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  • 51. Andersen, R
    et al.
    Anderson, OW
    Smedby, B
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Perception of the response to symptoms of illness in Sweden and the United States1968In: Medical Care, Vol. 6, p. 18-30Article in journal (Refereed)
  • 52. Andersen, 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.
    Changes in response to symptoms of illness in the United States and Sweden1979In: Health Handbook / [ed] George K Chacko, 1979, p. 942-55Chapter in book (Other academic)
  • 53. Andersen, 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.
    Comparative health systems - Part IV - Specific studies in several countries: Changes in response to symptoms of illness in the United States and Sweden1975In: Inquiry, ISSN 0046-9580, E-ISSN 1945-7243, Vol. 12, no 2 SUPPL, p. 116-27Article in journal (Refereed)
  • 54. Andersen, 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.
    Anderson, OW
    Medical care use in Sweden and the United States: A comparative analysis of systems and behavior1970In: Center for Health Administation Studies, University of Chicago, Research Series, Vol. 27Article, review/survey (Refereed)
  • 55. Andersen, 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.
    Eklund, G
    Uses of the Automatic Interaction Detector (AID) program for analyzing health survey data1971In: Health Services Research, ISSN 0017-9124, E-ISSN 1475-6773, Vol. 6, no 2, p. 165-83Article in journal (Refereed)
  • 56.
    Anderson, Peter
    et al.
    Newcastle Univ, England; Maastricht Univ, Netherlands.
    Kloda, Karolina
    Pomeranian Med Univ, Poland.
    Kaner, Eileen
    Newcastle Univ, England.
    Reynolds, Jillian
    Hosp Clin Barcelona, Spain.
    Bendtsen, Preben
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Department of Medical Specialist in Motala.
    Pelgrum-Keurhorst, Myrna N.
    Radboud Univ Nijmegen, Netherlands; Saxion Univ Appl Sci, Netherlands.
    Segura, Lidia
    Govt Catalonia, Spain.
    Wojnar, Marcin
    Med Univ Warsaw, Poland.
    Mierzecki, Artur
    Pomeranian Med Univ, Poland.
    Deluca, Paolo
    King’s College London, London, UK.
    Newbury-Birch, Dorothy
    Teesside Univ, England.
    Parkinson, Kathryn
    Newcastle Univ, England; State Agcy Prevent Alcohol Related Problems, Poland.
    Okulicz-Kozaryn, Katarzyna
    State Agency for Prevention of Alcohol-Related Problems, Warsaw, Poland.
    Drummond, Colin
    Kings Coll London, England; South London and Maudsley NHS Fdn Trust, England.
    Laurant, Miranda G. H.
    Radboud Univ Nijmegen, Netherlands; HAN Univ Appl Sci, Netherlands.
    Gual, Antoni
    Neurosciences Institute, Hospital Clinic, IDIBAPS, Barcelona, Spain.
    Impact of practice, provider and patient characteristics on delivering screening and brief advice for heavy drinking in primary healthcare: Secondary analyses of data from the ODHIN five-country cluster randomized factorial trial2017In: European Journal of General Practice, ISSN 1381-4788, E-ISSN 1751-1402, Vol. 23, no 1, p. 241-245Article in journal (Refereed)
    Abstract [en]

    Background: The implementation of primary healthcare-based screening and advice that is effective in reducing heavy drinking can be enhanced with training. Objectives: Undertaking secondary analysis of the five-country ODHIN study, we test: the extent to which practice, provider and patient characteristics affect the likelihood of patients being screened and advised; the extent to which such characteristics moderate the impact of training in increasing screening and advice; and the extent to which training mitigates any differences due to such characteristics found at baseline. Methods: A cluster randomized factorial trial involving 120 practices, 746 providers and 46 546 screened patients from Catalonia, England, the Netherlands, Poland, and Sweden. Practices were randomized to receive training or not to receive training. The primary outcome measures were the proportion of adult patients screened, and the proportion of screen-positive patients advised. Results: Nurses tended to screen more patients than doctors (OR = 3.1; 95% CI: 1.9, 4.9). Screenpositive patients were more likely to be advised by doctors than by nurses (OR = 2.3; 95% CI: 1.4, 4.1), and more liable to be advised the higher their risk status (OR = 1.9; 95% CI: 1.3, 2.7). Training increased screening and advice giving, with its impact largely unrelated to practice, provider or patient characteristics. Training diminished the differences between doctors and nurses and between patients with low or high-risk status. Conclusions: Training primary healthcare providers diminishes the negative impacts that some practice, provider and patient characteristics have on the likelihood of patients being screened and advised.

  • 57.
    Andersson, Agneta
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Health economic studies on advanced home care2002Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The aim of this thesis was to examine the cost-effectiveness of specific advanced home care and home rehabilitation interventions and to improve economic evaluation methods when applied to advanced home care. This included a comparison of two alternative ways of administering oxygen at home to patients with chronic hypoxaemia, as well as a review of scientific evidence on costs and effects of home rehabilitation after stroke. Also included were studies on prominent methodological issues in advanced home care - the redistribution of care efforts among caregivers and costing of informal care efforts.

    For patients with chronic hypoxaemia, a randomised, controlled trial showed that mobile liquid oxygen was considerably more costly compared to concentrator treatment. However, the treatment effects showed that liquid oxygen had a better impact on patient quality of life. The literature review revealed that the outcomes and costs of home rehabilitation after stroke are equal to those of alternative treatment strategies. Similar results were obtained in a study comparing hospital-based and home-based stroke rehabilitation, which also showed that there is a considerable redistribution of costs between health care providers and social welfare providers. Studies of patients in advanced home care in the county of Östergötland, Sweden, showed that the cost of informal care constitutes a considerable part of the care effort in all costing approaches used. Also, informal care costs were higher among patients who were men, who were younger, who had their own housing and had a cancer diagnosis.

    This thesis reveals that advanced home care interventions can differ regarding costs as well as effects, and thus comparisons between alternative home care interventions must also be performed. Further, redistribution effects are important to consider in evaluations. The cost of informal care is substantial in advanced home care. These costs must be included in evaluations with a societal perspective or else the comparisons will be biased.

  • 58.
    Andersson, Agneta
    et al.
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Carstensen, John
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Levin, Lars-Åke
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Emtinger, Bengt Göran
    The National Board of Health and Welfare.
    Costs of informal care for patients in advanced home care: a population based study2003In: International Journal of Technology Assessment in Health Care, ISSN 0266-4623, E-ISSN 1471-6348, Vol. 19, no 4, p. 656-663Article in journal (Refereed)
    Abstract [en]

    Objectives: Several studies have sought to analyze the cost-effectiveness of advanced home care andhome rehabilitation. However, the costs of informal care are rarely included in economic appraisals ofhome care. This study estimates the cost of informal care for patients treated in advanced home careand analyses some patient characteristics that influence informal care costs.Methods: During one week in October 1995, data were collected on all 451 patients in advanced homecare in the Swedish county of O¨ stergo¨ tland. Costs were calculated by using two models: one includingleisure time, and one excluding leisure time. Multiple regression analysis was used to analyze factorsassociated with costs of informal care.Results: Seventy percent of the patients in the study had informal care around the clock during theweek investigated. The patients had, on average, five formal care visits per week, each of which lastedfor almost half an hour. Thus, the cost of informal care constituted a considerable part of the costof advanced home care. When the cost of leisure time was included, the cost of informal care wasestimated at SEK 5,880 per week per patient, or twice as high as total formal caregiver costs. Whenleisure time was excluded, the cost of informal care was estimated at SEK 3,410 per week per patient,which is still 1.2 times higher than formal caregiver costs (estimated at SEK 2,810 per week per patient).Informal care costs were higher among patients who were men, who were younger, who had their ownhousing, and who were diagnosed with cancer.Conclusions: Studies of advanced home care that exclude the cost of informal care substantiallyunderestimate the costs to society, regardless of whether or not the leisure time of the caregiver isincluded in the calculations.

  • 59.
    Andersson, Anders-Petter
    et al.
    The Oslo School of Architecture and Design.
    Cappelen, Birgitta
    The Oslo School of Architecture and Design.
    Designing empowering vocal and tangible interaction: 2013In: The International conference on new interfaces for musical expression / [ed] Kyogu Lee, Kaejeon, Korea: Seoul National University , 2013, p. 406-412Conference paper (Refereed)
    Abstract [en]

    Our voice and body are important parts of our self-experience, and our communication and relational possibilities. They gradually become more important for Interaction Design due to increased development of tangible interaction and mobile communication. In this paper we present and discuss our work with voice and tangible interaction in our ongoing research project RHYME. The goal is to improve health for families, adults and children with disabilities through use of collaborative, musical, tangible media. We build on the use of voice in Music Therapy and on a humanistic health approach. Our challenge is to design vocal and tangible interactive media that through use reduce isolation and passivity and increase empowerment for the users. We use sound recognition, generative sound synthesis, vibrations and cross-media techniques to create rhythms, melodies and harmonic chords to stimulate voice-body connections, positive emotions and structures for actions.

