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  • 301.
    Henriksson, Martin
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Centrum för medicinsk bildvetenskap och visualisering, CMIV.
    Siverskog, Jonathan
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Johannesen, Kasper
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Eriksson, Thérèse
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Tröskelvärden och kostnadseffektivitet: innebörd och implikationer för ekonomiska utvärderingar och beslutsfattande i hälso- och sjukvården2018Rapport (Övrigt vetenskapligt)
    Abstract [sv]

    Resultaten från hälsoekonomiska utvärderingar redovisas oftast som en inkrementell kostnadseffektivitetskvot (ICER efter engelskans incremental cost-efectiveness ratio) vilken anger kostnaden per uppnådd effektenhet för den åtgärd som utvärderas. En åtgärd kan vara ett preventionsprogram, en diagnostisk metod eller en behandling i form av ett kirurgiskt ingrepp eller ett läkemedel (vi använder fortsättningsvis begreppet interventioner som ett samlingsnamn för alla dessa åtgärder). Vanligtvis används ett hälsorelaterat mått såsom kvalitetsjusterade levnadsår (QALYs) som effektmått. För att en ICER på ett meningsfullt sätt skall kunna tolkas och tillämpas i beslutsfattande krävs att vi har en uppfattning om vad resultaten representerar och vad de kan jämföras med. Inte sällan anges ett gräns-värde för när en intervention kan anses vara kostnadseffektiv i litteraturen, ett så kallat tröskelvärde för kostnadseffektivitet. Ambitiösa försök att skatta detta värde har nyligen presenterats och bidrar med ny kunskap på området. I ljuset av denna forskning är det också tydligt att det finns olika tolkningar av tröskelvärdet, vilket kan bidra till otydlighet i både beslutsfattande och diskussioner om vad som kan anses vara en rimlig gräns för kostnadseffektivitet. Syftet med föreliggande rapport är att beskriva olika tolkningar av tröskelvärdet, sammanfatta vilken empirisk kunskap vi har om detta värde idag och slutligen diskutera vidare forskning i en svensk kontext.

    I rapporten illustreras de två huvudsakliga definitionerna av tröskelvärde som återfinns i litteraturen.

    Konsumtionsvärdet av hälsa kan tänkas representera vad individer på marginalen är villiga att ge upp i konsumtion för att erhålla ytterligare en QALY. I den internationella litteraturen har detta värde kommit att benämnas v.

    Marginalproduktiviteten i hälso- och sjukvårdssektorn kan tänkas representera kostnaden för att generera ytterligare en QALY på marginalen i hälso- och sjukvårdssektorn. Tröskelvärdet med denna tolkning bör utgöra kostnaden per QALY för den minst kostnadseffektiva interventionen som återfinns inom hälso- och sjukvårdssektorn. I den internationella litteraturen benämns detta värde k.

    I rapporten diskuteras implikationerna av att använda de olika definitionerna i beslutsfattande samt hur de hänger ihop med alternativkostnader i olika delar av samhället. När en intervention tar resurser i anspråk som annars skulle ha använts till sjukvård är alternativkostnaden förlorad hälsa. Denna alternativkostnad kan representeras av marginalproduktiviteten i hälso- och sjukvårdssektorn, k. När en intervention tar resurser i anspråk som annars skulle ha använts för privat konsumtion är alternativ-kostnaden istället förlorad konsumtion, vilken kan representeras av konsumtionsvärdet av hälsa, v. Vilket perspektiv som anses relevant samt i vilken sektor konsekvenserna av olika interventioner upp-står bör därmed vara avgörande för vilken eller vilka definitioner av tröskelvärdet som kan behöva beaktas.

    Empiriska studier har i större utsträckning försökt skatta konsumtionsvärdet av hälsa (v) jämfört med marginalproduktiviteten i hälso- och sjukvårdssektorn (k). Kunskapen om båda storheterna är begränsad ur ett svenskt perspektiv. En större studie från England utgör det första och mest ambitiösa försöket att explicit skatta tröskelvärdet ur ett marginalproduktivitetsperspektiv med hjälp av större data-material. I den studien skattades tröskelvärdet till en kostnad per QALY motsvarande ungefär 150 000 kronor. I ett försök att översätta dessa skattningar till tröskelvärden i andra länder redovisas en kostnad per QALY i intervallet 170 000 till 210 000 kronor för Sverige. Skattningarna får anses vara behäftade med en hög grad av osäkerhet. Nyligen publicerade studier från Australien och Spanien redovisar skattningar motsvarande 185 00 och 250 000 kronor per QALY. I studier som undersökt konsumtions-värdet av hälsa redovisas skattningar på 30 000 till flera miljoner kronor per QALY.

    En stor del av variationen i resultaten kan troligtvis hänföras till metodologiska aspekter. Studierna varierar i flera dimensioner; praktisk undersökningsmetod (online, intervjuer eller pappersenkäter), utformning av svarsalternativ, statistiska metoder för att analysera data, typ av hälsoförändring som värderats (enbart livskvalitet, enbart livslängd eller en kombination), om värderade hälsoförändringar uppnås med säkerhet eller med en viss sannolikhet samt om hälsoförändringen som värderas tillfaller respondenten själv eller någon annan. Få studier med data från svenska individer där generella hälso-förändringar värderats av ett urval från allmänheten har identifierats. Den enda studien som vi identifierat i referentgranskade tidskrifter redovisar skattningarna för Sverige i intervallet 150 000 till 350 000 kronor. I en relativt ny svensk rapport som finns tillgänglig på Institutet för Hälso- och Sjukvårds-ekonomis (IHE) hemsida redovisas skattningar på 2,4 miljoner kronor per QALY.

    En slutsats i vår rapport är att det behöver tydliggöras hur valet av perspektiv faktiskt påverkar vilken eller vilka definitioner av tröskelvärdet som bör vara relevanta när hälsoekonomiska utvärderingar används som underlag vid beslutsfattande inom hälso- och sjukvården. Om ett bredare samhällsperspektiv anses relevant kan både konsumtionsvärdet av hälsa (v) och marginalproduktiviteten i hälso- och sjukvården (k) behöva beaktas.

    En annan slutsats är att oavsett vilken definition av tröskelvärde som anses relevant så har vi mycket begränsad kunskap om både marginalproduktiviteten i hälso- och sjukvårdssektorn och konsumtions-värdet av hälsa i en svensk kontext. Statistisk modellering av befintliga datakällor kan vara en fram-komlig väg för att skatta marginalproduktiviteten medan välgjorda experiment eller metoder för att studera individers värderingar av hälsa via faktiska beslut och ageranden i icke-experimentella situationer kan vara en framkomlig väg för att studera konsumtionsvärdet av hälsa.

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    Tröskelvärden och kostnadseffektivitet: innebörd och implikationer för ekonomiska utvärderingar och beslutsfattande i hälso- och sjukvården
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  • 302.
    Herz, Marcus
    et al.
    Univ Gothenburg, Sweden.
    Andreasson, Jesper
    Linnaeus Univ, Sweden.
    Andréasson, Frida
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för omvårdnad och reproduktiv hälsa. Linköpings universitet, Medicinska fakulteten.
    The precariousness of asylum-seekers care and support: informal care within and because of the immigration process2023Ingår i: International Journal of Care and Caring, ISSN 2397-8821, E-ISSN 2397-883X , Vol. 7, nr 1, s. 50-66Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Using ethnographic data, this article aims to analyse the provision of informal care by asylum-seekers in Sweden and how this intersects with the(ir) asylum process. The article argues that asylum seekers are framed by the Swedish welfare system and immigration authorities as ungrievable and deportable, which not only impedes their access to formal care systems and values, but also creates a strong need for informal care. Further, it is suggested that the informal care provided by asylum seekers should be included in current debate on informal care and its impact on peoples lives.

  • 303.
    Hill, Loreena
    et al.
    Queens Univ, North Ireland.
    McIlfatrick, Sonja
    Ulster Univ, North Ireland; All Ireland Inst Hosp and Palliat Care, Ireland.
    Taylor, Brian J.
    Ulster Univ, North Ireland.
    Jaarsma, Tiny
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten. Mary MacKillop Inst Hlth Res, Australia.
    Moser, Debra
    Univ Kentucky, KY USA; Univ Kentucky, KY USA.
    Slater, Paul
    Ulster Univ, North Ireland.
    McAloon, Toni
    Ulster Univ, North Ireland.
    Dixon, Lana
    Belfast Hlth and Social Care Trust, North Ireland.
    Donnelly, Patrick
    South Eastern Hlth and Social Care Trust, North Ireland.
    Strömberg, Anna
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Fitzsimons, Donna
    Queens Univ, North Ireland; All Ireland Inst Hosp and Palliat Care, Ireland.
    Patient and Professional Factors That Impact the Perceived Likelihood and Confidence of Healthcare Professionals to Discuss Implantable Cardioverter Defibrillator Deactivation in Advanced Heart Failure Results From an International Factorial Survey2018Ingår i: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 33, nr 6, s. 527-535Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Rate of implantable cardioverter defibrillator (ICD) implantations is increasing in patients with advanced heart failure. Despite clear guideline recommendations, discussions addressing deactivation occur infrequently. Aim: The aim of this article is to explore patient and professional factors that impact perceived likelihood and confidence of healthcare professionals to discuss ICD deactivation. Methods and Results: Between 2015 and 2016, an international sample of 262 healthcare professionals (65% nursing, 24% medical) completed an online factorial survey, encompassing a demographic questionnaire and clinical vignettes. Each vignette had 9 randomly manipulated and embedded patient-related factors, considered as independent variables, providing 1572 unique vignettes for analysis. These factors were determined through synthesis of a systematic literature review, a retrospective case note review, and a qualitative exploratory study. Results showed that most healthcare professionals agreed that deactivation discussions should be initiated by a cardiologist (95%, n = 255) or a specialist nurse (81%, n = 215). In terms of experience, 84% of cardiologists (n = 53) but only 30% of nurses (n = 50) had previously been involved in a deactivation decision. Healthcare professionals valued patient involvement in deactivation decisions; however, only 50% (n = 130) actively involved family members. Five of 9 clinical factors were associated with an increased likelihood to discuss deactivation including advanced age, severe heart failure, presence of malignancy, receipt of multiple ICD shocks, and more than 3 hospital admissions during the previous year. Furthermore, nationality and discipline significantly influenced likelihood and confidence in decision making. Conclusions: Guidelines recommend that healthcare professionals discuss ICD deactivation; however, practice is suboptimal with multifactorial factors impacting on decision making. The role and responsibility of nurses in discussing deactivation require clarity and improvement.

