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DN Debate. Patients irrvägar in search of care costs billions

Sjukvårdssverige has shown little interest for the right patient get to the right caregivers at the right time. Too many swedes sent on irrvägar by the care. It leads to unnecessary visits, duplication of work for staff, missed diagnoses and related injuries. In a new analysis, the winnings are calculated by removing the irrvägar be able to free up resources equivalent to 1.5 million more primärvårdsbesök, as well as reduced anxiety and anticipation that could be valued at billions of patients. Straighter care chains does not occur by itself. The regions, which now controls health care, the need to customize the provider's remuneration according to how well the patients are guided through the care chain.

A part irrvägar are so common that they hardly attract the attention.

A woman caller to the helpline service 1177 of trouble with the urinary tract. She will then get the council to contact a gynecologist. She will contact a gynekologmottagning, which seems good, but who sets the standards on the referral. She calls her health care center and waiting three weeks of the visit duration of the family doctor. Her doctor then the former is not available. She hits the first a nurse, then a new doctor who informs her that she will not need referral to a gynecologist and spreading the word about a reception that the doctor happen to know is more accessible compared to the first woman called to. The woman is calling the new gynekologmottagningen and get the time three weeks later.

the Patient has told you about his symptoms to health professionals five times, been in unnecessary primary care visits, and waiting at least three weeks in vain. If the symptoms would have been exacerbated had the patient is likely to be on his own volition visited the emergency room. Almost one-fifth of the patients in the emergency room indicate that they are there because they are experiencing other forms of care as unavailable.

the Total of an intelligent referral, which already exists in some parts of the world, can easily be two billion in saved health costs.

the OECD argues in a recent forskningsgenomgång that close to one in four patients visiting primary health care receives the wrong diagnosis, incorrect medication, or suffer from other mistakes that could have been avoided. About six percent of the hospital admissions is due to any such mistakes in primary care, which often is caused or exacerbated by the complicated healthcare chains.

Both health workers and patients in Sweden express much greater dissatisfaction with coordination of care and information to patients than in other countries. In particular for irrvägarna is probably the single most important reason why it has become the Swedish paradox – more doctors, but longer queues, compared to other countries.

Yet the county councils have shown little interest to examine how efficiently and smoothly patients are guided by health care organizations. The patient's perspective, its own valuation of time and the anticipation, was not taken into account. Studies and statistics on patients ' irrvägar is conspicuous by its absence. Why is not the question seriously?

Landstingsrevisorerna in the County of Stockholm (now the Stockholm Region) commented in a review of the proven large number of incorrect referrals, that the ”issue is not a priority” and ”the big win occurs, however, only when the remittenter have a much better and easily available support for that refer the the right. We have in this review does not come in contact with anyone within the stockholm county council (SLL), which has the mission to make the information available to remittenter...”

In our analysis compared the costs of different pathways through care, including the patient's valuation of time and worry, which so far rarely have been taken into account in health care. An example is patients via calls to 1177 comes into the care and get advice. Often, the council is to contact a natural health care centre, emergency or specialized care. Snittkostnaden for regions until a first contact with the health care specialist is estimated to be 1 900 sek and the patient's valuation of waiting and different kinds of time expenditure is estimated to be 700 sek. Regions spend annually about a billion dollars on phone calls to 1177 in a design where the majority are referred to other care, as they are in the majority of cases, the need to find and book themselves and talk about their symptoms again.

This cumbersome way compared with patients who contact a digital primärvårdsmottagning not unsorted locks to the video call with the doctor, but is designed so that it combines telephone counseling (the equivalent of 1177), digital nurse or doctor visits for those who can be treated via video link and also help with the booking of appointments for those who need a physical visit to another health care provider.

In that way the patient does not tell his case as many times, waiting times between health care providers is shortened, and patients are led more often to the right level of care. Based on fresh data from a such, becomes a significantly greater proportion of patients in the digital environment, completed by the nurse. Only when necessary is the involvement of a digital-working doctor or a natural health care provider. In this digital flow is calculated as health care average cost for the same sequence of care to be sek 900, less than half of normal today. Also the patient's valuation of anticipation and anxiety cut in half to approximately sek 350.

the Total of a more intelligent route guidance for primary care for these would then approaching five and a half billion for the taxpayer-funded health care and two billion saved in the patient's score.

another spreadsheet, analyze the patients referred from primary care to specialized care. Based on the research literature can be assumed that a proportion of patients are felremitterade and is rejected or treated in a more expensive or a worse way. Total in Sweden are written about three and a half million referrals from primary care physicians. The total of an intelligent referral, which already exists in some parts of the world, can easily be two billion in saved health costs. At the same time it would mean a little over a billion in the value of saved time and anxiety for patients.

Primary care is relatively small in Sweden, and should likely be expanded. 1177 is also expanded and may vägvisa patients better in the future. The various new digital vårdföretagen quickly improves the arrangements for the färdighantera digital or vägvisa the right. The potential to shorten patients ' irrvägar discussed though rarely.

. The regions should also pay higher remuneration to the performers who succeed better with that lead right. Compensation for a primärvårdsbesök can be adjusted by paying the lower payment on the referral visit at the next health care provider is not completed within a certain period of time, for example because it is rejected, was scheduled to the wrong referral hospitals, the referral was dropped off or sent to a health care provider with a long waiting time. In addition, should specialized care have an incentive to not reject referrals to follow.

A clear focus on ”the right patient to the right caregiver at the right time” is missing in the day, but would be able to solve a large part of the health care perceived lack of resources, and improve the quality significantly for patients. The tools are available. Now needed the courage and the willingness!

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