| 1. |
- Anderzén, Ingrid, et al.
(författare)
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Samverkan i Resursteam : effekter på organisation, hälsa och sjukskrivning
- 2008
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Vi utvärderar samverkansformen Resursteam, som bedrivits som ett försök för att minska långa sjukskrivningar. Resursteam innebär att ett team med hand-läggare från Försäkringskassan, husläkare, sjukgymnast och beteendevetare, vid regelbundna möten bedömer sjukskrivna personers rehabiliteringsbehov och ger förslag på åtgärder. Det övergripande syftet är att skatta effekten av Resursteam på den försäkrades sjukskrivningslängd och självskattade hälsa. Vi har genomfört (i) en kartläggning av verksamheten, (ii) en enkätstudie till sjuk-skrivna som deltagit i Resursteam och till jämförelsepersoner samt (ii) skattat effekten av Resursteam på självskattad hälsa och sjukskrivning. Resultaten är entydiga och visar på inga eller negativa effekter för de personer som ingått i Resursteam. Som exempel kan nämnas att tiden i sjukskrivning förlängs med cirka 20 procent i genomsnitt.
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| 2. |
- Arnetz, Judith E., et al.
(författare)
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Development and evaluation of a questionnaire for measuring patient views of involvement in myocardial infarction care
- 2008
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Ingår i: European Journal of Cardiovascular Nursing. - : Oxford University Press (OUP). - 1474-5151 .- 1873-1953. ; 7:3, s. 229-238
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND Patients' involvement in their healthcare has been associated with improved treatment outcomes in chronic illness. Less is known about the affects of patient involvement on the outcomes of acute illness, such as myocardial infarction. A better understanding of patients' views and behaviour during hospitalization might improve clinical practice and enhance patient involvement. AIM The aim of this study was to develop and evaluate a questionnaire for measuring patients' perceptions of their involvement during hospitalization for myocardial infarction care. METHODS Focus groups with myocardial infarction patients provided the basis for the construction of the questionnaire. Questionnaire validity and reliability were evaluated in a small pilot study and a larger cross-sectional study among myocardial infarction patients at eleven Swedish hospitals. RESULTS The questionnaire demonstrated good validity and reliability, with six factors measuring patient views and behaviour regarding involvement. CONCLUSION The questionnaire appears to be a useful tool for evaluating the perceptions and behaviour of patients regarding patient involvement in myocardial infarction care. Use of this questionnaire may provide insight regarding areas of patient-staff interaction that need improvement. Pinpointing such areas may lead to improved patient involvement, satisfaction with care, and treatment outcomes.
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| 3. |
- Arnetz, Judith E., et al.
(författare)
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Physicians' and nurses' perceptions of patient involvement in myocardial infarction care
- 2008
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Ingår i: European Journal of Cardiovascular Nursing. - 1474-5151 .- 1873-1953. ; 7:2, s. 113-120
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Tidskriftsartikel (refereegranskat)abstract
- Background: Patients' involvement in their healthcare has been associated with better health outcomes. However, few studies have examined whether patient involvement affects the work of healthcare professionals. A better understanding of professionals' views and behaviour is necessary for improving clinical practice and optimizing patient involvement. Aim: To measure perceptions and behaviour regarding patient involvement among physicians and nursing staff caring for patients with acute myocardial infarction. Methods: A questionnaire study conducted in 2005 among cardiology staff at twelve Swedish hospitals. The questionnaire included six scales measuring staff views and behaviour. Results: Physicians, registered nurses, and practical nurses did not differ significantly in their views of patient involvement, but did differ significantly in behaviour (p<.001). All three groups felt that an actively involved patient enriched their work, at the same time increasing their work load and taking time from other tasks. Physicians discussed daily activities and lifestyle changes with myocardial infarction patients before hospital discharge to a greater extent than nursing staff (p<.001). Conclusion: Physicians and registered nurses viewed time constraints as a hinder for patient involvement, while practical nurses felt unsure in communicating with patients. Considering these organizational and professional issues may improve patient involvement and health outcomes in myocardial infarction care. (C) 2007 European Society of Cardiology. Published by Elsevier B.V All rights reserved.
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| 4. |
- Arnetz, Judith E., et al.
