Table 3 Strategies and perceived impact of PCC practices and exemplifying citations

Strategies

Citations

1. Promoting early diagnosis and early contact with new patients

#1: Pain in the joints is more for primary healthcare. You can fill in the form before going to the primary care physician or nurse, and they will read it. When a (new) patient comes to us on referral, then this should already have been done. (Participant 2, round 2)

2. Sharing of health information and health plans

#3: At the end of the visit I print out the plan for the patient and we go through it together. “The goal is for you to be able to ski again, you shall contact the physiotherapist, you start with this drug and we follow up in 3 months. Lab tests will be taken and you will be contacted if we see anything, you can always contact us”. Then the patient knows what goes on and have it writing. (Participant 4, round 1)

3. Offering digital patient-professional communication

#8: You do your PER registration and lab tests as usual, but we have built a questionnaire, which was an idea that came from a patient who said,” I want to set my agenda for the meeting”, which is great. So we made a form and also included questions we tend to forget to ask, for example about dental certificates. Then you do not have to come here. Based on this form, the lab tests and the PER registration, you can choose whether you prefer contact via phone or video, or no contact if you feel well. (Participant 4, round 2)

4. Shifting tasks and initiatives from healthcare professionals to patients

#5: It is for the patient to gain power and knowledge and to become more involved. If we agree that the patient needs to submit lab tests once every 6 months, it is up to the patient to remember. I cannot force anyone to perform tests every 6 months and it is good to have less referrals so we can do more crucial things. So different reasons, but mainly for the patient to be able to do it on their own and access their results. (Participant 4, round 1)

#6: I file pre-registered data on how the patient has felt in the medical record so that we can discuss what we think about it during the meeting. Patients become involved in how their disease has evolved over time and then they remember. (Participant 7, round 1)

5. Providing support for self-care

#10 & #11: We constantly try to work with these new mobile apps and try them out. We inform our patients about them so they can choose if they think any app could be valuable for them. This is how you have to work, to keep informing about what is available and then it is up to the patients to decide. (Participant 3, round 1)

Strategies

Citations

6. Using regular follow-ups of quality indicators

The quality registry send out reports every 3 months and we have started to use it a more actively during staff meetings. We will work with it to see what happens at this unit. (Participant 2, round 2)

7. Arranging weekly unit meetings for continuous improvement and learning

We have a whiteboard where anyone can post a note to be discussed during our meetings. It can be anything, positive comments, constructive criticism, something that works well, or experiences, a digital tool that is not working properly. It is very positive, it means that you are constantly questioning how we work, really think in new ways and try to develop what we do. (Participant 3, round 1)

8. Operating as a test and improve-ment hub for digital tools

The “Care close to you” application (#9) is being developed by the region and we participate as active as we can. With this app you will be able to do many things, case management, patients will be able to send images of rashes etc. We have high expectations on this application. (Participant 4, round 2)

9. Collaborating with patient representatives in research and development

Today’s presentation for the patient council of the app “Care close to you” is an introduction in order to create a project group that will work with the development of the app. Anyone who is interested is welcome to join the group. Everyone present at today’s meeting is informed that either they or colleagues who are particularly interested and/or knowledgeable are welcome. The project team will meet a few times during the fall and together work out desirable content for the app. (Document 10)

10. Engaging patients in waiting rooms in improvements

The formal patient council was important in the beginning and still is, but now we have more micro-meetings or direct conversations with patients. You dare to ask the patients directly what they thought about the visit, if there was something that didn’t feel good. (Participant 1, round 2)

Perceived impact

Citations

Shift in the patient role

E-health services help patients to involve themselves in their own care. With online access to their own medical record, their health plan with what we together talked about, and to beforehand send what you want to talk about we have opened up for talks on the things the patient finds important, not just what we want to know. (Participant 2, round 2)

Shift in the health care professional role

A patient who reads their medical record and lab tests and can check the adverse effects. It is good to share the responsibility, it makes me feel secure. To cooperate with the patient instead of putting all responsibility on me helps. A patient who contributes is what a physician needs. (Participant 9, round 2)

Behavioral and cultural change at the unit

Changes of attitudes and climate are needed, in both directions. Caregivers may not be used to including patients like this, and all patients may not be comfortable with being asked their opinion if they want the caregiver to know. So it is attitude and cultural change …not resistance. It does not always run entirely frictionless. (Participant 1, round 2)