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Patient-centered care Sweden Docteur

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A 2012 evaluation of patient-centeredness in Sweden\'s health care undertaken by Elizabeth Docteur and Angela Coulter

A 2012 evaluation of patient-centeredness in Sweden\'s health care undertaken by Elizabeth Docteur and Angela Coulter


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  • 1. Granskar vård och omsorgMyndigheten för vårdanalys 7/3/12 Sid 1
  • 2. Patient-centeredness in Sweden’s health system – an external assessment and six steps for progressMyndigheten för vårdanalys 7/3/12 Sid 2
  • 3. Elizabeth Docteur•  Independent health policy consultant with 20 years’ experience•  Positions in the U.S. federal government, the international arena, the private sector and civil society.•  Previous Deputy Head of the Health Division at the Organization for Economic Cooperation and Development (OECD)•  Previous Vice President and Director of Policy Analysis at the Center for Studying Health Systems ChangeMyndigheten för vårdanalys 7/3/12 Sid 3
  • 4. Angela Coulter•  Director of Global Initiatives at the Foundation for Informed Medical Decision Making, Boston•  Senior Research Scientist at the Department of Public Health, University of Oxford•  Previous Chief Executive of Picker Institute Europe•  Previous Director of Policy and Development at the King’s FundProfessor Coulter has published more than 250 research papers and reports andseveral books including Engaging Patients in Healthcare (2011) and TheAutonomous Patient (2002)In January the Donabedian Foundation at Barcelona University awarded her the2012 Donabedian International Award in health care quality for her work on patient-centered care.Myndigheten för vårdanalys 7/3/12 Sid 4
  • 5. Patient-centeredness in Sweden’s health system – an external assessment and six steps for progressMyndigheten för vårdanalys 7/3/12 Sid 5
  • 6. What is patient-centered careand why is it important?•  Patient-centered care anticipates and responds to the needs and expectations of individual users and potential users of health services.•  Patient-centered care produces better patient experiences and is associated with better health outcomes. Can also assist in reducing costs via channels such as better patient compliance with prescribed treatments and fewer errors, duplication, problems; shorter hospital stays; quicker return to work.•  Making health systems more patient-centered is increasingly recognized as a critical performance goal (OECD, WHO), one of six aims for quality improvement put forward by US Institute of MedicineMyndigheten för vårdanalys 7/3/12 Sid 6
  • 7. Objectives of this study:The questions from Vårdanalys•  What framework can be used to assess the extent to which Sweden’s health care system is patient-centered?•  To what extent is Sweden’s health care system patient-centered?•  What changes in policy could help to strengthen patient-centeredness in Sweden’s health care system?Myndigheten för vårdanalys 7/3/12 Sid 7
  • 8. The framework - what we did:Phase 1 – Select framework for assessment and operational plan•  Review work on patient-centered health care by researchers, international organizations, patient groups•  Define an appropriate framework for assessing and benchmarking performance in Sweden and internationally•  Identify indicators and data to use•  Obtain input and feedback from expert advisory groupMyndigheten för vårdanalys 7/3/12 Sid 8
  • 9. The assessment – what we did:Phase 2 – Conduct assessment of patient-centeredness inSweden’s health system•  Interview 34 Swedish experts (patient representatives, government officials, academic and other experts)•  Analyze data on patient experiences from Sweden’s National Patient Survey and International Health Policy Survey•  Review academic research and policy literature, government reports and relevant laws•  Develop policy recommendations driven by main conclusions•  Obtain input and feedback from expert advisory groupMyndigheten för vårdanalys 7/3/12 Sid 9
  • 10. Framework for assessmentMyndigheten för vårdanalys 7/3/12 Sid 10
  • 11. Overall assessment “Overall, our assessment revealed a number of shortfalls in terms of achieving patient-centered care in Sweden’s health system. At the same time, we found evidence of progress in a number of areas. Also, the system benefits from a number of strengths that provide a good foundation on which to build when making needed effort to accelerate progress. Yet there are barriers that have impeded progress; tackling these can help to accelerate change.”Myndigheten för vårdanalys 7/3/12 Sid 11
