Health Care Politicians Research Articles

The certification of centers for weaning from mechanical ventilation in neurological and neurosurgical early rehabilitation by the German Society for Neurorehabilitation

Die Zertifizierung von Zentren für Beatmungsentwöhnung in der neurologisch-neurochirurgischen Frührehabilitation durch die Deutsche Gesellschaft für Neurorehabilitation (DGNR) ist ab dem 01.10.2021 möglich. Die Zertifizierungskriterien beschreiben ein Anforderungsprofil, das für eine fachgerechte und qualitätsgesicherte Versorgung von Beatmungspatienten in der neurologisch-neurochirurgischen Frührehabilitation (NNFR) steht. Das Zertifikat berücksichtigt die strukturellen Unterschiede der in der NNFR tätigen Einrichtungen und kann sowohl durch Facheinrichtungen als auch durch Frührehabilitationsabteilungen an Akutkrankenhäusern erworben werden. Die Durchführung der Zertifizierung erfolgt analog zur Zertifizierung von Stroke-Units der Deutschen Schlaganfall-Gesellschaft in Zusammenarbeit mit dem TÜV Rheinland. Zunächst sendet die Einrichtung den Erhebungsbogen an den TÜV Rheinland. Anschließend erfolgt die Begehung durch einen vom TÜV Rheinland gestellten leitenden Auditor und einen Fachauditor der DGNR. Deren Bericht wird dem Zertifizierungsausschuss der DGNR vorgelegt zur Erteilung einer Empfehlung oder Ablehnung der Zertifizierung. Die Zertifizierung schafft objektive Kriterien, die die Rolle der Neurologie in der Beatmungsmedizin in Deutschland beschreiben. So erleichtert sie den Dialog mit anderen beatmungsmedizinischen Disziplinen und ebnet den Weg für die Diskussion mit Politikern, Kostenträgern und nicht zuletzt Betroffenenverbänden über Behandlungsinhalte und -kapazitäten.

The patient as a policy problem: Ambiguous perceptions of a critical interface in healthcare.

The interface between the patient and the health service has changed, which constitutes a potential problem for various policy-makers. Using a critical policy perspective and drawing on the theory of problem framing, this paper explores how actor groups with different responsibilities perceive the patient as a constructed policy problem. This is a qualitative study where data consists of single episode interviews with healthcare politicians, senior administrators, service strategists, and unit mangers from one regional health authority in Sweden. A thematic content analysis of the interviews was carried out in accordance with “the framework approach”. The study illustrates how the actors interpret their reality using diverse problem frames. This becomes more visible when the framing is disentangled with regard to what perspective they employ in relation to different accounts: society or the individual, or the (healthcare) system or the (healthcare) professional. The actor groups are part of the same institutional context, which explains certain tendencies of similarities in terms of the accounts being used, but still they approach the constructed problem differently which is visible as shifts—scaling up and down—between different accounts. By analyzing and structuring the various problem frames (including its policy styles) we can enhance our knowledge about how those responsible for the governance of healthcare approach the patient as a policy problem, as something that concerns only the patient and/or the provider, or as something that needs to be addressed in broader strategic terms.

The Case of Female Perpetrators of International Crimes: Exploratory Insights and New Research Directions

Abstract Although conflicts are often considered to be an exclusively male domain, historical records of conflicts throughout the 20th century show that women also actively participate in warfare – not only as peace activists, humanitarian workers, health care providers, politicians and soldiers but also as perpetrators of crimes. Nevertheless, the participation of women in the commission of international crimes, such as war crimes, crimes against humanity and genocide, has long been considered an anomaly that falls beyond the ‘normal’ scope of conflict-related criminality. Consequently, this topic has been deemed marginal in scholarly circles and, until recently, has remained significantly under-researched. This article contributes to the existing research by presenting an original analysis of the characteristics of conflict-related criminality among women and of criminal prosecutions of female perpetrators of international crimes in modern conflicts, primarily focusing on World War II, and the wars in Bosnia and Herzegovina and Croatia. It further offers a first systematic overview and analysis of domestic trials of women prosecuted for international crimes before the courts in Bosnia and Herzegovina, Croatia and Serbia.

