| 1. |
- Schmidt, Ingrid, et al.
(författare)
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The national program on standardized cancer care pathways in Sweden : Observations and findings half way through
- 2018
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Ingår i: Health Policy. - : Elsevier. - 0168-8510 .- 1872-6054. ; 122:9, s. 945-948
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Tidskriftsartikel (refereegranskat)abstract
- In 2015, the Swedish government initiated a national cancer reform program to standardize cancer care pathways. Primary aims included shortened waiting times among patients with suspected cancer, increased patient satisfaction and reduced regional variation. The implementation phase of the program is now more than half way through and both achievements and challenges have been identified. The ongoing evaluation demonstrates that professional engagement and adjustments on the meso- and micro-level of the system are essential to achieving sustainable improvements. Waiting times have shortened for the pathways launched first, and patients are satisfied with a more transparent process. Physicians in primary care are satisfied to inform patients about the pathways but point out problems with comorbidity and complicated diagnostic procedures related to unspecific symptoms. Mechanisms and ethical considerations behind possible crowding-out effects need to be thoroughly highlighted and discussed with staff and management. The results so far appear promising but meso- and micro-levels of the system need to be more involved in the design processes.
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| 2. |
- Kandelaki, Ketevan, et al.
(författare)
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Patient-centredness as a quality domain in Swedish healthcare : results from the first national surveys in different Swedish healthcare settings
- 2016
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 6:1
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Patients' perception of the quality and patient-centredness of healthcare has gained increasing interest in the last decade in Sweden, as in other countries. The purpose of the study was to evaluate to what extent patients perceived Swedish healthcare as patient-centred and to explore the satisfaction levels related to gender, education level and to having or not having Swedish as one's mother tongue. Design and settings: This study has a cross-sectional design. Analyses were based on the first national patient surveys in Sweden, conducted between 2009 and 2010. The surveys included responses from 232 518 patients who had been in contact with primary, outpatient, inpatient, or emergency care units. Survey questions related to indicators of patient-centred care and sociodemographic variables were selected for the analysis. The patients' level of satisfaction in the selected indicators was analysed and compared by sociodemographic and background factors. Multivariable logistic regression models were used for analysis. Results: The patients expressed high levels of satisfaction in questions related to the 'Respect' indicator (81-96% satisfied) but lower levels in most of the other indicators of patient-centred care. Only 25-30% of the patients reported they had been told about possible warning signs of their condition or treatment and 58-66% said they had received enough information about their condition. Group differences were detected. The most satisfied patient groups were men, individuals with low levels of education and those with Swedish as their mother tongue. Conclusions: According to these first national patient surveys, achieving patient-centred healthcare for all citizens is a challenge for Swedish healthcare authorities. Future analyses of national patient surveys should show whether national efforts to encourage acceptance of patient-centred approaches and strategies for equal care will give intended results.
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| 3. |
- Wilkens, Jens, et al.
(författare)
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The 2015 National Cancer Program in Sweden : Introducing standardized care pathways in a decentralized system.
- 2016
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Ingår i: Health Policy. - : Elsevier. - 0168-8510 .- 1872-6054. ; 120:12, s. 1378-1382
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Tidskriftsartikel (refereegranskat)abstract
- Starting in 2015, the Swedish government has initiated a national reform to standardize cancer patient pathways and thereby eventually speed up treatment of cancer. Cancer care in Sweden is characterized by high survival rates and a generally high quality albeit long waiting times. The objective with the new national program to standardize cancer care pathways is to reduce these waiting times, increase patient satisfaction with cancer care and reduce regional inequalities. A new time-point for measuring the start of a care process is introduced called well-founded suspicion, which is individually designed for each cancer diagnosis. While medical guidelines are well established earlier, the standardisation is achieved by defining time boundaries for each step in the process. The cancer reform program is a collaborative effort initiated and incentivized by the central government while multi-professional groups develop the time-bound standardized care pathways, which the regional authorities are responsible for implementing. The broad stakeholder engagement and time-bound guidelines are interesting approaches to study for other countries that need to streamline care processes.
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| 4. |
- Olsson, Jonny, et al.
