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  • 1. Agreus, L
    et al.
    Borgquist, Lars
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Allmänmedicin.
    The cost of gastro-oesophageal reflux disease, dyspepsia and peptic ulcer disease in Sweden2002Inngår i: PharmacoEconomics (Auckland), ISSN 1170-7690, E-ISSN 1179-2027, Vol. 20, nr 5, s. 347-355Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background and objective: Dyspepsia, peptic ulcer disease (PUD) and gastro-oesophageal reflux disease (GORD) involve a substantial cost to Swedish society. There is a lack of up-to-date nationwide cost estimates after 1985. This study was conducted to present a comprehensive and updated cost analysis and study the change over time of the national cost of these disorders. Design and setting: Primarily, data from National Swedish databases and secondly, data from databases from the County of Uppsala for 1997 were used for the calculations and estimations. Perspective: Swedish societal perspective. Results: The total cost to Swedish society of dyspepsia, PUD and GORD in 1997 was $US424 million, or $US63 per adult. Direct costs totalled $US258 million (61%) while indirect costs totalled $US166 million (39%). The highest proportions of costs were due to drugs and sick leave, these being 37 and 34%, respectively. Conclusions: The cost of dyspepsia and GORD is substantial for patients, health providers and society. Since 1985, drug costs have increased substantially while the cost of sick leave has decreased.

  • 2.
    Agvall, Björn
    et al.
    Linköpings universitet, Institutionen för hälsa och samhälle, Allmänmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland.
    Borgquist, Lars
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Allmänmedicin. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    Foldevi, Mats
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Allmänmedicin. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland.
    Dahlström, Ulf
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Kardiologi. Östergötlands Läns Landsting, Hjärtcentrum, Kardiologiska kliniken.
    Cost of heart failure in Swedish primary healthcare2005Inngår i: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 23, s. 227-232Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives. To calculate the cost for patients with heart failure (HF) in a primary healthcare setting. Design. Retrospective study of all available patient data during a period of one year. Setting. Two healthcare centers in Linköping in the southeastern region of Sweden, covering a population of 19 400 inhabitants. Subjects. A total of 115 patients with a diagnosis of HF. Main outcome measures. The healthcare costs for patients with HF and the healthcare utilization concerning hospital days and visits to doctors and nurses in hospital care and primary healthcare. Results. The mean annual cost for a patient with HF was SEK 37 100. There were no significant differences in cost between gender, age, New York Heart Association functional class, and cardiac function. The distribution of cost was 47% for hospital care, 22% for primary healthcare, 18% for medication, 5% for nursing home, and 6% for examinations. Conclusion. Hospital care accounts for the largest cost but the cost in primary healthcare is larger than previously shown. The total annual cost for patients with HF in Sweden is in the range of SEK 5.0–6.7 billion according to this calculation, which is higher than previously known.Read More: http://informahealthcare.com/doi/abs/10.1080/02813430500197647

  • 3.
    Andersson, David
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Allmänmedicin. Linköpings universitet, Hälsouniversitetet.
    Magnusson, Henrik
    Linköpings universitet, Institutionen för medicin och hälsa, Sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Carstensen, John
    Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle. Linköpings universitet, Filosofiska fakulteten.
    Borgquist, Lars
    Linköpings universitet, Institutionen för medicin och hälsa, Allmänmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    Co-morbidity and health care utilisation five years prior to diagnosis for depression: A register-based study in a Swedish population2011Inngår i: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 11, s. 552-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background

    Depressive disorders have been associated with a number of co-morbidities, and we   hypothesized that patients with a depression diagnosis would be heavy users of health   care services, not only when first evaluated for depression, but also for preceding   years. The aim of this study was to investigate whether increased health care utilisation   and co-morbidity could be seen during five years prior to an initial diagnosis of   depression.

    Methods

    We used a longitudinal register-based study design. The setting comprised the general   population in the county of Östergötland, south-east Sweden. All 2470 patients who   were 20 years or older in 2006 and who received a new diagnosis of depression (F32   according to ICD-10) in 2006, were selected and followed back to the year 2001, five   years before their depression diagnosis. A control group was randomly selected among   those who were aged 20 years or over in 2006 and who had received no depression diagnosis   during the period 2001-2006.

    Results

    Predictors of a depression diagnosis were a high number of physician visits, female   gender, age below 60, age above 80 and a low socioeconomic status.

    Patients who received a diagnosis of depression used twice the amount of health care   (e.g. physician visits and hospital days) during the five year period prior to diagnosis   compared to the control group. A particularly strong increase in health care utilisation   was seen the last year before diagnosis. These findings were supported with a high   level of co-morbidity as for example musculoskeletal disorders during the whole five-year   period for patients with a depression diagnosis.

    Conclusions

    Predictors of a depression diagnosis were a high number of physician visits, female   gender, age below 60, age above 80 and a low socioeconomic status. To find early signs   of depression in the clinical setting and to use a preventive strategy to handle these   patients is important.

  • 4.
    André, Malin
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Allmänmedicin. Linköpings universitet, Hälsouniversitetet.
    Andén, Annika
    Linköpings universitet, Institutionen för medicin och hälsa, Allmänmedicin. Linköpings universitet, Hälsouniversitetet.
    Borgquist, Lars
    Linköpings universitet, Institutionen för medicin och hälsa, Allmänmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    Rudebeck, Carl Edvard
    Kalmar County Council, Sweden University of Tromso, Norway .
    GPs decision-making - perceiving the patient as a person or a disease2012Inngår i: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 13, nr 38Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: The aim of this study was to analyse the clinical decision making strategies of GPs with regard to the whole range of problems encountered in everyday work. less thanbrgreater than less thanbrgreater thanMethods: A prospective questionnaire study was carried through, where 16 General practitioners in Sweden registered consecutively 378 problems in 366 patients. less thanbrgreater than less thanbrgreater thanResults: 68.3% of the problems were registered as somatic, 5.8% as psychosocial and 25.9% as both somatic and psychosocial. When the problem was characterised as somatic the main emphasis was most often on the symptoms only, and when the problem was psychosocial main emphasis was given to the person. Immediate, inductive, decision-making contrary to gradual, analytical, was used for about half of the problems. Immediate decision-making was less often used when problems were registered as both somatic and psychosocial and focus was on both the symptoms and the person. When immediate decision-making was used the GPs were significantly more often certain of their identification of the problem and significantly more satisfied with their consultation. Rules of thumb in consultations registered as somatic with emphasis on symptoms only did not include any reference to the individual patient. In consultations registered as psychosocial with emphasis on the person, rules of thumb often included reference to the patient as a known person. less thanbrgreater than less thanbrgreater thanConclusions: The decision-making (immediate or gradual) registered by the GPs seemed to have been adjusted on the symptom or on the patient as a person. Our results indicate that the GPs seem to recognise immediately both problems and persons, hence the quintessence of the expert skill of the GP as developed through experience.

  • 5.
    André, Malin
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Allmänmedicin. Linköpings universitet, Hälsouniversitetet.
    Andén, Annika
    Linköpings universitet, Institutionen för medicin och hälsa, Allmänmedicin. Linköpings universitet, Hälsouniversitetet.
    Borgquist, Lars
    Linköpings universitet, Institutionen för medicin och hälsa, Allmänmedicin. Linköpings universitet, Hälsouniversitetet.
    Rudebeck, Carl-Edvard
    Linköpings universitet, Institutionen för medicin och hälsa. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    Clinical Strategies in General Practice: GPs' Perceptions2009Artikkel i tidsskrift (Annet vitenskapelig)
    Abstract [en]

    Background: General practice operates at the point of intersection between health care as a medical-technological and a humanistic enterprise, as manifested through the coherent attention given to both the patient as a person and to the disease.

    Objective: To analyse the problem-solving strategies of GPs with regard to problems encountered and presumed patient outcomes throughout the range of problems and patients encountered in the everyday work of the GP.

    Methods: Sixteen GPs from different areas of Sweden filled out questionnaires concerning 15-30 of their recent consecutive consultations.

    Results: In 94% of the consultations a somatic problem was registered, in 28% of these together with a psychosocial problem. Only a small fraction (5.8%) was registered as psychosocial problems only. In most of the consultations characterised as somatic, the main emphasis was on the symptoms only, whereas emphasis was given only to the person in consultations where the problem was registered as psychosocial. Immediate problem solving was used in about half of the consultations, where the patients were more often considered to be reassured, cope better and to be satisfied. With increasing psychosocial content of the consultations, the GPs registered more dissatisfaction, both for themselves and their patients.

