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  • 201.
    Hjelm, Katarina
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Medicine and Health Sciences.
    Atwine, Fortunate
    Department of Nursing, Mbarara University of Science and Technology, Mbarara, Uganda.
    Health-care seeking behaviour and use of traditional medicine in persons with diabetes in Uganda.2015In: Global Health Congress, Oxford 2015, Oxford University, 2015Conference paper (Refereed)
    Abstract [en]

    Health-care seeking behaviour is important as it determines acceptance of healthcare and outcomes of chronic conditions but has been investigated to a limited extent in persons with diabetes in developing countries.

    Qualitative study. Focus-group interviews.

    Reasons for seeking help from traditional healers were diabetessymptoms and failure of effect from western medicine. Help had been sought from different health facilities with the help of relatives and friends.

    Conclusion: A switch between healthcare providers influenced by popular and folk sectos was found. Despite beliefs of using different healthcare providers searching for complementary medicine, participants still experienced health problems related to diabetes.

  • 202.
    Hjelmfors, Lisa
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Strömberg, Anna
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping. Linköping University, Department of Medical and Health Sciences, Division of Nursing Science.
    Friedrichsen, Maria
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in East Östergötland, Center of Palliative Care.
    Sandgren, Anna
    Linnaeus Univ, Sweden.
    Martensson, Jan
    Jonkoping Univ, Sweden.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Using co-design to develop an intervention to improve communication about the heart failure trajectory and end-of-life care2018In: BMC Palliative Care, ISSN 1472-684X, E-ISSN 1472-684X, Vol. 17, article id 85Article in journal (Refereed)
    Abstract [en]

    Background: The aim of this paper was to describe the development of an intervention that is developed to improve communication about the heart failure (HF) trajectory and end-of-life care. We also present data that provides a first insight in specific areas of feasibility of the intervention. Methods: Co-design was used and patients, family members and health care professionals were constructive participants in the design process of the intervention. Feasibility of the intervention was tested in two areas; acceptability and limited efficacy. Results: Two communication tools were designed and evaluated; 1) a Question Prompt List (QPL) for patients and family members and 2) a communication course for professionals which was web -based with one face-to-face training day with simulation. Data on feasibility was collected with questionnaires that were developed for this study, from the 13 participants who completed the course (all nurses). They reported improved knowledge, confidence and skills to discuss the HF trajectory and end-of-life care. The QPL was evaluated to be a useful tool in communication with patients and family members. Conclusions: In a co-design process, future users identified the need for a QPL and a communication course. These communication tools can be used as a dual intervention to improve communication about the HF trajectory and end-of-life care. The QPL can help patients and families to ask questions about the HF trajectory and end-of-life care. The communication course can prepare the professionals to be knowledgeable, confident and skilled to discuss the questions in the QPL. Before the tools are ready for implementation in clinical practice, further studies testing the feasibility of the intervention are needed, including also patients and their families.

  • 203.
    Hofmann, Bjorn
    et al.
    Norwegian Univ Sci and Technol NTNU, Norway; Univ Oslo, Norway.
    Bond, Ken
    CADTH, Canada.
    Sandman, Lars
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Evaluating facts and facting evaluations: On the fact-value relationship in HTA2018In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 24, no 5, p. 957-965Article in journal (Refereed)
    Abstract [en]

    Health technology assessment (HTA) is an evaluation of health technologies in terms of facts and evidence. However, the relationship between facts and values is still not clear in HTA. This is problematic in an era of fake facts and truth production. Accordingly, the objective of this study is to clarify the relationship between facts and values in HTA. We start with the perspectives of the traditional positivist account of evaluating facts and the social-constructivist account of facting values. Our analysis reveals diverse relationships between facts and a spectrum of values, ranging from basic human values, to the values of health professionals, and values of and in HTA, as well as for decision making. We argue for sensitivity to the relationship between facts and values on all levels of HTA, for being open and transparent about the values guiding the production of facts, and for a primacy for the values close to the principal goals of health care, ie, relieving suffering. We maintain that philosophy (in particular ethics) may have an important role in addressing the relationship between facts and values in HTA. Philosophy may help us to avoid fallacies of inferring values from facts; to disentangle the normative assumptions in the production or presentation of facts and to tease out implicit value judgements in HTA; to analyse evaluative argumentation relating to facts about technologies; to address conceptual issues of normative importance; and to promote reflection on HTAs own value system. In this we argue for a(n Aristotelian) middle way between the traditional positivist account of evaluating facts and the social-constructivist account of facting values, which we call factuation. We conclude that HTA is unique in bringing together facts and values and that being conscious and explicit about this factuation is key to making HTA valuable to both individual decision makers and society as a whole.

  • 204.
    Holmar, Jana
    et al.
    Tallin University of Technology, Tallin, Estonia .
    Uhlin, Fredrik
    Region Östergötland, Heart and Medicine Center, Department of Nephrology. Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Fernström, Anders
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Region Östergötland, Heart and Medicine Center, Department of Nephrology. Linköping University, Faculty of Medicine and Health Sciences.
    Luman, Merike
    Tallin University of Technology, North Estonian Medical Centre, Tallin, Estonia.
    Jankowski, Joachim
    Aachen University , University Hospital Aachen, Germany .
    Fridolin, Ivo
    Tallin University of Technology, Tallin, Estonia.
    An Optical Method for Serum Calcium and Phosphorus Level Assessment during Hemodialysis2015In: Toxins, ISSN 2072-6651, Vol. 7, no 3, p. 719-727Article in journal (Refereed)
    Abstract [en]

    Survival among hemodialysis patients is disturbingly low, partly because vascular calcification (VC) and cardiovascular disease are highly prevalent. Elevated serum phosphorus (P) and calcium (Ca) levels play an essential role in the formation of VC events. The purpose of the current study was to reveal optical monitoring possibilities of serum P and Ca values during dialysis. Twenty-eight patients from Tallinn (Estonia) and Linköping (Sweden) were included in the study. The serum levels of Ca and P on the basis of optical information, i.e., absorbance and fluorescence of the spent dialysate (optical method) were assessed. Obtained levels were compared in means and SD. The mean serum level of Ca was 2.54 ± 0.21 and 2.53 ± 0.19 mmol/L; P levels varied between 1.08 ± 0.51 and 1.08 ± 0.48 mmol/L, measured in the laboratory and estimated by the optical method respectively. The levels achieved were not significantly different (p = 0.5). The Bland-Altman 95% limits of agreement between the two methods varied from -0.19 to 0.19 for Ca and from -0.37 to 0.37 in the case of P. In conclusion, optical monitoring of the spent dialysate for assessing the serum levels of Ca and P during dialysis seems to be feasible and could offer valuable and continuous information to medical staff.

  • 205.
    Husberg, Magnus
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Davidson, Thomas
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Hallert, Eva
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Non-medical costs during the first year after diagnosis in two cohorts of patients with early rheumatoid arthritis, enrolled 10 years apart2017In: Clinical Rheumatology, ISSN 0770-3198, E-ISSN 1434-9949, Vol. 36, no 3, p. 499-506Article in journal (Refereed)
    Abstract [en]

    The aim of the present study was to calculate non-medical costs during year 1 after diagnosis in two cohorts of patients with early rheumatoid arthritis enrolled 1996–1998 and 2006–2009. Clinical data were collected regularly in both cohorts. Besides information about healthcare utilization and days lost from work, patients reported non-medical costs for aids/devices, transportation, formal and informal care. Formal care was valued as full labour cost for official home help (€42.80/h) and informal care from relatives and friends as opportunity cost of leisure time, corresponding to 35% of labour cost (€15/h). In both cohorts, only 2% used formal care, while more than 50% used informal care. Prescription of aids/devices was more frequent in cohort 2 and more women than men needed aids/devices. Help with transportation was also more common in cohort 2. Women in both cohorts needed more informal care than men, especially with personal care and household issues. Adjusting for covariates in regression models, female sex remained associated with higher costs in both cohorts. Non-medical costs in cohort 2 were €1892, €1575 constituting informal care, corresponding to 83% of non-medical costs. Total non-medical costs constituted 25% of total direct costs and 11% of total direct and indirect costs. Informal care accounted for the largest part of non-medical costs and women had higher costs than men. Despite established social welfare system, it is obvious that family and friends, to a large extent, are involved in informal care of patients with early RA, and this may underestimate the total burden of the disease.

  • 206.
    Hälleberg-Nyman, Maria
    et al.
    School of Health Sciences, Örebro University, Örebro, Sweden; Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden.
    Forsman, Henrietta
    School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
    Wallin, Lars
    Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden; School of Education, Health and Social Studies, Dalarna University, Falun, Sweden; Department of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Ostaszkiewicz, Joan
    Centre for Quality and Patient Safety Research, Barwon Partnership, School of Nursing and Midwifery, Deakin University, Melbourne, Australia.
    Hommel, Ami
    Faculty of Health and Society, Department of Care Science, Malmö University, Malmö, Sweden; Department of Orthopaedics, Skaane University Hospital, Lund, Sweden.
    Eldh, Ann Catrine
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Dalarna University, Sweden; Uppsala University, Sweden.
    Promoting evidence‐based urinary incontinence management in acute nursing and rehabilitation care: A process evaluation of an implementation intervention in the orthopaedic context2019In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 25, no 2, p. 282-289Article in journal (Refereed)
    Abstract [en]

    Rationale, aims, and objectives

    The risk of developing urinary incontinence (UI) is associated with older age and hip surgery. There has been limited focus on factors that promote evidence‐based UI practice in the orthopaedic context. The aim of this study was to evaluate an implementation intervention to support evidence‐based practice for UI in patients aged 65 or older undergoing hip surgery.

    Methods

    A 3‐month intervention was delivered in 2014 to facilitate the implementation of UI knowledge in orthopaedic units in 2 hospitals in Sweden. Each unit appointed a multidisciplinary team of nurses and physiotherapists or occupational therapists to facilitate the implementation. The teams were supported by external facilitators who shared knowledge about UI and implementation science. Interviews, nonparticipant observations, and audits of patient records were performed.

    Results

    Prior to the intervention, there was no use of guidelines regarding UI. The intervention raised the internal facilitators' awareness of UI risks associated with hip surgery. As internal facilitators shared this information with their peers, staff awareness of UI increased. The teams of internal facilitators described needing additional time and support from managers to implement evidence‐based UI care. A management initiative triggered by the intervention increased the documentation of UI and urinary problems in 1 unit.

    Conclusion

    To promote evidence‐based practice related to safe procedures for older people in hospital care, there is a need to better understand strategies that successfully facilitate knowledge implementation. This study suggests that a multiprofessional team approach is promising for instigating a process towards evidence‐based management of UI.

  • 207.
    Höglund, Anna T.
    Uppsala universitet.
    Reflektioner över etik och prioriteringar i vården: intervjuer med vårdpersonal2003Report (Other academic)
    Abstract [sv]

    Enligt den etiska plattform för prioriteringar i vården som antagits av riksdagen är prioriteringar på grundval av enbart kronologisk ålder inte tillåtna. Genom att rangordna människovärdesprincipen över behovs- och solidaritetsprincipen, vilken i sin tur är överordnad kostnadseffektivitetsprincipen, angav prioriteringsutredningen vad som är icke tillåtna kriterier för prioriteringar. Hög ålder är ett sådant, liksom låg födelsevikt och svag social ställning hos patienten.

    Syftet med föreliggande studie var att undersöka genomslagskraften i gällande prioriteringsriktlinjer hos vårdpersonal av olika kategorier ett antal år efter den mest intensiva prioriteringsdebatten. Genom att få kunskap om personalens erfarenheter av att fatta prioriteringsbeslut kunde ytterligare frågor belysas, t.ex.: Känner personalen till riktlinjerna för prioriteringar? Tar man hänsyn till dem vid konkreta prioriteringsbeslut? Vad grundar man annars sina beslut på? Hur ser man på prioriteringar baserade på ålder? Vilka etiska argument har man för sina uppfattningar? Undersökningen utfördes med kvalitativ metod, bestående av djupintervjuer med ett mindre antal informanter. Informanterna utgjordes av både läkare, sjuksköterskor och undersköterskor, samtliga verksamma vid olika sjukhuskliniker.

    Resultaten av undersökningen kan delas in i tre kategorier. Den första gäller relationen mellan informanternas moraliska praxis och prioriteringsriktlinjerna. Här visade det sig att samtliga personalkategorier fattade prioriteringsbeslut, även om de var av olika slag beroende på personalkategori. Däremot var kunskapen om prioriteringsriktlinjerna låg. Endast några av de intervjuade läkarna kände till dem, däremot ingen av undersköterskorna eller sjuksköterskorna. Emellertid verkade samtliga intervjuade handla i enlighet med åtminstone de två första etiska principerna i riktlinjerna. Detta kan bero på att riktlinjerna i hög grad bygger på redan etablerade etiska principer i vården.

    Den andra kategorin av resultaten berör informanternas syn på åldersprioriteringar. Här visade sig en diskrepans mellan personalkategorierna. Sjuksköterskor och undersköterskor, som främst har att fatta prioriteringsbeslut i anslutning till basal omvårdnad, tog alla avstånd från prioriteringar baserade på kronologisk ålder. Bland läkarna framkom dock en viss acceptans för åldersprioriteringar. De etiska argument som framfördes till stöd för detta var ett rättviseresonemang, där man menade att vi bör sträva efter att låta alla människor får uppleva ett normallångt liv. Det kan motivera att en 50-åring prioriteras framför en 80-åring, om resurser inte finns att satsa på bägge.

    Den tredje och sista kategorin berör informanternas beskrivningar av problem och motsättningar i samband med prioriteringsbeslut på klinisk nivå. Det som främst lyftes fram här var de snäva ekonomiska ramar som personalen styrs av och som upplevs som ett hinder för förverkligandet av en god vårdetik, inklusive rättvisa prioriteringar. Ett annat problem, som lyftes fram av framför allt läkare, gällde att de upplever sig klämda mellan motstridiga riktlinjer från politisk nivå. Främst beskrev de hur valfrihetsreformen kan komma i konflikt med prioriteringsriktlinjerna, genom att en autonom patient med hjälp av valfrihetsrättigheten kan komma att prioriteras före en patient med större behov men med låg autonomi.

    Resultaten visar att kännedomen om prioriteringsriktlinjerna är låg i materialet samt starkt kopplad till yrkeskategori. Detta till trots verkar informanterna i hög grad agera i enlighet med riktlinjerna, men utan att reflektera över huruvida deras etiska handlande överensstämmer med nationella etiska principer. Det finns emellertid en viss acceptans för åldersprioriteringar bland de intervjuade, i högre grad än vad riktlinjerna medger, vilket tyder på ett glapp mellan nationellt angivna etiska riktlinjer och moralisk praxis på klinisk nivå. En slutsats av detta är att den etiska kompetensen hos personalen borde öka. För detta krävs mer än nationella etiska riktlinjer. Snarare ställs krav på arbetsorganisationen, t.ex. i form av organiserade forum för etikdiskussioner på klinikerna. Detta skulle kunna göra prioriteringsbesluten mer medvetna och minska diskrepansen mellan riktlinjer och praxis samt öka förståelsen mellan olika personalgrupper då det gäller resonemang i etiska frågor. Det finns också anledning att närmare utreda och diskutera vilka principer som bör gälla vid prioriteringar med avseende på ålder.

    Resultaten i min undersökning tyder på att riktlinjerna för prioriteringar i vården är allmänna och vaga och därmed också svårtydda för vårdgivare på klinisk nivå, samt att det finns konflikter inbyggda mellan principerna om människovärde, behov och kostnadseffektivitet. För att kunna implementera principerna i praktiken krävs därför dels att personalen blir mer informerad om att riktlinjerna finns och vad de föreskriver, dels en ökad tydlighet och öppenhet i beslutsprocessen omkring prioriteringar. Det är därför angeläget att arbeta för skapandet av arenor och procedurer för öppna prioriteringar i vården, både i betydelsen öppenhet i processen och öppenhet i vilka prioriteringsbeslut man tar.

  • 208.
    Ingadottir, Brynja
    et al.
    Landspitali, Iceland.
    Thylén, Ingela
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Medicine and Health Sciences.
    Knowledge expectations, self-care, and health complaints of heart failure patients scheduled for cardiac resynchronization therapy implantation2015In: Patient Preference and Adherence, ISSN 1177-889X, E-ISSN 1177-889X, Vol. 9, p. 913-921Article in journal (Refereed)
    Abstract [en]

    Purpose: To describe what knowledge heart failure patients expect to acquire in relation to their upcoming cardiac resynchronization therapy (CRT) device implantation, to describe their self-care and health complaints, and to explore the relationship between knowledge expectations and self-care, health complaints, and background factors. Patients and methods: Cross-sectional multicenter study with 104 patients scheduled for a first-time, elective CRT implantation in Swedish and Icelandic hospitals. Data were collected with the Knowledge Expectations of hospital patient Scale, European Heart Failure Self-care Behavior Scale, and Adjusted Postoperative Recovery Profile. Results: Patients expected most knowledge related to their disease and its treatment (median 4.0, interquartile range 0.13) and least on social issues (median 3.5, interquartile range 0.83). Their self-care was average (standardized mean 51.0 +/- 19.6) before the procedure. Patients had on average 8.2 (+/- 4.7) health complaints and rated fatigue and sexual problems as the most severe. Age was independently associated with knowledge expectations (Exp beta 0.049, P= 0.033). Conclusion: Heart failure patients waiting for a CRT device implantation have high expectations for multiple aspects of knowledge, including self-care issues, before their procedure. These expectations are similar to those of other surgical patients and they increase with age.

  • 209.
    Ingadóttir, Brynja
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Learning as a patient: What and how individuals want to learn when preparing for surgery, and the potential use of serious games in their education2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Introduction: Surgical patients need knowledge to participate in their own care and to engage in self-care behaviour in the perioperative period which is important for their recovery. Patient education facilitates such knowledge acquisition and several methods can be used to facilitate it, for example, face-to-face education and brochures or using information technology such as website or computer games. Healthcare professionals have been slow to seize the possibilities that information technology has to offer within the field, including the use of serious games. To optimise patient education, the information is needed on the patients’ needs and preferences and what they think about the idea of using a serious game to learn about self-care.

    Aim: The overall aims of this thesis were to describe the knowledge expectations of surgical patients, to describe how surgical patients want to learn, and to explore the potential use of serious games in patient education.

