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  • 2201.
    Wimo, Anders
    et al.
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Jönsson, Linus
    Fratiglioni, Laura
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Sandman, Per Olof
    Gustavsson, Anders
    Sköldunger, Anders
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Demenssjukdomarnas samhällskostnader i Sverige 20122014Report (Other academic)
  • 2202. Wimo, Anders
    et al.
    Jönsson, Linus
    Fratiglioni, Laura
    Sandman, Per Olof
    Umeå University, Faculty of Medicine, Department of Nursing. Division of Caring Sciences, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden; Department of Health Sciences, Luleå University of Technology, Luleå, Sweden.
    Gustavsson, Anders
    Sköldunger, Anders
    Johansson, Lennarth
    The societal costs of dementia in Sweden 2012: relevance and methodological challenges in valuing informal care2016In: Alzheimer's Research & Therapy, ISSN 0065-6755, E-ISSN 1758-9193, Vol. 8, article id 59Article in journal (Refereed)
    Abstract [en]

    Background: In this study, we sought to estimate the societal cost of illness in dementia in Sweden in 2012 using different costing approaches to highlight methodological issues.

    Methods: We conducted a prevalence-based cost-of-illness study with a societal perspective.

    Results: The societal costs of dementia in Sweden in 2012 were SEK 62.9 billion (approximately €7.2 billion, approximately US$ 9.0 billion) or SEK 398,000 per person with dementia (approximately €45,000, approximately US$ 57,000). By far the most important cost item is the cost of institutional care: about 60% of the costs. In the sensitivity analysis, different quantification and costing approaches for informal care resulted in a great variation in the total societal cost, ranging from SEK 60 billion (€6.8 billion, US$ 8.6 billion) to SEK 124 billion (€14.1 billion, US$ 17.8 billion).

    Conclusions: The societal costs of dementia are very high. The cost per person with dementia has decreased somewhat, mainly because of de-institutionalisation. The majority of the costs occur in the social care sector, but the costing of informal care is crucial for the cost estimates.

  • 2203.
    Winberg, Anette
    Jönköping University, School of Health and Welfare, HHJ, Quality Improvement and Leadership in Health and Welfare.
    Användbar och tillgänglig webbkatalog för habiliteringens kursutbud: Ett förbättringsarbete för tillgänglig webbkatalog och en studie av vilka faktorer som har betydelse för hur den används2018Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Background

    Knowledge about one's current disability and its consequences makes everyday life easier. The habilitation center offers approximately fifty courses each semester. The program was recently digitized which decreased costs and administration time and expected to increase accessibility and user-friendliness. Target groups and staff experienced the opposite.

    Purpose

    The QI-project aimed to improve the availability to the courses by making the e-catalogue more accessible and user-friendly.

    This study aimed to describe the staff's perception of the factors affecting the functioning of the e-catalogue at a micro, meso and macro level. The study was delimited to include the business perspective.

    Method

    The improvement ramp and the model of improvement. Focus interviews was analyzed with qualitative content analysis and linked to micro, meso and macro level with The Clinical Adoption Framework (CAF) as a theoretical reference frame.

    Results

    The QI-project didn't meet its objectives in full. The content analysis identified six factors at micro and meso level.

    Conclusions 

    For a digital tool to be perceived as useful, knowledge about the organization and its processes at a micro level is required, so that the right conditions and support can be given at a meso level.

  • 2204.
    Winblad, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Hur kan medborgare och patienter involveras i utformningen av hälso- och sjukvården?2013In: Prioriteringar i hälso- och sjukvården / [ed] Region Skånes etiska råd, Lund: Region Skånes etiska råd , 2013, p. 47-62Chapter in book (Other academic)
  • 2205.
    Winblad, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Hur kan patienter och medborgare påverka och styra hälso- och sjukvården?2011Report (Other (popular science, discussion, etc.))
  • 2206.
    Winblad, Ulrika
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Blomqvist, Paula
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Government.
    Boström, Linn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Patientcentrering i Sverige: aktuella initiativ2015Report (Other academic)
  • 2207.
    Winblad, Ulrika
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Isaksson, David
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Bergman, Patrik
    Gävle kommun.
    Effekter av valfrihet inom hälso- coh sjukvård: en kartläggning av kunskapsläget2012Report (Other academic)
  • 2208.
    Winblad, Ulrika
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Isaksson, David
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Blomqvist, Paula
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Government.
    Preserving social equity in privatized primary care: a matter of contract designManuscript (preprint) (Other academic)
  • 2209.
    Winblad, Ulrika
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Isaksson, David
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Josefsson, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Olsson, Fredrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Kvalitetskrav i valfrihetssystem – en analys av förfrågningsunderlagen: en analys av förfrågningsunderlagen2014Report (Other academic)
  • 2210.
    Winblad, Ulrika
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Isaksson, David
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Josefsson, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Olsson, Fredrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Kvalitetskrav i valfrihetssystem: en analys av förfrågningsunderlag för hemtjänst2014Report (Other academic)
  • 2211.
    Winblad, Ulrika
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Mankell, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Olsson, Fredrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Privatisering av välfärdstjänster: hur garanteras kvalitet i vård och omsorg?2015In: Statsvetenskaplig Tidskrift, ISSN 0039-0747, Vol. 117, no 4, p. 531-554Article in journal (Refereed)
    Abstract [en]

    In recent decades, the Swedish welfare system has come to involve more privateactors. Swedish law, however, is still clear that health and social care should be characterizedby good quality regardless of its mode of operation. A central concern hasbeen how to politically ensure quality as welfare providers become more numerousand of different types. To what extent are politicians still able to monitor qualitywithin private health- and social care? The article reviews several quality assurancemechanisms that are built into the privatization reforms: how contracts are specifiedand monitored and how patients use their choices to send signals about carequality. A review of the literature illustrates the difficulty for politicians to formulategood contracts and follow them up. Also, patients’ choices are not a reliablesource of information about care quality since they rarely make informed choices.Not being able to monitor quality in a proper way risks creating a legitimacy gapfor the entire welfare system.

  • 2212.
    Winblad, Ulrika
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Mankell, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Olsson, Fredrik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Vårdval inom specialistsjukvården: vilka krav ställer landstingen på vårdgivarna?2015Report (Other academic)
  • 2213.
    Winge, Monica
    et al.
    Karolinska Institutet, Sweden.
    Johansson, Lars-Åke
    Alkit Communications, Sweden.
    Nyström, Monica
    Karolinska Institutet, Sweden.
    Lindh-Waterworth, Eva
    Umeå University, Sweden.
    Wangler, Benkt
    University of Skövde, Sweden.
    Need for a New Care Model - Getting to Grips with Collaborative Home Care2010In: MEDINFO 2010: Proceedings of the 13th World Congress on Medical Informatics / [ed] C. Safran et al., IOS Press, 2010, p. 8-12Conference paper (Refereed)
    Abstract [en]

    In this paper we discuss the fact that more and more patients are treated in their homes by a set of organizations, sometimes with different ownership, and how this fact places new and severe demands on health care and home service staff to communicate and collaborate. We point to the need for managers in different organizations to agree on ways of communicating and collaborating on the operational level and how this aspect needs to be considered during procurement of home care services. Most importantly, by reasoning around a set of problematic areas, we derive a set of related problems and suggest solutions for dealing with them. The solutions are a mix of organizational/administrative measures and IT support for communication and coordination.

  • 2214. Winge, Monica
    et al.
    Johansson, Lars-Åke
    Nyström, Monica
    Lindh-Waterworth, Eva
    Umeå University, Faculty of Social Sciences, Department of Informatics.
    Wangler, Benkt
    Need for a new care model: getting to grips with collaborative home care2010In: Studies in Health Technology and Informatics, ISSN 0926-9630, E-ISSN 1879-8365, Vol. 160, no Pt 1, p. 8-12Article in journal (Refereed)
    Abstract [en]

    In this paper we discuss the fact that more and more patients are treated in their homes by a set of organizations, sometimes with different ownership, and how this fact places new and severe demands on health care and home service staff to communicate and collaborate. We point to the need for managers in different organizations to agree on ways of communicating and collaborating on the operational level and how this aspect needs to be considered during procurement of home care services. Most importantly, by reasoning around a set of problematic areas, we derive a set of related problems and suggest solutions for dealing with them. The solutions are a mix of organizational/administrative measures and IT support for communication and coordination.