Helmet Wars - or Can We Stop Banging Our Heads into the Wall and Have a Healthy Dialog about Bicycle Helmets?

The subject of bicycle helmets and helmet laws has been a widely discussed topic for years among health care specialists, cycling advocates and politicians. Who can be against protecting someone's head? If a simple device can save someone's life, why shouldn't everyone be using it? Numerous studies have attempted to quantify the safety benefits of helmet usage, but this still remains a highly contentious topic. More recently, linkages have been made between mandatory helmet laws and lack of success for bike share programs. As a cycling advocate representing the Montreal cycling community I am frequently asked to express my opinion on this topic. The discussion will focus on bicycle helmets as detrimental to the wider subject of cyclist safety. Helmet discussions implicitly place the blame on victims while allowing us to ignore more important safety topics which might require political will and necessitate a reallocation of space to favor active transportation. In the media, we frequently hear from trauma experts or first responders (with a chorus of cyclists who have been 'saved by their helmet' responding in the comments), yet we rarely hear from public-health advocates who are able to put the cyclist injuries into a larger context. Cyclist and pedestrian deaths may make for sensationalist reporting, but diseases associated with our sedentary lifestyles are a far larger public health challenge. In this presentation I would like to engage with the audience to explore strategies that might help to shift the safety conversation to more constructive areas.

Barriers to knowledge sharing in Chinese healthcare referral services: an emergent theoretical model

BackgroundThis paper reports on a research study that aims to identify and explain barriers to knowledge sharing (KS) in the provision of healthcare referral services in Chinese healthcare organisations.DesignAn inductive case study approach was employed, in which 24 healthcare professionals and workers from four healthcare organisations in the province of Hubei, Central China, were interviewed using semi-structured scripts.ResultsThrough data analysis, 14 KS barriers emerged in four main themes: interpersonal trust barriers, communication barriers, management and leadership barriers, and inter-institutional barriers. A cause–consequence analysis of the identified barriers revealed that three of them are at the core of the majority of problems, namely, the absence of national and local policies for inter-hospital KS, lack of a specific hospital KS requirement, and lack of mutual acquaintance.ConclusionsTo resolve KS problems, it is of great importance that healthcare governance agencies, both at the national and regional levels, take leadership in the process of KS implementation by establishing specific and strong policies for inter-institutional KS in the referral process. This paper raises important issues that exceed academic interests and are important to healthcare professionals, hospital managers, and Information communication technology (ICT) managers in hospitals, as well as healthcare politicians and policy makers.

Senior alert: a quality registry to support a standardized, structured, and systematic preventive care process for older adults.

The average life expectancy and the proportion of the elderly in the Western countries are increasing. The care processes used for the elderly are known to differ between the care providers in Sweden. Accordingly, the need to develop a system to support the processes in order to attain a standardized, structured, and systematic approach to improve preventive care processes for the elderly has been called for. The County Council of Jönköping developed a national Web-based quality registry, Senior Alert, with a focus on the following areas: falls, pressure ulcers, malnutrition, and oral health. The patients are evaluated using validated risk assessment instruments, and the care is planned, executed, evaluated. The registry supports the users to work with preventive care systematically and in a standardized way and provides feedback to the care providers on their preventive care processes. The registry helps the caregivers fulfill the preventive care according to the best available clinical knowledge and practice. The registry also provides the government and health care politicians with data for setting aims for elderly care. The registry is used in 90% of the municipalities and county councils throughout the country. The total number of risk assessments completed from 2009 to 2014 exceeded 1 000 000.

Overweight and Obesity before, during and after Pregnancy: Part 1: Pathophysiology, Molecular Biology and Epigenetic Consequences.

