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  • 1.
    Arvidsson, Eva
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment and Health Economics.
    Ett dilemma vid prioritering i primärvården: Hur ska man prioritera något som inte inträffat?2008In: Läkarstämman,2008, 2008Conference paper (Other academic)
  • 2.
    Arvidsson, Eva
    Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Hur tänker patienter och personal vid prioriteringar i primärvården? (föredrag)2010Conference paper (Refereed)
  • 3.
    Arvidsson, Eva
    Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Patients' attitudes to priority setting in Primary Health Care: Can patients accept scarce resources?: Who should make prioritizations?2006In: 6th International Conference on Priorities in Health Care, Toronto, 2006Conference paper (Other academic)
  • 4.
    Arvidsson, Eva
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Priority Setting and Rationing in Primary Health Care2013Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

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

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

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

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

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

    List of papers
    1. Day-to-day Rationing of Limited Resources in Swedish routine Primary Care: an interview study
    Open this publication in new window or tab >>Day-to-day Rationing of Limited Resources in Swedish routine Primary Care: an interview study
    Show others...
    2013 (English)Manuscript (preprint) (Other academic)
    Abstract [en]

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

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

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

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

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-88085 (URN)
    Available from: 2013-01-29 Created: 2013-01-29 Last updated: 2013-01-29Bibliographically approved
    2. Primary care patients' attitudes to priority setting in Sweden.
    Open this publication in new window or tab >>Primary care patients' attitudes to priority setting in Sweden.
    Show others...
    2009 (English)In: Scandinavian journal of primary health care, ISSN 1502-7724, Vol. 27, no 2, p. 123-8Article in journal (Refereed) Published
    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.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-18972 (URN)10.1080/02813430902883901 (DOI)19466679 (PubMedID)
    Available from: 2009-06-07 Created: 2009-06-07 Last updated: 2013-01-29
    3. Setting priorities in primary health care - on whose conditions? A questionnaire study
    Open this publication in new window or tab >>Setting priorities in primary health care - on whose conditions? A questionnaire study
    Show others...
    2012 (English)In: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 13, no 114Article in journal (Refereed) Published
    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.

    Place, publisher, year, edition, pages
    BioMed Central, 2012
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-87966 (URN)10.1186/1471-2296-13-114 (DOI)000312733800001 ()
    Note

    Funding Agencies|FORSS (Council for Research in Southeast Sweden)||county council of Jonkoping||county council of Kalmar||county council of Ostergotland||Faculty of Health Sciences, Linkoping University||

    Available from: 2013-01-28 Created: 2013-01-28 Last updated: 2017-12-06
    4. Priority setting in primary health care - dilemmas and opportunities: a focus group study
    Open this publication in new window or tab >>Priority setting in primary health care - dilemmas and opportunities: a focus group study
    2010 (English)In: BMC FAMILY PRACTICE, ISSN 1471-2296, Vol. 11, no 71Article in journal (Refereed) Published
    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.

    Place, publisher, year, edition, pages
    BioMed Central, 2010
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-61207 (URN)10.1186/1471-2296-11-71 (DOI)000283116400001 ()
    Note
    Original Publication: Eva Arvidsson, Malin André, Lars Borgquist and Per Carlsson, Priority setting in primary health care - dilemmas and opportunities: a focus group study, 2010, BMC FAMILY PRACTICE, (11), 71. http://dx.doi.org/10.1186/1471-2296-11-71 Licensee: BioMed Central http://www.biomedcentral.com/ Available from: 2010-11-05 Created: 2010-11-05 Last updated: 2013-01-29
  • 5.
    Arvidsson, Eva
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment and Health Economics.
    Three concepts Swedish GPs and district nurses find useful and a good base for prioritising2008In: 7th International Conference on Priorities in Health Care,2008, 2008Conference paper (Other academic)
  • 6.
    Arvidsson, Eva
    et al.
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Andre, Malin
    Uppsala University, Sweden .
    Borgquist, Lars
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Andersson, David
    Linköping University, Department of Management and Engineering, Business Administration. Linköping University, The Institute of Technology.
    Carlsson, Per
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Setting priorities in primary health care - on whose conditions? A questionnaire study2012In: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 13, no 114Article in journal (Refereed)
    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.