  • 2215.
    Winge, Monica
    et al.
    Stockholm University, Faculty of Social Sciences, Department of Computer and Systems Sciences.
    Lindh-Waterworth, Eva
    Scenario for a patient at home in health and social care2014In: Journal of Healthcare Leadership, ISSN 1179-3201, E-ISSN 1179-3201, no 6, p. 51-66Article in journal (Refereed)
    Abstract [en]

    This paper describes and discusses the situation for a typical patient with multiple illnesses and how his case would benefit from improved coordination, communication, and collaboration among all involved care providers. The paper is built around a patient case presented in a current scenario. The authors identified that for a single patient with several problems and diagnoses and the involvement of several care actors, the common issues concern lack of collaboration, lack of coordination, and awareness of what others have done to assess, plan, perform, and evaluate care. This presumably leads to a lack of care quality and a lack of effective use of care resources. The scenario and the findings are based on a patient-oriented perspective, on an analysis expressed in focus groups, and on interviews with key actors in health and social care. The paper also discusses the fact that an increasing number of patients are treated in their homes by a variety of organizations, and how this fact raises new and more intense demands on the various stakeholders forming the care staff to collaborate and coordinate care. We point to the need for managers in and between organizations to agree on the ways of collaborating at the operational level. Most importantly, by taking a basic set of issues as the starting point for reasoning, we derived a set of related problems and suggest solutions to deal with these. The literature currently lacks scenario descriptions that put the patient's situation into focus with respect to collaboration between health and social care. Finally, the paper presents a future case for collaboration including support by new e-services.

  • 2216.
    Winge, Monica
    et al.
    Karolinska Institute, Sweden.
    Wangler, Benkt
    University of Skövde, Sweden.
    Johansson, Lars-Åke
    Alkit Communications, Sweden.
    Nyström, Monica
    Karolinska Institute, Sweden.
    Lindh-Waterworth, Eva
    Umeå University, Sweden.
    CO-CARE - Collaborative Health and Social Care2008In: Proceedings of 13th International Symposium for Health Information Management Research / [ed] P. S. Bath, K. Day, T. Norris, Massey University, New Zealand , 2008, p. 113-124Conference paper (Refereed)
    Abstract [en]

    In this paper we discuss the fact that more and more patients are treated in their homes by a set of organizations, sometimes with different ownership. We explore how this poses new and stronger demands on health care and home service staff, as well as on different managerial and operational levels, to improve their communication and collaboration. We emphasize the need for managers in different organizations to agree on ways and forms of communication and collaboration between the operational levels, and the particular importance of this during procurement of home care services. As a result a number of methodological measures, strategies and IT solutions to support organizational development, coordination and collaboration are suggested.

  • 2217.
    Wireklint Sundström, Birgitta
    University of Borås, School of Health Science.
    Kunskapscentrum PreHospen: att vidareutveckla akutsjukvård utanför sjukhus i professionssamverkan2009Report (Other academic)
  • 2218.
    Wireklint Sundström, Birgitta
    et al.
    University of Borås.
    Abelsson, Anna
    Karlstad University.
    Jakopovic, Denis
    Karolinska Institutet.
    Wallin, Kim
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Bremer, Anders
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Rantala, Andreas
    Lund University.
    Kågström, Christer
    Luleå University of Technology.
    Ek, Bosse
    Mid Sweden University.
    Lingsarve, Johan
    Uppsala University.
    Tegelberg, Alexander
    Uppsala University.
    Aléx, Jonas
    Umeå University.
    Gyllencreutz, Lina
    Umeå University.
    Uppstu, Tom
    Umeå University.
    Lammgård, Tomas
    Örebro University.
    Adolfsson, Annsofie
    Örebro University.
    "Förödande att sänka kraven på ambulanspersonal"2017In: Svenska Dagbladet, ISSN 1101-2412, no 2017-06-08Article in journal (Other (popular science, discussion, etc.))
    Abstract [sv]

    Tidig och avancerad bedömning krävs när patienter möter personal inom ambulanssjukvården. Hur är det möjligt att frågan om sänkta kompetenskrav inom svensk ambulanssjukvård överhuvudtaget har väckts? undrar Nät­verket för ut­bildning av ambulanssjuksköterskor.

  • 2219.
    Wireklint Sundström, Birgitta
    et al.
    University of Borås, School of Health Science.
    Dahlberg, Karin
    Being Prepared for the Unprepared: A Phenomenology Field Study of Swedish Prehospital Care2012In: Journal of Emergency Nursing, ISSN 0099-1767, E-ISSN 1527-2966, ISSN 0099-1767, Vol. 38, no 6Article in journal (Refereed)
    Abstract [en]

    Introduction: This paper presents a study of prehospital care with particular focus on how ambulance personnel prepare themselves for their everyday assignments. Methods: The caring science field study took a phenomenological approach, where data were analyzed for meaning. Two specialist ambulance nurses, three registered nurses, and six paramedics participated. Results: The previously known discrepancy between in-hospital care and prehospital care was further interpreted in this study. The pre-information from an emergency medical dispatch (EMD) center provides ambulance personnel with basic expectations as to what they will have to take care of. At the same time that they maintain their certainty and control, our major findings indicate that prehospital care in emergency medical service requires the personnel to be prepared for an open and flexible encounter with the patient; to be prepared for the unprepared, i.e., to be open and to avoid being governed by predetermined statements. Discussion: Our findings suggest that the outcomes of good prehospital care affect patient security. The seemingly time-consuming dialogue with the patient facilitates understanding and decision-making regarding the patient's medical needs, and it is comforting to the patient. The ambulance personnel need to be well prepared for this task and fully understand that the situation might differ considerably from the information provided by the EMD centers. All objective information is of great value in this care context, but ultimately it is the patient who provides reliable information about her/his own situation.

  • 2220.
    Wireklint Sundström, Birgitta
    et al.
    University of Borås, School of Health Science.
    Dahlberg, Karin
    Caring assessment in the Swedish ambulance services relieves suffering and enables safe decisions2011In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 19, no 3, p. 113-119Article in journal (Refereed)
    Abstract [en]

    This study has a health care science approach and explores pre-hospital emergency care with emphasis on assessment. Health care science is focused on the patient with the general aim to describe care that strengthens and supports health. Assessment in the ambulance services has not been explored earlier from this perspective, despite the emphasis on ‘coming close’ to the acute suffering patient. The aim of the study is to describe and analyse assessment in caring situations. Data was collected by participant observations. The major findings point out the importance of professional carers’ recognition of the patient’s lifeworld as an essential part of assessment. The carers’ openness to the situation and to the patient’s suffering and needs vary from being of minor interest to complete focus of the assessment. It seems that assessments that focus solely on a patient’s medical condition can be an obstacle to a full understanding of the individual, and thereby the illness per se. A caring assessment based on an encounter and a dialogue between patient and carer, characterised by inviting the patient to participate, adds further dimensions to the objective data. Therefore, the inclusion of the patient perspective relieves suffering and enables more safe decisions.

