The	  growing	  elderly	  popula1on	                        	  	  	  	  -­‐	  a	  pa1ents’	  perspec1ve	  on	  challenges...
My	  presenta1on	  	  •  About	  Danish	  Pa7ents	  and	  ViBIS	       	  •  The	  aging	  popula7on	  in	  Denmark	  	  •...
Danish	  Pa1ents	         	  •             Umbrella	  organiza7on	  •             79	  pa7ent	  organiza7ons	  	  •       ...
 Danish	  Pa1ents	  is	  working	  for:	  	         Securing	  pa7ents	  the	  best	  possible	  condi7ons	  in	         t...
15.	  maj	  2012	  
ViBIS	  •  The	  Knowledge	  Center	  is	  established	  in	  2011	  to	  enhance	     involvement	  of	  pa7ents	  and	  ...
Gathering	            Analyzing	              Communica1ng	                                  Assesment	              Via	 ...
The	  healthcare	  system:	  	  Ø  Provides	  sufficient	  informa7on	  	  Ø  Communicates	  with	  pa7ent	  (and	  rela7v...
15.	  maj	  2012	  
Predic7on	  of	  eldery	  	  Source: Nyt fra Danmarks statistik, nr. 205, 4. maj 2011.www.dst.dk/pukora/epub/Nyt/2011/NR20...
Significant	  growing	  number	  of	  elderly	  people	  •  Popula7on	  will	  increase	  to	  6.1	  mio.	  in	  2050	  fro...
Chronic	  diseases	  2.500.000	  2.000.000	  1.500.000	  1.000.000	    500.000	            0	                    1987	    ...
       Diagnosis	  related	  to	  lifestyle	        	  700.000	  600.000	  500.000	  400.000	  300.000	  200.000	  100.000...
         	  	          	          Mul1	  disease	  1.000.000	    900.000	    800.000	    700.000	    600.000	    500.000	 ...
Change	  in	  disease	  paIern	                                        	  	                                           •  1...
Change	  in	  pa1ent	  role	                       	                               •  Seeking	  informa7on	               ...
Davids	  case	  	  The	  case	  illustrates	  the	  challenges	  securing	  coherence	  between	  different	  faces	  throu...
Davids	  case	  	  David	  is	  a	  50	  year	  old	  man	  Works	  as	  a	  sales	  manager	  Lives	  with	  his	  family...
System	  perspec1ve	       	  Emergency	                                                          Out-­‐pa7ents	          ...
Pa1ent	  perspec1ve	   	                                                                      The	                        ...
15.	  maj	  2012	  
”	  There	  must	  be	  unity	  in	  things	  .......	                             Organs infected by disease      and	  i...
 	                                                                                        Different	  professionals	  	  "I...
 Pa1ent	  in	  hospital	  ”	  Its	  very	  frustra7ng	  to	  wait	  for	  	  a	  phone	  call	  that	  never	  comes.	    ...
    	     	     	    Patient                                                            Focus on individual needs         ...
Solu1ons	  Ø Involvement	  of	  pa7ent	  and	  rela7ves	  Ø Coherence	  throughout	  the	  course	  of	     treatment	  ...
Effects	  of	  involving	  pa1ents	  •  It	  has	  been	  documented	  that	  pa7ent	  involvement	  	     has	  a	  posi7v...
At	  the	  individual	  level	   	   	  Professional	                       D                 	  Pa7ent	                  ...
At	  the	  organiza1onal	  level	  	              Effects            Adverse effects                                      ...
Adverse	  events	  –	  an	  individual	  level	  •  Pa7ents	  and	  rela7ves	  have	  important	  knowledge	  •  Pa7ents	 ...
Involvement	  on	  an	  organiza1onal	  level	  •  1.	  september	  2011	  pa7ents	  and	  rela7ves	  have	  been	  able	 ...
4-­‐month	  period	  of	  repor7ng	                    adverse	  events	                    	                    More	  th...
Status	  in	  Denmark	  	  •  Informed	  consent	  	  •  ”Regions	  and	  municipali7es	  have	  to	  secure	       qualit...
Goals	  for	  Danish	  Pa1ents	  	    •  Systema7c	  approach	  defining	  how	  	    •  Systema7c	  evalua7on	    •  Legis...
Coherence	                  15.	  maj	  2012	  
     	      	      Telemedicine	      	                                                                         Involvemen...
Status	  in	  Denmark	  •  A	  lot	  of	  smaller	  projects	  •  2012-­‐15	  some	  large	  scale	  project	  	  •  Telem...
