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Tidlig rehabilitering av eldre pasienter med hoftebrudd
No full textNORSK: Bakgrunn\ud
En nasjonal pasientsikkerhetskampanje, med planlagt oppstart i 2011, er under forberedelse. For å støtte beslutningsprosessen rundt valg av innsatsområder og tiltak, har vi foretatt en hurtigoppsummering av kunnskapsgrunnlaget om effekt av tidlig rehabilitering for eldre med hoftebruddskader.\ud
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Oppdrag\ud
Oppdraget ble gitt av Nasjonalt kunnskapssenter for helsetjenesten, sekretariatet for pasientsikkerhetskampanjen 2011.\ud
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Hovedkonklusjoner\ud
Selv om det foreligger et betydelig antall studier, fant vi at kunnskapsgrunnlaget for å bedømme effekten av ulike rehabiliteringstiltak, kombinasjoner av disse, organisering av disse eller hvilket tidspunkt for rehabilitering som gir best utfall var usikker og utilstrekkelig. Dette skyldes i stor grad at tiltak og utfallsmål er svært heterogene.\ud
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Konklusjonen er basert på gjennomgang av resultater i tre Cochrane-oversikter.ENGLISH: -page key messages\ud
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Background\ud
A national patient safety campaign, planned to start in 2011, is being prepared. To support decisions regarding the choice of priority areas and interventions, we have performed a rapid summary of evidence regarding early rehabilitation of elderly and fragile patients with hip-fractures. \ud
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Commission\ud
The summary was performed on commission of The Norwegian Knowledge Centre for the Health Services, The secretary of the patient safety campaign 2011. \ud
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Main conclusions\ud
Although a substantial number of studies have been performed, we found no conclusive evidence regarding choice of intervention, combinations of interventions, organisation of rehabilitation or timing of rehabilitation. This is largely attributable to heterogeneity in interventions and measures. \ud
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The conclusions were based on results in three Cochrane reports
Use and barriers to use of screening and brief interventions for alcohol problems among norwegian general practitioners.
No full textSUMMARY: AIM: To investigate the use and the obstacles to use of screening and brief interventions (SBI) for alcohol misuse among Norwegian general practitioners (GP). METHODS: A questionnaire with 68 questions about the use and barriers to use of SBI in general practice was mailed to 2000 randomly selected Norwegian GPs. RESULTS: The survey response rate was 45%. There was a much higher prevalence of using interventions (mean = 4.47 on a seven-point Likert scale) than of screening for alcohol problems (mean = 2.10 on a seven-point Likert scale). Regression models showed that knowledge and self-efficacy were the main predictors for GPs' use of screening instruments and use of interventions, respectively, in particular with regard to use of screening. However, GPs' views of their relationship with their patients, and structural factors were significant predictors. CONCLUSIONS: (i) Norwegian GPs do not necessarily see the link between screening for alcohol problems and conducting interventions. (ii) Factors on at least three levels, i.e. personal, social and structural, play significant roles for understanding the problems related to implementing the use of SBI in general practice. (iii) Training GPs in the use of SBI is important but may not increase GPs' use of SBI due to social and structural barriers.NORSK SAMMENDRAG: Bruk og hindre for bruk av kartlegging og tidlig intervensjon for alkoholproblemer blant norske allmennleger\ud
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I underkant av 1000 allmennleger svarte på et spørreskjema med 68 spørsmål om bruk og hindre for bruk av kartlegging og tidlig intervensjon i allmennpraksis.\ud
Studien viser at intervensjon blir mer brukt enn kartlegging av alkoholproblemer. Kompetanse og mestringsforventninger var de viktigste bestemmende faktorene for om allmennlegene tok i bruk både kartleggingsverktøy og intervensjon, men spesielt i forhold til bruk av kartleggingsverktøy. Allmennlegens forståelse av pasientrelasjonen og strukturelle faktorer var også viktige faktorer.\ud
Konklusjonen er at norske allmennleger ikke nødvendigvis ser en sammenheng mellom å kartlegge for potensielle alkoholproblemer og å foreta intervensjoner. For å forstå problemene med å implementere bruk av kartlegging og tidlig intervensjon i allmennpraksis, må man se på både personlige, sosiale og strukturelle faktorer. Å øke kompetansen hos allmennleger er viktig, men det alene vil ikke nødvendigvis øke legenes bruk av verktøyene
Det vil helst gå bra... Oppsummering av landsomfattende tilsyn i 2009 med kommunale sosial- og helsetjenester til barn i barne- og avlastningsboliger
No full textNORSK SAMMENDRAG: Kort sammendrag av Rapport fra Helsetilsynet 2/2010\ud
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I 2009 ble det gjennomført tilsyn i 75 kommuner/bydeler som har barne- og avlastningsboliger. Fylkesmannen og Helsetilsynet i fylket undersøkte sammen om kommunene sikrer forsvarlige sosial- og helsetjenester til barn i barne- og avlastningsboliger. Tilsynet ble gjennomført i virksomheter som gir heldøgns omsorgstjenester til barn under 18 år etter lov om sosiale tjenester.\ud
