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  • 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. 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.

  • 5. 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)
  • 6. 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)
  • 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.
    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)
  • 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.
    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)
  • 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.
    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)
  • 10. 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.

  • 11.
    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)
  • 12.
    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.

  • 13. 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)
  • 14. 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)
  • 15. 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.

  • 16. 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)
  • 17. Berfenstam, R
    Medelvårdtiden vid svenska sjukhus1968In: Landstingens tidskrift, Vol. 55, no 2, p. 29-30Article in journal (Refereed)
  • 18. 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)
  • 19. 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)
  • 20. 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)
  • 21. 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)
  • 22. 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)
  • 23. 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)
  • 24. 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)
  • 25. 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)
  • 26. 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)
  • 27. 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)
  • 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.
    Kort-rapport nr 2 från Tierpsprojektet1977Report (Other academic)
  • 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.
    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)
  • 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.
    Sjukvårdskonsumtionen i Tierpsområdet 1971: En personbaserad studie av olika slag av sjukvårdskontakter i en definierad befolkning1974Report (Other academic)
  • 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.
    Tierpsprojektet1978In: Socialmedicinsk Tidskrift, ISSN 0037-833X, Vol. 55, p. 417-20Article in journal (Refereed)
  • 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.
    Utveckling av insamlingsrutiner för uppgifter om läkarbesök i öppen vård: Tierpsprojektet (stencil)1975Report (Other academic)
  • 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.
    Vad är hälso- och sjukvårdsforskning?1975In: Landstingens tidskrift, Vol. 62, no 12, p. 31-33Article in journal (Other academic)
  • 34. 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.))
  • 35. 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)
  • 36. 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)
  • 37. 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)
  • 38.
    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.))
  • 39.
    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.

  • 40.
    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.

  • 41.
    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.

  • 42. 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)
  • 43.
    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.

  • 44. 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)
  • 45.
    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.

  • 46.
    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.

  • 47.
    Bjurling-Sjöberg, Petronella
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD).
    Wadensten, Barbro
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Pöder, Ulrika
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Nordgren, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning i Sörmland (CKFD). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Mälardalens högskola.
    Jansson, Inger
    Factors affecting the implementation process of clinical pathways: A mixed method study within the context of Swedish intensive care2015In: Journal of Evaluation In Clinical Practice, ISSN 1356-1294, E-ISSN 1365-2753, Vol. 21, no 2, p. 255-261Article in journal (Refereed)
    Abstract [en]

    RATIONALE, AIMS AND OBJECTIVES: Clinical pathways (CPs) can improve quality of care on intensive care units (ICUs), but are infrequently utilized and of varying quality. Knowledge regarding factors that facilitate versus hinder successful implementation of CPs is insufficient and a better understanding of the activities and individuals involved is needed. The aim of this study was to explore the implementation process of CPs within the context of ICUs.

    METHODS: An exploratory design with a sequential mixed method was used. A CP survey, including all Swedish ICUs, was used to collect quantitative data from ICUs using CPs (n = 15) and interviews with key informants (n = 10) were used to collect qualitative data from the same ICUs. Descriptive statistics and qualitative content analysis were used, and the quantitative and qualitative findings were integrated.

    RESULTS: The CP implementation was conceptualized according to two interplaying themes: a process to realize the usefulness of CPs and create new habits; and a necessity of enthusiasm, support and time. Multiple factors affected the process and those factors were organized in six main categories and 14 subcategories.

    CONCLUSIONS: Bottom-up initiatives, interprofessional project groups and small ICUs seem to enhance successful implementation of CPs while inadequate electronic health record systems, insufficient support and time constrains can be barriers. Support regarding the whole implementation process from centralized units at the local hospitals, as well as cooperation between ICUs and national guidance, has the potential to raise the quality of CPs and benefit the progress of CP implementation.

  • 48. Bjurulf, P
    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.
    Initiativgruppsrapport: Forskning inom allmänmedicin1981In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 78, p. 2850-51Article in journal (Refereed)
  • 49.
    Björn, Catrine
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Josephson, Malin
    Wadensten, Barbro
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences.
    Rissén, Dag
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg.
    Prominent attractive qualities of nurses work in operating room departments: A questionnaire study2015In: Work: A journal of Prevention, Assesment and rehabilitation, ISSN 1051-9815, E-ISSN 1875-9270, Vol. 52, no 4, p. 877-889Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The shortage of nurses in operating room departments (ORs) in Sweden and other countries can lead to reduced capacity and quality in healthcare, as well as more intense work for those on the job. Little is known about what nurses in ORs perceive as crucial for their workplace to be attractive.

    OBJECTIVE: To capture attractive qualities of nurses' work in Swedish ORs and take a first step in the process of adapting the Attractive Work Questionnaire for use in a health care context.

    METHODS: The AWQ was completed by 147 (67% ) nurses in four Swedish ORs. Principal Component Analyses (PCA) were performed to determine the underlying structure of the data.

    RESULTS: Factors contributing to job attractiveness identified in the area "work conditions" were: relations, leadership, equipment, salary, organisation, physical work environment, location, and working hours; in the area "work content": mental work, autonomy and work rate; and in the area "job satisfaction": status and acknowledgement. The PCA showed consistency with the original AWQ, Cronbach's alpha varied between 0.57-0.90.

    CONCLUSIONS: Prominent attractive qualities for nurses' work in Swedish ORs were possible to identify through the AWQ and the results suggest that the questionnaire can be useful in a health care context.

  • 50.
    Björn, Catrine
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg.
    Lindberg, Magnus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Caring Sciences. University of Gävle.
    Rissén, Dag
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Research and Development, Gävleborg.
    Significant factors for work attractiveness and how these differ from the current work situation among operating department nurses2016In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 25, no 1-2, p. 109-116Article in journal (Refereed)
    Abstract [en]

    AIMS AND OBJECTIVES: The aim was to examine significant factors for work attractiveness and how these differ from the current work situation among operating department nurses. A second objective was to examine the associations between age, gender, length of employment, work engagement, work ability, self-rated health indicators and attractiveness of the current work situation.

    BACKGROUND: The attractiveness of work is rarely taken into account in research on nurse retention. To expand this knowledge, it is relevant to examine factors that make work attractive and their associations with related concepts.

    DESIGN: Correlational, cross-sectional survey using a convenience sample.

    METHODS: Questionnaires were answered by 147 nurses in four operating departments in Sweden. Correlation and regression analyses were conducted.

    RESULTS: The nurses rated the significance of all factors of work attractiveness higher than they rated those factors in their current work situation; salary, organisation and physical work environment had the largest differences. The most significant attractive factors were relationships, leadership and status. A statistically significant positive correlation between work engagement and attractive work was found. In the multiple regression model, the independent variables work engagement and older age significantly predicted work attractiveness.

    CONCLUSIONS: Several factors should be considered in the effort to increase work attractiveness in operating departments and thereby to encourage nurse retention. Positive aspects of work seem to unite work engagement and attractive work, while work ability and self-rated health indicators are other important dimensions in nurse retention.

    RELEVANCE TO CLINICAL PRACTICE: The great discrepancies between the significance of attractive factors and the current work situation in salary, organisation and physical work environment suggest ways in which work attractiveness may be increased. To discover exactly what needs to be improved may require a deeper look into the construct of the examined factors.

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