(författare)
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Quality of Drug Prescribing in Elderly People in Nursing Homes and Special Care Units for Dementia : A Cross-Sectional Computerized Pharmacy Register Analysis
- 2010
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Ingår i: Clinical drug investigation. - Auckland : Springer Science and Business Media LLC. - 1173-2563 .- 1179-1918. ; 30:5, s. 289-300
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Tidskriftsartikel (refereegranskat)abstract
- Background: Drug prescribing to the elderly is extensive and often inappropriate. Furthermore, the number of drugs used is the most important risk factor for adverse drug reactions. Despite this, drug prescribing in the elderly in Sweden is high and increasing. In 2003 the Swedish National Board of Health and Welfare launched a set of indicators to evaluate the quality of drug therapy in the elderly. Use of this tool in combination with the Swedish computerized national register covering all persons receiving multi-dose drug dispensing (drugs dispensed in one dose unit bag for each dose occasion) would enable detection of inappropriate drug prescribing and could help reduce the risk of drug-related problems among the elderly. Objectives: To assess the extent and quality of drug prescribing in younger and older elderly residents receiving multi-dose drug dispensing in ordinary nursing homes (NHs) and special care units for dementia (NHDs), and to evaluate the relationship between the quality of prescribing and the number of prescribers per resident, in a Swedish county. Methods: The computerized national pharmacy drug register provided the database and a cross-sectional design was used. Selected drug-specific quality indicators proposed by the Swedish National Board of Health and Welfare in 2003 were used to assess the quality of drug prescribing. Results: This study included 3705 residents. Their mean age was 85 years and 72% were women. The mean number of prescribed drugs was 10.3 per resident. The proportion of residents with prescriptions for psychotropic drugs was 80% in NHs and 85% in NHDs. The prevalence of each drug-specific quality indicator was as follows: long-acting benzodiazepines 16.4% (NHs) versus 11.7% (NHDs), anticholinergic drugs 20.7% versus 18.5%, drug duplication 14.6% versus 13.6%, three or more psychotropic drugs 25.6% versus 35.3%, class C interactions (drug combinations that may require dose adjustment) 41.9% versus 38.7% and class D interactions (drug combinations that should be avoided) 8.1% versus 5.6%. Younger elderly residents (age 65-79 years) had a lower quality of drug prescribing. An increasing number of prescribers per resident was associated with a lower quality of drug therapy. Conclusions: We found a lower quality of drug prescribing, e.g. anticholinergic drugs prescribed to approximately 20% of residents of NHs and NHDs, and a higher rate of psychotropic drug use (>=80%) compared with previous studies in NHs. Our results also demonstrated a negative correlation between quality of prescribing and number of prescribers per resident.
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| 5. |
- Björkman, Ingeborg, et al.
(författare)
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Developing the role of the drug and therapeutics committees : Perceptions of chairs
- 2007
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Ingår i: International Journal of Health Care Quality Assurance. - : Emerald. - 0952-6862. ; 20:2, s. 161-178
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Tidskriftsartikel (refereegranskat)abstract
- Purpose – According to Swedish law, every county is required to have a local drug and therapeutics committee (DTC) to contribute to safe and cost-effective drug use. The law presents merely a framework and gives no detailed instructions addressing, for example, organisation and methods. The aim of this study is to explore the variation of conceptions of the role of the DTCs among committee Chairs and to compare the results with an earlier study. Design/methodology/approach – Data were collected by questionnaires and telephone interviews with committee chairs, which were analysed using a phenomenographic approach. Findings – Four conceptions were identified, namely: traditional, patient-aware, influential, holistic and cooperative, which all involved prescribers. In one conception the DTC acted as an expert to decision-makers. One conception included the notion that cooperation across the bureaucratic borders was important. Patients were involved in two conceptions. Comparison with the earlier study showed a trend toward higher patient awareness and a higher agreement on DTC goals with an increased focus on quality issues. Originality/value – This study demonstrates an alternative research method bringing in new perspectives when exploring activities within healthcare. Patient involvement in the work of the DTCs is increasing, but should be further explored and developed.
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| 6. |
- Björkman, Ingeborg, 1957-
(författare)
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Towards Improved Medication Use : Increasing Understanding of Professional Efforts
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Professionals and researchers have developed a number of strategies aimed at improving the quality and safety of medication use. However, studies continue to demonstrate persistent problems. For instance, the first paper in this thesis reveals the prevalence of potentially harmful drug combinations among elderly people in Europe. The following four papers focus on two professional groups and how they have approached safety and quality issues related to medication use: 1) the Swedish drug and therapeutics committees (DTCs) and 2) pharmacist involved in pharmaceutical care, an international movement. Qualitative research approaches were applied.Papers II and III focus on the DTCs: analyses indicate a development of the perception of the DTC role over time. The focus of the activities was broadened – from targeting prescribing physicians to incorporating decision-makers and patients. However, a clear patient-centered perspective was generally lacking. Moreover, the findings indicate a shift in focus from cost aspects of medication use to an increased focus on quality and safety aspects. In the studies addressing pharmaceutical care (Papers IV and V), the findings propose that different classification systems for drug-related problems had different characteristics which reflected differences in goals in the pharmaceutical care process. It was also found that the concept of pharmaceutical care was understood in different ways and that the perceptions were based on at least two different understandings of health and illness. First, a patient-centered perspective characterized by a holistic understanding of health and illness, and, second, an “EBM perspective” primarily based on a biomedical understanding of health and illness. This thesis has disclosed new aspects of how two groups of professionals perceive their work towards improved quality and safety of medication use. A patient-centered perspective among healthcare collectives is not obvious; therefore, efforts and comprehensive strategies supporting change are necessary. Strategies should focus on challenging the traditional thought patterns and care approaches among professionals and students.