  • 12. Dimension 1:Empowering patients through information and education Sweden has made good recent progress in strengthening and improving legislation pertaining to patient information and education. Nevertheless, important gaps in information and education are evident, in terms of how well those efforts have paid off in patients’ understanding and satisfaction with the information and education obtained.Myndigheten för vårdanalys 7/3/12 Sid 12
  • 13. Dimension 1:Empowering patients through information and education100% Percentage of patients answering the most preferable 90% answer on each question concerning information and education (unweighted index). 80% 79% Source: IHP International 77% 77% Survey of Sicker Adults (2011) 70% 72% 71% 70% 69% 60% 65% 60% 58% 50% 53% 40% 30% 20% 10% 0% ia a s y ce n y UK nd US an d al ad nd an an de wa la al tr n la m Fr we or er us Ca er er S itz Ze A eth G N Sw ew N NMyndigheten för vårdanalys 7/3/12 Sid 13
  • 14. Dimension 1:Empowering patients through information and education •  Legal obligation to provide individually tailored information about condition and available treatments, choice of provider and guarantee is often not met. •  Swedish patients more likely than others to say their doctors do not spend enough time with them, do not present options for treatment, do not give them opportunities to ask questions. •  Swedish patients say doctors often fail to tell patients about the side effects of their medicines and the danger signals to watch out for. •  Large cross-county variation in psychiatric care, inpatient specialist care.Myndigheten för vårdanalys 7/3/12 Sid 14
  • 15. Dimension 1:Empowering patients through information and education •  Relatively good telephone access •  Information portals (internet and telephone) are improving, being used.Myndigheten för vårdanalys 7/3/12 Sid 15
  • 16. Dimension 2:Respecting patients’ individual needs, preference and values Sweden’s health care system very often fails to anticipate and respond to patients as individuals with particular needs, values and preferences. Failure to meet patient expectations can have demonstrable costs to patients, the health system and the public purse.Myndigheten för vårdanalys 7/3/12 Sid 16
  • 17. Dimension 2:Respecting patients’ individual needs, preference and values 100% Percentage of patients answering the most preferable 90% answer on each question concerning preferences and needs (unweighted index). 80% Source: IHP International 70% 74% Survey of Sicker Adults, 2011. 71% 69% 60% 65% 64% 62% 61% 57% 50% 51% 40% 46% 42% 30% 20% 10% 0% ia a s y ce n UK nd US d l ad nd an ay de la an tra n la an w e er al us Ca er er m Fr or Sw i tz Ze A eth G N Sw ew N NMyndigheten för vårdanalys 7/3/12 Sid 17
  • 18. Dimension 2:Respecting patients’ individual needs, preference and values •  In international comparisons, Swedish patients are least likely to be engaged by their health care providers in their care and treatment decisions. The concept of shared- decision making has yet to take root in Sweden and there is little use of decision aids. •  Low patient engagement is associated with worse outcomes, including medical errors. •  Patients are not viewed as a source of expertise and information regarding their condition and needs. •  Swedish health care is said to be organized for administrative convenience, rather than convenience of patients (and providers). •  Psychiatric patients are particularly dissatisfied with their experience.Myndigheten för vårdanalys 7/3/12 Sid 18
  • 19. Dimension 2:Respecting patients’ individual needs, preference and values Swedish patients report that their health care providers treat them with respect and listen to them.Myndigheten för vårdanalys 7/3/12 Sid 19
  • 20. Dimension 3:Coordinating care across service providers andensuring continuity of care Inadequate coordination care across health-care providers is an important weakness in Sweden’s health system. Such problems are likely to have a negative impact on health outcomes and costs, in addition to having a negative impact on patient experienced quality of service.Myndigheten för vårdanalys 7/3/12 Sid 20