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  • 304.
    Hjelm, Katarina
    et al.
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Hälsouniversitetet.
    Apelqvist, Jan
    Diabetes-och Endokrin kliniken, Universitetssjukhuset i Malmö, Lunds universitet.
    Migrants with diabetes believe diabetic foot ulcers being unavoidable and impossible to prevent.2015Ingår i: 50th annual meeting of the EUROPEAN DIABETES EPIDEMIOLOGY GROUP.25-28 April 2015. Les Fontaines, Gouvieux-Chantilly, France.Study group of the European Association for the Study of Diabetes (EASD), Paris, France.: EUROPEAN DIABETES EPIDEMIOLOGY GROUP - EDEG , 2015Konferensbidrag (Refereegranskat)
    Abstract [en]

    Background: Since type 2 diabetes is developing into a pandemic, particularly affecting migrants in industrializing countries, the prevalence of diabetes complications is expected to increase. Diabetic foot disorders are the predominant source of complications and are serious and costly but highly preventable particularly by self-care. Health-related behavior, including self care and health care seeking, is guided by beliefs about health/illness but has not previously been studied in different migrant groups. We aim to describe beliefs about health/illness in foreign-born persons with diabetic foot ulcers that might affect self-care and health care seeking and to study whether there are dissimilarities related to origin. ‘

    Material and methods: Qualitative descriptive study. Semi-structured interviews with 26 persons, aged 38-86 years, whereof 13 born in European and 13 in non European countries, all except one in the Middle East, being residents in Sweden between 7-60 years (Md 18 yrs).

    Results: Most believed foot ulcers being unavoidable and problematic to detect, and mainly caused by internal factors such as diabetes, sometimes combined with external factors as inappropriate foot wear, hot water, or bare foot walking. Perceived health had deteriorated after onset of the foot problems due to immobility and pain. Middle Easterners differed as they discussed the importance to adapt to the will of Allah, leading to even poorer quality of life and view of future health. They described more foot problems and perceived religion (Muslim) with washing rituals of the feet being of importance for health. They were less often regularly monitored than European migrants. Economy affected health, more so in Europeans, due to expenses for medications and shoes. Many described limited activity in self-care, few had searched help for their foot problems and if so solely among professionals and had limited knowledge about the influence of glycaemic control on diabetes/foot status.

    Conclusions: Foreign-born persons perceived foot ulcers being impossible to prevent, experienced problems with detection, and had limited knowledge about self-care. Dissimilarities in beliefs related to origin were found that negatively affected self-care of the feet why it is important to assess individual beliefs and plan care and education accordingly. 

  • 305.
    Hjelm, Katarina
    et al.
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Medicinska fakulteten.
    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.2015Ingår i: Global Health Congress, Oxford 2015, Oxford University, 2015Konferensbidrag (Refereegranskat)
    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.

  • 306.
    Hjelmfors, Lisa
    et al.
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten.
    Strömberg, Anna
    Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken US. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad.
    Friedrichsen, Maria
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i östra Östergötland, Palliativt kompetenscentrum.
    Sandgren, Anna
    Linnaeus Univ, Sweden.
    Martensson, Jan
    Jonkoping Univ, Sweden.
    Jaarsma, Tiny
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten.
    Using co-design to develop an intervention to improve communication about the heart failure trajectory and end-of-life care2018Ingår i: BMC Palliative Care, E-ISSN 1472-684X, Vol. 17, artikel-id 85Artikel i tidskrift (Refereegranskat)
    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.

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  • 307.
    Hoffmann, Mikael
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Linköpings universitet, Medicinska fakulteten. NEPI Fdn, Sweden; Swedish Soc Med, Sweden.
    Timeline of and Expectations for the National Medication List in Sweden2023Ingår i: CARING IS SHARING-EXPLOITING THE VALUE IN DATA FOR HEALTH AND INNOVATION-PROCEEDINGS OF MIE 2023, IOS PRESS , 2023, Vol. 302, s. 327-331Konferensbidrag (Refereegranskat)
    Abstract [en]

    It is important to separate the continuous chains of medications orders (or decisions by the prescriber) in modern electronic health records from the one-way communication of prescriptions from healthcare to pharmacies. To support the self-administration of prescribed drugs the patient needs a continuously updated list of medication orders. For the NLL to function as a safe resource for the patient, it is necessary to have the information updated, curated, and documented by prescribers in a one-step process within the electronic health record. Four of the Nordic countries have chosen separate ways trying to achieve this. The experiences and obstacles during the introduction of the mandatory National Medication List (NLL) in Sweden and the resulting delays are described. The planned integration for 2022 is now delayed to 2025 and will probably only be achieved in 2028 or even 2030 in some regions.

  • 308.
    Hoffmann, Mikael
    et al.
    Stiftelsen NEPI, Sverige.
    Böttiger, Ylva
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för läkemedelsforskning. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Diagnostikcentrum, Klinisk farmakologi.
    Nationell process för värdering av off label-användning behövs2020Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 117Artikel i tidskrift (Refereegranskat)
    Abstract [sv]

    Läkemedelsverket rapporterar att man inte, utifrån sitt etablerade arbetssätt, kan genomföra nytta–riskvärdering av läkemedel utanför godkänd indikation. 

    Sjukvården har ett behov av en nationell process för värdering av off label-användning av vissa läkemedel. 

    Sjukvården behöver också fler och innovativa akademiskt drivna läkemedelsstudier.

  • 309.
    Hoffmann, Mikael
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Linköpings universitet, Medicinska fakulteten.
    Vander Stichele, Robert
    Univ Ghent, Belgium.
    Bates, David W.
    Brigham & Womens Hosp, MA 02115 USA; Harvard Med Sch, MA 02115 USA.
    Bjorklund, Johanna
    Umea Univ, Sweden.
    Alexander, Steve
    Univ Nottingham, England.
    Andersson, Marine L.
    Karolinska Inst, Sweden.
    Auraaen, Ane
    Org Econ Cooperat & Dev OECD, France.
    Bennie, Marion
    Univ Strathclyde, Scotland.
    Dahl, Marja-Liisa
    Karolinska Inst, Sweden.
    Eiermann, Birgit
    Karolinska Inst, Sweden.
    Hackl, Werner
    UMIT Private Univ Hlth Sci Med Informat & Technol, Austria.
    Hammar, Tora
    Linnaeus Univ, Sweden.
    Hjemdahl, Paul
    Karolinska Inst, Sweden.
    Koch, Sabine
    Karolinska Inst, Sweden.
    Kunnamo, Ilkka
    Finnish Med Soc Duodecim, Finland.
    Le Louet, Herve
    Council Int Org Med Sci CIOMS, Switzerland.
    Panagiotis, Papapetrou
    Stockholm Univ, Sweden.
    Raego, Lembit
    Council Int Org Med Sci CIOMS, Switzerland.
    Spedding, Michael
    Int Union Basic & Clin Pharmacol IUPHAR, France.
    Seidling, Hanna M.
    Heidelberg Univ, Germany.
    Demner-Fushman, Dina
    NIH, MD USA.
    Gustafsson, Lars L.
    Karolinska Inst, Sweden; Swedish Inst Drug Informat SIDI, Sweden.
    Guiding principles for the use of knowledge bases and real-world data in clinical decision support systems: report by an international expert workshop at Karolinska Institutet2020Ingår i: Expert Review of Clinical Pharmacology, ISSN 1751-2433, E-ISSN 1751-2441, Vol. 13, nr 9, s. 925-934Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction Technical and logical breakthroughs have provided new opportunities in medicine to use knowledge bases and large-scale clinical data (real-world) at point-of-care as part of a learning healthcare system to diminish the knowledge-practice gap. Areas covered The article is based on presentations, discussions and recommendations from an international scientific workshop. Value, research needs and funding avenues of knowledge bases and access to real-world data as well as transparency and incorporation of patient perspectives are discussed. Expert opinion Evidence-based, publicly funded, well-structured and curated knowledge bases are of global importance. They ought to be considered as a public responsibility requiring transparency and handling of conflicts of interest. Information has to be made accessible for clinical decision support systems (CDSS) for healthcare staff and patients. Access to rich and real-world data is essential for a learning health care ecosystem and can be augmented by data on patient-reported outcomes and preferences. This field can progress by the establishment of an international policy group for developing a best practice guideline on the development, maintenance, governance, evaluation principles and financing of open-source knowledge bases and handling of real-world data.

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  • 310.
    Hofmann, Bjorn
    et al.
    Norwegian Univ Sci and Technol NTNU, Norway; Univ Oslo, Norway.
    Bond, Ken
    CADTH, Canada.
    Sandman, Lars
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Evaluating facts and facting evaluations: On the fact-value relationship in HTA2018Ingår i: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 24, nr 5, s. 957-965Artikel i tidskrift (Refereegranskat)
    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.

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  • 311.
    Holmar, Jana
    et al.
    Tallin University of Technology, Tallin, Estonia .
    Uhlin, Fredrik
    Region Östergötland, Hjärt- och Medicincentrum, Njurmedicinska kliniken US. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten.
    Fernström, Anders
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för läkemedelsforskning. Region Östergötland, Hjärt- och Medicincentrum, Njurmedicinska kliniken US. Linköpings universitet, Medicinska fakulteten.
    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 Hemodialysis2015Ingår i: Toxins, ISSN 2072-6651, Vol. 7, nr 3, s. 719-727Artikel i tidskrift (Refereegranskat)
    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.

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  • 312.
    Holmer, Hampus
    et al.
    Karolinska Institutet, Sweden.
    Hurtig, Anna-Karin
    Umeå universitet, Socialmedicin.
    Irestig, Robert
    Capio Psykiatri AB, Stockholm, Sweden.
    Kosidou, Kyriaki
    Region Stockholm, Sweden.
    Kristenson, Margareta
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Regionledningskontoret, Enheten för folkhälsa.
    Lönnroth, Knut
    Karolinska Institutet, Sweden.
    Lövestad, Solveig
    Göteborgs Universitet, Sweden.
    Nejat, Sahar
    Region Stockholm, Sweden.
    Stafström, Martin
    Lunds Universitet, Sweden.
    Sarkadi, Anna
    Uppsala Universitet, Sweden; Svensk Förening för Socialmedicin och Folkhälsa, Sweden.
    Nu ses en ljusnande framtid för socialmedicinen2020Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 117, nr 46-47, s. 1508-1509Artikel i tidskrift (Övrigt vetenskapligt)
  • 313.
    Holmlund, Lisa
    et al.
    Karolinska Inst, Sweden.
    Hellman, Therese
    Karolinska Inst, Sweden; Uppsala Univ, Sweden.
    Engblom, Monika
    Karolinska Inst, Sweden; Acad Primary Hlth Care Ctr, Sweden.
    Kwak, Lydia
    Karolinska Inst, Sweden.
    Sandman, Lars
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Linköpings universitet, Medicinska fakulteten.
    Tornkvist, Lena
    Karolinska Inst, Sweden; Acad Primary Hlth Care Ctr, Sweden.
    Bjork Bramberg, Elisabeth
    Karolinska Inst, Sweden; Univ Gothenburg, Sweden.
    Coordination of return-to-work for employees on sick leave due to common mental disorders: facilitators and barriers2022Ingår i: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 44, nr 13, s. 3113-3121Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose To identify facilitators of and barriers to the coordination of return-to-work between the primary care services, the employee, and the employers from the perspective of coordinators and employees on sick leave due to common mental disorders (CMDs). Material and methods Descriptive qualitative study. Semi-structured interviews were conducted with eighteen coordinators and nine employees on sick leave due to CMDs. The Consolidated Framework for Implementation Research (CFIR) was used as a starting point for the interview guides and in the thematic analysis of data. Results The results show facilitators and barriers related to the CFIR domains "intervention characteristics," "outer setting," "inner setting," and "characteristics of individuals." Positive attitudes, an open dialogue in a three-party meeting, and a common ground for the sick leave process at the primary care centre facilitated coordination, while an unclear packaging, conflicts at the employees workplace, and a lack of team-based work were examples of barriers. Conclusion The results indicate a need for the detailed packaging of coordination; formalization of coordinators qualifications and levels of training; and acknowledgement of the role of organizational factors in the implementation of coordination. This is important to further develop and evaluate the efficacy of coordination.