Goals	  for	  Danish	  Pa1ents	    •    More	  larger	  scale	  projects	    •    Quality	  –	  not	  saving	  money	    •...
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Danish patients annette wandel 15 maj 2012 endelig

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Danish patients annette wandel 15 maj 2012 endelig

  1. 1.  The  growing  elderly  popula1on          -­‐  a  pa1ents’  perspec1ve  on  challenges  an   solu1ons  in  healthcare     Anne%e  Wandel   Chief  consultant     www.danskepa7enter.dk     15.  maj  2012  
  2. 2. My  presenta1on    •  About  Danish  Pa7ents  and  ViBIS    •  The  aging  popula7on  in  Denmark    •  Challenges  for  the  healthcare  system    •  Solu7ons  from  a  pa7ents’  perspec7ve   15.  maj  2012  
  3. 3. Danish  Pa1ents    •  Umbrella  organiza7on  •  79  pa7ent  organiza7ons    •  Represen7ng  860,000  members    •  10  employees  including  ViBIS  •  The  Danish  Knowledge  Center  of  User  Involvement  in  Health   Care       15.  maj  2012  
  4. 4.  Danish  Pa1ents  is  working  for:     Securing  pa7ents  the  best  possible  condi7ons  in   the  health  care  system,  through:     Ø  developing  policies  based  on  documented  knowledge            of  pa7ents’  perspec7ves       Ø  being  the  voice  of  pa7ents  in  rela7on  to  authori7es   and  the  public   15.  maj  2012  
  5. 5. 15.  maj  2012  
  6. 6. ViBIS  •  The  Knowledge  Center  is  established  in  2011  to  enhance   involvement  of  pa7ents  and  rela7ves  in  health  care  •  The  Knowledge  Center  is  working  to  raise  the  standards  of   prac7ce  involving  pa7ents  and  rela7ves  in  health  care  on  a   individual  and  organiza7onal  level   15.  maj  2012  
  7. 7. Gathering   Analyzing   Communica1ng   Assesment   Via  :   Ongoing  project   Filtering   -­‐  Website   Ongoing  prac7ce     -­‐  Advising   Li%erature  study   -­‐  Courses   including   interna7onal   -­‐  Facilita7ng       experience             What  is   meaningful  userinvolvement?   Many  different   intepre7ons  of  user-­‐ involvement         15.  maj  2012  
  8. 8. The  healthcare  system:    Ø  Provides  sufficient  informa7on    Ø  Communicates  with  pa7ent  (and  rela7ves)  about  individual  needs  for   informa7on  Ø  Requestes  and    involves  the  pa7ents’    knowledge,  preferences  and   resources  througout  the  course  of  treatment  Ø  Pra7ce  shared  decision  making    Ø  Empowers  pa7ents  to  handle  the    situa7on  living  with  a  disease  Ø  Systema7cally  collect  and  emplement  pa7ents’  knowledge  on  a   organiza7onel  level  to  improve  quality  of  health  care  services  Ø  Systema7cally  collect  and  apply    pa7ent  evalua7on  of  the  health  care     services   15.  maj  2012  
  9. 9. 15.  maj  2012  
  10. 10. Predic7on  of  eldery    Source: Nyt fra Danmarks statistik, nr. 205, 4. maj 2011.www.dst.dk/pukora/epub/Nyt/2011/NR205.pdf 15.  maj  2012  
  11. 11. Significant  growing  number  of  elderly  people  •  Popula7on  will  increase  to  6.1  mio.  in  2050  from  5.6  mio.   today  •  Number  of  people  over  65  years  old  will  increase  to  1.5  mio.     in  2044  from  934,000  today    •  A  growth  57  pct.  more  people  over  65  years  old   15.  maj  2012  
  12. 12. Chronic  diseases  2.500.000  2.000.000  1.500.000  1.000.000   500.000   0   1987   2005   2020   http://www.si-folkesundhed.dk/upload/ kap_35_folkesundheden_i_fremtiden.pdf 15.  maj  2012  
  13. 13.   Diagnosis  related  to  lifestyle    700.000  600.000  500.000  400.000  300.000  200.000  100.000   0   Diabetes   Cardio   Lung   Rheuma   Psych   Source:www.sst.dk/Planlaegning%20og%20kvalitet/Kronisk%20sygdom/ 15.  maj  2012   SST_proj_forst_inds/Monitorering%20af%20kronisk%20sygdom.aspx