(författare)
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Staff views and behaviour regarding patient involvement in myocardial infarction care : development and evaluation of a questionnaire
- 2008
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Ingår i: European Journal of Cardiovascular Nursing. - : Elsevier. - 1474-5151 .- 1873-1953. ; 7:1, s. 27-35
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND Healthcare legislation in several nations now dictates the responsibility of health care professionals to involve patients in decisions concerning care and treatment. However, few studies have examined the impact of patient involvement on the work of health care professionals. A better understanding of staff views and behaviour might enhance patient involvement. AIM The aim of this study was to develop and validate a questionnaire for measuring views and behaviour regarding patient involvement among physicians and nursing staff caring for patients with myocardial infarction. METHODS Focus groups among cardiology staff provided the basis for the construction of the questionnaire. Questionnaire validity and reliability were evaluated in a small pilot study and a larger cross-sectional study among cardiology staff at twelve Swedish hospitals. RESULTS The questionnaire demonstrated good validity and reliability, with two factors measuring staff views and four measuring behaviour. CONCLUSION The questionnaire appears to be a useful tool for evaluating the perceptions and behaviour of physicians and nursing staff regarding patient involvement in myocardial infarction care. Use of this questionnaire may provide insight regarding areas of staff-patient interaction that need improvement, as well as implications of patient involvement for the work of each professional group on cardiology wards.
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| 5. |
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| 6. |
- Fredriksson, Mio, et al.
(författare)
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Consequences of a decentralized healthcare governance model : measuring regional authority support for patient choice in Sweden
- 2008
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Ingår i: Social Science and Medicine. - : Elsevier BV. - 0277-9536 .- 1873-5347. ; 67:2, s. 271-279
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Tidskriftsartikel (refereegranskat)abstract
- What are the implications of a decentralized model of healthcare governance? This case study on patient choice in Sweden is an attempt to shed light on this issue. Due to decentralization and constitutional rights of self-determination, the regional authorities in Sweden, called County Councils (CCs), have far-reaching rights to manage the healthcare sector. The fact that patient choice is considered to be a soft law or a soft governance regulation, opens it up to regional variation. To examine the CCs level of support of patient choice, an index is presented. The Patient Choice Index (PCI) shows that there is extensive variation among the CCs. To explain the causes of these variations, a number of hypotheses are tested. The analyses imply that ideology and economy, and more specifically the CCs' governing majorities and running net profits, are major explanations for the level of support. A number of conclusions can be drawn from the results of this study. In short, the CCs appear to act according to a local point of view, which means that there is no functioning national patient choice standard, and thus patients do not have equal access to healthcare and patients' rights are unevenly distributed. Furthermore, the CCs' financial conditions and governing majorities seem to undermine equivalent reform realization in a national context. In summary, the results of this study emphasize the conflict between regional self-governance and national equality, which is particularly visible in the decentralized Swedish healthcare model.
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| 7. |
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| 8. |
- Or, Zeynep, et al.
(författare)
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Are health problems systemic? : Politics of access and choice under Beveridge and Bismarck systems
- 2009
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Industrialised countries face similar challenges for improving the performance of their health system.Nevertheless the nature and intensity of the reforms required are largely determined by each country’s basic social security model. This paper looks at the main differences in performance of five countries and reviews their recent reform experience, focusing on three questions: Are there systematic differences in performance of Beveridge and Bismarck-type systems? What are the key parameters of health care system which underlie these differences? Have recent reforms been effective? Our results do not suggest that one system-type performs consistently better than the other. In part, this may be explained by the heterogeneity in organisational design and governance both within and across these systems. Insufficient attention to those structural differences may explain the limitedsuccess of a number of recent reforms.
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| 9. |
- Stolt, Ragnar, et al.
