uu.seUppsala University Publications
Change search
Refine search result
1234567 1 - 50 of 467
CiteExportLink to result list
Permanent link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Rows per page
  • 5
  • 10
  • 20
  • 50
  • 100
  • 250
Sort
  • Standard (Relevance)
  • Author A-Ö
  • Author Ö-A
  • Title A-Ö
  • Title Ö-A
  • Publication type A-Ö
  • Publication type Ö-A
  • Issued (Oldest first)
  • Issued (Newest first)
  • Created (Oldest first)
  • Created (Newest first)
  • Last updated (Oldest first)
  • Last updated (Newest first)
  • Disputation date (earliest first)
  • Disputation date (latest first)
  • Standard (Relevance)
  • Author A-Ö
  • Author Ö-A
  • Title A-Ö
  • Title Ö-A
  • Publication type A-Ö
  • Publication type Ö-A
  • Issued (Oldest first)
  • Issued (Newest first)
  • Created (Oldest first)
  • Created (Newest first)
  • Last updated (Oldest first)
  • Last updated (Newest first)
  • Disputation date (earliest first)
  • Disputation date (latest first)
Select
The maximal number of hits you can export is 250. When you want to export more records please use the Create feeds function.
  • 1.
    Adamiak, Grazyna Teresa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Påverkan av organisatoriska och miljömässiga faktorer på tillgänglighet till akutsjukvården2004Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    The settings investigated were departments of internal medicine (IM), orthopaedics and surgery in acute care hospitals in Sweden. The objective was to identify exogenous and endogenous determinants of accessibility of health care. Both qualitative and quantitative analysis of utilisation was performed on national and regional level of data aggregation. The study proposes that accessibility to acute health services is influenced by exogenous factors, partly outside the control of health care professionals, such as season, physical proximity and overall supply. Organisational properties such as availability of inpatient beds, hospital and physician specialisation and the degree of system integration between provides of emergency care have effects on the quality of care. The novel finding is the strong association between acute readmissions and remaining inpatient utilisation indicating effects of bed supply on global use within IM. These conclusions follow:

    § structural changes on system level work as a method of prioritisation between patient groups by changes in criteria of accessibility;

    § the natural and organisational environments determine waiting times in EDs in hospitals by fluctuations of demand;

    § geographical accessibility coincides with the supply in terms of over- or underutilisation mirrored in the outcome of medical care;

    § effective access is determined by the divide of resources between inpatient and outpatient care and the total supply of inpatient care;

    § increasing demands on inpatient care in IM may be derived from deficiencies in the care of chronically ill, elderly patients;

    § transition of information and communication among care givers and patients varies in efficiency depending on vehicles for coordination and system integration;

    § the level of training of the admitting physician has effects on effective accessibility to inpatient care.

    There are conflicts between accessibility, efficiency and appropriateness of settings calling for attention to capacity to benefit in addition to needs as priority criteria.

    List of papers
    1. Integrated care for the elderly.: The background and effects of the reform of Swedish care of the elderly.
    Open this publication in new window or tab >>Integrated care for the elderly.: The background and effects of the reform of Swedish care of the elderly.
    2000 In: International Journal of Integrated Care, ISSN 1568-4156, no 1Article in journal (Refereed) Published
    Identifiers
    urn:nbn:se:uu:diva-91354 (URN)
    Available from: 2004-02-13 Created: 2004-02-13Bibliographically approved
    2. Lack of inegration and seasonal variation in demand explained performance problems and waiting times for patients at emergency departments: A 3 years evaluation of the shift of responsibility between primary and secondary care by closure of two acute hospitals
    Open this publication in new window or tab >>Lack of inegration and seasonal variation in demand explained performance problems and waiting times for patients at emergency departments: A 3 years evaluation of the shift of responsibility between primary and secondary care by closure of two acute hospitals
    2001 In: Health Policy, Vol. 55, p. 187-207Article in journal (Refereed) Published
    Identifiers
    urn:nbn:se:uu:diva-91355 (URN)
    Available from: 2004-02-13 Created: 2004-02-13Bibliographically approved
    3. Impact of proximity and hospital specialisation on appropriateness of emergency readmissions
    Open this publication in new window or tab >>Impact of proximity and hospital specialisation on appropriateness of emergency readmissions
    (English)In: Journal of Evaluation in Clinical PracticeArticle in journal (Refereed) Accepted
    Identifiers
    urn:nbn:se:uu:diva-91356 (URN)
    Available from: 2004-02-13 Created: 2004-02-13 Last updated: 2010-05-24Bibliographically approved
    4. Situation in Sweden
    Open this publication in new window or tab >>Situation in Sweden
    2003 In: Integrated Care in Europe.: Description and comparison of integrated care in six EU countries., 2003, p. 41-68Chapter in book (Other academic) Published
    Identifiers
    urn:nbn:se:uu:diva-91357 (URN)90 352 2605-4 (ISBN)
    Available from: 2004-02-13 Created: 2004-02-13Bibliographically approved
    5. The impact of physician training level on emergency readmissions within internal medicine
    Open this publication in new window or tab >>The impact of physician training level on emergency readmissions within internal medicine
    2004 (English)In: International Journal of Technology Assessment in Health Care, ISSN 0266-4623, E-ISSN 1471-6348, Vol. 20, no 4, p. 516-23Article in journal (Refereed) Published
    Abstract [en]

    Objectives: The research question was whether training level of admitting physicians and referrals from practitioners in primary health care (PHC) are risk factors for emergency readmission within 30 days to internal medicine.

    Methods: This report is a prospective multicenter study carried out during 1 month in 1997 in seven departments of internal medicine in the County of Stockholm, Sweden. Two of the units were at university hospitals, three at county hospitals and two in district hospitals. The study area is metropolitan–suburban with 1,762,924 residents. Data were analyzed by multiple logistic regression.

    Results: A total of 5,131 admissions, thereby 408 unplanned readmissions (8 percent) were registered (69.8 percent of 7,348 true inpatient episodes). The risk of emergency readmission increased with patient's age and independently 1.40 times (95 percent confidence interval [CI], 1.13–1.74) when residents decided on hospitalization. Congestive heart failure as primary or comorbid condition was the main reason for unplanned readmission. Referrals from PHC were associated with risk decrease (odds ratio, 0.53; 95 percent CI, 0.38–0.73).

    Conclusion: The causes of unplanned hospital readmissions are mixed. Patient contact with primary health care appears to reduce the recurrence. In addition to the diagnoses of cardiac failure, training level of admitting physicians in emergency departments was an independent risk factor for early readmission. Our conclusion is that it is cost-effective to have all decisions on admission to hospital care confirmed by senior doctors. Inappropriate selection of patients to inpatient care contributes to poor patient outcomes and reduces cost-effectiveness and quality of care.