  • 314.
    Holmlund, Lisa
    et al.
    Karolinska Inst, Sweden.
    Sandman, Lars
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Linköpings universitet, Medicinska fakulteten.
    Hellman, Therese
    Karolinska Inst, Sweden; Uppsala Univ, Sweden.
    Kwak, Lydia
    Karolinska Inst, Sweden.
    Bramberg, Elisabeth Bjork
    Karolinska Inst, Sweden.
    Ethical aspects of the coordination of return-to-work among employees on sick leave due to common mental disorders: a qualitative study2023Ingår i: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 45, nr 13, s. 2118-2127Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose Identify ethical issues that arise in the coordination of return-to-work (RTW) among employees on sick leave due to common mental disorders (CMDs). Material and methods 41 semi-structured individual interviews and one focus group interview with stakeholders (n = 46) involved in RTW: employees on sick leave due to CMDs, coordinators and physicians at primary health care centres, managers, representatives of the Swedish social insurance agency and occupational health services. A six-step thematic analysis focused on the ethical values and norms related to autonomy, privacy, resources and organization, and professional values. Results Five themes were identified: (1) autonomous decision-making versus the risk of taking over, (2) employee rights versus restrictions to self-determination, (3) respect for employee privacy versus stakeholders interests, (4) risk of unequal inclusion due to insufficient organizational structure and resources, (5) risk of unequal support due to unclear professional roles and responsibilities. Conclusion The main ethical issues are the risks of unequal access to and unequal support for the coordination of RTW. For the fair and equal provision of coordination, it is necessary to be transparent on how to prioritize the coordination of RTW for different patient groups, provide clarity about the coordinators professional role, and facilitate ongoing boundary work between stakeholders.

  • 315.
    Holmqvist, Malin
    et al.
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Dept Hosp Pharm, Region Jönköping County, Jönköping, Sweden; Jonkoping Univ, Sweden.
    Thor, Johan
    Jonkoping Univ, Sweden.
    Ros, Axel
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper. Linköpings universitet, Medicinska fakulteten. Futurum, Region Jönköping County, Jönköping, Sweden; Jonkoping Univ, Sweden.
    Johansson, Linda
    Jonkoping Univ, Sweden.
    Evaluation of older persons medications: a critical incident technique study exploring healthcare professionals experiences and actions2021Ingår i: BMC Health Services Research, E-ISSN 1472-6963, Vol. 21, nr 1, artikel-id 557Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BackgroundOlder persons with polypharmacy are at increased risk of harm from medications. Therefore, it is important that physicians and nurses, together with the persons, evaluate medications to avoid hazardous polypharmacy. It remains unclear how healthcare professionals experience such evaluations. This study aimed to explore physicians and nurses experiences from evaluations of older persons medications, and their related actions to manage concerns related to the evaluations.MethodIndividual interview data from 29 physicians and nurses were collected and analysed according to the critical incident technique.ResultsThe medication evaluation for older persons was influenced by the working conditions (e.g. healthcare professionals clinical knowledge, experiences, and situational conditions) and working in partnership (e.g. cooperating around and with the older person). Actions taken to manage these evaluations were related to working with a plan (e.g. performing day-to-day work and planning for continued treatment) and collaborative problem-solving (e.g. finding a solution, involving the older person, and communicating with colleagues).ConclusionWorking conditions and cooperation with colleagues, the older persons and their formal or informal caregivers, emerged as important factors related to the medication evaluation. By adjusting their performance to variations in these conditions, healthcare professionals contributed to the resilience of the healthcare system by its capacity to prevent, notice and mitigate medication problems. Based on these findings, we hypothesize that a joint plan for continued treatment could facilitate such resilience, if it articulates what to observe, when to act, who should act and what actions to take in case of deviations from what is expected.

  • 316.
    Holmér, Suzana
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i västra Östergötland, Rehab Väst.
    Nedlund, Ann-Charlotte
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Linköpings universitet, Medicinska fakulteten.
    Thomas, Kristin
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Linköpings universitet, Medicinska fakulteten.
    Krevers, Barbro
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Linköpings universitet, Medicinska fakulteten.
    How health care professionals handle limited resources in primary care - an interview study2023Ingår i: BMC Health Services Research, E-ISSN 1472-6963, Vol. 23, nr 1, artikel-id 6Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: Health care systems around the world are struggling with limited resources, in relation to the prevailing health care need. An accessible primary care is an important part of the solution for how to provide affordable care for the population and reduce pressure on the overall health care system such as unnecessary hospital stays and associated costs. As primary care constitutes an important first line of healthcare, the task of prioritising and deciding what to do and for whom lies in practice, primarily with the primary care professionals. Thus, the decisions and behaviour of primary care professionals have a central role in achieving good and equal health in the population. The aim of this study is to explore how primary health care professionals handle situations with limited resources and enhance our knowledge of priorities in practice. Methods: Semi-structured interviews with 14 health care professionals (7 nurses, 7 physicians) working in Swedish primary care were interviewed. Data were analysed inductively with content analysis. Findings: Three main categories were found: Influx of patients; Structural conditions; and Actions. Each category illustrates an important aspect for what primary care professionals do to achieve good and equal care. The influx of patients concerned what the professionals handled in terms of patients healthcare needs and patient behaviour. Structural conditions consisted of policies and goals set for primary care, competence availability, technical systems, and organisational culture. To handle situations due to limited resources, professionals performed different actions: matching health care needs with professionals competency, defining care needs to suit booking systems appointments, giving care at the inappropriate health care level, rearranging workhours, and passing on the decision making. Conclusion: Priorities in primary care are not, "one fits all " solution. Our study shows that priorities in primary care comprise of ongoing daily processes that are adapted to the situation, context of patient influx, and structural conditions. Healthcare professionals actions for how influx of patients is handled in relation to limited resources, are created, and shaped within this context which also sets the boundaries for their actions.

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  • 317.
    Hossain, Iftakher
    et al.
    Turku Univ Hosp, Finland; Univ Cambridge, England.
    Younsi, Alexander
    Univ Heidelberg Hosp, Germany.
    Leon, Ana Maria Castano
    Hosp Univ 12 Octubre, Spain.
    Lippa, Laura
    Osped Niguarda Ca Granda, Italy.
    Toth, Peter
    Univ Pecs, Hungary.
    Terpolilli, Nicole
    Munich Univ Hosp, Germany.
    Tobieson, Lovisa
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för neurobiologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Neurokirurgiska kliniken US.
    Latini, Francesco
    Uppsala Univ, Sweden.
    Raabe, Andreas
    Univ Bern, Switzerland.
    Depreitere, Bart
    Univ Hosp Leuven, Belgium.
    Rostami, Elham
    Uppsala Univ, Sweden; Karolinska Inst, Sweden.
    Huge variability in restrictions of mobilization for patients with aneurysmal subarachnoid hemorrhage- A European survey of practice2023Ingår i: BRAIN AND SPINE, ISSN 2772-5294, Vol. 3, artikel-id 101731Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: One of the major goals of neurointensive care is to prevent secondary injuries following aSAH. Bed rest and patient immobilization are practiced in order to decrease the risk of DCI. Research question: To explore the current practices in place concerning the management of patients with aSAH, specifically, protocols and habits regarding restrictions of mobilization and HOB positioning. Material and methods: A survey was designed, modified, and approved by the panel of the Trauma & Critical Care section of the EANS to cover the practice of restrictions of patient mobilization and HOB positioning in patients with aSAH. Results: Twenty-nine physicians from 17 countries completed the questionnaire. The majority (79.3%) stated that non-secured aneurysm and the presence of an EVD were the factors related to the establishment of restriction of mobilization. The average duration of the restriction varied widely ranging between 1 and 21 days. The presence of an EVD (13.8%) was found to be the main reason to recommend restriction of HOB elevation. The average duration of restriction of HOB positioning ranged between 3 and 14 days. Rebleeding or complications related to CSF over-drainage were found to be related to these restrictions. Discussion and conclusion: Restriction of patient mobilization regimens vary widely in Europe. Current limited evidence does not support an increased risk of DCI rather the early mobilization might be beneficial. Large prospective studies and/or the initiative of a RCT are needed to understand the significance of early mobilization on the outcome of patients with aSAH.

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  • 318.
    Husberg, Magnus
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Davidson, Thomas
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Hallert, Eva
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    Non-medical costs during the first year after diagnosis in two cohorts of patients with early rheumatoid arthritis, enrolled 10 years apart2017Ingår i: Clinical Rheumatology, ISSN 0770-3198, E-ISSN 1434-9949, Vol. 36, nr 3, s. 499-506Artikel i tidskrift (Refereegranskat)
    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.

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  • 319.
    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
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten. 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 context2019Ingår i: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 25, nr 2, s. 282-289Artikel i tidskrift (Refereegranskat)
    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.

  • 320.
    Höglund, Anna T.
    Uppsala universitet.
    Reflektioner över etik och prioriteringar i vården: intervjuer med vårdpersonal2003Rapport (Övrigt vetenskapligt)
    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.

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  • 321.
    Hörlin, Erika
    et al.
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för klinisk kemi och farmakologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i centrala Östergötland, Akutkliniken i Linköping.
    Munir Ehrlington, Samia
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för klinisk kemi och farmakologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i centrala Östergötland, Akutkliniken i Linköping.
    Toll, Rani
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för klinisk kemi och farmakologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i centrala Östergötland, Akutkliniken i Linköping.
    Henricson, Joakim
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för klinisk kemi och farmakologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i centrala Östergötland, Akutkliniken i Linköping.
    Wilhelms, Daniel
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för klinisk kemi och farmakologi. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i centrala Östergötland, Akutkliniken i Linköping.
    Is the clinical frailty scale feasible to use in an emergency department setting? A mixed methods study2023Ingår i: BMC Emergency Medicine, ISSN 1471-227X, E-ISSN 1471-227X, Vol. 23, nr 1, artikel-id 124Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The Clinical Frailty Scale (CFS) is a frailty assessment tool used to identify frailty in older patients visitingthe emergency department (ED). However, the current understanding of how it is used and accepted in ED clinicalpractice is limited. This study aimed to assess the feasibility of CFS in an ED setting.

    Methods :This was a prospective, mixed methods study conducted in three Swedish EDs where CFS had recentlybeen introduced. We examined the completion rate of CFS assessments in relation to patient- and organisationalfactors. A survey on staff experience of using CFS was also conducted. All quantitative data were analyseddescriptively, while free text comments underwent a qualitative content analysis.

    Results: A total of 4235 visits were analysed, and CFS assessments were performed in 47%. The completion rate exceeded 50% for patients over the age of 80. Patients with low triage priority were assessed to a low degree (24%). There was a diurnal variation with the highest completion rates seen for arrivals between 6 and 12 a.m. (58%). The survey response rate was 48%. The respondents rated the perceived relevance and the ease of use of the CFS with a median of 5 (IQR 2) on a scale with 7 being the highest. High workload, forgetfulness and critical illness were rankedas the top three barriers to assessment. The qualitative analysis showed that CFS assessments benefit from a clearroutine and a sense of apparent relevance to emergency care.