    Limitations: The GPs were not randomly selected and the results are based solely on the GPs perceptions.

    Conclusions: The GPs seemed to adjust their problem solving (immediate or gradual) to the registered problem and furthermore adjust the immediate problem solving, focusing either on the problem or on the patient as a person. This might be regarded as the quintessence of the expert skill of the experienced GP.

  • 6.
    André, Malin
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa. Linköpings universitet, Hälsouniversitetet.
    Borgquist, Lars
    Linköpings universitet, Institutionen för medicin och hälsa. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    Foldevi, Mats
    Linköpings universitet, Institutionen för medicin och hälsa. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Primärvård: Vårdcentraler, Rörelse & Hälsa, LAH, Ungdomsmottagningen .
    Mölstad, Sigvard
    Linköpings universitet, Institutionen för medicin och hälsa. Linköpings universitet, Hälsouniversitetet.
    Asking for ’rules of thumb’: a way to discover tacit knowledge in general practice2002Inngår i: Family Practice, ISSN 0263-2136, Vol. 19, nr 6, s. 617-622Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background. Research in decision-making has identified heuristics (rules of thumb) as shortcuts to simplify search and choice.

    Objective. To find out if GPs recognize the use of rules of thumb and if they could describe what they looked like.

    Methods. An explorative and descriptive study was set up using focus group interviews. The interview guide contained the questions: Do you recognize the use of rules of thumb? Are you able to give some examples? What are the benefits and dangers in using rules of thumb? Where do they come from? The interviews were transcribed and analysed using the templates in the interview guide, and the examples of rules were classified by editing analysis.

    Results. Four groups with 23 GPs were interviewed. GPs recognized using rules of thumb, producing examples covering different aspects of the consultation. The rules for somatic problems were formulated as axiomatic simplified medical knowledge and taken for granted, while rules for psychosocial problems were formulated as expressions of individual experience and were followed by an explanation. The rules seemed unaffected by the sparse objections given. A GP’s clinical experience was judged a prerequisite for applying the rules. The origin of many rules was via word-of-mouth from a colleague. The GPs acknowledged the benefits of using the rules, thereby simplifying work.

    Conclusion. GPs recognize the use of rules of thumb as an immediate and semiconscious kind of knowledge that could be called tacit knowledge. Using rules of thumb might explain why practice remains unchanged although educational activities result in more elaborate knowledge.

  • 7.
    André, Malin
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa. Linköpings universitet, Hälsouniversitetet.
    Borgquist, Lars
    Linköpings universitet, Institutionen för medicin och hälsa. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    Mölstad, Sigvard
    Linköpings universitet, Institutionen för medicin och hälsa. Linköpings universitet, Hälsouniversitetet.
    Use of rules of thumb in the consultation in general practice: an act of balance between the individual and the general perspective2003Inngår i: Family Practice, ISSN 0263-2136, Vol. 20, nr 5, s. 514-519Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background. Rules of thumb used by GPs could be considered as empirical evidence of intuition and a link between science and practice in general practice.

    Objective. The purpose of the present study was to analyse the description of the application of rules of thumb with regard to different situations in general practice.

    Methods. An explorative and descriptive study was started with focus group interviews. Four groups with 23 GPs were interviewed. The interviews were transcribed and analysed, and the rules and their application were classified by an editing analysis.

    Results. A specific set of rules of thumb was used for rapid assessment, when emergency and psychosocial problems were identified. When the main focus of the problems was identified as somatic or psychosocial, the GPs did not disregard the other aspects but described the use of rules in a simultaneous individualizing and generalizing process. The rules contained probability reasoning and risk assessment.

    Conclusion. Rules of thumb seemed to serve as a link between theoretical knowledge and practical experience and were used by the GPs in an act of balance between the individual and the general perspective.

  • 8. Arrelöv, B
    et al.
    Borgquist, Lars
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Allmänmedicin.
    Ljungberg, D
    Svärdsudd, K
    Uppsala .
    The influence of change of legislation concerning sickness absence on physicians' performance as certifiers: A population-based study2003Inngår i: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 63, nr 3, s. 259-268Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    In Sweden, a change of the legislation for sickness absence became effective on 1st October, 1995. The purpose of the change was to reduce costs for sickness absence by exclusion of non-medical criteria for sick-listing, more part-time sick-listing and faster rehabilitation. This study was conducted in order to describe and analyse certification practice of various physician categories, before and after the change in legislation. Thirty-one thousand seven hundred and thirty certificates for sickness absence, collected by the local offices of the National Social Insurance Board in eight Swedish counties, fulfilled the inclusion criteria. The number of certificates decreased temporarily. The number of certified net days, i.e. crude days multiplied by degree, tended to increase and there was no shift from full to partial sick-listing during the period. There were small changes regarding case mix, i.e. patient characteristics, and sick-listing physician category. The results were almost unchanged when these small changes were taken into account. General practitioners issued significantly shorter periods of sick-leave than the other categories both years. The goals of the legislative change were thus not met. The result of the study indicates that other factors than the legislation may be more important for physicians' practice. ⌐ 2002 Elsevier Science Ireland Ltd. All rights reserved.

  • 9. Arrelöv, Britt
    et al.
    Borgquist, Lars
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Allmänmedicin.
    Ljungberg, Britt
    Svärdsudd, Kurt
    Do GPs sick-list people to a lesser extent than other physician categories? A population-based study2001Inngår i: Family Practice, ISSN 0263-2136, E-ISSN 1460-2229, Vol. 18, s. 293-398Artikkel i tidsskrift (Fagfellevurdert)
  • 10. Arrelöv, Britt
    et al.
    Borgquist, Lars
    Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, Institutionen för tema.
    Ljungberg, Dan
    Hur en reformering av socialförsäkringen påverkar läkares sjukskrivningsmönster1998Rapport (Annet vitenskapelig)
    Abstract [sv]

      

  • 11.
    Arvidsson, Eva
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    Andre, Malin
    Uppsala University, Sweden .
    Borgquist, Lars
    Linköpings universitet, Institutionen för medicin och hälsa, Allmänmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    Andersson, David
    Linköpings universitet, Institutionen för ekonomisk och industriell utveckling, Företagsekonomi. Linköpings universitet, Tekniska högskolan.
    Carlsson, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    Setting priorities in primary health care - on whose conditions? A questionnaire study2012Inngår i: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 13, nr 114Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: In Sweden three key criteria are used for priority setting: severity of the health condition; patient benefit; and cost-effectiveness. They are derived from the ethical principles established by the Swedish parliament 1997 but have been used only to a limited extent in primary care. The aim of this study was to describe and analyse: 1) GPs, nurses, and patients prioritising in routine primary care 2) The association between the three key priority setting criteria and the overall priority assigned by the GPs and nurses to individual patients. less thanbrgreater than less thanbrgreater thanMethods: Paired questionnaires were distributed to all patients and the GPs or nurses they had contact with during a 2-week period at four health centres in Sweden. The staff registered the health conditions or health problem, and the planned intervention. Then they estimated the severity of the health condition, the expected patient benefit, and the cost-effectiveness of the planned intervention. Both the staff and the patients reported their overall prioritisation of the patient. In total, 1851 paired questionnaires were collected. less thanbrgreater than less thanbrgreater thanResults: Compared to the medical staff, the patients assigned relatively higher priority to acute/minor conditions than to preventive check-ups for chronic conditions. Severity of the health condition was the priority setting criterion that had the strongest association with the overall priority for the staff as a whole, but for the GPs it was cost-effectiveness. less thanbrgreater than less thanbrgreater thanConclusions: The challenge for primary care providers is to balance the patients demands with medical needs and cost-effectiveness. Transparent priority setting in primary care might contribute to a greater consensus between GPs and nurses on how to use the key priority setting criteria.

