PubMed Health⌕ Search

Biomedical subjects

Knut Lönnroth

Publications and source records attributed to Knut Lönnroth.

14 recordsLinked to original sources
PubMed2006

Turning liabilities into resources: informal village doctors and tuberculosis control in Bangladesh.

In 1998, the Damien Foundation Bangladesh invited semi-qualified, private "gram dakter" (Bangla for "village doctors") to participate in tuberculosis (TB) programmes in a population of 26 million people in rural Bangladesh. The organization trained 12 525 village doctors to not only refer suspected TB cases for free diagnosis but also to provide directly observed treatment (DOT) free of charge. Source of referral and place of DOT was recorded as part of the standardized TB recording and reporting system, which enabled us to quantify the contribution of village doctors to case detection rates and also allowed disaggregated cohort analysis of treatment outcome. During 2002 and 2003, 11% of all TB cases with positive sputum smears in the study area had been referred by village doctors; the rate of positive tests in patients referred by village doctors was 14.4%. 18 792 patients received DOT from village doctors, accounting for between 20% and 45% of patients on treatment during the 1998-2003 period. The treatment success rate was about 90% throughout the period. Urine samples taken during random checks of treatment compliance were positive for isoniazid in 98% of patients treated by village doctors. Within the framework of Public-Private Mix DOTS, services provided by semi-qualified private health care providers are a feasible and effective way to improve access to affordable high quality TB treatment in poor rural populations. The large informal health workforce that exists in resource poor countries can be used to achieve public health goals. Involvement of village doctors in TB control has now become national policy in Bangladesh.

Bangladesh↗
PubMed2006

Do policy changes in the pharmaceutical reimbursement schedule affect drug expenditures? Interrupted time series analysis of cost, volume and cost per volume trends in Sweden 1986-2002.

The last decades increasing pharmaceutical expenditures in Sweden and other western countries have created a need for reforms to reduce the trend. The aim was to analyse if reforms concerning the pharmaceutical reimbursement scheme in Sweden during the years 1986-2002 were associated with changes in cost, volume and cost per volume of pharmaceuticals. Effects of changes in the reimbursement schedule during the study period were evaluated for all registered pharmaceuticals in Sweden and for five indicator drug groups. Five policy changes during the study period were assessed. Three concerned increased patient co-payment (January 1, 1991; January 1, 1995 and June 1, 1999), one the introduction of reference based pricing and increased co-payment (January 1, 1993) and one a new structure of the reimbursement schedule (January 1, 1997). The National Corporation of Swedish Pharmacies provided pharmaceutical delivery data for all Swedish pharmacies. Possible breaks in the trend associated with the investigated reforms were analysed with linear segmented regression analysis. This showed that increased co-payments were not associated with changed level or slope of cost and volume. The new reimbursement schedule was associated with a decreased level of cost and volume, both for all drugs combined and for several of the indicator drug groups. It was also associated with an increased slope for both volume and cost in some indicator drug groups and for all drugs. Introduction of reference based pricing was associated with a reduced slope of cost/defined daily doses (DDD) in all of the indicator drug groups and for all drugs. The analysis showed that major changes in the reimbursement system such as the introduction of a new reimbursement schedule and reference based pricing were associated with reductions in cost and volume for the new reimbursement schedule and cost per volume for reference based pricing.

Drug Costs↗
PubMed2006

Hard gains through soft contracts: productive engagement of private providers in tuberculosis control.

Over the past decade, there has been a rapid increase in the number of initiatives involving "for-profit" private health care providers in national tuberculosis (TB) control efforts. We reviewed 15 such initiatives with respect to contractual arrangements, quality of care and success achieved in TB control. In seven initiatives, the National TB Programme (NTP) interacted directly with for-profit providers; while in the remaining eight, the NTP collaborated with for-profit providers through intermediary not-for-profit nongovernmental organizations. All but one of the initiatives used relational "drugs-for-performance contracts" to engage for-profit providers, i.e. drugs were provided free of charge by the NTP emphasizing that providers dispense them free of charge to patients and follow national guidelines for diagnosis and treatment. We found that 90% (range 61-96%) of new smear-positive pulmonary TB cases were successfully treated across all initiatives and TB case detection rates increased between 10% and 36%. We conclude that for-profit providers can be effectively involved in TB control through informal, but well defined drugs-for-performance contracts. The contracting party should be able to reach a common understanding concerning goals and role division with for-profit providers and monitor them for content and quality. Relational drugs-for-performance contracts minimize the need for handling the legal and financial aspects of classical contracting. We opine that further analysis is required to assess if such "soft" contracts are sufficient to scale up private for-profit provider involvement in TB control and other priority health interventions.

