| 1. |
|
|
| 2. |
|
|
| 3. |
- Hjortsberg, Catharina, et al.
(författare)
-
Costs for patients with psychotic illness : differences depending upon state of remission
- 2011
-
Ingår i: The Journal of Mental Health Policy and Economics. - Milano. - 1091-4358. ; 14:2, s. 87-93
-
Tidskriftsartikel (refereegranskat)abstract
- Psychotic illnesses have a substantial economic burden on patients, family members, friends, and society in general, still there have been limited attempts to estimate the costs associated with this condition. Moreover, nothing is known about the differences in costs between patients depending on disease severity, i.e. state of remission.AIM:Estimate the direct and indirect costs for a defined patient population with psychotic illness in Sweden, and demonstrate differences in direct costs depending on disease severity (state of remission).MATERIALS AND METHODS:The cost analyses are based on data from the Clinical Long-term Investigation of Psychosis in Sweden (CLIPS), which is an ongoing, single-centre, epidemiological study. Resource use and disease severity were captured for the patients during one year, 2007. Total costs per patients are estimated and cost differences between patients, depending on state of remission, are considered.RESULTS:199 patients with a mean age of 51 (63% men) were followed for 12 months. They had a mean of 6.4 inpatient-days, 1.4 physician visits, 18.6 nurse visits, 1.2 counsellor visits and 6.3 visits to other staff including tests and diagnostic procedures per patient- year. The mean total cost (direct and indirect) amounted to 62,500 per patient and year. Patients in steady state of remission had lower direct costs compared to other patients. Moreover, the size of the various cost items differed between patients' depending on state of remission. Patients in steady remission had almost no inpatient costs.DISCUSSION:For a comprehensive assessment of treatment of psychotic illnesses it is necessary to provide evidence of the costs related to disease severity. We find that patients suffering from psychotic illness have varying costs depending on their disease severity, and this study indicates that if patients can be kept in remission direct costs will decrease. We can also confirm that reallocation has taken place the last 15 years, between different cost items, from in-patient care at hospitals to out-patient care and assistance at home.LIMITATIONS:Information about informal care was collected from patients and not from informal carers themselves.IMPLICATIONS FOR HEALTH CARE PROVISION AND USE:Costs have been reallocated from in-patient care to costs for assistance at home, which is a reflection of the change in care of patients with mental problems that has taken place during the last 15 years. Patients in steady remission have lower costs compared to patients in steady non-remission or patients switching between the two states. A better surveillance of the disorder would lead to lower direct, as well as indirect, costs.
|
|
| 4. |
- Hjortsberg, C, et al.
(författare)
-
Direct and indirect costs for psychotic illness in Sweden
- 2010
-
Rapport (refereegranskat)abstract
- In this study the direct and indirect costs for a defined patient population with psychotic illness in Sweden was estimated. The cost analyses are based on data from the Clinical Long-term Investigation of Psychosis in Sweden (CLIPS), which was an ongoing, single-centre, epidemiological study at the time of this study. A bottom-up costing approach was used to estimate the total costs for schizophrenia, schizoaffective and delusional disorders in Sweden for 2007. Resource use were captured for the patients during one year. 199 patients with a mean age of 51 (63% men) were followed for 12 months. They had a mean (median) of 6.4 (0) inpatient-days, 1.4 (1.2) physician visits, 18.6 (8.4) nurse visits, 1.2 (0) counsellor visits and 6.3 (1.2) visits to other staff including tests and diagnostic procedures per patient- year. The mean cost in our study amounted to 578,000 per patient year which translates to an estimated cost of illness of 16.8 billion SEK for Sweden. Schizophrenia and related disorders significantly interferes with professional activities and as a result, the total burden on society is great. A reallocation has taken place the last 15 years, between different cost items, from direct costs to indirect costs and from in-patient care at hospitals to out-patient care and assistance at home.