    Keywords
    Emergency readmission; Clinical experience; Training level; Internal medicine; Referrals.
    Identifiers
    urn:nbn:se:uu:diva-91358 (URN)10.1017/S0266462304001448 (DOI)
    Available from: 2004-02-13 Created: 2004-02-13 Last updated: 2017-12-14Bibliographically approved
  • 2. Al-Janabi, Hareth
    et al.
    Coast, Joanna
    Flynn, Terry N
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics.
    What do people value when they provide unpaid care for an older person? A meta-ethnography with interview follow-up.2008In: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 67, no 1, p. 111-21Article in journal (Refereed)
    Abstract [en]

    Government policies to shift care into the community and demographic changes mean that unpaid (informal) carers will increasingly be relied on to deliver care, particularly to older people. As a result, careful consideration needs to be given to informal care in economic evaluations. Current methods for economic evaluations may neglect important aspects of informal care. This paper reports the development of a simple measure of the caring experience for use in economic evaluations. A meta-ethnography was used to reduce qualitative research to six conceptual attributes of caring. Sixteen semi-structured interviews were then conducted with carers of older people, to check the attributes and develop them into the measure. Six attributes of the caring experience comprise the final measure: getting on, organisational assistance, social support, activities, control, and fulfilment. The final measure (the Carer Experience Scale) focuses on the process of providing care, rather than health outcomes from caring. Arguably this provides a more direct assessment of carers' welfare. Following work to test and scale the measure, it may offer a promising way of incorporating the impact on carers in economic evaluations.

  • 3. Allander, E
    et al.
    Bjurulf, P
    Isacsson, SO
    Smedby, B
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Svanström, L
    Westrin, CG
    Skilj mellan besluts- och forskningsregister!1985In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 82, p. 4383-84Article in journal (Refereed)
  • 4.
    Almblad, Ann-Charlotte
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Child Health and Nutrition.
    Målqvist, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH), International Child Health and Nutrition.
    Engvall, Gunn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Neuropediatrics/Paediatric oncology.
    From skepticism to assurance and control: Implementation of a patient safety system at a pediatric hospital in Sweden2018In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 11, article id e0207744Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The use of evidence-based practice among healthcare professionals directly correlates to better outcomes for patients and higher professional satisfaction. Translating knowledge in practice and mobilizing evidence-based clinical care remains a continuing challenge in healthcare systems across the world.

    PURPOSE: To describe experiences from the implementation of an Early Detection and Treatment Program for Children (EDT-C) among health care professionals at a pediatric hospital in Sweden.

    DESIGN AND METHODS: Sixteen individual interviews were conducted with physicians, nurses and nurse assistants, which of five were instructors. Data were analyzed with qualitative content analysis.

    RESULTS: An overarching theme was created: From uncertainty and skepticism towards assurance and control. The theme was based on the content of eight categories: An innovation suitable for clinical practice, Differing conditions for change, Lack of organizational slack, Complex situations, A pragmatic implementation strategy, Delegated responsibility, Experiences of control and Successful implementation.

    CONCLUSIONS: Successful implementation was achieved when initial skepticism among staff was changed into acceptance and using EDT-C had become routine in their daily work. Inter-professional education including material from authentic patient cases promotes knowledge about different professions and can strengthen teamwork. EDT-C with evidenced-based material adapted to the context can give healthcare professionals a structured and objective tool with which to assess and treat patients, giving them a sense of control and assurance.

  • 5. Almkvist, Henrik
    et al.
    Bergman, Ulf
    Karolinska Universitetssjukhuset Huddinge.
    Edlert, Maria
    Juhasz-Haverinen, Maria
    Pehrsson, Åke
    Thörnwall Bergendahl, Gunilla
    Vég, Anikó
    Läkemedelscentrum, Centrum för vårdutveckling, Stockholms läns landsting.
    Wettermark, Björn
    Kvalitetsbokslut minskade läkemedelskostnaderna i primärvården: Stockholms läns landstings modell för decentraliserat kostnadsansvar2008In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 105, no 42, p. 2930-2934Article in journal (Refereed)
    Abstract [en]

    Increasing drug expenditures have resulted in various models to increase cost consciousness among prescribing doctors. In the County of Stockholm, Sweden, a model for quality assessment of prescribing was introduced in 2006. In all, 139 of 154 primary healthcare centres (PHCs) signed a contract linking extra payment to the adherence to the Drug and Therapeutics Committee guidelines if they analysed their prescribing behaviour in an annual quality report. During the first year, the adherence to guidelines increased from 80 to 83%, substantially higher than the 0-2% annual increase that had been observed previous years. The increase was similar for those PHCs not participating in the program. Qualitative analyses of all written quality reports indicate that the incentive scheme has resulted in an increased interest in quality assessment of drug prescribing. In total, 20 million SEK was spent on incentives, with estimated savings of 100 million SEK on drug expenditures.

  • 6. 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)
  • 7. 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)
  • 8. 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)
  • 9. 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)
  • 10. 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)
  • 11. Araya, Ricardo
    et al.
    Flynn, Terry
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics.
    Rojas, Graciela
    Fritsch, Rosemarie
    Simon, Greg
    Cost-effectiveness of a primary care treatment program for depression in low-income women in Santiago, Chile.2006In: American Journal of Psychiatry, ISSN 0002-953X, E-ISSN 1535-7228, Vol. 163, no 8, p. 1379-87Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The authors compared the incremental cost-effectiveness of a stepped-care, multicomponent program with usual care for the treatment of depressed women in primary care in Santiago, Chile.

    METHOD: A cost-effectiveness study was conducted of a previous randomized controlled trial involving 240 eligible women with DSM-IV major depression who were selected from a consecutive sample of adult women attending primary care clinics. The patients were randomly allocated to usual care or a multicomponent stepped-care program led by a nonmedical health care worker. Depression-free days and health care costs derived from local sources were assessed after 3 and 6 months. A health service perspective was used in the economic analysis.

    RESULTS: Complete data were determined for 80% of the randomly assigned patients. After we adjusted for initial severity, women receiving the stepped-care program had a mean of 50 additional depression-free days over 6 months relative to patients allocated to usual care. The stepped-care program was marginally more expensive than usual care (an extra 216 Chilean pesos per depression-free day). There was a 90% probability that the incremental cost of obtaining an extra depression-free day with the intervention would not exceed 300 pesos (1.04 US dollars).

