Personer som bor och vårdas på särskilt boende (säbo) har omfattande omvårdnadsbehov och ofta nedsatt kognitiv funktion, de är ofta multisjuka och har många olika läkemedel samtidigt.
Om en god vårdkvalitet ska kunna garanteras, måste kompetensen bland vårdpersonalen höjas, framför allt avseende specifik geriatrisk kompetens.
En betydande andel av de äldre som bor och vårdas på säbo avlider också där, trots att förutsättningarna för att ge en god palliativ vård vid livets slut är begränsade.
In Swedish primary care patients are registered at health centres where different professions, such as general practitioners (GPs), nurses, assistant nurses, counsellors, physiotherapists, psychologists and biomedical analysts, work.
In an international comparison personal physician continuity is low in Sweden. Several governmental inquiries propose that patients register with one GP or a care team. Do Swedish GPs want a personal patient list and how should this best be realised? A web survey was distributed to the members of the Swedish Union of General Practitioners and was answered by 838 GPs. 91% wanted a personal patient list if reasonably sized, the option to limit their list, and shared responsibility for the list with colleagues or a team. To be able to plan the working day themselves and designated time for collegial dialogue was considered essential for increased efficiency, well-being and reduced risk of patients harm due to their doctor’s knowledge gaps.
Personal physician continuity in primary care associated with fewer emergency room visits
Overloading of the emergency departments in hospitals is, in Sweden, a common problem that is often blamed on lack of access to primary care. We have conducted a cross-sectional study comprising more than 40% of the 347 837 inhabitants of Region Jönköping with access to complete individual data on healthcare consumption, personal doctor continuity, socio-economics, and accessibility data for all of the region’s health centres. Individuals with high personal continuity at their own health centre had significantly fewer emergency room visits compared to those with the lowest continuity: for younger adults 55% and for elderly 34% fewer emergency room visits. Access to doctor consultations or to counselling nurses in primary care was not associated with a lower number of emergency room visits. Our results show the importance of personal doctor continuity also for the group of younger adults.
Trots att det saknas vetenskapliga studier av hur ACG-systemet fungerar som ersättningssystem för vårdcentraler används det i 14 av 21 regioner.
Alla dessa 14 regioner tillämpar relativ ACG-viktning, vilket skapar en tävling i registrering av diagnoser: den vårdcentral som inte ökar sina diagnosregistreringar i samma grad som övriga får en sjunkande ACG-vikt och därmed minskad ekonomisk ersättning.
Vår granskning av över 4 500 journalanteckningar påvisade ett mycket stort antal icke relevanta diagnosregistreringar som konsumerat arbetstid och medför medicinska risker.
Patienter, som i dag ofta läser sina journaler och ser alla sina diagnoser, riskerar att uppleva sig sjukare än de är.
Chronic inflammatory joint disorders can be viewed as a spectrum of disease presenting one set of characteristics during childhood and another in adulthood. Few of the disorders are specific for children of a specific age, even if some conditions might be very rare in certain age groups. Juvenile idiopathic arthritis is a new name suggested for pediatric chronic inflammatory joint disorders. Drug therapy is based on the same principles as for adults: an aggressive approach with NSAID-drugs and low dose methotrexate in combination with local steroid injections. New drugs like TNF-blockade and COX-2 inhibitors are almost untested in children, with the exception of etanercept which has been studied in children with polyarticular disease and proven to be very effective. For rare cases with very severe joint disease hematopoietic stem cell transplantation is under evaluation.
The adaptation of the healthcare needed in the covid-19 pandemic poses challenges to patient safety. Proactive patient safety work must continue even under conditions such as a pandemic. Methods are needed that assess and support patient safety as the work is carried out. Patient safety in real time appears to be such a useful method in which patient record review to identify patient harm is combined with interviews with patients and healthcare staff. The method was used in wards and intensive care units (ICU) for covid-19 patients in Region Jönköping County. Patient harm was found in ICU care. Patients were overall satisfied with the care, and in the interviews with healthcare staff areas for improvement were identified. Valid indicators for patient record review to evaluate patient harm in covid-19 need to be developed. To judge if patient harm in care of a Covid-19 is avoidable or not is difficult since the level of knowledge and treatment principles in the disease develops very fast.
Traditionally, work with patient safety has mainly been focused on examining and learning from incidents retrospectively. Proactive methods to support and evaluate patient safety as work-as-done in real time are needed. Patient safety in Real time in Psychiatry (PiRiP), combining systematic reviews of inpatient records and interviews with inpatients and staff, can be such a method. We have evolved and tested this approach in psychiatric wards in Region Jönköping County and Region Västernorrland. We found that discussion and reflection with staff about the patients' views of care and treatment, observed strengths, risks and possibilities of improvement were of value to increase awareness and knowledge of how performance of daily work relates to patient safety. PiRiP adheres to the basic principles of patient safety as described in the national action plan for patient safety.
