Herman Bjørnstad

• Frigaard, Christine; Ofstad, Eirik Hugaas; Delor, Julia Menichetti; Schirmer, Henrik; Bjørnstad, Herman & Simonsen, Tone Breines [Show all 8 contributors for this article] (2026). Optimised heart failure medication in hospital-to-home transitions: An adherence burden for patients? Patient Education and Counseling. ISSN 0738-3991. 149. doi: 10.1016/j.pec.2026.109655. Full text in Research Archive Show summary

  Objectives When patients are hospitalised for heart failure (HF), doctors review and optimise their pharmacotherapy at subsequent care transitions. Studies show that patients, many of whom are old and frail, have adherence rates of only 40%-60%. Few communication studies have examined the burden of optimisation on patients as their regimens evolve. Focusing on prescription changes over multiple care transitions, we aimed to: (1) identify how many changes patients received, (2) characterise the support provided in discharge letters, and (3) assess patients’ implementation of changes at home. Methods We conducted an exploratory, observational cohort study with prospective longitudinal data collection. We recruited 23 older HF patients in Norway, collecting observational data (medical records, discharge letters, interviews, photographs) from their hospital visits (admission, discharge), general practitioner visit, and their homes. We inductively developed a systematic analytical procedure to identify prescription changes and to assess the quality of doctors’ written information about patients’ medication management at home. Results Doctors made a median of six prescription changes per patient (range 2–19) over a median timespan of 25 days, usually leading to more medications. Of the discharge letters patients received, 26% provided clear instructions about all changes and explanations of the benefit. While all patients reported adherence, home visits revealed 17% had discrepancies indicating non-adherence, and 61% dispensed medications from original pharmacy packaging with outdated dosing instructions. Conclusions To adhere to their optimised pharmacotherapy, HF patients needed to implement many incremental changes. Doctors' discharge letters were often unclear or lacked information about the changes. Practice implications To enhance patients’ ability to adhere to treatment, clinicians may consider: (i) improving the quality of discharge letters, including clarifying medication labels (ii) providing updated instructions for old medication packages, (iii) normalising and providing safety-net support for non-adherence to HF regimens. Further research is needed to test these actions.

• Bjørnstad, Herman; Frigaard, Christine; Gulbrandsen, Pål; Gerwing, Jennifer; Schirmer, Henrik & Menichetti, Julia (2025). How hospital doctors respond to contextual factors revealed by older patients with heart failure in hospital interactions: an interaction-based study. BMC Health Services Research. 25. doi: 10.1186/s12913-025-13505-y. Full text in Research Archive Show summary

  Background Patients with heart failure often face individual context-dependent challenges that affect their ability to follow a treatment plan. How hospital doctors recognize and respond to such contextual factors (CF) may influence health outcomes. This study aims to identify adherence related CF disclosed by older patients with heart failure during hospital interactions and to examine how doctors respond to them. Methods Audio-recordings from two key hospital interactions were collected from 42 older patients with heart failure. Occurrences of CF were identified based on a previously developed coding scheme and followed during the hospital interactions. We then analysed doctor’s responses to patient’s CF and categorized them as: (1) Solution-oriented, (2) Exploring (3) No follow-up. Results We identified 58 CF across 113 occurrences in 27 (64%) patients. Medication-related CF (47%) were the most frequently disclosed, followed by patient-specific (34%), condition-related (12%), and healthcare system-related factors (7%). Doctors’ responses varied: 26% (n = 15) of CF received no follow-up, 21% (n = 12) were only explored, 24% (n = 14) were explored and met with a solution-oriented action, and 29% (n = 17) were met with solution-oriented actions without any exploration from the doctor. Conclusions Older patients with heart failure often disclose important CF relevant to adherence during hospital interactions. Roughly half of these factors are not met with a solution-oriented response, with a substantial portion not being followed up by the doctors at all. Future research should explore how to better improve doctors’ ability to recognize and appropriately respond to CF disclosed by patients.