  • 2221.
    Wireklint Sundström, Birgitta
    et al.
    University of Borås.
    Hagiwara, Magnus
    University of Borås.
    Andersson, Henrik
    University of Borås.
    Abelsson, Anna
    Karlstad University.
    Jakopovic, Denis
    Karolinska Institutet.
    Wallin, Kim
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Bremer, Anders
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Kågström, Christer
    Luleå University of Technology.
    Ek, Bosse
    Mid Sweden University.
    Lingsarve, Johan
    Uppsala University.
    Tegelberg, Alexander
    Uppsala University.
    Hellman, Per
    Uppsala University.
    Aléx, Jonas
    Umeå University.
    Gyllencreutz, Lina
    Umeå University.
    Uppstu, Tom
    Umeå University.
    Lammgård, Tomas
    Örebro University.
    Adolfsson, Annsofie
    Örebro University.
    Ek, Tony
    Riksföreningen för ambulanssjuksköterskor.
    Hommel, Ami
    Svensk sjuksköterskeförening.
    Ribeiro, Sineva
    Vårdförbundet.
    ”Nationella riktlinjer behövs för ambulanspersonal”2017In: Svenska Dagbladet, ISSN 1101-2412, no 2017-06-29Article in journal (Other (popular science, discussion, etc.))
    Abstract [sv]

    Det är förödande att sänka kraven på ambulanspersonal. Därför efterlyser vi nationella riktlinjer och beslut som tydligt anger en lägsta utbildningsnivå för anställning inom ambulanssjukvården, skriver Nät­verket för ut­bildning av ambulanssjuksköterskor i en slutreplik.

  • 2222.
    Wireklint Sundström, Birgitta
    et al.
    University of Borås, School of Health Science.
    Jylli, Leena
    Winge, Karin
    University of Borås, School of Health Science.
    Svensson, Leif (Editor)
    Barn och smärta2009In: Prehospital akutsjukvård / [ed] Björn-Ove Suserud, Leif Svensson, Stockholm: Liber , 2009, p. 452-459Chapter in book (Other academic)
  • 2223.
    Wireklint Sundström, Birgitta
    et al.
    University of Borås, School of Health Science.
    Sjöstrand, Fredrik
    Vicente, Veronica
    Svensson, Leif (Editor)
    Optimal vårdnivå vid icke-akuta tillstånd2009In: Prehospital akutsjukvård, Stockholm: Liber , 2009, p. 199-212Chapter in book (Other academic)
  • 2224.
    Wireklint-Sundström, Birgitta
    et al.
    University of Borås, School of Health Science.
    Winge, Karin
    University of Borås, School of Health Science.
    LINDRA-studien2009Conference paper (Refereed)
    Abstract [sv]

    Erfarenheter av att genomföra en forskningsstudie i ambulanssjukvård. LINDRA-studien syftar till att öka ambulanssjuksköterskors möjligheter att bedöma, lindra och behandla bröstsmärta och oro hos patienter som söker ambulanssjukvård. Datainsamlingen startade i maj 2008; Ambulanssjukvården i Göteborg/SU, Skaraborgs sjukhus, Södra Älvsborgs Sjukhus och Halmstad (öster). Våren 2009 gjordes en utökning; Norra Älvsborgs Sjukhus och Uddevalla sjukhus, Kungälvs Sjukhus och Halmstad (väster). Det innebär att ca 500 ambulanssjuksköterskor ingår i studien, som i övrigt involverar 60 ambulanser och en båt i Västsverige. Hittills har knappt 600 patienter deltagit, som när studien är klar sommaren 2010 omfattar ca 1800 patienter. Preliminära resultat beräknas kunna presenteras under slutet av 2010. I hälso- och sjukvården ska forsknings- och utvecklingsarbete (FoU) ingå som en naturlig del (HSL, 1982:763). Däremot saknas tradition och rutin för FoU inom ambulanssjukvård. LINDRA-studiens genomförande har gett oss en rad erfarenheter av möjligheter och svårigheter att bedriva prehospital forskning. Vi kommer att berätta om hur ambulanssjukvård och forskning går att kombinera.

  • 2225.
    Wisell, Kristin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmacy.
    Winblad, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Kälvemark Sporrong, Sofia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics.
    Reregulation of the Swedish pharmacy sector: Changed rationales over time2015In: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 3, no 9, p. 70-76Article in journal (Refereed)
    Abstract
  • 2226.
    Wisell, Kristin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmacy.
    Winblad, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Sporrong, Sofia Kalvemark
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmacy.
    Reregulation of the Swedish pharmacy sector: A qualitative content analysis of the political rationale2015In: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 119, no 5, p. 648-653Article in journal (Refereed)
    Abstract [en]

    In 2009, a reregulation of the Swedish pharmacy sector took place, and a fundamental change in ownership and structure followed. The reregulation provides an opportunity to reveal the politicians' views on pharmacies. The aim of thiS study was to explore and analyze the political arguments for the reregulation of the Swedish pharmacy sector in 2009. The method used was a qualitative content analysis of written political documents regarding the reregulation. The primary rationales for the reregulation were better availability, efficiency, price pressure, and safe usage of medicines. During the preparatory work, the rationales of diversity on the market and entrepreneurship were added, while the original rationales of efficiency, price pressure, and better usage of medicines were abandoned. The reform can be seen as a typical New Public Management reform influenced by the notion that private actors are better equipped to perform public activities. The results point to that the reform was done almost solely in order to introduce private ownership in the pharmacy sector, and was not initiated in order to solve any general problems, or to enhance patient outcomes of medicine use.

  • 2227.
    Wiss, Johanna
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Healthcare Priority Setting and Rare Diseases: What Matters When Reimbursing Orphan Drugs2017Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The rarity of a disease can give rise to challenges that differ from conventional diseases. For example, rarity hampers research and development of new drugs, and patients with severe, rare diseases have limited access to qualified treatments. When drugs are available, clinical evidence has higher uncertainty and the drugs can be very expensive. When setting priorities in the healthcare sector, treatments aimed at patients with rare diseases, so called orphan drugs, have become a source of concern. Orphan drugs seldom show solid evidence of effectiveness or cost-effectiveness. Still, treatments for rare disease patients, available on the European market, has increased rapidly since the adoption of a regulation offering incentives for research and development of orphan drugs. The question arises as to whether the publicly funded health care system should provide such expensive treatments, and if so, to what extent.

    This doctoral thesis aims to investigate healthcare priority setting and rare diseases in the context of orphan drug reimbursement. Priority setting for orphan drugs is located at the intersection of economic, ethical and psychological perspectives. This intersection is explored by studying the public’s view on the relevance of rarity when setting priorities for orphan drugs, and by examining how orphan drugs are managed when making reimbursement decisions in practice. Papers I and II in this thesis employ quantitative, experimental methods in order to investigate preferences for prioritising rare diseases, and the extent to which psychological factors influence such preferences. Papers III and IV employ qualitative methods to further explore what factors (apart from rarity) influence priority-setting decisions for orphan drugs, as well as how decisions regarding orphan drugs are made in practice in England, France, the Netherlands, Norway and Sweden. Combining quantitative and qualitative methods has provided a more comprehensive understanding of the topic explored in the thesis, and the methods have complemented each other.

    Paper I shows that there is no general preference for giving higher priority to rare disease patients when allocating resources between rare and common disease patients. However, results show that preferences for treating the rare patients are malleable to a set of psychological factors, in particular “proportion dominance”. Paper II shows that the identifiability of an individual has no, or a negative, influence on the share of respondents choosing to allocate resources to him/her (compared to a nonidentified individual). Paper III confirms that rarity per se is not seen as a factor that should influence priority-setting decisions (i.e. accept a greater willingness to pay for orphan drugs), however, other factors such as disease severity, treatment effect and whether there are treatment alternatives were seen as relevant for consideration. Paper IV explores the challenges with and solutions for orphan drug reimbursement, as perceived by different actors in five European countries. Perceived challenges are related to the components involved when making reimbursement decisions, to the reimbursement system, and to the acceptance of the final decision. Solutions are either specific for orphan drugs, or general measures that can be used for orphan drugs as well as for other drugs.

    In conclusion, priority setting for orphan drugs is complex and requires particular attention from decision makers. There are many factors to consider when making reimbursement decisions for orphan drugs. The consequences of a decision are potentially severe (both for rare disease patients and for common disease patients, depending on the decision) and psychological factors can potentially influence decisions.