  • 60.
    Andersson, Anders-Petter
    et al.
    Kristianstad University, School of Health and Society. Kristianstad University, Forskningsplattformen Hälsa i samverkan.
    Cappelen, Birgitta
    The Oslo School of Architecture and Design.
    Vocal and tangible technology for music and health2013In: Book of abstracts: setting the tone: cultures of relating and reflecting in music therapy / [ed] Gro Trondalen, Oslo: The Norwegian Academy of Music , 2013, p. 24-24Conference paper (Refereed)
    Abstract [en]

    Our voice and body are important parts of our self-expression and self-experience. They are also essential for our way to communicate and build relations cross borders like abilities, ages, locations, backgrounds and cultures. Voice and tangibility gradually become more important when developing new music technology for the Music Therapy and the Music and Health fields, due to new technology possibilities that have recently arisen. For example smartphones, computer games and networked, social media services like Skype. In this paper we present and discuss our work with voice and tangible interaction in our ongoing research project. The goal is to improve health for families, adults and children with severe disabilities through use of collaborative, musical, tangible sensorial media. We build on use of voice in Music Therapy and studies by Lisa Sokolov, Diane Austin, Kenneth Bruscia and Joanne Loewy. Further we build on knowledge from Multi-sensory stimulation and on a humanistic health approach. Our challenge is to design vocal and tangible, sensorially stimulating interactive media, that through use reduce isolation and passivity and increase empowerment for all the users. We use sound recognition, generative sound synthesis, vibrations and cross- media techniques, to create rhythms, melodies and harmonic chords to stimulate body- voice connections, positive emotions and structures for actions. The reflections in this paper build on action research methods, video observations and research-by-design methods. We reflect on observations of families and close others with children with severe disabilities, interacting in three vocal and tangible installations.

  • 61. Andersson, Anna
    et al.
    Garpenby, Peter
    Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment. Linköping University, Faculty of Health Sciences.
    Medical management in search for systematic and open priorities in Sweden2004Conference paper (Other academic)
  • 62.
    Andersson, Ann-Christine
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science.
    How to reach effective health service delivery?2017In: Journal of General Practice, ISSN 2329-9126, Vol. 5, no 4, article id 1000320Article in journal (Refereed)
  • 63.
    Andersson, Ann-Christine
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Ainalem, Ingrid
    Centre for Innovation and Improvement (CII), Region Skåne, Malmö, Sweden.
    Berg, Agneta
    School of Health and Society, Kristianstad University, Sweden.
    Janlov, Ann-Christin
    School of Health and Society, Kristianstad University, Sweden.
    Challenges to improve inter-professional care and service collaboration for people living with psychiatric disabilities in ordinary housing2016In: Quality Management in Health Care, ISSN 1063-8628, E-ISSN 1550-5154, Vol. 25, no 1, p. 44-52Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to describe health care- and social service professionals' experiences of a quality-improvement program implemented in the south of Sweden. The focus of the program was to develop inter-professional collaboration to improve care and service to people with psychiatric disabilities in ordinary housing. Focus group interviews and a thematic analysis were used. The result was captured as themes along steps in process. (I) Entering the quality-improvement program: Lack of information about the program, The challenge of getting started, and Approaching the resources reluctantly. (II) Doing the practice-based improvement work: Facing unprepared workplaces, and Doing twice the work. (III) Looking backevaluation over 1 year: Balancing theoretical knowledge with practical training, and Considering profound knowledge as an integral part of work. The improvement process in clinical practice was found to be both time and energy consuming, yet worth the effort. The findings also indicate that collaboration across organizational boundaries was broadened, and the care and service delivery were improved.

  • 64.
    Andersson, Ann-Christine
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Andersson Gäre, Boel
    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). Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Thor, Johan
    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).
    Lenrick, Raymond
    Rapport om utvärdering av IVO:s lärande tillsyn2018Report (Other academic)
    Abstract [sv]

    Inspektionen för vård och omsorg (IVO) har i sin tillsynspolicy lagt fokus på att främja lärande för att stödja utvecklingen av god kvalitet och säkerhet i vård och omsorg. Under 2017 har IVO givit Jönköping Academy for Improvement of Health and Welfare vid Jönköping University i uppdrag att utvärdera tillämpning av lärande tillsyn. Syftet med denna studie var att belysa om, och om möjligt hur, IVO:s tillsyn kan stödja verksamhetsutveckling och förbättring i de tillsynade verksamheter. Det finns många teoribildningar kring lärande och kvalitetsutveckling. Denna rapport tar utgångspunkt i teorier om organisatoriskt lärande, samskapande och förbättringskunskap och belyser vad som kan bidra, och i så fall hur, till en ömsesidig tillit som leder till ett fördjupat lärande som grund för förbättring.

    Studien omfattar två tillsyner, där deltagarna bestod av personal från de berörda verksamheterna, samt IVO-inspektörer från de regionala IVO avdelningar. Det empiriska materialet samlades in genom intervjuer och en observation. En dokumentgenomgång av relevanta IVO dokument skapade underlag för utvecklandet av studiens intervjuguider. Intervjuerna bandades, transkriberades och analyserades med en metod inspirerad av tematisk analys, som utmynnade i fem teman: (I) Förberedelse inför tillsyn; (II) Genomförande i verksamheten; (III) Resultat i verksamheten; (IV) Förutsättningar för lärande; och (V) Önskemål för ökat lärande. Samtliga teman innehåller både förhållanden som stödjer (främjar) och som försvårar (hindrar) lärande:

    • Förberedelsearbetet ansågs inte bidra till en ökad tillit som förutsättning för lärande. Det uttrycktes en önskan om mer samskapande i förberedelsearbetet redan innan tillsynstillfället
    • Det framkom önskemål om att lärandet, som ett av målen med tillsynen, skulle lyftas tydligare i dialogen vid tillsynstillfället.
    • Det uppfattades som svårt att peka på reella resultat i verksamheterna som direkt berodde på tillsynen, men det beskrevs ändå som viktigt att tillsynen fanns.
    • Det fanns olika uppfattningar om hur IVO:s roll som tillsynsmyndighet påverkade lärandet. Ett större fokus på gemensam uppföljning skulle vara ett sätt att optimera lärandet både i verksamheterna och hos IVO:s inspektörer.
    • Ett lärande skulle gynnas av en tydlig gemensam problembeskrivning, samt fortlöpande uppföljningar och delad kunskap, exempelvis genom goda exempel och dialogkonferenser.

    Generellt fanns en stor samstämmighet mellan IVO:s inspektörer och de verksamhetsföreträdare som intervjuats, men vissa skillnader framkom också. Rapporten avslutas med några avslutande reflektioner.

  • 65.
    Andersson, Ann-Christine
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Andersson-Gäre, Boel
    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).
    Golsäter, Marie
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. CHILD.
    Melke, Anna
    Erfarenheter från lärandeseminarier: Barn som anhöriga: Reflektioner från följeforskning2016Report (Other academic)
    Abstract [sv]

    Under 2015 genomfördes nationella lärandeseminarier för att stärka implementeringen av den lag som ger barn rätt till information, råd och stöd när en förälder plötsligt avlider, är svårt sjuk eller skadad (HSL 2g §). Satsningen var ett förbättringsarbete som omfattade sex landsting som med hjälp av en projektledning träffades vid fyra tillfällen från januari till september. Två av träffarna skedde i Stockholm och två var digitala. Under våren 2015 knöts följeforskning till arbetet med frågeställningar om vilka resultat förbättringsarbetet gav och hur deltagarna upplevde arbetssättet. Syftet var att lyfta fram vad satsningen gav samt att lära inför framtida satsningar – är lärandeseminarier ett användbart arbetssätt för nationella implementeringssatsningar?

    Rapporten visar att lärandeseminarier tycks vara en användbar form. Teamen kan redovisa att de uppnått många av de mål som de föresatte sig under projekttiden. Det handlade om kartläggning av kunskapsläge och strukturer, kompetensutveckling samt utveckling av rutiner och material. Teamen uppskattade också att få delta i ett nationellt sammanhang som gav inspiration. Samtidigt framkom det önskemål om fortsatt och ännu mer handfast stöd i fortsatt implementering i klinisk verksamhet.

  • 66.
    Andersson, Ann-Christine
    et al.
    Division of Quality Technology and Management, Linköping University, Linköping.
    Elg, Mattias
    Division of Quality Technology and Management and HELIX Vinn Excellence Centre, Linköping University, Linköping.
    Perseius, Kent-Inge
    Nyckeln competence centre for pedagogy in health care, Kalmar County Council, Kalmar.
    Idwall, Ewa
    Faculty of Health and Society, Malmö University, Malmö.
    Evaluating a questionnaire to measure improvement initiatives in Swedish healthcare2013In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 13, p. 48-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Quality improvement initiatives have expanded recently within the healthcare sector. Studies have shown that less than 40% of these initiatives are successful, indicating the need for an instrument that can measure the progress and results of quality improvement initiatives and answer questions about how quality initiatives are conducted. The aim of the present study was to develop and test an instrument to measure improvement process and outcome in Swedish healthcare.

    METHODS:

    A questionnaire, founded on the Minnesota Innovation Survey (MIS), was developed in several steps. Items were merged and answer alternatives were revised. Employees participating in a county council improvement program received the web-based questionnaire. Data was analysed by descriptive statistics and correlation analysis. The questionnaire psychometric properties were investigated and an exploratory factor analysis was conducted.

    RESULTS:

    The Swedish Improvement Measurement Questionnaire consists of 27 items. The Improvement Effectiveness Outcome dimension consists of three items and has a Cronbach's alpha coefficient of 0.67. The Internal Improvement Processes dimension consists of eight sub-dimensions with a total of 24 items. Cronbach's alpha coefficient for the complete dimension was 0.72. Three significant item correlations were found. A large involvement in the improvement initiative was shown and the majority of the respondents were satisfied with their work.