  14. 14.         Mul1  disease  1.000.000   900.000   800.000   700.000   600.000   500.000   400.000   Number  of  people   300.000   200.000   13.052 1.048 100.000   0   one   two   three   four   five   diagnosis   diagnosis   diagnosis   diagnosis   diagnosis   15.  maj  2012  
  15. 15. Change  in  disease  paIern       •  1.7  mio.  living  with  a  chronic     disease   •  Complexity  is  growing   •  The  capability  of  handling  a  life   with  disease  is  increasingly   important     Ø  INVOLVING  PATIENTS’  RESOURCES   ARE  CRUCIAL  TO  TREATMENT   Ø  COHERENCE  IS    BECOMING  MORE   CHALLENGING   15.  maj  2012  
  16. 16. Change  in  pa1ent  role     •  Seeking  informa7on   •  Knowledge  of  disease  and   treatment   •  Increasing  demands  for   coopera7on     Ø  PATIENTS  HAVE  RESOURCES  AND   WANT  TO  BE  INVOLVED     15.  maj  2012  
  17. 17. Davids  case    The  case  illustrates  the  challenges  securing  coherence  between  different  faces  throughout  his  course  of  treatment:  diagnosis,  treatment  and  rehabilita7on  –  and  the  daily  life  of  David.     15.  maj  2012  
  18. 18. Davids  case    David  is  a  50  year  old  man  Works  as  a  sales  manager  Lives  with  his  family:  two  children  and  his  wife.    One  day  he  collapses    at  work  with  chest  pain  His  workplace  calls  an  ambulance  He  is  admi%ed  on  the  emergency    ward    David  has  had  a  heart  a%ack  –  and  is  diagnosed  with  diabetes    His  is    hospitalized  at  the  cardiac  ward     15.  maj  2012  
  19. 19. System  perspec1ve    Emergency   Out-­‐pa7ents   Hospitalized     Discharged   Rehabilita7on     ward   visit  Emergency     Out-­‐pa7ents   Hospitalized     Discharged   Rehabilita7on     Ward   visit   15.  maj  2012  
  20. 20. Pa1ent  perspec1ve     The   Out-­‐pa7ent   podiatrist   cardiac   ward   Pa7ent  educa7on   program   The   The  cardiac     rehabilita7on   ward   center  The  acute   ward   Caseworker   The   General   Municipality   diabetes   prac77oner   ward   15.  maj  2012  
  21. 21. 15.  maj  2012  
  22. 22. ”  There  must  be  unity  in  things  .......   Organs infected by disease and  it  all  hang  together  ....  But   frequently  you  find  that  when  you   arrive  at  the  eye  ward  so  even   though  they  are  nice  and   competent  and  everything,  you   are    a  pair  of    giant  eyes  with  legs   that  comes  walking  down  the   hallway.  And  the  same    on  the   diabetes  ward  -­‐    there  you  are  a   large  pancreas  with  legs  .....  and   on  vascular  surgery  ward,  there   One person you  are  a  pounding  vein   walking  ......  they  do  not  see  the   whole  person  "    (Pa/ent,  DSI,   2010) 15.  maj  2012  
  23. 23.     Different  professionals    "Its  weird,  because  its  only  one  thing  that  the  hospital  staff  are  looking  at  and  my  doctor,  she  does  not  really  look  at  that,  because  she  expects  that  the  hospital  takes  care  of  it.  So  you  feel  a  bit  like  one  is  a  jigsaw  puzzle.  With  one  piece,  you  can  go  there  and  they  can  look  at  it  and  maybe  take  care  of  it,  but  the  rest  is  not  their  business.  “  (EfB,  2007)      Only  one  to  create  coherence   15.  maj  2012  
  24. 24.  Pa1ent  in  hospital  ”  Its  very  frustra7ng  to  wait  for    a  phone  call  that  never  comes.   It  is  7me  consuming  and  it   costs  working  7me.  Many   conversa7ons  with  the  clinic  is   not  suitable  to  be  placed  in   open  workspaces  -­‐  so  I  may   have  to  take  7me  off  or  a  sick   leave”.           A  person    Pa/ent,  Det  borgernære  Hospital,  2010   15.  maj  2012  
  25. 25.         Patient Focus on individual needs Involvement(Needs/Demands)   Coordination Holistic view   Unsolved Access dilemma   Centralization Specialization Standardization System (Development) 15.  maj  2012  
