liu.seSearch for publications in DiVA
Change search
Link to record
Permanent link

Direct link
BETA
Bernfort, Lars
Publications (10 of 61) Show all publications
Ekberg, K., Bernfort, L., Karlsson, N., Linderoth, C. & Persson, J. (2017). Arbetsgivares kostnader, åtgärder och anpassningar för sjuknärvarande och sjukfrånvarande medarbetare: samband med återgång i arbete och produktion. Linköping: Linköping University Electronic Press.
Open this publication in new window or tab >>Arbetsgivares kostnader, åtgärder och anpassningar för sjuknärvarande och sjukfrånvarande medarbetare: samband med återgång i arbete och produktion
Show others...
2017 (Swedish)Report (Other academic)
Abstract [sv]

Studien syftade till att undersöka vilka åtgärder arbetsgivare gör för sjukskrivna medarbetare och vilka kostnader arbetsgivare och samhället har i samband med sjuknärvaro och sjukfrånvaro.

Totalt 3000 sjukskrivna personer i AFA Försäkrings register med diagnoserna psykiska besvär eller besvär i rörelseorganen fick ett informationsbrev och förfrågan om samtycke till att forskarna skulle få skicka en enkät till deras arbetsledare; 393 sjukskrivna gav samtycke. En  webbenkät skickades till dessa arbetsledare. Totalt 198 arbetsledare (50 %) till sjukskrivna personer besvarade enkäten.

Resultaten visar att arbetsgivare genomför en rad olika åtgärder och anpassningar när en medarbetare blir sjukskriven. Analyserna visade att dessa åtgärder och anpassningar i viss mån beror på vem den sjukskrivne medarbetaren är. Åtgärder och anpassningar var vanligare för sjukskrivna med psykiska diagnoser, för högutbildade och för sjukskrivna i högkvalificerade yrken. Kvinnor fick i högre grad anpassningar och åtgärder såsom ändrade arbetsuppgifter och psykosocialt stöd jämfört med män.

Demografiska faktorer visade sig ha mindre betydelse för om den sjukskrivne återgick i arbete eller ej. Multipla logistiska regressionsanalyser visade att åtgärder och anpassningar på arbetsplatsen hade signifikanta samband med en ökad chans för återgång i arbete. Resultaten visade också att för sjukskrivna medarbetare vars arbetsledare hade tagit många kontakter med andra aktörer, som HR-avdelningen, företagshälsan och/eller Försäkringskassan var sannolikheten lägre att den sjukskrivne medarbetaren återgick i arbete. Arbetsledare tog fler kontakter, om den sjukskrivne medarbetaren hade en psykisk diagnos.

Sjuknärvaro och produktionsförlust före, under och efter sjukskrivningen skattades av arbetsledarna. Sammanlagt beräknades produktionsförlusterna till cirka SEK 100 000 per sjukskrivningsfall. Härutöver lägger arbetsgivare tid på att ta kontakter, genomföra åtgärder och anpassningar och organisera om arbetet. Arbetsledare hade mycket oklar eller saknade helt uppfattning om vad tid, åtgärder och anpassningar kostar, varför detta inte har kunnat analyseras närmare. De beräknade genomsnittliga kostnaderna till följd av produktivitetsförluster är således en underskattning av de faktiska kostnaderna för arbetsgivare.

Studien visar att arbetsledares kunskap om vad sjuknärvaro och sjukfrånvaro kostar för verksamheten och för samhället är begränsad. En ökad kostnadsmedvetenhet skulle kunna stimulera till att större resurser läggs på att implementera policys för hälsofrämjande åtgärder och att utbilda arbetsledare i att hantera frågor om hälsa och arbetsförmåga på arbetsplatsen.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2017. 46 p.
Series
HELIX working papers, ISSN 1654-8213 ; 2017:3
National Category
Public Health, Global Health, Social Medicine and Epidemiology Work Sciences Social Sciences Interdisciplinary
Identifiers
urn:nbn:se:liu:diva-142072 (URN)
Available from: 2017-10-20 Created: 2017-10-20 Last updated: 2018-01-13Bibliographically approved
Roback, K., Bernfort, L., Lundqvist, M. & Alwin, J. (2016). Ordnad utmönstring av hälso- och sjukvårdsmetoder. Linköping: Linköping University Electronic Press.
Open this publication in new window or tab >>Ordnad utmönstring av hälso- och sjukvårdsmetoder
2016 (Swedish)Report (Other academic)
Alternative title[en]
Evidence based disinvestment of health care services
Abstract [sv]

Bakgrund

Det ligger en stor utmaning i att organisera en långsiktigt hållbar sjukvård som samtidigt håller hög kvalitet och är tillgänglig på lika villkor för alla medborgare.