    CONCLUSIONS:

    The psychometric property tests suggest initial support for the questionnaire to study and evaluate quality improvement initiatives in Swedish healthcare settings. The overall satisfaction with the quality improvement initiative correlates positively to the awareness of individual responsibilities.

  • 67.
    Andersson, Ann-Christine
    et al.
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Golsäter, Marie
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, HHJ. CHILD.
    Andersson Gäre, Boel
    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). Jönköping University, School of Health and Welfare, HHJ. ARN-J (Aging Research Network - Jönköping).
    Melke, Anna
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare. The Göteborg Region Association of Local Authorities, Gothenburg, Sweden.
    Learning through networking in healthcare and welfare: The use of a breakthrough collaborative in the Swedish context2017In: International Journal of Healthcare Management, ISSN 2047-9700, E-ISSN 2047-9719Article in journal (Refereed)
    Abstract [en]

    Breakthrough Collaborative (BC) aims at learning through networking, mainly at micro level, and is used as a tool to improve care and welfare organizations. The aim of this study was to explore and illuminate the challenges when applying BC model at meso and macro level. In 2010, the Swedish Health and Medical Services Act stated the responsibility of healthcare professionals to consider children’s needs as relatives. This study uses an interactive collaborative research model. To support healthcare organizations in the implementation of the regulation, county councils/regions in Sweden were invited to take part in a BC during 2015. Six teams from different county councils/regions participated. Team members were interviewed several times during the project time. Data were analyzed with an explorative and descriptive qualitative content analysis. The result illuminates the challenges faced when applying BC at meso and macro level. Most challenges concern preparation, support structures and system connections. There are similarities with the challenges met at micro level when BC is used at meso and macro level. But it seems even more important to consider how the team is constituted at meso and macro level to make use of the learnings and achieve long-term impact in the home organization.

  • 68.
    Andersson, Ann-Christine
    et al.
    Linköpings universitet, Institutionen för ekonomisk och industriell utveckling.
    Idvall, Ewa
    Malmö University.
    Perseius, Kent-Inge
    Kalmar County Council.
    Elg, Mattias
    Linköpings universitet, Institutionen för ekonomisk och industriell utveckling, Kvalitetsteknik.
    Sustainable Outcomes of an Improvement Program: Do Financial Incentives Matter?2013In: Total Quality Management and Business Excellence, ISSN 1478-3363, E-ISSN 1478-3371, Vol. 24, no 7-8, p. 959-969Article in journal (Refereed)
    Abstract [en]

    The purpose of this study was to evaluate whether an improvement programme can contribute to positive sustainable improvements in an organisation, and whether financial incentives are driving forces for improvements. The material was all projects (n=232) that applied for funding in a county council improvement programme between 2007 and 2010. The projects were analysed as to whether they received funding (n=98) or were rejected (n=95). In addition, a categorisation of the projects' intentions was analysed. Some projects were still ongoing, but 50 projects were implemented and sustained two or more years after being finalised. Implemented improvements were on different levels, from (micro-level) units up to the entire (macro-level) organisation. In addition, 27 rejected projects were finalised without funding. Eighteen of those 27 were sustainably implemented. This study indicates that there are incentives other than financial at work if an improvement programme contributes to sustainable improvements in the organisation. To encourage practice-based improvements is one way of incentivising the intention and effort to become and perform better.

  • 69.
    Andersson, Ann-Christine
    et al.
    The Jönköping Academy for Improvements of Health and Welfare, School of Health Sciences, Jönköping University, Sweden .
    Idvall, Ewa
    Department of Care Science, Faculty of Health and Society, Malmö University and Department of Intensive Care and Perioperative Medicine, Skåne University Hospital, Malmö, Sweden.
    Perseius, Kent-Inge
    The Swedish Red Cross University College. Nyckeln Competence Centre for Pedagogy in Health Care, Kalmar County Council.
    Elg, Mattias
    Division of Quality Technology and Management and HELIX Vinn Excellence Centre, Linköping University, Sweden.
    Two Different Strategies to Facilitate Involvement in Healthcare Improvements: A Swedish County Council Initiative2014In: Global Advances in Health and Medicine, ISSN 2164-957X, E-ISSN 2164-9561, Vol. 3, no 5, p. 22-28Article in journal (Refereed)
    Abstract [en]

    Background: From a management point of view, there are many different approaches from which to choose to engage staff members in initiatives to improve performance.

    Objective: The present study evaluated how two different types of improvement strategies facilitate and encourage involvement of different professional groups in health-care organizations.

    Methods/Design: Empirical data of two different types of strategies were collected within an improvement project in a County Council in Sweden. The data analysis was carried out through classifying the participants' profession, position, gender, and the organizational administration of which they were a part, in relation to their participation.

    Setting: An improvement project in a County Council in Sweden.

    Participants: Designed Improvement Processes consisted of n=105 teams and Intrapreneurship Projects of n=202 projects.

    Intervention: Two different types of improvement strategies, Designed Improvement Processes and Intrapreneurship Projects.

    Main Outcome Measures: How two different types of improvement strategies facilitate and encourage involvement of different professional groups in healthcare organizations.

    Results: Nurses were the largest group participating in both improvement initiatives. Physicians were also well represented, although they seemed to prefer the less structured Intrapreneurship Projects approach. Assistant nurses, being the second largest staff group, were poorly represented in both initiatives. This indicates that the benefits and support for one group may push another group aside.

    Conclusions: Managers need to give prerequisites and incentives for staff who do not participate in improvements to do so. Comparisons of different types of improvement initiatives are an underused research strategy that yields interesting and thoughtful results.

  • 70.
    Andersson, Annika
    et al.
    University West, Department of Nursing, Health and Culture, Divison for Health, Culture and Educational Sciences.
    Carlström, Eric
    University West, Department of Nursing, Health and Culture, Divison of Caring Sciences, postgraduate level. Göteborgs universitet, Sahlgrenska Akademin, Institutionen för vårdvetenskap och hälsa .
    Berlin, Johan
    University West, Department of Social and Behavioural Studies, Division of Social Pedagogy and Sociology.
    Organisering av en fingerad verklighet: Om övningar mellan blåljusorganisationer2013In: Nordiske organisasjonsstudier, ISSN 1501-8237, Vol. 15, no 3, p. 34-64Article in journal (Refereed)
    Abstract [en]

    This study aimed to elucidate exercise participants’ understanding of critical aspects of organizing and implementation of collaboration exercises with police, fire department and ambulance services. The focus is critical aspects in exercises that have, or are expected to have, bearing on the participants’ ability to learn. Collaboration exercises are used as a tool to reinforce and develop the preparedness for future incidents. The need for such exercises was usually advocated after critique to actions during largescale real-life incidents. The study had a qualitative approach and is based on phenomenographic analysis of interviews with participants from four exercises with different scenarios. The identified critical aspects of exercises were related to realism, acceptance for mistakes, exercise extent and aims and opportunities for joint discussions. The management of an accident can be described to a large extent depend on the organizations’ joint ability to adapt to the prevailing situation and to collaborate. For exercises to contribute to these abilities, they could benefit from shifting the focus to how to organize exercises that allow participants to test different decisions and actions, with less emphasis on the choice of scenario.

  • 71.
    Andersson, Annika
    et al.
    University West, Department of Nursing, Health and Culture, Divison for Health, Culture and Educational Sciences.
    Carlström, Eric D.
    University West, Department of Nursing, Health and Culture. Sahlgrenska Academy at University of Gothenburg.
    Åhgren, Bengt
    Nordic School of Public Health, Göteborg, Sweden.
    Berlin, Johan
    University West, Department of Social and Behavioural Studies, Division of Social Pedagogy and Sociology.
    Managing boundaries at the accident scene: a qualitative study of collaboration exercises2014In: International Journal of Emergency Services, ISSN 2047-0894, Vol. 3, no 1, p. 77-94Article in journal (Refereed)
    Abstract [en]

    Purpose The purpose of this study is to identify what is practiced during collaboration exercises and possible facilitators for inter-organisational collaboration.

    Design/methodology/approach Interviews with 23 participants from four exercises in Sweden were carried out during autumn 2011. Interview data were subjected to qualitative content analysis.

    Findings Findings indicate that the exercises tend to focus on intra-organisational routines and skills, rather than developing collaboration capacities. What the participants practiced depended on roles and order of arrival at the exercise. Exercises contributed to practicing leadership roles, which was considered essential since crises are unpredictable and require inter-organisational decision-making.

    Originality/value The results of this study indicate that the ability to identify boundary objects, such as injured/patients, was found to be important in order for collaboration to occur. Furthermore, lessons learned from exercises could benefit from inter-organisational evaluation. By introducing and reinforcing certain elements and distinct aims of the exercise, the proactive function of collaboration exercises can be clarified.

  • 72.
    Andersson Bäck, Monica
    et al.
    University of Gothenburg.
    Kjellström, Sofia
    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). Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Avby, Gunilla
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Identity work of successful primary care managers and competing institutional logics2017Conference paper (Refereed)
  • 73.
    Andersson Bäck, Monica
    et al.
    University of Gothenburg.
    Kjellström, Sofia
    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). Jönköping University, School of Health and Welfare, HHJ, Institute of Gerontology. Jönköping University, School of Health and Welfare, HHJ. ADULT.
    Avby, Gunilla
    Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
    Medical manager hybrids for handling institutional complexity and change in primary care2017Conference paper (Refereed)
    Abstract [en]

    Introduction: This article deals with hybrid persons combining medical professionalism and management for handling institutional complexity and change in primary care. Primary care and identity are in transition in many western countries, in Sweden emphasized by the 2007 reform for patient choice and competition. Research has shown that embedded hybrid actors, familiar and socialized in a field and to its logics, tend to be influential for handling complexity and change. Yet hydrids and their enactment in primary care is an underexplored area.