  • 12.
    Arvidsson, Eva
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    André, Malin
    Linköpings universitet, Institutionen för medicin och hälsa, Allmänmedicin. Linköpings universitet, Hälsouniversitetet.
    Borgquist, Lars
    Linköpings universitet, Institutionen för medicin och hälsa, Allmänmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    Carlsson, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    Priority setting in primary health care - dilemmas and opportunities: a focus group study2010Inngår i: BMC FAMILY PRACTICE, ISSN 1471-2296, Vol. 11, nr 71Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Swedish health care authorities use three key criteria to produce national guidelines for local priority setting: severity of the health condition, expected patient benefit, and cost-effectiveness of medical intervention. Priority setting in primary health care (PHC) has significant implications for health costs and outcomes in the health care system. Nevertheless, these guidelines have been implemented to a very limited degree in PHC. The objective of the study was to qualitatively assess how general practitioners (GPs) and nurses perceive the application of the three key priority-setting criteria. Methods: Focus groups were held with GPs and nurses at primary health care centres, where the staff had a short period of experience in using the criteria for prioritising in their daily work. Results: The staff found the three key priority-setting criteria (severity, patient benefit, and cost-effectiveness) to be valuable for priority setting in PHC. However, when the criteria were applied in PHC, three additional dimensions were identified: 1) viewpoint (medical or patients), 2) timeframe (now or later), and 3) evidence level (group or individual). Conclusions: The three key priority-setting criteria were useful. Considering the three additional dimensions might enhance implementation of national guidelines in PHC and is probably a prerequisite for the criteria to be useful in priority setting for individual patients.

  • 13.
    Arvidsson, Eva
    et al.
    Linköpings universitet, Institutionen för hälsa och samhälle, Centrum för utvärdering av medicinsk teknologi. Linköpings universitet, Hälsouniversitetet.
    André, Malin
    Falun.
    Borgquist, Lars
    Linköpings universitet, Institutionen för hälsa och samhälle, Allmänmedicin. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland. Linköpings universitet, Hälsouniversitetet.
    Carlsson, Per
    Linköpings universitet, Institutionen för hälsa och samhälle, Centrum för utvärdering av medicinsk teknologi. Linköpings universitet, Hälsouniversitetet.
    Lindström, Kjell
    Falun.
    Så resonerar läkare och sjuksköterskor vid prioriteringar av patienter i primärvård2007Rapport (Annet vitenskapelig)
    Abstract [sv]

    Studier av prioriteringar i primärvården är särskilt intressanta eftersom det är där de allra flesta av oss kommer i kontakt med hälso- och sjukvården. Det är också i primärvården prioriteringar och olika former av ransonering på grund av begränsade resurser är vanliga. De allra flesta av oss förstår och accepterar att vi inte omedelbart kan få träffa en läkare om det inte rör sig om akuta och allvarliga sjukdomstillstånd. Vi finner många gånger ett råd om egenvård som en tillfredställande lösning för tillfället. Hur olika prioriteringar görs ”bakom kulisserna” är dock många gånger oklart för oss. Vi kan ibland t.ex. undra varför vi får betala för vissa vårdtjänster medan andra är gratis. Osäkerhet om på vilka grunder prioriteringar sker gäller inte bara för patienter utan även sjukvårdspersonal. Erfarenheter från flera olika håll i Sverige pekar på att de etiska riktlinjer som utgör kärnan i riksdagens prioriteringsprinciper är svåra att använda i praktiken. Det är därför angeläget att få mer kunskap om hur prioriteringsprinciper och begrepp uppfattas av sjukvårdspersonalen för att utveckla arbetsformer som är begripliga och förenliga med rådande rutiner.

    Distriktsläkare, mottagningssköterskor och distriktssköterskor vid fyra vårdcentraler som tidigare deltagit i en prioriteringsstudie har inbjudits att diskutera prioriteringar utifrån ett antal frågeställningar. Resultaten från dessa diskussioner visar bland att olika begrepp tolkas på många olika sätt. En framgångsrik implementering av den etiska plattformen kräver antagligen betydligt mer av öppna diskussioner om prioriteringar och principer i det dagliga vårdarbetet.

    Två allmänläkare Eva Arvidsson från Kalmar och Malin André från Falun har bidragit med den största insatsen i projektet som för övrigt inbegriper Lars Borgquist från Avdelningen för allmänmedicin vid Linköpings universitet och Kjell Lindström från Primärvårdens utvecklingsenhet i Jönköping. Studien har finansierats av Forskningsrådet för sydöstra sjukvårdsregionen (FORSS).

    Jag vill på projektgruppens vägnar tacka alla medverkande från vårdcentralerna Lindsdal och Borgholm i Kalmar läns landsting, Öxnehaga i Jönköpings läns landsting och Ryds vårdcentral i Landstinget i Östergötland.

    Linköping 2007-07-24

    Per Carlsson

  • 14.
    Arvidsson, Eva
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    André, Malin
    Linköpings universitet, Institutionen för medicin och hälsa, Allmänmedicin. Linköpings universitet, Hälsouniversitetet.
    Borgquist, Lars
    Linköpings universitet, Institutionen för medicin och hälsa, Allmänmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    Lindström, Kjell
    Linköpings universitet, Institutionen för medicin och hälsa, Allmänmedicin. Linköpings universitet, Hälsouniversitetet.
    Carlsson, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    Primary care patients' attitudes to priority setting in Sweden.2009Inngår i: Scandinavian journal of primary health care, ISSN 1502-7724, Vol. 27, nr 2, s. 123-8Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To analyse attitudes to priority setting among patients in Swedish primary healthcare. DESIGN: A questionnaire was given to patients comprising statements on attitudes towards prioritizing, on the role of politicians and healthcare staff in prioritizing, and on patient satisfaction with the outcome of their contact with primary healthcare (PHC). SETTINGS: Four healthcare centres in Sweden, chosen through purposive sampling. PARTICIPANTS: All the patients in contact with the health centres during a two-week period in 2004 (2517 questionnaires, 72% returned). MAIN OUTCOMES: Patient attitudes to priority setting and satisfaction with the outcome of their contact. RESULTS: More than 75% of the patients agreed with statements like "Public health services should always provide the best possible care, irrespective of cost". Almost three-quarters of the patients wanted healthcare staff rather than politicians to make decisions on priority setting. Younger patients and males were more positive towards priority setting and they also had a more positive view of the role of politicians. Less than 10% of the patients experienced some kind of economic rationing but the majority of these patients were satisfied with their contact with primary care. CONCLUSIONS: Primary care patient opinions concerning priority setting are a challenge for both politicians and GPs. The fact that males and younger patients are less negative to prioritizing may pave the way for a future dialogue between politicians and the general public.

  • 15.
    Arvidsson, Eva
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    André, Malin
    Linköpings universitet, Institutionen för medicin och hälsa, Allmänmedicin. Linköpings universitet, Hälsouniversitetet.
    Borgquist, Lars
    Linköpings universitet, Institutionen för medicin och hälsa, Allmänmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    Mårtensson, Jan
    Department of Nursing, School of Health and Sciences, Jönköping, Sweden.
    Carlsson, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Utvärdering och hälsoekonomi. Linköpings universitet, Hälsouniversitetet.
    Day-to-day Rationing of Limited Resources in Swedish routine Primary Care: an interview study2013Manuskript (preprint) (Annet vitenskapelig)
    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.

  • 16.
    Borgquist, Lars
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Allmänmedicin. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    Arrelöv, BE
    jSvärdsudd, Kurt
    Uppsala universitet.
    Influence of local structural factors on physicians' sick-listing practice: A population-based study2005Inngår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 15, nr 5, s. 470-474Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Physicians have a central role as gatekeepers to the social security system, including sick-listing. Variation in physicians' sick-listing practices has been demonstrated in several studies. The objective of this study was to determine whether local structural factors affect sick-listing practice. Methods: A total of 57 563 consecutive sick-listing certificates, issued during 4 months in 1995 and 2 months in 1996, were collected from the local branches of the National Social Insurance Office in eight Swedish counties. County code, local community population size and presence of a hospital in the area were used as indicators of local structural factors. Length of the sick-listing certificates and of the sick-listing episodes were used as outcome variables. Results: After ajustment for the influence of category of issuing physician, patients' age, sex and diagnosis ('case mix'), and type of certificate there was a large variation of the length of the sick-listing certificates and of the sick-listing episodes between counties, between communities of various size and between communities with or without a hospital in the area. All these factors were independently and significantly correlated to the length of the certificate and of the sick-listing episode. Conclusions: The results support the hypothesis that physicians' sick-listing practice is influenced by local structural factors. © The Author 2005. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

