Arbeidsmengde, konsultasjonstid og utilsiktede effekter av takstsystemet

Source at https://www.fhi.no/.Dette notatet har bakgrunn i det NFR-finansierte forskningsprosjektet «Stykkprisfinansiering i primærhelsetjenesten: Utilsiktede bivirkninger for pasienter og samfunn?» (1). Forskningsprosjektet ledes av professor Arnstein Mykletun, seniorforsker ved FHI, og involvert i dette notatet er ph.d. stipendiatene Kristian Kraft og Eivor Hovde Hoff, samt forsker og fastlege Kristian Amundsen Østby, alle ved FHI. Dette notatet er et oppdrag for ekspertutvalget for gjennomgang av allmennlegetjenesten som fikk sitt mandat 11.08.22 av Helse- og omsorgsdepartementet (2). Analysene for notatet er utført i tidsperioden januar og februar 2023. Helsedirektoratet har frikjøpt arbeidstid fra ovennevnte for leveranse av disse analysene. Ekspertgruppens behov for innsikt og resultater var sammenfallende med planlagte problemstillinger for det NFRfinansierte forskningsprosjektet, og kunne derfor gjennomføres på grunnlag av KUHR-data og Fastlegeregisteret. Tilleggsfinansieringen til dette notatet har muliggjort å fremskynde visse analyser og tilrettelegge resultatpresentasjonen for ekspertgruppen. Dette notatet inngår også som rapportering i det nevnte NFR-prosjektet. Det er gitt nødvendige godkjenninger (dispensasjon fra taushetsplikten) fra Regional etisk komite (REK-nummer 210548) og er tilrådt av personvernombudet ved FHI. Det har ikke vært utført fagfellevurdering, begrunnet i den korte tidsrammen for prosjektet. Analyser i denne rapporten vil i noen grad inngå i fagfellevurderte internasjonale og nasjonale publikasjoner i framtiden

Health problems account for a small part of the association between socioeconomic status and disability pension award. Results from the Hordaland Health Study

<p>Abstract</p> <p>Background</p> <p>Low socioeconomic status is a known risk factor for disability pension, and is also associated with health problems. To what degree health problems can explain the increased risk of disability pension award associated with low socioeconomic status is not known.</p> <p>Methods</p> <p>Information on 15,067 participants in the Hordaland Health Study was linked to a comprehensive national registry on disability pension awards. Level of education was used as a proxy for socioeconomic status. Logistic regression analyses were employed to examine the association between socioeconomic status and rates of disability pension award, before and after adjusting for a wide range of somatic and mental health factors. The proportion of the difference in disability pension between socioeconomic groups explained by health was then calculated.</p> <p>Results</p> <p>Unadjusted odds ratios for disability pension was 4.60 (95% CI: 3.34-6.33) for the group with elementary school only (9 years of education) and 2.03 (95% CI 1.49-2.77) for the group with high school (12 years of education) when compared to the group with higher education (more than 12 years). When adjusting for somatic and mental health, odds ratios were reduced to 3.87 (2.73-5.47) and 1.81 (1.31-2.52). This corresponds to health explaining only a marginal proportion of the increased level of disability pension in the groups with lower socioeconomic status.</p> <p>Conclusion</p> <p>There is a socioeconomic gradient in disability pension similar to the well known socioeconomic gradient in health. However, health accounts for little of the socioeconomic gradient in disability pension. Future studies of socioeconomic gradients in disability pension should focus on explanatory factors beyond health.</p

Advantages of linking national registries with twin registries for epidemiological research

Linking national registries with twin data represents an opportunity to produce epidemiological research of high quality. National registries contain information on a broad array of variables, some of which cannot be measured reliably in regular health surveys. By taking kinship into consideration, twin studies have the benefit of being able to identify confounding stemming from genetic or shared environmental sources. In this paper, we use examples from our own interview and questionnaire-based twin studies from the Norwegian Twin Registry (NTR) on mental disorders, alcohol use and socioeconomic status linked to registry data on medical benefits to demonstrate the value. In the first example, we examined to what extent genetic and environmental factors contributed to sick leave and disability pension and the association between these two types of benefits. In the second example, we explored the genetic and environmental relationship between personality disorders and sick leave. In the third example, a co-twin control design was applied to explore whether there is a true protective relationship between moderate alcohol consumption and health. The fourth example shows to what degree anxiety and depression are associated with later sick leave granted for not only mental disorders, but also somatic disorders, adjusted for confounding by genetic and shared environmental factors. In the fifth example, we address the socioeconomic gradient in sick leave, adjusting for non-observed confounders associated with the family in a co-twin control design. Our examples illustrate some of the potentials obtainable by linking national registries with twin data. The efforts that have been made to create the NTR in Norway and the International Network of Twin Studies (INTR) internationally make these types of linkage studies easier to conduct and available to more researchers. As there are still many areas to explore, we encourage epidemiological researchers to make use of this possibility