  • 2228.
    Wiss, Johanna
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Carlsson, Per
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Prioritering av särläkemedel: en internationell utblick2016Report (Other academic)
    Abstract [sv]

    Denna rapport presenterar en översikt över hur fem europeiska länder hanterar subventionsbeslut av särläkemedel, dvs. läkemedel som används för att behandla patienter med svåra och sällsynta sjukdomar. Hälsoekonomiska utvärderingar visar att särläkemedel sällan är kostnadseffektiva när man utgår från traditionella gränsvärden avseende kostnad för vunnen hälsa. En ökning av antalet särläkemedel på den europeiska marknaden har bidragit till livliga diskussioner i Sverige och i andra länder om hur dessa ska hanteras inom ramen för rådande läkemedelssubventionssystem. Olika länder har hanterat frågan om dyra behandlingar riktade till patienter med sällsynta sjukdomar på olika sätt och utifrån ett svenskt perspektiv är det därför intressant att observera och inspireras av hur andra europeiska länder har hanterat frågan om särläkemedel.Syftet med denna rapport är: (1) Att beskriva prioriteringsprocessen av särläkemedel i Sverige, Nederländerna, Norge, Frankrike och England. Fokus ligger på de beslutskriterier som ligger till grund för beslut samt på hur prioriteringsprocessen ser ut; (2) Att redovisa lösningar och arbetssätt från respektive land som bidrag till den fortsatta diskussionen om prioritering och finansiering av särläkemedel i Sverige.

  • 2229.
    Wiss, Johanna
    et al.
    Linköping University. Linköping University, Department of Management and Engineering.
    Kalkan, Almina
    Rättvis värdering av hälsa: En kvantitativ jämförelse mellan Person Trade Off- och Time Trade Off- metoden2010Independent thesis Advanced level (degree of Master (Two Years)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    One must consider cost effectiveness when deciding how resources within the health sector should be distributed. Quality adjusted life years (QALYs) are used to measure the value of different medical treatments. QALY is based on utility maximization theory, which suggests that a QALY is always a QALY regardless of who receives it. Therefore, a produced QALY is worth the same regardless of the age or the initial health of the patient. Previous research has shown that these assumptions do not seem to fit the real preferences of individuals. Further, there are different methods of acquiring QALYs that give different outcomes. Two of these methods are Time Trade Off (TTO), in which respondents are confronted with a valuation of health change in time, and Person Trade Off (PTO), where respondents are confronted with a valuation in persons. Arguably, PTO is the preferred method that takes greater account of how individuals wish to allocate the resources of the society. From a distribution perspective focusing on age and initial health status, this paper aims to empirically identify the differences between TTO and PTO considering the measurement of preferences for life quality. The aim is also to examine whether the results obtained are consistent with the theoretical assumptions that are required for the preference to be accepted as a cardinal utility. A quantitative survey was carried out with 58 medical and 61 economics students. Half of the students received PTO and the other half TTO questions. The data collected was analyzed comparing the methods, the two student groups and men against women.

    The results from the survey show that, both with TTO and PTO, respondents on average believe that patients who are at a lower initial health level should be given priority over patients who are at a higher initial health level, and younger patients should be given priority over older patients. No significant differences were seen between PTO and TTO when it came to the age of the patient. Conversely, there was a significant difference between the methods for the valuation based on initial health status of patients. Measured with PTO a treatment for patients who are at a lower initial level is valued 28% higher than a treatment for those patients who are at a higher initial level, while the corresponding figure for TTO was 8%. Between medical students and economic students, there were significant differences in the question of age in the PTO. Between men and women differences were found in both methods.

  • 2230.
    Wiss, Johanna
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Levin, Lars-Åke
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    David, Andersson
    Linköping University, Department of Management and Engineering, Economics. Linköping University, Faculty of Arts and Sciences.
    Tinghög, Gustav
    Linköping University, Department of Management and Engineering, Economics. Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Prioritizing Rare Diseases: Psychological Effects Influencing Medical Decision Making2017In: Medical decision making, ISSN 0272-989X, E-ISSN 1552-681XArticle in journal (Refereed)
    Abstract [en]

    Background. Measuring societal preferences for rarity has been proposed to determine whether paying pre- mium prices for orphan drugs is acceptable. Objective. To investigate societal preferences for rarity and how psychological factors affect such preferences. Method. A postal survey containing resource allocation dilemmas involving patients with a rare disease and patients with a common disease, equal in severity, was sent out to a randomly selected sample of the population in Sweden (return rate 42.3%, n = 1270). Results. Overall, we found no evidence of a general preference for prioritizing treat- ment of patients with rare disease patients over those with common diseases. When treatment costs were equal, most respondents (42.7%) were indifferent between the choice options. Preferences for prioritizing patients with common diseases over those with rare diseases were more frequently displayed (33.3% v. 23.9%). This tendency was, as expected, amplified when the rare disease was costlier to treat. The share of respondents choosing to treat patients with rare diseases increased when present- ing the patients in need of treatment in relative rather than absolute terms (proportion dominance). Surprisingly, identifiability did not increase preferences for rarity. Instead, identifying the patient with a rare disease made respondents more willing to prioritize the patients with common diseases. Respondents’ levels of education were significantly associated with choice—the lower the level of education, the more likely they were to choose the rare option. Conclusions. We find no support for the existence of a general preference for rarity when setting health care priorities. Psychological effects, especially proportion dominance, are likely to play an important role when pre- ferences for rarity are expressed.  

  • 2231.
    Wittboldt, Susanna
    et al.
    Sahlgrenska University Hospital.
    Cider, Åsa
    Sahlgrenska University Hospital, University of Gothenburg.
    Bäck, Maria
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences.
    Reliability of two questionnaires on physical function in patients with stable coronary artery disease.2016In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 15, no 2, p. 142-149Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Exercise-based cardiac rehabilitation is highly recommended for patients with coronary artery disease, as it improves physical fitness and reduces mortality and morbidity. Physical fitness per se does not always correlate with the patient's physical function. For this reason, additional measurements of physical function could be included in cardiac rehabilitation programmes to further tailor interventions to suit the individual patient. As a result, reliable measurements to assess physical function are required for patients with coronary artery disease.

    AIM: The aim of this study was to evaluate the reliability of the Patient-Specific Functional Scale (PSFS) and the Disability Rating Index (DRI) in patients with stable coronary artery disease.

    MATERIAL: Fifty-one patients (11 women), age 63.9 (SD 7.6) years, with stable coronary artery disease and coronary-angiographic changes indicating an elective percutaneous coronary intervention, were recruited at the Cardiology Department at Sahlgrenska University Hospital, Gothenburg.

    METHODS: The reliability tests included stability over time, evaluated with a test-retest procedure using the intraclass correlation coefficient (ICC), and internal consistency, measured with Cronbach's alpha and item-total correlation coefficients.

    RESULTS: Both questionnaires were stable over time (DRI, ICC=0.74, and PSFS, ICC=0.72). The internal consistency for the DRI was good, with a Cronbach's alpha value of > 0.85 for all items. The item-total correlation coefficients presented acceptable values of > 0.40, apart from two items.

    CONCLUSION: We have provided introductory support for the reliability of the DRI and PSFS questionnaires in patients with stable CAD. These questionnaires can be used to assess physical function and to evaluate the effect of interventions in addition to measuring physical fitness.

  • 2232. Wittchen, H U
    et al.
    Jacobi, F
    Rehm, J
    Gustavsson, A
    Svensson, Mikael
    Karlstad University, Faculty of Economic Sciences, Communication and IT, Department of Economics and Statistics.
    Jönsson, B
    Olesen, J
    Allgulander, C
    Alonso, J
    Faravelli, C
    Fratiglioni, L
    Jennum, P
    Lieb, R
    Maercker, A
    van Os, J
    Preisig, M
    Salvador-Carulla, L
    Simon, R
    Steinhausen, H-C
    The size and burden of mental disorders and other disorders of the brain in Europe 2010.2011In: European Neuropsychopharmacology, ISSN 0924-977X, E-ISSN 1873-7862, Vol. 21, no 9, p. 655-79Article in journal (Refereed)
    Abstract [en]

    AIMS: To provide 12-month prevalence and disability burden estimates of a broad range of mental and neurological disorders in the European Union (EU) and to compare these findings to previous estimates. Referring to our previous 2005 review, improved up-to-date data for the enlarged EU on a broader range of disorders than previously covered are needed for basic, clinical and public health research and policy decisions and to inform about the estimated number of persons affected in the EU.