    CONCLUSIONS: The stepped-care program was significantly more effective and marginally more expensive than usual care for the treatment of depressed women in primary care. Small investments to improve depression appear to yield larger gains in poorer environments. Simple and inexpensive treatment programs tested in developing countries might provide good study models for developed countries.

  • 12.
    Arving, Cecilia
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Johansson, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Oncology.
    Nurse student perceptions of blended learning in a postgraduate course in cancer care2012Article in journal (Refereed)
  • 13.
    Avdic, Daniel
    Uppsala University, Units outside the University, Office of Labour Market Policy Evaluation. CINCH, Essen, Germany.;Univ Duisburg Essen, Essen, Germany..
    Improving efficiency or impairing access? Health care consolidation and quality of care: Evidence from emergency hospital closures in Sweden2016In: Journal of Health Economics, ISSN 0167-6296, E-ISSN 1879-1646, Vol. 48, p. 44-60Article in journal (Refereed)
    Abstract [en]

    Recent health care consolidation trends raise the important policy question whether improved emergency medical services and enhanced productivity can offset adverse quality effects from decreased access. This paper empirically analyzes how geographical distance from an emergency hospital affects the probability of surviving an acute myocardial infarction (AMI), accounting for health-based spatial sorting and data limitations on out-of-hospital mortality. Exploiting policy-induced variation in hospital distance derived from emergency hospital closures and detailed Swedish mortality data over two decades, results show a drastically decreasing probability of surviving an AMI as residential distance from a hospital increases one year after a closure occurred. The effect disappears in subsequent years, however, suggesting that involved agents quickly adapted to the new environment.

  • 14. Banefelt, J.
    et al.
    Hallberg, S.
    Fox, K. M.
    Mesterton, J.
    Paoli, C. J.
    Johansson, Gunnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Levin, L. A.
    Sobocki, P.
    Gandra, S. R.
    Work Productivity Loss And Indirect Costs Associated With New Cardiovascular Events In High-Risk Patients With Hyperlipidemia - Estimates From Population-Based Register Data In Sweden2014In: Value in Health, ISSN 1098-3015, E-ISSN 1524-4733, Vol. 17, no 7, p. A327-A328, article id CV2Article in journal (Other academic)
  • 15. Banefelt, J.
    et al.
    Hallberg, S.
    Gandra, S. R.
    Mesterton, J.
    Fox, K. M.
    Paoli, C. J.
    Johansson, Gunnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Levin, L. A.
    Sobocki, P.
    Burden Of Hyperlipidemia Resulting From Productivity Loss - Estimates From Population-Based Register Data In Sweden2014In: Value in Health, ISSN 1098-3015, E-ISSN 1524-4733, Vol. 17, no 7, p. A491-A492, article id PCV110Article in journal (Other academic)
  • 16.
    Baraldi, Enrico
    et al.
    Uppsala University, Disciplinary Domain of Science and Technology, Technology, Department of Engineering Sciences, Industrial Engineering & Management.
    Ciabuschi, Francesco
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Business Studies.
    Callegari, Simone
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Informatics and Media.
    Lindahl, Olof
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Business Studies.
    Economic incentives for the development of new antibiotics: Report commissioned by the Public Health Agency of Sweden2019Report (Other academic)
    Abstract [en]

    This report responds to a request by the Public Health Agency of Sweden (Folkhälsomyndigheten) concerning which incentives for antibiotics research and development (R&D) Sweden should take into consideration for potential public investments. Based on discussions and interviews with experts, feedback from stakeholders (i.e. potential recipients of Swedish incentives), company case studies and computer-based Monte Carlo simulations, this report provides a set of recommendations about the economic incentives that can be relevant for Sweden.

    The incentives identified for Sweden’s portfolio meet the following criteria: improving Sweden’s visibility in the antibiotics field, reinforcing Sweden’s national R&D infrastructure in this area, leveraging Sweden’s strengths and traditions, limiting the public expenditure per incentive, permitting rapid implementation and effects, providing highly needed support to the antibiotic pipeline in unique ways, and granting Sweden a key contribution and thus influence on the design and direction of each incentive.

    Based on these criteria, a Market Entry Reward (MER) was not considered a viable alternative for Sweden if implemented by Sweden alone, especially because of its demanding financial engagement (close to 1 B USD), which is necessary for this incentive to produce relevant effects on the antibiotics R&D pipeline. However, if Sweden were to decide to pilot an MER, it should focus on a fully delinked MER, which entirely substitutes market sales with lump sums paid on a yearly basis. An MER should moreover be financed primarily from the healthcare budget to avoid crowding out other incentives. A fully delinked MER would allow testing several features of this incentive model, such as the evaluation procedures to set the overall amount of the MER, the definition of the unit prizes to be paid by local healthcare facilities to the central government, and periodic reviews to reassess the amount of yearly lump-sum payments according to the confirmed therapeutic efficacy of the antibiotic.

    If Sweden were to collaborate with other countries, such as the G20 group or the 28 EU members, a reasonable amount for its share is 6 or 23 M USD, respectively, for a partially delinked MER and 9 or 34 M USD, respectively, for a fully delinked MER. There are, however, ways to combine push and pull incentives, which are quicker and more efficient than an MER, namely combinations of grants with milestone prizes, which are rewards paid to developers upon the successful completion of key R&D steps (e.g. Phase 1 clinical studies). In addition to producing better effects for the money spent, a combination of milestone prizes and grants also prevents large MERs from crowding out push investments as well as recipients such as small- and medium-sized firms (SMEs), who usually cannot wait for a reward that is delayed until the final approval of an antibiotic.

    The recommended portfolio of incentives for Sweden includes three incentives: grants, milestone prizes and Pipeline Coordinators, to be used in combination with each other as a way to cover the antibiotics R&D pipeline and achieve important synergies. The following features should be considered when implementing and funding the three selected incentives:

    1) Grants should be dedicated to early R&D projects (no later than Phase 2) and to reinforcing the national R&D infrastructure, with a longer-term perspective than the current 3-year timeframe. In this regard, Sweden should maintain and possibly increase its current yearly investments in antibiotics R&D grants of approximately 7 M USD/year (60 M SEK) over several years. These investments will pay off in the long run, both in terms of molecules that will enter the future R&D pipeline; and as a stock of competencies spread over an infrastructure of specialised R&D centres that can be leveraged

    for future antibiotics research. These competences must be built up immediately and the seeds for future R&D projects need to be planted as soon as possible.