  • 17.
    Borgquist, Lars
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    Carlsson, Per
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Hälsouniversitetet.
    Kostnadseffektivitetens betydelse vid prioritering av läkemedel2013Inngår i: Läkemedelsboken 2014 / [ed] Helena Ramström, Läkemedelsverket, Uppsala, Uppsala: Läkemedelsverket , 2013, s. 1182-1193Kapittel i bok, del av antologi (Annet vitenskapelig)
  • 18.
    Borgquist, Lars
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Allmänmedicin. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    Lind, jan-Inge
    Från parsjukhus till vårdkedjor? Kostnadsutvecklingen i Ystad-Österlens sjukvårdsdistrikt1995-1997 belyst ur tre besparingsperspektiv1998Rapport (Annet vitenskapelig)
  • 19.
    Borgquist, Lars
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Lundell, Lars
    Karolinska institutet Department of Clinical Sciences Intervention and Technology - Stockholm, Sweden Karolinska Institutet Department of surgery - Stockholm, Sweden.
    Lindgren, Stefan
    Lund University - Clinical Sciences, Malmö Malmö, Sweden Lund University - Clinical Sciences, Malmö Malmö, Sweden.
    Magsårssjukdomens paradigmskiften – från högspecialiserad vårdorganisation till egenvård [The paradigm shift for peptic ulcer disease]2018Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 115Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Knowledge development and paradigm shift for peptic ulcer disease is described over a fifty-year period using four levels of knowledge that place demands on the healthcare organization. When medical knowledge reached a healing level, continuity became subordinate. However, accessibility to treatment became more important. An important task for future healthcare will be to define and create broader knowledge structures. Efficiency losses can occur when control instruments apply to medical problems at low levels of knowledge which are not mature for this.

  • 20.
    Borgquist, Lars
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Allmänmedicin. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    Paulsson, Eric
    The physician and lifelonglearning1998Rapport (Annet vitenskapelig)
  • 21.
    Borgquist, Lars
    et al.
    Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, Institutionen för tema.
    Rehnström, Eva
    Läkemedelsinformation och förskrivningspraxis i primärvården1998Rapport (Annet vitenskapelig)
  • 22.
    Borgquist, Lars
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    W-Dahl, Annette
    Lund University, Sweden .
    Dale, Havard
    Haukeland University Hospital, Bergen, Norway..
    Lidgren, Lars
    Lund University, Sweden .
    Stefansdottir, Anna
    Lund University, Sweden .
    Prosthetic joint infections - a need for health economy studies2014Inngår i: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 85, nr 3, s. 218-220Artikkel i tidsskrift (Annet vitenskapelig)
  • 23.
    Carlsson, Per
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Hälsouniversitetet.
    Borgquist, Lars
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    The Importance of Cost Effectiveness in Prioritising Drugs2014Inngår i: Portrait of a health economist: ESSAYS BY COLLEAGUES AND FRIENDS OF BENGT JÖNSSON / [ed] Anthony J Culyer and Gisela Kobelt, Lund: IHE - The Swedish Institute for Health Economics , 2014, s. 17-24Kapittel i bok, del av antologi (Annet vitenskapelig)
  • 24.
    Carstensen, John
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle. Linköpings universitet, Filosofiska fakulteten.
    Andersson, David
    Linköpings universitet, Institutionen för medicin och hälsa, Allmänmedicin. Linköpings universitet, Hälsouniversitetet.
    André, Malin
    Landstinget i Uppsala län.
    Engström, Sven
    Landstinget i Jönköpings län.
    Magnusson, Henric
    Linköpings universitet, Institutionen för medicin och hälsa, Sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Borgquist, Lars
    Linköpings universitet, Institutionen för medicin och hälsa, Allmänmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    How does comorbidity influence healthcare costs? A population-based cross-sectional study of depression, back pain and osteoarthritis2012Inngår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 2, s. e000809-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives To analyse how comorbidity among patients with back pain, depression and osteoarthritis influences healthcare costs per patient. A special focus was made on the distribution of costs for primary healthcare compared with specialist care, hospital care and drugs.

    Design Population-based cross-sectional study.

    Setting The County of Östergötland, Sweden.

    Patients Data on diagnoses and healthcare costs for all 266 354 individuals between 20 and 75 years of age, who were residents of the County of Östergötland, Sweden, in the year 2006, were extracted from the local healthcare register and the national register of drug prescriptions.

    Main outcome measures The effects of comorbidity on healthcare costs were estimated as interactions in regression models that also included age, sex, number of other health conditions and education.

    Results The largest diagnosed group was back pain (11 178 patients) followed by depression (7412 patients) and osteoarthritis (5174 patients). The largest comorbidity subgroup was the combination of back pain and depression (772 patients), followed by the combination of back pain and osteoarthritis (527 patients) and the combination of depression and osteoarthritis (206 patients). For patients having both a depression diagnosis and a back pain diagnosis, there was a significant negative interaction effect on total healthcare costs. The average healthcare costs among patients with depression and back pain was SEK 11 806 lower for a patient with both diagnoses. In this comorbidity group, there were tendencies of a positive interaction for general practitioner visits and negative interactions for all other visits and hospital days. Small or no interactions at all were seen between depression diagnoses and osteoarthritis diagnoses.

    Conclusions A small increase in primary healthcare visits in comorbid back pain and depression patients was accompanied with a substantial reduction in total healthcare costs and in hospital costs. Our results can be of value in analysing the cost effects of comorbidity and how the coordination of primary and secondary care may have an impact on healthcare costs.

  • 25.
    Engstrom, Sevek
    et al.
    Uppsala University, Sweden .
    Borgquist, Lars
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    Berne, Christian
    University of Uppsala Hospital, Sweden .
    Gahnberg, Lars
    University of Gothenburg, Sweden .
    Svardsudd, Kurt
    Uppsala University, Sweden .
    Can costs of screening for hypertension and diabetes in dental care and follow-up in primary health care be predicted?2013Inngår i: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 118, nr 4, s. 256-262Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim. The purpose was to assess the direct costs of screening for high blood pressure and blood glucose in dental care and of follow-up in primary health care and, based on these data, arrive at a prediction function. less thanbrgreater than less thanbrgreater thanStudy population. All subjects coming for routine check-ups at three dental health clinics were invited to have blood pressure or blood glucose measurements; 1,623 agreed to participate. Subjects screening positive were referred to their primary health care centres for follow-up. less thanbrgreater than less thanbrgreater thanMethods. Information on individual screening time was registered during the screening process, and information on accountable time, costs for the screening staff, overhead costs, and analysis costs for the screening was obtained from the participating dental clinics. The corresponding items in primary care, i.e. consultation time, number of follow-up appointments, accountable time, costs for the follow-up staff, overhead costs, and analysis costs during follow-up were obtained from the primary health care centres. less thanbrgreater than less thanbrgreater thanResults. The total screening costs per screened subject ranged from (sic)7.4 to (sic)9.2 depending on subgroups, corresponding to 16.7-42.7 staff minutes. The corresponding follow-up costs were (sic)57-(sic)91. The total resource used for screening and follow-up per diagnosis was 563-3,137 staff minutes. There was a strong relationship between resource use and numbers needed to screen (NNS) to find one diagnosis (P andlt; 0.0001, degree of explanation 99%). less thanbrgreater than less thanbrgreater thanConclusions. Screening and follow-up costs were moderate and appear to be lower for combined screening of blood pressure and blood glucose than for separate screening. There was a strong relationship between resource use and NNS.

  • 26.
    Engström, Sven
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Allmänmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Primärvård: Vårdcentraler, Rörelse & Hälsa, LAH, Ungdomsmottagningen .
    Foldevi, Mats
    Linköpings universitet, Institutionen för medicin och hälsa, Allmänmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Primärvård: Vårdcentraler, Rörelse & Hälsa, LAH, Ungdomsmottagningen .
    Borgquist, Lars
    Linköpings universitet, Institutionen för medicin och hälsa, Allmänmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    Is general practice effective?: A systematic literature review2001Inngår i: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, Vol. 19, nr 2, s. 131-144Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective - To find evidence of the effectiveness of physicians working in primary care.

    Design - Systematic literature search in the Medline and Cochrane databases.

    Material - Out of 7223 titles found in the search, 45 studies, comparing, from different aspects, primary care with specialist care, were extracted.

    Main outcome measures - Health indicators, health care costs, quality of health care.

    Results - Primary care contributed to improved public health, as expressed through different health parameters, and a lower utilisation of medical care leading to lower costs. Physicians working in primary care, in comparison with other specialists, took care of many diseases without loss of quality and often at lower cost. The organisation of primary care was important in respect of reimbursement by capita tion, more group practices, higher personal continuity, and having generalists as primary care physicians.