    Methods: This thesis includes four studies that used both quantitative and qualitative data to describe aspects of patient learning in relation to surgery. Study I has a prospective and comparative design with survey data collected before surgery and before hospital discharge from 290 patients with osteoarthritis undergoing knee arthroplasty. Data was collected on fulfilment of knowledge expectations and related factors. Study II is a cross-­‐sectional study in 104 patients with heart failure who had been scheduled for cardiac resynchronisation therapy (CRT) device implantation. Data was collected on knowledge expectations and related factors. In Study III the perceptions of 13 surgical patients towards novel and traditional methods to learn about post-operative pain management are explored in a qualitative interview study using content analysis. Study IV describes the development and evaluation of a serious game to learn about pain management with the participation of 20 persons recruited from the public. The game was developed by an interdisciplinary team following a structured approach. Data on the efficacy and usability of the game was collected in one session with questionnaires, observations and interviews.

    Results: Participants reported high knowledge expectations. Knowledge expectations were highest within the bio-physiological knowledge dimension on disease, treatment and complications and the functional dimension on how daily activities are affected, both of which include items on self-care. Most participants wanted to know about the possible complications related to the surgery procedure. In none of the knowledge dimensions the expectations of participants were fulfilled. Participants received most knowledge on the physical and functional issues and received least on the financial and social aspects of their illness. The main predictor of fulfilment of knowledge expectations was having access to knowledge in the hospital from doctors and nurses. Trust in the information source and own motivation to learn shaped how the participants thought about different learning methods. Although the participants were open to using novel learning methods such as websites or games they were also doubtful about their use and called for advice by healthcare professionals. To develop a serious game with the goal to learn about pain management, theories of self-care and adult learning, evidence on the educational needs of patients about pain management and principles of gamification were found useful. The game character is a surgical patient just discharged home from hospital who needs to attend to daily activities while simultaneously managing post-operative pain with different strategies. Participants who evaluated a first version of the serious game improved their knowledge and described usability of the game as high. They were positive towards this new learning method and found it suitable for learning about pain management after surgery in spite of some technical obstacles.

    Conclusions: Surgical patients have high knowledge expectations about all aspects of their upcoming surgery and although they prefer direct communication with healthcare professionals as a source for knowledge they might be open to try using more novel methods such as games. Preliminary short-­‐term results demonstrate that a serious game can help individuals to learn about pain management, and has the potential to improve knowledge. A careful introduction, recommendation, and support from healthcare professionals is needed for implementation of such a novel method in patient education.

    List of papers
    1. The fulfilment of knowledge expectations during the perioperative period of patients undergoing knee arthroplasty - a Nordic perspective
    Open this publication in new window or tab >>The fulfilment of knowledge expectations during the perioperative period of patients undergoing knee arthroplasty - a Nordic perspective
    Show others...
    2014 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 23, no 19-20, p. 2896-2908Article in journal (Refereed) Published
    Abstract [en]

    AIMS AND OBJECTIVES: To describe the possible differences between knowledge expectations and received knowledge of patients undergoing elective knee arthroplasty in Iceland, Sweden and Finland and also to determine the relationship between such a difference and both background factors and patient satisfaction with care.

    BACKGROUND: Knee arthroplasty is a fast-growing and a successful treatment for patients with osteoarthritis. Patient education can improve surgery outcomes, but it remains unknown what knowledge patients expect to receive and actually acquire during the perioperative period and what factors are related to that experience.

    DESIGN: Descriptive, prospective survey.

    METHODS: In total, 290 patients answered questionnaires about their expectations (Knowledge Expectations of hospital patients - scale) before surgery and about received knowledge (Received Knowledge of hospital patients - scale) and satisfaction with hospital care (Patient Satisfaction Scale) at discharge. Sociodemographics, clinical information, accessibility to knowledge from healthcare providers (Access to Knowledge Scale), and preferences for information and behavioural control (Krantz Health Opinion Survey) were collected as background data.

    RESULTS: Patients` knowledge expectations were higher (mean 3·6, SD 0·4) than their perception of received knowledge (mean 3·0, SD 0·7). Multiple linear regression analysis showed that access to knowledge, information preferences and work experience within health- or social care explained 33% (R²) of the variation in the difference between received and expected knowledge. Patients reported high satisfaction with their care except regarding how their family was involved.

    CONCLUSION: Patients undergoing knee arthroplasty receive less knowledge than they expect, and individual factors and communication with healthcare providers during hospitalisation are related to their experience. The content of patient education and family involvement should be considered in future care.

    RELEVANCE TO CLINICAL PRACTICE: The results strengthen the knowledge base on the educational needs of knee arthroplasty patients and can be used to develop and test new interventions.

    Place, publisher, year, edition, pages
    Wiley-Blackwell, 2014
    Keywords
    Knee arthroplasty, osteoarthritis, patient education, patient expectations, patient satisfaction, surgery
    National Category
    Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-105225 (URN)10.1111/jocn.12552 (DOI)000343857700020 ()24476393 (PubMedID)
    Projects
    EEPO
    Available from: 2014-03-13 Created: 2014-03-13 Last updated: 2017-12-05Bibliographically approved
    2. Knowledge expectations, self-care, and health complaints of heart failure patients scheduled for cardiac resynchronization therapy implantation
    Open this publication in new window or tab >>Knowledge expectations, self-care, and health complaints of heart failure patients scheduled for cardiac resynchronization therapy implantation
    2015 (English)In: Patient Preference and Adherence, ISSN 1177-889X, E-ISSN 1177-889X, Vol. 9, p. 913-921Article in journal (Refereed) Published
    Abstract [en]

    Purpose: To describe what knowledge heart failure patients expect to acquire in relation to their upcoming cardiac resynchronization therapy (CRT) device implantation, to describe their self-care and health complaints, and to explore the relationship between knowledge expectations and self-care, health complaints, and background factors. Patients and methods: Cross-sectional multicenter study with 104 patients scheduled for a first-time, elective CRT implantation in Swedish and Icelandic hospitals. Data were collected with the Knowledge Expectations of hospital patient Scale, European Heart Failure Self-care Behavior Scale, and Adjusted Postoperative Recovery Profile. Results: Patients expected most knowledge related to their disease and its treatment (median 4.0, interquartile range 0.13) and least on social issues (median 3.5, interquartile range 0.83). Their self-care was average (standardized mean 51.0 +/- 19.6) before the procedure. Patients had on average 8.2 (+/- 4.7) health complaints and rated fatigue and sexual problems as the most severe. Age was independently associated with knowledge expectations (Exp beta 0.049, P= 0.033). Conclusion: Heart failure patients waiting for a CRT device implantation have high expectations for multiple aspects of knowledge, including self-care issues, before their procedure. These expectations are similar to those of other surgical patients and they increase with age.

    Place, publisher, year, edition, pages
    Dove Medical Press, 2015
    Keywords
    cardiac devices; CRT treatment; patient education
    National Category
    Health Care Service and Management, Health Policy and Services and Health Economy
    Identifiers
    urn:nbn:se:liu:diva-120368 (URN)10.2147/PPA.S83069 (DOI)000357535000001 ()26170641 (PubMedID)
    Note

    Funding Agencies|Landspitali University Hospital Research Fund, Landspitali - The National University Hospital of Iceland; Icelandic Nurses Association Research Fund; Ingibjorg Magnusdottir in Iceland; Medtronic-Vingmed AB; St. Jude Medical Sweden AB in Sweden

    Available from: 2015-07-31 Created: 2015-07-31 Last updated: 2019-06-27
    3. Perceptions about traditional and novel methods to learn about post-operative pain management: - a qualitative study.
    Open this publication in new window or tab >>Perceptions about traditional and novel methods to learn about post-operative pain management: - a qualitative study.
    2016 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 72, no 11, p. 2672-2683Article in journal (Refereed) Published
    Abstract [en]

    Aim: To explore the perceptions of surgical patients about traditional and novel methods to learn about post-operative pain management.Background: Patient education is an important part of post-operative care. Contemporary technology offers new ways for patients to learn about self-care, although face-to-face discussions and brochures are the most common methods of delivering education in nursing practice.Design: A qualitative design with a vignette and semi-structured interviews used for data collection.Methods: A purposeful sample of 13 post-surgical patients, who had been discharged from hospital, was recruited during 2013 - 2014. The patients were given a vignette about anticipated hospital discharge after surgery with four different options for communication (face-to-face, brochure, website, serious game) to learn about post-operative pain management. They were asked to rank their preferred method of learning and thereafter to reflect on their choices. Data were analysed using an inductive content analysis approach.Findings: Patients preferred face-to-face education with a nurse, followed by brochures and websites, while games were least preferred. Two categories, each with two sub-categories, emerged from the data. These conceptualised the factors affecting patients' perceptions: 1) 'Trusting the source', sub-categorised into 'Being familiar with the method' and 'Having own prejudgments'; and 2) 'Being motivated to learn' sub-categorised into 'Managing an impaired cognition' and 'Aspiring for increased knowledge'.Conclusion: In order to implement successfully novel educational methods into post-operative care, healthcare professionals need to be aware of the factors influencing patients' perceptions abouthow to learn, such as trust and motivation.

    Place, publisher, year, edition, pages
    Wiley-Blackwell, 2016
    Keywords
    Content analysis; educational methods; nursing; patient education; patient learning; post-operative self-care; vignettes
    National Category
    Nursing
    Identifiers
    urn:nbn:se:liu:diva-129199 (URN)10.1111/jan.13021 (DOI)000386079500010 ()27205900 (PubMedID)
    Note

    Funding agencies: Landspitali University Hospital Research Fund; Icelandic Nurses Association Research Fund

    Available from: 2016-06-13 Created: 2016-06-13 Last updated: 2019-06-27
  • 210.
    Jacobsson, Catrine
    Östergötlands Läns Landsting. PrioriteringsCentrum.
    Öppna prioriteringar inom omvårdnad: ett samarbetsprojekt med SSF och Vårdförbundet2006Report (Other academic)
    Abstract [sv]

    Prioriteringar har alltid gjorts och görs hela tiden på olika nivåer i vården. Alla vårdprofessioner påverkar hur vårdens samlade resurser fördelas och hur väl man tillgodoser patientens behov. Ett antal intervjustudier har visat att grunderna varierar för ställningstagande vad gäller vårdens innehåll samt att vårdpersonal i liten utsträckning är delaktiga i diskussioner och dialog i frågor som rör prioriteringar på olika nivåer inom hälso- och sjukvård. För att kunna fånga vårdtagarens alla behov krävs att allas kompetens tillvaratas. Detta utgör viktiga utgångspunkter för detta metodförsök att pröva en nationellt utvecklad arbetsmodell för öppna vertikala prioriteringar av omvårdnadsinsatser i samband med stroke. Inom detta diagnosområde finns också ett gediget nationellt kunskapsstöd för vårdens innehåll både vad gäller medicinska insatser samt omvårdnads- och rehabiliteringsinsatser.

    Under 2005 har PrioriteringsCentrum i samarbete med Svensk sjuksköterskeförening (SSF) och Vårdförbundet drivit ett samarbetsprojekt som syftat till:

    • Att pröva om den arbetsmodell för prioriteringar som tagit form i Sverige idag är möjlig att tillämpa inom omvårdnad vid stroke.
    • Att bidra till en utveckling av en arbetsmodell som kan omfatta vårdens alla professioner, tillgodose vårdtagarens behov samt gynna gränsöverskridande prioriteringsdiskussioner tillsammans med administratörer och politiker.

    Med utgångspunkt i en arbetsmodell som rekommenderas av Svenska Läkaresällskapet, tillämpas i Socialstyrelsens arbete och ett tidigare pilotprojekt inom strokeomvårdnad har tre strokeenheter i Sverige (Gällivare sjukhus, Södersjukhuset och Norrlands universitetssjukhus) diskuterat och prövat rangordning av kombinationen hälsotillstånd/insatser inom omvårdnadens ansvarsområde vid stroke. Totalt har 16 personer ingått i de tre arbetsgrupperna (sjuksköterskor och undersköterskor) och antalet möten i arbetsgrupperna har varierat mellan fem till tio. Varje enhet har sina specifika förutsättningar men utgångspunkterna har varit gemensamma.

    Övergripande visar försöket att arbetsmodellen med rangordning av hälsotillstånd/insats gett god vägledning för konkreta diskussioner om prioriteringar. Det visar också att arbete med öppna prioriteringar kan vara ett stöd för att tydliggöra och beskriva omvårdnadsinsatser och ett gemensamt förhållningssätt inom omvårdnad.

    Samstämmigt uttrycktes från arbetsgrupperna att det inte är rangordningen av omvårdnadsinsatser som är det primära resultatet av projektet utan processen med de resonemang och samtal som förts i grupperna om prioritering, rangordning och omvårdnad. Deltagarna lyfte också fram betydelsen av att känna till andra professioners prioriteringar för att fånga patienternas alla behov. Resultatet av arbetsgruppernas diskussion utifrån arbetsmodellen har strukturerats i två huvudområden;

    • Erfarenheter av processen som arbetsgrupperna genomgått lyftes som det mest betydelsefulla resultatet och kan sammanfattas i;utmanande men möjligtstöd för ställningstaganden
    • Arbetsmodellen - ett verktyg för att lyfta fram och diskutera vardagliga prioriteringar. Arbetsmodellen tydliggör också insatser som görs på oklar grund, bristen på vetenskapligt underlag och att prioriteringsarbetet utifrån arbetsmodellen tydligt visar behovet av att omvårdnadspersonal har god kunskap om aktuell forskning inom strokeområdet

    Grunderna i arbetsmodellen och framförallt försöken att rangordna kombinationen hälsotillstånd/insats har väckt många frågor:

    • vad gör vi och på vilka grunder?
    • vad innebär hälsa/ohälsa?
    • ur vilken utgångspunkt värderas svårighetsgrad?
    • hur ska effekter i form av patientnytta bedömas
    • vad innebär erfarenhetsbaserad kunskap?

    Metodförsöket lyfter tydligt fram ett antal behov och utvecklingsmöjligheter som utgör viktiga förutsättningar för en öppen dialog. Detta ger möjlighet till större delaktighet för alla vårdprofessioner i frågor som rör prioriteringar inom all vård och omsorg - inte bara inom omvårdnadsområdet.

    Metodförsöket har pågått under kort tid och svårigheterna med att tolka arbetsmodellens delar tenderade att växa allt eftersom arbetsgrupperna fördjupade sig inom området. En fortsatt utveckling av en gemensam svensk modell för öppna vertikala prioriteringar kräver tid, utbildningsinsatser, professionella och tvärprofessionella metoddiskussioner men framför allt att konkreta exempel på systematiska prioriteringsarbeten påbörjas inom olika vårdverksamheter.

    Organisationerna SSF och Vårdförbundet planerar nu i första hand att fortsätta stödja konkreta utvecklingsprojekt som prövar arbetsmodellen tvärprofessionellt men också utifrån olika vårdnivåer.

  • 211.
    Jansson, Sandra
    et al.
    Institutet för Hälso- och sjukvårdsekonomi, Lund.
    Anell, Anders
    Institutet för Hälso- och sjukvårdsekonomi, Lund.
    Subventionering av läkemedel: förutsättningar för öppna och legitima beslutsprocesser i Läkemedelsförmånsnämnden2005Report (Other academic)
    Abstract [sv]

    I oktober 2002 inrättades en ny svensk myndighet - Läkemedelsförmånsnämnden (LFN) - som har till uppgift att bedöma vilka läkemedel som ska subventioneras av allmänna medel utifrån läkemedelsföretagens ansökningar. Dessutom ska myndigheten verka för att prioriteringar i svensk hälso- och sjukvård ska bli mer öppna.

    I denna rapport redogörs för LFN:s beslutsprocess i samband med subventionsbeslut för originalläkemedel under år 2003 dels ur ett strukturellt perspektiv och dels ur ett processperspektiv. Syftet är att undersöka huruvida beslutsprocessen ger upphov till en öppen, rättvis och legitim prioriteringsprocess. Dessutom granskas olika intressenters påverkan på LFN:s myndighetsutövning, samt vilka faktorer som ökar respektive minskar förutsättningarna för öppna och legitima prioriteringar inom den svenska läkemedelsförmånen.

    LFN:s subventionsbeslut av receptläkemedel bedöms i hög grad uppfylla de fastställda kriterierna för öppna, rättvisa och legitima beslutsprocesser, men det finns fortfarande möjligheter att öka insynen i beslutsprocessen. Framför allt bör myndigheten fortsätta sitt arbete med att specificera vilken relativ betydelse de uppställda beslutskriterierna har i varje enskilt subventionsbeslut och definiera var myndigheten sätter sin gräns för vad som definieras som kostnadseffektivt. För att stärka legitimiteten i beslutsprocessen bör LFN även intensifiera sitt arbete med att föra ut kunskap och information till framför allt förskrivare och patienter. Dessutom bör nämnden explicit visa att förväntade konsekvenser av olika beslut har övervägts. Så länge ansökan omfattas av sekretesslagstiftningen torde det dock i praktiken vara svårt för LFN att i någon större omfattning öka insynen och deltagandet i själva beslutsprocessen.

    LFN:s genomgång av det totala läkemedelssortimentet kan förväntas leda till större konflikter med andra intressenter då läkemedel som redan används av patienter kan komma att lyftas ut ur läkemedelsförmånerna. Detta talar för att det i framtiden kommer att bli än viktigare för myndigheten att fortsätta sitt arbete med att legitimera den beslutsprocess som kringgärdar subventionsbeslut av receptläkemedel.

  • 212.
    Jendle, J
    et al.
    Faculty of Medical Sciences, Örebro University, Örebro, Sweden.
    Sandberg, A
    Novo Nordisk A/S, Vandtårnsvej 114, DK-2860 Søborg, Denmark.
    Buchs, S
    Novo Nordisk A/S, Vandtårnsvej 114, DK-2860 Søborg, Denmark.
    Swinburn, P
    Patient-Centered Outcomes, Mapi, London, UK.
    Hadi, M
    Patient-Centered Outcomes, Mapi, London, UK.
    Levin, Lars-Åke
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    A utility valuation study assessing the impact of postprandial glucose control on quality of life of individuals with type 1 or type 2 diabetes2017In: Journal of patient-reported outcomes, ISSN 2509-8020, Vol. 2, no 1, article id 20Article in journal (Refereed)
    Abstract [en]

    Background: Consideration of health-related quality of life (HRQOL) in diabetes has been associated with long-term and short-term complications such as hypoglycaemia, but not with short-term glucose control. This study aimed to collect health utilities related to different degrees of poorly controlled postprandial glucose (PPG) and its impact on HRQOL in the UK and in Sweden.

    Methods: Three health state descriptions were developed based on literature reviews and interviews with people with diabetes and healthcare professionals, characterising mild, moderate and severe impact of postprandial hyperglycaemic symptoms on HRQOL. Time Trade-Off (TTO) interviews with a 10-year trade-off period were conducted with samples of the UK general public and of Swedish people with diabetes. Mean TTO-derived health state values were expressed on a scale from 0 (death) to 1 (full health).

