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Biomedical subjects

Lars Borgquist

Publications and source records attributed to Lars Borgquist.

13 recordsLinked to original sources
PubMed2006

Prognosis assessment in stroke patients at discharge from hospital.

BACKGROUND: accurate prognostic assessments of need of help, health and dwelling situation in stroke patients are important for patient management, rehabilitation, discharge planning, and for providing reliable information to patients and their relatives. OBJECTIVE: to analyse factors affecting the accuracy of discharge prognosis assessments. DESIGN: prospective study of stroke patients discharged from hospital. SETTING: two cities in central Sweden. SUBJECTS: three hundred and ninety stroke patients, 65 years or older, living in their own homes and having no dementia diagnosis prior to hospital admission. METHODS: at discharge, physicians, nurses, occupational therapists and physiotherapists in the Departments of Internal Medicine and Geriatrics were asked to make an individual prognosis assessment regarding patients' need for help, health and dwelling situation at 3 and 12 months after admission to hospital. RESULTS: the prognosis assessments were on average accurate in 68.4% (3 months) and 61.5% (12 months), far better than chance (33.3%). There were no significant differences between staff categories. The accuracy was influenced by a number of patient linked factors, such as activity degree, household situation before admission, and Mini Mental State Examination level and need of help measured 1 week after discharge, and ranged from 22 to 89%, depending on factor combinations. CONCLUSIONS: prognosis assessments based on clinical judgement were on average quite accurate but the accuracy varied markedly with patient linked factors. Feedback of outcome might be one way to further improve the accuracy of prognosis assessment.

Activities of Daily Living↗
PubMed2005

Influence of local structural factors on physicians' sick-listing practice: a population-based study.

BACKGROUND: Physicians have a central role as gatekeepers to the social security system, including sick-listing. Variation in physicians' sick-listing practices has been demonstrated in several studies. The objective of this study was to determine whether local structural factors affect sick-listing practice. METHODS: A total of 57,563 consecutive sick-listing certificates, issued during 4 months in 1995 and 2 months in 1996, were collected from the local branches of the National Social Insurance Office in eight Swedish counties. County code, local community population size and presence of a hospital in the area were used as indicators of local structural factors. Length of the sick-listing certificates and of the sick-listing episodes were used as outcome variables. RESULTS: After adjustment for the influence of category of issuing physician, patients' age, sex and diagnosis ('case mix'), and type of certificate there was a large variation of the length of the sick-listing certificates and of the sick-listing episodes between counties, between communities of various size and between communities with or without a hospital in the area. All these factors were independently and significantly correlated to the length of the certificate and of the sick-listing episode. CONCLUSIONS: The results support the hypothesis that physicians' sick-listing practice is influenced by local structural factors.

Adolescent↗
PubMed2005

Caring externalities in health economic evaluation: how are they related to severity of illness?

In health economic evaluations, altruistic preferences in the form of caring externalities, i.e. that people care about others' health, is usually not taken into account. In this study we examined how people value their own and others' health. This pilot study was carried out by letting people answer willingness to pay (WTP) questionnaires where internal WTP (own health) and altruistic WTP (others' health) were isolated and examined. A common method used in health economic evaluations is cost-utility analysis, which is based on the maximisation of QALYs. QALY maximisation may be appropriate if altruistic preferences are non-existent or if they are linear in relation to internal preferences (QALYs gained). We found evidence for the existence of altruistic preferences and that these preferences were relatively higher for severe health states (and lower for mild states of health) compared to internal preferences, i.e. when severity of illness increased, the relative increase in caring was higher concerning others than oneself. The difference was statistically significant (P<0.001). Our results indicate that more attention and resources should be directed to severe health states, as compared to mild health states, than advocated by internal preferences in order to obtain more efficient resource allocation in the health care sector.

Adult↗
PubMed2005

Cost of heart failure in Swedish primary healthcare.

OBJECTIVES: To calculate the cost for patients with heart failure (HF) in a primary healthcare setting. DESIGN: Retrospective study of all available patient data during a period of one year. SETTING: Two healthcare centers in Linköping in the southeastern region of Sweden, covering a population of 19 400 inhabitants. SUBJECTS: A total of 115 patients with a diagnosis of HF. MAIN OUTCOME MEASURES: The healthcare costs for patients with HF and the healthcare utilization concerning hospital days and visits to doctors and nurses in hospital care and primary healthcare. RESULTS: The mean annual cost for a patient with HF was SEK 37 100. There were no significant differences in cost between gender, age, New York Heart Association functional class, and cardiac function. The distribution of cost was 47% for hospital care, 22% for primary healthcare, 18% for medication, 5% for nursing home, and 6% for examinations. CONCLUSION: Hospital care accounts for the largest cost but the cost in primary healthcare is larger than previously shown. The total annual cost for patients with HF in Sweden is in the range of SEK 5.0-6.7 billion according to this calculation, which is higher than previously known.