    Aim: The aim is to contribute to our understanding of hybrid persons and how they are combining medical professionalism and management in primary care, while managing complexity and change.

    Material and methods: In a case study of six successful primary healthcare centers, public and private, covering 56 interviews and observations with various professions, two medical managers ‘hybrids’ showed to be particularly interesting. These were analyzed in-depth, including analysis of staff’s and colleagues’ experiences and contrasted by other managers and hybrids. For the analysis we draw on institutional logic perspective (Thornton, Occasion & Lounsbury 2012) in order to capture preconditions as well as enactment of such change agents.

    Results/conclusions: The hydrids contributed to innovation, creativity and learning in their primary care centres. At their workplace, coherence and a good ambience coexisted with feelings of high work pace and lacking role clarity among the multidisciplinary staff. Categorized in line with McGivern and colleagues(2015) term as ‘willing hybrids’, the persons studied revealed high ambitions to challenge existing institutional order giving professionalism new forms, while seeking to innovate practices and division of work among healthcare staff in primary care. By doing so the hybrids integrated professionalism and managerialism and were influential in reframing problems and solutions, which aligned several logics at play. However several obstacles related to professional as well as bureaucratic issues appeared along the way.

  • 74.
    Andersson, David
    et al.
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
    Magnusson, Henrik
    Linköping University, Department of Medical and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
    Carstensen, John
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Arts and Sciences.
    Borgquist, Lars
    Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Co-morbidity and health care utilisation five years prior to diagnosis for depression: A register-based study in a Swedish population2011In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 11, p. 552-Article in journal (Refereed)
    Abstract [en]

    Background

    Depressive disorders have been associated with a number of co-morbidities, and we   hypothesized that patients with a depression diagnosis would be heavy users of health   care services, not only when first evaluated for depression, but also for preceding   years. The aim of this study was to investigate whether increased health care utilisation   and co-morbidity could be seen during five years prior to an initial diagnosis of   depression.

    Methods

    We used a longitudinal register-based study design. The setting comprised the general   population in the county of Östergötland, south-east Sweden. All 2470 patients who   were 20 years or older in 2006 and who received a new diagnosis of depression (F32   according to ICD-10) in 2006, were selected and followed back to the year 2001, five   years before their depression diagnosis. A control group was randomly selected among   those who were aged 20 years or over in 2006 and who had received no depression diagnosis   during the period 2001-2006.

    Results

    Predictors of a depression diagnosis were a high number of physician visits, female   gender, age below 60, age above 80 and a low socioeconomic status.

    Patients who received a diagnosis of depression used twice the amount of health care   (e.g. physician visits and hospital days) during the five year period prior to diagnosis   compared to the control group. A particularly strong increase in health care utilisation   was seen the last year before diagnosis. These findings were supported with a high   level of co-morbidity as for example musculoskeletal disorders during the whole five-year   period for patients with a depression diagnosis.

    Conclusions

    Predictors of a depression diagnosis were a high number of physician visits, female   gender, age below 60, age above 80 and a low socioeconomic status. To find early signs   of depression in the clinical setting and to use a preventive strategy to handle these   patients is important.

  • 75.
    Andersson, Elisabet
    et al.
    Halmstad University, School of Social and Health Sciences (HOS).
    Jönsson, Helena
    Halmstad University, School of Social and Health Sciences (HOS).
    Sjuksköterskans förmåga att uppmärksamma och åtgärda malnutrition hos äldre2011Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    It is the nurse’s responsibility to observe, prevent and treat malnutrition. The reform of geriatric care, where the responsibility for the elderly residents has been moved from county council into municipality, has implied that access to nurses in Home Care Service is deficient in proportion to the amount of residents. This matter together with poor knowledge in nutrition among the nursing care staff, accompanied by high burden of care, have led to deficiencies in nutritional care, which can remain for a long time before revealed. The aim of the literature study was to examine the nurse’s ability to discover and treat malnutrition in elderly Home Care residents. A literature study based on 20 scientific articles was made. The nutritional knowledge among nurses and members of nursing care staff is generally low, only a small amount of the nursing care staff had knowledge in nutritional screening methods and even fewer used screening methods in practice. The individual requirement of energy for the elderly in the studies was in most of the cases not met, but increased energy intake through energy enriched food or supplement drinks, had a positive effect to counteract malnutrition. Further research in Swedish conditions, where the knowledge among the nursing care staff ought to be inventoried, is highly relevant for further development of the Home Care Services.

  • 76.
    Andersson, Fredrik
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences. Ferring Pharmaceut AS, Denmark.
    Anderson, Peter
    Adelphi Real World, England.
    Holm-Larsen, Tove
    Pharma Evidence, Denmark.
    Piercy, James
    Adelphi Real World, England.
    Everaert, Karel
    Ghent University Hospital, Belgium.
    Holbrook, Tim
    Adelphi Real World, England.
    Assessing the impact of nocturia on health-related quality-of-life and utility: results of an observational survey in adults2016In: JOURNAL OF MEDICAL ECONOMICS, ISSN 1369-6998, Vol. 19, no 12, p. 1200-1206Article in journal (Refereed)
    Abstract [en]

    Background and aim: The impact of nocturia (getting up at night to void) on health-related quality-of-life (HRQoL) is often under-estimated. This study investigated the relative burden in terms of HRQoL and utilities of nocturia in a real-world setting. Methods: Patient data were collected from two surveys: a nocturia-specific, cross-sectional survey of physicians and their patients (DSP), and a general UK population health survey (HSFE). Utilities (EQ-5D-5L), productivity (Work Productivity and Activity Index), and the impact of nocturia symptoms (Nocturia Impact Diary and Overactive Bladder Questionnaires) were assessed against the number of voids. A robust linear regression model with propensity score weights was used to control for confounding factors in estimating utilities. Results: Physician-recorded data were available from 8,738 patients across the US, Germany, Spain, France, and the UK; of these, 5,335 (61%) included patient-reported outcomes. In total, 6,302 controls were drawn from the two surveys and compared to 1,104 nocturia patients. Deterioration of HRQoL was associated with increasing number of night-time voids (pamp;lt;0.0001). In particular, significant differences were observed between 0-1 and 2 voids (pamp;lt;0.001). The regression model demonstrated that nocturia (amp;gt;= 2 per night) is associated with a modest but significant deterioration in utility of 0.0134 (pamp;lt;0.05). Limitations: The cause of nocturia is multifactorial and the mostly elderly patients may have several concomitant diseases. The authors tried to adjust for the most common ones, but there may be diseases or unknown relationships not included. Conclusions: Nocturia negatively affected HRQoL and patient utility. A clear effect is seen already at two voids per night. Every effort should, therefore, be made to reduce nocturia below the bother threshold of two voids per night.

  • 77.
    Andersson, Gustaf
    Södertörn University College, School of Discourse Studies.
    Ungdomsdiabetes: ett livslångt kontrollbehov2006Independent thesis Basic level (degree of Bachelor), 20 points / 30 hpStudent thesis
  • 78.
    Andersson, Henrik
    et al.
    Toulouse School of Economics (LERNA, UT1C, CNRS), Toulouse, France.
    Hole, Arne Risa
    University of Sheffield, United Kingdom.
    Svensson, Mikael
    Örebro University, Örebro University School of Business. Karlstad University, Karlstad, Sweden; Health Metrics, The Sahlgrenska Academy, University of Gothenburg, Sweden.
    Valuation of small and multiple health risks: A critical analysis of SP data applied to food and water safety2016In: Journal of Environmental Economics and Management, ISSN 0095-0696, E-ISSN 1096-0449, Vol. 75, p. 41-53Article in journal (Refereed)
    Abstract [en]

    This study elicits individual risk preferences in the context of an infectious disease using choice experiments. A main objective is to examine scope sensitivity using a novel approach. Our results suggest that the value of a mortality risk reduction (VSL) is highly sensitive to the survey design. Our results cast doubt on the standard scope sensitivity tests in choice experiments, but also on the validity and reliability of VSL estimates based on stated-preference studies in general. This is important due to the large empirical literature on non-market evaluation and the elicited values' central role in policy making.

  • 79.
    Andersson, Henrik
    et al.
    CNRS, UT1C, Toulouse Sch Econ LERNA, F-31015 Toulouse 5, France..
    Hole, Arne Risa
    Univ Sheffield, Sheffield S10 2TN, S Yorkshire, England..
    Svensson, Mikael
    Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Karlstad Business School. Univ Gothenburg, Sahlgrenska Acad, Hlth Metr, Gothenburg, Sweden..
    Valuation of small and multiple health risks: A critical analysis of SP data applied to food and water safety2016In: Journal of Environmental Economics and Management, ISSN 0095-0696, E-ISSN 1096-0449, Vol. 75, p. 41-53Article in journal (Refereed)
  • 80.
    Andersson, Johanna
    et al.
    Nordic School of Public Health, Sweden.
    Axelsson, Runo
    Nordic School of Public Health, Sweden.
    Bihari Axelsson, Susanna
    Nordic School of Public Health, Sweden.
    Eriksson, Andrea
    Nordic School of Public Health, Sweden.
    Åhgren, Bengt
    Nordic School of Public Health.
    Integration in Vocational Rehabilitation: a Literature Review2011In: Integration inHealth and Healthcare: abstract book, 2011Conference paper (Other academic)
    Abstract [en]

    Context: With the increasing specialisation of services, integration has become important for health and other welfare organisations in order to address the complex problems of their patients or clients. This is particularly in care of the elderly, psychiatric care and vocational rehabilitation. The following presentation reports a review of literature on integration in vocational rehabilitation, focusing on models of integration as well as barriers and facilitators.