    Results: One hundred fifty participants from the general population were interviewed in the UK (57% female, mean age 35 years) and 150 participants with diabetes in Sweden (64% female, mean age 51 years, 42% type 1 and 58% type 2 diabetes). The mean TTO-derived health state values were for the UK and Swedish participants: mild impact of poorly PPG control (0.89/0.76); moderate (0.75/0.71); severe (0.56/0.58).

    Conclusions: Glucose lowering treatments associated with improved control over PPG levels could have important benefits to people with type 1 and type 2 diabetes since findings suggest that increasing severity in postprandial hyperglycaemic symptoms is perceived as having significant negative impact on HRQOL of individuals with type 1 or type 2 diabetes.

  • 213.
    Johannesen, Kasper
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences. Department of Health Economics, AstraZeneca Nordic, Södertälje, Sweden .
    Henriksson, Martin
    Department of Health Economics, AstraZeneca Nordic, Södertälje, Sweden.
    Getting value today and incentivising for the future: Pharmaceutical development and healthcare policies2017In: Nordic Journal of Health Economics, ISSN 1892-9729, E-ISSN 1892-9710, Vol. 5, no 1, p. 77-96Article, review/survey (Refereed)
    Abstract [en]

    To manage the challenge of limited healthcare resources and unlimited demand for healthcare, decision makers utilise a variety of demand side policies, such as health technology appraisals and international reference pricing to regulate price and utilisation. By controlling price and utilisation demand side policies determine the earnings potential, and hence the incentives to invest in research and development (R&D) of new technologies. However, the impact of demand side policies on R&D incentives is seldom formally assessed. Based on the key assumption that intellectual property rights, i.e. patents, and expected rent are key drivers of pharmaceutical R&D, this work outlines a framework illustrating the link between demand side policies and pharmaceutical R&D incentives. By analysing how policies impact expected rent and consumer surplus, the framework is used to understand how commonly used demand side policies (including timing and length of reimbursement process, international reference pricing, parallel trade, and sequential adoption into clinical practice) may influence R&D incentives. The analysis demonstrates that delayed reimbursement decisions as well as sequential adoption into clinical practise may in fact reduce both expected rent and consumer surplus. It is also demonstrated how international reference pricing is likely to increase consumer surplus at the expense of lower rent and thus lower R&D incentives. Although this work illustrates the importance of considering how demand side policies may impact long-term R&D incentives, it is important to note that the purpose has not been to prescribe which demand side policies should be utilised or how. Rather, the main contribution is to illustrate the need for a structured approach to the analysis of the complex, and at times highly politicised question of how demand side policies ultimately influence population health, both in the short and in the long term.

  • 214.
    Johansson, Gun
    et al.
    Karolinska Institutet.
    Lundberg, Ingvar
    Karolinska Institutet.
    Adjustment latitude and attendance requirements as determinants of sickness absence or attendance: Empirical tests of the illness flexibility model2004In: Social Science & Medicine, ISSN 0277-9536, Vol. 58, no 10, p. 1857-1868Article in journal (Refereed)
    Abstract [en]

    This study investigates whether the two dimensions of illness flexibility at work, adjustment latitude and attendance requirements are associated to sickness absence and sickness attendance. Adjustment latitude describes the opportunities people have to reduce or in other ways change their work-effort when ill. Such opportunities can be to choose among work tasks or work at a slower pace. Attendance requirements describe negative consequences of being away from work that can affect either the subject, work mates or a third party. In a cross-sectional design data based on self-reports from a questionnaire from 4924 inhabitants in the county of Stockholm were analysed. The results showed that low adjustment latitude, as predicted, increased women's sickness absence. However, it did not show any relation to men's sickness absence and men's and women's sickness attendance. Attendance requirements were strongly associated to both men's and women's sickness absence and sickness attendance in the predicted way. Those more often required to attend were less likely to be absent and more likely to attend work at illness. As this is the first study of how illness flexibility at work affects behaviour at illness, it was concluded that more studies are needed.

  • 215.
    Johansson Krafve, Linus
    Linköping University, The Tema Institute, Technology and Social Change. Linköping University, Faculty of Arts and Sciences.
    Valuation in Welfare Markets: The Rule Books, Whiteboards and Swivel Chairs of Care Choice Reform2015Doctoral thesis, monograph (Other academic)
    Abstract [en]

    This thesis takes an interest in how values attain a specific meaning in market reforms of welfare provision. The study builds on exploring how values are enacted rather than treating them as universal and stable. The aim of the thesis is to contribute conceptually to the understanding of how market-making activities in the welfare state bureaucracy handle the values at play in welfare reform.

    The empirical case is the governance of a so-called care choice system in a Swedish county council. The methodology for the study is “shadowing” of public officials working to formulate a so-called rulebook for care centres. The analysis describes how these officials handle a variety of values when designing the rulebook. How they choose to organize their work – the methods used to collect data about care centre performance, what governance tools they employ, how they arrange their work roles, and how they construct the rulebook – leads to value shifts and determines the meaning of values in practice.

    The officials’ work practice is political in the sense that it actively shapes the values enacted in the care choice reform. Therefore, it is of great importance to spur a broader debate about the organization of such governance practices, while there is a need to problematize simplistic images of what market reforms of welfare entails in practice. The thesis proposes that an “ecological” – i.e. a situated, reflexive, and malleable – approach to handling of contending values may contribute to such debates.

  • 216.
    Joukes, Erik
    et al.
    University of Amsterdam, Netherlands.
    Cornet, Ronald
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, Faculty of Science & Engineering. University of Amsterdam, Netherlands.
    de Keizer, Nicolette
    University of Amsterdam, Netherlands.
    de Bruijne, Martine
    Vrije University of Amsterdam Medical Centre, Netherlands.
    Collect Once, Use Many Times: End-Users Dont Practice What They Preach2016In: EXPLORING COMPLEXITY IN HEALTH: AN INTERDISCIPLINARY SYSTEMS APPROACH, IOS PRESS , 2016, Vol. 228, p. 252-256Conference paper (Refereed)
    Abstract [en]

    Data in an Electronic Health Record must be recorded once, in a standardized and structured way at the point of care to be reusable within the care process as well as for secondary purposes (collect once, use many times (COUMT) paradigm). COUMT has not yet been fully adopted by staff in every organization. Our study intends to identify concepts that underlie its adoption and describe its current status in Dutch academic hospitals. Based on literature we have constructed a model that describes these concepts and that guided the development of a questionnaire investigating COUMT adoption. The questionnaire was sent to staff working with patient data or records in seven out of eight Dutch university hospitals. Results show high willingness of end-users to comply to COUMT in the care process. End-users agree that COUMT is important, and that they want to work in a structured and standardized way. However, end-users indicate to not actually use terminology or information standards, but often register diagnoses and procedures in free text, and experience repeated recording of data. In conclusion, we found that COUMT is currently well adopted in mind, but not yet in practice.

  • 217.
    Jönsen, Andreas
    et al.
    Department of Rheumatology, Lund University, Lund,.
    Hjalte, Frida
    The Swedish Institute for Health Economics, Lund.
    Willim, Minna
    Lunds University, Lund .
    Carlsson, Katarina Steen
    The Swedish Institute for Health Economics, Lund.
    Sjöwall, Christopher
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Rheumatology.
    Svenungsson, Elisabet
    Karolinska University Hospital, K, Karolinska Institutet, Stockholm .
    Leonard, Dag
    Department of Medical Sciences, Section of Rheumatology, Uppsala University, Uppsala, Sweden.
    Bengtsson, Christine
    Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Rantapää-Dahlqvist, Solbritt
    Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Pettersson, Susanne
    Karolinska University Hospital, Karolinska Institutet, Stockholm.
    Gunnarsson, Iva
    University Hospital, Karolinska Institutet, Stockholm.
    Zickert, Agneta
    University Hospital, Karolinska Institutet, Stockholm.
    Gustafsson, Johanna T
    University Hospital, Karolinska Institutet, Stockholm.
    Rönnblom, Lars
    Department of Medical Sciences, Section of Rheumatology, Uppsala University, Uppsala, Sweden.
    Petersson, Ingemar F
    Department of Orthopedics, Lund University, Lund.
    Bengtsson, Anders A
    Department of Rheumatology, Lund University, Lund,.
    Nived, Ola
    Department of Rheumatology, Lund University, Lund,.
    Direct and indirect costs for systemic lupus erythematosus in Sweden. A nationwide health economic study based on five defined cohorts.2016In: Seminars in Arthritis & Rheumatism, ISSN 0049-0172, E-ISSN 1532-866X, Vol. 45, no 6, p. 684-690Article, review/survey (Refereed)
    Abstract [en]

    OBJECTIVES: The main objectives of this study were to calculate total costs of illness and cost-driving disease features among patients with systemic lupus erythematosus (SLE) in Sweden.

    METHODS: Five cohorts of well-defined SLE patients, located in different parts of the country were merged. Incident and prevalent cases from 2003 through 2010 were included. The American College of Rheumatology (ACR) classification criteria was used. From the local cohorts, data on demographics, disease activity (SLEDAI 2K), and organ damage (SDI) were collected. Costs for inpatient care, specialist outpatient care and drugs were retrieved from national registries at the National Board of Health and Welfare. Indirect costs were calculated based on sickness leave and disability pensions from the Swedish Social Insurance Agency.

    RESULTS: In total, 1029 SLE patients, 88% females, were included, and approximately 75% were below 65 years at the end of follow-up, and thus in working age. The mean number of annual specialist physician visits varied from six to seven; mean annual inpatient days were 3.1-3.6, and mean annual sick leave was 123-148 days, all per patient. The total annual cost was 208,555 SEK ($33,369 = 22,941€), of which direct cost was 63,672kr ($10,188 = 7004€) and the indirect cost was 144,883 SEK ($23,181 = 15,937€), all per patient. The costs for patients with short disease duration were higher. Higher disease activity as measured by a SLEDAI 2K score > 3 was associated with approximately 50% increase in both indirect and direct costs. Damage in the neuropsychiatric and musculoskeletal domains were also linked to higher direct and indirect costs, while organ damage in the renal and ocular systems increased direct costs.

    CONCLUSION: Based on this study and an estimate of slightly more than 6000 SLE patients in Sweden, the total annual cost for SLE in the country is estimated at $188 million (=129.5 million €). Both direct (30%) and indirect costs (70%) are substantial. Medication accounts for less than 10% of the total cost. The tax paid national systems for health care and social security in Sweden ensure equal access to health care, sick leave reimbursements, and disability pensions nationwide. Our extrapolated annual costs for SLE in Sweden are therefore the best supported estimations thus far, and they clearly underline the importance of improved management, especially to reduce the indirect costs.

  • 218.
    Jönsson, B
    et al.
    Stockholm School of Economics, Stockholm, Sweden.
    Christiansen, C
    Center for Clinical and Basic Research, Ballerup, Denmark.
    Johnell, O
    Department of Orthopedics, Malmö General Hospital, Malmö, Sweden.
    Hedbrant, Johan
    Linköping University.
    Karlsson, G
    Stockholm School of Economics, Stockholm, Sweden.
    Cost-effectiveness of Fracture Prevention in Established Osteoporosis1996In: Scandinavian Journal of Rheumatology. Supplement, ISSN 0301-3847, E-ISSN 1502-7740, Vol. 25, no Suppl. 103, p. 30-38Article in journal (Refereed)
    Abstract [en]

    This study presents the results of a computer simulation model for calculating the cost-effectiveness and cost-utility of treating patients with established osteoporosis in order to reduce the risk of fractures. The results are based on Swedish data for risk of fracture and costs. The treatment intervention modelled is based on treatment of a 62-year-old woman with established osteoporosis. The cost per hip fracture avoided is 350,000 SEK, assuming a 50% reduction in the risk of fracture due to 5 years of treatment. A sensitivity analysis for changes in the cost and effectiveness of treatment, the risk of fracture and the discount rate is performed. The cost per life-year gained and the cost per quality-adjusted life-year (QALY) gained is presented to enable comparison of the cost-effectiveness of treating osteoporosis with that of other health care interventions. A comparison between treating the same woman for osteoporosis and mild hypertension shows a cost per life-year gained of 220,000 SEK and 128,000 SEK respectively. Cost per QALY gained is very similar for the two interventions: 105,000 SEK and 103,000 SEK respectively. This model provides a tool to enable clinicians, administrators and health policy makers to analyze and understand the economic aspects of a major health policy issue.

  • 219.
    Kalkan, Almina
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Diffusion, implementation and consequences of new health technology: The cases of biological drugs for rheumatoid arthritis and the Swedish national guidelines2015Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Improvements in health technology raise hopes for better patient outcomes and a more efficient delivery of health care. However, the processes of diffusion and implementation of new health technology have been shown to be complicated and to pose a number of challenges for the healthcare sector. Many at tempts have been made to influence and manage the introduction and diffusion of health technology. One prominent example is the Swedish nat ional guidelines that aim at influencing both clinical and political decision - making in the health sector.

    The overall aim of this thesis is to describe and analyze the factors influencing the diffusion and economic consequences of the introduction of a new technology with large variations in use, and to explore the process of implementation of nationally produced guidelines as an instrument for improv ing effectiveness and equity. The empirical focus is kept on the biological drugs (bDMARDs) for rheumatoid arthritis (RA), since they implied a substantial treatment change when they were first int roduced and they are relatively costly; and on the national guidelines for cardiac care, since they were the first nat ional guidelines, hence allowing a long-term perspect ive in the exploration of their implementat ion.

    Paper I presents a register study that uses data from national and regional registries on healt hcare use and work disability of patients with RA and shows that there was a 32 percent increase in the total fixed cost of RA during 1990-2010, mainly after the introduct ion of bDMARDs. Paper II shows that choosing to initiate treatment with bDMARDs varied substantially among 26 rheumatologists presented with hypothetical patient cases, and that there were also disparities between rheumatologists practicing in the same clinic. Paper III presents data from the Swedish Rheumatology Quality Register covering 4010 patients with RA, and shows that when using multivariate logistic regression to adjust for patient characterist ics, disease activity and t he physician’s local context, physician preference was an import ant predict or for prescription of bDMARDs. Paper IV is a qualitative study about prescribing decisions, showing that a constellat ion of various factors and their interact ion influenced the prescribing decisions according to the 26 interviewed rheumatologists. The factors included the individual rheumatologist ’s experiences and perceptions of t he evidence, the structure of the department including responsibility for costs, peer pressure, political and administrative influences, and participat ion in clinical trials. The patient as an actor emerged as an important factor. Paper V is a longitudinal qualitat ive study exploring the responses among four Swedish county councils to the national guidelines for cardiac care through 155 interviews with politicians, administ rators and clinical managers. The results show that unilateral responses to the national guidelines within the county councils have been rare, but there have been at tempts to compromise and to at tain a balance between multiple constituents. There are examples of local information meetings, the use of the national guidelines in local healthcare programs, and performing audits with the national guidelines as a base. However, performing explicit prioritizat ion as advised in the NGCC is rarely found. Over t ime, however, a more systematic use of the national guidelines has been noted.

    In conclusion, the diffusion of new health technology is influenced by a wide array of factors both at individual and organizational levels, as well as their interact ion. The diffusion resulted in large economic consequences and unequal access due to variations also at clinical level. Moreover, given that healthcare decision-making is influenced by many different factors, the simple influx of evidence-based guidelines will unlikely result in automat ic implementat ion. At tempts to influence healthcare decisions need to have a systems perspect ive and to account for the interact ion of factors between different actors.

    List of papers
    1. Costs of rheumatoid arthritis during the period 1990–2010: a register-based cost-of-illness study in Sweden
    Open this publication in new window or tab >>Costs of rheumatoid arthritis during the period 1990–2010: a register-based cost-of-illness study in Sweden
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    2014 (English)In: Rheumatology, ISSN 1462-0324, E-ISSN 1462-0332, Vol. 53, no 1, p. 153-160Article in journal (Refereed) Published
    Abstract [en]

    Objectives. The objectives of this study were to analyse the total socio-economic impact of RA in Sweden during the period 1990–2010 and to analyse possible changes in costs during this period. The period was deliberately chosen to cover 10 years before and 10 years after the introduction of biologic drugs.

    Methods. A prevalence-based cost-of-illness study was conducted based on data from national and regional registries.

    Results. There was a decrease in the utilization of RA-related inpatient care as well as sick leave and disability pension during 1990–2010 in Sweden. Total costs for RA are presented in current prices as well as inflation-adjusted with the consumer price index (CPI) and a healthcare price index. The total fixed cost of RA was €454 million in 1990, adjusted to the price level of 2010 with the CPI. This cost increased to €600 million in 2010 and the increase was mainly due to the substantially increasing costs for pharmaceuticals. Of the total costs, drug costs increased from 3% to 33% between 1990 and 2010. Consequently the portion of total costs accounting for indirect costs for RA is lowered from 75% in 1990 to 58% in 2010.

    Conclusion. By inflation adjusting with the CPI, which is reasonable from a societal perspective, there was a 32% increase in the total fixed cost of RA between 1990 and 2010. This suggests that decreased hospitalization and indirect costs have not fallen enough to offset the increasing cost of drug treatment.

    Place, publisher, year, edition, pages
    Oxford University Press, 2014
    National Category
    Medical and Health Sciences Clinical Medicine
    Identifiers
    urn:nbn:se:liu:diva-100004 (URN)10.1093/rheumatology/ket290 (DOI)000329041900022 ()24136064 (PubMedID)
    Available from: 2013-10-24 Created: 2013-10-24 Last updated: 2017-12-06Bibliographically approved
    2. Individual variations in treatment decisions by Swedish rheumatologists regarding biological drugs for rheumatoid arthritis
    Open this publication in new window or tab >>Individual variations in treatment decisions by Swedish rheumatologists regarding biological drugs for rheumatoid arthritis
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    2015 (English)In: Scandinavian Journal of Rheumatology, ISSN 0300-9742, E-ISSN 1502-7732, Vol. 44, no 4, p. 265-270Article in journal (Refereed) Published
    Abstract [en]

    Objective: In Sweden, reports indicate surprisingly large regional variation in prescription of biological drugs, despite a growing number of clinical studies describing their beneficial effects and guidelines by professional organizations and agencies. Our objective was to ascertain whether there is also variation between individual rheumatologists in prescribing biologics to patients with rheumatoid arthritis (RA) and to evaluate reasons for treatment choices.

    Methods: Ten hypothetical patient cases were constructed and presented to 26 rheumatologists in five regions in Sweden. The cases were based on actual cases and were thoroughly elaborated by a senior rheumatologist and pre-tested in a pilot study. The respondents were asked whether they would treat the patients with a biological agent (YES/NO) and to explain their decisions.

    Results: The response rate was 26/105; 25%. Treatment choices varied considerably between the rheumatologists, some prescribing biologics to 9/10 patients and others to 2/10. In five of the ten hypothetical cases, approximately half of the respondents would prescribe biologics. No regions with particularly high or low prescription were identified. Both the decision to prescribe biologics, as well as not to prescribe, were mainly motivated by medical reasons. Some rheumatologists also referred to lifestyle-related factors or social function of the patient.

