Selvstyrende teams – er det svaret på organiseringen af fremtidens ældrepleje?

Selvstyrende teams, inspireret af den hollandske hjemmeplejeorganisation Buurtzorg, er fokus for ændringer i ældreplejen i mange danske kommuner. Selvstyrende teams kan potentielt bidrage til at skabe større sammenhæng for borgerne, bedre tværfagligt samarbejde, bedre arbejdsmiljø for de ansatte og måske endda mindre bureaukrati. Men modellen støder også på udfordringer og barrierer i en dansk kontekst, som vi vil se nærmere på i denne artikel

Mortality and use of psychotropic medication in patients with stroke:a population-wide, register-based study

OBJECTIVES: The study sought to describe whether psychotropic medication may have long-term side effects in patients with stroke compared with controls. SETTING: Use of national register data from healthcare services were identified from the Danish National Patient Registry in Denmark. Information about psychotropic medication use was obtained from the Danish Register of Medicinal Product Statistics. OBJECTIVES: We aimed to evaluate all-cause mortality in relation to the use of benzodiazepines, antidepressants and antipsychotics in patients with stroke and matched controls. PARTICIPANTS: Patients with a diagnosis of stroke and either no drug use or preindex use of psychotropic medication (n=49 968) and compared with control subjects (n=86 100) matched on age, gender, marital status and community location. PRIMARY OUTCOME MEASURE: All-cause mortality. RESULTS: All-cause mortality was higher in patients with previous stroke compared with control subjects. Mortality HRs were increased for participants prescribed serotonergic antidepressant drugs (HR=1.699 (SD=0.030), p=0.001 in patients; HR=1.908 (0.022), p<0.001 in controls, respectively), tricyclic antidepressants (HR=1.365 (0.045), p<0.001; HR=1.733 (0.022), p<0.001), benzodiazepines (HR=1.643 (0.040), p<0.001; HR=1.776 (0.053), p<0.001), benzodiazepine-like drugs (HR=1.776 (0.021), p<0.001; HR=1.547 (0.025), p<0.001), first-generation antipsychotics (HR=2.001 (0.076), p<0.001; HR=3.361 (0.159), p<0.001) and second-generation antipsychotics (HR=1.645 (0.070), p<0.001; HR=2.555 (0.086), p<0.001), compared with no drug use. Interaction analysis suggested statistically significantly higher mortality HRs for most classes of psychotropic drugs in controls compared with patients with stroke. CONCLUSIONS: All-cause mortality was higher in patients with stroke and controls treated with benzodiazepines, antidepressants and antipsychotics than in their untreated counterparts. Our findings suggest that care should be taken in the use and prescription of such drugs, and that they should be used in conjunction with adequate clinical controls

The economic burden of Tuberculosis in Denmark 1998-2010. Cost analysis in patients and their spouses

AbstractObjectiveTo evaluate the economic burden of tuberculosis (TB) in Denmark,Methods8,433 Danish TB-patients (1998-2010) were matched with 33,707 controls by age, gender, civil status and geography. Health-related costs (health system contacts and –procedures, medications) and socio-economic parameters (foregone earnings and social transfer expenses) were calculated on data from national databases. The same information was obtained for 3,485 spouses of TB-patients, and 17,403 controls.ResultsHealth-related costs were higher for cases throughout the period. Before diagnosis, cases posed € 1,180 more health costs per year than controls. Excess health costs in the 2 years around diagnosing and treating TB were € 10,509. Cases received an average excess public transfer income of € 3,345 before vs. € 3,121 after diagnosis. Average employment income deficiency was € 11,635 before vs. € 13,885 after diagnosis, but the increasing difference showed a linear shape throughout the period. Spouses also had lower income, more social transfer, and posed higher health-related costs than matched controls.ConclusionWe estimate the direct costs per TB patient to be €10,509. TB patients and their households are characterized by increasingly lower employment income, lower employment rate, and higher dependency on public transfer, but the socio/economic deterioration is rather a risk factor for TB than a direct consequence of the disease

Implementing Integrated Care – Lessons from the Odense Integrated Care Trial

Introduction: Creating coordination and concerted action between sectors of modern healthcare is an inherent challenge, and decision makers in search for solutions tend replicate new models across countries and settings. An example of this is the translation of the North West London integrated care pilot into a large-scale trial that took place in the Danish Municipality of Odense from 2013–2016. This article highlights the findings from our evaluation of the ill-fated project and discusses lessons learned. Methods: We examined implementation and short-term outcome in a multi-method evaluation based on qualitative interviews, direct observation, electronic surveys and quantitative analysis of change in ser­vice use and costs, using patient level data and a matched control group. Results and discussion: Despite an ambitious setup, ample financing, a shared governance structure and a well-functioning project organisation, implementation failed at the clinical level. Also, service use and costs for included patients increased significantly, without yielding the intended results. Primary explana­tions relate to an overly optimistic timeframe and a failure to take professionals’ wishes, daily practices and values into account. The results underline the importance of basing future attempts at integrated care on thorough studies of the perception of actual needs and timing, including rigorous pilot testing on a smaller scale, before attempting large-scale implementation

The UV Dose Used for Disinfection of Drinking Water in Sweden Inadequately Inactivates Enteric Virus with Double-Stranded Genomes

Irradiation with ultraviolet light (UV) at 254 nm is effective in inactivating a wide range of human pathogens. In Sweden, a UV dose of 400 J/m2 is often used for the treatment of drinking water. To investigate its effect on virus inactivation, enteric viruses with different genomic organizations were irradiated with three UV doses (400, 600, and 1000 J/m2), after which their viability on cell cultures was examined. Adenovirus type 2 (double-stranded DNA), simian rotavirus 11 (double-stranded RNA), and echovirus 30 (single-stranded RNA) were suspended in tap water and pumped into a laboratory-scale Aquada 1 UV reactor. Echovirus 30 was reduced by 3.6-log10 by a UV dose of 400 J/m2. Simian rotavirus 11 and adenovirus type 2 were more UV resistant with only 1-log10 reduction at 400 J/m2 and needed 600 J/m2 for 2.9-log10 and 3.1-log10 reductions, respectively. There was no significant increase in the reduction of viral viability at higher UV doses, which may indicate the presence of UV-resistant viruses. These results show that higher UV doses than those usually used in Swedish drinking water treatment plants should be considered in combination with other barriers to disinfect the water when there is a risk of fecal contamination of the water