    METHOD: Stepwise multi-method approach, consisting of systematic literature reviews, reanalyses of existing data sets, national surveys and expert consultations. Studies and data from all member states of the European Union (EU-27) plus Switzerland, Iceland and Norway were included. Supplementary information about neurological disorders is provided, although methodological constraints prohibited the derivation of overall prevalence estimates for mental and neurological disorders. Disease burden was measured by disability adjusted life years (DALY).

    RESULTS: Prevalence: It is estimated that each year 38.2% of the EU population suffers from a mental disorder. Adjusted for age and comorbidity, this corresponds to 164.8million persons affected. Compared to 2005 (27.4%) this higher estimate is entirely due to the inclusion of 14 new disorders also covering childhood/adolescence as well as the elderly. The estimated higher number of persons affected (2011: 165m vs. 2005: 82m) is due to coverage of childhood and old age populations, new disorders and of new EU membership states. The most frequent disorders are anxiety disorders (14.0%), insomnia (7.0%), major depression (6.9%), somatoform (6.3%), alcohol and drug dependence (>4%), ADHD (5%) in the young, and dementia (1-30%, depending on age). Except for substance use disorders and mental retardation, there were no substantial cultural or country variations. Although many sources, including national health insurance programs, reveal increases in sick leave, early retirement and treatment rates due to mental disorders, rates in the community have not increased with a few exceptions (i.e. dementia). There were also no consistent indications of improvements with regard to low treatment rates, delayed treatment provision and grossly inadequate treatment. Disability: Disorders of the brain and mental disorders in particular, contribute 26.6% of the total all cause burden, thus a greater proportion as compared to other regions of the world. The rank order of the most disabling diseases differs markedly by gender and age group; overall, the four most disabling single conditions were: depression, dementias, alcohol use disorders and stroke.

    CONCLUSION: In every year over a third of the total EU population suffers from mental disorders. The true size of "disorders of the brain" including neurological disorders is even considerably larger. Disorders of the brain are the largest contributor to the all cause morbidity burden as measured by DALY in the EU. No indications for increasing overall rates of mental disorders were found nor of improved care and treatment since 2005; less than one third of all cases receive any treatment, suggesting a considerable level of unmet needs. We conclude that the true size and burden of disorders of the brain in the EU was significantly underestimated in the past. Concerted priority action is needed at all levels, including substantially increased funding for basic, clinical and public health research in order to identify better strategies for improved prevention and treatment for disorders of the brain as the core health challenge of the 21st century.

  • 2233.
    Wold Jakobsson, Joakim
    Stockholm University. Stockholm University, University Library. Stockholm University, Faculty of Social Sciences, Department of Special Education.
    Arbetssätt och individualisering för elever med diagnosen ADHD.: ”På medeltiden hade man säkert jättenytta av lite ADHD, som bra krigare och kung. Men det är inte de kriterier som gäller i dagens samhälle.”2010Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Attention Deficit Hyperactivity Disorder (ADHD) är en av skolans vanligaste diagnoser och det uppskattas att omkring 2-3 procent av den svenska skolans elever tillhör denna kategori. Syftet med denna studie har varit att undersöka vilka tolkningar som finns för begreppet ADHD. Det har även varit ett syfte att undersökt hur en kommun i Stockholms län, en grundskola i den valda kommunen och grundskolans idrottslärare arbetar utifrån styrdokumenten för att skapa en individualiserad undervisning för elever med diagnosen ADHD.

    Intervjuer har genomförts med en kommunanställd specialpedagog, rektorn på den valda grundskolan samt tre av grundskolans idrottslärare för att spegla arbetet i den dagliga verksamheten.

    Det studien har kommit fram till är att begreppet ADHD är ett väldigt komplicerat begrepp som skolan, kommunen och forskare har svårt att enas om gemensamma förklaringar till. Enligt grundskolans styrdokument är diagnoser inte nödvändiga, men de kan ses som en stor hjälp för skolan och skolans lärare när det kommer till deras förståelse för elevens beteende. Diagnosen ADHD kan ses som ett fenomen i sig för att ge förståelse för personer runt omkring eleven. Om diagnosen ADHD skall användas i skolan bör den endast användas för att hjälpa eleven att på bästa sätt utvecklas kunskapsmässigt och personligt.

    En slutsats är att det behövs mer utbildning om begreppet ADHD i skolan för att undervisningen skall individanpassas till eleven med diagnosen ADHD på bästa möjliga sätt. Intervjupersonerna i studien har samtliga ansett att de själva skulle behöva mer utbildning för att öka förståelsen för en av skolans vanligaste diagnoser, ADHD.

  • 2234. Wramsten Wilmar, Maria
    et al.
    Ahlborg, Gunnar
    Jacobsson, Christian
    Dellve, Lotta
    University of Borås, School of Health Science.
    Healthcare managers in negative media focus: a qualitative study of personification processes and their consequences2014In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 14, no 8Article in journal (Refereed)
    Abstract [en]

    Background Over the last decade healthcare management and managers have increasingly been in focus in public debate. The purpose of the present study was to gain a deeper understanding of how prolonged, unfavorable media focus can influence both the individual as a person and his or her managerial practice in the healthcare organization. Methods In-depth interviews (n = 49) with 24 managers and their superiors, or subordinate human resources/information professionals, and partners were analyzed using a grounded theory approach.Results The conceptual model explains how perceived uncertainties related to the managerial role influence personification and its negative consequences. The role ambiguities comprised challenges regarding the separation of individual identity from the professional function, the interaction with intra-organizational support and political play, and the understanding and acceptance of roles in society. A higher degree of uncertainty in role ambiguity increased both personification and the personal reaction to intense media pressure. Three types of reactions were related to the feeling of being infringed: avoidance and narrow-mindedness; being hard on self, on subordinates, and/or family members; and resignation and dejection. The results are discussed so as to elucidate the importance of support from others within the organization when under media scrutiny. Conclusions The degree of personification seems to determine the personal consequences as well as the consequences for their managerial practice. Organizational support for managers appearing in the media would probably be beneficial for both the manager and the organization.

  • 2235.
    Wranne, Birgitta
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Förbättringsarbete om att öka patientens delaktighet: En fallstudie om att införa personcentrerad vård på en kardiologisk vårdenhet2016Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Enligt nationella patientenkäten är patienterna nöjda med vården, däremot skattas inte delaktigheten lika högt.  Ett sätt att öka delaktigheten är personcentrerad vård, som dessutom kan ge en mer effektiv vård med högre kvalitet. 

    Syfte: Studiens syfte var att beskriva och analysera ett förbättringsarbete om att öka patientens delaktighet genom införande av personcentrerad vård på en kardiologisk vårdenhet.

    Metod: Förbättringsarbetet genomfördes enligt Nolans förbättringsmodell. Studien var en fallstudie med induktiv ansats. Kvantitativ datainsamling skedde genom enkäter till patienter och medarbetare före och efter fem månaders förbättringsarbete. Kvalitativ datainsamling skedde genom foksugruppsintervjuer med medarbetare.

    Resultat: Enkäterna visade inga tydliga skillnader efter fem månaders förbättringsarbete. Både patienter och medarbetare skattade patientdelaktigheten högt. Det som skattades lägst av båda grupper var hänsynstagande till arbete, levnadsvanor och tidigare erfarenhet av sjukhusvård.

    Fokusgruppsintervjuerna visade att välinformerade patienter i större utsträckning kunde vara mer delaktiga. Medarbetarna fick en bättre förståelse av patienten, samtidigt fanns oro över att missa viktig information. Viljan fanns till personcentrering, men förutsättningarna saknades.

    Slutsats: Förbättringsmodellen är lämplig för införande av personcentrerad vård för att kunna testa vad som fungerar praktiskt. För att lyckas behövs tid och stöd från ledningen. Medarbetarna behöver träning, coaching och få vara delaktiga i förbättringsarbetet.