    Conclusion: Most emergency staff perceived CFS as relevant and easy to use, yet far from all older ED patientswere assessed. The most common barrier to assessment was high workload. Measures to facilitate use may includeclarifying the purpose of the assessment with explicit follow-up actions, as well as formulating a clear routine for the assessment.

    Registration: The study was registered on ClinicalTrials.gov 2021-06-18 (identifier: NCT04931472).

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  • 322.
    Ingadottir, Brynja
    et al.
    Landspitali, Iceland.
    Thylén, Ingela
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Jaarsma, Tiny
    Linköpings universitet, Institutionen för samhälls- och välfärdsstudier, Hälsa, Aktivitet, Vård (HAV). Linköpings universitet, Medicinska fakulteten.
    Knowledge expectations, self-care, and health complaints of heart failure patients scheduled for cardiac resynchronization therapy implantation2015Ingår i: Patient Preference and Adherence, E-ISSN 1177-889X, Vol. 9, s. 913-921Artikel i tidskrift (Refereegranskat)
    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.

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  • 323. Beställ onlineKöp publikationen >>
    Ingadóttir, Brynja
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för omvårdnad. Linköpings universitet, Medicinska fakulteten.
    Learning as a patient: What and how individuals want to learn when preparing for surgery, and the potential use of serious games in their education2016Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    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.

    Delarbeten
    1. The fulfilment of knowledge expectations during the perioperative period of patients undergoing knee arthroplasty - a Nordic perspective
    Öppna denna publikation i ny flik eller fönster >>The fulfilment of knowledge expectations during the perioperative period of patients undergoing knee arthroplasty - a Nordic perspective
    Visa övriga...
    2014 (Engelska)Ingår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 23, nr 19-20, s. 2896-2908Artikel i tidskrift (Refereegranskat) 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.

    Ort, förlag, år, upplaga, sidor
    Wiley-Blackwell, 2014
    Nyckelord
    Knee arthroplasty, osteoarthritis, patient education, patient expectations, patient satisfaction, surgery
    Nationell ämneskategori
    Hälsovetenskaper
    Identifikatorer
    urn:nbn:se:liu:diva-105225 (URN)10.1111/jocn.12552 (DOI)000343857700020 ()24476393 (PubMedID)
    Projekt
    EEPO
    Tillgänglig från: 2014-03-13 Skapad: 2014-03-13 Senast uppdaterad: 2017-12-05Bibliografiskt granskad
    2. Knowledge expectations, self-care, and health complaints of heart failure patients scheduled for cardiac resynchronization therapy implantation
    Öppna denna publikation i ny flik eller fönster >>Knowledge expectations, self-care, and health complaints of heart failure patients scheduled for cardiac resynchronization therapy implantation
    2015 (Engelska)Ingår i: Patient Preference and Adherence, E-ISSN 1177-889X, Vol. 9, s. 913-921Artikel i tidskrift (Refereegranskat) 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.

    Ort, förlag, år, upplaga, sidor
    Dove Medical Press, 2015
    Nyckelord
    cardiac devices; CRT treatment; patient education
    Nationell ämneskategori
    Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi
    Identifikatorer
    urn:nbn:se:liu:diva-120368 (URN)10.2147/PPA.S83069 (DOI)000357535000001 ()26170641 (PubMedID)
    Anmärkning

    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

    Tillgänglig från: 2015-07-31 Skapad: 2015-07-31 Senast uppdaterad: 2024-01-17
    3. Perceptions about traditional and novel methods to learn about post-operative pain management: - a qualitative study.
    Öppna denna publikation i ny flik eller fönster >>Perceptions about traditional and novel methods to learn about post-operative pain management: - a qualitative study.
    2016 (Engelska)Ingår i: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 72, nr 11, s. 2672-2683Artikel i tidskrift (Refereegranskat) 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.

    Ort, förlag, år, upplaga, sidor
    Wiley-Blackwell, 2016
    Nyckelord
    Content analysis; educational methods; nursing; patient education; patient learning; post-operative self-care; vignettes
    Nationell ämneskategori
    Omvårdnad
    Identifikatorer
    urn:nbn:se:liu:diva-129199 (URN)10.1111/jan.13021 (DOI)000386079500010 ()27205900 (PubMedID)
    Anmärkning

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

    Tillgänglig från: 2016-06-13 Skapad: 2016-06-13 Senast uppdaterad: 2019-06-27
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    Learning as a patient: What and how individuals want to learn when preparing for surgery, and the potential use of serious games in their education
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  • 324.
    Ingvarsson, Sara
    et al.
    Karolinska Inst, Sweden.
    Augustsson, Hanna
    Karolinska Inst, Sweden; Ctr Epidemiol & Community Med CES, Sweden.
    Hasson, Henna
    Karolinska Inst, Sweden; Ctr Epidemiol & Community Med CES, Sweden.
    Nilsen, Per
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Linköpings universitet, Medicinska fakulteten.
    Schwarz, Ulrica von Thiele
    Karolinska Inst, Sweden; Malardalen Univ, Sweden.
    von Knorring, Mia
    Karolinska Inst, Sweden.
    Why do they do it? A grounded theory study of the use of low-value care among primary health care physicians2020Ingår i: Implementation Science, E-ISSN 1748-5908, Vol. 15, nr 1, artikel-id 93Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background The use of low-value care (LVC) is widespread and has an impact on both the use of resources and the quality of care. However, few studies have thus far studied the factors influencing the use of LVC from the perspective of the practitioners themselves. The aim of this study is to understand why physicians within primary care use LVC. Methods Six primary health care centers in the Stockholm Region were purposively selected. Focus group discussions were conducted with physicians (n= 31) working in the centers. The discussions were coded inductively using a grounded theory approach. Results Three main reasons for performing LVC were identified.Uncertainty and disagreement about what not to dowas related to being unaware of the LVC status of a practice, guidelines perceived as conflicting, guidelines perceived to be irrelevant for the target patient population, or a lack of trust in the guidelines.Perceived pressure from othersconcerned patient pressure, pressure from other physicians, or pressure from the health care system.A desire to do something for the patientswas associated with the fact that the visit in itself prompts action, symptoms to relieve, or that patients emotions need to be reassured. The three reasons are interdependent. Uncertainty and disagreement about what not to do have made it more difficult to handle the pressure from others and to refrain from doing something for the patients. The pressure from others and the desire to do something for the patients enhanced the uncertainty and disagreement about what not to do. Furthermore, the pressure from others influenced the desire to do something for the patients. Conclusions Three reasons work together to explain primary care physicians use of LVC: uncertainty and disagreement about what not to do, perceived pressure from others, and the desire to do something for the patients. The reasons may, in turn, be influenced by the health care system, but the decision nevertheless seemed to be up to the individual physician. The findings suggest that the de-implementation of LVC needs to address the three reasons from a systems perspective.

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  • 325.
    Ingvarsson, Sara
    et al.
    Procome Research Group, Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Sweden.
    Hasson, Henna
    Unit for Implementation and Evaluation, Center for Epidemiology and Community Medicine (CES), Stockholm Region, Sweden; Unit for Implementation and Evaluation, Center for Epidemiology and Community Medicine (CES), Stockholm Region, Sweden.
    Augustsson, Hanna
    Unit for Implementation and Evaluation, Center for Epidemiology and Community Medicine (CES), Stockholm Region, Sweden; Unit for Implementation and Evaluation, Center for Epidemiology and Community Medicine (CES), Stockholm Region, Sweden.
    Nilsen, Per
    Linköpings universitet, Medicinska fakulteten. Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa.
    von Thiele Schwarz, Ulrica
    Unit for Implementation and Evaluation, Center for Epidemiology and Community Medicine (CES), Stockholm Region, Sweden; School of Health, Care and Social Welfare, Mälardalen University, Sweden.
    Sandaker, Ingunn
    SCBE Research Group, Department of Behavioral Science, Faculty of Health Sciences, Oslo Metropolitan University, Norway.
    Management strategies to de-implement low-value care-an applied behavior analysis.2022Ingår i: Implementation Science Communications, E-ISSN 2662-2211, Vol. 3, nr 1, artikel-id 69Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: There is a lack of knowledge about management strategies being used to de-implement low-value care (LVC). Furthermore, it is not clear from the current literature what mechanisms are involved in such strategies and how they can change physicians' behaviors. Understanding the mechanisms is important for determining a strategy's potential impact. Applied behavior analysis focuses on processes involved in increasing and decreasing behaviors. Therefore, the aim of this study is to understand what management strategies are being used to de-implement LVC and the possible mechanisms involved in those strategies, using concepts from applied behavior analysis.

    METHOD: We applied a qualitative study design using an inductive approach to understand what management strategies are in use and then employed applied behavior analysis concepts to deductively analyze the mechanisms involved in them.

    RESULTS: We identified eight different management strategies intended to influence LVC. Five of the strategies were developed at a regional level and had the potential to influence physicians' LVC-related behaviors either by functioning as rules on which LVC to de-implement or by initiating local strategies in each health care center that in turn could influence LVC practices. The local strategies had a stronger potential for influencing de-implementation.

    CONCLUSION: Both strategies at a systemic level (regional) and on a local level (health care centers) must be considered to influence LVC-related behaviors. Strategies at the center level have a specific opportunity to impact LVC-related behaviors because they can be tailored to specific circumstances, even though some of them probably were initiated as an effect of strategies on a regional level. Using applied behavior analysis to understand these circumstances can be helpful for tailoring strategies to reduce LVC use.

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  • 326.
    Ingvarsson, Sara
    et al.
    Karolinska Inst, Sweden.
    Nilsen, Per
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Linköpings universitet, Medicinska fakulteten.
    Hasson, Henna
    Karolinska Inst, Sweden.
    Low-Value Care: Convergence and Challenges; Comment on "Key Factors That Promote Low-Value Care: Views From Experts From the United States, Canada, and the Netherlands"Ingår i: International Journal of Health Policy and Management, ISSN 2322-5939, E-ISSN 2322-5939Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Interest has increased in the topic of de-implementation, ie, reducing so-called low-value care (LVC). The article "Key Factors That Promote Low-Value Care: Views From Experts From the United States, Canada, and the Netherlands" by Verkerk and colleagues identifies national-level factors affecting LVC use in those three countries. This commentary raises three critical points regarding the study. First, the study does not clearly define the national level. Secondly, national-level factors might not be relevant for all types of LVCs and thirdly, the studys rather limited sample makes it difficult to draw firm conclusions. We also include some critical comments related to some of the studys findings in relation to results of our recently published scoping review of the international literature on de-implementation and use of LVC 3 and an interview study with primary care physicians on LVC use 4. Finally, we provide some suggestions for further research that we believe is needed to improve understanding of LVC use and facilitate its de-implementation.