Aged↗
PubMed2004

A cost analysis of three methods of treating femoral shaft fractures in children: a comparison of traction in hospital, traction in hospital/home and external fixation.

INTRODUCTION: There is no consensus as to which is best treatment of femoral fractures in children. PATIENTS AND METHODS: We performed a cost analysis comparing three treatments of femoral shaft fractures in children aged 3-15 years at 3 hospitals during the same period (1993-2000). The analysis included total medical costs and costs for the care provider and were calculated from the time of injury up to 1 year. RESULTS: At hospital 1, treatment consisted of external fixation and early mobilization. At hospital 2, the treatment was skin or skeletal traction in hospital for 1-2 weeks, followed by home traction. At hospital 3, treatment was skin or skeletal traction in hospital until the fracture healed. RESULTS: The average total costs per patient were EUR 10,000 at hospital 1, EUR 23,000 at hospital 2, and EUR 38,000 at hospital 3. INTERPRETATION: The main factor for determining the cost of treatment was the number of days in hospital, which was lower in children treated with external fixation.

Adolescent↗
PubMed2004

Excessive use of rapid tests in respiratory tract infections in Swedish primary health care.

A 1-y retrospective study of problem oriented electronic patient records, for encounters concerning respiratory tract infection, was performed. The aim was to analyse the management of respiratory tract infections in primary health care in terms of diagnostic coding, tests and antibiotic treatment using data from electronic patient records. 12 primary health care centres with a registered population of 102,050 residents in 3 counties in southeast Sweden participated. Data were retrieved electronically from records of patient encounters concerning respiratory tract infections. The data were: patient age and gender, date of contact, diagnostic code, CRP and GABHS tests and results, as well as antibiotic prescriptions. In a total of 19,965 encounters, the most frequent diagnoses were common cold (40%), acute tonsillitis (18%), and acute bronchitis (15%). A total of 4445 GABHS tests (in 22% of encounters) and 6141 CRP tests (31%) were performed, and both tests were done in 1910 encounters (10%). A total of 7934 antibiotic prescriptions were registered. The proportion of patients tested and prescribed an antibiotic varied greatly between centres. We found an excessive, and much varying, use of rapid tests in encounters for respiratory tract infections. Data retrieval from electronic patient record systems was a feasible method to study the use of laboratory tests in relation to pharmacological treatment.

Adolescent↗
PubMed2004

Data from electronic patient records are suitable for surveillance of antibiotic prescriptions for respiratory tract infections in primary health care.

Diagnoses and antibiotic treatments were analysed in relation to respiratory tract infections (RTI). A 1-y retrospective study was made of electronic patient records (EPR) for encounters concerning RTIs in primary health care in Sweden. The study covered a registered population of 102,050 individuals at 12 primary health care centres in 3 counties. Data were recorded on number of episodes, encounters, diagnostic codes and antibiotic prescriptions. The yearly number of episodes of RTIs was 16,964 or 166 per 1000 inhabitants per y. The total number of encounters was 19,965. The most frequent diagnoses were common cold (40%), acute tonsillitis (18%), and acute bronchitis (15%). The yearly number of antibiotic prescriptions was 7961, accounting for 47% of the episodes or 78 per 1000 inhabitants per y. The most frequently prescribed antibiotics were phenoxymethylpenicillin (61%), tetracyclines (18%) and macrolides 8%). Standard EPRs provide a feasible source of clinical information which, taking limitations into consideration, could be used for the follow-up of trends in antibiotic prescribing and of adherence to guidelines with regard to RTIs.

Adolescent↗
PubMed2003

The influence of change of legislation concerning sickness absence on physicians' performance as certifiers. A population-based study.