  • 2236.
    Wright, Rebecca J.
    et al.
    Florence Nightingale Faculty of Nursing & Midwifery, King's College London, London, UK.
    Lowton, Karen
    Department of Sociology, University of Sussex, Brighton, UK.
    Robert, Glenn
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ. IMPROVE (Improvement, innovation, and leadership in health and welfare). Florence Nightingale Faculty of Nursing & Midwifery, King's College London, London, UK.
    Grudzen, Corita R
    Ronald O. Perelman Department of Emergency Medicine, School of Medicine, New York University, New York, NY, USA.
    Grocott, Patricia
    Florence Nightingale Faculty of Nursing & Midwifery, King's College London, London, UK.
    Emergency department staff priorities for improving palliative care provision for older people: A qualitative study2018In: Palliative Medicine: A Multiprofessional Journal, ISSN 0269-2163, E-ISSN 1477-030X, Vol. 32, no 2, p. 417-425Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Emergency department-based palliative care services are increasing, but research to develop these services rarely includes input from emergency clinicians, jeopardizing the effectiveness of subsequent palliative care interventions.

    AIM: To collaboratively identify with emergency clinicians' improvement priorities for emergency department-based palliative care for older people.

    DESIGN: This was one component of an experience-based co-design project, conducted using semi-structured interviews and feedback sessions.

    SETTING/PARTICIPANTS: In-depth interviews with 15 emergency clinicians (nurses and doctors) at a large teaching hospital emergency department in the United Kingdom exploring experiences of palliative care delivery for older people. A thematic analysis identified core challenges that were presented to 64 clinicians over five feedback sessions, validating interview findings, and identifying shared priorities for improving palliative care delivery.

    RESULTS: Eight challenges emerged: patient age; access to information; communication with patients, family members, and clinicians; understanding of palliative care; role uncertainty; complex systems and processes; time constraints; and limited training and education. Through feedback sessions, clinicians selected four challenges as improvement priorities: time constraints; communication and information; systems and processes; and understanding of palliative care. As resulting improvement plans evolved, "training and education" replaced "time constraints" as a priority.

    CONCLUSION: Clinician priorities for improving emergency department-based palliative care were identified through collaborative, iterative processes. Though generally aware of older palliative patients' needs, clinicians struggled to provide high-quality care due to a range of complex factors. Further research should identify whether priorities are shared across other emergency departments, and develop, implement, and evaluate strategies developed by clinicians.

  • 2237.
    Wubker, Ansgar
    et al.
    University of Witten/Herdecke, Essen, Germany & Rheinisch-Westfälisches Institut für Wirtschaftsforschung, Health Devision, Essen, Germany.
    Zwakhalen, Sandra
    Maastricht University, Maastricht, Netherlands.
    Challis, David
    The University of Manchester, Manchester, United Kingdom.
    Suhonen, Riita
    University of Turku, Department of Nursing Science, Turku, Finland.
    Karlsson, Staffan
    Lund University, The Swedish Institute of Health Sciences, Lund, Sweden.
    Zabalegui, Adelaida
    School of Health Sciences, Hospital Clínic de Barcelona, Mataró (Barcelona), Spain.
    Soto, Maria
    Gérontopôle de Toulouse, Department of Geriatric Medicine, University Hospital de Toulouse, Toulouse, France.
    Saks, Kai
    University of Tartu, Department of Internal Medicine, Tartu, Estonia.
    Sauerland, Dirk
    University of Witten/Herdecke, Department of Institutional Economics and Health Systems Management, Witten, Germany.
    Costs of care for people with dementia just before and after nursing home placement: primary data from eight European countries2015In: European Journal of Health Economics, ISSN 1618-7598, E-ISSN 1618-7601, Vol. 16, no 7, p. 689-707Article in journal (Refereed)
    Abstract [en]

    Background: Dementia is the most common cause of functional decline among elderly people and is associated with high costs of national healthcare in European countries. With increasing functional and cognitive decline, it is likely that many people suffering from dementia will receive institutional care in their lifetime. To delay entry to institutional care, many European countries invest in home and community based care services.

    Objectives: This study aimed to compare costs for people with dementia (PwD) at risk for institutionalization receiving professional home care (HC) with cost for PwD recently admitted to institutional long-term nursing care (ILTC) in eight European countries. Special emphasis was placed on differences in cost patterns across settings and countries, on the main predictors of costs and on a comprehensive assessment of costs from a societal perspective.

    Methods: Interviews using structured questionnaires were conducted with 2,014 people with dementia and their primary informal caregivers living at home or in an ILTC facility. Costs of care were assessed with the resource utilization in dementia instrument. Dementia severity was measured with the standardized mini mental state examination. ADL dependence was assessed using the Katz index, neuropsychiatric symptoms using the neuropsychiatric inventory (NPI) and comorbidities using the Charlson. Descriptive analysis and multivariate regression models were used to estimate mean costs in both settings. A log link generalized linear model assuming gamma distributed costs was applied to identify the most important cost drivers of dementia care.

    Results: In all countries costs for PwD in the HC setting were significantly lower in comparison to ILTC costs. On average ILTC costs amounted to 4,491 Euro per month and were 1.8 fold higher than HC costs (2,491 Euro). The relation of costs between settings ranged from 2.4 (Sweden) to 1.4 (UK). Costs in the ILTC setting were dominated by nursing home costs (on average 94 %). In the HC setting, informal care giving was the most important cost contributor (on average 52 %). In all countries costs in the HC setting increased strongly with disease severity. The most important predictor of cost was ADL independence in all countries, except Spain and France where NPI severity was the most important cost driver. A standard deviation increase in ADL independence translated on average into a cost decrease of about 22 %.

    Conclusion: Transition into ILTC seems to increase total costs of dementia care from a societal perspective. The prevention of long-term care placement might be cost reducing for European health systems. However, this conclusion depends on the country, on the valuation method for informal caregiving and on the degree of impairment.

  • 2238.
    Wännström, Ingrid
    et al.
    Karolinska Institutet.
    Peterson, Ulla
    Karolinska Institutet.
    Åsberg, Marie
    Karolinska Institutet.
    Nygren, Åke
    Karolinska Institutet.
    Gustavsson, J. Petter
    Karolinska Institutet.
    Can scales assessing psychological and social factors at work be used across different occupations?2009In: Work: A journal of Prevention, Assesment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270, Vol. 34, no 1, p. 3-11Article in journal (Refereed)
    Abstract [en]

    AIM: To assess the psychometric properties of a comprehensive tool for assessing psychosocial work characteristics(the QPSNordic), focusing on measurement invariance (MI) across occupations.

    METHODS: QPSNordic consists of 26 scales covering task, individual, and organizational aspects of work. Multiple group confirmatory factor analyses were performed in order to elucidate MI across a variety of occupational groups.

    SUBJECTS: Private sector employees and health care workers from the public sector participated. Equal size (n = 500) groups from six different occupations were drawn and entered in multiple group confirmatory factor analyses for assessment of MI.

    RESULTS: Nine of the 24 analysed scales functioned well across all occupational groups and could thus be used for valid comparisons across professions. The majority of the remaining scales showed MI at least across some groups.

    CONCLUSION: With some exceptions, the QPSNordic has good psychometric properties. Scales measuring organizational aspects of work could also be used across professional groups, enabling valid comparisons between differing workplaces and occupations.