  • 327.
    Israelsson, Johan
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för omvårdnad och reproduktiv hälsa. Linköpings universitet, Medicinska fakulteten. Kalmar Cty Hosp, Sweden; Linnaeus Univ, Sweden.
    Lilja, Gisela
    Lund Univ, Sweden; Skane Univ Hosp, Sweden.
    Bremer, Anders
    Univ Boras, Sweden; Kalmar Cty Hosp, Sweden.
    Stevenson-Agren, Jean
    Univ Sheffield, England; Linnaeus Univ, Sweden.
    Årestedt, Kristofer
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för omvårdnad och reproduktiv hälsa. Linköpings universitet, Medicinska fakulteten. Linnaeus Univ, Sweden.
    Post cardiac arrest care and follow-up in Sweden - a national web-survey2016Ingår i: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 15, artikel-id 1Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Recent decades have shown major improvements in survival rates after cardiac arrest. However, few interventions have been tested in order to improve the care for survivors and their family members. In many countries, including Sweden, national guidelines for post cardiac arrest care and follow-up programs are not available and current practice has not previously been investigated. The aim of this survey was therefore to describe current post cardiac arrest care and follow-up in Sweden. Methods: An internet based questionnaire was sent to the resuscitation coordinators at all Swedish emergency hospitals (n = 74) and 59 answers were received. Quantitative data were analysed with descriptive statistics and free text responses were analysed using manifest content analysis. Results: Almost half of the hospitals in Sweden (n = 27, 46 %) have local guidelines for post cardiac arrest care and follow-up. However, 39 % of them reported that these guidelines were not always applied. The most common routine is a follow-up visit at a cardiac reception unit. If the need for neurological or psychological support are discovered the routines are not explicit. In addition, family members are not always included in the follow-up. Conclusions: Although efforts are already made to improve post cardiac arrest care and follow-up, many hospitals need to focus more on this part of cardiac arrest treatment. In addition, evidence-based national guidelines will have to be developed and implemented in order to achieve a more uniform care and follow-up for survivors and their family members. This national survey highlights this need, and might be helpful in the implementation of such guidelines.

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  • 328.
    Jaarsma, Tiny
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för omvårdnad och reproduktiv hälsa. Linköpings universitet, Medicinska fakulteten. Australian Catholic Univ, Australia; Univ Med Ctr Utrecht, Netherlands.
    Strömberg, Anna
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för omvårdnad och reproduktiv hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärtcentrum, Kardiologiska kliniken US.
    Dunbar, S. B.
    Emory Univ, GA 30322 USA.
    Fitzsimons, D.
    Queens Univ Belfast, North Ireland.
    Lee, C.
    Boston Coll, MA 02167 USA.
    Middleton, S.
    St Vincents Hlth Australia, Australia; Australian Catholic Univ, Australia.
    Vellone, E.
    Univ Roma Tor Vergata, Italy.
    Freedland, K. E.
    Washington Univ, MO 14263 USA.
    Riegel, B.
    Australian Catholic Univ, Australia; Univ Penn, PA 19104 USA.
    Self-care research: How to grow the evidence base?2020Ingår i: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 105, artikel-id UNSP 103555Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Background and objective: The number of studies in the area of self-care is growing and international researchers are increasingly developing self-care interventions to improve outcomes of individual patients and communities. However, growth of the evidence is still slow due to challenges with designing and testing self-care interventions. In this article we address major methodological challenges with regard to the definition of self-care, use of theory, and research design, intended to provide guidance to researchers in this field. Method: During the inaugural conference of the International Center for Self-Care Research held in Rome, Italy in June 2019 we identified important issues in existing self-care research. Discussion and literature review lead to eight recommendation for future self-care research. Results: In preparation, begin with a theoretically sound definition of self-care. In planning the intervention, build on and extend previous studies. Use theory to develop self-care interventions and consider translational models to guide development, evaluation and implementation of complex self-care interventions. Employ a study design that fits the current phase and objectives of the research and measure self-care and related factors carefully. In reporting, describe the sample and setting sufficiently so that others can draw conclusions about generalizability and applicability to their practice and patient population. In interpretation, describe how the intervention is assumed to work (causal assumptions) and its key components. Conclusion: Our review of existing self-care research clearly illustrates that the recommendations we provide are needed if we are to substantially grow the evidence base supporting self-care. Embracing a core set of principles will allow us to build on each others work. Tweetable abstract: A core set of methodological principles is needed to substantially grow the evidence base supporting self-care. (C) 2020 The Authors. Published by Elsevier Ltd.

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  • 329.
    Jaarsma, Tiny
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för omvårdnad och reproduktiv hälsa. Linköpings universitet, Medicinska fakulteten. Australian Catholic Univ, Australia; Univ Med Ctr Utrecht, Netherlands.
    Strömberg, Anna
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för omvårdnad och reproduktiv hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärtcentrum, Kardiologiska kliniken US.
    Dunbar, S. B.
    Emory Univ, GA 30322 USA.
    Fitzsimons, D.
    Queens Univ Belfast, North Ireland.
    Lee, C.
    Boston Coll, MA 02167 USA.
    Middleton, S.
    St Vincents Hlth Australia, Australia; Australian Catholic Univ, Australia.
    Vellone, E.
    Univ Roma Tor Vergata, Italy.
    Freedland, K. E.
    Washington Univ, MO 14263 USA.
    Riegel, B.
    Australian Catholic Univ, Australia; Univ Penn, PA 19104 USA.
    Self-care research: How to grow the evidence base? (reprint) (Reprinted from International Journal of Nursing Studies, vol 105, 103555, 2020)2021Övrigt (Refereegranskat)
    Abstract [en]

    Background and objective: The number of studies in the area of self-care is growing and international researchers are increasingly developing self-care interventions to improve outcomes of individual patients and communities. However, growth of the evidence is still slow due to challenges with designing and testing self-care interventions. In this article we address major methodological challenges with regard to the definition of self-care, use of theory, and research design, intended to provide guidance to researchers in this field. Method: During the inaugural conference of the International Center for Self-Care Research held in Rome, Italy in June 2019 we identified important issues in existing self-care research. Discussion and literature review lead to eight recommendation for future self-care research. Results: In preparation, begin with a theoretically sound definition of self-care. In planning the intervention, build on and extend previous studies. Use theory to develop self-care interventions and consider translational models to guide development, evaluation and implementation of complex self-care interventions. Employ a study design that fits the current phase and objectives of the research and measure self-care and related factors carefully. In reporting, describe the sample and setting sufficiently so that others can draw conclusions about generalizability and applicability to their practice and patient population. In interpretation, describe how the intervention is assumed to work (causal assumptions) and its key components. Conclusion: Our review of existing self-care research clearly illustrates that the recommendations we provide are needed if we are to substantially grow the evidence base supporting self-care. Embracing a core set of principles will allow us to build on each others work. Tweetable abstract: A core set of methodological principles is needed to substantially grow the evidence base supporting self-care. (C) 2020 The Author(s). Published by Elsevier Ltd.

  • 330.
    Jacobsson, Catrine
    Östergötlands Läns Landsting. PrioriteringsCentrum.
    Öppna prioriteringar inom omvårdnad: ett samarbetsprojekt med SSF och Vårdförbundet2006Rapport (Övrigt vetenskapligt)
    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.

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  • 331.
    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 Läkemedelsförmånsnämnden2005Rapport (Övrigt vetenskapligt)
    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.

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  • 332.
    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
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten.
    A utility valuation study assessing the impact of postprandial glucose control on quality of life of individuals with type 1 or type 2 diabetes2018Ingår i: Journal of patient-reported outcomes, ISSN 2509-8020, Vol. 2, nr 1, artikel-id 20Artikel i tidskrift (Refereegranskat)
    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.

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  • 333.
    Jendle, Johan
    et al.
    Orebro Univ, Sweden.
    Ericsson, Asa
    Novo Nordisk Scandinavia, Sweden.
    Ekman, Bertil
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Medicincentrum, Endokrinmedicinska kliniken.
    Sjoberg, Stefan
    Karolinska Huddinge Univ Hosp, Sweden.
    Gundgaard, Jens
    Novo Nordisk AS, Denmark.
    da Rocha Fernandes, Joao
    Novo Nordisk AS, Denmark.
    Mardby, Ann-Charlotte
    Novo Nordisk Scandinavia, Sweden.
    Hunt, Barnaby
    Ossian Hlth Econ & Commun, Switzerland.
    Malkin, Samuel J. P.
    Ossian Hlth Econ & Commun, Switzerland.
    Thunander, Maria
    Lund Univ, Sweden.
    Real-world cost-effectiveness of insulin degludec in type 1 and type 2 diabetes mellitus from a Swedish 1-year and long-term perspective2020Ingår i: Journal of Medical Economics, ISSN 1369-6998, E-ISSN 1941-837X, Vol. 23, nr 11, s. 1311-1320Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background and aims

    The ReFLeCT study demonstrated that switching to insulin degludec from other basal insulins was associated with reductions in glycated hemoglobin and hypoglycemic events in type 1 (T1D) and type 2 diabetes (T2D), and reductions in insulin doses in T1D. The aim of the present analysis was to assess the short- and long-term cost-effectiveness of switching to insulin degludec in Sweden.

    Methods

    Short-term outcomes were evaluated over 1 year in a Microsoft Excel model, while long-term outcomes were projected over patient lifetimes using the IQVIA CORE Diabetes Model. Cohort characteristics and treatment effects were sourced from the ReFLeCT study. Costs (in 2018 Swedish krona [SEK]) encompassed direct medical expenditure and indirect costs from loss of workplace productivity. In the long-term analyses, patients were assumed to receive insulin degludec or continue prior insulin therapy (primarily insulin glargine U100) for 5 years, before all patients intensified to once-daily degludec and mealtime aspart.

    Results

    Switching to insulin degludec was associated with improved quality-adjusted life expectancy of 0.04 and 0.02 quality-adjusted life years (QALYs) over 1 year, and 0.16 and 0.08 QALYs over patient lifetimes, in T1D and T2D. Combined costs in T1D and T2D were estimated to be SEK 1,249 lower and SEK 1,181 higher over the short-term, and SEK 157,258 and SEK 2,114 lower over the long-term. Benefits were due to lower insulin doses in T1D, reduced rates of hypoglycemia, and lower incidences of diabetes-related complications. Insulin degludec was associated with an incremental cost-effectiveness ratio of SEK 64,298 per QALY gained for T2D over 1 year and considered dominant for T1D and T2D in all other comparisons.

    Conclusions

    Insulin degludec was projected to be cost-effective or dominant versus other basal insulins for the treatment of T1D and T2D in Sweden.

  • 334. Beställ onlineKöp publikationen >>
    Johannesen, Kasper
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Linköpings universitet, Medicinska fakulteten.
    The value of evaluating and implementing pharmaceuticals2021Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [sv]

    Läkemedel är en viktig komponent i dagens hälso- och sjukvård och en resurs som bidrar till att förbättra hälsan i befolkningen. Om läkemedelspriserna som sätts av de privata företag som utvecklar och äger rättigheterna till nya läkemedel är höga kan dock värdet som läkemedlen bidrar med till hälso- och sjukvården ifrågasättas. Offentligt finansierade hälso- och sjukvårdssystem behöver få ut mesta möjliga av begränsade resurser, vilket har blivit ännu tydligare de senaste åren med en åldrande befolkning, snabb teknisk utveckling och en global pandemi. Att sänka läkemedelspriserna kan öka värdet som läkemedlen bidrar med till hälso och sjukvårdssystemen idag. Samtidigt kan lägre priser minska incitamenten att utveckla framtida behandlingar. Därför måste hälso- och sjukvårdssystemen hitta en balans mellan att maximera värdet från de behandlingar som finns tillgängliga idag och att samtidigt stimulera utvecklingen av framtida behandlingar. 

