Gro Rosvold Berntsen

Fibromyalgia (FM) causes widespread pain, poor sleep, fatigue, and reduced quality of life. Exercise is the best supported non-pharmacological treatment, yet many patients report that it is insufficient on its own. Somatic tracking is a component of pain reprocessing therapy. It is promising in chronic back pain but untested as a stand-alone intervention in FM. The Fibromyalgia Somatic Tracking and Exercise Program Study (FIBROSTEPS) is a single-center 2 × 2 factorial randomized controlled superiority trial estimating the separate and combined effects of group exercise and somatic tracking on the impact of FM. Two hundred adults aged 18–65 years, of either sex, with FM diagnosed by the 2016 criteria, are randomized 1:1:1:1 after an 8-week baseline period to general activity recommendations plus usual care (control), supervised group exercise, somatic tracking, or both. Both interventions run for 16 weeks with one session per week (45 min physiotherapist-led group exercise; 40 min guided somatic tracking with a certified therapist). The primary outcome is change in total original Fibromyalgia Impact Questionnaire score (0–100) from week 8 to week 24, analyzed by intention-to-treat. Secondary outcomes include insomnia severity, daily pain intensity, and Fitbit-measured activity and sleep. The trial has 80% power for the two main effects; the exercise × somatic-tracking interaction is prespecified as exploratory. No results are reported; the trial will provide randomized evidence on somatic tracking in FM, alone and combined with exercise, informing multi-component FM rehabilitation. Trial Registration: ClinicalTrials.gov (NCT06922747). Ethics Approval: Regional Committee for Medical and Health Research Ethics (REK), reference 2025/853403.

BACKGROUND Physicians caring for patients with complex care needs often need to review large volumes of fragmented clinical information from several sources. Whether better access to more clinical notes is sufficient, or whether information must also be summarised and visualised to support clinical work, remains uncertain. OBJECTIVE The aim was to determine whether a digital tool integrating clinical notes from several sources with elements that summarise and visualise information (“DigiTeam”) improves the quality of physicians’ written case summaries and care plans for complex patient cases, and whether any improvement reflects summarising and visualising information, access to several sources, or both. METHODS A three-arm, parallel-group, superiority randomised controlled trial among physicians in Norway. Participants were randomised to one of three digital versions: access to clinical notes from a single-source, access to clinical notes from several sources, or DigiTeam, which combined notes from several sources with summaries and visualisations. Participants reviewed three real-world pseudonymised patient cases with complex care needs and wrote a patient summary and care plan for each case. The primary outcome was the quality of the written summaries and care plans, assessed against predefined expert-derived criteria. RESULTS Of 93 randomised physicians, 90 contributed data. Access to several sources did not improve overall quality compared with single-source access (mean difference 0.5, 95% CI −2.3 to 3.3; p=0.970). DigiTeam produced higher overall quality scores than multi-sources access without summarising and visualising elements (mean difference 6.49, 95% CI 3.2 to 9.8; p<0.001) and than single-source access (mean difference 6.95, 95% CI 3.7 to 10.2; p<0.001). DigiTeam also improved perceived information support, while time spent and usability did not differ between groups. CONCLUSIONS A digital tool that summarised and visualised clinical information improved the quality of physicians’ summaries and care plans without increasing time use or reducing usability. In contrast, access to more clinical notes alone did not improve quality. These findings suggest that, for complex patient cases, how information is presented matters more than how much information is available. In short, summarised and visualised information improved quality; more information alone did not. CLINICALTRIAL ClinicalTrials.gov, NCT07142616, registered on 21 August 2025

Aim: This study aimed to describe the development and usability testing of the digital tool DigiTeam to support physicians’ clinical workflow and identify key information elements to support clinicians in managing complex patient cases. Method: This qualitative study was guided by user-centered principles with observations and interviews of physicians who tested different versions of DigiTeam. Three patients volunteered to have their full electronic health records (EHR) from the following sources: general practice, hospital, and, if relevant, municipal health and social care services, included in DigiTeam. The prototype was developed to gain knowledge on how to present complex patient case information in EHR. The key clinical principles guiding the development were to support person-centered, integrated, and proactive care. The design principles included providing overviews before details, summarizing information, and using timelines. The data were continuously analyzed to support iterative development. Results: Seventeen physicians participated, and five versions were developed. The start page was simplified and at the end included only three key information elements that supported a quick overview: patient voice, medical history summary, and main health problems with healthcare contacts displayed on a timeline. The participants highly valued the prominent inclusion of the patient’s voice, which was maintained throughout. The elements on the start page were clickable, directed to pages with summarized information, and hyperlinks to clinical notes for further details and verification of the summarized information. The participants found the summarized information valuable but initially too text-heavy, resulting in versions with less text while retaining essential details. Conclusion: It was possible to develop a digital tool that supported person-centered, integrated, and proactive care by summarizing information to provide an overview of three main information elements: what matters to the patient, the main health problems, and medical history, with easy ways to obtain more detailed information. The next step is to test the effect of DigiTeam in a randomized controlled trial. Clinical trial number: Not applicable.