Antitubercular Agents↗
PubMed2006

Effects of co-financed interdisciplinary teamwork on sick leave for people with musculoskeletal disorders.

AIMS: The aim of the study was to assess if health care centres with a co-financing model for collaborative rehabilitation between primary health care, sickness insurance offices and social welfare offices reduced sick leave among persons with musculoskeletal disorders compared to health centres with conventional rehabilitation structures. METHOD: A comparative prospective study was conducted. Consecutive patients aged 16-64 with musculoskeletal disorders attending the health care centres with (n=107) and without (n=31) co-financing model were interviewed. In addition, we collected register data about patients' allowances for sick leave days for totally 18 months. RESULTS: The intervention group had an average of 94 days and the controls 87 days on sick leave during the 12-months period after inclusion in the study. At 12 months the proportion of patients sick listed was 31% in the intervention group and 32% in the control group. CONCLUSION: The study could not show that the co-financing model reduced the numbers of sick leave days among patients with musculoskeletal disorders. A possible explanation for the lack of positive impact on patients' health or work ability might be that the working procedure has in fact not really been changed and the tool mix lack solid evidence. The study identifies some methodological problems addressed in future research trying to link organisational changes with patient outcomes.

Adolescent↗
PubMed2005

What are the obstacles to generic substitution? An assessment of the behaviour of prescribers, patients and pharmacies during the first year of generic substitution in Sweden.

PURPOSE: The aim of the present study was to investigate obstacles to generic substitution and savings achieved during the first year after Sweden introduced generic substitution in October 2002. METHODS: Normal prescriptions encompassed by generic substitution were included. Data on dispensed prescriptions in the Vastra Gotaland region was obtained from the National Corporation of Swedish Pharmacies. The outcome variables were investigated in three categories of drugs represented by two indicator drugs each. RESULTS: In total, 501,400 dispensed prescriptions of six indicator drugs were analysed. The prescriber opposed substitution in 1-8% of the dispensed prescriptions, varying between the indicator drugs. Patients declined substitution more frequently when the average saving per substitution was low. Substitution occurred most frequently in indicator drugs where the average saving per substitution was high. The total possible saving was 26 million Swedish krona (Swedish krona 1=U.S. $0.13) for the indicator drugs. The actual saving achieved by substitution was on average 60% of the total possible savings and was largely dependent on the extent to which the pharmacies kept the cheapest brand in stock. CONCLUSIONS: Generic substitution has been implemented in practice although it did not reach full dividend during the first year. The potential savings from extended use of generic substitution are substantial.

Choice Behavior↗
PubMed2005

Interdisciplinary collaboration between primary care, social insurance and social services in the rehabilitation of people with musculoskeletal disorder: effects on self-rated health and physical performance.

Previous research shows there can be good results from co-financing between welfare sectors on the perceived quality of interprofessional collaboration. However, little is known about the impact on patient outcome of such schemes. This study aimed to assess whether co-financed teams with personnel from primary care, social insurance and social services have any effect on patients' health status. A comparative study of patients attending health care centres with and without a co-financed collaboration model was carried out. Although research has shown positive results from co-financed collaboration on staff and organization, we could not find that this new interdisciplinary team structure gave a better patient health outcome than conventional care.

Adolescent↗
PubMed2005

Using pooled budgets to integrate health and welfare services: a comparison of experiments in England and Sweden.

The lack of collaboration between health, social and other welfare services is believed to impair efficiency and reduce effectiveness in addressing the complex problems of patients. Differences in funding streams, political accountabilities, organisational structures and professional cultures are all alleged to contribute to barriers between services. Drawing on their respective evaluations, this paper describes experiments in England and Sweden that use pooled budgets between services to improve interagency and interprofessional collaboration and presents evidence on their impact. Despite differences in the funding and organisation of health and welfare services in each country, some similar conclusions are reached. Among senior managers and politicians, budget pooling broadened their awareness of interdependencies with other agencies and professionals in promoting patients' welfare. However, these broadened perspectives were not immediately shared by professionals working at the front line, with whom patients had immediate contact. Moreover, neither experiment yielded unequivocal evidence of improved cost-effectiveness or of the benefits of budget pooling on the outcomes for service users. These experiments also raise questions about the equity and accountability of welfare services because in both countries only a limited range of services has been integrated under the umbrella of the pooled budgets.

Budgets↗
PubMed2004

Public-private mix for DOTS implementation: what makes it work?