    Myndigheter och beslutsfattare inom hälso- och sjukvården använder olika policyer för att kontrollera priser på och användning av läkemedel. Dessa policyer är dock sällan föremål för formell analys och hur de påverkar hälsan på kort och lång sikt är ofta oklart. Syftet med den här avhandlingen var att undersöka hur policyer som styr läkemedelspriser samt implementering av nya läkemedel kan påverka både hälsan i befolkningen och incitament för forskning och utveckling (FoU) av läkemedel. 

    Den första studien beskriver ett ramverk för att bedöma effekten av läkemedelspolicyer på både hälsa och läkemedelsintäkter. Studien visar att policyer som inkluderar prissänkningar kan öka värdet som läkemedel bidrar med för hälso- och sjukvårdssystemen idag samtidigt som FoU incitamenten minskar. Utformningen av specifika policyer avgör storleken på effekterna och fördelningen av de vinster som lägre priser kan ge för patienter, vårdgivare, apotek och andra berörda parter. Den andra studien analyserar avvägningen mellan hur noggranna och hur kostsamma kostnadseffektivitetsbedömningar av läkemedel skall vara. Detta görs genom att betrakta bedömningen som ett diagnostiskt test med syftet att identifiera kostnadseffektiva behandlingar. Studien identifierar några policyrelevanta slutsatser, till exempel att processen bör vara flexibel över tid och baseras på egenskaperna hos behandlingen som är föremål för bedömning. Studie tre undersöker effekterna av regionala variationer vid implementeringen av trombocythämmaren ticagrelor. Studien visar att ytterligare 1 100 kvalitetsjusterade levnadsår (QALYs) kunde ha vunnits om alla regioner hade implementerat ticagrelor i samma utsträckning som regionerna med högst implementering. Värdet av att undvika regionala variationer vid implementering av ticagrelor skulle därmed kunna skattas till åtminstone 275 miljoner kronor (om en QALY antas vara värd 250 000 kronor). Studien visar också att det kan uppstå betydande kostnader i termer av förlorad hälsa om implementeringen styrs av sekventiella beslut där behandlingsriktlinjer och tillgänglig finansiering inte är synkade med beslutet att subventionera läkemedlet. I den fjärde studien undersöks effekten av ticagrelor i klinisk praxis genom att använda data från kvalitetsregistret SWEDEHEART. Studien finner att mortalitetsrisken när ticagrelor ges i rutinsjukvård reduceras i samma utsträckning som i den randomiserade PLATO-studien. Studien visar också på vikten av att använda lämpliga metoder för observationsforskning som undersöker kausala behandlingseffekter av läkemedel i klinisk praxis. 

    Sammanfattningsvis visar avhandlingen på vikten av att analysera och förstå effekten av policyer som styr pris på och implementering av läkemedel, oavsett om målet är att maximera värdet av tillgängliga läkemedel eller om hänsyn och så skall tas till att stimulera utvecklingen av nya läkemedel i framtiden. Värdet av att förbättra användningen av effektiva och kostnadseffektiva läkemedel är inte lika uppenbart eller konkret som besparingar från sänkta läkemedelspriser men förefaller kunna bidra till förbättrad hälsa i befolkningen både på kort och lång sikt.  

    Delarbeten
    1. Getting value today and incentivising for the future: Pharmaceutical development and healthcare policies
    Öppna denna publikation i ny flik eller fönster >>Getting value today and incentivising for the future: Pharmaceutical development and healthcare policies
    2017 (Engelska)Ingår i: Nordic Journal of Health Economics, ISSN 1892-9729, E-ISSN 1892-9710, Vol. 5, nr 1, s. 77-96Artikel, forskningsöversikt (Refereegranskat) Published
    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.

    Ort, förlag, år, upplaga, sidor
    University of Oslo, 2017
    Nyckelord
    pharmaceutical market, pharmaceutical regulation, R&D incentives, intellectual property rights
    Nationell ämneskategori
    Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi
    Identifikatorer
    urn:nbn:se:liu:diva-154061 (URN)10.5617/njhe.888 (DOI)
    Tillgänglig från: 2019-01-24 Skapad: 2019-01-24 Senast uppdaterad: 2021-12-28
    2. How to design the cost‐effectiveness appraisal process of new healthcare technologies to maximise population health: A conceptual framework
    Öppna denna publikation i ny flik eller fönster >>How to design the cost‐effectiveness appraisal process of new healthcare technologies to maximise population health: A conceptual framework
    2018 (Engelska)Ingår i: Health Economics, ISSN 1057-9230, E-ISSN 1099-1050, Vol. 27, nr 2, s. e41-e54Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    This paper presents a conceptual framework to analyse the design of the cost‐effectiveness appraisal process of new healthcare technologies. The frameworkcharacterises the appraisal processes as a diagnostic test aimed at identifyingcost‐effective (true positive) and non‐cost‐effective (true negative) technologies.Using the framework, factors that influence the value of operating an appraisalprocess, in terms of net gain to popula tion health, are identified. The frame-work is used to gain insight into current policy questions including (a) howrigorous the process should be, (b) who should have the burden of proof, and(c) how optimal design changes when allowing for appeals, price reductions,resubmissions, and re‐evaluations.The paper demonstrates that there is no one optimal appraisal process and theprocess should be adapted over time and to the specific technology underassessment. Optimal design depends on country‐specific features of (future)technologies, for example, effect, price, and size of the patient population,which might explain the difference in appraisal processes across countries. Itis shown that burden of pro of should be placed on the producers and that theimpact of price reductions and patient access schemes on the producer's pricesetting should be considered when designing the appraisal process.

    Ort, förlag, år, upplaga, sidor
    John Wiley & Sons, 2018
    Nyckelord
    cost‐effectiveness appraisal and decision making, economic evaluation, health technology appraisal
    Nationell ämneskategori
    Hälsovetenskaper
    Identifikatorer
    urn:nbn:se:liu:diva-140899 (URN)10.1002/hec.3561 (DOI)000428523400004 ()
    Tillgänglig från: 2017-09-14 Skapad: 2017-09-14 Senast uppdaterad: 2021-04-29
    3. Subcategorizing the Expected Value of Perfect Implementation to Identify When and Where to Invest in Implementation Initiatives
    Öppna denna publikation i ny flik eller fönster >>Subcategorizing the Expected Value of Perfect Implementation to Identify When and Where to Invest in Implementation Initiatives
    2020 (Engelska)Ingår i: Medical decision making, ISSN 0272-989X, E-ISSN 1552-681X, Vol. 40, nr 3, s. 327-338Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Purpose. Clinical practice variations and low implementation of effective and cost-effective health care technologies are a key challenge for health care systems and may lead to suboptimal treatment and health loss for patients. The purpose of this work was to subcategorize the expected value of perfect implementation (EVPIM) to enable estimation of the absolute and relative value of eliminating slow, low, and delayed implementation. Methods. Building on the EVPIM framework, this work defines EVPIM subcategories to estimate the expected value of eliminating slow, low, or delayed implementation. The work also shows how information on regional implementation patterns can be used to estimate the value of eliminating regional implementation variation. The application of this subcategorization is illustrated by a case study of the implementation of an antiplatelet therapy for the secondary prevention after myocardial infarction in Sweden. Incremental net benefit (INB) estimates are based on published cost-effectiveness assessments and a threshold of SEK 250,000 (22,300) pound per quality-adjusted life year (QALY). Results. In the case study, slow, low, and delayed implementation was estimated to represent 22%, 34%, and 44% of the total population EVPIM (2941 QALYs or SEK 735 million), respectively. The value of eliminating implementation variation across health care regions was estimated to 39% of total EVPIM (1138 QALYs). Conclusion. Subcategorizing EVPIM estimates the absolute and relative value of eliminating different parts of suboptimal implementation. By doing so, this approach could help decision makers to identify which parts of suboptimal implementation are contributing most to total EVPIM and provide the basis for assessing the cost and benefit of implementation activities that may address these in future implementation of health care interventions.

    Ort, förlag, år, upplaga, sidor
    Sage Publications, 2020
    Nyckelord
    health care decision making; implementation strategies; value of implementation
    Nationell ämneskategori
    Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi
    Identifikatorer
    urn:nbn:se:liu:diva-165244 (URN)10.1177/0272989X20907353 (DOI)000523170200001 ()32133911 (PubMedID)2-s2.0-85081645022 (Scopus ID)
    Tillgänglig från: 2020-04-20 Skapad: 2020-04-20 Senast uppdaterad: 2021-12-28Bibliografiskt granskad
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  • 335.
    Johannesen, Kasper
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Medicinska fakulteten. 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 policies2017Ingår i: Nordic Journal of Health Economics, ISSN 1892-9729, E-ISSN 1892-9710, Vol. 5, nr 1, s. 77-96Artikel, forskningsöversikt (Refereegranskat)
    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.

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  • 336.
    Johannesen, Kasper
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Linköpings universitet, Medicinska fakulteten.
    Janzon, Magnus
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärtcentrum, Kardiologiska kliniken US.
    Jernberg, Tomas
    Department of Clinical Sciences, Karolinska Institute, Danderyd University Hospital, Stockholm, Sweden.
    Henriksson, Martin
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Linköpings universitet, Medicinska fakulteten.
    Subcategorizing the Expected Value of Perfect Implementation to Identify When and Where to Invest in Implementation Initiatives2020Ingår i: Medical decision making, ISSN 0272-989X, E-ISSN 1552-681X, Vol. 40, nr 3, s. 327-338Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose. Clinical practice variations and low implementation of effective and cost-effective health care technologies are a key challenge for health care systems and may lead to suboptimal treatment and health loss for patients. The purpose of this work was to subcategorize the expected value of perfect implementation (EVPIM) to enable estimation of the absolute and relative value of eliminating slow, low, and delayed implementation. Methods. Building on the EVPIM framework, this work defines EVPIM subcategories to estimate the expected value of eliminating slow, low, or delayed implementation. The work also shows how information on regional implementation patterns can be used to estimate the value of eliminating regional implementation variation. The application of this subcategorization is illustrated by a case study of the implementation of an antiplatelet therapy for the secondary prevention after myocardial infarction in Sweden. Incremental net benefit (INB) estimates are based on published cost-effectiveness assessments and a threshold of SEK 250,000 (22,300) pound per quality-adjusted life year (QALY). Results. In the case study, slow, low, and delayed implementation was estimated to represent 22%, 34%, and 44% of the total population EVPIM (2941 QALYs or SEK 735 million), respectively. The value of eliminating implementation variation across health care regions was estimated to 39% of total EVPIM (1138 QALYs). Conclusion. Subcategorizing EVPIM estimates the absolute and relative value of eliminating different parts of suboptimal implementation. By doing so, this approach could help decision makers to identify which parts of suboptimal implementation are contributing most to total EVPIM and provide the basis for assessing the cost and benefit of implementation activities that may address these in future implementation of health care interventions.

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  • 337.
    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 model2004Ingår i: Social Science & Medicine, ISSN 0277-9536, Vol. 58, nr 10, s. 1857-1868Artikel i tidskrift (Refereegranskat)
    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.