    Methods: The review was based on a search in scientific journals from 1995 to 2010. It generated 13132 articles, which were reduced to 1005 after an initial overview. The abstracts were read by members of the research group. Each abstract was read by two members independently. If they agreed the article was included or excluded, but if not the whole group discussed the abstract. This procedure reduced the number of articles to 205, which were read in full text. Finally, 62 articles were included for thematic content analysis.

    Results: Most of the studies came from Sweden, while others came from Canada, Australia, UK, Netherlands, Norway and Denmark. In these studies different models of integration were identified. They were classified as structural or process oriented. The structural models included case management, partnerships, co-location and financial coordination, while the process oriented models included informal contacts, interorganisational meetings and multidisciplinary teams. There were also a number of barriers as well as facilitators of integration. The barriers included structural and cultural differences, while communication, trust and continuity were important facilitators.

    Discussion: There are different models of integration, but also many combinations. Case management is often combined with interorganisational meetings or multidisciplinary teams. There are also informal contacts in all models. There is a clear mirror effect between the different barriers and facilitators. Leadership may be either a barrier or a facilitator. In the same way, differences between organisations may be both barriers and facilitators. These results seem to be valid also for other fields of integration, for example care of the elderly, psychiatric care, and other forms of community care.

  • 81. Andersson, Johanna
    et al.
    Löfström, Mikael
    University of Borås, School of Business and IT.
    Bihari Axelsson, Susanna
    Axelsson, Runo
    Actor or arena: Contrasting translations of a law on interorganizational integration2012In: Journal of Health Organisation & Management, ISSN 1477-7266, E-ISSN 1758-7247, Vol. 26, no 6, p. 778-793Article in journal (Refereed)
    Abstract [en]

    Purpose – A Swedish framework law has enabled integration between public agencies in vocational rehabilitation. With the support of this law, coordination associations can be formed to fund and organize joint activities. The purpose of this study is to describe and analyze how the law has been interpreted and translated into local coordination associations and how local institutional logics have developed to guide the organization of these associations. Design/methodology/approach – Data was collected through observations of meetings within two coordination associations and supplemented with documents. The material was analyzed by compilation and examination of data from field notes, whereupon the most important aspects were crystallized and framed with institutional organization theory. Findings – Two different translations of the law were seen in the associations studied: the association as an independent actor, and as an arena for its member organizations. Two subsequent institutional logics have developed, influencing decisions on autonomy, objectives and rationality for initiating and organizing in the two associations and their activities. The institutional logics are circular, further enhancing the different translations creating different forms of integration. Research implications/limitations – Both forms of integration are legitimate, but the different translations have created integration with different degrees of autonomy in relation to the member organizations. Only a long-term analysis can show whether one form of integration is more functional than the other. Originality/value – This article is based on an extensive material providing insights into a form of interorganizational integration which has been scarcely researched. The findings show how different translations can influence the integration of welfare services.

  • 82.
    Andersson, Johanna
    et al.
    Nordic School of Public Health.
    Åhgren, Bengt
    Nordic School of Public Health.
    Assessing outcome in collaboration: the impact of assessment on collaboration practice2013In: Critical Management Studies Conference 2013: The University of Manchester. Abstracts, 2013Conference paper (Other academic)
    Abstract [en]

    Today the concept of efficiency is a guiding light in public management. Increased efficiency is thought to control spending and provide better services. Two approaches to achieve this are through assessments such as evaluation and audits; and collaboration between different actors. Collaboration can imply e.g. networks or partnerships and vary in intensity and formality. Regardless of form, collaborative efforts are generally thought to achieve services better adapted to address complex social problems, and diminishing overlaps and unclear responsibilities caused by fragmentation. Assessments are used to determine whether or not a program or a service is efficient, but the act of assessment itself is also intended to increase efficiency. Thus, the act of assessment influences the practice it is assessing. Furthermore, in order to be assessed, a program or a service has to be “evaluable”, which may also influence practice. Collaboration is often a solution to previous sector failure, and at the same time it is perceived as difficult to both achieve and sustain. Assessments are used as a tool to determine whether or not collaborative advantage is achieved and if the investments in collaboration should be pursued.

    Assessments of collaboration are a challenge since it confronts the regular vertical forms of organizing and thereby the focus of assessment. The challenge can be boiled down to the question of what collaborative arrangements can, and should, be held accountable for.

    Based on an ethnographic study and two years of field work, this question is critically analyzed with an example from Sweden. The financial coordination of rehabilitation measures act came into effect in 2004, and regulates the construction of coordination associations. The foundation of an association is a pooled budget to which all members, four different public authorities in the field of vocational rehabilitation, contribute. An important condition behind the law was the notion that public services were not adapted to, and therefore had trouble handling, some groups with complex problems needing support from two or more organizations at the same time. The overall, and ultimate, aim with financial coordination is to improve the working ability in the target population. Though the objective of the associations is, according to the law, to support collaboration, finance efforts within the collected area of responsibility and evaluate these efforts. The financed efforts may be both operative and strategic, and should in some way complement the operations of the member organizations or aim at development of new knowledge or methods. The associations have no power to make decisions of authority in relation to the target population, which remains with the professionals in the member organizations. Following this, it may be argued that the first target group of the associations is the regular organizations and next, as a secondary target group; the individuals in the target population. This means also that the target population is not the associations’ own but the regular organizations’ target groups. The aim with the associations is thus to contribute to the regular organizations working better in relation to this group. The associations have no tools at their disposal to contribute to the overall goal but the pooled budget. Their responsibility is to construct the budget, distribute the resources and follow up.

    However, as the findings presented and discussed in this paper show, the associations are generally held accountable to more than that in the frequent assessments being performed on both the associations and the efforts they finance. First, the associations are generally seen by others as being the efforts they finance. This makes the view of them almost like a new organization or authority, even though the efforts actually are organizationally owned and performed by regular organizations. Second, they are held accountable to the aim of improved working ability of the target group, i.e. the overall policy goal. Their objective to support collaboration and the notion that the law was introduced in order to ensure that, through collaboration, those individuals in the intersection of different organizations get the needed help is thus overlooked and focus is turned to effects on individuals.

    This paper argues that the assessments have highly influenced practice in the associations, and has shifted focus from organizational outcomes such as increased equity and quality of services due to decreased fragmentation, to individual outcomes such as employment and dependency of benefits. These latter outcomes are easier to account for and are also in line with conventional more hierarchical assessments. Since many associations perceive themselves to be questioned due to lacking efficiency, they may start seek legitimacy and thereby behave in line with the focus of assessments and start to “produce” improved working ability instead of supporting collaboration. Furthermore, the assessments and their focus on individuals tend to treat the associations not as a collaborative structure between four actors with a supportive aim, but as a regular organization with authoritative power. When the associations are held accountable for a group’s outcome, this group has been “passed on” from ordinary organizations on to the associations. Organizational outcome related to collaboration is greatly overlooked, in line with the “common wisdom” that collaboration is not an end in itself, and an end in public management collaboration must thus be measured as individual benefit. Increased quality and equity in services are thus outcomes that are not only not being assessed but might also be at risk of being lost with the current assessment focus. Last, there is an evident risk that the narrow and vertical assessment focus increases, instead of decreases, horizontal fragmentation within the welfare system due to its impact on coordination association practice.

  • 83.
    Andersson, Johanna
    et al.
    Nordic School of Public Health, Gothenburg.
    Åhgren, Bengt
    Nordic School of Public Health, Gothenburg.
    Axelsson, Susanna Bihari
    Nordic School of Public Health, Gothenburg.
    Eriksson, Andrea
    Nordic School of Public Health, Gothenburg.
    Axelsson, Runo
    Sahlgrenska Academy, University of Gothenburg, Sweden and Aalesund University College, Norway.
    Organizational approaches to collaboration in vocational rehabilitation: an international literature review2012In: International Journal of Integrated Care, ISSN 1568-4156, E-ISSN 1568-4156, Vol. 11, p. e137-Article in journal (Refereed)
    Abstract [en]

    Introduction: Collaboration between welfare organizations is an important strategy for integrating different health and welfare services. This article reports a review of the international literature on vocational rehabilitation, focusing on different organizational models of collaboration as well as different barriers and facilitating factors.

    Methods: The review was based on an extensive search in scientific journals from 1995 to 2010, which generated more than 13,000 articles. The number of articles was reduced in different steps through a group procedure based on the abstracts. Finally, 205 articles were read in full text and 62 were included for content analysis.

    Results: Seven basic models of collaboration were identified in the literature. They had different degrees of complexity, intensity and formalization. They could also be combined in different ways. Several barriers and facilitators of collaboration were also identified. Most of these were related to factors as communication, trust and commitment.

    Conclusion: There is no optimal model of collaboration to be applied everywhere, but one model could be more appropriate than others in a certain context. More research is needed to compare different models and to see whether they are applicable also in other fields of collaboration inside or outside the welfare system.

