Patienter och professionella vårdaktörer är i en gemensam förändrings- och lärandeprocess, där vården parallellt med medborgarna och samhället lär sig hantera digitalisering. Under senare år, bl.a. pådrivet av covid-pandemin, har digitaliseringen och införande av nya arbetssätt gått så fort att utvärdering och forskning inte hunnit med i samma takt. Syftet med rapporten ”Hur klickar vi med vården?” är att bidra med aktuell kunskap om patienters användarmönster och erfarenheter av digitala och fysiska kontakter med primärvården. Resultaten är tänkt att användas som faktaunderlag och stöd för vårdens utvecklingsarbete.

Sveriges Kommuner och Regioner (SKR) tog hösten 2022 initiativet till forskningsprojektet ”Hur klickar vi med vården?”. Uppdraget genomfördes under 2023 av en oberoende forskargrupp på Hälsohögskolan vid Jönköping University. Resultaten är presenterade i två delstudier baserade på registerdata från primärvården och intervjuer med patienter. All registrerad data från den regionala primärvården i Region Jönköpings län och Region Sörmland under perioden januari 2020 – december 2022 har ingått i undersökningen. Data från Region Jönköpings län omfattar ca 352.000 personer vilka sammanlagt hade haft kontakt med primärvården ca 4,2 miljoner gånger, motsvarande för Region Sörmland var ca 245.000 personer som hade haft ca 3,2 miljoner kontakter. I dessa data ingår kontakter med privata helt digitala vårdgivare och för Region Jönköpings län data från 1177 Sjukvårdsrådgivning. I rapporten ingår även 35 kvalitativa intervjuer med ett nationellt urval av patienter. Resultatet av den kvalitativa studien är presenterat som sex teman som beskriver patienters erfarenheter av kontakt med vården.

Health care in Sweden is heavily subsidized and costs for the user are small, both for physical consultation and telemedicine, and for public and private health care. It has been argued that telemedicine consultations will increase care consumption, lead to higher costs, and create inequalities. As older people often are less skilled in digital technology, increased digitalization of care might increase inequalities. Telehealth is mainly conducted by private companies. This study is based on all private telemedicine consultations in two regions in southern Sweden 2020-2022, with approx. 656,000 inhabitants. 106,000 persons had 343,000 telemedicine consultations, 3.2 consultations p/p. The number of consultations differed neglectable between age groups, for women median was 2.0 for the age groups (< 65/65-79/80+), and for men it was 1.0. The proportion of people WITH telemedicine consultations differed heavily between the age group as well as months. Total number of telemedicine consultations per month varied 4-8.5 thousand among women, and 2-4 thousand among men. The months with most consultations were March-June 2021. Proportion of telehealth consultations was low in the age group 65-79, and even lower among 80+. The proportion of consultations by people 65-79 years increased steadily and reached its peak July-September 2021 with >20%. After that, it increased rapidly down to < 3% among women and < 4% among men. The pattern was similar among people 80+ with peaks at approx. 2% among women and close to 2% among men. The conclusion is that there is still a huge age difference in the use of telehealth consultations.

OBJECTIVE: The study aimed to explore users' experiences and care patterns concerning telemedicine consultations with physicians in Swedish primary care from 2017 to 2019.

Design and participants: A mixed methods study involving 26 qualitative interviews with users of telemedicine consultations from a national sample, complemented by a quantitative registry study of data from 10,400 users in a Swedish region.

RESULTS: Users mainly described telemedicine consultations as a positive experience and perceived that the service met their current health care needs. Users also valued high accessibility, timesaving, and the contribution to ecological sustainability. Users felt competent about choosing when to use telemedicine consultations, most commonly for less severe health care concerns. This was confirmed by the quantitative results; only a few users had other care contacts within physical primary care before, or after, the telemedicine consultation, attended acute care or phoned 1177 Health Care Guidance.

CONCLUSIONS: This study provides a rare account of users' experiences of telemedicine consultations. Users expressed satisfaction with this up-to-date use of health care resources for them as individuals, the health care system, and the environment. Telemedicine consultations were perceived as efficient and safe according to users. In addition, the study shows a low degree of further physical contacts in primary care or in acute care related to the telemedicine consultations.

Key points

• Users have positive experiences of telemedicine consultations with physicians and experienced that the service had meet their actual needs for health care.
• Users were mainly satisfied with the service and highlighted the value of high accessibility.
• Users experienced that telemedicine consultants provided an alternative care service for mostly minor health problems, perceiving them to save time and resources for themselves, the health care system, and the environment.
• Most telemedicine consultations did not result in additional contacts with 1177 Health Care Guidance, physical visits to primary care, or acute health care.
• Telemedicine consultations with physicians were mainly used by persons aged 0-30 years and need to be further developed to suit other age groups.

Alumnutvärderingen visar mycket god nytta av masterprogrammet för individen, organisation och samhället. Alumnerna upplever att de kontinuerligt använder den kunskap som masterprogrammet har gett i förbättringskunskap och ledande av förbättringsprojekt. Samtliga alumner skulle rekommendera masterprogrammet till andra ledare i hälsa och välfärdsorganisationer.  Arbetet med ständiga förbättringar i masterprogrammet har vidareutvecklats utifrån resultaten.

Discharge from hospital is often strenuous for older people and requires adjustments from living an independent life to being in need of care and support. This study aims to explore older people’s concerns about their needs after discharge. Twenty-seven observations recorded at hospital discharge planning meetings were analysed with content analysis. An overarching theme emerged: being in a life transition, which reflected the older person’s vulnerable and ambiguous situation in the discharge process. The theme was developed from three categories: obtaining a secure life situation, need of continuous care and support, and influencing and regaining independence. The findings highlight that older patients want to influence their care after discharge. They strive to regain independence and express their concerns about how to obtain a secure life situation through care organized to fit their individual needs. Knowledge about older people’s concerns is important for health care providers and social workers involved in planning and individualized care and services.

Computer systems tend to deliver less than promised. In this article we investigate mechanisms that contribute to this gap through a computer system supposed to facilitate discharge planning. The aim of this system is to increase efficiency and quality, and make information exchange safer. We do the investigation from the perspective of Science and Technology Studies (STS) and skill acquisition. We find that information tends to be hindered from entering the system, rather than ending up in the wrong places as the case was before. Further knowledge that earlier was gleaned from person to person interaction is missing out. Despite being sparse and limited, the information stored in the system is sufficient to enable action. We therefore see that one risk is exchanged for another. In total, patient safety might suffer, and hence staff ought to compensate for this. This in turn reduces efficiency and hence also the promised gain from the system.