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Tilsynet avdekket brudd på regelverket i tre av fire virksomheter. Funnene viser at mange kommuner har mangelfull faglig styring, og er for lite opptatt av kvaliteten på tjenestene. Mye overlates til et engasjert personell, som sørger for at barna får mye god omsorg. Men mangelfulle skriftlige rutiner og mangelfull opplæring, kombinert med mange deltidsansatte og sårbare barn som flytter fram og tilbake, er blant det som gir grunn til bekymring. \ud
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Legemiddelhåndtering er en utfordrende oppgave som krever klare prosedyrer og tydelig ansvarsplassering. Tilsynet fant at en av to kommuner hadde brutt regelverket på dette området. Legemiddelhåndteringsforskriften gjelder når helsepersonell er involvert. Innholdet i forskriften var ikke godt nok kjent og etterlevd. Avvik kan i verste fall føre til uheldige hendelser med helsemessige konsekvenser. \ud
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Regelverket er ikke godt tilrettelagt for drift av barne- og avlastningsboliger. Det er dels mangelfullt og dels vanskelig tilgjengelig og komplekst. Statens helsetilsyn anbefaler en gjennomgang av regelverket med spesiell tanke på barn som oppholder seg i barne- og avlastningsboliger, deres særskilte situasjon og behov.SUMMARY IN ENGLISH: 1 Summary\ud
The Offices of the County Governors and the Norwegian Board of Health Supervision in the Counties together investigated whether the municipalities ensure that children in residential accommodation and respite care accommodation receive health and social services of an adequate standard. The results show that professional management in many municipalities is inadequate, and that not enough attention is paid to the quality of the services. Much is dependent on individual staff, who ensure that children are given adequate care. But lack of written procedures and inadequate training, combined with many part-time staff and vulnerable children who move back and forth between their home and residential care, gives cause for concern.\ud
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Administration of medication is an area that presents challenges, and for which clear procedures and clear allocation of responsibility are important. In this area, the supervision authorities found breaches of the legislation in one out of two municipalities. The regulations relating to medicinal products apply when health care personnel are involved. Knowledge about the regulations was inadequate and the requirements in the regulations were not always met. In the worst cases, breach of the regulations can lead to adverse events and damage to health.\ud
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In 2009, countrywide supervision of health and social services for children in residential accommodation and respite care accommodation was carried out in 75 municipalities and urban districts that provide services for children under 18 years of age in accordance with the Social Services Act. These children have reduced function, often have health problems, and need special care adapted to their individual needs. Their needs are often complex and demanding, and the consequences of inadequate services can be serious. This area was chosen for supervision because these children are vulnerable, because the risks associated with inadequate services are high, and because little supervision of these services has been carried out during the last few years. The municipalities were chosen on the basis of the supervision authorities’ local knowledge, including information about risk. Thus these municipalities are not necessarily representative for the country as a whole. \ud
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The aim of this countrywide supervision was to investigate whether the municipalities had a management system that ensures that children in residential accommodation and respite care accommodation receive health and social services of an adequate standard. Supervision was limited to five areas. The supervision authorities examined whether the municipalities organize services for children in residential accommodation and respite care accommodation in such a way as to ensure that: \ud
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children’s rights for contact with others, a meaningful daily life, and participation in leisure activities are met \ud
the needs of children with special nutritional needs are met \ud
the care that is provided is specially adapted to the health status of the children \ud
administration of medication is adequately dealt with \ud
the residences are specially adapted for the children.\ud
Many of the staff in residential accommodation and respite care accommodation are part-time staff, temporary staff and staff who have no professional qualifications. They cooperate with many other people, such as regular medical practitioners, teachers and support persons, in addition to parents. The municipality has responsibility for continuity of care, and that the quality of all the services provided for each individual child is adequate. Given the nature of the services, and the vulnerability of the children, sound management systems are required.\ud