Overweight and obesity before conception as well as excessive weight gain during pregnancy are associated with endocrinological changes of mother and fetus. Insulin resistance physiologically increases during pregnancy, additional obesity further increases insulin resistance. In combination with reduced insulin secretion this leads to gestational diabetes which may develop into type-2-diabetes. The adipose tissue produces TNF-alpha, interleukins and leptin and upregulates these adipokines. Insulin resistance and obesity induce inflammatory processes and vascular dysfunction, which explains the increased rate of pregnancy-related hypertension and pre-eclampsia in obese pregnant women. Between 14 and 28 gestational weeks, the fetal adipose tissue is generated and the number of fat lobules is determined. Thereafter, an increase in adipose tissue is arranged by an enlargement of the lobules (hypertrophy), or even an increase in the number of fat cells (hyperplasia). Human and animal studies have shown that maternal obesity "programmes" the offspring for further obesity and chronic disease. Pregnant women, midwives, physicians and health care politicians should be better informed about prevention, pathophysiological mechanisms, and the burden for society caused by obesity before, during and after pregnancy.

Priority setting in Swedish health care: Are the politicians ready?

Resource allocation in public health care principally involves politicians, administrators, and physicians. They all have their different roles, agendas and ambitions when it comes to how public health care resources should be spent. Previous studies on attitudes among health-care stakeholders have mainly focused on views and preferences among clinical decision-makers, while less attention has been paid to the views of health care politicians. The study aimed to investigate if the health care politicians' views on priority setting and decision-making in health care differed from other stakeholder groups. The study was based on a questionnaire conducted among health care politicians, administrators, and physicians in four county councils in Southern Sweden. The findings show significant differences between the politicians and the other two groups in their views on health-care resources, financing, priority setting and decision-making. The findings could, at least partly, be explained by the special situation it means for the politicians to be forced to be re-elected every fourth year to stay in power.

농어촌지역 한방 외래 다빈도 상병의 의료이용 변이분석

본 연구는 의과 일부 상병에 국한된 지역간 의료이용변이 연구의 범위를 한방으로 확대하여 다양한 실증적 연구기반을 마련하고 의과 상병의 지역간 의료이용변이가 한방에서도 존재하는지, 존재한다면 그 요인은 무엇인지를 파악하여 한방 의료서비스의 합리적 이용을 위한 정책수립에 필요한 기초 자료를 제공하는데 그 목적이 있다. 2010~2011년 건강보험 자료에서 의과, 한방외래 다빈도 10대 상병을 선정하고 86개 군 지역을 대상으로 지역 간 의료이용 변이여부를 분석하였다. 분석결과 한방에서도 지역별의료이용변이가 존재하는 것으로 나타났는데 내원일당진료비는 공급자측면 보다는 수요자특성이 주요한 요인으로 작용하였고 수진자당진료비는 공급자와 수요자특성이 동시에 주요한 요인으로 작용하였다. 따라서 한방 의료서비스의 합리적 이용을 위한 의료의 과다이용과 미 충족 방지를 위해 한방 의료서비스 표준화, 한방의료 역할강화, 올바른 의료이용과 불필요한 의료행위를 줄이기 위한 정보제공 및 정보공유 확대정책이 필요하다. The objectives of this study are to identify whether the small area variation also exists in the oriental medicine and, if it exists, what causes, to expand our boundary of research interests on the small area variation observed at the western medicine toward the oriental medicine as one of the fundamental research foundations and to provide any fundamental findings from this study results to the healthcare politicians to promote consumer's rational behaviors for the use of healthcare. This study analyzed the health insurance claim data (2010, 2011) which were the patients of western medicine and the outpatients of the oriental medicine with the top 10 most frequent diseases and looked into the variation of healthcare utilization among the areas after grouping resident area into an 86-area category. The study result shows that the small area variation was also observed at the part of the oriental medicine in which the characteristics of patients critically affect the healthcare expenditure per visit day rather than those of providers and the characteristics of both patients and providers equally affect the healthcare expenditure per patient. Therefore, this study suggests that government set up healthcare policies on the standardization of oriental medicine to prevent its over-utilization and unmet need, enforcing the roles of oriental medicine in the markets, enhancing the appropriate health care utilization, and expanding provision and sharing the health care information to reduce unnecessary health care utilization.