  • 7.
    Arvidsson, Eva
    et al.
    Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    André, Malin
    Linköping University, Department of Medicine and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    Borgquist, Lars
    Linköping University, Department of Medicine and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Carlsson, Per
    Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Priority setting in primary health care - dilemmas and opportunities: a focus group study2010In: BMC FAMILY PRACTICE, ISSN 1471-2296, Vol. 11, no 71Article in journal (Refereed)
    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.

  • 8.
    Arvidsson, Eva
    et al.
    Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment. Linköping University, Faculty of Health Sciences.
    André, Malin
    Falun.
    Borgquist, Lars
    Linköping University, Department of Department of Health and Society, General Practice. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care. Linköping University, Faculty of Health Sciences.
    Carlsson, Per
    Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment. Linköping University, Faculty of Health Sciences.
    Lindström, Kjell
    Falun.
    Så resonerar läkare och sjuksköterskor vid prioriteringar av patienter i primärvård2007Report (Other academic)
    Abstract [en]

     

    Background

    Experience from work with priority setting in health and medical care indicates that the ethical guidelines that are at the heart of Swedish Parliament’s principles for priority  setting  are difficult  to implement  into practical  clinical  decision- making. The same can be said of the model for priority setting drawn up by the Swedish National Board of Health and Welfare in the national guidelines  for care and treatment. For this reason, we need more knowledge on how principles for priority setting and related concepts are perceived by medical care personnel, the relevance of these concepts, and if there are other aspects that also impact the priority setting situation.  We also need to develop  new work methods  to meet Parliament’s intentions with priority setting in health and medical care.

    To contribute  to the development  of new  work  methods,  we chose  to study priority setting in primary care practice. Our primary purpose was to describe the way in which general practitioners and district nurses perceive the concepts severity  of  illness,  benefit  and  cost-effectiveness  when  they  rank  priority  for individual patients. Our secondary purpose was to compare medical personnel’s perception of the concepts severity of illness, benefit and cost-effectiveness with the definitions  of these  concepts  in the model  for vertical  priority  setting  as established by the National Board of Health and Welfare.

    Methods

    Focus group interviews as a source of data collection was selected as the method since the study was explorative and the intention was to obtain as many aspects as possible pertaining  to priority setting concepts.  The method is suitable for collecting a large amount of information within a previously unexplored subject. Interviews were conducted with eight groups of physicians and nurses from four different primary care centers. The respondents  selected had participated  in a prospective  study  on  practical  priority  setting,  i.e.  they  had  experience  of implementing the concepts severity of illness, benefit, and cost-effectiveness in setting priorities in their daily work.

    Results and Conclusions

    Both  the  physicians  and  nurses  expressed  a  simplified  interpretation  of  the concepts severity of illness and benefit. One example of such simplification was that many nurses said that when ranking the severity of a condition, they based their decision on how imperative  it was for the patient to see a physician.  A

     

    common response was that the concepts could be assessed from both patient and staff perspectives  but that these assessments  could differ. When asked to set priorities according to a specific template, respondents said that it was easier to rank patients with an acute condition that had a tangible effect on function and that could be immediately treated, than to rank patients according to factors that were a risk to their future health. This means that priority judgements based on knowledge of a patient category were perceived as uncertain and more difficult to use than direct personal experience of treating an individual patient. This was discussed, above all, by the physicians. Respondents gave several examples of actions taken despite that medical staff did not feel that there was any benefit to the patient.

    In a comparison  of how these three concepts  are described  in the model for priority setting on the policy level drawn up by the National Board of Health and Welfare and how medical personnel implemented the concepts, we found both similarities and dissimilarities.

