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  • 1.
    Alehagen, Urban
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Cardiology . Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Rahmqvist, Mikael
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment and Health Economics.
    Paulsson, Thomas
    AstraZeneca Sverige AB.
    Levin, Lars-Åke
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment and Health Economics.
    Quality-adjusted life year weights among elderly patients with heart failure2008In: European journal of heart failure, ISSN 1388-9842, Vol. 10, no 10, p. 1033-1039Article in journal (Refereed)
    Abstract [en]

    Background

    When assessing health-related quality of life (HRQoL) in elderly patients with heart failure (HF), the process of obtaining quality-adjusted life year (QALY) weights is generally complicated and time-consuming.

    Aim

    To evaluate whether information regarding HRQoL and QALY weights can be derived directly from the established and widely used New York Heart Association (NYHA) functional classification system.

    Methods

    NYHA functional status was assessed independently both by the individual patients and by the examining cardiologist in 323 elderly patients with symptoms of HF recruited from primary care. HRQoL was evaluated using the SF-36 questionnaire and a time trade-off (TTO) scenario. The TTO technique generates direct QALY weights.

    Results

    Both the TTO technique and SF-36 values demonstrated a statistically significant correlation with NYHA functional status. The TTO values also correlated with all SF-36 dimensions. Increasing impairment was associated with statistically significant drops in both SF-36 values and TTO-based QALY weights. For patients in NYHA classes I–IV the QALY weights were 0.77, 0.68, 0.61, and 0.50, respectively. Thus in elderly patients, symptoms of HF have a major impact on perceived quality of life.

    Conclusion

    The results of the present study show that QALY weights, an important instrument in the health economic evaluation of treatment strategies, can be derived directly from NYHA classification in elderly HF patients.

  • 2.
    Bernfort, Lars
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences. Region Östergötland, Heart and Medicine Center, Allergy Center.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Rahmqvist, Mikael
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Husberg, Magnus
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Levin, Lars-Åke
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Chronic pain in an elderly population in Sweden: Impact on costs and quality of life2015Report (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.

  • 3.
    Bernfort, Lars
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences. Region Östergötland, Heart and Medicine Center, Allergy Center.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Rahmqvist, Mikael
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Husberg, Magnus
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Levin, Lars-Åke
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Severity of chronic pain in an elderly population in Sweden-impact on costs and quality of life2015In: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 156, no 3, p. 521-527Article in journal (Refereed)
    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.

  • 4.
    Ernesäter, Annica
    et al.
    University of Gavle, Faculty of Health and Occupational Studies, Gävle and Uppsala University, Dept of Public Health and Caring Sciences, Sweden.
    Engström, Maria
    University of Gavle, Faculty of Health and Occupational Studies, Gävle and Uppsala University, Dept of Public Health and Caring Sciences, Sweden.
    Winblad, Ulrika
    Uppsala University, Department of Public Health and Caring Sciences, Health Services Research, Sweden.
    Rahmqvist, Mikael
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Holmström, Inger K
    Uppsala University, Department of Public Health and Caring Sciences, Health Services Research and Mälardalen University School of Health, Care and Social Welfare, Sweden.
    Telephone nurses' communication and response to callers' concern-a mixed methods study.2016In: Applied Nursing Research, ISSN 0897-1897, E-ISSN 1532-8201, Vol. 29, p. 116-121Article in journal (Refereed)
    Abstract [en]

    AIMS: The aim of this study was to describe telephone nurses' and callers' communication, investigate relationships within the dyad and explore telephone nurses' direct response to callers' expressions of concern

    BACKGROUND: Telephone nurses assessing callers' need of care is a rapidly growing service. Callers with expectations regarding level of care are challenging.

    METHOD: RIAS and content analysis was performed on a criterion sampling of calls (N=25) made by callers who received a recommendation from telephone nurses of a lower level of care than expected.

    RESULTS: Telephone nurses mainly ask close-ended questions, while open-ended questions are sparsely used. Relationships between callers' expressions of Concern and telephone nurses responding with Disapproval were found. Telephone nurses mainly responded to concern with close-ended medical questions while exploration of callers' reason for concern was sparse.

    CONCLUSION: Telephone nurses' reluctance to use open-ended questions and to follow up on callers' understanding might be a threat to concordance, and a potential threat to patient safety.

  • 5.
    Faresjö, Tomas
    et al.
    Linköping University, Department of Medicine and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    Rahmqvist, Mikael
    Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Educational level is a crucial factor for good perceived health in the local community2010In: SCANDINAVIAN JOURNAL OF PUBLIC HEALTH, ISSN 1403-4948, Vol. 38, no 6, p. 605-610Article in journal (Refereed)
    Abstract [en]

    Aims: Educational level is a strong determinant of perceived health, and also an important component in the socioeconomic concept. The aim of this study was to analyze a number of social conditions and lifestyle factors that might explain differences in self-reported health between the populations in two different social environments, one white-collar city and one blue-collar city. These "twin cities" are served by the same healthcare organisation, but differ in terms of social history and current social structure. Methods: The material consisted of responses to a community-based survey of individuals aged between 20 and 64 years, with an overall response rate of 49%. Differences in self-reported health status were tested with chi-square tests and regression analysis. Results: We found significant differences in perceived health between the two populations. These differences in self-reported health could not be explained by differences in demographic factors, lifestyles, or living conditions. However, when the educational level of the respondents was taken into account, the differences in perceived health diminished. Conclusions: Public health in local communities tends to reflect the social history and social heritage of the population. In this study, we found that educational level appears to be a vital factor for good perceived health of the individual in a community.

  • 6.
    Hallert, Eva
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Husberg, Magnus
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Kalkan, Almina
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Rahmqvist, Mikael
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Skogh, Thomas
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Rheumatology.
    Bernfort, Lars
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences. Region Östergötland, Heart and Medicine Center, Allergy Center.
    Changes in sociodemographic characteristics at baseline in two Swedish cohorts of patients with early rheumatoid arthritis diagnosed 1996-98 and 2006-092015In: Scandinavian Journal of Rheumatology, ISSN 0300-9742, E-ISSN 1502-7732, Vol. 44, no 2, p. 100-105Article in journal (Refereed)
    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.