    2) Two types of milestone prizes should be in focus for Sweden: first, a prize awarding a sum between 10 and 20 M USD at the end of Clinical Phase 1 to highly innovative molecules addressing specific pathogens and, second, a prize for projects successfully completing preclinical steps. Establishing a prize at the end of Clinical Phase 1 is a much needed and unique initiative, with significant effects on the early R&D pipeline, granting also strong international visibility to Sweden. Sweden could also take major responsibility for such a milestone prize by covering a relatively large share. The other recommended milestone prize, awarded at the end of the preclinical steps, would help refill the clinical pipeline and would therefore have more of a long-term effect.

    3) Pipeline Coordinators, that is, organizations that take an active role in selecting and supporting a portfolio of antibiotics R&D projects in various ways, are the last recommended incentive. Selecting among currently existing Pipeline Coordinators rather than creating a new one, Sweden should fund two types of such organizations: R&D Collaborations, which create collaboration platforms to perform early development activities for the antibiotic projects they support, and Non-Profit Developers, who conduct their own antibiotic projects with the aim of bringing antibiotics to market but without pursuing profit goals. The first type of Pipeline Coordinator, R&D Collaborations, is relevant for a Swedish public investment because they are potentially the most efficient incentive in making R&D projects profitable. However, to fully exploit this potential, R&D Collaborations must be refined to become more flexible, reduce bureaucratic burden and avoid conflicts between participants.

    Non-Profit Developers provide the most extensive support to selected products by intervening across the entire antibiotic pipeline to ensure products reach the market. Moreover, this model strongly promotes both global availability and responsible use (stewardship). Therefore, Sweden may fund Non-Profit Developers through its international aid budget and in this way make important contributions to global health.

    Both types of Pipeline Coordinators also offer the advantage that they can help connect Swedish antibiotics R&D centres to international platforms, which reinforce the effects of infrastructure-related grants. Moreover, all forms of Pipeline Coordinators are incentive models that can be used as tools to manage the other two incentives (grants and milestone prizes). In this capacity, they can, for instance, evaluate grant applications and the antibiotic projects eligible for milestone prizes, which require a deep insight into the details of a drug development project.

    A fourth model, regulatory simplifications, which radically cut costs and times for Clinical Phase 3, can also be relevant for Sweden due to its contained costs, rapid implementation and effects and connection with Sweden’s expertise. However, this incentive requires further analysis to fully grasp its implications for regulators and patient safety before being recommended for implementation.

    The three incentives recommended by this report – grants, milestone prizes and Pipeline Coordinators – should be used in combination to exploit the synergies between them and their ability to push and pull molecules in different phases of the R&D pipeline. For instance, when grants and milestones are used together, the public investment per approved new antibiotic is lower than the combined spending if the two incentives were used in isolation. If it is not possible to introduce and use the three incentives simultaneously, the following priorities should be applied: first of all, grants need to be kept at current levels and possibly increased to fund both single antibiotic projects and competence development in the R&D infrastructure, while starting to invest in a Non-Profit Developer and a milestone prize at the end of Phase 1, followed by the development and funding of R&D Collaborations and, finally, a preclinical milestone prize.

  • 17.
    Baraldi, Enrico
    et al.
    Uppsala University, Disciplinary Domain of Science and Technology, Technology, Department of Engineering Sciences, Industrial Engineering & Management.
    Ciabuschi, Francesco
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Business Studies.
    Callegari, Simone
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Informatics and Media.
    Lindahl, Olof
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Business Studies.
    Ekonomiska incitamentsmodeller för utveckling av nya antibiotika: Rapport på uppdrag av Folkhälsomyndigheten2018Report (Other academic)
    Abstract [sv]