Psychoonkologie

The relationships between the psyche and cancer are manifold. Psycho-oncology focuses on the psychological adjustment to life-threatening illnesses. Crises are not unusual in health care, but the perception of cancer is totally different because the diagnosis of cancer often results in an irrational shock reaction in all parties involved. A diagnosis of cancer is much more negatively perceived than any other incurable disease, such as cardiopathy or neuropathy with a comparable or worse prognosis. During the shock of having received a diagnosis of cancer, there is no awareness that cancer can be cured. Improvement of quality of life, identification of psychological distress and prevention of mental disorders are the main tasks of psycho-oncology. Psycho-oncological services are not longer regarded a luxury, but are recognized by health care politicians as being important. However, the financing of services remains unclear.

WAAR (World Alliance against Antibiotic Resistance): Safeguarding antibiotics

Resistance to antibiotics has increased recently to a dramatic extend, and the pipeline of new antibiotics is almost dry for the five next years. Failures happen already for trivial community acquired infections, like pyelonephritis, or peritonitis, and this is likely to increase. Difficult surgical procedures, transplants, and other immunosuppressive therapies will become far more risky. Resistance is mainly due to an excessive usage of antibiotics, in all sectors, including the animal one. Action is urgently needed. Therefore, an alliance against MDRO has been recently created, which includes health care professionals, consumers, health managers, and politicians. The document highlights the different proposed measures, and represents a strong consensus between the different professionals, including general practicionners, and veterinarians.

On a cold winter's day

Winter is here, it is cold outside. From my windows I can see that the Sound between Denmark and Sweden is covered with ice – like in the cold winter of 1658 when the Swedes used the frozen waterways to transport military troops. We were defeated and lost one third of Denmark to the Swedes. Like in those days, we did not expect a cold winter this year. Leading up to the Climate Summit in Copenhagen last December we had all expected a warm winter. Based on observational studies and extrapolations – admittedly poor evidence not higher than level 5 – we believed that the carbon dioxide we produced in recent years had changed the climate. And we thought that we would be able to control the weather by a slight change in behaviour. Did we insult the weather gods? Did we get too close to their jurisdiction? Was it Hybris to even suggest and discuss a plan for how to avoid climate changes? The answer is blowing in the cold wind. In times of uncertainty and even despair, it is nice to know that we have ACTA – the journal that publishes only scientific papers. Even if this issue of ACTA does not provide evidence that changes the World, it may give you some thoughts and ideas to come closer to an understanding of the nature of women, and the results of our care and interventions. In this issue of ACTA you will find an invitation to come to the European (EBCOG) and Nordic (NFOG) meetings this late spring. The chairman of EBCOG, Peter Hornnes, appraises the state of the current level of collaboration and harmonisation within Europe: It is too soon to have common European guidelines – they are simply unattainable. However, EBCOG wants to develop common standards – not to regulate the actual medical treatment – but to set up a framework to point out which issues we need to address and how. Examples of such standards are found in the guest comment. A European project on serious rare complications at delivery has been initiated by Marian Knight and Peter Brocklehurst from NPEU, Oxford. The project is based on reportings from delivery units in UK, who does not collect background data like the Nordic countries. In this issue of ACTA, colleagues from Italy (Stivanello et al.) report on peripartum hysterectomy and how far you can get with routine registration, without prospective collection of data in a specific project. The Nordic countries have started to collect case based data on peripartum hystertectomy, uterine rupture, placenta accreta and excessive postpartum bleeding using identical specific questionnaires – the NOSS project (www.noss.nu) – and will in this way update our knowledge on risk factors and current treatment modalities in these serious complications. We already have information on the background population and medical history and follow up in cases and controls in our medical birth registries and patient registers, which will enable us to get a more complete picture of the consequences of different attitudes towards cesarean delivery in obstetrics. In a commentary three UK researchers convey a dream that serum biomarkers may be used for a diagnosis of ectopic pregnancies in the future. Admittedly, we will need a lot of research before we have a kit – and we still need to select the women to test. Bols et al. have written an outstanding and very detailed systematic review of longitudinal studies on fecal incontinence after delivery – one of the subjects raised when we discuss mode of delivery and when we repair sphincter ruptures. They found that a third or fourth degree tear was the only factor that was associated with subsequent fecal incontinence. Now we only need good studies on how to prevent the ruptures – it seems that good Norwegian studies are on their way. Tyldum et al. in a well-defined cohort could not find any protective effect of pre-pregnancy physical activity on preeclampsia risk. This is an important message to convey to the prepregnant women who are on endorphins. The study is a good example of