Utmönstring i hälso- och sjukvården innebär att metoder/vårdåtgärder tas bort eller får begränsad användning inom det existerande utbudet av offentligt finansierade åtgärder. En kvalitetsförbättring pågår ständigt, där onödig, skadlig eller ineffektiv vård ersätts med nya bättre metoder, utan att det i allmänhet uppfattas som ett utmönstringsarbete. Med tiden uppstår dock en situation där det blir svårt att hitta uppenbart ”onödig, skadlig eller icke-effektiv” vård. Detta innebär att snävare prioriteringar eller ransoneringar måste göras i vårdutbudet och att utmönstring blir  en nödvändig komponent för att säkra vårdens kvalitet inom begränsade budgetramar.

Syftet med denna rapport om ordnad utmönstring är att beskriva hur utmönstring upplevs och utförs i Sveriges landsting och regioner samt hur arbetet bedrivs. Vi ger också en kortfattad översikt över vad som sker internationellt. Fenomenet utmönstring har exemplifierats genom ett antal pågående eller genomförda utmönstringsinitiativ och ett tentativt ramverk för ordnad utmönstring i en svensk kontext föreslås. Arbetet har delats upp i följande delar:

  • Intervjustudie för kartläggning av utmönstringsaktiviteter i Sverige
  • Fallstudier av aktiv utmönstring
  • Översikt över utmönstringsinitiativ internationellt
  • Beskrivning av processerna och olika typer av utmönstring i ett översiktligt ramverk

Metod

En inledande studie av litteraturen gjordes 2012 som underlag för en pilotstudie och som introduktion till ämnet. Litteratursökningen kompletterades med nya söktermer 2013 till 2015. Vidare har telefonintervjuer genomförts med experter i Sveriges landsting och regioner. En enkät konstruerades för att användas som intervjumall och för att även kunna fungera som epost-enkät om någon av våra informanter föredrog detta.

Resultat

I Sverige är det fortfarande en ganska begränsad aktivitet som kan benämnas ”ordnad utmönstring”. Utmönstring av hälso- och sjukvårdsmetoder började diskuteras öppet i början av 2000-talet, vilket ledde till att flera landsting började skissa på policyer för utmönstring, men föresatserna har inte alltid kunnat infrias. Ordnad utmönstring sker i en del landsting/regioner inom ramen för ett mer allmänt förbättringseller prioriteringsarbete och termen utmönstring används inte alltid. I intervjuerna tyckte ändå merparten att utmönstring var en viktig fråga som kräver specifik uppmärksamhet.

En ordnad utmönstring förutsätter alltid en aktiv handling, dvs. den inkluderar ett medvetet ställningstagande om att sluta använda, begränsa användning av eller dra tillbaka resurser från en existerande vårdpraxis. Utmönstringsarbetet har hittills dock i de flesta fall varit ”löst” organiserat. Den mest aktiva utmönstringen förekommer där det finns ett prioriteringsråd eller en grupp/enhet för ordnat införande och utmönstring.

I rapporten beskrivs utmönstringens komponenter och delprocesser i ett översiktligt ramverk. Frågan hur dessa processer ser ut besvarades till stor del i intervjuerna. Intervjuresultaten har sedan fogats samman med information från litteraturen i en beskrivning av hur en ordnad utmönstring kan se ut. Oavsett orsaker och mål med utmönstringsarbetet ställs man inför i stort sett samma problem och följer samma steg eller delprocesser. I stora drag består delprocesserna av:

  • identifiering av utmönstringsobjekt
  • urval och beredning av utmönstringsförslag
  • beslutsfattande
  • genomförande/implementering av beslut samt
  • uppföljning och eventuell omprövning av beslutad utmönstring

En av de delprocesser som hittills inte fått mycket uppmärksamhet är hur utmönstringsbesluten implementeras i verksamheterna. Detta verkar dock vara ett område på uppgång internationellt och vi har därför valt att utveckla detta i ramverket. Liksom vid implementering av nya metoder finns det vid utmönstring en rad strategier och praktiska åtgärder för att underlätta och påskynda den önskvärda förändringen. Dessa strategier bygger på olika mekanismer för att eliminera hinder och utnyttja drivkrafter.

För att illustrera de resultat som läggs fram i rapporten presenteras fyra utmönstringsfall lite mer ingående. Dessa visar hur det kan gå till när metoder identifieras som utmönstringsobjekt, hur ärenden bereds och genomförs samt vilka diskussioner som kan uppstå. Fallen har valts ut för att visa variationen i typ av utmönstringsobjekt och i utfall av utmönstringsarbetet.

Intresset för utmönstring har ökat internationellt under senare år. Problematiken med ökade kostnader för hälso- och sjukvården finns överallt i världen och utmönstring diskuteras i många länder. Från början var fokus på att utmönstra för att effektivisera vården. Utvecklingen gick sedan mot en omvärdering (re-assessment) av äldre metoder för att kunna göra evidensbaserade utmönstringar. Detta resulterade i så kallade ”low-value-lists” och ”do-not-do”- rekommendationer. Idag ställer man frågan hur de olika utmönstringsinitiativen fallit ut och studier har visat att efterlevnaden till”low-value-lists” är ganska blygsam.

Slutsatser

Mycket talar för att effektivare utmönstringsprocesser kommer att krävas för att få en långsiktigt hållbar finansiering av hälso- och sjukvården. Ivår studie har vi kunnat fastställa att utmönstring används för såväl effektivisering av vården som för kostnadskontroll.