    Conclusions - To compare the effectiveness of primary care and specialist care is a complex task and there are limitations in all studies. However, we have found evidence that increased accessibility to physicians working in primary care contributes to better health and lower total costs in the health care system. It is also clear that studies with evaluation of how to most effectively organise primary care are far too few. There is an extensive need for future research in this area, a suitable task for collaborative research between the Nordic countries.

  • 27.
    Engström, Sven G
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa. Linköpings universitet, Hälsouniversitetet.
    Carlsson, Lennart
    The Neurotec Department, Center for Family and Community Medicine, Karolinska Institutet, Stockholm, Sweden.
    Östgren, Carl-Johan
    Linköpings universitet, Institutionen för medicin och hälsa. Linköpings universitet, Hälsouniversitetet.
    Nilsson, Gunnar H.
    The Neurotec Department, Center for Family and Community Medicine, Karolinska Institutet, Stockholm, Sweden.
    Borgquist, Lars
    Linköpings universitet, Institutionen för medicin och hälsa. Linköpings universitet, Hälsouniversitetet.
    The importance of comorbidity in analysing patient costs in Swedish primary care2006Inngår i: BMC Public Health, ISSN 1471-2458, Vol. 36, nr 6, s. 36-42Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background

    The objective was to explore the usefulness of the morbidity risk adjustment system Adjusted Clinical Groups® (ACG), in comparison with age and gender, in explaining and estimating patient costs on an individual level in Swedish primary health care. Data were retrieved from two primary health care centres in southeastern Sweden.

    Methods

    A cross-sectional observational study. Data from electronic patient registers from the two centres were retrieved for 2001 and 2002, and patients were grouped into ACGs, expressing the individual combination of diagnoses and thus the comorbidity. Costs per patient were calculated for both years in both centres. Cost data from one centre were used to create ACG weights. These weights were then applied to patients at the other centre. Correlations between individual patient costs, age, gender and ACG weights were studied. Multiple linear regression analyses were performed in order to explain and estimate patient costs.

    Results

    The variation in individual patient costs was substantial within age groups as well as within ACG weight groups. About 37.7% of the individual patient costs could be explained by ACG weights, and age and gender added about 0.8%. The individual patient costs in 2001 estimated 22.0% of patient costs in 2002, whereas ACG weights estimated 14.3%.

    Conclusion

    ACGs was an important factor in explaining and estimating individual patient costs in primary health care. Costs were explained to only a minor extent by age and gender. However, the usefulness of the ACG system appears to be sensitive to the accuracy of classification and coding of diagnoses by physicians.

  • 28.
    Engström, Sven
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Allmänmedicin. Linköpings universitet, Hälsouniversitetet.
    Magnusson, Henrik
    Linköpings universitet, Institutionen för medicin och hälsa, Allmänmedicin. Linköpings universitet, Hälsouniversitetet.
    Enthoven, Paul
    Linköpings universitet, Institutionen för medicin och hälsa, Sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Walter, Lars
    FHVC landstinget i Östergötland.
    Thorell, Kristine
    Blekinge kompentenscentrum.
    Halling, Anders
    Allmänmedicin, Lunds universitet.
    Borgquist, Lars
    Linköpings universitet, Institutionen för medicin och hälsa. Linköpings universitet, Institutionen för medicin och hälsa, Allmänmedicin. Linköpings universitet, Hälsouniversitetet.
    Social status påverkar kostnader för läkemedel och vård: Vårdval bör ta hänsyn till socioekonomiska faktorer, visar registerstudie2009Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 106, nr 48, s. 3248-3253Artikkel i tidsskrift (Annet vitenskapelig)
  • 29.
    Engström, Sven
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Primärvård: Vårdcentraler, Rörelse & Hälsa, LAH, Ungdomsmottagningen .
    Mölstad, Sigvard
    Linköpings universitet, Institutionen för medicin och hälsa. Linköpings universitet, Hälsouniversitetet.
    Lindström, Kjell
    Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    Nilsson, Gunnar
    Department of Clinical Science, Family Medicine Stockholm, Karolinska Institute, Stockholm.
    Borgquist, Lars
    Linköpings universitet, Institutionen för medicin och hälsa. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    Excessive use of rapid tests in respiratory tract infections in Swedish primary health care2004Inngår i: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, Vol. 36, nr 3, s. 213-218Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    A 1-y retrospective study of problem oriented electronic patient records, for encounters concerning respiratory tract infection, was performed. The aim was to analyse the management of respiratory tract infections in primary health care in terms of diagnostic coding, tests and antibiotic treatment using data from electronic patient records. 12 primary health care centres with a registered population of 102,050 residents in 3 counties in southeast Sweden participated. Data were retrieved electronically from records of patient encounters concerning respiratory tract infections. The data were: patient age and gender, date of contact, diagnostic code, CRP and GABHS tests and results, as well as antibiotic prescriptions. In a total of 19,965 encounters, the most frequent diagnoses were common cold (40%), acute tonsillitis (18%), and acute bronchitis (15%). A total of 4445 GABHS tests (in 22% of encounters) and 6141 CRP tests (31%) were performed, and both tests were done in 1910 encounters (10%). A total of 7934 antibiotic prescriptions were registered. The proportion of patients tested and prescribed an antibiotic varied greatly between centres. We found an excessive, and much varying, use of rapid tests in encounters for respiratory tract infections. Data retrieval from electronic patient record systems was a feasible method to study the use of laboratory tests in relation to pharmacological treatment.

  • 30.
    Engström, Sven
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Primärvård: Vårdcentraler, Rörelse & Hälsa, LAH, Ungdomsmottagningen .
    Mölstad, Sigvard
    Linköpings universitet, Institutionen för medicin och hälsa. Linköpings universitet, Hälsouniversitetet.
    Nilsson, Gunnar
    Department of Clinical Science, Family Medicine Stockholm, Karolinska Institute, Stockholm, Sweden.
    Lindström, Kjell
    Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    Borgquist, Lars
    Linköpings universitet, Institutionen för medicin och hälsa. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    Data from electronic patient records are suitable for surveillance of antibiotic prescriptions for respiratory tract infections in primary health care2004Inngår i: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, Vol. 36, nr 2, s. 139-143Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Diagnoses and antibiotic treatments were analysed in relation to respiratory tract infections (RTI). A 1-y retrospective study was made of electronic patient records (EPR) for encounters concerning RTIs in primary health care in Sweden. The study covered a registered population of 102,050 individuals at 12 primary health care centres in 3 counties. Data were recorded on number of episodes, encounters, diagnostic codes and antibiotic prescriptions. The yearly number of episodes of RTIs was 16,964 or 166 per 1000 inhabitants per y. The total number of encounters was 19,965. The most frequent diagnoses were common cold (40%), acute tonsillitis (18%), and acute bronchitis (15%). The yearly number of antibiotic prescriptions was 7961, accounting for 47% of the episodes or 78 per 1000 inhabitants per y. The most frequently prescribed antibiotics were phenoxymethylpenicillin (61%), tetracyclines (18%) and macrolides 8%). Standard EPRs provide a feasible source of clinical information which, taking limitations into consideration, could be used for the follow-up of trends in antibiotic prescribing and of adherence to guidelines with regard to RTIs.

  • 31.
    Ernsth Bravella, Marie
    et al.
    Jönköping University, Sweden.
    Westerlind, Björn
    County Hospital Ryhov, Jönköping, Sweden.
    Midlöv, Patrik
    Lund University, Sweden.
    Östgren, Carl Johan
    Linköpings universitet, Institutionen för medicin och hälsa, Allmänmedicin. Linköpings universitet, Hälsouniversitetet.
    Borgquist, Lars
    Linköpings universitet, Institutionen för medicin och hälsa, Allmänmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    Lannering, Christina
    Unit of Research and Development in Primary Care, Futurum, Jönköping, Sweden.
    Mölstad, Sigvard
    Unit of Research and Development in Primary Care, Futurum, Jönköping, Sweden.
    How to assess frailty and the need for care? Report from the Study of Health and Drugs in the Elderly (SHADES) in community dwellings in Sweden2011Inngår i: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 53, nr 1, s. 40-45Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Abstract

    Knowledge about the need for care of elderly individuals in community dwellings and the factors affecting their needs and support is limited. The aim of this study was to characterize the frailty of a population of elderly individuals living in community dwellings in Sweden in relation to co-morbidity, use of drugs, and risk of severe conditions such as malnutrition, pressure ulcers, and falls. In 2008, 315 elderly individuals living in community dwellings were interviewed and examined as part of the SHADES-study. The elderly demonstrated co-morbidity (a mean of three diseases) and polypharmacy (an average of seven drugs). More than half the sample was at risk for malnutrition, one third was at risk for developing pressure ulcers, and nearly all (93%) had an increased risk of falling and a great majority had cognitive problems. Age, pulse pressure, body mass index, and specific items from the modified Norton scale (MNS), the Downton fall risk index (DFRI), and the mini nutritional assessment (MNA-SF) were related to different outcomes, defining the need for care and frailty. Based on the results of this study, we suggest a single set of items useful for understanding the need for care and to improve individual based care in community dwellings.