Involuntary autonomy: Patients' perceptions of physicians, conventional medicines and risks in the management of atopic dermatitis☆

Consumerism is a major force in western health care. It defines the process in which patients should or do play a more active and central role in making informed choices about health and illness. The talk of patients as consumers is closely linked, and is especially pertinent for patients managing a chronic illness. This article presents findings from a Danish qualitative study that set out to broaden the sociological debate on patients as consumers by including patients' perceptions of conventional medicines. In-depth interviews were carried out with 24 people who medically managed their own or their child's atopic dermatitis. The informants were recruited via the Division of Dermatology in a Danish Hospital which was planning an Information Day on atopic dermatitis (AD). The findings reveal how many of the informants who on the surface appear to match the profile of the so called 'consumer', by being active, critical, informed etc., in fact prefer to consult a patient-centred medical expert (a dermatologist) with good communication skills, who is able to inform, advise and support on issues of managing atopic dermatitis. These people are not seeking more independence but rather a partnership where responsibility for treatment (medicines) is shared. This preference appears to be closely linked with a sense of insecurity about what an outbreak of atopic dermatitis may lead to and insecurity about the medicines. Ultimately, the findings stress that health care politicians and professionals need to reflect upon patient's wants and needs when designing future health care. Turning health care into self-care may not be an appropriate strategy.

Involuntary autonomy: Patients' perceptions of physicians, conventional medicines and risks in the management of atopic dermatitis

Consumerism is a major force in western health care. It defines the process in which patients should or do play a more active and central role in making informed choices about health and illness. The talk of patients as consumers is closely linked, and is especially pertinent for patients managing a chronic illness. This article presents findings from a Danish qualitative study that set out to broaden the sociological debate on patients as consumers by including patients' perceptions of conventional medicines. In-depth interviews were carried out with 24 people who medically managed their own or their child's atopic dermatitis. The informants were recruited via the Division of Dermatology in a Danish Hospital which was planning an Information Day on atopic dermatitis (AD). The findings reveal how many of the informants who on the surface appear to match the profile of the so called 'consumer', by being active, critical, informed etc., in fact prefer to consult a patient-centred medical expert (a dermatologist) with good communication skills, who is able to inform, advise and support on issues of managing atopic dermatitis. These people are not seeking more independence but rather a partnership where responsibility for treatment (medicines) is shared. This preference appears to be closely linked with a sense of insecurity about what an outbreak of atopic dermatitis may lead to and insecurity about the medicines. Ultimately, the findings stress that health care politicians and professionals need to reflect upon patient's wants and needs when designing future health care. Turning health care into self-care may not be an appropriate strategy.