    A model based on these concepts can be of use in priority setting in primary care, but it must be supplemented  and improved  to be applicable  to ranking patients  in day-to-day  medical  care. Supplements  that may be necessary  are; clarification that a combination of medical and patient perspectives is intended, clarification of how to use the concept cost-effectiveness, and the addition of a time factor and factors related to the individual patient. There is also a need for a more  structured  way  of working  with evidence-based  care.  We also  need  to clarify the differences between setting priorities for patient categories and for individual patients in day-to-day medical care.

    In our opinion, the model for priority setting on the patient category level can be improved  to  be  more  applicable  as  a  template  for  decision-making  on  the individual patient level, however a supplementary  model may be necessary to support priority setting on the individual level.

  • 9.
    Arvidsson, Eva
    et al.
    Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    André, Malin
    Linköping University, Department of Medicine and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    Borgquist, Lars
    Linköping University, Department of Medicine and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Lindström, Kjell
    Linköping University, Department of Medicine and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    Carlsson, Per
    Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Primary care patients' attitudes to priority setting in Sweden.2009In: Scandinavian journal of primary health care, ISSN 1502-7724, Vol. 27, no 2, p. 123-8Article in journal (Refereed)
    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.

  • 10.
    Arvidsson, Eva
    et al.
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    André, Malin
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    Borgquist, Lars
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Mårtensson, Jan
    Department of Nursing, School of Health and Sciences, Jönköping, Sweden.
    Carlsson, Per
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Day-to-day Rationing of Limited Resources in Swedish routine Primary Care: an interview study2013Manuscript (preprint) (Other academic)
    Abstract [en]

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

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

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

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

  • 11.
    Broqvist, Mari
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Arvidsson, Eva
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Prioriteringar initierade på verksamhetsnivå2013In: Att välja rättvist: om prioriteringar i hälso- och sjukvården / [ed] Per Carlsson och Susanne Waldau, Lund: Studentlitteratur, 2013, 1:1, p. 189-206Chapter in book (Other academic)
    Abstract [sv]

    Den här boken är avsedd som ett stöd för alla som vill ge sig i kast med frågan om prioriteringar i hälso- och sjukvården. Den diskuterar orsakerna till att riksdagsbeslutet om prioriteringar inte genomförts i hälso- och sjukvården, trots att de etiska principer som prioriteringsordningen vilar på är djupt förankrade hos både vårdpersonal och befolkningen i övrigt. Vidare diskuteras grundläggande begrepp i sammanhanget liksom hälso- och sjukvårdens roll i förhållande till ohälsa och sjukdom i befolkningen. I boken betonas vikten av att många erfarenheter och perspektiv möts i dialogen kring prioriteringsfrågorna. En rad olika metoder och erfarenheter som kan underlätta det gemensamma arbetet presenteras också.Boken är avsedd som ett diskussionsunderlag för de som leder eller deltar i prioriteringssammanhang i landstingens och kommunernas hälso- och sjukvård. Den kan också användas i utbildningen av hälso- och sjukvårdspersonal.

  • 12.
    Mårtensson, Jan
    et al.
    Landstinget Jönköping.
    Carlsson, Per
    Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment. Linköping University, Faculty of Health Sciences.
    Arvidsson, Eva
    Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment. Linköping University, Faculty of Health Sciences.
    Frank, Linda
    Landstinget Jönköping.
    Lindström, Kjell
    Landstinget Jönköping.
    Borgquist, Lars
    Linköping University, Department of Department of Health and Society, General Practice. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care. Linköping University, Faculty of Health Sciences.
    Erfarenhet, kunskap och inställning till prioriteringar: En intervjustudie med personal i primärvården2006Report (Other academic)
    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.