In a recently published thesis, we propose a cultural shift in the assessment of suicide as an incident of severe patient harm, from a focus on errors and an often speculative avoidability, to healthcare's ability of risk management over time. Patient safety work needs to change in line with the development of knowledge in patient safety. This means a cultural change in the view of patient safety, with a clearer focus on healthcare's abilities in risk management and learning. Legislation and regulations regarding healthcare and the supervisory authority need to support this cultural change in assessment and investigations of patient harm. A shift from a focus on errors and deviations to quality and positive outcomes of care, proactive patient safety work, risk management, patient safety culture and management commitment is needed.
English summary:
Swedish surgical care shows high quality and patient safety. The reasons for this are several; among the most important are a generally well-educated staff and nation-wide quality registers. Areas in need of development are improved risk assessment and risk management, both for individual patients and for specific types of operations. The ability of the surgical team to synthesize information on what has been done and what should be done postoperatively and communicate this to the teams that take care of the patients after surgery needs further honing. This could result in decreased failure-to-rescue in the postoperative period. Also, strengthening of teamwork and team performance is needed. As new knowledge on the detrimental effects of rude behaviour emerges, it becomes obvious that further work to diminish this is needed. Research is under way of identifying the possibility to identify good and safe surgeons already at the start of their education.
Svensk sammanfattning:
Svensk operationssjukvård är i grunden bra och säker, även om undvikbara skador fortsatt förekommer i för hög utsträckning.
Framtida arbete behöver riktas in på bland annat preoperativ identifiering och hantering av patient- och ingreppsspecifika risker samt ett förbättrat teamarbete och arbetsklimat under hela den perioperativa perioden.
Bättre förmåga att fånga och vidta åtgärder mot avvikelser från det förväntade förloppet, det vill säga minskad »failure to rescue«, har visats vara ett effektivt sätt att reducera förekomsten av undvikbara skador.
Forskning pågår om hur man kan identifiera och träna dem med bäst förutsättningar att bli bra och säkra operatörer.
Frekvensen av erektil dysfunktion bland män och sexuell dysfunktion hos kvinnor med kardiovaskulär sjukdom är dubbelt så hög som i normalpopulationen. Återgång till sexuell aktivitet efter en kardiovaskulär händelse är ett vanligt problem, och information efterfrågas om hur sexuell aktivitet kan återupptas. Hälso- och sjukvårdspersonal inom hjärtområdet är medvetna om vikten av att diskutera sexuell funktion och aktivitet, men vet inte vilka specifika råd de ska ge. I en konsensusrapport från de amerikanska och europeiska hjärtförbunden AHA och ESC är därför avsikten att sammanfatta evidensen relaterad till sexuell rådgivning vid kardiovaskulär sjukdom och att vägleda läkare, sjuksköterskor, och annan hälsooch sjukvårdspersonal i praktiserandet av sexrådgivning.
Medicinska paradigm har en tendens att samlas under mer eller mindre lättfattliga begrepp. De senaste decennierna har paradigmen »evidens« och »kvalitet« dominerat [1]. Paradigmet skiftar nu mot »värde«.
In 2002, Läkartidningen published a call to apply improvement knowledge in efforts to change health services. Looking back over the past 20 years, we highlight many scientifically documented examples of such application. Many efforts, often within »breakthrough collaboratives«, have included Swedish national quality registries, with documented health outcome improvements related to application of Improvement Knowledge. Applications have been evaluated through improvement science studies. A literature review documented 32 PhD theses addressing healthcare improvement published by Swedish universities. Increasingly, improvement knowledge definitions and applications include - and harness - the experiences and knowledge among patients and their families. To meet challenges in the future, all health care stakeholders will need to master and apply improvement knowledge.
Patients' experience of abuse in health care (AHC) is common, and may cause long-lasting suffering. In Sweden, lifetime prevalence is estimated at 20 per cent among female patients and 8 per cent among male patients, and a background of other abuse is a risk factor. Most health care staff have experience of patients who have been abused, but the topic is surrounded by silence from both patients and caregivers. Models for training staff in groups have been evaluated and a more proactive stance can be fostered. Department heads and health care authorities are responsible for providing staff with options to counteract AHC. Caregivers need training in how to carry out consultations with patients who say they have been abused in health care, and this training should be included in efforts to increase quality of care. Changes are within reach but educational efforts are urgent.