Kids on kids' health: Creating a child health magazine with students from an urban, multicultural, low-income elementary school

Kids on kids' health: Creating a child health magazine with students from an urban, multicultural, low-income elementary school

The views of physicians and politicians concerning age‐related prioritisation in healthcare

The aim of this study is to describe the view of age-related prioritisation in health care among physicians and healthcare politicians and to compare their views regarding gender and age. Swedish physicians (n=390) and politicians (n=310), mean age 52 years, answered an electronic questionnaire concerning age-related priority setting in healthcare. The questionnaire had fixed response alternatives with possibility of adding comments. A majority of the participants thought that age should not influence prioritisation, although more physicians than politicians thought that younger patients should be prioritised. There were also significant differences concerning their views on lifestyle-related diseases and on who should make decisions concerning both vertical and horizontal prioritisation. The comments indicated that the politicians referred to ethical principles as a basis for their standpoints while the physicians often referred to the importance of biological rather than chronological age. Web-based surveys as a method has its limitations as biased samples and biased returns could cause major problems, such as limited control over the drop-outs. The sample in this study was, however, judged to be representative. The results indicate that supplementary guiding principles concerning prioritisation in healthcare are needed in order to facilitate decision-making concerning resource allocation on a local level. This paper adds important knowledge about decision makers' views on age-related priorities in healthcare, thus contributing to scientific base for prioritisation in healthcare and the ongoing debate in society.

Assessment of the clinical and economic outcomes of pharmacy interventions in drug-related problems

Due to drug-related problems (DRPs) that cause both unnecessary suffering and huge costs to society, many patients do not receive the intended beneficial effects of their treatment. Pharmacy practitioners have a key responsibility to respond to these problems, but more knowledge about the expected outcomes of their interventions is needed. The objective of the study was to assess the clinical and economic outcomes of community pharmacy interventions in patient DRPs. Drug-related problems in 13 different patient groups were identified and classified, according to the Westerlund System, by pharmacy practitioners from 89 Swedish pharmacies in 2006. The cases were documented in the pharmacy software and transferred to the national DRP database. An assessment model was developed and applied by the researchers (a pharmacist and a physician). This assessment was used to conduct a retrospective review by analysing the DRP and intervention documentation, in particular case descriptions from free text fields. Expected clinical patient outcomes of pharmacy interventions were judged in terms of improved therapeutic effects and prevented or relieved adverse drug reactions (ADRs). The review also assessed the expected patient outcomes with regard to initiated or avoided primary care contacts or avoided hospitalisations. The resulting hypothetically avoided direct societal costs and the estimated pharmacy personnel costs were calculated for the study and extrapolated to the Swedish nationwide level on an annual basis, to demonstrate the potential of national cost savings by pharmacy DRP-interventions. In 358 cases (68%), the pharmacy interventions were judged to have produced an improved therapeutic effect in the patient, and in 172 cases (32%) to have prevented or relieved ADRs. Primary care contacts were initiated for 151 patients (29%), and pharmacy interventions were assessed to have saved 68 (13%) primary care contacts and 16 (3%) future hospitalisations. The potential societal cost savings extrapolated to Sweden at the national level were estimated at euro 358 million. This is 37 times the expected pharmacy personnel costs for identifying and responding to the DRPs. Our study demonstrates that community pharmacy interventions in patient DRPs are most likely to lead to favourable clinical and economic outcomes. The convincing cost-benefit ratio should be presented to health care politicians and decision makers to encourage appropriate remuneration for these services.

Vergleichende Bewertung von Gesundheitsleistungen durch Laien am Beispiel der Therapie des Rektumkarzinoms

Multimodal treatment strategies make the assessment of health care services very difficult even for experts and almost impossible for lay persons. The aim of this project was to present complex data from scientific publications in a simplified way so that all essential information is preserved, but still assessable by lay persons and to compare their assessments with the recommendations of experts. Using the surgical treatment of rectal cancer with or without preoperative radiation as an example, the aims of treatment as well as the "outcomes" (actually intended study endpoints) and "outputs" (surrogate parameters) were defined, identified and presented graphically for five key studies of neoadjuvant treatment. German lay persons (n = 59) favoured in the majority of the cases (93 %) surgical treatment without preoperative radiation. Lay persons assessed the results in a similar manner to other groups (physicians, health care workers, and health care politicians) and lay persons of other cultural backgrounds. Altogether, the participants (n = 152) favoured surgical treatment without preoperative therapy in 86 % of the cases (653 of 760). This lay assessment did not correlate with the assessments and recommendations of the scientific societies responsible for the guidelines. Complex scientific results can be prepared in such a way that their assessment by lay persons is feasible. Lay persons orientate their assessment according to the outcomes, while the recommendations of the guidelines are more directed by the outputs. These different viewpoints should be taken more into consideration for the development of guidelines than they are now.