  26. 26. Solu1ons  Ø Involvement  of  pa7ent  and  rela7ves  Ø Coherence  throughout  the  course  of   treatment   15.  maj  2012  
  27. 27. Effects  of  involving  pa1ents  •  It  has  been  documented  that  pa7ent  involvement     has  a  posi7ve  effect:   –  Quality  of  life  and  pa7ent  sa7sfac7on   –  Clinical  outcome   –  Pa7ent  safety   –  Changes  in  the  provision  of  services  Source:  Coulter  A,  Ellins  J.  Pa7ent-­‐focused  interven7ons  –  A  review  of  the  evidence.  London:  The  Health  Founda7on,  2006.     15.  maj  2012  
  28. 28. At  the  individual  level      Professional   D  Pa7ent   E    -­‐  Experience   -­‐  Treatment  methods   C    -­‐  History  of  treatment   -­‐  Effects   I    -­‐  Overall  disease   -­‐  Adverse  effects   S          picture      -­‐  Risks   I -­‐  Life  situa7on   O   N -­‐  Preferences     15.  maj  2012  
  29. 29. At  the  organiza1onal  level     Effects Adverse effects Solution Risks ……. Clinical   Economic   Pa7ent   Experience Life situation Workplace Organisa7on   Preferences Cooperation   ……. …….. 15.  maj  2012  
  30. 30. Adverse  events  –  an  individual  level  •  Pa7ents  and  rela7ves  have  important  knowledge  •  Pa7ents  detect  other  types  of  errors  and  incidents  than  do   staff  -­‐  e.g.  in  pa7ent  handover/transi7ons  •  24  %    experience  adverse  events  during  hospital  stay  –  54   %  detect  the  event  themselves  •  Pa7ents  can  be  used  as  informants  in  order  to  prevent   medical  errors  and  to  improve  knowledge  on  adverse   events            Source:  Unit  of  pa7entperceived  quality,  2008:  h%p://www.pa7entoplevelser.dk/log/medie/Rapporter/2008/TUP_2007.pdf   15.  maj  2012  
  31. 31. Involvement  on  an  organiza1onal  level  •  1.  september  2011  pa7ents  and  rela7ves  have  been  able  to   report  adverse  events  to  a  central  database  by  law    •  The  informa7on  is  gathered  and  analyzed  in  Pa/entombuddet   –  and  commits  the  regions,  municipali7es  and  the  GP´s  to  act   on  reports  to  improve  pa7ent  safety   15.  maj  2012  
  32. 32. 4-­‐month  period  of  repor7ng   adverse  events     More  than  35,000  over  the  course   of  last  year    15.  maj  2012  
  33. 33. Status  in  Denmark    •  Informed  consent    •  ”Regions  and  municipali7es  have  to  secure   quality  and  efficient  use  of  resources…in   dialog  with  the  users…”    •  A  lot  of  individual  smaller  projects    •  Pa7ent  representa7ves  in  a  lot  of  bodies     15.  maj  2012  
  34. 34. Goals  for  Danish  Pa1ents     •  Systema7c  approach  defining  how     •  Systema7c  evalua7on   •  Legisla7on  can  support  that  (Norway)   15.  maj  2012  
  35. 35. Coherence   15.  maj  2012  
  36. 36.       Telemedicine     Involvement Patient   Holistic view Focus on individual needs(Needs/Demands) Coordination   Access   Work,   Involvement  of   family   pa7ent  and   Coherence   ect.     rela7ves     Easier  and  wider         Centralization Specialization Standardization System (Development) 15.  maj  2012  
  37. 37. Status  in  Denmark  •  A  lot  of  smaller  projects  •  2012-­‐15  some  large  scale  project    •  Telemedicine  is  supported  by  0,0068  %.  of  the   expenses  on  health  care  on  public  hospitals.            Source:  h%p://www.ssi.dk/Sundhedsdataogit/Na7onal%20Sundheds-­‐it/Aktuelt/2011/~/media/Indhold/DK%20-­‐%20dansk/Sundhedsdata%20og%20it/Na7onal%20Sundheds-­‐it/Nyheder/21102011/DialogudgaveAfNa7onalStrategiForTelemedicin.ashx   15.  maj  2012  
  38. 38. Goals  for  Danish  Pa1ents   •  More  larger  scale  projects   •  Quality  –  not  saving  money   •  Coherency  –  not  single  body  projects   •  Individual  needs  –  not  one  size  fits  all   •  User  innova7on  –  not  driven  by   technology   15.  maj  2012  

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