OBJECTIVE: To compare processes and outcomes of four public-private mix (PPM) projects on DOTS implementation for tuberculosis (TB) control in New Delhi, India; Ho Chi Minh City, Viet Nam; Nairobi, Kenya; and Pune, India. METHODS: Cross-project analysis of secondary data from separate project evaluations was used. Differences among PPM project sites in impact on TB control (change in case detection, treatment outcomes and equity in access) were correlated with differences in chosen intervention strategies and structural conditions. FINDINGS: The analysis suggests that an effective intervention package should include the following provider-side components: (1) orienting private providers (PPs) and the staff of the national TB programme (NTP); (2) improving the referral and information system through simple practical tools; (3) the NTP adequately supervising and monitoring PPs; and (4) the NTP providing free anti-TB drugs to patients treated in the private sector. CONCLUSION: Getting such an intervention package to work requires that the NTP be strongly committed to supporting, supervising and evaluating PPM projects. Further, using a local nongovernmental organization or a medical association as an intermediary may facilitate collaboration. Investing time and effort to ensure that sufficient dialogue takes place among all stakeholders is important to help build trust and achieve a high level of agreement.

Communicable Disease Control↗
PubMed2004

Spatial pattern of private health care provision in Ujjain, India: a provider survey processed and analysed with a Geographical Information System.

In developing countries like India, official information on private health care providers is scanty. This is an obstacle for effective health care planning and policy development. In this paper, we present a project aimed to enumerate, characterise and digitally map all private providers (PPs) using Geographical Information System (GIS) in a rural district in India. A team of surveyors carried out a census of private providers in the district. This data was combined with official data on geophysical characteristics and infrastructure, demographic situation and location of settlements and public health care providers. This study highlights the need to consider PPs in health policy making in India. The survey identified about 2000 additional PPs over and above those listed with the health authorities. About half practised modern medicine (Allopathy) while the rest practised other types of formal medical systems (Ayurveda or Homeopathy) or informal therapeutic systems. Individuals with no formal health care training constituted the majority of PPs. Formally trained doctors were highly concentrated in urban areas while trained non-doctors and untrained PPs dominated in the rural areas. The study shows how GIS can be used to create an improved basis for health services research. In the future, the digitised map will be used as a sampling frame and point of reference for studies on quality and utilisation of PPs in Ujjain district. However, the utility for health care planning is less clear. GIS has limitations in countries like India due to lack of valid routine data to enter into GIS as well as to competing demand for health care resources.

Data Collection↗
PubMed2003

Co-financing as a means to improve collaboration between primary health care, social insurance and social service in Sweden. A qualitative study of collaboration experiences among rehabilitation partners.

Collaboration between services has often been suggested as a means to increase effectiveness and reduce costs especially in the care and rehabilitation of long-term illness. In Sweden, a special legislation named SOCSAM was introduced in 1994, enabling financial collaboration between governmental and municipal authorities. In this paper we report on a qualitative study on collaboration around patients with musculoskeletal diseases. The aim of the study was to assess differences in goal formulation, collaboration and communication between staff in intervention health centres that have implemented co-financing projects and health centres working under conventional conditions. Focus group interviews were performed with staff at intervention and control health care centres. We found that the interdisciplinary collaboration had improved in the intervention health care centres compared to the controls. Our findings suggest that co-financing can enhance development of better forms of interdisciplinary and interorganisational collaboration through legitimising formulation of common long-term goals, while emphasising mutual benefits.

Cooperative Behavior↗
PubMed2002

Evaluation of the effect of co-financing on collaboration between health care, social services and social insurance in Sweden.

In this paper, we present an ongoing research project aimed to determine the impact of co-financing on collaboration around patients with musculoskeletal disorders. A trial legislation that allows the social insurance, social services and health care services to unite in co-financing under joint political steering has been tested in different areas in Sweden. In a series of studies, we compare collaboration processes and health outcome for patients with musculoskeletal disorders between health centres with co-financing projects and control health centres without co-financing projects. In this paper the studies are described and some preliminary results are discussed.

Journal Article↗
PubMed2002

[Reporting of side-effects--a system in need of improvement. Reporting of a physician questionnaire].

The spontaneous reporting system in Sweden is based on reporting by health care professionals of adverse drug reactions (ADRs) to the Medical Products Agency. The usefulness of the spontaneous reporting system is limited by a substantial degree of underreporting. In order to study factors that make reporting of ADRs difficult as well as to obtain responses to suggestions that could increase the reporting of ADRs, an enquiry was sent to 300 randomly selected physicians. The most important factors that make reporting of ADRs more difficult are lack of time and forgetfulness. Most physicians stated that they would report ADRs to a greater extent if reporting was simpler, if resources were available or if the response to the reporting was improved. The majority of the physicians who had a computer at work stated that they would like to access the reporting form electronically.

Adverse Drug Reaction Reporting Systems↗