PURPOSE:To report the results from a nationwide survey on glaucoma management in Sweden, performed as a part of an Open Angle Glaucoma project conducted by the Swedish Council on Health Technology Assessment 2004-2008.METHODS:In 2005, a survey was distributed to all providers of glaucoma care in Sweden: public eye departments, public outpatient departments and private practices. The questionnaire included questions on number of examined patients, types of examinations during one defined week, internal organization and access to diagnostic equipment. The questionnaire was endorsed by the Swedish Ophthalmological Society. Reminders were sent out to nonresponders.RESULTS:Response rate was high; 97% (33/34) of eye departments, 85% (39/46) of outpatient departments and 55% (69/125) of private practices. Out of 29 282 visits in ophthalmic care during the study week, 7737 (26%) were related to glaucoma. Diagnostic equipment was generally available; all public eye facilities and 92% of private practices had at least one computerized perimeter, while equipment for fundus photography/imaging was available at 100% of eye departments, 82% of outpatient departments and 62% of private practices. The number of visual field tests and fundus images was rather low. Survey results indicate that patients on the average underwent bilateral field testing every 2nd year and fundus imaging every 8th year.CONCLUSION:Glaucoma care generated about a quarter of all patient visits in Swedish ophthalmic care. Access to diagnostic facilities was good. To meet modern standards of glaucoma care, glaucoma damage must be measured and followed more closely than at the time of the survey.

Sankning av ogontrycket fordrojer synfaltsforsamringen vid glaukom och minskar risken for utveckling av glaukom vid okular hypertension.Det ar oklart om laserbehandling eller kirurgi ar battre an ...

Det ar angelaget att finna metoder for att forebygga psykisk ohalsa hos barn. Det finns tecken pa att psykisk ohalsa hos barn kan ha okat under de senaste decennierna och strukturerade insatser for ...

This thesis consists of an overview and five essays. The purpose of the thesis is to show how economics can contribute to a better understanding of medical practice variations – why they exist, their consequences, and the extent to which they can – and should – be influenced. The first essay, Econometric analysis of variation in cesarean section rates – a cross-sectional study of 59 obstetrical departments in Sweden, is an attempt to identify the causes of variation in cesarean section rates, and to discuss their economic consequences. The econometric model applied explains 27 percent of the variation. We conclude that the unexplained variation in cesarean section rates indicates inefficiency, mainly due to over-utilisation. Estimates of the economic consequences indicate an additional cost for unnecessary cesarean sections of 13-16 million SEK per year. The welfare loss to society due to undesired variation is tentatively estimated to be about twice as high. In the second essay, Estimating the effect of cesarean section rate on health outcome – evidence from Swedish hospital data, we test the null hypothesis of a zero effect of cesarean section rate on health outcome, against the alternative of a positive effect. We could not reject the null hypothesis of a zero effect, i.e., we did not find any significant positive relationship between cesarean section rate and health outcome, in terms of perinatal mortality or rate of asphyxia. In the third essay, Benchmarking in obstetric care – a comparative study based on data envelopment analysis (DEA), we apply the DEA method to compare technical efficiency (productivity) of inpatient obstetric care in Swedish hospitals in 1994 and 1995. The results indicate an average potential for enhanced productivity of at least 6-7 percent each year. Most hospitals show decreasing productivity 1994-1995, partly due to inability to adjust production capacity and costs to a decreasing demand. The last two essays apply a new method – Quality Satisfaction Performance (QSP) – for incorporating patient perspectives into the management of health care, i.e., as a basis for quality improvement. Change-oriented patient questionnaires – testing a new method at three departments of ophthalmology, is a pilot study. The results show consistently high patient satisfaction indices. Satisfaction varies somewhat among the different patient segments and departments. We conclude that decisions on improvements must be preceded by thorough assessment of costs as well as effects associated with the various changes. The last essay, Patient satisfaction and priority setting – an economic approach, aims at analysing if and how priorities according to the QSP approach are influenced when an economic perspective is explicitly included. This is accomplished by a cost-effectiveness analysis of certain proposed changes/improvements, and a cost-benefit analysis based upon the patients` willingness-to-pay for these changes. Our results show that the ranking between various improvements is strongly influenced when an economic dimension is included. We conclude that even a methodologically appropriate measurement of patient satisfaction may lead to cost-ineffective priority setting, unless economic consequences are explicitly considered.

Objectives: The aim of this study was to demonstrate the best way of identifying all relevant published health economic evaluation studies, which have increased in number rapidly in the past few decades. Nevertheless, health technology assessment projects are often faced with a scarcity of relevant studies.Methods: Six bibliographic databases were searched using various individually adapted strategies. The particular example involves the cost-effectiveness of diagnosing gastroesophageal reflux disease. Inclusion and exclusion criteria were formulated.Results: After irrelevant studies and duplicates had been excluded, sixty-eight abstracts were reviewed. We chose forty-one of them as relevant for full-text review, which identified fourteen papers as having met the inclusion criteria. Most of the relevant studies were identified by searching the National Health Service Economic Evaluation Database (NHS EED) and PubMed databases.Conclusions: A search in NHS EED, by means of the Cochrane Library or the Center for Reviews and Dissimination, along with a supplementary search in PubMed, is generally an appropriate, cost-effective strategy. However, because “cost-effectiveness” is not consistently indexed with Medical Subject Heading terms in PubMed, all economic search terms need to be used to fully identify the relevant references.

[From primary health care to invasive intervention. The cardiovascular patient's way through the Swedish health care system]