    Conclusion: The choice of initiation of biologics varied substantially among rheumatologists presented with hypothetical patient cases, and there were also disparities between rheumatologists practising at the same clinic. Treatment choices were primarily motivated by medical reasons. This situation raises concerns about a lack of consensus in RA treatment strategies.

    Place, publisher, year, edition, pages
    Informa Healthcare, 2015
    National Category
    Clinical Medicine
    Identifiers
    urn:nbn:se:liu:diva-113301 (URN)10.3109/03009742.2014.997286 (DOI)000359960100002 ()
    Note

    DOI does not work: 10.3109/03009742.2014.997286

    Available from: 2015-01-15 Created: 2015-01-15 Last updated: 2018-12-13Bibliographically approved
    3. Physician Preferences and Variations in Prescription of Biologic Drugs for Rheumatoid Arthritis: A Register-Based Study of 4,010 Patients in Sweden
    Open this publication in new window or tab >>Physician Preferences and Variations in Prescription of Biologic Drugs for Rheumatoid Arthritis: A Register-Based Study of 4,010 Patients in Sweden
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    2015 (English)In: Arthritis care & research, ISSN 2151-464X, E-ISSN 2151-4658, Vol. 67, no 12, p. 1679-1685Article in journal (Refereed) Published
    Abstract [en]

    Objective. The prescription of biologic drugs for rheumatoid arthritis (RA) patients has varied considerably across different regions. Previous studies have shown physician preferences to be an important determinant in the decision to select biologic disease-modifying antirheumatic drugs (bDMARDs) rather than nonbiologic, synthetic DMARDs (sDMARDs) alone. The aim of this study was to test the hypothesis that physician preferences are an important determinant for prescribing bDMARDs for RA patients in Sweden. Methods. Using data from the Swedish Rheumatology Quality Register, we identified 4,010 RA patients who were not prescribed bDMARDs during the period 2008-2012, but who, on at least 1 occasion, had an sDMARD prescription and changed treatment for the first time to either a new sDMARD or a bDMARD. Physician preference for the use of bDMARDs was calculated using data on each physicians prescriptions during the study period. The relationship between prescription of a bDMARD and physician preference, controlling for patient characteristics, disease activity, and the physicians local context was evaluated using multivariate logistic regression. Results. When adjusting for patient characteristics, disease activity, and the physicians local context, physician preference was an important predictor for prescription of bDMARDs. Compared with patients of a physician in the lowest preference tertile, patients of physicians in the highest and middle tertiles had an odds ratio for receiving bDMARDs of 2.8 (95% confidence interval [95% CI] 2.13-3.68) and 1.28 (95% CI 1.05-1.57), respectively. Conclusion. Physician preference is an important determinant for prescribing bDMARDs.

    Place, publisher, year, edition, pages
    WILEY-BLACKWELL, 2015
    National Category
    Clinical Medicine
    Identifiers
    urn:nbn:se:liu:diva-124498 (URN)10.1002/acr.22640 (DOI)000367681900008 ()26097219 (PubMedID)
    Note

    Funding Agencies|Norrbacka-Eugenia Foundation; Swedish Rheumatism Association

    Available from: 2016-02-02 Created: 2016-02-01 Last updated: 2017-11-30
    4. Factors influencing rheumatologists prescription of biological treatment in rheumatoid arthritis: an interview study
    Open this publication in new window or tab >>Factors influencing rheumatologists prescription of biological treatment in rheumatoid arthritis: an interview study
    2014 (English)In: Implementation Science, ISSN 1748-5908, E-ISSN 1748-5908, Vol. 9, no 153Article in journal (Refereed) Published
    Abstract [en]

    Background: The introduction of biological drugs involved a fundamental change in the treatment of rheumatoid arthritis (RA). The extent to which biological drugs are prescribed to RA patients in different regions in Sweden varies greatly. Previous research has indicated that differences in health care practice at the regional level might obscure differences at the individual level. The objective of this study is to explore what influences individual rheumatologists decisions when prescribing biological drugs. Method: Semi-structured interviews, utilizing closed-and open-ended questions, were conducted with senior rheumatologists, selected through a mix of random and purposive sampling. The interview questions consisted of two parts, with a "parallel mixed method" approach. In the first and main part, open-ended exploratory questions were posed about factors influencing prescription. In the second part, the rheumatologists were asked to rate predefined factors that might influence their prescription decisions. The Consolidated Framework for Implementation Research (CFIR) was used as a conceptual framework for data collection and analysis. Results: Twenty-six rheumatologists were interviewed. A constellation of various factors and their interaction influenced rheumatologists prescribing decisions, including the individual rheumatologists experiences and perceptions of the evidence, the structure of the department including responsibility for costs, peer pressure, political and administrative influences, and participation in clinical trials. The patient as an actor emerged as an important factor. Hence, factors both at organizational and individual levels influenced the prescribing of biological drugs. The factors should not be seen as individual influences but were described as influencing prescription in an interactive, nonlinear way. Conclusions: Potential factors explaining differences in prescription practice are experience and perception of the evidence on the individual level and the structure of the department and participation in clinical trials on the organizational level. The influence of patient attitudes and preferences and interpretation of scientific evidence seemed to be somewhat contradictory in the qualitative responses as compared to the quantitative rating, and this needs further exploration. An implication of the present study is that in addition to scientific knowledge, attempts to influence prescription behavior need to be multifactorial and account for interactions of factors between different actors.

    Place, publisher, year, edition, pages
    BioMed Central, 2014
    Keywords
    Prescription; Rheumatoid arthritis; Biological drugs; Implementation; Physicians; Clinical decision-making; Practice variations; Qualitative; CFIR
    National Category
    Clinical Medicine
    Identifiers
    urn:nbn:se:liu:diva-113028 (URN)10.1186/s13012-014-0153-5 (DOI)000345438200001 ()25304517 (PubMedID)
    Available from: 2015-01-12 Created: 2015-01-08 Last updated: 2017-12-05
    5. Management by Knowledge in Practice: Implementation of National Healthcare Guidelines in Sweden
    Open this publication in new window or tab >>Management by Knowledge in Practice: Implementation of National Healthcare Guidelines in Sweden
    2015 (English)In: Social Policy & Administration, ISSN 0144-5596, E-ISSN 1467-9515, Vol. 49, no 7, p. 911-927Article in journal (Refereed) Published
    Abstract [en]

    In the last ten years, the concept of management by knowledge has gained growing attention inSwedish healthcare, as well as internationally. In Sweden, the most prominent example ofmanagement by knowledge is the National Guidelines, aimed at influencing both clinical andpolitical decision-making in the health sector. The objective of this article is to explore the response among four Swedish county councils to the National Guidelines for Cardiac Care (NGCC). Empirical material was collected through 155 expert interviews with the target groups of the NGCC, politicians, administrators and clinical managers. Analysis of the responses to this multifaceted policy instrument was addressed by drawing on implementation theory (Matland 1995) and institutional theory (Oliver 1991). The NGCC are primarily based on the voluntary diffusion of norms. The county councils are a long way from having adapted all the means suggested by the National Board of Health and Welfare (NBHW): explicit prioritization, healthcare programmes and dialogue between the various actor groups. The high degree of ambiguity in the content of the NGCC, the inherent conflict and the multiplicity and uncertainty in the context of the county councils, have often resulted in avoidance and compromise. The strategic responses we observe can be viewed as an attempt to balance multiple constituents and achieve the various internal organizational goals. The ambiguity and conflict inherent in the policy of the NGCC influence the strategic responses made by the organization. The question remains how far management by knowledge can be applied in a political context.

    Place, publisher, year, edition, pages
    John Wiley & Sons, 2015
    Keywords
    Policy implementation; Institutional pressure; Strategic responses; Swedish National Guidelines
    National Category
    Health Care Service and Management, Health Policy and Services and Health Economy
    Identifiers
    urn:nbn:se:liu:diva-113304 (URN)10.1111/spol.12102 (DOI)000368267400006 ()
    Available from: 2015-01-15 Created: 2015-01-15 Last updated: 2018-11-09Bibliographically approved
  • 220.
    Kalkan, Almina
    et al.
    AstraZeneca Nordic Balt, Sweden.
    Bodegård, Johan
    AstraZeneca Nordic Balt, Sweden.
    Sundstrom, Johan
    Uppsala University, Sweden.
    Svennblad, Bodil
    Uppsala University, Sweden.
    Östgren, Carl Johan
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Ödeshög.
    Nilsson Nilsson, Peter
    Lund University, Sweden.
    Johansson, Gunnar
    Uppsala University, Sweden.
    Ekman, Manias
    AstraZeneca Nordic Balt, Sweden.
    Increased healthcare utilization costs following initiation of insulin treatment in type 2 diabetes: A long-term follow-up in clinical practice2017In: Primary Care Diabetes, ISSN 1751-9918, E-ISSN 1878-0210, Vol. 11, no 2, p. 184-192Article in journal (Refereed)
    Abstract [en]

    Aims: To compare long-term changes in healthcare utilization and costs for type 2 diabetes patients before and after insulin initiation, as well as healthcare costs after insulin versus non-insulin anti-diabetic (NIAD) initiation. Methods: Patients newly initiated on insulin (n = 2823) were identified in primary health care records from 84 Swedish primary care centers, between 1999 to 2009. First, healthcare costs per patient were evaluated for primary care, hospitalizations and secondary outpatient care, before and up to seven years after insulin initiation. Second, patients prescribed insulin in second line were matched to patients prescribed NIAD in second line, and the healthcare costs of the matched groups were compared. Results: The total mean annual healthcare cost increased from 1656 per patient 2 years before insulin initiation to 3814 seven years after insulin initiation. The total cumulative mean healthcare cost per patient at year 5 after second-line treatment was 13,823 in the insulin group compared to 9989 in the NIAD group. Conclusions: Initiation of insulin in type 2 diabetes patients was followed by increased healthcare costs. The increases in costs were larger than those seen in a matched patient population initiated on NIAD treatment in second-line. (C) 2016 The Author(s). Published by Elsevier Ltd on behalf of Primary Care Diabetes Europe. This is an open access article under the CC BY-NC-ND license.

  • 221.
    Kalkan, Almina
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Sandberg, Johanna
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Garpenby, Peter
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Management by Knowledge in Practice: Implementation of National Healthcare Guidelines in Sweden2015In: Social Policy & Administration, ISSN 0144-5596, E-ISSN 1467-9515, Vol. 49, no 7, p. 911-927Article in journal (Refereed)
    Abstract [en]

    In the last ten years, the concept of management by knowledge has gained growing attention inSwedish healthcare, as well as internationally. In Sweden, the most prominent example ofmanagement by knowledge is the National Guidelines, aimed at influencing both clinical andpolitical decision-making in the health sector. The objective of this article is to explore the response among four Swedish county councils to the National Guidelines for Cardiac Care (NGCC). Empirical material was collected through 155 expert interviews with the target groups of the NGCC, politicians, administrators and clinical managers. Analysis of the responses to this multifaceted policy instrument was addressed by drawing on implementation theory (Matland 1995) and institutional theory (Oliver 1991). The NGCC are primarily based on the voluntary diffusion of norms. The county councils are a long way from having adapted all the means suggested by the National Board of Health and Welfare (NBHW): explicit prioritization, healthcare programmes and dialogue between the various actor groups. The high degree of ambiguity in the content of the NGCC, the inherent conflict and the multiplicity and uncertainty in the context of the county councils, have often resulted in avoidance and compromise. The strategic responses we observe can be viewed as an attempt to balance multiple constituents and achieve the various internal organizational goals. The ambiguity and conflict inherent in the policy of the NGCC influence the strategic responses made by the organization. The question remains how far management by knowledge can be applied in a political context.

  • 222.
    Kall, Ingela
    et al.
    Närhälsan Stenungsund Rehabil, Sweden; Umeå University, Sweden.
    Larsson, Maria E. H.
    University of Gothenburg, Sweden; Primary Health Care Narhalsan Primary Care Research and De, Sweden.
    Bernhardsson, Susanne
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Närhälsan Rehabil Hönö Öckerö, Sweden.
    Use of outcome measures improved after a tailored implementation in primary care physiotherapy: a prospective, controlled study2016In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 22, no 5, p. 668-676Article in journal (Refereed)
    Abstract [en]

    Rationale, aims and objectivesIt is important that physiotherapists routinely use outcome measures to evaluate treatment results. There is limited knowledge about effective ways to increase use of outcome measures. The objectives were to investigate the effect of a tailored implementation of guidelines for evaluation of physiotherapy treatment and to explore differences in outcome subgrouped by demographic variables. MethodsA prospective, controlled study was conducted in primary care physiotherapy in western Sweden. 448 publicly employed physiotherapists participated. The intervention comprised a tailored, multi-component implementation of guidelines for treatment and evaluation of musculoskeletal disorders. The core component was a 3-hour implementation seminar. The control group received no intervention. Self-reported attitudes towards, access to and use of outcome measures were assessed with a web-based questionnaire before and after the implementation. ResultsAfter the implementation, a significantly higher proportion of physiotherapists in the intervention group than in the control group reported using outcome measures frequently, 54.8% vs. 35.6%, a 19.2% difference. The proportion of physiotherapists who reported that they considered outcome measures important to use and that they had easy access to outcome measures at their workplace, were similar in both groups at follow-up, 92.8% vs. 93.1%, and 95.2% vs. 90.8%, respectively. At follow-up, no differences related to demographic variables were found in the subgroup analyses. ConclusionsThe findings suggest that a tailored, multi-component implementation can be effective in increasing use of outcome measures. Although most physiotherapists considered outcome measures important and reported having easy access to them at their workplace, only a little more than half reported using outcome measures after the intervention.

  • 223.
    Karki, Sangeeta
    Linköping University, Department of Medicine and Health Sciences.
    HIV/AIDS Situatioin in Nepal: Transition to Women2008Independent thesis Advanced level (degree of Master), 80 points / 120 hpStudent thesis
    Abstract [en]

    This study is about age and gender specific HIV morbidity in Nepal. The main objective of the study is to find out the factors that affect the HIV prevalence in Nepali society and the relationships of different existing socio cultural and economic factors that have led females vulnerable to HIV infection especially to housewives. Qualitative and quantitative methods were used for the data collection.

    Initially, Nepal’s epidemic was driven by sex workers and drug users .Though HIV prevalence was concentrated in these groups for several years, now it has been proved that  the outbreak is not limited among those groups only, the prevalence among housewives , clients of sex workers, migrants and male homosexuals   are stretching up . Moreover findings have shown that the HIV epidemics is taking a devastating tool in women in Nepal, covering the more HIV prevalence number by low risk group housewives among the HIV affected female population. Lack of fully inclusive knowledge of HIV/AIDS; lack of knowledge of proper use of condom, negligence, and risky sexual behavior have compelled maximum risk for HIV contraction in society.

    Socio economic and cultural structures and the consequences of its correlation aggravated the HIV prevalence among people, especially have affected women. Discrimination of women is entrenched in Nepali society. Due to disparity and discrimination women are not able to get formal education that deprives them from any opportunity for the employment that leads poverty on them. Living under poverty often stems them to engage in high risk situations and likely to adopt risky sexual behaviors which in turn render them vulnerable to HIV infection. The masculinity of the society, and women’s less power for the decision making process have made females heavily dependent on males, and this constraint them from entering into negotiating for protective sex which put them in HIV infection .The study further revealed the triggering effect of powerlessness of housewives and risky sexual behavior of men to HIV infection to low risk group housewives.  If the same trends go on, the time is not so far for the Nepali women to take up the higher number of HIV prevalence, and the low risk group housewives will be highly vulnerable. It is already urgent to activate the plans and intervention program for the prevention of HIV prevalence which is stretching towards women especially to low risk group housewives. Based on the findings, conclusions and recommendations are drawn.

  • 224.
    Karlsson, Ingrid
    et al.
    Linköping University, Department of Social and Welfare Studies.
    Lyrén, Ann-Louise
    PrioriteringsCentrum.
    Prioriteringar i vårdens vardag: intervjustudie med vårdpersonal i Lycksele och Halmstad2005Report (Other academic)
    Abstract [sv]

    Denna rapport har tillkommit som en del av ett projekt om prioriteringar i den dagliga vården som drivs av Kommunal och Vårdförbundet. I projektet har Landstingen i Västerbotten och Halland samt kommunerna i Lycksele och Halmstad deltagit.

    Syftet med att genomföra intervjustudien var att öka kunskaperna om patientnära prioriteringar som vårdpersonalen gör och att öka kunskaperna om vilken betydelse ledarskapet har i prioriteringsprocessen. Följande frågeställningar belyses i rapporten:

    • Vad handlar prioriteringar om?
    • Vilka faktorer påverkar prioriteringar inom omvårdnadsområdet?
    • Vilka olika former har prioriteringsbeslut?
    • Vilka faktorer påverkar resursanvändningen?
    • Vad utgör grunden för de prioriteringar som vårdpersonalen gör?
    • Vilka grupper och verksamheter är högt respektive lågt prioriterade?
    • Vilken betydelse har ledningen, på olika nivåer, för prioriteringsarbetet?
    • Hur ser vårdpersonalen på det framtida prioriteringsarbetet?

    Metoden har sin utgångspunkt i ett brett angreppssätt för att belysa frågeställningarna. Datainsamling har genomförts som fokuserade gruppintervjuer, så kallade fokusgrupper. Både homogena och heterogena grupper avseende t ex profession, verksamhet och huvudman har förekommit. Sammantaget har 16 fokusgruppsintervjuer genomförts med i huvudsak undersköterskor/-vårdbiträden och sjuksköterskor, men även andra yrkesgrupper har varit representerade.

    De vardagliga prioriteringarna i vården handlade om att rangordna brukarnas (patienter/vårdtagares) behov, att skapa balans mellan olika prioriteringar och att dämpa negativa konsekvenser av oönskade prioriteringar. En del av dessa hade sin grund i det delade huvudmannaskapet inom vården som flertalet deltagare på ett eller annat sätt ställde sig kritiska till. Deltagarna återkom ofta till ansvaret för att göra rätt bedömning och att fatta svåra beslut och många upplevde att yrkesrollen splittras mellan det patientnära arbetet och andra arbetsuppgifter. Många val som den enskilde medarbetaren gör i sin vardag är beroende av prioriteringar som andra gör - vilka de inte har inflytande över. Det kan vara politiska beslut, andra huvudmäns prioriteringar, organisatoriska faktorer och beslut och val som andra professioner gör.

    Ökade krav från brukare och deras anhöriga skapade rädsla för att bli anmäld till Hälso- och sjukvårdens ansvarsnämnd vilket ibland leder till att beslut om prioriteringar som den enskilde medarbetaren står inför påverkas.