     

  • 32. Grahn, B
    et al.
    Borgquist, Lars
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Allmänmedicin.
    Ekdahl, Christer
    Är rehabilitering kostnadseffektiv?2000Inngår i: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 5, s. 445-453Artikkel i tidsskrift (Annet (populærvitenskap, debatt, mm))
  • 33.
    Grahn, B
    et al.
    Kronoberg Occupat Rehabil Serv, Vaxjo, Sweden Univ Lund, Dept Phys Therapy, Lund, Sweden Linkoping Univ, Dept Family Med, Linkoping, Sweden Linkoping Univ, Dept Hlth & Soc, Linkoping, Sweden.
    Ekdahl, C
    Borgquist, Lars
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och hälsa, Allmänmedicin. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    Motivation as a predictor of changes in quality of life and working ability in multidisciplinary rehabilitation - A two-year follow-up of a prospective controlled study in patients with prolonged musculoskeletal disorders2000Inngår i: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 22, nr 15, s. 639-654Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose : To evaluate the two year outcome of multidisciplinary rehabilitation for patients with prolonged musculoskeletal disorders (MSDs), in terms of health-related quality of life (HRQL) and working ability. In addition, predictors of outcome were examined. Methods : The rehabilitation group and the matched control group comprised 122 and 114 patients respectively. Baseline data were compared with two year follow-up data within and between the groups. The variables that were measured were : HRQL (Nottingham Health Profile), motivation, body awareness, pain, pain-related medicine consumption, psychosomatic symptoms, working environment and working ability. Results : Variables which improved significantly for the rehabilitation group compared with the control group were : HRQL (p=0.049), emotional reactions (p=0.043), pain related to movements (p=0.028) and need for pain-related medicines (p=0.009). Multivariate regression analysis including all patients revealed that motivation was a predictor of change in HRQL (p=0.001) and working ability (p<0.001). Conclusion : The rehabilitation programme appeared to improve HRQL to a greater extent than ordinary treatment available within primary care. The patient's level of motivation could be an important predictor of outcome.

  • 34. Grahn, B
    et al.
    Ekdahl, Christer
    Borgquist, Lars
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Allmänmedicin.
    Motivated patients are more cost-effectively rehabilitates. A two-year prospective controlled study of patients with prolonged muscusculoskeletal disorders.2000Inngår i: International Journal of Technology Assessment in Health Care, ISSN 0266-4623, E-ISSN 1471-6348, Vol. 16, s. 849-863Artikkel i tidsskrift (Fagfellevurdert)
  • 35.
    Grahn, B.E.M.
    et al.
    Kronoberg County Council, Lund University.
    Borgquist, Lars
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och hälsa, Allmänmedicin. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    Ekdahl, C.S.
    Lund University.
    Rehabilitation benefits highly motivated patients: A six-year prospective cost-effectiveness study2004Inngår i: International Journal of Technology Assessment in Health Care, ISSN 0266-4623, E-ISSN 1471-6348, Vol. 20, nr 2, s. 214-221Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives: To compare the six-year outcome of a multidisciplinary rehabilitation program with continued care within primary care in terms of health-related quality of life and cost-effectiveness. Furthermore, predictors of total costs to society were examined. Methods: A prospective, matched, controlled, six-year follow-up was designed. The study included 236 patients (42 men, 194 women) nineteen to sixty-one years of age with prolonged musculoskeletal disorders. The intervention comprised a four-week multidisciplinary rehabilitation and an active one-year follow-up based on a bio-psycho-social approach. The control group received continued care within primary care. The main outcome measures were quality of life measured using the Nottingham Health Profile, motivation identified by an interview and patient-specific total costs to society. Differences in mean costs between groups and cost-effectiveness were evaluated by applying nonparametric bootstrapping techniques. Results: Total costs per treated patient in the rehabilitation group and the control group were £43,464 (SD = 31,093) and £44,123 (SD = 33,333), respectively (p=.896). Multidisciplinary rehabilitation improved quality of life somewhat more cost-effectively. Motivation was revealed as a predictor of total costs. Conclusion: In the long-run, the evaluated multidisciplinary rehabilitation improved the highly motivated patients' quality of life most cost-effectively. The latently motivated patients may require rehabilitation, which is less intensive and with a longer duration, to improve their health in a whole-person perspective. The burden of prolonged musculoskeletal disorders to society was reaffirmed. Motivation could be a predictor of total costs, a factor which has to be taken into account in the examination procedure.

  • 36.
    Grahn, Birgitta E M
    et al.
    Lund University.
    Borgquist, Lars
    Linköpings universitet, Institutionen för medicin och hälsa, Allmänmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    Ekdahl, Charlotte S
    Lund University.
    Motivated patients are more cost-effectively rehabilitated - A two-year prospective controlled study of patients with prolonged musculoskeletal disorders diagnosed in primary care2000Inngår i: International Journal of Technology Assessment in Health Care, ISSN 0266-4623, E-ISSN 1471-6348, Vol. 16, nr 3, s. 849-863Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives: To compare the cost-effectiveness of a multidisciplinary rehabilitation program with traditional treatment within primary care in terms of the health-related duality of life (HRQOL) in patients with prolonged musculoskeletal disorders (MSD) on the one hand and the costs to society on the other. Predictors of total costs, such as motivation, socio-economic level, age, pain, and working environment, were investigated. Methods: A prospective, matched, controlled 2-year follow-up study was designed. The main outcome measures were HRQOL using the Nottingham Health profile (NHP) and patient-specific total costs due to society. The cost-effectiveness was expressed as a quotient of the total costs to society/NHP global score difference value. Results: Patients with prolonged MSD generate substantial total costs to society, chiefly in the area of indirect costs. Multidisciplinary rehabilitation improved HRQOL more cost-effectively. Motivation was revealed as a predictor of total costs. The relationship in savings in terms of indirect costs between the highly-motivated and the less-motivated patients was calculated at 4:1. Conclusions: The large group of patients with prolonged MSD generate substantial total costs, and even small reductions in direct and indirect costs could be of importance to society. The multidisciplinary rehabilitation program applied here was more cost-effective as compared with conventional treatment within primary care when it came to improving the patients perceived HRQOL. Motivation could be a predictor of total costs, which has to be addressed in the process of identifying the patient as a partner in the rehabilitation process.

  • 37.
    Grahn, Birgitta
    et al.
    Medicinska fakulteten Lunds universitet.
    Ekdahl, C
    Medicinska fakulteten Lunds universitet.
    Borgquist, Lars
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Allmänmedicin. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    Effects of a multidisciplinary rehabilitation programme on health-related quality of life in patientswith prolonged musculoskeletal disorders. A 6-months follow-up of a prospective controlled study1998Inngår i: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 20, nr 8, s. 285-297Artikkel i tidsskrift (Fagfellevurdert)
  • 38.
    Grodzinsky, Ewa
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Allmänmedicin. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    Borgquist, Lars
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Allmänmedicin. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    Lindström, Kjell
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Allmänmedicin.
    Ylikivelä, R
    Östgren, Carl-Johan
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Allmänmedicin. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland.
    Self-monitoring of B-Glucose (SMBG) in type 2 diabetes does not improve HbA1c level. Clin Chem Acta (Suppl).2005Inngår i: Focus on the patient. 16th IFCC Euromedlab.,2005, 2005Konferansepaper (Annet vitenskapelig)
  • 39.
    Grodzinsky, Ewa
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Allmänmedicin. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    Wiréhn, Ann-Britt
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Allmänmedicin. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    Fremner, Eva
    Haglund, S
    Larsson, Lasse
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för biomedicin och kirurgi, Avdelningen för klinisk kemi. Östergötlands Läns Landsting, Laboratoriemedicinskt centrum, Klinisk kemi.
    Persson, L-G
    Borgquist, Lars
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Allmänmedicin. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    Point-of-care testing has a limited effect on time to clinical decision in primary health care2004Inngår i: Scandinavian Journal of Clinical and Laboratory Investigation, ISSN 0036-5513, E-ISSN 1502-7686, Vol. 64, nr 6, s. 547-551Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To investigate the clinical logistics of laboratory routines at primary health care centres (PHCs). Design and methods: Prospective registration was carried out for each PHC using questionnaires during 2-week intervals between the end of November 2001 and mid-January 2002. The study included 9 PHCs in the county of Östergötland and 4 in the county of Jönköping, Sweden, with different numbers of blood tests analysed using point-of-care testing (POCT). Data for B-glucose, HbA1c, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), thyroid-stimulating hormone (TSH), T4, cholesterol, HDL-cholesterol, LDL-cholesterol and triglycerides were collected. Main outcome measures were median time from sampling to available test result (TATa) and median time from sampling to clinical decision (TATd), and the proportion of patients informed of the outcome of the blood test in question during the sampling occasion. Results: A total of 3542 samples were collected. The median TATa showed that B-glucose, ESR and CRP were immediately analysed at all 13 PHCs. For the other tests, TATa varied from immediately to about two days. The median TATd varied from immediately to about a week. When POCT was used, 30% of the patients were informed about the outcome of the test during the sampling occasion. Conclusion: POCT has a limited effect on the clinical logistics in PHCs.