|
|
| 5. |
- Hjärthag, Fredrik, 1973-
(författare)
-
BUP Värmland : en utvärdering av hur personalen uppfattar effekterna av omorganisation och förstärkning av vårdgarantin
- 2012
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Denna rapport redovisar resultatet av en utvärdering som har gjorts om hur personalen vid BUP Värmland uppfattar effekterna av en omorganisation och förstärkningen av vårdgarantin för de olika patientgrupperna. FoU Välfärd Värmland, Karlstads universitet, fick uppdraget av BUP Värmland, Landstinget i Värmland, att under hösten 2011 genomföra utvärderingen vilket gjordes genom en enkätstudie vänd till samtlig personal vid BUP Värmland. Utifrån den höga svarsfrekvensen och utförligheten i svaren, kan det konstateras att personalen vid BUP Värmland är mycket engagerad och mån om att verksamheten skall hålla en hög kvalitet. Organisationens struktur i sig är de flesta svarande nöjda med, men ett stort problem som många beskriver är att mängden patienter upplevs som oproportionerlig i förhållande till befintliga resurser inom BUP Värmland. Detta påverkar också möjligheterna att klara av den förstärkta vårdgarantin som har högprioriterats, enligt de flesta svarande på bekostnad av mer långsiktiga kvalitetsparametrar inom vården. Exempelvis uppges den tydlighet i nya organisationens flöde som var tänkt för patienter med neuropsykiatrisk problematik ha påverkats negativt av en högprioriterad vårdgaranti utifrån de begränsade resurser som finns. Organisationens delar inom BUP Värmland som utgörs av fyra olika enheter, upplevs också av flera i personalen som alltför åtskilda sinsemellan. Personalen är mån om bibehållandet av nuvarande kompetens genom fortbildning och handledning samt rekrytering av ny kompetens för att ännu bättre kunna möta aktuella och framtida vårdbehov.
|
|
| 6. |
|
|
| 7. |
- Hjärthag, Fredrik, 1973-, et al.
(författare)
-
Family burden and functional assessment in the Swedish CLIPS-study : Do staff and relatives agree on individuals with psychotic disorders' functional status?
- 2012
-
Ingår i: Social Psychiatry and Psychiatric Epidemiology. - : Springer Science and Business Media LLC. - 0933-7954 .- 1433-9285. ; 47:4, s. 581-587
-
Tidskriftsartikel (refereegranskat)abstract
- PURPOSE:In this study, the individuals with psychotic disorders' daily life function was investigated on six dimensions considering their relations to family burden. Functional ratings carried out by relatives and staff were also compared.METHODS:Totally 88 relatives, to as many individuals diagnosed with a psychotic disorder, participated in this study. Relatives were to rate their own perceived burden and their ill relatives' physical functioning, personal care skills, interpersonal relationships, social acceptability, activities, and work skills. The outpatient staff, in all 24 case managers also rated the patients' functional level on the same assessment tool as did the relatives.RESULTS:Most dimensions of patients' everyday functioning were highly correlated to relatives' burden. The two functional dimensions "interpersonal relationships" and "activities" were best at classifying burden when rated by relatives. Also, comparing independent functional ratings by relatives and staff showed that despite great agreements on most dimensions, they differed significantly on "social acceptability" where relatives rated the function to be poorer and "activities" where relatives rated the function to be better.CONCLUSIONS:Relatives, who perceive individuals with a psychotic disorder to be limited in their ability to interpersonal relationships and limited in their ability to activate in everyday life, are more likely to perceive a higher burden. Even though staff and relatives mainly agree on the patients' functional ability, they often differ in ratings regarding patients' social acceptability and ability to activate in everyday life. This should be worth considering in clinical practice as well as in future research.
|
|
| 8. |
- Hjärthag, Fredrik, 1973-, et al.
