Evaluering av utprøving av digital hjemmeoppfølging: Delrapport II

Med støtte fra Helsedirektoratet prøver seks lokale prosjekter i kommunal regi ut digital hjemmeoppfølging av personer med kronisk sykdom. Utprøvingen gjennomføres i perioden 2018-2021 som en del av Nasjonalt velferdsteknologiprogram. Formålet med utprøvingen er å få tilstrekkelig kunnskap om digital hjemmeoppfølging til å gi nasjonale anbefalinger om implementering av tiltaket. Utprøvingen evalueres av forskere fra Universitetet i Oslo, Oslo Economics og Nasjonal senter for distriksmedisin. I denne delrapporten beskriver vi erfaringer med og effekter av digital hjemmeoppfølging til og med høsten 2020

Does an activity based remuneration system attract young doctors to general practice?

<p>Abstract</p> <p>Background</p> <p>The use of increasingly complex payment schemes in primary care may represent a barrier to recruiting general practitioners (GP). The existing Norwegian remuneration system is fully activity based - 2/3 fee-for-service and 1/3 capitation. Given that the system has been designed and revised in close collaborations with the medical association, it is likely to correspond - at least to some degree - with the preferences of <it>current </it>GPs (men in majority). The objective of this paper was to study which preferences that young doctors (women in majority), who are the <it>potential entrants </it>to general practice have for activity based vs. salary based payment systems.</p> <p>Methods</p> <p>In November-December 2010 all last year medical students and all interns in Norway (n = 1.562) were invited to participate in an online survey. The respondents were asked their opinion on systems of remuneration for GPs; inclination to work as a GP; risk attitude; income preferences; work pace tolerance. The data was analysed using one-way ANOVA and multinomial logistic regression analysis.</p> <p>Results</p> <p>A total of 831 (53%) responded. Nearly half the sample (47%) did not consider the remuneration system to be important for their inclination to work as GP; 36% considered the current system to make general practice <it>more </it>attractive, while 17% considered it to make general practice <it>less </it>attractive. Those who are attracted by the existing system were men and those who think high income is important, while those who are deterred by the system are risk averse and less happy with a high work pace. On the question of preferred remuneration system, half the sample preferred a mix of salary and activity based remuneration (the median respondent would prefer a 50/50 mix). Only 20% preferred a fully activity based system like the existing one. A salary system was preferred by women, and those less concerned with high income, while a fully activity based system was preferred by men, and those happy with a high work pace.</p> <p>Conclusions</p> <p>Given a concern about low recruitment to general practice in Norway, and the fact that an increasing share of medical students is women, we were interested in the extent to which the current Norwegian remuneration system correspond with the preferences of potential GPs. This study suggests that an existing remuneration mechanism has a selection effect on who would like to become a GP. Those most attracted are income motivated men. Those deterred are risk averse, and less happy with a high work pace. More research is needed on the extent to which experienced GPs differ along the questions we asked potential GPs, as well as studying the relative importance of other attributes than payment schemes.</p

Is organizational justice climate at the workplace associated with individual-level quality of care and organizational affective commitment?:A multi-level, cross-sectional study on dentistry in Sweden

Purpose The aim of this study is to investigate whether organizational justice climate at the workplace level is associated with individual staff members’ perceptions of carequality and affective commitment to the workplace.Methods The study adopts a cross-sectional multi-level design. Data were collected using an electronic survey and a response rate of 75% was obtained. Organizational justice climate and affective commitment to the workplace were measured by items from Copenhagen Psychosocial Questionnaire and quality of care by three self-developed items. Non-managerial staff working at dental clinics with at least five respondents (n = 900 from 68 units) was included in analyses. A set of Level-2 random intercept models were built to predict individual-level organizational affective commitment and perceived quality of care from unit-level organizational justice climate, controlling for potential confoundingby group size, gender, age, and occupation.Results The results of the empty model showed substantial between-unit variation for both affective commitment (ICC-1 = 0.17) and quality of care (ICC-1 = 0.12). The overall results showed that the shared perception of organizational justice climate at the clinical unit level was significantly associated with perceived quality of care and affective commitment to the organization (p < 0.001).Conclusions Organizational justice climate at work unit level explained all variation in affective commitment among dental clinics and was associated with both the individualstaff members’ affective commitment and perceived quality of care. These findings suggest a potential for that addressing organizational justice climate may be a way to promote quality of care and enhancing affective commitment. However, longitudinal studies are needed to support causality in the examined relationships. Intervention research is also recommended to probe the effectiveness of actions increasingunit-level organizational justice climate and test their impact on quality of care and affective commitment

Overvåkingsdesign og budsjett for etablering av referanseverdier for økologiske kvalitetselementer i overflatevann, fase 2

Årsliste 2006EUs Rammedirektiv for Vann krever etablering av referanseverdier for alle økologiske kvalitetselementer i alle vanntyper og kategorier av overflatevann. Målet med prosjektet har vært å revidere forslaget til overvåkingsdesign for referanselokaliteter fra fase 1 prosjektet, ut fra nye statistiske analyser av hvor mange referanselokaliteter som er nødvendig for å skille referanseverdien fra moderat eller dårligere status for ulike kvalitetselementer i innsjøer, elver og kystområder. Rapporten inneholder oversikter over aktuelle referanselokaliteter/områder og budsjett for etablering av referanseverdier for alle kvalitetselementer i alle vanntyper i innsjøer, elver og kystområder, samt kostnadsmessige gevinster av nordisk samarbeid om etablering av referanseverdier i innsjøer og elver.Direktoratet for naturforvaltning