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The supervision authorities identified breaches of the regulations (nonconformities) in about three out of four services. In 59 services there were one or more nonconformities. The extent and nature of the nonconformities varied a lot. Seven services had neither nonconformities nor observations about areas with potential for improvement. The areas with breaches of the regulations that are presented in this report only show tendencies, and do not apply to all the municipalities.\ud
Sound management to ensure services of high quality\ud
Many municipalities do not have adequate internal control systems. Management systems must be used systematically to ensure that children receive adequate health and social services. For example, when many of the staff have no professional qualifications, many work part-time, and there are no guidelines, this can adversely affect the services that children receive. In addition to lack of written procedures, three of the institutions had not ensured that staff received systematic training. Lack of training applied to the following areas: medication, daily care of the children, diseases and disabilities, and methods of communication. The need for professional staff must be assessed on the basis of the children’s functional abilities and need for assistance. In several municipalities, no such assessment had been made. When many staff have neither professional qualifications nor professional skills, the services are vulnerable. Many municipalities lacked systems for dealing with nonconformities 1, and systems for evaluating and improving the services. If adverse events are not identified and made known, the organization has no basis for correcting deficiencies or for preventing similar incidents from happening again.\ud
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A meaningful daily life and adequate care for each child\ud
Many municipalities lacked routines for systematic assessment of the children’s needs for activities and health care. Lack of assessment makes it difficult to assess the needs for professional staff and skills. Not all the residences had personnel with adequate skills. Duty rotas and the need for training were often not adequately assessed in relation to the children’s needs. Individual adaptation requires planning, but one service in four lacked plans, or had inadequate activity plans, care plans or other types of plans. The greatest number of nonconformities were for lack of activity plans, particularly individual plans. The result can be that activities are only provided according to the skills of the personnel who happen to be present. This is particularly unfortunate for children who live permanently or for long periods in the residences, and can limit their functional abilities. Very few cases of inadequate nutrition were detected.\ud
Administration of medication\ud
Administration of medication is an area where there was particular need for improvement. Breaches of the regulations relating to medication were identified in about half of the municipalities. This is an area where there is a great danger of deficiencies occurring. It is clearly necessary for residential accommodation and respite care accommodation to have written procedures. These procedures should describe sound, adequate practice, so that the children are given the correct medication in the correct way. Nonconformities most often included lack of procedures or incorrect procedures, that procedures were not followed, that it was unclear who had responsibility for medication, and lack of professional personnel. These are serious deficiencies, which in the worst cases can have serious consequences for the health of children who are dependent on medication. The most common type of unsound practice with regard to dealing with medication was inadequate preparation of medication, in particular medicines. Preparation of medication shall normally be carried out by health care personnel with adequate qualifications, such as nurses or social educators. \ud
Adaptation of the residences for all the children\ud
Nonconformities were detected in one out of ten residences regarding adaptation of the residences for children with physical disabilities. In addition, twenty per cent of the municipalities received notification about physical conditions identified as areas with potential for improvement. Although the seriousness of these conditions varied, this is a worrying situation. A large proportion of children in residential accommodation and respite care accommodation have physical disabilities, which means that they have problems in moving around freely. Many of the findings related to conditions that created limited access for these children, particularly children in wheelchairs. This limits their possibilities to participate in activities with others. \ud
The recommendations of the Norwegian Board of Health Supervision\ud
The municipalities must monitor and follow up the quality of the services provided in each residence for children in residential care and respite care. Many municipalities have an inadequate overview of the services, and must improve their management in order to reduce the risk of inadequate services. The leadership cannot delegate responsibility to the staff without monitoring and following up the services systematically.\ud