In Sweden, a change of the legislation for sickness absence became effective on 1st October, 1995. The purpose of the change was to reduce costs for sickness absence by exclusion of non-medical criteria for sick-listing, more part-time sick-listing and faster rehabilitation. This study was conducted in order to describe and analyse certification practice of various physician categories, before and after the change in legislation. Thirty-one thousand seven hundred and thirty certificates for sickness absence, collected by the local offices of the National Social Insurance Board in eight Swedish counties, fulfilled the inclusion criteria. The number of certificates decreased temporarily. The number of certified net days, i.e. crude days multiplied by degree, tended to increase and there was no shift from full to partial sick-listing during the period. There were small changes regarding case mix, i.e. patient characteristics, and sick-listing physician category. The results were almost unchanged when these small changes were taken into account. General practitioners issued significantly shorter periods of sick-leave than the other categories both years. The goals of the legislative change were thus not met. The result of the study indicates that other factors than the legislation may be more important for physicians' practice.

Adult↗
PubMed2003

Determinants of hospitalisation rates: does primary health care play a role?

OBJECTIVE: To analyse the influence of rates of general practitioner visits on rates of hospitalisations. DESIGN: Ecological cross-sectional study of factors influencing hospitalisation rates. Aggregated data on primary care centre area level. SETTING: The county of Ostergötland, Sweden, with 3 hospital districts and 41 primary health care centres, and the hospital district of Jönköping in the county of Jönköping, Sweden, with 11 primary health care centres. OUTCOME MEASURE: Hospitalisation rates. RESULTS: Age and rates of outpatient hospital visits were the most important factors explaining the variation in rates of hospitalisations between the primary health care centre areas. Hospital districts, socioeconomic factors and rates of GP visits also influenced the rates of hospitalisations. CONCLUSION: When evaluating the influence of primary health care on the rates of hospitalisations, both socioeconomic factors and health care structure must be taken into consideration. Doing this, the rates of GP visits correlated negatively with the rates of hospitalisations.

Aged↗
PubMed2002

The more time spent on listening, the less time spent on prescribing antibiotics in general practice.

OBJECTIVE: To analyse the variation between primary care centres (PCCs) with regard to prescribing antibiotics and to investigate whether the variation can be explained by factors related to patient satisfaction and to socio-demographic characteristics of the populations in the catchment areas of the PCCs. METHODS: The frequency of prescription of antibiotics by GPs at the PCCs was used as the dependent variable in a multivariate regression analysis. Questionnaire data for patient satisfaction and register data for socio-demographic characteristics were used as explanatory variables. The study was set in a county in south-east Sweden, and 6734 patients consulting GPs at 39 out of the 41 PCCs in the county participated. Variables correlating with the frequency of antibiotics prescription at PCC level and with patient satisfaction were the main outcome measures. RESULTS: A seven-fold variation in the extent of the prescription of antibiotics between the PCCs was observed. In the multivariate analysis, a high antibiotic prescription rate relates to high overall patient satisfaction with GP consultation as well as to the share of males in the listed population but to low satisfaction with the time spent by the GP on listening to the patient. CONCLUSION: A high frequency of prescription of antibiotics at a PCC may reflect a general disposition among GPs to give priority to maintaining good relations with the patients. However, a low level of prescription may be consistent with patient satisfaction if more time is spent on listening to and informing the patients. Thus more time spent on listening to the patients may reduce the prescription of antibiotics without reducing patient satisfaction.

Anti-Bacterial Agents↗
PubMed2002

The cost of gastro-oesophageal reflux disease, dyspepsia and peptic ulcer disease in Sweden.

BACKGROUND AND OBJECTIVE: Dyspepsia, peptic ulcer disease (PUD) and gastro-oesophageal reflux disease (GORD) involve a substantial cost to Swedish society. There is a lack of up-to-date nationwide cost estimates after 1985. This study was conducted to present a comprehensive and updated cost analysis and study the change over time of the national cost of these disorders. DESIGN AND SETTING: Primarily, data from National Swedish databases and secondly, data from databases from the County of Uppsala for 1997 were used for the calculations and estimations. PERSPECTIVE: Swedish societal perspective. RESULTS: The total cost to Swedish society of dyspepsia, PUD and GORD in 1997 was $US424 million, or $US63 per adult. Direct costs totalled $US258 million (61%) while indirect costs totalled $US166 million (39%). The highest proportions of costs were due to drugs and sick leave, these being 37 and 34%, respectively. CONCLUSIONS: The cost of dyspepsia and GORD is substantial for patients, health providers and society. Since 1985, drug costs have increased substantially while the cost of sick leave has decreased.

Cost of Illness↗