  • 7.
    Hansson, Björn T
    et al.
    Landstinget i Östergötland.
    Rahmqvist, Mikael
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment.
    Inget stöd för könsskillnader i studie av väntetid till vård2007In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 104, no 43, p. 3187-3189Article in journal (Other academic)
    Abstract [sv]

    In Sweden the time patients spend on different waiting lists is regularly analysed in follow-up surveys and published on the Internet, but when these figures do not differ between men and women there is an interesting demand for analysing the figures separately for the sexes. With the aim of investigating gender differences we have analysed the time spent on 32 different waiting lists by 44,000 patients in hospital health care including surgery, orthopaedics, otorhinolaryngology, ophthalmology and thoracic surgery. When controlling for the patients' medical need and age we found that there were few significant gender differences regarding the time spent waiting for an appointment or elective surgery. Our conclusion is that it is not sufficient to draw conclusions on unadjusted figures for waiting lists for men and women respectively. Instead we recommend regularly performing regression analysis based on individual raw data.

  • 8.
    Jonsson, Dick
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment.
    Ferraz-Nunes, José
    Rahmqvist, Mikael
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Tema Health and Society.
    Socioeconomic evaluation of mental health as a base for financing mental health care in Sweden2003In: International Advances in Economic Research, ISSN 1083-0898, E-ISSN 1573-966X, Vol. 8, p. 107-118Article in journal (Refereed)
  • 9.
    Nilsen, Per
    et al.
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics.
    Skagerström, Janna
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Faculty of Health Sciences.
    Rahmqvist, Mikael
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Hultgren, Eva
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Blomberg, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Alcohol prevention in Swedish antenatal care: effectiveness and perceptions of the Risk Drinking project counseling model2012In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 91, no 6, p. 736-743Article in journal (Refereed)
    Abstract [en]

    Objective. To compare an earlier Swedish antenatal care counseling routine concerning alcohol consumption with an expanded model in terms of effectiveness in achieving abstinence in pregnancy. A further objective was to assess the womens perceptions of the alcohol counseling. Design. Cohort study. Setting. Antenatal care center in a provincial Swedish university town. Population. Women who received alcohol counseling; 1533 in cohort 1 (routine counseling) and 1476 in cohort 2 (expanded model). Approximately 93% of all pregnant women in Linkoping are registered at this center. Methods. Data were collected by means of an anonymous questionnaire. Thirteen questions in the questionnaire were analysed for this study. Main outcome measures. Replies from three questions concerning pre-pregnancy drinking and three questions on drinking during pregnancy. Results. The response rate was 60% for cohort 1 and 64% for cohort 2. Perceptions of the advice from the antenatal care center were generally favorable. Similar proportions of women, approximately 6%, in both cohorts drank at least once during the pregnancy (after pregnancy recognition). There were four predictors for drinking during pregnancy: older age; having previously given birth to a child; frequency of pre-pregnancy drinking; and perceiving the message from antenatal care as small amounts of alcohol during pregnancy dont matter.Conclusions. An expanded counseling model implemented in Swedish antenatal care did not reduce the proportion of women who continued drinking during pregnancy in comparison with a previous counseling model, although the advice provided in the new model was perceived more favorably.

  • 10.
    Nilsson, Erik
    et al.
    Department of Surgery, Motala Hospital, Motala.
    Ros, Axel
    Department of Surgery, Ryhov County Hospital, Jönköping.
    Rahmqvist, Mikael
    Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment. Linköping University, Faculty of Health Sciences.
    Bäckman, Karin
    Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment. Linköping University, Faculty of Health Sciences.
    Carlsson, Per
    Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment. Linköping University, Faculty of Health Sciences.
    Cholecystectomy: costs and health-related quality of life: a comparison of two techniques2004In: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 16, no 6, p. 473-482Article in journal (Refereed)
    Abstract [en]

    Background. Outcomes of previous health economic evaluations comparing minilaparotomy cholecystectomy and laparoscopic cholecystectomy have been inconsistent.

    Objective. To compare costs for minilaparotomy cholecystectomy and laparoscopic cholecystectomy and to study changes in quality of life induced by these operations.

    Design. Single-blind, randomized controlled trial, run from 1 March 1997 to 30 April 1999.

    Setting. One university hospital and four non-university hospitals in Sweden.

    Main measures. Cost and perceived health estimation according to the global quality of life instrument EuroQol-5D.

    Results. Of 1719 cholecystectomy patients at five centres, 724 entered the trial and were treated with minilaparotomy cholecystectomy or laparoscopic cholecystectomy, 362 in each group. Total health care costs were less for minilaparotomy cholecystectomy than for laparoscopic cholecystectomy (median values US$2428 for minilaparotomy cholecystectomy versus US$2613 or US$3006 for laparoscopic cholecystectomy with 100 operations per year and reusable trocars or 50 operations per year and disposable trocars, respectively). There was no significant difference in total costs (including costs due to loss of production) between minilaparotomy cholecystectomy and laparoscopic cholecystectomy with 100 operations per year and reusable trocars in laparoscopic cholecystectomy (US$3731 versus US$3649, respectively). However, in calculations assuming 50 operations per year and disposable trocars in laparoscopic cholecystectomy, this technique was more expensive than minilaparotomy cholecystectomy (US$4042 versus US$3731). Health-related quality of life was slightly but significantly lower for the minilaparotomy cholecystectomy group 1 week after surgery. One month and 1 year postoperatively no difference between the randomized groups was found.

    Conclusion. Total costs did not differ between minilaparotomy cholecystectomy and laparoscopic cholecystectomy with high-volume surgery and disposable trocars, whereas laparoscopic cholecystectomy was more expensive with fewer operations and disposable trocars. The gain in health-related quality of life with laparoscopic cholecystectomy compared with minilaparotomy cholecystectomy was small and of limited duration.

  • 11.
    Nygren, Mikaela
    et al.
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Roback, Kerstin
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Öhrn, Annica
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Health and Developmental Care, Patient Safety.
    Rutberg, Hans
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Health and Developmental Care, Patient Safety.
    Rahmqvist, Mikael
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Social Medicine and Public Health Science. Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Factors influencing patient safety in Sweden: perceptions of patient safety officers in the county councils2013In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 13, no 52Article in journal (Refereed)
    Abstract [en]

    Background

    National, regional and local activities to improve patient safety in Sweden have increased over the last decade. There are high ambitions for improved patient safety in Sweden. This study surveyed health care professionals who held key positions in their county council’s patient safety work to investigate their perceptions of the conditions for this work, factors they believe have been most important in reaching the current level of patient safety and factors they believe would be most important for achieving improved patient safety in the future.

