| 1. |
- Broqvist, Mari, 1958-
(författare)
-
Asking the public : Citizens´ views on priority setting and resource allocation in democratically governed healthcare
- 2018
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Resource allocation in publicly funded healthcare systems is inevitably linked with priority setting between different patient groups and between different service areas, so-called meso level priorities. Behind every priority-setting decision (investments, reallocating or rationing), are values affecting both the content of the decisions and how the decisions are made. The importance for priority-setting to reflect social values, has been emphasised for the legitimacy of the healthcare systems and the decision makers. Also important, if supposed to provide enough guidance in practice, is that content values, expressed in ethical principles and criteria, are further operationalised. Few studies exist where Swedish citizens have been asked about priority setting and rationing at meso level, and findings from other countries cannot automatically be transferred to the Swedish context.The overall aim of this thesis is to extend and deepen the knowledge of the Swedish citizens´ views on acceptance of rationing in healthcare, on appropriate decision makers for rationing, and on the severity criterion for priority setting. Two qualitative and one mixmethod study were conducted, where citizens were interviewed. Citizens´ views on severity were also compared, both with a Severity Framework, derived from parliamentary-decided ethical principles and used for resource allocation, and with health professionals´ and politicians´ ranking of different aspects of severity in a quantitative, survey study.Study I shows that citizen participants perceived that acceptance of rationing at meso level is built on the awareness of priority-setting dilemmas between patient groups. No such spontaneous awareness was found. Depending on reactions of self-interest or solidarity, acceptance was also perceived to be built on acceptable principles for rationing and/or access to alternatives to public care. Study II shows that awareness of the meso level forms the basis for awareness of different risks of unfairness, linked with potential decision makers (even health professionals). Collaborative arrangements were promoted in order to control for such risks, especially the risk of self-interest. Politicians, in contrast to previous studies, were favoured as final decision makers for rationing healthcare. In study III, citizen participants identified the same severity aspects as health professionals and experts had done in the Severity Framework. They contributed with some possible refinements, but also promoted aspects not in line with established ethical criteria for priority setting in Sweden. Study IV shows that citizen respondents differ to a larger proportion compared to politicians´ ranking of severity aspects, than with that of health professionals´. The greatest number of significant differences was found between politicians and health professionals.This thesis has several implications. Politicians ought to strive for greater public awareness of the priority-setting dilemma at the meso level in healthcare, both according to the process and the content values behind the decisions. Social values not in accordance to the parliamentary decision indicate a need to facilitate an ongoing dialogue, reason-giving activities and promotion of content values of solidarity. To capture social values on priority setting and rationing, ambitious public deliberation is not the only way. Methodologically stringent research, with a variety of study designs, could contribute in many important ways.
|
|
| 2. |
- Broqvist, Mari, 1958-, et al.
(författare)
-
The meaning of severity - do citizenś views correspond to a severity framework based on ethical principles for priority setting?
- 2018
-
Ingår i: Health Policy. - : Elsevier. - 0168-8510 .- 1872-6054. ; 122:6, s. 630-637
-
Tidskriftsartikel (refereegranskat)abstract
- The importance for governments of establishing ethical principles and criteria for priority setting in line with social values, has been emphasised. The risk of such criteria not being operationalised and instead replaced by de-contextualised priority-setting tools, has been noted. The aim of this article was to compare whether citizenś views are in line with how a criterion derived from parliamentary-decided ethical principles have been interpreted into a framework for evaluating severity levels, in resource allocation situations in Sweden. Interviews were conducted with 15 citizens and analysed by directed content analysis. The results showed that the multi-factorial aspects that participants considered as relevant for evaluating severity, were similar to those used by professionals in the Severity Framework, but added some refinements on what to consider when taking these aspects into account. Findings of similarities, such as in our study, could have the potential to strengthen the internal legitimacy among professionals, to use such a priority-setting tool, and enable politicians to communicate the justifiability of how severity is decided. The study also disclosed new aspects regarding severity, of which some are ethically disputed, implying that our results also reveal the need for ongoing ethical discussions in publicly-funded healthcare systems.
|
|
| 3. |
- Bäckman, Karin, 1967-, et al.
(författare)
-
Prioriteringar över kommunala förvaltningsområden : ett utvecklingsarbete i Motala kommun
- 2017
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Motala kommun är den första kommunen som på ett systematiskt sätt tagit sig an prioritering och resursfördelning inom alla sina förvaltningsområden med utgångspunkt i de etiska principer och riktlinjer för prioriteringar som gäller för hälso- och sjukvård. Arbetet omfattar utveckling av ett verktyg för prioritering, anpassat till ett kommunalt sammanhang och att använda det i ett systematiskt prioriteringsarbete kombinerat med politiska mål och visioner. Avsikten är att prioriteringsarbetet ska utvecklas till en hållbar rutin, integrerad i befintlig budgetprocess.Syftet med denna rapport är att beskriva det första skedet i utvecklingsarbetet, med tillhörande arbetsprocesser samt att analysera det utifrån ett förbättringsoch implementeringsperspektiv. Rapporten omfattar åren 2013-2015.Prioriteringscentrums engagemang i Motala kommun har inneburit att vi genom s k aktionsforskning har studerat utvecklingen av prioriteringsarbetet samtidigt som vi gett stöd till kommunen och deltagit i utvecklingsarbetet av verktyg och processer. Datainsamling har skett genom observationer, dokument, enkäter och olika typer av kontakter.I Motala kommun har prioriteringsprocessen och dess verktyg utvecklats i nära samarbete med involverade aktörer, de som skulle bli användarna. Prioriteringsarbetet har integrerats i kommunens befintliga ledningssystem och rutiner. Utvecklingen har skett stegvis i små förbättringscykler. På detta sätt har kunskap och lärande byggts upp inom organisationen och arbetet har präglats av långsiktighet.Motala kommuns utveckling av verktyg och processer för prioritering visar att det är möjligt att vägledas av nationella etiska principer för prioritering inom hälso- och sjukvård och att det går att kombinera dessa med politiska mål och visioner. Det har också varit möjligt att inkludera kommunens alla förvaltningar i prioriteringsarbetet i en öppen, systematisk process som kopplats till ordinarie budgetarbete.