  • 40.
    Hedin, H
    et al.
    Uppsala.
    Borgquist, Lars
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Allmänmedicin.
    Larsson, S
    Uppsala univ.
    A cost analysis of three methods of treating femoral shaft fractures in children: A comparison of traction in hospital, traction in hospital/home and external fixation2004Inngår i: Acta Orthopaedica Scandinavica, ISSN 0001-6470, Vol. 75, nr 3, s. 241-248Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction: There is no consensus as to which is best treatment of femoral fractures in children. Patients and methods: We performed a cost analysis comparing three treatments of femoral shaft fractures in children aged 3-15 years at 3 hospitals during the same period (1993-2000). The analysis included total medical costs and costs for the care provider and were calculated from the time of injury up to 1 year. Results: At hospital 1, treatment consisted of external fixation and early mobilization. At hospital 2, the treatment was skin or skeletal traction in hospital for 1-2 weeks, followed by home traction. At hospital 3, treatment was skin or skeletal traction in hospital until the fracture healed. Results: The average total costs per patient were EUR 10,000 at hospital 1, EUR 23,000 at hospital 2, and EUR 38,000 at hospital 3. Interpretation: The main factor for determining the cost of treatment was the number of days in hospital, which was lower in children treated with external fixation.

  • 41.
    Holtedahl, Knut
    et al.
    Department of Community Medicine, UiT The Arctic University of Norway, Norway.
    Vedsted, Peter
    Aarhus University, Research Unit for General Practice, Research Centre for Cancer Diagnosis in Primary Care, Denmark.
    Borgquist, Lars
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    Donker, Gé A.
    NIVEL Primary Care Database, Sentinel Practices, Utrecht, Netherlands.
    Buntinx, Frank
    Dept of General Practice, KULeuven, Belgium, and Maastricht University, Netherlands.
    Weller, David
    Usher Institute for Population Health Sciences and Medical Informatics, The University of Edinburgh, Doorway 1, Teviot Place, Edinburgh, Scotland, UK.
    Braaten, Tonje
    Department of Community Medicine, UiT The Arctic University of Norway, Norway.
    Hjertholm, Peter
    Aarhus University, Research Unit for General Practice, Research Centre for Cancer Diagnosis in Primary Care, Denmark.
    Månsson, Jörgen
    Department of Public Health and Community Medicine/Primary Health Care, The Sahlgrenska Academy at the University of Gothenburg, Sweden.
    Strandberg, Eva Lena
    Lund University, Department of Clinical Sciences Malmö, Family Medicine/General Practice, Sweden.
    Campbell, Christine
    Usher Institute for Population Health Sciences and Medical Informatics, The University of Edinburgh, Doorway 1, Teviot Place, Edinburgh, EH8 9AG, Scotland, UK.
    Ellegaard, Lisbeth
    Department of Community Medicine, UiT The Arctic University of Norway, Norway.
    Parajuli, Ranjan
    Department of Community Medicine, UiT The Arctic University of Norway, Norway.
    Abdominal symptoms in general practice: Frequency, cancer suspicions raised, and actions taken by GPs in six European countries. Cohort study with prospective registration of cancer2017Inngår i: Heliyon, ISSN 2405-8440, Vol. 3, nr 6, artikkel-id e00328Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Abdominal symptoms are diagnostically challenging to general practitioners (GPs): although common, they may indicate cancer. In a prospective cohort of patients, we examined abdominal symptom frequency, initial diagnostic suspicion, and actions of GPs in response to abdominal symptoms.

  • 42.
    Håkansson, A
    et al.
    Lund.
    André, Malin
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Allmänmedicin.
    Björklund, C
    Göteborg.
    Borgquist, Lars
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Allmänmedicin. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    Holmberg, S
    FoU Växjö.
    General practice research is growing quickly enough?2006Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, nr 103, s. 24-25Artikkel i tidsskrift (Annet vitenskapelig)
  • 43.
    Jacobsson, Fredric
    et al.
    Linköpings universitet, Institutionen för hälsa och samhälle. Linköpings universitet, Filosofiska fakulteten.
    Carstensen, John
    Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, Institutionen för hälsa och samhälle, Tema hälsa och samhälle.
    Borgquist, Lars
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Allmänmedicin. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    Caring externalities in health economic evaluation: How are they related to severity of illness?2005Inngår i: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 73, nr 2, s. 172-182Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    In health economic evaluations, altruistic preferences in the form of caring externalities, i.e. that people care about others' health, is usually not taken into account. In this study we examined how people value their own and others' health. This pilot study was carried out by letting people answer willingness to pay (WTP) questionnaires where internal WTP (own health) and altruistic WTP (others' health) were isolated and examined. A common method used in health economic evaluations is cost-utility analysis, which is based on the maximisation of QALYs. QALY maximisation may be appropriate if altruistic preferences are non-existent or if they are linear in relation to internal preferences (QALYs gained). We found evidence for the existence of altruistic preferences and that these preferences were relatively higher for severe health states (and lower for mild states of health) compared to internal preferences, i.e. when severity of illness increased, the relative increase in caring was higher concerning others than oneself. The difference was statistically significant (P < 0.001). Our results indicate that more attention and resources should be directed to severe health states, as compared to mild health states, than advocated by internal preferences in order to obtain more efficient resource allocation in the health care sector. © 2004 Elsevier Ireland Ltd. All rights reserved.

  • 44.
    Jacobsson, Fredric
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Centrum för utvärdering av medicinsk teknologi.
    Johannesson, Magnus
    Handelshögskolan.
    Borgquist, Lars
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Allmänmedicin. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    Is Altruism Paternalistic?2007Inngår i: Economic Journal, ISSN 0013-0133, E-ISSN 1468-0297, Vol. 117, s. 761-781Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

     We test if altruism is paternalistic with respect to health. Subjects can donate money or nicotine patches to a smoking diabetes patient whose willingness to pay for nicotine patches is positive but below the market price. In a between-subjects treatment, average donations are 40% greater in the nicotine patches group. When subjects can donate both nicotine patches and money more than 90% of the donations are given in kind rather than cash. These results are also confirmed in three additional stability experiments that vary the framing, use food stamps instead of money, and use exercise instead of nicotine patches.

  • 45.
    Lindström, Kjell
    et al.
    Linköpings universitet, Institutionen för hälsa och samhälle, Allmänmedicin. Linköpings universitet, Hälsouniversitetet.
    Engström, Sven
    Linköpings universitet, Institutionen för hälsa och samhälle, Allmänmedicin. Linköpings universitet, Hälsouniversitetet.
    Bengtsson, Calle
    Department of Primary Health Care, Göteborg University, Göteborg, Sweden.
    Borgquist, Lars
    Linköpings universitet, Institutionen för hälsa och samhälle, Allmänmedicin. Linköpings universitet, Hälsouniversitetet.
    Determinants of hospitalisation rates: does primary health care play a role?2003Inngår i: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 21, nr 1, s. 15-20Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective - To analyse the influence of rates of general practitioner visits on rates of hospitalisations.

