Abstract
BackgroundIn Sweden three key criteria are used for priority setting: severity of the health condition; patient benefit; and cost-effectiveness. They are derived from the ethical principles established by the Swedish parliament 1997 but have been used only to a limited extent in primary care. The aim of this study was to describe and analyse: 1) GPs', nurses', and patients' prioritising in routine primary care 2) The association between the three key priority setting criteria and the overall priority assigned by the GPs and nurses to individual patients.MethodsPaired questionnaires were distributed to all patients and the GPs or nurses they had contact with during a 2-week period at four health centres in Sweden. The staff registered the health conditions or health problem, and the planned intervention. Then they estimated the severity of the health condition, the expected patient benefit, and the cost-effectiveness of the planned intervention. Both the staff and the patients reported their overall prioritisation of the patient. In total, 1851 paired questionnaires were collected.ResultsCompared to the medical staff, the patients assigned relatively higher priority to acute/minor conditions than to preventive check-ups for chronic conditions. Severity of the health condition was the priority setting criterion that had the strongest association with the overall priority for the staff as a whole, but for the GPs it was cost-effectiveness.ConclusionsThe challenge for primary care providers is to balance the patients' demands with medical needs and cost-effectiveness. Transparent priority setting in primary care might contribute to a greater consensus between GPs and nurses on how to use the key priority setting criteria.
Highlights
In Sweden three key criteria are used for priority setting: severity of the health condition; patient benefit; and cost-effectiveness
In an earlier study we found that primary health care (PHC) staff viewed the three key priority setting criteria as useful [18]
Paired questionnaires were given to all patients who were in contact with the primary health care centres (PHCCs) regarding a health problem during the study period, and to the staff they were in contact with
Summary
In Sweden three key criteria are used for priority setting: severity of the health condition; patient benefit; and cost-effectiveness. They are derived from the ethical principles established by the Swedish parliament 1997 but have been used only to a limited extent in primary care. In Sweden, the Government launched a Parliamentary Commission on priority setting in health care, and their final report was published and solidarity principle and the cost-effectiveness principle have been transformed into three key criteria: severity of the health condition; patient benefit; and costeffectiveness of the medical intervention [11]. The three criteria are used for priority setting both nationally and regionally in Sweden [13,14,15]. Several countries with publicly financed health care systems use similar criteria [16,17]
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