    Methods

    The study population consisted of 218 health care professionals holding strategic positions in patient safety work in Swedish county councils. Using a questionnaire, the following topics were analysed in this study: profession/occupation; number of years involved in a designated task on patient safety issues; knowledge/overview of the county council’s patient safety work; ability to influence this work; conditions for this work; and the importance of various factors for current and future levels of patient safety.

    Results

    The response rate to the questionnaire was 79%. The conditions that had the highest number of responses in complete agreement were “patients’ involvement is important for patient safety” and “patient safety work has good support from the county council’s management”. Factors that were considered most important for achieving the current level of patient safety were root cause and risk analyses, incident reporting and the Swedish Patient Safety Law. An organizational culture that encourages reporting and avoids blame was considered most important for improved patient safety in the future, closely followed by improved communication between health care practitioners and patients.

    Conclusion

    Health care professionals with important positions in the Swedish county councils’ patient safety work believe that conditions for this work are somewhat constrained. They attribute the current levels of patient safety to a broad range of factors and believe that many different solutions can contribute to enhanced patient safety in the future, suggesting that this work must be multifactorial.

  • 12.
    Rahmqvist, Mikael
    Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment. Linköping University, Faculty of Health Sciences.
    Befolkningens hälsa och samhällets kostnader för vård och produktionsbortfall - resultat från ULF-studien 1996 och 20052007Report (Other academic)
    Abstract [en]

    Public health and health care consumption is permanently of current interest as research field and an object for many studies. In this study the results from the National Living Survey, ULF, are used for the years 1996/97 and 2004/05. The choice of years is done regarding to the circumstances that these years have more questions in depth concerning health and health care consumption. Of a total of 18 940 respondents 8 600 can be counted to the years 2004 and 2005.

    The first part of this study addresses the overlapping populations in a series of cost-of-illness studies, an overlap that tends to overestimate the costs when results from several studies are added. By using the prevalence figures from the ULF-study the true amount of overlapping in terms of combinations of conditions is calculated. Three independent studies from Sweden have previously estimating the societal costs for obesity, daily smoking and lack of exercise and these studies serve as an example of overlapping groups. In addition a trend analysis is performed to investigate the outcome in drug consumption costs related to the increase of obesity and the decrease of daily smokers. The second part of the report deals with the total figures of diagnosed diseases in the country combined with obesity as one condition of ill health.

    The example with the three cost-of-illness studies regarding obesity, smoking and lack of exercise show that direct costs could be overestimated with 26 percent and the indirect cost in terms of loss of production also very likely could be overestimated with one fourth if the result from the studies is added without correction for overlapping groups. If the group of smokers continue to decrease it could have an impact on drug consumption costs but since the number of obese and the effects of obesity probably will continue to increase there is no expectation on substantial reduction of future costs. However, surplus consumption of medicine related to life styles will not likely increase either as long as the number of smokers continues to decrease.

    The proportion of ill persons with one or more diagnosis increase in the population and regardless if obesity is counted as a diagnosis or not it is a great increase of the group that have more than one diagnosis. With obesity included 46 percent of the men and 51 percent of the women in the age 20-79 years had at least one defined diagnosis 2004/05. This can be compared with 40 and 45 percent respectively ten years earlier. Parallel with the increase of ill persons the proportion of persons with severe and frequent health problems also have increased. The deterioration of the public health is reflected in an increase of medicine consumption, more visits to district nurses and an increase in the use of complementary therapies. The number of visits to a physician appears not to have increased during the period.

  • 13.
    Rahmqvist, Mikael
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society.
    Doctors' advice to overweight patients concerning healthy lifestyles2002In: Scandinavian Journal of Nutrition/Næringsforskning, ISSN 1102-6480, E-ISSN 1651-2359, Vol. 46, no 1, p. 40-44Article in journal (Other (popular science, discussion, etc.))
    Abstract [en]

    Background: The physician has an important role that involves informing patients about the benefits of a healthy lifestyle. Objective: The aim was to estimate the proportion of patients who received advice about exercise and/or eating habits in primary health care (PHC) and hospital health care (HHC) in 1991 and 1995. A further aim was to explore the patient characteristics in the group that was given advice. Design: Subjects were 4890 respondents to a mail-distributed questionnaire who had paid at least one visit to a doctor in PHC or HHC within the last 12 months. Results: In PHC about 20% of the overweight patients received advice in 1991 and 1995, while in HHC the percentage receiving advice increased from 19% to 28%. Patients background characteristics could not explain this difference in trends. Male patients received more advice in both PHC and HHC, and this could not be explained by factors such as education, health or lifestyle factors, e.g. exercise and smoking. Conclusion: The results suggest that there is room for more doctors' advice about eating habits and exercise, especially for female patients and patients in primary health care.

  • 14.
    Rahmqvist, Mikael
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Tema Health and Society.
    Health and health care monitoring in a period of considerable social change: surveys of a Swedish population during the 1990s2003Doctoral thesis, comprehensive summary (Other academic)
  • 15.
    Rahmqvist, Mikael
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Hur fungerar punktprevalensmetoden som mätinstrument i sluten sjukhusvård?: Kostnader och prevalenser för vårdrelateradei nfektioner i somatisk slutenvård i Östergötland 20122016Report (Other academic)
    Abstract [en]

    In hospital care a constant alert is payed to Healthcare-associated infections (HAI). Patients who suffers from a HAI requires additional care in terms of, medication, longer hospital stays and these patients also have a higher mortality risk than average. This methodological study attempts to provide information on how much of health care resources is devoted to patients affected by a HAI. By merging two registers, the Healthcare register for Region Östergötland (HCR) and local data from a set of Prevalence point surveys (PPS), it was possible to add length of stay (LOS) and health care costs and one year overall mortality to the PPS data collected in the county of Östergötland 2012.

    In the merge of the two registers it was found that the patient composition in the PPS was not representative for the total patient mix in the region and that all similar point prevalence measurements more or less automatically gives an overrepresentation of patients with long hospital stays. With this over-representation of patients with LOS above average, follows an overestimation of the prevalence of HAI. An analysis of the material revealed that at least 15% of patients in the PPS were included just because of their long LOS.