  • De flesta landsting/regioner arbetar med eller har arbetat med utmönstring enligt definitionen beslut om att ta bort eller begränsa användningen av metoder/vårdåtgärder inom den offentligt finansierade hälso- och sjukvården.
  • De huvudsakliga anledningarna till att ta bort metoder är att man behöver: utveckla verksamheten, omfördela resurser till nya metoder, kontrollera kostnaderna och/eller effektivisera vården.
  • Vi identifierade två huvudtyper av ordnad utmönstring i Sverige: - ordnat införande med utmönstring som en integrerad del (”in/ututmönstring”) samt - proaktiv identifiering av utmönstringsobjekt med en efterföljande beredning och prioritering av objekten.
  • Metoder som utmönstras är en blandning av läkemedel, ickefarmakologiska metoder och sätt att organisera vården.
  • Många metoder som utmönstrats finns kvar som privat finansierade alternativ.
  • Prioriteringsprinciper är ofta vägledande i utmönstringsarbetet liksom metoder för evidensbaserad medicin och medicinsk teknologiutvärdering.
  • Viktiga kriterier för klassificering som utmönstringskandidat är att: - metoden har skadliga effekter eller mycket liten klinisk nytta - metoden inte är kostnadseffektiv - metoden upplevs ha negativa effekter på organisation och/eller arbetsmiljö
  • Det finns även metoder som utmönstrats pga. etiska ställningstaganden om vad den offentligt finansierade vården ska täcka in, utöver riksdagens etiska principer för prioritering eller enligt särskilda tolkningar av dessa.
  • Utmönstring sker idag utan någon högre grad av medborgarinflytande i processerna och dokumentationen av arbetet, i den mån sådan finns, är oftast inte lätt åtkomlig.

För att förbättra vårdkvaliteten och samtidigt kontrollera kostnaderna för sjukvården krävs att utmönstring blir en nationell fråga. Etiskt svåra frågeställningar i samband med utmönstring har gjort att detta är ett problem som beslutsfattare på regional politisk och administrativ nivå har svårt att tackla. Konflikter kan uppstå mellan patientens intressen och vårdgivarens budgetansvar och det är inte alltid lätt att avgöra vilka metoder som är medicinskt motiverade att använda i enskilda patientfall, vilket gjort att etiska dilemman uppstått.

Oavsett vilka etiska dilemman och svårigheter som uppstår, och vilken organisatorisk nivå besluten än fattas på, så kommer det att behövas en användbar arbetsmodell för att aktivt ta bort metoder från det offentliga vårdutbudet. I vår studie har vi skissat på ett ramverk som beskriver processerna i grova drag och där medicinska och ekonomiska såväl som sociala och etiska aspekter inkluderas.

Abstract [en]

Background

It is a great challenge to provide a sustainable health care that maintain high quality and is available on equal terms for all citizens.

Disinvestment in health care implies that existing health care services/interventions are removed from the publicly funded supply of health care or that they will be restricted in use. Quality improvements are continuously performed and unnecessary, harmful or ineffective services are replaced with new and better ones. This is generally not perceived as disinvestment. With time, however, a situation arises where it will be difficult to find "unnecessary, harmful or ineffective" care. This implies that clear priorities must be set for the provision of care and that evidence based disinvestment will be a necessary component to ensure the quality of care within limited budgets.

The aim of this report on evidence based disinvestment is to describe how this is perceived and performed in Sweden's county councils and regions. We also give a brief overview of international disinvestment initiatives. The concept of disinvestment is illustrated by a number of ongoing or completed disinvestment initiatives and through a tentative framework for disinvestment in a Swedish context. The work has four parts:

  • An interview study for mapping disinvestment activities in Sweden
  • Case studies of active disinvestment
  • An overview of disinvestment initiatives internationally
  • A description of disinvestment processes and different types of disinvestment in a schematic framework

Methods

An initial literature search was performed in 2012 as a basis for a minor pilot study and to provide an introduction to the subject. The literature search was supplemented with new search terms in 2013 and 2015. The interviews were conducted by telephone with experts at Sweden's county councils and regions. A questionnaire was constructed to be used as an interview template and to serve as an e-mail survey in case any of our informants preferred this.

Results

In Sweden, open discussions on disinvestment of health care practices began in the early 2000s, which led to several counties starting to sketch on disinvestment policies. Few policies were, however, realized in practice. Organized disinvestment occurs in some counties/regions in the context of more general improvement or prioritization efforts and the term disinvestment is not always used. The majority of our respondents still thought that disinvestment was a significant issue requiring special attention.

An evidence based disinvestment is always active, that is, it includes a conscious decision to stop using, restrict the use of, or withdraw resources from existing healthcare practices. The disinvestment work, however, was in most cases not clearly organized. The most active disinvestment work occurs where there is a priority setting committee or a group for evidence based adoption and disinvestment.

