Explaining regional variation in elective hip and knee arthroplasties in Finland 2010-2017-a register-based cohort study

Background A persistent research finding in industrialised countries has been regional variation in medical practices including elective primary hip and knee arthroplasty. The aim of the study was to examine regional variations in elective total hip and knee arthroplasties over time, and the proportions of these variations which can be explained by individual level or area-level differences in need. Methods We obtained secondary data from the Care Register for Health Care to study elective primary hip and knee arthroplasties in total Finnish population aged 25 + years between 2010 and 2017. Two-level Poisson regression models - individuals and hospital regions - were used to study regional differences in the incidence of elective hip and knee arthroplasties in two time periods: 2010 - 2013 and 2014 - 2017. The impact of several individual level explanatory factors (age, socioeconomic position, comorbidities) and area-level factors (need and supply of operations) was measured with the proportional change in variance. Predictions of incidence were measured with incidence rate ratios. The relative differences in risk of the procedures in regions were described with median rate ratios. Results We found small and over time relatively stable regional variation in hip arthroplasties in Finland, while the variation was larger in knee arthroplasties and decreased during the study period. In 2010 - 2013 individual socioeconomic variables explained 10% of variation in hip and 4% in knee arthroplasties, an effect that did not emerge in 2014 - 2017. The area-level musculoskeletal disorder index reflecting the need for care explained a further 44% of the variation in hip arthroplasties in 2010 - 2013, but only 5% in 2014 - 2017 and respectively 22% and 25% in knee arthroplasties. However, our final models explained the regional differences only partially. Conclusions Our results suggest that eligibility criteria in total hip and knee arthroplasty are increasingly consistent between Finnish hospital districts. Factors related to individual level and regional level need both had an important role in explaining regional variations. Further study is needed on the effect of health policy on equity in access to care in these operations.Peer reviewe

Sosiaali- ja terveyspalvelut: Tarpeen, käytön ja tuottamisen alueelliset muutokset ja tulevaisuuden vaihtoehdot

Tässä raportissa käsitellään sosiaali- ja terveyspalvelujen tarpeiden tulevia muutoksia eri alueilla kaupungistumisen ja väestön ikääntymisen myötä. Sosiaali- ja terveyspalvelujen sijoittumista tarkastellaan aluerakenteessa suhteessa keskusverkkoon ja toiminnallisiin alueisiin ja yhdyskuntarakenteessa erilaisia liikkumismahdollisuuksia kuvaavien vyöhykkeiden näkökulmasta. Palveluratkaisujen muutoksia lähestytään työvoimatarpeen, toimipaikkaverkkojen, rakennuskannan ja palvelujärjestelmien näkökulmasta. Palvelujen saavutettavuutta analysoidaan eri sairaalaverkkovaihtoehdoissa sekä terveysasemien ja päivystysten osalta. Sosiaali- ja terveyspalvelujen palveluverkon kehittämisen vaihtoehtoina käsitellään hajautettua, keskitettyä, monikeskuksista ja etäpalveluihin perustuvaa vaihtoehtoa. Terveydenhoitopalvelujen keskittämisen taloudellisia vaikutuksia analysoidaan aluetasolla kansantalouden yleisen tasapainomalliin perusteella. Tulosten mukaan palvelujen keskittäminen tuo tuottavuushyötyjä, mutta kasvattaa maakuntien välisiä eroja palvelujen saavutettavuudessa, liikkumiskustannuksissa ja työllisyyden kehityksessä. Tulosten pohjalta pohditaan keinoja yhdistää palvelutuotannon tehokkuus, riittävä saavutettavuus ja tasapainoinen alueellinen kehitys. Lisäksi tuodaan esille tarve kytkeä sosiaali- ja terveyspalvelujen ratkaisut muuhun aluesuunnitteluun

What patients think about choice in healthcare? A study on primary care services in Finland

Background: The ongoing Finnish health and social service reform will expand choice by opening the market for competition between public and private service providers. This study examined the attitudes of primary care patients towards choice and which patient-related factors are associated with these attitudes. Methods: A sample of attenders during one week in health centres of 12 big cities and municipal consortiums (including seven outsourced local units) and in primary care units of one private company providing outsourced services for municipalities (aged 18-95, n=8128) was used. The questionnaire included questions on choice-related attitudes, sociodemographic factors, health status, use of health services and patient satisfaction. Results: Of the responders, 77% regarded choice to be important, 49% perceived genuine opportunities to make choices and 35% were satisfied with the choice-relevant information. Higher age, low education, having a chronic illness, frequent use of services, having a personal physician and being satisfied with the physician and with waiting times were related to assigning more importance on choice. Younger patients, those with higher education as well as those with chronic illness regarded their opportunities of choosing the service provider and availability of choice-relevant information poorer. Conclusions: The Finnish primary care patients value choice, but they are critical of the availability of choice-relevant information. Choices of patients with complex health care needs should be supported by developing integrated care alternatives and by increasing the availability of information on existing care alternatives to meet their needs.Peer reviewe

The Finnish experience to save asthma costs by improving care in 1987-2013

The Finnish National Asthma Program 1994-2004 markedly improved asthma care in the 1990s. We evaluated the changes in costs during 26 years from 1987 to 2013. Direct and indirect costs were calculated by using data from national registries. Costs from both the societal and patient perspectives were included. The costs were based on patients with persistent, physician-diagnosed asthma verified by lung function measurements. We constructed minimum and maximum scenarios to assess the effect of improved asthma care on total costs. The number of patients with persistent asthma in the national drug reimbursement register increased from 83,000 to 247,583. Improved asthma control reduced health care use and disability, resulting in major cost savings. Despite a 3-fold increase in patients, the total costs decreased by 14%, from (SIC)222 million to (SIC)191 million. Costs for medication and primary care visits increased, but overall annual costs per patient decreased by 72%, from (SIC)2656 to (SIC)749. The theoretical total cost savings for 2013, comparing actual with predicted costs, were between (SIC)120 and (SIC)475 million, depending on the scenario used. The Finnish Asthma Program resulted in significant cost savings at both the societal and patient levels during a 26-year period.Peer reviewe

Verihiutaleiden estäjähoito toteutuu vajavaisesti sepelvaltimotautikohtauksen jälkeen

Lähtökohdat Sepelvaltimotautikohtauksen hoidoksi suositellaan tehokasta ja taukoamatonta verihiutaleiden kaksoisestohoitoa.Menetelmät Selvitimme rekisteriaineistoista kaikkien Suomessa v. 2009–13 sepelvaltimotautikohtauksen vuoksi hoidettujen yli 18-vuotiaiden potilaiden (n = 54 416) kaksoisestohoidon toteutumista.Tulokset Potilaista 49 % lunasti lääkityksen viikon kuluessa kotiutumisesta. Potilasvolyymi oli suurin keskussairaaloissa. Niissä lääkitys aloitettiin 50,8 %:lle. Yliopistosairaaloiden potilaista 57,4 % sai lääkitystä asian­mukaisesti, mutta aluesairaaloissa vain 31,3 %. Yleisimmin käytössä oli klopidogreeli. Uudempia valmisteita käytettiin enenevästi jakson loppupuolella.Päätelmät Antitromboottinen hoito toteutui suosituksiin nähden vajavaisesti. Hoidossa oli ongelmia etenkin, kun potilas kotiutettiin aluesairaalasta.</p