Vergleichende Bewertung von Gesundheitsleistungen durch Laien am Beispiel der Therapie des Rektumkarzinoms

Ziel der Untersuchung: Multimodale Therapiekonzepte machen die Bewertung von Gesundheitsleistungen selbst für Experten immer schwieriger und für Laien nahezu unmöglich. Ziel dieses Projektes war zu klären, ob Patienten bei komplexen Problemen ähnlich wie Experten entscheiden. Dazu waren komplexe Daten aus wissenschaftlichen Publikationen so vereinfacht darzustellen, dass zwar alle wesentlichen Informationen enthalten blieben, diese aber von Laien bewertet werden konnten. Basismethodik: Am Beispiel der operativen Therapie des Rektumkarzinoms mit und ohne Vorbestrahlung wurden die Ziele der Therapie, nämlich die „Outcomes” (tatsächlich angestrebte Endpunkte) und „Outputs” (Surrogat- oder Stellvertreter-Parameter) definiert, identifiziert und grafisch für fünf Schlüsselstudien zur neoadjuvanten Therapie dargestellt. Ergebnisse: Deutsche Laien (n = 59) bevorzugten in der Mehrzahl (93 ) die Operation ohne Vorbestrahlung. Laien bewerteten die Ergebnisse jedoch ähnlich wie andere befragte Gruppen (Mediziner, Gesundheitsnetzwerker, Gesundheitspolitiker) und Laien aus einem anderen Kulturkreis. Alle Befragten (n = 152) entschieden sich in 86 der Fälle (653 von 760) für die Operation ohne Vorbestrahlung. Die Bewertung der Laien stimmte mit den Empfehlungen der wissenschaftlichen Fachgesellschaften und der Leitlinien nicht überein. Schlussfolgerungen: Komplexe wissenschaftliche Daten können so aufbereitet werden, dass deren Bewertung durch Laien möglich ist. Laien scheinen ihre Bewertung an den „Outcomes” zu orientieren, während sich die Empfehlungen in den Leitlinien mehr an „Outputs” orientieren. Diese unterschiedlichen Sichtweisen sollten bei der Gestaltung von Leitlinien mehr als bisher berücksichtigt werden.

Public dialogue on healthcare prioritisation

The Swedish public healthcare sector is administered by county councils or regions with their own power of taxation. These authorities are facing difficult times as the gap between demand and healthcare resources is widening and the option to further increase county council taxes is not politically tempting. It is becoming ever more apparent that, sooner or later, limits to the public healthcare commitment must be set. In the north-western district of Region Skåne, the district board determined to initiate a public dialogue on prioritisation with local residents. Annual surveys were sent to 1% of the population (∼2500 individuals) during the period 2002–2004. The addressees were also asked if they wanted to participate in public meetings with the healthcare politicians. This study investigates what happened to the preferences and attitudes of the interest group when the participants were not only offered an opportunity to enter into a dialogue with their peers and representatives, but also received information on prioritisation matters. After the intervention, which consisted of two public meetings with politicians and five information booklets on prioritisation issues, the study group was asked to participate in a second survey. At the follow-up, 20% fewer thought that one should always have a right to public healthcare, even if troubles were trivial. Eighty four percent in the study group thought that the general public should participate in prioritisation discussions while only 64% in the control group agreed to this. Eighty two percent of the study group marked the dialogue project “good” or “very good”. The results indicate an increased acceptance for reallocations, a strengthened will to participate and more confidence in the politicians and their work. The study is descriptive and designed to make long-term follow-ups possible.