    En mängd andra beslut på olika nivåer påverkar omvårdnadspersonalens möjligheter till att göra prioriteringar som uppfattas som rimliga. Politiska beslut och beslut på förvaltningsnivå uppfattades ofta som pålagor och differens mellan de besluten och vad man på enhets- eller avdelningsnivå ansåg borde prioriteras var inte ovanligt. Det förekom också att politiska beslut om vårdgaranti och valfrihet uppfattades som oförenliga med tillgången på läkare och annan vårdpersonal, och ibland också på vårdplatser.

    Deltagarna framhöll också vikten av effektiv resursanvändning för att frigöra tid för arbetsuppgifter som de utifrån sin yrkesroll borde prioritera högre än vad som görs idag. Ett exempel var att överföring av arbetsuppgifter mellan sjuksköterskor och undersköterskor via delegeringar i kommunens äldreomsorg kunde utvecklas mot effektivare användning av kompetens och resurser.

    De etiska principerna i riksdagens prioriteringsbeslut var endast kända av några få deltagare. Som grund för prioriteringar framhölls istället etiska principer och riktlinjer i Hälso- och sjukvårdslagen och/eller Socialtjänstlagen samt den professionella kunskapen. Prioriteringar sker ibland också oreflekterat och bygger på intuition eller på rutiner som byggts upp inom verksamheten. Beslut om prioriteringar sker på ett flertal sätt, uppifrån utan delaktighet, hierarkiskt/professionellt, genom egna vardagsnära beslut och/eller i dialog med berörda.

    Områden som deltagarna ansåg behövde prioriteras högt upplevdes inte alltid tillräckligt högt prioriterade av huvudmannen. Detta gällde t ex demensvården och rehabilitering av de äldre. Främst prioriterades akuta insatser, basbehov och omvårdnadsuppgifter och deltagarna upplevde att det oftast inte fanns tid för något utöver det.

    Även om diskussioner om hur arbetet skulle bedrivas förekom nästan dagligen, saknade deltagarna generellt sett strukturerade diskussioner om prioriteringar. Uppfattningen om att det var ett långt avstånd mellan politiken och den praktiska situationen i verksamheten var generell och mer gemensamma diskussioner önskades. Långsiktighet och systematik genom framtagandet av gemensamma riktlinjer för prioriteringsarbetet framhölls som avgörande för att arbetet med prioritering utifrån prioriteringsbeslutets riktlinjer skulle bli framgångsrikt, d v s få genomslag i verksamheterna.

    En förutsättning för att resurserna till vård och omsorg ska användas på bästa sätt är att kunskaperna om prioriteringar ökar. Utvecklingsarbeten behöver startas och enligt deltagarna fanns utrymme för att utveckla, både vårdformer, arbetsmodeller och arbetsformer. Särskilt framhölls samarbete både mellan huvudmännen och mellan olika verksamheter som förutsättningar för ett bra arbete med prioriteringar. I det arbetet har ledning på olika nivåer stor betydelse bland annat för att skapa förutsättningar för prioriteringsarbetet och att skapa arenor där dessa frågor kan diskuteras.

  • 225.
    Karlsson, Louise
    et al.
    Linköping University, Faculty of Medicine and Health Sciences, Faculty of Health Sciences, Medical Programme.
    Olofsson, John
    Linköping University, Faculty of Medicine and Health Sciences, Faculty of Health Sciences, Medical Programme.
    Tidseffektivitet vid ljumskbråcksoperationer: - Jämförelse mellan privat- och offentlig vårdgivare2015Independent thesis Advanced level (professional degree), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Background:

    Inguinal hernia surgery is one of the most common surgeries within general surgery, with approximately 20 000 surgeries per year in Sweden. There are three places in Östergötland County where inguinal hernias are executed within outpatient surgery; at Aleris Specialistvård in Motala (ASM), Närsjukvården in Finspång (NiF) and at Medicinskt Centrum in Linköping (MCL).

    There is a theory that private health care providers are more time-efficient than public health care providers. The private health care providers are considered to perform more operations over a given time though no studies has been done on time efficiency.

    This study was performed to detect if there is a difference in time in the various steps during the surgery between the clinics, what causes these differences and if the patients differ.

     

    Methods:

    The study includes 70 patients distributed on three outpatient surgery clinics; ASM, MCL and NiF. The inguinal hernia operations were divided into shorter steps measured with a digital watch.  Furthermore, data were noted about the patients’ age, ASA-score, BMI and who were present in the operating room. Statistical analyses were performed with the Kruskal-Wallis one-way analysis of variance. The software used was SPSS version 22.

     

    Results:

    The study found no significant difference in BMI, ASA-score and age between the health care providers (p > 0,05). However, regarding the time efficiency, there were significant differences between the clinics.

     

    Conclusions:

    The study concludes that there are big differences in time, within the various steps in the inguinal hernia surgeries, between the clinics. The private health care providers were always faster than the public health care provider. Since no earlier studies have been made in this area, it would be interesting to see if there are similar differences in other types of surgeries.

  • 226.
    Kernell Tolf, Malin
    et al.
    PrioriteringsCentrum.
    Bäckman, Karin
    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.
    Programarbete: ett steg på vägen mot öppna prioriteringar2003Report (Other academic)
    Abstract [sv]

    Under 1990-talet infördes i flera landsting en ny typ av organisation som kom att kallas beställar-utförarorganisation. I mitten 1990-talet var denna styrform dominerande i landet. För att förstärka intentionen i beställarutförarorganisationen har s.k. programarbete vuxit fram. En arbetsmodell som utvecklades i Landstinget i Östergötland i mitten av 1990-talet, och som sedan har anammats av andra landsting.

    Denna rapport redovisar resultaten av en kartläggning som gjordes i åtta landsting/regioner under 2002. Studiens syfte var att kartlägga förekomsten av programarbete i landstingen, att studera på vilket sätt landstingen bedriver detta och om möjligt definiera vad som kan karaktäriseras som programarbete.

    I rapporten belyses följande frågeställningar:

    • Vad menas med programarbete?
    • Vilket är syftet med att införa programarbete?
    • Vad ingår i programarbete?
    • Vilka sjukdomsområden har valts ut att ingå i programarbetet och varför har de valts?
    • Hur har organisation och arbetssätt sett ut?
    • Hur är programarbete relaterat till öppna prioriteringar?

    Faktainsamlingen har dels skett genom intervjuer med centralt placerade tjänstemän i landstingen, dels genom studier av relevant bakgrundslitteratur och av landstingen publicerade rapporter, PM etc. Det har inte ingått i uppdraget att utvärdera programarbete med avseende på effektivitet eller måluppfyllelse, ej heller att värdera de olika programmens resultat eller att rangordna dem på något sätt.

    De landsting/regioner som ingått i undersökningen är: Landstinget i Östergötland, Västerbottens läns landsting, Västra Götalandsregionen – Hälsooch sjukvårdskansliet i Borås, Stockholms läns landsting – Nordöstra sjukvårdsområdet (NÖSO), Stockholms läns landsting – Centralt, Landstinget Västmanland, Örebro läns landsting samt Region Skåne.

    Resultatet visar att landstingen bedriver sitt programarbete på ett likartat sätt, men några skillnader kan ändå skönjas. De landsting som var tidiga att börja startade i mitten av 1990-talet, medan en andra grupp startade i början av 2000-talet och är tydligt inspirerade av dem som först anammade arbetsformen. I samtliga landsting betraktas programarbete som en långsiktig och kontinuerlig process, med undantag av två landsting som har avslutat eller gjort uppehåll i sitt programarbete.

    Behovet av att skapa struktur, ge allsidig kunskap och tydliggöra roller är återkommande svar på frågan vilket behov man ville tillfredsställa när man beslutade sig för att starta med programarbetet. Syftet kan vara flerfaldigt. Framförallt anges att syftet är att bättre belysa och värna om befolkningens behov av hälso- och sjukvård, att skapa ett kunskapsunderlag för politiska prioriteringsbeslut samt att utveckla dialogen mellan politiker och verksamhetsföreträdare. Programarbete kan ses som ett konkret sätt att för ett antal utvalda hälsoproblem beakta och bearbeta de olika moment som ingår i en beställarprocess: behovsanalys, utvärdering, prioritering, styrning och uppföljning.

    De områden som landstingen valt att studera och som formar olika program är oftast stora och inbegriper ett flertal sjukdomar. Några som återkommer hos flera landsting är stroke, diabetes, demens och psykisk ohälsa. Vilka kriterier som satts upp för valet av områden kan dock skilja sig åt. Några exempel är: misstanke om underförsörjda vårdbehov, sjukdomen/ohälsoområdet representerar ett stort hälsoproblem i befolkningen eller tillhör prioriteringsgrupp ett och två enligt prioriteringsutredningen.

    Organisationen av programarbetet skiljer sig åt mellan landstingen, men också mellan olika programområden inom landstingen. De flesta har dock någon form av fast struktur med en ledningsgrupp som leder och styr arbetet och har högsta ansvar för arbetets utveckling och form. I alla landsting förutom ett medverkar politiker, antingen i referensgrupper eller i förtroendemannagrupper. Expertgrupper med personal från vården (patientföreträdare) finns alltid med från sjukhusen men även personal från primärvården deltar, fast i något mindre omfattning. Kommuner, intresseorganisationer och patientföreningar har deltagit i varierande grad och personer med hälsoekonomisk kompetens förekommer i ett fåtal fall.

    Benämningen medicinskt programarbete valdes av Landstinget i Östergötland - som var först - och är den dominerande benämningen på programarbetet hos de landsting som ingår i denna studie. Vi kan dock notera att benämningen hälso- och sjukvårdsprogram vinner i popularitet. Även benämningen på de programområden som studeras skiljer sig åt, där benämningen sjukdomsgrupper eller behovsgrupper förekommer hos ett par av landstingen.

    Landstingen har dokumenterat sitt arbete i olika omfattning, några i form av tjocka systematiskt genomarbetade rapporter, andra i form av programblad på några sidor. Alla betonar att det är lika mycket själva processen och de möten den innebär som är viktig, som produkten av den (oftast en rapport).

    Landstingen lyfter fram flera positiva effekter av programarbetet, t.ex. så betonas just förbättrade möjligheter till möten mellan förtroendevalda, sjukvårdspersonal, tjänstemän, kommunen, patienter och medborgare. Att mötas för att diskutera frågor kopplade till sjukdomsgrupper handlar om ett möte på en ny domän där både politiker och verksamhetsföreträdare är nya, men ändå kan lämna värdefulla bidrag. Man får här en arena för möten mellan olika parter för att diskutera och därmed bättre förstå varandras roller och ansvarsområden. För politikerna är fokusgrupper och förtroendemannagrupper viktiga, särskilt för fritidspolitiker som annars kan ha svårt att vara med i diskussionen på samma sätt som heltidspolitiker. För politiker är det ett förtydligande av rollen som förtroendevalda befolkningsföreträdare.

    Programarbete har utvecklats positivt men det har också framkommit att det finns en del problem längs vägen som behöver bearbetas för att arbetet ska bli framgångsrikt i långa loppet. Att starta upp och etablera programarbete är tids- och resurskrävande och kan till en början möta skepsis från olika håll. Bland sjukvårdspersonal har det ibland funnits en ovilja att delta i arbetet och att avsätta tillräckligt med tid, byggt på att man upplever sig ha tidsbrist eller på att man inte ser värdet med det nya arbetssättet. Något som också lyfts fram är problemet med att få kommunerna att delta i arbetet. Intresset från kommunerna kan vara lågt, eller så är det praktiskt svårt att åstadkomma en lämplig representativitet. Att få primärvården intresserad av att delta i arbetet påtalas också som en svårighet. Även här kan det vara problem med att få en adekvat representativitet eller t.ex. bero på att landstinget omfattar ett stort geografiskt område.

    I flera landsting är nu programarbetena på väg att bli en naturlig del av styrprocessen och information från programmen bakas in i, och ligger till grund för, avtal och överenskommelser med olika vårdproducenter. Arbetet med öppna prioriteringar har startat på flera håll, i ett första steg med vertikala prioriteringar inom sjukdomsgrupper med framtagandet av olika rangordningslistor, men även i ett andra steg med horisontella prioriteringar mellan olika sjukdomsgrupper.

  • 227.
    Ketilsdottir, Audur
    et al.
    Landspitali Univ Hosp, Iceland; Univ Iceland, Iceland.
    Ingadottir, Brynja
    Univ Iceland, Iceland; Landspitali Univ Hosp, Iceland.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Self-reported health and quality of life outcomes of heart failure patients in the aftermath of a national economic crisis: a cross-sectional study2019In: ESC Heart Failure, E-ISSN 2055-5822, Vol. 6, no 1, p. 111-121Article in journal (Refereed)
    Abstract [en]

    Aims There are indications that economic crises can affect public health. The aim of this study was to describe characteristics, health status, and socio-economic status of outpatient heart failure (HF) patients several years after a national economic crisis and to assess whether socio-economic factors were associated with patient-reported outcome measures (PROMs). Methods and results In this cross-sectional survey, PROMs were measured with seven validated instruments, as follows: self-care (the 12-item European Heart Failure Self-Care Behaviour scale), HF-related knowledge (Dutch Heart Failure Knowledge Scale), symptoms (Edmonton Symptom Assessment System), sense of security (Sense of Security in Care-Patients evaluation), health status (EQ-5D visual analogue scale), health-related quality of life (HRQoL) (Kansas City Cardiomyopathy Questionnaire), and anxiety and depression (Hospital Anxiety and Depression Scale). Additional data were collected on access and use of health care, household income, demographics, and clinical status. The patients (n = 124, mean age 73 +/- 14.9, 69% male) self-care was low for exercising (53%) and weight monitoring (50%) but optimal for taking medication (100%). HF-specific knowledge was high (correct answers 12 out of 15), but only 38% knew what to do when symptoms worsened suddenly. Patients sense of security was high (amp;gt;70% had a mean score of 5 or 6, scale 1-6). The most common symptom was tiredness (82%); 12% reported symptoms of anxiety, and 18% had symptoms of depression. Patients rated their overall health (EQ-5D) on average at 65.5 (scale 0-100), and 33% had poor or very bad HRQoL. The monthly income per household was amp;lt;sic3900 for 84% of the patients. A total of 22% had difficulties making appointments with a general practitioner (GP), and 5% had no GP. On average, patients paid for six health care-related items, and amp;gt;90% paid for medications, primary care, and visits to hospital and private clinics out of their own pocket. The cost of health care had changed for 71% of the patients since the 2008 economic crisis, and increased out-of-pocket costs were most often explained by a greater need for health care services and medication expenses. There was no significant difference in PROMs related to changes in out-of-pocket expenses after the crisis, income, or whether patients lived alone or with others. Conclusions This Icelandic patient population reported similar health-related outcomes as have been previously reported in international studies. This study indicates that even after a financial crisis, most of the patients have managed to prioritize and protect their health even though a large proportion of patients have a low income, use many health care resources, and have insufficient access to care. It is imperative that access and affordable health care services are secured for this vulnerable patient population.

  • 228.
    Keurhorst, M.
    et al.
    Radboud University of Nijmegen, Netherlands; Saxion University of Appl Science, Netherlands.
    Anderson, P.
    Newcastle University, England; Maastricht University, Netherlands.
    Heinen, M.
    Radboud University of Nijmegen, Netherlands.
    Bendtsen, Preben
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Department of Medical Specialist in Motala.
    Baena, Begona
    Govt Catalonia, Spain.
    Brzozka, Krzysztof
    State Agency Prevent Alcohol Related Problems, Poland.
    Colom, Joan
    Govt Catalonia, Spain.
    Deluca, Paolo
    Kings Coll London, England.
    Drummond, Colin
    Kings Coll London, England.
    Kaner, Eileen
    Newcastle University, England.
    Kloda, Karolina
    Pomeranian Medical University, Poland.
    Mierzecki, Artur
    Pomeranian Medical University, Poland.
    Newbury-Birch, Dorothy
    University of Teesside, England.
    Okulicz-Kozaryn, Katarzyna
    State Agency Prevent Alcohol Related Problems, Poland.
    Palacio-Vieira, Jorge
    Govt Catalonia, Spain.
    Parkinson, Kathryn
    Newcastle University, England.
    Reynolds, Jillian
    Hospital Clin Barcelona, Spain.
    Ronda, Gaby
    Maastricht University, Netherlands.
    Segura, Lidia
    Govt Catalonia, Spain.
    Slodownik, Luiza
    State Agency Prevent Alcohol Related Problems, Poland.
    Spak, Fredrik
    University of Gothenburg, Sweden.
    van Steenkiste, Ben
    Maastricht University, Netherlands.
    Wallace, Paul
    UCL, England.
    Wolstenholme, Amy
    Kings Coll London, England.
    Wojnar, Marcin
    Medical University of Warsaw, Poland.
    Gual, Antoni
    Hospital Clin Barcelona, Spain.
    Laurant, M.
    Radboud University of Nijmegen, Netherlands; HAN University of Appl Science, Netherlands.
    Wensing, M.
    Radboud University of Nijmegen, Netherlands; University of Heidelberg Hospital, Germany.
    Impact of primary healthcare providers initial role security and therapeutic commitment on implementing brief interventions in managing risky alcohol consumption: a cluster randomised factorial trial2016In: Implementation Science, ISSN 1748-5908, E-ISSN 1748-5908, Vol. 11, no 96Article in journal (Refereed)
    Abstract [en]

    Background: Brief interventions in primary healthcare are cost-effective in reducing drinking problems but poorly implemented in routine practice. Although evidence about implementing brief interventions is growing, knowledge is limited with regard to impact of initial role security and therapeutic commitment on brief intervention implementation. Methods: In a cluster randomised factorial trial, 120 primary healthcare units (PHCUs) were randomised to eight groups: care as usual, training and support, financial reimbursement, and the opportunity to refer patients to an internet-based brief intervention (e-BI); paired combinations of these three strategies, and all three strategies combined. To explore the impact of initial role security and therapeutic commitment on implementing brief interventions, we performed multilevel linear regression analyses adapted to the factorial design. Results: Data from 746 providers from 120 PHCUs were included in the analyses. Baseline role security and therapeutic commitment were found not to influence implementation of brief interventions. Furthermore, there were no significant interactions between these characteristics and allocated implementation groups. Conclusions: The extent to which providers changed their brief intervention delivery following experience of different implementation strategies was not determined by their initial attitudes towards alcohol problems. In future research, more attention is needed to unravel the causal relation between practitioners attitudes, their actual behaviour and care improvement strategies to enhance implementation science.

