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Biomedical subjects

Dag Bratlid

Publications and source records attributed to Dag Bratlid.

13 recordsLinked to original sources
PubMed2006

Lack of patients? A hypothesis for understanding discrepancies between hospital resources and productivity.

BACKGROUND: Despite a substantial increase in hospital resources, increased hospital admissions and out-patient visits, long waiting lists have been a significant problem in Norwegian health care. A detailed analysis of the development in resource allocation and productivity at St. Olavs University Hospital in central Norway was therefore undertaken. METHODS: Resource allocation and patient volume was analysed during the period 1995 to 2001. Data were analysed both for emergency and elective admissions as well as outpatient visits specified into new referrals and follow-up consultations. RESULTS: Full time employee equivalents for doctors and nurses increased by 36.6% and 25.9%, respectively, and all employees by 28.1%. However, admitted patients, outpatient consultations and surgical procedures only increased by 10%, 15% and 8.3%, respectively. Thus, the productivity for each hospital employee, defined as operations pr. surgeon, outpatient consultations pr. doctor etc. was significantly reduced. A striking finding was that although the number of outpatient consultations increased, the number of new referrals actually went down and the whole increase in activity at the outpatient clinics could be explained by a substantial increase in follow-up consultations. This trend was more evident in the surgical departments, where some departments actually showed a reduction in total outpatient consultations. CONCLUSION: In view of the slow increase in hospital activity in spite of a significant increase in resources, it can be speculated that patient volume might be a limiting factor for hospital activity. The health market (patient population) might not be big enough in relation to the investments in increased production capacity (equipment and manpower).

Efficiency, Organizational↗
PubMed2005

[Are children getting the right drugs?].

In recent years there has been increased attention to the fact that pharmacotherapy in children does not have the same evidence based platform as in adults. This is mainly due to the fact that most drugs being developed are only studied in adults before they are approved, both because of practical and technical difficulties in doing research on (small) children as well as ethical considerations on the inclusion of children in the testing of a new drug. Furthermore, the pharmaceutical industry has also not been very interested in developing drugs specifically for children. In 1998 the American Food and Drug Administration (FDA) established that studies in children should also be included in the development of new drugs. This was legally formalised by Congress in the Best Pharmaceuticals for Children Act (BPCA) in 2002. This has resulted in a re-evaluation of several drugs primarily developed for adults but frequently used in children. So far the FDA has changed the product information for 87 drugs, 17 drugs have been given new dosage recommendations for children, for 21 drugs the description of side effects have been changed, and 11 drugs are no longer recommended for use in children because of lack of any demonstrable effect. There has also been increased focus on better drug formulations for children. Also in Europe the need for better and safer drugs for children is given attention. The European Commission has submitted a proposal for a legal approach to the problem similar to the BPCA legislation in USA, which will probably be approved by the EU parliament and take effect in 2006. Furthermore, there is a strong commitment to establish co-operation between the pharmaceutical industry and paediatric and pharmacological networks in order to increase and facilitate drug studies in children. The European Medicines Agency will have a central role in this work by developing lists of drugs for which paediatric studies are needed and prevent unnecessary competition and duplication of studies.

Adult↗
PubMed2005

[National health resources for highly specialised medicine].

BACKGROUND: In order to monitor quality and efficiency in the use of health resources for highly specialised medicine, a National Professional Council has since 1990 advised the Norwegian health authorities on the establishing and localisation of such services. MATERIALS AND METHOD: A comprehensive review of both the quality, economy and the geographical distribution of patients in each specialised service has been carried out. RESULTS: 33 defined national programmes were centralised to one hospital only and distributed among seven university hospitals. Eight multiregional programmes were centralised to two hospitals only and included four university hospitals. In 2001, a total of 2711 new patients were treated in these programmes. The system seems to have secured a sufficient patient flow to each programme so as to maintain quality. However, a geographically skewed distribution of patients was noted, particularly in some of the national programmes. INTERPRETATION: In a small country like Norway, with 4.5 million inhabitants, a centralised monitoring of highly specialised medicine seems both rational and successful. By the same logic, however, international cooperation should probably be sought for the smallest patient groups.

Centralized Hospital Services↗
PubMed2005

[Medical monopolies--a choice between quality and equality?].

BACKGROUND: The highly specialised medical services in Norway consist of 33 monopolies and 8 bipolies, involving both a duty of referral and a duty of admittance for defined patient groups. All the specialised services are located to large hospitals in southern Norway. MATERIAL: In conjunction with a thorough review of the specialised services, the geographical distribution of the 2711 patients treated in 2001 was analysed. RESULTS: The geographical distribution was highly skewed, with a decreasing coverage with increasing distances from the monopoly centres. The ratio between the county with the most and the one with the least use of the services was 2.3. Northern Norway had a significantly lower usage. INTERPRETATION: Monopolies seem to have an inherent tendency to give poor distribution of health care. Medical monopolies seem to have many of the negative effects associated with economic monopolies. A cautious attitude towards new and a rigid control of old monopolies is recommended. Equality of access to services should be maintained as a primary goal in public health care systems.

Centralized Hospital Services↗
PubMed2004

Hospitalisations for respiratory syncytial virus bronchiolitis in Akershus, Norway, 1993-2000: a population-based retrospective study.