    However, the PPS gives another unbiased answer that can be used for cost-calculations, this since it tells us the number of occupied beds are used by patients with a registered HAI. The average prevalence of HAI was 10 % in 2012 and thereby follows that 10 % of the beds lodge a patient with a documented HAI, the particular day of survey. Roughly this means that 10 % of the costs for caring patients in somatic inpatient care is related to patients with a HAI. That does not equal that 10 % of the costs are related to HAI but that 10 % of the costs are related to patients with a HAI.

    Several studies (including this) have found that patients with an HAI, on average has a twice as long LOS compared to patients without any registered HAI. Such a proportion makes 5 % of the total costs attributable to the HAI itself. After adjustments for the true expenditures of hospital bed days at different departments it was considered that 5.3 % of the health care costs was attributable to the additional treatment of the HAI. If a reduction of the prevalence of HAI could be 40 %, and only affect 6 % of the bed days per year, there would be a total cost reduction of 2.1 % per year in somatic inpatient care in the county of Östergötland.

    However, a validation survey of one PPS showed that the prevalence figures of HAI was significant underestimated and if the proportion of patients that suffers from a HAI are larger, the portion of the total costs increases, but the gain in any reduction can in turn be even more favorable.

  • 16.
    Rahmqvist, Mikael
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Infektioner i slutenvård: Omfattning och kostnader i Östergötland – en pilotstudie2013Report (Other academic)
    Abstract [en]

    Healthcare-associated infections (HAI) is an increasingly recognized problem in health care. Approximately 10 percent of all hospitalized patients in Sweden is expected to be hit by a HAI but there is considerable variation between the medical specialties. This study is exploratory and aims primarily to present a model to estimate the additional costs for medical care related to HAI. The material consists of the Point Prevalence Survey (PPM) which was conducted in Östergötland in 2011 and also the information from the County Council's Health Care register that was current for the patients who were hospitalized on days when PPM was conducted.

    There was a strong correlation between the recorded risk factors and the occurrence of an HAI. The two most prevalent risk factors were "Surgery" and "KAD" (indwelling urinary catheter) . The number of hospital days were twice as many compared to those not affected (25 days vs. 13 days) for those affected by a HAI on a number of included units. The cost per patient in that case was more than twice as high for the affected patients compared with those who were not affected ( SEK 331,000 compared with SEK 145,000). No age differences were noted between the groups.

    The patients who suffered a HAI on the included units of the University Hospital was one quarter of patients (24%) but these patients accounted for 40 percent of the total health care costs. The corresponding proportions for the entire county was that 16 percent of the patients had a certain infection and these patients accounted for 30 percent of the total costs. If the number of patients who suffer from a HAI could be reduced by one-third, or up to half of all recent cases, it would be theoretically possible to reduce total overall healthcare costs for inpatient care with between 4-12 percent.

    The pilot study resulted in limited opportunities to analyze the material in detail and therefore have a study with several years of data from the PPM together with records from Health Care register started.

  • 17.
    Rahmqvist, Mikael
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment.
    Kvalitet i vården ur patientens perspektiv: Variationer i betyg mellan olika patientgrupper och vårdenheter2004Report (Other academic)
  • 18.
    Rahmqvist, Mikael
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Läkarbesök och läkemedelskonsumtion bland barn med astma, diabetes och andra kroniska sjukdomar: Ett metodexempel på hur journaldata kan omvandlas till epidemiologi och sjukvårdskostnader2017Report (Other academic)
    Abstract [en]

    There are few studies about the Swedish health care costs for children with asthma or diabetes, and there are few publications that describes how to transform data from medical records into epidemiology. This report can help to bring some clarity in both these areas.

    Young patients with asthma and diabetes type 1 contribute to the example about health care costs. These two diseases are quite different in character, and this difference mirror how well medical records can be suitable for epidemiology. In principle, all children in the group with diabetes in the county of Östergötland could be found in the medical records of visits to a physician during a year, while for the children with asthma less than 50% was found, even when the records covered 7 years.

    Children with chronic diseases, according to the definition used here, that could be found in these medical records constituted 5% of the population 2-17 years in 2012. However, their costs for doctor visits at hospitals together with the actual costs for drugs represented 22% of the health care costs. When the costs of inpatient hospital services were added, the proportion remain, and those affected children accounted for 23% of the total annual health care costs.

    The average annual cost of care for those with blood diseases or diabetes was about 12 times higher compared to those who had no chronic problems registered. Patient groups with other types of chronic problems had a lower cost, and overall, the average cost of care for children with chronic problems was about 6 times higher than the residents without these problems.

    In health economics several different costs is usually calculated, such as; patient visits, costs for inpatient care and pharmaceuticals, as well as costs for loss of productivity and eventually also costs for premature death. Putting together all these different types of costs down to the individual level often requires fairly advanced data management. In this report it is described how raw data is transposed from single medical records into individual journal data, and then merged together to build the individual's own cohesive "record" and history.

  • 19.
    Rahmqvist, Mikael
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Medical and Psychological Methods for Preventing Sexual Offences Against Children. A Systematic Review: Chapter 5: Economic aspects of rehabilitation programmes for child molesters2011Report (Other academic)
  • 20.
    Rahmqvist, Mikael
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Medicinska och psykologiska metoder för att förebygga sexuella övergrepp mot barn. En systematisk litteraturöversikt: Kapitel 5: Hälsoekonomiska aspekter2011Report (Other academic)
  • 21.
    Rahmqvist, Mikael
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment and Health Economics.
    Nytta och effekter av sjukvårdsrådgivningen per telefon - En analys av rådgivningsverksamheten i Östergötland och Jämtland. Pilotstudie2008Other (Other (popular science, discussion, etc.))
  • 22.
    Rahmqvist, Mikael
    Linköping University, Faculty of Health Sciences. Linköping University, Department of health and environment.
    Patient satisfaction in relation to age, health status and other background factors: A model for comparisons of care units2001In: International Journal for Quality in Health Care, ISSN 1353-4505, E-ISSN 1464-3677, Vol. 13, no 5, p. 385-390Article in journal (Refereed)
    Abstract [en]

    Objective. To analyse the relationship between patient satisfaction and background factors such as age, gender, health status and pain. In addition, to use background factors to create less biased ranking in comparisons of patient satisfaction between medical specialities. Design. A questionnaire was sent by post to patients who had recently received inpatient care at a hospital within the County of ╓sterg÷tland, Sweden. The questionnaire contained 33 questions, 21 of which concerned the quality of health care and patient satisfaction. Setting. Inpatient departments at all four hospitals in the County of ╓sterg÷tland, Sweden. Subjects. All patients discharged from the hospital during a period of 6 weeks. Approximately 3400 patients aged 1-94 years responded to the questionnaire, resulting in a response rate of 69%. Main outcome measures. Patient satisfaction index score (PSI). Results. Of the background factors tested, patient age had the greatest explanatory value regarding the PSI, closely followed by experiencing anxiety during admission. With regard to variations in the PSI, about 20% could be explained by the background factors taken as a whole. Gender did not correlate with the PSI, although males were somewhat more satisfied than females. PSI scores differed among medical specialities and, interestingly, when age and other background factors were controlled for, the picture changed regarding the medical speciality that received the best PSI score. Conclusion. The change in ranking among medical specialities after adjustment for background factors emphasizes the importance of including background factors in patient satisfaction analyses in order to obtain less biased comparisons.

