Setting priorities in primary health care - on whose conditions? A questionnaire study

BMC Family Practice

Research Article

David Andersson¹  Lars Borgquist²  Per Carlsson³  Eva Arvidsson⁴  Malin André⁵ 

[1] Department of Management and Engineering, Division of Economics, Linköping University, Linköping, Sweden;Department of Medical and Health Sciences, Family Medicine, Linköping University, Linköping, Sweden;Department of Medical and Health Sciences, National Centre for Priority Setting in Health Care, Linköping University, Linköping, Sweden;Department of Medical and Health Sciences, National Centre for Priority Setting in Health Care, Linköping University, Linköping, Sweden;Department of Primary Health Care, County Council of Kalmar, Kalmar, Sweden;Department of Public Health and Caring Sciences - Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden;Department of Medical and Health Sciences, Family Medicine, Linköping University, Linköping, Sweden;

关键词: Primary Health Care;    Priority Setting;    Patient Benefit;    Future Complication;    Routine Primary Care;   

DOI  :  10.1186/1471-2296-13-114

 received in 2012-05-17, accepted in 2012-11-15,  发布年份 2012

来源: Springer

【 摘 要 】

BackgroundIn Sweden three key criteria are used for priority setting: severity of the health condition; patient benefit; and cost-effectiveness. They are derived from the ethical principles established by the Swedish parliament 1997 but have been used only to a limited extent in primary care. The aim of this study was to describe and analyse: 1) GPs', nurses', and patients' prioritising in routine primary care 2) The association between the three key priority setting criteria and the overall priority assigned by the GPs and nurses to individual patients.MethodsPaired questionnaires were distributed to all patients and the GPs or nurses they had contact with during a 2-week period at four health centres in Sweden. The staff registered the health conditions or health problem, and the planned intervention. Then they estimated the severity of the health condition, the expected patient benefit, and the cost-effectiveness of the planned intervention. Both the staff and the patients reported their overall prioritisation of the patient. In total, 1851 paired questionnaires were collected.ResultsCompared to the medical staff, the patients assigned relatively higher priority to acute/minor conditions than to preventive check-ups for chronic conditions. Severity of the health condition was the priority setting criterion that had the strongest association with the overall priority for the staff as a whole, but for the GPs it was cost-effectiveness.ConclusionsThe challenge for primary care providers is to balance the patients' demands with medical needs and cost-effectiveness. Transparent priority setting in primary care might contribute to a greater consensus between GPs and nurses on how to use the key priority setting criteria.

【 授权许可】

CC BY   
© Arvidsson et al.; licensee BioMed Central Ltd. 2012