This report describes disinvestment components and sub-processes in a schematic framework. The character of these processes was in large mapped by the interviews. Interview results were then synthesized with information from the literature into a tentative description of evidence based disinvestment. Whatever the causes and goals with disinvestment, the same problems arise and the work follows in large the same steps or sub-processes. Broadly, these sub-processes are:

  • identification of disinvestment objects
  • choice and preparation/assessment of disinvestment proposals
  • decision making
  • implementation of decisions and
  • follow-up and possible revision of decided disinvestments

One of the sub-processes, that so far received little attention in Sweden, is how disinvestment decisions are implemented in operational health care. We have chosen to develop this in the framework as it seems to be an area on the rise internationally. There is a range of strategies and practical measures to facilitate and accelerate a desired change. This has been thoroughly investigated regarding implementation of new methods. Such strategies are based on different mechanisms to eliminate barriers and utilize facilitators.

To illustrate the results presented in the report we present four cases of disinvestment in a little more detail. These are examples of how practices are identified as disinvestment objects, the preparation of cases, implementation of decisions, and of controversies that might arise. The cases have been selected to show the variation in types of disinvestment objects and the outcomes of disinvestment initiatives.

Disinvestment has gained increased interest internationally in recent years. The problem of rising health care costs is present everywhere in the world and disinvestment is discussed in many countries. Early on, the focus was on disinvestment for greater efficiency. Then the trend turned to re-assessment of old services to be able to make evidence-based disinvestments. This resulted in so-called "low-value-lists" and "do-notdo" recommendations. Today, the focus is on measurable outputs of different disinvestment initiatives and studies have shown that compliance with "low-value-lists" is modest.

Conclusions

There are many indications that the future will call for efficient disinvestment processes to obtain a sustainable health care financing. Our study shows that disinvestment is used both for efficiency reasons and for cost control.

  • Most counties/regions are using or have used disinvestment; defined as decisions to withdraw or restrict the use of services/interventions in publicly funded health care.
  • The main reasons for disinvestment is the need for: quality improvements, reallocation of resources to new practices, cost control and/or better efficiency.
  • We identified two main types of organized disinvestment in Sweden: -  evidence based adoption including disinvestment as an integral part, and - proactive identification of disinvestment objects with a subsequent assessment and prioritization of the objects.
  • Services that are withdrawn or restricted in use is a mixture of pharmaceuticals, non-pharmaceutical methods and organizational arrangements.
  • Many withdrawn services remains available as privately funded options.
  • Prioritization principles are often indicative of disinvestment work and evidence-based medicine and health technology assessment are considered as obvious components.
  • Important criteria for classification as disinvestment candidates are: - the service/intervention has adverse effects or very little clinical benefit - the service/intervention is not cost effective - the service/intervention is perceived to have negative effects on the organization and/or work environment
  • There are also services that have been removed due to ethical considerations on what publicly funded healthcare should cover.
  • Today, disinvestment takes place without sufficient openness and citizen involvement in the processes. Documentation of the work, to the extent there is any, is usually not readily accessible.

In order to improve health care quality, and at the same time control rising costs, it will be required that disinvestment is placed on the national agenda. Ethically difficult considerations associated with disinvestment have made it a question hard to tackle for decision makers at the regional political and administrative levels. Conflicting interests may arise between the patient and the caregiver's budgetary commitment. It is not always easy to determine which interventions are medically and socially justified in the individual patient case, which induces ethical dilemmas.

Regardless of the ethical dilemmas and difficulties that arise – and at which organizational level decisions are made – a useful working model will be required for active withdrawal of services from the supply of publicly funded health care. In our study, we have outlined a framework that describes the processes, including medical and economic as well as social and ethical aspects.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2016. 109 p.
Series
CMT Report, ISSN 0283-1228 (print), 1653-7556 (online) ; 2016:2
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-128619 (URN)LIU CMT RA/1602 (ISRN)
Available from: 2016-05-25 Created: 2016-05-25 Last updated: 2016-09-23Bibliographically approved
Hallert, E., Husberg, M., Kalkan, A. & Bernfort, L. (2016). Rheumatoid arthritis is still expensive in the new decade: a comparison between two early RA cohorts, diagnosed 1996-98 and 2006-09. Scandinavian Journal of Rheumatology, 45(5), 371-378.
Open this publication in new window or tab >>Rheumatoid arthritis is still expensive in the new decade: a comparison between two early RA cohorts, diagnosed 1996-98 and 2006-09
2016 (English)In: Scandinavian Journal of Rheumatology, ISSN 0300-9742, E-ISSN 1502-7732, Vol. 45, no 5, 371-378 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES:

To calculate total costs during the first year after diagnosis in 463 patients with early rheumatoid arthritis (RA) included during 2006-09 (T2) and compare the results with a similar cohort included in 1996-98 (T1).

METHOD:

Clinical and laboratory data were collected regularly in both cohorts, and patients completed biannual questionnaires reporting health care utilization and number of days lost from work.