  • 23.
    Rahmqvist, Mikael
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment.
    Personalens arbetssituation och patienternas skattning av vården - en jämförande studie mellan 2005 års enkäter i Landstinget i Östergötland2005Report (Other academic)
  • 24.
    Rahmqvist, Mikael
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment.
    The close relation between birth, abortion and employment rates in Sweden from 1980 to 20042006In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 63, no 5, p. 1262-1266Article in journal (Refereed)
    Abstract [en]

    Birth and abortion rates in Sweden have fluctuated since 1980 while the proportion between the rates are the same at the beginning and end of the period. An increase in birth rates in the late 1980s resulted in a peak in 1991 and 1992, with 124,000 live births each year. Thereafter followed a steady decline in the rate until 2000, when the number of live births was about 90,000. At that point, the trend changed to an increase. The aim of this analysis was to investigate any relation between employment rates and the number of live births among women aged 20-34, and at the same time to explore the trend for abortion rates compared to the trend for live births. The relation between employment status and live birth rate is statistically more significant for women than men, and the rates have a higher correlation for the period after 1986. Young adults in this age group are vulnerable to economic cycles that can explain this covariation but the decline in birth rates in economically developed societies has multidimensional aspects and many other possible explanations. Much has been done in recent years in Sweden to decrease household inequality for families with children to avoid the risk of relative poverty, but the fact that there is no explicit health policy to reduce the abortion level that remain unchanged since the early 1980s may appear as a notable lack of strategy in a country with many other health-related goals. © 2006 Elsevier Ltd. All rights reserved.

  • 25.
    Rahmqvist, Mikael
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment.
    The increase of psychological distress and the cyclic birth and employment rates in Sweden 1990 to 20042006In: Workshop on Welfare, Health and Social Change,2006, 2006Conference paper (Other academic)
  • 26.
    Rahmqvist, Mikael
    et al.
    Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Bara, Ana-Claudia
    University of Leeds.
    Patient characteristics and quality dimensions related to patient satisfaction2010In: INTERNATIONAL JOURNAL FOR QUALITY IN HEALTH CARE, ISSN 1353-4505, Vol. 22, no 2, p. 86-92Article in journal (Refereed)
    Abstract [en]

    To examine the relation of respondents characteristics, and perceived quality dimensions of health care to overall patient satisfaction in out-patient hospital care. A questionnaire concerning the perceived quality of health care sent to patients in out-patient medical care. All medical centres in Ostergotland County, Sweden, during a period in 2007. Seven thousand two hundred and forty-five patients aged 20 or older responded to the survey and provided their own ratings of the care. Global patient satisfaction as the overall rating of the encounter at the medical centre. The relation between respondent characteristics, quality dimensions and global satisfaction was examined using linear regression. Younger patients in emergency care were the least satisfied group (54%) and older patients with excellent health status were the most satisfied group (90%). Patients with perceived better health status and those with less education were more satisfied than those with more education or poorer health status. The two dimensions most strongly positively associated with global satisfaction were receiving the expected medical help and being treated well by the doctor. To wait at the reception without getting information correlated negatively to patient satisfaction, and participation in the medical decision-making correlated positively. By using a complete patient population, including all types of medical specialities, we have identified a set of common respondent characteristics and quality dimensions that are related to global satisfaction in out-patient hospital care.

  • 27.
    Rahmqvist, Mikael
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment.
    Bara, Ana-Claudia
    National School of Public Health and Health Services Management, Romania.
    Patients retrieving additional information via the Internet: A trend analysis in a Swedish population, 2000-20052007In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 35, no 5, p. 533-539Article in journal (Refereed)
    Abstract [en]

        

  • 28.
    Rahmqvist, Mikael
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment.
    Bara, Ana-Claudia
    National School of Public Health and Health Services Management, Romania.
    Patients retrieving information via the Internet: a trend analysis of a Swedish population, 2000-20052006In: The Annual EUPHA conference,2006, 2006Conference paper (Refereed)
  • 29.
    Rahmqvist, Mikael
    et al.
    Linköping University, Faculty of Arts and Sciences. Linköping University, The Tema Institute.
    Carstensen, John
    Linköping University, Faculty of Arts and Sciences. Linköping University, The Tema Institute.
    Trend of psychological distress in a Swedish population from 1989 to 19951998In: Scandinavian journal of social medicine, ISSN 0300-8037, Vol. 26, p. 214-222Article in journal (Refereed)
  • 30.
    Rahmqvist, Mikael
    et al.
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Ernesäter, Annica
    Uppsala University.
    Holmström, Inger
    Uppsala University.
    Triage and patient satisfaction among callers in Swedish computer-supported telephone advice nursing2011In: Journal of Telemedicine and Telecare, ISSN 1357-633X, E-ISSN 1758-1109, Vol. 17, no 7, p. 397-402Article in journal (Refereed)
    Abstract [en]

    We investigated satisfaction with a Swedish telenursing service and the health-care-seeking behaviour among callers who received a less urgent level of health care than they expected. A postal questionnaire was sent to a random selection of callers (n = 273) to Swedish Healthcare Direct in October 2008. The cases were 18 callers where the telenurse recommended a lower level of health care than the caller expected and who were not in complete agreement with the nurse. The controls were 22 callers who either received a lower recommendation, or were in disagreement with the recommendation. There were no differences between cases, controls and other callers regarding background factors or the telenurse classification of emergency. However, both cases and controls considered their need for health care as more urgent than the other callers. An independent test of the nurses reception, ability to listen and to take notice of the callers health problem, showed that nurses who had served cases, had received a significantly lower rating than other nurses. For nurses who had served controls, there was no such difference in rating. Cases and controls had fewer subsequent care visits than other callers, in the three days following the call, although the proportion of emergency visits was higher among cases and controls compared to other callers. If the caller and the nurse disagree about the nurses recommendations, the consequence can be a dissatisfied caller and more visits to unnecessary high levels of health care. Further training of the nurses may improve the telenurse service.