  • 2239.
    Wännström, Ingrid
    et al.
    Karolinska Institutet.
    Peterson, Ulla
    Karolinska Institutet.
    Åsberg, Marie
    Karolinska Institutet.
    Nygren, Åke
    Karolinska Institutet.
    Gustavsson, J. Petter
    Karolinska Institutet.
    Psychometric properties of scales in the General Nordic Questionnaire for Psychological and Social Factors at Work (QPSNordic): confirmatory factor analysis and prediction of certified long-term sickness absence2009In: Scandinavian Journal of Psychology, ISSN 0036-5564, E-ISSN 1467-9450, Vol. 50, no 3, p. 231-244Article in journal (Refereed)
    Abstract [en]

    Psychometric properties, particularly predictive validity, of scales in the General Nordic Questionnaire for Psychological and Social Factors at Work (QPSNordic) were assessed. The analysis is confined to the scales in the QPSNordic, and 24 of the 26 scales are included. A large group of Swedish county council employees (n= 3,976; response rate = 65%) participated in a study and were given the QPSNordic. Register data for long-term sick leave (>90 days), with diagnosis, were used for predictive analysis. The following main results were obtained: Reliability was generally satisfactory, confirmatory factor analysis indicated good fit, concurrent validity was good, some less often investigated organizational variables predicted sickness absence, and scales were differentially associated with absence due to psychiatric and musculoskeletal disorders. In conclusion, the psychometric testing of the QPSNordic so far suggests that it is a good instrument for assessing health-related factors at work.

  • 2240.
    Wåhslén, Jonas
    KTH, School of Engineering Sciences in Chemistry, Biotechnology and Health (CBH), Biomedical Engineering and Health Systems, Health Informatics and Logistics.
    Technical Solutions for Internet-based Wireless Sensor Networks in e-Health Applications2018Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    E-Health technology has developed rapidly in the last decade. Body-worn sen- sors have developed from an idea to a reality. Today, wireless sensors can perform functions from measuring heartbeats to advanced motion recognition. However, the integration of the various available solutions is still lacking. The research presented in this thesis examined important issues in wireless sensor networks and mobile phone systems for e-Health applications. The dissertation covers four essential areas for successful integration of IoT communication systems for e-Health. The first area is fusion of sensor data. In the previous licentiate thesis (2013), three algo- rithms were developed to synchronise data from multiple wireless sensors. The dissertation presents a method to merge data from wireless sensors with video streams. That was subsequently applied for automatic fall prevention and fall detec- tion using inertial sensors and a depth camera. The second area is mobile phone centric systems for Wi-Fi device-to-device sensor communication enabling mobility in ambient assisted living (AAL) services. The third area is a real-time monitoring and control system for Bluetooth wireless communication networks. Lastly, the dissertation presents a software framework to iteratively develop, tune and deploy functions in wireless sensor network using dynamic software updating.

  • 2241.
    Ydreborg, Berit
    Linköping University, Department of Medicine and Health Sciences, Work and Rehabilitation . Linköping University, Faculty of Health Sciences.
    To be in‐between: The road to disability pension with reference to the Swedish social insurance system2005Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: The Social Insurance is part of the Swedish welfare system that is intended to create economic security for citizens in the event of unemployment, sickness, functional disability, and old age. The Swedish sickness‐benefit insurance is based on the standard insurance principle meaning that sickness benefits are related to level of lost income. The increasing number of sick listed people and people with disability pension (DPs) in Sweden may lead to marginalisation of individuals as they are not part of the labour market. The government has decided that the number of sick‐listed people should be halved by 2008, which means a tougher judgment of the applications for sick leave compensation. To be qualified for sickness benefit the disease has to impair the work ability in relation to the specific demands of the work of that person. The evaluation of the work ability in a percentage is an important element with regard to the policy on disability. The social insurance officers (SIOs) who are assessing the work ability are dependent on judgments from the physicians as expertise, and the guidelines in the social insurance act. The eligibility criteria for DP and the process of dealing with applications for DP is scarcely studied.

    Objectives: The overall aim of the thesis was to explore demographic and health differences between those, who were granted and those, who were not granted disability pension. The second aim was to study how the process from applications to decisions on disability pensions were executed and perceived by the social insurance offices and to elucidate their working conditions during the decision process. Material and methods: The first two studies explored differences between those granted DP and those not granted DP. Study I was a register‐based retrospective case‐control study carried out in the area of a county in Sweden. The cases were all individuals rejected a full disability pension 1999‐2000, in all 99 cases. Controls were every tenth person who was granted a full DP during the same period, 198 controls. Determinants were recorded from the Social Insurance (SI). In study II demographic data and medical diagnoses were obtained from the SI records. Data concerning self‐reported health, HRQoL, social networks and use of health care were collected by a postal questionnaire. The study objects were the same as in study I. In study III and IV indepth interviews were carried through to study the social insurance officers’ perspective on the process from application to decision on disabilitypensions as well as their experiences of prerequisites and hindrances in their work with DP applications. The transcribed data were analysed by an inductive content analysis.

    Results: Unemployment, living in the main municipality and age below 50 years were determinants for rejection of DP. Medical status as described in the Social Insurance records had less association with the outcome. There are variations in praxis of rejection of applicants between social insurance boards in different geographical areas due to other reasons than medical. The nDP group had more often multiple diagnoses, and lower self‐reported health and HRQoL compared to those granted DP. Those not granted DP also had significantly smaller social networks.

    The SIOs perceived that they had to make rapid decisions within a limited time frame, based on limited information, mainly on the basis of incomplete medical certificates, and with no firm criteria for the regulations on the individual case level. Communication among the various authorities as employment offices and social services suffered from lack of common goaldirected strategy. In study IV the SIOs described their working conditions when executing the applications for DP. The SIOs perceived recurrent changes in rules and regulations as frustrating as they at the same time had to face the client. The large number of clients prevented them from being able to offer clients activities and support them in the way they were supposed to do. The SIOs powerful position and how their discretion was implemented made them feel responsible for performing their work well. SIOs are to be considered as typical street‐level bureaucrats as they have to perform their work between the policy, rules and clients.

    Conclusions: The individuals had an increased risk to be rejected DP if they were younger than 50 years, unemployed, and lived in the main city. No evident differences in medical diagnoses were found between the groups. The results indicate that there may be other reasons than medical in praxis. Contrary to expectations, those not granted DP do not seem to have better health, but rather to suffer from more sickness than those, who were granted DP. Unemployment leads to inability to qualify for compensation and benefits that are associated with participation on the labour market. The group not granted disability pension appears to be a disadvantaged group in need for a co‐ordination between different parts of the social welfare system.

    The different perspectives were perceived as obvious obstacles in the communication between professionals in the welfare system as they had other goals and demands. Clients, that have comprehensive problems and are in need of coordinated measures from many authorities to get entrance to the labour market still suffer from lack of coordination. One question is how the different public officers use their discretion when handling clients and how the cooperation can be improved.

  • 2242.
    Ydreborg, Berit
    et al.
    Linköping University, Department of Department of Health and Society. Linköping University, Faculty of Health Sciences.
    Ekberg, Kerstin
    Linköping University, Department of Department of Health and Society. Linköping University, Faculty of Health Sciences.
    Disqualified for disability pension: a case referent study2004In: Disability and Rehabilitation, ISSN 0963-8288, Vol. 26, no 16, p. 1079-1086Article in journal (Refereed)
    Abstract [en]

    Objectives: To analyse medical and other determinants for decisions about rejection or acceptance of applications for disability pension.

    Methods: A register-based retrospective case-control study was carried out in the area of a county in mid-Sweden. Cases were all individuals rejected a full disability pension 1999 - 2000, in all 99 cases. Controls were every tenth person granted a full disability pension during the same period, 198 individuals. Determinants were recorded from the protocols at the Social Insurance Office.

    Results: Unemployment (OR = 7.1, CI = 3.1 - 16.4), living in the main municipality, (OR = 2.8, CI = 1.4 - 5.8) and age below 50 years (OR = 0.4, CI = 0.2 - 0.8) were determinants for rejection of disability pension. Medical status, as described in the Social Insurance act, had no association with the outcome.

    Conclusions: There appear to be variations in praxis of rejection of applicants between Social Insurance boards in different geographical areas due to reasons other than medical. Socio-economic situation of the applicant may have an influence. Established criteria for determining work ability are needed.

