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Day-to-day Rationing of Limited Resources in Swedish routine Primary Care: an interview study
Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
Department of Nursing, School of Health and Sciences, Jönköping, Sweden.
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2013 (English)Manuscript (preprint) (Other academic)
Abstract [en]

Background: Rationing is a reality in all health care, but little is known about day-to-day rationing in routine primary health care (PHC). This study aims to explore strategies to handle limited of resources in Swedish routine primary care.

Methods: Data were compiled from 62 interviews with healthcare professionals (general practitioners, nurses, physiotherapists, and managers at primary care centres). A qualitative research method was applied in the analysis.

Results: The interviewed staff described perceptions of a general public with high expectations on PHC in combination with a lack of resources. Strategies to cope with scarce resources were avoiding rationing, ad hoc rationing, or planned rationing. Rationing was largely implicit and not based on ethical principles or other defined criteria. Trying to avoid rationing resulted in unintended rationing. Ad hoc rationing had undesired consequences, e.g. inadequate continuity of care and displacing certain patient groups, especially the chronically ill and the elderly. The staff expressed a need for support and for applicable guidelines, and called for policy statements based on priority decisions to help manage the situation.

Conclusions: The interviews suggested a need to improve the transparency of priority setting procedures in PHC, although the nature of the PHC setting presents special challenges. Improving transparency could, in turn, improve equity and the efficient use of resources in PHC.

Place, publisher, year, edition, pages
2013.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-88085OAI: oai:DiVA.org:liu-88085DiVA: diva2:601527
Available from: 2013-01-29 Created: 2013-01-29 Last updated: 2013-01-29Bibliographically approved
In thesis
1. Priority Setting and Rationing in Primary Health Care
Open this publication in new window or tab >>Priority Setting and Rationing in Primary Health Care
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Studies on priority setting in primary health care are rare. Priority setting and rationing in primary health care is important because outcomes from primary health care have significant implications for health care costs and outcomes in the health system as a whole.

Aims: The general aim of this thesis has been to study and analyse the prerequisites for priority setting in primary health care in Sweden. This was done by exploring strategies to handle scarce resources in Swedish routine primary health care (Paper I); analysing patients’ attitudes towards priority setting and rationing and patients’ satisfaction with the outcome of their contact with primary health care (Paper II); describing and analysing how general practitioners, nurses, and patients prioritised individual patients in routine primary health care, studying the association between three key priority setting criteria (severity of the health condition, patient benefit, and cost-effectiveness of the medical intervention) and the overall priority assigned by the general practitioners and nurses to individual patients (Paper III); and analysing how the staff, in their clinical practise, perceived the application of the three key priority setting criteria (Paper IV).

Methods: Both qualitative (Paper I and IV) and quantitative (Paper II and III) methods were used. Paper I was an interview study with medical staff at 17 primary health care centres. The data for Paper II and Paper III were collected through questionnaires to patients and staff at four purposely selected health care centres during a 2-week period. Paper IV was a focus group study conducted with staff members who practiced priority setting in day-to-day care.

Results: The process of coping with scarce resources was categorised as efforts aimed to avoid rationing, ad hoc rationing, or planned rationing. Patients had little understanding of the need for priority setting. Most of them did not experience any kind of rationing and most of those who did were satisfied with the outcome of their contact with primary health care. Patients, compared to medical staff, gave relatively higher priority to acute/minor conditions than to preventive check-ups for chronic conditions when prioritising individual patients in day-today primary health care. When applying the three priority setting criteria in day-to-day primary health care, the criteria largely influenced the overall prioritisation of each patient. General practitioners were most influenced by the expected cost-effectiveness of the intervention and nurses were most influenced by the severity of the condition. Staff perceived the criteria as relevant, but not sufficient. Three additional aspects to consider in priority setting in primary health care were identified, namely viewpoint (medical or patient’s), timeframe (now or later) and evidence level (group or individual).

Conclusion: There appears to be a need for, and the potential to, introduce more consistent priority setting in primary health care. The characteristics of primary health care, such as the vast array of health problems, the large number of patients with vague symptoms, early stages of diseases, and combinations of diseases, induce both special possibilities and challenges.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2013. 118 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1342
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-88086 (URN)978-91-7519-756-2 (ISBN)
Public defence
2013-01-31, Eken, Universitetssjukhuset, Campus US, Linköpings universitet, Linköping, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2013-01-29 Created: 2013-01-29 Last updated: 2013-01-29Bibliographically approved

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Arvidsson, EvaAndré, MalinBorgquist, LarsCarlsson, Per

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Health Technology Assessment and Health EconomicsFaculty of Health SciencesGeneral PracticeUnit of Research and Development in Local Health Care, County of Östergötland
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