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As a result of supervision, several deficiencies in management of the services have been detected, and the municipalities must:\ud
identify areas where there is a high risk of deficiencies occurring, in order to be able to prevent adverse events \ud
ensure that essential routines and procedures are developed to ensure that services for children are sound and adequate \ud
ensure that there are sufficient staff with adequate qualifications, skills and training to care for the children \ud
identify deficiencies and carry out work to improve the services.\ud
Experience gained from supervision in other municipalities can be used to assess routines and discuss areas of high risk. Breaches of the regulations must be corrected.\ud
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Supervision was carried out for services that are provided according to the Social Services Act. But most children in residential accommodation and respite care accommodation also need health services. This means that municipalities must pay special attention to the need for qualified staff, and ensure that they know which legislation is applicable. When health care personnel provide services, health legislation will usually be applicable, including the regulations regarding medication. \ud
The legislation is not well adapted for running residential accommodation and respite care accommodation. It is incomplete, and it is complex and difficult to interpret. In some areas, it is difficult for the municipalities to know what standards the authorities require. The Norwegian Board of Health Supervision recommends that the legislation should be reassessed in the light of the special situation and needs of these children.\ud
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1. When service providers observe deficiencies in the services, these should be registered. This is called registration of nonconformities
Can the prevalence of high blood drug concentrations in a population be estimated by analysing oral fluid? A study of tetrahydrocannabinol and amphetamine.
No full textAIM: To study several methods for estimating the prevalence of high blood concentrations of tetrahydrocannabinol and amphetamine in a population of drug users by analysing oral fluid (saliva). METHODS: Five methods were compared, including simple calculation procedures dividing the drug concentrations in oral fluid by average or median oral fluid/blood (OF/B) drug concentration ratios or linear regression coefficients, and more complex Monte Carlo simulations. Populations of 311 cannabis users and 197 amphetamine users from the Rosita-2 Project were studied. RESULTS: The results of a feasibility study suggested that the Monte Carlo simulations might give better accuracies than simple calculations if good data on OF/B ratios is available. If using only 20 randomly selected OF/B ratios, a Monte Carlo simulation gave the best accuracy but not the best precision. Dividing by the OF/B regression coefficient gave acceptable accuracy and precision, and was therefore the best method. None of the methods gave acceptable accuracy if the prevalence of high blood drug concentrations was less than 15%. CONCLUSION: Dividing the drug concentration in oral fluid by the OF/B regression coefficient gave an acceptable estimation of high blood drug concentrations in a population, and may therefore give valuable additional information on possible drug impairment, e.g. in roadside surveys of drugs and driving. If good data on the distribution of OF/B ratios are available, a Monte Carlo simulation may give better accuracy
EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs.
No full textTreatment of rheumatoid arthritis (RA) may differ among rheumatologists and currently, clear and consensual international recommendations on RA treatment are not available. In this paper recommendations for the treatment of RA with synthetic and biological disease-modifying antirheumatic drugs (DMARDs) and glucocorticoids (GCs) that also account for strategic algorithms and deal with economic aspects, are described. The recommendations are based on evidence from five systematic literature reviews (SLRs) performed for synthetic DMARDs, biological DMARDs, GCs, treatment strategies and economic issues. The SLR-derived evidence was discussed and summarised as an expert opinion in the course of a Delphi-like process. Levels of evidence, strength of recommendations and levels of agreement were derived. Fifteen recommendations were developed covering an area from general aspects such as remission/low disease activity as treatment aim via the preference for methotrexate monotherapy with or without GCs vis-à-vis combination of synthetic DMARDs to the use of biological agents mainly in patients for whom synthetic DMARDs and tumour necrosis factor inhibitors had failed. Cost effectiveness of the treatments was additionally examined. These recommendations are intended to inform rheumatologists, patients and other stakeholders about a European consensus on the management of RA with DMARDs and GCs as well as strategies to reach optimal outcomes of RA, based on evidence and expert opinion
Migrant participation in Norwegian health care. A qualitative study using key informants.
