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  • 1.
    Bäckman, Karin
    et al.
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Carlsson, Per
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Ekerstad, Niklas
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Lindroth, Katrin
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Förstudie om de mest sjuka äldre i riktlinjer för vård och omsorg2011Other (Other academic)
  • 2.
    Bäckman, Karin
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment.
    Carlsson, Per
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment.
    Lindroth, Katrin
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment.
    Transparent priority setting in Sweden - Reactions in the press2006In: The 6th International Conference on Priorities in Health Care,2006, 2006Conference paper (Other academic)
  • 3.
    Bäckman, Karin
    et al.
    Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment. Linköping University, Faculty of Health Sciences.
    Lindroth, Katrin
    Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment. Linköping University, Faculty of Health Sciences.
    Carlsson, Per
    Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment. Linköping University, Faculty of Health Sciences.
    Öppna prioriteringar i Östergötland: del II. Massmediernas rapportering av beslutsprocessen2005Report (Other academic)
    Abstract [sv]

    Denna rapport utgör andra delen av två som behandlar prioriteringsprocessen i Östergötlands läns landsting hösten 2003. I delstudie ett har vi studerat den politiska beslutsprocessen utifrån ett flertal frågeställningar och villkor som är viktiga för att en prioriteringsprocess ska uppfattas som rättvis och legitim (rimlig och accepterad av flertalet). En viktig del av demokratin är medierna, som har en betydelsefull roll som granskare och informationsbärare.

    Syftet med denna delstudie var att undersöka vilken roll massmedierna (dagstidningarna) spelade under prioriteringsprocessen i landstinget; hur de agerade under händelseförloppet och hur de framställde ämnet, samt öka förståelsen för på vilket sätt medierna kan tänkas påverka ett skeende.

    I materialet ingår länets fyra lokala dagstidningar, fyra stora nationella dagstidningar samt två kvällstidningar under perioden augusti till december år 2003 (Internetupplagan). Artiklarna har klassificerats utifrån variabler i ett förbestämt analysschema. Resultatet kan kort sammanfattas i följande punkter:

    • Totalt ingick 223 artiklar, varav 198 i länets dagstidningar i materialet. Flest artiklar publicerades i direkt anslutning till det politiska beslutet och tiden närmast därefter. Kvantiteterna i studien är antagligen något lägre än antalet artiklar publicerade i tidningarnas pappersversioner.
    • Nyhetsartiklar var vanligast följt av insändare. Ledare och debattartiklar utgjorde en mindre del.
    • Prioriteringsprocessen, eller resultatet av den (besluten om utbudsbegränsningar), var artiklarnas huvudämne.
    • Det var ungefär lika stort fokus på själva prioriteringsprocessen som sådan, som på resultatet av den, besluten. Debattartiklar var de som till största delen fokuserade på processen.
    • Ämnet ”vården” (d v s hälso- och sjukvården i stort, systemet/organisationsformen, att höja eller sänka skatter et c) var det enskilda ämne som oftast lyftes fram.
    • Politiker från något av majoritetspartierna eller medborgarna själva kom oftast till tals.
    • Negativt vinklade artiklar dominerade, men de positivt vinklade artiklarna tillsammans med de neutrala och beskrivande var sammantaget något fler än de negativa.
    • Knappt hälften av artiklarna såg hinder eller farhågor med öppna prioriteringar eller denna specifika prioriteringsprocess. De nationella dagstidningarna rapporterade om möjligheter med en ökad öppenhet i prioriteringsprocessen, medan kvällstidningarna rapporterade om hinder.
    • Argument för prioriteringar och den aktuella prioriteringsprocessen fokuserade mer på besluten i sig och de mer kortsiktiga effekter de får, medan kritikerna som ger argument emot gav uttryck för mer långtgående farhågor och såg återverkningar för samhället och hälso- och sjukvårdssystemet i stort.
    • Källor angavs i nyhetsartiklar, men saknas i andra typer av artiklar.
    • Få artiklar hade ett klart positivt tema. Dominerande teman i de mer negativa artiklarna uttryckte misstankar om att demokratin hotas och att vården nedmonteras och värdeladdade ord används. De mer neutralt hållna artiklarna var till största delen beskrivande i sin karaktär.

    Sammanfattningsvis är vi övertygade om att den omfattande mediebevakningen har bidragit till att uppmärksamma allmänheten på förekomsten av prioriteringar som ett ”nytt” fenomen och därmed också öka förståelsen av vad att prioritera i hälso- och sjukvården innebär i realiteten. Den relativt negativa och fragmentariska rapporteringen i samband med Landstinget i Östergötlands prioriteringar har antagligen i det korta perspektivet försvårat utvecklingsarbetet med öppna prioriteringar. Att försöka förändra medierna är ingen framkomlig väg till att få en mer saklig publicitet om prioriteringsarbetet, utan de som arbetar med att utveckla prioriteringsprocessen i landsting och kommuner måste själva lära sig kommunicera och lägga ned mycket tid på att utforma ”sitt budskap” för att inte bli helt utelämnade till mediernas egna tolkningar och rapporteringar. Vikten av en bra informationsstrategi är därför självklar.

    För att bemöta mediernas kritiska och fragmentariska rapportering – som delvis har sin grund i t ex missförstånd eller okunnighet, bevakning av egenintressen som är hotade i sak eller hotade på systemnivå - är det också viktigt att landsting och kommuner satsar tid och resurser på både mer och fylligare information till de egna medarbetarna. Genom att söka sig andra kommunikationsvägar än via medierna, t ex genom direkt medborgardialog, kan företrädare för vårdens prioriteringsarbete skapa nya former för att sprida information men också få till stånd en djupare dialog kring svåra frågor.