(författare)
-
Illness Related Components for the Family Burden of Relatives to Patients with Psychotic Illness
- 2010
-
Ingår i: Social Psychiatry and Psychiatric Epidemiology. - : Springer. - 0933-7954 .- 1433-9285. ; 45:2, s. 275-283
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Previous research has shown that symptom severity often implies an increased family burden. Few other illness related variables have, however, been investigated in this context. This study investigates how family burden is affected by symptom, function, and cognition, as well as how the patient perceives his/her illness and quality of life. Method: A total of 99 relatives, to as many patients diagnosed with psychosis and with their illness at a stable level, participated in this study. The relatives estimated their perceived burden, the patients rated the distress caused by their illness as well as the quality of their lives, and the care staff rated the patients’ symptom and function as well as tested their cognitive abilities. Results: Increased family burden can be tied to the patients’ increased symptom severity, to their impaired functioning as well as to the patients’ higher self ratings regarding distress. The family burden is also connected to the patient’s reduced working memory and reduced executive functioning, but this connection is not totally clear and should be further investigated. Of the variables that the patients were rated on, it was the overall functional ability measured with GAF that had the single most impact on perceived family burden. Conclusions: To control illness related variables such as symptoms, impaired functioning, impaired working memory and executive functioning, as well as the patients’ own experiences of distress, is important in order to lessen the burden for the relatives. All aspects of family burden are, however, not explained by these factors, which is why further research within this realm is required.
|
|
| 9. |
|
|
| 10. |
- Hjärthag, Fredrik, 1973-
(författare)
-
Screening Family Burden in Clinical Practice : The development of a new instrument and investigation of its correlates to psychotic disorders
- 2011
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The primary purpose of this thesis is to develop a short and user-friendly instrument for the assessment of family burden caused by psychotic disorders. A secondary purpose is to further investigate variables that might be linked to an increased burden. Of these variables, patients’ reduced functioning will be addressed in more detail. As a final purpose, ratings of disorder-related variables carried out by staff will be compared to similar ratings carried out by relatives. These different purposes are investigated in five studies.In the first study (Paper I) the instrument Burden Inventory for Relatives to persons with Psychotic disturbances (BIRP) is created. This new screening instrument contains ten statements and shows good psychometrical properties for those dimensions that are investigated. In the second study (Paper II) results show that increased family burden can be tied to patients’ impaired functioning as well as to patients’ higher self ratings regarding distress. In the third study (Paper III) different parts of patients’ observable behavioral functioning are investigated and results show that most functional dimensions correlate with family burden. Also staff ratings of function are compared with relatives’ ratings and despite similar patterns in ratings there are differences. In the fourth study (Paper IV) demographic variables are studied and results show that only higher age and fewer contact hours correlate significantly with lower burden. Also, the BIRP instrument shows good stability. In the fifth study (Paper V) correlations with family burden are generally stronger for relatives’ own ratings of illness activity as compared to symptom ratings made by staff. Relatives’ ratings of illness activity do not correlate significantly with staff symptom ratings on all instruments used.The conclusions of this thesis are that the new screening instrument BIRP can be considered a good instrument to use in regular clinical practice in order to measure relatives’ burden in connection to psychotic disorders. Also, the thesis contributes with knowledge about what in the psychotic disorder and which demographic factors might be linked to an increase of family burden. Findings also indicate that it matters who does the rating of a disorder-related variable. Furthermore, in this thesis a theoretical framework for family burden is presented.
|
|
| 11. |
- Lugnegård, Tove, et al.
(författare)
-
Social cognition impairments in Asperger syndrome and schizophrenia.