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| 7. |
- Björkman, Ingeborg, et al.
(författare)
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The role of drug and therapeutics committees : Perceptions of chairs and information officers
- 2005
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Ingår i: International Journal of Health Care Quality Assurance. - : Emerald. - 0952-6862. ; 18:4, s. 235-48
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Tidskriftsartikel (refereegranskat)abstract
- Purpose – Improved quality and safety in drug use is a public health goal of major importance. In Sweden, local drug and therapeutics committees (DTCs) have adopted the task of working for safe and rational drug use. This study aimed to explore how chairs conceived the role of the DTCs, to explore how information officers conceived their own role, and to determine whether the respondents included patients in their answers. Design/methodology/approach – Data were collected using questionnaires and the answers were analysed according to phenomenographic method to identify conceptions. “Patient awareness” was studied by content analysis. Findings – In both groups the prescribers were the focus of attention, and only a few respondents mentioned patients. A variation of four conceptions was found among chairs and three among information officers. It would be beneficial if DTCs used this knowledge in their development. Originality/value – The importance of “patient awareness” within DTCs must be further explored.
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| 8. |
- Schmidt, Ingrid
(författare)
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Communication and teamwork : Studies of the impact on quality of drug use in swedish nursing homes
- 1999
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis examines factors that affect the quality of drug-use practices in Swedish nursing homes.The analysis comprises six consecutive studies. Data from the first four studies come from a randomizedcontrolled trial conducted in 1994-1995 with the primary aim of assessing the impact of regularmultidisciplinary team interventions on the quantity and quality of drug prescribing in 36 nursing homes. Facilities in the experimental group participated in an outreach program designed to influence drug use through improved teamwork among physicians, pharmacists, nurses, and nurse's assistants. The data for the last two studies come from a follow-up study in the same sample of nursing homes.Baseline results showed extensive psychotropic drug prescribing, with the most commonly prescribeddrugs being hypnotics (40%), anxiolytics (40%), and antipsychotics (38%). After 12 months of team meetings in nursing homes in the experimental group, there was a significant decrease in the prescribing of inappropriate drugs, as defined by recommendations from the Swedish Medical Product Agency.Pharmacists documented the nature of drug-related problems discussed during the meetings, as well as staff member assessments of resident outcomes. The most common drug-related problems were unclear indications and the appropriate choice of drugs. Nineteen percent of changes in drug therapy had a beneficial effect on the resident's reported clinical status while 47% of changes resulted in no observable changes in clinical outcome. Eight percent of the changes were considered to have had a negative effect on the resident. In these situations, the previous therapy was restored. The remaining 26% were too complicated to evaluate; it was not possible for nursing staff to assess whether a behavioral change was a result of the change in drug therapy.Quality indicators based on published guidelines and recommendations were developed to measure quality of drug use. Using the facility as the unit of analysis, there was a great variation among facilities in the quality of drug use. Resident characteristics (age, sex, diagnosis) did not contribute to variation among facilities in the 1995 study; rather, facilities with multidisciplinary teams and/or a staff: resident ratio above the median, were found to have higher quality of drug use.To assess the long-term effects of the multidisciplinary team intervention, a follow-up study on druguse was conducted in 1998. In addition, nurses in the study's 36 nursing homes were interviewed regarding the quality of their communication with physicians.Three factors accounted for the major part of the variation in the quality of drug use in the follow-upstudy: Whether or not the homes received the experimental intervention; the perceived quality of nursephysician communication; and the proportion of residents with behavioral symptoms.In summary, this thesis provides convincing evidence that the level of drug use in Swedish nursinghomes is high, and the choice of drugs for use in the nursing home population is often inappropriate. Further, clinical characteristics of residents-explain some, but not all, of the large variation in the quality of drug use among facilities. Factors associated with higher quality of drug use include higher perceived quality of nurse-physician communication, and exposure to the structured multidisciplinary team intervention.
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| 9. |
- Claesson, Cecilia B., et al.
(författare)
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Drug use in Swedish nursing homes
- 1998
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Ingår i: Clinical drug investigation. - 1173-2563 .- 1179-1918. ; 16:6, s. 441-52
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Tidskriftsartikel (refereegranskat)
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