RESULTS:

Disease activity was similar in both cohorts T1 and T2 at inclusion. Significant improvements were seen during the first year in both cohorts but were more pronounced in T2. Outpatient care increased and hospitalization decreased in T2 compared with T1. Almost 3% of patients had surgery in both cohorts, but in T2, only women had surgery. Drug costs were higher in T2 than in T1 (EUR 689 vs. EUR 435). In T2, 12% of drug costs were direct costs and 4% were total costs. The corresponding values for T1 were 9% and 3%. In T1, 50% were prescribed disease-modifying anti-rheumatic drugs (DMARDs) at inclusion, compared to T2, where prescription was > 90%. Direct costs were EUR 5716 in T2 and EUR 4674 in T1. Costs for sick leave were lower in T2 than in T1 (EUR 5490 vs. EUR 9055) but disability pensions were higher (EUR 4152 vs. EUR 2139), resulting in unchanged total costs. In T1, direct costs comprised 29% and indirect costs 71% of the total costs. The corresponding values for T2 were 37% and 63%.

CONCLUSIONS:

The earlier and more aggressive treatment of RA with traditional DMARDs in T2 resulted in better outcomes compared to T1. Direct costs were higher in T2, partly offset by decreased sick leave, but total costs remained unchanged.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2016
National Category
Rheumatology and Autoimmunity Dermatology and Venereal Diseases Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:liu:diva-126395 (URN)10.3109/03009742.2015.1126344 (DOI)000383010700005 ()26854719 (PubMedID)
Note

Funding agencies: Medical Research County Council of South-East Sweden (FORSS); County Council in Ostergotland

Available from: 2016-03-23 Created: 2016-03-23 Last updated: 2017-05-03
Hallert, E., Husberg, M., Kalkan, A., Rahmqvist, M., Skogh, T. & Bernfort, L. (2015). Changes in sociodemographic characteristics at baseline in two Swedish cohorts of patients with early rheumatoid arthritis diagnosed 1996-98 and 2006-09. Scandinavian Journal of Rheumatology, 44(2), 100-105.
Open this publication in new window or tab >>Changes in sociodemographic characteristics at baseline in two Swedish cohorts of patients with early rheumatoid arthritis diagnosed 1996-98 and 2006-09
Show others...
2015 (English)In: Scandinavian Journal of Rheumatology, ISSN 0300-9742, E-ISSN 1502-7732, Vol. 44, no 2, 100-105 p.Article in journal (Refereed) Published
Abstract [en]

Objectives: To compare baseline sociodemographic characteristics in two rheumatoid arthritis (RA) cohorts enrolled 10 years apart, and to examine differences with respect to the general population. Method: Clinical and sociodemographic data were collected in 320 early RA patients during 1996-98 (TIRA-1) and 467 patients in 2006-09 (TIRA-2). Multivariate logistic regression tests were performed and intercohort comparisons were related to general population data, obtained from official databases. Results: TIRA-2 patients were older than TIRA-1 (58 vs. 56 years). Women (both cohorts, 67%) were younger than men in TIRA-1 (55 vs. 59 years) and in TIRA-2 (57 vs. 61 years). Disease activity was similar but TIRA-2 women scored worse pain and worse on the HAQ. Approximately 73% were cohabiting, in both cohorts and in the general population. Education was higher in TIRA-2 than in TIRA-2 but still lower than in the general population. Women had consistently higher education than men. Education was associated with age, younger patients having higher education. In both cohorts, lower education was associated with increased disability pension and increased sick leave. Sick leave was lower in TIRA-2 than in TIRA-1 (37% vs. 50%) but disability pension was higher (16% vs. 10%). In TIRA-1, 9% of women had disability pension compared with 17% in TIRA-2. A similar decrease in sick leave and an increase in disability pension were also seen in the general population. Older age and a higher HAQ score were associated with increased sick leave and being in the TIRA-2 cohort was associated with decreased sick leave. Conclusions: TIRA-2 patients were slightly older, better educated, had lower sick leave and higher disability pension than those in TIRA-1. Similar changes were seen simultaneously in the general population. Belonging to the TIRA-2 cohort was associated with decreased sick leave, indicating that societal changes are of importance.

Place, publisher, year, edition, pages
Informa Healthcare, 2015
National Category
General Practice
Identifiers
urn:nbn:se:liu:diva-117271 (URN)10.3109/03009742.2014.930926 (DOI)000351182100003 ()25352338 (PubMedID)
Note

Funding Agencies|Norrbacka-Eugenia Foundation; Medical Research County Council of South-East Sweden (FORSS); County Council in Ostergotland; Swedish Rheumatism Association