    På uppdrag av Folkhälsomyndigheten utreder vi i denna rapport en rad incitamentsmodeller för forskning och utveckling (FoU) av antibiotika som kan vara aktuella för en svensk offentlig investering. Baserat på diskussioner och intervjuer med experter, återkoppling från intressenter (d.v.s. potentiella mottagare av svenska incitament), företagsfallstudier och datorbaserade Monte Carlo-simuleringar lämnar rapporten rekommendationer kring de ekonomiska modeller som Sverige bör investera i. De incitamentsmodeller som valdes ut för den svenska portföljen uppfyller följande kriterier: de kan öka Sveriges visibilitet och förbättra den nationella FoU-infrastrukturen i antibiotikafältet, de bygger på Sveriges styrkor och tradition i detta fält, de innefattar begränsade investeringar, de kan införas och ge resultat relativt snabbt, de tillfredsställer på ett unikt sätt viktiga behov i antibiotikapipelinen, och de ger Sverige en möjlighet att spela en avgörande roll i själva skapandet och inriktningen av incitamentet. I enlighet med dessa kriterier, bedömdes att en ”Market Entry Reward” (MER) inte är genomförbar för Sverige ensamt. Det beror främst på att det krävs ett stort finansiellt åtagande (närmare 1 miljard USD) för att ett incitament som en MER ska kunna ge relevanta resultat på pipelinen. Om Sverige trots detta skulle välja att pilottesta en MER på egen hand, borde ett sådant försök fokusera på en s.k. ”totalt losskopplad” MER (Fully Delinked), vilket betyder att MER helt och hållet ersätter marknadsförsäljningen och istället ger fasta årliga utbetalningar till utvecklaren. En MER borde primärt finansieras via sjukvårdsbudgeten för att undvika undanträngningseffekter mot incitament i andra utgiftsområden. En totalt losskopplad MER skulle tillåta testning av flera olika aspekter såsom utvärderingsprocessen för att bestämma det totala värdet på en MER, internprissättning till sjukhus för att återfinansiera de statliga betalningarna, samt regelbundna mellanlägesrevideringar av årliga betalningar beroende på resistensläget. Om Sverige skulle samarbeta med andra länder, som exempelvis G20 eller EU:s medlemsländer, skulle en rimlig storlek på den svenska andelen vara 6 respektive 23 miljoner USD för en partiellt losskopplad MER, och 9 respektive 34 miljoner USD för en totalt losskopplad MER. Det finns dock andra sätt att kombinera push- och pull-incitament som är mer effektiva och snabbare än en MER, nämligen en rad kombinationer av ”grants” (forskningsanslag) och ”milestone prizes”, där det senare är belöningar som betalas ut till utvecklare när de framgångsrikt avslutar viktiga steg i sin FoU (t.ex. Fas 1 i kliniska studier). Förutom bättre effekter per investerat belopp, undviker en kombination av ”grants” och ”milestone prizes” dessutom att stora MER tränger undan push investeringar och mottagare såsom små- och medelstora företag (SMEs) som vanligtvis inte kan vänta på ett incitament ända tills det slutgiltiga godkännandet av ett antibiotikum. Den föreslagna incitamentportföljen för Sverige omfattar tre incitament: ”grants”, ”milestone prizes” och ”Pipeline Coordinators”. Dessa tre incitament skall användas tillsammans för att säkerställa att hela FoU-pipelinen för antibiotika stödjs och att viktiga synergier skapas. Följande aspekter borde tas i beaktning vid implementering och finansiering av de tre valda incitamenten: 1) ”Grants” borde riktas mot tidiga FoU-projekt (fram till Fas 2) och att förstärka den nationella FoUinfrastrukturen, med ett tidsperspektiv som ska vara längre än den nuvarande 3-åriga tidsramen. Det är viktigt att Sverige bibehåller och om möjligt höjer sina nuvarande årliga investeringar i ”grants” för FoU om antibiotika på cirka 60 miljoner SEK/år (7 M USD) och att dessa investeringar får fortsätta över många år i framtiden. Investeringarna kommer att ge långsiktiga effekter både i form av nya molekyler som kan fylla på den framtida FoU-pipelinen och genom fördjupade kompetenser, exempelvis i form av en nationell forskningsinfrastruktur bestående av specialiserade FoU-centra som kan utnyttjas i framtida antibiotikaforskning. Det bör understrykas att man inte kan fördröja dessa investeringar eftersom den här typen av kompetenser behöver byggas omedelbart och frön för framtida FoU-projekt behöver sås i detta nu. 2) Två typer av ”milestone prizes” borde implementeras av Sverige. Först och främst ett ”prize” som delar ut mellan 10 och 20 miljoner USD (bedömningar gjorda av de små företagen i fallstudien) vid slutet av klinisk Fas 1 som bör riktas mot höginnovativa molekyler mot specifika patogener. Därutöver bör ett ”prize” tilldelas projekt som framgångsrikt avslutar de prekliniska stegen. Att inrätta ett ”prize” vid slutet av klinisk Fas 1 skulle vara ett nödvändigt och unikt initiativ, som förutom starka effekter på den tidiga FoU-pipelinen dessutom skulle ge Sverige en stark internationell visibilitet. Genom att finansiera en större del av detta ”milestone prize” skulle Sverige ta ett stort ansvar för att aktivt skapa dessa mycket viktiga incitament. Det andra rekommenderade ”milestone prize”, som delas ut vid slutet av de prekliniska stegen, skulle bidra till att fylla på den kliniska pipelinen och skulle därmed ha mera långsiktiga effekter. 3) ”Pipeline Coordinators”, d.v.s. organisationer som på flera sätt tar en aktiv roll i att välja och stödja en portfölj av FoU-projekt om antibiotika, är det sista rekommenderade incitamentet. Snarare än att skapa en ny ”Pipeline Coordinator”, borde Sverige välja bland de som redan finns och finansiera följande två typer av sådana organisationer: ”R&D Collaborations”, som skapar samarbetsplattformar för att genomföra tidiga FoU aktiviteter för de projekten de stödjer, och ”Nonprofit Developers”, som genomför egna antibiotikaprojekt i syftet att föra nya antibiotika hela vägen till marknaden, dock utan vinstintressen. Den första typen av ”Pipeline Coordinator”, ”R&D Collaborations” är relevant för Sverige att investera i eftersom det handlar om den incitamentsmodell som potentiellt är mest effektiv i att skapa lönsamma FoU projekt. Men för att kunna utnyttja denna potential fullt ut behöver ”R&D Collaborations” vidareutvecklas för att bli mer flexibla samt minska byråkrati och konflikter mellan deltagarna. ”Non-profit Developers” är å andra sidan den modell som erbjuder det mest omfattande stödet till utvalda produkter genom att agera över hela antibiotikapipelinen för att se till att dessa produkter når marknadslansering. Dessutom, ger denna modell starkt stöd gällande global tillgång och ansvarsfull användning (”stewardship”). Därför, skulle Sverige kunna finansiera ”Non-profit Developers” via sin internationella biståndsbudget och därmed även ge ett viktigt bidrag till global hälsa. Båda typer av ”Pipeline Coordinators” har fördelen att de kan hjälpa att koppla svenska FoU-centra för antibiotika till internationella plattformar, vilket skulle förstärka effekterna av infrastrukturrelaterade ”grants”. Dessutom, är alla sorters ”Pipeline Coordinators” incitamentsmodeller som kan användas som verktyg för att styra övriga två incitament (”grants” och ”milestone prizes”). Tack vare denna förmåga, kan de utvärdera ansökningar till ”grants” och de antibiotikaprojekt som är berättigade till ”milestone prizes”, vilket kräver både djupa och detaljerade kunskaper i specifika antibiotikaprojekt. Utöver dessa tre incitamentsmodeller kan även en fjärde modell vara relevant: ”regulatory simplifications”. Denna modell innefattar regulatoriska förenklingar som radikalt sänker kostnader och tider för kliniska Fas 3-studier. Modellen kan vara relevant för Sverige tack vare att kostnaderna är begränsade, implementeringen och effekterna snabba samt att det finns en koppling till svensk expertis. Trots dessa fördelar, kräver detta incitament fortfarande vidare analyser för att fullt ut förstå dess implikationer för regelverket och patientsäkerhet innan den kan rekommenderas för implementering. De tre incitamenten som rekommenderas i denna rapport – ”grants”, ”milestone prizes” och ”Pipeline Coordinators” – bör användas tillsammans i särskilda kombinationer för att utnyttja synergierna mellan dem och deras förmåga att både trycka (”push”) och dra (”pull) molekylerna i olika faser i FoU-pipelinen. Dessa synergier innebär att när exempelvis ”grants” och ”milestone prizes” används samtidigt, blir den offentliga investeringen för varje nytt antibiotikum lägre än den sammanlagda investeringen om de två incitamenten används separat. Om det skulle vara omöjligt att införa och använda de tre incitamenten samtidigt, borde följande prioriteringsordning tillämpas: först och främst behöver nuvarande nivåer på ”grants” bibehållas och om möjligt höjas för att finansiera både enskilda projekt om FoU om antibiotika och för utveckling av kompetenser samt för FoU-infrastruktur, medan investeringar påbörjas i en ”Non-profit Developer” och i en ”milestone prize” vid slutet av Fas 1, följd av vidareutveckling och finansiering av ”R&D Collaborations” och slutligen av ett prekliniskt ”milestone prize”.