  • 13.
    Sandman, Lars
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Broqvist, Mari
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Gustavsson, Erik
    Linköping University, Department of Medical and Health Sciences, Division of Health and Society. Linköping University, Faculty of Arts and Sciences.
    Arvidsson, Eva
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Ekerstad, Niklas
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Carlsson, Per
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Vård som inte kan anstå: Tolkning i relation till den etiska plattformen och nationella modellen för öppna prioriteringar2014Report (Other academic)
    Abstract [en]

    Method

    The assignment from the National Board of Health and Welfare consists of three related parts. Part one presents different interpretations of the concept “care that cannot be deferred” based on an analysis of how the concept is used in the government bill and the wording of the Act. Several criteria are used to specify these interpretations. Part two analyses the interpretations of the concept “care that cannot be deferred” discussed in part one. The analysis is based on the ethics platform for priority setting. Part three aims to analyse how the concept “care that cannot be deferred” relates to the National Model for Transparent Prioritisation in Swedish Health Care and discuss whether it can be used to support prioritisation and rationing. The theoretical analysis is complemented by several examples of practical decision-making situations, as described by clinicians, that involve the care of non-registered individuals.

    Analysis

    In this report we have formulated several criteria that the concept “care that cannot be deferred” must fulfil according to the law (2012/13:407).

    These criteria address: Care need: The individual has a care need – i.e. a discrepancy exists between the desired and actual condition, which can be influenced by a care intervention.

    Limitations: The provider may place limitations on “care that cannot be deferred” delivered to non-registered individuals in Sweden and who are 18 years of age or older. Such limitations should be based on considerations involving:

    • Severity of the condition (current ill health, risk for future ill health, or special needs arising from previous assault and trauma).
    • Effect of the intervention if it is provided now compared to deferred intervention.
    • Cost-effectiveness of the intervention if it is provided now compared to deferred intervention.

    Limited responsibility: When applying the concept “care that cannot be deferred” the provider should assume that the individual is expected to be in Sweden for a limited time, but it is not necessary to consider the person’s opportunities to receive care once he/she is no longer in Sweden.

    Expanded responsibility: When applying the concept “care that cannot be deferred” the provider should assume that the individual is expected to be in Sweden a limited time, but should also consider the person’s opportunities to receive care once he/she is no longer in Sweden.

    Conclusions

    Based on the care need criterion, we conclude that non-registered individuals who seek care should be adequately evaluated in each case so the provider can determine whether a care need exists.

    We conclude that the limited responsibility criterion conflicts with the human dignity principle when it comes to limiting care based on chronological age and national registration. Further we conclude that the rationing of care implied by the limited responsibility criterion does not appear to be based on limited resources, but that the non-registered individual does not have the same right to health services as the nationally registered population does.

    We conclude that in choosing between the limited and the expanded responsibility criteria, the latter is preferable in light of the ethical platform since, to a greater extent, the expanded responsibility criterion allows consideration of relevant aspects (e.g. severity level, effect of intervention, and cost effectiveness) similar to the way the registered population is treated. Further, we conclude that the time limitation of the responsibility criteria is difficult to address since in many cases it is highly uncertain how long a person can remain in Sweden without necessary authorisation.

    We conclude that the factors presented for determining how to define “care that cannot be deferred” are basically the same as those in the national model for priority setting – i.e. severity of the condition (current and potential), effect of the intervention (and how it changes over time), and cost effectiveness. Concurrently we point to several contradictions in defining the definition, and in the law generally, that conflict with the ethical platform and the national model for priority setting. This includes the cases where specific diagnostic or treatment areas are explicitly noted, regardless of severity level, effect of intervention, or cost effectiveness.

    Further, we conclude that it is possible to point to several general combinations of severity level, effect of intervention, and cost effectiveness that can define “care that cannot be deferred” – so these combinations are very difficult to apply at the individual level. The reason is that it is difficult to determine individual risks and effects. As regards the registered population, a normal way to determine risks or effects would be either to provide treatment “for safety’s sake” or to wait, thus providing the opportunity for the patient to return if the  condition deteriorates or for the provider to call the patient for a return visit. If the provider decides that care can be deferred, usually there is an opportunity for a new evaluation at the initiative of the patient or provider. Since it is less certain that patients in the non-registered population can return for a new evaluation, it might seem reasonable to offer treatment more often for safety’s sake. Concurrently, this must be balanced against the risks associated with treatment and the opportunities to follow up on these risks wherever the individual resides.

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