Available from: 2015-04-22 Created: 2015-04-21 Last updated: 2018-01-11
Bernfort, L., Levin, L.-Å. & Gerdle, B. (2015). Chronic pain in a population 65 years and older: correlation with age of health care costs and quality of life. In: : . Paper presented at The 9th Congress of the European Pain Federation, EFIC,majestic city, Vienna 2-5 September 2015. .
Open this publication in new window or tab >>Chronic pain in a population 65 years and older: correlation with age of health care costs and quality of life
2015 (English)Conference paper, Poster (with or without abstract) (Refereed)
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-126438 (URN)
Conference
The 9th Congress of the European Pain Federation, EFIC,majestic city, Vienna 2-5 September 2015
Available from: 2016-03-24 Created: 2016-03-24 Last updated: 2016-04-06
Bernfort, L., Gerdle, B., Rahmqvist, M., Husberg, M. & Levin, L.-Å. (2015). Chronic pain in an elderly population in Sweden: Impact on costs and quality of life. Linköping: Linköping University Electronic Press.
Open this publication in new window or tab >>Chronic pain in an elderly population in Sweden: Impact on costs and quality of life
Show others...
2015 (English)Report (Other academic)
Abstract [en]

Chronic pain among elderly people has long been a well-known problem, in terms of both societal costs and the quality of life of affected individuals. To estimate the magnitude of the problems associated with chronic pain in an elderly population, data on both costs and quality of life were gathered. A postal questionnaire was sent out to a stratified sample of 10 000 inhabitants 65 years and older in Linköping and Norrköping. The survey included questions on demographics, habits, and life situation, and different kinds of questions and instruments related to well-being (e.g., quality-of-life and pain-specific questions). In the questionnaire respondents were asked whether they were receiving any help—informal care—from a relative. If they answered yes, they were asked for permission to contact the informal caregiver and to provide contact details. The amount of informal care provided by relatives to persons with chronic pain was investigated by use of a questionnaire directed to the caregiving relatives, containing questions about time spent providing informal care.

Data on costs were collected from registers of consumption of health care, drugs, and municipal services.

The results of the study showed a very clear association between existence and severity of chronic pain and societal costs. The study population was subdivided into three groups with respect to having chronic pain or not, and a pain intensity during the last week of 0–4 (mild), 5–7 (moderate), or 8–10 (severe) on a scale of 0–10. Taking all costs (health care, drugs, municipal services, and informal care) into account, persons in the severe chronic pain group consumed on average 72% more resources than persons in the moderate chronic pain group and 143% more than those in the no or mild chronic pain group. Differences were most pronounced concerning municipal services and informal care costs.

Even more alarming are the results on the quality of life of persons in the different groups. On the EQ-5D index, the average value for persons in the no or mild chronic pain group was 0.82. For those in the moderate chronic pain group the average value was 0.64, and for those in the severe chronic pain group the average value was only 0.38. EQ-VAS resulted in less pronounced but still clearly significant differences.

It is concluded that this study, reaching a rather large part of the target population, shows that existence and severity of chronic pain among people 65 years and older affects costs to society and the quality of life of affected individuals in a massive way.

Abstract [sv]

Kronisk smärta bland äldre är sedan länge ett välkänt problem, både i termer av samhälleliga kostnader och i termer av nedsatt livskvalitet hos drabbade individer. I syfte att uppskatta omfattningen av problemen med kronisk smärta i den äldre befolkningen insamlades data avseende såväl kostnader som livskvalitet. Ett frågeformulär sändes med post ut till ett stratifierat urval om 10 000 invånare 65 år och äldre i Linköpings och Norrköpings kommuner. Frågeformuläret innehöll frågor om demografi, levnadsvanor, livssituation samt olika frågor och instrument relaterade till personernas mående (t.ex. livskvalitet och smärtspecifika frågor). I frågeformuläret tillfrågades respondenterna om huruvida de mottog någon hjälp, informell vård, från någon närstående. Om så var fallet tillfrågades respondenten om tillstånd att kontakta dennes informella vårdgivare, samt kontaktuppgifter. Mängden informell vård tillhandahållen av närstående undersöktes med hjälp av ett frågeformulär innehållande frågor om tid som använts till informella vårdinsatser.

Uppgifter om kostnader inhämtades från register avseende konsumtion av sjukvård, läkemedel och kommunala insatser.

Studiens resultat visade på ett mycket tydligt samband mellan å ena sidan förekomst och grad av kronisk smärta och å andra sidan samhälleliga kostnader. Studiepopulationen delades in i tre grupper med avseende på kronisk smärta eller inte, och smärtintensitet på en 10-gradig skala under den senaste veckan (0–4 = lindrig, 5–7 = måttlig, 8–10 = svår). Med hänsyn tagen till alla kostnader (sjukvård, läkemedel, kommunal service och informell vård) konsumerade personerna med svår kronisk smärta i snitt 72% mer resurser än personerna med måttlig kronisk smärta, och 143% mer än personer med ingen eller lindrig kronisk smärta. Skillnaderna var tydligast avseende kommunala insatser och informell vård.

Ännu mer uppseendeväckande är resultaten gällande livskvalitet för personer i de olika grupperna. Genomsnittligt indexvärde utifrån EQ-5D var för personer med ingen eller lindrig kronisk smärta 0.82. För personer med måttlig kronisk smärta var motsvarande värde 0.64, och för personer med svår kronisk smärta var värdet 0.38. EQ-VAS resulterade i mindre uttalade men tydligt signifikanta skillnader.