  • 229.
    Keurhorst, M.
    et al.
    Radboud University of Nijmegen, Netherlands; Saxion University of Appl Science, Netherlands.
    Heinen, M.
    Radboud University of Nijmegen, Netherlands.
    Colom, J.
    Govt Catalonia, Spain.
    Linderoth, Catharina
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Müssener, Ulrika
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Okulicz-Kozaryn, K.
    State Agency Prevent Alcohol Related Problems, Poland.
    Palacio-Vieira, J.
    Govt Catalonia, Spain.
    Segura, L.
    Govt Catalonia, Spain.
    Silfversparre, F.
    University of Gothenburg, Sweden.
    Slodownik, L.
    State Agency Prevent Alcohol Related Problems, Poland.
    Sorribes, E.
    Govt Catalonia, Spain.
    Laurant, M.
    Radboud University of Nijmegen, Netherlands; HAN University of Appl Science, Netherlands.
    Wensing, M.
    Radboud University of Nijmegen, Netherlands.
    Strategies in primary healthcare to implement early identification of risky alcohol consumption: why do they work or not? A qualitative evaluation of the ODHIN study2016In: BMC Family Practice, ISSN 1471-2296, E-ISSN 1471-2296, Vol. 17, no 70Article in journal (Refereed)
    Abstract [en]

    Background: Screening and brief interventions (SBI) in primary healthcare are cost-effective in risky drinkers, yet they are not offered to all eligible patients. This qualitative study aimed to provide more insight into the factors and mechanisms of why, how, for whom and under what circumstances implementation strategies work or do not work in increasing SBI. Methods: Semi-structured interviews were conducted between February and July 2014 with 40 GPs and 28 nurses in Catalonia, the Netherlands, Poland, and Sweden. Participants were purposefully selected from the European Optimising Delivery of Healthcare Interventions (ODHIN) trial. This randomised controlled trial evaluated the influence of training and support, financial reimbursement and an internet-based method of delivering advice on SBI. Amongst them were 38 providers with a high screening performance and 30 with a low screening performance from different allocation groups. Realist evaluation was combined with the Tailored Implementation for Chronic Diseases framework for identification of implementation determinants to guide the interviews and analysis. Transcripts were analysed thematically with the diagram affinity method. Results: Training and support motivated SBI by improved knowledge, skills and prioritisation. Continuous provision, sufficient time to learn intervention techniques and to tailor to individual experienced barriers, seemed important Tamp;S conditions. Catalan and Polish professionals perceived financial reimbursement to be an additional stimulating factor as well, as effects on SBI were smoothened by personnel levels and salary levels. Structural payment for preventive services rather than a temporary project based payment, might have increased the effects of financial reimbursement. Implementing e-BI seem to require more guidance than was delivered in ODHIN. Despite the allocation, important preconditions for SBI routine seemed frequent exposure of this topic in media and guidelines, SBI facilitating information systems, and having SBI in protocol-led care. Hence, the second order analysis revealed that the applied implementation strategies have high potential on the micro professional level and meso-organisational level, however due to influences from the macro-level such as societal and political culture the effects risks to get nullified. Conclusions: Essential determinants perceived for the implementation of SBI routines were identified, in particular for training and support and financial reimbursement. However, focusing only on the primary healthcare setting seems insufficient and a more integrated SBI culture, together with meso- and macro-focused implementation process is requested.

  • 230.
    Kien, Christina
    et al.
    Department for Evidence-based Medicine and Clinical Epidemiology, Danube University, Krems, Austria.
    Reichenpfader, Ursula
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Department for Evidence-based Medicine and Clinical Epidemiology, Danube University, Krems, Austria.
    Nußbaumer, Barbara
    Department for Evidence-based Medicine and Clinical Epidemiology, Danube University, Krems, Austria.
    Rohleder, Sonja
    Department for Evidence-based Medicine and Clinical Epidemiology, Danube University, Krems, Austria.
    Punz, Petra
    Department for Evidence-based Medicine and Clinical Epidemiology, Danube University, Krems, Austria.
    Christof, Claudia
    Department for Evidence-based Medicine and Clinical Epidemiology, Danube University, Krems, Austria.
    Gartlehner, Gerald
    Department for Evidence-based Medicine and Clinical Epidemiology, Danube University, Krems, Austria.
    [Comparative effectiveness and safety of screening and counselling interventions conducted by non-physicians and physicians: A systematic review].2015In: Zeitschrift für Evidenz, Fortbildung und Qualität im Gesundheitswesen, ISSN 2212-0289, Vol. 109, no 1, p. 18-27Article in journal (Refereed)
    Abstract [de]

    BACKGROUND: Current forecasts project a future shortage of physicians which might compromise the quality of health care if not addressed adequately by health policy decisions. One proposed measure is to shift selected tasks and responsibilities from physicians to other medical staff, a strategy that has proven successful in some areas (e. g., chronic disease management). To date, no studies have systematically and objectively assessed whether the application of a similar strategy to screening and counselling in preventive medicine compromises patients' health outcomes and experiences.

    METHODS: A systematic search was conducted in MEDLINE, the Cochrane Library, CINAHL, and EMBASE (January 2000 - June 2014). We dually reviewed articles and assessed the risk of bias.

    RESULTS: 3,315 citations were identified and five relevant articles located. Overall, the available evidence indicated that there were no substantial differences in benefits and harms of screening (colon cancer screening, sexual transmitted diseases, and mammography) and counselling (genetic breast cancer risk) between non-physicians and physicians. The quality of evidence, however, is very low for most comparisons. Reported statistically significant differences for some outcomes need to be viewed cautiously.

    CONCLUSION: Shifting tasks from physicians to other medical staff for screening and counselling could be a viable strategy to address the shortage of practicing physicians. Adequate training by a physician, however, is a prerequisite for the safe and beneficial screening and counselling conducted by non-physicians.

  • 231.
    Kip, Michelle M. A.
    et al.
    Univ Twente, Netherlands.
    IJzerman, Maarten J.
    Univ Twente, Netherlands.
    Henriksson, Martin
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Center for Medical Image Science and Visualization (CMIV).
    Merlin, Tracy
    Univ Adelaide, Australia.
    Weinstein, Milton C.
    Harvard TH Chan Sch Publ Hlth, MA USA.
    Phelps, Charles E.
    Univ Rochester, NY USA.
    Kusters, Ron
    Univ Twente, Netherlands; Jeroen Bosch Ziekenhuis, Netherlands.
    Koffijberg, Hendrik
    Univ Twente, Netherlands.
    Toward Alignment in the Reporting of Economic Evaluations of Diagnostic Tests and Biomarkers: The AGREEDT Checklist2018In: Medical decision making, ISSN 0272-989X, E-ISSN 1552-681X, Vol. 38, no 7, p. 778-788Article in journal (Refereed)
    Abstract [en]

    Objectives. General frameworks for conducting and reporting health economic evaluations are available but not specific enough to cover the intricacies of the evaluation of diagnostic tests and biomarkers. Such evaluations are typically complex and model-based because tests primarily affect health outcomes indirectly and real-world data on health outcomes are often lacking. Moreover, not all aspects relevant to the evaluation of a diagnostic test may be known and explicitly considered for inclusion in the evaluation, leading to a loss of transparency and replicability. To address this challenge, this study aims to develop a comprehensive reporting checklist. Methods. This study consisted of 3 main steps: 1) the development of an initial checklist based on a scoping review, 2) review and critical appraisal of the initial checklist by 4 independent experts, and 3) development of a final checklist. Each item from the checklist is illustrated using an example from previous research. Results. The scoping review followed by critical review by the 4 experts resulted in a checklist containing 44 items, which ideally should be considered for inclusion in a model-based health economic evaluation. The extent to which these items were included or discussed in the studies identified in the scoping review varied substantially, with 14 items not being mentioned in 47 (75%) of the included studies. Conclusions. The reporting checklist developed in this study may contribute to improved transparency and completeness of model-based health economic evaluations of diagnostic tests and biomarkers. Use of this checklist is therefore encouraged to enhance the interpretation, comparability, andindirectlythe validity of the results of such evaluations.

  • 232.
    Kirk, Jeanette Wassar
    et al.
    Copenhagen Univ Hosp Hvidovre, Denmark.
    Bodilsen, Ann Christine
    Roskilde Municipal, Denmark.
    Sivertsen, Ditte Marie
    Copenhagen Univ Hosp Hvidovre, Denmark.
    Husted, Rasmus Skov
    Copenhagen Univ Hosp Hvidovre, Denmark; Clin Res Ctr, Denmark.
    Nilsen, Per
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Tjornhoj-Thomsen, Tine
    Univ Southern Denmark, Denmark.
    Disentangling the complexity of mobility of older medical patients in routine practice: An ethnographic study in Denmark2019In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 14, no 4, article id e0214271Article in journal (Refereed)
    Abstract [en]

    Aim Many older medical patients experience persistent functional limitations after hospitalization, such as dependency in activities of daily living, recurring fall incidents and increased mortality. Therefore, increased activity and mobilization during hospitalization are essential to prevent functional decline in older medical patients. No previous studies have explored how the social context influences how health professionals decide whether or not to mobilize patients. This qualitative study aimed to explore how social contextual circumstances affect the mobility of older medical patients in medical departments. Methods An ethnographic field study was conducted in six medical departments in three public hospitals in the capital region of Copenhagen, Denmark. Participant observations were carried out from January to June 2017. The researchers were present for up to 14 days (range, 8-14 days) in the six departments. A total of 210 pages of field notes were produced. The participants were health professionals involved in the care of older medical patients: physiotherapists, registered nurses, nursing assistants and physicians. A content analysis was conducted. Findings Five themes concerning mobility of patients emerged: (1) materialities; (2) professional roles; (3) encouraging moments; (4) patients and relatives; and (5) organization and management. Of these, professional roles seem to be the most important because it pervaded all themes. Different health professionals in the medical departments recognized, spoke and acted based on different cultural models. Conclusion It was found that mobility of older medical patients is entangled in a complex network of social contextual circumstances. Mobility of older medical patients is based on health professionals different cultural models, which shape distinct professional identities and lead to contradictions and blurring of the priorities and responsibilities among the health professionals involved in mobilization. The consequence is that no profession "owns" the responsibility for mobilization, thus restricting mobilization of the patients during hospitalization.

  • 233.
    Kleiboer, A
    et al.
    Section Clinical Psychology, Vrije Universiteit Amsterdam and EMGO+ Institute for Health Care and Research, Amsterdam, The Netherlands.
    Smit, J
    Department of Psychiatry, VU University Medical Centre and EMGO+ Institute for Health Care and Research, Amsterdam, The Netherlands.
    Bosmans, J
    Department of Health Sciences, Vrije Universiteit Amsterdam and EMGO+ Institute for Health and Care Research, Amsterdam, The Netherlands.
    Ruwaard, J
    Section Clinical Psychology, Vrije Universiteit Amsterdam and EMGO+ Institute for Health Care and Research, Amsterdam, The Netherlands.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Department of Clinical Neuroscience, Psychiatry Section, Karolinska Institutet.
    Topooco, Naira
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Linköping University, The Swedish Institute for Disability Research.
    Berger, T
    Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland.
    Krieger, T
    Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland.
    Botella, C
    Department of Psychology and Technology, Jaume University, Castellon, Spain.; Department of Personalidad, Evaluación y Tratamiento Psicológicos, Valencia, Spain.
    Baños, R
    Department of Personalidad, Evaluación y Tratamiento Psicológicos, Valencia, Spain.
    Chevreul, K
    URC-ECO, Ile-de-France (AP-HP), Paris, France.
    Araya, R
    Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK.
    Cerga-Pashoja, A
    Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK.
    Cieślak, R
    Department of Psychology, Szkoła Wyzsza Psychologii Społeczne, University of Social Sciences and Humanities, Warsaw, Poland.
    Rogala, A
    Department of Psychology, Szkoła Wyzsza Psychologii Społeczne, University of Social Sciences and Humanities, Warsaw, Poland.
    Vis, C
    Section Clinical Psychology, Vrije Universiteit Amsterdam and EMGO+ Institute for Health Care and Research, Van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands.
    Draisma, S
    Department of Psychiatry, VU University Medical Centre and EMGO+ Institute for Health Care and Research, Amsterdam, The Netherlands.
    van Schaik, A
    Department of Psychiatry, VU University Medical Centre and EMGO+ Institute for Health Care and Research, Amsterdam, The Netherlands.
    Kemmeren, L
    Department of Psychiatry, VU University Medical Centre and EMGO+ Institute for Health Care and Research, Amsterdam, The Netherlands.
    Ebert, D
    Department of Clinical Psychology, Philipps University, Marburg, Germany.
    Berking, M
    Department of Clinical Psychology, Philipps University, Marburg, Germany.
    Funk, B
    Institut für elektronische Geschäftsprozesse, Leuphana University Lüneburg, Lüneburg, Germany.
    Cuijpers, P
    Section Clinical Psychology, Vrije Universiteit Amsterdam and EMGO+ Institute for Health Care and Research, Van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands.
    Riper, H
    Section Clinical Psychology, Vrije Universiteit Amsterdam and EMGO+ Institute for Health Care and Research, Van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands.; Department of Psychiatry, VU University Medical Centre and EMGO+ Institute for Health Care and Research, Amsterdam, The Netherlands.
    European COMPARative Effectiveness research on blended Depression treatment versus treatment-as-usual (E-COMPARED): study protocol for a randomized controlled, non-inferiority trial in eight European countries2016In: Trials, ISSN 1745-6215, E-ISSN 1745-6215, Vol. 17, no 1Article in journal (Refereed)
    Abstract [en]

    Background: Effective, accessible, and affordable depression treatment is of high importance considering the large personal and economic burden of depression. Internet-based treatment is considered a promising clinical and cost-effective alternative to current routine depression treatment strategies such as face-to-face psychotherapy. However, it is not clear whether research findings translate to routine clinical practice such as primary or specialized mental health care. The E-COMPARED project aims to gain knowledge on the clinical and cost-effectiveness of blended depression treatment compared to treatment-as-usual in routine care.

    Methods/design: E-COMPARED will employ a pragmatic, multinational, randomized controlled, non-inferiority trial in eight European countries. Adults diagnosed with major depressive disorder (MDD) will be recruited in primary care (Germany, Poland, Spain, Sweden, and the United Kingdom) or specialized mental health care (France, The Netherlands, and Switzerland). Regular care for depression is compared to "blended" service delivery combining mobile and Internet technologies with face-to-face treatment in one treatment protocol. Participants will be followed up at 3, 6, and 12 months after baseline to determine clinical improvements in symptoms of depression (primary outcome: Patient Health Questionnaire-9), remission of depression, and cost-effectiveness. Main analyses will be conducted on the pooled data from the eight countries (n = 1200 in total, 150 participants in each country).

    Discussion: The E-COMPARED project will provide mental health care stakeholders with evidence-based information and recommendations on the clinical and cost-effectiveness of blended depression treatment.

    Trial Registration: France: ClinicalTrials.gov NCT02542891 . Registered on 4 September 2015; Germany: German Clinical Trials Register DRKS00006866 . Registered on 2 December 2014; The Netherlands: Netherlands Trials Register NTR4962 . Registered on 5 January 2015; Poland: ClinicalTrials.Gov NCT02389660 . Registered on 18 February 2015; Spain: ClinicalTrials.gov NCT02361684 . Registered on 8 January 2015; Sweden: ClinicalTrials.gov NCT02449447 . Registered on 30 March 2015; Switzerland: ClinicalTrials.gov NCT02410616 . Registered on 2 April 2015; United Kingdom: ISRCTN registry, ISRCTN12388725 . Registered on 20 March 2015.

  • 234.
    Klompstra, Leonie
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Medicine and Health Sciences.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Medicine and Health Sciences.
    Strömberg, Anna
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Physical activity in patients with heart failure: barriers and motivations with special focus on sex differences2015In: Patient Preference and Adherence, ISSN 1177-889X, E-ISSN 1177-889X, Vol. 9, p. 1603-1610Article in journal (Refereed)
    Abstract [en]

    Background: Adherence to recommendations for physical activity is low in both male and female patients with heart failure (HF). Men are more physically active than women. In order to successfully promote physical activity, it is therefore essential to explore how much and why HF patients are physically active and if this is related to sex. The aim of this study was therefore to evaluate physical activity in HF patients, to describe the factors related to physical activity, and to examine potential barriers and motivations to physical activity with special focus on sex differences. Methods: The study had a cross-sectional survey design. HF patients living at home received a questionnaire during May-July 2014, with questions on physical activity (from the Short Form-International Physical Activity Questionnaire), and potential barriers and motivations to physical activity. Results: A total of 154 HF patients, 27% women, with a mean age of 70 +/- 10 were included. In total, 23% of the patients reported a high level of physical activity, 46% a moderate level, and 34% a low level. Higher education, self-efficacy, and motivation were significantly associated with a higher amount of physical activity. Symptoms or severity of the disease were not related to physical activity. All the potential barriers to exercise were reported to be of importance. Psychological motivations were most frequently rated as being the most important motivation (41%) to be physically active. Physical motivations (33%) and social motivations were rated as the least important ones (22%). Women had significantly higher total motivation to be physically active. These differences were found in social, physical, and psychological motivations. Discussion: One-third of the HF patients had a low level of physical activity in their daily life. Severity of the disease or symptoms were not related, whereas level of education, exercise self-efficacy, and motivation were important factors to take into account when advising a HF patient about physical activity. Women reported higher motivation to be physically active than men, but there was no difference in the reported level of physical activity.

  • 235.
    Kollberg, Beata
    Linköping University, Department of Management and Engineering. Linköping University, The Institute of Technology.
    Performance Measurement Systems in Swedish Health Care Services2007Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    In the quality management literature, measurements are attributed great importance in improving products and processes. Systems for performance measurement assessing financial and non-financial measurements were developed in the late 1980s and early 1990s. The research on performance measurement systems has mainly been focused on the design of different performance measurement systems. Many authors are occupied with the study of the constructs of measures and developing prescriptive models of performance measurement systems. There is a need in the research to shift focus from studying the construct of measurements to how they are used in real face-to-face situations in specific contexts.

    The purpose of this thesis is to analyse the development, i.e. the design, implementation and use, of performance measurement systems in Swedish health care services. The study aims to increase the understanding of the role of performance measurement system in Swedish health care and thereby support health care improvements in general. Three research questions have been derived from the purpose. (1) How and why are performance measurement systems being developed in Swedish health care services? (2) What problems can be identified in the development? (3) What enabling factors can be identified in the development? A qualitative research strategy was selected for the research. The research is based on a multiple case study design conducted within two research projects. Information has been gathered through interviews, documents and observations.

    The idea of performance measurement systems develops through several tracks when implemented in health care and the development follows a purposeful process of activities. The development was initiated when major changes occurred in the organisation or its environment. Performance measurement systems are primarily used to support a dialogue between management and employees regarding organisational improvement. Problems experienced are related to struggles to reach national consensus for measures, involving management, and the clarification of various end-users’ needs. Enabling factors are the frequent interaction with people developing the system, management’s involvement, the use of multi-skilled teams, and visual displays.