BACKGROUND: RSV is recognized as the most important cause of serious lower respiratory tract illness in infants and young children worldwide leading to hospitalisation in a great number of cases, especially in certain high-risk groups. The aims of the present study were to identify risk groups, outcome and incidences of hospitalisation for RSV bronchiolitis in Norwegian children under two years of age and to compare the results with other studies. METHODS: We performed a population-based retrospective survey for the period 1993-2000 in children under two years of age hospitalised for RSV bronchiolitis. RESULTS: 822 admissions from 764 patients were identified, 93% had one hospitalisation, while 7% had two or more hospitalisations. Mean annual hospitalisation incidences were 21.7 per 1.000 children under one year of age, 6.8 per 1.000 children at 1-2 years of age and 14.1 per 1.000 children under two years of age. 77 children (85 admissions) belonged to one or more high-risk groups such as preterm birth, trisomy 21 and congenital heart disease. For preterm children under one year of age, at 1-2 years of age and under two years of age hospitalisation incidences per 1.000 children were 23.5, 8.7 and 16.2 respectively. The incidence for children under two years of age with trisomy 21 was 153.8 per 1.000 children. CONCLUSION: While the overall hospitalisation incidences and outcome of RSV bronchiolitis were in agreement with other studies, hospitalisation incidences for preterm children were lower than in many other studies. Age on admission for preterm children, when corrected for prematurity, was comparable to low-risk children. Length of hospitalisation and morbidity was high in both preterm children, children with a congenital heart disease and in children with trisomy 21, the last group being at particular high risk for severe disease.

Bronchiolitis, Viral↗
PubMed2004

[Withdrawal of treatment in severely ill newborn infants].

BACKGROUND: Improvements in diagnostics and treatment in perinatal medicine have enabled us to save more premature and critically ill infants and infants born with severe congenital anomalies. However, some of these children often develop complications with a poor prognosis both for survival and quality of life. An active decision to withdraw treatment is common practice in such cases. Little is known about the impact of this problem in neonatal care in Norway. MATERIAL AND METHODS: The records of 178 infants admitted as newborns and who died in our hospital during the period 1990-1999 were reviewed and analysed according to these groups: death in spite of full treatment, death because of active withdrawal of treatment, and death after palliative treatment. We also evaluated to what extent the parents were involved in the decision making process and how that process was documented in patient records. RESULTS: Death after withdrawal of treatment was identified in 65% of the cases and was mainly seen in critically ill immature and premature infants (74%). The parents were usually involved in the decision, though documentation in patient records of the decision making process was generally poor. The ethical, legal and practical implications of this state of affairs probably need to be reviewed.

Congenital Abnormalities↗
PubMed2003

[Waiting list situation at a regional hospital].

BACKGROUND: In Norway, waiting lists generated by the national VENTSYS system are used for hospital management and resource allocation. MATERIALS AND METHODS: Data were obtained from monthly reports from VENTSYS and the hospital's annual reports. General development in waiting parameters was analysed for the period 1997-2002. The number of patients waiting in January 2002 was compared to the total number of treated patients in 2001 (capacity). RESULTS: Waiting list numbers were stable. The number of patients on the lists corresponded to only 8% of patients treated. There was no correlation between capacity and number of patients on waiting lists for more than twelve months, or between capacity and average length of time on a list. Only a few departments had waiting lists corresponding to more than a few months' throughput. INTERPRETATION: Long waiting lists and waiting time are better explained by poor patient logistics and booking systems than by lack of resources.

Hospitals, District↗
PubMed2002

[Nurses on strike, waiting lists and waiting time at a regional hospital].

BACKGROUND: From 22 January to 6 March 2002, Norwegian hospitals were struck by the longest strike among nurses ever. The strike strategy was aimed at creating the least possible effect on patient treatment by mainly including nurses in administrative positions and in outpatient departments. However, several reports of increasing numbers of patients in line for treatment and of operations cancelled caused the minister of health to finally order the nurses back to work. MATERIAL AND METHODS: To get a more comprehensive view on the effect of the strike, patients in line for treatment at St. Olavs Hospital, a large regional university hospital, were analysed for the months January and February. RESULTS: Surprisingly, no major negative effects on the volume of treated patients and on the number of patients waiting for treatment were found. In fact, the total number of patients in line for treatment as well as the number of patients waiting more than 12 months were reduced during the strike. The mean waiting time for treatment was also reduced. INTERPRETATION: A limited strike may improve the selection of patients with high priority. Furthermore, the yearly summer vacation in hospitals, that also includes doctors, probably represents a larger health threat to patients than a limited and well planned strike among one single health profession.

Hospital Departments↗
PubMed2002

[Patient referral and patient volume in a regional hospital].

BACKGROUND: A general trend in health care is the increasing discrepancy between resources available and the volume of patients treated. Few studies have looked at a reduction in patient referral as a possible explanation for this situation. MATERIAL AND METHODS: The volume of hospital admissions and outpatient care 1996 through 2000 at a large regional hospital was related to the number of referrals over the same period. RESULTS: There was an overall increase in patient admissions as well as in outpatient care during the study period. However, while the number of new referrals seen as outpatients dropped by 1.2%, the number of patients in for controls increased by 27.1%. While some departments had an increase in both admissions and new outpatients, other departments had a dramatic decrease in new patient contacts but total patient volume was maintained by a comparable increase in control consultations. At the same time, there was a 15.1% overall drop in new patient referrals (new referrals for admissions down 44.4%, new referrals for outpatient care down 11.4%), in some departments even more. INTERPRETATION: The study shows that patient demand for hospital care is not unlimited and should also be considered when more resources allocated to hospitals do not result in increased patient volume.

Bed Occupancy↗