Denna studie, som når en relativt stor andel av målpopulationen, visar att förekomst och intensitet av kronisk smärta bland personer 65 år och äldre påverkar samhälleliga kostnader och drabbade personers livskvalitet mycket tydligt.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2015. 32 p.
Series
CMT Report, ISSN 0283-1228 (print), 1653-7556 (online) ; 2015:2
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-117729 (URN)CMT RA/1502 (ISRN)
Available from: 2015-05-07 Created: 2015-05-07 Last updated: 2016-09-23Bibliographically approved
Persson, J., Bernfort, L., Wåhlin, C., Öberg, B. & Ekberg, K. (2015). Costs of production loss and primary health care interventions for return-to-work of sick-listed workers in Sweden. Disability and Rehabilitation, 37(9), 771-776.
Open this publication in new window or tab >>Costs of production loss and primary health care interventions for return-to-work of sick-listed workers in Sweden
Show others...
2015 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 37, no 9, 771-776 p.Article in journal (Refereed) Published
Abstract [en]

Purpose: The aim of this study was to investigate, from the perspective of society, the costs of sick leave and rehabilitation of recently sick-listed workers with musculoskeletal disorders (MSD) or mental disorders (MD). Methods: In a prospective cohort study, 812 sick-listed workers with MSD (518) or MD (294) were included. Data on consumption of health care and production loss were collected over six months from an administrative casebook system of the health care provider. Production loss was estimated based on the number of sick-leave days. Societal costs were based on the human capital approach. Results: The mean costs of production loss per person were EUR 5978 (MSD) and EUR 6381 (MD). Health care interventions accounted for 9.3% (MSD) and 8.2% (MD) of the costs of production loss. Corresponding figures for rehabilitation activities were 3.7% (MSD) and 3.1% (MD). Health care interventions were received by about 95% in both diagnostic groups. For nearly half of the cohort, no rehabilitation intervention at all was provided. Conclusions: Costs associated with sick leave were dominated by production loss. Resources invested in rehabilitation were small. By increasing investment in early rehabilitation, costs to society and the individual might be reduced. Implications for Rehabilitation Resources invested in rehabilitation for sick-listed with musculoskeletal and mental disorders in Sweden are very small in comparison with the costs of production loss. For policy makers, there may be much to gain through investments into improved rehabilitation processes for return to work. Health care professionals need to develop rehabilitative activities aiming for return to work, rather than symptoms treatment only.

Keyword
Economic analysis; Sweden; mental disorders; musculoskeletal disorders; rehabilitation; sick leave; societal costs
National Category
Basic Medicine
Identifiers
urn:nbn:se:liu:diva-114181 (URN)10.3109/09638288.2014.941021 (DOI)000352139300006 ()25055999 (PubMedID)
Available from: 2015-02-11 Created: 2015-02-11 Last updated: 2018-01-11
Ekberg, K., Wåhlin, C., Persson, J., Bernfort, L. & Öberg, B. (2015). Early and Late Return to Work After Sick Leave: Predictors in a Cohort of Sick-Listed Individuals with Common Mental Disorders. Journal of occupational rehabilitation, 25(3), 627-637.
Open this publication in new window or tab >>Early and Late Return to Work After Sick Leave: Predictors in a Cohort of Sick-Listed Individuals with Common Mental Disorders
Show others...
2015 (English)In: Journal of occupational rehabilitation, ISSN 1053-0487, E-ISSN 1573-3688, Vol. 25, no 3, 627-637 p.Article in journal (Refereed) Published
Abstract [en]

Objectives The study aims to identify individual and workplace factors associated with early return to work (RTW)-defined as within 3 months-and factors associated with later RTW-between 3 and 12 months after being sick-listed-in a cohort of newly sick-listed individuals with common mental disorders. Methods In a prospective cohort study, a cross-sectional analysis was performed on baseline measures of patients granted sick leave due to common mental disorders. A total of 533 newly sick-listed individuals fulfilled the inclusion criteria and agreed to participate. A baseline questionnaire was sent by post within 3 weeks of their first day of certified medical sickness; 354 (66 %) responded. Those who were unemployed were excluded, resulting in a study population of 319 individuals. Sick leave was recorded for each individual from the Social Insurance Office during 1 year. Analyses were made with multiple Cox regression analyses. Results Early RTW was associated with lower education, better work ability at baseline, positive expectations of treatment and low perceived interactional justice with the supervisor. RTW after 3 months was associated with a need to reduce demands at work, and turnover intentions. Conclusions Early RTW among sick-listed individuals with common mental disorders seems to be associated with the individuals need to secure her/his employment situation, whereas later RTW is associated with variables reflecting dissatisfaction with work conditions. No health measures were associated with RTW. The study highlights the importance of considering not only health and functioning, but also workplace conditions and relations at the workplace in implementing RTW interventions.