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  • 4.
    Lindroth, Katrin
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Resolving health care's difficult choices: survey of priority setting in Sweden and an analysis of principles and guidelines on priorities in health care2008Report (Other academic)
    Abstract [en]

    This project report is the product of an extensive survey and analysis by Sweden’s National Centre for Priority Setting in Health Care. The project was commissioned by the National Board of Health and Welfare, which shall report to the Swedish Government on the priority setting activities of local governments (eg, county councils and municipalities) and assess how well they comply with the intent of Sweden’s Health and Medical Services Act and the Riksdag’s (Swedish parliament) resolutions on priority setting. We were also assigned to analyse problems in applying the guidelines on priority setting and to propose changes and clarification.

    The National Centre for Priority Setting in Health Care has been engaged in the complexities of prioritisation issues for many years. We welcomed the Government’s initiative and gladly accepted this assignment. Our ambition has been to describe the situation throughout Sweden from multiple perspectives. We reviewed the literature on studies and follow-ups related to the Riksdag’s guidelines. In studying the experiences of local governments in establishing healthcare priorities we focused on county council leaders, but complemented the study by interviewing representatives of major personnel categories. We also interviewed a smaller sample representing Swedish municipalities. Based on over 150 interviews, we describe current activities, plans for priority setting, and perceptions towards the current guidelines. Karin Bäckman served as coordinator for this part of the project. Other contributors from the National Centre for Priority Setting in Health Care included: Mari Broqvist, Per Carlsson, Peter Garpenby, Catrine Jacobsson, Per Johansson, Erling Karlsson, Sven Larsson, Karin Lund, Per-Erik Liss, and Ann-Charlotte Nedlund.

    In addition to the interview study, and under the leadership of Per-Erik Liss of the National Centre for Priority Setting in Health Care, we conducted an ethical analysis of principles and guidelines in priority setting. Anders Melin reviewed international ethical guidelines and principles in priority setting. A separate chapter presents a summary of this work. The ethical analysis also includes proposals for improvement, eg, reinterpretation and description of the ethical principles in the current platform, the addition of another ethical principle, and suggestions concerning the role of health services. Preliminary versions of the analysis were discussed at seminars with ethicists and individuals experienced in transparent priority setting and representing the National Board of Health and Welfare, the Pharmaceutical Benefits Board, the Swedish Association of Health Professionals, the Swedish Association of Registered Physiotherapists, the Swedish Federation of Occupational Therapists, and the Swedish Medical Association.

    Katrin Lindroth conducted literature reviews and edited the report. Elisabeth Furberg, Gustav Tinghög, Niklas Ekerstad, and Peter Wahlberg from the National Centre for Priority Setting in Health Care also contributed valuable perspectives. Appendix 3 presents the staff of the National Centre for Priority Setting in Health Care.

    Preliminary versions were discussed with the Board of Directors of the National Centre for Priority Setting in Health Care, who offered many constructive viewpoints.

    I would like to express my sincere appreciation to all who contributed valuable input and perspectives throughout the process. It is my hope that our collective effort will lead to improvement in regulations and work methods and will generate greater understanding for the importance of transparent priority setting in health care.

    Linköping, Sweden

    March 2007

    Professor Per Carlsson

    Director of the National Centre for Priority Setting in Health Care

    Download full text (pdf)
    Resolving Health Care´s Difficult Choices: Survey of Priority Setting in Sweden and an Analysis of Principles and Guidelines on Priorities in Health Care
  • 5.
    Sandman, Lars
    et al.
    Högskolan i Borås.
    Ekerstad, Niklas
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Lindroth, Kartrin
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Triage som prioriteringsinstrument på akutmottagning: en etisk analys av RETTS2012Report (Other academic)
    Abstract [en]

    Sweden’s emergency departments use a triage system to categorise patients for different levels of care. Triage involves the first step in the care of sick and injured patients in situations where it is not possible to care for everyone immediately, but cases must be prioritized and patient safety assured. The most common triage system used in Swedish emergency departments is called the Rapid Emergency Triage and Treatment System, RETTS (synonymous with METTS). RETTS involves a combination of evaluating the reason for seeking care and various vital parameters, i.e. critical physiological functions. The combined appraisal of the reason for seeking care and the vital parameters leads to five levels of priority, each of which involves different care. This provides guidance on where to treat emergent patients, how quickly the patient must see a physician, and the level of monitoring required.

    This study aims to investigate how the staff in Sweden’s emergency  departments described their experience with the triage system from an ethical perspective and also conduct an ethical analysis of the triage system. The interviewees responded that although there is no guarantee that the evaluations are always conducted in a similar way (which could lead to over or under triaging), the introduction of a triage system does provide some guarantee of compliance with the parliament’s guidelines on priority setting – that patients with the greatest need are first in line to receive care. Staff experience some sense of security in using the same parameters to evaluate all patients, which facilitates communication among the different functions in the emergency department. However, despite the standardised process, the system is not without shortcomings, and not all cases are appropriate for the method. Elderly with multiple disorders and people with psychiatric or substance- and alcohol-type problems problems are perceived as being difficult to evaluate and triage “correctly” for later placement in the appropriate continuum of care. The ethical analysis showed that the triage system per se adhered to the ethical platform’s emphasis on caring for those with the greatest needs first, but it does not consider the effects of the interventions that patients might receive (since such evaluation takes place later in the process). Since application of the triage method could have a negative impact on certain groups, this is problematic  from the perspective of the human dignity principle. From an ethical perspective it is important to be aware of a method’s limitations and not always assume that it can manage every case in an equitable manner. The study identifies the need for a deeper ethical analysis of triage in emergency departments that includes investigating actual implementation and its ongoing process.

    Download full text (pdf)
    Triage som prioriteringsinstrument på akutmottagning: en etisk analys av RETTS
1 - 5 of 5
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