  • 18. Barenthin, I
    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.
    A two-wave interview study of frequency of dental visits and dental complaints1979In: Community Dentistry and Oral Epidemiology, ISSN 0301-5661, E-ISSN 1600-0528, Vol. 7, no 3, p. 128-32Article in journal (Refereed)
    Abstract [en]

    A panel of 268 persons were interviewed twice at an interval of 2 years concerning their visits to dentists and their dental status. The answers they gave on the two occasions agreed well, except for the year of the last visit if it had taken place long ago. This was true both for the people who had gone to the dentist between the interviews and for those who had not. The panel was also asked whether they had any dental complaints. Sixteen percent of them reported complaints at one or both interviews. Complaints were more common among persons who did not often go to the dentist. The persons with complaints did not always get rid of them by going to a dentist. It is concluded that interview data be used for investigating the dental health and behavior of people who do not often go to the dentist, and that dentists are more successful in maintaining good dental health in people who have no dental complaints than in people who report having complaints.

  • 19. Bengmark, S
    et al.
    Schersten, T
    Sterky, G
    Liljedahl, S O
    Smedby, B
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Wedel, H
    [Length of stay after gallstone operations]1979In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 76, no 45, p. 3989-94Article in journal (Refereed)
  • 20. Berfenstam, R
    Medelvårdtiden vid svenska sjukhus1968In: Landstingens tidskrift, Vol. 55, no 2, p. 29-30Article in journal (Refereed)
  • 21. Berfenstam, R
    et al.
    Berg, B
    Boström, H
    Smedby, B
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Waern, U
    [Levels of outpatient care: A study within the framework of the Tierp project]1976In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 73, no 3, p. 127-30Article in journal (Refereed)
  • 22. Berfenstam, R
    et al.
    Berg, B
    Boström, H
    Smedby, B
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Waern, U
    Vårdnivåer i öppen vård: Kort-rapport nr 3 från Tierpsprojektet1978Report (Other academic)
  • 23. Berfenstam, R
    et al.
    Berg, B
    Smedby, B
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Sjukvårdskonsumtion i Tierpsområdet april-maj 1973: En personbaserad studie av olika slag av sjukvårdskontakter i en definierad befolkning1976Report (Other academic)
  • 24. Berfenstam, R
    et al.
    Hammarström, A
    Smedby, B
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Åberg, H
    [Sources of error in medical care statistics: Cerebrovascular lesions and hypertension]1980In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 77, no 46, p. 4255-57Article in journal (Refereed)
  • 25. Berfenstam, R
    et al.
    Jonsson, E
    Smedby, B
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Sterky, G
    Thurburn, T
    Wennström, G
    Hälsoekonomi: Ett samlat synsätt på fördelning av resurser för hälsa1979Report (Other academic)
  • 26. Berfenstam, R
    et al.
    Lagerberg, D
    Smedby, B
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Victim characteristics in fatal home accidents: Alcohol, mental disorder, and suicidal intent in officially registered accidents in the home1969In: Acta socio-medica Scandinavica, ISSN 0044-6041, Vol. 1, no 3, p. 145-64Article in journal (Refereed)
  • 27. Berfenstam, R
    et al.
    Petersson, O
    Smedby, B
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Evaluation research and measurement of benefits of health services (eds)1978In: Scandinavian journal of social medicine. Supplementum, ISSN 0301-7311, Vol. Suppl 13Article in journal (Refereed)
  • 28. Berfenstam, 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.
    [Health care research examines use and quality]1977In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 74, no 40, p. 3432-34Article in journal (Refereed)
  • 29. Berfenstam, 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.
    Initiativrapport: Omvårdnadsforskning1979In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 76, p. 103-05Article in journal (Refereed)
  • 30. Berfenstam, 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.
    [International comparison gives useful perspectives in hospital care]1969In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 66, no 20, p. 2111-19Article in journal (Refereed)
  • 31. Berfenstam, 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.
    Kort-rapport nr 2 från Tierpsprojektet1977Report (Other academic)
  • 32. Berfenstam, 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.
    Samverkan mellan medicinsk och social vård: Några erfarenheter från försöksverksamheten i Tierp1976In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 53, p. 365-72Article in journal (Refereed)
  • 33. Berfenstam, 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.
    Sjukvårdskonsumtionen i Tierpsområdet 1971: En personbaserad studie av olika slag av sjukvårdskontakter i en definierad befolkning1974Report (Other academic)
  • 34. Berfenstam, 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.
    Tierpsprojektet1978In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 55, p. 417-20Article in journal (Refereed)
  • 35. Berfenstam, 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.
    Utveckling av insamlingsrutiner för uppgifter om läkarbesök i öppen vård: Tierpsprojektet (stencil)1975Report (Other academic)
  • 36. Berfenstam, 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.
    Vad är hälso- och sjukvårdsforskning?1975In: Landstingens tidskrift, Vol. 62, no 12, p. 31-33Article in journal (Other academic)
  • 37. Berfenstam, Ragnar
    et al.
    Smedby, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Om sjuklighet och sjukvårdskonsumtion1963In: Medlemsblad för SSF:s Rikssektion för distriktssköterskor, Vol. 1, p. 23-26Article in journal (Other (popular science, discussion, etc.))
  • 38. Berfenstam, Ragnar
    et al.
    Smedby, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Sjuklighet och vårdkonsumtion: Redogörelse för en pågående undersökning1963In: Tidskrift för Allmän Försäkring, Vol. 2, p. 73-76Article in journal (Refereed)
  • 39. Berg, B
    et al.
    Bredberg, G
    Korpela, M
    Smedby, B
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    [The effect of an otologist at the health care centre]1980In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 77, no 18, p. 1752-54Article in journal (Refereed)
  • 40. Berg, B
    et al.
    Bredberg, G
    Korpela, M
    Smedby, B
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Vad betyder en öronspecialist vid vårdcentral?: En vårdnivåstudie inom ramen för Tierpsprojektet1980Report (Other academic)
  • 41.
    Berg, Noora
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Public Health.
    Al-Janabi, Thair
    National Institute for Health and Welfare.
    Santalahti, Päivi
    National Institute for Health and Welfare.
    Kuinka tukea terveydenhuollon ammattilaisia, jotka ovat turvapaikanhakijoina tai pakolaisina Suomessa?2017In: Journal of Social Medicine, ISSN 0355-5097, Vol. 54, no 3, p. 244-246Article in journal (Other (popular science, discussion, etc.))
  • 42.
    Berglund, Anna
    et al.
    Uppsala University, National Centre for Knowledge on Men.
    Lindmark, Gunilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Preconception health and care (PHC)a strategy for improved maternal and child health2016In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 121, no 4, p. 216-221Article, review/survey (Refereed)
    Abstract [en]