Place, publisher, year, edition, pages
Springer Verlag (Germany), 2015
Keyword
Common mental disorders; Return to work; Work conditions; Sick leave duration
National Category
Basic Medicine Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-121301 (URN)10.1007/s10926-015-9570-9 (DOI)000359948000017 ()25634798 (PubMedID)
Note

Funding Agencies|Swedish Research Council for Health, Working Life and Welfare (FORTE); County Council of Ostergotland, Sweden

Available from: 2015-09-16 Created: 2015-09-14 Last updated: 2018-01-11Bibliographically approved
Bernfort, L., Gerdle, B., Rahmqvist, M., Husberg, M. & Levin, L.-Å. (2015). Severity of chronic pain in an elderly population in Sweden-impact on costs and quality of life. Pain, 156(3), 521-527.
Open this publication in new window or tab >>Severity of chronic pain in an elderly population in Sweden-impact on costs and quality of life
Show others...
2015 (English)In: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 156, no 3, 521-527 p.Article in journal (Refereed) Published
Abstract [en]

Chronic pain is associated with large societal costs, but few studies have investigated the total costs of chronic pain with respect to elderly subjects. The elderly usually require informal care, care performed by municipalities, and care for chronic diseases, all factors that can result in extensive financial burdens on elderly patients, their families, and the social services provided by the state. This study aims to quantify the societal cost of chronic pain in people of age 65 years and older and to assess the impact of chronic pain on quality of life. This study collected data from 3 registers concerning health care, drugs, and municipal services and from 2 surveys. A postal questionnaire was used to collect data from a stratified sample of the population 65 years and older in southeastern Sweden. The questionnaire addressed pain intensity and quality of life variables (EQ-5D). A second postal questionnaire was used to collect data from relatives of the elderly patients suffering from chronic pain. A total of 66.5% valid responses of the 10,000 subjects was achieved; 76.9% were categorized as having no or mild chronic pain, 18.9% as having moderate chronic pain, and 4.2% as having severe chronic pain. Consumed resources increased with the severity of chronic pain. Clear differences in EQ-5D were found with respect to the severity of pain. This study found an association between resource use and severity of chronic pain in elderly subjects: the more severe the chronic pain, the more extensive (and expensive) the use of resources.

Place, publisher, year, edition, pages
Elsevier / Lippincott, Williams andamp; Wilkins, 2015
Keyword
Age; Costs; Elderly; Intensity; Pain; Severity
National Category
Clinical Medicine Basic Medicine
Identifiers
urn:nbn:se:liu:diva-116965 (URN)10.1097/01.j.pain.0000460336.31600.01 (DOI)000350526300021 ()25599240 (PubMedID)
Note

Funding Agencies|Grunenthal Sweden AB

Available from: 2015-04-13 Created: 2015-04-10 Last updated: 2018-01-11
Bernfort, L., Eckard, N., Husberg, M. & Alwin, J. (2014). A case of community-based fall prevention: Survey of organization and content of minor home help services in Swedish municipalities. Scandinavian Journal of Public Health, 42(7), 643-8.
Open this publication in new window or tab >>A case of community-based fall prevention: Survey of organization and content of minor home help services in Swedish municipalities
2014 (English)In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 42, no 7, 643-8 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The aim of this study was to survey minor home help services provided by Swedish municipalities with the main purpose to prevent fall injuries.

METHODS: If minor home help services were presented on the homepage of a municipality, an initial telephone contact was taken. Thereafter a questionnaire was administered, including questions about target groups, aim with the services, tasks included, costs and restrictions for users, budget, and experienced gains with the services. Municipalities not providing minor home help services were asked about the reason therefore and if the municipality had previously provided the services Results: The questionnaire response rate was 92%. In 191 of Sweden's 290 municipalities services were provided by, or in cooperation with, the municipality. Reasons for not providing the services were mainly financial and lack of demand. Services were more often provided in larger cities and in municipalities located in populous regions. In some municipalities services were performed by persons with functional disabilities or unemployed persons. CONCLUSIONS: BOTH PROVIDERS AND USERS EXPRESSED SATISFACTION WITH THE SERVICES ASPECTS EXPRESSED WERE THAT SERVICES LEAD TO GREATER SENSE OF SAFETY AND SOCIAL GAINS THE EFFECT OF THE SERVICES IN TERMS OF FALL PREVENTION IS YET TO BE PROVED WITH ONLY A SMALL FALL-PREVENTIVE EFFECT SERVICES ARE PROBABLY COST-EFFECTIVE IMPROVED QUALITY OF LIFE, SENSE OF SAFETY, AND BEING ABLE TO OFFER MEANINGFUL WORK TO OTHERWISE UNEMPLOYED PERSONS ARE IMPORTANT ASPECTS THAT MIGHT IN THEMSELVES MOTIVATE THE PROVISION OF MINOR HOME HELP SERVICES.

Place, publisher, year, edition, pages
Sage Publications, 2014
Keyword
Fall prevention, home help services, elderly, persons with disabilities, municipal services, organization, health policy
National Category
Health Sciences
Identifiers
urn:nbn:se:liu:diva-111783 (URN)10.1177/1403494814544400 (DOI)000344066600013 ()25114065 (PubMedID)
Available from: 2014-11-03 Created: 2014-11-03 Last updated: 2017-12-05Bibliographically approved
Organisations

Search in DiVA

Show all publications