  • 21. Dimension 3:Coordinating care across service providers andensuring continuity of care100% Percentage of patients answering the most preferable answer on each separate 90% question concerning coordination and continuity 80% (unweighted index). SOURCE: IHP International 70% 74% Survey of Sicker Adults (2011). 69% 60% 65% 64% 62% 60% 57% 50% 54% 52% 50% 49% 40% 30% 20% 10% 0% a ia s ay e en y UK US nd nd ad al nd nc d n la al a an str la or w Fr a we ma er Au er er itz Ze C eth N S G Sw ew N NMyndigheten för vårdanalys 7/3/12 Sid 21
  • 22. Dimension 3:Coordinating care across service providers andensuring continuity of care •  Poor international performance with respect to coordination; mediocre performance in terms of poor outcomes associated with coordination problems •  Inadequate cooperation among health care providers and between health and social services •  Technical problems in the function of electronic medical records that impede their full use for coordination •  Problems for vulnerable populations, such as the sickest elderly, patients with rare conditions.Myndigheten för vårdanalys 7/3/12 Sid 22
  • 23. Dimension 4:Taking a holistic approach to patients as people with medical,social, emotional, psychological and spiritual needs Some problems in taking a sufficiently holistic approach to patient care are evident, with relatively little variation in performance across counties.Myndigheten för vårdanalys 7/3/12 Sid 23
  • 24. Dimension 4:Taking a holistic approach to patients as people with medical,social, emotional, psychological and spiritual needs •  Specialist physicians, hospital staff, and hospital administrators can do more to take a sufficiently holistic view of patients, so as to better meet their needs. •  Need to look at how well spiritual needs are met (some evidence of problems) and how best to meet needs in a secular, multicultural society. •  Relatively low performance variation across counties suggests that this may not be an area in which the administration of health care services by the county councils has a particular impact.Myndigheten för vårdanalys 7/3/12 Sid 24
  • 25. Dimension 5:Involving family and close friends in the health care experience While evidence regarding patients’ experiences in involving family and close friends in their health care is relatively limited in depth and scope, available data suggests that there is room for improvement in this area. Several types of potential problems benefiting from further exploration were identified in the course of the present study.Myndigheten för vårdanalys 7/3/12 Sid 25
  • 26. Dimension 5:Involving family and close friends in the health care experienceMyndigheten för vårdanalys 7/3/12 Sid 26
  • 27. Facilitators and barriersto a more patient-centered health care in Sweden •  Achievements of Sweden’s health care system support a focus on patients •  Potential to exploit an impressive array of patient data •  Patient-centeredness is a public priority •  Developing efforts to track performance in achieving patient-centerednessMyndigheten för vårdanalys 7/3/12 Sid 27
  • 28. Facilitators and barriersto a more patient-centered health care in Sweden •  Enhanced choice may spur a more patient-centered care, but will not suffice for all patients •  Existing patient protections and guarantees are valuable, but need to be strengthened and enforced •  Local administration of health services has both benefits and disadvantages for patient-centerednessMyndigheten för vårdanalys 7/3/12 Sid 28
  • 29. Facilitators and barriersto a more patient-centered health care in Sweden •  Evident challenges from cost-containment pressure (e.g., constraints on time spent with patients) •  Need to accelerate attitudinal changesMyndigheten för vårdanalys 7/3/12 Sid 29
  • 30. Policy recommendations:Six steps toward a more patient-centered care1  Ensure compliance with existing “patients’ rights”2  Establish patients as full partners with their providers with a role in health and care decisions3  Engage and involve patients and their representatives in health policy and administrative decisions4  Sustain efforts to facilitate coordination and continuity of care (through remuneration changes, improvement of health ICT, etc…)5  Define a model of patient-centered health care that reflects the priorities of Swedish patients6  Strengthen efforts to assess and track patient centerednessMyndigheten för vårdanalys 7/3/12 Sid 30