(författare)
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Mechanisms behind privatization : a case study of private growth in Swedish elderly care
- 2009
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Ingår i: Social Science and Medicine. - : Elsevier BV. - 0277-9536 .- 1873-5347. ; 68:5, s. 903-911
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Tidskriftsartikel (refereegranskat)abstract
- For many years the Swedish Welfare State has been associated with a welfare model in which the public sector dominates both the provision and financing of the elderly care system. However, influenced by the ongoing trend of New Public Management, the past 15 years have been characterized by governmental regimes encouraging competition and as a result there has been a substantial increase in private providers. This case study on elderly care in Sweden provides new insights into the mechanisms behind the spread and growth of privatization. Our results show that in 1990 only 1% of the labour force in the elderly care sector was employed by private organizations, in comparison to 2003 when the private share had increased to 13%. The accompanying organizational changes have been controversial and are often criticized. In general, left-wing politicians have frequently defended the traditional welfare model dominated by public providers, whereas right-wing politicians have urged for a larger share of alternative providers. In this study, statistics between the years 1990 and 2003 were used to model the relationship between privatization and a number of economic, political and social/demographic variables. The results from regression and diffusion analysis imply that privately managed elderly care has established itself mainly in metropolitan areas dominated by right-wing regimes. Surprisingly, neighbouring municipalities tend to follow these pioneers irrespective of their political colour or economic situation. In fact, after shifting political power many of those neighbouring municipalities dominated by left-wing regimes not only maintain an abundance of private contractors but also encourage a continued process of contracting out publicly managed elderly care units. As a result, clusters of municipalities with an increasing degree of privatization arise despite political and economic differences. In conclusion, geographical proximity seems to be an important variable in addition to population density, ideology and financial situation when privatization reforms are implemented in the Swedish elderly care system.
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| 10. |
- Vrangbaek, Karsten, et al.
(författare)
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Patient reactions to hospital choice in Norway, Denmark, and Sweden.
- 2007
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Ingår i: Health Economics, Policy and Law. - 1744-1331 .- 1744-134X. ; 2, s. 125-152
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Tidskriftsartikel (refereegranskat)abstract
- This article is a comparative study of three Scandinavian countries –Norway, Denmark, and Sweden – all of which have provided the individualpatient with extensive rights to choose the hospital where he/she wishes toreceive treatment. In the paper, we present an analysis of the utilization of theopportunity to choose between hospitals in these three countries. The analysisaddresses two questions: (i) How many patients are exercising the right tochoose between hospitals in these countries and who is making use of thisopportunity? (ii) How can we explain the observed utilization pattern? Theresults of the study reveal clear similarities between the three countries andsuggest that few patients have actually chosen their hospital. However, a gradualincrease can be observed over the years. Few formal, legislative, or economicbarriers exist for patients. Instead, limited knowledge amongst patientsregarding reforms, combined with insufficient support from GPs and limitedinformation, can explain why few patients choose to receive care outside of theirlocal region.
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| 11. |
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| 12. |
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| 13. |
- Winblad, Ulrika
(författare)
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Do physicians care about patient choice?
- 2008
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Ingår i: Social Science and Medicine. - : Elsevier BV. - 0277-9536 .- 1873-5347. ; 67:10, s. 1502-1511
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Tidskriftsartikel (refereegranskat)abstract
- A new policy (patient choice) was introduced in Sweden in the early 1990s to give patients the right to choose their healthcare providers, however, evaluations show that few patients exercise this right. This paper analyses physicians' roles in putting the patient choice policy into effect. To examine attitudes, knowledge and behaviour among physicians, a questionnaire was sent to 960 physicians in one of the most populous counties in Sweden. The results show that the physicians approve of the policy, yet only a minority state that they regularly help patients to choose healthcare providers by giving them information and letting them choose where they will be referred. Instead, referrals are mostly based on medical grounds; the patient's wish to choose a specific provider is considered less important. In summary, we found that more than a decade after the policy was introduced, only a minority of physicians act according to the political intention. This could be one explanation for why many patients still do not exercise their right to choose a hospital.
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| 14. |
- Winblad, Ulrika, et al.
(författare)
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Kundval i hemtjänsten : erfarenheter av information och uppföljning
- 2009
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Kundvalsmodeller införs nu i snabb takt i allt flera kommuners och landstings vård- och omsorgsverksamheter. Kundvalet innebär att politikerna överlåter valet av utförare på de personer som behöver tjänsterna och ser till att dessa har flera olika utförare att välja emellan. Detta ställer kommunerna och landstingen inför två stora utmaningar: – tillhandahålla saklig och begriplig information om tjänsterna och utförarna – följa upp de utförda tjänsternas kvalitet. SKL har låtit göra en kvalificerad undersökning av hur kommunerna hanterar dessa frågor inom hemtjänsten, som är det område där det finns störst erfarenheter av kundvalsmodeller. Undersökningen har utförts av forskare på Institutionen för folkhälso- och vårdvetenskap vid Uppsala universitet på uppdrag av Sveriges Kommuner och Landsting.
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