- 2013
-
Ingår i: Schizophrenia research. - Amsterdam : Elsevier BV. - 1573-2509 .- 0920-9964. ; 143:2-3, s. 277-284
-
Tidskriftsartikel (refereegranskat)abstract
- Social cognition impairments are well described in both autism spectrum disorders, including Asperger syndrome (AS), and in schizophrenia spectrum disorders. However, little is known about whether there are differences between the two groups of disorders regarding this ability. The aim of this study was to compare social cognition abilities in AS and schizophrenia. Fifty-three individuals (26 men, 27 women) with a clinical diagnosis of AS, 36 (22 men, 14 women) with a clinical diagnosis of schizophrenic psychosis, and 50 non-clinical controls (19 men, 31 women) participated in the study. Clinical diagnoses were confirmed either by Structured Clinical Interview on DSM-IV diagnosis or the Diagnostic Interview for Social and Communication Disorders. Verbal ability was assessed using the Vocabulary subtest of the WAIS-III. Two social cognition instruments were used: Reading the Mind in the Eyes Test (Eyes Test) and the Animations Task. On the Eyes Test, patients with schizophrenia showed poorer results compared to non-clinical controls; however, no other group differences were seen. Both clinical groups scored significantly lower than the comparison group on the Animations Task. The AS group performed somewhat better than the schizophrenia group. Some differences were accounted for by gender effects. Implicit social cognition impairments appear to be at least as severe in schizophrenia as they are in AS. Possible gender differences have to be taken into account in future research on this topic.
|
|
| 12. |
- Olsson, A-K, et al.
(författare)
-
Psychometric properties of a performance-based measurement of functional capacity
- 2012
-
Ingår i: Psychiatry Research. - : Elsevier. - 0165-1781 .- 1872-7123. ; 197:3, s. 290-294
-
Tidskriftsartikel (refereegranskat)abstract
- The UCSD Performance-based Skills Assessment - Brief version (UPSA-B) describes the functions of patients without negative influences of environmental factors such as unemployment or shortage in housing. The aim of the present study is to further explore the psychometric properties of the UPSA-B as well as to ensure that the Swedish version can be used in clinical practice and for research purposes. Participants were 211 patients, 135 men and 76 women, diagnosed with schizophrenia, schizoaffective disorder, or delusional disorder. Results indicate that the UPSA-B is a reliable instrument with good psychometric properties regarding validity and reliability. The instrument also had a capacity to reveal differences between various patient groups, both diagnostic groups and groups based on remission status. The conclusion drawn is that the UPSA-B is a valuable instrument that could be used in future cross-national studies to describe the level of functioning for patients with schizophrenia and other psychotic illnesses.
|
|
| 13. |
- Östman, Margareta, et al.
(författare)
-
Family-Based Psycho-education : A Model Outmoded In Psychiatric Services Today?
- 2014
-
Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Family-based psycho-education – a model outmoded in psychiatric services today? Aim: To illuminate aspects of the resistance against a family based intervention a qualitative interview study with professionals was accomplished. Background: Family-based psycho-educational models, developed in the beginning of the 1970s, have in several Cochrane reviews shown evidence for a reduced rate of relapse and increased adherence to medication. Studies included in these meta-analyses all encompassed patients receiving in-patient care, and requiring relatives partaking in an extensive educational program. A multi-center randomised control study in Sweden, aimed to investigate the effects of a twelve-month long intervention of a psycho - educational model for people with severe mental illness, SMI, in psychiatric and community settings, showed a powerful resistance from primarily the professionals which had been well trained in the model and secondly the patients which had been offered the intervention. Method: In-depth interviews with 24 professions in psychiatric and community outpatient settings engaged in the RCT study. Results: The findings showed that both patients and professional partners are skeptical about treatment programs of family psycho-pedagogical nature and prefer pure patient perspective and more acute short interventions. A reason for this was according to the professions lack of resources, while their patients experienced a hindrance in bothering their loved ones. Conclusion: The findings might show that the model per se is outmoded, not fitting the new structures of support, with reduced inpatient care, for people with SMI. In worst case, the findings might indicate that family psycho education, notwithstanding evidence based, is unavailable to people with SMI and their relatives which might contribute to a structural stigmatization of this population. More research is needed to understand if our findings are consistent with findings in other international contexts.
|
|
| 14. |
|
|