No full textAbstract Background: Little is known about how migrants adapt to first-world public health systems. In Norway, patients are assigned a registered general practitioner (RGP) to provide basic care and serve as gatekeeper for other medical services. Objectives: To explore determinants of migrant compliance with the RGP scheme and obstacles that migrants may experience. Methods: Individuals in leadership positions within migrant organizations for the 13 largest migrant populations in Norway in 2008 participated in this qualitative study. Semi-structured interviews, with migrants serving as key informants, were used to elucidate possible challenges migrant patients face in navigating the local primary health-care system. Conversations were structured using an interview guide covering the range of challenges that migrant patients meet in the health-care system. Results: According to informants, integration into the RGP scheme and adequacy of patient-physician communication varies according to duration of stay in Norway, the patient's country of origin, the reason for migration, health literacy, intention to establish permanent residence in Norway, language proficiency, and comprehension of information received about the health system. Informants noted as obstacles: doctor-patient interaction patterns, conflicting ideas about the role of the doctor, and language and cultural differences. In addressing noted obstacles, one strategy would be to combine direct intervention by migrant associations with indirect intervention via the public-health system. Conclusion: Our results will augment the interpretation of forthcoming quantitative data on migrant integration into the public-health system and shed light on particular obstacles
Beregning av volum av et utvalg undersøkelser og prosedyrer i spesialisthelsetjenesten for nettstedet Fritt sykehusvalg Norge. Del 2: undersøkelser og ikke-kirurgiske prosedyrer
No full textNorsk Sammendrag: Bakgrunn Nasjonalt kunnskapssenter for helsetjenesten har identifisert koder og utført beregning av volum for utførte undersøkelser og prosedyrer innen spesialisthelsetjenesten på oppdrag fra Helsedirektoratet. De beregnede volumtall skal publiseres på Helsedirektoratets nettsted Fritt sykehusvalg Norge. Dette notatet omhandler del 2 av prosjektet og omfatter undersøkelser og ikke-kirurgiske prosedyrer. Del 1 omfattet kirurgiske prosedyrer og er beskrevet i et eget notat: http://www.kunnskapssenteret.no/Publikasjoner/6625.cms. Metode Datafiler fra Norsk pasientregister (NPR) for 2008 over alle innleggelser og polikliniske konsultasjoner ble brukt. Dataene var anonymisert, og valg av fagområder har vært i henhold til de fagområdene som nettstedet Fritt sykehusvalg Norge har. Kunnskapssenteret har som en del av kvalitetssikringen av datauttrekket, kontaktet aktuelle fagmiljøer for å sikre at de foreslåtte koder for datauttrekk til volumberegning av behandlingene gir et klinisk relevant resultat og presisjon i kodevalg. Kodene som ble brukt var diagnosekoder (ICD-10-koder), prosedyrekoder (fra NCMP og NCSP- klinisk prosedyrekodeverk) og takster. DRG-koder var ikke spesifikke nok for vårt formål. En kvalitetssikring av de beregnede volumtall ble utført ved at Helsedirektoratet sendte volumtallene til sykehusene for kommentarer og sammenlikning med sykehusenes egne registreringer før de ble publisert på Fritt sykehusvalg Norge. Resultat Det er beregnet volum for 36 prosedyrer og undersøkelser innen 14 fagområder. For fem fagområder og én type undersøkelse var det ikke mulig å beregne volum. Diskusjon Volumtallene beskriver aktivitet i spesialisthelsetjenesten på flere fagområder som er i pasienters, ansattes og helselederes interesse. De er ikke knyttet opp mot resultat av undersøkelse eller behandling
Examining the Global Health Arena: Strengths and Weaknesses of a Convention Approach to Global Health Challenges
No full text1-page key messages\ud
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In June 2009 the Norwegian Directorate of Health commissioned the Norwegian Knowledge Centre for the Health Services with compiling and analyzing available international research material on the strengths and weaknesses of a convention approach to global health challenges. The following report is a response to this commission.\ud
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This purpose of the report is to contribute towards resolving the challenges related to poor health amongst the world’s poorest and least healthy population. As such, it represents an initiative from the Norwegian public administration towards informing national and international governmental bodies of strengths and weaknesses of a global health convention approach to structure the international work on global health.\ud
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Key messages of the report:\ud
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Increasing global interdependence makes the health of the world’s poorest and most marginalized people a pressing issue for all nations of the world.\ud
There are observable weaknesses in the current international frameworks to improve health for the world’s most marginalized people, including shortcomings in the human rights approach to health.\ud
A global health convention could provide an appropriate instrument to deal with some of the intractable problems of global health, especially:\ud
clearly define what are basic survival needs\ud