    The research contributes to several insights to the research area of performance measurement system and health care practitioners. The research shows that the development process is far from straight forward and is formed by the influence of factors in the organisational context, which cannot always be predicted. By seeing the development as an innovation process, the focus is broadened from being technological towards the organisation as whole, which contribute to the existing research on performance measurement systems.

    List of papers
    1. Exploring the Use of Balanced Scorecards in Swedish Health Care Organizations
    Open this publication in new window or tab >>Exploring the Use of Balanced Scorecards in Swedish Health Care Organizations
    2004 (English)In: 7th International QMOD Conference, Monterrey, Mexico, 2004Conference paper, Published paper (Refereed)
    Abstract [en]

    Many Swedish health care organizations have during the last decade started implementing the Balanced Scorecard BSC as a systematic way of following-up and analyzing their activities. However, the knowledge of its use and contribution in a health care context is insufficient. Based on a multiple case study the authors explore the use of the BSC in the Swedish health care services. The authors conclude that the concept in a health care context is used as a quality management tool that make new demands on management. In addition, the authors bring out important factors for a long-term use of the BSC.

    Keywords
    performance measurements, balanced scorecard, visualization, case study
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-14566 (URN)
    Available from: 2007-06-18 Created: 2007-06-18
    2. Design and Implementation of a Performance Measurement System in Swedish Health Care Services: A Multiple Cases Study of 6 Development Teams
    Open this publication in new window or tab >>Design and Implementation of a Performance Measurement System in Swedish Health Care Services: A Multiple Cases Study of 6 Development Teams
    2005 (English)In: Quality Management in Health Care, ISSN 1063-8628, Vol. 14, no 2, p. 95-111Article in journal (Refereed) Published
    Abstract [en]

    Performance measurement is considered to be an important part in improving and controlling contemporary organizations. Despite the increased interest in using and improving performance measurement systems, the number of researchers investigating the design and implementation process in more detail is still very small. The purpose of this article is to increase the understanding of how a performance measurement system, called the flow model, is designed and implemented by development teams in Swedish health care. The purpose of the flow model is to follow up the requirements in the National Care Guarantee through 8 measures. From a multiple case study of 6 local development teams, we conclude that the performance measurement system of the flow model is designed and implemented in Swedish County Councils through 3 development tracks, which are reflected in close interaction between the local development team and people in clinical departments. Enabling factors in the design and implementation are (1) the recognition of a need to change the current situation, (2) the teams' interaction with people in the clinical departments. (3) the national network meetings arranged by the financier. (4) the struggle to motivate and inform the top management, and (5) the establishment of contact with other development teams and ongoing projects.

    Keywords
    hospitals, medical care, county councils, public health, design and implementation, innovation management, performance measurement, quality assessment, waiting time measurement
    National Category
    Engineering and Technology
    Identifiers
    urn:nbn:se:liu:diva-14567 (URN)
    Available from: 2007-06-18 Created: 2007-06-18 Last updated: 2009-05-22
    3. Measuring Lean Initiatives in Health Care Services: Issues and Findings
    Open this publication in new window or tab >>Measuring Lean Initiatives in Health Care Services: Issues and Findings
    2007 (English)In: International Journal of Productivity and Performance Management, ISSN 1741-0401, E-ISSN 1758-6658, Vol. 56, no 1, p. 7-24Article in journal (Refereed) Published
    Abstract [en]

    Purpose: To discuss how a performance measurement system called 'the flow model' is designed to measure changes towards lean thinking in health care services.

    Design/methodology/approach: Integrates literature from the health care sector and the lean production movement in order to understand whether lean thinking is applicable in healthcare and thereby identify key performance indicators that measure changes towards lean thinking in health care. The flow model is discussed in relation to this measurement framework.

    Findings: Finds that lean thinking is applicable in health care settings, and that the flow model is a suitable tool for following up these initiatives. However, it is argued that the flow model needs to be balanced with other measurements in order to receive a complete picture of lean performance.

    Research limitations/implications: Shows that the framework of measurements may be used in empirical research of assessing changes towards lean thinking in health care settings.

    Practical implications: Shows that health care practitioners may use the findings to develop measurements of the outcome of lean initiatives on existing care processes.

    Originality/value: Shows analysis and discussion of the application of an industrial concept - Lean Production - in health care services.

    Keywords
    Health services, Lean production, Sweden
    National Category
    Health Care Service and Management, Health Policy and Services and Health Economy
    Identifiers
    urn:nbn:se:liu:diva-14568 (URN)10.1108/17410400710717064 (DOI)
    Available from: 2007-06-18 Created: 2007-06-18 Last updated: 2017-12-13
    4. Goal Orientation and Conflicts: Motors of Change in Development Projects in Health Care Service
    Open this publication in new window or tab >>Goal Orientation and Conflicts: Motors of Change in Development Projects in Health Care Service
    2007 (English)In: Quality Management in Health Care, ISSN 1063-8628, Vol. 16, no 1, p. 84-97Article in journal (Refereed) Published
    Abstract [en]

    The article presents parts of a larger research study which aims to explain how a process-oriented innovation unfolds and develops over time in the health care system in Sweden. It is said that local development teams have a rather broad notion of what it takes to implement the flow model. The theory used to explain the developmental patterns which have been identified in the national and local projects was presented.

    Keywords
    Case Study, change processes, innovation, Health care management, information technology, waiting time information
    National Category
    Medical and Health Sciences Engineering and Technology
    Identifiers
    urn:nbn:se:liu:diva-14569 (URN)
    Available from: 2007-06-18 Created: 2007-06-18 Last updated: 2009-04-26
    5. Challenges Experienced in the Development of Performance Measurement Systems in Swedish Health Care
    Open this publication in new window or tab >>Challenges Experienced in the Development of Performance Measurement Systems in Swedish Health Care
    2006 (English)In: Quality Management in Health Care, ISSN 1063-8628, Vol. 15, no 4, p. 244-256Article in journal (Refereed) Published
    Abstract [en]

    The article discusses a study on the challenges faced by the Swedish health care industry in the development of performance measurement systems. The importance of performance measurement to the management of contemporary health care is explained. The need for the upper management to establish a quality council is also elaborated.

    Keywords
    health care industry, performance, medical care, caring, challenges, health care services, performance measurement system
    National Category
    Engineering and Technology
    Identifiers
    urn:nbn:se:liu:diva-14570 (URN)
    Available from: 2007-06-18 Created: 2007-06-18 Last updated: 2009-03-04
  • 236.
    Kollberg, Beata
    et al.
    Linköping University, Department of Management and Engineering. Linköping University, The Institute of Technology.
    Dahlgaard, Jens Jörn
    Linköping University, Department of Management and Engineering, Quality Technology and Management . Linköping University, The Institute of Technology.
    Brehmer, Per-Olof
    Linköping University, Department of Management and Engineering, Logistics . Linköping University, The Institute of Technology.
    Measuring Lean Initiatives in Health Care Services: Issues and Findings2007In: International Journal of Productivity and Performance Management, ISSN 1741-0401, E-ISSN 1758-6658, Vol. 56, no 1, p. 7-24Article in journal (Refereed)
    Abstract [en]

    Purpose: To discuss how a performance measurement system called 'the flow model' is designed to measure changes towards lean thinking in health care services.

    Design/methodology/approach: Integrates literature from the health care sector and the lean production movement in order to understand whether lean thinking is applicable in healthcare and thereby identify key performance indicators that measure changes towards lean thinking in health care. The flow model is discussed in relation to this measurement framework.

    Findings: Finds that lean thinking is applicable in health care settings, and that the flow model is a suitable tool for following up these initiatives. However, it is argued that the flow model needs to be balanced with other measurements in order to receive a complete picture of lean performance.

    Research limitations/implications: Shows that the framework of measurements may be used in empirical research of assessing changes towards lean thinking in health care settings.

    Practical implications: Shows that health care practitioners may use the findings to develop measurements of the outcome of lean initiatives on existing care processes.

    Originality/value: Shows analysis and discussion of the application of an industrial concept - Lean Production - in health care services.

  • 237.
    Kononowicz, Andrzej A.
    et al.
    Jagiellonian Univ, Poland.
    Woodham, Luke A.
    St Georges Univ London, England; Karolinska Inst, Sweden.
    Edelbring, Samuel
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Karolinska Inst, Sweden; Orebro Univ, Sweden.
    Stathakarou, Natalia
    Karolinska Inst, Sweden.
    Davies, David
    Univ Warwick, England.
    Saxena, Nakul
    Natl Healthcare Grp, Singapore.
    Car, Lorainne Tudor
    Nanyang Technol Univ, Singapore; Imperial Coll London, England.
    Carlstedt-Duke, Jan
    Nanyang Technol Univ, Singapore.
    Car, Josip
    Nanyang Technol Univ, Singapore; Imperial Coll London, England.
    Zary, Nabil
    Nanyang Technol Univ, Singapore; Mohammed Bin Rashid Univ Med and Hlth Sci, U Arab Emirates.
    Virtual Patient Simulations in Health Professions Education: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration2019In: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871, Vol. 21, no 7, article id e14676Article, review/survey (Refereed)
    Abstract [en]

    Background: Virtual patients are interactive digital simulations of clinical scenarios for the purpose of health professions education. There is no current collated evidence on the effectiveness of this form of education. Objective: The goal of this study was to evaluate the effectiveness of virtual patients compared with traditional education, blended with traditional education, compared with other types of digital education, and design variants of virtual patients in health professions education. The outcomes of interest were knowledge, skills, attitudes, and satisfaction. Methods: We performed a systematic review on the effectiveness of virtual patient simulations in pre- and postregistration health professions education following Cochrane methodology. We searched 7 databases from the year 1990 up to September 2018. No language restrictions were applied. We included randomized controlled trials and cluster randomized trials. We independently selected studies, extracted data, and assessed risk of bias and then compared the information in pairs. We contacted study authors for additional information if necessary. All pooled analyses were based on random-effects models. Results: A total of 51 trials involving 4696 participants met our inclusion criteria. Furthermore, 25 studies compared virtual patients with traditional education, 11 studies investigated virtual patients as blended learning, 5 studies compared virtual patients with different forms of digital education, and 10 studies compared different design variants. The pooled analysis of studies comparing the effect of virtual patients to traditional education showed similar results for knowledge (standardized mean difference [SMD]=0.11, 95% CI -0.17 to 0.39, I-2=74%, n=927) and favored virtual patients for skills (SMD=0.90, 95% CI 0.49 to 1.32, I-2=88%, n=897). Studies measuring attitudes and satisfaction predominantly used surveys with item-by-item comparison. Trials comparing virtual patients with different forms of digital education and design variants were not numerous enough to give clear recommendations. Several methodological limitations in the included studies and heterogeneity contributed to a generally low quality of evidence. Conclusions: Low to modest and mixed evidence suggests that when compared with traditional education, virtual patients can more effectively improve skills, and at least as effectively improve knowledge. The skills that improved were clinical reasoning, procedural skills, and a mix of procedural and team skills. We found evidence of effectiveness in both high-income and low-and middle-income countries, demonstrating the global applicability of virtual patients. Further research should explore the utility of different design variants of virtual patients.

  • 238.
    Kotecha, Dipak
    et al.
    Univ Birmingham, England; Univ Hosp Birmingham NHS Trust, England; Sandwell and West Birmingham Hosp NHS Trust, England.
    Chua, Winnie W. L.
    Univ Birmingham, England.
    Fabritz, Larissa
    Univ Birmingham, England; Univ Hosp Birmingham NHS Trust, England; Sandwell and West Birmingham Hosp NHS Trust, England; Univ Hosp Muenster, Germany.
    Hendriks, Jeroen
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Univ Adelaide, Australia.
    Casadei, Barbara
    Univ Oxford, England.
    Schotten, Ulrich
    Maastricht Univ, Netherlands; Maastricht Ctr Syst Biol, Netherlands.
    Vardas, Panos
    Univ Hosp Heraklion, Greece.
    Heidbuchel, Hein
    Antwerp Univ Hosp, Belgium.
    Dean, Veronica
    European Soc Cardiol, France.
    Kirchhof, Paulus
    Univ Birmingham, England; Univ Hosp Birmingham NHS Trust, England; Sandwell and West Birmingham Hosp NHS Trust, England; Univ Hosp Muenster, Germany.
    European Society of Cardiology smartphone and tablet applications for patients with atrial fibrillation and their health care providers2018In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 20, no 2, p. 225-233Article, review/survey (Refereed)
    Abstract [en]

    We are in the midst of a digital revolution in health care, although the application of new and useful technology in routine clinical practice is variable. The Characterizing Atrial fibrillation by Translating its Causes into Health Modifiers in the Elderly (CATCH ME) Consortium, in collaboration with the European Society of Cardiology (ESC), has funded the creation of two applications (apps) in atrial fibrillation (AF) for use in smartphones and tablets. The patient app aims to enhance patient education, improve communication between patients and health care professionals, and encourage active patient involvement in the management of their condition. The health care professional app is designed as an interactive management tool incorporating the new ESC Practice Guidelines on AF and supported by the European Heart Rhythm Association (EHRA), with the aim of improving best practice approaches for the care of patients with AF. Both stand-alone apps are now freely available for Android and iOS devices though the Google Play, Amazon, and Apple stores. In this article, we outline the rationale for the design and implementation of these apps. Our objective is to demonstrate the value of integrating novel digital technology into clinical practice, with the potential for patient engagement, optimization of pharmacological and interventional therapy in AF, and ultimately to improve patient outcomes.

  • 239.
    Kraai, I. H.
    et al.
    Univ Gröningen, Netherlands.
    Vermeulen, K. M.
    Univ Gröningen, Netherlands.
    Hillege, H. L.
    Univ Groningen, Netherlands.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Australian Catholic Univ, Australia.
    "Not getting worse": a qualitative study of patients perceptions of treatment goals in patients with heart failure2018In: Applied Nursing Research, ISSN 0897-1897, E-ISSN 1532-8201, Vol. 39, p. 41-45Article in journal (Refereed)
    Abstract [en]

    Background Knowledge of patient reported outcomes helps to provide personalized care on a patient level, optimize care on a population level, and identify the most appropriate patient reported outcomes for clinical trials. To be able to provide personalized care to patients with HF, it is important to know which treatment goals patients with HF consider the most important. This is particularly useful for interventions aimed at improving symptoms, functional status, or health-related quality of life. Aim: The aim of this study was (1) to explore which treatment goals patients with heart failure (HF) perceive as important for their treatment and (2) to identify which treatment goals take priority over other treatment goals. Methods: The study had a qualitative design and included one focus group interview with 6 patients with HF. Data were analyzed using qualitative content analysis. Results: The overall theme of this study was found to be Not getting worse. This theme was composed of 4 categories that described how the patients perceived the goals of treatment: to decrease symptoms, to improve physical function, to prevent readmission, and to live a normal life. None of the participants mentioned improved survival or being cured of their HF as a treatment goal. Conclusion Not getting worse was perceived as the treatment goal that matters to patients with HF and is in line with currently used endpoints for the evaluation of a treatment in a clinical trial. More research is necessary to develop endpoints that are consistent with the perception of patients, useful for clinical practice, and measurable.

  • 240.
    Krevers, Barbro
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Patienter, hälso- och sjukvårdens främsta angelägenhet: Från objekt till aktör2016In: Perspektiv på utvärdering, prioritering, implementering och hälsoekonomi: En hyllningsskrift till Per Carlsson / [ed] Martin Henriksson, Linköping: Linköping University Electronic Press, 2016, p. 55-61Chapter in book (Other academic)
  • 241.
    Krevers, Barbro
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Broqvist, Mari
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Bäckman, Karin
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Frågor till medborgare om öppenhet, prioriteringsprocess och beslutsfattare avseende prioritering och ransonering: En artikelöversikt2015Report (Other academic)
    Abstract [sv]

    Vårt syfte med denna rapport är att öka kunskapen om vad medborgare tillfrågats om i forskningsstudier avseende prioritering och ransonering inom hälso- och sjukvård. Avsikten är också att belysa studiernas syfte och tillvägagångssätt för att genom det få information om i vilken grad det finns tillförlitlig, överförbar och generaliserbar kunskap om vad medborgare tänker, anser och vill i dessa frågor. En sådan översikt kan visa på eventuella kunskapsluckor och därigenom belysa behov av framtida studier.

    Vi utgick från en metod för översiktsstudier och utvecklade sökord, granskningsstruktur och inklusions- och exklusionskriterier. I sökningen användes en kombination av sökord i tre databaser för internationella vetenskapliga tidskrifter. I granskning av artiklarna kategoriserades de utifrån vad medborgare hade blivit tillfrågad om, åtta frågeområden kunde identifieras.

    Denna rapport bygger på ett delresultat och omfattar artiklar inom tre frågeområden: öppenhet, prioriteringsprocesser och beslutsfattare. Av dem handlar fyra studier om öppenhet, tre om prioriteringsprocessen och nitton om beslutsfattare. De kommer från nio olika länder, varav de flesta från Europa, och är publicerade från 1993 till 2013. Studierna baseras på både kvalitativ och kvantitativa metoder av olika slag.

    Sammantaget gav vår artikelöversikt relativt få artiklar inom de tre frågeområden som ingår i rapporten och det finns även en del metodbrister i dessa studier t.ex. i urval och frågornas precisering. Det råder därmed osäkerhet om vad medborgare tänker, anser och vill när det gäller öppenhet, prioriteringsprocesser och beslutsfattare. Några exempel på kunskapsbrister som vår artikelöversikt pekar på är att kunskapen om svenska medborgares syn på dessa tre frågeområden är bristfällig och kunskap om hur medborgarnas åsikter förändras över tid saknas. Det råder även brist på kunskap om det finns skillnader mellan medborgare från olika länder inklusive Sverige, och deras syn på dessa tre frågeområden om prioritering och ransonering samt om deras syn skiljer sig åt i relation till välfärdssystem, demokratiska system, auktoritetskultur, grad av tillit, trygghet, etc.

    Andra kunskapsbrister gäller vilka faktorer som kan ha betydelse för medborgares syn när det gäller dessa tre frågeområden samt vad sådana faktorer i så fall skulle få för konsekvenser t.ex. för hur frågor ska ställas till medborgare, hur beslut beskrivs, hur beslutsprocesser ska gå till och öppenheten kring beslut.

    Det saknas även kunskap om involvering av medborgare verkligen leder till det som ofta framhålls som motiv för att involvera dem t.ex. bättre beslut, ökad legitimitet i beslut och större acceptans och tillit hos medborgare och/eller att de uppskattar detta som en demokratisk handling. Det saknas också kunskap om och problematisering av hur medborgares åsikter ska vägas mot andra gruppers synpunkter t.ex. i relation till politiker som är utsedda genom demokratiska val.