Examination of the double burden hypothesis—a systematic review of work–family conflict and sickness absence

Background: Women consistently have higher sickness absence than men. The double-burden hypothesis suggests this is due to higher work–family burden in women than men. The current study aimed to systematically review prospective studies of work–family conflict and subsequent sickness absence. Methods: A systematic search was conducted in the electronic databases Medline, PsycINFO, and Embase with subject heading terms and keywords with no language or time restrictions. Two reviewers independently screened abstracts and read full-texts with pre-defined inclusion and exclusion criteria. Results: Eight included studies (n = 40 856 respondents) measure perceived work–family conflict and subsequent sickness absence. We found moderate evidence for a positive relationship between work–family conflict and subsequent sickness absence, and that women experience higher levels of work–family conflict than men. Conclusion: Work–family conflict is associated with later sickness absence, and work–family conflict is more common for women than for men. This indicates that work–family conflict may contribute to the gender gap in sick leave. However, further studies are needed to confirm whether this relationship is causal

Time is money: general practitioners’ reflections on the fee-for-service system

Background Fee-for-service is a common payment model for remunerating general practitioners (GPs) in OECD countries. In Norway, GPs earn two-thirds of their income through fee-for-service, which is determined by the number of consultations and procedures they register as fees. In general, fee-for-service incentivises many and short consultations and is associated with high service provision. GPs act as gatekeepers for various treatments and interventions, such as addictive drugs, antibiotics, referrals, and sickness certification. This study aims to explore GPs’ reflections on and perceptions of the fee-for-service system, with a specific focus on its potential impact on gatekeeping decisions. Methods We conducted six focus group interviews with 33 GPs in 2022 in Norway. We analysed the data using thematic analysis. Results We identified three main themes related to GPs’ reflections and perceptions of the fee-for-service system. First, the participants were aware of the profitiability of different fees and described potential strategies to increase their income, such as having shorter consultations or performing routine procedures on all patients. Second, the participants acknowledged that the fees might influence GP behaviour. Two perspectives on the fees were present in the discussions: fees as incentives and fees as compensation. The participants reported that financial incentives were not directly decisive in gatekeeping decisions, but that rejecting requests required substantially more time compared to granting them. Consequently, time constraints may contribute to GPs’ decisions to grant patient requests even when the requests are deemed unreasonable. Last, the participants reported challenges with remembering and interpreting fees, especially complex fees. Conclusions GPs are aware of the profitability within the fee-for-service system, believe that fee-for-service may influence their decision-making, and face challenges with remembering and interpreting certain fees. Furthermore, the fee-for-service system can potentially affect GPs’ gatekeeping decisions by incentivising shorter consultations, which may result in increased consultations with inadequate time to reject unnecessary treatments

Mood, anxiety, and alcohol use disorders and later cause-specific sick leave in young adult employees

Background Mental disorders strongly influence work capability in young adults, but it is not clear which disorders that are most strongly associated with sick leave, and which diagnoses that are stated on the sick leave certificates. Better knowledge of the impairments associated with different mental disorders is needed for optimal planning of interventions and prioritization of health services. In the current study, we investigate the prospective associations between eight mood, anxiety, and alcohol use disorders, and later sick leave granted for mental, somatic, or any disorder. Methods Lifetime mental disorders were assessed by structured diagnostic interviews in 2,178 young adults followed for eight years with registry data on sick leave. Relative risk ratios were estimated for the associations between each mental disorder and the different forms of sick leave. Results All included diagnoses were associated with later sick leave. In adjusted analyses, major depressive disorder and generalized anxiety disorder were the strongest predictors of sick leave granted for mental disorders, whereas social anxiety disorder and specific phobia were the strongest predictors of sick leave granted for somatic disorders. Specific phobia and major depressive disorder had the highest attributable fractions for all-cause sick leave. Conclusions Mood and anxiety disorders constituted independent risk factors for all cause sick leave, whereas alcohol use disorders seemed to be of less importance in young adulthood. Disorders characterised by distress were most strongly associated with sick leave granted for mental disorders, whereas disorders characterised by fear primarily predicted sick leave granted for somatic conditions. A large part of all sick leave is related to specific phobia, due to the high prevalence of this disorder. The impairment associated with this common disorder may be under-acknowledged, and it could decrease work capacity among individuals with somatic disorders. This disorder has good treatment response and may be overlooked as a target for interventions aimed at prevention of sick leave