  • 2243.
    Ydreborg, Berit
    et al.
    Linköping University, Department of Medicine and Health Sciences, Work and Rehabilitation . Linköping University, Faculty of Health Sciences.
    Ekberg, Kerstin
    Linköping University, Department of Medicine and Health Sciences, Work and Rehabilitation . Linköping University, Faculty of Health Sciences.
    Nilsson, Kerstin
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Executing applications for DPs‐ social insurance officers’ experiences of prerequisites and hindrances in their working conditions2005Article in journal (Refereed)
  • 2244.
    Ydreborg, Berit
    et al.
    Linköping University, Department of Medicine and Health Sciences, Work and Rehabilitation . Linköping University, Faculty of Health Sciences.
    Ekberg, Kerstin
    Linköping University, Department of Medicine and Health Sciences, Work and Rehabilitation . Linköping University, Faculty of Health Sciences.
    Nilsson, Kerstin
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    From application to decision on disability pensions: Swedish social insurance officers’ practice2005Article in journal (Refereed)
  • 2245.
    Yngman Uhlin, Pia
    et al.
    Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care. Linköping University, Department of Medical and Health Sciences, Division of Drug Research.
    Fogelberg, Annika
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Nephrology.
    Uhlin, Fredrik
    Region Östergötland, Heart and Medicine Center, Department of Nephrology. Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Tallin University of Technology, Tallin, Estland.
    Life in standby: hemodialysis patients' experiences of waiting for kidney transplantation.2016In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 25, no 1-2, p. 92-98Article in journal (Refereed)
    Abstract [en]

    AIM AND OBJECTIVES: Our aim was to explore the experiences of hemodialysis patients who are waiting for a kidney transplant.

    BACKGROUND: Currently, more than 100,000 persons are waiting for kidney transplantation in the United States. In Sweden, the number is exceeding 600. The waiting period for a deceased donor can be one to three years or even longer in Sweden. This can be challenging, since the patients' situation, with chronic treatment and illness, is burdensome and requires advanced self-care.

    DESIGN: This study included a purposeful sample of eight patients (33-53 years old) who had been undergoing hemodialysis treatment for at least six months and were waiting for kidney transplantation.

    METHODS: The patients were interviewed, and descriptive content analysis was performed.

    RESULTS: Four categories emerged: (1) 'The waiting process,' what thoughts and expectations occur and what to do and how to be prepared for the transplant. (2) 'Awareness that time is running out,' patients felt tied up by treatment and by needing to be available for transplantation, and they had concerns about health. (3) 'Need for communication,' patients described needing support from others and continuous information from the staff. (4) 'Having relief and hope for the future,' patients described how to preserve the hope of being able to participate fully in life once again.

    CONCLUSIONS: This study reveals the need for extra attention paid to patients waiting for kidney transplantation. Patients' experiences during the waiting period indicate that pretransplant patients have an increased need to be prepared for the transition and for life post-transplantation.

    RELEVANCE TO CLINICAL PRACTICE: Dialysis patients on waiting lists must be prepared for the upcoming life change. This includes preserving hope during the waiting period and being mentally prepared for transplantation and a dialysis-free life. A pretransplant education program to prevent medical and psychosocial issues is highly recommended.

  • 2246. Yngman-Uhlin, Pia
    et al.
    Klingvall, Emma
    Wilhelmsson, Maria
    Jangland, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Education in Nursing.
    Obstacles and opportunities for achieving good care on the surgical ward: nurse and surgeon perspective2016In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 24, no 4, p. 492-499Article in journal (Refereed)
    Abstract [en]

    AIM: The purpose of this qualitative study was to explore and understand from the perspectives of nurses and surgeons the situations and processes that are important in the context of surgical care support or are obstacles to achieving good care.

    BACKGROUND: Medical advances and inpatients with multiple illnesses are on the increase. In addition, a high turnover of registered nurses has been identified. This contributes to an increasingly inexperienced nursing staff. Concurrently, studies have shown that patient safety and quality of care are linked to organisational structures and staffing education levels.

    METHOD: Eight nurses and six surgeons from three hospitals were interviewed and data were analysed by systematic text condensation.

    RESULTS: This identified three themes: shifting focus away from the patients, emphasising good communication, and using the competence of the team.

    CONCLUSION: This study contributes to a deeper understanding that many interruptions, insufficient communication and unused competence can be a threat to patient safety. Sweden has a high standard but this study elucidates that challenges remain to be resolved.

    IMPLICATIONS FOR NURSING MANAGEMENT: The focus on patients can increase by a balance between direct/indirect patient work and administration and by the support of clinicians using their full professional competence.

  • 2247. Zain Elabdien, B S
    et al.
    Olerud, S
    Karlström, G
    Smedby, B
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Rising incidence of hip fracture in Uppsala, 1965-19801984In: Acta Orthopaedica Scandinavica, ISSN 0001-6470, Vol. 55, no 3, p. 284-89Article in journal (Refereed)
    Abstract [en]

    The frequency and incidence of hip fracture in persons aged 55 years and older in the county of Uppsala during the years 1965, 1970, 1975 and 1980 are reported. For every 5-year interval, the number of hip fractures increased by 21-25 per cent. The ratio of women to men changed from 3.8 in 1965 to 3.1 in 1980. Trochanteric fractures were more common during the later years. The ratio of femoral neck fractures to trochanteric fractures decreased from 1.8 to 1.1 between 1965 and 1980. The incidence of hip fracture in the investigated part of the population increased from 43 per 10 000 in 1965 to 65 in 1980. The age-specific incidence increased especially in the group aged 85 years and older, in which fractures of the femoral neck were three times and trochanteric fractures four times more common in 1980 than in 1965. This investigation shows that the incidence of hip fracture has increased, particularly in the higher age groups. If the age-specific incidences continue to rise in the higher age groups, the frequency of hip fractures will be doubled within a 20-year period.

  • 2248.
    Zander, Viktoria
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Karolinska Univ Hosp Solna, Dept Womens & Childrens Hlth, Karolinska Inst, S-17176 Stockholm, Sweden..
    Eriksson, Henrik
    Swedish Red Cross Univ Coll, Dept Nursing & Care, S-11428 Stockholm, Sweden..
    Christensson, Kyllike
    Karolinska Univ Hosp Solna, Dept Womens & Childrens Hlth, Karolinska Inst, S-17176 Stockholm, Sweden..
    Mullersdorf, Maria
    Malardalen Univ, Sch Hlth Care & Social Welf, S-63105 Eskilstuna, Sweden..
    Development of an Interview Guide Identifying the Rehabilitation Needs of Women from the Middle East Living with Chronic Pain2015In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 12, no 10, p. 12043-12056Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was to develop an interview guide for use by primary healthcare professionals to support them in identifying the rehabilitation needs of forced resettled women from the Middle East living with chronic pain. Previous findings together with the existing literature were used as the basis for developing the interview guide in three steps: item generation, cognitive interviews, and a pilot study. The study resulted in a 16-item interview guide focusing on patients' concerns and expectations, with consideration of pre-migration, migration, and post-migration factors that might affect their health. With the help of the guide, patients were also invited to identify difficulties in their daily activities and to take part in setting goals and planning their rehabilitation. The current interview guide provides professional guidance to caretakers, taking a person-centered participative point of departure when meeting and planning care, for and together, with representatives from dispersed ethnic populations in Sweden. It can be used together with the patient by all staff members working in primary healthcare, with the aim of contributing to continuity of care and multi-professional collaboration.

  • 2249. Zetterström, R
    et al.
    Smedby, B
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Vårdbehov och vårdeffektivitet1979In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 76, p. 711-12Article in journal (Refereed)
  • 2250.
    Zhang, Chen
    et al.
    KTH, School of Technology and Health (STH), Health Systems Engineering, Health Care Logistics.
    Hanchi, Hamza
    KTH, School of Technology and Health (STH), Health Systems Engineering, Health Care Logistics.
    Meijer, Sebastiaan
    KTH, School of Technology and Health (STH), Health Systems Engineering, Health Care Logistics.
    Evaluating the Effect of Centralized Administration on Health Care Performances Using Discrete-Event Simulation2017Conference paper (Refereed)
424344454647 2201 - 2250 of 2342
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