  • 84. Andersson, Josefine
    et al.
    Åsell, Anna
    Många beslut och kort om tid: en enkätstudie om platschefers hälsa på ett byggföretag2007Independent thesis Basic level (degree of Bachelor), 10 poäng / 15 hpStudent thesis
    Abstract [sv]

    Sammanfattning

    Syfte och frågeställningar

    Vårt syfte är att undersöka om platscheferna på ett byggföretag i Stockholm använder sig av några strategier för att kunna hantera de krav arbetet medför. Vidare vill vi ta reda på hur de beskriver och upplever sin psykiska och sociala hälsa.

    Vi utgår från följande frågeställningar:

    • Hur upplever platscheferna sin egen hälsa?

    • Gör platscheferna några medvetna hälsobringande val för att främja sin hälsa, och isåfall vad?

    • Vad använder sig platscheferna av för copingstrategier mot de krav arbetet ställer?

    Metod

    Som metod användes en enkät som bestod mestadels av öppna frågor. Efter ett bekvämlighetsurval skickades enkäten ut till 24 platschefer på ett byggföretag. Enkätsvaren sammanställdes varpå författarna analyserade och tolkade resultatet.

    Resultat

    Platscheferna i studien har till synes en god självupplevd hälsa. De flesta tar sig tid till avkoppling samt avsätter tid för hälsobringande aktiviteter så som t.ex. motion och socialt umgänge. Dessutom ser flera personer motion och arbete som hälsobringande faktorer. Resultatet visade endast platschefernas medvetna copingstrategier mot krav och stress i arbetet. Många strategier som användes var av psykologisk karaktär så som att man planerar, prestera efter bästa förmåga samt att blunda för stunden. Hög grad av socialt stöd, meningsfullhet samt hanterbarhet i arbetet upplevs av de flesta deltagarna.

    Slutsats

    Enkätsvaren ger en begränsad bild av deltagarnas hälsosituation men utifrån de områden enkätstudien täcker in ser hälsan relativt god ut i nuläget bland samtliga platschefer. I förlängningen med en fortsatt stressande och kravfylld arbetssituation finns risker för platschefernas framtida hälsa. En förklaring till att många upplever meningsfullhet i arbetet kan bero på deras chefsposition som kan medföra en ökad motivation i arbetet.

  • 85.
    Andersson, Matilda
    Blekinge Institute of Technology, Faculty of Engineering, Department of Health.
    Att leva med Myelom2016Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Myelom är en sällsynt och obotbar sjukdom men är trots detta bland de vanligare haematologiska cancersjukdomarna. Fram till början på 1980-talet orsakade myelom en långsam med gradvis nedgång i patientens hälsotillstånd och medellivslängden då var 2 år efter diagnos. Nu har den förbättrade behandlingen av högdosterapi främjat patientvården och även ökat medellivslängden. Behandling och effekter av sjukdomen har olika påverkan på kropp och psyke och kunskapen om upplevelserna av att leva med myelom är en viktig del i omvårdnadsarbetet.

  • 86.
    Andersson, Mona
    Mälardalen University, School of Sustainable Development of Society and Technology.
    Ett nytt sätt att övervaka palliativpatienter: Exemplet Kullbergska sjukhuset2011Report (Other academic)
    Abstract [sv]

    Denna rapport beskriver ett nytt sätt att monitorera eller övervaka palliativa patienter inomden avancerade hemsjukvårdens domäner jämfört med ett mer traditionelltomhändertagande inom slutenvården. I det nyare sättet vistas patienterna i hemmet sålångt det är möjligt innan en ev. inläggning på sjukhuset behövs. Monitoreringen sker genomkontinuerlig kontakt via främst ett frågeformulär, som patienten eller dennes anhörigaoch/eller distriktssköterska skickar in till samordnande sjuksköterska inom palliativ vård.Genom att data kontinuerligt registreras av hur patienten mår kan läkaren se hursjukdomsbilden utvecklar sig och sätta in de resurser som behövs efter varje patient behov.Vid ev. behov av slutenvård ligger dessa patienter inne kortare tid eftersom derasallmäntillstånd inte är lika dåligt som för patienter, som direkt kommer till sjukhusetsakutavdelning eller slutenvårdsavdelning, enligt traditionellt omhändertagande. Dessa patienter behöver vistas längre tid på sjukhuset och behöver dyra och omfattandebehandlingar för att förbättra sin hälsostatus, så att de kan skickas hem igen. En fråga som därför har ställts i studien är om det nya sättet att monitorera är mer kostnadseffektivt ändet traditionella eftersom vårdtid och därtill hörande kostnader skiljer sig åt mellan dessabåda system att vårda palliativa patienter. För att svara på denna fråga har en jämförelseavseende vårdtillfällen, vårddagar och kostnader gjorts för åren 2003 och 2004, då ett traditionellt synsätt användes på Kullbergska sjukhuset med åren 2008 och 2009 då manövergått till avancerad vård i hemmet (ASIH) för de palliativa patienterna.

    Resultatet visar att antalet anslutna palliativa patienter år 2003 var 82 stycken, vilka hade 90 vårdtillfällen tillsammans. Det genomsnittliga antalet vårdtillfällen per patient (exklusive 26 patienter, som aldrig anslöts eller kom hem från sjukhuset) var 1,6 och det genomsnittligaantalet dagar som dessa låg inne var 17,3. Spridningen i antalet dagar var från 1 till max 76 dagar och totala antalet vårddagar var 971.

    År 2009 visar resultatet att antalet anslutna palliativa patienter ökat till 117 stycken och attde hade 60 vårdtillfällen tillsammans samtidigt som antalet som ej anslöts eller kom hemfrån sjukhuset har ökat till 37 stycken. Det genomsnittliga antalet vårdtillfällen per patient ärnu 0,8 dvs. en minskning med 50 % från 2003. Antalet vårddagar har nu minskat till 543 stycken och i genomsnitt ligger patienterna inne 6,8 dagar. Spridningen av vårdagar är från 1 dag till max 51 dagar.

    Sammanfattningsvis har det trots fler anslutna palliativa patienter, från 82 stycken år 2003till 117 år 2009, en ökning med 43 %, skett en minskning av det totala antalet vårdtillfällen,från 90 tillfällen till 60 det vill säga en reduktion med 33 %. Detta har också fått till följd enhalvering av antalet vårdtillfällen per patient mellan dessa år. Det totala antalet vårddagarhar minskat från 971 till 543, en reduktion med 428 dagar eller 44 %. Detta har medfört attdet genomsnittliga antalet inneliggande dagar minskat från 17,3 till 6,8, en reduktion med 10,5 dagar eller 60 %. Det som dock kan ses som förvånande är att antalet patienter som inte kom hem eller anslöts till ASIH har ökat mellan dessa år, från 26 till 37, en ökning med 11 patienter eller 42 %. Orsaken kan sannolikt finnas i det som kallas för brytpunkten, ett tillfälle som ses som en gräns för ändring av innehållet i vården och som innebär attlivsförlängande insatser inte längre har effekt eller att effekten är marginell eller till och mednegativ för patienten. Studier visar att läkare tycker att det är svårt att tala om för en patientatt livet snart är slut och att de kurativa insatserna inte längre har effekt.

    Den kostnadskalkyl som gjort utifrån ovanstående data visar att den totala kostnaden för å r2003 var 2 225 532 (971 vårddagar x 2 292 kr/dygn) medan den för 2009 hade sjunkit tilltotalt 1 672 983 (543 vårddagar x 3 081 kr/dygn). Frågan som ställdes i denna rapport var omdet nya sättet att monitorera palliativa patienter var kostnadsbesparande. Utifrån ovanstående resultat är svaret entydigt ja - den har varit kostnadsbesparande förlandstinget. Mot denna kostnadsbesparing bör man också ställa intäkter eller effekter förpatienterna, i form av påverkan på deras livskvalitet. Genom monitoreringen finns såväl enkontinuerlig uppföljning som stor tillgänglighet för patienterna. Resurser sätts in efter varjepatients behov varför patienten inte behöver förlora så mycket av sin livskvalitet och sinakrafter. Om en inläggning dock måste göras blir vårdtiderna korta. Genom dennamonitorering kan patienterna delta i ”vardagslivets lunk” så länge som möjligt och dettaligger i linje med den palliativa vårdens filosofi. Jag har inga speciella skäl att anta attlivskvaliteten har blivit sämre trots att jag inte själv genomfört någon studie av detta.

    Att monitorera på detta sätt kan också vara ett svar på den fråga som Socialstyrelsenefterlyst om vad som kan göras för att minska eller förhindra onödig sjukhusvistelse. Jag seringa skäl till varför det här nya sättet att monitorera inte skulle vara möjligt även på andra orter eller sjukhus.

  • 87.
    Andersson, Pierre
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Sundvall, Alexandra
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Upplevelsen Av Att Vara Nyutexaminerad Sjuksköterska Under Det Första Yrkesverksamma Året: En litteraturstudie2017Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Introduktion: Den nyutexaminerade sjuksköterskan har under tre år samlat på sig teoretisk kunskap och ska nu ge sig ut i arbetslivet och ge god och patientsäker vård. Hur första tiden i yrket upplevs har betydelse för hur den kommande rollen som professionell sjuksköterska blir.

    Syfte:Att beskriva hur nyutexaminerade sjuksköterskor upplever första åretsom legitimerad sjuksköterska.

    Metod:Litteraturstudie med systematisk datainsamling och urval med tio vetenskapliga artiklar.