setting principles for cooperation, accountability, and allocation of resources between stakeholders\ud
structuring and coordinating the financing of global health investments\ud
granting rules for access to health services, including setting demands for national priorities with respect to the provision of health services\ud
Challenges might be to muster international support for supra-national health regulations, negotiate compromises between existing stakeholders in the global health arena, and to gain WHO’s support as a convener of the parties and as a facilitator of the adoption process
Commonwealth Fund-undersøkelsen 2010: Resultater fra en komparativ befolkningsundersøkelse i 11 land
No full textNORSK: I 2010 deltok Norge for andre gang i Commonwealth Funds sammenlignende internasjonale helsetjenesteundersøkelse. Et representativt utvalg av den voksne befolkningen (18 år eller eldre) i elleve land har vurdert hvor godt helsetjenesten fungerer. Denne rapporten presenterer de norske resultatene og sammenligner dem med andre land eller grupper av land.\ud
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Hovedbildet er at det er svært få områder der Norge gjør det spesielt bra. På de fleste områdene skårer Norge middels, og på en del områder er Norges resultater dårligere enn gjennomsnittet.\ud
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Norge skårer dårligere enn gjennomsnittet på disse områdene:\ud
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vurderinger av de intervjuedes faste lege, og det gjelder både kommunikasjon, medbestemmelse og om den faste legen tar seg nok tid i konsultasjonene\ud
omfanget av brukeropplevde medisinske feil \ud
vurderinger av sykehusene ved utskrivning, og det gjelder både informasjon om medisiner, avtale om oppfølging hos en lege eller annet helsepersonell, skriftlig informasjon om hva man skulle gjøre når man kom hjem og hvilke symptomer man skulle være oppmerksom på\ud
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Norge skårer bedre enn gjennomsnittet på disse områdene:\ud
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andel som oppgir at de har fast lege\ud
tilgang til helsehjelp utenom ordinær arbeidstid\ud
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Norge skårer bare middels på resten av områdene.\ud
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Konklusjon:\ud
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De relativt entydige resultatene på noen av områdene indikerer at det er forbedringspotensial i Norge. Pasienterfaringer er en viktig del av kvaliteten på helsetjenestene. Etablering av systemer for måling av brukererfaringer på ulike nivåer og oppfølging av slike resultater anbefales. Videre er den pasientopplevde pasientsikkerheten dårligere i Norge enn snittet for alle landene samlet. Det planlegges en nasjonal pasientsikkerhetskampanje med start i januar 2011 i Norge. Kampanjen vil være et viktig tiltak for å imøtekomme utfordringene som denne undersøkelsen har avdekket.ENGLISH: 1-page key messages\ud
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In 2010, Norway participated for the second time in the comparative international survey about health issues from the U.S Health Care Foundation Commonwealth Fund. A representative sample of the adult population (18 years or older) in eleven countries has assessed how well health care works.\ud
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This report presents the Norwegian results and compares them with results from other countries or groups of countries.\ud
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This comparison reveals that there are very few areas where Norway particularly excels. In most areas the score is “medium”, while some areas the results are lower than average.\ud
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The Norwegian score is lower than average in these areas:\ud
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Assessment of the general physician (including communication, patient involvement and whether the physician spends sufficient time in consultations)\ud
Amount of user experienced medical errors\ud
Assessment of hospitals at discharge; it applies to information about medicines, follow-up agreement with a physician (including health professionals, written information about what to do when you come home and symptoms to be aware of)\ud
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The Norwegian score is better than average in these areas:\ud
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Proportion of population who report having a regular doctor\ud
Access to medical care outside normal working hours\ud
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The Norwegian score is only average in the other areas.\ud
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Conclusion:\ud
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Relatively consistent results in some of the areas indicate that there is potential for improvement in Norway. Patient experience is an important part of the quality of healthcare. Establishing systems for measuring the user experience at various levels and monitoring of such results is recommended. Moreover, the patient experienced poorer patient safety in Norway than the average for all countries combined. A Norwegian patient safety campaign starting in January 2011 in Norway will be an important measure to meet some of the challenges revealed by this survey