BACKGROUND In the face of the demographic change, patients, authorities, and professionals express a need to radically reorganize health services for patients with long-term and complex needs (CLNs) to maintain sustainability and quality of care. In line with policy recommendations, the Patients and Professionals in Partnership (3P)-project transition from reactive, single-disase, profession-centric care to digitally supported Person-centered, Integrated, and Proactive (Digi-PIP)-care. In this paper we collected insights from a wide stakeholder group associated with 3P, representing those who use, work for, or shape the Norwegian care system. OBJECTIVE To answer the following research questions: • What do stakeholders understand by the terms digitally supported, Person-centered, Integrated, and Proactive care? • How do we transform care towards Digi-PIP care? METHODS This research was a collaborative effort involving observations and co-creation in 4 Workshops, with 104 stakeholders representing patients, informal caregivers, professionals at all levels of care, healthcare decision-makers, e-health providers, and health service researchers from four innovation hubs in Norway and Denmark. Participants worked in groups, each creating three oral poster presentations of their discussions and insights. A condensed summary of the 45 filmed presentations was the basis for an inductive/deductive content analysis structured by the research questions. RESULTS A wide range of healthcare stakeholders recognize Person-centered, Integrated, and Proactive as intuitive, critical and synergistic features of high-quality and sustainable care. Stakeholders agreed on the essence of the three concepts: • Person-centered care (PCC) is guided by the patient’s answer to the What Matters To You? (WMTY?) question. • Integrated care recognizes the patient journey as a team product that requires a digital shared information flow. • Proactive care is key to sustainability. It builds on a prioritized shared care plan, which supports patient involvement and engagement for realistic self-care and “WMTY?”-goals. In addition, proactive care involves the active use of health data, sensors and algorithms to identify opportunities for prevention/ early treatment. Stakeholders suggested a wide range of innovations to transition to Digi-PIP care: • Education and training to support professionals in the delivery of person-centered care. • New organizational roles and logic to reduce care fragmentation. • A shared digitized information flow to enable all contributors to be aware of personal goals, shared care plans, and risk-reduction strategies. CONCLUSIONS Stakeholders agreed on what Person-centered, Integrated, and Proactive care is and found these features useful in describing sustainable high-quality patient journeys. Transforming care requires multiple synergistic innovations in education, organization, and digital information systems. There is a need for further research into the regulatory and economic support of such innovation

Experts predict that no society or healthcare system will be able to sustainably care for patients with chronic conditions in the next 20 years. 1 Similarly, healthcare is increasingly unsustainable for patients, overwhelmed by the work of accessing and using healthcare services and enacting self-care routines.

Background: Antibiotic resistance is a worldwide public health problem that is accelerated by the misuse and overuse of antibiotics. Studies have shown that audits and feedback enable clinicians to compare their personal clinical performance with that of their peers and are effective in reducing the inappropriate prescribing of antibiotics. However, privacy concerns make audits and feedback hard to implement in clinical settings. To solve this problem, we developed a privacy-preserving audit and feedback (A&F) system. Objective: This study aims to evaluate a privacy-preserving A&F system in clinical settings. Methods: A privacy-preserving A&F system was deployed at three primary care practices in Norway to generate feedback for 20 general practitioners (GPs) on their prescribing of antibiotics for selected respiratory tract infections. The GPs were asked to participate in a survey shortly after using the system. Results: A total of 14 GPs responded to the questionnaire, representing a 70% (14/20) response rate. The participants were generally satisfied with the usefulness of the feedback and the comparisons with peers, as well as the protection of privacy. The majority of the GPs (9/14, 64%) valued the protection of their own privacy as well as that of their patients. Conclusions: The system overcomes important privacy and scaling challenges that are commonly associated with the secondary use of electronic health record data and has the potential to improve antibiotic prescribing behavior; however, further study is required to assess its actual effect.

Iešsorbmen lea fuopmášahtti servodat- ja álbmotdearvvašvuođaváttisvuohta globálalaččat ja sisriikkalaččat. Iešsorbmen dáhpáhuvvá maiddái sámi servodagain gos ollu gilit ja bearrašat leat bahuid vahágahtton. Eará sániiguin, Sámis leat ollu oapmahaččat maŋŋá iešsorbmema. Dát kapihtal čalmmustahttá iešguđetlágán hástalusaid maid oapmahaččat sámi guovlluin vásihit go deaivvadit báikkálaš veahkehanásahusain. Kapihttalis digaštallat hástalusaid čadnon dasa go galgá veahki oažžut smávva servodagažiin ja veahkkeásahusa váilevaš ipmárdusa. Loahpas problematiseret makkár mearkkašupmi lea máhtus ja ipmárdusas oapmahaččaid dilálašvuođa birra ja dan kultuvrralaš konteavsttas mas son eallá.

The call for person-centered care (PCC) is not new, yet despite a high priority over many decades and numerous frontline interventions, a lack of PCC persists [ 1]. We hypothesize that PCC will continue to be a secondary feature until PCC is a widely understood to be at the core of care quality.

BACKGROUND Antibiotic resistance is a worldwide public health problem that is accelerated by the misuse and overuse of antibiotics. Studies have shown that audits and feedback enable clinicians to compare their personal clinical performance with that of their peers and are effective in reducing the inappropriate prescribing of antibiotics. However, privacy concerns make audits and feedback hard to implement in clinical settings. To solve this problem, we developed a privacy-preserving audit and feedback (A&F) system. OBJECTIVE This study aims to evaluate a privacy-preserving A&F system in clinical settings. METHODS A privacy-preserving A&F system was deployed at three primary care practices in Norway to generate feedback for 20 general practitioners (GPs) on their prescribing of antibiotics for selected respiratory tract infections. The GPs were asked to participate in a survey shortly after using the system. RESULTS A total of 14 GPs responded to the questionnaire, representing a 70% (14/20) response rate. The participants were generally satisfied with the usefulness of the feedback and the comparisons with peers, as well as the protection of privacy. The majority of the GPs (9/14, 64%) valued the protection of their own privacy as well as that of their patients. CONCLUSIONS The system overcomes important privacy and scaling challenges that are commonly associated with the secondary use of electronic health record data and has the potential to improve antibiotic prescribing behavior; however, further study is required to assess its actual effect.