    Resultat:Den första tiden i yrket visade sig innebära nervositet, stress och en känsla av att vara otrygg. De nyutexaminerade sjuksköterskorna upplevde under de första månaderna i yrket en frustration. Detta på grund av brist averfarenhetsbaserad kunskap och att deras prestationer inte matchar med förväntningarna från patienter såväl som kollegor.

    Slutsatser:För att övergången skall vara tillfredsställande måste många delar fungera under första året. Arbetsintroduktion, handledning och kollegor gjorde stor inverkan på hur första året upplevdes. En vanligt förekommande uppgift är att nyutexaminerade sjuksköterskor upplever brist på klinisk kunskap, denna kunskap utvecklas med hjälp av erfarenhet i yrket. Litteraturstudien visar att nyutexaminerade är i behov av stöd och support för att få en bra start i yrket. Därför anses det vara av vikt att stötta varandra under första tidenför att öka trivseln och undvika att sjuksköterskor slutar

  • 88.
    Andersson, Réka
    Linköping University, Department of Thematic Studies, Technology and Social Change. Linköping University, Faculty of Arts and Sciences.
    Gränsdragningar i Vårdens Vardag: Hanteringen av arbetsrelaterad psykisk ohälsa i det svenska välfärdssystemet2017Doctoral thesis, monograph (Other academic)
    Abstract [en]

    Mental ill health in working life is a major and growing problem in the welfare society. The problem is multifaceted and raises many questions about who is responsible, what kind of phenomenon it is and how it should be managed. This study examines how care professionals manage work-related mental ill health. Focusing on occupational healthcare and primary care, interest is directed towards how care professionals argue about workrelated mental illness, what dilemmas they face and the strategies they rely on in managing them. It also seeks to answer the question of responsibility regarding this complex problem, not least in the light of the privatization of occupational healthcare.

    The study uses a multidisciplinary perspective, combining concepts from technology and science studies (STS), sociology of professions and organizational theory in order to analyze various aspects of care management of work-related mental ill health. The empirical material is mainly based on interviews with physicians, psychotherapists, counsellors, occupational therapists, psychologists, rehabilitation coordinators and behavioral scientists, but also includes observations in primary care and occupational health care. The management of work-related mental ill health in everyday healthcare practice is characterized by the fact that the cause of the problem is complex, the division of responsibility unclear and that psychosocial causes of disease are controversial. The study discusses the challenges and possibilities of managing this complex problem in a broad sense. The analysis pays attention to the drawing of boundaries by the care professionals regarding both responsibility and the phenomenon of work-related mental illness. The concept of knowledge infrastructure is used to explain and understand the knowledge and material structures that the care professionals work within. The analysis shows that the care professionals have a pragmatic approach and use different strategies to create scope for dealing with work-related mental health.

  • 89.
    Andersson, Sofia
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Olsson, Cecilia
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Hundar och deras hälsoeffekter: En litteraturstudie om hundars påverkan på hälsan hos personer med demens2014Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Demens är en sjukdom som drabbar ungefär var femte person över 80 år. På senare tid har behovet av alternativa behandlingsmetoder ökat. Vårdhund anses var en brabehandlingsmetod inom demensvården med få eller inga biverkningar.

    Syfte: Syftet var att undersöka vårdhundars påverkan på äldre personer med demenssjukdomgenom att genomföra en litteraturstudie.

    Metod: En litteraturstudie baserad på 13 kvantitativa artiklar. Resultaten jämfördes ochlikheter och skillnader plockades ut för att sedan sammanställas.

    Resultat: Vårdhund kan leda till ökat socialt beteende, minskade psykiska symtom, minskatagiterat beteende, minskade depressiva symtom, ökad livskvalitet samt positiva effekter påden fysiska och fysiologiska kroppen.

    Slutsatser: Studiens slutsats är att vårdhund kan ha positiva effekter på hälsan hos dementa.Det krävs mer forskning för att kunna komma fram till om vårdhund är en effektivbehandlingsmetod som eventuellt skulle kunna komplettera eller till och med ersätta vissaläkemedel.

  • 90.
    Andersén, Peter
    et al.
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Bäckström, Torbjörn
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Dahlquist, Gisela
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Damber, Jan-Erik
    Engström-Laurent, Anna
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Gustafson, Yngve
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Hjemdahl, Paul
    Korsgren, Olle
    Olsson, Håkan
    Wiberg, Mikael
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Hand Surgery.
    Widmark, Anders
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Svensk medicinsk forskning behöver inte mer styrning2014In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 111, no 22-23, p. 980-981Article in journal (Other (popular science, discussion, etc.))
  • 91. Andreasson, J
    et al.
    Jonsson, A
    Suserud, Björn-Ove
    University of Borås, School of Health Science.
    Åström, S
    Ambulance personnel should take pictures at the sites of accidents!2001In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 26-27, no 98, p. 3162-3163Article in journal (Other academic)
    Abstract [sv]

    Bror Gårdelöf och Thomas Blomberg ställer i Läkartidningen 8/01 (sidorna 856-8) frågan om vem som skall fotografera på olycksplats. Per Örtenwall ifrågasätter i Läkartidningen 15/01 (sidorna 1825-6) om olyckan överhuvudtaget skall fotograferas. Författarna är sedan ett år verksamma i ett av de forskningsprojekt i Västra Götalandsregionen som Per Örtenwall nämner. Syftet är att utröna om bilder tagna på olycksplats tillför patienten och vården något av värde.

  • 92.
    Andreasson, Jörgen
    et al.
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Ahlstrom, Linda
    Eriksson, Andrea
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Dellve, Lotta
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    The importance of healthcare managers’ organizational preconditions and support resources for their appraisal of planned change and its outcomes2017In: Journal of Hospital Administration, ISSN 1927-6990, E-ISSN 1927-7008, Vol. 6, no 1Article in journal (Refereed)
    Abstract [en]

    Background: Healthcare managers are expected to lead and manage planned organizational change intended to improve healthcare process quality. However, their complex working conditions offer limited decision control, and healthcare managers often feel ill prepared and inadequately supported to perform their duties. Healthcare managers have previously described their need for organizational support, but we lack knowledge of the preconditions and resources that help managers implement planned change.Methods: This prospective cohort study examined healthcare managers at three Swedish hospitals implementing lean production and two Swedish hospitals implementing their own improvement model. Questionnaire data from 2012, 2103, and 2014 were used in following up. We used t-tests and a linear mixed model design in analysing the data.Results: Healthcare managers who perceived strong support from managers, employees, colleagues, and the organization and managers with the longest managerial experience had the least negative appraisal of change. Managers who perceived strong support from employees, management, and the organizational structure perceived higher levels of healthcare process quality.Conclusions: Long managerial experience and strong support from managers, employees, and the organization are important formanagers’ appraisal of, work on, and successful implementation of planned change. Top management must therefore ensure that the healthcare managers have sufficient managerial experience and support before they delegate to them the responsibility to implement planned change.

  • 93.
    Andreasson, Jörgen
    et al.
    University of Borås, School of Health Science.
    Eriksson, Andrea
    Dellve, Lotta
    University of Borås, School of Health Science.
    Health care manager’s views on and approaches to implementing models for care processes.2014Conference paper (Refereed)
  • 94.
    Andreasson, Jörgen
    et al.
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Eriksson, Andrea
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Dellve, Lotta
    KTH, School of Technology and Health (STH), Health Systems Engineering, Ergonomics.
    Health care managers' views on and approaches to implementing models for improving care processes2016In: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 24, no 2Article in journal (Refereed)
    Abstract [en]

    Aim: To develop a deeper understanding of health-care managers' views on and approaches to the implementation of models for improving care processes. Background: In health care, there are difficulties in implementing models for improving care processes that have been decided on by upper management. Leadership approaches to this implementation can affect the outcome. Method: In-depth interviews with first- and second-line managers in Swedish hospitals were conducted and analysed using grounded theory. Results: 'Coaching for participation' emerged as a central theme for managers in handling top-down initiated process development. The vertical approach in this coaching addresses how managers attempt to sustain unit integrity through adapting and translating orders from top management. The horizontal approach in the coaching refers to managers' strategies for motivating and engaging their employees in implementation work. Conclusion and implications for nursing management: Implementation models for improving care processes require a coaching leadership built on close manager-employee interaction, mindfulness regarding the pace of change at the unit level, managers with the competence to share responsibility with their teams and engaged employees with the competence to share responsibility for improving the care processes, and organisational structures that support process-oriented work. Implications for nursing management are the importance of giving nurse managers knowledge of change management.