  • 338.
    Johansson, Joel
    et al.
    Cty Hosp Ryhov, Sweden.
    Andersson, Roland
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för kirurgi, ortopedi och onkologi. Linköpings universitet, Medicinska fakulteten. Cty Hosp Ryhov, Sweden.
    Landerholm, Kalle
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för kirurgi, ortopedi och onkologi. Linköpings universitet, Medicinska fakulteten. Cty Hosp Ryhov, Sweden.
    Redéen, Stefan
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Centrum för kirurgi, ortopedi och cancervård, Kirurgiska kliniken US.
    Incidence of Appendiceal Malignancies in Sweden Between 1970 and 20122020Ingår i: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 44, s. 4086-4092Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background There is limited knowledge about the epidemiology of the major histological subtypes of appendiceal malignancy: adenocarcinoma and neuroendocrine neoplasm of the appendix (A-NEN). The aims of this national cohort study were to assess the prevalence, incidence and trends of appendiceal malignancies in Sweden. Method All individuals who underwent appendicectomy and all diagnosed with appendiceal malignancy from 1970 to 2012 were identified from the National Patient Register and the Swedish Cancer Registry. Demographic data of the background population were obtained from Statistics Sweden. The incidence rate (IR) and the prevalence of appendiceal malignancy per performed appendicectomy were calculated. Results We identified 3774 patients with appendiceal malignancy. IR of A-NEN was 5.8/10(6)person-years with a peak of 8.4/10(6)at age 20-30 years, whereafter it plateaued at a somewhat lower level. IR for adenocarcinoma was 3.7/10(6)person-years, starting at a very low level among the youngest and increasing to 15.4/10(6)at age 80-89 years. The IR of adenocarcinoma increased from 2.6/10(6)in 1970-1979 to 5.4/10(6)in 2010-2012. The IR of A-NEN was stable during the study period. The prevalence per appendicectomy was low for both types of malignancies among the young but increased with age, most dramatically for adenocarcinoma. There was a trend during the study period towards more extensive surgery. Conclusion Adenocarcinoma is most common and increasing in the elderly, whereas A-NEN affects all ages with a peak in young age. This peak probably reflects removal of occult A-NEN due to the higher appendicectomy frequency in the young.

  • 339. Beställ onlineKöp publikationen >>
    Johansson Krafve, Linus
    Linköpings universitet, Institutionen för tema, Tema teknik och social förändring. Linköpings universitet, Filosofiska fakulteten.
    Valuation in Welfare Markets: The Rule Books, Whiteboards and Swivel Chairs of Care Choice Reform2015Doktorsavhandling, monografi (Övrigt vetenskapligt)
    Abstract [sv]

    Avhandlingen intresserar sig för hur värden får sin praktiska innebörd i marknadsreformer av välfärdstjänster. Studien bygger på att undersöka hur värden blir lokalt iscensatta snarare än att behandla dem som universella och stabila. Syftet med studien är att utveckla begrepp för att förstå hur marknadsskapande styrning av välfärd hanterar de motstridiga värden som står på spel i välfärdsreform.

    Det empiriska fallet utgörs av styrningen av det s.k. vårdvalet i ett svenskt landsting. Metoden är ”skuggning” av tjänstemän som jobbar med att formulera en s.k. regelbok för vårdcentraler. Analysen beskriver hur dessa tjänstemän arbetar med att hantera olika typer av värden när de konstruerar regelboken. Hur de väljer att organisera sitt arbete – vilka metoder de använder för att samla in data om vårdcentralernas prestationer, vilka verktyg de använder för styrning, hur de ordnar sina arbetsroller, samt hur de konstruerar regelboken – leder till värdeförskjutningar och styr vilka uttryck de olika värdena får i praktiken.

    Tjänstemännens arbete är politiskt såtillvida att det aktivt formar de värden som får utrymme i vårdvalsreformen. Därför är det av stor vikt att skapa en bredare debatt kring organisering av sådan styrning, samtidigt som det kräver att man problematiserar förenklade bilder av vad marknadsreformer i välfärden betyder i praktiken. Avhandlingen föreslår att ett ”ekologiskt” – dvs. ett situerat, reflexivt och föränderligt – perspektiv på hanteringen av motstridiga värden i marknadsreformer kan bidra till en sådan debatt.

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  • 340.
    Johansson, Lisbeth M.
    et al.
    Futurum Acad Hlth & Care, Sweden; Jonkoping Univ, Sweden.
    Eriksson, Marit
    Futurum Acad Hlth & Care, Sweden.
    Dahlin, Sofia
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för samhälle och hälsa. Linköpings universitet, Medicinska fakulteten. Futurum Acad Hlth & Care, Sweden.
    Lingfors, Hans
    Futurum Acad Hlth & Care, Sweden.
    Golsater, Marie
    Jonkoping Univ, Sweden; Child Hlth Serv, Sweden.
    Healthcare professionals experiences of targeted health dialogues in primary health care2023Ingår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 38, nr 1, s. 231-239Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BackgroundIn Sweden, population-based targeted health dialogues are an important part of health promotion and disease prevention in primary health care. Targeted health dialogues are performed with a pedagogical approach to allow individuals to reflect over their resources, situation and motivation to change lifestyle habits together with a healthcare professional.AimThe aim of this study was to explore healthcare professionals experiences of targeted health dialogues in primary health care.MethodsThree focus group interviews were conducted with 20 healthcare professionals. The interviews were analysed using qualitative content analysis.ResultsThe main category A possibility to promote healthy behaviours and prevent disease describes how the targeted health dialogues were experienced as a valuable opportunity to promote health among inhabitants. The significance of the primary healthcare centres health promotion and prevention strategies was emphasised to enable the targeted health dialogues as a part of the assignment to promote health. These strategies were expressed as shared focus and organisational space and support making it possible for example to reach all socioeconomic groups. The work with targeted health dialogue was described as a complex task requiring extensive competence. Furthermore, the pedagogical tool including the visual health profile was experienced to have an important impact on the dialogue offering direction for actions to promote health and prevent disease.ConclusionsTargeted health dialogues can be a valuable opportunity for healthcare professionals in primary health care to promote a healthy lifestyle among inhabitants. Certain preconditions at both the meso- and the micro level is however required for this to come about.

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  • 341.
    Johnson, Ericka
    Linköpings universitet, Institutionen för tema, Tema Genus. Linköpings universitet, Filosofiska fakulteten.
    Book Review: A cultural biography of the prostate2022Ingår i: Asian Journal of Andrology, ISSN 1008-682X, E-ISSN 1745-7262, Vol. 24, nr 2, s. 228-228Artikel, recension (Övrigt vetenskapligt)
    Abstract [en]

    n/a

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  • 342.
    Joukes, Erik
    et al.
    University of Amsterdam, Netherlands.
    Cornet, Ronald
    Linköpings universitet, Institutionen för medicinsk teknik, Medicinsk informatik. Linköpings universitet, Tekniska fakulteten. 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 Preach2016Ingår i: EXPLORING COMPLEXITY IN HEALTH: AN INTERDISCIPLINARY SYSTEMS APPROACH, IOS PRESS , 2016, Vol. 228, s. 252-256Konferensbidrag (Refereegranskat)
    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.

  • 343.
    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
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Avdelningen för neuro- och inflammationsvetenskap. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Reumatologiska kliniken i Östergötland.
    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.2016Ingår i: Seminars in Arthritis & Rheumatism, ISSN 0049-0172, E-ISSN 1532-866X, Vol. 45, nr 6, s. 684-690Artikel, forskningsöversikt (Refereegranskat)
    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.

  • 344.
    Jönsson, Adam
    et al.
    Linköpings universitet, Medicinska fakulteten.
    Cewers, Emilie
    Linköpings universitet, Medicinska fakulteten.
    Ben Gal, Tuvia
    Rabin Med Ctr, Israel; Tel Aviv Univ, Israel.
    Weinstein, Jean Marc
    Ben Gurion Univ Negev, Israel.
    Strömberg, Anna
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för omvårdnad och reproduktiv hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärtcentrum, Kardiologiska kliniken US.
    Jaarsma, Tiny
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för omvårdnad och reproduktiv hälsa. Linköpings universitet, Medicinska fakulteten.
    Perspectives of Health Care Providers on the Role of Culture in the Self-Care of Patients with Chronic Heart Failure: A Qualitative Interview Study2020Ingår i: INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH, ISSN 1661-7827, Vol. 17, nr 14, artikel-id 5051Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Self-care is important in chronic diseases such as heart failure. The cultural background of health care providers might influence their view on self-care behaviour and education they provide. The aim of this study was to describe health care providers perceptions of the role of culture in self-care and how those perceptions shape their experiences and their practices. Methods: A qualitative study was performed in Israel, a country with a culturally diverse population. Data were collected using semi-structured interviews with 12 healthcare providers from different cultural backgrounds. Interviews were recorded and transcribed verbatim and analysed using content analysis. Results: Healthcare providers experienced cultural background influenced their patients self-care behaviour. Perceived culture-specific barriers to self-care such as dietary traditions interfering with the recommended diet, willingness to undertake self-care and beliefs conflicting with medical treatment were identified. Healthcare providers described that they adapted patient education and care based on the cultural background of the patients. Shared cultural background, awareness and knowledge of differences were described as positively influencing self-care education, while cultural differences could complicate this process. Conclusions: Cultural-specific barriers for self-care were perceived by health care providers and they identified that their own cultural background shapes their experiences and their practices.

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  • 345.
    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
    Linköpings universitet.
    Karlsson, G
    Stockholm School of Economics, Stockholm, Sweden.
    Cost-effectiveness of Fracture Prevention in Established Osteoporosis1996Ingår i: Scandinavian Journal of Rheumatology. Supplement, ISSN 0301-3847, E-ISSN 1502-7740, Vol. 25, nr Suppl. 103, s. 30-38Artikel i tidskrift (Refereegranskat)
    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.

