemic reached Norway, primary health care had to reorganize to ensure safe patient treatment and maintain infection control. General practitioners (GPs) are key health care providers in the municipalities. Our aim was to explore the experiences and management strategies of Norwegian GPs during the COVID-19 pandemic - over time, and in the context of a sudden organizational change.<p> <p>Design: Longitudinal qualitative interview study with two interview rounds. The first round of interviews was conducted from September–December 2020, the second round from January–April 2021. In the first interview round, we performed eight semi-structured interviews with GPs from eight municipalities in Norway. In the second round, five of the GPs were re-interviewed. Consecutive interviews were performed 2–4 months apart. To analyze the data, we used thematic analysis. <p>Results: The COVID-19 pandemic required GPs to balance several concerns, such as continuity of care and their own professional efforts. Several GPs experienced challenges in the collaboration with the municipality and in relation to defining their own professional position. Guided by The Norwegian Association of General practitioners, The Norwegian College of General Practice and collegial support, they found viable solutions and ended up with a feeling of having adapted to a new normal. <p>Conclusions: Although our study demonstrates that the GPs adapted to the changing conditions, the current municipal health care models are not ideal. There is a need for clarification of responsibilities between GPs and the municipality to facilitate a more coordinated future pandemic response.

• Heltveit-Olsen, Silje Rebekka; Sundvall, Pär-Daniel; Gunnarsson, Ronny; Arnljots, Egill Snaebjörnsson; Kowalzcyk, Anna & Godycki-Cwirko, Maciek [Vis alle 15 forfattere av denne artikkelen] (2022). Methenamine hippurate to prevent recurrent urinary tract infections in older women: protocol for a randomised, placebo-controlled trial (ImpresU). BMJ Open. 12:e065217(11), s. 1–11. doi: 10.1136/bmjopen-2022-065217. Fulltekst i vitenarkiv Vis sammendrag

  Introduction Methenamine hippurate is a urinary antiseptic used as preventive treatment for recurrent urinary tract infections (UTIs) in some Scandinavian countries. However, the scientific evidence for the preventive effect and safety for longer-term use is limited. The aim of this study is to assess whether methenamine hippurate can reduce the incidence of UTIs in older women with recurrent UTIs. Methods and analysis The ImpresU consortium is a collaboration between Norway, Sweden, Poland and the Netherlands. The study is a randomised, controlled, triple-blind phase IV clinical trial. Women ≥70 years with recurrent UTIs are screened for eligibility in a general practice setting. We aim to include 400 women in total, with 100 recruited from each collaborating country. The participants are randomised to treatment with methenamine hippurate 1 g or placebo tablets two times per day for a treatment period of 6 months, followed by a drug-free follow-up period of 6 months. The primary outcome is number of antibiotic treatments for UTIs during the treatment period. The secondary outcomes include number of antibiotic treatments for UTIs during the follow-up period and self-reported symptom of severity and duration of UTI episodes. Differences in complications between the treatment groups are measured as safety outcomes. We also aim to investigate whether strain characteristics or phylogenetic subgroups of Escherichia coli present in the urine culture at inclusion have a modifying effect on the outcomes. Ethics and dissemination Ethical approvals are obtained in all participating countries. The results will be communicated in peer-reviewed journals and at scientific conferences.

• Hartman, Esther; Groen, Wim; Heltveit-Olsen, Silje Rebekka; Lindbæk, Morten; Høye, Sigurd & Skoglund, Ingmarie [Vis alle 16 forfattere av denne artikkelen] (2022). Decisions on antibiotic prescribing for suspected urinary tract infections in frail older adults: A qualitative study in four European countries. Age and Ageing. ISSN 0002-0729. 51(6). doi: 10.1093/ageing/afac134. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Background a suspected urinary tract infection (UTI) is the most common reason to prescribe antibiotics in a frail older patient. Frequently, antibiotics are prescribed unnecessarily. To increase appropriate antibiotic use for UTIs through antibiotic stewardship interventions, we need to thoroughly understand the factors that contribute to these prescribing decisions. Objectives (1) to obtain insight into factors contributing to antibiotic prescribing for suspected UTIs in frail older adults. (2) To develop an overarching model integrating these factors to guide the development of antibiotic stewardship interventions for UTIs in frail older adults. Methods we conducted an exploratory qualitative study with 61 semi-structured interviews in older adult care settings in Poland, the Netherlands, Norway and Sweden. We interviewed physicians, nursing staff, patients and informal caregivers. Results participants described a chain of decisions by patients, caregivers and/or nursing staff preceding the ultimate decision to prescribe antibiotics by the physician. We identified five themes of influence: (1) the clinical situation and its complexity within the frail older patient, (2) diagnostic factors, such as asymptomatic bacteriuria, (3) knowledge (gaps) and attitude, (4) communication: interprofessional, and with patients and relatives and (5) context and organisation of care, including factors such as availability of antibiotics (over the counter), antibiotic stewardship efforts and factors concerning out-of-hours care. Conclusions decision-making on suspected UTIs in frail older adults is a complex, multifactorial process. Due to the diverse international setting and stakeholder variety, we were able to provide a comprehensive overview of factors to guide the development of antibiotic stewardship interventions.