• Frigaard, Christine; Menichetti, Julia; Schirmer, Henrik; Wisløff, Torbjørn; Bjørnstad, Herman & Simonsen, Tone Breines [Show all 8 contributors for this article] (2025). How do doctors address heart failure patients’ disclosures of medication adherence problems during hospital and primary care consultations? An exploratory interaction-based observational cohort study. BMJ Open. 15(4). doi: 10.1136/bmjopen-2025-098826. Full text in Research Archive Show summary

  Objectives To investigate how doctors and self-managing older patients with heart failure (HF) discuss the patients’ potential or ongoing medication adherence problems, and how such discussions evolve as patients transition from hospital to home, with particular focus on: (1) doctors’ communicative actions aimed at addressing patient disclosures of adherence problems and (2) patients’ feedback indicating whether their doctor’s supportive actions were acceptable to them. Design Exploratory interaction-based observational cohort study. Inductive microanalysis of authentic patient–doctor consultations, audio recorded for each patient at: (1) first ward visit in hospital, (2) discharge visit from hospital and (3) follow-up visit with general practitioner (GP). Setting Hospital and primary care, Norway (2022–2023). Participants 25 patients with HF (+65 years) and their attending doctors (23 hospital doctors, 25 GPs). Results Analysis of 74 consultations revealed that 25 HF patients disclosed 23 practical adherence problems indicating risks of unintentional non-adherence (eg, limited resources to manage medications) and 39 perceptual problems indicating risks of intentional non-adherence (eg, worries, negative experience or stance). Doctors addressed 79% of patients’ disclosures by: (1) exploring the scope of the problem or (2) providing supportive actions to improve patients’ ability or motivation to adhere. We calculated nearly five times higher odds for doctors to address patients’ practical problems to their perceptual problems (OR 4.79, 95% CI 1.25 to 25.83). Unresolved problems included: (1) doctors addressed patients’ disclosures, but patients signalled the supportive actions were unsuitable (37%) and (2) doctors left disclosures unaddressed (21%). Conclusions In this explorative study, the doctors were more likely to address the patients’ adherence problems associated with unintentional non-adherence risks than those associated with intentional non-adherence risks. Even when doctors attempted to address HF patients’ medication adherence problems, half of the problems remained unresolved, usually because patients indicated that the doctor’s suggestion to improve their situation was against their preference.

• Bjørnstad, Herman; Frigaard, Christine; Gulbrandsen, Pål; Gerwing, Jennifer; Schirmer, Henrik & Menichetti, Julia (2025). Contextual Factors Affecting Adherence Revealed by Old Patients with Heart Failure in Hospital and Primary Care Interactions: A Descriptive Study. Patient Preference and Adherence. 19, p. 1075–1087. doi: 10.2147/ppa.s505297. Full text in Research Archive Show summary

  Introduction: Old patients with heart failure are a vulnerable patient group facing various challenges, specifically during the transition from hospital to home. Non-biomedical factors, or “contextual factors”, such as patient attitudes and social support, can influence treatment adherence. However, their role in clinical interactions is not well understood. This study aimed to identify and describe how and when these factors manifest during clinical interactions in the hospital-to-home transition. Methods: We audio-recorded 42 old patients with heart failure admitted to hospital interacting with their physicians at: 1. the first ward visit, 2. discharge visit, 3. first primary care visit after discharge. Based on an umbrella review, we developed a list of 48 factors known to affect adherence among cardiovascular patients. Patient utterances from the recordings containing information on one of these factors (contextual indicators (CI)) were extracted and categorized according to the type of factor, mentioned impact, and being a facilitator or barrier to adherence. Results: From the 105 audio recordings, 742 CI were identified, each interaction containing an average of 7 CI (SD = 4.2; median = 6). CI considered to have a potential impact on patient’s life or adherence were overall evenly split between facilitators (n = 82, 42%) and barriers (n = 115, 58%), and both types of CI appeared in most patient trajectories. The most salient barrier CI was related to patients’ concerns regarding medications side effects and regimen complexity, while CI facilitators were more commonly related to patients’ knowledge, motivation and social support. Discussion: The findings from this study provide insights for clinicians to the main types of non-biomedical factors revealed by old patients with heart failure in medical interactions, which affect their treatment adherence. Clinicians should particularly consider patient concerns regarding medications’ side effects and the regimen complexity as important aspects to discuss, leveraging on motivational and social resources if present.