  • 346.
    Kabel, Daan
    et al.
    Linköpings universitet, Institutionen för ekonomisk och industriell utveckling, Logistik- och kvalitetsutveckling. Linköpings universitet, Tekniska fakulteten.
    Martin, Jason
    Linköpings universitet, Institutionen för ekonomisk och industriell utveckling, Logistik- och kvalitetsutveckling. Linköpings universitet, Tekniska fakulteten.
    Olsson, Jesper
    Sveriges Kommuner och Landsting.
    Gremyr, Ida
    Chalmers Tekniska Högskola.
    Elg, Mattias
    Linköpings universitet, Institutionen för ekonomisk och industriell utveckling, Logistik- och kvalitetsutveckling. Linköpings universitet, Tekniska fakulteten.
    Witell, Lars
    Linköpings universitet, Institutionen för ekonomisk och industriell utveckling, Företagsekonomi. Linköpings universitet, Filosofiska fakulteten.
    Will Self-monitoring Transform Healthcare? Using Institutional Theory to Understand an ongoing transformation in the Swedish Healthcare Service Ecosystem2023Konferensbidrag (Övrigt vetenskapligt)
    Abstract [en]

    There is a growing interest in the use of digital technologies to create new roles and relations between health professionals and patients. This technology-enabled transformation extends the traditional interactional way to deliver healthcare services, which has been historically grounded for over 100 years. A compelling argument for this interest is that for many diseases, not least for chronically ill persons for whom the majority of practices related to treating their medical condition is carried out in their home, there is a space for healthcare service delivery that is largely invisible for the healthcare provider. Swedish healthcare is currently finding ways to adopt and utilize self-monitoring as an integral part of healthcare services. Even though there is consensus among many stakeholders that self-monitoring can be a potentially transformative force, the speed of transition is slow. The evolving phase of the healthcare service ecosystem becomes interesting to investigate and how a variety of institutional logics shape the future of the digitally engaged patient. A service ecosystem has previously been defined as “a relatively self-contained, self-adjusting system of resource-integrating actors connected by shared institutional arrangements and mutual value creation through service exchange” (Vargo and Lusch, 2016, p.10). By applying institutional theory to the case of self-monitoring in Sweden, we are responding to the call in service science to contribute to a better understanding of the service ecosystem of healthcare and what facilitates and constrains the changing roles of its actors in value creation. The purpose of this study is therefore to better understand the shift from the view of patients as passive receivers of care into being active co-producers that takes part in decision-making and in the care delivery through self-monitoring. Taking an institutional logic approach, the authors identify key “roles” (subjects), “materials” (objects) and “practices” (ways of acting) in the healthcare service ecosystem that facilitate and constrain the emergence of self-monitoring technologies. To do so, the study draws on multiple sources of evidence. First, 20 interviews have been conducted with respondents representing various key actors in the healthcare service ecosystem (e.g., health-care professionals, patient organizations, hospital managers, policy officials, pharma industries and information officers). Second, we observed a development project where new self-monitoring systems were piloted in cancer care. Our study offers several important implications for service theory and management. For service theory, this study shows how alignment and misalignment between practices, roles and materials facilitate and constrain the emergence of self-monitoring technologies within the health service ecosystem. For service management, this study raises four barriers – conflicts, compliance, lack of knowledge and appropriate technologies - that are crucial to overcome when implementing self-monitoring technologies

  • 347.
    Kadowaki, Åsa
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård. Linköpings universitet, Medicinska fakulteten.
    Alvunger, Anna-Karin
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten.
    Israelsson Larsen, Hanna
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Primärvårdscentrum, Vårdcentralen Cityhälsan Centrum.
    Persdotter, Anna
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för omvårdnad och reproduktiv hälsa. Linköpings universitet, Medicinska fakulteten.
    Zak, Marta Stelmach
    Linköpings universitet, Institutionen för hälsa, medicin och vård. Linköpings universitet, Medicinska fakulteten.
    Johansson, Peter
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för omvårdnad och reproduktiv hälsa. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i östra Östergötland, Medicinkliniken ViN.
    Nyström, Fredrik H
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Primärvårdscentrum, Vårdcentralen Cityhälsan Centrum.
    Education of the primary health care staff based on acceptance and commitment therapy is associated with reduced sick leave in a prospective controlled trial2021Ingår i: BMC Family Practice, E-ISSN 1471-2296, Vol. 22, nr 1, artikel-id 179Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The use of cognitive behavioral therapy (CBT) to cope with mental distress and pain issues has helped many patients in primary health care in Sweden. However, the effects of CBT to reduce sick leave has not been equally convincing. Acceptance and Commitment Therapy (ACT) is an evolution of traditional CBT and we aimed to study if education based on ACT of the staff rather than the patients could reduce sick leave in primary health care. Methods: This was a prospective trial in 6 primary health care centers in Kalmar (total amount of registered subjects of 28,930) in which the staff (physicians, nurses and therapists) received group-based education according to ACT during 2018 and 2019. The effects were compared with 5 similarly sized control health care centers in the neighboring Region of Jonkoping in which no such education took place. The main aim was to study changes in sick leave in the 6 primary care centers of Kalmar and to keep track of more general trends by studying sick leave also in Jonkoping, letting sick leave in the year 2017 to be the reference period for both areas. Results: The staff at the health care centers in Kalmar reported to having attended a mean of 5.2 +/- 2 educational ACT-sessions with psychiatrist Kadowaki in Kalmar. Sick leave for ICD-10 F43 (reaction to severe stress and related adjustment-disorders) was reduced from a mean value of 28.7 +/- 9.1ongoing sick leaves/month in 2017 to 22.6 +/- 7.0 sick leaves/month in 2018 (-21%, p = 0.033) and to 18.1 +/- 10 sick leaves/month in 2019 (-37%, p = 0.038). The corresponding sick leave for any diagnosis (total sick leave) was reduced from 132 +/- 39 sick leaves/month in 2017 to 118 +/- 38 sick leaves/month in 2018 (-11%, p = 0.056) and to 102 +/- 37 sick leaves/month in 2019 (-21%, p = 0.021). The corresponding sick leave comparisons in the control health centers did not show any significant changes (all p-values >= 0.24). Conclusions: Total monthly mean sick leave was reduced 21% in the health care centers in Kalmar during the second year of the educational ACT intervention of the staff while it was unchanged in Jonkoping. This suggests a significant effect to induce a reduction in long-term sick leave for patients in primary health care in which the staff received education according to ACT. The results of this trial could serve as a basis for a randomized trial in order to ascertain causality.

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  • 348. Beställ onlineKöp publikationen >>
    Kalkan, Almina
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Hälsouniversitetet.
    Diffusion, implementation and consequences of new health technology: The cases of biological drugs for rheumatoid arthritis and the Swedish national guidelines2015Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    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.

    Delarbeten
    1. Costs of rheumatoid arthritis during the period 1990–2010: a register-based cost-of-illness study in Sweden
    Öppna denna publikation i ny flik eller fönster >>Costs of rheumatoid arthritis during the period 1990–2010: a register-based cost-of-illness study in Sweden
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    2014 (Engelska)Ingår i: Rheumatology, ISSN 1462-0324, E-ISSN 1462-0332, Vol. 53, nr 1, s. 153-160Artikel i tidskrift (Refereegranskat) 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.

    Ort, förlag, år, upplaga, sidor
    Oxford University Press, 2014
    Nationell ämneskategori
    Medicin och hälsovetenskap Klinisk medicin
    Identifikatorer
    urn:nbn:se:liu:diva-100004 (URN)10.1093/rheumatology/ket290 (DOI)000329041900022 ()24136064 (PubMedID)
    Tillgänglig från: 2013-10-24 Skapad: 2013-10-24 Senast uppdaterad: 2020-02-27Bibliografiskt granskad
    2. Individual variations in treatment decisions by Swedish rheumatologists regarding biological drugs for rheumatoid arthritis
    Öppna denna publikation i ny flik eller fönster >>Individual variations in treatment decisions by Swedish rheumatologists regarding biological drugs for rheumatoid arthritis
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    2015 (Engelska)Ingår i: Scandinavian Journal of Rheumatology, ISSN 0300-9742, E-ISSN 1502-7732, Vol. 44, nr 4, s. 265-270Artikel i tidskrift (Refereegranskat) 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.

    Ort, förlag, år, upplaga, sidor
    Informa Healthcare, 2015
    Nationell ämneskategori
    Klinisk medicin
    Identifikatorer
    urn:nbn:se:liu:diva-113301 (URN)10.3109/03009742.2014.997286 (DOI)000359960100002 ()
    Anmärkning

    DOI does not work: 10.3109/03009742.2014.997286

    Tillgänglig från: 2015-01-15 Skapad: 2015-01-15 Senast uppdaterad: 2018-12-13Bibliografiskt granskad
    3. Physician Preferences and Variations in Prescription of Biologic Drugs for Rheumatoid Arthritis: A Register-Based Study of 4,010 Patients in Sweden
    Öppna denna publikation i ny flik eller fönster >>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 (Engelska)Ingår i: Arthritis care & research, ISSN 2151-464X, E-ISSN 2151-4658, Vol. 67, nr 12, s. 1679-1685Artikel i tidskrift (Refereegranskat) 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.

    Ort, förlag, år, upplaga, sidor
    WILEY-BLACKWELL, 2015
    Nationell ämneskategori
    Klinisk medicin
    Identifikatorer
    urn:nbn:se:liu:diva-124498 (URN)10.1002/acr.22640 (DOI)000367681900008 ()26097219 (PubMedID)
    Anmärkning

    Funding Agencies|Norrbacka-Eugenia Foundation; Swedish Rheumatism Association

    Tillgänglig från: 2016-02-02 Skapad: 2016-02-01 Senast uppdaterad: 2020-02-27
    4. Factors influencing rheumatologists prescription of biological treatment in rheumatoid arthritis: an interview study
    Öppna denna publikation i ny flik eller fönster >>Factors influencing rheumatologists prescription of biological treatment in rheumatoid arthritis: an interview study
    2014 (Engelska)Ingår i: Implementation Science, E-ISSN 1748-5908, Vol. 9, nr 153Artikel i tidskrift (Refereegranskat) 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.

    Ort, förlag, år, upplaga, sidor
    BioMed Central, 2014
    Nyckelord
    Prescription; Rheumatoid arthritis; Biological drugs; Implementation; Physicians; Clinical decision-making; Practice variations; Qualitative; CFIR
    Nationell ämneskategori
    Klinisk medicin
    Identifikatorer
    urn:nbn:se:liu:diva-113028 (URN)10.1186/s13012-014-0153-5 (DOI)000345438200001 ()25304517 (PubMedID)
    Tillgänglig från: 2015-01-12 Skapad: 2015-01-08 Senast uppdaterad: 2024-01-17
    5. Management by Knowledge in Practice: Implementation of National Healthcare Guidelines in Sweden
    Öppna denna publikation i ny flik eller fönster >>Management by Knowledge in Practice: Implementation of National Healthcare Guidelines in Sweden
    2015 (Engelska)Ingår i: Social Policy & Administration, ISSN 0144-5596, E-ISSN 1467-9515, Vol. 49, nr 7, s. 911-927Artikel i tidskrift (Refereegranskat) 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.

    Ort, förlag, år, upplaga, sidor
    John Wiley & Sons, 2015
    Nyckelord
    Policy implementation; Institutional pressure; Strategic responses; Swedish National Guidelines
    Nationell ämneskategori
    Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi
    Identifikatorer
    urn:nbn:se:liu:diva-113304 (URN)10.1111/spol.12102 (DOI)000368267400006 ()
    Tillgänglig från: 2015-01-15 Skapad: 2015-01-15 Senast uppdaterad: 2018-11-09Bibliografiskt granskad
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  • 349.
    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
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Primärvårdscentrum, Vårdcentralen 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 practice2017Ingår i: Primary Care Diabetes, ISSN 1751-9918, E-ISSN 1878-0210, Vol. 11, nr 2, s. 184-192Artikel i tidskrift (Refereegranskat)
    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.

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  • 350.
    Kalkan, Almina
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Hälsouniversitetet.
    Sandberg, Johanna
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Hälsouniversitetet.
    Garpenby, Peter
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för hälso- och sjukvårdsanalys. Linköpings universitet, Hälsouniversitetet.
    Management by Knowledge in Practice: Implementation of National Healthcare Guidelines in Sweden2015Ingår i: Social Policy & Administration, ISSN 0144-5596, E-ISSN 1467-9515, Vol. 49, nr 7, s. 911-927Artikel i tidskrift (Refereegranskat)
    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.

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