• Hartman, Esther; Groen, Wim; Heltveit-Olsen, Silje Rebekka; Lindbæk, Morten; Høye, Sigurd & Sundvall, Pär-Daniel [Vis alle 17 forfattere av denne artikkelen] (2021). Multifaceted antibiotic stewardship intervention using a participatory-action-research approach to improve antibiotic prescribing for urinary tract infections in frail elderly (ImpresU): study protocol for a European qualitative study followed by a pragmatic cluster randomised controlled trial. BMJ Open. 11(10), s. 1–8. doi: 10.1136/bmjopen-2021-052552. Fulltekst i vitenarkiv Vis sammendrag

  Introduction Almost 60% of antibiotics in frail elderly are prescribed for alleged urinary tract infections (UTIs). A substantial part of this comprises prescriptions in case of non-specific symptoms or asymptomatic bacteriuria, for which the latest guidelines promote restrictiveness with antibiotics. We aim to reduce inappropriate antibiotic use for UTIs through an antibiotic stewardship intervention (ASI) that encourages to prescribe according to these guidelines. To develop an effective ASI, we first need a better understanding of the complex decision-making process concerning suspected UTIs in frail elderly. Moreover, the implementation approach requires tailoring to the heterogeneous elderly care setting. Methods and analysis First, we conduct a qualitative study to explore factors contributing to antibiotic prescribing for UTIs in frail elderly, using semi-structured interviews with general practitioners, nursing staff, patients and informal caregivers. Next, we perform a pragmatic cluster randomised controlled trial in elderly care organisations. A multifaceted ASI is implemented in the intervention group; the control group receives care as usual. The ASI is centred around a decision tool that promotes restrictive antibiotic use, supported by a toolbox with educational materials. For the implementation, we use a modified participatory-action-research approach, guided by the results of the qualitative study. The primary outcome is the number of antibiotic prescriptions for suspected UTIs. We aim to recruit 34 clusters with in total 680 frail elderly residents ≥70 years. Data collection takes place during a 5-month baseline period and a 7-month follow-up period. Finally, we perform a process evaluation. The study has been delayed for 6 months due to COVID-19 and is expected to end in July 2021. Ethics and dissemination Ethical approvals and/or waivers were obtained from the ethical committees in Poland, the Netherlands, Norway and Sweden. The results will be disseminated through publication in peer-reviewed journals and conference presentations.

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• Heltveit-Olsen, Silje Rebekka & Steenbuch, Inger Elisabeth (2025). Det er ikke sikkert du må ta antibiotika for å forebygge urinveisinfeksjoner. Aftenposten. Fulltekst i vitenarkiv Vis sammendrag

  Urinveisinfeksjon er en kvinneplage som ofte krever antibiotika. Norsk lege ser en annen løsning.

• Heltveit-Olsen, Silje Rebekka; Brækhus, Leni Aurora & Høye, Sigurd (2025). (+) Studie: Legemiddel som ikke gir resistens, forebygger urinveisinfeksjoner hos eldre. Dagens medisin. ISSN 1501-4290. Fulltekst i vitenarkiv Vis sammendrag

  Et gammelt, billig og mye brukt legemiddel har manglet god dokumentasjon, men er nå undersøkt i en norskledet studie, som er gjennomført i allmennpraksis i fire land.

• Heltveit-Olsen, Silje Rebekka; Fossum, Guro Haugen & Engelsen, Thea Cecilie (2024). Pandemien endret kommuneoverlegens rolle. [Internet]. Forskning.no. Fulltekst i vitenarkiv
• Heltveit-Olsen, Silje Rebekka; Høye, Sigurd & Brækhus, Leni Aurora (2023). Studie: Halverte bruken av urinveisantibiotika hos eldre uten at det gikk ut over pasientsikkerheten. [Journal]. Dagens Medisin. Fulltekst i vitenarkiv
• Fossum, Guro Haugen; Brænd, Anja Maria Lyche; Heltveit-Olsen, Silje Rebekka; Høye, Sigurd; Rørtveit, Guri & Straand, Jørund (2022). CovidNor - The Patient Study. Fulltekst i vitenarkiv
• Heltveit-Olsen, Silje Rebekka; Lunde, Lene; Brænd, Anja Maria; Spehar, Ivan; Høye, Sigurd & Skoglund, Ingmarie [Vis alle 10 forfattere av denne artikkelen] (2022). Experiences and management strategies of Norwegian GPs during the COVID-19 pandemic: A longitudinal interview study. Fulltekst i vitenarkiv
• Fossum, Guro Haugen; Heltveit-Olsen, Silje Rebekka & Høye, Sigurd (2020). Experiences of patients and primary health care professionals during the COVID-19 epidemic in Norway. Fulltekst i vitenarkiv
• Heltveit-Olsen, Silje Rebekka & Hartman, Esther (2019). Improving rational prescribing for urinary tract infections in frail elderly (ImpresU). Fulltekst i vitenarkiv

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