• Frigaard, Christine; Delor, Julia Menichetti; Schirmer, Henrik; Bjørnstad, Herman; Simonsen, Tone Breines & Wisløff, Torbjørn [Show all 8 contributors for this article] (2024). What do patients with heart failure disclose about medication adherence at home to their hospital and primary care doctors? Exploratory interaction-based observational cohort study. BMJ Open. 14(8). doi: 10.1136/bmjopen-2024-086440. Full text in Research Archive Show summary

  Abstract Objectives: The main objective of this study was twofold: to investigate what kind of information patients with heart failure (HF) tell their doctors about their medication adherence at home, and how often such information is provided in consultations where medication reconciliation is recommended. To meet these objectives, we developed an analysis to recognise, define, and count (1) patient utterances including medication adherence disclosures in clinical interactions (MADICI), (2) MADICI including red-flags for non-adherence, and (3) MADICI initiated by patients without prompts from their doctor. Design: Exploratory interaction-based observational cohort study. Inductive microanalysis of authentic patient–doctor consultations, audio-recorded at three time-points for each patient: (1) first ward visit in hospital, (2) discharge visit from hospital, and (3) follow-up visit with general practitioner (GP). Setting: Norway (2022–2023). Participants: 25 patients with HF (+65 years) and their attending doctors (23 hospital doctors, 25 GPs). Results: We recognised MADICI by two criteria: (1) they are about medication prescribed for use at home, AND (2) they involve patients’ action, experience, or stance regarding medications. Using these criteria, we identified 427 MADICIs in 25 patient trajectories: 143 (34%) at first ward visit (min–max=0–35, median=3), 57 (13%) at discharge visit (min–max=0–8, median=2), 227 (53%) at GP-visit (min–max=2–24, median=7). Of 427 MADICIs, 235 (55%) included red-flags for non-adherence. Bumetanide and atorvastatin were most frequently mentioned as problematic. Patients initiated 146 (34%) of 427 MADICIs. Of 235 ‘red-flag MADICIs’, 101 (43%) were initiated by patients. Conclusions: Self-managing older patients with HF disclosed information about their use of medications at home, often including red-flags for non-adherence. Patients who disclosed information that signals adherence problems tended to do so unprompted. Such disclosures generate opportunities for doctors to assess and support patients’ medication adherence at home.

• Løseth, Guro Engvig; Eikemo, Marie; Trøstheim, Martin; Meier, Isabell M.; Bjørnstad, Herman & Asratian, Anna [Show all 10 contributors for this article] (2022). Stress recovery with social support: A dyadic stress and support task. Psychoneuroendocrinology. ISSN 0306-4530. 146. doi: 10.1016/j.psyneuen.2022.105949. Full text in Research Archive Show summary

  How does social support bolster resilience? Here, we present a new dyadic paradigm to study causal mechanisms of acute and ecologically valid social support in the laboratory. The Dyadic Stress and Support Task (DSST) consists of a psychosocial stress phase and a recovery phase. During DSST stress, a pair of participants take turns to perform public speaking and mental arithmetic in front of a panel. Unable to see or touch each other, they witness each other’s performance and feedback. During DSST recovery, the pair either interact freely with each other for 5 min (social support condition) or interact separately with an experimenter (non-support condition). To establish the validity of the DSST, we tested 21 pairs of long-term close friends in a pilot study. Primary outcome measures were ratings of affective state and bodily arousal (VAS scales 0–100). Secondary outcome measures were heart rate and salivary cortisol. DSST stress successfully induced subjective Stress Activation, increased Negative Affect and decreased Positive Affect. We also observed increased heart rate and salivary cortisol. After DSST recovery, Stress Activation and Negative Affect ratings were reduced in both groups. Positive Affect was completely restored to pre-stress baseline levels in the Social support group, while remaining significantly lower in the Non-support group. The DSST successfully induced stress and negative affect and captured stress recovery in both groups. Free-form interaction with the friend enhanced recovery of affective state, supporting the validity of spontaneous interaction between friends as a model of social support.

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