    Dessa kunskapsbrister kan vara utgångspunkter för framtida intressanta och viktiga studier där medborgare tillfrågas om hur de ser på öppenhet,prioriteringsprocesser och beslutsfattare. Det kan ge betydelsefull kunskap om vilken roll medborgare och andra aktörer kan och bör ha i relation till prioritering och ransonering, vilka aktiviteter som bör genomföras och vilka konsekvenser det kan ge.

  • 242.
    Krevers, Barbro
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Bäckman, Karin
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Development of systematic prioritizations between different welfare sectors - and get it running2016Conference paper (Other academic)
  • 243.
    Kärner Köhler, Anita
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Nilsson, Staffan
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Primary Care Center, Primary Health Care Center Vikbolandet.
    Jaarsma, Tiny
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Tingström, Pia
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Health beliefs about lifestyle habits differ between patients and spouses 1 year after a cardiac event – a qualitative analysis based on the Health Belief Model2017In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 31, no 2, p. 332-341Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Spousal concordance on risk factors and lifestyle habits exists and can partly be explained by patients' and spouses' health beliefs and underuse of cardiac rehabilitation. However, there have been very few qualitative comparisons of health beliefs between patients and spouses after a cardiac event.

    AIM:

    To examine and qualitatively compare the health beliefs of patients with coronary heart disease and their spouses about lifestyle habits, 1 year after the cardiac event.

    DESIGN:

    Explorative and descriptive.

    METHOD:

    Semi-structured focus group interviews were conducted with patients (n = 14) 1 year after a cardiac event, as well as individual interviews with spouses (n = 8). The transcriptions underwent a deductive qualitative content analysis, within the framework of the Health Belief Model.

    FINDINGS:

    Patients' and spouses' health beliefs about lifestyle habits qualitatively differed in most predetermined main analytical categories of the Health Belief Model. The patients relied more on their own capacity and the healthcare system than on collaboration with their spouses who instead emphasised the importance of mutual activities to establish lifestyle habits. The spouses therefore experienced problems with different family preferences compared to the patients' wishes. Moreover, only patients believed supervised exercise was beneficial for risk reduction of coronary heart disease and they related barriers for medication to a self-healing body and a meaningless life without relatives and old habits. Patients and spouses agreed that despite the severity of illness, life was captured and that normalisation to a life as usual was possible.

    CONCLUSION:

    The patients' and spouses' qualitatively different health beliefs regarding health-related behaviours imply a new approach. Nurses and associated professionals need to follow-up patients' and spouses' in primary health care to support them in a tailored way, for example in problem-based sessions. Recognition and understanding of their different views and otherness could lead to compromises and goals to work with.

  • 244.
    Lampi, Maria
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    TRIAGE: Management of the trauma patient2017Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Triage, derived from the French word for sorting, aims to assess and prioritize injured patients, regardless of whether the injuries are sustained from everyday road traffic accident with few injured or a mass casualty incident. Triage seeks to provide the greatest benefit to the largest number of casualties in order to minimize morbidity and mortality. Triage in a pre-hospital setting entails management and sorting of patients according to an assessment of medical need, prioritization, and evacuation. In-hospital triage aims to rapidly identify the most injured and ensure timely and appropriate treatment according to the patient’s clinical urgency. A number of different systems for performing triage have been established and implemented globally. The methodology is recognized and utilized but there is still a need for an evidence-based strategy to optimize training and the efficacy of the different systems.

    The main aim of this thesis was to determine triage performance among prehospital personnel and investigate the potential advantage of a triage system for trauma patients. The papers included in this thesis evaluated the triage skills of physicians, pre-hospital personnel, and rescue services personnel by testing their performance before and after an educational intervention. The last paper evaluated potential benefits of using a triage system for trauma patients admitted to the emergency department at MOI Teaching and Referral Hospital in Eldoret, Kenya.

    The results presented in this thesis illustrate that triage skills are lacking among physicians. Experienced pre-hospital personnel are more skilled in performing triage than physicians. The triage skills of the rescue services personnel improved significantly after the educational intervention. Moreover, the potential benefit to trauma patients of implementing an in-hospital triage system in a resource-poor environment was shown. In conclusion, health care personnel, especially physicians without experience but highly involved in trauma patient management, seem to be in need of triage training. How to train, how to implement, and how to evaluate triage skills must be considered in order to develop effective training.

    List of papers
    1. Triage performance of Swedish physicians using the ATLS algorithm in a simulated mass casualty incident: a prospective cross-sectional survey
    Open this publication in new window or tab >>Triage performance of Swedish physicians using the ATLS algorithm in a simulated mass casualty incident: a prospective cross-sectional survey
    2013 (English)In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, Vol. 21, no 90Article in journal (Refereed) Published
    Abstract [en]

    Background: In a mass casualty situation, medical personnel must rapidly assess and prioritize patients for treatment and transport. Triage is an important tool for medical management in disaster situations. Lack of common international and Swedish triage guidelines could lead to confusion. Attending the Advanced Trauma Life Support (ATLS) provider course is becoming compulsory in the northern part of Europe. The aim of the ATLS guidelines is provision of effective management of single critically injured patients, not mass casualties incidents. However, the use of the ABCDE algorithms from ATLS, has been proposed to be valuable, even in a disaster environment. The objective for this study was to determine whether the mnemonic ABCDE as instructed in the ATLS provider course, affects the ability of Swedish physician's to correctly triage patients in a simulated mass casualty incident.Methods: The study group included 169 ATLS provider students from 10 courses and course sites in Sweden; 153 students filled in an anonymous test just before the course and just after the course. The tests contained 3 questions based on overall priority. The assignment was to triage 15 hypothetical patients who had been involved in a bus crash. Triage was performed according to the ABCDE algorithm. In the triage, the ATLS students used a colour-coded algorithm with red for priority 1, yellow for priority 2, green for priority 3 and black for dead. The students were instructed to identify and prioritize 3 of the most critically injured patients, who should be the first to leave the scene. The same test was used before and after the course.Results: The triage section of the test was completed by 142 of the 169 participants both before and after the course. The results indicate that there was no significant difference in triage knowledge among Swedish physicians who attended the ATLS provider course. The results also showed that Swedish physicians have little experience of real mass casualty incidents and exercises.Conclusion: The mnemonic ABCDE doesn't significantly affect the ability of triage among Swedish physicians. Actions to increase Swedish physicians' knowledge of triage, within the ATLS context or separately, are warranted.

    Place, publisher, year, edition, pages
    BioMed Central, 2013
    Keywords
    ATLS; Triage; Disaster; Education; Physicians; Mass casualty incident; Exercises
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-103718 (URN)10.1186/1757-7241-21-90 (DOI)000329181100001 ()
    Available from: 2014-01-24 Created: 2014-01-24 Last updated: 2019-02-11Bibliographically approved
    2. Improved and sustained triage skills in firemen after a short training intervention
    Open this publication in new window or tab >>Improved and sustained triage skills in firemen after a short training intervention
    Show others...
    2015 (English)In: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 23, no 81, p. 1-6Article in journal (Refereed) Published
    Abstract [en]

    Background: A previous study has shown no measurable improvement in triage accuracy among physicians attending the Advanced Trauma Life Support (ATLS) course and suggests a curriculum revision regarding triage. Other studies have indicated that cooperative learning helps students acquire knowledge. Objective: The present study was designed to evaluate the effectiveness of trauma cards in triage training for firemen. Methods: Eighty-six firemen were randomly assigned into two groups: the trauma card group and the direct instruction group. Both groups received the same 30-min PowerPoint lecture on how to perform triage according to the Sort Assess Lifesaving interventions Treatment and transport (SALT) Mass Casualty Triage Algorithm. In the trauma card group, the participants were divided into groups of 3-5 and instructed to triage 10 trauma victims according to the descriptions on the trauma cards. In the direct instruction group, written forms about the same 10 victims were used and discussed as a continuation of the PowerPoint lecture. Total training time was 60 min for both groups. A test was distributed before and after the educational intervention to measure the individual triage skills. The same test was applied again 6 months later. Results: There was a significant improvement in triage skills directly after the intervention and this was sustained 6 months later. No significant difference in triage skills was seen between the trauma card group and the direct instruction group. Previous experience of multi-casualty incidents, years in service, level of education or age did not have any measurable effects on triage accuracy. Conclusions: One hour of triage training with the SALT Mass Casualty Triage Algorithm was enough to significantly improve triage accuracy in both groups of firemen with sustained skills 6 months later. Further studies on the first assessment on scene versus patient outcome are necessary to provide evidence that this training can improve casualty outcome. The efficacy and validity of trauma cards for disaster management training need to be tested in future studies.

    Place, publisher, year, edition, pages
    BIOMED CENTRAL LTD, 2015
    Keywords
    Triage; Triage training; SALT Mass Casualty Triage Algorithm; Trauma cards; Direct instruction; Firemen
    National Category
    Other Medical Sciences not elsewhere specified
    Identifiers
    urn:nbn:se:liu:diva-122520 (URN)10.1186/s13049-015-0162-7 (DOI)000363098400002 ()26481218 (PubMedID)
    Note

    Funding Agencies|Swedish Civil Contingencies Agency

    Available from: 2015-11-09 Created: 2015-11-06 Last updated: 2019-02-11
  • 245.
    Larsson, Sussanne
    et al.
    Linköping University.
    Garpenby, Peter
    Linköping University, Faculty of Health Sciences.
    Lindvall, Paul
    Kommunal primärvård i Katrineholm: perspektiv på utveckling och samverkan1997Report (Other academic)
  • 246.
    Larsson, Sven
    PrioriteringsCentrum.
    Prioritering av hälsofrämjande och förebyggande insatser i hälso- och sjukvården2005Report (Other academic)
    Abstract [sv]

    Syftet med föreliggande rapport är att diskutera och analysera i vad mån det är möjligt att inordna de hälsofrämjande och förebyggande insatser i den begreppsapparat och i de processer som nu utvecklas för prioriteringar inom hälso- och sjukvården. Det konstateras att förebyggande åtgärder funnits med men att de hittills haft en relativt undanskymd roll trots att Prioriteringsutredningen och hälso- och sjukvårdspolitiska policydokument betonar vikten av prevention. Orsakerna till det är att kunskaperna om hälsofrämjande förebyggande arbete är ojämna och bristfälliga ute i vården; att de begrepp som används inte är entydigt definierade utan får olika innebörd för olika aktörer samt att själva målet att något inte ska hända någon gång i framtiden (sjukdomsincidensen ska minska) gör utvärdering och effektmätning besvärligare än för behandlingsinsatser.

    Hälsofrämjande och sjukdomsförebyggande arbete har som mål att värna om och förbättra folkhälsan genom att påverka hälsans bestämningsfaktorer. Olika hälsobegrepp diskuteras och det hävdas att ett vidare hälsobegrepp än det sjukdomsorienterade ”frånvaro av sjukdom” måste användas. Hälsans bestämningsfaktorer systematiseras i biomedicinska faktorer, livsstil och livsvillkor med fysikaliska och sociala miljöfaktorer. Särskilt markeras de relativt nya kunskaperna om vad de strukturella samhällsfaktorerna betyder. Ny forskning från neurovetenskap, immunologi och endokrinologi skapar teorier som kan användas för att förklara sambanden mellan samhällsstruktur, biomedicin och hälsa.

    Rapporten går igenom ett antal olika modeller för preventiva strategier och grundläggande begrepp diskuteras. Den i Sverige traditionellt använda indelningen i primär, sekundär och tertiär prevention är föga användbar i ett prioriteringsperspektiv, eftersom olika aktörer ger begreppen olika innebörd. En tankemodell som delar in det förebyggande arbetet i högriskstrategier och befolkningsstrategier underlättar att inordna åtgärderna i arbetsprocesserna med vertikala respektive horisontella prioriteringar.

    Det centrala avsnittet i rapporten tillämpar den arbetsmodell som utvecklats inom vertikala prioriteringar av sjukdomsgrupper på riskfaktorområden och förebyggande högriskstrategier. Slutsatsen är att det i vertikala prioriteringar med utgångspunkt från sjukdomsgrupper är möjligt att ta med förebyggande åtgärder på samma villkor som behandlande. Det sker också redan idag i viss utsträckning.

    Riskfaktorerna kan också betraktas som specifika hälsoproblem och prioriteringar av åtgärder mot dem kan systematiskt analyseras med hänsyn till sjukdomsrisk, kända åtgärder och deras kostnadseffektivitet samt graden av evidens. Screening, ”sekundär prevention” av sjukdomar bör prioriteras inom ramen för de vertikala prioriteringarna för respektive sjukdomsgrupp. Det diskuteras om det finns underlag att prioritera opportunistisk screening av vissa riskbeteenden bland patienter i sjukvården. Underlag av det skisserade slaget behövs för att instrument för horisontella prioriteringar av insatser mot olika riskfaktorgrupper ska kunna utvecklas.

    Olika strategier för befolkningsinriktade hälsofrämjande åtgärder presenteras översiktligt. Sådana kräver i regel samverkan mellan flera olika sektorer i välfärdssystemet och det hävdas att samarbetsformer måste utvecklas för att gemensamma prioriteringsprocesser ska kunna komma till stånd. Satsning på forskning, utvecklingsarbete och systematiska utvärderingar för hälsofrämjande och förebyggande arbete efterlyses.

  • 247.
    Laurenius, Anna
    et al.
    Goteborgs universitet Institutionen for kliniska vetenskaper - Gastrokirurgisk forskning och utbildning Goteborg, Sweden Goteborgs universitet Institutionen for kliniska vetenskaper - Gastrokirurgisk forskning och utbildning Goteborg, Sweden.
    Näslund, Ingmar
    Kirurgiska kliniken - Universitetssjukhuset Örebro Örebro, Sweden Kirurgiska kliniken - Universitetssjukhuset Örebro Örebro, Sweden.
    Sandvik, Jorunn
    Regionalt senter for fedmeforskning - St Olavs Hospital Trondheim, Norway Regionalt senter for fedmeforskning - St Olavs Hospital Trondheim, Norway.
    Videhult, Per
    Sektionen för övre gastrokirurgi - Kirurgkliniken Västerås, Sweden Sektionen för övre gastrokirurgi - Kirurgkliniken Västerås, Sweden.
    Wirén, Mikael
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Norrköping.
    Nordiska riktlinjer för kosttillskott och uppföljning efter obesitaskirurgi - Monitorering och supplementering med vitaminer och mineraler2018In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 115Article, review/survey (Refereed)
    Abstract [en]

    Each year 6,800 bariatric operations are performed in Sweden. Bariatric surgery involves both a reduced intake and a reduced absorption of vitamins and minerals. There has been debate about whose responsibility long-term follow-up is, particularly regarding monitoring vitamin and mineral status. The Swedish Society for Bariatric Surgery and the Norwegian Association for Bariatric Surgery, who oversee their respective national quality registers, have appointed an expert group to develop guidelines for postoperative supplementation and nutritional monitoring of vitamins and minerals, along with a schedule for routine follow-up. Several existing international guidelines have served as the basis for the development of this guidance. The Finnish Association for Metabolic Surgery and The Danish Association for the Study of Obesity have also decided to adopt the recommendations. The care of the patient group with severe obesity is a common responsibility of primary care and hospitals, as patients are heavily affected by obesity-related morbidity, which, even without surgery, requires major health care efforts, not least from primary care. After surgery, a large proportion of these efforts can be reduced, but focus changes.

  • 248.
    Levi, Richard
    Umeå, Sweden.
    Philosophical Practise in Medical Rehabilitation II: Feasibility and Practical Implementation.2011In: Philosophical Practice: Journal of the American Philosophical Practitioners Association (American Philosophical Practitioners Association), ISSN 1742-8181, Vol. 6, no 3, p. 844-849Article in journal (Refereed)
    Abstract [en]

    This paper reports a pilot implementation project of philosophical practise in a medical setting. During one year, seven medical professionals working at a neurological rehabilitation center each conducted 4

  • 249.
    Levin, Lars-Åke
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Vad är det som gör hälsoekonomiska utvärderingar av diagnostiska metoder så utmanande men samtidigt så spännande?2016In: Perspektiv på utvärdering, prioritering, implementering och hälsoekonomi: En hyllningsskrift till Per Carlsson / [ed] Martin Henriksson, Linköping: Linköping University Electronic Press, 2016, p. 62-67Chapter in book (Other academic)
  • 250.
    Levin, Lars-Åke
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Husberg, Magnus
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    Sobocinski, Piotr Doliwa
    Department of Clinical Sciences, Danderyd Hospital, Division of cardiovascular medicine, Karolinska Institutet, Stockholm, Sweden.
    Kull, Viveka Frykman
    Department of Clinical Sciences, Danderyd Hospital, Division of cardiovascular medicine, Karolinska Institutet, Stockholm, Sweden.
    Friberg, Leif
    Department of Clinical Sciences, Danderyd Hospital, Division of cardiovascular medicine, Karolinska Institutet, Stockholm, Sweden.
    Rosenqvist, Mårten
    Department of Clinical Sciences, Danderyd Hospital, Division of cardiovascular medicine, Karolinska Institutet, Stockholm, Sweden.
    Davidson, Thomas
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Health Sciences.
    A cost-effectiveness analysis of screening for silent atrial fibrillation after ischaemic stroke.2015In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 17, no 2, p. 207-14Article in journal (Refereed)
    Abstract [en]

    AIMS: The purpose of this study was to estimate the cost-effectiveness of two screening methods for detection of silent AF, intermittent electrocardiogram (ECG) recordings using a handheld recording device, at regular time intervals for 30 days, and short-term 24 h continuous Holter ECG, in comparison with a no-screening alternative in 75-year-old patients with a recent ischaemic stroke.

    METHODS AND RESULTS: The long-term (20-year) costs and effects of all alternatives were estimated with a decision analytic model combining the result of a clinical study and epidemiological data from Sweden. The structure of a cost-effectiveness analysis was used in this study. The short-term decision tree model analysed the screening procedure until the onset of anticoagulant treatment. The second part of the decision model followed a Markov design, simulating the patients' health states for 20 years. Continuous 24 h ECG recording was inferior to intermittent ECG in terms of cost-effectiveness, due to both lower sensitivity and higher costs. The base-case analysis compared intermittent ECG screening with no screening of patients with recent stroke. The implementation of the screening programme on 1000 patients resulted over a 20-year period in 11 avoided strokes and the gain of 29 life-years, or 23 quality-adjusted life years, and cost savings of €55 400.

    CONCLUSION: Screening of silent AF by intermittent ECG recordings in patients with a recent ischaemic stroke is a cost-effective use of health care resources saving costs and lives and improving the quality of life.

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