    Design  - Ecological cross-sectional study of factors influencing hospitalisation rates. Aggregated data on primary care centre area level.

    Setting - The county of Östergötland, Sweden, with 3 hospital districts and 41 primary health care centres, and the hospital district of Jönköping in the county of Jönköping, Sweden, with 11 primary health care centres.

    Outcome measure - Hospitalisation rates.

    Results  - Age and rates of outpatient hospital visits were the most important factors explaining the variation in rates of hospitalisations between the primary health care centre areas. Hospital districts, socioeconomic factors and rates of GP visits also influenced the rates of hospitalisations.

    Conclusion - When evaluating the influence of primary health care on the rates of hospitalisations, both socioeconomic factors and health care structure must be taken into consideration. Doing this, the rates of GP visits correlated negatively with the rates of hospitalisations.

  • 46. Lundberg, L
    et al.
    Johannesson, M
    Isacsson, D
    Borgquist, Lars
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Allmänmedicin.
    Health-state utilities in a general population in relation to age, gender and socioeconomic factors.1999Inngår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 9, s. 211-217Artikkel i tidsskrift (Fagfellevurdert)
  • 47. Lundberg, Lena
    et al.
    Johannesson, Magnus
    Isacsson, Dag
    Borgquist, Lars
    Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, Institutionen för tema.
    Effects of user charges on the use of prescription medicines in different socio-economic groups1998Inngår i: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 44, nr 2, s. 123-134Artikkel i tidsskrift (Fagfellevurdert)
  • 48.
    Lundkvist, j
    et al.
    Uppsala.
    Åkerlind, Ingemar
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Rikscentrum arbetslivsinriktad rehabilitering IHS.
    Borgquist, Lars
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för hälsa och samhälle, Allmänmedicin.
    Mölstad, S
    Jönköping.
    The more time spent on listening, the less time spent on prescribing antibiotics in general practice2002Inngår i: Family Practice, ISSN 0263-2136, E-ISSN 1460-2229, Vol. 19, nr 6, s. 638-640Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective. To analyse the variation between primary care centres (PCCs) with regard to prescribing antibiotics and to investigate whether the variation can be explained by factors related to patient satisfaction and to socio-demographic characteristics of the populations in the catchment areas of the PCCs. Methods. The frequency of prescription of antibiotics by GPs at the PCCs was used as the dependent variable in a multivariate regression analysis. Questionnaire data for patient satisfaction and register data for socio-demographic characteristics were used as explanatory variables. The study was set in a county in south-east Sweden, and 6734 patients consulting GPs at 39 out of the 41 PCCs in the county participated. Variables correlating with the frequency of antibiotics prescription at PCC level and with patient satisfaction were the main outcome measures. Results. A seven-fold variation in the extent of the prescription of antibiotics between the PCCs was observed. In the multivariate analysis, a high antibiotic prescription rate relates to high overall patient satisfaction with GP consultation as well as to the share of males in the listed population but to low satisfaction with the time spent by the GP on listening to the patient. Conclusion. A high frequency of prescription of antibiotics at a PCC may reflect a general disposition among GPs to give priority to maintaining good relations with the patients. However, a low level of prescription may be consistent with patient satisfaction if more time is spent on listening to and informing the patients. Thus more time spent on listening to the patients may reduce the prescription of antibiotics without reducing patient satisfaction.

  • 49.
    Marklund, B.
    et al.
    Research and Development Unit, Primary Health Care, Halland, Finland, Department of Primary Health Care, Sahlgrenska Academy, Göteborg University, Göteborg, Sweden, Research and Development Unit, Primary Health Care, PO Box 113, SE-311 22 Falkenberg, Sweden.
    Strom, M.
    Ström, M., Research and Development Unit, Primary Health Care, Halland, Finland.
    Mansson, J.
    Månsson, J., Research and Development Unit, Primary Health Care, Halland, Finland, Department of Primary Health Care, Sahlgrenska Academy, Göteborg University, Göteborg, Sweden.
    Borgquist, Lars
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och hälsa, Allmänmedicin. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    Baigi, A.
    Research and Development Unit, Primary Health Care, Halland, Finland, Department of Primary Health Care, Sahlgrenska Academy, Göteborg University, Göteborg, Sweden.
    Fridlund, B.
    Department of Primary Health Care, Sahlgrenska Academy, Göteborg University, Göteborg, Sweden, School of Health Sciences and Social Work, Växjö University, Växjö, Sweden.
    Computer-supported telephone nurse triage: An evaluation of medical quality and costs2007Inngår i: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 15, nr 2, s. 180-187Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aim: To evaluate a telephone nurse triage model in terms of appropriateness of referrals to the appropriate level of care, patient's compliance with given advice and costs. Background: A key concern in each telephonic consultation is to evaluate if appropriate. Method: An evaluative design in primary health care with consecutive patients (N = 362) calling telephone nurse triage between November 2002 and February 2003. Results: The advice was considered adequate in 325 (97.6%) cases. The patients' compliance with self-care was 81.3%, to primary health care 91.1% and to Accident and Emergency department 100%. The nurses referred self-care cases (64.7%) and Accident and Emergency cases (29.6%) from a less adequate to an appropriate level of care. The cost saving per call leading to a recommendation of self-care was €70.3, to primary health care €24.3 and to Accident and Emergency department €22.2. Conclusions The telephone nurse triage model showed adequate guidance for the patients concerning level of care and released resources for the benefit of both patients and the health care system. © 2007 The Authors. Journal compilation 2007 Blackwell Publishing Ltd.

  • 50.
    Mårtensson, Jan
    et al.
    Landstinget Jönköping.
    Carlsson, Per
    Linköpings universitet, Institutionen för hälsa och samhälle, Centrum för utvärdering av medicinsk teknologi. Linköpings universitet, Hälsouniversitetet.
    Arvidsson, Eva
    Linköpings universitet, Institutionen för hälsa och samhälle, Centrum för utvärdering av medicinsk teknologi. Linköpings universitet, Hälsouniversitetet.
    Frank, Linda
    Landstinget Jönköping.
    Lindström, Kjell
    Landstinget Jönköping.
    Borgquist, Lars
    Linköpings universitet, Institutionen för hälsa och samhälle, Allmänmedicin. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland. Linköpings universitet, Hälsouniversitetet.
    Erfarenhet, kunskap och inställning till prioriteringar: En intervjustudie med personal i primärvården2006Rapport (Annet vitenskapelig)
    Abstract [sv]

    Den svenska primärvården med vårdcentraler har utvecklats under en 40-årsperiod. Utvecklingen har delvis varit en anpassning till den alltjämt dominerande specialistvården med anknytning till sjukhusen. I takt med den medicinteknologiska utvecklingen har det också skett en överföring av flera patientgrupper i öppna vårdformer och många av de stora folksjukdomarna utreds och behandlas numera i primärvården. Resurstillskottet till svensk primärvård har i relativa tal varit mindre än det till sjukhusvård under den 40-åriga perioden och det har skapat prioriteringsproblem.

    Frågor om hur prioriteringar går till och bör gå till blir alltmer aktuella i primärvården i takt med att man upplever att resurserna inte räcker till. Studier och diskussioner om prioriteringar saknas till stor del och det har inte funnits någon vana att hantera prioriteringssituationer inom primärvården. Inte heller har det funnits stöd eller verktyg för att underlätta prioriteringsarbetet för de som arbetar i primärvården.

    Detta projekt om prioriteringar i primärvård vill belysa hur primärvårdspersonal tänker och agerar i prioriteringsfrågor och hur prioriteringsarbetet sker i praktiken vid ett slumpmässigt urval av landets vårdcentraler. Vi anser därför att resultaten är representativa för svensk primärvård.

    Projektet utgår från Institutionen för hälsa och samhälle vid Linköpings universitet (Per Carlsson, Eva Arvidsson och Lars Borgquist) i samarbete med Primärvårdens FoU-enhet i Jönköpings läns landsting (Kjell Lindström, Jan Mårtensson och Linda Frank). Arbetet har genomförts med ekonomiskt stöd från forskningsprogrammet Sjukvårdens förändringar, ett samarbete mellan Region Skåne, Västra Götalands Regionen, Landstinget Västmanland, Landstinget i Östergötland, Stockholms läns landsting, Socialstyrelsen och Sveriges Kommuner och Landsting.

    Tack till alla de personer som medverkat vid intervjuerna, övriga personer i projektet samt anslagsgivaren.

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