  • 95.
    Andreasson, Jörgen
    et al.
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare. 1KTH – Royal Institute of Technology, School of Technology and Health, Stockholm, Sweden.
    Åhlström, Linda
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Eriksson, Andrea
    1KTH – Royal Institute of Technology, School of Technology and Health, Stockholm, Sweden.
    The importance of nurse managers’ preconditions and support resources for their attitude and work with improved quality of care2015Conference paper (Refereed)
  • 96.
    Andréen, Sofia
    University of Skövde, School of Health and Education.
    Socialt välbefinnade hos barnmorskor inom förlossnings-/ BB-vård: En tvärsnittsstudie baserad på Job Related Social Well-being Scale2014Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
  • 97.
    Andrén, Eva
    et al.
    Landstinget Sörmland.
    Andrén, Mats
    Norrbottens läns landsting.
    Bragsjö, Stefan
    Landstinget i Kalmar län.
    Björkryd, Karin
    Landstinget Sörmland.
    Johansson, Åsa
    Norrbottens läns landsting.
    Nilsson, Anna-Karin
    Landstinget i Kalmar län.
    Tjernberg Nordlund, Annette
    Landstinget Gävleborg.
    Rosberg, Birgitta
    Uppsala läns landsting.
    Ahlström, Monica
    Landstinget i Kalmar län.
    Pettersson, Ulla
    Landstinget i Kalmar län.
    Broqvist, Mari
    Prioriteringscentrum.
    Carlsson, Per
    Linköping University, Department of Medical and Health Sciences, Health Technology Assessment and Health Economics. Linköping University, Faculty of Health Sciences.
    Öppna prioriteringar inom nya områden: logopedi, nutritionsbedömning, habilitering och arbetsterapi2011Report (Other academic)
    Abstract [sv]

    Det finns fortfarande ett behov av att öka kunskapen om och stödja den praktiska tillämpningen av riksdagens riktlinjer för öppna prioriteringar inom svensk hälso- och sjukvård. Flera förslag på hur ett sådant stöd kan se ut har tagits fram de senaste åren. Spridning av goda exempel är ett sådant förslag, metodstöd ett annat (PrioriteringsCentrum 2007). En mer påtaglig form av metodstöd är den nationella modell som vuxit fram för att konkretisera innebörden i riktlinjerna (Carlsson m fl 2007). Den får idag anses som välbeprövad inom ett flertal områden och har bidragit till att samsynen och kommunicerbarheten kring prioriteringar har ökat i landet. Erfarenheter visar dock att det behövs pedagogisk vägledning i hur modellen kan tillämpas. För att möta upp efterfrågan på sådant metodstöd erbjuder Prioriteringscentrum handledning i grupp. Den första handledningsgruppen är nu avslutad och det är deltagarnas prioriteringsarbeten som presenteras i denna rapport i syfte att sprida konkreta exempel på försök att tillämpa prioriteringsriktlinjerna.

    I rapporten presenteras fyra prioriteringsarbeten med fokus på:

    •    Regionsamverkan inom arbetsterapi
    •    Logopedi
    •    Yrkesspecifika prioriteringar på väg till teamet
    •    Från projekt till integrerat redskap

    Exemplet med prioriteringar i regionsamverkan utgörs av det prioriteringsarbete som genomförts i det s k femklövernätverket bestående av en samverkansgrupp för arbetsterapeuter i ledningsposition på sjukhusen i Uppland, Västmanland, Södermanland, Gävleborg och Dalarna. Arbetet var ett försök att skapa gemensamma prioriteringar i regionen för ett sjukdomsområde som kändes relevant. Valet kom att falla på arbetsterapi inom reumatologi. Arbetet har sedan huvudsakligen bedrivits i en projektgrupp, bestående av en representant från varje sjukhus där arbetet växlat mellan arbete på hemmaplan och avstämningsträffar i projektgruppen.

    Försöket har visat att det finns en samsyn inom regionen kring prioriteringar inom arbetsterapi och reumatologi. Säkerheten i prioriteringarna har ökat i och med att fem arbetsterapiorganisationer tillsammans bidragit med ett stort underlagsmaterial bl a genom att delge varandra sina kliniska erfarenheter. Förutsättningarna för en mer likartad vård i regionen har ökat. Arbetet har också gett upphov till frågor om i vilka situationer det är att föredra att prioriteringsarbete bedrivs lokalt, regionvis och/eller nationellt.

  • 98.
    Anell, Anders
    Institutet för hälso- och sjukvårdsekonomi (IHE), Lund.
    Subventionering av läkemedel i andra länder: Beslutsprocesser och användning av hälsoekonomiska utvärderingar2002Report (Other academic)
    Abstract [sv]

    Beslut om subventionering påverkar spridningen av läkemedel och utgör därmed ett instrument för prioritering av hälso- och sjukvårdens resurser. Liksom vid andra former av prioriteringar i hälso- och sjukvården är det relevant att ställa krav på rättvisa och legitimitet. Grundläggande för att uppnå legitimitet är att det finns en insyn i beslutsprocessen och att de kriterier som utgör utgångspunkt för besluten är kända.

    I denna rapport redovisas utformning av procedurer för beslut om subventionering i åtta länder. En specifik fråga som studeras är vilka beslutskriterier som används och betydelsen av hälsoekonomiska utvärderingar och kriteriet om kostnadseffektivitet. De länder som behandlas är Australien, Belgien, England, Finland, Frankrike, Kanada (provinserna Ontario och British Columbia), Nederländerna och Norge. Av dessa behandlas Belgien, Nederländerna och Norge översiktligt. I England studeras erfarenheter av National Institute for Clinical Excellence (NICE). NICE har som uppgift att rekommendera hur National Health Service (NHS) ska använda olika hälsoteknologier och är inte inblandad i beslut om subvention. Erfarenheterna från England kring uppbyggnaden av en transparent beslutsprocess och användningen av hälsoekonomiska utvärderingar har ändå bedömts som relevant för rapporten.

    Baserat på internationella erfarenheter kan konstateras att hälsoekonomiska utvärderingar kan ge stöd vid beslut om subvention och framför allt hur användningen av innovativa och dyra läkemedel kan avgränsas till patientgrupper som har störst nytta av en behandling. Samtidigt kan konstateras att kostnadseffektiva läkemedel inte alltid subventioneras och att läkemedel som har en låg kostnadseffektivitet ibland subventioneras ändå. Kostnadseffektivitet är alltså inte det enda och inte heller det viktigaste kriteriet som påverkar besluten. Andra viktiga kriterier är klinisk effektivitet, sjukdomens svårighetsgrad och behov av sjukvård, förekomst av alternativa terapier, budgetpåverkan och om en subvention är nödvändig med hänsyn till terapikostnaderna.

    Insynen i de kriterier som subventionskommittéer använder sig av vid bedömning av läkemedel varierar. Ingen av de studerade kommittéerna ger någon explicit information om den relativa betydelsen mellan olika kriterier eller i vilka beslutssituationer som information om kostnadseffektivitet spelar roll. En ökad tydlighet förefaller möjlig och skulle bidra till att förbättra insynen i de beslut och prioriteringar som görs. Samtidigt motverkas i så fall att hälsoekonomiska utvärderingar görs i onödan eller att de används som argument mot subventionering trots att andra kriterier är avgörande för besluten.

    Trots att uppdraget för NICE skiljer sig från subventionskommittéernas används hälsoekonomiska utvärderingar på likartat sätt i beslutsprocessen, i synnerhet vid bedömning av innovativa läkemedel. Det är svårt för subventionskommittéer att helt neka subvention av innovativa och dyra läkemedel, även i de fall kostnadseffektiviteten kan ifrågasättas. Beslutet har i många fall istället blivit att begränsa subventioneringen till de mest betydelsefulla indikationerna och/eller patientgrupperna. Det innebär också att subventionsbeslut inte kan isoleras från de rekommendationer som utformas av t.ex. läkemedelskommittéer. För svenskt vidkommande har läkemedelsreformens decentralisering av kostnadsansvar till sjukvårdshuvudmännen och det ökade ansvaret för läkemedelskommittéer en stor betydelse. Lokala läkemedelskommittéer som ansvariga för att främja en rationell läkemedelsanvändning ger bättre förutsättningar för att undvika detaljerade anvisningar om när läkemedel subventioneras från nationell nivå.

  • 99.
    Anell, Anders
    et al.
    Lund University, Sweden.
    Nylinder, Pia
    Lund University, Sweden.
    Glenngård, Anna H.
    Lund University, Sweden.
    Vårdval i primärvården: jämförelse av uppdrag, ersättningsprinciper och kostnadsansvar2012 (ed. 1)Book (Other (popular science, discussion, etc.))
  • 100.
    Anh Huyen, Nguyen
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Provider Payment Methods of healthcare service in Vietnam: a literature review2015Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background

     Achieving access to basic health care for the entire population without risk of catastrophic expenditure and impoverishment is an important goal for Vietnam’s health system. Provider payment methods (PPM), which is an important component of purchasing and health financing, are powerful tools to promote the health system and achieve health policy objectives. However, the current PPM in Vietnam appears have drawbacks in both framework and arrangement. Reforms  of PPM and the health financing system are required.

    Objective

     The objective of this study is to identify the PPM mechanism in the health financing system of Vietnam, in order to provide scientific evidences for the reform process.

    Methods

     A literature review using the search terms “Vietnam “, “provider payment method”, “purchasing” and “health financing” is carried out in different databases:  Pubmed, Google Scholar, Science Direct, World Health Organization (WHO) and Word Bank (WB) library. The reference lists of included studies are also screeedn in the selecting process. Studies are included following criteria 1. Published from 1995 to March of 2015 2. Written in English and 3. Report, analyze PPM evolved in health financing system. Not only articles and papers, reports and books are also included to be reviewed.

    Results

      Among 78 papers, reports and books primarily, only 10 studies are eligible with 4 studies conducting assessment and 6 studies being reviews. About the structure of PPM, Vietnam operates a mixed system which consists of global budget, line item, fee-for-services (FFS)  and capitation.  FFS play the biggest role in the system but also receive the most critical assessments. Capitation, which has evolved since 2005, is far from the success found in other coountries. There are 2 purchaser contributed in system, Vietnam social security (VSS) and Ministry of health (MOH).  The suggestion for developing the mix of system of capitation and fee for services or transforming FFS to the capitation and case-based payment system are discussed.

    Conclusion

      There is a limited number of PPM in Vietnam and it is necessary to implement more empirical studies such as pilot study for different new scenarios of mixing PPM  as well as evaluation studies to find the best reform process in the future. 

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