|
|
| 4. |
|
|
| 5. |
- Krevers, Barbro, 1955-
(författare)
-
Patienter, hälso- och sjukvårdens främsta angelägenhet : från objekt till aktör
- 2016
-
Ingår i: Perspektiv på utvärdering, prioritering, implementering och hälsoekonomi. - Linköping : Linköping University Electronic Press. - 9789176857441 ; , s. 55-61
-
Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- Numera framhålls det ofta att patienter och medborgare ska ta ett aktivt ansvar för sin hälsa och att patienter ska vara aktiva parter i hälso- och sjukvård. Det har inte alltid varit så, synen på patienter och deras ställning i hälso- och sjukvård har genomgått och genomgår en ständig förändring. Denna förändring avspeglar skeenden i samhället i stort när det gäller synen på individens inflytande, självbestämmande och ansvar. För att förstå vår nutid behöver vi känna till och förstå vår dåtid brukar det sägas. Det mottot har även bäring på vår förståelse av samspelet mellan hälso- och sjukvården och patienter. Vi behöver känna till förändringarna som synen på patienter har genomgått eftersom vården möter och ska tillgodose vårdbehov hos människor i alla åldrar, inte minst de som snart är ett sekel gamla. De som varit med länge kan ha andra förväntningar på vad det innebär att vara patient än de som är unga idag.
|
|
| 6. |
- Krevers, Barbro, 1955-, et al.
(författare)
-
The sense of security in care-relatives' evaluation instrument : its development and presentation.
- 2015
-
Ingår i: Journal of Pain and Symptom Management. - : Elsevier BV. - 0885-3924 .- 1873-6513. ; 49:3, s. 586-94
-
Tidskriftsartikel (refereegranskat)abstract
- CONTEXT: Relatives' sense of security in their family members' palliative home care is important, and a valid and reliable instrument is needed to measure this.OBJECTIVES: The aim of this article is to report the development, structure, and psychometric properties of a new instrument, the Sense of Security in Care-Relatives' Evaluation (SEC-R), in palliative home care.METHODS: Instrument development was based on a previous study and review of the literature; 213 relatives (55% women) of patients in palliative home care were recruited (response rate 73%) and participated in a structured interview based on a questionnaire. Principal component analysis (PCA) was used to identify subscales. The construction was tested in correlation with other scales and questions representing concepts expected to be related to sense of security in care.RESULTS: The PCA resulted in three subscales, namely care interaction, mastery and patient situation, which had an explained variance of 53%. Internal consistency of the subscales ranged from 0.76 to 0.78. The final instrument comprises 17 items. The scales were associated with the quality-of-care process and the relatives' situation, perceived health, quality of life, stress, general sense of security, and general sense of security in care.CONCLUSION: The SEC-R provides a three-component assessment of palliative home care settings using valid and reliable scales associated with other concepts. The SEC-R is a manageable means of assessment that may contribute to quality-of-care measures and to further research on relatives' sense of security in care.
|
|
| 7. |
- Turesson, Christina, et al.
(författare)
-
Patients' needs during a surgical intervention process for Dupuytren's disease.
- 2019
-
Ingår i: Disability and Rehabilitation. - : Taylor & Francis Group. - 0963-8288 .- 1464-5165. ; 41:6, s. 666-673
-
Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: To explore and describe clients' needs during a surgical intervention process for Dupuytren's disease.MATERIALS AND METHODS: Design: Interview study with 21 men undergoing surgical intervention for Dupuytren's disease. Qualitative content analysis was performed with the model of Patient Evaluation Process as a theoretical framework.RESULTS: The primary reason for seeking medical care was to receive an intervention to improve hand function. The need for knowledge was evident during the care process, and was connected to involvement in decision-making. During surgery and rehabilitation, participants needed support with pain relief, a sense of security, support for self-care, or sick leave. There was also a need for participation in the evaluation and improvement of care. Clients' life situations contributed to the occurrence of needs or were a resource for handling them. Depending on patient character, clients handled their perceived needs differently.CONCLUSIONS: Clients' needs during a surgical intervention process include needs for improvement of hand function, knowledge, and support during treatment, and participation in evaluation. Clients' needs change during the care process and can be influenced by their life situation or their character. The identified needs ought to be included in quality assessments from the carers' perspective, to ensure that important needs of the clients are met by the surgical intervention process. Communication and interaction between client and health care provider is a key aspect of fulfilling clients' needs. Implications for rehabilitation Patients have need for knowledge throughout the care process: about the disease, risk factors, treatment options, practical and medical information related to the treatment and recovery, and about the care process as a whole. Need for knowledge is closely connected to patients' experience of being involved in decision making. Patients need support with both general human and specific medical issues during surgery and rehabilitation. Patients' needs change during the care process and can be influenced by the patient's life situation or character. From the carers' perspective, the identified needs ought to be included in quality assessments to ensure that important needs of the clients are met by the surgical intervention process.
|
|
| 8. |
|
|