    Maternal health status before pregnancy is a decisive factor for pregnancy outcomes and for risk for maternal and infant complications. Still, maternity care does not start until the pregnancy is established and in most low-income settings not until more than half of the pregnancy has passed, which often is too late to impact outcomes. In Western societies preconception care (PCC) is widely recognized as a way to optimize women's health through biomedical and behavioural changes prior to conception with the aim of improving pregnancy outcomes. But the content of PCC is inconsistent and limited to single interventions or preconception counselling to women with chronic illnesses. It has been suggested that PCC should be extended to preconception health and care (PHC), including interventions prior to pregnancy in order to optimize women's health in general, and thereby subsequent pregnancy outcomes, the well-being of the family, and the health of the future child. With this definition, almost every activity that can improve the health of girls and women can be included in the concept. In the World Health Report of 2005 a longitudinal approach to women's wellness and reproductive health was highlighted, and the World Health Organization has proposed a more comprehensive maternal and child health care, also including psychosocial issues and intimate partner violence. The present article gives an overview of the recent literature and discusses contents and delivery of PCC/PHC in Western as well as low-income countries. The article puts special emphasis on why violence against women is an issue for PHC.

  • 43.
    Berglund, Erik
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Westerling, Ragnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Sundstrom, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.
    Lytsy, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Treatment effect expressed as the novel Delay of Event measure is associated with high willingness to initiate preventive treatment - A randomized survey experiment comparing effect measures2016In: Patient Education and Counseling, ISSN 0738-3991, E-ISSN 1873-5134, Vol. 99, no 12, p. 2005-2011Article in journal (Refereed)
    Abstract [en]

    Objectives: This study aimed to investigate patients' willingness to initiate a preventive treatment and compared two established effect measures to the newly developed Delay of Events (DoE) measure that expresses treatment effect as a gain in event-free time. Methods: In this cross-sectional, randomized survey experiment in the general Swedish population, 1079 respondents (response rate 60.9%) were asked to consider a preventive cardiovascular treatment. Respondents were randomly allocated to one of three effect descriptions: DoE, relative risk reduction (RRR), or absolute risk reduction (ARR). Univariate and multivariate analyses were performed investigating willingness to initiate treatment, views on treatment benefit, motivation and importance to adhere and willingness to pay for treatment. Results: Eighty-one percent were willing to take the medication when the effect was described as DoE, 83.0% when it was described as RRR and 62.8% when it was described as ARR. DoE and RRR was further associated with positive views on treatment benefit, motivation, importance to adhere and WTP. Conclusions: Presenting treatment effect as DoE or RRR was associated with a high willingness to initiate treatment. Practice implications: An approach based on the novel time-based measure DoE may be of value in clinical communication and shared decision making.

  • 44.
    Berglund, Erik
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Westerling, Ragnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Sundström, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Epidemiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
    Lytsy, Per
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    Length of time periods in treatment effect descriptions and willingness to initiate preventive therapy: a randomised survey experiment2018In: BMC Medical Informatics and Decision Making, ISSN 1472-6947, E-ISSN 1472-6947, Vol. 18, article id 106Article in journal (Refereed)
    Abstract [en]

    Background Common measures used to describe preventive treatment effects today are proportional, i.e. they compare the proportions of events in relative or absolute terms, however they are not easily interpreted from the patient's perspective and different magnitudes do not seem to clearly discriminate between levels of effect presented to people. Methods In this randomised cross-sectional survey experiment, performed in a Swedish population-based sample (n=1041, response rate 58.6%), the respondents, aged between 40 and 75years were given information on a hypothetical preventive cardiovascular treatment. Respondents were randomised into groups in which the treatment was described as having the effect of delaying a heart attack for different periods of time (Delay of Event,DoE): 1month, 6months or 18months. Respondents were thereafter asked about their willingness to initiate such therapy, as well as questions about how they valued the proposed therapy. ResultsLonger DoE:s were associated with comparatively greater willingness to initiate treatment. The proportions accepting treatment were 81, 71 and 46% when postponement was 18months, 6months and 1month respectively. In adjusted binary logistic regression models the odds ratio for being willing to take therapy was 4.45 (95% CI 2.72-7.30) for a DoE of 6months, and 6.08 (95% CI 3.61-10.23) for a DoE of 18months compared with a DoE of 1month. Greater belief in the necessity of medical treatment increased the odds of being willing to initiate therapy. ConclusionsLay people's willingness to initiate preventive therapy was sensitive to the magnitude of the effect presented as DoE. The results indicate that DoE is a comprehensible effect measure, of potential value in shared clinical decision-making.

  • 45.
    Bergman, Mats A.
    et al.
    Sodertorn Univ, Stockholm, Sweden..
    Johansson, Per
    Uppsala University, Units outside the University, Office of Labour Market Policy Evaluation.
    Lundberg, Sofia
    Umea Univ, Umea Sch Business & Econ, Dept Econ, S-90187 Umea, Sweden..
    Spagnolo, Giancarlo
    Univ Roma Tor Vergata, Ctr Econ Policy Res, EIEF, Stockholm Sch Econ SITE, Rome, Italy..
    Privatization and quality: Evidence from elderly care in Sweden2016In: Journal of Health Economics, ISSN 0167-6296, E-ISSN 1879-1646, Vol. 49, p. 109-119Article in journal (Refereed)
    Abstract [en]

    Non-contractible quality dimensions are at risk of degradation when the provision of public services is privatized. However, privatization may increase quality by fostering performance-improving innovation, particularly if combined with increased competition. We assemble a large data set on elderly care services in Sweden between 1990 and 2009 and estimate how opening to private provision affected mortality rates - an important and not easily contractible quality dimension - using a difference-in-difference in-difference approach. The results indicate that privatization and the associated increase in competition significantly improved non-contractible quality as measured by mortality rates.