  • 31.
    Rahmqvist, Mikael
    et al.
    Linköping University, Faculty of Health Sciences.
    Garpenby, Peter
    Linköping University, Faculty of Health Sciences.
    Kommunal primärvård i Katrineholm: vårdutnyttjande, vårdkvalitet och hälsa - en jämförelse mellan 1993 och 19961997Report (Other academic)
  • 32.
    Rahmqvist, Mikael
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Gjessing, Kristian
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Faresjö, Tomas
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Influenca-like illness among children: Young children suffer, primary care takes the strain, society bears the cost2016Conference paper (Refereed)
    Abstract [en]

    Conclusions

    Our results demonstrated a significant increase in the burden of disease during the peak influenza season with increased direct medical costs, especially in primary care. The largest impact of ILI was identified among the youngest children (2-4 years). Increased absence from work due to parents' care of ill children correlates strongly with the ILI encounters in health care. This loss of productivity represents a large indirect cost for society.

  • 33.
    Rahmqvist, Mikael
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Gjessing, Kristian
    Linköping University, Department of Medical and Health Sciences.
    Faresjö, Tomas
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Influenza-like illness: Young children, working parents and primary care take the strain2015Conference paper (Refereed)
  • 34.
    Rahmqvist, Mikael
    et al.
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Husberg, Magnus
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Effekter av sjukvårdsrådgivning per telefon: En analys av rådgivningsverksamheten 1177 i Östergötland och Jämtland2009Report (Other academic)
    Abstract [en]

    Background: In 2001, Sweden’s Ministry of Health and Social Affairs and the organizationthen known as the Federation of Swedish County Councils explored thefeasibility of a nationally coordinated health care hotline and in 2003 publishedtheir findings in a report titled “Vårdråd direkt – Sjukvårdsrådgivningar isamverkan” [Health care hotline – collaborative effort for medical advice].Jämtland has had a health care hotline unit since 2001 while ÖstergötlandCounty Council launched theirs in late 2003. By 2008, Östergötland andJämtland were two of the six county councils in the national health care hotlinenetwork that used the telephone number 1177. In 2009 the national hotlineadvisory service will essentially be complete, involving 16 health careauthorities and their affiliated units.

    National coordination offers several advantages. Neighbouring units can helpeach other in cases of overload, units with specialized expertise can provideadvisory services to others, and a common data and medical recordsmanagement system provides a good overview with efficiency gains. The nurseshave access to a computer-based decision support system to assist them in theiradvisory capacity. The 1177 telephone hotline service gives patients increased,round-the-clock access which provides professional, documented advice withthe aim to direct the patients to the most suitable care option, as well as givingappropriate advice on self-care.

    In cases where advisory services lead to a level of care that differs from the levelpatients initially expected, resources can be freed for other purposes. The“Vårdråd direkt” report refers to a potential for efficiency gains with suchpatient flow management, estimated at SEK 3 billion, or SEK 300 per inhabitantfor a fully established national advisory service. A few units have carried outhealth economics studies since 2001 which have shown a successfulredistribution of patient flow via the health care hotline. However, these studieshave had certain limitations in method and selection, which would justify furtherstudies of the effects of the advisory service.

    Method: The present study uses three independent data sources to study patient flow inÖstergötland, based on calls registered during 1 week in October 2008 and thenotes entered in each patient’s chart. All patients who called the hotline duringthat week have been checked against the health care data warehouse 1 weekbefore and 1 week after the call. A total of 660 of these patients were selected toparticipate in a questionnaire study including questions such as what level of care they expected before making the call, how they felt about the treatment theymet with, and the quality of the advice. The study also includes all patients inJämtland who called the hotline that same week in October; 670 patients fromthis patient population were selected for inclusion in the questionnaire study. Wedid not match patient data before and after the call for the Jämtland patients. Thenet response rate was the same in Östergötland and Jämtland, about 49 per cent,and the response rate varied from 30 to 60 per cent in the different age groupswhere older patients had a higher response rate than younger.

    Results and conclusions: In Östergötland the health care advisory hotline had about 200 000 calls where ajournal was recorded to a cost of SEK 20 million. The health care advisoryhotline determines level of care in 42 per cent of all documented cases(confidence interval, CI 38–46 per cent). In about 20 per cent of cases theadvisory service resulted in a less urgent level of care than the patient expectedwhile in 13 per cent of cases the patient was advised to obtain medical care at ahigher level than they had expected. Calculations in terms of number of doctorvisits were carried out in these two groups while the other 9 percent resulted in avisit in primary health care without any particular savings. In Östergötland,callers were advised to exercise self-care and/or schedule a visit to a nurse orpublic health nurse, rather than visit the doctor as they had planned, in 15 percent of cases, corresponding to a savings of 24,000 doctor visits annually.

    According to our assumptions about the cost of different types of medical visits,the gross effect in Östergötland was SEK 240 per capita per annum equal to 97million per annum. Based on these figures, calculated for the entire country (i.e.about 92 per cent of the population, since not everyone will be affiliated with thenational advisory service) the gross effect will be SEK 2 billion to a cost of SEK425 million. This is about half of the savings estimated in 2003.

    It can be difficult for a health care authority to demonstrate visible effects of anadvisory hotline in terms of savings in number of doctor visits. The effectsshould be most apparent the first years after the telephone advisory hotline isimplemented; once the hotline has been in operation for a number of years, thehealth care services would be adapted and optimized to the resource gainsprovided by the advisory services and the savings fully achieved. Someindications suggest that the health care hotline in Östergötland had an effect onthe statistics for doctor visits in 2004, when it began on a full scale. There was arelatively large decline in the total number of doctor visits in 2004 and asrecently as 2007, the total number of visits had not yet returned to the 2003 leveldespite an population increase that motivates another 25 000 visits.

    Our conclusion is that the health care hotline influences patient flow in a largenumber of cases, positively affecting resource utilization. Return on investmentfor the advisory service is good in terms of fewer health care encounters and anincrease in the percentage of encounters at the appropriate level of care, as wellas relevant self-care advice.

    Nevertheless, other parts of the health care system have not experienced anynotable relief from the health care hotline, as noted in discussions with referencegroup members that have experience of many parts of the health care system.For example, in Östergötland the patient calls to primary care centres hasincreased a bit the last year, despite a substantial increase in the number of callsto 1177. We hope that future studies will be able to provide an explanation forthis finding.

  • 35.
    Rahmqvist, Mikael
    et al.
    Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment. Linköping University, Faculty of Health Sciences.
    Levin, Lars-Åke
    Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment. Linköping University, Faculty of Health Sciences.
    Hur påverkas sjukvården i praktiken? Utvärdering av Socialstyrelsens riktlinjer för prioritering av hjärtsjukvård. Utgångsläget 2001-20032005Report (Other academic)
    Abstract [sv]

    Socialstyrelsens riktlinjer för hjärtsjukvård har utvecklats successivt de senaste åren och 2004 publicerades ”Beslutsstöd för prioriteringar” med ett tillhörande medicinskt faktadokument. Riktlinjerna omfattar 118 rangordnade åtgärder varav 72 har en rangordning 3 eller högre på en 10-gradig skala där 1 ges högsta prioritet. Vi har valt ut sju av dessa prioriterade åtgärder till att fungera som indikatorer på hur riktlinjerna tillämpas i svensk hjärtsjukvård. Denna rapport är den första i en serie rapporter där dessa och ytterligare några indikatorer ska följas över tid. En del av åtgärderna/indikatorerna är etablerade teknologier medan andra befinner sig i en introduktionsfas. Syftet med den första rapporten är dels att presentera lämpliga metoder för att följa trenden för de olika indikatorerna, dels att få en uppfattning om variationen i hjärtsjukvården och dels att försöka väga ihop resultaten till ett gemensamt mått på eventuell följsamhet till de föreslagna prioriteringarna.

    Utvecklingen under 2001-2003 visar på en stor variation mellan landstingen även när det gäller så kallade etablerade teknologier som reperfusion och behandling med ACE-hämmare. För dessa två teknologier sker ingen förändring i totalresultatet men förändringar, både minskad och ökad andel behandlade patienter, inträffar lokalt under perioden. Gemensamt för teknologierna under introduktion är att det sker en ökning i de flesta landstingen. Ett tydligt exempel på en gemensam ökning är kombinationsbehandling med ASA och clopidogrel, under 2001 behandlades 14 procent av patienterna med instabil kranskärlssjukdom medan det i samtliga landsting 2003 var en större andel patienter (än 2001 års genomsnitt) som fick kombinationsbehandlingen. Den relativa variationen mellan landstingen minskade samtidigt även om förskrivningen 2003 varierade mellan 18 till 54 procent.

    Tillämpningen av 2004 års riktlinjer var olika i landstingen 2003 såtillvida att det går att urskilja en grupp landsting som har en mindre andel behandlade patienter enligt riktlinjerna och en grupp landsting som har en större andel behandlade patienter jämfört med genomsnittet. Kommande studier får visa om skillnaderna minskar eller består mellan landstingen och i vilken utsträckning som patienterna får ta del av de prioriterade behandlingarna.

  • 36.
    Rahmqvist, Mikael
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment.
    Levin, Lars-Åke
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment.
    Stenestrand, Ulf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Utvärdering av Socialstyrelsens riktlinjer för prioritering i hjärtsjukvård 2001-20042006Report (Other academic)
  • 37.
    Rahmqvist, Mikael
    et al.
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Levin, Lars-Åke
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Stenestrand, Ulf
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Cardiology. Östergötlands Läns Landsting, Heart Centre, Department of Cardiology.
    Utvärdering av Socialstyrelsens riktlinjer för prioritering i hjärtsjukvård 2001-20062008Report (Other academic)
    Abstract [sv]

    Socialstyrelsens riktlinjer för hjärtsjukvård har utvecklats successivt och 2004 publicerades "Beslutsstöd för prioriteringar" med ett tillhörande medicinskt faktadokument. De riktlinjerna omfattade 118 rangordnade åtgärder varav 72 hade en rangordning 3 eller högre på en 10-gradig skala där 1 gavs till åtgärder med högsta prioritet. Vi har valt sju av dessa prioriterade åtgärder med rangordning mellan 1 och 3 att fungera som indikatorer på hur riktlinjerna tillämpas i svensk hjärtsjukvård. Denna rapport är den tredje och sista i en serie där dessa indikatorer följts över tid. En del av åtgärderna/indikatorerna var relativt etablerade behandlingar initialt medan andra befann sig i en introduktionsfas. Syftet med den avslutande rapporten är dels att uppdatera trenderna för de olika indikatorerna och åter studera omfattningen på variationen i hjärtsjukvård i riket och dels att presentera en förbättrad analysmetod.

    Behandling med ACE-hämmare och reperfusion var de två behandlingar som i våra tidigare rapporter betraktades som ganska väletablerade och de har också uppvisat minst relativ variation mellan landstingen. Båda behandlingarna ökar trots det med i genomsnitt cirka tio procent under analysperioden.

    Behandling med statiner ansågs vara på god väg att gå in i en balanserad och etablerad fas efter 2004 och med en fortsatt ökande förskrivning under perioden får nog behandlingen anses närma sig en etablering som praxis.

    Av de övriga två indikatorerna, kombinationsbehandling (ASA tillsammans med clopidogrel) och kranskärlsröntgen för patienter med instabil kranskärlssjukdom, har det varit en avsevärd större spridning mellan landstingen. Fördelningen mellan landstingen är mer homogen när det gäller utförd röntgen än vad läget är för kombinationsbehandling men ingen av behandlingarna kan anses ha etablerat sig färdigt nationellt ännu.

    Det är svårt att påvisa någon omedelbar effekt på nationell nivå efter publiceringen av riktlinjerna - i flera fall är trenderna linjära utan plötsliga uppgångar. Undantagen är kranskärlsröntgen för patienter med instabil kranskärlssjukdom där vi ser ett trendbrott uppåt efter 2004 och reperfusion på sjukhus som ökar tydligt efter 2004. Vi kan dock notera plötsliga förändringar i vissa landsting. Som exempel ändras förekomsten av prehospital trombolys i Jönköpings län; från att ha behandlat runt 20 procent av alla patienter med akut hjärtinfarkt prehospitalt 2005 behandlades så gott som alla patienter i den gruppen nästkommande år med PCI. En utveckling från prehospital trombolys till förmån för PCI är påtaglig i många län men kanske inte så tydlig som i Jönköping.

    Norrlandslänen nyttjar dock metoden och har även utökat andelen patienter som fått trombolys prehospitalt vilket är en utveckling som motiveras med långa transporter och tillhörande väntetider innan en PCI kan genomföras. Just den typen av val mellan olika strategier och val av reperfusionstyp har vi tagit hänsyn till när vi slagit ihop resultaten i ett index på de indikatorer som ingår i studien.

    Våra metoder att rangordna landstingen efter följsamhet till riktlinjerna indikerar att kortare vårdtider kan bli en effekt av följsamhet, de landsting som har relativt god följsamhet har de kortaste vårdtiderna för akut hjärtinfarkt. Andel återinläggningar skiljer inte åt mellan grupperna och är opåverkad av följsamheten medan vi får lite olika utfall när det gäller mortalitet inom 30 dagar.

    Oberoende av hur man konstruerar ett index för de valda indikatorerna framgår det att variationen är stor mellan landstingen i vilken utsträckning som riktlinjerna följs. I vårt uppdrag har det inte ingått att utreda metodologiska aspekter på det kvalitetsregister (RIKS-HIA) som utgör dataunderlaget men man måste ändå ställa sig frågan om regionala skillnader till viss del kan förklaras av olika inklusionskriterier till registret? Vår analys av antalet registrerade fall med akut hjärtinfarkt i RIKS-HIA kontra slutenvårdsregistret ger en vink om att så kan vara fallet och framtida projekt med trendanalyser och jämförelser mellan landsting bör fokusera mer på den delen eftersom det idag är möjligt att mer i detalj utreda skillnader i täckningsgrad länsvis.

  • 38.
    Rahmqvist, Mikael
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Samuelsson, Annika
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Region Östergötland, Center for Health and Developmental Care, Department of Infection Control. Linköping University, Faculty of Medicine and Health Sciences.
    Bastami, Salumeh
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Health and Developmental Care, Patient Safety. Public Health Agency, Sweden.
    Rutberg, Hans
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Direct health care costs and length of hospital stay related to health care-acquired infections in adult patients based on point prevalence measurements2016In: American Journal of Infection Control, ISSN 0196-6553, E-ISSN 1527-3296, Vol. 44, no 5, p. 500-506Article in journal (Refereed)
    Abstract [en]

    Background: The incidence of health care-acquired infection (HAI) and the consequence for patients with HAI tend to vary from study to study. By including all patients, all medical specialties, and performing a follow-up analysis, this study contributes to previous findings in this research field. Methods: Data from the Swedish National Point Prevalence Surveys of HAI 2010-2012 was merged with cost per patient data from the county Health Care Register (N=6,823). Extended length of stay (LOS) and costs related to an HAI were adjusted for sex, age, intensive care unit use, and surgery. Results: Patients with HAI (n=732) had a larger proportion of readmissions compared with patients with no HAI (29.0% vs 16.5%). Of the total bed days, 9.3% was considered to be excess days attributed to the group of patients with an HAI. The excess LOS comprised 11.4% of the total costs (95% CI, 10.2-12.7). The 1-year overall mortality rate for patients with HAI in comparison to all other patients was 1.75 (95% CI, 1.45-2.11), all 5 of these differences were statistically significant (P<.001). Conclusions: Even if not all outcomes for patients with an HAI can be explained by the HAI itself, the increase in inpatient days, readmissions, associated costs, and higher mortality rates are quite notable. (C) 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

  • 39.
    Roback, Kerstin
    et al.
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Rahmqvist, Mikael
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Carlsson, Per
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Investering i hälsa: Hälsoekonomiska effekter av  forskning inom medicinsk teknik och innovativa livsmedel2009Report (Other academic)
  • 40.
    Ros, Axel
    et al.
    Department of Surgery, County Hospital of Ryhov, Jönköping, Sweden .
    Carlsson, Per
    Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment. Linköping University, Faculty of Health Sciences.
    Rahmqvist, Mikael
    Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment. Linköping University, Faculty of Health Sciences.
    Bäckman, Karin
    Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment. Linköping University, Faculty of Health Sciences.
    Nilsson, Erik
    Department of Surgery, University Hospital of Umeå, Sweden .
    Non-randomised patients in a cholecystectomy trial: characteristics, procedures, and outcomes2006In: BMC Surgery, ISSN 1471-2482, E-ISSN 1471-2482, Vol. 6, no 17Article in journal (Refereed)
    Abstract [en]

      Background

    Laparoscopic cholecystectomy is now considered the first option for gallbladder surgery. However, 20% to 30% of cholecystectomies are completed as open operations often on elderly and fragile patients. The external validity of randomised trials comparing mini-laparotomy cholecystectomy and laparoscopic cholecystectomy has not been studied. The aim of this study is to analyse characteristics, procedures, and outcomes for all patients who underwent cholecystectomy without being included in such a trial.

    Methods

    Characteristics (age, sex, co-morbidity, and ASA-score), operation time, hospital stay, and mortality were compared for patients who underwent cholecystectomy outside and within a randomised controlled trial comparing mini-laparotomy and laparoscopic cholecystectomy.

    Results

    During the inclusion period 1719 patients underwent cholecystectomy. 726 patients were randomised and 724 of them completed the trial; 993 patients underwent cholecystectomy outside the trial. The non-randomised patients were older – and had more complications from gallstone disease, higher co-morbidity, and higher ASA – score when compared with trial patients. They were also more likely to undergo acute surgery and they had a longer postoperative hospital stay, with a median 3 versus 2 days (p < 0.001 for all comparisons). Standardised mortality ratio within 90 days of operation was 3.42 (mean) (95% CI 2.17 to 5.13) for non-randomised patients and 1.61 (mean) (95%CI 0.02 to 3.46) for trial patients. For non-randomised patients, operation time did not differ significantly between mini-laparotomy and open cholecystectomy in multivariate analysis. However, the operation for laparoscopic cholecystectomy lasted 20 minutes longer than open cholecystectomy. Hospital stay was significantly shorter for both mini-laparotomy and laparoscopic cholecystectomy compared to open cholecystectomy.

    Conclusion

    Non-randomised patients were older and more sick than trial patients. The assignment of healthier patients to trials comparing mini-laparotomy cholecystectomy and laparoscopic cholecystectomy limits the external validity of conclusions reached in such trials.

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