  • 46. Bergman, U
    et al.
    Boethius, G
    Swartling, P G
    Isacson, D
    Smedby, B
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Teratogenic effects of benzodiazepine use during pregnancy1990In: Journal of Pediatrics, ISSN 0022-3476, E-ISSN 1097-6833, Vol. 116, no 3, p. 490-92Article in journal (Refereed)
  • 47.
    Bergström, Anna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Skeen, Sarah
    Duc, Duong M.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Blandon, Elmer Zelaya
    Estabrooks, Carole
    Gustavsson, Petter
    Hoa, Dinh Thi Phuong
    Kallestal, Carina
    Målqvist, Mats
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Nga, Nguyen Thu
    Persson, Lars-Åke
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Pervin, Jesmin
    Peterson, Stefan Swartling
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Rahman, Anisur
    Selling, Katarina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH).
    Squires, Janet E.
    Tomlinson, Mark
    Waiswa, Peter
    Wallin, Lars
    Health system context and implementation of evidence-based practices-development and validation of the Context Assessment for Community Health (COACH) tool for low- and middle-income settings2015In: Implementation Science, ISSN 1748-5908, E-ISSN 1748-5908, Vol. 10, article id 120Article in journal (Refereed)
    Abstract [en]

    Background: The gap between what is known and what is practiced results in health service users not benefitting from advances in healthcare, and in unnecessary costs. A supportive context is considered a key element for successful implementation of evidence-based practices (EBP). There were no tools available for the systematic mapping of aspects of organizational context influencing the implementation of EBPs in low- and middle-income countries (LMICs). Thus, this project aimed to develop and psychometrically validate a tool for this purpose. Methods: The development of the Context Assessment for Community Health (COACH) tool was premised on the context dimension in the Promoting Action on Research Implementation in Health Services framework, and is a derivative product of the Alberta Context Tool. Its development was undertaken in Bangladesh, Vietnam, Uganda, South Africa and Nicaragua in six phases: (1) defining dimensions and draft tool development, (2) content validity amongst in-country expert panels, (3) content validity amongst international experts, (4) response process validity, (5) translation and (6) evaluation of psychometric properties amongst 690 health workers in the five countries. Results: The tool was validated for use amongst physicians, nurse/midwives and community health workers. The six phases of development resulted in a good fit between the theoretical dimensions of the COACH tool and its psychometric properties. The tool has 49 items measuring eight aspects of context: Resources, Community engagement, Commitment to work, Informal payment, Leadership, Work culture, Monitoring services for action and Sources of knowledge. Conclusions: Aspects of organizational context that were identified as influencing the implementation of EBPs in high-income settings were also found to be relevant in LMICs. However, there were additional aspects of context of relevance in LMICs specifically Resources, Community engagement, Commitment to work and Informal payment. Use of the COACH tool will allow for systematic description of the local healthcare context prior implementing healthcare interventions to allow for tailoring implementation strategies or as part of the evaluation of implementing healthcare interventions and thus allow for deeper insights into the process of implementing EBPs in LMICs.

  • 48. Birke, G
    et al.
    Holmberg, B
    Jonsson, E
    Scherstén, B
    Scherstén, T
    Smedby, B
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Health Services Research.
    Åberg, T
    Hälsoekonomi: Bot för sjukvården?1985Report (Other academic)
  • 49.
    Bjermer, Leif
    et al.
    Lund Univ, Skåne Univ Hosp, Dept Resp Med & Allergol, Lund.
    van Boven, Job F. M.
    Univ Groningen, Univ Med Ctr Groningen, Groningen Res Inst Asthma, Dept Gen Practice, Groningen, Netherlands.;Univ Groningen, Univ Med Ctr Groningen, COPD GRIAC, Groningen, Netherlands.;Univ Groningen, Dept Pharm, Unit Pharmacoepidemiol & Pharmacoecon, Groningen.
    Costa-Scharplatz, Madlaina
    Novartis Sverige AB, Täby.
    Keininger, Dorothy L.
    Novartis Pharma AG, Basel.
    Gutzwiller, Florian S.
    Novartis Pharma AG, Basel.
    Lisspers, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine.
    Mahon, Ronan
    Novartis Ireland Ltd, Dublin.
    Olsson, Petter
    Novartis Sverige AB, Täby.
    Roche, Nicolas
    Cochin Hosp, AP HP, Resp & Intens Care Med, Paris, France.;Univ Paris 05, Paris.
    Indacaterol/glycopyrronium is cost-effective compared to salmeterol/fluticasone in COPD: FLAME-based modelling in a Swedish population2017In: Respiratory Research, ISSN 1465-9921, E-ISSN 1465-993X, Vol. 18, article id 206Article in journal (Refereed)
    Abstract [en]

    Background: This study assessed the cost-effectiveness of indacaterol/glycopyrronium (IND/GLY) versus salmeterol/fluticasone (SFC) in chronic obstructive pulmonary disease (COPD) patients with moderate to very severe airflow limitation and ≥1 exacerbation in the preceding year.

    Methods: A previously published and validated patient-level simulation model was adapted using clinical data from the FLAME trial and real-world cost data from the ARCTIC study. Costs (total monetary costs comprising drug, maintenance, exacerbation, and pneumonia costs) and health outcomes (life-years (LYs), quality-adjusted life-years (QALYs)) were projected over various time horizons (1, 5, 10 years, and lifetime) from the Swedish payer’s perspective and were discounted at 3% annually. Uncertainty in model input values was studied through one-way and probabilistic sensitivity analyses. Subgroup analyses were also performed.

    Results: IND/GLY was associated with lower costs and better outcomes compared with SFC over all the analysed time horizons. Use of IND/GLY resulted in additional 0.192 LYs and 0.134 QALYs with cost savings of €1211 compared with SFC over lifetime. The net monetary benefit (NMB) was estimated to be €8560 based on a willingness-to-pay threshold of €55,000/QALY. The NMB was higher in the following subgroups: severe (GOLD 3), high risk and more symptoms (GOLD D), females, and current smokers.

    Conclusion: IND/GLY is a cost-effective treatment compared with SFC in COPD patients with mMRC dyspnea grade ≥ 2, moderate to very severe airflow limitation, and ≥1 exacerbation in the preceding year.

  • 50.
    Bjurling-Sjöberg, Petronella
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Standardiserade vårdplaner inom intensivsjukvård2014In: Implementering av evidensbaserad praktik / [ed] Per Nilsen, Malmö: Gleerups Utbildning AB, 2014, 1, p. 171-186Chapter in book (Other academic)
    Abstract [sv]

    Standardiserade vårdplaner beskriver rekommenderade hälso- och sjukvårdsåtgärder för specifika hälsoproblem. Kapitlet beskriver begreppet standardiserad vårdplan ur ett svenskt såväl som internationellt perspektiv. Praktiska erfarenheter av att implementera vårdplaner av detta slag på en intensivvårdsavdelning presenteras. Utfallet diskuteras på basis av olika implementeringsdeterminater. Kapitlet avslutas med reflektioner, bland annat kring fortsatt utveckling av standardiserade vårdplaner och tillämpning av implementeringsteori.

1234567 1 - 50 of 467
CiteExportLink to result list
Permanent link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf